AfroPHC had a 3hr virtual workshop, linked to UHC Day, on 1-4 pm (Central African Time) 10th Dec 2020 to workshop the question “What is next for AfroPHC, considering the UHC movement?” We were especially concerned about workforce issues in PHC under UHC.

The workshop from 1-4 pm consisted of a plenary of 60 min, group discussions for 60 min and feedback in the next 60min on the following questions. We also wanted to explore how to set AfroPHC up as a formal organisation. See the draft AfroPHC founding document

We had 311 registrants and ±100 attendants during the 3 hr workshop. We had professions of nurse (incl. FNPs), medical doctor, public health, ambulance assistant, pharmacist, dentist, physiotherapists, medical sociologist, researchers, medical eye health attend from SA, Kenya, Uganda, Zimbabwe, Nigeria, Rwanda, Lesotho, Zimbabwe + USA, UK, Pakistan, Myanmar.

There were welcomes from global leaders:

• Dr. Donald Li, World President of WONCA (World Organisation of Family Doctors) spoke of comprehensive person-centred PHC by qualified teams caring for designated populations for UHC. He was delighted by the AfroPHC work by frontline staff and urged them to show the way forward.
• Ms. Thembeka Gwaga, Vice President of the International Council of Nursing (ICN) appreciated AfroPHC for its leadership. She wanted and was glad that nurses were included in the leadership e.g., Bongi Sibanda. PHC includes all practitioners and must be inclusive. WHO Report on Nursing – emphasise nursing education and workforce issues. Global shortage will worsen in Africa with migration- gear ourselves for that.
• Dr. Mary Showstark, Communications Director of the International PA Educators Group (IPAG) and founder of of IFPACS for Students shared that the discipline of Physician Assistants were in 15 different countries under 14 different names across Africa. She said that PA’s were a valuable member of the PHC team and that they are looking at curriculum development and advocacy. PA’s are keen to work in interprofessional teams for patients and did not want to take other people’s jobs. She urged that different PHC disciplines cannot work in silos and wished AfroPHC well.

A key feature of the workshop was a plenary of four influential panellists who discussed how PHC activists should navigate the UHC movement and advance the vision of AfroPHC, moderated by Bongi Sibanda and Shabir Moosa

Key reflections on the AfroPHC Statement made by each of the four panellists were:

Mr. Jim Campbell: Director, Health Workforce Department at the World Health Organization welcomed the statement with the following reflections. He supported the leadership/advocacy role of AfroPHC especially as it was African (vs. regional) and inclusive of different PHC groups. He supported the language on multidisciplinary teams, as aligned to Astana/WHO language and stressed that all relevant health care workers be included especially representatives of labour to address decent work/pay issues. He shared that task-shifting was important (i.e. different occupations / scopes of practice takes on different roles) but that it was not the same as teamwork, where everyone is focused as a teamon holistic patient-centred care. On being asked whether doctors needed to be part of the PHC team he responded that the medical team was part of team to take all forward and that clinical supervision and leadership comes from specialists. He advised that we engage with healthcare worker management issues including the WHO policy on CHWs. He also advised education as lifelong learning vs training  as a once-off exercise. He urged AfroPHC to engage the private sector on mixed health systems and partnerships for public purpose with government stewardship.

Dr. Suraya Dalil: Director, Special Programme on Primary Health Care at the World Health Organization congratulated Afro PHC on the creation of the forum and the statement. She shared that the history of PHC, from Alma Ata in 1978 to the Astana Declaration in 2018 (within the SDG context) had people and equity at the core. She urged well-trained well-distributed, well cared for, empowered health care workers working from prevention to rehabilitation.  She said there was a need to create an enabling environment with supportive supervision, continued learning, safety at work, decent pay. She also said that gender and youth issues in human resource need to be addressed. She urged career development and progression, that we optimise quality and impact thro evidence-based policies. She urged investment in human resource and labour markets for PHC. She prioritised education with strong institutions. She felt that we need to strengthen data for human resources for PHC, noting that the healthcare workforce information system nomenclature is challenged and needs to be created. She hoped that WHO would help harmonise the different categories and disciplines in PHC. She urged that we include human resources in the private sector and to do workforce modelling, looking at gaps in delivery. She bemoaned the high unemployment of nurses. She urged that multidisciplinary teamwork in PHC goes beyond health of care, and that we liaise with networks and other disciplines e.g. education, environment, trade and community-based structures. We need to link individual care with population care (as seen needed in COVID). She urged the need to institutionalise the aligned policies at national level, including departments of finance, education and labour. She felt that we, as providers of care, are strategically located to develop trust between the state and the population. She informed the meeting of the WHA adopted the PHC Operational Framework with 14 levers (4 strategic and 10 operational lever). One of the operational levers is health workforce.

Prof. Joachim Osur: Technical Director, Amref Health Africa and Dean, School of Medical Sciences at Amref International University echoed AMREF’s support and community work. He suggested that we need actionable points and details e.g. what is team looking like and who is leading it? If we say health in all policies – is agriculture etc. also part of PHC? He urged that we engage with community systems in place (sociocultural/traditional) and don’t adopt a medical model of PHC service delivery and address financial resources for PHC: human resources, procurement etc. and raise the Abuja Declaration. He responded that healthcare workers need to be educated to manage resources. He also challenged matching the training to actual work tasks, not just diseases but psychosocial issues, thus needing comprehensive training with the multidisciplinary team based in workspace and involving others useful to intersectoral collaboration e.g. training institutions.

Dr. Prosper Tumusiime: Retired Director, Departments of Health Systems and Services Development and Universal Health Coverage & Lifecycle, WHO Regional Office for Africa appreciated the statement as it brings out principles. He stressed the need to outline aims/objectives of the forum in respect of healthcare workforce issues for UHC/PHC. He also urged that we address the multi-sectoral nature of PHC with SDGs and bring them in. He said that we need to use technology and digital health even in education. He said we needed sustainability of achievements with locally generated solutions. He urged AfroPHC to be clear and deliberate on PHC finances (both public and private) and to go beyond advocacy with actionable issues and evidenced needs in which we can track progress and find gaps in what we agreed. In response to questions on decentralised funding he share that in the past planning was done at ministry level with the periphery just receiving what was sent, not being part of planning. He urged that it was important to identify real requirements at grassroots level and quantify that to inform plans. He also urged empowerment of lower levels with funds to use but that this needed capacity and clear roles that removed layers of bureaucracy and was in accordance with the financial situation in the country. He said this needed support for better financial management but would create better accountability and involve local people. He said that the ministries of finance should also use this to raise money locally. He urged working groups around holistic PHC, Primary Care links to Secondary and Tertiary care, Research and Resources as part of planning.

There were also announcements of the 30by2030 campaign by Jan de Maeseneer, on a petition to urge major donors to set aside 30% of their disease spend on integrated PHC and the Wonca/AfroPHC MOU with World Continuing Education Alliance by Craig Fitzpatrick to improve access to education that is African-based.

The rest of the workshop involved group discussion on the questions below:

• What are the priority PHC workforce issues in Africa? It was felt that we need to address the policy context of low prioritisation of PHC and PHC workforce issues, including funding, decentralised PHC systems, human resource management, human resource development and e-health. It was felt that we needed appropriate models of PHC in Africa that included different cadres working to their own scopes but as a multidisciplinary team caring for a defined population, including addressing social determinants of health. PHC human resource management and development was non-standardised across Africa.
• How should we address these priority PHC workforce issues? It was felt that AfroPHC needed to collaborate with a variety of stakeholders both to develop a clearer position and to advocate for PHC, the team and patient/community voices. This needed to translate across the various areas of importance: political will/funding/health systems, human resource management, human resource development and other important issues for PHC e.g. e-Health. There were many issues of importance to address in PHC human resource management and development.
• What working groups should we be creating to take AfroPHC priorities forward? There were a few groups suggested: Policy, Training-Research, CHWs, Health Promotion and Teamwork (Interprofessional Collaborative Education and Practice).

The detailed group discussions will be captured in the AfroPHC Strategy for PHC in UHC. 

In addition there were key statements regarding developing AfroPHC as an organisation that were gauged.

Prepared by Prof. Shabir Moosa

25th January 2021