The 42nd Regional Health Ministers' Conference took place at the Sun n Sand Hotel in Mombasa, Kenya from the 6th to the 11th of February, 2006. It was inaugurated by the Vice President of the Republic of Kenya, The Honourable Moody Awori and attended by Health Ministers from the ECSA Region, representatives of regional and international organizations as well as developmental agencies. During the Conference, the Honourable Charity K. Ngilu, Minister of Health was elected Conference Chairperson for 2005/6 and Honourable Dr. Ntaba, Minister of Health of the Republic of Malawi was elected Conference Vice Chairperson. The theme of the Conference was “Scaling up Best Practices in health care in East, Central and Southern Africa” The Conference approved and adopted the following resolutions based on the main sub-themes of the Conference: Resolution 1: Monitoring framework for implementation of RHMC Resolutions Resolution 2: HIV/AIDS and TB Resolution 3: Malaria Prevention and Control Resolution 4: Human Resources for Health Resolution 5: Resource Mobilization Resolution 6: Alternative Health financing Resolution 7: Donor Coordination Resolution 8: Maternal New Born and Reproductive Health Resolution 9: Social Determinants of Health Resolution 10: Avian Influenza and Human Pandemic Resolution 11: Non- Communicable Diseases Resolution 12: Expression of gratitude to the Government and the people of Kenya RHMC/42/R1 Monitoring framework for implementation of RHMC Resolutions Noting that monitoring and evaluation of implementation of resolutions passed at RHMCs and sharing of information among countries in the ECSA region is generally weak; Concerned that most countries have no mechanism for following up resolutions made during the RHMC; Further noting that some member states have not established country core groups as a mechanism for following up implementation of resolutions as directed by previous RHMCs; And concerned that skills, tools, equipment and weak electronic connectivity within and among ECSA member states is also a major hindrance to effective information sharing and communication, The conference of Health ministers urges member states to: 1. Develop and or strengthen country level mechanisms to monitor and evaluate implementation of resolutions passed at RHMCs. 2. Strengthen information sharing within the countries and among the ECSA member states. 3. Ensure that country core groups are established and function as directed by previous RHMCs. The conference of Health ministers urges the secretariat to: 1. Develop a framework for monitoring the implementation of resolutions in collaboration with member states 2. Promote effective sharing of information and experiences amongst members states RHMC/42/R2 HIV /AIDS and Tuberculosis R2.1 Universal access to HIV/AIDS core interventions (prevention, treatment, care and nutrition) Concerned about the devastating impact of HIV/AIDS in the Region; Recalling Resolution number RHMC/40/R4 of the 40th Regional Health Ministers Conference held in November 2004 in Victoria Falls, Zimbabwe, on HIV/AIDS and TB; Noting the encouraging progress that has been made in scaling up HIV/AIDS interventions in the ECSA Region, including the 3 by 5 Initiative; Recognizing the need to utilize the lessons learnt and build on the momentum of 3 by 5 Initiative to expand the success; Further recognizing the need to reinforce prevention, treatment and care towards attainment of Millennium Development Goal No 6; Noting the World Summit document of September 2005 on the need to develop and implement a package for HIV prevention, treatment and care with the aim of coming as close as possible to the goal of universal access to treatment by 2010 for all those who need it, The 42nd Regional Health Ministers conference urges member states to: 1. Allocate more resources, strengthen and implement policies and programmes towards universal access to HIV/AIDS prevention, treatment and care interventions, for all those who need them; 2. Promote nutritional care and support for people living with HIV/AIDS, particularly those on ART and affected families 3. Ensure community involvement, participation and ownership in these responses The 42nd Regional Health Ministers conference urges the Secretariat to: 1. Advocate for mobilization of resources and facilitate sharing of country experiences and expertise across the Region, in support of scaling up of HIV/AIDS interventions towards Universal Access. 2. Collaborate with partners to provide the necessary technical support to countries, including developing a framework for monitoring progress. R2.2 HIV Infection and Alcohol Recognizing that an effective response to the HIV and AIDS epidemic must address the underlying social factors that drive risk behavior, including poverty and the ways individuals cope. Concerned by the high percentage of people, including youth, who turn to alcohol to cope with societal, poverty-related stress and HIV- related anxiety. Noting that excessive alcohol use increases vulnerability to HIV transmission, reduces the efficacy of HIV medicines and reduces drug compliance. The 42nd Regional Health Ministers conference urges member states to: 1. Incorporate issues related to alcohol in the national HIV/AIDS strategy and ensure that appropriate alcohol and HIV/AIDS policies, guidelines and programmes are in place. 2. Establish a regional and national technical working groups to spearhead the implementation of alcohol and HIV/AIDS programmes The 42nd Regional Health Ministers conference urges the secretariat to: 1. Conduct a situational analysis on policies, guidelines and programmes and legal frame works that exist in selected member countries and report back in the next conference 2. Collaborate with other partners to provide the necessary technical support to member countries. R2.3 Routine HIV Testing and Counseling Recognizing the important role of HIV testing in prevention and treatment of HIV/AIDS. The 42nd Regional Health Ministers conference urges member states to: 1. Strengthen existing routine testing and counseling policies and programs. 2. Initiate and scale up routine testing services by strengthening infrastructure for HIV testing, training more healthcare providers and improving supply chain management. The 42nd Regional Health Ministers conference urges the secretariat to: 1. Promote harmonization, adoption and implementation of RTC Policies and guidelines. 2. Collaborate with partners to provide technical assistance to member states on procurement and supply chain management. R2.4 Prevention of Mother to Child Transmission of HIV Infection Recognizing that PMTCT coverage remains low in most of the member states and noting that the main challenges in scaling up PMTCT services include inadequate human and material resources. Further noting that although most of the member states have developed PMTCT comprehensive guidelines, very few countries have specific policies on PMTCT. Realizing that in most countries PMTCT services are currently provided without adequate linkages to other services such as ART. The 42nd Regional Health Ministers conference urges member states to: 1. Scale-up the progress towards universal access to PMTCT services 2. Integrate PMTCT with ART programs and ensure continuum of care. 3. Develop and implement strategies that increase male participation in PMTCT services. The 42nd Regional Health Ministers conference urges the secretariat to: 1. Facilitate the sharing of best practices among member states. R2.5 Development of an HIV vaccine Noting that vaccines have been demonstrated to be a useful tool in the control and eradication of communicable viral diseases such as smallpox and therefore a vaccine to prevent HIV transmission will be an additional tool to the comprehensive strategies for the prevention and control of the pandemic. Further noting that there has been little progress in the development of HIV vaccines, The 42nd Regional Health Ministers conference urges member states to: 1. Place HIV vaccine research and development in the national and regional health agenda. 2. Develop national HIV vaccine plans for HIV vaccine research and development 3. Sustain political support and commitment including budgetary allocation to the development of HIV vaccines. The 42nd Regional Health Ministers conference urges the secretariat to: 1. Promote regional collaboration to strengthen regional scientific capacity for the development of HIV vaccines. R2.6 Tuberculosis Noting that 6 of the top 10 countries with the highest TB notification rates in Africa are in the ECSA region and that only two ECSA member states have attained the regional and global targets for case detection and treatment success. Further noting that on average 35% of TB cases in the ECSA region are also HIV positive and only half of these have access to ART. Recalling resolutions by the WHO Regional Committee for Africa declaring TB an Emergency in the African Region and calling for Acceleration of HIV prevention in the African Region respectively; commitments of African Heads of State and Government on HIV/AIDS, TB and Malaria in Abuja; the 2005 commitments of AU Ministers of Health in Gaborone; the Millennium Development Goal targets for AIDS and TB control, and declarations of previous ECSA Conferences of Ministers on the urgent need to scale up the fight against AIDS, TB and other priority diseases. The 42nd Regional Health Ministers conference urges member states to: 1. Fully endorse the 2005 WHO Regional Committee for Africa resolution by declaring TB a national emergency. 2. Rapidly scale up DOTS expansion best practices, especially public-private partnerships and community involvement in the delivery of TB control services 3. Scale up TB/HIV collaborative activities including HIV testing and ART to dually infected TB patients in the context of universal access. The 42nd Regional Health Ministers conference urges the secretariat to: 1. Collaborate with partners to develop and implement a framework for monitoring progress towards attainment of the Regional and Global TB control targets in ECSA Member States and report to the RHMC every year. R2.7 Trade Related Aspects of Intellectual Property Rights (TRIPs) and Public Health Noting that there are many flexibilities in the TRIPs agreement that allow governments of developing and least developed countries to establish pro-health measures such as compulsory licensing, government use provisions and parallel importation to scale access to more affordable medicines and yet most countries in the region have not taken full advantage of these flexibilities. The 42nd Regional Health Ministers conference urges member states to: 1. Review their patent laws and amend them in line with the best options available in implementing the TRIPs agreement. 2. Fully utilize the flexibilities available within the TRIPs agreement and Doha declaration. 3. Carefully review the implications of TRIPs-plus obligations on access to essential medicines when negotiating bilateral and/or regional trade agreements. 4. Galvanize the existing opportunities to scale-up access to essential commodities for HIV and AIDS treatment and care. The 42nd Regional Health Ministers conference urges the secretariat to: 1. Conduct training workshops for ministries of Health, Trade, Finance, Justice and other relevant stakeholders to facilitate better understanding of the TRIPs agreement. RHMC/42/R3 Malaria Prevention and Control Deeply concerned that malaria remains a major cause of morbidity and mortality within the region, yet it is preventable and curable; Noting that malaria has a huge economic burden and continues to afflict many people in the region and especially children and pregnant women; Aware that vector control is a key strategy to reducing malaria transmission; Further noting that Indoor Residual Spraying (IRS) using DDT, controlled and even eradicated malaria in other regions of the world and that some countries using it in the Southern Africa region have achieved remarkable reduction in malaria transmission; Considering that the ITNs coverage in most countries of the region remains below the Abuja targets; Noting that the cost of Artemesinin based Combination Therapies (ACTs) currently recommended by WHO as 1st line treatment of malaria is still high for the majority of the people in the region; Reaffirming Resolution No.1 of the 40th RHMC of 2004 and Resolution No.4 of the 36th RHMC of 2002; The 42nd Regional Health Ministers conference urges member states to: 1. Scale up use of effective and appropriate vector control measures, which include Indoor Residual Spraying (IRS) using DDT, pyrethrin or other insecticides; Insecticide Treated Nets (ITNs); larviciding; environmental management or a combination of these measures in conformity with WHO guidelines. 2. Promote local cultivation of artemisia annua and pyrethrum. 3. Promote the local production of insecticides such as pyrethrin for use in the prevention and control of malaria 4. Promote the local production of Long Lasting Insecticide treated Nets (LLINs) and ACTs. 5. Increase access to malaria prevention and treatment by removing taxes, tariffs, other levies on malaria prevention and control commodities including yarn. 6. Regularly monitor the efficacy of recommended medicines and commonly used insecticides for vector control and share findings and experiences with other member countries. The 42nd Regional Health Ministers conference urges the secretariat to: 1. Facilitate the establishment of a quality assurance mechanism of recommended medicines and insecticides used for malaria prevention and control in the region. 2. Facilitate the sharing of country experiences. RHMC/42/R4 Human Resources for Health Noting that several recommendations made during previous RHMCs continue to be pertinent human resources issues that need full implementation and periodic evaluation; Acknowledging that HIV and AIDS pandemic adversely impacts on human resource and quality health care; Recognizing that adequate human resource is critical for the effective implementation of HIV/AIDS intervention; Recognizing that out-migration of scarce health professionals from the ECSA region is a growing problem which continues to deplete the existing health care workforce; Recognizing that without accurate, current data for human resource policies, planning and management meaningful development in the region is difficult; The 42nd Regional Health Ministers conference urges member states to: 1. Develop national systems of continuing professional development that promote on-the- job and team-based training 2. Develop a system for tracking continuing professional development. 3. Develop and strengthen innovative mechanisms for staff recruitment based on norms that are regularly reviewed. 4. Adopt a common position on compensation for health workers recruited by developed countries. 5. Adopt a common position on ethical recruitment of health workers. 6. Develop financial and non-financial strategies to encourage retention of health professionals. The 42nd Regional Health Ministers conference urges the secretariat to: 1. Facilitate harmonization of curricula for training health professionals. 2. Promote the establishment of centers of excellence for training of health professionals in the region. 3. Support member countries in conducting appropriate research on human resource for health e.g. in retention, effects of out-migration, work-load studies and promote evidenced based best practices. 4. Facilitate the development of human resource information systems in member states. 5. Develop guidelines for ethical recruitment and compensation for health workers. RHMC/42/R5 R5.1 Resource mobilization Noting with concern that member states are experiencing difficulties in utilization of donor funds due to the different financing mechanisms from different donors and other donor conditionalities; Further noting that the slow disbursement of donor funds is delaying implementation of programmes; Recognizing that member states have functional existing financial mechanisms; Concerned that Ministries of Health are not fully aware of funds coming into the health sector from various donors The 42nd Regional Health Ministers conference urges member states to: 1. Enter into contractual agreements that will only utilize existing country financial mechanisms in the context of the National Strategic Plan, in line with the “three-ones” principle; that is one national strategic plan, one coordinating mechanism led by the Government, and one monitoring and evaluation framework. 2. Strengthen mechanism for coordinating donor funds utilization in collaboration with the ministry of finance. 3. Develop mechanisms of capturing donor fund disbursement 4. Utilize resource tracking tools at national and district levels The 42nd Regional Health Ministers conference urges the secretariat to: 1. Support member states to implement national health account for resource tracking at all levels. 2. Support member state to develop guidelines and criteria for equitable distribution of donor resources. R5.2 Improving access to drugs through coordinated informed buying: Recognizing that drugs and medical supplies are second to human resources for health as one of the most costly input in health services, Noting that pooled procurement of drugs and medical supplies increases access and affordability to health care services, Further noting that some member states are using drug price monitoring systems to significantly cut down costs of health services, The 42nd Regional Health Ministers conference urges the member states to: 1. Increase efforts to monitor drugs and medical supplies prices in local and international markets 2. To establish sharing of drug price information to support coordinated informed buying 3. To strengthen drug management systems with special emphasis on procurement and logistics The 42nd Regional Health Ministers conference urges the secretariat to: 1. Accelerate the process of establishing coordinated informed buying web tool in development. 2. To collaborate with other partners such as the WHO, SADC, EAC and COMESA to effectively share information on existing drug price monitoring systems. RHMC/42/R6 Alternative health financing Recognizing that the public finances are not adequate to meet all the health care needs; Noting that more than 50% of the population in most ECSA member states live on less than 1 US $ a day; Further noting with concern that most households access health care through out-of-pocket payments leading to catastrophic spending at household level; Recognizing that donor funding can not guarantee sustainability of health care delivery The 42nd Regional Health Ministers conference urges member states to: 1. Abolish user-fees for underprivileged and vulnerable groups in line with existing national policies. 2. Uphold Abuja Declaration to increase National Health budget to 15% of total government budget and work towards increasing the per capita spending on health according to WHO recommendation 3. Develop equitable and comprehensive health care financing structures such as financial risk pooling mechanisms that encompass social health insurance, enhanced public financing and community health financing The 42nd Regional Health Ministers conference urges the secretariat to: 1. Document and disseminate best practices among ECSA member states. RHMC/42/R7 Donor coordination While acknowledging that they donor support is significant in financing heath activities it noted with deep concern that there is lack of coordination of the multiple partners implementing health interventions which may result in duplication; Recognizing that there are many different donors active in the health sector in the region and their important role in the health sector; The 42nd Regional Health Ministers conference urges member states to: 1. Develop and implement effective donor coordination mechanisms at country level 2. Monitor and track donor activities at all levels of implementation. 3. Adopt Sector -Wide Approach (SWAp) and direct budget support in the funding of health sector The 42nd Regional Health Ministers conference urges the secretariat to: 1. Document and disseminate best practices among ECSA member states. RHMC/42/R8 Maternal/Reproductive Health, New born and Child Health Aware of limited access to quality, sustainable, equitable, maternal/ RH, newborn and child health services; Aware of the critical role of male participation in access and utilization of maternal/RH, newborn and child health services; Recognizing the important role of mobilizing communities towards greater participation in improving maternal/RH and child health services; Reaffirming Resolutions 2 of the 40th RHMC, Resolution 3 of the 38th RHMC and Resolution 2 of the 32 RHMC including their commitment to the past relevant recommendations of the RHMC and international resolutions to which member countries are signatory to in their respective strategies; The 42nd Regional Health Ministers conference urges member states to: 1. Allocate more resources to ensure universal access to maternal/RH and child health services; 2. Strengthen and implement policies and programmes to: a. Ensure universal access to safe delivery b. Ensure universal access to quality maternal/RH and child health services c. Ensure community participation and ownership in maternal/RH and child health services d. Promote positive male involvement in maternal/RH and child health services 3. Review and strengthen legislation to effectively address gender based violence and sexual offenses especially against women and children 4. Establish mechanisms to enforce legislation to effectively address gender based violence and sexual offenses, especially against women and children; The 42nd Regional Health Ministers conference urges the secretariat to: 1. Facilitate the documentation and sharing of best practices on establishment and enforcement of legislation on sexual offenses especially against women and children 2. Advocate for mobilization of resources for implementation of maternal/RH and child health services 3. Advocate for member states to develop policies on, adapt and conduct regular maternal and perinatal audits and share best practices 4. Facilitate and support countries to establish maternal and perinatal audit databases 5. Facilitate sharing of country experiences on addressing the problem of unsafe abortion RHMC/42/R9 Social determinants of health Deeply concerned that extreme poverty and lack of education are prevalent in nearly all member states; Noting that the social determinants of health (conditions in which people live and work; including such factors as extreme poverty, sanitation, water, transport, lifestyle, low social capital of women and children, violence and the environment) are underlying causes of diseases; Recognizing the Alma Ata Declaration of 1978 calling for the primary health care approach and extolling the concept of “health for all by the year 2000 and beyond” and the adoption of primary health care policies in all ECSA member states; Noting the ECSA health community emphasis on the adoption of the tenets of primary health care delivered in a multi-sectoral and multidisciplinary approach with individuals, families and community empowered to actively participate in their health and health care; Realising that the MDGs cannot be achieved without addressing the social determinants of health Recognizing that addressing the causes of ill health requires action across sectors and levels of government; The 42nd Regional Health Ministers conference urges member states to: 1. Express commitment from the highest level of government to scale up interventions on social determinants of health such as extreme poverty, water and sanitation, education, employment, social and physical environments; 2. Strengthen the links and coordination amongst ministries, civil societies and other stakeholders to put in place strategies and approaches that address the social determinants of health; 3. Allocate more resources to sectors that have a direct impact on social determinants of health 4. Uphold and ensure the right of all citizens to adequate housing, food, safe water and sanitation; 5. Promote universal access to a high quality primary health care systems with adequately funded infrastructures for health promotion, disease prevention and health protection; 6. Promote and maintain high quality public education systems and expand programs in early childhood education and care; 7. Develop programmes to reorient staff at all levels on PHC and to integrate action on social determinants into all health programmes 8. Address gender-based practices that negatively impact on health e.g. gender-based violence and discrimination, using a multi-sectoral and multidimensional approach; 9. To address alcohol abuse and other substance abuse as social determinants of health 10. Establish mechanisms such as multi-sectoral working groups including government, training institutions, and community organizations to prioritize areas of action on social determinants of health and to ensure the implementation of these resolutions 11. Plan, resource and implement a concrete programme of action in the region towards revitalizing primary health care and the thirty-year anniversary of Alma Ata in 2008. 12. Report every year on progress made in addressing social determinants of health The 42nd Regional Health Ministers conference urges the secretariat to: 1. Document the extent to which social determinants of health are integrated in government policies and plans 2. Identify policy gaps, good practices and institutional mechanisms to strengthen primary health care and action on social determinants across all of government and make appropriate recommendations. 3. In partnership with the multi-sectoral working groups in member states exchange information, experience, policy options and practices to support member states to address the social determinants of health. 4. Collaborate with the WHO Commission on the Social Determinants of Health and its work programmes to strengthen policy and action on the social determinants of health. 5. Collaborate with WHO/AFRO to support countries address social determinants of health 6. Prepare and present a consolidated report of action taken in the ECSA region on the social determinants of health at every RHMC RHMC/42/R10 Avian Influenza and Human Pandemic Recognizing the potential threat of Avian Influenza and Human Pandemic outbreak to life and economies in Africa, Noting that many countries in ECSA region have not yet developed Avian Influenza and Human Pandemic preparedness plans Further noting the close contact between human and domestic poultry and between domestic poultry and migratory birds that pass through the region, Noting with concern the high burden of diseases and the impact on the health systems, The 42nd Regional Health Ministers conference urges the member states to: 1. Urgently finalize countries’ Avian Influenza and Human Pandemic preparedness plans 2. Urgently operationalize emergency plans with main focus on disease surveillance. 3. Invest in strengthening laboratory capacities for diagnosis and research on Avian Influenza and Human Pandemic. 4. Review compensation laws applicable for culling birds in the event of an outbreak of Avian Influenza and Human Pandemic 5. Mobilize resources for Avian Influenza and Human Pandemic prevention and control The 42nd Regional Health Ministers conference urges the secretariat to: 1. To facilitate raising awareness and knowledge on Avian Influenza and Human Pandemic within the region. 2. Collaborate with other organizations e.g WHO, FAO, IBAH to identify and support the establishment of regional reference laboratories for Avian Influenza and Human Pandemic. 3. Facilitate the sharing of best practices in Avian Influenza and Human Pandemic prevention and control among member states. RHMC/42/R11 Non- Communicable Diseases (NCDs) Noting that Africa is plagued with a high burden of infectious diseases and at the same time is experiencing a rapid emergence of non communicable diseases. Further noting that according to WHO, in 2000, 59% of deaths in the world and 46% of the global burden of disease were due to NCDs and mental health and that chronic illnesses associated with NCDs account for almost 70% of all medical spending. The 42nd Regional Health Ministers Conference urges member states to : · Strengthen/establish NCDs programmes and put them at the top of the health agenda in line with evidence based information compiled through surveys, ongoing surveillance and evaluation. · Provide NCDs education and information · Promote healthy lifestyle activities to prevent NCDs · Allocate adequate resources/line budget for NCDs programmes. · Encourage the formulation of national strategic plans on NCDs. The 42nd Regional Health Ministers’ Conference urges the secretariat to:- · Strengthen the NCDs/Nutrition focal point within ECSA secretariat. · Promote regional collaboration to strengthen regional scientific capacity on NCDs activities · Facilitate harmonized in-service short course training in NCDs. RHMC/42/R12 Expression of gratitude to the Government and the people of Kenya Noting with profound appreciation the acceptance by the Ministry of Health of the Republic of Kenya to graciously host the 42nd Regional Health Ministers Conference; Deeply aware of the extensive and elaborate planning, coordination and preparations that went into all conference activities; Remaining forever grateful for the very warm hospitality extended to all Ministers an their delegations; Appreciating the excellent arrangements that were put in place during the entire conference by the Government and people of the Republic of Kenya; The 42nd Regional Health Ministers conference: 1. Wishes to express its gratitude to the Government and the people of the Republic of Kenya 2. Humbly requests the Minister of Health of the Republic of Kenya to convey the individual and collective gratitude of the Ministers and delegates to His Excellency, Mwai Kibaki, President of the Republic of Kenya.