Keynote Address Delivered by Amb. Lewis Brown at the Special Ministerial Session on Transformative Leadership During CPHIA 2023

Dec 7, 2023

Your Excellencies,
Honourable Ministers,
Distinguished Ladies and Gentlemen

On behalf of Her Excellency Madam Ellen Johnson Sirleaf, I commend the organizers for this 3rd Conference on Public Health in Africa and thank the Government and people of Zambia for their warm hospitality. Thank you to Africa CDC, led by Director General Dr. Jean Kaseya, for the opportunity to speak here today.
This conference encapsulates the new awakening that Africa cannot, should not, and will not wait for others to do for us what we must do for ourselves. In this spirit, no one should work harder for Africa than Africans. Certainly, none should lead us to where we want to go than ourselves. This consciousness must continue to be the cornerstone for the outcomes of this conference and future conferences.
From producing our own vaccines to developing epidemiological surveillance networks, and from constructing new public health institutions to pursuing Africa’s leadership in global health diplomacy, admittedly, many things have changed for the better in the last years. However, despite our best efforts:

  • 1 million newborn infants die on the African continent annually – this is 50% in their first day, and 75% in their first week;
  • 18 countries in the African region are among the 30-high tuberculosis countries in the world;
    230 million cases of malaria, and almost 600,000 malaria-related deaths were reported in Africa, representing 94% of the global malaria case burden;
  • 6 million children in Africa missed out on vaccinations in 2021, and a further 11 million children were under-immunized, accounting for 40% of under-immunized and missed children globally; and
  • In 2022, more than 116 million people were reportedly estimated to be living with mental health conditions before the pandemic, with suicide reportedly higher on the African Continent than the global average.

A kid missing a vaccine, a mother losing a child during birth, a person getting infected with HIV, and a sick parent being taken over long distances to medical facilities are not a thing of the past. These are reminders that our health systems are not strong enough, are not equitable enough, are not accessible enough, and are not efficient enough. I know this room does not need me to inform you about this. But this, too, is the size of the challenge. The task at hand is anything but easy. You meet at a time of increasing need to consider the long and difficult road to health security on our continent. Each of you represents the hopes of millions across our continent, a hope that we can travel that road successfully.

As you consider the future, please ask yourselves: Who will carry the Public Health flag of tomorrow? What should healthcare look like in 10 years? In 20 years? Who will be staffing our clinics and hospitals? From politics to education, are we preparing our countries, including digitally, to be ready to build upon and maximize the impact of treatments and technologies we see in other regions?

At this conference, I see an audience of experts in various fields of health. I see the brightest minds of our continent, and very likely, a coming together of the brightest minds in the world. But if we are talking about repositioning Africa in the global health architecture, we must cast our eyes beyond the attendees at this conference to also see the development, or lack thereof, of the human capital, which will be needed to sustain progress. How prepared is the next generation? How prepared are our institutions of learning to advance research, science, and public health? We are all aware of the brain drain – the emigration of highly trained workers from one country to another. In Nigeria, in only six years, 75,000 nurses have left the country. In 2022, Ghana had 4,000 nurses leaving the country. In Liberia, for instance, we are seeing a worrying shift away from the study of and required investments in science and medicines. Repositioning Africa is enabling our institutions of learning to stand up as they should with a new embrace of research in science and public health.

By 2030, Africa will face a shortage of 6 million health workers. Let me say that again: By 2030, Africa will face a shortage of 6 million health workers. At the same time, by 2030, young Africans are expected to constitute more than 40% of global youth. We have an unparallel advantage – and responsibility – to spearhead a foundational transformation of health care. History is calling on us.

Developing the needed human capital must go hand in hand with the resources that will be required. For example, at the community level, community health workers, most of whom are women and require additional training to provide much-needed life-saving services, have done so for years with passion and determination. Nonetheless, we keep hearing how inadequately paid they are for their services, and their lack of career advancement opportunities. Here, too, to put it succinctly: We cannot successfully reposition Africa if we cannot support community health workers. It is that basic. President Sirleaf is proud to be working alongside Director General Dr. Jean Kaseya, under the Africa Frontline First initiative, to develop a professional network of 200,000 community health workers that are skilled, supervised, salaried, and supplied.  Thank you, Dr. Kaseya and team for your steadfast leadership.

I asked a young lady what she thought the future for health should look like. Her answer was profoundly revealing. She said, hopefully we will no longer see our political leaders, who have responsibility to deliver high quality health services, traveling outside our countries, and even the continent, for check-up and treatment.
In any case, as the COVID-19 Pandemic has shown us, by the time we respond to an outbreak, it is  already too late. In our discussions for the future, prevention and rapid detection need to be at the core of our planning. This leads me to my next point: Inevitably, the future will be shaped by threats to climate change, migration, and non-communicable diseases. Therefore, we must foresee the needs and develop the capabilities to adapt to that changing landscape.

To change the paradigm of disease and neglect we see in many of our countries, we must change our own perspectives: For instance, we should not continue to wait for patients to come to us with ailments, we must go to the patients. We must find them, including to the very last mile. Repositioning Africa is taking health services to the doors of the sick. We can afford to do this because we are not a poor continent. Although it is fair to say, as that young lady suggested, we have been managed poorly.

Finally, the change we want to see must come at a pace that inspires hope. This requires a recognition of the inevitable: Politics is nothing else but health at a larger scale. We lose the initiative if we believe we can continue to shy away from engaging in politics, even the political aspects of health. Contrary to the popular view of scientists, it is not a lesser activity that ought not to seriously concern us. Politics determines the allocation of resources. Improving health requires resources. Politics, especially health politics, require our experience in meetings, hearings, parliamentary discussions, and other activities that inform the national direction we ought to follow, and the allocation of the resources we will need to get there.

Therefore, I invite you to take away the negative connotations around politics and become a champion of your cause for improved health conditions with your government. If you don’t get actively involved in making the decisions around the political prioritization of health, others with less incentives and knowledge will occupy your space and continue to decide for you.

Let me end with a reminder of the four aspects I believe can be the foundation for transformative change. Firstly, to be a health workforce powerhouse, we must invest in building a human capital pipeline. Secondly, public health must become an inclusive culture that permeates all of our institutions and activities rather than just a disconnected refuge for scientists. We must think about public health in the context of a whole-of-society approach, a duty shared from the cradle to the grave, so that we make wellbeing our enduring legacy. Thirdly, we must strengthen, without compromise, African agency. We must continue to demand of ourselves higher standards of leadership and accountability. With this spirit, I encourage each of you to be advocates and champions of your communities, districts, and country. We must live and breathe the freedom to dictate and determine our future. This means we must not just claim that Africa be repositioned but act to ensure and sustain Africa’s readiness. Lastly, and of no less importance, to accomplish the vision of the New Public Health Order, we require leadership that is deeply committed to making health for all a reality. We must champion health security in our politics and workspaces, and encourage others to join us.

It befits the moment, we are meeting in “Mulungushi” conference hall. Mulungushi represents the land where half a century ago, future Zambians demanded their independence. Africans gathered to deliberate, to convene, to rally. They said to themselves and said to the world: this is our land. This is our people to care for. This is our future to shape. This is our destiny to own. Today, as we gather again – what shall we say to future generations as we claim our health future? Together, change is possible.

Your Excellencies, Honorable Ministers, Distinguished Ladies and Gentlemen: Let us make the 3rd International Conference on Public Health in Africa a historical milestone for what is possible for Africa. Let us renew our efforts to reposition Africa rightly, purposefully and determinedly as a global powerhouse in health, well-being, and security. Many African lives depend on it.
God bless you. I thank you.

Amb. Lewis Brown
Special Aide, Office of the former Liberian President, H.E. Ellen Johnson Sirleaf.
Delivered at the Special Ministerial Session at the 3rd International Conference on Public Health in Africa, 2023 (CPHIA 2023)