The African Big Man health index - the one list where Sudan's Bashir is a star, and South Africa struggles

Spending more money on health means a better life for your citizens, right? Wrong.

IT is very hard work running an African country. So much so that several presidents have found themselves in hospital over the last one year, the latest being Sudanese president Omar al-Bashir, who underwent his second knee operation in three months on Monday.

This time it was his left knee, but it was the same Sudanese medical team that performed surgery on his right knee at Royal Care Hospital in May that carried out the latest successful operation.

Royal Care is Khartoum’s best hospital, while the country has the only cardiac hospital in Africa that provides completely free care.

In 2012, Bashir underwent two other surgeries, which his office described as “minor”. He joins a growing list of African leaders who have been in and out of hospitals this year, suggesting the African Big Man is not as infallible as he once was.

South Africa president Jacob Zuma in June triggered a scare after he was hospitalised for what was explained as fatigue following a “demanding election and transition programme to the new administration”. 

Zuma spent two days at an undisclosed Pretoria hospital. 

Cote d’Ivoire president Alassane Ouattara in February spent a month in a French hospital undergoing a sciatica operation, stoking concern over one of Francophone Africa’s main economic hubs. 

Algeria’s Abdelaziz Bouteflika was in January also away from his country for what officials said was a routine check-up. He was last year hospitalised in France for months after he suffered a mini-stroke.  

The latest regional concerns have centered around the health of Zambia president Michael Sata, 77, who last month spent nearly two weeks surreptitiously undergoing treatment in an Israeli hospital for an undisclosed illness. 

Zimbabwe’s Robert Mugabe has also made some of his famous trips to Singapore this year, amid persistent claims he is suffering from advanced prostate cancer, despite the official position of routine eye-checkups following cataract surgery.

Citizen’s grouse
A common gripe has been that African leaders prefer going for treatment abroad, an indictment of derelict healthcare systems back home which they are responsible for fixing. Zuma and Bashir this time appear to have put more faith in their countries medical facilities, a boost to national medical systems. 

In recognition of this, we took a look at the latest healthcare indices to see which other leaders would want to place their faith in their countries, and who would most likely bolt.

For this, we first looked at countries’ expenditure on health as a total of Gross Domestic Product (GDP) using the latest data from the United Nations Development Programme. 

The results were engaging—over the last five years Sierra Leone has spent the most on healthcare from both government and donor funds.

Liberia, Lesotho, Rwanda and Burundi followed—nearly all are countries recovering from internal conflict that all but decimated their health systems. 

There were also a few surprises among the star performers with Swaziland, Djibouti, Malawi and Sudan featuring high up.

The laggards were Congo-Brazzaville, Libya, Eritrea, Gabon and surprisingly, Seychellles. 

We were wrong. The top spenders became the laggards—Sierra Leone, Lesotho, Burundi.

There are many explanations for this, from the effects of war to the HIV/Aids pandemic, but for some countries we just couldn’t figure out what they were doing at the bottom of this list, such as Nigeria. When former President Umaru Yar’Adua was taken ill in November 2009, he was rushed to a Saudi Arabian hospital, where he spent several months before returning to Nigeria where he died in May the next year.

Expectation of long life
We then looked at the life expectancy at birth—with the argument that these funds should go some distance into raising the quality of life, and consequently, citizen’s longevity.

The best life expectancies were to be found in Tunisia, Libya (though perhaps not for much longer here), Cape Verde, Seychelles and Algeria. Madagascar, Rwanda, Ethiopia and Sudan were notable too. 

We then did a review of the two indices—which countries had marked life expectancy rises in relation to their spending? And which countries were their leaders likely to bolt off to a foreign hospital?

The results were astounding—spending more does not necessarily guarantee you a longer life.  Sierra Leone for example had the lowest life expectancy in Africa, despite spending the most, while Lesotho also came in next. 

Big African economies South Africa, Angola and Nigeria all fall in the bottom 20 in terms of life expectancy. Money does add life to your years, but not years to your life.

Some countries however appear to have done very well, such as Sudan - surprisingly, Rwanda, Djibouti, Sao Tome and Namibia, by managing to get healthcare value for their money. Policy makers will most likely want to take a closer look at them.


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