Health experts have condemned what they described as a disconnect between North and Sub-Saharan Africa, which they say is hindering the development of a comprehensive health strategy for the continent.
The divide is depriving Africans of benefits that could be gained through integration and cooperation in the health sector, said specialists speaking to SciDev.Net on the sidelines of the Africa Health Agenda International Conference (AHAIC), where North Africa was notably absent.
In the final round of the 5-8 March conference in Kigali, Rwanda, organisers presented a map of participating countries. Blue dots representing country delegates were spread throughout the continent, save for North Africa where official representation came only from Egypt.
The North African absence may reflect a structural division between healthcare systems in the North and their counterparts in Sub-Saharan Africa.
At the level of the World Health Organization (WHO), most North African countries fall under the organisation's Eastern Mediterranean regional office, while the rest of the continent belongs to the African regional office.
The WHO regional offices - first established in 1948 to group neighbouring countries with similar epidemiological characteristics - have significant autonomy in terms of leadership and priorities.
George Kimathi, director of the Institute for Capacity Development at the African Medical and Research Foundation (AMREF), told SciDev.Net: "There is no continent on our planet known as Sub-Saharan Africa, but rather it is one continent called Africa, and together we can overcome many health challenges."
Kimathi stressed the importance of cross-border cooperation through his work with the AMREF, which has more than 60 years of experience in the health sector in Africa.
"For example, what Tanzania is implementing can be useful for Morocco, and what Morocco succeeds in could help Senegal, and this is one of the basic benefits of cooperation, and without it, the continent loses a lot and its people are deprived of many benefits."
He said other benefits include better offers when purchasing medical equipment, diagnostic tools, treatments, and vaccines from foreign entities.
"[It is] crucial to enhance pharmaceutical manufacturing and local production on the continent, thereby ensuring greater independence from institutions that have placed Africa at the back of the queue for COVID-19 vaccines," he added.
Karim Bendhaou, chair of the Africa Engagement Committee at The International Federation of Pharmaceutical Manufacturers and Associations, agrees.
"We must understand the important role we can play in the health sector on the continent," he told SciDev.Net.
"Due to our geographical location, we can serve as a link between our continent and the global markets. Our shared challenges and interests with the rest of the continent ensure that our goal is to integrate with it rather than exploit it.
"We need to ask ourselves, is it better to build our health strategy and cooperation based on political concepts or based on our common requirements and interests?"
The disconnect
The division between North Africa and Sub-Saharan Africa also extends to health research, a study published last year in PLOS Global Public Health suggests.
The study measured the level of connectivity between each country and region in the continent through African organisations working in the health and health research sector.
It found that North Africa was the least connected with other regions, followed by the Southern African region.
Researchers emphasised the importance of mechanisms to increase the integration of North and South African regions with the rest of the continent, as they both host countries with advanced manufacturing capabilities in pharmaceuticals and vaccines, such as Egypt and South Africa.
Patrick Tipoo, a founding member of the African Vaccine Manufacturing Initiative (AVMI) and an expert with over three decades' experience in vaccine manufacturing, points out that establishing vaccine manufacturing infrastructure is costly.
However, he adds: "The COVID-19 pandemic has taught us about the risks of relying on imports and has drawn attention to the importance of supporting local production.
"The sustainable solution to enhance our health security cannot be based on a single country, we need cooperation at the continental level to achieve that."
David Mukanga, deputy director of regulatory systems in Africa at the Bill and Melinda Gates Foundation, says: "Our work has been focused on countries south of the Sahara, but we believe that North Africa is an integral part of the continent and can contribute significantly to the health sector.
"We are putting more effort to build bridges between different regions.
"Significant efforts are being made by the African Union and its institutions, such as the Africa Centers for Disease Control and Prevention, towards unifying efforts, which bodes well for a collective approach in the health sector across the continent."
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Ahmed Ogwell Ouma, acting director of the Africa Centres for Disease Control and Prevention (Africa CDC), says: "We are one continent and its 55 members work equally together."
Despite this, North African is the only one of five Africa CDC regions that is currently non-operational.
Ogwell Ouma explains that North African countries have not yet identified the location of the regional office "but a team based in the Ethiopian capital is working to coordinate efforts in the North".
Egyptian health official Mohamed Abdel Fattah, representing the country at the conference, indicated that the office would soon be operational, without specifying a date.
Kimathi says he is optimistic about the future of health coordination and cooperation across Africa.
"We are now meeting under the umbrella of the African Union to discuss political issues and we are coordinating our health strategy together under Africa Centres for Disease Control and Prevention," he adds.
"We also have the African Continental Free Trade Area for cooperation in economic aspects, so I believe we now have a mechanism to bring the entire continent together."
This piece was produced by SciDev.Net's Sub-Saharan Africa English desk.
