A lack of funding is hampering the fight to improve healthcare in Africa, the World Health Organization’s (WHO) regional director for the continent has warned, calling for additional resources to improve access to life-saving treatments.
More than 445,000 people were killed by malaria in 2016, with Africa accounting for 91 percent of those deaths.
Last year also saw reported malaria cases rising to 216m, up from 211m compared with the year before, according to the WHO’s latest global report. Ninety percent of those cases were in Africa.
The continent also suffered immensely in 2013 when Ebola killed more than 11,300 people and infected some 28,600 as it swept through the West African countries of Guinea, Sierra Leone, and Liberia.
Al Jazeera spoke to Dr Matshidiso Moeti, the WHO’s regional director for Africa, on the obstacles facing the organisation in the region, what lessons were learned from the Ebola crisis and what future does the continent face in light of the WHO’s funding shortage. The interview has been edited for clarity and brevity.
Al Jazeera: What are the main challenges and obstacles facing the WHO in Africa?
Matshidiso Moeti: The biggest challenge facing us is working with 47 countries in the sub-Saharan region. We have a large number of lesser-developed and low-income countries and that means they have insufficient resources. It also means that healthcare in those countries is weak and not up to the task of catering to the entire population. Since they are significantly dependent on external funding, it imposes certain restrictions on how they develop their policies.
Lack of funding while working with these countries is a major concern. One of the ways we support these countries is to have expertise in place – good and motivated experts working and being backed up at regional level. But we don’t have sufficient funding for all types of expertise.
Al Jazeera: Dr Tedros Adhanom, an Ethiopian, was elected WHO director general earlier this year. What does that appointment mean for Africa and its health agenda?
Moeti: Dr Tedros’ appointment is very significant for the region. It shows that he has the capacity to lead and play that role at a global level. It makes a difference in terms of the political access of the WHO to the highest level of political decision-makers around the continent. He has access to heads of states who we expect to be supporting the WHO’s work.
It also means that we have somebody as a leader who knows the context of Africa as well as the conditions.
Al Jazeera: How big is the fight against malaria and HIV in Africa? And are these fights being won?
Moeti: These are very big fights. But we’ve been working on these for a number of decades and I’d say we’re making progress. Malaria is very challenging but we’ve seen significant reduction in mortality from malaria. Innovations around diagnosis and treatment of malaria are starting to have some impact.
While we’re making progress, it is clearly not enough and it needs to speed up. We need improvement in terms of coverage to win the fight and for that we need additional resources.
Al Jazeera: You said the progress is not enough. What are the reasons behind that?
Moeti: That is due to a combination of issues. It’s partly due to lack of funding. We had a partnership in place for a number of years but that that clearly did not work. This partnership has just been reformed and has been relaunched so to speak with a much clearer strategy so that countries and partners have enough money.
The WHO will still need additional money to have all the expertise that we like in different areas. This has also a lot to do with health systems in countries. They are not properly equipped and don’t reach far enough quickly. The health workers, the testing equipment and good medication is also need to have a good outcome.
Al Jazeera: The WHO’s handling of Ebola in Africa was described as a massive failure and the organisation faced huge criticism. Why did that happen and what lessons were learned from it?
Moeti: The WHO learnt a lot from that, but so did the international health and development community. The WHO could’ve performed better. We got on the ground as soon as an unusually and more than expectedly Ebola outbreak started in Guinea.
By that time, the outbreak had spread to other areas and that is linked to the weakness of the health system in the country. The diagnostic capacity was not there in rural areas where it all started. But having said that, I think the WHO could’ve done better.
Al Jazeera: What could you have done better?
Moeti: There was a delay in declaring the outbreak. The collective responsibility of countries and the WHO to declare outbreak to stop international spread did not happen. It should’ve at the beginning of this outbreak. We learnt a lot from that in terms of how to strengthen the awareness of member states of their responsibilities and also how to achieve our own responsibility in carrying out certain warnings.
Secondly, the WHO’s capacity needed funding. It has been reduced over the years and therefore the capacity to serve and deploy sufficient teams in time to these countries, and in order to make a difference, wasn’t there. The WHO did not have the money to be on the ground in time to make a difference.
As a result, we have now started a reform of our contingency fund which enables us to deploy the right sort of experts quickly as soon as there is a concern that an outbreak is happening.
Al Jazeera: The majority of the WHO’s funding comes from donations. Bill Gates donated $2bn from 1998 to 2014. How does the WHO manage its agenda with that of these private donors?
Moeti: About 70 percent of our funding is from donations. Much of that is voluntary contribution. Gates Foundation is our number two donor. But from my own experience, they support us to work on issues that we have identified as priority, for example support us for our work on malaria, child health, polio and education.
So we define the reform agenda and that is promoted by a number of partners and member states. My own experience has been that they are not here to influence agendas.
We wish to have a more balanced funding mechanism. It’s very important so we can move money around and address some of the priorities that can be less attractive to donors but which we think are important in promoting health.
Al Jazeera: So with the lack of funding, what does the future hold for health in Africa?
Moeti: We’re already seeing improvements taking place, for example reduction in child deaths, malaria and even HIV-related deaths are going down. But it’s the domestic investment in health that is needed. The countries’ finance ministers and parliaments need to recognise good health is a major contribution towards development.
That being said, there’s still a lot to do. We’re also advising countries on how they need to invest in hospitals as well as primary care. We also need to diversify sources of funding for the health sector if we wish to improve the situation in Africa.