#Africa Africa’s healthcare challenge will not be met by public finances alone


In May the World Health Organisation (WHO) elected Ethiopia’s Dr Tedros Adhanom Ghebreyesus to be its new director general, the first African to be selected for the post.

He had previously served as Ethiopia’s health minister, most recently holding the post of foreign minister. His appointment is good news for Africa, says the WHO’s regional director, Dr Matshidiso Moeti.

“It reflects that Africa has the competence to lead the world’s work on health,” she says, adding that “this is also someone from his own life and experience who understands the challenges in the region, what is happening in the region.” His background in both health and foreign affairs, she argues, puts him in a strong position to drive Africa’s healthcare agenda.

“We need to engage political leadership even better than what has happened before in the era of the Sustainable Development Goals… this has to be done both at the country level and the kind of fora where African leaders meet and decide what some of the priorities on the continent are. I think he will be able to do that.”

Tedros’s appointment comes at a time of subdued growth across the continent, fuelled by the commodities slump, which has put added pressure on already stretched health budgets. And despite significant gains in recent years, Africa continues to bear a disproportionate share of the global disease burden – 24% despite having just 3% of the global health workforce.

Communicable diseases remain the most immediate challenge, with sub-Saharan Africa accounting for 90% of malaria deaths, 70% of people living with HIV and 26% of all tuberculosis cases. Non-communicable diseases such as heart failure, while still in the minority on the continent, are also rising on the back of changing lifestyles.

Investing in health

While some countries have maintained their public spending on healthcare, with commodity exporters hardest hit, Moeti says more needs to be done to drive efficiency gains in the sector.

“Countries need to put much more effort into coordinating the funding they need to reduce duplication, waste, and simply get more mileage out of what is being spent. I do think that countries could achieve a lot of efficiency from their investments in health, so that they get more return for the money they are currently putting in.”

The context is conducive to such policy making, she argues, pointing to a shift in how funding for healthcare is perceived by governments. Rather than being looked at as a drain on public coffers, while sectors like mining and infrastructure are seen as economically productive, Moeti says the value of investing in health is being better understood.

“I think we’ve moved beyond the productive or not productive discourse and this is beginning to be understood by leaders. We’ve seen how they have been increasing their investment in health. It is not yet where it needs to be, but it’s slowly moving in the right direction.”

Yet even with the best efforts by governments, Africa’s healthcare challenge will not be met by public finances alone. Traditionally seen as the exclusive domain of donors, governments and the global development community, business is increasingly looking at healthcare as a commercial opportunity.

This reflects a broader shift in the role of business in driving development. It is now widely accepted that, if the world is to meet the Sustainable Development Goals set out by the United Nations, partnering with the private sector will be key.

The UN’s Global Compact, a global network of companies promoting responsible and sustainable business practices, has a membership of more than 9,000 businesses across sectors, including most of the world’s largest multinationals. There is even a business network dedicated exclusively to healthcare, the Global Business Coalition for Healthcare.

Moeti is enthusiastic about the role business can play in driving better healthcare, saying that stronger partnership with business is a key priority for the WHO in Africa. “This is something that really is growing in African countries. I think the private sector has recognised that health is a sector in which there is profit to be made. The private sector can play different roles,” she adds, reeling off a list of areas from healthcare delivery, insurance and finance, to technology and infrastructure investment.

“Clearly business has the resources and capacity that African countries need to leverage to help improve the coverage of healthcare services. I think this is a positive development, and there is clearly growing interest.”

Maintaining equitable access

Exactly how to balance this relationship does however come with some complexities. While there is undoubtedly money to be made in healthcare, the nature of the sector as a fundamental pillar of development means it must be treated with care. Maintaining equitable access, for example, is key, as Moeti is quick to emphasise.

“Investments need to be made keeping in mind the principle of equity that many of the countries have adopted – ensuring that different households and different socioeconomic circumstances have access to basic healthcare quality. “What we don’t want to see is wonderful high-tech hospitals in cities for people who have money to pay, and then healthcare for the rest of the population not being available or lacking the quality needed for good basic healthcare.”

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