By Charlotte Ahmadu

From the Project Team Leader

The economic consequences of illness can be both devastating and catastrophic to individuals, families and countries who have no system in place to cushion its effect- as they say: You don’t know what you have until you lose it. Catastrophes have low probabilities and high severities and when individuals get sick, not only is their ability to produce wealth affected, but a country’s capacity to grow is also stilted.

Year after year, sub-Saharan African countries have continued to dominate the ‘Poorest Countries in the World’ rankings. National and International Organisations have pulled out all the stops to counterattack and solve this continent’s problems from giving debt-relief packages to providing free interventions for malaria eradication. Although these measures have proved helpful, their effect hasn’t been as momentous and situation-altering as developmental economists and scientists would have hoped.

Could I, therefore, suggest that the root of the continent’s problems is an institutional failure that fails to back up the interventions so carefully thought-out and designed?

In terms of healthcare, African countries dominate the list of highest out-of-pocket payments, the highest rates of catastrophic health expenditure and lowest healthcare delivery quality. From the testimonials we have presented to you, it is clear to see that few people have faith in the institutions provided by their governments to protect their health and wellbeing.

So what can be done?

I leave this question to you, dear reader. In hopes that as you seek to answer it, you will help lead our beloved continent to a new era of institutional change and resurrection of quality in care?

Story Twenty-One: Autobiographical

Background: 21-year old Miss. Ogechukwu has been epileptic for 10 years

“When I was younger, the doctor always told me- you must always take your prescribed medications if you want to be sound and healthy- then I was unaware of what my health condition was and why the doctor was always so staunch in reminding me to take my pills every day. As I got older, I started to question what was happening to me and I began to understand things slowly- sometimes I would just go blank and when I would regain myself, I would find myself lying helplessly on the floor. After a few hours, I would feel normal again. This was a ‘normal’ for me.

When I was 15, my parents finally told me the truth- I am epileptic. I was diagnosed early, which was good. I basically live on pills- sometimes I take up to seven (7) prescriptions in a day! I recently started psychotherapy… things haven’t been very bright for me.

The burden of my healthcare bills has fallen largely on my parents. Sniff, she smiles bravely, sometimes they yell at me, they complain that I’m the reason they can’t have any savings. I don’t have health insurance you see, so they have to pay for everything out-of-pocket.

She smiles impishly, I was in the university you know, I was studying Business Administration for my bachelor’s degree. But I had to freeze my studies when things got financially tight… I’m planning to go back to school later this year (this interview was conducted in 2018). My health condition is getting better… I’m stable now. It’s just… each time I go to the hospital, I always come back with more prescriptions for more drugs to take. I’m not being taken care of properly (she doesn’t explain this)… it’s just, how I feel about doctors has been a big challenge for me.

Hmm, I stay healthy by always taking my prescriptions, I drink a lot of water, eat healthy foods, stay away from bright lights and abnormal sounds as they trigger my kind of seizures. I go to the pharmacy weekly for my medication refills and to the hospital monthly. But I’ve got to tell you the truth- I’m tired of taking drugs every day!

Story Twenty-Two: Interview with Mrs I

Background: Mrs I

Que: Good morning Mrs I, it’s nice to see you once again in the pharmacy. How are you doing?

Ans: I’m good, it’s good to see you too.

Que: I’d like to ask you a few questions about your health and also get your opinion on what health insurance means to you. I’m doing a project on this with a few friends. You will be kept anonymous but your replies will be shared.

Ans: Okay. To my understanding, health care insurance is what I do to stay healthy. As for my health well, I’ve been diagnosed with breast cancer. What I’m most afraid of now is that the doctor has told me that the cancerous cells have spread around the affected breast.

Que: What interventions have been taken to get you back to good health?

Ans: I am currently on chemotherapy, but the doctor is now suggesting surgery. This actually scares me!

Que: You don’t have to worry about it, surgery is very effective and I think that as long as you continue being consistent with taking your medications, things will turn up for the better!

Ans: I definitely won’t fail to do so. Thank you for the advice and support, I really appreciate it.

Que: You are very welcome. I hope this diagnosis has not been affecting your finances?

Ans: To be honest, things haven’t been easy since I was diagnosed. I’m struggling to make ends meet. I no longer go to work because the chemotherapy has affected my day-to-day health and so all the bills are being paid by my husband. He’s barely earning much to cover our daily expenses. It’s been eating me up that my health condition is doing this to us. And now that the doctor is talking about surgery, I don’t know what to do- where will the money to pay for this surgery come from? It is so heartbreaking 😭😭

Que: I really feel for you, madam. This is why my friends and I are doing this project- we want to share people’s health experiences and burdens to advocate for the health insurance scheme. Please don’t feel anxious about the money for your surgery, I believe things will work themselves out.

Ans: This is a very good project. We’re all really looking forward to the day when we can get better health services at a cheaper rate.

Que: With diligence and resilience, that day will come. Thank you so much for your time and for telling us your story. I wish you quick recovery and good health in the near future.


Story Twenty-Three: Testimonial

“It’s been two years since I last visited the hospital. I don’t get sick and that’s the reason why I’m not on the Ghanaian health insurance scheme. In my opinion, it doesn’t work, it’s very inconvenient and to be honest, the way the elderly are taken care of at government healthcare centres just puts me off! It’s the worst, almost inhumane for these older people. There’s no sense of urgency or diligence among the healthcare workers. You can beat the OPD reception for hours before any attention is given to you.

This is why I prefer private hospitals- they have a system that works. Whenever my father needs a check-up or is sick, I take him there. He’s treated well and service is quickly rendered.

I don’t like medications but I do regularly take deworming medicines.

I think there is a lot of scopes for the government to do better with the NHIS. If they need more money, they can increase the registration fee for the insurance scheme, they need to have a working ambulatory service that can quickly respond to emergency situations. Where I work, people are often involved in road traffic accidents and I tell you, the response is too slow and too poor!”

  • Christy

Story Twenty-Four: Interview with Jane

Background: Jane is an African who has spent most of her life abroad, she is also living with sickle cell.

  1. What are some of the most memorable illnesses that you’ve had? And what interventions were made?

Jane: The most memorable illness I’ve had… hmm, that would be the one I just had recently (Jane was interviewed in August 2018) which was last month. I had chronic anaemia with sickle cell crisis and was diagnosed with pneumonia while in the hospital. So I had 5-6 Blood transfusions in 2 weeks. I was on antibiotics and 4 different pain medications which included paracetamol, tramadol and 2 others which I can’t remember.

  1. Do you have any chronic illnesses?

Jane: Does sickle cell count?

  1. How do you keep healthy?

Jane: I drink lots of water and take folic acid and penicillin every day.

  1. How do you plan towards your future health? E.g. A pregnant woman plans towards her delivery by packing a hospital bag and leaving it in the hallway.

Jane: I make no plans, I just try to stay as healthy as possible to reduce the number of hospital visits.

  1. Do you have any health insurance(s) coverage?

Jane: Currently I don’t.

  1. What does the burden of your medical bills look like, giving a roundabout figure?

Jane: It’s actually not much- around $150 yearly. I live in Qatar and health care is very affordable and free, depending on the situation. I’ve lived in 4 countries and it has so far, the most excellent health care I’ve encountered, and it’s also for a good price.

  1. How do you deal with unplanned illnesses?

Jane: I just try and stay calm and not stress about it. I cancel all my plans for that week if I have to go to the hospital.

  1. Have you had any memorable heavy health expenditures

Jane: I have never really benefited from health insurance, even when I had it. In 2014 when I was living in the States, I had a crisis and my insurance barely covered anything. I paid about $5,000 after being hospitalized for 4 days.

  1. What does a well-designed health insurance plan look like to you?

Jane: It would mean that all my health conditions in including dental are covered by my insurance plan. I didn’t choose to have sickle cell, I was born with it and I shouldn’t have to pay extra for something I have no control over.

  1. Would having access to good healthcare be one of the top 5 reasons you would choose not to live in Africa?

Jane: Yes, it is.


Story Twenty-Five: Interview with Zoé

  1. What are some of the most memorable illnesses that you’ve encountered and what interventions were made for them?

Zoé: Asthma is my most memorable illness. I was born with it and had to live with it throughout my childhood. The Ventolin inhaler, the Nebulizer machine and Salbutamol syrups were the medical interventions which we relied on at home. These helped to moderate the persistent symptoms of my severe asthma.

  1. How do you currently stay healthy?

Zoé: I watch what I eat and I always try to eat a balanced diet. I also drink a lot of water and avoid sweet drinks.

  1. How do you plan for your future health?

Zoé: Well health isn’t something you can really predict because anything can happen at any time. So having Medical Insurance (commonly known as Medical Aid where I come from) is extremely helpful, because I know my medical costs are covered. Sometimes, there may be a shortfall (copayment) depending on what procedure I need to have done, but it’s never a large amount of money.

  1. What does the burden of your medical bills look like?

Zoé: As I mentioned previously, Medical Insurance has been mine and my family’s “saving grace”. I honestly don’t remember my medical bills ever being a burden to me or my family so to speak, because we’ve all religiously have medical insurance. So the only burden we’ve ever really experienced is that of watching a loved one suffer in pain or rushing them to a hospital at odd hours of the day.

  1. What’s the coverage for your medical insurance? And is it national health insurance or a private premium?

Zoé: I am not 100% sure if we (Zimbabweans) have a National Health Insurance, but when I was younger my mother worked for the Government. At that time we were registered under the Premier Service Medical Aid Society (PSMAS)- which commonly covers most civil servants in Zimbabwe. But now we are registered under the Commercial and Industrial Medical Aid Society (CIMAS)- which is Zimbabwe’s leading Medical Insurance and yes it is a private premium.

  1. What does health insurance coverage mean to you?

Zoé: Health Insurance to me means peace of mind. It means my family and I don’t need to worry about any “what if’s” and accidental incidents.

  1. Tell me about your experience with catastrophic health expenditure?

Zoé: My experience with having no health insurance coverage involves my father-in-law. He lives in Nigeria and he had been unwell for several years after he was diagnosed with arthritis and diabetes. After a series of colds and flus, he fell very sick and he had to be rushed to a specialist cardiology hospital. The medical bills came as a surprise to the whole family as they were extremely high and unplanned for.

This was when I truly appreciated my own country’s health care system. I realized that health insurance is far more important than car insurance or any other type of insurance- because this is a human life you are trying to protect or save.

  1. Would having access to better healthcare be one of the top 5 reasons why you’d want to live outside Africa?

Zoé: Access to better healthcare is definitely something I would consider when looking for places to relocate to. It’s an essential part of the choice I would be making because with good healthcare and good coverage gives good peace of mind.

From the Project Team Leader

​“Health care expenses are uncertain because many illnesses occur rarely and seemingly at random. When they do, they may cost a great deal, and they can be financially troublesome if not ruinous to households. Costs could be so high that without financial help, treatment might not be available.”

  • Folland, S., Goodman, A.C. and Stano, M., 2007. The economics of health and health care(Vol. 6). Upper Saddle River, NJ: Pearson Prentice Hall, p 214.

This is the argument we’re making on the side of African governments providing free healthcare services and resources to its citizenry as a part of what should be every government’s moral obligation towards a welfare arrangement for the people it governs. Champions of the SDG3 under the umbrella of ‘Universal Health Coverage’ have begun to make their arguments known and heard.

Are we champions? Are wannabe Robin Hoods in white coats with embroidered patterns of a distinctive snake on our chest? Perhaps. But there is one thing this writer knows and that is if more people take up pebbles to make ripples on the river bed, eventually a wave of change will arise. Disastrous stories like these will no longer be the status quo for those below the high-income belt.

Do you know what a friend said to me just the other day? He said- for an African living and working in Africa, your membership to social strata will always be mercurial if you don’t belong to the upper or upper-middle class. I asked why, and he answered- two things determine an African’s standard of living: your job and your health, and both are blithely uncertain, especially your health.

I hope these stories and thoughts spur you into the grave and constructive discussions and also encourage you to purchase a private health insurance premium if you do not have health coverage under public insurance. As I grew up hearing- Prevention is better than Cure. Bonne continuation!

Bien amicalement à Vous,