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

MDGs in Sub-Saharan Africa need a Health System
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 
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
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