By the Treatment Action Campaign (South Africa), AIDS and Rights Alliance for Southern Africa, RAVANE+ PVVIH Network for the Indian Ocean Region (Mauritius) and the Grassroots Empowerment Trust (Kenya)
HIV is not in recession! TB is not in recession!
May 6, 2009 -- On the occasion of the Conference of African Ministers of Health in Addis Ababa, Ethiopia, a coalition of health advocates from sub-Saharan Africa warn that the lives of millions of people in sub-Saharan Africa are in jeopardy because of the lack of political will and investment to realise the right of access to life-saving treatment. Only one third of HIV-positive people in need of antiretroviral therapy (ART) to survive have access to treatment in the African region. The coalition fears that national and donor governments are betraying their health commitments, particularly promises to support the universal roll-out of ART by 2010.
"The broken promises and skewed priorities of governments and donors have reduced the right to health and access to treatment to unattainable rhetoric. In the last few months, we have seen trillions of dollars spent on financial ‘bailouts’ to stimulate economic recovery”, said Nonkosi Kumalo of the Treatment Action Campaign. "A tiny portion of this sum could have bought quality, sustainable healthcare for millions of people." Dr Bactrin Killingo of the HIV Collaborative Fund warned that “if the current cost constraints faced by HIV treatment programs are not addressed, while the demand for expensive second-line treatment increases, we will find ourselves in a situation similar to the ’90s, where millions of lives were lost unnecessarily because people could not afford the treatment they needed to stay alive”.
Africa: 68% of AIDS sufferers, 2% of health workers
The region of sub-Saharan Africa bears the greatest burden of disease, and has 68% of the world’s HIV-positive people but only 1% of the global expenditure on health, and 2% of the global health workforce. A recent African Union report states that sub-Saharan Africa faces “a grim scenario with respect to the health of its people”, estimating that only 7% of total government expenditure in the region goes to health despite the 2001 Abuja Declaration commitment to commit 15% of government expenditure to health.
These shortcomings will be highlighted at the CAMH in Addis Ababa, where the Africa Public Health Alliance is submitting a petition to African heads of state and ministers of health and finance to close the US$10.7 billion funding gap for regional implementation of the Global Plan to Stop TB. Most governments in the region cover less than half of their national health budgets with national resources, while the rest comes from out-of-pocket spending or international funders – most notably, for HIV and TB, the Global Fund. The financial support of the Global Fund and other donor agencies has had a remarkable impact on scale-up of services in sub-Saharan Africa.
The Global Fund reports that it has saved an estimated 2.5 million lives worldwide and has disbursed 57% of international donor aid raised for TB, 50% of malaria, and 23% of funds for HIV/AIDS. However, the increasingly steep trajectory of demand for Global fund grants, coupled with dwindling donor input and the global economic crisis, have resulted in the Global Fund announcing that it is at least $4 billion short of the money that it will need to continue funding essential HIV, TB and malaria services in 2010.
In 2005, the leaders of G8 countries, the richest nations in the world, committed to the goal of universal access to ART by 2010 – a goal that governments across the world pledged to support. Many of these same countries are now becoming antagonistic towards disease-specific funding, calling instead for “horizontal” approaches to health financing such as the International Health Partnership, without committing to the massive increases in funding that would be necessary to finance health across the board.
Containing disease should be top priority
The coalition rejects pitting HIV against other diseases. Contrary to what some influential health economists and ``development experts'' are claiming, there is ample evidence that ARV roll-out has strengthened health systems, and the work done by AIDS service organisations has revolutionised healthcare in the developing world. African heads of state in 2001 stated that, “We are fully convinced that containing and reversing the HIV/AIDS epidemic, tuberculosis and other infectious diseases should constitute our top priority for the first quarter of the 21st century”. This conviction is not reflected in the resources that African governments have commited to health, nor in the lethargic progress towards scaling up TB and HIV programs in the region. The global economic crisis threatens to worsen this situation, with a recent World Bank report estimating that the negative impact of this crisis on HIV programs will affect 70% of people on ART in Africa within the next 12 months.
Said Paula Akugizibwe of the AIDS and Rights Alliance for Southern Africa (ARASA): “We need to ensure that African lives do not become a silent casualty of the global financial downturn. Our lives are not cheap or expendable. We expect health to be prioritised over weapons, sports and lavish politics.” ARASA hosted a meeting on financing for Eastern and Southern African HIV/TB activists last week, out of which this coalition was formed to advocate around several key messages:
“We believe that health is our right. We are committed to sustained, universal access to ART. We are committed to prevention and treatment for TB, malaria and other illnesses that devastate our communities. We demand that African governments and donors honour their commitments to funding for health, and close the resource gaps as needed to secure universal access to HIV and TB treatment. Through a sustained and coordinated regional campaign, we will fight for our non-negotiable right to health until it is realised.”
May 8, 2009
BEIJING, May 8 (Xinhuanet) -- The Maternal mortality rates for sub Saharan Africa are extremely high at about 1,000 deaths per 100,000 live births in the past 10 years due to lack of medical facilities, according to a World Health Organization expert Thursday.
WHO director for Africa Luis Sambo said large number of women dying while giving birth has still not improved in Africa over the past decade.
According to the WHO, some 1,500 women die daily from complications related to pregnancy and childbirth on the continent because they have no access to skilled emergency care.
African health experts Wednesday called for innovative strategies to bring down mortality rates within the framework of access to health care for better maternal, neonatal and infant health.
They also recommended greater surveillance of traditional medicine and taboos, which have a negative impact on maternal, neonatal and infant health.
Ministers of health from African Union's 53 member states are meeting in a two-day meeting in Ethiopia to seek ways to slash maternal and infant deaths.
By Kristin Palitza
CAPE TOWN, May 18 (IPS) - International donors and African governments are likely to cut health budgets due to the global financial crisis. Health experts fear that increasing unemployment and poverty will lead to less food security and quality of nutrition, which will in turn put more stress on already weak health systems.
The implications, warns a newly-released World Bank report, could be grave.
"We need to ensure that African lives do not become a silent casualty of the global financial downturn," demanded Paula Akugizibwe, regional treatment literacy and advocacy coordinator of Windhoek-based AIDS and Rights Alliance for Southern Africa (ARASA) in Namibia.
"Our lives are not cheap or expendable. We expect health to be prioritised over weapons, sports and lavish politics," she added.
Tanzania was the first sub-Saharan country to announce a 25 percent cut of its annual HIV/AIDS budget.
"This will have a significant impact on human resources in the sector and on health service delivery," explained Akugizibwe. "Long-term health planning will become completely unpredictable."
The situation is not much better in neighbouring countries. The South African government has indicated that large private firms, especially mining companies, are likely to cut their HIV prevention programmes affecting thousands of employees and their families.
Even worse, Botswana’s presidential spokesperson Jeff Ramsay recently announced government will not be able to include new patients in its free antiretroviral (ARV) treatment programme from 2016 onwards, because it doesn’t have sufficient funds to expand the programme.
All this stands in direct contradiction to a commitment to set aside 15 percent of their national expenditure towards health made by African heads of state during a meeting in Abuja, Nigeria, in 2001.
"Very few countries have met this goal. The money is there. It’s all about prioritisation of resources," Akugizibwe told IPS. "The situation is very frightening, because governments cut back on already insufficient HIV treatment and care programmes," she warned.
Even international donor organisations have started to feel the financial crunch. The Global Fund to Fight AIDS, Tuberculosis and Malaria recently announced it is at least $4 billion short of the money it will need to continue funding essential HIV, TB and malaria services in 2010. The coalition believes there is a $10.7 billion funding gap for regional implementation of the Global Plan to Stop TB alone.
To mitigate the impact of the financial crisis on HIV health service provision, a number of AIDS and tuberculosis (TB) activists from across Sub-Saharan Africa – including ARASA, the South African Treatment Action Campaign (TAC) and the Kenyan Collaborative Fund for HIV Treatment Preparedness – have now come together to lobby for continued health financing.
The right to health and treatment are non-negotiable, the activists say. They now want to hold the heads of state and international aid organisations to their commitments made to increase and improve HIV treatment and care.
"Broken promises and skewed priorities of governments and donors have reduced the right to health and access to treatment to unattainable rhetoric," lamented TAC women’s health programme coordinator Nonkosi Khumalo.
The activist coalition demands that African governments and international funders close the gap on health financing and warn that the lives of millions of people in Sub-Saharan Africa are in jeopardy because of the lack of political will and investment to realise the right of access to life-saving treatment.
"In the last few months, we have seen trillions of dollars spent on financial bailouts to stimulate economic recovery. A tiny portion of this sum could have bought quality, sustainable healthcare for millions of people," Khumalo further explained.
According to the 2009 World Bank "Averting a Human Crisis During the Global Downturn" report, countries in Eastern and Southern Africa are the most vulnerable. Researchers estimate the negative impact of this crisis will affect 70 percent of people on ARV treatment in Africa within the next twelve months.
With a few exceptions, such as Botswana and South Africa, most countries have limited fiscal space they can use to cushion the impact of a decline in international aid, World Bank says.
Already, large percentages of households in Sub-Saharan Africa are poor, and the large number of people on treatment means ever-increasing treatment programme costs.
Yet, Sub-Saharan Africa only accounts for one percent of global health expenditure and two percent of the global health workforce. Currently, only one third of HIV-positive Africans in need of antiretroviral (ARV) treatment can access it, according to TAC.
Failure to meet the commitment to bringing universal access to treatment for people with HIV who need it, the World Bank report notes, will call into question the legitimacy of development assistance for health, threaten the gains in health system capacity delivered through HIV treatment programmes.
It will ultimately result in greater long-term costs due to higher rates of transmission, more TB cases and larger numbers requiring expensive second-line drugs for both HIV and TB.
Dr Bactrin Killingo, chairperson of the Nairobi-based Collaborative Fund for HIV Treatment Preparedness agrees.
"If current cost constraints faced by HIV treatment programmes are not addressed, while the demand for expensive second-line treatment increases, we will soon find ourselves in a situation similar to the 1990s, where millions of lives were lost unnecessarily because people could not afford the treatment they needed to stay alive".