Although highly diverse in terms of language, population size, culture, politics, and economics, West African countries share common public health challenges: high fertility and mortality rates and rapidly increasing HIV/AIDS prevalence rates that are exacerbated by conflict and poverty. Many of the health problems, including HIV and avian influenza, know no borders and threaten the entire region. Poor health diverts scarce resources and obstructs sustainable improvements in the regional productivity, and governments in the region continue to respond with varying degrees of success to these challenges primarily through their national health programs. Recent efforts to reinforce economic and political partnerships through ECOWAS highlight the need for a coordinated regional health initiative to complement national programs and to share experiences across the region.

USAID/West Africa Health Program Overview

With a budget similar to a USAID bilateral mission, but covering 21 countries in the sub-region including 7 bilateral missions, the USAID/West Africa health program focuses on catalyzing donor scale-up of improved service delivery models, and advocacy with governments for improved national and regional health policies.

USAID/West Africa brings extensive technical expertise and proven best practices in providing health services to countries with shared needs and the potential to bring these models to scale in collaboration with host governments and other donors. The program supports a network of "centers of excellence" for different health services around West Africa and facilitates active sharing and exchange of these experiences with health workers from other countries needing to improve their own programs. USAID/West Africa provides training and technical planning assistance to transfer those approaches, and collaborates closely with other donors to support full execution of the model and replication at additional locations. This partnership is effective in merging technical experience with vision and resources to achieve much greater health impact than USAID could have done alone. For example, when the USAID/West Africa program helped to establish the first center for the prevention of mother to child transmission of HIV (MTCT) in Mauritania, the bulk of resources were provided by UNICEF and the World Bank MAP project. The Ministry of Health and these other donors will collaborate to replicate the services at additional sites and expand national coverage.

Policy Advocacy and Replicating Best Practices

As the second major axis of the regional approach, USAID/West Africa supports the development and adoption of adapted health policies and service delivery guidelines together with host governments. Here again, the direct interventions of the USAID/West Africa health program are quite modest, but the indirect impact on health in the region, and the enabling environment being created for subsequent services, is much greater. Two recent examples of policy improvements are particularly important. The program continues to work with other countries in the region to adopt these policies and with other donors to finance scale-up of these proven best practices.

• The program has assisted parliamentarians to adapt model legislation to protect the rights of HIV-infected people and sign them into law in their countries, and 8 countries in the region have adopted similar legislated protection as of May 2007. This will directly benefit over 1 million infected individuals and lay the groundwork for 44 million adults in those countries to change their attitudes about the virus and seek HIV testing.
  
  
• Health Ministers from all 15 ECOWAS member states have signed a resolution to remove tarrifs from all malaria-related commodities. Taxes on imported drugs and materials have been a factor in making bednets and other products too expensive for many families to afford. This is not yet ratified by Ministers of Finance, but is a critical first step. Once this begins to take effect, it will make these products more accessible to nearly 143 million women and children in the region. Data on estimated indirect impact of best practice replication related to facility-based service delivery with other donors are difficult to measure and currently reflect the total universe of target population, but are being refined. These tables will be edited with the next web site update to better quantify the actual scale-up impact of donor partners.
  
  
• Estimated indirect impact from selected improved health policy and legislation is based on defined beneficiary populations in those countries which have adopted those policies.

RELATED HEALTH LINKS:

WAHO

The West Africa Water Initiative

The Transboundary Community Water Management Alliance