Rethinking global health – an African perspective

On 22 October, the University of Cape Town’s (UCT) Faculty of Health Sciences welcomed vice-president (VP) of Global Health Strategy at the United Nations (UN) Foundation, Dr Ahmed Ogwell Ouma, to the Neuroscience Institute as the keynote speaker for the annual Global Health Lecture.

“It is the 22 October. We are in the Neuroscience Institute, and this is the first time that I’m making a public call for a global health strategy for Africa. We need one and there isn’t a better place to begin that conversation than here, where a lot of history for the continent – academic and otherwise – resides.”

Those were Dr Ogwell Ouma’s opening remarks at the event, which was hosted by the Pan African Health Sciences Forum in conjunction with the UCT Chapter of the UN Association of South Africa.

The lecture was part of an extended Africa Day celebration in the Faculty of Health Sciences and brought to the fore a discussion around global health and the role that Africa plays in this important field.

Building resilience in Africa

In the wake of the pandemic and with many ongoing infectious disease outbreaks in Africa, as well as the myriad benefits that adequate healthcare can bring populations, Ogwell Ouma highlighted that there is a pressing need to start the conversation around global health in Africa – and move it along quickly.

“Global health is a discipline that actually strives to improve health and equity globally for literally everybody. For me, it addresses transnational issues that affect health. I will not focus too much on definition, because the bigger need is to pick up the speed of having a conversation around global health,” he said.

“When we talk about global health, we really need to emphasise the global part. Because many times we only remember global health when there is a big outbreak coming from the continent.”

“While other parts of the world face the similar challenges, they don’t have the same challenges as we have. We struggle with weaker health systems and sometimes resources not being made available quickly so that we can [address] some of these outbreaks a little bit faster.

“When we talk about global health, we really need to emphasise the global part. Because many times we only remember global health when there is a big outbreak coming from the continent – not when there is capacity that needs to be developed; not when infrastructure is being improved; not when policy is being developed; and not when resources are being allocated.

“So, it is up to us to make sure that global as part of global health becomes a conversation, and it needs to be important for each and every country, not just some.”

Principles for prosperity

Ogwell Ouma acknowledged that there are unique challenges for global health on the African continent. However, he also noted that we can use the lessons we have learned from operating in this unique environment to develop a resilient, long-term global health strategy that will serve our population well.

“Africa is complex, no doubt. Our global health challenges are complex. Our health systems are relatively weaker. Our investment in the health sector is small compared to elsewhere. Our investment in health security is even smaller. Our investment in ourselves to build our own capacity is really, really small,” he said.

“We are vulnerable in many different ways, and, out of that vulnerability, we can either suffer the consequences of being vulnerable or we can use it as an opportunity to start building something for ourselves that will limit and reduce the vulnerability that we have and lift our capacity a little bit higher than it is today.”

The VP of Global Health Strategy then outlined six principles that the global health community can use as a starting point for creating the policies and putting in place the structures that are needed to improve health outcomes on the continent:

• Solidarity: “African countries can be very friendly when it comes to helping each other. What separates us is not African. What separates us are influences from elsewhere. We need to see where our strengths are and use those to lift up those who are relatively weak.”
• Multi-sector action: “Global health is intersectional. For those who are going to be leading the discussion around global health – don’t medicalise it. Involve as many sectors as are necessary to build a strong global health community on the continent.”
• Community involvement: “We are developing a global health strategy for Africa, so the community then becomes the extended workforce because they will carry forward the right message in the right way to the right people, who we may not otherwise engage.”
• Domestic resources: At least 90% of the money that is used in healthcare is local. We must pay attention to that to optimise how it and all of the other non-tangible resources – knowledge, structures and networks – within a country are used.
• Youth involvement: “We need to ensure that we have the youth well represented, so that tomorrow, when we are unable to speak for ourselves, they will continue to speak for the continent.”
• Coordination: For every health emergency, countries will face the challenge coordinating partners who are willing to be part of the response. Here, a framework is needed to make this coordination simpler to engage with these parties.

A first step towards solidarity in healthcare

For Professor Salome Maswime, the head of global surgery in the Department of Surgery, the address was not merely a framing of strategies that Africa can use to better its own healthcare but a blueprint for how conversations around global health can be approached.

“We realise that we need to talk about what’s happening in the world at large, because what we do affects the world. African outcomes impact global health; when we don’t do well in Africa, it affects what healthcare is for the world. And when we do well, then our successes also contribute to the successes of others,” she said.

“So, tonight was a great opportunity to reflect on what Africa should do in terms of global health, but it’s also an important moment for UCT – looking at its contribution to global health as a whole and how we can support the global health agenda.”

Faculty of Health Sciences dean, Professor Lionel Green-Thompson, echoed this sentiment, noting that the path towards better health for all on a global scale requires solidarity.

“One thing that Dr Ouma mentioned as part of his strategy this evening is solidarity. When we think about what solidarity looks like, we know that a key part of it is having multiple people in agreement for important conversations. It’s about ensuring symmetry and building relationships,” he said.

“Global health itself is an emerging discipline of multiple stories; of multiple axes and contested knowledges. So, the importance of conversations like the one we’ve had tonight, as a university, is to tap into those knowledges and then to bring voices like Dr Ouma’s in to inform our conversations.”

The 2024 Global Health Lecture was sponsored by UCT’s Faculty of Health Sciences, Neuroscience Institute, Institute of Infectious Disease and Molecular Medicine, Division of Global Health: Global Surgery, as well as the United Nations Association of South Africa along with the South African Medical Research Council Platform for Pharmacogenomics Research and Translation Research Unit and the Drug Discovery and Development Research Unit.