Healthcare Systems and its Challenges in Africa

Hawa Abu, MD PhD MPH and Jafaru Samuel Abu, MBA, MSc, CNA

Landscape and Historical Background of Healthcare in Africa

Africa is the second largest continent in the world (after Asia) with an estimated population of 1.3 billion and a broad range of physical geography with four main regions: North, West, East, and South Africa. There are 54 African countries with their respective political systems, economic development trajectories, varying social practices, and cultural diversity with over 3,000 distinct ethnic groups.

Throughout African history, healthcare has largely evolved with complex and diverse perspectives shaped by a myriad of factors including indigenous healing practices, colonial influences, global health initiatives, and ongoing efforts to address deeply rooted systemic challenges, with the goal of providing affordable, accessible, and equitable healthcare for all. In the pre-colonial era, indigenous/traditional healing practices were well-established in African societies and rooted in spiritual beliefs, herbal medicine, and community-based care delivered by traditional healers. Although the Westerners had the belief that African traditional medicine was primitive and non-scientific, most parts of Africa have preserved their traditional healing practices to date. During the colonial era in the late 19th to mid-20th century, Western medicine was introduced by the ruling countries (Britain, Belgium, France, and Portugal), which mostly served their administrative and economic interests with very basic infrastructure and a focus on controlling the spread of infectious diseases among colonial masters and the African labor force. The advent of missionaries in Africa promoted healthcare development with the expansion of infrastructure including hospitals and medication dispensaries, training local healthcare workers, and executing disease control programs. In the post-colonial era (mid-20th century), many African countries had gained their independence, and efforts were geared towards developing national healthcare systems. However, systemic challenges including political instability, limited resources, and disparities in healthcare access have persisted across the continent. In 1978, the Alma Ata Declaration, by the World Health Organization (WHO) provided an important global initiative toward primary healthcare with an emphasis on communitybased participation, improved healthcare access, and integration of traditional and modern medical practices, which was widely accepted with varying implementation strategies across Africa.

Challenges of the Healthcare Systems in Africa

The obstacles to healthcare in Africa are multifaceted ranging from the limited workforce and health information systems to inadequate governance and insufficient healthcare budgetary, with varying extent across the respective African countries. However, common issues persist as follows:

The initial and most crucial challenge faced by the African healthcare system was the HIV/AIDS epidemic (1980s-1990s) which had a profound economic and social impact. Efforts made to address the epidemic included support from international aid and partnerships, NGOs, and donor countries to promptly develop infrastructure for early disease detection and initiation of antiretroviral therapy. Although there has been a remarkable decline in the incidence of HIV/AIDS, emerging health threats such as the Ebola crisis (2014-2016) and the COVID-19 pandemic have emphasized the inadequacies of the healthcare systems in sub-Saharan Africa; such as inadequate emergency response plans and strategies, poor access to healthcare, lack of medical supplies and equipment, poor integration of traditional healing practices and modern medicine as many families seek help from African traditional healers before presenting to a clinic/hospital, and the overwhelming levels of poverty with lack of basic amenities. These issues still persist placing the African populace at a high risk of morbidity and mortality from poorly contained and managed infectious diseases.

Besides the burden of infectious diseases (such as malaria, HIV/AIDS, tuberculosis, emerging and reemerging neglected tropical diseases), most African countries are experiencing the epidemiologic transition of the high double burden of infectious diseases and non-communicable diseases (obesity, hypertension, diabetes, renal impairment, and cancers) with an increasing prevalence of multimorbidity and competing health priorities. In addition to these conditions, there are co-existing poor health indices including high infant and maternal mortality rates, putting an extra strain on the healthcare system which is already inadequately funded by the government and understaffed by healthcare providers.

Since most African countries are unable to sufficiently meet the requirements for a stable and functional healthcare system to manage the growing rates of multimorbidity, there is widespread and pervasive mistrust in the broken-down and overburdened healthcare system which has facilitated medical tourism. Sadly, this has cost Africa an estimated $1 billion loss annually according to the 2015 World Bank statistics. Those who propagate medical tourism include African leaders who divert the funds meant to build the healthcare system for their personal use at the continent’s detriment.

In the last three decades, there has been a dramatic rise in the number of healthcare professionals migrating from Africa to developed nations around the world resulting in “brain drain” in the African continent. Migrating healthcare workers have left their home countries due to: very poor working conditions, inadequate medical equipment and supplies, working long and extended hours, paucity of biomedical and clinical research funding, unfairly low and delayed remuneration, high cost of living, economic and political instability, disruption in medical training, and interrupted delivery of healthcare services. These delays are caused by professional industrial action to get the attention of the government in order to address their unfavorable working conditions.

Recommendations to Overcome Healthcare Challenges in Africa

Although the challenges of the African healthcare system are complex and overwhelming, we seek solace in the African proverb, “The best way to solve a problem is to tackle it bit by bit, one step at a time”. Additionally, it is imperative that those who experience a given problem are included in the discussion, implementation, and evaluation of the proffered solutions. In April 2019, the African Epidemiological Association during their Annual Scientific (comprised of policymakers, program implementing partners, and healthcare researchers) identified strategies to mitigate these challenges of the African healthcare system. These proposed solutions included training and capacity building, providing health insurance for the African populace, advocacy and increased political engagement, increasing budgetary allocation to healthcare, improving healthcare infrastructure, and better recruitment and retention among healthcare workers. We hope these strategies are sustainable and that the African healthcare system is strengthened in the near future! +

Hawa Abu, MD, PhD, MPHAssistant Professor, Geriatric Medicine DivisionUMass Chan Medical School, Worcester MA

Jafaru Samuel Abu, MBA, MSc, CNARespiratory Therapy StudentQuinsigamond Community College, Worcester, MA