Africa Sustainability Index to strengthen health systems – Experts

By Chikwe Azoma

Healthcare Initiative, an initiative designed to enable data-driven dialogue about the future of healthcare, launched the Africa Sustainability Index at the 2021 Africa Health Agenda International Conference (AHAIC).

 Led by a panel of 10 independent African healthcare experts, the first-of-its-kind, data-driven policy tool measures the current status of health systems in 18 countries across Africa and provides valuable context as countries across the continent determine how to accelerate Universal Health Coverage (UHC) goals and progress on the United Nations Sustainable Development Goals (SDGs) in the face of the COVID-19 pandemic.

 Africa Sustainability Index presents an objective view of how health systems are currently performing and is intended to inform policies that promote sustainability and resiliency for the future. 

Through publicly available data, the Index examines 76 different measures split across six categories called Vital Signs. These Vital Signs – Access, Financing, Innovation, Quality, Health Status and Wider Factors of Health – provide a holistic view of the fundamental drivers of sustainable healthcare systems.

The Index also compares approaches between countries, identifies elements that lead to more sustainable care and promotes best practices through a future-focused analysis of real-world solutions.

Supported by Roche, experts from organisations including Amref, the World Bank, United Nations Development Programme /(UNDP), the African Society for Laboratory Medicine and the Africa Centres for Disease Control and Prevention collaborated to develop the Future Proofing Healthcare Africa Sustainability Index.

“Sustainable healthcare is a key element on the journey towards UHC and will impact millions of lives in Africa,” said Githinji Gitahi, CEO of Amref and Africa Sustainability Index panellist.

“The Sustainability Index is a useful tool in guiding stakeholders in the healthcare ecosystem on where to focus efforts, make improvements and identify best practices from other countries.

“On behalf of my fellow panel members, it is our intention that this tool will spark conversation about actions that are needed today to create more resilient, sustainable health systems in the future.”

The findings of the Africa Sustainability Index indicate that economic strength and political stability are key drivers behind overall performance in healthcare sustainability, with most of the countries that perform well in the Financing Vital Sign also doing well in the Index overall. These countries include South Africa, Rwanda, Algeria and Ghana.

The Index also reveals that all countries analysed have numerous areas of opportunity for improvement. There are strong variations throughout the continent related to the Access and Quality Vital Signs, suggesting that targeted policies in these areas will make an impact in achieving UHC goals. Driving disparities in Access are the number of doctors and specialises healthcare professionals per capita, as well as the level of access to preventative health services. South Africa is the highest ranking country in the Access Vital Sign, followed at some distance by Libya, Zambia, and Tunisia.

Another area of focus for improvement is within the Innovation Vital Sign, which has the lowest mean score of the six Vital Signs. Innovation was defined by the panel as ‘advancement, access and application of novel technology.’ South Africa is the top performing African nation in this Vital Sign, followed at some distance by Rwanda, Ethiopia, and Tanzania. Still, many best practices exist at the country-level, such as creating a future-looking policy and legal environments and adopting new 

As health systems across Africa currently face acute pressure from the COVID-19 pandemic, the Africa Sustainability Index aims to identify key drivers that affect the capacity of health systems to cope with system-level strain. Data from the Index can be used  to inform policies that help health systems continue to manage and ultimately recover from the crisis as well as be used as the foundation for policies that enable more resilient health systems that are prepared to address both health crises and ongoing population health needs.

 The results of the Financing Vital Sign suggest that there is little difference between some countries’ healthcare financing models. However, this similar approach does not yield similar results across all Vital Signs. While there is a clear positive correlation between economic strength, political stability and the sustainability of a healthcare system, there are strong variations in Access and Quality Vital which suggests that, beyond financial reforms, targeted policies in these areas could go a long way in achieving UHC.

Prof. Glenda Gray, President and CEO, South African Medical Research Council, and member of the Expert Panel, added, “Unless we analyse the consequences of the COVID crisis, it has the potential to increase healthcare inequity, costs and inefficiency. Yet, if harnessed, it can mean better healthcare for all in more sustainable and resilient health systems. There are actions that every country can take to start on this journey today. We must work together immediately to rebuild better and give African people the care that they deserve.”

 Countries included in the Index are Algeria, Angola, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Libya, Morocco, Mozambique, Nigeria, Rwanda, South Africa, Sudan, Tanzania, Tunisia and Zambia.

The Africa Sustainability Index is a first-of-its-kind, online policy tool that provides a unique overview of the current status of 18 health systems across Africa, at a time when healthcare systems are under increasing pressure as life expectancy improves, the demand for healthcare services increases, and the rise in noncommunicable diseases doubles the burden already in place from communicable diseases.

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