Health Reforms in Africa : A 2015 outlook ... [1]

Decades of poor health infrastructures and failed national health programs and policies have resulted in the erection of weak healthcare systems across the Subsaharan African subcontinent.

Healthcare systems that barely cater for the day to day needs of the everyday man, let alone cater for emergencies.

Practicing medicine in Subsaharan Africa can be tiresome not only for the doctor, but also for the patient.

The inability of the doctor to get appropriate medical facilities to carry out procedures, as well as the failure of the blood banks to provide appropriately

typed and cross matched blood to the bleeding or severely anemic patient who may die in the next few hours if he is not transfused with blood can be sorely disheartening.


The failure of the diagnostic microbiology and chemical pathology laboratories to provide accurate and on time laboratory results of the blood, urine or stool samples collected, all point to the malfunctioning health system in the region.

Let's take a look at Aina a 40 year old grand multipara who presents in labour at 2am in the morning at a village Community Health Centre.
Her history shows that this is her 8th pregnancy and that she had been in labour at a traditional birth attendant's hut for about 24 hrs, before being taken to a quack doctor some 10 miles from her village. At the quack's place her labour was augmented with oxytocin, after which fetal heart tones could not be heard and some bleeding was noticed. Uterine rupture was suspected and she was rushed to the community health centre about 40 miles from the quack's home.
The community health extension worker quickly made arrangement for her to be transferred to a tertiary health institution close by, however there was no ambulance to be used.
Relatives quickly went to a nearby truck stop to charter a rickety cab in which they transferred the woman to the hospital 50 miles away.
By the time she arrived at the hospital, it was too late to save the baby. All that the doctors could try to do was to save the woman's life. The fetus had been long gone.
The challenges surrounding obtaining properly screened, grouped and cross matched blood for this woman in an emergency situation is a story for another day.

The sad occurrence above typifies the day to day life of the African woman in the rural setting where access to health facilities for routine healthcare services such as antenatal care, well child clinics and immunization is a luxury. Let alone having access to health care service in emergencies.

In the city, one would imagine that health care services would be better,  but it isn't totally so.
Many privately owned hospitals operate under little or no governmental supervision and a times make fatal mistakes that may lead to increased morbidity and mortality with little or no consequences to the doctors and hospitals involved.

These hospitals are also high priced and only those that can afford the high fees patronize them.
Dying men, women and children are frequently turned back at hospital gates for inability to pay the required hospital deposit.

Failed procedures are often charged to the patient's account and he has to pay for another to be carried out.

One would expect that at least the government hospitals will be better off; however, that is not the case. They are poorly equipped, have small capacity when compared to the population it was built to serve, and are too expensive for the people.
Free services are either nonexistent or the processes are too long and foiled by corruption and bureaucracy to be effective.

These and lots more are the tales of woe of medicine in the city.

This has brought us to the need for sustainable health care programs that will cater for the rich and the poor alike.

Access to quality health care should be a fundamental human right in all Sub-Saharan African countries.

Why is the health system collapsing in Africa as a whole; One would ask?

Failure to develop and strengthen our primary health care system over the years is the bane of the problem.
Lack of political will and deep seated corruption have made governments across the subcontinent to under prioritize the health care of the people.

Pressing health issues of national and global significance ( such as Tuberculosis eradication, malaria, HIV & AIDS, and childhood diarrhea ) have made us dance around the real issues for decades on end, by restricting our focus to the pressing needs and hereby failing to address foundational issues.

Our attempts to provide quick fix solutions to health problems by focussing solely on the vertical approach has brought us to this point, coupled with the reluctance of funding organizations and governments to shoulder the financial responsibility and burden of tackling the issue of health care via the broader and more expensive horizontal approach.


The Ebola crisis in its wake has left almost in ruins an already crumbling health system. This has further exposed the weak and non existent health care structure in the Subcontinent. The epidemic basically cleared out whatever little they had left of health care systems in the 3 affected West African nations, leaving us with the question : Who will come and save us from our non functional and collapsing health systems?

Way forward:

Strengthening the primary health care system and associated programs will help alleviate the suffering of all and sundry. This will as well lay a good foundation upon which we can build a mighty edifice of sustainable health care programs and systems that can stand the test of time and crisis.
A health system that can withstand the pressures of a changing ecosystem, globalization, urbanization and increasing travels which increases the transmissibility of certain dangerous viruses which would normally have been restricted to a region.

                                    


Perhaps it's time to return to the Alma Ata declaration of 1978 and structure our health care reforms around its principles. This way we may be able to avoid the pitfalls of the past.