The African Health Monitor,
Issue 12
(complete edition: 6.4 MB)

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The challenges of strengthening health systems in the African Region (Editorial)
Luis Gomes Sambo
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The background and significance of the Algiers Declaration and the Framework for its Implementation to Improve Health Systems
Paul-Samson Lusamba-Dikassa, Derege Kebede, Issa Sanou, Emil Asamoah-Odei, Edoh William Soumbey-Alley, Peter Ebongue Mbondji, Chris Zielinski, and Luis Gomes Sambo
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The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving better health for Africa in the new millennium
Saidou Pathé Barry, Habib Somanje, Joses Muthuri Kirigia, Jennifer Nyoni, Khaled Bessaoud, Jean-Marie Trapsida, Jean Bosco Ndihokubwayo, Edoh William Soumbey-Alley, David Nyamwaya, Prosper Tumusiime, Ossy Kasilo, Alimata J, Diarra-Nama, Chris Mwikisa Ngenda, and Luis Gomes Sambo
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Development of Human Resources for Health in the WHO African Region: Current Situation and Way Forward
Magda Awases, Jennifer Nyoni, Khaled Bessaoud, Alimata J Diarra-Nama, and Chris Mwikisa Ngenda
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Technical efficiency of zone hospitals in Benin
Joses Muthuri Kirigia, Omer A. Mensah, Chris Mwikisa Ngenda, Eyob Zere Asbu, Ali Emrouznejad, Patrick Makoudode, and Athanase Hounnankan
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Problématique de l'accès des populations de la ville de Brazzaville aux combinaisons thérapeutiques à base d'artémisinine
J.M. Trapsida, R.Mankele, P. Nzébélé, and G. Okono
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Strengthening Public Health Laboratories in the WHO African Region: A Critical Need for Disease Control
Jean Bosco Ndihokubwayo, Francis Kasolo, Ali Ahmed Yahaya, Jason Mwenda, and Denis Kandolo
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Improving the availability, quality and use of health information, research evidence and knowledge to strengthen health systems
Derege Kebede, Chris Zielinski, Peter Ebongue Mbondji, Issa Sanou, Emil Asamoah-Odei, Edoh William Soumbey-Alley, and Paul-Samson Lusamba-Dikassa
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Communicable Diseases Epidemiological Report
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News and Events
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About the African Health Monitor
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According to WHO's definition, a health system comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health. Most national health systems include public, private, traditional and informal sectors. The four essential functions of a health system have been defined as service provision, resource generation, financing and stewardship.(1)

There is an absolute need for functioning health systems in order to ensure fulfilment of the health-related MDGs. Strengthening health systems poses a challenge anywhere, and in the African Region we have particular characteristics and national situations which require special applications.

If a health system is to succeed in delivering health services to people it needs the following key resource:

  • Political leadership that defines the social goals of the system: this involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design and accountability
  • A range of interventions for health promotion, prevention, and rehabilitation as well as for treatment. Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources.
  • The right number and mix of health workers with the appropriate skills. A well-performing health workforce is one that works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances
  • The required medicines, technologies, and facilities. A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.
  • Timely and reliable information, research evidence and capabilities in knowledge management. The acquisition, generation, sharing and use of information, research evidence and knowledge is critical so that the system can be adapted to changing circumstances, improve and develop.
  • Robust and equitable mechanisms and institutions for long-term financing. A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient.

These key resources are interdependent. Weakness of any one not only constrains the functioning of the system as a whole: it also limits the potential for scaling up the delivery of interventions so that they reach all who need them. Limiting factors include shortage of skilled health workers, poor governance or inefficient mechanisms for medicine purchase and distribution.

The Ouagadougou Declaration proposed by ministers of health on primary health care and health systems and the Framework for its implementation described by Barry et al in this issue of The Monitor represent an important step and opportunity to strengthen health systems in the African Region. The Ouagadougou Declaration focuses on nine major priority areas. The paper describes a framework developed to embrace each of these priority areas, together with recommendations for consideration by Member States in the development of their own country frameworks.

Also in this issue of The Monitor, Lusamba provide a background to the Algiers Declaration on Research for Health by describing the evolution of global and regional efforts to strengthen health research systems. The paper also describes the significance of the Declaration and the Framework for its implementation. A related article by Kebede et al focuses on the various knowledge gaps that are particularly important for the African Region as well as constraints to narrowing the gap. It presents a number of keys actions that countries can institute to narrow the knowledge gap as described in the Framework for Algiers Declaration.

The human workforce is another building block in the effort to improve health systems in the African Region. And Awases et al give an update of the situation.

The paper by Kirigia et al reviews research into the technical efficiency of zone hospitals in Benin, and concludes that there is some scope for providing outpatient curative and preventive care and inpatient care to extra patients without additional investment. This would entail leveraging of health promotion approaches and lowering of financial barriers to access to boost the consumption of underutilized health services, especially health promotion and disease prevention services.

Taking a look at a another specific case, this time in Brazzaville, Trapsida et al examine the issue of providing access to the city's populations to a range of artemisinin-based therapies.

Public health laboratories need to be strengthened in order to improve health systems, and Ndihokubwayo et al propose a range of actions for building national laboratory capacity.

This issue is rounded out by this quarter's Communicable Disease and Epidemiological Report.

Luis Gomes Sambo
Regional Director