Creating patient-centred healthcare requires that the patient’s voice be central to decision-making. This begs the question as to what extent patients’ voices can effect change in the healthcare systems that serve them? While consumer goods have long been driven by responding to customer demands and trends, healthcare systems in Africa have historically been designed according to infrastructure limitations, and not patient needs. However, as people become more aware of their rights around healthcare and take growing responsibility for their health, it stimulates an increase in service levels from governments providing healthcare. Empowered citizens are better able to use legislative frameworks and civil society mechanisms to advocate for and get involved in creating improvements to healthcare systems and services.

It’s important to note that countries have signed up to the Right to Health mandate, as part of the Human Rights Charter. Within that context is the Right to Medicines, whether these are part of a free service or are purchased by the patient. In delivering these Rights, many governments have signed up to the Universal Health Coverage goal, which in itself, meets the Sustainable Development Goals. All these commitments are articulated in national health policies, strategies and action plans.

Given the ongoing pressure of national competing priorities, countries in the developing world face multiple challenges in delivering on these commitments. Many governments are considering alternative ways to offer services in order to achieve success in delivering on their commitments, including the delivery of health products. Efficiency, sustainability and impact are not seen as possible to achieve through partnerships without other non-state actors, and application of strategies such as outsourcing of services.

In some countries outside of Africa, the patient voice has a significant impact on the way that healthcare services are delivered. In the UK, for instance, input from patient associations about healthcare services can compel authorities to implement changes on a district, regional, and even national level. This approach can be empowering for communities in African countries, particularly in hard-to-reach places, as it means they are able to use their communal influence to drive improvements to healthcare delivery. For example, in Kenya, World Vision supported a community-based advocacy approach called Citizen Voice and Action to contribute to improved access to healthcare services among children below the age of five and pregnant and lactating women in the underserved community of Illng’arua.

Of course, in many countries around the world, the patient voice around healthcare services is almost non-existent, but there are healthcare advocacy channels that can be used to create legislative and policy impetus for governments to re-centre patient needs at the heart of healthcare provision. For example, during the early 2000s in South Africa, HIV/AIDS advocacy group the Treatment Action Campaign mobilised communities to campaign for the right to health through a combination of human rights education, HIV-treatment literacy, demonstrations, and litigation. As a result of these efforts, there was a reduction in the price of many key antiretroviral medicines, hundreds of thousands of HIV-related deaths were prevented, and significant essential resources were added into the health system and directed towards those who needed them.

The thinking around how to elevate the patient voice includes a revived understanding that the entire system of healthcare provision in a country should aim to be delivering services to improve the lives of people needing medical care and products. Patient feedback is then an essential part of evaluating whether a system is working effectively. As patients’ knowledge of their rights around healthcare increases and they constructively demand improvements, healthcare can become patient-centred and more effective in serving those it exists to help.

About the authors

Bonnie Fundafunda, PhD. is the regional lead, supporting East and Southern Africa countries for ARC. He has over 20 years’ experience in health policy, planning, strategy, operational systems and business development in Africa.

Trip Allport is managing director of ARC. For over a decade, he has helped to shape and manage partnerships supporting market-oriented solutions to the world’s most challenging development issues between the private and development sectors.