An access to quality health is fundamental to good life and well-being that contributes to prosperity and wealth as healthy societies are more productive, can actively participate in the development process and live longer. Goal three of sustainable development goals aims to achieve universal health coverage that seeks equitable access to healthcare services to all men and women at all ages. Despite the public healthcare system destroyed during the civil war, the Federal Government of Somalia has set the health sector strategic plan which its primary purpose is to provide universal basic healthcare to all Somali citizens. Nevertheless, all health statistics currently show that health indicators in Somalia are among the lowest in the world. The WHO states that Somalia’s healthcare system remains weak, poorly resourced and inequitably distributed.
The healthcare system in Mogadishu is almost entirely privatized and the private healthcare sector plays a major role in filling the vacuum and replaced former government controlled public healthcare system. However, the majority of the public have no access to healthcare due to the high cost of private hospitals in Mogadishu. The private healthcare is too expensive and unaffordable by many low-income and even middle-income families. Furthermore, the quality of private health services in Mogadishu is very low as they are not effective and don’t meet the patient’s true needs. The unregulated private hospitals have several serious socio-economic effects including high poverty and inequality rates and low population growth rate. There are compelling reasons for the Federal Government and the Benadir Regional Administration to regulate both the prices and the quality of private health services to achieve the universal basic healthcare agenda.
The unequal access of essential health services pushed many into extreme poverty and further widens the inequality gap in the country. The high costs of private hospitals represent a great barrier that prevents the poor people access to essential health services since they can’t afford the several out-of-pocket medical care costs. Therefore, the burden of diseases disproportionately falls on destitute people and results in greater health disparities. For instance, the average cost of doctor’s visit, different diagnostic tests and medication is $120 which is unbearable burden on poor people who can hardly earn a monthly income of less than $200 and who were already struggling with other financial hardships. The poor people shift to Racep Tayyip Erdogan hospital, one of the few public hospitals in Mogadishu that provide affordable quality health services and medications but the patients often complain about the congestion and long waiting hours at the hospital. Furthermore, the expensive private healthcare causes a rising inequality since the morbidity rate or the number of people who suffer from diseases and medical condition becomes very high among the poor people. The high morbidity rate among the poor translates into a low productivity which in turn have negative impact on their incomes. Consequently, the poor get poorer and their living standards further worsens due to the unequal access to health services.
Mogadishu’s unaffordable medical care by the masses also leads to low population growth rate in the country. Although Somalia has one of the highest fertility rates in the world (a total fertility rate of 6.9 children per woman) as shown in the UNFPA annual report, the country’s population growth is low and relatively stable. Countries with similar high fertility rates such as Niger has a population growth rate of 3.8 while Somalia’s population growth rate is just 2.9%. The stagnant population growth rate is attributed to the staggering death rate in Somalia that offsets the high total fertility rate. A World Bank data shows that more than 60% of the total death in Somalia is caused by communicable diseases, maternal and nutrition conditions. The life expectancy in Somalia is 57.4 years while the life expectancy in Kenya and Ethiopia is 66.7 years and 66.6 years respectively. Moreover, substantial number of children under 5 years of age die of preventable diseases such as diarrhea and measles. The country also suffers from high under-five mortality rate where it now stands at 117 deaths per thousand live births while the under-five mortality rate in Kenya and Ethiopia is 43 deaths per thousand live births and 51 deaths per thousand live births respectively. (World Bank, 2019).
It is not rational to call the disbandment of private healthcare sector as done by the president Siyad Barre who put an end to private medical practices in 1970s because the federal government have not the capacity to provide free public health services but there are compelling reasons to control private healthcare sector and regulate the prices and quality of private health services in Mogadishu. The doctors, medical practitioners and private hospital owners contend that the rent and electricity bills as well as expensive imported medical equipment drive the high costs of private hospitals but there is suspicion that the objective of securing an engineered high profit by private hospitals leads to manipulating the prices of their health services. The private hospitals are accused of over servicing the patients by forcing them to go through various unnecessary diagnostic tests with the sole purpose of making huge amount of money. For instance, most private hospitals in Mogadishu require patients undergo all types of medical diagnosis including different types of blood tests, stool examination, urine test, ultrasound and CT scan regardless of patients’ health problems. The doctors know that just one type of blood test or just stool examination is enough for the diagnosis of the patient yet they demand several diagnostic tests and the patients are not medical professionals to refuse the unnecessary tests and avoid incurring high costs. Furthermore, the private hospitals also make large sums of money over selling medications. Most prescriptions by doctors in Mogadishu private hospitals are hand-written that directs the patients to buy the medicine from pharmacies owned by the hospital that charge high prices compared to prevailing market prices. It is noteworthy that the quality of private hospitals in Mogadishu is low since their health services are not safe and effective. The doctors who operate in those hospitals have no certified medical license and there are many cases of fake doctors and medical specialists in Mogadishu. A one recent case was a cancer specialist who was operating in a well-known private hospital with a fake post-graduate degree and some cancer patients possibly died on his malpractices.
The government must regulate the quality and prices of private healthcare to safeguard the people and ensure equal access to quality health services by all citizens. The government should establish an independent body that controls both the prices of private health services. The independent body can investigate the real drivers of high costs of private healthcare and also determine reasonable prices of different specific health services. The body can then publish the list of all regulated reasonable prices of various health services. For instance, the body sets the maximum prices or fees on medical diagnostic tests say $20 for ultrasound and $4 for urine tests and so forth. The body should also force the private hospitals apply the health price reference list and ensure that no private hospital charges a medical fee that is higher than those in the list. Moreover, the body must monitor and oversight the private hospitals ensuring that they are not exploiting the vulnerable patients through over servicing or demanding unnecessary health services. Finally, the Federal Ministry of Health and Health Department of Benadir Regional Administration should control the quality private hospitals. The government must require the private hospitals that their doctors, specialists and all medical practitioners should have certified medical license and also demand the private hospitals enhance the safety and effectiveness of their health services.
By Hussein JIMALE