In this blog, Divine Ikenwilo comments on a recent declaration of commitment by the Pan African Parliament. He shares his doubts about the impact of such declarations.
The year 2011 will, perhaps, be remembered as the year in which the fight against maternal and child deaths and ill-health received parliamentary support for the first time. Following the 3rd Pan African Speakers’ Conference in Johannesburg (October 17-18, 2011), African Speakers of Parliaments and Presidents of Senate 'unanimously adopted a landmark resolution on a Declaration of Commitment to prioritize parliamentary support for increased policy and budget action on Maternal, Newborn and Child Health in African countries'. This commitment, hailed as the first of its kind by African Speakers of Parliament, is expected, among other things, to improve political support to prioritising policy and financing of care for mothers and their children.
It is perhaps right in assuming that this commitment was necessary in the face of continuing evidence of the position of the continent (vis-à-vis other continents) in achieving targets for maternal and child health set out under the Millennium Development Goals 4 and 5. For example, despite improvements over the last eleven years, under-five mortality and maternal death rates in sub-Saharan Africa are the highest in the world and still above the MDG target rates. Any efforts to bring these (and many other health related problems) down will go a long way in not only achieving the MDG targets, but also improving life and the general well-being of the people of sub-Saharan Africa (SSA).
In a continent where a majority of health care financing is from private sources, with too often catastrophic consequences especially for the poor and vulnerable, an increase in the proportion of government spending on health could, all things being equal, be expected to improve universal access to vital care such as those for maternal and child health. The speakers’ commitment also comes with specific targets to increase government allocation of health spending to various levels (and in most cases, targeting the 15% mark agreed at the Abuja Declaration in 2001). The targets for specific countries also mean that policy makers, researchers and other observers can monitor progress towards the objectives.
In making a case for continued government intervention in the production of goods and services, economist John Kenneth Galbraith, had the following to say; ‘in the evolution of economic enterprise, the things which could be produced and sold for a price were taken over by private producers. Those that were not, but which were in the end no less urgent for that reason, remained with the state’. Although the private sector is still able to play an active role in the delivery of health care, the role of government becomes more sacrosanct as a result of the need to encourage universal coverage of health care services to cater for the vulnerable and thus improve equity.
Despite potential increases in government spending following the speakers’ declaration, there is evidence that increasing government spending on health does not necessarily favour the poor (Castro-Leal et al., 2000). Similarly, despite the abolition of user fees, financial protection remains elusive, as out-of-pocket spending remains high among the poor (Nabyonga-Orem et al. 2011). The inability to attain stated objectives is largely blamed on improper consultation and unexpected timing of such political declarations, unmatched by adequate preparations for reform (Meessen et al. 2011). It is now over 10 years since African Heads of Government committed to increasing government health spending to 15% of their respective national public budget. Critics would say that most countries have hardly met that 15% target while parliamentarians are committing to more promises.
In light of the foregoing, the impact of the speakers’ declaration on actual improvements in maternal and child health in the continent therefore remains doubtful. For now, it is just a statement of intent, and there is nothing binding in that commitment. There is hardly any continuity in some governments and parliaments in the continent, which mean that new governments and parliaments usually change everything; every declaration, every policy, every promise. It may therefore be useful to entrench the current speakers’ declaration (and any such declarations) in law (if possible) so that it remains binding on present and future governments.
In sum, the question that remains on my mind is whether this declaration is driven by political expediency or whether indeed, there is hope for us in the continent. It is now up to the parliamentarians to work with their respective governments and relevant ministries (for example, of health, finance and economic planning, who actually plan health care services) towards making a difference, not only in maternal and child health, but in the health of the entire people of our dear continent.