Who should pay the healthcare bill?


ONE OF THE BIGGEST DEBATES IN THE AFRICAN PHARMA-ceutical industry is the same as in the wider health sector--who should pay for medication and care: patients, the state or even employers?


Health care is provided in a number of ways around the world: through government expenditure and therefore taxation; through insurance schemes; through payment when needed; or often through combinations of all three methods. Yet most African people continue to pay for pharmaceuticals as and when needed, if they can afford them.

Many governments set their pharmaceuticals budget well in advance but the price of drugs changes, often in line with currency fluctuations. Nevertheless, government contracts are widely sought after because they involve very large volumes over long periods of time, providing a guaranteed income for producers. A variety of funding methods are being trialled in different parts of the continent. The government of Mozambique has introduced air travel taxes and a financial transaction tax to help fund health services.

A spokesperson for COHRED (the Council on Health Research for Development) said of African pharmaceutical manufacture: "The medicines produced must be affordable for the population they are manufactured to serve--particularly important in contexts where medicines are usually paid for out of pocket. Great care must be taken to achieving needed efficiencies in production and in scale. Even with these warnings, the overriding message is opportunity. Local production is another way in which African countries can demonstrate not simply self sufficiency, but also excellence."

Funding is a problem even in Africa's stronger economies. A World Bank report last year predicted that Ghana's National Health Insurance Authority (NHIA) could become bankrupt as early as this year because of the lack of state funding. It stated: "The system is too inefficient to absorb significant new resources, however; without major reforms, some of which lie outside the purview of the NHIS, it is difficult to argue for major increases in funding."

South Africa is seeking to spread the benefits of its health system and pharmaceutical availability to the whole population. On the grounds of cost, comprehensive free health care has been limited to children under the age of six and pregnant women, although more limited care is available for the whole population.

It had been hoped that the coverage of medical insurance schemes would...

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