Volcanoes, Globalization and Health Systems: an African Perspective

Q: You are based in Ethiopia. With the current transportation crises following the eruption of the volcano in Iceland, how did you manage to get here?

A: I was lucky because I happened to spend some time in Antwerp, Belgium. So instead of flying here, we decided to drive and after leaving in the morning we managed to get here last night around 6pm. This morning I wound up taking the role of the chair [PL01: Globalization and Health Systems: Regional Innovations], instead of the discussant. This was not planned, but given the situation it was necessary to readjust our presentations and our roles. Many speakers could not make it, so those who can come need to adapt.

Q: This is a nice transition with the topic of our conference - the capacity to adapt. I suspect that this is what Ethiopia’s health system needs too, right?

A: Yes, you’re absolutely right, it is very important to be able to adapt. For health systems in the developing world it is a must to adapt to the context, taking into consideration finances, healthcare delivery and so on. For example, my country has had to adapt human resources given the HIV/AIDS pandemic and its consequences. Today there are 1 million people living with HIV out of a population of 80 million inhabitants.

It was in 2006 that Ethiopia decided to start a new approach, one of universal health care to address the HIV/AIDS pandemic; since then we have been able to provide 55% of the population in need of anti-retroviral treatments with such medication. When we started we were reaching just 3% [of the population infected with HIV/AIDS]. But, of course, such a response requires the capacity to adapt: adapt in terms of human resources and adapt in terms of the organisation of care. In the past, health services were limited to hospitals. However, only 15% of the country’s population lives in urban areas, the rest is in a rural setting where hospitals are in many cases not available at all. Given this situation, the country needed to adapt, building health centres in rural areas and decentralising health. In terms of strategies, the capacity to decentralise has been very important in order to be able to provide anti-viral treatment.

When we launched the new approach for universal access, human resources were a major challenge. In order to address this challenge, we set up a system of mentorship, in such a way that some of the responsibilities would be transferred from doctors to nurses. My country has been adapting, shifting some of the tasks.

Q: HIV/AIDS required health systems to adapt. Looking forward, what kinds of challenges are we likely to face in the next 5 to 10 years?

A: I see three main issues. For one, HIV/AIDS has evolved. It is today a chronic disease, with a cumulative number of patients. As a consequence, the burden on health systems is increasing: that is one important challenge, which will continue to grow. A second challenge is related to treatment failures in health systems, resulting from the use of specific drugs. In Ethiopia, we have been using first-line drugs, mostly because they are cheap and also because they are not toxic. So, while the number of patients is increasing, their retention is increasingly difficult. This is true for HIV patients as well as patients needing treatment for other chronic diseases. The third very important issue I see is related to HIV/AIDS second-line treatment that would be needed but is difficult to get for reasons of distance, cost, etc..

Q: You are here in an international conference to discuss global health challenges. How they can be addressed, both on the national and international levels. What would you like to see result from this Conference?

A: For global health leaders, I see three important issues in terms of global health and response. First, there is the question of national leadership and governance; being able to respond to the human resource crises, to address the financial crises, to increase the support provided to developing countries by the North but also within developing nations, by working on the human capacity building. In the Southern hemisphere, we are required to provide good governance, in a nutshell. Global issues should be development issues, solidarity issues, security issues, matters of human rights and democracy. In my view, the core and central issue is to see health as a basic human right. If we formulate things in these terms, it will be possible to address everything else. Health is a development issue. As such, it should be viewed in a global and local context.

Q: Speaking of these interrelations, what about questions such as brain drain of health professionals who are leaving their countries once they have been trained?

A: Well, this is a very important and complex issue indeed. As far as human resources are concerned, the answer is production training, deployment and retention. So, these three are very important and need to be looked at as a package - not independently. As we have seen both, internal and external brain drain, retention is important. It is about strategies of countries and their capacity to develop adapted such strategies, thus strategies that take into consideration a given local context. In my view, people would generally agree that home is the best place to live. For the most part, people will not leave their home country if they can meet their needs there. If they do, it is because the environment in which they are is not conducive. From the moment we consider health as a human right, adequate management, motivations and financial incentives ought to follow and with that, people do not need to leave but can stay in their country.