WHO report on Seychelles gives thumbs-up on free health care

Seychelles healthcare is ranked as one of the best in Africa (Seychelles Ministry of Health)

(Seychelles News Agency) - Though the health sector in most African countries has been severely strained, Seychelles, an island nation of 90,000 people, is an exception to this tale. Substantial governmental investment in health care has seen Seychelles making significant gains in health which has seen most communicable and infectious diseases being eradicated.

Zimbabwean health expert, Dr William Muhwava who led a World Health Organization (WHO) study into Seychelles health system told SNA that his study team found out that the Indian Ocean island's health system could serve as a continental model scheme.

"Significant steps have been taken in increasing equity to access by making health services free in Seychelles," says Dr Muhwava who is a senior medical demographer and consultant on social determinants of health. "The full coverage of health care costs by the government almost completely accounts for income inequalities which would result in health inequalities."

Muhwava and his team compiled a 141-page report which was recently released by WHO's regional office for Africa which is based in Brazzaville the capital of Congo Republic. The report, Social Determinants of Non-Communicable Diseases and Other Public Health Issues in the Seychelles: Evidence and Implications found out that Seychelles is on target to achieve the Millennium Development Goals (MDGs).

The report notes that Seychelles has already achieved the "MDG on maternal health" and is on course to meet goal five of halving under-5 mortality rate by 2015. Other MDGs that Seychelles has achieved and were part of the health study included those on gender parity on primary schooling.

"Seychelles has made enormous gains in health. Communicable diseases have been brought under control." The report reads in part, "These have been supported by substantial government investment in the health system and the health delivery network. The investments have narrowed social disparities, particularly in access to health care services by eliminating user fees. This has ensured a high degree of protection of households against the financial risks associated with payments for medical treatment."

Lifestyle health issues are main concern for the small island state

According to the study the burden of Seychelles health care system has shifted to non-communicable diseases, injuries and mental health. Life expectancy for both males and females in Seychelles is high with non-communicable diseases such as cancer, heart attacks, diabetes, asthma and depression being the leading causes of mortality.

Male life expectancy according to the study is pegged at 68 years of age while for women it stands at 78 years. The report also found out that mortality due to cardio-vascular diseases which is the leading cause of death in the country has declined by 53 percent in men and 26 percent among females as a result of decreasing smoking and alcohol intake. About 20 percent of mortality in Seychelles is credited to cancer which comes second to cardio-vascular related ailments.

According to Muhwava, Seychelles has a model social safety net that cuts across all social barriers and has cushioned many households from medical care financial risks. "Seychelles has successfully addressed some social determinants of health. For example, universal education, less disparity between the rich and poor, low unemployment, gender issues are addressed and initiatives to empower children," Muhwava says.

One doctor per 780 people in Seychelles

The Seychelles health system borrows heavily from the United Kingdom model with a three-tier system comprising of a central referral hospital which resonates from the main Victoria Hospital, followed by cottage, rehabilitative, mental and youth hospitals in the second tier and district health centres across the republic.

A parallel health structure complements the government health care system. Indeed the findings by the Dr. Muhwava led WHO team confirm the deductions made by the Commonwealth Health Online (CHO) which is a health resource that profiles the 53 member states of the Commonwealth.

According to the CHO, Seychelles and its Indian Ocean neighbour of Mauritius are “notable exceptions” to much of Africa’s health system which suffers from severe understaffing. Seychelles which has remained in the top 10 of Ibrahim Index of African Governance (IIAG) since the year 2000, scored highly on sustainable economic opportunity which looks into infrastructure, business environment and public management.

In 2013 IIAG ranked Seychelles in the fourth position out of 52 African nations and first in the health, infrastructure and education categories.

"The coverage of service providers per capita is high in Seychelles, there is approximately one doctor per 780 people and one nurse serves 400 people. Second, there is a multi-sectoral approach to health promotion." Dr. Muhwava says.

"Other government ministries have health promotion components which complement the efforts of the Ministry of Health. Ministry of Education provides health education in schools and the Ministry of Community Development, Youth, Sports and Culture provide health education among the young people and other specific population groups."

The health expert also says that the report benefited largely from Seychelles "efficient data collection and management systems" which has been the bane in much of Africa stifling better policy interventions.

Common health service complaints

While the WHO report gives a positive assessment of the island's health services with comparison to other African countries in mind, the Seychelles' media have in recent times regularly reported of patient complaints, as well as dissatisfaction with the health services, particularly related to infant mortality, long waiting times at clinics, unavailability of specialized surgery and treatments for serious diseases and conditions.

Many Seychellois travel to other countries such as Singapore, Mauritius, Reunion island, India and the UAE to receive medical treatment when the services are not on offer in the Indian Ocean island country.

The Seychelles Ministry of Health has attributed much of the complaints to poor interaction and relationship between health care professionals and patients.

“Much of the complaints relate to ineffective communication. Waiting times can be perceived by some as being long especially to see some specialists. There is however a growing trend among people who use the private sector, they seem to think that because they have been referred by a private doctor they need to be given priority,” a high ranking official of the ministry told SNA in an email.

Seychelles is ranked as the 1st in Africa in the United Nations Human Development Index 2013, with 46th place in the world ranking, due to its high life expectancy, education, and GNI per capita, according to the UN.