Over the last several years, African countries have significantly improved people’s health. Between 2015 and 2022, the proportion of births attended by skilled health personnel increased from 59 percent to 70 percent. More women and girls (15-49 years) now have improved access to sexual and reproductive health services, from 51.6 percent in 2015 to 57.4 percent in 2023,[1] with life expectancy increasing from 46 per cent in 2000[2] to 61 per cent in 2023.[3]
However, while progress has been recorded, inequalities in health care access persist, mainly for under-reached communities, resulting in most African countries being at risk of not meeting health-related Sustainable Development Goal (SDG) targets by 2030. It is projected that sub-Saharan Africa’s infant mortality will be 54 deaths per 1,000 live births by 2030 (over double the SDG target of fewer than 25 per 1000). Three hundred ninety (390) women will die in childbirth for every 100,000 live births by 2030 (over five times the SDG target of less than 70 per 100,000).[4] Childhood vaccinations have experienced the largest decline in three decades, leaving millions of children at risk from devastating but preventable diseases.[5]
While the COVID-19 pandemic and climate crisis have significantly slowed progress, policy and investment choices have exacerbated the situation. For example, while evidence has shown that community health workers (CHW) can dramatically turn the tide towards improving access to primary health care, many African governments have been reluctant to put in place pro-CHW policies and investments. As of 2020, only South Africa had reached the Abuja Declaration target of allocating and spending a minimum of 15 percent of its government expenditures on health.[6]
By prioritizing policies and investments in responsive primary health systems, African governments will improve access to health care services and enable countries to achieve health-related SDGs. Responsive primary health care systems ensure the availability of health care services when and where they are needed, adapt to changes in demand and routinely factor in community needs and preferences.
Health-related SDGs aim to achieve universal health coverage and provide access to safe and affordable medicines and vaccines for all. To achieve this, governments in Africa can prioritize areas that can provide quick wins to accelerate progress, such as:
Invest in salaried and skilled CHWs: Across Africa, there are only 1.55 health workers per 1,000 population, far below the WHO threshold for universal health coverage.[7] The WHO guidelines on health policy and system support [8] encourage countries to harness the potential of CHWs to accelerate the expansion of essential primary health services by ensuring the availability of health care services when and where they are needed, especially for under-reached communities. In Kenya, CHW-led interventions increased infant vaccination by 10.1 percent by ensuring vaccine availability when and where it is most needed.[9] Countries need to leverage good-practice policy examples from countries like Pakistan and Malawi to adapt and replicate.
Invest in integrated supply chains: The availability and accessibility of health products of assured quality is a commitment under SDG target 3.8. Integrated health supply chain systems allow governments to have clearly defined strategies, consolidate product flows and leverage private sector resources to ensure health products are delivered where they are needed the most. In Mozambique, the Pharmaceutical Logistics Strategic Plan (PELF) enabled a single supply chain system that reduced redundancy in logistics processes and achieved cost savings through shared resources, ultimately improving access to health products across the country.[10] Governments should prioritize adopting policies and regulatory frameworks that integrate supply chain processes to improve primary health care delivery.
Amplify community voices in decision-making: Communities often have a more holistic view of health care needs and preferences. Under-reached communities’ voices highlight tensions in access to health care and enable a policy decision environment rooted in direct needs and preferences. Routinely factoring the voices of under-reached communities in planning, design, delivery and evaluation improves quality and access to health care. It builds mutual trust and meaningful exchange of ideas and information. The New Public Health Order[11] calls for respectful, action-oriented partnerships that enable governments at all levels and health providers to listen, understand and respond to individuals’ and communities’ real needs and priorities through action.
Governments already have blueprints and guidelines that can help accelerate progress responsively, from documents such as the 2001 Abuja Declaration, the Africa Leadership Meeting (ALM) agenda, the Declarations of Alma-Ata and Astana and more. As we are at a pivotal moment on our journey to 2030, there is an urgent need for political leadership and commitment to move from rhetoric to action guided by these blueprints and declarations.
Our responses through policy and investments will shape the future of the primary health system’s resilience and security. The urgency towards responsive primary health care systems cannot be overstated. We need to act now before it is too late.
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[1] The Sustainable Development Goals Report 2023: Special Edition, https://www.un-ilibrary.org/content/books/9789210024914
[2] https://www.afro.who.int/news/healthy-life-expectancy-africa-rises-almost-ten-years
[3] https://www.gavi.org/vaccineswork/hiv-progress-raises-life-expectancy-africa-un
[4] Africa CDC Strategic Plan 2023- 2027, https://africacdc.org/download/africa-cdc-strategic-plan-2023-2027/
[5] The Sustainable Development Goals Report 2023: Special Edition
[6] WHO African Region Health Expenditure Atlas 2023, https://www.afro.who.int/pt/node/19665
[7] https://www.villagereach.org/2023/07/07/three-reasons-to-invest-in-community-health-workers/
[8]WHO guideline on health policy and system support to optimize community health worker programmes, https://www.who.int/publications/i/item/9789241550369
[9] Nzioki, J. M., Ouma, J., Ombaka, J. H., & Onyango, R. O. (2017). Community health worker interventions are key to optimal infant immunization coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya. The Pan African Medical Journal, 28, 21. https://doi.org/10.11604/pamj.2017.28.21.11255
[10] https://www.villagereach.org/2021/06/21/provinces-align-strategies-to-improve-medicine-distribution-in-mozambique/
[11] The Africa CDC, New Public Health Order, https://africacdc.org/news-item/africa-calls-for-new-public-health-order/