Global Health from an African Perspective - with Joachim Kapalanga, MD

Main points

• Definition of global health in the context of Africa 
• Primary problems in quantity and quality in human resources confounded by the multiplicity of stakeholders
• Lack of harmonization of partnership and funding channels and modalities are different for stakeholders
• Lack of tracking of resources by governments
• Weak point: no direct government oversight of the project: no political will and/or no mechanism to harmonize the projects
• International programs often lack sustainability. Example: H3Africa Program (Human Heredity and Health in Africa) 
• Competition for the same skilled workers to carry out international programs who are thus diverted from provided healthcare to local populations. It also participates in the brain drain (example: H3Africa)
• No prioritization of the programs in the interest of home countries (medications, tests, equipment). Example in South Africa: patient genetic difference between California and Africa
• Accountability: No separation between politics and judicial systems. As a result, there is no prosecution when waste or corruption occurs in many cases. Example: SASA conference
• Successes: H3Africa with sickle cell and genetic diseases / Training of workers skilled in global health / Help in rural areas
• To counter the brain drain, two examples: (1) Brain Circulation, (2) Carnegie Foundation (cross appointments)   
• Rural areas. The situation has improved in the last decades but they are still underserved particularly regarding access and distribution. Moreover, facilities are underdeveloped, understaffed, and lack diagnostic tools. Example in Tanzania for the training of healthcare workers but it has plateaued. Priority: mother and children healthcare   
• Collaboration between African countries: despite African Union’s efforts there is little collaboration. No continent-wide standards for healthcare
• Current Ebola outbreak in Uganda (date: 10/3/2020)
• Disproportion between funding and priorities: HIV/AIDS, TB, malaria are well funded at the expense of other diseases like neglected tropical diseases and chronic diseases
• Deciders for best ROI: African governments but external players like the Bill Gates foundation have their own projects. 
• Political consequences if programs fail: no mechanism holding anybody accountable
• Influence of academia on decision-makers. Difficulty in developing policies to advise governments. They have problems on their own: insufficient funding, low salaries, lack of academic freedom, nepotism and lack of competent leaders and staff, lack of equal access to academic institutions
• High cost of tuition deprives African countries of bright students
• Advice for people wanting to get involved in global health in Africa: 

     - Despite of challenges, follow your heart

     - Work in rural settings. Personal examples (1) in Tanzania, (2)
       McMaster University, (3) Distributed medical education

• Advice to fix what is not working in global health in Africa: (1) Training level: Expand distributed medical education nationally or internationally in Africa, (2) More collaboration between academic institutions promoting global health creating guidelines
• Good example of a successful program that can be scaled: In Tanzania a training program initiated by a foundation in the Netherlands and taken by the Fogarty foundation 
• Good example of program successful for sustainability: Nutritional program started by Oxfam against kwashiorkor and marasmus
• Example of good collaboration between anglophone and francophone countries: Rwanda and Uganda and DRC (Democratic Republic of Congo) regarding Ebola

BIO

Dr. Kapalanga is a physician-scientist and educator who received his medical education from Yale University, the state university of New York, queen’s university and the university of Guelph. 

He is currently professor of paediatrics at the Schulich school of medicine and dentistry and the South Western Ontario academic health network - knowledge translation group, Canada. 

His scholarly and research pursuits are in the epigenetics of neurodevelopmental disorders and exploration of shared endophenotypes in neurobehavioral disorders. 

https://www.linkedin.com/in/joachim-kapalanga-62a64551/?originalSubdomain=ca