Policy harmonisation and collaboration amongst governments will play an important role in the ability of African countries to achieve UHC goals. Many African countries are already making progress towards UHC, however, the COVID-19 pandemic has impacted the availability and the ability of health systems to provide undisrupted health services. The private sector can contribute in policy harmonisation by pooling resources (both technical and financial), sharing information, and increasing collaboration with governments to ensure the efficient evaluation of health technologies.
Policy harmonisation and universal health coverage (UHC)
Healthcare policy harmonisation is the streamlining of regulation systems across multiple countries. Moving towards UHC requires strengthening health systems in all countries, and harmonisation of healthcare policies is key. Efforts to harmonise healthcare policy in Africa are still at the nascent stage and yet to realise their potential. As African countries advance efforts to achieve UHC, there is widespread recognition that we will not reach our goals without innovation of all kinds. Regulatory approvals are essential in ensuring the quality, safety, and efficacy of health products, but when regulatory processes are not aligned across African countries, these tools are prevented or delayed from reaching those who need them most. In addition, many regulatory agencies are under-resourced and over-burdened, creating bottlenecks and backlogs.
Challenges in policy harmonisation
The regulation of health products is an essential aspect of a functioning health system. National Regulatory Authorities (NRAs) play a critical role in ensuring the safety and efficacy of research, and support timely access to quality-assured, safe, and effective health products. Unfortunately, many low- and middle-income countries (LMICs) lack sustained funding and the technical expertise necessary to regulate the research and registration of new health technologies robustly and comprehensively. As a result, many NRAs are unable to fulfil their mandate, causing delays throughout the product development process. In order to improve regulatory capacity and infrastructure in Africa, there is need for countries to harmonize their healthcare policies with their neighbors.
When it comes to medical products and pharmaceuticals, each country is required to have a system that regulates those products, authorizes what can enter their market, and prevents substandard and falsified medicines from reaching health care facilities and dispensaries. This can be a lengthy, demanding process that requires considerable financial and human resources. One solution to this could be continental harmonisation. If each country has parallel policies, the chances are that products and services needed by people in that country may not be easily available because they are not allowed to be marketed or provided.
As far as regulation of medical products is concerned, one of the pressing issues at the moment is really that of substandard and falsified medicines in circulation on the African markets. Africa account for 42% of the world’s substandard and falsified medical products on the market and, of course, this is posing a big challenge in terms of public health because sometimes the public is subjected to these medicines, which can be very harmful. Another pressing issue is the different requirements for the registration of medicines. That means the industry finds it very difficult to get products into the market. This poses a challenge when it comes to availability of the most needed medicines, especially new products. Barriers to continued progress towards policy harmonisation include a lack of sustained funding, limited and varied technical capacity across countries in Africa, overreliance on a small number of donors, and limited bandwidth to expand regulation to different kinds of technologies and across phases of regulation.
Importance of policy harmonisation
Regulatory harmonisation across Africa has been endorsed at the highest political levels, and efforts to harmonise regulatory policies across Regional Economic Communities (RECs) are already having positive impacts. For example, drug approval times have already been reduced by half in the East African Community (EAC). Despite this progress, many barriers are still hindering the realization of African leaders’ vision of a single, harmonized African Medicines Agency (AMA) akin to the European Medicines Agency (EMA).
Healthcare policy harmonisation is vital for the UHC agenda. Through policy dialogue, African countries will be able to achieve the following:
Healthcare policy harmonisation is vital for the UHC agenda. Through policy dialogue, African countries will be able to achieve the following:
• Strengthen and streamline regulatory systems to support research and to get products approved efficiently while also ensuring quality.
• Embrace innovation and put systems in place to support scale-up to increase public health impact across the continent.
• Nurture a culture of accountability around commitments to UHC, including innovation.
• Ensure adequate investments for research and development for appropriate health products and technologies to meet the health needs of Africans.
• Embrace innovation and put systems in place to support scale-up to increase public health impact across the continent.
• Nurture a culture of accountability around commitments to UHC, including innovation.
• Ensure adequate investments for research and development for appropriate health products and technologies to meet the health needs of Africans.
Role of private sector in policy harmonisation
Improving health outcomes depend on the availability, accessibility, and capacity of healthcare workers to deliver quality people-centered integrated care. The COVID-19 pandemic dramatically demonstrated the invaluable role of the private sector and the need to engage the private sector in policy harmonisation. Private sector continues to play an increasingly important role in strengthening health systems. Scaling up the delivery of essential interventions to achieve appropriate health targets can be accelerated when collaborating with the private sector in policy making. Governments are increasingly turning to the private sector to improve quality and deliver value for money, build infrastructure, provide staff and training, raise quality, improve productivity, undertake social marketing, and enhance procurement. To adequately cater for the healthcare challenges faced by the continent, public private partnerships (PPPs) that focus on health systems strengthening activities should be prioritized along with specific disease focused initiatives to create supportive and sustainable healthcare systems for the advancement of UHC goals.
It is key that governments are the lead decisionmakers when it comes to the identification of key priority areas and when it comes to receiving funding for public health improvement, and therefore should collaborate and work with the private sector to ensure harmonisation of healthcare policies. Private sector can contribute in policy harmonisation by pooling resources (both technical and financial), sharing information, and increasing collaboration with governments to ensure the efficient evaluation of health technologies.
Conclusively, healthcare policy harmonisation is still constrained by issues such as follows:
• Weak institutional capacities for monitoring and evaluation in reference to weak health information systems, a lack of tools and skills, and weak accountability mechanisms.
• Desynchronized planning timeframes between programme and overall health sector strategies.
• Inadequate time to undertake comprehensive and good quality performance assessment.
• Weak mechanisms for following up on implementation of recommendations.
• Lack of effective stakeholder participation.
• Divergent political aspirations.
• Weak institutional capacities for monitoring and evaluation in reference to weak health information systems, a lack of tools and skills, and weak accountability mechanisms.
• Desynchronized planning timeframes between programme and overall health sector strategies.
• Inadequate time to undertake comprehensive and good quality performance assessment.
• Weak mechanisms for following up on implementation of recommendations.
• Lack of effective stakeholder participation.
• Divergent political aspirations.
Policy harmonisation offers numerable opportunities that need to be maximized. Identified challenges need to be overcome through strengthened Ministry of Health leadership, effective stakeholder engagement and institutionalizing follow-up mechanisms for agreed recommendations. In addition, health sector performance assessments need to be institutionalized as part of the accountability mechanism.
