Gender, Environment, and Development Research Initiative for Security and Empowerment
Atinuke Authur
Apr 26, 2023
Realigning Health System Strategies for Sustainable Development in Africa
It is almost a decade since the United Nations Sustainable Development Goals (SDGs), set to be achieved by 2030, were signed and adopted among 191 member countries. The new agenda, which builds on the Millennium Development Goals, aims to be relevant to all countries and focuses on improving equity to meet the needs of women, children, and the poorest, most disadvantaged people (UN, 2023; World Health Organization- Global Health Observatory, 2023). While there have been substantial improvements in SDGs among countries globally, the United Nations Development Program’s (UNDP) 2022 Africa SDG progress report (UNDP, 2023) shows that progress toward agreed SDGs remains slow and retrogressive in the region– suggesting operational failures among stakeholders as critical barriers to achieving the SDGs. The report further noted that without deliberate policies to accelerate progress toward the SDGs, by 2030, at least 492 million people will be left in extreme poverty, and at least 350 million by 2050.
Growing empirical evidence suggests that Africa's health systems and service provisions must be aligned for effective policy responses to system challenges. Service delivery is largely disease-specific programs that focus on one or two health system functions in isolation with no systematic evidence for positive and negative effects, necessitating a holistic approach to program coordination using robust frameworks (WHO, 2017).
Contextual Challenges with the African Health System in Relation to the SDGs
Recent world bank estimates suggest that one reason behind the slowdown in global extreme poverty reduction is the slow progress in Sub-Saharan Africa. This translates to 40% of the population living below the poverty line in 2018, and Sub-Saharan Africa accounts for two-thirds of the global extreme poor population (World Bank, 2020). These statistics continue to deteriorate and are further worsened by persisting political instability. The chaos in governance has perpetuated the constant personnel change among the political leadership, precipitating inconsistencies in system governance. Beyond these socioeconomic threats, the African region has also witnessed increased access to information, technologies, and human rights, along with slow economic growth and commodity-based economies (GSMA Intelligence, 2022). Increased penetration of new technologies and innovations comes with opportunities and threats in an increasing urbanization and globalization era.
Human activities have continued to push planetary boundaries past dangerous thresholds with devastating consequences for life and wellbeing. There is a need to understand the changing epidemiology of diseases and recurring outbreaks of emerging and re-emerging diseases in all sustainable development dialogues. These pressures are both local and international. Various climatic and environmental factors have contributed to emerging and re-emerging infectious diseases (WHO, 2021; CDC, 2022). Prime examples are the Ebola epidemic, the Lassa fever outbreak, and Corona Virus pandemic of 2019.
Socioeconomic disparities in access to quality healthcare persist among most African economies. Furthermore, the African Human Development Report 2016 highlighted the negative economic repercussions that gender inequality is costing sub-Saharan Africa– jeopardizing the continent’s efforts for inclusive human development and economic growth (UNDP, 2016). The African region is experiencing peculiar demographic, economic, social, and environmental challenges that pressure the health systems. While the need to explore ways to address identified health systems challenges is far from easy, there is substantial evidence that having robust frameworks and metrics to direct efforts and priorities of countries could be rewarding.
Policy Implications
Given the peculiar challenges prevalent among African economies, an advanced change-producing approach is imperative. The (WHOAFRO, 2017) proposed using a comprehensive health system strengthening framework to solve peculiar regional challenges and align Health System Strengthening (HSS) to countries' needs. The goal of the action framework is to guide African countries’ efforts to re-align their health systems in a way that facilitates the realization of Universal Health Coverage and the SDGs. The framework uses system-wide approaches to integrate HSS elements to attain sustainable development objectives of countries. It emphasizes essential elements governments should focus on and how to organize and channel efforts toward achieving prioritized features. Thus, the following policy actions are recommended in line with WHOAFRO’s commitment to working with countries to produce robust health systems suitable for individual countries’ contexts, needs, and priorities.
Sustainable development mandate should be pursued through practical, actionable, specific measures with robust enforcement mechanisms. This will foster positive synergy among stakeholders– policymakers, the private sector, and the scientific community. Such collaboration should be harnessed to re-align strategies that reposition health service delivery and strengthen health systems
Efforts should be consolidated to strengthen health systems policy research in practice, education, and policymaking for effective systems. Factors that facilitate and impede translating research into policy and practice should be evaluated to strengthen the relationship between researchers and policymakers. These help to identify priorities that need active public participation, solid political focus, and robust quantitative measurements.
Lastly, realizing the SDGs will involve unprecedented global mobilization of knowledge, responsibilities, and resources. Stakeholders should work together to discuss crucial pathways to success in a manner that reflects democratic representation and technical expertise. The paths to meeting global sustainable developments can never be identified through a top-down approach but through a highly motivated and energized network of problem-solving cohorts comprising the academia, governments, the private sector, Non-governmental Organizations, civil society, businesses, and notably, the youths who expectedly should be experts and leaders of a new profound but challenging era. Sustainable development’s problem-solving networks will thus become important institutions for generations ahead and could help actualize the regional agenda.
Conclusion.
Sustainability requires responsibility, accountability, and leadership. For the sustainable development agenda to thrive in Africa, political leaders and relevant stakeholders must adequately invest in its success.
References
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GSMA Intelligence (2022). The Mobile Economy Sub-Saharan Africa 2022. https://www.gsma.com/mobileeconomy/wp-content/uploads/2022/10/The-Mobile-Economy-Sub-Saharan-Africa-2022.pdf Accessed 29/03/2023
United Nations (2023). The 17 Goals. Available online at: https://sdgs.un.org/goals Accessed March 27, 2023
United Nations Development Program (2016). African Human Development Report 2016. Available at: https://www.undp.org/sites/g/files/zskgke326/files/publications/AfHDR_2016_lowres_EN.pdf Accessed 29 March 2023
United Nations Development Program (2023). 2022 Africa Sustainable Development Report. Available online at: https://www.undp.org/africa/publications/2022-africa-sustainable-development-report Accessed 29 March 2023
World Bank (2020). The number of poor people continues to rise in Sub-Saharan Africa despite a slow decline in the poverty rate. Available online at: https://blogs.worldbank.org/opendata/number-poor-people-continues-rise-sub-saharan-africa-despite-slow-decline-poverty-rate Accessed 29 March 2023
World Health Organization (2017). Leave no One Behind Strengthening Health Systems for UHC and the SDGs in Africa. (2017). Available online at: https://www.afro.who.int/sites/default/files/2017-12/UHC%20framework_eng_2017-11-27_small.pdf Accessed March 27, 2023
World Health Organization (2021). Climate Change and Health. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
World Health Organization-Global Health Observatory (2023). Monitoring health for the SDGs. Available online at: https://www.who.int/data/gho/data/themes/sustainable-development-goals#:~:text=The%20United%20Nations%20Sustainable%20Development,achieve%20by%20the%20year%202030. Accessed 29 March 2023