The main reason for Africa's weak healthcare systems is neither a shortage of policies, nor road maps, nor even funding. Lack of leadership capacity, reflected in corruption and flawed policy implementation, must be addressed, argues Dr Margaret Mungherera, immediate past president of the World Medical Association.
Since 1990 the Millennium Development Goals (MDGs) have galvanised the world into action. There is substantial evidence showing remarkable improvement in the health of populations, with many countries experiencing a dramatic increase in life expectancy. However, the positive developments are not equally distributed throughout the world. Only a handful of African countries have achieved one of the three health-related MDGs, concerning the reduction of child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases. The majority of African countries can probably only expect to meet any of the MDGs after 2050—at least 35 years after the target year of 2015.
Moreover, the African continent continues to suffer from a disease burden that is disproportionate to its population. For instance, despite having just 11% of the global population, Africa has 45% of the world's women dying from childbirth-related complications and 62% of the world's HIV/AIDS patients. This huge disease burden can largely be attributed to weak health systems.
African governments have responded to this challenge by ratifying several international and regional declarations, with a number of countries further incorporating national policies and Health Sector Strategic Plans (HSSPs) into national development plans. Subsequently, significant funds from domestic and foreign sources have been pumped into African healthcare sectors for the purpose of implementing these policies. Unfortunately, it is estimated that 20-40% of these funds are wasted, largely because of endemic corruption and flawed implementation that is not in line with policy.
The importance of capacity building
Africa's health systems have a plethora of stakeholders in the public, private and civil-society sectors, each with specific leadership roles to play. Unfortunately, they have failed to fulfill these, largely because they lack the capability. Developing leadership capacity should therefore be the main emphasis of any effort aiming to reduce Africa’s disease burden. It is for this reason that the World Medical Association has embarked on an initiative designed to strengthen the leadership role of African national medical associations in order to enable them to play a more effective part in strengthening the health systems of their countries.
It is unfortunate that it has taken the recent outbreak of Ebola for the world to realise that it is the weakness of African health systems that is the biggest threat to global health. We must hope that it will not take a greater crisis, or many more deaths—African or other—before the world understands that the key solution to strengthening these systems lies in effective leadership from within Africa rather than from outside the continent.
More views on the future of healthcare in Africa can be found in a new report, "The future of healthcare in Africa: progress on five healthcare scenarios", written by The Economist Intelligence Unit and sponsored by Janssen. The outlook for healthcare in Africa will also be discussed at an upcoming conference, Health Care in Africa 2014: fast-tracking to the future.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of The Economist Intelligence Unit Limited (EIU) or any other member of The Economist Group. The Economist Group (including the EIU) cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.
