Country ownership and global health partnerships critical in achieving Universal Health Coverage
By Tawanda Chisango1
Political and global health leaders meeting mid-December on the sidelines of the universal health coverage meeting in Tokyo discussed pathways to strengthen country led efforts supported by global partnerships to achieve universal health coverage. While the meeting focused on the imperative for country ownership, domestic health financing and sustained leadership and commitment for equitable health and universal health coverage, it underscored the importance of global health partnerships in Africa’s health agenda. Global health partnerships are a cornerstone for universal health coverage hence the event sought to highlight the contribution of these partnerships in moving the universal health coverage agenda forward. Here are the key takeaways from the meeting on how global health partnerships are shaping the health agenda in Africa.
What do global health partnerships entail?
Global health partnerships are entities that were established in the 21st century to undertake focused efforts to address global health challenges. They bring together governments, civil society, international organisations, the private sector and affected communities and advance multi-sectoral efforts to streamline health cooperation with a focus on specific health issues. Their goal is to achieve health improvements that no organisation could achieve alone. The Global Fund and GAVI represent examples of global health partnerships, along with others such as Stop TB Partnership, Roll Back Malaria, UNAIDS and many others.
With clear health mandates, these innovative public-private partnerships contribute to remarkable epidemiological impact by reducing the prevalence and incidence of major diseases of global health importance. At the same time, they also bring substantial effect to countries’ national health systems. These institutions play a central and critical role in translating global goals into effective investment strategies, saving millions of lives and successfully altering the trajectory of epidemics.
What does it take to achieve Universal Health Coverage?
Achieving universal health coverage requires a portfolio of investments in both hardware and software elements of a public health system. This includes ensuring that the health workforce is enhanced, ensuring that motivated, productive and fit for purpose health workers, health infrastructure, medical products and technologies are put in place. Furthermore improved service delivery to ensure rational and effective delivery of essential interventions to maintain health and health governance to establish facilitative mechanisms for making policies and promoting accountability are equally critical. Health information, research and innovation and health financing are also essential components for achieving the universal health coverage agenda.
Optimising health financing is central to making effective progress towards universal health coverage and in particular to reducing the gap between the need for and use of services and improving financial protection. While private funds play a role in all health systems, evidence shows that it is public, compulsory, pre-paid financing that helps countries move towards universal health coverage. Low levels of public financing are associated with reduced overall financial protection and worsened health outputs.
What panelists said about universal health coverage
‘We cannot achieve the sustainable development goals if we do not address the universal health coverage agenda and end the epidemics of AIDS, tuberculosis, malaria and other new emergencies. Senegal is moving towards universal health coverage and has already made remarkable progress. In 2015, the government set up the universal health insurance agency (CMU Agency) and in 2017 the budget allocation for health was raised to nearly 25 billion CFA francs’ - Dr. Bocar Mamadou Daff, Senegal Ministry of Health.
‘Kenya is committed to implementing health system reforms to accelerate movement towards universal health coverage and realize the right to health. The health system reforms target improvements in availability of health infrastructure, training, health information management and equitable health financing systems’ -Dr. Cleopa Mailu, Cabinet Secretary, Ministry of Health of the Republic of Kenya.
‘In the Sudan, there has been a strong commitment to protect citizens from catastrophic health expenditures to ensure healthier communities and a stronger and more resilient economy. In early 2016 the Sudanese government passed a new law that mandates that every citizen has access to health insurance and care services without facing financial risk’ said Dr. Bahar Idriss Abu Garda, Minister of Health of the Sudan.
‘To harness the demographic dividend and achieve the socio-economic and structural transformation of Africa’s Agenda 2063, it is clear that health has to be put at the centre. The AU is implementing the Africa Health Strategy for the next 15 years to achieve universal health coverage through promoting social protection, ensuring access to quality assured and affordable medicines, health financing, human resources for health, improved governance and accountability and multi-sectoral collaboration and partnerships’ - Dr. Marie-Goretti Harakeye, African Union Commission.
‘Investments made by the Global Fund have expanded access to essential health services and advanced universal health coverage by helping countries provide equitable and financially accessible health services to the most vulnerable’ - Dr. Marijke Wijnroks, The Global Fund to Fight AIDS, Tuberculosis and Malaria.
‘Gavi, the Vaccine Alliance, welcomes the international community’s commitment to universal health coverage. Immunisation is a well-defined first step towards this goal and can pave way for other free-of-charge, prevention focused services to reach populations through the public health systems. Immunisation is a starting point for building primary health care and public health system core capacities. Gavi, the Vaccine Alliance will continue to accelerate innovations, implemented at scale to contribute to Universal Health Coverage’ - Marie-Ange Saraka-Yao, GAVI, The Vaccine Alliance.
1 The writer manages the health communication portfolio in the Department of Social Affairs at the African Union Commission.
African Ambassadors in Japan commit to increased role in advancing Africa’s health agenda
By Tawanda Chisango1
Ahead of the Universal Health Coverage conference mid-December in Tokyo the African Union, the Global Fund and Friends Japan along with the African diplomatic corps organised a meeting to discuss key priorities for Africa’s health agenda and fostering partnerships with the Government of Japan. During the meeting African Ambassadors and the Government of Japan committed to continue to be advocates for mobilising resources and explore further collaboration in advancing Africa’s health agenda. African Heads of State and Government in July 2016 adopted new continental health policies that includes the Africa Health Strategy and the Catalytic Framework to end AIDS, TB and Malaria in Africa by 2030. The former focuses on strengthened health systems and universal health coverage while the latter provides clear priorities and targets to address Africa’s three biggest public health threats.
‘At the centre of the universal health coverage movement is the health for all agenda that seeks to ensure that we reach everyone in need including the poorest and most vulnerable. The African Union’s blueprint for socio-economic and structural transformation, Agenda 2063 puts health at the centre and seeks to ensure that by 2063, every citizen has full access to affordable and quality health care services without incurring any financial hardships”, said Dr. Marie-Goretti Harakeye, the Head of Division for AIDS, TB, Malaria and Other Infectious Diseases at the African Union Commission while addressing members of the diplomatic corps in Japan.
The African Union has put in place robust policies through a highly consultative process that included regional blocs and their health agencies, private sector, civil society and development partners.
Strengthening African Union’s health architecture to advance global health security
To translate these policies into action the African Union is spearheading the strengthening of the continental health architecture. In January 2017 the Africa Centres for Disease Control and Prevention was established and has made significant strides including the establishment of Regional Collaborating Centres in 5 AU regions and supporting national public health institutes to respond to emergencies across the continent. The African Union is pushing for the implementation of the Pharmaceutical Manufacturing Plan for Africa’s Business Plan, supporting regulatory harmonisation through the implementation of the AU Model Law on Medical Products as well as the Establishment of the African Medicines Agency and is working on modalities to establish a Fund for the Pharmaceutical Manufacturing Sector.
The Global Fund to Fight AIDS, TB and Malaria is strengthening Africa’s health systems and needs to be sustained
Friends of the Global Fund Japan and the Global Fund to Fight AIDS, TB and Malaria briefed African Ambassadors on the importance of this private public partnership in advancing Africa’s broader health and development agenda and how Ambassadors can strengthen their role in fostering partnerships and supporting Global Fund Replenishment.
‘Health is fundamental for social and economic development and addressing this agenda is at the centre of achieving the sustainable development goals. We need to ensure we end AIDS, TB and Malaria as public health threats through increased investments in programmes that have more value for money. Investing in global health is a highly cost effective way to achieve greater security and stability, to protect communities worldwide from infectious diseases and to halt emerging health threats,’ said Dr. Marijke Wijnroks of the Global Fund to Fight AIDS, TB and Malaria.
Programmes supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria have saved 22 million lives, according to the 2017 Results Report. Furthermore more than one-third of Global Fund investments go toward building resilient and sustainable health systems, which are critical to the fight against HIV, TB and malaria, improving the overall quality of health care, and enabling countries to respond to emerging regional and global health threats. Fully funding the Global is a critical priority for Africa especially given that 65% of the Fund is invested in Africa. The African Union works with Friends of the Global Fund (USA, Japan, Europe and Asia-Pacific) and partners in donor countries and across Africa to advocate for the replenishment of the Fund. Twelve African countries committed USD 34 million in the last cycle sending a strong signal to the international community that Africa is committed to shared responsibility and global solidarity.
Greater domestic health financing investments and increased accountability needed
Despite generating more than $520 billion annually through domestic resource mobilisation, more than 8.5 times the amount the continent receives in Official Development Assistance, most African governments have not been able to consistently meet their 2001 Abuja commitment to spend 15% or more of their domestic budgets on health programmes. However the comparison against the Abuja 15% target hides the fact that domestic financing for health always was and remains the primary source of funding for health. African countries spend on average 20 times more from their own resources than they receive from Official Development Assistance. The unprecedented economic growth in Africa offers a further area for new revenue collection, both through general taxation and through a variety of innovative financing mechanisms. Africa needs to translate these favorable macroeconomic conditions to increased resources for health. African Heads of State and Government in July 2016 endorsed the Africa Scorecard on Domestic Financing for Health which will be produced annually beginning 2016 to assist African Union Member States and partners in expenditure tracking and increased accountability in health financing.
1 The writer manages the health communication portfolio in the Department of Social Affairs at the African Union Commission.
African Union and partners call for continued shared responsibility and global solidarity to end AIDS as a public health threat by 2030
Abidjan, 08 December 2017- The African Union and the Global Fund to Fight AIDS, TB and Malaria on Wednesday jointly organised a satellite symposium on domestic health financing. Despite significant progress in responding to the AIDS epidemic Africa confronts the world’s most acute public health threats that remain largely underfunded. After decades of underinvestment the continent need sustained investments in health in a context where international support has levelled due to many competing global priorities.
‘The Ebola crisis demonstrated that health systems on the continent are underfunded. The response highlighted the importance of regional and continental solidarity. While there are many competing priorities more investments are needed build resilience in our health and community systems’ said Dr. Goudou Coffie, the Minister of Health and Public Hygiene of Cote D’Ivoire.
Côte d’Ivoire announced a plan to invest CFA 21 billion in HIV programmes in the country between 2018 and 2020 to transform its health systems. With the West and Central Africa region lagging behind in its AIDS response, Heads of State and Government in July 2017 endorsed the Emergency Catch up Plan to accelerate the HIV response. The estimated cost for ending AIDS alone by 2030 is USD 36 billion a year, which is roughly twice the current levels of funding of USD 19 billion a year.
‘Given the strong economic growth on the continent, African leaders can make stronger commitments towards increasing national health budgets, and sustain and grow contributions to the national response. Recent reports indicate that lower- to middle-income countries have increased their health spending by 10% per year, much faster than the growth of Official Development Assistance for health’ said His Excellency, Ambassador John Simon, Vice-Chair of the Board of the Global Fund to Fight AIDS, TB and Malaria.
The 2007 financial recession resulted in a paradigm shift in development cooperation as it hit African economies hard. While the world is just beginning to recover, there is need to recognise that the donor and Official Development Assistance environment has changed forever. A few figures can show this clearly. Official Development Assistance which in 1990 was USD 5.7 billion grew by 5 per cent per year between 1990 and 2000 and then increased by 11.3 per cent between 2000 and 2009 to USD 38 billion. However since 2009 this has levelled at 36 billion. African countries now more than ever before need to leverage on Africa’s huge economic growth to fund its health programmes.
Since 2010, several African countries have increased their investments in the health sector. Uganda increased domestic investment 1.6-fold between 2011 and 2013 from US$ 40 million to US$ 105 million. Between 2012 and 2013, DRC and Ethiopia increased their domestic investment by more than 80%. In Swaziland, all public bodies are required to devote 2% of their budget to workplace policies for their staff. Malawi requires all ministries and departments to allocate a minimum of 2% recurrent costs budget to HIV-related activities. In 2011 Gabon increased investments in the National Fund for HIV Prevention and Treatment by approximately 150%.
‘Promoting accountability on continental and global commitments is a key priority of the African Union. It is in this context that Heads of State and Government endorsed the Africa Scorecard for Domestic Financing for Health in July 2016’, said Dr. Marie-Goretti-Harakeye, the Head of AIDS, TB, Malaria and Other Infectious Diseases at the African Union Commission who presented the scorecard at ICASA.
The Africa Scorecard for Domestic Financing for Health is a key tool for Member States in financial planning and expenditure tracking that will be released bi-annually. The African Union is working with WHO and partners to strengthen National Health Accounts.
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For more information:
Tawanda Chisango | Advocacy and Partnerships Expert | Department of Social Affairs | African Union Commission I E-mail: email@example.com I Tel: +251934167052
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The African Union spearheads Africa’s development and integration in close collaboration with African Union Member States, the Regional Economic Communities and African citizens. AU Vision: to accelerate progress towards an integrated, prosperous and inclusive Africa, at peace with itself, playing a dynamic role in the continental and global arena, effectively driven by an accountable, efficient and responsive Commission. Learn more at: http://www.au.int/en/