'No development without health'

Both are long-term processes, Dr. Ebrahim Samba of the World Health Organization told Africa Recovery.

The health sector is not delivering services to Africa's people, declares Dr. Ebrahim Samba, director for Africa of the World Health Organization. Health sector reform requires reform of the entire civil service because you cannot isolate and forget about education, agriculture and so on, he adds. But building the necessary consensus among national leaders, ministers, civil society and donors "is very difficult."

Another problem, says Dr. Samba, is having enough resources and commitment for what is a long-term process (between 20 and 50 years). Asked about progress in securing greater budget allocations for health, he recalled the agreement made by African health ministers at a 1995 regional meeting in Brazzaville for all governments to allocate 5 per cent of national budgets to health, at a time when the average was 3-4 per cent. Governments are responding, Dr. Samba says, noting that some are spending over 14 per cent of the budget on health, with the average around 8-9 per cent.

But increasing the total allocation is not enough. Distribution is also vital, as many governments "are still spending too much on curative hospitals and not enough on prevention and primary health care, on childhood diseases that are controlled by very cost-effective immunization, on identifying priorities and really targeting them with budgetary reallocation." The total share of budget is very important, but reallocation is also very important and "we are still struggling with that."

Asked if health is no longer a "soft target" in structural adjustment, Dr. Samba is emphatic: "Oh yes! It was clear that structural adjustment hit health and education very badly. Among those people that were forcing structural adjustment, many now admit the negative effects. Structural adjustment said you must not recruit any more teachers and hospital workers; you must reduce their salaries. But you cannot improve the health of a country if you don't improve education and primary health care. These are the things that make the difference in terms of maternal and infant mortality and life expectancy. If you want to make an impact on health, you have to educate the people, particularly the women and girls, and also invest in basic health services. This was one of the things that structural adjustment attacked. Now, it is structural adjustment 'with a human face.' They have changed."

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