Outline

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