I.        Justification

Viral hepatitis infection affects 550 million people worldwide, viral hepatitis causes substantial mortality, globally accounting for more than 1 million deaths each year. In fact, most of 550 million people with chronic hepatitis B and C, the most of serious forms of Viral Hepatitis, do not know they are infected. This enables the infection to go unnoticed and undiagnosed until it has caused a serious liver damage or attains the chronic stage and shows forth dangerous signs and symptoms. This, in turn, has resulted in Viral Hepatitis comparable to other dreaded diseases like the HIV, Malaria, etc. It is also responsible for the estimated 1.4 million deaths annually from acute infection and related liver cancer and cirrhosis according to World Health Organization.

In the many deaths caused by hepatitis worldwide, Africa contributes (13.7 per 100,000 deaths) to it, which is about 10% of the total death. And this is noticeable that there is a need to take the necessary steps in fighting it. In addition, hepatitis B and C cause approximately 80% of all liver cancer deaths, and this means that its impacts are underestimated and has minimal public Health and political attention. This rapid increase of viral Hepatitis case is as a result of its mode of transmission. Hepatitis is transmitted through blood and bodily fluids and since we often come in contact with many people daily there is a higher tendency of its spread among the human populace.

The vast majority of individuals infected with viral hepatitis live in low to middle-income countries of Africa and Asia, where screening and access to care and treatment are not readily available. There are insufficient trained personnel or clinicians in these areas to deliver health care. Current prices of the medicines for treatment are variable and unaffordable. These prices threaten the sustainability of health systems in many countries and prevent the large-scale provision of treatment.

Against this backdrop, this capacity building training workshop leverage on the stakeholders, pharmaceutical companies, foundations, philanthropies, international organizations, non-governmental organization, among others to see how the requisite capacity to manage the viral hepatitis can be built and to see how immediate action to mitigate the problem to bring relief to the African Union Member States that are threatened by the infection. That can be achieved by tapping in the experiences ALPA and to extend its coverage to the entire continent gradually.

  II.        Aim

The aim of this capacity building training workshop on viral hepatitis was to equip participants with the requisite knowledge, and competencies to fight the endemic hepatitis and to share the experience on the challenges and successes of Hepatitis through establishing a lasting intra-African co-operation for the personnel working in the field and for this workshop to be the corner stone of a yearly for meeting to track progress in the matter.

  III.        Objectives

·        To raise awareness on Viral Hepatitis situations in the African continent.

·        To enhance intra-Africa cooperation among existing organizations and stakeholders fighting Viral Hepatitis.

·        To share the experiences on the prevalence and surveillance of the epidemic.

·        To benefit from the Egyptian experiences in the management of Viral Hepatitis.

·        To estimate the real situation of hepatitis in Africa and to know how drugs and vaccines on Viral Hepatitis can be accessible and affordable to the other Member States.

 IV.        Participants:

the workshop aimed at assembling participants representing various categories of stakeholders and partners from all over Africa, hence the participants were from almost 20 African countries Egypt, Nigeria, Sierra Leone, Lesotho, Sudan, Ethiopia, Cameroon, Morocco, Ghana, Malawi, Uganda, Guinee, Senegal, Kenya, Mali, Tanzania, Rwanda, Zambia, Burkina Faso;

·        National Chairman of Parliament Committee on Science from the AU Member States.

·        National Chairman of Parliament Committee on Health from the AU Member States.

·        Health Ministry Representative.

·        Science Ministry Representative.

·        Food and Drugs Authorities from the AU Member States.

·        Pharmaceutical Companies. (Pharco – ZETA Pharma – EVA Pharma )

·        International Organizations' Representatives. ( Clingroup holding)

·        Funding Agencies

·        ALPA’s Member Organizations (The National Organisation for People Living with Hepatitis B, SAAFARA Hépatites Sénégal, SOS Hepatites Guinee )

   V.        Activities:
The first day of the workshop included a field visit to EVA Pharma Pharmaceutical company, Eva Pharma was established in 1997, built on the heritage of Les Laboratoires Delta, Egypt's second oldest pharmaceutical company. Eva is one of the fastest growing pharmaceutical companies in the MENA region, and CEO Riad Armanious is aiming to take the company from the 21stranked generic company at the regional level to third over the next five years, while building business and operations on the ground in various African markets. Eva Pharma is an active contributor to the on-going drug industry in Egypt, North Africa and the Middle East, with huge market participation

The visit gave the participants a chance to see the recent technologies in the Pharmaceutical field in Egypt also the expansion plans for EVA Pharma reaching the African market as Zambia, Tanzania, Libya, Sudan, Morocco and Ethiopia along with their expansion in the Arabic world.

It was explained that EVA Pharma is present in 24 countries all around the world and that came through integrated value chain through research, development, high quality manufacturing, strategic sourcing and strong marketing.

·        Master Opening:

The workshop was opened by Eng. Dr. Ahmed Hamdy – Executive Director of the AU-STC, Prof. Gamal Shiha – Chairman of the ALPA, H.E. Ahmed Shahin, Representative of the Ministry of Foreign Affairs, Dr. Gamal Esmat Representative of the Egyptian Health Ministry and Mrs. Mona Mounir, Representative of the African Affairs Committee of the House of Representatives.

 The opening pointed out to the seriousness of hepatitis in Africa, as more than 70 million Africans are suffering from hepatitis, adding that some African countries do not have the keys to solving and describing the patients accurately and providing appropriate treatment. Furthermore, he pointed that one of the problems facing the African continent is that more than 55% of practitioners of the medical profession are attracted outside the continent in order to obtain a better standard of living and better income. Therefore, there must be a strategy for maintaining doctors in the continent. So that future generations would find an academic professor to come back to and be a role model.

 The Egypt success story in combating hepatitis C was tackled as an experience that can be exported to other African Countries, it was clarified that Egypt relied on Egyptian medicines and established more than 170 centers to combat virus C also worked on capacity building for doctors, even general practitioners, to fight liver viruses. It was stressed on Egypt's willingness to support the Egyptian-African relations to achieve rapid development and to provide assistance to African countries in various fields starting by the health field.

It was also pointed out the ALPA was established to be the voice of the African organizations working in the field of combating hepatitis with the aim of Africa free of hepatitis which will benefit all patients and the marginalized in particular, stressing that the right to treatment, is one of the most important human rights.

·        Session 1: " Is Hepatitis in Africa a priority? "

The session was moderated by Dr. Rana Zidan – Head External Affairs in the Egyptian Ministry of Health, the panelists were Mr. Kenneth Kabagambe – ALPA's Board Member and Africa's representative in the World Hepatitis Alliance and Mr. Ibrahima Gueye – ALPA's board Member and Hepatitis B patient. 

The session shed light on the health diplomacy practices in Egypt towards hepatitis. It was pointed out hepatitis cannot be ignored in Africa because there are about 60 There are 3 million people diagnosed with hepatitis B, we have 10 million people infected with the C virus, and death rates are 1.4 million dues to the disease, according to the World Health Organization.

About 194 countries declared their commitment to eradicate the epidemic and reduce the incidence rate of 95%, noting that the plans in the period from 2016 to 2020 aimed at reducing deaths by 30%, adding that the plans of African countries in line with global policies to fight hepatitis viruses, The World Health Organization (WHO) is providing guidelines to combat the disease, calling for cooperation at all levels.

When it comes to national action plans there are 52 countries on the level of the completion of the development of national plans to address hepatitis viruses, and there are 43 countries are still in the stage of developing plans of action, however elimination of liver viruses will not be without the participation of civil society and take responsibility.

It was pointed out that Uganda will organize the African summit of liver diseases during the next work in cooperation with many quarters.

Mr. Ibrahima Gueye shared his experience as a patient and how he was subjected to debt and offered his home and car for sale because of this disease. saying he was very scared when he learned that he was infected with the dreaded disease and how his life turned into hell because of the disease.

He explained that in 1979 he was diagnosed with the disease, and there were lack of information about the diseases as he knew that the person who enters the hospital to treat this disease does not get out of it, adding that he entered the hospital and stayed for two months and went out.

Later in 2010 he knew a lot about the disease, its causes and complications and the tests were very expensive, noting that the doctor advised to see a specialist or he will die.

He pointed out that it was known to use the treatment of interferon, but it was very expensive, and required urgent surgery along with the scarcity of the drug.

In 2016 he had to undergo surgery or there would be serious setbacks until he met with Dr. Gamal Shiha, who helped him to come to Egypt in May of the same year.  Where He did the surgery, and the blood analysis proved that everything fine.

·        Session 2: ''Success stories in combating viral hepatitis and capacity building for health practitioners in Egypt"

 The session was moderated by Dr. Mohamed Kyari along with the panelists Prof. Gamal Shiha – Chairman of the ALPA and the Egyptian Liver Foundation, Dr. Ayman Hassan, head of laboratory department at the Egyptian Liver Foundation and Dr. Inas Abdel Halim representative of the Health Committee in the Egyptian Parliament.

Dr. Gamal Shiha presented the Egyptian model, which succeeded in treating a large number of patients at very low cost and with high efficiency and started in one village and during the time reached 100 villages free of hepatitis viruses.

He extended his hope that the Egyptian model would adopt in the African continent, in accordance with the circumstances and possibilities of each country. He pointed out that the idea is not in the intellectual property or the secrets of the pharmaceutical industry but in the implementation.

He called on the developed countries to provide more funding for the treatment of millions of infected people in Africa especially French President Manuel Macaron and the International Organization of Francophonie, asked for $ 100 million to treat Africans with hepatitis.

He pointed out that the success in treating 4 million people infected with C virus efficiently and less expensive happened with government support and support from the big parties, and the same goes for the 70 million people infected with the continent, African countries.

Dr. Gamal Shiha explained that Egypt is one of the largest countries in the world in the incidence of hepatitis viruses, but after the model entitled "Teach, test and treat" was done, Egypt was able to eliminate the virus C, was applied in 63 villages in the level of 7 provinces.

It was clarified that Egypt has made a national plan to fight hepatitis viruses and has been negotiating for a special treatment price. More than 2 million Egyptians have been treated through 72 treatment centers over the past four years.

Revealed that there are about 8 million Egyptians infected with the disease and needs treatment, including about 4 million for treatment, 60% of them in the countryside, explaining that the strategy of treatment must be for the patients in rural areas first.

He praised the initiative launched by President Abdel Fattah al-Sisi to detect hepatitis and noncommunicable diseases, to examine 50 million Egyptians and provide treatment for the injured free of charge, pointing out that the initiative aims to research patients who do not know they are infected and provide them with treatment.

He pointed out that the Egyptian Liver Foundation, is a non-governmental organization, and its project village free of hepatitis started four years before the government, to have villages free of liver disease, which targeted citizens in their homes and worked on more education to raise awareness.

He explained that the village free of hepatitis project was in partnership with patients and villages, through the influential actors in the villages, such as Mayors and clergies, who had awareness and have a desire to treat the patients and willing to cooperate and facilitate presence in the village.

Dr. Enas Abdel Halim, pointed out to President Abdul Fattah Al-Sisi launch to the package of measures to ensure the advancement of the health sector, especially services to the needy, pointing out that this plan includes the implementation of comprehensive health insurance system and eliminate the waiting lists for surgical operations As well as the National Project for the Development of Model Hospitals.

Health systems in Africa face many challenges in the era of globalization, as the burden is a multiplicity of communicable and noncommunicable diseases