A WHITAKER GROUP PUBLICATION

JUNE 2011

AFRICA HEALTH NEWS

2011 UN HIGH LEVEL MEETING ON AIDS

NEW GLOBAL STRATEGY ON AIDS SETS AMBITIOUS NEW FIVE-YEAR TARGETS

Participants meeting in June in New York at the United Nations (UN) High Level Meeting on HIV/AIDS have adopted ambitious new targets in their eorts to defeat the disease. The meeting brought together 3,000 participants, including 30 Heads of State, to chart the course of the global HIV/AIDS response over the next ve years. With progress in slowing infections and the dramatic scaling up of those receiving antiretroviral (ARV) treatment, particularly in Africa, stakeholders are anxious to maintain momentum in the ght to defeat HIV/AIDS even in the current dicult funding climate. At the conclusion of the meeting, member states adopted a declaration that by 2015 seeks an end to mother-to-child transmission of the HIV virus, a 50% reduction in sexual transmission of HIV as well as among injectable drug users, an increase from 6.6 million to 15 million people on antiretroviral (ARV) therapy, and a halving of deaths among those co-infected by tuberculosis. UN Secretary-General Ban Ki-moon also called for a global commitment to eliminate AIDS by 2020. Member states pledged to close a $6 billion annual funding shortfall for global HIV/AIDs programs by increasing funding to between $22 billion and $24 billion a year by 2015. To say that adequate funding is critical to the success of our HIV and AIDS response is an understatement, said Nigerian President Goodluck Jonathan. Many countries, including mine, can neither achieve the targets we set for ourselves ten years ago, nor the MDGs (Millennium Development Goals), without the support of our development partners. Thirty years after the start of the pandemic, Africa continues to bear the brunt of the disease. In 2009, of the 33.3 million people worldwide living with HIV/AIDS, 22.5 million of them were in Africa. Of the 1.8 million people who died from the disease that year, 72% were Africans. In total, AIDS has claimed an estimated 25 million lives worldwide since 1980. President Paul Kagame of Rwanda, who chaired a special Heads of State and Governments meeting, called for greater leadership and vision in Africa in the ght to defeat AIDS. Leadership and ownership is key in this. We should ask ourselves, who owns this struggle? he said. President Kagame identied women, who in Africa comprise 60% of those infected with HIV, as one of the key groups and drivers of change in the ght against HIV/AIDS. The meetings declaration specically calls on national governments to address discrimination against women as part of their strategies to combat the disease. In society there are people who bear the biggest burden, President Kagame added. We must let them take center stage in the process.

Ending all mother-to-child transmission of HIV is a priority in the new global strategy to ght the pandemic.

GAME CHANGER STUDY SHOWS ARVs CAN PROTECT UNINFECTED

Men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners by 96% if they were put on antiretroviral (ARV) drugs when their virus counts were still too low to merit ARV treatment under current guidelines, according to a new study released in May by FHI, a researchbased global health and development organization. The study, known as HPTN 052, was designed to evaluate whether immediate versus delayed use of ARVs by HIV-infected individuals would reduce transmission of HIV to their partners or have a signicant impact on the health of those already infected. Begun in 2005, the study included 1,763 couples from 13 sites in Africa, Asia and the Americas. The ndings, described as a game changer by AIDS activists, adds greater urgency to global eorts to expand access to ARVs not only to those with higher virus loads, but also to more recently infected individuals whose immune systems are not yet suciently compromised to merit ARVs under current guidelines. The study also showed that putting HIV-positive individuals on ARVs earlier reduced morbidity by 40%. The implication is that we need to be providing treatment earlier than we do currently, said Dr. Guy de Bruyn, the principal investigator at the Chris Hani Baragwanath Academic Hospital in Johannesburg. Not only is it benecial to the individual, but its also highly eective in reducing transmission to their partners.

PAGE TWO INVESTMENTS IN HEALTH SUPPORTING IMMUNIZATION

STUDY CONFIRMS IMPORTANCE OF PRIVATE SECTOR MALARIA CONTROL PROGRAMS

A new study undertaken in four African countries by the Roll Back Malaria (RBM) Partnership and released in May conrms the importance of private sector investment in malaria control programs. The study, Business Investing in Malaria Control: Economic Returns and a Healthy Workforce for Africa, provides evidence that investing in malaria control eorts complementary to national programs brought companies in Equatorial Guinea, Ghana, Mozambique and Zambia an average internal rate of return of 28% annually. An estimated 300 million people suer from acute malaria annually, 90% of whom live in Africa. The disease costs the continent $12 billion a year in lost productivity. In Ghana, RBM reported, AngloGold Ashanti registered a 500% decrease in monthly malaria medication costs between 2004 and 2009 after working with Ghanas National Malaria Control Program to distribute insecticide-treated bed nets, implement rapid diagnosis and treatment, and spraying insecticide on the interior walls of homes. Combined data from three companies in Zambia - Mopani Copper Mines, Konkola Copper Mines and Zambia Sugar - showed that spending just $34 per employee annually between 2000 and 2009 on malaria control

DONORS COMMIT $4.3 BILLION TO BOOST VACCINATION

Public and private donors, meeting in London in June, pledged $4.3 billion over the next ve years - exceeding the $3.7 billion target - to immunize more than 250 million children in the developing world against a host of diseases. The GAVI Alliance, which hosted the conference, estimates that the increased funding will prevent more than four million premature deaths. The pledging conference was the rst held by GAVI, a partnership that aims to improve health in developing countries through immunization. It is comprised of public and private sector partners, the World Health Organization (WHO), UNICEF, the World Bank, research agencies and foundations. Donor governments more than doubled their previous commitments to GAVI, and a number of governments, including Brazil and Japan, pledged for the rst time. New private sector donors included the Anglo American Corporation, one of the worlds largest mining and natural resource groups. For their part, developing countries committed to maintaining or increasing the co-nancing of their national vaccine programs. GAVI estimated that the total level of co-nancing will triple to $100 million by 2015. Vaccine manufacturers announced in the lead up to the conference that they would lower prices on a range of vaccines in support of GAVI. This includes a two-thirds cost reduction on the recently-introduced rotavirus vaccine to combat a leading cause of childhood diarrhea. In recent years, immunizations against diarrhea, pneumonia and meningitis - all widely available in the developed world - have been introduced into Africa. The new funding will make it possible for many more children to receive these new vaccines. GAVI recently reported that a record 50 countries had applied for vaccine funding during its latest application round - nearly double the previous record in 2007. The new support will allow GAVI to fully fund approved requests. Today is an important moment in our collective commitment to protecting children in developing countries from disease, said President Ellen Johnson Sirleaf of Liberia. But every 20 seconds, a child still dies of a vaccinepreventable disease. Theres more work to be done.

Children with bed nets, distributed by NetsForLife, a partnership between the Coca-Cola Africa Foundation, ExxonMobil Foundation, Standard Chartered Bank and NGOs. resulted in a 94% drop in malaria-related lost work days per year. The numbers in this report show the dramatic successes that are possible when working on malaria, demonstrating that moderately priced interventions can result in real company benets, said Mr. Herve Verhoosel, RBMs External Relations Manager. The RBM Partnership was founded by the United Nations (UN), the World Health Organization (WHO), the World Bank and the UN Development Program (UNDP), and is comprised of 500 public, private and NGO partners.

BUILDING CAPACITY

GSK TO REINVEST PROFITS IN AFRICA TO ADDRESS HEALTH WORKER SHORTAGES

Global bio-pharmaceutical research company GlaxoSmithKline (GSK) announced in May that it will reinvest $5.7 million of its earnings in Least Developed Countries (LDCs). The money will fund in partnerships that support the training and retention of healthcare workers. The donation is the fulllment of a promise made in 2009 by GSKs CEO Mr. Andrew Witty to reinvest by 2012 one-fth of the companys prots in every LDC country where GSK does business, and represents 20% of the prots made by GSK in 37 LDCs in 2010. The reinvestment will be made through three leading NGOs: AMREF in East and Southern Africa, Save the Children in West Africa, and CARE International UK in Asia Pacic. The amount available for investment in each country will be proportional to the amount of prot generated there. The minimum investment will be $16,400. Although the prots we make in LDCs are relatively small at this time, our commitment to reinvest 20% of them provides a sustainable model to help improve healthcare infrastructure, said Mr. Witty. Among the projects that will benet from the GSK contribution are an expansion of a group of nurse-run clinics in Rwanda and the renovation of a clinical training center for midwives in Cambodia. Last year, as part of the same commitment, GSK gave back $4.6 million to health programs in its client countries in the developing world.

PAGE THREE INNOVATIONS IN HEALTH DELIVERY INVESTING IN HEALTH

ROLE OF MOBILE TECHNOLOGY ASSESSED AT FIRST mHEALTH SUMMIT IN CAPE TOWN

Participants at the rst ever African mHealth Summit in Cape Town in June were enthusiastic about the potential of mobile phone technology to improve healthcare delivery in Africa. They cautioned, however, that the rapidly emerging eld of mHealth needed to be better regulated and evaluated for effectiveness before the many pilot programs underway can be scaled up. With cell phone penetration in Africa exceeding infrastructure development such as paved roads and access to electricity and the internet, African health ministries and providers are embracing the use of mobile technology - in particular, the use of text messaging - as a way to reach underserved populations.

AFRICAN HEALTH FUND SURPASSES $100 MILLION TARGET

Aureos Capitals Health in Africa Fund, launched in 2009 to attract investment in Africas burgeoning health sector, surpassed its $100 million goal in May, according to Bloomberg news service. The fund, the first devoted exclusively to investment in Africas health sector, is part of Africas rapidly-expanding private equity market which is attracting investors who wish to take advantage of the continents growing population, rising incomes and double digit returns on investment. The Emerging Markets Private Equity Association estimates that private equity funds in sub-Saharan Africa raised $1.5 billion in 2010. The fund targets small- and medium-sized companies (SMEs) in Africa that provide healthcare services such as clinics, hospitals, diagnostic centers, laboratories, health management organizations, insurance companies, local pharmaceutical companies, medical schools and manufacturers of medical equipment. So far it has invested in Nairobi Womens Hospital in Kenya and C&J Medicare in Accra, Ghana. An investment in a hospital group and another in a medical devices manufacturing facility in East Africa have also reportedly been approved, with two health service businesses in West Africa under consideration. Aureos launched the Health in Africa Fund in June 2009, after concluding an analysis of healthcare provision in East Africa. The study showed that much of the African healthcare sector suffers from severe structural and systemic bottlenecks that could provide opportunities for private companies with the capacity to meet these challenges. We are very well placed to support solutions to the issues we have come to understand in the African healthcare market, said Mr. Davinder Sikand, Regional Managing Partner of Aureos in Africa. The provision of capital to SMEs operating in the health sector in conjunction with professional private equity support will certainly increase the efficiency of the African health market, he added. Early investors in the fund included the African Development Bank (AfDB), the International Finance Corporation (IFC) and the Bill & Melinda Gates Foundation.

GHANAS MDNet BRINGS DOCTORS TOGETHER

With only 2,000 doctors serving a population of nearly 24 million people and low internet coverage, physicians in Ghana needed a reliable and fast way to communicate and refer patients. In 2008, the Ghana Medical Association (GMA), with support from New York University, the US-based NGO Switchboard, and a local mobile provider, launched Mobile Doctors Network/ Medicareline program (MDNet). The service provides free mobile-to-mobile voice and text services to all Ghanaian doctors registered with GMA. More recently, a one-way bulk text messaging (SMS) service was enabled, allowing GMA to send information to doctors about national emergencies and meetings, as well as to contact doctors within a particular specialty. By facilitating access to free mobile phone service, MDNet has removed an important cost barrier for clinical consultations among doctors, advancing the provision of medical advice and the referral of patients needing specialized medical attention across Ghana. GMA will soon launch the rst Ghana doctor directory, which will include the physicians MDNet telephone number, hospital, specialty and region where he or she practices.
SOURCE: WHO MHEALTH GLOBAL SURVEY

Mobile phone subscriptions in Africa reached an estimated 500 million in 2010. Were enthusiastic that technology will help fast-track the delivery of services and reduce transport costs for poor people, South Africas Deputy Minister of Communications Obed Bapela said in the opening address at the summit. At the same time, were cautious about issues of condentiality and the vulnerability of patients that arises around cyber security issues. Up to 40 African countries currently use mobile health services, according to a World Health Organization (WHO) global survey of mHealth released at the summit. About twothirds of Africas mHealth programs are still in the pilot stage, with larger countries - in particular, Ethiopia, Kenya, Nigeria and South Africa - leading development in the eld. Despite mHealths boundless promise, the challenge to date has been that space and discussions have not been dominated by entrepreneurs, much less social entrepreneurs, said Mr. Bright Simons, founder of mPedigree, a service that allows consumers to use text message to verify the authenticity of their medications. Thats led to a perverse emphasis on pilot projects and research papers, not products and services, but thats beginning to change. Mobile technology in Africa has been mostly used in maternal and child health programs and programs to reduce the burden of specic diseases such as HIV/AIDS, malaria and tuberculosis. In 2008, Ghana pioneered a mobile program that enables doctors to consult with each other and make referrals (See box). Despite the rapid growth in mobile phone penetration, African countries in the WHO survey identied the lack of cellular network coverage as the top barrier to the implementation of mHealth.

PAGE FOUR LEADERS IN HEALTH OPEN RESEARCH COLLABORATION

KGOMOTSO KWENJE, SENIOR MANAGER, CLINICAL SERVICES DR. GILBERT KHOSA, MEDICAL DIRECTOR BHUBEZI COMMUNITY HEALTH CENTER, SOUTH AFRICA
As African governments and their partners work to bring the ght against HIV/ AIDS to Africas rural populations, they are increasingly reliant on healthcare professionals who are willing to leave careers in urban centers to serve some of the continents poorest citizens. In June, two such professionals, Ms. Kgomotso Kwenje and Dr. Gilbert Khosa, comanagers of Bhubezi Community Health Center in South Africa, became the rst recipients of the Frontline Heroes for Health Award, presented at the 10th Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) Awards Dinner in New York. The award, which this year was presented by Sir Richard Branson, Chairman of the Virgin Group, and Ms. Cynthia Carroll, CEO of Anglo American Corporation, recognizes leadership in community healthcare. Ms. Kwenje, who manages the centers clinical services, and Dr. Khosa, its medical director, both grew up in Mpumalanga province where the center is located, but left to pursue studies elsewhere. They returned in 2007 when the health center was opened with the support of the South African government, Virgin Unite, the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR), and Anglo Thermal Coal, the areas principal employer. Bhubezi is a one-stop healthcare center that brings primary health care and eective diagnosis and treatment for HIV/AIDS to an area where an estimated 20% of the population is HIV positive. The center charges a nominal fee for basic health services but provides free diagnosis and treatment for HIV/AIDS, tuberculosis (TB) and malaria. It also runs an ambitious prevention program and health education outreach to the community. Mo r e than 130,000 patients have been treated at our health center and this has revolutionized the way our community understands the concept of healthcare, Dr. Khosa Kgomotso Kwenje said. Importantly, HIV positive patients now recognize that antiretroviral treatment can drastically improve their quality of life. Bhubezi provides more than 3,500 people with antiretrovirals and employs more than 50 local people. Gilbert and Kgomotso both realized that local people would have to step up to the plate in the ght against the twin scourges of HIV and TB, and we commend them for their tireless commitment. For Anglo American and Virgin Unite, we feel the true spirit and passion comes from the frontline heroes who are at the heart and soul of so many of our eorts in supporting and uplifting communities around the world, Sir Richard commented at the awards dinner. Virgin Unite is the philanthropic arm of the Virgin Group. The health center is built on a model developed by Dr. Hugo Tempelman, a Dutch social entrepreneur who created Ndlovu Medical Center, a successful autonomous treatment facility in a rural area north of Pretoria that also supports local economic development programs. It plans to develop satellite clinics and follow Ndlovus lead in launching local entrepreneurial ventures such as food gardens, computer literacy classes and business skills development that will stimulate the areas economy and empower the local population to provide nancial support for the health center. GBC is a private sector coalition of almost 200 companies that supports the Global Fund to Fight AIDS, Tuberculosis and Malaria.
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SANOFI AND DNDi TO DEVELOP NEW DRUGS FOR NTDs

Bio-pharmaceutical research company Sano announced in June that it had signed an innovative three-year research agreement with Drugs for Neglected Diseases Initiative (DNDi) to develop new drugs for nine neglected tropical diseases (NTDs), and to allow open access to the drug research results. Under the agreement, Sano will bring molecules from its libraries to the partnership, with the intellectual property rights to the results being shared by both Sano and DNDi. The intention of the collaboration is not only to develop new treatments but to make their formulation more accessible to the wider research community focusing on the NTDs. The World Health Organization (WHO) estimates that 1.4 billion people worldwide suer from a variety of NTDs. Historically, research to develop treatments for these diseases has been severely underfunded because they disproportionately aect the worlds poorest people. DNDi is a public-private partnership founded in 2003 as a non-prot research and development organization focused on bridging the funding gap for NTDs. Diseases covered by the agreement include leishmaniasis, Chagas disease, human African trypanosomiasis (sleeping sickness), lymphatic lariasis (elephantiasis), onchocerciasis (river blindness), soil-transmitted helminthiasis, dracunculiasis (guinea worm disease), fascioliasis and schistosomiasis (bilharzia). This agreement is a major milestone in our access to molecules that can help combat neglected diseases, said Dr. Bernard Pcoul, Executive Director of DNDi. We believe that this level of private sector involvement in open research collaboration to deliver appropriate medicines as public goods is vital to addressing the needs of the most vulnerable populations of the world. The new agreement is the latest in a growing trend towards opening access to drug development research. Last year, ViiV Healthcare, which specializes in the development of HIV/ AIDS drugs, opened up its portfolio of antiretroviral drugs to generic manufacturers in 69 low-income countries, including all of sub-Saharan Africa. Sano has collaborated with DNDi previously to develop, manufacture and distribute the drug fexinidazole to treat sleeping sickness.

Dr. Khosa examines a patients xray at Bhubezi Community Health Center.