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

Africa free of New HIV infections (AfNHi) is an Africa regional advocacy network, which exists to unite African Civil Society voices and action on regional advocacy for HIV prevention research. AfNHi is committed to influencing Africa regional policies in order to accelerate ethical development and delivery of HIV prevention tools towards ending the AIDS epidemic by 2030.

AfNHi participated in the 2018 AVAC partner’s forum held on 13^th – 16^th February 2018 in Johannesburg South Africa. Attending this were AVAC partners, Fellows and HIV prevention research Advocates based in Africa bringing together 120 participants in the meeting.

AfNHi brought to the meeting rich discussions on Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa delivered through a formal presentation by the Secretariat followed by a panel presentation. Several opportunities were identified at the Africa regional level. Moving forward, AfNHi is developing a strategy on how to effectively engage.  Some of the opportunities identified were;

• Abuja + 12 which came as a result of African heads of states and government committing to eliminating AIDS, TB and Malaria by 2030 and Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa Mapping of legal and political framework and opportunities for engagement on HIV Prevention Research in Africa.
• The Catalytic Framework to end AIDS, TB and eliminate Malaria in Africa by 2030 which provide an overarching policy framework in effective response to HIV and AIDs, Tuberculosis and Malaria.
• Africa Partnership and Coordination Forum whose multisectoral nature can provide civil society or other health champions a platform to feedback on priority actions and progress they have made regarding implementation of the Catalytic Framework.
• AIDS Watch Africa comprises of Heads of State and Government who meet annually to review progress on the continental response to HIV/AIDS, TB and Malaria and their pronouncements and decisions – it presents an opportunity for peer review, sharing best practices and setting agenda on HIV prevention.
• Africa Union (AU) organs for example New Partnership for Africa’s Development (NEPAD) and African Centre for Diseases Control. NEPAD plays both regulatory and capacity strengthening roles. Their current focus is on the Catalytic Framework – promoting access to affordable, quality assured medicines, commodities, technologies and developing AU policy on Research and Innovation for Health.
• African Centre for Diseases Control which requires domestic financing to truly focus on African Health research issues. The opportunities would be to focus research and innovation on the region’s priority areas by strengthening collaborations within Africa’s research institutions to enhance evidence-informed policies as well as increased investments in research and innovation.
• Regional economic bodies (such as SADC, ECOWAS, COMESA, EAC and their research institutions) which provide opportunities to collaborate on innovative African projects and research in areas of economy and health. There is a possibility of approaching African Development Bank (AfDB) for financing such projects.
• Office of the 1st Ladies (OAFLA) – relevant specially to mobilize support from the heads of states for HIV prevention research at Africa region level.
• Regional parliamentary bodies
• Have demonstrated leadership in voting for regional policies on HIV e.g. the Eastern African Legislative Assembly (EALA)
• Parliamentary Caucus on TB – Presents opportunities to leverage on their work as TB champions to also champion HIV prevention research.
• African Civil Society Networks (e.g. African Civil Society Health Platform)
• Regional Coalitions involving CSOs, Researchers (e.g. AAVNET, CHReaD, SAHTAC)
• Push for increased domestic and international funding to health through innovative financing mechanisms, social health insurance schemes and increased allocations at various levels
• Presents opportunities to strengthen Africa-focused and led HIV biomedical prevention research, implementation and advocacy

AfNHi held a successful HIV prevention campaign on the sidelines of this meeting. The campaign sought to bring out key messages for HIV prevention. The campaign was done through asking the question –  what does HIV prevention meant to you?  And respondents were given an opportunity to express their views by writing answers to the question.

56 New sign – ups were registered making a big addition to the AfNHi membership!

On the 13^th to 15^th of February 2018, WACI Health together with Stop Gender Violence hosted a consultative meeting on Stop Gender Violence Campaign (SGVC) in Johannesburg, South Africa. In attendance were many representatives of civil society who are members of the Task Team namely Sizwe Nombasa Gxuluwe – WACI Health, Sakina Mohamed – Greater Rape Intervention Project (GRIP), Zarina Majiet – MOSAIC, Bafana Khumalo – Sonke Gender Justice, Steve Letsike – Access Chapter 2, Tshivase Nkumiseni – Thohoyandou Victim Empowerment Project (TVEP) and Nonhlanhla Skosana – Sonke Gender Justice. Apart from this, the forum came at a crucial time where not only the Task Team were meeting but the provincial coordinators as well.

The expected outcomes being to draft a work plan for 2018, develop agenda items for Annual Partners General Meeting (APGM) on 28 to 29 March 2018 and a funding strategy for the campaign beyond June 2018.

Sakina, who is the Secretariat, facilitated reflections on success achievements made by the campaign this past 2 years. It included outlining what worked well – the existence of processes and content for the campaign, finalizing and launching Shadow framework, securing funding from Networking HIV/AIDS Community of Southern Africa (NACOSA) and Amplify Change, provincial engagements and completing the National Strategic Planning on Gender-Based Violence (NSP GBV) & presenting it to local Department of Social Development. Challenges include – lack of participation and response to emails by some task team members, advocacy buy-in on Framework, structure and communication, commitment by partners, funding for more advocacy, meetings with national government departments and defined task team/membership role and responsibility. It was then noted that there needs to be changes in re-committing to the project and implementing tasks allocated, re-engaging task team members with relevant stakeholders and partners, taking ownership, exploring more funding opportunities and having concrete advocacy strategies.

Looking at the current state of the campaign, Task Team members gave a report and analysis of the successes and challenges – echoing similar issues raised in the reflections. Through suggestions on comprehensive strategies which can leverage the campaign forward and target influential people, it was concluded that:

• Develop a 1-pager with 3 – 4 key messages from the National Strategic Plan on Gender-Based Violence Shadow Framework
• Lobby and advocate with different stakeholders at identified platforms such as National Department of Social Development, Ministry of Women, Deputy President’s Office, Treasury
• Have consistent communication at all levels and documentation of the work done

Apart from this, the Secretariat reminded everyone of the importance to end violence in the spaces they work in – significant to this issue is power. For example; interrogating the concept of power and its operations, integrating one’s personal and professional values through team building platforms, providing safe spaces educational and sensitization workshops to raise awareness on GBV and supporting colleagues who are victims of violence in the workplace (even if this means exploring legal options). As civil society, we must make use of policy in our quest to end violence therefore it was agreed upon to look at government entities such as Department of Planning, Monitoring and Evaluation with Department of Social Development in reviewing the state’s response to GBV.

Task Team members listen attentively during one of the sessions

Photo credit: Secretariat

On the 16^th of February 2018 was the Provincial Coordinators strategic planning meeting which was attended by Western Cape, Mpumalanga, Kwa-Zulu Natal and North West provinces. WACI Health was represented in this meeting. Purpose for this meeting was for the task team and provincial coordinators to give an account of challenges and successes they have encountered regarding NSPGBV work done at provincial level.  For instance, Western Cape has taken the campaign to the local radio station Zibonele. They further articulated the need for consistency in messaging, strong media presence and advocacy. Secretariat emphasised that the SGVC is not about money – we don’t give funds. Its heart and soul activism. Mpumalanga has been actively involved in shelter programs. North West cited experiencing some challenges in communicating with partners whereas Northern cape highlighted the pulling out of funders and the importance of people sensitization on GBV issues. From these and other issues recorded, a work plan was developed as a way forward for the campaign and recommendations were made ahead of the AGM in March 2018.

Kudzai Mhishi, Health Policy Research Fellow – WACI Health

On October 13, 2017 WACI Health, the Health NGOs Network in Kenya (HENNET) and partners including KANCO, National Network of People Living with HIV – NEPHAK, International Community of Women Living with HIV (ICW+), Health Rights Advocacy Forum (HERAF), AIDS Healthcare Foundation (AHF), African Centre for Global Health and Social Transformation (ACHEST), Social Welfare Development program (SOWED), Program for Appropriate Technology in Health (PATH), Global TB caucus, HENNET, CBM, INERELA+, ADDK, Kibera Integrated Community Self Help Program (KICOSHEP), Malteser International, Medecins Sans Frontieres (MSF)- Belgium and National Organisation of Peer Educators (NOPE) convened for a consultation on Universal Health Coverage (UHC) advocacy and accountability with a specific focus on civil society engagement in the UHC2030 movement. This forum brought members from various civil society and community organizations and networks including the Ministry of Health (MoH) was also present at the consultation to provide updates on the country progress on UHC as well as give insights as to what the ministry sees as the role and entry points for civil society.

The consultation came at a critical point when counties would be getting into renewing their strategic plans. This presented a great opportunity for civil society to advocate for and persuade County Governments to place UHC high on the agenda by incorporating relevant indicators into their next 5-year County-specific strategic documents.

Discussions not only focused on UHC progress in Kenya but also the role of CSOs in advocacy and accountability and means of working better together through a coordinated Civil Society Engagement Mechanism (CSEM) at country level.

There were three key expected outcomes from this consultation:

1. Key recommendations on how to address the health systems strengthening (HSS)/UHC advocacy issues identified.
2. Recommendations on how UHC 2030 initiative can strengthen citizens’ voices and empower communities to demand accountability and take health actions.
3. Recommendations on how CSOs can work together for UHC advocacy and accountability in Kenya.

Dr. Margaret Makumi, an expert in strengthening Health Systems in Kenya, introduced UHC emphasizing that all citizens from any community had the right to access quality health services be it promotive, preventive, curative, rehabilitative and palliative health care without incurring financial hardship – ‘that’s the basis of UHC!’. Since health is a basic human right enshrined in the constitution of Kenya, Dr. Makumi encouraged CSOs to get involved at both national and county level through dialogue, influencing decision-making for a conducive policy environment for UHC.

She stressed on three important elements of UHC, equity in access to health services – everyone who needs services should get them not only those who can pay for them. In Kenya, for example the free maternal and child health services, free or minimal pay for primary health care (PHC) services though to some extent. Quality health services which should be good enough to improve the health of those receiving these services and the community should be protected against financial-risk, ensuring that the cost of using services does not put those accessing it at risk of financial harm

Moving towards UHC in Kenya: perspectives from the Ministry of Health

A representative from the Ministry of Health (MoH), Mr. Julius Mutiso affirmed the government’s continued commitment in implementing health systems reforms for UHC. Part of the reforms include employing adequate policies, legal and institutional frameworks such as Bills of Right (chapter 4) and the Constitution of Kenya 2010 (pp 31-38). This, he said, was the citizens’ right to health and a long-term development goal of Kenya Vision 2030. Again, it was highlighted that health services must not expose its citizens to financial risk.

Towards UHC, the MoH so far has done numerous actions such as introducing free maternity services, upgrading healthcare in informal settlements and providing more support in HIV/TB and Malaria programs. This, he said, has contributed to decreased maternal and infant mortality rate, improved uptake of health services (TB detection, ART treatment etc.) and improved utilisation insecticide treated nets. He further highlighted the following as key next steps towards UHC by the ministry:

Participants noted that while the government of Kenya has set up various programs towards making progress on UHC, civil society has not adequately engaged in such UHC discussions hence the need to organize and coordinate effectively as a way to strengthening CSO engagement.

A discussion on CSEM and coordination of UHC advocacy and accountability work brought forward the following key highlights:

Civil society must work together in engaging the government on UHC through accountability and advocacy efforts. This engagement could include: helping to identify who the marginalized in the population are; establish whether health services are reaching the vulnerable and whether programs are purposively targeting those that can easily be left behind; monitoring budgets and expenditure; participating in public information sharing forums and tracking results among other areas. It was agreed that through proper documentation, CSOs must ascertain what has worked well and what has not worked in the past and build upon this through a coordinated CSEM.

In conclusion, participants provided a set of recommendations on how CSOs in Kenya can work better together; how UHC2030 can strengthen citizen voices; and how to strengthen country CSEM.  As a next step civil society will reconvene to jointly develop an Action Plan to guide the country CSEM according to the recommendations of this consultation.

In 2015, the international community officially enshrined universal health coverage (UHC) in the Sustainable Development Goals which guides development efforts through 2030. A strong primary health care (PHC) system is the first step toward achieving UHC and we must address the funding shortfall as well as develop innovative financing strategies.

In many countries in Africa, health services remain unaffordable; often far from home, and quality can be uneven. Crises such as the Ebola epidemic bring into sharp focus how communities and individuals struggle in getting the care they need, sometimes resulting in death that could have been prevented. Primary health care ensures that all people in a community stay healthy and receive care when they need it.

I serve as a Policy Advisor at WACI Health whose mandate is to create political good will to end life threatening epidemics and the improvement of health for all in Africa. PHC is critical to achieving our vision and mission. As an advocate, I engage with Governments and the citizens to embrace PHC and for each of the parties to play their roles to ensure PHC is a functional system. This is not an easy task especially where there is so much mistrust of PHC by a large number of middle income citizens who prefer out of pocket spending for example over the counter drugs rather than seek services from the public facilities. This practice comprises the health outcomes of individuals due to missed or wrong diagnosis and treatment hence end up bearing heavy costs for specialized treatment when the complications occurs leading to draining of family resources increasing the likelihood of poverty.

We are also advocating for increased domestic resources, for example in Kenya where the devolved system of Government has health as a nearly fully devolved function with the exception of policy formulation to ensure that County Governments allocate resources to PHC and that they strengthen the systems such that their citizen can access the services they require at the nearest facilities to where they live.

Earlier this year, I found myself immersed in rich conversations on PHC with other civil society advocates, technical experts and development partners. I participated in a consultation hosted by PAI and Save the Children UK, convened in Johannesburg, South Africa. The three-day consultation, sharpened my understanding of the complexities that countries face in the quest for affordable, accessible and quality primary health care. Common threads in the conversation included: the need to address access, financing, removal of barriers, strengthening health systems and engaging citizens to make PHC work. It was however, clear to me that it is up to each country to define their own meaning and understanding of PHC.

The challenges confronting the health sector range from the spread of non-communicable diseases to inadequate funding of health interventions and over reliance to the international aid rather than domestic funding. A few key messages stood out for me from this consultation:

· A high-functioning PHC system is key to ensure a productive and a healthy population. Millions of people in Africa are driven to poverty by healthcare-related expenditures and in return poverty predisposes them to disease slowing all aspects of growth in the economy. Strengthening healthcare systems to increase access to affordable, appropriate and quality health services in any country is a prerequisite for long-term development and structural transformation.

· Basic curative, preventive and promotive healthcare should be available and accessible to all if we are to achieve the Sustainable Development Goals by 2030.

· Financing for health falls short of the 2001 Abuja Declaration, where nations committed to allocating 15 per cent of their national budget to health.

The verticalization of health programs has a negative effect to the health system, leading to the prioritization of certain services or diseases causing a fragmentation of PHC services. Rather, government and other support to PHC is more beneficial in addressing issues of access to services by all.

Countries must define PHC in their own context, based in essential health services with a clear funding stream and develop indicators and outcomes to measure progress and success.

The report and recommendations from the Primary Health Care Expenditure and Budget Advocacy Consultation is available here.