The future of healthcare in Africa progress challenges and opportunities. Chapter 1 Progress on ve healthcare scenarios for Africa 2. Introduction 2, Preventive care improves but rural urban divide persists 2. Business input and community empowerment 4,Universal health coverage advances 4. New applications for technology 5,International donors look for value 5. Conclusion 7, Chapter 2 Views from ve healthcare professionals and leaders in Africa 8. Dr Ernest Darkoh co founder BroadReach Healthcare 8. Liza Kimbo chief executive of cer Viva Afya 9, Dr Margaret Mungherera immediate past president World Medical Association 10. Onno Schellekens managing director PharmAccess Group 11. Professor Sheila D Tlou director UNAIDS Regional Support Team for Eastern and Southern Africa 12. The Economist Intelligence Unit Limited 2014, The future of healthcare in Africa progress challenges and opportunities. 1 Progress on ve healthcare scenarios,for Africa,Introduction. When The Economist Intelligence Unit published Chart 1. The future of healthcare in Africa see www, economistinsights com analysis future Maternal mortality ratio. maternal deaths per 100 000 live births women aged 15 49. healthcare africa in 20121 the continent s, health systems were confronting a diffuse 1990 2000 2010 2015 target. set of challenges the familiar threat from 900 900. communicable and tropical diseases increasing 800 800. pressures on health budgets caused by the 700 700,increase in chronic medical conditions and. growing violence and other problems associated,with persistent poverty 500 500. The lethal Ebola epidemic currently spreading,through West Africa has been a reminder of the. continued vulnerability of African populations 200 200. to infectious disease Yet there are signs that 100 100. increasing education and investment is lessening 0 0. the burden of communicable diseases in many Sub Saharan Africa Northern Africa. countries Africa has made progress in a number Source United Nations The Millennium Development Goals Report 2013. of important health related areas For example, maternal mortality has declined signi cantly we explored previously an increasing focus on. although it remains far short of the 2015 target primary and preventive care empowerment. The future of healthcare, in Africa a report from the see chart 2 of communities as healthcare providers the. Economist Intelligence Unit extension of universal healthcare the spread. sponsored by Janssen www This chapter will look at progress on the ve of telemedicine and a reduction in the role of. economistinsights com future scenarios for healthcare in Africa that international donors. analysis future healthcare,africa 2012,The Millennium. 1 Preventive care improves but rural urban divide persists. Development Goals Report,UN New York 2013 p 28, The rst future scenario from our 2012 report the 2013 Global Burden of Disease survey from. envisioned a refocusing of African health the Institute for Health Metrics and Evaluation. Global Burden of Disease systems on primary and preventive care and this suggest that they will increasingly take. 2013 Institute for Health,Metrics and Evaluation, development is clearly underway precedence as medical priorities 3. www healthdata org gbd, accessed on September Rates of chronic conditions such as hypertension In fast growing countries with large urban. 16th 2014 and diabetes continue to increase and data from populations such as Kenya demand for primary. 2 The Economist Intelligence Unit Limited 2014, The future of healthcare in Africa progress challenges and opportunities. care and outpatient services is rising Viva Afya Chart 2. a chain of outpatient private health clinics,Communicable vs non communicable diseases. targeted at lower and middle income clients has,in Sub Saharan Africa. expanded from ve clinics to 12 in the past two deaths in m. years and is exploring regional growth in Uganda Non communicable diseases. and Ethiopia according to its chief executive Communicable maternal neonatal and. nutritional disorders,of cer Liza Kimbo Focusing on the way that 7 7. care is delivered can have clear bene ts In,South Africa better implementation of primary 6 6. care including improved primary care HIV,intervention following the launch of a national 4. Mayosi B M Lawn J E, antiretroviral treatment programme in 2004 is 4 4 van Niekerk A Bradshaw. credited for an increase in life expectancy from a D Abdool Karim S S. low of 54 years in 2005 to 60 years in 2011 4 3 3 Coovadia H M Lancet. South Africa team Health,2 2 in South Africa changes. Yet in most parts of sub Saharan Africa and challenges since 2009. variation between urban and rural areas has 1 1 The Lancet Vol 380 No. made progress uneven Rural areas are hampered 9858 December 8th 2012. 0 0 pp 2029 2043, by long distances from services poor road 1990 1995 2000 2005 2010. infrastructure and low population density Source Institute of Health Metrics and Evaluation Global Burden of 5. Visagie S and Schneider,Disease 2013, making it more dif cult to attract healthcare M Implementation of the. workers and specialists and undermining the principles of primary health. 2008 Ouagadougou Declaration on Primary care in a rural area of South. economic viability of services 5 Eliminating Africa African Journal. Health Care and Health Systems in Africa as, these inequalities remains a key step towards of Primary Health Care. the framework for a range of projects targets, better care provision As the Ebola epidemic Family Medicine Vol 6 No. included support for Benin and Swaziland in 1 2014. has underscored increasing investment in,developing their health strategic plans and. public health infrastructure is a crucial part of,help for ten other African countries looking to 6. World Health, eliminating gaps in health coverage and creating Organisation Health Policy. strengthen district health system capabilities in, a broader system able to identify health targets Development www afro. the areas of planning management supervision, and collect and monitor data rather than who int en clusters a. and monitoring and evaluation 6, merely reacting to health crises as they arrive programmes hss health. While there are few overarching programmes policy a service delivery. There is also a pressing need for national programme components. a number of organisations are active in, governments to form their own targets and health policy development. this area including the African Healthcare html accessed on. Development Trust which sponsors projects strategies for promoting health alongside. September 16th 2014, primarily in northern Nigeria designed to international targets for healthy life expectancy. improve healthcare delivery and training and The health strategy of the New Partnership for 7. New Partnership for, Africa s Development NEPAD 7 and Jembi Health Africa s Development. the African Development Bank which is investing,NEPAD NEPAD Health. in public health infrastructure projects across Systems a non pro t organisation focusing. Strategy www sarpn org, the continent The World Health Organisation s on the development of e health and health documents d0000612. African regional of ce has also worked closely information systems8 are two Pan African NEPAD Health Strategy. on health policy development using the initiatives in this area pdf accessed on September. Jembi Health Systems,About www jembi,org about accessed on. September 16th 2014,The Economist Intelligence Unit Limited 2014. The future of healthcare in Africa progress challenges and opportunities. 2 Business input and community empowerment, Our 2012 report envisioned an Africa where new vacancies in some cases using physicians. tiers of community healthcare workers would assistants who have similar training to doctors. ll the gap created by a global market for highly and are able to provide routine care and some. skilled medical staff While this is happening in basic surgery but lack a medical degree This. some countries especially in remote areas with process is accelerating as some governments. sparse populations private sector and public raise salaries for doctors at public hospitals in. private partnerships are also helping to deliver order better to compete with both private sector. health services and work more closely with health providers and overseas employers. communities,Japan s government is helping to train and. Kenya s creation of county level government retrain 100 000 health workers for Africa. structures with budget setting powers over the nonetheless staff shortages remain a chronic. past few years has provided new opportunities problem Around half of Egypt s annual output of. for the private sector better to target healthcare newly trained doctors leaves the country in search. investment allowing investors to be closer to of higher salaries and Sierra Leone has been. the decision making Ms Kimbo observes forced to send many of its professionals abroad. for training while importing doctors and nurses, Report on the ministerial Private or donor nanced healthcare providers from Cuba and Nigeria to meet demand 9. level roundtable on,are nding new approaches to bridging workforce. Universal Health Coverage,WHO World Bank,Ministerial level Meeting on. Universal Health Coverage 3 Universal health coverage advances. February 18th 19th 2013,Geneva Switzerland, Another scenario in our 2012 report predicted through value added taxes VAT and setting. Lagomarsino G that most African governments would be closer up prepayment systems Some countries have. Garabant A Adyas A to extending health coverage to all of their started by building up partial coverage often. Muga R Otoo N Moving populations by 2022 and this remains a priority including public insurance for civil servants and. towards universal health for policymakers private insurance for the wealthiest and those. coverage health insurance,working for companies able to provide cover In. reforms in nine developing An article in The Lancet identi ed ve African. countries in Africa and Kenya meanwhile larger insurance companies. countries Ghana Rwanda Nigeria Mali and, Asia The Lancet Vol 380 are showing increasing interest in developing. Kenya that have made the most progress, No 9845 September 8th micro products for the middle classes Ms Kimbo. 2012 pp 933 943 towards developing universal healthcare 10 Over. notes that these developments have led to an,90 of Rwandans are now enrolled in health. increase in the percentage of Viva Afya clients, South Africa Health care insurance programmes as are around half of. with some form of health coverage to 30 from, overhaul Oxford Business Ghanaians and 20 of Kenyans but just 3 of. Group May 29th 2013 just 5 in 2011,those in Mali and Nigeria which are at an earlier. stage of reform South Africa frequently touted, Doherty J Getting Policymakers continue to debate how best to. as a potential leader in this area has made, South Africa ready for cover the poor or those who work in the informal. slower progress its National Health Insurance, NHI critical next steps sector and are least able to afford adequate. presentation to Economic, programme is still in the pilot phase 11 and there. coverage without government subsidies Ghana, Research Southern Africa are questions about future nancing 12. has helped to boost healthcare funds by imposing,ERSA Symposium critical. choices regarding universal Governments are looking at different ways of an additional VAT rate of 2 5 known as the. health coverage February nancing reforms including ring fencing a National Health Insurance Levy on selected. 6th 2014 portion of state budgets raising extra money goods and services with the additional revenue. 4 The Economist Intelligence Unit Limited 2014, The future of healthcare in Africa progress challenges and opportunities. going to its national health insurance scheme 13 observed will be ineffective if the care provided. However universal coverage the World Health is of such poor quality that it discourages people. Organisation WHO and World Bank ministers from seeking it 14. Table 1 Health insurance coverage,Out of pocket,Population enrolled expenditure. Country Coverage targeted Scope of services,of total of total health. expenditure 2010,Ghana Entire population 54 Comprehensive 27. Rwanda Entire population 92 Comprehensive 22,Formal sector expanding to. Kenya 20 Inpatient with pilot outpatient 43,informal sector. Mali Entire population 3 Comprehensive 53,Civil servants expanding to. Nigeria 3 Comprehensive 59,informal sector, Source Lagomarsino et al The Lancet September 8th 2012. Doubtful clouds hung,over Ghana Infrastructure,Fund February 24th. 4 New applications for technology 2014 www ghanaweb. com GhanaHomePage,NewsArchive artikel, Our 2012 report imagined an Africa in which helping specialists to support local providers php ID 301664 accessed. telemedicine is ubiquitous This vision has especially in large cities such as Nairobi where it on September 16th. 2014 See also Bagbin, yet to be fully realised partly due to patchy can take two hours for a specialist to travel from. A S K Earmarked Value, information and communications technology their hospital to a clinic on the city outskirts Added Tax VAT The. ICT infrastructure across the continent Experience of Ghana. Countries such as Ethiopia and South Africa have More broadly technology is helping to make presentation to Value. nevertheless made signi cant progress and the healthcare more ef cient and accessible In for Money Sustainability. Pan African e network the continent s biggest a continent where most people own a mobile and Accountability in the. phone providers such as Kenya s Safari com and Health Sector A Conference. project for distance education and telemedicine,of African Ministers of. covers 12 African countries 15 Nigeria s MTN are experimenting with micro. Finance and Health, insurance products using mobile payments July 4th 5th 2012 www. While many patients still prefer to deal with Mobile operators are also offering other sorts hha online org hso. clinicians face to face and direct consultation of mobile airtime credits that patients who are system files 3earmarked. may still be required depending on the disease ineligible for traditional credit cards can use to vatghana pdf accessed on. pay for healthcare September 16th 2014,telemedicine can play an important role in. Report on the ministerial, 5 International donors look for value level roundtable on. Universal Health Coverage, The nal scenario of our 2012 report suggested a health coverage At a 2013 WHO World Bank 15. Wamala D S and, future with scarcer donor funding International meeting representatives from the Rockefeller Augustine K A meta. donors still play a crucial role in helping to Foundation Save the Children and national analysis of telemedicine. success in Africa Journal, support cash strapped governments but they are government aid departments focused on the ways. of Pathological Informatics, increasingly looking to deploy aid where it will in which health systems are nanced Vol 4 No 6 May 30th. have the greatest impact particularly universal 2013. The Economist Intelligence Unit Limited 2014, The future of healthcare in Africa progress challenges and opportunities. To this effect the World Bank is sponsoring a such as HIV AIDS tuberculosis and malaria A. number of reform projects under its Results UK based international AIDS charity AVERT. Based Financing initiative which promotes notes that in 2012 domestic African sources. greater autonomy better management training already accounted for 53 of global HIV. and nancial incentives directed at primary care funding Countries such as Kenya Togo and. The World Bank Three centres that carry out pre agreed services such Zambia dramatically increased their domestic. Nigerian States Inject New as safe delivery of babies and child immunisation spending on HIV AIDS during the same period. Life into Healthcare for The initiative also applies to state and local the organisation noted while South Africa was. Mothers and Children, government bodies that provide health centres covering most of its HIV AIDS programme with. April 13th 2012 www, worldbank org en news and district hospitals with similar support In US 1bn in annual investment 18 In November. feature 2012 04 13 three Rwanda initial evaluations of the initiative s 2013 African health ministers pledged to. nigerian states inject new performance based incentives have found that increase domestic spending on health at a. life into healthcare for they contributed to rapid nationwide health meeting sponsored by the African Development. mothers and children print gains 16 Similarly the Health In Africa Fund Bank and the Global Fund to Fight AIDS. accessed on September, which the African Development Bank launched tuberculosis TB and Malaria in which the Global. with other donors in 2009 is measured not just estimated that domestic nancing could cover. The African Development by its nancial results but also by its ability to US 37bn of the US 87bn required to combat. Bank Group Health in help develop businesses serving the poor 17 the three diseases in low and middle income. Africa Fund www afdb org,countries between 2014 and 2016 19 In December. en topics and sectors, At the same time African countries are 2013 the Global Fund announced a successful. initiatives partnerships, health in africa fund increasingly tapping into their own funding to fourth replenishment of funding commitments 20. accessed on September tackle some of the most intractable diseases. AVERT Funding for HIV,and AIDS www avert org,funding hiv and aids htm. accessed on September,Press Release African,Health and Finance. Ministers pledge to increase,domestic spending on,health November 13th. 2013 www safaids net,content press release,african health and finance. ministers pledge increase,domestic spending health. accessed on September,The Global Fund to,Fight AIDS Tuberculosis. and Malaria Fourth,Replenishment www,theglobalfund org en. replenishment fourth,accessed on September,6 The Economist Intelligence Unit Limited 2014. The future of healthcare in Africa progress challenges and opportunities. Conclusion, While recent epidemics demonstrate that the and the realisation of universal health coverage. continent s traditional health threats are not yet which is set to become a key priority for the. in abeyance an increasing number of African post 2015 development agenda By contrast the. countries are already moving to address the new widespread penetration of telemedicine looks. maladies that come with greater wealth further off. The future for African health systems is likely On the whole there are encouraging signs that. to be de ned increasingly by public and private all stakeholders are taking a broader view of. investment that is linked to the improvement Africa s healthcare challenges and focusing on. of healthcare quality To this end government how to work more closely together to get better. budgets are likely to emphasise the development value from their healthcare investments. of both high performing primary care systems,The Economist Intelligence Unit Limited 2014. The future of healthcare in Africa progress challenges and opportunities. 2 Views from ve healthcare,professionals and leaders in Africa. 1 Dr Ernest Darkoh co founder BroadReach Healthcare. Rethinking Africa s healthcare of health rarely lie within the ambit of the. paradigm shifting the focus from ministries of health but are scattered across the. curative action to preventive care mandates of multiple ministries including those. Although the African health establishment has for education housing social services police. tried to do the right thing by focusing on curative water and labour As such we have barely begun. care prevention has become an afterthought to de ne what well being means in a systematic. Africa s healthcare paradigm must be changed sense much less develop effective models to. argues Dr Ernest Darkoh co founder of BroadReach deliver it. Healthcare an African based health analytics and,Although the African health establishment has. technical services rm, tried to do the right thing by focusing on curative. In many ways African health systems are care prevention has become an afterthought. groaning under devastating disease burdens Treating cancer diabetes injuries or other. for the very reason that we the African health conditions is not wrong but the paradigm. establishment are ful lling our tacit statement that allows them to spiral out of control is It is. of intent curing disease reactive requiring ever increasing numbers of. hospitals doctors and medicines in a system, People ll hospital beds they receive drugs we that is bound to implode This awed paradigm. cure disease has led to a results framework where success is. measured by the increase in hospitals or doctors,As resource constrained as they are many. which is actually a proxy admission of failed,African countries might learn from the practice. healthcare, of setting positive intentions If the intention is. to cure disease then you will nd yourself with Excluding immunisation programmes most. plenty of disease to cure Country after country African countries do not have coherent. in Africa has backed itself into this corner and integrated or effective prevention agendas Most. has then needed to plead for resources as its countries hope that nothing goes wrong to test. hospitals reach capacity their already overburdened curative systems. The World Health Organisation WHO de nes However when it does as seen with Ebola and. health as a state of complete physical mental HIV it reveals the precarious de cits of this. World Health and social well being and not merely the model. Organisation WHO,absence of disease or in rmity 21 However the. definition of Health www,who int about definition, overwhelming majority of effort and funding Changing the paradigm. en print html accessed on accordingly still focuses on ghting in rmity So what should be done differently The. October 23rd 2014 and disease Worse yet the social determinants paradigm must be changed to re ect what. 8 The Economist Intelligence Unit Limited 2014, The future of healthcare in Africa progress challenges and opportunities. is actually wanted which is healthy people the health well being pie Do any ministries of. Concerted thought is required to de ne well education housing labour or police internally. being develop a new set of success metrics de ne their mandate as keeping people well. create scalable models to deliver it adapt Currently most ministries of health are so siloed. working modalities to implement it and most that internal departments and programmes. importantly incentivise and reward prevention barely communicate let alone co ordinate with. other stakeholders on a de ned well being, I call it a life cycle well being based model agenda to which they are collectively held. where for each distinct year of one s life the accountable. leading risk factors are de ned and best, practice preventive interventions are delivered It will take many decades to turn the corner. proactively We must also improve our results but if nothing is done today the ever growing. frameworks which are currently limited in their inadequacies will persist It is time to reposition. ability to count what did not happen We must around a new intention reward prevention and. rede ne the group of entities that own pieces of redirect the future towards well being. 2 Liza Kimbo chief executive of cer Viva Afya, Healthcare in the community how are labour intensive Many have set up in house. business and policymakers can clinics to address primary healthcare needs. empower communities as healthcare and are involved with social outreach and other. providers in Africa initiatives A few ower farming companies in. Business and policymakers have an increasingly Naivasha Kenya have come together to set up a. important role to play in improving healthcare women s hospital. provision in Africa by helping to educate and,Every employer can and should engage in. empower local communities to identify their own,improving healthcare for their workforce and. healthcare needs says Liza Kimbo chief executive,families It is a worthwhile investment that. of cer of the Viva Afya chain of healthcare clinics in. improves the bottom line through better,Kenya The Economist Intelligence Unit spoke with. attendance and productivity There is also a need,Ms Kimbo about the ways of achieving this aim. to extend healthcare to the wider community, Where are businesses and other external by establishing clinics and hospitals or by. groups playing the biggest role in community supporting existing public health infrastructure. healthcare provision in Kenya and how should as the government cannot address these needs. this role evolve on its own Businesses should also extend their. existing health education efforts to address the, Liza Kimbo LK Non governmental growth of chronic diseases such as hypertension. organisations NGOs are often involved in and diabetes for example by showing people how. primary care and many are focused on hygiene to improve their diets monitor their blood sugar. food security and the provision of clean water all and measure blood pressure. of which have a very signi cant impact on public,How can outside decision makers help to. health outcomes,empower communities, Larger businesses especially those operating LK Our biggest problem is education and the. at a national level such as sugar and tea low levels of basic knowledge about healthcare. packing companies are usually more involved as exempli ed by the Ebola crisis A lack of. in healthcare possibly because these industries education and awareness and the reluctance to. The Economist Intelligence Unit Limited 2014, The future of healthcare in Africa progress challenges and opportunities. seek help for health problems kills more people How crucial is local autonomy in healthcare. than anything else decisions, Part of this is ignorance people may have very LK The more locally managed the healthcare. limited variety in their diets they may not the more in tune it will be with the needs of. necessarily seek medical attention at the rst the community In Kenya we are now seeing. sign of symptoms or they might not consider that the bene ts of devolution with increased. the conditions they have are treatable Another policymaking at county level Meru County is. in uencing factor is cultural beliefs which leads focusing on technology for improving malaria. people to consult traditional healers or misread diagnosis by training staff to use readers for. symptoms As a result people delay getting rapid diagnostic tests the county has sharply. their health needs attended to and preventable reduced prescriptions for malaria medication and. conditions become expensive to treat improved fever management. Health educators can help us make better use of,Kiambu County has tried to ful ll both training. the limited health resources available Businesses,and data collection needs by training community. and NGOs can play a big part in showing people,health workers and equipping them with basic. what they can do to protect their health in the,reporting tools on mobile phones. long term by taking a few preventive measures, such as monitoring their blood pressure and Strengthening local health management. sugar levels When one NGO spent a weekend in a structures and bringing them closer to the. rural area of Kenya screening for prostate cancer community allows for better management of the. hundreds came out to be checked workforce and of the limited resources available. based on actual community needs Improved,There is also a need to help communities form. management of community health data could be,their own localised health insurance schemes. used by counties to employ relevant specialists,whereby they pool their resources into a. according to disease burden,community fund much like employers do for their. 3 Dr Margaret Mungherera immediate past president World. Medical Association, Building Africa s healthcare leadership There is substantial evidence showing remarkable. capacity tackling the root causes of improvement in the health of populations. weak healthcare systems with many countries experiencing a dramatic. The main reason for Africa s weak healthcare increase in life expectancy However the positive. systems is neither a shortage of policies nor developments are not equally distributed. road maps nor even funding Lack of leadership throughout the world Only a handful of African. capacity re ected in corruption and awed policy countries have achieved one of the three health. implementation must be addressed argues Dr related MDGs 22 concerning the reduction of. World Health Margaret Mungherera immediate past president of child mortality improving maternal health and. Organisation Millennium the World Medical Association combating HIV AIDS malaria and other diseases. Development Goals MDGs The majority of African countries can probably. www who int topics, Since 1990 the Millennium Development Goals only expect to meet any of the MDGs after 2050. millennium development,goals en accessed on, MDGs have galvanised the world into action at least 35 years after the target year of 2015. October 23rd 2014,10 The Economist Intelligence Unit Limited 2014. The future of healthcare in Africa progress challenges and opportunities. Moreover the African continent continues The importance of capacity building. to suffer from a disease burden that is Africa s health systems have a plethora of. disproportionate to its population For instance stakeholders in the public private and civil. despite having just 11 of the global population society sectors each with speci c leadership. Africa has 45 of the world s women dying from roles to play Unfortunately they have failed. childbirth related complications and 62 of the to ful l these largely because they lack the. world s HIV AIDS patients This huge disease capability Developing leadership capacity should. burden can largely be attributed to weak health therefore be the main emphasis of any effort. systems aiming to reduce Africa s disease burden It is for. this reason that the World Medical Association, African governments have responded to this has embarked on an initiative designed to. challenge by ratifying several international strengthen the leadership role of African national. and regional declarations with a number medical associations in order to enable them to. of countries further incorporating national play a more effective part in strengthening the. policies and Health Sector Strategic Plans health systems of their countries. HSSPs into national development plans, Subsequently signi cant funds from domestic The recent outbreak of Ebola has once again. and foreign sources have been pumped into highlighted that it is the weakness of African. African healthcare sectors for the purpose of health systems that is the biggest threat to. implementing these policies Unfortunately global health We must hope that it will not take. it is estimated that 20 40 of these funds are a greater crisis or many more deaths African. wasted largely because of endemic corruption or other before the world understands that the. and awed implementation that is not in line key solution to strengthening these systems lies. with policy in effective leadership from within Africa rather. than from outside the continent, 4 Onno Schellekens managing director PharmAccess Group. The potential of mobile healthcare However living in Nairobi the capital and. in Africa mobile phones can succeed largest city in Kenya I have also witnessed how. where governments have failed inequality is on the increase and how many. The mobile phone is rapidly transforming Africa s people are still falling into desperate poverty. economic and social fabric Mobile phones can Take Grace a 27 year old mother of ve who. revolutionise the delivery of healthcare in Africa worked as a street cleaner in a leafy area of. says Onno Schellekens managing director of the Nairobi Following the death of her husband. PharmAccess Group Grace moved to Nairobi with her baby leaving. her other children behind in order to work and, With a simple click of a button or a phone call live with her sister Grace was seriously ill but did. many Africans can transfer money to support not seek medical help until she collapsed in the. their relatives traders can compare the most street She was sent home from hospital with only. current prices for their goods and people in a follow up appointment in three months time. remote villages can seek medical advice from a when in fact both she and her baby needed closer. doctor through a call centre The mobile phone is monitoring and counselling As a consequence. rapidly changing the economic and social fabric she was ill several times and when her contract. of Africa in ways that are dif cult to imagine was not renewed she subsequently lost her job. if you grew up in a developed country where and eventually her home when her sister threw. everything seems to work her out,The Economist Intelligence Unit Limited 2014. The future of healthcare in Africa progress challenges and opportunities. Breaking the vicious circle help protect against malaria Family members. No home no work no money poor health it at home or abroad can pay into a health. is a vicious circle People like Grace need help wallet on people s mobile phones where their. but African support systems are weak It is my contributions are exclusively reserved to pay for. dream that high quality healthcare will become healthcare costs. accessible to all and I believe that mobile phones. can revolutionise the delivery of healthcare in By receiving such bene ts directly on a mobile. Africa Like most Kenyans both rich and poor phone people are empowered to take care of. Grace has a mobile phone and uses mobile their own health They can use these entitlements. money The mobile phone offers unprecedented to access quality healthcare while at the. opportunities to improve access to healthcare same time clinics are paid without delay and. for the poor by connecting individual citizens transaction costs are radically reduced It is my. health providers as well as donors and local hope that in the near future Grace will have a. governments who give out health entitlements health wallet on her mobile phone which would. such as vouchers to vaccinate children to receive give her the certainty that she can afford to seek. family planning support or for bed nets to medical care at facilities of her own choosing. 5 Professor Sheila D Tlou director UNAIDS Regional Support. Team for Eastern and Southern Africa, Self suf ciency of African healthcare continues to rely on donor resources to sustain. systems the role of international current improvements and expand health and. donors as a source of funding for community services to scale up responses to. African healthcare HIV AIDS TB and malaria The response to HIV. African countries are increasingly tapping AIDS however provides important lessons on. into their own funding to tackle some of the how shared responsibility and global solidarity. most intractable diseases such as HIV AIDS can deliver results Country ownership strong. tuberculosis TB and malaria However donor political leadership and reduced dependence. funding will remain an important resource on external resources have enabled almost every. in bridging funding gaps and strengthening country in Africa to have success stories stories. healthcare systems says Professor Sheila D Tlou of many lives saved and hope for mothers and. director of the UNAIDS Regional Support Team for their babies For example domestic resources. Eastern and Southern Africa account for more than 70 of the HIV AIDS. budget in Botswana Namibia Mauritania,The past few years have seen unprecedented. Mauritius and South Africa,economic growth in Africa The World Bank s. latest Annual Report 2014 shows that with UNAIDS gures indicated that thanks to. real GDP growth projected to rise above 5 in increased investment and unprecedented global. 2015 16 Sub Saharan Africa will continue to be and community actions new HIV infections in. one of the world s fastest growing economies 23 Sub Saharan Africa declined by 33 and AIDS. Many countries have also shown improvements related deaths fell by 39 between 2005 and. in governance poverty reduction and overall 2013 Over 9m people living with HIV in Sub. human development creating opportunities for Saharan Africa are estimated to have accessed. World Bank Annual investments in equitable and sustainable health treatment in 2013 compared with 6m in 2010. Report 2014 www systems,worldbank org en about Bridging the funding gap. annual report accessed on However Africa is far from self suf cient in the However there are still some challenges. October 23rd 2014 broader healthcare delivery system The region UNAIDS estimates that Africa will require an. 12 The Economist Intelligence Unit Limited 2014, The future of healthcare in Africa progress challenges and opportunities. annual investment of US 11bn 12bn for its a increasing domestic resources. HIV AIDS response in 2015 that same year, the expected funding gap will be US 3bn 4bn b investing to address the challenges of. Donor funding remains an important resource in human resources in the healthcare sector. narrowing the gap and strengthening healthcare and. systems African leaders need to increase their,c combining the strengthening of. commitment to sustainable healthcare systems,healthcare systems with innovative service. and they are doing so,delivery models such as task shifting the. In 2012 the 19th Summit of the African Union rational redistribution of tasks among. adopted the Roadmap on shared responsibility and health workforce teams according to the. global solidarity for AIDS TB and malaria response World Health Organisation 25 health service. in Africa 24 This calls on African governments integration and point of care and community. and development partners to raise funding for mobilisation to create demand for access to. the three diseases together investing their fair equitable services that leave nobody behind. share based on ability and prior commitments,The post 2015 development agenda will also be. Resources from the international community,critical in ensuring that international donors. remain important in bridging the funding gap,continue to deliver on their commitments to. and strengthening healthcare systems to sustain,strengthen healthcare systems and fast track the. delivery of integrated HIV and other health,end of the AIDS epidemic by 2030. The HIV AIDS response has also taught us that,there are ways to maintain healthcare and. community systems including by,African Union Roadmap. on shared responsibility and,global solidarity for AIDS. TB and malaria response,in Africa www au int,en sites default files. Shared Res Roadmap,Rev F 5B1 5D pdf,accessed on October 23rd. World Health,Organisation Task shifting,global recommendations. and guidelines www who,int workforcealliance,knowledge resources. taskshifting guidelines,en accessed on October,The Economist Intelligence Unit Limited 2014. While every effort has been taken to verify the accuracy. of this information The Economist Intelligence Unit. cannot accept any responsibility or liability for reliance. by any person on this article or any of the information.
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REVIEW ARTICLE Stud attachments for the mandibular implant-retained overdentures: Prosthetic complications. A literature review Elie E. Daou * Removable Prosthodontics Department, School of Dentistry, Lebanese University, Beirut, Lebanon