As Africa navigates the aftermath of the COVID-19 pandemic, it faces a growing number of health threats. Recently, during the opening plenary of the biannual Africa Health Agenda International Conference (AHAIC) in Kigali, Rwanda, Dr. Githinji Gitahi, the Global Chief Executive Officer of Amref Health Africa outlined “the four C’s” facing the continent: Covid-19 (and ramifications), the Climate Crisis, Conflict, and Costs of Living. These multiple challenges underscore the inequalities and fragilities present in African regions. Resilient health systems will as much as possible need to cope with all these challenges, while also providing Universal Health Coverage (UHC), including for the rising non-communicable diseases (NCD) burden, and other more “routine” health concerns. In light of all these challenges, the question is not just how Africa can prepare for the next pandemic, rather it is how to foster and sustain resilient health systems and institutions that can address both present and foreseeable health crises across the African region. The path towards such health systems in Africa is fraught with many obstacles but also one of resilience, and hope.
The COVID-19 pandemic exposed the global health system’s disparities, with many parts of Africa initially – and to some extent still – facing limited access to vaccines, diagnostics & and therapeutics, as compared to wealthier nations. The blatant vaccine hoarding, inequities, and opposing interests have led to the current momentum, whereby many stakeholders realize something needs to change drastically. Or rather, *a lot* needs to change drastically. The resulting impetus triggered calls for a New Public Health Order (NPHO), which aims to achieve inclusive health security within Africa and lessen dependency on the international system. As such, this paradigm shift recognizes the need for indigenous solutions, regional manufacturing, and more innovation in Africa with innovative initiatives such as the Partnerships for Africa Vaccine Manufacturing and the African Vaccine Acquisition Task Force promoting research and domestic vaccine production and supply chain management for a more self-reliant health system.
The New Public Health Order is a work in progress, obviously, as the challenges faced by the continent are undeniably daunting. Africa struggles with a limited research and development industry, heavy reliance on imported medicines and vaccines, and a shortage of health professionals exacerbated by migration abroad (a brain drain which seems to have further deteriorated in the aftermath of the pandemic). Climate emergencies and ongoing conflicts also pose significant obstacles that the region must confront. At the AHAIC conference, a WHO Afro official pointed out that “50% of health emergencies in Africa are now caused by climate change”. And that includes not just climate emergencies such as floods and cyclones (as witnessed in Mozambique, Malawi or Madagascar in recent weeks and months); but also the growing number of spillover events across the continent and related outbreaks, in which the changing climate is one of the contributing factors (eg. the first-ever outbreak of Marburg virus disease in Equatorial Guinea, with another Marburg outbreak just this week declared in Tanzania); and other health emergencies where climate change seems to have accelerated the threat (like the ongoing cholera epidemic in Malawi and other countries). There are also old foes, like diphtheria in Nigeria. Meanwhile, poor health financing models continue to undermine public health institutions, leading to largely reactive rather than proactive responses.
There is however hope. Health outcomes can be improved and development can be accelerated by African-driven and context-specific solutions. Indeed, the health threat and complications prevalent in the African region are sometimes distinct from other parts of the world. New strategic investments, which include the WHO’s mRNA vaccine technology transfer hub in South Africa, Senegal’s full-service MADIBA vaccine facility, and – to a lesser extent perhaps – BioNTech’s vaccine manufacturing plant in Rwanda, indicate a promising path towards “resilience and self-sufficiency”. While the progress made so far is commendable, there is still a long way to go for many of these initiatives, and much work needs to be done to ensure their operation, sustainable business models, reliable supply chains, and efficient distribution channels before the next pandemic strikes. Fortunately, global health actors like GAVI are slowly but increasingly recognizing the need for sustainable business models, and starting to adjust their ways of working accordingly. Perhaps with the newly elected GAVI CEO, Dr. Pate, at the helm, the paradigm shift needed will really materialize on their side as well?
Shifting the focus from a dominant (Northern focused) narrative, African-led conferences are presenting a fresh and compelling vision for the future of health, gathering momentum and driving the push towards health equity. At AHAIC2023 in Kigali, Rwanda, the urgent need for increased investment in public health emerged as a critical element in the fight against diseases on the continent. By challenging the status quo and amplifying the voices of local experts and communities, these conferences are creating a powerful platform and sparking a renewed vision for the health sector in Africa. Capitalizing on this momentum, the Africa CDC’s new Strategic Plan (2022-2026) lays out clear priorities and actionable steps towards the NPHO and creating a safer, healthier, coordinated and prosperous Africa. Earlier this week, Ahmed Ogwell (Africa CDC) also tweeted that the 3rd Africa CDC International Conference on Public Health in Africa will be held on 27-30 November 2023 in Lusaka, Zambia – no doubt another milestone on the journey towards the NPHO.
Mere hopes, desires, discussions, and assessments of progress will not suffice, however. Addressing the underlying problems of healthcare issues in Africa is paramount before fostering resilient health institutions. Only then can we ensure capacity development and improve health outcomes across the continent. So it’s not just Africa CDC (and WHO Afro) that should show the way forward, African governments must also do their bit, and assume full responsibility for their health systems by providing sufficient domestic financing. Some encouraging examples are Rwanda’s community-based health insurance program, which covers over 90% of the population, or Kenya’s Health Development Fund and National Hospital Insurance Fund. Other countries should follow suit to achieve Universal Health Coverage. Favorable working conditions, fair pay, and compensation for health workers are also crucial for retaining them and delivering effective care.
In addition, the current donor-recipient dynamics must evolve to a respectful partnership model, where the Global South takes ownership of its health systems and the Global North supports the effort. Last but not least, the debt crisis in many African countries necessitates a comprehensive debt sustainability assessment and relief of sovereign debt by international institutions. Multilateral solutions for the debt crisis in many developing countries that take into account the affordable development financing needs are essential to enable countries to meet their economic, social, and human rights obligations.
Given the interconnected nature of today’s world, achieving the goal of responsive and resilient health systems in Africa thus requires everyone to contribute – African governments, wealthy countries, international institutions, civil society, and all other stakeholders. The urgency of this endeavor is heightened by the climate emergency, which has also added an extra layer of complexity. It is imperative that we collectively nurture responsive and resilient health systems that can adapt to changing health needs, leverage emerging innovations, and provide contextually-relevant support and programs to improve health outcomes.
Put differently, for the new Public Health Order to succeed, we need everyone to step up. Sooner rather than later.