Civil Society to AU: You Can’t Develop the Dead!

Published on 1st July 2008

Open Letter to Heads of States and Governments of African Union Member States Thru His Excellency Jakaya Kikwete, Chairman of the African Union and President of the Republic of Tanzania, His Excellency Jean Ping, Chairperson of the Commission of the  African Union
Your Excellencies,

We write to express our grave concern that 7 years after the Abuja April 2001 Pledge by African Heads of Sates and Governments to allocate 15% of national budgets to health, this pledge has not been met by most member states with only a hand full  even moving towards or meeting the commitment.

Unlike other pledges which may go unmet without instant and grievous consequences  for citizens of our countries, the non implementation of the 15%  pledge is rapidly devastating our populations and countries through  the deaths of fellow African's on such a scale that annual deaths  from both disease and non disease related health issues now exceed  the combined populations of many African countries and also surpass the deaths from any combination of modern day wars and conflicts.

Africans living with TB are currently estimated to be 4.2 million with 2.8 million new cases annually making TB one of Africa’s greatest Public Health threats. African TB deaths are now running at 639,089 per annum – the highest in the world (38.6% of global deaths). TB is also the biggest killer of HIV positive people an increasing number of which are women; Africa’s pivotal countries, Nigeria, Ethiopia, Kenya, DRC, South Africa have the continents highest overall TB prevalence levels; and a person with active TB can infect 10 to 15 persons a year. Latest Stop TB partnership / World Bank analysis indicates that the cost of not treating TB to Africa between 2006 and 2015 would be $519bn while TB can be controlled with $20bn in the same period.

Latest statistics for 2007 indicate that HIV prevalence in Africa is 22.5 million of the global total of 33.2 million, with 1.7 million new infections annually; Annual AIDS related death figures for Africa are 1.6 million and Aids Orphans are estimated at 12 million; the 10 countries globally with highest HIV-TB co infection are African 9 being from SADC and the 10th Kenya.

For Malaria: Annual African deaths are estimated at 1,136,000 (89.3%) of the world total with an increasing impact on maternal, infant and child health. Malaria costs Africa more than $12bn in lost GDP annually although it can be controlled for a fraction of this sum.

Latest comparable global maternal death statistics indicate that of the 536,000 women that died in 2005 of childbirth related complications; about half or 261,000 were African women. The 2005 figures also indicate that Africa is the only region where maternal deaths have increased since 1990 up from 205,000.  Maternal deaths which is almost 100% preventable dropped in every other continent over the same period.

For Child Mortality:  Most worryingly for the future of Africa, an estimated 4.8 million children under the age of 5 years die annually.  Just five diseases - pneumonia, diarrhoea, malaria, measles and AIDS - account for half of these deaths. Often ignored environmental health issues, or neglected diseases such  as river blindness or Onchocerciasis and Human African  Trypanosomiasis or sleeping sickness together affect around 60m  people in 36 African countries - and in turn facilitate vulnerability 
to HIV, TB, malaria, maternal and child mortality.

This loss of over 8 million lives a year to preventable, treatable and manageable diseases and health conditions – is unacceptable and unsustainable. It also constitutes an infringement on the right to health of African citizens as guaranteed in Article 16 of the African Charter on Human and Peoples Rights, Article 12 of the International Convention on Economic Social and Cultural Rights, The World Health  Organisation constitution, and other instruments.

We Fully Acknowledge the efforts of African governments to address Africa’s enormous Public Health crisis through: the AU Abuja April 2001 declaration incorporating the pledge by member states to allocate at least 15% of the national budgets to health; the 2007 African Union Health Strategy and other African health frameworks such as the Maputo Plan on Reproductive and Sexual Health, the AU plan on HIV, TB and Malaria, the African Pharmaceutical Plan and the health based MDGs.

However current evidence indicates gravely that it is not just enough to make declarations. The landmark AU African Health Strategy and  other Health Frameworks recently finalised by the African Union  Commission must also be sustainably financed by our own governments if they are not to become yet another collection of reference papers on Africa's failed attempts to resolve its most serious development  challenges.

Africa’s human capital is its greatest asset and that there can be no competing priorities more important than the lives of citizens – as other issues are meaningless if the people they are meant for are dead. Indeed no efforts at sustainable social and economic development can be successful when the average healthy life expectancy of African countries has now fallen to less than 40 years.

We therefore urge Excellencies to:

1.     Restate their commitment to the Abuja 15% pledge and increasing overall per capita expenditure on health at the next AU Summit and to accelerate its implementation.

2.    Take urgent steps to ensure that African Ministers of Finance, Planning and Economic Development begin immediately to work with Health Ministers through a joint meeting to develop the details for the implementation of the Africa Union Health Strategy and other Health Frame works.

3. Facilitate the African Union and UN-Economic Commission for Africa to implement the recommendations for the joint meeting of Finance and Health Ministers as adopted by the conference of African Ministers of Finance, Planning and Economic Development organised by both AU and ECA in April 2008.

4. Recognise that just as the global community urges the more industrialised countries to meet their own commitments to global health, that African governments are also expected to honour national commitments.

5. Ensure that regions, states, provinces and local governments within countries recognise that they have a responsibility to provide needs based primary health care services and as such must along with national governments allocate commensurate amounts of financing for health.

6. Work urgently with national, sub regional and continental parliaments to ensure implementation of the AU Abuja 15% commitment, combined with commensurate overall increase of per capita expenditure on health and implementation of the Africa Union Health Strategy and other African Health Frameworks.

7.  Recognise the crucial role of health workers and professionals in delivering health care, and ensure strengthening of health systems to guarantee retention of health professionals and sustainable quality health care.

8. Through the African Union and UN-ECA work with civil society to ensure that a progress report on implementation of the 15% pledge is on the agenda of the January 2009 African Union Summit


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