As we reflect on the past and the year ahead, we have much room for optimism, but, sadly, some room for pessimism too. Hitherto, we have made much progress both on the epidemic fronts but also in growing the ACB. Except for WCA, rolling out ART has continued on an upward swing, and with it, some benefit on the prevention side. New HIV infections are coming down. Deaths to AIDS are going down too. Up until 2015 malaria deaths dipped by 60 percent, saving over 7 million people, but this has since been reversed by this dreadful disease’s resurgence since 2016.
On the ACB front, we celebrate the launch of the CBLNs. We put our hats off to our out-going Global Fund Board, Alternate Board and Committee members and also CFPs – well done! In the same breath, we welcome the in-coming Board, Alternate Board and Committee members and also CFPs – bienvenue! Luckily, some of our leaders will be continuing in different roles. This is good for our institutional memory.
However, there are worrisome trends needing our every concerted efforts. The dwindling Development Assistance for HIV/AIDS (DAH) continues to be worrisome. We need to get back to the highs of 2010-2012. So too is our inability to spend to the $26 billion to 2020 levels projected by UNAIDS, if we are to stop the HIV epidemic in its tracks. The figures around HIV prevention are no longer very impressive: we are not spending us much as we should on primary prevention, due, supposedly, largely to the treatment roll out; no decline in new infections among adults; only a modest 6% decline among 15-24 AGYW.
The resurgence of malaria in some parts of the world, including some parts of our continent is also worrisome. We did so well between 2000 and 2015: malaria deaths fail by more than 60% during the period i.e. 7 million lives saved. Six countries have been certified by WHO as having eliminated malaria, 12 other countries have attained zero malaria status, and over 40 countries have fewer than 10,000 cases. What this means is that half the world is now malaria-free. For a moment the end of malaria was truly in sight. But then the resurgence hit; 2016 saw more than 216 million cases in 91 countries, an increase of 5 million from 2015. This is largely due to dramatic increases in resistance for a number of insecticides used to treat malaria, resistance towards some of the malaria drugs, plateauing and in some cases declines in funding, climate change, losses of habitat and biodiversity caused by deforestation, as well as the large numbers of mobile and displaced persons and refugees.
So too is the Missing TB cases situation. We are painfully aware that there are nearly 4.3 million, including 600,000 children, cases new cases of TB get missed by the health systems i.e. do not get diagnosed, treated or reported. Of this figure, Africa accounts for 26% mainly in Nigeria and South Africa.
These trends mean we should roll up our sleeves and up the game. This is no time for complacency. It means we need to prioritize certain issues.
Africa needs to heighten its ownership of Global Fund processes. We are the continent with the highest burden of the three epidemics. Our voice on the decision-making table must be commensurate with this reality. We must therefore invest in our ability to generate evidence-informed policy ideas. Ensuring that the 2020-2022 allocation cycle is based on robust mapping of epidemics should be our critical undertaking. We must also increasingly contribute towards the fund, and the 6th replenishment presents yet another opportunity to contribute; why not a $1m towards each year? Our leaders on the continent, who have the ultimate mandate of delivering better health to our people, need to have a say on Global Fund policies and decisions. We therefore need to tap into the AU’s convening power and ensure the AU shares our stance in Global Fund policies and decisions benefits from their deliberations.
Declining DAH funding is perhaps the elephant in the room with huge implications for the African continent. We need to work with advocacy and lobbyists to convince our partners in the North that it is not yet game over. But it has implications on the home grounds too. Our governments need to ramp up the finances too, at minimum to meet the Abuja commitments. This is another reason to heighten the argument for increased domestic financing as part of efforts to bridge the funding gap. Blended finance, innovative finance, consumption levies, social health insurance, etc., they should all be prudently and cautiously employed to contribute more to the response. And then of course, we should be more efficient in the utilization of resources. As the biggest spender of Global Fund resources, Africa needs to ensure maximum value for every dollar invested. There is no need to ask for more resources when we can’t spend what is available; our absorptive capacity, particularly in WCA regions, just have to be addressed head on. When products and commodities are wasted through pilferage. When funds are misused, pilfered and wasted through graft. Africa therefore has a huge responsibility to clean its house and ensure every penny invested creates the greatest value.
We need to re-double our efforts and act on emerging issues, effectively nipping them before they bud. HIV Prevention spending needs to be reprioritized. While treatment as secondary prevention works, we know it does not work all the time for everyone. We cannot not treat our way out of the HIV epidemic. The Global Fund needs to ensure primary prevention is not neglected – behavioural change, testing, condoms, lubricants, male circumcision, etc. in a well-targeted manner. We need to put the spotlight even more on AGYW and women before the epidemic explodes to our faces given the demographic proportions these groups command.
Malaria resurgence is equally another enormous challenge of our time. Combating this dreadful disease remains a global urgency, and nowhere is this truer than Africa. We welcome the re-ignition of commitments towards fighting malaria at the recently held Malaria Summit London where around $4.1 billion was pledged to combat this dreadful disease. This will likely prevent 350 million cases of the disease in the next five years and save 650,000 lives. Our science must continue to evolve and innovate our tools to prevent, detect and treat malaria, because conditions are evolving all the time hence the resistance. We should also invest in data and surveillance systems right up to sub-district levels to enable us to ensure a targeted response.
Missing TB cases is yet another emerging trend needing nipping in the bud to ensure we reach SDG, UHC and end TB strategy agendas. We need to invest in innovative and targeted interventions, gathering evidence – including TB prevalence studies – and expanding the most successful approaches, not in the least including engaging the private sector more, addressing health services barriers, addressing recording and reporting gaps and strengthening and better equipping primary health care.
Partnerships are another critical pillar of our collective work together and will remain so for the longest time. Through them we leverage funding, information, data, evidence and tap into innovative ideas. We cannot do without them. Ensuring we have signed partnership agreements with AU, RECs, UNAIDS, WHO, UNICEF, UNFPA, STOP TB, Roll Back Malaria, academia, Civil Society, including funding partnerships with friends of the African Constituencies is critical to our strengthening the African voice, indeed to our very survival.
Finally, we need to continue building the ACB from its current nascent stage to a strong continental organization that it should be. The immediate focus is to strengthen organizational systems. Of particular import is the governance systems to ensure the Bureau is anchored at the highest level on the African continent – the African Union. It is also critical that finance, human resource, and administrative systems are polished up in keeping with international organizations.