The document summarizes progress made in implementing the African Union Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response. It discusses achievements under the three pillars of the roadmap: increasing domestic financing; improving access to medicines through local production and regulatory harmonization; and strengthening leadership, governance and oversight. However, it also notes ongoing challenges including aid dependency, weak health systems, and difficulties translating political commitments into action. The conclusion calls for intensified implementation of national programs to attain health goals by building on progress while addressing remaining challenges.

2. Assembly Decision /AU/ Dec.413 (XVIII)
• January 2012 AU Summit: AUC and NEPAD
requested to produce a Roadmap on Shared
Responsibility and Global Solidarity for AIDS,
TB and Malaria Response.
• July 2012 : The AU Roadmap was endorsed to
support African countries to meet their
commitments in terms of the Abuja Call and
related AIDS, TB and malaria targets by 2015.

3. AU Roadmap pillars
Diversified,
balanced and
sustainable
financing models
Pillar 1
Access to medicines
through local
production and
regulatory
harmonisation
Pillar 2
Leadership,
governance and
oversight for
sustainability
Pillar 3

4. High level political commitment
January 2012
AWA mandate expanded to
include tuberculosis and
malaria includes all Heads of
State and Government
July 2012
High Level Ministerial Dialogue on
Value for Money, Sustainability and
Accountability in the Health Sector
calls for reducing and dependence
July 2012
African Leaders Malaria
Alliance (ALMA) Summit on
malaria calls for increased
domestic financing and
innovative financing
September 2012
United Nations General Assembly
African Union High-Level Side Event
on Shared Responsibility and Global
Solidarity for AIDS

5. High level political commitment
March 2013
PAP commits to monitoring the
implementation of the AU
Roadmap.
January 2013
At the AU Summit, CARMMA
commits to local production
of antiretroviral drugs,
condoms and other essential
drugs.
May 2013
Appointment of the AWA
vice chairperson and five
AWA Regional Champions
July 2013
Declaration of the Special
Summit undertook to accelerate
the implementation of the earlier
Abuja commitments

6. High level political commitment
July 2013
AIDS Watch Africa
Champions Action Plan
developed
August 2013
SADC Heads of State commit to
accelerate action on AIDS, TB and
Malaria
March 2014
Parliamentary roundtable
develops action plan.
May 2014
Regional Economic Communities
(RECs) meet to review
Implementation of the African
Union Roadmap

7. High level political commitment
June 2014
HOSG call for MS to
accelerate the
implementation of the
Abuja commitments on
ATM
September 2014
High level discussion on the
future of health financing on the
margins of the 69th session of
the UNGA in New York
November 2014
Briefings of the Africa
Groups, French Assembly
on the AU Roadmap and
Domestic Financing for
Health
April 2015
STC requested development of
Roadmap for AIDS, TB and
Malaria in line with 2013 Abuja
Actions

8. Progress Pillar One
• Most African countries diversified and
expanded funding sources for health to
reduce aid dependency.
• Between 2006 and 2011 global domestic
investment has doubled spending on AIDS, TB
and malaria.
• In the last four years, African countries have
increased their domestic resources to fight
AIDS by 150%.

9. Progress Pillar One-2
• RSA has contributed US$2 billion dollars
per year of domestic funding toward the
AIDS response
• RSA implemented interventions that
achieved price benchmarking, robust
allocation of preference points and price
stability
• Nigeria committed US$1 billion for
investments in treatment, care and
prevention in 2013

10. Progress Pillar One-3
• Zimbabwe’s AIDS levy increased from 5.7 million
in 2009 to 150 million in 2014.
• In 2011 Cameroon joined Congo, Madagascar,
Benin, Mali, Mauritius and Niger in applying an
airline levy with funds set aside for HIV
programmes.
• Benin piloted a scheme for results-based
financing in the context of plans to increase
domestic resources for HIV treatment and
prevention.
• Cape Verde, Comoros and other countries charge
alcohol excise taxes with funds earmarked for HIV
programmes.

11. Progress Pillar One-4
• Since 2010 the Government of Swaziland has
relied exclusively on domestic resources for its
ARV medicines.
• Rwanda and Uganda are charging levies on
mobile phone usage.
• The governments of Benin, Congo, Madagascar,
Mali, Mauritius and Niger charge airline levies.
• Over 90% of Rwandans enjoy health insurance.
• Over 90% of patients in both private and public
facilities in Ghana are health insurance
subscribers

12. Progress Pillar One-5
• Ethiopia committed 2% of the budget of each public
sector body for HIV.
• In Swaziland, all public bodies are required to devote
2% of their budget to workplace policies for their staff.
• Malawi requires all ministries and departments to
allocate a minimum of 2% recurrent costs budget to
HIV-related activities.
• Gambia’s contribution to its national AIDS response
has increased from GMD 1.8 million per year between
2008 and 2011 to over GMD 5 million in 2012.
• In 2011 Gabon increased the National Fund for HIV
Prevention and Treatment by approximately 150%.

13. Progress on Pillar One-6
• Tunisia is also aiming to finance just over 70% of its HIV
response domestically with almost universal treatment
coverage – including coverage for non-nationals in need
• Swaziland has increased its antiretroviral drugs tender
efficiency by introducing ceiling prices, supplier
performance data and more reliable quantification
methods
• Malawi is currently evaluating alternative options in order
to increase domestic funding.
• Domestic funding of the AIDS response has increased in
Namibia (60%), Rwanda (24%), Liberia (19%), Malawi
(19%), Zambia (16%), Togo (15%) and Madagascar (15%).

14. Progress Pillar Two
• The pharmaceutical manufacturing plan for Africa
(PMPA) sought to not only improve the continent’s
public health through contributing to a healthy human
capital but also aimed to strengthen the local industry
thereby creating jobs and enjoying the economic
benefits of a viable pharmaceutical industry.
• The endorsement by AU Heads of States and
governments of the PMPA business plan has attracted
the interest of national governments and regional
economic communities to develop the pharmaceutical
sector but it has also triggered a significant number of
partners to increase their support to the AUC and
other organs of the AU including Member states.

15. Progress Pillar Two-2
• Considerable progress has been made to scale up
pharmaceutical access and manufacturing, with a
particular focus on ARVs and ACT as well as other
malaria commodities such as insecticide-treated
nets.
• The implementation of the PMPA Business Plan
and related sub-regional plans developed by the
EAC, SADC and ECOWAS, will further support
increased pharmaceutical capacity in Africa.
• Establishment of the African Medicines Agency,
Endorsement of a model on medical products
regulations and harmonization, to the
development of a GMP compliant Industry.

16. Progress Pillar Two
• Increased regulatory harmonisation across the
continent. In 2012, NEPAD began developing an
AU model law on Medical Products Regulation for
adoption by national legislative bodies in an
attempt to harmonise medical products
regulation in Africa.
• The AMRH Initiative, supported by NEPAD, is
promoting the establishment of regional centres
of regulatory excellence, working through the
existing structures of RECs.
• Importance of TRIPS and IP approaches (EAC).
• South South Cooperation : Africa China Forums,
BRICS.

17. PMPA Consortium
• UN agencies (UNIDO, UNAIDS, WHO, UNFPA,
UNDP)
• FAPMA (Federation of African Pharmaceutical
Manufacturers ) and ANDI (African Network for
Drugs and Diagnostic Innovation)
• AfDB, UNECA, and USP (United States
Pharmacopoeia Convention)
• Myriad of challenges confronting the
pharmaceutical sector and hampering its growth
such as access to financing, human resources
development, access to technology and know-
how, inadequate regulatory systems, poor sector
strategies, incoherent policies etc

18. Progress Pillar Three
• Growing Importance of high level political advocacy
and early implementation
• The AUC, various organs of the AU (NEPAD, PAP,
APRM), RECs and AU Member States with the support
of stakeholders including development partners have
provided leadership for the implementation of the AU
Roadmap.
• AWA and the ALMA are also providing leadership for
high-level advocacy and accountability on AIDS, TB and
malaria responses across the continent.
• Member States are developing more robust, inclusive,
results-focused national strategies (costed strategic
Plans and related investment cases).

19. Progress Pillar Three
• At continental, regional and national level,
there are signs of strengthened protection in
law and policy for rights-based responses to
HIV, AIDS, TB and malaria.
• Integration with health systems focus – not
overly vertical – approach
• Role of Civil Society, private sector and
development partners.

20. Progress Pillar Three
• MS streamlining disease coordination and
governance to make the best use of limited
national human and financial resources with
the support of the United Nations
Development Programme (UNDP) and other
partners to make the best use of limited
national human and financial resources.
• Remarkable efforts made in aligning Global,
Regional and National strategies

21. • Difficulty in translating political declarations to concrete and
measurable actions.
• Heavy dependence of many African countries on external
financial support making financing for AIDS, TB and malaria
services neither predictable nor sustainable;
• Weak planning capacity, implementation and performance-
based management partly because of lack of institutional
and human resource capacity at national level;
• Insufficient policy planning and programming for addressing
health in national development frameworks which is
reflected in inadequate health system development, low
coverage and access to services
CHALLENGES - 1

22. • Inadequate laboratory networks for diagnosis of diseases and
human resources in terms of numbers, mix of skills, motivation,
and retention.
• Inadequate access to essential medicines, preventive
commodities and technologies across much of the continent.
• The lack of adequate policies and legislation protecting the
rights of PLWHA and TB patients by most countries hinder efforts
at effective responses. This is further compounded by many other
factors that include stigma and discrimination, gender inequity,
inadequate coordination at national, regional and international
level including weak M&E systems .
• Cross cutting issues-poverty reduction, nutrition, food security,
internal and inter-country migration and development
CHALLENGES - 2

23. • Leadership and governance- there is need to further strengthen
leadership and governance at various levels.
• High level advocacy and resource mobilisation
• Protection of human rights- based responses to health through
better access to justice, law and policies enforcement at
national and regional level to ensure that the needs of
vulnerable and key populations are taken into account in an
adequate way.
• Strengthening health and community systems-Member States
with support of partners should further strengthen health
system and community service delivery for greater efficiency
with focus on integrated AIDS, TB and malaria services.
• Prevention, treatment, care and support- Abuja Call and the
AU Roadmap should be extended for the period 2015 to 2030.
AFRICA TO MAKE HIV TB AND MALARIA
HISTORY By 2030 : RECOMMENDATIONS - 1

24. • Access to affordable, quality assured medicines and technologies-
develop and implement national action plans to ensure reliable access to
affordable and quality-assured medicines and health-related
commodities.
• Research and Development-further strengthen capacity on biological,
clinical and socio-cultural research, including traditional medicines and
vaccines research to generate evidence to improve and adapt policies and
programmes.
• Partnerships-diversify and strengthen partnerships with NGOs, CSOs,
private sector and international community to advance the agenda of
shared responsibility and global solidarity and create a conductive
environment for this to happen.
• Monitoring, Evaluation and Reporting- there is need to further
strengthen monitoring, evaluation and reporting mechanisms for more
effective responses.
RECOMMENDATIONS - 2

25. Extending AU Roadmap to 2030: Key
General Recommendations
• Create more space and opportunity for political advocacy
• Move beyond business as usual with emphasis on quality
and urgency
• Align global, regional and country level strategies and
strengthen the coordination at all level
• Need for focus on how strategies will be operationalized
making sure partners align their interventions to the
National and regional frameworks
• Need to capture how we will work more effectively together
to secure alignment in approach/implementation as well as
in strategy documents
• SDG tighter framing is forcing us to work more closely
together

26. Extending AU Roadmap to 2030: Key
General Recommendations
• Ensure strategies adapt to local context and regional specificity
• Prevention needs to be more strongly highlighted
• Need to clearly define a role for community level and gain
community participation and ownership (the Ebola crisis)
• Use local information to inform programmes, focus on young
women and girls (AIDS),– right things, right places, right time
• Impact, efficiency, sustainability, partnership, human rights,
gender and community focus - social determinants of health – all
critical
• Strengthen Health systems
• Define boundaries between health and other sector
responsibilities
• Strengthen Monitoring, Evaluation and Reporting mechanisms a
basis for evidence informed responses.

27. OPPORTUNITIES TO INCREASE
INVESTMENTS IN HEALTH
• Greater emphasis should be placed on longer-term
sustainable financing through, inter alia, efficiency
gains and mobilizing greater domestic resources.
• Drug resistance is a huge challenge to treatment
efforts for all the three diseases and need more
attention.
• Future efforts by the AU Member states and its
partners to sustain and accelerate progress in
human rights, gender equality and solidarity with
marginalized populations. Social Protections
measure need to be implemented to move
towards universal access to health services.

28. CONCLUSION
• In spite of the above, the progress made is still
insufficient to attain the Abuja target of universal
access to HIV and AIDS, TB and Malaria services by
2015 and MDGs.
• The ‘final push’ towards universal access and ultimately
ending the three epidemics should be advanced through
intensified implementation of national programmes with
the support of the UN system and international partners,
and better harmonization and coordination at national,
regional and continental levels (High Level leadership
and commitment to eliminate the three diseases as well
as socio economic grow in the region.