Health Sector Reform in Sub-Saharan Africa: Challenges and Prospects

Sub-Saharan Africa (SSA) has witnessed significant health sector reform since the 1980s and in the process has introduced user-fee, experimented with various forms of health insurance, and encouraged public-private partnership towards improving health equity and accessibility with the overall aim of achieving universal coverage. Fiscal constraint, starting from the 1980s, which necessitated a partnership with the Britton Woods’ institution leading to varying structural adjustment programmes, have conspicuous effects on health care delivery in all countries of the sub region. This paper describes health reforms embarked upon by sub-Saharan countries and chronicles public health care evolution with reference to key features of actors, process, design and context. A comprehensive review of the literature and relevant documents forms the basis for analysis and discussion. The review is guided by three overarching questions: What social and economic conditions necessitated health reforms in SSA?  How well have health reforms addressed issues of health quality, accessibility, and equity? How have the reforms improved or worsened health conditions of citizens? Salient lessons to be drawn from the thirty years experience of SSA on health care delivery are highlighted and the future prospects are discussed. It is noted that efforts to meet IMF conditions, the World Health Organization’s millennium development goals, and other international health partners’ demands without the required capacity and structural machinery to match the design and execution of health reforms serve to unveil the dismal performance of health sector reform in SSA. It also brings to bold relief the need for the sub-region to take ownership of health programmes by designing health policies that are both endogenously crafted and sensitive to local conditions and contexts.