n 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.
The global health landscape is changing. In less than two decades, the world has registered some of the most momentous advances against infectious diseases. Global partnerships against epidemics such as HIV, tuberculosis and malaria have galvanized remarkable amount of goodwill and resources that have significantly reduced the burden of these diseases. Those efforts have saved millions of lives globally. A new report by the Brookings shows that the Millennium Development Goals (MDGs) spurred major accelerations in the fight against child mortality, HIV and AIDS, tuberculosis and malaria. The Study found that through expansion and acceleration of pre-MDG rates of progress, between 21 and 29 million lives were saved.
Kenyan researchers are working on about eight potential HIV vaccines.None has shown efficacy, but scientists believe they are still potent if delivered efficiently into the body.And so they are not giving up.They have resolved to intensify their work and use other methods that will finally give the desired results.“Most of them were found to be safe, but failed to stimulate the body’s immune system,”
Borna Nyaoke, a clinical trial physician at the Kenya AIDS Vaccine Initiative, said yesterday.“Now we are trying different methods that can deliver it directly into the cell.”She said some of the new delivery methods include administering through nasal drops and electroporation, where the vaccine is given through a quick, high-voltage pulse to overcome the barrier of the cell membrane.
“We are working on a HIV vaccine. We will get it, but it will take time,” Nyaoke said during a world HIV Vaccine Awareness Day conference convened in Nairobi by WACI Health, a regional advocacy group. She said all the Kenyan vaccine candidates passed safety levels but stalled at Phase Two.Nyaoke said candidates would take at least another 10 years of testing even if scientists find a better delivery method. It is hard to make an HIV vaccine because the virus mutates quickly and a vaccine against one type may not protect against another.
Vaccines work by mimicking natural infections, during which the body produces antibodies that kill the virus.But HIV doesn’t stimulate this kind of response. The body’s immune systems are generally blind to the virus and unable to launch an effective antibody attack.There is also the lack of good animal models to study. KAVI, an affiliate of the University of Nairobi, has been conducting vaccine research since 2001. Globally, the efforts are more than 30 years old.
WACI health executive director Rosemary Mburu praised HIV research efforts in Kenya and called for more government funding.“Finding a vaccine is costly and involves a lot of research. But it is essential and possible. That is why we need to invest in it,” she said.
UNAIDS says a vaccine would be the most effective way to control the virus.“The biggest impacts in the eradication or control of infectious diseases in the history of public health have been achieved through vaccination,” Michel Sidibé, Unaids executive director, said. “This is why a vaccine is worth continuing to invest in.”
The African Civil Society Platform on Health and GFAN Africa Urge African and World Leaders to Urgently Address Drug Resistant TB
Drug Resistant TB: Time to Act is now
Tuberculosis is killing more people than any other infectious disease; close to two million people died from TB last year. The rise of these reported TB cases is a big cause for concern.
“But the emergence of new superbugs that can resist even the most powerful antibiotics should make bigger headlines”, Says Rosemary Mburu, Executive Director, WACI Health. “While antimicrobial resistance is going to affect treatment for many health conditions, drug-resistant TB is particularly concerning as it accounts for about one-third of all antimicrobial resistance deaths”.
The growth of these forms of drug-resistant TB has a potentially disastrous impact in the fight against the disease. In 2015, there were approximately 580,000 cases of drug-resistant TB. Only 20 percent of those were diagnosed, treated or reported to national health systems across the world. Drug-resistant TB ended up killing 250,000 of people that year.
“This form of the disease now threatens many recent gains made against the response to TB and HIV globally,” said Carol Nawina- Kachenga, Executive Director, CITAM+. “Over the last few decades, the global community has worked so hard to defeat HIV. Today, Tuberculosis, the world’s most infectious disease is threatening to reverse these gains by killing our communities. It is killing our grandmothers in Kinshasa, our mothers in Soweto, our brothers in Ndola and children all over Africa. It is pushing us further into poverty and killing our dreams.
“Africa is home to four of the 27 global high multidrug-resistant TB burden countries: Democratic Republic of Congo, Ethiopia, Nigeria and South Africa.” Says Olayide Akanni, Executive Director, Journalists Against AIDS, Nigeria. “ Our people continue to suffer in the face of lack of new drugs to treat drug-resistant TB and ineffectiveness of existing treatments, which are long and often cause adverse side effects.”
A widespread epidemic of extensively drug-resistant (XDR) tuberculosis is also unfolding in South Africa, where cases have increased substantially since 2002. Alone, the country contributed 562 of the 4,040 XDR-TB cases enrolled on treatment globally in 2014. “This is a time bomb in South Africa and President Jacob Zuma must champion TB R&D in South Africa and globally, through his G20 membership,” says Daniel Molokele, Steering Committee Member, CISPHA.
Global health partners must halt and reverse the growth of drug-resistant TB. The time to act is now.
On World TB day 2017, we, members of the CISPHA and GFAN Africa, united in our resolve to ending TB:
- Join other global health organizations in calling for TB to be added to the World Health Organization’s list of high priority drug-resistant bacteria. Our call comes in the wake of WHO’s first ever list of antibiotic-resistant pathogens released as part of the effort to address the growing threat of antimicrobial resistance. Currently, that list does not include TB.
- Call upon African governments to prioritize tuberculosis in national health and development agendas by increasing investments in research and development for TB to support creation and uptake of new tools and drugs to respond to drug-resistant TB.
- In the run-up to the upcoming G20 meeting in Hamburg, Germany, in July, we call upon G20 leaders – including President Jacob Zuma – to demonstrate leadership in responding to drug-resistant TB by committing to fund new research to develop better drugs and treatment regimens to respond to the disease.
About CISPHA: The Civil Society Platform on Health in Africa (CISPHA), is an Africa regional advocacy platform, which aims at a coordinated Civil Society response on health in Africa. The Platform was launched in 2009, when 60 networks and network organizations, joined forces to utilize evidence for Advocacy and Lobby at continental level, linking the efforts at national and regional levels to influence decision processes at the African Union and its institutions. CISPHA is hosted by WACI Health.
About GFAN Africa: Nested within CISPHA, the Global Fund Advocates Network (GFAN) Africa is a regional hub for GFAN. GFAN Africa unites voices and efforts from all over Africa to support a fully funded Global Fund to Fight AIDS, Tuberculosis and Malaria.
 In high burden TB settings it has been noted that 15-20% of all TB cases are among children.
By Stephen Mule
This year, the two deadliest infectious diseases traded places. The World Health Organization (WHO) announced that tuberculosis had overtaken HIV, as the deadliest infectious disease globally. The WHO report, released in October, estimated that there were almost 10 million new cases of TB in 2015. The disease killed 1.5 million people, ahead of 1.2 million claimed by HIV. For those of us who have committed ourselves to ending TB by 2030, this is extremely disconcerting.
But it doesn’t have to be that way. Advances in science have brought us so far that we cannot allow this disease to beat us now. One of the most important of those scientific imperatives is the understanding of how these two diseases fuel each other. For instance, TB kills more than a 1000 people living with HIV every day. To end HIV as an epidemic, we must end TB as an epidemic and vice versa.
To end this deadly combination, we must respond aggressively to co-infection between the two diseases. In 2004, WHO established guidelines on addressing HIV-associated TB, emphasizing the necessity of linking TB and HIV services. The guidelines also outlined a set of joint activities that needed to be delivered to address the interface between the two diseases. Those guidelines evolved further into a more complex mechanism that sought to expand detection and prevention of TB, among people living with HIV. The approach also aimed at enhancing ownership of TB-HIV work, especially among people working in the HIV field. The WHO updated those policy recommendations in 2012, giving greater clarity on 12 specific activities needed to improve health services and health outcomes for people with, and at risk of, TB and HIV.
To end these two epidemics, we need to make sure that these policy guidelines are implemented. Doing that is one of the key ingredients in sending these two diseases into retreat. In 2014, ACTION Global Health Advocacy Partnership investigated whether the guidelines had been translated into commitments at global and national levels and produced a report titled From Rhetoric to Reality. The study showed that while bold policy steps had been taken to fight both TB and HIV, much more was needed. To address gaps, ACTION recommended that national HIV strategic plans prioritize TB-HIV joint activities—with a specific focus on screening all people living with HIV for TB—to ensure access to TB prevention, testing, treatment, and care.
Two years later, ACTION conducted another study and released a report titled From Policy to Practice. This report explores the progress made in TB-HIV integration efforts since 2012. It shows that HIV programs globally are lagging behind in accelerating TB-HIV activities, while TB programs are, comparatively, performing well in their efforts to accelerate TB-HIV activities. The study also found that global guidelines to address TB-HIV have not been prioritized by leading donors and affected countries.
To defeat TB and HIV, we have do more. The HIV community cannot afford to be left behind any longer in instituting joint TB-HIV integration.
International funders of HIV must also invest more vigorously in TB-HIV programming. The science is unequivocal in showing that more work around where these two diseases interact is indispensable to ending these highly interlinked diseases.
In the last twenty years, we have had remarkable investments in responding to HIV and tuberculosis. Without a doubt, great progress has been made against these diseases. But to end them as epidemics by 2030, we must accelerate our investments and implementation in TB-HIV activities.
The window is closing fast. The choices are stark. We must find ways of doing greater TB-HIV integration or risk losing two fights at once.
Stephen Mule is a Member of Parliament in Kenya and the Chair of Africa TB Caucus.
Suzanne Ehlers is President and CEO of Population Action International;
Rosemary Mburu is Executive Director of World AIDS Campaign International
Website: The LANCET Global Health Blog
With the launch of the new Sustainable Development Goals, health and development experts around the world are reflecting on what it will take to accomplish them. As a global community, this is a unique opportunity to think carefully about what works and what doesn’t, and to use the new goals to redouble our efforts to support programmes, solutions, and systems that work.
To fuel progress in global development, we need catalysts that cut across multiple challenges and support multiple development interests. There is a widespread understanding among decision-makers in low- and middle-income countries that high-performing primary health-care systems play that catalytic role. These systems are central to reaching global and country-specific goals, achieving universal health coverage, and meeting the majority of individual and community health needs before they become emergencies. A healthy population in turn sets the stage for gains in education, economies, and peace and security.
Providing sexual and reproductive health services in the context of primary health care is a long-established principle and practice. The 1994 International Conference on Population and Development (ICPD) Programme of Action called for ensuring access to reproductive health through primary health care. Similarly, a 2008 UNFPA publication stated that achieving progress towards sexual and reproductive health and rights depends on a strong and functional health system in every country, especially at the primary and first referral levels.
With respect to HIV, tuberculosis, and malaria, the 2006 Abuja Call for Accelerated Action Towards Univeral Access called for the promotion and integration of access to prevention, treatment, care, and support in primary health-care services. High-performing primary health-care systems enable countries to maximise the impact of core investments in programmes to defeat these and other infectious and non-communicable diseases. For example, primary health-care systems can be the basis for the scale-up of essential HIV and AIDS services in hard-to-reach areas and among underserved populations.
Unfortunately, despite broad global agreement on the value of robust primary health care, there is not a simple recipe to achieve it. Domestic financing and country ownership are critical elements, and it is time for countries to set priorities and budgets that explicitly aim to strengthen primary health-care systems, complementing the efforts of donors. Civil society also has a key role to play, not only holding decision-makers accountable but also working with them to develop strong systems that can be reached by all.
To enact policies and budgets that lead to measurable primary health-care improvements, however, decision-makers need better information about the components of high-performing primary health-care systems, particularly their poorly understood service delivery elements – such as the quality of care, and patients’ ability to access the system, and the degree of coordination among various care providers. A new partnership called the Primary Health Care Performance Initiative (PHCPI) seeks to address this gap in information, giving decision-makers the tools to adopt policies and practices based on evidence.
We are excited about PHCPI because it presents an opportunity for collaboration among diverse communities working to address other issues of global health and development. This is a chance to look ahead to where improvements to primary health-care systems can take us all in the future. We can rise above disputes over which health issues deserve the most attention, or what set of indicators gives us the best picture of a system’s health. We can harness data to make policy decisions about health care that are truly responsive to communities’ needs. We can unite around the opportunity to dramatically improve the health of millions of people by focusing on primary health care, the frontline of health in people’s communities.
President Donald Trump has reinstated the Mexico City Policy – an abortion-related requirement prohibiting foreign non-governmental organizations that receive U.S. funding from using their resources on abortion or abortion advocacy. But other countries, led by The Netherlands, have moved swiftly to try minimize the impact of the Trump’s order.
The policy – also known as the global gag rule was established by President Ronald Reagan in 1984. It provides that to receive U.S. funds, organizations must desist from using money from any source (including non-U.S. funds) for abortion or abortion advocacy. President Trump’s provisions go beyond previous ones by Republican Presidents, which barred organizations from receiving U.S. government global-family-planning funding. His gag rules are extended to cover all other U.S. global-health funding. The memorandum signed by President Trump also extends the requirements beyond non-governmental organizations to include “global health assistance furnished by all departments or agencies.” In the last few weeks since this new order was signed, global health advocates have worried that the gag rule will harm global health, reversing gains made against many diseases, including HIV, tuberculosis and malaria. More importantly, the new order would affect the provision of reproductive health services for millions of women around the world.
It is why WACI Health is excited to hear plans by the Netherlands to establish an international fund to mitigate the effects of President Trump’s gag rule on women’s reproductive health services. Launching the She Decides initiative, Lilianne Ploumen, the Dutch minister for foreign trade and development cooperation, said new funding will be used “to make sure that women and girls all over the world have access to family planning services.” It is reported that seven other countries, including Sweden, Denmark, Belgium, Luxemburg, Finland, Canada and Cape Verde have offered their support.
In her message in support of women’s reproductive health rights, Marie-Claude Bibeau, Canada’s Minister of International Development and La Francophonie, said that Canada will make a significant contribution in sexual and reproductive health rights and advocacy for women’s rights, contribute to sex education for boys and girls, to the provision of contraceptives, to family planning, to legal safe abortions and to maternal and newborn health.
We commend the Netherlands for coming up with this great initiative. We commend the other countries that are standing up for women in these very uncertain times. The world has made remarkable progress in the fight against infectious diseases and in promoting and protecting reproductive health rights of women in the last two decades. We cannot stop now.
A growing wave of nationalism is sweeping across the West and demanding a sharper focus on domestic issues and lesser engagement abroad. For global health investments in Africa, which have been heavily supported by international funding, these happenings call for increased domestic investments in health and other areas of development.
The rise of nationalism sentiments have been wide ranging – from Austria, to France and the Netherlands. However, two recent developments – the victory by the Brexiters in the UK in June 2016 and the election of President Trump in the U.S. less than five months later – are certainly the most momentous. The two events are the best exemplifications of the global politics of the times. More and more countries seem to be looking inward, not outward. In his inaugural speech as the President of the United States, Donald Trump vowed: “From this day forward, it’s going to be only America first, America first. Every decision on trade, on taxes, on immigration, on foreign affairs will be made to benefit American workers and American families.”
While it is still early to know what effect the Trump administration’s policies will have on global development, The New York Times has reported that the administration is “preparing executive orders that would clear the way to drastically reduce the United States’ role in the United Nations and other international organizations.” The orders would kick off the process of reviewing and potentially repealing certain forms of multilateral treaties, the Times reported.
For years now, advocates across Africa have been calling on African governments to step up their investments in global health. Africa bears a disproportionate burden of diseases. It is estimated that sub-Saharan Africa has 11 percent of the world’s population but 24 percent of disease burden. Despite the tremendous progress made against the big three infectious diseases – HIV, TB and malaria – numerous African’s continue to die of these diseases every year. To end these diseases and others that continue to kill many on the continent, advocates have called on African governments to find ways to invest more of their own money towards this cause.
Progress against major infectious diseases in the last two decades has been unequivocal. For instance, an estimated 790 000 people died in the African Region from HIV-related causes in 2014, according to WHO. That was a 48 percent drop in number of deaths from the disease compared to 1.5 million people in 2004. That progress was achieved through strong investments by international development funders and African governments. To end HIV, TB and other diseases as epidemics, advocates have called on international funders and African governments to do more.
With the growing wave of nationalism, and the possibility that contributions by international funders can decline, African countries have a bigger duty to ensure that this progress does not stall. If funding levels from the U.S. – the single biggest investor in international funding for global health – falls, the dream of ending HIV, tuberculosis and malaria as epidemics by 2030 may not be realized. We hope that the U.S. and other big donor governments will safeguard and advance this work, completing the wonderful job they started. This is especially crucial, as we get closer than ever to ending major diseases as epidemics.
We call on African countries to step up their investments in global health to fill any gaps that may be left by a possible decline in international funding.
If it turns out that the growing anti-globalization sentiments will not result to reduced investments in global health, then that sustained funding and stronger investments by African governments can help us to press forward faster with the goals of ending HIV, TB and malaria as epidemics by 2030 as well as build stronger health systems to tackle other diseases. This would be a landmark victory for all in the world, which would save millions and millions of lives, revitalize communities, create stronger economies and spawn greater benefits for all people in all corners of the world.
In February, Africa elected Chad’s Moussa Faki Mahamat as the new chairperson of the African Union Commission (AU) replacing South Africa’s Nkosazana Dlamini-Zuma.
One of the most remarkable advances in global health under the leadership of Dlamini-Zuma, was the formation of the Africa Centers for Disease Control and Prevention, a public health agency to lead the transformation of Africa’s health.
The birth of Africa CDC is timely and crucial because it will address the uneven burden of disease as evident in sub-Saharan Africa that carries 11 percent of the world’s population but 24 percent of disease burden as per the AU Commission Strategic Plan 2014-2017.
As the secretariat to the Civil Society platform for Health in Africa (CISPHA), we are elated to witness the formation of this historic initiative – which Africa’s civil society advocated for vigorously.
It is a significant opportunity for Africa to improve the health of its people – a key element in shaping the continent’s sustainable development. We urge Mahamat to strengthen this new outfit and anchor it as a centerpiece of his leadership.
The weakness of many institutions in Africa lack of clear leadership and sufficient resources. We hope that the chairperson will give the agency the support it needs – both in leadership and in resources – to allow it to achieve its mandate of achieving better health for the people of the continent.