not valid -- Senegal

A regional platform to accelerate access to HIV testing and antiretroviral therapy in western and central Africa was launched by UNAIDS and partners on 7 December in Dakar, Senegal. The platform will enable scale-up of the test and treat approach, which calls for increasing HIV testing and immediately supporting people who test HIV-positive to have access to life-saving treatment.

The regional platform is an innovative mechanism—both a think tank and a task force—that aims to identify and analyse bottlenecks and quickly propose corrective actions to increase access to HIV testing, treatment and viral load tests. The platform will encourage operational research and new solutions, support monitoring to measure progress and allow partners to share experience and best practices. It will also support countries in mobilizing resources for a sustainable AIDS response.

Partners include United Nations agencies, national AIDS committees, technical and financial organizations, civil society and community organizations, and laboratories, researchers and experts.

All partners are committed to collectively contribute to this platform in order to meet the UNAIDS 90–90–90 treatment target in western and central Africa and put the region on track to end the AIDS epidemic as a public health threat by 2030.  

To support the capacity of countries to integrate human rights in their Fast-Track approaches to HIV programming, UNAIDS and the Alliance Nationale Contre le Sida (ANCS) Senegal held a three-day capacity building workshop in Dakar, Senegal from 22 to 24 June 2015.

The workshop highlighted the continued political, legal, cultural, social, and programmatic challenges that hinder efforts to address the HIV epidemic. Participants pointed out that existing programmes to address these challenges in Western and Central African countries remain largely insufficient and inadequate.

According to participants, human rights, gender equality and the involvement of people living with HIV and key populations are often cited in HIV planning documents. Yet, they are rarely translated into specific human rights programmes. And where these programmes are included in the national HIV planning documents, they are not addressed at the costing and budgeting phase, there are little metrics to track progress, and when implemented, these programmes are often not evaluated or taken to scale.

Participants

The workshop brought together more than 50 participants from 10 countries across Western and Central Africa including Burkina Faso, Cameroun, Chad, Côte d’Ivoire, the Democratic Republic of the Congo, Ghana, Guinea Bissau, Mali, Nigeria and Senegal.

Participants included decision makers and technical experts involved in HIV strategic planning at country level, officials from national AIDS commissions, Ministries of Health and Justice, people living with HIV and other key populations and community-based organizations. A wide range of technical and other partners including UNDP, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Office of the High Commissioner for Human Rights, the International HIV/AIDS Alliance and the Technical Support Facility for west and central Africa also participated in the workshop.

This workshop was the seventh and last in the series of regional workshops held since 2011, with support from the Ford Foundation.  

Key messages

• Participants stressed the importance of the workshop in highlighting approaches and tools for ensuring the inclusion of programmes to advance human rights and gender equality.

• The workshop led to the elaboration by each country team of a national action plan with specific commitments to integrate human rights and gender programmes in their national AIDS response that clearly spells out partners and timelines for its implementation.

• The meeting concluded with the development and endorsement of the “Dakar Declaration on scaling up the HIV response, realizing the human rights and full access to services for everyone in West and Central Africa” in which participants committed to specific actions in their respective countries to advance evidence-informed and rights-based programmes in national HIV responses.  

Valuing and increasing the participation of women and youth in the health sector is essential to achieving sustainable results, participants heard at the fifteenth Francophonie Summit, held in Dakar, Senegal, from 25 to 30 November.

In parallel with the Francophonie Summit, UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the Senegalese Ministry of Health, the French Ministry of Foreign Affairs and International Development, the GAVI Alliance and UNITAID organized a high-level meeting on 26 November that brought together national and international dignitaries. They emphasized the importance of strengthening health systems in La Francophonie and of involving women, youth and, more widely, communities in health issues.

UNAIDS Executive Director Michel Sidibé spoke of the need to place on the political agenda the response to major epidemics. Participants said that the Ebola virus disease outbreak, which to date has killed more than 5500 people in West Africa, demonstrates the fragmentation of leadership and weaknesses of health systems. These factors and a lack of financial resources have also affected the HIV response in the past.

The post-2015 development goals, which should promote a new architecture for global health, should allow the translation of lessons learned from these outbreaks into rapid action.

Putting human rights issues and health at the heart of concerns in the post-2015 development agenda will also make it possible to end the AIDS epidemic by 2030, which will mean a redistribution of opportunities. During his visit to Senegal, Mr Sidibé and Mark Dybul, Executive Director of the Global Fund, visited the Ambulatory Treatment Centre in Dakar, which treats a range of infectious diseases and where more than 51 000 HIV tests were carried out in 2013.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

More than 500 young Africans are gathered in the Senegalese capital of Dakar to participate in the 4th Pan-African Youth Leadership Summit taking place from 13-17 January 2014. Participants are sharing ways to effectively contribute to the acceleration of the Millennium Development Goals and play an important role in shaping the post-2015 development agenda. 

The event, which runs under the theme "Youth unemployment in the post-2015 development agenda", is organized by the Pan-African Network of Youth Leaders to the United Nations in collaboration with UNFPA and UNAIDS.

L to R: Mr Lov Verma, Secretary and Director General, National AIDS Control Organization, India and Chair of the 32nd UNAIDS Programme Coordinating Board, Marie-Francke Puruehnce, Executive Secretary, National Council for AIDS response, Republic of Congo and UNAIDS Executive Director Michel Sidibé. Credit: UNAIDS

The Republic of the Congo and the Republic of Senegal have become the first African countries to financially contribute to UNAIDS. These historic decisions are in line with the leadership demonstrated by Member States of the African Union in taking forward the Roadmap on Shared Responsibility and Global Solidarity.

It is also an illustration of the firm commitment by the Governments of the Congo and Senegal to play an active role in policy discussions on the UNAIDS Programme Coordinating Board.

“As Africa assumes its rightful place on the global stage, I believe that the decision by Congo and Senegal to contribute to UNAIDS demonstrates Africa’s leadership in the international AIDS response,” said UNAIDS Executive Director, Michel Sidibé. “We hope that African countries will continue to contribute and to play an increasingly prominent policy role in the UNAIDS Board,” he added.

The Roadmap, which was adopted in July 2012 during the 19th Summit of the African Union in Addis Ababa, Ethiopia, offers a set of African-owned solutions to enhance sustainable responses to AIDS, TB and malaria. Structured around three strategic pillars—health governance, diversified financing and access to medicines—the Roadmap defines goals, expected results, roles and responsibilities to hold stakeholders accountable over a three-year time frame, through 2015.

The Roadmap also calls on African Governments and international partners to jointly finance the funding gap by investing their “fair share”, taking into account their capacities and prior commitments.

UNAIDS Executive Director Michel Sidibé (left) met with the Prime Minister of Senegal, Mr Abdoul Mbaye, on 15 October.

Meeting on 15 October with the Prime Minister of Senegal, Mr Abdoul Mbaye, UNAIDS Executive Director Michel Sidibé commended the leadership of Senegal for its success in keeping national HIV prevalence low, at approximately 0.7%.

“Senegal is a model for this sub-region,” said Mr Sidibé. “It has shown that stabilizing the HIV epidemic and reducing the number of new HIV infections is possible. The priority now is to sustain the gains made so far,” he said.

Progress and challenges

In recent years, Senegal has considerably expanded access to antiretroviral therapy (ART), reaching 74% of people eligible in 2011. Between 2006 and 2011, the number of sites offering HIV counselling and testing increased from approximately 100 to more than 1000. In his meeting with the Prime Minister, Mr Sidibé encouraged Senegal’s leaders to move progressively towards routine HIV testing through the use of new technologies.

In 2011, 976 health facilities in Senegal offered services that prevent mother-to-child transmission (PMTCT) of HIV—up from 648 in 2010. Despite progress, national PMTCT coverage remains low, at about 40%. Mr Sidibé commended the progress realized to date while underscoring that extra effort is needed to ensure an HIV-free generation.

Prime Minister Mbaye said that his country was committed to eliminating new HIV infections among children by 2015.  “This will allow us to make the link to HIV testing and reduce maternal mortality,” he added.

Funding the national HIV response

The Prime Minister noted that though Senegal had recently received an HIV grant from the Global Fund to Fight AIDS, Malaria and Tuberculosis, the country would need to seek innovative sources of domestic financing to ensure that its HIV-positive population had access to ART over the long term. In doing so, Senegal could reduce its dependency on external aid for the national HIV response, which currently stands at about 80%, he said.

Mr Sidibé spoke of the need for the local production of antiretroviral therapy—a suggestion well received by the Prime Minister: “It is a very good idea that we will help carry forward. But to achieve a threshold of profitability, we must find sponsors and attract investors. The state is not the solution!” he said.

During his two-day mission in Dakar, the Executive Director attended a UNAIDS regional management meeting and met with the President of the National Assembly of Senegal, Mr Moustapha Niasse.

President of Senegal Macky Sall at Shared Responsibility & Global Solidarity event at UN Headquarters, NYC, on September 26, 2012.
Credit: UNAIDS/B.Hamilton

With new leadership and bold commitments, the Senegal has continued the success of its national AIDS response, keeping HIV prevalence low and earning the recognition of global partners for its progress and achievements.

“This is the time for Africa to intensify its efforts and create a new international compact against AIDS,” said President Macky Sall of Senegal at the recent high-level side event on Sourcing Sustainable Solutions for the AIDS response in Africa at the UN General-Assembly. “With the new vision of Shared Responsibility and Global Solidarity, the African’s Union’s Road Map has enabled Senegal to prioritize HIV prevention and plan to end HIV transmission from mother to child.” President Sall was one of the key African heads of state to join the Chairperson of the African Union, President Boni Yayi and US Secretary of State Hilary Clinton to address this side event that highlighted the AU’s Roadmap on Shared Responsibility and Global Solidarity for the AIDS, TB and malaria response in Africa.

At a recent meeting in Geneva, UNAIDS Executive Director Michel Sidibé also commended the work of Senegal’s National AIDS Council at a recent meeting with its Executive Secretary, Ibrahim N’Doye. During discussions on Senegal’s AIDS response, Dr N’Doye highlighted how political commitment contributed to the scale-up of HIV services in his country.

Under the leadership of President Macky Sall, the contribution of the Government of Senegal continues to increase steadily. The country has also called for greater transparency and initiated a resource tracking exercise with the assistance of UNAIDS aimed at maximizing AIDS investments and impact.

These efforts were recently backed by an audit by the Office of the Inspector General (OIG) of The Global Fund to Fight AIDS, TB and Malaria. Successful with its application for Phase 2 of an on-going HIV grant, Senegal will receive an additional US$ 33 million for the next three years. The renewed grant, approved by The Global Fund board on 24 September 2012, will contribute to financing the implementation of Senegal’s HIV National Strategic Plan.

According to the Global Fund, Senegal has been a model for the HIV response in the West and Central Africa region with a portfolio of well-performing grants, mobilized in-country partners, and a vibrant civil society. The recent report from the OIG highlighted that overall, results in Senegal were encouragingly positive. The OIG was able to confirm that appropriate oversight arrangements had ensured that all grant funds were properly utilized and produced very good results.

The report from the OIG also provided concrete recommendations to both country partners (Country Coordinating Mechanism and Principal Recipients) as well as the Global Fund Secretariat in order to enhance accountability through a more holistic and integrated approach. These recommendations included the need to strengthen financial management capacity of sub-recipients and the need to improve drug management, distribution and storage.

The country has made major efforts in the past five years to scale-up access to HIV prevention, treatment, care and support for its population, with a focus on key populations at higher risk.  It is one of the few countries in the West and Central Africa region, which has collected robust data on hard to reach populations such as sex workers, men who have sex with men and people who use drugs.

Scaling up HIV services

Dr Ibrahim N’Doye Executive Secretary, National AIDS Council of Senegal and UNAIDS Executive Director Michel Sidibé

The country has scaled up access to antiretroviral treatment (ART) substantially and treatment is now widely available in many parts of Senegal. The number of people receiving ART increased from 5500 in 2006 to 18 352 in 2011. Between 2006 and 2010, the number of sites offering voluntary counselling and testing also increased from 109 to 687 and reach the number of 1023 in 2011. The services to prevent transmission of HIV from mother to child were scaled-up from 404 in 2009 to 648 in 2010 and 976 in 2011.

Such combination of efforts is having positive results. According to UNAIDS, HIV prevalence among the general population remains stable at 0.7%, while HIV prevalence among sex workers has decreased from 19.8% in 2006 to 18.5% in 2011 and new HIV infections among youth has decreased.

L to R: Cyril Dubois, Global Fund’s chief of Division, west and central Africa, Minister of Health and Prevention of Senegal, Mr Modou Diagne Fada, UNAIDS Regional Director for West and Central Africa, Dr Meskerem Grunitzky-Bekele.

UNAIDS and the Global Fund have convened a meeting in Dakar, Senegal, to respond to the increasing need for risk management and accountability related to HIV funding. The event brought together more than 300 participants from countries in West and Central Africa who discussed financial, procurement and supply management risks as well as questions around accountability and governance.

The main objective was to provide organizations which are implementing HIV programmes with a better understanding of risk management to be able to secure funding from the Global Fund.

The meeting was opened by the Senegalese Minister of Health and Prevention, Modou Diagne Fada who announced that the Government of Senegal will gradually increase the proportion of its national budget which is spent on health to 15% by 2015.

Speaking at the plenary, UNAIDS Regional Director for West and Central Africa, Meskerem Grunitzky-Bekele, highlighted that “sound risk management is key for the AIDS response and crucial to optimizing resources for HIV.”

Participants identified several risk factors such as weak institutional architecture of the national AIDS response; limited availability of qualified personnel and poor financial and accounting management standards. Another risk factor identified relates to investment choices and the need to identify where to invest for a maximum effect and return was highlighted.

“A good understanding of accountability and the importance of proactive and transparent risk management during grant implementation constitute the two essential pillars of sound management that will prevent disruptions from happening,” said Cyril Dubois, Global Fund’s chief of Division, West and Central Africa. “These steps are complementary in order to ensure that the financing provided by donors is used most effectively. Such an approach creates an environment that will ensure that the grants provided to countries fully benefit the populations affected by the diseases,” he added.

Corrective actions were defined together with an action plan to put in place mechanisms and systems for preventive risk management and strengthen accountability at country level. According to the participants, the key elements to overcoming the situation are building countries leadership; providing comprehensive technical support in key areas such financial management, and creating spaces to access capacity development initiatives tailored to countries needs.

UNAIDS provided technical support for risk management through different phases of grants implementation. Over the past year, Guinea, Togo, Niger, Chad, and Central African Republic have received support in adequate budget definition and follow up, financial review and management, or evaluation of risk management-related technical assistance.