Friday, April 7th, 2017
Programs and Development
Every year, the World Health Organization sets aside April 7th for World Health Day, giving us a moment to advance the conversation about health and well-being. As individuals we often talk about how to stay healthy and what to do when we are not healthy. Of course, often without considering it, our assumptions are rooted within the context of a strong health system. That’s why in global and public health circles–and especially here at Partners In Health–we hear a lot about health system strengthening.
Being in a state of good health doesn’t stop with the well-being of our physical bodies. When I visit my GP, I take a lot of comfort in the knowledge that there is a complex system behind that doctor which can be activated at any moment for any problem. Sadly, the same cannot be said for many other countries in the world.
In West Africa, Liberia has a health system that walks a tightrope from ‘weak’ to ‘non-existent’. The protracted war in the country decimated most of the infrastructure that existed; hospitals, clinics, pharmacies, as well as the governance structures that run them. Thankfully, the 2003 Accra Comprehensive Peace Agreement marked the end of the war … but what remained of the health system was complete and utter decay. Only eighteen percent of health facilities in the country were considered to have basic functions and the country was left with about 30 doctors to serve a population of about three million – that’s one doctor for every 100 000 people. By 2014, the number of doctors in the country had increased only slightly to a total of 51, bringing the ratio up to one doctor for every 84,000 people. To put that in perspective, it would be like living in Victoria, British Columbia with access to only one doctor for the entire city. Making matters worse, two years ago Ebola struck Liberia. It took a herculean effort by the already-weak Liberian health system in order to arrive at the point to be declared officially “Ebola free”.
Haiti is another good example of a country in need of a stronger health system. During a trip in February, I visited a health centre a few hours north of Port-au-Prince, Haiti’s capital, and the medical director, took me on a tour of the facilities. We entered the front and she pointed to a corner, where there were a few pieces of plywood partitioned off from a waiting room with an office chair in the middle, and told me that it was the emergency department. There was no sign of an on-duty nurse, no cardiac monitor, no equipment to take vital signs – not even a stethoscope. “What would happen if I broke my leg?” I asked. The medical director told me that the most likely scenario is that I would be transferred to a hospital three hours away, but not by ambulance – because there isn’t one – and without any materials or medication to help me in the interim.
We continued to the maternity ward which, by contrast, seemed shiny and brand new. The delivery room was fully stocked, the birthing beds were rust-free, and lo and behold, I even saw a fetal monitor to monitor the fetus’ heartbeat before delivery – all of which had been purchased with money contributed by a donor a couple years ago. But those funds were only made available for materials. I remember getting the feeling that I was in a museum because there were a few usual suspects that seemed to be missing – namely doctors, nurses, and pregnant women. The health centre, while fully stocked in the maternity ward, didn’t have any staff because there was no money to pay anyone.
These two examples are not isolated. In fact, they are the norm in many countries around the world, and they demonstrate the very real outcome of grinding poverty and economic exclusion. We are told that when we are sick, or in pain, that the responsible thing to do is to go to the doctor. But what if there is no doctor? And if there is, what if there's no medication, or splinting materials, or diagnostic equipment? Good health requires a system that has the staff, stuff, space, and systems necessary to truly heal people who are sick and injured – which is why it’s so important that we keep on talking about good health not only as physical state, but as a system and a matter of justice.
Partners In Health Canada