Abuja at 12: Reflections on the progress and future directions in ending AIDS, TB and Malaria

By Dr Marie-Goretti Harakeye

The rapid spread of the AIDS epidemic at the turn of the century trumpeted major setbacks to Africa’s development trajectory.  In the face of greater adversity visionary leadership and tenacity was required to reverse the threats of AIDS, TB and Malaria to the continent’s steady progress.

The African Union has stood to the challenge and framed a compelling vision for the future of the continent and has developed powerful health policy frameworks and commitments  that have resulted in substantial reduction of the AIDS, TB and malaria burden. In the face of denial, fear, stigma and discrimination African leaders acted to stem the tide of these epidemics. The Abuja +12 meeting comes at a decisive moment in our African response to the AIDS, TB and Malaria responses.

Thirty-two years in the AIDS epidemic, twelve years after the Abuja declaration unprecedented progress has been achieved. The results speak for themselves. Only three decades ago the picture was very bleak especially for the new emergency posed by the AIDS epidemic. Thirteen years ago, AIDS was wiping out a generation of individuals and reversing important health and development gains being made in Africa. Hospitals were completely overwhelmed by the massive volume of dying people. According to the UNAIDS Report AIDS at 30 Nations at the Cross Roads during this period adult HIV prevalence rose from less than 1% to 24.5% in Lesotho and from 3.5% to 26% in Botswana. While less than 1% of adults in South Africa were living with HIV in1990, 16.1% were living with HIV a decade later.

The UNAIDS Global Report 2012 indicates that since 2001 signs of reversing the ADS epidemic is clear, the annual number of people newly infected with HIV in Africa has been reduced by 25% since 2001. Today, AIDS is no longer a death sentence in Africa. According to the same report more than five million people living with HIV in Africa are alive because they have access to treatment. The impact of what can be achieved through integrated TB and HIV services is remarkable. Between 2005 and 2011, 1.5 million lives were saved due to TB and HIV integration.

However while the 2012 WHO Global Tuberculosis Report points out that while significant progress has been made in ending TB the emergence of  MDR cases (multidrug-resistant) and XDR (extremely drug-resistant)  TB can cost up to 100 times more.  Timely investments are more critical, without accelerating action, 23 million people will fall sick with TB and 5,5 million will die of TB in Africa in the next ten years.

The picture is equally promising in Malaria, the 2012 WHO Malaria report shows a decrease in mortality rates by 26% globally and by 33% in Africa between 2000 and 2010. At present 25 countries are on track to eliminate malaria and many more have declared elimination as a national goal. The progress however remains fragile and Africa cannot be complacent.

 Africa is still bearing 90% of the world Malaria burden. Recent years have witnessed a gradual leveling off of international funding, staying well below the amount needed to achieve Abuja targets to achieve universal access to  AIDS, TB and Malaria services. In 2013 for example, the funding GAP for malaria control in Africa stood at US$3.6 billion for the period 2013-2015. Should effort to maintain high levels of coverage fail, gains could be quickly reversed and malaria will resurge, putting millions of lives at risk.

To sustain gains, the control and elimination of the three deadly diseases, national programmes need predictable international donor funding as well as increased domestic investment and innovative financing mechanisms that can tap into new resources. Africa will need deeper soul searching to take charge of its destiny and be inward looking to serve its own people. Key issues that Africa will need to address at the strategic level include the predictability and sustainability of existing funding mechanisms for Africa’s long term needs and the current challenges in dealing with broader public health issues such as systems strengthening.

The Abuja +12 meeting comes at a decisive moment in our African response to the AIDS, TB and Malaria responses. We are at the crossroads and Africa has to choose the path to take. The great question of the day is whether we remain moving around the world with a begging bowl or we learn how to fish and go fishing. African countries need to reduce their over-reliance on external funding and improve national budget support to the health sector and tap into private-public partnerships. The AU Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa (2011-12) charts a new partnership where African leaders have committed to greater ownership of the responses while urging global partners to sustain their commitments.

Dr Marie-Goretti Harakeye is the Head of Division AIDS, TB, Malaria and OIDs at the African Union Commission.

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