In this article, we will determine which countries have the worst healthcare systems in the world and delve into the implications of challenges in this sector. If you wish to see the list directly, head to 8 Countries With The Worst Healthcare System.
Despite the surge of healthcare innovations in this era, it’s disheartening to witness the vast disparities in healthcare quality among countries. Several nations suffer from inefficient and inaccessible healthcare systems. These inadequacies, beyond the immediate public health implications, can have detrimental effects on national economies.
Countries like the Central African Republic, Chad, South Sudan, Afghanistan, Haiti, and others consistently find themselves at the bottom of global healthcare rankings. In these nations, healthcare system issues arise from inadequate infrastructure, insufficient training for medical and paramedic staff, constrained budgets, and inadequate care for newborns and mothers, among other challenges. On the topic of newborn care, we have previously discussed the 20 Countries with the Highest Rates of Infant Mortality; you can read our article to find out where infants face the greatest risk.
It’s worth noting that countries with the worst healthcare systems not only represent a health crisis but also economic challenges. For instance, unhealthy workers tend to be less efficient and take more sick days, thereby reducing national productivity. Another consequence of a fragile healthcare system is brain drain; medical professionals from these countries often search for better opportunities abroad, causing an alarming talent drain in the home country, further worsening the situation. For example, a survey conducted by the Pakistan Journal Of Medical Sciences found that 33.3% of fresh medical graduates plan to leave Pakistan and settle abroad because of long working hours and poor pay.
A subpar healthcare system can also dissuade foreign investors who may be concerned about the health of the workforce and potential medical costs. Considering the impact of weak healthcare systems on tourism and associated revenue, countries with persistent public health issues, especially contagious diseases, invariably witness a decline in tourism. For instance, following the first report of the Ebola virus in 2013, by August 2014, nearly half of the monthly flights scheduled to Liberia, Guinea, and Sierra Leone were canceled, according to the World Travel and Tourism Council.
Logically, countries grappling with healthcare crises could look to emulate the systems of the 15 Countries With The Best Healthcare In The World. But since most countries with the worst healthcare system are least developed and heavily indebted, budget allocations to the healthcare sector and policy reforms hinder this development.
Companies’ Ability to Innovate Healthcare For Poorer Countries
Global pharmaceutical and healthcare behemoths like Pfizer Inc (NYSE:PFE), Johnson & Johnson (NYSE:JNJ), and Abbott (NYSE:ABT) possess the resources, expertise, and networks to revolutionize healthcare in impoverished nations. For example, given the larger populations and often a higher prevalence of certain diseases in less affluent countries, these companies can offer volume-based discounts. In this aspect, Pfizer Inc (NYSE:PFE) has already committed to selling 23 patented drugs, including Comirnaty (their COVID-19 vaccine), to 45 underprivileged countries on a not-for-profit basis.
Pfizer (NYSE:PFE) also continues to report strong performance of its core drugs along with the COVID-19 vaccine, which has been shipped to over 181 countries since December 2020. Similarly, another pharmaceutical giant, Abbott Laboratories (NYSE:ABT), operates in over 160 countries, and the company’s motto for 2030 is to enhance the lives of one in every three individuals, i.e., 3 billion people a year. Intriguingly, during the peak of the COVID-19 pandemic in 2021, Abbott Laboratories (NYSE:ABT)’s diagnostic kits for the virus witnessed skyrocketing sales. In the first quarter of 2021, COVID-19 diagnostic-testing sales accounted for $2.2 billion of the company’s total $10.5 billion in sales.
Diseases and health issues that predominantly plague poorer countries often don’t attract ample research attention due to potentially unprofitable markets. To address this and aid these nations, Johnson & Johnson (NYSE:JNJ) pledged $30 million in 2014 to enhance newborn health and boost survival rates until 2020. This commitment supported initiatives in 20 countries with high neonatal mortality rates, including Nigeria and Ethiopia. Furthermore, Johnson & Johnson (NYSE:JNJ) collaborated with Save the Children to offer newborn resuscitation and other vital services to approximately one million children globally.
Now, let’s turn our attention to countries with the worst healthcare systems.
25 Countries With The Worst Healthcare System
Our Methodology
We shortlisted countries with the worst healthcare systems in the world based on three metrics:
First, we selected the 25 lowest-ranking countries from the health pillar of the Legatum Prosperity Index. This index measures the extent to which people in over 167 countries are healthy and have access to necessary healthcare services. Next, we referred to the Global Health Index 2021. This index, developed in partnership between the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, analyzes countries’ preparedness to handle situations like COVID-19 and the general healthcare access their populations enjoy. The Global Health Index categorizes countries into 5 tiers based on their ability to handle disease outbreaks. The tiers’ are:
- Tier 1 = 0-20
- Tier 2 = 20.1-40
- Tier 3 = 40.1-60
- Tier 4 = 60.1-80
- Tier 5 = 80.1-100
Countries falling in tier 5 are supposed to have the best healthcare system, while those in the 1st tier are the worst in terms of healthcare provision. The index noted that none of the countries managed to be in the 5th tier, and the average score for over 190 countries was 38.5 out of 100. Any country with a score below 38.5 is in the alarming zone and does not have enough resources in the healthcare sector.
Lastly, and most importantly, we identified countries with the lowest life expectancy from the World Bank Database, as this metric indicates how effectively a country manages chronic and infectious diseases. To develop a scoring system for these countries, we used the weighted averaging method. We assigned a weight of 0.4 to life expectancy, 0.3 to the health pillar of the Legatum Prosperity Index, and 0.3 to the Global Health Index. Notably, the country with the lowest score on our list has the worst healthcare system in the world. We then listed these nations in descending order based on their healthcare systems.
Based on our findings, here are the 25 countries with the worst healthcare systems:
25. Madagascar
Insider Monkey Score: 22.2
In 2023, Madagascar has a population of nearly 30 million and a GDP of $15 billion. Almost two-thirds of the country’s population lives below the poverty line, lacking enough capital to spend on adequate healthcare. The healthcare system in Madagascar is highly underfunded due to a lack of infrastructure and insufficient qualified personnel. The majority of medical facilities are concentrated in urban areas, leaving rural inhabitants underserved. Poverty, limited government spending on health, and frequent natural disasters further hinder the country’s ability to establish a reliable healthcare system.
24. Haiti
Insider Monkey Score: 20.8
Healthcare in Haiti is characterized by a heavy reliance on international aid, as it is among the countries with the highest rates of poverty. Insufficient public funding and a shortage of healthcare professionals exacerbate the nation’s situation. The 2010 earthquake destroyed much of Haiti’s already fragile infrastructure. With 29.2% of the population living in extreme poverty, availing of sufficient healthcare becomes challenging.
23. Republic Of Congo
Insider Monkey Score: 18.8
The Republic of Congo is one of the hungriest countries in the world due to its extreme poverty and poor administration. Currently, 35.4% of the country’s population survives on less than $2.15 a day, and recurrent epidemics make life difficult for them. Although the government has made strides in improving healthcare, many regions remain underserved because of geographical barriers. Endemic diseases, such as yellow fever and malaria, place additional burdens on an already strained system.
22. Niger
Insider Monkey Score: 18.7
In Niger, the current GDP is $16.617 billion, and over 50.6% of its population lives in extreme poverty. The country’s healthcare system faces challenges like high infant and maternal mortality rates, which can be attributed to malnutrition, infectious diseases, and limited access to clean water and sanitation. Despite efforts, Niger lacks the medical facilities and trained professionals needed to cater to its growing population, especially since it ranks third among countries with the highest rates of population growth.
21. Papua New Guinea
Insider Monkey Score: 17.8
Healthcare in Papua New Guinea (PNG) is challenged by rugged terrain, which impedes access to remote areas, and a shortage of qualified medical personnel. PNG contends with high rates of communicable diseases like tuberculosis and malaria. With almost 40% of the population living in extreme poverty, delivering uniform healthcare is complicated in PNG.
20. Afghanistan
Insider Monkey Score: 17.1
Decades of conflict has severely impacted Afghanistan’s healthcare system, which has a current score of 28.8 (out of 100), according to the Global Health Index. Additionally, nearly half the people in Afghanistan grapple with severe economic challenges, leading to poor health outcomes and a high mortality rate. The country’s per capita GDP is $363, making it the seventh hungriest country in the world.
19. Mozambique
Insider Monkey Score: 16.8
Mozambique suffers from a shortage of skilled healthcare professionals, and its heavy reliance on foreign aid results in a high burden of diseases like HIV/AIDS and malaria. Frequent natural disasters and a significant disease burden strain the country’s fragile system. The Borgen Project reports that many people in rural Mozambique remain impoverished and are consequently cut off from the healthcare system.
18. Liberia
Insider Monkey Score: 16.8
Liberia’s healthcare system suffered immensely due to a 14-year civil war, which devastated infrastructure and resulted in a significant exodus of medical professionals. The 2014-2015 Ebola outbreak further exposed the system’s weaknesses, including a lack of isolation units and trained personnel. Rebuilding and fortifying the health system is a priority in Liberia. However, with poverty being a significant concern, the government’s spending on the healthcare sector is only 9.5% of its $3.5 billion GDP.
17. Angola
Insider Monkey Score: 15.8
Angola allocates 2.9% of its $67 billion GDP to the healthcare sector, earning it a score of 29.1 out of 100 on the Global Health Index. Despite the country’s oil wealth, there is a troubling disparity in healthcare access. While urban areas are better equipped, rural regions are often neglected. Diseases like malaria, yellow fever, and cholera are prevalent in Angola, adding more pressure to its already strained healthcare system.
16. Mali
Insider Monkey Score: 15.7
Mali’s current GDP stands at approximately $19.14 billion, with 4.31% dedicated to the healthcare sector. The country grapples with a high incidence of diseases like schistosomiasis, malaria, and malnutrition, which demand more resources. Financial barriers often deter many from seeking treatment, especially considering that nearly 15% of the population lives in extreme poverty.
15. Côte D’Ivoire
Insider Monkey Score: 14.9
Côte D’Ivoire’s healthcare system is heavily burdened by HIV/AIDS and malaria. Insufficient funds (the country spends 3.72% of its $70 billion GDP on healthcare) and a shortage of trained professionals exacerbate the problems in its healthcare system. While urban centers like Abidjan offer adequate medical facilities, rural areas lag behind. Past political instability and civil conflicts have further constrained government healthcare expenditure.
14. Cameroon
Insider Monkey Score: 14.8
Cameroon is among the countries with bad healthcare. Cameroon’s GDP is nearly $45 billion, with 3.77% dedicated to healthcare. According to the Global Health Index, Cameroon scored 28.6 out of 100 and secured 149th rank out of 190 countries in terms of disease management capacity. The country boasts a diverse health infrastructure that includes public, private, and traditional sectors. However, resource constraints and mismanagement are prevalent issues.
13. Sierra Leone
Insider Monkey Score: 14.3
Sierra Leone faces an extreme poverty rate of 26.1%, and its Global Health Index score is 32.7. The country’s health system is still rebounding from the aftershocks of its civil war and the 2014 Ebola outbreak. These calamities severely impacted the already fragile healthcare infrastructure, resulting in an overburdened workforce. Additionally, Sierra Leone contends with some of the world’s highest child mortality rates, registering 72.3 deaths per 1000 live births.
12. Benin
Insider Monkey Score: 13.9
In Benin, the healthcare sector expenditure is 2.59% of its GDP, indicating limited resources. Another challenge pushing Benin among countries with struggling healthcare systems is the inadequate training of health workers. Although healthcare is nominally free for children under five and pregnant women, many still incur out-of-pocket expenses.
11. Nigeria
Insider Monkey Score: 11.6
Nigeria is one of the countries with the worst healthcare in the world. It struggles with looming poverty and unemployment, which adversely impact public health. The country designates 3.38% of its GDP to healthcare. However, despite its substantial economic resources, corruption, underfunding, and a lack of infrastructure hamper Nigeria’s healthcare system.
10. Democratic Republic Of Congo
Insider Monkey Score: 11.3
In DR Congo, 60% of the population lives on less than $2.15 a day, making out-of-pocket health expenses prohibitive for many. The country’s healthcare system struggles due to prolonged conflict, manifesting in a severe shortage of infrastructure, resources, and trained staff. DR Congo’s Global Health Index score stands at 26.1, and the nation allocates 4.05% of its GDP to health.
9. Equatorial Guinea
Insider Monkey Score: 11
Equatorial Guinea’s health system remains under-resourced and inefficient despite its oil wealth. A stark disparity exists between the healthcare quality available to the elite and the broader population. Endemic diseases, particularly malaria, further strain the country’s healthcare system.
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Disclosure: None. 25 Countries With The Worst Healthcare System was originally published at Insider Monkey.