Overview

The Health Policy and Service Delivery Programme (HPS) is one of the six programmes within the Division of Health Systems and Services Development (DSD). It contributes to the Strategic Objective number 10 (SO10) which aims at improving health services through better governance, financing, staffing and management informed by reliable and accessible evidence and research using the Primary health care Approach.

The analysis of health systems in the African Region shows that over the last 30 years of implementing the PHC Approach there have been a number of achievements. Countries in the African Region have largely embraced their stewardship roles, including developing national policies and strategic plans that highlight universal access to essential services, intersectoral collaboration and community involvement in health. Countries have made efforts to strengthen district health systems through improving organization and management of health services to better respond to needs of people. Increased availability of information for planning and decision-making has facilitated the stewardship role. A few countries have managed to substantially increase public funding for the delivery of health services.

Domestic and international health policies in the African Region have been shaped by multiple international agreements and policies. Some of these international agreements and declarations include: Alma Ata Declaration of 1978; World Bank/IMF Structural Adjustment Program in the health sector of 1987; World Health Organization's Bamako Initiative in 1987; United Nations Millennium Declaration/Development Goals in 2000; Paris Declaration of 2005; and the second primary health care revolution of 2006 and the 2008 Ouagadougou declaration on PHC and Health Systems in Africa. These agreements and policies have heavily influenced the development of national health policies and national health strategic plans in countries within the Region.

There have been many challenges in implementing the PHC approach since Alma Ata. Most of these challenges are still outstanding and countries need to focus on them to ensure that their evidence based and people focused health policies and plans are effectively implemented. Specifically, some of the challenges include are as follows:

• The lack of common understanding of the PHC approach and the advocacy of different models by partners has been a major hindrance for its translation into appropriate policies and plans.
• Inadequate implementation of the notion of multi-sectoral determination of health at various levels. It appears that the need for a multi-sectoral approach is easy to appreciate but its implementation has not been.
• Low levels of health funding. By 2008 only 7 countries in the Region had a per capita Health Expenditure higher than US $34, which was estimated by the Commission for Macroeconomics and Health (CMH) as minimum financing required to cover essential interventions.
• The health financing architecture in most countries is based on minimal contributions from governments, high Out-of-Pocket (OOP) contributions, and vertically programmed donor projects which are not in favour of PHC Approach.
• The slow progress towards overcoming the negative influence of structural adjustment programs (reducing instead of increasing the fiscal space) for sustained improvements in health systems and effective implementation of the national health strategic plans.
• Civil strife, natural disasters and HIV continue to affect the ability of countries to develop and sustain high quality comprehensive health policies and plans as most health care resources continue to be directed to the large urban-based hospitals;
• Issues of governance in the use of resources have sustained donors unwillingness to fund comprehensive, broad-based programs. Vertical, definable, time-limited programs that could be changed every few years became the suitable alternative for donor agencies with resultant management challenges on the countries.

For more information please contact:

Dr. Babacar Drame
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Tel.: +47241 39329