I am back with my post on the African Union (AU) Summit, and the continent’s health agenda. This post will share some highlights shaping the continent's health agenda.
The 37th Ordinary Session of the AU Summit was held from January 15 to February 18, 2024. The Ordinary Session which brings together Heads of States, was held from February 17 to 18, 2024. The theme of this year's Summit was “[e]ducate an African fit for the 21st Century: Building resilient education systems for increased access to inclusive, lifelong, quality, and relevant learning in Africa.” This is a direct reference to Article 27 of the African Charter of Human and People’s Rights. The article states that “[e]very individual shall have the right to education.”
Education, a social determinant of health, has many positive impacts on health. Educational facilities are safe places for children ensuring their social and emotional development and overall wellbeing. Having access to education also ensures individuals can make knowledgeable decisions about their health and ensures they can also secure well-paying jobs in the future which will ensure individuals can access the necessities to maintain their well-being. Education is also vital for public health education and training healthcare workers.
Ministers of Health, Local Manufacturing Developments, and High-Level Breakfasts
Last Summit the inaugural Ministerial Executive Leadership Programme (MELP) for Ministers of Health was launched. This year’s Summit hosted the 2nd programme for Ministers of Health on the theme “Impactful Leadership in Health: A whole of Government Approach.” The theme highlights that public health is not just the sole responsibility of the Ministry of Health, rather other government agencies such as finance, education, infrastructure, etc. all have a role in ensuring a functioning health system.
The President of Nigeria, Bola Tinubu was appointed as a Health Champion of the African Union. This role will involve championing Human Resources for Health and Community Health Delivery Partnerships. This comes as President Tinubu committed to training over 100,000 healthcare workers in 16 months and to double the number of primary healthcare facilities. As the new Health Champion, he gave the opening remarks at MELP.
At the MELP, there was a panel on maternal mortality moderated by Dr. Magda Robalo, the President and co-founder of The Institute for Global Health and Development (IGHD). Dr. Magda’s tweet from the event mentions that “[t]here will be no achievement of the #SDG maternal mortality targets without #UniversalHealthCoverage and #genderequity. The centrality of countries’ ownership and leadership is unquestionable. Repositioning maternal health at the center of health systems strengthening is urgent.” She also recognized that she was moderating a mannel. Particularly for maternal mortality, it is important to center women and birthing people as they can share their lived experiences.
Africa CDC also presented key proposals to the Committee of Heads of State. The proposal included (1) Global Pandemic Treaty (2) Health System Strengthening, and (3) Local Manufacturing Agenda. On Local Manufacturing, the President of Kenya, co-hosted a meeting on vaccine manufacturing in Africa with the International Vaccine Institute (IVI) with other Heads of state present. Bringing these discussions to Heads of States, highlights their importance and helps to present them at the forefront of governments' agendas.
Moreover, The U.S. Global AIDS Coordinator & Senior Bureau Official for Global Health Security & Diplomacy, Dr. John Nkengasong, the former Director of the Africa CDC was also present at the Summit. The US Government and Africa CDC had several discussions on the margins discussing, (1) Expanding local manufacturing capacities for medical products, (2) Strengthening public health institutions' workforce, and (3) Expanding laboratory capacity. These are all pillars of Africa’s New Public Health Order
The Africa CDC also announced a pooled medicines procurement mechanism. Africa CDC’s Africa Medical Supplies Platform and the Africa Vaccination Acquisition Trust both launched during the COVID-19 pandemic, demonstrated that pooled procurement makes it easier for African countries to access medical supplies. Pooled procurement and continental institutions that support this give the continent a stronger bargaining power in global markets.
The Summit also held a high-level working breakfast on the Operationalization of the Africa Medicines Agency (AMA). The AMA aims to help regulate medical products and technologies through regulatory frameworks and the harmonization of products. Implementing AMA and having every AU Member State ratify this will help to achieve the New Public Health Order, strategic pillar 3 of implementing local manufacturing.
The World Health Organization (WHO) estimates that 42% of drugs originating from Africa are falsified or substandard.
The same high-level working breakfast also included discussions on Securing Africa’s Neglected Tropical Diseases (NTD)-Free Future. This was the first time this event was held at the Summit. Securing Africa’s NTD-Free Future is important as they are present in almost every African country. Health equity, addressing social determinants of health, are needed to eradicate NTDs. There is also a need to tackle barriers within health systems that lead to poor diagnosis and treatment of NTDs.
Nutrition and Child Health
Nutrition was another discussed topic, which continued discussions from last year. The African Development Bank, the AU Commission, and their partners called to boost Africa’s nutrition for children. This continued the discussions from last year’s summit.
The President of the African Development Bank, Dr. Akinwumi Adesina said “[w]e have a duty and a responsibility to reduce malnutrition and stunting in Africa by 40% by 2025.” Will we see this 40% reduction by next year?
Malnutrition and undernutrition significantly impact children’s growth. In Africa, 30% of children are stunted, which is almost 10% higher than the global estimate. Stunting is when a child has low height for their age and this is usually due to children not eating nutritious meals. When children are stunted this leads to poor cognitive and educational outcomes and a higher likelihood of having non-communicable diseases as children get older. Stunting has decreased since 2000 differently by the five AU regions.
Source: UNICEF, WHO & World Bank. 2023. UNICEF-WHO-World Bank: Joint child malnutrition estimates - Levels and trends (2023 edition). [Cited 24 April 2023]. https://data.unicef.org/resources/jme-report-2023
Download: https://doi.org/10.4060/CC8743EN-fig10
Financing, Youth Voices, and African First Ladies
Last Summit, there were discussions on unequal financial institutions, and this year there was the formation of a new alliance. The Alliance of African Multilateral Institutions formed by the African Export-Import Bank (Afrieximabnk), Shelter Afrique, Trade and Development Bank Group (TDB), African Reinsurance Corporation, Africa Finance Corporation (AFC), African Trade & Investment Development Assurance (ATDDI). Could this mean more continental funding available for health budgets, healthcare infrastructure, and training programs?
Another development was the launch of the #ICanSurvive toolkit by the Office of the Youth Envoy and the Youth Reference Committee.
This is a resource for youth mental health needs and also marks a significant step in recognizing these needs. This echoes Article 16 of the Africa Youth Charter and marks a step in bringing youth advocacy to the AU Summits.
In championing women, the Organisation of African First Ladies for Development (OAFLAD) also hosted its 28th Ordinary General Assembly. The theme was “Educate Her and Transform Africa: Enhancing Access to Health and Education for the 21st Century’s African Women and Girls.” This theme had a direct health link and UNFPA’s Executive Director, Dr. Natalia Kanem also discussed the connection between education and health. Some of these discussions were closed doors.
Implementation of Agenda 2063
This Summit also launched a report on the next phase (2024 - 2033) of the implementation plan of Agenda 2063. On the topic of public health reforms, health systems have been identified as an intervention in addition to the focus on health research. Priority 1 is Transformed education and skills systems. For research, the goal is that “Africa contributes at least 10% to the global scientific research output; at least 50% of the research output translates into innovation and production.” This includes urging Member States to invest in laboratories and research centres which can help to share knowledge among African researchers and ensure that countries can set their own public health research agendas. This can help promote relationships with institutions in academia, and the private sector. Increased research investments will also decrease the instances where data is saved in repositories outside of the country and drive solutions to health issues from within Member States and the continent.
Within the launch report, there is a health focus within Moonshot 6 titled “Africa’s Citizens are more Empowered and more Productive” and Strategic Objective 6.2 focuses on health and nutrition. This objective recognizes the need to increase access to healthcare to reduce maternal and child mortality ratios. The maternal mortality ratio is 414.2 deaths per 100,000 live births (2023), and if the current trajectory continues, it is estimated to decrease to 304.3 per 100,000 live births in 2033. The desirable reduction is over 50%, to 174.9 deaths per 100,000 live births by 2033.
The child mortality ratio on the continent is 67.3 deaths per 1,000 live births (2023), and in the current trajectory, it is expected to drop to 50.0 deaths per 1,000 live births (2033). The desired reduction in child mortality is over 50% to 25.8 deaths per 1,000 live births. The report highlights that the “right policies that factor in systemic health resilience and social determinants of health”, will help to achieve the desirable decrease. Social determinants will include policies that include a whole of government and a multi-disciplinary approach will include working with more than just Ministries of Health reiterating the theme of the MELP.
The launch of the next phase of Agenda 2063 also has a focus on promoting gender equality which upholds the Maputo Protocol. This includes ending harmful practices against women and girls such as female genital mutilation (FGM) and child marriage amongst others. There is also a call for the implementation of strategies such as the Africa Nutrition Strategy and continental frameworks like the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA), the Africa Health Strategy, and the Africa CDC Digital Transformation Health Strategy.
Another win for gender equity was that the MELP named an Africa CDC Tower after HE Dlamini Zuma, the South African Minister in the Presidency for Women, Youth and People with Disabilities of South Africa. She noted that women tend to get erased in history, and we should work on herstory.
Let us actively work towards not writing African women out of HERstory and strengthening our health systems!