Report of WHO-AFRO regional consultation on poverty and health, Harare, Zimbabwe, 19-21 July 2000

Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 1 WORLD HEALTH ORGANIZATION Regional Office for Africa Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 20002 © World Health Organization, Regional Office for Africa, 2000 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or use in conjunction with commercial purposes. Any other use of the document, including adaptation into electronic form, requires permission from WHO, and requests should be directed to Division of Healthy Environments and Sustainable Development, World Health Organization, Regional Office for Africa, Parirenyatwa Hospital, Mazoe Street, P. O. Box BE 773, Belvedere, Harare, Zimbabwe. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 3 TABLE OF CONTENTS BACKGROUND ...................................................... 5 OBJECTIVES AND EXPECTED RESULTS .................. 6 PARTICIPANTS ........................................................ 6 OPENING CEREMONY ........................................... 7 CONTENT OF THE CONSULTATION ..................... 7 WRAP UP SESSION ................................................ 15 CLOSING SESSION ................................................. 17 ANNEX 1: LIST OF PARTICIPANTS.......................... 18 ANNEX 2: PROGRAMME OF WORK...................... 34 ANNEX 3: GUIDELINES FOR GROUP WORK ........ 37 ANNEX 4: WORKING GROUPS ............................. 39 ANNEX 5: REPORT OF GROUP 1 .......................... 41 ANNEX 6: REPORT OF GROUP 2 .......................... 44 ANNEX 7: REPORT OF GROUP 3 .......................... 47 ANNEX 8: REPORT OF GROUP 4 ......................... 50 Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 20004 Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 5 BACKGROUND 1. For most of the countries in the African region, it is unfortunate that the advent of globalization coincided with a continuous declining trend in official development assistance, thereby obliging most of the countries to drastically reduce per capita public expenditure on health, with all its negative consequences. 2. Fortunately, there had been growing international concern about increasing and persistent poverty in developing countries, particularly in Sub-Saharan Africa which largely coincides with the African Region of the World Health Organisation. This concern had been expressed in multiple fora and also in such initiatives as the OECD’s International Development Goals, the ‘20:20’ investment targets of the Copenhagen Social Summit and the current debate on the linkage between Debt Relief with Poverty Reduction. 3. International development partners such as the African Development Bank Group, the World Bank, the International Monetary Fund, the European Union, and several United Nations agencies have made the alleviation of poverty one of their main, if not key, objectives. If these initiatives are successfully implemented, every country in the Region will have a lot to gain since poverty is not only a hindrance to economic growth and development, it is also a major contributor to the relatively low quality of life of people in the Region. 4. Poverty is multi-dimensional in its causes as well as in its cures. For example, poor health is a major contributor to poverty and good health status is one of the means to prevent poverty or, better still, offers a means to overcome poverty. For this reason, health is already considered as an important element on the international poverty reduction agenda. The on-going effort aimed at linking debt relief with poverty reduction has aroused several countries’ interest in developing and implementing poverty reduction policies, strategies and/or action plans. 5. The above-mentioned developments underscore the urgent need for national authorities (including the Ministry of Health) to: better understand the linkage between poverty and health; design a framework for linking debt relief with poverty reduction through health interventions; and determine the core health interventions that will contribute to poverty reduction/elimination. This need and challenge, therefore, provide the rationale for the organisation, by the WHO Regional Office for Africa, of a regional consultation on Poverty and Health. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 20006 OBJECTIVES AND EXPECTED RESULTS 6. The general and specific objectives of the consultation were as follows: General
To build a consensus among stakeholders on making health an important component of national poverty reduction policies, strategies and plans of action. Specific
To reach a common understanding between stakeholders on the linkage between poverty and health.
To discuss and agree on a WHO African framework for linking debt relief with poverty reduction through health.
To discuss and consolidate the core health interventions for poverty reduction/ elimination 7. The expected results of the Consultation were as follows:
Shared appreciation of the African perspective of Poverty and Health.
Common understanding of the WHO/African framework for linking debt relief to poverty reduction through health.
Consensus on the core health interventions for poverty reduction as well as commitment by countries and their development partners to implement it. PARTICIPANTS 8. A total of 156 people participated in the Consultation. They consisted of:
2 participants each from 45 out of the 46 countries in the Region, with one participant from the Ministry of Health (in most cases) and the other participant from the Ministry of Finance, Ministry of Solidarity, Ministry of Economic Planning and Development, Ministry of Labour and Human Welfare, Office of the President or the Special National Agency responsible for Poverty Reduction. One of the participants from Gabon was the Honourable Minister of Health.
Representatives of the UNDP, World Bank, International Monetary Fund, African Development Bank and European Union.
Experts in Poverty/Health from Cote d’Ivoire, Kenya and Nigeria
5 participants from WHO/HQ, 1 from WHO/SEARO, 1 from WHO/EMRO, and 1 from WHO/AMRO.
Economists from nine of the WHO country offices in the African Region.
Participants from the WHO Regional Office for Africa, Harare, Zimbabwe. Annex 1 contains the full list of participants Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 7 OPENING CEREMONY 9. Mrs. Emilienne Anikpo, Director of the Division of Healthy Environments and Sustainable Development, WHO/AFRO, welcomed participants and gave the background information relating to the consultation as well as an overview of the programme of work. Dr Rufaro Chatora, Director of the Division of Health Systems and Services Development, WHO/ AFRO, standing in for Director of Programme Management, Dr. Luis Gomes Sambo, provided the objectives and the expected results of the consultation. 10. The Regional Director of the African Region of the World Health Organisation, Dr Ebrahim Malick Samba, explained why the meeting was being held at the time, what debt relief meant for poverty reduction in Africa, and the role of Ministry of Health as well as the World Health Organisation in tackling the ‘disease’ of poverty in the Region. He supported the idea that an epidemiological perspective be adopted to deal with the ‘disease’ of poverty because it would enhance the correct identification of the causes, the determinants, the consequences and the feasible as well as the most relevant ways of dealing with the ‘disease’. He implored participants to strive hard to achieve the expected results of the consultation and subsequently declared it opened. CONTENT OF THE CONSULTATION 11. The 3-day consultation had the following content: plenary presentations; panel and general discussions on the presentations; and group work. See Annex 2 for the programme of Work. A. PLENARIES 12. For day 1, there were two sets of presentation made under the chairmanship of Dr A. Kaboré, Director of the Division of Communicable Diseases, WHO/AFRO. 13. The first one on Poverty and Health was made by Mrs. Anikpo. Her presentation attempted to give a general overview of the 35 – page background paper (on the subject) developed for the consultation. 14. Mrs. Anikpo started her presentation by pointing out that if nothing was done, Africa would be the only Region in the World where poverty is likely to increase during the 21st century. She provided some information on: percentage of people living in extreme poverty in 15 countries of the Region; affected populations across the Region; and the cost of poverty reduction programmes in 9 of the countries in the Region. She added Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 20008 that whilst different definitions of poverty had been provided, the way the poor see and feel poverty is important. 15. On the bi-directional linkage between poverty and health, she remarked that since poverty means that opportunities and choices related to most basic human development are denied, poverty keeps people in poor health and poor health keeps people in poverty. She presented the summary of a study in Guinea on the impact of onchocerciasis on individuals, households, and communities to illustrate the path from ill-health to poverty and also how the linkage between poverty and ill-health can be observed throughout the life of a child born poor. 16. She concluded by underscoring that poverty and health have many determinants in common and that poverty should be treated as a disease. Therefore the epidemiological approach could be applied to determine its symptoms, causes, distribution and cure. 17. The presentation was followed by discussions by panelists (comprising of representatives of African Development Bank (AfDB), the World Bank, the Tropical Institute for Community Health (TICH), European Union and the International Monetary Fund (IMF) and the participants. In their discussions, the panelists and other participants underscored the need to:
realise that African governments are not in a position to influence the direction, process and phase of globalization in order to minimize its negative impact on poverty;
link poverty reduction with economic growth and wealth distribution policies and strategies.
take adequate cognizance of the relationship between HIV/AIDS and poverty.
highlight environmental aspects of poverty e.g. deforestation. 18. The second set of presentations on Day 1 consisted of country presentations by The Gambia, Uganda, Rwanda, Mauritania, Cape Verde and Mozambique on the process and content of their national poverty reduction strategy and its implementation. 19. Rwanda is yet to formulate the poverty reduction strategy although they had agreed to adopt a multidimensional approach to poverty reduction. Mauritania developed a poverty profile in 1998 before formulating the poverty reduction strategy whose implementation is overseen by an inter-ministerial committee headed by the Prime Minister. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 9 20. The Gambia had formulated a poverty reduction strategy since 1992. The implementation which was evaluated in 1998, revealed that the reasons for the ineffectiveness of the strategy in tackling poverty in The Gambia included: weak linkage between macroeconomic and microeconomic aspects the poverty reduction efforts; low level of external resources; weaknesses in the institutional framework; lack of co-ordination among different sectors contributing to the programme; and political change. The revision of the first strategy is being done by taking cognizance of its observed weaknesses. The revised strategy will constitute the country’s poverty reduction strategy paper. 21. Uganda initiated the process of developing a poverty eradication action plan (PEAP) in 1995. PEAP was meant to choose public actions that would have the highest poverty impact and was also conceived as an instrument for implementing a Comprehensive Development Framework (CDF) in order to modernize Uganda, transform its society and eradicate mass poverty by the year 2017. The PEAP was finalized in 1997 through a wide consultative process involving government, development partners, NGOs, and civil society. The PEAP which has backing and support from the highest political level has four pillars: increasing incomes of the poor by providing the necessary infrastructure and enabling environment, and facilitating private and community effort in promoting income generating activities of the poor; improving the quality of life of the poor by providing essential services and building human capital; and strengthening good governance through institutional arrangements. The 1997 PEAP is currently in advanced stages of review in preparation for accessing the enhanced Highly Indebted Poor Countries (HIPC) fund. The Strategic Health Plan (SHP) is part and parcel of PEAP. 22. Mozambique’s plan to reduce poverty involved the allocation of resources to all regions and districts as well as to priority groups which comprised of vulnerable people, families which were primarily headed by women, and people without permanent income. The approach being adopted is a co-ordinated effort with all stakeholders. For Cape Verde, poverty elimination had been conceived as a long-term goal. The targeted groups for poverty reduction were women-headed families, young unemployed and vulnerable groups. The approach adopted had been multi-dimensional and participatory. Components of the poverty reduction programme included social mobilization and strengthening of relevant institutions involved in poverty reduction. 23. From the countries’ presentations and the discussion by the participants, the following messages came out clearly:
Countries were at varying stages in the formulation and implementation of their national poverty reduction strategies. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200010
Information about the extent and distribution of poverty was not equally available in all countries; whilst some countries had undertaken some form of poverty assessment, some others had not.
Political commitment which is critical to the development and implementation of poverty reduction strategies exists in varying degrees in the countries.
while a multi-sectoral approach had been adopted in tackling the poverty problem in all countries, the involvement of the Ministry of Health had at best been marginal in most countries.
The process adopted for the consultation of the various stakeholders had varied from one country to the other but what had continued to be a general problem was how to involve the poor themselves in the process.
The allocation of adequate national budget to fight poverty was still absent in many countries.
The extent of country ownership of the existing poverty reduction strategies was inadequate in many countries.
Poverty reduction strategies are best situated within the context of a long-term development framework.
Capacity to locally develop and implement national poverty reduction strategies would need a lot of strengthening in many countries.
National structures for the development but particularly the implementation of poverty reduction strategies would need to be given more attention in many countries in order to ensure broad participation and at the same time minimize the costs of running the structures. 24. There were two presentations on Day 2 under the chairmanship of Dr. Dan Kaseje of the Tropical Institute for Community Health (TICH), Kenya. 25. The first was made by Professor E. Lambo, AFRO Consultant, on the WHO/African framework for linking debt relief to poverty reduction through health (Paper 2 developed as background document for the consultation). He highlighted the reasons why most countries in the Region had not been able to achieve much success with regard to poverty reduction. Reasons adduced included: the magnitude of the problem; issues related to governance (lack of or inadequate accountability, transparency, well defined comprehensive strategy to address the problem, political will/commitment, voice of the poor in government); economic issues (limited resources, misallocation of the limited resources, debt burden, poor economic performance, and globalization); social issues including the near total collapse of the traditional support systems; and inadequate commitment from the international community. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 11 26. Given the health-related characteristics of the heavily indebted poor countries (HIPCs), he stressed that debt relief is a necessary condition for effective poverty reduction. For debt relief to contribute to poverty reduction, he argued that a framework would be needed to link both. He pointed out that the principles to guide the development of the framework include: appropriate macroeconomic framework; country leadership in its development; broad participation during the consultation process; integration of debt relief into the country’s anti-poverty framework; open and comprehensive medium term expenditure framework with priority on poverty-focused expenditures; accountability and transparency in the use of the debt relief savings for the implementation of the poverty reduction strategy. 27. Elements of the framework are: understanding the determinants, nature and characteristics of poverty; identification of all relevant and feasible public actions/interventions for achieving poverty outcomes; selection of the most cost-effective public actors and interventions; setting targets and development of indicators (particularly those related to outcomes); implementation of selected public actions/interventions; monitoring and evaluation of implementation and feedback of the results into the process. 28. He added that the implications of the framework for countries would depend on where each country had reached. For ‘advanced’ countries, they would only need to build on the existing initiatives/approaches (e.g. comprehensive poverty reduction plan, medium term financial framework, public expenditure reviews, sector-wide approaches); and for some other countries, they would need to revise methods of setting priorities, allocating resources and reassessing strategies. 29. He concluded by spelling out policy objectives, policy areas and main thrusts of a pro- poor health strategy which should be part of the poverty reduction strategy as well as part of the country’s health sector reform programme. A pro-poor health strategy and interventions developed as part of the poverty reduction strategy would provide the framework for linking debt relief to poverty reduction through health. 30. The second presentation titled Poverty Reduction Strategy Papers and Health was made by Mr. Mark Wheeler of HSD/HQ. He recalled the 4 strategies enumerated in WHO’s position paper (EB105/5) on Poverty and Health i.e. acting on determinants of health by influencing development policy, reducing risks through a broader approach to health, focusing on health problems of the poor, and ensuring health systems serve the poor more effectively. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200012 31. He made the following two propositions: (i) for a policy to be regarded as pro-poor, it is not necessary that all its benefits are captured by the poor; it is necessary only that the poor benefit disproportionately; (ii) efficiency gains are intrinsically desirable and efficiency is a necessary but not sufficient condition for the poor to benefit; but efficiency improvements are distributionally neutral, and are not part of the pro-poor policy. 32. He provided the elements of the following four policy thrusts on which there has been a consensus of a pro-poor health policy: improve the supply of personal health services and make them more accessible to the poor; improve the supply and effectiveness of general health services; reduce the financial burden of health care utilization on poor people; and promote policies in other sectors which affect the wider determinants of health and with particular benefits for the poor. 33. Following the two presentations, there was a panel discussion (involving the World Bank, IMF and AfDB) and general discussion by the participants. The major observations/ recommendations that came from the discussions were:
National governments would need to create an enabling environment for private sector to thrive and contribute to poverty reduction.
Countries should realize that the production of a well-articulated poverty reduction strategy paper (PRSP) is a necessary condition for debt relief.
Ministry of Health should take the lead in formulating the health component of the PRSP
Establishment of a multi-sectoral PRSP Committee to spearhead and oversee the process of developing and implementing PRSP is important
Even if substantial debt relief is granted by donors, countries must develop some strategy to deal with their domestic debts
The development and use of specific, measurable and time-bound targets and indicators for the monitoring and evaluation of the country’s PRS should be done in a participatory manner.
To address the poverty problems on a sustainable basis in most countries of the Region, there is need to go beyond debt relief to debt cancellation. Increased budgetary allocation (by governments) as well as increased development assistance funds would be needed.
Bilateral and multilateral donor agencies should provide the technical assistance needed in PRSP development and implementation from the country or within Africa instead of the current trend of sourcing them from outside Africa.
The development of PRSP should not be rushed in order to ensure adequate consultation in its preparation as well as country ownership. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 13 34. Two presentations were made on Day 3 under the chairmanship of Mr Faustin Boukoubi, the Honourable Minister of Health, Gabon. 35. The first was by Dr Rufaro Chatora, Director of the Division of Health Services and Systems Development, WHO/AFRO. In view of the fact that the core health interventions for poverty reduction had been discussed in the presentations of Professor Lambo and Dr Wheeler as well as by the World Bank panelist on the second day, Dr Chatora attempted to tie together relevant issues on Poverty and Health. 36. He elaborated on the vicious cycle of poverty and ill health and spelt the following as the special health determinants in Africa: poverty, political instability, poor economic performance, illiteracy and ignorance and poor performance of national health systems. He stated the goals of the health systems as improving health, enhancing responsiveness to the legitimate expectations of the population, and assuring fairness of financial contribution. 37. He also spelt out the functions of the health systems as resource generation, financing, provision and stewardship and elaborated on each of the functions. He added that pro- poor health systems should: prevent illness and protect health; protect the poor from impoverishing health costs; provide resources for drugs; supply and motivate health workers; and reorient and support providers towards improving the health of the poor. Services to be provided by the systems should be based on the epidemiological profile in the population at that point in time, their values and what the country can afford. 38. He concluded by emphasizing that a framework for improving performance of health systems based on pro-poor policies should take due cognizance of the functions that the systems are expected to perform as well as the objectives of the health systems. 39. The second presentation made by Dr Khalif Bile Mohamud, WHO Representative in the Islamic Republic of Iran was entitled Poverty and Health: the Basic Development Needs Concept as Viable Strategy for Joint Action - the EMRO/WHO Experience. He stated that the operational characteristics of Basic Development Needs (BDN) approach were: bottom-up integrated approach aiming at poverty alleviation and development; community involvement and self-reliance; and intersectoral collaboration. He indicated that the BDN approach to poverty reduction has reversed the conventional approach by making people the initiator of, and actor in the poverty reduction process. He presented the BDN elements with the corresponding indicators as well as the outcome and impact of BDN poverty alleviation interventions in the countries that have implemented the approach in the Eastern Mediterranean Region. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200014 40. He concluded by saying that poverty alleviation for health and health for poverty alleviation are two sides of the same coin and BDN offers an opportunity to pursue the two complementary conceptual frameworks simultaneously. 41. Following the two presentations, there was a panel discussion (involving the World Bank, IMF, and AfDB) and general discussion by the participants. The major observations that came from the discussions were:
Countries should remember that health services are only one of the determinants of health status.
Extending prepayment mechanisms should be done to shield families from catastrophic health care expenditures.
All stakeholders should recognize that economic growth (increase in GNP or GDP) is not synonymous with poverty reduction.
All sectors should identify their mandates within poverty reduction programmes.
Countries should reduce spending on defense and increase spending on health.
HIV/AIDS prevention and control should be a key component of poverty reduction strategies (PRS).
The poor should be shielded in the process of implementing macro-economic and health sector reforms.
Recognizing that majority of the demand for essential care occurs at the household level, there is need to develop appropriate strategies for enhancing effectiveness and sustainability of household level health care.
There is need to strengthen conceptual and analytical capacity in countries so that they can be better placed to analyze poverty situation and monitor the implementation of their poverty-reduction initiatives.
Efficiency of public sectors should be improved instead of viewing privatization as a panacea to poverty alleviation.
WHO should continue organizing similar workshops (and networking mechanisms) to ensure sharing of experiences, expertise, tools and information related to poverty- reduction among African countries. B. GROUP WORK 42. The Group Work focussed on the framework for linking debt relief to poverty reduction through health. Participants were divided into four groups (two francophone groups, one anglophone group, and one multilingual group). The guidelines for the Group Work is contained in Annex 3. The composition of the groups is as contained in Annex 4. The reports of the four groups as presented in a plenary session are contained in annexes 5 to Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 15 8. It is clear that whilst some of the observations/recommendations of the various groups underscored many issues that were raised in the plenary sessions, some other issues that were not discussed in the plenary sessions due to time constraint were discussed. WRAP UP SESSION 43. One of the aspects of the wrap up session was the presentation (by one of the country participants) of the major recommendations that came out from the presentations at plenary sessions, the discussions on the presentations and the group work. Recommendations were made to the countries, the development partners and the WHO as follows: a) Countries
Countries should adopt an epidemiological approach to poverty alleviation with regard to the: - Definition of the poverty problem - Identification of the determinants of poverty - Identification of the solutions
The content of PRS should contain strategies related to economic opportunities, enhancing capabilities, empowerment and improving enabling environment. These strategies should reflect gender differences.
Since good governance (in all its dimensions) and peace are important prerequisites for effective PRS implementation, each country must strive towards ensuring these conditions.
Countries should recognise that debt relief and, indeed, debt cancellation as well as additional Official Development Assistance (ODA) funds will not be adequate for addressing the poverty problem in a sustainable way. It is therefore important that poverty reduction should be accorded the highest priority in national budgetary allocation.
The pursuit of economic growth with equity is fundamental to dealing with the problem of poverty in the country. Therefore, countries should pursue this vigorously and relentlessly.
Given the bi-directional relationship between poverty and ill-health and considering the fact that three out of four of the objectives stated in the Agenda 2015 (Copenhagen) are related to health, Ministries of Health should play both a leading and pro-active role in national poverty reduction efforts. Towards this end, MOH should ensure that key health interventions and health system performance issues are included in the national PRS. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200016
The Ministry of Health should strengthen its advocacy capacity vis-à-vis other sectors will respect to poverty issues. b) Development Partners
Dr. Samba as Regional of the African Region of WHO and given his interest in poverty reduction, among others, should use the relevant fora to advocate for going beyond debt relief and poverty reduction to total debt cancellation and providing additional funds to support national poverty reduction efforts.
External partners should use local African experts who understand issues of poverty better. c) WHO
WHO should put in place a networking mechanism for sharing information, experience and expertise related to poverty reduction.
WHO should document best practices and disseminate them, especially those related to health interventions for poverty reduction.
WHO should play a critical role in co-ordinating agency support for strengthening national capacity for poverty reduction. 44. The second aspect of the wrap up session was the presentation of the next steps by Mrs. Emilienne Anikpo as follows:
WHO/AFRO to prepare and disseminate the report of the Consultation.
WHO/AFRO to consolidate, publish and disseminate the four background documents of the Consultation into one AFRO document on Poverty and Health in the African Region, taking into consideration the comments received before the Consultation as well as the relevant interventions made during the Consultation.
WHO/AFRO to constitute a Task Force with clear Terms of Reference to carry forward what the Consultation had started.
WHO/AFRO to brief African Health Ministers about the Consultation and also to reaffirm AFRO’s readiness to assist countries to develop and implement the health component of the national poverty reduction strategy.
Countries to submit to WHO/AFRO, if they have not done so: (i) their responses to AFRO’s questionnaire prepared for obtaining information for the Consultation and (ii) their national poverty reduction strategy Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 17
Countries to identify what form of technical support they would need from WHO/ AFRO to, for example, develop the health component of their national poverty reduction strategies, develop or strengthen relevant national capacity etc and subsequently notify AFRO through WHO/Country Office about their needs. CLOSING SESSION 45. Mrs Emilienne Anikpo, DES/AFRO, gave a vote of thanks by recognizing the contribution made by the Regional Director, the Director of Programme Management, other Divisional Directors, AFRO Secretariat, the interpreters, the chairmen of sessions, the invited experts and the participants towards making the Consultation a huge success. 46. Dr Ebrahim M. Samba, the Regional Director, thanked participants for responding far more than his expectations to make the consultation a success. He appealed to them, particularly to the national participants, to be proactive and to take on the challenge of poverty reduction. He promised that the report of the consultation, particularly the recommendations, would be shared with the national authorities at the highest level (through the WHO Country Representatives and the Minister of Health), the Organisation of African Unity, all Heads of UN Agencies, and bilaterals and multilaterals as well as major non-governmental organizations. He added that the Regional Office would start the implementation of the recommendations that relate to WHO and the development partners immediately and appealed to the national delegates to ensure that the recommendations applicable to countries were also implemented with dispatch. He then wished the participants travelling out of Harare a safe trip back to their destinations. 47. The Chairman, Mr Faustin Boukoubi, the Honourable Minister of Health of the Republic of Gabon, expressed his gratitude to the Regional Director, Dr Ebrahim M. Samba, for organizing the Consultation and congratulated him, his staff and participants for making the consultation a resounding success. He thanked participants for their co-operation throughout the third day when he served as chairman. He then declared the consultation closed. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200018 Akwenye O. Deputy Permanent Secretary Ministry of Health and Social P.O. Box 5654 Windhoek, Namibia Telephone No: 09-264-61/ 2032819 Fax No: 09-264-61/ 227-607/ 221332 Andriantsara Guy Health Economist WHO/Country Office B.P. 362 Antananarivo, Madagascar Telephone No: 22-225-82 E-mail: oms@dts.org Anikpo, Emilienne Director, DES WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Ansah, Evelyn District Director Ministry of Health P.O. Box 1 Dodowa, Ghana Telephone No: 233-21-768111/ 404813 E-mail: dodowahr@africaonline.com.gh Annex 1: List of participants Anyanwu, J.C. Economic Adviser WHO/Country Office P.O. Box 2152 Lagos, Nigeria Telephone No: 234-1-5453662-3 Fax No: 234-1-5452179 E-mail: anyanwuj@who-nigeria.org Asfaw, Getachew Chief, Division of Ministry of Economic P.O.Box 1037 Addis Ababa, Ethiopia Telephone No: 55-2800 Attiso, Kossi Directeur general adjoint Ministere de la Sante Publique Lome, Togo Azene, Girma Health Economist Ministry of Health P.O. Box 1234 Addis Ababa, Ethiopia Telephone No: 15-1791 Bachir, Ahmat Mahamat Directeur General Adjoint Ministere de la Promotion BP 286 Ndjamena, Chad Telephone No: (235)-515898 Fax No: (235)-515185 Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 19 Bagate, Bolou Conseiller Technique Ministere de la Sante Publique 01 BP 3251 Abidjan, Cote d’Ivoire Telephone No: (225) 20-21-26-36/ 20-21-77-66/ Balosang, Mmatsae Principal Health Officer Ministry of Health Private Bag 0038 Gaborone, Botswana Telephone No: (267) 353-561 Fax No: (267) 302-092 E-mail: mbalosang@gov.bw Bamgbose, J.K. Assistant Director, Federal Ministry of Health P.O. Box 55192 Lagos, Nigeria Telephone No: 09-5238365 Belhocine, Mohamed Director, DNC WHO/AFRO P.O. Box 773 Harare, Zimabwe Bene Hoane, W Division Manager African Development Bank 01 BP 1387 Abidjan, Cote d’ Ivoire Telephone No: (225)-20-20-41-20 Fax No: (225)-20-20-42-20 E-mail: w.bene-hoane@afdb.org Benstrong, Michael Director-General Ministry of Finance P.O. Box 350 Victoria, Seychelles Telephone No: (248)-225179/ 224581 Fax No: (248)-224620 E-mail: dssf@seychelles.net Beyai, Pa Lamin Health Economist WHO-Gambia P.M.B 170 Banjul, The Gambia Telephone No: 00 (220)-462283/4/6 Fax No: 00(220)-462289 E-mail: beyaipl@qanet.gm Bizo, Moussa Directeur adjoint des etudes Ministere de la Sante Publique BP 623 Niamey, Niger Telephone No: (227)-72-27-82 Fax No: 73-35-70 Bouakaz, Rachid Deputy Director Ministry of Health Algiers, Algeria Telephone No: 213-227-98-15 Fax No: 213-227-98-15/ 213-227-97-69 E-mail: rbouakaz@rhnsina.ands.dz Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200020 Chatora, Rufaro Director, DSD WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Chihanga, Mr. Head, Strategic Development Ministry of Health Box CY 1122 Harare, Zimbabwe Chimfwembe, Davis Principal Health Planner Ministry of Health P.O. Box 30205 Lusaka, Zambia Telephone No: 00260-1-254183/ 795363 Fax No: 00260-1-253173/ 254427 E-mail: idapplan@zamnet.zm Chirwisa FHP WHO/Country Office Kinshasa, DR Congo Conteh, Noah Dep. Director General Ministry of Health and Social Welfare 4th Floor Youyi Building Freetown, Sierra Leone Telephone No: 232-22-222963 Fax No: 232-22-242170 Boukoubi, Faustin Minister Ministry of Health BP 50 Libreville, Gabon Telephone No: 241-76-3590/ 241-72-2407 Fax No: 241-76-8821 Bro, Dr. DANIDA Harare, Zimbabwe Camara, Yero Boye Conseiller Ministere de la Sante BP 585 Conakry, Guinee Telephone No: (224)- 41-20-74/ 41-46-86 Fax No: (224)-41-46-86 E-mail: ctsns@sotelgui.net.gn Cardoso, Margariola Directeur de Cabinet Ministere de la Sante Publique C.P. 47 Praia, Cap Vert Telephone No: (238) 610-111 Fax No: (238) 610-129 Chao, Shiyan Economist World Bank 1818 H Street Washington, DC, USA Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 21 Cossa, Humberto Director of Planning Ministry of Health AV. Salvador Allenco 264 Maputo, Mozambique Telephone No: 258-1-427131/ 4 Fax No: 30-2103 E-mail: hapcossa@tropical.co.mz d’Almeida, Isabel Maria Directeur-General Ministere de la Sante Bissau, Guinee-Bissau Darikwa, Patricia European Union Health Sector Programme Manager P.O. Box 4252 Harare, Zimbabwe Telephone No: (04)-701912 Fax No: 72-5360 E-mail: Patricia.Darikwa@delzwe.cec.int De Matos, Eduardo Directeur Ministere de la Sante C.P. 23 Sao Tome, Sao Tome et Principe Telephone No: 23205/ 22433/ 22290/ 65176 Demas, Sylvia Chief Development Planner National Planning Commission P/Bag 13356 Windhoek, Namibia Telephone No: 264-61-2834111 Fax No: 264-61-226501 E-mail: sdemas@npc.gov.na Diallo, Binta WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Diaouga, Haoua Chargee de Programme Ministere du Plan BP 862 Niamey, Niger Telephone No: (227) -72-22-33 Diarra, Niagale Directrice Adjointe, Ministere de la Sante B.P. 232 Bamako, Mali E-mail: epssante@datatech.toolnet.org Diarra, Bakari Economiste Observatiore de Dev. Humain BP 9070 Bamako, Mali Telephone No: (00223)-238553 Fax No: (00223)-238552 E-mail: diarraf@dotstech.todnet.org Dieng, Abdou Issa Conseiller Technique Ministere de la Sante Dakar, Senegal Telephone No: (221)-821-5761 Fax No: (221)-822-26-90 Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200022 Fall, Khayar Chef de Division Min. des Affaires Economiques BP 238 Nouakchott, Mauritania Telephone No: (222)-25-03-49 Fax No: (222)-25-46-17 E-mail: khayarfall@hotmail.com Fernandes, Raul Coordonnateur National Programme de lutte contre la Pauvrete CL 236 Praia, Cap Vert Telephone No: 61-8833 Fax No: 6137-12 E-mail: pnlcp@mail.cvtelecom.cv Fonseca, Pedro Luis Director Ministere de la Sante Luanda, Angola Telephone No: (244)-2-390001/ 393995/ E-mail: minplan.pca@ebonet.net Franco, Roberto Resident Representative International Monetary Fund 65 Samora Machel Avenue Harare, Zimbabwe Telephone No: 737074/ 75 Fax No: 73-7076 E-mail: rfranco@imforg Doubane-Sana, Lucie Economiste, Service de Coordination de l’ aide Ministere de la Sante Publique B.P 1980 Bangui, Centrafrique Telephone No: (236)-61-76-96/ 30-46-59 Attas, H. Director General Ministry of Health (Zanzibar) P.O. Box 236 Pemba, Tanzania Telephone No: 223-7017 Dukuly, Meimei Consultant Ministry of Health and Social Welfare P.O. Box 10-9009 Monrovia, Liberia Telephone No: (231)-226317 Dzumbira, Naomi Senior Administrative Officer Ministry of Health and Child Welfare Box Cy 1122 Harare, Zimbabwe Telephone No: 73-0011 Etukudo, Akpan IRM WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Telephone No: 1-407-733-9303 Fax No: 1-407-733-9003 E-mail: etukudo@whoafr.org Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 23 Goeh-Akue, Kpakpo Directeur-adjoint Ministere de la Planification BP 544 Lome, Togo Telephone No: 21-0141 Gomba, Alexis Charge de Mission Ministere de l’Economie Bangui, Centrafrique Gonclaves, Adriano Chief of Department of Studies Ministere de la Sante Avenue 17 of September Luanda, Angola Telephone No: (2442)-391641-137/135 Guemouri, Amine Director Ministry of Solidarity Palais du Gouvernement Algiers, Algeria Telephone No: (213)-2-71-9-138/ 71-31-41 Fax No: (213)-2-73-59-96/ 73-64-39 Haile, Yohannes Director, Employment Division Ministry of Labour and Human Welfare P.O. Box 1483 Asmara, Eritrea Telephone No: 291-1-151846 Fax No: 291-1-151749 E-mail: milin@col.com.er Hounkpatin, Honorat WSH WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Hubbard, Anthony Assistant Minister Ministry of Health and Social P.O. Box 10-9009 Monrovia, Liberia Telephone No: 22-6317 Ilori, J.B. Director National Planning Commission Lagos, Nigeria Imani, Younoussa Director General Ministry of Planning Moroni, Comores Johnson, Philomena Senior Planning Analyst National Development Planning Commission P.O. Box C 633 Accra, Ghana Telephone No: 233-21-773011-3/ 307137 Fax No: 233-21-773055/46 Kabasha, Lubuika RUE WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200024 Kane, Youssouf Conseiller en sante Min. de la Sante et des Affaires BP 2745 Noukchott, Mauritania Telephone No: (222)-25-33-34 Fax No: (222)-25-28-03 E-mail: kaneyoussouf@hotmail.com Karega, Vincent Coordonnateur, PLP Ministere de la Planification BP 158 Kigali, Rwanda Telephone No: (250)-76703/ 75657 Fax No: (250)-76701 E-mail: minifin@rwanda1.rwandatel Kariisa, Eddie WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Kaseje, Dan Director Tropical Institute of Community Health P.O. Box 30690 Nairobi, Kenya Telephone No: 254-2-445020 Fax No: 254-2-440306 E-mail: tichnbi@net2000.ke Kabatende, Anne Marie Directrice de la Planification Ministere de la Sante Kigali, Rwanda Kabore, Antoine Director, DDC WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Kadama, Patrick Commissioner for Health Ministry of Health P.O. Box 7272 Kampala, Uganda Telephone No: (256)-40-340884 Fax No: (256)-41-340877 E-mail: kadama@starcom.co.ug Kain, Lahai Ministry of Economic Development and Planning Youyi Building, 7th floor Freetown, Sierra Leone Telephone No: 232-226959 Kamigwi, John Senior Economist Ministry of Health P.O. Box 30016 Nairobi, Kenya Telephone No: 254-2-717077 Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 25 Kebe, Amine Charge des Programmes Ministere de l’ Economie et des Finances 08-Rue Dr Guillet Dakar, Senegal Telephone No: 221-8225456 Fax No: 221-822-12-67 E-mail: amin_kebe@mefp-guillet.sn Khuele, M. (Mrs) Principal Economic Planner Ministry of Health and Social Welfare Box 514 Maseru, Lesotho Telephone No: 09-266-324561 Fax No: 09-266-310281 E-mail: hpsu@lesoff.co.za Kirigia, J PDC WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Klouvi, Leon Directeur de Cabinet Ministere de la Sante Publique Cotonou, Benin Kochoffa, Irenee Directeur Ministere de la Sante Publique DDSP ZOU/Collines Abomey, Benin Telephone No: 50-01-48/ 50-16-56 Fax No: (00-229) 50-03-64 Kofounga, Parfaio Economiste WHO BP 1616 Bangui, Centrafrique Telephone No: (236)-61-23-75 Fax No: (236)-61-01-37 Kombo, Jean Jose Conseiller administratif et financier Ministere de l’Economie et des Finances B.P. 2083 Brazzaville, Congo Telephone No: (242)-814143/ 510344 Fax No: (242)-814145 Konate, Abdoulaye Ministry of Economy and Finance 01 BP 6048 Ouagadougou, Burkina Faso Telephone No: (226)-324056/ 324377 E-mail: abdouloye.konate@finances.gov.bf Lamba, B.S. Sustainable Health Policy WHO-SEARO I.P. Estate, M.G. Road New Delhi, India Telephone No: 00-91-11-3317804/ 26415 E-mail: lambab@whosea.org Lambo, Eyitayo Principal IMH Consultants P.O. Box 5900 Ilorin, Nigeria Telephone No: 234-31-223487/ 223042/ E-mail: enquiries@imhconsultanta.com Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200026 Makuto, D Adviser WHO/HQ WHO CH 121 Geneva, Switzerland Telephone No: (4122)-791-2520 Fax No: (4122)-791-47-47 E-mail: makuto@WHO.CH Malin, Paul Acting Head of Delegation European Commission P.O. Box 4252 Harare, Zimbabwe Telephone No: 70-1912 Fax No: 72-5360 E-mail: hod.ecdelzwe@delzwe.cec.eu.i Mampunza, Miezi Directeur de Cabinet Adjoint Ministere de la Sante B.P. 179 Kinshasa, DR Congo Telephone No: 00243-880-25-13 Manga, Lucien VBC WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Matemachani, Rodney Economist International Monetray Fund 8th Floor, NCR House Harare, Zimbabwe Telephone No: 737074/5 Fax No: 73-7076 E-mail: rfranco@imf.org Lengota, Eugene Attache de Cabinet Ministere de la Sante Publique B.P. 50 Libreville, Gabon Telephone No: 241-76-35-90/ 241-722-407 Fax No: 241-748821 Lopes, Carlos Resident Representative UNDP 67 Union Avenue Harare, Zimbabwe Telephone No: (263-4) 79-2687 Fax No: (263-4) 79-2978 E-mail: carlos.lopes@undp.org Mabaya, David Director, Pharmacy Services Ministry of Health and Child Welfare P.O. Box CY 1122 Harare, Zimbabwe Telephone No: 263-04-791155 Fax No: 263-04-795353 E-mail: dmabaya@gta.gov.zw Maiga, Abdrahamane Economiste WHO/Country Office BP 99 Bamako, Mali Telephone No: 223-22-37-16/ 223-22-46-83 E-mail: maigaa@oms.org.ml Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 27 Matsebula, Thulane Health Economist WHO/Country Office P.O. Box 602 Mbabane, Swaziland Telephone No: (268)-404-3765 Fax No: (268)-404-2157 E-mail: whowr@realnet.co.sz Matusse, Christina Planning Officer Ministry of Planning and Economic Development Maputo, Mozambique Telephone No: 0-258-494987/ 497701 E-mail: cristina@DNPO.UEM.MZ Mgonya, S. N. Deputy Permanent Secretary Ministry of Finance P.O. Box 5380 Dar es Salaam, Tanzania Telephone No: 255-022-2151688 Mhishi, Mr. Director Ministry of Public Service and P. Bag 7707 Harare, Zimbabwe Telephone No: 263-4-794564 Fax No: 263-4-794568 E-mail: mhishi@sdf.org.zw Miankenda, Georges Conseiller Ministere de la Sante Publique B.P. 2101 Brazzaville, Congo Telephone No: (242)-813075-811295 Fax No: (242)-811433 Morfaw, Elizabeth WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Mohamud, Khalif Bile WR/ Iran WHO/Country Office Tehran, Iran E-mail: whoteh@who.un.or.ir Molina, Raul Director, Public Policy PAHO 525 23rd Street Washington, DC, USA Telephone No: 202-974-3142 Fax No: 202-974-3625 E-mail: molinar@paho.org Mondoha, Kassim Secretary General Ministry of Health B.P 1021 Moroni, Comores Telephone No: (269)-744071/ 732585 Fax No: (269)-730402 Msiska, Tomaida Advisor Office of the President P.O. Box 30136 Lilongwe, Malawi Telephone No: (265)-788832/ 788809 Fax No: (265)-788247/ 131/ 093 E-mail: whomalawi@malawi.net/ Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200028 Nasah, Boniface Director, DRH WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Nduwimana, Marie Rose Medecin Directeur Ministry of Health B.P. 1820 Bujumbura, Burundi Telephone No: (257)-226020 Fax No: (257)-229196 E-mail: minisant@cbinf.com Nedjim, Abdelkerim Deputy Director Ministry of Health B.P. 480 Njamena, Chad Telephone No: 235-51-60-90 Fax No: 235-54-48-21 E-mail: DACS10@calva.com Ngartelbaye, Morbe Economist WHO/Country Office BP 152 Njamena, Chad Telephone No: (235)-52-38-03 Fax No: (235)-52-31-59 E-mail: morbe.ngartel@intnet.td Munguti, Katui-Katua Professor University of Nairobi Nairobi, Kenya Musambo, Manengu Health Economist WHO/Country Office P.O. Box 32346 Lusaka, Zambia Telephone No: 260-1-223251-3/ 223215/ Fax No: 260-1-223209 E-mail: mmusambo@zamnet.zm Mwamakamba, Lusubilo WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Mwanza, Gregory Social Welfare Officer Min. of Community Dev and Private Bag W 252 Lusaka, Zambia Telephone No: 260-1-229492/ 229494/ 232796 Fax No: 260-1-2383-38 Myeni, David Economist Ministry of Economic Planning P.O. Box 602 Mbabane, Swaziland Telephone No: 268-404-3765/ 8 Fax No: 268-404-2157 E-mail: dmyeni@mepd.gov.sz Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 29 Ngufor, George Fotoh Chef de Division Ministere de la Sante Publique Division of Studies and Planning Yaounde, Cameroun Telephone No: (237)-22-26-72 E-mail: ngufor@yahoo.com Ngwira, Maoni Health Planner Ministry of Health Box 30377 Lilongwe, Malawi Telephone No: 76-2044 Nhanca, Andre Paulo Technicien Secretariat d’Etat de Lutte contre la pauvrete Bissau, Guinee-Bissau Nitcheu, Gisele ERA WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Njau, Faustin Senior Medical Officer Ministry of Health P.O. Box 9083 Dar es Salaam, Tanzania Telephone No: 022-21-20-26-1 Njoh, Michelin Charge d’Etudes Ministere de l’Economie et des Finances BP 13127 Yaounde, Cameroun Telephone No: (237)-235244 Fax No: (237)-22-27-51 Nkhata, Flanneys MPN WHO P. O. Box 30390 Lilongwe, Malawi Telephone No: 772755- 772450 Fax No: 77-2350 E-mail: whomalawi@malawi.net Nzeng, Antonio Conseiller Presidence de la Republique Malabo, Guinee Equatoriale Obuseng, S Economist UNDP Country Office P.O Box 70469 Gabarone, Bostwana Telephone No: (267)-352121 Fax No: 35-6093 E-mail: sennye.obuseng@undp.org Okaba, Hamidou Commissaire General Adjoint Commissariat du Plan B.P 172 Libreville, Gabon Telephone No: (241)-76-29-11/ 77-34-40 E-mail: okabah@hotmail.com Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200030 Phatela, M. Director Ministry of Development Planning P.O. Box 630 Maseru, Lesotho Telephone No: 09-266-31-11-00 Fax No: 09-266-31-02-81 Rabakosolofonirina, Nivaharisoa Chef, Service des conditions de Direction generale de BP 676 Antananarivo, Madagascar Telephone No: 22-665-26 Ramanandraibe, Lucie Chef, Unite de Management Ministere de la Sante Antananarivo, Madagascar Telephone No: 22-430-15 Fax No: 22-430-15 Ramdoo, U (Mrs.) Economist Ministry of Economic Royal Road Port Louis, Mauritius Telephone No: 201-2243 Fax No: 212-4124 Renner, Ade Health Economist WHO/Country Office P.O. Box 529 Freetown, Sierra Leone Telephone No: 22-3188 Fax No: 232-22-23713 E-mail: who@sierratel.sl Okorosobo, T WHO/AFRO P. O. Box BE 773 Harare, Zimbabwe Okello, David PDC WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Omaswa, F. Director General Ministry of Health P.O. Box 7272 Kampala, Uganda Telephone No: 256-41-340873 Fax No: 256-41-340881 E-mail: dghs@infocom.co.ug Osman, Saleh Permanent Secretary Ministry of Health Zanzibar, Tanzania Pascoal, Eva Health Economist WHO/Country Office Av. Zimbabwe, R30 Maputo, Mozambique Telephone No: 258-1-491991/ 492165 Fax No: 258-1-491990 E-mail: eva@oms-mz.org Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 31 Rocha, Adao Da Silva Consultant CP 577 Praia, Cap Vert Telephone No: 621270/ 626939 Fax No: 62-3141 Sakho, Moustapha Point focal HSR WHO/Country Office BP 4039 Dakar, Senegal Telephone No: (221)-823-0270/ 96 Fax No: (221)-823-32-55/ 823-75-45 E-mail: diops@telecomplus.sn or Samba, Ebrahim Regional Director WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Sambo, Luis Director of Programme Management WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Santos, Hermenegildo Coordonateur, SNLP Ministere de l’ Economie et des Finances Largo Das Alfandegas Sao Tome, Sao Tome et Principe Telephone No: 00-239-12/ 23842/ 23227 Fax No: 00-239-12-22182 Shirimpumu, Theophile President Commission nationale de lutte contre la pauvrete Kigali, Rwanda Sikhakhane, B. Assistant Director of Nutrition Ministry of Health Pretoria, South Africa Simelane, Lungile Health Planner Ministry of Health and Social Welfare P.O Box 5 Mbabane, Swaziland Telephone No: 268-40-44409 Fax No: 268-40-45113 E-mail: cddithis@realnet.co.sz Sindayikengera, Isidore Conseiller au Dept de la Min. Planification du Developpement BP 224 Bujumbura, Burundi Telephone No: 217819-04-00257/ 225394 Some, Romaric Economist Ministry of Health 03 BP 7009 Ouagadougou, Burkina Faso Telephone No: (226) 32-46-62/ 30-66-54 Fax No: (226) 30-66-54 E-mail: arlette.sanou@sante.gov.bf Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200032 Toure, Abdoulaye Chef, Division des Etudes Direction Nationale du Plan BP 221 Conakry, Guinee Telephone No: (224)-41-37-15 Fax No: (224)-41-30-59 Traore, Mamadou Directeur General BAILO 08 B.P. 533 Abidjan, Cote d’ Ivoire Telephone No: (225)-07072788 Fax No: (225)-22472788 E-mail: bailomt@palabre.net Valentin, Bernard Andre Health Economist Ministry of Health Pointe Ay Sel Mahe, Seychelles Telephone No: 371-222 Veerapen, R. (Mrs) Principal Assistant Secretary Ministry of Health and Quality 13, Ackbar Gujadhur Street Curepipe-Road Port Louis, Mauritius Telephone No: 696-0623 Villar, E Coordinator, POV/HSD WHO/HQ WHO 1211 Geneva, Switzerland Telephone No: (4122)-7912616 Fax No: (4122)-7914153 E-mail: Villare@WHO.CH Soucat, Agnes Team member, Health, Pop and World Bank 1818 H Street Washington, DC, USA Telephone No: (202)-473-4415 Fax: (202)-473-8107 E-mail: asoucat@worldbank.org Sow, Idrissa EHA WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Tesfasellasie, Ghirmai Chief, International Ministry of Health P.O. Box 1779 Asmara, Eritrea Telephone No: 291-1-201663 Fax No: 291-1-122899 Thorpe, S.J. ORH WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Touray, Abdou National Coordinator SPACO 14/15 Marina Parade Banjul, The Gambia Telephone No: (220)-226204 Fax No: (220)-228398 E-mail: Spaco@quanet.gm Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 33 Wainaina, Stephen Ministry of Finance and Planning Nairobi Kenya Wandjie, Thomas Deputy Director Ministry of Health BP 2976 Libreville, Gabon Telephone No: 241-26-80-30 Wangata, Jacques Expert Bureau d’ etudes et de recherches B.P. 171 Kinshasa, DR Congo Telephone No: 880-6111 E-mail: bepsante@raga.net Wheeler, Mark HSD WHO/HQ WHO 1211 Geneva, Switzerland Yabou, Lang Senior Assistant Secretary Ministry of Health Dept. of State for Health and Social Welfare Banjul, The Gambia Telephone No: 220-225710/ 228624 Fax No: 220-229325/ 222345 Yessah, Marie Conseiller Technique Ministere de la Sante Publique 05 BP 1122 Abidjan, Cote d’Ivoire Telephone No: 22-419682/ 20-22-6964 Fax No: (225)- 25-97-46 Zawide, Firdu PHE WHO/AFRO P.O. Box BE 773 Harare, Zimbabwe Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200034 ANNEX 2: PROGRAMME OF WORK 19 July, DAY 1 08:30 – 09:00: Registration 09.00 - 09.30: Opening remarks by Dr. Ebrahim Samba, Regional Director of the Regional Office for Africa of the World Health Organization 09.30 - 10.00: Plenary session
Introductory session by Dr. L. Sambo, Director of Programme Management, WHO/ AFRO.
Election of the Bureau.
Adoption of Programme of Work. 10.00 - 11.30: Plenary session
Presentation of Poverty and Health Paper by Mrs. E. Anikpo, Director, Division of Healthy Environments and Sustainable Development, WHO/AFRO.
Discussion (Panelists: AfDB, IMF, UNDP, World Bank, European Union, TICH). 11.30 - 11.45: Coffee Break. 11.45 - 13:00: Plenary session
Report of study group 1 (Rwanda/Mauritania) on Process and content of National PR strategy and its implementation.
Presentation.
Discussion. 13.00 - 14.30: Lunch Break. 14.30 - 15.30: Plenary session
Report of study group 2 (The Gambia/Uganda) on Process and Content of National PR strategy and its implementation.
Presentation
Discussion 15.30 - 15.45: Coffee Break. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 35 15.45 - 17:00 Plenary session
Report of study group 3 (Cape Verde/ Mozambique) on Process and content of National PR strategy and its implementation.
Presentation
Discussion 20 July, Day 2 08:30 - 09.30 Plenary session
WHO/African framework for linking debt relief with poverty reduction through health by AFRO Consultant, Prof. E. Lambo.
Poverty Reduction Strategy Papers and Health by HSD, WHO/HQ
Discussion (Panelists: World Bank, IMF, AfDB). 09.30 - 10.00: Plenary Session
Introduction to Group Work on WHO/African Framework for linking debt relief with poverty reduction through health. 10.00 - 10.30: Coffee Break. 10.30 - 12:30: Group work. 12.30 - 14.00: Lunch Break. 14.00 - 16.00: Group Work continued 16.00 - 16.15: Coffee Break. 16.15 - 17.15: Plenary session
Reports of Group Work.
Discussion. 21 July, DAY 3 08.30 - 10.00: Plenary session
Core health interventions for poverty reduction, by Dr. R. Chatora, Director, Health Systems Development Division, WHO/AFRO Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200036
Poverty and Health: Basic Development Needs approach as a viable strategy for joint action, by Dr. Khalif Bile Mohamud, WHO Representative, Islamic Republic of Iran 10.00 - 10.15: Coffee Break. 10.15 - 12.45: Plenary session
Discussion on core health interventions and basic development needs presentations (Panelists: ADB, IMF, European Union, World Bank, TICH). 12.45 - 15.30: Lunch Break. 15.30 - 17.00: Plenary Session
Wrap up and closing session.
Recommendations.
Next Steps.
Closing ceremony chaired by Dr. E. Samba, Regional Director, WHO/ AFRO Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 37 ANNEX 3: GUIDELINES FOR GROUP WORK 1. Topic(s) WHO/AFRICAN Framework for linking debt relief to poverty reduction through health 2. Time: 10:30 – 12:30 and 14:00 – 16:00, 20 July 2000 3. Groups: Members and meeting venue (see attached list) 4. Conduct of the Group Work – Guidelines i. Each group will be provided with a moderator, two rapporteurs and two facilitators. ii. The moderator is expected to direct the Group Work whilst the facilitators are to provide technical clarifications, as and when necessary, and also ensure that discussions do not veer away from the issues to be discussed. iii. Key issues that should be discussed during this group work are the following: a) Who should be involved (and how) in the development of a country’s comprehensive poverty reduction strategy to ensure that it addresses poverty in all its ramifications and also to enhance its (the strategy) successful implementation? b) What should be the major elements of the content of a country’s PRS? c) Why should a national PRS be made gender-sensitive and how? d) What is the relationship, if any, between the health interventions defined as part of your country’s poverty reduction strategy and the content of your health sector reform programme? e) What are the key factors for the successful development and implementation of a national PRS? f) Most African governments have repeatedly expressed the view that substantial debt relief is a necessary condition for poverty reduction in their countries. There is, however, the need to ensure that savings from debt relief will be used as part of the resources for dealing with the multidimensional poverty problem. Examine the proposed framework for linking debt relief to poverty reduction and provide additional suggestions for improving the framework so that its (the framework) use by African countries, in particular, will effectively link debt relief to poverty reduction. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200038 5. Expected output from Group Work The rapporteurs, with the assistance of the moderator and the facilitators, will prepare the key observations, conclusions and recommendations of the group on issues discussed. A maximum of 3 transparencies should be used by one of the rapporteurs to make a presentation of not more than 10 minutes at a plenary session. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 39 Group 1: (French) Akeng Jose Andriantsara Guy Attiso Kossi Bouakaz Rachid Cardoso Margariola Chirwisa Diallo Binta Diarra Bakari Doubane-Sana Lucie Imani Younoussa Kabasha Luibuika Kabore Antoine Kane Youssouf Karega Vincent Kebe Amine Klouvi Leon Kombo Jean Jose Konate Abdoulaye Maiga Abdrahamane Nedjim Abdelkerim Nitcheu Gisele Ngufor George Fotoh Okaba Hamidou Rabakosolofonirina Nivaharisoa Shiripumu Theophile Sindayikengera I Soucat Agnes Toure Abdoulaye Traore Mamadou Group 2: (English) Akwenye O Ansah Evelyn Anyanwu J.C. ANNEX 4: WORKING GROUPS Attas H. Balosang Mmatsae Bamgbose J.K. Bro Dr. Chatora Rufaro Chao Shiyan Chifwembe Davis Conteh Noah De Klerk G.H. Demas Sylvia Haile Yohannes Hubbard Anthony Johnson Philomena Khuele M. Lamba B.S. Mabaya Dr. Makuto D. Mhishi Dr. Mohamud Khalif Bile Morfaw Elizabeth Msiska Tomaida Munguti Katui-Katua Musambo Manengu Myeni David Njau Faustin Omaswa F. Phatela M. Ramdoo U. Renner Ade Sikhakhane B. Tesfasellasie Ghirmai Valentin Bernard Andre Wainaina Stephen Wheeler Mark Yabou Lang Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200040 Group 3: (French) Adams Orvill Bashir Ahmat Mahamat Belhocine Mohamed Bene Hoane W Camara Yero Boye Diaouga Haoua Dieng Abdou Issa Fall Khayar Fernandes Raul Goeh-Akue Kpakpo Gomba Alexis Guemouri Amine Hounkpatin Honorat Kabatende Anne Marie Kochoffa Irenee Mampunza Miezi Miankenda Georges Mondoha Kassim Nduwimana Marie Rose Ngartelbaye Morbe Njoh Michelin Nzeng Antonio Ramanandraibe Lucie Sakho Moustapha Some Romaric Traore Niagale Wandjie Thomas Wangata Jacques Group 4 (Multilingual – English, French, Portuguese) Asfaw Getachew Azene Girma Benstrong Michael Chihanga Mr. Cossa Humberto D’Almeida Isabel Maria De Matos Eduardo Dukuly Meimei Dzumbira Ms. Fonseca Pedro Luis Franco Robert Gonclaves Adriano Ilori J.B. Kain Lahai Kamigwi John Kariisa Eddie Kostermans Kornelis Lambo Eyitayo Magona I. Matsebula Thulane Matusse Christina Mgonja G.G. Molina Raul Mwanza Gregory Ngwira Maoni Nhanca Andre Paulo Obuseng S. Osman Saleh Pascoal Eva Santos Hermenegildo Simelane Lungile Touray Abdou Veerapen R Villar Eugenio Zawide Firdu Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 41 ANNEX 5: Report of working group 1 For each of the six questions, the group reached a common understanding of the issues being raised, albeit that the questionnaire was only available in English Question (a) Who should be involved (and how) in the development of a country’s comprehensive poverty reduction strategy to ensure that it addresses poverty in all its ramifications and also to enhance its (the strategy) successful implementation? An exhaustive list of actors, each impacting on poverty, is an imperative for the preparation of a realistic, executable strategy. The following methodology was employed: listing of the actors and steps: ACTORS
Beneficiaries
Politicians
Civil service
Government
Private sector
Civil society
Elected officials
Media
Development partners
Scientific community Poverty reduction programmes are trans-sectoral in nature, and the national poverty reduction strategy is a framework, which enables each actor to contribute to reducing poverty in a sustainable manner. D. ELABORATION PHASE 1. Launching of the initiative 2. Definition of poverty and its determinants 3. Diagnosis and analytical phase 4. Strategy formulation phase 5. Elaboration of short, medium and long term programmes 6. Adoption of the strategy by government (national consensus) Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200042 7. Follow-up/evaluation ACTORS DIRECT BENEFICIARIES ELECTED OFFICIALS CIVIL SERVICE GOVERNMENT PRIVATE SECTOR CIVIL SOCIETY (including all pressure groups who can influence government policy to become more transparent) MEDIA DEVELOPMENT PARTNERS SCIENTIFIC COMMUNITY Question (b) What should be the major elements of the content of a country’s PRS? In spite of the existence of diverse and different situations in the countries, common elements include
Respect of the rule of law
Pro-poor macroeconomic framework
Promotion of the private sector and high-growth potential technologies
Promotion of access to resources by the poor (land, micro-credit) and social infrastructure
Development of capacities
Identification of strategic orientations over the short, medium and long term Elaboration of evaluation criteria Question (c) Whenever social practices/traditions discriminate and impoverish a segment of the population, people are excluded from the wealth creation processes in countries. This is why every PRSP must take gender issues into consideration. How?
Ensure that all capacities are mobilized for wealth creation.
Apply positive discrimination in favor of disadvantaged groups Question (d) Health sector reform and PRSP overlap. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 43 The group made 2 recommendations:
As most countries are presently engaged in the 18 month-long preparations of PRSP’s, it was recommended that PRSP make full use of existing data and programmes for the elaboration of health sector reform programmes.
The PRSP is a framework suitable for coordination of all health sector related activities. As such, it takes into account programmes affecting health but not under the direct mandate of the Ministry of Health. Question (e) Key factors for the successful implementation of PRS
Peace
Political will (at the highest level)
Good definition of the determinants of poverty and target populations
Partnership and inter-sectoral collaboration
Availability of resources (human, financial, physical)
Appropriate institutional framework
Solidarity (national, regional, international) Question (f) There are no viable social projects without a stable economy. This is why every activity undertaken within the context of poverty reduction must create wealth. Moreover, resources generated or saved as part of debt relief must be allocated towards wealth creation. Suggestion for linking debt relief and poverty reduction
Indexing resources freed by debt relief towards quantifiable poverty reduction objectives.
Allocation of resources generated from debt relief towards health expenditures
Conditionalities should never adversely affect national entreprises and competencies
Increased financial support for new technologies, particularly those with high growth potential
Debt relief is only one means for financing poverty reduction. Other sources of finance must also be mobilized (government budget, private sector etc)
Encouragement of private sector investment in rural areas
Financing of infrastructure projects (roads, rural telephone systems, energy….) Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200044 Annex 6: Report of Group 2 Question (a). Who should be involved? (a) All sector ministries (b) NGOs (c) Civil Societies (d) Private sector (e) Community leaders (f) Development Partners (g) Special Action Cps (rep. Handicapped etc.) (h) Legislators (i) The poor How?
Dialogues
Community debates
Consultative meeting
Participatory methods The Process 1. Initiation – Head of state/Govt. 2. Situational Analysis
Sector ministry
Community leaders
Poor etc
Private sectors
NGOs
Civil/societies
Action Cps 3. Development of Draft document
Technical Committee 4. Consensus Building on document
All stake holders at all levels 5. Adoption of Final Framework for Poverty Reduction Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 45 Question (b) Major elements 1. Background (a) Economic (b) Political (c) Socio-cultural (d) The National Policy (e) Demographic (f) Review of Premiums PRSs 2. The nature and Distribution of poverty in country 3. Description of the process 4. Analysis of determinants and causes of Poverty 5. Targets and indicators 6. Possible Interventions and costs 7. Intervention with maximum impact on poverty 8. Monitoring and evaluation plan 9. Follow – up strategies NB Gender main streaming at every stage Question (c) Why PRS should be gender – sensitive Poverty affects the different gender differently and these differences must be taken into consideration How? Through targeting and mainstreaming Question (d) Relationship between Health Interventions in PRS and HSR They are the same in most countries Question (e) Key factors for successful development and implementation of PRS
Political will and commitment (as evidenced by in/c budgetary allocation)
Sound Institutional Framework for implementation
Effective coordination of sectoral programmes at all levels
Adequate capacity at all levels
Good Governance Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200046
Empowerment/Participation of the Poor
Macro-economic stability
National and Sub-regional stability
Political
Economic
Support from Development Partners
Debt cancel/action Question (f) Suggestion for improving framework for linking DR to PR
Conditionalities for DR must be negotiated with debtor countries and not imposed
Improve terms of trade to enable countries become more self-reliant
Improve Fiscal discipline in countries
Continuous debt sustainability analysis Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 47 Annex 7: Report of working group 3 Question (a) Phases: Conceptual phase and implementation phase Actors: Civil service (national and local) Civil society Elected officials Development partners Communities Private sector How: Elaborate the poverty reduction strategy by:
Proposing the broad strategic orientations for poverty reduction
Ensuring the technical soundness of the poverty reduction strategy paper
Providing technical support and recommendations to government on national policies and programmes Question (b) Main elements of the PRSP
Macro-economic policy
Good governance
Promotion of income generating projects
Promotion/adoption of employment creating policies
Access to basic social services
Coordination of poverty activities
Creation of an appropriate institutional framework for the implementation of the PRSP
Respect and promotion of womens’ rights
Protection of the environment
Access to productive assets (micro-credit, land) Question (c) How and why should the PRS take gender into account? Why:
% of women of total population
Contribution to economic activities
Marginalisation (illiteracy, exclusion)
Vulnerability Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200048
Poverty of women
Lack of access to resources
Family support How:
Application of international resolutions/declarations regarding women
Mainstreaming of gender considerations into development programmes and policies
Increased budgetary outlays for reproductive health
Eradication of harmful traditions
Improvement of gender dis-aggregated poverty data Question (d) Relationship between health sector interventions within the framework of PRS and health sector reform All health sector reform activities aim to reduce poverty The fight against communicable and non-communicable diseases is a poverty related issue Similarities and differences:
Social exclusion
Financing alternatives not taken into account by certain PRSP
In-kind contribution of communities towards the construction of health centers
Reform of health financing to provide better care to the poor (primary, secondary and tertiary health care)
Creation of health care support networks
Strengthening of health districts
Promotion of the use of generic medicines in the private and public sectors
Availability of generic essential drugs It is also necessary to revise existing health sector strategies to take into account gender and poverty. Question (e) Key factors for the successful elaboration and implementation of the PRS
Political will of governments
Good governance
Social stability
Resource mobilization Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 49
Intersectoral collaboration
Full involvement of all actors
Effective institutional framework
Strong economic growth
Effective monitoring system Question (f) Link between debt relief and poverty reduction Framework proposed on page 17 adopted by the group. However, it needs to take the private sector into account. Other proposals relative to resources tied to debt relief
Need to create an international mechanism to monitor usage of resources generated by debt relief
Allocation of resources to countries based on their priorities in terms of poverty reduction
Allocation of a percentage of these resources to health
Establishment of a follow-up mechanism to monitor implementation of the PRSP Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200050 Annex 8: Report of Working Group 4 Question (a) Who should be involved and how?
Political level –Govt., Elected Assemblies, Local Govt. and Political parties
Key departments – Finance, Health, Education, Agriculture etc.
Private sector, NGOs
The poor and community leaders
Development partners, particular those based in the country – WHO, WB, ADB, UNICEF, Bi-laterals. The Government should lead and specificity of each country needs to be considered – in developing organisational structures. Question (b) Major elements of country’s PRS
Definition of poverty
Situational Analysis on - Macro-economic parameters and other indicators – including social welfare indicators - Past experience & Lessons learnt - Identify problems/constraints/opportunities - List interventions that are potentially possible - Prioritize interventions including outcome targets, indicators and monitoring framework These interventions should cover income generation, provision of Social Services and Community Empowerment
Institutional Framework and capacity building
Implementation Plan and Budget and sources of funds/resources Question (c) Why make PRS Gender Sensitive?
Burden of poverty on men and women differs
A lot of support for households is expected from women Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 2000 51 How? Gender related activities should be cross-cutting and not isolated components Question (d) Health Reforms v PRS
Health Sector Reforms have tended to emphasize efficiency and Resource mobilization-and have tended to give low priority to equity issues
The Health Component of PRS should be integrated in Health Sector Reforms. Question (e) Key factors for success
Political/national will and commitment
National leadership and ownership at all levels
Clear goals/objectives and output oriented, as well as setting objectives and goals that are feasible in a given timeframe.
Linking PRS goals/objective to overall national and sectoral goals and policies
Good governance; transparency and accountability and a strong institutional framework
Political stability as well as control HIV/AIDS and population growth
Linkage between Macro/Micro levels and target groups to ensure that benefits reach the poor
Stakeholder participation at all levels.
International support
Monitoring system for all stakeholders.
Careful public sector reforms Question (f) Debt Relief in Africa
DR is necessary but not sufficient to eradicate poverty
HIPC countries should be grouped according to special characteristics (a) Those that cannot pay debts (b) Those struggling to pay debt (c) Those not in HIPC but have high Domestic Debt – criteria needs review
Clear institutional framework is needed to monitor allocation of resources from DR to ensure that resources reach target groups
DR should be accompanied by
Massive aid/investment inflows to HIPC and others on the margin
Better terms of trade to eradicate poverty in Africa are needed in relation to developed countries. Report of WHO-AFRO Regional Consultation on Poverty and Health, Harare, Zimbabwe, 19-21 July 200052