A Healthier Continent Could get Better

Wham colour boxes1Of all the things we can measure when looking at how society is faring, surely the most important relates to life itself. In Africa, where life is cheapest, there has been consistent improvement the last few years. The catch-all measure of how well or poorly people are doing must lie in their life expectancy. Happily, people in all African countries, with the single exception of Zimbabwe, are now living longer than they could expect to in the early stage of the continent’s uhuru in 1961, says the World Bank.

Much of the improvement coincides with the post-Cold War abandonment by many countries of state economic control and with the introduction of liberalisation across all societal facets. The setting at the century’s turn of global Millennium Development Goals will also have helped. While these goals are sometimes simplistic in targets set by calling for half, two-thirds or total reductions of bad things in ways that aren’t always real, their making countries report publically on progress being achieved clearly helps force the pace.

According to Johannesburg-based think tank Good Governance Africa (GGA), “the continent bears 25% of the world’s disease burden” but only spends 1% of the world’s health funds. Africa also has the world’s smallest health workforce at only 1.6 million, compared to South East Asia’s 7 million, the Western Pacific’s 10 million, Europe’s 17 million and the 22 million of the Americas. Even so, progress this century has sometimes been dramatic (see infographic).

A stand-out success has been South Africa, where the number of HIV infections have fallen every year since 2000, where more people now receive anti-retroviral treatment than need it and where malnutrition has fallen 70%, a resurgence of malaria has been defeated, vaccination of the very young has climbed from 64% to 89% in 20 years, and where both maternal and infant mortality rates have fallen dramatically.

This has happened with public healthcare spending (projected last week by Treasury to rise 12% a year for the next three years) increasing from 10% to almost 13% of the national budget. It comes with the building of 200 new public clinics since democratisation, bringing these to within 5km of 95% of our people. A now-you-see-it-now-you-don’t National Health Insurance scheme is to be introduced over 14 years, but this increasingly appears to be a catch-all term for the provision of basic public healthcare that would anyway be given, rather than a poor cousin to Britain’s NHS. And a big part of SA’s healthier society must be due to the country’s robust private healthcare which is subscribed to by 17% of people and which now provides a third as many hospital beds as the state.

Yet it is sobering to see what more could have been achieved on our continent if only moneys had been spent as intended. According to GGA calculations, African governments spend an average US$13.40 per person on healthcare, up $4 the past decade but way off the WHO recommendation of $50.
But here’s the thing, according to GGA head John Endres: “If all the foreign aid given to improve health was actually spent as intended, almost $61 per person would be available. And that’s just donor cash. It would make achieving Millennium Development Goals more realistic”.

– Paul Pereira (first published in The Citizen, 29 October 2013)

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