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Health Inequity

Health inequity in Africa: where to go?

By Lamis Beshir


Keywords: Health inequity, access to healthcare services, health policies, marginalized groups, Africa, gender mainstreaming

Poverty remains the cause and effect of Africa’s most severe problems. Although this is not the case each time but African governments have repeatedly highlighted the importance of bridging health inequities by improving the access to health for all.

Governments and policymakers are struggling with the challenge of creating and formulating effective health policies and healthcare systems that can ensure equity of access to adequate and satisfactory health services.

From the framework of the social determinants of health, the critical problems of malnutrition, HIV/AIDS, TB and other infectious diseases of sub-Saharan Africa are symptoms of poverty. Unequal access to health services by income group, rural/urban location and gender as social determinants result in a poorer health outcomes for disadvantaged and vulnerable groups. Inequities in health are avoidable and unfair differences in the utilization of health services between different socioeconomic groups. It is therefore evident that inequality and poor health are intertwined and strongly connected.

The burden of the major categories of poor health and disability are greater among lower socioeconomic groups in Africa. Even non-communicable diseases, which are frequently seen as diseases of affluence are increasingly being reported by lower socioeconomic groups. (John E Ataguba)

For women, the situation is compound and complex. Women have an additional greater need for reproductive health services. They are currently over-represented among the poorer populations, are more vulnerable to gender based violence and have a higher risk to HIV/AIDS.

The inverse care law (where the lowest socio-economic groups bear the largest burden of ill health but also have the lowest level of health service utilization and derive the least benefits from service use) is true for many African countries.

Addressing the health inequalities and improvement of services should be a priority since international evidence shows that the high frequency of health problems is associated with long-term work incapacity. Achieving high level of productivity is essential for development of efficient policies.

Recent assessments of Africa’s progress towards the health millennium developmental goals (MDGs) show that some expected progress has been partially achieved; however the rate of this progress has been inadequate to reach the health targets.

There is a great need for health plans to become more equity focused. Health policies and strategies should be tailored to improve the geographical and financial access, address socio-economic barriers and gender inequity. Gender mainstreaming in health would therefore mean taking into account the perspectives, roles and responsibilities of both men and women. It involves integrating an understanding of gender in all departments and projects rather than just designing projects and services to tackle and target women as an isolated group.

We also need to redefine health not as a specialized sector with hospitals, doctors, nurses and allied health professionals, but as a social objective (Frenk). We need very strong policies for empowering women, for promoting a fair justice system that allows the access of healthcare services to all. All of those are instruments of policy that are not within that ministry of health. They are shared by many other sectors particularly the social and economic sectors. But the ministry of health has to make sure that they are in place to prevent those sorts of causes of ill health, of disability, and death which are related to violence.

Intensive governments’ effort within the health, social and economic sectors are highly required if we are to address the not insignificant health inequities in Africa. It is very critical for policies to tackle the underlying social determinants of health, including the conditions that predispose to the greatest burden of ill health, the inequity and the risks of disease and disability.
The improvement rate and progress in such policies will greatly depend on the support by adequate resources.


Works Cited

Frenk, Julio. Globalization and Health: An Interview With Julio Frenk LYGIA NAVARRO. 3 March 2005.
John E Ataguba, James Akazili and Di McIntyre. "Socioeconomic-related health inequality in South Africa." International Journal for Equity in Health (2011): 10-48.


Lamis Beshir

Medical Doctor

Read more about Lamis and her view on being a futurist




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