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Resolved: The United States federal government should substantially increase its public health assistance to Resolved: The United States federal government should substantially increase its public health assistance to Sub-Saharan Africa. Topic Lecture

A little history l In 19 th Century Europe and the Western world, the A little history l In 19 th Century Europe and the Western world, the area was sometimes referred to as "Black Africa. " Africa as a whole was commonly known as "the Dark continent", a term that was usually intended to refer to the Sub-Saharan region. This was partly due to the skin color of its inhabitants and partly because much of it had not been fully mapped or explored by Westerners. These terms are now obsolete and often considered to be pejorative. Further, they are misleading, as dark-skinned Africans are indigenous to much of North Africa, as well.

Definitions: l Its – this is important because its refers to the United States Definitions: l Its – this is important because its refers to the United States federal government’s public health assistance. Affirmatives that do not increase the USFG’s assistance would not be topical.

Definitions: l l Public health assistance – this is not a term of art. Definitions: l l Public health assistance – this is not a term of art. Code of Federal Regulations – (not including any assistance under title XIX of the Social Security Act (42 USC 1396 et seq. ) for immunizations with respect to immunizable diseases and for testing and treatment of symptoms of communicable diseases whether or not such symptoms are caused by a communicable disease.

Definitions: l What is health? Definitions: l What is health? "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" [1]. In more recent years, this statement has been modified to include the ability to lead a "socially and economically productive life. " - WHO

Definitions: l Sub-Saharan Africa - is the term used to describe the area of Definitions: l Sub-Saharan Africa - is the term used to describe the area of the African continent which lies south of the Sahara desert. Geographically, the demarcation line is the southern edge of the Sahara Desert. Many countries such as Chad, Mali, Sudan, Niger, and Mauritania thus belong to both regions

Sub Saharan Africa l l Sub-Saharan Africa is the poorest region in the world Sub Saharan Africa l l Sub-Saharan Africa is the poorest region in the world still suffering from colonialism, slavery, native corruption and inter-ethic conflict. Many LDC’s – governments face problems dealing with AIDs due to the lack of technical support.

Definitions: l Sub-Saharan Africa - There are 42 countries located on the sub-Saharan African Definitions: l Sub-Saharan Africa - There are 42 countries located on the sub-Saharan African mainland. The 6 island nations include Madagascar, Seychelles, Comoros, Cape Verde and São Tomé and Príncipe.

Is the topic really that big? l l Yes! The topic is huge, how Is the topic really that big? l l Yes! The topic is huge, how do we limit it? Unfortunately the ways to limit the topic are not that great. Any affirmative that deals with improving health in SSA can be considered topical. However, the WHO does contain a list of health topics to help make the topic somewhat predictable.

Limiting public health l l l Go to www. who. int/topics/en/ This is an Limiting public health l l l Go to www. who. int/topics/en/ This is an A to Z list of all the health issues considered by the World Health Organization. Examples: AIDS, air pollution, education, medicine, water purification, biosafety, maternal health, medical waste, diarrhea, family planning, gender based violence, etc.

Limiting: l While it may seem like the list can go on and on, Limiting: l While it may seem like the list can go on and on, which it does, keep in mind a couple of things: – – Not everything on the WHO’s list will apply to SSA. The increase must be a substantial increase in public health assistance – thus affirmatives should deal with bigger topics.

The most predictable limiter: l l l The topic says, “increase its public health The most predictable limiter: l l l The topic says, “increase its public health assistance to Sub-Saharan Africa. ” What this means: I believe that affirmatives have to increase PHA to all of SSA and CANNOT specify a country within the plan text. This does however, not prevent affirmatives from making country specific advantages.

Other views of the topic l l l Can affirmatives specify countries in their Other views of the topic l l l Can affirmatives specify countries in their plan text? Yes - we believe that the topic allows for negatives can always have ground against squirrel affirmatives, but affirmatives will not have ground against unbeatable PICs. Makes the resolution a little tricky?

Wording l l l The impact of the word “To” The impact of the Wording l l l The impact of the word “To” The impact of the word throughout The impact of the within The impact of the phrase “one or more of the following countries” Open for interpretation, yes? What’s a good limiter?

WHO Agenda l WHO operates in an increasingly complex and rapidly changing landscape. The WHO Agenda l WHO operates in an increasingly complex and rapidly changing landscape. The boundaries of public health action have become blurred, extending into other sectors that influence health opportunities and outcomes. WHO responds to these challenges using a six-point agenda. The six points address two health objectives, two strategic needs, and two operational approaches. The overall performance of WHO will be measured by the impact of its work on women's health and health in Africa.

WHO Agenda l 1. 2. 3. 4. 5. 6. The WHO has a six WHO Agenda l 1. 2. 3. 4. 5. 6. The WHO has a six point agenda regarding health issues. Promoting Development Fostering Health Security Strengthening Health Systems Enhancing Partnerships Harnessing research, information and evidence Improving performance

Promoting Development l During the past decade, health has achieved unprecedented prominence as a Promoting Development l During the past decade, health has achieved unprecedented prominence as a key driver of socioeconomic progress, and more resources than ever are being invested in health. Yet poverty continues to contribute to poor health, and poor health anchors large populations in poverty. Health development is directed by the ethical principle of equity: Access to life-saving or health-promoting interventions should not be denied for unfair reasons, including those with economic or social roots. Commitment to this principle ensures that WHO activities aimed at health development give priority to health outcomes in poor, disadvantaged or vulnerable groups. Attainment of the healthrelated Millennium Development Goals, preventing and treating chronic diseases and addressing the neglected tropical diseases are the cornerstones of the health and development agenda.

Fostering Health Security l Shared vulnerability to health security threats demands collective action. One Fostering Health Security l Shared vulnerability to health security threats demands collective action. One of the greatest threats to international health security arises from outbreaks of emerging and epidemic-prone diseases. Such outbreaks are occurring in increasing numbers, fuelled by such factors as rapid urbanization, environmental mismanagement, the way food is produced and traded, and the way antibiotics are used and misused. The world's ability to defend itself collectively against outbreaks will be strengthened in June 2007, when the revised International Health Regulations come into force.

Strengthening Health Systems l For health improvement to operate as a povertyreduction strategy, health Strengthening Health Systems l For health improvement to operate as a povertyreduction strategy, health services must reach poor and underserved populations. Health systems in many parts of the world are unable to do so, making the strengthening of health systems a high priority for WHO. Areas being addressed include the provision of adequate numbers of appropriately trained staff, sufficient financing, suitable systems for collecting vital statistics, and access to appropriate technology including essential drugs.

Enhancing Partnerships l WHO carries out its work with the support and collaboration of Enhancing Partnerships l WHO carries out its work with the support and collaboration of many partners, including UN agencies and other international organizations, donors, civil society and the private sector. WHO uses the strategic power of evidence to encourage partners implementing programmes within countries to align their activities with best technical guidelines and practices, as well as with the priorities established by countries.

Harnessing research, information and evidence l Evidence provides the foundation for setting priorities, defining Harnessing research, information and evidence l Evidence provides the foundation for setting priorities, defining strategies, and measuring results. WHO generates authoritative health information, in consultation with leading experts, to set norms and standards, articulate evidence-based policy options and monitor the evolving global heath situation.

Improving Performance l WHO participates in ongoing reforms aimed at improving its efficiency and Improving Performance l WHO participates in ongoing reforms aimed at improving its efficiency and effectiveness, both at the international level and within countries. WHO aims to ensure that its strongest asset - its staff - works in an environment that is motivating and rewarding. WHO plans its budget and activities through results-based management, with clear expected results to measure performance at country, regional and international levels.

Health Issues There are SO many different health issues within Africa. If it effects Health Issues There are SO many different health issues within Africa. If it effects the daily lives of individuals then it is a health issue. No issue is more important than the other, right? Or are there issues that should be handled first, before others?

AIDS l l This will be the number one case on the topics. Acquired AIDS l l This will be the number one case on the topics. Acquired immune deficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). It was first recognized in the United States in 1981. AIDS is the advanced form of infection with the HIV virus, which may not cause recognizable disease for a long period after the initial exposure (latency). No vaccine is currently available to prevent HIV infection. At present, all forms of AIDS therapy are focused on improving the quality and length of life for AIDS patients by slowing or halting the replication of the virus and treating or preventing infections and cancers that take advantage of a person's weakened immune system.

AIDS l Sub-Saharan Africa is more heavily affected by HIV and AIDS than any AIDS l Sub-Saharan Africa is more heavily affected by HIV and AIDS than any other region of the world. An estimated 24. 5 million people were living with HIV at the end of 2005 and approximately 2. 7 million additional people were infected with HIV during that year. In just the past year, the AIDS epidemic in Africa has claimed the lives of an estimated 2 million people in this region. More than twelve million children have been orphaned by AIDS. The extent of the AIDS crisis is only now becoming clear in many African countries, as increasing numbers of people with HIV are becoming ill. In the absence of massively expanded prevention, treatment and care efforts, it is expected that the AIDS death toll in sub-Saharan Africa will continue to rise. This means that impact of the AIDS epidemic on these societies will be felt most strongly in the course of the next ten years and beyond. Its social and economic consequences are already widely felt, not only in the health sector but also in education, industry, agriculture, transport, human resources and the economy in general.

ARV’s – a method to solve AIDS l Standard antiretroviral therapy (ART) consists of ARV’s – a method to solve AIDS l Standard antiretroviral therapy (ART) consists of the use of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. Huge reductions have been seen in rates of death and suffering when use is made of a potent ARV regimen. About 39. 5 million people are now living with HIV, of whom more than 37 million live in low- and middle-income countries. WHO estimates that at least 6. 5 million of these people are in need of ART. As of June 2006, 1. 65 million people had access to ART in low- and middle-income countries. WHO is providing countries with ongoing guidance, tools and support in delivering and scaling up ART within a public health approach.

Infectious Diseases l l Any disease caused by invasion by a pathogen which subsequently Infectious Diseases l l Any disease caused by invasion by a pathogen which subsequently grows and multiplies in the body. Examples: African trypanosomiasis, Ebola, Hepatitis, Leprosy, Malaria, Tuberculosis, and Smallpox.

Tuberculosis l l Tuberculosis (TB) is a contagious disease. Like the common cold, it Tuberculosis l l Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease. The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of becoming sick are greater.

Child Mortality l l l l Children and adolescents make up nearly 40% of Child Mortality l l l l Children and adolescents make up nearly 40% of the world’s population. Among the most vulnerable of populations, their health problems account for over 50% of the gap in health equity between the world’s richest and poorest people. The global statistics on the unmet needs of infants, children and adolescents are daunting: Every minute 20 children under 5 years old die, leading to over 10. 6 million deaths a year. Over 1 million children die each year — and millions more suffer from diarrhoea and acute respiratory infections — due to inappropriate breastfeeding. 66% of child deaths each year are caused by diarrhoea, acute respiratory infections, measles, malaria and perinatal illnesses. 53% of childhood deaths are associated with malnutrition, as a direct or indirect cause. AIDS now accounts for 3% of deaths in children under five years old worldwide, — and for 6% in the WHO Africa region, where AIDS has become one of the biggest killers of young children and account for up to 57% of child deaths in the most affected countries. Sadly, the majority of these deaths are caused by conditions that are either preventable or treatable.

Drinking Water l Nearly 1. 2 billion people do not have access to safe Drinking Water l Nearly 1. 2 billion people do not have access to safe drinking water, according to the World Health Organization, and 2. 6 billion do not have access to basic sanitation. As a result, each year about 3. 1 million children and adults worldwide die from waterrelated illnesses such as diarrhea and malaria. The lack of clean water, combined with the lack of basic sanitation and basic hygiene education, is one of the largest obstacles to progress and development in the world, particularly in sub-Saharan Africa.

Maternal Health Services l There is a relationship between mobility, power and well being. Maternal Health Services l There is a relationship between mobility, power and well being. The differences between male and female travel patterns and the cultural rules and roles associated with these differences are undercharted in the policy environment. The impact of constrained mobility on bargaining also has its impact on what comes to be available as resource and service within local constraints. No better demonstration of these constraints can be found than in Africa's portrait of maternal mortality: constraints on mobility and on the resources for mobility and accessibility have devastating consequences for women's health on the African continent.

Maternal Health Services l Maternal mortality rates in West Africa are among the world’s Maternal Health Services l Maternal mortality rates in West Africa are among the world’s highest. Too often, pregnant women are unable to access quality prenatal and delivery services, with tragic consequences. Even when delivery services are available, traditional practices and lack of training in advanced medical procedures limit the services women can access at critical moments.

Family Planning l In recent decades, there have been tremendous advances in the development Family Planning l In recent decades, there have been tremendous advances in the development of safer and more effective contraceptives, and in the provision of affordable and accessible family planning services. Yet, still millions of individuals and couples around the world are unable to plan their families as they wish. It is estimated that over 120 million couples do not use contraceptives, despite wanting to space or limit their childbearing. In addition, many women who use contraceptives nevertheless become pregnant. Other couples who want to have children are unable to conceive.

Family Planning l l l Some of the causes of unmet need for family Family Planning l l l Some of the causes of unmet need for family planning services are: (i) lack of services or barriers to their access; (ii) poor quality of services, such as suboptimal interactions between clients and providers, substandard technical competence of providers, inadequate information, poor design and management of service delivery systems; (iii) technology issues, such as limited or inappropriate choice of methods and fear, or experience, of side effects; and (iv) broader social issues, such as an individual’s lack of knowledge, power imbalances within couples and families, and sociocultural, religious and gender barriers.

Gender-Based Violence l l Violence against women by an intimate partner is a major Gender-Based Violence l l Violence against women by an intimate partner is a major contributor to the ill-health of women. The health sector can play a vital role in preventing violence against women, helping to identify abuse early, providing victims with the necessary treatment, and referring women to appropriate care. Health services must be places where women feel safe, are treated with respect, are not stigmatized, and where they can receive quality, informed support. A comprehensive health sector response to the problem is needed, in particular addressing the reluctance of abused women to seek help.

Life Expectancy l l l The overall life expectancy in sub-Saharan Africa has dropped Life Expectancy l l l The overall life expectancy in sub-Saharan Africa has dropped precipitously over the past 10 years, mostly because of the AIDS epidemic, the WHO says. Life expectancy dropped for female babies from 51. 1 years to 46. 3 years. For males, the level dropped from 47. 3 years to 44. 8 years. AIDS is now the leading cause of death in Sub-Saharan Africa, far surpassing the traditional deadly diseases of malaria, tuberculosis, pneumonia and diarrheal disease. AIDS killed 2. 2 million Africans in 1999, versus 300, 000 AIDS deaths 10 years previously. "Healthy life expectancy in some African countries is dropping back to levels we haven't seen in advanced countries since Medieval times, " says Alan Lopez, Coordinator of WHO's Epidemiology and Burden of Disease Team. "This is just one example why the WHO decided to measure healthy life expectancy for all member countries using DALE for the first time, to give a truer picture of where good health reigns, and where it doesn't. "

Malaria l l l Malaria is caused by a parasite called Plasmodium, which is Malaria l l l Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, the parasites have developed resistance to a number of malaria medicines. Key interventions to control malaria include: prompt and effective treatment with artemisinin-based combination therapies; use of insecticidal nets by people at risk; and indoor residual spraying with insecticide to control the vector mosquitoes.

Water Scarcity l l The main conflicts in Africa during the next 25 years Water Scarcity l l The main conflicts in Africa during the next 25 years could be over that most precious of commodities - water, as countries fight for access to scarce resources. Potential 'water wars' are likely in areas where rivers and lakes are shared by more than one country, according to a UN Development Programme (UNDP) report. The possible flashpoints are the Nile, Niger, Volta and Zambezi basins. Water management is the main source of this problem.

Vaccines l l Four to five million annual deaths could be prevented by 2015 Vaccines l l Four to five million annual deaths could be prevented by 2015 through sustained and appropriate immunization efforts, backed by financial support. Vaccination is one of the most successful and costeffective public health interventions. Well over 2 million deaths are currently averted through immunization each year. There are several programs currently available that are trying distribute vaccines in Africa.

Poverty l Poverty is multi-dimensional in its causes as well as in its cures. Poverty l Poverty is multi-dimensional in its causes as well as in its cures. Poor health is a major contributor to poverty and good health status one of the means to prevent poverty or, better still, a means to overcome poverty. For this reason, health is already considered as an important element on the international poverty reduction agenda.

Nutrition l Nutrition is the intake of food, considered in relation to the body’s Nutrition l Nutrition is the intake of food, considered in relation to the body’s dietary needs. Good nutrition – an adequate, well balanced diet combined with regular physical activity – is a cornerstone of good health. Poor nutrition can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity.

Medicine l l Pharmaceutical products – more commonly known as medicines or drugs – Medicine l l Pharmaceutical products – more commonly known as medicines or drugs – are a fundamental component of both modern and traditional medicine. It is essential that such products are safe, effective, and of good quality, and are prescribed and used rationally. Africa does not have widespread access to medicines.

Ebola l l l The Ebola virus was first identified in a western equatorial Ebola l l l The Ebola virus was first identified in a western equatorial province of Sudan and in a nearby region of Zaire (now Democratic Republic of the Congo) in 1976 after significant epidemics in Yambuku, northern Zaire, and Nzara, southern Sudan. Ebola haemorrhagic fever (EHF) is one of the most virulent viral diseases known to humankind, causing death in 50 -90% of all clinically ill cases. Several different species of Ebola virus have been identified. The Ebola virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons. Transmission of the Ebola virus has also occurred by handling ill or dead infected chimpanzees.

Infrastructure l In order to reach Africa’s great potential, improving health must be a Infrastructure l In order to reach Africa’s great potential, improving health must be a top priority. Health care systems face daunting challenges and most Africans depend on public health services that are hobbled by inadequate budgets, under-investment in physical infrastructure, and insufficient numbers of trained health care providers. Most African countries also lack developed and wellfunctioning private markets for health care, thus adding to the burdens borne by already hard-pressed public systems. These institutional weaknesses make it difficult for countries to respond effectively to endemic diseases such as HIV/AIDS, tuberculosis, and malaria, as well as to the non-communicable diseases that increasingly affect patients in Africa and throughout the developing world.

Let’s get our Priorities Straight! l l l Public expenditure on health in African Let’s get our Priorities Straight! l l l Public expenditure on health in African countries must be increased. The public health systems must re-evaluate structural adjustment policies and health sector reform. Major under-funding of basic health services remains a problem. Declining child vaccination coverage is just one indication of the deterioration of health systems. Hospitals lack electricity and vaccines lack proper refrigeration, rendering them unusable. Phone and fax service often do not exist or are unreliable, frustrating efforts to communicate throughout the health facility network. Women must be empowered and educated, and microeconomic activities developed to enable them to be economically independent.

Health Systems l Weak health systems are one of the chronic problems which have Health Systems l Weak health systems are one of the chronic problems which have prevented major health gains and economic development in the region. Millions of people cannot access basic health services either because they cannot afford them or because quality services simply do not exist in their communities. The formal health care system has found itself at times disconnected from these poor communities.

Health systems l Health systems are a means to achieve the goal of improving Health systems l Health systems are a means to achieve the goal of improving health through organizing, financing and ensuring the quality of health services. How well the health system performs its role, though, can make a difference between life and death.

Health Systems Health systems are the primary means of delivering immunizations, which are the Health Systems Health systems are the primary means of delivering immunizations, which are the main approach to prevention of many infectious killers. For chronic diseases, health systems not only offer treatment, but through effective disease management can also postpone or prevent more serious consequences. However, the ability to manage chronic illnesses through the entire continuum of care over the lifetime of the patient requires health systems that are flexible enough to include a wide range of providers, ranging from doctors and nurses to community health workers, as well as social service volunteers and family members.

What is the purpose of a health system? l l l Improve the health What is the purpose of a health system? l l l Improve the health of the people it serves Respond to people’s needs and expectations Provide financial protection against the costs of illness

Who pays for health care? l In the 48 countries that comprise Sub. Saharan Who pays for health care? l In the 48 countries that comprise Sub. Saharan Africa, almost half of all healthcare costs are paid for out of pocket at the time a person seeks care. Many studies show that high out of pocket medical spending can plunge the sick, their families and sometimes their extended clan into poverty.

Is all hope lost? l NO! Though the statistics indicate that health care systems Is all hope lost? l NO! Though the statistics indicate that health care systems are somewhat in shambles, there is a positive side. There have been significant changes in Sub-Saharan Africa. New treatments have been discovered, new diagnostics, have been developed and new funding mechanisms – such as the Global Fund to Fight AIDS, TB and malaria (Global Fund), the Global Alliance for Vaccines and Immunizations and the US President’s Emergency Plan for AIDs.

Public Health in SSA l l The public sector is often the major provider Public Health in SSA l l The public sector is often the major provider of public health at one end of the continuum of care, and hospital services, particularly tertiary care, at the other end. In many areas, district hospitals provide the main source of secondary care as well. In both the public and private healthcare sectors several countries are facing severe shortages of qualified health personnel. An estimated 1 million health workers are urgently needed. Which is more than 3 times what is available in the area.

Challenges to the System l The challenges facing health systems in SSA are well Challenges to the System l The challenges facing health systems in SSA are well documented and span such issues as lack of drugs and supplies, poor regulations and quality standards, high customs duties and taxes, doctors and nurses not showing up for work, the brain drain, poor public accountability and corruption.

Management l According to the World Health Report, “Health Management and support workers provide Management l According to the World Health Report, “Health Management and support workers provide the invisible backbone for health systems; if they are not present in sufficient numbers and with appropriate skills, the system cannot function…”

Dirty Word? l Sub-Saharan Africa is a dirty term! Some object to the usage Dirty Word? l Sub-Saharan Africa is a dirty term! Some object to the usage of the term and see it is as misleading and a racist colonial way of viewing Africa. [1][2][3] [4] Academic and cultural writer Owen 'Alik Shahadah states "…This barrier of sand hence confined Africans to the bottom of this make-believe location, which exists neither linguistically, ethnically, politically or physically. . . Somalia and Djibouti are part of the same political Islamic alignment just like many so-called Arab countries. " (See Arab League). Others such as Okoth P Godfrey, Department of History University of California, states that European travelers and geographers created the concept of "two Africa’s, " sets up the removal of African contribution to world civilization.

Dirty Word? l l This will be a debate will occur the entire year. Dirty Word? l l This will be a debate will occur the entire year. The question becomes do affirmatives not use the phrase in the plan text to avoid a link or does the link not exist because its in the resolution?

What is the Bamako Initiative? l l In 1988, Bamako was the location of What is the Bamako Initiative? l l In 1988, Bamako was the location of a WHO conference known as the Bamako Initiative that helped reshape the health policy of sub-Saharan Africa. [5] The new strategy dramatically increased accessibility through communitybased healthcare reform, resulting in more efficient and equitable provision of services. A comprehensive approach strategy was extended to all areas of health care, with subsequent improvement in the health care indicators and improvement in health care efficiency and cost. The Bamako Initiative proposed decentralising health decision making to local levels and establishing realistic national drug policies to enhance the provision of essential drugs for Sub-Saharan Africans.

Providing essential drugs - The Bamako Initiative l l l There are many reasons Providing essential drugs - The Bamako Initiative l l l There are many reasons for drug shortages. Many countries, particularly in Africa, have not adopted an essential drugs list to ensure good supplies of the most commonly used drugs. There may not be enough foreign exchange to import the necessary raw materials to produce the drugs within country. Drugs can be lost due to theft, poor storage and wastage through expiry. When drugs are prescribed to patients there may be further losses due to over-prescription, unnecessary injections or incorrect prescriptions. Finally, patients may also waste drugs they have been prescribed if they are not sure of the correct dosage, lack confidence in the health staff or fail to complete a course of treatment because they feel better. Decentralizes health care Enjoyed some success

Making the Patient Pay l l As funding for health services continues to be Making the Patient Pay l l As funding for health services continues to be cut (often through the effects of third world debt), there is great pressure to maintain salaries for staff and, as a result, available funds for drugs are reduced even more. All these difficulties mean that both governments and health programmes are increasingly trying to raise funding for drugs directly from the patients. The Bamako Initiative was agreed by African Ministers of Health in 1987 with WHO and UNICEF, calling for community participation in managing and funding supplies of essential drugs. It is based around the eight principles listed at the top of this page (see box). Countries have varied considerably in the ways they have tried to put these principles into action.

Kenya and the Dominican Republic l l l Here the government has encouraged the Kenya and the Dominican Republic l l l Here the government has encouraged the setting up of ‘community pharmacies’ run by CHWs (community health workers). The pharmacies stock between nine and twelve essential drugs and these are charged at prices which not only cover their cost but also include a profit kept by the CHWs. In addition, insecticide-treated mosquito nets are sold at subsidised prices. Local people have been positive and feel that prices are fair, though many struggle to find the necessary funds. CHWs are positive because they can earn a small income – but there are dangers in this, particularly with the over-prescribing of unnecessary drugs to earn more money. Dominican Republic Research here (by Bitran) found that people would prefer to pay for good quality private healthcare, rather than use government health facilities which were free or low cost but were believed to offer poor healthcare and often lacked drugs.

Guinea and Ghana l l In Guinea, W Africa, the government supports comprehensive primary Guinea and Ghana l l In Guinea, W Africa, the government supports comprehensive primary health services. They have a nationally agreed set of charges for the more common diagnoses. These include drugs for treatment and after-care. Discussion groups were set up (by Waddington and Enyimayew) in the Volta region of Ghana to examine people’s attitudes to paying for health services. The actual charges for health services were not the only issue people considered. Equally important were the attitude of health staff, the availability of drugs, whether payments could be made by instalments or in kind and whether credit was available.

The eight principles l l l l Improving primary healthcare services for all Decentralizing The eight principles l l l l Improving primary healthcare services for all Decentralizing the management of primary health services to district level Decentralizing the management of locally collected patient fees to community level Ensuring consistent fees are charged at all levels for health services – whether in hospitals, clinics or health centers High commitment from governments to maintain and, if possible, expand primary healthcare services National policy on essential drugs should be complementary to primary healthcare Ensuring the poorest have access to primary health care Monitoring clear objectives for curative health services

Let’s talk about some of SSA l l l l Sudan Rwanda Congo Kenya Let’s talk about some of SSA l l l l Sudan Rwanda Congo Kenya Uganda Eritrea Ethiopia l l Somalia South Africa Angola Tanzania

Actors/Agencies l l l l USAID DOD State Department Executive Branch Congress Non-governmental agencies Actors/Agencies l l l l USAID DOD State Department Executive Branch Congress Non-governmental agencies Lopez More?

Current policies and programs l l l PEPFAR Global Fund to fight AIDS, TB Current policies and programs l l l PEPFAR Global Fund to fight AIDS, TB and malaria Children Survival Fund MEDFLAG (air force) Office of the US Global AIDS coordinator for all US AID programs More…

Affirmatives l l l l l AIDs MEDFLAG Gendered Violence Water qualities Landmines Doc Affirmatives l l l l l AIDs MEDFLAG Gendered Violence Water qualities Landmines Doc in a Box Maternal Health Care Humanitarian assistance Malaria, TB Child Mortality l l l l Development Assistance Financial Assistance Medical Assistance Sustainable Development Health professionals Nursing Family Planning Infectious Diseases

Topicality l l l The phrase To SSA Public Health Assistance USFG Topicality l l l The phrase To SSA Public Health Assistance USFG

Kritiks l l l SSA is a dirty word Agamben Radical Orthodoxy Borders Disaster Kritiks l l l SSA is a dirty word Agamben Radical Orthodoxy Borders Disaster Pornography Foucault Nietzsche Norm Zizek Threat construction Human Rights l l l Compassion Fatigue Imperialism/Colonialism Disease Kritiks ie Sontag Development Statism Afrocentrism African Feminism Globalization Nuclear war kritiks Spanos Capitalism

Counterplans l l l Agents – EU, World Bank, WHO, AU, OAU, Canada, Japan, Counterplans l l l Agents – EU, World Bank, WHO, AU, OAU, Canada, Japan, China, Australia, NATO, UN Consult – Japan, AU, OAU, China, NATO PIC out of SSA NGO’s Conditioned funding l l l Process CPs Treaties Region PICS Funding PICs – Bill and Melinda Gates, Warren Buffett Backfile Checker

Disadvantages l l l l Politics Spending Structural Adjustment Good China Malthus Aids Tradeoff Disadvantages l l l l Politics Spending Structural Adjustment Good China Malthus Aids Tradeoff Budget Tradeoff Relations

Advantage Areas l l l l l Death State collapse Racism Morality Gender Poverty Advantage Areas l l l l l Death State collapse Racism Morality Gender Poverty Development Civil Conflict Terrorism Security l l l l l US leadership Colonialism Brain Drain Relations Nuclear war Disease Infrastructure China Environment Genocide

Brain Drain l l l Ngo’s currently poach nurses and doctors away from local Brain Drain l l l Ngo’s currently poach nurses and doctors away from local communities, leaving most areas without any medical staff. Ngo’s are able to offer higher wages to the staff thus attracting them to leave the communities. Some claim that this is a reason why the infrastructure is unable to change.

Some helpful resources l l http: //sdiencyclopedia. wikispaces. com This website consists of definitions Some helpful resources l l http: //sdiencyclopedia. wikispaces. com This website consists of definitions to help you understand theory and other issues pertaining to debate.