[afro-nets] MDGs in Sub-Saharan Africa need a Health System

["Tarry Asoka" <carenet2020@yahoo.co.uk>]

MDGs in Sub-Saharan Africa need a Health System
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On April 25th 2006, another Africa Malaria Day (AMD) was celebrated with pomp in Abuja and most of the State capitals in Nigeria. Two weeks later, Africa Heads of States gathered in Abuja again to review, this time the target they had earlier set at the same venue. There were no short of speeches and declarations.  
 
While these talk shop was going on, the constraints that are preventing Africa from making progress towards the set targets in malaria control are quite obvious. They are not good policies or a reform agenda, but mainly factors that have to do with institutional, economic (financial), socio-cultural issues. These issues and the context are the same no matter the subject matter malaria, Tuberculosis, HIV/AIDS, Under Five Mortality, Maternal Mortality or something else. In deed even when the subject changes to a new or emerging problem, just as we have recently observed with the Avian Flu saga, the issues and context do not change. 
 
In the avoidance of doubt, the lack of proper institutional framework, the lack of an effective financial arrangement and social and cultural factors are the recurrent themes that are preventing efforts to tackling the scourge of malaria, TB, or any other disease in Sub-Saharan Africa (SSA).  But these are all systemic issues that are not peculiar to malaria or to any other health problem. They are indeed the very issues that have been plaguing the health systems of countries in SSA.
 
As we have observed there have no real progress since the Abuja declaration in 2000 despite huge efforts. We do not need any guru to tell us that the situation will not change in the next 5 or 10 years even if the Africa Heads of State continue to hold meetings every year for more talk. 
 
What needs to be done is pretty straight forward and does not need much re-thinking. It requires the will to stop doing most of the things that are being done along so called disease interventions, and refocus on getting the health systems working again.  
Forty years of development assistance have not moved countries in SSA from their poor health status to levels that support human dignity and encourage economic growth. In some cases, such as Nigeria, there has been retrogression. This is as a result of lack of systems thinking. Just as in a motor vehicle, the sum of all the parts (systems) do not add up, it leads to exceptional performance - efficient, comfortable means of moving people and goods at affordable cost.
 
The failure to adopt a ˜systems approach” is not only due to the need to show result in relative small areas through quick fixes, although the preferred approach by donors (World Bank, WHO, UNICEF and other bilateral agencies, overseen by technical experts), but due to lack of ability to transfer functional competencies that can that can enable health systems to manage cash flow, systems and people.

Dr Tarry Asoka 
Executive Director - Care-Net Ltd
http://www.carenet.info
+234-8023048497
mailto:carenet2020@yahoo.co.uk