Shaping the future of AIDS, TB and Malaria responses in Africa in the context of Post 2015 development agenda AWA Consu

1. Shaping the future of AIDS, TB and Malaria responses in Africa in the context of Post 2015 development agenda AWA Consultative Experts Meeting 27-28 May 2014 Nouakchott, Mauritania Dr. Marie-Goretti Harakeye Ndayisaba Head of Division, HIV/AIDS,TB, Malaria & OID AU Social Affairs

2. Introduction An integrated, prosperous andpeaceful Africa,  driven by its owncitizens and representing a dynamicforce in  global arena

3. AU Strategies • Short Term Plan • Long TermTerm Plan AU Strategic Plan 2014 -2017 Agenda 2063

4. Strategic Priorities 2014-2017

5. Disease burden & trends in Africa Africa bear a disproportionate burden of disease • 75% of the world’s HIV/AIDS cases (2011) • 90% of deaths due to Malaria (2010) • 40% of deaths associated with TB (2011) However, opportunities within the African context are many: • Strong political will to strengthen health systems • Resources for health have been increasing • Encouraging progress towards health MDGs in many countries • Community care in Africa – a relevant and successful approach

6. Translating political commitments into action • 2000 – 2001 : Leaders of African Union members states adopted the Abuja Declarations and Frameworks for Action on Roll Back Malaria, and on HIV and AIDS, tuberculosis and other related infectious diseases. • 2003 - Maputo Declaration on Malaria, HIV/AIDS, TB and Other Related Infectious Diseases • 2006- Abuja Call for Accelerated Action towards UA to ATM services : emerging international consensus on universal access to attain Millennium development Goal and other health related Millennium development goal • 2010 -Decision on the 5-Year Review of the Abuja Call -Decision on the Partnership for the Eradication of MTCT -Declaration on Maternal, Newborn and Child Health • 2012 -Decision on revitalization of AIDS Watch Africa -Decision on roadmap Shared Responsibility for Africa’s AIDS response • 2013 – Declaration: “Actions towards the Elimination of HIV and AIDS, Tuberculosis and Malaria in Africa by 2030” • 2014 – Luanda Declaration: Universal Health coverage; African Medicines Agency; Preventing; NCDs; MNCH,ACDCP and Accountability mechanism to assess implementation of declarations and other commitments Action on Roll Back Malaria, and on HIV and AIDS, tuberculosis and other related infectious diseases.

7. Shared Responsibility and Global Solidarity The results of embracing shared responsibility and global solidarity approach are paying substantial dividend: • In 2001, African Heads of State and Government pledged to increase their country’s funding for health to at least 15 percent of their annual budget • Partnerships and active investment on health have been soaring, various stakeholders came into the picture to combat ATM: • PEPFAR; • Global Fund; • Philanthropist came into the picture (e.g. Gates Foundation) • Official Development Assistance (ODA) from well off countries; • Development Partners (UN agencies); The contribution of partnerships became the game changer – the biomedical and behavioural adverse tide and burden of ATM has significantly declined. Examples: • Treatment coverage increased, and life expectancy is high • Discriminatory and punitive laws have been repealed in sizable # of countries

8. Unfinished business of the MDGs and Post-2015 development agenda In spite of progress made MDGs remain an unfinished business • That the post-2015 Development Agenda provides a unique opportunity for Africa to reach consensus on common challenges, priorities and aspirations, and to actively participate in the global debate on how to provide a fresh impetus to the MDGs and to examine and devise strategies to address key emerging development issues on the continent in the coming years. • Attention to Investing in human capital is pivotal to achieving Africa’s transformation, and health financing in Africa need prioritisation

9. Sustaining Africa’s development agenda: Addressing key priorities in health • Emanating from consultations, resent assessments, reviews, dominant world views, body of knowledge, evidence key health thematic areas that are important going into the future have been identified. • Substantive issues of importance a consensus on Africa’s key health priorities, concerns and strategies to be pursued to further transform the health outcomes post-2015 • The identified health thematic areas will arguably shape the future of the responses to ATM

10. Future Direction Thematic Areas: 1. Universal health coverage and access • The goal of universal health coverage (UHC) is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them • UHC is thus a critical component of sustainable development and poverty reduction and a key element of any effort to reduce social inequities now and in the future Challenge/s: Countries cited the lack of sufficient funding as a major obstacle to UHC Recommendations for future actions: • Support and strengthen the capacity of national institutions, community systems and human resources for health to mount evidence-informed and rights-based responses; • Strengthen multi-sectoral integrated collaboration in the implementation of UHC and improvement of Health Outcomes; • Member states to adopt equitable people-centred policies that empower citizens through addressing poverty, marginalisation, internal displacement and forced migration which will result in increased access to health services.

11. 2. Equitable access to health: Case of Women and girls in conflict and post-conflict settings Women and children have been disproportionately affected by conflicts as casualties of violence, as internally displaced persons and as refugees. Challenge/s: Conflicts create social, political, and economic conditions in which the adverse health conditions such as epidemics thrive, creating a vicious cycle Recommendations for future actions: • Establish a strong AU institutional framework that addresses the intersecting dynamics of gender, peace and security and health, with particular focus on conflict and post-conflict settings. • Establish and deploy mobile population specific equitable health care interventions in conflict and post-conflict settings. • Provide guidance on the implementation of programmes addressing violence against women.

12. 3. Strengthen health systems • Health systems strengthening is a fundamental pillar of the health sector • The Inadequate service delivery is mainly due to the insufficiency of human resources, poor infrastructure, equipment, medicines and technology Challenge/s: • National health systems continue to be compromised by various factors, such as drug stock-outs, discontinuity of care, insufficient quality control, inadequate collaboration between Tuberculosis and HIV services and the overall lack of comprehensive health and support services. Recommendations for future actions • Promote home-grown and creative solutions in governance of health systems as well as science, technology and economic policies. • Ensure systematic involvement of all the key development sectors whose actions have a bearing on health, at the highest level of government – “health in all” policies – as well as the alignment of donor funds to country priorities. • Commit to improve health systems including ensuring availability of well-equipped health facilities, increased health financing and strong information management.

13. 4. Domestic & innovative financing for Health, Ownership & Accountability • Significant progress has been made in Domestic Financing for health - between 2006 and 2011 global domestic investment has doubled spending on AIDS, TB and malaria. In the last four years, African countries have increased their domestic resources to fight AIDS by 150% Challenge/s: The biggest challenge of health sector is lack of adequate funding. Overseas development assistance (ODA) is still important – it remains a critical component of global solidarity for AIDS, global health and development. Recommendations for future actions: • Support country mapping and gap analysis in terms of funding and expenditure both domestic and international and establish an accessible database. • Strengthen involvement of parliamentary organs for increased advocacy and oversight nationally, regionally and continentally. • Ensure that large capital projects in Africa set aside funding to promote health and provide for HIV, TB and malaria services in communities affected by large capital projects – during project implementation as well as after

14. 5. Development of local pharmaceutical industries and regulatory harmonisation • Achievement of universal access to lifesaving treatment and commodities will demand concerted efforts to ensure a long-term supply of affordable, high quality antiretroviral drugs in the region. The Pharmaceutical Manufacturing Plan for Africa (PMPA) was articulated to improve access to Medicines on the continent • To improve public health ending unsustainable dependency, as well as to stimulate economic and industrial development local pharmaceutical industries and regulatory harmonisation is pivotal for the future health development efforts Challenge/s: • Lack of technical and human resource capacities, including poor R&D; • The inability of African nations to fully utilize TRIPS flexibilities

15. 5. Development of local pharmaceutical industries and regulatory harmonisation Cont… Recommendations for future actions: • Promote and implement the PMPA with the understanding that the pharmaceutical industry is knowledge intensive and requires a workforce of highly skilled professionals. • To assist our companies to develop and to mitigate risk to public health it is necessary to support the work spearheaded by the Africa Medicines Regulatory Harmonization (AMRH) initiative. • Strengthen reviews of laws and measures to fully incorporate and utilise all public health related TRIPS flexibilities

16. 6. Revolutionising prevention of HIV, TB and malaria • Prevention is recognised as a key, cost-effective response to HIV, TB and Malaria in the Abuja Call. There is empirical evidence that ATM prevention is feasible and effective on a large scale. • Prevention efforts in Africa have yielded substantial results in curtailing prevalence, incidence and death associated with HIV/AIDS, Malaria and tuberculosis. Challenges: • TB: One of the major challenges has been the large proportion of estimated TB patients (40%) that remain undetected • HIV/AIDS: Short funding cycles affect long-term programming and sustainability • Malaria: Current statistics show that over half (US$2.8 billion) of the estimated Malaria annual global resource requirement is still unfunded

17. 6. Revolutionising prevention of HIV, TB and malaria Cont…. Recommendations for future actions: • Expand, improve access and integrate existing HIV, TB and malaria prevention programmes • Maintain funding for and uninterrupted prevention of HIV and TB service delivery and supply of, life-saving malaria commodities to prevent resurgences of malaria that can occur rapidly with devastating loss of life • Accelerate HIV prevention programmes using a combination of effective evidence-based prevention , particularly for young people, women, girls and other vulnerable populations

18. 7. Treatment as prevention strategy • HIV treatment and other high-impact strategies have been rapidly brought to scale, resulting in sharp decline in AIDS-related deaths • Given its dual benefits, saving the lives of people living with HIV and sharply restricting the spread of HIV – antiretroviral therapy is a cornerstone of an effective response. Challenge/s: Large percentage of people eligible for receiving ARV treatment do still do not access treatment due to inadequate funding

19. 7. Treatment as prevention strategy Cont… Recommendations for future actions: • Create demand for HIV testing and treatment with key advocacy actions by various constituencies working on responding to the HIV epidemic at various levels. • Mobilise sustained investment, giving priority to innovation and using the available resources as strategically as possible. • Ensure that health and community systems, infrastructure, enabling laws and policies are in place to deliver treatment to all eligible people living with HIV.

20. 8. Elimination of new HIV infections among children and keeping their mothers alive • Of the world’s 35 million people living with HIV, 25 million are in Sub-Saharan Africa. Ninety (90%) of all pregnant women living with HIV are in Sub-Saharan Africa and 60% of infections in Africa are among women. Without intervention, up to 40% of all these women would pass infection to their babies. • In Africa 7.6million people are now receiving treatment, and 64% of pregnant women living with HIV, receive efficacious ARVs for prevention of mother to child transmission (PMTCT) Challenge/s: Available Resources is not adequate to meet the demand especially in hard to reach areas in the rural areas Recommendations for future actions: • Promote and support synergies and strategic integration between programmes for preventing HIV infection among children and programmes for maternal, new-born, child and reproductive health. • African Union to ensure that countries’ targets are being effectively monitored to promote accountability in meeting eMTCT targets. • Rapidly accelerate roll-out of anti-retroviral treatment (ART) for children and adolescents and eliminate adult-child inequities

21. 9. Leadership and accountability • Multiple influences from the political leadership cannot be underestimated • Strong governance and political will gives impetus to accountability for local and external funding, bolsters programme implementation, including streamlining disease coordination and governance • Countries that have had the greatest success have established ambitious targets for scaling up, with diverse national stakeholders holding each other accountable for results. Africa is therefore yearning for effective, accountable and participatory institutions and governance based on transparent laws and rules, effective public policy and services, strengthening the role of the state in development, enhancing the legitimacy of institutions and on building public trust.

22. 9. Leadership and accountability Challenge/s: • Occasional civil conflicts that compromise equitable health service delivery • Limited accountability and sub-standard governance and leadership • Africa shoulders huge disease burden Recommendations for future actions • Improve governance and coordination at all levels in order to ensure ownership and accountability for AIDS, TB and Malaria responses. • Streamline disease coordination and governance to make best use of limited national human and financial resources (build on the concept of “Three Ones”). • The HoSG are urged to maximise the opportunity presented by the AIDS Watch Africa platform to promote advocacy and accountability in the implementation of the African Union policy frameworks including AU Roadmap

23. 10. Partnerships for development • The role of partnerships and networking stands out in the successes in responding to global health. The AIDS, TB, and malaria response has adequately demonstrated this point. • The lesson of the global health is that triumph can only be achieved through partnerships. • Partnerships with communities, private sector, civil society organizations as well as development partners are essential to make an environment conducive to good health status as well as to deliver health services Challenge/s: • Regrettably, partnerships with African countries are built around official development assistance (ODA) to developing countries and has been an important source of finance for the MDG interventions • The declining ODA due to global recession has thus affected several African countries whose ATM programmes were mainly donor supported

24. 10. Partnerships for development Recommendations for future actions: • Advance intensive strategic collaboration with international and national partners as well as civil society and private sector partners to improve efforts to address the three diseases • Uphold and advance broader aid effectiveness principles • Ensure that external partnerships are aligned with Africa’s transformation aspirations and health priorities

25. 11. Research and development, generation of data, monitoring and evaluation & document best practices • Africa lags behind other regions of the world when it comes to innovation and knowledge creation • Efforts to strengthen research and data generation capacity and enhance the research portfolio to meet the needs at a national level therefore remain critical in order to strengthen monitoring and evaluation • In the context of Post 2015, efforts to generate evidence for programming and clinical interventions cannot be relegated a secondary priority but should take pre-eminence in the health domain.

26. 11. Research and development Cont… Challenge/s: • Several countries are still struggling to measure various indicators related ATM • The research output in Africa is low and often cannot match with fast-paced change in the world • Innovation projects are often very expensive to finance Recommendations for future actions: • Carve a niche in the area of research and development with specific focus on biomedical, clinical and socio-cultural research in Africa. • Improve the collection, analysis and use of data in AIDS, TB and malaria responses to improve monitoring and reporting. • Strengthen national, regional and continental monitoring and evaluation system(s) for better implementation of commitments as well as for ownership and accountability.

27. Conclusion: Opportunities • Africa has the second highest rate of economic growth in the world. This economic growth could be a game-changer for the continent. • The region’s economy grew 5.1% in 2011, and growth is projected to accelerate to 5.8% in 2014. • opportunities of demographic dividend are high • As Africa becomes healthier, even more economic growth will be possible. More people will be pulled out of poverty, and health outcomes will rise accordingly, thus increasing the opportunities of demographic dividend • Thus, an investment in health is an investment in economic growth and a stronger continent in every imaginable way.

28. Thank You “In order to accelerate the achievement of Millennium Development Goals in the area of health, we must fight against the epidemic and endemic diseases, deal efficiently with the pandemic …..” By H.E. Mohamed Ould Abdel Aziz, President of the Islamic Republic of Mauritania and Chairperson of the African Union and AWA, Addis Ababa, January 30-31 2014