How to reshape African health systems towards autonomy, self-reliance, by Pate

Recommends reimagining health systems with increased tax-based domestic financing

Julio Frenk Professor of the Practice of Public Health Leadership, Harvard T. H. Chan School of Public Health, United States, Muhammad Ali Pate, has made recommendations on how to reshape African health systems towards autonomy and self-reliance, and develop strategies and equal partnerships accordingly.

Pate, who was a former Minister of State for Health and Executive Director, National Primary Health Care Development Agency (NPHCDA), during a World Health Organisation (WHO) Africa Online Media Briefing on Health Issues in Africa, especially on COVID-19 pandemic and monkeypox, said: “We see the need for Reimagining health systems with increased tax-based domestic financing, expanding quality workforce, strengthening public health functions, accelerating digitisation, properly regulated and optimised markets, locally producing medical commodities and vaccines, to improve the health of populations and make the sector a key driver of economic growth.

“We see the need for Refocusing on producing health, prevention and well-being, in an integrated manner, with consideration of changes in the burden of disease, and determinants, such as education, hygiene, nutrition, migration, gender, environment and climate change will be necessary.

“All this, with a perspective of restoring intergenerational equity, shifting the balance of powers and involving the next generation of leaders.”

Pate, a public health economist, said WHO African Region Office (AFRO) is an important partner in this effort with Dr. Matshidiso Rebecca Moeti who is the WHO Regional Director for Africa as a member of the core panel and with the plans to have a series of labs on revitalising primary health approach, improving hospital and peri-operative systems.

The online media briefing also witnessed the virtual launch of WHO’s State of Health report by the Assistant Regional Director, WHO Regional Office for Africa, Dr Lindiwe Makubalo.

Pate said while the African continent may appear to have been relatively spared the direct primary health impact from confirmed COVID-19 cases, the lack of adequate testing in many countries suggests that the pandemic has afflicted the continent much more than what the reported cases indicate.

He said the report, on the State of Health, shares some good news, including that, prior to the COVID-19 pandemic, access to health care has been improving on the African continent over the last two decades, even though this was largely for infectious diseases and Maternal and Child Health (MNCH) services, with access to non-communicable diseases care lagging behind.

Pate said the quality of health care dimension has not improved as much and most people in Africa don’t have access to surgical care when they need it.

“Importantly, we have not made much progress on the system goal of financial protection, with millions pushed to poverty due to health expenditures,” the public health expert said.

Pate said many health systems remain fragile and poorly financed on the continent, and the secondary crisis as a result of disruptions of health services due to the pandemic has been significant, and likely to reverberate for years to come.

He said part of the issue is that African countries have come to rely on externally funded vertical programmes, with less domestic financing for health outside their wage bills.

“Pate, however, said the continent has seen how complementary investments by African countries, such as for national public health institutions, as well as the emergence of a strong African Centres for Disease Control, signify the very important roles of national and the African Union’s leadership and investments.

“Despite these gains, we know they are fragile. Health systems are constrained in the frontlines without an adequate workforce,” he said.

Pate said resolving this situation requires rethinking and reimagining a different future for health and economic resiliency in Africa and it also requires difficult conversations.

“That is why we assembled the Commission on the Future of Health and Economic Resiliency in Africa (FHERA), which I serve as co-chair based at the Harvard T.H. Chan School of Public Health (HSPH), along with Minister Awa Coll Seck from Senegal, and in collaboration with WHO Africa Region, Africa Centre for Disease Control and the United Nations Economic Commission for Africa (UN ECA),” he said.

Pate said the Commission is a multi-disciplinary, multi-stakeholder platform comprising African experts and practitioners, in public health, health systems, economics, financing, nutrition, climate, youth representation, and the private sector. “It represents an intentionally diverse group, with a global African perspective, not an Africa in isolation,” he said.

Meanwhile, Pate has identified health security as critical in ensuring Nigeria’s socio-economic and political stability.

The public health expert said: “Health insecurity can also affect economic security. We saw a pandemic crippling the world. It started as a health problem, but suddenly even those who didn’t have the disease were affected by the consequences of the pandemic.

“So, health security is a very key part of the development agenda of any reasonable society. In our country, for many years, we have been trying to improve primary healthcare and immunisation.”

According to a report by the News Agency of Nigeria (NAN), Pate stated this when he led a team of foundations and Non Governmental Organisations (NGOs) on a courtesy visit to Governor Atiku Bagudu at the Government House in Birnin Kebbi.

The delegation included WHO representatives, Solina and Sultan Foundations.

Pate, the team leader, said: “The purpose of our mission centred around health insecurity. There are infectious diseases that affect our children, young ones, women and adults every day. Whether they are things like measles that afflict our children and lead to loss of lives or pneumonia or tuberculosis or hepatitis or meningitis, all kinds of infections that can take the life of a young child or young person.”

According to the ex-minister, the diseases are preventable with immunisation. “The absence of systems to deliver those vaccines and immunisation services itself is a contributor to health insecurity because if you have infectious disease from one person to another, you are actually undermining the ability of people to have a chance of surviving to adulthood to be healthy and productive contributors to societal growth and development,” Pate said.