There are wide variations between the levels of performance of state health systems, both in investment and in the results achieved. Similarly, performance ranking is not always consistent with health impact. This suggests that countries are not well equipped to capture health investments and health-related outcomes. Furthermore, the focus on system performance in countries represents the best area of focus to move the slider towards the adoption of healthy lifestyles and well-being.

7.1 Life expectancy & fecundity

Life expectancy at birth has increased from 52.7 years in 2000 to 64.5 years in 2019. By 2030, one in six people in the world will be 60 years of age or older. Moreover, the trend in average adjusted life expectancy in good health is increasing in the African Region, from 46.7 to 56.5 years, over the period 2010–2021. This evolution shows a clear improvement in the health and well-being of the region's populations. Over time, women have a longer healthy life expectancy than men, 57.1 years versus 55 years respectively in 2019.

Early childbearing, or pregnancy and delivery during adolescence, can derail girls’ healthy development into adulthood and have negative impacts on their education, livelihoods and health. Many pregnant girls pregnant are pressured or forced to drop out of school, which can impact their educational and employment prospects and opportunities. Complications of pregnancy and childbirth are the leading cause of death for girls aged 15–19 worldwide, and low- and middle-income countries account for 99% of maternal deaths worldwide among women aged 15–49. In addition, the total fertility rate is declining in all regions. In the African Region, it remains high with 4.5 children per woman in 2017. However, the rate has declined over the past 30 years, from an average of 6.6 to 4.5 children per woman in the Region between 1980 and 2017.

7.2 Morbidity

The Region is regularly faced with an upsurge of vaccine-preventable disease outbreaks. The mobility of people in the region, including displacement due to conflict and other natural disasters, coupled with climate change which is changing the ecology and spread of infectious disease vectors, increasing the risk of outbreaks of yellow fever, cholera and malaria. Between January and March 2022 nearly 17 500 measles cases were reported in the African Region, representing a 400% increase over the same period previous year. Countries need to achieve and maintain 95% immunization coverage to eliminate measles. In 2021, 13 countries reported yellow fever outbreaks in Africa, compared to nine in 2020. As of December 2018, 168 out of 194 countries had introduced rubella vaccine, and global coverage was estimated at 69%. However, it is not enough in Africa and South-East Asia where rates of congenital rubella syndrome are the highest.

In 2021, Africa accounts for 2/3 of people living with HIV worldwide. The incidence of HIV infections globally declined by 39% between 2010 and 2020, far less than the 75% target agreed to by the General Assembly in 2016. Measures to slow the spread of COVID–19, along with the added pressures on health systems, have disrupted HIV services. About 70% of the world's hepatitis B cases are concentrated in Africa while 28 African countries now have a national hepatitis programme. Hepatitis strategic plans have been developed in 21 countries, while 17 countries have treatment and testing guidelines aligned with WHO guidelines. Every day, more than one million people worldwide contract a Sexually Transmitted Infection (STI). The African Region is particularly affected by the high prevalence of these infections, with an impact on the health and quality of life. The WHO African Region continues to pay the highest price for malaria. In 2020, the recorded 228 million malaria cases (95% of all cases); 602 000 malaria deaths (96% of all malaria deaths). 80% of all malaria deaths in the region are in children under 5 years of age.

The risk for a sub-Saharan African woman to develop cancer by the age of 75 is 14.1%, with breast cancer (4.1%) and cervical cancer (3.5%) together accounting for half of this risk. The growth and ageing of the population, urbanization and lifestyle changes to a rapid increase in incidence of cancer. Actions needs to be taken concerning the absence of preventive measures, the delay in diagnosis, the lack of health workers trained, the lack of dedicated facilities and equipment.

Births anomalies are among the leading causes of child mortality, chronic morbidity and disability. These diseases and abnormalities may be present at birth or acquired later. The prevalence of low birth weight among newborns measured at birth in sub-Saharan Africa was 9.76%. Among the 10 countries with the highest rates of preterm births per 100 live births are 8 African countries in 2016. Most stillbirths (84%) occur in low-income and lower-middle-income countries. In 2019, 3 out of 4 stillbirths occurred in sub-Saharan Africa or South Asia. Most stillbirths are due to poor care during pregnancy and childbirth. Despite progress in health services to prevent or treat the causes of child deaths, progress in reducing the stillbirth rate has been slowed (2.3% decrease per year over the last 20 years).

7.3 Mortality by cause

Each year, more than 500 000 people die from TB in Africa, although TB-screening and treatment is free in all countries. Around 44 per 100 000 people died from AIDS in 2018. the maternal mortality ratio remains very high with more than 525 deaths per 100 000 births. Despite its very high maternal mortality rate, sub-Saharan Africa has seen a substantial reduction in maternal mortality rate of about 38% since 2000. The highest burden of malaria is in Africa with 96% of all malaria deaths in 2020.

In 2021, COVID–19 killed 113 102 people on the continent, an official figure of more than 300 deaths every day. Current projections are for 23 000 deaths – or about 60 a day – for the whole of 2022. The (official) milestone of 12 million people infected (4 million in South Africa alone) was passed in the first quarter of 2022, while the number of deaths now exceeds 254 000.

7.4 Mortality by age

To reach this level of life expectancy, the babies who are born must be able to survive. Most stillbirths (84%) occur in low-income and lower-middle-income countries. It is estimated that nearly 2 million babies are stillborn each year (3/4 occurs in Sub-Saharan Africa or South-Asia). In 2020, the mortality rate among children under the age of one in Africa was around 41.6 deaths per thousand live births. Infant mortality on the continent decreased significantly compared to 2000, when approximately 81 newborn infants out of a thousand died before one year of age.

Nearly one in ten children still dies before reaching their fifth birthday in sub-Saharan Africa (95 deaths per 1000 live births). Malaria and malnutrition particularly affect children under 5 in certain regions. Between 2010 and 2016, the rates per 100 000 adolescents fell from 235.0 to 211.8 for young men and from 223.4 to 196.0 for young women. There is a difference in adolescent mortality rates between countries. And, within countries, differences in mortality rates remain between men and women. For example, Nigeria's adolescent mortality rate ranks 4th for women and 15th for men.

Adult mortality also decreased by 14.5% over 7 years (from 324 in 2010 to 277 in 2016) from 2010 to 2016 in the African Region. In the region as well as globally, the data describe excess male mortality in almost all countries. Mortality data, as well as birth rate data and other aspects of civil status, must be improved in most countries to learn the best lessons and implement the most effective preventive measures. In the absence of effective civil registration systems, deaths often must be estimated from imperfect data.