Health care for Africa
Archived article from Oct 15, 1999
By Steve Manas
A"one size fits all" model for privatizing health-care services can't work effectively in 54 diverse African nations, and state intervention is needed to ensure delivery of these services beyond the urban elite.
These are among the conclusions of Meredeth Turshen, associate professor of urban studies and community health at the Edward J. Bloustein School of Planning and Public Policy, in her book "Privatizing Health Services in Africa" (Rutgers University Press). A longtime observer of health-related issues on the continent, Turshen analyzes the disappearance of public health in the form of state services and the growth of a private market in health care that won't reach millions of poor and rural-dwelling Africans.
"Health services are needed more than ever, especially with the spread of AIDS and tuberculosis, and the re-emergence of malaria," Turshen said. "Many children are not being immunized. TB victims are not getting medicine in the early stages when the disease can be stopped from spreading. There's no preventive or curative work being done on malaria.
"Multifaceted, general health care is needed, but by privatizing, people can't access health care at all. With increasing unemployment, those without jobs have less chance of getting third-party insurance. And with so many workers becoming sicker and sicker, and large increases in associated costs, many insurers themselves are going out of business."
Another irony, according to Turshen, whose work was inspired by her second trip to Zimbabwe in mid-1994, is that the United Nations' World Health Organization (WHO) has been superseded by the World Bank as the leading international formulator of health-care policy, due in large part to its status as the largest donor agency, even outstripping the U.S. Agency for International Development. In her view, the qualities of humanity and compassion have been replaced by a drive for economic efficiency, which cannot replace dreams of equality, equity and the end of poverty.
"For all their rhetoric, the international financial institutions have shown that their overriding interests are monetary and that their objective is the growth of capitalism worldwide," she wrote. "They seek to extend the power of money by introducing financial criteria into the operation of all public services and by deregulating labor markets. ... In their view, social security regulations do not raise well-being and reduce exploitation but rather raise the cost of labor and reduce labor demand."
Turshen observed that behind WHO's health-care policy delivery model, which has emphasized the role of the state, there are decades of solid Third World experience and the realization that the for-profit sector is an inappropriate model for the populations of Africa.
"Behind the World Bank's untested model stands only the belief that the private sector is innately efficient," she said. "The bank doesn't tailor policies for individual countries with different levels of development. Given the frightfully high rates of mortality and morbidity in Africa and the past record of World Bank policy failures, the large-scale experiments in privatization now being undertaken cannot be justified. Too many lives are at stake."
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