I started traveling to Africa on public health-related missions at the beginning of the 1980s. From the beginning, Africa caught my interest and my imagination. It is, after all, the continent where my father was born—when my Lebanese grandfather went to work providing food to miners in Transvaal. In 1981, I started going on public health missions to many countries worldwide. Going to Africa was particularly interesting to me, since it allowed me to go to places and see situations that no tourist normally sees.
From the beginning I realized that there are two Africas: one normally portrayed in the media, a land of poverty, disease and war; and the other, a vital, energetic continent of hardworking men and women, a continent of beautiful children and young men and young women, a continent of humor and a continent of hope.
Today six of the 10 fastest growing economies in the world are in Africa. However, despite progress important problems remain such as youth unemployment. It is estimated that 70 percent of the population in Sub-Saharan Africa is under the age of 30 and that 60 percent of the unemployed are also young people.
New policies should be developed to incorporate them into the labor force. To achieve that, it is important to provide them with the basic skills that would enable them to live up to their earning potential. UNESCO and the International Labor Organization (ILO) have recommended that governments, international donors and the private sector develop integrated policies to create jobs for young people and ease the transition from school to work.
The emigration of professionals and young people has had a deleterious effect on the economies of African countries. Dr. Lalla Ben Barka, from the U.N. Economic Commission for Africa (ECA) said, “In 25 years, Africa will be empty of brains.” Some facts support his assertion: since 1990, Africa has been losing 20,000 professionals annually; over 300,000 professionals reside outside Africa; there are more African scientists and engineers in the U.S. than in the entire African continent. According to the United Nations, “emigration of African professionals to the West is one of the greatest obstacles to Africa’s development.”
In the health area, although considerable progress has been made in the fight against HIV/AIDS (South Africa will become the first African country to fully manage its HIV care and treatment program in a few years), other challenges remain. It is estimated that more than two million children under five are HIV-positive, and there are more than 12 million AIDS orphans placing social services under enormous stress.
HIV/AIDS, however, is not the only concern. The recent Ebola epidemic underscored the shortage of doctors and the weakness of the health infrastructure in several of the affected countries. On the positive side, and thanks in great part to foreign aid to combat the epidemic, basic health services in several countries have considerably improved.
South Africa has the highest tuberculosis death rate per capita worldwide, followed by Zimbabwe and Mozambique. The situation is exacerbated by the high number of cases of multidrug-resistant tuberculosis in several countries. In addition, diarrheal and respiratory infections, malaria, measles, and malnutrition represent big threats to children’s health. Malaria is the leading cause of death among children under 5.
The continuing exodus of physicians and nurses to industrialized countries exacerbates health problems. The World Health Organization (WHO) estimates that 23,000 health care workers leave Africa annually. Malawi, a country of 15.38 million people, has a severe shortage of doctors and nurses. According to WHO, there is only one doctor for every 40,000 people in the country.
According to a 2011 study by the British Medical Journal, the lost investment of domestically-educated doctors migrating from Sub-Saharan countries to Australia, Canada, the United Kingdom, and the United States was close to $2.2 billion. According to WHO, of the 57 countries recognized to have critical shortages of health care workers, 36 are in Sub-Saharan Africa. In addition to doctors, however, a wide array of professionals and technicians has left their countries of origin.
Health problems in Africa cannot be considered in isolation. Foreign technical and financial assistance is needed. More efforts must be made to increase access to primary health care, especially in rural areas, accompanied by health promotion, disease prevention, and improved health education activities.
Effective aid must bypass corrupt governments and find ways of helping people directly. Aid to Africa should be aimed at strengthening civil society and community-based organizations. Religious organizations have proven to be extremely helpful in the fight against HIV/AIDS.
African governments need to provide education for all age levels, and they need better trade conditions for their products. They don’t need loans that end up in the pockets of those in power. They need financial assistance given in a carefully planned and responsible way.
César Chelala, M.D., Ph.D., is a global public health consultant for several U.N. and other international agencies. He has carried out health-related missions in 50 countries worldwide. He lives in New York and writes extensively on human rights and foreign policy issues, and is the recipient of awards from Overseas Press Club of America, ADEPA, and Chaski, and recently received the Cedar of Lebanon Gold Medal. He is also the author of several U.N. official publications on health issues.
