Inter Press Service - June 1, 2001
Antoine Lawson
LIBREVILLE, Jun 1 (IPS) - Health experts blame unequal medical care and poor public health services for the latest outbreak of infectious diseases in Gabon. The high cost of medical care and increasing poverty, mostly among the country's most disadvantaged, has given way to an outbreak of numerous diseases successfully eradicated in other African countries, they say.
Malaria, tuberculosis, polio, leprosy, and other such diseases are taking a high toll on this central African country.
"The ineffectiveness of the health system is mainly the result of political choices and strategies," says Benoit Makana, head of epidemiological services at the health ministry.
Makana sees "bloating" in the health care system. "Sometimes in one area there will be two programmes for the same issue, while in another region certain issues will go completely unaddressed," he says.
Making matters worse, he adds, "Generally, only the most expensive specialty pharmaceuticals have been imported."
The government, however, has just signed an agreement with drug companies to import commonly used medications. With help from donor agencies, it is also trying to improve coordination within the health system.
"During our most recent mass vaccination campaigns against polio, we've noted progress in our ability to mobilize the public," says Francis Ozouaki, assistant director at the Josephine Bongo Maternity Hospital. "Nevertheless, polio continues to ravage Gabon."
In a bid to improve primary health care, the government also is funding the International Center for Medical Research in Franceville (CIRMF) to study sexually transmitted diseases and resistance to antimalarial drugs.
The fight against malaria, which remains Africa's most deadly disease, is a priority. The Ministry of Health and Population has announced its goal to halve malaria-related deaths by the year 2010 and to reduce the toll by another 30 percent by 2015 and 20 percent by 2020.
Worldwide, malaria kills between two million and three million people every year. "Of 487,688 people examined in 2000, 79,401 had malaria, or 16.28 percent. An infection rate such as this with Gabon's most deadly disease, among all age groups, is of great concern to us," Ozouaki says.
The tsetse fly, which carries sleeping sickness, or trypanosomiasis, continues to breed in villages and towns near lakes and in areas where people earn a living mainly from logging.
Sleeping sickness affects the nervous system and has become endemic in central Gabon's Lambarene region, where authorities counted 286 cases of the ailment in 1998 and 418 in 2000 among a rural population of 23,590 living principally from logging.
With no medical care, sleeping sickness is fatal and presently affects 500,000 people in sub- Saharan Africa, according to the World Health Organization (WHO). Approximately 60 million people in 36 countries are exposed to the disease, the agency says.
The government recently opened four new health centres specialising in tuberculosis treatment in a bid to comply with WHO guidelines, which call for at least one health centre for every 100,000 people.
Nevertheless, UN officials say they fear that the number of cases of tuberculosis will double in the next ten years, mainly because of an increase in the number of AIDS cases and insufficient funding for the fight against tuberculosis.
According to the health ministry, Gabon's hospitals treat 3,500 tuberculosis cases each year. According to WHO, the disease kills more women than all other infectious diseases combined. In Africa, more than 40 percent of AIDS patients die of tuberculosis.
AIDS is ravaging several African countries, and Gabon is no exception. The most recent estimates, issued in April, are that 6 percent of the sexually active population is HIV-positive, a jump from 2.2 percent in 1989. In Libreville alone, the numbers are even higher: 7.8 percent, according to the government.
The number of serious cases of malnutrition seen in health clinics is on the rise, adding to officials' concern about the spread of disease. Nationwide, 10 percent of children under the age of five are malnourished. Some 50 out of every 1,000 babies die before reaching the age of one and low birth weight is a contributing factor.
In addition, the UN Children's Fund says that basic health expenses have risen steadily. They jumped from 9.481 billion CFA francs in 1990 to 16.228 billion CFA francs in 1995. They again jumped from 19.244 billion CFA francs in 1997 to almost 40 billion CFA francs in 2000.
One US dollar is worth approximately 700 CFA francs.
Privately, national officials and donors complain that not all money allocated to control public health risks is used as intended, implying that waste and corruption remain problems in this resource-rich country of 1.2 million people. (END/AF/HE/tra- sz/al/aa/01)
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