Sub-Saharan Africa is struggling with the world's greatest health problems today, with malaria, tuberculosis and HIV/AIDS the biggest challenges. Yet financial constraints, poor infrastructure and a lack of skilled health care workers make it the region least equipped to deal with them.
The World Bank says that by 2006 an estimated 24.5 million people in Africa were living with HIV – 64 percent of the world's total. The epidemic is reversing gains in life expectancy, hurting productivity and poverty-reduction efforts, and decimating workforces.
Africa accounts for more than one quarter of the world's TB cases, although it has only 11 percent of the globe's population. The disease claims more than 500,000 African lives each year, according to the World Health Organization (WHO). Malaria exacts an even greater toll, claiming 90 percent of the one million deaths per year from the disease and incapacitating millions more.
Although these are the most dramatic health threats, others abound. They include parasitic and respiratory illnesses, tropical diseases, annual meningitis epidemics and high rates of maternal mortality.
Brain drain
One significant obstacle to dealing with the challenges is the lack of skilled medical personnel. On average, there is only one nurse available per 1,000 people in Africa, according to the British charity, Oxfam. In some countries the ratio is worse. Malawi, for example, only has one nurse for every 3,500 people. This compares with a ratio of one to 102 in Germany.
And although Africa is training health care workers, too many are leaving the continent for better paying jobs in the West.
Ted Alemayhu, founder and CEO of U.S. Doctors for Africa, a non-profit organization that sends physicians and nurses to the continent, says Africa is losing crucial assets to other parts of the world.
"How much does a particular doctor make in Zambia? His friend who emigrated to the United Kingdom or the [United] States makes potentially 100 times more. The problem is becoming not only Africa's – it's becoming the world's problem.
"While… people are dying by the millions, developed nations are pouring billions into the continent to figure things out and to find a sustainable solution."
Eroding productivity
Not only are large amounts having to be spent on fighting illness, the diseases and their human toll also hit productivity. The WHO says malaria alone causes an average loss of 1.3 percent annual economic growth in the worst-affected countries.
AIDS strikes individuals in their most productive years from ages 15 to 49, trapping them in a downward spiral of poverty. They often cannot afford treatment, have limited access to healthcare and miss work. Once they die, older family members are often forced to give up work to stay home to care for children left orphaned.
The International Labor Organization (ILO) estimates that by 2010, Aids will reduce the labor force in 35 of sub-Saharan Africa's countries by nine percent. As a result, the average worker will be younger and less educated.
In the private sector, at the same time as the number of consumers is dwindling, Aids is pushing up labor costs. Companies face rising fees for health insurance, sick leave and funeral benefits, according to the Global Business Coalition on HIV/Aids, TB and Malaria (GBC). They also have to bear the costs of recruiting and training new staff.
Creating partnerships
The impact of HIV/Aids alone has forced companies to come to terms with Africa's health challenges.
Businesses, especially large multinationals, have been addressing health care for employees more directly than in the past. And groupings such as the GBC, the World Economic Forum (WEF) and the Corporate Council for Africa (CCA) – which organizes U.S. companies in Africa – are involving the private sector in Africa's health care struggle.
The World Bank and the CCA support business coalitions across the continent in supporting HIV/Aids prevention, care and treatment. There are currently 28 such coalitions across the continent and a pan-African coalition based in South Africa. The composition of the coalitions varies from country to country and most of the older, stronger ones are in southern Africa.
Victor Barnes, director of the HIV/Aids initiative of CCA, says pressure from the public sector and the "recognition that these… partnerships are a win-win for everybody" have helped the private sector become more engaged.
He adds: "Part of it is the simple fact that when you start to talk about access to treatment and the kind of infrastructure required to deliver services beyond the urban center, the private sector has a real edge in its capacity to use its supply chain and some of its other organization capacity to help the public sector to actually deliver those goods and to do that in conjunction with civil society, with NGOs and CVOs [citizen volunteer organizations]."
The Roll Back Malaria partnership involves partners from around the world in fighting the disease. RBM was launched in 1998 by the World Health Organization, the United Nations Children's Fund (Unicef), the UN Development Program (UNDP) and the World Bank. It is now made up of a wider range of partners, including malaria-endemic countries and the private sector.
"Ten years ago and five years ago it was difficult to see concrete things," said Awa Marie Coll-Seck, executive director of RBM. "But today we can say that when you go to countries you are really happy. Partners are working together supporting countries and countries are really in the driver's seat."
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Creative solutions
Other efforts to support African health include the establishment of health clinic franchises that adhere to a particular standard. Medical clinics in Kenya established by the non-profit HealthStore Foundation, for example, are owned and operated by nurse practitioners, and drug outlets are run by medical practitioners. The foundation has opened 25 clinics in Kenya so far.
In addition, momentum is building to provide health insurance to more Africans.
The Dutch non-profit, PharmAccess, has introduced a scheme that it says builds solidarity while enabling Africans to get the healthcare they need.
The insurance schemes rely on risk pooling, donor support, co-payments and use of local private infrastructure to help extend coverage to the poorest of the poor.
Despite the range of efforts now being made to support the continent's beleaguered health sector, analysts say there is always room for new ideas.
"I don't think anybody has really figured out what the silver bullet of all this is," said Elizabeth Ashbourne, a senior operations officer with the World Bank who has specialized in establishing public-private sector partnerships on HIV/Aids.
"There's room in this challenge for anybody who's creative and dedicated and in it for the long term."
