April 13, 2016
In my Baganda community in Uganda, it is believed that the ancestors will bring misfortune on those who fail to attend the funeral of a close family member.
Almost every January, one of my new year’s resolutions is to attend all the funerals of close family and friends.
Last June, my one and a half year old niece Beatrice passed away in Uganda but I could not make it to the funeral. Living and working in the U.K. then, I was consumed by anger and guilt seeing firsthand how, yet again, a broken healthcare system in Africa had failed to stem an avoidable death.
My frustration and despair is far from unique. The latest Gallup World Poll revealed that sub-Saharan Africans feel their wellbeing is lower than that of any other population in the world. They feel the same about the quality of healthcare they receive. Less than a fifth of African governments have met the Abuja Declaration pledge of spending at least 15 per cent of their budgets on health. The global donor community has continued to plug the funding gaps. However, most recent data show that official development assistance for health plateaued between 2010 and 2013 before dropping between 2013 and 2014.
Faced with this funding shortfall, we must urgently find smart ways of increasing the efficiency of Africa’s healthcare systems. This means not just hospitals and clinics but also our oft-neglected community health systems. A mounting evidence base has demonstrated that community health workers are essential in strengthening health systems by responding to health crises like Ebola, providing routine care, and serving as a link to health care for hundreds of millions of individuals in rural Africa as they deal with diseases like malaria.
World Health Worker Week was held recently, highlighting once again the extreme shortfall of these frontline health staff. But it’s not just about boosting their numbers; it’s also about properly supporting and developing the skills of existing community health teams.
My niece Beatrice, who had gone to the village to visit her grandmother, succumbed to malaria that was initially misdiagnosed as a cold by an unskilled health worker. Had Uganda had a remunerated, sufficiently trained and well-coordinated cadre of community health workers, like Rwanda and Ethiopia’s, Beatrice’s predicament would likely have been flagged much earlier and she would have been referred to a more advanced health facility.
As it was, once she was found to have falciparum malaria — the most dangerous form — she was referred late to a chronically under-staffed local health center, whose healthcare workers were unavailable for an entire weekend.
In order to improve Africa’s community health services, we urgently need to strengthen management and leadership in ministries of health. One way to do this would be through the incorporation of performance management tools and best practices from the private sector, usually more adept than governments at managing huge and dispersed workforces.
An example is the balanced scorecard that was initially conceived by business school experts in the early ’90s to help private enterprises monitor operational performance and guide company strategy. Countries like Ethiopia now use this tool to monitor performance in the health sector and the trend is growing.
In my work at Aspen Management Partnership for Health we partner with countries like Kenya and Malawi that would like to adopt management resources and practices from the private sector such as real-time dashboards and 360-degree performance assessments. There is mutual interest in ensuring that it is no longer ‘business as usual’ in the leadership and management of national community health systems.
We as individuals and communities also have a role to play in reducing the burden on our healthcare systems. A colleague of mine in Sierra Leone recently told the mother of a sick girl to lie to her relatives, telling them she had died. That way, the money they would have willingly contributed to the child’s funeral could be diverted to the healthcare they were less willing to pay for. One study found that, in some cases, families in Africa spent up to 30 times more on funerals than the care of sick relatives, mostly in response to social pressure to bury their dead in a style consistent with the observed social status of the family.
But we write off our public healthcare systems at our peril. In fact, international donors and partners should be aware that bypassing a country’s systems and policies weakens its ability to determine its own future and care for its people in the long term. We must help to build these systems, using all the expertise at our disposal. At the same time, we should not be waiting for our families and friends to die before we spend our resources on them. This year, attending more funerals is not one of my resolutions; I would rather spend my time supporting Africa’s health systems. Let us all invest more in the living, not the dead.
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Originally published on CNN