The ABUJA Declaration-Or the First Legal Document On Reparations:

[Mimbari]

The Abuja Declaration and the Plan of Action:

An Extract from The African Summit on Roll Back Malaria,
Abuja, 25 April 2000 (WHO/CDS/RBM/2000.17)

The African Summit on Roll Back Malaria

The African Summit on Roll Back Malaria was held in Abuja, Nigeria on
the 25th of April 2000. It reflected a real convergence of political
momentum, institutional synergy and technical consensus on malaria
(and, to some extent, other infectious diseases issues).

Forty four of the fifty malaria-affected countries in Africa attended
the summit. Nineteen country delegations were led by the Heads of
State, while the remaining delegations were led by senior government
officials including the Vice President, Prime Minister or, in some
cases, the Minister of Health. The Summit was also attended by the
senior officials from each of the four founding agencies -Director
General of the WHO, Vice President of the World Bank, Executive
Director of UNICEF, and Director of UNDP Africa, as well as other key
partners including UNESCO, the African Development Bank, USAID, DFID,
CIDA, and the French Co-operation. The Heads of State and other
delegates reviewed evidence, debated options and ratified an action-
oriented declaration with strong follow-up processes. The Summit
concluded with the review and signing of the Declaration and the Plan
of Action (all countries present signed the Declaration).

By signing the Declaration the African leaders rededicated themselves
to the principles and targets of the Harare Declaration of 1997. They
committed themselves to an intensive effort to halve the malaria
mortality for Africa's people by 2010, through implementing strategies
and actions for Roll Back Malaria, as agreed at the Summit. In
addition, they agreed:

* to catalyze actions at regional level to ensure implementation,
monitoring and management of Roll Back Malaria;
* to initiate actions at country level to provide resources to
facilitate realization of RBM objectives;
* to work with partners towards stated targets, ensuring the
allocation of necessary resources from private and public sectors and
from non-governmental organizations; and
* to create an enabling environment in their countries which will
permit increased participation of international partners in malaria
control actions. The Leaders resolved to initiate appropriate and
sustainable action to strengthen the health systems to ensure that by
the year 2005:
* at least 60% of those suffering from malaria have prompt access
to, and are able to correctly use, affordable and appropriate
treatment within 24 hours of the onset of symptoms,
* at least 60% of those at risk of malaria, particularly children
under five years of age and pregnant women, and benefit from the most
suitable combination of personal and community protective measures
such as insecticide treated mosquito nets and other interventions
which are accessible and affordable to prevent infection and
suffering, and
* at least 60% of all pregnant women who are at risk of malaria,
especially those in their first pregnancies, have access to
chemoprophylaxis or presumptive intermittent treatment.

The Heads of State called upon all countries to undertake and continue
health systems reforms which will promote community participation and
joint ownership of Roll Back Malaria actions to enhance their
sustainability. Health systems should make diagnosis and treatment of
malaria available as peripherally as possible, including home
treatment, and accessible to the poorest groups in the community. In
addition, countries must continue to maximize vigilance to prevent the
re-emergence of malaria.

Development partners were called upon to cancel in full the debt of
poor and heavily indebted countries within Africa in order to release
resources for poverty alleviation programmes, such as Roll Back
Malaria and to allocate substantial new resources of at least US$ 1
billion per year to Roll Back Malaria. Additional resources are also
needed to stimulate the development of malaria vaccines appropriate
for Africa and to provide similar incentives for other anti-malaria
technologies. The collaboration between research institutions within
Africa and partners throughout the World' strengthened and sustained
to ensure the full utilization of research knowledge and programme
experience.

The Leaders themselves pledged:

* to implement the agreed Plan of Action within their own
countries;
* to develop mechanisms to facilitate the provision of reliable
information on malaria to decision-makers at household, community,
district and national levels, to enable them take appropriate actions;
* to reduce or waive taxes and tariffs for mosquito nets and
materials, insecticides, anti-malarial drugs and other recommended
goods and services that are needed for malaria control strategies,
* to allocate the resource required for sustained implementation
of planned Roll Back Malaria actions;
* to increase support for research (including operational
research) to develop a vaccine, other new tools and improve existing
ones;
* to commemorate this summit by declaring April 25th each year as
African Malaria Day;
* to call upon the United Nations to declare the coming decade
2001-2010, a decade for Malaria, explore; and
* to develop traditional medicine in the area of Malaria control.

The Leaders mandated the Government of Nigeria to report the outcome
of this Summit on Roll Back Malaria to the next OAU summit for follow
up action. In addition, they requested the Regional Committees of the
African and East Mediterranean Region to follow up the implementation
of this Declaration and regularly report to the OAU and seek
collaboration with UN agencies and other partners. The Summit host.
His Excellency Olusegen Obasanjo, President of Nigeria, in his closing
remarks observed, "Today we have begun to write the final chapter of
the history of malaria. We have raised the hopes and expectations of
our people - we must not let them down. We cannot afford to let them
down. May malaria be rolled out and development rolled in all African
countries."

The Abuja Declaration!

By the African Heads of State and Government
25 April 2000, Abuja, Nigeria

We, the Heads of State and Government of African countries, meeting in
Abuja , Nigeria on 25 April, 2000,

Recalling the Organization of African Unity (OAU) Harare Declaration
of 4th June 1997 on Malaria Prevention and Control in the context of
African Economic Recovery and Development, and the subsequent African
Initiative for Malaria control in the 21st century which became Roll
Back Malaria in Africa in late 1998,

Bearing in mind other major Declarations on health and development
adopted by the Organization of African Unity,

Recognizing the disease and economic burden that malaria places on
hundreds of millions of Africans and the barrier it constitutes to
development and alleviation of poverty,

Taking note that

* Malaria accounts for about one million deaths annually in
Africa,
* Nine out of ten cases of malaria worldwide occur in Africa south
of the Sahara,
* Malaria costs Africa more than US$12 billion annually, and can
be controlled for a small fraction of that amount,
* Those who suffer most are some of the continent's most
impoverished and that malaria keeps them poor,
* A poor family living in malaria affected areas may spend up to
25% or more of its annual income on prevention and treatment,
* Malaria has slowed economic growth in African countries by 1.3%
per year. As a result of the compounded effect over 35 years, the GDP
level for African countries is now up to 32% lower than it would have
been in the absence of malaria,
* Malaria can re-emerge in the areas where it is under control,

Considering that malaria is preventable, treatable and curable,

Acknowledging:

* The strong commitment to improving health and promoting well-
being of Africa's people by their governments, communities and
development partners,
* That all African countries have signed and ratified the
Convention on the Right of the Child (CRC) which recognizes the right
of all children to good health and nutrition,

Appreciating the momentum offered by Roll Back Malaria movement to
help reduce their malaria burden,

Emphasising that a unique opportunity now exists to reverse the
malaria situation in Africa,

1. REDEDICATE OURSELVES TO:

The principles and targets of the Harare Declaration of 1997.

2. COMMIT OURSELVES TO AN INTENSIVE EFFORT TO:

Halve the malaria mortality for Africa's people by 2010, through
implementing the strategies and actions for Roll Back Malaria, agreed
at the summit.
Initiate actions at regional level to ensure implementation,
monitoring and management Of Roll Back Malaria.
Initiate actions at country level to provide resources to
facilitate realization of RBM objectives.
Work with our partners in malaria-affected countries towards
stated targets, ensuring the allocation of necessary resources from
private and public sectors and from non-governmental organizations.
Create an enabling environment in our countries which will
permit increased participation of international partners in our
malaria control actions.

3. RESOLVE TO:

Initiate appropriate and sustainable action to strengthen the
health systems to ensure that by the year 2005,

At least 60% of those suffering from malaria have prompt access
to and are able to use correct, affordable and appropriate treatment
within 24 hours of the onset of symptoms.
At least 60% of those at risk of malaria particularly pregnant
women and children under five years of age, benefit from the most
suitable combination of personal and community protective measures
such as insecticide treated mosquito nets and other interventions
which are accessible and affordable to prevent infection and
suffering.
At least 60% of all pregnant women who are at risk of malaria,
especially those in their first pregnancies, have access to
chemoprophylaxis or presumptive intermittent treatment.

4. CALL UPON:

All member states to undertake health systems reforms which
will,

1. Promote community participation in joint ownership and control
of Roll Back Malaria actions to enhance their sustainability.
2. Make diagnosis and treatment of malaria available as far
peripherally as possible including home treatment.
3. Make appropriate treatment available and accessible to the
poorest groups in the community.
4. Continue to maximize vigilance to prevent the re-emergence of
malaria.

All development partners to:
5. Cancel in full the debt of poor and heavily indebted countries
of Africa in order to release resources for poverty alleviation
programmes including Roll Back Malaria.
6. Allocate substantial new resources of at least US$ 1 billion per
year to Roll Back Malaria.
7. Invest additional resources to stimulate the development of
malaria vaccines appropriate for Africa and provide similar incentives
for other anti-malaria technologies.
8. Strengthen and sustain collaboration of research institutions
within Africa and with partners throughout the World.
9. Foster the collaboration of research institutions with agencies
implementing Roll Back Malaria, to ensure full utilization of research
knowledge and programme experience.

5. PLEDGE TO:

1. Implement in our countries the approved Plan of Action attached
to this Declaration.
2. Develop mechanisms to facilitate the provision of reliable
information on malaria to decision-makers at household, community,
district and national levels, to enable them take appropriate actions.
3. Reduce or waive taxes and tariffs for mosquito nets and
materials, insecticides, anti-malarial drugs and other recommended
goods and services that are needed for malaria control strategies.
4. Allocate the resource required for sustained implementation of
planned Roll Back Malaria actions.
5. Increase support for research (including operational research)
to develop a vaccine, other new tools and improve existing ones.
6. Commemorate this summit by declaring April 25th each year as
African Malaria Day and to call upon the United Nations to declare the
coming decade 2001-2010, a decade for Malaria.
7. Explore and develop traditional medicine in the area of Malaria
control.

6. REQUEST:

The Regional Committees of the African and East Mediterranean Region
to follow up the implementation of this Declaration and report of the
OAU regularly and seek collaboration with UN agencies and other
partners.

7. MANDATE:

The government of Nigeria to report the outcome of this summit on Roll
Back Malaria to the next OAU summit for follow up action in
conjunction with the United Nations Agencies and other partners.

FRAMEWORK FOR MONITORING
THE PLAN OF ACTION, ABUJA DECLARATION

A. ELEMENTS OF THE PLAN
PRIORITY AREAS APPROACHES AND ACTIVITIES
Organization and management of the health systems

* Improve the managerial capacity of ministries of Health. Ensure
the existence of health policies and integrated programmes for
priority disease management and prevention. Develop core indicators to
monitor and evaluate progress of health system performance.
* Promote decentralization of the health system in order to
improve access to services.
* Build and strengthen capacity for health delivery at district
and community levels.
* Health system decentralization should match decentralization in
other sectors.
* Strengthen partnership with NGOs and the private sector to
provide universal coverage and access with built in complementarity,
consistency and continuum of care.
* Build and strengthen partnerships with other sectors whose
activities promote malaria transmission, by ensuring that
Environmental Impact Assessment (EIA), Health Risk Assessment (HRA)
and Health Risk Management (HRM) of all development projects take
place.
* Broaden health financing options at community level so as to
improve accessibility and affordability of malaria treatment and
preventive measures.
* Strengthen existing financial management system to ensure
transparency, equity and probity in the utilization of funds at all
levels.

Disease management

* Develop packages of interventions to address priority diseases
(curative and prevention ) such as IMCI.
* Ensure the allocation of necessary resources and facilitate
collaboration of all members of the health team in the delivery of
priority intervention packages.
* Encourage and support community based programmes for the early
diagnosis, prompt and adequate treatment of malaria.
* Take appropriate measures to ensure that adequate treatment for
severe malaria is available and affordable for the poorest section of
the community.
* Improve the quality of diagnosis and treatment by continuing
training and supervision. Provide functioning laboratory facilities,
appropriate equipment and essential drugs supply at referral centers.
* Provide health education and communication to schools, work
places, parents, especially mothers and persons caring for young
children, on the recognition of malaria. Improve capacity for
treatment at the home and for recognizing when to seek assistance for
severe cases.
* Establish guidelines for management of malaria and other
priority diseases by health personnel at all levels.

Provision of anti-malarial drugs and malaria control related materials

* Develop mechanisms to ensure adequate, uninterrupted and prompt
delivery of supplies, especially drugs, insecticides and other malaria
control related materials.
* Produce and update National drug policies for all priority
diseases and ensure their implementation and review across the
government and private sectors.
* Promote rational prescribing of anti-malaria drugs in both the
public and private sectors. Establish or strengthen an efficient
regulatory authority that critically reviews all applications for drug
registration and has a strong inspection and enforcement capacity.
* Support and contribute to the establishment and/or maintenance
of national and regional independent drug quality control laboratories

Disease prevention

* Sensitize the population and promote preventive measures, such
as house screening, ITN and other measures such as environmental
management.
* Support and encourage environmental measures taken by families
and communities to reduce mosquito breeding sites.
* Support and promote the formulation and use of traditional
medicines for malaria control.
* Support and promote the use of malaria preventive measures such
as chemoprophylaxis and/ or presumptive intermittent treatment for
pregnant women especially those in their first pregnancies.
* Initiate strategies to prevent the re-introduction of malaria to
malaria free areas.

Disease surveillance, epidemic preparedness and response

* Strengthen health information system to ensure reliable
reporting of malaria cases and deaths as part of the integrated
disease surveillance system.
* Provide such health information to health workers and policy
makers for appropriate decision making.
* Establish an alert mid effective epidemic preparedness and
response capability to detect and contain any outbreak as rapidly as
possible.
* Establish an effective system to alert malaria control
authorities and policy makers in other relevant sectors of new
development projects, population movements, as well as environmental
and climatic changes that could impact the malaria situation.

Sustainable control

* Promote essential multisectoral action to ensure that projects
and activities do not create vector breeding sites, or expose workers,
families and communities to a risk of malaria. Enact and enforce
appropriate legalisation and regulations to support control
strategies.
* Promote awareness among the business community on the negative
economic impact of a continuing malaria problem and influence them to
provide material and financial support to malaria control at all
levels. Provide official recognition to those making sustained and
substantial contribution.
* Provide special incentives such as soft loans, exemption from
excise, import and stiles taxes that would reduce the cost of
materials and supplies for malaria control.
* Establish and enforce appropriate legislation and regulations
that promote health and prevent disease.
* Build and strengthen partnerships with schools and work places
to increase access to malaria treatment and preventive measures.

Human Resources Development

* Provide continuing education opportunities for health services
personnel and communities to enable them keep abreast with national
policy and guidelines on malaria control.
* Establish short, medium and long term human resources
development programmme following capacity building needs assessment,
for all levels of health services delivery.
* Ensure that standards and guidelines for case management,
disease prevention, epidemic surveillance, transmission and control
are incorporated into pre-service and other training activities, and
that they provide a basis for evaluating competencies acquired by
trainees during training and work performance.
* Regularly review the curriculum of schools of medicine, nursing,
public health, allied sciences and other training institutions to
ensure that they are up to date with regard to national policies and
disease management standards.

Research including inter-disciplinary operational research

* In collaboration with appropriate institutions, develop or
strengthen the capacity and capability at all levels to conduct
research including interdisciplinary operational research on issues of
direct relevance to the control objectives, and ensure that results
provide guidance for programme changes as necessary.
* Exchange research results between countries of the region,
particularly those sharing similar problems and interests.
* Establish mechanisms for the development of priority research
agenda and co-ordination at country level. Ensure that results are
incorporated into control strategies.
* Support multi center studies for the development of vaccines,
new drugs and tools for malaria control.
* Promote research and development of traditional medicine.

B. INDICATORS FOR MONITORING
2000 - 2005
Organisation and management of the health system

* No of countries with a health policy.
* No of countries with district health plans which reflect the
policy.
* Policy of universal coverage for all with a basic intervention
package, including malaria interventions.
* Percentage of health facilities that have applied the
intervention packages.
* Percentage of total Government expenditures devoted to health.
* Ratio of health expenditures between primary, secondary and
tertiary facilities.
* % of districts systematically collecting and using health
information for planning.
* No of countries with anti-malarial drugs policy.
* No of countries with integrated disease Surveillance system.

Disease management

* % of districts at country level that are implementing IMCI at
facility, community and household levels to manage childhood
illnesses.
* % of high risk persons with a malaria attack getting appropriate
treatment in eight hours.
* No of countries with protocols for referrals at facility level.
* % of household with access to anti-malarial drugs within 24
hours.

Provision of anti-malarial drugs and malaria control related materials

* % of facilities with 1st and 2nd line anti-malarials available
* % of facilities with adequate parasite detection services

Disease prevention

* % of under fives sleeping under ITNs.
* % of pregnant women sleeping under ITNs.
* % of pregnant women receiving chemoprophylaxis or presumptive
intermittent treatment.
* % of sprayed houses.
* development of legislation and regulations on control strategies
for malaria.
* % of health projects with environment and health impact
assessment.

Disease surveillance, epidemic preparedness and response

* % of malaria epidemics detected within two weeks of onset.
* % of malaria epidemics properly controlled within two weeks of
onset.

Sustainable control

* No of countries that have instituted tax reduction measures or
waivers on anti-malarial drugs, insecticide treated mosquito nets and
other anti-malarial products.
* % of countries where environmental risk factors for malaria are
taken into account in the planning of development projects.
* No of countries where malaria prevention and treatment seeking
is integrated into primary school curriculum.

Human resources Development

* Presence of technical skilled staff (including IMCI) at the
required level of service delivery.
* % increase in knowledge, attitude and practices at community
level.

Research including inter-disciplinary operational research

* No. of new anti- malarial drugs and tools developed for use at
community and institutional levels.
* % of countries with effective collaboration in operational
research between national institutions and Ministries of Health.
* No of countries that have established mechanisms for the
development and co-ordination of priority research agenda at country
level including vaccine development.
* Research findings incorporated into control strategies.
* New findings in traditional medicine.

C. FRAME WORK FOR REPORTING
INSTITUTIONS MECHANISMS

1. Report to the heads of state and governments

OAU meeting of heads of states and government

* The WHO/AFRO/EMR0 Regional Directors in consultation with the
OAU Secretary General will provide a progress report on the
implementation of the POA of the Abuja Declaration to the annual
meeting of the Heads of State and Government of the OAU.
* Evaluation -Extra ordinary meetings of Heads of State and
Government will be held to review and evaluate the progress made in
the years 2005 (mid term) and 20 10 (end of term).

2. Reporting to the ministers of health

OAU ministers of health

Regional Committee Meeting/AFRO/EMRO

* The WHO/AFRO/EMRO Regional Directors in consultation with the
OAU Secretary General will provide a progress report on the
implementation of the POA of the Abuja Declaration to the annual
meeting of the Ministers of Health of the OAU.
* The WHO/AFRO/EMRO, Regional Directors, sub-regional groupings
such as ECOWAS, East African Community (EAC), Southern African
Development Community (SADC), Common wealth Regional Health
Secretariat for Eastern and Southern Africa (CRHSESA) and other
partners in consultation with the OAU Secretary General will provide a
progress report on the implementation of the POA of the Abuja
Declaration to the WH0 Regional Committee Meetings for AFRO and EMRO.

3. Reporting to partners

Global Meeting of Partners on RBM (Geneva)

Regional Meeting of Partners / Task Force on RBM

Partners at country level

* The WHO/AFRO/EMRO Regional Directors in consultation with the
Project Manager RBM/HQ will provide a progress report on the
implementation of the POA of the Abuja Declaration to the RBM Global
partners meeting.
* The WHO/AFRO Regional Director will provide a progress report on
the implementation of the POA of the Abuja Declaration to Regional
meeting of partners/Task force on RBM.
* Ministries of Health will report to partners at country level on
progress made on the implementation of the POA of the Abuja
Declaration.

4. Reporting by countries

Annual reports

* In collaboration with countries and partners WHO/AFRO/EMRO will
develop a format to enable countries use existing information to
report annually progress made on the implementation of the POA of the
Abuja Declaration.

--------------------------------------