Why capitalism is bad for public health systems in Africa

TAKUDZWA HILLARY CHIWANZA 

Ever since African countries were compelled to accept structural adjustment programs in the 1980s and 1990s, governments have been averse to social spending. As the years have progressed, African states have become relentlessly neoliberal in their governance approaches, a phenomenon that has had adverse effects for the poor and vulnerable. Inequality is now the order of the day in Africa, with no signs of abating in sight. And the most glaring inequalities are evident in healthcare systems.

Parirenyatwa Hospital, a public health institution in Harare, Zimbabwe. [Image: Pindula]

For decades, public health systems in African countries have been underfunded as governments were told that to register macroeconomic growth, they had to reduce spending in social services. The work that had been built by some socialist policies in the period that followed independence across African countries has been undone by decades of austerity and privatization.

African countries were instructed by the chief gatekeepers of global private capital (the World Bank and the International Monetary Fund) that if they wanted to reduce their deficits and embark on developmental paths, they had to stop spending, and that they had to restructure. They had to trust the private sector because it is more “efficient” than the state. States were told to remove their regulatory powers from the economy in sanctifying free market economics—all hail the great “market forces.”

As African countries implemented these structural adjustment programs to get funds from the World Bank and the IMF (adding to the debt crisis/burden), the private sector increased its grip on social services. Both local and international private capital. 

Liberal economic ideas from the West were transplanted into Africa, undemocratically so, even though it became clear that Western capitalism was incompatible with African contexts as inequality continued to widen.

Private capital is only concerned with profits before human welfare is taken into consideration. The profit motive becomes the raison d’etre for private capital and vindicates “investment.” This thinking is thoroughly entrenched within health sectors across African countries.

Health services are increasingly being outsourced to the private sector, and the role of governments regarding the provision of affordable heath services has become minimal. This syncs perfectly with the neoliberal global order that African countries desperately want to fit in, even though they are at the peripheries. 

Healthcare in African countries is now privatized. Private players operating health facilities charge exorbitant prices that literally condemn the poor to die. And yet, these private facilities offer better health services compared to public hospitals. It is a regrettable but prevailing reality in African countries.

With public systems crumbling because governments underfund them, believing private hospitals are the best (yet so unaffordable), African populations are not desirably healthy. And this directly impacts production capacities. 

What it means is that only the rich – those who have benefited from capitalism – can afford quality, decent healthcare. In a continent where unemployment rates are high, the fact that healthcare is now out of the reach of many is a grave moral affront that needs urgent redress. One could even argue that even for the middle class, an emergency such as a car accident or stroke could thrust them into serious poverty.

Just because profits have to be made, people are effectively being sentenced to death. How does a poor person have to part with a fee such as USD$100 to be given emergency services? Or, where we are dealing with cancer, one has to part with $1,000 to $2,000 for chemotherapy treatment? The Covid-19 pandemic also laid bare the inefficiencies of our overwhelmed public healthcare system that already runs on shoestring budgets. And this regrettable reality still obtains.

African governments should not renege on their primary responsibility to be the guarantors of life for citizens. Basic social services such as healthcare exist so that people survive and be productive. Healthcare, as such, should be free and must not be outsourced to the private sector which is only concerned with making profits before saving lives. Social justice must once again reign supreme across the whole African continent.