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A Broken Health System inEquatorial Guinea

DR. WENCESLAO MANSOGO ALO JULY 6, 2011

PRINTER-FRIENDLY VERSION EMAIL

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 healthsystem in Equatorial Guinea. In addition to practicing as a gynecologist in a private clinic, Dr. MansogoAlo is in charge of human rights in the political party Convergence for Social Democracy in EquatorialGuinea.

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 ofsomething 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 ofan established health policy that is clearly defined by the government. And yet, one can hardly speakof 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 projectsproposed by bilateral and multilateral organizations. Or, at times, the health care system is shaped bythe personal proposals of the President of the Republic, as occurred with the construction of themedical center La Paz in Bata. In this undeniably politicized system, the ideological loyalty to theruling 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 multilateralcooperation programs, and seem more destined to cover political gaps or to provide economic benefitto individuals allied with the government than to meet the countrys relevant health needs.

EG Justice: Why doesnt 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 theactions necessary for the implementation and evaluation of objectives as defined. Health does notconstitute 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.

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At the root of this disorder lies a well established characteristic of the countrys regime: thepoliticization of the health sector. Nothing functions in Equatorial Guinea outside the control of thepolitical system. For example, the real control of La Paz hospital in Bata is reserved for persons alliedwith President Obiang. The establishment of a professional medical associationwhich by definitionshould be independent of politicsis not permitted inside the country. Consequently, the health systemlacks the legal instruments and conventional ethics normally applicable to the exercise of the healthprofession in other countries.

So, at the same time modern centers like La Paz and Virgen de Guadalupe are erected, a parallelnational association of witches and healers (known as ASOMETRAGE: the National Association ofTraditional Doctors of Equatorial Guinea), is officially recognized in the country.2 Simultaneous to theestablishment of a medical faculty which lacks the necessary means to teach modern medicineandwhile Equatoguineans are sent to Cuba to study medicine, the government authorizes the practice ofmedicine by people who are not doctors. This contributes to the proliferation of clinics run by localnurses 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 ofthe health situation. The overall mortality rate is highboth among hospitalized and non-hospitalizedpatientsbut 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 aswell.

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 beenbuilt with state funds, but they function as private entities of President Obiang and his wife. Inaddition, these two health centers are not accessible to ordinary citizens; for the average citizen, forinstance, one night of hospitalization in the La Paz hospital in Bata is equivalent to two and a halfmonths salary. Paying for one night in the intensive care unit would require that same person to workfor six and a half months without eating.

These centers, well equipped in theory, dont respond to the expectations of the population. For

instance, they dont always have competent doctors on staff and they often have difficulty obtainingdisposable products and laboratory materials. At times, the doctors at these centers have to go to localpharmaciesas does the neighborhood nurseto purchase supplies. The La Paz center in Bata does nothonor, as should logically occur, medical requests of other doctors in the city for diagnostic tests, suchas 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 toneighboring Cameroon.

In addition to new Guadalupe clinics in Malabo and Mongomo, and the La Paz center in Bata, there are18 public hospitals in the country that were inherited from the colonial age, some of which have beenor are being rehabilitated. This may seem a positive point, but the image that patients receive at thesepublic hospitals is that of an austere, unsafe health system with doctors whose lack of competenceinspires little confidence. The attempt to improve the system via the importation of foreign doctorsand 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. Thefact that the presidents wife is using this program for political propaganda is less positive. Theinformation and education programs for the population remain deficient, and its not unusual to meetpeople who doubt the existence of HIV. In any case, it should be noted that the distribution ofantiretroviral drugs is very insufficient and remains limited to a few public facilities. In addition, manypatients in need of attention are rejected in some of these infectious diseases centers.

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

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

It must depoliticize health care by fundamentally reforming and organizing the national health systemto include competent leadership and management. This is a prerequisite for identifying andimplementing 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% in2011, to 5% annually, and guarantee the availability of these funds.

Establish universal standards of practice for all health professions, introduce essential ethicaland legal instruments, monitor the quality of knowledge of health care professionals, updatingwhen 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 transmitteddiseases.

Strengthen and expand the education and information programs to the population and fightagainst HIV/AIDS. Guarantee free access to antiretroviral treatment for individuals living withHIV.

Establish a program of school healthcare, with specific structures organized for care andpermanent monitoring of the state of health of school children and students.

Create specialized technical control centers to provide disease outbreak alerts, to distributemedicines 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 allEquatoguineans, regardless of their financial limitations.

Parallel to these actions, and in partnership with other sectors of the government, developingdecent housing, providing access to drinking water and sanitation, and promoting healthynutrition 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 ofSaint-Etienne and Lyon, France (respectively). Currently the Chief Medical Doctor at Espoir, in Bata,Equatorial Guinea.