Health Care in Sub-Saharan Africa: 21st Century Trends and Forecasts

This brief is part of the Insights @ Center for Emerging Markets, a publication focused on cutting-edge ideas and advice for global leaders about emerging markets.

By Richard Wamai (Northeastern University) and Hugh Shirley (Harvard Medical School)

Current Health Challenges

Currently, Sub-Saharan Africa is home to one in eight people in the world, and by the end of the century, it could be one in three. The continent's population and economic trajectories have inspired optimism despite its history of colonial exploitation and frequent poor governance post-independence. However, Africa has continued to lag other world regions in all major health outcomes despite enormous national and international efforts. Currently, Sub-Saharan Africa remains the region of the world with the lowest improvement in life expectancy. The high burden of disease, poor population health outcomes, and inequities are due to high levels of poverty, weak health systems, poor governance, historical colonialism, and present-day neocolonial foreign aid policies.

The region is made up of 47 countries and has a population of 1.07 billion, with a median age of 18 years. It has the highest number of underdeveloped countries in the world, and the highest number of people living below $1.90 per day in 2018. It also accounts for the highest number of deaths and disability due to infectious diseases in the world. Women and children are particularly vulnerable, having the world's highest maternal and under-five mortality rates. To improve health outcomes, women need to have access to education and contraception, and both mothers and children need to be vaccinated. Corruption and poor governance of foreign and domestic resources have exacted a toll on health development across the region.

Life expectancy in Sub-Saharan Africa was 61.2 years in 2016, rising slightly to 63.9 years in 2017. Even within the region, health disparities within and between countries are staggering, with the average person in Mauritius expected to live 21.9 years longer than the average person in Lesotho. The high rates of disease in Africa are often due to poverty, childhood nutritional deficiencies, unsafe water and sanitation, limited access to healthcare services, and a high prevalence of HIV/AIDS. While not unique to the region, human behavior, including demographic changes, migration, and consumption patterns, contribute to the spread of infectious diseases and make containment more difficult. Finally, the close interaction between humans, animals, and the natural environment can lead to conflicts and the transmission of zoonotic diseases, while poor disease surveillance and coordination during health emergencies allow infectious diseases to spread.

Recent studies predict that specific disease targets, such as reducing malaria and tuberculosis deaths by 2030 and 2035 respectively, are unlikely to be met. Moreover, while Sub-Saharan Africa has made significant progress towards meeting its global AIDS targets by 2030, achievements vary by country, age, gender, and socio-demographic status. Achieving treatment targets will require a combination of interventions targeted by profiles of population risk and geography, while governments and donors need to improve efficient resource utilization and accountability to meet the funding gaps required to meet the set targets.

One study in particular by Rweyemamu and colleagues for the UK Office of Science and Innovation's Foresight program warned of the dire impact and future threats posed by infectious diseases in Africa. The report predicted that human behavior, including demographic changes, migration, and consumption patterns, would present the highest disease risk in the 21st century. HIV/AIDS was labeled a “time bomb” that will continue to affect health and development in Sub-Saharan Africa while other diseases emerge; in 2022 it had 48 infectious diseases that were severe enough to require an international response.

Longer Term Challenges

Like much of the rest of the world, the burden of non-communicable diseases is increasing rapidly in Sub-Saharan Africa. Part of this transition is due to an aging population. The share of people over the age of 60 will double by 2030 and will continue to grow at an annual rate of about 4 percent over the next fifty years. In response to this looming threat, sub-Saharan countries must strengthen surveillance and health systems and adopt a model in which interventions are integrated across disease groups and health systems. This will not only save lives, but also reduce long-term healthcare costs. Climate change is negatively impacting health in sub-Saharan Africa currently, and its consequences will mount as the world reaches ever-higher emissions thresholds. Despite contributing very little to the climate crisis, the people of Africa will face significant challenges that will amplify existing health inequities.

Policy Implications

• The future of health in Sub-Saharan Africa is challenging yet promising. This could be the century for Africa. To address its short and long-term health challenges, improved financing for healthcare delivery and access are needed. This is particularly important as the region is vulnerable to the impact of climate change, which raises the risk of new epidemiological threats to its population. Moreover, as a persistent global funding gap for pandemics continues to affect Sub-Saharan Africa, the entire global aid model needs to be reformed in light of its negative impacts on the sustainability of the region's healthcare system. For instance, many foreign donors continue to foster a colonial legacy by imposing political, cultural, and religious morals and demands on recipient countries, and well-funded NGOs and foreign governments often siphon off the local health workforce. All in all, addressing these challenges is only going to be possible through political investments and African-grown and led models that “adjust rather than bend to the international health regime,” as well as improve local governance.

Original Work

Wamai, R.G., & Shirley, H.C. (2022) The future of health in sub-Saharan Africa: is there a path to longer and healthier lives for all? In: Greiner, C., Van Wolputte, S., & Bollig, M. (Eds.) African Futures. Brill, Leiden, the Netherlands, 67–98.

Contact

If you are interested in learning more about this work, contact Professor Wamai.