AFRICA-EUROPE FAITH AND JUSTICE NETWORK
RESEAU FOI ET JUSTICE AFRIQUE-EUROPE

174, rue Joseph II
B-1000 Bruxelles - Belgique
Tel. 32-2 234 6810 Fax 32-2 231 1413
aefjn@aefjn.org http://www.aefjn.org

The need for a response from the Church in Africa
to the European Union's
Accelerated Action on HIV/AIDS, Malaria and Tuberculosis

Introduction

For the period of 2001-2006 the European Union runs the Accelerated Action Programme for Aid for Poverty-Related Diseases (HIV/AIDS, malaria and tuberculosis) in Developing Countries. In 2002 the Commission committed € 22,875 million for Action Programme projects focusing on youth. For 2003, € 38,35 million are available for HIV/AIDS, malaria and TB programmes that enhance the links between prevention, treatment and care. The Church welcomes the international political will and financial means made available to call a halt to the epidemics of AIDS, TB and malaria in Africa.

However, the Church can neither ignore that, notwithstanding the capacity of Church health programmes in Africa, several Church health services have been denied access to these funds because the Catholic stance on the rights to reproductivity and sexuality differs from international and national policies. Nor can the Church ignore that the European Union's Action Programme is linked to the European trade agenda, which promotes further liberalisation of trade in goods and services between Europe and Africa. Both issues may affect the fundamental right of people, who avail themselves of Church Health Services, to have access to sufficient and affordable medicines and health care.

Considering the importance of the Church Health Services in Africa, there is a need for the Episcopal Conferences of Africa and Europe to study how best the Church Health Services in Africa can collaborate with the European Union's Accelerated Action Programme, while safeguarding especially the poorest sections of the African societies from possible negative consequences of hastily agreed participation.

International resolve to contain HIV, TB and Malaria:

Not withstanding all efforts, the international community has not been able to contain the spreading of HIV/AIDS, malaria and tuberculosis over the last decade. The devastating impact of these three major communicable diseases on societies in developing countries wipes out years of development efforts and threatens social and economic development worldwide, particularly in Africa that is worst hit by the epidemics.

Since 2000, with the creation of the Global Fund, a new momentum has been generated and is backed by increased financial commitments from governments, the World Bank, the International Monetary Fund, philanthropic foundations. Aiming at a global, comprehensive and accelerated response to the three major communicable diseases these sponsors finance new alliances between pharmaceutical companies, existing international initiatives (such as the International Partnership against AIDS in Africa (IPAA), the Malaria Medicines Initiative (MMI) or the Stop TB Initiative (STBI), UNAIDS or UNICEF) and public oriented health organisations.

These new alliances pursue public-private partnerships that run competitive, performance driven programmes for essential services that encompass prevention, treatment and care and support, particularly for the poorest and most vulnerable sections of the affected population. The partnerships consider two possible strategies: an "integrated approach" by collaborating with existing government or private health infrastructures in African countries, wherever these guarantee a sufficient quality of healthcare, or failing reliable health systems a "vertical approach" in which the partnerships will intervene with an infrastructure of their own to contain a given disease in a given area.

The European Community action programme 2003

Within the context of this global action, the European Commission proposed a plan of Accelerated Action for the period of 2002-2006. For the year 2003 only, the budget foreseen for aid to HIV/AIDS, TB and malaria programmes in developing countries amounts to €80.35 million: €8.1 million will be used to fund specific activities; €42 million is the annual EU contribution to Global Fund to fight AIDS, TB and Malaria; the remaining €30.25 million will be used for programmes allocated following a call for proposals.

The Commission calls for proposals from relevant public oriented organisations in Africa that are ready to work in partnership with international organisations, development organisations or academic institutions from the EU member states. The priority areas considered are:

1. Initiatives aimed at changing or introducing adequate, safe, effective and affordable anti-retroviral combination regimes, anti-malaria protocols and long-active TB protocols.
2. Initiatives aimed at increasing access to prevention and care services and coverage of essential services, particularly for Voluntary Counselling and Testing (VCT), detecting HIV infected adults, especially mothers and children; detection and treatment of anaemia due to chronic malaria of pregnant women and children; and increased detection of active tuberculosis in scattered rural settings or where HIV/TB co-infection is high.
3. Support to participation from African countries in relevant International Conferences.
4. Support to the Initiative for Pharmaceutical Technology Transfer (IPTT) which promotes the transfer of pharmaceutical manufacturing technology for anti HIV/AIDS, TB and Malaria medications to 12 existing private sector manufacturing sites in South Africa, Uganda, Ethiopia, Nigeria and Senegal.
5. Initiatives that collaborate in developing ethical criteria, regulatory aspects and preparedness of communities for the potential introduction of trials of an effective an safe HIV/AIDS vaccine in Africa.

· Considering the infrastructures, manpower and comprehensive range of health programmes and services in which the church is involved in Africa, it is obvious that many of the Church Health Services qualify for several elements of the European Union's Accelerated Action Programme and therefore must be involved in the elaboration and implementation of national and regional programmes.

Challenge for the church's health services

The European Accelerated Action programme does have enormous potential to alleviate suffering and improve living conditions for millions of people in Africa. However, the Church must see the proposed aid programme within the context of the European Union's agenda of international commitments to trade liberalisation.
If the Church Health Services should participate as an important partner in the European Union Accelerated Action Programme, we would like to draw the attention of the Episcopal Conferences on four points that may affect adversely the poorest sections of African societies.

1. A discrimination on grounds of belief
Finance for programmes is linked to international and national policies on rights for sexual and reproductive health, these are contrary to current Church teaching. Even though Church Health Services in certain African countries do manage comprehensive health systems that enhance the links between prevention, treatment and care, they have been denied funding because they promoted "Change of behaviour" programmes that do not fit in the categories of international rights to reproductivity and sexuality. We consider this to be discriminatory on grounds of believes, as church health services programmes do have a positive impact on both prevention and care of huge numbers of people and are therefore an alternative to be considered.

· Providing verifiable proof that the Church health systems and programmes, including the Change of behaviour programmes, do have a positive influence on national and regional prevention and care providing for HIV/AIDS, TB and malaria, Church leaders in Africa and Europe must approach governments to demand access to funding for programmes of the Church Health Services.

2. Assuring sustainable solutions for infected populations
The new international alliances formed to call a halt to HIV/AIDS, TB and malaria intend to use two strategies: the integrated approach, making use of existing preferment health systems, or failing those to use a vertical approach, intervening with their own infrastructure to eradicate one of the sicknesses in a given area.

Though the "vertical approach" may be efficient, this model of intervention raises the question of "what after the intervention?" Indeed the vertical approach involves neither the important component of technology transfer, nor the training of personnel. Therefore, once the programme finished, the area might very well be left vulnerable to a recurring of the disease.

· Church leaders in Africa and Europe should advocate for the use of the "integrated approach" for interventions on HIV/AIDS, TB and malaria eradication. This approach guarantees a sustainable health service to the population. Considering the strength and comprehensiveness of the Church Health Services and programmes, Church leaders must advocate that the church health infrastructures be considered as full partners in the proposed partnership so as to contribute to a lasting impact of the programmes.

3. Safeguarding the right of access to affordable medications
The reality is that the production, procurement, marketing and sale of both old and new medicines are protected by severe patent legislation that is jealously guarded by the pharmaceutical industry. The 2001 Doha Declaration on Public Health had given countries the right to overrule patent legislation in order to produce generic drugs at low cost and to purchase at the lowest price drugs needed to whenever public health would be endangered. Recent developments at the WTO negotiations on Trade Related Intellectual Property Rights (TRIPS) show that the Doha Declaration on Public Health is being undermined by limiting the number of diseases that can be considered and by favouring countries that now have production capacity. Those countries that have no manufacturing capacity would have to wait for a health problem to become "uncontrollable" before being able to declare a national emergency to start to apply for permission from the WTO or the WHO to purchase the medicines needed or to start producing the needed drugs.
Through the Initiative for Pharmaceutical Technology Transfer, the EU aid plan wants to transfer manufacturing technology for anti-HIV/AIDS, TB and malaria medications to 12 existing private sector manufacturing sites in only 6 African countries (South Africa, Uganda, Ethiopia, Nigeria and Senegal), leaving out other countries and their potential capacity to develop and produce their own needed drugs. Instead, these countries will be forced to purchase their needed drugs within the region, which may not necessarily be the cheapest drug available on the market.

· Church leaders in Africa and Europe should press their governments to support the Africa Group at the TRIPS negotiations at the WTO and to demand the right for all African countries, whether they have manufacturing capacity or not, the freedom to determine the grounds upon which to declare a situation of danger for their public health and therefore the right to overrule patent legislation and allow local manufacturing of needed medications or to purchase patented drugs from where-ever they are cheapest.

4. Safeguarding public health services against privatisation
One of the effects of globalisation is the rapid and often unnecessary pressure for privatisation and corporate takeover of public services - including education, healthcare or water management services. The global trade in services (GATS) is presently being negotiated at the WTO. Both in Africa and Europe, civil society groups, academics, church development agencies and politicians argue that privatisation may improve efficiency, yet studies on the effects of privatisation on the ground have repeatedly shown that this may not be in the best interest of the poor, as privatisation often means an increased commercialisation of services.

Under pressure of public opinion, the European Commission has undertaken not to further the privatisation of European public services. However the EU is under great pressure form the services industry to press for liberalisation of service sectors outside Europe. The fact that the EU aid programme will use the model of public-private-partnerships could be a first step towards possible privatisation of health services, unless the Church scrutinises carefully the terms of the public-private-partnerships.

· Church leaders in Africa and Europe should be aware of the drive of privatisation of services and of the possible negative impact of such policies on the poorest sections of African societies. In the light of this, Church leaders should question their governments on the impact and consequences of public-private partnerships that will be signed within the context of the HIV/AIDS, TB and malaria action programme.

Recommendation

African church health services, supported by their European sister-churches, are important partners for the European Commission's accelerated action programme to combat communicable diseases and can contribute significantly to bring to victims suffering of AIDS, TB and malaria the medicines that are available and the care that they need!

We recommend

a concerted effort by the African and European Episcopal Conferences
to elaborate motivated national and regional participation strategies
to the EU Accelerated Action Programme.
This could be done through one or several seminars where the different aspects and consequences of the EU proposals are studied.