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The cholera outbreak in Northeastern Nigeria is a source of concern as Borno and Yobe States alone have recorded well over three thousand cases with 97 deaths. Dr. Clement Peter, Health Emergencies Cluster Coordinator for Nigeria at the World Health Organisation joins CNBC Africa from Abuja to shed some light on the outbreak and ways to contain it.

Containing Nigeria’s cholera outbreak

Griffins Manguro | Ghent University
The World Health Organisation (WHO) has clear markers on the road to controlling the global HIV/AIDS pandemic. By 2020, about nine out of every ten people should know their HIV status. Nine out of ten HIV positive people should be on antiretroviral treatment (ARVs) and the virus should not be detectable in their blood.
<div id="attachment_91118" style="width: 1034px" class="wp-caption aligncenter"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-91118" class="wp-image-91118 size-full" src="http://cnbc.africa/wp-content/uploads/2017/03/Drugs-Wikimedia.jpg" alt="" width="1024" height="761" />Photo: Wikimedia.</div>
And by 2030, the WHO says, there should be no new infections, no AIDS-related deaths and no stigma or discrimination related to the virus.
These are all good goals and important ways to measure how countries are progressing. In Kenya, where I live and conduct my research, there has been some progress, but more must be done. We see progress in reducing new infections among adults, providing preventive medication and providing oral self-testing for HIV.
But more must be done to reduce new infections among adolescent girls and young women, female sex workers and men who have sex with men.
<h2>Fewer new infections, more people on treatment</h2>
Kenya’s latest HIV progress report shows that new infections are dropping.
There were 40% more people on antiretroviral treatment in 2017 than there were four years ago. Antiretroviral treatment prevents the virus from multiplying and prolongs the lives of HIV positive people. It also lowers the risk of transmission from HIV positive to HIV negative people.
Currently, 66% of the 1.5 million people living with HIV in Kenya are on antiretroviral treatment. The goal is to have at least 90% on treatment by 2020.
This strategy is based on WHO recommendations, which call for a person to start treatment immediately after testing positive. Previously it was recommended that people start ARVs only after their CD4 cells (blood cells which fight infection) dropped below 500 cells per cubic millimetre of blood.
<h2>HIV self-testing strategy</h2>
One of the biggest changes in Kenya’s strategy this year was the introduction of guidelines for oral HIV self-testing.
People can test themselves for HIV using their saliva. In most African countries, self-testing is mostly used for research. Kenya is the first country to introduce a plan to make it available nationally. The aim is to increase the number of people getting tested and link those who are HIV positive to care and treatment.
The self-testing kits became available in public and private health facilities and in some pharmacies countrywide from July and could be bought at subsidised prices. They will help fill a gap in HIV testing. The number of Kenyan adults who have ever tested for HIV has grown between 2008 and 2016, from roughly a quarter of adults to more than half.
But certain populations, such as men who have sex with men, sex workers and adolescents, have low testing rates. This is mostly because they may experience stigma and discrimination when seeking routine HIV services.
Self-testing is a way to avoid stigma and discrimination and boost people’s links to care.
But the process has some problems, including the absence of counselling before and after testing. Without good counselling, people who test positive may not seek treatment and care. This can be solved by community health volunteers following up at people’s homes. They already support family planning, maternal health and child health and can help people who use the kit and test positive.
<h2>Preventive medicine</h2>
Kenya also launched guidelines on the use of pre-exposure prophylaxis (PrEP). This comes in several forms, including vaginal rings and gels. The most common is a tablet taken daily.
PrEP is given to people in high-risk groups who are HIV negative to prevent them from contracting the virus. They may be in relationships where one partner is infected with HIV and the other is not. Others at high risk are male and female sex workers.
Kenya and South Africa are the only countries in Africa that offer this type of treatment as part of a national HIV prevention strategy.
<h2>On alert for infections among youth</h2>
Kenya also started paying more attention to young people. More than half of the world’s new HIV infections are in the group aged between 15 and 24.
In Kenya, too, 51% of new adult HIV infections were in this age group by 2016 – a steep increase from 29% in 2013. It is also the only age group in Kenya that has recorded an increase in new infections. This is because young people tend to have little knowledge about the virus and the behaviours that increase their chances of infection.
People in this age group often have sex while under the influence of alcohol, which can result in poor decisions. Girls in this age group also have transactional sex with older men.
<h2>Looking ahead</h2>
Kenya has made great strides against HIV and in providing care to all HIV infected people. But more work is needed.<img loading="lazy" decoding="async" src="https://counter.theconversation.com/content/88850/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" />The country must step up its efforts to get more men tested. It will also be important to get more adolescents and young girls to adopt HIV prevention methods, and to reduce stigma and discrimination among sex workers and men who have sex with men.
This article was originally published on The Conversation.

Kenya’s HIV progress report: good progress, but also big gaps

LONDON, Dec 4 (Reuters) &#8211; Last July, Ugandan officials seized fake versions of the cancer drug Avastin on sale in Kampala, revealing only the tip of an iceberg of bogus medicines found all too often in Africa.
It wasn’t a very good fake. The bottles contained blue-grey tablets, whereas genuine Avastin is a liquid given by infusion, and the fraudsters labelled the manufacturer as AstraZeneca . The real thing is made by Roche.
The low bar for criminals pushing dodgy drugs in Africa is just one reason why the continent needs to up its game in medicines regulation.
The World Health Organisation (WHO) estimates one in 10 drugs sold in developing countries is fake or substandard, leading to tens of thousands of deaths, many of them of African children given ineffective treatments for pneumonia and malaria.
Sub-Saharan Africa has more than its fair share, accounting for 42 percent of reports of counterfeit and low-quality products the U.N. agency has received since 2013.
Bad drugs flourish when regulation is weak and there is a lack of access to quality treatments. At the moment, Africa has a patchwork of national agencies, many short of funds and expertise to clamp down on fakes or approve genuine drugs efficiently.
Healthcare experts, who met in Ghana last week to push the case for coordinated drug oversight in Africa, have a lofty ambition to create an African Medicines Agency (AMA) by 2018. It would be modelled on the 22-year-old European Medicines Agency (EMA) but cover twice as many countries and 1.2 billion people.
Considerable practical and legal problems must be overcome. But the case for such collaboration has been spurred on by the 2014-15 Ebola outbreak, where an African regulatory forum for vaccines played a leading role in fast-tracking clinical trials.
The prize is big. Supporters of the AMA believe it will speed approval of modern medicines and encourage local drug manufacturing. Like the EMA, it would work alongside national regulators.
“It is time we had an institution that can harmonise the requirements for market authorisation and address issues around quality,” Margareth Ndomondo-Sigonda, AMA programme coordinator at the African Union’s (AU) Nepad economic development agency, told Reuters.
Supporters of such harmonisation include the WHO and the Bill &amp; Melinda Gates Foundation. Drugmakers also like the idea of simplifying access to an African market of 55 divergent countries where sales to date have been limited.
SLOW DRUG SALES
Five years ago, forecasters predicted annual African drug sales would reach $45 billion by 2020, driven by economic growth and the rise of non-communicable diseases like diabetes and cancer. Today, the same experts at research company IQVIA, previously known as IMS Health, suggest it is more likely to be around $25 billion.
The political will to make the AMA work is building, helped by the backing of the WHO’s first African director-general Tedros Adhanom Ghebreyesus. The Ethiopian hit the headlines in October when he appointed Robert Mugabe as a WHO goodwill ambassador shortly before the Zimbabwean president’s removal from power &#8211; a decision Tedros was quickly forced to rescind.
Suzanne Hill, the WHO’s head of essential medicines, sees “potentially a huge value-add” from having a central body assess drug quality, rather than each country doing it independently.
“Collaboration amongst regulators is essential,” she said.
Sceptics, however, doubt the practicality of a pan-African agency, given the lack of a common legal system or an equivalent of the European Court of Justice to arbitrate in disputes.
“The only reason the EMA exists is because the EU has binding legislation, standards and enforcement mechanisms. Africa hasn’t really got anything like that,” said one official at a Western drugs agency.
Harald Nusser, head of social business at Novartis, agrees it will be “much more complex” to build an African drugs regulator than the equivalent in Europe.
But Ndomondo-Sigonda, who ran Tanzania’s drug regulator for seven years, believes Africa can “leap-frog”, based on the experience of the EMA and the U.S. Food and Drug Administration (FDA), although she admits the AMA won’t be fully up and running next year.
While a draft AMA treaty was presented to ministers in Victoria Falls in August and Ndomondo-Sigonda expects formal endorsement from AU heads of state by late 2018 or early 2019, the treaty will then still need to be signed by at least 15 member states. Only after that can operations start.
INDUSTRY FEES
Like the EMA and FDA, the agency will be part-funded by fees paid by drugmakers as products are reviewed &#8211; a trade-off that has led to debates over conflicts of interest in Europe and the United States and will be a challenge in Africa.
“It’s very important that there is transparency over how money and information flows in an organisation like the AMA. That is a significant hurdle that needs to be addressed,” said Jayasree Iyer, head of the non-profit Access to Medicine Foundation.
For companies, better regulation could finally open up a market opportunity that has been constrained by bureaucratic delays and opaque supply chains.
But Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers and Associations, sees the AMA developing gradually. “There need to be realistic expectations.” (Reporting by Ben Hirschler; editing by David Stamp)

Africa’s plan to deal with bogus medicines

GENEVA/LONDON (Reuters) &#8211; The World Health Organisation (WHO) should overturn its decision to appoint Zimbabwean President Robert Mugabe as a goodwill ambassador, global health leaders said on Saturday, describing the move as unjustifiable and wrong.
Britain said Mugabe’s appointment was “surprising and disappointing” and added that it risked overshadowing the WHO’s global work. The United States, which has imposed sanctions on Mugabe for alleged human rights violations, said it was “disappointed.”
“This appointment clearly contradicts the United Nations’ ideals of respect for human rights and human dignity,” a U.S. State Department spokesperson said.
<div class="DPSlot_container_2dHIN DPSlot_inline_1oeo6">“This selection underscores why the United States continues to push for U.N. reform and leadership actions that uphold our shared U.N. ideals.”</div>
WHO Director-General Tedros Adhanom Ghebreyesus announced the appointment at a high-level meeting on non-communicable diseases (NCDs) in Uruguay on Wednesday.
The meeting was attended by Mugabe, 93. He is blamed in the West for destroying his country’s economy and numerous human rights abuses during his 37 years leading the country as either president or prime minister.
In a speech, Tedros praised Zimbabwe as “a country that places universal health coverage and health promotion at the centre of its policies to provide health care to all”.
The former Ethiopian health and foreign minister, who was elected last May as WHO’s first African director-general, added: “Today I am also honoured to announce that President Mugabe has agreed to serve as a goodwill ambassador on NCDs for Africa to influence his peers in his region to prioritize NCDs.”
But the NCD Alliance, which represents 28 international health groups seeking to combat chronic diseases, said it was “shocked and deeply concerned” to hear of the appointment, given Mugabe’s “long track record of human rights violations”.
Jeremy Farrar, a leading global health specialist and director of the Wellcome Trust charity also said the decision was “deeply disappointing and wrong” and called on Tedros to be brave and reverse it.
“Robert Mugabe fails in every way to represent the values WHO should stand for and those that Dr Tedros has stood for since becoming DG and has done over many years,” Farrar said. “Brave leaders are willing to listen, rethink and overturn bad decisions, this is one such case,” he said.
WHO spokesman Christian Lindmeier said the WHO chief had made the move seeking broad support for the agency’s work.
“Tedros has frequently talked of his determination to build a global movement to promote high-level political leadership for health,” he said by e-mail.
Human rights activists also criticised the move.
Hillel Neuer, executive director of the Geneva-based group UN Watch described the choice by WHO, a United Nations agency as “sickening”.
“The government of Robert Mugabe has brutalized human rights activists, crushed democracy dissidents, and turned the breadbasket of Africa — and its health system — into a basket-case,” he said.
He noted that Mugabe himself had travelled to Singapore for medical treatment three times this year rather than in his homeland.
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Reporting by Stephanie Nebehay in GENEVA, Kate Kelland in LONDON and David Brunnstrom in WASHINGTON; Editing by Jeremy Gaunt and Nick Zieminski
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Critics urge WHO to reverse Mugabe’s appointment

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Sustainable health financing has long been recognised as an essential part of Universal Health Coverage and an important plank in achieving the aims of the Sustainable Development Goals. In recent years the concept has led to numerous health reforms.

World Health Organisation

Containing Nigeria’s cholera outbreak

Kenya’s HIV progress report: good progress, but also big gaps

Africa’s plan to deal with bogus medicines

Critics urge WHO to reverse Mugabe’s appointment

Focus on Africa’s healthcare

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World Health Organisation

Containing Nigeria’s cholera outbreak

Kenya’s HIV progress report: good progress, but also big gaps

Africa’s plan to deal with bogus medicines

Critics urge WHO to reverse Mugabe’s appointment

Focus on Africa’s healthcare

News Tips

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