Africa’s Health – a burden

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This is according to Dr Eric Buch, NEPAD (New Partnership for Africa’s Development) Adviser on Health as well as a Professor of Health Policy and Management at the School of Health Systems and Public Heath, University of Pretoria.

Buch begins by pointing out, in no uncertain terms, that Africa suffers a burden of unnecessary disease which impacts families, impoverishes large numbers of people and undermines socioeconomic development on the continent.

The bottom line is that Africa’s health systems are struggling to provide effective and adequate healthcare. “At the heart of what we’re doing,” Buch points out, “is a process of trying to support efforts to tackle not only the major burdens of disease on the continent, including Aids, TB and Malaria, for example, but also many other diseases affecting communities like childhood deaths, caused by diarrhoea and pneumonia to sleeping sickness etc.”

In addition to the above, a horrible statistic is that an African woman stands a one in 20 chance of dying from a condition related to pregnancy and childbirth.

The strategy
“The focus of our strategies,” Buch explains, “is how to reduce this disease burden. We advocate that tackling the disease head on is difficult without having an effective functional health system.” He says that a good analogy for this integration is seeing HIV and TB, for example, as packaged in suitcases to be delivered and the health system as being the vehicle needed to deliver the solutions. “Without the vehicle,” he continues, “the packaged products will not go anywhere. The integrated approach – building the health system and impacting on disease burden too – is at the centre of what we’re advocating.”

However, Buch points out, in order to facilitate the above, an additional vehicle is needed, and that is investment. “We’re strongly advocating,” he says, “for our development partners not only to increase their investment in development aid for health, but also to change the architecture around which that aid is being given toward longer-term, more predictable financing of systems, as opposed to short-term funding of individual or small programmes.

The aid for improving, or the willingness thereof, from the country itself can be determined by that country’s
willingness to invest its own resources into the health and healthcare sectors.

“I feel very strongly,” says Buch, “that a country cannot say the health of its nation is a priority unless it is increasing its own investment in the health sector.” Buch, rather happily, acknowledges the fact that there has been a “marked increase in health spend” in African Union countries over the past few years, but also says that it has been insufficient to finance an effective health system which requires approximately $50 per capita per annum. “It is for this reason,” he says, “that NEPAD is using every opportunity to advocate the aforementioned framework elements to become part of the global and continental health approach.

Human Resources
What has been an under-recognised problem in Africa’s system is the health workforce crisis. Africa suffers from a lack of production of sufficient healthcare professionals combined with the fact that many emigrate subsequent to qualifying. Other challenges include the conditions under which healthcare workers work, inadequate auxiliary and community health workers, poor conditions of service, etc. “This is only the head of the hippopotamus, ” says Buch.

The human resource analysis led NEPAD to work at the forefront of global and continental efforts to combat this and, in so doing, has joined the Board of the Global Health Work Alliance (a multi-stakeholder organisation involving international organisations, private sector foundations, civil society and countries – all brought together by a common commitment
to tackle this crisis). NEPAD plays an active role in African efforts to address this problem. “Less than a decade ago,” Buch highlights, “this was a forgotten area in health systems in Africa and NEPAD has played its part in taking health workforce issues to the top of the development agenda, where it belongs.”

An influencing factor
“Although the NEPAD Secretariat is small when compared to other organisations,” says Buch, “there is no doubt that it has had an influence way beyond its finance and staffing by looking carefully at the niche role and contributions it can make. It has comparative advantage by virtue of its space as a Continental African Union Planning and Co-ordinating Authority and in line with the broad strategies determined by African Heads of State.”

One benefit of this influence is that the question of access to quality medicines is being addressed. “Onlyabout a half of all Africans get the medicines they require,” says Buch, “and not necessarily on a regular basis.” There are a great deal of factors that impede access to medicine, and NEPAD has tried to identify where it could make niche contributions within the framework of the Pharmaceutical Manufacturing Plan for Africa, adopted by the AU Summit.

Two areas are being worked on at the moment. The first is pharmaceutical innovation and technology transfer which aims to increase Africa’s capacity for pharmaceutical manufacturing. “We recently held a multi-stakeholder consultation, which reviewed the framework and tools, to assess countries technological capacities and help them plan,” says Buch. “The approach was supported and we’re now moving towards the implementation phase in pilot countries.”

The second area being addressed is the issue of medicine registration harmonisation. “What is clear is that on the continent there is a huge problem as far medicines registration is concerned, and this impedes timely access to necessary medicines for the poor,” Buch points out. He says this occurs because of long delays in getting medicines registered. Different documentation and requirements in different countries result in increased transaction costs for suppliers, leading to many of them withholding medical supplies from the market as the cost is not worth the return.

“This,” he continues, “is also an opportunity for us to achieve our Heads of State Strategy for integration of the continent and for using regional economic communities as drivers of development in order to create better economies of scale and a more effective collaborative use of scarce resources on the continent. What we’re working towards is the idea that regional economic communities will harmonise the medicine registration process and countries will work together using common technical documents and shared factory inspections, as well as common registration platforms to reduce costs and improve quality of registration.

“We see this project,” he concludes, “as a model of the strategies for regional economic integration which will work together collectively as engines of development.”