TB, HIV: Experts call for resilient, self-reliant health financing

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Health experts have called for resilient, self-reliant health financing in Africa to combat the persisting challenges of eliminating Tuberculosis and HIV.

The call was made during a hybrid event organised by the AIDS Healthcare Foundation (AHF) to discuss strategies for building a resilient and self-reliant health financing system in Africa on December 12, 2024.

The conversation highlighted the persistent gaps in health funding, particularly in the fight against HIV, TB and Malaria and emphasized the urgent need for innovative and sustainable solutions.

AHF-Africa bureau’s director of advocacy and policy, Oluwakemi Gbadamosi, set the tone emphasizing collective action. 

“Together we can break the barriers of gaps in HIV financing and drive action towards universal health coverage and the fight against HIV in Africa,” she stated.

Domestic resource mobilisation

Joseph Munsanje, the chairperson of Zambia's Parliamentary Caucus on sexual reproductive health and rights, stressed the importance of mobilising domestic resources to address health crises.

“Domestic resource mobilisation for health is key to sustainable healthcare in African countries,” Munsanje noted, adding: “We need to analyse sector by sector to ensure resources go to where they are badly needed. Communities must be involved, and their decisions should resonate at the national level.”

Jerop Limo, the executive director of AYARHEP in Kenya, highlighted the challenges young people face in accessing health services: “Many young people are forced to pay for services that are supposed to be free and travel long distances due to stigmatism”.

In addition, she said: “Healthcare systems need to prioritize expanded and genuinely free HIV health services while addressing corruption and ensuring accountability. Clinicians should not charge for services meant to be free.”

Limo also called for integrating health insurance into healthcare services, bringing services closer to communities, and eradicating corruption to achieve sustainable health systems.

Balancing donor and domestic funding

Farai P. Mahaso, the executive director of Batanai HIV and AIDS Service Organisation (BHASO) in Zimbabwe, underscored the need for balanced funding.

He said, “governments must encourage people to contribute to health insurance funds to diversify resources”.

“While donor funding remains crucial, African nations must push for self-sufficiency by prioritizing health in their budgets and leveraging technology for widespread impact,” he said.

High out-of-pocket Spending hindering access

Acting Director of Policy Planning at the Ghana AIDS Commission, John Eliasu, identified high out-of-pocket costs as a significant obstacle to sustainable healthcare access.

He advocated for the establishment of an emergency public health fund to address diseases like HIV and TB effectively.

Closing the funding gap

Representing the Developing NGO Delegation to the Global Fund Board from Ghana, Cecilia Lodonu-Senoo, revealed a glaring funding shortfall.

“Current funding for HIV is $20.9b (sh73.4 trillion), leaving a $7.9b (sh28.9 trillion) gap for Central and Southern Africa alone,” she explained. Lodonu-Senoo called for corporate contributions as part of corporate social responsibility and urged governments to prioritise health in their budgets.

“Donors are stepping back, urging African countries to own their health systems,” she added. “We need to strengthen domestic tax mobilisation, implement transparent systems, and ensure accountability to utilize resources effectively.”

Integrating HIV health insurance

Dr Yinka Falola-Anoemuah, the director of response at Nigeria’s National Agency for the Control of AIDS (NACA), emphasized the role of leadership. 

“We must integrate HIV health insurance into the broader health system, consider crowd-funding initiatives, and ensure political leadership drives these efforts,” she said.

The experts said a collective resolve to address the structural weaknesses in Africa’s health systems is critical to health sustainability.

They agreed that with enhanced domestic resource mobilisation, increased accountability and stronger political leadership, Africa could achieve a self-reliant, resilient health financing model that ensures universal health coverage and addresses the scourge of HIV, TB and other health crises.

Gbadamosi said such dialogues are a significant step toward reshaping Africa's health systems to be more inclusive, sustainable, and self-sufficient in addressing current and future health challenges.

TB and HIV/AIDS co-infection

AHF Uganda Cares national medical director Dr Augustine Lubanga urged immediate action saying when a person has HIV, they have a higher risk of getting TB.

“We have made some progress as a country, because before we had a situation where about 50 per cent of people that had HIV had also TB. However, now the achievement has been that TB-HIV co-infection stands at about 37 per cent,” he said.

However, he also said that there is more work to be done as far as combating the health challenges is concerned.

Currently, Uganda has an estimated 1.4 million People living with HIV of which 1.2 million are currently on treatment according to the 2022 Ministry of Health Annual Estimates.

New HIV infections in 2022 stood at 52,000. This figure means that on average, over 142 people get infected with HIV/AIDS daily. Weekly this further means that about 1,000 people get infected with HIV/AIDS.

On the other hand, about 326 people die weekly due to AIDS-related deaths. According to the health ministry, infections among young people (15 -24 years) accounted for 37% of all new HIV infections in 2022, with new infections occurring three times more among young girls compared to boys in the same period according to Dr. Robert Mutumba, the assistant commissioner at the health ministry.