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NEPAD health strategy - Initial programme of action
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2. SECURING HEALTH SYSTEMS AND BUILDING EVIDENCE BASED PRACTICE
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Strengthen the technical capacity for policy making and budget linked planning in Ministries of Health
The performance of a country's health system against the resources available is in no small measure attributable to the performance of the Ministry of Health. To be effective, Ministries need sufficient technical capacity for policymaking and for steering system and service development. They must have the capacity to bridge the policy to implementation gap. Capacity must cover the public and private sector, communicable and non-communicable disease, health systems operations and monitoring and evaluation, hospitals and districts and primary health care and community involvement. It should also cover human, financial and material resource management. The reality is that many ministries lack this depth of capacity and struggle to retain skilled staff.
The aim of this programme is to support the strengthening of technical capacity for policy-making and budget linked planning in ministries of health. The capacity required will be identified and a plan for strengthening developed and implemented. Specific emphasis will be placed on measures to retain skilled staff, and to building in-country capacity. Too often country's are too dependent on outside advisors, who do not adequately understand local circumstances and tend to come and go.
There are a number of specialised areas in which it will be difficult to build adequate capacity in every country and for which it is not cost-effective to do so, but which could be suitably provided for at the regional economic community (REC) level. The unique advantage of RECs is that they cluster adjacent countries that often face similar challenges and have an established process of working together. This project will therefore identify those areas of policy that could be effectively supported by a regionally determined framework, which could then be adapted to country situations. It will support the process of establishing effective health desks in the RECs.
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Launch a sustainable health systems programme including the following elements:
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Operationalise effective local health systems through establishing demonstration districts in all countries that can test delivery strategies and provide a model for replication
Efforts to reduce the heavy burden of disease in Africa are substantively dependent on the effectiveness of local health systems to deliver accessible quality care to their communities. In the face of declining economies and increased poverty and other factors much progress in local health systems has been reversed, but efforts are underway to redress this. There are a number of measures that have been well proven to be effective, but many have not been widely implemented. It is currently estimated that only 53% of Africans have reasonable access to health services but even for them, their local services are not necessarily effective.
The aim of this programme is to work on developing at least three fully effective health districts per country to serve as demonstration districts. Here, international approaches can be adapted to the local country situations and delivery strategies can be tested. These loci can then be used as building blocks and training sites for further national development. A number of steps will be implemented simultaneously, consequent on an assessment of the current functional impediments in local health systems. These steps include infrastructure planning and development, capacity strengthening for management, implementation of sustainable funding mechanisms, strengthening human resource capacity, increasing local accountability and community participation and empowerment. Capacity to support these developments at provincial and national level will also be developed.
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Create a fund to support innovations in health systems and the sharing of successful new approaches to encourage new developments and evidence based practice
One of the great difficulties in a financially stretched health system is to find funding to support innovation. Yet, there is need for and evidence of a pool of excellent ideas for enabling a wide range of new developments to enhance the effectiveness of health systems. Yet, many of these ideas do not emerge, as there are not ready mechanisms for their proponents to get support for, test and develop working examples of innovations. Too often, systems stagnate and do not explore new opportunities. In the private sector, this could lead to bankruptcy, in the public sector it can lead to stagnation and ineffectiveness
The aim of this fund is to provide hump funding to enable new ideas to be tried out, to encourage new developments and evidence-based practice, and to enable these to be shared within and across countries. The innovations supported will cover a wide range of areas, from community involvement, to drug delivery systems, to use of mid-level workers, to public-private partnerships and to the development of new styles and capabilities of management. Alternative innovative models will also be encouraged for the delivery of disease-specific programmes and their integration into the health system.
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Provide rural clinics with the infrastructure required for effective operation, starting with tele, radio or satellite communication to reduce isolation and enable calls for emergency assistance
One of the features that most impedes the effective operation of peripheral health systems is their lack of basic infrastructure. Amongst the most debilitating and demoralising for health staff is the lack of effective communication. This leaves them isolated, unable to seek advice or to call for emergency assistance. The despair that rural health workers feel when they watch patients with an emergency condition, such as obstructed labour die unnecessarily is one of the greatest stresses facing rural health workers.
NEPAD is committed to improving telecommunication and information technology across the continent. This programme seeks to ensure that all health centres and clinics have a reliable means of tele, radio or satellite communication with at least their district hospital. This communication system can also supplement supervisory visits to the clinic by enabling continuing education and support and allowing supply systems to become more effective.
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Test new models for drug supply to rural clinics and hospitals to overcome supply system problems
Supply system problems continue to plague health systems in Africa, the most devastating of which is the failure of drug supplies to regularly reach rural clinics and hospitals. Affordable drug prices and new drug developments will come to nought if they cannot reach those who need them.
This programme seeks to develop measures to control leakage from the system and to secure distribution, including effective stock control and transport. As even refrigerated goods regularly reach village stores, the possibility of contracting in private distributors is one consideration - the drug needs of a clinic would hardly add to the load in their vehicles. However, there are many challenges in developing this and other options. The purpose of this programme is to test out new models for drug supply, to ensure and secure a reliable system.
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Strengthen and increase capacity of training programmes for multipurpose clinic staff
For health systems to provide effective care, clinic staff needs to be competent across the range of basic health conditions that present to them. Yet, the reality is often different, and so conditions that could be readily identified and treated, or for which early referral could be effective are missed or inappropriately cared for, and opportunities for prevention of disease are lost. The realities of the number of staff in at a service point and the recognition of the value of comprehensive primary health care means that staff should not be selectively trained to only fill a narrow function.
The aim of this programme is to provide continuing education and development, particularly for staff that have displayed a commitment to staying and providing health care for the poor and the marginalised, and to build the capacity required to provide such training. New approaches to training and new methods of providing it that minimise its impact on service delivery will be developed. Adult learning methods will be the core pedagogy. The programme will be aimed at both professional and mid-level health workers.
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Increase the capacity for public health training in Africa, so that the required cadre can be cost-effectively achieved
Given the lack of capacity development on the continent it is not surprising that capacity for public health training in Africa has remained limited, while dependence on expensive international training has continued. Africa does not have the public health capacity required to effectively build health systems or address the burdens of disease, or the institutional training capacity to provide the necessary training.
The development of Centres of Excellence and Networks in Africa are key components of the general NEPAD strategy. This programme aims to strengthen public health capacity at identified public health schools and institutions across the continent and enable networking between institutions and professionals, who currently often network with their counterparts in the developed world, but not with their colleagues in Africa. It will also establish and maintain an inventory of public health education capacity in Africa, enable standardisation and accreditation of training institutions and encourage innovative methods of training and the use of technology supported learning. The programme will enable institutions to partner more collaboratively with counterparts in the developed world as they continue to offer what will become more focussed contributions that leverage their unique abilities, while building more cost-effective capacity on the continent.
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Increase funding for operations and health systems research, including community based interventions, to strengthen the evidence base for public health decisions and to enable health research to become integral to the health system
Evidence-based public health practice and the information deriving from operations and health systems research are playing an increasingly important role in the development of effective and efficient health systems. Yet, in Africa the evidence-base remains thin and health systems research often limited and marginalised.
The purpose of this programme is to increase the recognition of the value that health systems research has for health systems, and to enable it to become an integral functioning part of the health system in countries. This will include building capacity to analyse evidence and undertake health systems research, support development of national plans for prioritising areas for research, and establishing mechanisms for research findings to reach policy makers and influence practice.
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Build capacity in Africa for health research relevant to the challenges and needs of the continent and its health systems
While the value of health research is constantly emphasised, the capacity of African researchers and research institutions remain inadequate to support this. They are inadequately co-ordinated and too fragmented, often struggle for sustainable funding and are impeded by poor information technology and inadequate human resources and skills.
The aim of this programme is to develop a plan for the strengthening of national health research capacity and to support its implementation. As capacity is built, it will be critical to paying attention to retaining that capacity in Africa, through assuring ability to access funding for relevant research, with African institutions as the lead agencies. A key element will be training programmes that build capacity specifically required by countries to improve their health systems.
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Support the capacity for local production of essential drugs, including anti-retrovirals so as to make drugs more affordable
Africa remains far too dependent on importation of essential drugs. This has added to making decent health care provision unaffordable. The high cost of anti-retroviral drugs, so urgently needed in the face of the HIV/AIDS crisis is a case in point. There needs to be less dependency on the multinational pharmaceutical industry, who continue to indicate that they cannot make their drugs more affordable, while at the same time continuing to post record profits. Besides the potential for lower cost drugs, there are also the benefits of industrial development.
The aim of this programme is to ensure capacity in each of the regions in Africa to locally produce high quality essential drugs. The establishment of this alternative capacity is also likely to have a wider impact on overall pricing of drugs and the ability to more effectively use the opportunities to be exempt from international trade and patent agreements in the case of national emergencies.
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Advocate and leverage support for development of the new drugs and vaccines needed by Africa
So near yet so far is a reality regarding many new drugs and vaccines needed for the health problems of Africa, as a lack of research funding and potential profit stifle efforts. There have been some positive developments recently, but these need to be built on to bring the needed new drugs and vaccines to Africa's people.
This programme seeks to mobilise support for urgent effort for the new drugs needed in Africa, such as for sleeping sickness, leishmaniasis and malaria, It also seeks to encourage the development of vaccines against the strains of bacteria causing pneumonia and meningitis in Africa and viruses causing gastro-enteritis. The capacity of the international pharmaceutical industry needs to be brought to bear on these challenges, and government support on the continent and internationally is required to achieve an enabling environment for this. This programme seeks to advocate for and leverage such support.
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Establish reference laboratories in each of the regions in Africa to support disease control and drug resistance surveillance and provide training
The lack of disease and health system surveillance capacity continues to undermine disease control and health service development efforts. Such surveillance is in no small measure dependent on good laboratory capacity, starting with simple tests and backed up by national and reference laboratories capable of evaluating quality, doing complex tests and testing for drug resistance.
Although the building blocks are in place in Africa they need substantial strengthening and cementing together into a regional network, which is what this programme seeks to do. The aim is to ensure at least one reference laboratory in each of the regions in Africa and to provide the support and training necessary for their effective performance. The development of such institutional capacity in Africa is directly in line with NEPAD's strategy in this regard.
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