WHO Africa boss speaks on status of regional healthcare

Despite the progress made by most countries across the region, the health sector continues to show weaknesses in aspects such as quality, costs and response. Kigali will this week host the inaugural Africa Health Forum of the World Health Organisation in the African Region to look into ways that the sector could be fit for purpose. The two-day summit, organised under the theme, “Putting People First: The Road to Universal Health Coverage”, will chart the future of healthcare across the region and continent. The New Times’s Collins Mwai spoke to Dr Matshidiso Moeti, the World Health Organisation regional director for Africa, who is in the country for the summit. The interview covered a number of aspects including the state of healthcare in the region, preparedness for epidemics, non-communicable diseases and sustainability of funding models among other aspects. Excerpts: What would you say are East Africa’s biggest concerns in the health sector? Dr Matshidiso, WHO regional director. / Internet photo There are several aspects that are really important in the health sector in the region. We have a heavy disease burden, for a long time we have been having a burden of communicable diseases. Diseases like malaria, HIV which has been a tragedy as well as Tuberculosis. There has also been vaccine preventable diseases such as measles in some parts of the continent. There have also been outbreak of epidemics such as cholera, Ebola, among others. Communicable diseases have been going down in Africa but at the same time we are seeing a sharp rise in non-communicable diseases such as cardiovascular diseases such as hypertension, cancer, among others. We also have concerns such as mental health issues such as depression. We also have accidents and violence, Africa probably has the highest rate of motor vehicle accidents leading to fatalities. We also continue to see high rates of maternal mortality as well as babies dying. Our health systems are also very weak. They are not able to respond adequately to lower deaths from all these diseases neither are they able to prevent outbreaks from growing into epidemics. This was especially the case in Ebola, which was quite dramatic. The regional health sector is largely public sector driven with minimal private sector involvement. When the private sector is involved, the cost tends to go up. How can the private sector be brought on board and still achieve affordable care? We need to see the private sector getting more in health. The private sector seems to have understood that if you see the statements, interests of private sector entities, they are rising fast as a sector where they can make money. Our concern as a public health entity is that they do it well. In aspects such as health insurance, it should be firms that can be impactful in managing pooled resources and also invest different ways in providing healthcare, medicines and equipment, among others. Their investments need to be within the framework of what the country would like to do, provide equitable access and affordable health care. What needs to be done with the involvement of the private sector is to guard against what might become a tendency to have top notch latest technical and high quality health care which can drive up the cost upwards. There is a lot of scope, where private public partnership can contribute to affordable healthcare. What would be the preconditions of such a partnership? I think the most important thing is to have a common goal that citizens have access to a basic package of healthcare and for those who can afford private care to have that option too. We should not have private investment and attention to the latest treatment distort spending in a country. There is need to negotiate and see what is fairest so that at the end we have the basic access for a majority if not all the people. Another characteristic of the regional health systems in most countries is that they are largely donor-dependent in terms of financing, is there a window for sustainable self-financing? Ironically, even if countries appear to be more dependent on donors, the majority of budget for health in most countries comes from the national government. In most cases it’s about a 70:30 ratio. What is ironic is that the sort of attention that comes with the money that comes from outside is higher because its donor money, there are proposals involved, reports and making sure that its used for the purpose that it was given. Government budget is often used up in basic things such as salaries and infrastructure but does not receive as much attention on whether it is well used. We probably need to change the thinking and see to it that we get the most from health investments. The problem with international funding is that it comes targeting a disease or a specific intervention, which places a huge burden on countries that have to deal with a lot of donors individually. This causes fragmentation, which imposes heavy costs to the government in terms of managing it. A few years ago, there was a Paris Declaration, which emphasised that donor support should be aligned to national priorities and that donors should coordinate among themselves so that the government is not running all over the place trying to coordinate them. Donors were asked to have one format of reporting so that the government knows who is doing what. Over time, the attention to this principle has weakened. During this meeting, we will discuss to see ways in which we can pay attention to this and work in line to the principle. Though countries are highly dependent on donor initiatives, we need to also help countries become much more efficient in using their own money. There is a lot of room to improve efficiency, which would help countries get more value out of their money. The summit comes in the background of an Ebola outbreak in neighbouring DR Congo, what would you say of regional countries’ preparedness? Countries are not where we would like them to be but they are not where they were during the start of Ebola in West Africa. The tragic occurrence spurred countries and international partners, including WHO to work much more intensely on this. The DR Congo outbreak was a good example of this. We are better off but we are not at the level of international health regulations capacity. Countries are putting up more mechanisms in place such as emergency systems to prepare for response. But they do not have human resources that are needed, laboratory capacity, diagnostic capacity among other aspects required to improve response. However, it is going in the right direction despite not being where it ought to be. ‘Traditional’ ailments such as malaria and Tuberculosis, which have been curbed in other parts of the world, continue to trouble the region. What are we not doing right? This is part of what we want to share with our stakeholders during this meeting. First, it is important to have a system that reaches people where they live such that people can present themselves early for treatment and diagnosis. Make sure that people do not have to pay directly when they go for treatment because this is an inhibiting factor, if you do not have money you cannot be seen by the doctor directly. We need to have pre-financed insurance. We need to have human resources who are also motivated, a referral system for the referral of complicated cases. One of the things that can be done is technology whereby we will be speaking to the International Telecommunication Union whereby we will look at how we can use e-Health. I know that Rwanda is one of the countries in Africa that is driving the use of technology for development. Non-communicable diseases such as cancer, hypertension are currently on the rise and often have high costs of treatment, which is beyond most ordinary citizen’s reach. Where do we begin from? It is important to emphasise that we must invest in the prevention of these diseases. These are eminently preventable through life style changes. The government can do this by taxing alcohol, tobacco before we talk about treatment. We need to look at the type of marketing of unhealthy foods that is going on in most of our countries. As far as treatment is concerned, there has been a lot of intervention at the global level, we have set up some very good mechanism of looking at and talking about non-communicable diseases at a global level. The financing for non-communicable diseases is not where it should be, especially in treatment. The international community needs to do more by negotiating to bring down the cost of treatment of lifestyle diseases. People also need to get health insurance, which will help manage expenses of treatment. Governments now ought to pay enough attention to non-communicable diseases. We know that this is the trend in terms of disease burden. editorial@newtimes.co.rw

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WHO Africa boss speaks on status of regional healthcare