HARVARD GAZETTE ARCHIVES

Luís Gomes Sambo, the World Health Organization's regional director for Africa, presents a broad overview of Africa's health status in his Nov. 14 lecture at the Medical School. (Staff photo Kris Snibbe/Harvard News Office)

The African region of the World Health Organization (WHO) is composed of 46 African countries, primarily in the sub-Saharan region. These countries are populated by 718 million people and their economies are among the poorest in the world.

In his lecture, Sambo provided a brief description of the African region, the critical health challenges facing the region, and the key priorities.

The disease burden on the region's people is onerous, making economic and political progress difficult. "AIDS, tuberculosis, and malaria are the three diseases responsible for most of the morbidity and mortality in the region," said Sambo. According to Jack Chow, WHO's special envoy of the director-general, who introduced Sambo's talk, these three diseases are responsible for 6 million deaths per year in Africa.

Within the WHO African region, about 25.5 million people are infected with HIV. Local and international intervention efforts have been successful within some localities, but on the whole, according to Sambo, "the prevention efforts have not been effective in many countries and the incidence is still increasing." In particular among the younger population and among females, the HIV/AIDS prevention information that has been made available "has not produced the expected results and we need to do more in terms of prevention of HIV/AIDS."

Looking at HIV prevalence trends among pregnant women, Sambo showed that the prevalence is increasing at dramatic rates among Southern African populations. The prevalence among Eastern and Western African countries is actually in the decline, while the central African regions remain stable. "We have some positive development in a limited number of countries," said Sambo, "we will concentrate our efforts to study and learn the lessons that could be beneficial to other countries where the prevalence of HIV/AIDS is still on the increase."

One preventive measure is the use of condoms; however, Sambo described condom use as "very low." While access to condoms has improved consistently in some parts of Africa, this has not been the case throughout the continent.

Sambo said that HIV/AIDS patients are overwhelming the health care systems in African countries. Most hospital beds in countries such as Zimbabwe, Botswana, and Swaziland are occupied with HIV/AIDS patients, he said. "In some cases, the beds are not enough. You find patients on the floor and under the beds."

Tuberculosis is a disease that has been treatable since about 1950, according to Sambo, but still kills about half a million people each year in Africa. One of the problems is that the treatment regimen is quite long and many patients do not complete their treatment. "The situation has degraded so much that the [African] ministers of health declared TB as an African emergency and are, together with other partners, seeking more resources to address the needs of tuberculosis programs," Sambo said.

Malaria is another scourge on the African continent, accounting for more than 90 percent of the world's malaria cases. Three-quarters of these cases are among children under 5 years old. The most effective measure against malaria is the use of insecticide-treated bedding, yet less than 5 percent of under-5 children have this bedding. Another problem is drug resistance. In most African countries, according to Sambo, the traditional anti-malaria drugs are no longer effective and countries require newer, more expensive drugs to combat the disease.

In addition to malaria, children face a host of diseases, Sambo said, discussing African childhood death rates. The region accounts for 43 percent of global under-5 deaths, with 4.4 million deaths each year, "the vast majority of which are due to preventable causes," he said. Routine vaccination for childhood illnesses is quite low, with some countries having vaccination rates as low as 15 percent.

The key priorities of WHO in Africa are "primarily to assist the member states in reforming their health sectors in the context of their own policies, strategies, and plans," said Sambo. Not surprisingly, the member states' main priorities are HIV/AIDS, tuberculosis, malaria, and maternal and child health.

Sambo described a process by which the WHO undertook a country-by-country analysis to assess the health situation of each state to devise, together with the government ministers of health, a five-year health strategy. During this time, WHO will provide support to countries to strengthen their health systems, particularly at the local level. WHO will also provide technical support, as well as fundraising and policy advice. Finally, WHO will coordinate global efforts for health.

"We must try and get governments to consider health as a basic human right," said Sambo. "To consider health issues in their agendas and translate these policies into action and reflect these priorities in their national budgets."

Sambo, a medical doctor from Angola, was appointed the regional director for Africa by the WHO executive board for a five-year term, beginning February 2005. He has held numerous assignments at WHO, including service as the director of program management at the Africa regional office, effectively the second in command for the region.

bob_brustman@harvard.edu

Related stories: