It has been recognized that health is central to socioeconomic development. To achieve economic development, Africa needs to reduce its high disease burden. The achievement of the targets for Millennium Development Goals 4, 5 and 6 is therefore central to the achievement of the targets for the remaining 3 MDGs. Target 5 calls for the reduction of under-five child mortality, and the statistics reveal that about a quarter of these child deaths are newborn deaths, which are tied to adequate care during pregnancy, childbirth and early post-partum period. Considering that over 90% of the HIV infections are a result of heterosexual sex or mother-to-child transmission, HIV/AIDS illnesses in Target 7 are therefore SRH issues. It is also clear that Target 4 which calls for the elimination of gender disparity in education is a rights issue. The mainstreaming of Sexual and Reproductive Health and Rights and its linking with HIV/AIDS in health care delivery is therefore a logical approach to the achievement of MDGs. The overlap of interventions for SRHR and HIV/AIDS makes their linking a strategy for improving access to health care.
Studies also show that sexual and reproductive health contributes significant more to the disease burden in the region especially since the HIV/AIDS pandemic. This disease burden is highest among the poor in the community. The countries of the region have adopted the development of Poverty Reduction Strategy Papers (PRSPs) as a facility for eliminating extreme poverty on the continent. It is obvious that where a large proportion of the people are poor, PRSPs' health-sector input should prioritize those health interventions most likely to improve the health of the poorest in the community and help to reduce poverty. Strategies on maternal and child health are part of the criteria taken as evidence of pro-poor approach when evaluating PRSPs. It is also necessary to address barriers that prevent poor people from accessing health services.
This Aide Mémoire is formatted in the context of the discussions of the 2 nd Ordinary Session of the Conference of African Ministers of Health held in Gaborone in October 2005.
The Continental Sexual and Reproductive Health Policy Framework was adopted by the 2 nd Session of the Conference of African Ministers of Health held in Gaborone in October 2005. In that Session, the Ministers called for a Special Session to discuss the issues in greater detail and come up with a concrete plan of action for integration of SRH in PHC, among other things. Mozambique offered to host this special session. This decision was endorsed by the Summit of Heads of State and Government in Khartoum, Sudan in January 2006
The expected outcome of this special session will include a consensus agreement on specific, viable and implementable decisions on the integration of SRH and HIV/AIDS services, and the endorsement of a costed action plan on for the implementation of the policy framework, which will be submitted to the Summit of Heads of State and Government for endorsement.
The objective of this Special Session of Ministers of Health of the African Union is to obtain consensus on a unified approach to the delivery of Sexual and Reproductive Health and Rights, and HIV/AIDS services and endorsement of a costed Action Plan for the implementation of the Continental Sexual and Reproductive Health and Rights Policy Framework.
4. CHALLENGES TO DEVELOPING SRH AND HIV/AIDS LINKAGES
Challenges for the integration of these two major health care programmes include the following:
(a) Access to essential medicines
A matter that prevents governments from effectively dealing with the disease burden is the unavailability of essential reproductive health drugs partly because of logistical problems. Development of Reproductive Health Commodity Security, by including reproductive health drugs in the essential drugs list will save lives and also facilitate the effective delivery of the service by health workers.
(b) Limited public financing
Recognizing that health is central to poverty reduction and economic development, and further recognizing that SRH is a priority area of health sector for the majority of the people, especially the poor, SRH should be well articulated in PRSPs to ensure that it receives adequate attention in the allocation of funding. In the face of limited resources cost-effective service delivery should be applied; it is obvious that the great overlap between interventions for SRH and HIV/AIDS makes their integration a cost-effective strategy.
The increasing availability of ARVs will lead to increased survival of children born with HIV and improved health of many young adults with the infection. All these will aspire for the same reproductive lives as people without the infection. This means that the Global Fund should provide for the reproductive health needs of PLWHA. Linkage of HIV/AIDS and SRH programmes is therefore necessary.
(c) Shortage of skilled health professionals
Reduction of maternal and child morbidity and mortality requires the services of skilled health professionals, but integration of services also requires the development of multi-purpose health professionals. There is need to provide an appropriate mix of such multi-purpose health workers and specialized health professionals for referral services as well as provide necessary backstopping training of the other group. While health workers have tended to hesitate to accept full responsibilities of all PHC services, in practice this is the situation at the first level of care whereby the lone health worker provides all the services.
(d) Other Policy-related constraints include the following:
Ambivalence about the introduction of interventions of proven benefit . It is well known that young people are suffering from poor health and death as a result of lack of reproductive health education and services, harmful traditional practices including the promotion of early marriage, and lack of safe abortion services. The demographic instabilities caused by death of these young people are well known but policy makers are hesitant to introduce appropriate policies to alleviate the SRH problems of young people.
As a result of the relegation of the health sector to the periphery of national policy making, health research was not considered as an important aspect of national development . For example, basic social research is essential in devising the most cost-effective strategies by which linkages between SRH and other PHC services can be forged.
Governance issues and conflict continue to contribute to poor reproductive health through neglect of SRH services and violence against women and children. Partnerships with civil society could alleviate some of these issues.
THE SPECIAL SESSION OF THE CONFERENCE OF AFRICAN MINISTERS OF HEALTH
I. FORMAT OF THE CONFERENCE
The conference will be organized in two phases:
(a) AU Member States' Expert Meeting: 18 - 20 September 2006
The first three days of the Ministerial Conference will be the convening of the meeting of Experts from Member States addressing at a technical level the pertinent issues relating to the overall theme of Linking SRH with HIV/AIDS and other PHC services. Various presentations will be discussed and summarized for presentation to the Conference of Ministers for adoption.
(b) The Ministerial Meeting: 21 - 22 September 2006
This meeting will take place from the 18 th –22 nd September 2006, immediately following the Experts meeting. The proposed theme of the Session will be “ Universal Access to Comprehensive Sexual and Reproductive Health Services in Africa ”
This theme is consistent with the request of the 2 nd Ordinary Session of the Conference of African Ministers of Health (CAMH2), held in Gaborone, Botswana in October 2005.
The main objective of this Special Session will be to discuss pertinent issues related to linking of SRHR and HIV/AIDS for the attainment of the Millennium Development Goals (MDGs). In this regard, the format of the Ministerial Conference will be a Round Table discussion on the theme and with specific reference to the report of the Expert meeting.
Other major documents, which will be considered, include the following:
Review of Best Practices in the area of Sexual and Reproductive Health and Rights (SRHR);
Cost-benefit Analysis of Sexual and Reproductive Health (Macro-economics of SRH);
Strategy for the Elimination of Harmful Traditional Practices, including the Prevention of Obstetric Fistulae in Africa;
Adoption of a costed Action Plan for the Continental SRHR Policy Framework;
Endorsement of a costed Action Plan for Reproductive Health Commodity Security.
The expected outcome of this Special Session will include a consensus agreement on specific, viable and implementable decisions on the integration of SRH and HIV/AIDS services, and the endorsement of a costed action plan for the implementation of the policy framework, which will be submitted to the Summit of Heads of State and Government for endorsement.
Outputs of the session shall include the following:
a) Costed Action Plan for the Continental SRHR Policy Framework
b) Action Plan for Reproductive Health Commodity Security approved
c) Increased understanding of the role of SRHR in national development by Member States
(a) Working documents
- Continental Sexual and reproductive Health Policy Framework adopted at CAMH2
(b) Background documents will include:
- Related OAU/AU documents on health including HIV/AIDS
- Documents produced by UN agencies and other organizations
IV )PLANNING AND ORGANISATION
The organization of the Conference will primarily be the responsibility of the AU Commission and the Government of Mozambique with assistance provided by partner organizations. In this regard, a Hosting Agreement between the AU and Mozambique will be signed. The format of the Agreement is standard and is prepared within AU by Legal Counsel and other relevant Departments/Directorates with input from the host country. In preparing for the Ministerial meeting, the Chairperson of CAMH2 will also be consulted from time to time.
For the smooth organization, various Committees are established on country and AU levels.
(a) Country level:
The host country (Mozambique) shall set up a National Organizing Committee to organize the preparations for the Conference.
(b) AU level
The AU has set up the following three committees:
The Steering Committee:
This Committee will be composed of:
Government of Mozambique – Host country
Government of the current Chairperson of the AU (Congo);
Government of Botswana - Current Chairperson of 2 nd Conference of African Ministers of Health
Government of the past Chair of CAMH2 - Libya
The Governments are represented on the Steering Committee by the Permanent Representatives in Addis Ababa.
The Steering Committee will guide the preparatory process.
The AU Conference Organizing Committee
This is a standing committee of the AU Commission and is chaired by the Deputy Chairperson and comprises of a Representative of the Director in the Office of Chairperson; the Director, a.i. Conferences; the Director Finance; the Director of Administration and Human Resource Development; the Legal Counsel; the Head, Protocol; Press and Information and a concerned Department, in this case, the Department of Social Affairs. This Committee will finalize the Hosting Agreement and other logistics, including plans for an Evaluation Mission to Maputo to follow-up on preparations.
The Technical taskforce:
This will comprise of the Steering Committee and the following:
- Department of Social Affairs
- Agencies based in Addis Ababa
The Taskforce is responsible for overseeing the preparation of working documents and mobilization of financial and technical resources.
V )ORGANIZATIONAL MATTERS
Details on the organizational aspects of the Conference comprising resource mobilization, cost sharing, participation, and sponsorship, equipment and personnel requirements are to be contained in a host agreement to be signed between the African Union and Government of Mozambique.
The Commission of the African Union will be responsible for the invitations to Member States, invited guests and observers, the preparations of the Agenda, Programme and documents in consultation with the Bureau of the 2 nd Conference of African Ministers of Health. It will also avail translation, interpretation and secretarial personnel for the Ministerial Conference.
The Government of the Republic of Mozambique will be responsible for the provision of conference facilities and other related logistical arrangements as stipulated in the Hosting Agreement.
Partners will assist with the preparations of the main policy documents as well as the convening of the various meetings.
VI ) PARTICIPANTS
Participants will include: Ministers of Health, Social Affairs/Youth/Women from AU Member States, AU Commission, representatives of the Regional Economic Communities, NEPAD, Experts, UN agencies, international organizations and NGOs.
VI ) BUDGET AND OTHER RESOURCES
While the AU Commission will contribute the amount earmarked in the budget for the convening of the Ministerial meeting, financial and technical support might be provided by the Host Government and partner organizations to facilitate the preparation of documents as well as the participation of the independent experts and focal persons from the RECs.