Nigeria 14th of African countries with poor health systemA new study has ranked Nigeria low among 18 African countries with the worst health system. In a first-of-its-kind Health System Sustainability index report released this week, Nigeria ranked 14th with a total of 41 scores out of 18 African countries surveyed.

In the report, South Africa, with a total of 63 scores, ranked first; while Tunisia came second with 58 scores, followed by Morocco, which got 55 scores. The Democratic Republic of Congo came last with 33 scores. The Africa Sustainability Index, which was launched by the FutureProofing Healthcare initiative at the 2021 Africa Health Agenda International Conference (AHAIC), also revealed that Nigeria ranked last in maternal mortality, infant vaccination, and in neonatal mortality. The country also came 17th on births attended by skilled health staff and access to effective treatment for tuberculosis.

Nigeria, however, ranked first in laboratory quality. The Index report designed to enable data-driven decision-making for health and revealed correlations between economic strength and health system sustainability showed that countries with good access to services do not always have similar scores for the quality of the health services provided. The findings suggest that holistic policies that prioritise access and quality are needed to meaningfully impact universal health coverage (UHC) goals. Specifically, the report noted that like Angola, Nigeria performed well in responding to emerging health threats, leading the continent in its COVID-19 response stringency and also in testing cases of tuberculosis for multiple drug resistance.

“Nigerians are also the most likely in Africa to describe accessing medical services as ‘easy,’ which reflects a few barriers to treatment. Despite this, there is considerable room for improvement with respect to the health status of the Nigerian population; mortality rates from communicable diseases including water-borne illness and diarrhoea disease are high, and there is a high incidence of viral hepatitis and malaria,” the report said.

The report recommended that health outcomes could also be improved by prioritising neonatal care, as Nigeria faces low rates of infant vaccination and high rates of maternal and neonatal mortality. It also noted that there were considerable deficits in the availability of healthcare personnel combined with allied factors such as poor access to clean water, political instability and adult gender literacy gaps which accentuate the problems in the ecosystem.

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

The FutureProofing Healthcare Africa Sustainability Index presents an objective view of how health systems are currently performing and is intended to inform policies that promote sustainability and resiliency for the future. Through publicly available data, the Index examines 76 different measures split across six categories called Vital Signs. These Vital Signs – Access, Financing, Innovation, Quality, Health Status and Wider Factors of Health – provide a holistic view of the fundamental drivers of sustainable healthcare systems. The Index also compares approaches between countries, identifies elements that lead to more sustainable care and promotes best practices through a future-focused analysis of real-world solutions. Supported by Roche, experts from organisations including Amref, the World Bank, United Nations Development Programme /(UNDP), the African Society for Laboratory Medicine and the Africa Centres for Disease Control and Prevention collaborated to develop the FutureProofing Healthcare Africa Sustainability Index.

“Sustainable healthcare is a key element on the journey towards UHC and will impact millions of lives in Africa,” said Githinji Gitahi, CEO of Amref and Africa Sustainability Index panellist. “The Sustainability Index is a useful tool in guiding stakeholders in the healthcare ecosystem on where to focus efforts, make improvements and identify best practices from other countries. On behalf of my fellow panel members, it is our intention that this tool will spark conversation about actions that are needed today to create more resilient, sustainable health systems in the future.”

The findings of the Africa Sustainability Index indicate that economic strength and political stability are key drivers behind overall performance in healthcare sustainability, with most of the countries that perform well in the Financing Vital Sign also doing well in the Index overall. These countries include South Africa, Rwanda, Algeria and Ghana. The index also reveals that all countries analysed have numerous areas of opportunity for improvement, with strong variations throughout the continent related to the Access and Quality Vital Signs, suggesting that targeted policies in these areas will make an impact in achieving UHC goals. Driving disparities in Access are the number of doctors and specialised healthcare professionals per capita as well as the level of access to preventative health services. South Africa is the highest ranking country in the Access Vital Sign, followed at some distance by Libya, Zambia, and Tunisia.

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

As health systems across Africa currently face acute pressure from the COVID-19 pandemic, the Africa Sustainability Index aims to identify key drivers that affect the capacity of health systems to cope with system-level strain. Data from the Index can be used to inform policies that help health systems continue to manage and ultimately recover from the crisis as well as be used as the foundation for policies that enable more resilient health systems that are prepared to address both health crises and ongoing population health needs. The results of the Financing Vital Sign suggest that there is little difference between some countries’ healthcare financing models. However, this similar approach does not yield similar results across all Vital Signs. While there is a clear positive correlation between economic strength, political stability and the sustainability of a healthcare system, there are strong variations in Access and Quality Vital which suggests that, beyond financial reforms, targeted policies in these areas could go a long way in achieving UHC.

Countries included in the Index are Algeria, Angola, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Libya, Morocco, Mozambique, Nigeria, Rwanda, South Africa, Sudan, Tanzania, Tunisia and Zambia. “Unless we analyse the consequences of the COVID crisis, it has the potential to increase healthcare inequity, costs and inefficiency. Yet, if harnessed, it can mean better healthcare for all in more sustainable and resilient health systems. There are actions that every country can take to start on this journey today. We must work together immediately to rebuild better and give African people the care that they deserve,” said Prof. Glenda Gray, President and CEO, South African Medical Research Council, and member of the expert panel.

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