World Bank Group’s billion dollar private sector health initiative in Africa is failing to reach the poor

A billion-dollar flagship scheme to support private sector-led health care in Africa is bypassing poor people and concentrating instead on high-end urban hospitals catering mainly for the rich.

Oxfam says that the “Health in Africa” initiative, run by the International Finance Corporation’s (IFC) – the private sector arm of the World Bank Group – is undermining the Bank’s own public commitments to universal and equitable access to health.

“Health in Africa is not helping to reduce the health-care gap between rich and poor people in Africa. The IFC cannot demonstrate that this scheme is reaching poor people,” said Oxfam spokesperson Nicolas Mombrial.

Health in Africa was launched in 2008 and is backed by the French, Japanese and Dutch governments, and the Bill & Melinda Gates Foundation among others. Its aim is to encourage private sector health investment in Africa with a focus on ‘under-served’ people.

However, a recent independent review, along with Oxfam’s own analysis, finds that Health in Africa is failing to meet its commitment to the ‘under-served’ or to even measure whether poor people are being reached.

Instead, Oxfam found many of its investments have gone to expensive urban hospitals and clinics often explicitly catering for the wealthiest citizens. For instance, Clinique La Providence in Chad was to receive a loan of $1.5 million to make available ‘healthcare services for which Chadians are currently travelling abroad.

In Nigeria – a country that bears 14 per cent of the global maternal mortality burden – it invested $5 million in African’s first in-vitro fertilization clinic where one IVF cycle costs $4,600.

The biggest investment has been $93 million to Life Healthcare, South Africa’s second biggest private healthcare company with 63 hospitals. Life Healthcare’s services are unaffordable even for many comparatively wealthy South Africans – only selected services are covered by health insurance and only 15 per cent of South Africans have any kind of health insurance at all.

“The IFC must not use Africa as a laboratory in which to run risky experiments,” said Mombrial.

“The countries that have made the most progress towards universal health coverage have done so predominantly via public systems. The World Bank Group should be backing these proven solutions and supporting governments to expand their public health care.”

Oxfam says the IFC should halt the Health in Africa initiative until it can ensure that its investments are pro-poor. The World Bank Group needs to investigate all IFC health operations to ensure they are aligned with the Bank’s goals to end extreme poverty, promote shared prosperity and contribute to universal health coverage.