In the words of the African Development Bank’s Babatunde Omilola, there can be no return to “business as usual” for Africa’s underfunded health systems after Covid-19. Dianna Games examines the shortfalls exposed by the crisis and the solutions they require
The coronavirus pandemic has left governments in Africa scrambling to catch up as their historic neglect of public health systems is laid bare.
Dysfunctional hospitals with limited facilities are hurriedly being prepared for a possible influx of seriously ill, contagious patients. As a tsunami of cases hit developed markets, whose much more sophisticated health systems were beginning to strain under the immense pressure, government officials in Africa were forced to spring into action to confront the serious challenges in their own systems.
Government ministers hurried to find the resources and political will to bring service delivery to long neglected communities. In South Africa, towns and villages that have not had water for years rapidly had tanks delivered to enable communities to wash their hands to mitigate infection.
Derelict hospital facilities were given fast-track facelifts. The Wilkins Infectious Diseases Hospital in Harare, Zimbabwe, was given a hasty makeover by China. Publicity following the Covid-19 death of a local media personality at the facility had exposed appalling conditions. Yet these quick fixes are sticking plasters over a gaping wound.
In too many countries, the health sector remains on the backburner of government priorities, often regarded by policymakers as a cost, rather than an investment to improve the sustainability and transformation of their economies. The lack of a properly functioning health sector undermines the notion of qualitative or inclusive economic growth – particularly at a time of global pandemic.
According to UNECA’s 2019 report Healthcare and Economic Growth in Africa, Africa accounts for less than 2% of global health expenditure but 26% of the population and 36% of the global disease burden. Meanwhile, only a handful of countries have met the African Union’s 2001 guidelines to allocate 15% of their budgets to health. Average expenditure is in the 5-6% range.
Poor facilities at home have led to the externalisation of scarce foreign exchange resources by wealthier Africans who travel to access quality medical care elsewhere. Speaking at the launch of the UNECA report, an Ethiopian official said as many as 90,000 of the country’s citizens travel abroad for medical care every year – a revenue loss of about $500m per annum.
A crisis that affects everyone
With many of the preferred medical destinations in lockdown and internal borders closed, policymakers are reliant on the defective health systems they created. Said one Nigerian commentator: “This is the first time a problem in Nigeria affects everyone here. There is nowhere to run to. You can’t throw money at it. Your other passports don’t help! The only cure is a working health system!”
The picture is not encouraging. Public hospitals across the continent are battling with water and power deficits, medicine shortages and a lack of doctors and nurses, many of whom are lured overseas for better pay and working conditions. The average physician density in sub-Saharan Africa stands at 0.2 doctors per thousand people, according to the World Bank.
With Covid-19 comes a rash of new requirements for equipment and supplies, including ventilators. Nigeria, with 200m people, only has 500 ventilators countrywide, according to one government agency. Medical oxygen is in short supply, with limited production capacity, and the country has just 0.5 hospital beds per 1,000 people. Mali, with 20m people, has just over 50 ventilators, while Burkina Faso has just 11 for a similarly sized population. Most countries have less than 10.
According to the UNECA report, 20 African countries are severely or very health stressed, which means an above average disease burden, low official spending on health, high out-of-pocket expenditures, low density of health professionals and low GDP growth rates. Out-of-pocket expenditure borne directly by patients now accounts for 36% of health spending in Africa.
An opportunity for new thinking
Governments continue to dominate the healthcare space, despite generally offering sub-standard services. There are examples of successful public-private partnerships in health, but a suspicion of business prevents more engagement. Officials still develop national health plans without considering or including the participation of the private sector.
There have been incremental improvements in some areas, including increased life expectancy, and the political will to address the problem is growing on the back of a shift in continental strategy and the introduction of new initiatives.
But the current pandemic provides a golden opportunity for more critical thinking about the quality and effectiveness of interventions in Africa’s health sector now that policymakers are forced to pay attention.
That message was hammered home by Babatunde Omilola, the manager for the Public Health, Security and Nutrition division at the African Development Bank (AfDB), who has called for the scaling up of medical technologies, increased investment in basic health infrastructure and digital health tools, and the establishment of targeted funding schemes with development partners.
As he said in a blog for the AfDB on April 17: “There is no time to waste: while finding ways to battle the current pandemic may be daunting, it also presents an opportunity to focus on the strengthening of Africa’s health systems by adopting a comprehensive and integrated approach based on each country’s individual needs. Let us not go back to business as usual after this pandemic.”