This week, as they are set to host the G8 meeting next week in Deauville, France is being scolded for backsliding on aid to Africa as agreed at the 2005 G8 meeting in Gleneagles. Next year’s French presidential hopeful and (now ex) IMF chief Dominique Strauss-Kahn was also brought down by an allegation of sexual assault in his New York luxury suite by a chambermaid, 32 year old west African immigrant, and single mother of a teenage daughter. The WHO alludes to the kind of inequalities that make the expectation of aid and the alleged assault possible in an analysis of the 2011 World Health Statistics showing a gap of 23 years in life expectancy between people in the richest countries and those in the poorest. Amartya Sen reminds us though in an article comparing the effects of economic growth in India vs. China that the reach and impact of economic prosperity depend greatly on what the government does with the increased public revenue.
The WHO report also shows a wide gulf between rich and poor countries in availability of doctors: only 2.8 doctors per 10 000 people in the poorest countries, whereas in wealthy countries the number was 28.6 per 10 000. It is partly because of this sort of skewed distribution of health workers that task shifting is inevitable. A meta-analysis published in the BMJ compares the effectiveness and safety of clinical officers carrying out caesarean section in developing countries compared with doctors. There were no significant differences in maternal and perinatal deaths but that caesarean sections by clinical officers were associated with a higher incidence of wound infection and wound dehiscence.
Medical journals are alive and thriving in Africa, says a report on this year’s meeting of the African Journals Partnership Project (AJPP), a programme which pairs indigenous journals in sub-Saharan Africa with counterparts in the North. In one of the final posts on the AidWatch blog which closes this week, medical journals like BMJ and the Lancet are accused of consistently publishing dubious social sciences studies using unduly creative data. Even clinical studies in high impact journals are not without controversy. Earlier this month, JAMA published a study suggesting that reduction in population salt intake, presently being recommended as a policy population strategy to control NCDs, may be harmful. The study shows that people with the lowest salt intake have 56 percent higher risk of dying from cardiovascular disease than people with the high levels. The Lancet, co-sponsors of a recent report that puts salt reduction at the centre of NCD control responded this week saying the study is a “disappointingly weak” small observational study that uses sodium excretion as proxy for salt consumption, and asked that results of the JAMA paper should neither change thinking nor practice.
Finally, Nigerian women marched to the parliament house in Abuja to protest the delay in passing the National Health Bill, threatening to go nude in the event of further delay – the peak protest gesture in Nigeria. It is the first of such protests since Nigeria became a democracy. The National Health Bill promises to greatly increase and secure allocation of funds for primary health care and support Community Based Health Insurance. Like Amartya Sen wrote in his India vs. China article, “what a democratic system achieves depends greatly on which social conditions become political issues.” Let us hope that this is the beginning of a change in the health system of Africa’s biggest democracy.