Credit: UNAIDS

Big questions were raised about getting the best results in health and development at the World Bank’s Africa Development Forum 2013. The event brought together Ministers of Finance and Health from some 30 African countries to explore effective and creative ways to ensure the future health of the continent. 

With the umbrella theme finance and capacity for results, the aim of the forum was to identify concrete strategies to ensure that investments in health produce sustainable results on a large scale. Also sought, were new ways to finance and build institutional capacity so that African countries can design, implement and evaluate health investments.

“We need more money for health and more health for money in Africa,” said the host Makhtar Diop, Vice President of the World Bank Group, Africa Region in his opening remarks. “This landmark conference aims to jointly decide on concrete actions for countries and show partners how to further invest in health and sustainable growth in Africa,” he added.

Urgent change needed 

Several key characteristics of the continent’s health systems need to be urgently addressed, according to the participants. For instance, the average per capita health spending in Africa was seen as low. However, it is higher than in many South Asian countries where health outcomes are considered generally better. Therefore, Africa would not only need more health financing but also, it would need to spend what it has more effectively.  

In addition, out-of-pocket expenses for accessing health services were also defined as extremely high, constituting about one third of all health expenditure in sub-Saharan Africa and more than 60% in several countries like Cameroon and Sierra Leone. Such personal spending may contribute to increase poverty and decrease the use of medical services.

Many African countries are still heavily dependent on external resources to finance their health sector. For some, as much as 40% comes from this stream and in 26 of 33 countries in sub-Saharan Africa, donor support accounts for more than half of HIV investments. Participants defined this dependency as a serious sustainability issue requiring more self-sufficiency and building of domestic capacity with self-financing as the ultimate goal. 

Speaking about sustainable financing, the Minister of Finance of Nigeria Hon. Ngozi Okonjo-Iweala stated that, “It is not only the volume of financing that matters but how that really responds to the need of the poor,” said Minister Okonjo-Iweala. “In a country deciding on how to best respond to those needs, political will and leadership are key.

 In Africa, a shift from investments that focus on inputs and processes to those that focus on results and systemic changes is already underway. Health sector reforms and efficiency improvement initiatives, results-based financing (RBF), and public-private partnerships in many countries have resulted in rapid scaling up of service coverage and improved efficiency in how resources are used for health.

President of The World Bank Group Dr Jim Yong Kim (left) and UNAIDS Executive Director Michel Sidibé.

The RBF approach at the facility level, pioneered in Rwanda, has resulted in a substantial increase in coverage of high-impact activities such as immunization, family planning, the distribution of mosquito nets, and skilled attendance at delivery. Today, more than 20 sub-Saharan African countries are piloting some form of RBF. Development partners are also trying out this mechanism at the country level. For example, the new World Bank financing instrument known as Program-For-Results (PforR) will now be used in Ethiopia to link disbursement directly with achieving national programme results. Many sub-Saharan African countries have also established social safety nets. Through these initiatives, people with limited or no resources may have improved access to basic health services, among other services, so that they do not have to skip necessary care or endure financial hardship related to it.

The AIDS response: a new paradigm  

In charting the way forward Michel Sidibé highlighted the role of the AIDS response in pioneering a new paradigm of sustainable development, shared responsibility and global health solidarity. He stressed that, despite the progress made in reducing new HIV infections in Africa, more funding, both donor and domestic, and more strategic use of that funding for greatest impact were necessary.

“Our world is shifting and we have to think about long-term financing for results,” said UNAIDS Executive Director Mr Sidibé. “Our objectives are to help countries revisit their programmes and find new mechanisms for investments in health and social development. In the AIDS response, we are seeing a major shift with the domestic investments surpassing those of the donors. We also need to maximize external aid and value for money,” he added.

Participants at the forum committed to building on African countries’ successful initiatives and experiences showing promise such as national health financing strategies, efficiency improvement programmes, results-based financing and introducing safety nets for the poor.

Closing the conference, the President of The World Bank Group Dr Jim Yong Kim said, “We need to help countries to get innovative systems for health to lift the burden. We have a unique opportunity to recommit ourselves to universal access to health that is critical for short, medium and long term growth, ending poverty and building shared prosperity.”

Credit: UNAIDS

If artist Keith Haring were still alive he might have joined the anti-homophobia demonstrations taking place in Paris during the opening weekend of a new retrospective of his art.

More than 20 years after his death, a new exhibit still packs a big political punch. Entitled “The political Line” the show opened at the Musée d’Art Moderne de la Ville de Paris and at the Cent Quatre community centre on 19 April 2013.

One of the most influential artists of his time, Mr Haring was known for his political messages. His art focused on communicating difficult issues such as social justice and individual freedom.

Even the title “The political Line”—is a play on words—honouring both his political narrative and his emphasis on line drawings. The exhibit is also making a political statement by showing in two very different Paris neighbourhoods.  

“One is in the 16th, which is a very rich quarter, in a museum and one show here at the Cent Quatre in the 19th,” said Bettina Bauerfeind a guide for the Cent Quatre community center, at the heart of an urban renewal area. “This is an exceptional exhibition because it brings together people—he wanted to offer his artwork to everybody.”

“The fact that much of his art was painted and shown in public spaces means that people have to interact with issues like violence, AIDS and homophobia,” said Annemarie Hou, UNAIDS Director of Communications. “His art is as relevant today as it was when he painted them and he continues to influence a new generation of activism through art.” 

Diagnosed with HIV in 1998, the artist set up a foundation dedicated to AIDS and children’s issues. In honour of World AIDS Day in 2008, UNAIDS received two Keith Haring sculptures on loan from the foundation for the UNAIDS “Art for AIDS” collection.

The Paris retrospective follows a timeline of Mr Haring’s political messages—featuring more than 250 works of art. The exhibit runs until 18 August 2013.

L to R: ONE Senior Advisor and Washington Post Columnist Michael Gerson, South Africa’s Minister of Finance, Honourable Pravin Jamnadas Gordhan, EGPAF Family Ambassadors Fortunata Kasege and her daughter Florida Mwesiga, UNAIDS Executive Director Michel Sidibé, CTAOP Founder and UN Messenger of Peace Charlize Theron, BD CEO, President and Chairman of the Board, Vincent Forlenza, US Global AIDS Coordinator, Ambassador Eric Goosby.
Credit: UNAIDS/C.Kleponis

Shared responsibility of the AIDS response must become part of a new global compact. This was the central message of a high-powered breakfast meeting that took place in Washington, DC on 18 April.

The event brought together leaders in the response to AIDS with members of United States Congress, the Administration, the private sector and AIDS advocates to emphasize how the adoption of the ‘shared responsibility’ approach is translating joint efforts into real results.

The Executive Director of UNAIDS, Michel Sidibé thanked the United States for its longstanding leadership in the AIDS response through such ground-breaking initiatives as the multi-billion dollar President’s Emergency Plan for AIDS Relief (PEPFAR) and its support to the Global Fund to Fight AIDS, TB and Malaria. “The continued leadership and investment from the United States is not only helping to leverage additional resources from donor governments but also from the domestic budgets of low-and middle-income countries,” said Mr Sidibé.” 

South Africa’s experience, for example, shows how the shared responsibility is being translated into real results on the ground. The government now accounts for some three-quarters of the AIDS spending in the country and, under a Partnership Framework signed with the US, it will finance almost 90% of its response by 2017.

According to South Africa’s Minister of Finance, the Honourable Pravin Jamnadas Gordhan, “South Africans have turned the tide against AIDS. Our achievement is a tribute to the close collaboration between South Africans—government, business, researchers, and community workers—and the steadfast and generous support of our partners in the international community.”

South African film star, United Nations Messenger of Peace and founder of the Africa Outreach Project, Charlize Theron said, “The tipping point is upon us and we have an incredible opportunity to turn the tide on HIV and end the AIDS epidemic for good.  I ask that you please take this opportunity to heart and from wherever you sit—Congress, corporate America, the community—that you continue to use your power and influence to keep creating hope and help moving the AIDS response forward.  We can, we must, and we will overcome this epidemic together.”

Florida Mwesiga, Family Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, played a special role in highlighting the impact of HIV on young people. “I’m thankful that my mum was able to receive treatment that protected me from HIV while she was pregnant,” said Ms Mwesiga. “My mum continues her fight to ensure all mothers everywhere can experience the gift of an HIV-negative child,” she shared. “My mother’s courage to stand up and demand change inspires me every day. And it’s because of her that I feel so empowered to also make a difference,” added Ms Mwesiga reminding all participants that everyone has an important role to play in the response to AIDS.

It was clear by the end of the meeting that important contributions by the US to the AIDS response are crucial to achieving the ambitious but attainable goal of an AIDS-free generation. Ambassador Goosby concluded that, “Collectively, we've taken great strides in the global AIDS response. PEPFAR is proud of its close collaboration with host countries and other partners in supporting this transformational change. While much work remains to be done, through country ownership, smart investments, and shared responsibility, I am confident that we will create an AIDS-free generation.”

The event was co-hosted by the Charlize Theron Africa Outreach Project, the Elizabeth Glaser Pediatric AIDS Foundation, ONE, the United States Global Leadership Coalition, and UNAIDS. 

The Confederation of North, Central America and Caribbean Association Football (CONCACAF) and UNAIDS signed a Memorandum of Understanding on 19 April in Panama City, Panama and agreed to engage football in the AIDS response, particularly among young people.

The agreement was signed on the sidelines of the 2013 CONCACAF Under-17 Championship in the presence of CONCACAF President Jeffrey Webb and Senior Adviser Dr Djibril Diallo, who represented UNAIDS Executive Director Michel Sidibé. It was signed in the presence of FIFA President Sepp Blatter, FIFA Secretary General Jerome Valcke and Confederation of African Football (CAF) Secretary General Hishram ElAmrani.

The two organizations agreed to carry out joint advocacy and communication activities in competitions organized by CONCACAF in support of the UNAIDS “Protect the Goal” campaign. This initiative was launched in January at the 2013 Orange Africa Cup of Nations in South Africa and is part of UNAIDS’ sport for global advocacy programme. The campaign promotes HIV prevention and treatment, in advance of the 2014 FIFA World Cup in Brazil.

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The First Lady of Ghana, Lordina Mahama, has agreed to become UNAIDS premiere ambassador for the implementation of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.

First Lady Mahama has committed to lead Ghana's push towards reaching an AIDS-free generation. In her new role, she will encourage political dialogue in the country ensuring that AIDS remains high on the political agenda. She will work towards empowering women and girls, challenging stigma, and helping national and community leaders understand that the AIDS response cannot be separated from the work to improve the health of mothers and children.

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As part of the evaluation week organized by the United Nations Evaluation Group (UNEG) taking place from 15 - 19 April 2013 at the UN Headquarters in New York, a high-level panel event, entitled “UN Results – Are we achieving them? How do we know?” discussed whether or not the United Nations is achieving its objectives.

The main issues addressed by the panel members included how evaluation is contributing to the measurement of the results; if evaluation findings and recommendations are actually used for programme and policy improvements; and how the collective capacity of UN programmes can be built to improve  evaluation.

Delivering the opening remarks United Nations Secretary-General Ban Ki-moon emphasized how the evaluation of programmes is a critical function of the work of the UN. UNAIDS Executive Director, Michel Sidibé presented the experience of UNAIDS in carrying out monitoring and evaluation to effectively respond to the AIDS epidemic.

UNEG is an interagency network that brings together the evaluation units of the UN system, including UN departments, specialized agencies, funds and programmes, and affiliated organizations. It currently has 43 such members and three observers.

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The long-standing commitment of Denmark, Finland, Norway and Sweden to international development has rooted them firmly as leaders in international development assistance. They are strong advocates on human rights issues––addressing inequalities between and within countries––and have forward thinking policies for social development and health. 

This week the Nordic countries came together with UNAIDS in Helsinki to determine how, individually and as a group, they could bolster the response to HIV. Their aim: to build on the unprecedented progress already achieved and attain UNAIDS’ vision of zero new HIV infections, zero discrimination and zero AIDS related deaths.

The Nordics have played a particularly critical role in responding to the AIDS epidemic, keeping focused on and being strong supporters of evidence-informed public health strategies, providing support to the most vulnerable people in societies.

At the meeting the four Nordic countries discussed with UNAIDS the need for countries to take greater ownership of their national responses to HIV and how they can be supported in that transition; the importance of shared responsibility and global solidarity around HIV; and particularly the need for stronger partnerships to deliver results.

Opportunities beyond 2015 were also debated––including the role of the UN in a rapidly changing world. For UNAIDS, the meeting was a critical opportunity to ensure that UNAIDS’ and the Nordic countries’ priorities are aligned for maximum impact in responding to HIV.

“I appreciate the frank and open dialogue with our Nordic colleagues on shared priorities in advancing the AIDS response and ensuring our work addresses broader development goals around equity and human rights,” said Michel Sidibé, Executive Director of UNAIDS.

During the visit, Mr Sidibé also met with Maria Guzenina-Richardson, the Finnish Minister of Health and Social Services. They discussed Finland’s continued engagement in global health and the work of UNAIDS.

Following the discussions Mr Sidibé visited the Pro-tukipiste Centre, a registered non-profit organisation which promotes and supports the rights of people currently or previously involved in sex work. Pro-tukipiste was founded in 1990 and activities range from advocacy to social support, outreach work, health care and legal advice for migrant and resident female, male and transgender sex workers. They have social and health care service units in Helsinki and Tampere which include drop-in services and outreach work. Pro-tukipiste reaches up to 2 000 sex workers a year. All their services are anonymous and free of charge.

A special event to celebrate former President of Portugal Dr Jorge Sampaio’s commitment and dedication to raising the profile of public health and tuberculosis took place at the World Health Organization’s premises in Geneva on 15 April 2013. WHO Director-General, Dr Margaret Chan, the Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria, Mark Dybul and the UNAIDS Deputy Executive Director, Programme, Dr Luiz Loures among others honoured Dr Sampaio for his efforts to advocate among global leaders for improved tuberculosis control. A discussion about the future of high-level political advocacy followed the initial remarks.

Dr Sampaio was appointed as UN Secretary-General Special Envoy to Stop Tuberculosis in 2006 and since the beginning he embarked on an ambitious programme to raise the visibility of the disease.  In 2008, Dr Sampaio convened the HIV/Tuberculosis Global Leaders' Forum where the co-infection of HIV/TB was defined as a major constraint to economic development and a barrier to social justice and human rights. The Forum managed to increase the engagement of global leaders in supporting the coordination of tuberculosis and HIV services.

Dr Sampaio has always been keen to highlight the crucial role played by civil society and affected communities in the response to HIV and TB. He expressed his personal support by visiting tuberculosis health centres in countries across the globe, including Brazil, Estonia, Ethiopia, Indonesia and Kenya amongst others.

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Honduras has adopted a reform of the Penal Code that will ensure legal protection against discrimination based on sexual orientation and gender identity.

Honduras is moving a step closer to the UNAIDS vision of ‘zero discrimination’. Its Congress has recently adopted a reform of the Penal Code that will ensure legal protection against discrimination based on sexual orientation and gender identity.

"This has been a historic step for Lesbian, Gay, Bisexual, Transexual and Intersex (LGBTI) populations that have suffered from widespread violence and impunity in Honduras,” said Donny Reyes, Coordinator at Arcoiris, a civil society organization advocating for greater LGBTI rights. “Finally our right to freedom and to live in peace has been formally recognized,” he added.

Between 2009 and 2012, more than 90 homophobia-related killings were reported in the country, according to the Human Rights Observatory of Lesbian Cattrachas Network. These incidents, which are among the highest in the region, are attributed to the high levels of homophobia and transphobia that exists in Honduran society.

The high number of violent deaths and human rights violations against LGTBI people prompted Ana Pineda, the Minister of Justice and Human Rights to promote the reform of the Penal Code.

The amended code establishes as an offence with aggravating circumstances the “discrimination with hatred or contempt on the basis of sex, gender, religion, national origin, belonging to indigenous and Afrodescendant groups, sexual orientation or gender identity”.  This offence may be punishable by up to 3–5 years imprisonment and a monetary fine. The penalty increases if it is a violent crime.

Dialogue between the government, civil society and UNAIDS led to the creation of special units within the General Attorney’s Office to strengthen the investigation of allegations of violence on the basis of sexual diversity. Each unit comprises a qualified legal advisor, an analyst and three investigators. The Units are currently investigating 17 cases of killings on the basis of sexual orientation and/or gender identity.

“Strengthening investigation, establishing a legal framework which sanctions discrimination and making sure that judges will apply the new provisions are both crucial steps to prevent and reduce violence against members of the LGTBI community,” said Ms Pineda.

Reducing vulnerability to HIV

The amended Penal Code is expected to improve access to HIV-related services, education and employment for LGTBI people. The discrimination, exclusion and violence against LGTBI people have exacerbated their vulnerability to HIV infection by discouraging them from accessing health services out of fear.

In Honduras the HIV epidemic seriously affects men who have sex with men (MSM), where the prevalence of HIV has reached 9.9% compared to the 0.6% among the general population.

A recent report in The Lancet highlights that transgender people have at least 50 times the odds of men and women in the general population of becoming infected with HIV—due to biological as well as structural risks for HIV infection such as social exclusion, economic marginalization, and unmet health-care needs.

"This ruling will provide LGTBI people with greater access to HIV related services" said Nicole Massoud, UNAIDS Country Coordinator for Honduras and Nicaragua. “UNAIDS congratulates the State of Honduras for its commitment to promote and defend human rights. The challenge now is to ensure that all professionals are informed and trained on these new provisions to help ensure we reach zero stigma and discrimination.”

Parliamentarians from across Asia and the Pacific are urging sustained action on AIDS to ensure an AIDS-free generation in the region. The call came at a Forum held in Bali, Indonesia (25-26 March) where parliamentarians and civil society leaders from 35 countries in Asia-Pacific gathered to assess the progress made and the challenges remaining to achieve the Millennium Development Goals (MDG) in the region.

“We are just starting to see significant results in achieving the MDGs. We cannot abandon them; we must take the MDG agenda forward,” said Hon P Kamalanathan P Pancanathan, Member of Parliament from Malaysia. “We have seen important health, human rights and development gains through the AIDS response that can strengthen other work in global health and sustainable development,” he added.

Calls for a future based on human rights, equality and sustainability resonated throughout the Forum. Rapid increase of access to antiretroviral treatment, the meaningful engagement of communities in the design and roll out of programmes and the removal of laws, policies and practices that hamper access to HIV services for people living with HIV and key populations at higher risk were cited as critical priorities to ensure success in the response to AIDS.

“With political commitment, community mobilization, adequate funding and evidence-based approaches, the end of AIDS and the emergence of an AIDS-free generation can be a shared triumph of the post-2015 era,” said United Nations Secretary-General’s Special Envoy on AIDS in Asia and the Pacific, Prasada Rao.

Effective spending and shared responsibility were linked to results across health and development goals. “We have to ensure smart spending – making sure funds are focused where they are most needed and where they produce most efficiency – which in the Asia Pacific region means focusing on key populations at highest risk of HIV,” said Steven J Kraus, Director of UNAIDS Asia and the Pacific Regional Office at the Forum. “As representatives of the people—including and especially the most vulnerable—parliamentarians have a key role to play in giving voice to the voiceless,” he added.

The parliamentarian and civil society Forum took place alongside, and fed into, the fourth meeting of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, hosted by the President of Indonesia as Panel co-chair. As part of the Forum, a selected delegation of 20 senior parliamentarians and local elected representatives shared with the UN Secretary-General’s High-Level Panel their recommendations about key priorities identified for consideration in the crafting of the post-2015 development agenda.

The Parliamentarians and Civil Society Forum was hosted by the Indonesian Parliament, Indonesian Forum of Parliamentarians on Population and Development (IFPPD), and UNORCID, and co-organized by United Nations Millennium Campaign and the Asian Forum of Parliamentarians on Population and Development (AFPPD) with support from the Rockefeller Foundation, and in collaboration with UNAIDS and a number of other UN agencies, global civil society networks, international nongovernmental organizations, and parliamentary networks.