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We can improve health systems in Africa
Africa Renewal: You held your second annual meeting with Africa's ministers of health recently. Are you happy with its outcome?
Dr. Moeti: Yes, it was a very productive meeting. The ministers adopted key strategies and frameworks covering the broader areas of health security; health systems; women’s, children’s and adolescent health; ageing; communicable and noncommunicable diseases; financing; and the governance of WHO. They agreed to work towards political commitment and to mobilize more resources for health, as well as strengthen collaboration towards the sustainable development agenda.
Is there any feedback from this meeting that will change your strategy going forward?
I am inspired by the renewed enthusiasm to improve health care in Africa. I am confident that, with all hands on deck, we can improve it.
Please share with us your experience in your first year and what you hope to accomplish during your five-year term.
During the first year, my initial priority was to bring the Ebola virus outbreak in West Africa to an end, which was achieved in December 2015, and to strengthen the region’s preparedness and
capacity for timely response to outbreaks and emergencies. We also began to restructure WHO in Africa to effectively address the priorities of the continent. During my five-year term, I plan to achieve five priorities: improving health security, strengthening national health systems, sustaining focus on the health-related Sustainable Development Goals (SDGs), addressing the social determinants of health, and transforming the WHO secretariat in Africa into a responsive and results-driven organization.
You were appointed when the Ebola virus was ravaging Guinea, Liberia and Sierra Leone. What helped defeat the virus?
A number of factors were critical in getting to zero cases of Ebola, including high-level engagement with affected countries, donors, technical agencies and communities. I visited the three affected countries to engage with their presidents, national authorities, partners and the community to ensure that all required actions to stop the outbreak were implemented. Secondly, we mobilized financial resources required to support field operations. Thirdly, we deployed more than 3,800 experts from different fields, who played a critical role in implementing all the interventions in the field, such as tracing of contacts, treatment of patients, detection of the virus using mobile laboratories, and sharing of data and information with the global community on the status of the epidemic.
How could these countries be better prepared against future epidemics, like Zika, for instance?
It is critical for countries to enhance their capacity and capabilities to prepare for and respond to any public health event that may threaten public health security by implementing the International Health Regulations. These are a set of rules adopted by all countries to strengthen their core capacities, provide adequate funding and collaborate with partners. They are also designed to enhance cross-border cooperation on preparedness and to respond to threats arising from epidemic- and pandemic-prone diseases. The participation of civil society and the private sector is also very crucial.
What practical steps can African countries take to improve their national health systems?
Countries should strengthen the leadership and governance of health sectors to gain the confidence of all stakeholders. Governments should be more innovative in raising revenues from domestic sources and ensuring that all of their populations have access to essential health services. They should also improve the quality of health services and the safety of patient and health workers, and build partnerships with civil society and other partners in order to expand access. Investing in district and community health systems should be a priority that can contribute towards universal health coverage and the achievement of the SDGs.
SDG 3 calls for the promotion of healthy living and the well-being of all. What role should governments and partners such as WHO play to support Africa in achieving set targets?
The SDGs will require a new integrated and holistic approach from governments. While SDG 3 is the health-focused goal, intersectoral synergy and complementarity are essential for the health sector to meet its goal. Governments require new platforms to coordinate the social sector and health needs, including protecting the most vulnerable in their societies. Our role, as WHO and other partners, is to assist in building the capacity of the health sector so that technicians and decision makers can fulfill these needs.
What role will WHO play in mobilizing resources for poor countries that cannot afford huge budgetary allocations to the health sector?
We play a strong advocacy role in encouraging partners and donor countries to offer financial and other support to the most challenged countries. However, we must acknowledge that there is donor fatigue globally arising from conflicts, migration and humanitarian crises as they demand more resources from the international community. We need to mobilize more resources from within
our region so we can gradually reduce reliance on external donations. African countries may also need to look at innovative ways of mobilizing resources through targeted tax regimes (such as has been done elsewhere with airfares and “sin” taxes). WHO will offer technical guidance and expertise to build the capacity to mobilize and use resources more effectively while also ensuring transparency and accountability.
WHO has over the years proposed developing community-based mental health services worldwide. Do you have any update for Africa?
In the African region, there are several countries where community-based mental health services (CBMH) are being developed or strengthened. These usually incorporate a recovery-based approach which emphasises assisting individuals with mental disorders and psychosocial disabilities, vulnerable people and survivors of violence. The majority of community-based services in the region are run by NGOs and religious groups, with family and caregiver support. In some countries, the government co-contributes or takes full responsibility. Countries which have embraced the CBMH approach include Benin, Burkina Faso, DRC, Kenya, Ghana, Namibia, Rwanda, Senegal, South Africa, Togo, Uganda, Zambia and Zimbabwe.
HIV/AIDS and malaria continue to be key health issues in Africa, which has 11% of the world's population but is home to 60% of the people with HIV/AIDS. In the coming years, what would progress look like?
We have made significant progress by reducing deaths due to malaria by 66% in the last 15 years, while deaths due to HIV/AIDS have declined by almost half in the last 10 years. This has been largely due to the greater political commitment, stronger global partnership, increased financing, increased coverage with effective interventions and the meaningful engagement of AIDS patients.
And going forward?
The next five years will be crucial and we have to work hard if we are to achieve the targets of having 90% of people living with HIV knowing their HIV status, 90% of people diagnosed with HIV receiving antiretroviral therapy, and 90% of people who are on treatment achieving viral load suppression.
Of the 20 countries with the highest maternal mortality rates worldwide, 19 are in Africa, which also has the highest neonatal death rate in the world. Where is Africa getting it wrong?
Efforts are underway to tackle the high maternal and neonatal deaths in Africa. Eleven out of those 19 countries with highest maternal deaths were facing humanitarian, conflict or post-conflict situations that may have caused the breakdown of health systems, resulting in a dramatic rise in deaths due to complications that would be easily treatable. But some progress was made.
Can you share with us the areas where progress was made?
By the end of 2015, maternal mortality fell by 45% in the region. WHO specifically supported the development of road maps for reducing maternal and newborn deaths in Africa, and newborn deaths dropped by 38%. WHO supported over 36 countries to build capacity for newborn care both in facilities and the community. And this work continues. I must mention also that HIV-related maternal deaths fell from 10% in 2005 to 2% by the end of 2015.
Many believe a number of Africa’s health workers have emigrated to the West. With such a brain drain, how can Africa ensure adequate human resources for the sector?
We continue to encourage countries to expand private-sector training of health workers. We encourage adequate and timely payment of health workers, along with providing incentives to retain health workers in remote areas. Countries should also take into account the WHO Global Code of Practice on the International Recruitment of Health Personnel. The code encourages destination countries to collaborate with source countries in supporting the training of more health care workers. We also urge countries to discourage active recruitment of health personnel from developing countries facing critical shortages. However, the working environment and living conditions ultimately influence performance and motivation of the existing health workers, and we urge governments to address these.