The 73rd session of the WHO Regional Committee for Africa was held in Gaborone, Botswana, from 28 August to 1 September 2023, with two side events related to the FGHI process taking place on the margins: the African Health Leaders Policy Forum co-convened by the Ministers of Health of Ethiopia and Rwanda; and the WHO-AFRO/Africa Constituency Bureau for the Global Fund co-hosted Strategic Priorities for Africa’s Engagement with GHIs.
Side Event: AHLPF
On 30 August, an invitation-only dinner for Ministers of Health included Dr. Edwin Dikoloti, Minister of Health, Botswana; Dr. Robert Lucien Jean-Claude Kargougou, Minister of Health, Burkina Faso; Dr. Wilhemina Jallah, Minister of Health, Liberia; Dr. Sabin Nsanzimana, Minister of Health, Rwanda; Dr. Austin Demby, Minister of Health and Sanitation, Sierra Leone; Dr. Dereje Duguma, State Minister, Ministry of Health, Ethiopia; Bjørg Sandkjær, State Secretary, Ministry of Foreign Affairs Norway; Ambassador Gjermund Sæther, Norwegian Ambassador to South Africa; and Linda Mafu, Head of Civil Society and Political Advocacy at the Global Fund.
Key Areas of Discussion
Ministers agreed that there is a need to work together to prioritize the continent’s health needs, to undo bureaucratic restrictions on collaboration and deliver health solutions in a timely manner. They agreed that coordination methods of different global health actors need to be improved and aligned with strategic plans in-country. The group agreed on the need for GHI reform and noted that it is coming.
They also agreed that a greater attention is needed on epidemiological shifts, climate change and its impact on health. The ministers agreed that GHIs need to be more responsive in addressing issues while listening to countries and voices from civil society organizations. They pledged to continue discussions on the evolution of the global health financing architecture and to be action-oriented.
Side Event: Strategic Priorities for Africa’s Engagement in GHIs
On 31 August more than 70 participants, including more than a dozen country representatives, joined a WHO-AFRO and the African Constituency Bureau for the Global Fund (ACB) official side event, Strategic priorities for Africa’s engagement in GHIs.
Event Overview
Opening
In her opening remarks, WHO Africa’s Regional Director Dr. Matshidiso Moeti reflected on the importance of developing shared African positioning on health priorities that in turn would inform the work of the GHIs.
Dr. Jean-Jacques Mbugani. Global Fund West and Central Africa (WCA) Board member and Chair of the ACB noted that through the formulation of harmonized strategies and positioning, the ACB can drive priorities that respond to the needs of countries, including fragile states.
Ms. Linda Mafu. Head of the Political and Civil Society Advocacy department at the Global Fund, emphasized country ownership as being at the heart of the Global Fund and committed to ongoing collaboration with African regional bodies.
Dr. Richard Mihigo. Director of the COVID-19 Delivery, Coordination, and Integration department of Gavi, spoke to the progress seen in the COVID-19 response while noting Gavi’s commitment to ongoing innovation and adaptation to the evolving needs of countries and those most marginalized.
Panel discussion
Moderated by Mrs, Susan Mochache, East and Southern Africa (ESA) Global Fund Board member and Board member of the ACB, and Dr. Impouma Benido, Director of the Non-Communicable Diseases Cluster at WHO AFRO, the panel shone a light on countries’ experiences with GHIs, from progress to challenges and lessons learned.
Ms. Bjorg Sanddkjaer. State Minister of Foreign Affairs of Norway and co-director of the FGHI, shared with delegates the process to date undertaken to amplify African voices and chart the way forward for GHIs to better complement domestic financing to maximize country level health impacts, as part of country-led trajectories toward universal health coverage (UHC).
Prof. Aladje Baldé. The representative of the Minister of Health of Guinea-Bissau and President of the National Institute of Public Health, shared key challenges that the country has faced in strengthening its health systems, including in leveraging the Global Fund partnership and other GHIs. Challenges remain, for example when it comes to malaria in children and pregnant women and the lack of a harmonized data system and insufficient access to medicines. He called for partners to come together and do more because we know what works and we know that progress is possible, through joint learning across the continent and innovation for health for all.
Mr. Dabsou Guidaoussou. The representative of the Minister of Health of Chad and Secretary General in the Ministry of Public Health and Prevention spoke, referring to the best practices implemented in health system strengthening and how these may be adapted by other African nations. The representative referred to the significant reductions in AIDS-related deaths (down 60% since 2002). While noting that progress in TB and malaria has not been as dramatic, the representative stated that the key to this progress has been complementarity of efforts, rather than competition.
Khumbize Kandodo Chiponda. The Honorable Minister of Health of Malawi, spoke to the key lessons gleaned in the process of strengthening the country’s health system and how those lessons have influenced their approach to harnessing Global Fund and GHI investments. Among the lessons, the Honorable Minister highlighted the need to focus on the deadliest diseases, ensure health system sustainability, and engage communities in prevention and response. The Minister noted that while Malawi’s national responses to HIV, Tuberculosis and Malaria are recognized as successes, there are still significant gaps, including infrastructure – stating that if there is no infrastructure, people are left behind, for example those in rural areas. The Minister sighted issues of equipment, access to treatment, and data digitalization. It was noted that to maximize its work with GHIs, Malawi has developed a Health Sector Strategic Plan, to support a harmonized plan, budget and reporting mechanism.
Discussion from the floor
The representative from Mozambique expressed agreement with the points shared by the Hon Minister of Malawi, while at the same time highlighting that GHIs can sometimes contribute to the fragmentation of priorities and needs across the region. Greater harmonization across GHIs would thus be welcome.
The representative from Burkina Faso acknowledged the impact of the wide range of GHIs while observing the space for enhanced efficiencies and coordination. In the context of the Global Fund, he welcomed the process to identify national priorities within the frame of grant-making and reiterated that priorities funded by GHIs should be those which are consistently identified by countries.
The representative of Guinea informed the group about the existence of a joint technical coordination body and that the Global Fund and Gavi have agreed to work in collaboration with this body for HIV programs, with potential expansion to other diseases. He called upon GHIs to support the establishment of a national coordination mechanism to manage all the funds.
In final reflections from the floor, the representative of the Central African Republic spoke to the positive experiences of collaboration, dialogue and partnership across African nations. He made recommendations to organize sessions specifically designed to discuss this subject.
Closing of the session
In closing the session, Mrs. Mochache shared the commitment of the ACB to continue these discussions and represent them to the Global Fund. In summarizing the discussion, co-moderator Dr. Benido highlighted the following issues raised by the participants:
- Recognition of the pivotal role of most GHIs in achieving health outcomes, while
simultaneously underscoring the imperative for better coordination and alignment. - Emphasis on the optimization of GHI investments for both disease control and health
systems strengthening. - The need to cultivate a unified African voice with the GHIs. The Regional Committee of
WHO/AFRO and the ACB are critical in nurturing this collective voice, which will then be
represented to the Global Fund and other GHIs. - Countries should be given leverage to define their priorities and WHO/AFRO will continue to
support countries in developing funding application from GHIs. - The research report, ‘Reimagining the Future of Global Health Initiatives’, commissioned as
part of the FGHI process, will help to guide the collective thinking on the future of GHIs.
