Is it the end of globalisation? These questions and many more were discussed over the course of a fascinating first day, as the scholars assembled in the room agreed that they had a responsibility to help provide the answers now that banks and politicians had failed.
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He stressed the importance of understanding the difference in the challenges faced by America and the EU, and the fact that the ECB is in charge of a much more politically and socially diverse territory than the Federal Reserve. Loukas Tsoukalis agreed with this analysis, arguing that the U. He was not as optimistic about the Euro however he thinks that it can and must be saved, because the cost of failure is too high.
More than anything Tsoukalis spoke of his conviction that this is the end of an era, for the balance of power is now tilted eastwards. The political commentator William Pfaff made some interesting, and equally pessimistic observations: he does not think this crisis is simply a discrete moment in the history of Western civilization, rather it is a deeper malaise that is settling in without any real steps being taken to prevent it. It was interesting to see that both men, Tsoukalis and Pfaff, thought the grass was greener on the other side of the Atlantic, and this was the tone generally struck throughout the first session.
Some interesting points also emerged out of the ensuing discussion — namely that Germany is not blameless in this situation, for it was German channelling of cheap money into Spain that sparked the debt crisis there. Another point made was the fact that not all of Europe has suffered to the same extent, it is mainly the pension states such as Italy and Greece that have had the worst time, as opposed to the social welfare-based Scandinavian countries. It was a session that apportioned blame and identified problems, setting the stage for the rest of the day.
Each of these partners constituted a space for dialogue, and in each of those spaces there was a place for further dialogues. In each place there was a certain issue at stake, for example how to mobilise active community participation; how to mobilise funding for actions to deal with the EVD; how to mobilise experienced human resources for health to complement the national health workforce; how to mobilise national and international logistical resources, including security forces, to help contain the spread of Ebola and mount an effective response; how to construct the treatment centres; how to dispose of human and material waste contaminated with the Ebola virus; how to coordinate partner support; how to document best practices and response in each country; how to plan and mobilise resources for recovery of the health systems and building of resilient national health systems, etc.
When it was established in , WHO was the only global health organisation. The same was the case for the WHO Regional Office for Africa, which was the only regional health player when it was created in Today, there are many others in the global and regional health development arenas with overlapping roles and responsibilities [ 39 ].
This implies that there is urgent need for proactive and inclusive policy dialogue in every health development space and place between the WHO Regional Office for Africa and various health development partners and stakeholders to coherently and efficiently frame public health issues, get the issues on the policy agenda, and draft, approve and implement regional health policies and strategies and assess their impact [ 40 — 43 ].
A place could be viewed as a location created by the human cultural, social, economic and political experiences [ 44 — 48 ]. Providing leadership on matters critical to health and engaging in partnerships where joint action is needed;. Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;. Setting norms and standards and promoting and monitoring their implementation;. Providing technical support, catalysing change and building institutional capacity; and.
For WHO dialogue in any space or place to be worthwhile, it ought to contribute in creating an enabling environment for enhanced performance of one or more of its core functions and ultimately to enabling more people to maintain or improve their health. The work of the organisation is carried out by WHA, the Executive Board, and the Secretariat, comprising the Director-General, six regional directors and technical and administrative staff [ 51 ].
The work of WHA is supported by the Executive Board, consisting of 34 persons designated by as many Members, which meets twice in a year. Two of its nine functions are to give effect to the decisions and policies of WHA and to prepare its agenda. Each of the six WHO regions has a regional committee and a regional office. Three of its seven functions are to formulate policies governing matters of an exclusively regional character, supervise the activities of the regional office and cooperate with the respective regional committees of the United Nations and those of other specialised agencies and with other regional and international organisations that have interest in common with the organisation [ 51 ].
The RC convenes once per year, and at each session it decides on the time and place of its next session. The meetings are usually public [ 53 ]. The decisions of the RC are passed by a majority of the representatives present, who normally vote by a show of hands, except in the election of the Regional Director, which is by secret ballot.
African delegations at WHA and the Executive Board have a vital role to influence the direction of global health policy and agenda and to ensure regional public health concerns are mainstreamed in these items. Having an African Region position presents a common voice and has increased the influence of African delegates in orientating the direction of the global health agenda. Between and , 11 RC sessions were held that adopted a total of 59 public health resolutions [ 56 , 57 ].
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Eight resolutions aimed at accelerating the response to the determinants of health were on food safety and health; reduction of the harmful use of alcohol; healthy ageing; public health adaptation to climate change; poverty, trade and health; disaster risk management; and health promotion. The RC also adopted four important political public health declarations and their implementation frameworks geared at garnering intersectoral action on primary health care and health systems [ 58 ], research for health [ 59 ], non-communicable disease prevention and control [ 60 ], and health and environment [ 61 ].
In our view, even though the spaces of the WHO governing bodies are closed, i. After successfully presiding over the political emancipation of all the African countries from colonial rule, the OAU was considered to have served its mandate, and in the OAU heads of state and government saw the need to transition it to an African union to address contemporary development challenges [ 62 , 63 ]. The AU headquarters is in Addis Ababa. These are peace and security, gender equality, protection of human rights, and sanctity of human life [ 64 ].
The shared principles and objective provide a space for health development dialogues between AU and WHO. The Assembly is composed of the heads of state and government and it meets at least once a year in ordinary session. Its decisions are normally made through consensus. The Executive Council is composed of the ministers of foreign affairs or other ministers designated by governments of member states, and it meets twice a year.
Some of its functions are coordinating and taking decisions on policies related to education, culture, health, human resources development, food, agricultural and animal resources, and social security. The Commission is the AU Secretariat. Some of its functions include initiating proposals for consideration by AU organs and implementing their decisions, drafting AU common positions, harmonising AU policies and programmes with those of RECs, and supporting member states in implementing AU programmes [ 65 ].
In our view the spaces of the Assembly, the Executive Council and the Commission are the most pertinent for WHO health development dialogues. We will make reference to three such examples. First, the First African Ministers of Health Meeting convened jointly by WHO and the AU Commission in Luanda, Angola, 14—17 April culminated in the adoption of the Luanda Declaration and eight commitments on 1 universal health coverage in Africa; 2 definition of milestones for the establishment of the African Medicines Agency; 3 policies and strategies to address the risk factors for non-communicable diseases in Africa; 4 ending of preventable maternal and child deaths in Africa; 5 establishment of an African Centres for Disease Control and Prevention; 6 development of an accountability mechanism to assess the implementation of commitments; and 7 drawing up of the terms of reference for the conduct of the AU Commission—WHO biennial meeting of African ministers of health [ 67 ].
The road map was subsequently adopted by all the health ministers of the AU in and endorsed by the key partners in the Region. Between and the maternal mortality ratio decreased from to , the infant mortality rate from 94 to 60, and the under-five mortality rate from to Some people may attribute part of these declines to the effects of policy dialogues in various leadership spaces and places. The Assembly expressed appreciation for the establishment of APHEF by the WHO Regional Office for Africa to address the high occurrence of disease outbreaks, natural and human-made disasters and other public health emergencies in Africa.
The AU political space and place are critically important for high level dialogues with African heads of state and government on the need to increase domestic investments in improving the performance of national health systems, NHRS and systems for tackling the social determinants of health. To ensure that the dialogue stays on course, there may be need for the AU and the WHO Regional Office for Africa to institutionalise regular meetings for reviewing the implementation of a joint plan of action. Additional file 1 shows the dates of establishment, member states, headquarters, governing principles, aims, objectives, functions and governing organs of the RECs [ 76 — 79 ].
The four RECs were established between and The RECs share some common principles, including sovereign equality, solidarity, human rights, the rule of law, peace and security, and equitable and just distribution of the costs and benefits of economic cooperation and integration. The aim of each REC seems to be to widen and deepen cooperation and integration leading to the establishment of an economic union including a customs union, a common market and a monetary union and eventually a political federation, in order to promote sustainable and equitable social and economic growth to ensure poverty alleviation and to raise the standard of living and the quality of life.
Each REC has two main governing organs. The work of each REC is supported by a secretariat.
Interreligious and intercultural education for dialogue, peace and social cohesion
Even though the four RECs were established at different times and have headquarters in different locations, they have fairly common guiding principles, aims, functions and governance structures. Regional economic integration may have some positive effects for health development. First, removal or reduction of barriers to trade and investment such as tariffs and regulations catapults the movement of goods and services, including health-related commodities, increases economic growth and results in cheaper prices for consumers.
Second, integration paves the way for harmonisation of the regulatory procedures and authorities for drugs, which will help combat cross-border trafficking of spurious, falsely-labelled, falsified and counterfeit medicines [ 80 ]. Third, regional economic integration expands the market for medicines and medical devices, contributing to the economic feasibility of their production in the Region [ 81 ].
Fourth, job opportunities expand with the removal of restrictions on the movement of people, which may help ameliorate shortages in the health workforce in some countries. Fifth, RECs provide space and place for consensus and cooperation for amicable and peaceful resolution of disputes between member countries, contributing to both the regional physical and health security. Economic integration might have negative effects as well [ 82 ]. Second, since salaries are not harmonised across member states, health workforce emigration to countries with better remuneration and conditions of work might occur, exacerbating existing human development inequities.
Third, the lifting of barriers to trade might see industries abruptly relocating to states with lower labour costs, leading to sudden reductions in employment opportunities in loosing countries and a rise in the prevalence of mental health problems.
Fourth, regional integration might lead to the loss of national political and economic sovereignty. Also, economic mismanagement in one member state could have devastating effects on both the economic and social including health system performance of other member states, as witnessed recently in the European Union. The objective of the WAHO shall be the attainment of the highest possible standard and protection of health of the peoples in the sub-region through the harmonisation of the policies of the Member States, pooling of resources, and cooperation with one another and with others for a collective and strategic combat against the health problems of the sub-region [ 83 ] Article III, Paragraph I.
Even though the RECs control significant amounts of resources and sub-regional convening capabilities, we are of the view that WHO is yet to optimise their use to advocate for cross-border public health security action or for increased investment in systems that combat diseases and tackle the social determinants of health. For WHO to fully leverage those spaces and places there is need to develop or update any existing memorandums of understanding with the RECs. Institutionalised virtual quarterly meetings between the WHO Regional Office for Africa and each REC may enhance the quality of the social space and the results of dialogues.
HHA was established in It is a regional mechanism to coordinate the support of the bilateral and multilateral agencies to countries in strengthening health systems in line with the principles of the Paris Declaration on Aid Effectiveness [ 84 ] and the Accra Agenda for Action [ 85 ]. Past dialogues within the HHA space and place have yielded results. For example, HHA convened a high level dialogue of the ministers of health and ministers of finance in Tunis in that resulted in the adoption of the Tunis Declaration on Value for Money, Sustainability and Accountability.
The capacity to dialogue of the ministries of health, ministers of finance and parliamentarians, as well as other stakeholders continues to be strengthened through various HHA forums and capacity-building workshops. In addition, HHA has been providing coordinated support to countries in conducting health sector reviews and developing or updating national health policies and health sector strategic plans. There is need for an independent evaluation of HHA to ascertain the extent to which it has achieved its goal and objectives and to provide guidance on how to boost its performance, if it is worth maintaining.
Its functions are to 1 initiate measures for facilitating action for social and economic development; 2 conduct studies on economic and technological problems and developments and disseminate the results; 3 undertake the collection, evaluation and dissemination of economic, technological and statistical information; 4 provide advisory services to countries, but avoiding overlaps with services rendered by other United Nations bodies or specialised agencies; 5 assist in the formulation and development of coordinated policies as a basis for practical action in promoting economic and technological development; and 6 deal with the social aspects of economic development and the inter-relationship of economic and social factors [ 91 ].
Health development is under the division of social development policy. This UNECA-AU political space is vital for the WHO Regional Office for Africa to dialogue with the ministers responsible for national planning, budgeting and disbursement of sectoral resources so that they sustainably invest more domestic resources in national health systems, NHRS and other systems that address the broader determinants of health.
By end of fewer than 10 countries had met the Abuja target, which implies the need for intense and sustained dialogue within the space and place of the AU and UNECA annual meetings of ministers [ 2 ]. For instance, in the Fifty-sixth session of the RC was held there. It culminated in the adoption of eight public health resolutions on the immunisation strategy [ 93 ]; child survival [ 94 ]; HIV prevention [ 95 ]; poverty, trade and health [ 96 ], and health financing [ 97 ]; revitalising health services using the primary health care approach [ 98 ]; avian influenza [ 99 ]; and knowledge management [ ].
In the same year, the International Conference on Community Health in the African Region was convened, bringing together many health development partners, including the ministers of health and representatives of Member States, NGOs, civil societies and bilateral and multilateral agencies. The Sixty-sixth session of the RC is scheduled to take place in the same conference centre in Given the important role of UNECA as a regional arm of the United Nations and a convenor of the joint annual meetings of the ministers of finance, planning and economic development, it was only logical for the WHO Regional Office for Africa to propose the drawing up of an MOU to leverage that space and place for health development dialogues.
The areas of cooperation include definition and implementation of policies, strategies and plans of action for the development of health, including primary health care; preparation of project proposals for mobilising funds for implementing joint projects; exchange of information on social and economic conditions; and coordination of UNECA and WHO technical cooperation activities in health among African countries.
To ensure sustained health development dialogue, there is need for WHO to proactively dialogue with UNECA and AU to include a public health including health systems and social determinants of health item on the agenda at every annual ministerial meeting. Furthermore, to sustain the dialogue, it might be helpful to schedule regular virtual meetings between the leadership of the two organisations to follow up on the implementation of joint activities. The AfDB Group was established through an agreement initially signed by 23 states on 14 August in Khartoum that became effective on 10 September The objective of the AfDB Group is to contribute to poverty reduction by spurring sustainable economic development and social progress in its member countries.
It achieves this through performance of its core functions of mobilising and allocating resources for investment in the countries and providing policy advice and technical assistance to support development efforts. The bank invests heavily in infrastructure development, including providing loans for construction of health facilities.
The MOU aimed to provide assistance in health and related fields for the improvement of health conditions and for raising the standard of health in African member countries. Some of the areas of cooperation include 1 identification, preparation, appraisal, implementation and post-evaluation of development projects and programmes sponsored by the bank or the fund in health and health-related fields; 2 financing of projects and programmes related to health and health related fields; 3 planning, organisation and implementation of health-related projects sponsored by the AfDB Group in which WHO provides technical assistance; 4 assessment of the impact on health of various AfDB projects; 5 undertaking of research in the health sector by the regional member countries; 6 dialogue with the African member countries to assist them in health planning and formulation of health policies and strategies; 7 orientation and training of professional and technical personnel of the bank; and 8 exchange of experiences, relevant documents, data and other health information [ ].
In a specific agreement was signed between the Special Health Fund for Africa and AfDB concerning the administration and management of the financial resources of the fund [ ]. The MOU provides a potentially important economic space for health development cooperation and dialogues for the benefit of regional member countries. There is need to put the AfDB space into optimal use for health development dialogues with a view to stimulating further and broader investments from AfDB for health and strengthening infrastructure for health-related systems.
These three have claimed or created organic spaces in which like-minded professionals come together to share, debate and discuss pertinent issues from their experiences, research methodology developments and issues of common interest [ 15 ]. AFHEA serves as a platform for promoting the discipline and practice of health economics and policy, sharing and exchanging of health economics and policy research, and promoting the use of health economics and policy evidence in planning, policy development and decision-making [ ].
The federation is increasingly becoming an important platform for networking among national public health associations and sharing of public health knowledge and information in the African Region. Its vision is to transform societies, communities and households in Africa through provision of the highest attainable standard of sexual reproductive health care and rights SRHR for women in Africa throughout their lifespan. Its strategic objectives are to 1 strengthen organisational operations, policies, legislature, and research environment for SRHR; 2 strengthen health systems and universal access to SRHR; and 3 catalyse the adoption of high impact partnership models for SRHR [ ].
The same year the first AFOG conference was held in Addis Ababa with representatives from 67 countries from around the world [ ]. Its membership could include all regional health development non-state actors whose voice is currently not aired in the dialogue space and place of WHO governing bodies. Once established, ARHF will provide space to which representatives of non-state actors such as NGOs, civil society organisations, community-based organisations, private health care provider associations, pharmaceutical companies, and funders will be invited to debate and discuss policies and strategies for improving the performance of the national health systems, NHRS and the systems for tackling the social determinants of health.
Since it is the WHO Regional Office for Africa that will have created the ARHF space, there is a risk that it might have disproportionate power over the forum than would non-state actors. There will be need for institutionalising safeguards to ensure a level playing field that will obscure the inequalities in resources and power yielded by international NGOs, multinational corporations and multilateral institutions.
Efficient operation of multiple dialogues may require establishment of a well-resourced human resources, finances, ICT connectivity Cluster on Partnerships. The envisaged ARHF is meant to provide space for non-state actors to review policies, strategies and priorities before they are adopted by the RC. Third, currently WHO competes with some of the partner organizations for exra-budgetary resources from the same group of donors. This competition for scarce donor resources may hamper development of healthy cooperation and dialogue between WHO and such health development partners.
Fourth, the absence of clear division of roles and responsibilities between WHO and some of the partners mentioned in this paper engenders competition in supporting Member States health development endeavours. Attempts to dialogue will continue to be hindered until such a time that the division of roles and responsibilities of different health development actors is discussed and agreed upon.
Probably, the definition of roles and responsibilities may constitute the main agenda item for the first meeting of the envisaged ARHF for non-state actors. Fifth, given that AU and RECs do convene dialogues of their Heads of State, Ministers of Health and other health-related government ministers, they may not see concrete benefits of engaging in intense dialogues with WHO.
However, the existent of memorandums of understanding between WHO and some of the health development actors might indicate that they already perceive benefits of the collaboration. For example, WHO from time to time supports the African Union Commission in developing their health strategies and writing technical progress reports for health-related decisions of the AU Heads of State and Government. Therefore, to some of the partners WHO Regional Office for Africa may not have the moral authority to convene and lead the multiple dialogues alluded to.
Cognizant of this negative perception the current leadership at the WHO Regional Office for Africa has developed a transformation agenda aimed at fast tracking implementation of WHO managerial reforms in the region to redress the perceived weaknesses and restore credibility [ ]. We believe that those resources are critically needed by countries in the African Region to overcome the multiple challenges related to political leadership and governance, weak local and national health systems, sub-optimal systems for addressing the socioeconomic determinants of health, and weak national health research systems.
A regional health development barometer or scorecard could be developed and agreed upon at the RC, and subsequently country performance could be estimated using available data [ ].
The results from the barometer could constitute the basis for peer review at RC sessions. However, there is need to jointly revisit them to see whether they need updating, to agree on a few joint activities for each year if that is not already defined in the existing MOUs, and to institutionalise regular leadership meetings to track the implementation of declarations and resolutions and to exchange notes. As the WHO Regional Office for Africa Secretariat prepares for and embarks on health development policy dialogues in various spaces and places, it is important to bear in mind the determinants of a successful dialogue identified by Rajan et al.
We owe profound gratitude to Jehovah Jireh for sustenance during the entire process of writing this paper. The article contains the perceptions and views of the authors only and does not represent the decisions or stated policies of the World Health Organization. All the authors contributed equally in the review of the literature and writing up of this debate paper.
They all read and approved the final manuscript. Volume 16 Supplement 4 Health policy dialogue: lessons from Africa. Debate Open Access. Discussion To realise SDG 3 on ensuring healthy lives and promoting well-being for all at all ages, the African Region needs to tackle the persistent weaknesses in its health systems, systems that address the social determinants of health and national health research systems. Health policy dialogue Space and place Governing bodies Health development. The annual population growth rate is 2.
Data for [ 2 ] paint a bleak picture for the Region. The Region had 67 cellular phone subscribers per population, compared with 92 globally. Between and the African Region saw tremendous improvement in health indicators. In spite of all this progress, neonatal, infant, under-five and adult mortality rates in the Region were still relatively higher than the global averages of 20, 34, 46 and , respectively [ 2 ]. The progress realised in the health indicators could be attributed to the public health development momentum generated by the MDG declaration [ 3 ]. First, the ultimate objective of any WHO work is to contribute to the attainment by all peoples of the highest possible level of health [ 49 ].
Second, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Third, enjoyment of the highest attainable standard of health is a fundamental right of every human being without distinction of race, religion, political leaning, belief, or economic or social condition [ 50 ]. WHO aims to achieve its objectives through the performance of 22 functions [ 51 ], which have been summarised under 6 core functions [ 52 ]: Providing leadership on matters critical to health and engaging in partnerships where joint action is needed; Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; Setting norms and standards and promoting and monitoring their implementation; Articulating ethical and evidence-based policy options; Providing technical support, catalysing change and building institutional capacity; and Monitoring the health situation and assessing health trends.
One of the 13 functions of WHA is to determine the policies of the organisation see Article WHA has the authority to adopt, with a two-thirds vote, decisions, resolutions, conventions or agreements with respect to any matter within the competence of the organisation. According to Article 18 h , WHA can: … invite any organisation, international or national, governmental or non-governmental, which has responsibilities related to those of the organisation, to appoint representatives to participate, without right of vote, in its meetings or in those of the committees and conferences convened under its authority, on conditions prescribed by the Health Assembly; but in the case of national organisations, invitations shall be issued only with the consent of the Government concerned [ 51 ], p.
The objective of the agreement is to strengthen cooperation between the Commission and WHO: … in all matters arising in the field of health that are connected with the activities and commitments of the two organisations, including promoting and improving health, reducing avoidable mortality and disability, preventing disease, countering potential threats to health, making contributions towards ensuring a high level of health protection and placing health at the core of the international development agenda in the fight against poverty, the protection of the environment, the promotion of social development, and the raising of living and working conditions Article II.
Mind & Life Dialogues
There are a number of important attributes shared between WHO and the RECs that provide a strong foundation for fruitful regional health development dialogues. Second, the principles that are shared between WHO and the RECs, those of human rights, peace and security, equity, and solidarity are manifested through universal access to health enhancing services.
Third, in the treaties of the four RECs, it is clear that the ultimate goals of economic integration are to ensure poverty alleviation, raise the standard of living and improve the quality of life. The ECOWAS protocol describes the West African Health Organisation WAHO , its specialised agency, mission as follows: The objective of the WAHO shall be the attainment of the highest possible standard and protection of health of the peoples in the sub-region through the harmonisation of the policies of the Member States, pooling of resources, and cooperation with one another and with others for a collective and strategic combat against the health problems of the sub-region [ 83 ] Article III, Paragraph I.
Acknowledgements We owe profound gratitude to Jehovah Jireh for sustenance during the entire process of writing this paper. Availability of data and materials Not applicable. Competing interests The authors declare that they have no competing interests. Consent for publication Not applicable. References UN. Google Scholar WHO. World health statistics Geneva: WHO; Progress on health-related Millennium Development Goals and the post health development agenda.
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J Afr Law. A moral economy of corruption in Africa?
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