Brazzaville, 21 April 2008 -- Thirty years after the emergence of the slogan “Health For All”, the World Health Organization Regional Office for Africa, in collaboration with development partners and the Government of Burkina Faso, is organizing a major conference from 28 – 30 April in Ouagadougou, Burkina Faso, to renew commitment to primary health care as the means to achieve improvements in health outcomes for the people of Africa.

The three-day conference, which coincides with the 30th anniversary of the Alma Ata Declaration on Primary Health Care (PHC) and the 60th anniversary of WHO, aims to revitalize primary health care and health systems development in countries in the African Region in order to achieve the health Millennium Development Goals (MDGs).

“Good health is not a gift or commodity to be rationed on ability to pay.  The wealth of a nation should not determine the health of a people.   Quality, affordable care for people is a human right, a matter of basic fairness”,   said WHO Regional Director for Africa, Dr Luis Sambo. “The main problem is not  just poverty”, Dr Sambo added, “ The inability of populations to afford and access  quality health care  is blatant injustice… and there is no better strategy to employ than primary health care to fight injustice in the health sector.”

More than 500 participants from within and outside Africa are expected to take part in the conference which will be opened by the Head of State of Burkina Faso, President Blaise Compare.

Participants  include  Ministers of Health, policy and decision-makers  and managers of health services;  researchers, academicians,  and social anthropologists;  representatives of  training institutions and ministries operating in the area of health (e.g. education and finance ministries);  and representatives of international organizations , civil society, youth and women’s organizations  and the private sector, among others.

The Conference will be organized in plenary and parallel sessions to  discuss a range of topics including Human Resources for Health; health financing and essential  medicines and technologies; governance, decentralization, management  and delivery of essential and quality health services; public –private partnership for health management  and multisectoral collaboration for health development.

A Discussion Paper prepared by WHO, and  to be deliberated upon  at the conference, says that over the three decades since Alma Ata,  many countries  in the African have embraced PHC and  instituted measures to strengthen their health systems. Such measures include decentralization and establishment of health districts; training of personnel for PHC management; creation of social welfare development committees and integration of programmes like immunization, diarrhoeal diseases and essential drugs within PHC. Most have developed health policies and strategic plans clearly stating PHC as the main strategy for achieving improvements in health and the universal provision of a basic package of services to reach the MDGs, as the core of these documents.

Progress in PHC implementation

The  Paper adds :”Decentralization in the health sector has contributed to the growth of more responsive and equitably distributed health facilities as seen in Uganda and the former “homelands” in South Africa. Efforts to build facilities for provision of basic health services in the rural areas have led to improved geographical access to basic health services for larger numbers of people especially in rural areas. For example, in Uganda, the proportion of the population within five–kilometre radius of a health facility rose from 49% at the beginning of the 90s to 72% in 2004 ».

Appreciable progress has also been recorded in countries  like  Tanzania, Ghana, Kenya and Zambia  which  have taken pragmatic decisions to form partnerships with private providers of health services including NGOs, Faith-Based Organizations  and other private providers of health services and goods,  thus leading  to a  wider,  more effective coverage of basic services. Several countries have developed the legislative and regulatory frameworks governing the health sector and established regulatory institutions e.g. Medical and Nurses Practice Councils. There have been improvements in availability of information for decision-making in the region with the institutionalization of health management information systems in most countries. Many Member States have also developed developed Essential Medicines lists.

According to the report, a number of countries now issue good quality and comprehensive annual health sector reports, and, since the late 1990s, have instituted Sector Wide Approaches to health development whose essence is a partnership of sector stakeholders including public and private sectors and funding agencies under government leadership. This has put national governments more squarely in the steering role, making it possible to mobilize more resources in line with national policies and priorities, including implementation of the PHC strategy.

In some countries, community participation and involvement havr been enhanced by the inclusion of community members on health facility management committees, boards and area health committees. These committees usually have mandates to discuss development and sectoral issues and can allocate resources across and within sectors. A specialized form of community participation is the use of traditional healers and Traditional Birth Attendants who assist women in child birth in most African countries.  A few countries such Ghana, Malawi and Nigeria have developed laws and guidelines for the management of this form of community involvement

Summarizing progress made in PHC implementation in the Region, the report says :

“The institution of these and other  measures have led to improvements in the last three decades in the health status  of people in the Region, although these have been slower than in other parts of the world. Such improvements are demonstrated by the decline of under-five mortality rates from 188 to 165 per 1000 live births between 1970s and 2005, and the decline of infant mortality rate from 116 in 1980 to 99  per 1000 live births in 2005.   Deaths of children from immunizable illnesses have markedly declined, and, in a few countries, mortality due to HIV/AIDS has been reversed. Particular success has been achieved in the reduction of death from measles: by 75% between 1999 and 2005.”

Challenges

However, several challenges remain to be overcome as coverage of health services is still limited. For example, according to WHO, 12 out of 32 countries representing 54% of the Region’s population, has less than 50% population coverage of medical services.  The issue of equity in access has been limited due to lack of resources (equipment, poor infrastructure and shortages of health personnel), and poor access to health services for people living in inaccessible or hard to reach areas.

Another constraint is of programmatic nature: while the PHC policy has been heavily in favor of a comprehensive PHC approach, services continue to be highly focused on curative care. Some programmes are still operating vertically not only at national but at district level. Motivation towards community health is lacking among members of health teams due to poor working conditions (lack of transport, poor outreach sites, shortage of drugs, etc.) and low remuneration. Insufficient communication within the referral system affects coordinated functioning as many users bypass the referral structure partly because of shortage of personnel and limited scope of services offered by the primary level. Other challenges arise from the PHC concept. The lack of a common understanding of the concept has been a major hindrance for its translation into appropriate policies and plans.

Weak and fragmented Human Resources for Health (HRH) policy formulation and planning, and limited fiscal space have made it difficult to scale up production, recruitment and  implementation of appropriate motivation and retention schemes for health workers in many countries. This has led to inadequate numbers, inequitable distribution and poorly motivated health workers within the countries, and increasing migration of health workers out of the Africa Region. Inadequate distribution of health infrastructure coupled with limited functionality and poor maintenance due to inadequate resources for running costs are still significant hurdles to be overcome.  There is increased demand for essential medicines and health supplies due to the fast growing population in most countries of the region coupled with an increasing array of both communicable and non-communicable diseases.

The Discussion Paper is the main reference document that will guide deliberations at the conference, the third in the series of primary health care conferences - Buenos Aires in August 2007, Beijing in November 2007, and Bangkok in January 2008. A fourth conference will be held later in the year in Kazakhstan, a province of the former Soviet Union where the 1978 Alma-Ata Declaration was adopted.

The Ouagadougou Primary Health Conference is expected to adopt a new Regional Declaration, similar in spirit to Alma-Ata, which would propose the development and implementation of public policies and strategies at both regional and national levels to continue to improve the health of people in the African Region.

For more information contact:

Dr Amidou Baba-Moussa, Tel:+226 50 306 509,  babamoussaa [at] bf.who.int

Dr Alima A.J. Diarra, Tel: +47  241 392,  diarra [at] afro.who.int

Dr Saidou Barry, Tel: + 47 241 39337,  barrys [at] afro.who.int

Mr. Rodrigue  Barry, Tel: + 226 70 21 43 12,  barryr [at] bf.afro.who.int

Mr Samuel Ajibola, Tel: +47 241 39378,  ajibolas [at] bf.afro.who.int

Mr. Collins Boakye-Agyemang,Tel: +47 39420, e-mail:  boakyec [at] afro.who.int

Madam Flavienne Issembe, Tel: +47 39352,  issembef [at] afro.who.int

Madam Joana Teixeira, Tel:+47 39382,  teixeiram [at] afro.who.int