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
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
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