Cabo Verde, a small nation of 10 islands in the Atlantic Ocean has made giant strides in health care provision. When the country first gained independence in 1975, there were only 13 doctors on the islands, the average life expectancy was 56 years, and the infant mortality rate was high, at 108 deaths per 1 000 births.
Today, Cabo Verde has six hospitals, an infant mortality rate of slightly more than 15 deaths per 1 000 births. and an average healthy life expectancy of 64 years. In 2016, life expectancy was 79 years for women and 71 years for men. It is not a rich country, but the archipelago nation has achieved a health status that some larger and richer African countries are still struggling to match.
"Important principles, like equity, like the reduction of regional asymmetries has been achieved," said H.E. Dr Arlindo Nascimento do Rosário, Minister of Health and Social Security.
Although Cabo Verde has more hospitals, health centres and other health facilities today than it did on the eve of independence, this is only part of the reason for its achievements. The country's policy-makers have taken a wider view of health and focused on ensuring universal access to health care and providing primary health care services. Today, more than 80% of the population lives within 30 minutes of a health facility.
These gains have come despite spending only US$ 165 on health care per person in 2013. In 2001 it was US$ 65.
All Cabo Verdeans are entitled to a basic package of health services, which covers antenatal care; emergency treatment; and treatment and prevention for HIV, tuberculosis and malaria. Some other medicines and consultations involve a US$ 1 surcharge, but that fee is substantially less than the actual cost of the treatment or consultation provided.
Around 40% of Cabo Verdeans have social insurance through their employers, entitling them to more health services as well as sick pay.
The introduction of telemedicine in 2012 has made it easier to access specialized care and has reduced the rate of patient evacuations from the smaller islands to those with large hospitals. It has also made distance learning for medical professionals in the country a possibility.
The management of smaller health facilities has also been radically decentralized since 2016, saving the Government money and ensuring that managers live closer to the communities they are serving. For patients requiring treatment that is beyond the capacity of Cabo Verde's health care system, like tertiary care for some types of cancer, the Government provides flights to Portugal and covers the treatment costs there. Between 600 and 700 people receive this sort of health care each year.
Ensuring a healthy population requires collaboration with many different sectors. Cabo Verde has high literacy rates, allowing the rapid spread of health-related information, along with widespread access to electricity and sanitation. The country's experience demonstrates the importance of wider stakeholder engagement across government departments to improve its health care outcomes. Multisector collaboration is a key theme of the second WHO Africa Health Forum, which began on 26 March in Praia, Cabo Verde.
"The Africa Health Forum is a great opportunity for our partners in the region to know the efforts that Cabo Verde has done for the past 43 years, since its independence, towards universal health coverage, " said H.E. Dr Nascimento do Rosário.
On 25 March, about 50 participants of the Forum took a field trip to see how Cabo Verde's health system is working at all three levels of care - national, regional and community health posts. They observed the country's innovative initiatives with telemedicine, a human milk bank and teen pregnancy prevention in action, as well organizational reforms through the regionalization of the health sector to improve access to health services.