* Highly lethal hemorrhagic virus has killed over 1,300
* Worst-hit nations had weak, war-battered health systems
* Africa's heavy disease burden is big brake on development
* Beyond emergency, sustained healthcare investment needed
By Ed Stoddard and Pascal Fletcher
JOHANNESBURG, Aug 21 Surviving sickness can make
So while a western corner of Africa writhes in the deadly
grip of the Ebola virus, there are signs this emergency may
serve as a wake-up call to strengthen spending and investment on
public healthcare in the world's least developed continent.
"If anything, I think it is teaching us something," Mustapha
Sidiki Kaloko, the African Union's Commissioner for Social
Affairs, told reporters in Addis Ababa this month.
"It is not only a question of response ... it goes back to
the issue of strengthening our health systems. Prevention is
always better than cure," Kaloko said.
One often-repeated reason for the devastating rapacity of
the Ebola outbreak in Liberia, Sierra Leone and Guinea is that
those three small states were already weakened by poverty and a
decade of interlocking civil wars.
Deaths from the Ebola epidemic, the world's worst of this
highly lethal virus which has also touched Nigeria, have topped
1,300 and are still climbing.
Ironically, the disease struck Liberia and Sierra Leone at a
time when their governments had been ramping up health spending:
their total expenditure on health as a percentage of GDP was the
highest in Sub-Saharan Africa in 2012, at 15.5 and 15.1 percent
respectively, compared to 6.3 percent in Guinea, 6.1 percent in
Nigeria, and 8.8 percent in South Africa, WHO statistics show.
But the two states' war-ravaged health systems were still
very fragile. Liberia had one doctor for every 70,000 people,
Sierra Leone one for every 45,000, compared to one for every 360
people in Britain and one for every 410 in the United States.
And with medical workers bearing the brunt of the disease,
the underfunded and understaffed health structures of these West
African neighbours have been overwhelmed by the onslaught of
Ebola, which kills up to 90 percent of those it infects.
Extrapolate this to Sub-Saharan Africa's unenviable health
condition: a frequently cited WHO assessment shows the region
accounting for 11 percent of the world's population, yet bearing
24 percent of its global disease burden and commanding less than
1 percent of global health expenditure.
Ebola was first detected in central Africa in 1976. The
current outbreak is a grim hark-back to the dark spectres of
disease, war and poverty that have hamstrung Africa's advance
for decades. Many believe it should ring a shrill alarm bell for
the region's governments, and their donor backers, to pay more
attention to public health development.
In early August, as the spreading emergency tainted an
African leaders' summit in Washington, the World Bank pledged
$200 million to help Guinea, Liberia, and Sierra Leone.
World Bank Group President Jim Yong Kim made a point of
saying that besides the emergency response, the intention must
also be to "help to build up public health systems in West
Africa to strengthen the region's disease control capacity".
LESS WARS, LONGER LIVES
Bisected through the middle by the Equator, Africa is the
most tropical of continents, exposing hundreds of millions of
its people to conditions conducive to the spread of pandemic
diseases like malaria. Tuberculosis is another major killer.
The region also still suffers from the highest caseload of
HIV/AIDS on the planet, a huge debilitating burden.
"Africa is not a healthy continent," audit, tax and advisory
group KPMG said a 2012 report, saying the continent lagged the
world on all health indicators, including life expectancy.
"The main contribution to longer lives in Africa has been
through conflict resolution; the countries that have made the
most remarkable progress are simply those in which wars have
been resolved," the KPMG report said, citing dramatically
improved longevity in Liberia, as well as Eritrea and Angola.
Despite this, progress in basic health has been made, with
Africa child and infant mortality rates falling sharply in
recent years, from almost 85 per 1,000 live births in 2004 to
under 65 in 2012, though they remain the highest in the world.
Since 2001, the annual number of new HIV infections among
adults in Sub-Saharan Africa declined by 34 percent, the UNAIDS
agency said in a report on the global AIDS epidemic for 2013.
Healthcare expenditure in Africa has been rising too,
according to World Bank data, though at $95 per capita in 2012
it was less than a tenth of the global average of over $1,000.
Spending by African governments on health has often been
overshadowed by other perceived priorities, such as big-ticket
infrastructure projects linked to economic growth ambitions.
"SOFT" VS "HARD" PRIORITIES
"The challenge of course is that Africa is deficient in all
infrastructure, soft and hard, but the sort of obsession in the
last couple of years has been around funding for hard
infrastructure, commerce-enabling projects, roads, bridges,
railways, expanding ports and so on," said Simon Freemantle, a
political economist at Standard Bank.
Freemantle said if the Ebola emergency could draw attention
to the need to also fund "soft" social infrastructure - health
and education - this would be a "positive takeaway".
"In order for Africa to unlock any of its demographic
opportunity, we have to see the institutions supporting people
improve dramatically," he said.
Meanwhile, African spending on other kinds of hardware is
increasing. In 2013, Africa had the largest relative rise in
military spending of any region in the world, 8.3 per cent, to
reach $44.9 billion, according to a report by the Stockholm
International Peace Research Institute. Oil producers Angola and
Algeria topped Africa's military spenders.
Yet, even modest increases in health spending are seen going
a long way towards improving African health indicators,
including tackling outbreaks of hemorrhagic diseases like Ebola.
"We know how to prevent diseases like this, if we can get
the basic level of the healthcare systems up to speed," said
Columbia Business School Professor Amit Khandelwal.
"That doesn't cost very much money".
World Bank Director of health, nutrition and population
Olusoji Adeyi said enough information existed on "best buys" for
governments to improve public health. These included
cost-effective childhood vaccines for illnesses such as measles.
Whatever financial boost for Africa's health that does
result from the Ebola emergency, it will be too late for
hundreds already facing the disease's merciless threat in West
"Our people are dying ... Time is of the essence," Sierra
Leone President Ernest Bai Koroma said on Friday as he appealed
for more urgent help from the world.
(Additional reporting by Aaaron Maasho in Addis Ababa; Editing
by Susan Fenton)