Improving Health Outcomes in Africa: Challenges and Progress

1. Good Health and wellbeing in Africa: African Health Fund initiative Dr Koffi Ange HOUNGBEDJI Public Health Specialist Kigali, 13 March 2018

2. Outline • Health outcomes: Progress and Challenges in Africa • Health Financing issues in Africa • African Health Fund initiative: rational, Fund management, sources, monitoring and evaluation

3. Health outcomesProgress and challenges

4. Life expectancy at birth - Progress Increased by 5.1%, from 57 years in 2010 to 60 years in 2015

5. Child mortality - Progress • The under-five mortality rate per 1000 live births decreased by up to 64% from 153 in 2000 to 81 in 2015.

6. Maternal Mortality - Progress • Reduction of maternal mortality by 43% during MDG era • But still high about 542 per 100 000 live births in 2015

7. Adult mortality • Steady decline of adult mortality rate by 12.8% (from 341 to 300 per 1000 population in 2015)

8. Malaria incidence Rate - progress • Steady decline of 22% of malaria rate (from 299 to 240 per 1000 population between 2010 – 2016) • The burden of malaria in Africa remains very high, about 194 million new cases of malaria In 2016 • The mortality rate is declining but there were still up to 405,880 malaria deaths in the Africa in 2016.

9. HIV Burden in Africa - Progress • Reduction of new HIV infections by more than 38% during MDG • In 2016, an estimated 25.6 million people were living with HIV in the African Region • The mortality rate declined by an average annual rate of 13% from 139 in 2011 to 71 per 100 000 populationin 2016 • 72% of the death related to HIV in the world occurred in Africa

10. Africa still faced to challenge to reach SDG health outcomes

11. Africa is still behind compared to others region Under five mortality Maternal Mortality Rate Maternal Mortality Rate in Africa is 34 times higher than in Europe. Almost all maternal deaths (99%) occur in developing countries with more than half in sub-Saharan Africa. • 1 child in 13 dies before completing 5years – 15 times higher than in high-income countries (1 in 189) . • U5MR in Africa 8 times higher than in Europe in 2016

12. Still behind compared to others region, despite the progress…. People in South-East Asia live at least 9 years longer than Africans People in the Americas and Europe live at least 17 years longer than those in Africa. Life expectancy still very low

13. Still huge challenges despite the progress

14. Huge Challenges related to Health systems and services delivery issues Still Challenges related to governance and leadership in Africa: • inadequate legislation and enforcement; • Lack of accountability and transparency within health • limited community participation • weak cross-sector action to address health determinants; • Inequities in health systems; • under-resourced national health information and research systems • Technical solution Known but people cannot afford it and scaling up is limited

15. Huge Challenges related to Health systems and services delivery issues According to the service availability and readiness assessment (SARA) • The items that are particularly important for providing general services in Africa health services are still low(from 43% in Ethiopia to 77% in Kenya). • The availability of essential medicines and diagnostics is generally low • from 26% in Ethiopia to 73% in Kenya for essential medicines; • from 27% in DRC to 68% in Zimbabwe) for diagnostics. • The physical presence of some services is highly limited mostly in the first line health centers (cervical cancer screening, blood transfusion, ART, etc) • Low availability of items for offering advanced diagnostic services and high-level diagnostic services)

16. Health Financing issues in Africa

17. Main Health Financing challenge

18. Health Financing challenges • The greater part of spending in 2015 occurred in high-income countries with a smaller % of the population and disease burden. • LMIC and LICs accounted for a higher % of the total population, a higher % of the disease burden, and a lower percentage of total health spending • Africa suffers more than 24% of the global burden of disease but has access to only 3% of the world’s health workers and less than 1% of the world’s financial resources.

19. Countries with less gross domestic product (GDP) per person is still dependent of a large %of DAH and out-of-pocket spending to finance their health care • While countries with greater GDP per person do not receive DAH and tend to fund most of their health spending from their governments

20. Health Financing challenge The per capita government expenditure on health in 2014 $51.6 US Africa versus $1,858.3 in America and $1,828.1 in Europe.

21. Health Financing challenges -UHC achievement • African countries far from having a full UHC (UHC index score ≥80). By 2030 • 43% in African LICs • Just under 50% in African LMICs if the current pace remains

22. Health Financing challenge • The UHC which is paramount to achieve SDG 3 outcomes need more resources to be successful. • Overall, an incremental annual cost of $67.3 billion (2017 USD) per year or $59 per person per year including $31.7 billion for African LICs and 35.6 billion for African LMICs is needed to fill the gap between current UHC coverage and full UHC coverage in African’s low and lower middle income countries.

23. African Health Fund initiative: rational, Fund management, sources, monitoring and evaluation

24. African Health Fund initiative Think Collectively and Act locally Think big – Think strong foundation

25. AHF – Rational (1) • The pace of progress remains too slow and interventions are still working as business as usual • The African Health Systems are still substantially lagging behind compared to the other regions

26. AHF – Rational (2) • The health system and the availability of the services delivery and its readiness are still weak across the continent • The strong and sustainable health system should be the foundation of any health interventions. However it remains very underfunded and vulnerable to various chocks • Implementation of SDG3/UHC requires huge investments and huge gap remain to succeed.

27. AHF – Rational (3) The fraction of DAH dedicated to the sub-Saharan Africa remains low around 32% of global DAH while the region is faced to a greater number of population and burden disease

28. AHF – Rational (4) • Only 11% of DAH is dedicated to the HSS. • Health system strengthening initiatives on the continent remain either related to the vertical programs initiatives or pilot projects, most of which stops as soon as funding ends. • Lack of political leadership and commitment

29. Rational of AHF (4) - Resources allocation in the health system Current situation Desired situation Strategic level Implementation support and supervision level Operational level

30. AHF - Interventions Aim: Collaborate with the existing health funds and global health initiatives to provide support to countries in strengthening the long term and resilient African countries health system and achieve the health related SDG and UHC in particular.

31. AHF - Interventions Interventions Focus Interventions Focus Expanding health prevention programs (including NCD) Real time epidemiological surveillance (focus on community surveillance), innovation in products, service delivery, Health information system strengthening (data, digital health, R&D) Access to essential medicine and vaccine Sustainable health financing and financial protection • Expanded UHC policies and implementation. • Promote Health accountability at all level, leadership, stewardship, governance at decentralized level • Health human resources strengthening • Health infrastructures reinforcement • Foster cross sector collaboration in tackling the social determinants of health,

32. AHF – Amount and sources • The amount requested is about $67.3 billion (2017 USD) per year or $59 per person per year including • $31.7 billion for African LICs and 35.6 billion for African LMICs to fill the gap between current UHC coverage and full UHC coverage which is vital to achieve SDG3 • The sources of fund • African government participation, • foreign governments, • private sector organizations, • philanthropists, • Health foundation and non-governmental organizations, • the DAH globally.

33. AHF - Management structure • Location: the fund is conceived by African leaders and will be hosted in Africa. • Management structure: • A secretariat will be composed of a technical team (health expert and technicians), the representatives of donors and the representatives of the Ministers of Health. • A Board member will hopefully be renowned leaders and experts that will advise and monitor the performance and effectiveness of the fund and its beneficiaries.

34. AHF -Eligibility Eligibility: The AHF will be conditional, incremental and target-performance based. • Countries with a clear alignment of health system priorities with global 2030 and 2063 agendas. • Countries with strong commitment to invest and reform their health system • Countries with commitment in increasing domestic resources in their health budget will be awarded by proportional matching. • Countries with high disease burden level, mortality • Countries with evidence that they cannot reach the target by 2030. • Countries with weak health system strengthening

35. AHF - Monitoring and Evaluation Monitoring, Evaluation and accountability: • Countries performance will be rigorously tracked, after setting standardized targets for the interventions and programs. • A clear framework for monitoring and reporting, stating which governments are delivering to their responsibilities, must be established • Independent reporting against this framework will be encouraged. Fund replenishment: • AHF, Every three years when the level of 75% disbursement is reached. • Beneficiaries’ countries: when reached 75% of disbursement and achieved successfully the committed targets.

36. Summary of the current health situation and the basis of the African Health Fund

37. Thanks