Hello, happy new year, and welcome to my blog. My name is Clement Chiwaula, I founded Savannah Public Health Consulting this year which has been my long standing wish. I am very passionate about improving health in Africa, in addition to clinical work I want to support organizations improve quality of care through capacity building and systems strengthening. My vision with Savannah is to collaborate with like-minded individuals across Africa to work on healthcare projects to improve quality of care.

About myself

I was born in Zomba the former capital city of Malawi, a country in South Eastern part of Africa. I come from a large family of 9 children, and I am the eldest. I currently live in Austin Texas with my wife and three boys. My interests and hobbies, include medicine, social justice, nature photography, and soccer.

In Africa being the older child comes with added responsibilities, such as being a role model to the rest of the siblings, expectations are high and rightly so, no parent wants to raise a ” monster” let a lone a first born monster child. Africans believe in having bigger families and expect the older child to nurture their siblings. In my case I had extra expectations, I was more than the big brother I was like a father too. I grew up in difficult environments, my father had two divorces, the first from my biological mum, and of course the second from my step mum As such my childhood was spent living with a single parent or long periods alone with my siblings. Among the many problems we faced accessing healthcare when my siblings fell ill was an ordeal. Access to health care services remain a problem for most of the world’s population. In Malawi although healthcare is free for most part, to get the basic health care services is still a big challenge, poverty, bad roads are the first barriers, and when at the health facility, long waiting hours, and shortages of healthcare personnel and medications are the other problems. In Africa many families face frequent hospital visits due high incidences of infectious disease such as Malaria, and bacterial infections.

These were some of the problems we faced together with my siblings who had to rely on my help to get them medical care in these times. It is these childhood experiences that put me on the path to medical school. After high school I went on to receive medical training in Malawi and Ghana. Later I moved to the US where I completed a master’s degree in public health and received numerous other certificates in clinical research, program design and evaluation.

Today Malawi just like the rest of Africa continues to face the same old health problems, populations continue to grow around the same limited resources while the burden of old and emerging diseases continue kill more people than on any continent. The population of Malawi has almost doubled between the time I was finishing my high school in 2000 and now, but the number of public hospitals and trained personnel such as doctors and nurses has barely increased. In an environment where poverty, unstable economies and increased corruption affect progress and development it is hard to be optimistic about real changes. The major problem in African health systems perhaps is the shortage of health personnel, its well documented in literature and elsewhere, millions of dollars are poured into training
more personnel , and that increases the output of trained professionals, however, there is a paradox, despite these huge investment to train, many African governments often fail to retain these professionals for one reason or another, for instance a more recent counterproductive trend occurred in Malawi and Ghana when the ministries of health halted recruitment of newly graduating nurses and medical doctors (despite the need) due to political and financial reasons-they could afford to train but could not hire them at the end of training-absolute madness don’t you think?

Factors affecting healthcare delivery in Africa are extremely complex, most healthcare institutions are under resourced, the infrastructure and quality of care are severely compromised. Today I find myself equipped to contribute a pair of trained hands to ease some of this burden, Savanna Public Health consulting has been my long-term brainchild will our focus is collaborating with various organization to strengthen health systems and improve quality. Our approach is to mobilize the top public health professionals and medical doctors across Africa to join our initiative and serve. Our services encompass the following main areas;

  1. Capacity building & technical support
  2. Quality assurance
  3. Monitoring & Evaluation
  4. Research & academic writing

Weekly Discussion 2: Factors affecting quality of healthcare in Africa.

In the discussion for this week we begin to examine the factors affecting healthcare delivery in Africa. We start looking at human resource inflow and out flow and the current doctor patient ratios in some of the African countries. What are your comments? Do you agree with the statistics? How can we improve the situation? I am eager to hear from you.
1. Inadequate Human Resource
The major problem affecting healthcare delivery in Africa is inadequate human resource, the World Health Organization (WHO) reports that only 44 percent of its African member countries have a ration of less than one doctor per 1000 population compared to 10 in Europe, or 24 in the US [1]. Savanna Public Health Consulting is working in countries that, are some of the most affected areas and the factors are more complex, for instance, in Malawi the doctor patient ratio is 0.02 per 1000 population [2], Ethiopia 0.2 doctors per 1000 population, Burundi 0.1 doctor per 1000 inhabitants, Mozambique 0.1 doctors per 1000, Namibia 0.4 doctors per 1000, Uganda 0.12 doctors per 1000 people, while South Africa 4.3 doctors per 1000 inhabitants, and Egypt at 2.8 doctors per 1000 population are two the handful countries with better ratios [1].
The blame for the shortage of human resources has always been on the “brain drain”- an endless trend that’s taking Africa’s vital human resource of medical doctors and nurses to other parts of the world seeking better pay and working conditions. Duvivier and colleagues examined physician emigration from Africa to the U.S between 2005 and 2015, they found increase in African physician emigration to the U.S from 10684 in 2005 to 1384 in 2015, representing a 27% increase in 10 years [3] the results from this study indicate that African educated medical doctors make up at least 24% of all internationally trained U.S workforce with most doctors emigrating from Sudan (419), Ethiopia (666), Ghana (746), Sub-Saharan Africa (941), South Africa (1,709), Nigeria (3,669), Egypt (4,791) [4]. The brain drain has crippling effects for countries that are already struggling in multiple sectors such as the economy and agriculture sectors. The African Renewal Magazine published an interesting paper, conducted by a Canadian team of researchers that examined the financial effects of the brain drain for some countries. They studied nine sub-Saharan African countries (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe) and estimated that these countries suffered a loss of about $2.1 billion from investments for all doctors working in destination countries up to 2010. It costs African nations between $21,000 and $59,000 to train each doctor.[1].
The brain drain will remain a significant problem for a foreseeable future because training medical doctors takes years and comes with a huge price tag, for African countries whose majority citizens live below a dollar a day the challenge to improve health needs a pragmatic approach and discipline. It is not enough to look at how many medical professionals are leaving the continent, the WHO encourages sub-Saharan countries to scale up the work force to as much as 140% to attain the required international health development targets. However, one would wonder if this is attainable for any of the African countries, as mentioned earlier of worrying trends in Malawi and Ghana where the governments could not afford to hire newly graduated medical doctors and nurses despite the critical shortage of human resource- it is a paradox.
There is hope for some countries who have taken several initiatives to balance the human resource in flow and outflow through increased training of physicians and nurses. Published data from the WHO shows that 12 countries in sub-Saharan Africa (CAR, Ivory Coast, DRC, Ethiopia, Kenya, Liberia, Madagascar, Rwanda, Sierra Leon, Uganda, Tanzania, and Zambia) have managed to increase physician training significantly to offset the numbers leaving for greener pasture elsewhere. [4]. As of now these countries are producing on average 59 doctors for every 1000 practicing physicians in their workforce per year [4]. While this seem counter intuitive, it does keep the health systems functioning by maintain a backbone of health workers in the system, does this solve the problem of brain drain, it is hard to tell, however it does buy time and provide a framework to build on. Imagine if the efforts are doubled and other incentives added, there is a real possibility for success.
1. Kingsley Ighobor. Diagnosing Africa’s medical brain drain Higher wages and modern facilities are magnets for Africa’s health workers. Africa Renewal: December 2016 – March 2017. https://www.un.org/africarenewal/magazine/december-2016-march-2017/diagnosing-africa%E2%80%99s-medical-brain-drain. Accessed January, 2020.
2. Mundi Index. Malawi Physicians Density 2016. https://www.indexmundi.com/malawi/physicians_density.html. Accessed January, 2020.
3. Duvivier, R.J., Burch, V.C. & Boulet, J.R. A comparison of physician emigration from Africa to the United States of America between 2005 and 2015. Hum Resour Health 15, 41 (2017) doi:10.1186/s12960-017-0217-0.
4. Kinfu et al. The health worker shortage in Africa: are enough physicians and nurses being trained? Bulletin of the World Health Organization 2009; 87:225-230. doi: 10.2471/BLT.08.051599.