LSE alumna Amaka Okechukwu calls on African governments to implement policies that will reverse the tide of health tourism. This post originally appeared on afrimind.
“What are you going to do if you are sitting at home (in an African country) one day and your heart starts to hurt and you realize that you are having a heart attack? Will you get on a flight to Germany? No, chances are you will die.”
These are the words of Ernest Madu, a Nigerian who founded the Heart Institute of the Caribbean, a revolutionary clinic for cardiovascular diseases in Kingston, Jamaica. In a time when there is a focus on diseases like HIV AIDS, malaria and the like, his words make one ponder whether we are giving adequate attention to the state of healthcare infrastructure in certain Sub-Saharan African countries.
There are several facts that hint at the state of healthcare infrastructure in Africa. One of them is the growing rate of medical tourism where people travel abroad to seek medical treatment. Patience, Nigeria’s first lady, recently came back from a medical trip in Germany, Miles Zenawi the former Prime Minister of Ethiopia died while undergoing medical treatment in Brussels, Nigeria’s former president, President Yar Adua, was hospitalized for a long time in Saudi Arabia before his death was announced while he was in Nigeria. These trips are also made for seemingly less threatening ailments. For example, the former vice president of Nigeria, Atiku Abubakar sought treatment in London after damaging his knee. Similarly ,President Mugabe of Zimbabwe travelled for routine cataract surgery in Singapore last year. This travel is not just limited to government officials and includes the rich and middle class who can afford to do so. In Nigeria, thousands of citizens fly to India every month to seek medical treatment.
So why do lots of Africans pay exorbitant prices to seek medical help? Almost everyone knows the problems but very little discussion goes into the solutions. However in order to discuss solutions it is sometimes useful to understand the reasons why the problems exist in the first place. One of these reasons is the inadequate funding for healthcare in many African countries. Although many countries signed up to the Abuja Declaration to spend at least 15 percent of their annual budgets in the health sector, no country has met the requirements and health budgets are much less. Then there is the C word – corruption. Even with the few funds that are going to healthcare, some of it is siphoned off into private hands. However there is something to be said about poverty. Some countries – like Malawi –with a GDP of 5.7 billion dollars are simply poor. This means that even if they spent all 15 percent of their budget on healthcare, there will most likely still be a healthcare infrastructure gap.
This lack of funding is a bad leech that slowly sucks out the life from any healthcare system. First of all, it leads to decay in healthcare infrastructure. Secondly, it leads to underpaid doctors who either go on numerous strikes, or leave completely to go to other countries to practice. It is estimated that over 30 percent of foreign doctors in the US are African. Funding is not the only problem and is no excuse for some of the poor management in certain hospitals. A few years ago, my two year old cousin fell and had a concussion. After days of failing to find a functioning CT scanner in the hospitals in Abuja (including the “state of the art” National Hospital), she had to be flown to Lagos for a simple scan.
So what can be done? The first thing that is evident is that there needs to be funding. Is foreign aid the solution? Maybe it can be part of it. However in an era where foreign aid funding falls year after year, it is clear that it cannot be a long term solution or the only solution. One possible long term solution is the use of Public Private Partnerships (PPPs) in health. These involve collaborations with the private sector and non-governmental organizations in providing health. For example, in Lesotho, the government entered into an agreement with Netcare to build and operate a new referral hospital to replace the dilapidated Queen Elizabeth II hospital for a fixed annual fee from the government. In Malawi, the government currently has a partnership with CHAMS (an NGO), where they operate some of the government hospitals and recruit top quality doctors for the hospital in exchange for a fee. These examples all involve some form of government funding. However they also offer some benefits and solve some of the problems. First, not all the funding needs to come from the government as the private companies are able to recoup some of their costs from charging patients for their services. This reduces the fiscal impact of these projects. Second, it can solve some of the management problems seen with government-run hospitals. Private companies in this model have incentives to provide good healthcare if their payment are dependent on results.
Will this just be health care for the rich and not for the poor who might not be able to afford the treatments? No – it doesn’t have to be that way. There are ways to keep costs down. For example Ernest Madu’s hospital in Jamaica treats patients at a tenth of the cost of treatment in places like the US. One of the ways in which they keep the costs low is by manufacturing and servicing some of their own hospital equipment. In the state of the art Hospital in Butaro, Rwanda, one of the ways they kept costs low was by building the entire infrastructure by hand.
These are not the only potential solutions. There needs to be positive regulatory and legal framework to promote healthcare. Firstly, governments can support health innovations. For example, a Nigerian doctor, Seyi Oyesola co-invented a system called “Hospital in a box” to provide healthcare in remote areas. This system is powered by a truck battery, weighs 150 pounds and contains anaesthetic equipment, a defibrillator, a burns unit, plaster-making facilities, surgical equipment and a built-in operating table, all for a cost of US$25,000. In addition, government officials in many countries typically use government funds to travel for treatment abroad. With the exception of countries like Malawi where citizens can get funding from the government for treatment abroad, this policy of using meager public funds to treat rich government officials (who can afford to finance this privately) does not seem fair. It is not only a strain on the government’s budget but it does not create incentives for these officials to fix the domestic healthcare problems or even to be aware of them. These policies must therefore be removed.
The good news is that there are a lot of African countries that are already doing these things but there is no doubt that we still have a long way to go. I’ll end by rephrasing Mr Madu’s words:
“What are you going to do if you are sitting at home (in an African country) one day and your heart starts to hurt and you realize that you are having a heart attack? Will you get on a flight to Germany? No, if you are in Nairobi you can just swing by the Heart and Cancer Center. More countries need to follow suit!”