Tropical Health Matters

On July 8th the G8 issued a series of documents and declarations on issues under discussion, particularly a declaration on energy security and climate change, which some have seen as progress and others as a hollow acceptance of the status quo. The document on ‘Development and Africa‘ addresses a long series of policy and financial commitments of these rich nations over several summits. The health section of that document is produced below in full, and builds on the summit’s health experts’ report, the Toyako Framework for Action on Global Health, and a progress report on G8 support for Africa. One can think about the difference between a ‘declaration’ and a ‘document.’

Health

45. As a result of its growing political and financial commitment to fight infectious diseases, the G8 has raised international awareness on global health issues and contributed to remarkable improvements on health in partner countries, notably access to HIV/AIDS prevention, treatment and care; stabilization of tuberculosis incidence; increased coverage of innovative tools such as insecticide-treated nets against malaria; impressive falls in measles deaths; and considerable progress on polio which is closer to eradication than ever before. Investment through the Global Fund to Fight AIDS, Tuberculosis and Malaria together with national efforts, bilateral and other multilateral programs has enabled recipient countries to save more than 2.5 million lives to date. The Second Voluntary Replenishment Conference held in Berlin in 2007 raised US$ 9.7 billion for expanded activities during the period 2008-2010. But many challenges remain toward reaching the health-related MDGs. G8 members are determined to honor in full their specific commitments to fight infectious diseases, namely malaria, tuberculosis, polio and working towards the goal of universal access to HIV/AIDS prevention, treatment and care by 2010. In this regard, we welcome the report submitted by our health experts along with its attached matrices, showing G8 implementation of past commitments to ensure accountability. Building on the Saint Petersburg commitments to fight infectious diseases, the experts’ report sets forth the ‘Toyako Framework for Action’, which includes the principles for action, and actions to be taken on health, drawing on the expertise of international institutions. We also agreed to establish a follow-up mechanism to monitor our progress on meeting our commitments.

46. In view of sustainability we aim at ensuring that disease-specific and health systems approaches are mutually reinforcing and contribute to achieving all of the health MDGs, and will focus on the following:

(a)We emphasize the importance of comprehensive approaches to address the strengthening of health systems including social health protection, the improvement of maternal, newborn and child health, the scaling-up of programs to counter infectious diseases and access to essential medicines, vaccines and appropriate health-related products. We reiterate our support to our African partners’ commitment to ensure that by 2015 all children have access to basic health care (free wherever countries choose to provide this). We underline the need for partner countries to work toward sustainable and equitable financing of health systems. We also welcome the efforts of the Providing for Health Initiative as well as the International Health Partnership and the Catalytic Initiative. We reiterate our commitment to continue efforts, to work towards the goals of providing at least a projected US$ 60billion over 5 years, to fight infectious diseases and strengthen health. Some countries will provide additional resources for health systems including water.

(b)Reliable health systems require a reliable health workforce. To achieve quantitative and qualitative improvement of the health workforce, we must work to help train a sufficient number of health workers, including community health workers and to assure an enabling environment for their effective retention in developing countries. In this regard, we encourage the World Health Organization (WHO) work on a voluntary code of practice regarding ethical recruitment of health workers. The G8 members will work towards increasing health workforce coverage towards the WHO threshold of 2.3 health workers per 1000 people, initially in partnership with the African countries where we are currently engaged and that are experiencing a critical shortage of health workers. We will also support efforts by partner countries and relevant stakeholders, such as Global Health Workforce Alliance, in developing robust health workforce plans and establishing specific, country-led milestones as well as for enhanced monitoring and evaluation, especially for formulating effective health policies. In this context, we take note of the Kampala Declaration and Agenda for Global Action adopted in March 2008 at the First Global Forum on Human Resources for Health.

(c)We note that in some developing countries, achieving the MDGs on child mortality and maternal health is seriously off-track, and therefore, in country-led plans, the continuum of prevention and care, including nutrition should include a greater focus on maternal, new born and child health. Reproductive health should be made widely accessible. The G8 will take concrete steps to work toward improving the link between HIV/AIDS activities and sexual and reproductive health and voluntary family planning programs, to improve access to health care, including preventing mother-to-child transmission, and to achieve the MDGs by adopting a multisectoral approach and by fostering community involvement and participation.

(d)As part of fulfilling our past commitments on malaria, we will continue to expand access to long-lasting insecticide treated nets, with a view to providing 100 million nets through bilateral and multilateral assistance, in partnership with other stakeholders by the end of 2010.

(e)To maintain momentum towards the historical achievement of eradicating polio, we will meet our previous commitments to maintain or increase financial contributions to support the Global Polio Eradication Initiative, and encourage other public and private donors to do the same.

(f)To build on our commitments made on neglected tropical diseases at St Petersburg, we will work to support the control or elimination of diseases listed by the WHO through such measures as research, diagnostics and treatment, prevention, awareness-raising and enhancing access to safe water and sanitation. In this regard, by expanding health system coverage, alleviating poverty and social exclusion as well as promoting adequate integrated public health approaches, including through the mass administration of drugs, we will be able to reach at least 75% of the people affected by certain major neglected tropical diseases in the most affected countries in Africa, Asia, and Latin America, bearing in mind the WHO Plan. With sustained action for 3-5 years, this would enable a very significant reduction of the current burden with the elimination of some of these diseases.

(g)We support ongoing work to review travel restrictions for HIV positive people with a view to facilitating travel and we are committed to follow this issue.

Nic Dawes of the Mail and Guardian Online wants G8 leaders at their upcoming summit in Japan to make good on past promises.  He reports that, “A draft text of the G8 communiqué, leaked to the Financial Times, commits the group in broad terms to pledges on aid that were made at the 2005 summit in Gleneagles. But it makes no mention of the previously agreed 2010 deadline to increase aid to Africa by $25-billion annually. Also unmentioned is a target date for spending $60-billion to strengthen healthcare systems in the developing world which was agreed to at last year’s Heiligendamm summit in Germany.”

Although Dawes reported that, “Britain was more or less alone in wanting to stick to a firm time-frame on aid, UN officials, poverty relief activists and diplomats”  He did mention iIn addition that, “Germany, for one, is pressing for the Heiligendamm promise on health to be maintained.”

One particular G8 members has received criticism recently for promising more but ‘not enough’. AfricaFocus provided details: “At the end of May, Japan hosted the Fourth Tokyo International Conference on African Development (TICAD IV), receiving representatives from 52 African countries, including 40 heads of state or government. Government officials were consistently upbeat on the prospects both for African growth and for increased Japanese aid and investment. Civil society networks from Japan and Africa also welcomed increased Japanese involvement, but expressed disappointment at the level of commitment on AIDS funding and the dominant emphasis on private investment over direct support for development goals.”

The Associated Press notes that at least one other the G8 leader may also be aware of these discrepancies.  While there will be much on the Summit agenda about issues like global warming, “Bush himself says a priority of this year’s summit is not advancing new initiatives but making good on ones from previous summits, especially promises for health aid for countries in Africa and other underdeveloped nations. ‘We need to show the world that the G-8 can be accountable for its promises and deliver results,’ Bush said ahead of the summit. ‘America is on track to meet our commitments. And in Japan, I’ll urge other leaders to fulfill their commitments, as well.'”

Unfortunately a few US Senators have been holding US disease control aid hostage, making it difficult for the United States to speak with a united voice at the summit in Toyako, on the northern Japanese island of Hokkaido.

Summit organizers have released discussion points for ‘Development and Africa‘, which recognizes that this is the midpoint toward achieving the Millennium Development Goals. It also reviews three past Summits where these issues were discussed and proposes increases in Japanese aid.  We hope that these 8 leaders, with the support from all components of their governments back home, will make good on and even increase their commitments to health and development in Africa.

The recent African Union Summit in Egypt came to a close with Civil Society and Non-Governmental Organizations questioning whether the organization had the strength and will to tackle the really serious issues facing the continent. The Inter Press Service of Johannesburg reported that, “some civil society groups felt that the AU Summit lacked the critical analysis and genuine commitment to action needed to bring forth positive interventions in conflicts such as that in Zimbabwe or on other critical issues in Africa.” In addition, “Members of the NGO community criticised the summit for not devoting enough time to pressing issues such as the ongoing food and health crisis in Africa.”

News coverage of the Summit, especially in the North, was dominated by Zimbabwe’s plight, and doubts that the African Leaders could do much of substance to this thorn in their side. The New York Times, for example, editorialized that, “The signals from Monday’s opening session of the African Union summit, with Mr. Mugabe smugly in attendance, were not encouraging.”

The theme of this Summit was “Meeting the Millennium Development Goals (MDGs) on Water and Sanitation.” A report on the Status of Malaria in Africa was also scheduled. The report issued two years ago at AU’s AIDS, TB and Malaria special Summit noted progress in policy and planning, but deficiencies in monitoring and evaluation. Concern was expressed for greater coordination on treatment/drug policies among countries. Slow implementation of IPTp was noted. The report also highlighted difficulties in achieving ITN/LLIN coverage and its proper measurement.

Then last year the AU launched the Africa Malaria Elimination Campaign. The AU communique stated that, “Stakeholders at all levels were called upon to scale up efforts and supplement each other’s role. The AU Commission should ensure that Malaria Elimination for eventual Eradication is kept high on the agenda of the AU, RECs and international organisations.” With this developing history, we are more than curious to know the next steps against malaria outlined at the 11th AU Summit.

There are many reasons for concern about the effectiveness of international and regional bodies like the African Union. One would hope that such a body could foster healthy competition among members to work toward eliminating malaria. Also as the theme of this year’s World Malaria Day makes clear, malaria is a disease without borders, and regional cooperation is needed. If all leaders at such assemblies can do is find ways to avoid embarrassing each other, there is not much hope that they can successfully tackle a disease like malaria.