The Background to 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
Luis Gomes Sambo

World Health Organization, Regional Offi ce for Africa

Corresponding author:
Derege Kebede
Email: kebeded@afro.who.int

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ABSTRACT

The Algiers Declaration on Narrowing the Knowledge Gap to Improve Africa's Health was adopted during a Conference held in Algiers, Algeria, in June 2008. The Conference, which brought Ministers from the African Region together with researchers, nongovernmental organizations, donors, and the private sector, renewed commitments to narrow the knowledge gap in order to improve health development and health equity in the Region. This paper describes the background to the Algiers Declaration and the Framework for its implementation and their signifi cance in assisting countries' eff orts to strengthen health systems in the Region.



RÉSUMÉ

La réduction de la mortalité due à la rougeole contribue de manière signifi cative à la réalisation de l'Objectif du Millénaire pour le développement N° 4 (OMD 4), qui vise à réduire globalement les décès des enfants de moins de cinq ans des deux tiers d'ici à 2015, par rapport aux niveaux de 1990. La couverture de la vaccination systématique contre la rougeole est un indicateur clé pour mesurer les progrès en vue de la réalisation de cet objectif.

La mise en oeuvre de stratégies de réduction de la mortalité due à la rougeole dans la région africaine a conduit à d'importantes réalisations, notamment une réduction des décès provoqués par la rougeole de 92% entre 2000 et 2008. Malgré les progrès réalisés, l'engagement renouvelé par pays est nécessaire pour parvenir aux cibles de pré-élimination et, par la suite, atteindre l'objectif ultime de l'élimination de la rougeole d'ici à 2020.

Les pays devront renforcer leurs systèmes de vaccination en s'assurant que les services de vaccination de qualité touchent les populations diffi ciles à atteindre et, en complément, augmenter la mise en oeuvre des approches et des stratégies qui ont fait leurs preuves telles que l'approche “Atteindre chaque district”. Les lacunes au niveau de la mobilisation des ressources ont eu un impact négatif sur la capacité des pays à atteindre et maintenir un niveau élevé de vaccination systématique et de couverture des activités de vaccination de complément. Les pays devront aussi adopter une approche progressive en vue de la réalisation de l'objectif visant à éliminer la rougeole d'ici à 2020, en commençant par la réalisation en 2012 des cibles proposées de pré-élimination.

SUMÁRIO

A redução da mortalidade por sarampo contribui significativamente no alcançe do 4º Objectivo de Desenvolvimento do Milénio (ODM 4), que pretende reduzir, até 2015, a mortalidade em crianças menores de cinco anos em dois terços em comparação com os níveis de 1990. A cobertura de imunização de rotina contra o sarampo representa um indicador chave para a medição do progresso no alcance deste objectivo.

A implementação de estratégias para a redução da mortalidade relacionada com o sarampo na Região Africana resultou em avanços importantes, nomeadamente na redução de 92% das mortes estimadas provocadas pelo sarampo entre 2000 e 2008. Apesar dos progressos obtidos é preciso um compromisso renovado dos países para atingir os objectivos de pré-eliminação e, subsequentemente, atingir o objectivo fi nal da eliminação do sarampo até 2020.

Os países têm de reforçar os seus sistemas de imunização, assegurando que além de reforçar a implementação de abordagens e estratégias comprovadas como, por exemplo, o objectivo de atingir todos os distritos (Reaching-Every-District), os serviços de imunização também abrangem as populações mais difíceis de atingir. Falhas na mobilização de recursos resultaram num impacto negativo na capacidade dos países atingirem e manterem os elevados níveis de imunização de rotina e em suportarem actividades suplementares de cobertura de imunização. Além disso, os países têm também de adoptar uma abordagem passo-a-passo para atingir a meta da eliminação do sarampo até 2020, começando com a realização dos objectivos de eliminação propostos para 2012.


This paper describes the background the Algiers Declaration and the Framework for its implementation and their significance in assisting countries' efforts to strengthen health systems in the Region.

The Algiers Declaration to Strengthen Research for Health: Narrowing the Knowledge Gap to Improve Africa's Health was adopted during the Ministerial Conference held in Algiers, Algeria from 23 to 26 June 2008. The Conference, which brought together Ministers from the African Region together with researchers, nongovernmental organizations, donors, and the private sector renewed commitments to narrow the knowledge gap in order to improve health development and health equity in the Region.

The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving Better Health for Africa in the New Millennium was adopted during the International Conference on Primary Health Care and Health Systems in Africa, held in Ouagadougou, Burkina Faso, from 28 to 30 April 2008. The Conference reviewed past experiences on Primary Health Care (PHC) and redefined strategic directions for scaling up essential health interventions to achieve health-related Millennium Development Goals (MDGs) using the PHC approach for strengthening health systems.

The two conferences recommended that WHO develop a Framework for the Implementation of the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa and a Framework for the Implementation of the Algiers Declaration in the African Region to Strengthen Research for Health. After a broad consultation involving regional and global stakeholders, these frameworks were drafted by WHO-AFRO. Subsequently, The Fifty-ninth session of the Regional Committee for Africa (bringing together ministers of health from all 46 countries of the Region), held in Kigali, Rwanda, approved both Frameworks.

Background to Algiers

Much of the current focus on promoting health research to solve the health problems of developing countries has its roots in a landmark report to the Nobel Conference in Sweden in 1990. The Commission on Health Research for Development explained that only 5% of global health research investment was being directed to conditions accounting for 95% of global disease.

By 1993, the Council on Health Research for Development had been formed, followed by the Global Forum for Health Research in 1996. In 2000, both organizations joined with WHO and the World Bank to stage a landmark conference bringing together over 800 people from more than 100 countries in Bangkok, Thailand. The participants reviewed the national, regional, and global state of health research, and resolved to strengthen national health research systems.

Four years later, in Mexico, a ministerial summit on health research issued a statement for countries to develop national health research policies and to increase investment in health research. This statement was considered and endorsed at the 58th World Health Assembly in May 2005, and the critical role of high-quality research in the achievement of health-related development goals was acknowledged.

Several major summits have been held by African leaders, with support from global partners, to advocate for more investment in equitable, secure, and sustainable health systems. An informal session of the 55th Regional Committee for Africa, meeting in Maputo, Mozambique, in 2005, resulted in a call for long-term collaborative efforts for health research. Ministers of health urged that these efforts should be owned and spearheaded by countries facing the highest disease burden.

At high-level meetings in Abuja, Nigeria, and Accra, Ghana, in 2006, ministers of health agreed that an African perspective on health research for achieving sustainable health development was needed, with a particular focus on achieving the MDGs and the control of neglected tropical diseases. The Abuja meeting was the first time that African ministers of health made a commitment to support health research, accelerate efforts to develop and implement appropriate health research policies at national and regional levels, and foster collaboration and leadership in promoting essential national health research in Africa. The Accra meeting enabled delegates from Africa, Asia, and Latin America to declare a greater commitment to health research with respect to their countries' development, and discussed existing gaps in health research necessary for improving public health and for achieving the MDGs. Participants at both meetings discussed the critical issues that limit the translation of research into health policy and systems development, and identified strategies for the use of health research for disease control and the improvement of public health in countries with the highest disease burden.

At its 54th session (2004) the WHO Regional Committee for Africa adopted a strategy on health information systems(1). Later, at its 56th session (in August 2006), the Regional Committee selected Bamako, Mali, to host the 2008 Global Ministerial Conference on Research for Health (the first time that this conference was held in Africa). At the global level, an international group was set up by WHO headquarters to prepare for the conference. The Regional Committee also adopted a health research agenda(2) and strategic orientations for knowledge management(3) in the African Region. Both envisage the establishment of national mechanisms for comprehensive baseline assessments and preparation of strategic directions to be integrated with national health policies and plans.

The Ministerial Conference on Research for Health in the African Region was held in Algiers, the Republic of Algeria, from 23 to 26 June 2008, and brought ministers from the African Region together with researchers, NGOs, donors, and the private sector, in order to strengthen commitments and to agree on a common declaration for submission to the 2008 Global Ministerial Forum on Research for Health in Bamako, Mali. The Algiers Declaration was adopted by the ministers of health and heads of delegations who were present in Algiers. The Declaration was subsequently endorsed by all 46 health ministers of the African Region during the 58th Session of the WHO Regional Committee held in Yaoundé, Cameroon, 1 to 5 September, 2008.

Other WHO Regions held conferences similar to the Algiers conference, and each of them drew up declarations and key points for action suitable for their respective Regions. These declarations and findings fed into the Bamako Global Ministerial Forum, which was held from 17 to 20 November 2009, which took note of them in the framing of the Bamako Call to Action. The Bamako Call to Action is consistent with the Algiers Declaration, and as such endorses its implementation.

These high-level meetings of ministers of health from Africa highlight the collective desire to address health development challenges, as well as to improve the relevance and application of knowledge for health development in Africa.

A Framework for the implementation of the Algiers Declaration that was drafted by WHO was extensively discussed on a regional multi-disciplinary consultation held in Brazzaville (April 2009). The Framework was subsequently endorsed by the 59th Session of the WHO Regional Committee for Africa held in Kigali, Rwanda (September 2009).

The Algiers Declaration and the Framework for its Implementation

The Framework requests Member States to establish a broad multidisciplinary national working group to initiate the implementation of the Ouagadougou Declaration and the Algiers Declaration as well as establishing and strengthening a unit within ministries of health to coordinate efforts in this area (as detailed in the paper in this issue)

If countries implement the series of steps in the Algier Framework they would pave the way for strengthening their health systems. This can be achieved by developing the content, process and use of technology aimed at improving:

Ministries of health are expected to lead this process. However, other sectors, including other sector ministries such as education, science and technology, agriculture; as well as private sector (both profit and non-profit) are important partners in the process.

International partners should support country efforts by ensuring that external resources are increased, predictable, coordinated, and are aligned to country priorities and plans. Countries should make an extra effort to ensure that their plans at coordinating their knowledge processes at creation, acquisition, sharing and use should not be undermined by external pressures.

It is expected that the Framework will substantially help countries to accelerate the implementation of the recommendations for narrowing the knowledge gap. Countries need to adapt and use the framework to implement the Algiers Declaration in order to strengthen their health systems. Narrowing the knowledge gap through generation of new knowledge, and effective and efficient application of existing knowledge, will contribute to improving health outcomes in the Region.


ACKNOWLEDGEMENTS

We gratefully acknowledge the contributions of all those who have actively participated in, and assisted, the preparations and conduct of the Algiers Ministerial Conference and the follow up regional consultation in Brazzaville that discussed the Framework for its implementation.

REFERENCES