The Health Sector Gap in the Southern Africa Crisis in 2002/2003

Abstract

The southern Africa crisis represents the first widespread emergency in a region with a mature HIV/AIDS epidemic. It provides a steep learning curve for the international humanitarian system in understanding and responding to the complex interactions between the epidemic and the causes and the effects of this crisis. It also provoked much debate about the severity and causes of this emergency, and the appropriateness of the response by the humanitarian community. The authors argue that the over-emphasis on food aid delivery occurred at the expense of other public health interventions, particularly preventative and curative health services. Health service needs were not sufficiently addressed despite the early recognition that ill-health related to HIV/AIDS was a major vulnerability factor. This neglect occurred because analytical frameworks were too narrowly focused on food security, and large-scale support to health service delivery was seen as a long-term developmental issue that could not easily be dealt with by short-term humanitarian action. Furthermore, there were insufficient countrywide data on acute malnutrition, mortality rates and performance of the public health system to make better-balanced evidence-based decisions. In this crisis, humanitarian organisations providing health services could not assume their traditional roles of short-term assistance in a limited geographical area until the governing authorities resume their responsibilities. However, relegating health service delivery as a long-term developmental issue is not acceptable. Improved multisectoral analytical frameworks that include a multidisciplinary team are needed to ensure all aspects of public health are dealt with in similar future emergencies. Humanitarian organisations must advocate for improved delivery and access to health services in this region. They can target limited geographical areas with high mortality and acute malnutrition rates to deliver their services. Finally, to address the underlying problem of the health sector gap, a long-term strategy to ensure improved and sustainable health sector performance can only be accomplished with truly adequate resources. This will require renewed efforts on part of governments, donors and the international community. Public health interventions, complementing those addressing food insecurity, were and are still needed to reduce the impact of the crisis, and to allow people to re-establish their livelihoods. These will increase the population's resilience to prevent or mitigate future disasters.

Ethnobotany and Biocultural Diversities in the Balkans

“…Later, the affected populations started to gather local medicinal plants and prepare phyto-pharmaceuticals (Redžić 1999b). Similar behavior has been observed during other unfavorable conditions, such as droughts, famines, and world wars (Goto et al 1958;Smith Fawzi et al 1997;Toole and Waldman 1997;Huxley et al 2000;Griekspoor et al 2004). Conversely, human populations have chosen death from starvation over consuming wild natural sources of nutrition due to traditional food prejudices (Vračarić et al 1966;Bakić and Skare-Krvarić 1967;Bakota 1967;Vračarić et al 1967;Redžić 1993).…”

The Cost of War on Public Health: An Exploratory Method for Understanding the Impact of Conflict on Public Health in Sri Lanka

“…The poorer than expected performance in the remaining districts adds support to the idea that the indirect impact of conflict is as great if not greater than the direct costs as none of these districts were the epicenter of the war [3, 5–8]. …”

“…Such deaths occur in combatant and civilian populations alike as crude death rates, maternal mortality rates, and infant mortality increase during war and in the post-conflict period rise [2, 6, 10–12]. The destruction caused by war creates prolonged instability, and brings high direct- and opportunity-costs that impact household and national development [3, 5, 6, 8, 13–16]. In the best cases, a development trajectory slows but may recover; in the worst cases, intractable poverty and a conflict spiral result.…”

“Living from Day to Day”: Food Insecurity, Complexity, and Coping in Mutare, Zimbabwe

“…The maize was U.S.-produced genetically-modified maize, however, and this in turn precipitated a bitter local debate about health and the environmental dangers of GMO, the promotion of GMO crops in Africa (Clapp 2005;Mwale 2006;Zerbe 2004), and global power relations. Severe food shortages, after a second drought the following year (2002)(2003), provoked further policy debate, this time particularly about the interactions between the food crisis and HIV, the conflicting demands for international and local NGOs in diverting resources to or from health services to food aid, and the lack of strategies to support the re-establishment of livelihoods for the people hardest hit (Griekspoor et al 2004).…”