The events of the past two years require candid reflection on the future of health in Africa, which hangs in the balance should the vaccine injustice perpetuated against the people of this continent remains unyielding.
The reality of being left behind while the rest of the world moves towards attaining post-pandemic social and economic recovery is sobering. It stands in stark contrast to the hope and optimism that once characterised Africa’s health landscape.
The continent’s early post-colonial period (late 1960s to 1980s) saw health regarded as a basic human right, with services financed by domestic taxes and offered mostly free of charge at points of care.
The evolution of health in Africa since then has been disappointing. What was once inspiring progress has been derailed by a myriad of challenges that continue to plague the continent, with neo-liberal and neo-colonialist policies imposed by those who control the purse strings. This has contributed to the collapse of our health infrastructure and weakening of health policies.
Today, our continent is suffering from the long-term consequences of external influences on health. Poor investment in primary healthcare and infrastructure, lack of homegrown research, development and manufacturing capacity of critical resources such as vaccines and medical equipment have made access to quality, affordable healthcare a preserve of the wealthy – many of whom often seek health services abroad.
Unsurprisingly, the global north repeatedly refuses to acknowledge its role in the decimation of Africa’s health systems. Even where our contributions to global health deserve applause – such as with the South Africa-led discovery of the Covid-19 Omicron variant – these contributions have been diluted and used to further entrench inequity in global health, which can never be truly global if Africa is left out.
This is exactly what has happened in the recent past, with the travel bans instituted against several countries in southern Africa in response to the discovery of the Omicron variant reinforcing proof of wealthier nations’ unfair treatment of the continent.
It is this treatment that threatens to reverse gains towards achieving Universal Health Coverage in Africa. If the status quo is maintained, vaccine equity – beyond Covid-19 – will remain a pipe dream and the continent’s goal of ensuring that every citizen enjoys equal access to quality healthcare services, without the risk of financial hardship, will never be met.
As stated by the Africa Health Agenda International Conference Commission Report on the State of UHC in Africa 2021, we have a long way to go before we can attain UHC. Essential services coverage in Africa remains low, with approximately 52 percent of the population (615 million people) lacking access to healthcare.
Even where services are available, they are not attuned to the needs of vulnerable groups such as women, girls, the poor and minorities like those living with disabilities and the LGBTQ community.
On a continent where the average annual income is about $1,485 (Sh173,377), these services are also significantly out of reach owing to their cost, pushing 15 million people into poverty each year as a result of catastrophic out-of-pocket healthcare payments.
It's a troubling state of affairs, and one compounded even further by broader contextual challenges such as the legacy of colonisation, weak governance and accountability, underfunded health systems and a high disease burden, in addition to emerging and future challenges like climate change and the Covid-19 pandemic, among others.
These challenges have shone a spotlight on the weaknesses in Africa’s health systems and reminded us that, indeed, UHC and health security are two sides of the same coin. Yet despite the bleakness of the current state affairs there exist opportunities for health transformation on the continent.
Increasing political will to make advances towards UHC offers the promise of a healthier future for Africa, which can be achieved if African leaders can move beyond the rhetoric to speedy, decisive action.
Among the opportunities that can be leveraged to promote a much-needed renaissance of health on the continent include regional, multi-sectoral collaboration driven by belief in the same overarching values, key among them being that health is a universal, absolute human right.
Political commitments to UHC need to be utilised to advocate for more investments in health reforms. More African countries must enact pro-people UHC legislation and policies that are fit for purpose (not centred on health insurance reforms alone), inclusive and innovative.
Africa must quickly tap into its demographic dividend to nurture and improve human resources in health; cultivate domestic funding capacity to reduce reliance on external financing for health; embrace accountability and strengthen public-private partnerships for design and execution of policies and strategies that will reinforce health systems and lead to the development of the sector as a key pillar of economic growth.
We cannot afford to sit back and wait for the world to fix our problems. Covid-19 is testament to that. For Africa to recover from the devastating impacts of the pandemic and build resilient health systems in a post-Covid world, we must be willing to put in the work and create African solutions for African challenges. There is no time to waste.
Mbindyo is CEO, Amref Health Innovations, Dr Kanari is UHC Lead, Amref Health Innovations
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