WACI Health Secretariat - WACI Health

Article

August 7, 2018 byWACI Health Secretariat

In resource-rich Africa, more needs to be done to end malnutrition in children

Posted on May 22, 2018
By Joyce Nganga

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.

Uncategorized

August 7, 2018 byWACI Health Secretariat

HIV Vaccine – an accessible, effective HIV Vaccine to sustainably and conclusively end the AIDS Epidemic 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 15^th 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 or Uhambo, 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 or Imbokodo, 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.

Thank you Dr. Julia Amayo

Uncategorized

August 7, 2018 byWACI Health Secretariat

Domestic resource mobilization for sustainable health financing in Africa: Meeting UHC targets

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.

News

May 14, 2018 byWACI Health Secretariat

From Declaration to Action: Improving Immunization in Africa

Source: http://www.ipsnews.net/2018/04/declaration-action-improving-immunization-africa/

By Joyce Nganga

Joyce Nganga is policy advisor with WACI Health, an African regional health advocacy NGO headquartered in Kenya.

Inviolate Akinyi, a 46-year-old grandmother, got her granddaughter immunized using a mix of private and public clinics. Credit: Veronique Magnin – Habari Kibra Volunteer

NAIROBI, Kenya, Apr 25 2018 (IPS) – Inviolate Akinyi, a 46-year-old grandmother, is certain that her grand-daughter needs to get all her vaccines for her to grow up healthy and strong. She uses a mix of private and public clinics in Kibera, one of the largest informal settlement in Nairobi, to get the 15-month-old the shots she needs.

Mary Awour, mother to two-year-old Vilance Amondi, also believes immunization is important to protect her child against infectious diseases. She got all the required vaccines for him at the public Kibera South Hospital.

But many children in Africa are not as fortunate as these two children. Instead, they are faced with health threats like diphtheria, measles, mumps, whooping cough, rubella, tetanus, diarrhea, pneumonia and other childhood disease.

While immunization is a critical intervention for preventing these diseases, millions of children do not have access to them because of state fragility or conflict, lack of parental education, religious practices–and too often—inability to access the vaccines because of cost or geographic location. Children in remote rural or mountainous areas face greater barriers to vaccine access.

As recently as 2000, slightly under 10 million children died globally from vaccine preventable deaths before their fifth birthday. The numbers declined to 6.3 million by 2013 but sub -Saharan Africa accounted for 50 percent of the under-five deaths worldwide.

Mary Awour mother to two-year-old Vilance Amondi said she got all the required vaccines for him at the Kibera South Hospital which is government facility. Credit: Veronique Magnin – Habari Kibra Volunteer

While Africa has made significant gains in immunization in the last 15 years, one in five children still do not have access to life-saving vaccines. Of the more than 19 million children worldwide who did not get the three doses of Diphtheria, pertussis and tetanus (DPT) in 2013, 40 percent or 7.6 million were from sub-Saharan Africa.

According to a UNICEF report, in 2016, more than half of all children unvaccinated for DTP3 lived in just six countries, three of them in Africa: Nigeria, Ethiopia, and Democratic Republic of the Congo.

That same year, African leaders signed the Addis Declaration of Immunization (ADI), pledging to ensure that everyone receives the full benefits of available vaccines to inoculate them against infectious diseases like measles, mumps, rubella, hepatitis B, polio, tetanus, diphtheria, and pertussis.

The Declaration, which was ratified in January 2017, contains ten commitments including: increasing vaccine-related funding, strengthening supply chains and delivery systems, attaining and maintaining high quality surveillance for targeted vaccine preventable diseases, developing an African research sector to enhance immunization implementation, and making universal access to vaccines a cornerstone of health and development effort in Africa.

These steps to scale up immunization rates on the content in line with the rest of the world and achieving the targeted Global Vaccine Action Plan (GVAP) rate of 90 percent national coverage, and 80 percent coverage in every district or administrative by 2020. To date, representatives from 50 African countries have signed, and three statements of support were signed by civil society organizations, religious leaders and parliamentarians to support implementation of the ADI.

At only 80 percent coverage in Africa, routine immunization is the lowest of any region in the world. This is unsatisfactory since immunizations have long been proven as a cost-effective way to improve global health—and in the current age, a critical pathway to attaining the sustainable development goals.

Worldwide, more than three million deaths are prevented annually as a result of vaccinations. In the case of debilitating diseases like polio and meningitis, vaccines prevent permanent disabilities as well. Effective immunization programs are being heralded now for the impending eradication of the polio virus. One of the most lethal childhood infections, only eight cases were recorded in the world last year—in Afghanistan and Pakistan.

For Africa and elsewhere in the developing world, universal access to immunization is central to enabling individuals lead productive lives and for the continent to reach its full potential. Increasingly, we recognize that good health is a major driver of economic growth and must be at the center of all development plans. The cornerstone of this is strong immunization programs and sustainable systems.

As the world and Africa commemorates this year’s immunization week, in the full glare of GAVI transition, a challenge to universal access to immunization for poor and middle-income countries, our call to government is to re-examine their commitments and contributions towards domestic resources to ensure all children access immunization and that the gains made, will be sustained and even surpassed.

Women like Inviolate and Mary demonstrate the commitment of mothers to protect their children. It is up to government to remove the barriers, create the policy environment and make the resources available to fund routine immunization for every child.

News

May 14, 2018 byWACI Health Secretariat

Engaging Southern Africa Development Community (SADC) leadership on HIV and Sexual and Reproductive Health and Rights (SRHR) in East and Southern Africa (ESA) region

Despite progress in development and delivery of efficacious HIV prevention interventions, more than one million HIV incident cases are recorded annually. There is global momentum to fast track HIV prevention when evidence from countries that have reached treatment targets demonstrates that the world will not end AIDS without stemming new HIV infections.

Eastern and Southern Africa (ESA) Region has made good progress in addressing the HIV epidemic. Between 2010 and 2016, the number of new HIV infections declined by 29%; among children was a 56% drop whereas in adults a 24% decrease was noted. Declines in new infections were greatest in Mozambique, Uganda and Zimbabwe but in Ethiopia and Madagascar HIV incident rates increased – South Africa constitutes a third of all new infections in ESA region! In spite of these remarkable decline in new HIV infections, it’s not sufficient to reach targets of ending AIDS by 2030.

In 2016, the UN political declaration on ending AIDS by 2030 was preceded by establishment of a Global Coalition on HIV prevention with set targets and commitments. Achieving these targets, one may argue that it largely depends on a holistic approach in prevention which appreciates the structural barriers to access services. In recognition of this challenge, under the leadership of AIDS Rights Alliance for Southern Africa (ARASA) and UNAIDS, WACI Health among other civil society convened in Johannesburg ahead of the Southern Africa Development Committee (SADC) ministers of health meeting. It is from this consultation that civil society mobilized to discuss strategies on a national and regional level that have worked to address structural barriers to HIV prevention and where scale up is needed; explore available evidence; determine gaps in data and programming to inform future work and agreed on key advocacy steps that are needed to increase attention to prevention.

A panel discussion with key populations represented by Amsher, SWEAT, Tanzania IDUs and Gender DynamiX on HIV prevention

Photo credit: Jaque, UNAIDS

WACI Health participated in this meeting in her capacity as the secretariat to AfNHi. AfNHi is an African led network of HIV prevention research advocates based in Africa borne out of a joint vision by African Advocates seeking to fast track the biomedical HIV Prevention research agenda on the continent through local ownership.

Outcomes from this events included civil society reviewed progress of HIV prevention efforts in the region and implementation of the 100-day plans developed by SADC Member States following the launch of the Global HIV Prevention Coalition Roadmap in October 2017. There is need for continued political will and leadership at the national level to ensure that HIV prevention efforts gain momentum, are person-centred and no one is left behind – this among others is explicitly laid out in the Southern Africa Civil Society Statement developed.

Article News

May 14, 2018 byWACI Health Secretariat

Enhancing Social Accountability in Kenya’s health sector: A UHC perspective

In recent years, the term “Universal Health Coverage” (UHC) has become increasingly visible and prominent on global and national agendas of numerous countries. What is UHC and why is this concept so attractive for countries and development partners?

Apart from having a well-designed health system, UHC equally depends on a health financing system which assures adequate financial resources for health and their equitable use. It exists when all people receive quality health services they need without suffering financial hardship. According to the World Health Organization (WHO), there are about 1 billion people around the globe without any access to health care. While access to quality health care is a constitutional right, millions of Kenyans still struggle to afford payment of health services at either public or private clinics even citizens with public health insurance. Such barriers to accessing health services does not only impact the health status of people but contributes to societal inequities and undermine sustainability of social and economic gains. Nearly 1 million Kenyans fall below the poverty line because of health care related expenditures every year and expanding health care access will reduce this burden – about 20% of Kenyans have access to some sort of medical coverage.

Moving toward UHC is a political process that involve negotiations between different interest groups such as government, private sector and community. Civil society organizations (CSOs) frequently hold critical roles in representing communities, the disease-laden and key populations/vulnerable pushing for a more equitable distribution of health resources and services.

Stimulating dialogue on Enhancing Social Accountability among health stakeholders in Kenya
Photo credit: AMREF Health Africa

March 14^th and 15^th, under the leadership of Health Rights Forum (HERAF), WACI Health and many CSOs herald the first ever conference on Enhancing Social Accountability in Kenya’s health sector. It provided a platform for key stakeholders to share experiences, challenges, lessons learnt including progress towards UHC. Social accountability is a key element in the Kenya Community Health Strategy and it accentuates the need for strengthening communities in realizing their rights for accessible and quality health care. In order to improve quality, access and demand for health services; public participation is crucial in that it offers citizens the opportunity to engage with government in decision-making processes, community feedback, health sector investments planning and budgeting. This also ensures that government adopts a people-centred approach in their programs and social accountability mechanisms in planning and delivery of healthcare services as highlighted in the Kenya Health Policy 2014 – 2030.

With the devolved system of health, Kenya has seen an increase in use of social accountability tools including community or county score cards, public hearings and civic education to mobilize and empower citizens to participate effectively and ensure accountability is integral in management of both national and county government resources – much still needs to be done.

News Run4TB

April 5, 2018 byWACI Health Secretariat

Red Alert On TB Infection Control In Clinics

– Results of TAC survey of 207 public clinics shows TB infection control still falling short. – Government must urgently conduct an infection control audit of all public facilities

JOHANNESBURG, 19^th MARCH 2018 – In the run up to World Tuberculosis (TB) Day on 24 March 2018, the Treatment Action Campaign (TAC) assessed the state of TB infection control in a number of clinics across South Africa. Of 207 facilities assessed, 145 were found to be in a “RED” state with very poor infection control measures in place.

In March 2017, TAC produced our first annual TB audit. Last year, 72% of the facilities (115 out of 158) were ranked “RED” compared to 71% (145 out of 207) this year. 9% of facilities (15 out of 158) scored “GREEN” last year, compared to a dismal 1% this year (2 out of 207).

TB remains the leading reported cause of death in South Africa with over 33 063 deaths (8.4% of natural deaths) in the country in 2015[1]. Based on the latest data in 2016, the rate of new cases of active TB in South Africa remains extremely high at around 438 000[2]. While total TB rates do appear to be slowly declining (down from 250 000 in 2015), multi-drug resistant TB (MDR-TB) and extreme drug resistant TB (XDR-TB) rates are increasing. The World Health Organization (WHO) estimated 19 000 cases in South Africa in 2016 up from 7 350 in 2007[3]. TB can be spread through the air when people with active TB disease cough or sneeze. However, various infection control measures can be taken to reduce the risk of TB transmission.

“Our clinics should be places we feel safe, where we know we can get decent healthcare services. They certainly should not be places we can get TB. The reality is that many clinics aren’t even doing the basics to prevent us getting TB as we wait to see a nurse. They are overcrowded. People are not screened for TB. Often staff don’t even offer a tissue to someone coughing,” says Sibongile Tshabalala, TAC National Chairperson.

TAC branches in Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, and Western Cape engaged in the audit during TB month, March 2018. The following questions were answered by TAC members from local branches linked to each facility assessed:

Is there enough room in the waiting area?
Are you seen within 30 minutes of arriving at the facility?
Are the windows open?
Are there posters telling you to cover your mouth when coughing or sneezing?
Are people in the facility waiting area asked if they have TB symptoms?
Are people who are coughing separated from those who are not?
Are people who cough a lot or who may have TB given tissues or TB masks?

Based on the answers facilities were ranked RED (3+ questions answered “no”), ORANGE (1-2 questions answered “no”), or GREEN (0 questions answered “no”).

145 facilities were ranked “RED”, 56 facilities were ranked “ORANGE”, and only 2 facilities were ranked “GREEN”. 4 facilities were unable to be ranked due to incomplete data.

Facilities performed especially poorly in the length of waiting times, where over 90% of facilities (190 out of 207) failed to see people within 30 minutes of arriving, pointing to widespread human resource shortages across the clinics surveyed.
57% of facilities (119 out of 207) did not screen people for TB symptoms who were waiting to be seen and 56% of facilities (115 out of 207) did not offer tissues or TB masks to those coughing. It is unknown if this is due to a lack of resources, time, or will.
38% of facilities were found to be too small, and just under 70% of facilities did not (or could not) separate people who were coughing a lot from those who were not, pointing in part to infrastructural challenges that need to be addressed.

TAC commends the 2 clinics that were ranked GREEN – Goso Forest Clinic (EC) and Rhodes Clinic (EC). Our local branches linked to the 2 clinics will award them with certificates and urge them to continue ensuring effective TB infection control. However, if we wish to make progress against TB GREEN ratings should be the norm in the public healthcare system, not the exception.

An Excel sheet with the survey results (including provincial breakdown) can be accessed .

The problems highlighted in TB infection control through the audit are indicative of the wider crisis within the health system, where overstretched nurses at understaffed clinics lack the capacity and resources to engage effectively in infection control measures.

“While we stress that this is by no means a scientific survey and the results are not generalisable to the rest of the public healthcare system, it does suggest that infection control is a significant problem in many public sector health facilities. As a result, we demand that government carries out a full audit of all public buildings in South Africa, including schools, clinics, hospitals, correctional facilities and home affairs facilities, to assess whether sufficient TB infection control measures are in place,” says Tshabalala.

“If the government is serious about tackling TB, then infection control must be made a priority this year. We do not want to be raising the same issues this time next year – our 2019 audit must see a total turnaround of this situation.”

TAC branch, provincial and national leaders will be meeting with facility management, provincial and national health departments in the coming weeks to discuss the poor outcomes of our TB infection control survey.

All commitments and responses from these meetings will be published.

For more information and to arrange interviews contact:

Lotti Rutter | lotti.rutter@tac.org.za | 072 225 9675

Notes:

The full 2018 survey results can be found here:

For a breakdown of TB infection control results per province please see the following overviews:

Eastern Cape overview: https://tac.org.za/files/tb-infection-control-eastern-cape-march-2018.pdf

Free State overview: https://tac.org.za/files/tb-infection-control-free-state-march-2018.pdf

Gauteng overview: https://tac.org.za/files/tb-infection-control-gauteng-march-2018.pdf

KwaZulu-Natal overview: https://tac.org.za/files/tb-infection-control-kzn-march-2018.pdf

Limpopo overview: https://tac.org.za/files/tb-infection-control-limpopo-march-2018.pdf

Mpumalanga overview: https://tac.org.za/files/tb-infection-control-mpumalanga-march-2018.pdf

Western Cape overview: https://tac.org.za/files/tb-infection-control-western-cape-march-2018.pdf

The 2017 infection control audit can be found here: https://tac.org.za/news/tb-infection-control-falls-short-many-clinics-tac-survey/

NOTE: Not all facilities surveyed in 2017 were repeated in the 2018 audit, and several additional facilities were included this year.

NOTE: Even though TB is the number one reported cause of death in South Africa according to official death notifications, many deaths attributed to TB and other causes are in people with HIV and HIV is thus underrepresented in death notifications. The Thembisa model of HIV in South Africa estimates that there are roughly 150 000 HIV-related deaths per year. A recent Medical Research Council report estimates around 150 000 HIV-related deaths in 2012. These estimates indicate that HIV is still the number one cause of death in South Africa.

A summary of results is available here: https://tac.org.za/files/results-summary-tb-infection-control.pdf

Province	Is there enough room in the waiting area for everyone?	Are you seen within 30 minutes	Are the windows in the facility open?	Are there posters telling you to cover your mouth when coughing or sneezing?	Are people in the facility waiting area asked if they have TB symptoms?	Are people who are coughing separated from those who are not?	Are people who are coughing a lot or may have TB given TB masks or tissues?	RANK
Eastern Cape	17	20	1	5	15	15	18	Green – 2
								Orange – 6
								Red – 20
Free State	16	33	1	5	23	32	28	Green – 0
								Orange – 3
								Red – 31
Gauteng	10	24	4	6	11	17	17	Green – 0
								Orange – 5
								Red – 17
								Unknown – 2
KwaZulu-Natal	11	23	1	1	8	14	9	Green – 0
								Orange – 15
								Red – 11
								Unknown – 2
Limpopo	3	29	1	8	17	21	15	Green – 0
								Orange – 11
								Red – 20
Mpumalanga	15	35	1	9	26	20	27	Green – 0
								Orange – 8
								Red – 27
Western Cape	7	26	0	5	19	25	1	Green – 0
								Orange – 8
								Red – 19
National	79	190	9	39	119	144	115	Green – 2
								Orange – 56
								Red – 145
								Unknown – 4

[1] National Strategic Plan on HIV, TB and STIs 2017 – 2022. SANAC. Available at: http://sanac.org.za/wp-content/uploads/2017/05/NSP_FullDocument_FINAL.pdf

News

April 5, 2018 byWACI Health Secretariat

Conference on Retroviruses and Opportunistic Infections (CROI) Conference

Advances in both clinical research and prevention science have led to a significant reduction in HIV transmission globally. UNAIDS ambitious goal of achieving “90-90-90” targets by 2020 calls for 90% of people living with HIV to know their status, 90% of those diagnosed to receive sustained ART and 90% of those on ART to have viral suppression. One or two strategies will not be effective in reducing the HIV/AIDS pandemic to the realization of the AIDS Response in the 2030 Agenda for Sustainable Development.

Women continue to be infected with HIV at alarmingly high rates especially in sub-Saharan Africa where women constitute nearly 60% of adults living with HIV/AIDS. A range of effective, affordable and widely available prevention products are needed because no single approach will meet all women’s needs or get the epidemic under control considering that prevention should always include a combination of biomedical, behavioral and structural strategies.

WACI Health and other network partners at the Conference on Retroviruses and Opportunistic Infections Photo credit: WACI Health

The annual Conference on Retroviruses and Opportunistic Infections (CROI 2018) held between the 4^thto the 7^th of March 2018 at Hynes Convention Center in Boston, Massachusetts brought together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments and best research methods against HIV/AIDS and related infectious diseases. The preliminary findings of HIV Open Label Extension (HOPE) and DREAM studies of the dapivirine vaginal ring were released showing 90% of women who used the ring at least some of the time had an estimated 50% reduction in the HIV acquisition.

The ring is designed to provide women with a discreet and long-acting HIV prevention option. The interim analyses of DREAM announced at CROI 2018 showed an increase in ring use over its parent Phase III study – more than 90% of women participants used the ring at least some of the time. Analyses also suggest that the overall HIV incidence rate among women in DREAM is 54% lower than would be expected without use of the dapivirine ring based on statistical modeling. This finding has important limitations due to the lack of a placebo comparison group in the open-label study (meaning that all participants know they are using the active product). Interim data from a parallel open-label study of the ring called HOPE, led by the US National Institutes of Health-funded Microbicide Trials Network (MTN), reported nearly identical results at CROI. “DREAM suggests so far that when women know that the dapivirine ring has helped lower HIV risk in clinical trials, they are more likely to use it and see higher levels of protection,” said Dr. Zeda Rosenberg, founding chief executive officer of IPM. “We are encouraged by these interim findings because more than 35 years into the epidemic, women still lack the range of practical options they need to protect themselves against HIV.”

We have made tremendous progress in the AIDS epidemic. However, this progress is not assured because of several factors among them declining funding. Governments and donors must continue to prioritize the allocation of funding for HIV programming, life-saving treatment, prevention, research and development for new health technologies which will inform an essential part of the solution to HIV.

New vaccines, microbicides, drugs, diagnostics, and other health technologies are needed in the face of many emerging threats for communities to have multiple tools that protect them especially those who are at highest risk of becoming infected with HIV for instance adolescent girls and young women. Multipurpose prevention technologies (MPTs) most of which are still experimental designed to address two or more sexual and reproductive health concerns simultaneously for example, combining protection against unintended pregnancy and sexually transmitted infections to be made available.

Ending HIV by 2030 requires collaboration across sectors, supportive policies that do not lock people out of care and support, health systems strengthening above all communities taking center stage and the commitment to not leave anyone behind – including adolescent girls and young women.

News

April 5, 2018 byWACI Health Secretariat

United Nations Commission on the Status of Women 62 session in New York

Rural women make up more than a quarter of the world’s population. In Africa, about 80% of the women population live in rural areas – agriculture is their major source of income. This reality was affirmed during the 62^nd session of the United Nation Commission conference in New York which sought to examine the challenges and opportunities in achieving gender equality and the empowerment of rural women and girls. In her opening statement Dr Phumzile Mlambo-Ngcuka (Executive Director of UN Women) urged all participants to see this forum as a perfect opportunity for building alliances, focusing on acceleration and implementation of regional as well as global declarations to achieve gender equality and women empowerment.

UN Women Executive Director Phumzile Mlambo-Ngcuka addressing a session hosted by Ilitha Labantu on challenges of rural women empowerment

Photo credit: Sibulele Sibhaca

Women and girls in rural areas still encounter difficulties including gender violence, high maternal mortality rates, child marriage, HIV/AIDS, FGM, conflict and natural disasters. Most are directly linked to gender inequality and structural barriers which causes power imbalances. These barriers are worsened when women are excluded from governance mechanism, leadership and decision-making or representation in local and national institutions which diminishes their voice. All these must be urgently addressed for Africa to realize its development aspirations in attaining the Sustainable Development Goals and Agenda 2063.

WACI Health together with other civil society in South Africa are making frantic efforts in advocating for political will in governments developing policies and programs to protect women such as the National Strategic Plan on Gender-based Violence (NSP GBV), bring gender justice, improve their health outcomes and end gender violence

Minister of Women Bathabile Dlamini expressing that women should lead the struggle and shaping response in gender-based violence

Photo credit: Sibulele Sibhaca

Participants at CSW62 called on all stakeholders to address the limited access to quality social services, infrastructure, energy and labor saving technology, and tackle other inequalities.

To build in a bright future – invest in adolescent girls and young women!

There has never been a more critical time to invest in young people than now! With regards to health and development, young people have been overlooked and left behind many times. There are about 1.8 billion young people globally and nearly half of these are adolescent girls and young women.

Adolescent girls particularly those entering adulthood encounter numerous challenges including discrimination, gender violence, poor education and health outcomes, reduced opportunities and choices – their voices are often unheard. As for serious health risks, young women (15 to 24 years) are facing a triple threat. The highest risk of HIV infection is found within this group. In sub-Saharan Africa, young women account for 74% of new HIV infections. In addition to this, young women and girls have the lowest rates of HIV screening or testing and poor adherence to HIV treatment.

Investing in young girls and women indeed is a game changer. For example, this International Women’s Day celebrations WACI Health joined hands with other Kenyan civil society in calling for all stakeholders across multiple sectors to champion health of adolescent girls and young women by recognizing their issues as important, improving national programs and policies (tailoring Sustainable Development Goals and Global Strategy on Women’s, Children’s and Adolescents’ Health effectively) as well as increasing funding to ensure that young people survive, thrive and transform the world.

When educated, healthy, equipped with the right skills and opportunities; adolescent girls and young people hold the keys to unlocking many of the world’s pressing problems in poverty reduction, advancing gender equality, catalyzing national social and economic development, stopping HIV, maternal mortality and gender violence among many others – investing in the survival and success of the next generation.

As leaders of today and tomorrow, adolescent girls and young women can be a force for social change!

Article

March 16, 2018 byWACI Health Secretariat

Peter Sands calls on countries to reform taxes to free up funding for health

DAVOS, Switzerland — While new financial instruments can help address critical gaps in health care funding, the global health community also needs to be more focused on taxes and helping countries mobilize domestic resources for basic health care services, Peter Sands, the incoming executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, told Devex.

“I think people in the world of global health need to be thinking about and talking about taxes rather more than we do, because if you have a country that is only mobilizing — in terms of fiscal mobilization, i.e. tax revenues — a single digit percentage of GDP, it’s extremely unlikely they will be able to sustainably finance a health system delivering even the basics to all its population,” he told Devex in a recent interview.

Countries need to plan for self reliance, rather than on international development assistance as a way to fund their health systems, and to get there, need to work on tax raising and tax deployment strategies, Sands said. Once the basics are covered, other finance — be it private finance or insurance — can be brought in to support other aspects of health systems, he added.

In order to do that countries and organizations such as the Global Fund, need to get better at communicating the economic or investment case for funding disease prevention and eradication. And there is a strong case to be made, Sands said. High prevalence endemic diseases take people out of the workforce — not only those who are sick, but also those caring for the people who are sick. Epidemics are particularly disruptive because they change economic activity as people are scared and change their behavior, children don’t go to school, etc.

“There are very strong, hard-nosed economic reasons for taking action, but we are not making that argument as well as we could,” he said. “We tend to make it in sort of standalone analyses, in reports and things that don’t get integrated into the bits of paper sitting on a finance minister’s desk when they’re making budget allocation decisions.”

The Global Fund can help play a catalytic role in helping bridge the gap between research and implementation. While it doesn’t have to do the research itself, as it would be best if it were done by economists or government officials in the countries where it is needed, the Global Fund can help develop the methodologies and data-gathering approaches that inform how the analysis is done, he said.

“Ultimately, we have to be able to build a compelling investment case for the Global Fund itself, but governments in individual countries have to build an investment case to deploy domestic resources to the same objectives,” Sands said.

Too often, the global health and development community preaches to the converted, he said, but to change perceptions there must be an effort to convince the skeptical, be it the civil servant in charge of budget prioritization in a finance ministry, or a capital markets analyst at an investment bank, he said.

“The way we need to do that requires a degree of rigor around what is it about health issues that impedes development,” Sand said. “We need to be able to tell that story in a very rigorous and robust fashion because in a sense the people who need to be convinced are not the people who we’re normally talking to about this.”

No silver bullets

Sands will take up his post bringing with him a long career in finance, which gives him a unique perspective on some of the new financing mechanism, but doesn’t mean he has “the secret key to some treasure trove,” he said.

Innovative financing mechanisms — from impact bonds, to blended finance, matching funds and results-based funding — can all play “a significant and important role in what we’re doing both in terms of improving the effectiveness with which we deploy existing funds and in attracting new monies,” Sands said.

While there is promise in some of these mechanisms, they must be deployed in the appropriate situations, he said.

“Sometimes these things look like tools looking for a problem and I think we need to be very rigorous in identifying the underlying economics of the problem we are trying to solve and then picking the financing instrument that is best suited to that particular problem,” Sands said. “Sometimes, when I look at this in the development world, we seem to have force fit innovative finance mechanisms to problems where the economics dont really align with that mechanism.”

By Adva Saldinger // 06 February 2018 https://www.devex.com