Human Health

“Human well-being is defined as having sufficient access to the basic material for a good life, health, freedom and choice, good social relations and security (Biggs et al. 2004).” The environment, through the provision of ecosystem services such as fresh water and air, food and wood fuel, is a fundamental determinant of human health. Some examples of how human well-being and health are reliant on ecosystem services are as follows:

• Wood fuel is used to boil water to eliminate water-borne diseases and to cook food to kill parasites that can persist in food items and enter the human body when consumed.
• Medicinal plants are a primary source of medicine to the majority of the rural poor in developing nations.
• Fertile soils and access to water (rain, surface water or ground water) can ensure food security.

"Lack of access to safe water contributes to deaths and illness, especially in children. The most common of these are diarrhea, intestinal worms, trachoma, schistosomiasis (bilharzia) and cholera (Scholes and Biggs 2004)".

Access to basic ecosystem services is at times limited in the Limpopo River basin because of its biophysical conditions. When access to ecosystem services is compromised then health is also compromised. This is demonstrated by high child mortality rates, high incidences of HIV infection, low maternal health in parts of the basin and low overall life expectancy.

Life expectancy in 2007.

Source: World Bank 2010

The Millenium Development Goals and Health

In recognition of the link between health and persistent poverty the Millennium Development Goals were put in place by the United Nations guide efforts to reduce worldwide poverty by 2015. According to the September 2008 assessments the regional rates of progress in achieving these goals is uneven (UNDP 2008). Although individual countries within sub-Saharan Africa have shown progress in obtaining individual goals, as a whole, the region encountered many challenges and has been slow in meeting the goals. All of the Millennium Development Goals relate to health to some extent; however, three are directly related to health:

• Goal 4: Reduce child mortality
• Goal 5: Improve maternal health
• Goal 6: Combat HIV/AIDS, malaria and other diseases

As a region, Sub-Saharan Africa’s progress in meeting these goals has been challenged. In relation to Goal 4, although sub-Saharan Africa has only one-fifth of the world’s children under five, it accounted for half of all child-deaths in the developing world in 2008 (UNDP 2008). In relation to Goal 5, sub-Saharan has the lowest rate of births being attended by skilled health personnel (47 % on average) and is one of the two regions in the world with the highest number of maternal deaths. In relation to Goal 6, the number of HIV infected individuals is expected to grow slowly into the future.

Goal 4: Reduce child mortality

Although the mortality rate of children under five is high in the Limpopo River basin states, it dropped steadily in all four states between 2000 and 2007. World Health Organization data shows slightly different estimates. HIV/AIDS was the number one cause of death among children under five in Botswana (54 %), South Africa (57 %) and Zimbabwe (41 %) between 2000 and 2003; neonatal causes, including diarrhea were the second highest cause of death in the same three basin states. In Mozambique neonatal causes were number one (29 %), followed by pneumonia (21 %) and malaria (19 %); HIV/AIDS ranked fifth at 13 %.

Goal 5: Improve maternal health

With the exception of Mozambique, adolescent fertility rates (births per 1 000 women ages 15-19) have dropped in all four basin states (World Bank 2010).

The percentage of births attended by a skilled health staff in each basin state was estimated between the years 1998 and 2006. The lowest rate was 47,7 % in Mozambique in 2003 and the highest was 94,2 % in Botswana in 2000. Rates rose in South Africa from 84,4 % in 1998 to 92 % in 2003. In Zimbabwe there has been a drop in rates from 72,5 % in 1999 to 68,5 % in 2006 (World Bank 2010). Maternal mortality (per 100 000 live births) in 2000 was 100 in Botswana, 1 000 in Mozambique, 230 in South Africa and 1 100 in Zimbabwe.

Goal 6: Combat HIV/AIDS, malaria and other diseases

The percentage of the population infected with HIV rose slightly in both South Africa and Mozambique and dropped in Botswana and Zimbabwe. The dramatic decline in Zimbabwe is attributable to changed sexual behavior including a greater use of condoms (UNDP 2008).

Immunisation rates in South Africa fluctuated around 80 % and remained consistently high in Botswana. In Mozambique immunisation rates rose between 1999 and 2007 and in Zimbabwe they have dropped steadily since 1999.

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