Q&A Interview by: H.E. Amira Elfadil Mohamed – Commissioner for Health, Humanitarian Affairs and Social Development, African Union Commission

25 May 2021, Addis Ababa, Ethiopia

The annual commemoration of Africa Day presents an opportunity to celebrate the achievements of the African Union (AU) on various issues such as peace and security, continental integration, women and youth empowerment, eradication of diseases, culture, heritage and more. The AU Day also avails occasion to reflect on the transformative the AU Agenda 2063, and renew commitments to realise the healthy and prosperous Africa we want, in line with the AU theme of the year.

When it comes to overall disease prevention and care, the African Union Commission (AUC) supports the AU Member States towards ensuring their citizens experience the benefit of high-level policy dialogues and advances in public health. The continent faces significant challenges in responding to HIV, TB and malaria. Some of these challenges include harmful cultural practices; weak and fragmented health systems; inadequate resources for scaling up proven interventions; limited access to the health services and technologies available; poor management of human resources for health; recurrent natural and human-made disasters and emergencies; and extreme poverty. On Africa Day, AUC and AU Member States take stock on milestones gained in addressing the challenges and remaining gaps to march forward with strategy and relevance.

Additionally, Africa Day remains one of the many commemorative days on the global health calendar harnessed to call for renewed commitment, political will, and investment into implementing the Africa Health Strategy, and Catalytic Framework to end AIDS, TB, and Malaria by 2030. Africa Day 2021 comes when a health crisis has ushered in a new climate of uncertainty. The COVID-19 pandemic ‎may have disrupted the normal functioning of the continent’s health systems but not terminated the provision of health care. This year, communities and healthcare providers in the AU Member States should come together to raise their voices against structural inequalities, cultural beliefs, and stigma impeding response to AIDS, TB, and ‎malaria in Africa.

Culture and disease management in Africa are linked by a tangled web of ‎associations that are difficult yet necessary to understand. Culture determines value systems, beliefs, and practical knowledge that influence ‎human ‎behaviour, including understanding and pursuing good health and well-being. By casting light on arts, ‎culture and heritage‎, one of the anticipated outcomes is prioritising cultural influences during the design and implementation of health programmes in Africa‎.

The spread of HIV/AIDS has been linked to several harmful cultural practices such as traditional surgical practices‎, early marriages and widow inheritance. Culturally sanctioned gender relations also play a prominent role in Africa’s HIV/AIDS ‎epidemic, where HIV rates in women substantially exceed those in men. Open discussion about HIV/AIDS and prevention measures can often mean breaking local taboos or alienation. As a result, many hide their HIV-positive diagnosis ‎for fear of losing jobs and rejection by their social group.‎ All these factors that aggravate HIV prevalence in Africa need to be alleviated.

Effective malaria control programmes promote ‎personal protection measures and effective vector control strategies and provide ‎appropriate case management with early diagnosis and effective treatment. ‎This can only be sufficiently achieved with a sound understanding of locally contextualised health-seeking behaviour. There is a need for community-based approaches that match health care services with the people’s needs and resources.‎

Socio-cultural constructions influence the speed and extent of treatment-seeking trends among TB patients. TB has been attributed to supernatural causes including, breaking cultural rules that demand abstinence from a forbidden act ‎ in some settings in Africa. Improved education for communities about TB signs and symptoms and where to seek care for ‎signs and symptoms of TB may diminish several challenges. Engaging traditional healers may have ‎the added benefit of strengthening the links between western and traditional medicine may be ‎helpful for people with TB and other health conditions, improving overall TB response.

In 2018, the African Heads of State and Government endorsed the African Continental End TB Accountability Framework for Action and the End TB Scorecard Initiative and requested the Africa Union Commission, working with WHO, to produce the scorecard annually. This is in fulfilment of the 2018 United Nations General Assembly High-Level Meeting on TB (UNHLM-TB) Declaration and 2018 Common Africa Position on TB (CAP-TB), which urged governments to build resilient and sustainable health systems through implementing ambitious, fully funded TB policies and strategic investment plans; increasing domestic financing; strengthening national data systems and pursuance of innovations for TB diagnosis, prevention, and care. Given that Africa has the highest per capita incidence of TB globally, leveraging the Framework for Action and Scorecard to end TB on the continent will save millions of lives and yield a significant positive impact on achieving the global End TB Strategy by 2030.

The Zero Malaria Starts With Me Campaign – ‎implemented by the Commission in partnership with the Roll Back Malaria (RBM) Partnership to End Malaria – has thrust many AU Member States to making headway in defeating malaria through strong political commitment, ‎increased funding, and innovations devised to improve malaria prevention and control.‎ To date, nineteen (19) AU Member States have rolled out the Campaign. The Campaign’s focus is to empower the youth’s involvement in the malaria response. ‎The leadership of youth in Africa is crucial as young people account for 75% of the ‎continent’s population. The provision of a distinct place for youth engagement in the malaria response in Africa has paved the way for additional opportunities such as the ‎ Digital Youth Malaria Army initiative‎ by H.E Uhuru ‎Kenyatta, President of the Republic ‎of Kenya, the African Leaders Malaria Alliance (ALMA) Youth Advisory Council, and the Roll Back Malaria (RBM) Digital Youth Workstream. Africa’s youth should join these initiatives to ensure their communities and peers’ voices are ‎‎heard.

Global leaders will convene for the 2021 High-Level Meeting (HLM) of the UN General ‎Assembly on HIV/AIDS‎, taking place between 8th and 10th June 2021, to adopt a new ‎political declaration future direction of the HIV/AIDS response. A Draft Common Africa Position (CAP) on the 2021 High-Level Meeting of the ‎‎General Assembly on HIV/AIDS will be considered. The CAP shall assist in the negotiations during the upcoming UN-HLM ‎on HIV/AIDS. The CAP provides concrete recommendations for the HIV response in six broad areas ‎that ‎include: Leadership; Country Ownership; Governance; Accountability; Universal ‎and ‎equitable access to prevention, diagnosis, treatment, care, and support; Health ‎‎financing; Community participation and involvement; Research, development, and ‎‎innovation; and Promotion of human rights and gender equality.‎

The AU Member States should also seize the strategic recommendations set out in the Addis Ababa Commitment toward Shared Responsibility and Global Solidarity for Increased Health Financing Declaration, an initiative geared towards increasing domestic resources for health and reorienting ‎health systems in Africa‎.‎ Closely related to the successful implementation of the mentioned policy frameworks is the African Medicines Agency (AMA). AMA is a Specialised AU Agency with its own rules, membership and resources to enhance the capacity of State Parties and Regional Economic Communities (RECs) to regulate medical products to improve access to quality, safe and efficacious medical products on the continent. AMA aims to accelerate and strengthen regional medicines regulatory harmonisation initiatives and lay the foundation for a single African regulatory agency that will improve quality and access to medicines, including for AIDS, TB, and malaria in Africa.

In conclusion, I reiterate that embracing the culture and heritage of Africa’s community fosters a sense of acceptance that influences their willingness to be a part of the global health and development agenda. We must all work together to promote unity and deepen regional integration towards the end of AIDS, ‎tuberculosis (TB) and ‎malaria in Africa by 203‎0.