Opinion: How to future-proof Africa’s health systems

Health systems around the world — regardless of geographic location or income level — are grappling with the now year-long pandemic and the spillover effects that have resulted from delays and disruptions to the delivery of essential and routine health services. The dual burden of managing a pandemic and ongoing population health needs forces us all to make tough decisions, pursue innovative solutions, and ultimately answer the question: Will our health systems survive the pandemic and future health emergencies?

In Africa, countries across the continent are pursuing innovative solutions to accelerate universal health coverage goals and make progress on the United Nations Sustainable Development Goals, all while navigating the pandemic. Data is one of the most important inputs to inform these innovations and support recovery from this crisis.

Reliable, disaggregated, comprehensive data informs management and the resourcing of the delivery of health services. However, in many cases, policymakers must make decisions using incomplete or outdated data with suboptimal or even negative results. I compare this to a pilot being asked to fly an airplane with no data or using last year’s weather data.

At the 2021 Africa Health Agenda International Conference, I moderated a session that looked at the tools available for better decision-making. The session saw the launch of the FutureProofing Healthcare Africa Sustainability Index, an online policy tool, providing an overview of 18 health systems across the continent. It is composed of 76 different measures split across six categories called “Vital Signs”: access, financing, innovation, quality, status, and wider factors.

These measures were identified by experts across Africa who work in health systems, multilateral organizations, civil society organizations, think tanks, and academia. The index is designed to encourage data-driven dialogue on the future of health care and is an important resource as we work to achieve UHC goals and better health for all Africans.

During the AHAIC session — convened by research-focused health care company Roche — several of the health experts who oversaw the Index’s development shared takeaways for applying the “future-proofing” mindset to health systems in Africa:

1. Regional collaboration has an impact on innovation

While there is growing awareness in Africa about the importance of research, there is often a gap between conducting research to understand challenges better and implementing solutions based on research findings. Dr. Saber Boutayeb, professor of medical oncology at the University of Rabat in Morocco, discussed the importance of regional collaboration in creating sustainable health care systems, including building regional research clusters to maximize resources needed to finance the design and implementation of innovative research projects.

Other actions include: sharing data across national borders to increase knowledge sharing; prioritizing public-private partnerships to build sustainable models for regional collaboration; focusing on a regional approach to advance training for African health care providers; and implementing regional clinical studies to innovate and deliver the best level of care for patients in Africa.

2. Technology can speed up system-level changes and improve health delivery

The African Development Bank estimates that about 39 million Africans could be in extreme poverty in 2021. This poverty level, cost of care, and distance to facilities prevent people from accessing quality care. Seth Akumani, head of exploration at the Accelerator Lab at the U.N. Development Programme Ghana, put forward three key areas where technology can improve access to care: 1) leveraging mobile and digital technologies to improve access and solve delivery challenges; 2) digitizing health records, an area where the Index shows that there is currently limited uptake, can help collect and centralize quality, reliable health data; and 3) using technology to leapfrog systemic issues and bypass challenges — for example, using drones to deliver medicines, lab samples, vaccines, and so on.

3. Health care spending should be reprioritized to address system gaps. Access without quality is a waste

Olumide Okunola, senior health specialist at World Bank Nigeria, presented a thoughtful analysis on reprioritizing health care spending to address system gaps. The current system’s weaknesses revealed in the Index were driven in part by inefficient health spending and poor resource allocation.

We can repair these weaknesses by rethinking finance models, specifically on spending. This can be done by: 1) increasing budget allocations to health: the pandemic spurred an increase in health spending, and this should not end after the strongest effects felt from the pandemic begin to fade; 2) prioritizing resources for the poorest and most vulnerable members of society to begin closing the gap in access to and quality of care; and 3) preparing for the future now while understanding the immediate need to focus spending on addressing emerging trends and increasing rise in noncommunicable diseases.

4. We need to improve gender equity in health care

Professor Glenda Gray, president and CEO at the South African Medical Research Council, concluded the session with recommendations to improve gender equality in health care.

The first would be improving reproductive health. Data from the Index shows stark differences across the continent on access to reproductive health services. There is a positive correlation between access to these services and a good outcome in neonatal mortality. Where access is strained, women’s health takes a toll. For example, the Democratic Republic of the Congo scored the lowest on the Index for access to family planning and low for neonatal mortality.

The second step would be to improve access to quality primary and secondary education. Increasing women’s access to education can improve literacy and enable them to take care of their health. For example, Angola ranks low on the index for access to primary education and the adult literacy gender age gap.

Finally, elevating women to leadership roles, particularly in national health systems, can impact outcomes for women across the continent.

The road ahead for each country looks different, but the destination is the same. We must collaborate to future-proof health care and achieve UHC. The Africa Sustainability Index gives us a report card of our health systems’ performance/status. From the strongest performers to the weakest in each of these Vital Signs, all countries have room to improve. This index should serve as an inspiration and spark opportunities to democratize access, data, and approaches to strengthen responses to health challenges and improve solution implementation.