Momentum for Universal Health Coverage (UHC) in Africa is building and many African countries have already integrated UHC into their national health strategies. But with 11 million Africans pushed into extreme poverty each year because of out-of-pocket health expenses, how can Africa achieve UHC which delivers a quality package of care for people living in Africa?

The UHC debate was buzzing in Rwanda’s capital Kigali this week during one of the largest health gatherings in Africa, the Africa Health Agenda International conference 2019.  Co-hosted by the Ministry of Health of Rwanda and the African Medical and Research Foundation (Amref Health Africa), 1500 health leaders shared new ideas and home-grown solutions to the continent’s most pressing health challenges.

Participants discussed the need for countries to embrace the concept of UHC and do their utmost to make it work. They stressed that good health allows children to learn and adults to contribute to societies and the economy. They also underscored that it can allow people to emerge from poverty and provides the basis for long-term economic security, essential for the future of the continent.

Host country President, Paul Kagame was awarded the honour of excellence in recognition of his political leadership on UHC. In a tweet he thanked Amref saying, “We owe this progress to partners like you who have joined forces with us in our journey to deliver a dignified and healthy life for all Rwandans.” The Minister of Health of Ethiopia also received an award for Ethiopia’s work in promoting primary health care.

Ensuring that everyone has access to basic health services is a challenge and the key to the success of UHC will be ensuring that the quality of services is good enough to improve the health of the people who access them.

“We need to track the impact of UHC,” said Michel Sidibé, co-moderating a high-level ministerial panel. “Coverage is not enough, we need to be delivering quality, affordable, accessible services to all. The ultimate measure of success for UHC will be whether the poorest, the marginalized and the most vulnerable people are able to benefit.”

During the conference Mr Sidibé participated in a townhall with young people. He spoke to them about their meaningful engagement in the UHC process saying that young people need to ‘claim and own the space.’ He also talked to civil society groups about the remarkable progress towards achieving the UNAIDS 90-90-90 treatment targets across Africa and of the critical need of their continued engagement on HIV within UHC.

The first ever United Nations High-Level Meeting on Universal Health Coverage will take place on 23 September 2019 during the United Nations General Assembly under the theme ‘Universal Health Coverage: Moving Together to Build a Healthier World.’

Health is everyone’s concern. The world has been striving for access to quality and affordable health services since the Declaration of Alma-Ata, which called for health for all more than 40 years ago.

We have come a long way since then—improvements in access to, and the quality of, health-care services have increased life expectancy globally from 62 to 72 years. Yet progress is far from equal. Today, more than half of the world’s population do not have full access to essential health services, because they are unaffordable, inadequate, inaccessible for certain groups or simply unavailable.

There is increasing inequity around the world, with the richest 1% of the population now owning half of the world’s wealth. Life expectancy in the poorest countries of the world is appreciably lower than in the wealthiest, and living in areas blighted by poverty can mean a shorter life span and a lost future. The disparity is observed between countries and between different communities within countries, with the most vulnerable, marginalized and stigmatized being left behind.

Making progress towards universal health coverage that is truly universal means making progress towards equity, inclusion and social justice. It means a people-centred, human rights-based approach and community-led service delivery, as well as a recognition of the need to address the social determinants of health, including necessary reforms of laws and policies and removing stigma and discrimination and gender inequity.

The global response to HIV has illustrated the critical measures—decisive political leadership and commitment, community engagement and a response informed by scientific evidence—that can change the course of a global epidemic.

Reaching time-bound HIV prevention and treatment targets will make an important contribution to achieving the universal health coverage targets, and together will significantly accelerate progress towards realizing the Sustainable Development Goals.

In recognition of the theme of this year’s Universal Health Coverage Day, “Unite for universal health coverage: now is the time for collective action”, I call on everyone to embrace and contribute to the universal health coverage movement. United, we can make universal health coverage a reality for all.

12 December 2018
Michel Sidibé
Executive Director of UNAIDS

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

In order to highlight the need for sustainable and affordable access to quality medicines, the Executive Director of UNAIDS, Michel Sidibé, spoke about the necessity of implementing the African Union Pharmaceutical Manufacturing Plan. Speaking at the opening ceremony of Africa Industrialization Week 2018 in Addis Ababa, Ethiopia, he called for close cooperation with regional economic communities in order to build production cooperation hubs and lead pharmaceutical regulatory harmonization in Africa.

Commitments on gender-based violence and the rights of women made at an event held on the margins of the United Nations General Assembly in September entitled Eliminating Sexual and Gender-Based Violence and Protecting the Health and Rights of Women and Children in Humanitarian Settings were discussed during meetings Mr Sidibé held with Smail Chergui, the Africa Union Commissioner for Peace and Security, and the African Union Special Envoy on Women, Peace and Security, Bineta Diop.

During the meetings, discussions were held on how to increase efforts in responding to HIV in conflict and humanitarian settings and the need to increase awareness on HIV testing and on sexual and gender-based violence. Mr Sidibé and Mr Chergui agreed to conduct a high-level joint mission to South Sudan to highlight the needs of people facing a higher risk of HIV in the country owing to gender-based violence and the protracted conflict.

Also during his visit to Ethiopia, which took place from 17 to 20 November, Mr Sidibe’s met with Ethiopia’s Prime Minister, Abiy Ahmed, who said, “I am committed to change the narrative of Africa and Ethiopia through ongoing reforms and agree to strengthen efforts on people-centred health development for Ethiopia.”

“Thank you for agreeing to champion ending AIDS in Ethiopia and across the continent,” said Mr Sidibé.

The President of Ethiopia’s agenda on gender and peace and the rehabilitation of street children was the topic of conversation in a meeting between the President, Sahle-Work Zewde, and Mr Sidibé.

During a discussion Mr Sidibé had with the Minister of Health of Ethiopia, Amir Aman, a collaborative project was developed that will be centred around strengthening resource mobilization, enhancing and sustaining a multisectoral response across all sectors, engaging young people and enhancing HIV programmes following the location–population approach.

BERLIN, GERMANY, 16 October 2018—Eleven heads of the world’s leading health and development organizations today signed a landmark commitment to find new ways of working together to accelerate progress towards achieving the United Nations’ Sustainable Development Goals.

Coordinated by the World Health Organization, the initiative unites the work of 11 organizations, with others set to join in the next phase.

The commitment follows a request from Chancellor Angela Merkel of Germany, President Nana Addo Dankwa Akufo-Addo of Ghana, and Prime Minister Erna Solberg of Norway, with support from United Nations Secretary-General Antonio Guterres, to develop a global plan of action to define how global actors can better collaborate to accelerate progress towards the health-related targets of the 2030 Sustainable Development Agenda.

“Healthy people are essential for sustainable development – to ending poverty, promoting peaceful and inclusive societies and protecting the environment. However, despite great strides made against many of the leading causes of death and disease, we must redouble our efforts or we will not reach several of the health-related targets,” the organizations announced today at the World Health Summit in Berlin. “The Global Action Plan for Healthy Lives and Well-being for All represents an historic commitment to new ways of working together to accelerate progress towards meeting the 2030 goals. We are committed to redefine how our organizations work together to deliver more effective and efficient support to countries and to achieve better health and well-being for all people.”

The group has agreed to develop new ways of working together to maximize resources and measure progress in a more transparent and engaging way. The first phase of the plan’s development is organized under three strategic approaches: align, accelerate and account.

• Align: The organizations have committed to coordinate programmatic, financing and operational processes to increase collective efficiency and impact on a number of shared priorities such as gender equality and reproductive, maternal, newborn, child and adolescent health.
• Accelerate: They have agreed to develop common approaches and coordinate action in areas of work that have the potential to increase the pace of progress in global health. The initial set of seven “accelerators” include community and civil society engagement, research and development, data and sustainable financing.
• Account: To improve transparency and accountability to countries and development partners, the health organizations are breaking new ground by setting common milestones for nearly 50 health-related targets across 14 Sustainable Development Goals. These milestones will provide a critical checkpoint and common reference to determine where the world stands in 2023 and whether it is on track to reach the 2030 goals.

The Global Action Plan will also enhance collective action and leverage funds to address gender inequalities that act as barriers to accessing health, and to improve comprehensive quality health care for women and girls, including sexual and reproductive health services. 

The organizations that have already signed up to the Global Action Plan for Healthy Lives and Well-being for All are: Gavi the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Financing Facility, UNAIDS, UNDP, UNFPA, UNICEF, Unitaid, UN Women, the World Bank and WHO. The World Food Programme has committed to join the plan in the coming months.

The final plan will be delivered in September 2019 at the United Nations General Assembly.

For more information, www.who.int/sdg/global-action-plan

Media enquiries

• Gavi, the Vaccine Alliance: Frédérique Tissandier; +41 79 300 8253; ftissandier@gavi.org
• Global Financing Facility: Melanie Mayhew; +1 202-459-7115; mmayhew1@worldbankgroup.org
• Global Fund: Ibon Villelabeitia; +41 79 292 5426; ibon.Villelabeitia@theglobalfund.org
• UNAIDS: Sophie Barton-Knott; +41 79 514 6896; bartonknotts@unaids.org
• UNDP: Adam Cathro; +19179159725; adam.cathro@undp.org
• UNFPA: Omar Gharzeddine; +1 212 297 5028; gharzeddine@unfpa.org
• UNICEF: Sabrina Sidhu; +1 917 476 1537; ssidhu@unicef.org
• Unitaid: Andrew Hurst, +41795616807; hursta@unitaid.who.int
• UN Women: Maria Sanchez Aponte; +16467814507; maria.sanchez@unwomen.org
• World Bank Group: Maya Brahmam; +1 202 361 2594; mbrahmam@worldbankgroup.org
• WHO: Christian Lindmeier; +4179 500 6552; lindmeierch@who.int

Noncommunicable diseases (NCDs) are by far the biggest killers of people worldwide, responsible for 71% of all deaths globally. Defined by the World Health Organization as diseases of long duration and generally slow progression, the four main types of NCDs, which account for 80% of all NDC premature deaths, are cardiovascular diseases, cancer, chronic respiratory diseases and diabetes.

People of all ages can be affected by NCDs, but they tend to affect older people. With increasing numbers of people living with HIV accessing treatment and hence living longer, people living with HIV are increasingly falling ill with NCDs. Being HIV-positive, however, also increases the risk of developing NCDs, either because of the infection itself or owing to side-effects of the medicines used to treat HIV. The care that people living with HIV receive therefore increasingly needs to include care for NCDs.

Since people in many low- and middle-income countries are smoking more, drinking alcohol more and becoming less active, and their diets are changing, rates of NCDs are increasing. Age-adjusted death rates from NCDs are nearly twice as high in low- and middle-income countries as in high-income countries.

However, the successes to date in the AIDS response show what can be done if countries take decisive action. It is becoming increasingly clear that if the world is to control NCDs, the lessons of the AIDS response need to be learned and applied to the response to NCDs.

Health-care systems in regions that are home to most people living with HIV were designed to primarily address acute, rather than chronic, illnesses. However, HIV programmes in those same countries can be good models for how to step up services for NCDs, showing how to provide continuity of care, support adherence to treatment and engage communities.

The AIDS response has had a huge impact on global health. The impact of early diagnosis and treatment, HIV services being in many countries the entry point for broader health services, the importance of tackling poverty and other social determinants of health, raising community awareness and creating demand for services, the importance of putting civil society and communities in the centre, with their engagement, activism, advocacy and mobilization—these are all key lessons from the AIDS response that can guide the response to NCDs.

“The response to HIV has shown that the impossible is possible,” said Michel Sidibé, the Executive Director of UNAIDS. “UNAIDS will work with our partners in the United Nations system to share best practices from the AIDS response to guide countries, communities and other partners.”

As part of the world’s effort to combat NCDs, on 27 September countries will come together in New York, United States of America, at the United Nations for the Third High-Level Meeting on the Prevention and Control of Noncommunicable Diseases. UNAIDS is a part of the United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases and will be sharing its knowledge at the high-level meeting.

Health situation rooms—software platforms designed to support decision-making on countries’ health responses—are opening up across Africa, bridging data and decision-making in order to improve the health and lives of tens of millions of the world’s most vulnerable people.

Data integration, data warehousing and data visualization are the core of the situation room concept, providing transparent and improved information on a range of diseases. While situation rooms are virtual working space, some countries also use physical rooms in which the analytics can be discussed and acted upon.

The idea of a health situation room is that data—whether on the availability of HIV medicines, the effects of a strike by health-care workers or diagnoses of cervical cancer—are centralized, yet accessible to everyone. Whereas in the past health data on different diseases would be spread around several databases in assorted government ministries, disease-specific organizations, etc., situation rooms collect the data in one place, on one system, in a form that is easily shared. The information held by the situation room can be utilized on tablets or computers throughout the country.

“We must continue to innovate in our response to HIV,” said Michel Sidibé, the UNAIDS Executive Director. “Having reliable and up-to-date information is vital if the world is to meet its commitment to end AIDS and reach the Sustainable Development Goals.”

By pooling the health data in the virtual situation room, better and more focused health services can be made available to the people who need them. For example, having data on specific parts of a city helps to drive a location–population approach to HIV prevention services, ensuring that the right people are reached in the right place with the right services.

Through combining data on, for example, HIV, tuberculosis and cervical cancer, interlinkages between the diseases can be seen and responded to. Data can be viewed in real time, so, for example, levels of HIV medicines can be monitored in order to anticipate and respond to medicine stock-outs. Studying the effects of HIV test and treat campaigns in Uganda, the effectiveness of cervical cancer screening in Côte d’Ivoire and malaria testing and new diagnoses in Zambia are other examples how health situation rooms are benefiting health responses.

Five countries—Côte d’Ivoire, Kenya, Lesotho, Zambia and Uganda—have launched situation rooms. Data on indicators, including on HIV, tuberculosis, malaria, noncommunicable diseases and reproductive, maternal, newborn and child health are gathered, with different countries collecting different information depending on the local situation. Namibia, Mozambique and Zimbabwe are preparing to launch situation rooms, and several other countries are in the planning stage.

As part of its work, UNAIDS has been helping countries to set up their situation rooms, with UNAIDS working with countries to select the specific indicators and connecting data in the country to their situation room. Countries with existing data collection systems, that collect data separated by age and sex and at the local level, that have good Internet connectivity and that have qualified local staff are best placed to establish their own situation rooms.

The situation room programme has resulted in UNAIDS’ support to countries being enhanced, with UNAIDS able to support health information systems in a way unique in the United Nations system. UNAIDS is therefore supporting country and programmatic monitoring in a more meaningful way in those countries that have invested in situation rooms.

“For us, its strength is in bringing multiple data sets together, and sharing powerful analytics in a visual and understandable way,” said Andrew Kashoka, Deputy Director of Information Technology, Zambia Ministry of Health.

For the future, UNAIDS plans to ensure that countries have technical support so that they can continue to operate their situation rooms without support from UNAIDS. UNAIDS will also work with partners, including the Africa Centres for Disease Control and Prevention, the private sector and others, to reduce the dependency of countries on UNAIDS’ support in setting up and running the platforms.

Such investments in technology and collaboration between UNAIDS, governments and partners are driving innovative approaches to responding to AIDS and to ultimately ending the AIDS epidemic as a public health threat by 2030.

The UNAIDS Executive Director, Michel Sidibé, has completed a five-day visit to three countries in southern Africa. The mission included high-level political discussions, the launch of the Lesotho HIV health and situation room and a frank and open dialogue with women activists about how to address sexual harassment and abuse.

Beginning in Lesotho, Mr Sidibé attended the launch of the HIV health and situation room with the Deputy Prime Minister, Monyane Moleleki. Special guest Naomi Campbell was invited by UNAIDS to join the two-day country visit to learn more about the HIV response.

The Lesotho HIV and health situation room shows real-time service delivery data, producing a comprehensive picture and understanding of Lesotho’s HIV epidemic. It enables quick feedback on results at the national and community levels and identifies bottlenecks in access to health-care services.

“The launch of the Lesotho HIV and health situation room gives us access to data to shape impactful and efficient health programmes. These are the kind of innovations that will bring services to those who need them most and ensure that no one is left behind by the AIDS response,” said Michel Sidibé, the UNAIDS Executive Director.

On the eve of the launch, Mr Sidibé and Ms Campbell visited the Queen II Hospital in Maseru, Lesotho, and met with young women living with HIV and others affected by the epidemic.

“I commend the Government of Lesotho and its partners for the progress made in the AIDS response. But the work is far from done. The reality is that we are not reaching adolescent girls and young women. I leave Lesotho today empowered, inspired, encouraged and determined to do all I can to highlight this critical issue,” said Ms Campbell.

In South Africa, Mr Sidibé addressed the Pan African Parliament and underlined the importance of integrated health approaches that were people-centred. He urged parliamentarians to commit more domestic funding for health services to increase the sustainability of the AIDS response and to put in place more preventative measures to improve people’s health. In addition, he called for laws to protect women and vulnerable groups. 

Mr Sidibé left the parliamentary session to meet civil society activists concerned by UNAIDS' response to allegations of sexual harassment and abuse in the organization.

At a follow-up meeting the next day, Mr Sidibé and women activists met to discuss their concerns.

Mr Sidibé agreed with activists to issue a statement following the meeting. The statement begins:

‘During my recent visit to South Africa, I listened carefully to you, I heard you. The HIV epidemic is inextricably linked to sexual and gender-based violence and the two can never be separated. We need the passion of advocates to move issues forward.`

During his visit to South Africa, Mr Sidibé held separate meetings with the President, Cyril Ramaphosa, the Deputy President and South African National AIDS Council Chair, David Mabuza, and the Minister of Health, Aaron Motsoaledi. They discussed plans to increase the number of people on treatment by 2 million by 2020 and the need to empower local and provincial authorities to bring treatment and prevention services closer to vulnerable communities.

The last leg of Mr Sidibé’s visit saw him arrive in Lusaka, Zambia, to confer the 2018 UNAIDS Leadership Award upon Kenneth Kaunda for his efforts in strengthening the AIDS response.  

People living with HIV and other chronic illnesses are getting faster, simpler access to essential medicines thanks to new medicine dispensing machines being piloted in Johannesburg, South Africa.

The non-profit organization Right to Care is testing three pharmacy dispensing units at a shopping mall and two hospitals. Most of the people using the new machines are accessing repeat prescriptions for HIV medicines.

The machines connect users to pharmacy assistants by video for remote consultations in any of the 11 official languages of South Africa. The entire process, from consultation to the release of the medicines from the machine, takes only a few minutes.  

The machines are integrated with public health facilities responsible for patients with chronic conditions, in order to ensure that patients receive and adhere to effective treatments. The users of the machines get a printed receipt with the date of their next visit and receive a reminder by SMS. The system alerts pharmacists if patients are late to collect their medicines.

The device could be a game-changer for expanding access to HIV treatment. The South Africa UNAIDS Country Director, Mbulawa Mugabe, said, “One of our biggest challenges today in most countries in Africa is that health facilities are packed. We need to find ways in which we can relieve the congestion in the interest of patients themselves and also for the health systems.”

People living with HIV can often wait several hours to have their prescription filled at a local clinic. The process also takes up valuable time for skilled pharmacists. Now those tasks are being handled by junior pharmacists, who work with a robotic system to dispense pills in a matter of minutes.

The pharmacy dispensing units were engineered by Right to Care’s subsidiary Right e-Pharmacy in collaboration with the German company Mach4 and supported by German and American development agencies GIZ and USAID. The current trials are being conducted in collaboration with the Gauteng Department of Health and Right to Care hopes to expand the trial to two other African countries in the near future.

South Africa has the highest rate of HIV prevalence in the world and provides free treatment to 4.2 million people. The President of South Africa, Cyril Ramaphosa, recently set a target of expanding HIV treatment to an additional 2 million people by 2020. With millions of South Africans accessing medicines from clinics and hospitals, innovations such as these dispensing machines promise to help South Africa achieve its ambitious targets.

South Africa tests potential game-changer in HIV treatment

Zaheer Cassim reports for VOA from Alexandra township in Johannesburg.

Stigma and discrimination and other human rights violations occur in health-care settings worldwide, barring people from accessing health services or enjoying quality health care. Such stigma and discrimination further increases the vulnerability of people living with and affected by HIV.

To discuss this problem, nearly 300 Egyptian medical students, representing 18 universities across Egypt, met with representatives of academia, civil society, the government and the Egyptian Medical Syndicate. With support from UNAIDS, the Egyptian branch of the International Federation of Medical Students’ Associations held a one-day consultation on HIV-related stigma and discrimination in health-care settings on 21 April in Cairo, Egypt.

“People living with HIV should have equal rights and opportunities. Denial of access to health-care services is unacceptable. Through this consultation, we aim to inform our national strategy with new interventions for addressing stigma and discrimination,” said Walid Kamal, the National AIDS Programme Manager for Egypt.

During the consultation, the participants took stock of the progress made in addressing stigma and discrimination and decided to hold an ongoing dialogue to identify actions to address stigma and discrimination in health-care settings.

“We are witnessing an unprecedented opportunity for addressing discrimination in health-care settings with political support and programmatic vision. While resources are scarce, we count on the support of medical students as leaders of tomorrow and the power of volunteerism to address this issue,” said Ahmed Khamis, the UNAIDS Country Manager for Egypt.

The participants agreed that accountability mechanisms need to be in place to monitor and evaluate interventions, ensuring that proper actions are taken by the relevant authorities to address rights violations in health-care settings.

“Medical ethics is a must among health-care providers. The Egyptian Medical Syndicate is organizing workshops and conferences to enforce ethics among health-care providers. I would like to remind you all of the rights of patients,” said Sherine Ghaleb, representative of the Egyptian Medical Syndicate.

The participants agreed to prioritize launching the Ministry of Health and Population’s stigma-free policy and integrating HIV-related stigma and discrimination in the module on ethics taught to all doctors who graduate in Egypt. They also agreed to give access to the accountability and investigation mechanism of the Egyptian Medical Syndicate to civil society organizations and people living with HIV in order to report violations and to roll out information on post-exposure prophylaxis in the curricula of medical schools.

The recommendations made during the consultation were endorsed by the National AIDS Programme and will be included in Egypt’s road map for addressing HIV stigma and discrimination in health-care settings. Progress of the road map will be monitored by a group that includes a strong representation from people living with HIV.