Strengthened advocacy on domestic resource mobilization.
Through the Civil Society Platform on Health in Africa (CiSPHA) and Global Fund Advocates Network (GFAN) Africa, we worked with civil society to advocate for increased domestic investments in health. We provided civil society partners with data and other advocacy tools, at the national and regional levels and also facilitated development of messages, including a blog on Domestic Resource Mobilisation. We worked with regional and national civil society platforms to support civil society and community engagement with decision makers at various levels. For example, through GFAN Africa, WACI Health provided technical and financial support to partners in Kenya, Tanzania and Senegal on domestic resource mobilization. These efforts contributed to strengthening of the Civil Society Health Platform in Senegal, which would later become an avenue for civil society and community engagement in the development of the National Health Financing Strategy. In Tanzania, this work contributed to the development of a Civil Society Platform on Domestic Resource Mobilization, which is set to facilitate and strengthen Civil society and community engagement in Domestic Resource Mobilization.
(DRM) advocacy. At the sidelines of the Africa Partnership and Coordination Forum in November 2017, WACI Health led a group of civil society Organizations in organizing a CSOs regional meeting on DRM. At the meeting, CSOs pulled together a position paper on DRM, which was then shared with a wide range of stakeholders at the main forum. The forum serves as a continental platform to chart a collective way forward, identify opportunities for joint action, advocate for continued political commitment, and coordinate the efforts of the different partners to improve the health outcomes in Africa. Participants are drawn from the African Union Commission and its organs, regional economic communities, multilateral and bilateral development partners, non-state actors, parliamentary sector, UN agencies, and regional networks of community groups.
Tuberculosis — the world leading infectious disease – killed about 1.7 million people in 2016. Additionally, more than 10 million people globally got sick with the disease and about four million of them failed to be diagnosed, treated or reported by health systems.
The global state of TB management remains dire and the aim to end the epidemic by 2030 as agreed in the Sustainable Development Goals is still way out of reach. To change this, global health partners must pull together. To contribute to that effort, WACI Health is determined to keep TB prevention, treatment and management in the frontline. WACI Health and other global health partners demand and support efforts to accelerate action against TB.
In Africa, we are working with civil society organisations to galvanise and support leaders to champion more investments and better TB policies. For instance, we were part of a group that pushed to have more members of parliament attend the Global Ministerial Conference on Ending TB in the Sustainable Development in Moscow in November 2017. We are also supporting similar initiatives for the 2018 UN High-Level Meeting on TB in New York, to encourage the attendance of as many African heads of state as possible and to ensure that civil society key asks are prioritised by the heads of state. In commemoration of World TB Day in 2017, we issued a news release through the Africa civil society platform on health and GFAN Africa, with a focus on drug resistant TB. We called on WHO to add TB to its list of high priority drug-resistant bacteria and called on African governments to prioritise tuberculosis in national health and development agendas. We further challenged G20 leaders to demonstrate leadership in responding to drug-resistant TB by committing to fund new research to develop better drugs and treatment regimens. In South Africa, our World TB Day activities involved working with Section 27 and Treatment Access Campaign (TAC) to host two workshops — for TAC members in Free State Province and for Buffalo City Municipality AIDS Council civil society sector members in Eastern Cape. In both meetings, we underlined the need for civil society movements to play a greater role in advocating for proper implementation of the South Africa’s national TB strategic plan. In Kenya, we participated in the launch of Kenya’s first TB prevalence survey 2015/2016. We also participated in schools’ campaign to promote TB awareness in schools and the community. School children were engaged in essay writing and a photo competition on TB control in their communities. WACI Health worked with Hon Stephen Mule, Kenyan Member of Parliament and Chair African TB Caucus, to write a blog on the integration of TB and HIV.
Strengthened advocacy for the implementation of the national strategic plan (NSP) on ending gender-based violence (GBV) in South Africa:
In 2013 WACI Health was invited to join Stop Gender Violence (SGV) – a National Campaign to end gender-based violence. The purpose of the campaign is to call for a
fully costed and fully funded national strategic plan to end GBV. That plan will create a roadmap
that will align the country around a set of clear strategic priorities and create an accountability
mechanism for the performance of government, the private sector and civil organizations, in addressing GBV. When developed through broad-based national consultations and engagement, the plan to end GBV can be transformative. In 2017, WACI Health, as a member of the steering committee for this campaign, joined other CSOs to call on South African government to develop that plan to end GBV.
Highlights of achievements:
i). Shadow framework on NSP to end Gender Based Violence was developed and launched as an advocacy tool in October 2017
ii). Shadow Framework on NSP to end GBV handed over to various stakeholders including the then Deputy President’s Office, Honorable Cyril Ramaphosa, (now the President of the Republic of South Africa), workstream team of department of social development and department of women driving
the plan of action review process, European Union, and UN Women for buy in and as a tool of advocacy on what CS is calling for as response to GBV
iii). We achieved buy-in of provincial partners such as Provincial DSD of-fices, AIDS councils and
Commission for GenderEquality
iv). The campaign was presented in two conferences in 2016. These are: International Violence Prevention Conference and South Africa Violence Conference. We made a presentation of the campaign and shadow framework, which increased support for the campaign.
v). WACI Health (as a member of SGV Campaign) and MOSAIC are part of review process of the integrated plan of action working in collaboration with the national department of social development and department of women.
Public health officials and business leaders like Bill Gates have long warned that the world is not ready for the next pandemic. Now an initiative led by Tom Frieden, former director of the Centers for Disease Control and Prevention, has developed a tool that spotlights gaps in preparedness, and actions that countries and organizations can take to close them. The new website, PreventEpidemics.org, gives an individual score to each country and uses color codes to rank the world by five levels of preparedness.
Recently, WACI Health led diverse South African stakeholders in the TB community, including representatives of civil society, the private sector, TB-affected communities, and other constituencies, developed a set of key asks proposing specific commitments and targets for the draft political declaration of the High-Level Meeting.
This comes at a time when the world is calling on building commitment to end TB, not only at the political level with Heads of State and Ministers of Health, but at all levels from Mayors, Governors, parliamentarians and community leaders, to people affected with TB, civil society advocates, health workers, doctors or nurses, NGOs and other partners. All can be leaders of efforts to end TB in their own work or terrain
Attached are the letters addressed to the President of South Africa and also the respective minsters to attend this high-level meeting.
Tuberculosis (TB) remains an urgent public health threat and a leading infectious cause of death from a single infectious agent, ranking above HIV/AIDS. In 2014, the World Health Assembly resolved to end the global TB epidemic by 2035 which led to elaboration of the Sustainable Development Goals and End TB Strategy’s vision of making a world free of TB with no deaths or suffering due to the disease beyond 2015. As for 2016, about 10.4 million people fell ill with TB while 1.5 million deaths were recorded worldwide.
An ominous increase is being seen globally in the number of new cases of multi-drug resistant TB (MDR-TB). Over half a million new cases resistant to rifampicin (RRTB) – the most effective first-line drug – was reported in 2016, 47% of these cases were in India, China and the Russian Federation. Treatment of MDR tuberculosis is complex and expensive especially its most severe, extensively drug-resistant(XDR-TB) forms. Treatment is long (at least 2 years), drugs are toxic (specific expertise is needed to manage adverse reactions) and outcomes are poor (with low success and high death rates).
In a bid to attain specific targets set in the End TB Strategy through multisectoral action to address socioeconomic determinants and consequences of TB, WACI Health led 18 South African civil society organizations (CSOs) including TB affected communities co-signed a letter appealing to Head of State (HoS), Ministry of Health (MoH) and Ministry of Foreign Affairs (MoFA) commitment to attending the TB High-Level Meeting (TB HLM). TB remains the leading reported cause of death in South Africa with over 33 063 deaths (8.4% of natural deaths) in 2015. Other pertinent issues raised by CSOs comprised of establishing a national TB Caucus, investing in research, diagnostics and treatment for TB, developing a retainment strategy for health care workers, prevention strategy for all and TB response based on human rights approach.
To achieve the 90% reduction in mortality and 80% in incidence requires provision of TB care and prevention within the broader context of universal health coverage (UHC), financing and technological breakthroughs among others. Following political commitment from the Prime Minister towards ending TB by 2025, India’s domestic resource budget, for instance was substantially increased in 2017.
South Africa CSO team in partnership with Global Fund flew their flag high as they met with their SA Mission in New York to engage with them on key asks and requesting their assistance to urge HoS to lead the delegation to TB HLM, and also make sure that National Consultation with all stakeholders is held prior TB HLM to agree on country’s commitments, targets and effective response to TB.
Through the continuous engagement in-country Minister of Health, Dr. Aaron Motsoaledi, in his closing remarks at SA TB Conference on June 15, 2018 said:
“I received many requests and pleas from many TB advocates, including those attending this conference that South Africa must ensure that the country must participate in the HLM at the high level of leadership in government. As TB HLM is on 26 September 2018, we have not relaxed. We are mobilizing for all heads of state of BRICS countries to attend without failure because 50% of all drug sensitive TB as well as 60% multi-drug resistant TB in the world are found in BRICS countries. Presently South Africa is holding the chairpersonship of BRICS and so at the World Health Assembly in Geneva in May I was chairing a BRICS Ministers of Health meeting and I was given an assurance by BRICS Ministers of Health that they will do everything in their power to have their heads of state attending the High Level Meeting on TB. In addition, we asked our President to raise it next month during the BRICS Summit. We are currently chairing SADC and we will do the same to urge all SADC heads of state to attend. There is a forthcoming AU summit and we will also raise this issue at that forum.”
This for us is positive way towards big win and hope in having the South African government leading Africa to attend TB HLM and respond to TB more effectively while meeting the 2030 targets.
The congregation of health leaders at the 2018 World Health Assembly (WHA) in Geneva, Switzerland, this week, is an opportune time to shine a light on the problem of stunting in Africa and for African governments to do more to reverse the negative trends on the continent.
The World Health Organization (WHO) describes stunting as low height for age or height more than two standard deviations below its median Child Growth Standards, one of the most significant impediments to human development. Globally, in 2016, 22.9 percent children under five years of age, or 154.8 million, suffered from stunting. Of those, 59 million are in Africa. In 2012, the WHA Resolution 65.6 endorsed a comprehensive implementation plan on maternal, infant, and young child nutrition, which specified six global nutrition targets to achieve by 2025. The first seeks to realize a 40 percent reduction in the number of children under five who are stunted.
Good nutrition is present when a child consumes enough and well-balanced food that is age appropriate and contains all the nutrients necessary for healthy growth. In the reverse, malnutrition occurs when a child does not get enough good food for their daily body requirements.
Stunting is an indication of malnutrition or nutrition-related disorders that may arise following many factors, including poor maternal health and nutrition before, during, and after pregnancy; inadequate infant feeding practices, especially during the first 1,000 days of a child’s life; infections; or general lack of food.
A young student at the Early Childcare and Development Centre leads her class in reciting the alphabet. Photo credit: RESULTS Canada
Stunting is not only a physical issue; it is associated with underdeveloped brain with long-lasting harmful consequences, including diminished mental capacity, poor school performance, and increased risks of nutrition-related chronic diseases such as diabetes, hypertension, and obesity in adulthood. It worsens when infants’ diets are poor and sanitation and hygiene are inadequate. It is irreversible by the age of two.
While Africa’s land is fertile and productive, children here experience the highest rates of stunting. The contradiction can be explained by the fact that good nutrition is dependent on good agricultural practices, such as clearing of the land at the right time, planting, harvesting, and proper food storage. Inadequate food storage is a major problem for families in rural Africa; food goes bad after short periods of harvesting, leading to waste and seasons of lack.
Additionally, most rural families in any given region will consume similar, limited kinds food throughout their life. These are typically stable foods, but over-consumption and the narrow range of nutrients may lead to malnutrition. African governments must invest in infrastructure and local, regional markets where families can sell their excess crops and buy food from other regions to diversify their nutrient intake. Governments must also invest in the technology to promote proper storage. Inadequate water supply and unemployment are other conditions of poverty that impact families and lead to malnutrition in children. These kinds of investments combined with health and nutrition education are key to preventing malnutrition in Africa.
Governments’ primary role is to ensure that citizens attain the highest attainable standards of health. Therefore, governments must ensure scaling up evidence-based interventions such as iron, folic acid, and iron-folic acid supplementation; multiple micronutrient supplementation; calcium supplementation; iodine fortification through the iodization of salt; maternal supplementation with balanced energy and protein; neonatal vitamin K administration; vitamin A supplementation; promotion of exclusive breastfeeding; and care of preterm infants.
Civil society and communities, meanwhile, must keep on strengthening governance and accountability roles for governments, donors, and the private sector for quality and effective implementation of investments in nutrition as well as call for additional resources to fill the nutrition funding gaps in their countries.
Joyce Nganga is policy advisor at WACI Health, an African regional advocacy organization that champion the end of life-threatening epidemics and health for all in Africa.
Human Immunodeficiency Virus (HIV), a virus that causes Acquired Immuno-Deficiency Syndrome (AIDS), is one of the world’s most serious health and development challenges.
Since the beginning of HIV/AIDS epidemic, more than 70 million people have been infected with HIV and an estimate of 35 million people have died. In 2016, about 36.7 million people worldwide were living with HIV – of these nearly 18.8 million were women and girls while 2.1 million were children under 15 years. Sub-Saharan Africa remains disproportionately affected by the epidemic accounting for nearly two-thirds of the people living with HIV globally. Many of these African countries hardest hit by HIV are also struggling with disease burden, food insecurity climate change and poverty.
Prevention helps reduce HIV incidence rates, a good example would be Elimination of mother-to-child transmission (EMTCT). Globally since 2010, there has been a 50% decline in new HIV infection among children due to mothers having access to antiretroviral medicines which reduce the viral replication of the virus consequently reducing the risk of transmitting HIV virus to their babies before birth, during birth or during breastfeeding. In spite of advances in our scientific understanding of HIV or increased funding and implementation of current treatment and prevention programs by governments, global health community and civil society organizations – many people living with HIV or at risk of getting HIV still do not have access to prevention, care and treatment which is critical in achieving 90-90-90 targets. While existing HIV/AIDS tools are critically important in curbing the epidemic, a vaccine is essential to conclusively and sustainably end AIDS epidemic in Africa.
For this year’s 2018 HIV Vaccine Awareness Day commemoration, WACI Health AfNHi, collaboratively with IAVI and MESHA with technical and financial resources through AVAC convened a science café on 15th May 2018 with media, HIV Vaccines Advocates civil society and scientist. The meeting objectives were to take stock of the challenges, successes and current efforts in finding a HIV vaccine. This meeting also sought to examine the current HIV research landscape towards a vaccine and also to give insight on the importance of carrying out such research. Treatment options for HIV infection have improved a lot over the last three decades however HIV medicines can have side effects, be expensive and hard to access in some countries. Also, some people may develop drug resistance to certain HIV medicines calling for change of medicines.
Building on the success of the RV144 trial in Thailand which provided proof that an HIV vaccine could really work, two HIV vaccine candidates are now in these large trials. There are about 12 clades (also called strains or sub-types) of HIV which exist in the world. HVTN 702 orUhambo, a Phase III trial ongoing in South Africa, enrolled 5 400 men and women is testing a vaccine designed to prevent clade C – the most common HIV clade in Southern Africa. Meanwhile HPX2008/HVTN 705 orImbokodo, a Phase IIb currently in 5 countries across sub-Saharan Africa enrolled 2 600 women. In this region, more women are getting HIV than men and the test vaccine in Imbokodo trial is designed to protect people from more than one clade of HIV.
Researchers are working tirelessly to avail two kinds of HIV vaccines namely preventive and therapeutic. A preventive HIV vaccine will be administered to an HIV negative person so as to teach their immune system to recognize and effectively fight HIV in case they are ever exposed to it in future. A therapeutic HIV vaccine is designed to improve the body’s immune response to HIV in an HIV positive person. Researchers are also evaluating therapeutic HIV vaccines as part of a larger strategy to eliminate all HIV from the body and cure people of HIV. Neither licensed preventive nor therapeutic vaccines exist yet!
Current prevention tools for HIV such as using condoms consistently and correctly, male circumcision and pre-exposure prophylaxis (PrEP) work well. But researchers believe a preventive HIV vaccine will be the most effective way to completely end new HIV infections!
During this commemoration, Kenya based HIV Vaccine advocates paid tribute to Dr. Julia Amayo:
Dr. Amayo paved way for the success we celebrate today. As an advocate, she believed strongly in the power of community engagement in all processes including HIV research and development. Dr. Amayo was certain that Kenya was on the right path to getting an HIV vaccine. Doing everything within her capacity to make this a possibility, Dr. Amayo was a member of the Community Advisory Board in HIV vaccine research and development. In addition to this, she represented Nairobi region as a member of the HIV Vaccine Support Network (VSN) and also contributed substantially in developing HIV Vaccine Research and Development Guidelines – the final one in Kenya! Apart from this, Dr. Amayo participated in a survey that assessed community and health care workers’ knowledge of HIV vaccine research and development. This is the survey that informed the development of the HIV vaccine toolkit by International AIDS Vaccine Initiative (IAVI).
We will not forget your efforts and struggles for an HIV free generation in Africa.
Achieving Universal Health Coverage (UHC) and indeed the Sustainable Development Goals (SDGs) are goals that many countries in the African Region have adopted. While healthcare is a basic human right, likely to be accessible and affordable in developed nations, healthcare access remains beyond the reach of many individuals including women and children living in developing countries. UHC ensures that everyone, anywhere receives quality curative, promotive, preventive and rehabilitative health services they need without experiencing financial hardship.
A recent modelling exercise conducted by the WHO found that in order to achieve SDG 3 targets, a significant increase in funding would be needed. Using the Chatham house recommendations of government health expenditure per capita of at least $86 as a base, the amount per capita required to make progress towards SDG 3 is estimated at $127 per capita and $144 to reach the target. In Africa, health expenditure has increased significantly over the past two decades with out-of-pocket expenditure and external assistance being the main drivers. Out-of-pocket expenditure continues to push people into poverty. High cost of health is a barrier to access health services and a hindrance to economic development for the poorest members of society. Evidence shows that out-of-pocket expenditure has increased from $15 per capita in 1995 to $38 in 2014 leaving 11 million patients or families of patients in low income countries (LIC) and low-middle income countries (LMIC) to fall into poverty every year due to catastrophic payments.
To remove these barriers, it is recommended that governments commit out-of-pocket expenditure represent at least less than 20% of the total health expenditure and there are none for priority health services or for the poorest families – sadly LICs and LMICs are only halfway towards this target. Reducing catastrophic spending on health and impoverishment due to utilization of health services is one of the goals of UHC!
To assure that ideas are exchanged and information is shared on expanding public financing to end epidemics such as AIDS, TB and Malaria, strengthen health systems and champion ‘the UHC we want’; WACI Health the secretariat of Civil Society platform for Health in Africa (CiSPHA) in collaboration with Global Fund Advocates Network (GFAN) and Eastern Africa National Network of AIDS Service Organization (EANNASO) gathered in Ghana to rebalance these discussions.
While external Aid can help bring us closer to UHC, over reliance on it is extremely risky. In recent years we have witnessed how donor Aid country priorities have shifted at a global level; health is now just one of the many competing issues along with security, climate change, humanitarian crises and refugees. Also in many LICs, as economies grow, governments will increasingly face ‘transition’ which loosely refers to self-financing by national government of health programs previously supported by donor funds. This trend takes place within a context of greater competition for aid funding, and declining interest by some countries in foreign official development assistance (ODA).
Most LICs and LMICs have considerable scope to raise revenue by increasing tax collection efforts including more efficient tax administration and broadening the tax base. This is challenging and timeous but is doable. Reforming tax policies, for instance indirectly through value added tax (VAT) serves as an opportunity government could mobilize resources. Another potential revenue source is tax innovation such as sin tax, telecom tax, additional corporate and social responsible tax – these taxes are often earmarked to specific expenditures like healthcare or education however earmarking can introduce rigidity and counter-productivity. Tackling tax avoidance and evasion and tax incentives for companies especially those trading in natural resources can raise additional revenues in countries. Governments could also greatly benefit from plugging leakages in revenues resulting from corruption and the illicit flow of funds. In Africa alone as much as US$ 50 billion in illicit funds is being illegally diverted per year that is double the amount of overseas development aid that was received in 2014.
Governments, civil society and communities alike must pay attention to the nature of revenue sources being exploited to finance achievements of UHC so that they are equitable and sustainable. Good governance, robust transparency and sound accountability must be incorporated too.