Regional Health Governance in West Africa: The Role of the West African Health Organization

By: Edefe Ojomo; JSD Candidate, NYU School of Law; Lecturer, University of Lagos; Recipient of the Africa House/CTED Development Impact and Thoyer Fellowship

After the 2014 Ebola outbreak in West Africa, governments, international organizations, and private donors devoted significant resources to the strengthening of health systems by focusing on health governance across different levels, including regional health governance. The West African Health Organization (WAHO), established in 1987 to promote the highest standards of health amongst member states, was not equipped to provide a proficient response to the crisis. However, it has since adopted new measures to address similar outbreaks in the future. One of these has been the establishment of a Regional Center for Disease Control (RCDC). Despite these developments, the underlying regional health governance framework in West Africa has not changed very much over the past few decades, and my research explains the current system as a relational exchange between governance actors and their targets. It seeks to show what the governance deficits in the West African health system are and how they might be addressed.

Health indices in West Africa are among the lowest in the world, with high infant and maternal mortality rates, high disease prevalence, and low (infrastructure and personnel) capacity. National health institutions are unable to effectively protect the populations and territories under their control. Therefore, specialized institutions like WAHO are established under the auspices of the Economic Community of West African States (ECOWAS) to address governance challenges in specific sectors. Prior to 2014, WAHO was a little-known agency within the ECOWAS framework. But, since the 2014 Ebola outbreak in ECOWAS member states, WAHO’s prospective role as an alternative to weak national health systems, necessary for promoting both regional and national public health, has been recognized.

My research explores the institutional framework for regional health governance in West Africa, by looking at the laws, policies, and programs that establish and regulate the relationship between governance actors and their targets. It identifies the challenges in national and regional health systems and explains how these might be addressed. Regional institutions may be positioned to serve as a buffer to remedy health governance deficits by extending their own capacity and legitimacy. However, in order for this to happen, regional institutions must be aware of and accept this remedial role, while also addressing their own governance deficits.

My research involves data collection through document review and interactions with officials of WAHO about their role within the organization and in member states. This necessitated travel to Abuja, Nigeria, where I was able to attend the 2017 ECOWAS Health Ministers Assembly, organized by the ECOWAS Commission and WAHO Secretariat. The funding made available to me as a CTED fellow subsidized my travel costs and other expenses in Nigeria and, thus, enhanced my research experience.