Civil Society Regional Consultation on Universal Access in West and Central Africa
3-4 March 2011, Dakar, Senegal
On the initiative of the African Council of AIDS Service Organizations (AfriCASO), International HIV/AIDS Alliance (IHAA) and Enda Santé, with the support of the UNAIDS Regional Office for West and Central Africa, about fifty representatives from the main civil society organizations in West and Central Africa involved in the responses to HIV met on 28 February at the Pullman Hotel in Dakar (Senegal) in the framework of the regional consultation of the civil society on universal access.
The objectives of this consultation were to:
- Identify the different sectors where progress has been made and how the different partners and civil society organizations in particular are striving to meet the commitments related to Universal Access in West and Central Africa.
- Identify the obstacles impeding the full participation of the civil society in the acceleration of universal access in countries of the sub-region and propose the most appropriate solutions.
The discussion focused on:
- the thorough review of the situation and response of the epidemic in West and Central Africa, particularly in the areas of prevention, access to treatment and care, allocation and management of resources, governance and accountability;
- the process that should lead to universal access, including the forms and quality of the contribution of the civil society to the said process;
- the modalities of integration and synergy between the progress towards universal access and strategies for achieving the Millennium Development Goals (MDGs);
- the analysis of obstacles to community action in favor of universal access and identification of priority actions up to the year 2015.
To implement the new vision of UNAIDS, namely zero new infection, zero AIDS-related death and zero discrimination, the civil society identified, at the end of its discussions, the main obstacles to community action in favor of universal access in West and Central Africa:
- political and institutional instability in most countries of the sub-region, resulting in precariousness of the mechanisms and systems put in place in response to HIV;
- the weakness of the community systems in certain countries does not promote optimization of the community contribution;
- the high dependency of health programs, particularly HIV control programs, on external funding compromises the real appropriation of the response by the countries and sustainability of the resources;
- the persistence of stigma and discrimination, particularly against vulnerable population groups, and the existence of punitive laws associated with the transmission of the virus limit interventions targeting the highest-risk populations and their involvement in the response;
- highly-limited access to sustainable and foreseeable financial resources;
- inadequate good governance and accountability mechanisms, creating difficult and, sometimes, extreme situations;
- the perception of a low prevalence in the sub-region puts it at a disadvantage in the area of resource mobilization;
- inadequate allocation of resources in relation to the driving forces of the epidemic constituted by the key populations (MARPs);
- weakness of the drug management systems (supply and distribution), causing repeated stock-outs of ARVs and other necessary commodities for biological follow-up;
- inadequacy in the coordination and communication of the national responses.
To provide an adapted, strong and courageous response to this situation so as to ensure universal access in West and Central Africa by 2015, the civil society has made recommendations and proposed priority actions to governments, the international community and the African Union:
1. General Recommendations:
- Encourage ECOWAS and ECCAS to put in place a structure for producing medicines in the sub-region;
- Encourage, document and extend the good community initiatives;
- Further promote GIPA (Greater Involvement of PLWH) at all levels.
2. Revolution of the prevention
- Create and revitalize a great social movement in West and Central Africa in favor of PMTCT, with Nigeria as leader, with a view to eliminating vertical transmission from mother to child;
- Remobilize the youth, through positive transformational leadership, and further encourage the promotion of prevention at the work place in order to break the chain of sexual transmission;
- Ensure adequacy between determinants of the epidemic and allocation of resources.
3. Human rights and social protection
- Increase the technical and financial resources intended for the promotion and protection of human rights and gender equity;
- Consolidate and extend the partnership between human rights defense institutions/organizations, civil society organizations intervening in the response to VIH, judiciary and para-judiciary institutions and the security forces in the countries at the central et decentralized levels;
- Ensure efficient coordination and better monitoring of issues related to the respect of human rights and gender equity by civil society organizations;
- Act as a watchdog for the respect of the human rights of the key populations (MARPs).
4. Treatment, care and support
- Institute a national fund for financing medicines and ARVs;
- Guarantee access to quality medicines and care at affordable prices, including second and third generation treatments, as well as biological follow-up;
- Ensure the maintenance of the equipment;
- Remobilize persons living with HIV through a transformational positive leadership for improving the quality of the offer of care and support at community level;
- Put an end to the unacceptable situations of drug stock-outs associated with the management system and political instability of the States – tolerance ZERO.
- Ensure significant increase of the contribution of States to the funding of HIV programs at country level and institute internal audit, monitoring and early warning systems;
- Increase access to funding for civil society organizations in order to have a sustainable impact on the communities and individuals;
- Get parliamentarians to vote an adequate annual budget to the health sector for the achievement of MDGs 3, 4, 5 and 6;
- Integrate HIV/AIDS into the African Peer Review Mechanism (APRM) in West Africa;
- Establish observatories and early warning systems to ensure efficient governance and improvement in the management of financial resources;
- Seize the opportunity of the ongoing reform of the United Nations System and the Global Fund to review the national architecture of management, coordination and control of medium and long-term funding (Global Fund, PEPFAR, etc.).
6. AIDS & MDGs
- Ensure efficient involvement of the civil society in the process of development and review of national strategies and promote the relationship between MDGs 3, 4, 5 and 6;
- Ensure the integration of HIV into other health programs (TB, SRH, gender) for the attainment of the objectives of universal access and MDGs.
In the light of the above obstacles and recommendations and to contribute to the zero objective of the UNAIDS strategy for the period 2011-2015, community actors in the sub-region pledge to implement the following strategic actions:
- Mobilize the communities around prevention, particularly PMTCT through innovative strategies;
- Ensure the protection and promotion of human rights, particularly among the most vulnerable groups: sex workers, MSM, disabled persons,…
- Capitalize on the great experience of civil society organizations intervening in the responses to HIV and promote greater integration of HIV into health and development programs and contribute to the attainment of the other MDGs, particularly MDGs 4 and 5 (SIDAplusMDG);
- Act as a watchdog to ensure good governance and more efficient management of programs and funds, notably through the establishment of observatories;
- Compel governments to undertake the “Debt for Health” negotiation with donors to ensure the reinvestment of the money into MDGs 3, 4, 5 and 6;
- Encourage the African private sector and mobile telephone service providers (GSM) to make a significant contribution to the funding of health, in general, and the response to HIV, in particular.
Health is a human right. The demand of communities for better access to quality health services is, therefore, legitimate. Moreover, AIDS control participates in the emergence of our countries in quest of economic and social development, which should be translated into human development and, surely, into a re-conquest of human dignity.
In the name of these principles and prospects, gone is the time of compromises, which lead to compromise of principles in the efforts to be provided by all stakeholders in the response to HIV. Hence, civil society actors in West and Central Africa are determined to put their energy, their intelligence and their know-how and their solidarity to oppose any venture that tends to compromise the achievement of universal access, up to the last breath that God may grant them.
But they are also determined to invest this energy, intelligence, know-how and solidarity in the service of any initiative that can accelerate the progress towards universal access in the sub-region. This will effort will be sustained until the effective and sustainable achievement of access to HIV prevention, treatment and care services for all those who need them.
Acting together to break with fatality.
The struggle continues!
Done in Dakar on 28 February 2011