analysisBy Renu Modi
Underfunded, under-resourced, and avoided by those who can afford to go abroad, African healthcare urgently needs an overhaul.
Tomorrow, President Mohamed Ould Abdel Aziz is scheduled to finally fly home to Mauritania having recovered from his "accidental" shooting in October thanks to the care and attention of the French healthcare system.
Shortly before his emergency rush to Europe, Patience Jonathan, First Lady of Nigeria, had been receiving treatment in a German hospital for an undisclosed ailment. Before her, Prime Minister Meles Zenawi of Ethiopia had also opted to leave Africa's shores for medical attention, finally passing away in Brussels in August, and thus following in the footsteps of Presidents Malam Bacai Sanha of Guinea Bissau who died in a hospital in Paris this January and John Atta Mills of Ghana who died in July shortly after receiving treatment in the US.
This is by no means an exhaustive list but it does begin to illustrate the fact that the leaders of Africa clearly do not have faith in the medical systems of their own countries. They vote with their feet at times of medical emergencies and access healthcare beyond their own state borders.
Travelling overseas for healthcare facilities is not a new process, but it is becoming more common in many parts of the world. The privileged few in Africa who have big budgets, usually go to Europe for treatment. Those with a little less often go to India for higher quality healthcare at relatively affordable prices in private hospitals. (Ironically, India spends just 4.2% of its GDP on health, well below several countries in Africa, and its state-of-the-art private hospitals are unaffordable for the majority of Indians.)
But most in Africa cannot afford expensive treatment in Europe, India, or elsewhere. And they cannot even afford decent medical treatment - if and when it is available - in their own countries.
What does such disparity say about the health sector in Africa? Why are medical facilities so inaccessible in so many parts of Africa?
The bitter pill
Several factors contribute to the deficiency in healthcare in Africa. The public healthcare system in most parts of Africa is debilitated. With low investments in the sector, hospitals are understaffed, and medical training colleges are inadequate. Low salaries and limited career prospects often compel trained medical professionals to migrate to other countries. Africa has less than 15% of the world's population but 25% percent of the global incidence of diseases, and only 3% of the global health force. There are only two physicians per 10,000 persons in Africa, as compared to 14 in China, 27 in the UK and 42 in Norway.
The healthcare sector in Africa is under-financed; many African countries are not committed to the Abuja Declaration of 2001, in which member states pledged to allocate at least 15% of their annual budget to the health sector. The total expenditure on health as a percentage of the GDP in 2008 was between 4-6 % in Ethiopia, Kenya, and Nigeria, and 7 to 9 % in Ghana, Malawi, Rwanda, South Africa and Uganda. Only a few countries in Africa spend more on healthcare - around 13% of the GDP in Burundi, Liberia and Sierra Leone. And no country has reached the Abuja target, despite an overall increase in development assistance to healthcare from donors.
A regular supply chain of affordable medicines and pharmaceuticals is also not in place because of limited indigenous production of drugs and scarce medical research facilities. Weak regulation has meant that counterfeit drugs are easily available. Locally-produced drugs are often sub-standard. And expensive drugs have to be imported, which further increases the costs of healthcare.
The medical infrastructure in the private sector is relatively better in some countries such as South Africa, Mauritius, and Botswana, than in others. But private hospitals are expensive and beyond the reach of a majority of the people.
Healing the healthcare sector
It is clear that the healthcare sector in Africa needs to be urgently reformed.
Long-term changes could be brought about by increasing the funding for healthcare, prioritising medical research in budget allocations, and by increasing the remuneration for health sector workers.
As an intermediate step, advanced medical care could be made available through public-private partnerships in hospitals. This is already being done in a few places - for example, at the private hospitals run by the Aga Khan Foundation in Kenya and Tanzania. These hospitals are unaffordable for the majority in Africa, but with the advantage of proximity they could be an option for treatment or follow-up within Africa for the middle-classes and for people who can pool resources through family or social networks such as the Church.
To lower the cost of treatment, the governments of African countries could subsidise these partnership hospitals. A more viable alternative would be to build public hospitals that can hire the services of medical professionals from the private sector or from the general pool of medical professionals trained in the country, by offering them attractive salaries.
Policy-makers in Africa also need to address the contentious issue of the availability of affordable generic drugs, and reduce the continent's dependence on exorbitantly-priced patented drugs made by multinational companies. They should not look to support anti-generic drug laws, as Kenya did in 2009. Inexpensive generic drugs for the treatment of HIV, supplied by a few pharmaceutical firms from the likes of India, have made a big difference in Africa.
A dose of their own medicine
But none of these changes are possible without transparent allocation of funds and good governance. The most significant reason for the poor state of healthcare in Africa is a lack of political will to overhaul the healthcare system. The political elite have access to foreign hospitals, and their bills are reimbursed by the state exchequers. They do not have to suffer the consequences of poor medical facilities in their own countries.
If it becomes mandatory for the political leaders of African nations to undergo medical treatment at home, or becomes difficult for them through restrictive legislation to pursue treatment abroad, the healthcare sector in Africa would probably improve rapidly. In Nigeria, the federal government is reportedly planning to stop funding the foreign medical treatment of its leaders. With this, Nigeria could indirectly be taking a step towards meeting its commitment to the Abuja Declaration.
Civil society could also collectively oppose politicians who access medical treatment outside their own country. The combined legal and social pressure might force the governments to upgrade medical services at all levels, and this could eventually make decent healthcare available to all in Africa.
An earlier version of this article was originally published here at Gateway House.
Amendment (23/11/2012): The article originally stated that there are six physicians per 10,000 people in Africa. The World Health Organisation in fact estimates that there are just two physicians per 10,000 people in the African region. This has been corrected.
Renu Modi is the Africa Studies Fellow at Gateway House: Indian Council on Global Relations. She is the former Director of the Centre for African Studies, University of Mumbai.