Hon Tedros Adhanom Ghebreyesus, State Minister of Health of Ethiopia,
Hon Ministers of Health,
Regional Directors Emeritus of WHO in Africa,
Representatives of UNAIDS, UNICEF and World Bank,
Representatives of local and international organizations,
Conference participants,
Ladies and gentlemen.
At the end of August this year we gathered in this conference centre on the occasion of the 56 th session of the WHO Regional Committee for Africa. We are therefore most grateful to our hosts, the Government and people of Ethiopia, for having agreed to host this Joint UNAIDS, UNICEF, World Bank and WHO International Conference on Community Health.
I would also like to welcome you all to this conference. You represent many important stakeholders in health in Africa such as governments, civil society, health program managers, the youth, NGOs and development partners. This conference gives us an opportunity to interact and share ideas about community health issues.
I particularly would like to urge representatives of civil society and the youth to speak out and express your views in the discussions that are going to take place.
We are all here today because of our concern about the urgent need to improve the health of the people in the African Region.
The Alma Ata Conference on Primary Health Care recognized the need for community participation in health development. Today, we acknowledge that community ownership is critical to success of any development endeavour.
In developing national health policies or plans, it is critical that we work with the communities. Not just as recipients or beneficiaries but to make them active players in the process of change and reform. For the same reasons, we can not plant experiences from elsewhere and assume they will work, without consideration for local circumstances.
As we know, experience from elsewhere is not a substitute for local experience. In this sense, community values, and context should form the backbone of much of our health development work.
Success should be measured first and foremost by expression of satisfaction by the communities we serve.
Over the years we have had many successful examples of our efforts to operationalise the ideas that came out of Alma Ata. Today we have community structures working closely with the health workers based at the primary care facility. In some cases such health committees have a strong say in how the health centre and the health programs are run. In other cases, the community contributes in kind or in financial terms to the running of the health services. We have seen that where communities are adequately involved there are higher service utilization rates, better health outcomes and better satisfaction.
We advocate that communities form part of problem identification, problem-solving and response in health development. For example, the healthy settings approach focusing on the homes, workplaces, schools and food-markets uses community involvement as a central feature of the strategy. This ensures that communities are constantly brought into addressing their own problems in health as part of overall national development.
Many community-based interventions have used proven cost effective interventions in maternal, newborn and child health successfully.
Some of these are preventive treatment of malaria during pregnancy, oral re-hydration therapy, and treatment of acute respiratory illness, micronutrient supplementation an d optimal infant an d young child feeding including exclusive breastfeeding.
Community IMCI interventions in Morogoro District of Tanzania was demonstrated not only to be cost effective, but resulted in more than 25% reduction in infant mortality in that district within three years.
In Uganda community approaches to Making Pregnancy Safer produced a five fold decrease in maternal mortality in Soroti district within two years. Thus, a ppropriate policies that support effective comprehensive community participation in maternal, newborn and child health care are needed while resources required for bringing to scale proven public health interventions should be made available by national governments through strategic partnerships.
Here in Ethiopia, national authorities realized that they can not address all health issues through working with health professionals only. Thus this year for example, 225 bishops, heads of dioceses and clergies of the Ethiopian Orthodox Church in Amhara region undertook training in promotion of immunizations. They have now made immunizations part of child upbringing culture for the faithful. This is a good example that can be replicated throughout the country and indeed in other countries.
Also here in Ethiopia, there is a program to train health extension workers so that there will be one in each kebele or sub district.
Such approaches to community health will undoubtedly help improve health coverage in this country.
There are 26 countries implementing community HIV/AIDS treatment, care and support programs with community agents handling tasks such as oversight on laboratory monitoring, follow up of patients, nutrition support and organizing transport to clinic appointments. In this way the care and support program of TASO-Masaka in Uganda was able to report 97% treatment adherence rate after one year of operation.
The HIV/AIDS scourge remains a matter of concern. Prevalence and incidence rates remain high particularly among the youths, especially girls. Together with current efforts to expand treatment with ARVs we should concentrate on prevention. We count on the youth to disseminate information, change sexual behaviour, including effective use of known preventive measures in order to get a reduction in incidence rates.
As you may remember, this is the year of acceleration of HIV prevention efforts as adopted by the Regional Committee and launched by Member States.
This initiative should continue until we realize the expected result which is a significant reduction in HIV incidence rates.
The contribution that the community made in the prevention of onchocerciasis using a cost-effective intervention, particularly in the distribution of Ivermectin to communities and individuals in remote areas has been encouraging. In the years 1987 to 1996 about 4.5 million persons received ivermectin through health care outlets.
The community directed Ivermectin distribution program was started in 1999 to cover 16 countries. Through this program, it has been possible to expand coverage to about 40,000,000 people by 2005.
Amidst the ongoing burden of communicable diseases, it is becoming increasingly evident that the burden of disease due to non-communicable diseases (NCDs) is rising in the African region.
Major behavioural risk factors for NCDs include t obacco use, harmful alcohol consumption, unhealthy diet (low fruit and vegetables consumption), and physical inactivity; and b iological risk factors include obesity, raised blood pressure, raised blood glucose and raised blood lipids.
Unhealthy lifestyles account for a large burden of cardiovascular diseases and diabetes for example. Typically up to 80% of cardiovascular disease can be prevented through healthy lifestyles.
As we all know, life-saving medicines to treat chronic diseases are quite expensive and are unaffordable for most people due to poverty.
Being aware that primary prevention is very cost effective, we should invest in the reduction of risk factors in the entire population. This requires us to use interventions that target the entire population. Community action would make a great difference.
Dear Participants,
Let me recognize the presence of eminent persons. We have among us Dr Ebrahim Samba, Regional Director Emeritus who will bring his long experience in public health including working with communities in the very successful onchocerciasis control programme. He was Regional Director for ten years. Dr Gottlieb Monekosso, Regional Director Emeritus, also served for ten years as Regional Director. A tireless thinker who initiated the health district approach as a key strategy to operationalise health for all through district health systems, particularly in Africa.
I would also like to recognize the presence of former Directors of Programme Management, Drs A. D’Almeida and Koné Diabi.
I appreciate the interest and support from our sister agencies in particular Dr Peter Piot, Executive Director of UNAIDS, Mr. Per Engebak and Mrs. Esther Guluma, Regional Directors of UNICEF and Dr Gobind Nankani, Vice President of the World Bank for Africa.
I thank them for their contributions which made it possible for us to convene this conference. I also thank the Executive Secretary of ECA, for hosting us in this conference centre.
Naturally, there are those who have to make the technical presentations for the conference. I am referring to the experts that accepted to prepare and deliver the key presentations that will serve as a basis for discussion. These are Professors Akin Osingobun, Miriam Were, Cheikh Niang, and Phil Musgrove, among other experts here present.
Hon. Ministers, thank you again for your presence. You lead the health sector in your countries but you cannot make it alone. Partners and representatives of your communities should come together in supporting the translation of your policies into concrete action.
There are many challenges ahead. For example, the current international efforts at coordination and alignment of partners in support of national health development efforts will yield results provided that communities are actively involved. This requires bridging the gap between health services and communities. This way, we should be able to translate global thinking and national policies into actions at local level – resulting in improved health status of the people.
I am confident that with the active participation of all of you, this conference will generate new ideas to strengthen community health in Africa.
Thank you for your attention.