Blogs - African Centre for Global Health & social Transformation

MOBILIZING GLOBAL SOLIDARITY FOR UHC

Dear Colleagues,

Here is a discussion for our consideration and action at this time.

As the world prepares for the United Nations General Assembly (UNGA) in New York in September, 2023, it is important for us to prepare ourselves ideologically for this event. The theme for the UN High-Level Meeting on UHC is: Universal Health Coverage: expanding our ambition for health and well-being in a post-COVID world.
We need to remind ourselves of the basics; namely that health of the people is a precondition for productive lives. The right to life is also a right to health and a right to responsive health systems. The quality of life varies between regions and within countries; where in some cases there is unacceptable poverty, lack of social justice and equity. This is in a world which is connected, interdependent and globalized with knowledge and resources to achieve UHC but sadly lacks the will and organizational capacity needed to expand and achieve our ambition enshrined in the SDGs. Our response to the existential threat from Climate change is also constrained by our inability to mobilize for collective action.

There are admirable achievements such as negotiation of the SDGs, rolling out Global Health Initiatives such as GAVI and the Global Fund for AIDs, TB and Malaria and UN Agencies like WHO, UNICEF. The ability of these agencies to achieve UHC that leaves no one behind cannot be realized until the people themselves are reached and engaged through PHC that is owned and driven by the communities themselves and where the people participate as a duty and a right using the currently available resources. …

Achieving UHC is also challenged by the quality of partnerships between countries in implementing PHC and reaching communities. Some countries and their institutions are donors while others are recipients of aid for health. Many conferences have been held on aid effectiveness and there are good practice guidelines which are not generally followed. However, in my experience, if aid receiving countries take the leadership and are clear about what results they aim to achieve with the aid, donors are likely to follow. The implementing individuals from both sides need to be prepared for their roles and be personally committed to improving health.

There are also commercial determinants of health which are private sector activities and products that are detrimental or promotive of population health. Country health systems and corporate national and global institutions need to be awake to these and guide their populations accordingly as well during negotiation of contracts and trade deals.

The role of civil society organizations and academic institutions in mobilizing for UHC is critical. The contribution of these institutions is through holding governments and duty bearers to account and creating a climate of opinion among communities, countries, regions and globally that enables to adoption and implementation of health promoting policies. The health of the people cannot be left to the market. The COVID-19 pandemic has demonstrated the centrality of strong and resilient health systems in all countries. The COVID-19 experience provides all countries with an opportunity to rethink the priority of health systems in their national plans. The pressures for resources in every economy are many but keeping the heath agenda visible and funded is popular with the people who value their health highly. Population health should be a visible issue over which elections are won and lost in all countries.

This week, I am attending the WHO African Regional Health Ministers conference in Gaborone, Botswana. What has struck me here is the observation that there are African countries that are high performers in achieving health goals and at the same time there are countries where health indices are depressing. The difference between the two appears to be the level of political commitment to population health and political and social stability.

This discussion cannot be complete without referring to Human Resources for Health who are responsible for implementing health plans and running health systems. There is a global health workforce (HWF) crisis that was recognized over twenty years ago and is characterized by widespread shortages, mal-distribution and poor working conditions. I served in the past as Executive Director of the Global HWF Alliance at WHO and continue to follow this subject closely. I am disappointed to note that global interest in this subject has declined and the agenda is underfunded. HWF migration from the poor to the rich countries is rampant and out of control partly fueled by push factors of poor working conditions, low pay and unemployment in low income countries. The WHO Code on the International Recruitment of Health Personnel that was adopted by the World Health Assembly in 2010 is available to guide HWF migration. This Code provides for the training of a global pool of HWF to be shared using the Code. However, this is not happening which poses a threat to our ability to achieve UHC and global health security.

It is my prayer that the UNGA in September, 2023 will address the above issues and become an effective vehicle for mobilizing the right climate of opinion, global solidarity and harmony for expanding our ambition for health and well-being in a post-COVID world.

What are going to do about all this?

Sincerely,

Francis,

COORDINATING AFRICAN HEALTH LEADERSHIP

Dear Colleagues,

Here is our topic for this month.

I participated at the 5th Global Forum on Human Resources for Health (HRH) convened by the World Health Organization (WHO) in Geneva, 3th to 5th April 2023. This is the top global HRH event that takes place every two to three years; hosted by different countries round the world. At this Geneva meeting, the African Regional Office of WHO (WHO Afro) presented a draft of the African Health Workforce Investment Charter that is being developed by that office. The following day, The African Centers for Disease Control (Africa CDC) presented another draft of the African Health Workforce Strategy being developed by the Africa CDC. Upon making inquiries, it became evident that these two African Health institutions efforts to develop Health Workforce plans for Africa are in parallel and not coordinated. This is the reason I am moved to write about the urgent need for coordination and harmony between the WHO Afro and the Africa CDC. There are likely to be other areas of work where parallel, uncoordinated and conflicted pieces of work in Africa are being undertaken by these two institutions that will result in duplication of efforts, undesirable competition and create more problems than solutions to Africa’s health agenda.

According to the websites of the two organizations, “Africa CDC is a continental autonomous health agency of the African Union established to support public health initiatives of Member States and strengthen the capacity of their public health institutions to detect, prevent, control and respond quickly and effectively to disease threats. Africa CDC supports African Union Member States in providing coordinated and integrated solutions to the inadequacies in their public health infrastructure, human resource capacity, disease surveillance, laboratory diagnostics, and preparedness and response to health emergencies and disasters. It was established in January 2016 by the 26th Ordinary Assembly of Heads of State and Government and officially launched in January 2017. The institution serves as a platform for Member States to share and exchange knowledge and lessons from public health interventions”.…

On the other hand, “the mission of the WHO Afro is to enhance AFRO’s technical support to countries for scaling up proven public health interventions; and strengthen partnerships with UN agencies, regional economic communities and other stakeholders”.

I raised the matter of parallel efforts between Africa CDC and WHO Afro with Dr. Tedros Adhanom Ghebreyesus, the Director General of WHO. He confirmed his support for the Africa CDC and showed me a news item from Aljazeera in which Dr. Tedros, in 2013 as Ethiopian Minister of Foreign Affairs at the African Union Executive Council meeting in Abuja, Nigeria is quoted as follows “Ghebreyesus said Ethiopia is proposing to establish an African Center for Diseases Control and Prevention (African CDC) or Health Commission for Africa under the umbrella of the African Union.” Dr. Tedros believes that WHO Afro and Africa CDC can work well side by side synergistically provided there is clear guidance and clarity of roles provided by the African Union and that there are leaders in these institutions who are willing to work collaboratively and in partnership.

I have personally been active in the African health space for some time and I remember how WHO and the African Union worked well together to adopt the first African HRH Strategy by Health Ministers, coordinated by NEPAD. I also remember Bience Gawanas, then Commissioner for Social Affairs at the African Union, co-chairing a WHO Task Force on Education and Training of HRH.

It is critically important for the newly created Africa CDC to work harmoniously with the 75-year old WHO Afro. If this does not happen, the health of the people of Africa is in danger. Both organizations are overseen by the same Health Ministers who meet regularly and the structures for harmonization are available. The two organizations should also take note of the fact that there are other structures in Africa that have been created by the same authorities on health. Examples are the Health bodies of the Regional Economic Communities such as the West African Health Organization and the East, Central and Southern African Health Community.I have seen these two organizations effectively move many health programs in the countries. Along with these, are Civil Society organizations that have knowledge and expertise on various health topics. For example, we have the African Platform on HRH that has convened a number of consultations and has capacity to support the African HRH agenda.

This is a call for cohesion and synergy in moving the African health agenda forward as a global public health good. The development partners, donors and funders should keep this in mind as they support coordinated Africa’s health development.

What do you all think?

Francis

REALISING THE SOCIAL MISSION OF UNIVERSITIES AND TRAINING INSTITUTIONS.

Dear Colleagues,

There are many stories of poorly planned health workforce programs in our countries. There are also many meeting taking place on health professionals education and training. at the same time, there are strikes and reported cases of suicide resulting from failure to get employed after graduation and completion of internship.

Here below are my thoughts on long term solutions. Looking forward to seeing your responses.

There is a lot of renewed activity in Africa and globally on the subject of health professionals’ education and training. A meeting took place at the beginning of February, 2023, in Kigali, Rwanda, of the Governing Council of the African Forum for Research and Education in Health (AFREhealth). In November, 2022, two meetings took place; in Miami, USA and in Accra Ghana on this topic. In May 2022, there was a Forum in Canada; McGill University School of Population and Global Health on “Nurturing Leadership for Health: are Universities Stepping Up?” Another meeting took place last week of February, 2023 in Pretoria, South Africa. So, what is going on? Are we making any progress? Are health professional training institutions contributing to better health globally, regionally and nationally? Are they just about themselves?

The Lancet Commission on the Education of Health Professionals for the 21st Century issued its report ten years ago recommending a new generation of reforms in health professionals’ education. Universities, especially university leaders, are called upon to become the change agents among the people that they serve. These leaders should demonstrate social accountability and teach their students to be societal change agents by exemplary lives; engaging with their ministers of health, cultural, religious and civil society leaders. The purpose of this engagement is to ensure that better population health is visible in practice as a result of teaching and research. Failure to achieve this qualifies universities to be described as ivory towers that are disconnected from their communities.…

University leadership, including all Faculty should engage proactively with politicians and the public to ensure that knowledge, research and training are aligned with efforts to improve the performance of health systems and advocate and guide investments in health. This requires reviewing incentives for promotion of university lecturers that are currently skewed towards research and publications with insufficient emphasis on teaching and service. When students see this as a dominant role model, they also aspire to become researchers resulting in a gap in service and teaching.

Clinical excellence through services delivery is a pre-requisite for clinical teaching followed by the need to undertake research to address identified gaps in knowledge for improved services and teaching. This was described at Makerere Medical School as the three-legged African stool. If the legs of the stool are not of equal length or one of the legs is missing, the stool is unstable and unsafe. Growing up at Makerere, it was a requirement for all heads of clinical departments to be university employees alongside many non-university employees at the Mulago referral and teaching hospital. These university leaders were also advisors to the Ministry of Health in their respective clinical specialties.

In order for universities to have a social mission and be change agents, it is important for them to track and follow the performance of their graduates. Graduate tracking is a source of feedback that improves teaching and contributes to improved quality services delivered by the graduates. This is also needed to improve health workforce planning and management. There are many reports from African countries where graduates remain unemployed for long periods of time and many migrate especially to the developed countries at a huge cost to the source countries of migrant health workers. Tracking graduates by universities in partnership with their governments can also be an entry point into negotiating bilateral and multi-lateral agreements with other countries on managed migration, guided by the WHO Code on the International Recruitment of Health Personnel adopted by the World Health Assembly in 2010.

The Sub Saharan African Medical Schools Survey that looked at all Medical Schools in Sub Saharan Africa, found that many private medical and nursing schools have emerged with the primary business aim to make money with questionable attention to the quality of graduates. Regulation and accreditation of these schools is challenging because many have connections to politicians who interfere with the roles of regulatory and accreditation agencies. In some cases, Regional accreditation mechanisms are in place which help to protect the independence of the regulatory bodies and assure quality of the training institutions and graduates.

Another set of key players are the professional associations in the countries. These have a key role in ensuring the universities and training institutions are supported to play their rightful roles and that the standards of teaching and service, including ethics are responsive to societal health needs. The Global Health Workforce Alliance recommended a tool known as Country Coordination and Facilitation (CCF); a forum that creates partnership structures in countries comprising, Ministries of Health, Education, Public Service and Finance along with Professional Associations, to develop National Health Workforce Plans and ensure that these are implemented to scale. Effective CCF committees would guarantee the achievement of the required competencies, skill mix, numbers and budget so that all graduates get employed. This will make it possible for every person, in every village, everywhere have access to a motivated, skilled and supported health worker responding to population health needs.

This is a call to action to universities and training institutions. They should commit to pursuing social accountability by engaging with health professional associations in all disciplines and advocate with political leaders and the public for the creation of CCFs in the countries as vehicles for realizing their social mission and achieve better health of the people.

What do you all think?

Francis.

DECOLONIZING GLOBAL HEALTH FOR BETTER POPULATION HEALTH

Dear Colleagues,

The concept and discussion on OUR post colonial relations is important for population health outcomes and deserves our attention. Here are my thoughts. What are yours?

During the AFREhealth conference held in Harare, Zimbabwe last August, 2022 there were some presentations on the topic of decolonization of global health which were followed by vigorous discussions. I have since taken more interest on this subject and have been surprised to find that the subject of globalization is huge with many websites addressing diverse aspects of the subject including a group focusing on decolonizing contraception!
There are a number of highly regarded schools of public health and other institutions that are introducing new programs for students under Schools of Decolonizing Global Health and awarding Masters of Public Health degrees in Decolonizing Global Health.

So, what is decolonization with respect to global health? Decolonization of global health is variously defined as a movement that fights against entrenched systems of dominance and power imbalance in the work to improve the health of populations. This power imbalance may take place between countries, institutions, in commerce and trade in health commodities and in the policy dialogue arena. Generally, the imbalance and inequity is between previously colonized regions on the one hand and the successors of the colonizer countries and regions on the other hand. It is between the governments and institutions and individuals in the global north and the global south or the so-called rich and poor countries. At individual level, relics of our colonial history have left behind overt and covert ingrained perceptions and attitudes of superiority that result in behavior that patronizes colleagues and institutions based on which region we originate from. The net result is that a small outsider elite gets to determine what health interventions get implemented in what context, what resources go to whom, and, in short, who lives and who dies. …

At the level of institutions, there are many organizations active in global health that knowingly or unknowingly perpetuate the very power imbalances they claim to rectify, through extractive attitudes, policies and practices that concentrate resources, expertise, data and branding within high-income country institutions.
We also have philanthro-capitalism where global resources are concentrating in fewer and fewer hands and some of these companies and foundations are able to fund the global health industry and exercise disproportionate power in global health decision making by moving global health governance from democratic spaces to secretive high-diplomacy affairs away from the public arena.

On the other hand, before piling all the blame on our northern colleagues, we from the south have to accept and take some responsibility. I have participated in high level negotiation spaces on global health issues where our delegations from the global south have gone to meetings not well prepared, in small numbers compared to our northern partners and we have lost arguments because of our own weaknesses. An example is the decision to vest the leadership of the Global Fund to Fight Aids, Malaria and TB with a country partnership; the Country Coordinating Mechanism (CCM) and not with government agencies was forced on Southern delegations by Northern partners because we had not prepared our arguments well and in advance which the others had done.

On other hand when we have been well prepared we have got our way. An example here was the drafting and adoption of the WHO Code on the International Recruitment of Health Personnel at the World Health Assembly (WHA). In this case we held an African and partner retreat in Madrid one week ahead of the WHA where we rehearsed the arguments and procedures for adoption of the Code and everything went exactly as we planned.

At country level, where I served as Director General of Health Services as well as donor coordinator in the health sector, we worked well with the Ministers of Health and technical colleagues to ensure that we led the policy dialogue with partners. The Sector Wide Program that we implemented worked well producing results which attracted more and more donors. Based on this experience I am convinced that when countries lead donors will follow, especially when positive results in health outcomes can be demonstrated.

Returning to the discussion on decolonization of global health, I want to argue that the solution to the current imbalances starts with the southern partners taking charge and demonstrating leadership in our countries. With the political independence that we won over half a century ago we have the mandate and duty to show this leadership with respect our health policies and health systems. When we are clear and united about what we want to do for the good health of our people the northern partners will respect and support us. Sometimes we do not speak with one voice as a continent which makes it difficult for partners to support our policies and programs. There is evidence for this from African countries that take clear positions that are followed by northern partners who have good intentions. Those with wrong intentions are shown the road or find their way to the airport and they go away and stay away.

Similarly, global health sector negotiations need high quality advance preparation, consultation and solidarity among southern countries. If this approach is adopted at the African Regional level and in partnership with other southern countries, I have no doubt that global health will be decolonized. Some attitudes and mindsets die hard and persist but their negative consequences on the health of our people will be negligible.

What do you all think?

Sincerely,

Francis.

CLIMATE CHANGE IS HERE; PLEASE ACT NOW

Dear Colleagues,

Awareness among ordinary people on the threat of climate change is low and I am concerned.

The impact of Climate change in the daily lives of the people round the world has been very visible in the news. We have seen graphic pictures of starving children, and dying animals from drought and food shortage. We have seen wild fires destroy homes and disrupt livelihoods and we have seen pictures of floods destroying homes and disrupting livelihoods of communities and there are reports of rising sea levels threatening to wipe out small island nations.

There are epidemics of malaria and other diseases attributed to climate change and pandemics such as Covid-19 are expected to increase in frequency as a consequence of climate change. Yes, we have been informed about how the Antarctic ice sheet is melting and separating.

At personal level, I have a farm where I grow entirely rain-fed crops. The rains have frequently failed in recent years resulting in food crop failure and I have lost money in the process. Worse still, the local the population are chronically short of food.

My major concern is that while Climate change is the single biggest threat facing humanity, I do not see a matching effort to inform and educate African populations actively about this very serious threat to them. The African people know that the rains are irregular but they do not know why and how to respond. …

While no one is safe from the risks of climate change, the people whose lives are being harmed first and worst by the climate crisis are the people in rural Africa who contribute least to its causes, and who are least able to protect themselves and their families from the consequences.

Climate change is now affecting the social and environmental determinants of health – clean air, safe drinking water, access to food and secure shelter. It is estimated that between 2030 and 2050, climate change is expected to cause approximately 250, 000 additional deaths per year, from malnutrition, malaria, diarrheal diseases and heat stress among others causes. Countries with weak health infrastructure mostly from low income countries will be the least able to cope.

The Climate crisis threatens to undo the last several decades of progress in development, global health, and poverty reduction, and to further widen existing health inequalities between and within populations. It is severely jeopardizing the achievement of Universal Health Coverage (UHC) in various ways – including by compounding the existing burden of disease and by exacerbating existing barriers to accessing health services, often at the times when they are most needed.

What therefore should our countries be doing to create climate resilient health systems? First, governments and Civil Society should ring the alarm bells, beat the war drums to raise awareness and visibility of this crisis among the population. The evidence to highlight the crisis is already available in the impact of the crisis on livelihoods. These countries can already respond by reducing emissions of toxic greenhouse gases through better transport, food and energy-use choices which can result in improved health, particularly through reduced air pollution which is an issue in many of our cities. Adaptation of agricultural practices to growing food crops that are resilient and can be safely stored for long periods including appropriate water management.

Our academic institutions should undertake climate change and health vulnerability and adaptation assessments at population and health care facility level to generate additional evidence to support advocacy and plan the response. Our governments should develop National Adaptation Plans targeting population health which should be widely disseminated among the people. Our Parliaments should enact laws on climate change and allocate sufficient resources to ensure that the implementation of the laws is fully funded.

Health professionals should become advocates for climate action and equip themselves with the necessary data to influence public opinion and national policy as well as acquire the technical competence to prepare the health system and the workforce to respond to the Climate Change generated disease burden.
Collectively as the global community, we should join the movement and campaign to cause the big carbon emitting economies to act to curb emissions faster than is being done now and meet the targets on keeping global temperature rise to the required levels.

What do you all think?

Francis.

PROMOTING SOUTH-SOUTH COOPERATION IN THE CONTEXT OF COVID 19 CRISIS

Dear Colleagues,

Here is a blog written for us by Dr. Patrick Kadama; Director Health Policy and Strategy at ACHEST.

“building back better for more resilient health systems in Africa and the Global South”.

The impact of the COVID-19 Pandemic emerged in different ways across the globe. It directly caused devastation through unprecedented morbidity and mortality in the North but, its effects in the South, were deeply felt largely due, to weak health systems, gaps in social safety nets, scarce resources, and other factors of weak social and economic institutions. This divide distorted the global response to the pandemic. Major gaps exposed include the lack of international solidarity and sharing, including not only reluctance to share pathogen data and epidemiological information, but also resources, technology and tools, such as vaccines. This is contrary to the Nagoya Protocol for example. There has been disregard of the International Health Regulations and the WHO Code, resulting in recruitment of Health Professionals from the South to plug staffing gaps for managing the pandemic in the North. A North-South divergence in the fight against the COVID-19 crisis has emerged.…

This has unmasked a fact that at present, “Global Health” practice, perpetuates the very power imbalances it claim to rectify, through colonial and extractive attitudes, and policies and practices that concentrate resources, expertise, data and branding within institutions of the Global North. These colonial attributes of global health, place Africa at a great disadvantage for gainful participation in the governance power dynamics which are shaping health policies and responses. This has brought to the fore, gaps and structural asymmetry underlying the power imbalances in the vertically structured global health practice between the North and the South. A contextualized consideration of the Africa region is required to meet challenges relating to this spill-over of a colonial supremacy mind-set, of the vertical North to South Global Health construct.

The role of the horizontal approach of “South to South” Collaborations (SSCs) in development is characterized as offering a “unique pathway” that accelerates efforts towards achievement of the SDGs. SSCs is going beyond the aid agenda to integrate a variety of cooperation modes such as those advocated in the “Kampala Initiative” on cooperation and solidarity within and beyond aid. Studies of SSCs drivers, found that it produces good development results. SSCs must be used to support resilience of institutions to plug gaps that are making it difficult for African countries to mount strong pandemic responses. Measures must ensure that vulnerable populations that are over-represented in the labor-intensive, low-skilled activities that were most affected by lock downs, particularly the youth, women and children, are supported to access basic services for health, education and economic productivity for well-being. Cooperation should be designed around three basic areas of concern.
First, there is a capacity deficit requiring scaling up institutional resources to address the relative lack of expertise and technical knowledge, necessary for effective global health dialogue; Think Tanks, professional networks must be strengthened to guide and support delegations from the South, throughout negotiations in multilateral setting, for solidarity on common positions, say, in answering to the question of whether the world needs a Pandemic Treaty post COVID-19.

Second, there is fragmentation in the policy space requiring countries to pursue inter-sectoral collaboration for coherence between health and other sectors, to ensure that trade, economic and infrastructure investment policies, do not undermine public health, including that education and skills development policies are tailored in real time, to build systems responsive to population needs.
Third, Africa and the Global South must boldly rise-up to the imperative for action to confront and move reforms directed at correcting the historic distortions of an international governance and regulatory environment, that emerged from the colonial era and which perpetuates imbalance in power dynamics, hindering international solidarity and sharing. Now more than ever SSC is required for re-orientation and repositioning of African actors to rise to the occasion as a collective force, to decolonize health governance, health professional education and research, which shall be central to building back-better, resilient health systems across the continent.

The climate of opinions may be contentious but, this is the opportune time when African populations and the global south, must strongly call upon their delegates to the special World Health Assembly in November 2021, dedicated to considering the benefits of developing a “Treaty” or similar global instrument on pandemic preparedness post covid-19, as well as delegates to the Fifth UN-Conference on the Least Developed Countries in Doha, in January 2022, to engage the international community in the spirit of SSC, with a common voice for solidarity on the above concerns, to agree an ambitious new ten-year programme that builds-back-better and more resilient health systems, to accelerate more equitable progress towards the 2030 development Agenda for SDGs.

What do you all think about this?

Sincerely,

Patrick

COVID-19 IS AN OPPORTUNITY TO RETHINK AFRICAN HEALTH SYSTEMS

Dear Colleagues,

Here is a discussion we should all have at this challenging time.

Human history is characterized by transformations that follow major upheavals and challenges. Examples include the creation of the League of Nations in 1920 and the UN system in 1945 that followed the World Wars 1 and 2 respectively. Others are the establishment of the African Centers for Disease Control after the Ebola outbreak in West Africa in 2016. In Uganda, HIV led to the creation of the multisectoral Uganda Aids Commission; copied by other countries. COVID-19 pandemic is a major global upheaval that must trigger major transformations globally and in individual countries. There is evidence that the frequency of pandemics will increase and our preparedness and response is central to human survival. Louis Pasteur frightfully stated “Gentlemen, it is the microbes who will have the last word”. So how do we delay this?

Each country and the world should take stock of the experience of COVID-19 and apply lessons learnt to design future strategies. Globally, this is already happening; there is a WHO Panel studying COVID 19 origins, the UN General Assembly will convene to adopt a Pandemic Treaty and the June 2021 World Health Summit adopted the Kampala Declaration. A Scientific Advisory Group for the Origins of Novel Pathogens is being created by WHO for the One Health approach. What should African countries do?…

African countries have learnt many lessons from COVID-19; among the most prominent are that disease outbreaks can bring a country to a standstill and that public health cannot be left to the market. Governments have a key role in ensuring that there are effective multisectoral systems in place for disease outbreak preparedness and response. Africa has also painfully learnt that capacity is lacking in the continent to manufacture essential technologies to control pandemics and that in this crisis, African countries are shamefully the last to access these essential technologies. Investing in health systems and the health economy must therefore become a top priority as a matter of life and death. The pathogen economy calls for the African disease burden to be reflected in the African economies; instead of being a source of wealth for other countries as is the case now.

COVID-19 has helped to dispel the traditional belief among some economists that investing in health is a consumptive cost without economic returns. The UN High Level Commission on Health Employment and Economic Growth established by Secretary General in 2016, demonstrated that in some countries the health economy contributes up to 30% of GDP and that health employment is a source of jobs especially for women who form 70% of the health workforce. It has been shown that return on investing for example in immunizing children is by a factor of 9. Finally, it is recognized that SDG3 on “Good health and well-being through the life course” is the ultimate purpose of all other SDGs; contributing to them as well as benefiting from all SDGs. Good health and well-being require dedicated action to achieve and cannot be expected or assumed to become a passive side effect of other SDGs.

African countries must therefore prioritize the good health of their people as follows:

(i) Open national dialogues to promote personal and individual roles and responsibility that enables healthy people to remain healthy as they live at home, in the community and at work. Most people are born healthy and can remain so without losing their health provided they know how to listen to and obey their bodies. This should be taught in schools and through mass media and community health systems and there should be a health component in all government policies.

(ii) Establish strong community health systems, led by the people themselves through representative village health committees with community health workers who are facilitated to reach all households as the foundation of Integrated People Centered Primary Health Care (IPCPHC). This leaves no one behind and all people participate as a duty and a right and is the first line of defense against disease outbreaks. The village committee is connected to the rest of the health system, namely health centers and hospitals. A defined minimum package of health services should be agreed and provided free of charge to the population through general taxes. This services package can be expanded progressively as the economy grows.

(iii) Mobilize additional financing for services beyond the minimum services package through national and community health insurance schemes. Partnership with the private service providers and better donor coordination are needed for implementation of one well governed national health plan.

(iv) Deliver effective Health system governance led by accountable governments which is critical for desired results. This should focus on strict regulation and supervision of public and private service providers to assure acceptable quality of care, free from corruption and responsive to the voices of the people.

(v) Finally, African Union and Regional Economic Communities, WHO, and international community should support the African pathogenic economy through Public Private Partnerships to ensure that Africa is self-sufficient in all technologies that address the African disease burden, including vaccines, diagnostics, therapeutics and human resources. Political will for this has been demonstrated in some countries however additional mobilization is needed.

What do you all think?

Keep safe.

Francis.

MOVING FORWARD WITH HEALTH FINANCING REFORMS

Dear Colleagues,

Here is a discussion on health financing in Africa. It is one of our most challenging barriers to UHC.

Annual budget negotiations with national parliaments are going on right now in a number of African countries. Difficult decisions are being made on which aspects of health budgets should be prioritized for funding. This gives us an opportunity to contribute to these ongoing national and regional budget discussions.

Let us start by gaining a common understanding of health financing. It is defined here as “the raising, pooling and spending of financial resources with the primary intention of improving health”. The sources of health financing are the general tax, donor aid, deficit funding (or borrowing), ear-marked taxes, and social and private health insurance. This should exclude out-of-pocket spending by individuals at the point of receiving health care. Expenditures are made in health facilities, on community and out-reach services, pharmacies, drug shops, sanitation, nutrition, training and research. Today, health financing remains the most intractable challenge for the health and development globally. Indeed, some have argued that Universal Health Coverage (UHC) in poor countries cannot be funded internally.…

Yet the health of the people is central to everything as it is a precondition for their well-being and productive lives. The right to life is also a right to health and a right to a responsive health system. The second foundation is our innate humanity of feeling for each other so that the pain and suffering of one is felt, shared and addressed collectively and “no one is left behind” to suffer alone. On top of these moral arguments is the new evidence that health is no longer perceived as a cost but is an investment with high social and economic returns. The health economy on its own contributes to economic growth, employment and Gross Domestic Product (GDP). Indeed, the purpose of all Sustainable Development Goals (SDGs) is to contribute to the health and well-being of people and of our planet. Last but not least, voters value their health and investing in the health and well being of the population has high political returns.

Africa made major gains in health indices during the Millennium Development Goals (MDG) period. However Africa still lags far behind other regions of the world in health indices. The opportunity of SDGs and UHC should be used for Africa to catch up. This is why UHC is a political choice made by governments to provide citizens with the health services that they need without financial barriers. Strong government leadership is essential to create the conditions that enable people to live healthy lives. This includes marshaling actors from all government sectors and the whole of society to deliver integrated people-centered PHC by enacting enabling laws and regulations, providing access to information, healthy food, clean water, decent housing, quality education and other resources.

Many poor countries have proved that a country should not wait to become rich to attain quality universal health care. Studies have shown that poor quality of health care linked to low level health financing causes more deaths than disease itself. Furthermore, the Alma Ata Declaration on Health for All states that “Primary health care is the essential health care made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development”. The World Health Organization has recommended an annual per capita health expenditure of US$86. Countries can therefore take immediate progressive steps towards reaching this expenditure target. The Abuja Declaration which called for 15% of national budgets need to be applied with caution. Finance ministers do not find it workable, if each sector claims a percentage of the budget which add up to over 100%.

Existing resources in any nation can be used in such a way that a package of basic health care can be provided to everyone. The illustrious examples of poor countries are Costa Rica, Sri Lanka, Cuba, Kerala of India, Vietnam, Thailand and Indonesia. These countries took 20-30 years to attain universal health care and reduced their mortality to as low as that of the wealthy nations. The achievement of good health at low cost is possible based on the principles of political commitment to health as a social goal, a strong societal value of equity, political participation and community involvement, high investment in primary health care and other community based services, universal education, especially of women, and inter-sectoral collaboration for health.

African political leaders are called upon to commit to UHC and embark on this journey resolutely starting now with available resources and growing over time along the following five point plan:

(i) Through open national dialogue enact health financing laws,

(ii) Reorganize the governance of the health system to provide capabilities to implement the enacted health laws effectively and efficiently,

(iii) Agree a basic package of community-based promotive and curative health services based on the burden of disease and other mutually agreed criteria. Basic package services should be provided free at the point of service delivery, paid from general taxes and delivered through integrated, inter-sectoral, people centered PHC,

(iv) Provide services beyond the basic package by introducing a menu of financing mechanisms including ear-marked taxes, community, social and private health insurance schemes. These must be well governed to minimize inefficiency, waste and corruption,

(v) Monitor and review the performance of the health system regularly and make adjustments to grow the size of the basic package over time matched with the economic growth.

What do you all think?

Francis.

COVID-19 CRISIS: A CALL FOR COMPASSION FOR FRONTLINE HEALTH AND CARE WOKERS

The Year 2021 has been designated by WHO as the International Year of Health and Care Workers in appreciation and gratitude for their unwavering dedication in the fight against COVID-19 pandemic. In order for it to be beneficial, this year-long campaign must explore ways of how health workers can be more intentional about compassion for themselves while striving to show compassion to others. This article discusses the critical issues on compassion for health workers; highlighting what could be done to help them cope with the challenges they face in line of duty.

Definition of Compassion: The definition of compassion encompasses the recognition of the suffering of others and the need to act to help. It embodies a tangible expression of our humanity of empathy and caring for those who are suffering, and a desire to alleviate their distress. It is the knowledge that there can never be any peace and joy for me until there is peace and joy for you too. Lack of understanding of how to handle colleagues who are working under very stressful conditions can have major consequences on the psychological wellbeing and the performance of health workers. Supporting their psychological wellbeing must be a priority for health systems managers and the general population. …

Experience from the field in Uganda: The COVID-19 pandemic has challenged and exceeded the capacity of hospitals and intensive care units (ICUs) across many countries. Health workers have continued to provide care for patients despite exhaustion, personal risk of infection, and fear of transmission to family members, illness or death of friends and colleagues, and the loss of many patients under their care. Sadly, health workers have also faced many additional sources of stress and anxiety such as long work shifts, unprecedented social restrictions and personal isolation, which have affected their ability to cope.

Front-line health workers dealing with COVID-19 have expressed serious concerns regarding the condition of services and the quality of support they get from their managers. They complain about inadequate supply of personal protection equipment (PPEs), and infrastructure limitations for ICUs which make them vulnerable to contracting the infection at the work place. During the lockdown, some were assigned to long working hours; exerting emotional stress and physical exhaustion.

Insufficient resources and the absence of specific treatments for COVID-19 added to the challenges of managing severely ill patients. The fear of transmitting COVID-19 to loved ones led many to self-isolate from their families for prolonged periods of time. Above all, they felt neglected by apparent lack of a caring attitude from managers.

What can be done? We need to display greater kindness and empathy towards colleagues. Employers should love the people they lead and win their trust; feel for each other and share their pains. Front-line health workers should be given sufficient rest, time off and provided with basic tools to do their work.

Building leadership capacity and awareness on issues of compassion among supervisors and leaders at all levels is critical. We should also raise population and community awareness about the issues faced by health workers. We can take lessons from a recent event in the UK. People across the country took part in mass applause for nurses and other front-line NHS staff, in praise of their work during the COVID-19 pandemic. The ‘Clap for Our Carers’ initiative saw residents applauding from their doorsteps, windows and balconies, and motorists joining in by hooting their horns. Such simple acts of appreciation will go a long way to boost the morale of health workers.

What can we all do to raise awareness about compassion for health workers?

David Okello

THE GLOBAL SCRAMBLE FOR COVID-19 VACCINES

Who will live; those with money or all of us?

The Covid-19 pandemic is raging in Europe and USA and infection rates have exceeded those seen during the first wave last winter and spring. Political leaders are under stress and are taking drastic steps to reduce transmission and minimize mortality and morbidity which has provoked riots in some countries. These countries are working feverishly to rapidly vaccinate the population with a view to reaching 70 – 80% of the vaccinated population which is needed achieve effective herd immunity which can enable return in these countries to normal social and economic life as well as save lives.

There is panic in some quarters resulting in decisions to grab all available COVID-19 vaccines including doses to be produced in the future. There was for example a highly publicized call this week that requires vaccine manufacturers not to export any vaccines without permission from political leaders. Vaccine nationalism has cropped up as new terminology. It is counterbalanced by regular calls from the WHO Director General, Dr. Tedros and some European leaders, championing humanity, equity and solidarity to spare and avail some vaccines to LMICs who have no resources to develop and make vaccines for themselves. There is also the epidemiological argument that pockets of the virus anywhere is a threat to all countries and no country is safe until all countries are safe.…

It is this spirit that triggered global leaders to launch COVAX, a solution intended to accelerate the development and manufacture of COVID-19 vaccines, diagnostics and treatments, and guarantee rapid, fair and equitable access to them for people in all countries. Its secretariat is at GAVI in Geneva, a multilateral agency that is already coordinating the supply of vaccines to LMICs for many years. COVAX is working with manufacturers to provide investments and incentives to ensure that manufacturers are ready to produce the doses we need as soon as a vaccine is approved. The Facility also uses the collective purchasing power to negotiate competitive prices from manufacturers.

In 2016, I was a member of a global Commission that produced a report titled “Neglected Dimension of Global Security; a framework to counter infectious diseases crises”. This report admits the sobering truth that there is limited capacity for producing potentially lifesaving vaccines, and not everyone is able to get needed medical products at the same time. This requires difficult decisions about who gets the medical products first. The ability to pay should not determine where products are distributed, as in the case of a country that wishes to stockpile vaccines for its low-risk population. Rather, those who are at the greatest risk and in imminent danger during a crisis—whether they are front-line health workers or a vulnerable local population—should have priority.

This means that, in order to ensure equitable access and distribution of vaccines to those in need, countries must refrain from nationalizing their vaccine manufacturing output. This was illustrated during the H1N1 outbreak in 2009, when governments with preexisting contracts sought to preserve the capacity of firms located within their territorial borders to inoculate their own citizens before giving or selling to other countries. The rationale, which is understandable, was that the governments had an obligation to their citizens before exporting vaccines to other populations. However, the reality was that these populations were at very low risk and the prioritization was consistent with good public health policy.

Africa is currently experiencing a new spike of COVID-19 infections. While we appeal to the global community for solidarity, empathy and humanity, we need to appreciate that these infectious diseases crises are going to increase in frequency. We must call upon African countries to take note; mount an effective response now and prepare for the future pandemics by developing internal capacity to develop, manufacture and distribute vaccines, diagnostics and therapeutics within the continent in partnership with the rest of the world. Africa should join COVAX not just as a beneficiary but as a contributor of the best science and financial resources.

This is the vision of the AU/NEPAD, Pharmaceutical Manufacturing Plan for Africa (PMPA) endorsed by the Heads of State and Government in Accra in 2007. This is the time to rejuvenate this vision. It is a matter of life and death.

Let me conclude by applauding the Leaderships of African countries that have allocated funding for local development of therapeutics, diagnostics and vaccines for COVID-19. In some countries such as Uganda, clinical trials are now in progress and all people of good will, including regional bodies in Africa should support these efforts.

What do you all think?

Francis.

ENGAGING COMMUNITIES TO DEFEAT COVID-19.

Dear Colleagues,

Let’s discuss how to live with COVID-19 in our homes,communities and work places.

“So let’s do it. If health development does not happen in African communities, it will not happen in Africa nations’ is a statement by Miriam Were, a famed Kenyan Community Health Advocate in the book African Health Leaders; making change and claiming the future. “The path to UHC is integrated people centered Primary Health Care’ is another regularly stated position by Dr. Tedros, Director General of WHO. African Union Health Strategy 2016-2030 “calls for vibrant ways of leveraging community involvement and integration” …well as recommending a paradigm shift to assist Member States in addressing the effects of public health emergencies in a more systematic and comprehensive manner”.

At face value, these quotations sound obvious and undisputed; however, there is no palpable movement in Africa to translate this vision into reality in African communities.

What is palpable now is the effort on COVID-19 where advocacy is about Standard Operating Procedures (SOPs); namely hand washing, social distancing, contact racing, testing and care including provision of pulmonary ventilators. There is a flood of education messages sponsored by so many partners in the media which are telling people what to do and none asking for the people’s views. What is NOT palpable is the message that all these SOPSs take place within the homes of people, their communities and work places except for the use of pulmonary ventilators. What is NOT palpable are messages that ask for the views of the population and the challenges that they face accessing water, soap, stigma related to contact tracing, isolation, quarantine, travel, teenage pregnancies, gender based violence etc.…

During the first week of October, 2020, a team from ACHEST and the Ministry of Health visited a Community Health initiative in the Ngora district of Eastern Uganda where ACHEST is implementing a pilot on Inter-sectoral collaboration for health in five villages. Village Health Teams (VHTs) working under the oversight of the village administrator have mapped and numbered all households, they visit five to ten households each day, maintain a Village Health Register containing a record of the health status of members of households, they discuss and share information with the families and advocate for health seeking behavior, home cleanliness and hygiene. VHTs are facilitated with bicycles, cell phones and receive equivalent of $50 each month as compensation for their time. They work in close collaboration with the health facilities and other sectors and actors such as cultural and religious leaders, community development and agriculture extension staff and parish chiefs. Once a month they conduct Community dialogue and we watched the deliberations of such a meeting.

It is impressive how the community identifies their problems and discusses the solutions during the Community dialogue. Health seeking behavior has been transformed in these villages and in a short period of time. This is an example sustainable community ownership and accountability for their own health outcomes in practice. There have been so many such pilots in many countries but very few countries have scaled it up to national level.

This week,in a major scale move, the Prime Minister of Uganda launched the National Community Engagement Strategy for COVID-19. This is at the direction of President Y K. Museveni and developed by a multi-sectoral committee that I am honored to Chair. The overall goal is that all people in Uganda are aware, empowered and are participating actively in the prevention and control of COVID-19 as both a duty and a right, using existing structures, systems and resources as much as possible. This is underpinned by the principle that individuals have the primary responsibility for maintaining their own health and that of their families and communities. They are supported, where necessary, by skills, knowledge and technology of the professionals.

This CES will strengthen the existing Community Health Systems for Integrated People Centered Primary Health Care as the National COVID-19 response transitions to Phase 4 with widespread community transmission. The CES will ensure that infections do not occur in the community and if they do, will enable prompt identification, testing, treatment and rehabilitation as needed.

Inter-sectoral Collaboration and the Whole of Society approach are recognized as the most effective interventions for achieving SDGs, UHC and Pandemic control. COVID-19 is an opportunity to implement to scale the existing multi-sectoral Community Health Strategy. Uganda will have a strong Integrated People Centered Primary Health Care system for the current COVID-19 response and remain long after as the foundation and first line of defense against infectious diseases.

Expected outcomes from the Uganda CES are that: (i) Communities are moblised, aware, trusting and taking ownership of personal and community responsibility for health and well being, (ii) Communities are actively implementing COVID-19 SOPs and pandemic suppressed and mitigated, (iii) Uganda’s health system is strengthened and better prepared to achieve SDGs and UHC long after COVID-19, and that (iv) Inter-sectoral Collaboration and the Whole of Society approach for health institutionalized in Uganda.

I urge all African countries and partners to use COVID-19 as an opportunity to make health development happen in African communities. This will generate very high returns in social and human capital as well as economic growth when compared to many other investments.

What do you think?

Francis.

RACISIM, SECTARIANISM AND HEALTH OUTCOMES

Dear Colleagues,

This discussion is trending today. How can we use this debate to improve health outcomes for all?

The current global debate on racism provides an opportunity to discuss the contribution of racism and other forms of sectarianism to population health outcomes. The WHO Commission on Social Determinants of Health and other studies have pointed out racial discrimination as a key social determinant and driver of racial health inequities. This is mediated by direct and indirect pathways such as differential access to societal resources, education, employment and living conditions.

The world has been gripped by the reaction of disgust expressed through widespread global protests in over 60 countries against the killing of Floyd George a black man by a white policeman in Minneapolis, USA. This incident took place in broad daylight and was vividly captured in a live video recording that went viral and touched the hearts of many around the world. This global reaction is a vivid illustration of our humanity at work where we feel the pain of another human being and respond to stop the same from happening again to others. It is this humanity that has enabled our species homo sapiens to collaborate, learn together and prosper by turning planetary resources to our advantage.

However, we also have innate in us the tendency to promote self, kith and kin and other communities which are the building blocks of society. There are legitimate reasons for ‘birds of the same feather to flock together” as communities and when well managed; within defined boundaries and limits this has benefits for the overall common good and should be encouraged. These boundaries get breached when greed by individual and group self-benefit override and do harm to the overall societal common good. This becomes discrimination and constitutes the vices of racism, tribalism, nepotism and other expressions of sectarianism. …

The permanent challenge of our humanity is to get and maintain the right balance between individual and community interests on the one hand and the overall common good on the other. To a large extent we have been able to make progress in this direction but there are still significant gaps and historical vestiges of sectarianism that need to be dealt with within countries and as the international community. This is achievable through an open minded approach guided by our innate human tendency.

Racism has been practiced for centuries when it was accepted as normal through slavery, colonialism and apartheid. “Good” people including some churches owned and profiteered from owning slaves. Colonialism and apartheid were equally exploitative and accepted as normal. Time came when they were rejected as abhorrent and were ended. The legacy of these practices dies hard and persists in many ways. Knowingly or unknowingly there are people who regard and treat black and colored people as less and not equal to white people. A celebrated illustration was the refusal by Adolf Hitler to award four gold medals to Jesse Owen, a black American athlete during the Berlin 1939 Olympics. These conscious and unconscious biases contribute to the disproportionately poor outcomes observed in the treatment of patients of color in some settings. They also impact relations with the justice system, police and act as barriers to professional career growth and power dynamics in society.

African and Asian countries are now post-colonial and independent and sit on the same table with other nations at the UN and other platforms but there are still power inequalities which affect trade and the economies, resulting in health disparities between nations. Sub-Saharan Africa lags far behind other regions of the world in health and development indices and we should seize the opportunity offered by the SDGs to end for example, avoidable maternal deaths, poverty and ignorance; the aspirations for ending colonialism. The High Income Countries should fulfill international commitments on development assistance and fair trade in order to reduce these global inequalities.

I have to refer to so many white people who as religious missionaries left the comfort of their homes, traveled to the colonies and provided quality education and humanitarian services to African and Asian people. I am a product of these exceptionally dedicated missionaries who educated so many of us who are now leaders in our respective countries. This was humanity at its best expressed through religious belief.

This discussion will be incomplete without reference to the harm done by sectarianism in our own African countries and communities that negatively impact our health systems, governance and health outcomes. Tribalism, nepotism, religious bias are at play in many African countries and societies. Our best professionals are kept away from occupying leadership roles in our institutions because of sectarianism as key jobs go to “who knows who” and not “who knows what”. My personal experience is that well-qualified highly performing public servants tend to serve the common good and are generally above sectarianism.

We must not tire of expressing our disgust for these vices in the same in way that the world has responded to the murder of Floyd George. Our humanity and common good tendencies will prevail and overcome and will progressively deliver social justice and equity that leave no one behind. Keep going. Victory is certain.

What do you all think?

Francis.

COVID - 19 EXPOSES A GLOBAL SCRAMBLE FOR HEALTH WORKERS

Dear Colleagues,

Here is a subject dear to my heart and critical for achieving global health equity.

“Health Workers for All and All for Health Workers’ was the slogan of First Global Forum on Human Resources for Health, March 2008, Kampala, Uganda.

The COVID -19 pandemic has once again exposed the global health workforce (HWF) crisis that is characterized by wide spread shortages, mal-distribution and poor working conditions. This HWF crisis was documented by the report of the Joint Learning Initiative on Human Resources for Health in 2004. The HWF shortages have today resulted in a silent scramble to recruit health workers from poor countries by the richer countries. This scramble is inspired by the urgent needed to fill gaps in the scaled up COVID -19 responses and to address long standing HWF shortages.

Visa requirements for health workers have been eased and I have seen recruitment agencies openly advertising for health workers from Africa, Asia and the Caribbean in web posts of some government agencies and in social media. These agencies are convening meetings in poor countries to pirate away health workers who are needed more in their home countries. Significantly, some African and Caribbean countries have formally protested against these clandestine recruitment but have been ignored. These countries have been left to appeal to the patriotism of their HWF to mitigate the dreaded exodus that would cripple health systems during these times of crisis.…

This piracy of health workers, left uncontrolled, carries a public health threat to all countries of the world and is untenable. The pivotal role played by the HWF in public health and health emergencies as exposed by the COVID -19 pandemic is sufficient to classify health workers as a Global Public Health Good at par with or ahead of vaccines and drugs. The G20 leaders met recently with the WHO and agreed to collaborate in urgently in developing and equitably sharing new technologies including vaccines and therapies for COVID -19. They should also have included HWF in these discussions and it is regrettable that global support for the HWF agenda has declined. So what is the problem?

Evidence from the UN High Level Commission on Health Employment and Economic Growth (www.who.int/hrh/com-keeg/en) shows that between 2000 and 2010 there was 60% increase in migrant doctors and nurses working in OECD countries and the increase was 84% for those who migrated to OECD from countries previously identified by WHO with critical HWF shortages. Even worse, there are disturbing unethical stories of these migrant health workers being treated differently from local colleagues in destination countries and are impoverished and dying disproportionately from COVID -19.

These global HWF labour market dynamics are driven by demographic realities of ageing populations in the rich countries who require increasing health services and social care which cannot be met by the local labour market. The WB Global Monitoring Report 2015/16 and the UN Population Prospects 2019 Data booklet show declining working age populations in rich countries and the fact that half of worldwide population growth between2019-2050 will come from Sub-Saharan Africa. The Global HWF strategy 2030 estimates a global shortage of 18 million health workers. It points out that in the face of these demographic realities, rich countries will afford to import the health workers that they need while the poorer countries will not have resources to employ their needed HWF. This imbalance leaves global health security in a perilous state that is not acceptable. Fortunately, we have a solution.

The WHO Code on the International Recruitment of Health Personnel (www.who.int/hrh/migration) was adopted by the World Health Assembly in 2010 following acrimonious debates between Health Ministers from rich and poor countries over unregulated recruitment practices. The Code took six years to negotiate and is comprehensive. The objective is to scale up training and share a global HWF pool guided by the Code using voluntary ethical practices; taking into account the rights, obligations and expectations of source and destination countries and above all of the migrant health personnel. The goal is that countries will use the Code, led by Ministries of Health, to negotiate mutually supportive binding agreements for sharing and upholding the rights of all health personnel.

This is an appeal and a call to action for global solidarity and to all countries to take advantage of the COVID -19 pandemic to refocus attention and effort on the global HWF crisis and the WHO Code. This provides the only solution to move from current conflict to collaboration in our quest to provide a skilled, motivated and supported health worker for every person in every village everywhere.

How do we create a global movement that will make this happen?

Sincerely,

Francis.

STRATEGIES TO EXIT COVID-19 LOCK DOWN IN AFRICAN COUNTRIES

Dear Colleagues,

Here is a pertinent and timely discussion on how get out of the challenge of lock down from Dr. Patrick Kadama from ACHEST. Enjoy!

The Corona virus (SARS – CoV2) which causes the Corona Virus Disease 2019 (COVID-19) is not going to go away. People are going to have to learn to live with it; doing business and having social relations as, for example like they did with HIV/AIDS. Presently however COVID-19 has no cure or vaccine and as a result countries have sought to slow down the spread of the infection by instituting “lock downs ” to protect people and prevent their healthcare systems from becoming overwhelmed.

Lock downs impose stressful conditions on society and countries are now looking for measures to exit the unsustainable current socio-economic restrictions. A practical approach is to establish a system of National Alerts, with indicators as triggers for easing restrictions such as the New Zealand alert system for COVID-19. Given the limited knowledge about the new disease, the exit will be pragmatic and step wise, focusing on a multi-sector framework based on the following three objectives:

a) Get people back to work to revive economic activities and support livelihoods. (b) Minimize transmission of SARS-CoV2 infection under the new normal; (c) Institute Governance and leadership measures, for strengthening stewardship capability for social services to manage new norms.…

Get people back to work to revive social and economic activities:

Opening up economic activities should be gradual and not allowed to cause a flare up in infections. This will be achieved through scale up and strengthening of health and safety measures in workplaces prior to easing restrictions. Populations need to comply with new workplace hygiene and safety measures including sustaining new social conduct standards at work. Health and safety measures for public and private transport also need re-definition.

The return of economic activities should at best be prioritized and phased by sub-population risk profile. Age based relaxations can also start early allowing the young to go back to work, while shielding the seniors and those with underlying health conditions. African countries have up to 80% of the population young and living in sparsely populated rural settings. These should be among the first to benefit from relaxation of restrictions.

Urban business in informal settings should be given early priority for resumption of work due to their low level of reserves and resilience. Employers will have to develop post lock down guidelines on return to work taking this into account. Schools with children could reopen early, care being taken to test the teachers and preparing parents for their roles.

A return to large religious congregations, public meetings and sports, including social and political gatherings should not be rushed, but gradually phased in.

Minimize transmission of SARS-CoV2 infection under the new normal:

It is critical to accelerate the strengthening of health systems by scaling up testing to identify suspected infected cases, to safely isolate, treat and trace the contacts of COVID 19 infected individuals. Comprehensive national guidelines and protocols need to be developed to include public health measures anchored in Integrated People Centered Community Health that can reach every household in the country. Current measures to manage national borders will need to be continued and strengthened with guidelines on physical spacing of passengers flow and rapid testing on arrival and quarantine facilities and this includes opening up of air transport.

Research, learning and innovation should be encouraged for use of technology and locally generated solutions that are relevant to the culture and resources available to each country and society. Financial and human resources for this huge undertaking and budget re-allocations will be needed. Fortunately, many African countries have established dedicated resource mobilization committees that leverage the participation of the private sector to support this pandemic control.

Institute Governance and leadership, reforms for strengthening the stewardship of social services:

Leadership should be from the top with the Head of State in the forefront. This is critical to pull the whole country together to mobilize all sectors for a cohesive national response for strengthening social services stewardship capacity as well as new norms in social conduct and relations. Mobilizing the community is critical for success. Relaxation of lock down will be underpinned by adherence to the current preventive measures as the new normal in social conduct and relations. Social and physical distancing, regular hand washing, personal hygiene, use of sanitizers and precautions when coughing and sneezing, among others, are the new normal in order to suppress the spread of infections as lock down is eased.

Reforms for multi-sectoral action require setting up of appropriate structures. A high level politically led national committee supported by technical sub-committees such as the Scientific, Transport, Finance, Security and others as needed. All these should be coordinated by one command center that receives and processes and distributes information. They all need active participation and leadership of multi-disciplinary technical experts to develop and operationalize a flexible national strategic plan that is regularly evaluated and adjusted in the face of experiences.

In conclusion, let us accept that COVID-19 is here with us and will not go away until a vaccine or a cure is found. Lifestyle as we knew it before this pandemic may never be the same again. Let the people in all countries join hands with their governments to navigate the complex measures needed for exiting lock down. Together, we will overcome.

What do you all think?