One in four of the outbound passengers on Africa’s two major airlines, Kenyan and Ethiopian, at any given time are “sick and headed for India or Dubai” to get proper health care.
That’s according to Prof Khama Rogo of Kenya, an obstetrician-gynaecologist and an authority on international health care, who chaired an advisory committee during the Board of Health-care Funders conference in Cape Town in May.
He lamented the state of health care in Africa. Staff are on strike, have just completed a strike, plan to go on strike or “don’t know whether they’re on strike or working”, Rogo quipped at the event.
At the same time, he said Africa has to deal with an exodus of its health workers. “Several European countries, Australia, New Zealand and Canada signed an agreement with Africa to send our workforces to them. They did so knowing we can’t employ our own people, us having trained and upskilled them. It’s happening all the way from Sudan to South Africa. While nurse training is ongoing, local recruitment is declining.”
This shortage of nurses in Africa, he said, means mothers who need to take a sick child to a clinic have to get up at 6am, with little prospect of returning before 6pm. “Any Africa-trained nurse is more likely to get a job in the UK than locally.” Now, as Rogo points out, other countries are in competition with the UK for nurses from Africa.
We’re exporting labour to the developed world. There was a time when South Africa was the favourite place to work for the rest of Africa. No more, because of the perception of cost
— Khama Rogo
“We’re exporting labour to the developed world. There was a time when South Africa was the favourite place to work for the rest of Africa. No more, because of the perception of cost. It’s as expensive as Europe, so India and the Middle East are taking them,” Rogo said.
He said Africa continues to “adopt the colonial inheritance” in health care. “Why is South Africa not leading the way? What I see is an attempt to implement a French or British medical style, which is just not working in our public health-care delivery. The only way to achieve NHI [National Health Insurance] is to strengthen nurse-centred primary health care.”
Rogo said Africa’s poor are paying high prices for medicines. Paracetamol, for example, costs “20 times” as much in the Democratic Republic of Congo as it does in the developed world.
“Why are meds cheaper in India than here?”
Prof Alex van den Heever of Wits University told the conference that finding solutions was difficult when “paper policies” failed to address capacity weaknesses.
“What’s happening is just nothing,” he said of the South African human resources framework developed in 2014. “It remains chaotic. More and more nurses cannot be absorbed by the system. We lack capable task teams and structures in government that can prioritise problem-solving.”
Nomzamo Tutu, an occupational health physician and trustee of the Government Employee Medical Schemes (GEMS), said that in planning the delivery of health care, “we’re ignoring the pharmacies, the representatives of consumer organisations”. There were no doctor organisations at the May conference.
“We exclude the very people who will [replot and replan that delivery]. We can’t talk about patient-centricity unless we talk about the consumer and suppliers,” said Tutu. “NHI is just a huge plan, difficult to get to the bottom of.”
Tutu said GEMS, representing about 3,000 primary health-care practitioners, made recommendations “ages ago” to the Competition Commission for collective bargaining arrangements, yet was still awaiting an answer.
“We’re perpetuating a myth that 80% of South African citizens have no access to health. The system is fully developed but poorly run and overseen. If the emperor has no clothes, we have to say that. It’s time for a health Codesa.”
If the emperor has no clothes, we have to say that. It’s time for a health Codesa
— Nomzamo Tutu
Mapato Ramokgopa, division manager of the Competition Commission, said other regulators were meant to help implement the recommendations of the health market inquiry into private health care, which published its final report in 2019. She said if the recommendations were not implemented, systemic failures would persist.
Nothing happening
Van den Heever said failure to implement the recommendations meant key issues such as risk equalisation, social reinsurance, a price framework and the regulatory framework for private hospitals remain unaddressed.
“We also need an information regulator that supports quality and decision-making. It’s very clear that the national department of health is not prepared to make the call. Everyone assumes NHI will override medical schemes, but we’ll all be dead long before anything like an NHI is implemented,” he said.
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