The problem in Africa

1. Excellent but costly care is available for chronic disease in cities, but this only sharpens substantial inequities in access to care, between the urban rich and the urban and rural poor. Treatment gaps for prevalent chronic diseases are unacceptably high between countries; within-country disparities are even more pronounced, with gaps in rural areas often approaching 100 per cent because health services focus almost entirely on acute curative and episodic care (Samb et al., 2010).

2. Something has to be done to develop systems of primary care that are comprehensive and that are not dwarfed by externally driven vertical programmes; and to narrow these shameful treatment gaps.

3. The WHO 2008 Report, Primary Health Care: Now More Than ever, asserts that “a system's failure requires a system's solution” and warns against over-emphasis on specialized curative care and fragmented service delivery for short-term results (World Health Organization, 2008a).

The burden of non-communicable diseases (NCDs) in rural Africa is best addressed through strengthened primary health care.

The cycle of poverty and disease must be interrupted at the level of social determinants, as well as individual diseases (Geneau et al., 2010). This requires a broader, more comprehensive approach to health, and runs counter to the existing emphasis in health systems across Africa towards specialized and facility-based care. Health concerns us all – people, patients, communities, health extension workers – as well as other sectors: education, labour and agriculture. All of these people will need to work together to implement effective, evidence-based, and locally adapted health systems solutions.