The analyzes included in this part situate the level of coverage of essential health services by determining the most effective interventions to fight against communicable and non-communicable diseases and other health problems. Various constraints having been subject to the monitoring of various interventions in the countries, in the context of the COVID–19 pandemic. The assessment of health system performance use four dimensions 1) access to essential services; 2) quality of those essential services; 3) demand for essential services; and 4) resilience to shocks that interrupt service delivery. The overall health system performance for the Region is 52.9% of what they can feasibly do, ranging from 34.4% to 75.8%.

5.1 Access

On average, the systems in the Region are only able to assure 47.4% of the potentially possible access to essential services.

Access to essential services is monitored through three vital signs, with the lowest score regionally being the vital sign of physical access (29.6), compared to financial (55.2) and sociocultural access (57.4). Populations are not able to get to facilities providing essential services. The Region needs to invest relatively more in interventions that will overcome physical barriers to services to have the greatest impact on access to services. These include investments to scale up the numbers of the health workforce, infrastructure and medical supplies targeting populations with no, or inadequate service provision units.

5.2 Demand

In general, the right to demand for health is distant from the consumption of health care. High demand indicates that health systems are providing the services that people need to ensure their health and well-being.

The demand score in the African Region is relatively high compared to other performance measures. However, there is room for improvement, as the 52.8% score for effective demand, which is still low, fails to achieve effective performance. The demand for essential services is monitored through two vital signs, with the lowest score regionally being the vital sign monitoring individuals’ healthy actions (47.9), compared to individuals’ health-seeking behaviors (57.7). Many community-based interventions are primarily focused on taking services to the communities, as opposed to building community engagement and knowledge that is needed to generate strong service demand. The Region needs to invest relatively more in interventions that will improve individuals’ healthy actions to have the greatest impact on demand for essential services.

5.3 Quality

The quality-of-care index quality shows that the quality-of-care represents, in the Region, only 62.3% of what is possible. This index varied significantly from one country to another, from 39.7% to 84.7%. Namibia, Mauritius and Seychelles are above 80%. Quality of care is monitored through three vital signs, with the lowest score regionally being the vital sign monitoring user experience (54.9), compared to patient safety (61.0) and effectiveness of interventions provided (70.8). The Region needs to invest relatively more in interventions such as person-centered care initiatives that will improve overall user experience during the care process, to have the greatest impact on quality of care.

In the African Region, the number of people on HIV treatment increased by 1.47 million in 2021 (compared to over 2 million in previous years). The largest increase was in central and western Africa, while the increase in eastern and southern Africa was lower than in previous years. Efforts must continue to eradicate TB. The percentage of reported TB patients with a conclusive HIV test result was 69% in 2019, a 5% increase from 2018. Overall, 88% of TB patients with known HIV infection were on antiretroviral therapy in 2020. Member states are on track to achieve the goal of eliminating TB in Africa by 2030 if resources are properly allocated and the organization is well structured. Two of the key determinants of TB incidence identified in the Global TB Report 2020 are GDP per capita and undernutrition. The situation could be worsened by the economic impact of the COVID–19 pandemic.

5.4 Resilience

The health system resilience represents a score of 51.9% in 2020. In fact, resilience describes a systemic approach that links emergency and development. Even though most countries have experienced various crises and shocks, some are not systemically equipped. Countries that experience shocks generally experience a significant decline in health service due to low resilience. Resilience is monitored through two vital signs: the inherent resilience that captures the inbuilt capacity to anticipate, absorb, and transform functionality due to a shock event; and the epidemic preparedness and response core capacity that captures the complementary capacity to respond to a shock event. The lowest score regionally is on inherent resilience (49.1), compared to the IHR core capacity (47.6).