Category Archives: Leadership

Advocate to mobilise and sustain the political will of African Heads of State and Government to adhere to their commitments on AIDS, TB and Malaria.

What it takes to end AIDS, TB and malaria by 2030

What it takes to end AIDS, TB and malaria by 2030

By Tawanda Chisango

African leaders have set 2030 as the time frame to end AIDS, TB and malaria. Sustained leadership on the African continent to ensure diversified financing, access to affordable and quality assured medicines, sound governance and accountability is the key to ending AIDS, TB and malaria epidemics. The African leadership has demonstrated sustained leadership on these three biggest diseases on the continent beginning with the 2000 and 2001 Abuja Declarations. These have been followed by renewed commitments that include the 2006 Abuja Call and the 2013 Abuja Declaration to intensify ongoing efforts. The AU Roadmap on Shared Responsibility and Global Solidarity and the Pharmaceutical Manufacturing Plan for Africa has produced excellent results.

Significant progress has been achieved

The impact of Africa’s leadership and its commitment to global solidarity in the case of HIV has been significant. In less than a decade, access to HIV treatment in Africa increased more than 100-fold. Approximately 10 million people are now on treatment, new HIV infections in Africa’s South of the Sahara declined by 33%. AIDS-related deaths in the same region has declined by 30%.

Similarly, increased political commitment and expanded funding have helped to reduce malaria incidence by 31% in Africa. As a result, an estimated 337 million malaria cases and 3 million deaths were averted in Africa. Malaria mortality rates have declined by 54% overall and by 58% among children. Additionally, the picture of the TB epidemic is shifting positively with Africa’s TB treatment success rate reaching 82% in 2012.

How to surmount key challenges to end AIDS, TB and malaria

But despite historic gains, these epidemics are far from over. AIDS remains a leading cause of death in Africa, killing 1.1 million people on the continent in 2013, with an estimated 1.5 million new HIV infections. An African child still dies almost every minute from malaria. Approximately USD1 billion is required to cover the malaria funding gap by end of 2015 and the TB response will need to reach about 1.3 million people in Africa.

The fact remains that health funding in most African countries is below what is required to achieve a functional, basic health system, and to end these diseases. This funding crisis calls for accelerated innovative domestic financing that includes shifting existing budgets toward spending on the diseases, considering an alcohol or airline levy, new initiatives to diversity funding sources like boosting private sector commitments, increased global partnership and solidarity to ensure these needs are met. As Africa finalizes its long term developmental framework, Agenda 2063, Africa should tap into its huge economic growth to finance health. It should continue to push forward, collaborate, and innovate to defeat the continent’s biggest health issues.

African experts have already started work on catalytic actions to end AIDS, TB and Malaria by 2030 that will be considered at the AU 2016 Summit. Some of the key actions include addressing human resources for health, strengthening health information systems and research, increasing financing for AIDS, TB and malaria to ensure that responses are sustainable and predictable, fast tracking access to medicines, diagnostics and harmonization of regulatory systems. There are plans to have a single medicine regulatory agency by 2018.
Experts have further recommended the need to put in place an accountability framework and mandated the AU and Member States to develop indicators and scorecard to monitor uptake and implementation of high level declarations at country level. Investing in demand creation, community empowerment, understanding and addressing vulnerabilities are critical success factors. Some other areas that shouldn’t be neglected include socio-cultural drivers of the epidemic and the strengthening of existing / traditional family and leadership structures, basically because these factors are equally critical success factors.

Fully funding the Global Fund to Fight AIDS, TB and malaria must remain a key global priority in mounting an effective response to the three diseases.

Ending AIDS by 2030

For the AIDS epidemic, Africa should leverage on existing strategies such as the Global Plan and Fast-Track Strategy for Ending AIDS. The continent should continue to conduct the Know Your Epidemic/ Know Your Response studies, fully implement combination prevention strategies and ensure that eMTCT remains a priority.

The continent should ensure that programmes are in place that target those that contribute to the high numbers of new infections – this includes addressing eMTCT and strengthening programming for mothers, children, youth, young women, girls and key populations. There is need to create an enabling legal environment that promotes access to preventing and addressing legal barriers that hinder access. There is need to prioritize access for treatment for children and adolescents. About 90% of all children living with HIV are in Africa’s south of the Sahara, with only 23% accessing treatment, as a result of this, AIDS-related deaths are increasing in adolescents compared to other populations where AIDS-related deaths are declining.

Defeating Tuberculosis by 2030

Africa‘s TB treatment success rate reaching 86% in 2013. In 2013 the case detection rate had slightly improved at 52%. Africa outpaced other regions in determining the HIV status of all people with TB. Africa is the only continent not on track to achieve the Millennium Development Goals. The continent will need to strengthen TB diagnosis, treatment and TB-HIV collaborative activities. Africa should also take drastic measures to reduce the incidence of drug resistant TB and intensify advocacy for the TB epidemic to attract more funding especially from government sources. There is further need to strengthen TB diagnosis in children, address structural determinants of HIV/TB co-infections and intensify efforts towards vaccine development.

Eliminating malaria by 2030

The focus for malaria should be on maintaining or scaling-up universal coverage of key priority interventions for malaria. Key actions include committing adequate funding for and uninterrupted supply of live-saving malaria commodities.

One of the key priorities for eliminating malaria is to ensure that there is effective monitoring of effective insecticide use including research and development on alternative insecticides. African countries should implement the WHO T3 initiative by ensuring universal access to diagnostic, testing for all suspected malaria cases and quality-assured anti-malaria treatment for confirmed infections and tracking the diseases through timely and accurate surveillance.

To consolidate the progress already made the African Union Commission is working with the New Partnership for Africa’s Development (NEPAD) in consultation with Member States and development partners to develop a catalytic framework detailing milestones towards ending the epidemics of AIDS, TB and malaria in line with the Abuja +12, 2030 target.

Tawanda Chisango is the AIDS Watch Africa Programme Advocacy and Partnerships Expert

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Key highlights of the Abuja+12 Special Summit on AIDS, TB and Malaria

By AIDS Watch Africa

The Africa Union Abuja +12 special Summit will be held in Abuja, Nigeria from 12 to 16 July 2013. The theme of the special summit is “Ownership, Accountability and Sustainability of HIV/AIDS, Tuberculosis and Malaria Response in Africa: Past, Present and the Future’’. The overall expected outcome of the special summit is renewed leadership and stewardship by African leaders to eradicate HIV/AIDS, Tuberculosis and Malaria.

The special summit will review the status of African Governments investment in the various national responses to AIDS, Tuberculosis and Other Related Infectious Diseases (ORID); and will adopt a set of actions to enhance the continent’s response and efforts towards reversing the impact of these diseases by ensuring universal access to services and strengthened health systems, especially for the poor and most marginalised people. The Abuja+12 summit will review the efforts of the continent in addressing AIDS, Tuberculosis, Malaria and the impact of this response on the health, financing and government systems.

Forthcoming events during the summit

CSOs Forum – 4-5 July 2013

The civil society and Non – State Actors will engage in an interactive and constructive consultation as from the 4-5 July 2013. Participants for the forum would be drawn from CSOs and development partners relevant to the wide range of themes of the Abuja declaration review process (Health Financing, HIV/AIDS, Tuberculosis, Malaria and related health themes) and the health MDGs.The key outcome of the consultations will include recommendations on the key topics as well as a CSO Action Plan to facilitate the delivery of the identified result areas.

 Meeting of Experts- 8-9 July 2013

The Special Summit will be preceded by the experts meeting on the 8-9 July 2013 to review the background documents and make recommendation for consideration by the Permanent Representatives Committee. The experts will: review the progress and achievements in the attainment of the targets of the 2000, 2001 and 2006 Abuja Summits, in the framework of the Millennium Development Goals (MDGs); review and identify factors that underpin the persistent burden of HIV, TB and Malaria on the continent; identify gaps, constraints and challenges to the achievement of the Abuja and health related MDGs targets; and make proposals on renewing commitment by African Leaders to address challenges in meeting the Abuja Call and MDG targets and recommendations on Africa’s position on post 2015 development agenda

AIDS Watch Africa (AWA) Champions Breakfast Meeting-16 July 2013

The AIDS Watch Africa (AWA) Champions will be hosted to a breakfast meeting b H.E. President Jonathan Ebele Goodluck of the Republic of Nigeria. This will be the first AWA Champions meeting to be convened bythe Chairperson of AU/AWA,H.E Ato Hailemariam Desalegn, Prime Minister of the Federal Democratic Republic of Ethiopia. During the meeting the AWA Champions will deliberate on concrete strategies to championthe Future Direction framework of AWA 2012-2015, the Roadmap on Shared Responsibility and Global Solidarity for AIDS, Tuberculosis and Malaria response in Africa as well as update on the One Year Progress on AWA mandate.

Meeting of the Executive Council: 13 July 2013

The Meeting of the Executive Council will consider the reports of civil society and the meeting of the experts and submit a report to the Heads of State and Government Summit.

Special AU Assembly of Heads of State and Government: 15-16 July 2013

The special Summit will review the status of African Governments’ investment and the various national responses to HIV/AIDS, Tuberculosis, Malaria and Other Related Infectious Diseases (ORID); and will adopt a set of actions to enhance the continent’s response and efforts towards reversing the impact of these diseases by ensuring universal access to services and strengthened health systems, especially for the poor and most marginalized people.

Wither AIDS, TB and Malaria: Snapshots of Africa’s Progress

By AIDS Watch Africa

Progress in responding to AIDS

The annual number of people newly infected with HIV in Africa has been reduced by 25% since 2001. From 2009 to 2012 new HIV infections among children have been reduced by 38% in the ‘Global Plan’ priority countries and access to treatment remains low for children––only 3 in 10 children in need of treatment have access in most of the ‘Global Plan’ priority countries. The number of people who died from AIDS-related causes was 32% lower in 2011 than in 2005.

Various countries are developing more robust, inclusive, results-focused national strategies and related investment cases. The Pharmaceutical Manufacturing Plan for Africa Business Plan, an African-wide framework for increasing pharmaceutical capacity, has been developed and approved and will be supported through a consortium that is now being set up.

AIDS Watch Africa, an advocacy platform for African Heads of State on AIDS, TB and Malaria set up in 2001, has been reinvigorated in the past year, as African leaders recognized the need for accelerated momentum towards meeting the targets of Millennium Development Goal 6 by 2015 and for leadership beyond to fulfil their commitments to the Roadmap. All Member States of the African Union are now members of AIDS Watch Africa.

Progress in reducing Malaria deaths and cases has been substantial

In the course of the last decade, the global effort to control and eliminate malaria expanded significantly. As a result of a scale-up of control interventions – including an expansion of access to long-lasting insecticidal nets, indoor residual spraying programmes, diagnostic testing and quality-assured treatment – more than a million lives have been saved. Malaria mortality rates decreased by 33% in Africa between 2000 and 2010. What Africa will need to do- maintain high-levels of coverage with malaria interventions, strengthen malaria surveillance and response systems, prevent drug and insecticide resistance and engage sectors outside of health.

We are at a critical time in the fight against TB

In the last 13 years, critical progress has been made in the development of new tools, and in identifying the right approaches to fight the disease. TB is curable and can be defeated, but there are three challenges that underpin the TB emergency. The emergence of drug-resistant TB, which can cost up to 100 times more to treat in comparison to drug-sensitive TB, makes timely investments more critical. Domestic financing for TB in Africa is low. On average, African governments contribute 30% of their national TB budgets, whereas in the rest of the world governments contribute 70% on average . This makes many African governments highly dependent on external financing – and extremely vulnerable to any international aid fluctuations. 88% of external donor financing for TB is from one source: the Global Fund. This provides US$ 440 million each year for the fight against TB globally. However, most of this money is not going into Africa. For every $100 going to Sub-Saharan Africa from the Global Fund, only 6% is for TB. This small amount still represents half of Africa’s available TB funding (54%). Much greater ambition is needed in terms of providing diagnosis and access to treatment for all TB patients in most African countries. It is time for an emergency response. This need for scale-up should be reflected in ambitious national strategic plans, aiming at universal coverage and zero-TB related deaths.

Health Financing

Member states of the African Union are on average still far from meeting key health financing targets of the Abuja Declaration. In 2010, only 5 countries reached the target of allocating at least 15% of their annual budget to health. Twenty eight countries out of fifty spent the minimum of US$ 44 per capita as estimated by the High Level Task Force on Innovative Financing for Health Systems (HLTF).Only three countries in Africa reached the targets set in both the Abuja Declaration and the HLTF report. Out-of-pocket payments (OOP) still represent more than 20% of total health expenditure (THE) in 40 countries in Africa. A key challenge for member states and their partners is to ensure effective and efficient use of available international and domestic resources, improved predictability, alignment to national priorities and use of government mechanisms. The reinforced dialogue between Ministers of Health and Finance, as spelt out in the Tunis forum organized by Harmonization for Health in Africa in 2012, has shown increased engagement towards financing for health and improving the effectiveness of available resources.

A Critical Moment in African Health

By Mark Dybul

“Drop by drop, the pot hits the brim,” goes an African saying. The Abuja+12 Special Summit comes at a momentous time in our history. The call to take stock of Africa’s investments in health cannot be timelier. In today’s fight against AIDS, tuberculosis and malaria, every input will count immensely.

We are at a pivotal moment in the fight against these three diseases. Africa, especially sub-Saharan Africa, has been disproportionately affected by these diseases. Millions have died. With the loss of life and health, much else has been lost. The social fabric of many African societies has been torn, family incomes and country economies upset.

But the tide is turning. Today, data across the world tells us that the three diseases we fight against are in retreat. Fewer people are dying, fewer and fewer infections are occurring. In the art of war, when the enemy loses step, it is time to press forward. Forward fast and firmly.

At the Global Fund, we believe this is a transformative moment in the history of the fight against the diseases. The world has the tools and the knowledge to defeat these maladies. We need to raise enough money to implement these groundbreaking innovations.

This year, we are asking our donors for US$15 billion to enable us support the world to intensify the fight against these diseases over the 2014-2016 cycle. It is our assessment that such an investment will have a transformative effect in the incidence and death rates of HIV and AIDS, TB and malaria.

Nonetheless, this amount in itself will not be enough to free the world from the burden of these three diseases. To do that, we estimate a total global need of US$87 billion between 2014-2016. Money set aside by African and other governments around the world in their annual budgets will go a long way in helping us meet this target.

In April 2001, African leaders met in Abuja, Nigeria, and resolved to boost government spending in health to least 15 percent of their countries’ annual budgets. In a bid to spur collective investments from varied stakeholders, the leaders also urged economically advanced countries to meet the target of committing 0.7 percent of their GNP as Official Development Assistance to developing countries as provided for by the UN.

The Abuja Declaration, as it came to be known, was an unequivocal appeal for improved funding in the fight against infectious diseases such as AIDS, tuberculosis and malaria. That Abuja call has never been more resonant. While only a few countries have met this target, there has been remarkable progress in investing more in health in many countries across Africa.

Every extra dollar that has gone into investing in health as a result of that visionary act of leadership 12 years ago is an extra step towards defeating Africa’s infectious diseases. As African countries move forward along this trajectory of health investment and as we at the Global Fund seek to invest more in this cause, we are moving closer towards the common objective of reducing HIV, tuberculosis and malaria to low level epidemics.

Investing today will save millions of lives and tens of billions of dollars that the world would have to pay in future costs. If we do not invest now, the long-term costs will be staggering. We have a choice: we can invest now or pay forever.

As African countries meet once more in Abuja, this is a chance to renew our commitment towards these health investment goals. It is an important moment to press forward with that ambitious call at the cusp of the millennium in the Nigerian capital.

Along this journey, the Global Fund will continue to be a partner to Africa, a reliable friend as the continent seeks to achieve the milestone of controlling the three diseases and removing them as threats to public health.

As we work hard to galvanize support to fill the pot, we appreciate every contribution that African countries make towards investing in health in their own countries. It is all these types and sizes of support and efforts that will help us win the fight. Together, we can bequeath our children a world free from these diseases.