Recently, African leaders came together for a special Summit on HIV and AIDS under the theme of “Ownership, Accountability and Sustainability of HIV/AIDS, Tuberculosis and Malaria Response in Africa : Past, Present and the Future”. The Summit was held in Abuja Nigeria . It was jointly organized with various UN agencies including UNAIDS and several development partners.
The Summit analyzed the status of African governments’ investment in national responses to HIV and AIDS as well as other related infectious diseases (ORID). It afforded the leaders an opportunity not only to review achievements made in reversing the impact of epidemic, but also to renew political commitment to fight HIV/AIDS, TB and Malaria. The Summit focused, rightly, on three diseases: AIDS, tuberculosis and malaria. The latter is usually ignored even though it remains the major killer in Africa and mainly concentrated in 14 African countries which account for 80 percent of malaria deaths.
The Summit highlighted the issue of sustainability of the various HIV and AIDS programs which have until now been heavily dependent on donor and Western funding. African leaders reviewed the status of current health financing mechanisms and sought to implement innovative and sustainable health financing procedures.
The Leaders were apprised of the factors that continue to underpin the persistent burden of HIV and AIDS on the continent which worldwide has the largest number of those infected and the highest numbers of resultant deaths.
The Summit could not have come at a more opportune time. African countries are often perceived to be silent on AIDS and current external funding challenges demand new strategies that can ensure long term sustainability of the current response. With this Summit the African countries seem to be taking charge and adopting a more proactive posture. The response to the epidemic is also changing from an emergency stance to that of long term sustainability, especially in the context of the UN-led Post 2015 International Development Paradigm.
The African leaders noted that much progress has been made in addressing HIV and AIDS on the continent over the last decade. More than 22 countries have reduced HIV infection by more than 25 percent, many having made impressive reductions in AIDS related mortality and nine countries will be able to achieve 75 percent reduction in malaria cases
incidence by 2015.
However, on the flip side many countries will be unable to meet the 2015 Millennium Development Goals on HIV, TB and Malaria, the precursor to the new post 2015 Development Framework. The UN Secretary General Ban Kim Moon (represented at the Forum by UN Population Fund Executive Director Professor Babatunde Osotimehin) stated that with only 1,000 days to go many African nations had too much ground to cover in achieving many of the MDGs.
The Summit attracted an impressive and unprecedented number of African leaders. While this demonstrates high levels of political will and leadership to the epidemic, it was partly as a result because the Summit was taking place during the same time as the 43rd Ordinary Summit of Economic Community Of West African States (ECOWAS). It was also not missed on observers that apart from the Prime Minister of Ethiopia, all other heads of state left for home after the first of the two-day Summit reminding all that political will is still shaky.
Despite the encouraging news from the Summit , there is still a lot of work that needs to be done to ensure that response to the epidemic is sustainable and scaled up to meet unmet needs. Of special importance is the need for increased funding domestically and internationally and strengthening of health services if the goals for HIV and AIDS are to be met.
There is also need for continued African leadership and a cohesive and strong political will. Africa ’s efforts to take ownership of the response were marked by plans announced by the Prime Minister of Ethiopia for the establishment of an “African Centre for Disease Control and Prevention (African–CDC) under the auspices of the African Union (AU). The need to scale up Africa’s pharmaceutical manufacturing capacity especially in relation to generic medicines and other essential commodities for the control of malaria was also high on the agenda at the Summit .
A careful review of success achieved in addressing the epidemic in the last decade points to a combination of various factors such as community involvement, national leadership, precise health policies and immense global support.
Without community involvement achievements tend to be inequitable: universal access to health services is unlikely to be achieved and reaching the poor and marginalized populations tends to fail. Indeed, African countries that have been successful such as Ethiopia, which has reduced HIV incidence by 50 percent, has made community achievement a centerpiece of their efforts. Ethiopia has deployed almost 40,000 health extension workers to reach local communities, especially women across the country. The benefits are not just limited to HIV, but also to a reduction in maternal deaths and increases in child immunizations.
The need for precise public health policies that place major causes of morbidity and mortality (currently AIDS, tuberculosis and malaria) at the center should be of the highest priority. For example, it is crucial to review all relevant laws and policies to strengthen human rights-based protections that focuses on accessing HIV prevention programs and treatment expansion to the most vulnerable and at risk populations.
Higher domestic funding and sustained global support remain critical in the meantime. Funding pledges made by African leaders in the same city 13 years ago, later known as the Abuja Declaration that sought to dedicate 15 percent of national budgets to health care, have not been met. In some cases the proportion of funding going to health care has declined. According to the World Health Organization only one country achieved those targets, During the recent Summit the African leaders recommitted themselves once again to the 2001 Abuja Declaration.
External funding should not only be increased but should be of high quality in terms of flexibility, predictability, and reporting demands on national entities to ensure that it does the most good. Health funding should also be diversified to include the private sector. To its credit, the final and most recent Summit declaration in July 2013 focused not only on the need for diversified and innovating health sector financing, but also on the development of strategic investment plans and strategies.
Successes in efforts to address HIV and AIDS, TB and Malaria have a wide range of benefits for African countries including economic growth. This was the conclusion of a major report Abuja +12: Shaping the Future of Health in Africa that was launched during the Summit and published by the AU and UNAIDS. Without more widespread access to health services, Africa ’s human capital will decline dramatically and with it the predicted social economic growth and development potential of the African continent in the Twenty-First Century.