The future of healthcare in Africa: the need for urgent and radical innovation
“In all hospitals, even in clinics, there is no love. When you arrive at the hospital, they give you the patient form. He holds his pen. You tell him: Papa, write, my child is dying; he will answer, pay the money. He even crosses his legs; you are anxious, fidgeting and he will insist that you pay the money. Before the money arrives, the child dies. There is no love there. To use the hospital, it is money in full, or you will die if you do not have the money” (WHO, Focus Group Discussion women, 2012).
Africa narratives are changing positively; however, the encouraging development success is being seriously challenged by the weak health care system and the exploding population. African population is projected to reach 2.5 billion by 2050 and hit 4.4 billion by 2100. The unchecked population growth in the midst of poor healthcare systems, unemployment, insecurity, illiteracy, and many others is a significant threat to any meaningful development in Africa. Most African communities are still troubled with poor sanitation, malnutrition and lack of clean water despite the advancement in environmental and healthcare technology. Careful attention to the problem, however, presents growth opportunities and a huge market that could dwarf China’s. The place to begin the radical transformation is for African governments to give an unwavering commitment to improving the healthcare of her citizen.
In 2017, the World Health Organisation (WHO) reported that Africa bears 66% of the global burdens of HIV/AIDS, but only one-third of the population has access to antiretroviral medicines. The average life span is 61year for male and 64years for the female when compared with the global average of 70 years for male and 74 years for female. On a country by country basis, there are African countries with 50 years life expectancy. The above statistics encourage skepticism among other nations who see Africa as a continent that could not realize her potentials. To change this narrative, a radical approach is required to dramatically improve access to basic needs of life; healthcare and other poverty-related issues, otherwise the continent may become dangerously chaotic by the year 2050.
Key challenges confronting Africa Healthcare
Africa is responsible for 25% of global health burden but only accounts for 1% of global healthcare spending and a paltry 3% of the global health workers. The healthcare sector in Africa is bedeviled with a shortage of healthcare workers, inadequate infrastructure, abysmally low healthcare investment, weak regulatory framework and endemic corruption. Added to this is the prevalence of counterfeit drugs, in its report of 28th November 2017, WHO estimated that one in every ten medical products is substandard or falsified and 42% of these products are located in Africa. People go for this cheap alternative due to the high level of illiteracy and poverty coupled with a health care system that is mostly dependent on payment out of the pocket for hospital bills. Unfortunately, the situation is exacerbated in rural areas where there are little or no hospital facilities.
The above-enumerated challenges call for a radical approach in order to break away from the shackles of under-development.
Radical innovation in healthcare
How can Africa reinvent its health care system? How can the continent benefit from the ongoing disruption in the healthcare sector? What business models need to be implemented that will bring about a radical and sustainable innovation to healthcare delivery? innovative solutions for Africa healthcare must address the issue of accessibility and affordability. The radical and urgent innovation needed should transform the existing practices and thinking since majority of those practices and policies have failed her citizen. The radical innovation required for the healthcare industry must place power in the hands of the people, it must be private sector driven, it must drive down the cost of care and develop products that are accessible to every patient.
A paradigm shift is also required, it should embrace preventive health, rather than concentrating effort on the costly curative care that compels the government to build grandiose physical facilities that they are unable to maintain. Ernest Darkoh, the founding partner of Broad Reach Healthcare, an African healthcare services company, summed this up when he said that “the most successful outcome should be defined as never needing to see the inside of a hospital. The continuous need to build more hospitals and clinics should be considered a sign of failure. We must make disease unacceptable instead of building even larger infrastructure to accommodate it”. The following measures could trigger some of the needed changes in the healthcare sector.
- Redefine government role: government focus should gradually shift towards capacity building such as funding of medical education training and research. Creation of an enabling environment that will significantly ensure quality health care, Government should relinquish the current role of being a player in the industry to that of a regulator. Currently, most government hospitals buildings are dilapidated and equipped with obsolete equipment. The hospital is poorly managed and also poorly funded. The government should leave the issue of the development of physical infrastructure to the private sector. The budgetary allocation for that should have gone into erecting such structure should go into training, research and skill development of healthcare workers, and provision of health insurance to the extremely poor.
- Suspend tariff on medical and pharmaceutical products: tariffs have compounded the healthcare problem than what could be imagined. If the African governments are serious about giving quality health to its people, then it should suspend imposition of all forms of tariffs on medical and pharmaceutical products.
- Remove barriers to healthcare investment: an aggressive growth is achievable if investment in health care is attractive. To drive down the cost of healthcare delivery, all bureaucratic barriers that encourage corruption must be eliminated, while lending rate to healthcare projects should not exceed single digits.
- Invenctify preventive care: America is the biggest spender on healthcare with an average of $8,362 per person. Its neighbouring and isolated country of Cuba spends an average of $431 per person, but both countries achieve an average lifespan of approximately 80 years. What is required in Africa is an effective and efficient system that makes the citizen live a quality life? The focus should not be on the sophistication of the facilities or the grandiosity of the hospital because with all the high cost of care the US healthcare system still lags behind 36 other countries in the overall health system performance.
- Adopt simple technological Innovation: Africa was able to leapfrog into mobile telecommunication system, and with this technology, it can achieve so much more. Mobile phones are powerful tools through which Africans should be able to receive authentic medical services regardless of their location. In 2007, a Ghanaian innovator, Bright Simons founded mPedigree – a firm that makes use of technology to confirm the authenticity of a drug by sending an SMS. In Nigeria, there is a Mobile Authentication Service (MAS) to curb the issue of fake drugs. There is Matternet in Malawi for the delivery of HIV testing kits to clinics and hospitals. In another development, Doctors Without Borders use drones to transport TB test samples from a remote village in Papua New Guinea and have used the same drone tech to deliver condoms and birth control to women throughout Ghana successfully. All these are low-cost innovation that can make healthcare accessible and affordable.
Quality health care can be achieved without deploying overtly expensive infrastructures, this has been proven beyond reasonable doubt in Cuba. To make health care accessible and affordable in Africa, strong emphasis must be placed on prevention than the expensive treatment of illnesses for which, we may not have sufficient investment to acquire all the sophisticated diagnostic equipment. The keywords for Africa Healthcare are availability, simplicity and affordability. The private sector should come up with a radical innovation that creates new value networks that will eventually disrupt the current inefficient systems and practices.
The current situation for healthcare workers is appalling, and this has compelled thousands of them to migrate to developed countries. If the government invest massively in the capacity development of these health care professionals without the corresponding improvement in their condition of service, the investment will only have negative growth in the sector. One does not need too much foresight to imagine what the future holds if nothing is done. We must look towards the areas where healthcare is underperforming and radically apply new business models that will lead to transformational and sustainable growth.
Olukunle A. Iyanda
Dr Iyanda is Founder/Chief Executive Officer, BROOT Consulting, Lagos
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