Abuja 12 Policy Briefs

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MALARIACONTROL:

DAYS TO MAKE

A DIFFERENCE

With just 900 days left to achieve the

Millennium Development Goals (MDGs),

strategic decisions need to be made

about investing in initiatives that yield

high economic, social and health

benefits. Malaria control has proven to be

a highly cost-effective public health

strategy to save lives, improve maternal

and child health and lift obstacles toeconomic development and children's

education.

Malaria-endemic countries in Africa are

highly committed to reducing the disease

burden and have been working together

through platforms offered by the African

U n i o n ( A U ) , t h e Wo r l d H e a l t h

Organization, the Roll Back Malaria (RBM)

Partnership and the African LeadersMalaria Alliance (ALMA). The AU has

framed a compelling vision for the future

of the continent and has developed

powerful health policy frameworks that

have resulted in a substantial reduction of

the malaria burden.

MALARIA FACTS

Malaria is an entirely preventable and

treatable vector-borne disease. Disease

transmission affects 99 countries around

the world, with an estimated 3.3 billion

people a t r isk . Worldwide, WHO

estimates that 219 million cases and

660,000 deaths occur each year, inflicting

a heavy economic and social burden on

families, communities and nations;90% of

all malaria-related deaths occur in sub-

Saharan Africa, mainly among children

under five years of age. The 17 most

affected countries account for over 80%

of malaria cases. The highest malariamortality rates are being seen in

countries that have the highest rates of

extreme poverty. At present, 25 countries

are en route to eliminating malaria and

many more have declared elimination as

a national goal.

PROGRESS IN REDUCING MALARIA

DEATHS AND CASES HAS BEEN

SUBSTANTIAL

In the course of the last decade, the global

effort to control and eliminate malaria

expanded significantly. As a result of a

scale-up of control interventions

including an expansion of access to long-

lasting insecticidal nets, indoor residual

spraying programmes, diagnostic testing

and quality-assured treatment more

t h a n a m i l l i o n l i v e s h a v e b e e n

saved.Malaria mortality rates decreasedby an estimated 26%globally and by 33%

i n A f r i c a b e t w e e n 2 0 0 0 a n d

2010.Worldwide, 50 countries (of which 9

Roll Back Malaria Progress & Impact Series: A Decade of Partnership and Results, 2011World Malaria Report 2012, World Health Organization, 2012Assessment published in the World Malaria Report 2012 World Health Organization 2012

900 DAYS TO MAKE A DIFFERENCE

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are in Africa) are now on track to reduce

their malaria case incidence rates by

75%, in line with World Health Assembly

and RBM Global Malaria Action Plan

targets for 2015.However, these 50

countries make up only 3% of estimated

global cases of malaria.

S H O R T F A L L I N F I N A N C I N GTHREATENS FURTHER PROGRESS

In order to move closer to 2015 targets,

and to achieve wider economic and social

b e n e f i t s a c r o s s A f r i c a , m a l a r i a

investments need to be expanded

markedly between 2013 and 2015. Recent

years have witnessed a gradual levelling

off of international funding, staying well

below the US$ 5.1 billion that would be

needed each year to achieve universal

access to life-saving prevention and

control measures. In 2013, the funding

gap for malaria control in Africa stood at

US$ 3.6 billion for the period 2013-2015.

Should efforts to maintain high levels of

coverage fail, malaria will resurge in

areas where commodities cannot be

provided to at-risk populations in time.

2013 is therefore a critical year formalaria financing. With sustained funding

and commitment, endemic countries can

continue to progress towards ending

malaria deaths, but without it, gains could

be quickly reversed, putting millions of

lives at risk.

Maintain high-levels of coverage with

malaria interventions

It is critical that malaria-endemic

c o u n t r i e s c o n t i n u e s c a l i n g u p

interventions to achieve universal

coverage of all prevention, diagnostic and

treatment interventions, in line with WHO

policy recommendations. Together with

the UN Special Envoy for Financing the

Health MDGs and for Malaria, the RBM

Partnership is rolling out a strategy tomobilize financial resources to help

endemic countries meet the 2015 targets.

This includes supporting the

MALARIACONTROL:

DAYS TO MAKE

A DIFFERENCEWHAT CAN BE DONE?


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replenishment of the Global Fund to Fight

AIDS, Tuberculosis and Malaria, which

currently provides approximately 60% of

all international financing for malaria.

Increased domest ic f inancing for

malariaand the development of innovative

financing mechanisms are also key

elements of this strategy. Possible

innovative financing tools include airline

ticket levies and financial transaction

taxes; private sector financing through

bonds; pooled or bulk procurement; and

improved local manufacturing -- as called

for previously by RBM and ALMA.RBM

partners are also working closely with

national malaria control programmes

to resolve key logistics and technical

challenges at regional and country

level.

Strengthen malaria surveillance and

response systems

Currently, only around one-tenth of the

estimated global case count is detected

by surveillance systems. Without

effective surveillance systems, it is

impossible to rel iably measure

progress towards malaria targets.

Strengthened surveillance would

Disease surveillance for malaria control. Operational manual, and Disease surveillance for malaria elimination. Operational manual, World Health Organization, 2012http://www.who.int/malaria/areas/test_treat_track/en/index.htmlRoll Back Malaria Progress & Impact Series: A Decade of Partnership and Results, 2011World Malaria Report 2012, World Health Organization, 2012Assessment published in t he World Malaria Report 2012, World Health Organ ization, 2012


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resistance containment and the Global plan for

insecticide resistance management.

ENGAGE SECTORS OUTSIDE OF HEALTH

In order to be effective, cost-efficient and sustainable,

malaria control efforts should be better integrated in

the work of key non-health sectors, and be considered

in the context of the broader economic, environmental

and social challenges faced by endemic countries.

Factors such as climate change, urbanization,

industrial and infrastructural investments, and natural

resources management can substantially influence

patterns of malaria transmission.Changes in

demographic and population dynamics andecosystems alsohave an impact on the epidemiology

of malaria and the required package of control

measures that need to be rolled out. With all these

elements considered, malaria control should become

an integral part of national development strategies.

Completing the unfinished business

In the remaining two and half years, the international

community and malaria-endemic countries should

intensify malaria control and elimination efforts and

scale up cross-border activities to prevent re-

introduction of the disease into areas that have

become malaria-free. Malaria should remain a high

priority in the post-2015 agenda, together with efforts

to strengthen maternal and child health services and

expandcommunity health worker programmes. A

strong focus on health system strengthening is also

key to making visible progress against this disease.

To sustain the gains made to date, national malariacontrol programmes need predictable international

donor funding, increased domestic investment and

innovative financing mechanisms that can tap into new

resources.Coordinated action through regional inter-

governmental mechanisms, such as the African Union,

will be critical for fostering national support for strong

multisectoral collaboration, improving surveillance

and fighting drug and insecticide resistance. Finally,

sustained political commitmentand an effective global

partnership under the umbrella of Roll Back Malariawill be fundamental to future progress.


enable Ministries of Health to

direct financial resources to

populations most in need, to

respond effectively to disease

outbreaks, and to assess theimpact of control measures.

RBM partners therefore urge

and support endemic countries

to strengthen their malaria

surveillance and response

systems in line with WHO and

RBM guidance released in the

2012. Malaria surveillance is a

critical foundation of WHO'sT3:

Test. Treat. Track.approach.

P R E V E N T D R U G A N D

INSECTICIDE RESISTANCE

The double threat of emerging

drug and insecticide resistance

poses an urgent challenge that

should be addressed at the

national level, with support

f r o m th e g lo b a l m a la r ia

community. Parasite resistance

t o a r t e m i s i n i n t h e k e y

component of recommended

combination treatments for

malaria has already emerged

i n t h e G r e a t e r M e k o n g

subregion of South-East Asia. A

further spreadof resistant

strains, or the independent

emergence of artemisinin

resistance in otherregions,could threaten the success

ofmalaria control efforts in

A f r i c a a n d a r o u n d t h e

globe.Resistance to at least one

insecticide has been reported

from 64 endemic countries

globally, with the majority of

these countries being in Africa.

It is critical that national

malaria control programmesi m p l e m e n t t h e

recommendations contained in

the Global plan for artemisinin

http://www.who.int/malaria/publications/en/4


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POLICY BRIEF

Introduction

In Africa we bear a disproportionate

burden of disease with for example, 75%

of the world's HIV/AIDS cases and 90% ofdeaths due to malaria. 50% of global

deaths under five occur on our continent

l a r g e l y d u e t o n e o n a t a l c a u s e s ,

pneumonia, diarrhea, measles, HIV, TB

and malaria. As well as communicable

d i s e a s e s , t h e i n c i d e n c e o f n o n -

c o m m u n i c a b l e d i s e a s e s s u c h a s

cardiovascular disorders, cancer and

diabetes are on the rise and are already

very significant public health issuesespecially in the North of our continent. It

is estimated that by 2020 Africa will have

60 mil l ion people suf fer ing from

hypertension and nearly 19million

people living with diabetes.

To date we have been overly reliant on

imports for our essential medicines

needs. It is often estimated that 70% of

essential medicines used in Africa are

imported from other continents. Thissituation leaves us vulnerable in terms of

security of supply, is not long term


LOCAL PRODUCTION

OF PHARMACEUTICALSIN AFRICA

sustainable for the treatment of the

pandemics in the post MDG era, and

given the impossible task facing our

regulators to quality assure a vast

supply base, contributes to the scourgeof counterfeit and sub-standard

medicines.

We need to reorganize and strengthen

our pharmaceutical industry so that it

can explicitly help us in meeting our

medicine needs medicines that live

up to the acceptable international

standards of quality, safety and efficacy

and that are affordable. The African

Union Commission (AUC) with support

from the United Nations Industrial

Development Organization (UNIDO)

has developed a Business Plan for the

accelerated implementation of the

Pharmaceutical Manufacturing Plan for

Africa (PMPA). The plan recognizes the

different contexts that our countries and

regions face as well as the complexity of

the pharmaceutical industry. It sets out apractical approach to developing the

industry on our continent so that, first

and foremost, it can serve to improve

access to quality medicines to our

people.Through implementation of this

plan we will become less dependent on

importsand improveour self-reliance.

A s t ro n g e r a n d re l i a b l e l o c a l

pharmaceutical industry would also

c o n t r i b u t e t o t h e e c o n o m i c

development, job creation, humanresource development and associated

industrial development.

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Fig 1. Illustration of the foundations

required, key interventions and

ultimate ambition for developing

the pharmaceutical industry in

Africa

{Greek temple diagram}

The PMPA Business Plan key

Pillars

In order for our pharmaceutical

industry to develop there is a need

to create a conducive environment

which can be achieved through:

enhancing the talent pool for thep h a r m a c e u t i c a l i n d u s t r y

facilitating access to investment

capital and providing well-tailored

but t ime l imi ted incent ives

strengthening the regulatory

control of our pharmaceutical

markets and industry facilitating

our companies to access know how

and technoloy facilitating market

a c c e s s a n d i m p r o v i n g t h e

availability of market data.

Human Resource Development

The pharmaceutical industry is

knowledge intensive and requires

a workforce of highly skilled

professionals. We have the skills on

our continent but we need to

expand this talent pool and equip

our pharmaceutical industry with

the practical knowledge of how top r o d u c e m e d i c i n e s o f

i n t e r n a t i o n a l s t a n d a r d a t

competitive cost.

Investment Capital and Time

limited Incentives

Pharmaceutical companies need to

make significant investments and

require access to capital with long

term maturity and at affordablerates. Demonstrable commitment

from African leaders will increase the appetite for the

sector amongst the investment community but there

is a need to facilitate and support investment through

initiatives such as context specific and time limited

incentives. For example India supported the

development of its industry over decades through

incentives such as interest subsidies, working capital

credits and export incentives. Many of the products

that we import still benefit from export incentives and

there is a need to level the playing field if our

manufacturers are to be competitive and be able to

invest.

Increased Regulatory Control

For our companies to be able to invest they need tobe protected from the unfair competition of,

sometimessub-standard and even counterfeit

products requiring greater oversight of the market

place. To assist our companies to develop and to

mitigate risk to public health it is necessary to

implement a roadmap towards international quality

standards that they will be supported to and required

to follow, and this should be enforced by our vigilant

and strengthened regulatory authorities.

Access to Know How and Technology

In the short term it will be necessary to enable

companies to access the requisite skills and know

how to develop and implement upgrading plans in

accordance with the road map to international

quality standards. We also need to expand the range

of products manufactured in Africa and to realize the

opportunity for improving access to for example

second line ARVs that could be achieved through the

TRIPS flexibilities.

Facilitating Market Access and Improving the

Availability of Market Data

The Business Plan is closely aligned with the African

Medicines Regulatory Harmonisation (AMRH)

initiative. Through defragmenting our regional

markets the business environment for our

manufacturers will improve as they will be able to

serve a larger market with the efficiencies in

production that can then materialize.

There is limited market data available such that it isdifficult for companies to make informed decisions

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and for investors to properly assess the risk and opportunity that the

industry presents.

The PMPA Business Plan Implementation

The development of the industry requires coordination and collaboration ofa number of different players at national and regional levels. Therefore

political will is essential as is establishing policy coherence across

ministries to support our companies and establishing a sound multi

stakeholder strategy.

The Business Plan recommends that a consortium of development partners

must work together to provide technical assistance and capacity building

across the different dimensions of pharmaceutical sector development.

The nucleus of the consortium which is being convened under the authority

of the African Union will be made up of the African Development Bank,

UNAIDS, UNIDO and the World Health Organization (WHO). Other partners

such as the New Partnership for Africa's Development (NEPAD), the

Federation of African Pharmaceutical Manufacturers Associations (FAPMA),

the African Network for Drug and Diagnostic Innovation (ANDI) and the

United States Pharmacopeial Convention (USP), amongst others, also have

an important role to play.Subject to invitation from the AUC, the consortium

of partners is open to contributions from yet other agencies who are

interested in supporting local production in Africa.

Conclusion

Developing the pharmaceutical industry on our continent can contribute toimproved access to essential medicines, sustainability of treatment

programmes and to economic development. The PMPA Business Plan sets

out a practical approach that recognizes the complexity of the

pharmaceutical industry and the different situations that our countries face.

A consortium of African and International Partners is being convened to

provide coordinated technical assistance and capacity building so that we

reduce our reliance on imports, are able to provide high quality affordable

products for our people, can sustain treatment programmes in the post MDG

era and contribute to economic development through import substitution

and exports to international markets.

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1. Fighting TB is a prerequisite for fostering

economic growth, ending poverty and improving

livelihoods - addressing TB must therefore be

prioritized in national government programs

At a macro-economic level, TB significantly hampers

the economic development of middle- and low-

income countries. According to the recent report of

the High-Level Eminent Panel on the post-2015

development agenda, investment in TB will yield a 30-

fold return.

TB is a d isease that worsens poverty and

disproportionately affects poor communities. Studies

suggest that TB patients are out of work for an averageof 3 4 months; that household incomes decrease by

up to 80% as a result of a family member contracting

TB; and that each TB death deprives a family of 15 years

of income. TB creates a vicious cycle, with TBpatients

remaining poor because of the devastating impact it

has on their families' life.

The 2012 SADC Heads of State Declaration on TB in the

Mining Sectoris a response to the economic impact of

TB on a prominent African industrial sector. The recent

Swaziland Statement highlights solutions for a multi-sectoral, regional and international response to the

problem of TB in Africa.

BACKGROUND

Studies in Bangalore showed a decrease of household income due to TB diagnosis costs of 80%. In Malawi, studies

indicate that the income of a family decreased by 49%, in Yangon/Myanmar by 68% due to a TB infection of a family

member Stop TB Partnership (2000) Tuberculosis and Sustainable Development Geneva: Stop TB Partnership

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1. A cce l e r a t e d a c t i o n t o

integrate TB and HIV services in

Afr ican countr ies where co-

infection rates are highest will lead

to substantial cost-savings and

improved health and economicoutcomes

A key stumbling block to progress

in the fight against TB in the region

is the extremely high co-infection

rate of TB-HIV. In 2011, 80% of all

new TB-HIV cases in the world were

in Africa. 75% of all 435,000 people

wi th HIV who died o f TB in

2011worldwide were from Africa.

The impact of what can be achievedthrough integrated TB and HIV

services is remarkable: between

2005 and 2011, 1.5 million lives

were saved due to TB and HIV

integration. While this is notable

progress, much remains to be

done.Enhanced collaboration

between HIV- and TB-services is

required, too often patients are still

going to different sites, but patients

who have both diseases should be

seen and treated by one health

worker. The objective must be that

every HIV patient is tested for TB

and every TB patient is tested for

HIV, and that treatment is easily

provided.

Conclusions

We are the closest we have ever

been to defeating TB forever.

Impressive progress over the last

five decades shows that TB can be

stoppedwith strong political will

and adequate financial resources.

New tools are now available with

which to accelerate progress. We

must set ambitious targets against

TB if we are to overcome poverty,

foster economic growth and save

millions of lives. Health Financing

in Africa

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HEALTHFINANCING

IN AFRICA

The Heads of States' commitment toincrease government funding for health has been

emphasizedin the Abuja Declaration of 2001.The same commitment by Heads of state

has been reiterated inthe Africa Health Strategy: 2007-2015; the 2008 Ouagadougou

Declaration on Primary Health Care and health systems strengthening; the World Health

Assembly resolution 68.5 on sustainable health financing structures and universal

coverageand the 2012 Tunis Declarationof the Ministers of Health and Finance on value

for money, sustainability and accountability in the health sector. There is broad

agreement that sustainable,adequate and fair financing for health is one of the

prerequisite to achieving country and international health goals and MDGs.

Keys messages:

Member states of the African Union are onaverage still far from meeting key health

financing targets of the Abuja Declaration. In 2010, only 5 countries reached the target of

allocating at least 15% of their annual budget to health.

Twenty eight countries out of fifty spent the minimum of US$ 44 per capita as

estimated by the High Level Task Force on Innovative Financing for Health Systems

(HLTF). Only three countries in Africa reached the targets set in both the Abuja

Declaration and the HLTF report;

Out-of-pocket payments (OOP) still represent more than 20% of total health

expenditure (THE) in 40 countriesin Africa..

Only one country has managed to spend more than 15% of their annual budget,

the minimal level of US$ 44 per capita expenditure and OOP less than 20% of THE as

shown in figure 1.

A key challenge for member states and their partners is to ensure effective and

efficient use of availableinternational and domestic resources, improved

predictability,alignment to national priorities and use of government mechanisms;

The reinforced dialogue between Ministers of Health and Finance, as spelt out in

the Tunis forum organized by HHA in 2012, has shown increased engagement towards

financing for health and improving the effectiveness of available resources.

Member States are often challenged by conflicts, natural and man-made disasters

with significant public health consequences calling for provision of funds to address

these threats; in this regard financing of the African Public Health Emergency Fund

(APHEF) by member states should be prioritized.

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Financial risks and barriers to access to health

services

As shown in Figure 1, although 29 countries

have reached the level of US$ 44 THE percapita, 22 of these haveOOP payments

exceeding 20%of THE. This level is higher than

the ceiling at which financial risk protection

can be ensured. Countries that have reached

the US$ 44 per capita but have a high level of

OOP payments stil l need to focus on

developing and strengthening pooled

prepayment mechanisms. The potential to

identify new sources of tax revenue such as

sales taxes and currency transaction fees can

also be further explored. Ghana, for example,

has funded its national health insurance

scheme (NHIS) partly by increasing the value-

added tax (VAT) by 2.5%.

Domestic funds for health

Many African countries have limited capacity

to raise public revenue mainly because of the

informal nature of their economies. This

makes tax collection difficult including payroll

tax collection for social health insurance.The

p e r f o r m a n c e , a c c o u n t a b i l i t y a n d

administration of the tax system are often an

additional problem for many countries.

The extent to which countries will mobilize

public financial resources for health will

depend on the level of economic development

in that, countries with a high GDP percapita will

do better. This explains to a large extent why

countries, with comparable GGE as a

percentage of GDP will have significantly

different levels of THE per capita. Gabon is an

example here with a government expenditureof US$ 2410 per capita while others, with a

similar share of GGE over GDP (28%) for

example Malawi, spend only US$ 110 per

capita on health.

The capacity of countries to generate public

financial resources lies outside of the health

sector to a large extent. Health advocates

wishadditional reve nue streams to be

earmarked for health but very often they are

not. In general however, raising more public

revenues should indirectly benefit the

health sectorwhose share, even it is not

increased, will be from a larger resource

envelope.

External funds for health

Although external sources play a significant

role in financing health services in low

income countries, the current level of

funding still falls below commitments. It

would be possible to achieve a significant

increase in international resources for

health, if donor countries would fulfill their

promise to allocate 0.7% of their gross

n a t i o n a l i n c o m e ( G N I ) t o o f f i c i a l

development assistance (ODA). In 2009

only 5 out of the 22 donors met this

requirement.

Key recommendations

R e i n f o r c e f i n a n c i n g f o r

h e a l t h t h r o u g h n a t i o n a l s t r a t e g y

emphasizing appropriate policies for

revenue collection; using sound methods

and approaches such as sharing financial

risks and ensuring equitable and efficient

use of resources. .

C o n c r e t i z e e n g a g e m e n t

toimplement Universal health coverage

through strong and sustainable health

systems based on PHC.

Increase funding for health from

innovative financing, prepaid mechanisms

and pooled sources for health.

Sustainthe current process of dialogue between ministries of health and

f i n a n c e t h r o u g h i n t e r - m i n i s t e r i a l

committees, strategic alliances, and the

presence of senior health officials in

bilateral and multilateral discussions

between government and development

partners.

Prioritize fundingof the African

Public Health Emergency Fund, which was

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established by Ministers of

Health and endorsed by the AU

head of state of the AFRO region.

Improve effectiveness of externalfunding through addressing

identified challenges among

such as unpredictability and

fragmentation of health systems..

AU: Abuja declaration on HIV/ADS, Tuberculosis and other related infectious diseases. Abuja, Nigeria, April 2001.

CAMH/MIN: Africa Health Strategy (2007-2015). Addis Ababa, Ethiopia, November 2007.WHO/AFRO: Ouagadougou declaration on Primary Health Care and health systems strengthening:

Achieving Better Health for Africa in the New Millennium. Ouagadougou, Burkina Faso, April 2008.WHO: The Sixty-fourth World Health Assembly on Sustainable health financing structures and

universal coverage. Geneva, Switzerland. May 2011.HHA: Tunis declaration on value for money, sustainability and accountability in t he health sector.

A joint Declaration by the Ministers of Finance and Ministers of Health of Africa. Tunis, Tunisia. July 2012.AU: Decision on the Establishment of the African Public Health Emergency Fund (APHEF) -Doc. Assembly/AU/18(XIX) Add.4. Dec.436(XIX).The indicator %GGHE/GGE does not necessarily mean domestically generated resources only.If external resources are flowing through the government, these will be captured as well.Governance, taxation and accountability: issues and practices.Organization for Economic Co-operation and Development. Paris. 2008.WHO/AFRO: State of health financing in the African Region. Brazzaville. January, 2013.


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Burden of disease

The African Region has a high disease burden, with only 10% of the world population,

the Region's contribution to the global burden of HIV/AIDS, TB and malaria is 66%,

26% and 80% respectively. In general it contributes24% of global DALYS. It accounted

for 46% of Under-five deaths in 2011; 55% of the maternal deaths; 22% of AIDS-relatedand 90% of the malaria deaths. Thirteen countries are on track to meet MDG 4, while 24

are making progress, though insufficient. Only two countries (Eritrea and Equatorial

Guinea) are on track to meet the MDG 5 target.

Issues and challenges related to health systems

The goal of a health system is to improve the health of people in a manner which is

equitable, efficient, responsive and financially fair. A health system needs staff, funds,

information, supplies, transport, communications and overall guidance and direction

to function. Strengthening health systems thus, means addressing key constraints in

each of these areas. Some of the weaknesses and challenges identifiedinclude weakpolicies and guidelines; low public expenditure on health with only five countries

reaching the Abuja 15% target; shortage of adequately trained and motivated health

workers; inadequate supply and regulation of essential medicines, medical products,

and technologies; fragmentation of the health information system which is not fully

utilized and, low coverage of health services. In addition, health systems are sensitive

to weak governance, accountability, political instability, natural disasters,

underdeveloped infrastructure, and economic and financial instability.

Opportunities for Health Systems Strengthening

There is a strong and growing political willingness at various levels to strengthen

health systems. Governments have increased the proportion of their national budget

allocated to health. Regional initiativesundertaken include the Abuja Declaration to

increase government funding for health, the Ouagadougou Declaration on Primary

health care and health systems in Africa, the Africa Health Strategy 2007-2015 of the AU

and, the Tunis Declaration on value for money, sustainability and accountability in the

health sector. The region has shown innovation through increased and structured

participation of communities to improve the coverage of essential services through

Community Extension Workers as seen in Ethiopia, Rwanda and Mali. The amount of

Overseas Development Aid to the health sector has increased. Some global health

initiatives such as the Global Fund and the GAVI Alliancehave opened financial

windows for health system strengthening. Global and regional partnerships such as

the International Health Partnership (IHP+) and the Harmonization for Health in

Africa(HHA) have the objective to move towards better coordination and alignment of

donor funds to country priorities. These are all important conditions for effectively

strengthening health systems to meet the MDGs and move towards universal health

coverage.

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Recommendations

Governments should provide political leadership with effective regulation,

oversight and governance for health through formulation of national policies,

strategies and plans.

Governments' investment plans should focus on building institutionalcapacity, promoting equity in access to services by decentralizing health systems

and, enhancing community empowerment to participate in the management of

health services through a high commitment to PHC approaches.

Increase investment in health by allocating more funds to health from national

budgets whilst ensuring efficient utilization of all available funding. In addition,

there is need to reinforce advocacy for sustainable financing of health systems.

Countries should seize the opportunity of resources provided by global

health initiatives to strengthen the health system in a comprehensive manner.

Through independent bodies, countries should develop a scorecard on

health system performance and regularly high authorities on the progress made in

health system strengthening.Strengthen all the building blocks of the health system; increase the quantity

and quality of the health workforce, ensure availability and rational use of essential

medicines and other health commodities, improve and expand available

infrastructure, improvehealth information management systems and IT innovation.

Conclusion

Effective public health interventions are available to curb the heavy disease burden

in Africa. Unfortunately, health systems are often too weak to efficiently and

equitably deliver those interventions to people who need them, when and where

needed. Strong health systems are an effective means of improving the health of the

people of Africa.In addition to health being a human right, the dividend of a

healthier population in Africa is very high given the fact that healthy individuals are

more productive, and have a positive impact on the gross domestic product (GDP) of

a Nation. Therefore, investing in African health systems is an opportunity to

accelerate economic development, contribute to saving millions of lives, prevent

life-long disabilities, and move countries closer to achieving objectives of national

poverty reduction strategies, the Millennium Development Goals (MDGs) and

prepare them to move towards meeting the challenges of the post 2015 development

agenda

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Scientific advances and their implementation

have brought the world to a tipping point in the

fight against AIDS. The science guiding

interventions that address HIV risk reduction,

prevent transmission, and reducemorbidity

and mortality is now clear and established.

Enhanced country and programme capacity,

improved efficiencies, increased community

engagement and participation, and innovative

application of new technologies are helping

scale up the accessibility and utilization of

programme interventions, and achieving an

'AIDS-free generation' is now within reach.

Eliminating new HIV infections in children and

keeping mothers alive is critical to achieving

this goal, and the Global plan towards theelimination of new HIV infections among

children by 2015 and keeping their mothers

alive, endorsed by Africa leaders, UN

agencies, and development partners and

launched in 2011, has set a goal of reducing

new infections among children by 90% from

baseline 2009 levels.

Of the world's 34 million people living with

HIV, 23.5 million are in Sub-Saharan Africa, and

21 of the Global Plan's 22 focus countries are inAfrica. African women bear the majority of the

world's epidemic. 92% of all pregnant women

living with HIV are in Sub-Saharan Africa, and

60% of Africa's infections are among women.

Without intervention, up to 40% of these

women would pass infection on to their

babies. Much progress has been made,

particular in eliminating new infections

among children, with a 24% reduction in new

infections among children between 2009 and

2011, and a 40% reduction since 2003. InAfrica, 7.1 million people are now receiving

treatment, and 57 per cent of pregnant women

living with HIV received ef f icacious

antiretrovirals (ARVs) for prevention of mother

to child transmission (PMTCT). Access to early

infant diagnosis (EID) for HIV within the first

few weeks of life by infants born to women

with HIVinfection has increased to 35% in

2011, and while paediatric ART coverage has

steadily increasedonly 28% of children

needing treatment received it %in 2011. .

Special Summit on

HIV/AIDS, Tuberculosis

and Malaria

POLICY BRIEF:ELIMINATIONOF MATERNAL TOCHILD TRANSMISSIONJULY 2013, ABUJA, NIGERIA


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womenshould make concerted efforts to fully address other programme components

needed to achieve elimination goals, including primary prevention among women of

reproductive age,family planning and birth spacing and treatment for the health of the

mother It remains essential to include women, their partners, PLHIV networks,communities, civil society, and the private sector in the design and implementation of

programmes scaling up access to care, treatment, and support services. Efforts must

be pursued to ensure that health service delivery mechanisms for both MNCH and

care and treatment platforms are responsive to the needs of pregnant and postnatal

women living with HIV, and to the ongoing needs of these mothers, their partners, and

families. Universal access depends on communities supporting adolescent and family

friendly HIV testing and counseling, without stigma and discrimination, and

concerted national and subnational leadership is needed to make universal access a

reality.

2) Leveraging synergies, linkages and integration for improved sustainability.

Integrating HIV prevention and treatment for mothers and children into existing

platforms for maternal, newborn, and child health, antenatal care, and family

planning, will strengthen synergies, optimize outcomes for all women, and increase

cost effectiveness and sustainability. Prevention and treatment should not be 'stand-

alone', one time interventions, and more effective integration should not only increase

access but also promote entry into a continuum of care across multiple health services,

ensuring that HIV interventions contribute to global maternal and child health goals

and strategies. This is particularly true in Africa, where the AIDS epidemic accounts

for significant proportions of maternal and child mortality and morbidity. Integration

is essential for improving loss to follow-up, strengthening referral linkages, effectively

linking primary health care and treatment, increasing maternal and child access to

longer term treatment, and promoting community mobilization and engagement.

3) Country ownership and accountability. Because countries have diverse epidemics

and are at different stages of implementation in their efforts to eliminate new

infections among children, it is essential that the leadership and development of

context specific elimination plans rest at the country level. Strategic planning, priority

setting, and performance monitoring must be led and coordinated at both national

and decentralized levels, in collaboration with all critical stakeholders. Efforts to

improve monitoring and progress reporting should also promote more active use ofdata for programme planning, priority setting, and decision making at decentralized

levels. Country programs and their development partners must make adequate

human and financial resources available and adopt evidence-informed policies. The

sharing of best practices and lessons learned across countries needs to be improved,

and additional support provided at regional levels to promote effective frameworks

for cooperation and accountability. The roles, responsibilities, and contributions of all

stakeholders need to be clear, specific, and transparent, and to ensure the efficient

and effective use of resources, as well as address agreed upon gaps, bottlenecks, and

capacity building needs, national leadership is needed to ensure the adoption and

utilization of clear monitoring and evaluation frameworks and indicators to promoteaccountability and routinely assess programme progress.

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Introduction

A c c o u n t a b i l i t y h a s b e e n

identified as a key factor in

improving the response to AIDS,

TB and Malaria and the broader

health and development agenda

i n A f r i c a a n d w o r l d w i d e .

Accountability and transparency

plays a key role in promotinghealth policy development and

h e a l t h c a r e s e r v i c e

de l i v e r y . A cco u n t a bi l i t y i s

ensured through information

provision on set targets and

commitments, ensuring feedback

mechanisms, consultation and

p a r t i c i p a t i o n o f k e y

stakeholdersat all levels.

AIDS, TB and Malaria have remained high on the

African Union political agenda with several

commitments to address the challenge since

the 2000 and 2001 (Abuja Declaration). Over thepast twelve years, AIDS Watch Africa has served

as an African-led advocacy and accountability

platform to press for the urgent acceleration of

continental action to combat AIDS with a

broadened mandate in 2012 to also address TB

and Malaria.

Timeline of the African Union and AIDS Watch

Africa key commitments

2001: Abuja Summit on HIV/AIDS, TB and Other

Related Infectious Diseases, eight Heads of

State and Government; AIDS Watch Africa

(AWA) created as an advocacy platform at Head

of State level to monitor the African response

and mobilize resources.

2003 Maseru Declaration on HIV and AIDS/

Maputo Declaration on Gender Mainstreaming/

Maputo Declaration on HIV/AIDS, TB, Malaria

2004: AWA Secretariat was relocated to the AU

Commission

2003 The Protocol Relating to the Peace and

Security Council (PSC) of the African Union

(especially around violence)

2004-2005 Protocol to the African Charter on

Human and People's Rights on the Rights of

Women in Africa (Maputo Women Protocol)

2004 Solemn Declaration on Gender Equality inAfrica (SDGEA)

2005: Continental HIV/AIDS Strategic

Framework and AWA Action Planapproved

2005: Maputo Plan of Action for implementing

the Continental Policy Framework on Sexual

Reproductive Health and Rights (SRHR)

Accountability

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2005 Continental Policy on Sexual

and Reproductive Health and Rights,

(Maputo Plan of Action related)

2006: Brazzaville Commitment on

Scaling Up Towards Universal Access

to HIV a n d A IDS p r e v e n t io n ,

treatment, care and support in Africa

by 2010

2 0 0 6 : R e a f f i r m a t io n o f A b u ja

Declaration Plan of Action Special

Summit of the AU on HIV/AIDS, TB,

and Malaria (ATM) adopted

2006 Maputo Plan of Action, Plan of

Action on Sexual and Reproductive

He a l th a n d R ig h ts 2 0 0 7 - 2 0 1 0

(renewed till 2015)

2007: African Union Ministers of

Health adopt Africa 's Health

Strategy;

2010: AU Heads o f S ta te andGovernment approve A Partnership

For The Elimination of Mother-Child

Transmission of HIV in Africa

2010: African Union launches

Campaign for the Accelerated

Reduction of Maternal Mortality in

Africa (CARMMA)

2011: AU adopts Common Position onHIV/AIDS in activities pertinent to

the prevention and resolution of

conflict and post-conflict peace-

building

2012: AU Heads of State and

Government adopt the African Union

Roadmap on AIDS, TB and Malaria

(2012-2015)

Translating political commitments

into action

While political commitments play a vital

role in delivering results, critically

important is the need to translate

commitments into action. To ensure thatthat this is achieved accountability

mechanisms need to be institutionalised to

hold all stakeholders accountable to set

targets. The revitalisation of AIDS Watch

Africa in 2012 is a significant step in

ensuring that there is High Level

Accountability on the three diseases. The

Alliance of African Leaders on Malaria in

Africa has taken key steps in ensuring that

governments remain on track on their

Malaria commitments. Various civil society

organisations have developed scorecards

on AIDS, TB and malaria related to the

African commitments and haveemployed

various engagement strategies including

lobbying and advocacy at various levels to

ensure implementation of commitments.

Accelera ting the implementation of

African Commitments on AIDS, TB and

MalariaOver the years, quantitative and qualitative

approaches to measure the performance

of various stakeholders against their

commitments have generated some

recommendat ions to improve the

implementation of these commitments.

-Need to ensure that sets targets are

measurable- there is need to ensure that

commitments arequantifiedand costed toadequate monitoring and evaluation.

-Commitments have no teeth without the

money to back them up-Funding is

required by governments in order to roll

out commitmentsIf a commitment is left

unfulfilled and unattained they become

toothless, and this has a knock on effect for

other commitments. Every commitment

that is made and then ignored and notattained undermines the entire process of

having commitments.

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-Government needs to be involved more in the drawing up of the recommendations

early in the process.In many countries government still sits with more knowledge of

what is really happening on the ground and what can be realistically rolled out than any

other group, including civil society and funding partners. They need to be consultedand their political buy-in secured from the early stages of the design of the

commitments.

-Tracking mechanisms for various commitments do not exist- There is need to ensure

that the impact and roll out of commitments is monitoring and evaluation systems exist

to track progress, outcome and impact.

-The roles of implementing partners in the commitment should be clearly spelled out to

ensure clear division of labour for greater accountability.

-Civil society should not undermine thelong term accountability mechanisms or

capacity of government and development partners- governments are ultimately

accountable government to provide services.

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Abuja 12 Policy Briefs

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