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.
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.
Advances in science in the last two decades have led to tremendous progress against HIV. Breakthroughs in HIV treatment and prevention research have allowed the HIV community to halt and begin to reverse spread of the HIV epidemic. Biomedical approaches such as rapid and user-friendly HIV tests and affordable and effective antiretroviral treatment for people living with HIV have changed the landscape of the HIV response. Other impactful prevention tools have included voluntary medical male circumcision, male and female condoms, and oral pre-exposure prophylaxis (PrEP), among others.
All the same, the fight against HIV is far from won. HIV prevention efforts across the world have all but stagnated. According to UNAIDS, 2.1 million people became newly infected with HIV around the world in 2015. To end HIV as an epidemic by 2030, the world will need to do more, deploying traditional tools while developing new tools to accelerate the fight against the disease.
Research and development around new tools to help bolster HIV response is fundamental. It is why a new initiative called the Coalition to Accelerate and Support Prevention Research (CASPR) is exciting. Funded by USAID, and supported by PEPFAR, the coalition seeks to strengthen Africa-focused and led HIV biomedical prevention research, implementation and advocacy. The fact that the coalition is Africa focused is also fundamental because Africa has been left behind in many research and development issues.
The CASPR network, led by AVAC, brings together several Africa-based partners—including the Research institute of the University of the Witwatersrand (WRHI), WACI Health, HIV/AIDS Vaccine Ethics Group (HAVEG), the New HIV Vaccine and Microbicide Advocacy Society (NHVMAS) and the Advocacy for Prevention of HIV and AIDS (APHA)– to accelerate HIV prevention research in Africa. These groups along with partners with longstanding engagement in the region, including IAVI, FHI 360, Avenir Health, and Internews, will work collaboratively to build a network dedicated to advancing advocacy, policy, regulatory, community engagement and communications efforts that help accelerate biomedical HIV prevention research.
This initiative will support Africa to make its contribution in HIV prevention research, in areas such vaccine development. This is much needed. Africa can play its role, not only advocating for great use of the tools available to defeating HIV but also in contributing to creation of new tools to end the disease as an epidemic.
CASPR seeks to support an Africa-centered network dedicated to advancing biomedical HIV prevention research through a robust network of strategic partnerships and an interconnected array of activities such as linking prevention research advocacy to campaigns for increased domestic financing for health; establishing an African HIV Media Network; expanding the Good Participatory Practice framework; and increasing coordination between research partners, governments and civil society.
WACI Health reflects on the major developments in global health in 2016.
- In May 2016, WHO recommended a shorter treatment for multi-drug resistant TB, which not only reduces the length of treatment by half for many patients but also cuts costs by at least 50 percent. Full story
- In September, the World Health Organization certified Sri Lanka as a malaria-free nation. Full story
- In September, the Global Fund raised close to US$13 billion to accelerate the response to HIV, TB and malaria as well as build resilient and sustainable systems for health. Full story
- In October, the world launched the first child-friendly TB medicines. The new formulations will increase children’s adherence to the drugs as they are easier for children to take. Full story
- In November, trials for a new HIV vaccine started in South Africa. Full story
- In December, a new Ebola vaccine was found to give 100 percent protection against the disease. Full story
In our advocacy work over the last year, our partnership has accumulated a list of accomplishments and as a result propelled our vision of advocating for improved health for all in Africa. Below is a select few of those 2016 highlights.
High-Level Meeting in New York: CISPHA co-hosted a pan-African civil society meeting ahead of the United Nations High Level Meeting on HIV, playing a significant role in urging partners to commit to improved financing of the Aids response by ensuring that the Global Fund is funded strongly. The outcome document from the meeting became a critical reference text for both the Africa Union member states and donor governments. The deliberations are captured in this blog by GFAN Africa.
Kenya Contribution to Global Fund: Together with KANCO, WACI Health and the Kenyan civil society organizations we worked to engage Kenya Ministry of Health officials, including Cabinet Secretary for Health Dr. Cleopa Mailu and Acting Director of Medical Services Dr. Jackson Kioko. These leaders committed to advocate for an increased Kenyan pledge to the Global Fund replenishment. The objective came to fruition with a pledge of US$ 5 million by Kenya during the pledging conference in Montreal, Canada 16-17, September 2016.
Vaccines: In commemoration of the 2016 World AIDS Vaccine Day, WACI Health co-convened civil society representatives from the eastern and southern Africa region to renew, strength and accelerate civil society action on investments and innovation in AIDS Vaccine Research and Development, among other New Prevention Technologies. This meeting came up with a call to action, boldly calling upon African governments to accelerate HIV R&D investments
A great thing happened in Africa civil society circles in 2009 with the formation of CISPHA – the Civil Society Platform for Health in Africa. In seven short years, the group has covered a lot of ground, uniting many civil society organizations working in global health in Africa, demanding a space at the table, and articulating issues that nudge governments and other authorities to do more for the health of the people of the continent.
With remarkable experience forged in the trenches of global health advocacy, CISPHA has spent the last year firmly focused on the Sustainable Development Goals (SDGs) launched in New York in September 2015.
The framing of the SDGs was greatly successful in its eloquent capturing of the fact that all issues of development are interconnected. While CISPHA has chosen to focus its work on SDG3 – ensure healthy lives and promote well-being for all at all ages – it recognizes that to attain that goal there are many other fundamental factors covered in other SDGs that must come to play. Issues of poverty, education, gender equality, human rights, climate change, among others. As such, CISPHA seeks to build broader and richer partnerships for development.
In 2016, CISPHA focused much of its energy on GFAN Africa in supporting the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria – a partnership that has saved more than 20 million lives in the last 15 years of its operations. CISPHA regards the Global Fund as one of the most successful partnerships for development.
In 2016, the Global Fund held its replenishment to raise US$ 13 billion to accelerate the fight against HIV, tuberculosis and malaria and to build resilient and sustainable systems for health. A strong Fifth Replenishment for the Global Fund’s was one of CISPHA’s top objectives in 2016. The network lobbied and advocated for more support for the fight against HIV, tuberculosis and malaria, reminding governments of the impressive gains made against these diseases because of the work of the Global Fund partnership. It was time to accelerate that progress and end these diseases for good. CISPHA also mapped out reasons why the gains were fragile and why the world could not stop investing in the Global Fund.
It was exciting when we gathered in Montreal in September — in a meeting hosted by Prime Minister Justin Trudeau of Canada to see partners raise US$ 12.91 billion for the Global Fund. The amount raised — nearly meeting the US$ 13 billion goal — was the biggest commitment of funds to fight diseases in history. It was a remarkable feat especially in a time of many competing global priorities.
The African civil societies were especially gratified by the fact that for the first time African countries were front and center in galvanizing the world to invest more in the Global Fund. Beyond calling on the world to commit more resources to the Global Fund, African countries also made strong pledges themselves. Benin, Côte d’Ivoire, Kenya, Namibia, Nigeria, Senegal, South Africa, Togo, and Zimbabwe, Zambia, South Africa each made their contributions. The money raised will save 8 million lives, avert 300 million infections – most of them in Africa – and help build resilient and sustainable systems for health.
For CISPHA, which has committed itself to calling on Africa to invest more in the health of its people, this was a remarkable achievement. Nevertheless, we are not there yet. CISPHA now calls on African governments to commit more of their annual expenditures to health as demanded by Africa Scorecard on Domestic Financing for Health launched in July this year.
For now, CISPHA is thankful for the remarkable achievement in raising funds for the Global Fund, now expected to go beyond the US$ 13 billion. Above all, CISPHA is tremendously thankful for the strong showing of African countries in the Replenishment. For every, civil society group or partner that advocated to make this possible we thank you. We are looking forward to more such successes in 2017 and beyond.
In 2016 – after close to 20 years as World Aids Campaign International (WACI) – we rebranded, streamlining our mandate and renaming our organization WACI Health. As an Africa regional advocacy organization, WACI Health has taken a firm focus on ending life-threatening illnesses and improving health for all on the African continent. We aim to build broad collaborations that can galvanize sufficient political will to enhance and guarantee health equity, foster human rights and promote gender equality.
Our approach is three-pronged:
- Policy and advocacy
- Capacity strengthening for civil society, for stronger engagement in global health
- Civil society mobilization
In 1997, we began as World AIDS Campaign (WAC) with an aim to raise public awareness on the global Aids response, working amongst diverse civil society organizations. We led in the planning and observance of the International World Aids Day. Four years later, we became an independent non-governmental organisation based in the Netherlands.
In 2008, we undertook a strategic shift that led to the registration of World Aids Campaign International (WACI) in South Africa. Over the years, our scope of work has also increased from a HIV and Aids portfolio to an all-inclusive health advocacy package for Africa, with a broader, approach to inclusive health needs of people.
In 2016, we rebranded to WACI Health. Wearing this new hat, we have stayed true to our traditional role of responding to HIV and Aids even as we embrace a broader health development agenda.
WACI Health is an Africa regional advocacy organization committed to creating political will to end life-threatening epidemics and improve health for all in Africa.
We started out as World AIDS Campaign (WAC) in 1997, to focus on raising public awareness on specific issues on the global AIDS response. This was achieved by working to support and strengthen campaigning on HIV accountability among diverse civil society constituencies worldwide.
WACI was also tasked to lead the planning and observance of the International World Aids Day. In 2004, became an independent NGO based in the Netherlands.
In 2008, the organization undertook a strategic shift that would lead to the registration of World Aids Campaign International (WACI) in South Africa. Over the following (4) years, WACI would see a range of institutional and leadership transitions. From a global organization, founded and headquartered in Europe, working in various geographical regions, including: Europe, Africa, Asia, Middle East and North Africa, to an organization that is today based and focused on Africa addressing not only HIV but also broader issues in health.
The organization’s deliberate shift to focus on Africa was guided by the need to be more conscientious, more innovative and even more accountable and streamlined in our approaches as we continued to ensure that the organization maintained her pivotal role in the global AIDS response, while continually embracing and incorporating the broader health development agenda into her work.
After seven (7) years as World AIDS Campaign International, the organization is now referred to as ‘WACI Health’.
Health for all in Africa
WACI Health exists to champion the end of life-threatening epidemics and health for all in Africa by influencing political priorities through an effective, evidence-driven Pan-African civil society voice and action.
Our Strategic Approach
In our transition from World AIDS Campaign International to WACI Health, we remain committed to responding vigorously to epidemics such as AIDS, TB and malaria as well as associated causes of death. In addition, the shifting field of global health calls us to support long-term investments in health and explore the interconnectedness of major infectious diseases and conditions that continue to kill many across the world. At the core of our strategy is a deliberate intention to broadly contribute to health equity, human rights and gender equality.
Our approach is based on our theory of change, which is made up of three core strategies:
- Policy and advocacy: Policy watch and analysis for strategic input and accountability at global, regional and national levels. Through political advocacy, we will seek to influence perceptions, views and decisions of those in positions of power. We will continually seek to achieve improved tools for data analysis and evidence for advocacy.
- Civil society Capacity Strengthening: Strengthening capacity of Civil Society to engage as strong advocates for health in Africa. We will support realization of appropriate civil society capacity for utilization of tools, and knowledge to apply evidence in advocacy. We will seek to strengthen civil society and community organizing for health advocacy.
- Civil society mobilization: Building a civil society movement in Africa in order to raise a critical mass of people whose voices and action will be core to ending the epidemics and improving health for all in Africa. We envisage a movement that will broadly contribute to health equity, human rights and gender equality.
The theory of change is dynamic and interactive, with all of the strategies working together to impact 3 areas of Global Health work, which broadly point to our strategic goals.
- Resources for health: We will focus on urging national governments and international agencies to step up their investments in health through transparent investments.
- Research and Development: We will focus on supporting health research and development with an aim to see that its application and delivery results to access to health products, technologies, innovations and better health for the people most in need.
- Civic Engagement: We will strive to support stronger civil society and community voice and action. We see this strengthening/empowerment not only as a process in health advocacy but also an end in itself where empowerment contributes to sustainability beyond specific processes.
GENEVA – African countries increased investments in the Global Fund as global health partners seek to galvanize all sources of funding to end AIDS, tuberculosis and malaria as epidemics, and to build resilient and sustainable systems for health.
Benin, Côte d’Ivoire, Kenya, Namibia, Nigeria, Senegal, South Africa, Togo, and Zimbabwe each made contributions to the Global Fund’s Fifth Replenishment, hosted by Prime Minister Justin Trudeau of Canada in Montreal on 16-17 September. Altogether, the conference secured pledges of more than $12.9 billion from partners across the world.
Pledges by African countries to the Global Fund are aligned with a far more significant increase of domestic investment in health by African countries – US$10.9 billion committed for 2015-17. For the first time, Africa is now mobilizing more domestic funding for health than foreign funding in the sector.
Specific pledges to the Global Fund signal commitment beyond any specific country, toward a global approach to ending the epidemics.
President Faure Gnassingbé of Togo, making his nation’s first contribution to the Global Fund of US$1 million, said Togo will play its part in the fight against epidemics to end them for good.
President Macky Sall of Senegal said: “In an interconnected and interdependent world, diseases know no borders.” He added: “New impetus is needed to continue support to the countries affected by diseases. These countries should also invest more in the health sector so we can end these diseases for good.”
President Alassane Ouattara of Cote d’Ivoire also pledged US$1 million to the Global Fund, and spoke about the importance of focusing investments in programs that specifically address the disproportionate effects on women and girls.
President Uhuru Kenyatta of Kenya, when he announced a pledge of US$5 million just prior to the Replenishment Conference, said his country was contributing the funds in the spirit of solidarity and shared responsibility in the fight against diseases.
“The funds, which will be invested in prevention and treatment of diseases and in building health systems, will save lives and create more inclusive and thriving communities,” President Kenyatta said.
Mark Dybul, Executive Director of the Global Fund, said more investments in health by African countries have helped build remarkable momentum against HIV, tuberculosis and malaria – some of Africa’s most devastating diseases.
“African leaders have made investing in health a top priority,” Dr. Dybul said. “They are strong partners in a global movement that is determined to expand access to health services to everyone, leaving no one behind.”
The Replenishment Conference raised nearly $1 billion more than the previous pledging session in 2013, and benefitted from participation by leaders from countries all over the world, including heads of state of Senegal, Côte d’Ivoire and Togo and the prime ministers of Mali and Guinea.
The amount raised will save 8 million lives, avert 300 million infections, and help build resilient and sustainable systems for health. The conference is the beginning of a three-year replenishment period, and the Global Fund will work to gain further contributions in the coming months and years, with strong advocacy by civil society and partners worldwide.
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