9.2.2.6 Health management

In much the same way as the aforementioned sectors, the health sector is affected by the interaction of several ‘human dimensions’, e.g., inadequate service management, poor infrastructure, the stigma attached to HIV/AIDS, and the ‘brain drain’. HIV/AIDS is contributing to vulnerability with regard to a range of stresses (Mano et al., 2003; USAID, 2003; Gommes et al., 2004). Maternal malaria, for example, has been shown to be associated with a twice as high HIV-1 viral concentration (ter Kuile et al., 2004) and infection rates are estimated to be 5.5% and 18.8% in populations with a HIV prevalence of 10% and 40%, respectively. The deadly duo of HIV/AIDS and food insecurity in southern Africa are key drivers of the humanitarian crisis (Gommes et al., 2004; see also Section 9.6). While infectious diseases such as cholera are being eradicated in other parts of the world, they are re-emerging in Africa. A major challenge facing the continent is the relative weakness in disease surveillance and reporting systems, which hampers the detection and control of cholera epidemics, and, as a side effect, makes it difficult to obtain the long-term linked data sets on climate and disease that are necessary for the development of early warning systems (WHO, 2005).

9.2.2.7 Ecosystem degradation

Human ‘drivers’ are also shaping ecosystem services that impact on human well-being (e.g., Muriuki et al., 2005; van Jaarsveld et al., 2005). Several areas, for example, Zimbabwe, Malawi, eastern Zambia, central Mozambique as well as the Congo Basin rainforests in the Democratic Republic of Congo, underwent deforestation at estimated rates of about 0.4% per year during the 1990s (Biggs et al., 2004). Further threats to Africa’s forests are also posed by the high dependency on fuelwood and charcoal, major sources of energy in rural areas, that are estimated to contribute about 80 to 90% of the residential energy needs of low-income households in the majority of sub-Saharan countries (IEA, 2002). Moreoever, fire incidents represent a huge threat to tropical forests in Africa. An estimated 70% of detected forest fires occur in the tropics, with 50% of them being in Africa. More than half of all forested areas were estimated to have burned in Africa in 2000 (Dwyer et al., 2000; Kempeneers et al., 2002). Bush fires are a particular threat to woodlands, causing enormous destruction of both flora and fauna in eastern and southern Africa (for an extensive and detailed review on the role of fire in southern Africa, see SAFARI, 2004). The African continent also suffers from the impacts of desertification. At present, almost half (46%) of Africa’s land area is vulnerable to desertification (Granich, 2006).