WHO PAYS? (en)
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The World Health Organisation (WHO) report on « The Public Health Challenges of Neurological Disorders » is particularly welcome as it draws attention to a real health problem, which is deemed marginal in most sub-Saharan countries. The problem of accessibility to neurological care is complex in this region, as it implicates several actors on a background of acute scarcity of human and financial resources. Indeed, as indicated at the end of the editorial, the query “Neurology in sub-Saharan Africa – WHO cares?”(1) must be coupled with another question: “WHO pays?”
At this stage of development of sub Saharan Africa, it would seem totally unrealistic to focus neurological care at the village level. Any diagnosis of a neurological disorder requires further professional advice, and professional advice must be followed by specialised tests (EEC, EMG, CT-SCAN, MRI), which are usually very costly. Outside the Republic of South Africa, there are only 2 MRI in public hospitals (Nigeria, Zibabwe) in the whole of the sub-Saharan region. Moreover, as is well known, there is a scarcity of medical doctors, especially neurologists on the continent – 0.3 per million persons while the total African population is estimated at 600 million, which is equivalent to the combined population of Europe and Russia. The cost of a CT-SCAN is approximately $100 when 90% of the population live on $1 a day. To the costs of the professional advice and tests, one must add the costs of medication in the absence of any type of health insurance.
Financial solutions do exist and they do not require begging for more loans. In the developed world, health spending per person is estimated at $3100, about 11% of GNP. In developing nations, this amount drops to $81 (6% of GNP). A report made for WHO by Jeffrey SACHS and al. (2) – “Macroeconomics and Health : investing in health for economic development” – states that, in the health sector, a rise in financial commitments of 72 billion euros annually would translate into a gain of 396 billion euros over 15 years, whilst saving 8 million lives each year.
The report also estimates that an amount of $34 per person per year would be sufficient to cover the costs of basic health care in low income African countries, including HIV/AIDS, malaria, tuberculosis, maternal pathologies and prenatal care, diseases causing infant mortality (chicken pox, tetanus, diphtheria, respiratory infections, water borne diseases), malnourishment, preventable diseases and tobacco related diseases. The major part of this financial contribution should and could be financed by the public sector.
The recurrent clichés on the poor management of development aid, in particular by African countries, are not sustainable (3). A large part of external aid is well spent and has delivered spectacular results. In 1967, smallpox caused some 10 to 15 million deaths worldwide. Some thirteen years later, that disease had been eradicated thanks to the implementation of a special WHO programme. In 1988, there were some 350 000 polio cases. In 2003, only 784 cases of polio were recorded thanks to a 3 billion dollars control programme. This type of aid must be continued, and amplified, especially in the fight against the AIDS pandemic.
For a maximum efficiency, action must be taken in partnership and directly on concrete projects such as scholarships, training, lectures, and equipment (4). Creativity is necessary in promoting such initiatives, for example, with the use of NTIC ( 4, 5).