Background: Most African Nations are marred with failing health systems factored by the lack of financing, technology, resources and even the political will to develop and maintain them. But even worse are some social determinants that are immensely contributing to the gradual collapse of these health systems. These social determinants are factors within the control of the health system and so, should be religiously improved to maximise the effectiveness of services even in the face of lack and limitations. A case study from an African community is referenced and different issues concerning a failing health system have been identified. These issues are mostly of social nature.

Main Body: How social issues strongly affect health systems and especially those from African settings were discussed. Therefore, this Review aims at identifying these social determinants and providing solutions to improving them by demonstrating the need for patient satisfaction, health workforce satisfaction and an effective leadership in the health system. These issues are categorized according to the WHO building blocks after which the ‘Service Delivery’ component is selected to be discussed. Issues from the referenced context that contribute to a failed health service delivery include, the overuse of free public health services, staff shortage, crowding, immense workload, patient dissatisfaction, expensive private sector and organisational conflicts. These social issues are typical factors affecting most African health systems.