African health services from a community perspective

New study offers recommendations for improvements

TDR news item
18 April 2013

A multi-country study into health systems issues throughout Africa from a community perspective has been published by the World Health Organization’s Regional Office for Africa. Health Systems in Africa: Community Perceptions and Perspectives identifies the health issues and challenges that ordinary citizens throughout Africa experience, from the diseases they face and see most relevant, to the way they get and expect health care.

In her foreword, WHO Director-General Dr Margaret Chan calls the “results of this study … enlightening and revealing” and she highlights the need to develop policies and strategies that respond to people’s needs.

Seven recommendations

In all, the report makes seven recommendations that cover a broader definition of health, reforms needed for infrastructure and health financing mechanisms, the value of community-based involvement in planning, surveillance and management of common problems, and broader research and sharing of best practices. The study illustrates the importance of community involvement in the governance of health services, and the input they can provide to improve both care and coverage.

Dr Luis Gomes Sambo, Director of WHO’s Regional Office for Africa and Dr Uche Amazigo, former Director of the African Programme for Onchocerciasis Control, were initiators and principal investigators of the study. The research effort included almost 11 000 interviews in ten African countries with community representatives on how health and health care is perceived by African communities, how it’s implemented, and how communities can contribute to improving it.

Facilities, services and financial protection

More than two thirds of the interviewees rated the services at public sector facilities as grossly inadequate, citing the unavailability of drugs and equipment, poor attitudes of health providers, delays in the provision of care and long waiting times. Financial barriers were the main constraints to accessing health care, but transport was a significant factor. Three out of the ten participating countries have formal health insurance, and these gaps in social protection led to a call for more effective mechanisms that would spare households from catastrophic out-of-pocket expenditures.

Community perspectives on health include the physical, mental, emotional, spiritual, social and economic dimensions of well-being. TDR staff Dr Johannes Sommerfeld, a social health scientist, advised on the project design and assisted in the research protocol development. TDR has been collaborating with the study organizations for many years on community access research, notably on community-directed interventions.

For more information, please contact

Dr Johannes Sommerfeld