Challenges of preventive health adoption in Africa
Access to health care in developing countries remains an issue of concern. In the aftermath of independence, several African countries, following a socialist logic, decided to promote free access to public services, particularly health services. However, the economic recession in the 1970s and 1980s led international institutions and governments to review their system of free health care provision. It is in this context that the 1987 Bamako initiative was born, aimed at liberalising the African health system by giving patients full responsibility for covering their health costs. For the poorest households, this measure contributed to further accentuating their financial poverty. As a result of this initiative, between 5 and 30 percent of people still did not have access to healthcare in West Africa. How can this situation be explained?
As far back as I can remember, I didn’t like hospitals when I was younger. I remember one time I had a toothache and I had to go to a dentist. In the meantime, I had to pay the cable bill so I could watch a show I loved back then. I decided to ask my father for the cable money first. The next day, as my pain continued to grow, I asked my dad for money to go to the hospital. He was offended that I had chosen my hobby over my health, especially since it would be a few more days before he could have some money again.
This little anecdote highlights two elements: the prioritization of needs and the financial vulnerability of families. How do these two factors influence the choice of individuals to use health services?
Precarious financial situation
One of the first challenges of preventive health remains the financial situation of populations. In 2015, the rate of extreme poverty in sub-Saharan Africa, i.e. the proportion of people living on less than $1 a day, was ~40%, according to the United Nations. Indeed, this precarious financial situation plays a determining role in the access to health care for the populations of the region. The scarce financial resources held by these households must be used to cover critical consumption expenses such as health, but also food, housing, clothing, transportation, drinking water, electricity, and many others. It is therefore essential for households to prioritize their needs and expenditures according to the urgency of the situation, leading to a range of responses to health problems.
Neglect of early symptoms
Then, neglecting the first symptoms also represents a hindrance to preventive health. Indeed, the frequent choice to ignore the first symptoms, in case of illness, is very common in most African countries. The disease is considered as a temporary pain that will fade with time, rest, or even oblivion (Inshallah!). This situation can last several days or even months without adequate treatment. “What doesn’t kill us makes us stronger,” some would say.
Less controlled medication or medicine
When the pain finally begins to be persistent and burning, many people still choose to put as little money as possible into it, ignoring a medical visit with trained specialists and turning to self-medication. As a result, most households resort to drugs sold on the street. This solution allows them to relieve their pain, is less expensive, and is easily accessible to everyone. However, the quality and storage conditions of these drugs are not always controlled and they are marketed without formal information on dosage or side effects. As a result, the medication prescribed can have a serious impact on the patient’s general health by aggravating rather than curing their pain.
Finally, the use of traditional medicine is also a barrier to access to health services. Nearly 80% of African households use traditional medicine, especially in rural areas. This can be explained by the scarcity of hospitals or trained medical personnel and the precarious financial situation of the people concerned. So what is traditional medicine? In general, it is a session animated by rites and prayers, at the end of which the traditional doctor, often called “marabout” or “charlatan”, prescribes decoctions to the patient. Here too, the lack of dosage and rigorous quality control can become obstacles to the patient’s full recovery.
In the end, it is clear that access to health care depends on the financial situation of the population. The use of health services only takes place when the situation becomes serious or even critical. This is explained by the fact that populations are very poorly educated about the consequences of continued neglect of a failing health condition or live in very limited financial conditions. The poorest households are forced to prioritize their needs, sometimes relegating health to the background. It is therefore important to sensitize communities on the need to have regular consultations with an authorized doctor, in order to avoid serious cases of illness, which will, in turn, generate even more expenses for these vulnerable households. This is why KimboCare is now on the journey to offer these populations a solution adapted to their needs and financial situation.