Empowering communities through healthcare development

One of the most significant issues facing our communities today is inadequate healthcare capacity. To their credit, East African governments have prioritised healthcare and are committed to addressing this challenge.

This has yielded good progress in health infrastructure, systems and services development as well as in research and development. However, despite commendable progress across the region, the disease burden is growing.

 Infectious diseases continue to claim many lives, and child and maternal mortality remain high. This is compounded by an increasing burden of non-communicable diseases, including mental health issues and injuries.

Against this backdrop, healthcare capacity in East Africa remains insufficient. Today, the EAC region has less than 15 skilled nurses, midwives and clinicians for every 10,000 people – far below the 44.5 per 10,000 population required to attain the health-related Sustainable Development Goals. There is a severe shortage of specialists and super-specialists in the region.

To help meet this challenge, the Aga Khan University’s residency and fellowship programme, which trains 70 physicians every year, has significantly added to the pool of specialised human resources. The recent introduction of two new undergraduate degree programmes in East Africa, a Bachelor of Medicine & Bachelor of Surgery (MBChB) and a Direct Entry Bachelor of Science in Nursing, aims to create leaders in communities from where the students are drawn. 

Targeting high-school leavers, these two programmes aim to transform the higher education landscape in the region. The University accepts students from across East Africa based not on their ability to pay but on merit. To ensure access to all, many students receive financial assistance or tuition fee remission.

The need to build capacity in East Africa is driven not only by existing challenges but also by new and emerging threats. Disease outbreaks like Ebola, cholera, Covid-19, Rift Valley fever, Marburg virus disease and Mpox add to an ever-changing risk profile. Moreover, non-communicable diseases now account for a third of the disease burden in East Africa and are projected to be the leading cause of death in Africa by 2030. In addressing this changing risk profile, it is recognised that developing human capital alone is not enough. What is needed is continued investment in infrastructure development and in the quality of care, leadership and governance across health systems.

Unsurprising for a continent with a growing population, healthcare infrastructure needs across the region are large and diverse. Poorer countries and conflict-affected states face the highest rates of communicable diseases and the highest overall disease burden. Elsewhere, the increasing burden of non-communicable diseases requires adaptation of services and infrastructure.

As with other parts of the continent, health infrastructure in East Africa is unevenly distributed. It is estimated that the region has an average of 1.6 hospital beds per 1,000 people, with variable quality and major gaps in coverage of rural areas.

These are challenges across much of sub-Saharan Africa, where only half of primary health care facilities have access to clean water and only a third have access to reliable electricity.

As pioneers in delivering international quality standards, the Aga Khan health agencies have continued to invest in new technologies, solutions and infrastructure. Recent expansions include health facilities in Nairobi, Dar-Es-Salaam, Kampala, Mombasa, Kisumu, Mwanza, Dodoma, Kisii and Zanzibar. At the same time, the network continues to grow its rural presence through outpatient clinics and medical centres. 

In each case, the aim has been to develop an integrated health system demonstrating local examples of best practice to help raise the quality of care at other hospitals. Achieving quality certifications such as Joint Commission and SafeCare has helped elevate quality and safe care.

Strengthening capacity also means building pharmaceutical manufacturing capacity. The East African region needs this to ensure a reliable supply of medicines, to create jobs and to reduce reliance on imports.

To help meet this need, Industrial Promotion Services (IPS), an agency of the Aga Khan Fund for Economic Development, is developing a new manufacturing facility with WHO certification. The East African Combined Pharmaceutical Centre will establish long-term collaborations to provide affordable medicine in the region to international standards. Other IPS investments in this sector, such as Kampala Pharmaceutical Industries, are also addressing healthcare in local communities by tackling both communicable and non-communicable diseases.

An important factor affecting healthcare access in the region is the low level of insurance penetration. It is estimated that health insurance coverage, including national schemes, varies from less than 2 percent in Uganda and South Sudan to 22 percent in Kenya and 32 percent in the United Republic of Tanzania. 

To help improve market penetration of private insurance, Jubilee Health Insurance, an agency of the Aga Khan Development Network, is developing programmes to sensitise people to the benefits of getting coverage against the risks of specialist treatments.The East African states have made remarkable progress in tackling infectious diseases and community health. 

What is needed now is effective partnerships with development partners and the private sector to address the shortage of healthcare workers, improve healthcare financing and invest in quality.

Amin Mawji OBE is the Diplomatic Representative of the Aga Khan Development Network