President Barrow, Let’s Start With The Basics

Last month President Barrow met with International Medical Services (IMS), excerpts of the subsequent press release read:

“President Adama Barrow yesterday received a team from International Medical Services (IMS), an Israeli group specialised in providing health care services in Africa…group was committed to promoting health tourism in The Gambia, and was set to build a 220 million Euro modern 350-bed hospital. He said the hospital would likely result in other African countries reaching out to The Gambia for health care…The financing loan is to have a five-year grace period and would be paid between 15 to17 years after 10 years of operation. The project contract would include provision for upgrading some of the existing state hospitals and health facilities…investment in the health sector is a priority for the Barrow administration. He said the investment plan will include skills and transfer of knowledge to Gambian counterparts…The Gambian government is expected to identify a seven-hectare parcel of land for the project.“

Gambia is open for business, has been the slogan many have been touting to entice investors into the country, however, in crucial sectors like healthcare, education, agriculture and utilities, the Barrow government must align itself with investments that fulfill a development agenda and meets the hopes and aspirations of the population.   One cannot have issue with any investor coming into the country, investing in legal ventures in which The Gambia will realize much-needed tax and foreign exchange revenue.  However, it is imperative that investor proposals be vigorously vetted, and investors assume the cost and risk of projects that do not fulfill the developmental agenda in key sectors.  A government with a virtually non-functioning healthcare system, should not encumber itself with the financial burden of a project whose primary focus is medical tourism.

The best solution for better health care delivery should be targeted to the masses.  To finance a €220 million loan, the hospital will have to generate enough revenue to cover the loan repayment, interest and operational costs.  Assuming that the hospital operates at full capacity 365 day per year, each of 350 hospital beds will have to generate more than D6,000/day to pay back  the LOAN PRINCIPLAL ONLY; factor in the interest and operational costs, to be financially viable, that daily estimate will increase exponentially.  This is cost-prohibitive for most Gambians and does not even begin to scratch of surface to fix Gambia’s health delivery and public health system.

IMS has  similar projects in Equatorial Guinea in Malabo and Mongomo, according to the Human Rights Watch report on E. Guinea in 2017, “misspending on capital projects, such as the sophisticated new La Paz hospitals in Malabo and Bata that appear to be almost exclusively for the benefit of elites—rather than on primary healthcare that benefits most citizens….Doctors, nurses and patients told Human Rights Watch that Malabo General Hospital required out-of-pocket payment up front for any service, and that those who are unable to pay upfront are regularly turned away. “If people [in critical condition] don’t have money, they die,” a doctor who worked in the General Hospital in Bata said.  With the limited funds allocated to the health sector, the government has heavily invested La Paz, the two modern hospitals in Malabo and Bata staffed largely by foreigners. Both hospitals are well-equipped and charge fees that are well beyond what ordinary Equatoguineans can afford to pay.”

According to Dr. Mansogo Alo in a 2011 interview with EGJustice…”for the average citizen, for instance, one night of hospitalization in the La Paz hospital in Bata is equivalent to two and a half months’ salary. Paying for one night in the intensive care unit would require that same person to work for six and a half months without eating.”

Medical tourism has become a burgeoning industry in countries like Turkey and India who have become notables in the delivery of good healthcare at affordable costs. However, in these nations medical tourism was not a health policy.  Rather, these countries had robust health policy geared towards their populations, and laid the foundation for improving their health delivery systems. Medical tourism was an incidental result of those policies, as people from developing nations, and even the West, found the quality and costs attractive enough to travel abroad for medical treatment. .  Medical tourism is NOT HEALTHCARE POLICY. A sustainable healthcare policy should be a bottom up approach, and primary consideration should be given to the impact it will have on the masses.  No responsible government, especially in the developing world, should embark on a healthcare policy in which its citizens are only peripheral beneficiaries of large scale projects.   Government should not be involved in commercialized healthcare, when the basic healthcare needs of its citizen are not met.

It is a matter of urgency that the government shifts its investments priorities and put the masses in the forefront of any policy agenda.  Once the basic medical needs of Gambians are met, medical tourism will be a natural by-product of those efficient and functioning health programs.

With the daunting task of building Gambia’s healthcare institutions, there are foundational approaches that should be considered:

1. Outline a robust policy with benchmarks and timeframe for attaining goals
2. Increase budgetary allocations for healthcare
3. Invest in smaller regional hospitals, and overhaul the existing hospitals and assure that thy have adequate material resources, in addition to well-trained human resources
4. Direct resources towards disease prevention and management, sanitation, monitoring trends and public health education
5. Set up mechanism for monitoring personnel performance and continuing education training.
6. Allow Gambians investors with similar ventures to realize success, prior to bringing in foreign competitors

The most important aspect of healthcare delivery is ACCESSIBILITY.  The Barrow government must do some serious soul-searching and decide what kind of legacy they want to leave; whether one of shiny buildings and vanity projects which most of Gambian citizens can only admire from afar and never benefit from; or an efficient health delivery system which all Gambians will benefit from. A healthy population is a productive population.

Signed,

Sohna A. Sallah