context & challenges

Global context

At the political and geographical level, the growing interdependence between West and Central African countries should not be hampered by linguistic diversity and colonial legacies, as regional integrations in key areas such as health are needed.

While most WCA countries are moving towards a demographic transition, their health systems are still weak, inequitable, underfunded and unable to meet the basic needs of the most vulnerable populations.

It is important to place the need for regional integration and coordination in the context of the global and regional commitments demanded by civil society and community patient networks and accepted by governments in the region. The implementation of universal health coverage, as outlined in the Alma Ata principles, the Bamako Initiative, Agenda 2030 and Agenda 2063, the Political Declaration and others, in our national plans must include the gains and achievements of national and local civil society-led responses to HIV. The vertical approach that has been very effective and has saved lives must not be lost in the transition to a comprehensive and integrated health system.

Moreover, while there is undoubtedly a regional coherence in WCA, some sub-regions have their own specificities. In the Sahelian zone, for example, the security situation has made the provision of prevention and care services even more complex and inequitable. Areas of armed conflict or post-conflict are also marked by a lasting disintegration of health service provision.
The migration phenomena that have developed in recent years exacerbate the complexity of the contexts in which health interventions must be implemented.

Specific context of the response to the HIV epidemic

The response to the HIV epidemic in the WCA region is characterised by a wide range of contexts: epidemiology, socio-political environment, economic, security and climate issues, human rights and gender, geographical mobility and cross-border migration, etc. The specific situations in each country should not, however, obscure the salient points around which it is essential to act. However, the specific situations of each country should not obscure the salient points around which it is essential to act:

  • The dynamics of the HIV epidemic remain strong among key populations: data and observations reported by field workers tend to favour an increase in new infections among MSM, SW, adolescents and young women, drug users, people in prison and other closed settings, and certain other populations.
  • The services offered must be both responsive to the needs of the beneficiaries and in line with updated national and international strategies and recommendations.
    Investing available resources more strategically, through the mobilisation of sustainable national funding, in approaches and interventions that have a high impact on the dynamics of the epidemic is crucial to reversing the trends: community investment serves this purpose.
  • The promotion of an enabling environment (human rights and minority advocacy) is essential to combat stigma and discrimination.