African
heads of state have endorsed two major new initiatives to help end AIDS by
2030. The community health workers initiative aims to recruit, train and deploy
2 million community health workers across Africa by 2020.
The
western and central Africa catch-up plan aims to rapidly accelerate access to
HIV treatment in the region and close the gap in access between African
regions.
The
initiatives were endorsed at the AIDS Watch Africa Heads of State and
Government Meeting, held on 3 July during the 29th African Union Summit in
Addis Ababa, Ethiopia.
Western
and central Africa catch-up plan
Under
the leadership of countries and regional economic communities, and in
collaboration with UNAIDS, the World Health Organization, Doctors Without
Borders and other partners, the catch-up plan in western and central Africa,
which started implementation in late 2016, seeks to dramatically accelerate the
scale-up of HIV testing, prevention and treatment programmes, with the goal of
putting the region on the Fast-Track to meet the 90–90–90 targets by December
2020.
While
the world witnesses significant progress in responding to HIV, with 57% of all
people living with HIV knowing their HIV status, 46% of all people living with
HIV accessing treatment and 38% of all people living with HIV virally
suppressed in 2015, the western and central Africa region lags behind,
achieving only 36%, 28% and 12%, respectively, in 2015.
The
gap is considerable: 4.7 million people living with HIV are not receiving
treatment, and 330 000 adults and children died from AIDS-related illnesses in
2015.
“We
cannot accept a two-speed approach to ending AIDS in Africa,” said UNAIDS
Executive Director Michel Sidibé.
“To
put western and central Africa on track to end AIDS, we must address stigma,
discrimination and other challenges to an effective response, allocate funding
to support the most effective strategies and implement delivery strategies that
reach the communities most in need.”
The
catch-up plan will aim to increase the number of people on treatment from 1.8
million to 2.9 million by mid-2018, giving an additional 1.2 million people,
including 120 000 children, access to urgently needed treatment.
The
first call for a catch-up plan for the region was made at the United Nations
General Assembly High-Level Meeting on Ending AIDS in June 2016.
Since
then, at least 10 countries (Benin, Cameroon, the Central African Republic,
Côte d’Ivoire, the Democratic Republic of the Congo, Guinea, Liberia, Nigeria,
Senegal and Sierra Leone) have developed country operational plans deriving
from the western and central Africa catch-up plan with a focus on ensuring the
needed policy and structural changes.
Two
million community health workers
The
community health worker initiative aims to accelerate progress towards
achieving the 90– 90–90 targets by 2020—whereby 90% of all people living with
HIV know their HIV status, 90% of people who know their HIV-positive status are
accessing treatment and 90% of people on treatment have suppressed viral loads
— and to lay the foundation for sustainable health systems. Championed by the
President of Guinea and African Union Chair, Alpha Condé, the initiative seeks
to confront the acute health workforce shortages across Africa and improve
access to health services for the most marginalized populations, including
people living in rural areas.
“Recruiting
2 million community health workers is a critical step towards achievement of
the Africa-wide socioeconomic transformation envisioned in the African Union’s
Agenda 63”, said Mr Condé. “Few tools have the ability of community health
workers to drive progress across the entire breadth of the 2030 Agenda for
Sustainable Development.”
Substantial
evidence, from both Africa and elsewhere, demonstrates that well-trained,
properly supervised community health workers provide an excellent quality of
care and improve the efficiency and impact of health spending. Community health
workers have helped devise some of the most effective service delivery
strategies for HIV testing and treatment, and studies have also linked
community-delivered services with increased rates of immunization, exclusive
breastfeeding and malaria control coverage.
“Sustainable
community health work is a matter of survival and development in Ethiopia, said
Prime Minister of Ethiopia Hailemariam Desalegn. “My community health workers
have made better health happen. Achieving universal health coverage is not
possible without building community health systems.”
UNAIDS
estimates that there are more than 1 million community health workers in Africa
today, but most focus on a single health problem and are under-trained, unpaid
or under-paid, and not well integrated in health systems. The new initiative
endorsed by AIDS Watch Africa seeks to retrain existing community health
workers, where feasible, and to recruit new health workers to reach the 2
million target.
“Few
investments generate such a remarkable social and economic return as community
health workers,” said Jeffrey Sachs, Director, Earth Institute, Columbia
University. “Community health worker programmes are essentially
self-sustaining, in that they avert illness, keep workers healthy and
productive and contribute to economic growth and opportunity.”
While
community health workers may hold the key in many settings to achieving the
90–90–90 targets, the benefits of this new initiative extend well beyond the
AIDS response. The initiative will expedite gains across the health targets of
Sustainable Development Goal 3, create new jobs that will strengthen local and
national economies and offer new opportunities to young people. The new
initiative is aligned with the World Health Organization’s Global Strategy on
Human Resources for Health.
Start
Free, Stay Free, AIDS Free
At
the AIDS Watch Africa meeting, the participants also called on member states
and development partners to support the African Union campaign to eliminate new
HIV infections among children and keep mothers alive as part of the Start Free,
Stay Free, AIDS Free collaborative framework.
“Complacency
gives birth to regression of the gains made in reducing HIV prevalence, said,
Yoweri Museveni, President of Uganda. “We in Uganda have rekindled the campaign
to end AIDS; the science exists, as well as the medication. We can win this
battle.” AIDS Watch Africa
