In any talk about East Africa’s economic prospects, bureaucrats and politicians tend to take pride in the region’s swelling population, which is often presented in terms of the notional market it represents.
The youth bulge is presented as a labour reserve, available to drive the dreams of the investor looking for quick wins. The flipside of that coin—minimal social investment—is rarely spoken about in black and white.
Perhaps nowhere else are the results of this selective amnesia more vivid than in the health sector. With the exception of Tanzania and Rwanda, the rest of the region is caught in the odd asymmetry of unemployed health professionals walking the pavements while hospital floors remain critically understaffed.
In Kenya and Uganda, where a thriving private medical practice has developed, adequate social nets to give the poor access to quality care outside the public system are missing.
Ravaging the world for the better part of three decades, in East Africa, the HIV pandemic has had the unexpected effect of insulating lax and mostly corrupt governments from responsibility, first because of the shortened life expectancy, which has erased the health problems associated with a normal population curve.
Because they provided the basic commodities to address emerging issues such as HIV/Aids, the intervention of donors allowed governments to skimp on 360-degree investment in the sector.
The gospel of economic liberalisation that gained currency at the start of the 1990s also provided governments the perfect cover to abdicate their responsibility to think for and invest in the sector in a comprehensive way.
Now, as populations swell and live longer, the bubble is bursting. In addition to common killers like malaria and bacterial infections, the health system now has to cope with a growing burden of non-communicable diseases.
Low on the merit order for decades, the capacity to treat these diseases that were perceived as ailments of privilege, is near absent.
Access to diagnosis, let alone treatment, is a tall order for a people who are increasingly exposed to the risk of suffering diseases because of poor regulation and monitoring of the market. Without the urgency of HIV/Aids, the cost of treatment remains prohibitive.
Reforming East Africa’s healthcare will be a complex but not impossible task. A starting point would be to take back ownership of the sector through realistic budget allocations that address the input and output sides of the equation.
Overdependence on donors gives them the power to determine what we do with the scarce resources. And, as experience shows, they have not always been infallible.
Resolving the human resource question in health is necessary to remove the current wastage on training people we are not willing to employ.
Without people, critical areas like research and development of solutions and even manning and maintaining critical equipment will continue to manifest in gaps at the patient care level.
Cases of expensive medical hardware wasting away because technicians to operate them were not hired are all too common across the region.
Without new thinking at the policy level, and a culture of ethical responsibility, East Africa’s health sector will continue to waste resources.