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

2. 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

3. 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?

4. World Wealth Distribution: 1500

5. World Wealth Distribution: 2015

6. 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.

7. ….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

8. Health System Context

12. 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

13. 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 ( )
Pharmaceutical Manufacturing Plan for Africa (PMPA)
African Regional Nutrition Strategy (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

14. 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

15. 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”.

16. 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

17. 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

18. 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

19. Thank you for your attention