DR MOETI: Donor aid for health is shrinking, invest more national resources

The World Health Organisation’s Africa’s regional director, Dr Matshidiso Rebecca Moeti, spoke to Elizabeth Merab on the UN agency, funding and youth involvement in health decision making.

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We cannot run away from the fact that donor funding is shrinking by the day. How can African countries fill in the gaps and sustain the progress in healthcare?

It was inevitable that we would get here. Countries are developing, their economies are growing. This means that as countries graduate into middle income states, they need to smartly invest more of their resources in health.

If donor funding is reducing, African countries need to be working on ways to improve their own revenue. While they are trying to seal the gap, they need to work better on areas that need emphasis. It is not as if the money is not there, it may not be getting into the public purse. Therefore, we need to talk about flight of capital and address cases of some international donors not paying taxes to the degree that they should.

At the same time, instead of lamenting and worrying about the flight of donor money, countries need to invest much more effort in getting their own revenue from areas like taxation.

With a continent that is heavily populated with young people, what is the involvement of youth in an agenda like Universal Health Coverage?

We need to deal with the awkwardness of having old and young people in the room to talk about health or at least engage young people where they are and bring their views and voice into decision making.

At the WHO, we are learning to do this. Our adolescent health programme has not been among the best funded or our strongest and we are deciding that it deserves this added emphasis because it deals with the biggest demographic in the region.

We are therefore recruiting young people to change how we are working and asking our adolescent health programme to work with all the other programmes, so that those working on HIV/Aids, sexual and reproductive health, non-communicable diseases, and health systems development take on board the needs of young people.

Expound on the renewed WHO approach to dealing with health emergencies and outbreaks.

Lessons from the Ebola outbreak in West Africa revealed critical gaps in WHO’s emergency preparedness.

We are, therefore, adjusting our programmes to have a smart technical focus in line with the region’s priorities, basing interventions on evidence and lessons learned from experience. We have now reformed our Health Emergencies Programme and are part of a global WHO approach of one emergency programme, one workforce, one budget and one line of accountability.

That means, for example, that my director, who is the team leader in Africa, does not need to get permission from me for everything he has to do. One of the big changes we have put in place is that this director can work directly with the executive director in Geneva and the WHO country representative to make decisions.

This is the approach we used to address recent disease outbreaks in Africa such as the yellow fever outbreak in Angola.

We are also working with other partners in a structured way and co-ordinating the work that needs to be done between the three levels to provide better support.

How prepared are African countries to deal with emerging issues like antimicrobial resistance and disease outbreaks?

I genuinely think African countries (maybe not all of them) are better prepared on the whole than they were pre-Ebola outbreak.

But I also think we are not quite there yet. Health systems are still very weak. If you look at an objective tool like the International Health Regulations, there are very many gaps in African countries.

With data collected from about 12 of the 47 countries, we have more evidence-based information about the existing gaps and what needs to be done.

Countries have also begun putting together co-ordination mechanisms on the so called emergency operation centres, where you can deal with one of the key problems when something arises: “How do I have an effective co-ordination nod which directs the actions from investigations, confirmation, response, surveillance and monitoring to see that an outbreak is being brought under control’?” That is one more step to being better prepared.

We have also seen improvement in the laboratory capacity to quickly diagnose some of the organisms causing outbreaks.

At the end of the day, what needs to happen is that if an outbreak is starting somewhere and the infected person goes to a clinic anywhere in a country, you need to have in the health worker diagnostic capacity to pick up that something unusual is happening, report that and trigger investigations that will conclude what is going on.

Research has not fully been explored especially when you focus on Africa’s role. How can we see more research by ‘Africa for Africa’?

Africa has paradoxically been quite involved in global health research but much of this has been invested in by outside entities and the agenda of this research has been determined by the funders of the research.

We need our own domestic investment in research which will enable the countries to define their own research priorities and, most importantly, to work with the outcomes of those researches to inform policy and service delivery.

I have seen the private sector becoming more and more engaged in playing its role in healthcare. And we must admit that there are a lot of opportunities to harness the resources, skills and experiences of private sector.

However, I think it needs to be done within a framework of clear alignment with national priorities and for us, because this is the Sustainable Development Goals era, clear alignment with the idea of driving towards equity, better quality services access but also emphasising affordability.