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Key findings
  • On prioritisation of health care: On average across 34 surveyed countries, Africans continue to rank health as one of the highest priorities for their governments to address. It falls second (34%), just behind unemployment (35%), and is the most frequently cited problem in nine countries, led by Tanzania and Uganda (54% each).
  • On physical access to clinics: On average across 34 countries, field teams found that health clinics are easily accessible to citizens in 60% of enumeration areas they visited.
  • On lack of access to medical care: More than six in 10 respondents (62%) say they went without medical care at least once in the past year, including more than 80% of Guineans, Liberians, Sierra Leoneans, and Gabonese.
  • On quality of service: Among respondents who had contact with the health system, nearly half (49%) say they found it difficult to obtain medical care. At least seven in 10 report difficulties in Liberia (72%), Sudan (71%), Gabon (70%), and the Gambia (70%).
  • On government performance in improving basic health services: On average, 55% of respondents in surveyed countries say their governments are doing “fairly badly or “very badly” in improving basic health services – the first majority negative response since Afrobarometer started asking this question in 1999.
  • Summarising country performance: Comparing countries across multiple indicators, we find some of the most troubling health-care experiences in Liberia, Sudan, Gabon, the Gambia, Morocco, Senegal, Uganda, and Guinea. At the other extreme, Mauritius and Lesotho stand out with the most positive ratings of citizen experiences.

As Africa and the world begin to regroup now that the worst ravages of the COVID-19 pandemic appear to be past, it is an opportune time to take stock of the state of health care systems on the continent. The pandemic is not over – South Africa is just coming out of its fifth wave of infection (Al Jazeera, 2022), and there may be more to come (Landman, Irfan, & Resnick, 2022). In the meantime, the Africa Centres for Disease Control and Prevention (2022) and national governments continue to scale up their vaccination campaigns. But the war in Ukraine and global economic deterioration have finally supplanted COVID-19 at the top of the news cycle.

In the early stages of the pandemic, many assessments warned of the possibly extreme vulnerability of Africans to the pandemic based in part on the many challenges already facing health care systems across much of the continent (Mattes, Logan, Gyimah-Boadi, & Ellison, 2020). While the direst predictions did not come to pass in most countries – South Africa being a notable exception – the pandemic has highlighted gaps in health systems amid the recognition that the next global health crisis could hit harder if improvements and preparations are not made.

Taking a longer-term view, the United Nations Sustainable Development Goals (SDGs) also highlight the need to strengthen health systems (United Nations, 2018). SDG#3 focuses on good health and well-being. But Afrobarometer’s SDG Scorecards, based on our most recent data from 34 countries surveyed in Round 8 (2019/2021), show that from the perspective of citizens, only a handful of countries have been making significant progress toward achieving this SDG (Afrobarometer, 2021).

Instead, a growing number of Africans report going without medical care, and the share who cite health as one of their country’s most important problems is also on the rise. Even among those who do get care, increasing proportions report finding it difficult, and having to pay bribes, to obtain the medical services they need. Not surprisingly, citizens are also increasingly critical of their governments’ performance in this sector: For the first time in two decades of Afrobarometer polling, a majority of respondents say their governments are performing badly on improving basic health services.

Moreover, the evidence suggests that the challenges wrought by the pandemic were not the cause of these increasingly negative reviews: The downward trends were already under way before COVID-19 entered the picture, and in fact, in some cases the trends appear to be somewhat less negative since the onset of the pandemic.

Carolyn Logan

Carolyn is the director of analysis at Afrobarometer

Tosin Salau

Tosin Salau is a data analyst for Afrobarometer and a PhD student in the Department of Political Science at Michigan State University.