A Review of National Health Policies in Seven Countries in the WHO African Region

Objectives: This paper proposes an analytical framework for assessing compliance of national health policies with WHO/AFRO guidelines. Data sources: Data for this study was obtained from the national health policies of Botswana; Eritrea; Liberia; Namibia; Swaziland; Gambia; and Uganda. Study selections: National health policies of seven of the 19 Anglophone countries of the WHO African region were selected for review using simple random sampling method. These include: Botswana; Eritrea; Liberia; Namibia; Swaziland; Gambia; and Uganda. Data extraction: An analytical framework derived from WHO/AFRO guidelines for developing national health policies and plans was used in the review. It identifies components which are pertinent for appropriate national health policy formulation. Data synthesis: It appears that aspects related to policy content are well addressed. In relation to the process; there is need for improving the mapping of stakeholders and specifying their roles and aspects of collaboration; and the implications for meeting broad service and impact targets. Conclusion: Development of health policies needs to focus on all aspects of the analytical framework with emphasis on improving the articulation for mapping out stakeholders and specifying their roles and aspects of collaboration; and the implications for meeting broad service and impact targets

Status of Health Sector Strategic Plans in Five Countries of the WHO African Region

Objectives: To assess the adequacy of the existing strategic plans and compare the format and content of health sector strategic plans with the guidelines in selected countries of the African region. Data source: The health strategic plans for Gambia; Liberia; Malawi; Tanzania and Uganda; which are kept at the WHO/AFRO; were reviewed. Data extraction: All health strategic plans among the Anglophone countries (Gambia; Ghana; Kenya; Liberia; Malawi; Mauritius; Tanzania; Uganda; Zambia and Zimbabwe) that were developed after the year 2000 were eligible for inclusion. Fifty percent of these countries that fitted this criterion were randomly selected. They included Gambia; Liberia; Malawi; Tanzania and Uganda. The analysis framework used in the review included situation analysis; an assessment of appropriateness of strategies that are selected; well developed indicators for each strategy; the match between the service and outcomes targets with available resources; and existence of a clear framework for partnership engagement for implementation. Data synthesis: Most of the strategic plans identify key ill health conditions and their contributing factors. Health service and resource gaps are described but not quantified in the Botswana; Gambia; Malawi; Tanzania strategic documents. Most of the plans selected strategies that related to the situational analysis. Generally; countries' plans had clear indicators. Matching service and outcome targets to available resources was the least addressed area in majority of the plans. Most of the strategic plans identified stakeholders and acknowledged their participation in the implementation; providing different levels of comprehensiveness. Conclusion: Some of the areas that are well addressed according to the analysis framework included: addressing the strategic concerns of the health policies; identifying key partners for implementation; and selection of appropriate strategies. The following areas needed more emphasis: quantification of health system gaps; setting targets that are cognisant of the local resource base; and being more explicit in what stakeholders' roles are during the implementation period

A Rapid Assessment of District Health Systems in Six Countries of the WHO African Regions

Objectives: This paper reviews the adequacy of inputs and processes at district level to support outputs and outcomes of service delivery at district level using a rapid assessment. The outputs included in this study are those considered essential for the attainment of the Health related Millennium Development Goals(MDGs). Data sources: A questionnaire based rapid District Health Systems assessment was conducted among six African countries during the year 2007. Study selections: The study took place in a random sample of six out of 19 eng speaking countries of the WHO African region. These countries are Ghana; Liberia; Namibia; Nigeria; Sierra Leone and Uganda. Data extraction: The data was extracted from the questionnaires; entered and analysed in Excel spreadsheet. Data synthesis: In spite of the variability in quality and completeness of reporting on the selected parameters; this paper does indicate that according to country norms and standards; the inputs and processes are insufficient to lead to acceptable outputs and outcomes; especially those related to the MDGs. An important point to note is that comparability across countries is made on the basis of individual country norms and standards. Implicit in this assessment is that country norms and standards are reasonable and are appropriate for the attainment of the MDGs. However reasonable the country norms and standard are; it is unlikely that the low resource base as well as weak organisational and managerial capacities in most countries will support effectively the attainment of the MDGs. Conclusion: Most countries manage to offer the essential health services at all levels of care despite the relatively low level of inputs. However; their level of quality and equity is debatable. The general trend is that provision of the essential health services is more at the higher levels of care prompting concerns for the populations served at lower levels of care. There is also a tendency to have wide variations in the performance of service delivery geographically as well as at the different levels of the health systems. This paper recommends further exploration of the impact of focusing on improving quality of existing health services while increasing quantity of service delivery points to achieve higher coverage of essential health services

Health Economics: Potential Applications in HIV/AIDS Control in Africa

There is growing evidence that HIV/AIDS has enormous negative impact on health status and economic development of individuals; households; communities and nations in the African region [33]. Thus; there is urgent need for various disciplines to demonstrate how they can contribute in curbing the spread of this deadly disease in the African region. This paper; using an extended version of Professor Alan Williams [32] schema as the conceptual framework; attempts to demonstrate how health economics can be used to inform policy and managerial choices related to HIV/AIDS advocacy; prevention; treatment and management. It argues that the discipline of health economics (and economics generally) is extremely valuable in: measuring health impacts of the disease and interventions; evaluating the relationships between health care-seeking behaviour of individuals and health system specific attributes; the estimation of determinants of compliance of HIV/AIDS patients with treatment regimen; establishing of health institutions efficiency in combating AIDS; guiding choices of HIV/AIDS interventions; assessing the relationships between HIV/AIDS; development; poverty; and trade; programme planning; monitoring and evaluation; and assessing health system's overall performance. The paper is a modest attempt to show how the discipline of health economics can elucidate; and help in resolving practical and conceptual issues in HIV/AIDS control in Africa