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The Lancet Commission on the Future of Health in Sub-Saharan Africa

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The Lancet Commission on the Future of Health in Sub-Saharan Africa The Lancet Commissions The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa Irene Akua Agyepong, Nelson Sewankambo, Agnes Binagwaho, Awa Marie Coll-Seck, Tumani Corrah, Alex Ezeh, Abebaw Fekadu, Nduku Kilonzo, Peter Lamptey, Felix Masiye, Bongani Mayosi, Souleymane Mboup, Jean-Jacques Muyembe, Muhammad Pate, Myriam Sidibe, Bright Simons, Sheila Tlou, Adrian Gheorghe, Helena Legido-Quigley, Joanne McManus, Edmond Ng, Maureen O’Leary, Jamie Enoch, Nicholas Kassebaum, Peter Piot Executive summary collaboration with the global community, including non- Published Online Sub-Saharan Africa’s health challenges are numerous and traditional development partners. In addition to alignment September 13, 2017 http://dx.doi.org/10.1016/ wide-ranging. Most sub-Saharan countries face a double with the host country’s priorities, harmon isation of the S0140-6736(17)31509-X burden of traditional, persisting health challenges, such different global and domestic health mechanisms is See Online/Comment as infectious diseases, malnutrition, and child and important to reduce transaction costs of service delivery http://dx.doi.org/10.1016/ maternal mortality, and emerging challenges from an and reporting. S0140-6736(17)32102-5 and increasing prevalence of chronic conditions, mental A comprehensive approach and system-wide changes http://dx.doi.org/10.1016/ health disorders, injuries, and health problems related to are required. A fragmented health agenda will deliver S0140-6736(17)32128-1 climate change and environmental degradation. Although there has been real progress on many health indicators, Key messages life expectancy and most population health indicators • Africa’s health indicators remain behind those of other continents and major health remain behind most low-income and middle-income inequities exist. Health outcomes are worst in fragile countries, rural areas, urban countries in other parts of the world. slums, and conflict zones, and among poor, disabled, and marginalised people. Our Commission was prompted by sub-Saharan • Most sub-Saharan countries face a double burden of infectious diseases, malnutrition, Africa’s potential to improve health on its own terms, and and child and maternal mortality, in addition to emerging challenges of chronic largely with its own resources. The spirit of this conditions, such as hypertension, mental health disorders, and health problems Commission is one of evidence-based optimism, with related to climate change and environmental degradation. caution. We recognise that major health inequities exist • Substantial progress in many health indicators has been made in the Millennium and that health outcomes are worst in fragile countries, Development Goal era but progress at the present pace is a recipe for failure. rural areas, urban slums, and conflict zones, and among • The vision of this Commission is that by 2030 Africans should have the same the poor, disabled, and marginalised. Moreover, sub- opportunities for long and healthy lives that new technologies, well-functioning Saharan Africa is facing the challenges and opportunities health systems, and good governance offer people living on other continents. of the largest cohort of young people in history, with the • The main opportunities ahead cannot be unlocked by keeping to the same pace and youth population aged under 25 years predicted to almost using more of the same approaches to health systems, as even high-income countries double from 230 million to 450 million by 2050. The are struggling with the rapidly growing burden of chronic conditions. future of health in Africa is bright, but only if no one is • Africa-based and home-grown solutions—with the realities of each country and each left behind. community embedded at their cores—are required, and each country needs to chart Sub-Saharan countries face difficult development its own sustainable path to improve health outcomes. agendas in the decades to come, but also immense • A framework shift is needed to deliver better health outcomes through people-centred opportunities to be acted upon without delay. A key health systems, with focuses on prevention, primary care, and public health. message of this Commission is that the opportunities • There are historic, not to be missed opportunities to improve several health outcomes ahead cannot be unlocked with more of the same within the next decade, seizing the momentum generated by the Millennium approaches and by keeping to the current pace. Continu- Development Goals by bringing traditional challenges under control and preventing ation at the current pace of progress, using models of others from taking hold. service delivery and population health that are struggling • Achievement of good health for all citizens should be a political and investment with results, equity, and sustainability across the world, priority for every country, which will also contribute to economic growth and including in high-income countries, is a recipe for failure. sustainable development. Therefore, we advocate an approach based on people- • Countries can and should invest more in health and do more to address inefficiencies centred health systems and inspired by progress, which by identification of new funding sources and movement towards prioritisation of can be adapted in line with each country’s specific needs. health in domestic budgets. Moreover, we believe firmly that better health will not only • Local generation and use of innovation will accelerate better health outcomes, reduce benefit countries’ populations directly—it will also act as a inequities, and have huge scope for prevention and care by harnessing the rapid catalyst, enabling successful pursuit of other development growth in information and mobile technology in the African continent. agendas summarised in the Sustainable Development • Investment in higher education and research are essential for better health and Goals (SDGs). sustainable development by enhancing research capacity for identification of Leadership on Africa’s health, scientific, and develop- challenges and devising local solutions. ment challenges should come from Africans in close www.thelancet.com Published online September 13, 2017 http://dx.doi.org/10.1016/S0140-6736(17)31509-X 1 The Lancet Commissions Ghana Health Service, Accra, some results but will not succeed in strengthening health UHC should be designed with local values, sustainability, Ghana (I A Agyepong PhD); service delivery and public health systems, and will not and equity in mind from the onset. Ghana College of Physicians address the determinants of health. Broad partnerships and Surgeons, Public Health Faculty, Accra, Ghana beyond the medical and health community are essential There are historic, not to be missed opportunities to (I A Agyepong); Makerere to move the health agenda forward. Without a serious improve health within the next decade University Medical School, shift in mindsets across all levels of society, all sectors of Given the African region’s economic growth and societal Kampala, Uganda (Prof N Sewankambo MD); government, and all institutions it will be difficult to have changes, and building on the momentum from the University of Global Health meaningful and sustainable change. Young people in beginning of the SDG era, most sub-Saharan countries Equity, Kigali, Rwanda Africa will be key to bringing about the transformative have an opportunity to bring some traditional health (Prof A Binagwaho MD); changes needed to rapidly accelerate efforts to improve challenges under control and prevent others from taking Ministry of Health, Dakar, Senegal (Prof A M Coll-Seck MD); health and health equity across sub-Saharan Africa. hold and having the same devastating effect seen in other Africa Research Excellence This Commission highlights 12 strategic options that all regions of the world. Examples include elimination of Fund, Banjul, The Gambia sub-Saharan countries should consider in their policies polio and guinea worm, meeting demand for modern (Prof T Corrah MD); African and plans. These options are connected to the health- contraceptives, reduction of maternal mortality and Population and Health Research Center, Nairobi, Kenya related SDGs and integrate commitments made by water-borne diseases, greatly reducing the mortality and (A Ezeh PhD); Center for regional African bodies. The strategic options are as much incidence associated with HIV infection, making Innovative Drug Development about promotion of health and prevention of disease as substantial progress on sanitation, and prevention of an and Therapeutic Trials for they are about expansion of access to treatment. epidemic of tobacco-related diseases, among others. Africa, Addis Ababa University, Addis Ababa, Ethiopia Building health systems commensurate to the chal- (A Fekadu MD); National AIDS lenges of 21st century Africa requires action in the critical Achievement of good health for all citizens should be a Control Council, Ministry of areas of: political and investment priority for every sub-Saharan Health, Nairobi, Kenya • people-centred health systems, universal health African country (N Kilonzo PhD); FHI360, Durham, NC, USA coverage (UHC), the social determinants of health, In addition to a better life for people, more investment (Prof P Lamptey MD); London and health outcomes. in health will contribute to economic growth and School of Hygiene & Tropical • leadership, stewardship, civil society engagement,
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