Localise global health to transform Africa’s healthcare systems

Locally-led solutions are the most effective way to ensure decisions reflect the interests of the people that global health interventions seek to serve. Donor governments and funders have long expressed commitments to country ownership, which involves building local actors’ capacity to shape health policy development, advocacy, decision-making, civil society engagement, and domestic financing. 

But these commitments have been hampered by structures that favour centralised systems of international organisations from the Global North that define what needs to be done despite the focal roles played by local actors. Breaking down these power imbalances involves fostering systems and spaces that shift planning, financing and management of development programmes to local actors who know the most beneficial services people need.

The shift to locally-led solutions is better for the environment in avoiding the costly air miles of helicopter policies and interventions imported from outside but also less processed by the social and political perspectives of those much further away from the problems. The recent announcement by the Bill & Melinda Gates Foundation, committing $140-million to initiatives and research directed by African institutions and leaders to accelerate ending malaria and neglected tropical diseases is a good example of the direction of travel the development community should be taking.

Academia is starting to look at how best to be locally led too. The Lancet, a global medical journal, will continue to reject papers with data from Africa that fail to acknowledge African collaborators in the interest of building African research and promoting integrity, equity and fairness in research collaboration. African-led research has the potential to overcome the vicious cycle of brain drain and may ultimately lead to the improvement of health and science-led economic transformation of Africa. Amid limited financing and infrastructure, African scientists need to continue to strengthen research networks and create more partnerships in and outside the continent to foster collaboration. 

We need to hear perspectives and potential solutions to our health concerns from local and regional credible voices. 

The African Union is making progress in health security by strengthening domestic health manufacturing capacity for medical products and medical supplies and ensuring the quality of medicines made and sold across the continent, through the creation of the African Medicines Agency to be hosted in Rwanda. The creation of the agency will also add to the economic health of the continent by supporting manufacturing jobs and possibly creating export markets for quality products.

In Senegal, the adoption of community-based public health programming has decreased malaria transmission and improved maternal health (between 1990 and 2017, maternal mortality dropped from 540 to 236 deaths per 100,000 live births), while playing a significant role in the country’s response to Covid-19. Senegal achieved these public health gains through momentum from civil society, private sector partners and an active national government. 

The country has prioritised community health and promoted coordination among health and development partners. It also invested in strategies to pilot and scale-up critical community-based interventions, strengthen supply chains, and involve local people to promote healthy practices, enhance service delivery, and advocate for their health — fostering strong local ownership. While much remains to be done, Senegal’s progress serves as a model for the global health community in the challenge to achieve the United Nations’ sustainable development goals.

Localised solutions also hinge on ensuring the most marginalised groups have a seat at the table and a voice in the decision-making processes that inform global health interventions in their communities.

Historically, women and girls have been excluded from leadership positions and decision-making. Research shows women’s involvement in social and political processes leads to increased transparency in government decision-making, increased budget allocations for services that benefit women, and improved personal safety and social protection. Despite this, it is estimated that based on current progress, women will not achieve pay or leadership equality with men for at least another 135.6 years.

It is vital to enable the participation of women and girls’ grassroots organisations, networks and leaders in decision-making platforms at different levels relevant to their health outcomes. But this also relies on strengthening the capacity and skills of women to influence policies, laws and programs that affect their health and well-being. 

Locally-driven global health solutions will always be the best answer to the challenges we face, from malaria, neglected tropical diseases or sanitation issues — decisions need to be taken as closely as possible to the people affected by these problems. This involves going beyond transitioning service delivery and procurement to local actors but also translating action through policy, advocacy and governance. 

Although past efforts through the Paris Declaration on Aid Effectiveness (2005), the Accra Agenda for Action (2008), and the Busan Partnership for Effective Cooperation (2011) have lost visibility, their foundations on creating an enabling environment where governments and local actors lead while the civil society ensures accountability, needs identification and prioritisation continue to take shape. 

It’s on this basis that we foster national multi-sectoral involvement in public health by creating and strengthening coalitions regrouping countries’ main constituencies. Through the March to Kigali Campaign, we united African governments, financial partners, implementing partners, private sector representatives and communities to galvanise action against malaria and neglected tropical diseases. By speaking with one voice, we can maximise our efforts particularly regarding sustainable funding and domestic resource mobilisation to ensure every man, woman and child is empowered to live a long and healthy life.

If we are to achieve sustainable development, we can no longer afford to do things the old way. Instead, we need African governments and local actors with knowledge of people’s needs and priorities to drive the health agenda including determining solutions, advocating for and enacting appropriate policies, mobilising funding and implementing service delivery. This is the only way to ensure ownership of the continent’s health issues and the amplification of African voices towards solving them, and ultimately transformation of our health agenda in a way that works for us.

Yacine Djibo is the executive director and Fara Ndiaye is the deputy executive director of Speak Up Africa based in Dakar, Senegal. It is a political action and advocacy group that catalyses leadership, fosters policy change and increases awareness of sustainable development in the continent. 

The views expressed are those of the author and do not reflect the official policy or position of the Mail & Guardian.

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