Think SDG Network Panel. 8th May, 2017. Montreal, Canada.
I come from Uganda and have been active in the African Region especially the East, Central and Southern Africa part of the continent as well as globally for some time. I am currently the Executive Director of the African Centre for Global Health and Social Transformation (ACHEST) with head office in Kampala, Uganda that works at country, continental and global level to build capacity and synergy for health systems in Africa. Our focused areas of work are health systems leadership and governance and health workforce.
With respect to SDGs, I am proud to remind you that the Minister of Foreign Affairs from Uganda, Hon. Kutesa presided over the 69 session of UN General Assembly during which the formulation of the SDGs was finalized. He was gracious enough to send Ambassador Kafeero who was his Chief of Staff during his tenure as President of the UNGA to the Eastern African SDG HPTT Consultation in Kampala last October 2016. His message was:
• The level of participation and enthusiasm from Members States, parliamentarians, local governments, civil society, the private sector, think tanks, academia, women and youth groups, and other stakeholders was unprecedented. The SDGs, as the successor framework to the Millennium Development Goals (MDGs), are therefore on sound ground in terms of universal ownership.
• There was a palpable expression of the urgent need to eradicate poverty, achieve sustainable development that leaves no one behind, and protect the planet.
• To achieve all the above goals, we require peaceful and inclusive societies, access to justice for all, effective and accountable institutions as well as a revitalized Global Partnership envisaged in SDGs 16 and 17 respectively.
Here is the status of implementation of the SDGs in Uganda as of now:
The SDGs have been integrated into the national and regional development plans in the EAC. Uganda has already incorporated over 76% of the SDGs into the second National Development Plan for the period 2015-2020, as part of Uganda Vision 2040. This is a commendable milestone. We were able to achieve this through early multi-stakeholder engagement and sensitization when the SDGs were being formulated.
At the African continental level, the SDGs will be an integral part of the implementation of the African Union’s Agenda 2063 in order to achieve the vision of an integrated, prosperous and peaceful Africa, driven by its own citizens and representing a dynamic force in the global arena.
Secondly, we have to mobilize the necessary resources, both domestic and external, for implementation of the SDGs. As individual countries strive to scale up funding, development partners and multilateral organizations should fulfill their commitments as agreed upon in the Addis Ababa Action Agenda on Financing for Development.
Thirdly, we need a change of mindset so that SDGs are viewed as a holistic agenda, with inter-linkages across the various goals and between domestic and international action. At the national level, this will call for a government-wide approach and not operating in compartments or “silos.” In Uganda, SDGs are being implemented through existing structures. As part of its commitment to domesticating the 2030 Agenda, a National Coordination mechanism has been established to steer its implementation, coordinated by the Office of the Prime Minister.
Fourth, we have to ensure multi-stakeholder engagement and participation in implementation of the SDGs on the ground as well as in the follow-up and review mechanisms, which will foster greater ownership. The involvement of the civil society, women and youth groups, think tanks, academia, the media, and other stakeholders will be crucial in ensuring successful implementation.
The private sector, which in many African countries contributes over 70% of GDP and employs between 70-90% of the population will need to play a greater role through investments in SDG sectors, including health and education. The WHA 2016 endorsed the involvement of the Non-state Actors in the health sector through the FENSA framework.
National parliaments will have a key role to play in terms of resource allocation and oversight, while local governments, municipalities and cities also have important roles in service delivery and thus implementation of the SDGs. Uganda has a Parliamentary Committee on Health and two weeks a new Uganda Parliamentary Forum on Quality of Health Care launched and I was privileged to be one of the speakers during this launch ceremony. Africa has structure that brings together Parliamentary Committees on Health and my organization is working with them to develop a Handbook to guide the work of these committees.
The experiences from the early stages of implementation of the SDGs in Uganda, and many countries in Africa, point to the importance of their integration into national and regional development plans, pursuing a comprehensive approach, and the centrality of engaging multi-stakeholders.
Let us take a look at the context and background against which SDGs implementation is playing out in Africa.
On the positive side, MDG era witnessed dramatic massive progress in health indices in Africa such as a 54% reduction in child mortality, 60% reduction in malaria related deaths, HIV related declined and the epidemic is being contained and HIV is being transformed into a chronic disease.
The results of the Uganda UDHS 2016 released just a few weeks ago reflected this Africa success: the IMR 98 - 43 per 1000, U-5MR: 177 – 64 per 1000, TFR: 71. – 54 per woman, MMR: 524 – 368 per 100,000 live births.
Challenges: However, there are challenges: Africa still lags behind the rest of the world in health and development indices by far and this is a shame and is unacceptable. How do we accelerate this progress during the SDG period? At present there is a huge implementation gap in many countries between what we aim to achieve and what we routinely attain. Through the streamlining of evidence into policies and programs, we should be able to ensure that we have quality in what we do and so that our performance is continuously improving and our targets are achieved and exceeded with the resources at our disposal. The dynamic and interdependent SDG world requires new ways of working to improve global health, underpinned by a complex adaptive systems lens and approaches that build local ownership and organizational capacity. Other challenges include high population growth rates, poverty, and urban migration, food insecurity due to the negative consequences of climate change and epidemics and wars.
“Africa Rising” as an opportunity: Economic growth has been steady and according to AfBD, 8 of the 10 fastest growing economies globally are in Africa. 34 countries have proved deposits of viable minerals including oil. This has been underpinned by the AU new directions including zero tolerance for illegitimate leadership, being people centered, belonging not only to governments but also to CSOs such as ACHEST. There has been a campaign for mindset change through the message of the African renaissance. There is an African call for ownership and accountability through the NEPAD. All this is also supported by a Global movement on equity, social justice and the empowerment of women. We need to ride on these.
Where is health in all this?
Evidence from participatory poverty assessment studies shows that African people rate their health very highly. It is a big issue during national elections and politicians are often embarrassed by their performance on health. However, the competition for limited resources leaves investment in health as of lower priority. Health is classified by economists in as a non-productive and just a consumptive sector. First in priority order is infrastructure e.g. roads, energy etc. This needs to change. It is a falsehood. We need balanced and inclusive growth. Health is an important component of holistic approaches to development that seek to replace or supplement Gross Domestic Product as the main indicator of economic progress. The UNSG Commission on Health Employment and Economic Growth has shown health to be a key source of employment economic growth and a means towards empowerment of women. Further, uncontrolled outbreaks of infectious diseases have now been recognized as a neglected dimension of global security with huge economic consequences akin to wars.
Here are three things that need to change.
1. Leadership at all levels that propagates and advocates the urgent need to eradicate poverty, achieve sustainable development that leaves no one behind, and protects the planet. A climate of opinion needs to emerge in communities, nations, regions and globally that achieving the SDGs is critical for survival of the people and planet. This is not yet there.
2. Leadership that empowers and facilitates the emergence of strong and synergistic Civil Society Organizations and Movements capable of generating, presenting compelling evidence and mobilizing key decision makers to take necessary action. Such evidence and solutions should be home grown, African owned and driven. These Organizations should have a large degree of autonomy equipped with learning ability, a working environment which integrates knowledge management and encourages innovations and self-assessment and self-organization.
3. There is need for a change in the way global partnerships are conducted; donors and recipients should work as equal partners, learning from each other and respecting and the importance of strong ownership and diffuse leadership from low-income countries.
I will conclude by sharing with you the three levels of action articulated by a consultation last October in Kampala of HPTT and academic institutions from the Eastern and Southern African region.
• At the National level, cross sectoral work is the priority for achieving the SDGs. This approach provides health think tanks with many entry points for contributing to SDG implementation. In each country, the health Think Tanks should get together with their governments and assign themselves niches for work to take forward in synergy.
• At the Regional level the health Think Tanks would like to continue to work together and bring others for collaboration through a regional network. This will initiate the establishment of an Africa Regional Network of Health Think Tanks supporting implementation of SDG in the region. This Network of African Health Think Tanks will therefore have a common interest of taking “health outcomes as a centre-stage objective”, for supporting SDG implementation.
• At the Global level, the African Region Health Think Tanks and their network, will aim to link with other institutions from the world, engaged on similar streams of work for learning from each other, building capacity through mutual support, and collaboration.