Health Policy Development in Sub-Saharan Africa

National and International Perspectives

Published on, by Doyin Oluwole, MD, FRCP, Academy for Educational Development, Washington, D.C., September 18, 2008.


Worldwide, there is a growing realization that health is an integral part of sustainable development efforts. The critical importance of health among populations is also being recognized in foreign policy circles, in economic development discussions and within the context of socio-cultural issues of all countries – low, middle, and high income …

Proposed Way Forward for Sub-Sahara Africa:

As briefly shown in this article, there is no dearth of international agreements, national policies, and strategies in sub-Saharan Africa. Many countries are off track for the attainment of the MDGs while some will not attain them until 2050 or beyond due to

  • 1. poor performing health systems,
  • 2. growing health workforce crisis, and
  • 3. pervasive challenge of scaling up to achieve universal access to health care.

The critical challenge for countries in sub-Saharan Africa is to move from policy to action in the health sector. This move from policy to action should be grounded on each country addressing its priority health needs and mobilizing its people to improve the state of health at personal and community levels. Sub-Saharan Africa countries, in translating existing policies into national plans of action, should also ensure that health programs receive adequate funding, health services are implemented at scale, and health systems are monitored and evaluated in a transparent manner.

To translate national health policies into measurable national action plans, it is important to take cognizance of the following issues:

1. National plans should be developed to respond to the following key questions:

  • What? Essential interventions;
  • How? Through an integrated service delivery strategy;
  • Who? Skills required and which cadre can do what with a focus on the correct skills-mix;
  • Where? Home or at a health care facility;
  • With what? Supplies, commodities, and medicines.

2. Strengthening health systems should include:

  • Health workforce: innovative approaches to train, retain and sustain qualified workforce;
  • Make available essential medicines, equipment and supplies;
  • Measure progress: what is measured gets done.

3. Empowering individuals, families, and communities to own their health and demand quality services.

4. Scaling up rapidly: bring essential services to most or all the population quickly, equitably, and lastingly. This requires additional investment in health.


For sub-Saharan Africa to overcome its health problems, policymakers in the continent must regain control over the identification of national health priorities and the elucidation of national health policies. Governments, the private sector and the civil society should work together to develop and implement equitable health systems that serve the needs of all citizens, including those living in extreme poverty. As economic development improves the incomes and standards of living in many developing countries, an increasing gap is opening up between the rich and the poor. Families living in poverty are increasingly shut out of health care services.

It is very important to give “voice” to the poor in the planning and implementation of health services. (full long text).

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