Africa CDC’s final steps to operational autonomy

The Africa Centres for Disease Control and Prevention is working to gain greater independence from the African Union — transitioning from a specialized technical institution to an autonomous public health agency. Under the umbrella of the AU, the institution has been weighed down by slow processes hindering its ability to respond rapidly to health emergencies. But last February, African heads of state decided to give Africa CDC wings, saying it would amend the institution's statute to allow it to transition to greater autonomy. In July, the AU executive council approved the revised statute. Now, Africa CDC is trekking forward with implementation. In an interview with Devex, Dr. Ahmed Ogwell Ouma, the acting director, said a majority of the efforts are completed — it has worked to set up new systems for administration, human resources, finance, and procurement. But broadly, there are four remaining steps in order for Africa CDC to fully operationalize its new autonomy. Africa CDC will place new frameworks before heads of state for approval at the AU executive council and assembly meeting in February 2023. “There's still some journey to go because quite a number of these steps require member state involvement and therefore the political part of it also has to still play out,” Ouma said. The power of autonomy As a specialized institution, as opposed to a public health agency, Africa CDC has been stunted. It has not had ownership over its own procurement or human resources strategy, nor is there a legal instrument allowing it to work directly with governments. The AU is a bureaucracy rooted in long-term planning, said Dr. Ebere Okereke, honorary senior public health adviser at Africa CDC and senior technical adviser at the Tony Blair Institute for Global Change. But that pace doesn’t suit the management of deadly outbreaks. As the lead agency tasked with ensuring the continent’s health security, Africa CDC must quickly respond to emergencies, she said. The autonomy gives Africa CDC agility, allowing it to respond more rapidly to health emergencies, and enables it to declare health emergencies of continental concern, among other benefits. "The fundamental necessity of autonomy is to allow it to be agile; to allow it to be flexible, and to give it the space to move without having to go through the chain of command that the AU requires,” Okereke said. Ouma said the autonomy allows the agency to deploy experts in a day as opposed to previously a matter of months, although resources, access to countermeasures, and movement of people and goods can still slow their teams down. And with operational autonomy, Africa CDC is also not divorced from its source of power — which is the AU, Okereke said. The director general will have the power to convene heads of states. "It gives it the mandate to speak for the continent on public health issues directly,” she said. Awaiting AU approval There are four key areas up for adoption by heads of state in February: Governance frameworks. The AU must approve the structure of the new secretariat, governance board, advisory technical council, and committee of heads of state. Dr. John Nkengasong, the founding director of Africa CDC, stepped down from the institution in May. Following this, Ouma took the reins as acting director in the interim. Under the new autonomous status, Africa CDC will have a director general, as opposed to simply a director — which gives the new leader heightened levels of freedom. The AU Commission collected applications for the role of the new director general through December and is expected to finalize the process of hiring in 2023, of which Ouma is in the running. In addition to the top role, Africa CDC will also need to staff the new secretariat. Operational framework, rules, and procedures. The Africa CDC also needs a road map for its operations. This will include details, for example, on how it will move forward with emergency procurement, human resource recruitment and rapid access to funding. The AU will also approve a budget. The new governance structures — including for the new secretariat, governance board, advisory technical council, and committee of heads of state — need rules, procedures, and policies. “We must give them the rules and regulations within which they are going to be able to conduct their business,” Ouma said. Coordination frameworks. Africa CDC must coordinate with institutions and agencies within the AU around health security, among other partners. A framework is needed to clearly identify to whom responsibilities belong. A framework would outline the roles of national departments of health, AUDA-NEPAD, the AU Department of Health, Humanitarian Affairs and Social Development, as well as departments that focus on veterinary work, climate change, and trade. The Africa Epidemics Fund. Last February, heads of state supported the creation of an epidemic fund for the continent. The AU must approve the mechanisms for operating the fund so Africa CDC “can start mobilizing resources and utilizing those resources within that new framework,” Ouma said. Chalking up domestic funding If heads of state approve the frameworks in February, “We can have everything that we need, and we just go into implementation,” Ouma said. But access to financing will determine the speed of implementation. Ouma is urging African nations to provide the core funding support for Africa CDC in areas such as staffing, running the secretariat, and other governance mechanisms. “This should be member state-driven. The programmatic part — a significant portion of it — must come from our Africa member states, even if partners are going to support it,” he said. International pushback Moving through the procedural steps hasn’t been the only hurdle to achieving greater autonomy. In June, Devex reported that the World Health Organization’s regional office for Africa had briefed country governments on its opposition to granting Africa CDC expanded powers, such as the ability to declare health emergencies on the continent saying it requires “more discussion, further analysis and a full consideration of its implications.” But the AU executive council still moved forward with approving the revised statute. The agency has also faced resistance in at least one arena of asserting its position on the international stage. While there have been recommendations, and a push, for the World Bank to designate Africa CDC as an implementer of its new pandemic fund, the bank has not accepted this, according to Okereke. She said denying this position to Africa CDC hampers its ability to have a voice of influence around funding for pandemic response and preparedness for the continent. “They may change their mind. I hope so. I think they should,” she said.