Special Joint Conference of African Ministers of Finance and Health, Tunis 4-5 July, 2012

HIGHLIGHTS

• Africa Public Health.Info launches new 2012 Health Financing and Health MDGs Scorecard at Special Conference of Finance and Health Ministers http://goo.gl/uorlz ; presents scorecard to conference with first ever Africa Multi Year Health Financing Trends Analysis. http://goo.gl/3lxwY

• Africa Public Health 15% Plus Campaign calls on Finance and Health Ministers Conferences; and African Union Heads of State Summit of July 9 – 16 in Ethiopia to place improvement of 11 year old 2001 Abuja Health Financing Commitments on next years 2013 AU Summit Agenda – underlining that Africa’s post 2015 MDGs agenda must address pro-poor preconditions for meeting development targets – through a coordinated multi sectoral policy and investment strategy.

• Welcomes outcomes of landmark Special Conference of Finance and Health Ministers hosted by African Development Bank, co-organised with Harmonisation of Health in Africa Partners, in partnership with the African Union and UN Economic Commission for Africa.

• African Finance and Health Ministers Special Conference, agrees on 10 important steps to promote Value for Money, Accountability and Sustainability in the Health Sector.

STATEMENT

African Finance and Health Ministers at their historic special joint meeting including parliamentarians, civil society, bilateral and multilateral partners held on 4th and 5th July 2012 in Tunis, Tunisia have agreed on 10 important steps to promote Value for Money, Accountability and Sustainability in the Health Sector.

These steps include:

• Intensifying dialogue and collaboration between Finance and Health Ministries and with technical and financial partners;

• Taking concrete measures in countries to enhance value for money, sustainability and accountability in the health sector for reaching the objective of universal health coverage, accelerating progress towards the Health Millennium Development Goals, and other internationally agreed development targets by 2015 and beyond;

• Effective integration of socio-economic, demographic and health factors into broader development strategies and policies;

• Effective investment in the health sector based on evidence led strategies and high impact interventions;

• Promoting equitable investment in the health sector ensuring health financing is pro-poor and benefiting disadvantaged areas; strengthening regulatory capacity and development of a strong African pharmaceutical sector as a growth and job-creating sector in Africa;

• Laying a path to Universal Health Coverage in each country, including social health insurance, and effective safety nets to protect vulnerable individuals, households and communities;

• Improved efficiency in health systems, and equitable access to skilled health workers;

• Solidifying sustainable health financing systems that build on and coordinate a diversity of sources, including predictability of external resources to ensure all have access to quality essential health services;

• Strengthen accountability mechanisms, to ensure the highest possible level of results for money spent;

And most Importantly

Increased domestic resources for health through improved revenue collection and allocation, reprioritisation where relevant, and innovative financing - including giving priority to immunisations, non-communicable diseases, AIDS, Tuberculosis and Malaria, as well as reproductive, maternal, newborn and child health.”

Welcoming the conference outcomes, Rotimi Sankore Coordinator of the Africa Public Health Alliance 15% Plus Campaign, and Secretary of the Africa Public Health Parliamentary Network congratulated the Finance and Health Ministers, the HHA partners, the AU and UNECA stating:

“High level inter governmental and development partners coordination on Health Financing policy across Africa is one of the most important preconditions for progress on health and related development goals. This milestone conference demonstrates leadership in this regard – and all of Africa looks forward to supporting necessary follow up action between partners for successful implementation of this landmark initiative to promote Value for Money, Accountability and Sustainability in the Health Sector.”

In his presentation to the joint conference of Finance and Health Ministers on the session theme of “Reaching the Poor: The Post MDG Agenda” Sankore presented both the new 2012 Health Financing and Health MDGs Scorecard; and Africa’s first Multi Year Health Financing Trends Analysis, both underlining the need for a multisectoral policy and investment strategy that targets specific issues that underpin poverty – and highlighting why 11 years on, the 2001 Abuja Commitments to allocate 15% of domestic resources to health should be improved.

Sankore said: “The gap in health investment between industrialised and developing countries is currently too wide. Average percentage allocation of budget to health in Africa region is only 9.6% - but a much higher 16.9% in Americas; 14.6% in Europe; and 14.4% in Western Pacific.

Alongside this, and more importantly, average per capita investment in the Africa region is a low $41; but a much higher regional average of $1,566 in the Americas; and $1,677 in Europe. Individually, many countries in these regions invest between $3,000 and $6,000 per capita, while many African countries invest only between $3 and $20. These figures suggest that human life has more value in other parts of the world.”

“But it is not just a case of more industrialised nations outspending less industrialised ones. Costa Rica ($449) and Cuba ($623) have similar investment per capita to Botswana ($442) and Equatorial Guinea ($612) – Africa’s highest investors in health on a per capita basis - but have more efficient outcomes - similar to or better than more industrialised countries - due to better investment in critical non-health sectors and social determinants of health including: education and retention of health workforce, higher coverage clean water, sanitation, hygiene and nutrition, more equitable distribution of health services, and preventive action on vaccines coverage.”

“The consequent difference in average life expectancy in Africa region of 54 years, compared to 76 years in Americas, 75 years in Europe and 75 years in Western Pacific, shows that this special joint conference of Finance and Health Ministers and necessary follow up action is long overdue - especially now that experts estimate that an extra year of life expectancy in countries could translate to as much as a 4% growth in GDP"

He further underlined that: “Investment in health should be the top priority of every African government. Nothing can be more important than the health of people. Without people there is no society, no economy, no markets. The evidence is clear that 11 years on - Africa needs to improve and refine the Abuja 2001 commitments on health financing if governments are to have a more positive impact on the lives of Africans, especially the poor, disadvantaged and marginalised.

Other key highlights of the presentation to the special joint Ministerial conference include:

The new 2012 Health Financing Scorecard, and first Africa Multi Year Health Financing Trends Analysis demonstrates that it is possible to meet Abuja commitments of allocation of only 15% of budgets to health sector - and yet not make sustainable impact on mortality and morbidity - if there is no sustained improvement in actual per capita investment in health. I.e. 15% of 10 is greatly different from 15% of 100; but $100 per capita is a consistent value (see attached multi year trends analysis).

% Allocation Must Be Combined With Improved Per Capita Investment (i.e. 15% Plus formula): In 9 countries allocating less than 13% of budgets to health, but investing over a $100 per capita - health outcomes are better than in 12 countries allocating 13% to 15% to health but investing less than $30 per capita. (Except Botswana at dual 17% and $442 per capita) i.e. % allocation must be combined with actual improved per capita investment to make sustainable progress.

Budgets Must Be Needs Based and Address Actual Health Burden -If budgets are not needs based (and do not combine improved per capita and %) - meeting only the Abuja commitment of allocating 15% to health - but without substantial reduction in mortality and morbidity creates illusion of progress. Between 2000 & 2009, Africa lost an estimated 8 million lives annually to MDGs 4, 5 & 6 causes – more than the population of most African countries.

External Support is important – But Domestic Investment is Key: In 19 countries including 4 that are at that are at Abuja 15% commitment level - and others close to it, or even well below it - external resources for health accounts for between 20% and 80% of total expenditure on health - indicating need for improved domestic investment for sustainable development.

More Money for Health: In 33 countries investing only between a very low $2 and $37 per capita, little or no sustainable improvement and efficiency is possible – regardless of % allocation - unless they improve per capita investment in health to at least $ 44 or higher over 5 years or more;

*(For more highlights of presentation see links below statement to PDF of full media statement & Africa Public Health Presentation to joint Ministerial Conference: )

Linking Health Financing to the Post MDG Agenda, Sankore pointed out gaps in the MDGs that must be improved in shaping a new development paradigm:

“Targets were set for MDGs, but no targets were set for preconditions to meet those targets. Most African countries are operating with only between 30% to 65% of capacity for Human Resources for Health - but no improved education and working conditions targets were set for training and retention of health workers. Only a limited amount of efficiency can be squeezed from health systems in these countries, and in some cases no efficiency at all – No one can run efficiently on one leg. We must identify the actual number of extra training institutions, and trainers required in each country, and the level of investment required over specific number of years for thee gaps to be bridged.

While brain drain is a problem, the real problem is that there is a huge human capacity gap across a range of areas including health, but there is no accompanying human resources development plan”.

Drawing attention to the continents open wound of refugees and Internally Displaced Persons he added that –

“In setting our development priorities, we must also not forget the millions of refuges and Internally displaced persons - 13 million in the Horn and East Africa alone – the forgotten of the forgotten - whom more or less constitute the continents 55th country, but with no government to cater for them.”

Sankore ended his presentation to the Ministers, and partners present by calling on the AUC, UNECA, Conference host AfDB with partner HHA agencies to join in an urgent collaboration for a working conference of leaderships of key sectors that impact on quality of life to define the African Post MDG Agenda, these sectors being:

Finance, Planning and Economic Development; Social Development; Health, with Sanitation and Hygiene; Education; Population, Civil Registration and Statistics; Youth; Women and Gender; Agriculture, Food Security and Nutrition; Water Resources; Trade, Industry and Manufacturing; Power generation.

(Statement Ends)

*DIRECT LINKS TO DOCUMENTS:

1: New 2012 Africa Health Financing Scorecard - http://goo.gl/AAjw4
2. First ever Africa Multi Year Health Financing Trends Analysis - http://goo.gl/uBTDD
3. Full Tunis Conference Outcome Declaration in English and French courtesy of hosts AfDB and organisers HHA: http://goo.gl/naO0p
4. Joint Ministerial Conference Agenda with speakers: http://goo.gl/s1uRg
5. Parliamentarians Key to Institutionalisation of Value for Money, Accountability and Sustainability in Health Sector – http://goo.gl/TCB6i
6. Africa Public Health Presentation to joint Ministerial Conference: http://goo.gl/Nfk6G
7. PDF of full media statement: http://goo.gl/aVdMD

For further information please contact

Ogechi Onuoha, Partnerships and Communications Officer

Tel: +23417601902