Wanted! Health care Financing for Africa



By Adeola Akinremi, Email: adeola.akinremi@thisdaylive.com

Two unrelated recent events with discernible pattern in sub-Saharan Africa gave me hope and despair.

In Mombasa, Kenya, a kindergarten boy from a poor home died in a horrific accident. He fell through a hole on the floor of a moving school bus in which he was riding. The bus crushed him to death.  Despair.

The floor of the school bus had become weak and dangerous–probably due to wear and tear—with a big size hole in square shape that was covered with a plastic carpet to conceal the defect according to Kenya’s transport and safety authority, who investigated the accident.

Indeed, the wobbly picture of the school bus that I saw truly forced tears out of my eyes. Sadly, the 7-year-old schoolboy will no longer realise whatever ambition he had for the world to be a better place due to negligence and poor planning by Kenya government.

In Sierra Leone, health care services had become penurious that the CNN’s anchorwoman, Isha Sesay, cried out last month with a tweet.  Sesay wrote:  “when my mother took ill in Sierra Leone last December I had to take her to Nigeria. I’m so grateful for Nigerian nurses and doctors who saved her life… I am thankful there were medical options in Nigeria for my mother because I had none available in Sierra Leone.” Hope.

But Sesay’s experience with health care service in Nigeria is debatable, because the out-of-pocket medical treatment for her mother happened in Nigeria’s most expensive private hospital, and in the highbrow of Lagos—a kind of place that could boast of such well-equipped private hospital.

So, the experience Sesay had is at best for a limited number of people with such affordability. In Nigeria, health care financing is not advancing as expected, leaving millions of citizens with roadblocks to freedom as access to quality health care becomes a bottleneck. It is the same everywhere in Africa.

Last year, when Uganda’s only cobalt-60 radiation machine broke down, the Uganda government passed the burden to Kenya, sending thousands of patients affected by cancer to Nairobi, and delaying replacement of the radiation machine for one year.

Corruption, cronyism, record unemployment, slowing growth and stubborn inequality have dogged governance in Africa for decades. But the African leaders added one more problem: nonchalant attitude to health care financing for their citizens.

For instance, despite the progress made on policy initiatives in several African countries, mechanism for financing the implementation of the policies has been the elephant in the room. In Ghana, where appreciable progress has been made towards universal health coverage, the inability of the country’s national health insurance scheme to pay claims submitted by health care service providers has resulted in high indebtedness to the health facilities, placing the scheme in jeopardy.

Surely, in Africa people live with chronic diseases for years without medical history—an important tool in management of patient’s health condition. I started thinking: May be people are not falling sick. But the reality is that the out of pocket treatment has hindered many from going to hospitals for even the basic preventive medicine like doing periodic medical check-up.

Of course, when people come down with terminal disease we all know that early detection system failed either because the individual didn’t have access or due to nonchalant attitude. In most cases it is the former.

Really, it is regressive to continue out-of-pocket medical treatment in Africa as global health care cost rise through the roof. Evidently, the long-term solution to such problems is for political leaders to turn the commitment to a common cause, uniting their interest with that of others such as people with vested interests to remove the roadblocks.

For advocates, it means the health care services can reach the poorest and affordable, making universal health coverage a “hyperloop”: a word coined by Elon Musk to describe his new plan to reinvent transportation to eliminate the barriers of distance and time in the United States.

Taken together, Africa will need to improve health system to a level where health facilities are nearby, high quality and affordable, even for the most vulnerable.

But think about this: Africa is projected to see a 24 per cent increase in the number of births by 2030, yet the maternal deaths in the region is higher compared to others.

True, if you look at the graph, some of the highest mortality rates in the world are all countries on the African continent. In fact, in world Atlas, approximately 62 percent of all maternal deaths worldwide happens in Africa, with Sierra Leone leading the pack.

Another thing to think about is Africa’s population. By 2050, Africa would have increased the world’s population scope with additional 1.3 billion people, a time when Nigeria for example would have successfully defeated the United States in population contest.

Now, shouldn’t African leaders accelerate progress in health care financing to meet today’s needs of its citizens and prepare for the future?

Perhaps, it drives home the point that in Africa the rich also cry, when it comes to health care service. Do not go too far in your thought: think of how many African presidents and cabinet ministers have left home to become patients in hospitals abroad. Think of those who returned home in a coffin.

Now is the time to act and one good news is that a number of actors are harmonizing strategies to remove the obstacles and breakdown barriers in the process of translating known solutions to action.

So when I learnt of the United States Agency for International Development’s (USAID) commitment from the American people through African Collaborative for Health Financing Solutions, and partnership being forged by international nonprofit like Results for Development, Duke University and Feed the Children, I feel some excitement for the future of a typical African child—the one who offers reed to snake, listens to the sounds of anvils and customers in Camara Laye’s words.

Yes, I agree that the African Collaborative for Health Financing Solutions definitely presents an opportunity to national governments in Africa to mobilise multisectoral action behind a good cause.

Follow me on twitter: @adeolaakinremi1