The health of the nation is a subject to many factors. The historical background, cultural traditions, budget allocations to the healthcare system, professional healthcare staff, legal regulations, and environmental decisions either contribute to or hinder the formation of a favorable environment for the individual and public health improvement. Mortality rate is a feature, which demonstrates the quality of life in the state, climate and environmental conditions, education level, numerous political and social factors, and the quality of healthcare provision. Chad is among the most vulnerable countries of the world with high mortality levels. The impact of education, economy, political factors, and the healthcare system development on healthcare decisions is pivotal. Therefore, it predetermines enhancing or worsening public health. The population of the state amounts to 12,075,985 people, which makes Chad the 75th country in the world in terms of its population (CIA, 2017). It is the seventh state globally in terms of its death rate. Meanwhile maternal mortality level and the infant mortality rate make Chad the third and the fifth nation respectively (CIA, 2017). The average lifespan equals to approximately 50 years (CIA, 2017). Such poor health characteristics can be attributed to difficult political and social circumstances, low levels of education and income, inadequate healthcare services provision, and the lack of regulatory concepts. The country can be assumed to be able to overcome the difficulties in the healthcare sphere by improving political, social, economic, educational, medical, and other factors. The particular emphasis should be put on science and technology, which are likely to positively contribute to major healthcare tendencies with the prior improvement in political, economic, social, and environmental areas.
Impact of Political Factors, Economy, Education, and the Healthcare System on Healthcare Decisions
Political and economic choices, such as budget allocations, have the profound impact on healthcare decisions. Thus, health expenditures equal to 3.6% of the GDP. This number makes Chad the 169th country in the world (CIA, 2017). The insufficient investment in healthcare is one of the major problems in this sector, which entails many others. Chad has been living in the conditions of relative and rather fragile peace for about three decades. In 1990, the country started recovering after the long Civil war and Libyan invasions (CIA, 2017). However, the relative peace has been occasionally interrupted by controversial presidential elections and the resulting riots, as well as terrorist attacks by the notorious group Boko Haram (CIA, 2017). Chad is extremely diverse ethnically and culturally; and this factor also contributes to the political confrontation. The most numerous ethnic group is Sara comprising 29.9% of the population, then there are Kanembu and Arab involving approximately 9.7%, Wadai – 7.5%, Gorane – 5.8%, and other multiple Chadian ethnicities (CIA, 2017). In religious terms, the country is half Muslim with about 52% of Muslims, and half Christian with 24% of Protestants and 20% of Roman Catholics (CIA, 2017). Although religion does not seem to have a direct impact on the healthcare system or related decisions, there are certain aspects that religious leaders can influence. Such is the opposition to immunization, which is widespread in African states. People believe that by vaccinating their children they deprive them of fertility or allow foreign missioners to test some medicine (Machingaidze, Wiysonge, & Hussey, 2013.p. 1). Therefore, policymakers have to address this issue by cooperating with social and religious leaders to influence the public opinion and make a pivotal shift in the attitudes to immunization. The improved healthcare process is likely to reduce mortality rates in Chad.
In economic terms, it is the country with the low income, the developing economy, and the industrial sector. Despite the production of oil that started 14 years ago, the state has not managed to improve its wellbeing to any extent (CIA, 2017). Forty percent of Chadians live in poor and meager conditions (CIA, 2017). Thus, in spite of the oil production, the country does not benefit from this process now, since the price for the main export goods in Chad decreased approximately by 40% two years ago (Boyce & Hollingsworth, 2015). Boyce and Hollingsworth (2015) argue that the main reason for that is the expansion of the military campaign to combat the terrorist organization Boko Haram. Therefore, the political decision concerning the military conflict expansion has entailed negative economic, social, and healthcare consequences for the population.
The demographic profile of the country demonstrates that although fertility rates are high, and the youth exceeds 65% of the general population, the mortality levels are also high. Moreover, the lifespan of people living there is low (CIA, 2017). Chad infamously leads in maternal mortality rates caused by the low quality of life, anemia, the lack of education, and insufficient awareness of family planning (CIA, 2017). Maternal mortality among ignorant adolescents from rural areas is extremely high. Its high rates can be reduced through improving the female level of education and introducing family planning principles (MSF, 2016, p. 34). The problem with maternal mortality can be associated with extremely frequent pregnancies in the absence of adequate healthcare provision and nursing support. Moreover, work and education for females can help reduce reproductive pace and contribute to the improvement of the family life and wellbeing. Hence, high mortality rates are traditionally attributed to low standards of education and income among the population.
The overall educational level is a demonstrative measure of the country’s life conditions. Thus, the expenditures on education are rather low and comprise 2.9% of the GDP, which leads to low levels of literacy among people. It insignificantly exceeds 20% with over 30% of males and 14% of females being literate (CIA, 2017). The low educational rate implies that the majority of citizens, especially females, do not tend to enter universities. Instead, both males and females tend to accept the same social and cultural path including marriage and children until it is possible. The number of females in the country that use contraceptives does not exceed 5% (CIA, 2017). Thus, family planning as one of the health factors for women should be widely addressed in health communication initiatives.
Education and training of healthcare professionals within the state is inadequate due to the tough political situation. The country has been supported by the international missions such as Doctors without Borders (MSF) (MSF, 2016, p. 34). Healthcare staff working in Chad in 2016 amounted to 571 professionals; and the expenditure totaled 22.7 million euros (MSF, 2016, p. 34). Mobile clinics provided by the MSF concentrate on gynecology, obstetrics, and neonatal care, as well as detection, treatment, and prevention of infectious diseases (MSF, 2016, p. 34). The population suffers from such infections as diarrhea, typhoid fever, hepatitis A and E, and meningococcal meningitis (CIA, 2017). The outbreaks of malaria and hepatitis E in 2016 were successfully managed by the combined efforts of both national and international MSF specialists (MSF, 2016, p. 34). Malnutrition, the lack of hygiene, and sanitation are the major contributing factors to the extension of hazardous diseases. The provision of food, soap, and anti-mosquito screens has targeted the protection of families, particularly in remote rural areas (MSF, 2016, p. 34). Therefore, along with the actual funds and medicine provided by international missions, healthcare professionals constitute an essential part of foreign aid. The international nursing staff builds awareness of the population about the principles of hygiene, sanitation, family planning, prevention of diseases, immunization, and others.
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The healthcare system can be criticized for low levels of immunization among people. In general, the African population tends to avoid vaccination for perceived social and religious reasons or do not have an opportunity to participate due to remote distances and the absence of facilities, as well as qualified healthcare professionals (Machingaidze et al., 2013.p. 1). However, international missions address the issue of inadequate immunization as the key cause of increased maternal and infant mortality levels. Nevertheless, Chad still experiences the transmission of measles due to low vaccination coverage (Machingaidze et al., 2013, p. 1). Moreover, malnutrition is a healthcare problem that originates from economic, social, and political conditions that the population lives in. The MSF (2016) targets this issue by feeding people at therapeutic feeding centers (p. 34). More than 2,000 children were saved from severe malnutrition due to these organizations. The MSF (2016) emphasizes that an effective solution to the major problems of immunization and malnutrition will require international emergency support and long-term transformational system changes from the government. The Ministry of Public Health on behalf of the MSF manages hospitals for malnourished children (MSF, 2016, p. 34). Hence, both the government of Chad and international missions have to address the problems of immunization and malnutrition as those ones, which can significantly reduce mortality rates, especially for mother, infants, and kids.
Organizational and Legislative Impacts on Healthcare Policy
Political decisions have an essential impact on the healthcare policy. The decision of policymakers to accept approximately 400,000 refugees from the Central African Republic and Sudan in October 2017 has contributed to considerable debates and created tensions in the society. It itself suffers from insufficiency of resources and complex political circumstances (CIA, 2017). Coldiron et al. (2017) have studied the population of refugee camps and found out that the majority of deaths had been caused by violence; and mostly young males suffered. However, in terms of health-related issues, the refugees from the Central African Republic living there tend to experience the same problems as the local population. Both displaced people and the local residents suffer from malnutrition, lack of adequate sanitation, hygiene, and living conditions. The government of the country has addressed this issue at local and state levels by establishing refugee camps and providing emergency support (Coldiron et al., 2017). At the national and international levels, the refugees were aided by healthcare professionals and peacekeeping forces (Coldiron et al., 2017). According to Boyce and Hollingsworth (2015), the government of Chad has been encouraged by international organizations and agencies such as the MSF to improve the delivery of healthcare services in the locations with refugees and the host population. It can be achieved through the increase in financial motivation for healthcare specialists ready to work in the most deprived areas (Boyce & Hollingsworth, 2015). The insufficiency of healthcare services and professionals in remote districts contributes to the increasing mortality rates among the Chadians and refugees. Therefore, international organizations control the provision of healthcare services to refugees and the host population in Chad. Moreover, they advocate for the improvement of services delivery, particularly to displaced people.
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Environmental, Nutritional, Legal, Cultural, and Societal Factors Contributing to Health Disparities
The environmental issues influence healthcare conditions and create health disparities. Thus, people suffer from droughts and locust plagues, while the residents of the north are especially negatively affected by harmattan winds, which damage crops and thus contribute to the malnutrition problem and mortality rates (CIA, 2017). Therefore, the first health disparity is between the people in the north and the south of the country. The former ones tend to suffer from harmattans, which cause the burst of cardiovascular sicknesses, hypertension, respiratory and infectious diseases (Okeahialam, 2016, p. 143). Additional environmental issues influencing public health in Chad include desertification, soil and water pollution originating from inadequate waste disposal in rural areas, as well as the lack of potable water (CIA, 2017). Hence, health disparities associated with climate peculiarities and natural landscapes are rather evident.
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Another factor potentially contributing to health disparities is economic, which further entails the nutritional element. Low income and unemployment add to the problem of malnutrition for individuals and their families. Thus, health disparity in this relation implies the difference between the minority of citizens with sufficient resources to protect their families and the majority that struggles for food and better living conditions (Boyce & Hollingsworth, 2015). The legal factor is involved to a lesser extent since the current problems are usually solved at a local or international level. The government tends to escape this responsibility (Boyce & Hollingsworth, 2015). The cultural element may be considered in terms of religious beliefs, which prevent some residents from vaccinating their children (Machingaidze et al., 2013). Eventually, the most influential societal division element is the differentiation between the Chadian residents and refugees or displaced people. Nevertheless, Boyce and Hollingsworth (2015) emphasize the similar current development and economic issues of the poor food provision and inadequate living conditions in Chad both for refugees and the host population. Consequently, health disparities are based mostly on the environmental and economic differentiation.
Potential Impact of Science and Technology on Healthcare Trends
The existing social and economic chaos does not allow much growth and development in Chad. However, when the country solves its most urgent socioeconomic and political issues, it will need major transformations in the healthcare sector. Science and technology can potentially contribute to the improvement of healthcare services in the state. First, the remote underserved areas could benefit from telemedicine (Krupinski & Bernard, 2014). Second, the country’s healthcare could be enhanced with mobile applications similar to the technology eMOCHA utilized by the MSF in Bolivia. It allowed notifying about potentially hazardous insects to have them removed (MSF, 2016, p. 29). In Chad, the mobile application could be used to inform about the dangers of infectious diseases in the area and the timely isolation of sick people. Healthcare trends could essentially gain from scientific discoveries and the recent research. It could be ensured by the exchange of best practices and experiences by international healthcare professionals and acquaintances of Chadian physicians and nurses with the most recent scientific knowledge through medical literature and surveys.
Chad is the country that infamously leads to mortality rates in comparison with other countries of the world. On the one hand, the primary cause of that is the life-threating social environment shaped by poor political decision-making and neighboring with other low-income states. Refugees from adjacent neighbors worsen the overall situation; and thus it contributes to the growth of mortality rates. On the other hand, internal issues such as the low level of education, unemployment, poor sanitation, hygiene, and malnutrition are also influential. While social issues are highly dependent on political circumstances, the opposite one is also true. Additionally, since health communication to increase awareness of health-related matters among the population is crucial, people are unable to tackle the current worsening of the humanitarian situation. Along with the Chadian government, international organizations and agencies attempt to contribute to the improvement of catastrophic social, economic, sanitation, malnutrition, and living conditions of both refugees and the local population. Therefore, with the help at local, national, and international levels, Chad can overcome the existing difficulties and reduce high mortality rates as the measure of wellbeing in the state. Scientific and technological advances can be used to further improve the healthcare sector after the country solves its primary social and political issues.
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