Prof. G. L. Monekosso WHO Regional Office for Africa

28/04/08 Ouagadougou, Burkina Faso 2 Outline of the Presentation 1.Background 2.Performance of Health Systems in the African Region 3.Rationale for revitalization of PHC 4.Actions for revitalization of PHC and strengthening Health Systems 5.Roles and Responsibilities of stakeholders

28 April 2008 Ouagadougou, Burkina Faso 3 Background  Progress in health before and after Alma Ata  Strengths, weaknesses, opportunities and challenges over 30 years  Summary of achievements of countries between Alma Ata and the Millennium Conference

28 April 2008 Ouagadougou, Burkina Faso 4 Performance of Health Systems Achievements  Creation of health districts  Partnership with non-public health providers  Integrated community programmes  Community health workers/resource persons  Built health training institutions and produced appropriate cadres  Essential medicine lists

28 April 2008 Ouagadougou, Burkina Faso 5 Performance of Health Systems Challenges  Decreasing expenditure of health  Increasing cost of services including training  Human resources for health crisis  Weak capacity at the decentralized levels  Heavy burden of disease – HIV/AIDS, Malaria, Tuberculosis  Move from community participation and involvement to empowerment.

28 April 2008 Ouagadougou, Burkina Faso 6 Rationale for revitalization of PHC PHC is central to delivering on  Equity  Social justice  Solidarity  Universality  Accountability  Responsiveness

28 April 2008 Ouagadougou, Burkina Faso 7 Actions for revitalization of PHC and strengthening Health Systems Stewardship  Set equity goals monitored through regular surveys, oversight and leadership.  Strengthen regulatory frameworks  Institutional framework for community empowerment and development  Governance – efficient and effective use of resources

28 April 2008 Ouagadougou, Burkina Faso 8 Actions for revitalization of PHC and strengthening Health Systems Health financing  Fairness in financing – benefit-incidence analysis  Increasing allocation to health – directed towards priorities  Social protection from catastrophic expenditures through health risks sharing.

28 April 2008 Ouagadougou, Burkina Faso 9 Actions for revitalization of PHC and strengthening Health Systems Service delivery  Building managerial capacities at the district and sub-district levels  Evidence-based HRH policies for multiskilled, motivated, equitably distributed HRH  Procurement and supply chain management to ensure availability of essential medicines and supplies  Strengthening health information management

28 April 2008 Ouagadougou, Burkina Faso 10 Roles and Responsibilities  Empowered communities capable of providing oversight  Accountable governments committed to upholding health as a basic human right  Partners committed to increasing the level, predictability, flexibility and effectiveness of aid for health activities to facilitate the achievement of the MDGs.

28 April 2008 Ouagadougou, Burkina Faso 11 MDG 1 ERADICATE EXTREME POVERTY AND HUNGER MDG 4 Child Survival Neonatal care, breastfeeding, weaning diets, growth monitoring, control of diarrhoeal disease and respiratory infections and malaria; vitamin A and iodine deficiency, day nursery care, school health MDG 2 Universal Primary Education MDG 3 Gender Equality Empower Women Curative Care, Maternal Care Disease Control, Basic Immunizations Reproductive Health, Essential Drugs Health Literacy, Food Security Water and Sanitation MDG 5 Safe Motherhood Maternal risk screening., Control of malaria and aneamia.Tetanus toxoid immunization. Pre-natal hospital beds, blood transfusion, Basic obstetric surgery. Cancer screening. Ambulance services MDG 6 Healthy Workforce Accident, violence, substance abuse prevention, mental/adolescent health, food safety Prevention of HIV/AIDS, MALARIA, TUBERCULOSIS, other chronic non communicable diseases, healthy housing, rehabilitation, health insurance. PRIMARY HEALTH CARE MDG 7 ENSURE ENVIRONMENTAL SUSTAINABILITY MDG 8 A GLOBAL PARTNERSHIP FOR DEVELOPMENT THE MILLENNIUM GOALS – COMPLEMENTARY TO PRIMARY HEALTH CARE

28 April 2008 Ouagadougou, Burkina Faso 12 CENTRAL LEVEL 1 INTERMEDIATE LEVEL 2 INTERMEDIATE LEVEL 2 COMMUNITY DIALOGUE 4 DISTRICT LEVEL 3 DISTRICT LEVEL 3 1- National health conference 2- Provincial health forum 3- District health meetings 4- Community health dialogue ACHIEVING A CONTINUING CONSENSUS FOR COMMUNITY HEALTH POLICIES

28 April 2008 Ouagadougou, Burkina Faso 13 The way forward  Explicit policies and plans  Complementary roles of communities, governments and partners  Involvement of civil society and the Africans in the Diaspora

28 April 2008 Ouagadougou, Burkina Faso 14 THANK YOU