In the past two decades a consensus has emerged condemning corruption as one of the most damaging factors for development. Corruption is seen to undermine the cohesion and strength of whole societies, Lucy Koechlin (2013). Corruption is thus defined as the act of impairing integrity, virtue or moral principles, dishonest practices to citizens. According to Louise (2016) corruption is typically reached high levels of maternal and new born mortality in Africa.
No other factor compared to government corruption has had such a tremendous detrimental effect on infant mortality on the African continent.
Corruption has long been recognised as highly devastating in paving way for high mortality rates and it has proven to be the worst contributory factor, the most saddening factor being that most African governments are doing nothing, if at all, to abate the mortalities. An understanding of these effects can help create awareness and can attract changes and meaningful contributions toward health improvements thus reducing the deaths.
This study outlines and investigates the effects of mortality in the African region.
Attention has been paid to corruption spiraling right down to even local authorities.
All in all, the effects are anti-developmental with snowballing impact on the health sector impinging on basic social services. The pharmaceutical industry has become so entrenched in corruption to an extent that those endowed with the responsibility of saving lives prescribe a brand of medicine through bribes, leaving an ordinary man who cant afford at a disadvantage. Thus, the most affected are the sick, poor, children and women, McMichael al., (2008).
According to Mbaku, (2007) most underdeveloped and developing nations in the Sub-Saharan Africa record over 60% of the most corrupt countries in the World. Given that millions of Africans live below the poverty datum line. Because of the rise in corruption it has caused a strain on government and public institutions especially the health sector. Experts have also cited and discovered that corruption is the major problem in many African countries and in most cases hampers political and economic participation by other countries. Lerrick, (2005). In some countries e.g. Kenya one needs to bribe a receptionist to get a simple doctors appointment, let alone getting treated.
Policy and existing data
A lot of factors contribute towards infant mortality such as sudden infant death syndrome (SIDS), accidents respiratory issues to say the least. However, the major problem is funding. The little that is set aside on many African countries budget towards healthcare is stolen by some corrupt government officials, Hanson, (2009). Research shows that midwives in Africa trained or untrained attend to about 9/10 of births. Thomas, (2009).
Almost all African government lack accountability when it comes to health systems expenditure .As a result of the lower socioeconomic tiers, African women are unable to afford hospital fees, so they have to rely on the state to assist them .As such because government funding is lacking, and the little that is set aside for health care system is diverted to personal use, It inevitably lead to childs deaths. Little, if at all, is done to educate and equip women with tools on how to take care of their new babies. There is a general lack of birth planning, maintenance or even choice of doctors and or hospitals. (Cleland,et al.,2006). Any luck in funding health initiatives takes away the essential dependency of expectant mothers on doctors and midwives to assist them during pregnancy; Hanson, (2009). Committing to Child Survival (2012) Study has shown that lack of provision of resources into hospitals and health facilities has a negative impact on mortality rates through these factors;
Infections related to delivery contributed to 15% of new born deaths (2010)
Diarrhea contributed 11% deaths of under- five worldwide most of these deaths occurring in the Sub-Saharan Africa.
Almost half a million lives of under- five were lost occurring in Sub-Saharan Africa all because of underfunding of malaria vaccinations and provision of preventive measures.
In 2010,6% of children under- five deaths attributed to HIV. In some countries the rate is much higher 28% in South Africa and 23% in Swaziland.
There is another threat of maternal mortality which occur during labour, birth and the aftermath of birth. Unavailability of a Skilled Birth Attendant (SBA) can have negative effects on the birth and death of the child. World Health Organisation(WHO) estimates that 20% of under-five deaths approximately two million deaths annually-could be prevented given the available vaccines.
Vaccine preventable disease like tetanus, polio, diphtheria, whooping cough and or measles can easily be eradicated. Deaths from drinking unsafe water accounts for about 1.5 million deaths in addition to lack of access to water for personal hygiene and poor access to basic sanitation. Black, et al (2003).
Major cases and causes of infant mortality can be prevented and addressed through public policy. South Africa has a policy of screenings for birth defects in children, but not all women understand these screenings, their impact, the meaning and the follow up procedure. Institutional and public policy can also affect the protective factors and risks for Sudden Infant Death Syndrome (SIDS) for prematurity which ultimately leads to deaths Hitzeroth, et al., (2013).
Avoiding smoking and substance use during pregnancy also reduces the risk of prematurity and caesarian birth. (Brady, et al.,2005; March of Dimes,2010; Fleischma,2010). According to research, policy options that influence infant mortality include:
Intense awareness and education about newborn screening as screening prevents deaths, brain damage and serious ailments, Hirtzeroth, et al., (2013).
Ensuring availability of public education on how best to reduce SIDS amongst caregivers and expectant mothers. There are recommendations for those giving care to infants e.g; avoid sleeping on the stomach, too much heat, smoking during pregnancy, too soft and loose bedding (American Academy of Pediatrics 2005).
Having and maintaining funding for universal screening for drugs/substance use during pregnancy, and specific remedies/treatment for those women who use alcohol and or illicit drugs (Brady, et al .,2005 ;March of Dimes 2010)
Providing knowledge to reduce the number caesarean births and those unsafe home births.
An analysis in 13 eastern and southern African countries shows that universal coverage of scientifically proven cost effective interventions would reduce child deaths from the current two million to just 650 000.Even if partial coverage of the 60% target for malaria-as agreed in the Abuja Declaration-and 70% for other interventions were achieved, this can reduce mortality rate by 50%.In many countries coverage of survival interventions is low. Of the 24 preventive and treatment interventions revealed in 2000,only four(measles, breastfeeding and clean delivery) had a regional coverage of above 50%.In fact, eight interventions had coverage below 5%.At the same time observation in southern Africa indicated a deterioration of caring capacities among caregivers as food insecurity and poverty level (UNICEF 2006).
Out dated policies and colonial rules keep instilling certain restrictions on medical practice and Practitioners and continue guiding and misguiding clinical practices e.g. in Malawi the government employ registered nurse and midwives who are only allowed to perform four out of six basic Emergency Obstetric Care(EmOC) And mostly are not allowed to remove retained products nor assist in vaginal child delivery. Some of these restrictions hamper lifesaving services in areas where the government have no means to assist. (UNICEF, 2006). There is need to scale up child survival by taking advantage of programs such as Expanded Programs Immunisation with much focus on antenatal care attendance and Child Health campaigns. Plus getting the community involved through programs like community Integrated Management of Childhood illness. These can cover ground plus they have proven to be effective. Government should also ensure to reach out to the poor and marginalized communities. This is an achievable role if both players are involved i.e. the public and private sector(s). Demographic health surveys have indicated that it is achievable as evident in at least eight countries which have adopted these policies and there is a projection of at least 15% reduction in mortality within five years. It was a success in Burkina Faso, Egypt, Ethiopia, Malawi, Madagascar, Mozambique, Rwanda and Tanzania (UN Chronicle,2007)
Heron et al (2006) examined factors affecting infant mortality and its social impact in Africa. Nobles et al (2003) demonstrated the relationship of expenditure on health outcomes, specifically IMR. Peck (2003) augmented the discussion by strengthening argument on delivery of health initiatives with the role of the public service and its provision. Cramer (1997) in his study provided the measure by which health contributes to the wellbeing of the society. He drew relationships between health initiatives and their outcomes between the West and African nations; statistically producing representations on the impact of these initiatives.
The selection of literature was influenced by reviewing guidance provided by Cronin et al 2008
The million-dollar question is to find out what factors contribute to infant mortality in developing and underdeveloped countries. Lets first look at what infant mortality is; the number of deaths among live born infants from birth to under the age of one. In underdeveloped nations knowledge and education should be imparted into womens conscience for them to be fully aware of steps to be taken in childcare. Unlike developed nations, many African women do not have female education about the importance of breastfeeding for the first six months of a new born babys life, and that all the antibodies are transferred to the baby through breast feeding and knowledge of vaccinations. All these would help in the reduction of infant mortality and improve the health and quality for all people, Peck, (2003). There are also disturbing factors in the Sub-Saharan Africa; The transport system is not efficient thus it makes it difficult for some people to reach health services and all the delays involved upon reaching the health facilities.
The mortality rate is high in Africa this is solely because Africans have high rate of poverty, malnutrition, and limited or no access to health care. The figures of the deaths are so high as indicated by (Appendix-Table 1). In order to reduce mortality rate underdeveloped nations require funding and intervention from organisations is crucial and paramount to reduce infant mortality. Given all the help from other governments especially the west is vital but there is need for collaborative unabated effort from the government in question, health officials worldwide and the African community (UNICEF,2006).
The Infant Mortality Rate IMR works as a yardstick to determine whether a country is doing well economically and if a government has adequate or good living conditions. Its an economic indicator, Cramer,(1997) It is IMR is the most accurate measure of how well a country or society is satisfying or fulfilling the needs of the people.(p.299 .Cramer).The African infant mortality rate exceeds that of Western countries by over 60%.These figures are used to measure the overall health of communities worldwide(Cramer ,1997). From the research conducted by African Leadership for Child survival (2002) reports that Sub-Saharan Africa (SSA), constitutes about 38% of global neonatal deaths, with the highest new born death rate (34 deaths per 1000 live births in 2011). It was also estimated that half of the 10 million children under five years most of them die yearly in the world (an estimate of 1000 child death every hour). Most of these deaths originates from the Sub-Saharan Africa. This could be avoided given proper access to basic affordable health services. According to WHO ,2018 and UNICEF 2018 reports indicate that Sub-Saharan children have a life expectancy of 51 years but a tenth of which die in the first year of life. According to their research, 155 out of every 1000 children do not reach the age of five. Infant mortality rates (IMR) are usually frequent in the first month of life, with a neonatal mortality of 40 out of every 1000 births. WHO and UNICEF research shows that the main causes of the deaths is; neonatal causes(26%),child pneumonia(21%),malaria(18%),diarrhea(19%),HIV(6%),measles(5%) and accidents (2%).The research also states that for the IMR to be controllable it takes political sanity, transparency in directing resources for the cause and implementation of new strategies. According to UNICEF research neonatal deaths constitutes about approximately 30% of those deaths of under-five worldwide(1.1 million new born babies usually dont make it surpass one month alive, the highest rate being in the Sub-Saharan Africa where 11% of the children die before they reach the age of five unlike developed nations which 16 time lower.
The literature review identified that an extended research has been carried to establish the different social determinant affecting infant mortality and the injection of funds into reducing IMR using quantitative methods. As such the researcher identified a research gap; but no in-depth research was done to tackle the political corruption focusing on control, personalizing and embezzling government and international donor organisations funds. There is a deliberate lack to put in place healthcare system infrastructures that will benefit the rest of their population. As such the research Proposal question will thus address;
To what extent is political corruption impacting Health services Indicators for infant under five years in Sub-Saharan Africa?
Extra caution is supposed to be exercised in the management, usage, storage and sharing of researched data. Data should always be protected save for the purposes of researching and the degree of confidentiality should always be respected and thus should not be shared to unauthorized people.
Ethics: Many African governments have tried to improve the quality and quantity of modern health services for their people, NCBI, (2003), This was not the case during colonial era for it was the duty of the colonial masters. It is debatable that health expansion is evident, because if it was so we would be witnessing dwindling figures of infant mortality rate. Since education levels in many African countries has improved so should be access and utilization of health care facilities and child care. Other factors which improves the peoples wellbeing are technology and infrastructure developments such as roads which can facilitate food distribution, reduce effects of drought and provision of transportation to urban areas so as access to health services. Professional health care givers also play a pivotal role in determining childrens best interests. In most African culture its a norm to them not to seek medical attention thus even if the health facility is available some parents may disagree.
This report has outlined on the effects of corruption on infant mortality rate in the Sub-Saharan Africa. The implications of the findings clearly show that if there was zero corruption there would be better health provisions and availability of healthcare givers, and if the funds meant for health facilities if channeled to the right tasks there would be greater improvements in the health sector. Thus, a reduction in the infant mortality. So, there is a clear indication that all this suffering, injustice, inequality, and denial of an individuals legal basic right to health, is preventable.
According to a survey by (Al Bulushi, et al., 2006), The impact of all this especially to the poor, who sorely is depended upon their governments to take care of them. In most countries the health sector is divided into public and private sectors, thus the public sector suffers because the physicians end up concentrating on the private practice. Black market in health is very common many African countries fail to curb it and its now rife. Corruption, bribery, widespread extortion and other illegal practices are left unabated. The black market which is a result of corrupt administrations and malfunctioning health systems and low salaries of health care giver further helps to erode the sanity of the health systems.
According to a research by WHO (2018) states that it does not matter how much is invested if there is no balance among inputs, say the number of nurses per doctor. In the research made by WHO ,it thus outlines at least five indicators; health imbalances within the population, the level of population health, health system responsiveness(where the patient is supposed to be satisfied and efficiency of the system),distribution of the feedback in relation to class, and the distribution of health systems financial burden within the population(the payer)
There are always two sides to objectives of a good health-The best level-Goodness-and character differences among individuals and groups-fairness. A movement in the positive way of one and the other remaining constant indicates an improvement. However, lack of good health systems and gripping poverty vary directly with failure to secure civil rights. African budgets are having special consideration to the poor, yet this money never finds its way to the rightful beneficiaries.
The study seeks to outline the poor IMR figures in most African countries meaning that not only is corruption at its rife but also the effects it has on different health sectors. The researcher aspiring to develop a career in Global Public Health, has a belief that without; a smooth operative health systems, good governance which has its peoples welfare at heart will just worsen the situation rather more funds from the said governments should be channeled to publics health and not personal wealth.
The negative impact corruption has on health delivery cannot be taken lightly. Further research is thus recommended to assess the impact of corruption in other developing nations. Such studies may be repeated at certain intervals to continuously monitor any further changes that may result from more money being apportioned into the child health sector.