RETHINKING HEALTH DELIVERY SYSTEMS IN SUB-SAHARAN AFRICA

RETHINKING HEALTH DELIVERY SYSTEMS IN SUB-SAHARAN AFRICA

Nigeria-based public health specialist Dr Uche Amazigo has received an Honorary Doctor of Science degree from the University of KwaZulu-Natal in acknowledgement of her work on Onchocerciasis (River blindness), a disease that affects millions of people in sub-Saharan Africa.

River blindness is a disease transmitted by small black flies that live near fast-flowing rivers in fertile farm lands in 30 countries of sub-Saharan Africa. ‘In the early1990s, 120 million Africans were at risk, with 37 million infected and 1.5 million blinded or visually impaired,’ Amazigo said.

Addressing graduates, parents, University staff and other distinguished guests, Amazigo explained the challenges of tackling the disease. ‘For centuries our people believed that certain bewitched rivers eat the eyes. Hundreds of villages bordering fertile agricultural land were consequently abandoned, many preferring to protect their eyesight. Prospects for overcoming river blindness were bleak,’ she said. The disease brought immeasurable personal harm as well as socioeconomic damage throughout sub-Saharan Africa.

Amazigo said it was a "distinct honour and privilege" to talk about something to which she was extremely dedicated, namely, the need to identify - and exploit to the fullest - multisectoral solutions to improve the health of all sectors of society, in particular, the health of populations, those, for whatever reasons, are ignored by, or underserved by national health services. ‘When the poor in our sub-region are underserved because of unfair distribution of health system structures, human rights are violated by governments,’ she said.

Amazigo’s innovative research on the disease formed the basis for the UN/World Bank-administered African Programme for Onchocerciasis Control (APOC). In addition, she successfully co-ordinated and implemented the World Health Organisation’s African programme for river blindness control. Based on community-directed treatment with ivermectin (CDTI), the programme allowed for community participation in one of the largest control programmes undertaken for a single disease.

‘In our sub-region, health systems need good and effective delivery systems in which the end users are inclusively engaged; and engaged in determining as well as operating those systems. That is the fundamental basis for the success of the river blindness control programmes. Today, there is evidence of elimination of river blindness, made possible because of community involvement and the keeping of reliable treatment records.’

Amazigo said often at great cost, Africa had taught us that a "quick fix" imposed from outside does not work and usually represents a wasted investment. ‘Even where it seems to work, it simply does not strengthen any community health system in a cost-effective or sustainable manner. The community-directed system engages the poor as partners and not passive recipients, and builds sustainable infrastructure for long-term delivery of services. This viable strategy can be adapted to improve all health delivery services in sub-Saharan Africa. This is what Africa still desperately needs.’


author email : captainr@ukzn.ac.za