At the end of the colonial era in the 1960s, African nations began significant efforts to bolster their healthcare systems, particularly under the mandate of public health development, to extend the reach of medical facilities and services into their rural areas. Spending on health (and education) as a percentage of the annual budgets of these nations was relatively robust. These activities were supported by the United Nations’ World Health Organization which prompted a community-focused approach to healthcare and advocated that comprehensive healthcare was a basic right and a government responsibility.

However, much of this effort began to be undone in the 1990s when the economic crisis across the continent ushered in the era of the World Bank and IMF loans. The need to borrow meant that African states began to lose control over their ability to set their domestic spending agendas. The “structural adjustment” lending requirements within the loan agreements mandated that African borrowers spend less on social services, including health and education.

Africa is exposed to over 22% of the global disease burden and yet commands less than 1% of global health expenditure and has a chronic health infrastructure deficit. Under investment has put a strain on existing health workers, including their working conditions, which has contributed to a US$2B annual loss on training costs as African doctors emigrate to high-income countries. Under investment in National Medicines Regulatory Authorities (NMRAs) has led to inconsistency of skills and authority between countries along with limited access to competent regulatory professionals, all of which has contributed to regulatory fragmentation.

As African nations began to pay back the World Bank and bilateral creditors, it soon became apparent that the debt level was unsustainable. Over the last fourteen years, this situation has gotten much worse. Just before the millennium, an estimate suggested that from an aggregate standpoint, Sub-Saharan African countries were transferring more to their western creditors than four times what they were spending on healthcare for their people. With decreased domestic public spending and very weak private sectors, the social services net the government had historically provided began to fall. This led, and today continues to lead, to increased poverty on the continent-and poverty, in turn, has led to increased health challenges- particularly regarding communicable diseases.

Privatization of health care, another suggestion of the World Bank, has only served to create a two-tiered healthcare system in Africa –with wealthy Africans having access to healthcare and poorer Africans not having access. With slightly more than 10% of all Africans having formal sector jobs, health insurance is also scarce in most parts of the continent.

According to a new World Health Organization report, life expectancy in Africa has increased by an average of ten years. The World Health Organization announced the good news after examining life expectancy data among the 47 countries that comprise the WHO African Region from 2000 to 2019 as part of a continent-wide report on progress on healthcare access for all – a key SDG target. According to the UN agency’s report, Tracking Universal Health Coverage in the WHO African Region 2022, life expectancy on the continent has increased to 56 years, compared with 46 at the turn of the century.

In particular, the continent has benefited from better access to essential health services – up from 24% in 2000 to 46% in 2019 – along with gains in reproductive, maternal, newborn, and child health. Ringfencing these precious health gains against the negative impact of COVID-19 – “and the next pathogen to come” – will be crucial, as the World Health Organization noted that, on average, African countries saw greater disruption across essential services, compared with other regions.

More than 90% of the 36 countries that responded to the 2021 WHO survey reported one or more disruptions to essential health services, with the most badly affected immunization, neglected tropical diseases, and nutrition services. Direct causes of ill health and death in Africa are varied, with eight conditions in the top 10 causes. Lower respiratory infections, HIV/AIDS, and diarrheal diseases still represent the top three causes of both morbidity and mortality. The threats of Ebola and Covid-18 are also prevalent in some regions of the continent. Other diseases that continue to plague Africa’s people include diseases such as Polio, Diabetes, and River blindness.

It should, however, be noted that the levels of morbidity are on a downward trend. The DALYs per 100,000 population associated with the top 10 conditions have dropped by half since 2000. The largest drops are associated with communicable conditions, with malaria (66% reduction), HIV/AIDS (57.9% reduction), and diarrheal diseases ( 56.5% reduction) having the highest morbidity reductions. On the other hand, the conditions associated with the least reductions are all non-communicable: road injuries (0.9% reduction) and congenital abnormalities (7.2% reduction).

Similarly, the mortality levels are also lowering, with an average crude death rate due to the top 10 causes of mortality falling from 87.7 to 51.3 per 100,000 population. As with morbidity, the reductions in crude death rate were most significant in the same three communicable conditions: Malaria (66% reduction), HIV/AIDS (57% reduction), and diarrheal diseases (52% reduction). Again, the reductions in mortality are least with non-communicable conditions, led by road injuries (1% reduction), ischaemic heart disease (2% reduction), and stroke (3% reduction). This reinforces the need for countries to scale up interventions to reduce mortality associated with non-communicable conditions.

The major disease leading to mortality in Africa is Tuberculosis or TB. TB is also the ninth leading cause of death worldwide and the leading cause of a single infectious agent, ranking above HIV/AIDS. In 2017, 2.5 million people fell ill with TB in Africa, accounting for a quarter of new TB cases worldwide. HIV/AIDS, the second-highest killer, accounts for approximately 34 million HIV-positive people worldwide, and 69% live in Sub-Saharan Africa. There are roughly 23.8 million infected persons in all of Africa. Of all infected children worldwide, 91% of HIV-positive children live in Africa. Since the epidemic of HIV/AIDS, more than 75 million people have contracted the illness, and over 36 million have died from an HIV-related cause. In 2018, 1.1 million people in the WHO Africa region contracted HIV, and the same year resulted in 470,000 deaths from AIDS-related illnesses. In Africa, 81% of people with HIV know it, while 64% of people with HIV have access to lifesaving antiretroviral therapy.

According to the latest World malaria report, there were 247 million malaria cases in 2021 compared to 245 million in 2020. The estimated number of malaria deaths stood at 619 000 in 2021 compared to 625 000 in 2020. The WHO African Region carries a disproportionately high share of the global malaria burden. In 2021, the region was home to 95% of malaria cases and 96% of malaria deaths. Children under 5 accounted for about 80% of all malaria deaths in the region.

Over the two peak years of the pandemic (2020–2021), COVID-related disruptions led to about 13 million more malaria cases and 63 000 more malaria deaths. The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2021 the region was home to about 95% of all malaria cases and 96% of deaths. Children under five years of age accounted for about 80% of all malaria deaths in the region.

Four African countries accounted for just over half of all malaria deaths worldwide: Nigeria (31.3%), the Democratic Republic of the Congo (12.6%), the United Republic of Tanzania (4.1%), and Niger (3.9%). Malaria elimination is still a challenge, and only two African countries, Algeria and Morocco, have been certified malaria-free by the WHO.

COVID-19, a global pandemic declared by the World Health Organization (WHO), is crippling the global economy and upending people’s lives, threatening sustainable development across all dimensions. Africa also faces the dire consequences of the crisis, necessitating timely response, recovery, and rebuilding policies and strategies. Urban areas are the epicenters of the epidemic, accounting for most of the confirmed COVID-19 cases. The COVID-19 risk factors are acute in African cities partly due to the largely unplanned and poorly managed urbanization process resulting in widespread informal settlements and severe infrastructure and service deficits. In 2019, about 47% of Africa’s urban population lived in slums or informal settlements, translating into about 257 million people across Africa. Only 55% and 47% of Africa’s urban residents have access to basic sanitation services and hand washing facilities, respectively. 

Furthermore, most urban residents rely on the informal sector, which employs 71% of Africans, making them highly vulnerable to loss of income and unable to abide by restrictions and lockdown measures. African cities often have high population densities and overcrowded public transport and marketplaces, making social distancing almost impossible. These factors combined make Africa’s cities hotbeds for COVID-19.

As of November 18, 2022, the number of confirmed COVID-19 cases in Africa amounted to around 12.7 million, representing around two percent of the infections worldwide. By the same date, coronavirus cases globally were over 640 million, and deaths were over six million, and approximately 620 million people recovered. On the African continent, South Africa was the most drastically affected country, with more than 3.6 million infections.

Although African countries still have a long way to combat the virus fully, vaccination programs have been rolled out in most of Africa. Also, according to a survey, public opinion in several African countries shows a high willingness to be vaccinated. In terms of the absolute number of COVID-19 vaccine doses administered, Egypt ranks first in Africa and 23rd globally (more than 100 million) and the 10th highest number of doses administered per 100 people (90.4) on the African continent.

In 2008, Burkina Faso hosted a conference on Primary Health Care and Health Systems in Africa. The conference adopted the “Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving Better Health for Africa in the New Millennium.” This Declaration was endorsed by the 58th Regional Committee, which also adopted the related Resolution AFR/RC58/R3. A generic framework for the implementation of this Declaration has been prepared to build on the priority areas highlighted in the Declaration as well as other policies and goals related to health development. Also, on the policy front, African Union member states strongly endorse and share the values and principles of the Sustainable Development Goals adopted in 2015, in particular, Sustainable Development Goal #3:

The AU’s Regional Office supports Member States in revising or developing their national health policy and strategic plans. Also related to policy formulation, the Regional Office provides technical support to countries. To date, 44 national health policies have been developed/revised based on the AFRO guidelines. This represents an increase of 35% in the past four years. Developing these national health policies is improving through a more inclusive approach involving all relevant stockholders active in health development. However, efforts must be made to strengthen the capacity of countries in policy analysis.

Increasing localization of pharmaceutical supply chains, driven by the pronounced need for African markets to become self-sufficient, will accelerate market growth across many regions. The realization of the need to invest in diagnostic capabilities, highlighted by the COVID-19 pandemic, will enhance capacity and further expand the market. Additionally, Healthtech offers African markets the opportunity to bypass expensive traditional healthcare models. This rapidly growing sector can significantly improve the productivity of healthcare assets.