Here is our discussion topic for this period.
I want us to return once again to our previous discussions on the potential contribution of our African Techno-professionals to Africa’s transformation and to call upon this group to take our place as effective leaders where ever we are and at every turn. There is a critical mass of Techno-professionals in most African countries and our time is now.
This is inspired by two events that are taking place in East Africa right now. Along with my ACHEST colleagues, we attended the first event on 22 February, 2018 in Kampala. This was a Joint East African Community (EAC) Heads of State Retreat where host President Y K Museveni of Uganda complained that the conference hall was too hot and apologized to his colleagues. He wondered what the engineers and technicians were doing if they are not able to keep the room comfortably cool. He also wondered what his protocol officers were doing; always walking up and down, looking busy without results. President Uhuru Kenyatta of Kenya followed by complaining about bureaucrats in his country who delay the approval and implementation of investment plans for up to two years. These engineers who could not keep the meeting room cool, the protocol officers and the Kenyan bureaucrats are all our Techno-professionals in whom we have placed great hope for the future. We will come back to discuss how to support this group at a later date.
The second event takes place this week 19 -20 April, 2018 when ACHEST will work with other Experts from EAC member states of Burundi, Kenya, Rwanda, South Sudan, Uganda and Tanzania. The Techno-professionals will meet at the EAC Secretariat in Arusha, Tanzania with a very important brief to develop an Implementation Framework for the resolutions of the Heads of State Retreat in February, 2018.
The Heads of State Retreat theme was “Deepening and Widening Regional Integration through Infrastructure and Health Sector Development in the EAC Partner States”. With regard to health, the retreat sought to build consensus on regional health sector investment priorities for the attainment of Universal Health Coverage and the SDGs; showcase major health sector investments and opportunities in the region; mobilize new investments for the identified health sector priorities; and revitalize regional partnerships and linkages for improved health outcomes in the EAC. Non health sectors focus was on quicker delivery of priority projects in railways, ports, roads, inland waterways, energy and civil aviation sectors. All this effort, including the Heads of State retreat, is about transformation towards Strategic Purchasing by applying evidence-based approaches in defining investment priorities for this African region with a total population of over 200 million people. This should result in improved health system performance and making quicker progress towards universal health coverage for better and equitable health outcomes.
We advocate for efficient use of available resources among service providers and service users that will generate efficiency gains that free resources to cover a larger population. We must seek new ways of identifying and overcoming technical, institutional and political obstacles to effective implementation of strategic purchasing that leaves no one behind.
What principles should guide the identification of strategic purchasing priorities for the health sector in African countries? Here are suggestions from ACHEST some of which were presented during the Heads of State retreat last February:
We congratulate and thank the EAC Heads of State and Secretariat for driving this important process and inviting ACHEST and other regional thought leaders to participate.
We recommend a more integrated public health approach that is not focused on addressing specific diseases. The investment priorities should revolve around the establishment of strong integrated primary and community health services and systems. This should be the foundation for ensuring that the disease priorities are addressed through health promotion, disease prevention and control with active participation of individuals, households and communities.
We call for concerted movement by EAC member states towards building health systems that work for everyone and are focused on integration of the investment priorities that are anchored within people centered governance for services delivery across sectors that are based at household and community level, thereby leaving no one behind. The slogans are: ‘Health is made at home and only repaired in health facilities when it breaks down’; ‘If it does not happen in the community, it does not happen in the nation’.
We recommend institutionalization of approaches focusing on Continuous Improvement of Quality of Health Care (CQI), improved Health Sector efficiency and Health Sector statistics and disaggregated data sets. We propose investment in building capacity for Quality Assurance including planning, facilitative supervision, coaching and mentorship. The use of locally generated research evidence to inform continuous performance improvement through solutions made with local population participation and ownership.
We advocate for institutionalization of regular reviews and updating of service and performance standards and accreditation of facilities in all member states. Investment in Centers of Excellence on this should be a priority.
We propose investment in health workforce planning, development and management in order to produce and retain the required skills sets of fit for purpose health workers, serving where they are most needed and to mitigate the challenge and threat posed by migration.
There is sufficient evidence to show that the return on investment in health is high. EAC and African countries should allocate increased funding from domestic sources for health. Member states should commit to a minimum per capita annual expenditure on health. On top of this, flexible and growing well-managed approaches to pooled funding through multiple mechanisms should be supported. These include community health insurance schemes moving towards compulsory national health insurance in combination with optional private health insurance schemes.
Strong stewardship, leadership, management and governance will be required to achieve the aspirations of this investment agenda. This calls for political commitment, strong support from Techno-professionals and educated and informed demand from CSOs and communities. The investment needed to achieve this should be targeted at building leadership and governance capacity of governments at all levels, research institutions and CSOs.
I look forward to your comments and suggestions on promoting the leadership role of African techno-professionals in transforming investment approaches in health in our respective countries and the entire African region.