Universal healthcare is something few countries have managed to get right. The funding, logistics and skills required are extensive and implementation is downright impossible without a high level of connected infrastructure development to support this.
In Africa, all the above are a problem. As a result, universal healthcare on the continent remains a distant pipe dream.
Changing this could be transformational. Healthy and well-educated citizens lead to economic growth and development. Mark Attah, a neurosurgeon, entrepreneur and physician in the UK, recently highlighted this relationship in a Henley Business School Africa webinar looking at the prospect of better healthcare in Africa. “Health is wealth,” he said, so the question goes beyond just the ethical dimension of the right to good healthcare – it is also a matter of pragmatically promoting economic activity. In other words, it’s in each state’s interest to provide a well-functioning, universal healthcare system.
However, right now there are huge variations in healthcare offerings across the continent. Significant levels of inequality mean that some areas have pockets of excellence, as in parts of South Africa, for example, while others have next to no infrastructure or healthcare professionals to speak of.
Flavia Senkubage, the dean of the department of healthcare at the University of Pretoria, describes the architecture of healthcare in Africa as “very textured”. This, she says, is a result of levels of governance varying greatly from country to country; non-standardised information systems that make it difficult to use data analytics effectively and finance and funding being both sparse and unequal.
The funding problem is particularly painful. Not only is healthcare expensive, but as most African countries rely on donor funding, governments abdicate their responsibilities towards the sector and its citizens, instead leaving the job to NGOs and private players.
In 2019, nearly three-quarters of health spending in low-income countries was financed by out-of-pocket spending — costs borne directly by patients with no public or private insurance — and external aid.
How on earth did the continent get here? And, more important, how can it find a better way to meet the healthcare needs of its citizens?
Finding new ways to meet healthcare needs in Africa
The history of the Western model of healthcare in Africa started with missionaries. It was not free, but under the guise of spreading the word of God, healthcare was heavily subsidised, although provided at very different levels of sophistication, depending on who, and where, you were.
Today, the Western model continues to be implemented but with inherent problems. It’s challenging, and ineffective, to roll out a healthcare framework not born out of Africa’s regional contexts. Innovative solutions must be sought to match cultural traditions and meet the specific contextual characteristics of life in Africa.
For example, religion could be a vehicle for funding. As of 2020, over 650-million people in sub-Saharan Africa considered themselves Christian. Muslims amount to around 330-million and folk religions count over 33-million adherents. These are vast numbers and proof of the extensive spirituality that is important to many Africans. This support network has the power to reach to help fund healthcare in local communities.
Another possible funding model could look to the rapidly growing penetration of cellphones. Many people in Africa love to connect and communicate with each other, with the majority of people owning a cellphone, and a small tax associated with each voice call could provide a large and growing source of possible funding. If citizens would ultimately benefit from better healthcare, they would probably be open to the idea.
Innovation need not only come through pioneering new technologies, there are low-tech solutions to be considered, too. Malawi is making progress on addressing maternal mortality through the use of age-old and relatively inexpensive communication devices — walkie-talkies — to enable remote villages to call ambulances to transport pregnant women to hospitals or clinics in an emergency.
Finally, the power and immense knowledge stores of traditional healers are being recognised as important players in Africa’s healthcare stable. The World Health Organisation has produced a draft paper on utilising these often-skilled practitioners and countries such as South Africa are attempting to standardise training and provide more meaningful recognition of traditional healthcare through the Health Professions Council of South Africa (HPCSA).
An integrated approach between Western health models and traditional healers may be the solution to start to address the ineffective healthcare system in Africa.
An opportunity to rethink and reshape healthcare in Africa
As African countries seek to rebuild after the Covid-19 pandemic, which dramatically underlined the importance of a supportive and capable healthcare system to a country, the moment is right to reimagine healthcare systems that have not been working for all Africans.
Two things might make a seismic difference here. First, there may be an opportunity to tap into the knowledge, experience — and finances — of medical professionals in the diaspora who are passionate about Africa to help reshape and rethink healthcare systems. While too many such professionals have left in search of greener pastures, many are eager to find ways to contribute back home.
Second, the role of the private sector needs to be more consciously engaged. As Aliko Ahmed, a public health physician, global health diplomat and academic points out, there is a strong incentive for the private sector to get involved, not just in the provision of healthcare, but also in the training of healthcare professionals in Africa, and many private sector initiatives are already making a significant difference.
However, this must come with some provisos, most importantly a good regulatory framework to ensure quality and standards of care are met and that access to capital to allow businesses to enter this space is prioritised.
Each country would need to be intentional about its policies; the “how” of funding — where this is coming from and where it is going to — would need to be substantial and sustainable and greater coordination and standardisation will be required to provide commonality and regional support for healthcare systems. But there is power too in collaboration, in reaching beyond country boundaries.
While the challenges facing healthcare in Africa can seem overwhelming, there are many passionate individuals and organisations that are edging the system towards a better place. Finding ways to tap into and connect these innovative and hopeful initiatives might be the difference required for universal healthcare in Africa to move from pipe dream to possibility.
This article is based on a recent webinar hosted by the Dunning Africa Centre featuring expert panellists Mark Attah, Flavia Senkubage and Aliko Ahmed. To join future conversations go to https://events.africa.dunningcentre.com/
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