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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.

2020 has taken each one of us aback. COVID-19 struck and disrupted health, school, businesses, travel, play, prayer, and livelihoods. We have had to make decisions that affect our health in a way only seen and done in health facilities. While going out to the shop, we have to wear a mask and sanitize and the body temperature had better be right. COVID-19 has reminded us basic facts – that we must first secure our health and then we can deal with other facets of our lives. Public health is a pre-requisite to social, economic and political stability.

Gradually, and gladly so, the lockdown measures are easing. One major move to ease the lockdown is the announcement by the Cabinet Secretary of Education Prof. George Magoha on the re-opening of schools. Great news indeed. There are health risks related to schools being closed. For some children, schools are nutrition centers that also offer psychosocial support. For some girls, being out of school can mean greater risk of sexual exploitation, early pregnancy, forced marriage and HIV infection. The longer a girl is out of school, the less likely that she will return. Education, like health, narrows inequalities, is a driver for sustainable development, breaks down cycles of poverty and opens up a world of possibilities.

As COVID-19 fades away, the aftermath will remain with us for years to come as intensive efforts to find therapeutics, treatment and a vaccine continue. When Kenya was put in lock down, access to healthcare services dwindled. People were afraid of going to health facilities when they fell ill for fear of having COVID-19 and for fear of related stigma. This has resulted in the possibility of increased incidence of other killer diseases such as HIV, TB and malaria presenting fresh and unprecedented health challenges.

A modelling report by the Stop TB Partnership indicates that as a result of the COVID-19 pandemic, global TB incidence and deaths in 2021 would increase to levels last seen in between 2013 and 2016 respectively – implying a setback of at least 5 to 8 years in the fight against TB.

We must see the fight against COVID-19 and other diseases such as HIV, TB and malaria as one fight. Measures to mitigate the impact of COVID-19 on HIV, TB and malaria should involve a combination of intensive community engagement and maintaining awareness of the importance of services to defeat the three diseases while emerging from the COVID-19 response. Programs must identify and address gender inequalities in their design and response. One approach is to meaningfully engage women, supporting primary healthcare services needed to reduce child and maternal mortality; and supporting caregivers, who are mostly women, caring for those who fall ill from COVID-19 or other causes. Gender barriers to health must be removed.

Further, as we tackle COVID-19, health advocates, partners and our Government must ensure that the response to COVID-19 includes lessons learned from the fight against HIV, TB and malaria. Human rights be protected; stigma and discrimination must be addressed. The available COVID-19 resources be shared equitably. When treatment and a vaccine is found, it should be available to everyone, one everywhere for free. So that no one is left behind.

Lastly, COVID-19 will not be the last pandemic. The next pandemic must find Kenya better prepared, ready with strong and resilient health systems with a strong focus on primary healthcare founded on strong community health systems. A rights-based, equitable, people-centered system that is conscious of other factors that affect health and wellbeing such as climate change, food and housing.

To achieve these successes, I urge the Government to invest additional domestic resources for health to build back better for a healthier future for all Kenyans. That health is one of the pillars of the Big 4 agenda is a sign of President Kenyatta’s commitment to health. Health is an investment in human capital and a key factor to the development of our country.

I urge for efficient, effective and affordable healthcare for every Kenyan, wherever they are.

Maurine Murenga is the Executive Director of Lean On Me Foundation

On the occasion of the 6th Global Fund Replenishment Conference, held in Lyon (France) on October 10, 2019, the Ambassador of France to Ghana visited a facility that benefited from the Global Fund (Maamobi General Hospital), met with members of the Country Coordinating Mechanism (CCM) and beneficiaries.

The French Ambassador, Anne Sophie AVE, went to the Maamobi General Hospital in Accra where she was welcomed by the Director, Dr. Dorcas ANFU OKINE and various care staff of the establishment as well as the CCM Chair, Ms. Cecilia SENOO. She was able to meet with the National Disease Control Programs (NACP), the National AIDS Control Program (NACP), the National Tuberculosis Program (NTP), and the National Disease Control Program (NTP). She also visited the maternity ward where she met pregnant women and young mothers receiving Global Fund-funded treatment.

She then met with members of the CCM as well as representatives of the Ministry of Health and the Ghana Health Service to discuss the modalities for strategic management and monitoring of grants.

The end of the morning was dedicated to a meeting with direct beneficiaries of the Global Fund. H.E. the Ambassador AVE was able to speak with Mrs. Comfort ASAMOAH-ADU, Executive Director of the WAPCAS (West African Program to Combat AIDS and STIs), the main recipient of the Global Fund. This sequence was an opportunity to discuss with different beneficiaries and affected communities about their backgrounds and the challenges they face.

The Global Fund has several objectives: maximizing the impact of actions against HIV / AIDS, tuberculosis and malaria; building resilient and sustainable health systems; promotion and protection of human rights and gender equality and the mobilization of resources.

Since 2002, when it was created, more than $ 40 billion has been allocated to 140 countries to fight these three pandemics. By 2018, programs supported by the Global Fund to Fight HIV, Tuberculosis and Malaria have saved 32 million lives worldwide.
Ghana, the first recipient of a Global Fund grant, has received cumulative disbursements of US $ 817 million since 2002, including about US $ 110 million from France.

Malaria remains a leading cause of death in Ghana, but since 2006 significant progress has been made in reducing prevalence, incidence and mortality. Tuberculosis is treated successfully in 85% of cases, but screening coverage is still low, as is the case for HIV. HIV / AIDS remains a significant cause of death and prevalence is high among key populations (sex workers, men who have sex with men). New HIV infections do not decrease (19,100 cases / year in 2017), the number of people living with HIV is estimated at 320,000 in 2018.

On October 10, 2019, France hosted the 6th Global Fund Replenishment Conference in Lyon, meeting the financial needs for the 2020-2022 periods with a financial target of $ 14 billion to help save $ 16 million lives and avoid 234 million new infections in 2030.

The States present at this Conference have met their commitments: the Fund has collected $ 14.02 billion in pledges, including $ 1.4 billion from France, which remains the second largest contributor to the Global Fund since its creation in 2002, after the United States.

Global Fund resources alone will not be sufficient and the Government of Ghana will undoubtedly need strengthen its efforts through increased health budgets to eradicate the 3 pandemics.

Commonwealth Health Ministers meet every year. This year, the meeting took place virtually on 14 May 2020. The theme of the meeting was delivering a coordinated Commonwealth COVID-19 response. The meeting was timely as Governments the world over were caught out when COVID-19 struck. As the meeting took place, Global Fund Advocates Network – Africa members sent solidarity letters to their Ministers for health and to Her Excellency Amira El Fadil the Commissioner for Social Affairs at the Africa Union Commission

In the letters, Civil Society noted with concern the economic, social and health disruptions caused by COVID-19. They acknowledged and appreciated the efforts that the Governments, private sector, donors and individuals are putting in place to protect citizens from COVID-19 to save lives, mitigate its impact and sustain livelihoods.

They asked that the Ministers for Health ensure that: Governments continue to provide comprehensive healthcare services and remains focused on defeating other life threatening diseases as it battles COVID-19; Escalate engagement of community health systems so that communities are at the heart of the COVID-19 response especially in prevention, contact tracing and surveillance; Enhance multi-disciplinary partnerships for robust coordination at national, regional and global level.

Civil Society advocates from Kenya, Burkina Faso, Cameroon, Zimbabwe, Rwanda and Eswatini joined in this activity.