What should the future of health and health care services in Africa look like?
To face the challenges of COVID-19 and other emerging pandemics as well as the impacts of climate change, existing and emerging conflicts and an inflated cost-of-living, Africa must lead on solutions that address the continent’s health challenges through innovation, collaboration and investment.
That was the headline takeaway from AHAIC in Kigali earlier this month, the first African conference with a dedicated climate change agenda, where delegates from governments, private sector and civil society came together on a platform to develop a truly African agenda to address the intersections of climate, health and development.
It was amazing to be part of these discussions with our partners across sectors and to hear a unified message from diverse voices: building a strong and resilient African health system requires an Africa-led approach.
But what does that look like, and how will we get there? Aneesa Ahmed, Camilla Knox-Peebles, and Diana Mukami from Amref Health Africa reflect:
This means building the political will, commitment and leadership for a unified continental voice to advocate for global policy changes which meet the needs of African communities.
It is an oft-repeated line which holds its weight every time: Africa has contributed least to climate change, and yet communities in Africa are the most affected by the extreme effects of the climate emergency—from the increase in vector-borne and other communicable diseases because of extreme weather events to droughts leading to food and water insecurity.
To prepare for the health threats of the future, accelerated by rapid climate breakdown, it’s time for Africa to take a multi-sectoral approach and collaborate between government and non-state actors to ensure advocacy, commitment, allocation of resources and accountability to their shared climate, health and development agenda at the national, regional and global levels.
It also means employing a people-centred approach to address these shared health challenges, ensuring systems and service design that responds to the diverse unique needs of communities across the continent.
Primary healthcare is the foundation of a strong, resilient health system, and as Biruk Abate Halallo, Bill & Melinda Gates Foundation, Ethiopia reminded: "A coordinated and people-centred approach is key to primary healthcare."
Governments must invest in infrastructure and training health workers to support a strong primary healthcare system where people can access essential services including vaccinations, antenatal care, screening and treatment for communicable and non-communicable diseases.
Technology can help bridge the gap
Technology can be a great enabler to bridge the gap between people and the health services they need. But for this to help us build an equitable system, and ensure that technology serves the needs of communities, we need a more meaningful collaboration between governments, the private sector, healthcare workers, policymakers and communities.
As Daryl Burnaby, Global Health Director, GSK said: “No one sector can tackle the Sustainable Development Goals on its own. Private sector can and does play a role in convening various sectors to develop fit-for-purpose tech solutions.”
Communities play a crucial role
And communities play a crucial role to ensure that these service delivery innovations—whether digital health or community health worker programmes—are designed to address each community’s unique needs.
As Dr Redempta Mbatia, Executive Director, Tanzania Health Promotion Services said, community health workers are effectively managing preventive initiatives: “During the COVID-19 pandemic, we learnt that engaging the local government authorities and CHWs, backing them with resources they needed was key to strengthen vaccine uptake in communities."
Amref is similarly seeing the positive effect of technology innovations for health workers, including those at the community level. Three digital health tools were integrated in a project last year supported by partners Cognizant and GSK. This integration helps keep communities at the heart of our programme design for training and service delivery, improving the services that these health workers provide to millions of people across the region by ensuring trained health workers are focussing on giving the communities that need the most help, the right sort of help, at the right time.
Women and young people at the centre
Women and young people—who make up 60% of the African continent’s population (UN data, 2019)—must be key players in discussions, active designers in solutions and decision-making to ensure that their experiences and expertise inform Africa’s response to current and future health and climate crises.
As Dr Adelaide Lusambili, researcher at Aga Khan University’s Institute for Human Development said on a panel calling for stronger climate-health research collaboration, those who are impacted the most must lead the response: "Evidence shows that climate change/heat exposure will reverse gains in women's and adolescent girls' health outcomes. Integrated climate-health action is imperative now.” Indeed, women's health impacts population health. When you have good outcomes focussing on women's health, then you have a healthy population, said Dr Ida Mbuthia Medical and Scientific Affairs Lead East and West Africa, Roche Diagnostics. Dr Githinji Gitahi added that the reduction in malaria cases in Rwanda is a clear illustration of how increasing educational levels – especially for women and girls – will contribute to a progressive decline in communicable diseases across Africa.
Young people’s engagement in health and climate issues is crucial for progress to be made. There must be an enabling environment for their meaningful participation to share lived experience and expertise. The Raising African Voices competition winners showcased what youth leadership on climate action looks like—from biodegradable food packaging and regenerative farming methods to electric handcarts and e-tuk-tuks.
And, crucially, to partner across sectors and levels to invest in systems that prioritise Universal Health Coverage
Achieving UHC by 2030 will only be possible with deeper collaboration between stakeholders across all levels: governments; civil society; communities; and financial and technical institutions. And, said Dr Florence Temu, country director, Amref Tanzania, we must invest in health security equally as we invest in UHC. Investment in policies and systems based on UHC principles is critical to provide a framework to address country-specific, and indeed community-specific, health needs. But without investment in health security, our health systems may not withstand future threats.
This engagement and collaboration must be based on the plans created by countries, which combine their needs and priorities, and that are reflective of their entire population. Input and investment from partners and funders should align to those country-led needs and priorities, to support in implementation, and to ensure that these interventions are integrated into health systems for sustainable financing, and lasting change.
Innovation, collaboration, and investment will help us get there, but the final call to action goes to Dr Githinji Gitahi, Group CEO of Amref Health Africa: “We know that climate change and health are intrinsically intertwined, yet they have for decades now been treated as two separate issues... [We all] recognise the importance of engagement in critical dialogues to inform home-grown solutions. We all have a role in making this a reality, and we must take action.”