Congo: Health Data Strengthening

By nohemie mawaka | 07 Oct, 2016

Hi everyone,
My name is Nohémie Mawaka, a recent masters graduate from Simon Fraser University (Vancouver) specializing in global health research within the context of sub-saharan africa. I am moving to Congo (my native country) in January, and I have recently partnered with some clinics in Congo (DRC), in wanting to pilot a clinical data-based to strengthen the local research capacity. To do so, I have created a survey targeting research in the North and South, and hear from you in regards to the importance of data within global health and see its feasibility for Congo.

Please take 10 minutes of your time to answer the following survey, as it would be really helpful to me when applying for funding and crowd-funding, as I intend to be the lead investigator, along with other scholars from Congo and Canada. Thank you so much:

Big Data



Dilys Walker Replied at 5:32 PM, 7 Oct 2016

Dear Nohemie,

You might be interested in taking a look at a brief whiteboard video we created at the UCSF East Africa Preterm Birth Initiative to help orient stakeholders of all types, to the importance of data. Feel free to use it if you think it would be useful for you.

Wendy McQueen Replied at 5:48 AM, 8 Oct 2016

Hi Nohemie, Congratulations and with your commitment and determination I am sure you will succeed in your endeavors. I just wanted to address the term Sub-Saharan Africa? Especially when African use it.
I always found the term to be very offensive along with third world, developing world. I recalled Dr. King saying “even semantics have conspired to make that which is black seem ugly and degrading. In Roget's Thesaurus there are some 120 synonyms for blackness and at least sixty of them are offensive, such words as blot, soot, grim, devil, and foul.”
That inspired me one day to look up the meaning of the prefix sub.
According to the Merriam-Webster online dictionary “sub” as it implies means under, beneath, below, at lower rank or secondary level, division or smaller part of, subordinate, secondary, next lower than or inferior to, less than completely, perfectly or normally”. None of which describes the geographical location of what’s implied by the term sub-Saharan Africa.
So, what the the authors of this word mean? Well I think it is pretty evident. The term is racist and offensive and it needs to stop.

When I questioned Africans on the continent about the term, they usually would say, that is what they call us. As though we are powerless over the names or terms that is applied to us. Let us stop and encourage others to stop using this racist term.

stella Nambuya lugalambi Replied at 5:54 AM, 8 Oct 2016

Interesting take. I come from Uganda and sahara desert is in the north
of us, i always thought the countries south of the Sahara were reffered to
as sub sahara, just wondering what then would be a good name for these

Ronald Leiva Roldan Replied at 10:37 AM, 8 Oct 2016

Sub-Saharan Africa is, geographically, the area of the continent of Africa that lies south of the Sahara desert. According to the UN, it consists of all African countries that are fully or partially located south of the Sahara.
Nevertheless I agree with been careful with the use of words, a Lacannian philosophy dictates "the definition of a word define the conception of it" that justify the ethical implication of using any offensive, racist, fascist, segregative, despective, etc adjective to refer to another human been, "the use, makes a norm" that's one component of moral, the only way to change miss conception, to fight the extension of terms that propagate a culture of segregation. Could be sixty offensive terms to refer a person from Africa, could be "wet back", "white trash", "red neck" or any of those thousands of expressions used commonly without any limitations or in this case implication. Its an obligation stop using this kind of terms with the respective explanation, using despective/offensive terms to refer a person is the root of the problem, because language (significant/signification) define us.

Margaret Chirgwin Replied at 11:23 AM, 8 Oct 2016


I get tired or this. I find now there are times I simply cannot speak because I do not know what is the safe term for me to use to refer to something whether it is a country or a person for fear of being accused of being racist, anti-Semitic or insensitive to this that or the other. I personally think that you have not made the case that people living south of the Sahara desert are offended to be said to be from sub-Saharan Africa. As Stella says - what is for you the safe term that we can use to refer to these countries collectively? Simply not using a term such as sub-Saharan Africa will not change the bad behaviour of rich powerful countries towards poor powerless countries just as getting rid of certain words to refer to individuals with different abilities and characteristics does not get rid of the problems they face to be treated fairly, reasonably, equally. So I for one will continue to use sub-Saharan Africa without any racial/pejorative content as I do not think this term causes any offense and you make me tired to suggest yet another word must be found because you choose to label this term as racist. It is not. I would not deny that we need generally to behave differently towards all poor nations but simply changing the name will do nothing. Actually I find that focus on being politically correct with language has done little more than paper over but not really changed fundamental attitudes. Some terms clearly are found offensive by those who they refer to because of their history and how they have been used and these clearly should not be used but seriously this one does not carry the suggested negatives. If you can find me lots of people from sub-Saharan Africa who see this as a negative term then I will reconsider but so far this is just Wendy's idea - one I have never heard before despite working in this region over many years.

Munyaradzi Madhombiro Replied at 11:41 AM, 8 Oct 2016

I agree that for progress sack, we need separate attitudes from the real issues. We in sub-Saharan Africa have so many problems that are man-made that the World has been trying to deal with.take the example of HIV and how it took so much time for us to act on it. Take the issues of poverty, we are endowed with minerals that should make us one proud sub-Saharan Africa, but, we have some of the poorest and primitive societies. We need more progress by attending to real pressing issues like the disparities in spending for example on mental health that is very low

Geoffrey Dama Caetano Madeira Replied at 12:18 PM, 8 Oct 2016

Dear all,

I am proud of been part of this kind of research groups to help others to make better things in their own countries. But I do believe that if we focus and respect only what our friends/colleagues are requesting from us we can become strong and have more positive results than being discussing things that are out of this context now.

Now going direct to talk about health data strengthen, I would give examples that we experienced in Mozambique, my home country, when we went to collect routine data to assess the burden of non communicable diseases. There was a lot of gaps:
1. The guidelines given to our countries to collect demographic data such age or ethnicity were not representative
2. Most of our hospitals they do not have patients files for some one with hypertension for instance but they do have for HIV/AIDS, again because it was recommended
3. The commitment of each health professional on data entering and data collection is poor or they do not understand the importance of them
Finally the issue of having so many meetings during the normal work period with pocket money and good food in fancy places also contributes for that in my opinion

My advice would be to look for those kind of weakness and fight them but also trying to train every single health profession in good data collection and trying to show them the results. Additionally, the founds nowadays they are also trying to push us to use more technology but bare in mind that even that needs committed people with knowledge of the data quality.
Sorry if somehow I may have offended somebody

Wendy McQueen Replied at 9:04 PM, 8 Oct 2016

Thank you guys for such an engaging discussion. Thank you Geoffrey for keeping us on track. However, how one define one selves, speaks mountains about the type person one is. It seems some people missed my point about the definition of the word sub and what it implies. Pls reread my post. Sub is not south, it doesn't mean south nor does it even imply south, in terns of geographic location. Sub means under, are the countries under or beneath the Sahara? Are they lower in rank, secondary, insubordinate, inferior as the word is define?
Why the division anyways? Why not just say Africa. Not one African said hey, lets call all this area here, sub-Saharan Africa. Africans did not create nor sanctioned that name. That's why the certain organizations have a definition for it. If someone assigns a name or title to you without your consent then yes, it is offensive and insulting. To adopt this signed name without questions says a lot about a person. So, Margaret its offensive if the person say it's offensive. All of Africa are suffering from poverty and oppression why the division?
Most Africans don't even understand the term. That is why I am breaking it down for you.

Margaret Chirgwin Replied at 7:39 AM, 9 Oct 2016

Wendy - it is hard to find a way to talk to you. I find you choice to suggest you can judge me because I choose not to see the world the way you do pretty hard to deal with. This forum is for open discussion. You are the only person who has ever suggested that the word sub-Saharan Africa is offensive and I am wondering what is really driving you here. The history of Africa and the naming of Africa and its sub-divisions is complicated and I very rarely find the stories and consequences of the naming are good but this particular term just is I believe not one that is anything other than innocuous. It is not used as a derogatory term. It is like West Africa or East Africa it allows one to talk about a group of countries that have some similarities. You may not be aware but countries north of the Sahara have quite significant differences in terms of culture, ethnic origin and levels of development (at least before the recent destabilisation of Libya) so it is sometime useful to be able to refer to all those nations south of the Sahara because they have more similarities in terms of access to education, health care and other resources. It is always dangerous to generalise but the term gets used because it is useful and as I say I have never experienced it as derogatory and do not believe that people living in these countries have found it to be so. The fact that most people in the countries south of the Sahara do not know the meaning of the word - the geographic meaning - is an indication of lower levels of education rather than anything else and I find it rather sad that you would feel it a good thing to educate them that this is a derogatory rather than geographic term. I believe the term will have been coined when people looked at maps - people in Australia and South Africa have tried to get us to turn the map of the world upsidedown but traditionally the maps all present the world with north at the top of the page and south at the bottom. In this context countries south of the Sahara are beneath/below - that is spacial/geographic and any attempt to suggest otherwise makes me very sad. There is so much strife and challenge in the world and you want to make more? Why? I would note that African's did not choose to be called Africans and many would not find this a particularly useful/acceptable name either - they may not even recognise the "country" they now live in as an entity that they want or believe in. Much of the carving up of people into nation states has not been done with the permission of those who thus become "Kenyan" or "Nigeria". The creation of National states has split natural communities and cultural groupings - elsewhere in the world the Kurds would be a good example of a people divided into 3 different national states. So all very complicated but this term really is not a problem.

You might find this book interesting: also: - I personally believe that aid has continued this under development and is part of the problem. These are the issues that we need to address not try to suggest sub-Saharan is a racist word.

Wendy McQueen Replied at 8:54 PM, 9 Oct 2016

First of all, I am not judging you. Don't get mad at me for pointing something out you were unaware of. I am all aware of Walter Rodneys' book. Which is why I thought you understand my point. You choose to do is close your mind to it. Which is quite fine. Perhaps you should check out the book Tyranny of Words by Stuart Chase. My pointing out a problem does not add to the problem. Lets end racism now!

stella Nambuya lugalambi Replied at 11:50 PM, 9 Oct 2016

If non of these books are written by Africans then it's another
propagation of the same. Just answer the questionnaire the good medic
wrote and move on.

Margaret Chirgwin Replied at 4:16 AM, 10 Oct 2016

Stella - FYI Walter Rodney who wrote the book I referred to: How Europe Underdeveloped Africa is a Guyanese historian who was assassinated in Guyana in 1980 An interesting man. The second document merely shows the flows of aid into Africa and the flows of resources out and shows that more resources are still flowing out of Africa than into Africa and this for me is what we have to do something about.

Wendy - we will simply have to agree to disagree. I do not agree there is a problem with the word sub-Saharan Africa and I hope that you will not manage tomake this yet another word I will have to find a euphemism for.

I do not have relevant information for the questionnaire but did try to complete it as requested!