Monday 21 April 2014     20 Jumada Al-Thani 1435
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‘90% of AIDS treatment in Africa, still funded by donors’

Dr Babatunde Osotimehin  is the Executive Director,  United Nations Population  Fund (UNFPA). In this interview, he speaks on the need for  increase budgetary allocation for health, as dependence on external funding according to him introduces a sense of insecurity.

What does UNFPA bring to the Abuja+12 summit?
We are here to review how far Africa has gone. The outstanding thing done before was for governments to commit to raising health spending to 15% of their budget. We need to congratulate ourselves in Africa. First of all, we have reduced considerably the prevalence of HIV and reached many more people with treatment. We have almost 10 million people in the world on treatment-a major achievement.
 In 2001, when we started, hardly was anybody on treatment. We have also reduced malaria deaths and provided many people with insecticide-treated nets. Tuberculosis has also reduced.
But we cannot look at them in isolation, because 20% of maternal deaths in Africa are due to HIV. Pregnant women also die from malaria. In terms of specificity and broad movement of an integrated approach, we have done a great deal but there are still challenges. We need to reach more vulnerable people; inequalities have grown in many of our societies; people who cannot afford services are still not getting it. We also must ensure governments actually allocate more resources to these issues.
More than 90% of treatment of AIDS in Africa is still funded from external sources. That introduces a sense of insecurity in my view. Shared responsibility is something we have to do. Going forward, some greater integration of those specific disease entities and the greater concept of the healthcare delivery system that address holistic health will have to do so that we can further reduce maternal mortality and ensure family planning is available to women who want it. 222 million women in the world today want family planning and they are not getting it. All of that contributes to the disease burden we are talking about.
Our contribution as UNFPA to the conversation around integration is to ensure we can bring to the fore the specific things we do as co-sponsor of UNAIDs looking after prevention and ensure we can reduce infection and make sure the larger maternal mortality is also reduced on the continent.
MDG goals are just two years away. Any plans for implementation to meet set targets?
There are eight MDGs, and we have done well with many of them: education, gender equality, access to water. There are a couple where we haven’t done well: maternal mortality reduction and universal access to reproductive health services. And there is a reason for that. In 2000 when the MDGs were put in place, that particular target wasn’t part of it. It only came in 2007, so we have only seen six years of universal access paradigm to family planning. Given the last 900 days of the MDG we need to accelerate it and make sure we can reach more women. In the past years, there has been increase in availability and resources for family planning and I believe we are going to make a difference. We must remember that once women get family planning, we reduce maternal mortality by 30%.
In addition, domestic resources must go to it, and we must ensure governments take responsibility for all of this.
How can Nigeria deal with malaria in a sufficient and effective manner?
In the context of Nigeria, we must disaggregate and unpack Nigeria. Every time I hear people talk of Nigeria as a homogenous, it sends the message that there aren’t areas where progress is being made. What’s important is for us to ask what’s happening in each of the 36 states. I like to believe we see progress in some states and in others we still have challenges. Disaggregation should give us evidence to go to those states where we need to do more than we are doing, and use the states that have done well to share information and practice.
Family planning and population control is very controversial. How would UNFPA  push forward its advantages?
We are not in the business of population control. What we continue to talk to is the empowerment and freedom of the woman to make choices. There is evidence that when a woman has choice, information, access to services, she actually has fewer children. That is what we require to get so that every woman will have the number of children she can afford when she wants it and the space in between.
It has also implication for the health of the children and mother. We know for fact that when a woman has access to family planning, we reduce the incidence of maternal mortality.
In many developing countries, many young girls die from unsafe abortion because they have no access to information. We need to be able to give them information about their bodies, what they can do, how they can prevent these unfortunate incidents.
Nigeria is running a fragile health system. As a former health minister, what is your sense of it?
I would say Nigeria is running a vibrant health system where there are always arguments as to what professionals want as against what government can provide. I want to stand on record as in my time as health minister we did not have a strike, and it was because we engaged with the people to prevent strikes. At the end of the day, the solution to the health problems in Nigeria will come from the states. They must begin to take control of the health of the people. The federal government can make all the overarching rules, but when it gets to day-to-day administration, the states have to step up.
Recent report on midwifery shows reduction in maternal deaths. How can Nigeria strengthen the scheme?
I am happy that is working well, and I was part of it as minister of health in my time. It just goes to prove that if you want to reduce maternal mortality, there are probably two or three things you need to do: human resources for health, making sure commodities get to where it is required, and ability of people to pay for their services.
We see that in Ethiopia where they have deployed 40,000 of these people, they have crashed maternal mortality by half. Let us step it up, make sure we can train more people, deploy them to communities to they are close to the people and make sure they have all they require to provide services.
 Let us also look at payment for services. Once people have to pay and they don’t have the resources, they don’t come. But if we make sure there is a social protection floor and they can pay, people will go there.
When that happened in Sierra Leone, we had an increase of 400% uptake and a reduction of more than 60% in maternal mortality. We know what to do, so let’s just go do it.
Nigeria has the highest PMTCT burden in the world. What should be done?
Intensify our efforts. Prevention of mother-to-child transmission of HIV is something we know how it works. We already have deployed resources to do it, and I think it is a question of going out there and making sure it works. Again, let’s disaggregate; where are the cases so we can target them. Where are the cases? Nigeria is large, complex, but Nigeria also is simple, if you address the issue on a case-by-case basis.
FCT banned prostitution and same-sex marriage, both a most-at-risk group. Proponents call for policy to include them in terms of services, but Nigeria seems to be going in the other direction. What’s your sense of that?
The vulnerabilities to HIV, we know them and we need to have policies that ensure that between them and the general public, they don’t constitute any particular danger to themselves or the public. Policies have to be tailored such that we reduce transmission between them and the general public.
When it comes to laws, it is a national thing. We can only advocate based on evidence that these are things we need to be careful of, so we don’t accelerate things we don’t want to see happen.
What changes does the UN want on the continent, not just on the three diseases but a holistic reach that will improve the lives of Africans in the face of dwindling resources?
The world today is looking at a new development agenda, which is going to be global. As we go toward 2015, it is nice for us in Africa to come up with ambitious goals, not based on just disease paradigms but holistic ones. How do we ensure we have health education, preventive health, systems that respond to our health, public and primary health that respond at the level of communities? We want to see Africa define the well being of our people so that they can live a better healthy life.