Improving the State of African Healthcare in 2023: Challenges and Solutions
Healthcare in Africa is one of the most touched topics on the global stage. There have been various developments made in this area over the past couple of decades, yet, there's still a lot to be done. Let's take a look at the current state of healthcare in the continent.
In Africa, nearly half a million children died from malaria in 2020, a rate of one death per minute. However, malaria has been a leading cause of death in this region for decades, leading to research for solutions.
In 2019, the WHO launched a pilot routine vaccine program in Ghana, Kenya, and Malawi, the report of which has now made UNICEF award a mass production contract to GSK as it gears to make the vaccine available in 18 million doses.
But healthcare problems in Africa increase as economic situations worsen. Non-communicable diseases have been rising in sub-Saharan Africa for the past two decades, causing more cardiovascular risk factors like unhealthy diets, obesity, and air pollution.
Economic growth reduced poverty to 43% of the population, but access to needed specialist help and medication is still an illusion across the continent.
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Africa in Recent Times
One of the deadliest viral diseases, Ebola virus disease (EVD), was discovered in 1976 when two consecutive hemorrhagic fever outbreaks occurred across Central Africa. It first appeared near the Ebola River in the Democratic Republic of Congo (formerly Zaire), where it got its name. And the second occurrence was approximately 500 miles (850 km) away from what is now South Sudan.
Since then, there have been cases of ebola outbreaks across the continent. For example, the Democratic Republic of the Congo (formerly Zaire) reported 130 cases in recent 2020, with 55 deaths and 42.3% of catastrophic losses. And in 2021, Guinea reported 23 cases, with 12 deaths and 52.2% of fatal issues.
In western Uganda, the Ugandan Ministry of Health reported an Ebola virus disease (EVD) outbreak on September 20, 2022. Outbreaks have been reported in seven districts (Mubende, Kyegegwa, Kassanda, Kagadi, Bunyangabu, Kampala, Wakiso), making it the sixth EVD outbreak in Uganda, five of which have been caused by the Sudan ebolavirus.
Fighting to Survive COVID-19 Aftermath
With 12 million cases, 11 million recoveries, and 255,909 deaths in Africa, it may seem like much wasn’t affected compared to Europe's 257 million confirmed Covid-19 cases. The USA has 1,092,948 deaths, while Brazil recorded 687,680.
But Covid-19 in Africa has created economic problems and exposed the adverse effects of out-of-pocket (OOP) health spending, which is at a high rate compared to other continents. As a result, households can face damaging health expenditures, likely worsening poverty levels.
For example, Ghana's inflation rate as of 2020 and 2021 was estimated at 8.5% and 7.5%, respectively. But after the pandemic, the projections increased to 11.2% for 2020 and 9.3% for 2021. As of September 2022, Ghana’s inflation rate was at 37.2%, an increase from 33.9% in August.
The impact of out-of-pocket healthcare expenditures on a household's ability to purchase essential non-medical goods and services is a notable reality considering the poverty level in the African continent. For example, South Africa has a 55.50% poverty rate, while South Sudan has the highest poverty rate in the world at 82.30%, according to the World Bank.
Battling Lassa Fever
West African countries like Nigeria, Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Guinea all experience Lassa Fever — an acute viral hemorrhagic illness.
Each year in West Africa, approximately 100,000 to 300,000 people are infected with the Lassa virus, resulting in roughly 5,000 deaths. These estimates are ballpark figures since there’s no uniform monitoring. However, there is a high prevalence of Lassa fever in Sierra Leone and Liberia, as 10-16% of hospital patients yearly suffer from the disease.
Approximately 80% of those infected with the Lassa virus do not show signs of disease. However, in one in five cases, the virus affects several organs, including the liver, spleen, and kidneys. This calls for routine checkups for early detection, but facilities still need to be equipped, and human resource needs to be improved.
Problems with Healthcare in Africa
Africa is the second most populous continent, with over 1.2 billion people. With scarce resources, the COVID-19 pandemic, and outbreaks such as ebola and Lassa Fever, the biggest question is this: what is Africa’s most critical health problem?
1. Rapid Population Growth
According to the United Nations, 25% of humanity will be African by 2050. In 1960, the estimated African population was 257 million, which had increased to 482 million by 1983. And in 1993, the population grew to roughly 682 million at an annual growth rate of 3.2% — the highest among third-world countries.
In 2022, the African population is 1,415,216,977, an equivalence of 16.72% of the world population. With already scarce resources and an overwhelmed healthcare system, catering to such rapid growth is a big challenge for governments across the continent.
2. Low Healthcare Funding
Unlike high-income countries spending more than $4000 per capita on health, African governments spend $8 to $129. African countries have low Gross Domestic Products (GDPs) and tax collection efficiency, compounded by low health budgets due to competing priorities, resulting in poor health outcomes.
Though the African health sector is estimated to be worth $259 billion by 2030, government spending on health decreased compared to its overall expenditure in 21 African countries between 2001 and 2015.
3. Excessive Dependence on International Funds
As a result of low government funding is an excessive reliance on international bodies. Private health expenditure is more than 50% of total health expenditure in over 15 countries. 36% of all external funding was raised by 83 companies across Nigeria, Ghana, Kenya, and Uganda.
African ministers and the Economic Commission for Africa (UNECA) proposed a new debt service suspension initiative (DSSI), which allowed low-income countries to suspend debt payment obligations to creditors in 2020 and 2021. In addition, this initiative gave African governments resources to buy personal protective equipment (PPE) and support local PPE production during the pandemic.
4. Lack of Clinical Research
Clinical research prepares countries for health problems and helps solve existing health conditions. This directly improves the state of healthcare in African countries.
For example, sickle cell anemia (SCA) affects more than 1 million children, with roughly 60,000 experiencing ischemic strokes. As a result, it’s been the standard to screen children for stroke risk yearly in other parts of the world to reduce morbidity in children with SCA.
In Africa, the transcranial Doppler ultrasound (TCD) — used for this screening — was unavailable until clinical research in SCA. The proportion of clinical research starting in Africa was 3.9% compared to worldwide trials.
5. Migration and Brain Drain
Nigeria loses approximately $1.2 billion to medical tourism yearly, and over 5000 people leave Nigeria monthly for treatments abroad. This is because health professionals are leaving the country for greener pastures, reducing the number of personnel available for a country with 250 million citizens.
Factors responsible for such migration include:
low wages and few incentives
poor working conditions
inadequate management support
limited access to good technology
In 57 countries worldwide, there are critical shortages of health workers. The estimated global deficit is 2.4 million doctors, nurses, and midwives, with many of these shortages in sub-Saharan Africa.
How Can We Improve Healthcare in Africa?
Eighty-three companies across Nigeria, Ghana, Kenya, and Uganda raised 36% of external funding in the African health sector, according to Salient Advisory’s June report. This validates the presence of innovative ideas geared toward solving existing problems.
Since African investors led 58% of this funding, exploring other solutions to support the emerging talent and money pool becomes necessary. Therefore, the following are possible solutions to the healthcare problems in Africa.
1. Universal Health Care:
In recent years, strong economic growth has reduced Africa's poverty to 43% of the population. But with the population projected to reach 2.5 billion by 2050, it becomes necessary to achieve Universal Health Coverage targets by 2030 as the World Health Organization outlined.
Countries that achieve UHC will:
eliminate preventable maternal and child deaths
strengthen resilience to public health emergencies
reduce financial hardship linked to illness
enhance the foundations for long-term economic growth
UHC ensures easy access to healthcare without financial constraints and is vital to actualizing the World Bank’s goal of reducing the percentage of people living in extreme poverty to a maximum of 3% by 2030.
The World Bank's strategy includes:
increasing investments in affordable, quality primary healthcare
working with the private sector to unlock new models for health financing and delivery
using the Human Capital Project — a global effort for better investments — to improve health outcomes and support communities
2. Health Insurance
As of 2019, out-of-pocket expenditure in sub-Saharan Africa was 29.98%. In comparison, out-of-pocket expenditure in the European Union in the same period was 15.50%.
With 10.7% of households spending more than 10% of their non-food consumption expenditure on OOP healthcare payments and 2.6% spending beyond 20%, introducing health insurance ensures families can access healthcare when needed without having to choose between necessary amenities and their wellness.
3. Friendly Private Sector Policy
In 2018, Nigeria allocated 340.456 billion of the total 8.612 trillion to healthcare — a 3.95% allocation which is far off the 15% agreed upon at the April 2001 Abuja Declaration on health. It’s therefore evident that bridging the gap in current health coverage and financing needs requires the active participation of the private health sector.
Thus, African governments need to be more welcoming of innovative ideas by implementing policies to support and encourage healthcare founders. In Nigeria, Ghana, Uganda, and Kenya, regulators have taken steps to ensure consumer safety. For example, Ghana created the National Electronic Pharmacy Portal, a centralized e-pharmacy platform to monitor online pharmacy transactions.
With developments such as the CapitalMed Medical City in Egypt and the construction of four regional and two general hospitals in the Ivory Coast, there’s a glimmer of hope for the African health sector. However, more must be done from a governmental level across the continent to ensure access to healthcare isn’t a greener pasture to seek in countries abroad.
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References: (click the arrow to expand)
Akazili, J., Ataguba, J. E., Kanmiki, E. W., Gyapong, J., Sankoh, O., Oduro, A., & McIntyre, D. (2017). Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana. BMC international health and human rights, 17(1), 13. https://doi.org/10.1186/s12914-017-0121-7
AbdulKhaliq Akinwunmi is a marketer and writer based out of Lagos, Nigeria. He is a contributing writer at the International Youths Organization for Peace and Sustainability. He also helps Famasi Africa build the future of care by simplifying medications.
Edits and inputs by Aswin Raghav R.