Fati N’zi Hassane
Recently, a good friend of mine took his perfectly healthy daughter to a private hospital in West Africa for a routine check-up. The paediatrician thought she was a bit thin for her age and advised that she undergo a surgical procedure, which is known to trigger weight gain in children. Despite the family’s misgivings, the operation went ahead. She died on the operating table. It was a terrible loss. So many people I know in Africa have stories like this.
Public investment in essential public services has been in decline, creating a vacuum in healthcare provision that those seeking to make a profit are increasingly exploiting. But mixing profit maximisation with healthcare too often comes at an unacceptable cost. Today, many private hospitals are abusing and violating the rights of patients and their relatives and impoverishing them. I see the devastating results every day in Africa – people faced with no choice but to watch their loved ones die, or forced to sell everything or take loans to pay the exorbitant medical bills. However, the private sector continues to gain huge support as “the solution” to Africa’s development challenges.
Last month, I attended the Summit on the New Global Financial Pact in Paris on behalf of Oxfam. African leaders spoke passionately there about the issues affecting their citizens and, in particular, the need for public finance and public solutions. South Africa’s President Cyril Ramaphosa highlighted the profiteering by Big Pharma during the pandemic, and we kept saying, “What is more important, life or profits by your big pharmaceutical companies?” But the World Bank and the rich countries instead again offered the private sector as the answer. The new World Bank president, Ajay Banga, talked about how “for years, the World Bank Group, governments, and other multilateral institutions have tried – and fallen short – to mobilise meaningful private investment in emerging markets” and that “we must try a new approach … to catalyse private capital more effectively”.
In my view, the private sector knows quite well how to look after itself. It does not require taxpayers’ funding. Sadly, and without asking us, governments in rich countries have contributed to this misery by underwriting and investing in these predatory private healthcare companies, feeding them to grow in our countries and become ever more powerful. Oxfam recently released two shocking reports, based on complex and detailed investigative research in a number of countries. We show how development institutions belonging to the governments of France, Germany, and the United Kingdom, as well as the European Union and the World Bank, are investing billions of dollars in Majority World countries into for-profit private hospital chains that block or bankrupt patients, deny them emergency medical care, with some even imprisoning patients and retaining corpses for non-payment of fees.
They are making huge profits for their already rich owners. All this, in the name of advancing universal health coverage and fighting poverty. Ironically, the same rich countries provide healthcare and education funded by taxation and free of charge to their own citizens. In Kenya, Oxfam unearthed dozens of cases of alleged or confirmed human rights violations by the Nairobi Women’s Hospital since 2017, including a newborn baby detained for three months, a schoolboy for 11 months, and a single mother of two for 226 days during which time her bill escalated by more than 2,000 percent. The body of Francisca’s mother was locked in the hospital’s morgue for two years, she said. “I feel very sad seeing her … It is not easy for me because her body has changed … It does not look like a body any more, it’s more like a stone … We pleaded with the hospital to give us the body. We will never be able to pay the money, no matter how long they keep it.”
What upsets me most is that this hospital’s policy of detaining patients was already public knowledge before the rich countries chose to invest. In Nigeria, nine out of 10 of the poorest women give birth with no medical care, yet childbirth at Development Finance Institution (DFI)-funded Evercare Hospital would cost those women their 12 years’ income. Across all the hospitals getting these development funds, the average starting price for a childbirth procedure is more than a year’s income for an average earner in the poorest 40 percent.
During the COVID-19 pandemic, when people in my region of the world searched in desperation for scarce oxygen and life-saving care, exploitation escalated within some of these DFI-funded hospitals. In Uganda, one of Africa’s poorest countries and hardest hit by the virus, private hospitals funded by European governments and the World Bank charged patient “clients” up to $2,300 per day for treatment and care. The Maputo Private Hospital reportedly charged COVID-19 patients an upfront deposit of more than $6,000 for oxygen and more than $10,000 for a ventilator. In my view, the evidence is clear that the private sector is not the answer for the delivery of the public good. We know what the solution entails. Instead of promoting the growth of expensive, out-of-reach hospitals for the elite, countries should support quality universal public services – funded by taxes and aid – and delivered free of charge at the point of use.
For example, look at the incredible improvements in healthcare delivered by thousands of new health workers in Ethiopia, pioneered by then minister of health, Dr Tedros Adhanom Ghebreyesus, before his time leading the World Health Organization. European governments and the World Bank should stop funding for-profit private hospitals and evaluate the effect that their decades of investment in them have had on healthcare in Africa.
