31st March 2023,

Prioritize Investments for Africa’s Health Systems

By Shivani Shukla, LGT Impact Fellow for Financing Alliance for Health

Globally, approximately half of the population lacks access to essential health services, and more than half of them (~615 million) live on the African continent. Approximately 3 million people in the region die each year from HIV/AIDS, tuberculosis, and malaria. In addition to having the highest under-5 mortality rate in the world, parasitic diseases continue to cause hundreds of thousands of deaths and suffering. And now, the devastating health shock caused by COVID-19 has added to the pressure on Africa’s already strained health system and really pressurized the economies.

But future blows can be cushioned.

Ebola and COVID-19 have very clearly shown that outbreaks cannot be controlled top-down. Community Health Workers (CHWs) are best positioned to quickly detect, monitor, and control outbreaks. It has repeatedly been shown that investment in the foundations of health systems, such as well-trained CHWs and other frontline workers, is necessary both for health security and Universal Health Coverage (UHC). Since long before the COVID-19 pandemic, CHWs have been an integral part of disease prevention and control in sub-Saharan Africa and have played a critical role in identifying and stemming health emergencies.

Unfortunately, healthcare systems in Africa suffer from neglect and underfunding. Many countries do not have a budget for community health, and there is a clear lack of political commitment and government ownership. At the same time, global financiers often make investments in community health that are usually fragmented, volatile, unsustainable, and earmarked for disease-specific programs.

CHWs being the backbone of the health system are the most affected and face the biggest challenges: they remain unpaid, unrecognized, inadequately trained, and under-equipped.

Urgent need for action.

We’ve known for decades that investing in community health – is one of the most cost-effective, scalable, and impactful solutions for delivering life-saving health services to the most difficult to reach and vulnerable populations on the African continent.

I can see the difference in my community because of my work. Prior to my training, community members suffered from cough and malaria. Mothers also didn’t take their children for immunization. All this has changed now.
– CHW, Kenya

Despite this, funding for community health remains a challenge, with an estimated (and growing) US$ 4.4 billion annual funding gap. Investment is needed at all levels of the health system to ensure that CHWs are equipped, trained, and supported as part of a well-functioning health system. They are poised to play a pivotal role in fighting future pandemics and keeping our health in check.

Bridging the gap.

Financing Alliance for Health (FAH) is bridging this gap by closely working with country governments and international partners to enable innovative and additional investments, that also include the private sector, into primary and community health systems.

And as a health financing fellow at FAH, I am glad to be driving pivotal projects where we build capacity of country governments and the ecosystem, create & disseminate knowledge on key financing issues, and conceptualize and transform big ideas into action.

However, change cannot be achieved alone. It is imperative that we all act together and act now to support the backbone of our health systems – Community Health Workers, if we want to prevent deaths, promote gender equity, and achieve Universal Health Coverage (UHC).

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