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New WB Health Nutrition and Population strategy in the Middle East and North Africa: “Fairness and Accountability” (2013-2018)

  • A symposium on Health, Nutrition and Population Sector strategy for MENA took place on Friday July 5, 2013 at the Villa Valmer in Marseilles, France.  


    Mats Karlsson, CMI Director, opened the symposium by outlining the existing trends of population dynamism in the current context of regional political turmoil. The heightened aspirations for a new social contract and access to health services across the region constitute a core demand of citizens. The CMI is keen to assist member countries as they seek to build new health programs with the Bank by identifying needs and highlighting potential synergies between countries.


    Dr Enis Baris, Sector Manager for Health in the Middle East and North Africa Region Human Development Network, provided an general overview of health issues in MENA.  The region allocates a lower proportion of public spending on health matters than the world average, and thus “out of the pocket” spending on health is consequently higher than average. Demographic pressures and the recent economic turmoil that emerged in the wake of the Arab Spring have served to tighten pressures on both malnutrition and access to health services. This inevitably compromises the objectives set out in the Millennium Development Goals. Furthermore, there is a lack of prevention programs for other causes of death such as smoking or road traffic accidents. In order to avoid silo-based approaches and to address the health challenges through a global and comprehensive approach, MNSHD presented a new regional strategy structured around two pillars: “Fairness and accountability”. Every single action implemented within the health sector or policy carrying potential implications for on health is to be evaluated against these two principles. This new strategy shall be implemented through three consecutive steps:

    1. Determining client needs and prepare preliminary country profiles (Until December 2013);
    2. Developing tailored solutions thanks to in-country visits (Until June 2014);
    3. Implementing and managing solutions (Until June 2017).


    Open and animated discussions between the participants followed the presentation.  


    Representatives from Morocco stressed that this new strategy would help to prevent the lack of visibility that characterized previous health projects, avoiding the typical disease approach. The new strategy is also in line with the new Moroccan constitution that guarantees access to health care as a human right. Significant improvements in the health sector have been found thanks to the support of the African Development Bank: basic medical care coverage now is accessible to 54% of the population. However, it is essential to place specific attention on the increase in health spending (the growth rate of health sector exceeds the economic growth rate) and there remains the need for caution particularly given the recurrence of costly diseases such as diabetes, hypertension and kidney failure which cost both lives and resources.


    Similarly the representatives from Algeria explained that difficult choices would have to be made, for instance, whether to develop child care systems or high tech medicine. With an average ago of mortality of 74 years new pathologies appear, as well as many diseases linked to poor nutrition and polluted environment.  Indeed ancient diseases such as tuberculosis linked to poor hygiene and poverty are affecting an increasing number of people. Training of doctors remains key for the prevention and treatment of such diseases as is organization of drugs delivery.


    German colleagues insisted on the likely gains linked to developing prevention policies.


    Investing in the health sector means that the demand for care will automatically be created. These growing demands and rising expectation of the citizens must be answered. The representative from Morocco highlighted this, underlining that feasible, concrete and decentralized projects must be promoted.


    The researcher from INSERM agreed with this, concluding that in several cases (Egypt and Tunisia) universal coverage has been planned but it yet to be delivered. Non-delivery of essential services inevitably creates frustrations among citizens.


    Finally the Moroccan delegate suggested exploring the potential for integration between countries from the South Mediterranean in the health sector. Countries could mutually benefit from collaborations in training and sharing health coverage.


    The new CMI Environmental Health Initiative could play a key role in boosting the sector reforms underpinned by the core principles of “Fairness and accountability”. 


    Read the Enviromental Health Presentation on Strategy here.