The Harmonization for Health in Africa (HHA) mechanism organized a High-level dialogue among African ministers of finance and health on Value for Money, Sustainability and Accountability in the Health Sector. The conference emphasized the urgent need for greater domestic accountability, reduced dependence on foreign aid and value for money in the delivery of health services in Africa.

It concluded with a Tunis Declaration - a call for collaboration between ministries of finance and health, development partners and parliamentarians and civil society to deliver equitable, efficient, and sustainable health services in Africa.

The declaration called on the African Development Bank (AfDB) to take a lead role in "fostering and shaping the dialogue between ministers of finance and health and to facilitate and strengthen Africa's voice in the post-MDG agenda."

"34 African countries have confirmed to have either oil or gas, but the MDGs have not necessarily been the best in countries rich in natural resources", said AfDB president, Donald Kaberuka,

"The time has now come to say that we will be the major contributor to our own health, that of our children... we shall be responsible for the health of our people", said Mr Kaberuka referring to Africa's decreasing dependence on foreign aid for health.

"In sustaining Africa's economic growth, we are aware of issues of inclusiveness and inequalities. Africa's economies need healthy people. The health burden of a country is a burden on economic growth and competitiveness," he added.

Opening the conference, the Tanzanian minister of finance, Hon. William A. Mgimwa, said: "This conference is unique in many ways... is bringing together two sectors of utmost importance for improving the quality [of life] of all people in our continent that is Africa, the economy and health."

Much of the focus of discussions was centered on value for money, sustaining high-impact interventions, governance, safety nets and ICT.

The Ugandan minister of health, Christine J.D. Ondoa, told delegates "we think that ... [our health plan] will be geared towards enhancing value for money, where allocations are linked to output, not just processes and input."

Dr Nejmudin Kedir Bilal, of Abt Associates, demonstrated the high-impact of Ethiopia's health Extension Worker Program, saying: "The contraceptive prevalence rate in Ethiopia has doubled in the last five years", and adding that "in relation to malaria, there was a significant reduction in child mortality putting Ethiopia to the trajectory of achieving MDG 3."

Joy Phumaphi, executive director, African Leaders Malaria Alliance, and co-chair, Commission on Information and Accountability (COIA), highlighted the urgent need for better monitoring and information gathering for accountability: "How do we ensure that our citizens hold us accountable? We monitor the results of our investments."

Dr Tran Van Tien, vice director of the Department of Health Insurance at the Vietnamese ministry of health, told the audience that "Vietnam has chosen social health insurance as a path to universal coverage. It is challenging, but our experience shows that it is feasible and we use it to get more value for money for health, [and] to make healthcare systems more accountable to the public."

Julio Frenk, dean of the Harvard School of Public Health and a former Mexican minister of health, highlighted the role of health for economic growth, saying: "We must develop a new way of understanding the role of health in the broader global agenda if we are to execute the policies that can generate progress around the world," adding that "health is not only a consequence but also a condition for sustained and sustainable economic growth."

Dr Margaret Chan, the WHO director-general, emphasized the collaborative effort of both ministries of finance and health and also of HHA: "Prospects for better coordinated and more effective financial support are enhanced by the large number of agencies participating in the Harmonization for Health in Africa initiative."

In a special round-table session, ministers of finance and health, together with Mr Kaberuka and Abdoulie Janneh, under secretary-general, UNECA, discussed the post-MDG agenda. The discussions centered on the need for Africa to shape its own post agenda after 2015. The Gambian minister of health, Fatim Badjie, argued that "Africa needs to really come together" adding that it is "about harmonizing efforts and interventions...from ehealth to our institutions, there needs to be stronger partnership".

On 3 July, the Global Health Workforce Alliance, presented their strategy on "More Money for Human Resources for Health (HRH): More HRH for the money". The dual approach of the strategy highlights the combined need for not only more funding, but also for more efficiency and value for money for human resources in the health sector. Issues in HRH, particularly in relation to value for money were widely discussed in the conference.

On 4 July, the AfDB in collaboration with Harvard University launched a Ministerial Leadership in Health Program for Ministers of Finance. A cohort of 15 African ministers of finance will travel to Boston on 28 November to 1 December 2012 for the first training program at Harvard University.

The program recognizes the strategic role of ministers of finance in ensuring sustainable financing and value for money in health. It will highlight the importance of political leadership in improving national healthcare; examine the economic benefit of health; explore innovative health financing options; and provide useful strategies and instruments for improved value for money in health. The course will be very attractive to ministries who left the conference tasked with shaping their own agenda in health in Africa.

Background

The conference gathered 41 ministers of finance and health and/or their representatives from 33 African countries, African parliamentarians as well as more than 420 participants from the public and private sectors, academia, civil society and media globally. The Tunisian prime minister, Hamad Jebali, Donald Kaberuka, President of the African Development Bank, and Dr Margaret Chan, Executive Director of the World Health Organisation delivered the opening remarks.

Distinguished guests such as Dr Michel Sidibe, executive director of UNAIDS, Dr Babatunde Osotimehim, executive director for UNFPA, Gabriel Jaramillo, General Manager of the Global Fund to Fight AIDS, Tuberculosis and Malaria and Seth Berkeley, CEO of the Global Alliance for Vaccines and Immunizations (GAVI) delivered keynote speeches.

High-profile speakers such as Julio Frenk, dean of the School of Public Health, Harvard University and Hans Rosling, chairman of Gapminder Foundation also delivered keynote speeches during the conference.

It gathered the expertise from all over Africa as well as globally, featuring speakers from India, China, Brazil, Vietnam and Kyrgyzstan.