by Akofa Bart-Plange, Healthcare Development Consultant, one of our GHP West Africa Representatives (based in Accra, Ghana)

West Africa is made up of sixteen independent countries with highly interconnected economies. Nine of these countries are francophone, five anglophone and two lusophone (Portuguese-speaking). The multilingual makeup of its countries endows the West African region with an interesting demographic. This also affects the regional healthcare industry. Since the independence of these Sub-Saharan African countries over 50 years ago, the healthcare landscape has changed significantly and is expected to continue to grow as the continent progresses in development. Quality health is a prerequisite for development and it is becoming more evident that the achievement of this goal depends not only on the health sector but also on other factors, such as the environment, social systems, infrastructure and more importantly, regulatory structures and systems

It is predicted that the next half century will see a more holistic approach to providing quality health as systems and structures move towards not only curative, but preventative care as well. Dependence on multi-sectoral interventions will be required to improve access to and equity within the health systems.

The international community and regional development agencies are not being left out of this expansion. They are assisting with capacity building of national health systems and contribute funds.

CHALLENGES

Despite a significant transformation of the healthcare systems in most West African countries in the past couple of decades, the region is still grappling with the challenges of pervasive poverty, epidemic diseases and food insecurities among others. According to predictions Africa will face the challenge of a double burden of communicable and non-communicable diseases over the next 50 years. Communicable diseases such as HIV/ AIDS, Tuberculosis and Malaria remain the main causes of high mortality rates, whereas the prevalence of non-communicable diseases like diabetes, cancer and cardiovascular diseases are also on the rise due to the growing middle class and associated lifestyle changes. This presents a multi-faceted challenge in the health sector which is unfortunately difficult to overcome.

The population of Africa is predicted to grow significantly over the next 50 years. Predictions for the future reveal that the elderly will account for nearly 13% of Africa’s total population. Ageing increases the need for care and is directly proportional to the incidence of chronic conditions as well as long-term physical and mental disability. Unfortunately, the healthcare systems in the West African region are not well prepared to meet these geriatric needs.

The aforementioned challenges result in an overall insufficient healthcare infrastructure and high mortality rates (maternal, infant, adult). This outcome can be attributed to various factors:
1. Poor access to more affordable state-run healthcare facilities
2. Expensive privately-run healthcare facilities
3. Inadequate equipment and shortage of well-trained personnel at public healthcare facilities 4. Rural disadvantages concerning the distribution of health facilities
5. Inadequate drug-manufacturing plants and the issue of counterfeit drugs
6. Very low compliance with national health insurance schemes
7. Political influence in the purchase of healthcare equipment
8. Brain drain as health workers immigrate to more developed countries
9. Corruption and nepotism
10. Dependence on African traditional medicine
11. Persistent poverty
12. Insufficient budgetary allocation

SOLUTIONS

One way to address some of these challenges is to increase the share of health expenditure in the GDP. Healthcare financing remains a core element of the development of healthcare in West Africa. Appropriate healthcare financing systems and strategies are needed to improve access to products and services. This will enable countries to achieve Universal Health Coverage as well as the other targets set out in the Sustainable Development Goals.

For the creation of healthcare financing polices, it is crucial for government agencies to have knowledge about (1) the institutions which provide funding for healthcare (2) the institutions which obtain and administer resources to pay for healthcare and (3) the entities that receive these funds in order to provide the require products and services.
However, it is necessary to ensure better value for money throughout the West African healthcare systems. This means that they need to be more efficient, create less waste and make better use of their resources. In Sub-Saharan Africa, large amounts of funding have been directed towards healthcare infrastructure but less towards training of health professionals. A better balance concerning the allocation of funds is needed. This will improve and sustain the quality of healthcare delivery.

A second strategy for addressing West Africa’s healthcare challenges is to strengthen healthcare systems. Weak healthcare systems hamper the ability to respond swiftly to emerging challenges. A sustainable healthcare architecture is necessary to prevent lack of policy continuity, poor management of available resources, poor policy implementation and lack of resources.

THE FUTURE

Most African countries, not only West African countries, are on their way to providing their citizens with accessible, affordable and quality healthcare including a health insurance package. This path, albeit a slow one, will see massive restructuring of healthcare systems, promotion of public-private partnerships, leap-frogging into eHealth and improvements in the quantity and quality of the human resources in the healthcare sector. This truly makes West Africa the next frontier of healthcare.