Issued at the 3rd Ministerial Roundtable (MRT) during the 7th AFENET Scientific Conference, 12th November, 2018 Maputo, Mozambique
In this 3rd Ministerial Round Table (3rd MRT), Honorable Ministers of Health from 30 African Countries came together in Maputo Mozambique to discuss Policy, Guidance and future visions for the African Field Epidemiology Network (AFENET). This session is a follow-up on the previous MRTs that took place in Dar-es-Salam, Tanzania in 2011 and Abuja, Nigeria in 2016. It is also in fulfilment of a continuing resolution (No: A.3, Abuja 2016) of the Honorable Ministers that the MRT be institutionalized as a standing Ministerial Forum of subsequent biennial AFENET Scientific Conferences.
As the number of countries represented at this important forum continues to increase, it becomes necessary to emphasize the critical and strategic roles of AFENET in health systems strengthening especially Human Resource for Health (HRH) capacity development in Africa. AFENET was established in 2005 as a networking alliance of the Field Epidemiology and Laboratory Training Programs (FELTPs) and other applied epidemiology training programs mostly focusing on the countries in the WHO-Africa Region. A sister organization that coordinates the relationships of FETPs in Northern Africa and other Eastern Mediterranean countries is the East Mediterranean Public Health Network (EMPHNET).
In line with the Honorable Ministers’ mandate, AFENET has continued to expand its activities and has a current coverage of 37 Countries (34 countries with various levels of FELTP and 3 with only other health projects). AFENET is continuing to engage with all other remaining countries to establish FETP or at least affiliate them to existing FETPs. AFENET also has ongoing country negotiations for the establishment of FELTPs in all the remaining Sub-Saharan countries that are currently not engaged in any form. AFENET has been approached for collaboration by at least 3 countries and is already working with them. These countries share common epidemiologic considerations which were originally not in the AFENET catchment area, namely Sudan, Djibouti and Somaliland.
In view of the quality resolutions made in the past and their continued relevance and impact, the 3rd MRT therefore focused its attention on two major areas: namely, the review of the progress made in implementation of the previous two MRTs and a deliberation on new subjects for consideration. Regarding the first area of focus, the Ministers noted that an elaborate evaluation of the previous MRT resolutions has been conducted as well as a country-level dashboard for the progress made in implementation of the resolutions. This evaluation thus provides a baseline for future action and follow-up on progress. On the second area of focus, the Ministers deliberated on a new set of resolutions which AFENET is expected to add on to its guiding principles and in its partnerships with other stakeholders.
One very unique feature of this 3rd MRT, is its joint coordination and financing by the Africa -Centers for Disease Control and Prevention (Af-CDC) of the African Union and AFENET. This is in line with Resolution No’s E 1- 3 of the 2nd MRT, Abuja-2016, in which Honorable Ministers mandated AFENET to work closely with Af-CDC in all its relevant activities especially in HRH capacity development. This action by both Af-CDC and AFENET is both encouraging and highly commendable, and therefore, should be sustained.
The Ministers note and appreciate the continued collaboration and support being provided to AFENET by the World Health Organization (Head Quarters and WHO-Afro) through its global programs like the global outbreak alert and response network (GOARN), and the World Health Emergencies (WHE) programs. The Ministers specifically note and appreciate the United States Centers for Disease Control and Prevention (USCDC) for its long-standing funding and technical support for FETPs in Africa and other multiple collaborative projects with AFENET.
Summary of Key Gaps identified by the evaluation of the Previous MRTs:
A lot of achievements have been recorded following the mandates given to AFENET by the Honorable Ministers in both MRT-1 (Dar-es-Salam, 2011) and MRT-2 (Abuja, 2016). However, opportunities for improvement remain. Of the 12 countries that responded to the evaluation questionnaire:
· Only 3 have national budget lines for FELTP funding
· Only 3 have developed policy on FELTP as a national policy for HRH strengthening
· Only 3 have a formal policy on career path for FELTP graduates
· Only 4 have developed sustainable in-country FELTP funding mechanisms
· Only 2 have developed appropriate legislative instruments for FELTP financing
We, the undersigned Ministers and Representatives, applaud AFENET and its partners, especially the African Centers for Disease Control and Prevention (Af-CDC), the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (USCDC) for their tremendous contributions towards Human Resource for Health capacity development and response to epidemics in the continent.
Recalling the continued achievements of AFENET and partners in building the much-needed capacity for disease detection, surveillance, prevention and contribution to outbreak response;
Recognizing the need for additional urgent actions to further make our region, and by extension the global community safer and more effective/efficient to respond to epidemics and disasters;
Acknowledging that as representatives of Governments in Africa, we have a responsibility to guarantee health of Africans, and contribute to global health plans and commitments:
Building on the demonstrable benefits of the Ministerial Round Table to AFENET; the rising trend of successes being recorded by AFENET in the region; consolidating the strong partnerships between AFENET, Af-CDC, WHO and USCDC;
We resolve as follows:
A: Implementation, Monitoring and Evaluation of MRT Resolutions:
Since the establishment of MRT as a standing “Ministerial Forum” for Advocacy and Policy Guidance to AFENET, AFENET has monitored the implementation of the MRT- Resolutions and has developed a dashboard to show the level of implementation across countries. It is observed that most countries are yet to implement some (or all) of the previous MRT Resolutions.
1. Since these previous MRT resolutions are still in-date and relevant, every country (including those not in attendance) should take steps to expedite their full implementation as they emphasize on the sustainability of FELTPs.
2. All countries to expedite action in addressing the gaps identified by the MRT 1 and 2 evaluation process as itemized here-in.
3. Every country should designate a focal person and also develop a system for monitoring and evaluating the implementation of all subsisting country-specific MRT Resolutions. This will enable the effective follow up on the MRT-Resolutions, especially in the areas of Advocacy, Implementation and M&E Framework, Including identification of potential funding sources.
B. Prioritisation of FELTP expansion activities in Countries under Humanitarian Emergencies:
1. AFENET has worked mostly with the US CDC to expand the coverage of field epidemiology training across Africa. However, there are still many countries that do not have access to the various tiers of FELTP. AFENET should continue to work with partners to intensify efforts in the expansion drive, prioritizing the establishment of in-country FELTPs in those countries that frequently experience health emergencies or those under Humanitarian Emergencies (HEs). As an immediate priority, AFENET should work with partners to expand frontline FETPs in countries that are yet to establish in-country FELTPs.
2. The MRT observes with appreciation the role of all partners especially Af-CDC, WHO and USCDC in these efforts and therefore requests them to continue to support AFENET in this prioritized approach to expansion.
C. Need to leverage the platform of the recently launched AFENET Corps of Disease Detectives Initiative:
Honourable Ministers acknowledge the key role of the recently established AFENET Corps of Disease Detectives (ACoDD) as a significant step towards improving the quality of outbreak and other public health emergency response. The Ministers recognize that ACoDD is a mechanism to rapidly mobilize and deploy skillful epidemiologists to respond effectively to outbreaks of diseases across the continent thereby mitigating the negative health and economic impacts associated with these events. ACoDD was formally launched on May 7th 2018, in Kampala with the support of Af-CDC, WHO, USCDC, member countries and other stakeholders and it has already commenced action in several countries.
1. ACoDD provides a platform to respond to in-country and crossborder public health emergencies under the revised International Health Regulations (IHR 2005). ACoDD also provides a critical platform for developing a multi-disciplinary continental rapid response team to deal holistically with public health emergencies. Therefore, the Ministers request all partners including the World Health Organization (WHO), African CDC, US CDC and other Health Stakeholders in the Region to leverage this highly skilled Professional Corps in enhancing the effectiveness of public health emergency response in Africa.
2. The Ministers recognize that facilitating movement of ACoDD teams across the continent for international deployment and cross-border surveillance is key towards ensuring the effectiveness of ACoDD operations. Delays in immigration processes for deployment will negatively impact on response. The Ministers therefore, commit to facilitate international deployment into their countries as necessary.
3. Recognizing the relevance of ACoDD in the continental public health agenda, the Ministers commit to supporting ACoDD to ensure the full effectiveness of its operations.
D. Increase International Exposure for FELTPs
The Honorable Ministers commend AFENET for its current efforts in increasing exposure of African Health Professionals through the promotion of Internships (for Residents) and Sabbaticals (for Faculty) with International Health Organizations like WHO-AFRO.
This should be extended to other Health Organizations like UNICEF, UNFPA, UNHCR, etc. AFENET should also continue to explore more opportunities for global experience-sharing and exchange of experts for its residents, fellows, graduates and faculty
E. New Strategic Roles for AFENET: Post-Polio Certification and Humanitarian Emergencies:
The Honorable Ministers noted the contributions of AFENET towards the polio endgame and its final eradication. Therefore, AFENET should pro-actively expand and roll out its strategies in the areas of post-polio certification and the transitioning of the polio personnel towards other public health priorities especially in Humanitarian Emergencies: -
1. AFENET has played a key role in capacity development and coordination of the Polio STOP Teams in many countries, thus as part of the End Game Strategies, and polio transition process, AFENET should carefully and strategically build the capacity of these STOP Polio Teams for integration into priority routine Public Health Systems.
2. AFENET should collaborate with Global Polio Eradication Initiative (GPEI) in the Repurposing of it’s large pool of Human Resource for Health (HRH) into new relevant areas including humanitarian emergencies
F. Partnership of Af-CDC and AFENET:
The Ministers note with appreciation the progress made by AFENET towards implementing its Resolutions No’s A4 and E1 of the 2nd MRT, Abuja 2016.The Resolutions appreciated the establishment of the Africa CDC and emphasized the need for AFENET to collaborate with the African Union and other partners, especially the (then) recently established Africa-CDC.
The report on the implementation of the MRT resolutions indicates that Africa CDC has commendably leveraged on the existing efforts of AFENET and even gone further to engage and support AFENET, including the joint coordination of this 3rd MRT. An MOU to sustain this partnership between Africa CDC and AFENET has already been developed.
In line with these, Africa CDC in conjunction with relevant partners developed a ‘Strategic Framework for Public Health Workforce Development in Africa: 2019-2023’. Moving forward, Africa CDC will continue to coordinate and mobilize resources for all Stakeholders including AFENET in the development of Strategies for the promotion of job placement and professional development of public health workers, measurement of Health workforce gaps and models for longitudinal career progression in the continent.
Africa CDC will also collaborate with AFENET in leveraging its long standing and proven FETP competency-based training model to provide stronger advocacy, oversight and coordination of the FETPs including establishment of new training Programs based on identified gaps. Furthermore, standards and accreditation processes will be developed for public health training programs in laboratory, bioinformatics, etc. leveraging the existing accreditation process for FETPs which is being led globally by the Training in Epidemiology and Public Health Interventions Network (TEPHINET).
1. As a follow up to these positive developments, the Ministers request Africa CDC to continue to work with AFENET in its FELTP expansion plan and in rolling out more capacity development programs in other strategic areas in order to meet the relevant needs of Human Resources for Health in Africa.
2. Africa CDC is also requested to use its platform as the apex public health institute of the African Union to coordinate and mobilize the necessary financial resources and political commitment of member states’ Heads of Government and other development partners to enhance these collaborative efforts with AFENET.
3. All countries to ensure that their FETPs are duly accredited utilizing the globally accepted standards
Signed in Maputo, Mozambique. This Day, Monday, the 12th of November 2018.