SOAS University of London

Centre of African Studies

GDAI Residential School 2011: Governance and Health Systems Development in East Africa

In 2011 the Mo Ibrahim Foundation funded a second Residential School in Africa. It was held in Dar es Salaam (Tanzania), from the 18-22 July 2011, and focused on Governance and Health Systems Development in East Africa.

The long week, intensive programme was led by the School of Oriental and African Studies in partnership with the Institute of Development Studies, University of Dar es Salaam. The daily programme was put together with the support of Nouria Brikci (Senior Policy and Advocacy Adviser, Save the Children UK), Petronella Mwasandube (Health & Diversity Performance Consultant), Mike Jennings (Senior Lecturer in Development Studies, SOAS), Pat Pridmore (Reader in Education, Health and International Development, Institute of Education, University of London) and Susan Rifkin (Professor at the London School of Economics).

The residential school hosted 21 participants with a strong health management background and/or professional experiences (health executives, policy-makers, health academics and NGOs representatives), from East African countries (Burundi, Kenya, Tanzania, Rwanda, Uganda, Ethiopia, Somalia), who shared ideas and experiences on the wide issue of governance in relation to the development of health systems.

The speakers, who also co-ordinated the engaging workshops, discussed a broad range of themes, spanning from more theoretical and general overviews to specific case-studies. On the first day, Susan Rifkin gave an overview of the impact of development discourses and practices on health, over the past four decades. Then she focused on the emerging themes that will be discussed at the Conference on the Social Determinant of Health that will be held in Brazil, this autumn. In particular, she argued that “social determinants play a critical role on individual circumstances” and “in terms of health and health equity, governance is a foundation to ensure inequities reflected by all sectors can be adequately addressed”. Her presentation was followed by Pat Pridmore who looked  at the challenges of health governance in urban settings and suggested few governance strategies that can be adopted.

On the second day, Nouria Brikci and Peter Kamuzora talked about health financing. Nouria discussed in particular the importance of health financing for health governance, highlighting issues of universal coverage, participation, transparency and accountability, and responsiveness. She also talked about some of the financing mechanisms and the pros and cons of different user fees models, insurance schemes and tax financed schemes, making the case for removing user fees. Peter focused mainly on the challenges of implementing health financing policy reforms. He concludes that African governments should be able to make their own decisions on financing and implementing policies. He also argued that there is a need for increasing awareness of health financing in order to promote locally relevant and sustainable options, as well as involving different stakeholders in decision making.

The afternoon talk by Masuma Mamdani addressed the issue of access to health systems. She pointed to the importance of making an efficient use of resources in order to improve health outcomes and make access to health services universal. In analysing the Tanzania case she noted that there are still many barriers to effective access to health care by the very poor.
On Wednesday, the common thread in the talks was human resources for health. Speakers included Barbara McPake who compared data from developed and developing countries and showed how Africa suffers more than others for the “critical shortage of health service providers” and “maldistribution”. She explored possible solutions to this problem, including giving incentives. Petronella Mwasandube talked more specifically about leadership as a key to reach excellence in health, while Peter Ngatia focused mainly on task-shifting as a way to redistribute tasks from highly qualified health workers to those less qualified or experienced, as a way to face the shortages in the health workforce.

On Thursday, Mike Jennings introduced the topic of procurement and its importance as a development tool, particularly in health. He also referred to its research on the malaria bed net that he discussed in more details at the evening public talk on Tuesday 19. Roland van de Ven showed how, through the work of the EGPA, it is possible to virtually eliminate mother-to-child transmission of HIV. He introduced the district approach adopted in Tanzania as a positive example of working in partnership with local institutions, government, local organizations and communities, to build capacity at the district level. Emphasis was on financial sustainability, creating mechanisms for monitoring and mentoring, and the possibility for scaling up.

Then, Gorik Ooms talked about “Maximizing synergies between vertical funding and health systems”, while Carlos Chirinos led a practical workshop on Health, Development and the Media that provided health practitioners with an understanding of the effective use of media in raising awareness about contagious diseases and other health and hygiene topics that need to be disseminated to the general population. It also provided attendants with practical tools on how to engage with local and national media to support health awareness campaigns and hygiene practices. The presentation provided data and information on effective use of mediums including community radios, mobile phones and the Internet.

The last day was dedicated to discussing the role of community health agents (CHA). Senga Pemba argued that CHA can strengthen the health system, bridging the gap between community access to services and health workers shortages, especially in rural areas.

All sessions were broke up by workshops involving the participants and group discussions. The speakers’ PowerPoint presentations can be access on the Governance in Africa website: