Sunday 26 November 2023

Co-chaired by Dr John-Arne Røttingen, Future of Global Health Initiatives (FGHI) Co-Chair and Desta Lakew, FGHI Steering Group member, the consultation highlighted the leadership of African public health policy makers and advocates in driving alignment and coherence of external funding and technical assistance to national priorities.

Participants from ministries of heath, civil society organizations and global and regional health organizations and initiatives provided feedback on the draft Lusaka Agenda: Conclusions of the Future of Global Health Initiatives Process, which sets out a roadmap to foster better alignment and coherence of external funding and technical assistance – including from global health initiatives (GHIs) – to  government priorities, in support of country-led priority-setting processes and trajectories to strengthen health systems toward universal health coverage (UHC).

The second part of the meeting focused on steps that meeting participants are taking/can take to drive this change agenda forward and opportunities to link the FGHI process outcomes to African political and policy processes to drive visibility and implementation.

The consultation was one of two FGHI meetings convened in the margins of the Conference on Public Health in Africa (CPHIA), the other being an official side event co-convened with Africa CDC and Amref Health Africa. Together these meetings mark the end of a series of consultations held over the past 14 months. The FGHI process will conclude with the publication of the Lusaka Agenda on UHC Day on 12 December and with its sharing with the leadership of GHI boards, which will consider how to take forward the actions and calls to action.

In her opening reflections, Honourable Minister of Health of Ethiopia Dr Lia Tadesse noted that while the past few years have shown how investments countries have made in health and health systems have allowed them to respond to health challenges, they have also shown, during the Covid-19 pandemic, that the investments have not been enough. Countries are facing a multitude of challenges – from outbreaks, climate change, economic constraints, to changing epidemiology – that require countries and their partners not just to do more, but to do business differently.

Others noted the need to address challenges around power imbalances, around inefficiencies, around transparency and accountability, and called for change according to what ministries of health need, not just what donors need. One participant spoke compellingly about his country’s commitment to look at its owns systems, to build capacity – including through improved accountability systems – to  be able to take advantage of the kind of change it is asking for.

Participants pointed to the need for more resources for health, calling for more resources from domestic and external sources to fill the significant health financing gaps that exist.

Africa CDC Deputy Director Dr Ahmed Ogwell Ouma noted that the five strategic shifts underpinning the Lusaka Agenda are well aligned with Africa CDC’s New Public Health Order and underscored the importance of increasing domestic resource mobilization, highlighting Africa CDC’s work with countries in this regard.

The impact of GHIs over the past 20 years was acknowledged and celebrated and the engagement of GHIs in the FGHI process was appreciated. The importance of meaningful engagement of civil society and communities was stressed, including to bring lived experience into the conversation and to help drive accountability.

Welcoming the draft Lusaka Agenda and the five strategic shifts that underpin it, participants highlighted that the shifts were required for the totality of the global health financing ecosystem, and not just for GHIs. And that the goal of achieving equity in access and equity in health outcomes should be the overarching goal. Meeting participants reflected that this is not a new agenda, that we know the what and the why and we must focus on how we do things differently.

Other feedback included calls:

  • to bring governance, as the key enabler of change, to the top of the list of near-term priorities
  • to avoid new structures in the design of the change agenda
  • to ensure near-term actions translate also into mid- and long-term actions to achieve the strategic shifts
  • to simplify access to GHI resources
  • for governments to drive the change agenda in their countries, with the involvement of in-country stakeholders
  • for pathfinder countries to be identified with input from countries and considering Africa CDC pilot countries for increased domestic resource mobilization.

One participant expressed concerns about the risk of backsliding on progress made in disease-specific interventions as focus shifts also to UHC and health systems strengthening. Others noted that investments in health systems must not be instead of, but rather in addition to, investments targeting specific diseases and that data is needed to guide investments to facilitate accelerated progress on UHC and on specific disease issues.

While implementation of the Lusaka Agenda will be overseen by GHI boards, there was a call for external accountability mechanisms to monitor implementation. Meeting participants heard an update on work underway, with the support of Africa CDC, to establish such an AU accountability mechanism, considering linkages to existing mechanisms such as the Africa Leadership Meeting and National Health Financing Dialogues. The need for highest-level political oversight on the continent was underscored, for the eventual accountability mechanism to have the “ears of Ministers and Heads of State”.

FGHI Co-Chair Dr John-Arne Røttingen, recalling the time-bound nature of the FGHI process, noted that the FGHI Steering Group is broadly committed to continuing to focus attention on the agenda to ensure its implementation even as the process concludes in December 2023, with discussions underway on the shape this might take.

Participants (in-person)

Dr John-Arne Røttingen, FGHI Co-Chair, Ministry of Foreign Affairs, Norway (Meeting Co-Chair)

Desta Lakew, FGHI Steering Group member, Amref Health Africa (Meeting Co-Chair)

Honourable Dr Lia Tadesse, Minister of Health, Ethiopia

Dr Ahmed Ogwell Ouma, Africa CDC

Dr Frode Forland, Africa CDC

Faith Nekabari Nfii, Africa CDC

Muthoni Kahuho, Africa CDC

Dr Lwazi Manzi, AU Covid-19 Commission

Abebe Genetu Bayih, Coalition for Epidemic Preparedness Innovations

Linda Muller, FGHI Secretariat

Richard Mihigo, Gavi

Dr Magda Robalo, Institute for Global Health and Development

Francoise Vanni, Global Fund

Linda Mafu, Global Fund

Selemawit Bekele, Global Fund Advocates Network

Takashi Mori, Japan

Shinobu Ashida, Japan – JICA

Dr Norizuki Masataro, Japan – JICA

Dr Sultani Matendechero, Ministry of Health, Kenya

Gerald Manthalu, Ministry of Health, Malawi

Emilia Connolly, Ministry of Health, Malawi

Anna Seymour, FCDO, UK

Jo Scott-Nicholls, FCDO, UK

Justin Koonin, UHC 2030

Laetitia Bosio, UHC 2030

Sabere Traore, UHC 2030

Lori Sloate, United Nations Foundation

Rosemary Mburu, WACI Health

Clare Battle, Wellcome

Participants (virtual)

Dr Polydor Kabila, Democratic Republic of the Congo

Dr Patrick Kuma-Aboagye, Ghana Health Service

Lynda Wardhani, Ministry of Foreign Affairs, Indonesia

Ryuichi Komatsu, Japan

Prof Aamer Ikram, Pakistan

Hajime Inoue, World Bank

Dr Susan Sparkes, World Health Organization