Africa’s children are being failed by the hospitals they depend on — a wake-up call

Africa is home to the youngest population on Earth. By 2060, nearly 800 million children will live on the continent – an extraordinary demographic force that should be our greatest asset. But a landmark new study published this month in PLOS Global Public Health delivers a stark reality check: the children’s hospitals responsible for caring for this generation are stretched, strained and in many places simply not equipped to meet their needs.

The Children’s Hospitals in Africa Mapping Project (CHAMP) is the first and most extensive survey of its kind across sub-Saharan Africa. Funded by ELMA Philanthropies and a private gift from the late Charles Hamilton, it assessed 20 major paediatric hospitals in 15 countries – many of them top referral centres, the places families turn to when a child is desperately ill.

What we found is both inspiring and deeply troubling.

On the one hand, health and clinical teams across the continent demonstrate extraordinary dedication, skill and resilience. Neonatal units are ventilating premature babies against all odds; clinicians are delivering high-acuity care with determination and ingenuity; hospitals keep going despite constraints that would cripple many better-resourced health systems.

But the data paint a searing and undeniable picture: the foundational infrastructure required to deliver safe, high-quality paediatric care is dangerously inadequate.

Hospitals are at breaking point.

Across the sites surveyed, facilities were operating at or near maximum capacity. Many lacked basic emergency equipment, reliable power, safe water supply, essential medicines or sufficient space. Shortages were the rule, not the exception. Most hospitals did not have enough beds or cribs – leading to a practice unthinkable in high-income countries: multiple babies sharing the same crib, increasing the risks of cross-infection, sepsis and hospital outbreaks. Several hospitals lacked the capacity to perform basic emergency surgical procedures. Staff shortages were profound. Africa has one paediatrician for every 200,000 children – a staggering contrast with high-income countries, where the ratio is roughly one in 1,400.

And the greatest shock? Even in these leading hospitals – arguably the best-resourced child health facilities in their respective countries – the gaps were wider and more systemic than many of us anticipated.

If this is the state of the flagships, what does it mean for the hundreds of smaller district and regional hospitals where most children actually seek care?

And then came the Covid-19 warning – and a glimpse of what comes next.

The CHAMP survey reflects the pre-Covid period (2018 to 2019). Since then, paediatric services across Africa have endured pandemic-related disruptions, staffing losses and major funding cuts – including the recent withdrawal of several long-standing partners such as USAID. The picture today is almost certainly worse.

Add climate change to the circumstance: heatwaves, floods, water outages and electricity instability are already straining hospital resilience. Children will bear the brunt.

This is a global blind spot.

Children are not small adults. Their physiology, diseases and emergency needs are fundamentally different. Yet global health regulations, preparedness frameworks and national budgets often treat them as an afterthought.

The CHAMP findings should force a reckoning:

• Children’s hospitals must be recognised as critical infrastructure, not optional enhancements;
• Minimum resource standards for paediatric care must be defined, adopted and enforced;
• Governments and global funders need to dramatically expand the paediatric workforce – from nurses and paediatricians, to emergency and critical care specialists;
• Investment must target both hi-tech care and basic essentials: reliable power and water, oxygen, beds and safe infection-control systems; and
• Paediatric training programmes must be aligned with actual needs on the ground.

This is not only morally compelling, it is economically rational. Healthy children secure a healthy workforce and a healthy continent. Children are legal minors and cannot act in their own interests. They depend on adults and just look at what we have done, and failed to do.

Africa’s children deserve better.

And yet, despite the bleak findings, CHAMP is ultimately a hopeful project. Twenty-eight leaders from across the US and 15 African countries came together to design a rigorous, collaborative, African-driven assessment. The intention was never simply to diagnose problems, but to build a network that can mobilise and offer solutions.

The next step is clear: governments, funders, philanthropies and global institutions must treat this as a continental priority. The cost of inaction will be paid over generations.

Africa’s children – all 800 million by mid-century – deserve hospitals that can keep them alive, safe and thriving. They deserve a health system that matches their ambition and potential.

The CHAMP study is a wake-up call. In the wake of the G20 leadership gathering in South Africa, we call on our collective leadership to respond. DM

Ashraf Coovadia is academic head of the Department of Paediatrics and Child Health at Rahima Moosa Hospital and adjunct professor in the Wits School of Clinical Medicine, Johannesburg. Wilmot James is professor and senior adviser to the Pandemic Center at Brown University’s School of Public Health, Providence, Rhode Island. Lawrence R Stanberry is emeritus professor of paediatrics, Columbia University in the City of New York.