Donors learning to align with health priorities of African governments

The long struggle over who gets to set health priorities in Africa is tipping toward governments, as their investments in domestic health systems appear to be growing and donors increasingly recognize the importance of aligning with locally determined goals. While acknowledging it’s impossible to generalize donor behavior, “I see a trend towards alignment from the big to the small donors,” Dr. Ebere Okereke, chief executive officer of the Africa Public Health Foundation, said during a discussion at the Devex CheckUp @ WHA 77 panel on the sidelines of the World Health Assembly in Geneva. Her organization mobilizes resources for the Africa Centres for Disease Control and Prevention and the African Union’s New Public Health Order. What has often been missing in the past, she said, “is something to align within or against.” But that is changing, particularly in the wake of COVID-19 and other emergencies, where several countries pushed for donors to invest in local visions of how to respond. She pointed to Nigeria’s Coalition Against COVID-19 and the South Africa Solidarity Fund as examples. “We’re now looking to say how do we leverage that experience into routine health investments,” she said. It may begin with investments in capacity, to build up a workforce within governments and ministries that can help improve coordination and help donors understand what governments are seeking to accomplish. Though not an international donor, the Africa CDC might offer a model for investors or institutions looking to support governments in both creating and executing a vision. As the agency has worked with African nations on initiatives such as a Digital Transformation Strategy, which aims to use digital strategies to improve health systems, they have tried to conduct a “bottom-up process” that brings in representatives from the member states to discuss their priorities and develop a vision together, said Cyril Seck, a strategy adviser with the Africa CDC. It’s “cooperation, collaboration, coordination,” Seck said. “We realized we must align on priorities defined in the countries.” At the same time, there is some question about whether governments, while increasingly laying out their priorities within the health system, are prepared to back that up with financing. The COVID-19 pandemic spurred a dramatic increase in domestic financing. And Seck said domestic health funding has “steadily improved,” even if it is not at the desired level. But when it comes to “domestic public sector government-defined funding,” Okereke said there are signs that spending has dipped “as a consequence of the debts that a lot of countries … are facing as a result of the COVID response and the economic downturn.” Nevertheless, the pandemic brought a lesson for “traditionally less enthusiastic finance ministers that investment in the health sector is critical,” not just because it is often a critical employer, but also frequently a “generator of income and foundation for all the other parts of your economy to exist.” And Okereke remained confident that the “direction of travel was right, but it is quite slow.”