In Africa, governments are the biggest providers of healthcare, with an estimated 80:20 or higher ratio between government and the private sector.
Like other government services, healthcare is under intense financial pressure. This poses great problems in achieving the World Health Organisation’s (WHO’s) universal health coverage goals of ensuring that all people have access to effective and affordable health services.
One of the most critical health system challenges in Africa is the lack of healthcare workers. This is compounded by the fact that sub-Saharan Africa has to bear more than 24% of the global disease burden with only 3% of the global health workforce and 1% of global healthcare expenditure.
There is great desire to invest in new medical technology, but financial constraints lead to problems. The WHO has found that up to 70% of medical technology investments in low-income countries are ill managed or defunct on account of factors including lack of regular servicing. Without a sufficiently skilled pool of biomedical engineers, the necessary spare parts and funds, complex medical devices stop functioning.
The Kenyan solution
The government of Kenya effected a solution that supplied specialised, state-of-the-art medical equipment to 98 hospitals across all the country’s 47 counties. This was developed with the private sector, in this case my former employer GE. The solution was designed to cover a period of seven years. This programme included technology such as:
- heatre equipment
(at both level 4 and 5 hospitals)
- sterilisation equipment and theatre instruments
(at both level 4 and 5 hospitals)
- renal dialysis equipment
(level 5 and two national hospitals)
- intensive care unit (ICU) equipment
(at 11 hospitals across the country)
- X-ray and other imaging equipment
(at both level 4 and 5 and four national hospitals).
Goals included improved patient experience through increased equitable and reliable access to good-quality affordable healthcare and services; upgrading hospitals with modern technology; and upskilling and attracting more healthcare personnel with state-of-the-art technology and training.
Conscious of the barriers to success, the government contracted the suppliers to service, maintain, repair and replace the spare parts for all equipment throughout the programme in a managed equipment services (MES) model. This approach not only upgraded healthcare facilities across the country for key functions within the health system but also ensured increased uptime for the equipment and upskilling of healthcare workers.
The MES approach strengthens the health system in a way that is ideal for the African setting and increases the motivation of healthcare workers, as it relates to professional growth. These factors go a long way in ensuring the sustainability of the MES.
While there have been challenges in the roll-out of the programme on account of Kenya’s devolved healthcare system, one cannot deny the impact it is having on the lives of Kenyan people. The number of digital radiology images rose from 1,500 a month to nearly 30,000 a month between June 2015 and May of 2016.
This represents increased access, increased information and ultimately increased income for the healthcare system, given that the cost to the end users ranged between KSh200 ($2) and KSh800 per scan. Kenya’s bold approach moves the country in the direction of the WHO’s universal healthcare objectives with great vision and more importantly great purpose.
It is illustrative of the opportunity and type of model that the rest of the continent needs to consider within the healthcare industry. Most countries in Africa are spending much less than the level set by the Abuja Convention of 2001, where it was agreed that for Africa’s continued and sustained growth, healthcare spending by government needs to be at a level of 15% of the annual budget.
In 2014, Kenya’s healthcare expenditure stood at nearly 13% of the budgetary spend compared to an average spend of 10% in sub-Saharan Africa, according to the World Bank. As such the MES moves Kenya’s constitutional goals and national objectives in both the direction of the Abuja Convention and the universal healthcare objectives.
Health and prosperity
In its purest definition health is the extent to which individuals are able to realise aspirations and satisfy needs to change or cope with the environment. The measure of a good healthcare system includes lives saved or incidents averted through good management and preventative policies.
Some 54% of Africa’s 1.2bn population are aged between 15 and 59, representing the viable workforce. This group is the driving force of Africa’s economic growth and there is ample reason to invest in good healthcare, if only to sustain this workforce’s ability to project Africa into a more prosperous future.
According to one estimated UN projection, by 2035 the number of sub-Saharan Africans of viable workforce age will exceed that of the rest of the world combined. The cost of maintaining a robust health system will remain high. However, the value that this cost brings could be the boost needed to bring about the continent’s enhanced and sustainable growth.
Denver Phiri is a consultant and former head of health economics at GE Healthcare
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