OpenForum – a blog by the Health and Human Rights community

During his speech on World AIDS Day, South African President Jacob Zuma promised to ramp up HIV/AIDS prevention and treatment programs for children and high-risk groups. The new plan calls for treating all HIV-infected babies in a country whose child mortality rate has risen since 1990. “Our message is simple,” President Zuma said, “we have to stop the spread of HIV. We must reduce the rate of new infections. Prevention is our most powerful weapon against the epidemic.”

President Zuma’s commitments set a new ideological standard in South Africa that breaks from previous conceptions of the disease. Former President Thabo Mbeki received widespread criticism for his ideas about the nature and treatment of the epidemic. He is often noted as a denialist of the viral cause of AIDS and the effectiveness of antiretroviral treatment. A Harvard University study reported in The New York Times found that more than 330,000 premature deaths could have been prevented if Mbeki’s administration had backed the provision of antiretroviral drugs to AIDS patients.

Despite Mbeki’s misguided stance, that Jacob Zuma reversed his predecessor’s rhetoric on HIV/AIDS came as somewhat of a surprise. A husband to three wives – an acceptable facet of his Zulu heritage but a risk factor for contracting HIV – and the defendant in a 2006 criminal case for the rape of an HIV-positive friend, he is an improbable leader in the AIDS movement.

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A number of non-traditional practices are arising in poor and developing communities to fight high maternal mortality rates. One example that has taken hold in many African countries is the use of non-physician clinicians (NPCs) – health care providers who are not licensed physicians but who still provide substantial medical care. The retention rate of these types of practitioners tends to be higher, and the cost of training and deployment much lower, than those of doctors.

At a recent conference, health delegates from 42 countries agreed to implement a new strategy that trains NPCs in emergency obstetric surgery to address the lack of health care workers. Along with other developing areas, most African countries are suffering from a significant lack of medical professionals. This shortage is particularly implicated in the high rates of maternal and infant deaths during childbirth. The WHO has estimated that in sub-Saharan Africa alone, there is a shortage of nearly 1.5 million health care workers; women there face a 1-in-13 risk of dying in childbirth. Most women are unable or unwilling to access medical facilities or workers, even during emergencies; for example, in Ethiopia, only 6% of all births occurred in a health facility.

By expanding the number of NPCs and training them in surgical childbirth procedures, it is hoped that more births will be attended by trained health care workers who can assist women during emergencies. A program in Mozambique that trains midwives in surgical techniques has already achieved significant results. The country is on the way toward meeting several of the UN’s Millennium Development Goals, particularly those surrounding maternal and newborn health. Read more

Mother and Child in Bolivia

According to the World Health Organization (WHO), if you are a young Bolivian, you have a 6 percent chance of dying before your fifth birthday. Diarrhea and malnutrition, conditions rooted in poverty, are the leading causes of child mortality in the South American country. Against this background, a UNICEF-funded government health insurance plan will allow doctors to provide unrestricted care to children under the age of five as well as pregnant women. Bolivia’s health services still have much work to do to ameliorate the underlying causes of childhood diseases. UNICEF estimates that 2.5 million Bolivian children are living in poverty, leading to the compounded problem of chronic malnutrition.

While the UNICEF program, which covers the costs of the medical treatment of children, is an important step in making care readily available to Bolivians, the government still needs to reach out to the destitute rural and indigenous populations. Prohibitive distance and cost are not the only factors that separate these Bolivians from medical professionals. The systemic degradation of trust may stem from a communication barrier: Many doctors and nurses do not speak Quechua or Aymara (indigenous Bolivian languages). Cultural traditions, such as keeping a male child’s umbilical cord long to symbolize masculinity, or the association of white walls, such as those in hospitals, with the burial of babies, exacerbate the already dangerously poor health outcomes for these individuals. UNICEF’s health insurance program, while a critical first step in improving child life expectancy, will be unable to achieve lasting change in the most under-served populations until cultural dynamics, along with endemic poverty and rural inequality, are addressed.

More information on Bolivia below the fold. Read more