Opinion: Self-reliant African health care can’t be a copy and paste

The only way we can better prepare and manage future health threats and improve health outcomes across Africa is by building resilient health systems. But we can’t copy and paste what has worked elsewhere — we must critically focus on what works for us. While Africa accounts for 16% of the global population and 26% of the global disease burden, our governments are only spending $4.5 billion in capital expenditure on health as compared to the $26 billion required annually to meet the continent's evolving health needs over the next decade. We reflect on three lines of action that would ignite and multiply the impact of health policies, interventions, and financing that suit the African continent's social, economic, and environmental realities. Regional leadership and coordination for increased impact Global health initiatives have supported Africa and various lower-income countries to achieve significant improvements in health outcomes. Gavi, the Vaccine Alliance, for example, contributed to cutting child mortality by half in 73 lower-income countries, while the Global Fund to Fight AIDS, Tuberculosis and Malaria invests upward of $8 billion per funding cycle to eliminate HIV, tuberculosis, and malaria in sub-Saharan Africa. In the wake of the COVID-19 pandemic, as high-income countries focused inward to protect their national interests, regional initiatives such as the Pan-African Partnership to Accelerate COVID-19 Testing was launched and rolled out by the Africa Centers for Disease Control and Prevention, under the African Union's continental response strategy. Yet global health initiatives often bypass country systems, compete for limited human resources, and are not always harmonized with other donors and national government priorities. Africa's response to the COVID-19 pandemic demonstrated that home-grown solutions to continental health threats and challenges, if underpinned by strong political leadership and coordination, can provide the much-needed steer to upscale context-based interventions adapted to our needs. These questions remain to be answered: Where and how can we best streamline and improve the coordination and delivery of similar initiatives? How can we foster learning and adaptation from implementation practices to achieve the maximum impact on health systems strengthening and achieve universal health coverage? We can’t copy and paste what has worked elsewhere — we must critically focus on what works for us. --— To maximize returns on investment for global health initiatives and ensure regional initiatives are as efficient as possible, we should: • Ensure more comprehensive approaches as opposed to selective, siloed ones. • Improve country-level governance and alignment with countries' realities, needs, and evolving epidemiological profiles. • Strengthen country-level ownership and involvement of local civil society organizations and promote a culture of trust, transparency, and accountability. Integrate to tackle some of the deadliest diseases We believe there is great potential in integrating interventions that target the same populations and require the efforts of the same health and community health workers. Designing programs with efficiency gains in mind will translate into more value for the money and more health with less money. In Senegal, for instance, the national neglected tropical disease control program and the national malaria control program integrate disease surveillance efforts by jointly conducting data collection exercises and quarterly reviews with all health districts and medical regions. More opportunities remain to be explored in other critical areas, such as the integration of HIV/AIDS prevention and control with family planning, with many adolescent girls and young women at risk of unintended pregnancy and sexually transmitted infections. The unmet need for family planning and the HIV epidemic, for example, are mainly driven by similar root causes such as poverty, gender inequality, poor access to health care, and social marginalization of vulnerable populations. Studies across several African countries show a reduction in costs for service delivery, increased client knowledge, and increased use of modern contraceptive methods when there is an effective integration of sexual and reproductive health and HIV prevention, treatment, and care services. Tap into the intellectual resources of women in health Achieving gender equity is imperative for better health outcomes. Women make up almost 70% of the health and social workforce but are poorly represented in leadership and decision-making positions. Women are experts in the communities they serve as the first or only point of contact for patients in many instances. Yet, their role in health policy-making and decision-making spaces is scarce, despite their extensive knowledge, expertise, experience, and skills. We can no longer afford to ignore the wealth of intellectual resources we have in women regarding health and care — the cost of doing so is too high. We must meaningfully engage women in decision-making processes and spaces that influence health policies and programs. Gender-transformative policies and approaches should be embedded in the efforts to reshape global health initiatives and refocus health systems to a fit-for-purpose health sector governance system. Attention should be paid to the multiple administrative, legislative, societal, and other structural barriers that prevent women from leading and managing, remaining locked in service-delivery roles. After all, there is an intergenerational responsibility impending on us all. The current and next generation of young leaders are rightfully demanding their seat at the table on all matters that concern and may compromise their present and their future. Addressing gender equity issues today prepares a better future for tomorrow's generation. There is no better time to act than now Smart investments tailored to each country's needs and priorities are vital to building resilient and sustainable health systems responsive to emerging threats while providing essential health services. Building such systems will be the foundation for countries to achieve Universal Health Coverage and health security in an ever more mobile and interconnected world. We must maximize the efficiencies inherent in our health systems and pull up extra chairs for women to take their place at the decision-making table while breaking down the silos and effectively working across public, private, academia, research, and civil society sectors. By harnessing the power of these linkages, we can mobilize strained resources and invest in country-specific health system-strengthening solutions. But we need to start right now.