Image description: Two COVID vaccine vials.
States have specific obligations in the context of public health emergencies. Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) requires states to progressively build universal healthcare systems for the ‘prevention, treatment and control of epidemic, endemic, occupational and other diseases’. Under the International Health Regulations, which are legally-binding on 196 countries, states committed to develop ‘the capacity to respond promptly and effectively to public health risks and public health emergencies of international concern’.
Nonetheless, the COVID-19 pandemic has laid bare the shortfalls of healthcare systems worldwide, including in many African countries. The Global Initiative for Economic, Social and Cultural Rights (GI-ESCR) analysed how such gaps impinged on the right to health in Kenya and Nigeria, focusing on the lived experience of individuals living in urban informal settlements.
In Kenya, research showed that individuals living in poverty face financial, information, technological and geographical barriers when trying to access medical care during COVID-19. For instance, a COVID-19 positive, chronically ill woman explained that she could not obtain free medical care at a public hospital due to lack of ventilators, and that she had to obtain care in a for-profit hospital spending 300,000 shillings (about 2,612.85 USD). With only 19% of Kenya’s population having access to any form of healthcare insurance as of 2018, and with 36% of Kenyans living below the poverty line, these costs are unaffordable to many, leading to medical debt or healthcare renunciation.
A similar situation is found in Nigeria, where healthcare is starved of much-needed resources. In 2018, general government spending on health was as low as 0.57% of GDP, and healthcare spending as a share of total government spending was only 4.4%. Predictably, Nigeria is lacking enough quality medical resources to deliver COVID-19 treatment, testing, and vaccination, as well as other medical services, to its 206 million population. With public facilities under severe pressure, low-income individuals living in marginalised urban areas were often left with ramshackle for-profit clinics and laboratories offering substandard medical care, including using expired drugs and reagents, or employing unqualified staff.
While there are several interrelated factors contributing to this difficult situation, the two reports analyse how the progressive government-backed involvement of commercial private actors in healthcare gradually undermined the capacity of healthcare systems to protect the right to health at times of epidemics. In Kenya, the share of health facilities that are for-profit grew from 33% to 43% in less than 10 years over 2013-2021. In Nigeria, private actors already provide an estimated 60% of all medical services and this is set to increase, as Second National Health Strategic Development Plan to increase to 50% the percentage of institutions providing health services through public-private partnerships. The recently adopted National Health Insurance Authority Act 2022, which makes health insurance mandatory for all legal residents in Nigeria, would require further scrutiny as regards the involvement of the private sector and how this impacts the right to health.
The right to health is well-protected in Nigeria and Kenya, including under Article 16 of the African Charter of Human and People’s Rights. The United Nations Committee on Economic, Social and Cultural Rights (CESCR) has recently affirmed that to protect the right to health, it is imperative that States implement ‘appropriate regulatory measures to ensure that healthcare resources in both the public and the private sectors are mobilized and shared among the whole population to ensure a comprehensive, coordinated health-care response to the crisis’. This did not happen in Kenya and Nigeria, where the commodification of healthcare led to a system where most of the population rely on low-quality, fragmented commercial healthcare services, while the better-off rely on high-end private facilities or medical tourism.
The commodification of healthcare is further being encouraged by international institutions at global level, as highlighted in an open letter a group of civil society organisations sent to the World Health Organisation. By contrast, it is urgent to invert the paradigm and invest in universal public healthcare services. The reports thus recommend the governments of Kenya and Nigeria to:
- Increase government funding to health to at least 15% of national budget, in line with the Abuja Declaration.
- Strictly monitor and regulate private healthcare providers.
- Ensure universal access to social health insurance, or any other form of pre-pooled financing scheme.
- Develop stronger public healthcare systems accessible to all.