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Global inequalities in health
• Everyone has the right to a
standard of living adequate
for health and well-being
- Article 25, Universal
Declaration of Human
Rights
• Many people worldwide lack
access to even basic
healthcare
United Nations; UC Atlas of Inequality
Global inequalities in health
• A child born in Swaziland is nearly 30 times
more likely to die before the age of five than a
child born in Sweden
UC Atlas of Inequality
Global inequalities in health
UC Atlas of Inequality
Malawi
Countries at a glance
CDC, World Bank, Swiss Federal Statistical Office
Main causes of death
CDC, Swiss Federal Statistical Office
Malaria
Swissinfo 2003 WHO 2014
HIV and AIDS
UNAIDS
How can we address these
problems?
Suggestions?
Supply
• Many healthcare conditions predominantly affect
the world's poorest populations
Medicines
Storage
Few facilities
Very hot conditions
Modern facilities
Cold storage
Medicines
Electricity
“In an average week we will only have
electricity for 4 days and water for 3”
Medicines
Dosage
• Correct dosage needed for patients
• Trials for drug may not have been in these
populations or for the types of patients most
affected
• 9 of 10 children infected with HIV/AIDS live in sub-
Saharan Africa
• Most clinical trials are conducted using doses and
dosage forms designed for adults
IFPMA
Medicines
Rationale use
• Overuse, underuse or misuse of medicines
harms people and wastes resources
• In developing countries, less than 40% of
patients are treated according to clinical
guidelines
WHO; World Bank
• Less than 60% of children with acute diarrhoea
receive necessary oral rehydration therapy yet more
than 40% receive unnecessary antibiotics
• Only 50% of people with malaria receive the
recommended first-line antimalarial
Medicines
Delivery
Medicines
Hospital/clinic
Infrastructure
Waiting room
Infrastructure
Pharmacies
High tech Low tech
Infrastructure
Laboratories and testing
Infrastructure
Equipment
Infrastructure
Terrain
Infrastructure
Corruption
Malawi
• Economy depends on substantial
inflows of economic assistance from
donors
• Many of these cut off because of
suspected corruption
DRC
• Despite rich natural resources, poor
management has left it with second
lowest GPD on the planet
• listed among the 20 most corrupt
countries in the world, which has
resulted in low education and poor
health systems
• Around 80 per cent of African people live on less than US$2 a day. Corruption is one
factor perpetuating poverty
• Poverty and corruption combine to force people to make impossible choices like “Do
I buy food for my family today or do I pay a bribe to get treated at the clinic?”
Transparency International; WMF
Infrastructure
Prevention
• Intestinal parasites spread in areas with poor sanitation
• Children are most frequently infected with these
parasites as hygienic practices are often forgotten or not
used or taught
Education
and prevention
Education
Education
and prevention
Support
• It is essential that those caring for the children do not feel alone
• In 2013, WMF began a Support Group for those caring for the
children receiving HIV/AIDS treatment, care and support
• Parents and guardians now attend Health Education sessions on
how they can best care for their children who are living with
HIV/AIDS as well as for themselves
Education
and prevention
Nutrition
• Good nutrition is vital so children to gain the full benefit from the
powerful medicines they receive
• Parents and guardians are learning how to prepare the right meals
for their children and for themselves
• A popular initiative has been a demonstration garden where they
learn how to grow soya beans and other plants.
Education
and prevention
Staffing and training
World Bank; OECD
The College of Medicine (CoM) was
established in 1991. It is the only
medical school in Malawi
Education
and prevention
Technology
Education
and prevention
World Medical Fund
WMF’s UK registered charity number: 1063756
Key initiatives
Children's mobile clinic
• 4 x 4 vehicle carrying a clinical team
and medicines
• Mobile clinic visits villages and
remote locations
• WMF also has a Mobile Surgical
Unit to perform minor surgery deep
in the African bush
Children’s mobile clinic 2013
Source: WMF Annual report 2013
Note: A total of 25,637 cases were treated by the
Children’s Mobile Clinic in the Nkhotakota district
Electives for medical students
• Enable medical students to
learn first-hand how health
care delivery operates in a
developing world setting and
the challenges involved
– Gain practical, clinical training
in tropical medicine in a
unique cultural environment
• Usually spend 4 to 8 weeks
working with the WMF team
in Malawi
Many factors
Recommended