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Call for G8 to Tackle Health Crises in Poor Countries

Rising food and fuel prices will top the agenda at the G8 summit in

Japan, but many other pressing development-related problems also require action. Below, members of LIDC appeal to the leaders meeting in Hokkaido from 7-9 July to respond to the health crises in low income countries.

Boosting the Health Workforce in Sub-Saharan <span style="FONT-SIZE: 10pt; LINE-HEIGHT: 115%>Africa

Sarah Whitmarsh and Tana Wuliji, International Pharmaceutical Federation Collaborating Centre (FIPCC), School of Pharmacy

The International Pharmaceutical Federation Collaborating Centre (FIPCC) urges G8 leaders to support solutions to the health workforce crisis in sub-Saharan Africa.  Their leadership is critical for making positive changes in the region. Sub-Saharan Africa bears a quarter of the world’s disease burden yet only has three percent of the world’s health care professionals, according to the World Health Organization (WHO).  Half of its population lack access to essential medicines.

We support the WHO’s goal of increasing the number of health care professionals in Africa by an additional 1.5 million by 2015.  In particular, we suggest including a focus on the scaling up and skilling up of the pharmacy workforce. 

Staff shortages and poor training
There are relatively few pharmacists in sub-Saharan Africa and they are trained at a critically insufficient level.  On average in the UK, there is one pharmacist for every 1,300 people.  In Uganda, there is one for every 140,000. The shortage of pharmacists means that many clinics lack the training and staff to manage medicine supplies.  The subsequent scarcity of essential medicines means that diseases such as malaria that can be easily treated continue to claim millions of lives. 

Educating and employing more pharmacists in Uganda and other sub-Saharan countries would ensure a more robust supply chain of pharmaceuticals and increase the safe and effective access to medicines. Pharmacists counsel patients on how to take medications properly and how to deal with side effects, particularly important for complex therapies for HIV/AIDS.

Investment required
The WHO estimates a need of more than $6 billion to educate, employ and retain health professionals and have asked the G8 to commit to a minimum of $4 billion to achieve this goal.  We echo their call. The G8 has the means to provide the technical and financial capacity so that health care professionals can be trained locally, subsequently strengthening the health system infrastructure at the country level. Giving populations access to more health care professionals in general and pharmacists in particular is essential to achieving the United Nations Millennium Development Goals (MDGs) and the G8’s own health initiatives.   
Strengthening Health Systems in Low Income Countries: A Strategic Investment  
Dina Balabanova, Martin McKee, Anne Mills, Gill Walt and Andy Haines, London School of Hygiene and Tropical Medicine
Thirty years ago, at Alma-Ata in the former Soviet Union, the world’s governments committed to integrated comprehensive primary health care. Yet, since then, much development assistance has been selective, focusing on specific diseases and interventions. All those working in low income countries find themselves constrained by fundamental weaknesses in health systems.

Unprecedented challenges
The need for an integrated response is greater than ever. Today’s challenges are unprecedentedly complex. People are living longer, often because modern treatment allows them to control multiple chronic disorders, such as AIDS and heart disease and diabetes. The scope to intervene is greater than ever but the interventions are often multifaceted , requiring access to a range of health professionals and medications. The situation can only become more complex in the future.

Action to strengthen systems in low income countries is needed now. We welcome the call by the global health leaders for a renewed focus on health systems. They, together with the bilateral donors must strengthen their efforts to work together, building on each others’ comparative advantages, and reduce existing fragmentation. But what else?  Money and evidence must be linked so that funds are spent on things that work. This will require a serious investment in the capacity to conduct research and to produce knowledge brokers who can translate evidence into policy-relevant messages. Strengthening health systems will require simplified and coordinated aid flows and initiatives, and improved accountability for funding decisions. There must be flexibility, and funds may have to be spent on both immediate priorities (e.g. supplying essential drugs) and on system building (e.g. improving drug procurement). A long term vision and commitment to invest will be essential; sustainable change in health systems will take decades.


Role of governments
However, recipient governments must also change. They need to focus on the needs of the patient and the front-line provider, identifying the obstacles that prevent the delivery of effective care. They must ensure that the resources needed, from health workers to pharmaceuticals, are in place.  Often this will involve boosting salaries of health workers while making strenuous efforts to root out corruption. Integration must begin at the front line in the struggle for health and go all the way to the top. It should be based on clear goals and regular monitoring of health systems, recognising that this will require investment in information systems. We can no longer tolerate the scandal of ignorance whereby so many people are born, live, and die without these events ever being recorded.

The world is looking to the leaders of the G8 for leadership. We must all hope that they rise to the challenge of ensuring that health systems are fit for purpose.