– Results of TAC survey of 207 public clinics shows TB infection control still falling short. – Government must urgently conduct an infection control audit of all public facilities
JOHANNESBURG, 19th MARCH 2018 – In the run up to World Tuberculosis (TB) Day on 24 March 2018, the Treatment Action Campaign (TAC) assessed the state of TB infection control in a number of clinics across South Africa. Of 207 facilities assessed, 145 were found to be in a “RED” state with very poor infection control measures in place.
In March 2017, TAC produced our first annual TB audit. Last year, 72% of the facilities (115 out of 158) were ranked “RED” compared to 71% (145 out of 207) this year. 9% of facilities (15 out of 158) scored “GREEN” last year, compared to a dismal 1% this year (2 out of 207).
TB remains the leading reported cause of death in South Africa with over 33 063 deaths (8.4% of natural deaths) in the country in 2015. Based on the latest data in 2016, the rate of new cases of active TB in South Africa remains extremely high at around 438 000. While total TB rates do appear to be slowly declining (down from 250 000 in 2015), multi-drug resistant TB (MDR-TB) and extreme drug resistant TB (XDR-TB) rates are increasing. The World Health Organization (WHO) estimated 19 000 cases in South Africa in 2016 up from 7 350 in 2007. TB can be spread through the air when people with active TB disease cough or sneeze. However, various infection control measures can be taken to reduce the risk of TB transmission.
“Our clinics should be places we feel safe, where we know we can get decent healthcare services. They certainly should not be places we can get TB. The reality is that many clinics aren’t even doing the basics to prevent us getting TB as we wait to see a nurse. They are overcrowded. People are not screened for TB. Often staff don’t even offer a tissue to someone coughing,” says Sibongile Tshabalala, TAC National Chairperson.
TAC branches in Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, and Western Cape engaged in the audit during TB month, March 2018. The following questions were answered by TAC members from local branches linked to each facility assessed:
- Is there enough room in the waiting area?
- Are you seen within 30 minutes of arriving at the facility?
- Are the windows open?
- Are there posters telling you to cover your mouth when coughing or sneezing?
- Are people in the facility waiting area asked if they have TB symptoms?
- Are people who are coughing separated from those who are not?
- Are people who cough a lot or who may have TB given tissues or TB masks?
Based on the answers facilities were ranked RED (3+ questions answered “no”), ORANGE (1-2 questions answered “no”), or GREEN (0 questions answered “no”).
145 facilities were ranked “RED”, 56 facilities were ranked “ORANGE”, and only 2 facilities were ranked “GREEN”. 4 facilities were unable to be ranked due to incomplete data.
- Facilities performed especially poorly in the length of waiting times, where over 90% of facilities (190 out of 207) failed to see people within 30 minutes of arriving, pointing to widespread human resource shortages across the clinics surveyed.
- 57% of facilities (119 out of 207) did not screen people for TB symptoms who were waiting to be seen and 56% of facilities (115 out of 207) did not offer tissues or TB masks to those coughing. It is unknown if this is due to a lack of resources, time, or will.
- 38% of facilities were found to be too small, and just under 70% of facilities did not (or could not) separate people who were coughing a lot from those who were not, pointing in part to infrastructural challenges that need to be addressed.
TAC commends the 2 clinics that were ranked GREEN – Goso Forest Clinic (EC) and Rhodes Clinic (EC). Our local branches linked to the 2 clinics will award them with certificates and urge them to continue ensuring effective TB infection control. However, if we wish to make progress against TB GREEN ratings should be the norm in the public healthcare system, not the exception.
An Excel sheet with the survey results (including provincial breakdown) can be accessed here.
The problems highlighted in TB infection control through the audit are indicative of the wider crisis within the health system, where overstretched nurses at understaffed clinics lack the capacity and resources to engage effectively in infection control measures.
“While we stress that this is by no means a scientific survey and the results are not generalisable to the rest of the public healthcare system, it does suggest that infection control is a significant problem in many public sector health facilities. As a result, we demand that government carries out a full audit of all public buildings in South Africa, including schools, clinics, hospitals, correctional facilities and home affairs facilities, to assess whether sufficient TB infection control measures are in place,” says Tshabalala.
“If the government is serious about tackling TB, then infection control must be made a priority this year. We do not want to be raising the same issues this time next year – our 2019 audit must see a total turnaround of this situation.”
TAC branch, provincial and national leaders will be meeting with facility management, provincial and national health departments in the coming weeks to discuss the poor outcomes of our TB infection control survey.
All commitments and responses from these meetings will be published.
For more information and to arrange interviews contact:
Lotti Rutter | firstname.lastname@example.org | 072 225 9675
The full 2018 survey results can be found here: http://bit.ly/2tWvwHv
For a breakdown of TB infection control results per province please see the following overviews:
Eastern Cape overview: https://tac.org.za/files/tb-infection-control-eastern-cape-march-2018.pdf
Free State overview: https://tac.org.za/files/tb-infection-control-free-state-march-2018.pdf
Gauteng overview: https://tac.org.za/files/tb-infection-control-gauteng-march-2018.pdf
KwaZulu-Natal overview: https://tac.org.za/files/tb-infection-control-kzn-march-2018.pdf
Limpopo overview: https://tac.org.za/files/tb-infection-control-limpopo-march-2018.pdf
Mpumalanga overview: https://tac.org.za/files/tb-infection-control-mpumalanga-march-2018.pdf
Western Cape overview: https://tac.org.za/files/tb-infection-control-western-cape-march-2018.pdf
The 2017 infection control audit can be found here: https://tac.org.za/news/tb-infection-control-falls-short-many-clinics-tac-survey/
NOTE: Not all facilities surveyed in 2017 were repeated in the 2018 audit, and several additional facilities were included this year.
NOTE: Even though TB is the number one reported cause of death in South Africa according to official death notifications, many deaths attributed to TB and other causes are in people with HIV and HIV is thus underrepresented in death notifications. The Thembisa model of HIV in South Africa estimates that there are roughly 150 000 HIV-related deaths per year. A recent Medical Research Council report estimates around 150 000 HIV-related deaths in 2012. These estimates indicate that HIV is still the number one cause of death in South Africa.
A summary of results is available here: https://tac.org.za/files/results-summary-tb-infection-control.pdf
|Province||Is there enough room in the waiting area for everyone?||Are you seen within 30 minutes||Are the windows in the facility open?||Are there posters telling you to cover your mouth when coughing or sneezing?||Are people in the facility waiting area asked if they have TB symptoms?||Are people who are coughing separated from those who are not?||Are people who are coughing a lot or may have TB given TB masks or tissues?||RANK|
|Eastern Cape||17||20||1||5||15||15||18||Green – 2|
|Orange – 6|
|Red – 20|
|Free State||16||33||1||5||23||32||28||Green – 0|
|Orange – 3|
|Red – 31|
|Gauteng||10||24||4||6||11||17||17||Green – 0|
|Orange – 5|
|Red – 17|
|Unknown – 2|
|KwaZulu-Natal||11||23||1||1||8||14||9||Green – 0|
|Orange – 15|
|Red – 11|
|Unknown – 2|
|Limpopo||3||29||1||8||17||21||15||Green – 0|
|Orange – 11|
|Red – 20|
|Mpumalanga||15||35||1||9||26||20||27||Green – 0|
|Orange – 8|
|Red – 27|
|Western Cape||7||26||0||5||19||25||1||Green – 0|
|Orange – 8|
|Red – 19|
|National||79||190||9||39||119||144||115||Green – 2|
|Orange – 56|
|Red – 145|
|Unknown – 4|
 National Strategic Plan on HIV, TB and STIs 2017 – 2022. SANAC. Available at: http://sanac.org.za/wp-content/uploads/2017/05/NSP_FullDocument_FINAL.pdf
Advances in both clinical research and prevention science have led to a significant reduction in HIV transmission globally. UNAIDS ambitious goal of achieving “90-90-90” targets by 2020 calls for 90% of people living with HIV to know their status, 90% of those diagnosed to receive sustained ART and 90% of those on ART to have viral suppression. One or two strategies will not be effective in reducing the HIV/AIDS pandemic to the realization of the AIDS Response in the 2030 Agenda for Sustainable Development.
Women continue to be infected with HIV at alarmingly high rates especially in sub-Saharan Africa where women constitute nearly 60% of adults living with HIV/AIDS. A range of effective, affordable and widely available prevention products are needed because no single approach will meet all women’s needs or get the epidemic under control considering that prevention should always include a combination of biomedical, behavioral and structural strategies.
WACI Health and other network partners at the Conference on Retroviruses and Opportunistic Infections Photo credit: WACI Health
The annual Conference on Retroviruses and Opportunistic Infections (CROI 2018) held between the 4th to the 7th of March 2018 at Hynes Convention Center in Boston, Massachusetts brought together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments and best research methods against HIV/AIDS and related infectious diseases. The preliminary findings of HIV Open Label Extension (HOPE) and DREAM studies of the dapivirine vaginal ring were released showing 90% of women who used the ring at least some of the time had an estimated 50% reduction in the HIV acquisition.
The ring is designed to provide women with a discreet and long-acting HIV prevention option. The interim analyses of DREAM announced at CROI 2018 showed an increase in ring use over its parent Phase III study – more than 90% of women participants used the ring at least some of the time. Analyses also suggest that the overall HIV incidence rate among women in DREAM is 54% lower than would be expected without use of the dapivirine ring based on statistical modeling. This finding has important limitations due to the lack of a placebo comparison group in the open-label study (meaning that all participants know they are using the active product). Interim data from a parallel open-label study of the ring called HOPE, led by the US National Institutes of Health-funded Microbicide Trials Network (MTN), reported nearly identical results at CROI. “DREAM suggests so far that when women know that the dapivirine ring has helped lower HIV risk in clinical trials, they are more likely to use it and see higher levels of protection,” said Dr. Zeda Rosenberg, founding chief executive officer of IPM. “We are encouraged by these interim findings because more than 35 years into the epidemic, women still lack the range of practical options they need to protect themselves against HIV.”
We have made tremendous progress in the AIDS epidemic. However, this progress is not assured because of several factors among them declining funding. Governments and donors must continue to prioritize the allocation of funding for HIV programming, life-saving treatment, prevention, research and development for new health technologies which will inform an essential part of the solution to HIV.
New vaccines, microbicides, drugs, diagnostics, and other health technologies are needed in the face of many emerging threats for communities to have multiple tools that protect them especially those who are at highest risk of becoming infected with HIV for instance adolescent girls and young women. Multipurpose prevention technologies (MPTs) most of which are still experimental designed to address two or more sexual and reproductive health concerns simultaneously for example, combining protection against unintended pregnancy and sexually transmitted infections to be made available.
Ending HIV by 2030 requires collaboration across sectors, supportive policies that do not lock people out of care and support, health systems strengthening above all communities taking center stage and the commitment to not leave anyone behind – including adolescent girls and young women.
Rural women make up more than a quarter of the world’s population. In Africa, about 80% of the women population live in rural areas – agriculture is their major source of income. This reality was affirmed during the 62nd session of the United Nation Commission conference in New York which sought to examine the challenges and opportunities in achieving gender equality and the empowerment of rural women and girls. In her opening statement Dr Phumzile Mlambo-Ngcuka (Executive Director of UN Women) urged all participants to see this forum as a perfect opportunity for building alliances, focusing on acceleration and implementation of regional as well as global declarations to achieve gender equality and women empowerment.
UN Women Executive Director Phumzile Mlambo-Ngcuka addressing a session hosted by Ilitha Labantu on challenges of rural women empowerment
Photo credit: Sibulele Sibhaca
Women and girls in rural areas still encounter difficulties including gender violence, high maternal mortality rates, child marriage, HIV/AIDS, FGM, conflict and natural disasters. Most are directly linked to gender inequality and structural barriers which causes power imbalances. These barriers are worsened when women are excluded from governance mechanism, leadership and decision-making or representation in local and national institutions which diminishes their voice. All these must be urgently addressed for Africa to realize its development aspirations in attaining the Sustainable Development Goals and Agenda 2063.
WACI Health together with other civil society in South Africa are making frantic efforts in advocating for political will in governments developing policies and programs to protect women such as the National Strategic Plan on Gender-based Violence (NSP GBV), bring gender justice, improve their health outcomes and end gender violence
Minister of Women Bathabile Dlamini expressing that women should lead the struggle and shaping response in gender-based violence
Photo credit: Sibulele Sibhaca
Participants at CSW62 called on all stakeholders to address the limited access to quality social services, infrastructure, energy and labor saving technology, and tackle other inequalities.
To build in a bright future – invest in adolescent girls and young women!
There has never been a more critical time to invest in young people than now! With regards to health and development, young people have been overlooked and left behind many times. There are about 1.8 billion young people globally and nearly half of these are adolescent girls and young women.
Adolescent girls particularly those entering adulthood encounter numerous challenges including discrimination, gender violence, poor education and health outcomes, reduced opportunities and choices – their voices are often unheard. As for serious health risks, young women (15 to 24 years) are facing a triple threat. The highest risk of HIV infection is found within this group. In sub-Saharan Africa, young women account for 74% of new HIV infections. In addition to this, young women and girls have the lowest rates of HIV screening or testing and poor adherence to HIV treatment.
Investing in young girls and women indeed is a game changer. For example, this International Women’s Day celebrations WACI Health joined hands with other Kenyan civil society in calling for all stakeholders across multiple sectors to champion health of adolescent girls and young women by recognizing their issues as important, improving national programs and policies (tailoring Sustainable Development Goals and Global Strategy on Women’s, Children’s and Adolescents’ Health effectively) as well as increasing funding to ensure that young people survive, thrive and transform the world.
When educated, healthy, equipped with the right skills and opportunities; adolescent girls and young people hold the keys to unlocking many of the world’s pressing problems in poverty reduction, advancing gender equality, catalyzing national social and economic development, stopping HIV, maternal mortality and gender violence among many others – investing in the survival and success of the next generation.
As leaders of today and tomorrow, adolescent girls and young women can be a force for social change!
DAVOS, Switzerland — While new financial instruments can help address critical gaps in health care funding, the global health community also needs to be more focused on taxes and helping countries mobilize domestic resources for basic health care services, Peter Sands, the incoming executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, told Devex.
“I think people in the world of global health need to be thinking about and talking about taxes rather more than we do, because if you have a country that is only mobilizing — in terms of fiscal mobilization, i.e. tax revenues — a single digit percentage of GDP, it’s extremely unlikely they will be able to sustainably finance a health system delivering even the basics to all its population,” he told Devex in a recent interview.
Countries need to plan for self reliance, rather than on international development assistance as a way to fund their health systems, and to get there, need to work on tax raising and tax deployment strategies, Sands said. Once the basics are covered, other finance — be it private finance or insurance — can be brought in to support other aspects of health systems, he added.
In order to do that countries and organizations such as the Global Fund, need to get better at communicating the economic or investment case for funding disease prevention and eradication. And there is a strong case to be made, Sands said. High prevalence endemic diseases take people out of the workforce — not only those who are sick, but also those caring for the people who are sick. Epidemics are particularly disruptive because they change economic activity as people are scared and change their behavior, children don’t go to school, etc.
“There are very strong, hard-nosed economic reasons for taking action, but we are not making that argument as well as we could,” he said. “We tend to make it in sort of standalone analyses, in reports and things that don’t get integrated into the bits of paper sitting on a finance minister’s desk when they’re making budget allocation decisions.”
The Global Fund can help play a catalytic role in helping bridge the gap between research and implementation. While it doesn’t have to do the research itself, as it would be best if it were done by economists or government officials in the countries where it is needed, the Global Fund can help develop the methodologies and data-gathering approaches that inform how the analysis is done, he said.
“Ultimately, we have to be able to build a compelling investment case for the Global Fund itself, but governments in individual countries have to build an investment case to deploy domestic resources to the same objectives,” Sands said.
Too often, the global health and development community preaches to the converted, he said, but to change perceptions there must be an effort to convince the skeptical, be it the civil servant in charge of budget prioritization in a finance ministry, or a capital markets analyst at an investment bank, he said.
“The way we need to do that requires a degree of rigor around what is it about health issues that impedes development,” Sand said. “We need to be able to tell that story in a very rigorous and robust fashion because in a sense the people who need to be convinced are not the people who we’re normally talking to about this.”
No silver bullets
Sands will take up his post bringing with him a long career in finance, which gives him a unique perspective on some of the new financing mechanism, but doesn’t mean he has “the secret key to some treasure trove,” he said.
Innovative financing mechanisms — from impact bonds, to blended finance, matching funds and results-based funding — can all play “a significant and important role in what we’re doing both in terms of improving the effectiveness with which we deploy existing funds and in attracting new monies,” Sands said.
While there is promise in some of these mechanisms, they must be deployed in the appropriate situations, he said.
“Sometimes these things look like tools looking for a problem and I think we need to be very rigorous in identifying the underlying economics of the problem we are trying to solve and then picking the financing instrument that is best suited to that particular problem,” Sands said. “Sometimes, when I look at this in the development world, we seem to have force fit innovative finance mechanisms to problems where the economics dont really align with that mechanism.”
By Adva Saldinger // 06 February 2018 https://www.devex.com
Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa 13th – 16th February Johannesburg, South Africa.
Africa free of New HIV infections (AfNHi) is an Africa regional advocacy network, which exists to unite African Civil Society voices and action on regional advocacy for HIV prevention research. AfNHi is committed to influencing Africa regional policies in order to accelerate ethical development and delivery of HIV prevention tools towards ending the AIDS epidemic by 2030.
AfNHi participated in the 2018 AVAC partner’s forum held on 13th – 16th February 2018 in Johannesburg South Africa. Attending this were AVAC partners, Fellows and HIV prevention research Advocates based in Africa bringing together 120 participants in the meeting.
AfNHi brought to the meeting rich discussions on Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa delivered through a formal presentation by the Secretariat followed by a panel presentation. Several opportunities were identified at the Africa regional level. Moving forward, AfNHi is developing a strategy on how to effectively engage. Some of the opportunities identified were;
- Abuja + 12 which came as a result of African heads of states and government committing to eliminating AIDS, TB and Malaria by 2030 and Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa.
- The Catalytic Framework to end AIDS, TB and eliminate Malaria in Africa by 2030 which provide an overarching policy framework in effective response to HIV and AIDs, Tuberculosis and Malaria.
- Africa Partnership and Coordination Forum whose multisectoral nature can provide civil society or other health champions a platform to feedback on priority actions and progress they have made regarding implementation of the Catalytic Framework.
- AIDS Watch Africa comprises of Heads of State and Government who meet annually to review progress on the continental response to HIV/AIDS, TB and Malaria and their pronouncements and decisions – it presents an opportunity for peer review, sharing best practices and setting agenda on HIV prevention.
- Africa Union (AU) organs for example New Partnership for Africa’s Development (NEPAD) and African Centre for Diseases Control. NEPAD plays both regulatory and capacity strengthening roles. Their current focus is on the Catalytic Framework – promoting access to affordable, quality assured medicines, commodities, technologies and developing AU policy on Research and Innovation for Health.
- African Centre for Diseases Control which requires domestic financing to truly focus on African Health research issues. The opportunities would be to focus research and innovation on the region’s priority areas by strengthening collaborations within Africa’s research institutions to enhance evidence-informed policies as well as increased investments in research and innovation.
- Regional economic bodies (such as SADC, ECOWAS, COMESA, EAC and their research institutions) which provide opportunities to collaborate on innovative African projects and research in areas of economy and health. There is a possibility of approaching African Development Bank (AfDB) for financing such projects.
- Office of the 1st Ladies (OAFLA) – relevant specially to mobilize support from the heads of states for HIV prevention research at Africa region level.
- Regional parliamentary bodies
- Have demonstrated leadership in voting for regional policies on HIV e.g. the Eastern African Legislative Assembly (EALA)
- Parliamentary Caucus on TB – Presents opportunities to leverage on their work as TB champions to also champion HIV prevention research.
- African Civil Society Networks (e.g. African Civil Society Health Platform)
- Regional Coalitions involving CSOs, Researchers (e.g. AAVNET, CHReaD, SAHTAC)
- Push for increased domestic and international funding to health through innovative financing mechanisms, social health insurance schemes and increased allocations at various levels
- Presents opportunities to strengthen Africa-focused and led HIV biomedical prevention research, implementation and advocacy
AfNHi held a successful HIV prevention campaign on the sidelines of this meeting. The campaign sought to bring out key messages for HIV prevention. The campaign was done through asking the question – what does HIV prevention meant to you? And respondents were given an opportunity to express their views by writing answers to the question.
56 New sign – ups were registered making a big addition to the AfNHi membership!
On the 13th to 15th of February 2018, WACI Health together with Stop Gender Violence hosted a consultative meeting on Stop Gender Violence Campaign (SGVC) in Johannesburg, South Africa. In attendance were many representatives of civil society who are members of the Task Team namely Sizwe Nombasa Gxuluwe – WACI Health, Sakina Mohamed – Greater Rape Intervention Project (GRIP), Zarina Majiet – MOSAIC, Bafana Khumalo – Sonke Gender Justice, Steve Letsike – Access Chapter 2, Tshivase Nkumiseni – Thohoyandou Victim Empowerment Project (TVEP) and Nonhlanhla Skosana – Sonke Gender Justice. Apart from this, the forum came at a crucial time where not only the Task Team were meeting but the provincial coordinators as well.
The expected outcomes being to draft a work plan for 2018, develop agenda items for Annual Partners General Meeting (APGM) on 28 to 29 March 2018 and a funding strategy for the campaign beyond June 2018.
Sakina, who is the Secretariat, facilitated reflections on success achievements made by the campaign this past 2 years. It included outlining what worked well – the existence of processes and content for the campaign, finalizing and launching Shadow framework, securing funding from Networking HIV/AIDS Community of Southern Africa (NACOSA) and Amplify Change, provincial engagements and completing the National Strategic Planning on Gender-Based Violence (NSP GBV) & presenting it to local Department of Social Development. Challenges include – lack of participation and response to emails by some task team members, advocacy buy-in on Framework, structure and communication, commitment by partners, funding for more advocacy, meetings with national government departments and defined task team/membership role and responsibility. It was then noted that there needs to be changes in re-committing to the project and implementing tasks allocated, re-engaging task team members with relevant stakeholders and partners, taking ownership, exploring more funding opportunities and having concrete advocacy strategies.
Looking at the current state of the campaign, Task Team members gave a report and analysis of the successes and challenges – echoing similar issues raised in the reflections. Through suggestions on comprehensive strategies which can leverage the campaign forward and target influential people, it was concluded that:
- Develop a 1-pager with 3 – 4 key messages from the National Strategic Plan on Gender-Based Violence Shadow Framework
- Lobby and advocate with different stakeholders at identified platforms such as National Department of Social Development, Ministry of Women, Deputy President’s Office, Treasury
- Have consistent communication at all levels and documentation of the work done
Apart from this, the Secretariat reminded everyone of the importance to end violence in the spaces they work in – significant to this issue is power. For example; interrogating the concept of power and its operations, integrating one’s personal and professional values through team building platforms, providing safe spaces educational and sensitization workshops to raise awareness on GBV and supporting colleagues who are victims of violence in the workplace (even if this means exploring legal options). As civil society, we must make use of policy in our quest to end violence therefore it was agreed upon to look at government entities such as Department of Planning, Monitoring and Evaluation with Department of Social Development in reviewing the state’s response to GBV.
Task Team members listen attentively during one of the sessions
Photo credit: Secretariat
On the 16th of February 2018 was the Provincial Coordinators strategic planning meeting which was attended by Western Cape, Mpumalanga, Kwa-Zulu Natal and North West provinces. WACI Health was represented in this meeting. Purpose for this meeting was for the task team and provincial coordinators to give an account of challenges and successes they have encountered regarding NSPGBV work done at provincial level. For instance, Western Cape has taken the campaign to the local radio station Zibonele. They further articulated the need for consistency in messaging, strong media presence and advocacy. Secretariat emphasised that the SGVC is not about money – we don’t give funds. Its heart and soul activism. Mpumalanga has been actively involved in shelter programs. North West cited experiencing some challenges in communicating with partners whereas Northern cape highlighted the pulling out of funders and the importance of people sensitization on GBV issues. From these and other issues recorded, a work plan was developed as a way forward for the campaign and recommendations were made ahead of the AGM in March 2018.
WHO has published a global TB report every year since 1997. The main aim of the report is to provide a comprehensive and up-to-date assessment of the TB epidemic, and of progress in prevention, diagnosis and treatment of the disease at global, regional and country levels. This is done in the context of recommended global TB strategies and targets endorsed by WHO’s Member States and broader development goals set by the United Nations.
The data in this report is updated annually.
Reflections from a Civil Society Consultation on UHC2030 and Civil Society Engagement Mechanism (CSEM) in Kenya
Kudzai Mhishi, Health Policy Research Fellow – WACI Health
On October 13, 2017 WACI Health, the Health NGOs Network in Kenya (HENNET) and partners including KANCO, National Network of People Living with HIV – NEPHAK, International Community of Women Living with HIV (ICW+), Health Rights Advocacy Forum (HERAF), AIDS Healthcare Foundation (AHF), African Centre for Global Health and Social Transformation (ACHEST), Social Welfare Development program (SOWED), Program for Appropriate Technology in Health (PATH), Global TB caucus, HENNET, CBM, INERELA+, ADDK, Kibera Integrated Community Self Help Program (KICOSHEP), Malteser International, Medecins Sans Frontieres (MSF)- Belgium and National Organisation of Peer Educators (NOPE) convened for a consultation on Universal Health Coverage (UHC) advocacy and accountability with a specific focus on civil society engagement in the UHC2030 movement. This forum brought members from various civil society and community organizations and networks including the Ministry of Health (MoH) was also present at the consultation to provide updates on the country progress on UHC as well as give insights as to what the ministry sees as the role and entry points for civil society.
The consultation came at a critical point when counties would be getting into renewing their strategic plans. This presented a great opportunity for civil society to advocate for and persuade County Governments to place UHC high on the agenda by incorporating relevant indicators into their next 5-year County-specific strategic documents.
Discussions not only focused on UHC progress in Kenya but also the role of CSOs in advocacy and accountability and means of working better together through a coordinated Civil Society Engagement Mechanism (CSEM) at country level.
There were three key expected outcomes from this consultation:
- Key recommendations on how to address the health systems strengthening (HSS)/UHC advocacy issues identified.
- Recommendations on how UHC 2030 initiative can strengthen citizens’ voices and empower communities to demand accountability and take health actions.
- Recommendations on how CSOs can work together for UHC advocacy and accountability in Kenya.
Dr. Margaret Makumi, an expert in strengthening Health Systems in Kenya, introduced UHC emphasizing that all citizens from any community had the right to access quality health services be it promotive, preventive, curative, rehabilitative and palliative health care without incurring financial hardship – ‘that’s the basis of UHC!’. Since health is a basic human right enshrined in the constitution of Kenya, Dr. Makumi encouraged CSOs to get involved at both national and county level through dialogue, influencing decision-making for a conducive policy environment for UHC.
She stressed on three important elements of UHC, equity in access to health services – everyone who needs services should get them not only those who can pay for them. In Kenya, for example the free maternal and child health services, free or minimal pay for primary health care (PHC) services though to some extent. Quality health services which should be good enough to improve the health of those receiving these services and the community should be protected against financial-risk, ensuring that the cost of using services does not put those accessing it at risk of financial harm
Moving towards UHC in Kenya: perspectives from the Ministry of Health
A representative from the Ministry of Health (MoH), Mr. Julius Mutiso affirmed the government’s continued commitment in implementing health systems reforms for UHC. Part of the reforms include employing adequate policies, legal and institutional frameworks such as Bills of Right (chapter 4) and the Constitution of Kenya 2010 (pp 31-38). This, he said, was the citizens’ right to health and a long-term development goal of Kenya Vision 2030. Again, it was highlighted that health services must not expose its citizens to financial risk.
Towards UHC, the MoH so far has done numerous actions such as introducing free maternity services, upgrading healthcare in informal settlements and providing more support in HIV/TB and Malaria programs. This, he said, has contributed to decreased maternal and infant mortality rate, improved uptake of health services (TB detection, ART treatment etc.) and improved utilisation insecticide treated nets. He further highlighted the following as key next steps towards UHC by the ministry:
|Finalize and operationalize the Kenya Health Financing strategy|
|Improve on social protection to minimize financial hardships|
|Ensure availability of essential medicines, commodities and provision of quality health services|
|More support for public health programs and training of health workers|
|Expansion health infrastructure|
|More awareness on UHC at all levels|
|Provide technical support to counties implementing UHC|
Participants noted that while the government of Kenya has set up various programs towards making progress on UHC, civil society has not adequately engaged in such UHC discussions hence the need to organize and coordinate effectively as a way to strengthening CSO engagement.
A discussion on CSEM and coordination of UHC advocacy and accountability work brought forward the following key highlights:
Civil society must work together in engaging the government on UHC through accountability and advocacy efforts. This engagement could include: helping to identify who the marginalized in the population are; establish whether health services are reaching the vulnerable and whether programs are purposively targeting those that can easily be left behind; monitoring budgets and expenditure; participating in public information sharing forums and tracking results among other areas. It was agreed that through proper documentation, CSOs must ascertain what has worked well and what has not worked in the past and build upon this through a coordinated CSEM.
In conclusion, participants provided a set of recommendations on how CSOs in Kenya can work better together; how UHC2030 can strengthen citizen voices; and how to strengthen country CSEM. As a next step civil society will reconvene to jointly develop an Action Plan to guide the country CSEM according to the recommendations of this consultation.
In 2015, the international community officially enshrined universal health coverage (UHC) in the Sustainable Development Goals which guides development efforts through 2030. A strong primary health care (PHC) system is the first step toward achieving UHC and we must address the funding shortfall as well as develop innovative financing strategies.
In many countries in Africa, health services remain unaffordable; often far from home, and quality can be uneven. Crises such as the Ebola epidemic bring into sharp focus how communities and individuals struggle in getting the care they need, sometimes resulting in death that could have been prevented. Primary health care ensures that all people in a community stay healthy and receive care when they need it.
I serve as a Policy Advisor at WACI Health whose mandate is to create political good will to end life threatening epidemics and the improvement of health for all in Africa. PHC is critical to achieving our vision and mission. As an advocate, I engage with Governments and the citizens to embrace PHC and for each of the parties to play their roles to ensure PHC is a functional system. This is not an easy task especially where there is so much mistrust of PHC by a large number of middle income citizens who prefer out of pocket spending for example over the counter drugs rather than seek services from the public facilities. This practice comprises the health outcomes of individuals due to missed or wrong diagnosis and treatment hence end up bearing heavy costs for specialized treatment when the complications occurs leading to draining of family resources increasing the likelihood of poverty.
We are also advocating for increased domestic resources, for example in Kenya where the devolved system of Government has health as a nearly fully devolved function with the exception of policy formulation to ensure that County Governments allocate resources to PHC and that they strengthen the systems such that their citizen can access the services they require at the nearest facilities to where they live.
Earlier this year, I found myself immersed in rich conversations on PHC with other civil society advocates, technical experts and development partners. I participated in a consultation hosted by PAI and Save the Children UK, convened in Johannesburg, South Africa. The three-day consultation, sharpened my understanding of the complexities that countries face in the quest for affordable, accessible and quality primary health care. Common threads in the conversation included: the need to address access, financing, removal of barriers, strengthening health systems and engaging citizens to make PHC work. It was however, clear to me that it is up to each country to define their own meaning and understanding of PHC.
The challenges confronting the health sector range from the spread of non-communicable diseases to inadequate funding of health interventions and over reliance to the international aid rather than domestic funding. A few key messages stood out for me from this consultation:
· A high-functioning PHC system is key to ensure a productive and a healthy population. Millions of people in Africa are driven to poverty by healthcare-related expenditures and in return poverty predisposes them to disease slowing all aspects of growth in the economy. Strengthening healthcare systems to increase access to affordable, appropriate and quality health services in any country is a prerequisite for long-term development and structural transformation.
· Basic curative, preventive and promotive healthcare should be available and accessible to all if we are to achieve the Sustainable Development Goals by 2030.
· Financing for health falls short of the 2001 Abuja Declaration, where nations committed to allocating 15 per cent of their national budget to health.
The verticalization of health programs has a negative effect to the health system, leading to the prioritization of certain services or diseases causing a fragmentation of PHC services. Rather, government and other support to PHC is more beneficial in addressing issues of access to services by all.
Countries must define PHC in their own context, based in essential health services with a clear funding stream and develop indicators and outcomes to measure progress and success.
The report and recommendations from the Primary Health Care Expenditure and Budget Advocacy Consultation is available here.
Of the estimated 36.7 million people living with HIV/AIDS globally in 2015, 25.6 million live in sub-Saharan Africa. Also, 1.37 million (65%) of 2.1 million new infections that occurred worldwide in 2015 occurred in sub-Saharan Africa. Sub-Sahara continues to bear the greatest burden of HIV infection. If we want to reverse this trend, there is a critical need to invest and scale up prevention and treatment of HIV.
A preventive HIV vaccine is an essential component of a long-term end to the HIV epidemic. Such a vaccine would teach the immune system to create responses that prevent the virus from establishing infection in the body. No licensed preventive HIV vaccine exists at present. However, there are ongoing efforts at developing a HIV vaccine. More than 30 years has been invested in HIV research efforts. Vaccine research is a long and enduring effort. The HIV vaccine and research development is not different.
An HIV vaccine is both possible and essential. In 2009, a clinical trial known as RV144 achieved proof-of-concept that a preventive HIV vaccine is possible, and, since then, researchers have continued to build on the results of that trial. There are three ongoing researches testing concepts for HIV vaccine development. These researches are taking place in countries in Africa and North America. However, if and when a HIV vaccine is developed, the product will and should be effective for all persons.
This is the goal of all stakeholders working in the field of HIV vaccine development. While we wait for a HIV vaccine, global coverage of HIV treatment, care and existing prevention options needs to continue to increase and expand; and we should witness less of new HIV infections and deaths from AIDS. The tools we have can make significant difference if we ensure they get into the hands of those who need it. These tools are making significant differences in country’s HIV epidemic profile when barriers to their access are addressed.
We need to support access of all persons to any HIV prevention tool appropriate for their use – preexposure prophylaxis, post exposure prophylaxis, STI diagnosis and treatment, male and female condoms, HIV treatment as soon after diagnosis. HIV vaccine development and eventual rollout of a successful vaccine requires sustained financial support. Developing a successful vaccine is not cheap, but an HIV vaccine will pay huge dividends in lives saved. Modeling research estimates that in some parts of the world, an effective HIV vaccine could reduce new annual HIV infections by nearly half in its first 10 years, averting tens of millions of infections. We can’t afford to slow down promising and urgently needed research.
AfNHi 1, recognizes the importance and place of HIV vaccine in the efforts towards ending HIV by 2030. The end of HIV is only feasible with a HIV vaccine. It will take concerted efforts from all partners to make the successful development, testing and rollout of a safe, effective, licensed HIV vaccine accessible. Civil Society has a role to play in leading the charge in this campaign. Funding product development and clinical trials alone is not enough. AfNHi encourages the investment of all stakeholders in the HIV vaccine research and development process NOW.
1 AfNHi is an African-led HIV Prevention Research Advocacy Network, whose vision is Africa Free of New HIV Infections.