Dr Margaret Chan addresses Africa’s ministers of health and finance

Dr Margaret Chan
Director-General of the World Health Organization

Address at the Conference of Ministers of Finance and Health: Achieving Value for Money and Accountability for Health Outcomes
Tunis, Tunisia

4 July 2012

His Excellency Mr Jebali, Prime Minister of Tunisia, Dr Kaberuka, President of the African Development Bank, Dr William Mgimwa Minister of Finance, Tanzania, Excellencies, honourable ministers, friends, ladies and gentlemen,

This is an important meeting held at an opportune time, an urgent time. I thank the government of Tunisia for being such a gracious host.

I thank Africa’s ministers of health and finance for starting a dialogue well before this conference. We need this kind of new thinking, this kind of new approach.

Africa is making progress, sometimes stunning progress. But ways need to be found to accelerate this progress in all countries, not just a few.

You have decided to focus on improving efficiency, reducing waste, and using existing resources in more transparent and accountable ways.

You want to improve coordination, between countries and their development partners, and among the various sectors of government. As I said, this is an opportune time, an urgent time, for doing so.

In April 2001, the landmark Abuja commitment called on African nations to allocate at least 15% of their domestic budgets to health. More than a decade later, only six of the 53 African Union Member States have done so.

Even more disturbing is the fact that 11 African countries are investing a mere $5 or less per person per year in health. This is far below the amount of money needed to care for the most basic health needs.

This level of spending leaves the health system impoverished and does nothing to tackle the crippling shortage of health care workers that affects Africa most acutely.

It perpetuates some problems, with deep roots, that impede economic progress, put a brake on development, and keep poor people, and poor nations, trapped in poverty.

The decade since the Abuja commitment has been an eventful one. Our interconnected world was beset by one global crisis after another. The consequences were highly contagious and profoundly unfair, adversely affecting countries that had nothing to do with the causes.

The consequences linger. The world economy is still suffering from the shock of the 2008 financial crisis. We see no end in sight.

Money is tight, and spending is careful and cautious. Everyone wants value for money. Donors demand it. They are under intense domestic pressure, from the public and parliamentarians, to show that taxpayer’s money invested in health development is bringing results.

When belts keep getting tighter at home, and domestic health budgets are being cut, it becomes much harder to justify spending to improve health abroad.

Not all of the news is bad, not by any means. When the financial crisis hit in 2008, African economies suffered less than those in most other parts of the world and economic growth remained strong.

The banks tell us that the African continent is now on a path to sustained growth and poverty reduction. More and more African countries are being ranked as middle-income countries.

Policy-makers increasingly recognize that improved health is a prerequisite for sustainable development. They recognize that the health sector, when properly managed, is an important source of economic growth and employment.

What we must all face now is a stagnation, probably even a decline, in external funds made available for health development. This makes commitments of domestic funds for health, and their wise use, all the more important.

And that’s what this conference is all about. How can ministers of health, working in tandem with ministers of finance, speed up the progress towards better health in African in ways that anticipate a stagnation or even a decline in external financial support? The money is simply not there anymore.

In other words, how can smart planning, smart policy choices, and a frank dialogue, like this one, help African governments do more for health with resources that already exist?

How can your joint effort to identify and reduce sources of waste and inefficiency improve accountability as well as health outcomes, and ensure good value for money?

While health planning and policy choices are the responsibility of health ministers, finance ministers will need to do more to raise domestic resources for health. As set out in your documentation, a review of 22 low-income countries showed that, collectively, these countries could raise more than $1.4 billion by increasing taxes on tobacco products by 50%.

Ladies and gentlemen,

This conference has been exceptionally well-prepared. Your work is supported by background papers, discussions about practical problems and constraints within individual countries, and brainstorming meetings of ministers of health and finance to jointly analyze some deep-seated, long-standing problems.

You have been frank and fair in this dialogue, attributing some of the blame for low budgets and slow progress to both sides.

Ministers of finance continue to see health as an unproductive sector, a drain on resources instead of a gain in economic productivity and well-being. True. Ill health is a drain on resources, household resources as well as public funds. But good health is an economic asset for sustainable development.

As you have noted, health planning and budgeting have not always been based on evidence and conditioned by an analysis of country-specific constraints to service delivery.

Nor do they always comply with requirements for budget preparation and execution, as set out by ministries of finance. For their part, ministries of health have, in the past, sometimes failed to make a compelling investment case.

I can think of at least one reason why: the absence of solid data for measuring results and monitoring progress. Only a small number of African countries have reliable systems of vital registration and reliable cause-of-death statistics. Only a minority of countries routinely track how much is spent on health and what this money achieves.

When systems of vital registration are weak or non-existent, the impact of investments on health outcomes cannot be accurately tracked. This reality underscores the absolute need to strengthen fundamental health infrastructures and capacities.

Fortunately, strengthening systems for health information and accountability, that is, tracking resources and results, is an explicit objective of a growing number of health initiatives. Accountability is important to show progress, to show value for money and encourage further investment in health.

I respect your willingness to take a frank look at these problems and work together towards some solutions.

This conference benefits from some wider, well-established support as well. Prospects for better coordinated and more effective financial support are enhanced by the large number of agencies participating in the Harmonization for Health in Africa initiative.

They include the African Development Bank, the World Bank, UNICEF, UNAIDS, UNFPA, USAID, JICA, the Global Fund, UN Women, NORAD, and WHO. The Harmonization for Health in Africa initiative works regionally and, through the International Health Partnership Plus, as part of international efforts to support sound national health strategies and country compacts.

HHA also works with the Providing for Health Initiative and other health financing initiatives funded by bilateral agencies, such as DFID and the Rockefeller Foundation.

These initiatives aim to channel financial and other forms of support in ways that strengthen fundamental health infrastructures and capacities to achieve universal health coverage.

Universal health coverage is equitable and affordable. It is good for sustainable development for social justice, and it honours the right to health of all people.

Thank you.