1. AFRICA CAN SOLVE ITS OWN HEALTH PROBLEMS? SARALA NAICKER Division of Nephrology University of Witwatersrand Johannesburg, South Africa

3. FACTS second largest continent- over 30 million square kilometres 53 countries > 760 million population Population growth 2.3% World Bank Report, 2002

4. life expectancy at birth: 47 years infant mortality: 91/ 1000 live births maternal mortality: 175-200/ 100 000 live births HIV/AIDS: 28.5 million persons infected > 18 million deaths

5. ECONOMIC DATA SubSaharan Africa: < $1 per day 291 million North Africa: < $2 per day 30% of population

6. Annual healthcare expenditure Uganda: US$ 9 per person Tanzania: US$ 3.2 per person Mozambique: US$ 2.0 per person UK: US$ 1780 per person

7. South Africa: Expenditure Health care: R33.2 billion $100per capita per year 3% of GDP Crime/ violence: 6% of GDP

8. DOUBLE BURDEN OF DISEASE Botswana: HIV/AIDS 333000 39% of population 15-49 yrs Non-communicable disease: increase in cancer DM HPT

9. Physicians/ 100,000 Population Niger3.5 Benin5.7 Ghana6.2 Cameroon7.4 Togo7.6 Ivory Coast9.0 Nigeria18.5 USA279 Rockeller Foundation, 2003

10. BRAIN DRAIN FROM AFRICA Ghana: 60% medical emigration Zambia: 50/600 graduates in public sector South Africa: 30-50% emigration annually Zimbabwe: 360/1200 still practising in 2001 Sudan: 17% emigration in 1985-1990

11. NURSING BRAIN DRAIN Ghana: 2000 in one year Zimbabwe: 18000 nurses abroad South Africa: nurses with greatest expertise

12. Cost of medical emigration Each professional: loss of $184000; cost of training a doctor in UK £ 200-250,000 South Africa (1997): loss of R67.8 million ($10 million)

13. Can Africa solve its own health problems?

14. The first step…….

15. NEPAD Primary responsibility for success rests on governments and people of Africa

16. Governmental agreements Education and training in Africa in African institutions Trainee returns home after training period- no brain drain to South Africa

17. ISN Fellowship Training according to needs of home institution Trainee returns to render service to home country

18. PREVENTION PROGRAMMES Botswana: non-communicable disease surveillance, prevention and control Egypt: Schistosomiasis eradication South Africa: smoking, HBV vaccination, CKD prevention programmes Uganda: HIV/AIDS

19. INTERNATIONAL PARTNERSHIPS Government ministries of health International agencies –ISN –WHO –Other Academic centers Foundations Pharmateutical companies

20. INTERNATIONAL PARTNERSHIPS Build capacity Job creation Alleviation of poverty Education and appropriate training of healthcare workers eg. in prevention Public education/ health promotion