Resuscitating Africa’s Health Care
Recent reports that millions of dollars in aid went missing during the 2014 Ebola crisis has angered many health workers in Africa. But the mishandling of Red Cross money, as outrageous as it is, holds important lessons for how to improve health-care access to and outcomes on the continent.
FREETOWN, SIERRA LEONE – In late October, the International Federation of Red Cross and Red Crescent Societies (IFRC) confirmed what many had long suspected: millions of dollars donated to fight the Ebola outbreaks in Guinea and Sierra Leone had been mismanaged and stolen. The world’s oldest humanitarian organization was “outraged” by the findings, it said.
The Year Ahead 2018
The world’s leading thinkers and policymakers examine what’s come apart in the past year, and anticipate what will define the year ahead.
Needless to say, they were not alone.
I was national coordinator of Ebola burials for Sierra Leone at the height of the epidemic. For much of the crisis, beginning in 2014, we lacked the equipment and materials needed to contain the deadly virus. We lost many health workers amid the dearth of resources, and the thought of losing my own life – leaving behind a family and two young children – terrified me daily. These were anxious times for my country.
That anxiety has not vanished. My thoughts frequently return to colleagues who died during the heroic fight. And now, with confirmation that huge sums of aid were stolen, the grief is compounded by anger and disappointment – at the fraud itself, but also for what it says about Africa’s struggles to improve health-care access and outcomes.
The rampant fraud illustrates how problematic it can be when donors channel resources through big NGOs like the Red Cross. And the IFRC’s revelation is likely just the tip of the iceberg. Sierra Leone’s minister of health and sanitation first warned of the possibility of widespread fraud in May 2015; he even called for a full accounting of money received and spent. Unfortunately, his request was largely ignored.
The silence was lamentable, but not surprising; tracking donor funds is extremely difficult. When governments and private donors pledge monetary aid, the funds typically pass through a chain of large groups that determine how it will be allocated. But a full accounting often is never provided. For example, the United Nations Office for the Coordination of Humanitarian Affairs estimates that $3.3 billion was donated to the countries that were hardest hit by Ebola. And yet, the office’s data do not show how the money was spent.
There is widespread agreement among governments, development partners, and relief agencies that in a crisis like that caused by Ebola – or any other health emergency, for that matter – strong financial management is critical. Only with disciplined budgeting can staff be properly equipped and paid, hospitals stocked, and triage centers opened. When well-intentioned pledges fail to reach those in need, the result is measured in a lack of resources – from a shortage of doctors to a lack of vehicles to transport the sick and bury the dead.
Anger was my first emotion upon learning of the IFRC funding fraud. But it is the second sentiment – disappointment – that must drive Africa forward. If the continent is to make gains in achieving universal health coverage (UHC) and improving the quality of health care for everyone, it must start by ensuring that resources are used efficiently and fairly.
Some progress has been made in strengthening national planning processes and principles. And, according to the UHC 2030 Alliance, which works to improve the quality of and access to health-care systems around the world, recipient countries have done far more than their international counterparts to establish more effective budgetary frameworks. But Africa still has a long way to go before financial management and procurement systems meet adequate standards.
To improve the quality of Africa’s health-care systems, and avoid a repeat of the IFRC’s Ebola funding fiasco, countries that receive aid need better financial management protocols. In health emergencies, immediate aid is essential. But if that aid is to be allocated properly, recipient countries must already have the ability to manage large sums transparently. The goal must be to ensure that recipient countries have oversight over how donor funds are spent.
At the moment, the opposite is happening, and most African countries are like the parched sailor adrift at sea – we see money everywhere, but we have no ability to use it. To drink from the ocean of aid, African countries must first take control of their health-care funding destinies.
To do that, resources much be used efficiently. A regional and sector-wide approach is critical to improving coordination and preventing duplication. After the war and genocide in Rwanda, for example, the country’s government required that all development partners work according to the government’s agenda. Today, Rwanda is among the world leaders in health-care access and outcomes. Rwanda’s experience should serve as a model for other countries.
As the world observed Universal Health Coverage Day in December, I was left to reflect on the horrors of the last few years, and consider what steps we must take to improve health care in the future. In Sierra Leone, as elsewhere, the focus must be on strong leadership, governance, and partnerships. But most of all, we must use our collective dissatisfaction with past failures to fuel efforts to make quality health care a reality for everyone.