Dr Moeti has a clearer vision for WHO Africa Region
Tefo Pheage | Friday December 9, 2016 16:02
Mmegi: You have been talking about your early days in the office. Please share with us your experience and what you hope to accomplish during your five-year term?
Moeti: During the first year as regional director, my initial programmatic priority was to bring the Ebola Virus Disease (EVD) outbreak to an end which was achieved in December 2015 in West Africa, and to strengthen the region’s preparedness and capacity for timely response to outbreaks and emergencies. We also began to restructure the regional office to effectively address the priorities of the region. Some of the other actions included an accountability and internal strengthening framework project to improve our control environment.
During my five-year term of office, I have set out to achieve five clear interrelated priorities, which are of paramount importance to health in the region. These are: improving health security; strengthening national health systems; sustaining focus on the health-related MDGs/SDGs; addressing the social determinants of health; and transforming the WHO secretariat in the African Region into a responsive and results-driven organisation.
Mmegi: Upon assuming office in January 2015, you made a commitment to ensure that WHO’s African Region becomes the primary leader in health development in sub-Saharan Africa. What does that mean exactly?
Moeti: I assumed office at a time when the complex challenges facing the organisation called for a rethinking of the way the region prioritises and approaches health development programmes and services. I embarked on the ‘Africa Health Transformation Programme 2015–2020: a vision for Universal Health Coverage (UHC)’ that seeks to strengthen capacity and reorient WHO’s work in the African Region towards a more effective, efficient and results-driven approach. Universal health coverage - ensuring that everyone, everywhere has the opportunity to live a healthy and productive life without financial hardship, is a launch pad to boost Africa’s health and economic status.
UHC emphasises people-centred quality care, prevention as well as cure. Commitment to UHC will strengthen health systems through adequate human and financial resources, leading to better health security and health for Africa’s people. Becoming the primary leader in health development in sub-Saharan Africa means using the organisation’s financial resources and expertise in more efficient, effective, accountable, open and transparent ways to meet the needs and expectations of member states and stakeholders.
Mmegi: You were appointed when the Ebola virus was ravaging Sierra Leone, Guinea and Liberia. Please share the experience with us.
Moeti: It was a rough period. But we eventually conquered with a number of factors which were critical in getting to zero cases of Ebola. These include but were not limited to high level engagement of affected countries, donors, technical agencies and communities: enhanced coordination and partnership towards reaching zero case of Ebola and lastly deployment of experts from different fields.
These collective efforts resulted into the declaration of the end of EVD in each affected country in line with the International Health Regulations signed by about 193 member states including those from the African region.
Mmegi: What practical steps can African countries take to improve their national health systems?
Moeti: A lot. Steps that African countries can take include: strengthening the leadership and governance of health sectors, with effective policies and planning and ownership of plans that gain confidence of the populations, health partners and other stakeholders. We have tools and expertise for facilitating policy and social dialogues on health, and for assuring better transparency in resources mobilisation and use for health (such as the “National Health Accounts” surveys).
Secondly, more and better spending and effective financial protection for citizens is critical. This means improving the efficiency of mobilising, allocating and spending both public and private resources for health. Countries need to ensure that poor people and those working in the informal sector benefit from pre-payment and that providers get a fair deal.
Thirdly, there is need for people-centered services and multisectoral action. It is important to improve the quality of health services and the safety of patients and health workers and build partnerships with civil society, non-state providers and communities at large to expand access to key services and interventions.
There is also a need to target the poor and marginalised and no one should be left behind. Target vulnerable populations and design programmes tailored to their needs and scale-up pro-poor interventions such as demand-side incentives, including vouchers and conditional cash-transfers.
Fourthly, they need to strengthen health security like improving national preparedness plans including organisational structure of the government and promote adherence to the International Health Regulations (IHR).
There is also a need to establish platforms and processes to foster societal dialogue and enhance effective mechanisms for inter-sectoral dialogue and action. Strengthen national institutions and organisations to lead implementation of reforms for UHC.
Mmegi: HIV/AIDS and malaria continue to be key health issues in Africa. The continent has 11% of the world’s population but is home to 60% of the people with HIV/AIDS. In the coming years, what will progress look like on these fronts?
Moeti: We have made significant progress by reducing deaths due to malaria by 66% in the last 15 years, while deaths due to HIV/AIDS have declined by almost a half in the last 10 years. This has been largely due to the greater political commitment, stronger global partnership, increased financing, increased coverage with effective interventions and the meaningful engagement of the people affected by the diseases. Moving forward, we need to capitalise on the progress made so far to accelerate the response towards our collective vision of an African Region free of malaria and ending the AIDS epidemic as a public health threat in the next 15 years. The next five years will be crucial and we have to work hard if we are to achieve that vision. The targets set in the framework are to have 90% of people living with HIV knowing their HIV status; 90% of people diagnosed with HIV receiving antiretroviral therapy and 90% of people who are on treatment, achieving viral load suppression. In the case of malaria, the target is to reduce deaths due to malaria by 75% and also reduce new cases by 75% by 2025.
Mmegi: Of the 20 countries with the highest maternal mortality rates worldwide, 19 are in Africa. The region also has the highest neonatal death rate in the world. Where is Africa getting it wrong?
Moeti: Efforts are underway to tackle the high maternal and neonatal deaths in the region. It is important to note that 11 out of the 19 countries with highest maternal deaths were facing humanitarian, conflict or post conflict situations that may have caused the breakdown of health systems resulting in a dramatic rise in deaths due to complications that would be easily treatable. Although only two countries in our region reached the MDG 5 targets, some progress was made.
For instance by the end of 2015, maternal mortality fell by 45% in the region. This is as a result of reduced deaths in countries through WHO’s support and that of other partners. Specifically WHO supported the development of road maps for accelerating reduction of maternal and newborn deaths in all the countries of our region since 2005. Secondly newborn deaths dropped by 38% during the same period. In this area, WHO supported over 36 countries to build capacity for newborn care, both in facilities and the community and this work continues and HIV related maternal deaths fell from 10% in 2005 to two percent by the end of 2015.
We have supported countries to undertake reproductive, maternal, newborn, child and adolescent health programme reviews to identify the issues preventing countries from progressing as envisaged. Now we have renewed hope. After the launch of the Global Strategy for Women’s, Children’s and Adolescent’s Health in 2015, 24 countries have renewed their commitments towards ending preventable maternal, newborn and child deaths.
Mmegi: Only a handful of people living in sub-Saharan Africa, a region you come from, have access to safe drinking water. How is your office dealing with this issue, if at all?
Moeti: According to our recent data (WHO/UNCEF2015), 68% of the population in the region has access to improved drinking water sources. Indeed, this figure hides huge social inequalities and inequities, particularly between urban (87%) and rural (56%) areas. Rural populations are particularly disadvantaged, accounting for 93% of people relying on unimproved drinking water sources, including unprotected wells, springs and surface water.
Increasing access to safe drinking water is a collective responsibility of multiple stakeholders. WHO’s guidelines for Drinking-water Quality have informed national standard setting in countries.