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The NEPAD Health Strategy was adopted at the first African Union Conference of Health Ministers held in Tripoli in April 2003 and by the African Union in Maputo in July 2003. The health strategy is a medium-term one based on the recognition of what is required to sustainably tackle the huge burden of avoidable disease, death and disability in Africa. The health strategy recognises the broader socio-economic and political factors that are at the root of much ill health on the continent and emphasises the broad contribution of NEPAD to improving health. The strategy further identifies the specific actions that need to be undertaken by the health sector. These are elucidated in the strategy, but in summary they are to:
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Strengthen commitment, enable stewardship and harness a multi-sectoral effort
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Secure health systems and build evidence based practice
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Scale up disease control
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Reduce conditions associated with pregnancy and childbirth
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Empower people to improve their health
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Mobilise sufficient sustainable resources
Its medium-term programme is what NEPAD will advocate for and support. At the same time, NEPAD recognises that an appropriate initial programme, comprising a set of actions and projects is needed to set the path for the medium term and to lay the foundation for success. This initial programme of action is outlined in this document. It is not intended as a list from which to make selective choices, but rather as a composite set that needs to be actioned concurrently. As the strategy unfolds further elements will be added to this programme. NEPAD expects equity, in particular for the poor, displaced and marginalized, to be a central focus of every programme of action tied to its strategy.
The identification of programmes emerged through the same consultation process that the health strategy followed. Once the list of projects had been approved at the First Conference of African Health Ministers held in Tripoli in May (later adopted by the African Union in Maputo in July), NEPAD approached its partners, especially WHO Afro and regional NGOs to work with it in preparing more detailed project briefs. These briefs provide a justification for the project, set objectives and targets, present a strategy, action plan, budget and monitoring and evaluation framework, and outline the approach to co-ordination and facilitation. Although the briefs are still being refined, it is estimated that this initial programme of action will cost approximately US$2 billion a year to implement.
The question might be asked, why such a diverse range of programmes in the initial programme of action? The reason ties in with the overall health strategy. If NEPAD is serious about achieving its health vision, goals, objectives and targets, then it requires a strategy commensurate with doing so and an initial programme of action that sets it firmly on the path of success. This programme must simultaneously strengthen and scale up stewardship, health systems, disease control, community involvement and funding. The odd project or intervention will not do this; hence the broad based set of projects. This comprehensive, rather than patchy approach to developing health systems and tackling the huge burden of disease is one of the unique features of this strategy.
As core responsibility for implementation of NEPAD strategies lies with countries, (and where it requires a regional focus, with regional economic communities,) the expectation is that countries will take the lead in implementing the strategy and this initial programme of action, and incorporate these developments in into national health plans. It is also the responsibility of governments to popularise the health strategy in their countries and ensure that information about it flows within the public, NGO and private health sectors. Without countries taking ownership of NEPAD, the strategy will fail and the personal commitment of Heads of State will be a hollow one.
NEPAD recognises that programmes do not emerge organically and that facilitation is required. Thus, for each of the programmes there will be a NEPAD partner (or partners) as a lead agency responsible for co-ordinating and supporting the effort towards implementation of each programme of action on the continent. This could, according to their comparative advantage, be the African branch of a UN agency (e.g. WHO), an African institution (e.g. training, research), a regional non-governmental organisation or other partner that meets the general NEPAD criteria to be implementation partners. WHO Afro, with its capacity at its head office and its country offices is considered ideally placed to and has already provided essential technical support to the core NEPAD Health function and it is envisaged that this will continue.
NEPAD itself is not an implementation agency. Its role is to develop strategies and programmes and to facilitate, create focus and energy and to leverage, arising from its African determined and driven strategy. With countries and RECs it will take responsibility for performance against the plans. Monitoring and evaluation of progress and adjusting the strategy and actions, including proposing health development projects that are crucial for regional integration is also part of the role of the Secretariat. NEPAD will also support securing financial and other resource commitments from both African countries and development partners. NEPAD already has ongoing engagement with the G8, European Union and other international development partners and foundations. Initial donor mobilisation has been done for health and this will now be applied to the initial programme of action.
Countries can choose whether to participate in the initial programme of action. They of course may source their own funding for implementing the programme of action in their country. NEPAD plans to seek development partner funding, based on expressions of commitment from the G8 and other donor countries and from international foundations and other donor agencies. In terms of funding that NEPAD generates, it is not envisaged that such funds would go to NEPAD. Rather, they would flow to the NEPAD development partner, who would then address contracts with countries, or to the countries directly.
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