The African health systems


For many people, the words that come to mind when they think of African health systems are “corruption”, and “personnel, medicines and medical equipment shortages” among other negative connotations. Others see the glass half full and see a world of opportunity for growth. 

The current times present unique challenges to health systems globally with the rise of technology, climate change, outbreaks of diseases such as the COVID-19 pandemic and conflict. This means that health systems need to become more resilient, innovative and responsive. 

Sub-Saharan Africa was named the slowest growing region in 2021 with a projected cumulative per capita GDP growth over the 2020-25 period at 3.6 per cent, substantially lower than the rest of the world. While this refers to economic development, we cannot dissociate the impact that health systems have on economic growth, making health an even more important topic of discussion. 

Money. The WHO proposed a framework in 2007 that described health systems in terms of 6 core components one of which includes health financing. Simply put, money is important for health systems to function. From purchasing medical equipment to paying health personnel, procuring health services establishing health infrastructure and so on, money is necessary for both the growth and sustenance of health-established structures. 

Lack of political impetus towards funding the health sector in Africa has impeded the growth of health systems with many countries consistently allocating less than 7% of their budgetary allowance to health. Many member states of the African Union eagerly agreed to the Abuja Declaration in 2001 that targeted a minimum allocation of 15% of the country’s annual budgets to the health sector, a condition left largely unmet 23 years later. Low financial and political prioritisation means that health sector growth is hampered, with little opportunity to advance in tandem with the demands of the 21st Century let alone improve on pre-existing challenges. 

Secondly, the average insurance uptake rate in African countries is about 3% which means that the majority of populations use other financing options such as Out-Of-Pocket payments which have been closely associated with catastrophic spending. Economically speaking, the capacity of populations to contribute economically when facing illness is reduced due to both illness and impoverishment. 

People. Insufficient human resources for health plagues African health systems. In Kenya, for instance, there are 9 registered medical officers per 100,000 population with a healthcare worker-to-population ratio of 13.8 providers per 10,000 individuals (as of 2022). Côte d’Ivoire on the other hand currently has a doctor-to-population ratio of 1.6 to 10,000 which is insufficient for proper health coverage for its population (as of 2019).”

Woman nurse consulting patient at clinic Photo Freepik.

Having insufficient health workers means that facilities are under-resourced and unable to offer responsive care when demands arise. It means that innovation would be a far cry as workers do their best to offer near-decent care to the population. 

Hope. The flip side of this discourse is that there is great growth potential, especially with the advent of the 5th Industrial Revolution. Digital Technology has been increasingly useful in healthcare practice because of its innovative finesse and problem-solving capacity. Digital tools have the potential of realising health system efficiency by 15% in the next 6 years. Gains from this can be distributed towards health service improvement and health sector development. 

Technology may enable improved health service delivery through online consultation opportunities that overcome geographical limitations. Enhancing systematic efficiency is a benefit as well, especially through the development of electronic health records that reduce medical error and reduce delays of care by creating central health data access points. 

Regionalisation. The committed engagement of the African Union through the Africa CDC during the COVID-19 pandemic proved that regionalisation is of great benefit to Africa. 

Dr. Wanjiku Ngigi

In essence, regional bodies protect the interest of member states, offer economic growth opportunities and offer additional levels of accountability, especially in countries with failing democracies. 

It would be within Africa’s interest to engage more intentionally within regional bodies, then, if resilient health systems are at all to be achieved. Improving Africa’s health systems takes collaboration, commitment and a high sense of integrity to achieve but there is hope for better systems of operation and it starts with the first step. Africa, a Place Called Hope.  

Wanjiku Ngigi is a Medical Doctor interested in positively influencing Africa through championing better health care and service delivery. After Medical School, she went into clinical practice and felt the need for better health systems. This drove her to undertake the MSc in Health Policy, Planning and Financing offered at LSE/LSHTM. Apart from this, she is an author (30 Days of Transparent Faith), blogger ( and contemporary lifestyle content creator. Connect with her! 

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