Health: still bad solutions for real problems
Tribune.A seminar for the modernization of the health system, enhanced for its fence by the head of state has just been held at Algiers recently.I can't help but say a seminar yet !!!
Indeed, for decades for decades each Minister of Health if he does not concoct a new health law has been obliged to organize with great pomp assizes, a seminar or days of study on health to mark his passage.
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And to say that each time a lot of money is spent for a very poor result would be a sweet and the and my opinion in my opinion.Why a seminars of health when a health law was written in 2014, adopted in 2018 by the National Assembly but never applied to date for lack of application texts?
We are not told, the total vagueness surrounds these days supposed to modernize the health system, boycotted by the majority of unions in the sector.
It would have been more logical, it seems to me, to ask the question of the why of previous iterative failures, to prevent it from once again a gathering where bombance is made, where tons of recommendations that are produced thatend in a dusty drawer where they will go out.
Known problems
The problems of the health sector are well known and well listed for decades and we do not need yet another seminar, seated or days (the difference is only semantic) to identify them.
Health financing, serene and responsible questioning on free medicine, contractualization, reimbursement of acts by social security, transfers for care abroad, these are the main files that heavily handicap the functioning of our health system.
These files have already been the subject of multiple debates and what is sorely lacking, in my opinion, is rather political courage for the approach to find them solutions without dressing with the tinters of populism and demagoguery.
A multitude of laws are regularly promulgated but never applied and this in all areas and not only in the field of health always due to lack of political courage and this sacrosanct notion of social peace.
I want it as an example to stay in the field of health, the very important problem of the contractualization that is always not solved since to date we continue to operate by packages allocated to hospitals.
And yet, order 96-17 of July 6, 1996 (yes 1996 !!) stipulates that “the costs of care and stay in public health structures are covered on the basis of conventions concluded between security organizationssocial and health establishments concerned ”.
Not applied measures
From 1992, the finance law provides each year that "the contribution of social security organizations to the budgets of the health sectors, specialized hospitals and university hospital centers is intended for the financial coverage of the medical office of insured personsand their beneficiaries.The implementation of this funding will be carried out on the basis of contractual reports linking social security and the Ministry of Health and the Population, according to methods set by regulation ”.
This principle of contracting which aims to finance health structures according to acts, negotiable each year, is mentioned, as we have seen, since the 1990s.Why did he remain a dead letter when political power is aware of the importance of this measure?
The answer is obviously the lack of political courage.So I doubt that a seminar or more or less seams can cure our health system of the evils that gnaw.
This is called pretend to move so that nothing changes.Mr. President of the Republic honored this seminar on the modernization of the health system with his presence and he took the opportunity to once again praise the Algerian health system and distill some very questionable claims in our opinion.
Our health system would be the "best in Africa in terms of free care and health coverage" and that "shortcomings would not be linked to the lack of means and equipment but at the high level of citizens' expectations" according toMr. President of the Republic.
At the risk of being accused of "blackening the situation", I would say as a practitioner and also a citizen with all the respect that I owe to the first magistrate of the country this does not correspond at all to the daily reality that our fellow citizens live in questof care.
I cannot forget the oxygen crisis.How many patients died for lack of oxygen?Dozens, hundreds, will we have one day?Why have the responsibilities of both of this drama have never been established?
Do we have to admission the first head of the health sector to accept these permanent shortages of essential drugs and consumables that completely paralyze the activity of the Dam of practitioners and patients as a fatality?
No, our hospitals are dilapidated, under equipped, undergo the most diverse shortages of drugs, consumables and lack the minimum necessary to meet the demand of our fellow citizens such is the sad truth that we live today.
And the demand of our fellow citizens is far from being "high level" or the cause of this mess as we would like to make us believe.Can we accept that our fellow citizens who suffer from cancer bring some of their anticancer drugs by the "shopping bag" sector for those who have the means and that for others they can only recover from God?
How many children and adults suffering from cancer have died or have seen their chances of healing seriously compromised for lack of treatment?Will we one day have the counting there too? I doubt it very.Will we one day locate the responsibilities of everyone in this drama that lasts?
Yet our colleagues oncologists have continued to sound the alarm but it is as if they preached in the desert.This continuous drama at the very moment when I write these lines to the SU and in view of all those responsible for the country.
And it is surely not the Guéguerre that the Minister of Health and Minister of the Pharmaceutical Industry engages, each rejecting responsibility on the other who will appease the distress of the sick and their family.
No, it is not to blacken the situation to say that patients die or lose their chances of healing because of the gabegia that characterizes our health system that has become obsolete, it is rather an act of responsibility.
Yes, Algeria may be proud to have instituted free care.Introduced in 1973 by presidential decree, its objective, one cannot doubt it, was very noble and it allowed, by ensuring access to care to all strata of the population, to improve the main health indicators, namely the rateof maternal and child mortality, life expectancy, the eradication of certain diseases thanks to vaccination, prevention of transmitted diseases, etc ... to name a few.
Is it fair?
And we can only be proud of this approach which has honored our country.But is it not time to take stock of this free medicine concept and see, fifty years later, what is the efficiency of this system which, moreover, has more free than the name.
Should we continue to give free care to everyone without distinction even to those who are among the most wealthy and who often go first because they have their entrances to the hospital?Is it fair?
This recalls the heresy of subsidies of basic necessities both for the helpless as the billionaire.Should we continue to sleep on our laurels while today Algeria is no longer that of the 1970s?
Demographic and epidemiological transition, emergence of new diseases, reduced financing capacities, all these data encourages us to think with courage and above all without demagogy of this free care for all.Is it still viable?.This debate must take place and the sooner will be best because there is the sustainability of our whole health system.
Mr. President of the Republic during these meetings promised our fellow citizens to bring our health system closer to "that of western European health systems".
Certainly the intention is noble but in my opinion completely unrealistic because the figures are stubborn.Algeria devotes, year after year, between 5 and 7 % of its gross domestic product (GDP) for its health expenses with a national health expense (DNS) per capita which fluctuates around 300 and 400 dollars.For comparison, France devotes $ 4,500 to it, Germany 6000, Canada 7000 and the United States9,000 dollars, to name a few.
The high -income industrialized countries devote an average of 11 to 12 % of their GDP for health spending according to OECD figures in 2011.When we know that the GDP of these countries is ten times to fifteen times higher on average than ours, we understand that we cannot and, above all, we must not compare ourselves or try to copy a health system very far fromrealities and financial capacities of our country.
With what is allocated to our health expenses, can we continue to make Algerians believe that our health system with 10 or 15 times less financial resources can get closer to European standards while remaining free for everyone?
The calculations are quickly made and the equation quickly becomes impossible to resolve because it would be more of the metaphysical miracle than of the policy or of the health economy.And madness from a famous physics nobel would be to continue to do the same thing hoping for a different result.We owe the truth to our fellow citizens.
*Professor of pediatric surgery.
djidjelinacer@hotmail.com
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Important: the stands published on TSA are intended to allow readers to participate in the debate.They do not reflect the position of writing our media.
