1. What is the State of
Health in Africa today?
Our InFocus series each run
for a maximum of 3 months.
With the new face-lift on the
Blog, this segment is covered
under INFOCUS.
Picture: AHCC
When a new focus subject is
announced, they will move to
this segment and the current But the question still remains – are the services accessible
subject moved under the to everyone equally in Urban and Rural areas? Are they
Issues tab. affordable and is the available service package the
same for everyone, despite the individual influence and
We hope to generate debate on diverse issues during this financial standing?
time and depending on your reactions, those issues may
feature in the coming periods. The question we are asking Commodities availability (medication, medical tools
on the first post of our INFOCUS series on Health is then, and machinery, condoms) are also another aspect
What is the State of Health in Africa today? challenging the sector. Reports from different parts of the
continent express dismay in the lack of and proliferation
From a policy perspective, Africa is facing significant of fake medication; health workers lack the tools needed
challenges in the health sector that are demanding to perform their duties effectively – from hygiene to tools
significant political, economic and social action. Access for medical attention.
to services, health services infrastructure, health human
resource (doctors, nurses, technicians and pharmacists), And the continent is making slow progress in the arena
health commodities and research are some of the aspects of research, especially on health issues. In 2011, 7
impeding the health sector and people. African Women Scientists were awarded under the
African Union Kwame Nkrumah Scientific Awards. The
People’s ability to access services is based on whether or awards symbolized the progress being made in medical
not health centres are within easy reach; whether services research on diseases such as malaria. It encouraged
are paid, shared cost or free; whether if infrastructure to greater and equal participation of women in taking
the services makes it difficult to reach services or not and leadership to address challenges. This is but a small step
whether they know about the services being provided. in strengthening the research base on the continent.
This very much relates to health services infrastructure
(buildings – hospitals and clinics). How does this respond to the core question we are
asking?
Health human resource is another aspect challenging
the health sector. Are there adequate numbers of health Click HERE to read the rest of the article
human resource to provide services? The ratio of Doctors, on Connect African Development Blog.
nurses, technicians, pharmacists and managers to people
and facilities is not sufficient. The question of what ratio
of particular health workers per patient is adequate, is
relative. But it remains a fact that in most African countries,
the ratio is still less desiring. Countries like Tanzania and
Malawi have a ratio of 1:50000 and are least performing.
South Africa has a just over 1:1200 ratio. Small Island
states such as the Seychelles and Mauritius and North
Africa countries are performing well.

2. A Crisis - Africa’s
Health Human
Resources Shortage
Picture: AllAfrica.com
On this second piece of our INFOCUS series, we examine the Health Human
Resource crisis on the African continent. The biggest challenge in putting this
piece together was getting data to give us an impression of the situation on the
ground. We discovered that this challenge to us was in-fact one of the main issues
behind this crisis; weak Human Resource for Health Information Systems and
generally, Health Information Systems.
In this encounter, we will be looking at specifically, others. In the 2006 Edition of the World Health
what the situation is collectively on the African Report by WHO 57 countries were identified as
continent with respect to Human Resource for having a Human Resources for Health crisis. Of
Health - the doctors, nurses, laboratory technicians, these, 36 countries were in Africa. Despite the
pharmacists, managers - in all over 20 different cadre continued forecasting of relatively good economic
types. Again, information for all these levels is not performance by many countries on the African
readily available. Most of the little reporting and data continent, there is a still a burden in a number
that is available looks at Doctors and Nurses and is of areas including efficient management of
outdated. More comprehensive information and data development capital.
is needed. Here is what the Africa Health Workforce
Observatory says about the challenge of accessing But if we can go back to the issue at hand, here are
information on health workers through current HR for some facts we collected on what is happening on the
Health Information Systems; ground;
The entire system depends on different Though we do not like this Sub-Saharan
sources such as health professional regulatory Africa phrasing, the region faces the greatest
bodies, health facilities staffing, health training challenges. According to WHO, while it has
institutions, faith based organizations, censuses 25% of the global burden of disease, it has only
or surveys, payroll records and other various 3% of the world’s health workers.
services in statistics for which the completeness,
timeliness and comparability are widely 36 countries in Africa, as aforementioned, are
variable with the challenges of combining and confronting critical Human Resource for Health
compilation of information from multiple sources. shortages, meaning they have fewer than 2.3
doctors, nurses and midwives per 1000 people.
What is the situation? This figure is the minimum required to achieve
an 80% coverage rate for deliveries by skilled
In the first piece we posted in our INFOCUS series, birth attendants or for measles immunization.
one of the things we highlighted was the Doctor
Patient ratio on the continent. We saw that some Click here to finish reading this piece.
countries were performing considerably well than

3. Profile of ongoing Our last InFocus piece looked at the Africa’s Health Human
Resources Shortage as a growing crisis. We noted that whilst
Programs addressing the challenge was significant, there were some noteworthy
the Health Human programs on the ground working to address the shortages. In
this piece, we will be profiling some of these programs. If there
Resource Crisis in is a program we did not feature, please send us information
Africa about it. These are only a few we were able to find;
Tanzania: Benjamin William Mkapa Foundation
- Mkapa Fellows Program
MKAPA Fellows is a pioneering, innovative human
resource for health program that supports the efforts of
the Tanzanian government to tackle HIV/AIDS. What
they do is simple; they recruit and deploy dedicated
fellows to work in remote communities with acute short-
age of health professionals.
Picture: BMAF
Kenya: Africa Medical and Research
Foundation (AMREF) - Human Resource for
Health Project
The erosion of Kenya’s key health indicators -life
expectancy, infant mortality and maternal mortality -
during the last two decades can be traced in part to
the deterioration of the health workforce. The acute
shortage, inequitable distribution and inadequate
skills of health workers have contributed to this
negative trend. The Kenya health workforce
currently stands at 1.69 health workers per 1,000,
way below the WHO is recommended ratio.
This small number of health workers is further
inequitably distributed denying vast sections of the
population access to quality health care thereby
Picture: AMREF
impacting negatively on health indicators despite
the heavy investment made in the various areas.
The HRH Project is working with the goal to contribute to the increase in the ratio of the
health workforce to population and to achieve equitable distribution of health human
resource in Kenya.
The project seeks to build advocacy skills, capacity and knowledge among civil society,
the government and non-state actors, including professional associations and recruiting
agencies to address the problem of human resources for health (HRH) in Kenya.
The objective of the project is to enhance the capacity of CSOs, Government officers and
other non-state actors to advocate for HRH issues in Kenya.
To see the entire list, Click Here.

4. Health Financing in Africa;
a % comparison between Total
Health Expenditure, Government
Expenditure & GDP
At the 2001 Abuja, Nigeria African Summit on HIV/
AIDS, Tuberculosis and other related Infections
Diseases, Heads of States and other actors agreed
on what has been a key reference point on financing
for the health sector. The outcome of the Summit,
the popular Abuja Declaration saw a commitment
by Heads of States to allocate at least 15% of the
total budget for the Health Sector. How much of this
commitment has been realized since then?
Picture: Global Health Check
WE COMMIT OURSELVES to take all
neccesary measures to ensure the needed
resources are made available from all sources
and that they are efficiently and effectively
Health Financing in Africa, a comparison
utilized. In addition, WE PLEDGE to set a target
of allocating at least 15% of our annual budget
to the improvement of the health sector. Article
26: Abuja Declaration, 2001
We have compiled data and generated presentation
using the World Bank Databank, selecting a total
of 54 African countries to make the progress
comparison. What we are comparing is the
percentage (%) of the following areas;
Total Health Expenditure; this including both
public and private,
Total Government Expenditure i.e. total fiscal
budget expenditure,
GDP.
Analysis of the
information will
show you that there
is still much needed
to be done. There Source: World Bank
is also progress on
a number of areas.
We will discuss
these areas in part To finish reading this article, please click here.
two of this article,
expected in a few
days time.

5. Health Financing in Africa;
Why is action so difficult?
This is the second part to our two
part post on Health Financing
in Africa. It is also the final post
on our INFOCUS series on
Health. On this edition, we are
concluding the discussion on
health financing by asking, why is
it difficult to take action on assuring
the requisite financing for the
health sector following regional
commitments global standards and
specifically, WHO’s Commission on
Macroeconomics and Health (CMH)
recommendations.
The trend in health financing on the continent is not encouraging. We saw this in brief
on the first part of this post where we looked at health expenditure comparisons on the
continent. Information on country, regional and continental progress that is produced and
actively disseminated by structures and platforms at these levels is also difficult to find.As
we have noted on other issues we have covered, it is critical for Africa to produce, package
and actively share information on socioeconomic issues it is facing. The continent can not
be dependent on institutions beyond its borders to generate on understand of the state of
our problems.
Regional data on total Government spending per capita in dollars (weighted) how
that East and West African country Governments are spending between $8 and
$9 per head, Central African Governments are spending about $20 per head;
while the corresponding amount for North African Governments is over $40 and
Southern African ones over $140.
Health Financing in Africa, Special Summit of African Union on HIV/AIDS,
Tuberculosis and Malaria (2006).
Why are countries not investing and financing health adequately? Our thinking is that
the process of costing for national health delivery is still a challenge. There are still many
puzzle pieces that are missing for the costing process to be smooth. We examined
before the lack of human resource for health. Other challenges also include insufficient
infrastructure and health commodities availability. Costing in these circumstances using
the same approaches as elsewhere in the world may very well yield flawed results.
But we believe many of these countries have the financing to meet ‘universal access to
health’ commitments. What is required is for deliberate decisions to be taken to favor
increases in health financing. For example the regions highlighted in the quote above;
many countries in these blocks have extensive access to sources of financing in the form
of minerals and an increasing tax base (both local and foreign). But mismanagement of
resources, corruption and unfair speculation by the outside world on natural resources has
diminished the revenue margins these countries work with. So if you are already working
with an inadequate income, the focus will remain on spreading the revenue across all
sectors and as a result, health indicators will remain unfulfilled for decades to come.
This is the final post for this series. Read the rest by Clicking HERE.
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