In the 2017 World Happiness Report by Gallup, African countries score poorly. Of the 150 countries on the list, the Central African Republic, Tanzania and Burundi rank as the unhappiest countries in the world.
Tristate Heart and Vascular Centre in Nigeria. Photo: Tristate Heart and Vascular Centre
Some of the factors driving unhappiness are the poor state of the continent’s healthcare systems, the persistence of HIV/AIDS, malaria and tuberculosis, and the growth of lifestyle diseases such as hypertension, heart disease and diabetes.
Few African countries make significant investments in the health sector — the median cost of healthcare in sub-Saharan Africa is $109 per person per year, according to Gallup. Some countries, such as the Democratic Republic of Congo (DRC), Madagascar and Niger, spend just half of that per person annually.
In 2010 only 23 countries were spending more than $44 per capita on healthcare, according to the World Health Organisation. These countries got funding from several sources, including government, donors, employers, non-governmental organisations and households.
Private investment is now critical to meet the considerable shortfall in public-sector investment, say experts.
While many international organisations, such as UNICEF and the International Committee of the Red Cross, continue to support Africa’s healthcare system, private entities and individuals are also increasingly making contributions. For example, Africa’s richest person, Aliko Dangote, and the world’s second richest person, Bill Gates, have formed a partnership to address some of Africa’s key health needs.
In 2014 the Nigerian-born cement magnate made global headlines after donating $1.2bn to Dangote Foundation, which used the money to buy equipment to donate to hospitals in Nigeria and set up mobile clinics in Côte d’Ivoire.
A philanthropist himself, Gates wrote of Dangote in Time magazine: “I know him best as a leader constantly in search of ways to bridge the gap between private business and health.”
The Bill & Melinda Gates Foundation focuses, among other projects, on strengthening Africa’s healthcare resources. According to the Gates Foundation, as of May 2013 it had earmarked $9bn to fight diseases in Africa over 15 years. In 2016 the foundation pledged to give an additional $5bn over a five-year period, two-thirds to be used to fight HIV/AIDS on the continent.
While acknowledging the Gates’ generosity, locals noted that for many years the foundation had invested in the oil companies that have contributed in making health outcomes extremely poor in some areas of Nigeria. These companies include Eni, Royal Dutch Shell, ExxonMobil, Chevron and Total.
Facing a backlash, the Gates Foundation sold off some 87% of its investments in major coal, oil and gas companies, leaving approximately $200m in these stocks as of 2016. Groups such as Leave It in the Ground, a non-profit organisation advocating for a global moratorium on fossil exploration, are pushing for divestment.
“The link between saving lives, a lower birth rate and ending poverty was the most important early lesson Melinda and I learned about global health,” said Gates recently. The Gates Foundation supports reducing childhood mortality by supplying hospitals with necessary equipment and hiring qualified local practitioners to take care of patients and their children.
In 2016, the Dangote Foundation and the Gates Foundation formed a philanthropic dream team when they announced a $100m plan to fight malnutrition in Nigeria. The new scheme will fund programmes to 2020 and beyond, using local groups in the northwest and northeast Nigeria. The northeast has for the past seven years been ravaged by the Boko Haram’s Islamic militant insurgency, affecting all healthcare projects in the region.
Malnutrition affects 11-million children in northern Nigeria alone, and Dangote said the partnership would address the problem.
The foundations had already signed a deal to work together to foster immunisation programmes in three northern states: Kaduna, Kano and Sokoto.
The Gates Foundation states on its website, “Contributions towards the costs of the programme by the Bill & Melinda Gates Foundation, Dangote Foundation, and state governments will be staggered across three years: 30% in year one, 50% in year two, and 70% in year three, with the respective states taking progressive responsibility for financing immunisation services.”
The future of about 44% of Nigeria’s 170-million people would be “greatly damaged if we don’t solve malnutrition,” said Gates, at a meeting with President Muhammadu Buhari.
Despite the many international and local efforts, cultural and religious factors often impede efforts to address Africa’s weak health infrastructure. For example, in 2007, religious leaders in northern Nigeria organised against aid workers administering polio vaccinations after rumours started circulating that the vaccines were adulterated and would cause infertility and HIV/AIDS.
In 2014, during the Ebola crisis, villagers chased and stoned Red Cross workers in Womey village in Guinea, accusing them of bringing “a strange disease”.
The big players may be Dangote and Gates, but others less well known are also making important contributions to Africa’s healthcare. After the 2014 Ebola outbreak in West Africa, for example, which resulted in the loss of about 11,300 lives, private companies in the three most affected countries — Guinea, Liberia and Sierra Leone — partnered with the government to fight the virus.
The Sierra Leone Brewery, for example, helped in constructing facilities for Ebola treatment. Individuals, such as Patrick Lansana, a Sierra Leonean communications expert, also volunteered their services for the Ebola fight. He said: “I joined the fight against Ebola because I wanted to help my country. My efforts, and those of others, made a difference. It would have been difficult for the government and international partners to combat the virus alone.”
Private and public sectors need to collaborate to help Africa’s healthcare system from collapse, notes a report by UK-based PricewaterHouseCoopers consultancy firm. The report states that public-private partnerships, or PPPs, when fully synergised can bring about quality healthcare. Under a PPP in the health sector, for example, a government can contribute by providing the healthcare infrastructure, while private entities can be involved in the operations.
In a widely published joint opinion piece last April, Dangote and Gates stated that improving healthcare in Africa depends on a “successful partnership between government, communities, religious and business leaders, volunteers, and NGOs. This ensures that everyone is rowing in the same direction”.
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