WISH for Africa - funded Network of Community-Based Healthcare Providers

Further to the proof of concept studies conducted on behalf of WISH For Africa, we have set up three self-sustainable healthcare centres in low socio-economic areas of Lagos State of Nigeria.

It has been demonstrated by researchers that professional and efficient management of resources is needed in the private healthcare sector to achieve a sustainable and viable healthcare delivery system that can be easily accessed by the poor.

From a purely economic standpoint, we believe that an efficient management of resources will make it possible to lower cost of healthcare delivery. Lower prices mean that medical cover can therefore be extended to more people at reasonable cost, particularly in an environment where over 60% of the population live below the poverty line.

Some of the issues and problems identified during a proof of concept study undertaken by Wish for Africa are discussed below:

• In Africa , when people, poor people in particular, first seek diagnosis and treatment for an illness, including those that contribute the most to the population disease burden, such as malaria, sexually transmitted infections, diarrhoea and respiratory tract infections, they visit a private doctor, pharmacist, nurse, midwife, patent medicine vendor (PMV) or a traditional herbal practitioner. People use these private sector providers (PSPs) because they are often easily accessible, and they are perceived to be less formal and less expensive than their public sector counterparts (Alubo 2001). However there is little or no regulation within this sector, in fact, the regulation of medical and pharmaceutical practices in most African countries is very weak. In reality, there is practically little or no control over providers' activities, hence no deterrence against the supply of substandard care. In essence, there is no decent private healthcare service available to a large section of the population.
• The lingering economic crisis in most African countries has translated into multiple administrative and logistic problems in the delivery of decent healthcare in the private sector. From chronic shortages of medical supplies and lack of motivation of medical personnel due to poor pay packages to lack of a reliable third party payment structure; one can conclude that the medical care crisis in Africa is a direct manifestation of the deeper structural crisis of the African economy.
• The unresolved problem of reconciling the viability of private sector providers of healthcare as a business in the absence of an organised payment structure is also a fundamental issue. There are no organised third party structure in place, which could have at the least, guaranteed steady cash inflow for investment and development of the private healthcare sector (Alubo 1990). The issue of fee-for-service represents a cause for concern because of its impact on accessibility to healthcare services by the population on one hand, and the sustainability of the providers as a business entity on the other hand. The present system in most African countries is over-commercialised, thus depriving the people of much needed healthcare.
• Africa's various governments (military and civilian) have addressed these shortages through a combination of panicky importation of medical supplies and imposition of user fees as part of the general structural adjustment package (SAP) instituted by IMF and World Bank. Consequently, the persistent shortages and increased user fees have combined to discourage patronage of both public and private healthcare facilities and people have resorted to self-medication and patronising quacks and trado-herbalist centres with little or no quality of healthcare being delivered to the people.
• Fierce competition among providers has been observed to encourage over-acquiring capacity and technologies (hospital and delivery beds, laboratory and x-ray equipment, scanning machines, theatre equipment, ambulances etc) in excess of potential demand. Hence the consumers - the patients, who have come to identify such hardware as a quality index, end up being charged higher user fees, which in turn restricts access and ultimately, leads to poor patronage and reduced revenues to the provider (Ogunbekun et al. 1999). The for-profit motive and high fees of these providers altogether contribute to the limitations of access of patients to private sector healthcare services.
• Many developing countries of Africa have underdeveloped healthcare delivery systems. Listing the failings of many health systems, the WHO pointed to the fact that many health systems in majority of the poorly-performing countries focus on the public sector and often disregard the frequently much larger private sector providers of healthcare (WHO 2000).

Our vision for the future of healthcare delivery in Africa is to set up a network of primary healthcare centres in African communities, providing good quality affordable healthcare. Containing cost-escalation while enlarging access to quality care will impact very positively on the overall health system and set an important precedent on how healthcare should be delivered in these communities.

Please support us and help turn this vision into reality - Donate now and help set up a healthcare centre in an African community!