Leave no one behind: Strengthening health systems for UHC and the SDGs in Africa


Health in Africa

The current improvement in health amongst people in Africa, while unprecedented, is driven by specific interventions on which activities and funding have been disproportionately focused. This progress has, as a result, not been evenly distributed, not impacted on health at the expected levels, and is not sustainable. The Region is undergoing transitions in its demography, epidemiology, economy, culture and societal makeup that are placing new expectations on health. Added to this are new / re-emerging health threats to the people of Africa whose effects are magnified due to the easing of movement across the Region. Increases in funding by governments and partners may therefore not achieve the desired impacts on overall health if there is no change in the approach to service provision.

Current policy response

The current policy environment is conducive to guide an appropriate realignment of the health systems and service delivery focus in Africa to address the current challenges. Globally, the Sustainable Development Goals (SDGs) have placed health actions at the centre of sustainable development, with direct and indirect goals and actions defined across the goals and targets. Regionally, the WHO Regional Director for Africa’s Transformation Agenda has placed emphasis on a results-driven culture, calling for an increased focus on alignment of health system strengthening e´orts, plus scaling up actions in health security, noncommunicable diseases (NCDs), neglected tropical diseases (NTDs) and other relatively under-focused priorities for a holistic approach to the health challenges of the Region. Global and regional commitments towards system strengthening and refocused service provision have been made at the African Union, TICAD and other high level decision-making fora.

Key issues

The current health system and services provision focus is not aligned to allow e´ective policy response. Many priorities are still partner-driven, with limited policy or institutional buy-in.
Verticalization of efforts is still in effect, both for health services and health system strengthening initiatives, with limited linkages within and across the work areas. ˆere is also weak emphasis on an integrated approach to the system strengthening efforts being supported, leading to duplications and, in some cases, underinvestment in critical elements needed for effective service provision.

Action framework overview

The action framework is designed as a common framework for guiding investment in health systems strengthening actions. This will lead to the required capacity for service provision to facilitate attainment of health outcomes and the SDGs. It is designed to provide a comprehensive perspective of health systems and services relevant to countries in the region, to allow then to consider priorities that will help them attain their health goals. The action framework is unique in that it:

  • Provides one framework consolidating both HSS and disease programmes interventions

  • Presents cross cutting elements for monitoring health system performance and outcomes

  • Integrates future (e.g. health security, NCDs) and current priorities (e.g. HIV, malaria)

The framework defines areas that countries need to prioritize actions at the impact, outcome, output, process and input domains. These provide the logical approach for planning and monitoring actions, with countries able to predict, and attribute trends and achievements.