on Monday, 31 March 2014.

Last month I

participated at 58th Health Ministers Conference (HMC) for East, Central and Southern Africa (ECSA) held at Arusha, Tanzania that brought together Health Ministers and Senior Executives from eleven countries. Present too were high level representatives from the African Union Commission, the WHO Afro, the West African Health Organization, UNAIDS and development partners. ACHEST conducted a one-day preconference workshop on Stewardship, Governance
and Leadership of Health Systems for Permanent Secretaries and HIV Directors
from these countries and presented the outcome to the Ministers which was very well received.
There were other preconference workshops on the World Bank funded Strengthening of Laboratory Services and on Health Professionals Education through professional colleges. The HMC witnessed the formal launch of the new College of Health Sciences for the ECSA Region that now consolidates into one umbrella institution four already existing colleges of Nursing, Surgery, Anesthesiology, and Pathology. Others are set to join in the near future namely Ophthalmology and Internal Medicine. I left this HMC feeling verygood. Why?

The atmosphere and the outcomes of the HMC illustrated that Africa was moving inthe right direction. Capacity and synergies of local institutions was being strengthened, the HMC embraced the relevance and importance of building stewardship and leadership capacities of the Health Ministers themselves as individuals and of the executives in their ministries to support them. The Ministers received copies of a draft “Handbook for Health Ministers” and agreed to contribute comments before it is finalized so that it is more contextualized and owned by them, enriching content and adding to the comments already received from the preconference workshop. I would like to use my experience from this HMC to highlight how we can together better use the many existing African institutions.

We start again from our usual guiding principles namely that transformative and sustainable change is endogenous; brought about by the beneficiaries feeling the need and dropping their own sweat to deliver the change. Secondly, that it is essential for all countries to grow a critical mass of individuals and institutions that work closely with their governments to deliver and sustain this change. Thirdly, that the sustainable capacities of the institutions and individuals is built from what is already available but not dropped in from outside. Here are two contrasting illustrations on how we can either use or not use African institutions in Africa. There are many of both types.

The sub Saharan African Medical Schools Study[i] was funded by the Bill and Melinda Gates Foundation through a grant to the George Washington University (GWU) to map medical schools in Africa. The donor required that GWU works with African partners. The study was overseen by An Advisory Committee of predominantly experienced African medical educators. The University of Pretoria as the partner institution administered questionnaires for the study. The study report was launched in Africa at Makerere University and the African capacity built among members of the Advisory Committee are now supporting the implementation of other programs such as the Medical Education Partnership Initiative in Africa which has enhanced sustainability and ownership of the outcomes.

Another study titled “The Labor Markets for Health in Africa: A New Look at the Crisis”[ii] was funded by the government of Norway through a grant to the World Bank. The Acknowledgments section of the study report makes painful reading with a long list of non- African institutions that contributed to the work. The African Development Bank where the lead author works is the only African institution named. One African contributor to a chapter recollects being asked for a quick comment on an already written chapter and was not aware that their name got included as an author. The report content has factual and context issues. Just two examples: Chapter 3 under “Performance” is an entirely negative sweep damning all African health workers. Are they not aware of the many heroic African health workers saving lives under the toughest conditions and some nominated for the Nobel Peace prize? There are many published positive commentaries on the Performance of African Health Workers that deserved to be referenced under this section. Chapter 11 opens with “Until recently the public sector was nearly the only health care supplier in Sub-Saharan Africa.” Are they are not aware of the preeminent long serving Faith-based providers and the rampant Traditional health practitioners? Yet, this report states: “The World Bank does not guarantee the accuracy of the data included in this work”. Who then takes responsibility for an outcome like this? These comments are made in good faith and on demand from in and outside Africa. I hope they will be taken as an opportunity for improvement. Are there other examples of both types worth sharing?

Your comments are welcome.

Comments (10)

  • Nelson Sewankambo

    Nelson Sewankambo

    11 April 2014 at 07:06 |
    Dear Francis,

    Thank you for these great ideas you have shared with us. The first part is extremely encouraging and makes me plan to get up every morning with greater enthusiasm and interest than before in order to do more for this continent. The example of the study on the “The Labor Markets for Health in Africa: A New Look at the Crisis” is depressing and yet it is true there are likely many other examples like that. I have the report but have not yet read it. I must create time to do so this month.
    I fully agree we must support and nurture our institutions (in the broadest sense of the word institutions). It is by so doing that the institutions will earn credibility and be able to outcompete others who are taken for granted that they know what they are doing and yet produce the kind of products that you have referred to in your communication.

    Warm regards,

    Nelson Sewankambo
  • Stephen Kinoti

    Stephen Kinoti

    11 April 2014 at 07:08 |
    Dear Francis,

    This is an excellent analytical piece which raises important issues we all need to be aware of and attempt to address. As you eloquently articulate, African Professionals and Institutions must take the lead in transforming Africa’s health.
    Condescending utterances, omissions, and actions must not discourage us, rather they should give us the motivation and strength to stand up for the African masses. The African regional organizations, institutions and mechanisms continue to give us the platforms and bully pulpits for advancing health and social transformation for a better African future.
    Thank you for your continued leadership and contribution towards this. It was nice meeting you at the ECSA Health Ministers conference.

    Kind regards all.

    Stephen Kinoti
  • 3.	Adamson S Mula

    3. Adamson S Mula

    11 April 2014 at 07:31 |

    I agree with you. But also, if we go out perennially asking for basic financial support DfID, USAID, and other northern donors, how we will ensure also that we drive our own agenda. Is this not an oxymoron to expect that we advance our own interests without paying for it? As an interconnected world, there is no way we could fund all our expenses and that may even not be desirable. But if, even the pen, lap top I use must be funded by NIH, then there is a problem.

  • 4.	Yoswa DAMBISYA

    4. Yoswa DAMBISYA

    11 April 2014 at 07:33 |
    Dear colleagues,

    All very interesting observations! Regarding Adamson's point on funding - the trick is to push for genuine partnership, based on mutual respect regardless of the funding. It is also to recognise that we must have something we are bringing to the table, otherwise why would the NIH be interested in funding the College of Medicine, Malawi? There must be some things they can do only with COM's participation. That is the resource we need to play to our advantage.

    Case in point, a few years back the South African Health Minister asked one funding agency to keep their money unless they were prepared to work within the SA national (HIV/AIDS) plan. Without questioning the merits of the SA plan then, I felt proud that someone in authority in an African country could stand her ground. The funder had to explore ways of engaging the SA government better, and as I recall, they had to send an African then working with the organisation to come and talk to the SA government into getting back on board. On the face of it may appear as if the SA government can afford to do that while others cannot, but the fact is that most of our governments do not.

    At a smaller level, we are to blame when we agree, as Prof Omaswa points out, to append our names to papers that have been written without our involvement. We are to blame when we agree to participate in studies where our role is peripheral, and yet the work is in our own backyard. If we can't be equal partners, at least we can ensure meaningful roles for our institutions when we get involved. From my little experience, I know when one puts one's position clearly a lot is possible. Not easy, I know, but we need to keep trying. In this regard, the reaction of (some) African governments to the arrangements for the EU-AU summit could be exemplary.

    Best regards,

  • 5.	Stephen Kinoti

    5. Stephen Kinoti

    11 April 2014 at 07:34 |

    Of course you are right. We are responsible for our own health and future. In April 2001, African Union countries meeting in Abuja, Nigeria, pledged to increase government funding for health to at least 15%, and urged donor countries to scale up support. Only one African country has reached that target.
    Overall, 26 have increased the proportion of government expenditures allocated to health and 11 have reduced it since 2001. In the other 9, there is no obvious trend up or down. Current donor spending varies dramatically, from US$ 115 per person in one country, to less than US$ 5 per person in 12 others.
    We need to continue encouraging African governments to do better using every available mechanism.

  • 6.	Nelson Sewankambo

    6. Nelson Sewankambo

    11 April 2014 at 07:35 |
    Dear Stephen,

    Which is the reference document for these figures? Many of would like to have access to them and know which country is doing what.

    Nelson Sewankambo
  • 7.	Stephen Kinoti

    7. Stephen Kinoti

    11 April 2014 at 07:37 |
    Dear Nelson,

    Please see the WHO report: The Abuja Declaration: Ten Years On
    Hope this helps,

  • 8.	Prof. L Gwanzura

    8. Prof. L Gwanzura

    11 April 2014 at 07:38 |
    Hi Professors!

    I am sure if we stop the current way of doing things as regards financial sources we became proactive we could easily find ways of funding ourselves than keep on perennially asking for financial support from DfID and USAID. If we got our own governments, mines or institutions to stop selling or exporting our minerals agricultural products etc. before they are processed to their final products, each of our home countries would have enough monies to support us. Beneficiation of all our exports including Human resources is the way forward. Yes WE CAN!!!!

    Prof. L Gwanzura
  • 9.	Prof. Were

    9. Prof. Were

    11 April 2014 at 07:40 |
    Dear Francis,

    I have read your write-up with much interest. I have been particularly impressed with the way you work with ECSA over the years. Thank you very much. And then you, too, for the two contrasting examples you give. They make the point very clear. We need to take note of this and also bring it to the attention of the agencies we work with.
    Yes, the point about using African institutions is very important. Forgive me if you have already done this work and I am not aware of it. I wonder if ACHEST could facilitate the compiling of institutions dealing with health in ECSA countries. If the name is given and a bit on the organisation/institution's main focus, this may be one way of encouraging agencies to make use of African institutions. Again, thank you for your leadership.
    With kind regards and best wishes,

  • 10. E. Rwamasirabo

    10. E. Rwamasirabo

    11 April 2014 at 07:55 |

    Iam happy to get in touch with you after such a long time. In the first place thank you for keeping this debate alive otherwise members of these local institutions risk getting buried forever. One of the most challenging aspects that we need to fix is our difficulty as local institutions to come together and own our own agenda based on the fundamental solutions to use it for the purpose our communities' needs; then the question of who will fund us becomes an secondary issue: good ideas are always easier to sell. With regards to healthcare, there are lots of initiatives that we can steer on our own agenda as a foundation; there are thousands of examples on the continent. Donor money that comes to support them is very welcome and it is really up to us to
    How do we bring these initiatives to the front add value and build on this local foundation? By seating together and listen to each other and build together. This is happening with these heath colleges you talked about. Being a member of the college of surgeons, I feel very privileged to seat together with brothers and sisters from 10 African countries and beyond, plan together, teach together and examine together surgeons that are going to take care of our lives tomorrow.
    I joined the discussion quite late and hope I did not go off the point the main focus.
    Greetings to all!

    E. Rwamasirabo, MD

    Kigali, Rwanda

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