PUBLIC HEALTH IN AFRICA

1. PUBLIC HEALTH IN AFRICA THE CONTEXT, THE GAIN THE LOSS AND THE WAY FORWARD (PH: ability of HH, Community, State System to take care of own health &meet daily needs and challenges: env., lifestyle, livelihood) PHC IN AFRICA

2. THE CONTEXT:THE STATUS OF DEVELOPMENT (GLOBAL) • More advance is made in the last 50 years than in 500 years before the 20th Century • Public health interventions and socioeconomic development reduced mortality and raised life expectancy • But disparity widened, with a third of the global population wallowing in absolute poverty • We still lose more than 11 million children to preventable diseases • The absolute number of illiterate women is rising • Those favored by trends insulated from reality as they take decisions & others consequences PHC IN AFRICA

3. THE CONTEXT: THE STATUS OF DEVELOPMENT (AFRICA) • If the 1960s were characterized by the great hope of seeing an irreversible process of development launched throughout Africa, the present age is one of disillusionment • Development has broken down, its theory is in crisis, its ideology the subject of doubt • Agreement on failure of devt. in Africa is sadly universal PHC IN AFRICA

4. THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT In Africa • Basic human development indicators are declining since early 80s • Except a few countries the figure on population with access to basic social services has been static or sluggish at best, complicated by transition(rapid growth) • Africa carries more than its fair share the global pervasive poverty, disease and death with appalling gap • 1.2 billion without adequate shelter, overcrowded, no access to safe water, sanitation, recreation, safety & cannot meet PH needs (who is responsible to ensure PH for ALL) PHC IN AFRICA

5. THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT Attenuation of human capital base • The labor force participation is going down with growing population to feed, aggravated by decimation and/or diversion of productive force by HIV/AIDS and conflicts • Rising school dropouts • Brain drain, both internal and external by ‘green pastures’ • Inappropriate tooling of human resource – ‘Training for export’ PHC IN AFRICA

6. THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT PHC IN AFRICA

7. THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT • Man-made and/or natural disasters & degradation of the environment • Draught and famine • Overuse of agrochemicals • Squandering of resources leading to conflicts • Africa as a dumping ground (sometimes guised as “donations”) • Corruption and looting PHC IN AFRICA

8. THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT Unjust World Order • Unbalanced global trade • Imposed reforms, restructuring and adjustment • Debt burden (relentless and huge servicing) PHC IN AFRICA

9. THE CONTEXT THE STATUS OF HUMAN DEVELOPMENT THE VICIOUS CYCLE TRAPPED HOUSEHOLDS ILL HEALTH POVERTY PHC IN AFRICA

10. FACTORS DETERMINING PUBLIC HEALTH INTERVENTION PHC IN AFRICA

11. PH: THEGAINS (limited) • Reduced child and maternal mortality • Increased coverage • Increased allocation of resources for health • Growing recognition the health-development interplay PHC IN AFRICA

12. PHTHEGAINS (limited) • Affordable public health inventions • Enhanced integration of health actors • Patchy spots of excellence observed PHC IN AFRICA

13. PHTHE LOSSES • Worsening situation among the poorest (The neglected pool) • Millions still die from ‘preventables’ • Poor preparedness for emerging scenario leading to reversal of gains PHC IN AFRICA

14. PH: WHY LOSSES (4Ps) The People viewed as • Vulnerable, powerless, sick, at risk (The needs-focused approach) instead of partners and resources The Problem conceived as • Disease, malnutrition, poor sanitation instead of poverty, inequity, ignorance and marginalization PHC IN AFRICA

15. PH: THE DISTORTIONS The Main Package (service) • Drugs, vaccination, latrine, health talk (neglect of the social context) instead of income and food security, equity in access to services and empowerment The Professional mainly shaped to • Give, prescribe, inject, educate, help, save, ask instead of facilitate, mobilize, dialogue, partner, feedback to people. PHC IN AFRICA

16. PH: THE DISTORTIONS Capacity limited to • Skills and knowledge instead of Ability, Resource, Authority and Responsibility PHC IN AFRICA

17. PH PACKAGE TO INCLUDE • Increased productivity • Increased education performance • Fairer/accountable global and national systems • Increased savings and investments (human, social, economic, environmental) • Planned Human Capital: more investment in fewer children • Greater (redistributive) equity, social and political trust and stability • Greater social capital, greater accountability, greater effectiveness and equity • Investment in health will reduce deaths, lower population growth and provide 6 fold economic return by the year 2015. USD 66 billion new investment by the yea 2015 will save 8 millions lives per year. • Reduce differentials (social status, capacity, exposure, outcome and consequences) PHC IN AFRICA

18. PH: THE WAY FORWARD – THE WORKING TOOLS DIFFERENTIAL VULNERABILITY INCOME, CULTURE, ENVIRONMENT, GENDER, EDUCATION, POLICY, RACE, AGE, DISABILITY CONCEPTUAL FRAMEWORK SOCIAL STRATIFICATION ACHIEVEMENTS AND MIX IN ABILITY, AUTHORITY, RESPONSIBILITY AND RESOURCE DIFFERENTIAL CAPACITY RISK/PROBABILITY OF EXPOSURE TO HIV/AIDS DUE TO ONE'S RELATIVE SOCIALCONTEXT DIFFERENTIAL EXPOSURE SOCIAL AND CLINICAL OUTCOMES RESULTING FROM EXPOSURE DEPENDING ON RELATIVE VULNERABILITY OR CAPACITY DIFFERENTIAL CONSEQUENCES PHC IN AFRICA

19. PH: THE WAY FORWARD – THE WORKING TOOLS PRIVATE SECTORS NGOs Poverty TRAINING INSTITUTIONS TRAPPED Households PUBLIC SERVICE Ill health COMMUNITY FRAMEWORK FOR PARTNERSHIP PHC IN AFRICA

20. The Spiral of Continuous Dialogue • Instructions: • Delete sample document icon and replace with working document icons as follows: • Create document in Word. • Return to PowerPoint. • From Insert Menu, select Object… • Click “Create from File” • Locate File name in “File” box • Make sure “Display as Icon” is checked. • Click OK • Select icon • From Slide Show Menu, Select Action Settings. • Click “Object Action” and select “Edit” • Click OK ASSESSMENT-2 ACTION & MONITORING ASSESSMENT-1 ACTION PLANNING ANALYSIS DECISION REFLECTION Fig.1: The Dialogue Spiral Fig.2: One cycle of the Spiral with Stages PHC IN AFRICA

21. Steps in Organised Dialogue STEP 1 Listen and learn about their priority concerns and gaps and how they are affected by them/it. (WHAT ARE THE CONCERNS AND CURRENT, often hidden, ALTERNATIVES) STEP 2 Listen and learn about their current practices to solve / cope with the problem/s, gaps etc (WHY THE CURRENT SITUATION / CURRENT ACTION / BEHAVIOUR) STEP 3 Listen and learn about their preferred future situation and suggested actions to achieve it (HOW CAN THE PREFERRED FUTURE BE ACHIEVED), give input including the recommended practice (if not yet mentioned or summarise from their contributions). STEP 4 Select together with them the most effective, feasible, appropriate options, (WHICH OPTIONS ARE BEST), based on existing capacity and opportunities. Summarise agreement and reflect on possible results if implemented (this provides a basis for commitment as well as monitoring and evaluation) STEP 5 Plan action, including monitoring and evaluation (WHEN DO WE TAKE ACTION AND WHO IS RESPONSIBLE) STEP 6 Follow up, assess implementation of the joint action plan, based on information (note modifications, compliance or rejection), feedback, celebrate results and re- plan, making necessary adjustments. PHC IN AFRICA

22. Framework for PH Assessment 1. Structures and institutions for participatory action (micro to macro): Capacity,representative-ness, inclusiveness, transparency and accountability 2. Participatory program management: Stakeholder involvement in program processes and decisions such as situation analysis, planning, action, monitoring and evaluation 3. Management information system: Design and selection of measurable indicators, data collection, analysis, recording, reporting and local consumption 4. Human resource development and management: re-orienting, and retooling, training, supervision, motivation and control to mainstream participatory approaches. 5. Participatory resource mobilization and management: Mobilization, allocation, expenditure tracking to enhance transparency, accountability and efficacy. 6. Comprehensive communication strategy: Comprehensiveness of the message, appropriateness and diversity of the channels, demystifying content and language to fit the audience, and the interactive-ness of the communication process including documentation, dissemination and feedback. 7. The minimum public service package: Service package definition, its effectiveness, policy relevance, accessibility and affordability. 8. Sustainable linkages and partnerships: Nature of linkage, partner capacity, relevance and effectiveness of partner investment, sustainability of either the linkage or the investment. PHC IN AFRICA

23. CAPACITY BUILDING FOR SUSTAINABLE SERVICE ABILITY DONOR/STATE-DRIVEN TRANSITIONAL SERVICE DELIVERY & CAPACITY BUILDING AUTHORITY COMMUNITY/HOUSEHOLD CAPACITY RESPONSIBILITY RESOURCE EFFECTIVE SUPPLY FROM NEED TO EFFECTIVE DEMAND REGULATED MARKET PHC IN AFRICA

24. AFRICA STILL ASKS DR MAHLER’S QUESTIONS OF 1978, ALMA-ATA Are we ready • To address the gap between the haves and the have-nots? • For partnership-participatory and intersectoral action? • For equitable and just health? • To make preferential allocation of resources to the marginalized? • Put people at the center of our action, to recognize them for their capacities and contributions as partners and not for their needs? • To introduce radical but relevant structural changes in our systems? • To fight political and technical battle to overcome social, economic and professional obstacles to PHC? • To mobilize global solidarity for ‘Health For All’? PHC IN AFRICA

25. AFRICA STILL ASKS DR MAHLER’S QUESTIONS OF 1978, ALMA-ATA • To mobilize global solidarity for ‘Health For All’? PHC IN AFRICA