“Where is the political will from our leaders to provide the HIV treatment and prevention services we need?” asked civil society activists at the African Union (AU) Heads of State Summit in Kampala on July 27.
The Summit convened for the first time under the theme “Maternal, Infant and Child Health and Development in Africa”, but activists and health experts said security and terrorism dominated the discussions.
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| Bactrin Killingo, Program Manager of ITPC |
It appears that heads of state prefer to build roads than address maternal and child health challenges, even though the equivalent of a minibus full of pregnant women die every hour, said Bactrin Killingo of ITPC after repeatedly challenging the heads of AU states to scale up their national budget allocations for health to at least 15%.
Those women die “not because of bad roads, but as a result of HIV and pregnancy-related complications and other preventable causes.”
Prior to the Summit, ITPC, Save the Children, the International Community of Women Living with HIV, OXFAM, World AIDS Campaign, HealthGAP, Action Aid Uganda and other groups organized a mock debate and advocacy concerts to target world leaders to increase health spending to raise awareness about funding gaps and stir up public interest in the broken promises of the Abuja declaration.
Few countries reach the goal
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| Head of AU states |
Ten years ago, heads of state committed in the Abuja declaration to allocate at least 15% of budgets in health, but the money has not followed. South Africa, despite bearing the burden of HIV and tuberculosis epidemics, has not met the target once. Only six of 53 countries have reached the goal: Rwanda, Botswana, Niger, Malawi, Zambia and Burkina Faso.
But the health outcomes in these six countries are not at all satisfying. Rwanda and Malawi rely on external donors while Niger, Burkina Faso, Zambia and Botswana spend less than $20 per individual for health. Niger has one of the highest rates of Malaria-related death in the world and one in every 100 women in Malawi dies when giving birth. Furthermore, the average life expectancy in Zambia is only 42 -- one of the lowest in the world.
At the Pre-AU Summit meeting, civil society discussed these stats and suggested the causes may be ineffective programming, fund diversion or corruption. Speaking at the Regional Committee for Africa held in Guinea, Dr Magaret Chan, director-general of the World Health Organisation, discussed the preliminary findings of the World Health Report 2010, which estimates that 20% to 40% of all health spending is wasted through inefficiency due to weak health systems.
More support needed
AIDS activists and health experts at the AU Summit demanded African leaders take more responsibility in tackling health issues by mobilizing resources to accelerate socio-economic development through investing in health. Social determinants -- clean water, nutrition, gender equity in health, health workers -- play an important role in maximizing the benefit of health investment and contribute to higher life expectancy.
The US government invests $3,076 per capita and life expectancy there is 78.2 years. Middle-income countries like Cuba and Costa Rica invest in health about 10 times less than the US, but have adequate investment in health workers, health care infrastructure and other social determinants, resulting in life expectancies of 78.3 years and 78.8 years respectively.
Civil society therefore proposed “15% plus”, suggesting leaders should follow WHO recommendations and allocate at least $40 per capita to health and investment in other social determinants, setting aside resources for high-priority health concerns like HIV prevention and treatment. The “15% plus” encourages governments to mobilise resources through innovative financial mechanisms and utilize those resources to meet the health needs of the population while monitoring funds to avoid wastage.
Major donors scale back
Donor communities follow domestic trends. World leaders have used the global financial crisis as an excuse to short-change funds for health. Major donors are cutting back their funding, destabilizing many health-related programs in developing countries. Between 2011 and 2013, the Global Fund will need $20 billion to expand its funding to meet the health-related MDGs, but experts warn that raising even $13 billion from G8 world leaders would be a huge stretch. US President Barack Obama, despite having promised a fair share for the Global Fund ($3.2 billions), proposed to cut funding through the President’s Emergency Plan for AIDS Relief to only $1 billion for 2011.
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| G8 leaders and healthcare investment, picture from Oxfam International |
Some senior politicians in the US administration have shifted the focus from fighting AIDS to battling other problems – those afflicting young mothers, for example -- despite AIDS-related complications being the leading worldwide killer of women of reproductive age in Africa.
Cutting aid helps no-one
The effect of global and domestic pullback on funding can be seen in HIV programmes. ITPC has found early warning signs resulting from the scale back of AIDS commitment: caps on the number of people enrolled in treatment programs, more frequent drug stock outs, and wider financial gaps for treatment.
In Uganda, the US government funds antiretroviral therapy for at least 184,000 of an estimated 200,000 people currently on ARVs, well below the 322,000 who require the treatment and cannot access it. Pushback from funding results in 80,000 new patients not being served each year. In Zambia, many people living with HIV are on a waiting list.
Lobbies by people living with HIV, clinicians and advocates in Uganda have not been in vain. At the end of the AU Summit, restrictions that capped enrolment of new HIV patients in Uganda were reversed. The White House has now pledged to return to the rate of new patient enrolment taking place before treatment caps were put in place: about 3,000 new patients a month until 2013. Civil society welcomed the statement amid concerns that there could be more “Kampala situations” if heads of African states do not commit to permanent budgetary allocation for HIV treatment.
Resources
MTT8: Rationing Funds, Risking Lives: World Backtracks on HIV Treatment (Factsheet)
MTT8: Rationing Funds, Risking Lives: World Backtracks on HIV Treatment (Full report)
Abuja declaration
Africa Public Health Alliance & 15%+ Campaign
2010 Africa Health Financing Scorecard
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