Finding a Viable Path Towards Sustainable Health Development in African Countries

Lenias Hwenda

Accra, Ghana  Lenias is passionate about improving access to quality affordable treatments.

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​Lack of access to medicines is not just an African problem. It is a problem that affects health systems all over the world. All around the world, countries have only so much money. They are increasingly forced to decide what to spend it on. In this respect, African countries face the same budgetary problems as the rest of the world. What is different is that we have a higher burden of disease. Our infrastructure is inadequately prepared to meet current health care needs let alone serve the needs of our burgeoning youthful population. We need to find a viable path towards sustainable health development in countries.
 
In this respect, the challenges that we face in African countries are greater. That is why we need to invest in developing national infrastructure needed to serve the growing health care needs of a young population with their entire lives ahead of them. Only then can we be prepared to face the challenges facing our countries in the coming decades from changing disease patterns from the dominance of infectious diseases to the dominance of NCDs.
 
The resilient infrastructure that we need to strengthen African health systems in any meaningful and sustainable way will take time to develop. It is an enormous task, overwhelming to contemplate. We should take comfort in the knowledge that others have walked this path before, with success, but that success is not a given. We must roll our sleeves and get to work. Just because our problems are hard, does not mean we should not attempt to solve them. 

​​We have been on this journey since the early sixties. We are still going through a process that others have completed. We have made progress in some areas, but not in others. No matter. Rome was not built in a day. Our experiences over these many decades provide ample opportunity for learning how we can best bring the change that we seek. What matters is that we keep moving, in the right direction, doing things that need doing.
 
Our challenges are many. The allocation of money to national health budgets in African countries is still not enough. One of the factors that exacerbate health care funding is that the African tax base is very low. According to Transparency International, governments lose huge sums of money due to tax evasion, practiced by elites and by multinational companies. Taxation is a key component of sustainability of health care in African countries. Tackling tax evasion in African countries requires the cooperation of international partners. However, as long as the international partners are reluctant to enforce global rules and laws designed to mitigates against this, the problem will persist. 
 
If African countries ministries of health are not being allocated sufficient funds, this leads to less than optimal health care outcomes in countries. In turn, this creates the impression that African countries are not serious about improving health. Yet I have met many health leaders who are committed to improving health for their people. Medicines for Africa exists to support their efforts.
 
It is necessary that ministries of health find additional resources needed. However, the task of increasing budgetary allocation towards health can be complicated in cases where ministries of health receive proportionally higher amounts of funds compared to other areas of national concern. For example, in Ghana, 3% of the GDP is allocated towards health, which is apparently three times more than what the other ministries get. This makes it difficult for the ministry to argue for more funds from the government, in which case health ministries should seek to generate funds from other sources. This could be done by creating efficiencies that allow countries to get better value for money and generate savings. Medicines for Africa works with countries to create cost savings when buying medicines.

Providing health is the primary responsibility of governments. As responsible corporate citizens, the private sector can and should contribute to creating sustainable health care systems. They can do so by paying tax or developing health infrastructure. Through shared responsibility for population health, we can do even more.
 
One issue that need addressing is who sets the development agenda in African countries. This is critical to developing health systems that are capable of serving the health care needs of entire nations.  Development solutions have greater chances of being sustainable if they are owned and driven by Africans, but truly African driven solutions are lacking,  and they are often ignored. Changing the current development paradigm requires that African countries learn to say “no” to things that do not achieve the required development goals. It is about time that African countries insist that their development partners treat them like adults that can work together in a true spirit of partnership.

Doing so comes with responsibility. It means countries paying more for their health care costs themselves with development partners supporting core objectives set by the country. More countries are increasingly paying for healthcare from their own pockets as development funding declines. For example, Namibia pays for most of its ARVs as does Botswana and a number of others. When Botswana announced that it would put every child and woman with HIV on antiretroviral therapy (ARV), many thought it a fanciful and naïve goal. That dream is now a reality. This reality shows that where there is a will, there is a way.