The African way of health and medical insurance


By Dr Tafataona Mahoso

IN the NewsDay for November 20 2019 and within the context of the on-going so-called ‘Doctors’ Strike’, Father Oscar Wermter, S. J., wrote:

“The most important muti (medicine) is trust.  

The patient and his family must be able to trust the physician that he/she will be knowledgeable, skilled, accept responsibility and hold the patient in his or her hands.  

This trust is a relationship of identifying with the sick person: ‘Whatever he or she is suffering from is also my affliction.’ 

(The doctor) must care for the patient as if it was his or her son, daughter, brother, sister, cousin or niece…  Sure, I must pay the medical expert and cover the expenses for the medication he or she has been prescribing for the unwell family member.  

But it is not primarily a business transaction.” 

The neo-colonial health and medical system has not just turned the whole organisation, control and delivery of health and medical service into a super-capitalist system, in the case of Zimbabwe at present the majority feel that the system holds them to ransom and is blatantly extorting money from the public.  

For the most part, all the privatised institutions and services reject our own money and demand US dollars!This problem raises serious questions about all doctors’ associations regardless of whether my particular doctor’s surgery is public or private. 

The insatiable demand for payment in US dollars raises serious questions about the primary purpose of the entire organised medical system. 

It is in this context that we must raise the question about what the basic philosophy is which informs the medical profession from curriculum to housemanship, graduation, onto employment and practice.

When Kofi Appiah-Kubi published his book Man Cures, God Heals in 1981, more than 85 percent of the population of Ghana relied, for health and medical services, on the indigenous African system.  

At the same time, a minority, 15 percent of the population, enjoyed 85 percent of the national health expenditure. 

One highly centralised hospital, Korle Bu Hospital, incurred 50 percent of the entire national bill for drugs at the time!

Payment time in the African system  

In the African system, patients and their families consulting the physician or healer were served using resources and payments paid or provided for at least two-or-three years before by those treated (served) ahead of them.  

Current patients were, therefore, treated for free and advised to bring their payments and/or tokens of appreciation long after healing or cure had occurred.  

In Zimbabwe, today, the ill person or relatives must first raise funds, including foreign currency, before approaching the doctor or hospital.

In Zimbabwe, in the recent past, midwives (vananyamukuta) organised annual festivals where the healthy children they had delivered two-or-three years before would be brought back with tokens of their parents’ appreciation.  

This festival was described as ‘vazukuru vauya nebota rambuya’, which literally meant, ‘Grandchildren bringing their porridge to the midwife for tasting’.

But the gifts which were brought to the midwife varied, depending on the endowment of the particular family.  

These included goats, cattle, sheep and chickens, often with grain or flour.

The ‘grandmother’ (nyamukuta), would choose the best goats or even a heifer from her own herds to slaughter for her vazukuru.

The festival included families telling their own stories of deliverance and healing, accompanied by singing, dancing and the playing of musical instruments.

In Ghana, according to Appiah-Kubi:

“During an annual festival which takes place in September, the village (Nana Nsia’s shrine) is filled with people from all over the country.  

People who have made some pledge come in to fulfil their promises.  

Others come with new requests and bigger pledges. During my visits, I had the privilege of attending two festivals.  

The village was so crowded that people were even sleeping in classrooms, the open market and sometimes in open fields.  

The village was a scene of colour, splendour and joy.  

It was a time of reunion and reaffirmation of trust and faith in the cult and of recounting the past, giving thanks for the present, and hoping for a brighter future.  

For the priest-healer and her helpers, it was time to evaluate and reap the year’s harvest.”

The festival went on for two weeks.  

Because the payment system was not regarded as payment and was open-ended, the author of Man Cures, God Heals confirmed that there were no defaulters.  

All who were served successfully always came back to give thanks and to deliver their gifts to the physicians and healers. But the reader cannot fail to note that, despite Appiah-Kubi’s praise of the African system, he described Nana Nsiah’s movement in negative Eurocentric language.  

He called it a cult.

In contrast, the women who wrote Our Bodies, Ourselves listed many illnesses which are caused or made worse by the contemporary medical establishment.  

Likewise, the trainer of trainers of medical doctors in Egypt, Professor Tarek H. A. Hassan complained in 1985 that:

“(Western–oriented) medicine has raised the cost of medical care and diminished its cost-effectiveness.  

In its posture of neglect of prevention, of prepathology states and causes, in its neglect of the role of the patient, of friends and peers; in its neglect of understanding of the life-cycle and cyclicality; in its disdain of the possible contributions to preventative approaches, including music, and the arts; in its dissociation from social or environmental commitment; in all these postures and many more – modern health is making health an unattainably expensive dream for the majority.” 

Interestingly, Professor Hassan recommended inclusion of the arts in the medical training curriculum as one of the ways to re-shape the orientation of the medical doctor; the very same thing that is taken for granted in the training of African medical practitioners and healers among the Akan of Ghana. 

But more is needed beyond the re-orientation of doctors.  

The medical system’s tight integration into neo-liberal capitalism is even a more forbidding challenge. 

In other words, while much of the world now recognises the African relational philosophy of the dariro as the way to go, while much of the world is beginning to speak of our need to establish a circular economy against ‘corporate cannibalism’, too many Africans are busy pursuing neo-liberal capitalist reforms leading to the very same dead-end which advanced capitalist systems have reached.  

The result for health is what we face throughout the health sector today.  

The ‘doctors’ strike’ is only one symptom of the problem, made worse by white racist sanctions.


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