Chapter 1 Context: It Shames Us & Diminishes Us All Amanuel, Matt, & Tim

Health Systems Org and Delivery User imposed fees (limits access to medical care) Lack of resources (physicians and nurses) and social workers as well as difficulty in retaining those in the country Lack of power by states to make decisions on health care issues without approval from the Bank and the Fund Local groups to provide care for the sick and the orphans (eg. HIV/AIDs+ women groups) Government hospital system

Financing Grants vs Loans ; interest and debt servicing Limit on number of nurses and doctors employed by the public sectors Limit on % of GNP that can be spent on social sectors including healthcare Cost sharing Sale of public sector corporations Lack of fulfillment of promises by donor countries (eg. 0.7% of GNP for ODA)

International Coordination UN (various sessions – Special Sessions) WTO talks (various rounds) G8; London Club; Paris Club World Bank Multi-country HIV/AIDs Program (MAP) for Africa The Blair Commission (health care + other development aspects) The MDGs especially ~ reduce child mortality; improve maternal health; combat HIV aids and other diseases; (international cooperation?)

Barriers Colonialism Irresponsible / Predatory lending Structural Adjustment Programs Conditionality Macroeconomic limits User fees Economic protocols

Responsibility International Financial Institutions World Bank International Monetary Fund Donor Nations Phantom Aid Technical Assistance Tied Aid Administrative Costs Dependence

Recommendations Relieve the Burden of Debt Relieve Interference from IMF Reliance on G8 Commitment Decrease Phantom Aid Portion [~60% of Total Aid] Technical Assistance Tied Aid Administrative Costs

State of Africa Ultimately, the fate of Africa is at the hands of the Africa with the needed support of the international community. Africa remains in a tangled web of International Debt Extreme Poverty Agendas of Individual Countries HIV/AIDS Crisis & Other Disease Prevalence Lack of Ability to Act Unrestrainedly

“…whose future is in the hands, at least in part, of those who have always pretended to care, and have never really cared…”

Discussion How should the international community support Africa?

Discussion What are some ideas for implementation of an African health care system? Who? How?

Discussion Is it fair to impose SAPS?

List of Acronyms GNP Gross National Product IFIS International Financial Institutions IMF International Monetary Fund MAP Multi-country HIV/AIDS Program MDGS Millennium Development Goals

List of Acronyms ODA Official Development Assistance SAPS Structural Adjustment Programs UNDP United Nations Development Program WEOG Western European and Others Group