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Marshall Ndlela, [email protected]

AFRICA is a continent with immense potential, rich in natural resources, cultural diversity and human capital. Yet, it is also a continent that faces many challenges, especially in the health sector. According to the World Health Organisation (WHO), Africa accounts for 17 percent of the world’s population but only one percent of the world’s health expenditure. 

Moreover, Africa bears 24 percent of the global disease burden but has only three percent of the world’s health workers.

Why is Africa’s health care system so compromised and what are the root causes of this situation?

One of the main reasons is the legacy of colonialism and exploitation that has shaped Africa’s history and development for centuries. 

Colonial powers such as Britain, France, Portugal, Belgium and Germany, invaded and occupied most of Africa from the late 19th century until the mid-20th century, imposing their political, economic, and cultural domination over the continent. They exploited Africa’s natural resources such as gold, diamonds, rubber, cocoa and oil, for their own benefit while neglecting the welfare and development of the local populations. They also imposed arbitrary borders, dividing ethnic groups and creating artificial states that often lacked cohesion and legitimacy. They also suppressed the political and cultural expressions of the Africans, denying them their rights and dignity.

One of the areas where the colonial impact was most evident and detrimental was the health sector.

Colonial powers did not invest in building a comprehensive and accessible health care system for the Africans, but rather focused on preserving the health of their own soldiers, administrators and settlers who were deemed particularly vulnerable to the tropical climate and its diseases. They also used coercive and racialised health interventions such as sanitary segregation, forced vaccination and criminalisation of venereal diseases to control and discipline the African populations. The settlers also introduced new diseases such as syphilis, influenza and smallpox that decimated the Africans who lacked immunity and adequate treatment. They also disrupted the traditional healing practices and knowledge of the Africans, which were often dismissed as superstition and witchcraft.

The colonial health system was not only inadequate and oppressive, but also left a lasting mark on the post-colonial health system in Africa. After gaining independence in the 1960s and 1970s, most African countries inherited a weak and fragmented health system, with poor infrastructure, equipment, and human resources. They also faced new challenges such as rapid population growth, urbanisation, poverty and political instability that increased the demand and complexity of health care. Moreover, they had to deal with the legacy of colonialism such as the lack of trust and confidence in the state and its institutions, the persistence of ethnic and regional divisions and the dependence on foreign aid and influence.

One of the consequences of this situation is the vulnerability of Africa’s health system to epidemics and outbreaks of infectious diseases such as cholera, malaria, tuberculosis, HIV/Aids and ebola. These diseases not only cause high mortality and morbidity but also have devastating social and economic impacts such as reducing productivity, increasing poverty and undermining development. 

For example, the recent cholera outbreaks in Zimbabwe and Zambia, which have killed more than 400 people and infected thousands in each country, have exposed the weaknesses and gaps in the health system such as the lack of access to clean water and sanitation, the shortage of health workers and supplies and the poor co-ordination and response capacity.

One of the solutions to address this situation is to demand and obtain compensation and reparations from the former colonial powers and the West, who have been responsible for the historical and ongoing exploitation and underdevelopment of Africa. The West owes Africa a huge debt, not only for the plundering of its natural resources and the enslavement of its people but also for stealing its intellectual property and the hindering of its technological transfer.

The West has also contributed to the worsening of Africa’s health situation by imposing unfair trade and debt policies, by supporting corrupt and oppressive regimes and by fuelling conflicts and wars. Therefore, the West should pay Africa for the damages and losses it has caused and also support Africa’s health system with adequate and sustainable funding, technology and capacity building.

However, compensation and reparations are not enough to improve Africa’s health system and situation. Africa also needs to take its destiny into its own hands by strengthening its political and economic sovereignty, promoting its cultural and social diversity and fostering its innovation and creativity. 

Africa has a rich and diverse heritage of healing practices and knowledge, which can be integrated and complemented with modern medicine and technology. Africa also has a vibrant and resilient civil society, which can play a vital role in advocating and participating in health care. Africa also has a young and dynamic population, which can be the driving force for change and development. Africa has the potential and the power to overcome its challenges and to achieve its aspirations.

λ Marshall Ndlela is a Zimbabwean based in South Africa. He is a holder of a Master’s Degree in Finance and Accounting from the University of Chichester, England. He can be contacted via [email protected]