Chapter 1Context: It Shames Us & Diminishes Us AllAmanuel, 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