Africa's Failing Approach to Health Care
by Thompson Ayodele (bio)
After decades of neglect, effective health care is one of the biggest concerns in Africa. Both foreign donors and African governments, making finding a solution a priority, have opened the money taps. Foreign hard currency is flowing into the health ministries of African countries in unprecedented quantities.
Despite this generosity, there is little improvement: health care professionals are demoralized, access to essential medicines remains low and corruption is still a serious problem.
According to the World Health Organization (WHO), over 50 percent of Africans lack access to essential medicines. Children in developing countries unnecessarily die from preventable diseases such as diarrhea, measles and malaria. With up to 80 percent of Africans paying for treatment straight from their own pockets, it's clear public health systems are failing to deliver.
This failure happens in part because nearly all foreign aid first passes through government health ministries. According to studies by the WHO and the Center for Global Development, bureaucrats have little idea what happens to the money after they receive it.
These lax controls allow money to be subverted for private gain. A study by Maureen Lewis of the World Bank shows how corruption in the health care sector of developing countries undermines donor effectiveness.
In my own Nigeria, for instance, a recent study found that 28 government-run health care centers received no drugs for over two years. Donated drugs such as Vitamin A capsules, Mectizan and Coartem tablets and oral rehydration salt are pilfered and re-sold on the black market. The Global Fund considered suspending two of Nigeria's five-year grants totaling $80 million because of concerns about grant management, transparency of fund allocation and grant implementation and the ability of the Nigerian government to achieve grant goals. Similar grants to Uganda and Chad have already been terminated.
Drug disbursement, however, is just one of dozens of forms of corruption - including mismanagement of funds at the ministry and hospital level, absenteeism, charges for normally free services and abuse of hospital procurement contracts.
According to Human Rights Watch, "the government's failure to tackle local-level corruption violates Nigeria's obligation to provide basic health and education services to its citizens."
Additionally, chronic mismanagement has left health workers without paychecks and hospitals with obsolete equipment. It is hardly surprising donor funding does not seem to be making much of a difference.
It is clear this situation will never improve while health care remains under government control. Except for commitment to one's job, bureaucrats have few incentives to actually deliver care. Any manager of a private company can attest that goodwill alone is useless. Unless there is a significant change in the way the health sector is managed, there will be few improvements no matter how much money donors spend.
Bearing in mind the historic failure of African public health systems to provide citizens with the care they deserve, governments should no longer be charged with providing and managing all health care. The private sector should be given a far bigger role.
The advantages of private control are three-fold. It would reduce corruption. Corruption exists in the private sector, but private enterprises failing to show integrity risk exclusion from future contracts. Secondly, since private businesses care deeply about their reputations, there is pressure to deliver. After all, without a reputation, there are no customers - and therefore no business. Putting private sector bodies into competition also forces them to improve their productivity and patient care. Costs would fall and standards would rise.
The opposite happens in the public sector, where there are few incentives to improve ways of working and operations are disrupted with changes of administration and personnel.
It has been demonstrated by various health departments in Africa that most of the funds granted for disease prevention or control are largely misused. Donors must let the private sector be the foundation upon which efficient and durable health care delivery will be built. To do otherwise would be to condemn millions to an early death.
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Project 21 associate Thompson Ayodele is the executive director of the Initiative for Public Policy Analysis think-tank in Lagos, Nigeria. A longer version of this commentary was published in the Nigerian Daily Independent newspaper on February 13, 2008. Comments may be sent to firstname.lastname@example.org.
Published by The National Center for Public Policy Research. Reprints
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