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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 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

For a recent article on the status of global health programs, see

++++++++++++++++++++++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 <>

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

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,

Sisonke Msimang, Open Society Initiative for Southern Africa (OSISA): Tel. +27 11 403 3414,

Eric Friedman, Physicians for Human Rights: +1-202-728-5335 ext. 303,

Abiola Akiyode-Afolabi, Women Advocates & Research Documentation Centre (WARDC): +234 8055951858

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

(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 FrontiŠres; 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]

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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