The African Public Health Emergency Fund: The Way Forward (AFR/RC66/15)
The African Public Health Emergency Fund (APHEF or the Fund) was established by the Regional Committee in 2012 with the aim of providing catalytic resources for initiating timely responses to public health emergencies. Ever since, commitments have been made at every subsequent Regional Committee session to improve the functionality of this solidarity fund.
Despite all the commitments made, actual contributions to APHEF have remained very low.
Between 2012 and June 2016, only 13 countries had ever contributed to the Fund.1 Total contributions stand at US$ 3 619 438. This constitutes about 1.5% of the expected amount. Of the 13 countries that have contributed so far, Eritrea has done so three times, Rwanda twice and the rest have contributed once (Annex 2).
APHEF has contributed to the management of public health emergencies in the Region (Annex 3). The Fund has so far disbursed a total of US$ 2.73 million to support life-saving interventions in 13 countries.2 Only four of the countries that have received APHEF support have ever contributed to the Fund.3 None of the requested amounts for each of the emergencies could be fully allocated, mainly owing to inadequate funds. US$ 473 897 was the average requested amount, while the average allocation was US$ 210 257 (Annex 3). For 12 of the 13 requests received from 2014 to 2016, funds were made available within two working days as stipulated in the APHEF operations manual.
In 2016, APHEF has supported responses to the yellow fever outbreak in Angola and the El Niño crisis in Ethiopia. In 2014 and 2015, the Fund supported the provision of emergency health care to internally-displaced populations in the Central African Republic and South Sudan; refugees in Cameroon and flood victims in Burundi, Malawi and Zimbabwe. In addition, APHEF supported the responses to the outbreaks of meningococcal meningitis in Niger and Ebola in the Democratic Republic of the Congo, Guinea, Liberia and Sierra Leone. The disbursements from APHEF complement resources from other funding initiatives such as the newly established Contingency Fund for Emergencies (CFE),4 which supports WHO deployments.
Considering the crucial role of APHEF, the Sixty-fifth session of the Regional Committee reiterated the importance of strengthening its functionality. The ministers of health deliberated on possible demotivating factors that could explain the inadequate contributions. These included significant variations in the amounts of countries’ contributions and the limited involvement of the ministries of finance. The Committee adopted a report, AFR/RC65/R5, that called for the revision of the APHEF framework.
The above report requested the Secretariat to establish a multidisciplinary expert group to review the current APHEF framework and undertake an assessment to understand the reasons why countries are not making their contributions. Furthermore, it requested the Regional Director to facilitate consultations between ministers of health and finance, and other relevant sectors.
WHO convened a meeting of the multidisciplinary group of experts from the ministries of health and finance in June 2016. The key questions the experts deliberated upon included whether APHEF was needed, why it was not functioning optimally and how its functionality could be improved. The experts unanimously acknowledged the usefulness of APHEF and highlighted the critical challenges to be addressed. They reviewed the APHEF formula for contributions and made recommendations for consideration by the Regional Committee (Annex 1a). In addition, WHO conducted an assessment using a structured questionnaire filled by the countries, to understand the difficulties they face in honouring their contributions.
This paper highlights the key issues and challenges affecting the optimal functioning of APHEF. It takes into account recommendations from the multidisciplinary expert group and proposes actions for improved performance.