African Global Health: An initiative committed to achieving Health Sovereignty in the Global South

The COVID-19 pandemic has played a crucial role in accelerating the shift in healthcare. Indeed, the pandemic has been an unprecedented global health crisis that has shaken the foundations of healthcare systems worldwide. It has exposed vulnerabilities in health systems, especially in Africa, and underscored the critical need for sovereign health systems to address the continent's unique challenges.

The concept of sovereign health systems has recently gained prominence in global health discourse by focussing on the right to self-determination and independence of control over its health systems, Policies and Programs. It is imperative for the health system to remain sensitive to the local cultural norms, the social and the economic context, and in recognition of the global nature of health challenges. It should be capable of implementing informed and prioritized choices, to provide accessible, equitable, high-quality healthcare services to its citizens. In Africa and the broader Global South, achieving sovereignty in healthcare has been a long-standing goal (1).

The work of African Global Health in advancing sovereign health systems in Africa and in creating bridges through the Global South is a testament to the potential for positive change in the global health landscape. By promoting local leadership, strengthening infrastructure, building capacity, supporting research, and fostering smart collaborative global partnerships, the aim is to pave the way for healthier, more self-reliant nations within a sovereign African continent. As these efforts continue to make strides, they offer a blueprint for other regions, particularly in the Global South, seeking to build their own sovereign health systems, ultimately improving the well-being of their populations.

While sovereignty is a non-debatable right and purpose, it is essential to establish partnerships and connections not only in Africa but also in the Global South and beyond, working together hand in hand to the completion of a mutual goal: a better tailored healthcare system to the specific needs of the populations. Sustainable Development Goals (SDGs) adopted by the United Nations (UN) provide the impetus for these projects focused on people, planet and economic sustainability (2). It calls for a multi-sectoral approach to Health sovereignty with the desired outcome of Universal Health Coverage (UHC) aimed at equitable access to healthcare whenever and wherever it is needed without causing financial burden and leaving no one behind, especially focusing on the vulnerable populations. In this regard, the continental and regional focus on prioritizing investment in primary healthcare which addresses 90% of the community health needs and enables inclusive economic prosperity, remains crucial.

On the other hand, as climate change is becoming a significant and urgent global threat, Africa is no exception to that, being a continent already grappling with a range of socio-economic challenges. Rising temperatures, unpredictable weather patterns, and increased occurrences of extreme events, such as droughts and floods, are impacting the livelihoods of millions of people across the continent. Climate change increases the disease burden and deaths through health emergencies, air pollution, water pollution, and interruption of food chain and nutrition. Africa is particularly vulnerable, with exacerbating food, and water insecurity further increasing the risk of regional conflicts, resulting in increased refugees, all of which further burden the already weak health systems and dwindling resources. Hence, African nations are increasingly recognising the need for coordinated regional efforts mainly to mitigate climate change, and pandemic preparedness, while transitioning to more sustainable and resilient stable economies. Addressing climate change in Africa is an environmental imperative and a pressing socio-economic and humanitarian one. Early warning or surveillance systems are still very weak and require strengthening for resilience and adopting a one-health approach.

The exacerbation of contamination of water, deforestation, and other waste management environmental challenges with increasing migrants and displaced people is drawing global attention. As their stay becomes protracted, they entirely depend on the host environment to sustain their livelihood which adds further pressure on the environment. The vicious cycle of climate change reducing available resources (food, water, a safe environment), causing and aggravating conflicts that lead to increased migration and an increased vulnerability concerning health, leading to additional environmental deterioration continues to accelerate and requires urgent attention of all key stakeholders (3).

This era also calls for an up-to-date healthcare system, utilizing current means of communication and digitalisation, digital health technologies such as artificial intelligence, wearable devices, and telemedicine which are essential for a modern and accessible health approach. After the COVID-19 pandemic, the utility of digital health interventions in combating infectious diseases and non-communicable diseases has become prominent. For example, there were transformative tools and technologies implemented to prevent, control, diagnose, communicate, manage, and treat diseases during lockdowns and other tumultuous periods. In addition, detecting physiological responses following COVID-19 vaccination and audio-based digital testing of COVID-19 are being addressed with wearable smartwatch devices. It is important for the various governments to prioritize efforts in Africa's digital health interventions as an important accelerator of the UN SDG 3 targets by 2030 and the WHO global strategy on digital health 2020-2025 (4). The promising potential of transitioning healthcare training and delivery from an in- person to a digital medium in low-resource settings is being prioritized in countries such as Ethiopia. COVID-19 had a significant burden on patients, healthcare providers, and the healthcare system, hence the Ethiopian government and its partners intervened to sustain healthcare services (5).

In light of the new era, achieving health sovereignty and aligning with the UN SDGs agenda in the African continent as well as in the global south is not realized merely through one path but rather through multiple aspects and determinants linked to health in one way or another. This claimed sovereignty has been a long-term purpose in the continent but due to the recent global pandemic, it has become an urgent matter. During the pandemic, the United States of America with the higher Global Health Security Index (GHSI) score of 75.9 also recorded one of the highest COVID-19 cases and deaths. On the other hand, Somalia with the GHSI score of 16.0 had one of the lowest COVID-19 cases and deaths. Therefore, high GHSI scores were not positively associated with reducing COVID-19 cases (6). The COVID-19 pandemic has cast a spotlight on the state of health in Africa, revealing both vulnerabilities and strengths within the continent's healthcare systems. While the challenges have been significant, valuable lessons have emerged, which can guide the path towards achieving health sovereignty in Africa. These endeavors will require commitment, cooperation, and sustained investment from domestic governments and the international community to build a healthier, more resilient Africa.

It is also noteworthy that the disease burden in African countries with substance use disorders, depression, health risky behaviors, obesity, diabetes, Alzheimer's disease, delayed educational performance among children and adolescents, are health issues that consist of the first causes of Disability Adjusted Life Year (DALY) in Africa (7). In this regard, health harm reduction strategies and programs came to minimize the previously mentioned health harmful conditions. Health Harm Reduction refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of the different health hazardous behaviors, recognizing that those unable or unwilling to stop a certain behavior can still make positive change to protect themselves and others.

Therefore, Health Harm reduction programs now operate across a range of services and in different regions of the world. As of 2020, 86 countries had one or more programs using a harm reduction approach, primarily aimed at reducing blood-borne infections, substance and nicotine dependence, unhealthy food, risky driving and car accidents, among others (8). More African countries will decrease the burden from non communicable diseases through adopting the South to South collaboration, replication of the success models among African countries, implementation of the evidence based health harm reduction programs, information technology and science transfer from an African country to another. African Global Health has a crucial role in this regard.

In summary, African countries' commitment to unite together, grew together with the Global South countries, as a body of ‘African Global Health’ is the way forward. Commitment, cooperation, and sustained investments are the fuel to build resilience and health sovereignty in Africa.