This article was first published on Medsuitemedia.co.za in June 2022
Healthcare in Africa
South African health care commentators seldom provide information on health care activities on the continent of Africa. This article consists largely of a brief snapshot provided to the author by an African veteran in the healthcare field. It appears from the information provided that despite the problems South African heath care providers have experienced and continue to experience, the South African patients tend to be extremely fortunate in the health care services that are available to them.
That South Africa’s health care services compare well with most other services on the continent does not mean that South African service providers should cease in their efforts to supply best-in-the-world care. Unfortunately, interventions by officials and poor management of public services by government appointees has resulted in a serious deterioration in the quality of many government-owned and managed facilities.
Serious pressure has been exerted by members of the incumbent political party and its appointees to the management of government-owned health facilities, for the government to nationalise the private health-care savings and insurance systems. Comparing the health care systems operating in the rest of the African continent, the observer cannot fail to conclude that this is the last thing South Africa should do.
A message that comes out of this brief sketch is that it is unwise for government officials to attempt to dominate the healthcare supply field. And if they do purchase health care supplies from private suppliers, it is unwise of them to delay payment for goods and services, as any delay in paying disrupts the supply chain and may even make further essential supplies unavailable to patients,
In Africa the governments are the major suppliers of drugs to the population at large. This is normally underpinned by government-owned and managed tender systems for drugs and medical devices, stored in government owned centrally placed drug warehouses, very often not kept at optimal temperatures. The central store relies on Districts to provide estimated drug requirements by therapeutic class. Unfortunately, the lack of knowledge on how to manage a supply chain results in a well-below average channel management with stock-outs a standard occurrence.
In every country there is a small but vibrant private sector supplying drugs to the few private practitioners and, in some wealthier countries private hospitals as well as many so called “drug stores” often owned by pharmacists, nurses or self-taught “medics”.
As a rule of thumb between 2%-6% of the population, in most developing world countries in Africa, can afford drugs purchased in the private sector. One of the biggest scourges is the level of counterfeit drugs as well as expired drugs that are sold to customers as the major denominator is buying as cheap as possible, which often means counterfeit drugs which are a dark part of the supply chain.
There are exceptions such as South Africa, a middle-income country trying its best to become a lower income country through political mismanagement. The pharmaceutical industry is well developed and there are world class private hospitals and a highly trained medical profession.
In East Africa, Kenya is the dominant economic powerhouse. Much lower than South Africa but a giant in the East. Namibia has a good but small private sector due to its historic links to South Africa.
In West Africa, Nigeria is a giant due to population size and a very small minority of people controlling the oil wealth. There is a fairly large private sector, both in terms of drug manufacturing and supply, private clinicians and private hospitals catering for around 3% of the population.
Ghana, although much smaller than Nigeria, also has a small but vibrant private sector. Like all other African countries, most healthcare is supplied via government facilities. Drug companies do not rush to do business with the public sector, as in most cases the drug suppliers in Africa must wait more than 365 days for payment from the public/government sector.
The Francophone countries Côte d'Ivoire, Senegal and Cameroon have small but stable private sectors, mainly served with drugs from France. The political mischief- making by its former Colonial Master has sadly reduced Côte d'Ivoire’s private sector to a shadow of its former self. Morocco has well-developed private and public sectors due to some heavy financing from Saudi Arabia. Algeria has a good healthcare sector, with local manufacturing. Egypt also has excellent private hospitals but a mediocre manufacturing sector, with its biggest problem being productivity.
A critical observer examining the South African healthcare system of 20 years ago with the systems in place on the rest of the continent would without doubt have advised other African countries to implement similar private systems in their own countries. Part of the advice to respective governments, including the South African government, would have been to encourage the establishment of competitive private healthcare providers wherever possible, with governments selling off their facilities to private purchasers. The evidence invariably shows that governments should not attempt to run businesses.