Health capacity building: How Africa’s health systems can cope, COVID-19 and beyond?

There have been and will continue to be, many avoidable deaths in Africa as governments battle to create equity in their budgets and push to make health a priority. Health budgets have always suffered from underfunding and significant understaffing, this not only leads to deaths but the suffering of people with illnesses and diseases because they cannot access health care.

It was under these circumstances, that as 2020 dawned, 54 African countries’ health departments were, “as normal as they were”, and had to stretch staff, treatment facilities, and medications to meet the demands of the people. The arrival of the COVID-19 pandemic jolted the entire world, including Africa, and her 1.4 billion people. Already underfunded health budgets buckled and almost collapsed. Budgets were reprioritized, and health departments bolstered, but the consequence was the abrupt shut down of medical facilities for the “run-of-the-mill” healthcare. As is the norm, Africa was bailed out with massive loans and grants by the international community; its unfair practices to developing countries will continue to cripple the already “fragile” economies.

The African Development Bank set up a USD 10 billion COVID-19 Response Facility to help mitigate macroeconomic “shocks” for African countries. The Bank also announced a USD 3 billion social bond to support its COVID-19 funding efforts. While this provided some reprieve, the next hurdle being faced is rebuilding the economies after the lockdown and finding enough money for COVID-19 vaccines.

Unfortunately, the lion’s share of many countries’ budgets goes towards transportation, security, and much-needed water programs. The Africa CDC (Centres for Disease Control and Prevention) says the continent’s limited health budget, weak health facilities, and shortage of health workers are a hindrance to the fight against pandemics in general. A shocking indictment is that only 50% of African Union member states have modern health facilities. About 10% of GDP is spent on healthcare for most African countries. Many health budgets are supplemented by organizations, both public and private. While the intentions are good, the funding is often not aligned with the government’s priorities. In a “smack” in the face of Africans, often the funding can only be accessed if the money is used according to the funder’s programs.

In my humble opinion, what the continent needs is food and basic medications for the chronic diseases that we have all come to hate. Nutritious and inexpensive food; and affordable and efficacious drugs are what is needed for this great continent. Africa has the highest incidences of maternal and infant mortality in the world, among all continents.

Grave significance is what happened as COVID-19 was being dealt with. Other health care programs came to a screeching halt. Some of these included antenatal care, HIV, TB, family planning, and regular routine immunizations.

Africa, already drowning in debt, now faces the COVID-19 debt which has not been easy because of our past borrowing and repayment practices. And in a cruel twist, prolonged post-COVID treatment may be needed by many thousands of people, many of whom were left debilitated; a direct link to the after-effects of COVID.

Africa has faced many battles, and she has the scars to prove it, and yet, every time she thinks she has sprung clear, another battle emerges. A vicious cycle which will even be difficult for some of the EU member countries. 

However, the Collaborative Africa Budget Reform Initiative (CABRI) States governments, must reprioritize carefully, with foresight, and within good timelines. They believe this could benefit entire economies.

Governments should engage on health budgets at high levels, like the African Union, and also mandate their members of the Pan African Parliament to lobby for brainstorming and conceptualising ideas that could change the face of healthcare. Health budgets should be increased, but novel ways should be found to ensure money is spent where it is needed, what it is needed and when it is needed. This can only happen if there are transparent processes and accountability. A win would be if donor funders are engaged so that they are aligned with the government’s health programs.

It is imperative to point out two things for African countries and the international community. First, African countries need to keep focusing on strengthening their health systems as a whole. Although it has been slow, progress has been made in this area. The objective of universal health coverage has been gaining traction in Africa, often supported by high-level political will. In this context, more harm than good could come from diverting large amounts of funding through ad-hoc channels that might not be effective or cost-efficient (and which could also offer opportunities for corruption) while bypassing mechanisms for strengthening health systems in the long term.

 Second, we need to reconfigure international cooperation more broadly on health care. A global funding mechanism that serves as a transnational instrument for responding to health crises and also cross-subsidises health systems between countries at different levels of development, is a promising way forward. But the problems that confront health systems in developing countries are bigger than financing and go beyond the health sector. Issues such as trade imbalances (African countries often need to purchase medicine and medical equipment on international markets but are short of the foreign exchange required to do so), loss of health workers through migration, capital flight and corruption are all constraints on health provision and delivery in the poorest countries. These challenges are interlinked, and they can only be resolved through a different set of global governance mechanisms than exists today.

 So, what can we do in the short term? To reduce the spread of the virus, many African countries have been quick to implement confinement measures even when confirmed cases were very low. However, confinement and social distancing will be difficult to sustain, especially in countries without scalable social protection systems. The majority of workers across the continent operate in the informal sector and many survive on what they earn each day through face-to-face transactions.

Let’s all wake up and smell the roses because… A HEALTHY NATION IS A WEALTHY NATION!

Dr. Michael K. Obeng


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