AS countries across the world grapple with Covid-19, Africa’s healthcare system, is now under scrutiny, having been starved of investment for many years, writes Agnes Gitau*.
Many analysts predict that the region is likely to suffer the worst of the pandemic despite having registered lower numbers of positive cases and fatalities in comparison to other regions. At the time of writing this article, (April 13) the region has just over 14,000 cases and 793 fatalities, according to Africa Centre for Disease Control.
There have been notable efforts by some countries in the region to quarantine, trace, test and empower communities to mitigate the impact of Covid-19. But as numbers rise and infections spread from urban to rural Africa, many are anxious that the pandemic will cripple the already weak system and impact Africa’s human and economic development.
What is the state of Africa’s healthcare?
Back in 2001, realising the importance of a healthy Africa, members of the African Union met in Abuja and agreed to commit at least 15 percent of the annual national budgets to improve healthcare for their citizens. Almost two decades after the (Abuja declaration 2001) https://www.who.int/healthsystems/publications/abuja_declaration/en/, this commitment has been overtaken by many other declarations commonplace within the Africa Union. Despite some notable improvements, only a handful of member states have achieved this commitment, with Rwanda, whose health care budget accounts for 20 percent of its annual budget, in the lead followed South Africa 14 percent, Ethiopia 3.5 to 5.6 percent, Kenya 6 percent, and Nigeria below 4 percent.
Only a handful of countries can afford $34 to $40 per year per person that the WHO prescribes for the basic healthcare, leaving the continent very exposed. The International Finance Corporation (IFC) estimates that the region requires at least $66bn to fill the financing gap in the healthcare system. The investment could be directed to:
- Better production facilities and distribution/retail systems for pharmaceuticals and medical supplies
- About 90,000 physicians, 500,000 nurses, and 300,000 community health workers
- Over half a million hospital beds
A further blow to the continent is the dual-disease burden of both communicable diseases (HIV/AIDS, Ebola etc) and non-communicable diseases (diabetes, heart disease, cancer). With rising economies and urbanisation, non-communicable diseases (NCDs) present new challenges to Africa’s emerging health systems. For example, NCDs like diabetes and heart disease are now responsible for at least 40 percent of deaths in South Africa. In just over a decade, such diseases are projected to be the leading cause of mortality in Africa. https://www.weforum.org/agenda/2018/01/africa-lead-healthcare-fourth-industrial-revolution.
What were individual countries doing even before Covid-19 ?
- Kenya – Vision 2030 (http://vision2030.go.ke/social-pillar/#66) and Big 4 Agenda (http://www.president.go.ke/). This is by encouraging universal uptake of the National Hospital Insurance Fund (NHIF) coverage to all. Also, in October 2019, The Government Rolled out Cervical (HPV) Vaccination for Pre-teenage girls (10 years and above) as a free vaccination to reduce cases of cervical cancer among women. http://www.president.go.ke/2019/10/18/kenya-rolls-out-vaccination-to-prevent-cervical-cancer/.
- Rwanda – Has a Health Sector Strategic Plan (http://moh.gov.rw/fileadmin/templates/Docs/FINALH_2-1.pdf). Has a car free-day. Led in offering free cervical cancer (HPV) vaccination in 2018. https://www.weforum.org/agenda/2018/08/why-rwanda-could-become-africa-healthcare-leader/.
- Nigeria – Finalised National Health Policy in 2016. Has the National Health Insurance Scheme (NHIS), National Immunisation Coverage Scheme (NICS), Midwives Service Scheme (MSS), Nigerian Pay for Performance scheme. https://www.afro.who.int/news/nigeria-develops-new-national-health-policy-accommodate-emerging-trends and https://socialprotection.org/discover/blog/health-care-nigeria-challenges-and-recommendations.
- Ethiopia – Had a Health Sector Transformation Plan (HSTP) in 2015/16, with ambitious goals to improve equity, coverage, and utilisation of essential health services, improve quality of health care and enhance the implementation capacity of the health sector at all levels of the system. A revised strategy, for 2017–2025 builds upon the successes and challenges of HSTP. Heath Spending is between 3.5 to 5.6 percent, which is less than the 7 percent that WHO estimates for low-income countries, so needs to improve. https://www.hfgproject.org/ethiopias-health-financing-outlook-what-six-rounds-of-health-accounts-tell-us/
Private healthcare financing in Africa.
Despite efforts by a number of countries to provide healthcare, a majority of Africans finance health care privately, recent reports indicate that restrictions on travel, border closures due to Covid-19 means that African billionaires who would never go to hospitals in Africa are stuck and have had to seek help from these weak facilities like any other African. Fifty percent of Africa’s health care financing is out of pocket as many Africans are left with no choice but to seek healthcare wherever it is available at whatever cost, this has pushed many to poverty.
But as governments make efforts towards healthcare provision, private financial investors to complement these efforts will be key to lifting the healthcare infrastructure.
A growing number of Africa with disposable income are driving demand for private health care in some countries. This has attracted private equity and debt investors with an interest in this sector. The $1bn Africa healthcare fund that was established by IFC in 2008 has attracted investors from DEG, Gates Foundation, AFDB etc. The Fund, managed by Aurerios Capital, invests in:
· Health services (clinics, hospitals, diagnostic centres, labs)
· Risk pooling and financing vehicles (health management organizations, insurance companies)
· Distribution and retail organisations (eye clinics, pharmaceutical chains, logistics companies)
· Pharmaceutical and medical-related manufacturing companies
· Medical education
· Providers of medical education
If anything positive is to come out of the Covid-19 pandemic, I hope it will be an investment in Africa’s healthcare, a combination of both public and private sector to ensure universal health care coverage for everyone.
*Agnes Gitau is the Managing partner at GBS Africa, a boutique Africa focused advisory firm.
Email: firstname.lastname@example.org Twitter:@agnesgitau