Rosemary W. Mburu, Executive Director for WACI Health
” But you know, you kept telling yourself, you have to show up, you have to wake up, you have to show up. You needed to be in those meetings to say why it’s essential for equitable access to the vaccine. So just showing up day after day made me proud of civil society, of communities.”
Moderator: Tian Johnson
Complied by Vivienne Naidoo
Webinar Recordings & Supplementary Materials:
Rosemary W. Mburu is a Vaccine Advocacy Resource Group (VARG) member and has been a champion for healthy communities for over fifteen years and currently serves as the Executive Director for WACI Health. Mburu is a civil society leader in Africa and has extensively supported civil society to engage with decision-makers at the community, national, regional and global levels. As a civil society leader, her contribution includes facilitating civil society spaces and networks that enable Africa civil society’s leadership in Global Health. These include the Civil Society Platform on Health in Africa (CiSPHA), Global Fund Advocates Network (GFAN) Africa Hub, Africa Free of New HIV Infections (AfNHi), and Civil Society Engagement Mechanism for UHC2030. Ms Mburu’s work focuses on creating political will and ensuring accountability towards improved health outcomes for all in Africa by engaging with governments and key multilateral and bilateral global health institutions. Mburu has served in various capacities within the global health architecture, including on the UHC2030 Steering Committee, UNITAID Communities Advisory Group and GAVI CSO Steering Committee. She is a member of the African Union Commission Technical Working Group on the ALM- Investing in Health. Ms Mburu has co-authored several peer-reviewed journal articles, including Global Health in the Age of COVID-19: responsive health systems through a right to health fund (Health and Human Rights Journal); Clinical trial ethics (International Journal of Clinical Practice); Investments in HIV Prevention Research (African Journal of Reproductive Health); Biomedical HIV Prevention (BMC Proceedings); and Strengthening Primary Healthcare (Lancet Global Health). Ms Mburu has a Masters in Public Health (Ohio University), a Masters in Business Administration (Frostburg State University, Maryland), and a Bachelor of Education (Kenyatta University, Kenya).
QUESTION AND ANSWERS
*This section contains a transcribed account of the Question-and-Answer Session*
Amongst this fast-moving landscape, how do we practically build solidarity when there’s such competition for resources and positioning between countries?
Three things come to my mind, and one is that we have to learn. Our countries have to learn. We as individuals have to learn. And I think for me, the best place to learn from is what happened in Italy. And it’s still vivid in my mind when the Prime Minister of Italy stood and said, You know what, beyond here, I do not know what to do. It is beyond me, as the country’s leader; it’s beyond us as a nation. We just now need a supernatural power to help us. What the power in that message is saying that as a nation, there comes a time when you cannot save yourself, there comes a time when your wealth cannot save you, there comes a time when your privilege cannot save you. For me, that’s huge learning to say that we need each other within the country. And when a pandemic like this hits, it reduces us to one people; as we struggle together, we go through hell together. That’s a reflection to say, what can we learn that a nation is so affected to a point where the leader surrenders and acknowledges that not our wealth, not our privilege, nothing at this particular time, we have to stick together as a nation. And I think there are lessons there for even our governments that perpetuate discrimination within the same country that leave other people behind, where not everybody is treated equally. There is a lesson there for our countries and also for the globe. I think the other thing we need to do is that we need to push for the strengthening of our regional bodies.
In the absence of the African CDC, I don’t want to think about what would have happened in Africa because clearly, nobody was thinking about us. We had to think about ourselves like we needed our own leadership. And that’s how the African CDC helped in terms of that leadership. In the future, we need to think about regional solidarity and knowing that when something like this happens, we need to rally resources as a region. We need to back each other and help each other to navigate through this. What we are learning about the nationalisation of resources or vaccines, etc., is that we need to think about sustainability models in terms of financing to set up infrastructure in terms of strengthening our capacity to respond to pandemics—strengthening our capacity to roll out, diagnostics, therapeutics, in vaccines, you know, when such a thing happens. Just thinking about what we learn from what we saw from countries like Italy gives us a profound lesson, what we have seen on what regional coordination means and why we need to ensure that we continue to build on that even beyond the acute phase of responding to COVID-19. And the sad thing for me is that, as civil society and communities, we need to reshape this narrative together with our governments as people in low and middle-income countries. We need to call for solidarity. What is happening with the People’s Vaccine Campaign is amazing. Because it brings together us as a people, together with our governments and the agencies, you know, you need to tell the rest of the world that we need a people’s vaccine, and that is what this campaign is doing. It’s shifting, and it’s changing a narrative in terms of saying, we cannot win this unless we have a people’s vaccine. So it’s about building a narrative around solidarity as a people and our governments, decision-makers, agencies. So those are my thoughts, Tian.
Rosemary, Waci Health has been a longtime leader in really driving the discussion of domestic financing for health responses. And I’d be interested in hearing your perspectives on whether COVID has shifted that needle forward or perhaps backwards? What do you think the impact of COVID has been on the advocacy work to get governments to increase their investment in domestic health financing?
I think COVID-19 has emphasised the need for governments to invest in domestic resources. And it has highlighted the need for governments to figure out how to do that. One of the things we have learned during our work is that many governments do not have fiscal space to expand their investments and domestic investments in health. So we need to take a step back and have conversations with governments on how they can develop their fiscal space to increase their revenue base, to diversify how they can tap into more revenue. One of the most significant avenues through which our governments can raise additional resources and expand the revenue base is by strengthening the tax systems, how tax is collected, how it’s allocated, and how its generated and how it’s accounted. Those are things that within our region, we have a lot of room for improvement for those. So we have to think about mechanisms of strengthening our tax revenue systems within our countries. And that should not be confused with taxing people more. So you’re not talking about increasing the taxes or additional taxes. We are saying, for the taxes that are already agreed upon within a country, we need to interrogate how the collection system is? How is the allocation system? And how is it been accounted for? Because if you did only that, you could help to generate additional money. The second thing is that we are not good stewards of the little money that we already have. At the country level, there are high levels of inefficiencies within our countries. So we have to ask for additional money, yes, within the health sector, to do what we need to do. But we also need to call for efficiencies, and we need to hold agencies accountable for the money they have. There are so many loopholes, so even the little we have is not necessarily effective as it should be. So we need to talk about allocative efficiency; where are we allocating money? And are those the areas that actually will give the impact we are looking for? Are those areas that will provide us with better health outcomes? Where are we putting our money? So it’s about resources in terms of additional resources and very much about what we are doing with the resources we already have.
What particular challenges have you seen in building solidarity in a COVID space now where there is extreme competition for resources within civil society to carry out COVID work?
In terms of solidarity, one thing to acknowledge is that we have many civil society groupings, many civil society platforms. The way civil society in country A organises might be different from the way civil society in country B organises. Still, there needs to be a point where we can all come together. And it’s okay to have as many coalition’s as we can, as many networks as possible. We need to find a way to meet our priorities, where we champion the same cause. I keep giving the People’s Vaccine example because I have heard about different civil society organisations and networks. And I like the way we are being led on a concept. We have been led on an issue, and it’s quite issue-based. It doesn’t matter what kind of an organisation I’m leading, and it doesn’t matter whether I’m competing or my priorities compete with those of the African Alliance.
Still, we are united by the fact that we believe in equity. We believe in the need to ensure that everybody is vaccinated, can access a vaccine and other tools. Can we find a way to meet on issues, priorities, how we can have calls or consultations, how can we strengthen how we talk and how frequently we talk and what we talk about? So just been focused on issues on the cause, on the desired outcomes. I think that would help us a lot in our solidarity. Less of who is funded by who, who is not funded and stay away from even categorising, international organisations on the continent, you have regional organisations, national organisations, the end of the day, it’s imperative that we come together on the cause. This cause unites us because it’s for the person’s benefit at the end of the day. It also comes to my mind that we should have our work more and more be people-centred or human-focused instead of being systems focussed or determined by the politics of the day. If you’re thinking about the person if you are thinking about the human. We will think about the best thing for the person and not for the system. Not for politics, we will think about what does this person want? How can I use my voice to call for what people want or who else is within that ecosystem that I can work with? And that will help us to work together. And then there’s also the angle around access to resources for civil society. And I know it’s a, it’s a vast topic. One of the things we could do is be more vocal about how civil society advocacy work is funded. And you find that a lot of funding agencies will not fund African civil society directly. So the funding will come from a foundation in the US. And it has to first go to an organisation in the US before it can come to a non-governmental organisation (NGO) or a civil society organisation in Kenya. And within that whole trail, you have a lot of admin and overhead money that stays there that perhaps we could leverage for actual advocacy work. So that’s how advocacy is work funded. So that’s something to think about. But also, we need to think about when advocacy organisations are funded, what exactly is funded. One of the challenges is that advocacy work funded is activity-based in terms of funding. So you have partners who want to fund activities. And what we see during COVID-19 is many organisations, many advocacy organisations closing down because there are no activities funded at the moment. We indeed have a lot of colleagues and organisations that do this work voluntarily. But it is also true that for organisations to survive, you need to invest in the structures you need to invest in the institution to have a sustainable work and voice. So it’s how organisations are funded. I think that’s something to think about and what is funded within organisations. I think that can help with this inner tension around who is funded, who is not funded, etc. But you know, it’s a bigger topic that perhaps we should have a conversation about.
How do we protect the investments we’ve all worked on for many years in HIV (human immunodeficiency virus), Tuberculosis (TB), malaria? Secondly, have you seen any practical examples of how we can urgently start rebuilding faith in clinics, in the safety of clinics, in the importance of going to the clinic earlier rather than later for sickness, etc. So if you could share some perspectives on those?
In terms of safeguarding the investments or the gains so far? For me, the best way to do that, and I think we’ve seen that with HIV response, is to invest in communities, which goes back to the point that no global health response will be won or successful without communities. And why I say that is because nobody has a better interest of the people than communities. So that’s one. And number two is because communities can access anyone, anytime, navigate that within the restaurants, navigate within communities and neighbourhoods and villages, etc. So I think it’s essential to build an infrastructure that puts first of all community systems strengthening at its centre and not as an afterthought. Put community systems at the centre of it, and then equip the community. You could say that workers or community leaders or the community respond with the tools and resources they need. What we know, for example, if you take TB with a directly observed therapy or the door to door kind of visits, the people who sustain that response are the community leaders who check on the patients who follow up, etc. And so I think that’s a model that has worked in TB and HIV. It’s a model that shouldn’t be scaled. Right now, a lot of it is done with no resources. So I think the notion that the community can do this for free is something we should challenge. Again, I think there is a need for proper remuneration for the community system space for community leaders who do that work. There’s something there to think about how you structure community responses, community leadership, and community health workers’ components within the whole response. That’s one way of ensuring that you safeguard against it. And the next thing was what to do next?
What innovative ways or strategies, or suggestions can you share with us today regarding how we start undoing the Public relations (PR) damage that COVID has done to the public health facility?
Yeah, so literacy, literacy, literacy, literacy. First of all, the trust was gone way before COVID came about. A lot of people do not trust public systems. Many, even colleagues and people we know, people you work with, cannot go to public health facilities because their trust is zero. So we need to think about how the public perception of the public health system, public perception of facilities, public perception of their own government. So that’s one. Number two, how do we understand access or behaviour helps our health-seeking behaviour? And what are the different determinants that help us determine or decide whether we’re access care or not? So when I talk about literacy, I’m reminded about the HIV movement. Again, I think we still have so many things to borrow from there. Because literacy helps educate the public or the masses on the need for these services, they need to seek health services at public health facilities or whichever facility they need to go out and seek care. With literacy, we can build trust and build a public perception that embraces the facilities that embrace healthcare provision facilities and centres that get communities and anybody seeking care, trust and show up when they need to show up. So I think it’s literacy. There is a lot to learn from the HIV response, whether it’s literacy about the different treatments, the various interventions. Still, within this case, we have a massive role in making health a public good because right now, it hasn’t been and will help shift the way people perceive health-seeking practices.
Rosemary, could you share your one biggest concern today in terms of our response to COVID-19? And could you share with us the one moment in the last year in the context of COVID that reaffirmed your faith in the work of civil society and made you proud to be the leader you are in the space? So those two reflections.
Thank you. So one with COVID-19, one of the things that stands out for me that needs attention or concerns me is the lack of transparency and the nationalism that we are seeing. So in terms of lack of transparency. A specific case to cite in an area of concern is on the Access to COVID-19 Tools Accelerator (ACT-A), the Access to COVID-19 Tools Accelerator auxiliaries at the facility we talked about, and I see Peter here. He’s a member of the facilitation council. Very interesting to talk about a facility where he represents civil society within them. But what we are hearing from people who are colleagues who sit there is a lack of transparency. And that limits civil society and communities engagement, and the way they can support ACT-A in its mandates of ensuring that ACT-A COVID-19 tools developed are distributed equitably. That lack of transparency means that, for example, civil society is not aware of how some of the decisions are being made. They are not aware of some of the entry points, etc. So that’s one, number two, the lack of involvement of low and middle-income countries. We also hear that our countries and stakeholders within the ACT-A, the ACT-A remains vague for them, not knowing what the entry points, not knowing what they’re supposed to do with it. And no international outreach. We did see that yesterday, the first shipment from COVAX for vaccines to Africa arrived in Accra. And so very interested to know the dynamics around that and when we will get in the next shipment from COVAX to Africa. But still, for me, the inequitably, the way we still don’t have equitable access is very striking. For me, the goal of COVAX is to distribute 2 billion doses by the end of 2021. We have all seen where the doses are going to be going. And we have seen the graph. And so it’s very worrying in terms of equity. And I think that’s an area to think about. One moment that I’ve been super proud of civil society and communities, and it confirms to me that I’m in the right sector. And I’m here to stay. It’s just how when COVID-19 came last year was a challenging year for the whole world. But it was a difficult year for civil society and communities, and we didn’t know exactly how to respond. What we could see was that people were dying, dying of TB, dying of malaria. People were not accessing health services, and this was a considerable challenge. Our families and friends were getting infected with COVID-19. We lost friends and family, so that the elements of resilience among civil society and communities wowed me like we kept going. We kept going. We did zoom after zoom, zoom after zoom call. It was so tiring, so exhausting, and there are times when you would sit behind zoom and say, hey, am I still saving lives? But you know, you kept telling yourself, you had to show up, you had to wake up, you have to show up. You had to be in those meetings to push for why communities need to be engaged in the trials in the ACT-A. You needed to be in those meetings to say why it’s essential for equitable access to the vaccine. So just showing up day after day made me proud of civil society, of communities. And now the accountability that I see right, left, centre, around the vaccines diagnostics around the whole thing, is amazing. So it has been a moment of pride, even though it has been very difficult, but it has been so for everyone. So that’s my reflection Tian.