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Unity of the living and healthy – not a unity of the diseased, dying and dead

From the 1-3 July 2007, African leaders will meet in Accra, Ghana at the 9th Ordinary Session of the Assembly of the African Union. The major agenda item is the proposal and plans for the United States of Africa. Africa’s underdevelopment as manifested in its public health catastrophe is not on the AU summit agenda. This raises the crucial question of the kind of unity African leaders wish to achieve. Significantly the debate about the proposed union has revolved mainly around political issues without commensurate attention to the development issues which were no less important to the founders of the Pan African movement.

It is now six years since Heads of State of African Union member states pledged in Abuja in 2001 to commit at least 15 per cent of national budgets to health. To say it is tragic that in 2007 only two out of fifty three AU member countries (Botswana and Seychelles) have clearly met that pledge does not even begin to describe the situation. It is beyond tragedy.

In these past few weeks, all roads led to the G8 Summit in Germany. In what has become an annual ritual since the turn of the century, international campaigners Bono, Bob Geldof and an impressive assortment of Development and AIDS related organisations led the calls for more aid to Africa, and for Africa not to be forgotten in the clamour over climate change. As usual, selected African leaders turned up with begging bowls and for photo calls. Leading international campaigners have since described the aid pledged by the G8 this month as 'a farce' and 'grossly inadequate'.

We know that many of the more developed countries have played historical roles in under developing Africa. 400 years of industrial scale slavery, in addition to colonialism, ruthless exploitation of Africa’s resources, cynical ‘interventions’ and the debt burden have cost Africa dearly. The ‘foreign’ aid to Africa is a percentage of what has been taken out in human and natural resources, and is but a small step towards repairing the damage done to Africa.

But we also know that African leaders cannot seriously expect other countries to commit to, or meet pledges to ‘save’ Africa when they themselves appear indifferent to Africa’s future. To be going forward with plans for African unity without simultaneously meeting the most fundamental commitment to African development – that of health - is misguided to say the least.

It is comical for us to be calling on the G8 countries to meet the recent Gleneagles pledges when the vast majority of AU member states have not met their own Abuja 2001 pledge. This is not a pledge we can afford to pass unfulfilled. The Africa Public Health Rights Alliance (APHRA) and its '15% Now!' Campaign revealed on Human Rights Day (December 10) 2006 that by crossing continental, sub regional, country, health, disease specific and development information from a wide range of agencies and institutions we computed that an estimated 8,000,000 Africans are dying annually from preventable, treatable and manageable diseases and health conditions – mainly Malaria, TB, HIV, child and maternal mortality. This figure does not include organ related disease (heart, liver, kidney and lung diseases), an assortment of cancers, vaccine preventable diseases and so forth which could very easily add another million – or more. The consistency of these figures over the past six years alone means that Africa has suffered an estimated 48,000,000 preventable deaths since 2001.

By coincidence, the dream of the United States of Africa is planned to be actualised by 2015, the same year the Millennium Development Goals are to be met. If Africa’s health catastrophe continues unabated we could loose another 72,000,000 lives by then. This is the equivalent of whole nations dying out within a year or a decade. Many African countries (such as Botswana, Burundi, Eritrea, Gambia, Lesotho, Liberia, Libya, Namibia and Swaziland) have populations of between 1-8,00,000. Most of the island countries have populations of less than a million. Even Africa’s most populous countries (DRC, Ethiopia, Kenya, South Africa, Sudan - with the exception of Nigeria at 130,000,000) all have populations of between 30-80,000,000.

It would therefore not be an exaggeration to describe over 120 million preventable deaths between 2001 and 2015 as genocide – by inaction. In this case and for every life lost, government indifference to Public Health is the equivalent of an Interehamwe machete or Nazi gas chamber. If we were set up memorials to the preventable deaths from one year alone, we would need 100 stadiums in Africa with the capacity to each host 80,000 skulls – each a stadium of shameful silence, and a monument to government without responsibility.

Africa Must Unite! But for it to be a meaningful unity it must not be a unity of the dead. It must not be unity as a continental graveyard.

Meeting the 15 per cent pledge will be a significant indication that African leaders care for their countries and are prepared to live up to their primary responsibility of keeping their citizens alive and healthy. No meaningful and sustainable development of Africa can happen without sustainable financing for health care. Indeed the status of public health is the most significant indicator of social and economic development. This is why the Right to Health is the most crucial Right of all – we all have to be alive and well to exercise any other Rights. The dead have no Rights – except perhaps the ‘Right to a decent burial’.

To postpone the meeting of the 15 per cent pledge to the future is to accelerate the death of Africa. We call on the African Union to place the 2001 15 per cent pledge on the July 2007 summit agenda and at the very least to introduce it as urgent business [under item vii, AOB]. We further call on them to make it a major agenda item of the next summit or to call a special summit dedicated to meeting the 15% pledge. This should be preceded by a special summit of Finance and Economic Development Ministers

To further illustrate the full scale of Africa’s health disaster, it is not enough to demonstrate only the unprecedented scale of preventable death. It is also crucial to demonstrate the scale of Africa’s impotence and one example will suffice.

Without health workers, no amount of free medicines can be delivered to citizens, and all ‘foreign’ AID is meaningless. Yet many African governments have no clue how close to death their countries are due to shortage of health workers of all categories.

The DRC with a population of 57 million, roughly equivalent to the populations of UK, France and Italy has only 5,827 doctors compared to the France’s 203,000, Italy’s 241,000 and the UK’s 160,000. But it is not just a case of the most developed countries being able to train more health workers, or to poach from Africa to make up their shortfalls. Cuba with a population of about 11 million has roughly the same population as Malawi, Zambia or Zimbabwe. But Cuba has 66,567 Doctors compared with Malawi’s 266, Zambia’s 1,264 and Zimbabwe’s 2,086. Not surprisingly, Cuba has roughly the same life expectancy (77 years) as the G8 Countries, the Scandinavian and other developed countries while the average life expectancy for African countries compared to it here is 37 to 40 years. The success of Cuba in the areas of health care and education demonstrates it can be done. Despite issues with the Castro government, western countries have visited Cuba to study how they have achieved their health success. To come anywhere near meeting the World Health Organisation recommended health worker’s to patient ratio or meeting the health based MDG’s these African countries compared to Cuba will need to train and retain roughly 59,000 Doctors each in 8 years. The DRC will need to train and retain at least 150,000. The numbers for nurses, pharmacists and most categories of health workers are comparable across board. This should be Africa’s priority.

In other words, there is no alternative to long term in country sustainable financing to rebuild Africa’s Public Health systems including health workers and improved working conditions and remuneration for them, adequately equipped clinics and hospitals, improved sanitation and environmental health, clean drinking water and so forth. Without these Africa may achieve its dream of continental unity, but it will be a fools paradise.

We are for a United Africa. But it must be a unity of the living, and of a healthy African people – able to enjoy full civil, social, economic and political Rights - not a unity of the diseased, dead and dying. Successfully unity can only be based on successful development of which health is the corner stone.

The Africa Public Health Rights Alliance and its 15 per cent Now campaign calls on you to join the undersigned below in signing the petition calling on AU member countries to fulfil their 15 per cent Abuja pledge as the first genuine step towards a healthy United States of Africa.

* Rotimi Sankore is Coordinator, Africa Public Health Rights Alliance and its “15% Now!” Campaign.

You can read the full petition and see current signatories at the link shown below. You can sign by sending your name, position, organisation and country to [email][email protected] - Also stating if signing in a personal or organisational capacity.

*Signatories to the petition do not necessarily endorse the views expressed in this article.

Current signatories of the petition include:

Archbishop Desmond Tutu, Honorary Chair of the Africa Public Health Rights Alliance 15% Now! Campaign, South Africa
Professor Dennis Brutus, Centre for Civil Society, University of Kwazulu Natal, South Africa
Professor Wangari Maathai Nobel Peace Prize Winner, Green Belt Movement, Kenya

And many others.

You may click here to see the petition text and full list of current signatories

Rolling petition to be submitted to the African Union Calling on member states to urgently fulfil their 2001 pledge to commit 15% of budgets to health. Next Summit July 1 – 3 2007.

To Heads of States and Governments
Of the African Union

African Union Headquarters
P.O. Box 3243
Addis Ababa

Your Excellencies,

Appeal to African Union member States to without further delay implement the 2001 Abuja Summit pledge to allocate 15% of national budgets to healthcare

We write to appeal to you to act without further delay on arguably the most crucial challenge African leaders will have to confront in modern times, that of taking immediate and concrete action to end the tragic loss of an estimated 8 million African lives annually to preventable, treatable or manageable diseases, illnesses and health conditions.

Africans and friends of Africa were reassured when African governments themselves recognised the scale of Africa’s health crisis at the 2001 Abuja African Union Summit on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases (ORID), and committed to allocate at least 15% of national budgets to health care. However 5 years on, the great majority of the AU’s 53 member governments including those most hit by Africa’s worsening Public Health crisis have not even began the process of meeting this pledge.

Having convened numerous meetings on HIV/AIDS, TB and Malaria especially since the 2001 Abuja summit your Excellencies know that numerous lives have been lost and continue to be lost annually. Latest UNAIDS, World Health Organisation and other statistics for 2006 indicate that an estimated 24.7 million Africans are living with HIV, new infections are at a high of 2.8 million and annual death figures are 2.1 million. AIDS orphans are estimated at 12 million. For Tuberculosis, African deaths are running at 586,911 annually (35% of the world total), African’s living with TB are estimated to be 3,740,695 (26%). New and aggressive drug resistant strains could easily lead to a doubling of TB figures within a short period. For Malaria, annual African deaths are estimated at 1,136,000 (89.3% of the world total). As the relevant global and African agencies and institutions compile these retrospectively, the situation could well be much worse today.

Statistics from UNFPA, UNIFEM, WHO and other institutions indicate maternal mortality ratio estimates are highest in Africa at (830) per 100,000, followed by Asia (330), Oceania (240), Latin America and the Caribbean (190), and the more developed countries (20). Consequently an estimated 300,000 African women - over half the global total - die annually as a result of inadequate facilities and staffing for childbirth. Experts estimate that the spill over effect for this decade alone is an estimated death of 5 million women, and children from birth related complications if the trend continues. In addition there will be 49 million maternal disabilities.

Numerous UN and African institutions endorse the position that “since almost all maternal mortality is avoidable, the death of a woman during pregnancy or childbirth is a violation of her rights to life and health as well as being a social injustice”. Sadly, increasing numbers of maternal deaths are caused by indirect, non-obstetric conditions including infectious disease (HIV/AIDS, malaria, tuberculosis and hepatitis), chronic diseases (of the heart, lung and liver), gender-based violence and multiple problems faced by pregnant women in emergency situations. These maternal mortality levels constitute a colossal negligence of the obligation of African governments to provide adequate reproductive health.

Most worryingly for the future of Africa, an estimated 4.8 million deaths of children under the age of 5 years occur annually. Just five diseases - pneumonia, diarrhoea, malaria, measles and AIDS - account for half of these deaths. Again global and African institutions are in agreement that alongside providing proper nutrition “most of these lives could be saved by expanding low-cost prevention and treatment measures...including exclusive breastfeeding of infants, antibiotics for acute respiratory infections, oral rehydration for diarrhoea, immunization, and the use of insecticide-treated mosquito nets and appropriate drugs for malaria.”

Significantly, Africa tops virtually every other global mortality league table: from malnutrition; to water borne diseases like typhoid and cholera; to cervical, breast, prostrate and other cancers; heart, liver, kidney and lung disease etc. This is not counting river blindness, polio and others, which disable individuals and communities. These losses are untenable and unsustainable.

The implications for social and economic development are horrendous. Without a healthy and active population especially in the key age groups and social groups most affected, Africa has no future. Already UN and other experts estimate that the number of lives that will be lost to major diseases in the next 20 years alone is well over the 100 million mark. This is over double the estimated figures for all other worst hit parts of the world combined.

In such circumstances, your Excellencies and your immediate successors may well end up presiding over the extinction of your own people. We doubt that there will be little point in having governments if there is no one to govern.

We do not make this point lightly. The number of African lives lost annually to preventable, treatable and manageable health issues alone is equal to loosing annually, the entire populations of either Eritrea (4.4m people), Libya (5.8m people), Sierra Leone (5.5m people), or Togo (6.1 people). Or, any combination of 3 or 4 of the following countries: Botswana, Swaziland, Lesotho, Namibia, Gambia, Gabon, Mauritius, Mauritania and Namibia all with populations of 1.5 to 2 million annually. Consequently Africa’s fastest growing industry is the coffins and burial business. In 20 years the number of lives lost could be equivalent to the population of Nigeria - (at 130 million) - Africa’s most populous country.

We therefore urge your Excellencies to without delay ensure that the process for each country meeting the 15% Abuja pledge is started immediately and met by the next budget year.

We also urge you to ensure that a significant percentage of the 15% is dedicated to resolving Africa’s health worker shortages, which is indisputably the most crucial component of every health sector. Without them to diagnose, prescribe or otherwise prevent, treat and care, no amount of medicines will resolve Africa’s Public Health crisis. The World Health Organisation report for 2006 states that although there is a universal health worker shortage, it underlines that Africa is the only continent where the total number of health worker shortages (817,992) exceeds the existing number of health care workers (590,198). Lack of financial resources for the health sector and policies of some developed countries means that ‘Brain Drain’ has exacerbated this problem. Consequently, Africa has more health workers working outside Africa than any other continent.

A failure to reverse these health worker shortages within the next 4 to 6 years means that all of Africa’s 2010 Universal Access targets for prevention, treatment and care for HIV/AIDS, TB and malaria will definitely not be met. Even worse the three 2015 health related Millenium Development Goals - based on scaling up reproductive health, children’s health, and tackling the HIV/AIDS, TB, malaria and other diseases may be an impossibility. Without doubt, the future of Africa hinges on whether or not its public health crisis, (its overall human resource crisis) and in particular its health worker shortage is resolved.

Excellencies, while we recognise that historical injustices and crimes against humanity such as: the slave trade and colonialism (in which Africa lost over a 100 million people over a longer 400 year period); and more recently the debt burden; and conditionalities imposed by the IMF and other IFI’s capping budget expenditures, resulting in ceilings on health and crucial sectors of the economy have blighted development of African countries - fulfilling your 15% pledge without further delay will go a long way towards demonstrating African governments political will, restoring African dignity and ensuring that Africa’s healthcare needs are met on a sustainable basis, (and not dependent on donor support) in order to uphold what is undoubtedly the most crucial Human Right of all, the Right to Health, and ultimately to Life itself.

We appeal to you to act urgently


Archbishop Desmond Tutu, Honorary Chair of the Africa Public Health Rights Alliance 15% Now! Campaign, South Africa
Professor Dennis Brutus, Centre for Civil Society, University of Kwazulu Natal, South Africa
Professor Wangari Maathai Nobel Peace Prize Winner, Green Belt Movement, Kenya


Action Group for Health, Human Rights and HIV/AIDS (AGHA), Nelson Musoba, Uganda
Actionaid, Ludfine Anyango, Kenya
Actionaid International, Ojobo Atuluku , Nigeria
Africa Health Research Organization, Dr. Abubakar Yaro , Ghana
Africa Internally Displaced Persons Voice (Africa IDP Voice), Mr. Joseph Chilengi / Brenda Mukutu, Zambia
African Centre for Democracy and Human Rights Studies (ACDHRS), Gambia
African Women’s Development Fund (AWDF), Ghana
African Network of Adolescents and Youth in Population and Development (AfriYAN), Edford G. Mutuma, Zambia
African Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (ANERELA+), Henrix Zama, South Africa
Alliance Rights, Nigeria Oludare Odumuye (Programme Director), Nigeria
Association of Female Lawyers of Liberia (AFELL), Cllr. Abla Gadegbeku Williams (1st Vice President), Liberia
AWC, Alex Dianga
Budongo Forests Community Development Organization (BUCODO), Madira Davidson (Executive Director), Uganda
Bundesverend Freus Radios Sovegel, Germany
CEDPA USAID/ Health Policy Initiative, Laurette Cucuzza (Snr. Advocacy Advisor), USA
CERDH (Centre for Human Rights, Democracy and Transitional Justice Studies), Mr Joseph Yav Katshung, DRC
Centre for Research, Education and Development of Rights in Africa (CREDO-Africa), Dapo Awosokanre, Nigeria / Africa Diaspora-UK
Centre for Social Justice and Peace-Africa, Dr. Eusebio Wanyama, PhD (DIRECTOR), Kenya
Civil Resource Development & Documentation Centre, Oby Nwankwo, Nigera
Civil Society Legislative Advocacy Centre ˆ CISLAC Auwal Musa, Nigeria
Coalition of African Parliamentarians Against HIV/AIDS (CAPAH), Hon Lediana Mafuru, Tanzania
Community Perception, Ernest Kirwa, Kenya
Community Working Group on Health, Tafadzwa Carlington Chigariro (Intern), Zimbabwe
Cross-of Ministries International Uganda (CGMI),Rev, Edima Richard, Uganda
Darfur Consortium, Achieng Akena, Uganda
Department of Nursing Sciences, School of Medicine, Moi University, Benson W. Milimo (Nurse), Kenya
Development Alternatives With Women for New Era (DAWN-Africa), Ms. Fatou Sow/ Dr. Afua Hesse, Nigeria
DKA Support Office, Danich Petrasora
DVV International Madagascar, Rahadisoa Lucu Agnes, Madagascar
European Green Party, Joan Behrend
European Green Party, Ulrike Lunacek, MP Austria/Spokesperson, Austria
Fahamu ˆ Networks for Social Justice, Firoze Manji (Director), Kenya
Foundation for Sustainable Development, George Agan, Kenya
Foundation for Sustainable Development, Amanda Schwartz, Kenya
Forom Syd, Johanne Lindberg
George Washington University, Fitzhugh Mullan, MD (Murdock Head Professor of Medicine & Health Policy), USA
Global Aids Alliance, Paul Zeitz, USA
Global Fund for Women, Judy Gordon, USA
Global Fund for Women, Sande Smith, Snr Communications Officer, USA
Grassroots People’s Movement, Charles Ngano (Actions Coordinator)
Green Belt Movement Charles Gitani / Judy Kimamo, Kenya
Human Rights Olwch, Ogallah Japhet, Kenya
Institute of Economic Affairs, Frederick Muthengi, Kenya
Inter-African Committee (IAC),Dr. Morissanda Kouayte (Director of Operations),
International Association of Political Science Students, Adhengo Boaz, Kenya
International Oil Working Group, Katherian Sheetz,
International Press Centre, Lanre Arogundade, Nigeria
International Refugee Rights Initiative, Dismas Nkunda, Uganda
International Young Catholic Students (IYCS), Mawog Matthew, France
International Young Catholic Students (IYCS), Andrianasoko Sylria, Kenya
Intersect Worldwide, Sally Fisher (President), South Africa
Institute for Democracy in South Africa ˆ Governance & Aids Prog (IDASA), Kondwani Chirambo/Josina Machel, South Africa
Kenya Treatment Access Movement (KETAM), James Kamau, Kenya
Kenya AIDS NGOs Consortium (KANCO), Allan Ragi (Executive Director), Kenya
Kenya Health Rights Advocacy Network (KHRAN), Miano Munene, Kenya
KIGEZI Healthcare Foundation, Dr. Anguyo Geoffrey, Uganda
LEADS Adejor Abel, Nigeria
Marakwet Youth Network, Kipehuniba Kafelulo
Network of Zimbabwe Positive Women (NZPW+), Martha Tholanah (Coordinator), Zimbabwe
NGODEP, Mwinyi Juma, Kenya
Nigeria Social Forum, Kenneth Okoineme, Nigeria
North Rift Human Rights Network, Kelitem C. Benjamin / Stephen Cheboi
Pan African Christian AIDS Network (PACANet), Rev. Edward Baralemwa (Executive Director), Uganda
Oeuvre de Charité et Développement de LEMBA (OCDL ongd/asbl) Cyprien Mananga, Congo
Open Society Initiative for Southern Africa (OSISA), HIV Program, Sisonke Msimang / Delme Cupido, South Africa
Open Society Initiative for West Africa (OSIWA), Senegal
OSISA Policy and Advocacy Manager, Roshnees Narrandes
Physicians for Human Rights, Eric A. Friedman (Snr Global Health Policy Advisor), USA
POSITIVE-Generation fogué foguito, Cameroon
Positive Women’s Network, South Africa, Prudence Mabele, South Africa
Public Personalities Against Aids Trust, Tendayi Westerhof, Zimbabwe
Santayalla Support Society (Togo), Tete-koffi Wilson, Togo
Senator Josejuvan Sacramento, Mexico
Senator Teresa Ortno, Mexico
Society for Women and AIDS in Africa ˆ Southern Africa (SWAA Mozambique), Christiano Macuamule, Mozambique
Society for Women and AIDS in Africa, Connie Mureithi, Kenya
Southern Africa HIV & AIDS Dissemination Services (Safaids), Dominica Mudota, Zimbabwe
Southern Africa Regional Poverty Network, Caroline Sande, Political Dimensions Programme Manager, South Africa
Southern and East African Alliance of Parliamentary Committees on Health and HIV/AIDS (SEAPACOH), Hon Blessing Chebundo, Zimbabwe
Standard Newspapers, Edith Fortunate, Kenya
Stop TB and HIV/AIDS, Abdoulaye Cham, Gambia
Student-Worker Solidarity Society, Iddrisu Tanko, Ghana
Students acting for Gender Equality, University of Delaware, Amy Vernon Jones, USA
Tbaction Kenya,Lucy Chesire, Kenya
The Battle for Life, Mug-Jay Shino,
Treatment Action Campaign (TAC), Regis Mtutu, South Africa
Tuberculosis National League Aurelia Nicole Nguejo, Cameroon
University of Nairobi Medical Students Association, Kevin Ongeti, Kenya
UK AIDS and Human Rights Project, Dr Delphine Valette (Director), UK
VDAYE, Susan Lister, USA
Volunteer for Africa, D. Njagi
VSO-UK Nina O‚Farrell (Policy Advisor HIV 7 AIDS), UK
WECADI, Samson Kasozi,
West African Social Forum, Ms Abiola Akiyode-Afolabi
Women Advocates and Research Documentation Centre (WARDC), Nigeria
Women in Law and Development in Africa (WiLDAF/FeDDAF), Togo
World Aids Campaign (WAC), Mr. Marcel van Soest, Netherlands
World Aids Campaign (WAC), Felicita Hikuam, South Africa
Youth Development Forum (YODEFO), Ibrahim Kasozi (Executive Director), Uganda
Zimbabwe Activists Against HIV and AIDS (ZAHA)
Zimbabwe College of Public Health Physicians, Dr. Jabulani Nyenwa, Zimababwe
Agatha Wangeri Kahara, Kenya
Alfred K. Nyale
Andre Jaime Makwarimba Calengo- Lawyer and Human Rights activist,Mozambique
Believe Dhliwaya, Canada
Brian MacGarry (Catholic Priest), Zimbabwe
Catherien Nyakanini
Diana A. Kolek, Kenya
Dr. Wolfpang Boahin
Emily Helmeid, USA
Eric Ponda
Francis Hansen, USA
Giampaolo Cadalanu, Italy
Hajjat Fatmo Anyanzwe, Kenya
Hamakwa Mantina (MD), Zambia
Janine Boneparth
Joyce Joan Wangui, freelance journalist
Laurah Harrison (Lawyer), Zambia
Dr. Panganai Dhliwayo (MD) Namibia
Sharton Cordaro
Silvia Norara, USA
Tjwangwa Dema, Poet, Botswana
Thomson Odoki (Social Worker), Uganda
Tonia Corwin, USA
Zachary Schater, USA