On 1 April, GFAN Africa facilitated a regional day of action to extend sincere gratitude  to the United States, the Biden-Harris Administration, and the U.S. Congress led by House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer for the $3.5 billion emergency funding commitment they secured for the efforts of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to fight the COVID-19 pandemic in low- and middle-income countries.

These resources will support low and middle-income countries to rapidly expand their testing capacity and ensure health care workers are adequately protected with personal protective equipment (PPE). The investment will support countries to contain the virus and its variants, ensure those infected have access to care and treatment (including adequate oxygen supplies) and prepare for successful vaccine delivery. It will save many lives, reduce suffering and help economies to reopen safely.

GFAN Africa’s in country partners joined in sending this thank you letter to USAID missions in 20 African countries; USAID mission to the African Union; and USAID Africa Bureau. Our partners- Impact Santé Afrique- for outreach in Francophone Africa also translated the letter into French. The 20 countries activated in this ‘Thank You’ outreach are: South Africa, Tanzania, Zambia, Ghana, Kenya, Malawi, Zimbabwe, Zambia, Nigeria, Ethiopia, Eswatini, Cameroon, Madagascar, Benin, DRC, Senegal, Cote D’Ivoire, Burkina Faso, Rwanda and Uganda.

GFAN Africa jointly with Run4TB mobilized in-country partners for letter writing, a jam session, social media and print media activities to mark World TB Day 2021. A letter addressed to Ministers for Health asked the Ministers to engage communities in planning and implementing strong, integrated TB and COVID-19 mitigation and response measures; to review, update and implement TB policies by the end of 2022 to align with the latest WHO and internationally recognized guidelines; and to participate in the next step up for TB survey on TB policies. The letter further asked the Ministers to lead the implementation of the UN political declaration on TB by December 2022 to outline progress, next steps and support the UN Secretary General’s proposal to hold a follow up High-level meeting on TB in 2023.

The letter was sent to Ministers for Health in Eswatini, Zambia, Kenya, Ghana, Zimbabwe, Rwanda and Malawi. In Nigeria, a goodwill message with excerpts from the Letter to the Minister for Health was presented at a press briefing organized by the Honorable Minister for Health to mark World TB Day.

Excerpts from the letter were published in newspapers in Ghana, Malawi, Eswatini and Zimbabwe by eight media houses.

Further, the letter was sent to the Commissioner and the Head of Division for Health at the Africa Union Commission urging their office to encourage countries to adopt the recommendations in the Step for TB and the deadly divide reports and to meet their UNHLM commitments and targets.

A one hour live jam session was part of the World TB Day activities. A live band sang songs on ending TB with interludes of discussions on the urgent need to end TB with viewers sending their comments in real time. During the session, Naomi Wanjiru a GFAN speaker urged that TB should not be forgotten amid the COVID-19 pandemic. Here is a link to the jam session.

On 12 November 2020, Positive Women Together in Action an organization in Eswatini held a roundtable discussion jointly organized with GFAN Africa on the impact of COVID-19 on young women and adolescent girls living with HIV. During the conversations, the young women and girls shared their experiences on accessing treatment during the COVID-19 pandemic. The 33 participants from various support groups from different communities in the four regions of Eswatini spoke about the impact of COVID-19 on women and AGYW living with HIV.

On a positive note, the multi-month dispensary of ART medication was implemented. Participants felt this was a positive impact of COVID-19 because before the pandemic they used to visit the healthcare centres for their refill and the cost was catastrophically high for them.

The young women and girls appreciated the food parcels and COVID-19 grant support being provided by the Government through the National disaster Management Agency (NDMA) and other organizations while others received financial support, which has never happened before the pandemic.

Discussing the negative impact of COVID-19, participants noted that there was an increase in the number of cases of gender-based violence during the lockdown period. “Partners spent their days together and started realizing each other’s shortfalls and this led to violence within homes” noted Thabisile Mavimbela. Stress, trauma, depression and general mental health challenges led to increased cases of gender-based violence.

‘’I have seen that our health sector has neglected other health conditions. Health workers deliver ART medication to our homes but why don’t they bring medication for other conditions so that they deliver a comprehensive service?’’ asked Cebsile Shabangu during the conversation.

The Government of Eswatini must sustain focus on all life threatening diseases amid COVID-19.

#LEMOUVEMENTCONTINU

Pour vaincre la COVID-19, protéger les progrès contre le VIH, la tuberculose et le paludisme, et sauver des vies : NOUS DEVONS NOUS UNIR POUR LUTTER !

La COVID-19 a frappé et perturbé la santé, les écoles, les entreprises, les voyages, les cultes religieux, et les moyens de subsistance des citoyens. Nous avons dû changer nos comportements sociaux. En sortant de chez nous, nous devons porter un masque et nous devons toujours laver les mains. La COVID-19 nous a rappelé que nous devons d’abord assurer notre santé pour pouvoir faire face aux autres aspects de notre vie. La santé publique est une condition préalable à la stabilité sociale, économique et politique. Cela nous emmène à souligner que l’investissement pour les services de santé centré sur les besoins des populations pour prévenir, détecter et combattre les maladies est une nécessité pour le développement.

Les gouvernements doivent donc augmenter leurs investissements dans la santé.

Lorsque les pays ont été mis en quarantaine, l’accès aux services de santé a diminué. Les populations craignaient de se rendre dans des établissements de santé lorsqu’elles tombaient malades par crainte d’avoir la COVID-19. Selon un article du journal 360 Afrique, au Cameroun les consultations dans les hôpitaux ont chuté de 41.2% pour les mois de février, mars et avril 2020 par rapport à la même période en 2019 ; le taux d’hospitalisation quant à lui a chuté de 28 ,5%. Cette crainte de la COVID-19 dans les établissements de santé a entraîné la possibilité d’une incidence accrue d’autres maladies telles que le VIH, la tuberculose et le paludisme, affaiblissant ainsi nos systèmes de santé.

Les services de lutte contre le VIH, la tuberculose et le paludisme ont été largement perturbés pendant le confinement. Un rapport de modélisation du partenariat Halte à la tuberculose indique que l’incidence mondiale de la tuberculose et les décès dus à cette maladie en 2021 augmenteraient pour atteindre des niveaux qui n’ont pas été observés depuis 2013 et 2016 ; Ce qui implique un recul d’au moins 5 à 8 ans dans la lutte contre la tuberculose en raison de la pandémie de COVID-19. Aussi, selon un rapport de l’ONUSIDA, la lutte contre le VIH pourrait encore reculer de 10 ans voire plus. Là où la COVID-19 a provoqué de graves perturbations c’est dans les programmes de prévention du paludisme qui ont été interrompus, notamment par la distribution tardive des moustiquaires.

Les écoles ont été fermées pendant des mois et heureusement elles réouvrent progressivement. Pour les filles non scolarisées, cela peut signifier un risque accru d’exploitation sexuelle, de grossesse précoce, de mariage forcé et d’infection par le VIH. Plus une fille reste longtemps en dehors de l’école, moins elle a des chances d’y retourner. Le niveau de risque est énorme.

Les pays doivent alors se concentrer sur la meilleure façon d’accélérer le rétablissement des services de santé, afin de réduire le fardeau de la COVID 19.

Les mesures visant à atténuer l’impact de la COVID-19 sur le VIH, la tuberculose et le paludisme devraient impliquer une combinaison d’engagement intensif de tous les acteurs et de maintien de la sensibilisation à l’importance des services pour vaincre ces trois maladies tout en dégageant la réponse au COVID-19. Les programmes doivent identifier et traiter les inégalités entre les sexes dans la conception de leur réponse. Une approche consiste à faire participer les femmes de manière significative, en soutenant les services de soins de santé primaires nécessaires pour réduire la mortalité infantile et maternelle, et en soutenant les soignants qui sont pour la plupart des femmes. Les obstacles à la santé liés au genre doivent être supprimés.

En outre, alors que nous nous attaquons à la COVID-19, les gouvernements, la société civile et les partenaires  doivent s’assurer que la réponse au COVID-19 comprend des stratégies et des leçons tirées de la lutte contre le VIH, la tuberculose et le paludisme et que des ressources sont allouées à cette fin. Les droits de l’homme doivent être protégés ; la stigmatisation et la discrimination doivent être combattues. Les ressources disponibles pour la COVID-19 doivent garantir un accès équitable au dépistage, à l’analyse et au traitement. Lorsqu’un traitement et un vaccin sont trouvés, ils doivent être accessibles à tous, partout et gratuitement pour que personne ne soit laissé pour compte.

Cela nécessite une solide collaboration mondiale pour accélérer le développement, la production et l’accès équitable aux nouvelles technologies de prise en charge et de traitement de la COVID-19, VIH, TB, Palu.

Enfin, la COVID-19 ne sera pas la dernière pandémie. La prochaine pandémie doit nous trouver mieux préparés, prêts à disposer de systèmes de santé solides et résistants, axés sur les soins de santé primaires et fondés sur des systèmes de santé communautaires solides. Un système fondé sur les droits équitables, centré sur les personnes et conscient des autres facteurs qui affectent la santé et le bien-être, tels que le changement climatique, l’alimentation et le logement.

Pour obtenir ces succès, les gouvernements doivent investir des ressources nationales supplémentaires dans le domaine de la santé afin de reconstruire un avenir plus sain et plus sûr. Les gouvernements doivent également considérer la santé comme un investissement dans le capital humain en réalisant que la santé est un facteur clé du développement de notre pays.

Nous devons nous unir pour lutter et continuer le mouvement pour des soins de santé efficaces, effectifs et abordables pour tous, et partout.

Les organisations de la société civile signataires :

GFAN AFRICA, CS4ME, ISA, APDSP CAMEROUN, PHICC, OFIF, AFEDEC CAMEROUN, AJECP CAMEROUN, SIDAF, AFFIRMATIVE ACTION, FONDATION MOJE.

8th October 2020

We, the undersigned health advocates from across Africa, welcome the Inaugural African Union (AU) Biennial Joint Meeting of Ministers of Health and Finance for Eastern and Southern Africa Regions. We applaud African Union for the leadership on the ALM framework and commitments, which has laid a foundation for Domestic Financing agenda in Africa.

This framework recognises that Africa’s human capital development cannot solely be supported by external partners. It also demonstrates Africa’s leadership towards increased and efficient investments in health. Around the world, COVID-19, has led to an economic contraction. On average, Africa’s economy is forecast to contract by about 4% in 2020. Given significant revenue shortfalls, most governments are responding to the crisis by increasing spending mostly financed by increasing debt.

Several countries have also introduced tax policy measures (including tax cuts and deferrals) to counter the economic effects of Covid-19. We welcome the temporary debt relief through a reduction in debt financing obligations in 2020 by international debt actors. The suspension of debt service payments from official bilateral creditors through the Debt Service Suspension Initiative (DSSI) between May and December 2020 has allowed beneficiaries to reallocate spending to health and other Covid-19- related areas.

We recognise that prior to the pandemic, there was a high degree of variation across Africa and within regions, in per capita levels of public spending on health. We are concerned that most member states had not met the recommended health investments threshold of 5% of GDP; 15% of total Government Total Expenditure; $86 per capita. Our concern is not only on health spending in 2020 but also on what may occur in 2021 and future years as government spending falls and normal debt servicing resumes. We therefore submit the following perspectives:

1. Governments will need to raise additional revenues. This will require building more effective tax systems. Those with the broadest shoulders will need to bear more of the burden, whether through administrative reforms to improve collection, or through changes in tax policy. The efficiency of the tax system can also be improved through the expansion of environmental taxation and cutting wasteful subsidies and tax expenditures (Granger, et al., 2020).
2. Ministries of Finance will need to take measures to maintain higher levels of government spending and reallocate funds towards the health sector. In countries where per capita expenditures are falling overall, funds will need to be reallocated to the health sector if health spending is not to fall in the midst of a global pandemic. Whilst all sectors tend to consider themselves under-funded, Ministers of Finance will have to assess the needs of the health sector, and whether it is potentially underfunded relative to others.
3. Health Ministers will need to better allocate and make better use of funding within the sector. Better priority-setting can help focus spending on the most efficient and effective programmes (Glassman et al., 2017). Reforms to expenditure management can ensure that frontline service providers have sufficient flexibility to respond to the new conditions and improve performance (Barroy et al., 2019). Advocates urge AU Ministers to put tighter systems to manage corruption– we have heard of corruption cases that are on the rise over CODIV-19 tenders across Africa. Ministries of Health will need to improve the value-for-money of spending at a time when the overall fiscal position is strained.
4. Governments will need to address social barriers to equitable access to health services. With COVID-19 pushing millions into extreme poverty, the economic shocks — and disruptions to health, nutrition, and education systems – have multiplied the devastation of the pandemic well beyond the direct impact of illness from the virus. There is a need for a powerful, equitable response to the pandemic that protects the poorest and most marginalized communities. This includes ensuring that gender and human rights barriers to equitable access to services are addressed. Ensure that savings from the Debt Service Suspension Initiative (DSSI) are reallocated to health and other Covid-19-related and that spending goes where the most need exist to ensure investment in basic needs for the most vulnerable. Once the urgency of addressing the health crisis subsides, African governments will need to focus interventions on mitigating the lasting economic damages of the Covid19. To preserve labour productivity, there is a need to continue human capital accumulation including health, nutrition and education.
5. Need for greater health R&D investments. The AU Health Research and Innovation Strategy (HRISA) 2018-2030 underlines the need for country-led health research and information management systems to inform disease surveillance, preparedness and response in the event of an epidemic emergency. The Policy identifies the need for “a paradigm shift” to establish effective disaster preparedness and response management systems at continental, regional and country levels. In this sense the impact of the COVID crisis itself provides a powerful demonstration of the need for greater health R&D investment. We urge you to ensure an enabling environment for health research by establishing and/or strengthening a legal and policy framework that will nurture scientific careers, protect research subjects and ensure that research findings translate to health policy, product development, manufacturing and commercialization.

As communities and civil society, we are committed to our role on accountability in ensuring that Africa builds back better. We urge for more meaningful inclusion and engagement of communities as critical stakeholders in planning and financing.

1. Global Fund Advocates Network (GFAN) Africa
2. Africa free of New HIV Infections (AfNHi)
3. WACI Health
4. East African Network of AIDS Service Organizations (EANNASO)
5. Hope for Future Generation, Ghana
6. Journalists Against AIDS, Nigeria
7. Community Working Group on Health, Zimbabwe
8. CITAM+, Zambia
9. Health promotion Tanzania (HDT)
10. Human Rights Empowerment Program, Malawi
11. Tanzania Network of Women Living with HIV (TNW+)
12. Stop TB Partnership Kenya
13. ZOOLOOh International
14. We Rise and Prosper

Hope for Future Generations (HFFG Ghana) welcomes the Inaugural African Union (AU) Biennial Joint Meeting of Ministers of Health and Finance for Eastern and Southern Africa Regions which took place on 8 – 9 October 2020.

We applaud the African Union for the leadership on the Africa Leaders Meeting framework and commitments, which has laid a foundation for the Health Financing agenda in Africa. This framework recognises that external partners cannot solely support Africa’s human capital development. It also demonstrates Africa’s leadership towards increased and efficient investments in health.

In Ghana, COVID-19, has led to economic contraction. Given significant revenue shortfalls, most countries, including Ghana are responding to the crisis by increasing spending mostly financed by increasing debt. Ghana has also introduced tax policy measures (including tax cuts and deferrals) to counter the economic effects of Covid-19.

We welcome the temporary debt relief by lending partners through a reduction in debt financing obligations in 2020. The suspension of debt service payments from official bilateral creditors through the Debt Service Suspension Initiative (DSSI) between May and December 2020 will allow for the reallocation of spending to health and other Covid-19-related areas.

We are concerned that prior to the pandemic, Ghana had not met the recommended health investments threshold of 5% of DGP; 15% of total Government Total Expenditure; $86 per capita.

Our concern is not only on health spending in 2020 but also on what may occur in 2021 and in the years to come as government spending falls and normal debt servicing resumes. We therefore submit the following perspectives:

1. The Government of Ghana will need to raise additional revenues. This will require building more effective tax systems. Those with the broadest shoulders will need to bear more of the burden, whether through administrative reforms to improve collection, or through changes in tax policy. The efficiency of the tax system can also be improved through the expansion of environmental taxation and cutting wasteful subsidies and tax expenditures (Granger, et al., 2020).

• The Ministry of Finance will need to take measures to reallocate increased funds towards the health sector. Whilst all sectors tend to consider themselves under-funded, Hon Kwaku Agyeman Manu will have to assess the needs of the health sector, in comparison to other sectors and fund health adequately.
• The Minister for Health will need to better allocate and make better use of funding within the health sector. Better priority setting can help focus spending on the most efficient and effective programmes (Glassman et al., 2017). Reforms to expenditure management can ensure that frontline service providers have sufficient flexibility to respond to the new conditions and improve performance (Barroy et al., 2019).
• The Government of Ghana will need to address social barriers to equitable access to health services. With COVID-19 pushing Ghana into extreme poverty, the economic shocks – and disruption to health, nutrition, and education – have multiplied the devastation of the pandemic well beyond the direct impact of illness from the virus. There is a need for a powerful, equitable response to the pandemic that protects the poorest and most marginalized communities. This includes ensuring that gender and human rights barriers to equitable access to services are addressed.

Ensure that savings from the Debt Service Suspension Initiative (DSSI) are reallocated to health and other Covid-19-related expenses and that spending goes where it’s needed the most to ensure investment in basic needs for the most vulnerable.

Once the urgency of addressing the health crisis subsides, the Government should focus interventions on mitigating the lasting economic damages caused by Covid-19. To preserve labour productivity, there is a need to continue to progressively build human capital for health, nutrition and education.

• The Government should invest more in health research & development. The impact of the COVID-19 crisis is a powerful reminder of the need for greater investments in health research and development in Ghana.

As communities and civil society, we are committed to our role on accountability in ensuring that Ghana builds back better.