Following the 9th anniversary of the April 2001 African Heads of State commitment to allocate at least 15% of annual domestic budgets to health, Nobel Peace Laureate Archbishop Desmond Tutu, honorary chair and patron of the Africa Public Health Alliance and 15% Plus Campaign, has called on African heads of state, and ministers of health and finance to work urgently towards a 10th year anniversary High Level Progressive Review of the landmark African commitment on health financing.
On Eve of World Health Assembly and Pre AU Summit African Ministers of Health Meeting - Nobel Laureate Archbishop Desmond Tutu and Africa 15% Plus Campaign:
- Express Concern that 2010 Africa Health Financing Scorecard Launched Today Shows Only 6 out of 53 AU Member States Have Met Abuja Commitment to Allocate 15% of Budgets to Health After 9 Years.
- Call for a High Level 10th Year Anniversary Progressive Review of the 2001 African Heads of State Abuja Commitment.
- New Scorecard Underlines that 32 African Countries Investing Less than $20 Per Capita in Health Should Double Investment to Meet the WHO Recommended Minimum Package - To Have Any Chance of Achieving Health MDGs and African Health Priorities.
- Recommends Progression to 15% Plus Package of Integrated Health and Social Development Financing to Ensure Sustainable African Economic and Social Development.
On the heels of the 9th anniversary of the April 2001 African Heads of State commitment to allocate at least 15% of annual domestic budgets to health, Nobel Peace Laureate Archbishop Desmond Tutu also Honorary Chair and Patron of the Africa Public Health Alliance & 15% Plus Campaign has called on African Heads of State, and Ministers of Health and Finance to work urgently towards a 10th year anniversary High Level Progressive Review of the landmark African commitment on health financing.
In the call issued on the eve of the World Health Assembly beginning 17th May where African Health Ministers are also holding a special pre July AU Summit meeting on the 15th of May, Archbishop Tutu stated:
“The laudable 2001 health financing commitment of African Heads of States and governments needs a Progressive High Level 10th Year Review so we can understand better why after 9 years, only 6 out of 53 AU member states have met the 15% pledge”
“However we underline that the review must be progressive because the latest research findings following 4 years of analysis and advocacy indicates that even the 6 countries that have met the 15% pledge are still amongst the most affected 10 countries in at least 1 or more Health MDG categories. This is due mainly to a combination of low per capita investment in health; and also low investment in social determinants of health such as clean water, improved sanitation and sustainable use of environment, poor nutrition; in addition to poor policy and budget support for pillars of health including gender equity in health; pharmaceutical capacity and access to medicines; and for education and labour sectors to train and retain needed numbers of health workers”
“The conclusion therefore is that to ensure accelerated progress on the 10th year global review of the Millennium Development Goals and other global development frameworks, Africa also needs to improve on the laudable Abuja commitment and progress from just 15% to 15% plus by doubling Per Capita Investment in health, and also investing more in crucial social determinants and pillars of health.”
“African Ministers of Health can demonstrate their commitment to this needed progressive review by agreeing at their coming World Health Assembly meeting, to initiate work with Finance Ministers, and also recommend that the July African Heads of State Summit focussing on Maternal and Child Health should commit to a 10th Year High Level Progressive review of the April 2001 15% Commitment before or by April 2011"
Archbishop Tutu further emphasised that: “In reality progressing to 15% plus will just be a formal but courageous harmonisation and integration of various existing African commitments on health, clean water, sanitation, food security, environment, gender equality, population and social development in general to ensure inter-sectoral implementation for accelerated progress in the next 5 years of global frameworks including the International Conference on Population and Development (ICPD) Program of Action, MDGs, and Beijing Platform”
Rotimi Sankore Coordinator of the Africa Public Health Alliance & 15%+ Campaign elaborated further on findings of the study:
“Per capita investment provides a more accurate measurement of investment in the health sector. Our study summarised in the Health Financing Scorecard released today shows that 32 African countries are investing less than $20 per Capita in health, with 11 countries investing as low as between $1 and $5. This is far below the WHO recommended minimum package of at least $40."
$1 can barely provide a day’s dose of aspirin or treat a case of Malaria, $5 cannot treat a case of TB, and $20 cannot provide HIV treatment, tackle leading causes of Child Mortality, or provide a health workforce for health needs of all citizens, especially skilled birth attendance necessary to reduce Maternal Mortality."
The 15% commitment findings to be published in full just before the July AU Summit focussing on Maternal and Child Health also demonstrates that a country achieving the old Abuja 15% commitment by investing only $5, $10 or $15 per capita on health will only achieve selective, limited and unsustainable success on African and global health targets.
"Average government per capita expenditure on health in Europe and the Americas is between $1,252 and $1,350 respectively compared to the African average of a mere $25 to $27. This is in addition to better provision of clean water, improved sanitation and environmental policies, gender equity in health, health workers and pharmaceutical capacity”. Average percentage allocation of budgets to health in Europe and the Americas is also between 14.8% and 16.8% - compared to the Africa average of 8.7% - so this shows that going by percentage alone could be misleading."
However it’s not just a case of developed countries being able to outspend developing countries on health.
“Cuba and Costa Rica have achieved a status of being in the top group of countries with the highest life expectancy of between 78 years and 82 years, but have achieved this with modest per capita health investment compared to G8 countries. Cuba invests only $332 per capita on health and Costa Rica $275, but still manage to have a higher life expectancy of 78.3 years and 78.8 years respectively – just above the U.S.A at 78.2 years but which invests $3,076 per capita on health – almost 10 to 11 times what Cuba and Costa Rica spend on health.”
“The commendable position of both countries has been achieved based on maximising efficiency of health and social development investment that has ensured 98% (Costa Rica) and 91% (Cuba) of their population have access to improved water sources, 96% and 98% access to improved sanitation, and 90% and 99% vaccination coverage, amongst others. In addition both countries have amongst the highest health workers to population ratios in the world.”
African commitments must be progressively reviewed based on compelling global evidence.
A 15% plus health and social development investment package is also supported by the preliminary findings of the Harmonisation of Health in Africa Agencies including WHO, UNICEF, UNFPA, UNAIDS, PMNCH, Africa Development Bank, USAID and World Bank which recommends an additional per capita investment of at least $21 to $32 over a five year period.
"The fact that health life expectancy in Africa is at an all time average low of 41 years and Africa looses approximately 8 million lives a year to MDG 4, 5 and 6 health issues alone is evidence that investment in health is key to Africa's sustainable economic and social development".
Need for September Health MDGs Review to Include New Indicators on Health Financing and Health Workers, and also Non Communicable Diseases.
Rotimi Sankore also highlighted the rising mortality from Non Communicable Diseases and called for the global MDGs review in September to take account of this by including them in the MDGs.
"Today non-communicable diseases account for about 35 million deaths annually out of global total of about 58.7 million. Most of these deaths (about 20 million) are in low and middle-income countries."
The World Health Organisation has recently warned that chronic diseases including cardiovascular, diabetes, cancer and chronic respiratory illness are now responsible for 60 per cent of the world’s deaths with at least 80 per cent of these deaths occurring in less developed countries. These are worsened by smoking, alcohol which are less regulated in less developed countries. These in turn impact negatively on infections diseases such as HIV, TB and Malaria.
"Without a shadow of doubt, failure to upgrade the MDGs to include targets on NCD's, and also targets on key issues such as health financing and health workforce will reduce the chances of all MDGs being achieved by 2015."
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