The African Union Commission convened global and regional health leaders, National Heads of States and Governments in Addis Ababa on the 9th February 2019 for the African Leadership Meeting (ALM)- Investing in Health.
A crucial outcome of the meeting was the “Addis Ababa Commitment toward Shared Responsibility and Global Solidarity for Increased Health Financing Declaration”. The Declaration, otherwise known as the ALM Declaration, is an initiative geared towards increasing domestic resources for health and reorienting health systems in Africa.
The endorsement of the ALM Declaration by Heads of State and Government of African Union (AU) Member States serves as recognition for the need to improve the health financing status quo in Africa, by investing increased domestic funds for health in a more effective and efficient way.
The Declaration specifically calls for Increased Domestic Resource Mobilization for Health; and in tackling existing inefficiencies in health budgets towards financing more effective and efficient health systems. The declaration also calls for better collaboration between multi-sectoral actors - regionally and globally - to strengthen existing health systems in AU Member States. It further invites the private sector to explore and seize existing opportunities for investing in the health sector.
High-impact, multi-sector partnerships will go a long way in strengthening the concrete asks of the ALM Declaration which include:
The ALM Declaration also appoints H.E. President Kagame as AU Leader for Domestic Health Financing and charges the AU Commission with leading implementation of these interlinked components of the ALM Agenda and with coordinating the alignment of partners to Africa’s priorities.
The Africa Scorecard on Domestic Financing for Health measures progress by AU Member States against global and continental benchmarks on health financing and public finance management. In short, it measures performance against outcomes.
The health financing progress Tracker will complement the Scorecard by bridging the gap between desired outcomes [the Scorecard] and the steps countries will need to take to get there. The final Tracker will fulfil two functions:
The Tracker is being developed for use by senior technical officials within Ministries of Finance (MoF) and Health (MoH) as well as by the Hubs – who will provide support to country efforts. Coordinated by the AU, it is being developed in adherence to the Paris, Accra, Busan principles for effective development assistance: country-led, build on what exists, leverage the wealth of country experiences and existing tools & data, and seek to reduce the reporting burden.
The ALM Declaration calls for the establishment of Regional Health Financing Hubs in each of Africa’s five regions. The Hubs are intended to become regional communities of practice based within Regional Economic Communities (RECs). Hubs will provide the technical and practical expertise to support REC Member States to implement the reforms set out in the Tracker as well as to coordinate the alignment of development partner efforts to Africa’s priorities.
The first Hub will be piloted in the East African Community (EAC) during 2021. To this end, following an assessment mission of the AU Commission in February 2020, the EAC has convened an Expert Working Group (EWG) of EAC Member States and key partners to consider the hubs and establish the EAC pilot.
The 2001 Abuja Declaration was a historic milestone for Africa. The AU Member States met and pledged to set a target of allocating at least 15% of their annual budget to improve the health sector. Over the years, health expenditure in Africa has increased significantly, but domestically financed government spending has stalled.
According to the 2019 Africa Scorecard on Domestic Financing for Health: only two AU Member States dedicate 15% of the government budget to health; five dedicate 12%; twelve dedicate 10%; twenty dedicate 8% of GDP on health; and 29 spend less than 7%. Moreover, out-of-pocket spending on health exceeds 20% in 41 AU Member States.
Development partner spending on health constitutes more than 50% of total health spending in three AU Member States; more than 40% of total health spending in 10 Member States; 25% in 20 Member States; and 10% in 17 Member States.
This must change. The future of Africa depends on its people. To make progress on the path of sustainability requires that Member States make substantial incremental increases in domestic investment in health every year. The Declaration, if implemented with sustained political commitment and accountable leadership will deliver Africa to the desired change.
July 11-12, 2019
The Pan African Parliament Summit: Brazzaville, Republic of Congo
Parliamentarians in attendance signed a communiqué where they pledged to support the ALM Declaration through various ways, importantly, by passing policies aiming at increasing domestic health financing and enhancing accountability during implementation of the Declaration;
July 29 - 2 August, 2019
Third Ordinary Session of the Specialized Technical Committee on Health, Population and Drug Control (STC-HPDC 2019): Cairo, Arab Republic of Egypt
The Department tabled several suggestions to Ministers of Health from African Union (AU) Member States regarding domestication of the ALM Declaration and respective implementation mechanisms and strategies. Following in-depth discussion, they endorsed establishment of: Regional health financing hubs; A domestic health financing tracker; An Accountability Framework; and Technical Working Groups. They also endorsed digitization of the Africa Scorecard on Domestic Financing for Health and the tracker;
The Commission sent out letters to AU Member States calling upon their commitment towards health financing with specific reference to participating in the Replenishment Cycles and Conference in Lyon. 24 AU Member States responded to this call and leading to a cumulative pledge of US$ 75.2 million from Africa. This, in fact, is a 90% increase in Africa’s pledges from the 2017-2019 Replenishment cycle, which is a commendable indication of growing commitment from our leaders to improving health financing in Africa;
November 12, 2019
ALM Declaration Technical Working Group Meeting Kigali, Republic of Rwanda
The Department organised and executed the first ALM TWG. The conceptual frameworks guiding formation of the tracker, the regional health financing hubs and accountability framework were presented to the vast pool of health financing experts across both public and private sectors present at the meeting. The experts offered their recommendations which were used to improve the concept notes. They were also briefed on the outcome of the July STC-HPDC 2019 regarding the same.
November 13 – 14, 2019
AIDS Watch Africa (AWA) Experts Consultative Meeting: Kigali, Republic of Rwanda
Health experts from AU Member States working in the field of AIDS, TB and malaria were convened to prepare a report with key advocacy, resource mobilisation and accountability issues posed by the three diseases for the consideration of the AWA Heads of State and Government Action Committee.
The progress of implementation of the ALM Declaration was presented to the experts who were well-pleased with the initiative and pledged their support. The meeting was attended by health experts from 21 AU Member States, AUDA-NEPAD, 4 Regional Economic Communities (RECs) and 24 partner organisations.
November 15 2019
African Union - Regional Economic Communities (RECs) Coordination Meeting: Kigali, Republic of Rwanda
A working meeting with representatives from RECs was conducted to discuss hosting the regional health financing hubs within RECs. Representatives from Southern African Development Community (SADC), West African Health Organisation (WAHO), the East African Community (EAC), and Intergovernmental Authority on Development (IGAD) presented on their ongoing efforts towards strengthening health financing in Africa. The information was used to determine the RECs assessment mission schedule for 2020.
January – February 2020
The formation of the main ALM technical working group (TWG) and subcommittees took place. The members will shape and lead the strategic direction in which implementation of the ALM Declaration heads.
February 10, 2020
African Union Summit: Addis Ababa, Ethiopia
His Excellency Paul Kagame, President of the Republic of Rwanda and AU Leader for domestic health financing briefed the AU Assembly on the progress of implementation of the ALM Declaration. His report was complemented by briefing from His Excellency Cyril Ramaphosa, the President of the Republic of South Africa and Chairperson of the African Union (AU) and AIDS Watch Africa (AWA) about the progress attained by AWA in 2019.
February 20, 2020
Regional Economic Communities (RECs) Assessment Mission: Arusha, Tanzania
The Commission conducted its first RECs assessment mission in February to evaluate the capacity of the East Africa Community to host a regional health financing hub.