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Africa: Health Promises, Time to Deliver
AfricaFocus Bulletin
Jan 25, 2007 (070125)
(Reposted from sources cited below)
Editor's Note
In his State of the Union message this week, U.S. President George
Bush declared "To whom much is given, much is required." He went on
to pledge to "continue to fight HIV/AIDS, especially on the continent
of Africa." But while activists acknowledge the additional
attention given to health in recent years, they say both African
and international leaders are still falling far short of fulfilling
their promises.
U.S. activists in particular note that President Bush and Congress
have grossly underfunded international efforts such as the Global
Fund to Fight AIDS, TB, and Malaria (see http://www.globalaidsalliance.org for an ongoing campaign to increase
this funding). At the World Social Forum held this year in Nairobi,
Kenya, African activists joined by Nobel Laureates Archbishop
Desmond Tutu and Wangari Maathai called on African leaders to live
up to their 2001 pledge to commit 15% of national budgets to
health. And an international coalition of medical experts and
organizations is stressing that improvement in health programs
requires not only money but new policies to support healthcare
workers in Africa and reduce the outflow of skilled workers to
richer countries.
This AfricaFocus Bulletin contains a press statement on a petition
to the leaders of the African Union, from the Africa Public Health
Rights Alliance, a coalition of Africa groups, and an international
call for action on the health workforce in AIDS-affected countries.
For earlier Bulletins and links on health issues, please visit
http://www.africafocus.org/healthexp.php
For a recent article on the status of global health programs, see
http://www.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
Press Statement for World Human Right's Day December 10, 2006
"Right to Health Most Important Right of All" says Africa Public
Health Rights Alliance
From: Rotimi Sankore <[email protected]>
Alliance Launches "15% Now!" Campaign.
On the occasion of Human Rights Day 2006, the African Public Health
Rights Alliance launches the "15% Now!" Campaign and opens for
signature the global petition calling on African leaders to without
further delay implement their 2001 Abuja AU Summit pledge to commit
15% of annual national budgets to health in order to end the tragic
loss of an estimated 8 million lives annually to preventable,
treatable and manageable diseases, illnesses and maladies.
For full petition text see
http://www.geocities.com/africa_15percentnowcampaign/petition.html
Speaking to the launch of the petition which will be presented to
the AU at its January 22-29 2007 Summit, the campaign s coordinator
Rotimi Sankore stated:
"The horrendous figures that demand urgent action speak for
themselves. An estimated 1.1 million deaths annually from malaria,
2.1 million from HIV/AIDS, almost 600,000 from TB, 4.8 million from
child mortality, 300,000 from maternal mortality and that s not
counting malnutrition, water borne diseases like typhoid and
cholera, or cervical, breast, prostrate and other cancers; heart,
liver, kidney and lung disease."
Underlining the looming tragedy that the shocking figures
demonstrate, Rotimi stated further:
"Unless they act without delay, the present generation of African
leaders may well end up presiding over the beginning of the
extinction of modern day Africa. The number of African lives lost
annually to preventable, treatable and manageable health issues
alone is equal to losing annually, the entire populations of
Eritrea (4.4m people), Libya (5.8m people), Sierra Leone (5.5m
people), or Togo (6.1 people). The coffins and burial business must
be Africa s fastest growth industry. In the next 20 years Africa
could lose more people than the 100 million it lost in all the 400
years of slavery and colonialism from which we are yet to fully
recover. In 20 years an equivalent number to the population of
Nigeria (130million) Africa s most populous country could die"
Expressing concern that a campaign is apparently necessary to urge
African governments to fulfil their 15% pledge, Sisonke Msimang,
Program Manager for Open Society for Southern Africa HIV/AIDS
Program stated:
"The evidence suggests African Heads of State are not taking the
Abuja 15% commitment as seriously as they should. 5 years after the
pledge, the great majority of the AU s 53 member governments
including those in southern Africa most hit by Africa s worsening
Public Health crisis have not even begun the process of meeting
this pledge."
She emphasised that "it s almost as if African governments don t
realise that without a healthy and active population especially in
the key age groups and social groups most affected by the health
crisis Africa has no future. Maternal mortality for instance is
almost 100% preventable. The fact that the figures for Africa are
the highest in the world suggest that our governments still think
that reproductive health which applies to half the populations of
our countries is a fringe service"
The Petition also identifies key healthcare challenges which the
resources from the 15% commitment should be focussed on resolving.
One of them is Africa s health worker shortages that have been
exacerbated by OE Brain Drain , which subsidises healthcare systems
of more developed countries.
Speaking on how brain drain has worsened Africa s public health
crisis, Eric A. Friedman, Senior Global Health Policy Advisor of
Physicians for Human Rights, a partner of the campaign, stated:
"In country after country, the shortage of health care workers,
along with the lack of support for health care workers who struggle
heroically to save lives, is a central obstacle to delivering a
wide range of critical health services. Simply put, without the
health workers, health services can t be delivered, and horrific
levels of death and disease will persist. Much of the shortage is
due to brain drain, as health workers migrate to countries in the
North. Many of these countries train too few health workers
themselves, so rely on health professionals from abroad to help
meet their health care needs. Wealthy nations special connection
to the health worker crisis in Africa due to brain drain requires
that they work on a variety of fronts to prevent brain drain and
support the development of effective and equitable health systems
in Africa. Moreover, their own human rights obligations demand an
intensive and multi-faceted response to this crisis."
Abiola Akiyode-Afolabi Director of Women Advocates Research and
Documentation Centre and Chair of the Nigerian and West African
Social Forums underlined the implication of African governments of
meeting their 15% pledge:
"Unless the 15% commitment is fully implemented, all of Africa s
2010 Universal Access targets for prevention, treatment and care
for HIV/AIDS, TB and malaria will definitely not be met. Even worse
the three 2015 health-related Millennium Development Goals - based
on scaling up reproductive health, children s health, and tackling
the monster killer diseases of HIV/AIDS, TB, malaria and other
diseases may be an impossibility"
The petition, which will be presented to the African Union at its
January 2007 Summit in Addis Ababa, also acknowledges that:
"We recognise that historical injustices and crimes against
humanity such as: the slave trade and colonialism; and more
recently the debt burden; and conditionalities imposed by the IMF
and other IFI s capping expenditure, resulting in ceilings on
health and crucial sectors of the economy have blighted development
of African countries,"
Nevertheless it underlines to African leaders that:
"Fulfilling your 15% pledge without further delay will go a long
way towards demonstrating African governments political will,
restoring African dignity and ensuring that Africa s healthcare
health care needs are met on a sustainable basis, (not dependent on
donor support) in order to meet what is undoubtedly the most
crucial Human Right of all, the Right to Health, and ultimately to
Life itself"
The first phase of the petition drive will be rounded-off with a
rally at the World Social Forum which holds in Nairobi, 20th-25th
January 2006.
For further information please contact the following:
Contacts- Rotimi Sankore, Centre for Research Education &
Development of Rights in frica (CREDO frica): +44 207 424 5744,
[email protected]
Sisonke Msimang, Open Society Initiative for Southern Africa
(OSISA): Tel. +27 11 403 3414, [email protected]
Eric Friedman, Physicians for Human Rights: +1-202-728-5335 ext.
303, [email protected]
Abiola Akiyode-Afolabi, Women Advocates & Research Documentation
Centre (WARDC): +234 8055951858 [email protected]
Petition signed by, among others,
Action Group for Health, Human Rights and HIV/AIDS (AGHA), Uganda
Africa Health Research Organization
Africa Internally Displaced Persons Voice (Africa IDP Voice)
African Network of Religious Leaders Living with or Personally
Affected by HIV and AIDS (ANERELA+).
Centre for Research, Education and Development of Rights in Africa
(CREDO-Africa)
Civil Society Legislative Advocacy Centre - CISLAC Nigeria
Cross-of Ministries International Uganda (CGMI)
Development Alternatives With Women for New Era (DAWN-Africa)
KIGEZI Healthcare Foundation, Uganda
Open Society Initiative for Southern Africa (OSISA)
Oeuvre de Charite et Developpement de LEMBA (OCDL ongd/asbl) - DRC
POSITIVE-Generation (Cameroon)
Positive Women's Network, South Africa
Physicians for Human Rights (PHR)
Southern Africa HIV & AIDS Dissemination Services (Safaids)
Santayalla Support Society (Togo)
Stop TB and HIV/AIDS-The Gambia
Society for Women and AIDS in Africa - Southern Africa (SWAA
Mozambique)
TBaction Kenya
Treatment Action Campaign (TAC)
Tuberculosis National League (Cameroon)
Women Advocates and Research Documentation Centre (WARDC)
Urgent Call for U.S. Initiative on Health Workforce in
AIDS-Impacted Countries
http://healthgap.org/hcwcall.html
(December 1 2006) The critical shortage of health care workers and
weak health systems is the key bottleneck to scaling up access to
AIDS treatment. While the needs of individual countries must be
determined locally, experts estimate that sub-Saharan Africa needs
at least 1 million new health workers to meet essential health
needs. Sustained commitment and creative action are necessary to
develop and support the health workforce needed to secure the right
to health and achieve universal access to AIDS treatment by 2010,
as well as other international health goals.
We urge the President of the United States and Members of Congress
to lead a global health workforce initiative in AIDS ravaged
countries. The U.S. should:
1.Invest significant new resources in a number of impoverished
countries to recruit, train, support, and effectively utilize the
number of health workers needed to achieve universal access to AIDS
treatment for all in need by 2010 and universal access to primary
health care by 2015, while supporting a new G8 initiative to assist
additional countries. The U.S. should contribute at least 1/3 of
the funds, estimated at $650 million for the first year and scaling
to $2.6 billion over time, for a five-year total of $8 billion. The
U.S. contributions should support national human resource plans
within the context of comprehensive country health plans that
improve health systems performance to achieve sustainable results.
Funding should be predictable and long-term, flowing directly to
the public sector and local NGO and faith-based care providers as
appropriate. The U.S. should also support effective regional and
global initiatives.
The U.S. should invest in (a) long-term strategic planning; (b)
strengthening and expanding capacity of health training
institutions; (c) retaining health workers through adequate
compensation, safe and improved work conditions, stronger
supervision, continuing education, and care including AIDS
treatment; (d) human resource and fiscal management; (e) equitable
distribution including incentives to work in underserved areas; (f)
re-deploying unemployed health workers.
2. Cover costs to public health systems of implementing PEPFAR and
other U.S. initiatives. U.S. agencies should support training and
retention for at least the number of indigenous health workers
necessary to meet program goals. Aggressive proactive measures must
be adopted to avoid drawing from other local health priorities or
programs.
3. Launch a substantial community health worker initiative to
train, compensate, and deploy community members, especially women
and PLWHA, to provide basic care, treatment, prevention services,
and referrals. Community health workers should have access to care,
including AIDS treatment, and be offered a career pathway. The
program should be integrated into primary health systems, and
ensure adequate supervision, support, and ongoing training.
4. Reduce brain drain by increasing the number of U.S. health
professional graduates and improving U.S. health worker
distribution. The U.S. government and professional health
communities should expand training opportunities in the U.S.,
discourage active recruitment from poor nations, and work with
developing and developed countries and international organizations
to develop migration and recruitment policies that mutually benefit
source and destination countries. Some experts estimate that the
U.S. will need to increase the annual number of medical school
graduates by at least 5,000 and of nursing graduates by at least
25,000 over the next 10-15 years.
5. Create new possibilities for U.S. and diaspora health workers to
serve abroad to help meet immediate care and treatment needs while
providing training and support to strengthen health systems. The
U.S. should develop programs in cooperation with local governments,
prioritize strengthening local institutions, and support
South-South exchanges.
6. Convene and support country-level teams of all stakeholders to
devise and implement coordinated plans to achieve universal access
to health services. The U.S. should provide technical assistance
and facilitate the country team's access to all necessary sources
of external funding. Cross-sectoral country-level planning is
necessary to promote national ownership, donor coordination, and
cross-sectoral planning and harmonization.
7. Contribute 1/3 of the predicted need of the Global Fund to fight
AIDS, Tuberculosis and Malaria, for both the coming year and,
gradually, a sum equivalent to an additional year to alleviate
donor shortfalls and enable more ambitious applications. Health
systems strengthening must be sustained as a category of GFATM
financing.
8. Reform IMF-supported spending and wage policies that limit
national and donor investments in health and education. Barriers to
access such as user-fees for health and education should be
eliminated. The U.S. should provide funds to compensate for lost
revenue and support increased utilization of services.
9. Remove Congressional and agency limits to funding recurrent
expenses, salaries, and sectorwide approaches, and allow
flexibility to agencies seeking to strengthen health systems and
scale-up access to care and prevention.
The undersigned organizations and experts urge the President and
Congress of the United States to adopt and implement these
recommendations.
Distinguished experts:
Lincoln C. Chen, MD, WHO Special Envoy on Human Resources for
Health; Director, Global Equity Center at Harvard Kennedy School of
Government, MA, USA
Jeffrey D. Sachs, Director of The Earth Institute, Quetelet
Professor of Sustainable Development; and Professor of Health
Policy and Management at Columbia University; Director of the UN
Millennium Project and Special Advisor to United Nations
Secretary-General Kofi Annan on the Millennium Development Goals,
USA
Peter Mugyenyi, MD, Director, Joint Clinical Research Centre,
Uganda
Paul Farmer, MD, Partners in Health, MA, USA/Int'l
Joia Mukherjee, MD, Partners in Health, MA, USA/Int'l
Fitzhugh Mullan, MD, Murdock Head Professor of Medicine and Health
Policy, Department of Health Policy, George Washington University,
School of Public Health and Health Services, USA
Allan Rosenfield, MD, Dean, Mailman School of Public Health,
Columbia University, NY, USA
Jim Yong Kim, MD, PhD, Chief, Division of Social Medicine and
Health Inequalities, Brigham and Women's Hospital, Harvard Medical
School; former Director, Department of HIV/AIDS, World Health
Organization, USA
Thomas E. Novotny, MD, MPH, Dir. International Programs, UCSF
School of Medicine, Professor in Residence, Epidemiology and
Biostatistics; former Assistant Surgeon General and Deputy
Assistant Secretary for International and Refugee Health, U.S.
Department of Health and Human Services, USA
Alan Berkman, MD, Acting Chair and Coordinator of Global AIDS
Programs, Department of Epidemiology, Mailman School of Public
Health, Columbia University; Founding Member, Health GAP (Global
Access Project), USA
Laurie Garrett, Senior Fellow for Global Health, Council on Foreign
Relations; former health and science writer for Newsday; Pulitzer
Prize-winning journalist and author, USA
Jo Ivey Boufford, M.D., Professor of Public Service, Health Policy
& Management at New York University's Wagner School, Clinical
Professor of Pediatrics at New York University Medical School;
Former Principal Deputy Assistant Secretary for Health, U.S.
Department of Health and Human Services, USA
David Hoos, MD, MPH, Assistant Professor of Epidemiology, Director
Multicountry AIDS Care and Treatment Program, Mailman School of
Public Health, Columbia University, USA
James Orbinski, Former Int'l President, M�decins Sans Fronti�res;
Research Scientist, Associate Professor, Univ. of Toronto, Canada
Josh Ruxin, Assistant Clinical Professor of Public Health, Center
for Global Health and Economic Development, Mailman School of
Public Health and The Earth Institute at Columbia University, USA
Gilbert Kombe, MD, MPH, Partnership for Health Reformplus Project,
Abt Associates Inc., MD, USA
Sai Subhasree Raghavan, MD, Executive Director, Solidarity and
Action Against the HIV Infection in India (SAATHII), India and USA
Robert S. Lawrence, MD, Edyth H. Schoenrich Professor of Preventive
Medicine, Associate Dean, Professional Practice and Programs,
Director, Center for a Livable Future, Johns Hopkins Bloomberg
School of Public Health, MD, USA
Nelson Sewankambo, MD, Dean, Faculty of Medicine, Makerere
University; Founding Member, Academic Alliance for AIDS Care and
Prevention in Africa, Uganda
Anne Merriman, MD, Founder and Director of Policy and International
Programmes, Hospice Africa, Kampala, Uganda
Bhawani Shanker Kusum, NGO Delegate, PCB UNAIDS for Asia/Pacific
Ezinna Enwereji, President, Health and Environmental Research
Society, College of Medicine, Abia State University, Nigeria
Chiledum A. Ahaghotu, MD, Assoc. Professor of Urology, Howard Univ.
Hospital; Surgical Team Leader, Imo State Medical Mission, Nigeria,
USA
Donald Cephas Epaalat, Commonwealth Nurses Federation Board, Member
for East, Central and Southern Africa, Kenya
Deborah A. McFarland, PhD, MPH, Professor, Department of Global
Health, Rollins School of Public Health, Emory University, USA
Jocelyn Tindiweegi, Head Nursing Officer for Mbarara University
Teaching Hospital, Uganda
Lark Lands, MS, PhD, Medical writer, editor, and educator, CO, USA
John Mandisarisa, MPH, Bsc, Dip, Nat'l Workplace HIV Prevention and
Care Officer, Ministry of Health and Child Welfare, Zimbabwe
John S. James, Publisher, AIDS Treatment News, PA, USA
Christine C. Quinn, Speaker of New York City Council, NY, USA
Ewald Horwath, MD, Clinical Professor of Psychiatry, College of
Physicians and Surgeons Columbia University, Medical Director,
Columbia University HIV Mental Health Training Project, NY, USA
Bruce G. Trigg, MD, Medical Director, STD Program, Region 1,3,T,
New Mexico Department of Health, NM, USA
Alan R. Lifson, MD, MPH, Professor of Epidemiology and Community
Health, University of Minnesota, USA
Thomas L. Hall, MD, DrPH, Dept. of Epidemiology and Biostatistics,
UCSF School of Medicine, CA, USA
David Wheeler, MD, Medical Director, Inova Juniper Program, USA
Lucy Bradley-Springer, PhD, RN, ACRN, FAAN, Principal Investigator
& Director, Mountain Plains AIDS Education and Training Center;
Associate Professor of Medicine, University of Colorado at Denver
Health Sciences Center, USA
Badru Male, Senior Health Promotion Manager, Brent and Harrow
Community Health Projects, UK; Member of UK Advisory Board on HIV
Treatments; founding member of Community Health and Information
Network (CHAIN), UK
Babafemi Adenuga, MD, Program Dir., Family Medicine Residency;
Medical Dir., Family Health Center; Assistant Professor, Dept. of
Community & Family Medicine, Howard Univ. Hospital; Medical Team
Leader, Int'l Medical Mission, Imo State of Nigeria, USA
Zbigniew S. Pawlowski, MD, DTMH, Professor Emeritus of Parasitic
and Tropical Diseases, Poznan University of Medical Sciences;
former WHO HQ staff, Poland
Jon Ungphakorn, Senator, Government of Thailand, Board Secretary
AIDS Access Foundation, Thailand
[and over 350 U.S., African, and other international organizations.
For full list see http://healthgap.org/hcwcall.html]
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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