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World Health Gap Narrowing But Challenges Remain, WHO Data

The World Health Organization’s annual statistics show progress is being made around the world in cutting child mortality – but it will miss its target of a two-thirds reduction by 2015.

The number of under-fives dying fell from 12 million in 1990 to less than seven million in 2011, the data shows.

But that will not be enough to reach the 2015 Millennium Development Goal.

The WHO says the health gap between countries is narrowing, but there are continuing inequalities in health care.

Many people in low- and middle-income countries have insufficient access to medicines in the public sector, meaning they rely on the private sector, where prices can be up to 16 times higher, says the WHO.

In these countries, an average of only 57% – and in some cases as little as 3% – of selected generic non-branded medicines are available in the public sector, according to data compiled by the global health body.

The World Health Statistics 2013 report compares progress made by countries with the best health status and the worst status over two decades, from 1990.

The statistics are compiled from many sources, including government birth and death registrations, hospital records, household surveys and research projects.

“Our statistics show that overall the gaps are closing between the most-advantaged and least-advantaged countries of the world,” said Dr Ties Boerma, director of the Department of Health Statistics and Information Systems at the WHO.

“However, the situation is far from satisfactory as progress is uneven and large gaps persist between and within countries.”

The gap in child mortality fell, from 171 deaths per 1,000 live births in 1990 to 107 deaths per 1,000 live births in 2011, according to the latest statistics.

Global statistics on the number of women dying in childbirth have also improved, but the WHO says the global decline in maternal deaths (3%) will have to double to meet the goal of reducing maternal deaths by three-quarters.

Commenting on the report, the charity Save the Children said that as well as improving access to healthcare for the poorest families, the world must redouble efforts to tackle hunger, which contributes to a third of child deaths.

“We have made incredible progress in cutting the numbers of children who die every year by improving treatment of preventable diseases and making vaccines available to the poorest children,” said Brendan Cox, Save the Children’s director of policy.

“But unless we tackle hunger, we risk losing this momentum, and children will continue to die needlessly.”

Key trends in the report

  • Preterm birth is the leading global killer of newborn babies and the second most important cause of death (after pneumonia) in all children aged under five years
  • Every year about 15 million babies are born before 37 weeks of pregnancy – one million die
  • Almost 10% of the world’s adult population has diabetes

Credit: The BBC News

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Development of Science and Technology in Ghana/Africa – part 4

This article looks at several other methods the government of Ghana (and that of other African countries) can explore to quicken the pace of Science and Technology (S&T) development in their respective countries. For a systematic development in any field, there must be a well formulated policy/plan which seeks to guide the field. The necessary adjustments to the policy/plan are then made with advancing knowledge in the field. That is for Ghana and other African countries to make a leap in S&T, they need to have a sound S&T policy in place. Such a policy should be partly guided by the type of technology they wish to develop in their respective countries. Broadly speaking, two forms of technology could be available to a country and they are the Borrowed Technology (BT) and Indigenous Technology (IT). The former, as the name implies is a type of technology which is accessed from another country whilst the latter is developed in the home country.

Ghana and other African countries need to be clear about the direction they are taking as far as the two types of technology are concerned because, that will largely guide the nature of Research and Development (R&D)they set up.  The question then is, do African countries stick to the Borrowed Technology or the Indigenously Developed Technology, or use both of them simultaneously? Definitely, we cannot move away from developing our Indigenous Technology, because we need that to be able to process many of our raw materials that we consume and export. That is to say, the Indigenous Technology, when well-developed has several advantages including development of skills of the labor force, availability of jobs and reduced prices of consumer products. However, IT alone may not be enough to keep up with the technological demands of our growing economies and especially improve the standards of living of people in the short-term. And so in addition to the IT, African countries can borrow technology from scientifically and technologically developed countries, adapt and possibly improve such technology to suit their environment(s). For instance, one area of importance to many African countries is improving farm yields, and currently we are aware that Biotechnology among others has the power of accomplishing that task. So if such a technology is available we can establish an R&D to adopt and adapt it to our benefit – saving us the trouble of researching from the scratch. In other words, it will be a good idea if African countries formulate policies, which make use of both Indigenous Technology and Borrowed Technology simultaneously, which in turn is expected to guide planning and investments in R&D related to S&T development.

Funding is required to develop Indigenous Technology and properly use Borrowed Technology. Especially in the Borrowed Technology situation, expertise would have to be sought at a cost probably from the country or countries which have developed the technology. To minimize the costs for such technology transfers, the government of Ghana (and that of other African countries) should seek to form bilateral relations in science, technology and innovation with the industrialized and newly industrialized countries. Under such bilateral relations, we can benefit from among others, training of our personnel, sharing of technologies, solving of common problems together and systematic development of capacity and capability for science and technology. Such bilateral relations should also seek to actively establish research and training centers of excellence in Ghana (and other African countries). The African Union (AU) is poised to encourage the development of S&T in Africa and harmonize emerging technologies and innovations among member states, which is a good first step.

Funding for R&D in Science and Technology (S&T) can come from three main sources: the private sector, government funds and foreign loans. It is very helpful when the private sector contributes significantly to R&D development of a country because that means the private sector is robust and is building the skills of the labor force and creating jobs. However in Ghana, private sector contribution to R&D is very small (less than 5%) compared to about 40% or more in industrialized and newly industrialized countries. Government funding of R&D through locally generated funds is economically wise for the main reason that the government tends to dictate its scale of preference for projects and their funding. However, in the last case of funding R&D with foreign loans, there could be a problem in that the lender usually sets up guidelines for the use of the money and that could conflict with the priorities of the government and indeed the country. This situation can lead to stagnation or even retrogression in S&T growth. So it is advisable that government tries as much as possible to generate funds from its local resources to pursue R&D in S&T programs.

Process Plant Technology is a South African technology company, based in Johannesburg.

It must be understood that many of the countries which have excelled in S&T have devoted considerable amount of resources to R&D and currently, the percentage of Gross Domestic Product (GDP) invested in R&D is an important parameter in measuring technological advancement. That is, in those countries with high science and technology development, investments have been between 1 – 4 % of their GDP. South Africa is investing close to 1% of its GDP in R&D and it appears to be the only country in Sub-Saharan Africa with advanced development in Science and Technology. In Ghana and in many other African countries, the percentage GDP invested in R&D has been below 0.5% and consequently, the level of S&T development in such countries has been poor. The African union (AU) recommended that African countries strived to achieve an investment of at least 1% of their GDP in R&D by 2010, but it is not clear how many African countries were able to meet that goal. It is imperative that African countries strive to achieve that goal and go beyond that in the short-term as part of their commitment to use S&T to transform the economies of their countries.

As we mentioned above, in Ghana, the contribution to R&D development from the private sector is very small. This does not augur well for development of S&T especially in the circumstances where government funding to that sector is also weak. Government must take bold steps to encourage R&D in industries by creating a congenial atmosphere for that purpose. It must also put in place measures which do not favor wholesale import of semi -finished goods to be assembled to finished products in Ghana – some of the key reasons being that, importation of semi finished products takes away research and development (R&D) from the local industry, diminishes technological advancement and reduces job creation, which are bad for the economy. So government must rather encourage imports of raw materials (if they cannot be found locally); and process such raw materials in Ghana to finished goods for consumption locally or for export.

One area lacking proper coordination and management in Ghana and other African countries is harnessing innovative ideas from academia and translating them into industrial products. To address that, government must set up an innovation and technology transfer office to oversee such creative endeavors. Such an office, among others will seek to minimize the bottlenecks which come up during the process.

These are few suggestions which will impact on the S&T development in Ghana and other African countries. Please look out for the next article.

By Nana Osei-Kwabena

sciencnt@yahoo.com

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Development of Science and Technology in Ghana – Part 3

This article will be focusing on tertiary education with emphasis on the universities in Ghana and how they influence the development of Science and Technology. Most of the points which we shall discuss are also shared by universities in other African countries. In Ghana, the National Council for Tertiary Education (NCTE), under the Ministry of Education is directly responsible for managing tertiary education institutions. The universities are established to teach, educate, research and develop innovative ideas for the benefit of society, but depending on the resources a university has, its role may just be a partial fulfillment of the above functions.

Since the establishment of our public universities (University of Ghana, University of Science and Technology, University of Cape Coast) decades a go, there has been very little discussion about redesigning the curricula at the universities to specifically meet the demands of Science and Technology development in Ghana. Essentially, the same content of science syllabi has been taught over decades and may partially explain our present level of development in Science and Technology. The university graduates who have been produced by this system are not well suited to provide the necessary inputs for the Science and Technological development of our nation. In other words, they are unable to contribute effectively in that direction and the situation is not peculiar to Ghana, but to many other African countries. We need to take a critical look at the academic content of our science syllabi at the universities and restructure them to solve the problems of our country. To achieve this, academia and our local industry should foster good relationships so as to be able to identify specific problems in Science and Technology that need to be addressed in Ghana. The scientific and technological problems identified should then be reorganized and translated into a significant part of the lab and project work done at the universities. Such lab and project work will give room to students and professors alike to research and come up with solutions. A student who has graduated with such expertise is relevant to the economy because his or her skills can be directly employed or deployed to contribute to the Science and Technology development of the country.

This brings into question the state of funding at the universities to pursue Research and Development (R&D). Currently sources for funding R&D at the universities in Ghana mainly come from the government subvention, the GET fund and local industries. But contributions from these sources have not been enough to kick-start vigorous R&D in Ghana. I am suggesting here that a Research and Development Fund (RDF) is set up by the Ghana government and the government must be committed to contributing a reasonable percentage of the Gross Domestic Product (GDP) of Ghana into it annually. This must be seen by the government as building the capacity and capability for Science and Technology development in Ghana. The rest of the contributions to the fund must come from local industries, the African development bank, universities and countries with economic interest in Ghana as well as philanthropists. Researchers will have access to funds from the RDF by developing research proposals (which should contain among others, the objectives of the research, methods to pursue the research, expected outcomes and amount of funds needed for that purpose) and submitting them to an independent body for consideration. Such a body should be made up of varied professionals such as science professors, entrepreneurs and social scientists who are knowledgeable in their field. One key requirement for awarding grant money to an applicant will be that the proposed research should seek to address some of the key problems of our country. To efficiently manage the funds, it will be the duty of government, policy makers and fund administrators to have a scale of preference in place to determine which areas of Science and Technology need urgent funding and/or more funding. Establishment of a robust RDF will be one of the few but effective ways of creating an enabling environment for research into Science and Technology in Ghana. In line with the above, the Government of Ghana should set up a Research, Technology and Innovation center (RTIC) at the universities if it has not already done so, to see to the patenting of ideas which come out of such pursuits and transfer the technology as appropriate.

Funding is not the only factor that limits research. In fact adequate time is also a requirement for research. Where the student: faculty ratio is large (that is a large student population compared to the number of professors), professors have little time to engage in research. This is because the professor spends most of his or her time meeting with students who need assistance and the rest of the time for marking/grading papers. To partially alleviate the situation so as to be able to create some time for research, I recommend the following: first, conditions should be created such that professors teach continuously and intensively for at most two semesters and then the third semester is devoted to intensive research – that is, alternating two semesters of teaching and one semester of research. Second, I recommend that we de-emphasize the essay question format. This is because the essay question format usually requires the experience and knowledge of only the lecturer to mark/grade and can involve a great deal of time if it is to be done objectively, whereas other formats like multiple -answer question could be graded by the Teaching Assistants (TAs). Thus, in any examination we can limit the essay-type questions to about 50 % or less, the professor then provides answer keys for the rest so that TAs can mark/ grade them.

Generally, because of the fast pace of research discoveries in Science and Technology in the developed world, there could be a gap in scientific/technological knowledge between professors in the developing and developed countries – with the professors in the developing countries being at a disadvantage. This calls for several measures. The most basic is that the universities must subscribe to leading journal publications from America and Europe. These publications must be made available in electronic form so that both students and professors can have easy access to them, and it is important that both of them read the material. Seminars must be regularly organized to give room to both students and professors to discuss latest information they have read and gathered from the journals. This will partially bridge the information gap. I am also proposing that, it is about time we look into making some of our professors in the developed countries adjunct professors in our local universities. What that means is that, such professors in the developed countries will be attached to our local universities and they will spend about a month or so annually teaching at our universities. The adjunct professors will help build syllabi, teach and give seminars in areas they think are “new” in their field. This is intended to bridge the science information and technology gap between the developed and developing nations like Ghana. After all, this is not a new concept in other fields – especially soccer. When Ghana and other countries are going to play international games, they invite seasoned professionals playing in other countries to join the national team so as to increase their chances of winning. So we can employ the same technique here with our skilled science and technology professionals in the developed countries.

It is not clear whether the universities in Ghana (and for that matter other African countries) have a reward system in place for the professors teaching and researching on Science and Technology. Here, it is suggested that a well formulated reward system be put in place to acknowledge professors who are able to contribute to the development of Science and Technology in Ghana. Specifically, the system must identify and reward professors who are able to develop innovations which can lead to or has led to better technologies to teach science, process food and medicinal plants, increase the yield of animal and crop farming, tap into wind, solar and biomass energy… just to mention a few. And the reward should come in the form of good salary, research funding, equipment and larger laboratory space.

These factors are likely to attract and retain good professors, and catalyze the Science and Technology development in Ghana and other African countries. Please look out for the next article.

By Nana Osei-Kwabena
sciencnt@yahoo.com

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Development of Science and Technology in Ghana/Africa – 2

By Nana Osei-Kwabena

This article will be focusing on pre-tertiary education in Ghana and how it influences the development of Science and Technology. Parallel examples would be drawn from other African countries as appropriate.

The Ghana education system and that of many other countries can be divided into two main areas:  pre-tertiary and tertiary education. In Ghana, the pre-tertiary is managed by the Ghana Education Service (GES) whereas the tertiary is managed essentially by the National Council for Tertiary Education (NCTE). How do we define education? There are several definitions available, but I will define education as a systematic development of the human mind through a measured exposure to information and reasoning.

For decades, the educational system of Ghana and that of the West African Examination Council (WAEC) member countries were based on an adapted British educational system, which entailed 6 years of primary education, 4 years of middle school and 7 years of secondary education.  Policy makers in Ghana identified several problems with this system, which included prolonged school years and purely academic content of curricula. And so in in 1987, the pre-tertiary education in Ghana was radically reformed. The length for pre-tertiary education was shortened to: 6 years primary, 3 years Junior Secondary School (JSS) and 3 years Senior Secondary School (SSS). In essence, pre-tertiary education was shortened from 17 to 12 years. The direct effect of this reform was that it reduced the cost of pre-tertiary education and made more funds available to expand and improve existing infrastructure so as to partially meet the requirements of the Free and Compulsory Universal Basic Education (FCUBE) for all.  Currently, all the WAEC member countries are using this system and it appears similar to the American pre-tertiary education system. Though a lot of effort has gone into the implementation of the new educational system, it has had its fair share of problems. Among others, all of the WAEC member states have been faced with various degrees of poor examination performance in science – as have been determined by WAEC. And the cause may be one of two things, that the educational system is not working well for our students in science or it is lacking the necessary inputs to enable it work efficiently. In any system, a good input usually produces a good output (and vice versa) and so the latter point of lack of necessary inputs may be a large contributor to the poor performance in science of the current educational system. This is not to say that the WAEC member countries including Ghana are not working on the problems. In fact they are, but then they must prioritize Science and Technology to enable it to receive the necessary resources (human, funding and recognition) to thrive.

The quality of science and technological education at the Junior Secondary School (JSS) level is crucial because it is a foundation for further science studies at the Senior Secondary School (SSS) or entry into the labor force. However, many of the teachers who handle this subject are SSS graduates who may not have mastery over the subject. This issue is particularly prominent in the private sector. To make the situation worse, many of these SSS graduate teachers of science may not have majored in science at the SSS. And so, poor science is done/delivered at the JSS level making the students perceive science as a difficult and complicated subject – a perception that can be carried with them for the better part of their school life and influence their decisions in Science and Technology in the future. As our student population grows and Science and Technology evolves, so should be our trained teachers. It is a good effort by the government of Ghana to develop the teacher training certificate programs into diploma programs. However, here it is recommended that the government of Ghana makes plans to strengthen the science discipline in the 38 or so training colleges in Ghana and more importantly encourage more teachers to be trained in science and technical skills so that they can replace some of the SSS teachers. Several more training colleges should also be built for that purpose. The other WAEC member countries can work along similar lines.

In 1995, the government of Ghana established the Science Resource Centers (SRC) project as part of the educational reforms. The SRCs covered one hundred and ten (110) senior secondary schools spread across Ghana. The idea behind this project was to bridge the gap between resourced schools and non-resourced schools in science within a forty kilometer radius. Indeed, this was a bold decision taken by government of Ghana. Assuming that the resource centers had enough funds to buy equipment and materials, the one most important element/factor that will be needed for successful delivery of science education at such places will be the competency, dedication and current knowledge in science and technology of the teaching staff. That is not or cannot be guaranteed and so it would not be out of place if professors at our universities are attached to the SRCs – to assist in the teaching of especially more difficult concepts in theory and lab work to both teachers and students. In fact in the United States, many science College professors are tied to the high schools. They go there to teach and also to oversee what their colleagues at the high schools do. This is an inspiration to both teachers and students alike. In the same manner, SSS science teachers should be attached to JSS schools so that they can offer some help in the teaching of the science subject at that level. This measure will allow for fluidity in Science and Technological education in Ghana and other African countries.

The science syllabi of the old educational system and the new one are not very much different in academic content but the students within the new educational system are much younger than the old system. It will not be productive to essentially stick to the science syllabi of the old system if we want to make progress, because those syllabi do not have aspects that seriously deal with the problems of our country. We should seek to comprehensively redesign the science syllabi and make them more relevant to our economy. The syllabi should be able to cover at least some of the basic problems we face as a nation and creative methods (which will not be limiting) to remedy them. I recommend that about 10 – 40% of the science syllabi (whether integrated science or pure science subjects) are devoted for this purpose and the rest to the core science principles – for the duration of the pre-tertiary education. These percentages should be linked to the level of education such that at the primary school level, 10 -15% of the science syllabi will be devoted to problems and solutions confronting the nation, 15-25% at the JSS and 25-40% at the SSS. Equally important is the fact the syllabi should be directed towards raising curiosity, creativity and entrepreneurship in students. To craft such a syllabi will require extensive brainstorming by competent scientist, policy makers and even business people. We should not assume that the problems of the country can be best tackled at the university. National development in Science and Technology in our present circumstances will require the contribution from all.

Another area which needs serious consideration is the lack of well written textbooks (either from the government or the public) to suit the demands of our science and technological development. Most of the science books on the market are still essentially based on the old educational system. Though I think it is a good and bold step to produce indigenous books for use by our students, the book writers must be assisted. It would not be out of place if the Curricula Research and Development Division (CRDD) of the Ghana Education Service and similar bodies of other WAEC member countries organize workshops for book writers in their respective countries or together so that authors are more informed of what is required of them and that the CRDD have some control of what the public consumes in terms of scientific material. From my standpoint, attending the CRDD workshops should be a pre-condition for writing science books, and with time more stringent measures could be put in place to control quality of science material on the market.

These are a few of the adjustments we could make to the pre-tertiary educational sector in Ghana/Africa to boost Science and Technology development. Please look out for the next article.

By Nana Osei-Kwabena

Email: sciencnt@yahoo.com

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Developing Science and Technology in Ghana/Africa – Part 1

In this series of articles, we shall be identifying problems facing the development of Science and Technology in Ghana and attempt to propound solutions to them.

Science is a branch of knowledge that discovers facts about repeated occurrences (whether in nature or in the laboratory) and formulates theories and laws on them. Technology on the other hand is the utilization of these laws to make devices that enhance our living standards or enable us to do more science. In most cases, Science and Technology go hand- in-hand but a strong scientific base is needed for technological advancement.

The importance of Science and Technology cannot be over emphasized. Science and Technology is one of the key paths for rapid economic development and industrialization of any country. Science and Technology allows for the country’s natural resources to be processed in good quantities before exported as value added good (industrialization and commercialization). Science and Technology brings innovation such as discovery of a drug which treats diseases with unmet medical needs or equipment for performing difficult tasks. These innovations (including the processed raw materials) can be exported for foreign exchange, which in turn improves the standards of living of the people of the country and is good way of transforming developing nations like Ghana into the middle income economy or higher.

But Science and Technology is not a natural resource of any country. This resource can be developed or acquired with determination and commitment from governments and policy implementers. When we obtained independence in 1957, Dr. Kwame Nkrumah announced plans for moving Ghana rapidly into middle income economy – by developing the Science and Technology capability and capacity of Ghana. Subsequently he established several research bodies and built infrastructure to see to the implementation of Science and Technology development in Ghana. But most of the institutions/infrastructure he put in place did not benefit much from his foresight as he was overthrown shortly afterwards. Notwithstanding, subsequent governments of Ghana have made modest additions (over approximately 40 years) to the existing infrastructure and institutions for Science and Technology development but the impact has hardly been felt. This is because we are still faced with problems of the primitive technology era such as:

1.       Frequent power outages

2.       Dependence on rain-fed agriculture and use of hoes, machetes for farming

3.       Lack of capacity to process raw materials including maize, cassava, tomatoes and the like

4.       Poor health care

5.       Heavy dependence on imported goods including food, second-hand clothing and shoes

6.       Many parts of the country are still underdeveloped and live in darkness

7.       Lack of creativity among many science graduates

8.       Dependence  on cement for building, with hardly any alternatives

…….Just to mention a few.

What is surprising is that, the problems confronting science and technology in Ghana especially in the 21st century is not different from many an African country and so the question arises as to what African countries consciously or unconsciously do similarly to slow down the development of science and technology? It may not be possible to know all the facts at least from my standpoint of view, but what many African governments share in common among others is that, their countries:

1.       Do not have systematic policy for Science and Technology development

2.       Have a very small fraction of their Gross Domestic Product (GDP) set aside for Science and Technology development

3.       Are not developing and adapting  appropriate technology – ‘approtech’ for their economies

4.       Are not sharing information in Science and Technology with other African countries

5.       Are not building common science research centers for African development

6.       Do not have right caliber and number of  human resources to teach science

7.       Teach science without the necessary creativity and lab work to back it

8.       Have high illiteracy and poverty rates making Science and Technology an abstract discipline

9.       Are not attracting their citizens who have been scientifically trained in developed countries

If it is the commitment of the government and people of Ghana to transform the country from low income into the middle income economy in the near future, then it is imperative that we make Science and Technology a major resource for Ghana. Because irrespective of the amount and number of natural resources we have, without Science and Technology we can never truly benefit from such resources. In the next few articles we shall attempt to examine the situation further and look at areas that can help improve and develop Science and Technology in Ghana/Africa.

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President Mugabe Ignores Pregnant Women and Spend 300,000 on a Reality Show

A woman experiencing pain moments after delivering her baby, Picture by Patrick Farrell

A United Nation multimedia radio reported on Tuesday October 25 that in Zimbabwe eight mothers die giving birth every day. Already infant mortality statistic is worrisome in the African country.

With the medical advances we have at this time in human history, this should not be acceptable.

After many years of reckless domestic and economic policies under Pres. Robert Mugabe, the heath care system of Zimbabwe is almost the worst that comes to mind. It is not difficult to understand why maternal death is that high in Zimbabwe.  The economic situation almost excludes the likelihood of expecting mothers attending the hospital or clinic because they cannot afford to pay for the bills. Pregnant mothers in Zimbabwe go through their pregnancy term without any check ups. Last year, the Mugabe regime actually authorized hospitals and clinics to charge patients in foreign currency.

In some communities in Zimbabwe, it is luckiest of pregnant women who are able to obtain the services of community midwives. Even though some of the midwives are able to handle most common situations, they do not have the experience to handle the most challenging pregnancy complications, such as bacterial infection, gestational hypertension, pre-eclampsia, obstetrical hemorrhage, and ectopic pregnancy. These require gynecologist and obstetricians.

The average Zimbabwean earns $1.50. It is therefore not unexpected that most of them depend on community midwives and are not able to see gynecologist. Approximately 100 children die daily in Zimbabwe daily due to easily preventable diseases.

Zimbabwe is among the top 6 countries in the world with the worse record on maternal mortality. In spite of this, President Mugabe doesn’t even pretend to have a clue or care. A few days ago, the president and the First Shopper spent $300,000 on a date with the loser of the reality show Big Brother Show. Consider this in the light of the standard of living in Zimbabwe and it may even appear pornographic.

The average Zimbabweans could live on this for 200,000 days! Even in the US with the highest cost of health care, the average cost to deliver at the hospital with a normal vaginal birth is about $15,000. This means the amount the president’s family spent with the Big Brother loser could handle 20 hospital births.

Maternal mortality and infant mortality is a big burden on African countries. The chance of a woman dying from complication of pregnancy or delivery is 1 in 15! in Africa; in North America it is 1 in 3750.

This is a fight that can be won, but it requires strong political will with multidisciplinary programs focusing on prevention and early management of complications. The figures are not good and so are those for malaria, but when was either of these a key manifesto in any election across the continent?

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