Tuesday, April 12, 2011

If Tanzania Had More Health Personnel, Would HIV Be More or Less Common?

Apparently "One-third of U.S. hospital admissions can expect a medical error, an infection or other adverse outcome". But sometimes up to 90% of these outcomes can remain undetected. This is in the country with the highest health spending per head in the world. What percentage of patients in Tanzania, say, could expect a medical error?

For a start, who is counting? There is generally no way of keeping track of such errors, even serious ones. There are too few health personnel, too few of them are trained and most hospitals don't have the capacity to keep such records or prevent such incidents.

On the plus side, if you could express it that way, most Tanzanians will never see a doctor and won't spend too much time, if any, in a health facility. The percentage of patients suffering adverse outcomes may be higher than in the US but the number of people involved is a hell of a lot lower.

An article about the pastor in Loliondo, Arusha Region, who claims to have a concoction that cures just about anything, points out that the people flocking to drink the potion are not just following the herd; they are desperate.

This is a significant observation. For people in rural parts of Tanzania, and that's over 80% of the population, all health services are elusive, requiring a lot of patience, faith and perserverence, perhaps even some money.

This magic potion is even said to cure HIV/AIDS. It costs less than a dollar, 500 Tanzanian shillings. Of course, people have to pay the costs of waiting for days, not working, paying for accommodation, food, transport, bribes and anything else that someone can screw money out of them for.

But this may not be so different from some antiretroviral (ARV) programs, where the drugs, if you can get hold of them, are free. And ARVs don't guarantee survival either. Under the right conditions ARVs are very powerful, but many Tanzanians don't live in such fortunate circumstances.

This article cites estimates that Tanzania needs 126,000 health workers but only has 35,202, a 76% deficit. The ratio of doctor to patient in some places is as bad as 1 to 62,000 but in Kigoma, that ratio is one to 308,000. Coincidentally (perhaps), Kigoma is also the region with the lowest HIV prevalence in the country.

Per capita health expenditure is $22 in Tanzania, 2.7% of the global average. Much of that, an estimated 75%, comes out of the pockets of people where the majority wouldn't earn much more than a couple of dollars a day. Most illnesses, clearly, go untreated.

When I think of health conditions in East African countries and then look at HIV prevalence, I wonder why HIV prevalence is not a lot higher. And I wonder why HIV prevalence is so much higher in other African countries where far more people have access to health care.

But looking at the figures for adverse outcomes in the US, I'm not so surprised. Good health facilities are dangerous enough, I hate to think of the uncounted hazards people face in bad health facilities. In countries with high HIV prevalence, health facilities could be among the worst places to go.


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