Tala's blog

African Health Activists React to Conclusion of AU Heads of State Summit:
Declarations Don’t Save Lives, Show us the Money for Health!
At the close of the African Union (AU) Heads of State Summit, health experts and activists from across Africa expressed grave concern that leaders are not delivering on fundamental commitments to expand investments in maternal and child health and other life saving health services, including treatment and prevention for HIV, tuberculosis and malaria. The Summit convened for the first time under the theme “Maternal, Infant and Child Health and Development in Africa” but security and terrorism dominated many heads of states’ formal remarks. “Without access to essential health services, like access to HIV treatment and prevention and access to quality antenatal care, we cannot have security if people are dying from preventable diseases and conditions,” said Angela Asio of Uganda Network on Law, Ethics and HIV/AIDS (UGANET). “Uganda lost almost 80 people in a tragic and senseless bomb attack two weeks ago—in the same way, we are experiencing the equivalent of countless bomb blasts every day in the form of needless deaths of mothers and children across Africa. This is unacceptable.”

Governments around the world are reneging on their commitments toward Universal Access to HIV care, treatment and prevention. The decision by the U.S. government to downgrade the effort on HIV/AIDS is now well-known and documented. European governments are also pulling back in their support for AIDS care, treatment and prevention. Governments in Africa, Asia, and Eastern Europe, have failed to live up to their commitment to fund AIDS treatment and other health needs. Already, access to HIV treatment is being cut back. Waiting lists are growing. Drug stock outs are increasing at an alarming rate all over the world. Instead of meeting Universal Access and MDG targets, governments around the world are retreating from their commitments.
There are many important discussions that will take place during the International AIDS Conference from July 18 – 23rd in Vienna. However, in order for any of those discussions to have any relevance, ALL conferees must first address the growing crisis in funding for AIDS care and prevention. All conferees must now become AIDS activists!

Shocking results from a study involving post-mortem examinations at a hospital in KwaZulu-Natal Province have revealed the extent to which tuberculosis (TB) is taking a toll on the lives of young, HIV-positive South Africans. The study, published in the 22 June issue of the PLoS Medicine journal, found that out of 240 inpatients aged between 20 and 45 - who died after being admitted to Edendale Hospital between October 2008 and August 2009 - 94 percent were HIV-positive and half had TB. South Africa is battling devastating dual epidemics of HIV and TB, with 80 percent of TB cases occurring in people who are also HIV-infected. While TB is known to be the country's leading cause of death, the difficulty of diagnosing the disease in HIV-positive people makes it hard to determine the true number of TB-related deaths.

The central role of communities in the response to tuberculosis has long been recognised by policy makers1 and patients2 as an ethical and pragmatic imperative for successful programmes. In many countries, especially where tuberculosis is fuelled by HIV, government health-care providers have been outstripped of their ability to cope with the levels of service delivery needed to meet targets.3 Therefore advance on the implementation of tuberculosis programmes needs broader community engagement.
Experience has shown the immense added value of such engagement. For example, in Lesotho, lay health workers who give home-based services to patients are a cornerstone of the country's drug-resistant tuberculosis programme.4 Community engagement not only increases the strength and scope of implementation efforts, but also plays an important part in the development of policies and programmes,5 because a truly patient-centred approach to tuberculosis6 needs to be shaped by the patient.
However, the prevailing dearth of information about community participation in national tuberculosis programmes7 suggests that the patient-centred approach, although embraced in rhetoric, has been neglected in practice. Health-care workers continue to be the main providers of directly-recorded treatment, as is the case in 86% of countries reporting to WHO,7 despite the barriers to access and adherence that clinic-centred models of care can create. In many countries, patients' behaviours are subjected to punitive regulation under environmental and public health laws, which endorse measures such as immigration restrictions and mandatory detention in the response to tuberculosis.
These examples are far from being patient-centred and from promoting community participation, despite the indisputable and substantial benefit that this participation would bring to tuberculosis programmes. Instead, they point to the persistence of the historically coercive model of tuberculosis control,8 a model that inherently disenfranchises patients and can lead to violation of rights, alienation of patients, and reinforcement of stigma, thus undermining the improved outcomes that the model ostensibly aims to achieve.

There are about 40 agenda items at the World Health Assembly. Most of them are really important to some element of the world's population, many will have a decisive role in how people get treated, and if they will get the care they need. I had never known before how exclusive this High Level Meeting was. When I see the posts below from Health Action International and Public Citizen about being denied the right to hold their satellite meetings, I'm glad that civil society responds with the World Open Health Assembly. I'll be online for the opening. Wouldn't miss this new way of making meetings accessible for anything. C u there, Tala Bintu.

Funding shortages for MDR-TB, donors asked to fulfill their commitments.
Despite increases in funding for some U.S. global health programmes, the world faces a “huge gap” for HIV, TB and malaria funding, especially with regards to MDR-TB, with some countries pegged to lose much of their international financial support in the coming months. Dr. Amy Bloom of USAID said, “this is a very exciting time for those of us in the U.S. government. Over the last few years we’ve seen an increase in our funding, especially for PEPFAR, our malaria fund and TB funding, but now we’ve entered a phase where we’ve reached a much more holistic approach as well.”

The UN committee on economic social cultural rights appears to have no experience, much less any expertise, on issues relating to the right to health, according to my study of all 18 members CVs which are online. Over the last few decades, health activists have made a major impact on turning the right to health into treatment and care for millions in need, and improved the way governments have responded to both pandemics and neglected diseases. Health activists must be involved in UN Rights Committee, and have the possibility of representation through NGO seats on this mechanism. We must advocate strongly for our place at the table.

The multiple blogs below that speak up about Big Pharma having influence inside WHO raise the ethical question that I saw on the survey on Taking the Pulse :
- Do you think all direct / indirect engagement with pharmaceutical companies should be declared openly and publicly?: Yes No Unsure. I clicked YES. Without a doubt.

FYI: Website: http://heapol.oxfordjournals.org/cgi/content/full/24/6/407

“……Global health funding has increased in recent years. This has been accompanied by a proliferation in the number of global health actors and initiatives. This paper describes the state of global heath finance, taking into account government and private sources of finance, and raises and discusses a number of policy issues related to global health governance.

Among the findings are that the volume of official development assistance for health is frequently inflated; and that data on private sources of global health finance are inadequate but indicate a large and important role of private actors. The fragmented, complicated, messy and inadequately tracked state of global health finance requires immediate attention. In particular it is necessary to track and monitor global health finance that is channelled by and through private sources, and to critically examine who benefits from the rise in global health spending…..”