Advancing Africa’s Leadership and Unified Voice Towards Realization of the Lusaka Agenda

Author:

Ida Hakizinka

Article Type:

Article Number: 3

The Lusaka Agenda provides a comprehensive set of recommendations designed to contribute to health systems strengthening, catalyzing sustained domestic financing, strengthening approaches to health equity, enhancing operational efficiency and strengthening coordination of products, R&D and regional manufacturing for accelerating progress toward attaining Universal Health Coverage and Sustainable Development Goals. This article documents discussions by African country and regional health stakeholders, global health initiatives and development partners that sought to set the stage for African leadership towards realization of the Lusaka Agenda on the continent.

Introduction

Several stakeholders, including representatives from 20 African countries, regional bodies, development partners, Civil Society Organizations (CSOs) and global health initiatives (GHIs) recently met in Addis Ababa, Ethiopia, on June 12-13, 2024. Convened by the World Health Organization Africa Region (WHO Afro), Africa Centres for Disease Control and Prevention (CDC), and Africa Constituency Bureau, the meeting entitled “Technical Consultation on Advancing Africa’s Leadership and Unified Voice towards Realization of the Lusaka Agenda” also had Wellcome Trust, The Global Fund, Global Financing Facility for Women, Children and Adolescents (GFF) and Gavi supporting its organization.

 

This meeting aimed to enlist country-led discussions of the key shifts and near-term priorities espoused in the Lusaka Agenda, including development of the roadmap for the implementation of the Lusaka Agenda, which was officially launched on Universal Health Coverage (UHC) day, December 12, 2023, in Lusaka, Zambia​​. The Lusaka Agenda identified five critical shifts to provide direction on how the GHI ecosystem could evolve going forward: Strengthening primary health care (PHC) and health systems, Catalyzation of sustainable domestically-financed health services, Achieving Equity in Health outcomes; Achieving strategic and operational coherence and Coordination and Coordinating priority products, R&D & Regional manufacturing. These changes are reinforced by immediate priorities around governance, consensus on common metrics or indicators that will define success and alignment with government systems.

 

This article combines the discussions, conclusions, and future action from the meeting to synthesize the findings, discuss the implementation roadmap as well as the game changing and early measures described in the Lusaka Agenda, while consolidating it with lessons learned on this topic from previous Aidspan analysis on what can be expected from it and coverage of discussions including at the 51^st Global Fund Board meeting.

 

Overview

The Lusaka Agenda is a comprehensive framework aimed at transforming health systems across Africa to achieve Universal Health Coverage (UHC) and accelerate the attainment of Sustainable Development Goals (SDGs). The initiative highlights the necessity of Africa leadership, sustainable health financing and functional and effective coordination among Global Health Initiatives (GHIs) to achieve its targets. The elaborate implementation roadmap under the Lusaka Agenda sets out to operationalize key shifts and near-term priorities. Some elements of the roadmap are strengthening or updating legal and policy frameworks; ensuring sound public financial management systems; and fostering partnerships as stakeholders collaborate with a shared vision in pursuit of common health goals.

 

Highlights

The meeting was opened by statements from key representatives, WHO Afro, Africa CDC, Global Fund and Amref Health Africa along with the Minister of Health for Ethiopia. Speakers underscored the place of the Lusaka Agenda in advancing Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs). Stakeholder representation demonstrated the depth of support and commitment to the success of the Agenda, calling for it to be country-led and driven by African member states.

 

The session focused on the importance of community engagement and amplifying voices affected by health challenges. The participants emphasized that country-led initiatives and champion countries are important for piloting successful health interventions and scaling up implementation. The importance of collaboration, alignment and country ownership in the implementation of the roadmap was highlighted as well as monitoring, evaluation, and accountability. A draft regional implementation roadmap was also developed during the workshop in Addis Ababa. The document outlined key milestones, roles and responsibilities, and the phased approach to implementation, which will be deliberated on and signed off by African Ministers of Health during the WHO Afro Ministerial Meeting in August.

 

The interplay between the Lusaka Agenda, an African Union Agenda 2063 and WHO strategic directions were presented by Dr. Patrick Kuma-Aboagye, Director General, Ghana Health Service, and Dr Ruth Nigatu, Chief of Staff, Ethiopian Ministry of Health, Co-Chair, Lusaka Agenda Technical Working Group. They pointed to five key shifts and regional manufacturing as drivers of reduced health product dependency, all in the service of an integrated approach to health system strengthening under African leadership. The overview was to provide a foundation for discussions by explaining the Agenda aims, strategies and priorities. The audience responded to the focus on in-country manufacturing as part of the regional agenda and emphasis on African leadership, demonstrating how the agenda might just revolutionize African health systems. The agenda was built on the premise that ongoing monitoring and evaluation of progress with data and evidence is critical for success, as well as fostering innovation and technology in health system strengthening

 

The panel discussions revolved around different viewpoints towards the operationalization of the Lusaka Agenda. Notable challenges identified included the need for a single planning entity to coordinate GHIs engagements, concerns about donor funding reductions, and the importance of using tools already in existence such as health financing scorecards. Key messages from panelists were the importance of alignment, cooperation and including non-traditional partners like ministries of finance and education.

 

The participants and the panelists had a range of voices from different disciplines, and all emphasized the central importance of cohesive strategies to overcome health system fragmentation. They discussed how the lessons that emerged from Lusaka Agenda had pushed discussions at country level, but GHIs’ portfolio managers were at different understanding levels. Panelists also covered harmonizing with national priorities, inclusiveness and leveraging existing resources and tools. They highlighted the need for an all-in-one, multi-sectoral approach of health systems with participation from ministries beyond health, e.g. in finance and education.

 

Panelists and participants contributed very insightful views on the struggles and opportunities of putting in place the Lusaka Agenda, emphasizing the need for a common approach to a shared working methodology and best practices. The discussion has reinforced the importance of political will and leadership in driving forward the implementation of the Lusaka Agenda, highlighting that strong leadership is required from all levels of Biodiversity governance – from national governments to grassroots communities – if the Lusaka Agenda is to be effectively achieved.

 

In addition, the conversation underscored that to achieve a strong and reliable healthcare sustainability would involve addressing health systems issue, given particular focus on social determinants of health which include poverty, education, and Gender Based Violence (GBV) as well as an understanding of Primary Health Care (PHC), and an unified perception of PHC is key that goes even beyond community health workers, beyond healthcare provision to encompass a whole delivery model applicable across all levels.

 

Dr. Hillary Kipruto, Health Systems Specialist, WHO Afro, with a presentation on health system metrics and measurement highlighted the necessity for a shared common set of metrics within the arenas of global health components to ensure progress can be tracked amongst the complex landscape. The specific metrics are intended to measure health system performance, enable data collection, and be concordant with national priorities.

 

Piloting in a few countries will further fine-tune the metrics approach and experience of its implementation using PHC and UHC indicators, emphasizing country-led health system metrics. The purpose is to develop common indicators partners can use to track health systems investment, as part of efforts to collect and report data on whether these are having the desired impacts of strengthening health system functions and capacities in line with national priorities. Less explicitly, WHO has incorporated elements of the Lusaka Agenda in its General Program of Work (GPW14) and will assist countries to develop PHC/HSS matrixes and integrated planning, budgeting and monitoring frameworks. Toward that end, it will be necessary to develop common metrics with which to track progress and institutional accountability in implementing the Lusaka Agenda. The measurement systems are necessary to avoid parallel structures and ensure accurate monitoring of progress and to allow for comparisons and enable well-informed choices.  Participants emphasized on the Health Equity Progress Indicators which are needed to track progress on health disparities. Digitalization Optimization Standardization of the digital health tools and apps need to be optimized and aligned to avoid fragmentation and hence, prevent efficient data management and analysis.

 

Participants emphasized also on country ownership and Leadership – reasserting the central importance of national ownership and leadership to lead implementation of the Lusaka Agenda through aligning global health efforts behind national priorities and plans. A great emphasis should be on public and civil society organizations to have meaningful engagement in planning and implementation of health programmes and on how to address financial health issues in the wake of fiscal challenges, as well as around scaling up domestic resource mobilization and exploring innovative financing options.

 

The meeting also highlighted the need of strong accountability mechanisms, which must be put in place to monitor progress, maintain transparency, and ensure that stakeholders are held accountable for implementing the Lusaka Agenda. This includes developing effective governance systems for GHI coordination and alignment. Donors, GHIs, and development partners are urged to support CSOs and communities in their roles of accountability and advocacy​​. The meeting reinforced the crucial role of CSOs and communities in ensuring accountability and advocating for health equity, especially for marginalized populations. Their involvement in planning, implementation, and monitoring is essential for the success of the Lusaka Agenda​​.

 

The concept of pathfinder countries was introduced as part of Lusaka Agenda implementation strategy. Pathfinder countries are responsible for leading on key shifts and near-term priorities, and in doing so serve as examples to other nations. Nominees will be chosen according to their leadership potential engagement and the specific health system requirements. These countries will develop country-specific workplans, convene partners and track progress allowing insights that can be used in other contexts. Countries like South Sudan, Ghana, and Malawi have expressed interest in participating​​.

 

Champion countries will drive the Lusaka Agenda through development of workplans, organization of partners, and oversight and reporting on progress. They will set the role for partners, convene stakeholders regularly to track progress against workplan accomplishments. Those countries will provide critical proof of concept for the main thrusts of Lusaka Agenda. Participants discussed ways to leverage outreach with non-champion countries to end any potential complacency in advancing the Lusaka Agenda. These conversations facilitated a sense of unity for lessons learned, best practices and issues that all faced. Key themes mentioned as critical to achieve the goals of the Lusaka Agenda included stakeholder engagement, collaboration and alignment.

 

The meeting also included discussions on local manufacturing as part of the Lusaka Agenda’s implementation strategy. The focus was on reducing dependency on imported health products by promoting regional manufacturing. This approach aims to create a sustainable and self-sufficient health system that can respond to local needs more effectively. The session also stressed the importance of stakeholder alignment to establish a vision for local manufacturing of GHI in Africa. The creation of an African Pooled Procurement Mechanism and commitments from organizations like Gavi and CEPI to support African products were highlighted​​.The heart of the discussion revolved around the collaborative effort necessary in this industry and how investors must invest in all levels of manufacturing, from the ground up. Such coordination is key to avoiding market fragmentation and maintaining the momentum in manufacturing efforts

 

During the panel discussion, the importance was on developing a mechanism to coordinate and support manufacturers as well as obtaining demand guarantees from member states and international buyers. The session also highlighted workforce development, technology transfer and regulatory alignment as key factors to support in-country manufacturing. The discussions also illustrated how local manufacturing can improve the availability of essential health products and strengthen supply chains across the continent.

 

The meeting had deliberations on accountability frameworks, key principles, and strategies for the Lusaka Agenda’s implementation. Participants reached a consensus on financing the implementation roadmap, the significance of a unified ministerial commitment for a strong regional implementation, the selection of pathfinder countries, the necessity for continuous stakeholder involvement, and the establishment of a comprehensive accountability mechanism within the African Union’s architecture. The forthcoming steps involve finalizing the implementation roadmap, selecting pathfinder countries, and commencing joint actions to bring the vision of the Lusaka Agenda to fruition​​​. Continuous stakeholder engagement, collaboration, and alignment are vital for realizing the vision of the Lusaka Agenda​​.

 

Conclusion

The Lusaka Agenda is a significant step towards accelerating achievement of Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) in Africa. The agenda highlights important changes and priorities for immediate action, setting out a course to transform health systems in foresight of significantly improved health outcomes. As a follow-on, effective implementation of the Lusaka Agenda requires strong leadership, stakeholders working together and commitment to sustainable funding and equitable health. Stakeholder engagement needs to be more seriously taken and also civil society organizations and the communities need to increase their participation. The implementation agenda requires firm and clear governance mechanisms for accountability and transparency.

 

This meeting in Addis Ababa, again highlighted these elements and set the stage for the follow-on phases to implement the Lusaka Agenda. All Africans can have resilient and equitable health systems with the commitment of African leaders, supported by Global Health Initiatives (GHIs), development partners, Civil Society Organizations (CSOs). The Lusaka Agenda, facilitated by sustained engagement, the development of capacity and effective accountability systems and Monitoring and Evaluation (M&E), is likely to deliver health systems improvements with long-lasting effects on the health and wellbeing of populations across Africa.

 

Stakeholders can build a future health system of increased resilience by overcoming barriers and exploiting the opportunities offered by the Lusaka Agenda, enabling it to address the diverse health service needs of populations. It allows health services to respond internationally to the present, rapid-moving challenges of global health while they are also well-placed to meet other challenges in the future based on primary care, sustainable financing and fair access simultaneously effective roster for provide quality health cover. By working together to uphold these values and build on them, the Lusaka Agenda can help drive real progress towards universal health coverage and the SDGs in Africa.