03 Dr Somanje H Sahara Health Systems Responses

55thth AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.2009.

WHO Regional Office for AfricaWHO Regional Office for Africa

Heath system responses and need Heath system responses and need Heath system responses and need Heath system responses and need Heath system responses and need Heath system responses and need Heath system responses and need Heath system responses and need

for changed multisectoral for changed multisectoral for changed multisectoral for changed multisectoral for changed multisectoral for changed multisectoral for changed multisectoral for changed multisectoral

approaches to improve the health of approaches to improve the health of approaches to improve the health of approaches to improve the health of approaches to improve the health of approaches to improve the health of approaches to improve the health of approaches to improve the health of

migrantsmigrantsmigrantsmigrantsmigrantsmigrantsmigrantsmigrants

55THTH AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCHAFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH

Gallagher Estate, Midrand, South AfricaGallagher Estate, Midrand, South Africa

30 November30 November-- 3 December 20093 December 2009

Dr. H. SomanjeMO/HPS/DSD/AFRO



OutlineOutline

Background

Health Systems challenges related to migration

Health system responses and expected outcomes

Needed multisectoral changes

The primary health care framework for change

Conclusion



Background

� The number of migrants in all forms is increasing in Africa

� about 2% of Africa’s population – increasing health service needs

� In 2008, there emerged a number paradigm shifting documents

� The final report of the WHO commission on Social determinants of health

� The Ouagadougou Declaration on Primary Health Care and Health Systems

� The 2008 World Health Report on Primary Health Care – Now More Than Ever

� World Health Assembly Resolution 61.17 on the Health of Migrants

� All the above documents emphasize on the enjoyment of health services as a

human right by all regardless of whether they are migrants or not

� Migrants still face a lot of challenges related to access and utilisation of health

services



HEALTH SYSTEMS CHALLENGES RELATED TO MIGRATION

� Health outcomes can be influenced by the multiple dimensions of migration� Legal status

� Employment opportunities

� Social exclusion

� Some groups of migrants experience increased health risks� Legal status, Employment opportunities, Social exclusion

� Internally displaced

� Health needs of migrants are not fully considered in the framework of the broader agenda on migration and development

� Inadequate data on migrants’ health and their access to health care to substantiate evidence-based policies

� Inadequate focus on utilisation of health services as a human right when promoting social inclusion



Health system responsesHealth system responses

All organisations, people and actions All organisations, people and actions whose primary intention is to promote, whose primary intention is to promote,

restore and maintain healthrestore and maintain health

HEALTH SYSTEMS BUILDING BLOCKS HEALTH SYSTEMS BUILDING BLOCKS AND THEIR OUTCOMESAND THEIR OUTCOMES

IMPROVED HEALTHIMPROVED HEALTH(level and equity)(level and equity)

RESPONSIVENESSRESPONSIVENESS

SOCIAL AND FINANCIAL SOCIAL AND FINANCIAL RISK PROTECTIONRISK PROTECTION

IMPROVED EFFICIENCYIMPROVED EFFICIENCY

ACCESSACCESS

COVER AGECOVER AGE

QUALITYQUALITY

SAFETYSAFETY

SYSTEM BUILDING BLOCKSSYSTEM BUILDING BLOCKS OVERALL GOALS / OUTCOMESOVERALL GOALS / OUTCOMES

The six building blocks and their The six building blocks and their priority areas priority areas

BUILDING BLOCK PRIORITY AREAS

SERVICE DELIVERY Packages, Delivery models, Infrastructure, Management, Safety & quality and Demand for care

HEALTH WORKFORCE

National workforce policies and Investment plans; Advocacy; Norms, standards and Data

INFORMATION Facility and population based information & surveillance systems; Global standards, tools

MEDICAL PRODUCTS, VACCINES & TECHNOLOGIES

Norms, standards, policies; Reliable procurement; Equitable access; Quality

FINANCING National health financing policies; Tools and data on health expenditures; Costing

LEADERSHIP/ GOVERNANCE

Health sector policies; Harmonization and alignment; Oversight and regulation



Ouagadougou Declaration Priority AreasOuagadougou Declaration Priority Areas



Needed Multisectoral Changes 1/2Needed Multisectoral Changes 1/2

•• Is there need for change?Is there need for change?

Albert EinsteinAlbert EinsteinThe problems we face today cannot be solved at the The problems we face today cannot be solved at the

same level of thinking we were at when we created same level of thinking we were at when we created themthem

Mahatma GhandiMahatma GhandiThe difference between what we are doing and what The difference between what we are doing and what

we are capable of doing would solve most of the we are capable of doing would solve most of the worlds problemsworlds problems

Stephen CoveyStephen CoveyWe cannot continue what we are currently doing and We cannot continue what we are currently doing and

expect different resultsexpect different results



Needed Multisectoral Changes 2/2Needed Multisectoral Changes 2/2

•• Critical sectors include those responsible for:Critical sectors include those responsible for:conditions of their legal status, employmentconditions of their legal status, employmenthousing, education, occupational health, housing, education, occupational health, nutrition and food security, environmental nutrition and food security, environmental conditions conditions and access to water and sanitationand access to water and sanitation

•• Adopt the primary health care framework in Adopt the primary health care framework in ensuring universal coverage, people ensuring universal coverage, people centeredness in all policies, planning, centeredness in all policies, planning, implementation and inclusive leadership implementation and inclusive leadership

•• However, partners need to be coordinated to However, partners need to be coordinated to support countries in a harmonised and aligned support countries in a harmonised and aligned mannermanner



Framework for implementing the Changes

� Adopt the primary health care framework in ensuring

• universal coverage reforms,

• people centeredness reforms

• inclusive leadership reforms

• an all government public policy



Linkages Linkages -- PHC Reforms & Ouagadougou PHC Reforms & Ouagadougou DeclarationDeclaration

Community Partic

ipation

Community Partic

ipation

Health Technologies

Health Technologies

Health Financing

Health Financing

Human Resources for H

ealth

Human Resources for H

ealth

Health Service delivery

Health Service delivery

Community ownership & participation

Community ownership & participation

Health information,

Health information,

Research for health

Research for health

Leadership and Governance

Leadership and Governance

Health information

Health information

Research for health

Research for health

Community ownership

Community ownership

Community Ownership and Participation

Community Ownership and Participation

Partnership for health development

Partnership for health development

Health Financing

Health Financing

Three ways of moving towards Three ways of moving towards universal coverageuniversal coverage



Primary care as a hub of coordination

Effective Community InvolvementEffective Community Involvement--huge cost savings huge cost savings



ConclusionConclusion

Legislation to minimise the discrimination of migrants in accessing their health and other social needs

Equitable allocation of resources during the budget sessions to all social sectors: health, agriculture, education, water, communication, energy, infrastructure development etc

Ensuring community involvement in implementation of the Primary Health Care reforms based on an all government approach

Dee Hock: ““ The problem is never to get new The problem is never to get new innovative thoughts into your mind, but how to get innovative thoughts into your mind, but how to get the old ones outthe old ones out ””



ThankThankYouYou

Health & Medicine

03 Dr Somanje H Sahara Health Systems Responses