CategoriesAfNHI Blog

COVID 19 AND LACK OF FUNDING NEGATING GAINS HIV PROGRESS

Stakeholders have warned that COVID 19 disruptions are likely to set back efforts made in curbing HIV infections back to ten years or more. According to UNAIDS’ new report released in July 2020, while securing antiretroviral therapy has been steadily improving, the progress is inequitable. In its report, Seizing the moment, the World Bank warns that if we don’t act, even the gains made will be lost. To reach the Millions still left behind, nations must double down and work with more urgency.

Unequal progress

Prevention of new HIV infections in Africa is far behind the rest of the world. Nearly two million people were newly infected with the virus, more than three times the global target. Seizing the moment report shows unequal progress, leaving behind vulnerable people and populations. For example, infected key populations such as gay men and their partners, men who have sex with men, sex workers, drug users and people in prison, accounted for 62 per cent of these new HIV infections. Women and girls from marginalised communities face barriers to accessing reproductive health services, especially contraception and HIV services. Those living with HIV/AIDS face stigma. A total of 59 per cent of all new HIV infections in Sub-Saharan Africa in 2019 were among women and girls, with 4500 girls and young women between 15 and 24 years old becoming infected every week. Thus, a growing number of young women are getting HIV infection, despite only making up 10 per cent of the population in sub-Saharan Africa.

Exclusion, stigma and discrimination

Social inequity and exclusion, stigma and discrimination have proven to be significant obstacles in curbing the new HIV infections. At least 82 countries criminalise HIV transmission, exposure, or non-disclosure, 103 criminalise sex work, and 108 criminalise the use, possession, or consumption of HIV related drugs.

Progress in targets

There is, however, a significant reduction in HIV transmission levels where comprehensive HIV services are provided. In addition, combining proactive medical practices with social and economic support for young women in Eswatini, Lesotho, and South Africa has narrowed inequality gaps and driven down the incidence of new HIV infections. Fourteen countries have achieved the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally suppressed), including Eswatini, which has one of the highest HIV prevalence rates in the world, at 27% in 2019, and which has now surpassed the targets to achieve 95–95–95. The expansion of antiretroviral therapy has saved countless lives.

However, in 2019, 690 000 people died of AIDS-related illnesses in 2019, and 12.6 million of the 38 million people living with HIV did not receive life-saving treatment. Although progress has been made, it is masking the lack of progress and challenges that continue to persist, threatening the progress made during the past decade, with tragic consequences for people’s lives, economies, and health security. Again, Sub-Saharan Africa is most affected.

A case for biomedical research

Reducing new HIV infections need to be a deliberate act in Africa. It is imperative that the locally tailored, evidence- based, and community-owned programs be tailored to sustainably reduce new HIV infections.

In the just-concluded 5th  Biomedical HIV Prevention Forum (BHPF) hosted virtually in South Africa which focused on Financing of HIV Prevention Research in Africa, findings revealed that most countries did not have funding for biomedical research, and where research happened, it was mostly donor-driven.

To achieve Africa free of New HIV infections (AfNHi)’s vision of ending new HIV infections in Africa, the BHPF aims at mobilising scientific knowledge and building bridges between science and policy. In addition to mapping potential for collaborative national and regional activities within the AfNHi network, the forum looks to strengthen connections between policy and research through information exchange with HIV prevention advocates.

Reporting on the state of funding biomedical research in Africa, Dr Caleb Mulongo, in his research findings based on four countries; Kenya, Rwanda, Eswatini and Malawi noted that none of the four countries met the recommended allocation of two per cent of a country’s domestic budget to biomedical research.

While the Abuja Declaration targets that 15 per cent of the national budget be allocated to the health docket, none of the four studied countries (Kenya, Rwanda Eswatini and Malawi) met the target. The highest was Malawi with 11.5 per cent, with Kenya reporting the lowest allocation at less than seven per cent. Rwanda allocated about eight per cent while Eswatini allocated about nine per cent of their national budget to health.

When it comes to research allocation, Malawi set aside 1.06 per cent, which was the highest allocation from the studied countries. Eswatini had the least allocation, at 0.3 per cent.  Kenya allocated 0.79 per cent while Rwanda 0.27 per cent. It is evident low allocation in the health sector which is not adequate to support quality and universal coverage of health means there is very little if any funding to allocate to biomedical research.

More than underfunding

The mini-BHPF conferences held in Rwanda, Zimbabwe and Cote d’Ivoire, presented during the main BHPF forum had similar findings, that their respective countries had not prioritized biomedical research for preventing new HIV infections. More challenges beyond funding were nevertheless noted. There was a lack of expertise in writing proposals, those in charge do not know how to bind for funds to support their activities and where research was conducted, it was noted that because it was donor-driven, it did not particularly prioritise local issues, but rather ran with the donors’ agenda.

Own the process

A challenge has been thrown to African governments to invest more in biomedical research for HIV prevention funding, as well as invest in making sure systems are in place for translating findings into actions. A case of Malawi was noted, whose National Research Council of Malawi (NRCM) is domiciled in the Office of the President. This positioning is thought to be responsible for the higher allocations in the Health docket, hence elevating research as a national priority.

Other stakeholders including advocates for change, Civil Society and communities, Researchers and Front-line providers were called upon to keep the momentum for biomedical research HIV prevention funding, by pushing for better allocations of funds, elevating the discussion to the national level where policymakers sit and as well as information sharing across the countries.

 

 

 

 

CategoriesGFF We Want

A GFF that supports CSOs and enhances their capacity to engage with governments adequately

Civil society organizations have continued to support the GFF through advocacy in the GFF implementing countries eg CSOs in Senegal, for example, reported that their participation in all stages of the investment case development contributed to the national decision to go beyond traditional health issues and include nutrition, national statistics (such as birth registration), and
gender equality as investment case priorities. Scorecards were produced by CSOs in implementing countries to improve financial accountability and transparency. These scorecards assess the progress of initiatives established to support RMNCAH-N programs in their respective nations to enhance joint accountability.

CSOs are mobilizing support for investments to support RMNCAH-N projects. Civil society organizations are pushing donor markets to invest in the GFF resource mobilization. CSOs in recipient countries are working to persuade governments to invest domestic resources and also do solidarity pledges during the GFF resource mobilization efforts. CSOs have been essential in
supporting and urging governments to identify and solve critical health issues. CSOs have played an important role in country decision-making processes, as well as in monitoring community concerns and needs in order to protect and promote crucial services, as well as accelerate progress on health outcomes for women, children, and adolescents.

The use of scorecards and the “CSO how to Guide” developed by advocates has made it easier to understand the GFF framework at national level and the scorecards to track government expenditure, resulting in greater support and allocations to RMNCAH-N services in implementing countries. In Ethiopia – CSOs participated in a GFF workshop in Nigeria, where they were learnt on how to evaluate their investment case and identify the quantities of funding available from the World Bank and IDA. Sierra Leone- CSOs used the GFF How to guides to engage with World Bank and government authorities to promote information sharing, resulting in greater openness in the use of funds. CSOs in Liberia CSOs were able to track success at the facility level, assisting in identifying progress of RMNCAH-N programs in their country and unlocking more monies from donors. CSOs were allowed to request access to information on how the GFF monies were being used by the Ministry of Finance by using the scorecards and
how to Guides.

In the course of implementing the advocacy initiatives CSOs face many challenges such as i. inadequate collaboration amongst CSOs though a lot of efforts have gone into this ii. Countries do not have coordinated health plans showing linkages between the various country efforts that they are aiming to be met iii. The lack of country focus was also noted in meeting vaccination
needs of children and maternal health. Some countries (e.g., Angola) were noted to have budgets for COVID-19 but not funds for other diseases that adversely affect their populations e.g., Polio, Malaria. iii. CSOs also lack the capacity around budget advocacy and analysis iv. There is little transparency around Government’s funding and how disbursements and expenditure is done.

CategoriesGFAN Africa

Young People Take on the Global Week of Action

During the Global Action week, WACI Health convened a young people round table dubbed youth extravaganza that brought together differPicture1ent youth organizations ,adolescent girls ,and young women in Kenya  to learn more on how they could contribute to the success  of the Global fund objectives of fighting HIV/AIDS, TB and Malaria. The meeting was an opportunity for the participants to interact with representatives from  from the Global Fund Secretariat ,and the Global Fund Advocates Network in Africa and to join in a fun filled activity of folding paper origamis that would later be sent to the embassies in solidarity ,and messaging of the 7th replenishment campaign.

From the meeting, the young people learnt that the Global Fund is involving young people through the youth council ,and through utilizing social media platforms to amplify the voices of young people to be involved in the #FightForWhatCounts campaign.

For the seventh replenishment the Global Fund needs a minimum of US$18 billion to get the world back on track toward ending HIV, TB ,and Malaria to build resilient ,sustainable systems for health ,and strengthen pandemic preparedness. The Global Fund investment case lays out important milestones ,and highlights the need to invest more funds into the Global Fund  as the main strategy to fight for what counts and protect everyone, everywhere from the deadliest infectious diseases and build a healthier, more equitable world.

Investing in health and community systems and specifically in pandemic preparedness is above all about making smart and sustainable investments in people. Putting people and communities at the center helps build the trust that is the vital foundation for any pandemic response. By combining increased investment in HIV, TB ,and Malaria interventions and strengthening systems for health with additional investments in pandemic preparedness through the Global Fund, we should maximize the impact of every dollar. Through this, we stand a chance of having a return on investment, i.e., for every dollar given 31 dollars will be given back in return once healthcare systems are fully inclusive ,and operational.

Often the role of the youth is ceremonial or relegated to social media ,and communication while they have the capacity to engage in the decision making processes. The Global Fund Youth Council is working with young people to bring out the unique perspective ,and collate inputs on how services can be improved for young people including young key populations. Young people will work with the Global Fund on innovative, person centered approaches to reach young people in all their diversity affected by the three diseases.

Pictdure1

Now is the time to fight for what counts, to get back on track to ending the pandemics so the beat loudly ,and proudly continues for healthy communities and a more equitable world free from fear of deadly infections.

To join the network of young people engaged in the Global Fund replenishment fill in your details in the link here 

CategoriesGFF We Want

Financing mechanism for the GFF: A GFF that responds to the country’s needs

The GFF financing mechanism focus on smart financing, bringing programs to scale by leveraging much larger sums of domestic government resources, International Development Assistance (IDA) and International Bank for Reconstruction and Development (IBRD) financing, aligned external financing, and private sector resources. The GFF employs a variety of tactics and processes to achieve its objectives. Among them are:

 

  1. investment cases, which are nationwide, evidence-based plans that prioritize high-impact interventions to achieve results and identify bottlenecks to achievement;
  2. financing mobilization for investment cases;
  3. complementary financing of the investment case;
  4. increased government investment forRMNCAH-N;
  5. innovative engagement of global and local private sector resources; and (vi)
    health financing strategies focused on sustainability.

As of June 2020, the GFF had directly spent roughly USD 602 million in grants linked to approximately USD 4.7 billion in World Bank IDA/IBRD funding and assisted in aligning significantly greater quantities of domestic and foreign financing in support of GFF partner country investment proposals.

The GFF has been instrumental in supporting Ministries of Health (MoH) to mobilize additional funding for RMNCAH-N. For example, Kenya’s RMNCAH+N investment case recognized that sustained and additional domestic financing would be critical to the successful implementation of RMNCAH-N activities in the country. MoH Kenya developed a roadmap for Universal Health
Coverage (UHC) and a health financing strategy geared toward additional domestic resources and aligning support from development partners to achieve UHC in order to ensure sustainable financing for RMNCAH-N and address health financing fragmentation.

During the previous GFF replenishment in Oslo in 2018, USD one billion in pledges were generated and linked to an extra USD 7.5 billion in World Bank IDA/IBRD resources for the health and nutrition of women, children, and adolescents. The Bill & Melinda Gates Foundation, Burkina Faso, Canada, Côte d’Ivoire, the European Commission, Denmark, Germany, Japan, Laerdal Global Health, the Netherlands, Norway, Qatar, and the United Kingdom were among those who contributed to the fund. Norway was the greatest contributor to the fund, accounting for 35.8 percent of the money raised. The $1 billion in contributions was critical in achieving the GFF’s goal of expanding its presence to 50 countries with the greatest needs in order to alter how health and nutrition are funded. Following the replenishment, the GFF announced nine new nations have joined in May 2019, bringing the overall number of GFF-supported countries to 36.

CategoriesGFAN Africa

COMMUNITIES AND CIVIL SOCIETIES CONVENE IN SUPPORT OF THE GLOBAL FUND 7th REPLENISHMENT

Over 20 years of the existence of the Global Fund partnership, the world’s largest multilateral investor in grants for systems for health, communities and civil society has made extraordinary progress in the fight against HIV, TB, and Malaria. The Global Fund Advocates network in Africa hosted pre-preparatory meetings of the Global Fund’s Seventh Replenishment 2024-2026 on the 21st and 22nd of February 2022 in Nairobi, Kenya.

a

Communities and civil society partners from Africa and the world convened to reflect on the status of HIV, TB, Malaria, and health systems in the region, see how the 20 years of Global Fund being in existence have impacted lives, and look at prospects for health financing in Africa. Other agendas of the meeting included discussing Global Fund’s seventh replenishment preparatory meeting and key messaging, as well as discussing strategies and key actions to take forward, leading up to the replenishment.

 

According to the Results 2021 report, as of 2020 over 44 million lives have been saved, with 219 million people on antiretroviral therapy for HIV, 4.7 million people received TB treatment and 188 million mosquito nets were distributed in 2020. In the report, there was a clear decrease in case finding and preventive services across all 3 epidemics responses due to COVID-19. COVID-19 is threatening the progress made so far on the journey of epidemic control. It has had such a huge impact on the three diseases, and as a result disrupted crucial health services, such as testing, and access to treatment services, and commodities. This has placed the countries at risk of increasing their incidence rate. Trends indicate that services are progressively resuming but we must significantly increase our effort to regain progress lost in 2020 and get back on track to ending the three pandemics by 2030.

bDespite the interruptions caused by COVID-19, both civil society and communities concurred that now more than ever, Governments need to increase their allocations for health and consequently their pledges and contributions to the Global Fund. The 6th Global Fund replenishment had presented an unprecedented and bold ask of USD $14 Billion as the world’s health security needs more funds to prevent future interruptions by pandemics.

Prospects for sustainable health financing in Africa rely heavily on Increased domestic resources for health by governments to enhance resilient health systems and invest in health research development and innovation while working with government, the civil society and communities. Countries were strongly encouraged to strengthen attention to sustainability in their national planning and program design with support from the Global Fund and partners as necessary.

Some of the major discussion points in the meeting were: How Global Fund can better work with communities and civil society organizations, how different stakeholders such as policy makers and young people can participate and be engaged in 7th replenishment advocacy to ensure a successful replenishment. These key messages, strategies and tactics developed would be used in the lead up to the replenishment conference.c

The discussions also highlighted the need for countries to honor pledges. Amongst the issues concluded were, strategies on how to encourage countries that pledge, and honor their pledges to continue donating, and advocate for countries that pledge, and have a history of not honoring their pledges to do so.

In the Lead up to the Global Fund 7th Replenishment, communities and civil society proudly and loudly stand boldly with the Global Fund in asking for USD $18 Billion to fast track the fight to end HIV, TB and Malaria in the context of COVID-19 and future pandemics.

 

Written by Elizabeth Wangui & WACI Health

ENDS

CategoriesGFF We Want

The GFF We Want & Love

The GFF We Want & Love

Tackling the greatest health and nutrition issues affecting women, children, and adolescents

      Helping to mobilize local resources to ensure sustainability and local ownership

            Empowering communities to strengthen their health systems by funneling resources to countries

 

Going the extra mile to resource CSOs & youth to drive critical action around healthcare and equality

Fighting to contain the impacts of the Covid 19 pandemic and to reclaim the gains

Focusing on driving country-specific priorities to strengthen health systems

 

Working to increase countries’ ability to thrive in the global economy

Ensuring that women and girls are empowered as leaders whose voices are considered

 

Working with CSOs to facilitate local monitoring and accountability for mobilized funds

Advocating for domestic and international resource mobilization for RMNCAH+N

Not leaving anyone behind

                     That is the GFF We Want and Love!

Copyright © 2023 WACI HEALTH. All Rights Reserved. Designed By Pinch Africa.