Change across healthcare ecosystems in Africa

Dr Anuschka Coovadia is the head of healthcare for Africa at KPMG

A few of these countries are beginning to witness the birth of universal healthcare coverage, driven by the pursuit of national health insurance systems, with the concomitant reorganisation of the provider market. However, most African healthcare systems remain disorganised, fragmented, overburdened and under-resourced.

Most countries have made healthcare development a national priority and many vibrant debates are being held, on how best to achieve ‘healthcare for all’, within the resource constraints that exist.

Bold investments are being made into healthcare, by both the public and private sector, which hold the promise of greater access, better quality and more affordable services. Global innovations are bring adapted and adopted to suit the local need. And most importantly, the everyday African woman and man are beginning to value their health and wellbeing like never before, creating a new type of healthcare consumer, who is no longer willing to accept directives, dismissals, denials, disrespect and disdain.

Key trends

Africa’s population boom, rapid rate of urbanisation, widespread proliferation of mobile devices, increasing access to the internet and social media; and drive towards consumerism is leading towards an unparalleled level of focus and scrutiny on the adequacy of social infrastructure, provided by the State to its people, in each of the 54 countries.

Education, health and social services have become key pillars of many political campaigns around the continent and civil society is growing stronger and more organised, in terms of voicing its expectations, frustrations and demands. High levels of poverty and income inequality persist in many countries, despite the growth of a new middle class.

And the remarkable economic power of African communities, at the base of the income pyramid, is increasingly being recognised as a greater reckoning force.

Social media is connecting activism across these previously divided classes. And many are beginning to accept the view that prosperity should be shared and economic growth needs to be inclusive.

Healthcare is now being seen as both a critical driver and output of this transformation. Historically, most African countries have undercommitted financial resources to the healthcare sector, both in absolute and relative terms. This lack of investment has led to inadequate or poorly maintained healthcare infrastructure, a lack of sufficient human resources for health, serious challenges with regards to access to safe and affordable medicines and a lack of prevention of avoidable morbidities and mortalities.

These unnecessary deaths scar the face of progress and remind us of how far we still have to go.

Key challenges

• High burden of disease due to infectious causes
• Increasing burden of noncommunicable diseases
• High reliance on out-of-pocket payment
• Inadequate human resources for health
• Incomplete, ineffective or poorly implemented regulations
• Weakened systems of governance
• Political appointees to critical healthcare leadership positions
• Lack of information on cost and quality of healthcare services
• Poor referral networks between primary, secondary and tertiary levels of care
• Inadequate disease surveillance and emergency response systems
• Lack of sufficient investment in research and innovation
• Lack of adequate healthcare infrastructure
• Weak regional collaboration structures
• Inadequate management structures
• Technological immaturity and fragmentation
• Poor healthcare literacy

While there is a high degree of variation between and within each countries, the similarities are remarkable. A common set of solutions exist too, which could allow the very different African countries to ‘start where they are’ and move forwards, towards the goal of better health for all.

Resuscitating the system

Successful investors, entrepreneurs and scholars are often defined by their swiftness to see beyond negative perceptions – to see, that is, when the tide is turning for the better. Today, Africa’s growth areas (those cities, countries and regions where business is thriving) are fast overturning historic pessimism about Africa.

And the upward trend in investment into the healthcare sector in Africa, by both foreign and local interests, has been astounding. While governments and the elites may or may not invest in national health systems, the African consumer is choosing to circulate its capital in new offerings of high quality, accessible, cost-effective healthcare services that are rapidly springing up across the continent.

Nurses, doctors, clinics, pharmacy chains, diagnostics firms, emergency services, hospitals and specialist centres of excellence are rapidly reorganising themselves around a patient-centric model of care. In many instances, these services are provided by the private sector but actively supported by the public sector, which is starting to recognise their value.

Same solutions, different countries

• Prevention and promotion across public and private sectors
• Population and patient segmentation and stratification
• Scaled-up primary care
• Centralised and localised clinical services as necessary
• Clinical pathways supported by improvement science
• Workforce development and motivation
• Hospitals as health systems
• Medical home as a hub for aged care
• Community-based mental health services

Patients as partners. Communities as carers. A dignified death

Healthcare is most accurately viewed as an ecosystem - a web of specialisation and diversification. In this complex system, services for higher-income and lower income groups can impact favourably on each other. So too can the management of wellness and disease. The greatest synergy is achieved when national priorities are delivered upon by both the public and private sector.

Disruptors

MHealth and eHealth platforms are providing the previously missing links between different points of contact with the patient. These valuable connections are helping patients to navigate the system, get access to better information and connect to the right type of service, at the right time and at the right price.

They are also connecting primary or rural health clinics directly to speciality services, which are still predominantly found in urban areas. The retail revolution is bringing healthcare services directly to consumers in the spaces where we work, live and play. Shopping malls, places of worship, the workplace, community centres, universities and schools are all becoming important touch points with the healthcare system. As care moves closer to the community, population health and wellness can be more easily promoted, disease can be diagnosed earlier and chronic conditions can be managed better.