This article provides insufficient context for those unfamiliar with the subject.(November 2020) |
The Health Sector in Eswatini is deteriorating and four years into the United Nations sustainable development goals, Eswatini seems unlikely to achieve the goal on good health. As a result of 63% poverty prevalence, 27% HIV prevalence, and poor health systems, maternal mortality rate is at a high of 389/100,000 live births, [1] and under 5 mortality rate is at 70.4/1000 live births [2] resulting in a life expectancy that remains amongst the lowest in the world. [3] Despite significant international aid, the government fails to adequately fund the health sector. Nurses are now and again engaged in demonstrations over poor working conditions, drug shortages, all of which impairs quality health delivery. Despite tuberculosis and AIDS being major causes of death, diabetes and other non-communicable diseases are on the rise. [4] Primary health care is relatively free in Eswatini save for its poor quality to meet the needs of the people. Road traffic accidents [5] have increased over the years and they form a significant share of deaths in the country. [6]
Furthermore, tuberculosis remains a significant problem. The shift has been towards multi-drug resistant strains. TB has an 18 percent mortality rate and 83 percent of cases are co-infected with HIV. [7] There are roughly 14,000 new TB cases diagnosed each year. [8]
The Human Rights Measurement Initiative [9] finds that Eswatini is fulfilling 74.1% of what it should be fulfilling for the right to health based on its level of income. [10] When looking at the right to health with respect to children, Eswatini achieves 85.5% of what is expected based on its current income. [10] In regards to the right to health amongst the adult population, the country achieves only 52.8% of what is expected based on the nation's level of income. [10] Eswatini falls into the "bad" category when evaluating the right to reproductive health because the nation is fulfilling only 84.2% of what the nation is expected to achieve based on the resources (income) it has available. [10]
The global shift towards more non-communicable diseases does not spare Eswatini. However, scanty research is on mental illness in the country yet increasing levels of poverty, sexual violence, HIV/AIDS, alcohol and cannabis abuse [11] are highly associated with mental health issues. Lack of policy, poor facilities, and limited personnel [12] all contribute to poor awareness and is a concern that shall soon explode as a crisis in the population and burden it of disease in the country.
Eswatini does not have an expansive mental health infrastructure. Most healthcare is centralized in cities where only approximately 20% of the population lives. Though recently there may have been additions, in 2011 there was one psychiatrist in National Psychiatric Referral Hospital and in the country. [13] Impractical as it may, they attended inpatients, prisoners, children, and outpatients. [14]
Given Eswatini's overall health situation, many health-oriented non-governmental organizations, university programs, and other organizations work in the country on research and service projects related to health. However, mental health remains the periphery. Despite all these negatives, there is but one organization working on awareness and promotion of mental health in the country. [15]
Eswatini has made significant strides in fighting HIV/AIDS. From being highest in prevalence and incidence in late 2000s, it has shifted to be a model for HIV control in the world. Urgency, programmatic shifts and international aid make the frontline in the combat against the epidemic. The first case of HIV in Eswatini was reported in 1986, approximately 26 years after the first known case in the world. Fast forward about two decades later, it was reported the biggest killer; at 64% of all deaths in the country. In 2003, the Eswatini government (then Swaziland) declared HIV/AIDS a national crisis, with 38.8% of tested pregnant women infected with HIV (see AIDS in Africa). Prime Minister Themba Dlamini declared a humanitarian crisis due to the combined effect of drought, land degradation, increased poverty, and HIV/AIDS. NERCHA [18] was formed in 2003 to coordinate action against the disease. HIV care guidelines were published in 2010, revised in 2015 and most recently in 2018 to improve models of care, and fit emerging developments in the fight against HIV/AIDS. A 2016 SHIMS 2 [19] found a significant decrease in prevalence of HIV compared to 2012 in SHIMS 1. [20] Eswatini scores lowest incidence and related deaths today in the region. [21] Universal ART coverage and extensive outreach targeted at hard to reach populations for HTC are responsible for the country's success towards the 90/90/90 2020 UNAIDS goal of ending HIV.
Public expenditure for HIV/AIDS was 4% of the GDP of the country, whereas private expenditure was 2.3%. [22] [ specify ] Infant mortality was 57.19 per 1,000 in 2014, [23] [ specify ] 47% of all deaths under 5 were caused by HIV/AIDS. [24]
There were 16 physicians per 100,000 persons in the early 2000s. [22]
In September 2018 as the government had not paid suppliers the health service ran out of food and medicine. Swazipharm could not buy drugs. In May 2017 US$18 million was said to be owed to drug companies. There were only 12 working public ambulances in the country in June 2018. [25]
There were 135 medical facilities in Eswatini in 2019, including four hospitals run by the Ministry of Health and two hospitals run by NGO missions. The other medical facilities are clinics and health centers. [26]
Name | Location | Type facility | Ref |
---|---|---|---|
Mbabane Government Hospital | Hhohho Region | Referral Hospital | [26] |
Pigg's Peak Government Hospital | Hhohho Region | Regional Hospital | [26] |
Good Shepherd Hospital | Lubombo Region | Mission Hospital | [26] |
Mankayane Hospital | Manzini Region | Regional Hospital | [26] |
Raleigh Fitkin Memorial (RFM) Hospital | Manzini Region | Mission Hospital | [26] |
Hlatikhulu Hospital | Shiselweni Region | Regional Hospital | [26] |
HIV/AIDS originated in the early 20th century and has become a major public health concern and cause of death in many countries. AIDS rates vary significantly between countries, with the majority of cases concentrated in Southern Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total population infected worldwide – approximately 35 million people – were Africans, of whom around 1 million have already died. Eastern and Southern Africa alone accounted for an estimate of 60 percent of all people living with HIV and 100 percent of all AIDS deaths in 2011. The countries of Eastern and Southern Africa are most affected, leading to raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about twenty years. Furthermore, life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic, with life-expectancy in some countries reaching as low as thirty-nine years.
India's population in 2021 as per World Bank is 1.39 billion. Being the world's most populous country and one of its fastest-growing economies, India experiences both challenges and opportunities in context of public health. India is a hub for pharmaceutical and biotechnology industries; world-class scientists, clinical trials and hospitals yet country faces daunting public health challenges like child undernutrition, high rates of neonatal and maternal mortality, growth in noncommunicable diseases, high rates of road traffic accidents and other health related issues.
Diseases of poverty, also known as poverty-related diseases, are diseases that are more prevalent in low-income populations. They include infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is one of the major social determinants of health. The World Health Report (2002) states that diseases of poverty account for 45% of the disease burden in the countries with high poverty rate which are preventable or treatable with existing interventions. Diseases of poverty are often co-morbid and ubiquitous with malnutrition. Poverty increases the chances of having these diseases as the deprivation of shelter, safe drinking water, nutritious food, sanitation, and access to health services contributes towards poor health behaviour. At the same time, these diseases act as a barrier for economic growth to affected people and families caring for them which in turn results into increased poverty in the community. These diseases produced in part by poverty are in contrast to diseases of affluence, which are diseases thought to be a result of increasing wealth in a society.
Available healthcare and health status in Sierra Leone is rated very poorly. Globally, infant and maternal mortality rates remain among the highest. The major causes of illness within the country are preventable with modern technology and medical advances. Most deaths within the country are attributed to nutritional deficiencies, lack of access to clean water, pneumonia, diarrheal diseases, anemia, malaria, tuberculosis and HIV/AIDS.
Health in Ethiopia has improved markedly since the early 2000s, with government leadership playing a key role in mobilizing resources and ensuring that they are used effectively. A central feature of the sector is the priority given to the Health Extension Programme, which delivers cost-effective basic services that enhance equity and provide care to millions of women, men and children. The development and delivery of the Health Extension Program, and its lasting success, is an example of how a low-income country can still improve access to health services with creativity and dedication.
Tropical diseases, especially malaria and tuberculosis, have long been a public health problem in Kenya. In recent years, infection with the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS), also has become a severe problem. Estimates of the incidence of infection differ widely.
Health care services in Nepal are provided by both public and private sectors and are generally regarded as failing to meet international standards.
The Tajikistan health system is influenced by the former Soviet legacy. It is ranked as the poorest country within the WHO European region, including the lowest total health expenditure per capita. Tajikistan is ranked 129th as Human Development Index of 188 countries, with an Index of 0.627 in 2016. In 2016, the SDG Index value was 56. In Tajikistan health indicators such as infant and maternal mortality rates are among the highest of the former Soviet republics. In the post-Soviet era, life expectancy has decreased because of poor nutrition, polluted water supplies, and increased incidence of cholera, malaria, tuberculosis, and typhoid. Because the health care system has deteriorated badly and receives insufficient funding and because sanitation and water supply systems are in declining condition, Tajikistan has a high risk of epidemic disease.
HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).
In precolonial Ghana, infectious diseases were the main cause of morbidity and mortality. The modern history of health in Ghana was heavily influenced by international actors such as Christian missionaries, European colonists, the World Bank, and the International Monetary Fund. In addition, the democratic shift in Ghana spurred healthcare reforms in an attempt to address the presence of infectious and noncommunicable diseases eventually resulting in the formation of the National Health insurance Scheme in place today.
The quality of health in Cambodia is rising along with its growing economy. The public health care system has a high priority from the Cambodian government and with international help and assistance, Cambodia has seen some major and continuous improvements in the health profile of its population since the 1980s, with a steadily rising life expectancy.
The current population of Myanmar is 54.05 million. It was 27.27 million in 1970. The general state of healthcare in Myanmar is poor. The military government of 1962-2011 spent anywhere from 0.5% to 3% of the country's GDP on healthcare. Healthcare in Myanmar is consistently ranked among the lowest in the world. In 2015, in congruence with a new democratic government, a series of healthcare reforms were enacted. In 2017, the reformed government spent 5.2% of GDP on healthcare expenditures. Health indicators have begun to improve as spending continues to increase. Patients continue to pay the majority of healthcare costs out of pocket. Although, out of pocket costs were reduced from 85% to 62% from 2014 to 2015. They continue to drop annually. The global average of healthcare costs paid out of pocket is 32%. Both public and private hospitals are understaffed due to a national shortage of doctors and nurses. Public hospitals lack many of the basic facilities and equipment. WHO consistently ranks Myanmar among the worst nations in healthcare.
A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index. Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.
Health in South Africa touches on various aspects of health including the infectious diseases, Nutrition, Mental Health and Maternal care.
The health status of Namibia has increased steadily since independence, and the government does have focus on health in the country and seeks to make health service upgrades. As a guidance to achieve this goal, the Institute for Health Metrics and Evaluation (IHME) and World Health Organization (WHO) recently published the report "Namibia: State of the Nation's Health: Findings from the Global Burden of Disease." The report backs the fact that Namibia has made steady progress in the last decades when it comes to general health and communicable diseases, but despite this progress, HIV/AIDS still is the major reason for low life expectancy in the country.
Malawi ranks 170th out of 174 in the World Health Organization lifespan tables; 88% of the population live on less than £2.40 per day; and 50% are below the poverty line.
Lesotho's Human development index value for 2018 was 0.518—which put the country in the low human development category—positioning it at 164 out of 189 countries and territories. Health care services in Lesotho are delivered primarily by the government and the Christian Health Association of Lesotho. Access to health services is difficult for many people, especially in rural areas. The country's health system is challenged by the relentless increase of the burden of disease brought about by AIDS, and a lack of expertise and human resources. Serious emergencies are often referred to neighbouring South Africa. The largest contribution to mortality in Lesotho are communicable diseases, maternal, perinatal and nutritional conditions.
The quality of health in Rwanda has historically been very low, both before and immediately after the 1994 genocide. In 1998, more than one in five children died before their fifth birthday, often from malaria. But in recent years Rwanda has seen improvement on a number of key health indicators. Between 2005 and 2013, life expectancy increased from 55.2 to 64.0, under-5 mortality decreased from 106.4 to 52.0 per 1,000 live births, and incidence of tuberculosis has dropped from 101 to 69 per 100,000 people. The country's progress in healthcare has been cited by the international media and charities. The Atlantic devoted an article to "Rwanda's Historic Health Recovery". Partners In Health described the health gains "among the most dramatic the world has seen in the last 50 years".
The United States Intelligence Community (IC) has a long history of producing assessments on infectious diseases. Most of these papers are distributed to government administrators and inform the choices of policymakers. Three of these assessments stand out as analytical products that have had important impact on the awareness, funding and treatment of infectious diseases around the world. The first paper is the National Intelligence Estimate on the Global Infectious Disease Threat, the second paper is the assessment on the Next Wave of HIV/AIDS, and the third paper was the assessment on SARS. This page summarizes the findings of these three papers and provides information about their impact.