Drawing on epidemiological and healthcare outcomes data reported in the WHO Global Health Observatory data repository, this report profiles the current status of African healthcare and from key analytics of plenary reports elsewhere formulates some future trends in healthcare for the African continent. The traditional “vertical” focus to tackling healthcare challenges it is argued, should be transformed into a “lateral” one whereby the aim is to fortify healthcare delivery by a broad and socio-economic approach. Decades of economic austerity from political conflict, corruption and poor fiscal management have impacted heavily on healthcare outcomes in Africa but in recent years commensurate with positive macroeconomic developments, such as job creation growing at a rate of 3.8% between 2000 and 2015 amidst one of the youngest employment populations worldwide, there have been significant improvements in healthcare outcomes. For example since 2000, Africa has seen the highest regional hike in life expectancy of 8 years for both sexes (16.0% increase) in contrast to the Americas slowing to a 3 year increase unisexually (a mere 4.0% increase). Looking ahead the rise in popularity of corporate social responsibility and ‘double bottom line’ accounting, in which corporations keep track of social and environmental achievements alongside their financial performances, will mean that many large international corporations will feel the social gravity of embracing the challenge to improve the state of healthcare in Africa.
This report delineates the critical barriers and drivers for healthcare improvements in Africa and will augment the knowledge base of healthcare policy groups and stakeholders who have executive decision making authority in foreign aid, NPO sectors of the relevant healthcare departments.
This report identifies the key challenges of the very current African healtcare system and outlines the critical changes that are necessary if there are to be significant gains in African healthcare outcomes in the future. In essence it is a “must buy” for any heath policy professional assigned to bettering health in Africa.
- Burkina Faso
- Cabo Verde
- Central African Republic
- Cote d'Ivoire
- Democratic Republic of the Congo
- Equatorial Guinea
- Republic of the Congo
- Sao Tome and Principe
- Sierra Leone
- South Africa
- South Sudan
Introduction – Page 2
A Profile of African HealthCare – Page 4
Life Expectancy and Mortality – Page 5
The Crisis Diseases: AIDS, Ebola, Malaria and Tuberculosis – Page 9
Primary Healthcare across Africa – Page 11
Secondary Healthcare across Africa – Page 13
The Healthcare Spending Criteria – Page 15
Public Healthcare Expenditure – Page 17
Foreign Sources of Expenditure – Page 19
Payor Insurance Schemes – Page 21
Some African Trends in the Healthcare Sector – Page 23
Generic Sources of Information – Page 26
With the majority of African Union states spending as little as $4 per capita on healthcare, it is not surprising that the African continent is still heavily reliant on foreign aid for funding of its healthcare system. Where healthcare funding deficits are not addressed, public health policy has become a “knee jerk” response to tackling prevalent life threatening diseases and epidemics. Hence the flawed “vertical” focus it is argued, should be transformed into a “lateral” one whereby the aim is to fortify healthcare delivery by a broad and general approach. Nonetheless over the past decade there have been improvements in both political stability and economic performance on the African continent as a whole, which has in turn impacted favourably on epidemiological indicators. For example since 2000, Africa has seen the highest regional hike in life expectancy of 8 years for both sexes (16.0% increase) in contrast to the Americas slowing to a 3 year increase unisexually (a mere 4.0% increase).
Regardless of the national government-foreign aid combination of funding, poor infrastructures and economic disparity between urban and rural economic development have made it difficult to provide healthcare services to numerous communities in remote areas and moreover with these regions being financially harder hit, this has accelerated the emergence of private healthcare initiatives to help bolster healthcare inequalities. Comparing other global regions to African healthcare provision, stark differences are revealed on the basis of healthcare statisitics alone, for example in Germany there are 8.9 hospital beds per 1000 of the population, while in The Gambia, hospital bed provision is as little as 1.1 per 1000.
To emphasise the mistaken vertical approach on healthcare systems, an inequitable distribution of funds to high profile causes such as HIV/AIDS, more recently the Ebola virus or malaria thus downgrading other key healthcare issues like paediatric and maternal health, nutrition and patient record systems, will inevitably have a long term negative impact on healthcare outcomes in Africa. Other long term limiting factors to improving healthcare outcomes for this continent are in the big pharma corporate arena where there are no home-grown African entities. Moreover the continent has a severe shortage of trained specialists to conduct clinical trials so that new medicines can control the diseases of their region partly owing to the brain drain of doctors and nurses who settle abroad.
In its colonial past, war and political conflict has obviously had devastating impacts on healthcare systems across the African continent and the consequences were dire for basic healthcare statistics. However for certain African nations, it has become the case of the “phoenix rising” with Eritrea for example in a cross border struggle with Ethiopia spanning over 30 years from 1961, finally gaining its independence in 1993, this country has seen its life expectancy at birth for both sexes increase by a substantial 18 years over the period of 2000-2012 whereas the WHO region average increased only by 7 years in the same period. Similarly Rwanda, a country ravaged by civil war in the 1990s but now with relative political calm, has posted its life expectancy at birth for both sexes as increasing by 19 years over the same period.
Unlike in the western economies where key causation of mortality due to cardiovascular disease, cancer and degenerative diseases such as Alzheimer's bears heavily on a high saturatefat diet and lifestyle factors such as physical inactivity, stress and smoking, the bane of African mortality lies in communicable diseases. Such diseases have been singled out as HIV/AIDS, lower respiratory infections (e.g. tuberculosis), diarrhoeal diseases (e.g. cholera and typhoid) and malaria which were the leading causes for the African region in 2012, killing 3.3 million people. This stands at just over 33% of all deaths in the region. Public health and control of such diseases is heavily dependent on the infrastructure, reliability of public services such as fresh drinking water, public sanitation measures adopted and the public health education programmes implemented.
In 2015 on a daily basis worldwide, according to WHO data, 830 women deaths were attributable to complications of pregnancy and child birth. Of the 830 daily maternal deaths, a major portion of those deaths - 550 occurred in sub-Saharan Africa and 180 in Southern Asia, compared to 5 in developed countries. Although worldwide maternal mortality has seen a significant reduction since 1990, there is still a huge inequality in maternal healthcare outcomes between Africa and elsewhere in the world.
On the communicable disease control frontier, Africa can claim some success. In sub-Saharan Africa for example, a region ravaged by HIV and related tuberculosis infections in the late 1990s and early millenium, it has seen the number of AIDS-related deaths fallen by as much as 39% during the years 2005 to 2013. One of the noted successes in reducing HIV prevalence in this region has been the “ABC” programme advising individuals to “abstain, be faithful and condomise”. This approach has been claimed by health ministers in Uganda, Kenya and Zimbabwe to have attributed to the falling numbers of those infected with HIV in particular by means of reduction in the number of sex partners.
African healthcare is no longer at the mercy of preferential pricing on life saving drugs like antiretrovirals (ARVs) and given the positive impacts of changes to the Doha Declaration – reduced production costs of medicines on African soil, domestic control over a life-saving drug and enhanced local healthcare capacity, it is envisioned that there will be even greater curbs to AIDS mortality in Africa.
For tuberculosis (TB), Africa still accounts for the worst disease burden at 281 cases per 100 000 population in 2014 (in contrast to the global average of just 133). Although Africa is not among the WHO regions (the two regions were the Americas and the Western Pacific) that have achieved all three 2015 Millennium Development Goals (MDGs) for reductions in TB disease burden (incidence, prevalence and mortality), in all criteria of incidence, prevalence and mortality however, rates are all decreasing in the African continent.
Despite the implementation of a global plan of action in May 2012 by WHO as formally announced as the Global plan for insecticide resistance management in malaria vectors (GPIRM), there remains two main challenges to African healthcare systems in tackling malaria disease control: implementing adequate and routine monitoring for insecticide resistance in local vectors; and the monitoring of data in a timely and effective manner.
Both public and private sector organisations and other NGOs in Africa still prioritise primary healthcare merely because it is the most economical means of boosting health outcomes and to deliver better quality healthcare interventions cost effectively.
In becoming the “lateral” or “horizontal” based healthcare provider, some of the practical and pragmatic approaches that African health ministry needs to embrace is overhauling the public sanitation systems for clean drinking water supplies and sewage removal or equipping maternity and infection control units with higher technology services.
Rwanda has been singled out as an African success story for healthcare. Its primary healthcare includes the completely free of charge mosquito nets and certain vaccinations are of no charge for Rwandan child bearing mothers. Infrastructure wise their national health system has been upgraded to electronic medical records and takes advantage of mobile phone text messaging to acquire reports from rural health workers.
Higher disposable incomes in urban households represents a sizeable customer base which indeed is driving the expansion and development of private hospitals and private health maintenance organisations (HMOs) offering better quality healthcare services than public standards of the past in many major African cities.
Finally as a case study, up until the last five years, Kenya was a typical sub-Saharan African country of having a two-tier healthcare system where if you were rich you would be referred to one of the exclusive private hospitals, while your health would be at the mercy of a sub-standard and dysfunctional state healthcare sector if you were the poor majority. In recent years HMO companies like the Avenue Group have been trying to close this gap between these two socio-economic levels with its low-cost model of keeping medical tests to a minimum and getting doctors to delegate on tasks that nurses can do. Indeed Avenue is now a success story in Kenya with its number of outpatient clinics doubling to 14. Affordability of health insurance is a critical factor limiting the expansion of secondary healthcare in Africa as a whole, especially since the number of Africans holding a service sector employment position which offers formal provision of health insurance is still something that local African governments need to work on.
With pressures in recent years for Western governments to tighten their budgets and therefore if their pledge to give to foreign aid is in the balance, this will impact on how African governments plan and commit to building up their healthcare infrastructure. Inevitably African governments would do well to emancipate themselves from foreign government donor funding, as fiscal problems in donor nations fuel isolationist instincts and suddenly indebted Western countries cut the amounts they have allocated to foreign aid.
On the other hand, and more positively, there are signs that the private sector will be willing to compensate for much of the funding lost as governments and NPOs cut back. The rise in popularity of corporate social responsibility and ‘double bottom line’ accounting, in which corporations keep track of social and environmental achievements alongside their financial performances, will mean that many large international corporations will feel the social gravity of embracing the challenge to improve the state of healthcare in Africa.
- Amsterdam Institute for Global Health and Development
- Avenue Group
- Carter Center
- Health Insurance Subsidy Program (HISP)
- Kenyan Ministry of Health
- Koisagat Tea Estate
- Mediclinic Southern Africa
- National Health Insurance Fund (NHIF) Tanzania
- Netcare and Life Healthcare
- Nigerian Ministry of Health
- South African Medical Association
- US National Health Accounts
- Ugandan National Association of Private Hospitals
- United States Agency for International Development (USAID)
- World Bank Group (WBG)