Wednesday, December 14, 2011
A doctor working in the South West of Kenya finds conditions in health facilities very difficult and says that "Basic provisions like gloves and syringes are constantly out of stock". While this sort of thing is attested in reports such as Kenya's Service Provision Assessment and Tanzania's Sikika reports on levels of supplies and personnel, it's often unclear how health professionals cope with such shortages. Do they send patients home, reuse what is available to them or what?
Dr Lucy Ngina says that "We are always sending patients to buy their own syringes, needles and even bags for intravenous fluid." But she sometimes has to make do with gloves that are too large, for example, risking her own safety and that of her patients.
Although billions of dollars have flowed into HIV related services in African countries, spending on health in general has not increased in the last ten years and the number of healthcare personnel has remained static, although the population has increased at a rate of 2.5% per year or more in Kenya.
Apparently the Kenyan health system is "one of the most dangerous in the world, producing the worst outcomes as measured by mothers and babies who die during childbirth." It may be dangerous in other respects but more attention is paid to certain indicators than others. It is likely, for example, that TB, hepatitis B and C and other transmissable diseases are commonly transmitted in health facilities. But it is less likely that anyone is collecting much data on these phenomena.
One of the problems mentioned is the way big donors, such as the US aid agency (USAID) and the Gates Foundation, tend to concentrate on the 'big diseases', which already receive a lot of attention from other quarters. Many other diseases, often treatable and preventable, are ignored.
Another problem is 'brain drain', which can refer to health personnel qualifying in developing countries and choosing to work in wealthy countries; trained personnel being recruited into the ever-expanding private health sector; or it can refer to wealthy countries' going to developing countries to recruit the best qualified candidates they can find and persuading them to work in the West. Recent calculations may exaggerate how much this costs developing countries in monetary terms but it's probably impossible to calculate how much it costs in terms of human sickness and death.
Doctors currently on strike in Kenya are not just demanding better pay, they are also demanding better working conditions for the sake of their health and the health of their patients. Modern medicine is great when it is properly funded and safely administered. But poor and unsafe conditions can render health facilities even more dangerous than no health services at all.
In countries with serious HIV epidemics, outbreaks in hospitals could infect hundreds, even thousands of people over relatively short periods of time; partcularly when none of the various HIV institutions are actually looking out for hospital associated HIV transmissions.