Health experts have warned that the continued lack of political will, corruption and misguided donor influence will continue widen the gap of inequality in healthcare in African countries.
As such, the experts, said it will be hard to attain United Nations’ (UN) Sustainable Development Goal (SDG) three which aims at ensuring that all people obtain the good quality essential health services they need without enduring financial hardship. There are 17 SDGs with 169 targets that all the 191 UN member states have agreed to try to achieve by the year 2030.
Deliberating during a special consultation on governance for health in Africa hosted by African Centre for Global Health and Social Transformation (ACHEST), an independent think tank promoted by a network of African and international leaders in health and development, in Kampala from July 16-18, medical experts said long-term, effective change in complex issue areas typically happens only if the government and key public stakeholders are pushing in the same direction.
During the meeting, ministry of Health officials were not represented. The minister of Health, Jane Ruth Aceng, who was supposed to open the conference, did not show up and the other official, who represented her, came in briefly and went away. State Minister for Primary Healthcare, Sarah Opendi, who was supposed to get the feedback and receive the communiqué of the conference resolutions, also never showed up.
World Bank Group lead health specialist and head, Health in Africa, Dr Khama Rogo, said the biggest driver of high cost of healthcare in the public sector is because of the inflated prices at which government buys the health inputs.
“The private sector can buy cheaper drugs than the government. Government can inflate it three times. There is no point hospitals should buy medicine at an inflated rate.” Dr Rogo said.
Dr Rogo said the inflated costs by governments have made the cost of healthcare very expensive and not affordable.
“That is why now you find that essential medicines like Aspirin, Panadol and the rest are three times the actual cost. When you go to the ministries of Health and tell them to buy medicines directly from the manufacturer, they will not listen and want to do things their way. The absence of the ministry of Health and academia in this very important meeting cannot be underestimated. They are not interested in this.” Dr Rogo said.
“Our governments are much more interested in places where procurements are being done in basements. That is why across Africa, the regulated offices are not upstairs. The offices are always based in the basements.” added Rogo.
At the meeting, African and global consultants called for a deliberate effort from all stakeholders and actors to ensure incorporation of indigenous knowledge systems into scientific innovations geared towards people-centred health policies, community based practice, public health and clinical services.
They also want efforts for a mindset change to focus on domestic home-grown solutions to African problems in the African context, to be promoted but with complementary contributions by partners from the North.
“We are strongly urging for a systematic approach to ensure that the paradox of trained, unemployed health professionals in the face of existing vacancies and shortages within the health facilities is addressed as a matter of urgency” said part of the communiqué released by the experts after the meeting.
The health consultants further called on all stakeholders and actors to;
“Promote community based training programs through professional colleges to encourage retention of experts and to proactively adopt value based selection of health workers for improved service quality and effectiveness to address in particular the high levels of maternal mortality.”
To achieve success, the experts contend that the government and a large segment of the public must be willing to recognize the problem, understand the problem in a similar way, and agree on solutions.
“The existing gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries, is politically, socially, and economically unacceptable and is, therefore, of common concern to all countries” the executive director ACHEST, Prof Francis Omaswa said.
While emphasizing the need to build leadership for health workforce at all levels, Prof Omaswa, however, noted that vested interests by some government officials is holding back efforts by health professionals to provide efficient healthcare services
“Like here in Uganda, the people who manage health work force are personnel officers; they are not health work management specialists. There are no people skilled to plan for the management of diseases” Prof Omaswa said.
“It is living normally with the intolerable. You know what to do, the solutions are known, but you cannot implement because of vested interests. We need to come out and shout that this should stop.” he added.
In his presentation, “Dying for Economic Growth; the story of mismatched solutions”, Dr Sam Agatre Okuonzi, chairman board of governors, Arua regional referral hospital, cited unemployment, inequality, unreliable and volatile aid, as perils of reforms of poor countries like Uganda.
“The ministry of Health officials can tell you that the condition of health services are good today. But I can tell you, the health services now, are worse than before,” Dr Okuonzi said.
“As Africans we invite a lot of people who come and advice us. Many of them have their goals, but as a country we are supposed to align them to our goals. Transparency is not going to be easy or possible because we have many stakeholders with opposing interests.”
Dr Okuonzi, gave Bhutan, as a case study of a country that poor countries like Uganda should emulate.
“When we talk about mindset, we need to talk about Bhutan because they know what they want. They are a happy country in terms of psychological well being, use of time and ecological diversity” the health economist said. .
“But we have a problem in Africa of mindset, the notion that what we have may not be good for us, so we allow other people from the World Bank to come and advice us. I don’t have the answers. I hope they will come. We are living in a messy and complicated global village.”
Dr Luis Gomes Sambo, the former World Health Organisation (WHO) regional director for Africa, deplored the core issues around governance for health in Africa, saying it is pertinent to get the trained health workforce into systems where they are employed.
“If we really want to achieve universal health coverage, we need to get the existing staff into the systems. In my country where I come from Angola, we currently have 3,000 trained doctors but the country cannot employ them. We cannot train people that we cannot employ” said Dr Sambo.
A Ghanaian neurosurgeon, Dr Samuel Kaba Akoriyea, argues that African countries ought to conduct human resources gap analysis.
“Teachers under the ministry of Education; are complaining about lack of employment. Health workers through the ministry of Health are doing the same. We are going to compete for little resources from government. But have we conducted our human resource gap analysis?” Dr Kaba asked.
Dr Kaba also suggests that Africa should now have its own sustainable development goals.
“The MDGs came a number of years ago and ended. Fours ago, we started the SDGs that will go to the year 2030. Now, after the SDGs, we now need African SDGs” Dr Kaba said.
The three-day think tank of experts brought together over 70 stakeholders from government, civil society, academia, inter-governmental institutions and agencies to explore the core issues around governance for health that are retarding progress in Africa, towards the SDGs.
They were drawn from 13 countries in the three regional groupings of East Africa Community (EAC), Economic Community of West African Countries (ECOWAS), Southern African Development Community (SADC), deliberated passionately on the key aspects of health, how to improve health, what has been done in the past, and what is not being done now. They included Uganda, Kenya, Zambia, Ghana, Sudan, Angola, Guinea, Mali, Burkina Faso.
The special consultation for selected African health leaders and partners, undertook an in-depth historical and current review of the opportunities and challenges in governance for health globally and their implications for Africa. Uganda’s Prime Minister, Dr Ruhakana Rugunda, assured the health experts that he will organize a meeting with parliament and cabinet so that they present their case.
The health experts deliberations’ come ahead of the September 23, UN High Level Meeting, which is supposed to conclude with a political declaration to drive action on the issue.
The meeting, under the theme, “Universal Health Coverage: Moving Together to Build a Healthier World,” will take place in the midst of the annual UN General Assembly week. It is considered the last chance to mobilise highest level political support for health issues before the world reaches the 2023 midpoint of the 2030 Sustainable Development Goals.
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