Civil Society - Executive summary

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The global burden of disease from the five major types of viral hepatitis – A, B, C, D and E – urgently demands an intensified response. As the World Health Assembly’s passage of viral hepatitis resolutions WHA 63.18 in 2010 and WHA 67.6 in 2014 reflects, civil society is helping to define a new era in the response to viral hepatitis. However, the World Hepatitis Alliance is concerned about civil society being insufficiently involved at the national level.

The 2014 Global Community Hepatitis Policy Report is a civil society response to information provided by governments for the World Health Organization’s 2013 Global Policy Report on the Prevention and Control of Viral Hepatitis in WHO Member States. The World Hepatitis Alliance asked civil society organisations to review the information their government submitted for the 2013 WHO report and to comment on its accuracy using a 25-point survey instrument. The survey also asked civil society organisations to write short statements about what they considered to be key aspects of the policy response to viral hepatitis in their countries.

Ninety-five organisations from 58 countries and one special administrative region responded to the World Hepatitis Alliance’s request. Seventy-six organisations were able to comment on their governments’ responses from the 2013 report. The other 18 organisations responded from countries where the government had provided no information for the 2013 report. They instead provided short statements.

Almost 30% of respondents to the civil society survey identified themselves as hepatitis patient groups, and another 16% identified themselves as nongovernmental direct service providers. Forty-two percent of respondents were from countries in the European region, with considerably less representation of countries in other regions. Most respondents were from either high-income countries (41%) or upper-middle-income countries (22%).

The following survey items were most commonly identified as points on which civil society respondents agreed with their governments’ responses:

  • the existence of a national strategy or plan for the prevention and control of viral hepatitis;
  • the existence of a national hepatitis A vaccination policy;
  • injection safety in health care settings; and
  • infection control for blood products.

The following survey items were most commonly identified as points on which civil society respondents disagreed with their governments’ responses:

  • whether the government has a viral hepatitis prevention and control programme that targets specific populations;
  • viral hepatitis surveillance; and
  • disease registration and reporting.

The World Hepatitis Alliance is particularly concerned about five key issues raised by civil society survey findings:

  • There appears to be considerable disagreement between governments and civil society organisations about how national responses to viral hepatitis are being managed.
  • There does not appear to be a sufficient level of partnership between government and civil society actors in many countries, and civil society actors may not have appropriate input into government hepatitis strategies and policies.
  • Far too few countries have national viral hepatitis strategies, which are the foundation of an effective response. Even where official strategies are in place, the question remains of whether a strategy is actually guiding a unified national response.
  • The shortcomings of existing viral hepatitis surveillance systems have the potential to undermine efforts to address this group of diseases at the national, regional and global level.
  • While recent hepatitis C treatment advances are greatly welcomed, there is the danger that excitement about the new drugs will draw attention and funds away from essential viral hepatitis prevention priorities.

Quantitative and qualitative findings from the 2014 Global Community Hepatitis Policy Report lead the World Hepatitis Alliance to make the following recommendations to governments:

  • Establish robust monitoring mechanisms to track viral hepatitis activities and key performance indicators nationally. Monitoring outputs should be widely disseminated, and special efforts should be made to share information with civil society stakeholders.
  • Engage more directly with civil society, including hepatitis patient groups, and help foster the creation of new hepatitis patient groups where none exist.
  • Develop comprehensive multisectoral national viral hepatitis strategies, drawing on WHO and the World Hepatitis Alliance for technical support. Sufficient funding must be allocated to implement those strategies.
  • Integrate the implementation of national viral hepatitis strategies with national public health agendas, while at the same time monitoring specific hepatitis-related outcomes.
  • Introduce or improve national viral hepatitis surveillance systems.
  • Issue evidence-based guidance on hepatitis prevention and establish consensus about which aspects of viral hepatitis prevention should be prioritised based on the national epidemiological context.
  • Recognise and seek to overcome barriers that deter members of most-at-risk populations from accessing hepatitis prevention and treatment services and commodities.
  • Ensure access to prevention and treatment services for everyone in need without discrimination.

Encouraging diverse actors to participate in new forms of partnership is of paramount importance because the response to viral hepatitis must take into account many different types of public health and development issues. All voices need to be heard if the global community is to make real progress on viral hepatitis, one of the most complex health threats of the twenty-first century.