AS the ebola crisis continues to gain momentum across West Africa, the deeper and more deadly malaise affecting African health may at last come centre stage.
Countries at the heart of the storm – Liberia, Sierra Leone and Guinea – are set to receive unprecedented levels of resource to help control the outbreak of the virus, and in-country donor programmes are being realigned to tackle the emergency. But as crisis funds pour in, fears of donation “leakage” are rising among local populations — a chronic and debilitating condition described by the World Bank as “quiet corruption”.
Quiet corruption is the failure of public servants to deliver goods or services that are paid for by governments or their donor partners. It is a pervasive and widespread practice across Africa and has a disproportionate effect on the poor. Sickness and disease are crippling challenges, costing so much more than a few days work or a few miles’ hike. Everywhere people have to pay – either through bribes or direct payments – to receive health care that should be their entitlement as citizens of democratic states or as beneficiaries of donor aid.
Quiet corruption is symptomatic of the lack of monitoring and accountability in healthcare delivery. Donated medical supplies, medicine and equipment, are routinely sold on the black market to the poorest and most vulnerable. Consequently the sick seek cheaper remedies through traditional routes, or simply go without. With the current ebola crisis, fears that emergency aid will be squandered in a similar way have real substance.
Sub-Saharan Africa has the worst health record in the world; with 11 per cent of the global population, Africa bears a quarter of the world’s disease. It receives less than one per cent of global health expenditure and has only three per cent of the world’s health workers. In Sierra Leone, for example, the country has only 130 doctors serving a population of almost six million. There is one health worker (doctor, nurse, midwife or other community health worker) for every 5,000 people.
When the deadly ebola virus first struck, medical practitioners were on strike over better pay and working conditions in both Liberia and Nigeria — the most populous state in Africa where the virus has now spread. Given the burden of malaria, TB, HIV/Aids, a multitude of other tropical diseases and often life-threatening living and working conditions, health workers face an impossible task in keeping their populations healthy, exacerbated by the fact that aid often does not get through. Governments do not prioritise public healthcare and the sector’s workforce is pitifully inadequate. Despite best efforts of dedicated personnel, a crisis such as ebola simply cannot be contained.
The ebola outbreak in West Africa has been described by the World Health Organisation as the “largest, most severe, most complex outbreak in nearly four years of the disease’s history”. To date, around 1,500 people have died and over 2,500 have been infected. There is no capacity to manage the outbreak among weak health systems in West Africa and local medical services are overwhelmed. This chronic impediment is exacerbated by local traditions and among citizens, increasing locals’ vulnerability to the disease. Fear of hospitals and doctors, for example, and the belief that health workers are deliberately transmitting the disease are common.
These realities should not come as a surprise. It is known that the region of sub-Saharan Africa will not meet any of the Millennium Development Goals (MDGs), and basic health provision is just one of a number of areas deeply neglected by African governments. The failure is deepened by the unwillingness of international partners to hold anyone to account.
Health systems and local conditions in West Africa therefore provide the “perfect storm” for a virulent virus such as ebola to take hold. But this is an unnecessary outcome. When the stakes are highest – the control of HIV/Aids, for example – the international community can make astounding progress in the advancement of controls in the most challenges environs.
For example, since 2001 the annual number of new HIV infections among adults in sub-Saharan Africa has declined by 34 per cent. United and committed efforts can achieve health outcomes more generally, including improved access to clean water, infection control, laboratory services, better working conditions and pay for medical personnel, and most importantly facilitating a shift in strategy from emergency responses – such as the current ebola crisis – to the development of sustainable and accountable healthcare.
What is needed is a comprehensive approach inspired by international solidarity among decisions-makers and a real buy-in from global citizens whose generous charitable donations, and taxes contribute so much to donor crisis programming.
Too often donors assume that “giving” is enough, but it is not. A greater public response is needed to remind those responsible for the delivery of western aid that it is the ordinary citizens of West Africa who should be the sole beneficiaries and that, when this fails, people will be held to account for the failures.
• Dr Christine Cubitt is a Bingley-based academic and the editor of a scholarly online journal Governance in Africa.