Africa: Global Health Summit Faces Huge Challenge - How Will We Afford Growing Cost of Essential Healthcare?

A child is assessed for malnutrition at a health facility in Um Sagour camp in Sudan's White Nile State (file photo).
24 May 2024

Approximately 4.5 billion people (over half of the global population) do not have access to essential health services, according to the WHO and World Bank report tracking "significant"  progress towards universal health coverage (UHC) by 2030.

In addition, at least two billion people suffer from severe financial hardship due to out-of-pocket healthcare costs. In the past 20 years, less than a third of countries can improve healthcare access for their citizens or reduce the financial burden of healthcare. Most people are forced to choose between settling their medical bills or catering for other basic needs such as food, clothes, and housing.

As African health leaders prepare for next week's 77th World Health Assembly (WHA77), these critical issues were discussed during an online briefing on the continent's health agenda.

"The theme of this World Health Assembly is 'Health for All and All for Health' and I think it's a way of really underlining the fact that we all need to work together - governments, partners, people, private sector, innovators - to produce health for everyone, meaning everyone has a right to good health wherever they are," said Dr. Matshidiso Moeti, the WHO Regional Director for Africa.

The WHA77 provides updates on progress toward the WHO's ambitious "triple billion" targets: one billion more people gaining access to Universal Health Coverage (UHC), one billion more protection from health emergencies, and one billion more experiencing improved health and well-being.

And as the road to UHC by 2030 looks shaky, those leaders need to "understand what we are going there to do", said Dr. Githinji Gitahi, the Group CEO of Amref Health Africa.

"At this moment, Africa is facing a public health crisis... Only four to 6% of the people have access to health services" as defined by the UHC index. 54% of people do not have access - that is significant," Dr. Gitahi said.

Dr. Ngashi Ngongo, the Chief of Staff and Head of the Executive Office of Africa Centres for Disease Control and Prevention (Africa CDC), said his organisation "would like to see the discussion also focus on Africa's critical public health priorities linked to universal health coverage and health security, including recurrent outbreaks, emerging and re-emerging diseases, the burden of endemic diseases, antimicrobial resistance, non-communicable diseases, and high maternal and child mortality".

Dr. Ngongo said Africa's major health challenges, including outbreaks, endemic diseases like malaria, HIV, TB, antimicrobial resistance, rising non-communicable diseases, and persistently high maternal and child mortality rates.

"Last year alone, we registered 166 public health events and outbreaks. That's a huge challenge when we look at the context of Africa in terms of the systems and financing and overall capacity to respond."

"To address these challenges, Africa CDC has launched its second strategic plan for 2023-2027, focusing on seven strategic pillars, including strengthening integrated health systems and accelerating disease surveillance and epidemic intelligence. Our goal is to build a safer, healthier, and more prosperous Africa," he said.

"Together, we can build a safer, healthy, and prosperous Africa that will help us to realize the goal of the agenda 2063 of Africa we want."

Pandemic Preparedness and Response

Dr. Moeti said that they're very much committed to building capacity. "We help member countries identify training needs for healthcare workers at all levels," she said. "We've established hubs in Nairobi and Dakar with essential training materials. This allows us to deliver key resources to countries within 2-4 days."

She addressed the ongoing negotiations on improving international health regulations and pandemic preparedness. "A key focus will be how lessons from COVID-19 shape global pandemic response," she said. "African nations are actively engaged... We must ensure Africa's unique needs are reflected in the final agreement."

There has been progress in Africa with UHC, Dr Moeti said. However, she said significant work remains.

The African region has made progress toward achieving UHC, with the average Service Coverage Index rising from 23 in 2000, to 46 in 2021, which means that the African Region is just
approaching the halfway mark (of 50 index points) to achieve UHC, with only seven years left to 2030, reports WHO.

"More Africans now access essential health services, and the trend is positive," she said. "The proportion of people pushed into extreme poverty due to healthcare costs has reduced from 45% in 2000 to 14%."

She said the growing non-communicable diseases (NCDs) burden in Africa and the need for integrated, person-centered approaches to tackle this along with infectious diseases. "There is an emergence of a fast-growing almost pandemic of non-communicable diseases, revealing a significant financial gap that necessitates a more integrated way of working to utilize available resources effectively."

Dr Moeti emphasized the importance of ensuring that all efforts are directed toward preparing for and responding to the impact of the climate crisis on health systems.

"We are seeing now, the climate crisis... And out of that, we have almost, you know, 300 people or more that are dead... And this is going to be repeated year in and year out," agreed Dr. Gitahi. He referenced the flooding in Kenya, and said that at least 50,000 people are displaced and access to healthcare facilities disrupted.

"We are now involved in efforts to vaccinate against cholera and the ability of vaccines to reach everyone who is at risk. And all of that comes from a climate crisis," he said.

Catastrophic out-of-pocket costs

Dr. Gitahi offered his insights into the significance of the World Health Assembly and the pressing health challenges facing Africa.

"The vulnerable are the ones carrying the health systems in their countries, which multiplies the vulnerability...the household GDP per capita expenditure on health is highest in the low-income countries," he said. Dr. Gitahi pointed out the inequity that the most vulnerable populations bear the highest out-of-pocket burden for healthcare, exacerbating existing vulnerabilities.

Dr. Gitahi said that there is a critical issue of low access to essential health services across Africa, with a large portion of the population without access, and the unequal burden is on vulnerable populations, especially in low-income countries where healthcare costs strain household finances.

So when we are talking about these issues, we are talking of Africa, not because Africa is special, but because Africa is the most vulnerable

He expressed concern about the rollback of sexual and reproductive health rights, especially for vulnerable populations. "We're seeing a worrying trend of state-backed groups restricting civil society and adolescents' access to essential reproductive health services and information," he said. "This lack of access only worsens the situation for those most at risk."

Africa's population is rising, with growth exceeding 2% annually, one of the fastest rates globally, and by 2050, it's projected at over 25% of the world's total. This surge is accompanied by the growing youth population - over 75% of Africans are under 35 (depending on the region), and more than half are under 19. However, Dr. Gitahi said the so-called youth bulge "presents a double-edged sword. It holds the promise of a demographic dividend, but without proper investment and opportunity, it risks becoming a generation without hope".

"These challenges are not just Africa's burden, but a global concern," he said. "In terms of equity, the world must prioritize the most vulnerable, for we are only as strong as our weakest link."

The 77th World Health Assembly is from May 27 to June 1, 2024, in Geneva, Switzerland.

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