To solve East Africa’s healthcare challenges, here’s what needs to be done

Healthcare in East Africa faces a dual burden. Infectious diseases like malaria and HIV/Aids still cause severe illness and death, yet the rise of non-communicable diseases (NCDs) like cardiovascular disease and diabetes cannot be ignored.

In Tanzania, NCDs now account for one third of all deaths and in Kenya, similar conditions are responsible for more than half of in-patient hospital admissions.

This double burden of diseases further strains the region's limited healthcare resources. In addition, the region has a critical shortage of healthcare workers. Health experts also list funding shortfalls and poor management of health services as the top challenges faced by the region.

It is difficult to see solutions when faced with this spate of negative statistics. But states as well as private and non-governmental sector initiatives can be leveraged to improve healthcare.

With the right combination of raising awareness about challenges, promoting innovation and facilitating knowledge exchange to spread best practices across the region, solutions can be unlocked.

A good starting point is to analyse shortcomings of past interventions. 

Policy-level interventions

Most NCDs can be prevented. If risk factors like tobacco use, unhealthy diets, alcohol abuse and physical inactivity are targeted, heart diseases, strokes and type-2 diabetes can be drastically reduced.

The Kenyan Ministry of Health has a national strategic plan for the Prevention and Control of NCDs which follows a World Health Organization (WHO) action plan to address NCDs.

The goal is to place the fight against NCDs into existing public health structures like state hospitals, or community health services. WHO recommends laws to curb tobacco and alcohol abuse as well as food and nutrition strategies. These have been implemented to differing degrees in the region.

Others have implemented similar policies, but regional research says only “modest progress” has been made against NCDs. While policies exist on paper, implementation is criticised by researchers. 

State-led initiatives are powerful because national resources can be used to train medical workers, fund crucial programmes and infrastructure upgrades. However our research on financing in primary health care shows that the impact of these initiatives has been hampered by declining government and donor funding.

 Fixing funding gaps

There are different approaches for solutions; from performance-based responses implemented in Rwanda, to seeking investments from multilateral institutions and partner nations. Three factors stand out. First, information systems must be improved for more efficient health spending. Countries will then be in a stronger position to establish universal health coverage.

Health funds can be raised through taxation like an excise tax, an approach that can simultaneously raise funds and reduce NCDs. WHO calls this approach “the most effective tax measure for promoting health” because it changes the price of harmful products while reducing people’s out-of-pocket costs.

All healthcare fixes must consider a country's own social, economic and political context rather than taking a one size-fits-all approach.

According to the Astana Declaration, public-private partnerships are key to expanding primary healthcare in developing countries. Such partnerships can provide the increased investment needed to train and hire  health workers so community demands are met.

Researchers argue that coordinated government efforts as well as those that bring sectors together and promote innovative approaches can be effective in addressing NCD challenges.

While private investment for health infrastructure is projected to grow, laws like Kenya’s Digital Health Act can boost innovation, for example telemedicine services, where cellphones or other digital devices enhance existing healthcare facilities.

Digital tools can train community health promoters (CHPs) and help them manage their caseloads as they go door-to-door. Kenya’s Electronic Community Health Information System, or eCHIS-Kenya, is one such example. With it, CHPs can collect accurate and updated information about patients in informal settlements where paper records cannot.

This centralised information has been used to successfully vaccinate almost 1.7 million people in high-risk areas against cholera in just 10 days. These tools enable health systems to direct resources with a data-led approach. 

Innovation, coordinated efforts and sharing best practices 

Reports by McKinsey and IQVIA show that these technologies are set to play a crucial role in expanding access to healthcare. As this use of technology advances, public-private partnerships in the health sector can tap into modern tools to advance healthcare.

The recent launch of a drone initiative at Huruma Sub-County Hospital shows how this works. This technology will collect samples from 117 public health facilities in the county to improve the speed of diagnosis and treatment for people.

Successful partnerships are enabled when actors from different spheres gather, share information and best practices in engaging meetings.

Through these partnerships, the negative narratives around healthcare in the region can be turned into lessons for the world to learn from as nations work towards UN sustainable development goals. 

Tom is senior exhibitions director at Medic East Africa