Providing assistance in Sub-Saharan Africa
Oliver Cuenca explores what it takes to provide medical assistance to travellers in Sub-Saharan Africa
The region known as Sub-Saharan Africa encompasses an area of approximately 23.9 million square kilometres, and contains a total of 49 countries, including some of the continent’s most popular tourist destinations. These include nations such as South Africa, Botswana, Kenya, and Zimbabwe, among others.
Yet the region also poses a number of unique challenges to assistance companies when travel plans go awry, particularly in rural areas.
Responding to incidents in rural areas
For Peter Flemmer, Business Development Manager at HAC Medical, a major issue encountered by his company when responding to a patient in Sub-Saharan Africa is the lack of appropriate landing sites – which is particularly challenging when attempting to reach a patient outside of daylight hours.
“Most air strips have no landing lights, and so cannot be accessed between sunset and sunrise,” he said. “To give you an example, in Zimbabwe there are just three runways with landing lights – two of which are only kept on after 18:00 hrs by request.”
He added that such requests typically needed to be submitted before 17:00 hrs, and often involve a “hefty” additional hourly charge.
However, he noted that because HAC Medical regularly flies tourists to such “bush air strips”, its pilots are familiar with what airfields are appropriate. He added that the company maintains a regularly updated database of suitable landing sites to support its operations. Additionally, HAC Medical has modified its King Air fixed-wing aircraft to allow safe landings on dirt runways.
Thulasizwe Mbokane, Deputy Operations Manager at Alliance International Medical Services (AIMS), echoed this, reporting that “in rural areas where infrastructure is lacking” his company will specifically look to work with providers that they know have suitable aircraft.
Additionally, when an air evacuation is simply not possible, “we arrange long-distance ground transfers”, he explained. “This is a common practice in countries like Namibia, where we ensure that the patient is moved to a facility with adequate medical provisions, even if it requires a lengthy ground journey.”
Ensuring a high quality of healthcare
For Jane Munyua, Medical Assistance Manager at AMREF Flying Doctors (AFD), another key challenge is the lack of suitable medical facilities in many rural areas. However, she explained that on such occasions where they suspect a patient is in a “substandard healthcare facility”, AFD’s medical team will “offer a truthful medical evaluation … monitor the patient’s condition, and communicate updates to the assistance partner”.
Most air strips have no landing lights, and so cannot be accessed between sunset and sunrise
If the patient would benefit from a more advanced medical centre, they will then recommend this course of action.
Flemmer added that, in many cases, “tourists are often in an area where there are no medical facilities, or if there is a ‘clinic’, this may be no more than a room with no running water or electricity which is being visited by a nurse once in a fortnight”. This makes a swift medical evacuation an even greater priority for patients.
He said that in countries like Zimbabwe where his company operates, “we have established a network of doctors that we can call upon to respond on our behalf while we are activating”.
However, Mbokane noted that this variability of service – often driven by factors such as the remoteness of the area, or language barriers – could be mitigated to some extent by travellers. He recommended that “clients should take the time to understand their destination prior to arrival, and declare their travel plans”.
“This awareness helps in anticipating the level of medical facilities and assistance available,” he said, while declaring travel plans “allows assistance companies like AIMS to provide smoother and more efficient support”.
Vetting hospitals and healthcare providers
Munyua said it is important to take a “rigorous approach” to making sure that hospitals and other healthcare providers are trustworthy, carrying out a range of checks, including “desk audits and physical visits to hospitals wherever feasible”, to verify their capabilities firsthand.
“We leverage our network of assistance partners in the region to gather comprehensive information and insights about these healthcare facilities,” she added. “This enables us to confidently select and work with providers who meet our stringent standards for quality and reliability.” She added that AFD also takes the approach that sharing information among its “global counterparts” is vitally important.
To ensure that they meet the appropriate standards necessary, it is important to undertake comprehensive hospital audits of healthcare partners throughout Africa, said Mbokane.
After this, a service-level agreement (SLA) can be established with the hospitals and treating doctors, outlining the “expectations and standards of care”.
Mbokane also highlighted the necessity of cost containment services, to “ensure there is no over-servicing, and that the patients receive necessary and appropriate treatments without additional or hidden costs”.
Clients should take the time to understand their destination prior to arrival, and declare their travel plans
Geopolitical challenges
Munyua explained that while AFD has not encountered any “major” geopolitical challenges that have affected its operations in recent years, she admitted that “political disruptions like coups, political protests, and petty crimes could impact our services”.
Mbokane agreed, naming political unrest in countries like Sudan and Somalia as being significant challenges that his company has had to work around. Such situations, he explained, can lead to a number of challenges such as security concerns, airspace closures, and disruption to local transportation and medical facilities.
These challenges can, however, be mitigated by utilising the local expertise of partners, conducting case-by-case assessments for safety and feasibility, and being flexible in making alternative arrangements.
Munyua added that to mitigate such risks, her company will:
- Gather intelligence internally
and from contracted partners - Conduct thorough risk assessments
- Collaborate closely with local authorities for timely updates
and support - Implement robust security protocols (including emergency plans)
- Ensure teams are well trained and flexible in their response.
Flemmer said that his own company had encountered similar issues. In particular: “Flight clearance in some countries is controlled by the army”, for whom a “sense of urgency is not necessarily their prime objective”.
He added that, to address this, “we have engaged on a diplomatic level to try and improve this”.
Additionally, since the Covid-19 pandemic, “requirements to obtain Port Health clearance have become more bureaucratic and time-consuming”, said Flemmer.
Language hurdles
While the continent of Africa is home to over 3,000 languages, communication with partners isn’t as much of a challenge as it might initially appear. Flemmer noted that,
in reality, it is possible to speak effectively using a handful of different major languages.
“Within Zimbabwe, 90% of the population are fluent in English. All our team are fluent in English, as well as local languages. This also applies to most surrounding countries that
used to be British colonies,” he said. “In Mozambique, whilst around 80% of the urban population speak Portuguese, many speak or understand Shona, a language spoken in Zimbabwe.”
When other languages are required, however, Flemmer said HAC “generally have contacts, either internally or externally, who we can turn to to translate for us where necessary”. Additionally: “Languages in the region are all are based on Niger-Congo languages and the commonality allows for a degree of comprehension.”
To ensure that they meet the appropriate standards necessary, it is important to undertake comprehensive hospital audits of healthcare partners
Munyua added: “With tools like Google Translate and reliable internet connectivity, we can effectively communicate with patients despite language differences.
“Additionally, [the company] is fortunate that Swahili, the national language spoken in Kenya (where AFD is headquartered), is also widely understood in many neighbouring countries, which facilitates communication in much of the region.”
Likewise, Mbokane explained: “While countries within the Southern African Development Community (SADC) generally have a good command of English, Mozambique stands out with Portuguese as its primary language.” Additionally, AIMS employs a diverse team “proficient in various local languages”.
Border and visa issues
Munyua explained that while border and visa issues can be a potential hurdle, AFD’s flight operations team will take “proactive steps” to gather all required travel documentation “well in advance of patient transport”.
“In instances where visas are needed, we have established procedures and partnerships that allow us to assist patients in obtaining these documents efficiently,” she said. Additionally, such problems can be mitigated by “leveraging local assistance on the ground, and maintaining direct communication with consular officials when necessary”.
Mbokane agreed, adding that it is important to “utilise the local expertise of ambulance providers and agents” to ensure a speedy transportation across borders.
Additionally, he explained that transporting the patient by air can also mitigate some visa issues, said Mbokane, because “patients are cleared based on the medical emergency, which waives visa requirements, and they automatically obtain a three-month visa upon arrival via air ambulance”.
Conclusion
While there are similarities in how assistance providers must operate in Sub-Saharan Africa and in other parts of the world – in particular, the need to rely on local knowledge and build strong partnerships is universal – there are some challenges that are more common in the region than elsewhere. Political hurdles can be greater due to the instability or unreliability of some governments in the region, while the scarcity of good landing sites and healthcare in rural areas also present further challenges. Ultimately, though, the solutions are the same: ensuring that due diligence is given when vetting healthcare providers, creating strong relationships, and remaining flexible in the face of changing situations.