Health Policies and Service Delivery

The focus is on: 

• Contributing in developing community health policies and strategies to promote communities' ownership and participation in the health system

• Contributing in building institutional and individual capacities in countries for community participation, organisation and management of the health system

• Contributing in institutionalizing monitoring of community-based health activities

• Increasing awareness of countries and advocate for mainstreaming community ownership and participation in national health policies and health strategic plans

• Supporting countries to strengthen coordination of and collaboration with civil society organizations particularly community-based organizations and NGOs in community health development.

The Regional Office is advocating to countries for the implementation of the Addis Ababa Declaration on Community Health in the African Region. An effort is being made to strengthen the capacity of the HPS Programme in this area through staff recruitment.

The focus is on:

• Supporting countries in conducting stakeholder analyses.
• Supporting countries in developing and implementing planning and coordination mechanisms such as Sector-Wide Approaches (SWAps), Medium Term Expenditure Framework and Compacts.
• Providing support to countries in increasing their awareness on health policy analysis for evidence based policy formulation in the context of the overall country development policy. In all these areas, the HPS program has been providing technical support to countries generally through development of policy documents like guidelines, norms and standandards, providing direct technical support to countries in collaboration with other programs and partners where necessary and capacity building within the organisation and among national level planners and policy decision makers.

The Regional has increased the awareness of various partners in strengthening health systems for better health outcomes using a holistic approach based on the 6 building blocks that are interrelate and synergistic. The Regional Office is also playing a leadership role in coordinating the Harmonization for Health in Africa.

The focus is on:

• Supporting countries in development of District Implementation Plans through availing training modules for district level health planning and training of trainers.
• Supporting countries in conducting district health system performance assessments and evaluations
• Supporting countries to expand access across the range of services needed to improve health outcomes and response to legitimate demand for care using the Primary Health Care Approach in the context of district health systems
• Contributing to strengthening of the organization, management and operationalisation of district health systems and services.

Significant efforts have been made to build capacity among both WHO staff and key staffs in countries to enable them to effectively contribute in health systems development including the preparation of proposals for health systems strengthening (HSS) in the context of GAVI and Global Funds. Countries with the support of development agencies are making efforts in using the global health initiatives as opportunities for strengthening their national health systems. To date, out of 36 eligible countries in the African Region, 22 countries have had their proposals for HSS approved to a total amount of US$ 309,824,995.The Global Fund granted funds to twelve countries to strengthen their national health information systems for a total amount of US $ 230,857,867 for phase one upper ceiling 2 years.

In 2007, a Rapid Assessment of DHS was conducted in 21 countries to determine their capacity to scale up essential health interventions. The results indicated that despite the relatively low level of inputs most countries managed to offer the essential health services at all levels of care, albeit with debatable levels quality and equity.

A Framework for scaling up essential health interventions to reach the health related MDGs was developed by an interdivisional team to guide AFRO work in supporting countries in an integrated approach.

During RC 59, four countries namely Burkina Faso, Ghana, Rwanda and Uganda shared best practices in strengthening DHS. Countries appreciated this initiative and recommended WHO to institutionalize this practice.

The focus is on :

• Orienting countries in the development of the formulation of their National Health policies through availing of guidelines and tools.
• Providing integrated and coordinated approaches (leadership, advice, partnership) to countries in developing their National Health policies.
• Building capacities within the Ministries of Health (in collaboration with units in DSD and other AFRO Divisions) for policy dialogue, policy analysis, policy formulation.

In 2008, the Regional Office organized an International Conference on Primary Health Care and Health Systems was successfully co organized by WHO, UNICEF, UNFPA, UNAIDS, AfDB and World Bank and hosted by the Government of Burkina Faso. Over 600 participants from the 46 Member States of the African Region and outside Africa attended the Conference. Two documents AFR/PHC/08/1 (Discussion Paper) and AFR/PHC/08/2 (Summaries of Country Experiences on Primary Health Care Revitalization) were produced and shared among participants.

Member States shared their and they strongly endorsed the values and principles of PHC. The Conference adopted the "Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving Better Health for Africa in the New Millennium". This Declaration was endorsed by the 58th Regional Committee which also adopted the related Resolution AFR/RC58/R3. A generic Framework for the implementation of this Declaration has been prepared building on the priority areas highlighted in the Declaration as well as other policies and goals related to health development.

Within the context of implementing the Declaration four countries (Angola, Equatorial Guinea, Mozambique and Nigeria) started the process of revitalization of PHC including community based health services. Ten countries strengthened capacities of their district health systems in areas such as planning, management, integration of activities, supervision, and monitoring and evaluation. Congo, Ethiopia and Mauritania developed tools and or reviewed their essential health packages to concentrate scarce resources on high impact interventions. Niger developed a strategy on quality assurance. Madagascar undertook District Health Systems Rapid assessment. This brings to 25, the number of countries that undertaken a rapid assessment of the operationality of the district health system in the past three years.

The Regional Office continued to provide support to Member States to revise or develop their national health policy and health strategic plans. Eritrea and Malawi developed their National Health Policy bringing the total of countries that have developed their with national health policies in the past five years to 19. Benin, Swaziland developed their health strategic plan (HSP), making a total of 22 countries in the past 5 years while Comoros, Eritrea, Namibia and Senegal are in the process of revising their HSP.

Ghana, Madagascar and Uganda organized their annual joint health sector review. Comoros has developed their Public Health Code. Benin and Democratic Republic of Congo undertook an organizational audit of their Ministry of Health. Uganda finalized its stakeholder mapping and developed and costed a scale up plan. Ghana strengthened partners' coordination. By the end of 2007, Kenya, Malawi, Uganda and Zambia had already reviewed and revised their health sector management structures.

On policy formulation, the Regional Office continued to provide technical support to countries. To date 44 national health policies have been developed/revised based on the AFRO guidelines. This represents an increase of 35% in the past 4 years. The process of developing these NHP is improving through a more inclusive approach involving all relevant stockholders active in health development. However, efforts have to be made to strengthen the capacity of countries in policy analysis.

The focus is on:

• Guidance on approaches to expand coverage of Essential Health Services through a package of quality health services to improve access, and reduce morbidity and mortality rates especially among women and children.
• Advocacy for provision of higher quality of basic health services and increased focus on serving the disadvantaged areas and the vulnerable groups.
• Promotion of full community participation in health services delivery through their involvement in the planning, operation and control of formal health services delivery.
• Promoting the contracting of health services to take advantage of private sector resources in the expanding availability and access to quality health services.

The Regional Office has developed a guideline on Monitoring and Evaluation of Health sector Reforms. The purpose of this guideline is to therefore provide planners and policymakers in the African region with guidance on monitoring and evaluating the process and progress of health sector reforms within and across countries on a regular basis. The latest countries that received support from AFRO for their health sector reforms are DRC and Kenya.

The focus is on:

• Supporting countries in conducting their annual health sector reviews in collaboration with other partners.
• Supporting countries in the development of appropriate indicators for use during the health sector reviews.
• Establishing mechanisms for facilitating learning from the experience of other countries and regions for continuous improvement of quality of health services.
• Promoting the dissemination of best practices between regions and districts within countries

By the end of 2007, a total of 11 countries reviewed the roles of hospitals in national health systems, shared good practices, identified hospital performance indicators and made recommendations for strengthening hospitals. National health policies and plans from 37 countries were analysed to assess the extent to which priority programmes such as HIV/AIDS, tuberculosis, malaria, and child and maternal health were considered. A framework for policy analysis was developed and applied to analyze health policies and strategic plans.

During the last four years there was an increase of 47% regarding the percentage of countries that have institutionalize annual health sector review binging the number of countries to 28 from 19 countries. However, up to 16 countries are yet to institutionalize health sector reviews. Standardized approach is under development to facilitate the process in countries.

The focus is on

• Orienting countries in the development of their National Health Plans through availing of guidelines and tools.
• Providing integrated and coordinated approaches (leadership, advice, partnership) to countries in developing their National Health Strategic Plans.
• Building capacities within the Ministries of Health (in collaboration with units in DSD and other AFRO Divisions) for dialogue, analysis and health strategic planning.

To date a total of 45 countries have developed/revised their NHSP showing an increase of 42% in the past 4 years. These plans are more comprehensive and are based on good situation analysis. In many countries these plans are the basis for harmonizing partnerships, ensuring alignment and facilitating coordination. They also contribute to strengthening country ownership and establishment of mutual accountability for results.

The focus is on:

• Collaborating with priority programmes to improve organizational and managerial capacities of public and private hospitals.
• Providing support to implement and apply health service delivery standards, norms and other approaches to ensuring quality in hospitals.

In 2007, the Regional Office organized a workshop gathering 11 countries that had shared their good experiences on strengthening hospitals within national health systems. A technical and financial support was provided to Niger to document Hospital Reform process at the National Hospital in Niamey.