Report of the Dakar Conference (21-23 October 2013): “Renewing health districts for advancing universal health coverage in Africa” – download the report as pdf here

Rapport de la Conférence de Dakar (21-23 octobre 2013) : “Renouveler la stratégie du district sanitaire pour faire avancer la Couverture Sanitaire Universelle en Afrique” – téléchargez le rapport comme pdf ici

Schedule & presentations from the Dakar Conference:

21 October 2013

Session 1 (Plenary) 09H00-10H45

  1. Dr Mandiaye Loume, first adviser of the Minister of Health & Social Action of Senegal
  2. Welcome message by the Deputy Regional Director of UNICEF WAHO, Mrs Christine Muhigana – on behalf of Harmonisation for Health in Africa
  3. Speech by Jean-Pierre Bellefleur – on behalf of the ambassador of France in Senegal
  4. Objectives of the conference – The Harare Declaration & health districts in Africa : for an updated vision, Prof Bruno Meessen – on behalf of the organizing committee
  5. Official opening by the Director of Cabinet Minister of Health & Social Action of Senegal

Suspension of session

Discussion per table facilitated by Dr Belma Malanda, Community of Practice Health Service Delivery

End of session: 3 tables share one expectation orally, all expectations are written on cards pinned on to the wall

Session 2 (Plenary) 11H15-13H00

  1. Covering the health needs of the populations in sub-Saharan Africa: the persisting challenges – presentation by Guido Borghese, UNICEF WCARO
  2. The challenges facing the local health systems: illustration with the case of Senegal –presentation by Mrs Coumba Faye, Community Health Coordinator, General Direction, Ministry of Health and Social Action of Senegal
  3. The importance of the local coordination of health stakeholders: experiences in the North – Prof Jan De Lepeleire, KUL, Belgium

Plenary Discussion facilitated by Prof Bart Criel, ITM, Antwerp
Introduction to the afternoon programme – Belma Malanda

Session 3 (in parallel) 14H00-15H45

Session 3A : “The Health District facing the challenges of social determinants and inter-sectorial action”

  1. The District of Bwamanda: an experience in multi-sector action – Dr Billy BongosoIfeka, CDI Bwamanda, DRC 
  2. An experience in total sanitation through community action – the district of Tororo – Dr David Okumu, Ministry of Health, Uganda 
  3. Community participation and nutritional intervention in the district of Nyanza – Zabulon Mutabazi, Ministry of Health, Rwanda

Followed by a debate, facilitated by Hyppolite Kalambay (DRC), with the Chief District Medical Officers on how to implement inter-sectorial action at the local level.

Session 3B: “Putting the Health District to the test of implementation and of ideas” 

  1. The various faces of the local health systems in2013, Gaston Foro (Ministry of Health, Burkina Faso) & Hassana Youssoufa (Ministry of Health, Cameroon)
  2. Health District: a proposal renewed through Performance-based Financing?, Serge Mayaka, Public Health School of Kinshasa 
  3. Advocacy for a renewed vision of Community Participation, Jean-Louis Lamboray, Constellation, Belgium

Debate facilitated by Dr Abdel El Abassi (Tunisia)

Session 4 (in parallel) 16H15-17H45

Session 4A: “Individuals, households and the community as co-producer of their own health: a potential to be harnessed… but a challenge in terms of coordination” 

  1. Allocate a role to patients: the experience of Patient Experts in the area of HIV, Elizabeth Mushabe, TASO Uganda 
  2. Reconsidering the role of the District in community action –the experience of EQUIP –  Rogers Mandu, Makarere University 
  3. How to improve community participation in Africa? Basile Keugoung, Cameroon 

Discussion facilitated  by Jean-Louis Lamboray, Constellation. Attempts will be made to respond to 3 questions:

  •  How do we ensure that the numerous initiatives that depend on community health workers are mainstreamed at the District level?
  • How do we move from the model  of instrumentalized community worker to a model in which the communities, households and individuals become full stakeholders of their health?
  • What changes would this produce in the conceptualisation and operation of the local health systems?

Session 4B: “Local health priorities, bottlenecks and performance: what information, for whom and to decide on what? ”

  1. Operational challenges in Africa: survey conducted in four West African countries. Dr Atsu Seake-Kwawu, Ministry of Health (Ghana)
  2. Classifying Health Districts according to their performance: Uganda’s experience, Christine Tashobya, Makerere University
  3. Strengthening the model teams through targeted planning and quality enhancement in Uganda, Hector Tibeihaho, Uganda Child Fund

Discussions facilitated by Ngashi Ngongo, Eric Mercier and Jean Servais, with the Experts at the central level, the District Medical Officers and Researchers around bottlenecks, district performance measurement , information sharing  and its appropriate application.

An attempt will be made to understand why this mode of action is underutilized in many countries.

Session 5 (Plenary) 18H00-18H30

Reports from the parallel discussion sessions – chaired by Mariame Sylla, UNICEF WCARO

4 Rapporteurs for each parallel session – summary available online on the discussion group of the Community of Practice

22 October 2013

Session 6 (Plenary) 08H30-10H15

Chaired by Ngashi Ngongo, UNICEF New-York

Panel discussions – questions & answers

Introduction to the parallel session programme by Belma Malanda

Session 7 (In parallel) 10H45-12H30

Session 7A: “The Health District in the face of the challenge of mainstreaming the for-profit private sector (focusing on urban health)” 

  1. Mainstreaming the drug stores, a research project in Uganda – Phyllis Awor, Makerere University 
  2. Mainstreaming the private clinics through performance-based financing, experience of Douala, Cameroon, Jean-Claude Taptue, Douala Procurement Agency 
  3. Mainstreaming the private sector through health information system – the experience of the City of Kigali, Rwanda, Nicole Kanyoto, CTB Kigali 

Discussion facilitated by Dr Faustin Chenge (Public Health School, Lumumbashi) and Stefaan Van Bastelaere (CTB) around two complementary issues: 1/ how to organize health care in the urban areas; 2/ how to better align the private sector on public objectives 

Session 7B: “Local health systems: the track for new institutional arrangements”  

  1. The experience of performance-based financing in South Kivu, DRC – Pacifique Mushagalusa, South Kivu Purchasing Agency
  2. Contracting out the faith-based sector in the DRC, Charles Mushagalusa, BDOM Bukavu

Discussion facilitated by Prof. Bruno Meessen around the theme “how to strengthen health systems for greater accountability through institutional arrangements”.

Session 8 (In parallel) 14H00-15H30

Session 8A: “Administrative decentralisation: a challenge or an opportunity for local health systems?”

Three case studies on decentralisation: 

  1. Burkina Faso –  Abel Bicaba, SERSAP 
  2. Ghana –  AkuKwamie, University of Ghana 
  3. Kenya – Adeline Azrack-Muthee, UNICEF Nairobi

Discussion facilitated by Namoudou Keita, WAHO. Twenty-five years ago the health system was ahead of others. Today, in some countries, the health system rather appears to undergo decentralization reforms which do not always take on board the peculiarities of the health sector. How do we regain the advantage? 

Session 8B: Monitoring and coordinating health care supply: do we strengthen the district management teams … or opt for the networking model?

  1. An experience of strengthening the Health Districts in the Tahoua Region (Niger) – Maina Boucar, URC/USAID Niger
  2. Building the capacities of District Managers: the experience of the continuing training programme of the Makerere University- Christine Tashobya, Uganda
  3. Networks and peer support in Mali, Sekou Coulibaly 
  4. Experience in networking in Guinea, Abdoulaye Sow, FMG 

The discussion, facilitated by Tarcisse Elongo, WHO AFRO, will focus on the roles of the District Management Teams and the skills required at this level, considering the changes in the context and the practice of health policies. We will also explore complementary or alternative models of coordination (e.g. non-hierarchical networking).

Session 9 (In parallel) 16H00-17H30

Session 9A: New roles for Technical and Financial Partners, with special focus on Fragile States 

  1. Health district and the role of technical assistance: case study from the DRC, Nathalie Ribesse, UCL, Belgium
  2. The Project ‘Access to Health Care’ in DRC, Pascal Ngoy, IRC/USAID 

The discussion will be facilitated by Karel Gyselinck, Belgian Technical Cooperation

Session 9B: Doctors in 1st line health services and broadening the MPA: a priority  – several challenges.

  1. The experience of community doctors, Sekou Coulibaly, Association of Rural Doctors of Mali
  2. Medicalisation of the 1st line of health care in Guinea, Abdoulaye Sow, FMG
  3. Improvements in healt care for persons living with a chronic disease in the District of Buikwe, Uganda – Martin Muhire, URC-Kampala
  4.  When Doctors become Managers, Nadine Sossouhounto, Bénin

 A discussion facilitated by Oumar Ouattara (AEDES)

Session 9C : Information and Communication Technologies: what contribution for better coordination of health systems ?

Presentation on three technological innovations by:

  1. Jørn Braa, District Health Information System 2 (DHIS2)
  2. Cheikna Toure, Union of Mutual Health Systems of Mali
  3. Alfred Antoine Uzabakaliho, Open RBF, Rwanda

Discussion facilitated by Nicolas de Borman (Blue Square) around technological solutions designed to enhance performance and accountability of health districts

Session 10 (Plenary) 17H45-18H30

Chaired by Jean Ette, WHO AFRO (IST Central Africa)

7 Rapporteurs for each parallel session

23 October 2013

Session 11 (Plenary) 08H30-10H15

Chair person: René Adzodo, WHO AFRO (IST Western Africa)

Panel – Questions & Answers

Explanations about the programme of the day  and the group discussions – Belma Malanda & Faustin Chenge

Session 12 10H45-13H00

Content    «Country break-out sessions»

  • Group work per pair of similar countries with facilitation
  • Participants are divided into groups of 2-3 counterpart countries (in terms of language and challenges faced by the health system)
  • Participants will identify the implications of what has been shared over the three days for their context/country /health district based on a series of questions.

Content    «Community of Practice session»

  • Facilitators, rapporteurs and a group of member of the CoP ‘Health Service Delivery’ will work apart; based on the results of the plenary and parallel sessions, they will draft a conference summary, identify the main lines of action for the future and will share among themselves the follow-up work.
  • Facilitated by Belma Malanda and Karel Gyselinck

Session 13 14H00-15H00

Poster evaluation & Conference assessment (fulfilled expectations)

Facilitated by Basile Keugoung and Bruno Meessen

Working group gathering country rapporteurs and the sub-group of the CoP in charge of the conference synthesis

Session 13 15h00-16h00

Presentation of the final synthesis: lessons, action points and recommendations

Technical closing of the conference