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The future of health care in Africa

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Lola Dare
Lola Dare
Lola Dare
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Eric Buch at University of Pretoria
Eric Buch
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Abstract

Depends on making commitments work in and outside Africa A s the group of eight leading industrialised nations (G8) meets for its summit at Gleneagles, Scotland, next week Africa is at a crossroads. It faces a double edged crisis: its healthcare workforce is rapidly depleting, and its health systems are weak, fragile, and hanging on a precipice. A direct consequence of this is that the indicators for health development in the continent are dismal. About one in six African children die before their fifth birthday, with half of these dying from diseases preventable by vaccines; and one woman dies every two minutes from complications of pregnancy and delivery.1 From all such indications and current evidence, it would appear that very few countries in the continent will achieve the millennium development goals.2 The goal to reduce deaths among children aged under 5 (figure) is just one example. Progress in reducing mortality in children aged under 5 years, comparing sub-Saharan Africa with low and middle income countries in the rest of the world. Red represents sub-Saharan Africa, blue low income countries, green middle income countries (with solid lines indicating path to goal, dotted lines progress to date, and dashed lines projected progress at current rate) Chronic underinvestment, interventions by global partnerships that focus only on single diseases, and sporadic financing by both national governments and their partners have left African health systems prostrate. They are unable to deliver drugs, tools, and …
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The future of health care in Africa
Depends on making commitments work in and outside Africa
A
s the group of eight leading industrialised
nations (G8) meets for its summit at
Gleneagles, Scotland, next week Africa is at a
crossroads. It faces a double edged crisis: its healthcare
workforce is rapidly depleting, and its health systems
are weak, fragile, and hanging on a precipice. A direct
consequence of this is that the indicators for health
development in the continent are dismal. About one in
six African children die before their fifth birthday, with
half of these dying from diseases preventable by
vaccines; and one woman dies every two minutes from
complications of pregnancy and delivery.
1
From all
such indications and current evidence, it would appear
that very few countries in the continent will achieve the
millennium development goals.
2
The goal to reduce
deaths among children aged under 5 (figure) is just
one example.
Chronic underinvestment, interventions by global
partnerships that focus only on single diseases, and
sporadic financing by both national governments and
their partners have left African health systems
prostrate. They are unable to deliver drugs, tools, and
other interventions of proved effectiveness against the
leading causes of early death and illness throughout
the continent. The apparently unabating national and
household poverty in Africa is widely debated, and yet,
despite the substantial growth in the global economy
over the past half century, most of Africa remains poor.
The living conditions are not conducive to good
health, and people are without access to the
inexpensive drugs and medicines that have proved
efficacious and beneficial.
3
The world can no longer
ignore Africa and its people, and commitments to
reverse this unacceptable trend are now at centre stage.
Interventions in health policy will be just as important
as efforts to move forward Africa’s social and economic
development agenda.
The diversity and complexity of healthcare
systems in Africa mean that mag ic bullets or “one size
fits all” approaches are doomed to fail. Such
approaches have not achieved success and, anyway,
cannot be sustained at the current fiscal capacity. Sus-
tainable financing from national budgets and real
increases in overseas development assistance to Africa
are critical if the continent is to join the rest of the
world in improving global health and continuing the
marked fall in mor tality among children since 1960
seen elsewhere.
There is strong evidence that Africa has risen to
this challenge. The health strategy of the New Partner-
ship for Africa’s Development (NEPAD) outlines
actions that are to be taken by Afr ican countries in the
renewed spirit of partnership and collaboration. The
strategy identifies key actions to strengthen health sys-
tems, improve partnership and communication with
communities, and focus local action on the leading
burdens in Africa
—
malaria, HIV/AIDS, and obstetric
emergencies. African governments have signed up to
the NEPAD health strategy,
4
and increasingly govern-
ments are allocating at least 15% of their total budgets
to health care in compliance with the Abuja target
agreed in 2003.
5
The implementation of this commitment by
African governments is being monitored closely by the
African Union, and the union has called on the
international community to fill the $19bn (£10bn;
€16bn) gap in health financing that the World Health
Organization has determined that Africa is unable to
self finance.
6
The union is also making concerted
efforts to expand the options for healthcare financing
and to engage the private sector in innovative partner-
ships that can deliver basic healthcare services to Afri-
can families and households. The Commission for
Africa, consulting widely on health issues, heard the
voice of the continent. It is not surprising, therefore,
that the commission’s report has much in common
with the key regional strategies within Africa to
improve health systems and outcomes.
Year
Source: World Bank
Deaths per 1000
1990 1995 2000 2005 2010 2015
0
100
150
200
50
Path to goal
Sub-Saharan Africa
Low income
Middle income
Projected progress at current rate
Progress to date
Progress in reducing mortality in children aged under 5 years,
comparing sub-Saharan Africa with low and middle income countries
in the rest of the world. Red represents sub-Saharan Africa, blue low
income countries, green middle income countries (with solid lines
indicating path to goal, dotted lines progress to date, and dashed
lines projected progress at current rate)
Saturday 2 July 2005
B
MJ
BMJ 2005;331:1–2
1BMJ VOLUME 331 2 JULY 2005 bmj.com
The report of the Commission for Africa has tried
to chart the way forward, calling for an additional
increase in overseas development assistance of up to
$25bn a year by 2010, and a further investment of the
same amount by 2015, subject to a review of progress.
The report provides bold and innovative targets to
which members of the G8 and others are expected to
commit at their summit this week. The report is
labelled by some the Marshall plan for Africa, a
reference to the European recovery programme
followed by the United States for the reconstruction of
Europe after the second world war and named after
the former US secretary of state George Marshall.
The commission’s report rightly identifies strength-
ened health systems, good governance, peace, and
security as central to the efforts to stem Africa’s down-
ward spiral. It also acknowledges the importance of
partnerships supporting pan-African institutions and
regional organisations, and a framework that recog-
nises the need for partners to respond to both regional
and national priorities. The commission urges that
immediate attention is given to the deficits in Africa’s
health workforce, information and management
systems, and essential medicines and other health
commodities; it also highlights the need for invest-
ments to follow the NEPAD health strategy and invest
in regional institutions.
Health workers comprise the core of the healthcare
system in Africa. Several groups have called on the G8
to invest in Africa’s efforts to stem the brain drain and
to produce the right multidisciplinary workforce to
improve the performance of health systems and meet
regional and global targets for health. Africa does not
simply need more health workers; inv estments must
also help to increase the motivation, retention, and
accessibility of the workforce to make a real difference.
Regional cooperation is crucial to solving the human
resources crisis. This could include support for “brain
sharing” between the nations in the region that produce
health workers, such as South Africa and Nigeria; nego-
tiation of expansion in fiscal space (the flexibility of
financial management often restricted by conditions of
loans and grants) in national budgets; and technical
cooperation in medical education and training.
In addition, many public-private par tnerships in
Africa are starting
—
with variable success
—
to expand
access to medicines, health commodities, and services.
This expansion includes franchising of health services,
outsourcing, and cooperative arrangements for pooled
procurement and distribution of medicines and other
commodities. Such models may be useful, but to
sustain any initial gains and reverse the continent’s
poor record on health and development, African insti-
tutions will need global support to track achievements;
learn lessons; document success; produce and manage
knowledge; and share vision and experiences.
As the leaders in the industrial w orld meet this week
to focus on Africa and deliberate on its future, they must
go beyond the traditional strategy of counting numbers
and examine the critical shifts in thinking that are
required to make any greater investment succeed and
mov e the continent forward. Increasingly , that success
will depend on partners being willing and able to
respond to the priorities of national governments and
regional institutions in Africa. The commitments are
pouring in, and Africa is once again the focus of global
attention. But much still needs to be accomplished.
Lola Dare executive secretary
African Council for Sustainable Health Development (ACOSHED),
29 Aare Avenue, New Bodja Estate, Ibadan, Oyo State, Nigeria
(L.Dare.acoshed@yahoo.com)
Eric Buch health adviser
New Partnership for Africa’s Development (NEPAD), Midrand,
Pretoria, South Africa
Competing interests: None declared.
1 Unicef. The state of the world’s children: childhood under threat. New York:
Unicef, 2005.
2 Hecht R. Achieving the health mid decade goals—investing in health. Forum 6,
Global Forum for Health Research, 12-15 November 2002, Arusha, Tan-
zania [conference presentation].
3 Commission for Africa. Our common interest. London: Commission for
Africa, 2005.
4 New Partnership for Africa’s Development. Health strategy. Midrand:
NEPAD Secretariat, 2003.
5 African Union. The Abuja Declaration on HIV/AIDS and other related infec-
tious diseases. (At the African Summit on HIV/AIDS, TB and other related
infectious diseases, Abuja 26-27 April, 2003). www.uneca.org/adf2000/
Abuja%20Declaration.htm (accessed 27 Jun 2005).
6 African Union. Decisions and declarations. Decisions on the interim report on
HIV/AIDS, tuberculosis, malaria and polio. Assembly of the African Union,
4th ordinary session, 30-31 January 2005, Abuja, Nigeria. Addis Ababa:
African Union, 2005.
Stopping Africa’s medical brain drain
The rich countries of the North must stop looting doctors and nurses from
developing countries
A
frica will be the major focus of the G8 summit in
Gleneagles next week, and rightly so. Nearly 11
million children aged under 5 years are dying
every year worldwide from treatable diseases. Most of
them are living in developing countries, with more than
four million of these deaths in sub-Saharan Africa.
1
Along with the disastrous effects of warfare, HIV/AIDS is
wiping out young adults and leaving frail, malnourished
children in the care of their siblings and grandparents.
It is difficult to see how the countries of sub-Saharan
Africa can dev elop economically and politically when
such large proportions of their adult populations are liv-
ing with chronic diseases such as HIV/AIDS, tuberculo-
sis, malaria, and other tropical diseases. Antiretroviral
drugs could make a dramatic difference, and so could
appropriate aid. Although the dev eloped countries of
the North are giving aid with one hand, they are robbing
African countries with the other by siphoning off their
most precious resource
—
trained doctors and nurses.
The Commonw ealth’s developing countries are particu-
larly hard hit because their health professionals speak
English and are therefore a valuable commodity to plug
manpow er gaps in the United States, Canada, the United
Kingdom, New Zealand, and Australia.
Editorials
BMJ 2005;331:2–3
2 BMJ VOLUME 331 2 JULY 2005 bmj.com
... Furthermore, there is here an opportunity to capitalise on this real need for one (s) who would like to invest into a sort of African 'Healthcare Corps' (AHC), in order to make it possible for Africans to have some recourse, and an effective one at that when plagued with sickness (Karar & Kuhnert, 2017;Letiche, 2010;Naidoo et al., 2017). Too many Africans lack any sort of system even germane to this today (Dare & Buch, 2005;Okumu et al., 2017); and for a continent the size of Africa, with a diaspora and natives equipped with the skills, talent, and financial power the sort of which Africans dispose, there is an opportunity for Africans to start thinking, themselves, of a solution, entrepreneurial as it may be (Frese & Friedrich, 2002) to a problem that is only causing too many ravages in a continent many increasingly consider to be one of the richest in the world, even if only because of the undisputed rich talent pool with which it is endowed (Robson, Haug, & Obeng, 2009), its natural resources and especially, its plethora of potent medicinal plants (Agostini-Costa, 2018;Ahmed et al., 2018;Akharaiyi et al., 2017;Ben-Arye et al., 2018;Haile et al., 2017;Karar & Kuhnert, 2017;Kpobi et al., 2018;Maema, Potgieter, & Mahlo, 2016;Miara et al., 2018;Naidoo et al., 2017). ...
... The purpose of engaging in an endeavour of this study is first to contribute to the nascent body of knowledge on entrepreneurship in Africa (Frese, & Friedrich, 2002;Robson, Haug, & Obeng, 2009) but also to draw attention on the lack of a functional healthcare in the continent (Agostini-Costa, 2018;Baylies, 1986;Dare & Buch, 2005;Okumu et al., 2017;De Prince Pokam & Hall, 2011). ...
... Given the preceding, it is appropriate to engage in a serious reflection on African healthcare, especially because the dismal condition of HS in Africa can no longer be ignored (Dare & Buch, 2005;Haile et al, 2017). A look at the prevailing Healthcare conditions in Africa hereafter depicted, would persuade many about the importance of serious intervention in the healthcare field, the following list being by no account exhaustive: (1) Alienated from their traditional medicine, Africans have been left without a real replacement on which to turn in case of need, depriving them from a Healthcare backbone (Ahmed et al., 2018;Challand, 2004); (2) in other words, the current HS in many African countries can be defined as inadequate at best (De Prince Pokam & Hall, 2011) or fragile (Dare & Buch, 2005;Okumu et al., 2017) and in shamble at worse (Feierman, 1985), as it witnessed rates (a) as bad as over 10,084 patients per physician in 2005 to a growth of nearly 15,000 patients per physician only in a matter of four years later, in Cameroon only (De Prince Pokam & Hall, 2011);(b) and numbers suggesting about 20,000 patients per physician in Ghana; (c) or even 100,000 per physician in the same country, in rural regions (Hill et al., 2014); (3) this led to a high infant mortality rate the like of which still exists in Africa only: (a) In Ghana, for instance 1 in 66 or 15 out of 1000 babies born die (Hill et al., 2014) before they have reached their first year (Fetter, 1993); (b) in 2011 for Liberia, this number, i.e. the infant mortality rate, was between 57-110 out of 1000 compared to only 8 out 1000 deaths in the US (Kruk, Rockers, Kruk, 2011); (c) some advance the number of 200 deaths per 1000, when applied to the African continent in general (Fierman, 1985). ...
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Purpose: Doctors play a critical role in providing nutrition care and supporting patients to adopt healthy dietary habits. Improving the quality of nutrition education in medical schools is necessary to build the capacity of doctors to deliver effective nutrition care to help reduce malnutrition especially for sub-Saharan Africa. This study investigated Ghanaian undergraduate clinical level medical students’ satisfaction with their current nutrition education, preparedness to provide nutrition care, perceived relevance of nutrition education to their future practice and their relationships. Method: A survey among 207 clinical level medical students was conducted. An 11-item questionnaire with subscales was used to assess students’ demographic characteristics, satisfaction with current nutrition education, preparedness to provide nutrition care and perceived relevance of nutrition education to their future practice. Results: Ninety-two percent (n=187) of the students considered nutrition education to be relevant to their future practice. However, the majority of the students (70%) were dissatisfied with the amount of time dedicated to nutrition education in their curriculum; integration of nutrition into organ-system based modules (62.0%); inclusion of nutrition materials to promote independent study (62.8%) and nutrition course content (59.0%). Only 22.2% felt adequately prepared by their current nutrition education to provide nutrition care in the general practice setting. Satisfaction with current education in nutrition was positively related to students’ preparedness to provide nutrition care in the general practice setting. Discussion: Students were dissatisfied with their current education in nutrition, felt inadequately prepared to provide nutrition care and considered nutrition education to be highly relevant to their future practice. The findings of this study provide additional evidence that suggests changes in the current format and content of nutrition education in medical education.
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... Two-thirds of the world's population lacks adequate access to medical imaging [11], and because of financial constraints and infection risks, there is often no access to invasive monitoring [12]. Even more basically, regular access to potable water and electricity cannot be guaranteed in the capital cities of many developing countries and even less so available in rural areas, which house up to 80% of the population [13]. A reliable oxygen supply remains a critical problem for hospitals in developing countries, and lack of oxygen is still a cause of death in Africa, including some capital cities [14]. ...
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