Renewing health districts for advancing universal health coverage in Africa

In this blog post, Bruno Meessen (ITM, Antwerp and member of the organizing committee of the regional conference in Dakar) introduces the final report of the conference dedicated to the health district strategy in Africa. 

Access the report: here

From October 21^st till October 23^rd, around 20 country delegations and 170 experts – district medical officers, national directors, researchers, technical assistants and social entrepreneurs – attended a regional conference in Dakar, Senegal, dedicated to “Health districts in Africa: progress and perspectives 25 years after the Harare Declaration”.  The event was organized by the Harmonization for Health in Africa Community of Practice “Health Service Delivery”, in collaboration with UNICEF, WHO, WAHO, Be-Cause Health, the Ministry of Health of Senegal and ITM, with the financial support of the Belgian Development Cooperation and the French Muskoka Fund.

A landmark event

The mandate assigned to participants was clear: to share experiences and knowledge to update the thinking about the organization of health care services at local level.  The event was remarkable in several respects.

The focus of the conference, first of all, stood out. The health district strategy is the backbone of health systems all around Africa; this is so much taken for granted, however, that it barely gets attention anymore. This is a mistake. The strategy is powerful: it has shaped the provision of health services on the whole continent, and in rural areas in particular; if well implemented, it can be a key component in the response to the needs and demands of the population. Indeed, there has been a problem with the implementation of the strategy. The strategy has too often been transformed into a doctrine.  From a dynamic and flexible model, it has become a rather rigid blueprint on how to organize one’s public health sector. Many opportunities have been missed. An update of the strategy was needed, given the major societal, economic, epidemiological and technological changes occurring on the continent.

Second, a few years from now, the conference will also be considered a landmark event because of its outcome. We encourage you to read the whole report, of course, to realize why. Let’s just illustrate the paradigm shift in terms of vision with two examples.

In Dakar, we extensively discussed the fact that the health system goes beyond health facilities. A greater role could and should be played by individuals, households and the community as co-producers of their own health. In the coming decades, they will be key ‘resources’ to prevent and mitigate suffering, morbidity and premature death due to the demographic and epidemiological transitions.

Another trend was the recognition of the reality of market liberalization. Health market liberalization was identified as a source of both opportunities and risks. A top priority for African health authorities is to recognize the very pluralistic nature of today’s health sector and their responsibility as stewards of the health system (which, again, goes beyond just managing their own (public) health facilities).

Steps forward

The new vision entails a substantial shift in terms of approach at district level. The strategy should be much more flexible, inclusive, open to dialogue with the many actors, and facilitating innovation and learning at organizational level.

Obviously, it will take some time for adapting health policies at country level, but judging from the  spirit in Dakar, there seems to be a strong commitment from countries and partners to move forward on this road. The new vision is gaining momentum, and we believe that all together, we can get things moving even more rapidly. For instance, three weeks ago, senior health officials from countries from the Economic Community of West African States (ECOWAS) worked on the outcome of the Dakar conference. They put forward plans of action to work on the identified priorities. It is indeed our collective responsibility to build strong local health systems on the whole continent.

The report

Of course, the Dakar conference is not an isolated event: it is part of a much greater mobilization. The event was yet another important step in a process, started by previous meetings, especially the Ouagadougou conference (2008), the Tunis meeting on Value for Money (2012) and of course the Harare conference of 1987.

Therefore, the report does not try to answer all questions. It should be read keeping in mind major orientations already given at other global and regional levels. The focus of the report lies really on the local health systems and how to organize them. We believe the local health system was somewhat missing in our collective efforts towards universal health coverage, in spite of its obvious importance.

The report comprises three main sections: the first one gives the background of the conference (including a reminder about the Harare Declaration), the second one provides our analysis (why a renewal of the health district strategy is needed) and a third one is dedicated to directions for action.  The report ends with 12 priorities and 3 wishes. It’s New Year time, after all.

We hope the report will inspire you, regardless of the role you play in health systems in Africa. The Community of Practice Health Service Delivery will dedicate most of its energy in 2014 to move this agenda forward, both at country and regional level. Feel free to contact the facilitation team if you see a possibility for joint efforts. We want to build a strong coalition.

Thanks a lot for your support in 2013 and we hope, in the years to come.