Getting more health care for your money

by Matshidiso Moeti | World Health Organization
Thursday, 28 March 2019 14:44 GMT

ARCHIVE PHOTO: Via-Juliana Akre, a 41-year-old a nurse, poses for a photograph in Abidjan, Ivory Coast, March 3, 2016. REUTERS/Thierry Gouegnon

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

The drive towards universal health coverage in Africa is not just about the amount of money we spend but precisely how well we spend it

Matshidiso Moeti, Regional Director of the WHO Regional Office for Africa. 

Africans are living longer. Between 2012 and 2015, average healthy life expectancy across the region grew more than in any other region of the world, from 50.9 to 53.8 years of age.

That’s three more years of being productive, realizing your dreams and savouring the smile of a loved one.

Yes, we are starting from a low base: health metrics in sub-Saharan Africa are still lower than those in the rest of the world. And yes, too many Africans are still dying of diseases like cholera and malaria, which have been defeated in many other regions of the globe.

But such a significant improvement in healthy life expectancy is a positive trend that makes us proud.

And African countries can achieve even more if they significantly increase investments.

Unfortunately, only three countries, Madagascar, Swaziland and Zimbabwe, have consistently reached the regional target of spending 15 percent of the government budget on health.

In fact, research has shown that health and economic development are deeply intertwined. Africa could generate as much as $ 100 billion in economic gains in the next five years if annual health spending per person was increased by as little as $ 30.00. Investing in health care makes economic as well as humanitarian sense.

But if we dig down into the data we have collected around health care in the region, an important trend emerges: It is not only investing more, but investing smartly. World Health Organization (WHO) analysis of health expenditures and healthy life expectancy – or the number of years a person can expect of 'good health' – has found the link weak.

For example, Eritrea annually spends $ 51.04 on health care per person, but Eritreans have a healthy life expectancy of 56 years – higher than South Africa, where annual health care spending is $ 1,148 per person and healthy life expectancy is 54 years.

Our analysis finds that we need to pay attention to how money is spent on health. And this has explicit implications on how we develop health care policy across the region.

On average, 39 percent of Africa’s health budgets are spent on medical products, while expenditure on the health workforce and infrastructure are 14 percent and 7 percent, respectively.

Looking closely at spending patterns, however, suggests that spending priorities in some countries are currently misaligned. Countries in Africa that have stronger, better performing health systems such as Algeria, Mauritius, Seychelles or Sao Tome and Principe, invest up to 40% on the health workforce and 33 percent on infrastructure.

The discrepancy between regional averages and the continent's frontrunners in healthcare suggests a change in direction – and a focus on primary care through health workforce and infrastructure investment – would improve the health systems in countries that aren't performing as well as they could.

The population in Africa are currently underserved: health systems – the people, institutions and resources needed to deliver health-related services – are only performing at 49 percent of their potential capacity. On average, there are only two physicians and 15.5 hospital beds per 10 000 people in Africa.

Because this is precisely the point: You don’t need to be rich to be healthy.