Healthcare demands in Africa are changing. Ensuring access to clean water and sanitation, battling ongoing communicable diseases and stemming the tide of preventable deaths still dominate the healthcare agenda in many countries. However, the incidence of chronic disease is rising fast, creating a new matrix of challenges for Africa’s healthcare workers, policy makers and donors.

Africa’s healthcare systems are at a turning point. The reforms that governments undertake over the next decade will be crucial to cutting mortality rates and improving health outcomes in the continent. The Economist Intelligence Unit has undertaken this research to focus on how African healthcare systems might develop between now and 2022. It looks at both current challenges and promising reforms. The five scenarios that have emerged from this research reflect these trends, and are intended to show the possible consequences of decisions being taken by healthcare’s stakeholders today.

Like many other regions, Africa must reassess its healthcare systems to ensure that they are viable over the next decade. Unlike other regions, however, Africa must carry out this restructuring while grappling with a uniquely broad range of healthcare, political and economic challenges.

The continent, already home to some of the world’s most impoverished populations, is confronting multiple epidemiological crises simultaneously. High levels of communicable and parasitic disease are being matched by growing rates of chronic conditions. Although the communicable diseases—malaria, tuberculosis, and above all HIV/AIDS—are the best known, it is the chronic conditions such as obesity and heart disease that are looming as the greater threat. These are expected to overtake communicable diseases as Africa’s biggest health challenge by 2030.

Additionally, continued high rates of maternal and child mortality and rising rates of injuries linked to violence, particularly in urban areas, are weighing down a system that is already inadequate to the challenges facing it. Healthcare delivery infrastructure is insufficient; skilled healthcare workers and crucial medicines are in short supply; and poor procurement and distribution systems are leading to unequal access to treatment. The financing system is as deficient as the healthcare-delivery system that it supports. Public spending on health is insufficient, and international donor funding is looking shakier in the current global economic climate. In the absence of public health coverage, the poorest Africans have little or no access to care. What is more, they frequently also lack access to the fundamental prerequisites of health: clean water, sanitation and adequate nutrition.

Despite these major challenges, reforms of the continent’s healthcare systems are possible. Indeed, some evidence of reform is already present. A number of countries are trying to establish or widen social insurance programmes to give medical cover to more of their citizens. Ethiopia, for one, has demonstrated the power of strong political will to create a primary-care service virtually from scratch. Yet the sheer diversity of the continent means that overall progress has been patchy at best.

Considering the massive challenges facing Africa’s healthcare systems, several major reforms will be needed continent-wide to ensure their viability in the long term:

• shifting the focus of healthcare delivery from curing to preventive care and keeping people healthy;
• giving local communities more control over healthcare resources;
• improving access to healthcare via mobile technologies;
• tightening controls over medicines, medical devices, and improving their distribution;
• reducing reliance on international aid organisations to foster development of more dependable local supplies; and
• extending universal health insurance coverage to the poorest Africans.

Implementation of these reforms could strongly influence the future shape of healthcare in Africa. The Economist Intelligence Unit has identified the following five extreme scenarios to show how the system might develop over the next decade:

• health systems shift to focus on preventive rather than curative care;
• governments transfer healthcare decisionmaking to the local level;
• telemedicine and related mobile-phone technology becomes the dominant means of delivering healthcare advice and treatment;
• universal coverage becomes a reality, giving all Africans access to a basic package of benefits;
• continued global instability forces many international donors to pull out of Africa or drastically cut support levels, leaving governments to fill the gaps.