African leaders should seek treatment at home

Africa awaits the day when its leaders shall take pride in their own healthcare systems and facilities to the extent that they too, like the people who elect them into power, receive treatment in their own public hospitals at home. By Allen Choruma

It’s becoming a norm in Africa that African Presidents and top politicians seek medical treatment overseas, especially in Europe, the US and the Far East. This is a clear sign of the lack of confidence in healthcare systems they have overall charge over.

As African leaders fly away in chartered jets, gobbling millions of dollars of tax payers’ money, they leave behind healthcare systems in their home countries in a depressing condition. Ordinary people have to bear the brunt of dilapidated healthcare infrastructure, poor quality services, shortages of essential drugs and exposure to falsified and sub-standard medication.

African politicians at large have little motivation and incentives to invest in healthcare in their own countries as they seldom use these facilities. Healthcare doesn’t seem to be a top priority for most African leaders since, whenever they need medical treatment, they are flown overseas on taxpayers’ money.

Re-elected as President of Nigeria, septuagenarian Muhammadu Buhari, has broken records during his first term in office in terms of spending prolonged periods of time abroad seeking medical treatment.

It is reported that President Buhari during his first term in office (2015-2019) spent more than 170 days (almost six months) making trips to London for medical treatment. His first trip, in February 2017, lasted 50 days and his second one lasted over 103 days, from May to August.

In 2018, Nigeria witnessed massive strikes by health staff over deplorable working conditions, the poor quality of healthcare and discontent over inadequate public spending on health. The budget allocation for health was only 4% (N340.5bn; $0.944bn) out of a total budget of N8.612tn. This is nowhere  near the 15% budget figure set by the Abuja Declaration, signed by all African heads of state in 2001.

Taking the cost of medical treatment aside, the cost of parking Buhari’s private jet in London during his medical tourism trips caused widespread public anger in Nigeria, with the media touting a figure of £4,000 a day, while the Presidency maintained it was £1,000 a day.

Former Zimbabwe President, Robert Mugabe, was a cut above other African Presidents. Mugabe was known for his plethora of trips to the Far East, with Singapore and Malaysia his preferred medical tourism destinations.

Leaving behind a health system in shambles, Mugabe was reported to having flown to Singapore in 2011 and 2014 for a simple eye cataract operation and follow-up checks, which could have been performed by ophthalmologists at home. 

A few months ago, in November, 2018, a year after being deposed from power by the military, Mugabe was reportedly advanced $4m, a payment made directly to him through the Reserve Bank of Zimbabwe, to cover his two months’ stay in Singapore for medical treatment.

This trip, paradoxically, took place at a time when junior doctors in Zimbabwe were on a 40-day strike over poor salaries and working conditions, inadequate protective clothing, antiquated hospital infrastructure and the shortage of drugs in public hospitals. Much of the $4m reportedly spent by Mugabe could have gone to upgrading Zimbabwe’s rural hospitals.

Recently Zimbabwe’s Vice-President, Constantino Chiwenga’s foreign medical trips to South Africa and India caused a lot of public furore.  In February the Vice-President, accompanied by a Deputy Minister of Health, hired a private jet, a Boeing 737, equipped with an intensive care unit and specialised health team on board, to ferry him to India and back. It was reported that the chartered jet, hired from Royal Jets of Abu Dhabi, UAE, cost $500,000 for the trip.

Shocking contrast

The list of African politicians who seek medical treatment abroad is almost endless. Some African Presidents have died in office while abroad seeking medical treatment.

These include Michael Sata of Zambia who died in the UK in 2014, Malam Bacai Sanhá of Guinea Bissau, who died in France in 2012, Meles Zenawi of Ethiopia who died in Belgium in 2012, Omar Bongo of Gabon, who died in Spain in 2009 and Levy Mwanawasa of Zambia, who died in France in 2008.

While African heads of state merrily splash out fortunes on their treatments abroad, the continent is still plagued by diseases which can be prevented and managed and also, totally eradicated from some countries.

Healthcare in Africa has remained a challenge for decades and the demands continue to grow.  Out of a population of 1.2bn, about 60% (720m) are below 24 years of age and require primary healthcare services such as family planning, prenatal and antenatal care, vaccinations, good nutrition, reproductive and adolescent health services and access to basic healthcare.

As a strategy designed to improve healthcare delivery systems in Africa, African heads of state in 2001 passed the Abuja Declaration in which they unanimously agreed to spend 15% of annual expenditure budgets in healthcare.

Eighteen years down the line, it is disheartening to note that very few African countries have reached the targets set by the Abuja Declaration. According to the WHO Global Health Expenditure Database for 2016, average healthcare expenditure in Africa stood at 10% of national budgets.

Only a handful of countries, Malawi, Ethiopia, Gambia and Swaziland were spending above 15% of their public expenditure towards healthcare. At the second-tier level, 11%-14%, were countries such as South Africa, Namibia, Central African Republic, Burundi, Lesotho, Cape Verde and Tanzania. The lowest-ranked countries, below 5%, were Eritrea, Cameroon, Angola and Nigeria.

The WHO statistics show that healthcare expenditure still remains a low priority for African governments. Most countries thus rely on foreign and donor aid hand-outs to fund their healthcare systems. In order to improve healthcare in Africa, governments should step in and show responsibility and commitment by ensuring that public health is funded predominantly by national budgets.

WHO records show that although most African countries have increased their health budgets, with the average per capita public spending on health in Africa rising from $70 in 2000 to more than $160 in 2014, these figures still fall below the Abuja targets set in 2001.

Inequality in health

What is more worrying is that a closer analysis of public expenditure on health shows that health budgets in Africa are not equitable and evenly distributed; marginalised rural poor people receive less healthcare coverage and  many cannot even access basic primary health care.

According to the WHO 2016 assessment report, Public Financing for Health in Africa: From Abuja to SDGS: “For every $100 that goes into state coffers in Africa, on average $16 is allocated to health, only $10 is in effect spent, and less than $4 goes to the right health services. This failure to ensure that public financial resources reach the health services that need them has undoubtedly had a negative impact on health sector results…”

African governments should increase fiscal space to support healthcare provision, align healthcare budgets to improved service provision, evenly distribute health services to cover the poor and vulnerable, strengthen revenue collection to support public healthcare, create conditions that attract private investment into healthcare, improve working conditions for healthcare personnel, and shun foreign medical tourism in word and in deed.

The heads of state can set an excellent example by seeking their treatment at home instead of abroad. Maybe then, we shall see a rapid improvement in healthcare delivery.   NA