Poverty and US Presidents: Decisions that affect Africa's Public Health

Excerpts from my book: African Health Systems; The local solutions that have long impact, developed as part of my field work during my Nieman Year to be published by the end on 2009:

The problems of accessing World Health Organisation (WHOAFRO) are a reflection of the many systems of Government that have all been characterised with poor leadership and bogged down by very few home grown ideas. A respected Malawian Dr. Habib Somanje is part of the office, though readily accessible during his days as director of preventive health in the Ministry of Health, efforts to locate him within the WHO offices took more than 103 days and thanks to his coming to Malawi in Janaury 2009 I was able to get his email contact for the first time. Decision making is the biggest problem in African health systems that even those that can make life saviong decisions on diseases like cholera have to sometimes wait for a central authority to release some basic treatments.

International decisions have failed Africa. Recently a South Asia economist said "If Japan, Korea, China and others such as Taiwan and Malaysia followed the IMF and World Bank prescriptions for economic development, they would have remained as poor as Africa has developed to be. The decisions of the two institutions and Western Governments shows lack of understanding of the needs of the poor nations."

The decision by President Barack Obama to reverse a Bush order to suspend support to insititutions that support abortions shows how Africa's continued dependency on foreign decisions and support will affect-in the short and long term-its delivery of public health service.

Marie Stopes International is the main funder of the Banja La Mtsogolo a reproductive health NGO that has saved hundreds of Malawian women lives through pre and post natal services that Government has now signed an agreement with it-due to its expanded services- to provide basic health services to be subsidised the tax payer to ensure access to many.

Bush in his conservative women stopped such American support that would have huge consequences not only the lives of mothers but the other general services that the NGO's provide to the communities they live.

Not withstanding the global financial crisis expected to send all the major economies into recession in the last quarter of 2008 and first quarter of 2009, all eyes will be on Obama to see if he will adopt some of the Bush policies that saw America investing in billions in HIV and Aids and Malaria. This is a decision not of Africa but an American President to make.

While hundreds of lives in Zimbabwe, Malawi and Zambia continue to rely on foreign aid and decision making process, small community initiatives including that of primary health care by communities have shown to make long lasting impact, that in a Central district of Salima in Malawi near Chipoka harbour they have stayed years without registering a case of cholera.

Cholera is likely to break out in many parts of Malawi, Zambia or Zimbabwe during the rainy season. The decision was simple, the local chief and others decided to take sanitation issues into their own hands. The local Assembly was left out and people decide to decide their future without the local authority. Today they are a cholera free community.

There are many stories of mothers who are educating others in the Kangaroo method, making a home ORT and others, but for decisions made away outside Africa they really need to take into account the larger picture and the impact on local communities. Otherwise the see saw decision making based on presidential beliefs throws away the value of human life to become a political debate.

There is more to what African can achieve if we start valuing their input and state that local people know better the problems and solutions to their challenges. Japan and Korea proves the case, for WHO and WTO they must learn the same!