In this post, Guest Blogger Udo Obiechefu attempts to start a conversation on some of the issues impacting access and availability of care in West Africa. In his next post, Udo will explore avenues for solving these issues. Enjoy!
The issues related to health care delivery and access in West Africa is plentiful. Lack of adequate funding, a small workforce, poor organization, and a dearth of viable private sector solutions are just a few of the many dilemmas preventing countless West Africans from attaining sustainable access to quality care. Discussions addressing these issues are numerous and ongoing. I will attempt to contribute the discussion by starting a conversation revolving around three major dilemmas facing West African healthcare. In part two we will discuss possible solutions.
Part 1: The Problems
The Private Sector: Is Private Health Insurance Realistic?
A problem that is evident within the realm of West African healthcare is the lack of an adequate, cost appropriate private sector market. Much of this is due to the fear of high costs and conjecture surrounding the profit motives of potential investors. Although these suspicions may be warranted due to the insurance industries checkered history in other parts of the world, it is important to acknowledge the lack of strong private sector options as another problem plaguing healthcare access in West Africa. Because of the high out of pocket expenses encumbered by those seeking medical services, healthcare providers have difficulty predicting the flow of revenue. This lack of predictability has lead to the inability of providers to improve the quality of services. As a result of this and many other factors the private sector has remained underutilized.
The reality is that West Africans have proven capable of and willing to prepay for services. This is evident in the success of prepaid cellular cards. Of course, the healthcare market has many complexities and comparisons with the mobile telecommunications market can be a stretch, but what is evident is the basic premise of prepayment is not a foreign idea. The problem resides in the fact that consistent access to quality medical care can be difficult to come by. Questions must be asked about how private insurance can better provide realistic options for citizens of West Africa. What options are available for middle income West Africans? Can the private sector play a role for those living in poverty? More work has to be done in researching all possible avenues for improving the health of West Africans. At this point in time the lack of a competitive private health insurance market has to be viewed as a deficiency.
Staffing: Understaffed, Overworked and Unemployed
The World Health Organization recommends, as a minimum standard, one physician for every 5,000 inhabitants of a geographic area. Many West African nations fall far short of this criteria. Burkina Faso, Benin, Senegal, Sierra Leon, Niger and Mali all average less than ten physicians per 100,000 inhabitants. This staffing crisis is also present in nursing and hospital administration. Despite the fact that Africa, as a continent, accounts for over 40% of the worlds communicable diseases, it comprises less than five percent of the global health workforce. Unfortunately West African nations are not producing healthcare workers at the rate of demand. Also troubling is the fact that many of the healthcare workers who are available are located in larger cities which leaves those in rural areas an additional burden.
Notwithstanding the issue of shortage, there is also the issue of funding. There are many nurses and midwives who are underemployed or unemployed in West Africa. This is due to nations lacking the financial ability to meet even modest salary demands. This has caused many capable medical professionals to leave the region in hope of finding more opportunity elsewhere. West Africa is being devastated by a “brain drain”. Due to economic, social, and personal reasons well educated, qualified and motivated healthcare professionals in West Africa are seeking opportunities in the west. Europe and North America are reaping the rewards of West African educated healthcare professionals. These issues have lead to an over reliance of many *ECOWAS governments on skeleton staffing or temporary foreign health workers. This dependency has produced a system where instead of making systemic changes to the current healthcare structure that would aid in the production and maintenance of a larger workforce, there is a culture of anticipation and need for the next available foreign assistance to provide relief to a poorly functioning arrangement.
Healthcare Financing: “…..Or lack thereof”
Donor funding accounts for 25% of healthcare financing in one third of African nations. This statistic also holds true for numerous ECOWAS nations. Many foreign funding sources that contribute large amounts of aid to West African countries operate cyclically and can at times cut funding without the host country being prepared to absorb the financial impact. Even more concerning is the high percentage of funding that comes from out of pocket expenses. Sixty percent of health expenses are paid for out of pocket in Africa. These expenses can come in the form of user fees at public facilities, direct payments to private providers and even cash payments to traditional healers.
Numerous West African nations struggle with developing revenue streams to finance their healthcare systems. User fees are currently a source of revenue for West African governments. Although many primary care services are exempt from fees (immunizations, family planning, treatment of communicable disease), it still has proven a burden to care for many poor families. User fees have shown to be largely unpopular and many ECOWAS nations are currently exploring their abolishment. With the abolishment of fees comes the need to find a suitable source of additional revenue which can be quite difficult for low income nations.
Check Back for Part 2……