It has been a week of heightened activities as African leaders, civil society and other interested actors engaged with Japan on mutual areas of cooperation – engagements that have now led to the Nairobi Declaration.
The Nairobi Declaration is hinged on three pillars: promoting structural economic transformation through economic diversification and industrialization; promoting resilient health systems for quality of life; and promoting social stability for shared prosperity.
The transformation of Africa critically requires that all the three be taken seriously and expeditiously, particularly when it comes to their implementation. Every person, group or institution that purports to see a transformed Africa must begin to play their part in realizing this.
Without doubt, as an international organization whose mission is to promote the rights and wellbeing of older people across the world, HelpAge International will be keenly observing how the second and third pillars will be achieved for people of all ages. The commitment to promote resilient health systems, for one, is not only important for social development and economic growth, but it backs a fundamental human right that continues to be undermined by the many challenges stressing Africa’s health systems.
Importantly, TICAD VI committed to promoting resilient health systems for quality of life. Several studies conducted by HelpAge in different regions of Africa indicate that secure income and access to quality and affordable health and care services are the top two most important factors in ensuring that older persons are able to live dignified lives. These determinants also underlie two of the key Sustainable Development Goals: to eradicate extreme poverty for all, and promote healthy lives and well being at all ages. In developing a strategy to promote resilient health systems that improves quality of life, TICAD VI has recognized the importance of living with dignity for people of all ages, including older persons, and the interlinking factors that contribute to healthy and dignified living.
TICAD VI’s strategy for achieving this ambitious goal includes strengthening health systems, bolstering responses to public health crises, improving nutrition, and supporting universal health coverage. What will be critical, however, is that each of these strategic elements must be implemented in keeping with the inclusive and age-friendly agenda – enshrined in the World Health Organization’s Global Strategy and Action Plan on Ageing and Health, which UN member states endorsed at the World Health Assembly in Geneva in April of this year. For one, healthy older people mean less strain on our health systems. Additionally, investing in healthy aging means that older persons can and will continue to contribute to the social and economic development of their countries; access to care and enabling physical and social environments are instrumental in ensuring later years are active and positive.
This will only grow in importance, as population ageing will undoubtedly test the sustainability and workability of TICAD VI’s strategies and tactics. The 2015 World Health Report on Aging indicates that by the year 2050, the proportion of people over 60 globally will almost double from 12 to 22%, and in just five years they will outnumber those children younger than five-year-old. No continent rivals the rising number of older persons among its population than Africa. As such, it is critical that TICAD’s strategies for improving the resilience of health systems in Africa are backed by efforts to support one of the greatest determinants of health in older age: universal health coverage.
The unequivocal support given to Africa’s quest for Universal Health Coverage (UHC) at the TICAD VI is thus another milestone of the strategy. At a side event co-organized by the World Bank Group with the governments of Kenya and Japan, the Global Fund to Fight AIDS Tuberculosis and Malaria (Global Fund), Japanese International Cooperation Agency, the World Health Organization, the African Union Commission, and other partners, there was strong commitment to support the call for UHC.
UHC aims to make sure people of all ages can access quality health services without suffering financial hardship. But without resources, such intentions won’t deliver. That is why it is refreshing to see that at TICAD VI, the World Bank and the Global Fund committed to investing $24 billion over the next three to five years to support the realization of UHC in Africa. In the words of Jim Yong Kim, President of the World Bank Group, “investment in universal health coverage is an investment in the future”. Participants seem to agree that no country can claim not to afford Universal health coverage. The key point is prioritization and proper management.
Finally, the third crucial milestone component of the TICAD VI Nairobi Declaration is the explicit importance of inclusivity across all components of the strategy – an issue which must be addressed for any measures to be considered successful. To Leave No One Behind requires implementing the strategy in a manner that supports both the Global Strategy and the WHO Action Plan on Ageing and Health, as well as the African Union’s African Health Strategy 2016-2030 and the recently adopted African Union Protocol on the Rights of Older Persons.
While sub-Saharan Africa has achieved remarkable improvements in health outcomes over the last 15 years, progress has been uneven. The 2014 report from a two-year pilot project undertaken by HelpAge International in Tanzania, Mozambique, Cambodia and Peru, as well as other programmes implemented in partnership with Department for International Development (DfiD) and the Swedish International Development Cooperation Agency (Sida), showed that inclusion of older people in community healthcare is vital to maintaining a good quality of life.
However, community health care systems are wholly ill-equipped when it comes to ageing health: few African health systems have a comprehensive strategy for providing geriatric care, or train health professionals in the afflictions affecting people in older age. Most health clinics lack testing tools for non-communicable diseases (NCDs), which typically affect older persons, and the majority are unable to provide lifesaving drugs used to manage NCDs.
As we look towards the implementation of the three pillars of TICAD IV, we must not relent in efforts to leave no one- no age, no gender– behind.
Which is why, despite my overarching support for the TICAD IV Nairobi Declaration, I must call out a categorical omission: While the third pillar focused on promoting social stability mentions many vulnerable groups, it does not mention older persons. We in the civil society look forward to Japan’s key role in humanitarian and development assistance, including its commitment from the TICAD VI to scale up measures to strengthen social safety nets among others. However, leaving no one behind means that all vulnerable groups need to be included in all strategies and plans to sustainably develop Africa, and ensure protection in times of conflict and emergency.
Having recently adopted the Protocol on the rights of the older persons, Africa must stand to ensure that not just the TICAD VI’s Nairobi Declaration, but all partnerships with international partners include older persons in order to inclusively and systematically tackle social, environmental and economic determinants of health within national contexts, and cut the burden of disease, financial risks, inequality and injustice.
By: Dr. Prafulla Mishra Ph. D.
The writer is Prafulla Mishra, Ph.D. — Regional Director, HelpAge International East West and Central Africa.