A central component of universal health coverage is public health spending. Since the inception of the Abuja Declaration, most African countries have increased their budget allocation to health. From 2000 to 2016, economic growth in Africa averaged 4.6 percent annually, making it the second-fastest-growing region worldwide.  Despite this, funding has not yet reached the required levels to ensure universal health coverage. It is widely fluctuating, making that sector unable to plan and implement health interventions effectively, partly caused by aid dependence. Even though primary and preventive care is vital to achieving equity and sustainable progress towards UHC, governments are unwilling to allocate sufficient funding for key population programmes.

The 55 Member African States made a solid commitment to increasing health resources at home while strengthening health systems to address Africa’s health priorities while improving resource utilisation through enhanced accountability.  The coverage, financial protection, and equity are directly impacted by how public funds are allocated, spent, and used. The Sustainable Development Goals (SDGs) were adopted in 2015. There is now a growing awareness that it is more important to consider the nature of resources available and their use than focus solely on the volume of resources required to succeed.

Learnings from countries’ experiences in promoting UHC through reform of public spending indicate that success requires a combination of:

•  Appropriate allocation of resources to health care – public resources are not allocated efficiently and do not target priority areas, notably health services for the most vulnerable;
• Annual public health budgets are not fully disbursed because of financial management efficiencies, resulting in missed opportunities for better health outcomes;
• It is often possible to move toward more equitable service coverage and financial protection without significant expenditures if public funds are used differently.

Under the Global Action Plan to achieve the SDGs, the Sustainable Financing for Health Accelerator (The Global Fund to fight AIDS, Tuberculosis and Malaria, the Global Financing Facility in particular) as well as the Global Fund Advocates Network Africa, RBM Partnership to end Malaria, WACI Health and UHC 2030 are collaborating to develop and deliver training on UHC Budget Advocacy in sub-Saharan Africa.  The multi-stakeholder collaboration aims to hold governments accountable for health funding policies, levels, and allocations, in a constructive way.

The training aims to develop training on health financing, UHC,As a result, there and budget advocacy to country-level actors from civil society, media organisations, and elected representatives and that can provide in-country support to budget advocacy activities undertaken by CSO actors and mentorship.

Countries that participated are Ethiopia, Ghana, Kenya, Liberia, Malawi, Mozambique, Nigeria, Rwanda, Sierra Leone, Tanzania, Uganda, and Zambia.

Through the passing of the torch caravans in Southern Africa, Zimbabwe, Malawi and Zambia, the impact of the Global Fund on HIV/AIDS, tuberculosis (TB) and malaria has been explained. From mid-August onward, the Torch will cross into the East African region, where a series of events will be held to show how this partnership is changing lives.

“From the beginning, communities affected by the three diseases and civil society have been at the heart of everything the Global Fund does. Aid provided by the Global Fund extends beyond HIV, TB, and malaria in Africa. We have seen positive results in the health outcomes of our communities thanks to the integrated, person-centred health services, “says Rosemary Mburu, Executive Director of WACI Health in Kenya.

A variety of partners has helped accomplish the goals of the Global Fund throughout the years, including governments, multilateral agencies, bilateral partners, civil society groups, and people affected by diseases.

“We celebrate Global Fund’s 20 years of impact in Zimbabwe. Global Fund has helped save lives. This torch is a reminder of lives saved and also the work that remains undone. During this caravan, we will have a number of activities here in Zimbabwe. We will then hand over the torch to Malawi,” Rusike said.

According to the World Health Organization (WHO), Zimbabwe has been removed from the global list of tuberculosis (TB) high burden countries.

We will continue to follow the torch as it travels across Africa, where there is much celebration and appreciation for the support received from Global Fund.

On 8 June 2021, GFAN Africa organized a webinar titled – The Global Fund at 20: An Africa Civil Society Dialogue on the sidelines of the HLM on HIV/AIDS. The webinar marked the launch of a series of activities by GFAN Africa to celebrate the 20^th anniversary of the Global Fund partnership.

In her remarks, Linda Mafu the Head of Political and Civil Society Advocacy at the Global Fund appreciated the role of civil society in reminding the world about the need for global solidarity for HIV treatment. This led to the creation of the Global Fund. She added that civil society fought for the right to life. She emphasized the 20 years celebration of the Global Fund are a celebration of life, political leadership and partnerships with civil society.

The webinar was held on the sidelines of the high-level meeting on HIV/AIDS and Florence Anam from GNP+ outlined the following civil society asks for the high-level;

1. Equitable and equal access to HIV prevention, treatment, care and support services for key populations and those in situations of vulnerability
2. Elimination of the structural barriers to achieving zero new infections, zero deaths and zero discrimination

• Fully resourced, efficient and sustained HIV response, integrated into systems for health, development, social protection, humanitarian settings and pandemic responses

Hon Daniel Molokele the Member of Parliament for Whange constituency in Zimbabwe renewed the call for a fully funded Global Fund especially at this time when there is donor fatigue and as the seventh replenishment is coming up.” In line with SDG3, it will not be possible to achieve targets in Africa without a fully funded Global Fund hence the need for the partnership to be fully resourced,” he noted. He urged civil society to push for increased domestic resources for health.

“HIV, TB, and Malaria are diseases happening at community level and community engagement is the best approach to fight the three diseases,” noted Olivia Ngou the Executive Director of Impact Sante Afrique. She appreciated that the Global Fund has put civil society and communities at the forefront of its interventions including at the decision making level.

Dr Vuyiseka Dubala-Majola from the Africa Center for HIV and AIDS Management in South Africa revealed that she is one of the 38 million people whose lives have been saved by the Global Fund. She added that in Western Cape Province of South Africa, she was one of the first people to benefit from ARVs free, from the Global Fund in 2004. Noting that Africa has come a long way, she emphasized that there are many more lives to save hence there is need for sustained and rigorous advocacy efforts.

“To world leaders, your efforts and investments in health are bearing fruit and should be sustained,” said Joyce Ouma a GFAN Speaker. She added that the Global Fund has helped her stay alive.  She urged for efforts to protect the gains made so far towards defeating HIV, TB and malaria and asked that the world must urgently invest additional resources to defend progress against HIV, TB and malaria, fight COVID-19, and save lives.

The Global Fund has played a critical role in efforts towards ending TB, noted Carol Kachenga from CITAM Plus. She added that she is a beneficiary of the work of the Global Fund, as she expressed disappointment that people still die from TB, a disease that is preventable and treatable.  She decried the deadly divide between TB commitments and the reality as she called for urgent action and sustained focus on TB amid COVID-19.

On 21 April 2021, GFAN Africa facilitated a regional day of action to thank Germany for their additional contribution of EUR 140 million to the Global Fund. These resources will support the Global Fund’s efforts to fight the COVID-19 pandemic in low- and middle-income countries and mitigate the impact on HIV, tuberculosis and malaria programs, including through deploying diagnostic tests, protecting front- line health workers and strengthening health systems.

This contribution comes at a critical time when the COVID-19 pandemic continues to ravage the world, adversely affecting the most vulnerable communities, threatening progress against HIV, TB and malaria, and putting a strain on already overstretched health systems, including at community level. In June 2020, Germany contributed EUR 150 million and we are grateful for this earlier contribution.

This thank you letter was sent by GFAN Africa’s in-country partners to German Embassies in 13 African countries and to German missions to the African Union and the East African Community. Our partners- Impact Santé Afrique – for outreach in Francophone Africa also translated the letter into French. The 13 countries that joined in this ‘Thank You’ outreach are South Africa, Tanzania, Ghana, Kenya, Malawi, Zimbabwe, Ethiopia, Eswatini, Cameroon, Madagascar, Benin, Lesotho and Senegal.

At GFAN Africa, we applaud Germany for their commitment to global health, as we thank Germany based colleagues whose strategic advocacy contributed to this significant outcome.

On 21 April 2021, GFAN Africa and partners, including communities living with and affected by HIV, TB and malaria and civil society organizations organized a day of action to thank Netherlands for contributing to the ACT Accelerator and to the Global Fund. The letters of appreciation sent by civil society organizations in 14 countries in Africa to Netherlands embassies and consulates expressed sincere gratitude to the Netherlands for their contribution of €52 million to the Access to COVID-19 Tools (ACT) Accelerator. These funds are critical to support the accelerated development, production, and equitable access to COVID-19 tests, treatments, and vaccines.

€12 million will be channeled through the Global Fund to strengthen the COVID-19 response while protecting gains made against HIV, TB, and malaria over the last two decades. The remaining €40 million will be invested in the purchase of vaccines through COVAX – the vaccines pillar of the ACT-Accelerator. This pledge follows a previous contribution of €85 million to the global response to COVID-19. Since the pandemic began, the Netherlands contributed €137 million. Read the full letter here.

Impact Santé Afrique, our partner in Francophone Africa translated the letter to French and civil society organizations sent the letters to Embassies of Netherlands in Francophone Africa. The 14 countries that joined in this ‘Thank You’ outreach are South Africa, Tanzania, Ghana, Kenya, Malawi, Zimbabwe, Cameroon, Madagascar, Benin, Zambia, Niger, Burkina Faso, Cote D’Ivoire, Nigeria, and Senegal.

The letter was shared widely on social media. You can view the twitter messages here and retweet

World Malaria Day falls on April 25, 2021. The theme for this year is: Zero Malaria – Draw the Line against Malaria. This is the right time to draw the line against malaria by taking action to end the disease at this time when COVID-19 has made the fight harder. On this day, let’s highlight and appreciate the efforts that have been made over the years to control malaria and celebrate the gains so far.

Since 2000, the world has made historic progress against malaria, saving millions of lives. According to the World Health Organization’s world malaria report 2020, 7.6 million malaria-related deaths have been averted since 2000. This is a huge success resulting from concerted efforts by Governments, donors, and multilateral institutions such as the Global Fund partnership, which provides 56% of all international financing for malaria, and has invested more than US$13.5 billion in malaria control programs since the year 2002.

In Ghana, data suggests that the proportion of deaths attributed to malaria per 100,000 population has decreased from 10.8/100,000 in 2012 to 1.1/100,000 in 2019.

Notwithstanding, half of the world still lives at risk of malaria. Ghana remains part of the top countries in the world which contributes to the global malaria burden.  Globally, 409,000 people died from the disease in 2019. An estimated two-thirds of these deaths are among children under the age of five. Every two minutes, a child dies from malaria. These statistics should make us restless, especially because malaria is a preventable and treatable disease.

As malaria continues to cause needless deaths, COVID-19 has complicated the fight to end malaria. A new report by the Global Fund to Fight AIDS, Tuberculosis and Malaria shows that in 2020, COVID-19 massively disrupted health systems and health service delivery for malaria in low- and middle-income countries in Africa.  Indeed, the COVID-19 pandemic and restrictions related to the response caused disruptions to essential malaria services. Initial messaging that aimed to reduce coronavirus transmission advised the public to stay at home if they had a fever, potentially disrupting treatment for those who may have had malaria and needed treatment. The lockdowns slowed down malaria prevention programmes such as the distribution of mosquito nets. This disruption to malaria prevention and treatment is causing increase in deaths from the disease and potentially will lead to a surge in deaths in subsequent years. Children and pregnant women particularly remain at great risk.

The fight against malaria must remain a priority. It is time for rigorous efforts to protect everyone who is at risk of malaria and to guard the tremendous strides made in fighting the disease. This calls for high impact investments in education, prevention, diagnosis and treatment, including research and development and building stronger health systems.  To achieve this, there is need for stronger political leadership, more funding including domestic resource mobilization and increased innovation. Community engagement, robust partnerships with private sector, foundations, academia, Government, civil society, for joint planning, execution, transparency and accountability will play an important role in malaria elimination.

Continuing to invest in research & development, scaling up country-driven solutions as well as innovations such as real-time data and next-generation nets will help us stay ahead of the mosquito and its killer tactics. Social and gender norms that present barriers to accessing healthcare especially among poor and vulnerable women and girls who are often primary caregivers should be addressed.  These actions to beat malaria must strongly engage communities and the youth.

The commendable efforts to beat COVID-19 must not be at the expense of accelerating progress against malaria. Malaria investments can be leveraged to fight COVID-19 and emerging diseases by promoting and facilitating safe and timely treatment of fever and ensuring that health workers are adequately protected and equipped.

Critically, malaria programmes must be integrated with broader efforts to build stronger systems for health, which are anchored on established community health systems. Further, ending endemic diseases such as malaria will contribute to strengthening fragile health systems and beating pandemics like COVID-19 because ending malaria will reduce the burden on health systems and increase capacity to detect, prevent, and respond to pandemics.

 

Despite the unprecedented challenges presented by COVID-19, malaria elimination remains a viable goal that will contribute to achieving universal healthcare coverage so that everybody has access to efficient, effective and affordable healthcare wherever they are and whenever they need it.

Malaria elimination is possible. Zero malaria is within reach.

World Malaria Day falls on April 25, 2021. The theme for this year is: Zero Malaria – Draw the Line against Malaria. This is the right time to draw the line against malaria by taking action to end the disease at this time when COVID-19 has made the fight harder.

On this day, let’s highlight and appreciate the efforts that have been made over the years to control malaria and celebrate the gains so far.

Since 2000, the world has made historic progress against malaria, saving millions of lives. According to the World Health Organization’s world malaria report 2020, 7.6 million malaria-related deaths have been averted since 2000. This is a huge success resulting from concerted efforts by Governments, donors, and multilateral institutions such as the Global Fund partnership, which provides 56% of all international financing for malaria, and has invested more than US$13.5 billion in malaria control programs since the year 2002.

In Ghana, data suggests that the proportion of deaths attributed to malaria per 100,000 population has decreased from 10.8/100,000 in 2012 to 1.1/100,000 in 2019.

Notwithstanding, half of the world still lives at risk of malaria. Ghana remains part of the top countries in the world which contributes to the global malaria burden. Globally, 409,000 people died from the disease in 2019. An estimated two thirds of these deaths are among children under the age of five. Every two minutes, a child dies from malaria. These statistics should make us restless, especially because malaria is a preventable and treatable disease.

As malaria continues to cause needless deaths, COVID-19 has complicated the fight to end malaria. A new report by the Global Fund to Fight AIDS, Tuberculosis and Malaria shows that in 2020, COVID-19 massively disrupted health systems and health service delivery for malaria in low- and middle-income countries in Africa. Indeed, the COVID-19 pandemic and restrictions related to the response caused disruptions to essential malaria services. Initial messaging that aimed to reduce coronavirus transmission advised the public to stay at home if they had fever, potentially disrupting treatment for those who may have had malaria and needed treatment. The lock downs slowed down malaria prevention programmes such as the distribution of mosquito nets. This disruption to malaria prevention and treatment is causing increase in deaths from the disease and potentially will lead to a surge in deaths in subsequent years. Children and pregnant women particularly remain at great risk.

The fight against malaria must remain a priority. It is time for rigorous efforts to protect everyone who is at risk of malaria and to guard the tremendous strides made in fighting the disease. This calls for high impact investments in education, prevention, diagnosis and treatment, including research and development and building stronger health systems. To achieve this, there is need for stronger political leadership, more funding including domestic resource mobilization and increased innovation. Community engagement, robust partnerships with private sector, foundations, academia, Government, civil society, for joint planning, execution, transparency and accountability will play an important role in malaria elimination.

Continuing to invest in research & development, scaling up country-driven solutions as well as innovations such as real-time data and next generation nets will help us stay ahead of the mosquito and its killer tactics. Social and gender norms that present barriers to accessing healthcare especially among poor and vulnerable women and girls who are often primary caregivers should be addressed. These actions to beat malaria must strongly engage communities and the youth.

The commendable efforts to beat COVID-19 must not be at the expense of accelerating progress against malaria. Malaria investments can be leveraged to fight COVID-19 and emerging diseases by promoting and facilitating safe and timely treatment of fever and ensuring that health workers are adequately protected and equipped.

Critically, malaria programmes must be integrated with broader efforts to build stronger systems for health, which are anchored on established community health systems. Further, ending endemic diseases such as malaria will contribute to strengthening fragile health systems and beating pandemics like COVID-19 because ending malaria will reduce the burden on health systems and increase capacity to detect, prevent, and respond to pandemics.

Despite the unprecedented challenges presented by COVID-19, malaria elimination remains a viable goal that will contribute to achieving universal healthcare coverage so that everybody has access to efficient, effective and affordable healthcare wherever they are and whenever they need it.

Malaria elimination is possible. Zero malaria is within reach.

By Mrs. Cecilia Senoo,

Executive Director, Hope for Future Generations Ghana

Focal Person, Global Fund Advocates Africa (GFAN Africa)

Developing Country NGO Delegation to the Global Fund Board (DCNGO)