Addressing Health Financing Vulnerabilities in Africa Due to the COVID-19 Pandemic

Dear Colleagues,

Abstract

This article is an introduction to this Special Issue on “Addressing Health Financing Vulnerabilities in Africa due to the COVID-19 Pandemic”, which is based on a collaborative research project on this theme funded by the Swedish International Development Cooperation Agency (SIDA) and led by the African Economic Research Consortium (AERC), the leading economic capacity building institution in Africa. In this introduction, we first set out a brief background on the health status, health system, and COVID-19 pandemic in Sub-Saharan Africa. The article then describes the AERC project and its structure and concludes by providing a list of the areas covered in the papers published in this Special Issue.

Introductory chapter

Background

Sub-Saharan Africa, perhaps to a greater extent than any other region in the world, still faces a grim scenario with respect to the health of its people. While the continent has seen improvements in health outcomes, including child mortality, the quality of life in Africa remains low, as evidenced by high morbidity rates, and many countries missed on the Millennium Development Goals targets in this area. Poor population health status is mirrored by crises in health financing and human resources for health. Most of the notable successes in the health area have been made possible in large part through development support. This suggests that reductions in development aid in general, and health-related aid in particular, could potentially jeopardise the gains made thus far. It is well known that Africa’s healthcare system is one of the weakest in the world, leading to poor health indicators. Life expectancy and mortality rates are the lowest and have improved very slowly overtime despite progress being made in key macroeconomic statistics, such as growth in per-capita GDP and poverty reduction.

The COVID-19 pandemic sent the economies of many African countries reeling into recession. Several studies have documented that apart from contractions in GDP per capita, the pandemic disrupted sources of livelihood for millions of African people, putting them at risk of malnutrition, hunger, and other deprivations. Hence, the gains made in reducing extreme poverty in Africa were in great danger of being reversed due to the pandemic. The vulnerabilities in the African healthcare system were also exposed during the pandemic, where most households would have to rely on out-of-pocket expenditure, sacrificing essentials such as food and schooling to meet urgent healthcare needs. The prices of vital medical goods needed to prevent the spread of the virus increased since the onset of the pandemic, and any such increase dissipated scarce household resources in the difficult choice between food availability and protection from the virus. Additionally, the COVID-19 pandemic found many African health systems to be poorly prepared for the huge healthcare demand it generated. As the infection continued to grow across the continent, the potential of healthcare systems to buckle under excess demand pressure and supply constraints was a real and imminent danger.

The AERC project for this Special Issue

This Special Issue draws together a number of papers addressing healthcare financing vulnerability, with much of this problem being seen and interpreted in the context of the COVID-19 pandemic. The papers were first written as part of a collaborative research project led and supported by the African Economic Research Consortium, which focused on “Addressing Healthcare Financing Vulnerabilities in Africa due to the COVID-19 Pandemic”. Based in Nairobi but with a continent-wide focus and mandate, the African Economic Research Consortium’s (AERC’s) principal objective is to strengthen local capacity for conducting independent, rigorous inquiry into problems pertinent to the management of Sub-Saharan African economies through a synergistic programme combining research with postgraduate training in economics and supplemented by a communication and policy outreach to disseminate and share results to policymakers and other major actors. .It is supported by a wide range of international and African funders. The AERC is a highly integrated knowledge organisation spanning research, training, and policy outreach, comprising a vast network of universities, policymakers, researchers, educators, and international resource persons.

To address the challenges associated with the financing of health and healthcare in Africa, the AERC conceived a collaborative research project on the theme Healthcare financing in Sub-Saharan Africa, funded by the SIDA. Overall, the AERC-SIDA-funded project generated empirical evidence that provided insights into the financial sustainability of African health systems, as well as policy options that can be implemented to adjust the systems to save and protect lives in efficient and equitable ways. As explored by the collaborative research project, some of the factors explaining poor health status are the structure and policies of healthcare financing in most African countries, which constitute the following common features. First, the shares of public resources in national budgets devoted to healthcare are relatively low in comparison to the disease burdens in many African countries. Second, the distributions of healthcare facilities are spatially unequal in most cases, leaving the majority of the population without access to basic healthcare services, particularly people who live in remote areas. Third, private and public provisions of healthcare compete rather than complement each other, denying hundreds of millions of African people affordable and well-functioning healthcare systems. Coupled with limited health insurance schemes, out-of-pocket expenditure as a share of household resources in Africa is one of the highest in the world.

The successes achieved in the implementation of Phase I of the Healthcare Financing in Sub-Saharan Africa Project, and the COVID-19 pandemic study, highlighted one positive challenge: the increased demand for focused, rigorous evidence for policymaking, and how to mitigate health-related risks in development programming. This demand led to the conceptualization of Phase II of the project, i.e., “Addressing Health Financing Vulnerabilities in Africa due to the COVID-19 Pandemic”. The project built on the experience gained in implementing Phase I of the project in a relatively stable socioeconomic environment, taking into account the volatility and uncertainty created by the pandemic, for which the aftermath was bound to last for a long time.

The project followed the collaborative research approach where a few framework papers were commissioned to provide insightful analysis on the themes selected using novel research methods. The framework papers illustrated the kinds of empirical analyses to be conducted at country levels and provided the exposition of existing or new conceptual models of health financing. To understand the underlying differences in care innovations across countries and to obtain insights into better management of the COVID-19 pandemic in light of country-specific healthcare infrastructure and health financing policies, the project used the country case studies approach. Since the project was implemented amid the COVID-19 pandemic, innovative approaches to collecting additional data, for instance using remote survey tools, were employed, with great success. There were, however, data on coping strategies pursued by households regarding how to address the spread and severity of COVID-19, including household expenditure patters on preventive tools (masks, sanitizers, detergents, gloves), and the use of medications, including biofortification supplements believed to improve immunity. In addition, the cost related to the treatment of a family member affected by the virus could be helpful information to understand the transfer of health financing responsibility from the public to citizens when health systems are not functioning well. More than 15 research papers were commissioned, the majority of which are published in this Special Issue. The areas covered in this Special Issue in relation to the COVID-19 pandemic include health expenditure, food insecurity, healthcare financing, and cash transfers.

Dr. Dianah Ngui
Prof. Dr. Germano Mwabu
Prof. Dr. Tomson Ogwang
Guest Editors

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• health expenditure
• food insecurity
• healthcare financing
• cash transfers
• health financing vulnerabilities