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Health Systems and Fragility in Francophone Africa

4/19/2019

34 Commentaires

 
Photo
​Aloys Zongo, Joel Arthur Kiendrebeogo, Willem van Put, Bruno Meessen (on behalf of the working group on Health System & Fragility)

A worrying deterioration of the security situation is underway in several Francophone African countries. Other countries have been stuck for years in a state of instability. The number of so-called 'fragile' contexts is widening. A working group was set up on ‘Collectivity’ to reflect on the issue and propose activities that would help address it. Its members call us to action. In this blog post, they present their initiative.

The concept of fragility refers to a situation where the state structure lacks the political will and / or the capacity to provide people with the basic functions required to reduce poverty, promote development, and ensure security and human rights. In its latest Africa's Pulse report, the World Bank recalls that Africa is particularly concerned: 53% of the fragile contexts in the world are in sub-Saharan Africa. And among these, we will find almost all the countries of Francophone Africa.

Insecurity is growing in the Sahel region as a result of abuses committed by various terrorist groups (as in Burkina Faso, Mali and Niger, and around Lake Chad). And even more worryingly, inter-community violence has increased. Burkina Faso and Mali have been particularly affected by this situation in recent weeks.

The links between insecurity and health are numerous. The combination of "epidemics and conflict" is particularly threatening, as evidenced by the Ebola virus epidemic that has been raging in North Kivu since August 2018 and has already registered 751 deaths. The response to this epidemic is particularly complicated by conflict, political instability, deterioration of the health system and distrust of the population. Beyond the Ebola epidemic, the entire health system is under threat.
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Is it not time to call things by their name? Committed as we are to development initiatives (eg Universal Health Coverage), are we not ignoring the dynamics of fragility in our countries?

Health systems and fragility

There is a rich literature on health systems in fragile and conflict-affected contexts. Unfortunately, the French-speaking world is generally absent from the debate. As we have highlighted in our concept note, national and international actors engaged in the development of health systems in Francophone Africa are relatively silent on the issue. The analysis-grid of the fragile state has been very little applied by researchers to French-speaking Africa and the Sahel countries in particular. This lack of attention coupled with a lack of scientific knowledge jeopardizes our collective action and could jeopardize the achievement of sustainable development goals. There is a huge need for relevant empirical analyses to drive action in our countries, in the Sahel region or Central Africa.

All the pillars of the health system are likely to be negatively affected by the ongoing weakening, with the consequent disruption of our already underdeveloped health systems. Let's just talk about some challenges:


  1. The inability to provide health services to a large part of the population: for example, because of insecurity, the advanced strategies for vaccination are not carried out, hence the risk of epidemics occurring. Added to this is the closure of many health centers, the abandonment of positions by some health workers, the inaccessibility of some refugee sites by humanitarian NGOs.
  2. Failure of the reference system / counter reference. In Burkina Faso, for example, ambulances were targeted by terrorists, preventing evacuations in some localities. Moreover, even moving from one locality to another is not without danger, as illustrated by (even if it remains an isolated case) the fate of a pregnant woman and her companion who died, from terrorist attacks while traveling to a health center to give birth.
  3. The lack or insufficiency of financial resources, infrastructure, equipment, human resources, medicines and other health products for quality health services. Indeed, insecurity leads, on the one hand, a reallocation of public budgets to reinforce security, on the other hand, a reduction in economic growth. In Guinea, for example, the Ebola virus epidemic has led to a reduction in economic growth (it was 0.5% in 2014 against a forecast of 4.5% according to the World Bank). As for Burkina Faso, the national budget allocated to the Ministry of Health decreased from 12.81% (of the total budget) in 2014 to 10.70% in 2018 - This has led to a reduction in investments in the health system.
  4. The failure of the supply chain of medicines and other health products. Insecurity negatively affects the already fragile supply chain of medicines and other health products. Indeed, because of the inaccessibility of certain localities due to insecurity, the supply is interrupted or delayed. This causes prolonged ruptures with consequent morbidity and mortality of diseases.
  5. The failure of health information systems. For example, because of difficulties to travel and closure of some health facilities, epidemiological surveillance data and monthly average consumption of drugs and other health products, immunization reports are no longer transmitted or are late. This negatively affects the planning of input orders (medicines, reagents, vaccines, etc.) at the central, intermediate and peripheral (district) levels, as well as the surveillance and management of epidemics / diseases.
  6. The poor quality of governance / regulation of the system. Indeed, all activities of coordination, supervision and monitoring of health services in the field are no longer effective in all districts due to insecurity. As reported by a supervisor in Burkina Faso, "I was asked to do the supervision by telephone, WhatsApp or Messenger, given the physical inaccessibility of certain areas". But do telephone networks always allow this kind of solution?
The case of each fragile context is particular. Insecurity is far from being the only problem. The links between fragility and health system performance are of course complex and certainly not unidirectional. Thus, those who join the armed struggle often come from communities that feel neglected by public services and / or who no longer trust the state; which makes public action even more difficult.

Establishment of a working group on "Collectivity"

At a recent workshop organized by several communities of practice at the Institute of Tropical Medicine in Antwerp, researchers and practitioners discussed this issue. At the end of the discussions, the participants proposed to launch a multi-stakeholder process on the subject. A call for applications has been launched on Collectivity. Together, we produced a concept note that proposes an action program that covers a first year.

Our ambition is to launch a process so that the different actors (political decision-makers, civil society, private sector, researchers, technical and financial partners, etc.) involved in strengthening the health systems of the Francophone concerned countries recognize the reality of fragility in these countries,  in order to identify proven or promising approaches to address it. Of course, every fragile context is unique and dynamic; the solutions will have to be local and adapted. But it is not impossible that some health interventions, still too little generalized (e.g. community health workers, free health care for a basic package of services), appear particularly relevant, not only from a public health perspective, but also as a strategy to restore trust between Nation States and their people.

We are aware of raising sensitive issues. That's why we need to build a strong and effective partnership between policy makers, practitioners and researchers. The process we are proposing is also part of the effort developed by our Communities of Practice for nearly ten years now. We want to prove that collective and systemic learning is possible even in health systems affected by fragilty.

We invite you to read our concept note. As you understand, we are now looking for people and actors who want to support the initiative.

34 Commentaires
Elina
4/29/2019 10:48:49 am

This appears like an important initiative. However, could you please, clarify what is the fragility framework diagram referred to in your CN but not really explained? Apologies if I missed it as I read quickly through the document. Also, what is the importance of differentiating the Francophone countries in the region from others (beside the linguistic differences and need for translation)? Would you not want to include Northern Nigeria in this process for example?

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Joël
4/29/2019 05:16:05 pm

Dear Elina,

Many thanks for your interest and your comment. In fact, what we mean by "fragile state framework diagram" is analyzing countries' current situation through the lens of fragility. An error inadvertently occurred in the translation of the CN from French to English. Sorry for that. We will use/adjust existing frameworks/grids for that.

The reason of our focus on Francophone countries is that these countries are usually "neglected". Our literature review highlighted this, most of focus being on Anglophone countries. But we are open and may include non Francophone countries throughout discussions.

Best regards,

Joël

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12/9/2024 05:10:59 am


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1/10/2025 08:59:19 pm


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cindy byrd
1/23/2025 09:58:43 pm

We can always make our relationship the best for us, My husband left me for another woman and I was left in the dark. It happened so fast and I had no say in the situation at all. He just dumped me after 3 years without no explanation. I became very worried and needed help. So i searched for help online and I came across a website that suggested Dr Excellent can help get ex back fast, restore broken relationships and stop a divorce. I contact Dr. Excellent through his website and he cast a love spell to help us get back together. Shortly after he did the spell, my husband started testing me again and felt horrible for what he just put me through. He said that I was the most important person in his life and he knows that now. Ever since then, everything has returned back to normal. Thank you Dr. Excellent for saving my broken Marriage and brought my husband back to me!".. I and my family are living together happily again. Dr. Excellent is the best online spell caster that is powerful and genuine. If you have any problem contact him and i guarantee you that he will help you. I highly recommends Dr. Excellent to anyone in need of help. Here his contact. Call/WhatsApp him at: +2348084273514 "Or email him at: [email protected]

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cindy byrd
1/29/2025 08:51:46 pm


What I did to Got my Ex wife back and Restored our broken marriage. I'm Michael George from England. My wife left me a month ago after 14 years of being together. I’ve spent the last month agonizing, crying, feeling guilty and feeling the lowest ever. i did so much to get her back but nothing worked out not until i saw a comment online when someone was testifying of how Dr. Excellent helped him to restored back his wife and that was how i contacted him through his email and after writing my issue out he assured me that he will help me to get back with my wife in 11hours after casting the love spell, and after he did the spell my wife came back home and pleaded that she is very sorry for the pain she caused me and the kids. I am back with my wife and we are both happy and living together again. I know there are many people out there that want to get their love back. Contact him for solution to your relationship and marital problem. Here his contact. Call/WhatsApp him at: +2348084273514 "Or email him at: [email protected]

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Doris Bella
3/11/2025 03:26:59 am

IS IT POSSIBLE TO ACTUALLY GET BACK FUNDS LOST TO SCAM? YES! CONTACT THE HACK ANGELS RECOVERY EXPERT

I lost about 846,000 pounds worth of Bitcoin to a fake investment trading platform that tricked me into investing on their platform with the intent of earning a 15% daily profit. I was losing it all to a point that I couldn't afford to take care of my bills and my Family. I was very disappointed with myself and was drowning in shame. I got really depressed until I had this discussion with my attorney who then introduced me to a hacker called THE HACK ANGELS EXPERT. They are the best recovery team out there now. They are very fast and efficient in the recovery of your lost funds. I couldn’t believe my lost funds were recovered, at first it was like a dream, but it’s all reality. I just have to put this review out here. The experts really helped me get my Bitcoin back from the scammer. If you have ever fallen victim to one of the many Bitcoin scams out there, don’t hesitate to reach out to the experts and have your Bitcoin recovered back. You can contact them using the address below:

WhatsApp +1(520)200-2320)
([email protected])
(www.thehackangels.com)

I am posting this because I am so happy getting my stolen Bitcoin back. I am not the first to recommend them because his recommendations can be seen everywhere

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Rita yolis link
3/19/2025 01:56:31 am

Best Recovery Experts for Stolen Crypto Assets Recovery / Recover Your Stolen Crypto

Losing Cryptocurrency can feel like losing a part of yourself. I never thought I would fall victim to one, only to lose all my savings to a fraudulent scheme, But thanks to CAPTAIN WEBGENESIS CRYPTO RECOVERY CENTER, a Crypto assets recovery expert, I was able to reclaim my lost funds and regain my financial stability. I invested in various coins and tokens, and for a while, everything seemed to be going well. However, my excitement quickly turned to despair when I discovered I had been scammed out of all my money. I had to quickly find a solution to get back my lost Bitcoin. That's when I discovered CAPTAIN WEBGENESIS CRYPTO RECOVERY CENTER who came to my aid and recovered all my lost funds. I express my sincere gratitude to CAPTAIN WEBGENESIS CRYPTO RECOVERY CENTER for helping me in my dark moment.

More Info;(Captainwebgenesis. com),
Email: (Captainwebgenesis@hackermail. com).

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sonshine jojo
4/8/2025 05:06:50 am

Good day viewers am here to recommend a herbal doctor that is really amazing, shearing this testimony of how i got cured completely from herpes is the best news to provide on social media. am so excited the herbal medicine works perfectly for me and am now totally cured from herpes with the medication he sent to me. Please contact Dr Payo for quick help if you are suffering from any disease ? WhatsApp him via +2348110096692 and also on Email; [email protected] 

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Athony Isak
6/6/2025 09:54:00 am

My heart is so filled with joy. If you are suffering from Erectile dysfunction or any other disease you can contact Dr. Moses Buba on this [email protected] or His website : https://www.facebook.com/profile.php?id=61559577240930 .website page https://bubaherbalmiraclem.wixsite.com/website
. For more information from me reach me via WhatsApp : +44 7375 301397

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tasha kenny
6/29/2025 06:09:19 pm

My appreciation goes to Dr Lucky for curing my HERPES with his healing medication, i do not have much to say but with all my life i will for ever be grateful to Dr Lucky to reach me when i thought it was all over, today i am happy with my family after the medical doctor have confirmed my HERPES status Negative, i have never in my life believed that HERPES could be cured by Dr Lucky healing medication. so i want to use this means to reach other persons who have this disease that all hope is not lost yet, try and contact him by any means for any kind of disease with his Email ( [email protected] or
him facebook page https://www.facebook.com/drluckytreat ) Or Whatsapp his number (+2348154637647  

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tasha kenny
6/29/2025 06:10:13 pm

My appreciation goes to Dr Lucky for curing my HERPES with his healing medication, i do not have much to say but with all my life i will for ever be grateful to Dr Lucky to reach me when i thought it was all over, today i am happy with my family after the medical doctor have confirmed my HERPES status Negative, i have never in my life believed that HERPES could be cured by Dr Lucky healing medication. so i want to use this means to reach other persons who have this disease that all hope is not lost yet, try and contact him by any means for any kind of disease with his Email ( [email protected] or
him facebook page https://www.facebook.com/drluckytreat ) Or Whatsapp his number (+2348154637647  

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sherry morse link
7/11/2025 01:21:28 pm

I am profoundly grateful for your compassionate care and herbal treatment protocol that cured my herpes. Your holistic approach balancing herbs, lifestyle guidance, and emotional support was exactly what I needed. Throughout my treatment you held space for every question and concern, responding with clarity and kindness. Your unwavering belief in natural healing inspired me to believe in myself again. Now, free from outbreaks and anxiety, I feel empowered, confident, and alive. Your dedication to evidence-based herbal care is extraordinary and your commitment to my well-being was palpable. You didn’t just treat symptoms you addressed the root, guided my healing journey and celebrated each milestone with me. Thank you, Dr. Ademise, for restoring my health and hope. You truly are a remarkable healer and a blessing in my life. and to contact below

WEBSITE: drademise.wixsite.com/healinghome

YOUTUBE: Dr. Ademise

EMAIL: [email protected]

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