Health in a Changing Landscape in Africa
Dr. Feng Zhao
Health Manager
Human Development Department
The African Development Bank
 A rapidly changing landscape in Africa
 An innovative strategy for engaging in health
 AfDB’s engagement in health in Ghana
 Plan for next phases
 Areas of interest
Changing Landscape
 Continued economic growth
 Population dividend
 Changing aid dynamics
 Increased need for value for money and
domestic accountability
 Opportunity for innovative ways of delivering
services (e.g. ICT solutions)
Guiding documents
Medium-Term Strategy
Human Development Strategy
 Focus Area 1. Improve Competitiveness and Employment
 Focus Area 2. Value for Money and Accountability in Service Delivery
 Focus Area 3. Risk Protection, Inclusion and Social Cohesion
Public sector window
Private sector window
Lending: Loan/grant
Non-lending: Analytical work; TA
New strategic thinking on health
 The Bank has been supporting health since 1970s
 Traditionally, the Bank focused on health sector infrastructure
e.g., hospital construction
 Shift in Instruments: Stand-alone vs. partnership; focusing on
value for money and domestic accountability (Kaberuka’s
 Shift in focus: Health infrastructure vs. system strengthening
 Partnership: PPP; alternative financing mechanism (e.g. value
for money trust fund)
 Demand for African leadership
 The Bank has recently made strategic HR
investments ( for example the hiring of health
economists, HRH and health insurance
specialists) and is now well positioned to
exploit the new opportunities
New approach
(a). The new approach includes multi-sector
operations e.g. health (including nutrition) in
agriculture, climate change, water and
sanitation; private sector operations such as
PPPs for hospital construction and
management; provision of essential drugs e.g.
for HIV/AIDS; ICT operations in eHealth.
New approach
(b). The Bank will pursue innovative partnerships
to mobilize and leverage resources for the
Continent. For example, the Bank is currently
discussing a new Multi-donor TF to support
value for money and domestic accountability as
well as to sustain the coverage of essential HIV
services that are affected by the decrease of
ODA from the traditional donor community.
New approach
(c). The Bank will work with RMCs and private
sector to revitalize the pharmaceutical industry
and make it an engine for economic growth and
job creation. In this regard, the Bank is
discussing with South Africa to explore the best
way of supporting the first ARV production line of
the continent.
New approach
(d). The Bank will also focus on knowledge
products in critical areas such as health
insurance and eHealth. For example the Bank is
currently working on a Continent-wide study of
health insurance models which can be applied in
Past support to Ghana
 ADB is involved in the Health sector in Ghana since 1990 under three Health
projects. These projects were focused on health system strengthening.
 The first ADF intervention in Ghana’s health sector (Health I) was approved in
January 1990. It was for a loan amount of UA 13.88 million for the development of
two national teaching hospitals, Korle-Bu and Komfo Anokye Hospitals as well as a
regional hospital, Effia Nkwanta Hospital. The ADF allocation for Ghana in 1991 was
able to finance only three out of the five district hospitals requested for Health II i.e.
Yendi, Kibi and Keta District Hospitals. Both projects were successfully completed
and Borrower’s Project Completion Reports submitted. The Borrower experienced
long delays between project appraisal and commencement of project activities as
well as untimely payment of counterpart funds in the implementation of both
projects. Previous Bank Group experience in the sector noted weak project
management and irregular payment of counterpart funds resulting in delays in
project implementation.
Current support to Ghana
 The third project (Health III project) is still ongoing and the
disbursement date line is 31st March 2012. The main
achievement of the Health III project is the Construction of
Tarkwa hospital which is 98% complete and the Bekwai
Hospital which is 50% complete. A capacity building
component is also part of the project.
 The Bank is involved in the sectoral dialogue and has
participated in the three health summits held annually and the
monthly partner meetings.
Economic Sector Work
 In view of the importance the Bank attaches to issues of regional integration and the
need to take into account challenges related to access to drugs (ARV, drugs for TB
and malaria) in the West African Region a filed visit was undertaken to Ghana from
31 January -4th February 2011 by representatives from Benin, Cote d’Ivoire and
Burkina Faso) UNAIDS in collaboration with the Bank facilitated the process of
exploring the possibility of establishing a manufacturing industry in West Africa. The
study seeks to find out the real and concrete possibility and interest of the Ghana
private and public institutions to host an Italian initiative in the field of
Pharmaceutical Company.
 Ghana was part of the countries visited. The main findings of the study
showed the need to upgrade Drugs local factories in the country. The main
report is under review for the final approval. Discussion will be followed up
with the Italian Cooperation for a more in depth analysis of the local
production of drug’ sector.
Future support
 The Bank is exploring more PPP activities in the Health sector. The issue of
Human resource for health could be address under PPP activities.
 For 2012 a Health impact assessment in the oil and gas sector is scheduled
subject to the availability of funds trough the bilateral funds. The HIA will be
a diagnostic study with baseline information to help monitor and measure
impact of the oil and gas developments on the target communities. The
TOR and proposal are already available.
 Discussion continues with the Italian Funds to upgrade the drug’s industries
in the countries
 The Bank is involved in the development of the Health financing strategy.