A recent Amref Health Africa conference brought to light the harsh reality African countries face with regards to healthcare. The conference brought together experts from across the continent to discuss these challenges, the enormous opportunities, share their experiences and insights on improving health outcomes in Africa, and explore potential solutions. One of the key themes to emerge from the conference was the need for Africa to take responsibility for its health system by focusing on locally sustainable solutions, primary health care, technology for equity, and optimal health service delivery models.
As I sat through the conference listening to speakers from all over Africa share their experiences, some inspiring and some heartbreaking, my mind kept going back. I was thinking about the pregnant woman I had recently scanned in Lokitaung, Turkana county. The sheer joy on her face when she heard the baby’s heartbeat and saw the movements of her limbs during her first ultrasound, even though it was her third pregnancy, was truly remarkable. Is this a true definition of reaching the last mile with quality healthcare services? I kept wondering how such discussions could enable thousands more of these women to access services in hard-to-reach areas.
To reach such patients with equitable health services, African governments, health organizations and other stakeholders must work together in a concerted effort to address various issues. These include disparities in health insurance coverage, climate change on health outcomes, the rise of noncommunicable diseases, funding for health care, resource use law, and a declining population dividend. At the same time, we need to invest in locally sustainable solutions, such as vaccine development and primary health care models. This will require a paradigm shift in partner coordination and an equitable distribution of resources.
Fortunately, there are signs of progress. Rwanda’s success in achieving insurance penetration of over 90% demonstrates what is possible when governments prioritize access to healthcare. Zambia’s health care reforms, which focus on community participation, have significantly improved maternal health outcomes. However, the disparities in these results are quite concerning; while Rwanda is apparently doing very well on many fronts, neighboring countries like Uganda are still struggling with less than 10% health insurance penetration.
“We have to fight for an Africa and economic growth if we are to establish a more equitable system,” joked Dr Githinji Gitahi, chief executive officer of Amref Health Africa.
One of the critical issues facing the African healthcare system is the need for increased local manufacturing capacity for vaccines and other medical products. This has left the continent heavily dependent on imports, which can be expensive, unreliable and subject to export restrictions. The COVID-19 pandemic has highlighted Africa’s urgent need to build up its manufacturing capacity for vaccines and other essential medical products. The continent needs to invest in research and development, build partnerships with local producers and create an enabling policy environment that supports local manufacturing. Not only will this help ensure Africa has access to reliable and affordable vaccines, it will also create jobs and stimulate economic growth.
Another key challenge facing the African health system is the need for locally sustainable solutions. The continent is home to diverse ecosystems, from arid and semi-arid lands (ASAL) to rainforests, and each region faces unique health challenges. With over 50% of Africa’s population living in arid and semi-arid lands, we could see an increase in malnutrition, infectious and diarrheal diseases, and zoonotic diseases. In rainforest regions, deforestation and other environmental changes can lead to the emergence of new diseases.
The surge in NCDs also poses a significant threat. To address these challenges, Africa must focus on developing locally sustainable solutions tailored to the specific needs of each region. As clearly stated by the CDC Acting Director for Africa, Dr. Ahmed Ogwel, the institution will support its member countries to rapidly and effectively detect, prevent, control and respond to disease threats; this is evident from the very rapid response to Covid 19 resulting in containment in Africa.
Primary health care and delivery models are also critical components of a resilient health system. Primary health care is the first point of contact for patients and is critical in the prevention and management of communicable and non-communicable diseases. However, in many African countries, primary health care is underfunded, understaffed and in need of the necessary infrastructure and equipment.
To address this problem, Africa needs to prioritize primary health care in its health system. This was well captured by one of the speakers, Prof Oyewale Tomori, a Nigerian virologist, who asked us to “invest our money where our mouth is”, challenging African countries to invest much more in healthcare. This is to ensure that it is adequately funded and staffed, and that patients can access essential services such as vaccinations, prenatal care and treatment for common illnesses.
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This was compounded by Ms Priya Basu, from the African Pandemic Secretariat, who called on African countries and other supporters to contribute to this fund; ‘we need to prepare better for the next outbreak as Africa is prone to outbreaks of different types; the aim of the fund is therefore to stop the rapid progression of these outbreaks into pandemics as happened with covid 19′.
Delivery patterns also play a vital role in ensuring patients get the care they need. Innovative delivery models, such as community health worker programs, can help bridge the gap between patients and healthcare facilities, particularly in remote or underserved areas. Telehealth and other digital health solutions can also improve access to healthcare and reduce costs. However, to be effective, these models need to be tailored to the specific needs of each region. A robust health system must support them with adequate funding, staffing and infrastructure.
As we look to the future, we must continue to focus on Africa’s health for Africans. Building a strong and resilient African health system requires a multi-faceted approach focusing on sustainable solutions at the local level, multi-stakeholder involvement, accountability and being population-centred in our approaches. In his observations, Dr. Githinji further reminded us that “we all have a role in making this happen and we need to act; we are ONE AFRICA, and that is what defines us; the spirit of UBUNTU must live on’.