Assembly Decision /AU/ Dec.413 (XVIII)

• January 2012 AU Summit: AUC and NEPADrequested to produce a Roadmap on SharedResponsibility and Global Solidarity for AIDS,TB and Malaria Response.

• July 2012 : The AU Roadmap was endorsed tosupport African countries to meet theircommitments in terms of the Abuja Call andrelated AIDS, TB and malaria targets by 2015.

AU Roadmap pillars

Diversified,

balanced and

sustainable

financing models

Pillar 1

Access to medicines

through local

production and

regulatory

harmonisation

Pillar 2

Leadership,

governance and

oversight for

sustainability

Pillar 3

High level political commitment

January 2012AWA mandate expanded to

include tuberculosis and

malaria includes all Heads of

State and Government

July 2012High Level Ministerial Dialogue on

Value for Money, Sustainability and

Accountability in the Health Sector

calls for reducing and dependence

July 2012African Leaders Malaria

Alliance (ALMA) Summit on

malaria calls for increased

domestic financing and

innovative financing

September 2012United Nations General Assembly

African Union High-Level Side Event

on Shared Responsibility and Global

Solidarity for AIDS

High level political commitment

March 2013PAP commits to monitoring the implementation of the AU Roadmap.

January 2013At the AU Summit, CARMMA commits to local production of antiretroviral drugs, condoms and other essential drugs.

May 2013Appointment of the AWA vice chairperson and five AWA Regional Champions

July 2013Declaration of the Special Summit undertook to accelerate the implementation of the earlier Abuja commitments

High level political commitment

July 2013AIDS Watch Africa Champions Action Plan developed

August 2013SADC Heads of State commit to accelerate action on AIDS, TB and Malaria

March 2014Parliamentary roundtable develops action plan.

May 2014Regional Economic Communities (RECs) meet to review Implementation of the African Union Roadmap

High level political commitment

June 2014HOSG call for MS to accelerate the implementation of the Abuja commitments on ATM

September 2014High level discussion on the future of health financing on the margins of the 69th session of the UNGA in New York

November 2014Briefings of the Africa Groups, French Assembly on the AU Roadmap and Domestic Financing for Health

April 2015STC requested development of Roadmap for AIDS, TB and Malaria in line with 2013 Abuja Actions

Progress Pillar One

• Most African countries diversified andexpanded funding sources for health toreduce aid dependency.

• Between 2006 and 2011 global domesticinvestment has doubled spending on AIDS, TBand malaria.

• In the last four years, African countries haveincreased their domestic resources to fightAIDS by 150%.

Progress Pillar One-2• RSA has contributed US$2 billion dollars

per year of domestic funding toward the

AIDS response

• RSA implemented interventions that

achieved price benchmarking, robust

allocation of preference points and price

stability

• Nigeria committed US$1 billion for

investments in treatment, care and

prevention in 2013

Progress Pillar One-3

• Zimbabwe’s AIDS levy increased from 5.7 millionin 2009 to 150 million in 2014.

• In 2011 Cameroon joined Congo, Madagascar,Benin, Mali, Mauritius and Niger in applying anairline levy with funds set aside for HIVprogrammes.

• Benin piloted a scheme for results-basedfinancing in the context of plans to increasedomestic resources for HIV treatment andprevention.

• Cape Verde, Comoros and other countries chargealcohol excise taxes with funds earmarked for HIVprogrammes.

Progress Pillar One-4

• Since 2010 the Government of Swaziland hasrelied exclusively on domestic resources for itsARV medicines.

• Rwanda and Uganda are charging levies onmobile phone usage.

• The governments of Benin, Congo, Madagascar,Mali, Mauritius and Niger charge airline levies.

• Over 90% of Rwandans enjoy health insurance.

• Over 90% of patients in both private and publicfacilities in Ghana are health insurancesubscribers

Progress Pillar One-5• Ethiopia committed 2% of the budget of each public

sector body for HIV.• In Swaziland, all public bodies are required to devote

2% of their budget to workplace policies for their staff.• Malawi requires all ministries and departments to

allocate a minimum of 2% recurrent costs budget toHIV-related activities.

• Gambia’s contribution to its national AIDS responsehas increased from GMD 1.8 million per year between2008 and 2011 to over GMD 5 million in 2012.

• In 2011 Gabon increased the National Fund for HIVPrevention and Treatment by approximately 150%.

Progress on Pillar One-6

• Tunisia is also aiming to finance just over 70% of its HIV response domestically with almost universal treatment coverage – including coverage for non-nationals in need

• Swaziland has increased its antiretroviral drugs tender efficiency by introducing ceiling prices, supplier performance data and more reliable quantification methods

• Malawi is currently evaluating alternative options in order to increase domestic funding.

• Domestic funding of the AIDS response has increased in Namibia (60%), Rwanda (24%), Liberia (19%), Malawi (19%), Zambia (16%), Togo (15%) and Madagascar (15%).

Progress Pillar Two• The pharmaceutical manufacturing plan for Africa

(PMPA) sought to not only improve the continent’spublic health through contributing to a healthy humancapital but also aimed to strengthen the local industrythereby creating jobs and enjoying the economicbenefits of a viable pharmaceutical industry.

• The endorsement by AU Heads of States andgovernments of the PMPA business plan has attractedthe interest of national governments and regionaleconomic communities to develop the pharmaceuticalsector but it has also triggered a significant number ofpartners to increase their support to the AUC andother organs of the AU including Member states.

Progress Pillar Two-2• Considerable progress has been made to scale up

pharmaceutical access and manufacturing, with aparticular focus on ARVs and ACT as well as othermalaria commodities such as insecticide-treatednets.

• The implementation of the PMPA Business Planand related sub-regional plans developed by theEAC, SADC and ECOWAS, will further supportincreased pharmaceutical capacity in Africa.

• Establishment of the African Medicines Agency,Endorsement of a model on medical productsregulations and harmonization, to thedevelopment of a GMP compliant Industry.

Progress Pillar Two

• Increased regulatory harmonisation across thecontinent. In 2012, NEPAD began developing anAU model law on Medical Products Regulation foradoption by national legislative bodies in anattempt to harmonise medical productsregulation in Africa.

• The AMRH Initiative, supported by NEPAD, ispromoting the establishment of regional centresof regulatory excellence, working through theexisting structures of RECs.

• Importance of TRIPS and IP approaches (EAC).• South South Cooperation : Africa China Forums,

BRICS.

PMPA Consortium• UN agencies (UNIDO, UNAIDS, WHO, UNFPA,

UNDP)• FAPMA (Federation of African Pharmaceutical

Manufacturers ) and ANDI (African Network forDrugs and Diagnostic Innovation)

• AfDB, UNECA, and USP (United StatesPharmacopoeia Convention)

• Myriad of challenges confronting thepharmaceutical sector and hampering its growthsuch as access to financing, human resourcesdevelopment, access to technology and know-how, inadequate regulatory systems, poor sectorstrategies, incoherent policies etc

Progress Pillar Three• Growing Importance of high level political advocacy

and early implementation

• The AUC, various organs of the AU (NEPAD, PAP,APRM), RECs and AU Member States with the supportof stakeholders including development partners haveprovided leadership for the implementation of the AURoadmap.

• AWA and the ALMA are also providing leadership forhigh-level advocacy and accountability on AIDS, TB andmalaria responses across the continent.

• Member States are developing more robust, inclusive,results-focused national strategies (costed strategicPlans and related investment cases).

Progress Pillar Three• At continental, regional and national level,

there are signs of strengthened protection inlaw and policy for rights-based responses toHIV, AIDS, TB and malaria.

• Integration with health systems focus – notoverly vertical – approach

• Role of Civil Society, private sector anddevelopment partners.

Progress Pillar Three

• MS streamlining disease coordination andgovernance to make the best use of limitednational human and financial resources withthe support of the United NationsDevelopment Programme (UNDP) and otherpartners to make the best use of limitednational human and financial resources.

• Remarkable efforts made in aligning Global, Regional and National strategies

• Difficulty in translating political declarations to concrete andmeasurable actions.

• Heavy dependence of many African countries on externalfinancial support making financing for AIDS, TB and malariaservices neither predictable nor sustainable;

• Weak planning capacity, implementation and performance-based management partly because of lack of institutionaland human resource capacity at national level;

• Insufficient policy planning and programming for addressinghealth in national development frameworks which isreflected in inadequate health system development, lowcoverage and access to services

CHALLENGES - 1

• Inadequate laboratory networks for diagnosis of diseases andhuman resources in terms of numbers, mix of skills, motivation,and retention.

• Inadequate access to essential medicines, preventivecommodities and technologies across much of the continent.

• The lack of adequate policies and legislation protecting therights of PLWHA and TB patients by most countries hinder effortsat effective responses. This is further compounded by many otherfactors that include stigma and discrimination, gender inequity,inadequate coordination at national, regional and internationallevel including weak M&E systems .

• Cross cutting issues-poverty reduction, nutrition, food security,internal and inter-country migration and development

CHALLENGES - 2

• Leadership and governance- there is need to further strengthenleadership and governance at various levels.

• High level advocacy and resource mobilisation

• Protection of human rights- based responses to health throughbetter access to justice, law and policies enforcement atnational and regional level to ensure that the needs ofvulnerable and key populations are taken into account in anadequate way.

• Strengthening health and community systems-Member Stateswith support of partners should further strengthen healthsystem and community service delivery for greater efficiencywith focus on integrated AIDS, TB and malaria services.

• Prevention, treatment, care and support- Abuja Call and theAU Roadmap should be extended for the period 2015 to 2030.

AFRICA TO MAKE HIV TB AND MALARIA HISTORY By 2030 : RECOMMENDATIONS - 1

• Access to affordable, quality assured medicines and technologies-develop and implement national action plans to ensure reliable access toaffordable and quality-assured medicines and health-relatedcommodities.

• Research and Development-further strengthen capacity on biological,clinical and socio-cultural research, including traditional medicines andvaccines research to generate evidence to improve and adapt policies andprogrammes.

• Partnerships-diversify and strengthen partnerships with NGOs, CSOs,private sector and international community to advance the agenda ofshared responsibility and global solidarity and create a conductiveenvironment for this to happen.

• Monitoring, Evaluation and Reporting- there is need to furtherstrengthen monitoring, evaluation and reporting mechanisms for moreeffective responses.

RECOMMENDATIONS - 2

Extending AU Roadmap to 2030: Key General Recommendations

• Create more space and opportunity for political advocacy

• Move beyond business as usual with emphasis on qualityand urgency

• Align global, regional and country level strategies andstrengthen the coordination at all level

• Need for focus on how strategies will be operationalizedmaking sure partners align their interventions to theNational and regional frameworks

• Need to capture how we will work more effectively togetherto secure alignment in approach/implementation as well asin strategy documents

• SDG tighter framing is forcing us to work more closelytogether

Extending AU Roadmap to 2030: Key General Recommendations

• Ensure strategies adapt to local context and regional specificity• Prevention needs to be more strongly highlighted• Need to clearly define a role for community level and gain

community participation and ownership (the Ebola crisis)• Use local information to inform programmes, focus on young

women and girls (AIDS),– right things, right places, right time• Impact, efficiency, sustainability, partnership, human rights,

gender and community focus - social determinants of health – allcritical

• Strengthen Health systems• Define boundaries between health and other sector

responsibilities• Strengthen Monitoring, Evaluation and Reporting mechanisms a

basis for evidence informed responses.

OPPORTUNITIES TO INCREASE INVESTMENTS IN HEALTH

• Greater emphasis should be placed on longer-term sustainable financing through, inter alia, efficiency gains and mobilizing greater domestic resources.

• Drug resistance is a huge challenge to treatment efforts for all the three diseases and need more attention.

• Future efforts by the AU Member states and its partners to sustain and accelerate progress in human rights, gender equality and solidarity with marginalized populations. Social Protections measure need to be implemented to move towards universal access to health services.

CONCLUSION• In spite of the above, the progress made is still

insufficient to attain the Abuja target of universalaccess to HIV and AIDS, TB and Malaria services by2015 and MDGs.

• The ‘final push’ towards universal access and ultimatelyending the three epidemics should be advanced throughintensified implementation of national programmes withthe support of the UN system and international partners,and better harmonization and coordination at national,regional and continental levels (High Level leadershipand commitment to eliminate the three diseases as wellas socio economic grow in the region.