Traditionally, international support to Africa’s public-health systems has prioritised technical-assistance initiatives. These often focus on direct training of existing health personnel and provision of equipment such as laboratory equipment.
However, strengthening health systems goes beyond filling immediate gaps to improve short-term outcomes. It aims to create a health system that can adapt and respond to diverse challenges including epidemics, financial crises and other external challenges. Strengthening the system requires longer-term investment in the structures that address the current challenges, as well as those of the future, and incorporates public-health functions and structures alongside the health-systems building blocks as defined by the World Health Organization (WHO).
Effective public-health institutions are the foundation of resilient public-health systems. The critical and essential role of national public-health institutions (NPHIs) in the public-health architecture has been well documented and emphasised in the ongoing Covid-19 pandemic. The continent’s regional public-health institutions such as the West African Health Organization (WAHO) and Africa Centres for Disease Control and Prevention (Africa CDC) also demonstrated the added value of regional and continental coordination of Africa’s health-security capabilities.
Yet, investment in strengthening the organisational capacity of these public-health institutions remains secondary to technical-assistance offers.
Donors, partners and funders interested in sustainably strengthening public-health systems need to look beyond the traditional technical-assistance models and invest in building the systems, processes and structures that enable these organisations to function effectively. This includes strengthening financial and people-management systems (including leadership capabilities), monitoring and evaluation capacity, strategy development and implementation, and developing delivery mechanisms. Strengthening these foundational elements of public-health institutions enable these organisations to be more effective in the long term and optimise the resources available to them.
Foundations, governments and others working to achieve global health equity should prioritise the long-term commitments required to strengthen public-health institutions. While the impact of these investments may not be as immediate as technical-assistance programmes, they lead to sustainable and transformative system change. Additionally, where resources are limited they add value through coordination and enhance the impact of public-health interventions while ensuring value for money.
In the long term, strong national, regional and continental institutions will provide Africa with the public-health infrastructure to effectively prepare for, prevent and respond to public-health threats beyond emerging and re-emerging infectious diseases to encompass preparedness and response to climate change, population growth and displacement, and other wider threats to health and wellbeing.
How Strong Public-Health Institutions Underpin the New Public Health Order for Africa
Last month at the 75th World Health Assembly WHO member states voted to strengthen global epidemic preparedness and control, approving a report from the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR) on the creation of a new and strengthened global instrument for pandemic preparedness and response for global health security.
However, achieving global health security also requires strong national and regional public-health systems, for which national and regional public-health institutions are key.
In our last blog we reflected on the components of the New Public Health Order for Africa: strengthening the continent’s public-health institutions and workforce, expanding local manufacturing of health products, increasing domestic investment in health and promoting action-orientated partnership. Here we argue that strong public-health institutions underpin achievement and sustainability of all elements of the New Public Health Order for Africa.
At the inaugural International Conference on Public Health in Africa (CPHIA), hosted by the Africa CDC in 2021, 63 per cent of public-health experts agreed that stronger public-health institutions were the most critical component of the New Public Health Order for Africa to tackle public-health threats.
The Covid-19 pandemic re-emphasised the foundational importance of the workforce in health systems. However, limited investment in local training programmes and a brain drain of health professionals continues to challenge the health-workforce capacity for the African continent. It has been estimated that Africa has trained only about a fifth of the 25,000 epidemiologists it needs. Functional, resilient and successful institutions train, attract and retain health staff and develop strong public-health leaders who may then go on to play important roles in the broader global health system.
One example is the Nigeria Centre for Disease Control (NCDC) whose last director, Dr Chikwe Ihekweazu, was appointed head of the World Health Organization Hub for Pandemic and Epidemic Intelligence. The Tony Blair Institute for Global Change (TBI) has been working alongside NCDC leadership since 2016 to strengthen the organisation by establishing systems and processes that enable NCDC to deliver on its mandate to protect the health of Nigerian citizens. NCDC is now a functional and effective organisation with strong leadership capacity embedded across the organisation. The translation of NCDC into an effective and viable institution enabled it to attract highly qualified public-health professionals to work within it – most recently demonstrated by the appointment of Dr Ifedayo Adetifa as Dr Ihekweazu’s successor. Strong public-health institutions therefore not only provide the right environment for trained African professionals to thrive in and make an impact on the global stage, they also attract African diaspora back to the continent as they recognise the opportunity to make an impact.
The Covid-19 pandemic has also added momentum and urgency to the long-time ambitions to build manufacturing and pooled-procurement ecosystems for medical products for the African continent. The African Vaccine Acquisition Trust (AVAT) was established as an African Union (AU) instrument for pooled procurement of Covid-19 vaccines and the African Medical Supplies Platform (AMSP) to facilitate access to essential medical products such as ventilators and facemasks that are needed to support the pandemic response. Africa CDC, as the AU’s public-health institution, was a key driver in the creation of these structures which will go on to have a wider public-health role beyond the Covid-19 pandemic and Covid-19 vaccination programmes.
The presence of effective public-health institutions, such as the Africa CDC at the AU and WAHO at the Economic Community of West African States (ECOWAS), provide the focus and necessary professional expertise to steer and inform the political commitment required for these collaborative solutions in response to the global emergency. In addition to their role coordinating the pandemic response, including vaccine procurement and delivery, the Africa CDC has also been at the centre of the AU’s ambition to change the vaccine-manufacturing ecosystem for the continent.
In 2021, the AU established the Partnerships for African Vaccine Manufacturing (PAVM) to scale up vaccine manufacturing in Africa by leveraging pan-African and global partnerships, building domestic, global, public and private-sector partnerships to increase vaccine manufacturing in Africa from the current level of 1 per cent to 60 per cent by 2040. PAVM, hosted by the Africa CDC, has placed the public-health and health-security needs of the continent at the centre of this ambition, summarised in its Framework For Action.
The ongoing Covid-19 pandemic has driven an unprecedented level of engagement of the private sector in the response to a public-health emergency in Africa. The need to rapidly scale up access to diagnostics, deliver contact tracing and support cases in the community has driven a welcome extension of private-sector health providers beyond their traditional domain of health-care provision into supporting the emergency public-health response. These new private-sector partners, working alongside Africa’s public-health institutions, have the potential to enhance public-health preparedness and response capacity in response to future public-health events as they combine the technical expertise and government relationships of the public-health institutes with the expertise and resources of the private sector.
In Senegal, for example, at the start of the Covid-19 pandemic Institut Pasteur de Dakar (IPD), the national public-health institution in Senegal, worked with Mologic (now Global Access Diagnostics), a UK-based company, to develop affordable diagnostics for Covid-19. As a result, diagnostic-test platform diaTROPIX was inaugurated at IPD to promote access to diagnostics in Africa through the development, production and distribution of rapid diagnostic tests. This led to a technology-transfer partnership between the two institutions and Bionote, a South Korean company, to produce antigen tests for Covid-19.
Partnerships between private-sector providers and public-health institutions can more rapidly bridge the gap from research and innovation to technology transfer, local manufacturing and service delivery to African populations. To ensure the focus remains on the health priorities of the citizens, public-health institutions must have the capabilities to be effective partners with the skills and resources to drive such partnerships.
Therefore, to enable African countries and the African continent to effectively prevent, prepare for, and respond to ongoing public-health challenges, the next epidemic and fully realise the New Public Health Order for Africa we should invest in strengthening Africa’s public-health institutions. More specifically, we need to invest in building the systems, processes and structures that enable these organisations to function effectively as part of the global health-security architecture.