Improving the health of people living in Africa is a basic foundation for future prosperity. Yet countries across the continent have access to just 1 per cent of the world’s financial resources for health but bear 24 per cent of the global burden of disease, according to the World Health Organization.
Overcoming this lack of finance is a big challenge to delivering the goal of universal health coverage on the continent, says Vera Songwe, executive secretary of the UN Economic Commission for Africa.
Cash-strapped governments are struggling with a health financing shortfall estimated at $66bn a year.
To close the gap, she and other experts say African countries must look beyond government budgets to find additional sources of finance for health systems. African Union countries pledged in 2001 to allocate at least 15 per cent of their budget to the health sector each year. But, nearly two decades on, health investment in most countries is lagging behind.
“There are limited resources available to direct into healthcare in Africa and therefore there is a need to mobilise African government capital, multilateral, bilateral as well as private capital to help design and fund an equitable healthcare system,” says Biju Mohandas, who leads investments in health and education in sub-Saharan Africa for the International Finance Corporation, a branch of the World Bank.
Funding institutions such the IFC have stepped into the breach. The agency in 2008 established the Health in Africa initiative to encourage private involvement in healthcare and protect against impoverishment due to illness.
According to Mr Mohandas, the private sector can play an essential role in healthcare in most sub-Saharan African countries to help cope with demands placed on overstretched state-run facilities. He adds that the majority of the poorest people in these countries tend to use private healthcare providers as their first port of call.
Mr Mohandas believes establishing universal health insurance can improve access to healthcare for these end users. This in turn can stimulate private investment in healthcare infrastructure. The Health in Africa initiative has advised several governments, including in Kenya and Nigeria, on the design of universal health insurance.
“I think there is a recognition that no one sector can do it all themselves,” says Nancy Wildfeir-Field, president of GBCHealth, a US group that aims to bring together companies and organisations to collaborate in healthcare. “Each sector, whether it be the government, [non-governmental organisations] or the private sector — be it private companies, commercial companies or foundations — has something that it brings to the table.”
In 2017, GBCHealth joined with the Aliko Dangote Foundation, a charitable fund set up by the Nigerian industrialist in 1994, to form the African Business Coalition for Health. “We asked ourselves how can we use our joint resources to mobilise the African business community around African health issues and the development of African solutions,” says Ms Wildfeir-Field.
GBCHealth’s other initiatives include the Corporate Alliance on Malaria in Africa. This brings together 12 companies and institutions, including Access Bank, oil major Chevron, and Syngenta, the agrochemical business, to fight malaria. Its work has ranged from providing malaria prevention awareness training and tools for mosquito surveillance, to investing in a laboratory for studying mosquitoes in Angola.
Another programme, the Demographic Dividend, aims to widen access to reproductive and sexual health facilities for women and girls by investing in advocacy, research and training.
However, not all policymakers are convinced about the private sector’s role in delivering healthcare to most of the population.
Civil society organisations have also expressed fears that governments are being put under pressure to privatise parts of the health sector. The African Commission on Human Rights, a branch of the African Union, in May called on member states to ensure the proper regulation of private companies in health provision.
It also expressed concerns over the trend among bilateral donors and international institutions of urging states “to privatise or facilitate access to private actors in their health and education sectors”.
Anna Marriott, public services policy manager at Oxfam, the development charity, cautions that private funding is not the “magic bullet” to solve the financing gap for internationally agreed health goals.
“The WHO is unequivocal that we will not achieve universal health coverage unless we finance it using public health funding,” she says.
Ms Marriott believes that increasing private sector involvement in African health provision can distort healthcare priorities in countries with weak healthcare systems.
“Every country in the world has a mix of public and private health,” she says. “Where there is greatest risk of the private sector doing damage is in a country without a strong public health system, without strong regulation. Without that you are in danger of the private sector dictating policymaking in their own interest and against the interests of the majority of people.”