My attention has been drawn to a recent FrontPage Africa publication of August 26 2017 titled: “43,000 People Infected with HIV AIDS in Liberia”.
Few weeks prior, I began working on a proposed National Health Agenda that I’ve tentatively called: “Triple R” the antidote to Liberia’s daunting Healthcare quagmire.
“Triple R” is the acronym for (Recognize, Rescue and Reinvent). The Hope is to have realistic, achievable, and cost effective national health goals.
This is in no way a disregard for herculean tasks being performed by our health workers and international partners under the most impossible conditions, and the great policies on the books; the intent as imperfect as it maybe because I am not omniscient, is to bring fresh ideas, redirect priorities, and hopefully usher in an optimum and sustainable personal, community and National Health blueprint.
This piece however, is a direct opinion/analysis of the FPA publication mentioned which was extracted from Liberia National AIDS commission report. While there are global gains over the years including an ambitious UNAIDS 2030 cure/eradication benchmark, our nation from all indications is losing the fight against HIV/AIDS (HERE).
The numbers are alarming and worrisome. According to the National AIDS Commission, there is an “increase in the number of persons living with HIV in Liberia from about 33,000 persons to 43,200 persons.”
With the availability of antiretroviral drugs/therapy, the report also suggests that though 2,000 pregnant women need the drugs annually, only 1,382 or 69.1% are served. These drugs prevent mother to child transmission, this is a silver bullet to prevent a potential national HIV infant registry which will put a burden on our already “meager” resources.
What is/are the barrier(s) keeping 30.1% from getting life-saving medications? Is it cost, Refusal, or availability? Recommendation: Every Pregnant woman must be tested, and positive finds must be tracked and offered free counseling and anti retroviral medication.
In Public Health, accurate data collection is as important as its multidimensional interpretation. According to the report the data suggests a downward spiral since 2007: “from 5.4% in 2007, to 4.0% in 2008, 2.6% in 2011, and 2.5% in 2013.” These numbers if accurate imply progress.
But from the percentage being served, the problem is being transferred; and a potential infant HIV crisis looms! This crisis can be averted if we tackle the source, i.e. making sure every pregnant woman gives birth to a healthy baby by preventing neonatal transmission. Prevention is the best health practice.
Furthermore, it is important to stress the need for personal and collective responsibilities when it comes to health. The greatest public health concern that could potentially annihilate mankind is airborne because it would spread at a supersonic speed, and we don’t have adequate prevention mechanisms for the world’s seven billion people. However diseases transmitted by bodily fluid like HIV and Ebola can be prevented with the right preventive, strategies and attitudes.
The HIV/AIDS crisis is part of a complex health crisis our nation faces. It is important understand the ripple effect of this disease on the National Human resource. That’s there is a need to shift focus to primary prevention (being healthy) instead of scrambling to contain cost intensive tertiary interventions (disease treatment).
This also means taking personal responsibilities (abstinence, faithfulness, needle share and Proper Condom use), status check, having an open conversation and removing the taboo and stigma of the disease.
Collectively, it’s important to promote sex education, support for and training of healthcare workers, the accessibility to new testing technologies, as well as the availability and affordability of antiretroviral therapy (ART).
ART is a huge medical breakthrough that stagnates or decrease of the viral load thus making long and healthy living possible for those infected. It also mitigates transmission from mother to child. And the most exciting news from the Center for Disease Control last week indicates that proper control the Viral Load makes HIV transmission impossible. Yes, you read that right. Infected persons cannot transmit the disease if they get the treatment to reduce their viral load (thinkprogress.org). Now the question is: How will it be paid for?
The truth is; Politics touches every aspect of our lives directly or indirectly. While I intend to remain a Public Health Professional and apolitical in these discussions, it is an open secret that the implantation of important health programs and policies have been hampered by systemic and endemic corruption as well as the lack of vision and political will to steer new course.
A new course Prioritizing crippling health issues and properly funding them; a shift from asking for donor cash to asking for capacity development and support in kind (logistics and equipment) until we have an independent, tested and proven accountability mechanisms that book public crooks.
Here is a quick glance at the Government of Liberia 2015 budget (p. 227):
- 2013-2014 budgetary allotment
- 100-Curative services:
- 2013 2014 budgetary allotment was $18,128,644
- 2014 2015 budgetary allotment was $ 22,395,768
- 2015 2016 budgetary allotment was $ 24,593,606
The amounts are gradually increasing to treat diseases every year.
Now look at the numbers for preventive services during the same time under review:
- 200-Preventive services:
- 2013-2014 budgetary allotment $5,050,087
- 2014-2015 budgetary allotment $ 2,954985
- 2015-2016 budgetary allotment $ 3,780,868
There is an inverse relationship. The most important which is prevention is getting limited funding while there is an incline in the funding for disease treatment which is already getting at least 300% more than the prevention allotment. Let’s be fair to Liberian officials, this phenomena is not unique to Liberia. Most countries apply similar logic.
This is one of several areas where policy makers and Public health specialists clash. The only difference between those countries and Liberia is: they have a safety net to help the poor meet their basic health needs.
In the United States healthcare spending increased from $2.1 trillion in 2006 to 4.3 trillion in 2017. Most of said amount is spent at the tertiary (disease treatment) level. And most of the diseases driving up the cost are Life style choices related like (smoking, alcoholism, risky-sexual and social behaviors). One can’t help but wonder what the numbers will look like when emphasis is placed on prevention and access for the next decade.
The U.S Department of Health and Human Services Healthy People 2020 goal is to prioritize this shift. Prevention is an essential and effective component of any evidence-based strategy to improve the value of current health spending, slow the growth of health care costs, and ultimately reduce long-term health spending (university of Connecticut.edu).
As a realist and a Pragmatist, my intension is not to spew empty criticisms without any contributing solution. Moreover, some if not most of these recommendations are perhaps already on the book or floating around somewhere. If they are and are being ineffective, then there is a need for reassessment and program re-evaluation. That way, we can figure out what’s working and what’s not.
Personal health: The success of Public Health begins with a successful personal health. There is a need for personal health responsibility. Make healthy choices like hands washing, regular exercise, and health implication of pleasurable habits like smoking, alcoholism, risky sexual habits, drug abuse etcetera.
Understandably, we can have another discourse about abject poverty, limited access to healthcare, and the inability for the average person living on less than a $1 a day to seek medical care. While these conditions adversely impact health beyond the control of many, it is equally important to make the best of what we can control. How many people think about the food they eat and the impacts on their health? How many think of exercise as a vital part of health? How many persons you have heard saying: “but something got to kill me”..
In other words: “I will die someday, so I really don’t care”. Individuals have to take some personal responsibilities which might even save them from the unaffordable cost for a treatment in a system that’s already broken. This is no insensitivity to the health issues that are inevitable and no fault ours, the point is taking some responsibility to control the things we can; like digging our drinking wells next to septic/sewage tank and not simply boiling our water to drink or washing our hands after using the bathroom.
Collective approach: we have to openly discuss health issues. Understand and draw the line between superstition and medical science. There is a need for us to collectively destigmatize health conditions. Shame, reproach and judgment sent victims in obscurity; from there they spread the disease, thus endangering a whole community and the nation at large.
The recent Ebola pandemic is a classic example. Culturally competent discussion of health is pivotal. Finding the commonalities between herbal and scientific medications could also be ground braking.
Institutional Support (Government and NGOs): they need to focus on a granular approach with emphasis, support and funding preventive measures. To say our healthcare system is dilapidated would be an understatement. As we galvanize support for infrastructure and logistics, health personnel development is an integral piece of the puzzle.
National health agencies with their international partners MUST spend under 25% of budget on recurring and administrative cost and the rest on program implementation. Unfortunately, most government agencies local and International organizations break the bank salaries, offices, high-end cars and equipment and channel the crumbs to the core issue (health intervention).
With the metastatic Cancer of corruption, support must be in capacity development and kind (logistics, equipment and training) instead of cash until we have independent, tested and proven accountability mechanisms with indiscriminate Punitive measures for the corrupt.
All these measure are not far fetch; while this discussion was prompted by the recent HIV report, this is a great way to begin our national health discourse. Together we can build and sustain viable and healthy nation free of HIV/AIDS and other challenging diseases.
Boakai Boley, MPH, BSc, Contributing Writer