Second Africa Regional Health Report Launched

Cotonou, 3 November 2014 - Good governance, health in all policies, data-driven decision-making and proper staff remuneration are some of the proven critical actions carried out by countries in the Region to improve the health of the people. These and others, including performance-based health management and community-based intervention, are recommended in a report launched today in Cotonou, Benin at the World Health Organization (WHO) Regional Committee for Africa.

Entitled The Health of the People – What works, the African Regional Health Report 2014 contains an assessment of the current status and trends in the health of the people living in the 47 countries of the WHO African Region. As a follow-up to the first African Regional Health Report published in 2006, it provides a rich discussion of strategies successfully deployed in the Region, as well as a distillation of lessons learnt over the years.

“We have distilled what we have learned from examining what has worked in Africa. It is hoped that countries will take up the challenges of implementation or scale-up of proven effective interventions through strong health systems to move towards universal health coverage,” says Dr Luis Sambo, WHO Regional Director for Africa.

Organized thematically, the report looks at the range of initiatives and actors involved in health development in the Region, reviews the threats limiting the health and lives of the people and describes how they are being identified, controlled, mitigated and prevented. The report also discusses the key determinants of health, including social determinants, food and nutrition, the physical environment, and risk factors related to life-style.

Other core contents of the report include a review of the efforts – by governments, international partners, technical agencies, researchers and other stakeholders – to strengthen health systems in the Re-gion, and a list of strategies that, if applied, can make a significant difference to the health of the people of the Region. Many of these are things that, had they been applied before Ebola virus disease ar-rived in western Africa, would have provided early warning and inbuilt resilience to even such a powerful shock.

“Now, more than ever, we need to know – and do – the things that work. Not what might work, not what could work in 10 years’ time, but what does work, and should be done here and now, to improve the health of the people of the Region”, the Regional Director added.

Key findings of the Report

Good governance is a key determinant of good health outcomes. The active engagement of national, traditional and religious leaders and “champions” to increase community acceptance of polio vaccina-tion is seen as one of the strengths of the polio eradication programme in the Region.

The report draws attention to ongoing efforts by African governments to consider health in all policies through raising revenue or using fines for breaches of the law to finance health services. 

The increased use of real time quality data to respond effectively to people’s health needs is also highlighted. Cited as an example of what works is the use of cell phones for surveillance, training and diagnostic support for remote health workers. 

The Region’s severe shortages of health workers are now being reversed in several countries where salaries have been increased and payment guaranteed. Strengthening education and training of health workers is also crucial, but so is providing viable, adequately supported positions to ensure that graduates are absorbed in the health system.

Several approaches to reducing financial obstacles to accessing health care have been taken by countries, such as removing financial barriers to ensure equitable access, especially direct payments (user fees), providing financial coverage for people who cannot afford to contribute, making prepayment compulsory and establishing large risk pools. 

By linking employer and staff performance to health results, some countries have improved accounta-bility and health outcomes. 

External quality assessment of public health laboratories in almost all countries has led to the im-provement of their diagnostic performance. The report recommends benchmarking, accreditation, genuine supervision, evaluation and constructive feedback to ensure that all health work – from com-munity level up – is performed at the highest world standards. 

The report draws attention to the importance of involving communities and building their capacity to scale up proven interventions across all levels. It also notes some of the major partnerships and initiatives active in the Region that have yielded health solutions that work: Harmonization for Health in Africa, a regional mechanism led by the WHO Regional Office for Africa to coordinate partners’ support for strengthening African health systems; the International Health Partnership+ country compacts, used as a tool for mutual accountability; and the Meningitis Vaccine Project, a partnership between WHO and PATH (with funding from the Bill & Melinda Gates Foundation) that developed the men-ingitis A vaccine, one of the great public health achievements of this century. 

Increased vaccination coverage has had an impressive impact on reducing child deaths and disability in the Region, particularly those due to measles and polio, although coverage levels vary widely between countries. Political commitments at national and international levels have also improved access to interventions that contribute to child survival. The report shows that the reduction in maternal mor-tality seen in the Region has been the result of deliberate investments in some countries to address challenges such as lack of financial and geographical access to quality maternity services. However, health care of older people is becoming a major challenge with a growing number living with chronic diseases and disability.

The implementation of behavioural change and HIV prevention strategies has led to a sharp decline of HIV infections in some countries. Access to antiretroviral therapy has improved during the past decade due to the use of standardized, simplified treatment protocols and decentralized service delivery. One of the most important actions is the expansion of DOTs (Directly observed treatment short course). The integration of HIV/tuberculosis services, both for testing and treating, and a strong collaboration between tuberculosis and HIV programmes has led to better scale up of these two pro-grammes. 

The use of insecticide-treated bed nets, diagnosis-based treatment with artemisinin-based combination therapy, engagement of communities and strengthening capacity in vector control has contributed to a decrease of more than 50% in malaria deaths in children during the past 12 years. 

Following the effective implementation of the Integrated Disease Surveillance and Response (IDSR) strategy over the past decade, significant improvement in the detection, reporting and response to pri-ority diseases has been recorded. The importance of early detection was underscored by the ongoing epidemic of Ebola virus disease in western Africa, which has surpassed all other outbreaks in terms of cases, deaths and geographic spread.

The Region is still at an early stage in the epidemic of NCDs. To stem the tide of these disorders and conditions, it will need to develop a response to this challenge using low-cost solutions, particularly prevention and health promotion.

Efforts are being made to reduce risk factors related to lifestyle by, among other things, accelerating implementation of the WHO Framework Convention on Tobacco Control, increasing alcoholic bever-age taxes and prices to reduce overall alcohol consumption and heavy drinking. Countries have taken steps to strengthen their resilience to the adverse effects of climate change by establishing multisectoral country task teams and by assessing environmental risk factors affecting human health and vulnerability to climate change. An emergency response framework (ERF) has been put in place to help guide an effective response to acute public health emergencies triggered by natural disasters
or conflicts.

The report concludes that most countries in the Region have shown significant progress on the health and health-related Millennium Development Goals. It demonstrates that more progress can be achieved if countries implement the top ten strategies or recommendations that are stated in the report.

The health of the people: what works – the African Regional Health Report 2014
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For further information contact:

Dr Derege Kebede 
Tel: +4724139170 
Email: kebeded [at] who.int

C. Boakye-Agyemang 
Tel: +4724139420 +242 066142401 
Email: boakyeagyemangc [at] who.int

Samuel Ajibola 
Tel: +4724139174 
Email: Ajibolas [at] who.int