Financial Times

The world’s shortest life expectancy, largely caused by communicable and parasitic diseases stamped out in the developed world; two thirds of the global burden of HIV/Aids; widespread lack of clean water, sanitation and nutrition; rising rates of chronic diseases such as diabetes, hypertension, obesity and cancer – any one of Africa’s healthcare challenges would be daunting in isolation. Together, they are all but overwhelming.

How to respond? The Economist Intelligence Unit has some suggestions.

They are contained in a report published on Thursday, The future of healthcare in Africa, commissioned by Janssen Pharmaceutica, a Belgian subsidiary of Johnson & Johnson of the US.

As ever, the biggest challenge is financial. As the report puts it:

The improvement and extension of healthcare delivery in Africa is also being constrained by gaps in financing. Sub-Saharan Africa makes up 11% of the world’s population and accounts for a full 24% of the global disease burden, according to the International Finance Corporation.24 But the continent region commands less than 1% of global health expenditure.

Here is its chart showing the shortfall in public spending (click to enlarge):

There is no sign of improvement in that situation – indeed, says the report, seven countries have cut spending on health over the past decade. A worsening of this situation is one of three trends the report identifies that could prompt African nations to overhaul their health services.

First is the double disease burden of communicable and chronic diseases, with lifestyle diseases such as obesity expected to become the biggest challenge by 2030. Second is the rise of a middle class willing to pay for better services. Third is the prospect of cuts to developed world foreign aid programmes in the global economic downturn, draining scarce resources from Africa’s public health services.

Based on a survey of the literature on Africa’s healthcare systems and 34 interviews with academics, healthcare providers, policymakers and others, the EIU has come up with five “extreme scenarios” as potential outcomes of those trends, intended, says the report, to prompt debate on the ramifications of different health policies. It describes them as different but complementary visions of the future; elements of each could coexist with others. They are:

1. Refocusing on primary and preventative care, educating people about healthy lifestyles. This will help to limit the growth of chronic conditions.

2. Empowering communities as healthcare providers, training community workers and helping local people to take charge of their own healthcare.

3. Implementing universal coverage through basic health insurance packages, which most African countries will be able to provide a decade from now. Public private partnerships will build hospitals and train medical professionals. In wealthier countries, the private sector will become the dominant healthcare provider.

4. Making telemedicine ubiquitous, using technology – such as diagnosis via video conference – as the main means of extending services across Africa.

5. Encouraging local suppliers. As foreign aid budgets are cut, foreign donors will pull out of much of Africa. Wealthy countries will develop local manufacturing of basic drugs and medical equipment.

But the report says these scenarios are unlikely to develop over the next decade and presents substantial risks to each of them. Nevertheless:

�� what can be expected is that elements of all five will be present in Africa’s healthcare landscape, to varying degrees, over the next decade. A number of obstacles, however, will need to be overcome.

Chief among the challenges, unsurprisingly, is funding, which will involve hard political choices. Other challenges include changing attitudes to cooperation between the public and private sectors and putting greater emphasis on primary care for the poor. Perhaps optimistically, it concludes:

… particularly for the most developed countries, the reverberations from the global financial crisis offer an opportunity for governments to imagine a future of greater self-sufficiency in healthcare provision.

Redesigning healthcare in Africa

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