Influence of globalization and international aid on the health outcomes:African Region

First of all, we note that globalization - as a process of interpenetration and interdependence of markets and socio-cultural communities - has led to the activation of supranational entities and intergovernmental organizations. The UN and its agencies, the European Union, the World Bank and other entities that contribute to setting international social standards are actors in health policy. These organizations compete to spread their own ideas. And for a member-state of these organizations, there is a dilemma in choosing the strategy of structures and coordinating conflicting prescriptions and recommendations. This dilemma is a reflection of the inherent conflict in the processes of globalization and quite different interests behind political solutions to specific global problems. For instance, in the African region, there is a significant difference between the levels of socio-economic and political development of human entities, different attitudes to the main problems of existence, and different value systems (Aikins et al.,2018).

At the same time, the processes of globalization in the economic sphere are occurring faster than in the political sphere. The competition between different ideological paradigms and the coexistence of alternative approaches to solving global problems slows down the spread of ideological paradigms of economic liberalization, which are closely related to the formation of the world system, the homogenization of national health systems, and the leveling of national traditions.

Some scientists, based on the calculation of correlations between the Maastricht index of globalization and health indicators, state the positive impact of globalization processes on the health of the population, as levels of mortality, both infant and adult in more globalized countries decline (Jefferies,2015). However, such statistical indicators can be interpreted differently: as evidence of the division of countries participating in the globalization processes into «winners» and «losers», belonging to the so-called peripheral world. That is, it once again proves the global imbalance, which anti-globalists like to emphasize and supporters of the politicization paradigm, which defends the radicalization of the egalitarian principle and actualizes the problem of social justice (Adepoju,2011). French scientist Brolan (2014) noted that it was globalization that caused «the strengthening of numerous types of imbalance: in most developing countries ,where poverty, inequality and violence feed on the deterioration of life , associated with the increased penetration of capitalism and the neoliberal trend in the internationalization of commodity exchange.

However, the inequality of countries cannot be interpreted as an unambiguous and direct consequence of globalization, because it existed before that. Moreover, failure to take into account the historical socio-economic contrasts between countries hinders the effective implementation of initiatives of international organizations in the field of public health. Indian researcher Hoy (2014) , notes that , for example, the WHO strategy «Health for all» was «unable to recognize differences in social, cultural and geographical conditions, as well as diseases that are most common in certain countries» . Therefore, this strategy is subject to criticism and, despite certain achievements of national governments, «Health for all» has proved to be an unattainable goal, especially at the global level.

Modern public health policy is based on the fact that the state recognizes the right of everyone to health protection, ensures its protection, and guarantees all citizens the realization of their rights in the field of health protection. WHO has consistently advocated for the responsibility of governments for the health of their populations: according to the «Health for all» strategy (1978), governments should be responsible not only for the financing of the health care system, but also for the health of the population (Matthes,2016). In general, the organization's policy documents are based on the principle of equality in receiving health care, i.e. its universality and the redistribution of income in favor of poor groups of the population.

Globalization processes are taking place against the background of regionalization of politics, the construction of supranational entities of a regional nature that seek to influence health policy. Thus, the European Union plays an active role in the implementation of the «New Public Health» concepts. The Maastricht agreement (1993) gave the European Commission certain powers in the field of health, in particular, to prevent diseases and dependence on psychoactive substances, and to distribute information and educational programs. The Commission's public health action plan identifies a number of priorities: cancer, AIDS, healthy lifestyle education, drug addiction, health monitoring, rare diseases, diseases caused by environmental pollution, accidents and injuries. To weighty decisions of the EU in the area of health include: the prohibition of advertising of alcoholic and tobacco products, ban smoking in public places, setting requirements on the minimum content of tar in cigarettes, price control through taxation and etc.

At the same time, such processes as the spread of transnational discursive democracy, which presents the idea of human rights and puts the global order on the issue of social justice, are important for the implementation of the concept of public health. Precisely for this purpose, international organizations have been developing humanitarian assistance programs for patients, refugees and the population in the war zone. People in the African region who are involved in armed conflicts receive medical services through the international humanitarian program of the international non-profit organization “Doctors without borders”. The goal of the program is to provide free humanitarian and medical assistance to victims of conflicts, natural disasters, and epidemics.

The process of globalization does not deny a certain «localization» of the policy of decentralization of many spheres of life and development of local self-government, increasing the importance of local communities. This increases the influence of local elites and the local context on policies, including those initiated by global actors.

So, the positions of global policy actors differ, and they offer different «prescriptions» (recommendations and standards) for the «treatment» of the health system. Such regulatory activities at the international level in the conditions of modern ultra-fast communication technologies, which, according to Bozorgmehr (2019), have the effect of «implosion», which predetermines the politicization of health issues and strengthening the role of the media in shaping the global health policy agenda. However, the impact of globalization on health is not unambiguous and one-dimensional. We are not talking about internationalization of relations and strengthening of international exchange, but about changing the worldview and ideological paradigms of health policy. In contrast to the egalitarian and paternalistic ideas on which the concept of «new public health» is based, there are more utilitarian approaches that present the pragmatic effects of preserving health and developing competition in the market for providing medical services, noting the expediency of observing the principles of the social sphere as well as the decentralization of the health system.

There is no doubt that such a component of globalization as the restructuring of capitalism through the approval of transnational corporations has put the issue of mechanisms for the redistribution of public resources and the provision of public goods on the policy agenda. This has prompted political debates and decisions to reduce the size of the government expenditure on social services and healthcare. At the same time, the political discourse focuses on saving financial resources, encouraging private initiatives, and increasing attention to the role of market mechanisms. One of the active «builders» of the neoliberal model of the world system- the World Bank promoted that good health of the population is a prerequisite for successful economic development. On the other hand, increasing incomes of the population, especially the poor, will allow people to take better care of their health. This international organization advocates for the right of users to choose health care providers, which includes decentralization and privatization of public institutions, involvement of non-governmental organizations; notes the reallocation of public expenditures; supports the financing of low-cost and effective health measures such as immunization, prevention programs, and others. Now the World Bank, taking into account the content of its recommendations to the governments of the borrowing countries, looks like a consistent supporter of the ideas of social liberalism.

1.3 Influence of international organizations on health: previous research findings

The World Health organization (WHO) can be considered one of the key factors in global health policy. It defines health as a state of complete physical, mental, and social well-being, not just the absence of disease or physical disability (McCall et al.,2018). The health status of the population is affected, in particular, by the environment: demographic situation, spiritual and cultural levels, financial situation, social relations, conflicts, mass media, urbanization and the pace of industrialization, and so on. This is a systematic understanding of the health of the population or public health led to the formation of the concept of «new public health», which considers health protection as a complex phenomenon that goes beyond the influence of medical services (Ebi,2018). Within this concept, it is considered that the health policy provides planned and unplanned actions of private and public organizations that affect the health of the population. These actions affect not only healthcare institutions, but also a number of other organizations.

The most famous among them are organizations such as the international organizations for human rights “Human Right Watch” and “Amnesty International”, non-profit humanitarian organization “Mйdecins Sans Frontiиres”(MSF), the International Committee of the Red Cross (ICRC), the international humanitarian organization “Oxfam” , the environmental organizations as “Green world” and “Greenpeace”, and others. In 2019, members of the organization «Doctors without borders» provided emergency medical care, where the population faces problems of limited access to medical services as a result of the program in 2018, 35,000 people were treated, and in 2019, 45,650 people were treated.

Thus, during 2008-2019, the indicator of expenditures aimed at meeting the needs of the population in medical and pharmaceutical care ranged from 54.49 (2014) to 120.5 dollars. Per capita (2017), and the average value was $ 104.83. US/per capita. In 2014 and 2018, there was a decrease in the value of this indicator by 3.8 and 6.0%, respectively. The increase in data compared to the previous period was observed in 2013, 2014, 2016, and 2017.

Overall, from 2009 to 2019, the value of the cost of health care and pharmaceutical supply per capita grew by 2.11 times.

International organizations run many similar assistance programs and collaborate with each other for greater effectiveness, collecting and analyzing disease data into a single database. Along with many organizations that provide international assistance and support to the medical sector, it is worth highlighting one organization that is inherently focused on the healthcare sector.

The World Health Organization is working to create structured dynamic databases, known as data archives, in coordination with departments of health ministries in countries, that deal with Health Management Information Systems (HMIS) at the national level. The Global Precipitation Measurement (GPM) has developed an easily adaptable structure for such an archive in the RIZ2 system, which is accompanied by a guide to the relevant data elements and indicators, their definitions and calculation methods, intended to cover the main thematic areas.

In addition, WHO recommends that countries evaluate the surveillance system. One example of this assessment and its role in improving surveillance systems is that of Mozambique' case ,where “malaria remains one of the most important national health problems in the country, despite the recent decline in morbidity and mortality rates from malaria, which accounts for 29 % of all deaths in hospitals and 42 % of deaths among children under 5 years old” argued Andersson (2011). Mozambique takes this issue seriously and puts a lot of effort into fighting with malaria all over the country. Eliminating this disease is a difficult task for Mozambique due to correlations in the dynamics of various disease factors throughout the country. Thus, for each province, an individual approach and solutions to specific problems are required. A comprehensive information and monitoring system for malaria allows to assess the local needs and problems of the population of different districts of the country, as well as provide reports and data to the government to develop a further action plan for eradication of the disease.

All standard data on insecticide resistance provided by WHO, are included in the WHO Global database on insecticide resistance and are available for study using the malaria threat Map platform. In 2019, the purpose of this online tool was expanded to include the task of providing information about invasive species of mosquitoes, and now it can be used to see the geographical distribution of mosquitoes of the genus Anopheles Stephensi, determined based on reports of their detection.

Scientific researches on related issue show that between 2015 and 2018, in 21 countries in the African region with moderate or severe malaria burden, the prevalence of anemia among children under five years of age was twice as high as among children with a negative result of rapid diagnostic tests for malaria (MRDTs). Among children, who tested positive for malaria, 9% had severe anemia and 54% had moderate anemia; in comparison, only 1% of children without malaria had severe anemia and 31% had moderate anemia. (See Figure № 1)

Figure № 1

Comparison of percentages of severe and moderate anemia diseases among children with positive and negative tests for malaria in Africa from 2015 to 2018.

Source: World Health Organization (2018).The Work of the World Health Organization in the African Region: Report of the Regional Director.

Overall, it is estimated that in 2018, about 24 million children in sub-Saharan Africa were infected with P. falciparum, and about 1.8 million of them probably had severe anemia.

In Africa, the largest absolute increase in the number of malaria cases in 2018 compared to 2017 was noted.

The number of deaths from malaria decreased from about 400,000 in 2010 to 260,000 in 2018, with the most pronounced decrease in this variable observed in Nigeria, where the number of deaths from malaria decreased from about 153,000 in 2010 to about 95,000 in 2018. (See Figure №2)

Figure №2

The number of deaths from malaria overall in Africa and Nigeria in 2010 and 2018.

Source: World Health Organization(2019).The state of the health in the WHO African Region

By 2018, at least 40% of the population at risk of Contracting malaria slept under nets treated with long - acting insecticide (soidd), with the highest rate in Uganda (80%) and the lowest in Nigeria (40%).

In 2018, it is estimated that in Burkina Faso and the United Republic of Tanzania alone, more than half of pregnant women received three doses of an antimalarial drug as part of intermittent preventive therapy for malaria during pregnancy (Iptb). In Cameroon, Nigeria and Uganda, the estimated coverage rate was about 30% or less.

In 2018, six countries in the Sahel sub-region of Africa implemented the seasonal Chemo-prevention of malaria (CMP) program; of the 26 million children in the target population of this program, an average of 17 million received treatment in a single cycle of CMP.

The percentage of requests for help for fever in children under five years of age ranged from 58% in Mali to 82% in Uganda.

To protect women living in Africa in areas with moderate to high levels of malaria transmission, WHO recommends the use of Iptb using the antimalarial drug sulfadoxine-pyrimethamine (SP). It is estimated that in 36 African countries that reported Iptb coverage levels in 2018, 31% of pregnant women who received this treatment received the recommended three or more doses of Iptb, compared with 22% in 2017 and 2% in 2010, indicating a significant improvement in coverage rates.(See Figure № 3)

Figure № 3

Percentage of using Iptb by pregnant women in 36 African countries in 2010,2017 and 2018.

Source: World Health Organization (2019). World malaria report 2019.

Of all women who seek prenatal care at least once, about 18% do not receive any Iptb, which can be seen as a missed opportunity that could significantly and quickly improve iptb coverage.

The main element of the Global Malaria Technology Strategy 2016-2030 (GTS) is the transformation of malaria surveillance into a key activity. WHO recommends regular monitoring and evaluation of these systems in order to determine whether malaria surveillance systems are in line with the goal.

In order to facilitate data analysis and interpretation, WHO Global Malaria Program (GMP) in collaboration with the University of Oslo, has developed standardized modules on malaria for District health information systems 2 (riss2), which serve for routine collection and aggregation of standard data for individual cases and contain relevant data elements, panels of key epidemiological indicators and data quality indicators, reporting forms, and a training program for data analysis at the agency level.

As a result of the activities of international organizations and the processes of globalization in Africa since 2010, malaria diseases have significantly decreased by 12%.

WHO and other UN agencies as United Nations Children's Fund (UNICEF), Joint United Nations Programme on HIV/AIDS (UNAIDS), ILO, UNDP and others that deal directly or indirectly with health issues actively contribute to the fact that the discourse on the right to health protection for all people, the provision of additional social guarantees to those who have certain health problems and consequently special needs, has become global in nature, has actually become part of global communication processes, reflected in international conventions and declarations signed and ratified by many states. Commonly, health is presented as a public and individual good, the protection of which should be a priority of state policy aimed at a comprehensive solution of health problems. Thus, in the field of health, the UN structures - within the framework of the paradigm of moderate globalism - adhere to a modernizing political strategy focused on the formation of a system of power on a legal basis, the approval of ideas of transnational discursive democracy. This trend continues. Bridge (2002) defined it as «the global process of democratization».

The health sector is indirectly but very significantly affected by the economic and trade agreements concluded by the member-states of the World Trade Organization. Formally, such documents are aimed at regulating market competition, promoting free trade, removing barriers to the movement of goods and capital, and prohibiting protectionism of local goods and services. However, in practice, this means a «free» market for medical services, medicines, greater freedom of employers, etc., and this undermines the already weak position of the collectivist social protection system and the concept of public health protection.

Some experts insist on more active use of bottom - up approaches to planning and implementing policies in the health sector (McKee et al.,2014). According to Kishore (2010), in order for «Health for all» to become a reality, 95% of medical care must be provided at the community level under its administrative and financial control: «An adequate health system should become a function of the community and replace the supercentenarian, super-bureaucrat, super-professional, and super-medical health system that has become a lucrative trade in human suffering» (Kishore et al.,2010). Instead, the WHO strategy offers a number of vertical management solutions to address primarily socio-economic problems. But the World Bank and the IMF, which seek to reduce the burden of state responsibility for all spheres of public life, push for political and administrative deconcentrating of power, and initiate a policy of deregulation. The multi-vector «instructions» of global actors are not transferred mechanically to the local level, they are fragmented and modified in various combinations.

Chapter 2. Analysis of the impact of globalization and international assistance for health in the African region

2.1. Current state of the African region

Healthcare sector

At present, the position of Africa in the international system is assessed as rather weak due to the fact that the African region is not able to keep up with economic and human development. On the other hand, such weak performance of African countries may partially be explained by the social and political instability in the region and the power of authoritarian regimes that have captured most of post-colonial Africa, further undermining the opportunity for an effective fight against globalization.

Additionally, one of the most important public health problems in the African region is the selection of medical workers and their professional training, taking into account the population growth and the lack of medical workers due to early death, retirement, dismissals of their own free will and on the initiative of the administration. Africa is severely short of professional specialization and medical workforce. The problem of “brain drain” in the African region remains relevant to this day. Although many young professionals remain in Africa to contribute to the development of their country's healthcare. With the help of numerous programs from international organizations, African doctors can learn the latest techniques in the field of medicine and successfully apply new knowledges for improving domestic healthcare systems.

Economic sector

The economy of the African continent was formed mainly as a result of the activities of colonial administrations and private foreign companies as an appendix to the economy of the home countries. Its current state is determined by the influence of various external factors. Therefore, when analyzing the indicators and problems of economic development in this region, we have to take into account, along with national circumstances, the current situation and long-term trends inherent in the world economy and international economic relations. The large number of countries on the continent and the commonality of most of their economic problems determine a generalized approach to the presentation of the material. There are two sub-regions: North Africa and sub-Saharan Africa. Most African countries are small, economically weak, with small populations and little developed natural resources (Nhemachena ,2017). These countries are mostly economically dependent on their former colonial areas. The economic development of African countries is characterized by unevenness, instability and large-scale crisis phenomena, both of purely economic origin and caused by political factors.

Today, the African continent has become a field of competition between the leading Western countries -- the United States, France, Great Britain, and Japan. As an economically least developed region of the world with limited opportunities for high-yield industrial investment, Africa attracts the attention of these countries primarily for its unique natural resources. The main share of investment is directed to the development of raw materials on the continent. As an effort to ensure their production of raw materials, Western countries are concentrating investment in a dozen countries in the region, which have significant reserves of oil, metallurgical raw materials, uranium, diamonds and other valuable materials, and favorable climatic conditions for plantation farming.

Nigeria's textile industry previously created jobs for more than 350.000 people, but now only a tenth of that number, demonstrating the challenge of deindustrialization in Africa, which has occurred during a decade of rapid economic growth driven by high commodity prices. Over the past 15 years, sub-Saharan African countries have experienced economic growth of about 5% per year on average. The commodity boom, which was caused, in particular, by rapid urbanization in China, largely helped African economy. With China's slowing economy, prices for many commodities produced in Africa fell again. Copper, for example, is now sold at half the price it was at the peak. This, in turn, slows Africa's growth: the IMF estimates that the growth rate will fall to 4 % soon, which, many believe, will lead to a repeat of the consumer boom and bust. One of the main reasons for concern is that Africa's manufacturing industry has not benefited from the boom.

The United Nations Economic Commission for Africa (ECA) estimates that from 1980 to 2019, the contribution of the African manufacturing sector to the continent's overall economy actually decreased from 12% to 11%, and is the smallest share compared to any region that is developing (Skovdal , 2015).

In addition, in most countries in sub-Saharan Africa, the share of production has fallen over the past 25 years. The comparison between Africa and Asia is striking. In Africa, manufacturing provides just over 6% of all jobs, a figure that has barely changed for more than three decades since 2008.

Many countries go through the process of deindustrialization during economic enrichment. Growth in services, such as entertainment, helps reduce the share of production in the country's economy. But many African countries are reducing production, even though their economies are still poor, thus losing the chance to profit from moving workers from the agricultural sector to higher-paying positions in factories.

Premature deindustrialization is not only occurring in Africa. In other countries, there is also a slowdown in the number of factories, partly due to the fact that high technological development reduces the need for low-quality labor. «Steel production is now less labor-intensive» says Margaret McMillan -a professor of economics at Tufts University. This means that it is becoming increasingly difficult for African companies to create jobs at the same rate that Asian firms have been creating since the 1970s (Stierman et al.,2018).

However, deindustrialization seems to have a significant impact on African countries. This is partly due to the fact that poorly developed infrastructure significantly increases the cost of production. In 2010, the African Development Bank found that electricity-a significant item of expenditure for each producer-costs on average three times higher in Africa than even in South Asia. Poor roads and crowded ports also increase the cost of moving raw materials and shipping finished products.

Another disadvantage of Africa, oddly enough, is the availability of a large number of natural resources. The boom in commodity prices over the past decade has brought with it the «Dutch disease»: economies that benefit from exporting petroleum products have increased their exchange rates, making imports of goods such as cars and refrigerators cheaper, but producing and exporting their own products more expensive.

Another obstacle to Africa's development is its location. A number of East Asian countries have succeeded using the «flying geese» paradigm: the main country creates an example to follow. This first happened in the 1970s, when Japan moved its labor-intensive production to Taiwan and South Korea. But Africa seems to have lost its chance. China's light industry is moving to neighboring Bangladesh and Vietnam, rather than to far-off Africa, despite a large amount of cheap labor. Thus, Africa's economic growth is not driven by export-oriented production.

However, in some African countries, the trend is reversed. Ethiopia's production grew by an average of more than 10% per year between 2006-2019, partly due to foreign investors. The industrialization of Ethiopia is taking place through cooperation with horticultural companies from the Netherlands, leather and textile companies from China and Turkey. This case is covered by cooperation with pharmaceutical companies in Germany and Sweden (Aikins et al.,2018).

Ha-Jun Chang, co-author of the ECA report, argues that Ethiopia's relative success has come through targeted policies. Poor countries often find it difficult to decide whether to expand their new infrastructure or focus on the most promising areas. Instead of running electricity across the country, Ethiopia has focused on building electrical and transport links to its industrial parks. It was also advisable to attract companies associated with industries that are already present in the country. Due to the fact that firms buy raw materials from local producers, the quality of local products increases, because foreign firms send their managers and technical specialists to local ones. This helps them create more competitive products (Adepoju,2011).

But it is not only Ethiopia that is progressing. Tanzania, where industrial production has grown by 7.5% annually since 1997-2019, is pushing for Chinese and Singaporean clothing firms to enter its market and began building its first mega port and industrial Park last month. Rwanda has attracted investments from Helen guy, women who created the most successful Shoe company in Ethiopia. Its clothing factory plans to hire 1,000 employees by the end of the year (Hammonds et al.,2017).

Yet factories don't create nearly enough jobs for the millions of young people moving to the city each year. Most of them end up working in low-productivity businesses, such as stores or restaurants. Africa accounts for only 2% of global demand. In order to grow rapidly, African countries need to shift production to more productive industries. Without decisive action, they risk another lost decade.

In some African countries, programs to modernize the national economy are being developed and implemented. However, for most countries, the international community should provide its experience and material assistance to create conditions for transition to the market. The future of Africa and its place in the world economy depends on many circumstances. First, it depends on how quickly and how effectively the governments and peoples of this continent will be able to overcome the trends of disintegration and social chaos, and some countries will be able to turn the para -- economy into a normally functioning economy with sustainable development. Secondly, from the actions of world cooperation, represented by international organizations and financial institutions. Third, the emergence of leaders in Africa who have authority, the ability to lead society in any conditions, and who understand African realities in the light of global changes. Given these circumstances, more attention should be paid to the development of agricultural areas in agricultural production, and pricing policies and incentives for investment by small farmers should be supported by institutional and structural reforms. It is important to strengthen control to prevent environmental violations and land desertification. It is necessary to solve the problems of inefficient state-owned enterprises and eliminate bureaucratic procedures in the public sector of the economy. It is possible to carry out privatization in cases where it is justified from a financial point of view and socially acceptable. The role of social protection must be strengthened and financial flows from public and private sources must be restored to African countries.

2.2 Analysis of the impact of globalization on health in the African region

In the African region, where life expectancy is low, social inequality is constantly increasing. Income inequality hinders the formation of social capital, which in turn has a negative impact on public health. The weakening of social capital leads to the disunity of society, increasing the sense of isolation and vulnerability of its members to social problems, which in turn leads to an increase in the number of stressful states and depressions. Moreover, in order to relieve stress, people who encounter stressful circumstances can resort to alcohol abuse, tobacco smoking, and psychotropic drugs. Such abuse significantly increases the risk of death due to external causes (accidents, violent actions, etc.) not only for the poor, but also for the entire society (Rowson et al.,2018).

The decrease in the absolute number of inhabitants of the African region is the result of such opposite demographic processes as low birth rate and high mortality, which is a central indicator of the relationship between socio-economic determinants and the health of the population of the modern African region (Stewart,2016). The conditions, in which people are born, grow up, live, work, and age, including health systems, are actually characterized by social determinants. These circumstances are shaped by the distribution of money, power, and resources at the global, national, and local levels, which in turn are influenced by the policies being implemented. It is the social determinants of health that are at the root of most health inequities, i.e. discriminatory and differences in health indicators that are observed in countries and between countries and can be removed (Aikins et al,2018).

An extremely important characteristic of the country's socio-economic development, which affects the demographic situation in it, is also the standard of living of the population. To characterize it, a number of quantitative and qualitative indicators can be used that reflect various aspects of people's well-being, satisfaction of their physical and spiritual needs, such as the total volume of consumption and quality of food, the amount of wages, working conditions, housing conditions, the ratio of free and working time, the educational and cultural level of the population, etc. (Bozorgmehr,2019). However, in a market economy, the domination of money relations is the most universal indicator of the level of income, which expresses the level of life of the population.

The study of the relationship between the population's income and its health is one of the issues that are currently in the focus of scientists ' attention (Silva,2018). The main aspect of these studies is the impact of inequality in the distribution of income on the health status of the population, which is usually indicated by the indicator of mortality or life expectancy.

Income differentiation leads to unequal access to quality health care, goods and services that directly or indirectly contribute to improving health, which in turn leads to a decrease in the effectiveness of preventive health care and disease control measures.

Another approach is the negative impact of inequality of states on health due to the occurrence of socio-psychological stress, which leads to the development of neuroses, hypertension, cardiovascular diseases, increased mortality from accidents, suicides and homicides.

The negative effect of social stratification on public health is mediated. Therefore, health policy should aim to reduce the total burden of adverse conditions. In efforts to reduce health inequalities and create more acceptable conditions for public health protection, health policy cannot be separated from other actions that are applied for the development of the state. Accordingly, the link between health policies and those of other sectors, such as employment, maintaining income levels, and social security, living conditions, and education, is vital for all States. It is confirmed that by creating equal opportunities for income generation and increasing the associated level of cultural development of society, it is possible to improve the psychosocial well-being of the population.

The real level of well-being of the population can be estimated using qualitative and quantitative parameters, which determine the health and quality of life. Scientific research highlights the relationship between inequality in wealth and the level of life expectancy.

The study found that globalization affects various aspects of health care, and its influence is controversial, non-linear. The manifestations of globalization in healthcare are presented in Figure №4.

Figure №4

Globalization of healthcare

Source: Hughes, O. E., & ONeill, D. (2008). Business, government and globalization. Basingstoke: Palgrave Macmillan.

The impact of globalization on health systems is manifested in the unification of health systems associated with increasing life expectancy and rising health care costs. An increasing number of countries are using the social health insurance system, where the combination of compulsory medical insurance (MHI) and voluntary medical insurance (VHI), according to WHO experts, is the most successful solution for organizing and financing a health system.

Globalization contributes to the growing role of international institutions, regulating healthcare at the supranational level (UN, WHO, Global Fund to Fight HIV / AIDS and Tuberculosis, Malaria and their departments). They act together, take into account each other's positions, thus forming a unified global healthcare network and relevant global policy, designed, in particular, to coordinate efforts, mobilize funds for implementing global health strategies.

Globalization has both positive and negative aspects. It can increase well-being. And it also stimulates a growing sense of solidarity and shared responsibility for people's health. But there is one problem: the globalization process is not governed by any rules that guarantee a fair or balanced distribution of its benefits. As has been noted by various studies, the economic benefits of globalization, commonly, are received by those countries and population groups that already have a high level of well-being and a sufficiently developed economic environment, as a result of which other countries and population groups are lagging more and more and not receive benefits from globalization processes. The globalization process will not self-regulate in such a way as to ensure fairness in the distribution of benefits. In all these areas, conscious and thoughtful political decisions are needed.

The lack of social solidarity causes the deterioration of the health of older people (Bennett,2013). This occurs both in the absence of decent respect for the elders in society, which leads to a sharp sense of their uselessness, and due to the fact that in such a public atmosphere, state bodies seem to be allowed to perform their functions inappropriately for the social protection of people of older age groups. These people, burdened with acquired diseases over the years, with the beginning of changes in the state have lost their labor savings and have no source of income other than a very small pension. This caused a sharp drop in the ability to purchase the necessary goods and services, which could not but affect the overall health situation of this population. After all, one of the consequences of the residents ' poverty was a decrease in the consumption of a number of food products. Full-fledged nutrition is among the most active factors in the prevention of diseases and promotion of human health. (Hoy et al.,2018).

Consequently, raising the standard of living and thus neutralizing many socio-economic factors that affect health should also serve to increase the level of pension provision and the level of remuneration for a number of employees, primarily in the public sector. However, the achievement of a qualitatively new stage in the growth of incomes of the population of our state becomes an obstacle to the growth of prices, especially for groups of goods of social significance, which is also one of the characteristic features of the current socio-economic situation in the African region. As a result, the standard of living of citizens in comparison with residents of economically developed European countries remains low and therefore it is too early to speak about the complete overcoming of poverty in African countries.

The key point in ensuring the development of the health care system is the level of funding for the system and the appropriate amount of financial resources (Bozorgmehr,2019). Achieving a new quality of work in the medical industry in accordance with the requirements of modern times, based on world experience, requires an increase in health care costs. At the same time, the total amount allocated to the health system in the African region in 2018, including medical subventions and expenditures from the General and special funds, was 89 billion 935 million 700 thousand. Doll. This is 2.53% of GDP, which is much less than in countries with such a qualitative parameter of the level of health as the state of mortality of the population, whose GDP per capita is also several times higher than in our country.

Today, the health system in the African region is in reformation. The most important among the problems facing at the present stage of development of national health care is organizational and economic problems. These are, first of all, such as: forming the optimal resource potential of the health system and the socially necessary structure of medical personnel; determining and searching for possible and necessary amounts of funding, innovation and investment; improving the territorial organization of medical institutions and quality management of medical care; improving disease prevention and healthy lifestyle, improving the territorial availability of medical care, that is, improving regional health policy.

World Health Day 2019 was dedicated to the prevention, detection and treatment of diabetes. Eighty percent of people with diabetes live in low-and middle-income countries. According to WHO, if urgent action is not taken, the number of deaths from diabetes can increase by more than 50%. By 2030, diabetes may become the 7th cause of death worldwide. Extrapolating this problem to the situation in the African region, the prevalence of diabetes among our population since 1991 (1676.60 per 100 thousand people). persons) is constantly growing (+81.38% in 2019 to 1991) and amounted to 3041.00 per 100 thousand persons in 2019.

Thus, the above shows that the most important thing in the African region is the implementation of measures to achieve public health results, taking into account social and economic influences. This requires close attention to public health issues. In contrast to individual health, which is largely determined by biological factors, public health is directly determined by social and economic factors, including the current health system, which should ensure the availability of medical care and its proper quality.

2.3 Evaluation of international health assistance in the African region

The assistance of international organizations such as those of the UN system to African countries is provided through the support of the main budget of UN institutions from donor states. Regular contributions become an integral part of the assets of the respective organizations. As part of the United Nations Development Program (UNDP), a regular budget is adopted every four years: the bulk of the funds is allocated for the maintenance of the organization and the implementation of programs, the list of which is approved by the Executive Council on the basis of a framework partnership agreement with the country.

International financial institutions - the IMF and the World Bank group, which have the status of specialized agencies of the United Nations - occupy an important place in the system of promoting the development of healthcare sector in Africa. The activities of the International Development Association (IDA), one of the main institutions of the World Bank, are aimed at reducing the incidence of diseases and mortality rates in the African region by providing loans and grants to implement programs for the development of the health sector, reducing the unequal distribution of international assistance and improving the living conditions of the population.

To achieve the goals of an ambitious and broad-based health transformation plan, the African region actively engages numerous national stakeholders, governmental and non-governmental organizations, as well as international organizations and development agencies working in the health sector, which ensures consistency and coherence in the health system reform process.

WHO supported the health development agenda in the African region by promoting information exchange, coordination and coherence among partners. WHO also supported the Ministry of Health in providing leadership in the policy development dialogue to ensure a multidisciplinary approach to health sector regulation and building national partnerships in all health-related areas among national and international partners through the following measures.

Also, the WHO has organized and facilitated a number of high-level coordination meetings with multiple partners, thus providing an opportunity for various agencies to prioritize their activities, coordinate areas of work, and strengthen concerted efforts to support the transformation of the national health system.

Moreover, WHO regularly provides opportunities for collaboration between the African region and international medical communities, promotes links with recognized international organizations and associations, and promotes the participation of delegates from the African region in key international health events.

WHO supported the African region in its quest to become a partner of the international UHC2030 movement, which forces the development of the universal health system? At the seventy-second session of the World Health Assembly in May 2019, a Global Agreement on steps towards universal access to health services was signed.

In August 2019, WHO led the process of organizing a meeting to strengthen dialogue among international partners on how the international community can further support the African region in activities to improve the health of the country's population.

Among the key areas of work and achievements, defined by Ogutu(2019):

- During a joint mission in 2016, WHO initiated a joint statement with other international partners in support of the proposed direction of health sector reform in the African region.

- WHO has organized and facilitated a number of technical missions to share knowledge about health system reform, provide technical assistance, and conduct seminars on drafting laws on new approaches to financing.

- WHO contracted and advised consultants who supported the Ministry of Health at all stages of drafting documents and approving the concept of health financing reform. This concept was the first step in the development and approval of a new law on changes in the field of healthcare financing.

- In May 2019, WHO and the World Bank organized a high-level bilateral meeting with international partners to review and document the results achieved in the three years since the launch of the Health Finance Reform, with the aim of further catalyzing the transformation of the health system in the African region.

Chapter 3. Directions for improving the impact of globalization and international health assistance: African region

3.1 Problems of development of globalization and modern international health organizations in the African region

The development of medicine over the past century has allowed us to solve many problems in the field of health preservation, the main result of which was to increase the life expectancy of people, overcome epidemics of some very dangerous infectious diseases, and use effective means of treating non-infectious acute and chronic health pathologies. However, dynamic changes in modern society form new challenges in the medical sphere, which it is not able to solve without the development of a preventive policy and activation of education, media, labor protection, recreation, sports systems to form a new culture of public health, attracting them to healthy and health-improving life practices (Ebi,2018).