In the modern world, many of the societal pillars that were initially thought of as separate continue to reveal themselves as intimately intertwined. A discussion on education brings forth the need to, especially for Africans, rewrite what has been understood as history. A conversation on security comes with the imperative of economic stabilization. And concerns on demographics raise the issue of food security; while examining national healthcare matters reveals infrastructural gaps. It suggests, therefore, that holistic solutions to our wide-ranging challenges require leaders to see the bigger picture. This has become evident in efforts to create efficient health systems in Africa.
Accordingly, efficient health systems can only be provided by leaderships that strive to link the gaps in the nation’s social structure and its corresponding dynamics. In other words, any people-oriented leadership must take into account people’s social determinants – the conditions in the environment where they are born, where they live, learn, play or work – when drafting healthcare policies because it is these determinants that affect health outcomes and, in turn, determine people overall well-being.
The World Health Organization outlines six building blocks of an efficient healthcare system: health service, healthcare workforce, health information systems, medical devices and products, health financing, and health leadership and governance. Not only should the six building blocks be present, but they must also work together for there to be an efficient healthcare system. Most importantly, WHO focuses on leadership and governance because it is the revolving platform on which the other five blocks operate. Therefore, good leadership is the oxygen of a nation’s healthcare system.
These building blocks can be used as a measure to evaluate the resources that countries allocate to the health sector, such as human resources, technology and financial investments. As mentioned earlier, the interconnection between these pillars is key to guaranteeing an effective healthcare system.
The first block – Health Services – depends on the ability of a country’s governance system to deliver effective, safe and quality healthcare services to its people whenever and wherever they are needed. This refers to the primary healthcare system, whose fundamental philosophy should be to ensure that the entire population have access to essential healthcare services. However, the notion of access and coverage invariably bring questions about the infrastructure into the equation.
Although fundamental, the focus shouldn’t be on health infrastructure (such as hospitals) alone, but also on general infrastructure that will attract the necessary qualified medical personnel and reduce the urban exodus by encouraging the locals to participate in the economy of their regions.
The second block – Healthcare Workforce – reflects the ability of the leadership to design an education system that produces health providers proportional to the population and provides for their continuous training. The training must include specialized and multidisciplinary personnel, from laboratory technicians to experimental surgeons, to ensure the best possible outcomes.
Highly selective medical schools
Clinical fields, such as medicine, midwifery, nursery are skills like any other skill. Unfortunately, even when it is clear that Africa’s reality requires a huge number of clinical-related jobs – Africa currently has an average of 0.2 medical doctors per 1,000 people – medical schools in Africa continue to be excessively selective, a challenge that must be reconsidered if we are to produce the workforce that caters to people’s multi-faceted healthcare needs.
The medical profession is afforded a status in society as a “higher-calling” because at its core it is supposed to attract those who are primarily driven by the desire to serve their communities, and this should remain the main criterion of selection. However, the tendency has been a gap between the haves and have nots in terms of their access to the profession making facilitating inclusion of passionate young people from disadvantaged backgrounds whose primary ambition is to serve their communities an issue of pressing urgency, if the profession is to return to its noble instinct.
The third block – Health information systems – is the backbone of an efficient healthcare system. It addresses data, which allows the proper analysis and dissemination of reliable information: Continuous data gathering and analysis reveal important systemic – and even social – health determinants that require attention and intervention to improve the system. And for that to be achieved, public and private investments in African health tech startups are crucial.
The fourth block – Medical devices and products – is another cornerstone of a vibrant healthcare system. Since the Covid-19 pandemic, Africa has learnt the imperative necessity of the manufacturing of vaccines. Almost all our medical devices, from medical PPEs to test kits, had to be imported. Worst still, Africa’s own shortcomings are compounded by external factors and actors. For instance, the pharmaceutical industry’s reluctance to share the COVID-19 Technology Access Pool (C-TAP) with African countries reinforces the point that Africa urgently needs to invest in its own manufacturing capacity of medical products. This only validates the principle that everything is political, even – or especially – healthcare!
Moreover, in the long run, it is cost-effective for a country, region, a continent to mass-produce and manufacture their own medical devices and products. Not only does local production lower the price, but the potential for exports would also be an added value for local economies. Investment and job opportunities would also be created throughout the whole industrial chain.
The fifth block – Health financing – encompasses adequate healthcare funding that sustains both the healthcare providers and the receivers. Its necessity should dictate the use of public taxes and the prioritization of public-private partnerships to avoid catastrophes for the ordinary citizen since, simply put, the ultimate objective pursued by any effective leadership is to ensure that a healthcare provider easily affords the health they provide and a health receiver is not denied access to healthcare services on account of financial constraints.
Two more vital socio-economic blocks of healthcare that the WHO failed to mention are nutrition and physical exercise. These two can address the current major public health concern of non-communicable diseases (NCD), mainly cardiovascular diseases, cancers, respiratory diseases and diabetes which represents 80% of all premature NCD deaths. In fact, good nutrition and physical exercise represent for governments a potential health investment that will unequivocally decrease the healthcare burden in the long run. Globally, non-communicable diseases are a huge healthcare burden, especially in the western hemisphere where they have been directly linked with people’s culinary habits and sedentary lifestyles. To cope with that burden, the west has perfected the art of keeping people affected with non-communicable diseases alive, but it has been an outrageously expensive endeavour. Africans cannot – and should not – aspire to afford such avoidable costs. Therefore, turning to more natural and accessible measures, such as healthy nutrition and physical exercise, provide a more sustainable alternative.
Further, physical exercise includes endless ways of impacting and engaging the youth in the life of our nations. Sport-based scholarships and the availability of tracking fields, stadiums and sports arenas (especially those in high schools) are efficient strategies in developing healthy recreational activities and refraining from lifestyles devoid of intentional regular physical activities.
Finally, the inclusion of the arts in all high schools’ curriculums would definitely positively influence the mental health of young people and, at the same time, give the youth a sane platform for expressing themselves, finding their place and redefining the meaning of their lives in an ever-changing world. Music, poetry, dance, conversational and writing skills refresh the mind; they represent a psychological refuge and provide safe spaces to process feelings, reduce stress, promote self-discovery and increase self-esteem. Mental health and the arts are intimately linked in that the arts provide to community members tools and an imagination outlet that can allow them to fully express their worldview. Amongst other mental health management approaches, the arts represent a huge potential in addressing community mental health.
Healthcare is indeed a potential job creation for the youth. From the clinical perspective to all the important adjunct activities, each of the blocks represents a huge pool of investment and job opportunities. Healthcare should not be viewed as an end in itself but as a tool for population empowerment. Healthcare, in a national context, should go beyond saving lives; it should aim to empower them. A physically healthy nation thrives; a mentally healthy nation innovates; a comprehensively healthy nation protects itself. Universal health coverage is not about healthcare; it is about the total organization of society.
All of the above-mentioned parameters only work when the local healthcare leadership and governance (the sixth block) adequately formulates, implements and oversees the process. Indeed, the burden is on our leaders and the advisors they choose to work with. Moreover, the fact that the complex challenges we face cannot be resolved using simplistic approaches, the available technologies should be leveraged to holistically address these challenges and, crucially, only those who see the bigger picture will be able to achieve universal health coverage for their people.