A Broken Health System in Equatorial Guinea

A Broken Health System in Equatorial Guinea

Dr. Wenceslao Mansogo Alo July 6, 2011
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Wenceslao Mansogo Alo, an Equatoguinean doctor, describes the challenges of practicing medicine in Equatorial Guinea.

Recently, EG Justice interviewed Dr. Wenceslao Mansogo Alo,1 about the condition of the health system in Equatorial Guinea.  In addition to practicing as a gynecologist in a private clinic, Dr. Mansogo Alo is in charge of human rights in the political party Convergence for Social Democracy in Equatorial Guinea.

EG Justice: What is your opinion of the health system in Equatorial Guinea?

Dr. Mansogo Alo: To speak of the “health system” in Equatorial Guinea is, in my opinion, to speak of something that does not exist.

A true health system implies a rigorous organization that integrates competent human resources, material structures, and sufficient finances with the principal objective of achieving the objectives of an established health policy that is clearly defined by the government.  And yet, one can hardly speak of a true "health policy" in terms of planned action, of an "organization", "competent human resources", "adequate structures", or "sufficient financial means" targeted for health in Equatorial Guinea.

Everything occurs as if health care in Equatorial Guinea conforms to and is organized around projects proposed by bilateral and multilateral organizations.  Or, at times, the health care system is shaped by the personal proposals of the President of the Republic, as occurred with the construction of the medical center “La Paz” in Bata.  In this undeniably politicized system, the ideological loyalty to the ruling regime takes precedence over competency and the quality of patient care.

It is in this light that we can view specific actions in the fight against diseases like tuberculosis, HIV/AIDS, malaria, and onchocerciasis. Such efforts are primarily designed by bilateral and multilateral cooperation programs, and seem more destined to cover political gaps or to provide economic benefit to individuals allied with the government than to meet the country’s relevant health needs.

EG Justice: Why doesn’t an established and clearly defined health policy exist?

Dr. Mansogo Alo: It is very possible that our leaders can identify the health needs of the population. But they seem incapable of defining time-bound objectives, establishing priorities, or coordinating the actions necessary for the implementation and evaluation of objectives as defined. Health does not constitute a priority in Equatorial Guinea.

The health system suffers from multiple dysfunctions and aberrations of diverse causes and dimensions.  Identifying and describing them is a vast project that can only be touched on briefly here.

At the root of this disorder lies a well established characteristic of the country’s regime: the politicization of the health sector. Nothing functions in Equatorial Guinea outside the control of the political system.  For example, the real control of La Paz hospital in Bata is reserved for persons allied with President Obiang.  The establishment of a professional medical association—which by definition should be independent of politics—is not permitted inside the country. Consequently, the health system lacks the legal instruments and conventional ethics normally applicable to the exercise of the health profession in other countries.

So, at the same time modern centers like La Paz and Virgen de Guadalupe are erected, a  parallel national association of witches and healers (known as “ASOMETRAGE”: the National Association of Traditional Doctors of Equatorial Guinea), is officially recognized in the country.2  Simultaneous to the establishment of a medical faculty— which lacks the necessary means to teach modern medicine—and while Equatoguineans are sent to Cuba to study medicine, the government authorizes the practice of medicine by people who are not doctors. This contributes to the proliferation of clinics run by local nurses and Chinese practitioners who are not doctors. This creates chaos in the health system. 

Equatorial Guinea lacks accurate health statistics; consequently, one cannot get a realistic picture of the health situation. The overall mortality rate is high—both among hospitalized and non-hospitalized patients—but no one can provide specific numbers on mortality or accurate information about cause of death. Other important data, such as the number of children born in the country, remain unknown as well.

EG Justice: What improvements have you noted in recent years?

Dr. Mansogo Alo: In the last five years, the modern health clinics La Paz and Guadalupe have been built with state funds, but they function as private entities of President Obiang and his wife.  In addition, these two health centers are not accessible to ordinary citizens; for the average citizen, for instance, one night of hospitalization in the La Paz hospital in Bata is equivalent to two and a half months’ salary. Paying for one night in the intensive care unit would require that same person to work for six and a half months without eating.

These centers, well equipped in theory, don’t respond to the expectations of the population. For instance, they don’t always have competent doctors on staff and they often have difficulty obtaining disposable products and laboratory materials. At times, the doctors at these centers have to go to local pharmacies—as does the neighborhood nurse—to purchase supplies. The La Paz center in Bata does not honor, as should logically occur, medical requests of other doctors in the city for diagnostic tests, such as conducting a simple chest x-ray.  Many citizens are asking what the hospital was created for.

Sadly, the presence of these centers has not stopped medical evacuations abroad, including to neighboring Cameroon.

In addition to new Guadalupe clinics in Malabo and Mongomo, and the La Paz center in Bata, there are 18 public hospitals in the country that were inherited from the colonial age, some of which have been or are being rehabilitated. This may seem a positive point, but the image that patients receive at these public hospitals is that of an austere, unsafe health system with doctors whose lack of competence inspires little confidence. The attempt to improve the system via the importation of foreign doctors and nurses, generally Cubans, has not changed that perception.

The financing for the government program to fight HIV/AIDS is, without a doubt, a positive step.  The fact that the president’s wife is using this program for political propaganda is less positive. The information and education programs for the population remain deficient, and it’s not unusual to meet people who doubt the existence of HIV. In any case, it should be noted that the distribution of antiretroviral drugs is very insufficient and remains limited to a few public facilities. In addition, many patients in need of attention are rejected in some of these infectious diseases centers.

EG Justice: What recommendations do you have for improving the health system in Equatorial Guinea?

Dr. Mansogo Alo: To improve the wellbeing of Equatoguineans, it is imperative that the government prioritize actions designed to improve the healthcare system.

It must depoliticize health care by fundamentally reforming and organizing the national health system to include competent leadership and management. This is a prerequisite for identifying and implementing health care priorities. Additionally, the government should:

  • Increase the annual health care budget by a factor of 10, from 0.59% in 2010 and 0.52% in 2011, to 5% annually, and guarantee the availability of these funds.
  • Establish universal standards of practice for all health professions, introduce essential ethical and legal instruments, monitor the quality of knowledge of health care professionals, updating when necessary, and fight against illegal practices.
  • Provide well-educated human resources and adequate material resources to hospitals.
  • Organize a rigorous, sustained, and monitored campaign against the major endemic diseases (malaria, Tuberculosis, trypanosomiasis, onchocerciasis, etc.) and sexually transmitted diseases.
  • Strengthen and expand the education and information programs to the population and fight against HIV/AIDS. Guarantee free access to antiretroviral treatment for individuals living with HIV.
  • Establish a program of school healthcare, with specific structures organized for care and permanent monitoring of the state of health of school children and students.
  • Create specialized technical control centers to provide disease outbreak alerts, to distribute medicines and medical supplies, and to disseminate health information.
  • Redefine the nature and sectors of bilateral and multilateral health assistance.
  • With the means currently available to the country, create a universal social security system, one that will stop functioning as a black box for the ruling class and can start covering all Equatoguineans, regardless of their financial limitations.
  • Parallel to these actions, and in partnership with other sectors of the government, developing decent housing, providing access to drinking water and sanitation, and promoting healthy nutrition and eating habits among the population should all become priorities.

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1. Dr. Wenceslao Mansogo Alo. M.D. Gynecology; M.S. Medical and Biological Sciences, Universities of Saint-Etienne and Lyon, France (respectively). Currently the Chief Medical Doctor at “Espoir,” in Bata, Equatorial Guinea.

2. According to a 2010 joint report issued by UNAIDS and the government of Equatorial Guinea, approximately 800 traditional doctors were registered in ASOMETRAGE in 2008-2009.

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