GLOBAL, AFRICAN AND SOUTH AFRICAN HEALTH STRATEGIES AND PERSPECTIVES ON SDG 3: GOOD HEALTH AND WELL-BEING FOR ALL

Marlon Cerf

The South African Medical Research Council (SAMRC)

National Science and Technology Forum

Discussion Forum

4-5 September 2017

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STRENGTHENING HEALTH SERVICES

To create an enabling health services environment to improve patient experience and outcome

To enhance health services through robust governance, improved coordination, growing critical

mass and applying enabling processes to realise effective healthcare and cost efficiencies

To develop, maintain and retain healthcare workers

To recognise health as part of a system that is interdependent and reciprocally influenced by

other parts of that synergistic system

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GLOBAL GROSS EXPENDITURE ON R&D

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Increased R&D expenditure contributes to GDP growth

Quality health and education drive economic growth

WHO GLOBAL STRATEGY ON INTEGRATED PEOPLE-CENTRED HEALTH SERVICES Person centred = patient experience + outcomes

Healthcare access to all 1bn no access

Focus on the life course Emergence of NCDs HIV as a chronic disease Co-morbiditity and drug resistance challenges Precision medicine for better health treatment

Effective, efficient, safe and timely Resource constraints in Africa and South Africa

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UNIVERSAL HEALTH COVERAGE (UHC): TARGET 3.8 OF GOAL 3

UHC is a major global health, political and ethical goal

All people and communities to have access to quality health services without risking financial hardship

Health promotion and prevention > treatment

Service delivery improvements

Fragmentation → co-ordinated, collaborative partnerships

National Health Insurance (NHI)

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UHC’S 5 INTERDEPENDENT STRATEGIC GOALS FOR INTEGRATED PEOPLE-CENTRED HEALTH SERVICES

1. Empowering and engaging people: better service to patients especially poor; better decisions

2. Strengthening governance and accountability: robust, coherent, integrated approach; harmonization and alignment of programmes

3. Reorienting the model of care: prioritise primary and community healthcare and the coproduction of health; build stronger primary healthcare systems and shift towards outpatient care; apply enabling technology

4. Coordinating services: focus on delivery to care through alignment and harmonization of processes at every level of care and across sectors (e.g. social services and education); allow for early detection and rapid response to health crises (NAPHISA)

5. Creating an enabling environment: to effect goals 1-4, consolidate stakeholders for transformational change; legislative frameworks, financial arrangements, workforce reorientation and public policy making

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PHYSICIANS

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SCIENCE GROWTH

The impact of good investments and effective interventions are becoming evident High burden of diseases remain a challenge

HIV/AIDS, TB and malaria pose the greatest challenges The increasing burden of both death and disability from NCDs

Chronic diseases more prevalent, linked to demographic, behavioural and social Changes and urbanisation Hypertension, stroke, diabetes, chronic respiratory, substance abuse are growing

Worsening protein energy and micronutrient malnutrition in many countries Increases morbidity and mortality Dietary changes and inactivity are driving the emergence of chronic diseases and obesity

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AFRICAN HEALTH LANDSCAPE

AFRICA’S BURDEN OF DISEASE

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AFRICAN SOCIO-ECONOMIC DEVELOPMENT PRIORITIES AND CHALLENGES

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SOCIAL PRIORITIES AND CHALLENGES ECONOMIC PRIORITIES AND CHALLENGES

Economic growth, jobs and structural transformation Agriculture, food and nutrition security Energy Sustainable consumption and production Infrastructure development

Poverty, inequality and social exclusion Education Water, sanitation and access to basic services Demography and population growth Urbanisation and sustainable human settlements Health Youth unemployment Gender and women’s empowerment

SOCIO-ECONOMIC PERSPECTIVES

Good health at low cost for all is the goal

The GDP of Africa is estimated to grow 11-15% from 2011 to 2030

In terms of healthcare funding, value for money relates to smart, scale and sustainable investments Shared medical equipment scheme in Kenya AIDS levy in Zimbabwe Decentralized health services to improve health service delivery in Pakistan

Two-thirds of growth in the economy is driven by human capital viz. health and education Governments and the private sector need to invest in the health and education of the people Research and innovation drive the economy

South-South collaboration must be explored for investment opportunities

The private sector is embedded in the public sector—tap into this resource

Africa has the biggest resource of youth with 196m young people Africa has 1.8m volunteers – harvest optimally

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HEALTH PERSPECTIVES

Enable learning and provide support across the continent with early warning systems to prevent and respond to outbreaks

Health promotion and disease prevention is cheaper than treatment $4.7bn to treat Ebola patients

The harmonization of health research priorities must be integrated into national research systems

For effective health coverage, we require good nutrition, family planning (empower women), cure epidemics, decent jobs (including the informal sector), and the alleviation of poverty

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SOUTH AFRICA’S BURDEN OF DISEASE

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Cause of death Deaths %

HIV/AIDS 180,870 29.4

Hypertensive heart disease 39,272 6.4

Lower respiratory infections 38,576 6.3

Cerebrovascular disease 37,913 6.2

Tuberculosis 37,519 6.1

Diarrhoeal diseases 26,564 4.3

Ischaemic heart disease 24,510 4.0

Interpersonal violence 20,155 3.3

Road injuries 18,166 3.0

Diabetes mellitus 13,667 2.2

COPD 11,458 1.9

Nephritis/nephrosis 9,130 1.5

Top 12 causes 457,800 74.3

Total 615,788 100.0

SAMRC is committed to addressing the burden of disease that impacts health

Responding to South Africa’s needs

To improve quality

of health

infrastructure in

South Africa

Number of facilities

maintained, repaired

and/or refurbished in

NHI Districts

178 facilities

maintained, repaired

and/or refurbished

in NHI Districts

197 facilities

maintained,

repaired and/or

refurbished in NHI

Districts

125 facilities

maintained,

repaired and/or

refurbished in

NHI Districts

120 facilities

maintained,

repaired and/or

refurbished in NHI

Districts

Strategic objective Performance

indicator

Estimated

performance

Medium-term targets

2016/17 2017/18 2018/19 2019/20

The NHI, Health Planning And Systems Enablement Programme aims to improve access to quality health services through the development and implementation of policies to achieve universal health coverage, health financing reform, integrated health systems planning, monitoring and evaluation, and research

NATIONAL HEALTH INSURANCE (NHI)

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ENABLING SUCCESS FACTORS

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Effective coordination, championship and stewardship with decisive priority setting

Training, skills transfer and mentoring to grow critical mass and skills to address

health needs

Collaborative partnerships including public-private and public-public ventures

Monitor and continuously improve health service delivery efficiencies

Enabling health services support and technology to deliver integrated healthcare

Robust clinical and corporate governance

Health system strengthening and resilience (absorb, adapt, transform) with distributed leadership

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WHO’s Director-General Margaret Chan “… I regard universal coverage as the single most powerful concept that public health has to offer…. It operationalizes the highest ethical principles of public health. It is a powerful social equalizer and the ultimate expression of fairness.”

Tackling Africa’s health challenges offers us the opportunity not only to improve the well-being of citizens but also to initiate a virtuous cycle in which health investments, boost economic productivity, thereby providing resources for a further investment in health systems (Sachs & Malaney, 2002)

Ubuntu are deeply rooted in local values and motivate mutual action towards a collective goal

Remarks of Dr. Margaret Chan at a WHO/World Bank ministerial-level meeting on UHC in Geneva on February 18, 2013

Sachs J & Malaney P. 2002. The economic and social burden of malaria. Nature 415(6872):680-685.

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http://www.mrc.ac.za

“Building a healthy nation through research and innovation”