The African Development Bank (AfDB) has identified one peculiar thing that Botswana has one thing in common with Kuwait and it is not related to riches: both have health policies that are least inclusive.
The inclusiveness of the health sector is related to the level of development in a specific country and is based on three pillars: the quantity of health care services, the quality of health care services measured by health outcomes and the accessibility (equal or unequal access) to health care services. Seven out of the 10 countries with the least inclusive health policies are located in Sub Saharan Africa: Botswana, Democratic Republic of Congo, Chad, Angola, Nigeria, Gabon and Equatorial Guinea. The other three countries are Iraq, Saudi Arabia and Kuwait.
Study after study has showed that while Botswana is among the top five in terms of expenditure on education globally, the country’s level of educational productivity is disappointingly low. It turns out that the health sector has a similar problem. The AfDB says that while the country’s level of expenditure in health care is relatively high, it still shows a “poor public allocation of health resources” to rural areas. The latter lack health infrastructure (only 42 percent of the rural population has access to improved sanitation facilities) and qualified professionals. With regard to the latter, Botswana’s density of physicians is 0.336 per 1000 people.
“Although the availability of resources matters, its efficient and equitable allocation is crucial for inclusive health care services,” the bank says.
Malawi, whose economy is not as strong as Botswana’s, is among the top 10 countries which have an inclusive health index above their level of development. The other countries in that group are Cuba, Uruguay, Rwanda, Greece, Argentina, Kyrgyz, Solomon Islands, Moldova and Liberia. Sub-Saharan Africa is deemed to have insufficient healthcare infrastructure, short supply of skilled healthcare workers and a deficient health financing system. AfDB says that while all African countries have signed the Abuja Declaration, pledging to devote 15 percent of their national budget to health, most of them are far from reaching this target. Against this background, the incidence of non-communicable diseases in Africa, which are the biggest killers in the developed countries, is rising fast (from 21 percent of total cause of death in 2000 to 29 percent in 2012) and is expected to become the major health challenge and health financing burden in the continent by 2030. In addition, low pay and poor standard of living in the region are creating brain-drain of health professionals to the developed world which condition contributes to health inequalities and poor primary health care services.