Africa Health

Africa can and must do more to support nurses and midwives

Nurses and midwives are the backbone of health systems globally. Of the world’s 43.5 million healthcare professionals, more than 20 million are nurses and midwives. They play a critical role, particularly in sub-Saharan Africa, as quite often they are the first and only healthcare professionals people will see.


Pauline Bakibinga,

African Population and Health Research Center

Because nurses and midwives respond to the needs of people in all settings, they are critical to the achievement of global health goals. The World Health Organisation (WHO) recognises the vital role they play in promoting universal health coverage and sustainable development.

The WHO says the world needs 9 million more nurses and midwives to reach the global Sustainable Development Goal on health by 2030. It recommends a ratio of 83 nurses per 10,000 people. But – even with variations noted across the region – most countries in sub-Saharan Africa have fewer than 20 nurses for 10,000 people. The region is home to 1.07 billion people, about 15% of the global population. But it carries 24% of the global burden of disease and has only 3% of the world’s health workforce.

One of the reasons the small health workforce is a problem is that nurses and midwives can make a significant impact in managing and preventing the leading causes of death in the region. These are infectious diseases, conditions affecting newborn babies and mothers, and nutritional conditions. Nurses provide primary and community care, and participate in disease prevention and health promotion programmes.

Adequate numbers of healthy and motivated health professionals are also critical to governments’ effective responses to public health emergencies such as COVID-19.

Addressing the shortage

The goal of good health and well-being for all the world’s people by 2030 is feasible, but it might not be attained. It won’t be easy to address the shortage of healthcare professionals, especially in regions like sub-Saharan Africa.

It will take greater efforts to make nursing an attractive career, starting with appropriate training, then working conditions and pay, and retention of staff where they are most needed.

Nursing, like other caring professions, is highly demanding; even more so in developing countries, where demands on staff are often greater than the support offered.

This support should start with equipping people properly for the job. The Global Health Workforce Alliance and the Lancet Commission highlight a mismatch between current healthcare challenges and professional education. For instance, the population structure in the region is changing, with more people living longer, but training in the health aspects of ageing is not common in Africa.

Know Africa Health

Professional training in sub-Saharan Africa is largely limited to a technical focus on clinical care with little attention to health promotion and disease prevention at the community level. A focus on medical care limits the understanding of the broader context that affects people’s health. This is particularly important for vulnerable populations whose health and well-being are closely related to factors such as environment, housing, income level and education. Healthcare professionals, especially nurses and midwives, need to understand these social determinants of health so as to provide more holistic, comprehensive care.

In the past few years countries have instituted reforms to nursing and midwifery education, shifting from content-driven curricula to competence-based programmes that are responsive to the primary healthcare needs. Digital technologies have been successfully used to support the learning of healthcare professionals globally and progressively in sub-Saharan Africa.

But many challenges remain. These include inadequate preparation of mentors and educators, lack of resources to implement the changes and limited involvement of key stakeholders. In sum, these limit the number of appropriately trained nurses.

Another way that nurses and midwives could be supported is by giving greater value to their work. This might encourage greater numbers of people to join the profession. The health workforce in sub-Saharan Africa suffers from persistent gender stratification of professional status – women dominate at the level of service delivery while men dominate decision-making. Remuneration is low and working conditions are often poor.

The conditions vary across the region, so the shortage is felt more acutely in some areas than in others. Most nurses and midwives prefer to live and work in urban areas, for better opportunities, but 60% of the population resides in rural areas. In urban areas, though a majority of the population resides in informal settlements, trained health professionals prefer to work in the more developed areas. As a result, people living in urban informal settlements have poorer health than people in rural areas and other urban areas.

What’s needed

Support for nurses and midwives could start with curriculum reforms that equip them better for the work they will do.

Innovative teaching strategies are also needed, responding to the career stages of the different healthcare professionals and accommodating those in training and in practice. Technology could allow them to benefit from mentors and educators who are physically distant while giving them flexibility to create learning goals in their preferred locations. For instance nurses in East Africa have benefited from mobile and e-learning platforms developed by different digital health service providers.

There is also potential for greater collaboration between regions and countries, and between public and private sectors, to share best practices.

Health care managers need to make work environments conducive to doing the job better. They should ensure that all nurses and midwives have the resources they need, such as working equipment, protective gear and social support from colleagues and significant others. Occupational health and safety measures through adequate infection prevention and control are paramount.

With strong leadership and political commitment, matched with more domestic funding for the health sector, it’s possible to build a stronger workforce and achieve the 2030 goals on health.The Conversation

Pauline Bakibinga, Associate Research Scientist, African Population and Health Research Center

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cities In Africa Lagos

Lagos chequered history: how it came to be the megacity it is today

Ndubisi Onwuanyi, University of Benin. Lagos was an orderly urban environment 70 years ago. This was the case from the 1950s, when the city was a federal territory through to the 1960s when it became federal capital – a status it held until 1991.

The foundations of orderliness for any city are planning and management. Lagos had this in place in the early days. The city was governed by an elected Lagos City Council, Nigeria’s oldest, established in 1900. It was governed according to colonial legislation, particularly the 1948 Building Line regulations and the 1957 Public Health Law.

The city was much smaller and was made up of Lagos Island (Eko) which included Ikoyi and Obalende neighbourhoods. It was a beautiful environment that featured Portuguese, Brazilian, and British Victorian architecture. Its streets were clean and tree-lined. Urban crime was virtually non-existent.

Governance standards declined when political control of Lagos, and the rest of Nigeria, came under military rule between 1966 and 1979 and again from 1984 to 1999. Proximity of the two capitals – federal and state, respectively – in the Ikoyi and Ikeja neighbourhoods of the same conurbation, put more pressure on the city. In the 1970s the city expanded to link up previously distinct areas such as Ikeja, Mushin, Orile, Ojo, Oshodi and Agege.

The result was increased pollution, congestion and wear on infrastructure. This was particularly true between 1970 and 1991.

But things have changed. Efforts have been made to revitalise the city in terms of a cleaner and greener environment, improved road and water infrastructure, urban bus system and waste management, overhaul of security and consultation with citizens through town hall meetings.

Nevertheless, big challenges remain. The city still has far too many slums and squatter settlements, it lacks a functioning public transportation system, proper traffic management, efficient waste disposal, sanitation, adequate potable water supply and routine road maintenance.

Lagos also suffers because of problems that afflict the country. There isn’t regular electricity supply, and there are high rates of poverty and unemployment. And, as elsewhere in the country, many residents don’t comply with laws on building, traffic and sanitation.

The history

Lagos was affected positively as well as negatively by Nigeria’s 1970s emergence as a major crude oil producer.

On the upside, there was investment in infrastructure. This included the building of the second bridge linking the Island, the Eko Bridge, and re-building of the first (colonial) Carter Bridge. The third and longest bridge was commissioned in 1990.

These bridges were aimed at improving accessibility between the two islands (Victoria and Lagos) and the mainland. But, uncontrolled commercial development on the islands has produced persistent traffic bottlenecks. This has been worsened by the lack of a public transport system.

Two developments added to pressures on the city. Its population burgeoned while infrastructure lagged behind. This period marked the beginning of the decline of planning for the city. The worst periods were the late 1980s and the 1990s. As architects Rem Koolhaas and Kunle Adeyemi noted in an interview, these were Lagos’ darkest times:

Lagos, in the 1990s, was the ultimate dysfunctional city and an example of what happens to a society where the state is absent. At that point the state had really withdrawn from Lagos; the city was left to its own devices, both in terms of money and services.

The city was being governed by the military. But it was not cut out for governance, had no accountability and couldn’t care less about planning and environmental issues. As a result it routinely disregarded existing regulations.

In the 1990s, for instance, the largest public park in Lagos – the old, colonial 10-hectare Victoria Park in Ikoyi – was sold as residential development land. The waterfront of the Lagos Cowrie Creek in Victoria Island was also sold for commercial development, effectively blocking direct public access to the waters and a picturesque view of Ikoyi.

The collapse of zoning all over Lagos also led to residential neighbourhoods such as Victoria Island and southwest Ikoyi being converted for commercial use. The military had no reasoned response to Lagos’ urban challenges. Instead, it took the decision in 1975 to establish a new capital in Abuja.

This move, which finally came to fruition in December 1991, left Lagos forlorn.

The positives

Positive changes have taken place.

For example, over the past 15 years the authorities succeeded in raising more taxes using money to restore basic infrastructure, expand public services and strengthen law enforcement.

Research shows that the commitment to reform the city was driven by electoral pressures as well as elite ambitions to construct an orderly megacity. The return to democracy helped to make these changes possible by enabling an elected government to work in the people’s interest.

Improvements includes public transport and the reclamation and greening of previously disused and misused spaces below Lagos’s many flyovers, bridges and interchanges. In addition, roads have been fixed and pavements built. In some parts of the city there is potable water supply and blighted residential and commercial areas have been rebuilt.

But, given decades of neglect, a great deal still needs to be done.

What’s broken

One of the biggest problems is the lack of coherent and integrated development .

Another major issue is flooding which Bongo Adi, a Lagos based environmental expert argues, hasn’t been decisively tackled.

Nor have improvements over the past decade impressed everyone. As Femi Akintunde argues, Lagos remains deplorable, rowdy, unsanitary, and a city of the urban poor. Akintunde is the managing editor and CEO of Financial Nigeria International Limited.

Lagos still ranks low on liveability. Its governance deficits are acutely felt by the poor, but also touch wealthier residents.

For these issues to be fixed, the standard of governance has to improve.

Who should run the city?

There are two potential authorities: Lagos state, sitting at the top, and the municipal authorities which interact with the grassroots.

The problem is that Lagos city isn’t really run by the city authorities. But effective urban governance should be “bottom-up”, making it possible for the people to take increasingly greater control over their lives.

In addition, being run from the top means that local capacity is being stunted. This has implications for sustainable change. As international fellow at International Institute for Environment and Development Jorgelina Hardoy says,

sustainable development in cities largely depends on the actions and capacity of local governments.

Whoever takes charge should recognise the necessity of getting residents’ buy-in before implementing modernisation policies. The city can’t develop by leaving its people behind.

Also, city planners should not plan for only the rich to the exclusion of the poor and disadvantaged. While accepting that slums and informal settlements have to be tackled, my research recommends a policy rethink that should involve

The Conversation

enabling strategies which fully address the rights of people who are illegally settled on public land.

Ndubisi Onwuanyi, Lecturer, University of Benin

This article is republished from The Conversation under a Creative Commons license. Read the original article.

War and Conflict in Africa

Mali’s volatile mix of communal rivalries and a weak state is fuelling jihadism

The Mali National men’s team will be battling other twenty three nations for the Africa Cup of Nations 2019 honors. Back home, a more deadly conflict rages on. The following article on a new book on the ages old conflict sheds new light on the central Malian situation as it is today.

File 20190328 139364 v685n0.jpg?ixlib=rb 1.1
A weak Malian state prompted local ethnic communities to organise armed self-defence groups. Flickr

Stig Jarle Hansen, Norwegian University of Life Sciences

Mali’s Mopti region has seen a drastic rise of violence since 2015. Last year at least 202 civilians were killed in 42 incidents. In March this year more than 150 were killed in attacks against two villages in this central Malian region.

The attack on the Mopti region was launched by alleged Dogon hunters. The Dogon are one of the largest ethnic groups in the region.

Most of those killed in Mopti were from the Fulani ethnic group. Also among the targets were staff involved in demobilisation, disarmament and reintegration of local “self-defence groups” stationed in one of the villages.

The killings highlight the age-old conflict between the nomadic and predominantly Muslim Fulani and the generally polytheistic and sedentary Dogon and Bambara ethnic groups, in this region. The conflict has an element of the classical pastoral-sedentary conflict and an element of religious friction built into it.

Contributory factors

Yet, there are other factors contributing to what is an increasing tension between the ethnic groups. Pastoral-sedentary conflicts are not new. A weak Malian state prompted local ethnic communities to organise armed self-defence groups that also at times acted offensively. In a situation of mutual distrust, fear could easily lead to violence and aggressive action.

Other factors have fuelled tension and violence. Human geographer Tor Arve Benjaminsen and others suggest that agricultural expansion has limited pastoralist mobility and access to some of the Fulani’s traditional pastures. For example, rice cultivation has encroached on traditional Burgu pastures (semi-aquatic tropical grass used for food). Additionally, new dams on the Niger River have changed the flood pattern leading to the decline of the Burgu pastures.

Land disputes within communities are also fuelling conflict. This can be seen in the light of the weakening of traditional mediation structures that is less and less successful in ending such conflicts. And the influx of small arms from the 1990s and onwards has made land conflicts more deadly, leading to a cycle of retribution between ethnic groups.

Read more: On the brink: why 2019 may be another bad year for beleaguered Mali

To make matters worse, the central government is either unwilling or unable to punish communal violence. The central Malian government previously used local militias as agents when unable or unwilling to provide local security. This has contributed to local insecurity and led to distrust between locals and the government. In this setting local militias are easily tempted to bring in new allies – including jihadists.

Government delegation of power to local militias, combined with communities in need of allies in local conflicts and the absence of local security, present opportunities for jihadists to enter a new area and gain success, finances and recruits.

The setting also creates difficulties for international actors trying to stem their influence. The West, for instance, almost never engages in local reconciliation and rural security. It focuses mostly on the destruction of jihadist affiliated militias.

As I argue in my new book, dynamics like these are similar to those in other areas in Africa that have provided fertile breeding grounds for jihadists in the past.

Mopti region in central Mali. Source:

The Fulani and jihadists

The Fulani started joining the jihadists when they gained control of the north of Mali in 2012 and 2013. For example, nomadic Fulani from the Douentza region joined Movement for Oneness and Jihad in West Africa training camps in Gao. Others joined Ansar Dine. But many returned to Mopti from Northern Mali when the jihadists lost territorial control.

Today, the Dogon and Bambara routinely accuse the Fulani of allying with the Makina Liberation Front, also known as the Katiba Macina, which forms part of the wider al Qaeda affiliated Jama’at Nusrat al-Islam wa-l-Muslimin.

Read more: What’s behind Mali livestock herders joining jihadist groups

On the other hand, Fulanis claim they are stereotyped by their enemies as jihadists. But it’s important to note that the Macina Liberation Front, led by the charismatic Amadu Koufa, routinely uses pro-Fulani rhetoric. Koufa also refers to a Fulani golden age, and a reestablishment of the historic Macina caliphate. He also recently reemerged in a jihadist video mocking France and Mali for claiming he was dead.

Further north, outside Mopti in the Menaka region, the Islamic State in greater Sahara has also injected itself in local conflicts supporting Fulani sub-tribes. Islamic State forces in Menaka, engage in cattle rustling and cattle “protection” for locals. Further south this element is also there in Ibrahim Dicko, the leader of the Burkina Faso-based Ansarul Islam. He similarly plays on the Fulani’s grievances against the central government.

This picture is further complicated by conflicts among the Fulani and by the Islamic State at times choosing allies who are rivals of the Fulani.

Downward spiral

For the locals in Mopti, the jihadists are very real. Not all of them are from Macina and some sign their attacks in the name of other jihadist partners. Many attacks have no groups taking responsibility for them.

The labels are fluid and the borders between jihadism and self-defence are blurred. Ethnic groups often provide recruits to many different armed groups. These groups actively undermine the state’s already weak justice system, and the increased insecurity hinders both business, general travel and farming.

This contributes to the downward spiral by increasing the impact of the root causes of Mopti’s problems.

Stig Jarle Hansen, Associate Professor of International Relations, Norwegian University of Life Sciences

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Football Africa Sports in Africa

Africa Cup Of Nations 2019 – Meet The Teams

Qualification for the 2019 Africa Cup of Nations finals wrapped up this weekend with best twenty four teams booking their place at the continental showpiece in Egypt. AFCON 2019 is scheduled to kickoff on Friday 21st June and end 28 days later on Friday 19th July.

True to Africa, it’s been a nonlinear path to this point. Rescheduling, readjustments that turn everything on all axes and beautiful stories that restore faith in humanity are all part of the gravy of expressive African football coming your way soon. There have been disappointments too – Pierre-Emerie Aubameyang’s Gabon missing out and 2012 winners Zambia’s elimination come to mind.

It wouldn’t be African if our chiefs failed to meddle. And flex they did as big (wo)men in Sierra Leone continued the continent’s age old tradition of skirmishes with football governing bodies. The expected happened, a ban, and Kenya and the ‘rained on lion’ of African football, Ghana, rested a bit easier through the qualifications.


Still, it wouldn’t be a 21st century African story without a grand family reunion. Cue for the Berahino, Clarence Seedorf and Madagascar’s Jérémy Morel. The latter of the three might have spoken for them all – present, past and future African diaspora- who are ‘coming back home’ when he twitted:

I confirm that I will proudly take part in the Afcon 2019 under the colours of Madagascar, it will make you smile or cringe, but no matter, you do not deny your family background when they call you and I place my affection where I want it

With that statement laden with brashness that undeniably spells A.F.R.I.C.A.N, ladies and gentlemen, here is the best of Africa and their African stories.

Africa Cup Of Nations Finals 2019 Teams: East Africa

Flag of Uganda a Africa Cup of Nations 2019 finalist


Two consecutive AFCON qualifications. In 2019, a showing beyond the group stage perhaps? Maybe aim for a World Cup slot latter?

Flag of Kenya a Africa Cup of Nations 2019 finalist


Football, politics and donations. The triumvirate that we love to hate. Kenya’s journey to AFCON 2019 after a fifteen year wait gave us the latest episode of the longest running theme in the soap opera that African football can be. Picture this:

It’s 2017 and Harambee Stars still have to face Ghana and Ethiopia. In the backdrop of the 15 year wait, it’s possible it could be another unfruitful yield. The Deputy President makes a pledge ‘ Make it to the finals and 500,000 USD is yours.’ A combination of luck (Sierra Leone ban) and splendid results ( Before the final qualifying match against Accra in Ghana Kenya was vying for first place in the group not having conceded a goal) the deed is done, save for the pledge.

“The money has not been paid and I’m not aware of its whereabouts. I was not there when the DP made this promise,”

Kenyan Sports Principal Secretary Kirimi Kaberia when facing a parliamentary committee on sports. According to thisreport, the confusion has been cleared, and the boys are set to get 70% of the money to share out.
Flag ofTanzania a Africa Cup of Nations 2019 finalist


Thirty nine years later, Tanzania is back. And oh, welcome back legend of the African game Emmanuel Amunike! That scintillating display against Uganda in Dar was simply sumptuous. Three nil, the result against a side that hadn’t conceding a goal through out the qualifiers! More of that in Egypt and Tz is sure to be everyone’s second team.

Flag of Democratic Republic of the Congo a Africa Cup of Nations 2019 finalist

Democratic Republic of Congo

Like a number of nations that qualified for AFCON 2019, this emerging football power house had to contend with elections during the qualification period. That DR Congo, Burundi, Madagascar and Zimbabwe are even here is testament to the changing story about Africa and elections in the 21st century.

By way of evidence of these nations participation, it’s safe to proclaim that African nations are Nassim Nicholas Taleb’s Antifragile. No other nation is emblematic of this bold claim like DR Congo, who additionally had also to contend with an Ebola outbreak, in order to emerge among the continent’s best twenty four men’s football teams.

Flag of Burundi a Africa Cup of Nations 2019 finalist


One of the tournament ‘débutantes’. A clear exhibition that the expanded format of AFCON 2019, from 16 to 24 teams, inadvertently benefited the Eastern half of the continent.

It wasn’t a simple task, but we are a very united squad. We were successful thanks to our unity. Being the first generation from Burundi to qualify for the Cup of Nations is something we will always have

Saido Berahino speaking to Radio France International on Burundi qualifying for the African Cup of Nations finals 2019. Berahino fled Burundi with his mother and siblings at age 10 when his father was killed in civil war. They were granted refugee status in England where he later begun his career with West Bromwich Albion before moving to Stoke City after a fallout following a protected transfer saga. He represented England at youth level, was even called up to senior squad. The striker has been representing the country of his ancestors after FIFA approved a switch of allegiance in August 2018.

AFCON Finals 2019 Teams: West Africa

Flag of Nigeria a Africa Cup of Nation 2019 finalist


This is a young super eagles team that breezed through the qualifiers without their talismanic captain John Obi Mikel. The question remains if the former Chelsea man, if recalled when fit, should take more of Mexico’s Rafael Márquez role? Or should he be shuttled back into the starting eleven?

However that saga turns out, Nigeria should benefit from the continuity of having the same coach for the second tournament now. In a continent where the big boys plying European football often bully coaches, federations and/or bankroll the team, the likely destabilizing effect of an unhappy Mikel cannot be ignored. Nonetheless one of the tournament favorites.

Flag of Ghana a Africa Cup of Nations 2019 finalist


Earlier this 21st century, the black stars were Africa’s Germany. A nation beaming with precious talent backed by excellent organization and expected only to grow from strength to strength. There was that loss to a seasoned Egypt side in 2010. Then after that it became all meh! Needing a goalkeeping blunder to win one nil, late against Kenya’s plucky Harambee stars could be this or that. A sign of a seasoned side astute at winning ugly. Or simply an under-powered side.

Flag of Ivory Coast a Africa Cup of Nations 2019 finalist

Ivory Coast

Flag of Senegal a Africa Cup of Nation 2019 finalist


Flag of Mali a Africa Cup of Nation 2019 finalist


Flag of Guinea a Africa Cup of Nation 2019 finalist


Flag of Guinea-Bissau a Africa Cup of Nation 2019 finalist


Flag of Benin a Africa Cup of Nation 2019 finalist


Flag of Cameroon a Africa Cup of Nation 2019 finalist


Trust Cameroon to flex the most on any given AFCON edition, any given country. To be precise, it’s always has been about their uniforms. In earlier years, it was bit the football. But of late, their style has been aggressive as always but more direct, less flair. This AFCON, the sauce of the defending champions will come from an unlikely source.

Clarence Seedorf and Patrick Kluivert! How about that for a technical bench. What’s more? They can bank on the support of Mr. Cameroon, Africa’s most decorated, Samuel Eto’o

There is a good technical staff that arrived some months ago, which has been doing a great job with some players. Other players are yet to arrive……We will try to protect the team that will be selected for the 2019 Afcon so that issues not related to football wouldn’t emerge and destroy the work of the entire staff

Africa Cup Of Nations Finals 2019 Teams: North Africa

Flag of Tunisia a Africa Cup of Nation 2019 finalist


Flag of Algeria a Africa Cup of Nation 2019 finalist


Flag of Egypt a Africa Cup of Nation 2019 finalist


Flag of Morocco a Africa Cup of Nation 2019 finalist


Flag of Mauritania a Africa Cup of Nation 2019 finalist


Fun Fact: The flag of Mauritania was only adopted on 15th August 2017 following a constitutional referendum. Wikipedia offers that the two red stripes ( the additions to the new flag) represent: “the efforts and sacrifices that the people of Mauritania will keep consenting, to the price of their blood, to defend their territory.”

The latent tensions between Mauritania and her neighbor Morocco over territory is one of Africa’s oldest stories. Will the Africa Cup of Nations Finals 2019 prove a geopolitical stage? Will football allow for some friendly banter between the two estranged brethren?

Africa Cup 2019 Teams: Southern Africa

Flag of Angola a Africa Cup of Nation 2019 finalist


Flag of Madagascar a Africa Cup of Nation 2019 finalist


It took 46 years for the Indian Ocean islanders to become the 40th different nation and the first nation, besides then hosts Cameroon, to qualify for the Africa Cup of Nations finals 2019.

CAF congratulates Madagascar for qualifying for African of Nations of Nations Finals 2019
Image Courtesy: CAF
Flag of Zimbabwe a Africa Cup of Nation 2019 finalist


The stand out result qualifying has to be the 2-1 triumph over emerging African football powerhouse The Democratic Republic of Congo while down to 10 men at the Stade des Matyrs in Kinsasha. The warriors went on to live to their moniker ‘the worry us’ going down to Liberia in Monrovia whilst all that was needed was a draw for qualification to Africa Cup of Nation finals 2019. Then tragedy struck before The Warriors final qualification match against Guinea-Bissau at the National stadium in Harare when a female fan died following a stampede. This happened when fans jostled to get into the stadium. May her soul be well with the ancestors.

Flag of Namibia a Africa Cup of Nation 2019 finalist


Flag of South Africa a Africa Cup of Nation 2019 finalist

South Africa

Oh, South Africa! Oh, Bafana Bafana! Ke Nako seems so distant now. Still, when South Africa believes, Africa imagines. It may just be a game, but sports has its magic.

People have become disinterested in the national side. Too many disappointments for too long have left them feeling disconnected from what was once a true beacon of South African sporting excellence.

Nick Said for ESPN chronicles the dead enthusiasm for Bafana Bafana.