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Health Care in Sub-Saharan Africa: A Ticking Time Bomb

They all dream of a future that is better than their parents’ time. Doctors, lawyers, and engineers are among the professions immortalized in their notebooks. They are confident that working hard in school will help them to realize their dreams. With the nations of sub-Saharan Africa (SSA) full of children who have such dreams, just how bright is their future?

Every profession is essential to the well-being and growth of a country. It is impossible, and in fact, inappropriate, to categorize these professions in order of importance. However, health and health care, in my opinion, comes somewhere near the top. Poor health and the delivery of suboptimal health care have negative consequences that extend beyond the individual. Families, communities, and countries bear the brunt of the repercussions.

This article does not attempt to examine the disconnect between childhood dreams and living those dreams as adults. Rather, the focus is on the practice of medicine in the face of increasing incidence of noncommunicable diseases (NCDs), such as cardiovascular diseases (e.g., heart attacks, stroke), cancer, chronic respiratory diseases (e.g., chronic obstructive pulmonary disease, asthma), and diabetes. These diseases are propelled by lifestyle changes and challenged by the increasing shortage of health care professionals (HCPs). The statistics speak for themselves: Diabetes, cancer, cardiovascular, and respiratory diseases will be the leading killers in SSA by 2030. The 54 low- to middle- income countries in Africa will be home to the world’s highest increase in NCD deaths over the next decade. In a report commissioned jointly by the Global Health Workforce Alliance (GHWA) Secretariat and the World Health Organization (WHO), SSA had a deficit of an estimated 1.8 million health workers in 2013. This deficit is projected to rise to 4.3 million by 2035. Although all NCDs deserve equal attention, let’s concentrate on stroke.


The incidence of stroke in Africa is among the world’s highest, is increasing, and is reported to occur at a younger age. Hemorrhagic stroke is more common among Africans, while ischemic stroke is more common among Europeans and Americans. Hemorrhagic stroke is more challenging to prevent and manage in SSA, and has higher morbidity and a lower survival rate than ischemic stroke. Genetics and environmental factors may play a 2 role in the racial differences in stroke incidence and survival. Irrespective of the contributing factors, the reality is that Africa is suffering a silent crisis of stroke events.

Shortage of Health Care Workers

This crisis is layered on top of the critical shortage of health care workers in SSA. Forty-seven countries in SSA have fewer than 2.28 physicians or nurses per 1,000 people, the threshold widely regarded as a minimum for delivering basic health care services. Most countries in SSA have less than one doctor for every 5,000 people. This shortage of health care workers only adds to the significant burden and increasingly poor health outcomes of a continent whose population is projected to almost double by 2050. This is a ticking time bomb as far as health and health outcomes are concerned.

Stroke Investigative Research and Educational Network (SIREN) Study

Now that we have laid out the problem, what does it all mean, and what can we do with what we have? Keeping the attention on stroke, its increasing prevalence is well recognized by stroke experts across SSA. The Stroke Investigative Research and Educational Network (SIREN) study, is the largest study of stroke in Africa to date. The study examined and quantified the contributions of the top modifiable risk factors for stroke among Africans. According to the study authors, “low-income and middle-income countries in Africa have scant resources for acute care and rehabilitation.” They suggested that “the most plausible strategy to reduce the burden of stroke in SSA is comprehensive and pragmatic preventive efforts targeted at its dominant risk factors.”

This game plan requires a collective effort from the lay public and HCPs. They need to be knowledgeable about stroke, its risk factors, and management. To maximally engage the available health care resources requires that HCPs are confident in their ability to recognize stroke symptoms. They must also have the essential clinical skills to diagnose, promptly manage an acute stroke event, and initiate primary and secondary prevention interventions. Understanding how HCPs currently manage patients with stroke in SSA or patients with high-risk factors for stroke provides a useful baseline to build on to achieve optimal health outcomes.

Initiative for Continuing Professional Development for Healthcare Practitioners

The Missing Link to Improved Health Outcomes (MiLHO) Initiative provides online CME courses that recognize and consider Africa’s unique medical practice environment by developing evidence-based and relevant content. The initiative aims to expand opportunities for CME to assist healthcare practitioners in staying current with evidence supporting patient care in their local setting. Courses are certified by the CPD Certification Service. Visit the MiLHO Initiative to learn more.