President Donald Trump has reinstated the Mexico City Policy – an abortion-related requirement prohibiting foreign non-governmental organizations that receive U.S. funding from using their resources on abortion or abortion advocacy. But other countries, led by The Netherlands, have moved swiftly to try minimize the impact of the Trump’s order.

The policy – also known as the global gag rule was established by President Ronald Reagan in 1984. It provides that to receive U.S. funds, organizations must desist from using money from any source (including non-U.S. funds) for abortion or abortion advocacy.  President Trump’s provisions go beyond previous ones by Republican Presidents, which barred organizations from receiving U.S. government global-family-planning funding. His gag rules are extended to cover all other U.S. global-health funding. The memorandum signed by President Trump also extends the requirements beyond non-governmental organizations to include “global health assistance furnished by all departments or agencies.” In the last few weeks since this new order was signed, global health advocates have worried that the gag rule will harm global health, reversing gains made against many diseases, including HIV, tuberculosis and malaria. More importantly, the new order would affect the provision of reproductive health services for millions of women around the world.

It is why WACI Health is excited to hear plans by the Netherlands to establish an international fund to mitigate the effects of President Trump’s gag rule on women’s reproductive health services.  Launching the She Decides initiative, Lilianne Ploumen, the Dutch minister for foreign trade and development cooperation, said new funding will be used “to make sure that women and girls all over the world have access to family planning services.” It is reported that seven other countries, including Sweden, Denmark, Belgium, Luxemburg, Finland, Canada and Cape Verde have offered their support.

In her message in support of women’s reproductive health rights, Marie-Claude Bibeau, Canada’s Minister of International Development and La Francophonie, said that Canada will make a significant contribution in sexual and reproductive health rights and advocacy for women’s rights, contribute to sex education for boys and girls, to the provision of contraceptives,  to family planning, to legal safe abortions and to maternal and newborn health.

We commend the Netherlands for coming up with this great initiative. We commend the other countries that are standing up for women in these very uncertain times.  The world has made remarkable progress in the fight against infectious diseases and in promoting and protecting reproductive health rights of women in the last two decades. We cannot stop now.

A growing wave of nationalism is sweeping across the West and demanding a sharper focus on domestic issues and lesser engagement abroad. For global health investments in Africa, which have been heavily supported by international funding, these happenings call for increased domestic investments in health and other areas of development.

The rise of nationalism sentiments have been wide ranging – from Austria, to France and the Netherlands. However, two recent developments – the victory by the Brexiters in the UK in June 2016 and the election of President Trump in the U.S. less than five months later – are certainly the most momentous. The two events are the best exemplifications of the global politics of the times. More and more countries seem to be looking inward, not outward. In his inaugural speech as the President of the United States, Donald Trump vowed: “From this day forward, it’s going to be only America first, America first. Every decision on trade, on taxes, on immigration, on foreign affairs will be made to benefit American workers and American families.”

While it is still early to know what effect the Trump administration’s policies will have on global development, The New York Times has reported that the administration is “preparing executive orders that would clear the way to drastically reduce the United States’ role in the United Nations and other international organizations.” The orders would kick off the process of reviewing and potentially repealing certain forms of multilateral treaties, the Times reported.

For years now, advocates across Africa have been calling on African governments to step up their investments in global health.  Africa bears a disproportionate burden of diseases. It is estimated that sub-Saharan Africa has 11 percent of the world’s population but 24 percent of disease burden. Despite the tremendous progress made against the big three infectious diseases – HIV, TB and malaria – numerous African’s continue to die of these diseases every year. To end these diseases and others that continue to kill many on the continent, advocates have called on African governments to find ways to invest more of their own money towards this cause.

Progress against major infectious diseases in the last two decades has been unequivocal. For instance, an estimated 790 000 people died in the African Region from HIV-related causes in 2014, according to WHO. That was a 48 percent drop in number of deaths from the disease compared to 1.5 million people in 2004. That progress was achieved through strong investments by international development funders and African governments. To end HIV, TB and other diseases as epidemics, advocates have called on international funders and African governments to do more.

With the growing wave of nationalism, and the possibility that contributions by international funders can decline, African countries have a bigger duty to ensure that this progress does not stall.  If funding levels from the U.S. – the single biggest investor in international funding for global health – falls, the dream of ending HIV, tuberculosis and malaria as epidemics by 2030 may not be realized. We hope that the U.S. and other big donor governments will safeguard and advance this work, completing the wonderful job they started. This is especially crucial, as we get closer than ever to ending major diseases as epidemics.

We call on African countries to step up their investments in global health to fill any gaps that may be left by a possible decline in international funding.

If it turns out that the growing anti-globalization sentiments will not result to reduced investments in global health, then that sustained funding and stronger investments by African governments can help us to press forward faster with the goals of ending HIV, TB and malaria as epidemics by 2030 as well as build stronger health systems to tackle other diseases. This would be a landmark victory for all in the world, which would save millions and millions of lives, revitalize communities, create stronger economies and spawn greater benefits for all people in all corners of the world.

In February, Africa elected Chad’s Moussa Faki Mahamat as the new chairperson of the African Union Commission (AU) replacing South Africa’s Nkosazana Dlamini-Zuma.

One of the most remarkable advances in global health under the leadership of Dlamini-Zuma, was the formation of the Africa Centers for Disease Control and Prevention, a public health agency to lead the transformation of Africa’s health.

The birth of Africa CDC is timely and crucial because it will address the uneven burden of disease as evident in sub-Saharan Africa that carries 11 percent of the world’s population but 24 percent of disease burden as per the AU Commission Strategic Plan 2014-2017.

As the secretariat to the Civil Society platform for Health in Africa (CISPHA), we are elated to witness the formation of this historic initiative – which Africa’s civil society advocated for vigorously.

It is a significant opportunity for Africa to improve the health of its people – a key element in shaping the continent’s sustainable development. We urge Mahamat to strengthen this new outfit and anchor it as a centerpiece of his leadership.

The weakness of many institutions in Africa lack of clear leadership and sufficient resources. We hope that the chairperson will give the agency the support it needs – both in leadership and in resources – to allow it to achieve its mandate of achieving better health for the people of the continent.

A new research report from ACTION shows that while countries have taken steps in the right direction to combat the deadly duo of TB and HIV, policy improvements have not all translated into changes at the facility level.

The report, From Policy to Practice: How the TB-HIV Response is Working launched at the International AIDS conference in July 2016, affirms that of all the countries with high burdens of HIV-associated TB, the government of South Africa has most fully embraced TB-HIV integration and actively taken steps to implement collaborative activities. Support for TB-HIV collaboration flourishes within the Ministry of Health, who was the first country to develop a joint strategic plan for HIV, TB, and STIs.

South Africa’s government has been incredibly innovative in its fight against TB and HIV, and has recently begun to implement the recommendations in South African HIV and TB Investment Case published in March 2016. This investment case, which began as a requirement for a Global Fund HIV proposal and was taken further by the government, affirms that HIV and TB represent among the most serious of all health threats to the people of South Africa. South Africa is also in a unique position among high burden countries to scale up R&D for new diagnostics and treatments.

Despite the country’s strong efforts to fight TB and HIV, the report highlights a key challenge: A health system fractured between overburdened public clinics and well-resourced private providers accessible only to elites means that many people who need services are being left behind. To address inequity, South Africa is rolling out a national health insurance financing system over the next 14 years and is working to address quality of care in public clinics.4,5 For the “ideal clinic” concept to be realized, public health facilities, especially at the primary health care level, need to be resourced (i.e., financially and staffing-wise, with trainings to build capacity, and dissemination and implementation of new guidelines and policies).

On this World AIDS Day, ACTION partner WACI Health in collaboration with TB/HIV Care Association proposes to creating a moment where recommendations from the report From Policy to Practice: How the TB-HIV Response is Working along with the case study Combating TB-HIV in South Africa can be brought to relevant stakeholders including government, donors and civil society. This event will be taking place in Mdantsane NU 1 Community hall on the 8^th of December 2016 from 9h30.

The key messages are as follows:

1. The South Africa government should increase investment in research and development by 33 percent to support the advancement of new tools to fight TB and TB-HIV.
2. The Ministry of Health should work with primary health care facilities to support the implementation of TB-HIV policies.
3. Donors should continue to invest in high impact TB-HIV interventions and support sustainable national programs.
4. Civil society must work to promote equitable access to care and support community-based responses to TB-HIV care

For further information, please contact:

Sizwe Nombasa Gxuluwe, Waci health, email: nombasa@wacihealth.org, Cell:082640554

Nairobi, May 17-18 2016. In commemoration of the 2016 World AIDS Vaccine Day, representative civil society groups from the Eastern and Southern Africa (ESA) region convened to re-invigorate and accelerate Civil Society Action on investments and innovation in AIDS Vaccine Research and Development among other New Prevention Technologies (NPTs).

The timing of this meeting, hosted by WACI Health, KANCO, MANASO, EANNASO in partnership with IAVI, coincided with the process for the High Level Meeting on HIV&AIDS- a process that would lead to the endorsement of a political declaration reiterating commitment by UN member states to bring about an end to the AIDS epidemic.

Africa civil society had agreed to a common civil society regional position on the HLM, which included this specific language on preventive vaccines:Boldly pursue new scientific solutions and expand investment in research and development for improved diagnostics, easier and more tolerable treatment regimens, preventive and therapeutic vaccines, and other prevention technologies as well as a functional cure.

Is Prevention being left behind?

This particular language and demand, which set the tone for the 2 day’s meeting, had been inspired by concerns over slowed but not reversed tide of new HIV infections. As noted by Ms. Jacquline Makokha, UNAIDS Regional Support Team for Eastern and Southern Africa, in her remarks callingupon CSOs to join UNAIDS in its efforts to revitalize HIV prevention. She added that in overall, provision of large scale, effective HIV prevention interventions were yet to be optimized, hence the slow reduction of new infections. She further noted that with funding for prevention dwindling, fewer than one in five people at risk of HIV infection today has access to prevention programs.She elaborated on theUNAIDS quota for prevention campaign, which calls for 25% of all funding for HIV/AIDS programs to prevention efforts.

Still too many new infections

While prevention approaches including condoms, VMMC, antiretroviral treatment as prevention (TasP) and PrEP have brought about substantial reductions in new HIV infections, with a record of 14% decline in ESA region between 2010-2015, there are still too many people becoming infected worldwide to bring the epidemic to a halt. According to UNAIDS 2016 data, 2.1 million people became newly infected with HIV in 2015, globally. Eastern and Southern Africa is home to 960,000 of those, accounting for 46% of the global total of new HIV infections.

Need for new tools

The need for new tools to bolster existing strategies for prevention and ultimately end the pandemic is undeniably of paramount importance.  Glenda Gray, President of the South African Medical Research Council, and colleagues,in their paper on ending AIDS, argue that the widespread elimination of HIV will require the development of new, more potent prevention tools. The paper goes further to point out that true containment of the epidemic requires the development and widespread implementation of a scientific advancement that has eluded us to date—a highly effective vaccine. A safe, effective, licensed, affordable and accessible vaccine would help to sustain the impact of expanded access to existing treatment and prevention options.

Dr Borna Nyamboke of KAVI Institute of Clinical Research, in her remarks further stressed that efforts to ensure broader access to HIV testing and treatment as well as existing and emerging HIV prevention options must go hand-in-hand with efforts for additional ways to prevent HIV, including a vaccine.‘Indeed, there are now more tools than ever to help control the HIV epidemic, but an HIV vaccine remains a critical component of the long-term strategy for ultimately ending the epidemic.’

Long timeframe for availability; planning for access

While vaccine development is a slow, iterative process, now 35 years into the HIV epidemic, researchers believe that an HIV vaccine is closer than ever,given the probable start of new vaccine efficacy trials in 2016/2017. Results from theseefficacy trials would likely not be available until 2021. In addition, positive results are just the beginning of making a vaccine available to those who need it. Moving from trial results to licensure, wide-scale manufacturing and rollout plans can add several years to the process. Therefore, planning for access after positive results should take place in parallel with the research.

Advocates, donors, policymakers, regulators and funders all have a role to play in planning now to ensure that positive results from a trial are translated as quickly as possible to a safe, effective, licensed and widely accessible HIV vaccine.

HIV Prevention R&D Investment

Research on HIV&AIDS is identified as important in HIV and AIDS response world over with hopes for advanced treatment, vaccine, and a cure being purely hinged on HIV&AIDS Research. However, overall funding has remained at nearly the same level for approximately a decade. In 2015, preliminary reported funding for HIV prevention R&D decreased from US$ 1.25 billion in 2014 to US$1.18 billion. Changing funding dynamics and priorities in donor countries have shaped these trends and will continue to do so in years to come.  Currently, neither national budgets nor regional commitments to health demonstrate adequate investment in new HIV prevention R&D.

DrNdukuKilonzo, the Director of the Kenya National AIDS Control Council, speaking to the 36 CSO leaders from 13 countries in the ESA region, in her opening remarks made reference to NACC’s leadership towards increased investments for HIV research agenda in Kenya- an initiative that could be replicated in other African countries. NACC’s policy brief on domestic financing of the HIV and AIDS research agenda provides guidance on the policy directions required to ensure a greater return on investment. Most notably NACC willwork to ensure commitments of allocation of 2% of GDP to the National Research Fund (NRF) and 10% of total HIV spending to HIV research are materialized

Civil society role and commitment

Thirty six CSO leaders from 13 countries in the ESA region gathering in commemoration of WAVD 2016 at this meeting, reiterated their commitment to addressing HIV&AIDS, and a world without AIDS. To achieve that vision, civil society must not lose sight of two things:

• Making maximum use of the prevention and treatment strategies available right now.
• Investing in research and development of critically needed new prevention options.

The group further called Civil Society in Africa to strengthen and sustain momentum to support innovation and accelerate research & development toward new prevention options (like vaccines and microbicides), better treatment therapies, and a cure. The meeting underscored the need for Civil Society and communities to continue to discuss and share experiences on how CSOs are transitioning to respond to HIV R & D needs in the quest for an end to AIDS.

CS committed to step up advocacy and issued a call to action, boldly calling upon African governments to accelerate HIV R&D investments through:

1. Budgetary allocation of at least 15% of national budgets to health so as to increase funding to accelerate R&D for newer and improved health technologies including HIV new prevention technologies.
2. Budgetary allocation of at least 2%of ministries of health budget to research
3. 10% of HIV allocations be earmarked for research
4. 25% of HIV allocations be earmarked for prevention efforts

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.

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.