Inadequacies within the African healthcare sector have been a critical area of concern for a long time, far preceding the global health crisis. The COVID-19 pandemic has further exposed weaknesses in African economies in managing emergency health hazards and exponentially accentuated various healthcare deficiencies — from lack of medical supplies and care facilities, to inequalities in the delivery of quality healthcare services.
Due to poor health sector infrastructure in Africa, the response to the pandemic has been reactive, with countries scrambling to get systems in place to deal with the crisis. And while the extent of the COVID-19 impact was somewhat unforeseen, epidemiologists have been warning governments for years that a viral pandemic such as this was highly likely to occur.
This type of unpreparedness is simply not acceptable — both in terms of a crisis as well as for pre-existing healthcare issues. It is the responsibility of governments to put into place significant reforms that support sustainable healthcare in Africa. These reforms have to take into consideration current urgent needs, as well as address future needs based on changing socio-political factors, technological advancement, medical progress and so forth.
The following are some key considerations for policy reforms that support sustainable healthcare in Africa:
Develop emergency prepared health systems: Health systems in many African countries are ill-prepared to respond to health emergencies. Social welfare programmes should be designed to support the most vulnerable segments of the population during an epidemic outbreak. Such emergency packages warrant proper investment to ensure rapid response when disaster strikes. We live in a world of uncertainty, and emergency preparedness is of paramount importance.
Finance and resources: In the majority of African countries, there is one hospital per one million people, one doctor per 10,000 people and one hospital bed per 10,000 (World Health Organization). Conservative figures by the World Bank posit that Africa requires $100 billion to tackle COVID-19 across all sectors, excluding pre-existing healthcare needs. Swift and impactful regulatory changes are imperative to help manage the financial demands. These include improved budgeting models, public-private partnerships, investing in preventative measures, performance-based funding, revising procurement processes to be more transparent and inclusive, and developing comprehensive, sustainable health coverage schemes that are supported by the government.
Research: Data-based decision-making founded on research will pave the way for effective and results-driven solutions. The World Economic Forum states that “an emerging approach is for healthcare organizations to collect data as part of ongoing clinical care to generate data on patient and economic outcomes.” This approach has been stressed by economists and researchers, both for the development of solutions to overcome healthcare challenges, as well as for robust predictive models for future health and well-being demands.
Technology: Amid the negative impacts of COVID-19 is an opportunity to leapfrog technology and innovation in Africa. Technology has already worked well as a public health tool. Examples include the use of drones in Rwanda for blood transfusion service delivery to remote regions, the use of WhatsApp in West Africa to disseminate information during the Ebola outbreak in 2014 and the “SMS for Life”[ a programme that works to improve access to essential medicines and vaccines at the point of care, the health facility, by eliminating stock-outs first launched in Tanzania in 2019 later expanded to Cameroon, the Democratic Republic of the Congo, Ghana and Kenya] to help manage malaria treatments and stock. However, countries need to have policy frameworks in place to support emerging health technologies, particularly with the onset of COVID-19 and the vital need to track and manage this viral threat.
Education and workforce: Policy change has to start from the education sector to develop a skilled workforce to effectively manage improved healthcare systems. This includes the abovementioned technology-driven models. The healthcare sector is not exempt from the Future of Work and the Fourth Industrial Revolution progress demands, and neglecting this factor will lead to dire consequences for the already inadequate African healthcare industry.
Good governance and capacity-building: My policy brief on healthcare in Cameroon (co-authored by Rosy Pascale Meyet Tchouapi) explains that despite efforts by the government to enhance good governance and improve the performance of health systems, bad governance and corruption seem to be an issue, including in the health sector. COVID-19 and healthcare research by the African Economic Research Consortium (AERC) states that even at the early stage, healthcare effectiveness is highly correlated with the institutional strength of a country, particularly in the area of political stability and adherence to the rule of law. Hence, the road ahead points towards developing public trust in following government guidelines and overhauling healthcare financing systems, including reforming its reach to the masses and increasing readiness to deal effectively with the pandemic.
Diversify supply chains and intensify intra-African trade: The pandemic has shown that Africa faces severe shortages of medical commodities and equipment. This is an opportunity for the continent to explore alternatives to diversify supply chains in order to reduce dependency on primary commodity exports. African governments should provide support to the manufacturing sector that paves the way for the structural transformation and industrialization of economies. It is also time for Africans to think regionally and design cross-border cooperation programmes that enhance intra-African trade.
Improve health infrastructure and working conditions of personnel: Raising money to pay for healthcare delivery is a concern of African countries, but more important are questions on how to organize healthcare facilities and compensate medical personnel. Health infrastructure and wages of healthcare professionals in Africa are appalling, leading to vast brain drain in the health sector.
Mechanisms for change need to be implemented urgently and rigorously when it comes to healthcare reforms in Africa. Such measures need to be sustainable and aimed at addressing existing healthcare needs, as well as building resilience to shocks such as the COVID-19 pandemic.
Healthcare is closely linked to the economic landscape of a region. As explained by economic researcher Janvier Mwisha-Kasiwa, “Health is both a direct component of human well-being and a form of human capital that increases an individual’s capabilities and opportunities to generate income and reduce vulnerability”. This approach can be used to justify increased investment in health in developing countries.
Currently, less than five countries in Africa meet the Abuja Declaration target set 19 years ago for 15 per cent of public expenditure to be devoted to health, with COVID-19 underscoring weak health systems and fragmentation caused by vertical funding systems.
Reforms across the healthcare sector are both possible and essential for the continent, particularly as we face the social and economic aftermath (and potential resurgence) of the global health crisis.
Strong, purposeful and decisive action by leaders is critical to circumvent devastating social and economic regression.
But the good news is that positive change through policy reform and capacity-building can turn the tide and revolutionize the African healthcare landscape.