A call to the 2007 G8 Summit to support African national health plans and comprehensive health workforce strategies
African Council for Sustainable Health Development (ACOSHED), African Medical and Research Foundation (AMREF)
We are African organisations deeply committed to improving the health of the people of our continent. Yet we are deeply concerned about the lack of progress, and in some countries reversal of progress, resulting in millions of preventable deaths that continue to burden our countries each year. It is clear that as long as our health systems remain weak in many dimensions and our countries face a health workforce crisis, the current unacceptable trends will persist. In spite of this slow progress, we remain optimistic. We have observed progress in some regions and countries, and identify with the deepening commitment to the health of many of our Government and institutions. Our Regional Economic Communities have assumed an important leadership role within the continent in catalyzing actions required to strengthen health systems and achieve health MDGs. We are convinced that the engagement of our partners locally and globally can translate into the political will, resources, and efficiency required to transform health on our continent. With so many lives at stake, our neighbors, our children, and ourselves, we must succeed. Cognizant of the continuing intolerable burden of disease, African Union ministers of health have developed an Africa Health Strategy 2007-2015 that seeks to “provides a strategic direction to Africa’s efforts in creating better health for all.” At the core of the Africa Health Strategy is the strengthening of health systems based on carefully costed National Health Plans that incorporate the commitments made by African governments, including achieving the Millennium Development Goals and universal access to HIV/AIDS treatment, care, prevention, and support by 2010. The chief responsibility for the success of these plans lies with our own governments. We will hold our governments accountable. We will insist – and are demanding – that they take the necessary steps to achieve the promises of good health, a foundation of healthy societies. Collectively, we will hold our governments accountable to increasing health sector investments to at least 15% of the national budget, improving the efficiency in allocation and application of these resources, and the implementation of health workforce and systems strengthening strategies capable of providing quality health care to all people. We further commit to work with our governments to identify sustainable financing strategies that can replace point-of-service payments (i.e., user fees) for essential health services and to meet their other commitments and responsibilities including as part of the human right to health. However, the successful implementation of the National Health Plans requires support from Africa’s development partners, especially from the nations that comprise the G8. Even if African governments significantly increase their own funding for National Health Plans, these plans will have significant financing gaps. Many of the actions required for these plans to succeed will require solutions and expertise that crosses national and even continental boundaries. Building health systems must include building partnerships between health care providers and the communities that use those services. It requires donors to listen to African communities to find out what their needs and concerns are, so that services are tailored to those needs, as opposed to imposing systems that may be effective elsewhere but not in Africa. It is about using the opportunities that exist within communities to advance health care, by harnessing the knowledge, resources, and energy in the community and applying it to work together with the formal health system. We call upon the upcoming G8 summit in Germany to recognize the Africa Health Strategy developed by our health ministers and to engage in substantive dialogue with communities, civil society, governments, regional economic communities, and the African Union. This dialogue should be backed by firm commitments about steps that we know will be required of wealthy countries if African National Health Plans are to succeed. We call upon the G8 countries to fulfill existing pledges, including the commitment of 0.7 per cent of their own Gross National Income (GNI) to Official Development Assistance (ODA), the doubling of aid to Africa by 2010, and to adhere to the commitments of the Paris Declaration on Aid Effectiveness, including those that relate to alignment and harmonization of aid investments with country plans and leadership. We ask that this G8 summit also make the following commitments, which are required for African National Health Plans to succeed: Fiscal Space 1. Provide long-term, predictable funding to cover financing gaps identified in National Health Plans and plans for universal access to HIV/AIDS treatment, care, prevention, and support, and harmonize health assistance with country-driven National Health Plans. 2. Work with International Financial Institutions and developing country governments and civil society to ensure that fiscal and monetary policies are aligned with the best estimates of the fiscal space required to achieve the MDGs and other human development goals and commitments. 3. Accelerate debt cancellation and ensure that debt cancellation supplements rather than displaces aid. 4. Provide the needed financial and technical support to developing countries to design and implement sustainable financing schemes that can support the elimination of point-of-service payments (user fees) for essential health services and that are designed to enable all people, including the poor, access to quality health services. Health Systems and Workforce 5. Work with the AU and other continental partners to identify a basic package of health systems interventions, implemented at the community and district levels, that can provide the backbone for the delivery of health service packages required to achieve the MDGs and universal access to the best attainable health care. 6. Support the development and implementation of inter-sectoral and comprehensive health workforce strategies that are integrated with a broader health sector response and public service reforms to address numbers of health workers as well as other variables such as internal distribution, skills mix, work environments, productivity, and management capacity. 7. Engage developing countries to formulate a comprehensive strategy to address health worker migration that emphasizes co-development, including by adopting policies to develop self-sustainable workforces within OECD countries and to follow ethical recruitment practices. 8. Increase support to developing countries to fully utilize TRIPS flexibilities to improve access to medicine, including by helping build capacity to utilize these flexibilities and by avoiding any restrictions to such flexibilities – or any other provisions that may be detrimental to health – in trade agreements. Mutual Accountability 9. Support initiatives and programs that promote peer and independent mechanisms to track the progress of our governments and their partners to the commitments and declarations made at global, continental, and regional fora. 10. Through diplomatic levers, technical assistance, and other strategies, support African civil society efforts to hold our own governments accountable to their commitments and responsibilities. Signed Action Group for Health, Human Rights and HIV/AIDS (AGHA) UGANDA Action Health Incorporated NIGERIA Addis Development Vision ETHIOPIA Africa Jesuit AIDS Network PAN-AFRICA/KENYA Africa Public Health Rights Alliance / 15% Now! Campaign PAN-AFRICA/NIGERIA African Council for Sustainable Health Development PAN-AFRICA/NIGERIA African Federation for Sexual Health and Rights PAN-AFRICA/NIGERIA African Medical and Research Foundation (AMREF) PAN-AFRICA/KENYA AIDS Law Project SOUTH AFRICA AIDS Rights Alliance for Southern Africa SOUTHERN AFRICA/SOUTH AFRICA Alliance Cornerstone Youth Organisation NIGERIA Center for Health Sciences Training, Research and Development NIGERIA Christ Soldiers Foundation GHANA Christian Community Development of Burundi BURUNDI Christian Health Association of Kenya KENYA Council of Nigerian Youths NIGERIA Department of Nursing Sciences, School of Medicine, Moi University KENYA Eastern Province Hospice Association SOUTH AFRICA Ecumenical Pharmaceutical Network KENYA Ethiopian Public Health Association ETHIOPIA Gays and Lesbians of Zimbabwe ZIMBABWE Global Health Watch GLOBAL/SOUTH AFRICA Health Action International Africa PAN-AFRICA/KENYA Ideas Research and Management Assistance KENYA Ikonzo Musanda Self Help Group KENYA Kenya AIDS Intervention/Prevention Project Group (KAIPPG)/Kenya KENYA Kenya Health Rights Action Network KENYA Kenya Network of HIV Positive Teachers KENYA Kenya Treatment Access Movement KENYA Kigezi Health Care Foundation UGANDA Mapendo International PAN-AFRICA/KENYA Medical Care Development Inputs KENYA National Nurses Association of Kenya KENYA Network of Zimbabwean Positive Women ZIMBABWE Nigerian Partnership for Transforming Health Systems NIGERIA People’s Health Movement – South Africa SOUTH AFRICA Public Health Association of South Africa SOUTH AFRICA Resources Oriented Development Initiatives (RODI) Kenya KENYA St. Francis Hospice SOUTH AFRICA Students for Equity in Health Care UGANDA Uganda National Health Users’/Consumers’ Organisation (UHNCO) UGANDA Volunteers To Support International Efforts In Developing Africa LIBERIA Wits Palliative Care, Chris Hani Baragwanath Hospital SOUTH AFRICA World Care Council/Conseil Mondial de Soins-AFRO DEMOCRATIC REPUBLIC OF CONGO Zimbabwe Association of Doctors for Human Rights ZIMBABWE Zululand Hospice Association SOUTH AFRICA Donald Cephas Epaalat Commonwealth Nurses Federation, Board Member for East, Central and Southern Africa (ECSA) KENYA This statement has also been supported by organizations and individuals from beyond Africa. Although the statement was intended for African organizations to sign, and a separate statement of support was developed for U.S. organizations, other organizations also spontaneously expressed their support and solidarity. ActionAid International USA USA AfricaRecruit UNITED KINGDOM American Jewish World Service USA CARE USA USA Church World Service USA Empower India INDIA European Forum for Primary Care THE NETHERLANDS Gay Men’s Health Crisis USA Global AIDS Alliance USA Global Health Council USA Health Alliance International USA Health Gap USA ICMDA (International Christian Medical and Dental Association) HIV Initiative AUSTRALIA Kenya AIDS Intervention/Prevention Project Group (KAIPPG) International USA Management Education and Research Consortium USA Marianists International USA Medical Mission Sisters -- Sector North America USA Mishkin and Associates USA National Physicians Alliance USA New Rules for Global Finance Coalition USA Nigerian Public Health Network UNITED KINGDOM Pangaea Global AIDS Foundation USA Partners In Health USA Physicians for Human Rights USA Save the Children UNITED KINGDOM Search for a Cure USA Society Association HIV.LV LATVIA Support Group for ARV Users NEPAL The AIDS Institute USA United Methodist Church, General Board of Church and Society USA University Coalitions for Global Health USA Wemos THE NETHERLANDS Professor Jan De Maeseneer, MD,PHD Head of Department of Family Medicine and Primary Health Care, Ghent University BELGUIM Fitzhugh Mullan, MD Murdock Head Professor of Medicine and Health Policy The George Washington University USA Haavard Nygaard University of Berkeley, California USA