Health and health systems in the Sahel : background paper for the Comite permanent Inter-Etats de lutte contre la secheresse dans le Sahel (CILSS) = Sante et systemes sanitaires dans le Sahel : document d"information pour Comite intersectoriel pour la lutte contre la secheresse dans le Sahel (CILSS)

Life expectancy in the Sahel is 49 years, compared with 51 years for sub-Saharan Africa as a whole, and 61 years for all developing countries. Mortality under age five has dropped from 333/1,000 in 1960 to 203/1,000, but is still more than twice the comparable figure for all developing countries. The leading causes of mortality in the Sahel are infectious and parasitic diseases, conditions related to pregnancy, and malnutrition. AIDS is also quickly becoming a major cause of mortality. The top five causes of child deaths are: acute respiratory infections (ARI), especially pneumonia; malaria; dehydration due to diarrhea; measles; and neonatal tetanus. Underlying these causes are high levels of malnutrition. Disease patterns in the Sahel are closely related to economic, social, and cultural factors. Low levels of education are an underlying cause of both poor economic performance and health problems; this is especially true for women. Inadequate access to health care is also a problem. Government health care budgets are generally biased in favor of urban hospitals, which serve a relatively small percentage of the population. There are some innovative approaches underway to improve access in rural areas, including community-based health insurance, partnerships between ministries of health and communities, and collaboration with NGOs. But meeting the health needs of a regional population expected to increase from 47 million in 1994 to 70 million by 2010 will demand of the nine Sahelian countries both reforms in the public sector and active collaboration with the private sector. Includes bibliography. (Author abstract)