This commentary is the last in our three-part series on a New Public Health Order for Africa, an action framework from the African Union and the Africa Centres for Disease Control and Prevention (Africa CDC) that calls for strengthening the continent’s public-health institutions and workforce, expanding local manufacturing of health products, increasing domestic investment and promoting partnership.
When more than 2,500 public-health experts gathered in Kigali in December 2022 for the second International Conference on Public Health in Africa (CPHIA), they highlighted implementation of the Africa CDC’s New Public Health Order as a key driver in safeguarding health security across the continent. More recently, in February 2023, the Africa CDC released its next strategic plan to guide implementation of the framework. Central to this goal is the need to strengthen public-health institutions at the national and continental levels.
We’ve written previously about why Africa’s public-health institutions are the foundation of strong public-health systems and essential to the realisation of the New Public Health Order. Effective public-health institutions provide flexibility, efficiency and the ability to coordinate with partners during and between emergencies – at the national, regional and continental levels.
To support institutions to deliver most effectively on their mandates and for the people they serve – which in turn contributes to more resilient public-health systems across Africa – the Tony Blair Institute for Global Change (TBI) has been working in partnership with the Bill & Melinda Gates Foundation, the Africa CDC, West African Health Organization (WAHO) and Nigeria Centre for Disease Control (NCDC).
A Journey of Transformation at the NCDC
TBI has been supporting Africa’s public-health institutions since 2016 when, at the request of former NCDC Director General Dr Chikwe Ihekweazu, we worked with leadership to transform the organisation, applying our delivery approach to a public-health institution for the first time.
TBI’s advisory approach focuses on the fundamental processes essential for public-sector delivery, including prioritisation, policy, planning and performance management, and our advisors work with leaders to strengthen systems, skills and structures. Prior to the NCDC, we focused this advisory work at the centre of government, often in the offices of a prime minister, president or senior minister. Our project with the NCDC, funded by the Bill & Melinda Gates Foundation, was the first time we applied our expertise and approach to a public-health institution, complementing the technical support provided by other partners.
The partnership was a success. Between 2016 and 2021, the NCDC workforce grew from a staff of 70 to approximately 500 people, the legislative framework establishing the NCDC was signed into law by the president of Nigeria, a national-reference laboratory was fully operationalised and the NCDC transitioned to a unified digital disease-tracking surveillance software.As a result, the NCDC was able to respond rapidly to Covid-19, including developing a national pandemic-response plan.
The Health Institutional Capacity Strengthening Programme
From the start of the pandemic, WAHO and the Africa CDC coordinated regional and continental responses for which they were praised. The Africa CDC is a relatively young organisation – it was established in 2016 in response to the West African Ebola epidemic – with a mandate to safeguard health security across the continent and strengthen Africa’s national public-health institutes (NPHIs). It achieves this primarily by developing and strengthening regional-coordination centres across the continent. WAHO, on the other hand, was established more than 35 years ago, in 1987, to prevent and prepare for disease outbreaks and promote high-quality delivery of routine health care across Economic Community of West African States (ECOWAS) member states. WAHO also has a dual political and operational mandate to harmonise policies and practices among member states and provide direct support to bridge gaps in health-care delivery. Both organisations play key roles in Africa’s public-health ecosystem and in ensuring African citizens are safe from ongoing and future threats.
The pandemic also highlighted the common operational constraints and challenges these organisations face when responding to public-health emergencies. In 2020 and 2021 respectively, TBI began to support strengthening the institutional capacity of WAHO and the Africa CDC under the guidance and direction of both organisations’ leadership, building on the lessons learned from our partnership with the NCDC.
To understand the organisation’s needs, challenges and priorities, we undertook a series of baseline assessments and consultations with the leadership of WAHO and the Africa CDC. These assessments provided clarity and helped create a robust evidence base on which to build partnerships with each organisation.
What Institutional Capacity-Strengthening Priorities Does the Programme Address?
Many of the priorities for institutional capacity strengthening across both WAHO and the Africa CDC mirror those identified in our earlier partnership with the NCDC, including the need to develop an implementable strategy, build clear communications and knowledge-management plans, and strengthen leadership capacity. To address these, TBI advisors based in Addis Ababa (where Africa CDC is headquartered) and the ECOWAS region, who have expertise in public-sector delivery, have been working closely with Africa CDC and WAHO leadership to:
Develop implementable strategies, and appropriate structures and systems to support implementation.
Strengthen leadership capacity.
Build operational systems and structures for effective coordination and collaboration among stakeholders.
Support development of platforms that optimise coordination and knowledge sharing.
Strengthen strategic communications and knowledge management.
Strengthening Institutional Capacity in a Changing Environment
Both organisations have new leadership. Dr Jean Kaseya has recently been appointed as director general of the Africa CDC while WAHO Director General Dr Melchior Aïssi is in his first year in the role. Additionally, the global context and ecosystem that both organisations operate in continues to evolve. In 2022, the Africa CDC was elevated to an autonomous agency of the African Union. Through that new status, it will have more operational flexibility to deliver on its expanded mandate. WAHO has also continued to support member states and their ministries of health and NPHIs through periods of political instability – such as the recent coups in Burkina Faso, where WAHO is headquartered. Both organisations have also continued to support their member states’ responses to Public Health Emergencies of International Concern (PHEIC) such as Covid-19 and Mpox, and recent cases of Marburg Virus in Equatorial Guinea and Tanzania. TBI will continue to work with the institutions’ leadership to strengthen their capacity so they are best able to deliver on their key priorities.
How the Programme Is Contributing to Africa’s Public-Health System
Despite their individual mandates, African public-health institutions do not work in isolation. They operate in a complex global health ecosystem in which they collaborate with each other and a diverse range of institutions at the national, regional and continental levels, including research institutions, medical manufacturers and regulatory authorities. Given this complexity and interconnectedness – and the emergence of pivotal new institutions, such as African Medicines Agency – it is essential to adopt a holistic approach.
This programme focuses on strengthening institutional systems, structures and processes, working towards such a holistic approach. By capturing cross-cutting learning, there is an opportunity to develop and apply a capacity-strengthening approach that complements existing frameworks – such as the World Health Organisation’s essential public-health functions and health-system-strengthening building blocks, and the International Association of National Public Health Institutes – to a wide range of institutions and serve the wider public-health ecosystem in Africa.