Insight: Health in Africa and the IIAG results

When the nations of the world agreed on the Sustainable Development Goals (SDGs) in 2015, they recognised that strong governance was an essential underpinning for achieving the other goals. SDG 16 aims to promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.

As a former Minister of Foreign Affairs, Minister of Health and Director-General of the World Health Organization (WHO), I have seen the critical importance of strong governance for well-functioning health systems. Governance affects every level of the health system, from strategic plans and laws made at national level, to the day-to-day work of managing of clinics and district health facilities.

Strong governance is critical for well-functioning health systems.

COVID-19 and the importance of governance

The COVID-19 pandemic was a clear demonstration of the importance of governance, both nationally and internationally. In many countries, strong leadership and governance enabled a comprehensive approach that informed, engaged and empowered citizens, and kept the death toll relatively low. By contrast, inadequate leadership and governance in other countries created a disjointed approach that led to a loss of public trust and erosion of government legitimacy that cost lives. At the global level, the pandemic exposed and exacerbated gaps in global governance: instead of collaborators in the face of a shared threat, some countries saw themselves as competitors, creating horrific inequities in access to vaccines and other life-saving tools, especially in Africa.

As the world recovers from the pandemic and seeks to accelerate progress towards the SDGs, enhanced governance, both nationally and internationally, will be essential. As part of our commitment to strengthening health systems around the world, WHO is committed to supporting good governance for health systems, but also for the many other sectors that have an impact on health, such as agriculture, commerce, trade, education, energy, transport, and more.

In Africa, despite the challenges of a growing population, the impact of health emergencies, shortages of health workers, fiscal constraints and the growing burden of non-communicable diseases, many countries have made great progress in eradicating diseases, increasing access to health services, and are leaders in developing new digital solutions for diagnostics, health information, financing, and service delivery. The 2022 Ibrahim Index of African Governance (IIAG) shows an encouraging trend towards stronger, more effective governance and, as a result, stronger and more effective health systems. However, there are areas where further work needs to be done. For example, in 2020, WHO’s SCORE assessment found that in Africa, only 44% of births and only 10% of deaths were registered. Strengthening systems for Civil Registration and Vital Statistics (CRVS) are essential for understanding and meeting the health needs of populations.

The 2022 IIAG shows an encouraging trend towards stronger more effective governance and, as a result, stronger and more effective health systems.

The Indian writer and philanthropist Rohini Nilekani says that, “We cannot be mere consumers of good governance; we must be participants; we must be co-creators.” Strong public participation in the design and delivery of health systems is essential. Yet the Index Report indicates that in many countries, opportunities for public participation is shrinking, while many have out-of-date health laws and inadequate resources to effectively regulate a growing private health sector.

WHO is leading important work in all these areas, providing guidance for countries on how to engage systematically with their populations, how to update and reform their laws, and how to build the capacity of governments to engage constructively with the private sector. The former President of Lebanon, Émile Lahoud, said that, “Democracy, good governance and modernity cannot be imported or imposed from outside a country.” While lessons can and should be learned from the experience of other countries, there is no one-size-fits-all approach. But the principles are the same: participation; rule of law; transparency; responsiveness; consensus orientation; equity and inclusiveness; effectiveness and efficiency; and accountability.

There is no one-size-fits-all approach, but the principles are the same: participation; rule of law; transparency; responsiveness; consensus orientation; equity and inclusiveness; effectiveness and efficiency; and accountability.

I commend the important work of the Mo Ibrahim Foundation and thank it for the 2022 Index Report. WHO is ready to support all countries to strengthen governance on the road to a healthier, safer, fairer future for all Africans.