To Heads of States of African Union Member States Through H.E. President Bingu wa Mutharika,President of the Republic of Malawi,And Chairperson of the African Union, 24 June 2010 Excellencies, We the undersigned write to bring to your urgent attention grave concerns of African citizens that some Heads of State are being advised to repudiate crucial commitments on health and social development, in particular the 2001 Abuja pledge by African Heads of State to allocate at least 15% of national domestic budgets to health to help tackle Africa’s health emergency, These concerns have been heightened following several well reported public statements by some senior officials of member states to the effect that “governments have other competing priorities besides health”, with some reportedly going as far as stating that Presidents should be advised to drop the Abuja Commitments, and also requesting that references to it be deleted from conference documents and outcomes. At a time when Africa should be leading on implementing African and global investment and policy commitments on health and social development, it is worrying that some senior government officials are reportedly dis-inclined to uphold crucial commitments made by AU Heads of States, without regard to African lives this will cost, or the impact on human development. As you may already know Excellencies’ (even allowing for overlaps, and taking into account some recent progress) Africa still tragically losses an estimated 6 million lives a year to a combination of just 5 preventable, treatable or manageable MDG’s 4, 5 and 6 health issues, with tens of millions also suffering from these : Malaria (801,000 deaths / 212 million cases)1; HIV and AIDS (1.4 million deaths / 22 million PLW-HA)2; TB (385,000 deaths / 3.8 million PLW-TB)3, Maternal Mortality (265,000 deaths / Millions of injuries and pregnancy related disabilities)4, and Child Mortality (4.1 million deaths)5. Alongside infectious diseases and MDG health issues, the World Health Organisation has recently highlighted that non-communicable diseases - including: heart disease; stroke; diabetes; chronic respiratory disease; various cancers; asthma; and others caused by unhealthy working and social conditions, and harmful products (such as alcohol and tobacco) – are now responsible for an estimated 35 million global deaths annually, and increasingly affecting the developing world which has weaker health systems. In addition the lives of over a billion people globally (many in rural Africa especially) are blighted by treatable but disabling neglected tropical diseases including: Trachoma; Onchocerciasis/River Blindness; Sleeping Sickness (human African trypanosomiasis); Chagas Disease; Leprosy; Dengue Fever; Ascariasis/Roundworm; Hookworm; and Lymphatic Filariasis / Elephantiasis. Consequently Healthy Life Expectancy in Africa is at a record low of 45 years resulting in un-fulfilled personal, national and continental potential and aspirations, and the loss of billions of dollars in productivity. Considering these enormous challenges, and given the clear and globally recognised correlation between healthy life expectancy, productivity and consequently GDP and GNI, it would be a historic setback for African governments to drop health and social development commitments, or suggest in anyway that the health of African economies exists in isolation from the overall health of African citizens. Excellencies’ you all assumed office with the stated intention of improving the lives of citizens of AU member states. While it is true that all sectors play a role in overall development, this cannot be achieved by deserting fundamental commitments to the health sector which plays a pivotal role in human and social development. This includes a basic level of domestic public financing to run public health programmes, resource facilities, train and retain vital staff, purchase medicines and equipment and ensure effective health systems. Health sector investment complements and does not compete with separate but no less vital investments in ensuring 100% of African’s should have access to clean water, improved sanitation, food security and improved nutrition, sustainable use of environment, clean energy, planned housing, good roads, efficient and safe public transport, and education. The Abuja 15% commitments were broadly based on the global trend of regions with best performing health indicators investing on average between 15% - 17% of budgets in health (Current Africa average is 9.6%). Nine years after the Abuja commitments, only 3 countries are currently meeting this pledge,6 although 6 have previously done so, and many have made important progress supported by parliaments and civil society. However and very significantly, at present 34 African countries are investing less than the World Health Organisation recommended minimum package of $40 per capita in health. These include 27 African countries investing less than $20, and 15 countries investing as little as $2 - $10 per capita on health which is insufficient to meet a combination of diverse health challenges. Clearly per capita investment in health needs to improve alongside percentage allocation for Africa and its citizens to have a chance to fulfil potential and aspirations. While Africa (at average of $34 per capita) invests significantly less than best performing regions (at average of $1,374 - $1,546 per capita) the experience of Costa Rica and Cuba for example (currently investing $356 and $558 per capita) demonstrates that it is not only how much, but how efficiently funds are utilised alongside investment in other crucial sectors. Both countries invest less than the US, which invests $3,317 per capita on health. But by combining this with almost 100% vaccination coverage; vital investment in social determinants, to ensure 89% to 100% of the population have access to clean water, improved sanitation, nutrition; and training and retention of required health workers, both countries achieved same life expectancy with arguably one of the worlds richest countries. The Abuja commitments therefore need to be upheld, and indeed improved upon taking into account: needs based budgeting; overall improved per capita investment; improved investment in crucial social determinants; and gender equity in health amongst other principles. This formulation, which upholds and progress the Abuja commitments has been described as 15% plus. To ensure progress on implementation of commitments on a sustainable basis supported by all citizens and sectors of society, we urge you to ensure: that the July 2010 Kampala AU Summit restates the Abuja commitments; and supports the AU Commission in fulfilling its mandate, and work with governments and civil society to monitor, provide evidence and report on health gains, and crucially ensure a progressive 10th year review of the 2001 Abuja commitments by April 2011. In accepting global solidarity on health and social development, such as more developed countries commitment to devote 0.7% of their GNP as ODA especially in the last 5 years of the MDGs, African governments need to fulfil African commitments and obligations to enable us accept global solidarity with dignity. Excellencies’ while improved domestic public funding of the health sector is required to meet obligations on health and social development, we also urge you to lead Ministers of Finance, Planning and Economic Development and all ministers to examine how to strengthen promotion of health, population and social development across all sectors. The global Commission on the Social Determinants of Health provides indisputable evidence of gains that can be made on social development through intersectoral action for health. We further urge promotion of executive, parliamentary and civil society co-operation and dialogue to audit and improve performance. We acknowledge the important re-statement of the Abuja Commitments by the first joint meeting of African Ministers of Finance, Planning and Economic Development in 2008, and urge them to stand by, improve on and implement these commitments in the context of: needs, health challenges of various countries and improved per-capita investment for health. We further acknowledge continued efforts of Excellencies and the African Union on health development and financing including various Special Summits, and Ordinary Summit focus on health and related themes. We appeal that especially in this important year for global and African social development commitments, the modest progress made through a combination of efforts of African civil society, health and social development agencies, global solidarity, the AU and African governments should not be reversed. Rather we should accelerate momentum on these efforts to ensure speedy economic and social development of Africa. Organisations who wish to be signatories to the letter are invited to email this to ausummit2010@africa15percent-plus.net before July 13. It is planned that the letter will be presented to the AU following the AU Summit Civil Society meeting 14th to 16th July in Uganda.