Africa’s Complicated Path to Global Health Equity
A healthcare provider screens people for African sleeping sickness.

The global health landscape is marked by paradoxes. The last several decades have been shaped by progress and setbacks – new medicines and emerging diseases, technological advancements and entrenched inequities. 

The Ebola outbreaks and COVID-19 pandemic exposed many of the already existing inequities in our global health ecosystem, from unequal access to vaccines to restrictive intellectual property laws that prevent low- and middle-income countries from developing their own medical products.

 As we witness both remarkable progress and glaring disparities in global health, it is abundantly clear that we have to redefine our approach as health funding, research and decision-making for African countries cannot be managed in the Global North. 

Advancing health equity and ownership in Africa is not merely a moral imperative; it is an essential pathway to harnessing the vast potential of the continent. In pursuit of this imperative, we must dismantle the barriers within global health institutions that have hindered Africa’s progress, and foster partnerships that empower African nations to lead the charge in shaping their own health destinies, being mindful of the new mantra: decolonising global health.

Disproportionate impact of infectious diseases

Africa has historically been disproportionately affected by infectious diseases such as HIV/AIDS, malaria, tuberculosis, and several other neglected tropical diseases with some conditions like yaws and guinea worm resurfacing in areas where they had previously been eradicated. 

At the height of the HIV/AIDS epidemic, access to life-saving antiretroviral therapy (ART) was severely limited in Africa as high drug prices, patent protections, and trade barriers made it challenging for African countries to procure and provide ART to their populations. 

In contrast, high-income countries in the Global North had widespread access to ART, which significantly improved the prognosis and quality of life for people living with HIV.

A woman prepares for an HIV test in Uganda.

Many African countries also have amongst the highest maternal and child mortality rates in the world, reflecting disparities in access to quality health care, including skilled birth attendants and emergency obstetric care. In some cases, very basic interventions such as clean water and clean hospitals can make a very significant difference in mortality. 

 Africa also faces significant health inequities in terms of access to sexual and reproductive health and rights (SRHR), such as limited or insufficient access to contraception and comprehensive sexual health education, which is sometimes hindered by religious practices in some African countries.

These barriers and inequities have hampered Africa’s health progress. Addressing and dismantling them demands a comprehensive approach.

Funding mechanisms must advance equity

 First, global health funding mechanisms must have a stronger focus on advancing health equity. This means directing more resources to countries and regions with the greatest health disparities and challenges, as well as prioritizing investments in health system strengthening, including infrastructure and workforce development. 

African governments should also explore innovative financing mechanisms that drive up domestic financing for health – such as social health insurance, community-based health financing, and public-private partnerships – to diversify funding sources for health.

 Simultaneously, all stakeholders must work to dismantle the systemic biases within global health, including empowering more women to hold leadership roles and prioritizing the health needs of vulnerable and marginalized communities. 

Moreover, while international partners and donors play a vital role in supporting health interventions across the continent, Africa’s health priorities, policies and research must be locally led. Empowering African leaders and experts is key to addressing these biases and ensuring that the unique challenges faced by African nations receive the attention and resources they deserve.

Collaboration is important for impact

 Collaboration across sectors and geographies is also indispensable in the pursuit of global health equity. International organizations, governments, academia, civil society, and the private sector all have a role to play in sharing best practices and directing resources where the need is greatest.

South-South cooperation, in particular, can facilitate knowledge-sharing and foster greater collaboration among countries facing similar resource constraints and health challenges.

The year 2030 is just around the corner and questions still remain about our ability to reach the sustainable development goals which, while not legally binding, require African governments, researchers and scientists to take responsibility.

African-led and supported research initiatives, conferences and platforms are crucial for understanding health disparities and designing effective interventions. 

The upcoming Third International Conference on Public Health in Africa (CPHIA 2023) will provide a platform for African leaders to reflect on lessons learnt in health and science, spotlight African research and innovation, and align on a way forward for creating more resilient health systems. 

Platforms like CPHIA exemplify the potential of home-grown initiatives to tackle health challenges through regional collaboration, with a focus on equity and inclusivity.

In our increasingly interconnected world, the urgency of advancing health equity in Africa cannot be overstated. 

The pursuit of health equity is an immediate and collective responsibility and requires a multifaceted approach that encompasses equitable and sustainable funding, empowered leadership, successful homegrown initiatives, and inclusive collaboration. 

By harnessing the collective will of all stakeholders, we can dismantle the barriers that have hindered Africa’s health progress and usher in a healthier, more equitable Africa.

Prof Margaret Gyapong is the Director of the Institute of Health Research, University of Health and Allied Sciences (UHAS) in Ghana, and co-chair of the upcoming Conference on Public Health in Africa (CPHIA).

Shingai Machingaidze is Acting Chief Science Officer at the Africa Centre for Disease Control and Prevention (Africa CDC) and the CPHIA secretariat lead.

Image Credits: Xavier Vahed/DNDi, 2011, Sokomoto Photography for International AIDS Vaccine Initiative (IAVI).

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