1. AFRICA MUST ACT WITH GREATER URGENCY ON HIV/AIDS AND THE RIGHT TO HEALTH
Statement by CSOs at the Fourth Ordinary African Union Summit of the Heads of States, 24-31st January 2005, Abuja, Nigeria
Signed by the African Network for the Campaign on Education for All (ANCEFA), African Womens Development and Communications Network (FEMNET), African Centre for Democracy and Human Rights (ACDHR), Center for Democracy and Development (CDD),
Pan African Movement (PAM), Pan African Development Education and Advocacy Programme(PADEAP), West African Students Union (WASU), Womens Rights Advancement and Protection Alternatives (WRAPA), Development Network of Indigenous Voluntary Agencies (DENIVA), Fahamu, ActionAid International, Oxfam GB
Summary
The fourth Ordinary African Union Summit of the Heads of States takes place at a time when the consequences of poorly financed and collapsing public health services across the continent can only be described as a public health emergency. Returning to Abuja where four years ago they committed themselves to accelerate the fight against HIV/AIDS, Tuberculosis and other related infectious diseases, it is clear that key obstacles continue to prevent hundreds of millions of Africans from realising the right to health. African Governments and the African Union must reinvigorate the fight against the violation of HIV/AIDS and health related rights.
Recommendations
- African Governments must commit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%.
- African government should ensure that treatment of AIDS and infectious diseases is provided free, reaches vulnerable groups and in an accountable manner.
- African Governments, who have to yet ratify the AU Protocol on the Rights of Women, must do so. It is a major instrument in securing the right to health for Africa’s women and girls.
- The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and measures from industrialised countries to compensate for the brain drain of African health workers.
- The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and securing measures from industrialised countries to compensate for the brain drain of African health workers.
- African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005.
Situational analysis
Across our continent the health status of women remains precarious and in many instances, worsening, not only because of HIV but also because of the many unacceptable inequalities that exist in women’s health, the limited choices that are made available to women and finally, the lack of accountability for their health.
- Pascal Mocumbi, Prime Minister, Mozambique, 2003.
The majority of Africa’s 800 million citizens continue to remain locked out of health facilities across the continent. By the time the Summit opens, Africa will have lost 20 million people to the plague of AIDS. Behind them, they would have left 12 million orphans to fend for themselves. While our leaders meet, outside the doors of the Abuja International Conference Centre, 80% of the 40 million people currently living with HIV/AIDs across the world will be struggling to fight a debilitating disease that in some parts of the industrialised world is no longer a killer disease. 55% of these will be women.
By the time the Summit opens on the 24th January, 90 million African women and girls will have been forcibly circumcised or had their genitals mutilated. Between the opening and the closing Summit ceremonies, 77,000 women and girls will have undergone unsafe abortions in countries where restrictive abortion policies ensure that no standards can be maintained or monitored. As a result of this and other factors, a staggering 47/48 sub-Saharan African countries will not meet the goal of reducing maternal mortality and one in ten babies will not survive child birth due to poor and inadequate health infrastructure in Africa.
Yet, this is sadly no longer news in a continent numbed by the domestic stories of neglect, blocked access to life-saving drugs and poverty. What could be news is the scaling up of international and African public resources into expanding access to health-care services.
Expand public financing for health and education
When African Heads of States met in Abuja in April 2001, they correctly declared HIV/AIDS, Tuberculosis (TB), and other related infectious diseases (ORID) as a state of emergency. Recalling and reaffirming their commitment to all relevant decisions, declarations and resolutions in the area of health and development and on HIV/AIDS, particularly the "Lomé Declaration on HIV/AIDS in Africa" (July 2000) and the "Decision on the adoption of the International Partnership against HIV/AIDS" (Algiers 1999) they stated;
“WE COMMIT OURSELVES to take all necessary measures to ensure that the needed resources are made available from all sources and that they are efficiently and effectively utilized. In addition, WE PLEDGE to set a target of allocating at least 15% of our annual budget to the improvement of the health sector.”
Now known as the “Abuja 15% commitment” this target was seen as a critical contribution to the fight against HIVAIDS and other diseases. Shockingly, despite this public commitment, four years on many countries continue to spend less than 10% of the revenue on health. African Governments must commit in this Summit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%.
New research published by the Global Campaign for Education and endorsed by UNAIDS, shows that a complete primary education makes a strong and direct impact on HIV infection rates, especially among young women. Girls with a complete primary education are 2.2 times less likely to contract HIV than those with some or no primary education. Education equips young people to understand and apply facts and gives them the status, clout and confidence to avoid unsafe and exploitative relationships. Investing in free primary education for everyone but especially for girls, is one of the most effective and urgently needed measures to fight the epidemic. Investing in secondary education would bring additional benefits. Consequently, the AU needs to give priority to free, universal and compulsory basic education with gender equity, both in its own strategies for development and poverty reduction, as well as in its dialogue with forums such as the G8.
Debt cancellation is pre-requisite for progress
The heavy external debt burden …continues to mortgage African economies and cast a shadow over our People’s’ future. To date, the proposed remedies are ad hoc.
- Secretary General of the Organisation of African Unity, July 2002
A comprehensive AIDS plan for Africa would cost US$10 billion per year, yet African nations spend one and a half times this amount in debt servicing. In many countries, more is spent on debt servicing than on education and health or is received in aid grants and foreign direct investment. For the same money, the global fund against HIV/AIDS, Malaria and Tuberculosis could stop these diseases and provide Anti-Retrovirals (ARVs) for the three million people living with HIV in all developing countries not just Africa.
This absurdity can only be seen from the experience of one country. Tanzania for instance, currently pays US$39 million dollars per annum in debt servicing while receiving only US$27 million in aid. It is revealing to recall that after the second world war, Germany was considered to be harshly penalised for having reparations set at 7% of its exports, yet in 2005 Tanzania is supposed to “adjust” and grow with debt servicing set at 60% of its exports.
Yet, this Summit occurs at a time when momentum has built once more around the necessity for debt cancellation. Several G8 countries have bi-laterally cancelled debts owed by African countries. In February 2005, the G7 Finance Ministers will consider proposals to underwrite debt cancellation by committing additional bi-lateral financing or by re-valuing IMF gold reserves. The benefits of this would be immense. Debt cancellation would enable countries like Ethiopia to expand access by doubling its expenditure on health and thus reaching beyond the 60% who are currently reached by health services.
There is precedence in Africa for successful re-channeling of debt relief into basic social services. At least six countries in Africa offer insight into the possibilities debt cancellation could create. In Benin for example, 54% of HIPIC relief monies was channeled into improving health programmes by recruiting health staff for rural clinics, implementing HIV/AIDS and anti-malarial programmes and improving access to safe water and increasing immunisation. Malawi has been able to allocate a 30% cut in debt servicing per year to enhance their HIV/AIDs health care system. US$1.3 million of debt relief money has been critical to resourcing Uganda’s National HIV/AIDS plan. Cameroon was able to launch a comprehensive national HIV/AIDS strategic plan funded to the tune of US$114 million with help from debt savings. In Niger, a special programme that focuses on rural education, health, food security and water systems has been fully financed through HIPC. This has mainly been used so far in building classrooms and rural clinics. In Burkina Faso, HIPC relief has been spent on health (33%), education (39%) and rural roads (28%).
As Jubilee Zambia coordinator Teza Nchinga notes, "Respect for the basic human rights (food, health care and education) of millions of Zambians should take priority over repayment of debts to comparatively wealthy creditors especially when capital on these debts has already been paid a number of times over." The African Union Commission must lead on behalf of African countries by aggressively demanding debt cancellation from the G8 in 2005. African Governments on the other hand, must follow the example of these six countries who have had re-channeled monies freed up from debt relief into strengthening health systems including the retention of health workers.
Industrialised countries must deliver on their aid commitments
Currently, despite the increases pledged in the UN Financing For Development Conference in Monterrey, rich countries spend half of the foreign assistance they did in 1960. If they were to meet the OECD targets of 0.7% of their GNP this would increase aid levels from US$70 billion to US$190 billion dollars. Yet, only the UK and Spain have set dates to meet these targets. 12 other countries are far from this and do not seem to be in a hurry.
Compared to expenditure on defense or domestic agricultural subsidies, this would be a very small amount. Looked at in terms of the cost to individual taxpayers, it would cost an additional US$80 dollars per person per year or put more simply, the average price of one cup of coffee a week.
G8 countries continue to prioritise aid to countries where they have geo-political interests rather than fighting poverty. Over 2004, America set aside US$ 65 billion dollars for fighting the war in Afghanistan and Iraq. This could have financed the exact annual budget deficit for the entire continent of Africa. Put another way, six months of US funding for the war in Iraq (US$ four billion) could have met the annual budget deficit for the global fund against HIV/AIDS, Malaria and Tuberculosis. Yet increasing aid is only one measure, improving its quality is another. For instance, nearly 30% of aid is tied to goods and services from donor countries. In the case of the US, this figure is as high as 70%.
The quality of foreign assistance also continues to be undermined by IMF and World Bank fiscal and macro-economic models, which act to constrain expenditure on basic social services. In a study of twenty Poverty Reduction Strategies, sixteen were found to contain fiscal targets for inflation and the budgetary envelope that had not been subjected to public discussion. They were targets that had been established by the World Bank or the IMF. Last year for instance, Ethiopian and Tanzanian Governments will have to meet 85 and 78 policy conditions respectively.
The AU clearly sees itself providing leadership, monitoring states performance and accountability, advocacy with states and beyond, setting up standards, harnessing new continental initiatives, and as a knowledge hub. This clear emphasis on harmonising the plethora of new initiatives and monies that are offered for flooding Africa and which are, in many cases, confusing national plans and programmes, is welcome.
To this end, the AU must challenge the proliferation of uncoordinated initiatives such as the US PEPFAR Presidential Initiative. Bilateral initiatives such as PEPFAR may reinforce donor-driven approaches, increase the administrative burdens of recipient countries and drain resources away from existing, experienced, multilateral initiatives. Such initiatives create parallel systems where the national government using inexpensive generic fixed dose combinations and that of PEPFAR using expensive brand names. This leads to confusion of both patients and health providers.
The African Union must take a more vigorous lead in engaging the international community to deliver the Monterrey promises and improve the volume and quality of foreign assistance to Africa. It is vital that donors’ initiatives and programmes should implement nationally defined policies especially regarding access to medicines.
Improving Access to Care and Support
The major challenge facing the people living with AIDS and people affected by AIDS is the issue of access to treatment and care. The World Health Organization (WHO) in December 2003 came up with an initiative to treat three million people by 2005. This is believed to be approximately half of the estimated six million people in dire need of antiretroviral therapy. This is the popular 3 by 5.
Despite the fact that some African governments have subsidized distribution programmes, less than 1% of Africans in need of ARV treatment had access to ARVs, compared to 85% in developed countries in 2004. South Africa has committed to providing free treatment to 53,000 people by March 2004. This is a fraction of South Africa's HIV positive population, estimated to be over five million. The Nigerian government began a treatment programme to provide ARVs for 10,000 people in November 2002. At a conservatively estimated number of 3 million people living with HIV&AIDS in Nigeria in 2004, this is quite clearly inadequate.
Access to ARVs is also determined by power within and between households. Findings from CSO participatory research studies in Zambia and Nigeria suggest that intra-household power relations conspire to constrain women’s access to ARVs. Women in Zambia have a disproportionate access to ARVs (30%) despite comprising of 50% of the population. In January 2004, less than 30% of people who had access to ARVs were women in Zambia. In many families who cannot afford to have more than one person on ARV, it is the male head of household that is chosen. At another level, scanty or total ignorance of prevalent diseases, the weak bargaining position of women and the pervasive cultural endorsement of male liberty to have free and multiple sexual relationships (in and out of marriage) has escalated the distributive impact of STDs and led to the high prevalence of HIV/AIDS across communities all over Africa.
In many countries across Africa the right to health is not enshrined in either the constitution or laws. It is in this context that the African Union Protocol on Women’s Rights and in particular the provisions in articles 14 and 15 significantly contribute to grounding the obligations of Governments. Yet, despite encouragement by the African Union Commission under the leadership of President Konare and civil society campaigning, only seven Governments have ratified the Protocol, a further 33 have signed but not ratified. To this end, African Governments who have not yet done so must re-commit to ratify with urgency, the AU Protocol on the Rights of Women, as a major instrument in securing the right to health for Africa’s women and girls.
Class equities also affect the distribution of ARVs. Interviewed recently, a 29 year old father of three kids in Nigeria said;
“The ARV that come to the center are not given to those of us who have come out to declare our status, but to those BIG men who bribe their way through and we are left to suffer and scout round for the drug. “
Attempts to bring down the costs of ARVs are obviously the way forward. In Nigeria, Malawi and Zimbabwe, tariffs on essential drugs have been removed. The Governments of Zambia and Mozambique have issued compulsory licensing for ARVs for their treatment programmes. Zimbabwe has also allocated precious foreign currency to a local company to manufacture generic ARVs, and is currently running trials on AZT at two of its largest hospitals. However, Zimbabwe’s lack of foreign currency has made it difficult to secure an adequate supply of drugs. In Kenya and Malawi also many public hospitals have no drugs for treatment of HIV/AIDS-related infections.
Access to essential medicines rests on African countries being able to domestically produce or source cheap drugs from southern based generic drugs industries. The AU should consider initiating dialogue with WHO, UNCTAD and the EC to explore the feasibility of establishing African centers of excellence in the producing of high quality local production of medicine especially ARVs. African states should be encouraged to influence both public and private health service providers to dispel misinformation about generic drugs being inferior to brand products, eliminate the costs of ARVs to users and actively target the rural poor with special emphasis on gender equity. Key to this will be the replication of policies that cut taxes and tariffs and promote price regulation to countries that have not already done so.
We welcome existing plans for a continental conference on the rights of people with HIV/AIDS to raise the profile of rights abuses and to chart a new chapter in the evolution of national laws and standards consistent with the spirit of the African Charter of Human and Peoples Rights. We call on the AU Commission to extend an invitation to People with AIDS organizations and networks across the continent to help design this process.
African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005. The AU must ensure that new trade agreements especially Trade Related Aspects on Intellectual Property Rights (TRIPS), bilateral and regional trade agreements do not undermine access to medicines in Africa.
The absence of effective conditions to fight HIV/AIDS and other infectious diseases such as malaria, tuberculosis and polio conditions and poor remuneration of African health workers has led to an exodus of trained health personnel. Calculating the cost of training, every doctor that leaves the continent costs Africa US$60,000. This results in a staggering subsidy to G8 countries of US$500 million every year just for health personnel.
To increase access to medicines African governments should redirect aid and debt money towards investing in basic health services including retention of health workers. Donors’ initiatives should follow national medicines policies especially using inexpensive generic fixed dose combinations. The AU should advocate with states, donors and the pharmaceutical industry to decrease the prices of second line treatment for HIV.
Conclusions
As African Governments meet once again in Abuja, they must embrace the opportunity of an invigorated African Union Commission to turn words into further deeds and directly confront the state of emergency. The temptation to simply re-affirm the 2001 Abuja Declaration must be avoided in order for the costs of this Summit to be justified. Increasing domestic resourcing, improving the quality of health programmes particularly to rural communities and delivery on debt cancellation are key to preventing hundreds of millions of Africans from being denied the right to health.
Recommendations
- African Governments must commit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%.
- African government should ensure that treatment of AIDS and infectious diseases is provided free, reaches vulnerable groups and in an accountable manner.
- African Governments, who have yet to ratify the AU Protocol on the Rights of Women, must do so. It is a major instrument in securing the right to health for Africa’s women and girls.
- The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and measures from industrialised countries to compensate for the brain drain of African health workers and stop recruiting more workers.
- African Governments must prioritise monies saved by debt relief for strengthening health systems that ensure the retention of health workers.
- African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005.
* Useful Reading Materials
- African Union, Report of the African Summit on HIV/AIDS, Tuberculosis, and other related infectious diseases. Abuja Nigeria, April 2004
- African Union, HIV/AIDS Strategy 2005-2007
- ActionAid International, Responding to HIV/AIDS in Africa, a comparative analysis of responses to the Abuja Declaration in Kenya, Malawi, Nigeria & Zimbabwe, June 2004
- ActionAid International, 3 by 5: Ensuring HIV/AIDS Care for All. June 2004
- Fahamu/SOAWR, Pambazuka News 190: Special Issue on the Protocol on the Rights of Women in Africa: A pre-condition for health & food security, January 2005
- Oxfam International, Paying the Price, January 2005
2. SUMMARY OF DECISIONS OF THE AFRICAN UNION FOURTH ORDINARY SUMMIT, ABUJA, NIGERIA JANUARY 2005
Compiled By: Eve Odete, Pan Africa Policy Officer, Oxfam GB
Summary of Decisions of the African Union Fourth Ordinary Summit, Abuja, Nigeria Jan 2005
Key Meetings
Assembly of the African Union, Fourth Ordinary Session
30-31 January 2005
Assembly /AU/Dec.55-72 (IV)
Assembly/ AU/ Dec. 1-2 (IV)
Decisions and Declarations
Executive Council
Sixth Ordinary Session, 24-28 January 2005
EX. CL/Dec. 165-191 (VI)
Decisions
EX. CL//Rapt/ Rpt (VI)
Rapporteur’s Report of the Sixth Ordinary Session
Of the Executive Council
Permanent Representatives Committee
Ninth Ordinary Session
PRC/Rpt (1X)
Report of the Ninth Ordinary Session of the Permanent Representatives’ Committee
Rationale for this compilation and the policy cycle it documents
This summary has been prepared for policy analysts working for Oxfam, international, continental and regional networks and allies to inform us on the key deliberations and decisions of the most important decision-making organ of the African Union. It captures key decisions, upcoming dates and opportunities for continental policy development.
The sequence of the Summits is as follows; one week of intense meetings starting with the Permanent Representatives Council (Addis based Ambassadors), Council of Ministers (National Ministers) and the Assembly itself (Heads of States). While the Assembly is the supreme decision making body, the discussions from Ambassador level are important to understand the issues being prioritized and deliberated. Opportunities for policy influencing decrease as the meetings go on. Indeed, even lobbying space becomes more difficult to secure particularly with the Commissioners.
1. Health and HIV/AIDS
Permanent Representatives Committee
Ninth Ordinary Session
PRC/Rpt (1X)
On HIV/AIDS, tuberculosis, malaria and other related infectious diseases, the PRC observed;
The need for Africa to take the lead in Trade Related Intellectual Property Rights (TRIPS) negotiations to promote access to affordable generic drugs - Africa has to plan properly for dialogue at TRIPs negotiations and other fora;
Assembly of the Africa Union
Fourth Ordinary Session
Decisions and Declarations
Assembly/ AU /Dec. 55 (1V)
CALLS UPON the international community, especially the rich industrialized countries,
to fully fund the Global Fund in line with previous commitments made in this regard, and taking into account the magnitude of the health emergency presented by these diseases in Africa;
URGES Member States to:
Take the lead in TRIPs negotiations and in implementing measures identified for promoting access to affordable generic drugs;
Ensure that every child receives polio immunization in 2005;
Prepare inter-ministerial costed development and deployment plans to address the Human Resources for Health crisis;
Prepare health literacy strategies to achieve an energized continent-wide health promotion endeavour;
URGES Member States to intensify efforts towards more effective and well-coordinated implementation of national programmes to promote health systems development as well as improve access to prevention, treatment, care and support; along the “Three ones initiative”; the “3 by 5 Strategy” and Global “Child Survival Partnership”;
RESOLVES to take all the necessary measures to produce with the support of the international community, quality generic drugs in Africa, supporting industrial development and making full use of the flexibility in international trade law and; REQUESTS the AU Commission within the framework of NEPAD to lead the development of a Pharmaceutical Manufacturing Plan for Africa;
CALLS UPON the International Community to match the US$19 billion gap in health financing which the WHO has determined that Africa is not in a position to self finance;
2. Trade
Permanent Representatives Committee
Ninth Ordinary Session
PRC/Rpt (1X)
On on-going WTO negotiations the Commissioner for Trade and Industry
highlighted the need for Africa to send a strong political message to the international community to find a solution to the cotton initiative which affects more than 10 million African producers living below the poverty line. She further pointed out the issue of the unfair behaviour of the Northern countries with regard to agricultural subsidies and the need to lay emphasis in the political message on the importance for Africa to meet food security objectives, rural development and poverty reduction. In conclusion, she stressed the need for the African Group to maintain solidarity and unity with the G90 on issues of substance within the WTO.
The PRC recognized the importance of the WTO negotiations for the socio-economic development of Africa and emphasized the need for capacity building in Member States and RECs and for better coordination of efforts among New York, Geneva, Brussels, African Groups and the AU Commission in Addis Ababa. It agreed with the recommendation for a fast-track approach to the cotton issue while emphasizing the need to come up with a common position on cotton, springing from the outcome of the recently held Bamako meeting. It further called for the document to be enriched with more information on the roadmaps finalized in Geneva and the reaction of the RECs on the issue as well as with the outcome of the Bamako meeting on cotton. It highlighted the importance of coming out with concrete proposals on the issue of Special and Differential Treatment; on the possibility for African countries to have access to required drugs for public health inclusion in national legislations as decided by the WTO Council. The PRC also emphasized the need to pursue the proposal for support to cotton producers in their exports and for the creation of a fund to compensate losses. In this regard, the PRC also called for other commodities to be part of the list of tradable goods for negotiations at the WTO.
It also called for a meeting on services in order to deal with African concerns in that sector. It recommended that, in addition to other partners, the expertise of ECA should be tapped for capacity building purposes. The PRC recommended that the AU Commission take the necessary measures to implement the proposal to send a strong political message to the international community to fast track negotiations on the cotton issue.
On Negotiations of the Economic Partnership Agreements:
The Commissioner recalled the provisions of the Cotonou Partnership Agreement (CPA) which aim at making EPAs, instruments for the promotion of rapid and sustainable development, the eradication of poverty and the smooth and gradual integration of Africa into the global economy. She quoted in particular Article 37.3 which provides for the strengthening of capacity in the public and private sector during the preparatory phase through measures that increase competitiveness and support regional integration initiatives such as assistance to budgetary adjustment and reform, infrastructure development and investment promotion. She added that the first phase of negotiations was not sanctioned by a formal agreement and that all 48 ACP African countries had embarked on the second phase within four groupings without any country expressing desire to remain outside the process. She then drew the attention of the Committee on the major challenges involved in the negotiations for African countries as raised by the RECs during the first meeting of the coordination mechanism between the AU and the RECs. These are: (i) geographical configuration of the EPAs, (ii) the issue of compatibility between WTO and EPA Rules; (iii) the reciprocal relationship between the EU and ACP countries given the gap between their levels of development, (iv) the imbalance in the present multilateral trading system, (v) the heavy procedures of access to EDF resources and additional resources to African countries to face direct and indirect adjustment costs.
She stressed the fact that, although EPAs were about to enter into force in three years’ time, the provisions of Article 37.3 were still not implemented. In this regard, she highlighted the need for RECs to remain united and proposed that Council calls on the EU to allow the AU Commission as an integration Organisation to access EDF resources for the implementation of the NEPAD programme.
The PRC expressed concern about the geographical configuration for the negotiation of EPAs which does not coincide with the RECs as organised within the AU. It called for the AU to develop capacity for the coordination of EPA negotiations to ensure that Africa speaks with one voice although EPAs divide Africa into RECs/negotiating groups and that the North African countries are part of the Barcelona process.
On the issue of resources, the PRC pointed out that EU resources were categorised into programmable and non-programmable resources and that the AU not being a party to the CPA was not eligible under the first category but should be able to access the non-programmable resources. In conclusion, the PRC stressed the need for African countries to build capacity not only for market access but above all in order to face supply-side constraints so that they can make good use of whatever agreement they will enter into in 2007.
The Executive Council
Sixth Ordinary Session
Decisions
Doc. EX.CL/151 (VI)
Decision on WTO negotiations
RECALLS the Doha Ministerial Declaration in which the international community undertook to place the needs and interests of developing countries at the heart of the WTO Work Programme;
COMMENDS the African Group for its efforts aimed at bringing to the Doha Work Programme back on track and for remaining engaged in the WTO negotiations in accordance with the technical guidance and policy framework provided under the Kigali Declaration and Consensus on the post-Cancun Doha Work Programme ;
RECALLS ALSO the outcome of the Special WTO General Council session held in Geneva from 27 July to 1 August 2004;
TAKES NOTE of the July Package adopted by the WTO General Council on 1st August 2001;
RECOMMENDS the speedy adoption of an approach to resolve the cotton issue based on the results of the meeting held in Bamako from 12 to 13 January 2005;
ALSO RECOMMENDS the early consideration of the issue of agricultural subsidies and the adoption of an Africa Common Position on commodities in general;
CALLS UPON the African Group in Geneva to continue to engage fully and actively in the negotiations with a view to achieving a pro-development outcome from the Doha Round;
ALSO CALLS UPON the same to finalise the Tunis roadmap and Work Plan in order to engage collaborative research and capacity building efforts from regional and international organizations on specific areas to enable Africa to positively contribute to the modalities stage of the negotiations leading up to the 6th Session of the WTO Ministerial Conference;
URGES Member States to continue to coordinate efforts both at the technical and political levels with like-minded groups, in particular, the G90;
WELCOMES Egypt’s invitation for a meeting to be held in Cairo, in May 2005, to discuss ways to deal with the challenges facing cotton producing countries in Africa;
REQUESTS the Commission to convene a Ministers of Trade meeting to chart the way forward as far as Africa’s Agenda is concerned.
FURTHER REQUESTS the Commission to report on progress to the 7th Ordinary Session of Council.
Executive Council-Rapporteur’s Report
With regard to the on-going WTO negotiations, Council recommended that special attention should be given by the AU to the crucial issues of agricultural subsidies and commodities, particularly cotton.
Decision on the negotiations of ACP-EU economic Partnership Agreements
COMMENDS the Commission and the RECs for concluding the establishment of an informal Coordination and Information Exchange Mechanism on EPA Negotiations with the European Union (EU) for which the Commission has been entrusted the coordinating role and also for holding the first meeting of the mechanism successfully;
ENDORSES the recommendations of the Commission/RECs meeting and URGES the Commission to:
Develop institutional capacity building programmes for the Commission and the RECs so as to make work synergies viable and reliable and accelerate the integration process in Africa;
Prepare, in close collaboration with the RECs, requests to the European Union and other development partners for financing of projects that will enhance continental integration;
Identify thecommon supporting programmes relative to implementation of EPAs at the level of the RECs;
Mobilize African research institutes, including the ECA, to appraise the adjustment and other costs of EPAs on African economies.
STRONGLY RECOMMENDS that efforts between the Commission and the RECs be further strengthened and coordinated in the second phase of negotiations, especially with regard to priorities and roadmaps set for negotiations so as to ensure that the process of continental integration in Africa is deepened in accordance with the Constitutive Act of the African Union;
WELCOMES the establishment of the Joint AU-EU Monitoring Mechanism whose objective is to ensure, through exchange of information and discussion of key issues, the consistency and coherence of the EPA process with Africa’s plans and aspirations for regional and continental integration and the establishment of a Pan-African Market and the promotion of synergies between the EPA process and ACP-EU cooperation, notably in the context of regional indicative programmes;
URGES the Commission and the EU to operationalise the mechanism in an effective manner so as to ensure that EPAs indeed enhance the regional integration process and development in Africa as well as the building of regional markets through the effective removal of production, supply and trade constraints;
ALSO URGES the EU to grant access to the Commission as an integration organization to EDF resources for projects of a continental nature;
REQUESTS the Commission to report on progress made on the EPA negotiations to the 7th Ordinary Session of Council in July 2005.
ENDORSES
Candidature of Hon. Jaya Krishna Cuttaree, Minister of Foreign Affairs, International Trade and Regional Co-operation of Mauritius, to the post of Director General of the World Trade Organization, at elections scheduled to be held in 2005.
3. Food Security
Permanent Representatives Committee
Ninth Ordinary Session
Report (1X)
Follow-up on Maputo, Sirte and Ouagadogou Declarations on Food Security:
The Commissioner concluded by proposing the creation of an African Food Security Committee to serve as a platform of exchange on matters of food security in the continent, and the establishment of an African Union representational office in Rome to coordinate Africa’s food security matters with relevant world bodies mandated with the issue.
Executive Council
Sixth Ordinary Session
Rapporteur’s Report
Follow-up of Maputo, Sirte and Ouagadogou Declarations on Food Security
On the status of food security in Africa, the following observations were made:
A reliable early warning system be established as it constitutes the preferential tool for combating food insecurity – the early warning system should be capable of anticipating the emergence of food crises, taking stock of production and available resources, and monitoring phenomena such as natural disasters (floods; droughts; invasion or outbreak of endemic diseases affecting animals, crops and plants);
Once established, the early warning system together with continued monitoring should be relied on to generate a steady flow of situation reports as this would facilitate the generation and communication of relevant information to Member States and all stakeholders in time for them to take appropriate measures;
Special attention should be given to the Southern Sahelian region as this area constitutes the main locust corridor between the Sahara and the countries further north;
Regional strategic desert control measures should be implemented by the concerned Member states;
There was need to strengthen the capacity of Member States in the area of fighting migratory pests and animal diseases that pose a threat to food security, and in so doing
to make use of recent technological methods in veterinary science and pest control.
Dakar-Agricultural Initiative
The Senegalese delegation informed Council of the holding in Dakar, Senegal from 4 to 5 February 2005, of the Dakar-Agricultural Initiative which would be a Forum at which agricultural issues would be discussed. It indicated that various key figures from Africa and the rest of the world would be taking part in this meeting and, in this regard, invited all countries of the African Union to participate in this Forum.
Meeting of Ministers of Agriculture
The Egyptian delegation highlighted the importance of agriculture for African economies and underscored the need for Africa to meet to discuss strategic issues such as cotton. It informed Council that Egypt was organizing in May 2005 a meeting of African Ministers of Agriculture with the participation of UNCTAD and other institutions to examine the situation and come up with a Common Position for the defence of African agricultural products.
Assembly of the Africa Union: Decisions and Declarations
Assembly /AU/Dec.59 (IV)
NOTES WITH GRAVE CONCERN the serious economic and social impacts of the 2004 desert locust invasion of the Northern, Western and Eastern regions of Africa;
REQUESTS the Commission and Member States to take all necessary measures to implement the Maputo, Sirte and Ouagadougou Declarations and their relevant Plans of Action;
Agriculture
Decision on allocation of 10% national budgetary resources to agriculture and rural development over the next 5 years
REQUESTS the Chairperson of the Commission to define, in collaboration with Member States and the NEPAD Secretariat, the core areas of agriculture and rural development relevant to the 10% allocation adopted in the Maputo Declarations;
CALLS UPON Member States to implement the present Decision in order to improve the financing of agriculture.
Editorial
Up to two-thirds of all Africans in east and southern Africa (ESA) live in rural areas, three-quarters of them living below the poverty line. Agriculture contributes 35% to the southern African regional GDP and 13% of total export earnings. In addition, about 70% of the population of the region depends on agriculture for food, income and employment. The recent widespread food crisis in the region that pushed more than sixteen million people into severe food shortage is further evidence that agriculture and food security still play a fundamental role in determining the development and health of the poorest in the region.
The Regional Network for Equity in Health in Southern Africa (EQUINET) recognising the importance of food security in health equity, commissioned a paper that explores equity concerns around food security and nutrition within the SADC and East Africa region, drawing information from available secondary data. The paper aims to analyse the current food security and nutrition situation in the region and the health and equity issues and policy concerns arising. EQUINET has commissioned this analysis of the determinants of the current situation, and the policy influences that enhance or undermine equity in food security and nutrition, to propose areas for policy and programme engagement and for research and debate by EQUINET.
This paper argues that there are at least five good reasons why food security and nutrition should be given high priority in actions to improve health equity and socio-economic development across the region:
1. Poverty, hunger and under-nutrition are getting worse in ESA, even though they are improving in almost every other region. This undermines the achievement of UN Millenium Development Goals in this region.
2. Instead of the potential virtuous cycle that could be created between improved nutrition and improved economic wellbeing, ESA is currently caught in a vicious cycle of worsening poverty, hunger and under-nutrition accentuating income and health inequalities and increasing vulnerability.
3. Proven effective interventions indicate that public policy can make a difference, that nutritional improvements can be effected, even under conditions of poverty, and that these can have positive impacts on economic wellbeing.
4. Implementing public policies that address food security provides an opportunity to deal with the demands of AIDS, the challenges of the competing signals from global trade to health and development and the challenges to equitable public policy in the current governance of the food supply system.
5. Confronting hunger and nutrition provides one further area where alternatives can be built that promote policy objectives of justice and equity. This calls for interventions that build a multi-disciplinary and integrated response to food security and nutrition, especially focused upon gender inequalities, community control over productive resources and fair trade - ie one that is shaped on food sovereignty.
This analysis suggests that equity in health will be difficult to achieve in this region unless there more explicit attention is paid to the underlying nutrition and food security determinants. These in turn are being shaped by larger forces such as trade rules, corporatisation of the food supply chain, HIV/AIDS, gender inequalities etc. However we can start to identify areas of common action that would strengthen equity in food security, nutrition and health outcomes.
At a minimum an equity programme should focus on:
- Building civil - state alliances around a programme of action that links a food sovereignty perspective with the equitable public policy that supports this.
- Promoting further assessment of the links between trade and health in the region to feed into advocacy for trade policies and agreements that strengthen public health.
- Supporting, informing and evaluating policies and initiatives that provide safety nets to those most affected by negative effects of trade and agricultural policies and of HIV and AIDS.
- Continuing to identify how gender inequalities exacerbate the impact of globalisation and HIV and AIDS on the poorest families and decrease the efficiency of policy responses and propose programme and policy responses for these problems.
* The full article is available at http://www.equinetafrica.org/bibl/equinetpub.php
* Please send comments to admin@equinetafrica.org
Following the 1994 elections in South Africa, the new ANC government committed itself to the development of a District Health System that would meet the health needs of local communities and allow for grassroots input into the management of primary health care. Ten years later, there is still indecision and confusion surrounding the governance and financing of primary health care delivery and it is not clear which authorities will take leading responsibility for administering the district health services.
Municipal health workers together with their provincial counterparts and community health workers stand in the front line of delivering primary health care to the majority of South Africans. The SAMWU/MSP/IHRG National Survey into the State of Occupational Health and Safety in the Municipal Health Clinics asks “Who cares for health care workers?” While the health care profession embraces important ethics of service and sacrifice in meeting the health needs of the public, our research points to neglect of the health and well-being of health care workers themselves.
We found little taking place to identify hazards, evaluate risks, prevent workplace injury and illness and ensure that the conditions in which health workers care for others allows them to care also for themselves. Even where measures are provided, there is little employee involvement in shaping these health and safety practices.
We found that probably the biggest health and safety hazard facing health care workers in the public health sector in South Africa is the shortage of staff. Growing queues of patients lead to stress, burnout and increase the risk of accidental injury. Lack of facilities, equipment, and medicines further frustrate clinic staff and add to tensions between staff and the communities.
This situation is not simply a management problem- it is also reinforced and reproduced by health workers themselves. The inclination of the majority of health workers to accept appalling working conditions, to isolate themselves, and to individualise their workplace traumas, stress and exhaustion, presents an enormous challenge to SAMWU and other unions organising in the public health sector.
We intend to shape an alternative to that neglect. As activist investigators, we are challenging the silence and neglect that characterises work in the health sector. This starts with our research activity - asking questions; identifying workplace hazards; documenting case studies of workplace injury and illness; interviewing management and workers in the clinics; sharing stories of needle-prick incidents; interrogating policy and protocols; challenging employers’ non-compliance; discovering rights and responsibilities; and examining the extent of effective representation and functioning of health and safety committees.
* This briefing is edited by the EQUINET secretariat at TARSC. Please send feedback or queries on the issues raised in this briefing to Nick Henwood, IHRG at ihnick@ihrg.uct.ac.za or to the EQUINET secretariat email admin@equinetafrica.org .
* The research report cited will be available in late January as a downloadable pdf file from the Municipal Services Project website (http://www.queensu.ca/msp/) or from the EQUINET website at www.equinetafrica.org
Call Closes On January 7 2005
This call invites applicants to participate in the EQUINET programme on trade and health being held in co-operation with the Southern and East African Trade Information and Negotiations Institute (SEATINI) and with the EQUINET Secretariat (Training and Research Support Centre)
The call:
EQUINET invites middle to senior policymakers, academics and civil society members working in areas of trade and / or health from countries in East and Southern Africa to participate in a capacity building and research programme on trade and health, i.e. to
- Participate in country-level training on trade and health to be held between January and March 2005
- In country level teams, to undertake and report on national assessments of trade and health, supported by technical and financial resources, between March and June 2005
- Review the country level assessments at a regional meeting in mid 2005
- Make recommendations on follow up of the programme
Initial countries will be selected on the basis of a critical mass of interested people from across both trade and health disciplines and from state, academia and civil society.
The programme
Southern African countries developing equity-oriented policies face significant external pressures. Globalisation has deepened the liberalisation trends initiated by the structural adjustment programmes, while WTO agreements have extended trade liberalisation to significant new areas, including trade in services, trade related investments and intellectual property rights. As a result of these intrusions, governments enjoy less policy flexibility to pursue pro-equity goals and to regulate in the public interest. Commercialisation of health systems, exacerbated under the WTO TRIPS and GATS agreements undermines: access to care; access to essential drugs and medical technology; cross-subsidy from the wealthy to the poor; cost-containment measures in both the public sector and to users; retention of skilled health workers in public facilities and; the regulation of the private sector to promote equity. Instead of the health system becoming a vehicle for social cohesion, solidarity and equity, it runs the risk of reinforcing existing social, economic and health inequalities.
New agreements such as the Trade Related Aspects of Intellectual Property Rights (TRIPS) do provide limited space for countries to act in interests such as public health. They demand significant institutional resources and capabilities to identify and take advantage of those spaces. These resources are not always available to individual countries in the south. Regional co-operation, such as at the Southern African Development Community (SADC) level, is important for responding to these global pressures. It offers a strategic platform for countries to reinforce their bargaining power, co-ordinate their efforts and provide regional solutions to challenges faced.
To support regional responses, EQUINET aims to build proactive capacity in the region to understand, assess the health consequences of and respond to these agreements. EQUINET has with its partners in the region proposed options for using TRIPS flexibilities, for protecting national authorities and public health systems under and from the GATS and for resisting the commercialisation of health services. EQUINET advocates for government authority to regulate trade in areas where this is needed to deliver on obligations to protect the right to health and for the protection of public over commercial interests in health.
With support from IDRC and SIDA and through the Centre for Health Policy (Wits University) and SEATINI, EQUINET is implementing a programme of work and capacity development in the field of trade and health that seeks to:
- Pilot a training programme and materials on trade and health systems for countries in Southern and East Africa
- Provide technical and resource support for country level teams to carry out national assessments, identify options for promoting health systems and equity goals within current trade and investment policies and agreements and identify areas for follow up work, policy review and negotiation.
The programme will
- Carry out country-level training workshops on trade and health between February and March 2005
- Support country level teams to undertake and report on national assessments of trade and health with mentoring from SEATINI and CHP between March and June 2005
- Review the country level assessments at a regional meeting of the country teams to be held in mid 2005 to identify options for promoting health systems and equity goals within current trade and investment policies and agreements and identify areas for follow up work, policy review and negotiation, together with relevant stakeholders and expertise.
- Make recommendations on follow up training, on widening the programme and on specific areas for research and follow up work.
Call for participation and applications:
Interested applicants should submit a 1-2 page ‘expression of interest’ that provides
- a personal CV,
- brief information on the institution that they work in, and their position in the institution.
Please send applications to the EQUINET secretariat (admin@equinetafrica.org)/ Fax 263-4-737 220) and the programme co-ordinators (riazt@iafrica.com and haroon.wadee@nhls.ac.za) by January 7th 2005.
Applicants will be informed by mid-January 2005 on the outcome of their submission, including sponsorship and of the logistic follow up. Participants of existing EQUINET programmes are welcome to apply.
The focal points for queries on this programme are Riaz Tayob, SEATINI (riazt@iafrica.com) and Haroon Wadee, Centre for Health Policy, Wits University (haroon.wadee@nhls.ac.za or haroonwadee@hotmail.com).
Antoinette Ntuli, Health systems Trust South Africa, Co-ordinator EQUINET HRH theme network
After decades of neglect, Human Resources for Health (HRH) has in the past few years moved to centre stage of both international and regional debates. Within southern Africa health personnel continue to be scarce in services where they are most needed, are a critical bottleneck to the uptake of new resources from global funds and the region is suffering from escalating out migration of health workers.
Dealing with this impact of the migration of health personnel raises debates about effective and just strategies. Those that restrict health worker rights of movement often don’t work and punish individuals. ‘Ethical human resource’ policies and codes appear to have made little difference to practice on the ground, especially when movement is driven by pull and push factors in both sending and receiving countries. So what comprehensive measures will secure the human resources that southern Africa needs for its health services?
EQUINET is addressing this through a network of institutions from government and non government sectors in southern Africa and working with institutional hubs in Canada, Australia and the UK (given their role as countries absorbing significant numbers of the regions health workers). The network aims to collaborate on research and use the evidence to harmonise policy engagement and advocacy.
At a meeting in April this year the network of researchers developed the analytical framework to guide this work. This framework takes the policy interest of the country planners and authorities in the region as the starting point, and includes four major components:
1. Equitable human resource policies- what will encourage health workers to work in areas of greatest need? This work is looking at what positively and negatively affects the internal distribution of health personnel, including both traditional and allopathic practitioners. In Zimbabwe, Oliver Mudyarabikwa at the UZ Medical School is identifying the factors that cause a maldistribution of public sector health workers. Yoswa Dambisya of the University of the North in South Africa is following up on the distribution of pharmacists who trained at the University of the North, to understand what drives their choices of both sector and location of work. Steve Reid of the University of KwaZulu-Natal in South Africa is exploring what educational factors influence the choice of rural or urban sites of practice of health professionals.
2. Ethical Human Resource Policies- how to respond to international migration of health workers?. Given the work already taking place on codes of practice, and reasons for health workers leaving EQUINET is focusing its work on identifying “what makes health personnel stay”. If the retention factors are known then ethical policies in other countries should reinforce and not undermine these factors and should contribute resources towards their achievement. Scholastika Lipinge of the University of Namibia is exploring how health professionals perceive their conditions of service, and the extent to which this acts as a factor keeping them in the country and the public sector. In Malawi, Adamson Muula from the College of Medicine in the University of Malawi is exploring the coping mechanisms of health workers who stay in the Malawi health sector to identify possible strategies to support these mechanisms and reinforce health worker retention.
3. How are the HIV and AIDS epidemic and the resources for AIDS affecting the distribution of health personnel? The network has built links through its work on HIV and AIDS and its networks with Municipal Services Unions to understand the impact of HIV and AIDS on health workers, and to explore how new resources for treatment are being used in relation to improving (or undermining) the availability, conditions and retention factors of health workers, especially within district health systems.
4. What can we learn as a region and where do we need to act regionally? Country level evidence will be shared regionally, recognising the gain for exchange of experience, policies and interventions across countries in the region. This is also a regional issue, both in terms of the flow of health personnel across national boundaries and the need for a regional policy response to international factors. Common evidence from all countries in the region, and more detailed evidence from Swaziland, Botswana, Namibia, South Africa, Zimbabwe and Malawi will be used to build a more detailed regional picture of the distribution and flows of personnel and the factors affecting this. We will also carry out in early 2005 an analysis of the policy environment, in terms of the priorities, actors and forces in this area and the options this raises for national and regional authorities.
EQUINET and HST are aware of the significant volume of work taking place in different institutions and countries on this issue. We have a database on human resources for health on our website at www.equinetafrica.org through which we hope to share materials and information that we access and encourage people to use and contribute to it.
When the African Ministers of Health raised issues of health personnel migration at the 2004 World Health Assembly they were profiling a situation that calls for policy recognition, such as through protocols and codes, but also for wider strategies and interventions. Those strategies should as first call reinforce the health workers who stay in the system, particularly those who work at primary care and district level, and strengthen the environments that encourage health workers to do this.
* EQUINET briefings are edited by R Loewenson, EQUINET secretariat, Training and Research Support Centre. Please send feedback or queries on the issues raised in this briefing to the secretariat email admin@equinetafrica.org . Reports cited are available as a downloadable pdf file from our website at www.equinetafrica.org
The World Health Organization (WHO) recently released the first set of comprehensive data comparing the prevalence of HIV/AIDS in poor countries with the rates of antiretroviral (anti-HIV) drug access in those nations. The data are striking and disheartening, yet have received little press coverage. Indeed, at the time of their release, some American newspapers ran editorials indicating that antiretroviral access has received "too much attention".
Two problems are implicit in such a contention. The first is political. AIDS is very much a symptom - albeit the most extreme symptom - of the large diseases of inequality and poverty that result not only in HIV, but also in hunger, hemorrhagic fever and housing problems. The same credit and political obstacles that have led to gender discrimination in housing and employment have led women into prostitution and relationships based on sexual dominance [1, 2]. The same structural adjustment programs and neoliberal economic policies that have crashed farming sectors and forced thousands into migration are the same policies that have led migrants to the barracks of minefields to live with depression, alcoholism and the subsequent solicitation of prostitutes [3-5]. And so to address AIDS appropriately would be to appreciate that it does not simply receive "too much attention", but that the attention it receives should be drawn towards its base - and this includes the inequalities in healthcare access that are symbolized by antiretroviral access disputes.
The second problem with the new popular line of thought on antiretrovirals is a statistical problem. The recently-released WHO data are striking but perhaps not surprising. If "too much attention" has been focused on drug access, then why are only six-tenths of a percent of the 1.6 million infected people in Tanzania able to access antiretroviral medications? Why are only 1.5% of the 2.4 million in Mozambique and the Congo able to gain such access? In a country like Zimbabwe, where one of every four adults is infected, only one of every fifth can access an antiretroviral medication. As one scrolls through the WHO's data, the numbers of infected persons continue to be expressed in seven digits, while the percent of those gaining access to antiretrovirals continues into smaller and smaller decimal ranges.
* Please click on the link to read the full article.
EQUINET NEWS IS THE ELECTRONIC MAILING LIST OF THE NETWORK FOR EQUITY IN HEALTH IN SOUTHERN AFRICA (EQUINET) http://www.equinetafrica.org/ EQUINET NEWS is a newsletter designed to keep you informed about materials on the Internet on equity and health in southern Africa, focusing primarily on EQUINET's principal themes. The newsletter also includes news about Equinet activities, policy debates or theme work to keep you updated on work taking place. Further information on the materials in these briefings is available from TARSC (email: admin@equinetafrica.org).
The SADC Health Protocol came into force at the 2004 SADC Mauritius Summit and now applies across the region. It outlines the priorities and mechanisms for regional co-operation in health. We look forward to the protocol being raised and discussed within the parliaments of the region to see how far we are making progress in the regional priorities and approaches signed on to by the heads of state in Mauritius.
Why should parliaments be important to struggles for equity in health? Parliaments are a watchdog of public policy and consolidate this policy in law. In their legislative role they are able to transform social norms and values into binding legal entitlements. Their oversight role on the budget and on the actions of the executive provides an important opportunity to ensure that these legal entitlements are realized in practice. For example parliaments are an important watchdog of the government Abuja summit commitment that at least 15% of government budgets are invested in the public health sector. They can give voice through various processes of debate, inquiry, public hearings and consultation to public views, including the views of those areas and groups where such voice may be weaker or less articulate.
In an EQUINET, GEGA and SADC Parliamentary Forum regional meeting in South Africa in August 2003, it was recognized that parliaments are uniquely placed to build alliances with the Executive branch of government, across political parties, between different portfolio committees and with civil society, health sector and other agencies at national and regional level in support of health equity. (The report of this meeting is found at www.equinetafrica.org) The parliamentary reforms taking place in the region provide an enabling environment for this. At the August 2003 regional conference, delegates agreed that the establishment of parliamentary committees on health provided a forum for deeper review, policy monitoring and analysis, and noted that a range of health related activities were already taking place. These committees have held public hearings on laws and policies, visited and investigated conditions in the health system, held systematic hearings on the national budget and its consistency with national health policies and promoted public awareness on key areas of social norms and action in health, such as HIV and AIDS. In Zambia, South Africa and Zimbabwe, for example, with support from institutions in EQUINET and GEGA, parliamentary committees on health have analysed and made input on equity issues in the health budget and have visited districts to follow up on the equity issues raised. In Tanzania the parliament has established a parliamentary forum on AIDS at which key issues such as equity in access to Antiretroviral treatment have been debated. In Malawi parliaments have raised and promoted debate on issues of migration of health personnel and on the quality of health services at the district level.
In June 2004, during the EQUINET regional conference on equity in health, parliamentary committees and organisations working on health equity agreed that these critical areas of work needed more consistent regional exchange of information and good practice, support and activity. They would also benefit from longer term co-operation with state, academic and civil society institutions working on health equity. How can this be achieved? Is a more regular forum of health committees needed, within the SADC framework? How can the current work and institutional partnerships with parliaments be better networked and more consistently supported to ensure greater exchange of information, learning and good practice? These issues were raised as matters of concern to organisations like EQUINET working with parliaments and we invite readers and institutions working with parliaments to give feedback to these queries. What experiences exist in the region of work with parliamentarians on equity in health? How can we better strengthen and support such parliamentary roles, particularly if we are to achieve our goals of equity and social justice in health, and the policy commitments expressed in the SADC Health Protocol?
This briefing is produced by the EQUINET secretariat at TARSC. Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat email admin@equinetafrica.org . Reports cited are available as a downloadable pdf file from our website at www.equinetafrica.org
A new report on the funding by nine African and Latin American countries on HIV/AIDS has found that countries must do more to ensure a comprehensive response to the epidemic—incorporating prevention, treatment, care and support. The study, undertaken by NGO research institutes in each country, was jointly coordinated by Idasa in South Africa and Fundar in Mexico.
The study, entitled Funding the Fight: Budgeting for HIV/AIDS in Developing Countries will be discussed by researchers during a one-day meeting taking place in Johannesburg this week. This research project makes a remarkable contribution to the field of HIV/AIDS resource-tracking, in that comparable budget analysis studies were undertaken by civil society organisations.
The study found that while many countries have developed national strategic plans and programmes, these were poorly costed and budgeted. It also found that the tracking of resources allocated towards HIV/AIDS in national budgets was hindered by weak or absent links between allocations and their intended objectives and outputs. Governments have inadequate systems in place to track the allocation of resources for HIV/AIDS.
Yet the research yielded a number of important findings. In Africa most countries, until recently, have focused on prevention more than treatment. This despite the fact that WHO/UNAIDS estimates that 3.8 million Africans are in need of treatment, while only 150 000 people are currently receiving the life-prolonging drugs. The study notes the boost to HIV/AIDS spending following the recent announcement and launch of ARV treatment programmes in South Africa, Mozambique, Kenya and Namibia. However the researchers caution that even though governments may increase their allocations to provide treatment, this programme may be undermined if more money is not made available to strengthen the health system overall.
In the Latin American countries, where HIV/AIDS prevalence is below 1%, the bulk of government spending on HIV/AIDS is earmarked for providing antiretroviral treatment. In Argentina 90%, in Chile 80%, Ecuador 74% and Nicaragua 54% of the national AIDS budget is committed to providing treatment and care and support, with less resources available for prevention. The researchers warn that treatment alone may not be enough to curb the epidemic and that the governments of Latin America need to increase their allocations and commitment to prevention.
The Report points out that all the African countries are falling below the 15% target agreed upon by Governments at an OAU Summit in Abuja in 2001. Amongst the African countries, the health allocations as a share of total government expenditure range from 6% in Kenya to approximately 15% in Mozambique. South Africa’s allocation is estimated to be just under 12%. Health budgets in the Latin American countries, with the exception of Nicaragua, were primarily financed through state revenue, whereas in the African countries, except South Africa, they tend to rely primarily on donor funds.
While it is difficult to isolate specific HIV/AIDS allocations from the overall health budget, the report finds HIV/AIDS earmarked funds consume less then 4% of health budgets in the Latin American countries included in the study, ranging in 2002, from under 1% in Chile to 3.5% in Argentina. In Africa, the priority accorded to HIV/AIDS programmes in health budgets varied significantly—from 1.6% in Mozambique, to 11.4% in Kenya in 2002. In South Africa the HIV/AIDS allocations have climbed steadily from 0.67% of the consolidated national and provincial health budget in 2000/1, to 3.86% in 2004/5. HIV/AIDS-specific allocations made up 0.49% of South Africa’s overall national budget in 2004/5.
An important finding from the Report is that the increasing allocations being made to HIV/AIDS may be squeezing out other health priorities. In all countries the researchers observed that while HIV/AIDS allocations have been increasing, this has not been matched by a commensurate increase in allocations to the health sector overall. Without adequate attention to strengthen and support overall health infrastructure, facilities and medical personnel, HIV/AIDS programmes will be undermined, and simultaneously the health care delivery will strain under the burden of HIV/AIDS.
The report urges African countries to increase their own financial commitments to HIV/AIDS interventions. It points out that with the exception of South Africa, most African countries rely to a great extent on donor funding. Greater commitment of state funds is essential to the longevity of scaled-up programmes, particularly treatment.
The report has been able to yield very valuable findings, and the researchers are calling for budget reforms and greater transparency of government allocations for, and actual spending on, HIV/AIDS. This information will enable civil society and citizens to better understand and monitor how much is being spent on HIV/AIDS, for what programmes, and in what regions and provinces. Effective government responses to AIDS require us to know where the money is coming from, where it is going, and how well it is being spent.
For more information contact: Alison Hickey, Manager, AIDS Budget Unit, Idasa. Cell: 083 280 2759; Teresa Guthrie, Project Co-ordinator, AIDS Budget Unit, Idasa. Cell: 082 872 4694. To order a hard copy of the report, contact: nomzi@idasact.org.za A full electronic version will be available October 2004: www.idasa.org.za
EQUINET is currently carrying out work in line with the SADC Business Plan on HIV and AIDS on monitoring, protomting good practice, supporting research and sharing information on health systems and equity issues in treatment access. More information on this programme is available from the EQUINET secretariat at TARSC, email admin@equinetafrica.org.
The debt relief movement is poised for a historic day this October 1st when G-7 finance ministers discuss 100% multilateral debt cancellation for impoverished countries. Debt cancellation would free up significant funds for development, including fighting AIDS and strengthening health systems. You can help make this happen.
If you are a health professional, please lend your name to an international health professional sign on letter that will reach all G-7 finance ministers and presidents/prime ministers before this important meeting. This letter is copied below. If you would like to add your name, please respond by September 20th to aidsact@phrusa.org with your full name, degree, affiliation, and state/country.
International Health Professional Sign-on Letter
September, 2004
Dear G-7 Presidents and Prime Ministers:
We write to you as health professionals from diverse countries in Africa, Asia, Latin America and the Caribbean, North America, Europe, and Australia who strongly support debt cancellation for poor countries. Debt cancellation is a prescription urgently needed to help heal seriously ailing health systems – some of which cannot even provide minimal care – in many of the countries in which we live and work.
Debt cancellation would free large sums of money, funds that should be used to build stronger and more equitable health systems, which are desperately needed if the fight against AIDS and other killer diseases is ever to be won. Right now we are losing that fight. AIDS alone kills about 3 million people per year, as another 5 million people becoming infected with HIV annually. At the end of June 2004, fewer than 10% of people in developing countries in urgent need of AIDS treatment were receiving it. In light of the health crises that many of our countries face, debt cancellation is necessary on human rights and humanitarian grounds. We therefore urge you to endorse 100% multilateral debt cancellation for impoverished countries when the issue is discussed at the meeting of G-7 finance ministers this October 1.
We know that poor countries need this debt relief urgently. African countries alone are collectively spending about $15 billion per year servicing their debts to wealthy creditors, including multilateral institutions. The fifteen focus countries of the U.S. President’s Emergency Plan for AIDS Relief spent $10.3 billion servicing their debts in 2001; this is more than the $9 billion these countries are scheduled to receive over the Emergency Plan’s entire five years. The World Bank, IMF, and regional development banks are typically the largest creditors of the most impoverished nations.
Relief from debt could be instrumental in enabling countries to meet AIDS treatment targets, as well as other health goals. Your governments all support the World Health Organization’s (WHO’s) 3 by 5 initiative, which aims to get 3 million people in developing and middle-income countries on AIDS treatment by the end of 2005. Yet treatment goals cannot be achieved without health workers. And as so many of us know through our own experiences, many countries, particularly in Africa, have nowhere near the necessary numbers of health personnel. For example, WHO and the World Bank have reported that Tanzania and Chad, both countries that would benefit greatly from debt cancellation, require their health workforces to triple and quadruple in size, respectively, to achieve the Millennium Development Goals.
The connection between suffering health systems and the debt payments that limit funds available to them is palpable. To a significant degree, the severe shortage of health workers in Africa is a symptom of acute underinvestment in health systems, many of which suffer from too few staff, too few supplies, and too few drugs. This underinvestment is a central cause of the migration of health professionals to wealthy nations, where health systems are stronger and pay is better. Creating the conditions that will enable health professionals to remain in their home countries and allow them to provide the best care possible for their patients will cost money. Health care workers will continue to leave if they are unable to meet the charge of our professions: serving our patients. Our colleagues will continue to emigrate so long as they do not have medicines for their patients, or functioning equipment, or proper supervision. And they will continue to leave so long as they cannot support their families or be confident of their own safety. They need fair salaries, equipment to protect themselves from occupational infections of HIV and other diseases, and psychosocial support to help cope with the constant death and stressors they face.
Full multilateral debt cancellation for impoverished nations could go a long way towards meeting people’s right to the highest attainable standard of health. Indeed, debt relief that countries have received under the Heavily Indebted Poor Countries (HIPC) initiative has already begun to do so. In Malawi, savings from debt relief have paid for extra staff and support in primary health centres, nurse training, and improving the supply of essential drugs in health facilities. In Mozambique, debt relief funds helped increase the number of children receiving immunizations for tetanus, whooping cough, and diphtheria. Debt relief savings have also helped fund primary health care in Uganda, including salaries of health care workers, while countries including Uganda and Cameroon have used debt relief savings to help finance HIV/AIDS programs.
Debt cancellation is an excellent investment not only in people’s health, but also in countries’ economic well-being. Increased spending by impoverished countries in health, education, and other fields that promote human development, which will result from debt cancellation, goes hand-in-hand with economic growth. As WHO’s Commission on Macroeconomics and Health has highlighted, investments in health will increase worker productivity, creating economic gains that would far exceed the initial cost to creditors of debt relief. Debt cancellation will help put countries that are economically marginalized and heavily dependent on foreign aid onto paths towards economic autonomy and integration in the world economy. By contrast, without debt cancellation and other investments to reverse the spread of and treat people with HIV/AIDS, decreased worker productivity will make countries increasingly dependent on foreign assistance and unable to participate in the global economy.
We therefore urge you to support 100% multilateral debt cancellation for impoverished countries, including HIPC countries and as well as non-HIPC countries that are in need of this relief. We hope that your finance ministers will announce your governments’ support for such an initiative at their October 1 meeting. And we encourage you to work with countries whose debts are cancelled to ensure that their savings from debt payments are used on poverty reduction and human development. Countries can establish mechanisms to ensure that savings from debt services payments are used to reduce poverty and to promote human development. Uganda has established a Poverty Action Fund into which savings from debt relief are channelled, and which includes a series of procedures to ensure that the debt relief savings are well spent. Other countries, including Tanzania and Malawi, have established similar mechanisms.
We also encourage you to work towards a permanent solution to the debt of impoverished countries – including for countries that do not receive 100% multilateral debt cancellation and for any new debt assumed by those countries whose debts are cancelled – by creating a new understanding of what level of debt countries are expected to repay. In particular, we urge you to announce that from this time forward, countries will be neither obliged nor expected to make debt payments that would compromise their ability to meet their people’s basic needs or otherwise fulfill their people’s human rights.
We are health professionals. Our job is to heal. So it pains us to see debt payments siphoning away funds that could go far towards enabling our colleagues and ourselves do our jobs and meet the needs of the patients we serve. We fervently hope that you will help enable us to be the healers that we were trained to be.
Sincerely,
[If you would like to add your name, please respond by September 20th to aidsact@phrusa.org with your full name, degree, affiliation, and state/country.]