Aarli JA, Diop AG, Lochmüller H
"The Chairman of the Commission fo the African Union, Alpha Oumar Konare, recently claimed that Africa now confronts the world's most dramatic health crisis. Sub-Saharan Africa has become the poorest region in the world. Many countries still suffer from the legacies of colonialism and slavery. Interethnic conflicts add to the problems. With a population of about 700 million, around 45% live for less than a dollar a day. The medical infrastructure is poorly developed and has approached collapse in some areas. The AIDS situation represents an additional socioeconomic problem. There is a lack of hospital beds for neurologic disorders in sub-Saharan Africa. The median number of neurologic beds per 10,000 population in low-income countries is 0.03, compared to 0.73 in high-income countries. Neurologists are scarce and unequally distributed. In Europe, there is one specialist per 20,000 population; in Africa, one per 3 million people. Less than 50% of the sub-Saharan African countries have neurologic societies. There is a lack of nurses and subspecialized neurologic services (neurologic rehabilitation, EEG, EMG, neuroradiology, and stroke units), facilities for postgraduate training are poorly developed, more than two thirds have no disability benefits available, and basic drugs used for neurologic disorders may not be available or are too expensive. While social insurance is the most important source of financing health service in Europe, none of the responding countries in Africa use social insurance as the primary method of financing. Out-of-pocket expenditure is still the primary method of financing in 84.2% of low-income countries. This is likely to result in further inequity of neurologic services. The major conclusion is that the avaialble resources are insufficient to meet global burden associated with neurologic disorders."