The crowds trooping to Loliondo over the past few weeks have been described as the epitome of either gullibility, desperation or both.

The efficacy of Mwasapile Ambikile’s concoctions aside, this is not the first time East Africans are stumbling over themselves to access medical treatment.

Last October, thousands of Kenyans flocked Mombasa for free screening and treatment aboard a Chinese hospital ship, the “Peace Ark” at Mbaraki wharf along Likoni crossing. 

The free medical camp saw patients arrive as early as 6.00 am.

Some patients had set up camp in Likoni days before the vessel docked.

A considerable number had travelled hundreds of kilometres, from as far as Garsen, Garissa, Kilifi, Taita Taveta, Kwale, Lamu and Nairobi.

A critical examination of medicare statistics in the region reveals that Loliondo is merely a dramatic expression of a common, almost hackneyed narrative—the story of woefully inadequate medical services across East Africa, where health centres are perennially understaffed, drugs are frequently out of stock, hospice care is far out of the reach of most terminally ill patients, and the poor, constrained by finances, are forced to seek treatment only when their situation has become critical.

Against the backdrop of the dismal condition of health care in the region, the thousands flocking to “take of the cup” cannot be considered a spontaneous event, or just another example of the herd mentality, but instead the logical consequence of mounting desperation in health services, which inevitably reached tipping point.

For instance, according to the World Health Organisation, globally, there is an average of 14 physicians per 10,000 of the population.

In low income countries across the world, this figure drops to four physicians per 10,000 people.

Africa is served by just two physicians per 10,000. Even against Africa’s dismal statistics, East Africa still comes up short: There is only one physician per 10,000 of the population in Kenya and Uganda, and less than 0.5 in Tanzania.

Tanzania’s health sector in particular is suffering a severe staff shortage: According to a 2008 abstract by the Ministry of Health, proposed staffing levels indicate that the existing health facilities in mainland Tanzania require approximately 126,000 health workers.

However, only 35,202 professional health workers are currently engaged in the sector, indicating a staggering deficit of 90,722, or a 76 per cent staff shortage, for both public and private health and social welfare services.

The country’s population per medical doctor— both physicians and clinical officers—is over six times the World Health Organisation recommendation of 10,000, standing at an average of 64,000.

In some parts of Tanzania, this figure can shoot up to four times higher than the national average—in Kigoma, for instance, there is one medical officer per 308,000 of the population.

In Mara, that figure is 167,000, and in Tabora there is one medical officer per 132,000.

The numbers are even more worrying when we examine the availability of specialist doctors.

According to a 2008 report by Tanzania’s Ministry of Health, excluding Zanzibar, there are only 447 specialist doctors available in the country, representing a 69 per cent deficiency in the country’s needs.

There are 130 dental surgeons available, which represents a 76 per cent deficiency.

The country is suffering a 90 per cent shortage of physiotherapists—according to the report, in 2008, there were a mere 18 physiotherapists available.

The situation in Uganda is equally inadequate. The majority of the vacancies in the public health sector are in health centres predominantly located in rural communities.

In these facilities, up to two thirds of posts are vacant. From November 2008 to-date only 51 per cent of the approved positions at the country’s national referral hospitals are filled.

Medical officers are still thin on ground—Hoima and Kabale Regional Referral hospitals, for example, are staffed with only 6 and 7 medical officers respectively.

Per capita health expenditure in East Africa, at $28 per person per year, is a mere 3 per cent the global average.

Kenya spends $34 per capita on health; this figure drops to $28 in Uganda, and $22 in Tanzania—compared with $76 in Africa as a whole, against a global average of $802 per capita.

Government contributions towards per capita health expenditure in the region is only $11, meaning that most are forced to turn to other sources of funding to meet medical bills.

This could be private insurance schemes, or more often, their own pockets.

Private health insurance is taken by only a small minority, and social security mechanisms to cushion the poor against catastrophic health expenditure are inefficient at best, and in the worst case scenario, completely non-existent.

This is demonstrated by out of pocket health expenditure in the region: In 2007, global averages for out of pocket health expenditures as a percentage of private health expenditure stood at 44 per cent.

For Africa as a whole, that proportion was 60.1 per cent.

In East Africa, however, the figures stood at 51 per cent in Uganda and 75 per cent in Tanzania. 77.2 per cent of private health expenditure in Kenya came from the pockets of patients.
Recent studies in Uganda show that up to a tenth of the household expenditure is spent on out of pocket health expenses.

35 per cent of antiretrovirals, which should be free of charge, are paid for.

The studies also reveal that 28 per cent of the households in Uganda are unable to keep up with medical bills, with considerable variations by wealth quintile and region.

In 2008, 2.3 per cent of households were pushed into impoverishment because of medical bills.

In addition, catastrophic health expenditure actually increased from 8 per cent to 28 per cent between 1996 and 2006 despite the elimination of user fees in 2001.

These figures mean that getting sick is a risk many East Africans simply cannot afford to take.

For casual labourers, taking a sick off or having to spend money on drugs could translate into a dramatic cut back in spending on food and education, and absence from work could easily cost them their employment.

For other households, their grip on “middle class” status already tenuous, prolonged or complicated illness could very well mean sinking into, and remaining in poverty.