Health Budget speech by Dr Aaron Motsoaledi, MP, Minister of Health, National Assembly
15 May 2013
My colleague the Deputy Minister of Health
MECs for Health present
The Chairperson and members of the Health Portfolio Committee
Honourable Members of Parliament
Ladies and Gentlemen
Honourable Speaker, it is now well documented and generally understood that South Africa faces a quadruple burden of disease. Many other countries are faced only with a double burden.
These four are:
- A very high prevalence of HIV and AIDS which has now entered into a synergistic relationship with TB;
- Maternal and Child morbidity and mortality;
- Exploding prevalence of non-communicable diseases mostly driven by risk factors related to life-style; and
- Violence, injuries and trauma.
These four colliding epidemics resulted in death notification doubling between 1998 and 2008 to 700 000 per year as noted by the National Planning Commission. Life expectancy in the country also took a knock and declined to worrying levels.
We had to respond to these very urgently and very decisively.
In addition to our Ten Point Programme, the Department of Health signed the Negotiated Service Delivery Agreement with the President. We committed to four (4) objectives which we called outputs during this term of government.
- Increasing Life Expectancy;
- Reducing maternal and child mortality;
- Reducing the burden of disease from HIV and AIDS and TB;
- Improving the effectiveness of the health system
After going into a deep analysis of the problems, it became clear that unless we deal decisively with HIV and AIDS and TB, it would be foolhardy to believe that we could ever decrease the high levels of mortality and morbidity in our country. Hence our plans had to have a very strong element of a desire, commitment and passion as far as HIV/AIDS and TB are concerned.
This did not mean that the other epidemics were less important, it simply emphasised that the central driver of morbidity and mortality in South Africa was largely HIV and AIDS and TB.
Honourable Speaker, we responded comprehensively through well designed plans to deal with HIV and AIDS and TB, and the implementation of these plans was well executed.
Among others Honourable Speaker, we increased the health facilities providing antiretrovirals (ARVs) from only 490 in February 2010 to 3 540 to date. The number of nurses trained and certified to initiate ARV treatment in the absence of a doctor were increased from only 250 in February 2010 to 23 000 nurses to date. This programme is called NIMART or Nurse Initiated Management of Antiretroviral Therapy. NIMART made it possible to increase the number of people on treatment from 923 000 in February 2010 to 1,9 million to date – that is actually doubling the number on treatment.
I wish to take this opportunity to thank all the health workers for this sterling performance – especially the nurses without whom this numbers would have been impossible to achieve.
Very recently Honourable Speaker, we have introduced the ground breaking fixed dose combination (FDC) therapy which made it necessary to train 7 000 health workers for smooth implementation.
Another very important windfall from these FDCs is that by February 2010, it used to cost us R313.99 per patient per month to provide ARVs. With the FDCs, it is now costing us only R89,37 per patient per month. We are now able to treat many more people per month with the amount of money that we used to treat one person with in 2009.
The results we achieved from these endeavours are very sweet indeed.
By the end of last year, researchers, local and international started reporting a dramatic increase in life expectancy in our country. They also reported a decline in under five mortality and maternal mortality ratio. Our biggest challenge is the neonatal mortality rate. These researchers include our Medical Research Council’s Rapid Mortality Surveillance Report, the Lancet, and United Nations agencies like the UNAIDS.
All these researchers attributed the decline in mortality and the concomitant increase in life expectancy to our comprehensive response to the HIV epidemic, especially the ARV treatment programme.
The fact that we are testing large numbers of our people and large numbers are on treatment has brought much relief to individuals, families and communities.
As far as TB is concerned Honourable Speaker, we started in earnest on 24 March 2011 to introduce new programmes. We unveiled new strategies to combat TB.
(a) Firstly, we unveiled the GeneXpert technology. Honourable Speaker, the last time in the world that a new technology do diagnose TB was unveiled was more than fifty (50) years ago. The World had then thought we had defeated TB. We now know better. We are hence immensely relieved that a new, faster and very effective technology has now been unveiled by scientists commissioned to do so by the World Health Organisation’s Stop TB Partnerships.
Before GeneXpert technology, it used to take us a whole week to diagnose TB. Now it takes us only two (2) hours.
It used to take us three (3) months to conclude that a person has multi-drug resistant TB, now it takes us only two (2) hours to know that.
I am very proud that South Africa was the very first country on this continent to unveil the GeneXpert technology. Since its unveiling on 23 March 2013, we have distributed 242 GeneXpert units around the country. This 242 constitute 80% of all facilities we would like to cover. We had spent R117 million shared by the National Department of Health, the Global Fund and the Center for Disease Control in the USA to achieve this 80% coverage. We have conducted 1,3 million tests using this technology since 2011. This constitutes more than 50% of the total tests conducted in the whole world.
In five (5) months’ time, we will achieve 100% coverage of all the district hospitals with the GeneXpert technology. From there we will move to the big community health centers.
The biggest of these machines, that can diagnose forty-eight (48) patients at a time, the others can do only 4 or 16, are called GeneXpert 48. We only have two (2) in the whole country. We have placed one at the Ethekwini Municipality at Prince Mshiyeni Hospital. The second one is in the Cape Metro at Greenpoint National Health Laboratory Service (NHLS) laboratory.
We have done this because both Ethekwini and the Cape Metro are the most very heavily challenged cities as far as TB is concerned.
On World TB Day, on 24 March this year, you are aware that the Deputy President of the Republic unveiled a GeneXpert technology at Pollsmoor Prison, on behalf of all Correctional Services facilities. This was in response to a Constitutional Court ruling where an inmate took the government to court, and the State was held liable for inmates contracting TB in jail. Yes, it is now well established that the highest rate of TB in our country is in correctional service facilities. They too, will be supplied with GeneXpert units to screen all inmates on entry to facilities and also to screen them twice a year once they are inside.
We will also request for the names of those who are found by the GeneXpert to be having TB, from the Minister of Correctional Services in order to send health workers to their families so that the whole family of an inmate can be screened. One person with TB has a potential to infect 15 others in their life time.
Honourable Speaker, the second strategy we have adopted was to establish family teams. On our database, we have 405 000 families in South Africa who have a member diagnosed with TB. The family teams are visiting these families to screen all members within such a family.
About four (4) weeks ago, the Statistician-General went to Thabo Mofutsanyane Region to release StatsSA’s yearly figures on the cause of death. He released the 2010 figures and announced that TB was found to be the number one (1) killer in the country – not surprising given the synergistic relationship between TB and HIV and AIDS as I said earlier.
We are eagerly waiting for the 2011 and 2012 figures to see how effective our programmes have been. For now, we can report that in 2008 our TB cure rate was 67,5% but in 2012 it has improved to 75,9%. The target set by the World Health Organisation is 85% cure rate. We are steadily but surely moving in that direction. However Honourable Speaker, I have one very serious request to make. Having turned the corner should not be regarded as a signal for South Africans to be complacent. We still have a very long road to travel with HIV/AIDS and TB.
The National Development Plan has clearly indicated that by 2030, we must have a generation of under twenties (20) being free of HIV and AIDS and we must have a decrease in TB contact indices.
At the recent SANAC Plenary we have decided that the Presidency will we need to re-launch for us the HIV Counselling and Testing (HCT) Campaign in the country. This launch must happen at Gert Sibande District in Mpumalanga. It is now officially declared a district with the highest prevalence rate of HIV in the country.
I have a serious complaint Honourable Speaker, that since the campaign started, there is one extremely powerful place in this country were the HCT campaign was never launched. It is called the Parliament of the Republic of South Africa.
Please Honourable Speaker, may I humbly ask that you choose a date where we will come and publicly launch this campaign here in Parliament with you and the Chairperson of the National Council of Provinces (NCOP) taking the lead, followed by leaders of all political parties in this hallowed chambers. Then the provincial legislatures, District Councils and local councils will follow suite. I will then have the power and courage to ask churches, schools and all other centers of our civil life to choose their own days to do so.
I promise to supply a GeneXpert unit as well as a mobile XR unit for the benefit of Members in this Parliament because you also will need to be screened for TB as well, on top of testing for HIV and AIDS.
Honourable Speaker, let me now deal with the intractable problems that the health care system is faced with. It is output number four, i.e the efficiency and effectiveness of the healthcare system in the country.
You are well aware Honourable Speaker, that our flagship programme to change the efficiency and the effectiveness of the healthcare system in this country is the NHI – the National Health Insurance system.
While South Africans have been throwing mud at each other about NHI, I need to indicate that we need to stop wasting our time. NHI has gone global. The World Health Organisation (WHO), the United Nations (UN), the World Bank, prestigious institutions of high learning such as the Harvard University, have recently entered the fray in support of NHI and in giving well researched guidance to countries on how to get about to implement NHI – not to debate whether it is needed or not. The world has gone far beyond that stage.
Recently the World Bank and Harvard University organised a workshop of all Ministers of Finance to guide them on how their treasuries can support NHI for the benefit of economic growth.
It is of course not called NHI in every country. The World Health Organisation and all the UN agencies are calling the generic term, Universal Health Coverage. We will stick to the term NHI.
The Prestigious British medical journal, the Lancet has launched a series since late last year to allow academics, health activists and researchers to write articles to guide countries about this concept of Universal Health Coverage.
It doesn’t matter what you call it – the concept is the same i.e every citizen has a right to access to good quality, affordable health care, and that the access should not be determined by the socio-economic condition of the individual.
Hence whether you call it NHI as we are doing here in South Africa, or NHS as they do in England, or Seguro Popular as they say in Mexico or Obama Care as the Americans call theirs, the concept is the same.
In the editorial of Vol. 380 of September 8, 2012 of the Lancet it states that “certain concepts resonate so naturally with the innate sense of dignity and justice within the hearts of men and women that they seem an insuppressible right. That healthcare should be accessible to all is surely one such concept. Yet in the past, this notion has struggled against barriers of self-interest and poor understanding”.
The editorial goes further to say: Building on several previous Lancet Series that have examined health systems in Mexico, China, India, South East Asia, Brazil and Japan, today we try to challenge those barriers with a collection of papers that make the ethical political, economic and health arguments in favour of Universal Health Coverage and will be presented in New York on September 26 to coincide with the United Nations General Assembly. The series was facilitated by the Rockefeller Foundation and edited by David de Ferranti of the Results for Development Institute in Washington DC. The conclusions support the World Health Organisation (WHO) Director-General Dr Margaret Chan’s assertion that Universal Health Coverage is the single most powerful concept that public health has to offer”.
Honourable Speaker, the editorial goes on to say and I quote again: “Universal Health Coverage, like any other health system, must be accountable for the quality of its outcome and the compassion of its care. The emphasis should be on responsiveness to service users, rather than on profit for share holders”.
It is very clear Honourable Speaker and Honourable Members that the whole world, and not only our country is gearing to rid itself of archaic healthcare financing systems that cater for the privileged few, and punishes the poor, in favour of healthcare systems that will benefit all – and all citizens of a country.
This assertion, led to another article in the Lancet series I have just mentioned. It argues that Universal Health Coverage is poised to be a third global health transition.
The argument is based on the fact that since humanity came into being, there have been only two great transitions in health on this planet.
The first was the demographic transition that began in the late 18th century and changed the planet in the 20th century through public health improvements, including basic sewerage and sanitation, which helped to reduce premature deaths greatly.
The second transition was the epidemiological transition that began in the 20th century and eventually reached even the most challenged countries in the 21st century.
Communicable diseases, from smallpox to poliomyelitis were vanquished or controlled on a scale never imagined, opening the way for contemporary action to tackle non-communicable diseases.
Now a third great transition seems to be sweeping the globe, changing how healthcare is financed and how health systems are organised. For a along time, getting healthcare has meant first paying a fee to the provider – a practice that effectively burdens sick and needy people, that has meant choosing between going without needed services or facing financial ruin”.
Honourable Speaker in implementing NHI or Universal Health Coverage countries are clearly going to pay different prices for different durations in time, depending on internal objective factors and dynamics within each country. Hence a country like Qatar, is going to implement NHI starting in July this year and completing in December next year. Here in South Africa, we have given ourselves 14 years to achieve the same.
Unlike Qatar, there are two main prices we are going to have to pay for successful implementation of NHI.
The first price is that the quality of services in the public health system has to drastically undergo a metamorphosis – the quality simply has to improve and there is no running away from that.
The second price is that the cost of private healthcare has to drastically reduce. We need to firmly regulate the prices in private healthcare.
Honourable Members, as a Department of Health, we strongly welcome last week’s announcement by the Minister of Economic Development, Honourable Minister Patel, that through the amended Competition Act, the Competition Commission will launch a public market inquiry into the cost of private healthcare. We as a Department are fully behind Minister Patel and the Competition Commission on this one and we are ready to engage and offer all evidence we have at our disposal. We are eagerly waiting for the Commission to call us! For those who don’t understand where this is coming from, I wish to refer you to our National Development Plan, Vision 2030 and I quote:
“A national health insurance system needs to be implemented in phases, complemented by a reduction in the relative cost of private medical care and supported by better human capacity and systems in the public health sector”.
As to how we are going to pay the first price I have mentioned earlier, i.e on the issue of quality in the public health system, we shall outline that in the White Paper that will be released soon. We did indeed take a very long time since the Green Paper was launched. There were lots of inputs and developments that needed our very careful attention and considerations.
We will be ready very soon.
It will be released with a clear plan on how NHI is to be implemented based on the two main prices which I said the country has to pay.
Because these are elaborate plans, it will not be possible at all to outline them here. They will be made available in due course. They will include the whole concept of non-negotiables in healthcare, the delegation of powers to CEOs who are being newly appointed and trained. This will also include abolishing the dreaded depot system of drug supply to allow CEOs to get medicines directly from suppliers.
But I wish to take this opportunity to emphasize over and over again, that the NHI will be based on a preventative and not a curative healthcare system.
I will then repeat in many more occasions to come that Primary Health Care, meaning prevention of diseases and promotion of health is going to be the heartbeat of NHI in South Africa.
We will drive this healthcare system according to the dictates of the National Planning Commission which clearly states that among the important things to be done, is to reduce the burden of disease, not to allow them to flourish and then try to run helter skelter in trying to cure them, with very limited facilities, both human and financial, which is the hallmark of public health systems on the African continent.
We wish to demonstrate with a few examples on what prevention of diseases and promotion of health can do to a country’s health system.
A report compiled by the Mail & Guardian’s newly established BHEKISISA health reporting center and published on Friday last week demonstrates one of the examples
It shows how four years ago, the Department of Health introduced two very new vaccines, Prevenor, to reduce the risk of children contracting Pneumonia, and Rotarix to prevent incidences of diarrhoea in children. Remember that diarrhoea was killing 25 South African children under the age of five (5) each day.
At the time of the inception of the two vaccines, National Institute of Communicable Diseases, the NICD, was tasked with the work of monitoring and evaluating the impact of these vaccines on hospitalisations in three South African hospitals – in Cape Town, KwaZulu-Natal and Gauteng.
The findings were that at Ngwelezele Hospital in Kwa-Zulu/Natal the under five mortality rate was three times higher than in Soweto. However, the Ngwelezene Hospital ward that deals specifically with diarrhoea i.e the gastrointestinal ward, has recently been closed down as a result of the introduction of this vaccine. Around 2006, this ward used to admit close to 1 000 children annually. It is now closed down – no more need!!
On average, in all these three sites there has been a 70% reduction in admission due to diarrhoeal diseases attributable to Rotavirus.
Seeing the successes that vaccines can bring Honourable Speaker, our next target is cancer of the cervix of the uterus. One of the biggest killers of women.
According to Prof Lynette Deny, and Dr Yasmin Adam of the Department of Obstetrics and Gynaecology at Groote Schuur Hospital and Chris Hani Baragwanath Hospital respectively, cervical cancer affect 6 000 South African women annually. 80% of them are African women.
Out of these 6 000 affected, between 3 000 and 3 500 die annually as a result of this cancer.
More than 50% of women affected are between 35 and 55 years of age. Only 20% are older than 65 years of age.
HIV positive women are five times more likely to get it than HIV negative women.
This cancer is caused by another dangerous virus – the human papilloma virus. The good news is that there is now a vaccine against this virus. The very bad news is that it is available in the private sector but the costs are prohibitive between R500 and R750 a dose (3 doses are needed for protection) – even in the private sector the uptake is very slow due to this prohibitive costs.
At the moment Honourable Speaker, to make these vaccines affordable, the Bill and Melinda Gates Foundation established GAVI (Gates Action for Vaccines and Immunisation) to help poor countries.
Unfortunately, South Africa does not qualify for GAVI prices which we are made to understand, are at only $4,00 per dose.
We are also aware that the PAHO (Pan American Health Organisation) has negotiated a price of $13,00 a dose for Latin American countries.
I am extremely happy to announce that in consultation with the Minister of Finance and the Minister of Basic Education, we have decided that we shall commence to administer the HPV vaccines as part of our School Health Programme as from February next year.
We will enter negotiations in our own right to also be given a fair deal in the interest of the lives of the women of this country.
We are advised by scientists that the vaccine is only fully effective before sexual activity commences.
For this reason, we shall administer it to all 9 year and 10 year old girls in Quintiles 1, 2, 3 and 4 schools.
This will cover 385 000 of the 9 and 10 year olds. We are not unduly discriminating against Quintile 5 schools. Children from poor families who find themselves for one reason or the other in Quintile 5 schools will also be covered.
I am calling for parents of all remaining learners in that category of schools, that since they can afford, for now they must try to acquire the vaccines themselves until we are able to cover all learners in the mentioned age bracket in all the schools. I am calling on all Medical Aid Schemes in the country to pay for these vaccines to help parents in the category of learners who will not be covered when we commence the programme. The benefits far outweigh all the costs. It costs up to R100 000 per patient in the public sector to treat each of the 6 000 cervical cancer patients.
I am scared to quote you the figures for the private sector treatment.
Honourable Speaker, this week, very bad news emerged from our health facilities about an entity called RWOPS – Remunerated Work Outside the Public Service – whereby doctors fully employed by the State conduct their own private work during certain hours. RWOPS is not illegal. It was passed by the Cabinet around 1994.
The only problem is that it is being abused by some unscrupulous individuals.
I must emphasise Honourable Speaker, the overwhelming number of doctors in the public service are very decent law abiding hard working citizens who are deeply committed to their patients.
It is only a few who are tarnishing the name of the profession. I am appealing that the events that unfolded over the media this week must not be misconstrued that most doctors are involved in this practice and start regarding all doctors as some form of criminals. I want to repeat, the majority are very ethical citizens who understand their calling.
The few individuals who are involved, are not only punishing patients, they are also destroying the medical training in the country because they leave medical students to their own devices. Even specialists in training are badly affected by being abandoned by people who are supposed to guide them in every step of their training.
I have already warned the private sector, who are benefitting from this bad practice, that in the long run, they also will suffer because the country will produce poorly trained doctors.
I have given this matter to the Deans of all our medical schools where this practice seems to be very rife, to discuss the matter and come up with recommendations which will be presented to all stakeholders in health. We will call a press conference to determine the way forward. But we can’t avoid criminal charges to those who have been caught red-handed because we have their names and know their activities.
We will also refer their names to the South African Revenue Service (SARS) to see if they are paying tax in the double income they are getting.
We are also appealing to the private sector who are hell-bent on attracting this public servants with lots and lots of perverse incentives. This is going to destroy everybody in the long run.
I wish to take this opportunity to thank the Deputy Minister, the Director-General and all managers in our Head Offices and facilities. Our health workers still remain our heroes and heroines despite a few who want to tarnish their good names. I wish to thank them for the sterling work performance done under very trying circumstances.
I thank you.
Issued by the Department of Health,
May 15 2013
Swazi Government and the US-based Futures Group lack accountability in failed circumcision programme?
It was an ambitious plan to circumcise the majority of men in Swaziland, an effort to reduce the risk of HIV transmission in a country with the world’s highest HIV prevalence. How could it have gone wrong?
“First they told me that circumcision will not really protect me against HIV. Then they tell me that I cannot have sex for some weeks or months after circumcision. I told them ‘fusaki’ [get out]!” Eric Dlamini, a 22-year-old law student, told IRIN.
These views are at the heart of the failure of the Accelerated Saturation Initiative (ASI) to achieve more than a fraction of its targeted goal, the circumcision of 80 percent of Swazi males between ages 15 and 49 within a year.
The programme, a partnership between the Ministry of Health and Social Welfare and the US-based Futures Group, was launched in 2010, and extended to 30 March 2012 when initial efforts showed a failure to achieve targeted results. But only about 20 percent – or 32,000 – of the targeted demographic were circumcised through the programme.
US$15.5 million was spent on the programme, or $484 per circumcised male.
“We do not believe [ASI] was a failure but an additional prevention measure that is contributing to the overall combination efforts to end the HIV/AIDS pandemic in the country,” US Embassy in Swaziland spokesperson Molly Sanchez Crowe told the local press.
Imposed from outside?
Male circumcision has been scientifically proven to reduce a man’s risk of contracting HIV through vaginal intercourse by as much as 60 percent. Follow-up studies have found that the effectiveness of male circumcision in HIV prevention is maintained for several years.
Government health officials, like Minister of Health Benedict Xaba and Khanya Mabuza, the acting director of the National Emergency Council on HIV and AIDS (NERCHA), have noted that ASI taught the country important lessons and left behind several clinics and other health infrastructure.
But a year after the programme ended, Swazi health officials are still trying to figure out what went wrong. Health workers, who spoke to IRIN on the condition of anonymity, pointed out that the programme was hastily implemented. They wondered why the short implementation time was not extended. Ending the programme, they fear, may suggest to international donors that the country is a hopeless cause.
“We have been struggling with HIV for 20 years, and we see programmes come and go. Some are fads… and some are not well thought out. The Swaziland programme came from the outside. The health ministry was willing to go along because there was money there. But it was imposed,” said Thandi Mduli, an HIV testing officer in Manzini.
Officials with health-oriented NGOs admitted to IRIN they are “terrified” of criticizing an initiative funded by the “mighty” US President’s Emergency Plan for AIDS Relief (PEPFAR) and involving the global population control NGO Population Services International (PSI).
The ASI programme was an attempt to duplicate in Swaziland the circumcision successes seen in Kenya and other countries, without apparently doing the pre-campaign ground work. Kenya has carried out an estimated 477,000 circumcisions since its programme started in 2008, according to the government.
In 2011, UNAIDS and PEPFAR launched a five-year plan to have more than 20 million men in 14 eastern and southern African countries undergo medical male circumcision by 2015.
Reasons for failure
“There were a lot of issues involving male circumcision that were not properly explained to Swazi men, so they rejected it and they talked to their friends, and word of mouth was negative instead of positive. This is the opposite of what a campaign like this needs to work,” said NERCHA’s Mabuza.
Other issues included unfamiliarity of the procedure. “When I heard I would still have to wear a condom, I said, ‘What is the point?’” said Samkelo Mduli, a university student.
A survey commissioned by the Futures Group in 2011 found that although there was a 91 percent awareness of circumcision, nationally, the largest barrier to circumcision was fear of pain. Other barriers included fear of something going wrong, and a general lack of understanding of the procedure.
Another reason for the rejection of circumcision was not anticipated by ASI promoters: belief in witchcraft, which is widespread in Swaziland. Criminals are known to seek “strengthening” potions made with human body parts. Killings associated with “ritual murder” routinely correspond with national elections. Victims, usually children or older people, are found with body parts missing. One attack made headlines in the Swazi press recently.
“That’s also what I wanted to know, and they wouldn’t tell me – what happens to my foreskin once it is cut off?” said Mduli.
Health Minister Xaba alluded to this when he told the Times of Swaziland, “Some men feared that the foreskin could end up in wrong hands, being used by some unscrupulous people for their ulterior motives.”
“This is embarrassing and nobody wants to talk about it,” said the programme director of a faith-based HIV/AIDS initiative in Manzini. “The circumcision initiative failed because of this arrogance on the part of its promoters. It would have been easy to be honest and explain to the Swazi men that their foreskins would be incinerated like all surgical refuse. But the promoters said, ‘Oh, no, we can’t talk about witchcraft. What will the donors say?’”
By Samuel Mungadze
A NATIONAL Strategic Plan for HIV, tuberculous (TB) and sexually transmitted infections has been adopted on Friday, during South African National Aids Council (Sanac) meeting in Secunda, Mpumalanga, which was chaired by Deputy President Kgalema Motlanthe.
The National Strategic Plan has a target to have 3-million people on antiretroviral (ARV) treatment by 2015. South Africa currently has 1.9-million people on treatment.
The plan also aims to eliminate the transmission of HIV infection from mother to child by 2015 and to reduce AIDS-related maternal deaths. The country has in the recent past seen significant changes in the rate of mother-to-child HIV transmission.
Between 2008 and 2012, the rate of mother-to-child HIV transmission dropped from 8% to 2.7%. There was a leap in the percentage of HIV-infected women receiving ARV therapy between 2011 and 2012, from 87.3 % to 99%.
Similarly, 99 % of all infants born to HIV-infected women receive prophylactic ARV medication to reduce the risk of early mother-to-child HIV transmission in the first six weeks.
In this plan “Sanac aims to reduce TB incidence and mortality caused by TB in people living with HIV by 50 % in 2015″, read the statement from the council.
Sanac also approved plans to launch an HIV prevention programme aimed at sex workers. Details of the project were, however, not released with the council saying it would do so closer to the launch.
The National Strategic Plan is one of the many plans the government is implementing. Early, this month, Health Minister Aaron Motsoaledi announced the introduction of fixed-drug combination ARV therapy.
Patients living with both HIV and TB, have started being treated on the new therapy.
Fixed-drug combination therapy is a combination of three crucial antiretroviral medications in one tablet, taken only once a day.
This eliminates the need for patients to take three or more pills at various intervals per day.
19 April 2013
From the Business Day Live
Written by Sonke Gender Justice Network
Sonke Gender Justice Network, the MenEngage Africa Network and the Women’s Health Research Unit at the University of Cape Town are proud to host the second MenEngage Africa Training Initiative course: ‘Masculinities, Leadership and Gender Justice in Sub-Saharan Africa’, to be held from 16-26 September 2013 at the University of Cape Town in South Africa. This follows the highly successful pilot course that took place in August 2012.
To apply for this training course, complete the online application at:www.menengage.org/mati2013application.
For further information, please go towww.mengage.org/mati2013course or refer to the attached document.
About the course
‘Masculinities, Leadership and Gender Justice in Sub-Saharan Africa’ is a short, intensive, ten-day residential course which seeks to expand the skills and knowledge of women and men in the Sub-Saharan Africa region to scale up work on engaging men and boys in gender equality, and build a network of leaders and gender justice advocates. In so doing, it aims to strengthen existing work on the greater involvement of men and boys in the prevention and response to sexual and gender-based violence, sexual and reproductive health and rights, HIV and AIDS, fatherhood, LGBTI rights and other issues pertaining to gender equality.
The course will incorporate a mix of thematic and skills-building sessions – covering both theoretical and practical components – as well as a site visit and daily opportunity for reflection. Thematic sessions will address the topics mentioned above, while the skills building sessions will specifically address leadership (including youth leadership), organisational development, research methods, advocacy, resource mobilisation and monitoring and evaluation.
As part of the training, participants are expected to submit a ‘Project for Change’ proposal, which will be refined during the course and, most importantly, implemented within their respective organisations once the course is completed. The Project for Change is a project or programme that is applicable to engaging men for gender equality. It can focus on sexual and gender based violence, HIV and AIDS, sexual and reproductive health or, LGBTI rights to name a few potential thematic areas. The project can be an existing one that needs to be expanded or strengthened, or a new initiative that must be implemented upon completion of the course. Through the implementation of the Project for Change, it is hoped that participants will be able to practically employ the additional skills and knowledge gained from this training.
To assist participants with the implementation of their Projects for Change, the course incorporates a six month Mentorship Programme. This mentorship component is a critical aspect of the training as it seeks to provide participants with ongoing support and guidance as they implement their projects at the conclusion of the training. Participants can elect their own mentor or have one appointed for them. Ultimately, certification for the MenEngage Africa Training Initiative (MATI) will be based on satisfactory implementation of the Project for Change and thorough engagement in the Mentorship Programme.
The organisers trust that this course will contribute to the strengthening of both individual and organisational capacities, and it is with great pleasure you are hereby invited to apply to attend.
Summary of the first course
From 20-30 August 2012, the first MenEngage Africa Training Initiative course ‘Masculinities, Leadership and Gender Justice in Sub-Saharan Africa’ took place at the University of Cape Town in South Africa. It brought together 23 participants (14 males and 9 females) from 13 African countries. Course content was delivered by global and regional experts and leaders in the fields of gender, human rights and social justice, for example, on topics such as ‘Why Engage Men?’ and ‘Gender, Culture, Tradition and Religion.’ Evaluations from the first course indicated that participants found the training very useful and it increased their knowledge and skills by 41 %. This is a positive outcome demonstrating that the modules on the course were effective in transferring knowledge and skills to participants on how to work with men and boys for gender equality.
The course is intended for gender activists, programme staff and project managers from women’s rights, children’s rights, sexual and reproductive health and rights, HIV and AIDS, and LGBTI organisations, youth leaders, government officials, UN Agency representatives, donors, academics and media advocates.
Who is eligible?
The ideal candidate will:
- Work in a field where they can influence gender justice and gender equality through their positions within non-governmental organisations (NGOs), community-based organisations (CBOs), government, UN agencies, donors, academic institutions, faith based organisations, juridical systems or other relevant organisations in Sub-Saharan Africa
- Have a minimum of 3-5 years work experience in gender, advocacy, human rights, social justice and/or sexual and reproductive health and rights issues
- Demonstrate commitment and interest in strategies and programmes aimed at engaging men for gender equality within Sub-Saharan Africa
- Have proven and demonstrable leadership experience/skills
- Have a basic understanding of gender issues, particularly around gender justice
- Demonstrate an understanding, commitment and willingness to be part of an intense ten day residential course
- Have an innovative proposal for a ‘Project for Change’, to be implemented on completion of the course
- Have the support of their organisation for both participation in the course and implementation of their Project for Change (where applicable)
- Hold a Bachelor’s degree in international relations, human rights, health rights, gender or other relevant fields (practical experience will be taken into account in lieu of an educational background)
- Be fluent in English
- Have interest/experience in running training courses
There are no registration fees. Applicants are requested to cover all travel-related costs in full. Accommodation and course costs will be covered by the hosts.
A very limited number of scholarships to cover the full cost of participation are available. The hosts encourage ALL interested parties to apply.
To apply, please go to http://www.menengage.org/mati2013application to fill out the on-line application form.
Applications are to be completed by no later than 31 May 2013. Once completed, you will receive an email confirming receipt of your application. Successful candidates will be notified by no later than 1 July 2013.
For further information, kindly contact Tanya Charles at email@example.com
9 May 2013
By New Vision
Uganda has been described as the Pearl of Africa. However, in this beautiful land, there are a number of harmful cultural practices that make it a place no child would want to live in. As the third series ofthe Tumaini Awards is launched, Shami lla Kara explores how Uganda Youth Development Link, a nongovernmental organisation, is helping youth find meaningful ways of earning a living as a means of fighting commercial sexual exploitation of children.
Commercial sexual exploitation of children is an insidious cancer that is stealthily spreading and eating deep into the fabric of our society. Cited in the International Labour Organisation’s (ILO) Worst Forms of Child Labour Convention 1999 (No.182) that ILO member states must eliminate without delay, this practice violates the rights of the sexually exploited children, scarring their psychological, physical and social status, thereby relegating them to sub-human living.
ILO defines commercial sexual exploitation of children as “the exploitation by an adult with respect to a child or an adolescent, female or male, under 18 years; accompanied by a payment in money or in kind to the child or adolescent (male or female) or to one or more third parties.”
According to a 2011 study by the Uganda Youth Development Link (UYDEL), an organisation that is involved in fighting and increasing awareness about this practice, commercial sexual exploitation in Uganda is on the increase, with statistics revealing that there are 18,000 children affected, from 12,000 in 2004.
Another study, carried out by the Jinja Network for the Marginalised Child and Youth in 2011, revealed thatcommercial sexual exploitation in Jinja was rampant, with young girls being exploited by trailer drivers, tourists and businessmen, among other abusers.
The UYDEL report, titled, Commercial Sexual Exploitation of Children in Uganda, further shows that the helpless children, who fall in the 14-17 age bracket, endure sexual exploitation for a pittance and risk their lives to earn between sh2,500 and sh5,000 per client.
This exposes them to a high likelihood of unwanted pregnancies, being beaten by the clients or gang-raped and contracting sexually transmitted diseases that include HIV/AIDS.
According to ILO, victims of this practice include “runaways, children from dysfunctional families, children of sex workers, homeless children, AIDS orphans, migrant children, children from ethnic minorities and out-of-school children.”
In Uganda, the UYDEL 2011 report reveals that children, who did not attend school and were engaged in economic activities such as bartending and working in lodges were also vulnerable to being sexually exploited for money.
The report further discloses that the practice is prevalent in urban areas such as Kampala and it has even infiltrated schools.
It adds that victims of the practice are usually trafficked children, orphans, and children coming from economically underprivileged situations.
What the NGO does
Rescuing children from commercial sexual exploitation is one project under the child rights protection programme of the NGO. The programme also covers child trafficking and child labour.
The NGO is involved in other programmes that include HIV prevention among children and a youth programme; the alcohol and substance abuse programme and the adolescent, sexual and reproductive health programme.
It is also involved in social research and has published several publications covering childrelated topics.
Founded in 1993 by Rogers Kasirye, who is also its executive director, the NGO’s mission is “to empower disadvantaged and vulnerable youth with cognitive life and livelihood skills so as to make them useful citizens of Uganda.”
UYDEL’s areas of operation include Kampala, Mukono, Wakiso, Busia and Kalangala.
It employs 57 personnel that include psychologists, social workers, instructors and artisans.
UYDEL’s target beneficiaries are disadvantaged and vulnerable youth aged between 10 and 30 years found living on the streets, in slums, teenage mothers, youth who have dropped out of school and those from poor families.
The organisation also works with parents and other community members for the wellbeing of the youth. In 2011 alone, UYDEL admitted 1,812 vulnerable youth to its programmes
The programmes are implemented through the NGO’s outreach post in Bwaise and its five drop-in centres, four of which are in Kampala and include, Nakulabye, Nateete, Makindye and Kamwokya, as well as one in Mukono district.
Additionally, UYDEL also has a rehabilitation and vocational centre at Masooli parish in Wakiso district, where youth who have no where to live are given temporary accommodation
The centre also trains the youth in skills that include plumbing, hairdressing, catering, welding and metal fabrication and tailoring.
The NGO further finds field placements for at least six months for the youth.
This approach has supported strong and sustained behavioural change and helped withdraw adolescents and youth who were engaged in child labour and other exploitative activities to find meaningful ways of earning a living
Besides vocational skills training, the youth also access psycho-social support services, counselling services, medical care such as the testing and treatment of sexually transmitted infections and therapy at the centre in Masooli.
Through performance therapy, rehabilitated children are empowered to tell their stories, an initiative that has reached out to over 1,000 youth in eight slum communities.
UYDEL also engages the youth in behavioural change communication sessions, which aim at encouraging sustained behavioural change.
These sessions cover topics such as drug abuse, children’s rights, sexual and reproductive health and life skills. These sessions are also conducted in the communities for youth, who cannot come to the centres through community outreach dialogues.
UYDEL is also involved in advocacy activities that include creating awareness about Article 33 of the United Nations Convention on the Rights of the Child and work with parents, children and communities to support prevention programmes advocating for drug-free environments.
The NGO has, of recent, been included in a pilot campaign by the International Olympic Committee to help fight substance use in youth through sports.
7 May 2013
More than 120 HIV clinicians, policy makers, and laboratory scientists gathered in Cape Town, South Africa from 18-20 April 2013 at the invitation of the African Society for Laboratory Medicine (ASLM), the World Health Organization’s Regional Office for Africa (WHO-AFRO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Society for AIDS in Africa (SAA), and the Southern African HIV Clinicians Society for a three-day consultation to discuss how best to design and implement effective and sustainable HIV viral load testing programmes in Africa.
Convening under the theme “Viral Load Testing in African HIV Treatment Programmes,” healthcare professionals and stakeholders from more than 20 African Ministries of Health and other global partners developed consensus strategies for strengthening or expanding HIV viral load testing capacity in Africa; attendees also worked to enhance partnerships to support the scale-up of this important diagnostic test and monitoring marker of HIV infection.
“Viral load is the best tool we have for monitoring treatment success and deciding when to switch to new antiretroviral therapy (ART) medications,” said Dr. Gottfried Hirnschall, Director, HIV/AIDS Department, World Health Organization. “To better support people on ART and support the preventive benefits of ART in reducing HIV transmission, improving access to simple, affordable viral load testing in resource-limited settings is a priority for the coming years.”
“Ensuring that people living with HIV have access to safe and accurate monitoring of the virus is a basic human right,” said Michel Sidibé, Executive Director of UNAIDS. “Testing needs to be simpler, quicker, more cost effective and more widely available, only then will the full benefits of antiretroviral therapy be realised.”
As part of an overall effort to achieve an AIDS-free generation, many countries in Africa have started to adopt and implement HIV viral load testing programmes. A number of challenges exist which limit test access and cost-effectiveness. This consultative meeting aimed to:
• Develop strategies and recommendations for adopting and implementing HIV viral load testing policy, in consideration of World Health Organization guidelines;
• Review operational, technical and financial challenges to expanding access to HIV viral load testing in Africa, especially in difficult to reach areas;
• Discuss strategies for development of technical skills and technology transfer; and,
• Develop strategies to utilise existing capacity of and implement future point-of-care HIV viral load technologies.
Speakers and attendees included representatives from African Ministries of Health, the South African National Health Laboratory Service, World Health Organization, UNAIDS, United States Centers for Disease Control and Prevention, government global health programmes, private organisations and industry.
“As African health programmes continue to achieve marked success concerning patient outcomes, mature laboratory programmes remain integral to this achievement. ASLM is the first pan-African organisation committed exclusively to advancing and guiding laboratory medicine,” says Dr. Tsehaynesh Messele, ASLM Chief Executive Officer. “Laboratory services play a pivotal role in maintaining strong, healthy communities, part of which is monitoring HIV viral load in patients.”
4 May 2013
On May 5th, International Day of the Midwife, AAI Commends Increased Accountability to Maternal Health in Malawi.
By Agnes Mizere
As midwives around the world celebrated the ‘International Day of the Midwife’ on Sunday, Malawian chiefs continued their daily campaign to save the lives of expectant mothers to further reduce the country’s maternal mortality rate.
Malawi’s maternal mortality rate has reduced from 675 out of 100,000 to 450 out of 100,000.
With the deadline for the Millennium Development Goals (MDG) rapidly approaching in 2015, the message that “the world needs midwives more than ever” is becoming more urgent including in Malawian villages.
Previously many village women were relying on Traditional Birth Attendants (TBA) during labour and delivery until they were stopped from assisting them. Instead village women are being encouraged to deliver their babies in hospitals and clinics under the supervision of midwives.
Under the Presidential Initiative on Safe Motherhood and Maternal Health, Senior Chief Kwataine explained how chiefs are determined to make sure “no woman dies while giving birth” and that plans are underway for more women to graduate as community midwives to replace TBAs in different villages.
He was speaking after a sensitization meeting in Traditional Authority Mwambo’s area in Zomba where 19 traditional leaders exchanged notes on how best to tackle maternal health.
Among other things, the chiefs agreed to form village committees to target those at grass-root level and another one at T/A level. The idea was to encourage villagers to send expectant mothers to hospitals or clinics.
“If approached TBAs should tell the expectant woman to go to hospitals or clinics where there is trained personnel. The TBAs are not supposed to put their hands on any woman who is pregnant. Gone are those days, we don’t need them to deliver babies so TBAs should find another job. We want young blood, women with a credit in MSCE to graduate as community midwives to replace TBAs in different villages,” stressed Kwataine when asked.
He emphasized the need for pregnant women to deliver safely as the main reason why the traditional leaders as owners and custodians of culture were now playing a leading role to ensure women do not die during childbirth.
According to Kwataine, the rate rose to 1120 per 100,000 some years back but with their Presidential Initiative on Safe Motherhood and Maternal Health, the messages are going down to Traditional Authorities, village heads and “those responsible for the pregnancies including their husbands.”
He also mentioned the need to stop girls under the age of 18 from getting married as statistics show them being vulnerable and facing potential complications during childbirth
5 May 2013
By Daniel Wasonga
Non-communicable diseases (NCDs) are not passed from person to person, and include those such as cancer, diabetes and hypertension. They may be of long duration and slow in progression, or in some instances, result in rapid death. NCDs are categorized mostly by their non-infectious causes and not their duration. Like all diseases that develop slowly and worsen over a long period of time, NCDs require chronic care management.
Expectant mothers, especially those beyond the first 42 days, are uniquely vulnerable to NCDs and require proper maternal care at home or in healthcare facilities. Exposure of these women to any disease is detrimental to their health and that of their unborn babies. Chronic diseases increase the health risks of expectant mothers and without adequate care, maternal mortality will rise beyond the current undesirable levels, especially in the developing economies.
NCDs disproportionately affect the low and middle income countries, where 80% (29 million) of deaths related to these diseases occur. Women in general already bear the burdens of NCDs, which are compounded by myths and misconceptions. Social and cultural taboos often prohibit women from opening up about issues such as family planning and unwanted pregnancies, which impairs the few efforts being made at improving these conditions. Furthermore, the constant “blame game” has not really helped in bringing stakeholders together in finding solutions for the specific issue of maternal mortality related to NCDs.
The cost of treatment is high. For expectant mothers who are the sole breadwinners in their households, getting proper care for NCDs may be difficult. This is especially the case in Africa, where cancer, cardiovascular disease, chronic respiratory disease and diabetes are leading causes of death in women. Worldwide, these diseases kill 18 million women yearly.
The impact of these diseases on society as a whole is enormous – maternal mortality goes beyond its consequences on individuals. The loss of women who are at their prime would leave an economic and social gap in society. Ignoring this aspect of the link between maternal mortality and NCDs is a mistake our decision makers and policy formulators should not make.
The overwhelming emphasis on reproductive and maternal health has pushed the special focus on NCDs to the periphery, an approach that is not effective. Maternal mortality remains the least achieved of the Millennium Development Goals (MDGs) and multi-faceted solutions promise better returns. A comprehensive approach to women’s health that goes beyond the maternal focus is essential and much more sensible. The current interventions are too rigid and limited to the MDGs with little or no focus on post-MDG initiatives.
Although some achievements have been made in Africa on reversing maternal mortality, the progress has been limited and unequally distributed within and among countries. The upcoming Conference of African Ministers of Health should focus on compounding the gains made within countries and ensuring there is no disconnect between government and initiatives taken at the grassroots level. In the push towards achieving the MDGs, Africa needs renewed commitments from the governments and feasible, effective monitoring and evaluation mechanisms. Best interventions should also be shared between countries to underline the collective efforts in eradicating maternal mortality.
23 April 2013
IN RWANDA, NOTWITHSTANDING CONSIDERABLE INCREASES, CONTRACEPTIVE USE NOT KEEPING PACE WITH DESIRE FOR SMALLER FAMILIES.
Complications from Unsafe Abortion Harm Women and Drain Health Resources
Findings from the first national study on the incidence of unintended pregnancy and abortion in Rwanda show that nearly half (47%) of all pregnancies in the country are unintended. The report, Unintended Pregnancy and Induced Abortion in Rwanda: Causes and Consequences, was issued by the National University of Rwanda School of Public Health (NURSPH) and the Guttmacher Institute, which jointly conducted the study.
These unintended pregnancies are occurring despite the county’s remarkable progress in increasing contraceptive use over the last decade. In 2010, 44% of married or cohabiting Rwandan women were using a modern method of contraception, compared with just 4% in 2000. However, the increase in contraceptive use has not kept pace with the growing desire for smaller families and does not extend to the increasing proportion of unmarried young women who are sexually active.
In 2010, an estimated 19% of married women (250,000) and 56% of unmarried sexually active women 15-29 years old (40,000) had an unmet need for contraception—they wanted to avoid pregnancy but were not using a contraceptive method.
The findings were presented in Kigali on March 23 at a Family Planning Day event organized by NURSPH. The event brought together key stakeholders, including Ministry of Health officials, UN representatives, leading NGOs working on health issues and reproductive health advocates, who reviewed the most recent evidence on unintended pregnancy and unsafe abortion and developed a set of policy recommendations to better address the reproductive health needs of Rwandan women. Among these recommendations were expanding provision of postabortion care; making emergency contraception widely available throughout the country; better integrating family planning services and postabortion care; and educating women and medical and law-enforcement professionals about the conditions under which abortion is legal in Rwanda.
“The study’s findings indicate that Rwanda must build on the strong progress made over the last decade and further strengthen its family planning policies and programs,” said Paulin Basinga, formerly with NURSPH and lead author of the report. “Expanding the range of contraceptive options available to women and targeting those women who are at highest risk of unintended pregnancy are especially important if we are to reduce the rate of unplanned pregnancies in the country.”
The researchers found that approximately 22% of all unintended pregnancies end in induced abortion. Rwanda’s abortion rate—25 per 1,000 women of reproductive age—is significantly lower than that of Eastern Africa (38 per 1,000), and lower than that for the African continent as a whole (29 per 1000). Although the abortion rate is relatively low, abortion still places a heavy burden on Rwandan women and the health care system because virtually all abortions occur outside of the formal health system where safety cannot be assured.
In 2009, 24,000 of the approximately 60,000 women who had an abortion suffered complications that required medical treatment. Of these, just 17,000 received adequate treatment in a health facility; thus, 30% of the women who needed care did not receive it. According to the study, this was most likely a result of insufficient access to postabortion care and reluctance on the part of women to seek treatment, which could potentially expose them to harsh judgment or even prosecution for engaging in a stigmatized and illegal act.
Poor Rwandan women, in urban and rural areas, are far more likely to experience complications (54–55%) than wealthier women in both rural (38%) and urban areas (20%). According to experts surveyed, poor women are most likely to self-induce or rely on untrained providers such as traditional healers. Abortions from these sources have the highest estimated rate of complications—61–67%.
“The Rwandan government has already started to take action to improve access to postabortion care and we hope these findings provide further guidance on how to strengthen efforts to ensure that all Rwandan women receive the care they need,” said co-author Ann Moore of the Guttmacher Institute.
For more information:
Click here for the full report Unintended Pregnancy and Induced Abortion in Rwanda: Causes and Consequences, also available in French
After the March 2013 launch of AAI’s Country Coordinating Mechanisms (CCMs) Community Consultation Report entitled “Who is really affecting the Global Fund decision making process?” AAI has begun conducting advocacy around the findings. The objective is to use the research as an accountability tool, acting as a best-practice and gaps analysis evidence base for improving the meaningful participation processes of women, girls and those marginalized by their sexual orientation in Global Fund processes.
Download the full report: Who is really affecting the Global Fund decision making processes? A Community Consultation Report
Download the survey report: Who is really affecting the Global Fund decision making processes? A Quantitative Analysis of CCMs
Download the media release: AIDS Accountability International on the Global Fund
To achieve this, AAI conducted its Global Fund Advocacy Week at the Global Fund Secretariat in Geneva, Switzerland, from 15-19 April 2013, since engaging Fund Portfolio Managers and Senior Technical Advisors on gender and key populations is critical for holding both the CCMs and the Global Fund Secretariat accountable for their obligations to marginalized populations. AAI also endeavoured to connect with other partners in Geneva, such as the World Young Women’s Christian Association (World YWCA), the International Labour Organization (ILO) along with funding partners and independent stakeholders.
On Monday 15 April 2013, AAI began its Global Fund Advocacy Week in Geneva by meeting with Nyaradzayi Gumbonzvanda (General Secretary) and Hendrica Okondo (Global Programme Manager SRHR & HIV Focal Point for Africa) at the World Young Women’s Christian Association (World YWCA). The discussion focused on reducing the distance for dialogue between young girls and policy makers, creating spaces of “conversational accountability” and “intergenerational dialogues” so that young girls can have the opportunity to engage with decision makers, but in less technical forums. Leadership was also a topic of strategic thinking, with AAI and the YWCA brainstorming around how to redefine leadership so that it does not rest on the pillars of education or income.
The following day, AAI met with a team of senior technical specialists at the Global Fund Secretariat. Speaking with Linda Mafu (Head, Political and Civil Society Department), Sara Davis (Senior Specialist in Human Rights and Equity), Motoko Seko (Gender and Human Rights Specialist) and Mauro Guarinieri (Senior Advisor, Community Systems Strengthening and Civil Society), AAI pushed for greater accountability towards Human Rights in Global Fund processes. It was agreed during the meeting that viewing human rights through a public health lens can often be highly effective in certain contexts where the rights and women, girls and LGBT people can be politically and culturally sensitive. This supports the research findings in AAI’s CCM Report. AAI and the Global Fund also discussed the new CCM guidelines (2010) which say that CCMs should demonstrate effort to include key affected populations in the country dialogue process. In terms of the way forward, it was raised that Fund Portfolio Managers might benefit from capacity building on how to engage better with civil society outside of the CCM, as well as on human rights and key populations issues.
Continuing with Global Fund Advocacy Week, AAI met with two Fund Portfolio Managers (FPMs), Richard Cunliffe (Botswana, Swaziland) and Viviane Hughes-Lanier (Niger). At these two meetings, AAI consulted with the FPMs about how best to strengthen Africa’s CCMs through improved participation of marginalized groups. The result was a recommendation from the Secretariat to build the capacity of civil society to become principal or sub-recipients, train key populations CCM members on how to influence a meeting, and train the CCM Chairs and Co-Chairs on how to run a meeting that includes discussions of strategic thinking around human rights considerations.
At the end of the week, solid plans had been made to move forward with the project in a manner that continues to involve the Secretariat in Geneva. This way, AAI can increase its impact in pushing for greater accountability to women, girls and SOGI groups from both the CCMs in country, and the FPMs and Technical Specialists at the Global Fund in Geneva.