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ACCESS TO HEALTHCARE IN AFRICA AND THE MIDDLE EAST
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2 About this report3 Introduction 4 Chapter One – The Global Access to Healthcare Index: An
overview of the results for Africa and the Middle East6 Chapter Two – Extending health coverage10 Chapter Three – Delivering primary care12 Chapter Four – Boosting the healthcare workforce and supply
chains14 Conclusion
CONTENTS
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ABOUT THIS REPORTAccess to healthcare in Africa and the Middle East is an Economist Intelligence Unit report, commissioned by Gilead, which examines the challenges and opportunities health systems in the region face as they attempt to improve access to high-quality care that meets the needs of their populations. It is based on the findings of a global index measuring how healthcare systems across 60 countries are working to fulfil the health needs of their populations. This report is part of a regional series of a wider programme that includes a global report which summarises the overall results and implications.1
The 15 African and Middle Eastern countries included in the index are as follows: Algeria, the Democratic Republic of the Congo (DRC), Egypt, Ethiopia, Iran, Israel, Kenya, Kuwait, Mozambique, Nigeria, Saudi Arabia, South Africa, Tanzania, the UAE and Uganda. In addition to the index findings, this report includes insights from additional desk research and five in-depth interviews with senior healthcare practitioners, academics and policymakers.
Our thanks are due to the following for their time and insight (listed alphabetically):
l Marie-Goretti Harakeye, head of the social affairs department, African Union Commission, Addis Ababa, Ethiopia
l Ewout Irrgang, technical director, Tanzania, PharmAccess Foundation, Amsterdam, The Netherlands
l Son-Nam Nguyen, lead health specialist, World Bank
l Amit Thakker, chairman, Africa Healthcare Federation, Kenya
l Robert Yates, project director, Universal Health Care Policy Forum, Chatham House, London
The report was written by Andrea Chipman and edited by Martin Koehring of The Economist Intelligence Unit.
June 2017
1 The Economist Intelligence Unit, Global Access to Healthcare. Available at: www.accesstohealthcare.eiu.com
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INTRODUCTIONAfrica and the Middle East occupy, to an extent, two ends of a spectrum. African countries face very complex healthcare challenges as they seek to manage a range of infectious diseases, while at the same time grappling with the growth of non-communicable diseases and accidents, all against a backdrop of health systems that are substantially underdeveloped compared with those in other regions.
In the Middle East, meanwhile, there is a contrast between the wealthy Gulf states, in which chronic disease is the central health challenge, and other parts of the region, where less developed health systems and strained resources challenge policymakers. In Africa, too, the gap in resources between the most advanced private-sector medical facilities and the most basic public clinics is vast.
This disparity is evident when looking at the overall scores of participating countries on the Global Access to Healthcare Index, which we will do in Chapter 1. We will then examine the challenges of extending health coverage (Chapter 2), delivering primary care (Chapter 3) and boosting the healthcare workforce and supply chains (Chapter 4).
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CHAPTER 1: THE GLOBAL ACCESS TO HEALTHCARE INDEX: AN OVERVIEW OF THE RESULTS FOR AFRICA AND THE MIDDLE EASTThe two domains that comprise The Economist Intelligence Unit’s Global Access to Healthcare Index—accessibility and healthcare systems—include a number of sub-categories, all of which contribute to the ranking of the 60 countries included in the index (see chart 1). The index ranks 15 countries from each of four broad regions of the world: Africa/Middle East, the Americas, Asia-Pacific and Europe. Within each region, countries with the largest populations were selected, representing a diversity of income levels. Population and income criteria were established in order to compare countries facing similar organisational challenges owing to their size, and to highlight achievements across income levels.2
The accessibility domain provides a country-level snapshot of current access to prevention and treatment services across a set of disease areas: child and maternal health services; infectious diseases, such as malaria, HIV/AIDS, tuberculosis and viral hepatitis; and non-communicable diseases, such as cardiovascular diseases (CVDs), cancer and mental health. The index evaluates these areas according to a series of key performance indicators, focusing on health outcomes. The index evaluates progress within these sub-indices considering current global policy agendas, such as the Sustainable Development Goals (SDGs).
In the case of the healthcare systems domain, the index measures the conditions that allow for good access to effective and relevant healthcare services, such as policy, institutions and infrastructure. The index takes a forward-looking approach to the category, namely, is the country implementing the right mechanisms today for optimal access tomorrow?
2 For a detailed description of the methodology, please refer to the accompanying methodology paper: The Economist Intelligence Unit, Global Access to Healthcare Index: Methodology, May 2017. Available at: http://accesstohealthcare.eiu.com/methodology/
Chart 1
Source: The Economist Intelligence Unit, Global Access to Healthcare Index.
Access to healthcare
Accessibility
Child and maternal health
Infectious diseases
Non-communicable diseases
Access to medicines
Equity of access
Healthcare system
Coverage
Political will
Reach of infrastructure
Efficiency and innovation
The components of the Global Access to Healthcare Index
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Egypt, the highest-ranked country on the African continent, is tied for 40th place, followed closely by South Africa in 43rd and Mozambique in 49th place among the 60 countries in the index. Countries such as Ethiopia, Nigeria and Uganda are clustered just a few places from the bottom. In the case of the Middle East, Israel is the country with the highest overall ranking in 12th place, followed by the United Arab Emirates (UAE) in 23rd and Kuwait in 27th place (see chart 2).
When looking at the headline scores for the broader domains—accessibility and healthcare systems—there are more discrepancies. No country in the region, except for Israel (9th), scores higher than 25th for accessibility, with similar results for the healthcare systems domain; in the case of the latter, six of the ten lowest-ranked countries are in the Africa and Middle East region.
The main access-related challenges for the region are how governments can extend insurance coverage and improve financing of healthcare (see Chapter 2), and how well they are doing at responding to multiple healthcare threats while maintaining and developing key primary-care systems (see Chapter 3). Yet Africa struggles particularly with managing other challenges, including the underdevelopment of supply chains for medicines and severe problems maintaining a sufficient health workforce (see Chapter 4). These areas have provided fertile ground for both local entrepreneurs and public-private partnerships.
Ultimately, those governments that are already ahead of the pack in extending access are in a better position to undertake a more comprehensive development of their healthcare systems, according to Marie-Goretti Harakeye, a public-health specialist and head of infectious diseases at the African Union Commission in Adis Ababa, Ethiopia. “If you have enough funding, the other thing to deal with is to make sure we have value for money.
Chart 2
Source: The Economist Intelligence Unit, Global Access to Healthcare Index.
Note: The index includes 60 countries from each of the four broad regions of the world—Africa/Middle East, the Americas,Asia-Pacific and Europe—representing a diversity of income levels.
Ranking of countries from Africa and the Middle East in the Global Access toHealthcare Index(score out of 10)
8.01
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6
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8
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Israel
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36
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54
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59
7.1UAE
6.8Kuwait
6.6Iran
6.5Algeria
6.1Saudi Arabia
5.6Egypt
5.5South Africa
4.2Mozambique
3.8Tanzania
3.6Kenya
3.2Ethiopia
3.2Nigeria
3.2Uganda
2.8DRC
Global rank (of 60)
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CHAPTER 2: EXTENDING HEALTH COVERAGETwo countries are generally cited as leaders in tackling the problem of coverage through national health insurance: Rwanda and Ghana. Other countries, such as Ethiopia and Kenya, have been looking to develop their own solutions, either by increasing domestic financing for health (Kenya) or expanding access to health services using community health workers (Ethiopia).
“There are a lot of innovative approaches to financing,” says Dr Harakeye, noting that some low- and middle-income countries such as Ghana, Gabon and Benin, among others, have generally tried to start promoting social protection, including subsidised health programmes or other forms of assistance with healthcare expenses at the community level to reduce out-of-pocket expenditures.
In other countries, such as Zimbabwe, Tanzania, Kenya and South Africa, initial efforts to increase access have focused on specific health threats, most notably HIV/AIDS treatment and access to anti-retroviral drugs, Dr Harakeye observes.
For most African countries, the development of extended coverage has happened in several stages, according to Ewout Irrgang, technical director for the Tanzania office of the Netherlands-based PharmAccess Foundation. “In Africa, you have a combination of community-based and voluntary cover, which doesn’t cover everyone, but it’s a start. Later down the line, some countries—Tanzania, Ghana, Ethiopia, Rwanda—look into combining multiple community-based insurance programmes, supported by the state.”
However, efforts to envision a broader scope for coverage have generally required a greater political and financial commitment, those interviewed say. In the case of Ghana, the government has been extending its national health insurance scheme through funding from a value-added-tax levy of 2.5% imposed in 2004. In Gabon, efforts to expand coverage have been funded in part through the taxation of mobile phones, says Robert Yates, director of the Universal Health Care Policy Forum at Chatham House, a London-based think-tank. In Rwanda, mutual health insurance systems—autonomous organisations administered by members, who determine their own benefit packages and premiums—have evolved to complement existing social and private health systems.3
Although Mr Yates praises the use of innovations to improve the financing of healthcare systems, he argues that small-scale, voluntary insurance programmes are ultimately inferior to publicly funded systems. “Private community health insurance is a waste of time—it doesn’t work. Rwanda started with mutuals that were private, community-based and voluntary, but rapidly moved to them being compulsory and progressive and subsidised.”
The debate over public financingAlthough the heads of state of African Union countries agreed in the Abuja Declaration of 2001 to increase health budgets to at least 15% of total annual budget outlays by 2015, many African countries remain well below that target. “Government spending on health as a share of total government spending has decreased in half of the countries in the region over the last two
3 Ministry of Health, Mutual Health Insurance Policy in Rwanda, December 2004, p. 3. Available at: http://www.africanchildforum.org /clr/policy%20per%20country/rwanda/rwanda_healthinsurance_2004_en.pdf
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decades,” says Son-Nam Nguyen, lead health specialist at the World Bank. “Only four African countries met the Abuja target in 2014.”
As much as 70% of healthcare services are now allocated within the private sector, including faith-based organisations, according to Amit Thakker, chairman of the Africa Healthcare Federation based in Nairobi, Kenya. He notes that while the share of people with “prepaid” insurance and medical plans is in single digits, many Africans are informally covered by employers or larger groups that pay for healthcare services for employees and families, using self-funding mechanisms. But with less than one-third of healthcare funded by taxation, some two-thirds still comes from out-of-pocket (OOP) expenditure, he adds.
OOP expenditure has risen in nearly all African countries, from around US$15 per capita in 1995 to US$38 per capita in 2014, according to Mr Nguyen. “Financial barriers are therefore significant and prevent people from accessing health services; when they do seek care, out-of-pocket payments often drive them into poverty.” He notes that, on average, around 11m Africans fall into poverty every year as a result of high OOP expenses.
Not surprisingly, the ranking of most countries in the region is relatively low in the Global Access to Healthcare Index sub-domain on population coverage of the healthcare system (see chart 3). This category comprises sustainable financial protection (based on OOP expenditure on health)
Chart 3
Source: The Economist Intelligence Unit, Global Access to Healthcare Index.
Note: The index includes 60 countries from each of the four broad regions of the world—Africa/Middle East, the Americas,Asia-Pacific and Europe—representing a diversity of income levels. The metrics evaluated in this sub-domain include: sustainablefinancial protection, and prevention and public health services as a percentage of total health expenditure.
Ranking of countries from Africa and the Middle East in the area of populationcoverage of the healthcare system(score out of 10)
8.71
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Global rank (of 60)
South Africa
Kuwait
Saudi Arabia
UAE
Algeria
Israel
Iran
Egypt
Kenya
Tanzania
Mozambique
Nigeria
DRC
Ethiopia
Uganda
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and prevention and public health services as a percentage of total health expenditure. South Africa is the regional leader, tied in 7th place (out of 60 countries), followed by Kuwait (tied in 12th), Saudi Arabia (14th) and the UAE (tied in 15th). Five of the bottom seven countries in this category are in Sub-Saharan Africa.
But even where coverage does exist, the services on offer may not be sufficient. A symptom of this is the trend of rising medical tourism. For example, according to a report by PwC Nigeria, a consultancy, medical tourism accounted for nearly 20% of the total expenditure by Nigeria’s Federal Ministry of Health on salaries of healthcare workers, public health programmes and the operating costs of health facilities.4 This flight of better-heeled patients has been especially concentrated in oncology, orthopaedics, nephrology and cardiology.5
As their delivery of healthcare has improved, more advanced health systems in western and southern Africa have been able to share best practice as well as the importance of strong leadership. “Some countries are doing very well, but there is a need for some dedicated resources to make sure that countries can learn from others,” Dr Harakeye highlights.
Political will and private partners
The ability of Africa and the Middle East to improve both the provision and the quality of services will ultimately depend in large part on a combination of political will, closer co-operation between the public and the private sector and an ability to deploy healthcare services more efficiently.
Most countries in the region are ranked relatively low in the Global Access to Healthcare Index sub-domain on political will for increased access, which measures ten-year growth of both OOP expenditure as a percentage of total expenditure on health and general government expenditure on health as a percentage of total government expenditure (see chart 4). Regional leaders in the category include the UAE (in 10th place out of 60 countries) and South Africa (11th), while Tanzania is at the bottom of the ranking.
Having a costed national health strategy should be a key goal, Dr Harakeye says, in order to establish national health accounts that function well and to bring all stakeholders together. This is particularly important to avoid waste and duplication of scarce resources, she adds.
A 2016 report from the World Bank, Universal Health Coverage (UHC) in Africa: a framework for action, sets out five key approaches to “improving technical and allocative efficiency”, according to Mr Nguyen. They include increased and better spending and effective financial protection; people-centred services; targeting the poor and marginalised and leaving no one behind; strengthening health security; and establishing political and institutional foundations for the UHC agenda.6
Major challenges remain. With regulation weak and services dispersed among both public and private healthcare providers, collection of data is especially difficult, Dr Thakker says. Moreover, many of the problems in providing access already arise at the primary-care level, and the next chapter will shed more light on the deficiencies and opportunities in this area.
4 PwC, Restoring Trust to Nigeria’s Healthcare System, 2016. Available at: https://www.pwc.com/ng/en/assets/pdf/restoring-trust-to-nigeria-healthcare-system.pdf
5 C Mama, “Africa’s healthcare crisis – some novel solutions”, New African Magazine, March 7th 2017. Available at: http://newafricanmagazine.com/africas-healthcare-crisis-novel-solutions/
6 World Bank, Universal Health Coverage (UHC) in Africa: a framework for action: Main report, 2016. Available at: http://d o cu m e n t s . wo rl d b a n k . o rg /cu ra t e d /en/735071472096342073/Main-report
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Chart 4
Source: The Economist Intelligence Unit, Global Access to Healthcare Index.
Note: The index includes 60 countries from each of the four broad regions of the world—Africa/Middle East, the Americas,Asia-Pacific and Europe—representing a diversity of income levels. The metrics evaluated in this sub-domain include: out-of-pocketexpenditure as a percentage of total expenditure on health (ten-year growth), and general government expenditure on health as apercentage of total government expenditure (ten-year growth).
Ranking of countries from Africa and the Middle East in the area of political will forincreased access to healthcare(score out of 10)
8.51
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3.6
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Global rank (of 60)
UAE
South Africa
Saudi Arabia
Kuwait
Israel
Algeria
Egypt
Mozambique
Iran
Nigeria
Ethiopia
DRC
Kenya
Uganda
Tanzania
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CHAPTER 3: DELIVERING PRIMARY CAREProviding good primary care—a key priority across most of the world—is essential in Africa, where governments are still battling high rates of infectious diseases such as HIV/AIDS and tuberculosis, intermittent health crises such as outbreaks of Ebola, and the growing threat posed by non-communicable diseases.
Many African countries have struggled to provide the most basic care to their citizens, which is reflected in the continent’s weak performance in fulfilling the UN’s Millennium Development Goal related to maternal and child mortality. This is again highlighted by poor performances in the index sub-domain on child and maternal-health services (see chart 5).
Indeed, the Ebola crisis of 2013-16 demonstrated how unprepared three of the continent’s most underdeveloped health systems—those of Liberia, Sierra Leone and Guinea—were to cope with the epidemic. Yet the provision of primary care is where some of the most innovative approaches to extending healthcare access have been seen, notes Dr Harakeye. Mobile phones and other technologies that can be used in remote areas have often been at the nexus of this experimentation. “Using mobile phones, you can adjust the supply of medicines and also highlight the beginning of
Chart 5
Source: The Economist Intelligence Unit, Global Access to Healthcare Index.
Note: The index includes 60 countries from each of the four broad regions of the world—Africa/Middle East, the Americas,Asia-Pacific and Europe—representing a diversity of income levels. The metrics evaluated in this sub-domain include: measlesimmunisation coverage; births attended by skilled health personnel; and demand for family planning satisfied with modern methods.
Ranking of countries from Africa and the Middle East in the area of access to childand maternal-health services(score out of 10)
8.91
=2
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Global rank (of 60)
Iran
Algeria
Egypt
Israel
Kuwait
UAE
Saudi Arabia
South Africa
Kenya
Tanzania
Uganda
Mozambique
DRC
Ethiopia
Nigeria
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epidemics. If the community calls, they get health, and they are also sharing data on how they are performing,” she explains.
In Kenya, where efforts to expand access to primary care have been plagued by high levels of rural poverty, underdeveloped infrastructure and political violence, a new constitution, passed in 2010, devolved government decision-making to local governments with the aim of providing greater equity, Dr Thakker notes. “It’s about giving localities more power, to give them a bespoke model of devolved human resources for health, staffing needs and priorities.”
Ethiopia’s government has made primary healthcare, health promotion and prevention a core focus of its healthcare policy since the end of the civil war in 1991. Under the direction of Tedros Adhonom, who served as minister of health from 2005 to 2012, the government began with the ambitious goal of achieving universal primary healthcare within five to seven years and trained and deployed at least 38,000 health extension workers.7 In addition, the health ministry trains promising female students with at least a tenth-grade education to become health extension workers and make them part of the country’s salaried civil service.8
A similar approach is evident in Iran, where community workers, known as behvarz, with two years of training in family and preventive medicine, provide healthcare in rural or remote areas, where it is difficult to recruit physicians.
Elsewhere in the Middle East, there is a concerted focus on strengthening primary-care systems, especially in Jordan and the Gulf Co-operation Council (GCC) countries, where chronic diseases such as obesity and diabetes have reached crisis levels.
The pressing challenges of boosting healthcare workforces and supply chains are discussed in the next chapter.
7 World Health Organisation, CURRICULUM VITAE: Dr Tedros Adhanom Ghebreyesus: Candidate for Director-General of the World Health Organization Endorsed by the African Union. Available at: http://www.who.int/dg/election/cv-tedros-en.pdf?ua=1
8 N K Bilal et al, “Health Extension Workers in Ethiopia: Improved Access and Coverage for the Rural Poor”. In Yes Africa Can: Success Stories from a Dynamic Continent. Edited by P Chuhan-Pole and M Angwafo, The World Bank, 2011:433-43.
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CHAPTER 4: BOOSTING THE HEALTHCARE WORKFORCE AND SUPPLY CHAINSOne of the most pressing and unique challenges facing African healthcare systems is the shortage of adequately trained healthcare workers. The problem is a legacy of the smaller number of training programmes available on the continent as well as poor pay and working conditions, which have helped to exacerbate the brain drain to Europe and North America.
Although Africa accounts for 24% of the global burden of disease, it has only 3% of the global health workforce, Mr Nguyen from the World Bank notes. He adds that shortages of health workers at the national level are exacerbated by “severe imbalances in their distribution within countries, especially between rural and urban areas”.
A 2011 article in the British Medical Journal found that some 25-50% of African-born doctors were working overseas, leading to an effective loss of US$2.6bn invested to train them.9
In the Middle East, countries such as those in the GCC have an easier time retaining physicians, although they remain heavily dependent on their expatriate workforces; for example, 76% of Saudi physicians are expatriates.10
The divergence between some Middle Eastern and African countries is highlighted by the index sub-domain on the reach of the healthcare infrastructure, which is based on the density of healthcare personnel as well as the quality of vital statistics (see chart 6).
In countries such as Iran, meanwhile, the government has focused more closely on integrating medical education and health services and on making the educational system more accountable to population needs, according to researchers at the Health Policy Research Centre at Shiraz University of Medical Sciences in Iran.11 As part of this transition, their 2013 study found that the country’s health service had gone from employing 3,000 foreign physicians in 1983 to fully meeting its requirements for physicians and other health workers.12
Yet sub-Saharan Africa, in particular, continues to suffer from other supply issues, including access to medicines. The availability of selected drugs has been found to be as little as 21% in the public healthcare system and 22% in the private system of some African countries, according to Mr Nguyen.
Entrepreneurs have taken innovative approaches to filling some of the gaps. For example, a number of mobile technology projects are attempting to extend the promise of telehealth. Kangpe Health, a mobile and web app that has received seed money from start-up incubator Y Combinator, aims to allow laypeople in remote areas to contact doctors through applications on their mobile devices, typing questions and paying a small fee to get answers or a medical referral within ten minutes or less.
The service, which now operates in Ghana and Kenya, has 60,000 users but serves a combined population of some 245m people.13 The company hopes ultimately to connect patients to health
9 E Mills I, “The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis”, British Medical Journal, November 24th 2011.
10 Deloitte, 2015 health care outlook; Middle East, 2015. Available at: https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2015-health-care-outlook-middle-east.pdf
11 KB Lankarani et al, “Health in the Islamic Republic of Iran, challenges and progresses”, Medical Journal of the Islamic Republic of Iran, Vol 27, No 1, February 2013.
12 Ibid.
13 S Buhr, “Kangpe is a mobile service connecting Africa to healthcare”, TechCrunch, March 17th 2017. Available at: https://techcrunch.com/2017/03/17/kangpe-is-a-mobile-service-connecting-africa-to-healthcare/
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insurance or further care through the platform. Similar programmes include MedAfrica in Kenya, Matibabu in Uganda and HelloDoctor, which is operational in ten African countries.
A separate venture between a Vancouver surgeon and British Colombia-based Conquer Mobile aims to create a surgical application for smartphones and tablets that will allow African healthcare workers to get surgical training in traumatic brain and spinal injuries remotely. The mobile app, known as mobile-optimised skill training, or MOST, includes both games and skill questions and avatars of patients, who have been programmed to react and provide feedback.14
In addition, there are a variety of innovative projects dedicated to bringing state-of-the-art healthcare to Africa’s people. In January 2017 GE and Standard Bank announced the launch of a new “Healthcare Accelerator”, a growth and training programme designed for healthcare professionals, in a joint venture with Londvolota, a South African trust focused on developing entrepreneurial capacity within black-owned industrial companies in the country. The Accelerator programme, which will be based at the GE Africa Innovation Centre in Johannesburg, will include courses covering business plan development, digital practices, human resources and marketing.15
Some of the continent’s most developed hospitals in countries ranging from Morocco to Cameroon and South Africa, meanwhile, are adopting SOPHIA, an artificial intelligence platform, to analyse genomic data to identify mutations that cause diseases and use them to improve the design of patient care. The technology could be especially useful in treating breast cancer in Africa, where 60% of women diagnosed with the disease die, compared with 20% in the US and the EU.16
14 C Correia, “Local Surgery App created to save African lives”, CBC News Online, March 10th 2017. Available at: http://www.cbc.ca /news/canada /british-columbia /local-surgery-app-created-to-save-african-lives-1.4020681
15 M Mamabolo, “Standard Bank, GE Launch Healthcare accelerator at Africa Innovation Centre”, ITWEB Africa, January 30th 2017. Available at: http://www.itwebafrica.com /enterprise- solutions/501- south-africa/237338-standard-bank-ge-launch-healthcare-accelerator-at-africa-innovation-centre
16 “African hospitals embrace Artificial Intelligence”, YesAfrica, March 24th 2017. Available at: http://www.yesafrica.biz/lifestyle/tech/african-hospitals-embrace-artificial-intelligence-118664
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CONCLUSIONAfrica arguably faces a broader range of challenges than other regions of the world, with underdeveloped healthcare systems struggling to cope with the twin threat of a growing burden of non-communicable diseases on top of the existing threat of infectious diseases.
Many of the same difficulties with underinvestment exist in the Middle East, while the wealthier Gulf states face the legacy of decades of adaptation to a western lifestyle, with accompanying levels of chronic disease.
As we have seen, efforts to improved basic healthcare coverage have been ambitious, but results have been mixed across the region. Meanwhile, continued low levels of public financing for health mean that public-sector facilities are often overburdened and the quality of care remains low in many places.
As elsewhere, addressing these myriad problems is likely to require both political will and commitment to improving investment in healthcare—and difficult choices. In particular, continuing workforce shortages mean that African countries will need to be more creative about using local health workers and training them to provide a greater range of care in their own communities.
Meanwhile, while private-sector investments are increasingly producing state-of-the-art medical facilities in many African countries, governments are likely to get the greatest benefits from investments in primary and preventive healthcare, which can help to forestall more expensive problems over the long run.
While every effort has been taken to verify the accuracy of this information, The Economist Intelligence Unit Ltd. cannot accept any responsibility or liability for reliance by any person on this report or any of the information, opinions or conclusions set out in this report.
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