Kristin Palitza
BAMAKO, Nov 18 2008 (IPS) – Health systems on the continent are riddled with inadequate policies, strategies, lack of institutional capacity, poor scientific review mechanisms and weak funding for research in the public and private sector, said Luis Sambo, regional director of the World Health Organisation (WHO) in Africa.
What makes matters worse is a human resource crisis throughout the continent, based on lack of training, capacity shortages and migration of skilled health carers, Sambo further explained. Other challenges are limited access to technologies, such as Information Communication Technology (ICT), and weak physical infrastructure, he added.
Sambo was speaking at the WHO Global Ministerial Forum on Research for Health which opened in Bamako, Mali, on Monday.
Although African health experts generally agree with Sambo that the continent s health systems face many challenges, many place the blame for the situation not on a knowledge gap , as Sambo put it, but on the control of international institutions, such as the World Bank and International Monetary Fund (IMF), on national policy making in developing countries.
International finance institutions not African governments are responsible for the health crisis on the continent, as they have undermined Africa s health through the policies they have imposed for the past two decades, Peter Ndemere, executive secretary of the Uganda National Council for Science and Technology, told IPS.
There is no knowledge gap. African governments are struggling with implementation of health systems due to resource challenges and because their policies are imposed by [international organisations such as] World Bank and the WHO, he added.
The World Bank and IMF have used poor and highly indebted African countries dependency on their loans to heavily influence economic policy-making and have pushed African governments towards greater economic integration in international markets at the expense of social services and long-term development priorities. The dependency has grown beyond reasonable levels and has become unacceptable, said Ndemere.
For Africa to overcome its health problems, policymakers on the continent must regain control over national health priorities and policies, he added. Instead of making loans dependent on following World Bank economic policies, the bank should lend money based on a consultation process tailored to each donor country.
WHO and World Bank should find out from governments what their countries needs are, and negotiations for support should take place along those lines, said Ndemere. We need national approaches instead of global solutions to each and every problem. There has to be a paradigm shift. Otherwise health systems will eventually crash.
Sambo, however, insists health systems crumble because they do not consider current health research. We see a very limited use of research outputs for decision-making [when it comes to health policies throughout the continent], even if they are available, said Sambo. We need to support the translation of research results into action [to improve health systems].
Meeting public demand for universal health care is a marker for good governance in any country, he added with reference to the Millennium Development Goals (MDGs) most African countries have committed themselves to reach by 2015.
Social protection needs to be included in health policy making, Sambo further said, because social issues, such as poverty, poor housing and lack of employment are all contributors to ill health and markers of policy failure.
Walter Erdelen, assistant director-general of the United Nations Educational, Scientific and Cultural Organisation (UNESCO), agreed: It s not always easy to change patterns, but we simply have to reach millions to whom health care is still a luxury.
World Bank senior health advisor Ok Pannenborg also demanded more aggressive support for health systems, especially in developing countries. He criticised the fact that only marginal attention has been paid to developing well-functioning and equitable health systems and making existing health services more effective.
First [investing resources into] fighting diseases and only later fixing health care systems does not bring satisfactory results, Pannenborg said, stressing the fact that, particularly in Africa, better health systems were needed if countries want to successfully fight HIV, malaria and tuberculosis.
Africa hit a wall because of corrupt and badly designed health structures, severe human resource shortage and lack of health facilities, Pannenborg added. He said trying to access health care in Ethiopia, for example, was like living in Washington DC in the United States, which has a population of half a million people, with only 18 physicians available in the entire city.
Research can play an important role in helping to understand problems affecting health systems and develop new models for health care provision, Pannenborg said. Yet, it is of little use unless someone translates findings into action and innovation, he added.
Pannenborg acknowledged, however, that even with policies informed by cutting-edge health research, African countries struggle to implement policies due to structural hurdles. There are many challenges, including weak transport that hinders supplies from reaching remote areas, food insecurity, few good health insurance options for the poor, lack of housing and lack of skilled health care personnel, to mention a few examples, he said.
Governments need to consider that health is not an isolated issue but intersects with matters of transport, employment, poverty, education and food security, among other issues. That s why inter-departmental cooperation within a country is so important, he said, noting that departments cannot work in isolation if they want to develop successful policies.
Other experts highlighted the fact that there are no global, one-size-fits-all solutions to national health care demands. The cookie-cutter approach doesn t work, noted Keizo Takemi, senior fellow of the Japan Centre for International Exchange. It is essential that each country invests in health policy research and develops national best practices.
Takemi stressed the importance of governments finding a people-centred, community-driven approach to health systems development. We need to focus on the demand side and put our efforts in bottom-up policy making, he said.
Africa needed pro-poor health systems , Pannenborg agreed. Governments needed to implement programmes that specifically facilitated health service provision to the disadvantaged. He also suggested that countries invest in monitoring and evaluating results of their current health systems. You need to find out what s working and what is not to be able to adapt strategies into more successful ones, he said.
