The Mozambican city of Maputo, naturally endowed with one of the longest Indian Ocean coastline, is beautiful and inviting. Being in Mozambique the week of 19-22 April, was exciting. First, perhaps because of the calming breeze and waters of the Indian Ocean and second because of the possibilities I encountered in a meeting with many inspiring people working in global health. We were here for the ‘Regional Global Fund Forum for Sharing Experiences among Implementing Countries’. Present at the meeting were over 150 delegates from the 7 countries that form a grouping called ‘High Impact Africa 2’: Kenya, Mozambique, Tanzania, Uganda, Zambia, Zimbabwe, and Ethiopia.

Meeting Alberto[1] was, however, perhaps, my most precious and unforgettable Maputo experience. Precious for the openness and resilience that Alberto exhibited and the unforgettable fire he lit up in my belly.   The ambivalent range of emotions I experienced- anger, shame, pride, hope, and determination-reminded me that the global health advocacy work some of us do truly does save lives and is worth every minute and penny.

Co-infected with HIV and TB, Alberto told the story of his life in its fullness. Joys, struggles, hopes, the lows, and the highs. Stigma, lack of nutritional support, inefficiencies in the health system, burn out among community health workers and much more.

Moments of hope in this encounter included when he dashed into his house and brought out a black polythene bag. One by one he spread his HIV and TB medication on the floor, explaining each medication including when and how many times he takes his drugs. He recounted the numerous occasions he has been hospitalized. He is on TB treatment for a second phase of six months.Jane, the health care worker who visits Alberto at his house several times a week, through the Global Fund supported DOTs program,narrated that Alberto’s doctors had recently confirmed that he was resistant to a number of drugs and had ordered change of medication. In his view, he would not have lived to tell this story had it not been for the drugs.

Alberto is a living example of how investments in TB and HIV programs are keeping people like him alive, by identifying them and enabling them to access both HIV and TB treatment among other services. With these investments, Alberto has also been linked to care through the DOTs program. There are about 3 million TB cases that are still not diagnosed or are diagnosed but not registered by the National TB programs globally, and specifically in Africa which, is home to 16 out of the 30 TB high burden countries. Also, there are many people living with HIV out there who are yet to be screened for TB. Yet, over 50% of deaths of people living with HIV are TB related.

Alberto is a reminder of the need for greater TB/HIV collaboration in order to ensure that synergy between TB/HIV programs is optimized. National governments ought to increase domestic investments not only in TB/HIV programs but also in health in general. International investments in health are also critical in providing resources for health services and care.

The Global Fund is a unique funding mechanism to accelerate the end of AIDS, tuberculosis and malaria as epidemics. Global Fund supported programs have saved 17 million lives since 2002, and the Fund is on track to reach 22 million lives saved by the end of 2016. This clearly makes the Fund one of the smartest investments in global health and key in realizing the Sustainable Development Goal 3 for Health. To keep people, like Alberto, alive, the Global Fund needs at least US$13 billion for the next replenishment period (2017-2019)[2].

My hope, inspired by Alberto and the beautiful city of Maputo, is that by the time my 10 years old girl is 25, we will have fixed healthcare for ALL in Africa.

***********

Rosemary Mburu is the Executive Director of WACI Health, which hosts the Africa Civil Society Platform on Health (CiSPHA) and GFAN Africa hub. WACI Health is an ACTION partner, a global health advocacy partnership.

[1] Not his real name.

[2]Investment Case for the Global Fund’s 2017-2019 Replenishment:The Right Side of the Tipping Point For AIDS, Tuberculosis and Malaria, December 2015, http://www.theglobalfund.org/en/search/?q=investment+case

With the launch of the new Sustainable Development Goals, health and development experts around the world are reflecting on what it will take to accomplish them. As a global community, this is a unique opportunity to think carefully about what works and what doesn’t, and to use the new goals to redouble our efforts to support programmes, solutions, and systems that work.

To fuel progress in global development, we need catalysts that cut across multiple challenges and support multiple development interests. There is a widespread understanding among decision-makers in low- and middle-income countries that high-performing primary health-care systems play that catalytic role. These systems are central to reaching global and country-specific goals, achieving universal health coverage, and meeting the majority of individual and community health needs before they become emergencies. A healthy population in turn sets the stage for gains in education, economies, and peace and security.

Providing sexual and reproductive health services in the context of primary health care is a long-established principle and practice. The 1994 International Conference on Population and Development (ICPD) Programme of Action called for ensuring access to reproductive health through primary health care. Similarly, a 2008 UNFPA publicationstated that achieving progress towards sexual and reproductive health and rights depends on a strong and functional health system in every country, especially at the primary and first referral levels.

With respect to HIV, tuberculosis, and malaria, the 2006 Abuja Call for Accelerated Action TowardsUniveral Access called for the promotion and integration of access to prevention, treatment, care, and support in primary health-care services. High-performing primary health-care systems enable countries to maximise the impact of core investments in programmes to defeat these and other infectious and non-communicable diseases. For example, primary health-care systems can be the basis for the scale-up of essential HIV and AIDS services in hard-to-reach areas and among underserved populations.

Unfortunately, despite broad global agreement on the value of robust primary health care, there is not a simple recipe to achieve it. Domestic financing and country ownership are critical elements, and it is time for countries to set priorities and budgets that explicitly aim to strengthen primary health-care systems, complementing the efforts of donors. Civil society also has a key role to play, not only holding decision-makers accountable but also working with them to develop strong systems that can be reached by all.

To enact policies and budgets that lead to measurable primary health-care improvements, however, decision-makers need better information about the components of high-performing primary health-care systems, particularly their poorly understood service delivery elements – such as the quality of care, and patients’ ability to access the system, and the degree of coordination among various care providers. A new partnership called the Primary Health Care Performance Initiative (PHCPI) seeks to address this gap in information, giving decision-makers the tools to adopt policies and practices based on evidence.

We are excited about PHCPI because it presents an opportunity for collaboration among diverse communities working to address other issues of global health and development. This is a chance to look ahead to where improvements to primary health-care systems can take us all in the future. We can rise above disputes over which health issues deserve the most attention, or what set of indicators gives us the best picture of a system’s health. We can harness data to make policy decisions about health care that are truly responsive to communities’ needs. We can unite around the opportunity to dramatically improve the health of millions of people by focusing on primary health care, the frontline of health in people’s communities.