Despite Africa’s exponential economic growth and development over the past decade and additional support from the international donor community, progress and the realisation of achieving the UN Millennium Development Goals (MDGs) has been slow in progress.
Greater gains have been made over the past 15 years, however Africa’s performance overall continues to lag on health indicators and with the result, the continent is off-track to meet all MDGs.
In addition, a number of challenges still face the vast majority of the continent, including insufficient internal and external resources allocated to achieving the MDGs, inadequate human resources, weak institutional capacity, persistent inequities in access to proven interventions, inadequate statistical health data and weak monitoring and evaluation capacity.
Looking closer at the specific MDGs that have an impact on health-related issues on the continent, the following challenges still exist:
* Reduce child mortality (MDG 4): Although the majority of African countries have made steady progress in reducing child and under-five mortality, only six countries are on track to reduce the under-five mortality rate by two-thirds between 1990 and 2015.
More African countries need to scale up preventative healthcare in the fight against the main diseases that cause child mortality, namely measles, pneumonia, diarrhoea, malaria and Aids. Targeted interventions for newborn babies need to be accelerated, as newborns are more likely to succumb than older children.
A potential solution to this challenge is empowering more women and removing social barriers to their accessing basic services, introducing measures to give poorer families better access to critical services and increasing the local accountability of health systems are all policy interventions that will improve the quality of health systems and reduce mortality rates.
* Improve maternal health (MDG 5): The maternal mortality rate for the African region as a whole stands at 460 deaths per 100 000 live births. Progress has been insufficient to meet the MDG goal of 213 deaths per 100 000 live births by 2015.
Indeed, only two countries, Eritrea and Equatorial Guinea, are on track to reduce maternal mortality by three-quarters between 1990 and 2015. Most countries in southern Africa have made no progress at all on this target. Moreover all countries in the region have an unmet need for family planning, a need to limit childbearing and to increase spacing between births.
In addition, one in four women on the African continent who wish to space or delay their next pregnancy cannot do so because of lack of contraceptives. The rates of delivery attended by a skilled health practitioner are very low, especially in West Africa. Lack of access to maternal health services tends to be especially acute in rural areas and urban slum communities.
The cost of accessing prenatal care services (including transportation and user fees), geographical access and cultural barriers are major impediments to women seeking care during their pregnancies.
Maternal mortality also remains the leading cause of death in adolescent girls. Poor quality of service for pregnant women is another major concern. In Malawi, for example, a recent study found that only 13% of clinics had 24-hour midwifery care, which represents a major hazard for maternal emergencies.
* Combating HIV, Aids, malaria and other diseases (MDG 6): Africa is starting to win the battle against HIV and Aids in most countries, partly due to the significant vertical funding from external aid agencies.
There has been a fall in the prevalence rate, particularly among women, a steep decline in the regional rate of new infections, a reduction in the number of Aids-related deaths and a drop in mother-to-child transmission of HIV and Aids. Greater access to antiretroviral therapy, in combination with behavioural changes such as the increased condom usage have underpinned HIV and Aids progress in Africa. Sustaining access to critical antiretroviral medicines in an uncertain funding environment will however present a major challenge to countries worst affected by the disease.
With regard to malaria, the acceleration of preventative and control strategies such as the distribution of free or heavily subsidised insecticide-treated bed-nets has reduced its incidence. Malaria mortality rates have consequently declined by more than one-third since 2000. But access to the most effective drugs, namely Artemisinin-based combination therapy, is still limited. Furthermore, the targeting of substantial amounts of donor funding to individual diseases has reduced amounts available for broader health needs.
TB remains a major problem in the African region with 500 000 deaths annually that account for over 26% of notified TB cases in the world. Southern Africa is the worst affected sub-region. The number of new infections is stable in North Africa, which is the least affected sub-region. While 19 countries have been able to treat over 85% of those affected, the co-infection of TB and HIV as well as drug-resistant TB and multidrug-resistant TB continue to complicate treatment of the disease.
As we enter the last two years of the UN MDG mandate, time is running out for Africa to fulfil its mandate agreed to with the UN. But strides have been made in improving the lives of millions on the continent, which include the most vulnerable in society. Greater policy focus and efforts will need to be developed and effectively implemented in the future to ensure that more is done in relation to development and progress on the continent to have a real impact for the generations to come.