3 non-health keys that can unlock the economy for health.

if you don't make it how can you regulate it?

If the economy is key to health, then, a developing country with large masses of poor and excluded people, CAN NOT depend on a private led health system. The private capitalist goal is neither equality, human rights nor health for all. Only public sector leadership can guarantee that the most vulnerable will not be left behind. Governance and accountability, are a matter of life and death, for developing countries competing against the push and pull of market forces.

In countries like Nigeria, most of health supply is in private hands. As a result, Out of Pocket (OPP) payments are among the highest in the world. This is incompatible with development. Because of its dependence on a global logistic chain that is largely foreign to recipient countries, donor financing quickly turns into a vicious cycle that crowds out public spending. Economists call this tight relationship between productivity and health expenditure, the first law of health economics.

For millions of working class poor to survive, one, we have to end donor financing, and two, we have to end the foreign technical advice that leads to donor dependency.

Contrary to donor-supported thinking, for developing countries to get on their feet, their health systems have to be publicly owned, funded, and advised by government & indigenous experts. Perpetual funding without personal responsibility and accountability only breeds spoilt children. Or, as one famous children’s story puts it, if you pay, you dictate.

But: there is a role for the private sector in pharmaceuticals, logistics and services. This economic space must be tightly regulated. In that tight space, the supply chain must be all-local. An import based, and purely for-profit motive will only exclude millions of vulnerable people from the supply of health.

Drug manufacture

For a health system worth the name, we have to do this non-health thing: develop industrial capacity. Drugs, consumables & disposables have to be locally manufactured and in bulk.

We can’t hope to build a health system on drug imports because access will then be limited by end user cost. Local production will help lower end user costs and if scaled up, it will guarantee access and availability. Production will be fully subject to regulation, competitive pricing, innovation, consumer-oriented markets and competitive distribution.

Standardization of quality

Health facilities and service quality must also be standardized. A single, locally sourced standard must be applicable, replicable & regulable, anywhere, nationwide. But then, again, building systems, construction materials and rules of service cannot exist in isolation from generalized poverty. If we have too many poor people, they will be forced to prioritize cheap materials over quality, resulting in a haphazard uncontrolled construction culture. We can’t expect to regulate quality when we can’t determine if those inputs and materials are easily available locally.

Skills & spare parts

We also need to build local capacity for standard-quality construction skills, spare parts and tools for maintenance. In addition to physical, non-imported, local manufacturable or assemblable materials, quality of the workmanship itself, as a type of service delivery, must be set to one single standard. This same standard must be applicable in every facility, no matter where located, in a big city or even the most remote villages.

See? We must not think in silos about health. All this is a development problem, not a health problem, still, it determines health outcomes.

Backward thinking & antiquated systems will persist if we continue to allow foreign technical advisers and donor agents to come to tell us about health quality. Because of their limited budgets, self-interest and geopolitics, they can not afford to go into the necessary detail: that there is a whole-of-government approach, outside of health itself, to build truly independent health systems.

We are always left feeling like moral failures. We learn helplessness and dependency on their drip drop donations, and top-down advice. It takes a holistic, in depth deconstruction of a century of slow or no development, to finally answer why our health systems are still stuck in the stone age, since the stone age. Our aim should be policy meetings without a single foreign technical adviser or donor in the room, where all ministries and agencies regardless of sector, collaborate.

As the economy develops, and each sector is growing, a healthy, secure and insured population will be the result.