TB HIV Care Voices: TB, Traffic jams and Politics. The United Nations High Level Meeting on Ending TB

Staff blog. Submitted by: Alison Best (Communications Manager)

Apparently New Yorkers hate it when the United Nations General Assembly is in session. I can understand why. Hotel prices in the city that hosts the headquarters of the United Nations skyrocket, roads close and the already heavy traffic becomes gridlocked.

In the midst of this, the United Nations High Level Meeting on Ending TB, so long heralded as an historic moment by the TB community, didn’t really seem to make a dent. Even within the United Nations building itself, surrounded by a bank of camera crews and deadpan security officials with airport X-ray machines, the meeting wasn’t a big deal. The film crews were not there for the TB meeting. The security officials didn’t care. Nick Herbert, member of parliament for the United Kingdom who was instrumental in setting up the Global TB Caucus – a collective of over 2300 parliamentarians from around the world committed to championing the response to TB – tweeted a picture of the United Kingdom’s empty seat in the assembly hall and wondered whether Theresa May, present in the UN building, would be stepping across the hallway to represent the UK in the meeting billed as a turning point in the fight against TB. She didn’t.

So was the meeting a failure?

From my perspective, no. The meeting was always only the first step in a long journey. As it was pointed out over and over again during the meeting and before it, the political declaration adopted by the Member States will be meaningless unless it is supported by action. The success or failure of the meeting will be crafted in the months and years to come as countries take up the commitments made in the document, scale up their efforts and ‘get ambitious,’ as one speaker phrased it, about ending TB, or lapse back into the old ways of doing things.

Are we poised to ‘get ambitious’? Well, Theresa May never showed up. Nor did any European Head of State. But Cyril Ramphosa, President of South Africa did. And Emerson Mnangagwa, President of Zimbabwe did. And Muhammadu Buhari, President of Nigeria did. And Filipe Nyusi President of Mozambique, and President Uhuru Kenyatta of Kenya. As African Head of State after Head of State stood up and announced their commitment to the response to TB, I was reminded of something else. In a side-event hosted by the New Partnership for Africa’s Development Agency (NEPAD), it was pointed out that the event was the only one organised by a regional agency – and it was an African regional agency. Add that to the fact that South Africa’s Minister of Health was key in campaigning for the UNHLM to take place and it seems like we can draw a conclusion. Africa is taking TB seriously.

We need to be taking TB seriously. A quarter of everyone who developed TB in 2016 was in the African region, and a quarter of all deaths from TB was in the African region. In South Africa, we should be well aware that TB is our leading cause of death and has been for more than a decade.

Speaker after speaker in the NEPAD event emphasised the importance of domestic financing for health – what NEPAD’s CEO, Dr Ibrahim Assane Mayaki, called ‘owning the means of implementation’. International donors are currently critical to the functioning of TB programmes in many African countries. We need to be thinking about what will happen when their investment dwindles, when they are no longer interested in taking up their seat at the table, or in the assembly hall. For example, ‘development partners’ made up 85% of what Mozambique spent on health in 2015, nearly 71% of what Liberia spent and 85% of what Namibia spent. On average, for the 52 nations in the African Union for which data was available, donors accounted for 22% of what was spent on health, and governments 35%. The rest of the cost of health care was shouldered by households and employers. If donors withdraw and African governments do not increase the amount of money they spend on health care, it will be the affected individuals, and possibly the companies they work for, who will end up footing the bill.

The good news is that African countries have signed the Abuja Declaration that commits them to spending more than 15% of their total budget on health care. The bad news is that this declaration was signed in 2001 and fifteen years later, only two of 55 countries had met the target. South Africa fell just short. It’s a lesson in how political declarations don’t automatically lead to action.

So if we want the political declaration signed at the UNHLM last month to be translated into action, if we actually want to end TB, we should remember that TB takes up a small space in the hustle and bustle of global affairs. But we should also remember that our African leaders have shown up. Now it’s our turn. We need to show up, support our leaders, and hold them accountable to their commitment to end TB.

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