It is common knowledge that dry weather and erratic rainfall over the past two years have led to a severe decline in production. In some countries, this is compounded by economic crisis, instability and population displacement, resulting in widespread food shortages. The underlying high prevalence of HIV infection, and AIDS, has resulted in reduced production in household units and affected communities, and reduced numbers of health workers, teachers, etc. In Lesotho it is estimated that the prevalence of HIV/AIDS is 31%, in Mozambique 13%, in Swaziland 33.4%, in Zambia 21.5%, in Zimbabwe 33.7% and in Malawi it is 15% (UNAIDS 2002).
Of special concern to WHO, is the fact that the governments of the region have to provide crucial services on very small budgets (for example, in Mozambique and Malawi the health expenditure is respectively US$ 8 and 10 per person per year World Bank, most recent data referring to the period 1990-98); as a result severe shortages of essential medicines and other supplies in health centres are frequent. On a more specific note, low salaries and difficult conditions for health workers have resulted in a "skills drain," that the current hardships risk to accelerate.
This is not the first crisis of this sort in Southern Africa. In 1992-93, drought and complex emergencies in Mozambique and Angola combined together to call for a major humanitarian efforts. In that occasion, WHO learnt at least three major lessons:
i. drought and food shortages are public health affairs, at least as much as matters of production and distribution of food. In a severe and protracted crisis, the entire society and its structures are hit, including the health systems. Just to give few examples, in that same period hospital admissions doubled, governments had to curtail the import of essential drugs, health workers left their jobs and the sub-region suffered severe cholera and dysentery epidemics;
ii. in order to survive, people rely on very fragile coping systems - they sell vital assets, migrate, etc; once the crisis is over, their vulnerability will be more severe than it was before, and recovery will have to start from "less than Zero";
iii. Non-food aid is slow at the beginning of a food crisis, but increases as the emergency unfolds and its effects on health -i.e. starvation and growing mortality- are documented. External support targets life-saving interventions, but funds can also help the sector recovery. It is important, therefore, that aid is used for redressing the sector flaws and not for recreating past vulnerabilities. Thus, while providing life-saving services and preparing for rehabilitation, the health sector also needs to start rethinking itself: the sooner, the better;
WHO's strategic view and approach :
1. Countries must be enabled to mount appropriate responses to the nutritional and health crisis, at all levels: this goes from tackling prevailing causes of morbidity among children and women, to stemming the skill drain and handling public concerns, e.g. about the health consequences of consuming GM crops
2. Up to date information must circulate regularly and widely: on health (mortality, morbidity -in particular communicable diseases- and malnutrition) and access to essential health services among different communities.
3. The responses to the health aspects of the crisis must be effectively coordinated, and this implies optimising the comparative advantages of all partners, using evidence-based strategies and seeking maximum service coverage within available resources
4. Health systems must reach those in need as close as possible to their actual residence with adequate supplies of medicines and appropriate foods for nutritional rehabilitation, so to minimise the risks associated to people's displacement and concentration. The capacity to respond to specific health problems - including disease outbreaks - must be put in place as close as possible to where it is actually needed.
Thus, WHO is
- reprogramming national plans of action so as to enable national authorities to respond to immediate needs
- increasing its in-country support to national efforts on epidemiology, surveillance, disease control, nutritional capacity, health systems performance
- strengthening its presence at sub-regional level , so to increase the regional support to country and local responses
- contributing to wider UN system co-ordination ( e.g. through Johannesburg Office)
- working for stronger and effective alliances with NGOs