As distressing as this story is, it’s not just a distant tragedy. Children account for one in five antimicrobial resistance (AMR) deaths globally. Another telling statistic: every year, over 700,000 children under the age of five die from pneumonia, a disease that antibiotics should be able to treat. However, critical antibiotics that should cure sick children are unavailable, untested, or don’t exist for the youngest patients. This is a failure of incentive, as children are complex to study and chronically deprioritized by the global policies that govern their supply. The AMR crisis in children is thus, at its core, a policy crisis. A crisis that could very well be worsening, moreover. 

Antibiotic shortage and AMR amplify each other

Antibiotic shortage and antimicrobial resistance do not simply coexist; they amplify each other. When the right antibiotic is unavailable, clinicians are forced to prescribe second-line alternatives that are less targeted. This is not just suboptimal care, it accelerates the selective pressure that drives resistance. The case of the 25-month-old boy could be dismissed as a distant tragedy, but the crisis is not confined to rural Africa. A systematic review from 2025 found that shortages are increasingly prevalent, even in high-income countries, routinely producing treatment failure, prolonged hospital stays, and inferior substitute prescribing. Children who receive the wrong drug can die, but they may also carry and spread a more resistant strain. A shortage is thus not just a supply problem with potentially fatal consequences for children; it can also accelerate AMR.

Even when antibiotics exist, they are frequently unavailable to children in any meaningful clinical sense. A few months ago, The Lancet Regional Health Western Pacific uncovered a shocking gap in children’s medicine in the Oceania region. Of the 12 antibiotics recommended by WHO for serious drug-resistant bloodstream infections, only six were licensed for children under 12, while merely three were for infants. Researchers describe it as “the decade long delay” –  the average between approving a new antibiotic for adults and finally studying it properly for children. During that window, pediatricians are left guessing. They prescribe off-label, estimating doses from adult data for bodies that metabolize drugs in an entirely different way.

Upcoming World Health Assembly: a window of opportunity?

In May 2026, the World Health Assembly will consider an updated Global Action Plan on AMR. The current draft contains robust language on surveillance and innovation but lacks a dedicated focus on children and newborns. Without child-specific targets, member states face no accountability to disaggregate AMR data by age, prioritize pediatric formulations or close licensing gaps on a defined timeline. Let’s not mince words: a plan that does not name children does not protect them. The political will to change this exists, different frameworks for mandatory pediatric licensing timelines have been outlined. What is still missing is the global governance architecture to push for them.

The child in Banjul did not die because no one knew how to treat him. He died because the system failed to ensure the medicine that existed was approved for his age, and was on the shelf when he needed it. This is a policy failure, and policy failures can be fixed. The World Health Assembly’s updated Global Action Plan is an opportunity to do exactly that: to mandate child-specific AMR data and research, set time-bound licensing requirements, and build supply chain accountability frameworks that hold member states responsible for keeping essential pediatric antibiotics in supply while resourcing those who cannot supply their own. Because this crisis does not begin and end at a nation’s income level. It begins when children’s health and rights are not prioritized in the first place.

Don’t get me wrong, I am not a skeptic of technology. Having spent four years of working with digital health tools in Uganda, I recognise the genuine promise AI holds for healthcare. AI can reduce inefficiencies, improve patient flow and experience, expand access to healthcare in remote areas, and enhance diagnostic capabilities, among many other possibilities. However, I cannot shake the feeling that we are getting the sequence spectacularly wrong. In our rush to deploy cutting-edge AI, we risk building the penthouse while the foundation continues to crumble.

“The sand”

Approximately 1 billion people access healthcare from facilities without reliable electricity access or with no electricity at all. This energy gap is acute in rural areas with over 50,000 healthcare facilities in rural Africa lacking electricity supply, though many urban facilities also face inconsistent unreliable power supply. With inconsistent electricity and limited renewable energy alternatives, how do we deploy sophisticated AI systems in facilities that cannot refrigerate vaccines properly, cannot keep lights on for nighttime procedures, and cannot guarantee staff will have power to even load the AI interface?

Let’s be wildly optimistic and assume we solve the electricity crisis tomorrow, for example if efforts by the World Bank and others pay off. We would still confront the reality of inadequate healthcare staffing, deteriorating facilities, poor internet penetration, and a workforce with minimal digital literacy. A 2022 survey of 47 African countries found that the region has a ratio of 1.55 health workers  (including nurses, midwives and physicians) per 1000 people, far lower than the WHO recommended 4.45 health workers per 1000 people to achieve universal health coverage. While AI can improve efficiency and enable health workers to see more patients, it cannot replace them. Maybe OpenAI and the Gates Foundation see the future differently, but healthcare at its core depends on human connection, contextual judgment, and the application of tacit knowledge, qualities that remain fundamentally beyond AI’s reach.

Internet access is fundamental to leveraging AI’s healthcare potential, yet the digital divide remains stark: internet usage averages just 23% in low-income countries compared to 94% in high-income countries. In Africa specifically, nearly 400 million people in Eastern Africa and 268 million in Western Africa remained offline as of October 2025. Limited connectivity breeds limited digital literacy. In 2011, in rural Ghana and Tanzania for example, only 40% of health workers had ever used computers, just 29% had received any computer training, and roughly 80% were computer illiterate or beginners. A more recent 2017 study still found that a substantial amount of health workers in sub-Saharan Africa were not sufficiently familiar with computer tools, lacking important computer skills. Zoom out further: 12 of the world’s 20 countries with the weakest digital skills are in Africa, where only 11% of university graduates have formal digital training. The gap between AI’s requirements and Africa’s reality is staggering!

The need for sequencing

Am I advocating for abandoning AI and digital health tools altogether? Absolutely not. I’m arguing for prudent sequencing, for not skipping the foundational steps that ensure sustainability and enable AI to deliver on its promise. Before we invest millions in AI deployment, we must ask critical questions: Will these tools function when the power goes out? When the internet is down? When the only available health worker has never used a computer? If the answer is no, then we’re not solving Africa’s healthcare crisis. We’re creating dependence on systems that will fail precisely  when they’re needed most.

AI itself isn’t the problem. The problem is magical thinking. It’s the belief that we can somehow bypass the hard, unglamorous work of building functional health systems and jump straight to the sexy, Silicon Valley solution. That technology can paper over the cracks in infrastructure, staffing, and resources.

Real healthcare transformation requires doing the boring work first. Training and employing more health workers. Building and renovating health facilities. Ensuring consistent electricity and internet. Establishing dependable supply chains. Then we can intelligently integrate technology that actually works in African contexts. This means digital tools must be built for the realities they serve, not imported wholesale from high-resource settings where power outages are rare, internet is ubiquitous, and every health worker has grown up with computers. Technology designed for San Francisco won’t work in Kampala without adaptation, or without the infrastructure San Francisco takes for granted.

Yes, AI belongs in Africa’s healthcare future, but as the cherry on top. You cannot build a digital health revolution without power, without skills, without infrastructure.

And right now, we’re trying to do exactly that.

The medicinal and aromatic plants mentioned in this year’s theme bridge the gap between ancient traditional systems and modern clinical science, providing bioactive compounds that treat complex diseases and serving as the blueprint for most of the modern pharmaceutical drugs. Overall, human medicine is heavily connected to plant biodiversity. Indeed, in recent decades the rate of use of medicinal plants has increased in both developing and developed countries. Developing countries however heavily rely on them, compared to developed countries. One of the main reasons for this is that medicinal plants are readily available, align with different cultures and are perceived to be safe and effective when taken. As a result, the demand for these plants (including in developed countries) is so high that some of the different species are threatened with extinction. Moreover, extinction potential for numerous plants is being exacerbated by climate change.

Efforts thus ought to be ramped up to conserve these plants. Indeed, conserving and preserving medicinal plants not only contributes to health but also stabilizes ecological systems. This ultimately contributes to the different Sustainable Development Goals (SDGs) including SDG 1 (Good Health and Wellbeing), SDG13 (Climate Action) and SDG 15 (Life on Land) among others.

Moving forward in the context of sub-Saharan Africa

There is a need for increased research on medicinal and aromatic plants especially in developing countries. This is crucial to support understanding of the active compounds within these plants, their efficacy and ecological requirements for their replication. While some studies have been undertaken, many aspects and sites are understudied. Yet, important insights could be drawn from the dynamics of such plant uses as well as from their ecological requirements. For example, in Uganda, medicinal plants are known to be critical and have recently been integrated in the health system. Besides, they were widely utilized during the COVID-19 pandemic reflecting the value that local people attach to them.

However, despite their critical value, studies on their application in different locations, efficacy and ecological requirements are very limited. Additionally, stakeholder engagement on their conservation is limited. Their use for medicinal purposes is mainly left for the public health professionals while conservation efforts are considered the territory of conservationists. More robust joint efforts across different stakeholders within Uganda would lead to improved, safer and more sustainable use. One of the opportunities that can be used in this respect is the One Health platform which includes stakeholders from different disciplines. Indeed, medicinal plants provide One Health benefits by addressing public health challenges while also contributing to healthy ecosystems. Drawing upon different stakeholders from different disciplines can thus provide opportunities for improved and more sustainable utilization of these plants across the country. I hope such conversations will emerge during the World Wildlife Day (WWD) celebrations in Uganda slated for February 26th, 2026. This will be a great platform so as to improve stakeholders’ understanding of the complexities in the utilization of medicinal and aromatic plants.

Beyond Uganda, such conversations should be held in other countries as well, and not just when World Wildlife Day is commemorated but also at other events. This is crucial as the world faces numerous health issues and security threats that could be addressed using compounds from such plants.

Some of the medicinal and aromatic plants used in Uganda. Background picture: Mondia whitei . Picture at the bottom: Piper guineense

“How would you describe the past year, and the year ahead, in one word?”

The answers are usually hopeful. Change. Clarity. Growth. Stability.

If I had to describe the past year in one word for the global health community, however, I would choose grief. It feels as though we have lost something in the world of global health and development. Some losses are tangible, such as funding, programs and jobs. Others are less visible but deeply consequential, such as trust, confidence and a sense of direction. To borrow Sir Jeremy Farrar’s words, citing Lenin: “There are decades where nothing happens; and there are weeks where decades happen.” Last year felt exactly like the latter.

Just before Christmas, many Dutch households received a 72-hour survival guide outlining how to cope during the first days of a national emergency. Ironically, during the same week, residents in Utrecht experienced bacterial contamination of their water supply triggering panic buying of bottled water, and shutting down office coffee machines. Perhaps this was a small glimpse of what a “national emergency” feels like in the Dutch context.

The point I am trying to make is that we are living through a period of constant, overlapping crises: preparations for war, a global health funding crisis, disruptions to essential health services (TB, HIV, malaria, …), widespread misinformation, erosion of trust in science, an increasing climate emergency, and the ever-present risk of another pandemic driven by emerging or re-emerging infectious diseases.

These emerging (and re-emerging) problems demand creative solutions. During the previous Emerging Voices for Global Health (EV4GH) venture in Nagasaki in 2024, linked to the  8th Global Symposium on Health Systems Research, we held rich discussions across many health topics, identified numerous problems, and debated intensely. But how many concrete solutions have emerged since then? If we are honest with ourselves, we must admit that thinking solely within the boundaries of academia will not be enough to address the challenges we now face. Let’s be honest: how many people are actually reading our prestigious academic publications, flashy reports, or scrolling back through the screenshots from conferences saved on their phones (usually only when storage runs out)? We need to bring the broader community into these conversations and involve them in co-creating solutions.

Encouragingly, global health stakeholders like Wellcome Trust have already begun rethinking the future of global health, calling for urgent reform. They are far from the only ones, a number of processes and initiatives are ongoing to re-imagine global health so that it’s ‘fit for the future’. Emerging Voices remain uniquely positioned to help shape that future. We know the problems; we live the problems. But we urgently need more collective problem‑solving (and perhaps a bit less discussion?).

This year’s EV venture in Dubai aims to offer a structured platform for critical engagement with the current global health agenda. This includes conversations on global health reform, power and politics, and related issues, shaped through exchanges with senior global health experts and peers. Crucially, the aim is not dialogue for its own sake, but the co-production of solution-oriented outputs.

EVs have been “emerging” for many years. Arguably, many EVs from the previous cohorts are “Emerged” by now, they have done and are doing great work in their countries, regionally or at global level.  Nevertheless, my hope is that 2026 becomes a year of transformation for EV4GH.

The current EV Board is working hard to make this happen, in spite of the undeniably difficult times.

See you in Dubai in November!

The EV4GH Governance team at a recent preparatory meeting in Dhaka

The Program began with LHWs working as stipend-based volunteers; later they became permanent government staff however, increasing costs and making expansion difficult. A number of innovative reforms were rolled out in the LHW Program in Punjab, following the devolution of health services to the provinces. Still, by 2012, half of Punjab’s population remained uncovered by the LHWs, especially in urban slums and remote villages. Workforce numbers fell further over the years due to retirements, terminations and hiring freezes, and LHW roles remained limited despite additional tasks assigned to them. The program could not adapt to new health challenges or tools due to the limited capacity of the workers, and investments in newer reforms. These newer reforms focused more on strengthening primary care service delivery in existing health facilities (e.g., equipping them for 24/7 basic Emergency Obstetric and Newborn Care (EmONC)). High salary obligations of LHWs also restricted growth and innovation. By 2020, the need for an overhaul of the LHW Program, and a new community health strategy in Punjab was clear, prompting the Government to explore alternative models.

Punjab reform

In 2025, Punjab’s Government launched a major reform in this regard: the outsourced Community Health Services program, of which the centerpiece is a new Community Health Inspector (CHI) cadre. Starting as a pilot with 500 CHIs in late 2024, around 20,000 CHIs are now being recruited and deployed across the province to work alongside the ~39,000 existing LHWs. This effectively doubles the community health workforce and is designed to ensure that every community – rural or urban – has at least one health worker. The aim  is for CHIs to fill the gaps left by the LHW program and bring a fresh, modern approach to community healthcare. They are also meant to replace every other outreach health worker in their catchment areas (e.g., the vaccinator, sanitary inspector, etc.) by taking over a holistic approach to health services through a single cadre.

The CHI initiative is not just an expansion in numbers, it also represents a qualitative leap in how community healthcare is delivered. Being certified by the Pakistan Nursing Council, CHIs are more qualified than traditional LHWs. This allows them to provide a broader range of services. While they still provide maternal and child health care, they also address general health needs for all ages including outreach vaccination services, disease surveillance, screen and monitor chronic illnesses, provide health education on nutrition and hygiene, treat minor ailments, and quickly refer serious cases to nearby health facilities. In essence, a CHI serves as an “all-in-one” community health provider not limited to one demographic or task, but acting as a frontline resource for the entire community.

The management and accountability structure of CHIs is also transformative. Instead of being hired as government employees, CHIs are recruited through third-party organizations, who are contracted by the Health and Population Department. This outsourcing model infuses flexibility and performance-based payments into the system. The government sets the qualifications, training standards, and job descriptions for CHIs, and outlines performance benchmarks (in the form of coverage targets). The contracted organizations hire individuals meeting these criteria and deploy them as CHIs. This arrangement means CHIs work on a contractual basis, with performance closely monitored and evaluated by the third party and the Government. Another modern element is the integration of digital technology. Each CHI will use a tablet to record data during community visits, feeding into the electronic health database. This creates a real-time picture of community’s health. Digital records let CHIs track patients over time and improve referrals. Health officials can also monitor these reports to spot trends (e.g. outbreak predictions) and respond promptly. It’s a significant upgrade from the paper-based registers LHWs used – a faster and more accurate flow of information to decision-makers is now possible. Over time, the real-time data from CHIs will enable more responsive public health actions and the establishment of a community health registry.

In terms of their role in communities, CHIs serve as the primary liaison between the community members and the formal health sector. A CHI is assigned a specific catchment area – eg. a cluster of villages or a neighborhood in a city with the mandate to get to know that community’s health profile in detail. By virtue of frequent home visits and interactions, CHIs become trusted figures to whom people can turn when they have any health issues.

Future impact

The CHIs are expected to already have a positive impact in the near future. By plugging service gaps, more people will receive essential healthcare at their doorstep leading to healthier communities. Each area having an assigned health worker will no doubt also increase public trust in the system.

I had the privilege of visiting Bhutan recently for a regional workshop on antimicrobial resistance (AMR) surveillance and data visualization, organized by Fleming Fund Antimicrobial Resistance and One Health South Asia (AMROH SA). Flying into Paro, one of the world’s most dangerous airports,  with its dramatic descent between Himalayan peaks, was a fitting introduction to a country as unique as it is inspiring.

Paro Taktsang (a sacred Tiger’s Nest Bhutan monastery) located in Paro, Bhutan

What struck me most was Bhutan’s integrated vision for health, happiness, and sustainability. Bhutan is the only country in the world that uses Gross National Happiness (GNH) as a development metric alongside GDP. Rooted in Buddhist philosophy, GNH emphasizes a balance between material progress and mental, cultural, and spiritual well-being. Every five years, Bhutan conducts a national happiness survey. Recent results show increasing GNH, driven by better health, improved living standards, and active cultural participation. This aligns beautifully with the WHO definition of health as “a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity”.

From a global health lens, Bhutan is addressing commercial determinants of health better than most. The country has no KFC or MacDonald fast-food chains, no billboards, and limited multinational influence. Television arrived only in the early 2000s. Most shops are small and locally owned. In 2010, Bhutan banned tobacco sales and imposed a 100% tax on imports for personal use. Healthcare and education are guaranteed by the Constitution, which mandates free access to both modern and traditional medical services.

On the One Health and Planetary Health part, Bhutan’s example is extraordinary. In 2021, following a royal decree, the country launched its most ambitious Nationwide Dog Population Management and Rabies Control Programme to vaccinate and sterilize all free-roaming dogs. Within two years, Bhutan became the first country in the world to achieve 100% sterilization of its free-roaming dog population. This is a true One Health success integrating animal welfare, public health, and community action.

During our workshop, we also learned that Bhutan is effectively combatting AMR well by strictly regulating the use of antimicrobials in food production. As a result, resistance levels are significantly lower compared to neighboring countries such as India, Nepal and China.

The exclusive post stamps from the rabies control program in Bhutan

Environmentally, Bhutan is the world’s only carbon-negative nation. Over 70% of its land is covered in forest, and the Constitution mandates that at least 60% remain forested at all times. The country absorbs more carbon than it emits, thanks to strong conservation laws and hydropower-based clean energy.

Looking ahead, Bhutan is developing Gelephu Mindfulness City (GMC), a special administrative region aiming to fuse economic development with ecology and mindfulness. Its vision includes five “zero” goals: zero plastic, zero malaria, zero rabies, zero drug use, and zero crime. Despite being small and landlocked, Bhutan has achieved what many wealthier nations struggle to: aligning development with well-being and planetary stewardship.

Nevertheless, Bhutan also faces its own set of challenges. The country is currently experiencing significant emigration and brain drain, particularly among young professionals seeking better job opportunities and higher incomes abroad. Bhutan remains resource-limited and is in need of both human and technical resources. With the development of this new mindfulness city, we hope that Bhutanese living abroad, as well as foreigners, will contribute to sustaining and enriching a distinct Bhutanese identity.

A few days, later a friend and former workmate who was working with one of the USAID funded NGOs in Uganda that supports people living with HIV called me with news that they had been told to lay down their tools. I could tell from the tone of his voice that he was worried as I imagine many other USAID- funded project employees were. By now, we know how that sorry saga ended – Trump, Musk & co have dismantled most of USAID, with also lots of USAID-funded project employees in Uganda as ‘collateral damage’, not to mention their patients. 

Nevertheless, the writing had been on the wall for quite a while. And Uganda even got an explicit warning in 2023.

“Whoever signs the cheque keeps you in check”

For decades, the West’s neocolonial stranglehold on low- and middle-income countries (LMICs) has been glaringly apparent through the conditional strings attached to aid. Only a few years ago, in 2023, Uganda was thrust into the spotlight, teetering on the brink of losing PEPFAR funding due to its draconian anti-gay legislation. The backdrop: i n 2024 alone, the US government channeled more than $471 million in health and development assistance to Uganda. And in the fiscal year 2020/21, international financing entities provided around 50% of the funding for HIV programs in Uganda. More generally, in a country where development partners finance more than half of the health budget, one would have expected a higher level of preparedness to handle health crises independently. Did the Ugandan government learn anything from this reliance, or was the threatened PEPFAR funding in 2023 cut just another wake-up call that went unheeded?

In response to a recent Ebola outbreak in the country amidst USAID funding cuts in early February, the permanent secretary of the Ministry of Health, Diana Atwine  responded with the following :  “I just want to assure you that with or without the current freeze we are going to work within our means,” “We have … everything at our disposal to handle the situation.”

But can Uganda truly sustain its health financing without foreign aid, or was this assurance merely a brave face in the face of an impending crisis? If left without a choice, can the Ugandan government re- prioritize and find innovative ways to fund its health budget?

Experts have argued that this dependency on aid has stifled local innovation and self-reliance. Aid dependency has worsened corruption in Uganda with corrupt government officials seeing aid as a “free cash flow”. Corruption is so rampant that news of officials embezzling public funds barely raises an eyebrow anymore in Uganda. Alarmingly, a recent Inspectorate of Government report revealed that 20% of surveyed households had been asked to pay bribes to health workers, highlighting the dire state of Uganda’s healthcare system.

Impact so far

As the dust settles from the U.S. pulling the plug on its foreign assistance to Uganda, the health sector is left gasping for air—quite literally. With a $160 (UGX 604 Billion) million-sized hole blown into the budget, programs that once thrived on PEPFAR’s generosity—HIV/AIDS treatment, malaria prevention, maternal health—are now scrambling for survival. Clinics are understaffed, testing kits are running dry, and thousands of health workers funded by USAID are now involuntarily “on leave,” scrolling job boards instead of patient charts.

End of March, Health Minister Dr. Ruth Aceng, addressing Parliament’s Health Committee called for urgent alternative funding to sustain critical health programs—ranging from HIV/AIDS and malaria to nutrition and health worker salaries. A cabinet paper has been drafted, and the Ministry is scrambling to integrate affected services into routine care.

In sum, this crisis has exposed the fragility of a system too dependent on foreign lifelines, and while it may be a painful wake-up call, it’s also a rare opportunity to rethink, rebuild, and reclaim ownership of national health financing.

A new era

In the face of the imminent public health risks confronting Uganda, I align with the optimists who perceive this as an opportunity rather than a catastrophe – at least in the medium term.

There is much to be gleaned from the experiences of other Sub-Saharan African nations that have markedly diminished their reliance on donor funding. In the previous decade for example, Ghana’s external assistance for health, as a proportion of total health expenditure, declined from 25% to 11% (between 2015 and 2019).    Ghana is currently ramping up domestic resource mobilization and exploring innovative health financing models to insulate its health system from external aid volatility.  And it’s clear that Ghana is far from the only country now embarking on this road, also advocated by Africa CDC  in a recent note, Africa’s Health Financing in a New Era.

As Dambisa Moyo aptly put it in 2009, “Africa is addicted to aid. For the past sixty years it has been fed aid. Like any addict it needs and depends on its regular fix, finding it hard, if not impossible, to contemplate existence in an aid-less world. In Africa, the West has found its perfect client to deal to.” Dead Aid: Why aid is not working and how there is another way for Africa

As Uganda stands at this critical crossroads, the question remains: Can Uganda break free from the cycle of aid dependency and forge a path towards sustainable, self-reliant health financing?

From my side, it’s a resounding “Yes”.

Structural adjustment programs and the Aid trap

Donor dependence has meant that African health systems are perpetually in a state of transition. On the surface, it’s easy to blame African leaders for failing to support their own health systems. But the root of this stasis lies in two critical disruptions. First, were the structural adjustment programs (SAPs) of the 1980s, which dismantled health as a collective responsibility, and second was the donor aid dominance that followed, which outsourced health funding and governance to foreign technocrats. SAPs were introduced by the International Monetary Fund (IMF) and the World Bank as conditions to which African states had to abide if they were to receive loans and financial aid. These programs aimed to stabilise economies, reduce government deficits, and promote market-oriented reforms. Their neoliberal logic was simple: cut public spending, reduce debt, and let market forces take over. But in practice, it meant that African Governments could no longer afford to fund social services such as health. Out-of-pocket health costs skyrocketed, access to healthcare decreased, and mortality rose. Then, donors stepped in to patch the holes left by SAPs. But instead of restoring government health budgets, they created parallel health systems, funding disease-specific programs independently of national health services—each program with its reporting requirements, staff, deadlines, and inevitable expiration date. Reliant on donor funding, health ministries learned to survive by chasing donor priorities rather than setting their own.

The illusion of transition

But as Western aid retreats, Africa is asked to stand independently and take ownership of its health systems. But take ownership of what exactly? A fragmented, externally engineered system designed to respond to short-term donor interests. The rallying call for African governments to step up and realise this opportunity as moving on from foreign aid is galvanising, of course. However, the problem is not that African governments are unwilling to lead. It is that decades of donor-driven financing have left them managing systems that, fundamentally, are illegible to themselves. The illusion of “transition” assumes that African governments can simply step in where donors left off. But that assumes the system belonged to them in the first place. Furthermore, with shrinking Western aid, Africa increasingly looks to the East to support health- another dependency in the making. But these new funders offer no real alternative, only variations of the same theme. Their technologies depend on foreign expertise, and their contracts are just as restrictive. The terms, in the end, are still unequal.

A possible way out?

The legacy of SAPs and donor aid is far more insidious than fragmented systems that cannot be inherited. For decades, global health aid has operated as a power that extends beyond funding and into the structure of health values and governance. The Bretton Woods institutions’ push for privatisation shattered the idea of health as a public good and a responsibility of the government. Today, African policy-makers still articulate a health agenda framed in the language of cost recovery, public-private partnerships, or sustainability—euphemisms for outsourcing health to the market. The task for African countries, then, is not to replace Western aid but to dismantle the entire architecture of exception that made it necessary in the first place. This requires confronting and redesigning the values and structural distortions that SAPs and aid has introduced into African health systems. This means committing to equitable domestic health financing, restructuring institutions and rewiring health governance. Most of all, it means that health system sovereignty is not about declarations of self-reliance but the unglamourous political work of building systems that fund health as a public good.  

credit: KEMRI-Wellcome Trust Research Programme

Based in New Delhi, India, I conduct online communication sessions for students aged 7 and above from various countries, utilizing innovative digital tools to enhance their learning experience.

Through Effective Communication, for which there are a number of strategies one can use with children (eg. active listening, using simple and clear langue, …), the following skills & traits can be strengthened in them:  (1) Critical Thinking & Problem-Solving – sharing ideas helps children analyze situations and find solutions; (2) Collaboration & Teamwork –  Learning to express themselves helps kids perform well in diverse settings. (3) Emotional Intelligence & Self-Confidence – good speaking abilities allow children to express their emotions, needs, and opinions (more) confidently.

As I noticed myself during my online communication classes in which I teach and train communication skills, the results are very impressive if various innovative approaches like storytelling, debates, and presentation skills are used on a regular basis. 

New innovative digital tools can add an extra layer. In my classes, I used a number of digital tools and techniques, which helped me to enable personalized learning experiences and address different learning needs, styles, and backgrounds while making education more accessible and interactive. Getting mentored in a diverse learning environment and interacting with students from different geographies has shown great results. AI-powered feedback, timely evaluation, and personalized sessions enable learners to improve, helping them to identify their strengths and weaknesses. Lessons can be planned through multiple modalities like videos, animations, and audiobooks. Through Collaborative and Interactive Learning zoom meetings, one can facilitate peer discussions. The use of digital whiteboards enables brainstorming, online challenges, and competitions to encourage real-time conversations across borders with students from various time zones and learning abilities.

Among others, I noticed a marked improvement in children’s social skills. Kids also felt quite confident while speaking.  And sometimes the impact is even bigger: as reported by one of the parents, “My child was not interested in studies but after the online classes he has improved and is interested in studying“. The adoption of a hybrid learning model, combined with interactive classroom discussions helped this particular student to enhance his comprehension and verbal fluency.

By capitalizing on  technological advancements in the virtual ànd real classroom, we can equip children with essential skills for lifelong success. However, like with any other technology, too much of screen time can lead to eye strain, and other health issues. Therefore, it is recommended to educate parents ànd kids to use technology in a balanced way.

Empowering Young Voices: Conducting an online class for public speaking

India has over 104 million people belonging to Scheduled tribes (ST) (Census 2011). The term ‘Scheduled Tribes’ first appeared in the Constitution of India  (Article 366 (25))  and allows to define populations with specific traits and cultures, limited contact with the wider communities/population, and which have achieved lower levels of progress (economic, development etc) than the larger community. Scheduled tribes in India account for more than one-third of the world’s tribal and indigenous populations. Most tribal communities are socio-economically and geographically marginalized – dispersed across remote hilly, desert, or forest regions. They demonstrate poor health outcomes, including high maternal and infant mortality rates, malnutrition, and bear the double burden of infectious diseases like tuberculosis, malaria and noncommunicable diseases.

An already low-resourced health system exacerbates the issues of exclusion which many tribal and other vulnerable populations face. Geographical remoteness and harsh terrains make accessing health facilities a challenge. Health workforce shortages are worse in remote areas often rendering existing health facilities non-functional. For example, the state of Himachal Pradesh showed a 77 % shortfall of nurses according to a report by the Expert Committee on tribal health. Thirty three percent of posts for doctors in primary health centres are vacant, and 84% posts for specialist doctors in community health centres in the tribal regions remained vacant. Poor public health infrastructure, financial renumeration, and non-financial incentives (education for children, opportunities for professional engagement or advancement, social isolation, etc), contribute to a hesitancy in medical practitioners to serve in remote and rural areas.  Poor health infrastructure implies doctors are often compelled to refer patients to higher level centres.

The government has tried to address these challenges with strategies to attract doctors to work in tribal areas, such as an additional salary, but the meagre financial incentives (in some states) meant the strategies were not as effective as intended. Some states attracted doctors by offering additional marks for the entrance exam for specialization during postgraduate entrance exams for each year of service in the tribal areas. These strategies however are unable to effectively attract and retain health workers in rural and remote areas for long.

India has a reservation policy (i.e. affirmative action in which a few positions are earmarked for those from vulnerable populations) where a fixed number of seats are reserved in government jobs and educational systems for the weaker sections of the society including the STs. This was done to ensure fair representation and empowerment of the socially and educationally marginalized. In 2007–2008, the government introduced a 7.5% reservation for seats in medical colleges too. Such affirmative action policies aim to fill the gaps in inequities faced by marginalised communities, yet the overall development of tribal communities remains a distant dream. Despite their desire to serve their community, doctors and other health workers are restricted by health system challenges.

Over the last 7 decades since India’s independence, there were opportunities and attempts to improve the lives of tribal communities, yet the tribal populations continue to demonstrate poorer health and development indicators. The communities often lack basic health facilities, education, transportation, power, internet, and other services, and the future remains bleak. In 2018, an expert committee published a report on tribal health to address the challenges and the need for a dedicated tribal health policy. The committee advised that MBBS (i.e. Bachelor of Medicine and Bachelor of Surgery) doctors who are willing to reside in tribal regions be given training and diplomas to provide speciality care such as emergency obstetric care, new-born care, and pediatric care since they have a significant shortage for specialists. Furthermore, substantial financial and non-financial incentives can be provided to increase the retention of these doctors, who are less likely to move to urban areas for potentially more lucrative opportunities. There may be opportunities to organise good quality medical and surgical camps by specialists to fill in gaps in access to specialist health services.

The question remains, though, whether the government will prioritize tribal health and its overall development or whether it is time for scheduled tribe doctors to put up with the subpar facilities and return to serve their communities. Put differently, will individual actions such as these benefit the community, or will the structural disparities in health and development remain, relegating marginalised communities to underdeveloped and weaker segments of society?

The Sustainable Development Goals (SDGs) are based on the principle of “leaving no one behind.” The SDGs won’t be attained if the poorest and most marginalized people remain left behind.  So, I expect that soon the government will prioritize the tribal areas, support the community, and improve their healthcare system. That would, among others, also imply that five years from now, when someone asks me where I am, I’ll be able to respond “back home, helping my community,” without feeling like I’ve had to make a compromise.

Village in tribal region of District Lahaul & Spiti, Himachal Pradesh, India. (Photo: Amir Jaspa)

It was a gathering of stakeholders from across the globe who converged to attend the 5^th AfHEA Biennial Scientific Conference on Primary Health Care (PHC) as a Foundation for Universal Health Coverage (UHC).

The event, held in Accra, Ghana, West Africa from where it was born, out of the International Health Economics Association (IHEA). It was a thrill for me as an aspiring Health Policy & Systems Research (HPSR) expert coming from the mainstream media.

Against the backdrop of the jollof rice ‘war’ between Ghana and Nigeria, I was very excited to moderate a session involving an all Ghanaian team with dons like Prof. Irene Agyepong, Dr. Isaac Morrison and Dr Charity Sarpong, among others who presented papers and were panellists. They spoke on a per capita payment system as a viable strategic purchasing option for assuring universal access to PHC in Ghana.

This edition which was also the 10^th anniversary of AfHEA was themed ‘Securing PHC for all: the foundation for making progress on UHC in Africa,’ with global actors and stakeholders in the industry presenting papers on their findings from their various researches, health ministries, organisations and governments. The goal was charting the way forward for Africa to achieve UHC by 2030.

Supported by Ghana’s Ministry of Health, The World Bank, World Health Organisation Africa Region, iDSI Health, Bill & Melinda Gates Foundation, the Korean Government and UNFPA among others, AfHEA 2019 spotlighted the challenges people in Africa face every day in accessing healthcare and what financial protection or its non-existence they are having to contend with.

It was also a forum which brainstormed on how innovations, new research and political will power could advance UHC and change the narratives to ensure health for all, even at the lowest level of healthcare provision.

Representatives from the various ministries of health, researchers and other stakeholders from across the continent spoke on their respective journeys towards achieving UHC reflecting on the challenges and successes in the various papers and discussions they presented and/or participated in.

In his speech at the opening ceremony of the conference, Ghana’s Vice-President, Dr. Mahamudu Bawumia said the government has approved the operationalization of Zipline’s drone technology to deliver drugs and blood to rural areas in the country. This is in a bid to ensure a cost-effective approach of providing quality healthcare.

He said, “Next month, Ghana will begin the introduction of drone technology in the delivery of medical supplies. We are taking a lead from Rwanda who pioneered this in Africa. Once we start our drone delivery service will be the largest in Africa. We are also innovating means of healthcare delivery to reduce cost and be as efficient as possible. We are trying to rely on technology to help us be more efficient and also be cost-effective.”

This initiative which is expected to start in April 2019, challenges other African leaders, especially the ‘giant’ of the continent, Nigeria, where communities would rather resort to traditional self-treatment methods than visit primary health centres where they are very often met with the lack of medicines.

The five-day event started with pre-conference workshops on grants writing, applied health economics in Africa, tracking progress towards UHC and promoting informed choices in young people as per sexual and reproductive health.

One of the takeaways at the opening plenary was from Dr. Asamoah Bah, former WHO Deputy Director General who made an analysis of global health in comparison to fashion where styles trend until they later go out of vogue. Bah took participants down memory lane where the snag was Primary Health for All by the year 2000 which was reflective of the different campaigns that have happened over the years with regards to UHC and PHC and why it is important for them to be sustainable rather than fade out of style.

Nigeria’s Dr. Emmanuel Meribole highlighted some of the country’s achievements in the last five years regarding UHC, the national health act and the basic healthcare provision fund among others. The plenary while raising questions on accountability and the need for it, also called for a critical view on policies and programmes beyond simply adopting them.

The conference also featured sessions on hospital management and financing, public health research issues, the influence of cultural practices on the spread of diseases and health systems strengthening among others.

This year, there was something new to AfHEA introduced by Leanne Brady, a Health Policy & Systems Researcher, for which she was also recognised at the conference gala night. This was a session on decolonising health policy and systems research to include and exclude a number of elements like allowing for more Low and Middle Income Countries to participate more actively and decolonising colonial residues which still determine actions in former colonies as well as the sensitivity of choosing locations for confabs that would benefit the global south.

As part of the celebrations, individuals along with the local organising committee were honoured for their efforts towards pursuing the ideals of AfHEA at the gala night which was held at the famous Labadi Beach Hotel. They included among others, the local organising committee for successfully organising this year’s outing and Leanne Brady for suggesting a new angle to the usual AfHEA format.

Prof Di McIntyre, the Executive Director of IHEA received the François Diop Award for lifetime contributions and achievements in health economics.

At the closing session there was a call for more youth engagement at the forum with emphasis on not ignoring them on the road to UHC as their health concerns should command their own context and shape the conversations surrounding it.

Some of the takeaways from the conference included the need for more synergised working structures among all stakeholders from policy makers to financiers, academia, health economists and the media.

According to Prof. John Ataguba a health economist at the University of Cape Town, South Africa, purchasing is often forgotten within health financing. “Purchasing is an aspect of health financing that Nigeria needs to begin to look at strategically. Strategic purchasing is basically ensuring that decisions made in terms of purchasing services have some underlying principles in ensuring that you cut down cost and also ensuring that you can get services as less expensive as possible but of adequate quality to the last person who uses the services.”

While there were over 450 registered attendees at the outing this year from about 40 countries with Nigeria having the largest number of members, it is hoped that lessons taken away will not gather dust only to be cleaned out and rehearsed in time for the next biennial.

In March 2017, the Institutionalizing Community Health Conference (ICHC) was organized in Johannesburg. It provided an opportunity for countries to track their progress and explore how to further prioritize programs and policies, with a focus on community health. Accordingly, 400 community health champions from 24 countries adopted a list of 10 critical principles and spelled out their country’s action plan. One of the 10 principles was about providing opportunities for country-to-country lesson sharing and developing a shared global learning agenda. There was also a call for the engagement of implementers and researchers, who often work in silos, and for real-time research, monitoring, evaluation and learning, so that after adapting successful interventions, they can be replicated and scaled up. This sounded like the perfect program for a new community of practice (CoP).

Communities of practice are groups of people who share a passion for something they do and who interact regularly to learn how to do it better. Adopted as a knowledge management (KM) strategy in big corporations, it is also increasingly being adopted in social sectors like education and public health. Over the last few years, several CoPs have been set up in global health. A transnational community can be an avenue for peer-to-peer collaborative networks, which are driven by willing participation of their members, and focused on learning, sharing knowledge, developing expertise and solving problems. We live in a connected world, where finding and sharing information is just one click away; because of this, a truly global health community can easily apply this CoP concept to the domain of community health. A stronger South-South collaboration can advance the agenda of community health and instead of reinventing the wheel, a vibrant platform could be a starting point for learning and contextualizing some of the drivers of what makes implementation successful, and also some of the associated challenges.

Launch of the new CH-CoP

Against this backdrop, we are happy to announce that a Community Health-CoP (CH-CoP) has been launched recently. It will be led by an international facilitation team, with technical support from the Institute of Tropical Medicine, Antwerp and the financial support of UNICEF. We are giving ourselves 12 months to demonstrate the impact of the CoP. We aim to be a bilingual CoP (English and French) that creates value for everyone who is interested in the broader field of community health. During this first year, we will focus on convening policymakers, health professionals, planners, funding and implementing agencies, non-governmental organizations, grassroots organizations, startups and research institutions at all levels (national, regional and international), in a platform that enables knowledge sharing, collaboration and action at country level.

As for the areas of work, a strong momentum was set in Johannesburg. We will of course continue to develop our learning agenda collectively, but we anticipate that areas of interest, besides those listed above, will be: the integration of community networks and service delivery mechanisms, ensuring quality of services, equitable financing and payment mechanisms, governance structures and social accountability, engaging civil society, faith based organizations and the private sector, harnessing new technology. The indicated subjects will guide us in the development of case studies, policy notes, evidence synthesis and collaborative studies.

Based on established trust and a collaborative atmosphere, the CoP will, we hope, provide global momentum around community health. Things have started this week.  To join us, see instructions below.

The CH-CoP page, discussions and resources are freely accessible here.

 o join the community and contribute or access the full content, you must first create a personal account on “Collectivity”, the collaborative platform where the CoP Is hosted.

• To create your account, click here then and follow the instructions (5-7 min process)

• To access the CH-CoP once you have created your account, click here or explore the “communities” section of Collectivity. Feel free also to contact us personally.