District health in Africa: Progress and Prospects 25 years after the Harare Declaration

Regional conference – Dakar21-23 October 2013

Ministère de la Santé et

de l’Action sociale

REPUBLIQUE DU SENEGAL

Objectives & content of the conference

The Harare Declaration & health districts in Africa : time for an updated vision

Organising Committee

Background

• 3-7 August 1987: WHO interregional meeting in Harare, on strategies to strengthen district health systems.

• Extension of the “Health for All” movement of Alma Ata (1978)

• Key meeting for the adoption of a strategy allowing to realize primary health care.

Many changes in Africa since 1987

• Much greater demand for accountability and results. How to respond to new expectations?

• Session 6

Changes in the health sector

• How to adapt the district system?• Across sessions.

New knowledge and new platforms

A diagnosis still valid?

A definition

• Is this definition still satisfactory or is it misleading?

12 points of action

• Have we implemented these 12 points of action?

• Were they right ? (or guided by a wrong assessment)

• Still relevant? • Should we add new ones?

National policy

• Implemented… but maybe too much as a blue print? (health pyramid)

• Shortcomings:– A too rigid and administrative view.– No satisfactory answer for cities. – How to engage with private actors.

• Sessions 2, 3B & 7A

Decentralisation

• Partial implementation, varying across countries. • New context: administrative decentralisation.• New - sharper - propositions.• Key question: decentralisation of what, to whom?• Sessions 7B & 8A

Planning, (targeting) & information

• Done (yet, without targeting and not with an intensive use of health information system).

• Too much faith in the planning process? Who should set priorities?

• Sessions 4B and 9C

Community participation

• Bamako Initiative, community health workers.• “Self-reliance” - still relevant?• Have we found the appropriate mechanisms? Or

contradiction in the terms?• Session 4A

Intersectoral action

• Probably one of our weakest achievements! Very health sector–inward looking so far.

• Question: how can we do that?

• Session 3A

District management team

• Why so few great leaders at district level?• Wrong approach or an unrealistic assumption?• What are the alternative approaches for coordination of

actors? How to steward a pluralistic health sector?

• Session 2 (keynote), 8B

Resource mobilisation

• Bamako Initiative, a few weeks later!• A lot has been tried… with mixed results• UHC = Health for All + Protection from catastrophic

health care expenditure• Not the focus of this conference.

Integration of vertical programs

• Worse than in 1987?

• Not taken as a theme per se. But present in the program.

Referral hospital

• The always forgotten component!

• Keynote speaker session 11.

Action-research

• Could one formulate more precise recommendations?

• Heavy presence of scientists at this conference!

Equity

• Much higher on the agenda in 2013 than in 1987!• Better formulated today.• Some innovations.• How to do more?• Keynote speaker 1, session 2.

Coordination with technical and financial partners

• Strong momentum in the early nineties… a bit lost with GHI… back with HHA and CoPs?

• New instruments: SWAp, PBF…• Session 9A + Philosophy of this conference.

Need for an updated vision – first line services

• More flexibility at Health Centre level (expansion of the minimum package of activities).

• Return of the community health worker strategy.

• Patient-centered care.

• Session 9B, session 11 (keynote 1)

Key objectives

1. Assess the health district strategy.2. An updated vision.3. Action points & recommendations.4. A strong and shining CoP.5. A knowledge agenda.

A conference manifesto

There will be no Universal Health Coverage without strong local health systems: it’s

time to update the health district strategy in Africa

We look for the action points.

→ Your job!

Thank you

• Follow us on our online platforms! (p2 program)