A decade ago, the world united at the 67th World Health Assembly to pass Resolution WHA67.20 for strengthening evidence-informed policy-making and priority-setting processes in health. This historic resolution singled out the vital role of evidence in shaping health policy and priority-setting processes. Member states pledged to support the use of evidence to guide healthcare decision-making in healthcare, with the World Health Organization (WHO) assigned for support and guidance.
This resolution meant that evidence-based approaches would be integrated into global public health policymaking.
"Africa is at a pivotal moment, aiming for an integrated, prosperous, and peaceful future by 2063, as outlined in the socioeconomic blueprint for the continent," said Dr. Raji Tajadin, Deputy Director of Africa Centres for Disease Control and Prevention (Africa CDC). "We aim to build a continent that is integrated, prosperous, and at peace with itself by the year 2063. This is a socioeconomic blueprint for Africa, as articulated and endorsed by our heads of state and government."
Since its inception, the Africa CDC health economics and financing programme spearheaded this vital agenda on the African continent, leading the way in driving evidence-based, priority-setting for health. With Africa at the center stage, Africa CDC, the Centre for Global Development, the UK's Foreign, Commonwealth and Development Office, and France's Development Agency brought together policymakers, health experts, and global leaders to discuss the progress made on a critical World Health Assembly resolution from a decade ago.
During the keynote address on setting priorities and developing resources in Africa under the new public health order, Dr. Tajadin said there are five critical pillars of the new public health order endorsed by African heads of state; increasing healthcare workforce development, building local manufacturing capacity for vaccines and other essential medical supplies, increasing domestic resources dedicated to healthcare, and promoting strong partnerships that are action-oriented.
"Health is not just the agenda of the Ministry of Health alone; it's a whole-of-society agenda," he said. "We need to put our hands on deck to make sure that we have a resilient health system in place so that routine health services continue to run hand in hand as we respond to our emergencies."
The continent faces challenges in meeting healthcare needs, especially during emergencies. He acknowledged the challenges African health systems face in meeting the needs of their populations, which became even more critical during emergencies like the COVID-19 pandemic. In the aftermath of the COVID-19 pandemic, there has been renewed emphasis on reorienting health systems towards primary health care to make progress on universal health coverage and health security.
"We all saw the way the COVID-19 pandemic disrupted routine health services. We saw the way the pandemic decimated our primary healthcare system," said Dr. Tajadin. He called for the need to build resilient health systems capable of maintaining essential services like immunizations, chronic disease management, and maternal care while also responding to emergencies.
"The idea of prioritization is not new, but it has become more crucial based on the context," added Dr. Salam Gueye, WHO African Region Emergency Director. "In the aftermath of COVID-19, resources are scarce, and the needs are significant. That's why the focus on prioritization is so important."
He added that in the African region, the financial level of domestic public resources for health remains inadequate compared to the resource requirement.
"In 2021, in the middle of COVID-19, the health spending in the region was on average U.S.$132 per person," said Dr. Gueye. "This contrasts the estimated total costs to achieve the SDGs of about U.S.$249 per person per year. At the same time, the current fiscal constraints facing countries in the region threaten efforts to mobilize additional resources for health."
He added that external funding continues to play an important role in financing health in our region, comprising, on average, over 20% of current health spending between 2011 and 2021 and equal to or more than 40% in eleven countries.
"We have championed this cause for a decade now," said Dr. Gueye.
"In the WHO African Region, we support evidence-based priority setting…," Dr. Gueye said. "We have also demonstrated this collaboration with Africa CDC in raising awareness and building the capacity of policymakers in Eastern and Western Africa on priority setting in health."
Funding Shortfall, Widening Gaps
The healthcare systems in Africa face significant challenges, including underfunding and being overburdened, leading to significant disparities in access and quality of care. Public health spending remains insufficient, and dwindling foreign aid due to the global economic crisis only worsens the situation.
Africa accounts for 16% of the global population, but bears 25% of the global disease burden, according to WHO. However, it is responsible for only 1% of total health expenditure globally. "The situation is compounded by Africa averaging over 150 disease outbreaks per year...," said Dr. Tajadin,"...with 164 emergency events recorded in 2022 alone, further straining already weak health systems."
"The current unfavorable economic landscape, both globally and within the continent of Africa, warrants effective ways of tackling these challenges in the face of limited fiscal space to ensure our ambitions and long-term visions are materialized."
Dr. Tajadin added that evidence-informed priority setting provides a powerful tool to navigate complex resource allocation decisions among competing priorities transparently and inclusively based on evidence.
"Without such a systematic approach, implicit ad-hoc decision-making risks inconsistent and sub-optimal outcomes with life-and-death implications, especially in Africa," he said.
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Africa Gets Framework for Health Resource Allocation
The 67th World Health Assembly unanimously passed the historic resolution WHA67.23 calling for all countries to develop a systematic, evidence-informed approach to setting health priorities. This resolution underscored the global consensus on the importance of a structured framework for health decision-making processes, advocating for the implementation of evidence-informed priority setting as a fundamental principle in the management of healthcare resources.
Since the resolution's passage, efforts have been made to support African countries in implementing evidence-informed priority setting. However, it's crucial to ensure these initiatives are member-state-owned and led, prioritizing the best interests of African nations.
While various partners have supported African Union member states in implementing evidence-informed priority setting, these efforts haven't always been tailored to the specific needs of each country. "To address this gap," said Dr. Tajadin, "the Africa CDC, in collaboration with health ministers and key partners like WHO and others, has developed and launched a continental framework for evidence-informed priority setting in Africa."
Dr. Gueye said that WHO-Africa remains committed to "sustaining this collaboration and partnership and providing technical guidance to countries in the Africa region for improved health outcome and well-being".
