The current Ebola crisis has sparked a fuse and brought attention to what has been the plight of many poor Africans for a generation. The key question is why it has taken African governments, businesses and ordinary people so long to wake up to the fact that inadequate healthcare systems are a ticking time bomb.
Thus, this explosive health issue has implications for all Africans and the world at large. As far back as 2006, I raised the issue of human resources for health, and the massive wholesale loss of skilled healthcare professionals from Africa to the west and the Middle East. This is in part due to the poor working conditions in Africa and the rising demand in the west where there are much better working conditions. Africa has two physicians and 11 nurses/midwives per 10,000 of the population. In contrast, there are 14 physicians and 28 nurses/midwives for the same population ratios globally. In Europe, there are 33 physicians and 68 nurses/midwives and in the Americas, there are 23 physicians and 55 nurses/midwives (World Health Organisation for Africa – Atlas of Health Statistics 2011).
In the UK, between 2002 and 2008, the Nursing and Midwifery council for England, Wales, Scotland and Northern Ireland registered 11,500 qualified medical staff from Africa to practice in the UK. In addition, the General Medical Council has 14,377 registered clinicians from African countries. These numbers do not include Africans who have trained and qualified in the United Kingdom or African trained pharmacists, therapists and other supporting healthcare professionals working outside the continent. The ratio of healthcare workers is similarly high in the USA, Canada, Europe and the Middle East. The growing loss of vast numbers of African healthcare professionals from across the continent generates huge structural deficits with respect to building much needed robust and resilient healthcare systems across African economies.
In April 2006, African diaspora organisations organised a high level event with Save the Children UK which explored human resources for health in Africa. The discussion group came up with recommendations for action. The summary report from the event
Since then I have been personally involved in conference after conference and meeting after meeting focused on this pressing issue. I have taken part in numerous surveys and have mapped the skillsets of diaspora healthcare professionals as well as micro-scale healthcare projects. My involvement has always been with the expectation that many of the recommendations for action would lead to the transformation required. Unfortunately, nothing has happened. The current Ebola crisis has exposed to the world what the poor of Africa have been going through for years. The silent cries have increasingly become a loud shout for help NOW!
Most of Africa’s ruling elites do not use the national health systems they preside over. They prefer to fly to Europe or the Middle East, where they can access reliable healthcare provision as private patients at great cost to the public purse in their home countries. As such, they fail to give any priority to ensuring that African health systems deliver high quality services for ordinary people. Even the emerging middle class are forced to identify private healthcare providers or deplete meagre savings in order to seek treatment abroad. In addition, one of the main drivers of diaspora remittance transfers to Africa is the constant call for funds to meet family healthcare bills. This poor state of affairs has led to the growth of informal and unregulated healthcare systems commonly used by poor people. These informal systems are compromised by increased risks due to unqualified healthcare workers adopting unsafe healthcare practices.
Unfortunately the Ebola crisis must be seen as an opportunity that must be seized upon to turn the tide of healthcare in Africa. African leaders and Africans must stand up to deliver and demand the required change now. There is little need to set up committees or commission reviews. Instead, it is time to implement the various policy recommendations that have gathered dust on various shelves. One example is Africa’s Road Map for Scaling Up the Human Resources for Health for Improved Health Service Delivery in the African Region 2012–2025, produced by the WHO.
In summary, across Africa, transformation of healthcare is required at all levels. This includes public health (prevention), treatment (health service delivery) and the various elements required to support quality assured healthcare systems. The priority actions should include:
• Aggressive strategies such as those deployed to attract business investment must be used to build healthcare systems in Africa. Presently, African countries, with the exception of just a few, spend less than 15 per cent of government expenditure on health, despite pledges by the African Union in 2001 during the Abuja Summit. It is important that all African governments recognise health as a priority investment.
• Robust monitoring of spending and the implementation of regulation for healthcare systems is critical.
• Valuing healthcare workers, both medical and non-medical staff, across Africa and beyond by ensuring terms and working conditions are fit for purpose.
• Building and sustaining integrated healthcare systems in order to promote both preventive and curative healthcare.
• Healthcare research and development which is exclusively Africa focused and Africa centred.
• Building healthcare systems which are underpinned by trust. Thus patients must believe that healthcare professionals are not motivated by financial gains but by ethical professional standards.
• Eradicating unregulated healthcare provision that compromises public safety.
• Educate and inform the wider public about how to hold their elected officials to account on healthcare issues.
• Identify ways to engage the expertise and experience of Africa’s broad healthcare diaspora.
The current crisis demands that we all change and demand change. Like many African diaspora healthcare professionals, I am willing to support the transformational change required. What we need however is for our various political leaders to lead with humility and do what is right for the wider public rather than serving the interests of a small group of ruling elites. The many lives lost to the current Ebola crisis, to malaria, TB and HIV, among others, demands that we must all make a change NOW.