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NEPAD health strategy - Initial programme of action
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1. STRENGTHEN COMMITMENT, ENABLE STEWARDSHIP AND HARNESS A MULTI-SECTORAL EFFORT
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Create a NEPAD Presidential Advocacy for Health Group to mobilise commitment from Africa and from development partners to the NEPAD health strategy
The initial developmental documents by the founding presidents for NEPAD emphasised the severity of the health burden facing Africa and its impact on development, in particular of HIV/AIDS, Tuberculosis and Malaria. NEPAD has retained its strong focus on health issues since then. Yet, NEPAD has been criticised for not placing health and in particular HIV/AIDS high enough on its agenda. There is also concern that continental and international mobilisation on health from the continent has not been strong enough. It has been suggested that even subsequent to the Abuja Declarations on Malaria and on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases by Africa's Heads of State, health has not played a central role on the continent, nor in its engagement with development partners. One can debate whether this is a fair critique or one that fails to recognise the attention given by many Heads of State to health issues. However, what is not in doubt is the need for consistent visible evidence of NEPAD's commitment to health and its recognition of the detrimental effect that the health burden has on the continent's development.
A key contribution to the health commitment of NEPAD will come from the establishment of a Presidential Advocacy for Health Group. These Heads of state would play a central role in mobilising commitment from the AU, RECs, individual countries and development partners. The special knowledge and insight they will develop on the health issues and challenges will position them well to advocate for health and health system development amongst fellow Heads of State. They will also engage development partners on the contributions they can make, steering them to support this African determined and driven strategy and towards a scale of support that can make a real difference. They voice of the Presidential Advocacy for Health Group and the positions of the NEPAD health strategy, will be heard on international and national platforms and there will be active responses to international developments.
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Establish a health system observatory programme to provide the capacity to monitor and evaluate progress towards achieving this strategy, including reporting to the NEPAD Heads of State
A striking feature in assessing progress in health systems in Africa is the lack of current information provided in a digestible fashion to enable effective monitoring and evaluation. This has led to a continuation of the use of outdated information and to clichйd critiques of health system development in Africa that may not reflect the reality. Although African Heads of State committed their countries to spending 15% of public expenditure on health, there is no ready source to establish whether or not this is happening on the continent. This, and other country information gaps, impedes recognition of progress and loses leverage for the health sector to present itself as a credible vehicle for investment, that will not only improve health but also advance social and economic development.
The establishment of an African Health System Observatory would close this gap. The observatory would not be structured to simply provide neutral country descriptions, but also to offer an analytic framework that explores health system progress, including against the NEPAD health strategy, at the country and the regional economic community level. The observatory will in this way also support the work of the NEPAD African Peer Review mechanism. But, its main value would be to help countries track their progress and benchmark themselves against other countries on the continent.
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Institutionalise the preparation of National Health Accounts as a tool to determine financial flows to the health sector
National health accounts are recognised as the most valuable tool to assist countries in addressing the challenge of health sector financing. It allows countries to make wise choices and to identify inefficiencies and inequities in resource allocation and utilisation. Yet, to date only 12 countries have undertaken the preparation of national health accounts. This is seen to be due to limited awareness of their importance, and a lack of technical capacity and financial resources to collect the data required.
This programme aims to institutionalise national health account's tools in African health systems, including the establishment of national health accounts units in government institutions. It will also strengthen institutional capacity in Africa outside of government to support national health accounts work. National health accounts should not be seen in isolation, but should be linked to medium-term expenditure frameworks and international financing and health systems development strategies.
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Reach an international agreement on migration especially with regard to ethical recruitment of health personnel from Africa, while putting in place mechanisms to address the adverse conditions of service for health professionals
While it is true that highly skilled health professionals will continue to migrate out and within the African region, it is the rate at which this is happening that has reached crisis proportions. It is estimated that 23 000 health professionals emigrate annually. Health is a labour intensive, skill dependent sector, and Africa will never be able to establish an effective health system if it continues to bleed its professionals so profusely. Countries are not simply losing the economic investment they have made in training these health workers; their loss leads to an increase in the burden of disease, which then impedes the social and economic development of the country.
This programme aims to engage countries, regional communities, international organisations and developed countries to commit themselves to contributing to the reversal of the high levels of brain drain. This includes reaching an international agreement on migration to achieve an ethical approach to the recruitment of health personnel from Africa. At the same time it will explore and support putting in place mechanisms to address the adverse conditions of service for health personnel and to enhance other motivation and retention strategies.
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