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Public health in Africa: Transitioning from aid to strategic partnership

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The COVID-19 pandemic has emphasised the detrimental effects of Africa’s overreliance on western and international stakeholders for solutions to its healthcare challenges. The continent suffered huge consequences from the global COVID-19 supply chain crisis. Africa’s vaccine capacity depends almost entirely on international donors; Gavi, a global health partnership representing international donors, buys vaccines at low […]

The COVID-19 pandemic has emphasised the detrimental effects of Africa’s overreliance on western and international stakeholders for solutions to its healthcare challenges. The continent suffered huge consequences from the global COVID-19 supply chain crisis.

Africa’s vaccine capacity depends almost entirely on international donors; Gavi, a global health partnership representing international donors, buys vaccines at low prices from pharmaceutical companies. UNICEF has a vast network to distribute these vaccines across low- and middle-income countries.

Hence, with the continent being unable to manufacture its vaccines, Africa had to rely on Covax, the vaccine-sharing initiative for COVID-19 vaccine supply. Unfortunately, with competitive procurement by governments with deeper pockets, hiked prices of vaccines, and increased stockpiling, Africa has been unable to cater fully for the vaccination of its vast population.

While these foreign aids and interventions have helped to increase capacity in Africa’s public health sector, they are rarely Afrocentric in approach and have not given rise to country leadership and ownership of health systems

However, this is a manifestation of a much larger systemic problem. Africa depends heavily on western funding, products, and approaches to build and strengthen its health system. While these foreign aids and interventions have helped to increase capacity in Africa’s public health sector, they are rarely Afrocentric in approach and have not given rise to country leadership and ownership of health systems.

These include preventive and diagnostic interventions that are typically developed for western cultures and health development programs that are developed and optimised in the west. There is an urgent need to transform the relationship between Africa and its aid providers from that of a recipient with little say in its development interventions to that of a strategic partner.

Consequences of overreliance on foreign aid on Africa’s public health system

Despite successes that have been recorded through foreign interventions in Africa’s health systems, many experts argue that reliance on foreign assistance has, mostly, developed a culture of dependency in Africa and fostered paternalism—as opposed to partnership.

A major challenge with relying on donor funding is that the funder ultimately determines the priority of the health interventions. It is not uncommon for internationally funded health programmes to be designed abroad without consideration for the unique characteristics of the diseases and health landscape in Africa, while African scientists and public health experts are turned into mere programme managers to implement such interventions.

This could be the reason many programmes in Africa focus on a single disease such as HIV, while other important diseases endemic to the African region, such as the neglected tropical diseases, are given little attention.

The consequences of this are the development of health workers and services that specialise in a single disease with limited knowledge on other critical endemic diseases, poor indigenous research and development capacity, and an inability to effectively tackle the growing burden of disease on the continent, amongst others.

Country ownership of health systems and a more rapid and sustainable development in Africa’s public health sector require an African/locally led approach that relies on existing national and regional capabilities, and jointly beneficial global partnerships. This will ensure that globally funded health interventions align with the strategic priorities of the continent and contribute more meaningfully to the advancement of public health.

Strategies to move from aid dependency to strategic partnerships

African governments and key stakeholders in the public health sector must make concerted efforts to build global strategic partnerships that strengthen the continent’s health systems. Strategies to achieve this include:

• Development and strengthening of south-south partnerships and collaborations: South-south partnerships are crucial for enabling Africa play a more active role in international policy and decision-making processes that support its efforts towards sustainable development.

To achieve such partnerships, Bloom Public Health has been actively facilitating south-south collaborations in Africa. A few months ago, it brokered a strategic meeting between the Director-General of the Drug Regulatory Authority of Pakistan (DRAP) in Pakistan and the Director-General of the National Drug Quality Control and Valuation Laboratory (LANACOME) Cameroon.

The meeting resulted in an initial commitment for an intense collaboration between the two agencies, which would be facilitated by Bloom Public Health. The points of collaboration were capacity-building, pharmaceutical sector strategy, and information sharing between the organisations.

• Ensuring an African/locally led approach in the design of global public health development interventions: African governments need to establish policies that allow recipient countries to take part in the design of internationally funded public health interventions, rather than participating only in the implementation process.

Where this may not be possible, programs should be developed to ensure a gradual handover of ownership to the recipient country before the end of the program. This is crucial to ensuring sustainability of public health interventions.

For decades, billions of dollars worth of medicines have been shipped to Africa for various public health interventions. An African led intervention would have created the possibility of local production by strategic investments.

NIPRD and Bloom Public Health are initiating a paradigm shift in the implementation of a World Bank funded program in Nigeria. We hope this becomes a model for future public health interventions on the continent.

Conclusion

Global partnerships play a crucial role in strengthening Africa’s public health sector and provide opportunities to leapfrog towards a more sustainable healthcare system. Africa must therefore draw critical lessons from the COVID-19 pandemic and transition from aid dependency to global strategic partnerships.

Anyakora is the CEO of Bloom Public Health and a public health expert

Odibeli is a pharmacist and the research and communications coordinator at Bloom Public Health