Why private health education in Africa?

At last there is a glimmer of hope for Zambia’s cash-strapped health system. Lusaka’s first private school of nursing opened its doors mid-2005. What are the problems faced by African health systems? Why should the private sector invest in health education in Zambia? How can private health education help to ease the tremendous problems that confront health systems in Africa?

There are many popular misconceptions about development in Africa; one of the most pernicious is that qualified manpower can be provided by the state system. It is not that the state system in most countries is of bad intent but it simply lacks the cohesion and the monitoring capacity to provide a clear link between costs and benefits. The result is that unqualified personnel leave schools and colleges and that, for instance, nurses are deployed in limited numbers and with far too few qualifications.

There is no denying that Governments do their utmost. Equally there is no denying that Governments, donors and recipients are not doing enough and for this the private sector will suffer unless it can find an appropriate role. AIDS patients destroy a wealth of human resources investment unless saved by treatment programmes and society as a whole suffers reduction in consumers and producers if the health issue is not tackled properly.

Even under normal circumstances, this would be a catastrophe. Nursing staff, apart from performing the duties every Westerner is familiar with, are for many Africans the highest level of medical personnel they are ever likely to meet. And circumstances are not normal. The groundswell of AIDS is undermining not only every element of society but, notably, the medical system itself: the higher echelons first. In Zambia 3,5% of nurses die on a yearly basis due to AIDS related illnesses at an average age of 36 according to research done by Boston University. Furthermore 20% of adults in Zambia are HIV-infected and AIDS patients occupy 80% of hospital beds. There is an urgent need and a desperate scarcity of medical staff.

As for the brain drain, the UK for example is believed to have taken on at least 3,000 African nurses a year since 2001. A recent report revealed that, in 2002-3, almost half of the new nurses registering to work in Britain were from abroad.

The state system will not be able to cater for all these needs in the foreseeable future. Additional support needs to be mobilized. Teaching staff on a clear and enforceable contract may earn more but most probably, will perform much better than their colleagues in the state system. Students paying for their education are likely to be better motivated and more demanding than their counterparts in state institutions and we feel resources from the private sector can be more easily mobilized towards an education that can demonstrate a return on investments.

With aid fatigue having reached funders like Rotary Clubs, NGO’s and wealthy private individuals, a set up that takes into account the known weaknesses of Africa is needed to make sure that mistakes are not repeated. In this way, open-ended and life-long contracts will be avoided and good pay will be tied to good performance. Students, with the possible exception of the most talented, will be asked to pay for their studies and will therefore have a stake in their own success. They will work harder and be more critical regarding the product they are paying for. Such a school, logically, will have to pay its own way. There are two exceptions, however:
1. Starting capital will need to come from abroad and;
2. A long-term basis scholarship programme for students who are both bright and impoverished will need to be sponsored.

We seek one more pillar of invaluable support. Private health education would immensely benefit from external support and insights, where necessary from abroad. A private health institution would need to solicit not only money but also management advice, training of trainers and exchange programmes for both students and teachers.


This is the reasoning behind the establishment of the Lusaka Nursing Institute (LNI) in July 2005. The Institute is going through a fruitful if also eventful first year. Initially we have found that some staff suffer from what one may call the passivity-syndrome, but we have been able to replace them with better-motivated staff. The link between cost and benefit is therefore much more direct. We have also found that there is a great interest in receiving education at our school. Too few students have managed to raise the money required for the schoolfees, however this reinforces the idea of a scholarship programme.

We cannot promise the earth but we are very optimistic. Join us and see your investment in Zambian development bear fruit.