A new model to make care more accessible to
people is not only possible but affordable.
Despite improvements in recent years, the health of the vast majority of sub-Saharan Africans remains in jeopardy. The figures are sobering. One in six children born in the region today will die before age five. African women face more than 100 times the risk of maternal mortality than do women in the developed world. And the average life expectancy in sub-Saharan Africa is a mere 51 years. Sadly, most countries in the region appear unlikely to meet the United Nations’ Millennium Development Goals for health,1
let alone to address significant chronic issues beyond their scope.
The fundamental problem is a pervasive lack of access to primary health care. Conservative estimates suggest that four in ten people in sub-Saharan Africa have no access to medical facilities or personnel. Our experience in the region suggests that the actual figures are often much higher. Moreover, because of Africa’s vast distances and large rural populations, solving its access problem using only traditional clinics staffed with doctors and nurses would be prohibitively expensive and require decades to accomplish.2
Meanwhile, millions of Africans would continue to suffer from diseases that are relatively simple to prevent, treat, and cure.
This need not happen. Our work in recent years suggests that a combination of three delivery approaches could catalyze Africa’s health systems and boost access across the continent, thus dramatically improving the lives of its people. The keys are to employ community-based health officers who would provide essential primary care at the village level, to adopt mobile phone–based “telemedicine” approaches that connect health officers and rural patients with specialized care, and to create networks of mobile health clinics that transport diagnostics and other technologies to remote places. Together, these approaches could quickly save many lives at relatively low cost—about $2 to $3 per person a year, compared with about $8 for traditional clinics.
Access to primary care drives health outcomes. Here’s how: quality access brings treatment and prevention; with treatment and prevention comes education; and with education comes demand. Greater demand for health care, in turn, creates more opportunities for successful and timely treatments that boost demand still further. All of this leads to healthier populations and saves lives.
This cycle is broken across much of sub-Saharan Africa, however, since access to health care is limited or nonexistent. Only 60 percent of the region’s population has even nominal access to health facilities, and the effective figure is often much lower after you factor in the number of doctors, actual access to drugs and equipment, and the productivity of health workers. In Tanzania, for instance, fully 80 percent of the people will never see a doctor in their lifetimes.
To see what might be done, we studied the experience of eight countries3
that have improved on more than one of the United Nations’ Millennium Development Goals for health. Along the way, we interviewed upward of 100 health experts, including African health ministers, academics, specialists from health organizations, and representatives of donor agencies. Notably, we found that each of the eight countries (regardless of income level, geography, or political system) had succeeded by delivering a thorough yet pragmatic range of primary-care services4
to the “last mile” in rural areas.
Encouraged by what we learned, we next looked for novel ideas that might extend these successes. The effort led us to examine 100 or so delivery methods being explored by private, public, and nonprofit groups around the world. From these, we identified the three most promising approaches for Africa.
A new model
While there is no “silver bullet” solution, our work suggests that a model combining local health officers, telemedicine, and, where possible, mobile clinics could help African countries leverage their existing health systems to scale up access to primary health care quickly, effectively, and cheaply. While the model’s individual components aren’t new, together they could help revolutionize health care in African and other low-income countries.
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1 Among other social, educational, and health targets, the United Nations seeks to reduce child- and maternal-mortality rates and drastically reverse the spread of HIV/AIDS and malaria by 2015. For details, see un.org/millenniumgoals.
2 A 2007 analysis by our McKinsey colleagues found that meeting sub-Saharan Africa’s need for health workers solely using traditional doctors and nurses would require about 600 additional medical and nursing schools and take more than two decades to train the requisite numbers of personnel. See Michael D. Conway, Srishti Gupta, and Kamiar Khajavi, “Addressing Africa’s health workforce crisis,” mckinseyquarterly.com, November 2007.
3 Bolivia, Brazil, Ethiopia, Iran, Peru, Rwanda, Uganda, and Vietnam.
4 The activities of the eight countries were consistent with the Declaration of Alma-Ata, adopted at the International Conference on Primary Health Care in Kazakhstan in 1978, which called for effective action to implement a universal standard of primary care. The principles—broad-based care covering the essential preventive and curative needs of local populations—are relevant today and were reendorsed in the 2008 World Health Organization report Primary Health Care: Now More than Ever.