What are the real accelerators for health gains in Africa in the post-MDG era?


by Dr. Githinji Gitahi

Dr. Githinji Gitahi, a medical doctor and businessman, is the global CEO of Amref Health Africa. He is based in Nairobi, Kenya. 


World leaders are meeting in New York later this week to close the door on the Millennium Development Goals and open another on the Sustainable Development Goals. What lessons do we take with us as we launch these global goals? And, where do we need to accelerate action?


The Millennium Development Goals (MDGs) have shown how we can pull the world together for a common objective to ensure widespread gains against poverty and disease. But, it has also highlighted long-standing challenges in some parts of the developing world where gains have not been achieved and health indicators, in particular, are significantly below the global targets set in 2000.



On infectious diseases, significant and laudable reductions in new HIV infections have been achieved during the MDG era. However, sub-Saharan Africa still accounts for more than 70 per cent of all new HIV infections, and AIDS-related deaths remain the number one killer of adolescents aged 10 to 19. Yes, access to knowledge, testing and medicines must be a key focus in the post-MDG era.  But so must the much overlooked role of substance abuse in this adolescent epidemic; HIV health promotion needs to go hand-in-hand with efforts to reduce alcohol and substance abuse in young people.


Africa additionally faces an emerging and rapidly growing health burden from non-communicable diseases. While infectious diseases currently top the list of leading causes of death, it is estimated that this trend will change in the next decade with hypertension, diabetes, chronic pulmonary disease and cancers leading the way.  But, the growing need to tackle non-communicable diseases in sub-Saharan Africa cannot be met by lessening our investment in fighting deadly infectious diseases, such as malaria, measles, TB and HIV.


It’s clear the massive gains in health over the past 15 years have been due largely to an increase in international financing along with strengthened political commitment and an expanding global economy, especially in Africa and Asia. To maintain and improve gains made, we must ensure sustained political commitment, predictable financing and strategic investments in health systems, disease surveillance and new tools. 


At the same time, accountability, efficiency, value for money, and transparent tracking of health expenditures must become standard principles in the use of health care resources by African governments and non-governmental stakeholders alike. They must also recognise that Community Health Volunteers, respected individuals within communities who are given basic training that allows them to educate their communities in maternal health, disease prevention (HIV, malaria, TB), and refer individuals to health facilities, are not a stop gap in achieving universal healthcare.  They are an integral part of the strategy and should be integrated into health plans and budgets. Governments must also enact polices that adopt task shifting to address the shortage of human resources for health.



In the absence of adequate resources, the use of innovation in training health professionals, as well as in health promotion, will be a key tool in achieving the Sustainable Development Goals. African governments should be ready to adopt mobile technology innovation to expand training and save costs.


Recognizing the particular health challenges faced by women, infants and children in sub-Saharan Africa and advocating globally for increased investment in this area is a vital role all stakeholders must continue to play. The sad reality is that the global goals set in 2000 for improving the health of women and children have not been met by most countries in sub-Saharan Africa.  In 2013, 179,000 African women died in pregnancy or childbirth, 56 per cent of all maternal deaths worldwide.


With only one in two mothers accessing skilled assistance (from a doctor, nurse or midwife) during delivery, it is clear that the biggest problem lies in access to care, and that human resources for health must remain a key focus in the post-MDG agenda. Africa has only three per cent of the world’s health professionals struggling to cope with its health needs, compounded by an inadequate mix of health workers within a context of poverty and lack of adequate infrastructure -- key contributors to lack of access to health services.


Adolescent pregnancy also remains a factor in the slow progress of reducing maternal mortality. Adolescent childbearing remains high in sub-Saharan Africa, at 116 births per 1,000 adolescent girls in 2015, which is more than double the world’s average. As Africa’s population grows, considering that already nearly half of Africa’s population has yet to enter the reproductive age, this problem is only going to get worse.


Adolescent pregnancy is wrought with complications and must remain an area of focus. Sex education and family planning interventions must be stepped up as evidence continues to show an increase in early sexual encounters. Increasing school enrolment is helping but the rapidly growing under-18 population is eating away at the gains.



Family planning cannot be left as an ‘implied target’ under Sustainable Development Goal 3, as it is a key determinant to the absolute and effective achievement of tangible gains by the citizens of Africa. Universal access to sexual and reproductive health in Africa is a fundamental criterion to achieving the Sustainable Development Goals.


Non-profit organizations like Amref Health Africa are not off the hook, either, as the world seeks to improve upon the global MDGs. And we’re doing our part by aiming to train 15,000 midwives by 2018, along with our other core health systems strengthening activities. 


But, we must all advocate with key stakeholders to consistently focus attention on translation of evidence to investment decisions for sustainable health systems in Africa.