Accelerated Development in Sub-Saharan Africa: an agenda for action

The vision of a heart-healthy and "stroke-free" world is achievable through the aggressive prevention and control of cardiovascular risk factors. In sub-Saharan Africa, a region plagued by infectious and parasitic diseases, nutritional deficiencies, and excessive maternal and perinatal morbidity and mortality, the prevention of cardiovascular diseases (CVD) and risk factors is rarely on the public health agenda. In Africa, however, as recently documented by the World Health Organization's Africa Regional Office, CVD and other chronic non-communicable diseases are on the increase and already represent a significant burden on public health services. Age-specific mortality and morbidity associated with CVD and chronic diseases are higher in sub-Saharan Africa than in established market economies. Correspondingly, adverse trends in risk factor profile are beginning to appear especially in many urban centers in sub-Saharan Africa. Addressing and reversing these trends will take more than just targeting individuals and their behaviors and lifestyle choices. More importantly, to support heart-healthy choices, emphasis must be placed on policy development, systems changes, and issues in the social environment factors such as the need to strengthen legislation and regulatory mechanisms, which control the leading risk factors (eg, tobacco, physical inactivity, and poor nutrition). We must develop and conduct heart-healthy and "stroke-free" initiatives to take place in diverse community settings: schools, worksites, communities, and healthcare systems. In addition, public health capacity and infrastructure must be strengthened to provide adequate surveillance and the assurance that best practices are implemented. Action is needed to integrate health promotion, risk factor control and disease prevention within the primary healthcare setting. Above all, population-based approaches must be used to promote education and awareness of the importance of CVD risk factors. In sub-Saharan Africa, where most people have no more than one CVD risk factor, a unique opportunity exists for primordial prevention, ie, preventing the development of risk factors in the first place. The policy and environmental change strategies discussed provide a road map to a heart-healthy and "stroke-free" future.

A heart-healthy and "stroke-free" world through policy development, systems change, and environmental supports: a 2020 vision for sub-Saharan Africa.

The study described in this report is a follow-up to the original research conducted at Hospital Carrion in 1996-98 The goal of the present study carried out from 2000-02 was to determine the sustainability of the PAC intervention introduced in the hospital and the extent to which the outcomes of the intervention have continued Hospital Carrion has provided PAC services without external technical or financial assistance for postabortion care since the conclusion of the original study The present study is the first known research to examine how well a PAC intervention and resulting improvements have been maintained over the long term The objectives of the study were to assess changes over time in the following outcomes: the use of MVA for incomplete abortion; provision of family planning information to postabortion patients; acceptance of contraception by postabortion patients prior to discharge; provision of medical care information to patients; length of hospital stay and resources used by the hospital and patients for PAC services An additional research objective was to describe the organizational and environmental contexts that influenced changes in the PAC outcomes (excerpt)

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Sustainability of postabortion care in Peru.

The meaning of "capacity building" for the nurse workforce in sub-Saharan Africa: An integrative review

Official development assistance (ODA) from the Organization for Economic Cooperation and Development (OECD) countries to developing countries has increased between 1965 and 1989 from $27.4 billion to $43.6 billion in 1987 prices. As a share of gross domestic product funding has remained much the same at between .15% to 1.04%. Health-related activities receive only a portion of this funding. The UN reports that OECD/DAC bilateral aid which is 85% of bilateral aid contributed 6.7% of this aid to population and health in 1989. The amount earmarked for social priority areas (basic education primary health care and extension of basic water systems) varied among countries: 4.0% in Italy to 15.8% in Switzerland. World Bank figures reveal that 5.3% of all bilateral aid which is 75% of total aid was spent on health and population. Multilateral aid was reported as 7.8% which was similar to UN reports. Figures from different sources range from $2.5 to $2.7 billion spent on health and population. Neither donor ODA nor the proportion of recipients gross national product spent on health is very large. The purpose of this paper is to reveal the decision-making process behind external support in the health sector. The Alma Ata Declaration of 1978 was signed by 134 countries and indicated commitment to support for primary health care (PHC). During the World Summit on Children in 1990 159 countries approved of specifically improving the health of children. Topics covered in the discussion include the focus on 1) health aid for programs rather than institutional development; 2) donor rationale for support (implementation is impossible without support and time limits are set); 3) identification of eligible situations where programs are sustainable without external support; 4) projects requiring one-time support recurrent support in temporary efforts and temporary support to recurrent activities; and 5) establishment of an institute for operational research and development to ensure innovative programs. Unfortunately the considerations identified are not the only factors in decision making because earlier policy decisions or existing projects may interfere. The best options for new projects are to keep these considerations in mind.

Which way to sustainability? External support to health projects in developing countries

Experiences in South Asia and Africa are compared, and a critical need for development of institutional capacities in Africa is identified. It is argued that in addition to investment in essential health services, there is a need for concerted effort among leaders in African governments, donor organizations, universities and professional bodies to develop a comprehensive plan of action for capacity development in the health sector.

James D. Shepperd

Papers

Capacity building for the health sector in Africa.