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AfHEA Opening Speech v4


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Mr Chairman and Hon Minister of Health and Prevention of the Republic of
Senegal (Monsieur le président de la séance et Ministre de la santé et de la
prevention Medicale du Senegal)

The Hon Mr S T Varpilah, Deputy Minister of Health of the Republic of Liberia,

Hon Senator Anthony Manzo, Member of the Nigerian Senate Committee on

Honorable Ahmed Safana, Member of the Nigerian House of Representatives,

Representatives of regional and sub-regional institutions present, notably the
African Union, the West African Health Organization (WAHO) and the East,
Central and Southern Africa (ECSA) Health Community,

Representatives of the technical and financing partners

Members of the Board of Trustees, the executive and scientific committees, as
well as members of AfHEA

Dear Invited Guests, Dear Participants,

Good morning and a big welcome to the second conference of the African
Health Economics and Policy Association.

I would like to recognize the presence of the representatives of our different

      AfDB (African Development Bank)
      Bill and Melinda Gates Foundation
      CTB (Belgian technical cooperation)
      HEPNET
      IDRC of Canada
      iHEA (International Health Economics Association)
      MLI (Ministerial Leadership Initiative on Global Health)
      P4H (Providing for Health)
      Rockefeller Foundation
      UNAIDS
      UNFPA
      UNICEF
      USAID
      WHO
      World Bank

I also want to recognize the participants from academic institutions and
research organisations including the students who are present, I cannot
mention them all but I would just like to name the Health Economics Unit of
Cape Town which has played a vital role in the emergence and continued
development of AfHEA, the Centre Africain d’Etudes Superieures en Gestion (or
CESAG), which has recently reached out to AfHEA and is in fact co-sponsoring
the conference, and whose students have been among the strongest militants
for AfHEA from the start. We have participants from KEMRI (Kenya Malaria
Research Institute), Ifakara Research Institute in Tanzania, Institut de la
Recherche en Science de la Santé (IRSS) in Burkina, many universities across
Africa, and so many other institutions etc. Beyond Africa, we appreciate the
collaboration of institutions such as the LSHTM, the ITM of Antwerp, KIT of
Amsterdam, Results for Development Institute, Abt Associates, etc.

Many of you have come from long distances and every one of you has other
priorities you could have spent this week on, so we are especially grateful to all
of you for making the time and spending other resources to come to this
conference. In fact, the conference has been over-subscribed. The numbers
you see here are beyond what we initially expected and yet fewer than those
who wanted to come. That came as a pleasant surprise and obviously is a sign
of success for AfHEA but it also entailed logistic challenges that required us to
make some adjustments to the programme, and we hope that you bear with
us if there are some inconveniences, such as in the accommodation
arrangements for some of you, meal times at 2pm as well as pressure on other
hotel facilities. We are grateful to the management of Palm Beach Hotel for
their understanding and the efforts they made to accommodate the
unexpected number of participants during what is their peak tourist season
I would like to thank the Senegalese Govt and especially the Minister of Health
for their hospitality and their magnificent and constant support for holding the
conference in Senegal. We have benefited immensely from their collaboration
and assistance with numerous challenges during the preparatory phase.

Allow me to say a special welcome to Marie-Goretti Harakeye, representing
the African Union. Marie-Goretti was until very recently a member of AfHEA’s
executive committee, and a member of the constitutional committee at the
Accra conference. It is therefore with great emotion that we receive her today
as representative of a key regional institution and head of the HIV/AIDS, TB
and Malaria department of the AUC on Social Affairs. Marie-Goretti, toutes
nos felicitations, tu es la bienvenue aujourd’hui. Sache que tu es toujours
chez toi dans la famille d’AfHEA.

I also want us to keep in our minds and our prayers the participants from
Tunisia and Algeria, who registered but had to pull out of the conference at the
last minute due to events in their countries. And yesterday, while we were
waiting for most participants to arrive, I heard that it was not certain some of
the team from Cote d’Ivoire would get here, because of fighting and gun shots
in some of their neighbourhoods. That they all eventually made it to the
airport apparently with only minutes to the departure of the flight is a tribute
to the tenacity, the courage and determination of our AfHEA members
concerned to come to the conference. Ladies and Gentlemen, please join me in
congratulating the Cote d’Ivoire team for braving everything in order to be at
this conference today. Thank you for your example.

The theme of this conference is “Towards universal health coverage”. This
theme was chosen by our scientific committee and the Board in recognition of
the worldwide movement today particularly in developing countries towards
providing health care coverage for all the population, and in particular,
ensuring cover for poor and vulnerable groups that are usually unable to
achieve such coverage on their own resources. This movement includes rights-
based approaches and human capital perspectives, that are more and more
current in international debates and policy discussions. Ensuring good health
for all is good policy for a viable and long term social and economic
development. This was recognized by WHO which has been advocating since at
least the 2005 World Health Report that countries pursue health system
policies that enable each and every one to have access to health services
without financial barriers at the point of service. This culminated in the
publication towards the end of last year of the report on universal coverage,
which will be presented to the conference this afternoon.

Our conference theme therefore finds its topicality and relevance within this
global context. Africa, after all, is the continent that has the highest
percentages of out of pocket expenditure both in terms of total health
spending and in terms of the proportion of private health expenditures. In the
twenty-first century, this is no longer acceptable. In the coming period, AfHEA
would like to engage with our decision makers in Africa on this critical issue. At
this conference there are various presentations that we hope would help to
clarify many related questions: How are health systems financed in Africa?
What are the options for covering the poorest and vulnerable? How to ensure
that there is an optimal use of available resources? And so many others that
you will find in the programme.

This is part welcome address and part report to our stakeholders on our
progress since the last conference. So if you will permit me, I would like to look
briefly back on the journey we have traveled to get to this conference today.
AfHEA was launched in Accra after several years of preparation and discussion
among the prospective members about what kind of association they wanted
to set up.

This led us to set up a member-driven association who set ourselves the vision
of “better and equitable health for Africans through better policies and
efficient use of resources to improve health outcomes”.

By the way, for those who do not know this, we settled on the acronym AfHEA
partly because in several African languages from East to West and to the
North, that is how the word health is also pronounced.

Our Mission is to contribute to the promotion and strengthening of the use of
health economics and health policy analysis in achieving equitable and efficient
health systems, as well as, improved health outcomes in Africa, especially for
the most vulnerable populations.

Now I would like, with some technical help, to display graphically our key
milestones in the setting up and development of AfHEA :

We would like to invite the partners present today to take a look at our
business plan in order to see whether there are areas that fit with their mission
and goals in Africa and whether therefore we could develop some
collaboration around those areas. You have already seen our capacity to
mobilize, and the energy and commitment that is here, none of that is in any
doubt. In fact the key challenge we face now is whether we will have the
means and capacity to meet the pent-up demand for our services as clearly
demonstrated by the fact that we had to turn away more than 50 people
wanting to come to the conference, including people willing to pay for

As our business plan shows, a major area of emphasis of AfHEA’s work in
future is going to be in the area of the link between research and policy. This is
already concretely expressed at this conference through the plenary session
themes and the presence of high level decision makers at the conference and
among our plenary panelists. In addition to this, we also intend to produce
policy briefs from the key messages of the conference for dissemination and
technical assistance work with decision makers at regional, sub-regional and
national levels. I would like to thank P4H, the Rockefeller Foundation and IDRC
for their collaboration with us to produce and disseminate these policy briefs
during and after the conference. I would particularly like to mention Jean
Perrot, Mwihaki and Marie-Gloriose for their personal commitments and pro-
active roles in the last few months and weeks in helping to push this agenda

Let me briefly explain AfHEA’s conference value proposition including our
business model. We aim to put together a great scientific conference, in terms
of the quality of research presented and state of the art in innovative thinking
in African health economics, financing, policy and related fields. For this we
must charge the estimated real costs per head to AfHEA for attending the
conference, based on number of participants expected and including a
conference fee that ensures that AfHEA will continue to operate after, and be
able to prepare for the next, conference. The principle is that everyone,
whether you are executive director or member of the Board or any other
category of participant, must pay this charge whatever their source of funding,
for us to defray our costs and be able to operate till the next conference. But in
the interests of equity and our focus on supporting less advantaged African
researchers, we then work aggressively to mobilize resources from our
partners in order to:

   1. Pay for or subsidize the participation costs of priority categories for
      AfHEA, including students, African abstract authors without funding and
      conference resource persons. This subsidy includes other participant
      costs such as air fares.
   2. If possible, reduce the conference charges for everyone to make our
      proposition as attractive as we can make it without making a loss.

We also relentlessly pursue cost reduction as a mantra and we are getting
better and better at this. The charge per head for this conference is 30% lower
than for Accra due to lower overhead and accommodation costs. Hopefully this
trend will continue without adversely impacting quality. After two conferences,
we feel confident that our business model has been vindicated. For instance,
AfHEA is paying for a smaller proportion of participants at this conference than
we did for the Accra conference.

AfHEA has been built essentially on the energies and enthusiasm of its
members. In fact AfHEA is really the energies you find in this room. But energy
and enthusiasm of course is not enough. AfHEA was lucky to find partners from
the start that were willing to invest in our mission and who were impressed by
that energy and commitment. Among those partners were iHEA, WHO-AFRO,
the Gates Foundation, the Rockefeller Foundation, and indeed the Ghana
Health Service, to whom we remain grateful.

In that regard, I want to say a special welcome to Bill Swan, deputy executive
director of the International Health Economics Association (iHEA), who has
come all the way from Canada to AfHEA on what is also his first ever visit to
Africa. Bill’s presence here today signifies clearly that AfHEA belongs to a larger
family which is the world-wide. iHEA played a critical part in helping AfHEA to
get off the ground, and Bill here, and Tom Getzen the executive director, both
spent quite some time helping to mediate our relationship with some of the
key donors of the first conference. The advice they gave us at key moments
also turned out time and again to be really helpful.

The Rockefeller Foundation has proved to be a very strong and reliable partner
of AfHEA. They were the second largest contributor to our inaugural
conference, after the Gates Foundation. They continued after the conference
to support our business plan development and are again one of the major
funders of this conference. I want to especially mention the role of Mwihaki,
the RF Africa representative based in Nairobi. Mwihaki did not just relate to us
as a funder, she actually took an active interest in the technical work of AfHEA
and kept up constant communication by phone and email, checking in about
the conference preparation, discussing how to take the business plan ideas
forward and even offered to help draft a concept note for the policy related
work. Thank you very much Mwihaki.

The Gates Foundation provided AfHEA with the financial foundation to take off
and continue operating till now. Few people know that the Gates Foundation is
actually one of the major funders of this conference, it may even be a surprise
to Dan Kress but I suspect not to Bill Swan. This is because the Gates
Foundation allowed us to use the surplus funds left over from their grant to
the Accra conference to prepare the second conference. Their role however
went beyond providing funding and equally or even more importantly, they did
two other things that were very supportive: They took a lead in mobilizing
other partners to support AfHEA, and they told us upfront after the Accra
conference that anytime we needed them to stand as a reference for our bona
fides, they would do so without hesitation. You can imagine how very helpful
that was in seeking to extend our partner base.

For that matter, I want to pay a special tribute to Dan Kress because I don’t
know if I will have the opportunity to do so again, he leaves us tomorrow
evening due to other pressing matters. Dan is one of the greatest friends of
AfHEA there is. And on a more personal note, Dan Kress recruited me into Abt
Associates more than 10 years ago. The circumstances had a funny side, that
also showed how easy it is to get along with Dan. I was told that there was a
staff of Abt Associates staying at Novotel in Accra, and that I should try to meet
him, nothing really about an interview, so I went over to see him with a friend
who was a member of parliament in Ghana. We saw him in the hall of Novotel
clutching quite a bunch of papers under his arm. After the introductions and he
told me he was to interview me about my interest in joining Abt, so naturally I
turned to ask my friend if he would leave us alone for a moment, but Dan
would have none of it and so we had this hilarious time of an interview in the
lobby of the hotel. But then he saw that I kept glancing at the bunch of papers
he was clutching, and so he told me “oh yes, I know all about you already,
these are all your writings, I have been reading up on your work in preparation
for this interview”! That sounded to me like the reverse of what have should
been, perhaps I should rather have been reading up on his work! Anyway not
long after, Dan went on to the World Bank and is now deputy director of
Global Health at the Gates Foundation, and through all the years, we have kept
in touch, and I have to say that I have never yet met anyone else with a
stronger commitment to the cause of international public health and who also
has such an easy going personality.

Despite representing a major conference funder, it was really typical of him
that when he arrived for the Accra conference, and saw us very busy in the
hotel lobby, the first thing he asked me was whether there was any task I
wanted him to help with, and he kept insisting until we gave him some of our
organizational tasks. Thanks, Dan.

One area we think we have achieved relative success so far is in the expansion
of our partnership base since the first conference. The first conference had 4
funding partners. The direct funding partners of this conference now include,
in addition to those of the first conference, the IDRC of Canada, P4H, UNAIDS,
UNFPA, and the World Bank, ie another 5 new partners that have decided to
invest in AfHEA’s mission and goals. We are grateful to all of our funders, as
well as to all those, like MLI, ITM, CTB, who have sponsored many participants
directly. Since these partners are all here for the conference. I am going to
have other opportunities to thank them again before the end of the

I would like to thank Minister Varpilah, the Liberian Deputy Minister of Health,
for honoring the conference with his presence. I work on health financing
issues in Liberia in my official capacity and I know just how very busy the
deputy Minister is, given that among other stresses of his job, in Liberia the
President sets 90-day deadlines to his Ministers for the achievement of agreed
targets. We are grateful, Minister Varpilah.

I would like to ask you all to join me in giving a special welcome to the strong,
10-person Nigerian Government delegation to the AfHEA conference. I knew
that Nigeria does not do small, but this is highly impressive by any standards. I
particularly want to acknowledge the time sacrificed by the Senator and the
Hon Member of the House of Representatives because they are facing the last
couple of weeks or so before the general elections in Nigeria, so we are very
honored that you valued our conference enough to come at this particular
time. My only complaint, sirs, is that you have eclipsed our Ghanaian
delegation by this show, and that hurts me personally. (Obasanjo story)

I cannot of course end without thanking the fantastic AfHEA team and other
volunteers that brought us this conference. I will however just mention them
briefly for now because I know that I have other opportunities during the
conference to thank them more fully. I would like to thank AfHEA Board
members, led by the Chairperson, Dr Eva Pascoal, other members are here,
Prof Di, Kodjo Ezoua and Kodjo Evlo; the scientific committee led by Prof Di
McIntyre, a true pillar of AfHEA both intellectually and organisationally, and
who was assisted by John Ataguba for the last abstract administration work;
thanks Jon.

The Senegal local organising committee with Farba Lamine Sall, Ndeye
Maguette, Daouda, Aboubacry Fall, Mme Tall, and several others, thank you
for the regular meetings, the chasing of suppliers and invoices, the very hard
preparatory work. Merci a tous.

The AfHEA executives and conference planning committee including Chinwe,
Pascal (I will have more to say about Chinwe and Pascal in the next day or
two), Divine, Arthur, Marina, Djesika, Morris, Ogoamaka and Alice. Thanks a lot
Morris for the hard work.

Other volunteers who spent sleepless nights with us in the last few days trying
to deal with the challenges posed by the higher than anticipated interest in the
conference, such as Dr Manasse Kassi, Paul-Philippe Dom Dje and Enos in Togo.
I would like to thank Martine Cisse, our finance and administrative officer who
has had to cope with very late hours and a high volume of work almost from
the moment she started to work with us.

I would like to say particular thanks to my colleagues of the World Bank, esp
Amsatou and Maud who have been really super, but also Francois and Driss
who are here, and Tonia, Chris Lovelace and Hadia who are not here. They
have been very supportive. Without Amsatou’s help for example, some of your
journeys would have ended at Dakar airport. And do join me to congratulate
Amsatou who has just gotten married.

I also want to thank the World Bank team that designed and facilitated the
pre-conference workshop on measuring equity and financial protection in
health yesterday, Adam, Caryn and Daniela; as well as our CESAG partners, in
particular Koffi Amani, for a greatly appreciated free training session on equity.
That course added a lot of value to our conference this time and we are going
to explore doing more of this in future though I can’t promise they will always
be free.

I hope that I have been successful in conveying to you the picture that so far as
AfHEA has made any progress, this has been the result of team work, and a
very strong team it is. That also this has been basically a volunteer driven
organisation, though we hope to change that fast. There is just so far you can
go on volunteer effort, and we cannot sustain that indefinitely, so we are
addressing that. The volunteer phase was however crucial to harness passion
and commitment, and to reduce admin expenses to the lowest possible.

We are all working to realise AfHEA’s medium term objective of being the “go
to place” for health economics, financing and health policy issues in Africa.

I would like to end by thanking again our hosts, the Government of Senegal,
and especially the Minister of Health and Prevention, for his personal
commitment, clearly shown by his presence today as Chair of the opening

Merci infiniment.

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