The current Covid-19 pandemic is forcing all major policy sectors in the West to treat health as a priority. The crisis has ramifications for all government departments, including border security, education, the legal system and finance ministries.

As the pandemic dominates global news, some have pointed out that populations in Africa and southern Asia struggle every day with under-equipped health systems, compounded by weak infrastructure and a lack of reliable energy sources.

Improvements in health are not only a desirable outcome of the SDGs, but also a critical tool for achieving them

That’s why, before the pandemic hit, consensus was growing within the international policy community that wellbeing should not be treated as a matter for the health sector alone. Health in All Policies (HiaP) is an intersectional approach that brings health into the centre of policy and planning and has been implemented in 41 jurisdictions across the world. This includes Sub-Saharan Africa, where the population has the worst health, on average, in the world, carrying 24% of the global disease burden, despite accounting for 11% of the world’s population.

The first major global report on the policy, published in 2019 on behalf of the Global Network for Health in All Policies, proposes the approach as one of the most effective ways for countries to achieve the United Nations’ Sustainable Development Goals. Could the Sub-Saharan nations adopting this new approach — Sudan, Zambia, Namibia and Kenya — lead the way for the rest of the region?

Putting health first

The Sustainable Development Goals (SDGs) are structured around ensuring “healthy lives and wellbeing for all at all ages” as a strategic priority, aiming for a holistic approach to strengthening health systems. With its latest General Programme of Work, launched in 2018, the World Health Organisation (WHO) has recognised that improvements in health are not only a desirable outcome of the SDGs, but also a critical tool for achieving them.

Health in All Policies is an intersectional approach that recognises health and wellbeing as an overriding objective, bringing it into the centre of planning and policy. Governments adopting the approach consider the health implications of all major policies, facilitating and supporting communication and coordination between ministries.

“Health and development are inextricably linked”

Sudan is an early adopter in the region, establishing eight intersectoral policy working groups in early 2016, as well as a monitoring, steering and strategy group. They developed a roadmap, matching key health challenges to relevant ministries. For example, Bilharzia — a parasitic disease caused by a worm that lives in fresh water — must be taken into account by a series of ministries: Electricity and Water, Agriculture, Environment, Education and Human Resources Development.

Joy Mauti’s PhD is on the Health in All Policies strategy as relates to the UN’s development agenda. She believes the approach has particular potential when applied to countries in Sub-Saharan Africa. “Health and development are inextricably linked,” she said, giving the example of distributing sanitary towels to girls. This encourages them to stay in education, improving gender equality and strengthening the economy in the long run. “We call it a win-win,” she said.

Mauti says Sudan is “way ahead” of other countries in Africa partly due to a high level of political commitment. The former President, Omar Al-Bashir, supported HiaP as a roadmap for the country, while the former Vice President met regularly with the policy working groups. However, the need for presidential support means the approach is vulnerable to changes in government.

The importance of dedicated staff and high-level support

The Global Status Report on Health in All Policies found that the more established the HiaP practice, the more likely a jurisdiction was to have a strong authorising environment, with formal structures in place to oversee the approach.

Health in All Policy frameworks may prove useful in confronting Covid-19 globally

Kenya and Namibia have drawn up HiaP frameworks but lack the support from central government needed to mainstream the approach. “Policies are good on paper,” Mauti says. “Practice is a whole different story.”

Her research in Kenya found that the implantation of HiaP in the country was “arbitrary”. Health in All Policies falls under the remit of the Ministry of Health and little is known about the approach within other government ministries. The paper recommends setting up a department under the President’s Office.

Budgets are also a source of tension. Less than half of the 41 jurisdictions implementing the approach had allocated a dedicated budget for HiaP activities.

Mauti says that in the context of Africa, the approach will fail if it requires a significant dedicated budget. “If you decide to finance HiaP as another vertical program, then definitely it won't work,” she says. “You have to make every sector understand that health is important, so they can even budget for HiaP within their own activities.”

The Global Status Report found that dedicated personnel were key, while a dedicated budget was only desirable. It was possible to implement the approach with minimal funds invested in staff.

Health in All Policy frameworks may prove useful in confronting Covid-19 globally. But the approach is relatively new and is only considered to be “established” in 13 jurisdictions, with Sudan the only country in Sub-Saharan Africa.

During the Ebola epidemic, which peaked in Western Africa in 2014, lessons were learned on the importance of addressing the social determinants of health, which include income, education and employment. In Sub-Saharan Africa, the capacity to provide critical care is the lowest in the world, so a holistic policy response is needed as there is limited capacity within health systems to absorb the pandemic.

Joy Mauti is hopeful that strengthening the approach across the continent can bolster the resilience of societies to the current pandemic and bring a broad range of future benefits. “All sectors of the government need to come together to address public policy with health at the centre,” she says. “For societies to thrive, they have to be healthy.” — Niki Seth-Smith

(Picture credit: Unsplash)