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AfHEA OPENING ADDRESS 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 Health, 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 partners: 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 here. 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 : SLIDES 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 themselves. 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 forward. 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 conference. 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 session Merci infiniment.
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