Africa Builds Advanced Healthcare Capacity as Workforce Gaps and Urban Inequality Persist

Africa has substantial advanced healthcare capacity, but specialist services remain concentrated in urban centres and a few countries, leaving major gaps in equitable access, workforce and cross-border referrals. WHO calls for regional centres of excellence, stronger specialist training, digital referral networks, public-private partnerships and coordinated investment to turn existing capacity into accessible, affordable care across Africa.

Africa's advanced healthcare system is more developed than often assumed, but access remains deeply unequal. A major assessment by the World Health Organization Regional Office for Africa (WHO AFRO), conducted with WHO country offices, national ministries of health and participating health facilities, shows that significant specialist capacity already exists across the continent. The central challenge is now to make these services easier to find, reach and afford. The assessment covered 447 health facilities across 36 of the WHO African Region's 47 Member States. Nigeria reported the largest number of facilities at 93, followed by Ethiopia with 59, Kenya with 53 and Ghana with 32.

Advanced care is growing, but access remains unequal

The study found that 56.2% of reporting facilities were tertiary hospitals, while 57.7% were publicly owned. Private for-profit facilities represented 26.6% and private not-for-profit institutions 13.9%, showing that non-state providers already play an important role in advanced healthcare.

Geography presents a bigger concern. Around 73.4% of facilities were located in urban areas, leaving rural populations with much weaker access. Patients needing cancer treatment, dialysis, neurosurgery or complex paediatric care may therefore have to travel long distances, increasing costs and potentially delaying treatment.

Still, the scale of existing capacity is significant. Orthopaedics was available in 237 facilities, advanced paediatrics in 211, neurology in 208, nephrology in 190, oncology in 184 and cardiology and heart care in 183.

Some subspecialities are also becoming well established. Neonatology was routinely provided by 174 facilities, joint replacement by 165, haemodialysis by 163, neurocritical care by 139, chemotherapy by 134 and neurosurgery by 131.

However, highly complex treatments remain scarce. Paediatric cardiology was routinely provided by only 56 facilities, cardiothoracic surgery by 46, radiation oncology by 39 and immunotherapy by 30. Kidney transplantation was available routinely in just 12 facilities, bone marrow transplantation in six and heart transplantation in only one. No reporting facility routinely provided liver transplantation.

Specialists, not just machines, are the critical gap

The findings send an important message to governments and development partners: expanding advanced healthcare cannot be achieved simply by purchasing sophisticated medical equipment.

The largest specialist workforces were found in surgical oncology, with 686 specialists, joint replacement with 621, neonatology with 604, chemotherapy with 599 and neurocritical care with 497. By comparison, kidney transplantation had only 40 specialists, bone marrow transplantation 24 and heart transplantation just two.

Facilities providing advanced services generally recorded readiness scores between 50% and 83%, with most exceeding 70%. Medicines usually received the strongest adequacy scores, while equipment generally performed better than workforce availability. Interventional cardiology recorded the highest overall readiness at 83%, while heart transplantation scored only 50%, including just 25% workforce adequacy.

For policymakers, this means investment in specialist education, fellowships, retention, multidisciplinary teams and regional professional exchanges should accompany investment in hospitals and technology.

Laboratory infrastructure offers another opportunity. A parallel assessment identified 732 specialized laboratory facilities across all 47 Member States. Surveillance and outbreak-response capacity was reported by 246 facilities, molecular and PCR diagnostics by 207, research and clinical-trial capabilities by 202, and sequencing and genomics by 91. However, only 49 facilities reported ISO accreditation, while highly sophisticated technologies remained limited.

A regional healthcare network could deliver better value

The economic implications extend beyond healthcare. When patients cannot obtain advanced treatment at home or do not know where it exists elsewhere in Africa, they may seek treatment overseas. This can increase household expenditure and move healthcare spending outside African economies while existing regional facilities remain underused.

The findings strengthen the case for regional centres of excellence. Rather than every country attempting to establish expensive, low-volume services such as organ transplantation or highly specialized cancer treatment, countries could share strategically located facilities through reliable cross-border referral systems.

Such a model could help governments avoid unnecessary duplication of costly infrastructure while creating sufficient patient volumes to sustain specialist expertise. Development partners could support regional training programmes, referral networks, advanced laboratories, quality systems and digital health infrastructure.

The private sector is equally important. More than 40% of reporting facilities were private for-profit or private not-for-profit institutions. This creates opportunities for hospital operators, insurers, pharmaceutical companies, medical-device manufacturers, laboratories and digital-health businesses. However, poorly regulated private expansion could deepen inequality if sophisticated services remain concentrated in wealthy urban markets.

Turning existing capacity into wider access

WHO's proposed African super-speciality health atlas could become an important part of the solution by showing where advanced services are available and helping clinicians and governments make better referral and investment decisions.

The report recommends stronger specialist training, sustainable financing, telemedicine, electronic referrals, remote diagnostics, public-private partnerships and harmonized rules for cross-border care. It also calls for better integration of private and faith-based providers into national referral and health-information systems.

There are limitations. Only 36 of 47 Member States supplied clinical-service data, some identified facilities were not assessed and much of the information was self-reported. The actual regional capacity could therefore differ from the reported figures.

Nevertheless, the policy message is clear. Africa is not starting from zero. It already has substantial specialist hospitals, laboratories and medical expertise. The next development challenge is to connect these resources across borders, strengthen the specialist workforce and make advanced treatment financially and geographically accessible. For governments, development partners and investors, that shift offers an opportunity to turn scattered centres of medical excellence into a more efficient and equitable regional healthcare system.