As we approach the end of a disastrous year that brought death, misery and economic hardship for so many around the world, those of us lucky enough to still be here have a lot to reflect upon. Indeed, the ongoing coronavirus pandemic exposed the economic, social and political fault lines in our societies and bared our vulnerabilities like never before.
BY Kastern Noko
For many on the African continent, COVID-19 was not the only public health emergency of the past year. In the Democratic Republic of Congo, for example, people were also faced with the re-emergence of Ebola and a measles outbreak. In Nigeria, a yellow fever outbreak detected in early November has already claimed dozens of lives.
In Cameroon, an outbreak of cholera in September killed at least 90 people. As our governments struggled to efficiently respond to multiple, interconnected public health crises, we became acutely aware of the shortcomings and failures of our health systems and social safety nets
And perhaps for the first time in recent history, our political leaders also personally experienced the weaknesses of local health systems. With international travel having come to a halt, they found themselves unable to travel to Europe, Asia and the Gulf for treatment, and had to make do with treatment and facilities available in their own countries. Burundian President Pierre Nkurunziza unexpectedly died in June, a week after travelling to Kenya for medical treatment, at the age of just 55.
So these last few days of 2020 should be an opportunity for every single one of us in Africa, but especially for our political leaders, to ask: Where did our health systems go so wrong, and what can we do to make sure we never again find ourselves in such a disastrous situation in the face of a global health emergency?
A time when healthcare was a political priority
In 1952, when Kwame Nkrumah became Ghana’s prime minister, the country’s health system was crumbling. According to medical historian Stephen Addae, the health service consisting of a few mostly European doctors and a small cadre of auxiliary medical staff was only able to meet the needs of around 20% of the population and its efforts were mostly concentrated in the relatively prosperous southern regions of the country.
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Yet, Nkrumah, who was Ghana’s first post-colonial leader after the country’s declaration of independence from Britain in 1957, managed to turn the situation around in less than a decade.
He built new health centres and medical field units across the country, adopted modern healthcare concepts, introduced holistic medical care to communities, invested in educating medical staff and created doctor-led health teams to oversee local medical operations.
With no direct out-of-pocket payment at the point of service delivery, healthcare in the country was financed entirely through government tax revenue. As a result of his efforts, the infant mortality rate declined from a high of 350/1 000 in 1915 to 110/1 000 in 1960.
The successful national health system Nkrumah managed to build in a matter of just a few years with limited resources is testament to what a government can achieve if it prioritises healthcare.
Tanzania also has a similar success story. In 1967, the government of independent Tanzania’s first president Julius Nyerere initiated major health sector reforms in line with the socialist principles outlined in the Arusha declaration, with the aim of providing high-quality public healthcare to the poor and marginalised citizens of Tanzania. By 1977, the government had banned private, for-profit healthcare in the country and was able to provide free health services to all Tanzanians.
These are only two examples of how in the early post-colonial era many young African States significantly improved their health sector by making health a public investment priority.
As renowned economist Thandika Mkandawire explains, during this period, most African States assumed a developmentalist attitude and sought to improve the socio-economic conditions of their citizens, in addition to securing their newly earned political and civil rights.
But it all changed in the 1980s when the IMF and the World Bank introduced their so-called “structural adjustment programmes” on the continent. Following the advice they received from these institutions, African governments severely reduced their investments in social and public services, hoping that the private sector would fill the gap.
As a result, healthcare institutions across the continent started charging patients, and unsurprisingly, health indicators plummeted. It was only in 2001 that the IMF and World Bank accepted that their policy experiments had been a failure in Africa.
After almost two decades of neoliberal “structural adjustments” the situation on the continent was so dire that in 2001 African States gathered in Abuja and committed to spend at least 15% of their GDPs on healthcare.
This was an impressive and ambitious commitment. But today, almost two decades after that meeting, only a handful of countries have been able to meet, or even get close to that target. To the contrary, many African States are still reducing their health spending on a regular basis. In fact, instead of making the health of their citizens a State priority, many African governments in the past two decades left their national health services to the mercy of donor countries and international non-governmental organisations (NGOs).
Today, the healthcare systems of many African countries are heavily subsidised by donor funding. We depend on the charity and whimsical decisions of donor countries to survive.
The danger posed by this arrangement became ever more clear this year, as the economies of traditional donor States themselves had been shattered because of the pandemic, leaving them unable and unwilling to fund healthcare in Africa. Britain, for example, decided to reduce its international development assistance budget by over US$5 billion in 2021 to focus on domestic spending.
Today, as countries around the world race to secure COVID-19 vaccines to protect their citizens and bring an end to the pandemic, many African States with their minuscule health budgets are at the mercy of predatory pharmaceutical companies.
This pandemic made it abundantly clear that no State can leave the health of its citizens at the mercy of donor nations, NGOs or a private sector that prioritises profits over lives.
Moving forward, African States have no option other than to massively increasing their public health spending. Health needs to be the political priority that it was in the post-independence period. The first independent African governments showed us how nations could get on their feet in a short period by making public healthcare a priority.
Our political leaders, who, for too long, focused on nothing other than their own short-term political survival, need to understand that successful health systems can only be built through long-term planning and investment — we cannot cure cancer by putting a band-aid on it.
In 2010, renowned Malawian economist and public intellectual Thandika Mkandawire famously wrote: “Africa must run while others walk.”
Now devastated by a pandemic and an ongoing economic crisis, every continent on this planet is running — running to hoard vaccines, protect their citizens and heal their economies. So, perhaps it is time for Africa to not only run but sprint.
And Africa can only bolt towards a prosperous, healthy future if its leaders make healthcare a priority. As African States prepare their national budgets for 2021, let this priority be evident in word and in deed. Access to healthcare is, literally, a life or death matter.