PUBLIC HEALTH IN AFRICA

1
PUBLIC HEALTH IN AFRICA

• THE CONTEXT, THE GAIN THE LOSS AND THE WAY
  FORWARD
• (PH ability of HH, Community, State System to
  take care of own health meet daily needs and
  challenges env., lifestyle, livelihood)

2
THE CONTEXTTHE STATUS OF DEVELOPMENT (GLOBAL)

• More advance is made in the last 50 years than in
  500 years before the 20th Century
• Public health interventions and socioeconomic
  development reduced mortality and raised life
  expectancy
• But disparity widened, with a third of the global
  population wallowing in absolute poverty
• We still lose more than 11 million children to
  preventable diseases
• The absolute number of illiterate women is rising
• Those favored by trends insulated from reality as
  they take decisions others consequences

3
THE CONTEXT THE STATUS OF DEVELOPMENT (AFRICA)

• If the 1960s were characterized by the great hope
  of seeing an irreversible process of development
  launched throughout Africa, the present age is
  one of disillusionment
• Development has broken down, its theory is in
  crisis, its ideology the subject of doubt
• Agreement on failure of devt. in Africa is sadly
  universal

4
THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT

• In Africa
• Basic human development indicators are declining
  since early 80s
• Except a few countries the figure on population
  with access to basic social services has been
  static or sluggish at best, complicated by
  transition(rapid growth)
• Africa carries more than its fair share the
  global pervasive poverty, disease and death with
  appalling gap
• 1.2 billion without adequate shelter,
  overcrowded, no access to safe water, sanitation,
  recreation, safety cannot meet PH needs (who is
  responsible to ensure PH for ALL)

5
THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT

• Attenuation of human capital base
• The labor force participation is going down with
  growing population to feed, aggravated by
  decimation and/or diversion of productive force
  by HIV/AIDS and conflicts
• Rising school dropouts
• Brain drain, both internal and external by green
  pastures
• Inappropriate tooling of human resource
  Training for export

6
THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT
7
THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT

• Man-made and/or natural disasters degradation
  of the environment
• Draught and famine
• Overuse of agrochemicals
• Squandering of resources leading to conflicts
• Africa as a dumping ground (sometimes guised as
  donations)
• Corruption and looting

8
THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT

• Unjust World Order
• Unbalanced global trade
• Imposed reforms, restructuring and adjustment
• Debt burden (relentless and huge servicing)

9
THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT

THE VICIOUS CYCLE

TRAPPED HOUSEHOLDS

ILL HEALTH
POVERTY
10
FACTORS DETERMINING PUBLIC HEALTH INTERVENTION
11
PH THEGAINS (limited)

• Reduced child and maternal mortality
• Increased coverage
• Increased allocation of resources for health
• Growing recognition the health-development
  interplay

12
PHTHEGAINS (limited)

• Affordable public health inventions
• Enhanced integration of health actors
• Patchy spots of excellence observed

13
PHTHE LOSSES

• Worsening situation among the poorest (The
  neglected pool)
• Millions still die from preventables
• Poor preparedness for emerging scenario leading
  to reversal of gains

14
PH WHY LOSSES (4Ps)

• The People viewed as
• Vulnerable, powerless, sick, at risk (The
  needs-focused approach) instead of partners and
  resources
• The Problem conceived as
• Disease, malnutrition, poor sanitation instead of
  poverty, inequity, ignorance and marginalization

15
PH THE DISTORTIONS

• The Main Package (service)
• Drugs, vaccination, latrine, health talk (neglect
  of the social context) instead of income and food
  security, equity in access to services and
  empowerment
• The Professional mainly shaped to
• Give, prescribe, inject, educate, help, save, ask
  instead of facilitate, mobilize, dialogue,
  partner, feedback to people.

16
PH THE DISTORTIONS

• Capacity limited to
• Skills and knowledge instead of Ability,
  Resource, Authority and Responsibility

17
PH PACKAGE TO INCLUDE

• Increased productivity
• Increased education performance
• Fairer/accountable global and national systems
• Increased savings and investments (human, social,
  economic, environmental)
• Planned Human Capital more investment in fewer
  children
• Greater (redistributive) equity, social and
  political trust and stability
• Greater social capital, greater accountability,
  greater effectiveness and equity
• Investment in health will reduce deaths, lower
  population growth and provide 6 fold economic
  return by the year 2015. USD 66 billion new
  investment by the yea 2015 will save 8 millions
  lives per year.
• Reduce differentials (social status, capacity,
  exposure, outcome and consequences)

18
PH THE WAY FORWARD THE WORKING TOOLS

• CONCEPTUAL FRAMEWORK

DIFFERENTIAL VULNERABILITY
INCOME, CULTURE, ENVIRONMENT, GENDER, EDUCATION,
POLICY, RACE, AGE, DISABILITY
SOCIAL STRATIFICATION
ACHIEVEMENTS AND MIX IN ABILITY, AUTHORITY,
RESPONSIBILITY AND RESOURCE
DIFFERENTIAL CAPACITY
RISK/PROBABILITY OF EXPOSURE TO HIV/AIDS DUE TO
ONE'S RELATIVE SOCIAL CONTEXT
DIFFERENTIAL EXPOSURE
SOCIAL AND CLINICAL OUTCOMES RESULTING FROM
EXPOSURE DEPENDING ON RELATIVE VULNERABILITY OR
CAPACITY
DIFFERENTIAL CONSEQUENCES
19
PH THE WAY FORWARD THE WORKING TOOLS

PRIVATE SECTORS NGOs
Poverty
PUBLIC SERVICE
TRAINING INSTITUTIONS
TRAPPED Households
Ill health
COMMUNITY
FRAMEWORK FOR PARTNERSHIP
20
The Spiral of Continuous Dialogue

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ASSESSMENT-2

ACTION MONITORING


ASSESSMENT-1
ACTION
PLANNING

ANALYSIS

DECISION
REFLECTION
Fig.1 The Dialogue Spiral
Fig.2 One cycle of the Spiral with
Stages
21
Steps in Organised Dialogue

• STEP 1 Listen and learn about their priority
  concerns and gaps and how they are affected by
  them/it. (WHAT ARE THE CONCERNS AND CURRENT,
  often hidden, ALTERNATIVES)
• STEP 2 Listen and learn about their current
  practices to solve / cope with the problem/s,
  gaps etc (WHY THE CURRENT SITUATION / CURRENT
  ACTION / BEHAVIOUR)
• STEP 3 Listen and learn about their preferred
  future situation and suggested actions to
  achieve it (HOW CAN THE PREFERRED FUTURE BE
  ACHIEVED), give input including the recommended
  practice (if not yet mentioned or summarise from
  their contributions).
• STEP 4 Select together with them the most
  effective, feasible, appropriate options, (WHICH
  OPTIONS ARE BEST), based on existing capacity
  and opportunities. Summarise agreement and
  reflect on possible results if implemented (this
  provides a basis for commitment as well as
  monitoring and evaluation)
• STEP 5 Plan action, including monitoring and
  evaluation (WHEN DO WE TAKE ACTION AND WHO IS
  RESPONSIBLE)
• STEP 6 Follow up, assess implementation of the
  joint action plan, based on information (note
  modifications, compliance or rejection),
  feedback, celebrate results and re- plan, making
  necessary adjustments.

22
Framework for PH Assessment

• 1. Structures and institutions for participatory
  action (micro to macro) Capacity,
  representative-ness, inclusiveness, transparency
  and accountability
• 2. Participatory program management Stakeholder
  involvement in program processes and decisions
  such as situation analysis, planning, action,
  monitoring and evaluation
• 3. Management information system Design and
  selection of measurable indicators, data
  collection, analysis, recording, reporting and
  local consumption
• 4. Human resource development and management
  re-orienting, and retooling, training,
  supervision, motivation and control to mainstream
  participatory approaches.
• 5. Participatory resource mobilization and
  management Mobilization, allocation, expenditure
  tracking to enhance transparency, accountability
  and efficacy.
• 6. Comprehensive communication strategy
  Comprehensiveness of the message, appropriateness
  and diversity of the channels, demystifying
  content and language to fit the audience, and the
  interactive-ness of the communication process
  including documentation, dissemination and
  feedback.
• 7. The minimum public service package Service
  package definition, its effectiveness, policy
  relevance, accessibility and affordability.
• 8. Sustainable linkages and partnerships Nature
  of linkage, partner capacity, relevance and
  effectiveness of partner investment,
  sustainability of either the linkage or the
  investment.

23
CAPACITY BUILDING FOR SUSTAINABLE SERVICE
ABILITY
DONOR/STATE-DRIVEN TRANSITIONAL SERVICE
DELIVERY CAPACITY BUILDING
AUTHORITY
COMMUNITY/HOUSEHOLD CAPACITY
RESPONSIBILITY
RESOURCE
EFFECTIVE SUPPLY
FROM NEED TO EFFECTIVE DEMAND
REGULATED MARKET
24
AFRICA STILL ASKS DR MAHLERS QUESTIONS OF 1978,
ALMA-ATA

• Are we ready
• To address the gap between the haves and the
  have-nots?
• For partnership-participatory and intersectoral
  action?
• For equitable and just health?
• To make preferential allocation of resources to
  the marginalized?
• Put people at the center of our action, to
  recognize them for their capacities and
  contributions as partners and not for their
  needs?
• To introduce radical but relevant structural
  changes in our systems?
• To fight political and technical battle to
  overcome social, economic and professional
  obstacles to PHC?
• To mobilize global solidarity for Health For
  All?

25
AFRICA STILL ASKS DR MAHLERS QUESTIONS OF 1978,
ALMA-ATA

• To mobilize global solidarity for Health For
  All?