On April 16, 1913, Dr Albert Schweitzer and his wife Hélène Breslau, a nurse, arrived in Lambaréné to provide modern medical care to local Africans – and not just native Africans, but also missionaries and anyone else in need, regardless of race, nationality, religion or socioeconomic status. One aspect of Schweitzer’s work that is greatly underappreciated is how extensively he engaged the Africans themselves in his efforts. For example, even though Schweitzer set no preconditions to his efforts to relieve the suffering of a human being in need, he also believed that every human being has the capacity, and therefore the responsibility, to contribute to helping others. Today, on the cusp of the 100th anniversary of the Schweitzer Hospital, the context of health care in Lambaréné, as in all of Africa, has changed enormously since Schweitzer’s arrival, but the principles that guided the design and operation of his hospital have shown themselves to be timeless.
Under the leadership of President Ali Bongo Ondimba, Gabon has embarked on an ambitious effort to improve the entire health care system of the country. Enormous progress has been made in two crucial aspects: physical infrastructure and development of universal health insurance. And yet so far the impact on fundamental health indices has not matched the financial investments. Measures of basic health outcomes – maternal mortality, infant mortality and control of tuberculosis and HIV – remain far behind the levels one would expect from the resources invested.
The next phase of health system reform requires three additional crucial steps that the president is now beginning to pursue. First, Gabon needs radical improvements in its health information systems. Health statistics must be more reliable and available sufficiently quickly that they can drive improvements in management and results. Second, payments in today’s health system are not linked closely enough to performance, so that there is little accountability of those who receive funding to produce results. Third, Gabon needs to strengthen its training programmes for health care personnel – physicians, nurses, midwives, community health workers, hospital and health centre managers, and epidemiologists – including in how to work within a system in which financing is tied to outcomes.
In part to help catalyse the nationwide changes that are needed, President Bongo Ondimba and I announced in 2011 that in April 2013 we will open the Centre Hospitalier Universitaire International Albert Schweitzer à Lambaréné (CHUI-ASL), which will integrate clinical care, public health and prevention, research and training. The CHUI-ASL will be designed to serve as a major resource in helping Gabon to achieve rapid progress in meeting national health objectives, including the health-related Millennium Development Goals, starting in the Moyen-Ogooué province. The CHUI-ASL will closely coordinate all planning and implementation with the Ministries of Health, Budget and Education.
One of the most fundamental challenges is to do this not as a service delivered by an enlightened government and outside donors to a passive recipient population, but instead through an active partnership with the entire population of Gabon, in which every citizen of the country is expected to contribute – just as Dr Schweitzer expected every patient and family member to contribute. Success in convincing each citizen that health is in large part his own responsibility has the potential to mobilise enormous human resources. It could serve as a model for the broader national mobilisation of the population that is crucial to every other aspect of the Emerging Gabon strategy.
If these ambitious goals for results-driven comprehensive health system improvement can be achieved in Lambaréné and the Moyen-Ogooué province, and then extended nationally, Gabon has the possibility of achieving Dr Schweitzer’s vision on a national scale – ensuring prompt and effective responses to the health care needs of every person in need, regardless of social standing, where every penny is accounted for in terms of maximum value delivered. That would be an inspiring model not only for Africa, but also for the world.
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