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AFRICA HEALTH NEWS
A WHITAKER GROUP PUBLICATIONJANUARY-FEBRUARY 2009
HIV/AIDS
PEPFAR REPORT HAILSSUCCESS OF PARTNERSHIPS
e President’s Emergency Plan for AIDS Relief (PEPFAR) is suc-cessful in large part because of the public-private partnerships (PPPs)the US government has developed with host country governments,NGOs, faith and community-based groups and the private sector,said PEPFAR’s outgoing Coordinator, Ambassador Mark Dybul, inJanuary.
“We have the resources, but the leadership, the brilliance, the realsuccess, is of the people and the countries,” he said at the release of PEPFAR’s annual report. “at’s really one of the geniuses of this pro-gram...that leads with country ownership, that pushes good governance,results-based approaches, all sectors being engaged.”In today’s resource-constrained world, PPPs are the key to sustain-ability. In addition, they help facilitate increased interventions and le- verage private sector resources to multiply impact. PEPFAR supportedeight large-scale, multi-country PPPs in 2008, as well as an array of country-level PPPs and workplace programs with local private sectorentities.Two such initiatives mentioned in the report are the Partnershipfor an HIV-Free Generation,a global PPP initially pilotedin Kenya to advance youth-fo-cused HIV prevention, and thecreation of a Wellness Centerin Uganda in partnership withBecton, Dickinson and Compa-ny and the International Coun-cil of Nurses. e center willserve 29,000 health workers inUganda and their families.In 2008, PEPFAR contin-ued to expand its partnerships,working with 2,667 organiza-tions up from 1,588 in 2004, of which 86% were local.PEPFAR has also worked withits international implementingpartners to develop strategiesfor handing over programs aslocal organizations increasetheir capacity to work directly with the US government.Goals for future PPPs, the report stated, include expanding privatehealth insurance options and strengthening health systems, includinghuman resource capacity and expanding information communicationsand technology offerings.Ambassador Dybul also emphasized that PEPFAR investments arebuilding Africa’s health care capacity across the board and ultimately strenthening democracy by building accountability frameworks. “Peo-ple feel a sense of accountability and development that we haven’t hadbefore,” he said.Launched by former President George Bush in 2003, PEPFAR has sofar spent $18.8 billion and exceeded its goal of supporting anti-retrovi-ral therapy (ART) for two million people by 2008. As of September 30,2008, the initiative has provided ART for more than 2.1 million peopleworldwide, of which the great majority are in the 12 focus countries insub-Saharan Africa. ese include Botswana, Côte d’Ivoire, Ethiopia,Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanza-nia, Uganda and Zambia.In July 2008, the US Congress reauthorized PEPFAR with $48 billionin funding through 2013. e initiative also includes funding for tuber-culosis and malaria. Between 2009 and 2013, PEPFAR plans to workin partnership with host nations to support treatment for at least threemillion people, prevent 12 million new infections, and care for 12 mil-lion people, including five million orphaned and vulnerable children. Italso plans to support training for at least 140,000 new health workers.PEPFAR is expected to receive strong support from the new US Ad-ministration because both President Barack Obama and Vice PresidentJoseph Biden were sponsors of the PEPFAR reauthorization. e fund-ing, though authorized, is still to be appropriated by Congress.
 A baby receives care at a PEPFAR- funded clinic in Addis Ababa,Ethiopia.
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PEPFAR ACHIEVEMENTS 2004-2008
☑ Supported treatment for more than 2.1 million people,saving nearly 3.28 million adult years of life.☑ Increased the share of those receiving treatment who arechildren from 3% in 2004 to 8% in 2008.☑ Supported care for more than 10.1 million people affect-ed by HIV/AIDS, including more than 4 million orphansand vulnerable children.☑ Supported HIV counseling and testing for nearly 57 mil-lion people.☑ Supported tuberculosis treatment for more than 395,400HIV-infected patients through September 2008.☑ Reached an estimated 58.3 million people to preventsexual transmission of HIV through the ABC approach.☑ Distributed more than 2.2 billion condoms.☑ Supported prevention of mother-to-child HIV transmis-sion during nearly 16 million pregnancies, providing anti- viral prophylaxis for nearly 1.2 million HIV-positive preg-nant women, allowing nearly 240,000 infants to be bornHIV-free.☑ Partnered with 2,667 organizations, of which 86% werelocal.☑ Supported an estimated 3.7 million training and retrain-ing encounters for health care workers.
 
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NEW INITIATIVE TOIMPROVE HEALTHOUTCOMES IN UGANDA
Uganda’s Makerere University has launcheda new partnership with the Johns HopkinsUniversity in Baltimore to improve healthoutcomes in Uganda by extending the educa-tion capacity of Makerere’s College of HealthSciences.
e first phase of the project, made possibleby a $4.97 million grant from the Bill and Me-linda Gates Foundation, focuses on aligningMakerere’s education and research with theGovernment of Uganda’s national health goalsand priorities, as well as identifying strategiesto ensure the long-term sustainability of theuniversity’s efforts to address evolving healthpriorities and health manpower needs.Working with the Johns Hopkins Center forGlobal Health, Makerere will develop and testeffective teaching, research and practice strate-gies with a focus on translating research intopolicy implementation.“We see this project as a major steppingstone to ensure that Makerere will be thehub for capacity building and influencing thehealth sector to improve lives in Uganda andthe East Africa region for years to come,” saidDr. David Peters, Associate Professor in theDepartment of International Health at JohnsHopkins Bloomberg School of Public Health.e project will be led by Dr. Peters andDr. George Pariyo, Head of the Departmentof Health Policy, Planning and Managementat the Makerere University School of PublicHealth.One of the early focus areas for the initia-tive will be to reduce neonatal and maternalmortality by removing constraints on womengiving birth in hospitals.“We want to test strategies to reduce thebarriers for maternal mortality like reductionin hospital fees. We are proposing that we testout ways of subsidizing costs, for example,through vouchers,” Dr. Pariyo told the
 Monitor 
 newspaper.Dr. Ibingira Charles, Dean of the School of Biomedical Sciences at Makerere, describedthe project as a bridge between students andthe community. “Students have been learningbut there has been a disconnection betweenthem and the community through integrat-ing learning and service delivery,” he said.“We hope to impact communities by lookingat how we can translate research into policy.Once we are able to do this, it will be easier todirectly impact the lives of Ugandans.”
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NEW PARTNERSHIP SEEKS TO STRENGTHENTANZANIAN HEALTH WORKFORCE
Tanzania’s Muhumbili University of HealthAllied Sciences (MUHAS) announced in Jan-uary that it will partner with the University of California, San Francisco (UCSF) to developand implement strategies to enable MUHASand other African institutions to meet theircountries’ health workforce needs.
Student dentists training at MuhimbiliUniversity in Tanzania
e project, funded by a $7.5 million grantfrom the Bill & Melinda Gates Foundation,seeks to harness the resources of the two uni- versities to develop an institutional partner-ship that can be replicated in other low-re-source settings.Faculty from MUHAS and the MUHASSchool of Public Health will work with theircounterparts at the UCSF schools of medicine,nursing, pharmacy and dentistry to share cur-ricula and educational technologies, and de- velop collaborative research programs.“rough this collaboration, MUHASwill recruit and train faculty, strengthen theacademic environment for education and re-search, and revise undergraduate and post-graduate curricula in order to increase its out-put of health professionals to serve the needsof the country,” said MUHAS Vice ChancellorProfessor Kisali Pallangyo.e partnership builds on an already estab-lished relationship between the two universi-ties, which are both public health institutionsthat train doctors, nurses, pharmacists, den-tists and allied health professionals.
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GLIA PROGRAM TO PROTECT LONG HAULTRUCK DRIVERS FROM HIV SHOWS RESULTS
e Great Lakes Initiative on AIDS (GLIA),a regional collaboration between six East Af-rican governments ratified by treaty in 2005,is starting to see the results of its program toeducate long distance truck drivers about thedangers of unprotected sex and the need tobe tested for HIV infection.
Working with National HIV Coordinat-ing Commissions and truck and workers’unions, in 2007 GLIA helped launch the pro-gram among its member states - Burundi,Democratic Republic of Congo (DRC), Kenya,Rwanda, Tanzania and Uganda - to address theproblem of HIV infection in a highly mobileand vulnerable population.A key facet of the program is to encouragethe truckers themselves to ‘know their epidem-ic’ and plan and institute their own response.Since then, the results have been impressive:■ In Kenya, more than 11,000 truckers haveundergone voluntary HIV testing and coun-seling, many at a well-equipped truck stop onthe well-traveled Mlolongo Road.■ In Rwanda, 60% of truckers now knowtheir HIV status.■ In Uganda, workers’ unions have distrib-uted condoms, carried out voluntary counsel-ing and testing and held behavioral changesessions.■ In Tanzania, truckers living with HIV haveopenly declared their status and formed a sup-port and advocacy group. One spillover effectis that sex workers at truck stops have begun touse condoms more consistently.■ In DRC, truck drivers report they are hav-ing fewer sex partners and increasing condomuse.To support this progress, GLIA has con-tracted with an international NGO, Constella-tion for AIDS Competence, to educate leadersof trucker networks on HIV response and toencourage them to pass the training on.GLIA is funded with a $20 million grantfrom the World Bank. Its objective is to imple-ment HIV/AIDS interventions regionally toadd value to individual country efforts.
 
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East Africa has become the third most im-portant growing region in the world for Ar-temisinin, the active ingredient in the mosteffective antimalarial, the United Nations(UN) reported in January.
Until recently, almost all
 Artemisia annua
plants, native to Asia, were grown in Chinaand Vietnam, but in 2002 a handful of Kenyanfarmers contracted with the local company Botanical Extracts EPZ Ltd. (BEEPZ) to plant40 hectares of the plant.
 Artemesia annua
cultivation now supportsat least 40,000 smallholder farmers growing4,000 hectares of the crop in Kenya, Tanzaniaand Uganda.Commercialization of the plant was madepossible by grants from Britain’s Departmentfor International Development (DfID) andthe Swiss pharmaceutical company Novartis.BEEPZ pays between $550 and $600 per met-ric ton. One hectare can produce up to twometric tons of dry leaves.Cultivation of the plant in Africa is consid-ered critical to ensuring a less expensive supply of the drug that has taken over from the olderquinine-based medicines no longer consideredeffective against several forms of malaria.According to the UN
 ,
the Kenyan govern-ment buys about 17 million doses of Artemis-inin drugs annually at a cost of $24 million forfree use at government clinics. At private phar-macies, the cost per dose ranges from about$5.50 to $8.20.In 2006, BEEPZ paid out $1.7 million tofarmers. e company completed an Artemis-inin extraction plant in 2007 and now suppliesNovartis with enough Artemisinin for morethan 22 million doses of the drug.
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EAST AFRICA NOWA KEY SUPPLIER OFARTEMISININ
Workers cultivate Artemisia annua plants inTanzania
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NOVO NORDISK TO SUPPLY AFFECTEDCHILDREN WITH FREE INSULIN
Danish bio-pharmaceutical company NovoNordisk announced in December that itwould provide diabetes care and free insulinto 10,000 children in the Democratic Repub-lic of Congo, Guinea-Conakry, Tanzania andUganda beginning in 2009.
e five-year program, called “Changingthe Future for Children with Diabetes,” will bebased on a hub-and-spoke concept with satel-lite centers around existing hospitals and clin-ics. With an estimated cost of $25 million, it isaimed at building sustainable solutions for im-proving availability, accessibility, affordability and quality of diabetes care for children withtype 1 diabetes.An estimated 38,000 African children havetype 1 diabetes, the majority of whom diewithin a year of diagnosis due to lack of ac-cess to insulin. While still relatively rare inAfrica, type 1 diabetes is on the rise due toincreased urbanization and changes in dietary and exercise habits. “e premature death of achild caused by lack of insulin is unacceptable,when a life-saving solution is available,” saidDr. Jean Claude Mbanya, President-elect of the International Diabetes Foundation (IDF).“We must work together across borders tokeep these children from dying. is is why Iwelcome this new program being launched by Novo Nordisk.”e bio-pharmaceutical company aims tocollaborate with as many local partners as pos-sible, including governments and diabetes as-sociations, and regional chapters of the IDF. Inaddition to providing free insulin, it will focuson helping to improve the health care infra-structure of the host countries.“is project will not only provide insu-lin free of charge to an extremely vulnerablegroup, it is also designed to build long-termsolutions for insulin distribution and sustain-able diabetes care for all people with diabetesin the world’s poorest countries,” said Mr. LarsRebien Sǿrensen, President and CEO of NovoNordisk A/S.Novo Nordisk hopes to expand the programbeyond the initial four participating coun-tries.
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GLOBAL PARTNERS BEGIN FINAL PUSHTO ERADICATE PARASITE
e Bill & Melinda Gates Foundation andBritain’s Department for International De- velopment (DfID) announced in Decemberthat they were jointly committing $55 mil-lion to the effort led by the Carter Center tofinally eradicate Guinea worm disease.
“Guinea worm is poised to be the seconddisease eradicated from Earth, ending need-less suffering for millions of people from onethe world’s oldest and most horrific afflic-tions,” said former US President Jimmy Carter,whose Atlanta-based center has been workingfor more than two decades on the eradicationeffort.He said that cases of Guinea worm diseasereached an all-time low in 2008 with less than5,000 cases reported in six African nations,down from 3.5 million cases in 1986 in 20 na-tions in Africa and Asia.In the first 10 months of 2008 only 4,410incidents of Guinea worm were reported inEthiopia, Ghana, Mali, Sudan, Niger and Ni-geria. It is already suspected that the last caseshave been reported from Nigeria and Niger,according to the Carter Center.e Gates Foundation is contributing $40million as a challenge grant to the Carter Cen-ter. It includes an outright contribution of $8million and encourages other donor organiza-tions and individuals to provide an additional$32 million that the Gates Foundation willmatch one-to-one. e British governmenthas pledged about $15 million. e funds willbe shared equally between the Carter Centerand the World Health Organization (WHO).Guinea worm disease will be the first diseaseto be wiped out without a vaccine or medicine.Interventions include health education, freecloth filter distribution and larvicide applica-tions. To date, about $225 million has been in- vested in the eradication effort.“e drive to eradicate Guinea worm dis-ease is one of the world’s most impressiveglobal health success stories,” said Dr. ReginaRabinovich, Director of Infectious DiseasesDevelopment at the Gates Foundation.
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