Africa’s Health Challenges

The editors were responsible for a previous series on healthcare governance arising from the 2003 severe acute respiratory syndrome (SARS) outbreak. In this project they have been joined by eight other specialists to create a text highly relevant to current global concerns about potential pandemics originating on the African continent. This volume is the first of a two-part series highlighting some of the health issues that, while global, are most acute in sub-Saharan Africa because of shifting populations, poor healthcare infrastructure and poverty. Africa’s Health Challenges focusses on challenges relating to sovereignty and health worker migration and shows how these are just as relevant as the movement of pathogens.

Part 1 introduces the challenge of global mobility. This can be voluntary movement resulting from tourism, education and economic activity. The authors point out that people can now travel around the world in a shorter period of time than that required for the incubation of many diseases. Therefore people who do not yet realize that they are ill can spread pathogens throughout the world. This is even more relevant when migration is coerced by violence, natural disaster, famine or political instability. War is the most dangerous scenario as it affects the entire social infrastructure. The production and distribution of food, provision of clean water, the maintenance of power supplies, communication channels and the availability of health care are all disrupted. Africa is an interesting area to study, not only because of specific issues to do with population movement but because the continent serves as a subset of global activity. In other words, the problems encountered in Africa are not unique to the region, yet they may be more acute and thus more visible here.

Part 2 focusses on issues of sovereignty and explores challenges arising from conflicting concepts of sovereignty. State sovereignty often arises from previous military victories. Popular sovereignty represents the will of populations. These two types of sovereignty may be in conflict even within democratically governed nations. In terms of health care, issues of sovereignty can be complex due to some of the problems introduced in Part 1 of this book. Local diseases can quickly spread to become international pandemics. Who is responsible and how can that responsibility be addressed? The authors demonstrate how sovereignty has historically been a shifting concept and propose that the concept needs to be redefined to fit the modern age.

Part 3 explores the health care and health governance challenges that are most visible in the African context. The authors argue that the most important component of any health care system is the body of health care professionals who deliver the services necessary to prevent, diagnose and treat disease. In this respect Africa is facing a crisis as large numbers of health professionals, mainly doctors and nurses, leave the region annually. Some medical professionals leave to seek specialist training which is unavailable in the region, but for others the motivation is economic. The two countries receiving the greatest number of African health care workers are the UK and the USA. This represents a flow of resources from poor to rich countries, not only in terms of a valuable resource but also in terms of the training costs which have in most cases been shouldered by medical professionals’ countries of origin. The authors propose a co-development model as a solution, empowering medical migrants to become agents of change in their countries of origin. However, this optimistic model presupposes the willingness of doctors to return to their countries of origin at some stage of their careers. Members of the African diaspora are already involved in establishing and funding research and education in their countries of origin. Nevertheless, if medical professionals remain abroad permanently their expertise and their economic contributions to local development are minimized.

While the migration of health care professionals is a pressing issue, population migration is an even larger challenge. Tuberculosis, HIV/AIDS, Malaria and SARS are all diseases that are spread easily by mobile populations. Today we can add Ebola to the list of dangerous pathogens that are easily spread, particularly in populations with pre-existing health issues. International law recognizes healthcare as a human right and therefore migration cannot be used as an excuse to deny healthcare to certain populations. This is a difficult challenge in an area where resources are already limited.

Part 4 addresses some of these challenges with chapters on subjects ranging from the integration of traditional healthcare to sustainable economic development and strengthening healthcare capacity. The focus of this section is to demonstrate that while challenges are high, innovation, creativity and international political will can be harnessed to create sustainable solutions to Africa’s health care needs.

Part 5 consists of the concluding chapter, which ties all strands together, acknowledging the challenges but proposing that intelligent healthcare governance is the solution. The authors remind us that many of these challenges are not new; it is the scope that has altered. Solutions need to be adjusted to reflect the reality of the global society in which we all live and work. Good global healthcare is a challenge to all health professionals and the solutions are in our hands.