Medical Practice and Reviews Vol. 1(1), pp. 9-11, April 2010 Available online at http://www.academicjournals.

org/mpr 2010 Academic Journals

Short Communication

Healthcare problems in developing countries

Ibekwe Perpetus Chudi
Department of Obstetrics and Gynaecology, Ebonyi State University Teaching Hospital, Abakaliki, Nigeria. E-mail: drogoperps@yahoo.com.
Accepted 8 February, 2010

Developmental and reproductive health indicators in developing countries are still deplorable, and adverse health consequences have been linked to poor socio - economic growth and development. Healthcare problems in developing countries are multifaceted and result from a combination of factors, socio - cultural, economic, political as well as poor planning and/or poor implementation of health policies and programmes. Also, there is the problem of availability, accessibility, affordability, sustainability of services and weak referral systems. These problems are reviewed and practical suggestions made on the way forward. Key words: Healthcare problems, solutions, developing countries. INTRODUCTION Developmental and reproductive health indicators in developing countries are still typical of a sub - Saharan Africa where mass poverty, illiteracy, ignorance, disease, low status of women, unrestricted sexual behaviour resulting in high population growth rate, harmful traditional practices and poor social amenities all combine to nurture reproductive ill health and developmental backwardness .Africa accounts for 25% of the worlds landmass but more than 70% of the approximately 50 poorest countries of the world are in sub - Saharan Africa (Harrison, 1997). Also, whereas Africa harbours about 12% of the worlds population, it is able to secure only 1% of worlds trade and 0.4% of its manufacturing export (Harrison 1997). More than 75% of populations in sub Saharan Africa live below the internationally defined poverty line of US D 2 per day (The World Bank, World Development Indicators, 2005). In Nigeria, 90% of the population live on US D2 per day and 60 - 70% on less than US D 1 per day (Population reference Bureau. nd 2007). Currently, Nigeria ranks 152 out of the 175 nations on the human development index (Federal Ministry of Health (FMOH, 2002; Adepoju, 2005). Adverse health consequences have been linked to poor socio - economic growth and development; it is therefore not surprising that these poor developmental indicators are impacting negatively on health. In developing countries, the average life expectancy is 40 years, with the lowest in Botswana, Lesotho and Swaziland (35 years); Nigeria has a life expectancy of 44 years (compare this with life expectancy of 82 in Japan and 80 in Switzerland) (Population Reference Bureau, 2007). People living in Sub-Saharan Africa have the least access to an improved water source that could supply safe drinking water, as only 45% of people in rural areas have access to improved drinking water source (UNICEF, 2005). The most important component of health related to population and socio-economic development is reproductive health. The reproductive health indices in developing countries are deplorable. Maternal mortality rate is highest in the African region, estimated at an average of 1000 deaths per 100,000 live births (World Health Organization (WHO), 2004). The declaration of Safe Motherhood Initiative (SMI) in Nigeria in September, 1990 marked a milestone in the advancement of maternal health. This initiative was applauded and embraced by many countries including Nigeria, ostensibly because of the potential developmental benefits that will accrue to several nations following the reduction in maternal mortality that is expected to follow the initiative. Paradoxically, eighteen years after this initiative, some countries in sub-Saharan Africa and in particular Nigeria has made little progress in the attainment of the goals of SMI. Nigeria still has one of the poorest maternal and child health indices in the world, maternal mortality ratio ranging between 800 - 3000 per 100,000 live births, life time risk of dying from pregnancy related complications of 1:8 (compared to 1:10,000 in developing countries), contraceptive prevalence rate of 8%, total fertility rate of 5.9, infant mortality rate of 100 per 1000 (Population reference Bureau, 2007; National demographic and Health Survey (NDHS), 2003; Society of Gynaecology

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and Obstetrics of Nigeria (SOGON), 2005). Undoubtedly, these poor reproductive health indices affect the economy of the nation, the growth of which has remained stunted over several years. Healthcare problems in developing countries are multifaceted and result from a combination of factors. Socio - cultural, economic, political factors as well as poor planning and/or poor implementation of health policies and programmes. On the part of the end users, there is also the problem of availability, accessibility, affordability and sustainability of services. Availability of healthcare facilities is an important problem as there is gross deficiency in the distribution of health facilities. Under normal circumstance, there should, at least, be a primary health centre within a five kilometre radius. It is from this point that most patients are seen and appropriate referrals made. In a national study on essential obstetric care facilities in Nigeria by the Federal Ministry of Health, only 13.9% of the estimated annual births take place in health facilities. (Federal Ministry of Health [FMOH], 2003). Where the health facility is available, accessibility becomes the problem. This contributes to significant delays in accessing health care. In most countries, roads are inaccessible and transportation system is chaotic. Thus, when a person takes a decision to seek medical attention, it may take days to reach health care facility. Sometimes, pictures have been painted where patients are brought to the hospital on wheel barrows, bicycles, on donkeys or physically carried on stretchers. When eventually, the person arrives hospital, affordability of the available services becomes the issue. Recognising that the majority of the populace live below poverty line, especially in rural areas, it becomes easy to appreciate why most of our people can not avail themselves of the available healthcare facilities. However, with the emergence of the National health Insurance Scheme (NHIS), there may be a solution in sight. Nevertheless it should be noted that the NHIS did not target the rural populace where 66% of the population in sub - Sahara Africa live (Population Reference Bureau, 2007) and who actually needed these facilities most. For those who can afford the cost of medical attention, it may become obvious that there is gross inadequacy of human and material resources for full medicare. In the same National study on essential obstetric care (EOC) facilities in Nigeria, it was shown that only 4.2% of public health facilities met the EOC standard. (Federal Ministry of Health, 2003). Another major problem within the healthcare system in the developing countries is the weak referral systems from a lower to a higher health facility in the hierarchy. This leads to delays in commencing medical treatment and often leads to preventable deaths. The developing world bears 90% of the disease burden, but allocates less than 10% of its annual budget to healthcare. This misplaced priority is disastrous and places these countries in a vicious cycle ill health,

disease, poverty and backwardness. Perhaps, a great deal of the underlying causes of disease, injury and death in developing countries lie beyond the preview of the healthcare system. They cover a range of physical factors (inadequate sanitation, water, drainage, waste disposal, housing and household energy) and behavioural factors (personal hygiene, sexual behaviour, driving habits, alcoholism and tobacco smoking). Many of these environmental and occupation related health problems turn into public health problems when they become widespread, a factor aggravated by inadequate public health infrastructure. Yet, policies in these sectors especially for these negative impacts are often not based on health criteria. The health sector itself tends to focus its interventions within the health - care delivery system, not necessarily in other sectors that are the sources of the problem. Similarly, naturally occurring ecological factors that can exert negative impacts on all sectors (mosquito - borne diseases, floods, droughts etc) are seldom addressed systematically by any of the sector at risk, even though some sector may be exacerbating their effects. As a result, the enormous health benefits possible through interventions outside the health sector are not being realised. The medical profession has a great challenge in tackling these health related problems in developing countries. The first task is the reversal of the brain drain syndrome that is currently taking its toll, not only in the health sector but also in other vital areas of the national life of developing countries. It is ironical that such developing countries that should be manpower recipients are rather manpower donors. This has led to the depletion of the available human resources, especially of the highly skilled medical professionals. To worsen matters, some of the available health professionals are aversive to working in public health facilities and rather run private medical practices. Such private hospitals are usually very expensive and beyond the reach of the average person. In some cases, the system makes it difficult and frustrating for health professionals to function effectively and efficiently. Lack of facilities and equipment to work with are issues to contend with. It is frustrating but not uncommon that a radiologist could be employed in a facility without functioning x - ray machine or ultrasound, or a neurosurgeon could be working in a facility without computerised tomography scans. Health systems should be strengthened with both human and material resources to make them functioning and functional. Indeed, the availability of skilled health providers (particularly midwives, nurses, doctors and obstetricians) is critical in assuring high quality health care delivery. Indeed, the MDG 4 and 5 for child and maternal health are unlikely to be achieved without attention to the recruitment and retention of health professionals. Their services should be made accessible, available, acceptable, affordable and user friendly, and should be equitably distributed in both rural and urban communities. Incentives should be

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given to skilled personnel to attract them to rural areas where their services are mostly needed. Again, weak referral systems contribute to delays in accessing health facilities for prompt and appropriate care. There must be an effective and efficient referral system linking all levels of healthcare. Such a system must include feedback to the original referral point or health profession in order to foster an ethos of reflective practice and for strengthening continuity and quality of care. Procurement and installation of appropriate communication equipment including mobile phones, two way radios and emergency means of transportation including ambulance services will aid prompt referral. Also, fostering community participation in strengthening the referral system is essential for bridging the gap between facilities and communities. Concomitant with the provision of functioning and functional health systems and strong referral mechanism is the creation of enabling environment for the public to avail themselves of the services. For instance, there is need to improve the poor infrastructural facilities such as rural road network and transportation as well as safe water and sanitation services. Pervading poverty, particularly among women, impact adversely on affordability of services. Therefore, there is great need to improve the socio - economic status of women. Negative socio-cultural barriers and harmful traditional practices that are inimical to health should be abolished through advocacy and legislation. Further, individuals, the households and the communities have an important role to play in improving the healthcare system. Using approaches and mechanisms, such as behaviour change communication (BCC), communities can be empowered to define, demand and access quality skilled care through mobilization of community resources. Active participation of the community enhances selfreliance, ownership and sustainability of key actions. Conclusion In conclusion, the healthcare problems in developing countries result from a combination of factors. There is therefore an urgent need for a concerted effort on the part of individuals, communities, governments and partners interested in the provision of qualitative healthcare in

developing nations, towards putting in place workable structures at the healthcare facilities to alleviate these problems. In the short term, provision of health services that are adequate, accessible, available, affordable and user friendly, and development of transportation, and availability of adequate healthcare infrastructural facilities such as good roads, water and providers as well as equipment/structures to take care of emergency obstetrics, are areas that need emphasis and urgent attention. In the long term, it is the combination of education, improved socioeconomic standard of the people, women empowerment and education of women, career opportunities and full access to reproductive health information and services that will have the target impact on health. In addition, developed countries should provide necessary technological and financial assistance to the developing countries, conduct more research on public health problems of developing countries and improve their public health service capacity.
REFERENCES Adepoju A (2005). The impact of structural adjustment on the population of Africa: the implications for education, health and empowerment. United Nations Population Fund (UNFPA), New York 1993. Communique from the 38th Annual Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) (2005), High Rate of Maternal Deaths in Nigeria is a cause for Alarm. Makurdi, Benue State, Nigeria. Trop. J. Obstet. Gynaecol. 22(1): 100. Federal Ministry of Health (2002). Population and the quality of life in Nigeria. Resources for awareness of population in development (RAPID). Federal Ministry of Health (FMOH) (2003). National study on Essential Obstetric Care facilities in Nigeria, FMOH. Abuja, Nigeria. Harrison KA (1997) Maternal Mortality in Nigeria. The real issues. Afr. J. Reprod. Health 1: 7-13. National demographic and Health Survey (NDHS) (2003). Federal Ministry of Health, Abuja, Nigeria. The World Bank (2005). World Development Indicators. Population reference Bureau (2007). World Population Datasheet. www. prb.org. UNICEF (2005). End-decade Databases. World Health Organization (2004). Lifetime Risk of Maternal Deaths. Geneva.