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Navigating Challenges for a Sustainable Healthcare System in Africa

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Access to healthcare services is fundamental to building a healthy future in Africa. However, one of the biggest challenges faced in achieving sustainable healthcare is ensuring that people living in rural areas have equal access to quality medical care.

Rural communities often face geographical barriers, limited infrastructure, and a shortage of healthcare professionals, making it difficult for individuals to receive the necessary healthcare.

Glimpse of challenges in Africa’s healthcare

Malaria remains a dire health threat in Africa, claiming the lives of nearly half a million children between 2020 and 2021, equating to one child per minute; this long-standing crisis, however, prompted extensive research for solutions.

In 2019, the WHO initiated a vaccine pilot program in Ghana, Kenya, and Malawi. Following a successful report, UNICEF has granted a mass production contract to GSK, aiming to produce 18 million vaccine doses for wider distribution.

However, Africa faces escalating healthcare challenges due to deteriorating economic conditions. Over the past two decades, non-communicable diseases, on the other hand, have surged in sub-Saharan Africa, driven by increased cardiovascular risk factors such as poor diets, obesity, and air pollution.

In contrast to high-income countries allocating over $4000 per capita to healthcare, African nations typically invest a meagre $8 to $129. These countries grapple with low Gross Domestic Products (GDPs) and inefficiencies in tax collection, further strained by competing financial priorities, resulting in subpar health outcomes.

Despite projections that the African health sector will be valued at $259 billion by 2030, government spending on healthcare declined relative to overall expenditure in 21 African nations from 2001 to 2015.

For instance, Nigeria annually loses around $1.2 billion to medical tourism in 2021, expected to increase in 2023 with over 5000 citizens seeking treatment abroad each month. This exodus of healthcare professionals for better opportunities abroad exacerbates the problem, especially for a nation with 250 million inhabitants.

This trend is not unique to Nigeria; worldwide, 57 countries face severe shortages of healthcare workers, contributing to a global deficit of an estimated 2.4 million doctors, nurses, and midwives, with a significant concentration of these shortages in sub-Saharan Africa.

Dr Jean Kaseya, the director general of Africa Centres for Disease Control and Prevention (Africa CDC), emphasised the need for collective efforts to safeguard the African population’s health and enhance access to high-quality health products by bolstering local manufacturing.

Dr Kaseya stressed the importance of reducing Africa’s reliance on global agreements and addressing inequities in health product access and supply chain challenges during health crises. Speaking at the Africa Health ExCon-2023 in Cairo on 9th June 2023, he expressed concern over the fragility of international cooperation systems, particularly in the face of global threats like the Covid pandemic. Dr Kaseya highlighted that Africa had faced challenges in equitable access to Covid vaccines, therapeutics, and diagnostics.

To address these issues, he mentioned the adoption of a new roadmap by African Union Heads of State and Governments to establish a New Public Health Order for Africa. This roadmap focuses on strengthening institutional capacity-building, supporting healthcare workers, exploring innovative financing mechanisms, and expanding local manufacturing of health products across the continent, aligning with Agenda 2063.

Further, on 22nd September 2023, the World Health Organisation (WHO), which had reported that Malawi’s largest-ever cholera outbreak, declared a public health emergency on 16th August 2023, is no longer deemed an emergency. Following WHO African guidelines, the Ministry of Health initiated After Action Review (AAR) meetings at sub-national levels to assess the outbreak response.

Dr Gertrude Chapotera from WHO explained that the AAR process identifies what was done well and what went wrong, aiming to establish best practices and recommendations for future emergencies. UNICEF’s Dr Mira Khadka stressed the importance of a structured timeline to understand the outbreak’s progression.

District officials, like Dickson Kazembe in Zomba, recognised the value of self-evaluation and plan to use AAR as routine health service practice. Neno’s Sekanawo Kapila highlighted the importance of AAR in emphasising prevention. One successful intervention was the installation of 640 chlorine dispensers with support from WHO, the Ministry of Health, Partners in Health, and UNICEF.

Dr Limbani Mwapata noted the need for a centrally placed contingency fund to support government efforts during disease outbreaks, reflecting the AAR discussions across all districts.

Exploring new pathways

Further, while efforts are being made to safeguard and improve the African healthcare system, in 2019, sub-Saharan Africa grappled with a significant out-of-pocket healthcare expenditure, reaching 29.98%. In contrast, the European Union reported a notably lower figure at 15.50% during the same period.

This situation led to 10.7% of households in the region allocating more than 10% of their non-food consumption expenditure to out-of-pocket healthcare payments, while 2.6% were burdened with expenses exceeding 20%. Introducing health insurance can ensure families can access necessary healthcare without making difficult choices between essential needs and their well-being.

Before the Covid crisis, telemedicine emerged as an alternative to fill Africa’s inadequate health resources and infrastructure gap. The pandemic has accentuated this need as more than 400 million people have little or no access to healthcare today. In today’s fast-paced world, technology has become an indispensable tool in every industry, and healthcare is no exception.

In Africa, where access to quality healthcare is often limited, leveraging different aspects of technology can revolutionise healthcare delivery and create a healthier future for the continent. 

While a few African countries have already approved policies and guidelines for telemedicine, most nations still need to address regulation, delivery models, internet access and human resource challenges. Governments and insurance stakeholders also need to discuss win-win reimbursement schemes that allow the democratisation of telemedicine and provide lasting benefits for patients at an effective cost.

Across Africa, Public-Private Partnerships (PPPs) in the healthcare sector are on the rise. Governments are increasingly acknowledging the pivotal role played by the private sector in the delivery and sustainability of healthcare services, aiming to address the numerous gaps present across the continent.

However, for this innovative approach to succeed, several critical factors must be considered, like favourable fiscal conditions, robust political commitment, integration into national health strategies, institutional backing and establishment of PPP policies, and transparent regulatory framework.

Conclusively, community-based healthcare approaches are essential in countries and regions with limited or inaccessible healthcare facilities. Engaging with communities and empowering them to take charge of their health can significantly impact them. This can be done through initiatives such as health outreach programs, mobile clinics, and community health workers.

These approaches provide basic healthcare services and educate individuals and communities on disease prevention, hygiene practices, and healthy living habits. With community-based healthcare approaches, African countries can address the underlying causes of health issues and work towards sustainable solutions. 

Onah Caleb is a research assistant at Benue State University (Nigeria). He runs the blog KaylebsThought.


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