Rethinking Africa's healthcare paradigm

September 30, 2014


September 30, 2014

Dr Ernest Darkoh

Founding partner

Dr Ernest Darkoh is a globally recognised expert in health systems design and implementation with experience in more than 20 countries across Africa, Asia and the Americas. He is a co-founder of BroadReach Healthcare, an Africa-based health analytics and technical services firm.


Although the African health establishment has tried to do the right thing by focusing on curative care, prevention has become an afterthought. Africa's healthcare paradigm must be changed, argues Dr Ernest Darkoh, co-founder of BroadReach Healthcare, an African-based health analytics and technical services firm.

In many ways, African health systems are groaning under devastating disease burdens for the very reason that we, the African health establishment, are fulfilling our tacit statement of intent: curing disease.

People fill hospital beds; they receive drugs; we cure disease.

As resource-constrained as they are, many African countries might learn from the practice of setting positive intentions. If the intention is to "cure disease", then you will find yourself with plenty of disease to cure. Country after country in Africa has backed itself into this corner, and has then needed to plead for resources as its hospitals reach capacity.

The World Health Organisation (WHO) defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". However, the overwhelming majority of effort (and funding, accordingly), still focuses on fighting infirmity and disease. Worse yet, the social determinants of health rarely lie within the ambit of the ministries of health, but are scattered across the mandates of multiple ministries, including those for education, housing, social services, police, water and labour. As such, we have barely begun to define what well-being means in a systematic sense, much less develop effective models to deliver it.

Although the African health establishment has tried to do the right thing by focusing on curative care, prevention has become an afterthought. Treating cancer, diabetes, injuries or other conditions is not wrong, but the paradigm that allows them to spiral out of control is. It is reactive, requiring ever-increasing numbers of hospitals, doctors and medicines, in a system that is bound to implode. This flawed paradigm has led to a results framework where "success" is measured by the increase in hospitals or doctors, which is actually a proxy admission of failed healthcare.

Excluding immunisation programmes, most African countries do not have coherent, integrated or effective prevention agendas. Most countries hope that nothing goes wrong to test their already overburdened curative systems. However, when it does, as seen with Ebola and HIV, it reveals the precarious deficits of this model.

Changing the paradigm

So what should be done differently? The paradigm must be changed to reflect what is actually wanted, which is healthy people. Concerted thought is required to define well-being, develop a new set of success metrics, create scalable models to deliver it, adapt working modalities to implement it and, most importantly, incentivise and reward prevention.

I call it a "life-cycle well-being-based model", where for each distinct year of one's life, the leading risk factors are defined and best-practice preventive interventions are delivered proactively. We must also improve our results frameworks, which are currently limited in their ability to count what "did not happen". We must redefine the team of entities that own pieces of the health/well-being pie. Do any ministries of education, housing, labour or police internally define their mandate as "keeping people well"? Currently, most ministries of health are so siloed that internal departments and programmes barely communicate, let alone co‑ordinate with other stakeholders on a defined well-being agenda to which they are collectively held accountable.

It will take many decades to turn the corner, but if nothing is done today, the ever-growing inadequacies will persist. It is time to reposition around a new intention, reward prevention and redirect the future towards well-being.


Preventive healthcare is one of the themes discussed 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 future of 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.

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