Strengthening health and well-being in Sub-Saharan Africa

Sub-Saharan Africa is often viewed as a region of extremes, with both tremendous resources and enduring difficulties. In recent years, demand for those resources has stoked strong economic growth but that growth has played out amid well-documented—and daunting—challenges: conflict, poverty, and the twin scourges of HIV and AIDS, Ebola to name just a few. A deeper look at what is occurring in Africa today reveals a more complex—and hopeful—picture.

 Globally, sub-Saharan Africa bears the greatest burden of disease. Despite these low ratings, health care is not a primary policy concern for people in these countries. Instead, sub-Saharan Africans cite jobs as a top priority, followed by improving agriculture and tackling corruption.

In recent decades, global attention to the harrowing state of health in sub-Saharan Africa has increased dramatically. Funding to combat the major health problems there has reached unprecedented levels, and marked improvements have been made. In Zanzibar (Tanzania), for example, malaria deaths have been cut substantially. And in Uganda, maternal mortality has dropped by more than half.

These efforts have also produced important results. In a growing number of African nations, the catastrophic rate of new adult HIV infections appears to be falling: according to the UNAIDS (the Joint United Nations Programme on HIV/AIDS), the number of new infections in sub-Saharan Africa declined by approximately 25 percent in 2018. Similarly, tuberculosis rates are slowly decreasing across the region. Malaria incidence and mortality are declining not only in Zanzibar but also in several other parts of Africa.

But while health aid has increased to sub-Saharan Africa from high-income countries, residents there do not view health care as a top policy priority. Instead, 31 percent of people picked new jobs as their top concern, and 21 percent picked improving agriculture. Tackling corruption was next at 14.4 percent. Education and health care were chosen by 13.6 percent and 13.5 percent, respectively. Providing electricity was picked by only 6.3 percent.

The region continues to face profound health challenges. Tanzania, for example, has made progress against childhood mortality, yet one in every nine Tanzanian children still dies before age five. And the country’s maternal mortality rate remains stubbornly high, despite almost three-quarters of these deaths being preventable.

The current Ebola epidemic which began in August last year in eastern Congo has already infected at least 2,062 people, killing 1,390 of them, a tragedy whose repercussions go well beyond the direct death toll. In a continent where malaria alone takes half a million lives, the impact of Ebola on the health systems and the social and economic stability of the region suggest that the crisis is far from over.

Of course, just because people in sub-Saharan Africa do not see health care as the highest priority does not mean that aid agencies are incorrect to prioritize it, People in the region may be poorly informed or after centuries of high morbidity, they may not believe the government or anyone else is capable of providing meaningful relief. But even if they are well informed, it might also be the case that aid agencies believe -- correctly or not -- that they are more effective at saving lives than at generating economic growth.
Basic solutions

A third of sub-Saharan Africa's (SSA) population comprises persons aged 10-24 years. These youth are growing up in a context marked by pervasive poverty, limited educational opportunities, high HIV/AIDS prevalence, widespread conflict, and weak social controls.

 For the sub-Saharan African region to take advantage of the dividends of a growing youthful population, the region must raise her capacity to generate rigorous scientific evidence to inform policies and programs designed to improve the health and wellbeing of her young people. This means that governments should not only encourage and fund research on young people’s health and development but also actively use evidence generated to inform policies and programs geared towards the youth.

To address the rising burden of diseases, improve health systems, and attain better health, the continent needs strong public health research capacity. Countries with a weak population and public health research capacity have limited capacity to identify and prioritize their health needs and, hence, are unable to develop and implement effective interventions to promote well-being.

Strengthened capacity to understand the determinants of health in relation to gender, ethnicity, cohorts, and communities among different African populations holds the key to effective interventions to improve health outcomes and health systems in the region. It is now generally accepted that Africa's progress depends on her ‘ability to understand, interpret, select, adapt, use, transmit, diffuse, produce, and commercialize scientific and technological knowledge in ways appropriate to [her] culture, aspirations, and level of development approaches to science and technology in development.

Ensuring healthy lives and promoting the well-being for all at all ages is essential to sustainable development. Significant strides have been made in increasing life expectancy and reducing some of the common killers associated with child and maternal mortality.

Major progress has been made on increasing access to clean water and sanitation, reducing malaria, tuberculosis, polio and the spread of HIV/AIDS. However, many more efforts are needed to fully eradicate a wide range of diseases and address many different persistent and emerging health issues.

The private sector plays a significant role in spearheading innovations across Africa. In addition to providing capital investment, businesses can share strategic logistics and marketing know-how, source from local distributors and assess the scalability of projects –all key measures in ensuring lasting social and economic value. The private sector also drives other stakeholders to advocate for sound policies, tailored solutions, improved infrastructure and relevant research.

Instilling a culture of innovation is a promising way to propel the whole of Africa in its efforts to eradicate diseases and improve health. All health organizations should pioneer solutions customized to the unique context and culture of communities across Africa. Nevertheless, more support is needed, particularly from governments, to encourage future entrepreneurs to seek to invent new solutions with the potential to create a lasting impact on the health of hard to reach communities.

The Ebola crisis has also highlighted the urgent need for national and international investment in the affected countries in order to strengthen the health and surveillance systems, as one of the major priorities.  If we are to win the current war on Ebola, we must employ unconventional approaches, even ones that might be considered controversial. The fact is, people who are poor and neglected are more susceptible to infectious diseases and distrustful of authority. Distrust of authority, civil war and Ebola are a recipe for disaster even with the most costly response and medical counter measures.

 This epidemic is in a truly frightening phase and shows no sign of stopping anytime soon; we can expect and should plan for more cases in DRC and neighboring countries. The Ebola crisis has shown that, in global health, turning a blind eye may result much more expensive than acting on time. That moment, unfortunately, has arrived.

Furthermore, to ensure solutions are scalable, sustainable and impactful, governments, businesses, academics and NGOs must all bring their respective strengths to the table, combining local and international capacities in advocacy, fundraising, business expertise, scientific knowledge and data, holistic and integrated solutions can be developed, resulting in a larger positive impact – a win-win situation for all involved.

Finally, Researchers need to develop innovative ways to reach out to national authorities, policy makers and key stakeholders who will use their evidence in their operations in the continent.  Strengthened research capacity to understand the social determinants of health among different African populations is key to addressing the drivers of poor health and developing interventions to improve health outcomes and health systems in the region.

Funding agencies and governments should support research on typically under-researched areas of people’s health in SSA including mental health, injuries, and non-communicable diseases and encourage future entrepreneurs to seek to invent new solutions with the potential to create a lasting impact on the health of hard to reach communities #SDG3 #HealthforAll #UniversalHealthCare #StrengtheningHealth #HealthyLives #SDGS #Wellbeing