The third Thanzi Programme Workshop took place in February 2023, convening health researchers and policy makers in Africa and the UK to explore how health economics research can help African Heads of State meet the commitments set-out in the African Union’s ALM Declaration initiative, to improve health financing across the continent.
Healthcare resource allocation is a challenging process, particularly for African decision makers where access to essential healthcare is under constant pressure due to disease burden, population growth and constrained health funding. While progress has been achieved in increasing health investment across Africa, the situation remains a concern – impacted further by the effects of COVID-19.
The signing of the African Leaders Meetings Declaration (ALM-Declaration) by all African Heads of State in 2019, serves as a call to action for stronger, more resilient health financing systems, which can maximise the delivery of sustainable, efficient and equitable health for all. The Declaration sets-out a number of commitments, including the establishment of regional Health Financing Hubs – overseen by the African Union agency AUDA-NEPAD – which aim to strengthen research into healthcare financing in African contexts.
The ALM Declaration recognises that these commitments cannot be realised by governments alone: there is a need for shared responsibility and stewardship across the wider spectrum of healthcare, including partnerships with private health sectors and other cross-sectoral partners. To help realise these goals, the Thanzi Programme Workshop was an opportunity to convene senior representatives from Pan-African organisations, agencies and health communities and facilitate discussion to help identify how international research communities – such as the Thanzi Programme – may best contribute to the realisation of the commitments set-out in the ALM Declaration.
Hosted by the University of York on 28 February – 2 March 2023 in partnership with the East Central & Southern Africa Health Community and AUDA-NEPAD, the workshop convened senior African Leaders from the African Union Commission, Southern African Development Community, East African Community, and the West African Health Organisation; representatives from national ministries of health and national public universities in Ghana, Malawi, Senegal and Uganda; members of the Thanzi Programme and international donors and development non-governmental organisations to set an agenda for collaborative research designed to meet the aims of the ALM Declaration.
As part of the workshop, Alex Rollinger, Sakshi Mohan, Wiktoria Tafesse, Priscilla Kandoole, Timothy Hallett and Andrew Phillips delivered presentations on research, capability building and research-policy engagement from the Thanzi Programme with the aim of guiding health resource allocation decisions in the ECSA region.
Presenters showcased examples of how health economics, health system epidemiological modelling and public finance research is being utilised in Malawi and Uganda to improve investment in health. Recent health economics research outputs have led to the development of new frameworks to support the design of the Malawi Health Benefit Package 2017-2022. Researchers have also worked closely with the Malawi Ministry of Health, Kamuzu University for Health Sciences and non-profit faith-based providers (FBPs) in Malawi to explore the role of FBPs in Malawi and develop new evidence on the utilisation of and quality of care delivered by government and faith-based service providers.
Within the pillar of epidemiology, the Thanzi la Mawa project has developed a novel health system model (a holistic representation of the Malawi health system’s processes and mechanisms), to better understand how to most effectively allocate resources to tackle public health challenges and improve population health. In future, it is hoped that this model can be used by policy makers in Malawi and in other African countries to help inform how health priorities are addressed through policy interventions.
Prof. Yoswa Mbulalina Dambisya (Director General, ECSA Health Community) greeting Prof. Charlie Jeffery (Vice-Chancellor, University of York)
Supporting the Realisation of the ALM Declaration: exploring the need for interdisciplinary research
Workshop delegates expressed interest in expanding the research agenda in both the ECSA and WAHO regions, using an interdisciplinary approach to inform resource allocation and help examine how different health financing models can be utilised. Delegates commended the efforts of the Thanzi Programme in its mission to bring research closer to policy making, and highlighted the continued need for locally-driven, innovative research and evidence to inform policy decision making with the ultimate goal of achieving Universal Health Coverage.
More research is required into how African Union member states manage the uptake of new health interventions, or scale-up the provision of existing services, as well as how investment in other sectors beyond health (e.g. road safety, agriculture, climate change, biodiversity) can have positive spill-over impacts upon the health sector. Behavioural economics is also a priority for future research, including to better understand how healthcare resource allocation actions on an individual basis and changes to governance structures can help to address ‘resource leaks’.
Supporting the Realisation of the ALM Declaration: strengthening capability in health economics
Participants engaged in productive discussions on the importance of increasing access to health economics capability and capacity strengthening opportunities across ECSA and WAHO, including how the University of York can facilitate this growth. Key platforms to support postgraduate learning were identified as the Health Economics MSc programmes led by Kamuzu University of Health Sciences, Makerere School of Public Health, Université Cheikh Anta Diop and University of Ghana, and brand new Health Economics Distance Learning MSc Scholarship for African applicants (all due to commence from 2023-24). It is hoped that regional ‘networks’ of training providers in Africa and Europe can be established in future, to enhance access to engagement and joint learning initiatives.
Plans are also underway to expand the growth of the Global Health Economics Hub’s online training provision (led by Thanzi and ECSA-HC), to feature more open access resources on health economics theory and methods for use by early-career researchers and policy-makers across the continent.
Looking to the future, Prof Aggrey Ambali Head of Science, Technology & Innovation Hub at AUDA-NEPAD) reflected on the importance of continued collaboration between regional and international health communities, to assist African Member States in realising the ALM Declaration, and support ongoing work to establish Regional Health Financing Hubs (RHFHs) in all five regions of Africa. Two major announcements were made during the workshop to support these ambitions:
- Firstly, commitment has been given to establish a regional Health Economics Community of Practice in West Africa, led by WAHO. This HE-COP will be a sister community to the already well-established East Central and Southern Africa HE-COP, and will represent a catalyst for collaboration: facilitating shared learning between academics and policy makers who can help to support the long-term health financing goals of West Africa RHFH.
- Secondly, the University of York and Thanzi Programme proposed reconvening all Workshop participants in two years time, as an opportunity to assess the progress made against the ALM-Declaration commitments and collectively revise any research priorities.
By: Stephanie Richards, April 2023