SPECIAL INTERVIEW—Dr. Martha Phiri , AfDB director for human capital, youth and skills development
‘Quality healthcare infrastructure is crucial’
The African Development Bank (AfDB) was in Lilongwe, Malawi last week for a consultative mission to the Southern Africa Development Community (Sadc) region to validate its strategy for Quality Health Infrastructure in Africa 2021-2030. In this interview, AfDB director for human capital, youth and skills development DR MARTHA PHIRI explains to our contributor GOLIE NYIRENDA what the strategy is all about and other related issues.
How important are the consultation meetings and what does the bank want to achieve at the end of these meetings?
The consultation meetings were intended to afford our key stakeholders, namely Ministers of Health and Senior Health Officials in Sadc member states the opportunity to provide inputs to guide the strategy before its presentation to the bank’s board in February 2022. These consultations are crucial to ensure development of an inclusive, impactful and sustainable strategy.
Consultations will also be held with health development partners and civil society organisations. At the end of the consultations, we would like confirmation from our stakeholders that the strategy is both relevant and timely, and that when implemented it will assist African countries to develop healthcare infrastructure that is inclusive and resilient to improve the quality of life of all citizens.
Why is the bank coming up with this new strategy, what necessitated its development?
The strategy has been developed following a call by the Governors of the bank at their annual aeetings in August 2020, where they requested the bank to define its role in addressing Africa’s health infrastructure deficits, drawing on its core expertise in infrastructure development. Coming against the backdrop of the Covid-19 pandemic, the Governors recognised the centrality of health to improving the quality of life of Africans and enabling them to achieve their full potential. The pandemic exposed serious weaknesses in Africa’s health systems and related infrastructure. A detailed scoping study, benchmarking Africa against other regions in terms of prevailing and emerging health needs against availability of healthcare services and related infrastructure informed the strategy.
Despite recent progress, child and maternal mortality remain high in many African countries. With just 15 percent of the global population, Africa accounts for 50 percent of global deaths from communicable diseases reflecting a lack of access to quality health services. For example, a third of Africans live more than two hours away from health services, and there are severe shortages in hospital beds, medical equipment, and drugs.
The economic costs of health challenges are severe. It is estimated that Africa loses $2.4 trillion in annual output due to poor health. So the objective of this Strategy is to support African countries to accelerate the development of quality health infrastructure and ensure that all individuals receive the health services they need without financial hardship so as to progress towards the Sustainable Development Goal III and the AU Agenda 2063 on health.
On the strategy, what are the key focus areas? And how are these relevant for Malawi?
The bank’s strategy focuses on three health infrastructure categories that match the bank’s comparative advantage, while offering flexibility to respond to the diverse needs of African countries. First, primary health care infrastructure for under-served populations, with supporting infrastructure investment to ensure that facilities are connected to water and sanitation, energy, transport; and communications services.
Second, secondary and tertiary healthcare facilities, involving the development and equipping of new facilities, alongside specialist facilities for cancer, dialysis and pain management and the rehabilitation and expansion of existing facilities.
Last, diagnostic infrastructure utilising a range of delivery models, including public-private collaborations. Connectivity for innovative health solutions will be a running theme across the three categories, to leverage digital technology including mobile services and telemedicine, and support improvements in health information systems.
Our discussion with the government and other partners in the country show that the bank strategy is relevant for Malawi as reflected by the priorities in the third Health Sector Strategic Plan and Health Financing Strategy [2022-2028] which has been recently completed.
The AfDB has supported health infrastructure in the past and in Malawi in particular, what is different in this strategy?
The bank’s support to the health sector started in 1975. However, after 2000 the Bank’s strategic focus changed and its investments in health were significantly scaled back. In recent years, the Bank has faced a strong demand for health support from member countries, particularly during health crises.
During the Covid-19 pandemic the bank provided about $4 billion to African countries to save lives and livelihoods. However, this engagement has taken place in an ad hoc way, without a clear strategic plan. What is different is that the strategy is now tightly focused on health infrastructure as an area of comparative advantage. The bank will complement its infrastructure investments with support to knowledge work, technical assistance and policy reforms. This aims at building capacity to implement investment projects on time and within budget and to ensure that completed health facilities deliver the expected health outcomes.
How will the Bank work with other development partners and financiers in the implementation of the strategy?
The strategy is based firmly on the Bank’s comparative advantage, in particular, its role as an infrastructure financier, working alongside other development partners specialised in other aspects of health system strengthening. The strategy does not attempt to intervene in all areas of health needs but recognises the need to work with other partners with a clear division of labour to deliver well-coordinated health investments in line with each country’s strategic priorities.
The investments will be tailored to the needs of countries, with a focus on strengthening resilience to future health emergencies and promoting sustainable and equitable health financing solutions.
In terms of resources, what is required to have adequate and quality health infrastructure on the African continent?
A scoping study found that the continent’s $4.5 billion in public health capital expenditure per year, is far below the estimated $26 billion annual investment in new health infrastructure needed to meet evolving health needs over the next decade. This is in addition to the significant investment required for the maintenance and upgrading of existing health infrastructure.
That is why the Bank’s financing will only be catalytic. The governments will require prudently scale-up financing while promoting increased participation of the private sector complemented by donor funding. The bank will provide investment project financing, risk-sharing instruments to leverage private sector resources, debt and equity investments in private companies, and the promotion of innovative sources of finance, such as diaspora funds. It will use trust funds and other technical support facilities to build capacity, generate knowledge for evidence based policy reforms and promote public private partnerships.
What are the bank’s expectations from the consultation meetings?
The Bank’s expectation from the consultations with Ministers of Health and all key stakeholders in Sadc and other parts of the continent is to receive inputs that will help us sharpen the strategy and get confirmation of its relevance to African countries, prior to presentation to the AfDB Board of Directors.
What is your last word?
On behalf of the bank I would like to thank the Sadc Secretariat and the Malawi Chair for allowing us to share the strategy with health officials at the joint meeting of the Sadc Health Ministers and Ministers responsible for HIV and Aids.
I also wish to thank Hon Felix Mlusu, Minister of Finance and Governor of the Bank and Hon Khumbize Kandodo Chiponda, Minister of Health for their time and guidance on the strategy. We also appreciate contributions from development partners and other stakeholders in Malawi
