Tessa Quinn
Access to healthcare is a significant issue in Africa, with many people lacking basic access to emergency care and hospitals. While some countries like Zanzibar, Comoros, and São Tomé and Príncipe have good access indices, with more than 95% of their populations within two hours of a hospital, other countries in Africa struggle with providing adequate healthcare services. Notably, most African countries lack basic inventories of healthcare service providers, including the number of hospitals, which poses a challenge when addressing healthcare gaps on the continent.
| Characteristics | Values |
|---|---|
| Number of hospitals in Africa | Unknown, but Nigeria has 879, followed by the Democratic Republic of Congo (435), Kenya (399), and South Africa (337) |
| Hospital beds per 1000 people in South Africa | 1.7-2.3 |
| Countries with good access to hospitals | Zanzibar, Comoros, São Tomé and Príncipe, Kenya, South Africa, and Nigeria |
| Countries with a high number of public hospitals | Nigeria, Democratic Republic of Congo, Kenya, and South Africa |
| Challenges | Lack of data on hospital numbers and locations, insufficient infrastructure and roads, lack of basic inventories of healthcare providers |
| Goals | All 48 countries surveyed aim to deliver universal healthcare by 2030 |
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What You'll Learn
Nigeria has the most hospitals in Africa
Access to healthcare is a significant issue in Africa, with many people facing long journeys to reach a hospital. In fact, most African countries lack basic inventories of healthcare providers, including the number of hospitals. However, Nigeria stands out as a leader in healthcare accessibility within the continent.
Nigeria boasts the highest number of hospitals in sub-Saharan Africa, with 879 hospitals recorded. This is a significant figure, especially when compared to other countries in the region. For instance, the Democratic Republic of Congo, which has 435 hospitals, Kenya with 399, and South Africa, which has 337 hospitals.
Nigeria's large number of hospitals is particularly notable given the country's population size. As one of the most populous nations in Africa, Nigeria accounts for close to a fifth of sub-Saharan Africa's population. This means that a substantial proportion of people in the region have relatively good access to hospital services.
The availability of hospitals in Nigeria contributes to improved healthcare outcomes. It enables better access to emergency care, which is crucial in addressing the main causes of medical emergencies in Africa, including road accidents, obstetric complications, severe illnesses, and non-communicable diseases.
While Nigeria leads in the number of hospitals, the country continues to face healthcare challenges. Improving access to healthcare services remains a priority, and there is a need for ongoing investment in infrastructure, ambulatory care, and transportation networks to ensure that people can reach these hospitals promptly. Nonetheless, Nigeria's high number of hospitals is a positive step towards achieving the sustainable development goal of delivering universal healthcare by 2030, a goal that all 48 countries in the survey have committed to.
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South Africa's hospital bed distribution
South Africa has a total of 337 hospitals, with 84% of private hospitals and 23% of public hospitals having Intensive Care Units (ICU) and/or High Care Units (HCU). The country has a higher number of hospital beds per 1000 people than the international benchmark, with estimates ranging from 1.7 to 2.3 beds per 1000 people. This is in contrast to the global standard of 1.5 beds per 1000 people.
The distribution of hospital beds in South Africa varies across provinces and between public and private sectors. The Eastern Cape Province, located on the southeastern coast of South Africa, has an inequitable distribution of resources, with the eastern regions having poorer access to mental health facilities and human resources than the western regions. The province has an approximate geographical area of 169,580 km2, representing 14% of the country's land area.
In terms of critical care resources, a national audit found that there were a total of 3,414 ICU and high care beds in South Africa, with 64% in the private sector and 36% in the public sector. The ICU bed-to-total hospital bed ratio is significantly higher in the private sector (8.9%) compared to the public sector (1.7%). This disparity is even more pronounced when comparing hospitals with ICU beds only (3.9% in the public sector vs 9.6% in the private sector).
During the COVID-19 pandemic, a combination of public and private sectors provided hospital care to patients requiring ward and ICU beds. The private sector provided a significant proportion of high care and ICU beds, with 88.4% and 49.4% respectively, during the first wave. The median length of hospital stay during the pandemic ranged from 6.63 to 6.78 days across the three waves.
South Africa's healthcare system faces challenges, including a high incidence of HIV/AIDS and TB, and limited access to private medical insurance. These factors impact the distribution and utilisation of hospital beds, particularly during public health crises such as the COVID-19 pandemic.
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Emergency care and access to hospitals
Access to emergency hospital care in Africa varies substantially within and between countries. While some countries, such as Nigeria, Kenya, South Africa, and Zanzibar, have good access indices, with more than 90% of their populations living within a two-hour travel time of a hospital, others, such as South Sudan, fall far short of this benchmark.
The lack of access to emergency care has severe consequences. Nearly half of all deaths and about a third of disabilities in low- and middle-income countries could be avoided if people had timely access to emergency medical treatment. The main causes of emergencies in Africa include road accidents, obstetric complications, severe illnesses, and non-communicable diseases.
To address the issue of access, various interventions are necessary. These include building new hospitals, improving ambulatory care, constructing and repairing roads, and updating hospital lists with information on capacity and capability to provide emergency care. Additionally, there is a need to improve infrastructure and health worker training, as many hospitals in Africa lack the basic infrastructure and trained personnel required to provide emergency and surgical care according to World Health Organization standards.
Despite the challenges, there is a growing focus on improving access to emergency care in Africa. The African Federation for Emergency Medicine has been advocating for the development of emergency care systems on the continent, and efforts are being made to gather data and create a Pan-African database of hospital locations to better understand and address access issues.
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Private vs public hospitals in Africa
The number of hospitals in Africa is unclear as many countries lack basic inventories of healthcare providers. Nigeria, which accounts for close to a fifth of sub-Saharan Africa's population, has the highest number of hospitals at 879. Other countries with significantly high numbers of public hospitals are the Democratic Republic of Congo (435), Kenya (399), and South Africa (337).
In Africa, the main causes of emergencies are road accidents, obstetric complications, severe illnesses, and non-communicable diseases. However, people across the continent often have to travel far to reach a hospital. Only 16 countries in a survey of 48 countries achieved 80% coverage in access to a hospital within two hours.
When it comes to private vs public hospitals in Africa, there are several key differences. Public healthcare in Africa is typically government-funded and offered to all citizens, but it often suffers from long wait times, rushed appointments, outdated facilities, and poor disease control and prevention practices. Private hospitals, on the other hand, are known for their high-quality services, state-of-the-art facilities, and shorter waiting times. They are able to attract highly skilled specialists due to the availability of advanced medical technology. However, private healthcare is primarily accessible to wealthier individuals who are members of medical aid funds or can afford out-of-pocket expenses.
In South Africa, for example, the private healthcare sector is renowned for its superior quality and shorter waiting times compared to public healthcare. Doctors in the public sector often refer patients to private facilities due to a lack of suitable resources or when faster treatment is required. Efforts to improve the public healthcare sector in South Africa are ongoing, with the introduction of the National Health Insurance (NHI) scheme striving to create a unified healthcare system and improve accessibility and affordability.
The challenges within the African healthcare system, including the disparities between private and public hospitals, highlight the need for continued development and investment to ensure universal healthcare access by 2030, as committed to by all 48 countries in the sustainable development goal.
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Healthcare subsidies in Africa
Healthcare subsidies are essential to combat poverty and ensure that people can access the services they need without facing financial hardship. Africa accounts for 16% of the global population and bears 23% of the worldwide disease burden, yet it only accounted for 1% of total global health expenditure in 2015. Per capita, the rest of the world spends ten times more on healthcare than Africa.
Despite commitments to prioritize public spending on healthcare, African governments' allocations to health have grown minimally over the past two decades, falling far short of the Abuja Declaration's target of allocating at least 15% of national budgets to healthcare improvement. This stagnation and widening regional inequalities have led to inequalities in healthcare access and outcomes. Only two of the African Union's 55 member countries—Cabo Verde and South Africa—met the 15% target in 2021. Several countries, including Madagascar, Benin, Eritrea, and Chad, have significantly reduced their per-person spending over time.
The issue of healthcare funding in Africa is complex and influenced by various factors. Firstly, there is the challenge of out-of-pocket payments, which remain a significant contributor to total health expenditure in Africa. These payments are inefficient and regressive, often leading to catastrophic health expenditures and impoverishment. Secondly, there is a need for better coordination and streamlining of financing architecture, reducing duplication of efforts and high transaction costs. Thirdly, external factors such as climate-related events, the cost of servicing external debt, and public spending limits imposed by lending programs can impact healthcare funding. Finally, the high cost of providing uncompensated care, similar to the burden faced by safety-net hospitals in the United States, needs to be addressed.
To address these challenges and move towards Universal Health Coverage (UHC), African countries need to consider long-term resource requirements and sustainable financing. This includes raising adequate funds to ensure people can access needed services without financial risk. Governments should also focus on improving health security and common goods for health, as these are the backbone of health systems. Additionally, addressing the targeting problem of subsidies is crucial, ensuring that public subsidies effectively reach the poor and addressing the constraints that prevent them from accessing subsidized services.
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Frequently asked questions
It is unclear exactly how many hospitals there are in Africa, as many countries lack basic inventories of healthcare providers. However, Nigeria, which accounts for close to a fifth of sub-Saharan Africa’s population, has the highest number of hospitals at 879.
South Africa has 337 public hospitals.
Hospital accessibility varies across Africa. In large countries such as Kenya, South Africa, and Nigeria, more than 90% of the population can reach a hospital within two hours. However, in smaller countries like Cape Verde and São Tomé and Príncipe, the number of hospitals is significantly lower.
Africa faces several challenges in providing adequate healthcare to its citizens. These include a lack of infrastructure and roads, insufficient surgical resources, and a lack of data on healthcare providers. Additionally, issues such as hunger, homelessness, violence, and disease further complicate the healthcare situation.
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