Health Policy

© 2025 by

Adebowale Awosika-Olumo

All rights reserved.

Nopart of this bookmay be reproduced, storedina retrieval system, or transmittedinany form orby any means, electronic,mechanical, photocopying, recording,orotherwise,without the priorwritten permission of the author.

Table of Contents

Foreword

Acknowledgments

Chapter 1: The Need for Change

Chapter 2: Global and Macro-Budgeting for Healthcare

Chapter 3: Micro-Budget Allocation and Public Health

Chapter 4: The Importance of Public Health and Preventive Care

Chapter 5: Clinical Care and Universal Health Insurance

Chapter 6: The Role of Free Market and Government in Healthcare Funding

Chapter 7: Healthcare Delivery and Priority Setting

Chapter 8: Healthcare Financing and Nutrition Policy in sub-Saharan Africa

Chapter 9: Healthcare Financing and Disease Surveillance in sub-Saharan Africa

Chapter 10: Healthcare Financing and Preventative Dental Care in sub-Saharan Africa

Chapter 11: Healthcare financing and participation in clinical trials in Sub-Saharan Africa (SSA) Sayo Awosika-Olumo MD., MPH., PhD and Debo Awosika-Olumo MD., MS., MPH, PhD., FACE

Chapter 12: Healthcare Financing and Educational and Agricultural Policies Interconnections in Sub-Saharan Africa

Chapter 13: Healthcare Financing and Health Management Organization in sub-Saharan Africa

Chapter 14: Ethical and Efficient Healthcare Delivery

Foreword

In an era of unprecedented global health challenges, the urgency for transformative and forward-thinking health policies has never been greater. Across Sub-Saharan Africa, healthcare systems are at a crossroads, facing complex issues that demand innovative solutions, bold leadership, and a radical reimagining of how healthcare is delivered and sustained. Within this landscape, Revolutionizing Wellness: Navigating the Future of Health Policy for Radical Change emerges as an essential and timely contribution.

This book, authored by my dear brother, Dr Adebowale Awosika-Olumo—known affectionately as Cousin Debo—is more than just an academic analysis; it is a deeply personal and passionately crafted blueprint for change. Dr Awosika-Olumo has always been a visionary. His curiosity and dedication to making a difference were evident when I met him. I vividly recall our conversations about healthcare—his aspirations, frustrations, and unwavering commitment to improving health systems for those who need them most. His drive was not just about theoretical policy shifts but about real, actionable change that could transform lives. This book is a testament to that commitment.

Despite considerable progress, healthcare systems in Sub-Saharan Africa continue to grapple with significant obstacles—persistent health disparities, economic constraints, limited infrastructure, and systemic inefficiencies. These challenges are not just policy dilemmas but ethical imperatives that demand urgent and courageous action. Incremental adjustments will not suffice. A radical overhaul of how healthcare is structured, financed, and delivered is essential to building a future where quality healthcare is not a privilege but a fundamental right.

This book provides a compelling and thought-provoking roadmap to achieving that vision. It delves into crucial policy instruments, including global budgeting, universal access to care, and micro-budget allocation—all foundational elements in creating a sustainable, efficient, and equitable healthcare system. Dr Awosika-Olumo masterfully articulates the importance of global budgeting to ensure continuous and sufficient funding, reducing financial unpredictability while fostering private-sector engagement.One of the book’s most insightful contributions is its distinction between public health preventive care and clinical care services. Governments can strategically allocate resources to strengthen disease prevention, maternal and child health programs, infrastructure development, nutrition initiatives, and ethical clinical research. The emphasis on preventive healthcare enhances population health and reduces long-term medical costs, creating a more resilient system.

Equally compelling is the book’s exploration of universal health coverage (UHC) as an indispensable tool for achieving healthcare equity. Dr Awosika-Olumo presents a well-reasoned argument for government oversight in licensing providers, maintaining quality assurance, and creating a competitive yet fair market for healthcare delivery. He highlights how UHC can eliminate financial barriers, streamline administrative costs, and ensure healthcare services reach those most in need.

Importantly, this book does not ignore the complex ethical questions accompanying healthcare reform in resource-constrained settings. How do we fairly ration healthcare when resources are limited? How can moral reasoning guide policy decisions to ensure justice and equity? How can public engagement shape a system that reflects the values and needs of the people it serves? These are critical dilemmas that demand thoughtful, inclusive, and ethically grounded solutions—questions that this book challenges policymakers and healthcare professionals to confront head-on.

Beyond policy and economics, this book is also a call to action. It challenges governments, healthcare leaders, and all stakeholders to embrace a new paradigm that is not just reactive but visionary, not just incremental but revolutionary. It urges us to harness the power of technology, innovation, and strategic planning to create a healthcare system that is both sustainable and just.

As we stand at this pivotal moment in healthcare history, the insights and strategies outlined in this book serve as a guiding light. To truly revolutionize wellness and build a future where healthcare is a universal right, the innovative approaches presented here must be embraced, refined, and, most importantly, implemented.

To all who read this book—whether you are a policymaker, a healthcare professional, an advocate, or simply someone who cares about the future of global health—I encourage you to engage deeply with its ideas. Let it challenge you. Let it inspire you. Moreover, most importantly, let it propel you toward action.

The future of healthcare in Sub-Saharan Africa—and indeed, the world—depends on all of us.

Michael Adekunle Charles

Dr. Michael Adekunle Charles is an experienced diplomat, medical doctor, and public health expert, serving as the CEO of the RBM Partnership to End Malaria — the most prominent global platform for coordinated action toward a world free from malaria. Charles has many years of experience leading the organization’s African malaria coordination, providing technical, managerial, and operational support.

Acknowledgments

This book would not have been possible without so many people's love, support, and encouragement.

First and foremost, to my incredible wife—Morounsayo Awosika-Olumo, your unwavering belief in me, patience, and constant support have been my anchors throughout this journey. To my children (Ademusoyo, Adedayo, and Oluwademiladeayo), and my darling health policy wonk niece—Derin Aladesanmi all inspire me daily with curiosity and boundless energy, thank you for reminding me why I do what I do. Your love is my greatest motivation.

To my colleagues and peers in the social media groups I belong to—your insights, discussions, and shared wisdom have been invaluable in shaping my thoughts and deepening my understanding. The sense of community and collaboration you provide is truly priceless.

To my family members, friends, mentors, and all those who have offered guidance, encouragement, or even a simple word of motivation along the way—thank you. Your belief in this project helped bring it to life.

Lastly, to my readers, this book would be just words on a page without you. Thank you for taking this journey with me.

With gratitude,

Debo Awosika-Olumo

Contributors

Dr. Morounsayo Awosika-Olumo PhD., MD., MPH

Clinical research epidemiology

Baylor College of Medicine

Houston, Texas

About the Author

Dr. Adebowale Awosika-Olumo is a visionary leader, entrepreneur, and public health consultant dedicated to advancing emerging-market healthcare and environmental solutions. As the President and CEO of GHMIGROUP INC., Dr. Awosika-Olumo has spearheaded innovative initiatives that bridge health equity gaps and promote sustainable development.

In addition to corporate leadership, Dr. Awosika-Olumo is a contributing faculty member at Walden University and a professor of global health at the University of Maryland Global Campus. His academic work focuses on global health challenges, public health epidemiology, health outcomes and equity, sustainability, and the integration of artificial intelligence in healthcare.

A Fellow of the American College of Epidemiology, Dr. Awosika-Olumo has made significant contributions to the field of public health, influencing policies, improving healthcare accessibility, and fostering collaborations across industries. His expertise spans epidemiology, health equity, and the application of emerging technologies to address pressing health challenges worldwide.

Beyond professional and academic endeavors, Dr. Awosika-Olumo actively engages with professional networks and social media communities, contributing to thought leadership and discussions that drive meaningful change. His passion for transformative solutions and commitment to health equity are at the heart of this book, offering readers valuable insights into building a more inclusive and sustainable future.

Dr. Awosika-Olumo lives with his wife and with the support of his children, whose unwavering support fuels their mission to create a lasting impact in the world.

Chapter 1: The Need for Change

Navigating the Future of Health Policy for Radical Change in Sub-Saharan Africa

This illustration depicts the future of health policy in sub-Saharan Africa, focused on radical change. The image features a diverse group of African healthcare professionals and policymakers gathered around a futuristic digital map of Africa, showcasing health innovations such as telemedicine and mobile clinics. The background blends a modern city skyline with traditional African landscapes, symbolizing the integration of technology and culture.

Vignette: The Crossroads of Transformation

Dr. Amina Kwesi stood before a diverse group of stakeholders in the bustling capital of Zandoria, a fictional sub-Saharan African nation. As the newly appointed Minister of Health, she faced the daunting task of overhauling a healthcare system plagued by chronic underfunding, widespread disparities, and a crippling brain drain of medical professionals.

Zandoria's health challenges were manifold: high maternal and infant mortality rates, a persistent HIV/AIDS epidemic, rising non-communicable diseases, and frequent outbreaks of infectious diseases. However, Dr. Kwesi saw an opportunity for radical change.

She envisioned a future where cutting-edge technology merged with traditional healing practices, artificial intelligence empowered community health workers, and preventive care took center stage. Implementing such sweeping reforms required navigating complex political landscapes, addressing deeply rooted cultural beliefs, and securing sustainable funding in a resource-constrained environment.

As Dr. Kwesi prepared to unveil her ambitious 10-year plan, she knew the road ahead would be fraught with challenges. Success would demand innovation and consensus among diverse stakeholders—from village elders to international donors, from traditional healers to tech entrepreneurs.

Questions:

How can Dr. Kwesi effectively integrate modern technological solutions with traditional healing practices to create a healthcare system that is both culturally acceptable and scientifically sound? What potential conflicts might arise, and how can they be mitigated?

Given Zandoria's limited resources, what strategies can Dr. Kwesi employ to prioritize and address the nation's multiple health challenges? How can she ensure that focusing on specific areas does not neglect other critical health needs?

Considering the ongoing brain drain of healthcare professionals, what innovative approaches can Dr. Kwesi implement to build and retain a skilled healthcare workforce? How might these approaches challenge conventional models of medical education and practice?

How can Dr. Kwesi design and implement a health financing system that ensures universal health coverage while remaining sustainable in Zandoria's economic context? What role might public-private partnerships, international aid, and community-based insurance schemes play in this system?

No nation is born a loser or a winner, but Nations are born a chooser.

The current state of sub-Saharan Africa's (SSA) healthcare system is dire, necessitating a drastic shift from its moribund status to ensure quality and affordable healthcare becomes a fundamental right for all citizens. Universal healthcare access is both a moral imperative and a practical necessity in addressing society's socio-economic concerns.

Sub-Saharan Africa (SSA) stands at a critical juncture in its health policy journey. Despite notable progress in improving overall health outcomes, the region continues to grapple with challenges that impede its path toward a healthier future. The need for radical change is not just warranted but essential, as persistent health disparities, economic constraints, and systemic inefficiencies demand a revolutionary approach to wellness and healthcare policy. This chapter delves into the pressing issues, innovative solutions, and actionable strategies needed to propel sub-Saharan Africa toward a transformative era in health policy.

Disproportional Disease Burden

This chapter examines the disproportionate disease burden in sub-Saharan Africa, exploring its challenges and perspectives.

Introduction

This overview of the health disparities faced by sub-Saharan Africa highlights the region's disproportionate share of the global disease burden. This introduction will set the stage for a deeper exploration of the factors contributing to this imbalance and the impact of healthcare delivery systems.

Understanding the Disease Burden in Sub-Saharan Africa

This section quantifies the region's disease burden using key statistics and recent findings. It highlights the leading causes of morbidity and mortality, including infectious diseases, malnutrition, and emerging non-communicable diseases. The goal is to provide a clear understanding of the region's health challenges and the scale of its disease burden.

Factors Contributing to the Disproportionate Disease Burden

This section will delve into the socio-economic factors contributing to sub-Saharan Africa's health disparities, such as poverty, limited access to clean water, and inadequate sanitation. It also examines the challenges posed by weak healthcare infrastructure and environmental factors affecting health. Understanding these contributing factors is crucial for addressing the disproportionate disease burden in the region.

Impact of Healthcare Delivery on Disease Burden

This section analyzes the state of healthcare systems in sub-Saharan Africa, including the role of international aid and local governance in healthcare delivery. Success stories and notable improvements in healthcare access and outcomes will be highlighted. This section aims to understand how healthcare delivery impacts the disease burden in the region and what can be learned from successful initiatives.

Strategies for Addressing the Disproportionate Disease Burden

This section outlines policy recommendations for strengthening healthcare systems, the importance of education, community health programs, and preventive measures. Additionally, it discusses the role of technology and innovation in transforming healthcare delivery in sub-Saharan Africa. Strategies for addressing the disproportionate disease burden will be examined, aiming to provide actionable solutions for policymakers and stakeholders.

Adult health in developing countries receives little attention in public health discussions. In low- and middle-income countries (LMICs), adult health (ages 20–59) is essential for the well-being of both younger and older populations and for sustainable development. Cost-effective prevention, early detection, and treatment strategies are paramount for improving adult health (Awosika-Olumo, 2003; Okoroiwu et al., 2020; Shah et al., 2019), especially given the high rate of premature deaths in LMICs.

For example, while overall cancer incidence is lower in LMICs than in high-income countries (HICs), cancer-related mortality is significantly higher, particularly among individuals aged 65 or younger (Torre, 2016; Ghoncheh, 2016). This premature mortality leads to lost productivity and exacerbates economic hardship (WHO, 2016).

Sub-Saharan Africa region is notable for having some of the highest rates of preventable neonatal and maternal mortality, as well as deaths from infectious diseases, antimicrobial-resistant infections, and malnutrition on a global scale. Despite recent economic growth leading to positive changes like rapid urbanization, increased alcohol and tobacco consumption, and a rising prevalence of non-communicable diseases (which now account for over 37% of all deaths), new challenges are emerging (Health in Africa 2024; WHO, 2022). As life expectancy increases in African populations, the number of individuals living with multiple chronic health conditions, also known as multi-morbidity, is also on the rise (Health in Africa 2024). Although this concept is still being explored, recent studies have shown significant connections in Africa between multi-morbidity and factors such as urbanization, female gender, age over 50, and higher education levels.

The impact of rising multi-morbidity on Africa's health systems is uncertain, highlighting the need for public health initiatives to adapt to this evolving landscape. Historically, health programs have primarily focused on treating individual diseases, but the current situation necessitates a shift toward diagnosing and managing patients with overlapping health conditions. This transformation is essential for effectively addressing the intricate health needs of African populations and ensuring the sustainability and flexibility of healthcare systems in the region.

Healthcare financing remains a major challenge in sub-Saharan Africa. Stenberg et al. (2017) found that among 67 low- and middle-income countries—accounting for 95% of the global population in this category—there is an annual funding shortfall of over $370 billion to achieve the Sustainable Development Goal (SDG)—ensuring healthy lives and promote well-being for all at all ages health targets. Approximately half of these low-medium-income countries are in SSA, where the gap in health financing is particularly severe (Jeetoo & Jaunky, 2023).

Despite comprising 16% of the global population and carrying 23% of the world’s disease burden, Africa received only 1% of total global health expenditure in 2015. Regarding per capita spending, the world allocates ten times more resources to healthcare than Africa (Jeetoo & Jaunky, 2023).

Current State of Health in Sub-Saharan Africa

This illustration depicts the current state of health in Sub-Saharan Africa. This image contrasts a busy urban hospital with overcrowded waiting areas against a rural clinic with limited resources, highlighting disparities in healthcare access. The background blends traditional huts with modern buildings, symbolizing the coexistence of old and new elements.

Vignette: Current State of Health in Sub-Saharan Africa

Sub-Saharan Africa faces numerous health challenges but shows signs of progress and potential for improvement. Infectious, non-communicable, and socio-economic factors shape the region's health landscape. Despite these challenges, ongoing efforts are being made to enhance healthcare systems and improve health outcomes.

Questions

What primary health challenges does sub-Saharan Africa currently face?

How has life expectancy in sub-Saharan Africa changed in recent years?

What role do socio-economic factors play in the health outcomes of sub-Saharan Africa?

What strategies are being implemented to improve health systems in sub-Saharan Africa?

How do health disparities within sub-Saharan Africa affect different populations?

Background

Stark contrasts mark sub-Saharan Africa's health landscape. Life expectancy figures and health outcomes trail significantly behind global averages, influenced by complex, interwoven factors. Poverty, limited access to healthcare, and nutritional deficiencies create a compounded crisis, exacerbating disease burden and mortality rates—particularly among the most vulnerable populations such as women and children (Jiang et al., 2024).

Despite its vast natural and human resources, the region continues to struggle with a high prevalence of infectious diseases, further aggravated by inadequate healthcare infrastructure and services. Additionally, disparities between and within countries highlight the uneven distribution of healthcare resources, making the fight against health inequities an uphill battle (Oladipo et al., 2022).

Introduction

In this present day, the sub-Saharan Africa region continues to confront many health challenges, albeit with progress evident in certain areas. This introductory segment establishes the backdrop for a thorough examination of the health landscape in sub-Saharan Africa, primarily focusing on prevalent health concerns such as infectious diseases such as HIV and malaria and emerging contagious threats, alongside the escalating burden posed by non-communicable diseases.

By gaining an insight into the present health status, we can unravel the intricate web of factors contributing to the region's health challenges and deliberatively explore potential pathways toward enhanced health outcomes.

The health panorama of sub-Saharan Africa in 2023 depicts a blend of advancements and persistent hurdles. Noteworthy achievements have been observed, specifically in the realm of combating HIV, with Eastern and Southern Africa registering a remarkable 57% decline in new infections (Fuseini et al., 2021; Müllerschön et al., 2019; Okoye et al., 2021). Despite these triumphs, the region remains embroiled in challenges revolving around infectious diseases, malnutrition, and the burgeoning threat posed by non-communicable diseases (NCDs) (Fuseini et al., 2021; Scott & Webb, 2014). Delving into the pivotal health benchmarks and metrics that delineate the current health status of sub-Saharan Africa will shed light on the health dynamics prevalent in the region and lay a solid foundation for comprehending the encompassing health challenges it faces.

Major Health Issues Confronting the Region

The health landscape of sub-Saharan Africa is fundamentally characterized by its ongoing struggle against infectious diseases, exacerbated by the emergence of novel pathogens and the surge in non-communicable diseases (NCDs) (Amu et al., 2024; Arhin & Asante-Darko, 2023; Hollingworth et al., 2023).

Infectious diseases have long stood as the primary adversary of the region, with HIV/AIDS, malaria, and diarrheal diseases leading the forefront in terms of morbidity and mortality rates (Oladipo et al., 2022). Recent years have witnessed the emergence of ailments such as Ebola, cholera, meningitis, and the global menace of COVID-19, adding layers of complexity to the region's health crisis(Moyo et al., 2023).

Concurrently, the looming threat of NCDs is on the upswing, with a growing portion of deaths attributed to ailments unrelated to infections (Health in Africa, 2024). Malnutrition, intricately interlinked with poverty, remains a pervasive issue, exerting a significant influence on the health outcomes of millions (Azevedo, 2017; Health in Africa, 2024; Moyo et al., 2023).

This segment seeks to unravel the intricate fabric of the significant health issues in sub-Saharan Africa, underscoring the critical imperative for multidimensional approaches to healthcare and disease prevention.

Challenges Facing the Health Care System

The healthcare landscape in Africa faces several challenges, notably issues with financial accessibility. Out-of-pocket spending comprises 36% of healthcare expenses, leading to a $66 billion annual financial gap. From 2000 to 2015, African governments allocated an average of 7.2% of their budgets to healthcare, though funding distribution varies among countries. Nigeria, Congo, Egypt, and South Africa have differing healthcare funding approaches. Nigeria heavily relies on out-of-pocket payments (77%), with minimal government funding (14%). Congo and Egypt also depend significantly on out-of-pocket expenses (48% and 60%, respectively). Nigeria and Congo receive limited external funding (8%) for healthcare. In contrast, South Africa allocates 54% of healthcare spending from government sources, reducing out-of-pocket payments to just 8%. The issue of high out-of-pocket healthcare spending is particularly prominent in Nigeria, Congo, and Egypt, while South Africa has a more balanced funding model with lower reliance on out-of-pocket expenses (Erlangga et al., 2023; Frimpong et al., 2022; Utan, 2021).

Three core challenges encapsulate the healthcare dilemma in sub-Saharan Africa: inadequate human resources, insufficient budget allocations, and poor leadership and management (Achoki, 2016; Blaise & Yongsi, 2023; Cassell, 2019; Larson, 2018; Oleribe et al., 2019; Zekeng, 2016). The shortage of skilled healthcare professionals exacerbates the inability to meet the healthcare needs of a rapidly growing population, while meager health budgets limit the scope and quality of services. Leadership gaps further erode the efficacy of healthcare delivery, impeding the implementation of comprehensive health policies and reforms (Oleribe et al., 2019). Addressing these fundamental issues is pivotal to reshaping the health landscape in sub-Saharan Africa, fostering environments where innovations can thrive and lead to substantial health improvements.

The healthcare systems in sub-Saharan Africa face numerous challenges that hinder the delivery of modern care and ultimately undermine the population's well-being. Unequal access to quality healthcare, as highlighted by Blaise (2023), is a prominent issue plaguing the region. This inequality stems from various factors, such as disparities in wealth, geography, and education, leaving certain communities and individuals without proper