New ‘Africa Sustainability Index’ measures health systems for 18 African countries

A healthcare worker receives her COVID-19 vaccine jab as part of Rwanda's vaccination drive. /Photo courtesy: Ministry of Health - Rwanda.

The FutureProofing Healthcare initiative, an initiative designed to enable data-driven dialogue about the future of healthcare, launched the Africa Sustainability
Index at the 2021 Africa Health Agenda International Conference (AHAIC) on Tuesday.

Led by a panel of 10 independent African healthcare experts, the first-of-its-kind, data-driven policy tool measures the current status of health systems in 18 countries across Africa and provides valuable context as countries across the continent determine how to accelerate universal health coverage (UHC) goals and progress on the United Nations Sustainable Development Goals (SDGs) in the face of the COVID-19 pandemic.

A medic examines a patient on the Phelophepa Health train in Springs, Johannesburg, South Africa, on Sept. 10, 2020. /Xinhua/Yeshiel)

The FutureProofing Healthcare Africa Sustainability Index presents an objective view of how
health systems are currently performing and are intended to inform policies that promote
sustainability and resiliency for the future.

Through publicly available data, the Index examined 76 different measures split across six categories called Vital Signs. These Vital Signs – Access, Financing, Innovation, Quality, Health Status, and Wider Factors of Health – provide a holistic view of the fundamental drivers of sustainable healthcare systems.

The Index also compares approaches between countries, identifies elements that lead to more sustainable care, and promotes best practices through a future-focused analysis of real-world solutions. Organizations including Amref, the World Bank, United Nations Development Programme /(UNDP), the African Society for Laboratory Medicine, and Africa Centres for Disease Control and Prevention collaborated to develop the FutureProofing Healthcare Africa Sustainability Index.

“Sustainable healthcare is a key element on the journey towards UHC and will impact millions of lives in Africa,” said Githinji Gitahi, CEO of Amref and Africa Sustainability Index panelist. “The Sustainability Index is a useful tool in guiding stakeholders in the healthcare ecosystem on where to focus efforts, make improvements, and identify best practices from other countries.

A passionate advocate for pro-poor Universal Health Coverage, Githinji Gitahi joined Amref Health Africa as the Global Chief Executive Officer in June 2015./AMREF Africa

The findings of the Africa Sustainability Index indicate that economic strength and political
stability are key drivers behind overall performance in healthcare sustainability, with most of the countries that perform well in the Financing Vital Sign also doing well in the Index overall. These countries include South Africa, Rwanda, Algeria, and Ghana.

The Index also reveals that all countries analyzed have numerous areas of opportunity for
improvement. There are strong variations throughout the continent related to the Access and Quality Vital Signs, suggesting that targeted policies in these areas will make an impact in achieving UHC goals.

Driving disparities in Access are the number of doctors and specialized healthcare professionals per capita, as well as the level of access to preventative health services South Africa is the highest-ranking country in the Access Vital Sign, followed at some
distance by Libya, Zambia, and Tunisia.

Doctors conducting surgery at a Kenyan hospital. /Getty Images

Another area of focus for improvement is within the Innovation Vital Sign, which has the lowest mean score of the six Vital Signs. Innovation was defined by the panel as ‘advancement, access, and application of novel technology.’ South Africa is the top-performing African nation in this Vital Sign, followed at some distance by Rwanda, Ethiopia, and Tanzania.

Still, many best practices exist at the country-level, such as creating a future-looking policy and legal environments and adopting new technologies.


The Africa Sustainability Index is available on