European perspectives on global health: a policy glossary

5. Europe must act now for
global health : Four select
policy areas to shape the
global health agenda
Europe should support the
improvement of health
systems worldwide
A health system organises and manages the
actions necessary to achieve and maintain the
goals of health for all. It requires the active
cooperation of many people and agencies,
including health and care specialists but
also other branches of central and local
government, business organisations, schools
and communities, NGOs, foundations, families
and individual citizens.
Health systems in poor countries, particularly those in
Africa, are under increasing strain, they face a growing
burden of disease, as described in a previous section,
and diminishing public sector budgets. In many
countries salaries are insufficient to retain clinical staff
in rural areas, so they move to the cities in order to be
able to supplement their income from private patients
and “gratitude payments” and an increasing number
migrate to Europe where they can earn more. Health
systems in Africa and other near-neighbour states
represent the front line of global health surveillance
for Europe but the capacity to monitor global disease
threats depends upon local capacity for public health
and health service provision.
For these reasons, Europe needs to increase its
investment in global health systems in partnership
with developing countries. This could take many forms
including : budgetary support for health ministries,
support for training and staff development, further
twinning and other two-way relationships between
health services, cooperation on health systems
research and agreement on staff exchanges and
migration. While health aid is increasing, the <strong>European</strong>
Development Fund has been slow to support human
resources for health. Much of current aid is focused
on disease-specific programmes, which both create
additional problems of coordination for health
ministries and draw staff and resources away from
basic health care.
The New Partnership for Africa’s Development
( NEPAD ) “Health Strategy” of 2003 proposed action
on seven key problems facing their health systems :
• Strengthening government commitment and
stewardship
• Building secure health systems and services
• Strengthening programmes to reduce the burden
of disease
• Providing skilled care for pregnancy and childbirth
• Enabling individual action to improve health
• Mobilising sufficient sustainable resources
• Improving equity for the poor displaced and
marginalised
This strategy, which included a commitment to
increase government health spending to 15 % of
GDP, could provide the basis for partnership between
Europe and African countries to support health
systems, promote innovative reforms and train and
retain health personnel. Innovation and training must
be born out of local needs and experience recognising
the huge disparity between countries even within
Africa. Thus it is essential to build capacity for health
60 <strong>European</strong> Foundation Centre – <strong>European</strong> Partnership for Global Health