Yesterday, President Obama wrapped up a weeklong trip to sub-Saharan Africa, during which he traveled with his family to Senegal, South Africa, and Tanzania, speaking across the continent on issues such as trade and investment, democracy and institution building, youth, and the development agenda. As the trip wound down, the administration announced the Power Africa program, a $300 billion dollar plan that will leverage public-private partnerships to build energy infrastructure across the continent, beginning with six initial countries. This is certainly good news, as more than two-thirds of people in sub-Saharan Africa have no access to electricity; this, in turn, limits economic growth, as well as health and education services. Following widely lauded legislation during the Clinton and Bush administrations, including the Africa Growth and Opportunity Act and PEPFAR, respectively, Power Africa will seek to solidify Obama’s legacy in advancing what the United States can do to help sub-Saharan Africa.
But before the world turns its attention elsewhere, perhaps the administration is omitting an important question about its relationship with the subcontinent: What can Africa do for the US? Increasingly, development partners are witnessing significant healthcare innovation happening in Africa; if scaled, that innovation could overcome basic health barriers on the continent and also inform our own healthcare challenges in the US.
Six of the ten fastest-growing economies in the world are in sub-Saharan Africa, but this growth will not be inclusive or permanent without substantive investments in healthcare and health infrastructure—both physical and human. PEPFAR brought attention to disease-specific programs targeting AIDS and tuberculosis, as well as high rates of maternal and infant mortality. And while these all pose formidable challenges to lasting development across sub-Saharan Africa, one lesson that stakeholders have learned is that health systems need strengthening to defeat disease burdens. Over the last ten years, with the help of targeted assistance, governments and NGOS across the continent have developed health innovations that are demonstrating significant success, and if replicated and scaled, they could improve health outcomes globally while unlocking Africa's true growth potential.
We should put fire beneath that innovation by investing in its trajectory. Establishing a pipeline of ideas that we could scale globally and resource for implication across entire populations—both in the US and Africa—instead of treating Africa as a “hopeless continent” in need of external intervention.
Moreover, this is seemingly very low-hanging fruit given President Obama's domestic healthcare legacy and recent discourse suggests that US healthcare is open to such innovations, as the industry is increasingly disjointed. Essentially, both African and US systems have major challenges yet significant successes, and a partnership to improve health infrastructure and health facilities could address and inform their respective shortcomings.
US hospitals themselves are in particular need a significant reboot. US facilities remain designed around an antiquated, inflexible paradigm of care: notably, obligations for institutional improvements to expensive facility investments made over the last several decades. The spatial planning and design of medical facilities (or lack thereof) on its own is a serious symptom of the US healthcare predicament—by and large patients are less healthy after visiting hospitals. Large buildings and labyrinthine complexes ineffectively deliver patient care and retard healthcare institutions from efficiency and innovation. US healthcare on a systemic level is facing a volume-to-value revolution, a shifting reorientation from a reverence for facilities to outcome-based improvements in health that offer new hope for better care and reduced cost. Without a comprehensive investigation into the spatial determinants of health (sick facilities, sick systems, and sick regions), we will fail to address a fundamental barrier in delivering the new value-based health paradigm that the Obama administration is arguing.
Resource-scarce societies, on the other hand, operate under different constraints; they implement resourceful methods to produce functional innovations and holistic health programming. In a 2012 Stanford Social Innovation Review article, Paul Farmer, co-founder of Partners In Health, along with Rebecca Onie and Heidi Behforouz, described this resourcefulness as the understanding that “failure more often stems from ineptitude (not properly applying what we know works) rather than ignorance (not knowing what works).”
In environments that have unreliable electrical grids and limited maintenance expertise with expensive, often rare replacement parts, mechanical systems are challenging to maintain and therefore rarely effective. The converse is that US facilities are completely reliant on such technologies. Resource-scarce settings teach us that we must design technology in context and integrate it with community needs, providing for easy, efficient upkeep, adaptation, and delivery.
Rwanda is proving a leader in such interventions, spending resources responsibly and across mediums of care, and leveraging models that deliver big outcomes with low costs. The Government of Rwanda has implemented universal health coverage (to 92 percent of the population) and an incentive system for facilities that rewards hospitals and clinics with better patient outcomes. The 45,000 Community Health Workers initiative has proved invaluable in rural Rwanda. It uses inexpensive labor to visit and monitor patients, drastically reducing the incidence of complications and emergencies through regular check-ins that don’t require costly hospital stays. Community health workers are truly innovative in that they leverage human infrastructure to deliver care and improve health, avoiding expenditure on costly facilities and late stage treatment. Rwanda, alternatively, is addressing the public's health, not just people who are already sick enough to require hospitalization in expensive facilities.
Numbed by choice and excess, US healthcare is at a crossroads, while healthcare in the global south is at a threshold. Leveraging American human capital and resources to scale and to replicate such interventions in the global north is a true opportunity for the Obama administration. In the US, we can simplify and streamline bloated facilities and hospital networks, and reduce costs. And in the global south, resources that support delivery and clinical care can deliver invaluable vaccinations, prenatal care, and nutrition. Indeed, neither population deserves anything less.