Tue, Jan

Decoupling Healthcare Financing From Excessive Donor Dependence. Image credit - AAA Business

Thoughts From Afar
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Also, healthcare donor funding directly fuels corruption. There are many anecdotal reports of funded projects being completed by bureaucrats with data riddle with forged documents and ghost name payments with the bulk of the funds sleazed by those at the top.

Dambisa Moyo in Dead Aid opines, “Africa is addicted to aid. For the past sixty years, it has been fed aid. Like any addict it needs and depends on its regular fix, finding it hard, if not impossible, to contemplate existence in an aid-less world. In Africa, the West has found its perfect client to deal with.”

As a contrarian, I find the above statement disheartening but true. In my professional life, I have had to deal with drug addicts hooked on to heroine being weaned off by shifting them on to methadone. The irony is, few if any are able to kick the habit using these schemes. Yet, these schemes seem to be promoted irrespective of all the data showing poor treatment outcomes. Africa seems to be on a similar trajectory regarding the issue of donor funding with few even prepared to contemplate a discussion about turn off the funding tap.

According to the Financing Global Health Database, as of 2015, the breakdown of Ghana’s health financing was as follows; 16.9% Development assistance for health, 38.4% Government health spending, 40.9% Out-of-pocket spending and 3.7% Prepaid private spending. It is estimated that in 2040 the breakdown will be as follows; 8.42% Development assistance for health, 55.6% Government health spending, 33.4% Out-of-pocket spending and 2.6% prepaid private spending

In essence, development assistance to the health sector will be halved by 2040, with all other components of our health care financing declining too whilst the component provided by the government will increase by close to 20%.

Factoring in a population growth rate of 2.2% per annum and a projected population of 43.5 million in 2040, these figures should set us thinking creatively to ensure we can sustain our MEAGRE healthcare gains. Sadly, we seem to be oblivious to this, behaving like sitting ducks and waiting for the worse.

For me, sitting and waiting without a coherent agenda is a non-starter. In a world where leading aid agencies have been shown to be complicit in the sexual exploitation of women and children, whilst claiming to be there for their interest; our country should be thinking of how to go it alone without their help in the first place.

Ghana’s healthcare strategy has been amorphous and ubiquitous since independence, suffering the stop-start syndrome with successive governments. However, one thing that has run through each strategy is the quest to improve healthcare access and life expectancy. Unfortunately, to achieve this, our bureaucrats and politicians have spent more time writing proposals to donor agencies than ensuring that an enabling environment exists to foster thinking so as to generate a creative approach towards healthcare funding.

History teaches us that all developments in healthcare worldwide have happened because some have dared to challenge the status quo. The history of the National Health Service of the United Kingdom will never be complete without a huge acknowledgement of the contrarian views of Aneurin Bevan after World War II when that country was confronted with huge disparities in healthcare access. Childhood leukaemia would still be ravaging if the likes of Emil J Freireich, Emil Frei, and James F. Holland hadn’t defied the illogicality of the 1960’s treatment approach which confined all affected children to a certain painful death and researched a new way of combating the disease. Today the treatment success rate is one of the highest amongst all cancers.

Thus in my view, the time has come for us to start a contrarian conversation on our healthcare system without donor funding. In having this conversation we must accept the following realities. No human society has undergone transformational development at the mercy of another country’s taxpayers. In reality, no country or agency is Father Christmas, donor funds come with conditionality and strings. These funds also make our bureaucrats lazy with tunnel vision thinking, jetting to one western capital or the other to justify why our otherwise precarious situation requires more hand-outs whilst lining their pockets will allowances. In doing so, they bastardise or self-esteem and help fuel the perception that we are inferior humans. Ironically, these same western countries, following our attainment of lower middle-income status, coupled with constraints on their own budgets have started cutting back on our funding believing we have what it takes to fund our healthcare. This cognitive dissonance thus results in our system being continually extractive, frowning on innovation whilst stifling entrepreneurship in the area of healthcare, leading to low job creation and a potential for significant unemployed middle-level health workers.

Also, healthcare donor funding directly fuels corruption. There are many anecdotal reports of funded projects being completed by bureaucrats with data riddle with forged documents and ghost name payments with the bulk of the funds sleazed by those at the top. Finally with the disparity between the disease burden of the middle class and working class narrowing with communicable diseases dwindling and non-communicable chronic diseases on the ascendancy, relying on external funds will imply we have no end date to becoming self-sufficient. For a country that has been independent for over six decades, this is a huge indictment.

As a first step, it may be beneficial to cut the number of foreign trips bureaucrats make to court the attention of donor agencies’, encouraging them instead to use the time to develop a blueprint for the liberalisation of the healthcare market, diversifying it from its current state to one based on local entrepreneurship and technological innovation. Such an approach whilst raffling a few feathers will be the biggest indication that government doesn’t believe in business as usual. Following this blueprint, the private sector especially the young should be encouraged to buy into this print following a national policy dialogue and encouraged to stretch the frontiers of healthcare innovation. We will be amazed if we tried at what we will achieve.

Weaning ourselves off this funding stream would actually be exciting. To start with it could rekindle entrepreneurship amongst health workers and help with a drive towards the digitalisation of our health delivery system. Should this happen, this would create a thriving new service industry for health that would create jobs and contribute to the nations GDP. Innovation could also help increase the reach of the specialist doctors and increase efficiency. With our precarious healthcare human resource numbers, such a development will be a huge plus. Considering that the data suggests out of pocket spending on health will continue to be a major contributor to individual health funding, a thriving private health insurance environment, rivalling in some instance and augmenting in others the National Health Insurance scheme could emerge.

Such an action could also drive foreign direct investment in the area of health care, decreasing the requirement for the government to put up health infrastructure minimising the impact of healthcare on the national debt stock. It could also encourage many health professionals in the diaspora to contribute either remotely through telehealth or directly during routine visits to our healthcare delivery.

Overall my view is that weaning ourselves of health aid, will bring about competition, improve access, encourage innovation, generate jobs, expand the health economy and contribute to the national GDP.

Should that happen, the effect will be more funds available to government and the percentage of the budgetary allocation to health in monitory terms seeing a significant boost. This is the exciting blueprint I believe government and technocrats should be selling to the citizenry. This is what would bring self-confidence and make us believe in the view of our first president Kwame Nkrumah that, “the black man is capable of handling his own affairs.” In the end, we would take a real shot at breaking this unhealthy addiction to donor-funded healthcare after over sixty years of trying.

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