Now is the Time for Action: Universal Access to Comprehensive Sexual and Reproductive Health Services in Africa

Special Session of the Conference of African Union Ministers of Health, Maputo, Mozambique

Your Excellency Prime Minister of Mozambique,

Madam Chairperson, Minister of Health of Botswana,

Excellencies Ministers of Health,

Allow me to call you sisters and brothers of the African Continent,

Friends and colleagues,

I am deeply honoured to address this Special Session of the African Union Ministers of Health. It is a special event for me, since it is my first time to address member States of the African Union, together and in one place. So, I ask for your indulgence to allow me to share with you what is in my heart, soul and mind on the very special subject of UNFPA’s mandate—universal access to comprehensive sexual and reproductive health. This is what our world leaders have committed themselves to achieve by 2015 at the United Nations 2005 World Summit.

My good friend, Joy Phumaphi, Deputy Director-General of the World Health Organization (WHO), who spoke earlier, asked us to face the sad reality of the health conditions of African women and to acknowledge our shortcomings. I hope that I can complement her by sending a message of hope; because I believe that Africa has the will to move forward in many areas and we saw it moving.

As Ministers of Health, your presence is testimony to your commitment to action and to keep Africa moving in the area of sexual and reproductive health. We are all in the business of saving lives and this is what makes our work challenging and our lives meaningful.

Permit me at the outset, Excellencies, to commend the African Union Commission for fostering your Continental Policy Framework on Sexual and Reproductive Health and Rights and its approval by African Heads of State. I acknowledge the leadership of African Ministers of Health, who met in Gaborone and made this policy possible.

I would like to take this opportunity to pay tribute to the Chairperson of the African Union Commission for his vision and leadership. I also express our deepest appreciation to the African Union Commissioner for Social Affairs, Advocate Bience Gawanas, for her dedication and leadership in spearheading this policy and plan of action. It is with both passion for human rights and compassion for the people we serve that we can achieve our common goals—my sister Bience has both well rooted in her mind and heart.

I would like to express UNFPA’s gratitude to the Government and people of Mozambique for your warm welcome and generous hospitality. And we congratulate the Government for the progress it has made in ensuring peace and development.

I would also like to pay special tribute to the European Commission for its sustained and unwavering support to the right to sexual and reproductive health and its strong commitment to partnership. We are appreciative of the European Commission’s political, moral and financial support to this conference. I see this support and cooperation between the European Commission and the African Union as a successful example of two regional intergovernmental bodies coming together to support the people of Africa as they exercise their right to health, including reproductive health. It is not only North-South cooperation that is helped, but also South-South cooperation, which is a common objective that brings us together.

I cannot but also address special words of gratitude to my colleagues and friends in the United Nations family. I would like especially to express my appreciation to WHO, our technical reference point, as well to the United Nations Children’s Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) for their cooperation in bringing coherence to our collective work in the area of reproductive health and HIV and AIDS.

Finally, allow me to thank our longstanding partner, the International Planned Parenthood Federation (IPPF), for your continued partnership—and leadership—in promoting the principles and objectives of the Programme of Action of the 1994 Cairo International Conference on Population and Development (ICPD).

My sisters and brothers,

Universal access to reproductive health is more than a goal that was agreed upon by 179 governments at the Cairo Conference, and reaffirmed by leaders at the 2005 World Summit.

Sexual and reproductive health is a human right. It is part of the human right to health. And as the great leader, Nelson Mandela, said: “To deny any person their human rights is to challenge their very humanity.”

Today, the humanity of many Africans is being challenged. The sad truth is that poor sexual and reproductive health is a leading killer in Africa.

The good news is that this does not have to be the case. Effective, practical and doable interventions exist. And we know that progress is being made to achieve universal access to reproductive health by 2015 or as close to that as possible, depending on national contexts.

With the Continental Policy Framework, you have laid the foundation for further progress. And the Plan of Action that is before us provides a way to bring the Continental Policy to life. We are here because we all feel a sense of urgency.

We have the policy and are about to adopt the work plan, and I must say a very well formulated and set out regional workplan, but we all know that the real difference will be made at country level, in the communities where people live. The real difference will be made when health clinics and hospitals are staffed with the appropriate skilled medical and health staff and professionals who provide quality care and are equipped with the necessary drugs and supplies.

Key to success are strong national health plans, with clear workplans for reproductive health, that are costed and with clear targets, and that are backed by domestic resources. By demonstrating commitment in your own budgets to reproductive health, you are spurring international financial assistance to match your commitment and resolution.

Linking HIV/AIDS and Sexual and Reproductive Health

Excellencies,

Sisters, brothers and friends,

We have no time to waste and you all know what HIV and AIDS mean to each country of the region. Therefore, it is essential to take urgent action to link HIV/AIDS efforts with sexual and reproductive health.

Stronger integration will make better and more efficient use of existing facilities, human and financial resources. Two immediate actions that can be taken are linking HIV prevention and family planning, and integrating HIV/AIDS in maternal and newborn health programmes. The immediate benefits are great, I am sure you all know them.

With no cure in sight for AIDS, our first line of defence remains HIV prevention within the quest for universal access to prevention, treatment, support and care.

Prevention is particularly important for young people.

Focus on Youth

There is a need for comprehensive and expanded youth-friendly services such as we see here in Mozambique in the impressive and internationally recognized Geracao Biz. Let us give space to young people to lead us in this struggle so that with them we can meet their needs and support them to realize their human rights. Intergenerational understanding and solidarity is the only way for all of us in this struggle to save lives, build economies and work towards better lives. It is the only way to ensure the human rights of young people.

Progress for Women is Progress for All

The same principle applies to women. The women of Africa are a force for positive change and they are the backbone of their families and communities. By promoting and protecting the rights of women, and fostering their leadership and partnership alongside men, we will register greater success. As leaders proclaimed at the World Summit, progress for women is progress for all. Here again, fostering understanding and solidarity among women and men is the only way for all of us in this struggle to save lives, build economies and work towards better lives. It is the only way to ensure the human rights of women.

Maternal and Newborn Health

A strong Africa requires healthy people, including mothers and babies. Every woman should have the information and services she needs to plan her family and enjoy a healthy pregnancy through antenatal care. Every woman’s delivery should be attended by a skilled health professional capable of providing basic emergency care and, if needed, referral for more comprehensive services. And every woman should be free from unsafe abortion and the devastating condition of obstetric fistula. All this is well stated in the Plan of Action awaiting your approval. 

Let us work within the spirit and words of paragraph 8.25 of the ICPD Programme of Action, in which you, member States, meeting in Cairo in 1994, asserted that abortion should never be a form of family planning and that expanding family planning services allows women to plan their pregnancies and decreases abortion. In that same paragraph, you said that, where it is legal within the context of national legislation, abortion should be safe. Only three countries in the world have laws that prohibit abortion and they are not in the Africa region. Each country in this room has laws to regulate abortion and yet women are still dying. So, lead the way in saving women’s lives by implementing what you committed yourselves to in Cairo.

The maternal and newborn health roadmaps that each of you have developed, or are currently developing, are fundamental to success. UNFPA and other partners including WHO, UNICEF and the World Bank are committed to these vital efforts and we join hands to support your leadership at the national and regional levels.

Family Planning

Your Excellencies, my sisters and brothers,

Though family planning programmes are expanding in some countries, there are other countries where progress is stalled or even reversing.

Today, there is an urgent need to reignite the family planning movement in Africa. The unmet need for these services is great and UNFPA, IPPF and other partners stand ready to assist you in this important effort.

Strengthening Health Systems and Human Resources

To scale up services for sexual and reproductive health, massive investment is required in the training of health personnel at all levels. Improvements are also needed in their status, pay and working conditions so that they stay here in Africa and provide the health services that people desperately need. Countries that have successfully scaled up health services have included workforce planning and training as part of the process.

But national efforts alone are not sufficient. The challenge of strengthening health systems is a complex and demanding one and it requires international support. By leading the way in this investment, you are encouraging the World Bank, the African Development Bank, and other bilateral and multilateral bodies, to join you in investing more of their resources in health systems and the human resources that staff them. As many of you already know, our State of World Population 2006 report was about women and migration. In it, we highlighted the alarming trend of the loss of doctors and nurses from Africa to developed countries as well as the movement of such health personnel among countries of the region.

Migration is the physical expression of the right to livelihood, among other rights. But at the same time, it has direct impact on the viability of the health systems in countries on this continent whose health resources are extremely stretched as they face HIV and other communicable diseases among other illnesses. Therefore, we call on all countries involved in the sending, transition and receiving migration journey to establish mechanisms to manage the movement of people through dialogue and positive agreements. It is important that reinvesting in the health systems and the health human resources of sending countries becomes part of the discussions and bilateral and/or multilateral agreements as some developed countries have already started to do. By joining forces, we can ensure that migration policies promote the strengthening of public facilities in the service of the people.

Reproductive Health Commodities

If all individuals are to be able to exercise their human right to sexual and reproductive health, it is critical for a reliable and consistent supply of reproductive health commodities—such as condoms, contraceptives, pharmaceuticals, HIV test kits, delivery kits, and surgical equipment and supplies—to be assured.

Progress on reproductive health commodity security is being made in many countries and within the West Africa Health Organization, and we can learn from their examples. They are focused on establishing national coordinating bodies, instituting national budget lines for commodities, and making sure these commodities are included in essential drugs lists.

Research shows that success hinges on an integrated approach with nationally owned procurement systems, supply management and predictable funding.

I am pleased to have among us today the first Director of Reproductive Health Supply Coalition, John Skiabic, with whom we have established excellent cooperation since the advocacy provided by this Coalition is the other side of the coin of ensuring that supplies are made available, accessible, affordable and predictable.

Costs and Benefits

Sisters, brothers and friends,

At the 2005 World Summit, Heads of State and Government committed themselves to: “achieving universal access to reproductive health by 2015, as set out at the International Conference on Population and Development, integrating this goal in strategies to attain the internationally agreed development goals, including those contained in the Millennium Declaration, aimed at reducing maternal mortality, improving maternal health, reducing child mortality, promoting gender equality, combating HIV/AIDS and eradicating poverty.”

Investing in comprehensive sexual and reproductive health is a proven poverty reduction strategy and, as such, it should feature prominently in all development plans as well as poverty reduction strategies and health sector approaches.

The estimated overall cost of delivering a package of sexual and reproductive health and HIV prevention services in Africa is estimated for the period 2007-2010 at $28 billion, out of which a large part is devoted to strengthening health systems. This corresponds to an estimated per capita expenditure of $6 starting next year, rising to a little over $8 in the next four years. Can we afford it? My answer is yes, if our priorities are lined up correctly.

To move forward, UNFPA is pleased to support you in developing national capacity for the costing, development, implementation of and leveraging and mobilizing funds for your national reproductive health plans. As more and more countries engage in sector-wide approaches and direct budget support, these plans will ensure that reproductive health is given the priority it deserves in these nationally led planning and investment programmes.

Conclusion

In conclusion, I would like pledge the continued support of UNFPA to your leadership to achieve universal access to reproductive health by 2015, which I hope will be a specific goal under MDG 5, maternal health, in your own national implementation plans. My colleagues and I will do all we can to support you and to leverage greater support and resources from other development partners. As you lead the way forward as ministers of health, we will stand by you every step of the way.

Together, we will build an ever-expanding alliance for reproductive health in Africa as part of the strategies to fight poverty. Through leadership and partnership, we will achieve the right of the people of Africa to LIFE, in all its amazing and beautiful, but sometimes difficult and complex patterns. But that is the reality of what life is about and we all work to ensure that women, men and young people can live healthy, productive and dignified lives. This is our collective passion for the rights of people and our compassion to achieve it the right way with the people who need it most.

I thank you.