Improving Health Outcomes in Africa: Five Key Messages from an Intersectional Approach

Africa faces a complex landscape of health challenges. To effectively navigate this terrain and improve health outcomes for its citizens, a multifaceted approach is necessary. This article expands on my keynote presentation at the London School of Economics during the launch of the Advancing Health Equity policy brief co-authored by recent PfAL Alumni and MSc Global Health Policy graduates, Elmer Aluge and Dr. Chris Agape. These were my five key messages that emphasized an intersectional approach to health security on the continent.

1. Governance: The Bedrock of a Healthy Africa

My opening message underscored the vital link between good governance and a robust health sector. Just as responsive leadership fosters economic growth, it also lays the foundation for an equitable and efficient healthcare system. Countries like Singapore, New Zealand, and Rwanda, which exhibited strong leadership during the COVID-19 pandemic, serve as prime examples. Strong institutions are equally crucial. A study by the Africa CDC reveals that only 18 out of 55 African countries have a fully functional National Public Health Institute (NPHI) with a clear legal framework. This lack of robust institutions hampers the ability to deliver on core public health functions like Disease surveillance, emergency preparedness and outbreak response, and public health workforce development and research amongst others

2. Resource Constraints: Bridging the Gap

The second message confronted the harsh reality of limited resources plaguing African healthcare systems. The continent's health burden far outpaces available resources to tackle it. While factors like poor governance and corruption undoubtedly contribute, the root cause lies in the insufficient economic development of many African nations. The current annual health expenditure of African governments, at $4.5 billion, pales in comparison to the estimated $26 billion needed to meet evolving health needs over the next decade. This funding gap is further exacerbated by low GDPs, inefficient tax collection, and competing national priorities. Improving domestic financing and expanding the economic base of African countries through the African Continental Free Trade Area (AfCFTA) offer a glimmer of hope by potentially leading to increased domestic resource availability. As Gatome-Munya and Olalere famously said, "15% of an elephant is not 15% of a chicken.” For our countries to invest more in healthcare, they must earn more and improve governance.

3. Climate Change: A Looming Threat to Health

The impact of climate change on health is already being felt in Africa. The World Health Organization (WHO) reports that climate-related health emergencies are on the rise, accounting for over half of public health events on the continent in the past two decades. This translates to increased incidents of flooding, water-borne diseases, vector-borne diseases, droughts, and famines. These factors often lead to internal conflicts, further straining already fragile health systems. The key challenge lies in establishing effective early warning and response systems. But just as we have seen in the peace and security domain, possessing early warnings is insufficient; the true test lies in the state's capacity to prevent, prepare, and adapt to climate-induced crises. Robust public health surveillance, knowledge, adequate human resources, and financial resources are essential for interpreting data and formulating appropriate responses.

4. Digital Technologies: A Double-Edged Sword

Africa's rapid mobile penetration and technological advancements offer immense potential for revolutionizing the health sector. Telemedicine, health tech innovations, and local solutions addressing challenges like health system automation all point towards a brighter future. However, a focus solely on digital interventions risks neglecting fundamental issues. Technology should serve as a tool to improve access to primary healthcare, not a replacement for the basics. In other words, we must avoid the "digital trap" where, like the proverbial carpenter who only sees nails, we see technology as the solution to every problem. Investing in areas like genetic sequencing, drug procurement, and health literacy is equally important. Additionally, fostering an operating environment with clear policies and regulations is crucial to stimulating digital health innovation and avoiding stifling it. The global conversation on Artificial Intelligence (AI) also becomes relevant in this context, requiring careful consideration of its ethical implications in the healthcare sector.

5. A Collective Responsibility: Towards Global Solidarity

My final message emphasized the importance of global collaboration. Recent outbreaks of Ebola, COVID-19, and Monkeypox exposed the stark inequalities in global health. The ongoing debate on the pandemic treaty lays credence to this reality. Developing nations often face significant barriers in accessing advanced technologies and vaccines needed to combat these diseases. A recent paper by Gyapong and Machingaidze titled "Africa's Complicated Path to Global Health Equity" argues that dismantling these barriers requires leadership from all actors within global health institutions. Africa, for its part, needs to establish a new legitimacy based on responsive governance and demonstrably improved health outcomes for its citizens. The continent has shown its capacity for transformative leadership and collective action in times of crisis. However, sustaining these efforts necessitates ongoing collaboration with global partners. The example of South Africa being "punished" for identifying the Omicron variant is a stark reminder of the need for a more equitable approach to global health challenges. Similarly, intellectual property rights debates highlight the importance of fair access to technologies that can improve health outcomes in Africa.