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Sub-Saharan Africa from crisis to sustainable growth is a comprehensive 300- page document which closely. and sometimes bluntly. analyses the economic and social position today. lt comments: "Sub-Saharan Africa as a whole has now witnessed almost a decade of falling per capita incomes. increasing hunger. and accelerating ecological degradation. The earlier progress made in social development is now being eroded. Overall. Afri- cans are almost as poor today as they were 30 years ago. This situation has spur- red many governments to undertake far-reaching reforms. More than half have embarked on structural adjustment programmes. The countries that have persisted with reforms since the mid- 1980s are showing the first signs of improvement These give grounds for believing that recovery has started." Here are some of the points made by the World Bank: - The crisis is taking a heavy toll in human terms. In several countries expenditure on social services is sharply down. school enrolments are falling. nutrition is worsen - ing. and infant mortality con- tinues to be high. - In many places political instability. coup d'etats and ethnic strife are exacting a terrible toll on helpless people. And the costs of destabilisation in southern Africa have been enormous. - Population growth has steadily risen during the past three decades. Now well over three per cent it is outpacing GDP (gross dom- estic product) . In contrast in most other developing coun- tries population growth has declined. 30 - If Africa is to avert hunger and provide its growing population with productive jobs and rising incomes. its economies need to grow by at least four to five per cent a year. - Primary health care comes first. Major strides toward better health care are pos- sible. even within the budgetary constraints facing African countries. if expendi- tures are re-directed from high -cost curative medicine in modern hospitals to pre- ventive and community- based systems_ Mass immu - nization campaigns are cheap and effective against several major childhood kill- ers. And even very poor people w illingl y pay for health care if they demon- strably get value for their money. This above all means ensuring a reliable supply of inexpensive drugs through better procurement pro- cedures and regular delivery to clinics and health posts. - Two out of every three rural Africans are still without safe water. Universal access to clean water. which is a prerequisite for better health. should be an integral part of the long -term strategy. - More and more Africans are going hungry_ Severe food shortages were excep- tional in 1960; now they are widespread. lt is estimated that about one-quarter of Sub-Saharan Africa's popu- lation - more than 100 mil- lion people - faces chronic food insecurity. - School enrolments have been vastly expanded during the past three decades ... The long-run goal remains to expand enrolments - especi- ally of girls. because female education has a particularly strong effect on family welfare. - In health care. a little money can go a long way. According to WHO. depend- ing on the level of infrastruc- ture development it should be possible to provide essential primary health care with a recurring cost of US $1 0 per capita per yea r. For even the poorest countries with GNP (gross national product) per capita of around $200. the public expenditure for gradually achieving universal primary health care would be no more than two per cent of GNP. increasing to three per cent by 2000. provided measures for improving effi- ciency are adopted. • Princess Chulabhorn of Thailand, WHO Ambassador At a special ceremony held on 1 December 1989 in Geneva. Or Hiroshi Naka- jima. Director-General of WHO. appointed Princess Chulabhorn of Thailand as a Goodwill Ambassador of the World Health Organization. An eminent scientist. Princess Chulabhorn has a doctorate in organic chemistry from Mahidol Uni- versity in Thailand . She is at present Director of the Chu- labhorn Research Institute in Bangkok and takes a very close interest in humanitarian and social problems In his address to the Princess. Or Nakajima declared "I know that your scientific and per- sonal accomplishments. and the traditions of your country Thailand for which I have the strongest affection . will ensure that you have lasting influence as a Goodwill Ambassador of WHO. I am convinced that you will inspire all those whom you meet - national and world leaders. your professional colleagues and students - with a common desire for the the security and peace which will enable us to harness our resources and forge new alli- ances in order to improve both he-alt~ and the quality of life. " • Princess Chulabhorn of Thailand with the Director-General Research in health sciences Almost 100 specialists. from various European and African countries and from India. took part in December 1989 in an international colloquium held in Antwerp (Belgium) under the title of "Research in health sciences. an indispensable tool for development" Organized by the Prince Leopold Institute of Tropical Medicine. with financial support particularly from the Belgian Government and the European Economic Com - munity, the colloquium summed up the needs of tropical countries in regard to health research . Some participants deplored the imbalance which exists between research projects on tropical diseases. which represent about 80 per cent of all projects. and those con- cerned with nutrition and public health. Or Gentilini. of Paris. said in this context that there was a certain disdain for operational research All speakers emphasised the need for multidisciplinary research. including in parti - cular the social sciences. and stressed the importance of education and training in tro - pical health. The interactions between health and develop- ment should also be given special attention. they said. since disease ecology changed with agricultural development and urbani - sation. lt was true that the new technologies offered prospects of progress in the control of tropical diseases. but it was still necessary to ensure close cooperation between North and South to enable those technologies to be adapted to the specific problems of the developing countries. WORLD HEALTH , March 1990 "' "' -"' :;; l!. t: 0 I s 0 0 .r::. "- Research in tropical health is needed today more than ever In his concluding remarks. Dr Rene Le Berre. of the WHO Special Programme for Research and Training in Tropical Diseases. recalled Europe's long tradition of research on health in the tropics . Emphasising that many countries in Africa were still not in a position to cope on their own with the enormous problems facing them. he urged that research for development should be carried out through close cooperation between WHO. the EEC and the European countries as a whole. • Young people against AIDS On 1 December 1989 World . AIDS Day was cele- brated throughout the world . Important events took place in thousands of towns and communities as well as at the headquarters of WHO in Gen - eva and in the six WHO regio- nal off1ces. W HO sponsored this second World AIDS Day - which has now become an annual event - in order to encourage greater awareness and better knowledge of the human immunodeficiency virus (HIV) and of AIDS. and in order to extend and strengthen the efforts being made throughout the world to prevent the infection and to care for infected persons. The ceremony organized in Geneva to mark World AIDS Day included meetings on the theme adopted for 1 989 "Young people and AIDS." WHO headquarters remained continuously in contact with events throughout the world and passed on messages of §Oiidarity. sympathy and understanding in regard to AIDS. Dr Hiroshi Nakajima. Director-General of WHO. himself inaugurated this World AIDS Day. which fea- tured in particular discus- sions between young people and AIDS patients. and the showing of two films on the disease. • WORLD HEALTH, March 1990 Nevvsbriefs * Two new Assistant Directors-General have been appointed at WHO headquarters with effect from I January 7 990 They are Or Ralph H Henderson (United States) . who was formerly Director of WHO's Expanded Programme on lmmumzat10n (EPI). and Or Nikolai P Napalkov (USSR). formerly Dtrector of the Petrov Research Institute of Onco- logy in Leningrad. * Spokeswoman. Mrs Therese Gastaut (France) has been appotnted Programme Manager of WHO's Office of Informa- tion and the Director-General's spokeswoman She was previously Director of the Information Service of the United Nations Office in Geneva. She succeeds Mrs Ann Kern (Australia) . for two years Director of the WHO Division of Public Information and Public Relations. Mrs Gastaut's appointment forms part of the reorganization of information activities in WHO. * African emergencies. In its time. Noah's Ark was an appropriate response to an emergency situation lt did not. of course. prevent the Flood but it did reduce the loss of human life . . . lt is not surprising . therefore. that "The Ark" has been chosen as the title of the the ark bulletin of the WHO Panafrican the <Jfncan bulletm on health emergency preparedness and response Centre for Emergency Pre- paredness and Response at Addis Ababa in in this issue l)oN'f' l!E $ILL7 1'11fllc's. f'Ulvry l'loflt: lVII Hi 'fW~ CfJflf' HIM ! Ethiopia. As can ~~ news Items I CAIJ IT CDI' IVtlll be Seen from the on health ALL 1ltli SIJF~we!oS COver 0 f the emergency Ill/ TME' IJII)jllb · second issue. humour still has its place. despite the often tragic nature of the situations with which the Centre is called upon to cope. This second issue of " The Ark" includes 44 news items that management in Alric• relate to the management of different kinds of emergency - whether natural or man-made - throughout Africa Better medical education. Deans and Directors of schools of medicine and health sciences held a three-day meettng recently tn Brazzaville and drew up recommenda- tiOns atmed at improving the quality of medical education in , the African Region WHO's Regional Director for Africa. Professor G. L. Monekosso. thanked the participants for their work and said that the fruit of their endeavours represented a sign of hope for the future. He commented that "a new movement towards education for all" had now been added to the philosophy of Health for all. • In the next issue Who make up two-thirds of the illiterate in the world? Who do two-thirds of the world's wo rk and produce at least half of the world's income? Yet w ho are the poorest among the poor? The answ er to all these questions is: Women . The April issue of World Health examines the health of women and its bearing on the hea lth of all . If you would like to obtain the catalogue of WHO publications, or receive sample copies of other WHO periodicals which you want to evaluate be- fore placing a sub- scription, please con- tact: World Health Organization, Distri- bution and Sales, 1211 Geneva 27, Switzerland WORLD HEALTH for readers everywhere During 1990 there will be no change in the cost of a one-year subscription. (Two- year and three-year subscriptions have been discontinued) . The rates are: US$ 0 Sw.fr. 0 One year 20.- 25.- WHO also offers its "Health Hori- zons" combined subscriptions to both World Health (ten issues per year) and the quarterly World Health Forum The annual price will be: . US$ 0 Sw.fr. 0 52.- 65.- 0RDER FORM Please enter my one-year subscription to World Health 0 Health Horizons 0 I enclose cheque/international postal order in the amount of: Name: Street: . City: ................ ...... . 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