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The spread of the coronavirus in Africa has exposed the precarious nature of many of its health systems. I am writing this at a tense moment in the history of public health on the continent.
A pre-Codiv-19 survey by Afrobarometer, an online data analysis tool, found that one in five Africans faced a frequent lack of much-needed health services.
Africa’s investment in health has been reiterated, but little has been done to boost financial investment. Now the chickens have returned home to rest.
The number of people with the coronavirus remains low compared to what has been seen in the United States, Great Britain, Europe, and even Asia. Africa was the last frontier in the incipient spread of the virus.
The first coronavirus case was reported on the mainland on February 14 in Egypt.
On March 18, the first case in sub-Saharan Africa was reported in Nigeria.
The slow spread on the continent gave false hopes that Africa and its people would be saved from the worst of the pandemic. But when it began to spread, reality quickly sank. He laid out what we have always known for a long time. Most of Africa’s health systems are not adequately equipped, and their fragility is on the brink of a total nightmare.
Measures taken by countries.
The initial response to the Covid 19 pandemic by individual countries in Africa was rapid. Various authorities have applied travel restrictions, total blockades and even curfews.
Rwanda, for example, announced an immediate closure and has been supplying food and water to its vulnerable populations; South Africa announced a national shutdown and launched dozens of mobile test units, with a combined daily test capacity of 30,000. Nigeria has extended its confinement in Lagos and Abuja.
Kenya, on the other hand, instituted a national curfew from dawn to dusk, while limiting movement within its capital city and settings to isolate the rest of the country.
Another advantage is that the vast majority of Africa’s population lives in rural areas, which means less overcrowding and limited social interactions.
The other strength is that some African countries have experience in the fight against communicable diseases such as tuberculosis, HIV, Ebola, Rift Valley fever, among others.
This implies the tenacity and flexibility to fight another addition to the communicable disease family within your existing infrastructure.
The wise you live, you learn, seems to be working for Guinea, Sierra Leone and Liberia. These three West African countries were the hardest hit by the Ebola outbreak between 2014 and 2016. Informed by their past experience, they have been implementing some of the lessons, such as testing at entry points and contact tracing.
This level of déjà vu worked for Nigeria and Senegal when Ebola spread in these countries. They had had the benefit of time to see what had worked in neighboring countries.
They used the arsenal of lessons to stop the spread of Ebola through port-of-entry screening, rapid and comprehensive tracing, contact monitoring, and rapid isolation.
The question to ask now is: Would the implementation of Universal Healthcare have saved the continent from the problems it is experiencing right now?
Universal Health Care (UHC) is based on a simple but critical principle that everyone receives quality health services without reference to their financial ability.
The unique consideration for the service is that you get treatment if you need it, whether you can afford it or not. The Sustainable Development goal stipulates that by 2030, all regions will have universal health care.
We are ten years from the deadline, and there is a Coronavirus to remind us why having strong healthcare systems would have alleviated this burden.
According to Dr. Githinji Gitahi, CEO of Amref Health Africa, “Many countries have adopted the political declaration that was made at the UN general assembly in September and accepted and signed. The conversation has happened but the walk has not happened.“
The fissures that exist in most of Africa’s health infrastructure have been discovered amid the coronavirus pandemic. It is now a last-minute effort to equip systems that no longer had sufficient resources.
On a BBC Africa Facebook Live, the Director of the World Economic Forum for Africa, Elsie Kanza said “We have already seen the negative effects in terms of health care as countries strive to fine-tune facilities. Before they were weak and now governments have to operate in a crisis mode to close those gaps.“
Operating under pressure in the midst of a pandemic comes with its own additional frustrations.
Africa health crisis
Africa bears a third of the global burden of disease and its health infrastructure is deficient by global measures, including the doctor-patient relationship.
With a population of over 1.3 billion people, most countries have an average of two doctors for every 10,000 people. Nigeria, the most populous country in Africa, has a ratio of four doctors per 10,000 people, Kenya has two, while the Democratic Republic of the Congo has one according to the WHO. The proposed WHO ratio is 1 doctor per 1,000 people.
In addition, some of the continent’s health systems have been supported by donor funds. With the economic downturn and contraction in Western Europe and North America, Africa will have to rely heavily on its own resources in the future.
So far, there have been complaints about the quality of care for those in need of treatment, while healthcare workers regret that they have not been adequately equipped to deal with a COVID-19 problem.
Currently, there is a fear that the number of people infected will increase and that bed spaces, especially for those requiring intensive care, may not be sufficient.
The World Health Organization estimates that there are fewer than 5,000 ICU beds available in 43 African countries. This translates to having 5 beds for every million people.
In some 41 countries, fewer than 2,000 ventilators are available in public health centers according to WHO data. These numbers will change dramatically once the efforts of different countries to increase capacity are completed. There is also the donation made by Chinese billionaire Jack Ma that has not been factored.
Fans are crucial for those who need critical care.
Financing of universal health coverage
Overall, funding for healthcare in Africa has been the proverbial elephant in the room.
At the African Union Heads of State Summit in 2001, members pledged to allocate at least 15 percent of their annual budgets to improve the health sector, in what is popularly known as the Abuja Declaration. Few countries have kept their promise. They include Rwanda, Malawi, Mauritius, and Seychelles.
Many others have fallen short, and some spend a meager 5-7 percent of their budgets on health.
The irony is that the Abuja statement was just one of many other conversations to make sure health care gets the financial attention it deserves. As time has shown, member countries have perfected the art of breaking their own rules.
Nigeria, the African economic giant that also houses the continent’s largest population, is still struggling to shift commitment from political conversation to action.
Dr. Githinji Gitahi, CEO of Amref Health Africa, says “They have made important commitments, but in real terms, no significant progress has been made. Some of the challenges in Nigeria are challenges that lie in a decentralized political environment where the state has to work closely with the national government to carry out some of these projects.’’.
Where Nigeria has failed, Rwanda has been hailed for progress toward achieving universal health care.
According to Dr. Githinji, “Rwanda has used an approach to social health insurance that is based on compulsory social health insurance in which people who have the ability to win contribute and the state contributes balance and those who cannot contribute anything, the state brings everything.’’
Despite the affordability and sustainability challenges experienced in Rwanda, significant progress has been made towards Universal Health Coverage.
Tanzania for its part has made significant progress in universal health coverage. According to the President of the Tanzania Medical Association, Dr. Elisha Osati, “When you look at the health policy on providing health care to all, Tanzania has the infrastructure in place. We have really tried to make sure we have the infrastructure. ”
However, the sector is grappling with financial challenges according to Dr. Osati, “This is in part because the budget allocation is not yet the proposal. Our economy is not that strong either, so everything that is available should be distributed to all sectors. But for its part, the government has really tried to progress. “
The other country that has been praised for its progress in investing in UHC is Ghana. So much so that its health system has been described as one of the most successful on the African continent. However, it is still struggling to find a sweet spot where healthcare financing is guaranteed.
“We have seen Ghana reach a significant number of people with financial protection, but again they have faced sustainability challenges from their benefits package that they offered to the public. I have a feeling that engagement in West Africa, especially Francophone Africa, is stronger than its counterparts in East and Central Africa, ” he adds.
Dr. Lydia Dsane-Selby, executive director of the Ghana National Health Insurance Authority, says “Obviously, a major policy like this will face challenges, but these have been addressed as we move forward. We did not have a national ID card, so we had to compile a member database and eventually had to go biometric to make sure we had a unique way to identify members. Defining the benefits package while it is financially sustainable has also been a challenge. ’’
Ghana now has a membership of 12.5 million in the national health insurance plan, which is approximately 42% of the population.
While the country is referred to as one of the models of an insurance plan that has worked for its people, Dr. Dsane-Selby is quick to add: “There is no perfect health system in the world. We all strive to achieve the best possible care for the resources we have. I am proud to be in a country that thought innovatively and created a health insurance plan that is a hybrid of several of the best-known insurance models, but that applies only to Ghanaian circumstances. What we must remember is that you do not sit on your laurels. One must continually innovate to achieve the best possible scenario.’’
In Senegal, the budget allocation to health is 8%, which is still below the commitments of the Abuja declaration. In addition to that, Senegal has a fairly strong health infrastructure. Under its One Health approach, Senegal has exemplified good leadership in coordinating and monitoring health operations. In the 2019 UHC progress report, he was praised for his ‘solid foundation to prevent, detect and respond to threats to public health’.
Kenya is testing UHC in about 5 counties. President Uhuru Kenyatta wants Kenya to achieve Universal Health Coverage by 2022. However, the country is grappling with the high burden of non-communicable diseases like cancer, diabetes and heart disease.
With Covid -19 already complicating a bad situation, it will be interesting to see how Kenya is navigating this time around to make quality healthcare a priority.
Universal health coverage is not a completely new idea in Uganda. It had begun to implement some policies aimed at reducing the cost burden on the poor. For example, it abolished user fees for health services in public facilities beginning in 2001. The program has been fraught with serious challenges. In some facilities, people are required to purchase their own medications. In others, women giving birth are expected to wear their own gloves. Uganda is struggling with weak health infrastructure, unequal access to services and inadequate health workers.
For its part, the DRC still needs to strengthen its health financing system. The current system blocks people due to high outlays by those seeking medical care. Its high dependence on external funds to finance health care places the DRC in a disadvantageous position, especially during this Covid -19 pandemic.
There are some lessons that countries can learn from Ivory Coast. He had to leave UHC in 2012 after a brief experiment. Some of the reasons why it was not feasible include mismanagement against rising costs and corruption. All this had a cost for the government that had to pay around US $ 60 million in nine months.
Financing Africa’s health care remains a moving target, and with a new and aggressive contagion like COVID-19, known as the worst challenge to the world and continent in history, Africa will have to dig into its deepest reservoirs of strength. and resistance to live. Tell your own story.
The writer, Anne Mawathe, is the health editor for the BBC Africa Life Clinic.
