From one country to another, living and dying could not be more different. February 28th is Rare Disease Day, a worldwide observance co-ordinated by the Consumers, Health, Agriculture and Food Executive Agency of the European Commission. This week you are likely to see on your evening news bulletin the “face” of the awareness campaign, Mirena, who is living with Ehlers-Danlos syndrome.
This rare connective tissue disorder can be disfiguring and lead to chronic fatigue as well as difficulties in walking. Groundbreaking research promises a better life for those with the condition.
In Africa, the challenges are a little different. Common diseases remain almost as deadly as they’ve always been; even while the rare ones take their toll. This is because many parts of the continent still lack a good, basic healthcare system. However, hope is to be found in the fact that incredible success stories can also be seen across the continent.
To illustrate the situation, this article will focus on the two countries that epitomise the two extremes of healthcare in Africa; extreme improvement and extreme failure. The country that corresponds to the former is, no doubt, Rwanda, which features quite frequently on this blog. The latter case will be well illustrated by its giant neighbour to the west, the Democratic Republic of the Congo (DRC).
It is still impossible to say anything about Rwanda without a preface on the genocide from which the country dragged itself in 1994. From the piles of human bodies littering the countryside after that fell time, Rwanda has become one of the countries pointed at to show that even the most hopeless cases can be turned around, in healthcare as in much else. Even Americans admire it and wish their healthcare system was half as good.
In practically every metric, Rwanda has improved significantly. Infant mortality has decreased by almost 70 percent in the last 18 years, to 30 per 1000 live births. Some 97 percent of all Rwandese women and girls are vaccinated against HPV, a major predictor for cervical cancer; this is among the best rates in the world. Life expectancy has increased from 48 to 64 since 2000, at a rate far outpacing all its neighbours.
The number of hospitals and clinics, as well as the doctors and medical workers who staff them, has increased. On average, a Rwandese citizen now sees a doctor twice a year, compared to once every four years in 1994. So successful has it been, Rwanda is now experimenting with futuristic technologies in the sector. It is using drones to deliver drugs and blood to remote areas, which would be hard to reach otherwise.
A lot of this success has been attributed to the healthcare system the country developed in the early 2000s. A community-based health insurance scheme, where the poorest pay nothing and the richest pay a seemingly paltry 8 USD (Rwanda’s GDP per capita is 754 USD, so it isn’t paltry at all) per year, Rwandans are able to cover 45 percent of their country’s total healthcare costs. The rest comes from the government and donors. This system covers 96 percent of the population.
Not all is a bed of roses however. Such an efficient system, especially when it is funded by donors, easily lends itself to the promotion of what to the rational mind would not pass as healthcare. The same drones that deliver regular medicine also deliver contraceptives and condoms. The same hospitals where successful births are midwifed also sterilise men and put IUDs in women. It is a heinous blemish on what is perhaps the healthcare system all of Africa should adopt.
And nowhere could such an adoption do more good than in the country on the other side of Lake Kivu. In the DRC, one is always tempted to say the situation could be worse. But in Congo, the worst has already been experienced. Many times over. Things always could be better. Except they never are. The country has one of the least effective healthcare systems in the world, if it even qualifies to be called a system.
Of course, it wasn’t always so. At independence, the DRC had more hospital beds per person than all African colonies combined. Sure, that system was there to take care of Belgian colonists. But it was there; and could well have been turned and adapted to serve the citizens of the independent country. Sadly, Congo’s trajectory has never trended upwards for significant periods of time.
Preyed upon by kleptocratic government bureaucrats in the times of Mobutu, constrained by limited manpower and finances afterwards, and hampered by the vastness and roughness of the terrain as well as constant insecurity in our own times, organised healthcare is so alien to the Congolese people that over 70 percent of them have no access to it.
Infant mortality is 104 per 1000 live births. It has the second highest number of Malaria cases worldwide. Its share of tuberculosis patients in the world is among the highest. Malnutrition is a widespread problem; its effects on women who are pregnant or of childbearing age are profound.
To confound the situation, there is very little data about the sector, and little means of collecting it, to even have an accurate finger on the pulse of the country. So all the statements above are based on estimates; the situation is likely worse. And, to crown all the confusion, the current status is seen as an improvement from the past.
Reading about healthcare in the DRC is depressing, so it bears mentioning that there is a hospital, called Monkole, which is doing a lot of good work in the Capital Kinshasa. It, and a few others, are encouraging spots of brightness. One hopes this brightness will soon be reflected in the whole country, if only it can survive the political turn it has taken recently.
These two countries, then, illustrate the state of healthcare in Africa – which would be too vast otherwise to even begin writing about. They show clearly that success can be had – even though it may come with shadows – and that, where little effort is made, healthcare systems can be so emasculated as to be non-existent.
So, Africans have their share of rare diseases, and quite share it is. Nevertheless, in much of the continent, they compete for rarity with good basic healthcare systems that every Western citizen may take for granted. It is on developing these that African countries should focus for now. There is no lack of example on how that can be done.
Mathew Otieno writes from Nairobi, Kenya.