The Impact of Indian Initiatives in Africa: Reflections on the Cooperation in the Health Sector

Pooja Priya

Commentary

Africa’s Health Challenges

In recent years, Africa’s health challenges have received a considerably higher level of attention in terms of research. The conventional focus on Africa’s health issues has been on HIV, malaria and tuberculosis. HIV is said to have originated in the continent of Africa and this origin can be traced back to the 1960s during which studies have suggested that approximately 2000 people were infected with HIV in Africa. This was further proved by the stored blood samples from an American malaria research project which was carried out in Congo.1 HIV in Africa grew rapidly till the 2000s, during which although there were advancements in treating the virus such as antiretroviral therapy (ART), there still is no cure or an effective vaccine for the same.2 Further, it is also crucial to highlight how HIV and tuberculosis are correlated to one another within Africa. It has been stated that the increased rate of tuberculosis in Africa has led to a rise in antituberculosis chemotherapy, which involves using intramuscular injection for one or two months as part of the treatment. This has in turn resulted in an increase in the use of medical injections and malfunctioning of it leading to HIV infections and death.3 3 Another leading health issue that Africa has seen in recent years is mental health disorders due to deep-rooted beliefs in superstitions and witchcraft in African countries. In the African countries, a few of the leading reasons for the lack of focus on mental health are poor medical infrastructure and policymaking, along with the strong spiritual beliefs that individuals and communities hold regarding evil spirits and punishment from God among others. These beliefs further lead to a misunderstanding of the aetiology of mental disorders such as dementia in leading African countries being led by Nigeria, followed by Ghana and South Africa.

India -Africa nexus in the health sector

Having shed light on what were and still continue to be Africa’s leading health issues, it then becomes imperative to look at how India has played a role in maintaining health diplomacy with Africa as a region and with specific African countries. This can be seen in two different eras or periods, i.e. colonial and postcolonial periods. The cooperation between India and Africa in the health sector can be traced back to the colonial period i.e. the 1890s during which Indian doctors were sent to the east coast of Africa and particularly, Kenya. This engagement in history becomes a pivotal event in the process of installation of western medicine in Kenya and gradually in other parts of Africa.4 Stating the scenario of how the nature of the partnership looks like post the independence of India and African countries, it can be seen that cooperation in the form of lines of credit was extended by the Government of India in the areas of pharmaceuticals, ICT interventions in the health sector and medical tourism among others. The origin of India-Africa cooperation in medicine can be traced back to 2001. It was around this time period that pharmaceutical giants were suing the South African government because of their efforts in sourcing cheap forms of antiretroviral (ARV) drugs. It was then that the Indian generic drug manufacturer Cipla volunteered to sell the authentic drugs for less than one dollar a day approximately in Africa and paved the way for the development of a global action plan which focused on increasing access to medicines.5

Further, the partnership between India and Africa intensified in the year 2016 when Indian Prime Minister Modi visited four nations i.e. Mozambique, South Africa, Tanzania and Kenya. The goal of these visits was to develop mutual economic interests and developmental aspirations, which co-aligned with how India planned to export medicines to Africa along with creating manufacturing units within the region. This resulted in 80 per cent of African consumption of pharmaceuticals to be sourced from India. Further, this ARV has contributed to reducing the number of HIV/AIDS in the region. For instance, in 2017, 60 per cent of people living with HIV/AIDS in the African region were receiving ARV treatment, which reflected India’s cooperation with the region in the health sector.6 Further, this has contributed as an achievement to the 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS, which focused on the reduction of 90 per cent of HIV-positive cases by the year 2020. Along with the intention to intercept AIDS within the region, India has extended other health initiatives to Africa such as the use of telemedicine, mHealth, mobile neuroophthalmology services, e-pharmacy, NCG-Vishwam Cancer Care Connect, Electronic Resources in Medicine (ARMED) Consortium, National Digital Wellbeing Platform, National Digital Health Mission (NDHM) and National Nutrition Mission. One of the recent additions is medical tourism.7

Medical Tourism: mobility from Africa to India

In addition to the other initiatives that have been discussed with respect to India’s cooperation with Africa in terms of the health sector, there are other pathways through which India has provided support in the health sector to the latter, i.e. through medical tourism. Medical tourism can be defined as the process of travelling outside the country of residence for the purpose of receiving medical care.8 In its traditional sense, it was understood as the mobility of patients from underdeveloped countries to their developing counterparts. For instance, patients from the western and southern parts of Africa have been getting treatment; in hospitals across India.9 1 In recent years, patients from African countries have confided in the Indian health infrastructures due to the absence of strict healthcare policies in their country of origin, issues with accessing minimal healthcare and the unavailability of technologically advanced hospitals.10 Consequently, the Indian healthcare system provides for the lack of the above; in addition to that, it has large numbers of highly skilled doctors with various specializations, affordability of healthcare in terms of finances and varied options of the hospitals that are being offered to African patients across different Indian cities.11

In recent years, there has been a growth in medical tourism within African countries. This can be seen in the following ways, i.e. growth of local healthcare in Africa, the region beginning to politically respond to developing countries’ healthcare underdevelopment and further focus on advancing domestic health care. Additionally, due to the increase in the growth rate of the economies of the African countries, the image of “underdevelopment” has been slowly shifting towards the category of “developing”.12 This is exemplified through the construction of large hospitals by their Indian counterparts to be able to provide regular consultation, and postoperative care to African patients. Narayana is building a 130-bed specialist cardiac hospital in Nairobi in partnership with the International Finance Corporation and the Abraaj Group. On the other hand, Medanta, established Medanta Afri-care, an ultramodern medical centre in Nairobi in 2012.13

Health cooperation in the light of the Global Pandemic

The period of the global pandemic reflected the cooperation between India and African countries through health diplomacy. Due to the African countries’ inability to be equipped for COVID-19 due to poor healthcare infrastructure, there was a need for medical attention from India. Although the African countries depend upon several regions and countries i.e. EU, Switzerland, China, USA and others, India was estimated to have the most economically feasible health care provisions for the former. Since the start of the global pandemic, the social acceptance and medical diagnosis both seemed to have failed terribly, leading to the continent’s inability to fight the pandemic. For instance, as of 12 August 2021, the confirmed cases and deaths were recorded to be as high as 7,111,780 and 179,801 respectively. South Africa seems to be hit hardest with a substantial number of confirmed cases and deaths amounting to 2,554,240 and 75,774 respectively.14

It is estimated that the Indian government has provided 270 tonnes of food aid to Sudan, South Sudan, Djibouti, and Eritrea to relieve the misery of people impacted by the pandemic. India has also launched a capacity-building program for healthcare workers in African countries, through which teams of doctors assisted African countries such as Mauritius and Comoros to combat the COVID-19 pandemic. Further, India has also provided medical equipment and telemedicine support with top Indian institutions such as the India Institute of Medical Sciences (AIIMS), and Raipur and engaged the local African institutions to train the frontline healthcare workers to combat and control the ongoing health crisis. Additionally, the Ministry of External Affairs (MEA) organized an e-ITEC course, “COVID-19 pandemic: prevention and management guidelines for healthcare professionals” to bring forward the frontline healthcare workers of the African countries. For mapping COVID-19 in rural areas, technical assistance in terms of ArogyaSetu and the E-Gram Swaraj apps have been shared with African countries.15

Through this cooperation that was extended to the African countries by the Indian government during the COVID-19 pandemic, it can be said that the latter has maintained a cordial relationship with many African Nations in the health sector. This support has also further built Africa’s capacities in terms of meeting the Goals for Sustainable Development in meeting target number three, i.e. good health and well-being. This cooperation has helped Africa look beyond the medical conditions that it was dealing with prior to the pandemic, for instance, the 10th Ebola outbreak in 2018, HIV and tuberculosis which according to the reports of the World Health Organisation (WHO) was already draining the medical capacities of the region.16

Future Prospects in the post-COVID era

Looking forward into the post-COVID era, it can be seen that India and Africa will further come together in collaboration with respect to the development of healthcare infrastructure and the reduction of emerging health issues. Other than providing regular medical checkups and post-covid care to patients, the Indian private sector has extended other initiatives. These include the setting up of Dr LalPath Labs, which is aimed to set up joint testing labs with local partners in African countries.17 Further, the Apollo group has set up hospitals and health centres within the African continent, which is educating people about the need to focus on health care and move beyond the local beliefs and notions of illness and disease. Health care will continue as an arena for India-Africa cooperation in times to come.

*Ms. Pooja Priya is an Assistant Professor at the Department of Sociology, School of Liberal Education, Galgotias University.

1. A. B. Kharsany, & Karim, Q. A, “HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities.” The open AIDS journal, 10, 2016, pp. 34–48. https://doi.org/10.2174/1874613601610010034 (Accessed April 22, 2022)
2. P. Kazanjian, “The AIDS Pandemic in Historic Perspective,” Journal of the History of Medicine and Allied Sciences, 69(3), 2014, pp. 351–382. http://www.jstor.org/stable/24631705 (Accessed May 20, 2022)
3. D. J. Roberts, & A. D. Harries, “Tuberculosis and HIV infection in Africa,” National Library of Medicine298(6675), 1989, at https://doi.org/10.1136/bmj.298.6675.751-b (Accessed May 15, 2022)
4. J.Iliffe, “Review of the book Indian Doctors in Kenya, 1895–1940: The Forgotten History, by Anna Greenwood and Harshad Topiwala,]” Bulletin of the History of Medicine 90(4), pp. 734-735. At doi:10.1353/bhm.2016.0124 (Accessed May 10, 2022)
5. “India-Africa cooperation in the Healthcare sector”, Diplomatist, November 2019, at https://diplomatist.com/2019/11/16/india-africa-cooperation-in-the-healthcare-sector/ (Accessed April 20, 2022)
6. “Is trade with India changing Africa’s health care landscape?”, Brookings, March 1, 2019, at https://www.brookings.edu/blog/future-development/2019/03/01/is-trade-with-india-changing-africas-health-care-landscape/ (Accessed April 30th,2022)
7. V. Duclos, “Of Doctors and Wires ICTs, Healthcare, and India’s Telemedicine Venture into Africa.”, Research Gate, January 2014,at https://www.researchgate.net/publication/273409506_Of_Doctors_and_Wires_ICTs_Healthcare_and_India’s_Telemedicine_Venture_into_Africa (Accessed April 21, 2022)
8. M.R.Christie, “ Medical Tourism,” Medical Clinics of North America, 92(6), November 2008, at https://www.sciencedirect.com/science/article/pii/S002571250800117X (Accessed May 27, 2022)
9. “Medical Tourism to India From Africa: Complete Medical Solution At An Affordable Cost”, Medigence, October 08, 2017, at https://medigence.com/blog/medical-tourism-to-india-from-africa/ (Accessed May 1, 2022)
10. Ibid.
11. “India’s medical tourism gets Africans’ attention.”, United Nations, March 2017,at https://www.un.org/africarenewal/magazine/december-2016-march-2017/india%E2%80%99s-medical-tourism-gets-africans%E2%80%99-attention (Accessed May 2,2022)
12. “Indian healthcare taps the African market.” African Business, May 29, 2017, at https://african.business/2017/05/economy/indian-healthcare-taps-african-market/ (Accessed May 29, 2022)
13. Ibid.
14. Rajani Mol et al., “India’s Health Diplomacy as a Soft Power Tool towards Africa: Humanitarian and Geopolitical Analysis.” September 17, 2021, pp. 1109 –1125.
15. Ibid.
16. B.M.Kuehn, “Africa Succeeded Against COVID-19’s First Wave, but the Second Wave Brings New Challenges,” JAMA. 2021, pp. 327–328.
17. “The Prospects for India-Africa Relations in 2022.”, Diplomatist, January 20, 2022,at https://diplomatist.com/2022/01/20/the-prospects-for-india-africa-relations-in-2022/(Accessed May 12, 2022)

Keywords: Africa

January-December 2021
Africa Trends