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2018 was a good year, but challenges remain

HEALTH

2018 was a good year, but challenges remain

Dr Matshidiso Moeti, WHO Regional Director for Africa, looks back on 2018, the year that marked the 70th anniversary of the World Health Organisation, and what the Regional Office for Africa, member states, and partners have achieved together in the past two years, as well as what still needs to done for more people in Africa to enjoy better health and well-being.

As we begin a new year, let’s take a look back on 2018 to allow its lessons to inform our future in public health. We can build on our achievements to realise the bold global triple billion targets, where WHO aims to ensure that by 2023 one billion more people benefit from universal health coverage, one billion more people have better protection from health emergencies, and one billion more people enjoy better health and well-being.

This new general programme of work is shifting the way we measure results, with greater emphasis being placed on the contribution of the WHO African Region (WHO/AFRO) to health outcomes and impact. Our work will be rearranged into three pillars to match the triple billion targets: Universal Health Coverage, Health Emergencies, and Health Promotion, with results being driven at the country level. I am very excited about these changes, which promise unsurpassed public health improvements.

Last year was a significant year for public health as we celebrated 70 years of the WHO’s existence and the 40th anniversary of the Alma Ata Declaration that called for urgent and effective national and international action to develop and implement primary health care throughout the world, and particularly in developing countries.

As we reflect on the past year, I would like to express my gratitude to all our partners and member states for their commitment to improving the health of the people in the African Region. Despite challenges, we continued to register significant results through your hard work and support.

Managing change

Our Transformation Agenda (TA) is making a difference in the lives of people across Africa. Launched in 2015, the TA aims to transform WHO/AFRO into an organisation that is proactive, transparent and delivers results. In 2018, the impact of this bold and ambitious reform was clear.

Transformation at the country level is progressing well. Country support plans are being developed through consultation and bottom-up planning with governments and partners.

In April 2018, I launched Phase Two of the Transformation Agenda, putting people at the centre of change. A Change Management Team is guiding over 150 volunteer change agents across levels and disciplines in the regional and country offices, who are promoting behaviour change to produce results.

Our work in the area of emergency preparedness continued to improve during 2018. In line with the International Health Regulations requirements, 10 member states conducted Joint External Evaluations (JEEs) to identify and address gaps in health security. This brings the total to 38, more than any other WHO region, and exceeded the target of 80% by 2018.

Twenty-one African countries now have a national action plan for health security. Several emergency simulation exercises – including with senior ministry officials – were conducted in 2018 and the information generated was used to promote better planning. Thirty countries have conducted risk assessment and profiling exercises.

The African Region continues to experience significant emergencies, with 21 emergencies having been graded by mid-December 2018.  Our Incident Management System that guides the response and coordination of emergencies was activated within 24-48 hours as defined in the WHO Emergency Response Framework (ERF), thus allowing us to deploy experts rapidly to areas where they were needed. Furthermore, the region experienced cholera, Lassa fever and yellow fever outbreaks in 2018. Through joint efforts with member states and partners, most of these outbreaks were brought under control. 

Unfortunately in DR Congo, two outbreaks of the Ebola virus disease were recorded in 2018. The first, which was announced in the west of the country in May, was successfully halted within a relatively short period of time, by the end of July.

The second outbreak, which was declared a week later in the east of the country, has, however, been very challenging to control, largely due to insecurity in the area. This has now become the second largest Ebola outbreak ever recorded. We continue to work with the Congolese government, the UN system and other partners to ensure that this outbreak is stopped. This is one of our biggest health challenges in 2019.

Universal health coverage

We have continued to implement the Framework for Health Systems Development to advance universal health coverage using our UHC Flagship Programme. 

In 2018, we conducted UHC scoping missions in 10 countries, resulting in the development of roadmaps that clearly define inputs and investments needed to attain UHC and the Sustainable Development Goals (SDGs). The roadmaps are being used to coordinate partner efforts in complementing government initiatives towards the UHC.

In a first for the region, we produced The State of Health in the WHO African Region report to guide member states and donors on where hard-earned resources will bring the best results for achieving the SDGs. This report has demonstrated that the biggest challenges to attaining good health outcomes are low availability of services for populations and poor financial risk protection.

Moving forward, we are using this evidence to advise each member state, and are also developing toolkits for countries to support the planning, implementation, and monitoring of initiatives. This will help to improve health system resilience, quality of care, and demand for services and access.

In 2018, we saw an increased political commitment and leadership in health at the highest level. In September, all UN member states adopted the declaration of the first-ever UN high-level meeting on the fight to end tuberculosis.

In October, all WHO member states endorsed the Astana Declaration on primary health care, committing to strengthen primary health care systems as a precursor to achieving UHC.

In November, African ministers of health and environment gathered in Libreville and agreed on a strategic plan to increase investment and fast-track joint action on health and the environment in line with the requirements of the SDGs.

We have continued to make significant progress towards polio eradication, with eight months remaining before reaching the landmark of no polio on the continent for three years. We need to keep our eyes on the ball by ensuring that polio surveillance is of good quality across the region and that we scale up the use of new tools for monitoring surveillance such as GIS (geographic information system) mapping.

Countries are making good headway in eliminating neglected tropical diseases. Kenya became the 41st country to be certified free of Guinea Worm Disease, and we expect Human African Trypanosomiasis to be eliminated very soon. Ghana has eliminated trachoma, and in 2017 Togo eliminated lymphatic filariasis.

We have made significant advances in the AIDS response, and today four in five people (20.8m) living with HIV in the African Region know their status. In 2019, we will work actively with countries in West and Central Africa to accelerate the expansion of HIV testing services to bring them in line with other sub-regions.

Unfortunately progress against malaria has stagnated. The 2018 World Malaria Report shows that 10 African countries and India now account for 70% of the global burden. WHO and the Roll Back Malaria partnership have launched a country-led, high burden to high impact response to get countries back on track to end the malaria epidemic by 2030.

I am gravely concerned that noncommunicable diseases (NCDs) are silently killing our people. A person aged between 30 and 70 years has a one in five chance of dying of one of the four major NCDs – cancer, diabetes, cardiovascular diseases (like heart attacks and stroke), and chronic respiratory diseases – due to factors like tobacco use, alcohol abuse, insufficient physical activity and unhealthy diet. We need to respond effectively to both the factors and the conditions, if we are to achieve a reduction in the cases and deaths from NCDs.

Partnerships

I am committed to expanding our partnerships and exploring synergies to bring equitable access to healthcare services. Some highlights of the impact of our work with partners include the WHO-UK partnership framework, which saw a delegation from the UK join us to visit Ethiopia in April. This helped to enhance ties between the WHO, the Ethiopian government, the African Union (AU) and the Africa Centres for Disease Control and Prevention (Africa CDC) on strengthening health security.

Together with the AU, we hosted a side event at the UN General Assembly in September on stopping falsified, substandard medicines in Africa, adding impetus for the new treaty on the African Medicines Agency to be ratified by member states.

A number of new partners have joined us to support work on eliminating and eradicating neglected tropical diseases.

Last year, I sought to deepen relationships with newly appointed ministers of health by hosting an orientation meeting at the Regional Office in November. This was very well received and will become a regular event.

This year, Phase Two of our Transformation Agenda will focus on countries as we concentrate on delivering results, promoting efficiency, accountability, quality, and value-for-money.

Greater effort will also be made to communicate our work in improving health outcomes, particularly at the country level. I will continue to engage with member states and partners to accrue the immense health benefits that come by joining hands for a common purpose. NA

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