Time for Africa to fund own health systems

ZIMBABWE is hosting the 67th edition of the World Health Organisation regional committee for Africa conference underway in Victoria Falls. The meeting comes at a good time as the continent is still celebrating the appointment of WHO director-general Dr Tedros Adhanom Ghebreyesus, who is the first African to lead the global health agency.

Health has been evolving over the years. Historically, formal healthcare systems were developed to respond to a few selected commonly occurring communicable diseases. For long, communicable diseases like HIV and Aids, cholera, measles, just to name a few have been the leading causes of death and the disease burden in Africa.

But, the situation has now changed with the emergence of non-communicable diseases such as cancer and diabetes, which are straining the health sector and also killing more people at an alarming rate.

At the same time, a few donors are willing to dedicate funding as they too have their own problems to deal with in their backyards.

So far in many African countries, due to a plethora of reasons, governments are not spending much on health budgets, leaving them underfunded.

While most African governments commit to allocate at least 15 percent of their national budgets towards health, the money does not usually come as health competes with other sectors like security and defence, education, agriculture, among others, which are also extremely key development indicators of any country.

Because of this lack of funding of the health sector, many African countries, Zimbabwe included, have for years been relying heavily on donor funding to keep the health sector on its feet.

Yes, the donors have done a lot in the past to fill in the gaps and also ensured that some countries reached set targets for the UN Millennium Development Goals in 2015, while some promised to ensure that the 17 new Sustainable Development Goals stay on track.

The biggest challenge now is the fatigue that is crippling donors. This lack of funding can easily reverse the gains made in the health sector.

As ministers of health discuss these issues and map the way forward in Victoria Falls, it is important for them to note that over-reliance on development assistance is clearly not working and the chief reason why Africa is in constant poverty and failing to grapple with disease.

Some of the prescriptions that can help Africa shut the aid taps and reduce dependency have been put forward by economists, and it is up to governments to take them up.

As Zambian writer and economist Dambisa Moyo suggests, African governments should raise money by issuing bonds on international credit markets. Instead of obsessing over more aid, Africa should be calling for fairer trade and stepping-up efforts to attract Chinese investment and earn our own money, which can be put toward funding our health programmes.

As President Mugabe aptly put it in his opening speech at the Victoria Falls Conference, financing for health remains challenged. There indeed is a need to further innovate around how we finance health, and how we efficiently and sustainably invest such financing. Local solutions are always the best.

For example, in Zimbabwe, the informal sector is not taxed for what people earn by either making sofas, sewing, operating tuck shops etc., only paying taxes through value added tax.

This also has resulted in Government only relying on the formal sector for taxes; a situation that has resulted in the national purse getting less, while the demand for social services balloons.

It is important to take a moment and think of how a doctor working at Government hospitals like Parirenyatwa Group of Hospitals and Harare Central — who is supposed to take care of the same people — who do not pay taxes — is paid. It is also imperative to think of where the medicine the same people, who are not paying taxes, will come from when they do not give Caesar what belongs to Caesar.

Yes, health is a basic human right enshrined under the Universal Declaration of Human Rights, and there should be no discrimination on who should get a service or not.

But the issue is if someone at least earns something they should also give something back if our health sector is to improve. That money, if available, can even be put towards research of non-communicable diseases like cancer, high blood pressure and diabetes, which are causing untold suffering in many African countries. There is also need to curb corruption at all levels to ensure that funds set for health programmes are not abused.

Zimbabwe has proved that it can manage programmes well as evidenced by the good standing the country’s National Aids Trust Fund, commonly referred to as the Aids Levy has had globally with most developing countries using it as a test case.

The recently introduced Mobile Airtime Levy as health financing innovations to fund some critical areas in the health sector such as HIV and Aids, increasing cancer cases and pharmaceutical products for health institutions, if managed in the same manner the National Aids Trust Fund was handled, can also help close the tap on donor funding.