health district in africa (hha)
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District health in Africa: Progress and Prospects 25 years after the Harare Declaration. Regional conference – Dakar 21-23 October 2013TRANSCRIPT
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District health in Africa: Progress and Prospects 25 years after the Harare Declaration
Regional conference – Dakar21-23 October 2013
Ministère de la Santé et
de l’Action sociale
REPUBLIQUE DU SENEGAL
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Objectives & content of the conference
The Harare Declaration & health districts in Africa : time for an updated vision
Organising Committee
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Background
• 3-7 August 1987: WHO interregional meeting in Harare, on strategies to strengthen district health systems.
• Extension of the “Health for All” movement of Alma Ata (1978)
• Key meeting for the adoption of a strategy allowing to realize primary health care.
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Many changes in Africa since 1987
• Much greater demand for accountability and results. How to respond to new expectations?
• Session 6
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Changes in the health sector
• How to adapt the district system?• Across sessions.
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New knowledge and new platforms
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A diagnosis still valid?
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A definition
• Is this definition still satisfactory or is it misleading?
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12 points of action
• Have we implemented these 12 points of action?
• Were they right ? (or guided by a wrong assessment)
• Still relevant? • Should we add new ones?
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National policy
• Implemented… but maybe too much as a blue print? (health pyramid)
• Shortcomings:– A too rigid and administrative view.– No satisfactory answer for cities. – How to engage with private actors.
• Sessions 2, 3B & 7A
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Decentralisation
• Partial implementation, varying across countries. • New context: administrative decentralisation.• New - sharper - propositions.• Key question: decentralisation of what, to whom?• Sessions 7B & 8A
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Planning, (targeting) & information
• Done (yet, without targeting and not with an intensive use of health information system).
• Too much faith in the planning process? Who should set priorities?
• Sessions 4B and 9C
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Community participation
• Bamako Initiative, community health workers.• “Self-reliance” - still relevant?• Have we found the appropriate mechanisms? Or
contradiction in the terms?• Session 4A
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Intersectoral action
• Probably one of our weakest achievements! Very health sector–inward looking so far.
• Question: how can we do that?
• Session 3A
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District management team
• Why so few great leaders at district level?• Wrong approach or an unrealistic assumption?• What are the alternative approaches for coordination of
actors? How to steward a pluralistic health sector?
• Session 2 (keynote), 8B
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Resource mobilisation
• Bamako Initiative, a few weeks later!• A lot has been tried… with mixed results• UHC = Health for All + Protection from catastrophic
health care expenditure• Not the focus of this conference.
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Integration of vertical programs
• Worse than in 1987?
• Not taken as a theme per se. But present in the program.
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Referral hospital
• The always forgotten component!
• Keynote speaker session 11.
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Action-research
• Could one formulate more precise recommendations?
• Heavy presence of scientists at this conference!
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Equity
• Much higher on the agenda in 2013 than in 1987!• Better formulated today.• Some innovations.• How to do more?• Keynote speaker 1, session 2.
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Coordination with technical and financial partners
• Strong momentum in the early nineties… a bit lost with GHI… back with HHA and CoPs?
• New instruments: SWAp, PBF…• Session 9A + Philosophy of this conference.
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Need for an updated vision – first line services
• More flexibility at Health Centre level (expansion of the minimum package of activities).
• Return of the community health worker strategy.
• Patient-centered care.
• Session 9B, session 11 (keynote 1)
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Key objectives
1. Assess the health district strategy.2. An updated vision.3. Action points & recommendations.4. A strong and shining CoP.5. A knowledge agenda.
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A conference manifesto
There will be no Universal Health Coverage without strong local health systems: it’s
time to update the health district strategy in Africa
We look for the action points.
→ Your job!
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Thank you
• Follow us on our online platforms! (p2 program)