Balancing Global and Local Health Priorities in East Africa

The discussions of the impact of global health challenges and their effects within the Kenyan context have gained significant momentum over the past two years as COVID-19 shone a brutal light on the vulnerabilities of the local health sector. The potential for global health crises to disrupt Kenya’s ability to develop and improve health outcomes for its citizens has become more apparent than ever. In this later stage of globalisation, nations are witnessing an era of deepening and accelerated interconnectedness. Social, intellectual and economic relations are no longer constrained by national borders and no country exists in a vacuum. International travel, and an unrestrained flow of both knowledge and capital have simultaneously improved and complicated a nation’s ability to contend with health challenges.

Actors in the Global Healthcare Arena

The modern global healthcare architecture arose from the ashes of the Second World War when nations came together to address collective threats through international action. The United Nations (UN) Charter, signed in 1945, called for the establishment of a new international health organization, the World Health Organization (WHO) whose mandate was to build a healthier world. Today, WHO is at the forefront of the global mobilisation against health threats, as it seeks to direct and coordinate international action with local governments to achieve the best outcomes possible. However, the global health space is filled with a myriad of actors who can exercise significant influence on health outcomes within countries. There are approximately 270 key players who can act as movers and shakers in the global health space that influence the Kenyan health sector. In addition to the UN and WHO, there are bilateral treaty organisations, continental organisations, development partners and other philanthropic bodies who can influence health outcomes. Few health initiatives now depend on a single organization. Unfortunately, there appears to be a lack of a coordinating forum to align the interests of these actors as they do not operate from the same script. As a result, governments must step into this vacuum to organise and direct a synchronised effort at the regional and national levels to harmonise standards, drive policies, devise solutions and promote best practices across their territories.

Global policy agenda is often composed of the issues that international and national actors pay particular attention to and can change over time. Many national health policy responses are guided by ideas championed by international organisations. In Sub-Saharan Africa, there is a greater reliance on international organisations for standards, technical assistance and financial support. The external funding accounts for approximately 24 per cent of the total health expenditure in most of these countries and can be even higher for some of them. Global agendas therefore influence national development processes and financial flow. This then shapes national resource prioritisation and allocation. This reliance on guidelines by international organisations can be seen in African countries that have reformed their health financing towards achieving Universal Health Coverage targets outlined by the Sustainable Development Goals (SDGs) adopted by the United Nations.

Healthcare Challenges in East Africa

East Africa faces significant health threats from infectious diseases, pandemic risks, death from childbirth, malnutrition and biohazards. To mitigate these threats, it is critical for each country to leverage international and regional actors as well as to have the ability to mobilise effectively at the national level. Although the ecosystem of global players remains vital to solving health challenges, African governments must play an active role in serving the unique needs of their individual populations.

The Government’s Role in Steering Healthcare Initiatives

Since developing countries still heavily rely on donor resources, there is a concern over the asymmetrical power relationship between the international financial institutions (IFIs) and national governments. Private foundations have also become more influential in the global health arena. The contributions of these private foundations, while significant, are often limited to very specific areas of focus and interest. Donor funds are frequently allocated based on global priorities. During health crises, funds can be re-allocated to emerging priorities. This poses a challenge to many African governments that still need to finance key health projects in their own countries. The pandemic was a ‘wake up call’ for many countries as global supply chains shut down and access to vaccines became political with some countries acting in their own best interests. Capacity building in the healthcare sector and engagement of the private sector came into focus as countries tried to bolster their long-neglected health sectors. Additionally, consensus building and managing the expectations of multiple actors in the health space is important to avoid policy incoherence. Government health officials need to be able to manage this complexity and promote synergy within the health ecosystem.

When coordinating this effort, a government must be mindful to balance effective engagement with these transnational actors while also facilitating autonomy and flexibility at the national and county levels. In order to engage and leverage global agencies and actors effectively to improve health outcomes, governments must lead the response in their countries.

In 2013, Kenya transitioned into a devolved system of governance comprising two levels: the national government and 47 semi-autonomous county governments. Under devolution, the health service delivery function was transferred to county governments while the national government retained policy and regulatory functions. The national government therefore must create space for county government actors to operate with a level of autonomy while still maintaining the ability to lead national responses to health crises which can sometimes be difficult. There is also a rise in patient advocacy groups, private sector actors and public involvement in healthcare policy discussions.

During a guest speaker session for the Leading High Performing Healthcare Organizations (LEHHO) Programme, the Kenyan Health Chief Administrative Secretary (CAS) Dr. Mercy Mwangangi, emphasised the importance of diplomacy when engaging in critical negotiations. She asserted that building mutual understanding is key to engaging in meaningful discourse to address health challenges regionally, nationally, and at the county level.

In conclusion, we live in a global village and public health officials must address health inequalities by engaging actors in harmonised ways to strengthen health systems. It is also interesting to note that the concept of ‘local health’ in the post-pandemic world is now at the forefront of African policy debates. Promoting local manufacturing, shortening supply chains, and unlocking the potential of public-private partnerships to improve health systems has come into renewed focus.

The Leading High Performing Healthcare Programme explores the diverse and complex challenges that confront regional healthcare leaders. By going through this Programme, healthcare leaders acquire the skills and frameworks needed to implement new processes, organisational designs, and leadership strategies within their  organisations. Learn more about the Leading High Performing Healthcare Organisations Programme here

Article by Shailja Sharma, Executive Fellow and Coach

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