In the 2017 World Happiness Report by Gallup, African countries scored poorly. Of the 150 countries on the list, Central African Republic, Tanzania and Burundi ranked as the unhappiest countries in the world.

Some of the factors driving unhappiness are the poor state of the continent’s health care systems, the persistence of HIV/AIDS, malaria and tuberculosis, and the growth of lifestyle diseases such as hypertension, heart disease and diabetes.

Few African countries make significant investments in the health sector—the median cost of health care in sub-Saharan Africa is $109 per person per year, according to Gallup. Some countries, such as DR Congo, Madagascar and Niger, spend just half of that per person annually.

In 2010 only 23 countries were spending more than $44 per capita on health care, according to the World Health Organisation. These countries got funding from several sources, including government, donors, employers, non-governmental organisations and households.

Private investment is now critical to meet the considerable shortfall in public-sector investment, say experts.

While many international organisations, such as UNICEF and the International Committee of the Red Cross, continue to support Africa’s health care system, private entities and individuals are also increasingly making contributions.

For example, Africa’s richest person, Aliko Dangote, and the world’s second richest person, Bill Gates, have formed a partnership to address some of Africa’s key health needs.

In 2014, the Nigerian-born cement magnate made global headlines after donating $1.2 billion to Dangote Foundation, which used the money to buy equipment to donate to hospitals in Nigeria and set up mobile clinics in Côte d’Ivoire.

A philanthropist himself, Gates wrote of Dangote in Time magazine: "I know him best as a leader constantly in search of ways to bridge the gap between private business and health.”

The Bill & Melinda Gates Foundation focuses, among other projects, on strengthening Africa’s health care resources. According to the Gates Foundation, as of May 2013 it had earmarked $9 billion to fight diseases in Africa over 15 years.

In 2016 the foundation pledged to give an additional $5 billion over a five-year period, two-thirds to be used to fight HIV/AIDS on the continent.

While acknowledging the Gates’ generosity, locals noted that for many years the Foundation had invested in the oil companies that have contributed in making health outcomes extremely poor in some areas of Nigeria. These companies include Eni, Royal Dutch Shell, ExxonMobil, Chevron and Total.

Facing a backlash, the Gates Foundation sold off some 87 per cent of its investments in major coal, oil and gas companies, leaving approximately $200 million in these stocks as of 2016. Groups such as Leave It in the Ground, a non-profit organization advocating for a global moratorium on fossil exploration, are pushing for divestment.

"The link between saving lives, a lower birth rate and ending poverty was the most important early lesson Melinda and I learned about global health,” said Gates recently. The Gates Foundation supports reducing childhood mortality by supplying hospitals with necessary equipment and hiring qualified local practitioners to take care of patients and their children.

Dangote-Gates collaboration

In 2016, the Dangote Foundation and the Gates Foundation formed a philanthropic dream team when they announced a $100 million plan to fight malnutrition in Nigeria. The new scheme will fund programmes to 2020 and beyond, using local groups in the northwest and northeast Nigeria. The northeast has for the past seven years been ravaged by the Boko Haram’s Islamic militant insurgency, affecting all health care projects in the region.

Malnutrition affects 11 million children in northern Nigeria alone, and Dangote said the partnership would address the problem.

The Foundations had already signed a deal to work together to foster immunisation programmes in three northern states: Kaduna, Kano and Sokoto.

The Gates Foundation states on its website, "Contributions towards the costs of the program by the Bill & Melinda Gates Foundation, Dangote Foundation, and state governments will be staggered across three years: 30 per cent in year one, 50 per cent in year two, and 70 per cent in year three, with the respective states taking progressive responsibility for financing immunisation services.”

The future of about 44 per cent of Nigeria’s 170 million people would be "greatly damaged if we don’t solve malnutrition,” said Gates, at a meeting with President Muhammadu Buhari.

Building trust

Despite the many international and local efforts, cultural and religious factors often impede efforts to address Africa’s weak health infrastructure. For example, in 2007, religious leaders in northern Nigeria organised against aid workers administering polio vaccinations after rumours started circulating that the vaccines were adulterated and would cause infertility.

In 2014, during the Ebola crisis, villagers chased and stoned Red Cross workers in Womey village in Guinea, accusing them of bringing "a strange disease.”

The big players may be Dangote and Gates, but others less well known are also making important contributions to Africa’s healthcare. After the 2014 Ebola outbreak in West Africa, for example, which resulted in the loss of about 11,300 lives, private companies in the three most affected countries—Guinea, Liberia and Sierra Leone—partnered with the government to fight the virus.

The Sierra Leone Brewery, for example, helped in constructing facilities for Ebola treatment.

Public-private partnerships

Private and public sectors need to collaborate to help Africa’s health care system from collapse, notes a report by UK-based PricewaterHouseCoopers consultancy firm.

The report states that public-private partnerships, or PPPs, when fully synergised can bring about quality health care. Under a PPP in the health sector, for example, a government can contribute by providing the health care infrastructure, while private entities can be involved in the operations.

In a widely published joint opinion piece last April, Dangote and Gates stated that improving health care in Africa depends on a "successful partnership between government, communities, religious and business leaders, volunteers, and NGOs. This ensures that everyone is rowing in the same direction.” 

Africa Renewal