Investing in health systems for universal health coverage in Africa

Abstract

Background: This study focused on the 47 Member States of the World Health Organization (WHO) African Region. The specific objectives were to prepare a synthesis on the situation of health systems' components, to analyse the correlation between the interventions related to the health Millennium Development Goals (MDGs) and some health systems' components and to provide overview of four major thrusts for progress towards universal health coverage (UHC).

Methods: The WHO health systems framework and the health-related MDGs were the frame of reference. The data for selected indicators were obtained from the WHO World Health Statistics 2014 and the Global Health Observatory.

Results: African Region's average densities of physicians, nursing and midwifery personnel, dentistry personnel, pharmaceutical personnel, and psychiatrists of 2.6, 12, 0.5, 0.9 and 0.05 per 10 000 population were about five-fold, two-fold, five-fold, five-fold and six-fold lower than global averages. Fifty-six percent of the reporting countries had fewer than 11 health posts per 100 000 population, 88% had fewer than 11 health centres per 100 000 population, 82% had fewer than one district hospital per 100 000 population, 74% had fewer than 0.2 provincial hospitals per 100 000 population, and 79% had fewer than 0.2 tertiary hospitals per 100 000 population. Some 83% of the countries had less than one MRI per one million people and 95% had fewer than one radiotherapy unit per million population. Forty-six percent of the countries had not adopted the recommendation of the International Taskforce on Innovative Financing to spend at least US$ 44 per person per year on health. Some of these gaps in health system components were found to be correlated to coverage gaps in interventions for maternal health (MDG 5), child health (MDG 4) and HIV/AIDS, TB and malaria (MDG 6).

Conclusions: Substantial gaps exist in health systems and access to MDG-related health interventions. It is imperative that countries adopt the 2014 Luanda Commitment on UHC in Africa as their long-term vision and back it with sound policies and plans with clearly engrained road maps for strengthening national health systems and addressing the social determinants of health.

Figure 1

The WHO Health system framework.

Figure 2

Relationship between percentage of births attended by skilled health personnel and nursing and midwifery personnel per 10 000 population.

Figure 3

Relationship between percentage of births attended by skilled health personnel and per capita total expenditure on health.

Figure 4

Relationship between unmet need for family planning and number of district hospitals per 100 000 population in the African Region.

Figure 5

Relationship between contraceptive prevalence rate and nursing and midwifery personnel per 10 000 population.

Figure 6

Relationship between contraceptive prevalence rate and per capita total expenditure on health.

Figure 7

Relationship between measles immunisation coverage among 1-year-olds and general government expenditure on health as a percentage of total health expenditure.

Figure 8

Relationship between percentage of female population aged 15¿24 years without comprehensive, correct knowledge on HIV/AIDS and general government expenditure on health as a percentage of total health expenditure.

Figure 9

Relationship between antiretroviral therapy coverage among people eligible for that treatment and the level of external resources for health as a percentage of total expenditure on health.

Figure 10

Relationship between percentage of children under 5 years sleeping under insecticide treated nets and general government expenditure on health as a percentage of total government expenditure.

Figure 11

Relationship between percentage of children aged under 5 years with fever receiving antimalarial treatment and number of health posts per 100 000 population.

Figure 12

Relationship between case detection rate for all forms of tuberculosis and per capita total expenditure on health.

Figure 13

Relationship between smear positive tuberculosis treatment success rate and general government expenditure on health as a percentage of total government expenditure.