What is the State of Health in Africa today?

Our InFocus series each run for a maximum of 3 months. With the new face-lift on the Blog, this segment is covered under INFOCUS.

When a new focus subject is announced, they will move to this segment and the current subject moved under the Issues tab.We hope to generate debate on diverse issues during this time and depending on your reactions, those issues may feature in the coming periods. The question we are asking on the first post of our INFOCUS series on Health is then, What is the State of Health in Africa today?

From a policy perspective, Africa is facing significant challenges in the health sector that are demanding significant political, economic and social action. Access to services, health services infrastructure, health human resource (doctors, nurses, technicians and pharmacists), health commodities and research are some of the aspects impeding the health sector and people.

People’s ability to access services is based on whether or not health centres are within easy reach; whether services are paid, shared cost or free; whether if infrastructure to the services makes it difficult to reach services or not and whether they know about the services being provided. This very much relates to health services infrastructure (buildings – hospitals and clinics).

Health human resource is another aspect challenging the health sector. Are there adequate numbers of health human resource to provide services? The ratio of Doctors, nurses, technicians, pharmacists and managers to people and facilities is not sufficient. The question of what ratio of particular health workers per patient is adequate, is relative. But it remains a fact that in most African countries, the ratio is still less desiring. Countries like Tanzania and Malawi have a ratio of 1:50000 and are least performing. South Africa has a just over 1:1200 ratio. Small Island states such as the Seychelles and Mauritius and North Africa countries are performing well.

But the question still remains – are the services accessible to everyone equally in Urban and Rural areas? Are they affordable and is the available service package the same for everyone, despite the individual influence and financial standing?

Commodities availability (medication, medical tools and machinery, condoms) are also another aspect challenging the sector. Reports from different parts of the continent express dismay in the lack of and proliferation of fake medication; health workers lack the tools needed to perform their duties effectively – from hygiene to tools for medical attention.

And the continent is making slow progress in the arena of research, especially on health issues. In 2011, 7 African Women Scientists were awarded under the African Union Kwame Nkrumah Scientific Awards. The awards symbolized the progress being made in medical research on diseases such as malaria. It encouraged greater and equal participation of women in taking leadership to address challenges. This is but a small step in strengthening the research base on the continent.

How does this respond to the core question we are asking?

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On this second piece of our INFOCUS series, we examine the Health Human Resource crisis on the African continent. The biggest challenge in putting this piece together was getting data to give us an impression of the situation on the ground. We discovered that this challenge to us was in-fact one of the main issues behind this crisis; weak Human Resource for Health Information Systems and generally, Health Information Systems.

In this encounter, we will be looking at specifically, what the situation is collectively on the African continent with respect to Human Resource for Health - the doctors, nurses, laboratory technicians, pharmacists, managers - in all over 20 different cadre types. Again, information for all these levels is not readily available. Most of the little reporting and data that is available looks at Doctors and Nurses and is outdated. More comprehensive information and data is needed. Here is what the Africa Health Workforce Observatory says about the challenge of accessing information on health workers through current HR for Health Information Systems;

The entire system depends on different sources such as health professional regulatory bodies, health facilities staffing, health training institutions, faith based organizations, censuses or surveys, payroll records and other various services in statistics for which the completeness, timeliness and comparability are widely variable with the challenges of combining and compilation of information from multiple sources.

What is the situation?

In the first piece we posted in our INFOCUS series, one of the things we highlighted was the Doctor Patient ratio on the continent. We saw that some countries were performing considerably well than

others. In the 2006 Edition of the World Health Report by WHO 57 countries were identified as having a Human Resources for Health crisis. Of these, 36 countries were in Africa. Despite the continued forecasting of relatively good economic performance by many countries on the African continent, there is a still a burden in a number of areas including efficient management of development capital.

But if we can go back to the issue at hand, here are some facts we collected on what is happening on the ground;

Though we do not like this Sub-Saharan Africa phrasing, the region faces the greatest challenges. According to WHO, while it has 25% of the global burden of disease, it has only 3% of the world’s health workers.

36 countries in Africa, as aforementioned, are confronting critical Human Resource for Health shortages, meaning they have fewer than 2.3 doctors, nurses and midwives per 1000 people. This figure is the minimum required to achieve an 80% coverage rate for deliveries by skilled birth attendants or for measles immunization.

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Picture: AllAfrica.com

A Crisis - Africa’s Health Human Resources Shortage

Our last InFocus piece looked at the Africa’s Health Human Resources Shortage as a growing crisis. We noted that whilst the challenge was significant, there were some noteworthy programs on the ground working to address the shortages. In this piece, we will be profiling some of these programs. If there is a program we did not feature, please send us information about it. These are only a few we were able to find;

Kenya: Africa Medical and Research Foundation (AMREF) - Human Resource for Health Project

The erosion of Kenya’s key health indicators -life expectancy, infant mortality and maternal mortality - during the last two decades can be traced in part to the deterioration of the health workforce. The acute shortage, inequitable distribution and inadequate skills of health workers have contributed to this negative trend. The Kenya health workforce currently stands at 1.69 health workers per 1,000, way below the WHO is recommended ratio. This small number of health workers is further inequitably distributed denying vast sections of the population access to quality health care thereby impacting negatively on health indicators despite the heavy investment made in the various areas.

The HRH Project is working with the goal to contribute to the increase in the ratio of the health workforce to population and to achieve equitable distribution of health human resource in Kenya.

The project seeks to build advocacy skills, capacity and knowledge among civil society, the government and non-state actors, including professional associations and recruiting agencies to address the problem of human resources for health (HRH) in Kenya.

The objective of the project is to enhance the capacity of CSOs, Government officers and other non-state actors to advocate for HRH issues in Kenya.

To see the entire list, Click Here.

Tanzania: Benjamin William Mkapa Foundation - Mkapa Fellows Program

MKAPA Fellows is a pioneering, innovative human resource for health program that supports the efforts of the Tanzanian government to tackle HIV/AIDS. What they do is simple; they recruit and deploy dedicated fellows to work in remote communities with acute short-age of health professionals.

Picture: AMREF

Picture: BMAF

Profile of ongoing Programs addressing the Health Human Resource Crisis in Africa

At the 2001 Abuja, Nigeria African Summit on HIV/AIDS, Tuberculosis and other related Infections Diseases, Heads of States and other actors agreed on what has been a key reference point on financing for the health sector. The outcome of the Summit, the popular Abuja Declaration saw a commitment by Heads of States to allocate at least 15% of the total budget for the Health Sector. How much of this commitment has been realized since then?

WE COMMIT OURSELVES to take all neccesary measures to ensure the needed resources are made available from all sources and that they are efficiently and effectively utilized. In addition, WE PLEDGE to set a target of allocating at least 15% of our annual budget to the improvement of the health sector. Article 26: Abuja Declaration, 2001

We have compiled data and generated presentation using the World Bank Databank, selecting a total of 54 African countries to make the progress comparison. What we are comparing is the percentage (%) of the following areas;

Total Health Expenditure; this including both public and private,

Total Government Expenditure i.e. total fiscal budget expenditure,

GDP.

Analysis of the information will show you that there is still much needed to be done. There is also progress on a number of areas. We will discuss these areas in part two of this article, expected in a few days time.

To finish reading this article, please click here.

Source: World Bank

Picture: Global Health Check

Health Financing in Africa; a % comparison between Total Health Expenditure, Government Expenditure & GDP

Health Financing in Africa, a comparison

Health Financing in Africa; Why is action so difficult?

This is the second part to our two part post on Health Financing in Africa. It is also the final post on our INFOCUS series on Health. On this edition, we are concluding the discussion on health financing by asking, why is it difficult to take action on assuring the requisite financing for the health sector following regional commitments global standards and specifically, WHO’s Commission on Macroeconomics and Health (CMH) recommendations.

The trend in health financing on the continent is not encouraging. We saw this in brief on the first part of this post where we looked at health expenditure comparisons on the continent. Information on country, regional and continental progress that is produced and actively disseminated by structures and platforms at these levels is also difficult to find.As we have noted on other issues we have covered, it is critical for Africa to produce, package and actively share information on socioeconomic issues it is facing. The continent can not be dependent on institutions beyond its borders to generate on understand of the state of our problems.

Regional data on total Government spending per capita in dollars (weighted) how that East and West African country Governments are spending between $8 and $9 per head, Central African Governments are spending about $20 per head; while the corresponding amount for North African Governments is over $40 and Southern African ones over $140. Health Financing in Africa, Special Summit of African Union on HIV/AIDS, Tuberculosis and Malaria (2006).

Why are countries not investing and financing health adequately? Our thinking is that the process of costing for national health delivery is still a challenge. There are still many puzzle pieces that are missing for the costing process to be smooth. We examined before the lack of human resource for health. Other challenges also include insufficient infrastructure and health commodities availability. Costing in these circumstances using the same approaches as elsewhere in the world may very well yield flawed results.

But we believe many of these countries have the financing to meet ‘universal access to health’ commitments. What is required is for deliberate decisions to be taken to favor increases in health financing. For example the regions highlighted in the quote above; many countries in these blocks have extensive access to sources of financing in the form of minerals and an increasing tax base (both local and foreign). But mismanagement of resources, corruption and unfair speculation by the outside world on natural resources has diminished the revenue margins these countries work with. So if you are already working with an inadequate income, the focus will remain on spreading the revenue across all sectors and as a result, health indicators will remain unfulfilled for decades to come.

This is the final post for this series. Read the rest by Clicking HERE.

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