Africa's elite have a record of jetting abroad for medical treatment. As the global health sector buckles under Covid-19 and flights stay grounded, they are forced to face up to the chronic state of hospitals at home.
In order to protect their fragile health care systems, governments around the continent have closed borders and halting air traffic. More than 30 of Africa's 57 international airports have closed or severely limited flights, according the the US State Department.
Flight trackers show only a few planes crossing over the African continent, with many of them being domestic flights.
Low satisfaction, even before COVID-19
A survey by the pan-African Afrobarometer research network recently showed that more than half of all Africans go without the necessary medical care at least once in a given year. Four in 10 patients experience long waits or never receive care, while about one in eight recounts having to pay a bribe in order to obtain treatment.
Africans identify health as the second-most important national problem their governments should address, according to Afrobarometer. Spending on health care in Africa is roughly 5% of gross domestic product, about half the global average.
Experts are warning that many countries will be overwhelmed if the coronavirus spreads. Ethiopia had just three hospital beds per 10,000 people in 2015, according to the World Health Organization. Central African Republic has three ventilators in total and in Zimbabwe, doctors have reported doing bare-handed surgeries for lack of gloves.
However, with Africa's elite now grounded at home, there is hope they will start spending more money on local medical facilities.
Small budgets for health care in Nigeria
In Nigeria about 41% report difficulties in obtaining medical care, according to the Afrobarometer survey. This does not come as a surprise given the low health care expenditures by the government in recent years despite previous agreements.
In 2001, African heads of governments came together in Abuja, Nigeria, and agreed that a minimum of 15% of the national budget of each country should be ploughed into the health sector.
Yet, the reality looks very different in Nigeria and many other countries. "In fact, in the last three years, it has been hovering around 3.9% (in Nigeria). So that is far away from where we are supposed to be," says Dr Osama Enabulele, the former president of the Nigerian Medical Association. This is further highlighted in the fact that about 60% of all Nigerians seek medical treatment at private clinics rather than public hospitals.
In the face of the coronavirus pandemic, the government and private donors have been making efforts to improve the situation. For example, initially, the country only had five testing facilities, four of them public and one of them private. This number has now been raised to nine.
"Some state governments for instance have gone ahead to procure as many as 20 ventilators from a base of about one or two," Enabulele says. Outside investments to the health care system are helping to provide additional protective equipment, testing kits and ventilators, he says.
"We have been losing around $2 billion (€ 915 million) annually on account of medical tourism and that obviously doesn't help upscale activities, programs, projects and activities in the health infrastructure in our country," says Enabulele.
The COVID-19 travel bans offer an opportunity, he says. "I see this experience as one that will get the elites and especially the rich ones to now commit themselves more to providing for the health sector."
Zimbabwe's elite steps in
Frozen medical posts, basic medicine shortages, lack of water, queues at hospitals and doctors on strike. "Zimbabwe's health care system was in bad shape … and then came COVID-19," says Blessing Gwanyira of the Harare-based NGO, Citizens Health Watch.
In Zimbabwe the COVID-19 pandemic has exacerbated a health care crisis that has been going on for years. There are currently 14 confirmed cases of the coronavirus and only a single testing facility in the whole country at Wilkins Hospital in Harare.
Thirty-year-old Zororo Makamba, a well-known journalist, was the first recorded death related to COVID-19. He was being treated at Wilkins Hospital and his brother has since reported on the dire conditions at the facility. The lack of plugs prevented the use of a ventilator and essential medicine had to be sourced by Makamba's family.
Recently, the government unfroze 4,000 posts for health workers. "We still have nurses who are not going to work because they do not have protective clothing," says Gwanyira. "This has been an issue even prior to the COVID-19 outbreak. They did not have water to wash, alcohol rubs, the swabs."
The lack of the basics such as water and electricity have strained the health care system for years, Gwanyira says. Now, she is witnessing how different the rich are stepping in to help.
Telecommunications mogul Strive Masiyiwa has donated 45 ventilators to public hospitals. A leading fuel company, Sakunda Holdings, is involved in the refurbishing and upgrading two hospitals in Harare.
However, Gwanyira is concerned that these hospitals will only be accessible to those who can afford treatment.
Health care aid restricted
South Africa: Transforming African health care
While there is a growing hope that investments in the health care system will rise due to a stranded elite, the measures against the spread of COVID-19 have also had adverse implications.
Travel restrictions have had a troubling side effect: aid organizations are struggling to keep supplies and personnel moving in a region where millions rely on outside help for basic care.
"The travel restrictions that have been put in place by many governments jeopardize our ability to get our staff and our humanitarian aid where they are needed," says Patrick Youssef, the incoming regional director for Africa of the International Committee of the Red Cross.
Some organizations including Medecins Sans Frontieres (MSF) say they rushed personnel into some places before the border closures and have supplies to keep facilities running for the coming weeks because governments have kept borders open for humanitarian aid.
As COVID-19 effectively pushes the rich to invest in local medical infrastructure, an opportunity to fix issues around health care systems in Africa has opened. However, the skepticism over who will ultimately benefit and what happens once travel restrictions are lifted remains.