There are about 1.8 billion young people aged between 10 to 24 years in the world. This is by far the largest generation of youth in history! Approximately half of them – 900 million – are adolescent girls and young women.

Majority of the adolescent girls and young women live in low and middle-income countries. With regards to HIV, this young cohort is disproportionately affected by the virus. In 2016, 2.3 million adolescents and young women were living with HIV. Eastern and southern Africa regions carry the heaviest burden with an estimated 230 000 new HIV infections annually. Overall, the number of African adolescents and young people is estimated to increase to more than 750 million by 2060. Bearing these projections in mind, new HIV infections among young people are expected to rise even if our global progress to HIV response is maintained.

To end AIDS as a public health threat by 2030, UNAIDS estimates US$26.2 billion is needed for the global HIV response in 2020 alone. This means the world must increase the amount of resources available for HIV by US$1.5 billion each year between 2016 and 2020. There is a lot more emphasis on countries most affected by the HIV epidemic to finance their own responses and find more efficient and cost-effective ways to do so.

The world will convene in France in October 2019 for the 6^th replenishment of the Global Fund to raise new funds towards ending AIDS, TB and Malaria by 2030 in alignment with the Sustainable Development Goals. In addition to the pledges which will be made, there is an increasing need for implementing countries (of the Global Fund grants) to step up their domestic resources for health especially investments in young women. There is limited research within the HIV evidence base specifically among adolescents and young women. Where data on youth exist, the way it is presented sometimes fails to tell the full story.

Photo credit: PEPFAR

Girls and women are powerful agents of change as well as drivers of sustainable development. Evidence from around the world confirms that investing in girls and women, by education and health, creates a ripple effect that yields multiple benefits such as greater accumulation of human capital; increased productivity, income and economic development. For example, a study in Botswana found that each additional year of secondary schooling by adolescent girls reduced cumulative HIV infection risk by 8.1%. Yet, despite all we know, decision makers have failed to consistently make adolescent girls and young women a priority. They are deprived of access to health services, confront barriers to education, are vulnerable to gender-based violence and face discrimination in political and economic spheres.

Now, at the dawn of the SDGs, we have an opportunity to correct this wrong and prioritize the health, rights, and wellbeing of girls and women everywhere.

Strengthened advocacy on domestic resource mobilization. 

Through the Civil Society Platform on Health in Africa (CiSPHA) and Global Fund Advocates Network (GFAN) Africa, we worked with civil society to advocate for increased domestic investments in health. We provided civil society partners with data and other advocacy tools, at the national and regional levels and also facilitated development of messages, including a blog on Domestic Resource Mobilisation. We worked with regional and national civil society platforms to support civil society and community engagement with decision makers at various levels. For example, through GFAN Africa, WACI Health provided technical and financial support to partners in Kenya, Tanzania and Senegal on domestic resource mobilization. These efforts contributed to strengthening of the Civil Society Health Platform in Senegal, which would later become an avenue for civil society and community engagement in the development of the National Health Financing Strategy. In Tanzania, this work contributed to the development of a Civil Society Platform on Domestic Resource Mobilization, which is set to facilitate and strengthen Civil society and community engagement in Domestic Resource Mobilization.

(DRM) advocacy. At the sidelines of the Africa Partnership and Coordination Forum in November 2017, WACI Health led a group of civil society Organizations in organizing a CSOs regional meeting on DRM. At the meeting, CSOs pulled together a position paper on DRM, which was then shared with a wide range of stakeholders at the main forum. The forum serves as a continental platform to chart a collective way forward, identify opportunities for joint action, advocate for continued political commitment, and coordinate the efforts of the different partners to improve the health outcomes in Africa. Participants are drawn from the African Union Commission and its organs, regional economic communities, multilateral and bilateral development partners, non-state actors, parliamentary sector, UN agencies, and regional networks of community groups.

Tuberculosis — the world leading infectious disease – killed about 1.7 million people in 2016. Additionally, more than 10 million people globally got sick with the disease and about four million of them failed to be diagnosed, treated or reported by health systems.

The global state of TB management remains dire and the aim to end the epidemic by 2030 as agreed in the Sustainable Development Goals is still way out of reach. To change this, global health partners must pull together. To contribute to that effort, WACI Health is determined to keep TB prevention, treatment and management in the frontline. WACI Health and other global health partners demand and support efforts to accelerate action against TB.

In Africa, we are working with civil society organisations to galvanise and support leaders to champion more investments and better TB policies. For instance, we were part of a group that pushed to have more members of parliament attend the Global Ministerial Conference on Ending TB in the Sustainable Development in Moscow in November 2017. We are also supporting similar initiatives for the 2018 UN High-Level Meeting on TB in New York, to encourage the attendance of as many African heads of state as possible and to ensure that civil society key asks are prioritised by the heads of state. In commemoration of World TB Day in 2017, we issued a news release through the Africa civil society platform on health and GFAN Africa, with a focus on drug resistant TB. We called on WHO to add TB to its list of high priority drug-resistant bacteria and called on African governments to prioritise tuberculosis in national health and development agendas. We further challenged G20 leaders to demonstrate leadership in responding to drug-resistant TB by committing to fund new research to develop better drugs and treatment regimens. In South Africa, our World TB Day activities involved working with Section 27 and Treatment Access Campaign (TAC) to host two workshops — for TAC members in Free State Province and for Buffalo City Municipality AIDS Council civil society sector members in Eastern Cape. In both meetings, we underlined the need for civil society movements to play a greater role in advocating for proper implementation of the South Africa’s national TB strategic plan. In Kenya, we participated in the launch of Kenya’s first TB prevalence survey 2015/2016. We also participated in schools’ campaign to promote TB awareness in schools and the community. School children were engaged in essay writing and a photo competition on TB control in their communities. WACI Health worked with Hon Stephen Mule, Kenyan Member of Parliament and Chair African TB Caucus, to write a blog on the integration of TB and HIV.

Strengthened advocacy for the implementation of the national strategic plan (NSP) on ending gender-based violence (GBV) in South Africa:

In 2013 WACI Health was invited to join Stop Gender Violence (SGV) – a National Campaign to end gender-based violence. The purpose of the campaign is to call for a

fully costed and fully funded national strategic plan to end GBV. That plan will create a roadmap

that will align the country around a set of clear strategic priorities and create an accountability

mechanism for the performance of government, the private sector and civil organizations, in addressing GBV. When developed through broad-based national consultations and engagement, the plan to end GBV can be transformative. In 2017, WACI Health, as a member of the steering committee for this campaign, joined other CSOs to call on South African government to develop that plan to end GBV.

Highlights of achievements:

i). Shadow framework on NSP to end Gender Based Violence was developed and launched as an advocacy tool in October 2017

ii). Shadow Framework on NSP to end GBV handed over to various stakeholders including the then Deputy President’s Office, Honorable Cyril Ramaphosa, (now the President of the Republic of South Africa), workstream team of department of social development and department of women driving

the plan of action review process, European Union, and UN Women for buy in and as a tool of advocacy on what CS is calling for as response to GBV

iii). We achieved buy-in of provincial partners such as Provincial DSD of-fices, AIDS councils and

Commission for GenderEquality

iv). The campaign was presented in two conferences in 2016. These are: International Violence Prevention Conference and South Africa Violence Conference. We made a presentation of the campaign and shadow framework, which increased support for the campaign.

v). WACI Health (as a member of SGV Campaign) and MOSAIC are part of review process of the integrated plan of action working in collaboration with the national department of social development and department of women.

Human Immunodeficiency Virus (HIV), a virus that causes Acquired Immuno-Deficiency Syndrome (AIDS), is one of the world’s most serious health and development challenges.

Since the beginning of HIV/AIDS epidemic, more than 70 million people have been infected with HIV and an estimate of 35 million people have died. In 2016, about 36.7 million people worldwide were living with HIV – of these nearly 18.8 million were women and girls while 2.1 million were children under 15 years. Sub-Saharan Africa remains disproportionately affected by the epidemic accounting for nearly two-thirds of the people living with HIV globally. Many of these African countries hardest hit by HIV are also struggling with disease burden, food insecurity climate change and poverty.

Prevention helps reduce HIV incidence rates, a good example would be Elimination of mother-to-child transmission (EMTCT). Globally since 2010, there has been a 50% decline in new HIV infection among children due to mothers having access to antiretroviral medicines which reduce the viral replication of the virus consequently reducing the risk of transmitting HIV virus to their babies before birth, during birth or during breastfeeding. In spite of advances in our scientific understanding of HIV or increased funding and implementation of current treatment and prevention programs by governments, global health community and civil society organizations – many people living with HIV or at risk of getting HIV still do not have access to prevention, care and treatment which is critical in achieving 90-90-90 targets. While existing HIV/AIDS tools are critically important in curbing the epidemic, a vaccine is essential to conclusively and sustainably end AIDS epidemic in Africa.

For this year’s 2018 HIV Vaccine Awareness Day commemoration, WACI Health AfNHi, collaboratively with  IAVI and MESHA with technical and financial resources through AVAC convened a science café on 15^th May 2018 with media, HIV Vaccines Advocates civil society and scientist. The meeting objectives were to take stock of the challenges, successes and current efforts in finding a HIV vaccine. This meeting also sought to examine the current HIV research landscape towards a vaccine and also to give insight on the importance of carrying out such research. Treatment options for HIV infection have improved a lot over the last three decades however HIV medicines can have side effects, be expensive and hard to access in some countries. Also, some people may develop drug resistance to certain HIV medicines calling for change of medicines.

Building on the success of the RV144 trial in Thailand which provided proof that an HIV vaccine could really work, two HIV vaccine candidates are now in these large trials. There are about 12 clades (also called strains or sub-types) of HIV which exist in the world. HVTN 702 or Uhambo, a Phase III trial ongoing in South Africa, enrolled 5 400 men and women is testing a vaccine designed to prevent clade C – the most common HIV clade in Southern Africa. Meanwhile HPX2008/HVTN 705 or Imbokodo, a Phase IIb currently in 5 countries across sub-Saharan Africa enrolled 2 600 women. In this region, more women are getting HIV than men and the test vaccine in Imbokodo trial is designed to protect people from more than one clade of HIV.

Researchers are working tirelessly to avail two kinds of HIV vaccines namely preventive and therapeutic. A preventive HIV vaccine will be administered to an HIV negative person so as to teach their immune system to recognize and effectively fight HIV in case they are ever exposed to it in future. A therapeutic HIV vaccine is designed to improve the body’s immune response to HIV in an HIV positive person. Researchers are also evaluating therapeutic HIV vaccines as part of a larger strategy to eliminate all HIV from the body and cure people of HIV. Neither licensed preventive nor therapeutic vaccines exist yet!

Current prevention tools for HIV such as using condoms consistently and correctly, male circumcision and pre-exposure prophylaxis (PrEP) work well. But researchers believe a preventive HIV vaccine will be the most effective way to completely end new HIV infections!

During this commemoration, Kenya based HIV Vaccine advocates paid tribute to Dr. Julia Amayo:

Dr. Amayo paved way for the success we celebrate today. As an advocate, she believed strongly in the power of community engagement in all processes including HIV research and development. Dr. Amayo was certain that Kenya was on the right path to getting an HIV vaccine. Doing everything within her capacity to make this a possibility, Dr. Amayo was a member of the Community Advisory Board in HIV vaccine research and development. In addition to this, she represented Nairobi region as a member of the HIV Vaccine Support Network (VSN) and also contributed substantially in developing HIV Vaccine Research and Development Guidelines – the final one in Kenya! Apart from this, Dr. Amayo participated in a survey that assessed community and health care workers’ knowledge of HIV vaccine research and development. This is the survey that informed the development of the HIV vaccine toolkit by International AIDS Vaccine Initiative (IAVI).

We will not forget your efforts and struggles for an HIV free generation in Africa.

Thank you Dr. Julia Amayo

Achieving Universal Health Coverage (UHC) and indeed the Sustainable Development Goals (SDGs) are goals that many countries in the African Region have adopted. While healthcare is a basic human right, likely to be accessible and affordable in developed nations, healthcare access remains beyond the reach of many individuals including women and children living in developing countries. UHC ensures that everyone, anywhere receives quality curative, promotive, preventive and rehabilitative health services they need without experiencing financial hardship.

A recent modelling exercise conducted by the WHO found that in order to achieve SDG 3 targets, a significant increase in funding would be needed. Using the Chatham house recommendations of government health expenditure per capita of at least $86 as a base, the amount per capita required to make progress towards SDG 3 is estimated at $127 per capita and $144 to reach the target. In Africa, health expenditure has increased significantly over the past two decades with out-of-pocket expenditure and external assistance being the main drivers. Out-of-pocket expenditure continues to push people into poverty. High cost of health is a barrier to access health services and a hindrance to economic development for the poorest members of society. Evidence shows that out-of-pocket expenditure has increased from $15 per capita in 1995 to $38 in 2014 leaving 11 million patients or families of patients in low income countries (LIC) and low-middle income countries (LMIC) to fall into poverty every year due to catastrophic payments.

To remove these barriers, it is recommended that governments commit out-of-pocket expenditure represent at least less than 20% of the total health expenditure and there are none for priority health services or for the poorest families – sadly LICs and LMICs are only halfway towards this target. Reducing catastrophic spending on health and impoverishment due to utilization of health services is one of the goals of UHC!

To assure that ideas are exchanged and information is shared on expanding public financing to end epidemics such as AIDS, TB and Malaria, strengthen health systems and champion ‘the UHC we want’; WACI Health the secretariat of Civil Society platform for Health in Africa (CiSPHA) in collaboration with Global Fund Advocates Network (GFAN) and Eastern Africa National Network of AIDS Service Organization (EANNASO) gathered in Ghana to rebalance these discussions.

While external Aid can help bring us closer to UHC, over reliance on it is extremely risky. In recent years we have witnessed how donor Aid country priorities have shifted at a global level; health is now just one of the many competing issues along with security, climate change, humanitarian crises and refugees. Also in many LICs, as economies grow, governments will increasingly face ‘transition’ which loosely refers to self-financing by national government of health programs previously supported by donor funds. This trend takes place within a context of greater competition for aid funding, and declining interest by some countries in foreign official development assistance (ODA).

Most LICs and LMICs have considerable scope to raise revenue by increasing tax collection efforts including more efficient tax administration and broadening the tax base. This is challenging and timeous but is doable. Reforming tax policies, for instance indirectly through value added tax (VAT) serves as an opportunity government could mobilize resources. Another potential revenue source is tax innovation such as sin tax, telecom tax, additional corporate and social responsible tax – these taxes are often earmarked to specific expenditures like healthcare or education however earmarking can introduce rigidity and counter-productivity. Tackling tax avoidance and evasion and tax incentives for companies especially those trading in natural resources can raise additional revenues in countries. Governments could also greatly benefit from plugging leakages in revenues resulting from corruption and the illicit flow of funds. In Africa alone as much as US$ 50 billion in illicit funds is being illegally diverted per year that is double the amount of overseas development aid that was received in 2014.

Governments, civil society and communities alike must pay attention to the nature of revenue sources being exploited to finance achievements of UHC so that they are equitable and sustainable. Good governance, robust transparency and sound accountability must be incorporated too.