Healthcare in Africa independent study

Exposing the Failures of Health Care in Africa
Olugbile Kehinde
C. T . Bauer College of Business
Independent Study -SCM 4398
December 2015

Dedication and Acknowledgment
I want to dedicate this paper to all those who lost their lives
in the fight for eradicating Ebola. Thank you for your selfless
sacrifice and dedication towards helping patients and citizens who
have lost hope.
I want to acknowledge my professor, Elizabeth Fletcher for
giving me the opportunity to gain more knowledge by researching
my continent’s weaknesses in the Health Care sector. And also for
the support she has shown me since 2013.
With this knowledge and exposure I have gained, I would
also do my part and pass on the information I have acquired to help
build a stronger health care system in Africa.

Abstract
The health care system in Africa is overwhelmed with the
inadequacies of infrastructure, political instability and shortage of
health care workers that keep occurring. The Ebola virus, mortality
rates keep getting high, hospitals are getting abandoned and health
care workers not motivated enough to work. The recent outbreak in
the Ebola virus is at the verge of destroying the ravaged health care
system that has been struggling to survive. Health workers are
abandoning their jobs, due to recent deaths of colleagues, the
government is not giving enough funds to try and rebuild the
health system. Foreign aid investments are more willing to help
rebuild the broken health system in Africa more than the supposed
government. Apart from the lack of basic infrastructure, brain
drain is also indirectly killing the continent. It is necessary to
provide training and education to health care workers in rural areas
or settings where there are little or no resources. Providing safe
anesthetic is crucial, this would help lower the maternal morality

rates. Investing in the education and training of health workers
would sustain health care. General Electric, World Health
Organizations is doing a fantastic job in the area of training and
funding.
An overview of the health care system in Africa.
The structure of Healthcare in Africa has given rise to
numerous life threatening diseases like Ebola, HIV/AIDS, Malaria
and so on. The infrastructure is not suitable for a developing
country or nation at that. There are concerns that the healthcare
might never get better. There are factors that have contributed to
this poor healthcare system, and if nothing is done, then the future
of healthcare would be devastating. When we look at the history of
health care in Africa, we can definitely say that evolution has taken
place. In the past, Traditional healers used to be hospitals for
Africans. These traditional rulers were believed to have the ability
to cure any sickness and diseases and also to bring upon sickness
and diseases. So they were believed to be both healers and gods.

Till today, some people still go to them for help, even though
modern medicine is available. At the point we are at, there has not
been any major change in health care in these developing
countries, but with the support of organizations like WHO, GE
foundation and Duke University, Africa’s health care system
would be of standards.
The importance of this research is to plan a better and secure
future of health care, and to also note areas of improvement. Africa
needs to step up and make sure there is a functioning system.
The factors that play a role in the healthcare system are Political
Instability, infrastructure, Lack of training facilities and also the
healthcare workers themselves are part of the malfunction of the
system. Africa does not need fancy or expensive health
equipment’s; all they need is well-informed health care workers
with knowledge on how to prevent outbreaks or illnesses and basic
standards of hygiene, reliable provision of personal protective
equipment’s and other supplies when required. This research

would point out the weaknesses of the health care system and also
offer solutions on how to continuously improve the system.
Political instability
Political instability is when activities threaten to change or
actually change the traditional way of a country’s government.
This would affect mostly the economic growth of the country.
Political Instability does not have to take a violent turn before it
starts being visible in a country; sometimes it can just be a change
in government that would cause this change or war. The health
sector in Africa has gone worse, due to unemployment, poverty
inflation and this is because of the political instability. Households
depending on their income for health care services have reduced
the level of dependence they have on hospitals. Africa would be
taken as a case study. The aim is to see what choices of health care
people go for. The choices are private healthcare, public health
care or self-medication. What really drives health care provider
choice in Africa? The private health sector is always the obvious

choice for high-income earners. The high-income earners are also
mostly in close proximity with the private hospitals, and even if the
cost is high, it does not bother them. The middle income earners on
the other hand have to weight cost and quality, they have to decide
which is more important. Public hospitals are mostly in central
areas, and are not very accessible, so now distance would also be a
factor to consider. Most people in the rural areas opt for self-
medication. They either go to the traditional healers or sometimes
a member of their family, mostly the grandmothers would know
how to make a concoction for treatment. It really comes down to
the level of education attained by income earners, prompting them
to choose what they think is best for them. Those with higher level
of education would choose either the private or public hospitals
while those with little to no education would rather indulge in old
traditional practices of medicine. Since the distance and price is the
most prominent factor, the government has to make it possible for
even low-income earners to be able to afford paying for public
hospitals. The government can build facilities in the most remote

areas and recruit top quality doctors and nurses. The doctors and
nurses should also be paid what they would have earned if they
were in the city to ensure top quality care is given.
If the government can prioritize health care, funding’s for
new buildings would be available. There would also be adequate
and efficient health workers. The government needs to have an
attractive package for doctors and nurses in terms of salaries and
benefits so as to make them willing to work efficiently. There are
also a lot of Africans who go out of the country to school. Some of
them who leave Africa to study medicine abroad don’t come back
to Africa. The reason most of them give is “what does Africa have
to offer me”. This is because they don’t get the value of their
tuition. Most of them paid millions just to have that quality
education and it wont serve them right to come back and give back
to Africa to be paid pennies. The government needs to invest in
quality education; training centers and make salary packages
attractive enough for citizens to serve their country.

Education and Training
Education and training is by far the most important. We can
have the most complex machines and equipment’s, but if we don’t
even know why we use this equipment’s, it could end up hurting
us. To help us treat the sick, we sometimes need survivors of the
diseases to be able to impact the knowledge they have, because
they have gone through the same process. The deadly disease that
is now being talked about is the Ebola Virus. The World Health
Organization and other partners are in the process of training
health workers and also Ebola survivors to work with patients who
are infected. They also need to train other staffs like cleaners,
security men so they can also protect themselves. By doing this,
more people in that environment would become exposed to the
knowledge of Ebola and how to protect themselves.
The transfer and exposure of blood and body fluids is also a
common but yet a preventive mistake that can be avoided. There
should be training and seminars on the proper use of medical

equipment’s and if possible, proper funding so clinics don’t have
to reuse disposable materials. This problem mostly occurs in the
rural and remote settings of Africa. There should also be
surveillance cameras or a supervisor on site to be sure every law is
followed. WHO decided to fund a study to educate medical
practitioners in South Africa. A questioner type of survey was
what the mentors from WHO decided to use as the basis of the
training. These questions were given to every staff that worked in
that particular hospital down to the cleaners. The reason why this
was done was to know the extent of knowledge the staffs had about
working with patients. When the results came back, they realized
that more than half of the staff were clueless about body fluids
being transferred. Only 27% of the staff new not to recap syringes
and this was only because they suffered exposure due to recapping
syringes, the rest of the 73% workers thought it was okay. Some of
the nurses did not necessarily use the same syringe, but they used
the same cap used to cover a used syringe. This cap would
obviously have been contaminated by the previous one. Some of

the staffs also weren’t aware of reporting issues to the health and
safety clinics or the occupational health clinic. After conducting
seminars for the staffs, they were more aware of the dangers
associated with body fluids and most of them complied with the
guidelines stated for them to follow.
GE foundation is committed to aid the Clinton Global
initiative to help expand imPACT (improving perioperative and
anesthetic care training) in Kenya. This training is designed for
health workers who are in charge of childbirth by surgical means,
basically making sure they always save mother and child. In
Africa, 830 women die daily due to preventable causes during
childbirth. Women can die from infection, severe bleeding, and
complications from delivery. Some of these causes develop during
the pregnancy and if treated early, there would be low risk to loss
of life. Infection has a huge role to play in these deaths, using
unsterilized equipment’s or even simply due to the lack of good
hygiene from the doctors or the hospitals can cause infection. As

maternal health improves, health globally generally improves. This
imPACT program is aimed to improve safe surgery and anesthesia.
The method used is a “Train the Trainer” method. The intention of
this program is to educate graduates and in return, these graduates
would educate and train others. More than 50% of the graduates
were women; this is also good because now, women would also be
getting that extra training. It is not very popular to find female
healthcare workers in these rural parts who actually have an
education. This foundation that GE has invested in would also
serve as a platform for success and also a standard for practicing
safe surgery.
Infrastructure
The recent outbreak called the EBOLA virus has made the
health care system overwhelmed with the question of, how can we

protect the system and fight this virus? Ebola Virus affected a lot
of countries in West Africa; it can be spread through the body fluid
of a person who has been infected with the virus. The health care
facilities were never the best, and when the Ebola virus came, this
made the facilities worse. The virus killed a lot of health workers
in Africa and made some quit their job. Some patients who went to
hospitals for regular check ups and even childbirth could not be
attended to, due to this Ebola virus. It basically stopped the flow of
normal business and brought it to halt in some hospitals. The
health system that existed was not designed for outbreaks such as
Ebola, it was only to help cure common diseases like malaria,
fever etc. There wasn’t any trained health care worker to prevent
the spread of any diseases. HIV/AIDS is a disease that African
health care workers are used to. They have been briefed on
HIV/AIDS and have even come in contact with patients to have the
disease. All they were taught, including us the public was that we
could live with people who have HIV/AIDS, we can even share
their cutlery with them and sleep on the same bed. The only

warning was not to have any unprotected sex with patients of
HIV/AIDS, not to share unsterilized equipment’s, or syringes.
Health workers obviously thought it was the same for the Ebola
Virus. They thought they were mentally prepared, that it was not as
bad as HIV/AIDS. There are few infrastructures in place that can
be used as training centers for health workers, but these
infrastructures do not have some of the equipment’s needed. This
can be either due to lack of funding by the government or
corruption.
Primary health care delivery is the provision of basic
preventive services like immunization against polio and basic
vaccinations for chicken pox, yellow fever and other preventive
viruses. Africa is not doing too badly in those areas. I remember
growing up in Africa, I would see health care workers parading the
streets and educating people about these viruses. They would tell
us the implication of not getting ourselves protected. This was
mostly done in poor neighborhoods and rural settlements. There
was also a translator for people who don’t understand English;

there would be someone to translate it into the local dialect. The
health workers who were part of this exercise weren’t from big
public or private hospitals, they were mostly from small clinics and
they joined staffs and resources to go on this exercise. If they have
enough funds from the public, they come back the next week to
vaccinate people for free and also do medical check ups free of
charge. Some people who were ignorant said that all they wanted
was money to pay salaries, but in reality, they were actually
educating the public. This was back in 1999; it has been a while
since I have seen health workers give their time to this kind of
exercise. A lot has changed since then, not that the health system
was great but because the right structure wasn’t in place to
encourage these workers.
There would obviously be life after these viruses has struck
the community, but it is how the government responds that matter.
There were about 60 doctors who took care of almost four million
people, now most of these doctors are dead along with nurses and

other staffs. Replacing health care workers would not be as easy,
but structures also need to be put in place so that work can resume
quickly and efficiently. There are also volunteers who are serving
and helping the health care industry. The government needs to
make sure that emergency teams with buses and phones are in
place. There should also be a help line or call support center that is
functioning. There should also be computers to keep track of
records. In Africa, they mostly use papers to keep track of patients
information, but now that some hospitals were deserted, and
exposed, it would be hard to keep patients record confidential.
There were also videos made by health organizations and
also just the general public about the awareness of Ebola, and how
to prevent or manage it, those videos should not be shut down
because we don’t hear of any cases of Ebola, instead it should be
kept because those videos also talk about the same methods that
could prevent diarrhea, flu and other communicable disease.
Diarrhea and other sanitary disease is very common in Africa, and
this is because of the lack of good hygiene. Measures taken to

prevent and kick out Ebola should still be practiced, like placing
hand sanitizers in rural communities. It would also be a good idea
to put in place video infrastructures in the facilities with access to
Internet. This would make it possible for doctors to communicate
with other doctors or patients in places that cannot easily be
reached. This also makes it easier for medical expertise outside of
4the country to transfer knowledge without having to travel.
Health care in Liberia even before the Ebola outbreak was a
nightmare. An obstetrician-gynecologist narrated what she went
through working in Liberia in 2012-2014.She sometimes had to do
operations using her iPhone flash light because there was power
outage, or she would take pictures of specimens and send them to
her colleagues for visual interpretation because there were no
pathologists. She held the hands of women dying of sepsis or
hemorrhage because antibiotics and blood products were difficult
to acquire. Provision of gloves, sterile gowns, oxygen, and basic
medical equipment were limited. There was shortage of nursing
and support staff. The common phrase in Liberia is “dying to give

life”, this was because pregnant women died due to illnesses that
could have been prevented. When the Ebola virus surfaced in
Liberia, the health workers would re use gloves and sterile gown so
they wont run out. They also didn’t have face shields, this was
obviously begging the virus to spread faster. It was hard to keep
track of patients with Ebola because most houses didn’t have a
proper address and also the bad roads made it difficult to get to
certain places. Foreign aid agencies started pulling out of Liberia,
saying that it was too risky and the country was unpredictable. As
of October 31 2014, 13,500 people died of Ebola in Liberia.

This is a child ward in Africa. We can see how filthy the place is.
This child has been abandoned to her own fate, there are no
facilities in place to ensure proper care of patients. A popular
saying has been going on in Nigeria since the out break of Ebola
“the fear of Ebola, is the beginning of wisdom”. When I asked a
nurse what it meant, she told me that it means anyone who is
willing to help Ebola patients is basically a fool and is ready to die.
This is the kind of mentality some of the health workers have. I do

not blame them a 100 percent, because if they had the right
facilities and equipment’s in place, we would have been able to
contain this Virus sooner.
Health Care Workers
To conclude it all, we need to also make sure the health care
workers are satisfied with their jobs. Job satisfaction is the way an
employee emotionally reacts at work and if this satisfaction is
positive, job performance would increase and vice versa. Nurses in
the rural parts have taken up roles and responsibilities beyond their
training. The Nurses are obviously not being paid the salary they
deserve, but they have no choice but to continue work. Female
nurses are mostly the breadwinners of their families, and this is one
of the reasons why they cant quit their job. Also most of the time,
the proximity to work is very close and this makes it easier for
them to work overtime, but this would also make them see their
families less often. There should also be protection for health care
workers, like making sure they are fully equipped with the right

gear or outfit for a particular job. Some of the health care
infrastructure was long damaged during the civil war in the 1990s
and this also left the country itself in ruins. Guinea, Sierra Leone
and Liberia are still trying to recover, the war also brought about
the economic downturn they are currently facing.
Africa is suffering from “brain drain”, this is when highly
trained people or intelligent people decide to work in a country
different from theirs. The WOLRD HEALTH ORGANIZATON in
its annual report as of 2006 reported that out of 57 countries in
Africa, 36 countries are suffering from shortage of health workers.
Building facilities and stocking up on basic equipment’s would be
a waste if we don’t have nurses to administer drugs or doctors to
perform surgeries.
Doctors without borders are a big part of the health care in
Africa. They risk their lives to help save patients who need urgent
medical attention. They have been a great example to show that
there really isn’t any need for fancy equipment’s to be able to save
lives. During the Ebola outbreak, they used basic amenities like

tents and planks to build a temporary shelter. They lost a lot of
patients due to Ebola, but they were still able to save some. Some
of the doctors are also in Nigeria risking their lives. The challenges
they have is not only outbreak of disease but also security risks
with Boko Haram getting more intense. They use schools and
churches to set up temporary cite for medical help, they create
resources without having to wait on long-term approval from the
government. Health care workers in Africa can also learn from
them.
In Africa, we also need survivors of illnesses who have gone
through a similar health experience so they can be a support
system to patients going through the same ordeal. Survivors of
illnesses or virus are mostly immune to what made them sick, this
makes it possible for them to sit and talk to other patients without
worrying about their health. There hasn’t been any recent study to
show how long the survivors would be immune, but for now, they
are doing the best they can to help the patients. With the recent
outbreak of the Ebola virus, there has been support staffs who are

also Ebola survivors working to help Ebola victims. They
understand the needs of the victims better than the doctors and the
victims would rather listen to them because they have first hand
experience with the virus. To be a support staff, there is an
interview process and the candidate has to be mentally and
physically prepared.
There is an uneven distribution of health workers in Africa,
with the refusal of health workers not going to where they have
been posted. This is due to lack of motivation, which would
decrease the service level of the health care system. There are two
broad categories that determine how health workers would respond
to work; financial incentives (salary, benefits, vacation) and non-
financial incentives (living conditions, management,
professionalism). Salaries are the major incentive but can still be
contained if the living conditions of health workers living in the
rural parts improve. Health workers also complain about the lack
of basic equipment’s to do their job. Management would also need
to make sure staffs are involved in decision making, this would

make them motivated especially if the financial incentive is
wanting.
Choosing the right supply chain for health care
The supply chain of health care would play a vital role in
setting up all these facilities and infrastructure. The shortage of
drugs and other medical supply is what would be a total failure to
the delivery of health care. There is a need for multiple suppliers
and not just one major supplier because human lives are on the line
if there is a failure in the system. Malawi’s public health would be
a case study. In Malawi, private hospitals enjoy steady supply of
drugs and other basic materials, while the public hospitals in
Malawi suffer shortages of supplies. The reason is because of the
sourcing strategy adopted. The public hospitals rely on the
government while the private hospitals have multiple sourcing
options. The question now is, is single sourcing the reason for
supply failure, or is the supplier the reason for stock outs. Single
sourcing is putting all your eggs in one basket; buyers should

recognize all the risks involved. A health system should never
choose a single source. The suppliers might be dealing with issues
like bankruptcy, shipping, economic instability that might cause
delay in delivery. The suppliers would enjoy benefits of a
monopoly system because there is no competition. Single sourcing
is the failure of the supply chain health system, if this does not
change, the system would get worse and result in deaths of
patients. Health care should rather go for multiple sourcing to
hedge against supply failure.

Refrences
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