How does one simply “glance” at West Africa? With 19 countries, over 300 million people, and more than 500 languages, countless cultures and histories, the region is one of the most diverse and complex on the continent. Despite these differences many of the health challenges faced by people in the region are the same, such as high fertility rates (above 6.5 in Niger and Sierra Leone), high maternal mortality, and continuing challenges with diarrheal and respiratory disease leading to unnecessary deaths in children under 5.
Decades of efforts in the region to combat malaria, tuberculosis, and HIV/AIDS were reinvigorated by the massive public health response to the 2014 Ebola outbreak. Over 11,000 people have died in the Ebola epidemic, and the disease continues to affect Guinea and Sierra Leone. Much of what was discussed following the world’s push for solutions to Ebola highlighted major obstacles to providing care in West African health systems. Despite the challenges that remain, the CHMI database has identified a number of successful health interventions with market-based approaches.
Within the 129 programs which we currently profile in West Africa (half of which are in Nigeria, and are featured in Database at a Glance: Nigeria), many are beginning to find footholds among governments focused on extracting lessons learned from the private sector. Some of the most common approaches of programs in West Africa include franchising, the use of information-communication technology (ICT), and provider training to strengthen systems. The majority of programs surveyed for this analysis are private, not-for-profit models. Many rely upon donor funding, and are past the pilot phase of operations. Over 50% of these programs serve the general population, while over one third operate primary care services. Nigeria and Ghana receive the most attention from funders and networks looking to source innovations, while Benin and Mali have expanded efforts in technology and private sector improvements to health in recent years.
Social Franchises and Health Networks
Programs organizing delivery as semi-independent providers through social franchises (14) and health service networks (14) are well-documented in West Africa, where they are also well-studied and funded by external organizations. According to the UCSF Global Health Group’s 2014 Social Franchising Compendium, franchising can provide access to health commodities, clinical and business management, and quality standards that are not always available from government oversight.
HealthKeepers, a well-known program in Ghana that operates as a for-profit social franchise, is often referred to as the “Avon Ladies” of West Africa. Since CHMI first visited HealthKeepers in 2010, the organization has gone on to scale its operations by securing funding from partners including USAID and Grand Challenges, and documented 3,580 disability-adjusted life years diverted in 2012.
The ProFam networks in Benin, Mali, and Cameroon, supported by PSI, and the BlueStar networks in Ghana, Senegal, Nigeria, and Sierra Leone which are supported by MSI act as health service networks, which contract private providers throughout the country to represent the organization, and franchise clinics. These programs have the benefit of support from the international donor community and larger parent organizations. They often employ motivated community members and youth to lead health education talks and advertise services and products. The franchised clinics are well respected in their regions, and the high rural distribution of franchised outlets seen in many of these networks ensures that products reach both rural and urban populations.
Innovations in Technology in West Africa
Advances in technology have allowed West African populations to “leapfrog”  many historic challenges faced by remote rural populations, such as language barriers and lack of access to health knowledge. The West African context is one where the emerging policy framework that encourages innovations, an agility to adapt to new trends, and flexibility in designing programs that accurately suit different contexts and cultures.
In Mali and Burkina Faso, Djantoli uses mobile phones to link community health agents to experts who monitor the health of the mother and child remotely from a central hub. Djantoli has managed to treat and prevent disease among more than 3,500 children since 2010 with the help of mobile technology. Djantoli (formerly Pesinet) is cited in the World Economic Forum’s report on leapfrogging as an example of a technology-enabled systems approach to health in an emerging economy where the supply chains of personnel and medicines slow to a trickle by the time they reach rural areas.
VaxTrac, in Benin, uses biometric records to ensure greater and more efficient control of national vaccine campaigns. Millions of dollars of vaccines are wasted every year by the simple lack of records available for young children, and every extra dose given accidently to a child is a vaccine dose not received by the next child. Vaxtrac records patient fingerprints and basic information through an internal system, allowing them to track which children have received vaccines and when. With additional support from international funding organizations, VaxTrac is now bringing the lessons they have learned serving the remote populations in West Africa to Nepal.
Health Systems Strengthening through Provider Training
Even before the Ebola crisis Last Mile Health worked in the most remote regions of Liberia, reaching populations underserved by government-run health facilities. The program recruits and trains community frontline health workers and provides the equipment, support and incentives necessary for these FHWs to serve as professional health providers in their communities. When the Ebola outbreak threatened to destroy the progress that Liberia had made, Last Mile Health’s connections to remote communities and supply routes used to equip FHW’s allowed the organization to rapidly respond to the disease.
On a broader scale, Clinics4All works in Burkina Faso, Cote D’Ivoire, the Gambia, Ghana, Guinea, Guinea-Bissau, Mali, Nigeria, Senegal, and Sierra Leone to train health workers to install shipping container-based clinics in regions of need. Beyond providing this innovative product to a wide array of countries, the program trains community health workers to serve as outreach to nearby communities and task shift disease management and laboratory services that bridge CHWs to overburdened doctors and nurses.
The Need for Greater Documentation
CHMI has long operated through a network of in country regional partners, including Solina Health in Nigeria. As we continue to expand our database of health innovations, we rely on our network of program managers, researchers, donors, and social entrepreneurs to identify new innovations across the region. Know of an innovative program operating in West Africa that we missed? Register your username on CHMI and create a program profile today!
CHMI is also actively seeking programs for its work with the UBS Optimus Foundation, which is currently identifying, studying, and supporting the diffusion of innovations that deliver health, education, and violence prevention interventions to children in Cote D’Ivoire, Ghana, Liberia, and Sierra Leone. Please let us know of any relevant programs doing innovative things with health, education, and/or prevention of violence against children in these countries.
 Health Systems Leapfrogging in Emerging Economies: Project Paper, World Economic Forum, January 2014
Photo Credit: ©VaxTrac