Africa CDC’s Health Economics Unit: More Important than Ever

Never before has the health of the population been so front-of-mind for so many people. African countries continue to face multiple burdens with limited resources, and COVID-19 has brought a new awareness of how vulnerable health systems can be.

Health economic analysis can help to maximise health for the resources available and help build effective and efficient health systems. The African Centres for Disease Control and Prevention (Africa CDC), which turns 5 today, plays a critical role in driving progress towards healthier African populations, and has designed and implemented the Africa joint continental strategy for COVID-19 and is uniquely well placed to champion evidence-to-policy health economics across the continent.

With support from the Centre for Global Development, the Health Economics Unit (HEU) at Africa CDC was established in November 2020. Now, the HEU has a crucial role to play—not only for the Africa CDC, but also for the African Union (AU) and member states, as it brings health economics closer to policymaking and provides an opportunity to strengthen capacity, research evidence, and health economics thinking. This moment is a unique opportunity to institutionalize health economics into continental, sub-regional, and country level health decision making in Africa.

The context: Multiple health emergencies in the face of limited resources

African policymakers face unprecedented public health challenges due to concurrent health emergencies like CVID-19, cholera, Ebola, and meningitis (Figure 1).
COVID-19 poses a major threat to African health systems and economies while also disrupting social systems like education and social services. These emergencies add pressure to health systems that are also simultaneously striving to achieve UHC with limited budgets (African countries typically spend less than $100 on health per person per year).

Health economics can strengthen health systems in Africa

2021 saw significant successes in the development and deployment of lifesaving health technologies, like with vaccines targeting Covid-19 and malaria. These successes are great opportunities, but continue to pose major policy challenges due to resource constraints. Access to, and delivery of, new vaccines continues to be difficult at a continental, sub-regional, and country level in Africa.

While the COVID-19 vaccine supply in African countries has improved, it is still low, so how can countries use limited vaccine supplies to maximise impact on the pandemic? In over half of African countries where estimates are available, the cost of high-coverage COVID-19 vaccinations exceeds the total health expenditure. Is this the best use of health finances? Or should Africa, the continent most affected by malaria globally, focus more on deploying medical products? Or should governments distribute more insecticide-treated bed nets for malaria? Or should they focus more on expanding HIV treatments or improve delivery of routine health services?

African policymakers need evidence to guide tough choices. In the race to significantly ramp up access to the latest health technologies, these choices are especially urgent as new, highly transmissible variants of COVID-19 appear. All choices exist within the same envelope of health resources, and in the context of slowing, or in some cases reducing, development assistance for health.

One application of health economics is to assess the benefits, costs, and trade-offs of allocating scarce resources to finance health services. Health economics provides a guide on how to decide whether to invest in new technologies such as vaccines. For instance, for COVID-19, the Africa CDC HEU and CGD have produced a toolkit that uses health economics to support countries to tackle policy questions like:

• “Which vaccines present value-for-money?”
• “What is the optimal vaccine delivery method?”
• “What is the cost-effectiveness of targeting specific age groups with vaccine delivery, in the context of challenging access?”

These are questions facing African policymakers, and for which health economics and health technology assessment could provide guidance.

Now is the time for the Health Economics Unit

Since its inception five years ago today as a specialized technical agency of the African Union, the Africa CDC has led disease control and prevention efforts at the continental front, while guiding sub-regional and country efforts. The Africa CDC particularly specializes in:

• surveillance and disease intelligence,
• public health emergency preparedness and response,
• laboratory systems and networks,
• public health research,
• and information systems.

The new HEU is an important part of this organization.

From its position within Africa CDC, the HEU was designed to support the mobilisation and use of important health economics evidence for both the Africa CDC and African countries, including support for local capacity building. For example, the HEU is working with research partners to address key questions facing policymakers in Ethiopia, Kenya, and Nigeria that are also relevant for continental COVID-19 response. In addition, the HEU is working with collaborators to explore the return on investment of national and regional laboratory initiatives. HEU is also working with multiple countries to estimate the cost of travel-related COVID-19 screening measures.

The limits to health economics capacity in African research and policy institutions are well documented. The aim of the HEU is to leverage itself within the Africa CDC and AU to mobilize existing health economics expertise and deploy them for continental, sub-regional, and country policy processes. The HEU also works with partners to strengthen health economics capacity across countries so that they can include health economics in decision making.

Conclusion

COVID-19’s health and economic devastation on African countries is a clear call for health and finance decision makers to rally economic analyses for both COVID-19 and broader health response.

For too long, the health economics agenda in Africa has been driven by external actors with varied interests. We call on all stakeholders, researchers, and policymakers to come together. Now is the time for African driven health economics research and policy agenda, and the HEU at Africa CDC can serve as a catalyst by working with existing regional and country level experts and stakeholders to improve decision making.