A
healthy nation is a wealthy nation. This statement has in its core a truth that
any investment in the health of a nation is not a wasted, expensed cost but an
investment in the economic gains of the nation. During the recently concluded 6th TICAD (Tokyo International Conference on African Development) conference in Nairobi, there was great focus on health and development and the need to
improve the health of Africa to improve its economic outlook. It is with this
in mind that the President of World Bank Jim Yong reaffirmed the commitment of
the institution in strengthening African Health systems towards universal
health coverage (UHC) by allocating $30 billion over the next five years for
the strengthening of African health systems. This is a realization that health
is crucial to economic development and wealth creation.
At
the turn of the millennium, The UN millennium development goals (MDGs) were
developed and sought to address poverty and other crucial health outcomes
including reducing child mortality, improving maternal health and combating
HIV/AIDS, Malaria and other diseases. Through various partnerships, The Global
fund has been able to work with countries to reduce the burden of disease in
Africa and other developing countries of the world. Further , in 2001 African
countries made the Abuja declaration to increase government support to health
sector to at least 15% of their budgets. More than a decade later only one
country managed to reach this target with at least 11 countries reducing
spending on health in the time period.
This
background confronts the continent as we begin the implementation of the
expanded Sustainable Development Goals- post 2015.With a focus on the Health
goal of the SDGs I wish to state that while individual countries will have
different paths to attainment of Universal health Coverage, commitment of
leadership is the single most important factor that can contribute to success
of this initiative. A challenge to all leaders gathered for TICAD is to
reassess their health systems and define ways of improving it towards universal
health coverage. The Ebola outbreak in West Africa was a wake-up call to
strengthen the health systems of the region to be able to tackle epidemics in
future.
Good Governance and Leadership
The pursuit to have strong viable health systems can only be achieved if several key pillars are addressed. First, strong health systems are based on good governance and leadership but anchored on stewardship and support of visionary leaders who make it their legacy to support the achievement of Universal health coverage. Other than Tanzania, no other country on the continent has shown a consistent commitment by successive regimes towards health. This might be attributed to the almost singular leadership style and uniform party affiliation of all the presidents of that country to date. In most African countries, a regime change signals a change in focus priority areas such that it’s difficult to ensure continuity of any interventions.
Good Governance and Leadership
The pursuit to have strong viable health systems can only be achieved if several key pillars are addressed. First, strong health systems are based on good governance and leadership but anchored on stewardship and support of visionary leaders who make it their legacy to support the achievement of Universal health coverage. Other than Tanzania, no other country on the continent has shown a consistent commitment by successive regimes towards health. This might be attributed to the almost singular leadership style and uniform party affiliation of all the presidents of that country to date. In most African countries, a regime change signals a change in focus priority areas such that it’s difficult to ensure continuity of any interventions.
Increased government healthcare expenditure
Secondly, governments in Africa need to make efforts to increase healthcare expenditure as a percentage of their GDP. Many African countries have an unsustainable level of out-of-pocket healthcare expenditure by the population. Innovative health financing systems should be encouraged without the governments shirking from their responsibility of providing health services to the people. While considering the health financing system to adopt its important to look at the outcomes of various health systems as opposed to the economic expediency of any measure that may be taken. Taking into consideration the market failure inherent in healthcare, we should be cautious in approaching health financing as market-forces driven economic sector but as a merit good that should drive towards the greater agenda of social welfare ideals. It’s important to note that better health outcomes are attained in countries with a greater percentage of health expenditure by the government as compared to privately provided health systems. This has been consistently shown in WHO reports and other studies. Therefore there is a need to frame our systems with this in mind while investing in strong resilient health systems.
Secondly, governments in Africa need to make efforts to increase healthcare expenditure as a percentage of their GDP. Many African countries have an unsustainable level of out-of-pocket healthcare expenditure by the population. Innovative health financing systems should be encouraged without the governments shirking from their responsibility of providing health services to the people. While considering the health financing system to adopt its important to look at the outcomes of various health systems as opposed to the economic expediency of any measure that may be taken. Taking into consideration the market failure inherent in healthcare, we should be cautious in approaching health financing as market-forces driven economic sector but as a merit good that should drive towards the greater agenda of social welfare ideals. It’s important to note that better health outcomes are attained in countries with a greater percentage of health expenditure by the government as compared to privately provided health systems. This has been consistently shown in WHO reports and other studies. Therefore there is a need to frame our systems with this in mind while investing in strong resilient health systems.
Address deficiencies in human resources
Thirdly,
there is need to address deficiencies in healthcare human resources on the
continent. Africa bears 11 % of world population, 24% of the disease burden and
only 2% of the health workforce. This net deficiency in health workers and the
ever growing brain drain to western nations of highly qualified professions
calls all of us to action towards looking for solution to this perennial,
ever-growing problem. Greater private-public cooperation in training and investment
in community health workers might be some of the way to alleviate the problem
and reduce the gap in health workforce. Other capacity enhancement measures can
be adopted with adequate use of technology to ameliorate this situation. Some
of the useful innovative ways of ensuring success of community health have been
spearheaded by non-government entities. www.amrefhealthafrica.com has been involved in
educational activities for community health workers in various areas of East
Africa with commendable results in reduction of diseases and improvement of
maternal and child health. AMREF has also been involved in e-learning program
of nursing upgrading program that has seen an increase in the pool of available
trained community health nurses in Kenya. This is just one among many
initiatives, which if strengthened by the governments of the region could be
replicated all over the continent with better results.
Therefore
we need a re-assessment of our health systems, increase of government
contribution to health sector financing and investment in human resources for
health as priority areas to start a renaissance in African health and healthcare.
This does not mean other pillars of health system are not important, but I
would urge governments in the region to look at the above as the cornerstones
towards universal health coverage.
