During the last few months my attention has once again been sharply drawn to the perennial topic of the need for stronger coordination in order to build synergies and promote cohesion and avoid dispersing our effort and resources. Even if we act separately we can at least move in tandem, collectively gaining momentum and accelerating faster towards the attainment of our shared goals. The motto of the Republic of Kenya is "Harambee" which might translate as lifting heavy loads together in unison (Kenyan colleagues are welcome to elaborate).
We have discussed the need for country ownership and leadership before; let's now look at how we could achieve a continental "Harambee" for health in Africa. The situation is getting better and I see light at the end of the tunnel and coordinated action is critical now more than ever.
To illustrate, this month alone, I have encountered two separate initiatives both examining the need for and modalities for establishing African Health Networks. Both are sponsored by international partners who were not aware of each other's effort. I have also received invitations to participate in three meetings on Neonatal, Child and Maternal health convened by three separate promoters and all taking place here in Africa in the space of three months. Yet, Africa at continental level is very well organized on this topic, however, here again; one of promoters does not appear to be aware of this. There must be many other such uncoordinated initiatives that I know nothing about taking place in the continent. Here is the problem:
Africa has well established coordination structures in the health sector. We have the African Union Commission (AUC) whose mandate is "to be the interface between Africa and the rest of the world". The AUC has a department and a team led by a Commissioner for Social Affairs with health specialists; there are four sub Regional health communities' with secretariats in Central, East, Southern and West Africa. Three of these are quite active. There are also two WHO Regional offices in Brazzaville and Egypt. The UN family and partners in Africa also have a coordination structure known as Harmonization for Health in Africa (HHA) with a secretariat at WHO Afro. On top of these there are specialized African health institutions that act as centers of excellence in various fields and are in official relations with the bodies mentioned above and routinely play the role of expert resources to these bodies. The above named agencies have access to African governments including Ministers and Heads of State and governments. I have seen these African institutions work very well over a long period of time. Why are these authentic structures not being used as entry points by our international partners?
I have consulted a number of African leaders from some of the mandated African institutions. They are all familiar with the problem and are not surprised and to quote some: "We have all the policy instruments and we have repeatedly told these people that they are not listening to us"; "it is the power of money that makes them to ignore us"; "Africa has become everybody's playground" etc.
Let's illustrate the point more with the effort on achieving MDG 4 & 5 over which multiple meetings are taking place. Africa has already moved on its own way ahead of the UN system. There is an Africa Health Strategy 2007, The Maputo Plan of Action 2008, CARMMA for advocacy, adopted by Ministers of
Health 2009, and the Kampala Heads of State and Government Declaration 2010.
These instruments were developed through African leadership and the participation of the agencies listed above. Most countries in Africa have launched CARMMA and have national road maps for achieving MDG 4 & 5. What is needed now is supporting individual countries to implement their respective road maps. Africa was ahead of the UN summit and this was pointed out at the UNGASS last year. Africa has policy instruments in virtually all the priority health areas and these can be found on the web site of the AUC and the various partner institutions. How then can we generate the cohesion and the synergies that we are looking for?
First, AUC needs to mobilize the African institutions so that all are cognizant of existing instruments and to establish monitoring mechanisms on the status of their implementation. The key players are known and have been mapped. These institutions should be facilitated to play their roles effectively with the support of partners. Second, the international partners should familiarize themselves with African institutions and call on the AUC as the first point of contact when contemplating interventions in Africa; some are not aware of its existence! The AUC should be able to guide partners on status of all key issues and refer as needed to respective African centers of excellence. African institutions when approached by international partners' should refer them to the AUC and the designated issue leaders in the continent. Most important of all is that international and African partners' should immediately start to use and not bypass the existing structures. Will this happen any time soon? Are there other ways? I look forward to your frank comments.