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I think I want to research health disparities which must be addressed to reach SDG 3. I will focus in Sub-Saharan Africa and Asia. I will talk about how health education should be promoted and sponsored to get rid of inequalities.

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Goal 3: Good health and well-being - The Global Goals

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Ensure healthy lives and promote well-being for all at all ages.

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Some of the biggest health disparities are located in sub Saharan Africa. Many problems can be found here and health disparities can be found here.

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Abstract

Background

Despite the end of apartheid in the early 1990s, South Africa remains racially and economically segregated. The country is beset by persistent social inequality, poverty, unemployment, a heavy burden of disease and the inequitable quality of healthcare service provision. The South African health system is currently engaged in the complex project of establishing universal health coverage that ensures the system's ability to deliver comprehensive care that is accessible, affordable and acceptable to patients and families, while acknowledging the significant pressures to which the system is subject. Within this framework, the Bertha Centre for Social Innovation & Entrepreneurship works to pursue social impact towards social justice in Africa with a systems lens on social innovation within innovative finance, health, education and youth development. The aim of this study is to demonstrate the capacity for social innovation in health with respect for South Africa, and to highlight some current innovations that respond to issues of health equity such as accessibility, affordability, and acceptability.

Methods

Different data types were collected to gain a rich understanding of the current context of social innovation in health within South Africa, supported by mini-case studies and examples from across the African continent, including: primary interviews, literature reviews, and organisational documentation reviews. Key stakeholders were identified, to provide the authors with an understanding of the context in which the innovations have been developed and implemented as well as the enablers and constraints. Stakeholders includes senior level managers, frontline health workers, Ministry of Health officials, and beneficiaries. A descriptive analysis strategy was adopted.

Results

South Africa's health care system may be viewed, to a large extent, as a reflection of the issues facing other Southern African countries with a similar disease burden, lack of systemic infrastructure and cohesiveness, and societal inequalities. The evolving health landscape in South Africa and the reforms being undertaken to prepare for a National Healthcare Insurance presents the opportunity to understand effective models of care provision as developed in other African contexts, and to translate these models as appropriate to the South African environment.

Conclusions

After examining the cases of heath innovation, it is clear that no one actor, no matter how innovative, can change the system alone. The interaction and collaboration between the government and non-state actors is critical for an integrated and effective delivery system for both health and social care.

Background

South Africa is a land of painful contrasts. Its vast mountain ranges, rolling farmland and vineyards, and glittering cities overlook the reality of informal settlements, unreliable and unsafe transportation routes, and rampant unemployment. This is certainly not what was envisioned when the work began of dismantling apartheid, a system of institutionalized racial segregation that had existed in the country since 1948. Following the release of Nelson Mandela in February 1990, after more than 27 years of incarceration, the South African government, the African National Congress, and various other political organizations embarked on a series of negotiations that peacefully brought about the end of the apartheid regime. These negotiations culminated in South Africa's first non-racial elections in 1994, which were supposed to usher in a new era where all South Africans, in the words of Nelson Mandela, could embrace the "cherished ... ideal of a democratic and free society in which all persons live together in harmony and with equal opportunities."

Despite this early promise, South Africa remains racially and economically segregated. The country is beset by persistent social inequality, poverty, unemployment, a heavy burden of disease and the inequitable quality of health service provision. Challenges within the social care environment in South Africa include lack of access to the basic requirements of life such as clean water, nutrition, sanitation and education. The country has seen substantial economic growth in the post-apartheid era, yet over half of South Africa's population lives in poverty [ 1]. The disparity between socio-economic groups within the country is one of the widest in the world; in 2018, the World Bank released a report on poverty and inequality in South Africa, and named it the most inequal society globally due not only to income inequality but also to wealth inequality. In its report, the World Bank found that the top one percent of South Africans control 70.9% of the country's wealth while 60% of the country's population collectively controls only seven percent of the country's assets [ 2]. Despite the end of apartheid, this split is largely still along racial lines.

Post-apartheid, the South African government has invested heavily in social programs with the goal of reducing poverty and inequality. These include the establishment of the Black Economic Empowerment program, geared towards investment in black owned businesses; the expansion of safety net schemes such as free primary education, the development of a National Health Insurance plan, and promotion of minimum income grants to parents; and ambitious infrastructure projects improving access to water, sanitation, housing and healthcare facilities. In many ways, the South African government's social protection program is efficient and efficacious, but in its totality, its degree of success is sporadic. Poverty levels in the country have been growing since 2015, and those at greatest risk include children, black Africans, people living in rural and remote areas, and those who have little or no access to education [ 1]. In 2015, more than 30 million South Africans, or nearly 56% of the population, lived on less than United States Dollolar (USD) 5 per day; this is still true in 2019 [ 2].

Arguably, a rationale for these sobering statistics is the simple fact that South Africa's legacy of exclusion means that the country's white minority, some nine percent of the population, still benefits from apartheid's unequal policies. Those who have always had access to opportunity continue to have access-through intergenerational wealth and mobility, land ownership, quality education, and so on. This means that inequality is being passed down, and large numbers of South Africans remain vulnerable to the government's inability to address this extreme disparity.

Within this framework, the Bertha Centre for Social Innovation & Entrepreneurship, a specialized unit within the University of Cape Town's Graduate School of Business, works to pursue social impact towards social justice in Africa, through teaching, knowledge-building, convening and catalytic project work with a systems lens on social innovation within innovative finance, health, education and youth development. Within the context of the Bertha Centre's work and activities, social innovation is defined as "A novel solution to a social problem that is more effective, efficient, sustainable, or just than existing solutions and for which the value created accrues primarily to society as a whole rather than private individuals" [ 3].

At the Bertha Centre, we believe that through inclusivity and radical collaboration, social innovation in health can open the doors to broadscale systemic impact by bringing together different disciplines, emphasizing co-creation, and pioneering solutions and business models that respond to real health needs. Through exploring new ways of doing, being and understanding, we hope to achieve a more equal society which works towards overcoming and addressing social and environmental challenges [ 4].

Methods

A few examples of innovative health solutions within South Africa and elsewhere in Africa are described below and were investigated by the Bertha Centre through desk research, site visits, and numerous interviews with founders, staff, funders, and government officials. These cases were selected for inclusion based on the definition of social innovation included earlier in this writing.

Discussion and results

The health system in South Africa

The South African healthcare system is currently engaged in the complex project of establishing universal health coverage that ensures the system's ability to deliver comprehensive care that is accessible, affordable and acceptable to patients and families, while acknowledging the significant pressures to which the system is subject. South Africa faces healthcare challenges in three major areas: the growing quadruple disease burden (see below); systemic and structural challenges in service delivery; and societal challenges associated with poverty and unemployment.

The vast burden of diseases is a major challenge, and the overburdened public health system is unable to accommodate increased demand. South Africa's quadruple burden of diseases consists of HIV and AIDS, communicable disease, non-communicable disease, and violence and injuries. The consequence of these colliding epidemics is high levels of mortality and morbidity [ 5]. South Africa has the world's largest population of people living with HIV-7.1 million people are afflicted-and one of the highest incidence rates of multi-drug resistant tuberculosis in the world [ 6]. South Africa is further experiencing a growing burden of chronic non-communicable disease. In 2016, cardiometabolic conditions (diabetes, cerebrovascular, heart and hypertensive disease) and other non-communicable diseases accounted for 57.4% of deaths in the country [ 7].

The South African health system faces a range of systemic and structural challenges, which include widespread inefficiencies, staff shortages, variability in skill sets between rural and urban areas, and suboptimal care levels and patient management [ 8]. The healthcare system consists of a large poorly funded public sector and a smaller better resourced private sector. The national Department of Health holds overall responsibility for healthcare, and specifically for the public sector across South Africa's nine provinces. Nearly half of public health resources are allocated to district health services, which include primary healthcare clinics, community health centres and district hospitals.

Healthcare remains the load of the state because of high levels of poverty and unemployment, and the persistent inequality between public and private sector healthcare has created a system in which the public sector is overburdened in comparison to the private sector. The public sector provides services to roughly 84% of the population without private health insurance, and yet the government spends less than half the total health expenditure on healthcare [ 9]. Annual per capita expenditure on health ranges from USD 1400 per patient in the private sector to approximately USD 140 in the public sector. This discrepancy is also reflected in the availability of healthcare providers across the two spheres. Despite being one of the top five African countries in terms of density of medical personnel per 1000 population, the South African public health system is chronically understaffed, particularly in rural and remote areas [ 10]. Around 70% of doctors work only in the private sector, which leaves 30% of physicians available to service the public sector [ 9].

At the time of this writing, South Africa is introducing universal health coverage, under the banner of a National Health Insurance (NHI) system, that is envisaged as a response and solution to these three major challenges. The goal of the NHI is to foster healthcare reform to improve service provision and healthcare delivery for all socioeconomic groups, while also partnering with providers and organizations within the private sector in the delivery of healthcare. Private sector healthcare and medical aid schemes will remain in existence, but the NHI is intended to ensure that South Africans are able to access both the public and the private sectors through a blended model that will provide services in a manner that will benefit the entire population. In 2012, the NHI began a phasing process that will see it into existence over a period of 14 years. However, the implementation of the NHI only serves to accentuate the scale of the interventions necessary to ensure a well-functioning health system. The public sector's critical shortages, maldistribution of resources, and underrepresentation of medical personnel and other health professionals highlights the urgent need for a more integrated health system, and the necessity of improving quality of care, access to services and general health equity [ 11].

In addition, apartheid-era urban planning means that public services, institutions and facilities remain inaccessible and inconvenient to large numbers of South Africans. Cape Town's Groote Schuur Hospital serves as a pertinent example. A large, government-funded, tertiary and quaternary care facility, Groote Schuur functions as the University of Cape Town's teaching hospital. It is located in Cape Town's Observatory suburb, a far distance for patients who have been referred for care from the townships on the city's periphery. Transport into the Cape Town city center is expensive, unreliable and unsafe. A commute for a hospital visit could cost up to USD 3, when an average service-sector job pays as little as USD 10 per day [ 12].

In the context of deep inequality, new methods of addressing and overcoming social and environmental challenges need to be explored. Due to its status as a developing country and emerging economy, South Africa is a ripe testing ground for entrepreneurship and social innovation. Entrepreneurs and innovators do not feel bound by traditional solutions and are able to reach members of the country's most vulnerable populations. In addition, the sheer magnitude of the health challenge has led to the realisation that improving health outcomes will require the collaboration of the public and private sectors, as well as civil society. This realisation echoes the findings of Mason et al. in their determination that "a prevailing characteristic of social innovation is its responsiveness to failures or shocks of economic, social welfare, and wider political systems" [ 13] and that its function can be interpreted as a response to "failures of or gaps in institutional systems" [ 13].

Healthcare, and services promoting health as a resource, in South Africa, and across the continent, is ripe for systemic innovation that capitalizes on resource scarcity, because it allows for new methods and technologies to be adopted more quickly. These innovations can take many forms, for example, where mobile technology is used to provide health services and information, risk pooling where micro-insurance providers can tailor products to lower-income markets, and service provision, where services are re-engineered to achieve quality yet affordable healthcare [ 14]. The work of social innovation provides an opportunity to develop transformative and systemic solutions that move the system as a whole closer to achieving health equity, embodying what Mason et al. terms its greatest value i.e. "its capacity to redress system failures at local levels" [ 13].

Access to health and case studies

Although government remains a key provider of basic services, social innovations are primarily developed at the frontlines of healthcare delivery by individuals and communities in response to a pressing need, often not met by government services. These social innovations take various forms from technological products, processes, novel organisational models or market mechanisms. Social innovation is most often implemented and tested at a local, grass-roots level before being extended to district, provincial, and national levels, and is often adopted at an ad-hoc fashion. A few examples of innovative health solutions within South Africa and elsewhere in Africa are described below.

The World Health Organization defines equity and health equity as follows:

Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. "Health equity" or "equity in health" implies that ideally everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential [ 15]. The simplistic argument could be that simple access to health is ipso facto health equity. However, a better way to appreciate the dilemma is to consider access to health along three dimensions, and to posit that if a health system were to view these dimensions as a lens through which it understands and responds to its challenges, it might move closer to achieving a greater degree of health equity.

Physical accessibility

The first dimension of access to health is physical accessibility. This speaks to the availability of good health services within reasonable reach of those who need them and of opening hours, appointment systems and other aspects of service organization that allow people to obtain the services when they need them.

Imagine you have a 2-year-old who wakes up one day with a fever and you realise that she could have malaria. You know that the only way to get her the medicine, and you need to walk or hitchhike 50 km to reach the nearest clinic. This is the reality for many parents who live in rural and remote areas of South Africa. Health innovation is bridging this gap between the patient and the healthcare facility. An example is the Transnet Phelophepa Health Trains, which use South Africa's railway network to take mobile clinics into the country's heartland, treating 200 000 patients per year [ 16].

Imagine that you have a chronic illness, but your work requires you to travel from your township home on the urban periphery into the city centre, a journey that could take you up to 3 h. Where would you find the time to visit a health facility within its opening hours to pick up your chronic medication? Sizwe Nzima developed a solution that addresses these issues of accessibility and convenience that face many people in Cape Town's poorer areas. In 2013, he established Iyeza Express, a bicycle courier service employing local youth as specialised medical couriers. His team collects chronic medications from public health facilities and delivers them directly to people's homes, providing valuable services to over 1000 people living in Khayelitsha township. Iyeza Express has grown into Iyeza Health, a health logistics company that aims to strengthen public health systems through improved access to community-based patients.

Similar examples can be found across Africa. VillageReach in Malawi has developed a proactive model that works to create an enabling context and connect key players - including cellphone service providers - to enable healthcare delivery in the last mile, or that final link between a patient and the healthcare system. Chipatala cha pa foni (meaning Health Center by Phone), its toll-free health hotline, provides community members in remote areas with the opportunity to interact with the health system without having to travel long distances to the nearest health facility. The Ihangane Project in Rwanda provides another example; by engaging with health workers and patients, the organisation works to build community ownership of local health systems. Since 2016, it has worked with communities across Rwanda's Ruli district to build eight community health buildings which are used to provide village-level access to health care, while the buildings also serve as locations for education and community meetings.

Financial affordability

The second dimension of access to health is financial affordability. This is the measure of a person's ability to pay for services without financial hardship. It takes into account not only the price of the health services but also indirect and opportunity costs (e.g. the costs of transportation to and from facilities and of taking time away from work). Affordability is influenced by the wider health financing system and by household income.

In 2013, entrepreneur Neo Hutiri was diagnosed with tuberculosis. During his 6-month treatment period, he had to travel to the Bophelong health clinic in Johanesburg every 2 weeks, where he would queue for hours to pick up his medication. During that period, he had plenty of time to think: what if he was able to create a solution that would allow patients to collect their repeat medications in a matter of minutes rather than hours? The Pelebox Smart Locker is such a solution. Instead of incurring the indirect and opportunity costs of queuing at the health clinic, patients simply receive a one-time PIN on their phone, which they use to unlock the locker to retrieve their medication [ 17]. Neo's solution has the potential to improve a healthcare system under great strain, and this has been recognised; Neo has partnered with the Department of Health since 2016, and to date the Pelebox Smart Locker has allowed more than 8000 patient collections across Gauteng Province [ 18].

South Africa runs the largest HIV antiretroviral therapy programme in the world, and the bulk of those patients receive treatment in the public sector. HIV-positive patients require regular check-ups, adherence support and counselling services; however, their compliance with their treatment is compromised when the overburdened public health system does little to protect patient privacy [ 19]. The complex health challenge of HIV cannot be solved only within the public sector; it requires the collaboration of the public, private and not-for-profit sectors. Public-private partnerships (PPP) is one such collaboration: this is a mechanism through which private sector involvement in developing, financing and providing healthcare infrastructure and service delivery within the public sector is harnessed. One such PPP is the GP-Down Referral Model, launched by BroadReach Healthcare in 2005 in partnership with the North West Province Department of Health. The GP-Down model works by shifting the delivery of antiretroviral therapy of stable patients from the overburdened public sector to private independent general practitioners. The model frees up resources in the public sector, and improves the care offered to patients - now, they are able to consistently see the same physician - while also reducing the direct and indirect costs of having to access the public health system [ 19]. Through PEPFAR grants and subsidies in kind from the provincial government, this co-funded model allows BroadReach to pay for model set-up and staffing costs, as well as providing patient adherence support and covering the costs of GP consultation fees; in its turn, the North West Province Department of Health provides the antiretrovirals as well as the laboratory support [ 19]. Patients reported that they valued the chance to build more trusting relationships with their doctors, while they were also able to save money and visit a clinic closer to home where appointments were timely.

Acceptability

The third and final dimension of access to health is acceptability. This captures a person's willingness to seek services. Acceptability is low when patients perceive services to be ineffective or when social and cultural factors such as language, age, sex, ethnicity or religion of health provider discourage them from seeking services.

The issues of language and culture in South Africa are applicable examples of how important acceptability is in seeking out healthcare services, and in truly being able to access health as a resource. South Africa recognizes eleven official languages, of which English is the primary language for state discourse, and more often than not, the primary language of the health community. This can be very isolating to patients whose mother tongue is isiXhosa, Venda, or Zulu, and who, in consequence, cannot communicate with their healthcare provider or might need to rely on a child or a nurse as a translator. This is the case for many patients who live in the Umkhanyakude district of KwaZulu-Natal. There is little electricity, running water or sanitation in this region, and its population of more than half-a-million is served by only five public hospitals which are beset by chronic shortages of professional healthcare staff [ 16]. In response, The Umthombo Youth Development Foundation offers an innovative solution by addressing the skills shortages in rural health by providing scholarships for promising young people to study, who then return to their home communities as doctors, nurses, social workers, physiotherapists, and other healthcare professionals. These graduates are able to communicate with their patients in their own language, and are held in high esteem by their communities [ 16]. At the time of this writing, the Foundation has supported 385 graduates; of those graduates, 177 no longer have further work back obligations. Of these 177 healthcare professionals, 65% still work in rural facilities and an additional four percent are working with rural NGO's [ 20].

An example beyond South Africa is Last Mile Health, a health innovator located in Liberia. In partnership with the Liberian government, Last Mile Health trains community health workers to prevent, diagnose and treat a range of medical conditions and diseases using smartphone technology. These community health workers address the needs of people in remote communities that lack access to care due to distance and poverty. By recruiting, training, equipping and paying community members to deliver lifesaving health services to their neighbours, Last Mile Health ensures that patients are able to access care from a trusted healthcare professional who they know, understand, and believe will provide them with the appropriate treatment and medication for common medical conditions such as malaria and pneumonia.

Conclusions

South Africa's health care system may be viewed, to a large extent, as a reflection of the issues facing other Southern African countries with a similar disease burden, lack of systemic infrastructure and cohesiveness, and societal inequalities. And yet the evolving health landscape in South Africa and the reforms being undertaken to prepare for a National Healthcare Insurance presents the opportunity to understand effective models of care provision as developed in other African contexts, and to translate these models as appropriate to the South African environment. A main focus of the South African Ministry of Health in regard to the National Health Insurance is the delivery of high-quality accessible primary care to all citizens and, thus, research on translational models of primary care hold value for local policy makers. Kenya's innovative approach to primary health care provision is particularly ripe for examination, as, contrary to South Africa, almost half of Kenya's poor utilizes services provided by the private health sector. South Africa could also gain relative to its policy and regulatory environment and the innovation ecosystem of other African countries. For example, mobile health has been used more extensively in countries such as Kenya and Uganda, as compared to South Africa, to support care delivery in low-income communities.

No one actor, no matter how innovative, can change the system alone. The interaction and collaboration between the government and non-state actors is critical for an integrated and effective delivery system for both health and social care. The social innovation felt at a grass-roots level must be celebrated and promoted on a national level so that successful ideas, products, services and solutions are connected to policy makers at all levels of government. Across the health system and within communities, there are individuals with the potential of making a valuable contribution that could achieve positive systemic change. The value and importance of each of these change agents need to be recognized, nurtured and supported such that a broader collective agenda of equity, access and accountability can be achieved.

South Africa can be viewed as a microcosm of existing global challenges-inequality, youth unemployment, poverty, health inequity. These challenges can seem overwhelming, but South Africa has a strong infrastructure, media freedom, an active civil society, a relatively robust economy, and most importantly, amazing human talent and possibility [ 21]. As a result, the country has the right active ingredients to make real progress, and so contribute to providing African solutions to African problems.

Availability of data and materials

Abbreviations

NHI:

National Health Insurance

PPP:

Public Private Partnership

PEPFAR:

The President's Emergency Plan for AIDS Relief

NGO:

Non-Governmental Organisation

USD:

United States Dollar

References

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Acknowledgements

The Social Innovation in Health Initiative (SIHI). TDR, the Special Programme for Research and Training in Tropical Diseases, co-sponsored by UNICEF, UNDP, the World Bank and WHO

Funding

Katusha de Villiers is based at the UCT GSB Bertha Centre for Social Innovation & Entrepreneurship. No additional funding was received for this paper.

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Bertha Centre for Social Innovation and Entrepreneurship, The University of Cape Town Graduate School of Business, Cape Town, South Africa

Katusha de Villiers

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Katusha de Villiers

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Correspondence to Katusha de Villiers.

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de Villiers, K. Bridging the health inequality gap: an examination of South Africa's social innovation in health landscape. Infect Dis Poverty 10, 19 (2021). https://doi.org/10.1186/s40249-021-00804-9
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Keywords

# data[].attributes.attachment_link.title
Bridging the health inequality gap: an examination of South Africa's social innovation in health landscape - Infectious Diseases of Poverty

# data[].attributes.attachment_link.description
Background Despite the end of apartheid in the early 1990s, South Africa remains racially and economically segregated. The country is beset by persistent social inequality, poverty, unemployment, a heavy burden of disease and the inequitable quality of healthcare service provision.

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Disparities meaning unfair and challenges for treatment can be seen different throughout many different countries and regions. The groups that can be discriminated against can be due to race, ethnicity, immigration, gender, etc.

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MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

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Health disparities refer to differences in the health status of different groups of people. Read more.

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Mapping out health disparities in heat maps helps to visualize and identify them. This helps to make complicated data in to easy understanding information.

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The description here really describes what health disparities are. How they're different and the same throughout many regions. Different factors can be put into play to and have affects how they effect regions.

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Health disparities are largely preventable health differences that adversely affect populations who experience greater challenges to optimal health and are closely linked with intergenerational social, economic, and/or environmental disadvantages—primarily based on identification as an individual from a racial and/or ethnic minority group and/or by low socioeconomic status (SES) in society.

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Global health is a big factor in our everyday life that effects every one. This website starts with explaining that they have done research on the past to the present and done comparison between well developed and poor countries.

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An overview of our research on global health.

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Health disparities increase across countries every year. Especially in low income regions, which can be found in Sub-Saharan Africa, South Asia, Latin America, the Caribbean, North Africa, the Middle East, Eastern Europe and Central Asia.

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An overview of our research on global health.

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The title does justice of how health should be seen. She speaks greatly on my goal.

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Health care is a right — not a privilege

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In a powerful personal narrative and slam poem, healthcare executive Maija Williams exposes the stark disparities in the current system, recounting her experience dealing with a dangerous medical emergency. She delivers a passionate call to action for everyone to recognize health care as a fundamental right that must be delivered equitably.

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Health Disparities in the 21 century were not only due to lack of access but I also because of corruption within their region and their poor governance over their resources.

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Health Care in Sub-Saharan Africa: 21st Century Trends & Forecasts

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Interventions to improve health in Sub-Saharan Africa must target the population’s changing needs and infrastructure demands.

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In sub-Saharan Africa they lack the man power and where they do not they lack the adequate health care infrastructure, many problems they face are brought up.

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A Call for Global Action

Sub-Saharan Africa, a region spanning four time zones and 49 nations, has always struggled to provide quality healthcare to its inhabitants. Many Africans struggle daily with finding enough food to eat. Accessing healthcare is beyond their reach. Despite significant strides in economic development and technological advancements, affordable healthcare remains a distant dream for most Africans.

Africa has 24% of the world's disease burden yet just 3% of the health workers. Only 5% of Africans have access to safe surgery, and Africa needs nearly 50 times the current number of surgical workers. Limited access to safe and effective medical care in sub-Saharan Africa is a profound humanitarian crisis demanding urgent global attention and action.

Historical Context and Current Challenges

To grasp the scale of the healthcare challenges in sub-Saharan Africa, it is crucial to consider the historical context. Colonialism left a legacy of economic and political instability, which continues to affect the region's infrastructure and healthcare systems. Post-independence, many countries in sub-Saharan Africa struggled to establish stable governance necessary for the development of healthcare systems and trained local personnel.

Insufficient Healthcare Infrastructure

One of the most significant issues facing sub-Saharan Africa is the lack of adequate healthcare infrastructure. Many rural areas lack even basic medical facilities, and where they do exist, they are often poorly equipped and understaffed. According to the World Health Organization (WHO), sub-Saharan Africa has only 1.3 health workers per 1,000 people, far below the minimum threshold of 4.5 recommended by the WHO to deliver essential health services. The shortage of healthcare professionals is another daunting barrier.

Burden of Infectious Diseases

Infectious diseases pose another significant challenge. Sub-Saharan Africa bears a disproportionate burden of conditions such as HIV/AIDS, malaria, and tuberculosis.

Dr. Jon Fielder, founder and CEO of African Mission Healthcare, who invested two decades of his life providing medical treatment and education to HIV/AIDS victims in sub-Saharan Africa, recently wrote to the US Senate, "Despite PEPFAR's many successes, far too many newborns in Africa are being born with HIV - one million over the next decade if no changes are made to business as usual. We know how to bend the curve towards the elimination of maternal-to-child transmission ... and need support to do so."

According to UNAIDS, sub-Saharan Africa accounted for 59% of all people living with HIV globally in 2020. The region also sees 94% of global malaria cases and deaths, according to the WHO. These diseases place immense strain on healthcare systems that are already under-resourced and underfunded.

Lack of Access to Essential Medicines

Access to essential medicines remains a significant hurdle. Many sub-Saharan African countries rely heavily on imported pharmaceuticals, which can be prohibitively expensive. The high cost of drugs and limited availability, means that many people cannot access the treatments they need. These barriers are particularly devastating for those with chronic conditions, such as diabetes or hypertension, who require regular medication to manage their health.

Counterfeit and substandard medicines also pose a risk. In some parts of sub-Saharan Africa, up to 30% of medicines on the market are counterfeit, according to the WHO. These fake drugs not only fail to treat the illnesses they are intended for but can also cause serious harm or even death.

And, the recent global pandemic, highlighted that 80% of African health facilities lack access to the most basic and essential of all medicines, oxygen.

Maternal and Child Health Crisis

Maternal and child health is another area of concern. Sub-Saharan Africa has the highest maternal mortality rate in the world, with 533 deaths per 100,000 live births, according to the WHO. This rate is far more than double the global average of 211. Factors contributing to high maternal mortality include a lack of skilled birth attendants, inadequate prenatal and postnatal care, and insufficient access to emergency obstetric services.

Child mortality rates are equally alarming. According to UNICEF, the region accounts for half of all under-five deaths globally. Preventable diseases, such as pneumonia, diarrhea, and malaria, are the leading causes of these deaths. Malnutrition, poor sanitation, and limited access to clean water further exacerbate the situation, making it difficult for children to survive and thrive.
Financial Barriers to Healthcare
Financial barriers prevent poor populations from accessing healthcare in sub-Saharan Africa. Out-of-pocket payments for healthcare services are common, placing a heavy financial burden on families. The World Bank reports that more than 40% of healthcare financing in the region comes from out-of-pocket payments. For many households, the cost of healthcare can push them into poverty, creating a vicious cycle of ill health and economic hardship.

What Needs to Be Done

Despite these daunting challenges, there are promising initiatives and strategies aimed at improving healthcare in sub-Saharan Africa. A respected thought-leader and one of the most strategic nonprofit organizations, African Mission Healthcare, recommends the following six critical steps:

1. Strengthening Healthcare Infrastructure: Investing in healthcare infrastructure is paramount. This not only includes building new facilities, upgrading existing ones, and ensuring they are adequately equipped but also developing strong healthcare systems across the region.

2. Increasing the Healthcare Workforce: Addressing the shortage of healthcare professionals requires both short-term and long-term strategies. African Mission Healthcare has implemented the Mission Healthcare Teaching Network to develop teaching hospitals from which graduates fan out across the continent to care for and train others. Additionally, investing in medical education and training programs will ensure a steady supply of qualified healthcare professionals.

3. Improving Access to Essential Medicines: Governments and international organizations must work together to improve access to affordable, quality medicines. This can be achieved through bulk purchasing agreements, local production of generic medicines, and stringent regulation to combat counterfeit drugs. African Mission Healthcare works with trusted suppliers to procure medical supplies on behalf of our partners. African Mission Healthcare has taken a leadership role in the installation of oxygen plants and oxygen distribution systems to ensure that the most basic and essential of all medicines is provided to those in need.

4. Focusing on Preventive Care: Emphasizing preventive care can help reduce the burden of disease. Public health campaigns to promote vaccination, good hygiene practices, and healthy lifestyles can prevent many diseases. The twin epidemics of HIV and tuberculosis continue to ravage communities across sub-Saharan Africa. African Mission Healthcare provides hands-on clinical training to expand the knowledge of health workers so they can more effectively manage these diseases and medications and so that they can provide preventative information to each patient treated. Strengthening primary healthcare services, including training family physicians and nurses, will also ensure that diseases are detected and treated early.

5. Leveraging Technology: Telemedicine and mobile health technologies offer innovative solutions to bridge the gap in healthcare access. These technologies can provide remote consultations, health education, and disease monitoring, particularly in rural and underserved areas. African Mission Healthcare's online learning platform for healthcare workers is currently used by over 20,000 healthcare workers to increase the speed and effectiveness of their healthcare education.

6. International Cooperation: The global community has a crucial role to play in addressing the healthcare crisis in sub-Saharan Africa. Individuals, foundations, and nations that can gift resources are urgently needed to implement the five health initiatives detailed by African Mission Healthcare. Donate now to help.

A Call to Action

The healthcare crisis in sub-Saharan Africa is a multifaceted issue that requires a comprehensive and collaborative approach. While the challenges are significant, they are not insurmountable. By investing in healthcare infrastructure, increasing the healthcare workforce, improving access to essential medicines, and focusing on preventive care, we can make significant strides toward ensuring that all people in sub-Saharan Africa have access to the healthcare they need for the life they want.

It is imperative that the international community recognizes the urgency of this crisis and acts decisively. The health and well-being of 1,226,641,550people are at stake. By working together, we can build a future where access to quality healthcare is a reality for everyone, regardless of where they live. This is not just a moral imperative; it is essential for achieving global health equity and fostering sustainable development.

In the words of Nelson Mandela, "Health cannot be a question of income; it is a fundamental human right." Let us honor this principle by committing to action and ensuring that the people of sub-Saharan Africa receive the medical care and support they deserve.

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The Healthcare Crisis in Sub-Saharan Africa: | African Mission Healthcare

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Ray R. Harris A Call for Global Action Sub-Saharan Africa, a region spanning four time zones and 49 nations, has always struggled to provide quality healthcare to its inhabitants. Many Africans struggle daily with finding enough food to eat. Accessing healthcare is beyond their reach. Despite significant strides in economic development and technological advancements,...

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South Asians are more likely to have abnormal cholesterol, obesity and other risk of diseases which greatly impacts their health disparities.

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Heart disease disproportionately affects South Asians (individuals from Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), who face a four-fold greater risk of atherosclerotic cardiovascular disease compared to the general population. In fact, the South Asian community experiences a 40 percent higher chance of mortality from heart attacks than the average population, and has a higher mortality rate from ischemic heart and cerebrovascular disease compared to other ethnic groups. Despite representing a quarter of the global population, South Asians account for 60 percent of the world's heart disease patients.

These disparities are incredibly relevant as the U.S. South Asian community grew 40 percent between 2010 and 2017 and many South Asians have lost loved ones at a young age due to heart disease. Historically, however, there has been little research specifically focused on South Asian health because the Asian community has long been viewed as a monolithic group . South Asian Heritage Month , observed from July to August, makes this an ideal time to highlight the factors contributing to this disparity and promote initiatives to improve South Asian health outcomes.

Why Do South Asians Face this Disparity?

The risk of heart disease among the South Asian community is influenced by a combination of genetic predispositions and lifestyle factors. Diabetes is a major risk factor for heart disease as people with diabetes are more likely to have heart disease than those without diabetes. The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study examined the determinants of heart disease, and found a higher prevalence of type 2 diabetes in South Asians (23 percent) compared with other populations (18 percent in Black Americans, 17 percent in Latino or Hispanic populations, 13 percent in Chinese Americans and 6 percent in white Americans).

In addition to diabetes, abnormal cholesterol and obesity increase heart disease risk, and South Asians experience elevated rates of all three. South Asians are more likely than other ethnic groups to have low levels of high-density lipoproteins (HDL, also known as "good cholesterol"), high triglyceride levels, and small low-density lipoproteins (LDL), which significantly heighten the risk for heart disease. In the U.S., over 40 percent of South Asian men and over 30 percent of South Asian women have high blood pressure , and South Asians tend to have excess body fat around the abdomen and organs, which increases the risk of heart disease.

Recommendations & Policy Considerations

Destigmatize mental health issues. Mental health is often an integral component of cardiac health, but seeking help is often stigmatized in the South Asian community. This stigma is a barrier to treatment as it can delay diagnosis and mental health treatment, leading to a higher potential for negative cardiovascular health outcomes. The South Asian Mental Health Initiative & Network (SAMHIN) offers a of mental health professionals of South Asian origin, which can increase treatment acceptability for South Asian patients. The National Alliance on Mental Illness launched the initiative to destigmatize mental health by empowering communities to have honest conversations about struggles. We need more resources like these, which connect South Asians with trusted mental health providers and promote open conversations around mental health. For South Asians, it can also be beneficial to utilize traditional cultural practices such as meditation and yoga to relieve stress and anxiety.

Make lifestyle changes. South Asiansdo not need to completely eliminate traditional South Asian dishes from their diet, which is a crucial component of culture, but rather modify the way these dishes are prepared and consumed. Examples of diet improvements include limiting portion sizes and the consumption of refined grains, eating more fermented foods, using sugar substitutes, and increasing non-starchy vegetable intake. Conveniently, many whole grains, fermented foods like idli and dosa, and non-starchy vegetables like cauliflower, cabbage, and okra are already staples of the South Asian diet. Additionally, increasing physical activity is also important.

Educate health care providers on South Asian health. It is imperative to equip health care providers with educational resources on South Asian health so they can better serve their patients. For example, Cigna offers comprehensive digital resources for providers such as Diabetes Among South Asians and South Asians and Heart Health: Take Control Now . Providers should familiarize themselves with South Asian health, and share recommendations with their South Asian patients. Relatedly, Dr. Sandeep Krishnan , interventional and structural cardiologist, recommends screening young South Asian patients for diabetes and paying attention to borderline Hemoglobin A1C (HbA1c) levels.

Increase attention and research on South Asian health. In 2017, Representative Pramila Jayapal introduced the South Asian Heart Health Awareness and Research Act . This bill amends the Public Health Service Act to allow the Centers for Disease Control and Prevention to fund the promotion of heart disease and type 2 diabetes awareness in South Asian communities. The Rutgers Robert Wood Johnson Medical School established the South Asian Total Health Initiative (SATHI) to bring researchers, health practitioners, and public health experts together in promoting research and education to improve health outcomes for South Asians. Pushing for federal legislation and research programs such as and the MASALA Study are key to improving heart health for South Asians.

Implementing more community-based programs such as the South Asian Network's CHAI: Community Health Action Initiative , which promotes access to health care for South Asians, is also necessary to improve health outcomes and address heart disease in this community. The Memorial Sloan Kettering Cancer Center launched their South Asian Health Initiative (SAHI) to serve the South Asian immigrant population in New York City by providing free screening for high blood pressure, diabetes, and high cholesterol, aiding in health insurance enrollment, and educating about free/low-cost health care. Programs such as these are essential in connecting underserved South Asian communities to necessary services.

The South Asian community is incredibly diverse, encompassing many different languages, religions, and traditions. However, the thread tying us together is our deep-rooted desire to care for our community. This care must include tackling heart disease on both an individual and a systemic level, which demands an unwavering collaborative effort between health care providers, researchers, elected officials, and community organizations.
The opinions expressed in this blog post are the author's own and do not necessarily reflect the view of AcademyHealth or of their respective affiliated employers/organizations.

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Reducing Heart Disease Disparities in South Asian Communities

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Heart disease disproportionately affects South Asians (individuals from Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), who face a four-fold greater risk of atherosclerotic cardiovascular disease compared to the general population.

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South Asian countries face health care issues to to the rapid growth of their cities, leaving those who cannot afford the growth left behind to struggle with financial, educational and transportation problems.

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Johns Hopkins Bloomberg School of Public Health

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A new series published August 20, 2024 in The Lancet Global Health and The Lancet Regional Health Southeast Asia presents recommendations for improving primary health care in five South Asian countries: Bangladesh, India, Nepal, Pakistan, and Sri Lanka. At a Lancet launch event on October 1 at 9 a.m. EDT, study authors will discuss their recommendations and explore what they learned through the analysis of primary health program implementation in those countries.

The series is edited by Krishna D. Rao, PhD '04, MSc, associate professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health

South Asian countries face many common health challenges due to noncommunicable diseases, population aging, rapid urbanization, socioeconomic inequalities, and low public spending on health. Improving and expanding primary health care's role in health systems can serve as a cost-effective strategy in addressing these challenges in South Asia and other low- and middle-income countries.

The series offers nine action items for policy- and decision-makers to reorient health systems towards primary health care:

Contextualize policies on primary health care.

Scale up innovations.

Allocate adequate financial resources.

Strengthen the governance function of health ministries.

Establish meaningful public-private engagements.

Use digital health tools.

Reorganize service delivery.

Enable effective change-management processes.

Encourage practice-oriented research.

Major themes emerging from the series include the growing burden of noncommunicable diseases, which disproportionately impacts marginalized populations; the growth in urban populations, resulting in socio-economic inequalities and health disparities; and the key role community health workers play in improving population health and the importance of investing in them.

Noncommunicable diseases: The region has a high burden of noncommunicable diseases, such as heart disease, diabetes, cancer, and respiratory illnesses, as well as a high rate of modifiable risk factors, such as tobacco and alcohol use, unhealthy diet, and lack of physical activity. While there is political commitment to address NCDs across the region, there are challenges in doing so, such as shortages of human resources and essential medicines for NCDs, as well as a lack of dedicated financing. Authors emphasize integrating NCDs into the primary care system by implementing early detection of NCDs at the primary care level, dedicating funding for uninterrupted supplies of essential NCD medicines and technologies that can be delivered at primary care facilities, and developing the capacity of health workers to care for NCDs.

Urban health: South Asia is rapidly urbanizing. Cities often find it challenging to provide quality health care and healthy living and working conditions to all residents. Large inequalities in health characterize the region's cities. Addressing these challenges through primary health care requires a multi-sectoral response with effectively resourced urban local bodies, such as those in housing and sanitization, and increased public financing for health care. "Policies should ensure quality services and financial protection through expansion of public sector services and strategic engagement with private providers, particularly those serving low-income urban populations," says Rao.

Community health workers: Community health workers are the backbone of primary health care service delivery. South Asia's current and future health challenges require further adaptations of community health worker (CHW) programs. Yet, in many South Asian countries, CHWs are not formalized within the health systems and not treated or paid adequately as professional health workers. Strengthening CHWs programs in South Asia requires adequate, dedicated, and consistent public funding; supporting career pathways that foster professional development; providing greater clarity of roles and responsibilities; and better integration into the health workforce.

Register for the launch event.

Read the series.

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Lancet Series Launch: The Current and Future Outlook for Primary Health Care in South Asia | Johns Hopkins Bloomberg School of Public Health

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A new Lancet series draws learnings from implementation of primary health care programs in five South Asian countries.

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"Non-biological factors and social determinations of health are important to include in CVD risk assessment for women." This sentence goes on to continue to describe on how not only the female gender is discriminated against bu t their background can also come into play against their discrimination.

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Non-biological factors and social determinants of health important in women's CVD risk assessment

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A new scientific statement reviews research about racial and ethnic differences in cardiovascular risk factors among women in the U.S. In addition to traditional risk factors, women of underrepresented races or ethnicities experience challenges in the diagnosis and treatment of cardiovascular conditions due to language barriers, discrimination, difficulties in acculturation or assimilation, lack of financial resources or health insurance, or lack of access to health care.

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Advancing Health Services Research to Eliminate Health Care Disparities

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Findings from health services research highlight continuing health care disparities in the United States, especially in the areas of access to health care and quality of care. Although attention to health care disparities has increased, considerable…

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Sarah Nadeau Associate Director, Media Relations

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Top 10 Ways To Improve Health and Health Equity

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Policies to strengthen the nation’s health must ensure that individuals and communities are healthy, thriving, and inclusive through long-term, sustained investments.

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National Foundation for Infectious Diseases

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In Pursuit of Equity: Overcoming Health Disparities

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To close out Black History Month, public health thought leaders share their insights on overcoming health disparities and ensuring health equity

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How can we reduce health inequalities? - Health inequalities - Equity and justice - Social and economic impacts on health - Population health - Public Health Scotland

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Differences in health across the population, and between different groups in society, that are systematic, unfair and avoidable

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Inadequate Healthcare in Pacific Islands

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Inadequate Healthcare in Pacific Islands

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Health disparities are big problems and can be found in different regions throughout the globe. In the Pacific Islands countries and territories "face significant healthcare challenges due to a high burden of noncommunicable and communicable diseases". These islands face healthcare problems due to the fact that they are isolated and often diagnose diseases or sicknesses too late.

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Inadequate Healthcare in Pacific Islands - Ballard Brief

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Pacific Island Countries and Territories (PICTs) face significant healthcare challenges due to a high burden of noncommunicable and communicable diseases (NCDs and CDs), limited rural healthcare access, and chronic shortages of medical personnel and resources.