Two hundred and five African and global organisations and networks have called on the Assembly of Heads of State of the African Union to ensure the Implementation Plan of the AU Africa Health Strategy is urgently and adequately funded, and for the AU Abuja 15% Commitment to health to be implemented by all member states. The Implementation Plan was adopted by African Ministers of Health on the 17th of May 2008 following presentation of the Health Strategy last year by the AU Commission Social Affairs Division. It provides guidelines for implementing various African health frameworks, health MDGs and global Universal Access targets including on TB, HIV and AIDS, Malaria, Child and Maternal Health. The Health Strategy Implementation Plan will be presented for final approval to the Assembly of Heads of States meeting in Sharm El Sheikh, Egypt on the 30 June and 1 July. In a statement on the eve of the Assembly, Rotimi Sankore Coordinator of the Africa Public Health 15% Now Campaign stated: "The AU Africa Health Strategy is a landmark document. But without funding for its Implementation Plan from our Heads of State and Finance Ministers, it will be reduced to an empty gesture resulting in even more deaths than the current 8 million African lives lost annually to mainly five health conditions being TB, HIV and AIDS, Malaria, Child and Maternal Mortality." He added that: "While many of our Finance Ministers recognise the urgency of increased and sustainable health financing, they have not acted on this and need to do so. It is also serious cause for concern that some think that there are other issues more important than health. We are not saying that roads, or energy are not important. But we are saying that dead or dying people have no need for them." He emphasised further that: "Africa's human capital is its greatest development asset. But with Africa loosing 4.8 million infants and children annually, and average healthy life expectancy dropping to less than 40 years in many countries - not only is our future dying before our eyes, millions of skilled workers and professionals that provide the engine for economic development, and underpin the purchasing power vital to growing economies are dying in their prime." He cautioned African governments against being carried away by hollow economic growth statistics stating that - "Statistical economic growth - with no sustainable investment in social development: health, food production, education, gender equality, water and sanitation - is negative growth - because there is no real improvement in living standards and social and economic rights." The 15% Now Campaign Coordinator underlined that: "We must start investing sustainably in health now before the cost of containing infectious diseases in particular spirals out of control. For instance, latest Stop TB partnership / World Bank analysis indicates that the cost of not treating TB to Africa between 2006 and 2015 would be $519bn while TB can be controlled with $20bn in the same period." * Reacting to the views in some quarters that some disease specific issues have allegedly cornered more than their fair share of funding, the 15% Now Campaign Coordinator stated that: "Financing the Africa Health Strategy Implementation Plan means funding both health systems and disease specific issues. It is not appropriate to suggest too much money has been spent on any one disease, when it is clear from prevalence and mortality levels of all diseases that not enough has been spent on any disease. We need both. Without a shadow of doubt we need more, and better working conditions for health workers and professionals to ensure wider access to healthcare. But we also need specific medicines and commodities for prevention, treatment and care - be it for HIV, TB or Malaria. Medicines will not prescribe or dispense themselves, but health systems without specific and adequate medicines and commodities are also ineffective. With the growing interaction between TB and HIV, between Malaria and Child Health, or with the cross cutting nature of Reproductive and Sexual Health, it is also clear that we need more integrated health funding". * Calling on African leaders to ensure that they go from the AU Summit to the Japan G8 in early July with a message that they are meeting their own commitments alongside calls for global commitments to be met, the 15% Now Campaign Coordinator stated further that: "Sustainable investment in health can only come from our own governments. Overseas Development Solidarity from TICAD, G8, the EU or private global foundations can only be useful if it is seen as an addition to, and not a replacement for African governments meeting their own commitments to health and other development issues." "If we compare health expenditure and key indicators between more developed and developing countries of roughly equivalent population: Japan which hosts the G8 next month and Nigeria have 127m and 144m people respectively. Japan spends 17.8% of its budget on health. Nigeria only 3.5%. Japan has 270,371 doctors, 1.2m nurses and midwives, and 241,369 Pharmacists. Nigeria only 34,923 doctors and 210,306 nurses and midwives, and 6,344 pharmacists. Japans healthy life expectancy is 75 years and Nigeria's a mere 42 years. Japan has 17,000 people living with HIV, Nigeria has 2.9m. Japan has a TB prevalence of 37,490, Nigeria has 889,666." "Even taking into account the poaching of African health workers by developed countries to subsidise their own health systems, at current levels of investment in health systems and disease specific issues, it is clear to see that Japans health will get better while Nigeria's will get worse unless Nigeria increases its own health investment to ensure that international solidarity is meaningful." "With only 0.3 percent of external health funding compared to between 10% and 60% of external funding for health in most African countries, a country like Cuba has demonstrated that it is possible for a medium income country to achieve equivalent healthy life expectancy as G8 countries through long term sustainable investment in health systems and disease specific interventions." Civil Society Message of Concern to Assembly of Heads of State, Egypt AU Summit To Heads of States and Governments of African Union Member States His Excellency Jakaya Kikwete, Chairman of the African Union and President of the Republic of Tanzania, His Excellency Jean Ping, Chairperson of the Commission of the African Union African and Global Civil Society Message of Concern on Non-Implementation of the 2001 Pledge by African Governments to Allocate 15% of National Budgets to Health Your Excellencies, we write to express our grave concern that 7 years after the Abuja April 2001 Pledge by African Heads of Sates and Governments to allocate 15% of national budgets to health, this pledge has not been met by most member states with only a handful even moving towards or meeting the commitment. Our serious concern is based on the fact that unlike some other pledges which may go unmet without instant and grievous consequences for citizens of our countries, the non implementation of the 15% pledge is rapidly devastating our populations and countries through the deaths of fellow African's on such a scale that annual deaths from both disease and non disease related health issues now exceed the combined populations of many African countries and also surpass the deaths from any combination of modern day wars and conflicts. For Tuberculosis: African’s living with TB are currently estimated to be 4.2 million with 2.8 million new cases annually making TB one of Africa’s greatest Public Health threats. African TB deaths are now running at 639,089 per annum – the highest in the world (38.6% of global deaths). TB is also the biggest killer of HIV positive people an increasing number of which are women; Africa’s pivotal countries, Nigeria, Ethiopia, Kenya, DRC, South Africa have the continents highest overall TB prevalence levels; and a person with active TB can infect 10 to 15 persons a year. Latest Stop TB partnership/ World Bank analysis indicates that the cost of not treating TB to Africa between 2006 and 2015 would be $519bn while TB can be controlled with $20bn in the same period. For HIV: Latest statistics for 2007 indicate that HIV prevalence in Africa is 22.5 million of the global total of 33.2 million, with 1.7 million new infections annually; Annual AIDS related death figures for Africa are 1.6 million and Aids Orphans are estimated at 12 million; the 10 countries globally with highest HIV-TB co infection are African 9 being from SADC and the 10th Kenya. For Malaria: Annual African deaths are estimated at 1,136,000 (89.3%) of the world total with an increasing impact on maternal, infant and child health. Malaria costs Africa more than $12bn in lost GDP annually although it can be controlled for a fraction of this sum. For Maternal Mortality: Latest comparable global maternal death statistics indicate that of the 536,000 women that died in 2005 of childbirth related complications, about half or 261,000 were African women. The 2005 figures also indicate that Africa is the only region where maternal deaths have increased since 1990 up from 205,000. Maternal deaths which is almost 100% preventable dropped in every other continent over the same period. For Child Mortality: Most worryingly for the future of Africa, an estimated 4.8 million children under the age of 5 years die annually. Just five diseases - pneumonia, diarrhoea, malaria, measles and AIDS - account for half of these deaths. Often ignored environmental health issues, or neglected diseases such as river blindness or Onchocerciasis and Human African Trypanosomiasis or sleeping sickness together affect around 60m people in 36 African countries - and in turn facilitate vulnerability to HIV, TB, malaria, maternal and child mortality. This loss of over 8 million lives a year to preventable, treatable and manageable diseases and health conditions – is unacceptable and unsustainable.[1] The above also constitutes an infringement on the right to health of African citizens as guaranteed in Article 16 of the African Charter on Human and Peoples Rights, Article 12 of the International Convention on Economic Social and Cultural Rights, The World Health Organisation constitution, and other instruments. We Fully Acknowledge the efforts of African governments to address Africa’s enormous Public Health crisis through: the AU Abuja April 2001 declaration incorporating the pledge by member states to allocate at least 15% of the national budgets to health; the 2007 African Union Health Strategy and other African health frameworks such as the Maputo Plan on Reproductive and Sexual Health, the AU plan on HIV, TB and Malaria, the African Pharmaceutical Plan and the health based MDGs. However current evidence indicates gravely that it is not just enough to make declarations. The landmark AU African Health Strategy and other Health Frameworks recently finalised by the African Union Commission must also be sustainably financed by our own governments if they are not to become yet another collection of reference papers on Africa's failed attempts to resolve its most serious development challenges. Africa’s human capital is its greatest asset and that there can be no competing priorities more important than the lives of citizens – as other issues are meaningless if the people they are meant for are dead. Indeed no efforts at sustainable social and economic development can be successful when the average healthy life expectancy of African countries has now fallen to less than 40 years. We therefore urge Excellencies to: 1. Restate their commitment to the Abuja 15% pledge and increasing overall per capita expenditure on health at the next AU Summit and to accelerate its implementation. 2. Take urgent steps to ensure that African Ministers of Finance, Planning and Economic Development begin immediately to work with Health Ministers through a joint meeting to develop the details for the implementation of the Africa Union Health Strategy and other Health Frame works. 3. Facilitate the African Union and UN-Economic Commission for Africa to implement the recommendations for the joint meeting of Finance and Health Ministers as adopted by the conference of African Ministers of Finance, Planning and Economic Development organised by both AU and ECA in April 2008. 4. Recognise that just as the global community urges the more industrialised countries to meet their own commitments to global health, that African governments are also expected to honour national commitments. 5. Ensure that regions, states, provinces and local governments within countries recognise that they have a responsibility to provide needs based primary health care services and as such must along with national governments allocate commensurate amounts of financing for health. 6. Work urgently with national, sub regional and continental parliaments to ensure implementation of the AU Abuja 15% commitment, combined with commensurate overall increase of per capita expenditure on health and implementation of the Africa Union Health Strategy and other African Health Frameworks. 7. Recognise the crucial role of health workers and professionals in delivering health care, and ensure strengthening of health systems to guarantee retention of health professionals and sustainable quality health care. 8. Through the African Union and UN-ECA work with civil society to ensure that a progress report on implementation of the 15% pledge is on the agenda of the January 2009 African Union Summit Signatories - 15% Now Campaign Partners, Participants in Abuja Public Health Financing Conference and Organisations Dedicated to Public Health Development and Financing in Africa: Archbishop Desmond Tutu, Noble Prize Winner & Honorary Chair Africa Public Health Alliance 15% Now Campaign 1. AAPSO, Ghana 2. Abantu for Development, Kenya 3. Abibimman Foundation-Ghana 4. ACTION – Advocacy to Control TB Internationally (Results Canada) 5. Action for Conflict Transformation, Zimbabwe / South Africa 6. Action Group for Health, Human Rights and HIV/AIDS (AGHA), Uganda 7. Action Aid, Nigeria 8. Actors Guild of Nigeria 9. ACTWID KONGADZEM ACTIVISTS NETWORK, BAMENDA, CAMEROON 10. Advocacy Nigeria – Promoting Reproductive Health 11. Africa Against AIDS Zimbabwe - Zimbabwe 12. Africa Civil Society Coalition on HIV and AIDS 13. Africa Health Research Organization 14. Africa Internally Displaced Persons Voice (Africa IDP Voice) 15. Africa Japan Forum, Japan 16. Africa Public Health Development Trust 17. Africa Youth Association, Ethiopia 18. African Centre for Democracy and Human Rights 19. African Council for Sustainable Health Development (ACOSHED) 20. African Network of Adolescents and Youth in Population and Development (AfriYAN) 21. African Federation of Medical Associations [AFMA] 22. African Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (ANERELA+) 23. African Women’s Development Fund (AWDF) 24. AfriCASO (African Council of AIDS Service Organizations) 25. Afro Global Alliance 26. Agency for Cooperation and Research in Development (ACORD) 27. ANCEFA, Senegal 28. APHRA, Egypt 29. Arab Program for Human Rights Activists. Egypt 30. ASSOCIATION BURUNDAISE POUR LE BIEN-ETRE FAMILIAL (ABUBEF) 31. Association African Solidarité ( A.A.S), Ouagadougou/ Burkina Faso 32. Association for Reproductive and Family Health, Nigeria 33. Association of Religious Leaders Living with HIV/AIDS [NINERELA+] – Nigeria 34. CAFOB, Burundi 35. Cameroon National Association for Family Welfare 36. C-CfA Uganda Unit - Uganda. 37. Civil Society Alternative Process of Sierra Leone (CSAP-SL) 38. Centre for Citizen Participation in African Union 39. Centre for Development and Population Activities (CEDPA) 40. Centre for Economic Governance and AIDS in Africa (CEGAA) 41. Center for Health and Gender Equity – USA 42. Centre for Health Science Training Research and Development (CHESTRAD) 43. Centre for Hospital and Health Services Improvement (CHAHSI) 44. Centre for LCHR, Sudan 45. Citizens United to Promote Peace & Democracy in Liberia (CUPPADL) 46. Civic Monitors for Human Rights, Egypt 47. Coalition of African Parliamentarians Against HIV/AIDS (CAPAH) 48. Commission Nationale Justice, Chad 49. Counsel National les Libertes in Tunisia 50. CICC 51. Civil Society Legislative Advocacy Centre – CISLAC Nigeria 52. Civil Society MDG Campaign/GCAP Zambia 53. Coexist Initiative Kenya 54. COMMUNICATION DU CONSEIL NATIONAL DE LA JEUNESSE DJIBOUTIENNE (CNJD) 55. Community Development Association, Darfur, Sudan 56. Community Working Group on Health (CWGH), Zimbabwe 57. Cordaid, the Netherlands 58. CORE Group Ethiopia 59. Cross-of Ministries International Uganda (CGMI) 60. CURIOUS MINDS, GHANA 61. Democratic Nurses Association of South Africa [DENOSA] 62. Development Alternatives With Women for New Era (DAWN-Africa) 63. Development Generation Africa International (DGAi), Nigeria 64. EASSI, Uganda 65. East African Law Society 66. East, Central & Southern African Health Community 67. Eastern Africa National Networks of AIDS Service Organizations (EANNASO) 68. Ecumenical Service for Peace, Bamenda Cameroon 69. Egyptian Centre for Womens Rights 70. Egyptian Initiative for Personal Rights 71. EKA Partners, France 72. Ethiopian Nurses Association 73. Equality Now, Kenya 74. Fahamu 75. Family Care International (FCI) 76. FAI, Nigeria 77. Famedev, Senegal 78. Fantsuam Foundation 79. FAWE, Senegal 80. FEMNET, Kenya 81. Friends of Africa International 82. Friends of the Global Fund Africa 83. Gender and Transport Network (GATNET) 84. Ghana Coalition of NGOs in Health, Ghana 85. Ghana Medical Association 86. Global Call to Action against Poverty-Liberia (GCAP-Liberia) 87. Global Fund to Fight Aids Tuberculosis and Malaria 88. Global Health Workforce Alliance (GHWA) 89. Greenbelt Movement International 90. Health Development Initiative-Rwanda 91. Health Economics and HIV Research Division (HERD) Kwazulu Natal University 92. Health Education and Research Services (OHERS) 93. Health GAP (Global Access Project) USA 94. Health Reform Foundation of Nigeria (HERFON) 95. Health Rights Advocacy Forum – Kenya 96. Health Triangle, Zambia 97. Health Workforce Advocacy Forum (HWAF) Uganda 98. Hoima Environmental Project - Uganda 99. Human Rights Centre, United Kingdom 100. International coalition of AIDS activists. 101. International Forum for Rural Transport and Development (IFRTD) 102. International Planned Parenthood Federation – Africa 103. International Press Centre 104. International Refugee Rights Initiative 105. International Treatment Preparedness Coalition (ITPC) 106. Initiative For Community Development, Nigeria 107. Institute for Consumer Protection, Mauritius 108. Institute for Democracy in South Africa – Governance & Aids Prog (IDASA) 109. IPAS 110. Japan AIDS and Society Association, Japan 111. Journalists Against AIDS (JAAIDS) Nigeria 112. KCHRED, Sudan 113. Kenya Aids NGO Coalition 114. Kenya Clinical Officers Association(KCOA) 115. Kenya Hospices and Palliative Care Association (KEHPCA) 116. Kenya Medical Association 117. Kenya Medical Women’s Association 118. Kenya Treatment Access Movement-KETAM 119. KIGEZI Healthcare Foundation, Uganda 120. Land Access Movement of South Africa 121. Liberian united to expose hidden weapons (LUEHW) 122. Macarthur Foundation 123. Malawi Health Equity Network 124. MATRAM-Mozambique AIDS Treatment Access Movement 125. NADEEM Centre, Egypt 126. National Consumers and Environmental Alliance (ANCE-Togo) 127. National Nurses Association of Kenya 128. National Empowerment Network of People Living with HIV/AIDS in Kenya 129. National Nurses Association of Kenya 130. NDYOKO - Recreação Infantil 131. Network of People living with HIV/AIDS in Nigeria [NEPWHAN] 132. Network Together for the Sustainable Development of the District of Arta in the Republic of Djibouti. 133. Network of Zimbabwean Positive Women (NZPW+) 134. NIGERIA HIV/AIDS RESEARCH NETWORK (NARN) 135. Nigerian Medical Association 136. Nigerien des personnes vivant avec le VIH-SIDA 137. Noon Centre for LCHR, Sudan 138. Open Society Initiative for West Africa (OSIWA) 139. Oeuvre de Charité et Développement de LEMBA (OCDL ongd/asbl) DRC 140. Oxfam International 141. Packard Foundation 142. Pan African Parliament (Health, Labour and Social Affairs Committee) 143. Pathfinder, Nigeria 144. People’s Health Movement, South Africa 145. PELUM (Participatory Ecological Land Use Management) 146. Population Action International (PAI) 147. Positive Life Association of Nigeria (PLAN), Ibadan, Nigeria 148. POSITIVE-Generation (Cameroon) 149. Positive Women’s Network, South Africa 150. Promoting People's Awareness and Development (FOPAD) 151. PPFA - Nigeria 152. Public Health Association of South Africa 153. Physicians for Human Rights (PHR) 154. Pro-femme Rwanda 155. RAFIKI REHABILITATION PROGRAMME 156. Regional Network for Equity on Health in East and Southern Africa (EQUINET), East and Southern Africa 157. RESULTS Japan 158. Rozaria Memorial Trust 159. Santayalla Support Society (Togo) 160. SILVERLINE DEVELOPMENT INTIATIVES, Nigeria 161. SAFEHAVEN INTERNATIONAL, Nigeria 162. Social Aspect of HIV Research Alliance (SAHARA), Senegal 163. Society For The Prevention and Eradication of Tuberculosis in Nigeria 164. Society for Women and AIDS in Africa – Southern Africa (SWAA Mozambique), 165. Socio Economic Rights Initiative, Nigeria and USA 166. Solidarity Community Care Organisation, Namibia 167. South African Medical Association 168. Southern Africa HIV & AIDS Dissemination Services (Safaids), 169. Southern and East African Alliance of Parliamentary Committees on Health and HIV/AIDS (SEAPACOH) 170. Stop TB and HIV/AIDS-The Gambia, 171. Stop TB Partnership 172. Sudanese People Living with HIV/AIDS Care Association 173. SWAA International 174. Talent Youth Association, Ethiopia 175. TANERELA (Tanzania Network of Religious Leaders Living With or Personally Affected By HIV and AIDS. 176. Tanzania National Malaria movement (TaNAM) 177. Tbaction Kenya 178. Trade Union Confederation of Sierra Leone (TUC-SL) 179. Treatment Action Campaign (TAC) 180. Treatment Action Group (TAG), USA. 181. Treatment Action Movement (TAM) - Nigeria. 182. Treatment Advocacy and Literacy Campaign (TALC) 183. Tuberculosis National League (Cameroon), 184. Uganda Medical Association 185. Upendo Widows group, Kenya. 186. UN Millennium Campaign 187. WANEP, Ghana 188. Wildaf, Togo 189. Women Advocates and Research Documentation Centre (WARDC) 190. Womens Legal Centre, Cape Town South Africa. 191. World Aids Campaign (WAC) 192. World Vision International 193. World Young Women’s Christian Association 194. YALDA, Botswana 195. YCWA - Zimbabwe 196. Youth For Community Academic and Development Services(YOCADS), Liberia 197. Youth Hotline Network, Nigeria 198. Youth Network for MDG (milllenium for development goals), Madagascar 199. Youth Intercommunity Network, Thika Kenya. 200. Youth Vanguard For Social Justice, Kebbi State, Nigeria. 201. Zambia AIDS Law Research & Advocacy Network in Zambia 202. ZIMBABWE AIDS NETWORK, ZIMBABWE. 203. Zimbabwe College of Public Health Physicians 204. Zimbabwe Human Rights NGO Forum 205. Zimbabwe Women’s Resource Centre and Network (ZCRWN) Africa Public Health – “15% Now!” Campaign: Background Note for Editors. The Africa Public Health “15% Now!” campaign launched on December 10 2006 - International Human Rights Day - is the first to articulate Public Health for Africa as a Rights and Development issue across Africa and beyond. It brings together actors from various key sectors of civil society. The Campaign is based on the premise that “we all have to be alive and well to exercise any other rights in any meaningful way” and therefore that Right to Health and to Healthcare is arguably the most crucial right of all as articulated by Article 16 of the African Charter on Human and Peoples Rights, the constitution of the World Health Organisation and Article 12 of the International Covenant on Economic, Social and Cultural Rights. Current social development and health indicators from international and African institutions show that over 8 million African lives are lost annually to preventable, treatable and manageable health conditions and diseases mainly - Child Mortality, Maternal Mortality, HIV/AIDS, Malaria, and TB. Any loss of life to disease is bad enough. The annual loss of populations equivalent to entire African countries - and over a few years greater than the losses from all modern day global wars and conflicts combined is both unacceptable and unsustainable, and brings Africa closer to the slippery slope to collapse of society and extinction. Public Health is not realisable without adequate and sustainable health financing. Meeting the Abuja 2001 by African leaders to allocate 15% or more of annual budgets to health is crucial to Public Health in Africa. Yet this pledge remains largely unmet with just two countries, Botswana and Seychelles demonstrating their commitment to the 15% pledge. The key objective of the Africa Public Health 15% Now Campaign is to engage the African Union, sub-Regional Economic Communities such as the East African Community (EAC), Economic Community of West African States (ECOWAS) and Southern Africa Development Community (SADC) etc, their institutions / member countries, and the African public towards: 1) Promoting greater awareness and understanding of African Health Issues 2) Actualisation of the AU African Health Strategy, other African Health Frameworks, Health based MDG's; and Universal Access Targets for Prevention, Treatment and Care; 3) Adopting Comprehensive Health Policies based on a Public Health Rights and Development philosophy - and mobilising the commitment of financial and other resources for sustainable implementation of health policies - including through meeting the AU Abuja pledge to allocate 15% of budgets to health. The Africa Public Health 15% Now Campaign will also engage global stake-holders and actors including donors, the UN, EU and their institutions, World Bank, IMF, and international Non-governmental Institutions and organisations especially those concerned with health, social and economic development.