<br><br><div class="gmail_quote">From <span dir="ltr"><<a href="mailto:tschrecker@sympatico.ca">tschrecker@sympatico.ca</a>></span> <br><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex;">
<div lang="EN-US" link="blue" vlink="purple" style="word-wrap:break-word">
<div>
<p class="MsoNormal"><span class="Apple-style-span" style="font-size: 15px; color: rgb(31, 73, 125); "> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D">How does this announcement from the Heads of State Summit fit
with the AU finance ministers’ decision in March to repudiate the Abuja 15%
commitment? Could anyone provide some clarification?</span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D"> </span></p>
<p class="MsoNormal"><span class="Apple-style-span" style="font-size: 15px; color: rgb(31, 73, 125); ">Ted Schrecker</span></p>
<p class="MsoNormal"><span class="Apple-style-span" style="font-size: 15px; color: rgb(31, 73, 125); ">University of Ottawa</span></p>
<p class="MsoNormal"><font class="Apple-style-span" color="#1F497D" size="5"><span class="Apple-style-span" style="font-size: 18px;"><br></span></font></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D"> </span><b><span style="font-size:10.0pt">From:</span></b><span style="font-size:10.0pt"> <a href="mailto:ausummit2010@africa15percent-plus.net" target="_blank">ausummit2010@africa15percent-plus.net</a>
</span></p></div></div></blockquote><div><br></div><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex;"><div lang="EN-US" link="blue" vlink="purple" style="word-wrap:break-word">
<div><p class="MsoNormal"><span style="font-size:10.0pt"><b>Subject:</b> Summit Review:15% Campaign Welcomes Restatement of Financing
Commitment-Identifies 6 Key Policy & Budget Priorities</span></p><div><div style="border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in"><p class="MsoNormal"><span class="Apple-style-span" style="font-size: 14.1667px; "> </span></p>
</div></div>
<div>
<p class="MsoNormal"><b>Public Statement - Issue Date August 19, 2010.</b><span style="font-size:10.5pt"></span></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">The Africa Public Health Alliance & 15% Plus Campaign
has welcomed the laudable decisions by the recent July 2010 AU Heads of State
Summit - on various health policies, and budget commitments especially the
restatement of the 2001 Abuja commitment to allocate at least 15% of annual
budgets to health.</p></div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">In the recently released official certified copy of the July
Summit Decisions, African Heads of State at the end of July committed amongst
others to:</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<ul type="disc">
<li class="MsoNormal"><i>“Provide sustainable financing by enhancing
domestic resources mobilization, including meeting the 15% Abuja target,
as well as mobilizing resources through public-private partnerships and by
reducing out of pocket payments through initiatives such as waiving of
user fees for pregnant women and children under five and by instituting
national health insurance;</i></li>
</ul>
<div>
<p class="MsoNormal"> </p>
</div>
<ul type="disc">
<li class="MsoNormal"><i>Strengthen the health systems to provide
comprehensive, integrated, maternal, newborn and child health care
services, in particular through primary health care, repositioning of
family planning including reproductive health commodities security,
infrastructure development and skilled human resources for health in
particular to train Community Health Workers to mitigate the human
resource crisis in the Health sector”;</i></li>
</ul>
<div>
<p class="MsoNormal"> </p>
</div>
<ul type="disc">
<li class="MsoNormal"><i>REAFFIRM the commitments undertaken at the
Special Summits on HIV/AIDS, TB and Malaria in 200, 2001, and 2006… Extend
the Abuja Call for Accelerated Action Towards Universal Access to
HIV/AIDS, Tuberculosis and Malaria Services in Africa (the Abuja Call) to
2015 t0 coincide with the MDGs;</i></li>
</ul>
<div>
<p class="MsoNormal"> </p>
</div>
<ul type="disc">
<li class="MsoNormal"><i>UNDERSCORE the need to promote throughout the
continent, programs for the total eradication of mother to child
transmission so that no child is born with HIV/AIDS.”</i></li>
</ul>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b>*(Attached At End of Review - Full Texts of Certified
Official Final Decisions on Theme of Maternal, Newborn, Child Health; & MDG
6)</b></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>However, the Africa Public Health Alliance & 15%
Plus Campaign has identified 6 key areas requiring improved elaboration in
countries implementation of Summit Decisions on Maternal, Newborn and Child
Health; Financing; Universal Access & PMTCT. These factors constituting
pillars of the improved 15% Plus formula are:</i></b></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><span style="font-size:10.0pt">1. Social Determinants;
Vaccinations; Integrated Health, Population and Social Development Investment,
Crucial to Reducing Child Mortality – and Improving Overall Healthy Life Expectancy.</span></b><span style="font-size:10.0pt"></span></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Non-health sector social determinants affecting Child
Mortality, and overall health outcomes were not directly addressed by the
Summit decisions.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">The main causes of an estimated 4.1 to 4.5 million deaths
annually of African children under 5 years are: malnutrition including
deficiencies in essential vitamins and minerals; diarrhoea; pneumonia /
respiratory infection; malaria; measles; tetanus - alongside prenatal
conditions; and increasingly Mother to Child Transmission of HIV.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>In other words, about half of annual under 5 deaths
(over two million deaths) linked with malnutrition, unclean water, poor
sanitation and environmental policies can be prevented by providing key social
determinants not included in health sector budgets: i.e. improved nutrition and
food security; clean water; improved sanitation, and environmental measures –
alongside other key preventive public health actions such as improved
vaccination coverage.</i></b></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Although identified in other AU policy documents, and
underlined in work of the AUC Department of Social Affairs, the high impact of
social determinants requires they be visibly emphasised in high level decisions
(as key social development factors) affecting Child Mortality and general
health outcomes. This will help ensure comprehensive frameworks for integrated
social development investment at national level – and improve Healthy Life
Expectancy, currently at a low Africa regional average of 45 years.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><span style="font-size:10.0pt">2. Per Capita Investment
in Health, as Important as Percentage Allocation.</span></b><span style="font-size:10.0pt"></span></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">African Heads of State have responded positively to the
calls of citizens not to abandon health commitments, by upholding the 2001
Abuja commitment to allocate at least 15% of budgets to health. </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>However, four years of global and African budget
analysis and tracking has demonstrated that only 15% to health does not have
the desired impact if inadequate in terms of actual investment per person.</i></b>
Percentage allocation alone provides mainly a broad picture of government
priorities, whereas efficient budgeting requires needs based analysis built on
unit, or per person estimates.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>32 African countries currently invest less than $20
per capita, including four of the six countries that have achieved the 15%
target. This is less than half the World Health Organisation recommended
minimum package of at least $40 per capita (which also assumes that crucial
none health sector social determinants or social development issues, such as
clean water, improved sanitation and nutrition have been addressed). </i></b> Some
countries currently invest as little as between $2 and $10 per capita in health
which barely provides some plaster and aspirins, and inadequate to tackle a
combination of health challenges such as Maternal and Child Mortality; HIV, TB
and Malaria.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>Research by the Africa Public Health Alliance and 15%
Plus Campaign has also demonstrated improvement in life expectancy and other
indicators in some African countries allocating less than 15% of budgets to
health, but which have higher per capita investment in health of between $38
and $424 per capita </i></b>- alongside significant percentage allocation;
required investment in social determinants; as well as pillars of health such
as vaccinations, and health workforce. These include countries such as Egypt,
Tunisia, Mauritius and Seychelles. </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Global comparison also demonstrate that countries broadly
similar to some African countries such as Costa Rica and Cuba have achieved the
health MDGs based on (1) Improved health per capita investment, which enabled
targeted investment in key areas such as vaccinations, health workforce, gender
equity in health, and primary health care; (2) Improved investment in social
determinants of health including safe water, improved sanitation, food and
nutrition.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">For instance Costa Rica currently invests $356 per capita in
health, or 25.8% of national budget; and Cuba invests $558 per capita, or 14.5%
of budgets to health. In addition and as recommended by the WHO, they also
implement excellent preventive health and social determinants programs by
ensuring 98% (Costa Rica) and 91% (Cuba) of their population has access to
improved water sources respectively; 96% and 98% access to improved sanitation;
and 90% and 99% vaccination coverage. Also combining this with amongst the best
global ratio of health workforce to the population.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Consequently both countries have achieved life expectancy of
well over 70 years, similar with G8 countries such as the United States which
invests US $3,317 per capita or 19.5% of its budget to health; or Japan which
invests $2,237 per capita, or 17.9% of budget to health.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>The 15% Plus formula - which emphasises dual
improvement of per capita investment with percentage allocation; alongside
improved investment in social determinants - is increasingly acknowledged and
supported by senior policy makers.</i></b> The 10th anniversary of the 2001
commitments in 2011 is an excellent opportunity to formally improve and upgrade
the old Abuja commitments based narrowly on only percentage allocations.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><span style="font-size:10.0pt">3. Integrated Health,
Education and Labour Policy are Crucial to Resolving Health Workforce Shortages
– and Meeting All Health MDGs.</span></b><span style="font-size:10.0pt"></span></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Commendably, the Summit decisions explicitly recognises the
importance of resolving health workforce shortages, primary health care and
stronger health systems. <b><i>The main causes of Maternal Mortality:
Haemorrhage; Sepsis, infections; Hypertensive disorders; Anaemia; Obstructed
labour; Complications of abortion; & increasingly HIV/AIDS related
complications in expectant mothers - all require highly skilled personnel, well
equipped and stocked clinics and hospitals to resolve them sustainably.</i></b></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">It is crucial however to underline that resolving health
workforce shortages at country level requires - comprehensive strategies
involving - long term collaboration of health, education, labour and human
resource sectors.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>Presently, most African countries have only between
10% to 40% of actual numbers of doctors, nurses and midwives, and other health
workforce required to provide quality health care at primary level.</i></b>
Doubling, tripling or quadrupling staff to make up for shortages will require
providing more training institutions and facilities, and teaching staff, as
well as deployment and retention strategies for rural and urban areas that will
include improved working conditions and remuneration.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">None of the health MDGs 4; 5/5b; and 6 will be met without
full resolution of the health workforce shortages, and certainly not
Reproductive, Maternal, Newborn and Child Health, which are human resource
intensive. The laudable progress of African countries like Egypt in producing
record numbers of diverse health workers, and Ethiopia which has started making
important progress is based on integrated health, education, labour and human
resource policies.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Without integrated planning by the health, education, labour
and human resource sectors, removal of user fees for pregnant women and
children will in most cases mean more people will turn up to access non
existent services.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><span style="font-size:10.0pt">4. Ensuring Gender Equity
in Health Budgeting; Adolescent & Youth Health.</span></b><span style="font-size:10.0pt"></span></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Budget allocation is arguably the most crucial policy
instrument of governments. Successful implementation of Reproductive, Maternal,
Newborn and Child Health policies at country level requires a high degree
of gender based assessment of budgets, equity in budgeting, as well frameworks
to ensure women’s rights and gender equality.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>Without required gender budgeting to provide for the
specific needs of women and men, and without legislative and social change to
protect women’s rights to especially reproductive and sexual health, or family
planning – Maternal Mortality will not be sustainably reduced.</i></b></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Similar policy and budgeting is required for adolescent and
youth health, including ensuring access to education and commodities.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Importantly, reduction in Maternal Mortality will require
the active participation of African Women, Gender and Youth policy makers –
alongside health policy makers - in implementing key policy such as the AU
Africa Health Strategy, Maputo Plan on Sexual and Reproductive Health, and the
Campaign for Reduction of Maternal and Child Mortality (CARMMA).</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><span style="font-size:10.0pt">5. Improving Capacity for
Production, Purchase and Distribution of Pharmaceuticals, Essential Medicines
and Commodities to Prevent Stock Outs. </span></b><span style="font-size:10.0pt"></span></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">The Summit decisions commendably underline the critical
importance of commodities in Reproductive, Maternal and Newborn and Child
Health (RMNCH); the urgency of meeting commitments on Universal Access to HIV
and AIDS, TB and Malaria Services; and in particular to end Mother to Child
Transmission of HIV - <b><i>but does not explicitly link this to urgent
actualisation of the existing Pharmaceutical Plan for Africa.</i></b> </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">Given the unmet need for RMNCH commodities for millions of
citizens, and high burden of infectious diseases such as HIV, TB, Malaria and
others - regional and country level capacity for production of diverse
pharmaceuticals, essential medicines, and commodities – including storage and
efficient distribution needs to be urgently improved. </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">This is especially true for: specific aspects of MNCH such
as Preventing Mother to Child Prevention of HIV, which potentially affects
millions of women and children, and where timely and efficient treatment is the
only form of prevention; TB which is easily curable but treatment intensive;
distribution of mosquito nets, and malaria treatment.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>It also needs to be explicitly underlined and
elaborated that for regional and country level improvements in pharmaceutical
and commodities capacity - most of the needed policy and investment falls
outside the health sector.</i></b> The training of highly skilled scientists,
engineers, and technicians requires targeted investment in the education
sector; Primary level pharmaceutical and commodities production requires
improved manufacturing and industrial investment; Necessary negotiations and
legislation for Trade and Related Aspects of Intellectual Property Rights
(TRIPS), require building the capacity of the trade sector.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><span style="font-size:10.0pt">6. At Least One Well
Staffed and Equipped Primary Health Clinic Per Community.</span></b><span style="font-size:10.0pt"></span></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>The great outrage of Africa’s health tragedy is that
for millions of citizens, the nearest primary health clinic is beyond
reasonable physical proximity – sometimes tens or hundreds of miles away</i></b>
– especially for the great majority in rural areas.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">The poor demographic distribution of primary health clinics,
is one of the greatest obstacles to access to quality healthcare – alongside
poor investment in health workforce, poor pharmaceuticals and commodities
capacity, poor provision of social determinants, lack of gender equity in
budgeting, and overall poor per capita or per person investment in health.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">No country has been able to sustainably achieve desired
health outcomes, without majority of its citizens being within at least half an
hour away from the nearest well equipped and staffed primary health clinic – or
at least without the ground and air ambulance facilities to bridge distances in
emergencies - it cannot be different for AU member states. </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">As an intergovernmental organisation, the AU can make broad
statements of intention, and produce policy frameworks – but even when fully
comprehensive and integrated - it is up to member states to implement these in
detail – sometimes encouraged by citizens to do so in a timely manner.</p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b><i>For both federal and none federal countries, any
health and social development policies and budgets that do not set out a
transparent framework for a rolling plan to build, adequately equip and staff
primary health clinics - on a basis of at least one for every community within
a limited time - are deficient and need to be urgently improved.</i></b></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal">But if they are not to be ghost facilities – they need to be
backed up - by comprehensive plans: for integrated education and labour policy
and budgeting for training and retaining health workers; improved capacity for
production and distribution of essential medicines and commodities; gender
equity in health policy and budgeting, including underlining the needs of
children, youth and the elderly; overall improved per capita investment to
ensure that key issues such as Maternal Newborn and Child Health; HIV and AIDS,
TB, Malaria, and neglected diseases are all addressed. </p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><b>ENDS</b></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<div>
<p class="MsoNormal"><b>List of Attached Documents Being Summit Decisions:</b></p>
</div>
<div>
<p class="MsoNormal"> </p>
</div>
<div>
<p class="MsoNormal"><span><span style="font-size:8.5pt">i.
Decisions on AU July 2010 Summit Theme on Maternal, Newborn and Child Health</span></span></p>
</div>
<div>
<p class="MsoNormal"><span><span style="font-size:8.5pt">ii.
Summit Decisions on Eradication of Mother to Child Transmission of HIV</span></span></p>
</div>
<div>
<p class="MsoNormal"><span><span style="font-size:8.5pt">iii.
Summit Decisions on 5 Year review of Universal Access to HIV and AIDS, TB and
Malaria.</span></span></p>
</div>
</div>
<div>
<p class="MsoNormal"><span><span style="font-size:8.5pt">iv.
PDF Copy of Summary Review</span></span></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:8.5pt"> </span></p>
</div>
<div>
<p class="MsoNormal"><font class="Apple-style-span" size="4"><span class="Apple-style-span" style="font-size: 14px;"><b><br></b></span></font></p></div><div><div>
</div>
</div>
<div>
<p class="MsoNormal"><font class="Apple-style-span" size="4"><span class="Apple-style-span" style="font-size: 14px;"><br></span></font></p></div><div>
</div>
<div>
<p class="MsoNormal"><span style="font-size:8.5pt"> </span></p>
</div>
</div>
</div>
</blockquote></div><br>