Africa bears the brunt of the world's health burden and most key indicators show that it is also lagging behind in realising the Millennium Development Goals (MDGs) on health. In this special report, Neil Ford critically examines a wide range of issues central to health and healthcare delivery systems in Africa, including: investment opportunities, the high costs of both state and private provision, affordable basic health insurance and the state of the drug and pharmaceutical industry. Also analysed are the issue of the professional brain drain from the continent, and the benefits of both old and new technologies in service provision, which some countries are successfully employing to assist some of the the most needy communities.
With just over 11% of the global population, but 24% of the global disease burden, sub-Saharan Africa is the hub of international demand for health services. Yet the scale of the problem is usually matched by an inability to pay for health services, either directly through private sector provision or health insurance, or indirectly through taxes used to fund state-organised health care. Thousands of local and international nongovernmental organisations (NGOs), have tried to plug the gaps in many areas, while private service providers have appeared in the more affluent parts of the continent. But, by and large, basic health services are absent from vast swathes of Africa.
Government-run insurance schemes have made a big impact in some countries. An estimated 90% of Rwandans are now covered by the Kigali government's scheme, while the figure has reached 50% in Ghana, although the model varies enormously from country to country. The Kenyan government offers fairly wide-ranging inpatient cover for about $20 a year for an entire family, although additional payments are required for outpatient treatment and many operations. Such state schemes are used to top up government funding but it is still the national government that makes the biggest contribution to healthcare costs. But microinsurance is another option, where people pay tiny sums, often as low as one US cent a week for health insurance, often to the same companies that offer life insurance.
But such huge challenges will require highly innovative solutions. The benefits of mobile technology and mHealth (mobile health services) are outlined here, but older technologies can also play a role. Several NGOs, including Riders for Health, are using motorbikes to enable medical staff to reach patients in areas where roads are often not best suited to travelling on four wheels. Riders for Health now operates in seven African countries. Couriers are used to transport supplies, samples and test results, which can now arrive in just two or three days, rather than weeks or even months.
Since 1993, South Africa has benefitted from a health service dispensing train, known as Phelophepa. What started out as a three-carriage operation has now expanded to 16 carriages, providing everything from cancer screening, dentistry and mental health services, to optometry and a pharmacy. It is managed by Dr Lillian Cingo and two thirds funded by state owned transport parastatal Transnet, with the remaining costs paid by a variety of other sources.
Since its launch it has provided treatment to hundreds of thousands of people. Apart from offering treatment and consultations, it also provides illness prevention information to help people help themselves. Such a train can obviously never be a solution in all areas but using unusual methods of service provision and tapping into existing doctor trainee manpower is one kind of innovative solution that is needed to make a real impact across the continent.
Despite the mismatch between funding and need, there are an increasing number of investment opportunities for African and foreign companies if they know where to look. Generic drugs have greatly reduced the cost of medicine in most parts of Africa, particularly for the biggest killers, such as malaria, tuberculosis and HIV/Aids, and Indian firms have cashed in on their ability to replicate existing drugs.
However, it is perhaps no surprise that it is South Africa that has the biggest private health sector in Africa. The public sector is much larger but the small private sector, funded by health insurance schemes, is growing quickly from its largely white market to serve more middle-class black South Africans. Indeed, as a result of the far higher spend per patient, the private sector attracts over half of all health spending in the country. This inevitably leaves many...