Southern social world-regionalisms: The place of health in nine African regional economic communities

Abstract

This article presents key results from a comparative qualitative Social Policy study of nine African regional economic communities’ (RECs) regional health policies. The article asks to what extent has health been incorporated into RECs’ public policy functions and actions, and what similarities and differences are evident among the RECs. Utilising a World Health Organization (WHO) framework for conceptualising health systems, the research evidence routes the article’s arguments towards the following principal conclusions. First, the health sector is a key component of the public policy functions of most of the RECs. In these RECs, innovations in health sector organisation are notable; there is considerable regulatory, organisational, resourcing and programmatic diversity among the RECs alongside under-resourcing and fragmentation within each of them. Second, there are indications of important tangible benefits of regional cooperation and coordination in health, and growing interest by international donors in regional mechanisms through which to disburse health and -related Official Development Assistance (ODA). Third, content analysis of RECs’ regional health strategies suggests fairly minimal strategic ambitions as well as significant limitations of current approaches to advancing effective and progressive health reform. The lack of emphasis on universal health care and reliance on piecemeal donor funding are out of step with approaches and recommendations increasingly emphasising health systems development, sector-wide approaches (SWAPs) and primary health care as the bedrock of health services expansion. Overall, the health component of RECs’ development priorities is consistent with an instrumentalist social policy approach. The development of a more comprehensive sustainable world-regional health policy is unlikely to come from the African Continental Free-Trade Area, which lacks requisite social and health clauses to underpin ‘positive’ forms of regional integration.

The Roles of Regional Organisations in Strengthening Health Research Systems in Africa: Activities, Gaps, and Future Perspectives

“…Notably, Yeates and Surender’s analysis of regional economic communities’ integration of health policy into their overall policy functions found that public health and healthcare is increasingly a strategic interest of these regional structures, but with differences in the way health policy is institutionalised and prioritised at the regional level. 46 Although Yeates and Surender use a health systems framework for their analysis of health policy and programmes, there are analogous themes and cross-cutting issues to our findings from using a health research systems framework.…”

“…One of their significant findings is the persistence of a siloed, vertical, and narrow approach to health within regional health policy and programmes without much emphasis on health system strengthening or universal healthcare. 46 We suggest that this lack of integrated and cross-cutting approaches within the health domain at the regional level raises questions about institutional capacity of some regional organisations to address HSciR pillars across sectors. Our research has shown that health research systems at the national level are intersectoral by definition, involving health, higher education, and science, technology and innovation policy actors and stakeholders.…”

Mapping regional cooperation of state actors for health research systems in Africa: A social network analysis

“…Another option would be to review health research policy diffusion or research uptake in a regional network as a measure of cooperation effects. For example, research has shown that African RECs have incorporated health to PLOS GLOBAL PUBLIC HEALTH varying degrees into their policy portfolios, but there is still a lack of knowledge about their impacts on national health or health research systems [2]. Measuring the impact of regional cooperation should also account for challenges of multi-level governance [45].…”

“…Regional organisations are increasingly involved in health policy matters within their broader sectoral integration mandates, [1] including in Africa [2,3]. Public health emergencies such as the 2014 Ebola outbreak and current COVID-19 pandemic have highlighted the unique roles that regional organisations in Africa can play in coordination, resource pooling, or scientific leadership when they have institutional capacity for these [4][5][6].…”

“…Acknowledging this history of regional bodies on the African continent and their health programmes and policies [2,3,[48][49][50], with emerging knowledge about their roles in health research [5,39,45], there is still much unknown about the constellation of actors in regionalism for health sciences research (HSciR). Therefore, this study aims to map the state-based regional organisations in Africa involved in HSciR, characterise the network of actors, and test the hypothesis of whether regional network strength correlates with national health research indicators.…”