Regional integration in West Africa
The West African Ebola virus epidemic
Barriers to an integrated health policy in West Africa
Benefits of an integrated health policy in West Africa
The right way forward for West African health policy
Health Policy in Regional Organizations – A driver for more integration in West Africa?
Anaemene, B. U. (n.d.). Health Diplomacy and Regional Integration in West Africa: The West African Health Organization’s Experience. Retrieved at 06/03/2018 from https://www.researchgate.net/profile/Anaemene_Benjamin2/publication/280902998_H ealth_Diplomacy_and_Regional_Integration_in_West_Africa_The_West_African_He alth_Organization's_Experience/links/55d1bd3208ae2496ee658037.pdf.
This article argues that the literature on regional integration, more specifically on regional organizations in West Africa, has neglected the relevance of the social sector for the successful regionalization of West African states by exclusively examining the economic dimension of integration. Thus, the paper fills this research gap and provides an assessment of the contribution of the West African Health Organization (WAHO) to regional health integration, which constitutes one area of social integration. Even though it is not a peer-reviewed journal article, it is valuable since it sheds some light on the progress made so far and the challenges organizations like WAHO face.
Bappah, H. Y. (2015). Human security in practice: securing people from the threat of epidemic - What can we learn from the Ecowas Response to Ebola? Strategic Review for Southern Africa, 37 (1), 190-199.
Bappah (2015) discusses the role ECOWAS (Economic Community of West African States) played in the fight against the cross-border Ebola virus in West African states. It critically evaluates its response using a time line analysis. The actions taken by the organization were undercut by weak and overstrained national health institutions, missing health personnel, slow decision making processes within the organization, the absence of an efficient health emergency response mechanism. He outlines the lessons learnt during the Ebola crisis and the need to also address non-military threats in the region.
Deacon, B., Ortiz, I., & Zelenev, S. (2007). Regional social policy. UN DESA Working Paper No. 37. Retrieved at 05/03/2018 from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1001491.
This paper published by the UN Department of Economic and Social Affairs takes a broader perspective on regional social policy in general terms. It discusses the concept in an antidote to the globalization and points to the advantages that the regional perspective on social policy accompanies. In addition, the authors identify several areas of regional social policies, among them health policy which is relevant for the purpose of this work, and report on experience in the African Union and other regional organizations engaged in social policy. Despite the fact that the paper is not a peer-reviewed journal article, the academic quality of literature published by an UN Department is accepted here.
Holst, J. (2009). The potential of regional trade agreements for extending social protection in health: lessons learned and emerging challenges. Open Health Service and Policy Journal, 2, 84-93.
This peer-reviewed article takes a different perspective on regional health integration. It demonstrates the opportunities that regional trade agreements offer not only to economic integration but much more to the social dimension of integration. Following Holst (2009) approach, differences in the structure, regulation and financing of national health systems are not insuperable and shared social protection and health services are possible. Peace and economic integration are not the sole determinants of regional development; social (and health) policy is increasingly recognised as being equally important and possible for regions.
Ifediora, O. F., & Aning, K. (2017). West Africa's Ebola pandemic: toward effective multilateral responses to health crises. Global Governance: A Review of Multilateralism and International Organizations, 23 (2), 225-244.
This article contributes to the academic discourse on the emergency induced by the Ebola virus in West Africa and finds that the crisis detected the institutional weaknesses at the global (United Nations), continental (African Union), regional (ECOWAS) and national levels. Ifediora and Aning (2017) analyse the health governance structures of ECOWAS and demand advances in the coordination and collaboration between the different levels of organizations (from global to regional) to avoid a second emergency health case like Ebola.
Loewenson, R., Modisenyane, M., & Pearcey, M. (2014). African perspectives in global health diplomacy. Journal of Health Diplomacy, 1 (2), 1-19.
By means of a systematic literature review on African health diplomacy, the article finds that health policy is a “soft power” and able to give Africa a voice in global health diplomacy if certain conditions are met (such as more regional cooperation and harmonization in national health issues). But there are several factors African policy makers should pay additional attention to when engaging in global health policy (the loss of sovereignty, the role of private actors, the management of development aid, etc.). Despite the fact that the article is not directly about regionalism, the concept of global health diplomacy illustrates the need for West African health integration.
Onzivu, W. (2006). Globalism, regionalism, or both: health policy and regional economic integration in developing countries, an evolution of a legal regime. Minnesota Journal of International Law, 15 (1), 111-187.
Onzivu (2006) takes a more institutional and legal oriented perspective when he investigates how international trade paved the way for discussions on health and social policy by means of new regimes, health policies and governance mechanisms. The institutional setup of the African Union and ECOWAS in terms of their health policies is analysed and the factors for a successful integration of regional health policy are outlined. The publication in an international law journal shows that health integration is an interdisciplinary field of research and cannot be limited to regional studies.
Ouma, S., & Abe, O. (2017). Regional integration, public health capabilities, and the place of the World Health Organization in Africa. Albany Law Journal of Science & Technology, 27( 3), 232-259.
Ouma and Abe bring a new issue into the discussion on regional health policy, the Visa-free travel in African States. The elimination of the Visa requirement facilitates the free movement of people in certain African states but open borders also contribute to the spread of diseases. The authors of this peer-reviewed article argue for a better cooperation among states, especially on health policy, to protect their citizens against the downsides of the globalisation such as the Ebola virus or the Zika virus.
Riggirozzi, P., & Yeates, N. (2015). Locating regional health policy: Institutions, politics, and practices. Global Social Policy, 15 (3), 212-228.
This article provides a review of the scientific literature on three related concepts: global social policy, regional studies and diplomacy studies in relation to health policy. The key insight is that scholars of these three fields must recognize regional organizations as the key institutions that act, frame and challenge global health policy. Regional organizations constitute the platforms for policy makers, academics and practitioners to come together and push health policy integration. The article was published in a fully peer-reviewed journal.
Robert, R. (2004). The social dimension of regional integration in ECOWAS.International Labour Office Working Paper No. 49. Retrieved at 06/03/2018 from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=908485.
The working paper by Robert (2004) provides an overview on the social dimension of regional integration in ECOWAS and tries to explain how regional organizations can promote social policy in the global age. It describes the institutional set up and the main achievements of ECOWAS, with a closer look at labour law harmonization and strategies for poverty reduction, gender empowerment and democracy building. Despite health policy is not a central issue here, Robert (2004) rightly demonstrates how cooperation between West African States (outside the agenda of security policy) has contributed to a broader recognition of the dimension of social policy. The International Labour Office is the permanent secretariat of the International Labour Organization and publications are therefore assumed to be of academic quality.
Shigayeva, A., Atun, R., McKee, M., & Coker, R. (2010). Health systems, communicable diseases and integration. Health Policy and Planning, 25, i4-i20.
Shigayeva et al. (2010) take a more technical view and assess the opportunities for integrating national health systems into a regionally shared system. Health systems differ according to their regulatory norms, rules, funding, personnel, structures and values. A systematic literature review shows that a harmonization of these differences is associated with several benefits. At the same time the authors detect a lack of empirical evidence on the positive effects of health policy integration, which is, according to them, due to the complex and multifaceted nature of the issue.
Sombié, I., Aidam, J., Konaté, B., Somé, T. D., & Kambou, S. S. (2013). The state of the research for health environment in the ministries of health of the Economic Community of the West African States (ECOWAS). Health Research Policy and Systems, 11 (1), 35.
This article discusses a novel issue, the concept of Research for Health (R4H), and describes the enabling and disabling conditions within the Ministries of Health of the ECOWAS states that West African health researchers face. Research for Health is a central element in combating diseases and increasing the development of a region. The author set up a list of factors that improve the environment for research (such as capacity building, harmonization of activities, networking opportunities, etc.). Health Research Policy and Systems is a peer-reviewed journal on the organization and use of research in health.
In the last decades, scholars recognised the importance of social policy for the development of regions. Thereby the attention of regionalists turned from the traditional fields of integration, being trade and security, to social policies. The globalization and the related increasing inequality between the Global South and industrialized states demonstrate the need to bring social policy on the agenda of decision-makers at all political levels. Since “The idea of a trans-national social policy is increasingly taking hold among scholars and development practitioners” (Deacon, Oritz & Zelenev, 2007, p. 2) regional social policy is an emerging and growing field of research. In 2006 for example, the journal Global Social Policy published a special issue on regional social policy (see editorial by Yeates (2007)) and many articles on this issue were discussed at the UNESCO High-Level Symposium on the Social Dimension of Regionalism in 2007. Regional social policy scholars study several fields, among them labour policy, migration policy, housing policy, but also health policy. Healthcare provision is a basic need to all humans and is therefore a particularly relevant area of policy in regional development studies. While there is a rich amount of scientific work on regional health policy in South and Latin America (see e.g. Amaya, Rollet, Kingah (2015); Carrillo Roa & Santana (2012) or Riggirozzi (2014, 2015)), only a few scholars studied regional health policy in West Africa. But in the last years some interesting papers were published, which discuss the health policy of West African states and its regional organization, ECOWAS, certainly initiated by the Ebola emergency in Guinea, Sierra Leone and Liberia. Bappah (2015) analyses ECOWAS response to the Ebola crisis and provides recommendations to strengthen the regional health provision system, while Ifediora and Aning (2017) find institutional flaws (also at member states’ and ECOWAS’ level) as being responsible for the weak answer of the African community. Another factor that has been identified in the literature is the technical difference between member states’ health systems (Shigayeva et al., 2010). This discourse is complemented by some articles that examine very specific aspects of West Africa’s health policy. Ouma and Abe (2017) connect the elimination of the Visa requirement to the recurring challenge of epidemics in West Africa and Sombié et al. (2013) investigates the enabling and disabling conditions that researcher of medical sciences in the region face. In general, it can be observed that scholars work hard to close the research gap between regional studies and health policy in West Africa and we can look forward to further interesting publications on regional health policy in West Africa.