The PANAFRICAN Review
that far in terms of geographical coverage , they were well organized , the providers well trained , and , just as important , held to account . Indeed , those who were familiar with how colonial-era bureaucracies worked have stated that public servants at the time were “ masters in taking responsibility .” That can hardly be said today about most public servants in Africa generally . Unfortunately , so many decades after Africans were promised that independence would bring nothing but happiness , health , good education , and prosperity , there is little to show for it .
In the health sector , more doctors , nurses and other specialists have been trained since independence . More financial resources have gone into the sector as well . The health sector has continued to witness the construction of large numbers of health facilities , mainly lower-level dispensaries and clinics , but not as many tertiary facilities such as referral hospitals . Nonetheless , while in terms of geographical coverage , the situation has slightly improved , the quality of delivery in many cases has deteriorated considerably when one takes a look at the state of health services across Africa , especially in rural contexts . Local-level qualitative research across the continent has established some common factors responsible for poor delivery , which are detailed below .
Limited Physical Access To Health Facilities
In some countries , health facilities are located at a considerable distance from where people live , so that they have to walk for kilometres to get there . This has several implications . One is that people who are otherwise busy with day-to-day activities such as clearing land , ploughing , sowing , harvesting , childcare and others , are unlikely to seek healthcare except in extreme circumstances when whatever affliction they have has become unbearable . This includes pregnant women who miss out on antenatal care , most of whom opt to deliver their babies at home under the watch of friends , mothers ( -in-law ) and traditional birth attendants , and who choose self-medication for themselves and their children over trekking kilometres to go to health facilities . Here lies the most important explanation for why pregnant women still die in childbirth back in their villages or while on the way to health facilities after assisted delivery at home has failed because of complications . Here lies an important explanation for why young children still die of preventable and curable ailments such as diarrhoea and why by the time people report to health facilities for check-ups and treatment , it is usually too late to do anything about their ailments in terms of treatment or cure .
Psychological Inaccessibility
A key issue about access to healthcare is psychological access . Across rural communities in Africa , there are persistent beliefs about some illnesses and what causes them . Witchcraft is believed to be one of the main causes of poor health . Other causes include ancestors who may be angry about one transgression or another . And these factors could be deemed responsible for infertility in women , impotence in men , and various forms of bodily pains and physical ailments . For many years , for example , symptoms associated with HIV / AIDS were associated with these causes . Depending on the local belief system , reactions to some illnesses may entail seeking the services of local herbalists and sometimes even fortune tellers . Here is another reason while otherwise treatable illnesses become fatal , killing millions of people who won ’ t seek modern services at all , or until it is too late .
Shortage Of Healthcare Professionals
There are instances where physical access is easy because health facilities are located within easy reach and where psychological access is not compromised by what some call “ traditional beliefs ”. Here the challenge may be that there are no qualified health workers such as nurses and doctors , or that those who are available are few , overworked , underpaid , or rarely paid because their salaries are subject to delay , sometimes for months . Lack of healthcare professionals usually leads to users of health services having to wait for hours on end before they are attended to , because of the sheer number of people seeking care . And by the time one gets to see the health workers , who are usually demoralized and stressed , the interaction may be unpleasant . Overworked health workers are prone to suffering high levels of stress . If they are underpaid or if their salaries are not paid on time , then that makes matters worse . If service users report cases of health workers being rude ,
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