Building a resilient health system in Africa

When COVID-19 first arrived, it found health systems on the continent of Africa in a precarious place. Across the continent, governments struggled with a shortage of essential non-pharmaceutical interventions such as masks, personal protective equipment, oxygen delivery systems, lack of professionals trained in critical care, and insufficient health centers with an inadequate number of beds in intensive care units. While epidemics like Ebola have shown where health systems failed, the COVID-19 pandemic has unveiled the apparent inequalities between regions of the world, most especially between Africa and other developed areas. The additional burden of dealing with COVID-19 is taking its toll on Africa’s already fragile health systems. Most African countries have lean health financing and infrastructure development. With 25% of the global disease burden, sub-Saharan Africa has 3% of the world’s health workforce. One in three Africans is estimated to earn below $1 a day in rural areas. Weak health systems’ response to the COVID-19 pandemic could quickly bring about a monumental socio-economic crisis.

Primarily, COVID-19 is a health concern. In rebuilding African economies, there is a need for African countries to build a solid healthcare system. The past low levels of investment in the health sector have resulted in weak health systems in the continent. It would interest you to know that despite the rise in national budgetary allocations to this sector, the proportion remains poor and insufficient to improve the quality of and access to health services. According to Africa News, in 2021, only 10 of the African countries offer free and universal healthcare to their citizens, including Algeria, Botswana, Burkina Faso, Gabon, Mauritius, Namibia, Rwanda, Seychelles, Tunisia, and Zambia. Yet, in 2001, Nigeria committed to devoting at least 15% of its budget to the health sector. In 2018, no African country managed to meet this commitment. The five (5) countries where public health expenditure is less than 3% of government spending include the Republic of Benin, Cameroon, Comoros, Eritrea, and South Sudan. African governments’ low levels of investment have increased brain drain in the health sector. This situation is worsened by COVID-19; to reinforce their medical staff, most western countries are now employing foreign doctors, including Africans. Each African government spends between $21,000 and $59,000 to train only one doctor. According to a report by African News, it is estimated that Africa loses about $2.0 billion to this brain drain. In addition, by 2030, Africa will have a shortage of 6.1 million people working in the medical sector.

With the emergence of COVID-19 vaccines, vaccination roll-out can serve as one pillar of the health systems response worldwide and in Africa. We have seen several success stories regarding vaccination coverage in just less than a year, most especially from high-income countries. In Portugal, such success led to getting away with lockdowns or wearing masks outdoors. Unfortunately, many countries in the African continent are still at the bottom lane of the queue for vaccination access except for Seychelles, which has achieved a vaccination roll-out of over 75% of its population. The African continent is dependent on vaccine imports, producing only one percent of the vaccines it administers. African economies have received most of their COVID-19 vaccine doses through either bilateral agreements or COVAX Facility. However, while initiatives like COVAX are needed to fulfill the continent’s short-term needs, they will do little to improve the continent’s capacity to provide necessary vaccines for itself in the future. Developing Africa’s vaccine manufacturing capabilities will help the continent cope with the unexpected future crisis and enable countries to improve the provision of existing vaccines. According to a report published by Anadolu Agency in 2019, an estimated 19.8 million children worldwide did not receive the measles vaccine through routine immunization coverage; many of those children live in Africa. Yet, vaccines are only part of a list of pharmaceutical products to which African states usually struggle to secure access. In 2015, 1.6 million Africans died from malaria, tuberculosis, or HIV/AIDS – Preventable or treatable diseases – because of chronic drug shortage. In addition, the African continent needs to position itself so that it doesn’t just look inward and only produce vaccines for the African market but is competitive in exporting to other parts of the world. That economy of scale is pertinent for the continent.

The role of African governments is critical in this journey toward strengthened health systems and global health. It is crucial that African economies collectively make the funding of the health sector a top priority in their annual budgetary expenditures. Estimates have shown that Africa’s existing vaccine market is worth $1.3 billion and is expected to grow to about $2.4 billion by 2030. These figures show the enormous market for vaccines. Nothing stops the continent from producing its vaccines. A starting point can be producing syringes and needles first. In rebuilding African economies, governments need to build a solid healthcare system.

In conclusion, the Centre for Values in Leadership has decided to title the theme for this year’s annual lecture: “Economic Evolution of life after Covid-19: Measures to rebuilding economies in Africa”. The annual lecture would bring together policymakers and a few others to discuss the measures required of governments to rebuild African economies. So be sure to register for this year’s edition coming up on 7th February 2022.



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