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World Health Organization Beijing China by alicejenny


									      New approaches for South-South
          collaborations in health

                China-Africa Roundtable

                    Michael O’Leary, WR China
             Tim Evans, Assistant Director General, WHO

In close collaboration with Peking University, Institute for Global Health

                           December 4, 2009

                    World Health Organization, Beijing China
Outline of presentation
• The context: The Africa of the Future
• Sub-Saharan African health systems: factors that impede
• North-South health aid: important contributions but less
  effective than expected
• China’s Africa Policy: guidance for future collaborations
• Strengthening South-South collaborations: why is health
• China’s comparative advantages: development models
  and approaches that can address health problems in SSA
• Ways of working: best practices internationally to enhance

                World Health Organization, Beijing China
Africa’s population is dynamic: by 2050, 3
in 10 people will be living in Africa

            World Health Organization, Beijing China
Life expectancy in Africa will increase
from 46 to 65 years by 2050

            World Health Organization, Beijing China
Africa contains 53 countries of enormous
diversity: economically and socially…

            World Health Organization, Beijing China
World Health Organization, Beijing China
The broader development context (Sachs,

 8 million people die
   unnecessarily each year
   from being poor
 Serious governance issues in
   Africa with failed states
   difficult to turn around

 Instruments of change include not only aid
 but also good governance and security

             World Health Organization, Beijing China
Health is one of the greatest challenges to
development, with high adult mortality..

            World Health Organization, Beijing China
high levels of disability (adjusted life

             World Health Organization, Beijing China
And high rates of child mortality.

            World Health Organization, Beijing China
The disease burden is rapidly shifting
towards non-communicable diseases…

            World Health Organization, Beijing China
And the health challenges in a changing

            World Health Organization, Beijing China
Health systems face serious constraints in terms
of infrastructure, human resource shortages

              World Health Organization, Beijing China
Health spending averaging US$ 27 per
person per day (US$ 52 PPP)

           World Health Organization, Beijing China
                     Weak health
                     systems results
                     in service
                     delivery failures

                     Maternal mortality
                     ratios average 900
                     maternal deaths
                     per 100,000 live

World Health Organization, Beijing China
North-South health aid has been substantial but
does not meet financial gaps and focuses on

 Financial gap to meet MDGS for health by
   2020 estimated at US$30-50 billion p.a.
 US$ 14 billion health aid dispersed (2004-7)
    • US and Global Fund (GFATM) account
      for >50%
    • 78% of these funds are dedicated to
      MDG 6 (HIV/AIDS, TB, and malaria)

              World Health Organization, Beijing China
International health aid has not been as
effective as intended

 • Lack of attention to health delivery systems,
   institution building, infrastructure, and human
 • Financing under short-term timeframes
 • Earmarked funding for specific diseases
 • Predictability: among 30 major donors to Africa,
   71% of total commitments disbursed
 • Conditionalities tie aid dollars to specific uses.
 • Weak alignment between donor priorities and
   recipient country needs

                World Health Organization, Beijing China
     Multiple partners in health place huge
    transaction costs on Ministry of Health:
                                           the situation in D.R. Congo
   Multilateral agencies                                                                      State and Parastatal organisations
                                                Gavi                        Ministry of
                         BAD                                                                                             Fonds Social de
                                                              IMF                                  53 specialised         la République
      World bank                                                                                     programs                                                         Schools of
                                 UNFPA                                                                                                                               Public Health
                                                                                                                      11 Provincial            Faculties of
                                                                              13 MoH                                Ministries of Health        Medicine
                                                                                             11 provincial
                                                        WHO                 Departments      management
                   Global Fund                                                                                                           Ministry of
                                                                                                                       BCECO             Education

       UNICEF                    WFP                                                                           Bilateral Funding / Technical agencies

                                                                              MOH                                        BTC CTB
13 Donor Government program                                                 (15 Staff)                                               VVOB
   coordination committees                                                                                                                                    SIDA
                                                                                                               USAID                Apefe

                           ECHO                                                                                                       Salvation
                                                                                                   BASICS                                                     BDOM
                                         MSF                                   Louvain
                                        Belgium                               development                                          ECC
                                                                    Fometro           Foundation
                                       Merlin                                                         World
                                                   Cemubac                                            Vision

                                                                                                    GB                                           More than 200 health partners
    INGO's (Emergency)                                              Novib

                                                  Int and Nat NGO's (Development and church related)
                                                       World Health Organization, Beijing China
[Source: Porignon, WHO, 2008]
   Donor ear-marking of Aid for health
distorts national priorities, Rwanda 2006

           World Health Organization, Beijing China
Synergies leading to systems transformation

                World Health Organization, Beijing China
            Building on the past and present

•   Bamako Initiative
•   Structural adjustment
•   Investing in Health
•   Better Health in Africa
•   African Renaissance
•   Global Alliance on Vaccines and Immunization
•   Macro-economic Commission on Health
•   Global Fund for AIDS TB and Malaria
•   Abuja Declaration
•   Paris Declaration on AID effectiveness
•   Blair Africa Commission/Gleneagles G8
•   US Presidential Malaria Initiative
•   International Health Partnership
•   Acrra Agenda for Action.

                    World Health Organization, Beijing China
 Some international best practices
• Technical collaboration should align with
   recipient government's national health plans,
   goals, and strategies, to increase sustainability,
   reduce duplication, and improve coordination.
• Partnerships with international organizations
  can complement and create synergies with
  other activities, and meet unmet needs.

                World Health Organization, Beijing China
       China’s Africa Policy

A guideline for future collaborations

          World Health Organization, Beijing China
The 8 principles have been reaffirmed under the
China-Africa policy in 2006, which emphasized 4
principles for cooperation

 • Sincerity, friendship and equality
 • Mutual benefit, reciprocity, and common
 • Mutual support and close cooperation
 • Learning from each other and seeking
   common development

              World Health Organization, Beijing China
Technical cooperation in health under the
China-Africa policy emphasizes …

• Human resource development and education
• Applied research, and technology cooperation
  and transfer
• Civil service system building, public administrative
  reform, and training of government personnel
• Emergency response, and capacity building in
  disaster reduction and relief

               World Health Organization, Beijing China
Why should China invest more in health
in Africa?
• Health investments are in line with China’s
  own strategies for a harmonious society.
• Investments in health make good economic
  sense over the long term in promoting human
  capital and healthy workforce.
• Control of infectious diseases has global
  health implications.
• Health care is a component of social stability –
  of crucial importance to the future of Africa.

              World Health Organization, Beijing China
 China’s comparative advantages
 in South-South collaborations

• Emphasis on institutions and capacity building.
• Policy of no-conditionality, allowing strategic and
  flexible use of resources.
• Packaging grants, concessional loans, and
  commercial investments for a synergistic effect in
  promoting social welfare.
• Willingness to invest in needed infrastructure.
• Potential for China’s domestic pharmaceutical
  industry to contribute to global access to
  essential medicines.

                World Health Organization, Beijing China
China’s successful programs in health that
may inform South-South collaborations:

a)   PHC: Primary health care approach
b)   MCH: Successes in maternal and child health
c)   TB: Tuberculosis control program
d)   Health care reform plan
e)   Quality-assured essential medicines supply

               World Health Organization, Beijing China
 China, with its current health reform plan,
 continues to inform the global PHC Movement, by:

• A holistic approach to well-being, as in traditional
  Chinese medicine (patient at the center of care).
• Aiming for universal coverage, integrating
  prevention and curative care.
• Investing in professionalization of health workers.
• Recognizing 3 components of effective delivery: a 3-
  tiered health care network, rural cooperative
  medical insurance system, and preventive medicine.
• Maintaining strong emphasis on preventive
  medicine, with population mobilization for health.

                World Health Organization, Beijing China
China's success in reducing maternal
mortality may inform global programs

   Fig.1 2000~2007 maternal death rate (1/100 000) MOH CHINA

                World Health Organization, Beijing China
    Key aspects of the MCH program include:
•   Setting forth laws, regulations, and policies that protect and
    promote the health and women and children.
•   Systematic retraining of midwives (1950s-80s) to increase
    knowledge of sciences, biology and safe delivery methods
    as the basis of a professional primary level staff.
•   Making widely available and easily accessible family
    planning information, services, and methods.
•   Setting forth explicit guidelines for the management of
    women during pregnancy and post-partum.
•   Advocating facility-based childbirth, and ensuring its quality.

                    World Health Organization, Beijing China
China has made major achievements in TB
      Control between 1991 – 2005
100%                                                                                              100%

80%                                                                                               80%

60%                                                                                               60%

40%                                                                                               40%

20%                                                                                               20%

 0%                                                                                               0%
       1991   1992 1993   1994 1995   1996 1997   1998 1999 2000   2001 2002   2003 2004   2005

                              DOTS 覆盖率              治愈率            发现率
                              World Health Organization, Beijing China
  This success was the result of dedicated
  funding, strong partnerships, and adaptation of
  WHO guidelines
• Complete patient management system (free
  diagnosis, registration, and home visits).
• Incentive program: bonuses for village doctors for
  patients enrolled, and completed treatment.
• Strengthening and expanding the rural health care
  network for TB prevention and treatment at each
  level of the health system.
• Systematic upgrade of staff skills.
• Establishment of national institutions (e.g. TB Control
  Center) to strengthen management, finance, and
  operational research.
                 World Health Organization, Beijing China
    Key elements of China’s health reform plan, and
    emphasis on systems building, may be shared:

•    Adequate funds: 3 yr implementation, US$ 125 billion.
•    Strengthening 4 systems: public health, service delivery,
     medical security, drugs.
•    Emphasizing "broad coverage at low levels" – first build
     systems and institutions; then expand & ensure quality.
•    Setting out Government role to ensure access to basic
     services, medicines and public health.
•    Ensuring M & E systems to keep the plan on track,
     identify problems, and make policy adjustments.

                   World Health Organization, Beijing China
    China’s large pharmaceutical industry has great
    capacity to increase the global supply of quality
    assured generic essential medicines
•    Successful PHC, including MCH and TB programs,
     requires quality-assured essential medicines.
•    Over 400 firms in China produce active ingredients for
     the production of HIV, malaria, and TB medicines.
•    But - small scale surveys in some countries have found
     substandard quality of imported Chinese medicines.
•    The GoC has yet to implement stringent regulatory
     requirements for medicines production.
•    The inspection system does not yet guarantee quality of
     active pharmaceutical ingredients.

                   World Health Organization, Beijing China
    China could play a role in increasing access to
    quality-assured generic essential medicines, by …

•    Implementing revised GMP guidelines to strengthen
     SFDA’s medicines regulatory system in line with
     WHO/international standards.
•    Regulating product quality for exports, particularly to
     poor regions with weak regulatory capacity.
•    Providing incentives for firms to participate in WHO
     prequalification (PQ), with its explicit quality standards.
•    Expand on partnerships in the WHO Global Strategy on
     Public Health Innovation and Intellectual Property, to
     partner with Africa in research, for technology transfer in
     local production capacity, and to use TRIPS flexibilities.

                     World Health Organization, Beijing China
       China’s development approaches:
• Sustainability requires local adaptations.
• A key approach combines piloting, and
  decentralized implementation.
• Regions or health facilities serve as pilots to test
  programs or models before nationwide
• Models are then combined with central policy
  guidance, targeted financial investments, and
  decentralized implementation plans for scaling-up.

                World Health Organization, Beijing China
       China’s development approaches:
       systematic institution-building
•   Policy implementation is facilitated by developing strong
    public institutions, and investing in human resources.
•   Investments include technical training for professionals,
    building institutional capacity through fellowship
    programs, and increasing research capacity.
•   These has allowed China to draw on international
    innovations, and adapt them to the Chinese context.
•   Capacity building and communication is further
    supported through systematic twinning between health
    facilities, research institutions, and individuals.

                  World Health Organization, Beijing China
    An example of systematic institution-building:
    China’s counterpart support policy
•    Policy: to address resource imbalances between rural
     and urban areas; individuals, facilities, institutions.
•    Example:
     “Thousands of doctors supporting rural areas” project
     by MoH, SATCM, MoF.
     10,000 medical personnel from large and medium-
     sized cities sent to county and township hospitals to
     increase technical capacity and service quality.
•    Counterpart support currently done under South-South
     collaborations under educational exchanges for
     African nationals to study in China.

                   World Health Organization, Beijing China
         WHO support at country level
•   National health plan lifecycle                         African
     –   Assessment to inform development                  country
     –   Alignment of partners
     –   Assistance in implementation
     –   Analysis of progress and evaluation

•   Focused technical assistance
     –   Disease priority programs e.g. TB
     –   Emergencies/outbreaks
     –   Systems supports e.g. workforce                 National
     –   Synergies between disease programs
         and health systems                             Health Plan
•   Capacity Strengthening
     – Ministry of Health
     – Specific national programs
     – Institutes of Public Health               WHO                  China

                         World Health Organization, Beijing China
In conclusion, special thanks for the
vision and leadership of:

Professor Han Qide, Director of Institute for
  Global Health of Peking University, Vice
  Chairman of Standing Committee of
  National People’s Congress

Minister Chen Zhu, Minister of Health

Dr. Ren Minghui, Director-General of the
   Ministry of Health's Department of
   International Cooperation

             World Health Organization, Beijing China

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