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2010 Reality Check: What the UK, EU and Africa must do to put the Health Related MDGs Back on

ACTION FOR GLOBAL HEALTH UK POLICY CONFERENCE . 2010 Reality Check: What the UK, EU and Africa must do to put the Health Related MDGs Back on. 28 th June 2010 LONDON, UK. Gerald Tushabe, Health & Human Rights Advisor - Action Group for Health, Human Rights and HIV/AIDS(AGHA),

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2010 Reality Check: What the UK, EU and Africa must do to put the Health Related MDGs Back on

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  1. ACTION FOR GLOBAL HEALTH UK POLICY CONFERENCE 2010 Reality Check: What the UK, EU and Africa must do to put the Health Related MDGs Back on 28th June 2010 LONDON, UK Gerald Tushabe, Health & Human Rights Advisor - Action Group for Health, Human Rights and HIV/AIDS(AGHA), Africa Regional Focal Point Officer –IFHHRO.

  2. 1. Introduction: MDGs • Euphoria of the signing of the MD has waned as reality of achieving MDGs increasingly becomes problematic • In the case of Africa, It is unlikely that they will be attained by 2015 despite verifiable improvements on some MDGs especially Infant Mortality over the last 10 yrs • In the wake of time constraints, calls to prioritize certain MDGs over others have been made.

  3. Introduction Cont’d • This may be counter-productive & must be avoided given the interconnectedness between all MDGs • There is need for a holistic approach for long term development of Africa • This paper thus focuses on health related MDGs: Challenges, Opportunities and Way forward.

  4. Health systems challenges1. Domestic Spending on health • Target: In 2001 Sub--Saharan African (SSA) countries like Uganda created the Abuja target of 15% of public spending going to health care in the country. • Yet to date, 41 SSA governments allocate less than 15% of their spending on health – for example, in 2009, Uganda allocated 8.2% (about half of the goal they committed to) of national spending on health care. The per capita expenditure on health was US $ 10.4 compared to the US $ 45 required to meet the minimum health care package. About half of this was out of pocket spending.

  5. Consequences of underfunding • SSA countries have become dependent on aid. Currently donor support as a percentage of health expenditure in SSA is at an average of 18%, going as far as 41% among some donor darlings like in Uganda; • Human Resources: high staff attrition and human resources are inequitably distributed; failure to recruit special cadres; • EMHS: Drug shortages and Stock-Outs • Infrastructure: limited staff accommodation and limited work space and equipment, etc

  6. 3. Absorption Capacity: • Funds are un utilized at the end of the FY New Vision: Ministries fail to spend sh700b- Monday, 24th May, 2010- “….the biggest chunk of unutilized money was for roads, under the works ministry and drugs under the National Medical Stores….” Mugambe said the finance ministry had asked the Health ministry to ensure that drugs reach the intended beneficiaries. He attributed the problem to poor planning by ministries and inadequate specifications of output….” • WHY? Late Disbursements? Prolonged Procurement Procedures?

  7. 4. Mismanagement of Public Resources Mismanagement of public resources and failure to promote accountability by our Governments has affected aid flow for health/HIV/AIDS programs. • In 2005, the Global Fund decided to suspend five grants worth $213 million because of mismanagement of funds. • While an estimated 300 people were accused in the mismanagement, only four so far have been successfully prosecuted • Not much effort has been made to recover money from GAVI which was mismanaged. • Currently CHOGM funds being investigated by PAC reveal instances of gross mismanagement involving the Head of State.

  8. Human Resources for Health • Staffing levels low by all standards: • WHO - Staff Ratio of 1: 1818 vs. 1: 439 • HSSP – 56% of positions filled by qualified health workers. • Significant shortage of certain categories of staff; • Gross Mal-distribution: • 70% of MOs, 80% of Pharmacists and 40% on Nurses/Midwives are based in urban areas with 12% of the Pop; • Significant variation in district staffing levels (30% to 90%); • Majority of staff are located in Central Region (over 60% of MOs);

  9. Human Resources for Health Cont’d • Problems of Skills: quality of workforce now under MoES instead of MoH • Lack of HRH strategic information and research • Mismatch between production/training and needs • Poor recruitment and deployment • Demotivation e.g. • Housing, recognition and reward • Supervision • Professional development • Absenteeism • Weak regulation

  10. Recommended Actions • Advocacy to raise attention to national budgeting processes and perhaps channeling private spending into a risk pool to avoid overspending by individuals while at the same time addressing equity in access; • Strengthen instruments of accountability in our countries such as audit and procurement procedures;

  11. Recommendations Cont’d • Promote the role of civil society organizations and Parliaments in monitoring the use of funds and promote mutual accountability between Governments and donors; • Work with the justice, law and order sector to effectively respond to criminal acts in relation to mismanagement of public resources; • There is need for additional attention to training skilled health workers and create conducive conditions to retain them in health care system.

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