The argument for the development of the private health sector in Africa could not have been more strongly made than at a recent international conference held in Accra under the aegis of the World Bank Group.
Featuring diverse success stories on health care financing and insurance from Ghana, Kenya and Mali, it was perhaps the story of the exploits of the Malian Association of Rural Medical Practitioners that most caught the imagination of participants and positioned an entrepreneurial private sector as possible solutions to access to healthcare. Shortages in the numbers of health professionals have also often been aggravated by inequitable distribution. The underlying reasons were most succinctly made by Dr. Khama Rogo former President of the Kenyan Medical Association and now with the World Bank Group.
Although acute shortages in health personnel have been observed, it is becoming increasingly indisputable that many African governments are unable or will be unable to adequately fund the huge wage bill that is anticipated should all these qualifying health professionals be employed in the public sector. The phenomenon was cited in Kenya for example where although the State could certainly do with more doctors, securing employment for all qualified doctors was increasingly becoming challenging due to budgetary limitations. As a result, some newly qualified doctors or housemen realizing the housemanship as a part of training have begun offering their services for free in order to be signed off for full certification. Similar scenarios have been reported in Nigeria.
In Ghana, Ministry of Health estimates put the number of doctors in 2007 at 2, 026 and yet if the West African state were to achieve prevailing doctor: patient ratios of 1: 1000 in some middle income countries by 2025 by which time its population is expected to hit 32 million, it would require not less than 32, 000 doctors. Twice this number of nurses would be required also if the estimates contained in the 2006 UN World Population Prospects are anything to go by. Assuming that governments were able to fund the training of all these doctors, is it safe to also assume the state’s ability to employ all these doctors? The clarion call for governments, doctors and other major stakeholders to embrace a new era of entrepreneurial driven health agenda could not therefore have been made more loudly. While this should not be seen purely as a commercialization of the health needs of the people, it should be positioned within a framework that ensures the availability of such health services to the less privileged and underserved areas and this the Malians seem to have done brilliantly.
Like most African countries, Mali operates a three tier referral system at primary, secondary and tertiary levels. What is unique though is the massive involvement of the private health sector at the community levels where private practitioners are at the forefront of offering primary health care services. In perhaps the best example of public private partnership, the Malian Association of Rural Doctors working through an interesting partnership with the European Union and a French non governmental organization plus some recent interest from the World Health Organization, is working to place young doctors in very remote communities where access to quality healthcare has long been limited.
Young doctors are set up with five million CFA which covers the medical facility, training and the equipment. These doctors are then attached for a month to senior colleagues with rich experience in rural medical practice. A mentoring relationship is thus established which goes on for a two year period. The doctor is then placed on a fixed salary plus varying allowances dependent on the work load in the community. Some challenges identified include feelings of isolation of these doctors in these remote areas and the continued maintenance of quality in medical practice. Over its long duration, over 27% of doctors placed by the Association of Rural doctors have been known to practice for more than five years.
With the La Beach Hotel awash in renewed undimmed entrepreneurial skirmishes among the motley collection of health professionals, businessmen, owners and managers of private hospitals, heads of health training institutions etc, the stage was set for the inevitable question of funding. How does one raise the requisite funds if one were so inclined to penetrate the private health sector? And what an answer the conference provided in a detailed and insightful presentation on the African Health Fund managed by the Aureos Capital Group with the express aim of investing in commercial healthcare small and medium-scale enterprises as a means of increasing access, affordability and quality care.
The Aureos Capital Group has this interesting concept of tying its fortunes somewhat to the extent to which it is able to penetrate so-called bottom of the pyramid markets. In other words, they target markets in which services are offered to disadvantaged areas which they view as having the potential and perhaps the hunger for growth. They lend anything between $250, 000 and $5 million based on a viable business plan. It is their intention both to recoup their profits and to exit the partnership within a defined time frame. Interestingly while preferring to invest in already existing facilities, the Group is very amenable to assisting viable and convincing start-ups.
In addition, the World Bank Group pledged its preparedness to engage private health sector industry players whose sights might be set on funding in excess of the $5 million. Secondly the Bank is also currently seeking partnership with interested Ghanaian banks that would provide funding to private health sector business initiatives costing less than $ 250, 000. For those who have long lamented the mixed fortunes of Ghana’s private health sector, this might just be the needed spark.