The Africa Sustainability Index, part of Roche’s FutureProofing Healthcare initiative, has highlighted the financial, political and socio-economic conditions faced by many African nations as they strive for truly sustainable healthcare systems.
The recent launch of the Africa Sustainability Index has shown the necessity of information and data-gathering; providing key insights into healthcare landscapes of 18 African countries and giving us a greater overall picture of the continent’s challenges and success stories. This wealth of data – gathered as part of Roche’s FutureProofing Healthcare initiative has highlighted the financial, political and socio-economic conditions faced by many African nations as they strive for truly sustainable healthcare systems.
The challenges are particularly relevant as African countries continue to fight for universal health coverage (UHC) and aim to meet the United Nations’ Sustainable Development Goals – even in the face of a pandemic. Yet even though these obstacles remain a major concern, African nations have been able to subvert them, often through tailor-made solutions born of cross-country thinking. At the Index’s launch in March, the same experts who helped analyse this new data also weighed in on the solutions – both potential and already in practice – that can uplift the healthcare sector across Africa.
The pandemic forced African governments to re-examine their finance models for the health sector, and now that the budgets have been allocated, the FutureProofing Healthcare African panel strongly advocate that they cannot again be reduced once the crisis has been averted. For World Bank Nigeria Health Specialist and FutureProofing expert panel member, Olumide Okunola, the current spending on healthcare across the continent should be the norm. However, it is not simply about more money flowing into healthcare systems, but rather using it intelligently to improve quality overall. Ideally this would mean more health infrastructure, but even more importantly prioritising the poorest and most vulnerable in society – both in rural and urban settings – to ensure they have access to the best possible care.
“This increase in spending should be the norm… but we also need to prepare for future epidemics involving non-communicable diseases,” said Okunola.
Okunola also noted that there was a trend towards outbreaks of disease across the continent. Prevention, he said, through awareness campaigns, medical research and health education across each country, would ultimately save countries billions with a relatively minor investment.
However, for many governments on the continent, finding the funds to finance healthcare programmes can be problematic. This extends to resource mobilization — including what portion of government budgets are allocated to and spent on healthcare — alongside out-of-pocket expenditures. This is often influenced by an individual country’s economic strength, the availability of public financing, the involvement of the private sector, and the healthcare system funding structure, and it all impacts a country’s ability to offer affordable healthcare to its citizens.
“Outside of physical facilities, it may be better to train and equip primary healthcare workers within more rural communities,” says Yaw Asante Awuku, Consultant Gastroenterologist, School of Medicine, University of Health and Allied Sciences in Ghana and a member of the FutureProofing expert panel.
For Prof Awuku, the key to delivering these services is infrastructure, which unfortunately, is sorely lacking across the continent. Where healthcare infrastructure does exist, there is generally a lack of affordable, quality facilities, not enough beds, and not enough accredited laboratories to process testing, and further research and development. The World Health Organization reported in April 2020 that there were just 2,000 ventilators across 41 African countries, and 5,000 intensive care beds across 43 of them.
But infrastructure should not be the only focus of where budgets should be allocated. Development of people is also integral. The World Bank’s research has shown that in sub-Saharan Africa, there are 0.2 doctors for every 1000 people, well below the average of 1.6. To ensure that healthcare careers are desirable, there must be an investment in training, hiring, better remuneration and insurance.
However, on a patient level, many Africans fail to seek preventative treatment for reasons outside of their control, usually due to distance from healthcare facilities, or simply a lack of money. Seth Akumani of the United Nations Development Program in Ghana and FutureProofing expert panel member believes that it will be technology at the heart of developing sustainable healthcare solutions to remedy this divide. Taking advantage of Africa’s massively growing mobile accessibility means bringing healthcare to people directly, and there are already massive mobile initiatives that reach millions of Africans and provide both medical advice and health awareness campaigns.
Limited infrastructure can also be circumvented through the clever use of digital solutions, such as the recent deliveries of COVID-19 tests across Ghana using drones – with the same systems being used for future vaccine rollouts. There is also a need to focus on the digitisation of medical records in Africa, as this is directly linked to the quality of healthcare and data gathering.
“What we don’t measure, we can’t improve. Fundamental to our ability to improve healthcare is our ability to collect quality data,” Akumani noted.
Many experts believe that health systems built around digital technology and capacity to collect – and analyse – massive amounts of data, is key to overall improvement of access to medical care. Across the continent, there have been innovative forms of preventative healthcare emerging, which might also assist in the funding issues that so many countries face.
The advent of telemedicine also allows community workers to connect to medical professionals via the internet while assessing patients and to receive guidance and instruction on what needs to be done, saving time, cost and increasing accessibility to treatment.
“Africa is conservative, it is something we have to face,” says Professor Glenda Gray, President and CEO of the South African Medical Research Council and FutureProofing expert panel member.
Access to reproductive healthcare and family planning is repeatedly failing in many African countries, based on the Index’s findings, which means that young African women are often the most affected by limited healthcare systems. Gray explained that social issues, such as teenage pregnancy are inextricably linked to poverty and illiteracy. According to Mah-Séré Keita, Director of Programs at the African Society for Laboratory Medicine and FutureProofing expert panel member, blockades to career development for African women emerge even in childhood, with the issue again tracing back to limited opportunities.
The link between a lack of education and lower life expectancy should be at the forefront of policy-maker’s mind, as this level of disadvantage has a direct result on individual health and societal issues. The somewhat limited data from certain African countries has confirmed this, which is why improving data gathering across the continent will help unearth the full extent of these worrying trends. The WHO’s report on Addressing the Challenge of Women’s Health in Africa has posited that all regions should be promoting women’s health at a legislative level. “Governments… are urged to formulate policies and enact legislation designed to bridge the gender gap and to protect women and girls in the following areas: maternal health, education and employment, and harmful sociocultural practices (such as FGM, domestic violence and human trafﬁcking),” it reads.
Another possible solution lies in the promotion of more female leaders in the African healthcare sector, and for both Keita and Gray, this is intrinsically linked to education. The same WHO report suggests that this transformation of the sector lies in nurturing young women from the earliest parts of their lives, creating policy that ensures women’s education at a primary, secondary and tertiary level.
However, for the women that do engage in healthcare careers, there is a significantly lower chance that they will be in the top positions, meaning lower earning potential and fewer opportunities to mentor and lead by example. Governments and educational institutions need to provide more for young women pursuing medical careers, and grants for female-led research should be more prevalent.
"This increase in spending should be the norm...but we should also prepare for future epidemics involving non-communicable diseases."
Olumide Okunola, Senior health specialist, World Bank, Nigeria
"Outside of physical facilities, it may be better to train and equip primary healthcare workers within more rural communities."
Yaw Asante Awuku, Consultant Gastroenterologist, School of Medicine, University of Health and Allied Sciences in Ghana
"What we don't measure, we can't improve. The future of African healthcare is in our hands."
Seth Akumani, Head of Exploration, Accelerator Lab, UNDP Ghana
"Africa is conservative, that is something we have to face."
Glenda Gray, President and CEO of the South African Medical Research Council
Dr Saber Boutayeb, Professor of Medical Oncology at the University of Rabat, Morocco, and FutureProofing expert panel member, believes that it is only through regional collaboration in Africa that true innovation and solutions to these challenges can be found. For many countries, the awareness of the importance of research and finding locally tailored solutions is already in place. Yet with the onset of the COVID-19 pandemic, regional thinking at an institutional level was brought to the fore, explained Keita.
Even the 2020 World Health Organisation’s COVID-19 response report acknowledged the ways in which continental authorities have focused on strengthening regional collaboration between all 47 African member states," added Prof Boutayeb.
The African Centre for Disease Control (Africa CDC), in collaboration with the WHO and the African Union, was responsible for establishing regional task forces with an overall responsibility for screening, detection and diagnosis, infection and prevention control, as well as clinical management of infected persons. This has already resulted in a better understanding of the disease, not just on a country-by-country basis, but within the context of a full continent. Numerous countries had also pulled together to set up the African Medical Supplies Platform, a multi-national initiative whose aim was to give Africa a better chance in the global struggle to secure enough testing kits, protective equipment and vaccines, amid the continent’s economic loss of an estimated $65 billion monthly due to lockdowns.
Even on a smaller scale, there have been several instances of African countries directly assisting their neighbours.
"We’ve seen Uganda supporting Sierra Leone in improving viral load testing and diagnostics, while contributing financial aid and implementing projects alongside the Global Fund... Yet outside of the pandemic, there remains a lack of financial and human resources to get such projects off the ground," noted Prof Boutayeb.
However, when these sorts of collaboration occur, major developments emerge shortly after, he said. Morocco’s hosting of the International Congress on Cancers in Low- and Middle-Income Countries in 2020 has already led to a phenomenal new African initiative, a programme of nationwide telepathology for consultation and cancer diagnosis. It is through the sharing of data across national borders that can also assist in an overall better understanding of disease and epidemics, allowing for better healthcare delivery on the whole.
For each of these experts, the importance of data gathering and analysis in combating the challenges faced by Africa could not be overstated. As the Africa Sustainability Index continues to grow its scale and scope, there will be further opportunities to develop new solutions, unearth new data and share insights between countries.
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