Global Health Watch 1 in one file

Box B1.1 Countries in decline – health and health care in Africa,
the former Soviet Union and Afghanistan
Life expectancy in many Sub-Saharan Africa (SSA) countries has now
dropped below 50 years. Much of this is due to HIV/AIDS, fuelled and
compounded by high levels of poverty, food insecurity and conflict. While
the burden of disease has been increasing, health care systems have been
deteriorating. The best evidence of this is stagnating or decreasing rates of
child immunization and maternal mortality – two indicators that are particularly
sensitive to the functioning of health care systems. Immunization
coverage rates peaked at 55% in 1990 and stagnated throughout the 1990s.
By 2000, only 53% of children in the SSA region were immunized against
diphtheria, tetanus and whooping cough (WHO, UNICEF and World Bank
2002). Of 41 SSA countries, only six had maternal mortality ratios of less
than 500 per 100,000 live births in 2004 (UNFPA 2004). In 35 countries, at
least one woman died for every 200 live births. Seventeen countries had a
maternal mortality ratio of 1000 or more – one death per 100 live births.
In 12 countries, the maternal mortality ratio worsened between 1994 and
2004 (UNFPA 2004, WHO, UNICEF and UNFPA 2001).
In all 15 of the new republics of the former Soviet Union, life expectancy
at birth fell between 1990 and 2000. Although there are several reasons for
this reversal of human development, an underlying problem has been the
effects of post-Soviet political and economic change upon the health care
systems of these countries (see: http://www.ghwatch.healthformersoviet
union)
More than 20 years of conflict have contributed to the destruction of
Afghanistan’s health care infrastructure (Waldman and Hanif 2002). In
2002, 60% of Afghans had no access to basic health services and two-thirds
of Afghanistan’s districts lacked maternal and child health services (Transitional
Islamic Government of Afghanistan 2002). The maternal mortality
ratio is 1600 per 100,000 live births – every 20 to 30 minutes a woman dies
because of pregnancy-related complications (Ahmad 2004). The government
has very weak institutions and a lack of both military and administrative
control in large parts of the country which remain under the control of
warlords and local commanders (World Bank 2004).
• Fifth, it emphasizes appropriate and effective community involvement within
the health care system.
Approaches to health care
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