Challenges in African Healthcare Delivery Part 1 – An Introduction

In 2007, the WHO produced a framework for healthcare systems; they described 6 pillars which are as follows:

1. Service Delivery

2. Healthcare Workforce

3. Health Information Systems

4. Medicines and Technologies

5. Financing

6. Leadership/Governance

Currently in most African countries there are structural issues in all of these pillars. To begin to purposefully and intentionally work to strengthen African healthcare systems, these six areas are what we need to focus our attention on.

In a study published in 2019 aimed at identifying challenges in African healthcare systems some of these issues were raised. This study was done by Oleribe, Momoh et al. at the African Epidemiological Association Meeting. It was a Brainstorming Session with 10 groups of 7–10 participants from 11 African countries, Cuba, Portugal and the UK.

Key challenges identified:

1. Inadequate Human Resources

2. Inadequate budgetary allocation to health

3. Poor Leadership and Management

Let us look at these a bit more in-depth as they are some of the pillars that WHO described. We will review the other pillars in detail in next week’s article and in future articles we will discuss potential solutions.

It is impossible to look at the African healthcare landscape and not remark on the vast shortage of Human Resources. Many African doctors and nurses have felt they had no option but to go abroad to Europe or the Americas to seek better working and family lives than currently provided in Africa. There also many African healthcare professionals who have stayed but feel unable to perform to their maximum potential because of systemic failings.

We need to fix this. I have spoken to many doctors and nurses who would love the opportunity to come back to Africa to contribute their quota on a recurrent temporary or permanent basis if there was an appropriate system for them. I also have met very talented doctors and nurses still in the country who are ready and willing to do their jobs to the best of their abilities.

We need to build the infrastructure that will encourage our talent to stay or come back. And we need to pay them well for their work.

We live in a global village people reasonably expect good pay for their good work. We cannot continue to expect that healthcare workers and their families live on a comparative pittance whilst expecting to attract them back to Africa. However, it is not all about money. It is also about supporting and empowering Africans to turn their creative and innovative talent towards restoring the broken pillars of our healthcare systems.

The demand is there for doctors of all specialties, nurses, physiotherapists, radiographers and other allied healthcare workers to stay or come back to Africa to work. However, we need to answer that demand with the infrastructure and funding so that they feel comfortable leaving the relative security of the western economies to come home to join the effort and build our African healthcare systems.

Very few countries in sub-Saharan Africa are able to spend the $34–40 a year that the WHO considers the minimum for basic healthcare. Money for African healthcare comes from three main sources:

1. Government Budgetary Allocation

2. Private investment and spending

3. NGO and charity funding

In Africa, we are overly reliant on the NGO and charity sector to solve many of the systemic issues in our healthcare delivery and this needs to change. In fact it has been donor attention that has led the successful efforts to fight HIV/AIDs, Tuberculosis and Malaria. Yes we need the NGO and charity sector but to support not to be the main drivers.

We need to focus on encouraging a consistent and systematic increase in the healthcare budgetary allocation by the governments of each African country. This needs to be disbursed effectively and free from the drain of corruption.

We also need Private investment. Banks, venture capitalists, private equity funds, angel investors, high net-worth individuals; we need you all. It is my hope and belief that African public – private partnership is what is ultimately going to fund the transformation we seek in African healthcare delivery.

Finally, we look at poor leadership and management. This issue always comes up and it is true that for many years, there has been a chronic paucity of good leadership and resources have been squandered however, things are changing.

I have had many encouraging conversations with individuals from the grassroots to the corridors of power and I know that healthcare is now firmly on the agenda. There is an ongoing change in the guard and new and effective leaders are taking their places in all countries across the continent. It might take a while to see the benefit but I am confident that over the next ten years, the African healthcare space will be greatly altered for the better.

This week on my podcast, I will be discussing some of these issues with a very clever lady, Dr Mary Balogun, Consultant in Community Medicine & Occupational Health at the University College Hospital, Ibadan, Nigeria. She is a seasoned consultant, a senior lecturer and researcher with over 20 years experience as a physician, I am very looking forward to learning from her vast professional wisdom and experience and I hope you will listen and join the conversation.

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