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People to People - Symposium on Medical Education and Global Healthcare in Africa - November 2012

People to People - Symposium on Medical Education and Global Healthcare in Africa - November 2012

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Symposium on Medical Education and Global Healthcare in AfricaHosted by People to People and University of KentuckyUniversity of Kentucky Hospital27 November 2012Coordination, Cooperation and Commitment to the Health Sector David H. ShinnAdjunct Professor, Elliott School of International AffairsGeorge Washington UniversityThank you for inviting me to make remarks at this important symposium. It is a pleasureto address a diaspora organization that is contributing something constructive back to its countryof origin. I also commend the University of Kentucky for taking such an active and positive rolein this conference and its support of People to People.I am a political scientist not a medical practitioner. My approach to medical educationand global healthcare in Africa reflects the views of a former diplomat and current academicspecialist on African affairs. Let me begin with the obvious.Massive Health Care Needs in AfricaAfrican countries have massive health care needs. A few basic facts as of 2009 provided by the World Bank about Sub-Saharan Africa illustrate the point. I will also provide thecomparable figures for Ethiopia since most of you are part of the Ethiopian diaspora and helpingyour country of origin.In 2009, life expectancy at birth for Sub-Saharan Africa was 52.5 years; for Ethiopia itwas 55.7 years. The under-five mortality rate in Sub-Saharan Africa per 1,000 children was 130;for Ethiopia it was 104.The prevalence of HIV in the 15-49 age group in Sub-Saharan Africa was 5.4 percent; for Ethiopia it was about 2 percent. The incidence of TB per 100,000 people in Sub-Saharan Africawas 344 cases; for Ethiopia it was 359 cases. The total number of clinical cases of malariareported in 2009 for all of Sub-Saharan Africa was 72 million; Ethiopia accounted for 3 millionof these cases. The number of reported deaths from malaria for all of Sub-Saharan Africa was113,000; Ethiopia reported 1,100 of these deaths.The share of GDP devoted to health care in Sub-Saharan Africa averaged 6.6 percent; inEthiopia it accounted for 4.3 percent. The countries in Sub-Saharan Africa generally, includingEthiopia, have a long way to go before they can be satisfied with their health care systems.1
 
Ethiopia does better than average on a number of these indicators, but poorer on several otherseven after allowing for its large population.Health Care CoordinationThere are numerous actors trying to improve health care in Africa. They include hostgovernments, bilateral donors, international organizations, NGOs and private foundations. Thereis always room for improvement in the coordination of health care assistance from donor governments and organizations destined for developing nations.The governments of recipient nations have the primary responsibility for assuringcoordination. The resident offices of the World Health Organization and ad hoc donor groupsfrequently contribute to the coordination process but only the host government can assure thateffective coordination takes place. This is not an important role for an NGO such as People toPeople. On the other hand, if People to People identifies deficiencies in the coordination of health care, it should bring them to the attention of the host government. There will be occasionswhen its activities on the ground offer an ability to identify deficiencies that might be missed bythe host government or the donor organizations.Some of the more recent or returning donors in the health sector such as China, India,Brazil, Turkey, Chile, South Korea and Cuba have little experience with donor coordination andmay, for example, need to be encouraged by host governments to coordinate more closely withlarger and more established donors such as the European Union, World Health Organization andUnited States. The more information that is shared by donor governments and organizationsearly in the decision-making process, the easier it will be for the host government to improvehealth care delivery and assure that resources are not wasted or duplicated. It is also essential to bring foundations such as Gates, Packard, Carter, Clinton and Soros that have made significantcontributions to the health sector into this process.An organization such as People to People is well placed to encourage coordination withEthiopian diasporas in other countries and with other NGOs such as the Ethiopian NorthAmerican Health Professionals Association that is also focused on aiding the health sector.Health Care AdvocacyThere is one particular role organizations like People to People can play that shouldoccupy a much higher priority in the next several years. The national budgets of most donor governments, including the United States, are under increasing stress. There will simply be lessmoney available to support all kinds of assistance programs in the developing world. BecausePeople to People has a focus on the health sector, it is in its interest to advocate with appropriateelements of the United States government and governments in other countries where it can makeits voice heard in favor of maintaining financial support of the health care sector.2
 
There may be a tendency by governments to cut all foreign assistance sectors until thereis significant improvement in the global economy. In any event, it is not realistic to expectincreases in funding over the next several years, but good advocacy work can help in maintainingexisting funding. The first goal is to ensure that governments continue to keep health care as atop priority in their foreign aid programs.Over the past four years, the health sector has had powerful backers in the form of Secretary of State Hillary Clinton and Assistant Secretary of State for African Affairs JohnnieCarson. But both of these officials will be leaving government early in the New Year and their successors are not known. People to People can advocate after their successors are named toretain health care as a top priority and perhaps suggest ways that a focus on health care isinstitutionalized in the State Department.People to People is even better placed to advocate how finite funding resources in the USand possibly other donor countries should be utilized. For example, has the time arrived whenmore of the limited U.S. funding should shift from a heavy focus on combating HIV/AIDS,malaria and TB to more attention on influenza, neglected tropical diseases or some other healthchallenge? This is not my area of expertise, but it is a question that People to People should beasking itself and then discussing with the government of Ethiopia just as health care NGOsoperating in other countries should be doing with the governments in their countries.Other health care NGOs in Ethiopia should be asking themselves the same question,coordinate their conclusions with all health care NGOs and then raise the issue with thegovernment of Ethiopia. If there is a consensus that the current expenditure mix is not the rightone, People to People and similar organizations can be an important voice in trying to change themix even if additional financial resources from donor countries and organizations are notavailable. This message is most effective vis-à-vis donor organizations when it comes fromrecipient governments such as Ethiopia in combination with well-established NGOs such asPeople to People.The Brain DrainFinally, let me turn to the brain drain. The medical profession—doctors, nurses andtechnicians—has probably been more impacted by the brain drain than any other skill sector inAfrica. Ethiopia has lost many of its professional medical staff over the past 40 years. This isanother area where organizations like People to People could make a contribution by brainstorming and then proposing recommendations to the governments in their country of originfor slowing the outward migration of medical talent.Most of the solutions for dealing with this issue such as increasing pay and benefits for medical personnel are well known and would not add constructively to the dialogue. But theremay be some innovative and low cost ideas that have worked in some African countries but not been tried in others.3

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