Speaking at WEF Davos 2015, Anuschka Coovadia, Head of Healthcare Markets, KPMG Africa says: “We are still searching for robust, reliable and relevant systems, which are capable of the effective provision of affordable, high quality healthcare for all. And while we are finding our way, our solutions are being slowly and deliberately fashioned out of our unique, distinct and complex sets of needs and challenges.”
African patients are changing, but at different rates. While we are seeing a fast growing middle-class, increased consumerism and rapid urbanisation, the majority of people are still living in rural areas, in deep poverty, with low levels of healthcare literacy and minimal access to care. Conflict and war, high levels of inequality and penetrating social disruption work synergistically to disempower the sick.
“What’s more, fears tend to dominate over hope, which is a sad side-effect of being sick in a sick healthcare system,” says Coovadia. “Additionally, there is an overwhelmingly high reliance on out-of-pocket spending to pay for treatment which often leads to financial devastation for a family. Furthermore, there are low levels of trust in healthcare providers, which has led to the development of many parallel, and often conflicting, systems of care.”
As a result, in the absence of consistent, transparent information on the quality and cost of healthcare, most patients rely on word of mouth, chance and perception to choose a doctor, clinic or hospital and they lack an effective mechanism of recourse, when these providers fail them.
Continues Coovadia: “Africa also bears the world's heaviest disease burden, driven by the pervasively high prevalence of diseases such as HIV/AIDs, Tuberculosis and Malaria. In addition, our disease profile is becoming more complex with the growth in the middle class, changing patterns of food consumption and activity.”
The rise of non-communicable diseases such as Diabetes and Cardiovascular conditions brings new challenges to the planning, financing and delivery of care, as the impact from these diseases could be effectively contained by early detection, lifestyle modification and tight disease management. However, these levers are difficult to pull in geographically, economically and culturally diverse populations with poor health-seeking behaviours. “System shocks such as the recent outbreak of Ebola, have further highlighted the lack of our ability to respond regionally to an emergent threat, which has global consequences and profound local repercussions,” adds Coovadia.
A major concern is resources. While the continent may be rich in natural resources, we are poor in human resources. “We face a dire shortage of doctors and nurses, as well as a woefully insufficient pipeline of future healthcare professionals,” says Coovadia. “Working conditions are harsh and sometimes thankless; remuneration levels battle to remain competitive and attractive, particularly in rural areas. Career entry and progression is often a long, lonely and unrelenting struggle for the aspiring professional, within the fragmented, highly competitive, under-resourced and under-funded training systems. Developing leadership, management and research capabilities also tends to be neglected in order to meet more urgent needs. The impact of this will be felt severely in the future, as our emergent African healthcare system starts to look to its own people for guidance, oversight and local solutions.”
Despite a common abundance of healthcare policies, the actual delivery of care is significantly impeded by the lack of adequate healthcare infrastructure and the presence of inconsistent and incomplete regulatory and governance frameworks.
These foundations of healthcare are further weakened by the current low levels of technological maturity within the system, despite the high levels of adoption of certain technologies, like mobile, amongst the healthcare consumers. Moreover, investments in strengthening these core structures typically require extensive capital resources, but the rates of return, on this capital, often have high levels of variability and are difficult to compare directly to other competing opportunities. There are sometimes high sunk costs, indirect rather than direct benefits and lower or slower returns, than what is required by private capital. Brilliant isolated projects have been seen to collapse under the weight of their own overheads, because they have failed to develop an activated market around them, which would make the venture viable and sustainable. Systems of patronage and concealed vested interests also erode investor trust. A lack of access to capital or a lack of a suitable entry point for capital often leads to a mismatch between opportunity and investment.
Continues Coovadia: “Healthcare systems in Africa are further complicated by the sometimes opposing objectives, priorities and capabilities of the public and private sectors, operating in the countries. While the public sectors commonly lack financial resources, effective operations and human resources management and strong governance frameworks; the private sectors are often viewed as pursuing profit margins that are inappropriately high, given the embedded social nature of healthcare. Overall the private sector provides approximately half of the healthcare in Africa, but quality, cost and the integration of services remain variable, as providers frequently function outside coherent, consistent and complete regulatory platforms. In many of our countries, the public and private healthcare sectors have been unable to overcome the divide between them, which is an unfortunate missed opportunity for strengthening the provision of care on the continent.”
Given these complex, interrelated and mutually reinforcing healthcare system challenges, it is unsurprising that Africa has lagged behind the rest of the world on progress on achieving the Millennium Development Goals (MDGs), although some significant gains have been made. The MDGS are set to be soon revised, when the United Nation member states meet in September 2015 to decide on the Sustainable Development Goals (SDGs), which will guide the global development agenda until 2030.
Where health is concerned, the vision for 2030 is focused on working towards healthy lives for all through the pursuit of the following goals:
- Further reducing maternal mortality rates as well as new-born and child morbidity
- Eradicating epidemics such as HIV/AIDS, tuberculosis and malaria
- Substantively reducing deaths from non-communicable diseases
- Promoting mental health
- Ensuring universal health coverage and universal access to affordable medicines and vaccines
- Providing comprehensive sexual and reproductive health, including modern methods of family planning
- Decreasing deaths and illnesses caused by pollution and environmental degradation
Despite the inherent challenges in the systems and the specific set of hurdles faced by those who seek to innovate, improve and implement new products or services - in markets that commonly suffer inertia, actively resist change or seek to protect against new entrant – transformative concepts have managed to shine through and these will be critical to ensure that by 2030 Africa reaches the goals set out by the SDGs in 2015.
“In fact, it is highly likely that the next decade will witness the emergence of new defined "African Model" of healthcare, which will not be constrained by the entrenched practices and structures seen in the Western world. It is also likely that this system will progress rapidly and spread extensively in order to meet the latent and growing needs of its people - based on the provision of cost-effective primary healthcare, strong referral networks, the use of certain technologies, task-shifting and new categories of healthcare workers, training system and, regional regulatory authorities. This will be critical to meet our goals and this time, ensuring our economic growth is inclusive, sustainable and actually translates into better lives for all our people,” concludes Coovadia.