Taking on the Challenges of Health Care in Africa

As the types of illnesses change throughout the continent, half the population still lacks adequate health services.

June 16, 2015

| by Lily B. Clausen

 child sitting in a wheelchair at the Center for the Rehabilitation of the Handicapped in Yaounde, Cameroon

Access is still the greatest challenge to health care delivery in Africa. | Reuters/Finbarr O’Reilly

Technology is transforming how health care is delivered in Africa, giving more people in remote areas there and around the world access to better care. Likewise, easier access to data helps both doctors and policymakers make better-informed decisions about how to continue to improve the system.

Even with these strides, however, the continent’s health care system faces big challenges.

The health care professionals on the ground in Africa know the frustrations firsthand: counterfeit pharmaceuticals; shopping malls equipped with air-conditioning, while sweltering medical clinics limp along without it; much-needed medical equipment such as MRI machines getting caught up in the gridlock of international customs.

Africa, too, is confronting an increased demand beyond the treatment of AIDS, malaria, and other communicable diseases to address the noncommunicable ones such as hypertension, which are growing as the middle class increases.

Three health professionals — Abayomi Ajayi, Letitia Adu-Ampoma, and Azure Tariro Makadzange — recently discussed these hurdles on a panel about health care in Africa at the Stanford Africa Business Forum at Stanford GSB. They shared their thoughts about scaling health care businesses in Africa during an interview with Stanford Business.

How is technology influencing the health care industry?

There should be an opportunity for entrepreneurs to enter the health delivery space in Africa.
Azure Tariro Makadzange

Abayomi Ajayi, obstetrician and gynecologist:

Access is still the greatest challenge to health care delivery in Africa. Fewer than 50% of Africans have access to modern health facilities. Many African countries spend less than 10% of their GDP on health care. Also, there is a shortage of trained health care professionals from Africa because many of them prefer to live and work in places like the U.S. and Europe.

African countries have to embrace technology to close the health care gap, and private-public partnerships can help with that. We have seen that maintenance is usually one of the major problems with technology in the public sector, as everybody’s property is usually no one’s, and therefore no one takes responsibility for keeping it up to date and making repairs.

What is the role of Africa’s government in providing health care?

Azure Tariro Makadzange, infectious disease physician:

I think government is responsible for ensuring that everyone has access to health care, however, I don’t think that health care is a public good that is the sole responsibility of the government. There should be an opportunity for entrepreneurs to enter the health delivery space in Africa.

Unfortunately, due to aid and its influences, it is exceedingly difficult for local entrepreneurs to compete with the foreign-funded public programs. There are no incentives for entrepreneurs to enter that space to provide health care to the middle classes and the working poor.

The low-hanging fruit for many at the moment is providing health care to Africa’s growing wealthy class while creative, innovative, and sustainable solutions to providing care to the majority who cannot afford expensive care are lacking.

What’s the biggest challenge for health care delivery in Africa?

Letitia Adu-Ampoma, of Sandoz, the generic pharmaceuticals division of Novartis:

I think there are several big challenges for health care delivery in Africa, says Adu-Ampoma who noted she was speaking for herself and not the companies she works for.

Worker Shortage

The number, quality, and capability of health care workers across countries as a ratio to the population is low.

Corruption in the Public Sector

Corruption diverts much-needed resources away from health care delivery and reduces patient access to services. Examples include medical staff in public sector health care institutions who sell drugs that should be free, and theft (for personal use) or diversion (for private sector resale) of drugs and supplies at government storage and distribution points. In addition, bribes to gain approval for drug registration or to pass drug-quality inspections are resulting in fake drugs “legitimately” entering markets.

Counterfeit Drugs

A darker consequence of the rise of technology is that it enables counterfeiters to run even more sophisticated operations and make counterfeit drugs that are harder to detect. An example of this can be found in Nigeria where, despite regulators adoption of counterfeit drug “track and trace systems,” there is evidence that some of these systems are being successfully “copied” by counterfeit drug producers. As a result, counterfeit drugs now present themselves as authentic drugs.

Changing Medical Needs of the Population

Much of the current focus of health care delivery in Africa is on traditional and visible factors like HIV and malaria. However, changes in lifestyle and a growing middle class are making noncommunicable diseases like cardiovascular disease, cancer, and diabetes big issues among populations. Rapid urbanization and increased Westernization of lifestyles among the middle classes is causing an increase in the risk factors that cause noncommunicable diseases.

People consume more fast food and packaged foods, which tend to have high levels of sodium; they engage in less physical activity, sitting in their cars and buses on their way to work; and they are more likely to consume alcohol in their leisure time. Another risk factor is an increase in smoking rates across populations.

Abayomi Ajayi is an obstetrician and gynecologist at Nordica Fertility Centre Lagos in Nigeria; Azure Tariro Makadzange is an infectious disease physician at the Ragon Institute of MGH, MIT and Harvard, and also at the University of Zimbabwe College of Health Sciences and Letitia Adu-Ampoma is head of compliance in West and Central Africa for Sandoz, the generic pharmaceuticals division of Novartis. In April, they addressed the Stanford Africa Business Forum at Stanford GSB.

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