Abuja+12 and the health development declaration

In April 2001 the leaders of African Union Member States assembled in Abuja, Nigeria and adopted the Abuja Declarations and Frameworks for Action on Roll Back Malaria, and on HIV and AIDS, tuberculosis and other related infectious diseases.The primary objective of the Abuja Declarations and Frameworks was for Africa to collectively and individually work towards arresting and reversing the burden of the infectious diseases mentioned above. African Union heads of states also pledged to allocate at least 15% of their annual budget to improve the health sector.It is important for us to look back so that the citizens of Africa could ask their leaders specific questions on the level of progress in addressing these health issues.Also in May 2006, the African Union at a special summit on HIV and AIDS , Tuberculosis and Malaria themed ‘Universal Access to HIV/AIDS, Tuberculosis andMalaria Services by A United Africa by 2010’ observed that“We the Heads of State and Government of the African Union, meeting in Abuja, Nigeria, from 2-4 May 2006 to review the progress made in implementing the Abuja Declaration and Plan of Action on Roll Back Malaria (RBM) of 2000, and the Abuja Declaration and Plan of Action on HIV and AIDS, Tuberculosis and Other Infectious Diseases (ORID) of 2001; focused our deliberations on the Theme: “Universal Access to HIV and AIDS, Tuberculosis and Malaria Services by a United Africa by 2010”. We recall that the twelve priorities for our Abuja Plan of Action on HIV and AIDS, Tuberculosis and Other Related Infectious Diseases included Leadership at National, Regional and Continental Levels to mobilize the society as a whole; Resource Mobilization; Protection for Human Rights, Poverty, Health and Development; Strengthening Health Systems; Prevention of Primary and Secondary Infections; Improvement of Information, Education and Communication; Access to Treatment, Care and Support; Access to Affordable Drugs and Technologies; Research and Development on HIV and AIDS, Tuberculosis and ORID; Partnership; and Monitoring and Evaluation.Marked progress has been also observed in the proportion of national budgets allocated to health as 33% of countries have allocated at least 10% of their national budget to health while one country has attained the target of 15%. Heads of State have engaged with the G8 countries for additional resources and debt relief.” Some challenges observed in that meeting were;

• The health crisis reflected in terms of weak health systems, infrastructures inadequate laboratory network for diagnosis of diseases, human resources in terms of numbers, mix of skills, motivation, and retention which have become major barrier to the implementation of disease control programmes in general and HIV and AIDS, TB and Malaria programmes in particular.

• Inadequate access to essential medicines, preventative commodities and technologies across much of the continent; inadequate global supply of long lasting Insecticide Treated Nets (ITNs) and Artemisinin-based Combination Therapy (ACTs) and indoor residual spraying (IRS) with effective insecticides;

• Lack of adequate policies and legislation protecting the human rights of PLWHA and TB by most countries;

• Failure to take into account the link between HIV and AIDS and sexual and reproductive health;

• Stigma, discrimination and gender inequity, which result in inadequate application of the human rights of people infected or affected by HIV and AIDS and directly hampers their ability to access services;

• Poor or inadequate coordination of regional and national and international partnerships;

• Weak monitoring and evaluation (M&E) systems and cumbersome M&E framework for the Abuja Declaration on HIV and AIDS and TB and ORID;

• Conflicts that result in mass displacement, violence, loss of livelihood and property as well as major breakdowns in essential services.

• Other cross-cutting issues such as ensuring good nutrition and food security, and internal and inter-country migration for reasons other than conflicts;

• Policy planning and programming for addressing health in national development frameworks by most countries which is reflected by inadequate health system development, low coverage and access to services for the three diseases;

• An increasing burden of disease and other development challenges.

We need to ask the question “to what extend were the challenges identified in 2006 addressed in Africa?”In a report by World Health Organisation (WHO) in 2010 titled ‘The Abuja Declaration : 10 years on’, it was observed that only three countries are on track with respect to the health MDGs whereas 27 countries have no or insufficient progress.Twenty six countries have increased the proportion of total government expenditures allocated to health since 2001. However, only Tanzania has achieved the Abuja Declaration target of “at least 15%”.Meanwhile, eleven countries reduced their relative contributions of government expenditures to health during the period. In the other nine countries, there is no obvious trend upwards or downwards. The median level of real per capital government spending from domestic resources on health has increased from US$ 9.4 to US$ 13.4 over the decade.Now that on July 15th , another meeting is holding tagged Abuja + 12 , it is important to look back and answer the questions of how far we have gone and what could be done to accelerate progress in addressing HIV, Tuberculosis,  Malaria and health in general.Written by Dr Aminu Magashi, Evidence Advisor and Regional Coordinator (North), Evidence for Action Nigeria