Corruption is a serious problem in most governmental institutions for many African countries, especially in the healthcare department.  The World Bank created the term “quiet corruption” in 2010 to explain why healthcare systems are failing and said it was a major reason why African countries cannot succeed in fully developing. [1]  Hospitals are not receiving the funding they should be, medical deliveries are not being made, and healthcare workers are not being paid.  These are some of the real reasons why healthcare in Africa is at such a low quality.  It is a misconception that many people do not go to the doctor when they are sick or do not have access to a hospital.  Although this may be the problem in some cases, in others, people know that they will not be able to receive the healthcare they deserve because of the presence of corruption in the facilities.  “People stop looking for health because they know they won’t get it.” [1]  Africans know that once they get to the hospital or clinic, they will have to pay out of pocket for the services rendered, when in reality there was aid money given to the country for this specific cause.  Thousands of deaths could be prevented if these people were able to access the type of healthcare donors intend on providing. 

            The lack of accountability and absence of controls on medical substances can be named as the root of the corruption.  Once foreign aid money goes through the health ministries, there is little or no system of keeping track of where the money goes after or how it is used.  Facilities end up not having money to pay its healthcare workers, causing them to seek jobs elsewhere, leaving the population with a shortage of doctors and nurses.  [2]

            Fortunately, there can be a quick fix to this problem.  Unfortunately, for the governments of Africa, money would need to be given to the private sector instead of the public.  If aid was allotted more to the private sector, the money can be directly distributed to the healthcare facility, instead of going through bureaucrats.  The private sector would also need to take accountability more seriously because the donors could just as easily give the money to another non-governmental aid organization.

Diane Donchak

Corruption can be found in many areas of business, but when it’s found in healthcare it becomes most disturbing. In the healthcare arena, corruption can prevent vital services from reaching waiting recipients and, in effect, kill human life. Corruption is a concern in all countries; however, it is an especially critical problem in developing countries and transitional economies where resources are already scarce and inadequate management can destroy growth and limit development. The health sector is particularly vulnerable to corruption. Reasons for this include the diversity of services and outlays, the scale and expense of procurement and the nature of healthcare demand. Two areas where there is great potential for corruption and where it is a recognized concern is the procurement of drugs and equipment, and the economic activities engaged in by health providers.

Although many countries and organizations have dealt with corruption accusations, one country whose corruption scandals have been making headlines is Zambia. In May 2009 foreign aid for government health projects in Zambia, where most of the national health budget is donor-funded, was frozen after allegations of corruption were directed at the Zambian government. The governments of the Netherlands and Sweden announced they had suspended aid after a whistleblower alerted Zambia’s Anti-Corruption Commission {ACC} to the embezzlement of over $2 million from the health ministry by top government officials. The Dutch government, the largest supporter of Zambia’s tuberculosis (TB) program, contributes about 13 million euros ($18 million) annually to rural healthcare, preventing malaria, TB and HIV, and training medical staff. About 14 percent of Zambia’s 11.7 million people are HIV positive, and about half of the estimated 300,000 people in need of antiretroviral (ARV) medication obtain it from government clinics and hospitals. The Zambian government stated that they were working hard to find the “culprits”, bring them to justice, find the money, and make sure this doesn’t happen again.

As of March 2011, many HIV positive Zambians were still worried about receiving their medications. There was a ray of hope with the development of a project promoting the anti-corruption efforts of Transparency International Zambia (TIZ) and the Medicines Transparency Alliance (MeTA). These organizations want to improve transparency and accountability in the selection, procurement, sale, and distribution of essential medicines in Zambia. The project offered the Zambian authorities and other stakeholders an opportunity to positively transform the pharmaceutical sector and the general healthcare landscape by adhering to the core international principles of MeTA. This included the belief that “good health is crucial to human dignity and social and economic development” and that a break in the procurement, distribution and supply of medicines could result in needed medications not being available to the poor.

However, there continues to be worries on the surface. There have been many documented cases of gross violations of the MeTA’s principles by both the public and private players in the health sector. The Ministry of Health, through which Zambia had signed up to the MeTA’s governing principles, is a major violator. In December of 2011, the Global Fund was forced to suspend aid to Zambia following the release of a multi-million dollar scandal, which implicated the ministry. The Zambia National Aids Network (ZNAN), the Principle Recipient of the Global Funds in Zambia was also implicated.

Clearly, the fight is not yet won against pilfering and the general mismanagement of resources that have continued to affect Zambia’s health sector. In 2010 ARVs and other needed drugs went up in flames after a storage unit at a rural health center caught fire under suspicious circumstances. While Zambia has tried to prevent wrongdoings in its health sector, more has to be done. The Zambian Medical Association (ZMA) believes it is necessary to put in place mechanisms that will help wean Zambia from over–dependency on donor support for its HIV/AIDS programs. ZAM spokesman, Dr. Robert Zula, feels that there is a need to introduce an AIDS and TB-specific national budget and establish a National Fund for ARVs. The TIZ believes that transparency and accountability in the healthcare delivery system can only succeed with enhanced participation by citizens.

There does appear to be a continued effort to help the Zambian people. The Global Fund announced that it has strengthened its capacity to prevent and detect fraud and the misuse of drugs by its aid recipient countries, including Zambia. Strict measures include the appointment of a high-profile panel of international experts to regularly review the system and ensure tighter controls of its funding mechanisms. Dr. Kamoto Mbewe of the Ministry of Health, has also announced the Government’s measures to order essential drugs worth USD 6 million, which have already started arriving in Zambia. While there is no guarantee in providing healthcare for Zambia, there are continued efforts to procure the supplies and initiate the services that are so needed by the Zambian people.

Diane Donchak

Malaria is a common, but deadly tropical disease transmitted through the bites of infected mosquitoes.  It kills almost one million people every year – the vast majority being children under five years old. Each year there are 247 million new cases of malaria with ninety percent of all malaria deaths occurring in sub-Sahara Africa. Malaria costs an estimated $12 billion in lost productivity in Africa.  With these staggering figures it is no wonder that combating malaria has been the focus of many government and private organizations. One strategy that has been successful in fighting malaria, but not without impediment, is the use of insecticide-treated bed nets (ITNs) and long lasting insecticide-treated bed nets (LLINs).

Few control methods can be considered as clinically effective and as cost effective in fighting malaria mortality and morbidity as these bed nets. They act as a barrier protecting the skin of those sleeping beneath them and as well as killing infected mosquitoes that try to get past the net.  A bed net which can typically cover two people costs about five dollars.  Even though many countries and organizations have praised the use of bed nets as an inexpensive and practical way to fight malaria, the method has not been without controversy and adversity.

According to the Huff Post, health groups have spent more than a billion dollars buying millions of bed nets to fight malaria. Twenty African countries have increased their bed net coverage at least fivefold. If the bed nets are reaching people at risk, this fivefold increase puts some countries on target to reach a U.N. goal of providing a bed net to all 350 million people at risk of malaria by the end of this year. But some experts say the figures are an artificial symbol of success against the disease. Philip Stevens, a health-policy expert at the London International Policy Network, states “These are meaningless input measures that tell us only (the UN) is effective at spending other people’s money,” showing little regard for the use of bed nets.  We know that bed nets can work, and that people have them. However, there is limited data supporting the fact that people are actually sleeping under these bed nets. According to UNICEF and its partners, the percentage of children sleeping under bed nets ranges from 4 percent in Cameroon, Swaziland, and Guinea to 62 percent in Zambia. Richard Tren, director of Africa Fighting Malaria, said UN policies have skewed towards bed nets when they should really focus on other proven tools like pesticides as well as access to malaria medications.

Although bed nets are an excellent prevention against malaria, there are apparent issues surrounding their implementation. Education is a major factor surrounding their use. Throughout Africa there are areas that look upon bed nets with suspicion. Community engagement, instruction, and the monitoring of their use are vital. Even though churches, often the only functioning institution in many communities, are utilized as a trusted delivery system, proper distribution remains a big concern. In Tanzania and Malawi, more bed nets go to the rich than to the poor even though the poor are more susceptible to the disease. The wealthier households were also more likely to repair nets that have been damaged, which plays an important role in their effectiveness. A large part of the distribution of bed nets is controlled by antenatal programs that provide these nets for pregnant women and children. However, many elderly and those without children are being missed. It has been noted that some of the poor who received bed nets have sold them to obtain provisions such as food and water. Compliance in the use of bed nets has been a significant concern. In Kenya, 71% of the people own bed nets but compliance and the actual use of the nets was noted to be 56%.  Door to door visits, as demonstrated by workers for Nets for Life, is needed to access the utilization of bed nets.  Tewolde Gebremeskel, head of the national malaria control unit in the health ministry in Asmara, notes that distribution of mosquito nets and raising public awareness regarding the methods to prevent malaria are imperative factors in controlling the epidemic. He also stated that distribution should be increased in high malaria zones noting mosquito breeding spots and heavy rainfall, which can affect the number of infected mosquitoes. The whole picture surrounding malaria continues to be thoroughly examined.

Bed nets can prove to be a valuable tool in the fight against malaria. However, it is only when combined with education regarding their use, proper distribution, and follow-up visits that bed nets can be fully utilized.  Bed nets, as well as education, research, political and economic stability, and access to anti-malaria drugs are all major factors needed to put an end to this devastating disease.

Chronic pain is a significant disease category, in terms of its incidence and cost.  The Institute of Medicine of The National Academies estimates that approximately 116 million Americans suffer from chronic pain and direct health care costs and indirect costs including lost productivity, totals approximately $560 to $635 billion annually[1].  Effective treatment of chronic pain is essential to lower the burden of this disease.   However, effective treatment often requires the use of opioid medications, controlled substances that can be abused and diverted. The nature of these medications, coupled with regulatory loopholes in the state of Florida, has allowed “Pill Mills” and the “Oxycontin Express” to emerge.  In addition,  recent alarming trends in deaths due to prescription drug overdose, opioid medications have caused them to become highly stigmatized[2].  In effect, and to the detriment of patients opioid medications are under-prescribed by doctors who fear feeding “the monster”[3].

The past 15 years has seen an increase in regulatory policy development in an attempt to prevent the abuse of prescribed opiates, yet their focus on criminal investigations and prosecutions of physicians has unfortunately escalated their reluctance to prescribe[4]. Policies that demonize healthcare providers effectually compounds the problem of the under treatment of chronic pain. The Risk Evaluation and Mitigation Strategies (REMS) program is a recent major initiative by the Food and Drug Administration (FDA), that shifts the focus from demonizing individuals to informing them, by requiring the education of practitioners and patients prior to the prescription of opioid medications in an attempt to promote appropriate and effective prescribing practices.  Research has shown that despite the REMS program, the unwillingness of a substantial proportion of physicians to prescribe opiates will persist⁹. Therefore, despite the scale of this policy initiative (REMS), its impact on the burden of chronic pain may fall short.

The question remains, is there a policy initiative that can help to rectify the losses the field of pain management has suffered as a result of the corruption opioid drugs has been involved with?  I say, yes.  Education, healthcare, and government are meant to work systematically to produce positive health outcomes, yet for chronic pain and opioid use, this system has failed.  The number of primary healthcare providers far exceeds the number of board certified Pain Management Specialists, who are well versed in appropriate opioid administration[5].  With limited availability of these specialists, physicians who are undertrained in the field are treating, and prescribing opiates for many chronic pain patients.  This practice was compounded when the Joint Commission on Accreditation of Health Organizations set as an initiative the endorsement of the effective treatment of pain in the 1990’s[6].  Due to this strong initiative an influx in the prescription of opioids for the treatment of pain occurred and created an artificial confidence in prescribers of opioids. Therefore one problem is matching the supply of Pain Management Specialists with the demand for opioid therapy, possible via increased fellowship opportunities at academic institutions.

Furthermore, currently the Drug Enforcement Agency requires the licensure of controlled substance (including opiates) prescribers.  However, this licensure is granted to any medical doctor, who applies, that has passed all three steps of the United States Medical Licensing Exam[7].  As discussed earlier, Pain Management Specialists are specifically trained in the appropriate administration of opioids, yet they carry the same licensure as those without this specialization.  Since the abuse of prescribed opioid medications is a persistent and serious problem, inefficiency of controlled substance licensing practices may be considered problematic.

The persistent under treatment of chronic pain and prescription opioid abuse signifies that it is urgent that significant policy reform be implemented.  Corruption related to opioid pain medications has certainly created a catch-22:  arguably the most effective tool to improve the outcomes and burden related to chronic pain is the effective prescription of opioid medications, which is the very tool that healthcare providers are hesitant to prescribe due to the potential for abuse and misuse.  Physicians who think, “You’re damned if you do, and you’re damned if you don’t”, are not too far off from reality when it comes to effective pain management.

After 11 months in NYC, I am still not used to seeing older mothers with strollers walking around the city. These mothers make me think about the fact that, not only in this city but also in many other places specially in the developed world, women are getting pregnant, either through IVF or naturally, around their 30s, 40s and even their 50s (1)(7)(8).

As a 24-year old women who is not planning on having children soon but that might want to be a mother someday, I ask myself if to be an older mother is how I expect to see myself in 15 years. My first intuitive answer to this question is “No, I want to be a young healthy mother that has energy to play with her kids. However, I also want to be a mature, educated mother with a stable economic situation and with enough time to spend with my children”. The second part of my answer is what many future mothers are prioritizing nowadays, and that is why young mothers in developed cities like NYC are scarce. Beyond my intuitions of being an energetic young mother, I would not prioritize this first part of my answer, but should women do it? Should they be young mothers, who are generally more full of energy and good health? Or should they postpone motherhood in order to be more educated and financially stable mothers, who might have more time to spend with their children?

To answer these questions I went first to my parents and friends and these were their opinions:

First intuitions were always against older motherhood, because health risks for the mother and the child seem serious; because biological timing for reproduction was a strong argument and because being a young parent was much more fun. However, after I presented some of the arguments that the NY Magazine article (7) describes, their intuitions began to weaken.

My mother, for example, felt like the fact that so many grandparents raise their grandchildren in Colombia is a very strong counter-argument against the idea that older parents are tired and therefore, less capable of being active, energetic parents. The idea that older fathers are not such as controversial topic as older mothers are, made my mother uncomfortable. Nonetheless, after saying that it might not be such a bad idea for women to postpone pregnancy, she finally concluded with: “It was so much fun to have you and your brother being young. It is definitely much more fun ”. Even if she thought arguments were appealing, she was still not totally convinced that it is a good idea to be an older mother.

Second, we discuss the ethical implications of this topic at one of my Bioethics classes and different opinions came out:

Some argued that it was definitely wrong for older women to become mothers, because their children would not only face more health risks, but also the premature lost of their parent. Most of the times, they would not be able to go through college with their parents´ support. In contrast, these young adults would have to take care of their parents. Others thought it was justifiable to take health risks both for the mother and for the child, and the potential emotional pain of loosing the parents being a teenager or a young adult as a trade-off for a more secure lifestyle. These people thought that the fact that older parents could have more time, resources and be more mature to face parenthood would justify older motherhood. Indeed this view is supported by studies like Prof. Brian Powell’s work in Indiana University (1).

The conclusion of this discussion was a matter of priorities and personal ideals. There was no agreement on whether it should be morally permissible to delay motherhood or not. It all seemed to depend on how each one values, for example, an educated mother, an energetic mother or a healthy mother, among other categories, as the main ones in motherhood.

Finally, studies present mix evidence on the question of older motherhood. It has been proven that older women have more pregnancy and delivery problems and higher risks for poorer newborn outcomes. They suffer more chronic and pregnancy-related diseases, higher BMI, more interventions, high risk of prenatal mortality, low birth weight and pre-term birth. Most of these problems increase since the early 30s (3)(6). However, there is no conclusive evidence that shows long term negative effects on children’s behaviors, social/emotional outcomes or schools performance (2). In addition, no negative effects on the well being in early and middle childhood of children with older mothers have been proven (5).

This issue is definitively very complex. More research needs to be done from different points of view to determine the wide range of impact that delayed motherhood has on the child, the family, the community and the mother. As more women choose to delay motherhood, greater is the need to have precise and detailed studies, which approach this topic from a realistic and holistic perspective.

Sources

1. Associated Press. (2004, March 12). More Older Women Revealing in Motherhood. NBC. Retrieved from: http://www.msnbc.msn.com/id/6593933/ns/health-womens_health/t/more-older-women-reveling-motherhood/#.

2. Bradbury, Bruce. (2011, January). Young Motherhood and Child Outcomes. Social Policy Research Centre. University of New South Wales. Retrieved from: http://education.arts.unsw.edu.au/media/File/Report1_11_YoungMotherhood.pdf.

3. Campell, Denis. (2009, June 15). Doctors Warn of Risks to Older Mothers. The Guardian. Retrieved from: http://www.guardian.co.uk/society/2009/jun/15/older-mothers-health-risks.

4. Friese Carrie, Gay Becker, Robert D. Nachtigall. (2008). Older Mother and the Changing Life Course in the Era of Assisted Reproductive Technologies. Journal of Aging Studies 22: 65-73.

4. J. Bolvin et al. (2009). Association Between Maternal Older Age, Family Environment and Parent and Child Well-Being in Families Using Assisted Reproductive Techniques to Conceive. Social Science and Medicine 68: 1948-1955.

6. Klemetti R, Gissler M, Hemminki E. (2011) Health Implications of Ageing Motherhood. Journal of Epidemiology and Community Health. Vol 65 suppl. Uppl. Pp.A120-A120. Retrieved from: http://md1.csa.com/partners/viewrecord.php?requester=gs&collection=ENV&recid=15447780&q=&uid=&setcookie=yes.

7. Miller Lisa. (2011, September 25). Parents of a Certain Age: Is There Anything Wrong with Being 53 and Pregnant? New York Magazine. Retrieved from: http://nymag.com/news/features/mothers-over-50-2011-10/

8. MSNBC Services. (2004, November 23). More Older Women Having Babies Study Says. Retrieved from: http://www.msnbc.msn.com/id/6567698/ns/health-womens_health/t/more-older-women-having-babies-study-says/#.TuY8r2BhHzM

Family planning and reproductive health programs around the world are increasingly recognizing that men are an important audience for their services. Not only do men have reproductive health concerns of their own, but their behaviors affect women’s reproductive health. This issue was brought to the attention globally when The Programs of Action of both the 1994 International Conference on Population and Development in Cairo and the Fourth World Conference on Women in Beijing recognized the role of men in reproductive health and highlighted the need to develop more programs that reach men with reproductive health information and services[1].

While far-reaching in scope, the core of the ICPD was recognition that a sustainable world was not about numbers, but about people, and that all people, particularly women, must have access to reproductive health. This worldwide consensus recognized that achieving universal access to reproductive health is critical for individual health, family well-being, economic development and a healthy planet.

What has Changed

According to the State of World Population 2007 report by the UNFPA it shows that men are concerned for women’s reproductive health, and are willing to participate in making decisions[2].  The problem may be the communication: husband and wife may want the same thing, but they don’t tell each other.  The result can be a bigger family than either really wanted. Husband and wife communication about reproductive health, including family planning, has been improving over the past few decades, the report notes.  However, a large minority of men still consider sexual and reproductive health to be exclusively women’s concern – so they don’t discuss it.

Worse, men often impede women’s efforts at family planning, as the women in Sabakati’s program charge. Dr Everald Hosein co-ordinates the University of the West Indies’ Caribbean Population and Family Health Programming in Port of Spain, Trinidad and Tobago.  He says that almost every method of contraception a woman might choose can be opposed by her partner for one reason or another.  For example, some men complain that condoms and intra-uterine devices interfere with their sexual pleasure.  In many cultures, misunderstandings and myths about female sexuality and reproductive systems persist – though there are indications that male attitudes towards a range of taboos (including concerns about menstruation and ‘cleanliness’) are changing.

Boys and men should be taught about responsible sexuality and the importance of their involvement. Well one way is a “Male participation policy” which is the articulation of principles acknowledging gender inequities and stating the need to involve men in overcoming them to improve health. A high level commitment of this kind can be implemented across various sectors.

The situation is critical, but policy-makers have consistently neglected improving family planning services. Today, a bill for reproductive health has been presented to Congress, but the stakes of passing the legislation seem unlikely. Two major factors impede its success. One is the constitutionality linked to abortion, as it is consider a crime even in cases of incest, rape and to save the mother’s life. Second, as the Philippines is a Catholic state, religion plays an important role in the battle to legalize abortion; “the church believes that the bill is an attempt to promote and legalize abortion.[6]”

Although this dismal scenario, increasing abortion rates and women’s family planning declarations show that education and mass communications have impacted the way in which women think about their future lives. The rapid urbanization process in this country has also made women more aware of the burden of big families. Modern contraceptives can be used to prevent unwanted pregnancies, and although their usage is increasing the government has no plans to spread their availability. In rural areas, traditional methods remain the leading practice to prevent abortions, however, they are not very effective.

Local legislation has proven to fail the needs of society when it comes to discuss family planning. Strong punishment methods are imposed to avoid women from deciding the fate of their unborn children, yet that does not stop them from wanting to practice an abortion. A recent report from the New York based Center for Reproductive Rights reveals that “criminalization of abortion has not prevented abortion in the Philippines, but it has made it extremely unsafe.[7]”

Considering this, the Philippines should concentrate on providing more flexible laws to avoid the mortality and disease burden caused by abortions. The WHO recalls that 20 percent of maternal deaths are caused by unsafe abortions in the Philippines.[8] As the national framework offers little protection to this critical health issue, it is in the hands of international watchdog organizations like the United Nations to advocate for greater attention to the issues surrounding maternal health. The WHO for example has published numerous materials guiding safe abortion practices and manuals to provide the proper medications for this purpose.[9]

Nonetheless, it is difficult for developing countries such as the Philippines to reform their current policies on abortion when in the developed world (most notably the US) abortion is not considered a human right. Ultimately abortion should be considered a health issue, not necessarily a “human rights crisis”. There is a dire need for the Philippines to recognize that its health system is being severely affected by the increasing practice of unhealthy abortions. Once this is done, the country should assess the opportunities to provide women more mechanisms to prevent unsafe medical practices that would put their lives at risk. Reforms in the Philippines are just a matter of time.

Having researched maternal mortality for a few different classes (including this one) and interned for a maternal health organization for two semesters, I was aware of how many women were affected by this global epidemic. I knew that every minute another woman dies from pregnancy related causes.[1] I knew that compared with the ratios from sub-Saharan Africa, where the risk can be as high as 1 in 7 women dying from pregnancy-related causes, the United States’ risk of 1 in 4800 was undeniably shocking but served to put things in perspective.[2] I knew about the startling statistics that the United States ranks only 50^th in terms of maternal health around the world.[3] Yet regardless of all of these numbers that I knew, it was still a tremendous shock to hear about it happening right here, so close to home. Things like this remind us that although this is a global crisis, it can hit us much closer to home than we had ever imagined, and really alter the way we think about statistics like 1 in 4800.

Despite the fact that causes of maternal mortality can differ from country to country – sometimes from not enough medical intervention, and sometimes from too much – this is still an issue that affects all women, all around the world. And it is an issue that is yet to receive the global attention and prioritization it deserves. Hundreds of thousands of women die every year from pregnancy-related causes, and almost all of those deaths could have been prevented.

While the 99% versus 1% rhetoric seems to have infiltrated all aspects of social, economic, and political life these days, with people occupying Wall Street one day, and occupying the food movement the next, being a woman in the developed world makes me a part of a different kind of 1%, with a responsibility to call attention to another glaring disparity. Over half a million women die from pregnancy related causes every year, and 99% of these deaths occur in the developing world.[4] This unfolding climate of the 99% versus 1% provides us with a new advocacy tool to elevate the fight against maternal mortality to becoming a local, national, and global priority.  Recent happenings remind us that maternal mortality a heartbreaking tragedy that affects us right here, in New York City, and we are only 1% of this problem. It is time for maternal mortality to move to the forefront of the global conscience, because women dying from pregnancy-related complications every day is unacceptable here, and is unacceptable for the other 99% of women around the world.

In his anti-fraud campaign, President Jacob Zuma has prioritized the identification of corruption.  Throughout this process, it has become apparent that the Eastern Cape is a hotbed of corruption in the health field.  In 2011, an external audit identified R35 million in duplicate and multiple payments in just four supplier records.  In their investigation, they found 165 suppliers who listed the same phone number, while 934 had the same postal address.[2]  These instances suggest very high levels of multiple payments, and reflect the lack of oversight that has previously existed.  South Africa has also encountered large-scale thefts of medicine and supplies, with an example being the report of R120,000 worth of infant formula being stolen.  While it was originally intended for the children of HIV-positive mothers, three foreign businessmen and four health department employees are being prosecuted for the theft.[3] 

Fortunately, South African officials are making an effort to identify these crimes and address them.  Sibongile Zungu, a health department official acknowledged the problem by stating, “Corruption has a devastating effect on poor people – especially corruption in the health service. Where resources are scarce and many people need those resources, corruption can often set in. We hope to make significant strides in reducing fraud and corruption risks.”[4]  This quote underlies the cruelty of healthcare corruption in that it disproportionately affects the most vulnerable populations and serves as an additional barrier for receiving adequate care.

Moving forward, South Africa must continue to identify these fraudulent cases and prosecute aggressively.  There are cases where corruption may be indicative of larger problems within the health system, such as providers who accept bribes because they do not feel compensated fairly, many of the cases within South Africa point to opportunistic employees and outsiders who are taking advantage of the flood of cash that has resulted from the HIV/AIDS epidemic.  In addition to seeking out existing corruption cases, the country needs to implement preventative measures to protect donor and state investments in overcoming this disease and ensure that citizens have access to the resources needed to combat this illness.  These measures will promote transparency in tracking government and donor funding.  By analyzing provider budgets, the state should be able to disentangle where money is coming from while also ensuring that the funds received from conditional grants are spent appropriately.[5] 

Recently, scientists have begun experimenting by genetically engineering mosquitoes.  This “special” kind of mosquito is engineered to create offspring that die before they reach adulthood.  This means that they would be dead before they could spread diseases like malaria and dengue fever.  There has been some controversy surrounding this issue.  Many people feel that it is dangerous to allow these mosquitos to enter the ecosystem without knowing the consequences that may occur first.  Some environmental concerns have arisen, as well as weariness about how effective the mosquitos will actually be in ridding malaria.  Other people just do not feel safe with genetically engineered mosquitos flying around.  After all, once the mosquitos are let into the wild, they cannot be brought back.

A test study has already been carried out in the Cayman Islands and scientists hope to launch other experimental trials in Central and South America, as well as some parts of Asia.  Early results from the Cayman Island study have come back mostly promising.  However, one setback that did arise is that the male mosquitos that were genetically engineered were not nearly as aggressive as the wild ones to find mates. This brings about problems, considering the mosquitos need to procreate for this theory to work.  Only time can tell if the new breed of mosquitos will make a difference in fighting off diseases.

Although it seems cutting edge, if these test studies continue to show impressive results, I cannot help but think that people should consider allotting more aid money to this type of research instead of continuing with the same methods that we know have not been effective enough in eradicating the disease.  These genetically engineered mosquitos can potentially, if all goes as planned, kill off the entire species of mosquito that carry the malaria gene.  Maybe if this works, we can at least hit the Abuja targets that were not met in 2010, and aim for them by 2013!