THE death this month of Malawi’s p resident Bingu wa Mutharika in a private clinic in Johannesburg brings to mind other African leaders whose lives ended in hospitals far from the public health systems of their home countries. Malawi’s first post-independence president, Hastings Banda, died at a private clinic in SA in 1997. Africa’s longest-serving president, Omar Bongo of Gabon, died in a Spanish hospital, while Togo’s former leader, Gnassingbe Eyadema, died in an aircraft in 2005 while being evacuated for emergency treatment abroad. Nigeria’s Umaru Yar’Adua was admitted to hospitals in Germany and Saudi Arabia, while Tanzania’s Julius Nyerere died in a London hospital.

Most of the continent’s current leaders also prefer to be sick in foreign hospitals and private clinics. Angolan President Eduardo Dos Santos has been treated in Spain and Brazil and plenty of Angolans will bet he hasn’t seen the inside of a local health facility. The same applies to Zimbabwe’s Robert Mugabe, who frequents hospitals in Malaysia and Singapore.

Cost is not an issue for Africa’s political elite, who prefer to pour taxpayers’ money into overseas medical facilities rather than spending it on improving health systems at home.

Getting ill in most African countries is not for the faint-hearted. But as incomes improve, Africans return from abroad and expatriate numbers grow, healthcare is becoming a major investment opportunity — private healthcare, that is.

McKinsey research suggests that healthcare spending in sub-Saharan Africa will more than double its 2006 levels to reach about R245bn a year by 2016, 60% of which will go to private healthcare. To meet increased demand, it says, total investment of up to R200bn will be required.

 But most Africans cannot afford private healthcare facilities and most don’t have access to medical insurance. Even public healthcare is seldom entirely free for patients.

 Africans battle a range of communicable and parasitical diseases. The continent bears 66% of the world’s HIV/AIDS burden, which swallows up resources in public healthcare systems. Now the continent faces a dramatic increase in lifestyle-related diseases, such as diabetes, hypertension and cancer. The experts say that probably 85% of diabetes cases are undiagnosed and the incidence may be higher than HIV in 20 years’ time.

 Rising health costs in developed countries have resulted in a shift in focus to promoting health rather than treating sickness. In the UK, primary health interventions saved about 80000 people from dying of cardiovascular disease over a decade. H ealthcare experts will tell you how difficult it is to change people’s behaviour. In Africa, fighting the battle from a prevention perspective will be even harder. The basic tools of prevention, such as sanitation, clean water and nutrition, are generally not in place.

Countries have become dependent on donors to foot the bill for health spending but this assistance is declining with financial problems in donor countries. Governments have to now think about more strategic and sustainable interventions.

 In 2001, 53 African countries signed the Abuja Declaration pledging to dedicate 15% of national budgets to improving healthcare. The World Health Organisation reports that only SA and Rwanda have met the target in the decade since then. Seven states have cut spending. Poor management systems, a lack of maintenance and hygiene in facilities, poor municipal services, inadequate equipment and fraud in tendering and procurement processes also deter progress.

Healthcare issues are complex but two issues seem clear. Government funding is well below what is needed to sustain a basic healthcare system and what exists is not being used efficiently. The other is that if political leaders who influence policy and funding choices were forced to use public health systems, they would find a way to address many of the challenges they blame for the condition of systems that force them to flee to other countries when they feel a bit poorly.