Dear Colleagues,

Here is a blog written for us by Dr. Patrick Kadama; Director Health Policy and Strategy at ACHEST.

"building back better for more resilient health systems in Africa and the Global South".

The impact of the COVID-19 Pandemic emerged in different ways across the globe. It directly caused devastation through unprecedented morbidity and mortality in the North but, its effects in the South, were deeply felt largely due, to weak health systems, gaps in social safety nets, scarce resources, and other factors of weak social and economic institutions. This divide distorted the global response to the pandemic. Major gaps exposed include the lack of international solidarity and sharing, including not only reluctance to share pathogen data and epidemiological information, but also resources, technology and tools, such as vaccines. This is contrary to the Nagoya Protocol for example. There has been disregard of the International Health Regulations and the WHO Code, resulting in recruitment of Health Professionals from the South to plug staffing gaps for managing the pandemic in the North. A North-South divergence in the fight against the COVID-19 crisis has emerged.

This has unmasked a fact that at present, “Global Health” practice, perpetuates the very power imbalances it claim to rectify, through colonial and extractive attitudes, and policies and practices that concentrate resources, expertise, data and branding within institutions of the Global North. These colonial attributes of global health, place Africa at a great disadvantage for gainful participation in the governance power dynamics which are shaping health policies and responses. This has brought to the fore, gaps and structural asymmetry underlying the power imbalances in the vertically structured global health practice between the North and the South. A contextualized consideration of the Africa region is required to meet challenges relating to this spill-over of a colonial supremacy mindset, of the vertical North to South Global Health construct.

Dear Colleagues,

Here is a discussion we should all have at this challenging time.

Human history is characterized by transformations that follow major upheavals and challenges. Examples include the creation of the League of Nations in 1920 and the UN system in 1945 that followed the World Wars 1 and 2 respectively. Others are the establishment of the African Centers for Disease Control after the Ebola outbreak in West Africa in 2016. In Uganda, HIV led to the creation of the multisectoral Uganda Aids Commission; copied by other countries. COVID-19 pandemic is a major global upheaval that must trigger major transformations globally and in individual countries. There is evidence that the frequency of pandemics will increase and our preparedness and response is central to human survival. Louis Pasteur frightfully stated “Gentlemen, it is the microbes who will have the last word”. So how do we delay this?

Each country and the world should take stock of the experience of COVID-19 and apply lessons learnt to design future strategies. Globally, this is already happening; there is a WHO Panel studying COVID 19 origins, the UN General Assembly will convene to adopt a Pandemic Treaty and the June 2021 World Health Summit adopted the Kampala Declaration. A Scientific Advisory Group for the Origins of Novel Pathogens is being created by WHO for the One Health approach. What should African countries do?

African countries have learnt many lessons from COVID-19; among the most prominent are that disease outbreaks can bring a country to a standstill and that public health cannot be left to the market. Governments have a key role in ensuring that there are effective multisectoral systems in place for disease outbreak preparedness and response. Africa has also painfully learnt that capacity is lacking in the continent to manufacture essential technologies to control pandemics and that in this crisis, African countries are shamefully the last to access these essential technologies. Investing in health systems and the health economy must therefore become a top priority as a matter of life and death. The pathogen economy calls for the African disease burden to be reflected in the African economies; instead of being a source of wealth for other countries as is the case now.

Dear Colleagues,

Here is a discussion on health financing in Africa. It is one of our most challenging barriers to UHC.

Annual budget negotiations with national parliaments are going on right now in a number of African countries. Difficult decisions are being made on which aspects of health budgets should be prioritized for funding. This gives us an opportunity to contribute to these ongoing national and regional budget discussions.

Let us start by gaining a common understanding of health financing. It is defined here as “the raising, pooling and spending of financial resources with the primary intention of improving health”. The sources of health financing are the general tax, donor aid, deficit funding (or borrowing), ear-marked taxes, and social and private health insurance. This should exclude out-of-pocket spending by individuals at the point of receiving health care. Expenditures are made in health facilities, on community and out-reach services, pharmacies, drug shops, sanitation, nutrition, training and research. Today, health financing remains the most intractable challenge for the health and development globally. Indeed, some have argued that Universal Health Coverage (UHC) in poor countries cannot be funded internally.

The Year 2021 has been designated by WHO as the _International Year ofHealth and Care Workers_ in appreciation and gratitude for their unwavering dedication in the fight against the COVID-19 pandemic. In order for it to be beneficial, this year-long campaign must explore ways of how health workers can be more intentional about compassion for themselves while striving to show compassion to others. This article discusses the critical issues on compassion for health workers; highlighting what could be done to help them cope with the challenges
they face in line of duty. 

Definition of Compassion: The definition of compassion encompasses the recognition of the suffering of others and the need to act to help. It embodies a tangible expression of our humanity of empathy and caring for those who are suffering, and a desire to alleviate their distress. It is the knowledge that there can never be any peace and joy for me until there is peace and joy for you too. Lack of understanding of how to handle colleagues who are working under very stressful conditions can have major consequences on the psychological wellbeing and the performance of health workers. Supporting their psychological wellbeing must be a priority for health systems managers and the general population.

Who will live; those with money or all of us?
The Covid-19 pandemic is raging in Europe and USA and infection rates have exceeded those seen during the first wave last winter and spring. Political leaders are under stress and are taking drastic steps to reduce transmission and minimize mortality and morbidity which has provoked riots in some countries. These countries are working feverishly to rapidly vaccinate the population with a view to reaching 70 – 80% of the vaccinated population which is needed achieve effective herd immunity which can enable return in these countries to normal social and economic life as well as save lives.

There is panic in some quarters resulting in decisions to grab all available COVID-19 vaccines including doses to be produced in the future. There was for example a highly publicized call this week that requires vaccine manufacturers not to export any vaccines without permission from political leaders. Vaccine nationalism has cropped up as new terminology. It is counterbalanced by regular calls from the WHO Director-General, Dr. Tedros, and some European leaders, championing humanity, equity, and solidarity to spare and avail some vaccines to LMICs who have no resources to develop and make vaccines for themselves. There is also the epidemiological argument that pockets of the virus anywhere is a threat to all countries and no country is safe until all countries are safe.