Major Challenges Facing Africa Health Care

Everyone has a right to decent and effective health care without facing financial ruin. Despite Africa bearing only 17 per cent of the world population, the continent accounts for 23 per cent of the total global diseases and only three per cent of the world’s health workers. This not only shows how weak the health systems are but also shows how the region’s healthcare remains the worst in the world. Various epidemics have consistently disrupted and overwhelmed the continent. Contagious and infectious diseases like Malaria, Tuberculosis and HIV/AIDS have time and again exposed the weak foundations of the health care delivery system. Malaria and HIV/AIDS is said to cause 69 per cent of deaths in Africa.

Even with tangible improvements in reduction of maternal deaths, of the more than half of women who die daily due to pregnancy and childbirth-related complications, half of these are from Africa. According to the World Health Organization (WHO), the risk of a child dying before five years in Africa is eight times that of Europe with five children under age five dying every minute in Africa. In recent years, the Ebola crisis and the response in West Africa have shone a light on Africa weak health systems. According to experts, the vulnerable Africa health systems are as a result of years of under-funding, weak leadership and management, among other factors.

Here is an overview of the seven significant challenges facing the African healthcare sector

High Cost and Lack of Access

When it comes to demand for medical facilities and medicine, Africa has very high demand. The continent bears more than a quarter of the global disease burden. Unfortunately, health care facilities are limited or exist in inaccessible locations. Data shows nearly half of deaths in Africa could have been avoided if people accessed medical emergency in time. A good example has been in the rural and remote areas, where people are forced to travel a long distance to reach a medical facility. This lack of transportation, bad roads, high cost and lack of doctors contribute to the loss of many lives.

In urban areas where medical facilities exist or are near, the high cost of healthcare makes patients bypass critical primary or preventative care. Often, drugs prices are always going up, making it near impossible to access medications or follow medication regimes that help overcome patient’s health conditions. Increased out of pocket drug costs have hindered many from seeking required medical treatments.

The lack of medicine price standardization means more people will continue to pay more for their drugs as charges are often hiked. This high cost of drugs creates a bigger problem in the health care system as patients who don’t take the required medication run the risk of getting sicker, which increases the medical costs.

Lack of Human Resources

There is a severe shortage or lack of specialists in Africa hospitals. In most African hospital’s patients are forced to queue for long hours before seeing a doctor. This deficit of health workers in hospitals is caused by under-funding in the education and training system, doctors migrating to other continents for better pay, change of career to better paying one and early retirement or deaths.

The weak healthcare education system is said to be a larger contributor to this acute shortage of health workers. Currently, Africa is said to have just 170 medical schools serving 47 countries, with about 10000 estimated to graduate each year. Of the 47 countries, six have no medical schools, and 20 have just one medical school.

Data shows that Africa has just one doctor for every 5000 people. For the provision of quality health care, the World Health Organization (WHO), recommends a ratio of 1:1000. But for countries like Kenya, the situation is dire. To fill gaps in the Kenyan hospitals, the government imported 100 specialized doctors from Cuba in 2019 and sent 50 doctors to Cuba for specialized treatment.

Currently, the country doctor to patient ratio is 1:6100, six-time more than WHO set standard. Only 7,333 are registered doctors in Kenya, and of this, 2,089 are specialist doctors. WHO says Kenya needs at least 63,000 more health workers for its 47 million and growing population.  

Corruption 

 The level of corruption and embezzlement of public funds in Africa is damning, and nearly all sectors of the economy are affected. However, this plaque has hit the health sector the hardest making it a significant barrier in providing high quality services. Globally, the health care sector accounts for 11 per cent of the worldwide gross domestic product, according to the World Bank.

Nepotism, bribery, kickbacks, exploitation, extortion and grant graft have all become part and parcel of the sector. Billions that could help avert thousands of deaths and help African countries from over-relying on foreign aid are lost to corruption. Funds allocated for construction or upgrading or equipping of healthcare facilities find their way into the pockets of greedy and corrupt politicians, health administrators and providers or suppliers’ providers.

Equipment has been stolen from hospitals and free lifesaving public medicines diverted to private hospitals and pharmacies and sold at exorbitant prices. Reports of irregularities in procurement or illegal awarding of contracts for medical consumables and equipment or payments of good and services not offered are exposed daily. In public hospitals, doctor’s absenteeism, late arrival and early departure from work denies many essential services and often leads to avoidable deaths.

There have been measures to detect, prevent or control corruption in the sector for many African nations. However, corruption has been near impossible to tackle.

Fake drugs

The high cost and lack of affordability of medicines in hospitals have seen the region become a playground for business people to sell fake and counterfeit drugs. Daily, counterfeit drugs are trafficked from Europe, India and China to Africa. While the demand for medicines is high, only three per cent of medicines in the market are produced in Africa.

Studies say Kenya, Nigeria, Togo and Benin are large consumers of these fake and counterfeit medications. Fake drugs mainly in the market include anti-malaria, inflammatory and antibiotics and recently cancer drugs. In the absence of quality and affordable drugs, people in Africa turn to cheaper counterfeit products readily available in the market.

Word Health Organization says that hundreds of thousands in sub-Saharan die each year because of fake and low-quality medicines. The study has shown these drugs are ineffective, toxic and patients who use them to develop immunity for genuine medications, especially for diseases like malaria and tuberculosis.

The counterfeit drug market is very lucrative, according to WHO. Annually, the industry makes $200 billion. Experts say the counterfeit products will continue to have devastating effects on people and the health care sector at large due to lack of regulatory system and political will power by African governments.

Lack of government funding

One of the biggest challenges of the health sector in Africa has been a lack of government financing. The scale and severity of this role are seen in the fact that in the 2001 Abuja Declaration, African countries pledged to spend at least 15 per cent of their annual budgets on the health sector.

Yet, almost two decades later, only Rwanda, Niger, Zambia, Botswana, Malawi and Burkina Faso have attained or gone past that target. Even the 15 per cent target would still not help in countries where the per capita health expenditures, averaging between $20 and $25, fall way below the $40 per capita recommended by the WHO.

The failure to attain such a target twenty years later shows how little African governments prioritize healthcare. Such under-funding has led to a myriad of challenges across all levels of the healthcare system, including poor and scarce healthcare infrastructure, under-staffing, low investment in training and research.

Other problems include a lack of mitigation plans in cases of outbreaks, under-staffing, and low salaries for health works, often leading to industrial action.

Over-reliance on donors

The problem of low government funding brings about another major challenge that of over-reliance on foreign aid. While the presence of donor backed programs has helped prevent a dire situation from being any worse, it has remarkably failed to make significant strides on the overall state of healthcare. The over-reliance on the donor funds has mostly contributed to this lack of progress.

Firstly, many governments tend to cut funding on areas supported by donor funds, thereby stretching further an already thin budget. It also means the country does not get to develop capacity in these areas relying on expertise and funding provided by the donors.

In instances where donor funding or donor services have ceased, a crisis happens as the country is hardly prepared to transition from reliance on donor funding to self-sufficiency. A recent example is the withdrawal of the US-funded PEPFAR program from supporting blood transfusion services. The removal has exposed the lack of structures from a legal guideline to a supporting budget by the government authorities. In 2016, for instance, the Kenyan government contributed to only 16 per cent of the budget for blood transfusion services. These huge gaps in resources and operational framework that need government address will contribute to the loss of more lives before matters are sorted.

Other negative effects that come with such a reliance on donor funding is that donors determine the course and conditions of the financing. This means donors largely control the countries’ healthcare priorities and sort out some health issues while other areas suffer from negligence. 

Tradition, Culture and Lack of Faith

It’s not a secret that Africans lack faith in their health systems and that this mistrust and suspicion didn’t start yesterday. For years now, doctors and hospitals credibility in the eyes of the public has been eroded. The main reason has been the failure by the healthcare delivery system to offer safe, affordable or reliable healthcare.

From overcharging to misdiagnosis, discrimination, negligence and exploitation. Hospitals are seen as businesses interested only in profits.

This distrust or lack of confidence in the healthcare system during infectious diseases outbreaks like Ebola has seen many people intimidate, shun or chase away health workers, spread false information or create a hostile environment for people to seek care. During vaccinations, parents hide their children or close doors because they don’t trust health workers.

But for thousands of other Africans, this is different. Their culture, tradition or faith don’t permit them from seeking medical intervention. Their beliefs lie only on traditional healers seen as legends and are majorly consulted.

Conclusion 

Improving healthcare standards in the continent is an essential element for development in Africa. It’s also crucial to the attainment of Sustainable Development Goal 3. A robust health care system is vital for a reliable workforce and sustainable economic growth. Sound health systems are well-financed by their governments, provides high quality health services, have enough human resource and facilities and medical supplies are always available and provides universal health insurance. Several countries have made remarkable progress. However, many are still playing catch up while lack of political will is derailing efforts to achieve the health targets envisioned in SDG3. 

 

 

 

 

 

 

 

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