Exactly 26 years ago a close relative of mine died from kidney failure. He was in his early sixties and had been in and out of hospitals due to chronic hypertension that had led to his premature retirement at the age of 50. Apparently, kidney damage and uncontrolled high blood pressure each contribute to the negative spiral of kidneys. Back then dialysis was not readily available locally. After a long and drawn-out process, the medical board’s approval for going out of the country came in too late to save his life.
This story is just one of the many other similar untold stories of tragic deaths causes by substandard diagnosis and inadequate medical care.
Indicators of social wellbeing such as healthcare grew medicately from their value three decades ago. A UNDP data of HDI (Human Development Indicators) bears out the hard truth. In Ethiopia health index measured by life expectancy at birth was 44 years in 1985 and 64 years in 2014 (Human Development Report UNDP, 2015). It is evident that life expectancy has not kept up with the growth in GDP. (See chart below)
On the other hand, figures on death caused by preventable infections are nothing short of surprising. The MOH (Ministry of Health) has moved in the right direction in response to this acute need by rolling out a project that is behind the opening of primary health care posts throughout the rural areas. However, these centers’ equipments are in disrepair, the staff are either incompetent or indifferent and basic medications are mostly out of stock. More often than not patients deteriorate to a point where these centers cannot provide any meaningful intervention. Compounded by poor road network, patients expire before reaching a bigger and better health centre.
Science and technology could come to the rescue of Ethiopians’ need for better and affordable healthcare. Some efforts like Hello Doctor and Doctor Alle are attempting to deliver consultations on issues that range from psychological to physical ailments. The services are provided by calling a four digit number and speaking with a specialist for a per-minute charge that is for the most part cheaper than a mini-bus taxi trip to see a doctor. Be reminded though that these over-the-phone consultations do not replace in-person doctor visits. They, however, save time and money by helping people identify which path of care to go down on.
Also prioritizing needs is crucial. Once again science and technology have a host of advanced analytics tools that enable the identification of areas which require more resources. For instance, data on hospital patients should be aggregated consistently across all hospitals in the country instead of bits and pieces of information gathered to support an ad-hoc policy prescription. A well-designed data framework and data warehouse unleashes the power of data. This is because patterns emerge indicating which intervention works best for particular clinical or public health cases. Other countries, particularly the UK and America, who can afford to be more wasteful with their resources than Ethiopia have harnessed medical data with tremendous success via integrated electronic health records.
Dissatisfied with local health care facilities, Ethiopians have always had to travel abroad to buy medical care. A study revealed that their choice of destination is heavily dependent on cost as well as the impression of past patients. Thus a pattern emerged where Thailand, India and recently USA and Dubai have won the largest share of the market.
There has never been a publicly available study on the efficacy of the treatments at these countries’ hospitals. Patients and family tend to pick the popular choice instead of shopping for the right center partly because the information is not easy to find. Some hospitals have opened offices in Addis and the regions serving as information hubs. These offices make travel arrangements too. With some treatments costing upwards of one million birr, the decision to spend such hefty sums is driven by the inelastic nature of the demand for healthcare.
An idea as grand as the Wollo Tertiary Care and Teaching Hospital was meant to fill the high-level healthcare gap of the country, in so doing stemming the outflow of medical tourists. But the project did not get off the ground allegedly because of financial constraints. Ambitious as it may sound, there was a casual mention of creating the capacity to make the center one of the favourite medical tourism destinations with Africans.
Getting medical care away from home is not without problems. Notwithstanding patients’ pre-departure struggle with raising funds to cover the cost of treatment they also face some other major hurdles that impact them adversely, potentially frustrating the medical intervention’s effectiveness. Most importantly results of diagnosis also known as medical reports often show an over/under emphasis of conditions. Here a combination of antiquated and/or miscalibrated equipments’ sensitivity to measurements and incompetent authors of reports such as lab technicians, radiologists etc are to blame. In the worst case, though, the receiving hospital’s diagnosis turn out completely different than the original report. The diagnosis might be more serious, and by extension, costlier than the original analysis on which treatment plans, quotations e.t.c were based.
Despite the stress patients and their family go through, medical tourism is a viable alternative. Bringing it into the purview the medical legislatures of the country works best. A starting point would be licensing agents. This act alone deters scammer hospitals and agents to do business, thereby preserving the well-being of the citizenry. It is not rare to see some patients ending up worse than they started out after obtaining treatment at a centre with substandard care. Another step involves incentivizing reputable international hospitals to come to Ethiopia and set up branches. Ultimately this solves the two critical issues with healthcare provision in the country. First, it injects competition at the level of both price and quality of care. Secondly it has the capacity to reduce the chronic exodus of high-caliber doctors and medical professionals via the creation of better employment conditions.
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