Strengthening African Health Systems Yoswa M Dambisya ECSA Health Community 18 July 2017 SWALEC Stadium, Cardiff

The Presentation The context of the Health Systems in Africa International obligations and African Commitments African solutions to weak health systems Stronger Ministries of Health for stronger health systems The ECSA-HC Strategic initiative on Global Health Diplomacy Looking ahead

The African Challenge High disease burden, diminishing resources, decreasing share of world resources Population growth, no concomitant economic growth Lack of cooperation/synergy between different stakeholders/institutions Lack of policy coherence to achieve systemic change. Ideals contained in many commitments: AU Agenda 2063: the Africa We Want SDGs: Leaving no one behind Is there an African health system?

World Wealth Distribution: 1500

World Wealth Distribution: 2015

Obligations and Commitments WHO Constitution (1946) Alma Ata Declaration (PHC/HFA2000, 1978) Ottawa Charter for Health Promotion (1986) Rio Political Declaration on Social Determinants of Health (2011) Political Declaration of the UN High-level Meeting of the General Assembly on the Prevention and Control of NCDs (2011) Rio+20 outcome document (2012) Helsinki Statement: Health for All is a major societal goal of governments, and the cornerstone of sustainable devt.

….Prioritize health and equity as a core responsibility of governments to its peoples. …… Affirm the compelling and urgent need for effective policy coherence for health and well- being. ….. Recognize that this will require political will, courage and strategic foresight

Health System Context

Health for the SDGs Health is central to all the three dimensions of sustainable devt: Social, economic, Environmental. Health is a beneficiary of, and a contributor to, development. Health is important as an end in itself and as an integral part of human well-being: material, psychological, social, cultural, educational, work, environmental, political, personal security…. It is also a key indicator of what people-centred, rights-based, inclusive, and equitable development seeks to achieve. SDGs: People, Planet, Prosperity, Peace, Partnerships

Africa Health Strategy 2016 – 2030 Agenda 2063: The Africa We Want” and 2030 Agenda for Sustainable Development, including its SGDs. Reinforces pre-existing commitments: Sexual and Reproductive Health and Rights Continental Policy Framework and its extended Maputo Plan of Action (2016-2030) Pharmaceutical Manufacturing Plan for Africa (PMPA) African Regional Nutrition Strategy 2015 - 2025 (ARNS) Various AU Abuja commitments, calls, declarations aimed at combatting AIDS, tuberculosis and malaria in Africa Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa By 2030 Global Strategy for Women’s, Children’s and Adolescent Health 2016 - 2030

Towards stronger Ministries for stronger health systems A work in progress, intended to: Prepare Ministers/Ministries to “hold their own” through building political, diplomatic & people skills Help Ministers defining “their agenda/space” (esp. non-health professionals) Building the technical capacity of (senior) Ministry staff Emphasis on health systems stewardship Address weak research & evidence use, promoting evidence-driven policy frameworks Executive leadership and management forums Overall: better Leadership and Governance

Fundamental considerations To be an effective steward of health resources, a ministry of health must do more than deliver care. It is critical to understand the country context in which health systems transformation must occur. Unless & until there is critical mass of actors in-country – No progress! A challenge in many African countries is changing the mind-set of ministries from “powerlessness” to a “can-do attitude”.

ECSA Strategic Initiative on GHD Resolution of the Health Ministers (50th HMC) urging member states to strengthen their capacity in GHD Seminars for Health Ministers and Senior Officials Pre-WHA workshops for technical staff Consultations with Geneva Missions around EB and WHA Agenda Collaboration with the University of Nairobi for a Masters in GHD – due to commence in 2017/18

Other collective efforts HRH development through the ECSA College of Health Sciences – several professional colleges offering specialist training in the region Expert committees on Health Financing, addressing issues including NHAs for more efficient utilization of health funds; innovative ways of funding health Regional projects to build capacity in various areas, e.g. diagnostic capacity; emergency preparedness and epidemic response capacity and the implementation of IHR (2005) Engagement on the Global Security Agenda Work on AMR

Looking ahead Most of the battles towards the SDGs will be in Africa, so should the efforts if we are to realise those Goals There are deliberate efforts to do things differently, and the ground is receptive to new thinking The central role of a stronger health system is an imperative that is now easy to buy-into, and increasingly self-evident But like Love, Health systems strengthening is a many- splendored thing….. Efforts should be led by the components that need most attention

Thank you for your attention