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