Governance and  Health in Africa

During the launch of the Report of the High Level Roundtable on the Governance Issues in the Multi-Stakeholder Response to the Ebola Virus Disease (EVD) in West Africa, in Addis Ababa, Ethiopia, on August 26, 2016, the APN team sat down with 2016 APN grantee from University of Khartoum, Sudan, Dr. Fatma Ibnouf on the sidelines of the event to find out her views on a set of issues ranging from the relationship between governance and health in Africa, and the Report of the High Level Roundtable. The interview also sought her reflections on possible areas of priority for strengthening the capacity of stakeholders within African societies to effectively respond to epidemics and consolidate human security on the continent.

APN: What in your view is the relationship between governance and the ability of African societies to respond to epidemics?

Outbreaks of epidemics such as Ebola pose challenges to many African states and societies. This also raises questions of whether appropriate governance structures are in place to effectively respond to the threats posed by such epidemics. In my view, governance in Africa often falls short of timely and effective responses to epidemics. Part of the challenge relates to the weakness or lack of mechanisms for societies’ engagement with the effective governance of the health and social sectors. Engaging local communities to make their voices heard can go a long way in shaping the governance-health nexus. More effort should be directed towards enhancing the capacity of concerned local stakeholders to engage with the health sector and state institutions. For example, the free flow of information between those in charge of the health care system and people at the grassroots is essential for fostering the close relationship and cooperation that can help African societies respond better to health-related challenges. Primary healthcare or community-based approaches should constitute part of the strategy for systematically working with local societies to overcome some of the bottlenecks confronting participatory policy formulation and implementation. Governance should be responsive and highly flexible, allowing people to engage directly with the state institutions, including basic service providers. These will involve enhancing the capacity of citizens not only to articulate their needs and interests, by also to gain access to existing knowledge and lessons learnt from how other societies have effectively dealt with epidemics. It should be noted that tackling epidemics such as Ebola is a long-term endeavor. Finally, responding to challenges posed by vulnerability to epidemics goes beyond the provision of healthcare delivery, and includes the capacity and responsiveness of governance institutions to the demands of citizens.

APN: Do you think that the Report of the High Level Roundtable is relevant to your project on care-work arrangements in post-conflict contexts? Explain with regard to the case of Sudan.
Some of the observations and findings of the Report of the High Level Roundtable are relevant to my project. It is also essential for countries such as Sudan to learn as much as it can from other countries’ responses to epidemics, so it can work towards building strengthened response mechanisms. Although Sudan is not among Ebola-affected African countries, it has experienced prolonged conflict with implications for its capacity to respond to health emergencies or epidemics. People living in post-conflict countries tend to face significant difficulties partly linked to post-conflict reconstruction of institutions, including accessing healthcare services and related information. Efforts to empower citizens to better respond to epidemics requires creating an enabling environment that supports them in building their capacities and coping mechanisms. Although the Report of the High Level Roundtable points-out that seventy five per cent of women were either direct victims of, or indirectly affected by the Ebola, it does not relate this to their role as care-givers. In my opinion the impact of Ebola and epidemics in general are gendered. Gender inequalities place a very heavy burden on women. Household-based care is also clearly gendered across African countries and places a disproportionately high burden on women. In most cases including post-conflict contexts, people who fall ill become unable to work or attend school, forcing family members mostly women to care for them. Such women are themselves also unable to go out to work or fend for their families, and are exposed to the risk of possible infection and worse still, death.

APN: Can you identify at least three areas of priority that policy makers, practitioners and scholars need to pay attention to in the area of human security in African countries?

Consolidating human security is a major challenge and a lot goes into deciding areas of priority. With regard to the ways in which governance can promote better and more effective responses to health challenges and strengthen human security on the continent, I will suggest on the following. First, to address emerging health challenges, states should strive to strengthen inclusive and participatory decision making, and treat universal access to healthcare as a priority at the individual, family, and community level. Governance should also emphasize enabling individuals and health-based institutions to work towards building stronger health systems that can produce positive outcomes in favor of human security in Africa. Second, is the need for a gendered and care-sensitive response to epidemics. This requires the recognition of the important role of care providers, and the risks they face, in designing interventions and policies aimed at responding the health challenges and emergencies. I would also argue that a care-sensitive approach is critical for human security in Africa. Third, it is well known that there is no one-size-fits-all approach towards maximizing synergies between various actors/sectors to strengthen healthcare systems because local contexts may vary significantly. Therefore, in the case of Sudan there is a need to conduct high-quality research to provide knowledge capable of informing locally relevant evidence-based policies and actions directed towards preventing or responding to epidemics. It is also important for researchers, healthcare professionals, local communities and government officials/policy makers to hold continuous dialogue on expanding universal access to affordable and gender-sensitive primary healthcare services.



Fatma Osman Ibnouf is Assistant professor and Researcher and Trainer at the Development Studies and Research Institute (DSRI), University of Khartoum, Sudan. Dr. Ibnouf holds a 2016 APN Individual Research Grant.