25th June, 2010
With the G8 G20 in Toronto this year, Dr John Nduba AMREF's Director of Reproductive and Child Health, outlines a way forward - how Africa can meet the health related Millennium Development Goals.
1. Closing the Gap Between Communities and Health Services
This gap can be cultural, physical, infrastructural, policy (for example user fees) poor access to information, low quality or absence of services, or directly arising from poverty.
AMREF strongly believes that health services must be organised and developed around communities as key participants, including the training of their own resource persons to act as a bridge and facilitator with the formal health service. Such community health workers have to be included in the remuneration system of the health service as they form the first tier of human resources for health, and can be held accountable for a defined set of tasks. Expecting them to be volunteers has not worked in the past, and yet they have a crucial role to play.
2. Combating the Human Resources Crisis
Africa has 13 per cent of the global population and 25 per cent of the global burden of disease but only 1.3 per cent of the global workforce.
Globalisation, vertical funding for programmes, low resource allocation to training, poor remuneration packages, and poor human resource management all combine to create this crisis that makes it impossible to deliver on health development targets including the Millennium Development Goals.
More investment and dependable funding arising from a shared sense of responsibility between developing and developed countries in this matter will alleviate this problem for developing nations. Support to innovative training methods especially the use of technology and retraining of staff are essential in rapid and efficient production of health workers. Task shifting is a policy that should be supported to ease shortages of key staff
3. Improve Weak and Under-Financed Health Care System
Especially basic or primary health care services that are not able to provide a minimum package of adolescent and adult reproductive health, and maternal and child health services, contribute to poor maternal health and high child mortality. While vertical programme funding is useful and effective in control of endemic and epidemic diseases, such funding can be used within a health systems framework based on the WHO building blocks to strengthen the health system for effective primary health care delivery.
AMREF prioritises resource allocation and management support to the health centre and community levels of the health system because 80% of maternal and child health problems can be solved there. Support and supervision from the district level is a crucial element in health systems management
4. Integral parts of all Health Interventions must include Cross cutting issues of gender, gender-based violence, and the lack of male involvement in maternal and child health care
Malnutrition, both protein calorie and micronutrient is highly prevalent in African communities and contributes to both maternal and child mortality significantly. Few or no resources are currently allocated to this major underlying problem which needs to be brought under view once more.
5. Ensure 0.7% ODA for Development Partners and 15% of Recipient Countries Budgets go Towards Health Spending
Development partners and recipient countries need to refocus on the meaning of the new global health paradigm and find ways of actualizing the many international commitments already made, in particular meeting the thresholds of 0.7% of GDP for ODA allocation, and 15% allocation of budgets to health in recipient countries
6. Support Civil Society
Civil Society has increasingly played a productive and complementary role to governments in raising the profile of maternal and child mortality and the other health MDGs. This role needs to be supported and adequate resources allocated so the civil society can increasingly take more responsibility for service delivery issues that they are better at. Their operating space needs to be expanded in countries that have major restrictions.
Dr John Nduba
Director of Reproductive and Child Health
AMREF
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