On Tuesday, the Africa APPG hosted a high-level panel discussion chaired by Baroness Kinnock. The meeting brought together Parliamentarians, Ambassadors and High Commissioners from African countries and leading experts on health in Africa to discuss African health leadership.
Lord Crisp opened the discussion by highlighting the importance of the new relationship African Health Leaders seek from the UK and other partner countries. This is discussed in detail in the African Health Leaders (OUP) book which was also launched at this event and is co-edited by Lord Nigel Crisp and Dr Omaswa.
The key message which resonated throughout the meeting and discussion was the call for donors to prioritise ownership of health systems by the communities they are trying to reach and allow them to set their own priorities. The top down approach does not fully appreciate the spiritual, cultural and political undertones to health that exist amongst many communities and groups. The Ebola outbreak in West Africa is a prime example of this, H.E. Mr. Edward M. Turay, High Commissioner of Sierra Leone explained that there was at first some scepticism in some parts of the population that Ebola was real. Further, he confirmed that cultural practices in Sierra Leone such as the washing of the body by the family before burial has contributed to the rapid spread of the disease.
Dr. Francis Omaswa, Director of African Centre for Global Health and Social Transformation explained that colonialism had impacted on Africa’s self-confidence and led to its current struggle to take ownership of its institutions. He said this ownership is key to health system strengthening and that Civil Society needs to be brought in and effectively engaged in this effort.
Dr Luis Sambo, Executive Director of the African Region of WHO, covered the costs and constraints including the issue of brain drain of healthcare professionals, the need for better training and to renegotiate the costs of essential technologies with suppliers. Dr Sambo also drew attention to the positive stories including the decline of HIV and Malaria partly through better community education on how the diseases are contracted.
Dr. Uche Amazigo, formerly Director of the African Programme for Onchoceriasis control argued that development partners need to build on the cultural practices and strengths that already exist so as not to impose a pre-packaged plan of what is “right for them”. She spoke of how donors seek a quick fix but explained that long-term active community investment and participation in solutions and education is necessary to effect change at community level. If it cannot work at the community level, then in cannot work at country level.
Professor Catherine Odora-Hoppers, South African Research Chair in Education & Pascal International Observatory, University of South Africa, peeled back a further layer, asking questions on how ownership of health systems can be taken to the “heart and gut”. She said that to progress we need to “rethink thinking”; Africa needs to be allowed to pursue a different epistemology from the Western one. She argued that ownership needs to be institutionalised and suggested that the wrong questions were being asked at the research and policy level in understanding the strengths and weaknesses of current efforts. More pressure needs to be put on institutions to ensure social and natural sciences work together. One way to do this would be to place bicultural experts at every institutional level to allow for innovation from the bottom up and community level. Finally, she argued that the constitutional rules of system above the institutional level also need to be interrogated to see how far they allow the space for community input.
The African Health Leaders book is now available online at- http://ukcatalogue.oup.com/product/9780198703327.do