Noam Levey, who received a 2013 AHCJ Reporting Fellowship on Health Care Performance, recently reported on health care spending in Mozambique for the Los Angeles Times. In the piece, Levey pointed out that Mozambique’s economy is booming – but in contrast, its health care spending is lagging.
The decision to limit health resources had an especially profound effect in remote areas of Mozambique. Levey reported from Chokwe, a rural town about 100 miles north of the coastal capital of Maputo, and described a newborn baby boy who stopped breathing shortly after his birth, just before sunset.
Nurses were able to revive him with a ventilator and a suction machine. But if he had been born only two hours later, he would have died – limited resources mean the ward is staffed only until 7 p.m.
Infant mortality is not unusual in Mozambique. Levey noted that Mozambican children are 15 times more likely than American children to die before reaching the age of five. Poor health indicators like this are common across Africa, where many countries with burgeoning economies have de-prioritized health care spending. According to Levey:
Despite rapid economic growth, countries including Mozambique are spending on areas other than healthcare, leaving much of Africa with too few clinics, hospital beds, doctors and health workers and with inadequate systems for linking them together. At the Chokwe hospital, doctors have had to make do without an ultrasound machine since spring. Over the last decade, more than half of sub-Saharan countries have either cut the share of government spending devoted to healthcare, or barely increased it, according to World Health Organization data. In Mozambique, healthcare dropped from 15% of the government budget in 2001 to 9% in 2012.
Also, former World Bank health director Julian Schweitzer advised that simply increasing spending isn’t sufficient – health care money needs to be invested in health delivery systems through training, personnel, and equipment. But in recent years, industrialized nations have not been around to help.
“Many industrialized nations, including the United States, are under pressure to scale back foreign assistance amid their own economic struggles,” Levey wrote. He cited data from the Institute for Health Metrics and Evaluation, which indicates that global health aid has plateaued over the last four years.
In West Africa, the deadly Ebola epidemic has highlighted the consequences of this spending gap.
“Ebola has focused attention on the inability of local health systems to contain a major disease outbreak,” Levey said. “But even in African nations untouched by the epidemic, health systems are struggling with insufficient financing and poor organization.”
The hospital I visited two days ago offers prenatal care, maternity services, postpartum care, well-child and (HIV) at-risk child consultations, family planning services, cervical and breast cancer screening, HIV care and treatment, tuberculosis services and gender-based violence services. It sounds great on paper. In reality, almost 200 women waited for hours to (hopefully, if time allowed) get screened for cervical cancer (in a country with one of the highest rates in the world), get contraception, get HIV treatment or get their child’s immunizations – after walking dozens of kilometers early that morning.
As Haelle notes, southern Mozambique is more than 6,000 miles from the countries fighting Ebola, but health systems across the continent have been neglected.
Resources on global health spending:
- Global Health Expenditure Database and Dynamic Ratios (World Health Organization)
- Health System Financing Profile, by country (WHO)