1. WHO Regional Office for Africa
Heath system responses and need
for changed multisectoral
approaches to improve the health of
migrants
5TH AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH
Gallagher Estate, Midrand, South Africa
30 November- 3 December 2009
Dr. H. Somanje
MO/HPS/DSD/AFRO
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

2. Outline
WHO Regional Office for Africa
Background
Health Systems challenges related to migration
Health system responses and expected outcomes
Needed multisectoral changes
The primary health care framework for change
Conclusion
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

3. Background
WHO Regional Office for Africa
The number of migrants in all forms is increasing in Africa
about 2% of Africa’s population – increasing health service needs
In 2008, there emerged a number paradigm shifting documents
The final report of the WHO commission on Social determinants of health
The Ouagadougou Declaration on Primary Health Care and Health Systems
The 2008 World Health Report on Primary Health Care – Now More Than Ever
World Health Assembly Resolution 61.17 on the Health of Migrants
All the above documents emphasize on the enjoyment of health services as a
human right by all regardless of whether they are migrants or not
Migrants still face a lot of challenges related to access and utilisation of health
services
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

4. HEALTH SYSTEMS CHALLENGES RELATED TO MIGRATION
WHO Regional Office for Africa
Health outcomes can be influenced by the multiple dimensions
of migration
Legal status
Employment opportunities
Social exclusion
Some groups of migrants experience increased health risks
Legal status, Employment opportunities, Social exclusion
Internally displaced
Health needs of migrants are not fully considered in the
framework of the broader agenda on migration and development
Inadequate data on migrants’ health and their access to health
care to substantiate evidence-based policies
Inadequate focus on utilisation of health services as a human
right when promoting social inclusion
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

5. Health system responses
WHO Regional Office for Africa
All organisations, people and actions
whose primary intention is to promote,
restore and maintain health
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

6. HEALTH SYSTEMS BUILDING BLOCKS
AND THEIR OUTCOMES
SYSTEM BUILDING BLOCKS OVERALL GOALS / OUTCOMES
IMPROVED HEALTH
ACCESS (level and equity)
COVER AGE
RESPONSIVENESS
SOCIAL AND FINANCIAL
RISK PROTECTION
QUALITY
SAFETY IMPROVED EFFICIENCY

7. The six building blocks and their
priority areas
BUILDING BLOCK PRIORITY AREAS
SERVICE DELIVERY Packages, Delivery models, Infrastructure,
Management, Safety & quality and Demand for
care
HEALTH National workforce policies and Investment
WORKFORCE plans; Advocacy; Norms, standards and Data
INFORMATION Facility and population based information &
surveillance systems; Global standards, tools
MEDICAL Norms, standards, policies; Reliable
PRODUCTS, procurement; Equitable access; Quality
VACCINES &
TECHNOLOGIES
FINANCING National health financing policies; Tools and data
on health expenditures; Costing
LEADERSHIP/ Health sector policies; Harmonization and
GOVERNANCE alignment; Oversight and regulation

8. Ouagadougou Declaration Priority Areas
WHO Regional Office for Africa
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

9. Needed Multisectoral Changes 1/2
WHO Regional Office for Africa
• Is there need for change?
Albert Einstein
The problems we face today cannot be solved at the
same level of thinking we were at when we created
them
Mahatma Ghandi
The difference between what we are doing and what
we are capable of doing would solve most of the
worlds problems
Stephen Covey
We cannot continue what we are currently doing and
expect different results
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

10. Needed Multisectoral Changes 2/2
WHO Regional Office for Africa
• Critical sectors include those responsible for:
conditions of their legal status, employment
housing, education, occupational health,
nutrition and food security, environmental
conditions and access to water and sanitation
• Adopt the primary health care framework in
ensuring universal coverage, people
centeredness in all policies, planning,
implementation and inclusive leadership
• However, partners need to be coordinated to
support countries in a harmonised and aligned
manner
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

11. Framework for implementing the Changes
WHO Regional Office for Africa
Adopt the primary health care
framework in ensuring
• universal coverage reforms,
• people centeredness
reforms
• inclusive leadership
reforms
• an all government public
policy
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

12. Linkages - PHC Reforms & Ouagadougou
Declaration
WHO Regional Office for Africa
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tio
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om ea alth urc for ation, icipat
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n
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d P lopm
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un for atio nanc n ity ip fo Fin
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ow heal n m
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ip
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

13. Three ways of moving towards
universal coverage

14. Primary care as a hub of coordination
WHO Regional Office for Africa
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

15. Effective Community Involvement
-huge cost savings

16. Conclusion
WHO Regional Office for Africa
Legislation to minimise the discrimination of migrants in
accessing their health and other social needs
Equitable allocation of resources during the budget sessions
to all social sectors: health, agriculture, education, water,
communication, energy, infrastructure development etc
Ensuring community involvement in implementation of the
Primary Health Care reforms based on an all government
approach
Dee Hock: “The problem is never to get new
innovative thoughts into your mind, but how to get
the old ones out”
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.

17. WHO Regional Office for Africa
Thank
You
5th AFRICAN CONFERENCE ON SOCIAL ASPECTS OF HIV/AIDS RESEARCH 2009.