Equity, quality and accessibility are the main excellent performance criteria of health systems, proposed by the WHO.
These criteria are far from being met, especially in the context of the aspirations and realities in the use of modern technologies by the scientific communities of the countries of the southern hemisphere. The main limiting factor is economic, as theoretical scientific knowledge can be acquired with fewer difficulties. In fact, the absence of appropriate equipment is a serious problem to the application of scientific concepts. When we consider the meager budgets of research laboratories, the limited equipment of African hospitals and medical cabinets, it is clear that the offer of quality care within a background of equity remains a big challenge. Thus, the gap between the countries of the northern hemisphere and those of the southern hemisphere is widening. This detachment of a part of the world is not unavoidable if we employ imagination, creativity and solidarity. The mobilization of financial resources should be done on CONCRETE PROJECTS. Building on a culture of immediate results – there is an emergency – the scientific community should insist on obtaining financial resources from political and institutional leaders for “palpable” projects. What can we do? At what level should we act?
1 – Internet. The network is diffusing knowledge freely throughout the world, 24 hours / day. There is however a cost to pay. Besides scientific information and communication between practitioners, the internet allows for technical assistance to be given at a distance and to maintain the quality of equipment in the field. The Internet needs to be extended very rapidly, while avoiding waste of time and money in big rallies and « summits » which do not have any effect as was recently observed with the world meeting on society and information. Big meetings on communication and the interest in new technologies in the development of the sciences and techniques for poor countries constitute a completely useless additional load. Assistance to establish low-cost connections for the scientific communities of the southern hemisphere would save the situation.
2 – The Administrations of a large number of countries of the northern hemisphere have the discipline of regularly renewing hospital medical equipment even when they are still in good condition. A convention with some institutions could re-orient these machines in good functional state to countries of the southern hemisphere.
3 – The entreprises of the northern hemisphere. The cost of the latest machines is and will remain for a long time inaccessible to most scientists and physicians in Africa. Some of the proposed options are of relatively low interest or even lack a scientific basis. It is important to conceive and develop reliable, robust and scientifically validated equipment with basic functions, avoiding useless sophistications that simply blow up the selling price of these ‘gadgets’. The automobile industry has seized the opportunity of this observation and aims at the market in the developing or emerging countries from a realistic point of view. Thus, Renault (France) now proposes reliable cars to countries of the southern hemisphere for 8000 euros.
4 – The enterprises of the southern hemispheres. The firms of the southern hemisphere can produce reliable pieces of equipment that respect scientific norms, at unchallengeable costs. Thus, ventriculo-peritoneal shunt valves conceived on proven scientific basis and produced by Indian companies, are available for 30 euros instead of 1000 euros, the price of models commercialised in Europe and the USA by the « major » companies.
5 – Scientific Societies. Through a collaboration between the World Federation of Neurosurgical Societies and an important international medical instruments company, neurosurgical kits and high quality operating microscopes are sold at prices that are accessible to hospitals of the southern hemisphere. This very interesting example can be copied
The discussion is open but action should be the leading rule.