The health, economic and social effects of COVID-19 in Africa and around the world have been unprecedented. In this series, young Africans both on the continent and in the diaspora share their views on the impact of the COVID-19 pandemic.
The opinions expressed in this article are solely those of the author, and do not necessarily reflect the opinions or views of the Mo Ibrahim Foundation.
Health system governance in times of COVID-19: The good, the bad, and the ugly
Health system governance refers to the management, monitoring, and implementation of decisions that surround the demand and supply of health services. Performances in health system governance vary among countries with weak practices largely identified in low- and middle-income settings. African countries share a history of the most challenging and varied health problems in the world.
While the continent has learned from these experiences, COVID-19 is exacerbating its already fragile systems. The available data in the latest Mo Ibrahim Foundation’s paper titled - COVID-19 in Africa: A call for coordinated governance, improved health structures and better data- confirm the ugly truth that Africa is the worst performer in most health-related areas: ‘Only 10 African countries provide free and universal healthcare to their citizens, while healthcare in 22 countries is neither free nor universal’. The projected scenarios are grim. With the virus’s high lethality rate coupled with risks of larger populations’ potential exposure, it is expected that Africa’s health expenditure will rise by up to $10.6 billion caused by inflationary pressures resulting from supply side shortages in food and pharmaceuticals. The list of other bad news is long and alarming especially when health-related data coverage is low, but few encouraging efforts are visible.
Some positive news is the relatively quick response and coordinated efforts among African countries to step up their initiatives, which were a contrast with other regional organisations around the world. The Africa Centres for Disease Control and Prevention (Africa CDC) collaborated from an early stage with the African Union Commission (AUC) and the World Health Organization (WHO) to lead a number of training exercises. In contrast with two laboratories in Senegal and South Africa that could diagnose the virus in early February, at 'least 43 African laboratories in 43 African countries were trained to test the virus’ within the space of a month.
What the mixture of “good”, bad, and ugly realities suggests about the pandemic is that the future lies in strong and well-functioning health system governance. A good health system governance reflects societal strength. It is bound with effective management of a broad range of areas: education; transport; communication systems; liveable housing; sanitation infrastructure; immunisation coverage; prevention of communicable and non-communicable diseases; control of factors affecting mortality rate at different age level such as maternal care, child nutrition, etc.; and of course provision of hospital care. In other words, it is related to a combination of both healthcare and non-healthcare factors.
Known barriers affecting the effective delivery of quality health services also include ‘shortages and maldistribution of qualified health workers’. The 2019 Mo Ibrahim Foundation Forum Report on Africa’s Youth, already noted the lost productivity of the next generation of workers due to a neglect of investments in human capital, in particular health and high quality education. Overall, several non-healthcare related challenges in addition to disease outbreaks affect the region’s capacity to address health concerns including political changes, technological adjustments, or even demographic transformations resulting from shifting gender roles and migration among other societal changes. This means that the correlation between health systems and governance is not simple. Its study needs to be updated and expanded to acknowledge a larger set of indicators capturing its essence.
The way forward for health system governance depends on effective governance in a wide range of areas. A good health system infrastructure is one that has the capacity to respond and cope with daily challenges in addition to emerging ones. In light of the current pandemic, an effective health system governance also needs to be forward looking and be prepared to address the impending economic and societal issues that are lurking ahead. Existing regional cooperative initiatives in health system governance on the continent need to be strengthened and their impact acknowledged in addition to their limitations.