Globally, institutional capacity in public health care systems, law enforcement and regulatory agencies, as well as the capacity of the state to commandeer production of essential goods and services, has become decisive interventions in this pandemic.
In March, Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), called on African leaders to take seriously the threat from the virus.
“Africa should wake up, my continent should wake up,” the Ethiopian, the WHO’s first African head, said.
African leaders are getting a wake-up call that they must fix their healthcare systems as a result of flights grounded and countries across the world on lockdown in the wake of the Convid-19 pandemic. Millions of dollars have also poured in from wealthy individuals and corporations to countries on the continent to fight the deadly virus Covid-19.
Most of African central banks have joined the global wave of emergency meetings and unusual measures to cushion their economies against the impact of the coronavirus pandemic. While many of the central banks in the region target inflation and have to prop up volatile currencies, they have also used non-traditional policy tools in addition to aggressively cutting interest rates to salvage economic growth and encourage more lending to consumers and businesses.
Nations on the continent, such as South Africa declared a national state of disaster, Ghana sets aside the local-currency equivalent of $100 million to combat virus-driven contagion and Kenya’s central bank dropped charges on mobile-money transactions to curb the use of cash for hygiene reasons.
In March, monetary policymakers in Mozambique reduced reserve requirements to boost liquidity, and those in Nigeria announced measures, including the extension of a moratorium on principal debt repayments.
The Ivorian Prime Minister recently announced an action plan of CFA1, 700 billion (about $2.9 billion) to slow down and mitigate the impact of the coronavirus on the country’s population and economy. In order to help the continent cope with the pandemic, Abiy Ahmed, Ethiopia’s Nobel Peace Prizewinning prime minister, called on G20 countries to extend Africa a $150bn aid package.
Africa’s health system trial
Kenya is one of the countries showing interest in improving its healthcare. As Specialty professions increase, so will its improved access to medical care among Zambians. Given the country’s economic prosperity which has been enjoyed from time immemorial, the government in South Africa ensures its citizens get top-notch healthcare. Rwanda is a country with the most sought-after healthcare system in Africa. The challenges related to leadership and governance; health workforce; medical products, vaccines and technologies; information; financing; and service delivery.
Even though effective public health interventions that could have prevented most of deaths exist, coverage is low due to weak and under-resourced health systems. Some of the weaknesses can also be attributed to challenges related to leadership and governance; health workforce; medical products, vaccines and technologies; information; financing; and services delivery.
Fundamentally, some of the weaknesses can also be attributed to the challenges related to leadership and governance; health workforce; medical products, vaccines and technologies; information; financing; and service delivery.
The crisis has been exacerbated by inequities in workforce distribution and brain drain. Thus, the delivery of effective public health interventions to people in need is compromised particularly in remote rural areas.
Workforce shortages pose a greater threat to the development of health care systems in Africa. In order to address the shortage of healthcare professionals, especially in regions like sub-Saharan Africa.
It will take greater efforts to make nursing an attractive career, starting with appropriate training, then working conditions and pay, and retention of staff where they are most needed.
Training a doctor takes many years of tertiary and professional education, but to get to this stage personnel need to already have a robust primary and secondary education. Education systems in African countries have an impact on how effectively healthcare systems can be developed.
Africa is confronted by a heavy burden of communicable and non-communicable diseases. Cost-effective interventions that can prevent the disease burden exist but coverage is too low due to health systems weaknesses.
Then there is the strain on African health systems imposed by the high burden of life-threatening communicable diseases coupled with increasing rates of noncommunicable diseases such as hypertension and coronary heart disease. Basic sanitation needs remain unmet for many: only 58% of people living in sub-Saharan Africa have access to safe water supplies. Noncommunicable diseases, such as hypertension, heart disease, diabetes and are on the rise; and injuries remain among the top causes of death in the Region.
Out of 58.03 million people who died globally in 2005, 10.9 million (18.8%) were from the WHO African Region. The majority of deaths (64%) that occurred in the Region resulted from HIV/AIDS (19%), lower respiratory infections (10%), malaria (8%), diarrhoeal diseases (7%), cerebrovascular disease (4%), ischaemic heart disease (3%), tuberculosis (3%), measles (3%), low birth weight (2%), birth asphyxia and birth trauma (2%) and maternal conditions (2%).
There is rampant corruption in medical products and technology procurement systems, unreliable supply systems, affordable prices, irrational use, the wide variance in quality and safety. This has contributed to the current situation where 50% the population in the Region lack of access to essential medicines.
Health financing on the continent is characterized by low investment in health, lack of comprehensive health financing policies and strategic plans, extensive out-of-pocket payments, lack of social safety nets to protect the poor, weak financial management, inefficient resource use, and weak mechanisms for coordinating partner support.
In terms of health service delivery, the lack of active organisation and management of health services combined with the above indicated challenges have in tandem led to the current state where 47% of the populace have no access to quality health services, 59% of pregnant women deliver babies without the assistance of skilled health workers. In relation to water and sanitation which contribute to reducing burden of communicable diseases, 64% of the population lack sustainable access to improved sanitation facilities, and 42% lack sustainable access to an improved water source.
Conversely, there is also a dearth of information and communications technology (ICT) and mass Internet connectivity in Africa, compounded by a paucity of ICT-related knowledge and skills limiting capacities of national health management information systems (HMIS) to generate, analyse and disseminate information for use in decision-making.
Strengthening Africa’s health systems
Unfortunately, health systems are too weak to efficiently and equitably provide those interventions to people who need them, when and where needed. Though we can deliver short-term aid and try to develop innovative vaccines or treatments for these diseases, the real issue is the danger of a weak health care system. To address this, Africa must focus on building better healthcare infrastructure.
Health care administrators need to make work environments conducive to doing the job better. They should ensure that all nurses and midwives have the resources they need, such as working equipment, protective gear and social support from colleagues and significant others.
Occupational health and safety measures through adequate infection prevention and control are paramount. There is also potential for greater collaboration between regions and countries, and between public and private sectors, to share best practices.
Nurses and midwives could be supported is by giving greater value to their work. This might encourage greater numbers of people to join the profession.
There is a risk of ‘brain drain’ as the highly trained doctors see opportunities to earn higher salaries and enjoy better living and working conditions in developed countries. In order to maintain a sufficient workforce, this problem will need to be overcome, either through higher salaries and benefits, requirements to work for mandated periods after qualifying, or training an excess of doctors.
Active public health interventions must be available to curb the heavy disease burden on the continent. Fortunately, the health policy-makers know what actions ought to be implemented to strengthen health systems. However, it might not be possible to sufficiently implement those actions without a concerted and harmonized fight against corruption, sustained domestic and external investment in social sectors such as; health, education, water, sanitation, and enabling macroeconomic and political (internally secure) environment.
It the responsibility healthcare stakeholders in Africa to develop new medicines to treat disease, but these medicines are inadequate if they can’t get to the patients who need them most. Healthcare players should work together with all other relevant stakeholders by moving away from simply providing aid, to building sustainable infrastructure that can ensure needed therapies are available in even the most remote areas.
For Africa to be a resourceful and wealthy, various countries on the continent must prioritise their healthcare systems. Everyone should have access to good health, no matter where they live.
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