Africa: Aids, TB and Malaria . . . Africa Declares Commitment

from All Africa

This Day (Lagos)

Roland Ogbonnaya
Lagos

Kigali, the capital of Rwanda, a country located in central Africa, since after its civil war and genocide in 1994, may have not played host to such a large contingent of world leaders in government, business and civil society as it did last week. Friends of the Global Fund Africa popularly referred to as Friends Africa, a new pan-African advocacy organisation, chose Kigali as the venue for the inauguration of its board and first board meeting to chart the way forward in the fight against HIV/Aids, tuberculosis and malaria, the three diseases it claimed have been dealing a great blow to African continent.

In Kigali, Friends Africa brought together some of the most committed, credible and influential voices of Africa as an indication of African leaderships' determination to lead the fight against the three diseases.

The board inaugurated by the Rwandan President, Paul Kigame include Chris Kirubi, chairman HACO Industries, Kenya; Archbishop of Cape Town, Winston Ndugane, South Africa; General Yakubu Gowon, Nigeria's former President; Mrs. Janet Kagame, Rwanda First Lady; Ngozi Okonjo-Iweala, Nigeria's former Minister of Finance and Francoise Ndayishimiye of Burundi.

Others are Mr. Aigboje Aig-Imoukhuede, lawyer and chief executive officer (CEO) Access Bank Plc, Nigeria, who is the chairman of the board; Sheila Tlou, minister of health, Botswana; Angelique Kidjo, musician/songwriter from Benin Republic; Jeffery Sachs, director Earth Institute, Columbia University, New York and Jonathan Oppenheimer of South Africa.

Among the board members are Youssou N'Dour, musician/songwriter from Senegal; Donald Kaberuka from Rwanda and the President, African Development Bank; Mr. Ofori Attah from Ghana and co-founder, Databank Financial Services Limited and Dr. Akudo Anyanwu Ikemba, Nigeria and chief executive officer (CEO) Friends of the Global Fund Africa.

At the inauguration which had its theme as: "Africans Taking Responsibility and Achieving Result in the Fight Against AIDS, TB and Malaria," Dr. Ngozi Okonjo-Iweala delivered a message on how to get governments to spend effectively on the health sector and how to get them keep their commitment. She was joined by the chairman of the board, Aig-Imoukhuede who spoke on the objectives of the board.

Welcoming guests to Kigali, a capital city described as "the land of a thousand hills," Kigame said that his government has over the years been able to build 220 health centres and three new general hospitals throughout Rwanda in order to bring health facilities down to the rural as well as urban people. He said that Rwanda has also been able to tap funds from Friends Africa in its pursuit to fight HIV/AIDS, tuberculosis and malaria, especially in the preventive aspect of it.

"Health system needs to be built rehabilitated and equipped, especially in the area of primary health system. We have also enthroned good governance and democracy. If we can maintain and build on what we already have, we are on our way to improve our health system," the Rwandan President said. He further explained that Rwanda has in its annual budget increased allocation of health to 10 per cent and 20 per cent to education, saying that one cannot talk about health without education.

While expressing his appreciation to Friends Africa for chosen Rwanda as host of the inauguration, Kigame said the organisation has been constituted as a great factor in the fight against the three diseases in Africa.

Aig-Imoukhuede, in a remark after the board inauguration, described it as a unique privilege to serve alongside a team of highly credible committed individuals on the board of Friends Africa. He disclosed that the mission of the board is simply to assist in mobilising African governments, private sector and civil society for the purpose of bringing about sustainable and effective methods to fight Aids, tuberculosis and malaria through the Global Fund and other innovative mechanisms.

Aig-Imoukhuede, who described himself as a capitalist told the audience that colleagues and friends have often asked him why he is giving so much time to the cause that generates no financial gain to him and the bank. He said the answer lies on the fact that about six million people die annually from the three pandemics.

"To put it more vividly, 16,000 people will die today. And we all know that the greater proportion of these deaths will take place on our own continent Africa. The answer I give to these my friends is that I can't wait until it is my uncle or even myself that is affected before I do something. We must all join hands in the fight of the three pandemics to the finish; they may just end up finishing us.

"It is today universally acknowledged that to intervene meaningfully and on a sustainable basis in the fight against Aids, TB and malaria a massive global mobilisation of resources is required. The Global Funds guiding principle of country ownership is not only unique, but has compelled each country to determine its needs and priorities. Country ownership has deepened stakeholder involvement and developed local speciality to fight the three pandemics in a sustainable manner," the Access Bank Plc Bank boss said. Aig-Imoukhuede expressed appreciation and gratitude to the people and government of Rwanda for making the event possible and being such fantastic hosts.

Dr. Helen Evans, the deputy executive director of Global Funds, in a remark said the timing of the inauguration of the board of Friends Africa couldn't be better. She said that Global Funds was meeting in Kigali within weeks of the organisation's fifth anniversary. During these five years, Evans said the organisation has grown, through the efforts of many people, from the mere ideas of a public/private partnership to finance a massive effort to prevent and treat Aids, TB and malaria, to becoming one of the largest financiers of malaria and TB programme with more than 396 grants in 136 countries.

The first board meeting of Friends of the Global Fund Africa, Evans stressed, represents a great milestone in the development of the Global Fund, which was created as a true partnership between the north and south and unlike many other development initiatives, the involvement of the south was instrumental in the creation and early success of the fund.

"Our board is the most inclusive governing body in any international organisation outside the United Nations, both in composition and certainly also in real influence. However, principle and practice don't always immediately gel and over the past years there has been some concern that the north's general tendency to drive policies and priorities also has crept into the work of the Global Fund. The creation of Friends Africa, with its tremendously impressive diverse and strong board provides an opportunity to address that concern," she added.

Evans disclosed that results to date also show the critical importance of civil society and private sector implementers alongside government, while direct financing to civil society principal recipients can improve the speed and the capacity to achieve results. In Zambia for example, Evans said the direct financing of the Churches Association and ZNAN under the oversight of the CCM has been critical. She added that civil society organisations are essential and high performing implementers alongside government.

"We also see the private sector as an important partner in both supporting and in rolling out programmes to fight disease. Progress here has been slower as we all find our way but we have seen some early successes in bringing together private sector expertise and resources with Global Fund grants such as in Gambia, the Lumombo region and most lately in Niger.

"Friends Africa can play a crucial role in improving the ties and communication between partners. Friends Africa also has a crucial role in exchanging information on best practices across borders and then in promoting to the broader world that it is possible to achieve change and that the money is having an impact-this is extremely important if money is to keep flowing," Evans emphasised.

Dr. Ikemba, the CEO of Friends Africa and former fellow of the Centres for Disease Control (CDC) Atlanta, USA and lecturer at Tufts University School of Medicine in an address at the inauguration explained that the bulk of the burden of Aids, TB and malaria is felt in Africa where most of the related deaths occur. As a result, she said many African countries are plagued with unacceptable health indices.

"I come from Nigeria where life expectancy is 45, child mortality is 20 per cent and maternal mortality is one of the highest in the world. With such grim statistics, fertility rate continues to soar leading to population explosion, which further fuels the poverty circle. I will like to see a new Africa with improved health indicators and I realise that it will take every sector to accomplish this. It will take a business mind and efficiency of the private sector, the reach of civil society and the commitment of government," Ikemba stressed.

She said that Global Fund in its effort to fight Aids, TB and malaria, has pooled and will continue to pool the resources necessary to improve these statistics. Launched in 2002, Ikemba stated that the fund has been at the forefront of responding to the continued public health threat posed by the three pandemics. With $6.6 billion in grants awarded to 136 countries, Ikemba added that the fund's commitment to the fight is clear. She stressed that with 60 per cent of the Global Fund money is coming to Africa, the funds commitment to the continent is clear.

She regretted that the funding gap is a high as $20 billion per annum. As recipient countries, she said Africa must get involved in resource mobilisation by advocating to "our own governments, the private sector and to traditional donors. We must drive the demand for the Global Fund and put an end to the debate on absorptive capacity. We must take leadership and ensure strong in-country governance and successful implementation of Global Fund grants. To achieve truly sustainable results, recipient countries must become stronger stakeholders in the Global Fund and other forms of development assistance."

Speaking earlier to THISDAY in Kigali, Okonjo-Iweala, former Minister of Finance said she has been committed to Friends Africa from inception because of its objectives, which are really laudable. She stated that "it was time for Africans to accept their problem and also solvers of such. I believe that Africans are those to resolve their problems and not outsiders. We should not wait for others to come and solve our problems.

"I expect the organisation to encourage private sector, civil society and government to raise funds in order to support the work of Global Funds which include fight against Aids, tuberculosis and malaria. Another function of the organisation is to encourage other bodies to acquire resources in performing some of these Friends Africa functions. The organisation is also into dissemination of information on what they are doing.

"In the last seven months the organisation was inaugurated by President Olusegun Obasanjo in Abuja, the organisation has done marvellous jobs, which include the establishment of stronger machinery of advocacy," she added.

While commending Friends Africa, Okonjo-Iweala also said that there has been growing commitment on the part of some African leaders in the support of the fund in the fight against Aids, tuberculosis and malaria. "I'm beginning to see some changes and level of commitment by some African leaders unlike about 10 years ago. President Kigame and his wife Janet as well as President Obasanjo are examples of leaders who have shown great commitment and political will. In Ghana (John) Kuffoe has also done well. In Malawi and Uganda, their leaders are waking up to the reality that things cannot continue to go the way they were in the past."

The former minister disclosed that each African country has set a target, "especially in the area of reducing high prevalence of HIV/Aids from the level they are now to 1.0. In Nigeria, we have had good success from 5.8 prevalence few years ago to 4.0. The same thing has happened in Ghana and even in Uganda, where the prevalence has gone down. However, we cannot begin to dance on the street because there are lot of work to be done because some of these records are not accurate."

Despite how grim the situation may look, the newly inaugurated members of the Friends Africa said there is hope for Africa. This is encapsulated in the declaration of the board after its inauguration as they pledged total determination to combat the scourges of HIV/Aids, tuberculosis and malaria in Africa. They further recognised the special leadership provided by the former secretary general of the United Nations, Mr. Kofi Annan and Obasanjo in the fight against the pandemics.

"We are deeply conscious that these three diseases present an existential threat to the very survival of the peoples of Africa, with the continued viability of some states challenged by the pandemics.

"We emphasise that there can be no sustainable economic development in Africa if the impact of these disease are not halted and begin to be reversed as agreed in the millennium development goals adopted at the united nations general assembly in 2000.

"Conscious of the need for real local ownership and accountability in the fight against these pandemics, we have established the Friends of the Global Fund (Africa) as an organisation through which Africans in all sectors-public, private and civil society-will now take charge of the fight against these pandemics that threaten our existence and survival as a continent," the board further declared.

Friends Africa was founded in 2002 after Obasanjo launched it during the Africa Heads of States in Abuja in order to create and sustain visibility and awareness for the Global Fund to fight Aids, TB and Malaria across the African continent, as well as to build political and financial support for the organisation. Friends of the Global Fund Africa joins Friends organisations in the U.S, Japan and Europe as non-governmental advocates on behalf of the Global Fund.

In just five years, the Global Fund has become a leading force in the fight against HIV/Aids, tuberculosis and malaria in Africa. It has signed more than 200 grant agreements for $3.2 billion in almost every country on the continent.

The Global Fund unfortunately suspended funds to Nigeria last May, because the country failed to meet targets on "drug access and transparency". This suspension however, does not affect a $180 million Global fund grant, which had not yet been approved. It is hoped that these funds will be used effectively, judiciously and transparently.

While the majority of Global Fund investments in Africa support efforts to fight Aids, the Global Fund has emerged as the predominant funder of TB and malaria programs, making up two-thirds of international commitments for these diseases in 2006 globally.

To date, tens of millions of people have already been reached with life-saving services. Programs in Africa financed by the Global Fund have provided antiretroviral treatment to 575,000 Africans with HIV, treated 442,000 people with effective tuberculosis medications and distributed nearly eleven million insecticide-treated bed nets to protect children and families from malaria.

According to the Chairman of Global Fund, Dr. Jacobs the organisation is a unique global public/private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/Aids, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. The Global Fund, she added works in close collaboration with other bilateral and multilateral organisations to supplement existing efforts dealing with the three diseases.

"Our mission is to galvanise African government, private sector and civil society for the purpose of bringing about sustainable and effective methods of addressing the issues of Aids, TB and malaria in Africa through supporting the Global Fund and other innovative financial mechanisms in the fight against the three diseases for the end goal of helping communities affected by the three diseases," Dr. Jacobs who is from the Caribbean added.

In 1946, the World Health Organisation (WHO) defined health as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity." More recently, this has been expanded to include the ability to lead a "socially and economically productive life." Many have argued that the WHO definition of health is an ideal, which is very far from reality. How true this argument is for Africa, a continent plagued by many difficulties including poverty, illiteracy, war, sickness and disease.

Each of the above situations, Dr. Jacobs emphasised, influences the others and is in turn influenced by them. "For instance, poverty increases vulnerability to sickness and makes good health care unaffordable while illiteracy encourages the fatal combination of folklore and local 'alternative' remedies for treating diseases.

"Not too long ago, in many parts of the world, the erroneous belief that having sexual contact with virgins could cure Aids increased the rate of infection among young women, and left many girls, some as young as eight years devastated by the emotional and physical effects of rape.

"With conditions ranging from psychological to physiological, the health burden of Africa is overwhelming, making the available healthcare services ineffective in the fight against the deteriorating health situation. The gravity of the situation is apparent considering the figures for Africa in the August 2006 Epidemiology Fact Sheet on HIV/Aids and Sexually Transmitted Infections developed by WHO in collaboration with UNICEF and UNAIDS. The report puts the average maternal mortality rate at 596/100,000 live births while the average infant mortality rate is 135/1,000 live births," she stated.

The cheering news is that Aig-Imoukhuede and Ikemba are committed to the cause of African development, which is currently undermined by the devastation of Aids, Tuberculosis and Malaria, and making a positive effort to altering the future of Africa in the prevention and treatment of the three diseases.