9 July 2017

Africa: WHO - Now Tedros Is Boss, What Significance for Africa?

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Photo: http://www.drtedros.com/
Dr. Tedros Adhanom Ghebreyesu.

For the first time in its 69-year existence, on May 23rd, 2017, after a stiffly contested election, an African, Dr. Tedros Adhanom Ghebreyesus, more popularly called "Dr. Tedros" or simply "Tedros," emerged Director General of the world's apex health body, WHO.

With his emergence, Africans like Nigerian Health System and Policy Specialist, Dr. Ejemai Eboreime see Africa as now well-placed to define and lead the next phase of global health development. The continent has already demonstrated its capacity to take on this challenge.

The jubilations, Eboreime said, were not provoked by sentiments but by a track record of Tedros' competence in improving equity in access to healthcare as Ethiopia's health minister (2005-2012). While the world strived to improve Africa's health systems, Ethiopia met the Millennium Development Goal target of reducing child mortality by two-thirds, two years early. HIV infections, malaria and tuberculosis mortality also declined by 90%, 75% and 64%, respectively.

Eboreime added that, "the world has for long attempted to improve health systems in Africa, using interventions synthesized outside the continent by "experts" alien to the uniqueness of African challenges. Also, interventions in Africa have been "cut and paste" approaches that assume that "all Africa is the same," thus one size fits all. Dr. Tedros, being African, understands the contextual nuances of Africa and has demonstrated that African nations have the potential to lead their own development using homegrown and context-adaptive approaches."

"The rest of the world can learn a lot from African experiences towards improving health systems globally. I think Africa's jubilation is premised on this understanding."

Regardless, there are still concerns.

Physician and PhD student at the Institute of Tropical Medicine Antwerp, Jean-Paul Dossou, from the Republic of Benin, said, "some people may feel that Africa is now leading a relatively "weak" organization with a poorer impact, globally" (as compared to before when WHO was uncontested or at least less so than in the 2000s era of global health initiatives).

He said, "This is the main challenge Tedros will need to address - getting WHO back in the driving seat."

In April 2001, the African Union countries agreed to set a target of allocating at least 15% of their annual budget to improve the health sector and urged donor countries to scale up support. This meeting birthed the Abuja Declaration but a ten-year appraisal by WHO (in 2011) showed that not all countries implemented it.

On what effect Tedros' emergence might have on this, Eboreime said, "numerous economic and political factors are responsible for this. I think WHO, under Dr. Tedros' leadership, will be better positioned to understand the varying contextual factors impeding implementation of the Declaration and provide advocacy and technical support towards improving funding for health, particularly as it applies to ensuring universal access to quality healthcare, which is the mantra upon which he won the election. However, given the contextual challenges of African nations, UHC is the foundation upon which any meaningful development can be premised in Africa. It should therefore be a non-negotiable priority agenda for countries under WHO-AFRO." This is a point Tedros stressed in his speech as he said he considers UHC "the captain of the team."

Eboreime, who works at the National Primary Health Care Development Agency, Abuja,also said, "Primary Healthcare has been identified as the ideal vehicle through which UHC can be achieved, particularly in Low and Middle-Income Countries. Despite its importance, PHC is often deprioritized, underfunded and understaffed, making it the weakest link in health systems of many countries. Borrowing words from Dr. Tedros, I would say, "No more excuses!" Now is the time to strengthen PHC if we are to attain UHC and indeed the SDGs. I am confident that the new WHO leadership will infuse a new spirit in revitalizing PHC in African nations towards attaining quality care for all."

Yibetal Assefa, an Ethiopian Fellow at the School of Public Health, the University of Queensland, Australia, said, "UHC is based on both national commitment and global solidarity (developed countries should allocate 0.1% of their GDP to global health). This requires a lot of advocacy and negotiation. Dr. Tedros has developed skills in global health diplomacy from his post as the foreign minister in Ethiopia." Tedros' recent tour in the US and his attendance of the G20 summit are certainly promising signs of global health diplomacy skills.

Public health specialist Prof. Faustin Chenge, from the Democratic Republic of Congo, like many Africans, hopes that with an African WHO boss, a fresh and dynamic approach will be used to improve healthcare availability and the health and well-being of Africa's populations and "will push and support reforms in the governance, funding, and provision of healthcare towards UHC."

Even though UHC tops the DG's "to do" list, with the current state of UHC on the continent and its non-availability to most of the citizenry, Chenge said, "achieving UHC in many African countries during Dr. Tedros' term is, of course, not feasible.

"But he will certainly be able to push and support reforms in order to help all countries realize more of their health potentials. I think the ambition will not be to achieve UHC, but to put UHC on track in most African countries. This is possible and feasible."

Transparency and credibility are still major issues in health structures. To this, Professor of Virology and President of the Nigerian Academy of Science, Oyewale Tomori said, "people mention that there are competing interests which make it impossible to achieve UHC, unfortunately, in many African countries, the competing interests are corruption and lack of accountability."

WHO is a global organization, but Africa is a key focal area and in this regard, Dossou, who is also an expert in Public Health, Infectious Diseases, Epidemiology hopes Tedros will acknowledge this and thus see his position as a global one even if he is from Africa.

He advised that, "equity and fairness should drive his policy. He may give more attention to Africa, because of the share of global burden of diseases of Africa. But a mere Afrocentric approach based on his continent of origin would be a political mistake that may further weaken WHO and reduce its legitimacy and thus its capacity to help effectively address the key challenges of the continent."

Tomori argued that establishing and sustaining a reliable and efficient disease surveillance system is another priority that the new DG should consider in order to prevent and control emerging and re-emerging diseases.

He said, "Africa is notorious for the occurrence of severe disease outbreaks and an impotence in effectively controlling these outbreaks. Given the inter-play of different issues- economic, social, cultural, environment- in health, we need to adopt the "One Health" concept in finding solutions to the health problems of Africa which calls for interdisciplinary collaborations and communications in all aspects of healthcare for humans, animals and the environment."

Like others, Tomori also emphasised against a one size fits all approach, saying, "given that health problems and challenges vary from country to country, there can be no one size fits all and I am sure the new DG is aware of this. In any case, to be effective and successful, the objectives of UHC must be tailored to solve the health problems of each country." A point Tedros expressed himself similarly in recent speeches.

With several African countries dealing with humanitarian crisis and IDP and/or refugee situations healthcare remains an unresolved issue for people in camps.

Tomori said although this is something Tedros should be concerned about, he should rather spend time convincing African leaders to address the issues that create humanitarian crises - political intolerance, wars and famine, among others.

He said, "depending on donors to provide food and other materials (which often end up in wrong hands) to the displaced persons, is not the solution. The solution is ensuring good governance a pre-requisite for equitable and affordable health. The solution is including the "public" in public health.

Assefa who has known Tedros for 16 years, suggested a few more ideas to help the new WHO boss achieve a healthier, productive and prosperous Africa and healthier world.

He said, "Health is a multi-sectoral issue. It is important that Tedros works with other stakeholders and sectors so that they can work together for the good health of the global population.

"He needs to bring the lessons from Ethiopia - health systems strengthening, primary healthcare (including community engagement), and leadership commitment."

African emergency preparedness and response, is also key, said Assefa who thinks Tedros can play a critical role in bringing WHO-AFRO and CDC-Africa together so that there will be a synergistic and collaborative effort in emergency preparedness and response in Africa.

Propagating more collaboration, Assefa said, is vital. By way of example, he thinks it's important that Tedros also uses the different WHO offices in the North and South so that lessons from one region will be disseminated and utilized in others. This would include, in the SDG era, a South-South, North-South and South-North flow of information and best practices.

He said, Tedros will need the goodwill and collaboration of other global health initiatives and sectors

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