Currently, activists are calling governments to domestically mobilise resources to contribute to Global Fund programmes to fight HIV/AIDS, tuberculosis and malaria in Africa.
The Global Fund is an international financing organisation that aims to attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, tuberculosis and malaria; to support attainment of the Sustainable Development Goals established by the United Nations.
The current campaign on domestic resources mobilisation is founded on the fact that Global Fund targets over $14 billion fundraising to be able to fight the three diseases over the next three years, starting 2020.
The sixth replenishment cycle could help save 16 million lives, cut the mortality rate from HIV, TB and malaria in half, and build stronger health systems by 2023.
Nooliet Kabanyana, the executive secretary of Rwanda NGOs forum on HIV/AIDS and health promotion, explains that if funds decline, it could affect the advocacy campaigns in fighting the epidemics.
She says Rwanda is a champion of Global Fund in Africa in domestic resources mobilisation and, President Paul Kagame recently urged African presidents to increase resources in their countries in the health sector.
“We need more prevention and support to those affected by the epidemics by ensuring that governments increase such funding,” Kabanyana says.
According to the Abuja Declaration, governments should spend 15 per cent of their budget on health, and Rwanda has exceeded the target. Activists say governments should look at more domestic resources mobilisation efforts for sustainability.
In 2017, Global Fund investments benefited 17.5 million people with antiretroviral therapy for HIV; five million people with TB treated; and 197 million mosquito nets distributed.
THE SITUATION IN RWANDA
Dr Aimable Mbituyumuremyi, the malaria and other parasitic diseases division manager, Rwanda Biomedical Centre (RBC), says malaria continues to represent a real public health concern in Rwanda despite a number of measures put in place and effort combined for malaria control.
He says malaria cases increased between 2012 and 2016 and the most affected districts are in Eastern and Southern parts of the country.
Following the Malaria Contingency Plan put in place in 2016; a 50 per cent decrease in severe malaria cases and mortality in the last two years was registered.
Rwanda has noted estimated reductions in its malaria burden, with 430, 000 fewer cases in 2017 than in 2016, according to a WHO Malaria Report 2018; a slight decrease in malaria cases from 4,812,883 in 2017 to 4,142,933 malaria cases in 2018.
From 2016 to 2018, malaria cases decreased more than 10 times in Nyagatare and Kirehe districts where Indoor Residual Spraying (IRS) has been sustainably implemented.
“This is one of the malaria control interventions in early diagnosis and treatment aiming at preventing severe malaria and malaria-related deaths,” he says.
With the introduction of Home Based Management of Malaria (HBM) for both adults and children through Community Health Workers (CHWs) in Rwanda, people with malaria are being diagnosed and treated early. Before this strategy, they had to travel to health facilities to get services.
He says this delayed services, and led to increased number of severe malaria cases and mortality. Today, it is not the case because more than 50 per cent of people get services at community level.
This has led to the reduction of 50 per cent in both severe malaria cases and mortality due to malaria in the last two years.
He says there is budget limitation to cover Indoor Residual Spraying for malaria control in all 15 high malaria burdened districts for proper malaria control in Rwanda; (only five out of 15 districts were sprayed in 2017/2018).
He adds that there is increased work load for community health workers, leading to challenges in proper reporting of inexistence of cross-border malaria control strategies for integrated regional malaria control.
The TB programme has been working in the country since 1995. Government programme strategies have been changing according to the situation of the disease in the country.
According to 2018 global report by WHO, Rwanda is on the right track in combating TB.
For susceptible TB, WHO estimates around 7,000 cases of TB in Rwanda while at National level; there are around 5,800 cases, which is approximately 82 per cent.
For drug resistance diagnosis, there are 81 cases, which is around 86 per cent, while a report from WHO indicates that there are 93 cases.
For the incidence, WHO indicates that there are 57 cases by 100,000 people.
These, according to officials, are not alarming figures compared to situations in other countries.
Dr Yves Habimana Mucyo, the director of multidrug resistance at Rwanda Biomedical Centre (MDR), says there has been decentralising of TB services at the lowest level of the health system.
He says they work closely with community health workers in identifying TB cases among the community, where they help them get treatment at the community level or health facility.
Another strategy, he says, is sensitising the population on TB through media, using community leaders and community gatherings such as Umuganda, among others.
The Ministry is also working with institutions like University of Rwanda’s College of Science and Technology through different departments like medicine and school for nurses to include TB diseases and management in their curriculum.
There is also strengthening the capacity of different health facilities, especially laboratory components.
This includes investing in laboratory materials like microscopy or centres of TB diagnosable treatment equipped with microscopy.
There are now 69 Xpert MTB/Rif machines, which is a new technique and is more sensitive for diagnosis of TB.
“The new technique also has the capacity to detect the resistance of TB within two hours; one is able to get the results and susceptibility of resistance to the treatment,” he says.
There is also availing of TB treatment countrywide to help everyone diagnosed with TB get treatment and drugs on time.
Analysing data to have the epidemical picture of the disease and plan for future control of the disease in the country is another strategy.
Mucyo says there is need to create awareness, noting that although a lot has been done, there are still cases where people (patients) go to health centres when the diseases have advanced, which makes treatment hard.
He explains that this is so because some choose to spend time seeking help from native doctors because of the poor mentality they have about the disease.
Dr Jean De Dieu Ndagijimana Ntwali, in charge of prevention mother-to-child (MCT) at RBC, says Kigali has the highest prevalence of HIV which is around 6 per cent; and yet low coverage of couple testing antenatal care.
The national prevalence is 3 per cent, while that of women alone stands at 8 per cent in Kigali city.
The number of people infected is 2.7 per a thousand people every year.
He says it means that there are around three people who are infected in a thousand every year.
85 per cent of couples come together for HIV testing and antenatal care; 23 per cent of women are tested positive, who are newly identified, whereas 77 per cent already know the programme.
“This means that there is still a big number of women getting pregnant while they are HIV infected, meaning they don’t use protection or family planning methods,” he says.
In 2007, the rate was at 2 per cent; the number of women that are tested positive at antenatal care is decreasing because of strategies put across, says Ntwali.
Mother-to-child (MCT) in Rwanda now stands at 1.5 per cent; this means that among the 10 thousand women who are getting pregnant and exposing their infants to HIV, 1.5 per cent are actually affecting their children.
He says primary preventions, especially with young girls, are needed, as well as strategies on encouraging couples to go for antenatal care.
Ntwali says women who are affecting their children with the virus are those coming in late for antenatal care.
Another category, he says, are young girls, explaining that because of stigma from society, they tend to hide the pregnancy and only surface at the health facility during the time of birth.
Some girls living and working in Kigali, Ntwali says, take their babies upcountry to stay with their parents after they give birth.
“These parents have little knowledge on the status of the child, if the child is infected. They will only seek help when the child is seriously ill, which is a big problem,” he says.
He says there is a need to sensitise the population on going early for HIV testing. However, Ntwali says, there is advocacy during campaigns on HIV primary preventions, especially for young girls.
For infected women, he says, it’s important to be encouraged to go for treatment in case they get pregnant, and also make sure they take their medication well to suppress the viral load.
For general population, there is advocacy to go for antennal care as a couple.
There is HIV sensitisation for those who don’t have time to go to health facilities regarding self-test kits found in pharmacies.
There is need to invest in distributing condoms in different parts of the country for HIV prevention. Self-testing kits should also be affordable and distributed all over. Concerning malaria fight, more money should be allocated to giving mosquito nets to all Rwandans, especially the poor.
Jacky Mukandahiro, Mother
More campaigns are needed in areas with many HIV infected people to avoid infecting others. Community health workers must be provided with capacity building and tools to fight Malaria, HIV and TB and scale up health posts in remote hills areas in the villages.
Janvier Mbabazi, Tour guide
I think more effort should be put in campaigns where people can be examined for HIV and given antiretroviral drugs early.
Alexender Mukurarinda, Economist
Health ministry should improve ways of mosquito net distribution in rural areas. The campaigns must continue to be organised regarding prevention.
Kevin Ntirushwa, Teacher