Revisiting Health System Performance Assessment in Africa

Health systems in Africa have long faced a huge burden of disease, amidst pressing resource constraints. However, despite the constraints, the last three decades have seen the region make progress in tackling some of the most critical health challenges. Notably, many countries have registered improvements in child survival, which could be attributable to the rapid expansion of priority health interventions such as childhood immunizations, nutritional supplementation, malaria prevention and treatment, among others. HIV/AIDS and Tuberculosis, that ravaged the region are also being addressed, by scaling up prevention and treatment programs. Despite the progress, much remains to be done. For instance, under-5 mortality rates in many countries still remains unacceptably high. Non-communicable diseases such as diabetes are also increasingly becoming dominant as contributors of health loss in many countries. Associated risk factors such as high caloric intake, obesity and low physical activity have also been shown to be on the increase in many countries, raising the scepter of a double burden of disease in the region. Responsive health systems have to be aware of these trends and seek to address emerging challenges comprehensively. In our thesis, we have revisited the key considerations for health system performance assessment, contextualized to the on-going public health debates in the sub-Saharan Africa region. Overall, we have underpinned our analysis on the generally accepted premise that effective health systems are supposed to improve health, in ways that are responsive and financially fair, and make the best and most efficient use of the available resources. In the process of improving population health, it is recommended that health systems should also ensure equity. Furthermore, as an intermediate step towards improving health, those in need, should have access to (both physically and financially) the essential medicines, health technologies and services that they require.