We live in a time of unprecedented progress in healthcare. However, there are a number of “mega-trends” developing which directly impact developing countries and most critically the churches, healthcare providers and medical professionals we are in ministry with.
Several years ago John Nesbitt authored a #1 NY Times best seller called Megatrends. The author identified 10 major trends that he proposed were relentlessly shaping all of society worldwide. His premise was that things like the growth of technology and the emergence of a global economy were rapidly changing the future of our world in significant ways that could only be fully appreciated when viewed as a whole. The allure of Nesbitt’s book was that he was then able to relate how those tsunami trends were going to affect us individually.
This month I would like to share with you some of the trends that we are seeing in terms of healthcare and development in the developing world. These are the things impacting what could essentially be called the “business of healthcare” – the need, the resources, the market, the competition, etc.
Next month I would like to share with you the changes that are occurring within western Christianity and the traditional supporting partners for medical missions.
Finally, we will summarize how all these trends are creating both an unlimited opportunity for the Christian church and the very real risk that much of what the church has accomplished in medical ministry over the last 150+ years may decline and slowly disappear.
Healthcare and Development Trends in the Majority World
- As the population in the developing world is becoming much more urbanized, healthcare needs are intensifying.
The developing world population is quickly becoming urbanized. For the first time in history, more than 50% of the world’s population lives in an urban area. As much as one out of three urban dwellers (approximately 1 billion people) are living in slum conditions.[i] By 2025 the United Nations projects that there will be 27 mega-cities, (10 million+) and most of them will be in developing countries.
This urbanization is completely changing the nature of healthcare services required in these countries. The needs associated with rural, primary care are now being replaced by violence and injury, non-communicable diseases (cardiovascular diseases, cancers, diabetes and chronic respiratory diseases), unhealthy diets and physical inactivity, harmful use of alcohol, as well as the risks associated with disease outbreaks.
The impact: Mission hospitals and clinics which once focused entirely on lower level primary care services now must become much more sophisticated diagnostic and treatment centers – or be relegated to being left behind as low quality, inadequate and irrelevant.
- There is an accelerating pace of development of new medical technologies and as a result an accelerating demand for capital and infrastructure.
Just as the U.S. and other western countries have seen the accelerating costs of medical technology, majority world healthcare providers face the same pressures. In 1970, total US health care spending was about $75 billion, or only $356 per person. In less than 40 years these costs have grown to $2.6 trillion, or $8,402 per person. As a result, the share of economic activity devoted to health care grew from 7.2% in 1970 to 17.9% in 2010. Most healthcare policy experts believe new technologies and the spread of existing ones account for a large portion of medical spending and its growth.[ii]
The impact: For church owned healthcare providers, keeping pace with the demand for services and the change in services requires increasing expensive new technology, more sophisticated infrastructure and better trained personnel. This also means an acceleratingdemand for capital investment.
- While virtually every country in the world is making progress in terms of development as measured annually by the UN HDI (human development index), the disturbing news is that the rate of development in the lowest ranking countries is slowing, not accelerating.
The good news is that HDI and life expectancy have increased dramatically in developing countries over the last 20 years and health indices confirm progress in medical care. However, the high growth rate of the population, mass poverty, deeply entrenched inequality and lack of political empowerment contribute to slowing overall development.[iii]
The impact: At a time when we would expect an improving capability of the population to afford to purchase basic healthcare services, the increasing population of poor remains unable to afford any healthcare services – which means an ever increasing demand for free care.
- The healthcare budgets of the least developed countries are seriously underfunded and many are actually cutting healthcare budgets.
In 2001, the African Union governments all pledged to allocate at least 15% of their annual budgets to healthcare by 2015; so far, just six countries have met this goal.[iv]
While aggregate spending on health has increased- from 8.8% up to 10.6% – about a quarter of African Union (AU) member states have regressed and are actually spending less than in 2001. In many instances, impoverished countries are being forced to repay foreign debts instead of spending precious cash on essentials like schools and hospitals.
Additionally, much of the outside healthcare funding which countries receive is dedicated to disease specific projects (most notably AIDS) rather than investments in overall healthcare infrastructure, human resources or primary care services.
The impact: The healthcare funding situation is getting worse, not better, in many developing countries leaving church medical ministries with increasing numbers of poor patients while falling further and further behind.
- While great scientific and technological advancements are occurring at a pace never seen before in the history of the world, there is still a dire shortage of trained healthcare workers.
Today, according to the WHO, the world is short 7.2 million healthcare workers and it is getting worse, NOT better. WHO points to several key causes – an aging health workforce with staff retiring or leaving for better paid jobs without being replaced, while inversely, not enough young people are entering the profession or being adequately trained. Increasing demands are also being put on the sector from a growing world population with risks of non-communicable diseases (e.g. cancer, heart disease, stroke etc.).[v]
In sub-Saharan Africa the shortages are especially acute. For example, in the 47 countries of sub-Saharan Africa, just 168 medical schools exist. Of those countries, 11 have no medical schools, and 24 countries have only one medical school. With current medical training programs there is no way these countries can even begin to reach acceptable levels of physicians, nurses and technicians.
Impact: “No health without a workforce”. We can have revolution of medical technologies and treatments available, but there is no one trained to administer those medical services. Melinda Gates stated that “…there is enormous belief that you can’t get that life-saving technology out there without people adopting it. And that’s the critical next piece.” [vi]
A Crisis in Church-affiliated Healthcare
When written in Chinese the word ‘crisis’ is composed of two characters. One represents danger, and the other represents opportunity.
We live at one of the tipping points of modern society. Medical technology and treatments are changing worldwide at a pace never before imagined. Never has there been the opportunity to impact the lives of so many people. Yet, the infrastructure, human resources, funding and systems to serve people lags far behind. We have the medicines and technology, but not enough hospitals or health workers to deliver it.
We face a CRISIS – a great opportunity for God’s church and at the same time the potential for the decline and ultimate demise of many church healthcare ministries.
Next month – The huge changes in the western church affecting healthcare ministries
 The United Nations, “World Urbanization Prospects: The 2007 Revision Population Database.”
 Health Care Cots A Primer, Kaiser Family Foundation May 2012
 Trends since 1960, African Development Bank
 theguardian.com, Wednesday 24 July 2013
 WHO news release 11 November 2013
 Financial Times, 12.09.11
[i] The United Nations, “World Urbanization Prospects: The 2007 Revision Population Database.”
[ii] Health Care Cots A Primer, Kaiser Family Foundation May 2012
[iii] Trends since 1960, African Development Bank
[iv] theguardian.com, Wednesday 24 July 2013
[v] WHO news release 11 November 2013
[vi] Financial Times, 12.09.11