Why Africa needs a new approach to healthcare

While numerous investors see Africa as “the promised land”, it should be noted that we are still searching for robust, reliable and relevant systems that are capable of the effective provision of affordable, high-quality healthcare for all. And while we are finding our way, our solutions are being slowly and deliberately fashioned out of our unique and complex sets of needs and challenges.

Above that, while we are seeing a fast-growing middle class, increased consumerism and rapid urbanization, the majority of people are still living in rural areas, in deep poverty, with low levels of healthcare literacy and minimal access to care. Conflict and war, high levels of inequality and penetrating social disruption work synergistically to disempower the sick.

Additionally, there are low levels of trust in healthcare providers, which has led to the development of many parallel and often conflicting systems of care. As a result, most patients rely on word of mouth, chance and perception to choose a doctor, clinic or hospital, and they lack an effective mechanism of recourse when these providers fail them.

Africa also bears the world’s heaviest disease burden, driven by the pervasively high prevalence of diseases such as HIV/AIDs, tuberculosis and malaria. In addition, our disease profile is becoming more complex with the growth of the middle class and changing patterns of food consumption and activity.

System shocks such as the Ebola outbreak have further highlighted the lack of our ability to respond regionally to an emergent threat, which has global consequences and profound local repercussions.

An unrelenting struggle

While the continent may be rich in natural resources, we are poor in human resources. Africa faces a dire shortage of doctors and nurses, as well as a woefully insufficient pipeline of future healthcare professionals. Working conditions are harsh and sometimes thankless; remuneration levels battle to remain competitive and attractive, particularly in rural areas. Developing leadership, management and research capabilities also tends to be neglected to meet more urgent needs. Resultantly, the impact of this will be felt severely in the future, as our emergent African healthcare system starts to look to its own people for local solutions.

Despite an abundance of healthcare policies, the actual delivery of care is significantly impeded by the lack of adequate healthcare infrastructure and the presence of inconsistent and incomplete regulatory and governance frameworks.

Healthcare systems in Africa are further complicated by the sometimes opposing objectives, priorities and capabilities of the public and private sectors operating in the countries. While the public sector commonly lacks financial resources, effective operations and human resources management and strong governance frameworks; the private sector is often viewed as pursuing profit margins that are inappropriately high given the embedded social nature of healthcare.

Overall, the private sector provides approximately half of the healthcare in Africa, but quality, cost and the integration of services remain variable, as providers frequently function outside coherent, consistent and complete regulatory platforms. In many of our countries, the public and private healthcare sectors have been unable to overcome the divide between them, which is an unfortunate missed opportunity for strengthening the provision of care on the continent.

Owing to these challenges, it is unsurprising that Africa has lagged behind the rest of the world on progress on achieving the Millennium Development Goals (MDGs), although some significant gains have been made. The MDGs are set to be soon revised, when the United Nation member states meet in September 2015 to decide on the Sustainable Development Goals (SDGs), which will guide the global development agenda until 2030.

Where health is concerned, the vision for 2030 is focused on working towards healthy lives for all through the pursuit of the following goals:

• Further reducing maternal mortality rates as well as newborn and child morbidity
• Eradicating epidemics such as HIV/AIDS, tuberculosis and malaria
• Substantively reducing deaths from non-communicable diseases
• Promoting mental health
• Ensuring universal health coverage and universal access to affordable medicines and vaccines
• Providing comprehensive sexual and reproductive health services, including modern methods of family planning
• Decreasing deaths and illnesses caused by pollution and environmental degradation

Despite the inherent challenges in the systems, transformative concepts have managed to shine through and these will be critical to ensure that, by 2030, Africa reaches the goals set out by the SDGs in 2015.

It is highly likely that the next decade will witness the emergence of a new “African Model” of healthcare, which will not be constrained by the entrenched practices and structures seen in the Western world. It is also likely that this system will progress rapidly and spread extensively to meet the latent and growing needs of its people ‒ based on the provision of cost-effective primary healthcare, strong referral networks, the use of certain technologies, task-shifting and new categories of healthcare workers, training system and regional regulatory authorities. This will be critical to meet our goals and ensure that Africa’s economic growth is inclusive, sustainable and actually translates into better lives for all our people.

The World Economic Forum on Africa 2015 takes place in Cape Town, South Africa from 3-5 June. 

Author: Anuschka Coovadia, Head of Health Africa, KPMG

Image: Staff members of Teaching Hospital receive the first vaccination treatment for yellow fever in El Geneina, West Darfur in this November 14, 2012 handout. REUTERS/Albert Gonzalez