The state of health and well-being is a function of the levels of attainment of the dimensions related to outcomes – the health and health-related services desired by the population. For sustainable development, these services must cover all the populations, irrespective of their needs and locations. Outcomes in health consider the availability of health services, the coverage of the needs of the populations, the risk factors, health security and financial health protection.
6.1 Availability of essential services
The availability of essential health services throughout life course is one of the pillars for the universal health coverage. These include family planning, which addresses the goals of reducing child mortality, improving maternal health and promoting women's empowerment and gender equality. In the Region, 79% of the facilities offered family planning services while 82% can offer antenatal care services. The offers of services concerning pregnancy are decisive for the future of child and mother.
Particular attention must be paid to early childhood services such as vaccination, growth development, but also curative care. In the Region, 68% of health facilities in countries with available data have comprehensive emergency obstetric and neonatal care services. On average, fewer than one in two pregnant women in Africa give birth in the presence of skilled health personnel, and only 12% of those who need emergency care for themselves and their newborns actually receive it. In fact, 9 out of 10 facilities offer the three essential preventive and curative care services for children under five. Adolescents and youth (aged between 10 and 24 years) represents one third of the population in the Region. However, the availability of adolescent’s services is only 65%.
Among adults prone to non-communicable diseases, services must be accessible and adapted. Management of hypertension was disrupted in 59% of countries, and management of diabetic complications in 56% of countries due to COVID–19 crisis. Closing or slowing down services is likely to further worsen patients' underlying conditions, leading to more severe cases of non-communicable diseases. It also exacerbates the susceptibility of people living with chronic diseases to COVID–19. Countries need to plan for more comprehensive essential health packages to ensure the availability of services for all.
6.2 Coverage of interventions
Coverage of interventions analyses the levels of utilization achieved for ‘traditional’ health services. Coverages for non-communicable diseases and health promotion services are the lowest, while the coverage for communicable disease control interventions is the highest although progress has been made in recent decades in the area of contraception, contraceptive use remains low in sub-Saharan Africa. Across countries, the median contraceptive prevalence rate (CPR) among women of reproductive age was just 28% in 2017. Recent evidence indicates that increasing the frequency of antenatal visits in the health system for women and adolescents is associated with a lower likelihood of stillbirths, as these visits provide more opportunities to detect and manage potential problems.
In the Region, children under five with symptoms of pneumonia who were taken to a health facility for treatment have increased between 2016 and 2019 from 47% to 57%, and those with fever symptoms taken to a health facility for care seeking has increased from 57.2% to 60.0% in the same period. Due to limited access to safe water and adequate sanitation and hygiene, this age group remained the main victim of diarrhea. Strategies to manage this disease have reduced mortality to 437 000 deaths in 2018, which is three times less than in 2000.
People living with HIV who know their status are 67% in the Region, with a large variation across countries while the coverage of mother-to child- transmission is 87%. In order to stop maternal transmission of HIV, efforts are still needed, in particular to reduce even more drastically the number of contaminations through breastfeeding. About the prevention of malaria, 38 African countries have adopted intermittent preventive treatment during pregnancy (IPTp) to reduce the burden of malaria during pregnancy. Coverage with three doses of IPTp (IPTp3) has increased from 1% in 2010 to 16% in 2015 and 32% in 2020 but remains well below the target of at least 80%. In the Region, 31 countries had planned campaigns of insecticide-treated nets (ITNs) and indoor residual spraying (IRS) coverage stands at 5.3% of the entire population at risk of malaria in the African Region in 2020.
Concerning the preventive chemotherapy of neglected tropical diseases, there is an overall decrease in the coverage since 2018/2019 to 2020 in Africa: Lymphatic Filariasis (63.4% to 41.8%), Onchocerciasis (from 73.8% to 47.1%), Soil-transmitted helminthiases (from 66.4% to 44.6%), Trachoma (from 64.2 in 2019 to 23.8). This general declined might be due to the prolonged supply of medicines certainly accentuated by the COVID–19 crisis, which resulted in resources being redirected and priorities being reviewed. This health crisis has put spotlight on mental health, which has always been neglected in the African Region. Indeed, the population have one psychiatrist for every 500 000 inhabitants, which is 100 times less than the WHO’s recommendations. In fact, the coverage the coverage of services for severe mental health in the Region is 0.072 per 100 000 population.
6.3 Risk factors and behaviors
Risk factors induce health-promoting behaviors and lifestyles in terms of diet, physical activity, etc. The prevalence of exclusive breastfeeding of children up to 6 months for the Region is 45.7%. This means that less than one in two children under six months is exclusively breastfed in the Region between 2010 and 2018. Early breastfeeding is essential for the survival of the newborn and for the establishment of long-term breastfeeding. In fact, Three out of five newborns are not breastfed within an hour of birth.
The African Region has the highest rates of anemia in children aged 6–59 months (60.2%), and the second highest rate of anemia in women of reproductive age (40.4%) following the South East region in 2019. The prevalence of insufficient physical activity in adults over 18 years shows an overall average of 22.10% lack of physical activity among adults. It is a leading risk factor of NCDs. Moreover, women (25.63%) are less physically active than men (18.4%) in the Region, this can explain why they (38.8%) suffer more of overweight and obesity than men (22.8%). This condition is raising in the Region with time and health consequences (NCDs) too.
6.4 Health security
Health security is a key measure in the African Region, given the devastating effect of epidemics and health emergencies on health and wellbeing. In order to strengthen and sustain prevention, preparedness and response capacities for health security, the global community and particularly the African Members States, should accelerate building and investment in critical elements of health systems. Although IHR capacities are necessary, they are insufficient on their own to prevent, detect and respond to public health events. In many settings, health systems have not been at the center of national efforts to implement the IHR. The effectiveness of such a mechanism must be based on strong, resilient and responsive systems capable of preventive measures, of absorbing shocks, of adapting to disturbances and of responding to the changing needs and contexts created by public health events, while ensuring the continuity of essential health services.
6.5 Financial risk protection
Financial risk protection focuses on the level of financial barriers hindering the utilization of essential services, which is driven by low levels of social security and pooling of health resources in the African Region. In fact, 7.72% of the African population spend more than 10% of household income on health care expenditure. This proportion ranks the region after North America and Europe and Central Asia. the global average is 12.67% of the population spending more than 10% of income for health care.