AID POLICY:New Deal for Developing Nations

Posted on December 29, 2011 by

DAKAR, December 2011 (IRIN) – At the global aid effectiveness forum in Busan, South Korea, in November and December this year, the “G7+”, a group of nations which includes 19 fragile and conflict-affected states, agreed a New Deal on fragile states, which sets out concrete and, they hope, more relevant ways to improve peace- and state-building goals.

The New Deal will be piloted in Afghanistan, the Central African Republic, the Democratic Republic of Congo, Liberia, Sierra Leone, South Sudan, and Timor-Leste, with help from Australia, Belgium, the Netherlands, the UK and the USA.

It identifies five peace- and state-building goals as prerequisites for development without which “no MDG [Millenium Development Goals] will be met”, said Marcus Manuel, director of the Budget Strengthening Initiative at the UK’s Overseas Development Institute (ODI), one of the architects of the New Deal.

The goals include legitimate politics, security, justice, economic foundations and revenues and services. “If you don’t sort them [these criteria] out, no matter how many schools you build, if you haven’t figured out the payroll, you won’t be able to move forward,” Manuel told IRIN.

For years donor governments have struggled with how to approach development support to fragile states, which lack the systems or resources to process aid effectively, and often have high levels of corruption leading to low value-for-money.

Aid to fragile states has often propped up corruption, rather than weakened it, says the World Bank.

Some 1.5 billion people live in conflict-affected and fragile states, most of which are not on track to meet a single MDG.

However, the recognition that fragile states need a different approach to aid altogether, has gradually turned from policy and discussion – at the Paris and Accra aid fora and declarations for action – into a more concrete action plan, said Manuel.

New approach

Under the proposed changes (to be presented to member states at the UN General Assembly in September 2012 ) “compacts” with countries will be agreed, i.e. there will be a shared understanding of aid modalities and priorities drawn up by donors, recipient governments and civil society.

Rather than each donor assessing a recipient’s fragility, countries will be encouraged to carry out their own fragility assessments, which should create more apt solutions, Manuel told IRIN. For instance, the government of Timor-Leste deemed the need to re-house internally displaced people as a security priority once the conflict was over, and proposed giving each displaced family significant cash sums to do so. Donors said this approach was too expensive and would not work, but it did, and paid off, says the ODI.

With country ownership at the heart of aid efforts, donors should not shy away from direct budget support to fragile governments early on, if the right safeguards are set up first, says the ODI in a briefing paper. Donors waited five years after the conflict to invest in government structures in South Sudan, versus two years in Sierra Leone and Rwanda, and just a few months in Afghanistan, and in each example the early support was “critical” to rebuilding state structures, says the ODI.

In Guinea, deemed by many to be a fragile state, the health and public hygiene minister, Naman Kéita, told IRIN donor hesitancy to fund ministries directly, hampered their chances of setting ambitious agendas.

However, supporting national auditing systems, and strict financial safeguards come with this approach, stress aid analysts.

In other proposed shifts, donors will agree to streamline aid flows and their administration under the New Deal, for instance by setting up just one programme management and monitoring unit in each ministry rather than the current practice, where each donor may have its own. When the Rwandan government insisted on this approach, the capacity of its ministries started to increase rather than be over-stretched.

Practical things, such as caps on pay rates also need to be introduced, say the G7+, though the modalities are yet to be worked out. In Liberia, the UN was hiring well-qualified professionals at the same time as the government was, but the UN hired 10 times as many staff, and could pay them two to three times more, constraining the government’s ability to hire.


However, some practitioners with long experience of working in fragile states, say country ownership and dismantling corruption may not always be a priority for governments.

John Morlu, ex-auditor-general in Liberia, who some say was pushed out of the job because his anti-corruption probesthreatened high-level government officials, was skeptical. “I think we have to be very careful. We talk about countries taking ownership, but do they want to take ownership? I can think of cases in Liberia where it’s much easier to say, `This is UN driven, this is IMF [International Monetary Fund] driven’ because that gives you the political cover you need.”

Furthermore, local citizens may have priorities other than greater transparency and less corruption, Guinean and Sierra Leonean youths told IRIN: they want jobs more than anything else.

Manuel hopes that as country systems strengthen, development progress will also speed up – for now, patience is still required: a 2011 World Bank report estimates it takes 20-30 years to dismantle corrupt systems in a government.

[Courtesy IRIN News]

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Measles Immunization:1.7 million Children Targeted

Posted on December 22, 2011 by

NAIROBI, 21 December 2011 (IRIN) – Amid rising measles and polio cases, tens of thousands of children are being targeted for immunization in health campaigns in affected regions of the Democratic Republic of Congo (DRC), according to the UN Children’s Fund (UNICEF).

At least 128,965 measles cases, with 1,573 deaths, have been recorded in the DRC in 2011, and 89 wild polio-virus type 1 cases had been reported up to 13 December, UNICEF said.

The current campaign against measles in Kinshasa is targeting at least 1.7 million children aged 6-59 months.

Alphonse Toko, UNICEF’s immunization specialist in the DRC, said: “Vaccination is the most efficient tool to protect children from epidemics that kill or paralyze”.

On 16 December, Health Minister Victor Makwenge Kaput urged parents to get their children vaccinated.

A door-to-door polio vaccination initiative using mobile health teams, which started on 19 December, will end on 21 December in the provinces of Bandundu, Bas-Congo, Kasaï Oriental, Katanga, Maniema and South Kivu, where at least 1.1 million children under five are being targeted.

The polio virus re-emerged in the DRC in 2006, with 13 cases being recorded at that time, before peaking at 100 cases in 2010.

[Courtesy IRIN]

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INDONESIA: HIV traps women and girls in poverty

Posted on December 17, 2011 by

The number of reported HIV cases has tripled in Indonesia in recent years, curtailing productivity and trapping affected girls and women, especially, in poverty, according to a recent UN Development Programme (UNDP) report.

Women, representing a quarter of all people living with HIV in Indonesia, shoulder family finances when their partners can no longer work, or when they face education and employment discrimination, said the report.

“Discrimination against people with AIDS is still very strong in Indonesia, especially for women. Many HIV-positive women are being called ‘bad women’ or ‘bad girls’, but at the same time, many of them have to work more after their husbands were diagnosed with HIV,” said Chya Wibisono, an HIV-positive officer at the local NGO,Indonesia Women’s Positive Network.

Women in HIV-affected households put in longer hours but were less likely to own their homes, livestock and vehicles. They were also more likely to be widowed and denied inheritance rights – the case for 71 percent of all HIV-affected widows.

Across all countries covered by the study (Cambodia, China, India, Indonesia and Vietnam), HIV-affected households experienced significant drops in incomes, savings, assets, and ability to buy protein-rich food.

Compared with non-HIV-affected families, affected families in Indonesia were 38 percent more likely to live below the international poverty line of US$1.25 per person per day – the second highest of all the countries surveyed – with more than a quarter of these households reporting having to sell assets to pay medical costs, the report says.

While antiretroviral therapy (ART) for HIV is provided free, the medication has reached about half of patients in need, compared with 94 percent in Cambodia, where free ART coverage has proven to be effective in reducing households’ financial burden, according to the UNDP report.

“Real [progress] has been made to improve ART coverage in Indonesia. The percentage of coverage has increased significantly from 25 to 50 percent over the last three years, but this is still far from enough,” said Nancy Fee, country coordinator of UNAIDS in Indonesia.

As of December 2009, some 18,000 people had reported HIV at an advanced stage, of whom 6,653 were receiving ART, according to the government.

People were going without medication mostly because they had not tested for HIV and did not know their status; in addition, continuity and availability of ART stock as well as availability of certified health workers to administer the drugs were challenges, according to the government.

Daughters in HIV-affected families were also more likely to be pulled out of school than sons to take care of their sick family members.

“It is most often [girls] who are removed first. This is both to save resources spent on schooling, as well as to utilize the girl child for labour,” said Clifton Cortez, health and development practice leader at the Bangkok-based UNDP Asia-Pacific Regional Centre.

The UNDP report suggested conditional cash transfers – paying children based on their school enrolment and attendance – to encourage parents to keep children in school.

According to the World Bank, the risk of HIV infection is more than halved for young people, particularly girls, who stay in school and complete a basic education.

In Indonesia, 28 percent of women surveyed between the ages of 15-24 had not heard of HIV and had little knowledge of condom usage, said the UNDP report.

However, Nafsiah Mboi, secretary of the government’s National AIDS Commission, dismissed concerns that women and children bore the economic brunt of HIV.

“There is no specific scheme for HIV-affected families or women, but everyone who is poor can ask for assistance. There is no discrimination,” she said.

While a National Social Security System (SJSN) has been in place since 2004 – a basic framework for reforming the country’s social security programme covering health insurance, employment injury, pensions and death benefits – the International Labour Organization estimated 54 percent of the country’s population (mostly workers in the informal economy, employees without contracts and their families) were still excluded in 2011 from the national social health protection scheme.

Instead of small government-funded isolated projects, Fee from UNAIDS said the country needed a “universal social protection floor” – a minimum level of essential social services and income security for all in times of economic and financial crisis – to ensure everybody, including those affected by HIV, had equal access to healthcare and other social services.

Parliament approved legislation on 28 October that aims to implement SJSN and provide universal health insurance coverage by 2014.

[Courtesy IRIN Plus News]

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AFRICA: HIV-positive women infant-feeding confusion

Posted on December 10, 2011 by

ADDIS ABABA, 9 December 2011 (PlusNews)
The latest guidelines on infant-feeding options for HIV-positive mothers in Africa have not been disseminated in many countries, leaving women dangerously confused about the best nutritional path to protect their children from contracting the virus, a new report shows.

The UN World Health Organization’s (WHO) 2010 guidelinesrecommend exclusive breastfeeding with an antiretroviral (ARV) treatment intervention for the first six months of a child’s life to reduce transmission, and continued breastfeeding – with complementary feeding – until the child is at least a year old. Alternatively – where it is acceptable, feasible, affordable, sustainable and safe – WHO recommends complete avoidance of all breastfeeding.

For HIV-positive mothers in most sub-Saharan African nations, exclusive breastfeeding is the most practical option. According to a large African study, Kesho Bora, giving HIV-positive mothers a combination of three ARVs during pregnancy, delivery and breastfeeding cuts HIV infections in infants by 43 percent by the age of 12 months and reduces transmissions during breastfeeding by 54 percent compared with WHO’s 2006 recommendations, where ARV drug regimens ended at delivery.

“The six months of exclusive breastfeeding is what is crucial for mothers to understand – that not doing it is what raises the child’s HIV risk; but we are finding that while many countries have officially adopted the WHO guidelines, they have not trickled down, and health centres, policy-makers and communities are still unclear on what advice to give mothers,” said Aditi Sharma, of the International Treatment Preparedness Coalition (ITPC), and coordinator of a report, The Long Walk: Ensuring comprehensive care for women and families to end vertical transmission.

Based on new research by community health workers from Cameroon, Cote d’Ivoire, Ethiopia and Nigeria, the report – launched at the 16th International Conference on AIDS and STIs in Africa (ICASA) in Addis Ababa, Ethiopia – found that prevention of mother-to-child transmission programmes were focused too narrowly on the provision of ARVs to HIV-positive pregnant women, rather than more comprehensive approaches that involved family planning, maternal healthcare and exclusive breastfeeding.

“Nutritional counselling doesn’t exist in rural areas,” the report quoted one Cameroonian woman as saying. “Health personnel are not trained and women do not know how to care for their children.”

Although the Nigerian government had revised guidelines to comply with the WHO, consensus did not exist in support of the recommendations, and some clinicians and researchers continued to oppose breastfeeding because they believed it deliberately exposed babies to possible HIV infection. Several focus group participants indicated they assumed that replacement feeding was preferable to breastfeeding, and that it had been recommended by health practitioners.

“The guidance on infant-feeding options needs to urgently get into the curriculum and training of health workers and other people who support community healthcare, such as traditional birth attendants,” said Sharma, adding that efforts needed to be made to support mothers to exclusively breastfeed their children.

“It is not enough to issue guidelines – in places where women may complain of insufficient breast milk or inadequate nutrition, they need nutritional support to ensure they can continue to exclusively breastfeed,” she added.

Conference speakers said community health systems were crucial to the success of prevention of mother-to-child HIV transmission services, as community health workers and traditional birth attendants were often the first port of call for a confused mother. Community health systems can also be used to engage men – frequently absent from ante-natal visits – in their wives’ experiences.

Beatrice Ochieng, author of a study on infant feeding choices in poor settings in the Kenyan capital, Nairobi, noted that just 23 percent of 357 women in the study discussed their chosen feeding option with their partners. “There is a need to support partner involvement through partner counselling and testing, during antenatal and postnatal care,” she said.

According to Ncumisa Vika, who works with the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) in South Africa, male involvement in reproductive health services, including PMTCT, remains low, creating challenges and barriers around disclosure of HIV-positive status to a partner, psychosocial support, adherence to treatment, and infant-feeding decisions. In 2010, in collaboration with community health organizations in South Africa’s Tshwane District, EGPAF was able to send invitation letters to the partners of all HIV-positive women who attended antenatal clinics, which boosted male participation in reproductive and family health matters.

Overall, ITPC’s Sharma said, there was a need for more comprehensive delivery prevention of mother-to-child services in Africa. “Countries must ensure that policy filters down to the women in all aspects of PMTCT – from HIV prevention for women to family planning, to the best ARV prophylaxis option to proper infant feeding to proper healthcare for the mother, child and family,” she said. “It is the only way we can achieve the 2015 targets of reducing vertical transmission by 90 percent.”

[Courtesy IRIN]

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KENYA: Poor Mental Healthcare

Posted on November 30, 2011 by

 

NAIROBI, 30 November 2011 (IRIN) – A shortage of mental health specialists and facilities, ignorance and stigma, are among the challenges facing the provision of quality psycho-social care in Kenya, say specialists. 
There is a huge treatment gap in Kenya, where there are currently 81 psychiatrists for a population of 41.6 million,”
” Monique Mucheru-Wang’ombe, a consultant psychiatrist at the Ministry of Medical Services, told IRIN. 

With most psychiatrists in private practice, only about 25 are in the public sector and then largely in the urban areas while the population was primarily rural, said Mucheru-Wang’ombe. 

According to the UN World Health Organization (WHO), in most countries, particularly low- and middle-income countries, mental health services are severely short of resources – both human and financial – with more being spent on the specialized treatment and care of people with mental illness and to a lesser extent on integrated mental health systems. 

Instead of providing care in large psychiatric hospitals, WHO urges countries to integrate mental health into primary healthcare in general hospitals and develop community-based mental health services. 

“Institutionalization is not the way to go,” echoes Mucheru-Wang’ombe, adding that community-based mental health services helped to make the provision of care more accessible and reduced stigma. 

She added that the integration of other health services such as dental or maternal and child services within the same institutions would also help to reduce stigma, as would awareness-raising on the importance of treatment and long-term management. 

Cases of families hiding away mentally-ill patients are common due to the negative perceptions associated with such illnesses. “Mental illnesses are thought to be a consequence of demon possession, evil spirits or curses. It therefore takes long for patients to seek help from the formal health sector,” she said. 

A general misconception in the coastal region where drug abuse is rife, for example, is that most of those suffering from mental illnesses have themselves to blame, exposing them to social ridicule. 

Some families therefore opt to hide their sick relatives to avoid embarrassment. 

The media has also been blamed for helping to perpetuate the stigma. “…It is a shame that coverage is almost always sensationalistic and further dehumanizes people who are already relegated to the fringes of society,” writes Judith E. Klein, the director of the Mental Health Initiative in a blog. 

“The stigmatization of people with mental disabilities runs very deep, and it is very difficult for them to shed it,” says Klein. “Sensationalist media coverage does everybody a disservice because it reinforces the message that disabled people are hopeless, pathetic burdens to society and that if only they received more charitable assistance, perhaps society could take a breath and forget about them – again – at least until the next scandalous story breaks.” 

According to Frank Njenga, a consultant psychiatrist, there is little psycho-social help available to those in acute need, such as survivors of frequent rapid onset disasters in the country, for example, the recent Sinai slum fire. 

Widespread poverty is also a factor, said Njenga. 

Mama Naima* told IRIN that a lack of money to take her 22-year-old son for specialized treatment had forced her to rely on traditional herbal concoctions. 

The provision of mental health services is a relatively new area in Kenya, says Adrienne Carter, a psychotherapist/trainer with the Independent Medico-Legal Unit (IMLU). 

“The usefulness of counselling in the healing of mental health problems is not yet well known, especially in the area of torture and other traumatic events,” said Carter. “There are numerous communities within Kenya that suffered greatly during the post-election violence. Some… managed to get psychological assistance, but most of them continue to suffer, untreated.” 

An experience is considered traumatic if the person never experienced it before, it is overwhelming and it changes one’s life completely, it involves death or serious threat to one’s life. Witnessed events may include observing the serious injury or unnatural death of another person due to violent assault, accident, war or disaster or unexpectedly witnessing a dead body or body parts. 

The disorder developed as a result of traumatic events may be especially severe when the stressor is human (such as in torture, rape). 

With traumatized people often exhibiting various physical reactions such as body aches, sleeping problems, nightmares and numbness, they mostly go to medical doctors to try to ease their pain, she said, “but the medications prescribed by the physicians help only for a short time… unless the root causes are treated, the physical symptoms continue to persist. 

“It is necessary to process the trauma and assist in integrating it within the psyche of the traumatized individual. If the trauma is not integrated within the psyche, the traumatized individual is often found to suffer from Post-traumatic Stress Disorder [PTSD].” 

PTSD is characterized by re-experiencing of the traumatic event or persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness and symptoms of increased arousal. 

“Unfortunately, people experiencing these symptoms are frequently misdiagnosed with schizophrenia and other psychotic disorders… [and] may end up for many years in mental hospitals where they are ‘treated’ with heavy doses of medications that do not and never will cure their symptoms.” 

[Courtesy IRIN]

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Tanzania Tightens Borders Over Yellow Fever

Posted on November 25, 2011 by

Tanzania has announced more rigorous plans to ensure all travellers entering the country have yellow fever certificates, the East African Legislative Assembly (EALA) has been informed.

Tanzania is the only East African Community partner state that strictly enforces the International Health Regulations requirements on yellow fever in respect to regional and international travellers, even though the other four partner states are members of the World Health Organization.

Addressing the EALA sitting in the Burundian capital Bujumbura, the acting chairman of the Council of Ministers, Mr Musa Sirma, said since all partner states are signatories to the International Health Regulations, there was need for them to become vigilant.

However, some legislators accused Tanzanian of double standard, saying the country only implements the surveillance at the Kilimanjaro Airport, leaving all the other entry points unchecked.

“Does yellow fever threaten Tanzania only through one entry point, the Kilimanjaro Airport?” Gen. Mugisha Muntu, Uganda, asked. Meanwhile, Ms Dora Byamukama, also a Ugandan MP, asked if Tanzania had mechanisms of ensuring the yellow fever certificates people carried were genuine.

Ms Margaret Zziwa, Uganda, said it is not necessary for citizens within East Africa to struggle acquiring Yellow Fever certificates, arguing that there has not been any disease outbreak in the region for many years. She said such impediments to peoples’ travels within the community would affect the spirit of the Customs Union Treaty, agreed upon by all the five member states.

“It is to the detriment of the movement of the people, because it adds cumbersomeness of the peoples’ travels. Some people even have to pay bribes to get the certificates which means it abets corruption,” Ms Zziwa said.

However, Mr Sirma, also the Kenyan Minister in charge of East African Affairs, denied any double standards, insisting that Tanzania would implement the yellow fever checks on all boarder points of Nyerere Airport, Mwanza Airport and some inland cross-border ports of entry such as Namanga.

“The Republic of Tanzania will, through implementation of active surveillance and national vaccination strategies protect travellers entering the country which is considered endemic for yellow fever,” Mr Sirma said.

Mr Surma said in one of their previous meetings, the council of ministers agreed that all countries in the community become strict about yellow fever adherence and surveillance to avoid the disease spread.

Yellow fever is one of the diseases considered a stumbling block to economic and social development in Africa, although there has not been a major outbreak in the EAC for a long time now.

A mosquito-borne disease, yellow fever symptoms include; high fever, chills, headache, muscle aches, vomiting, and backache. Last year, Northern Uganda districts of Lamwo, Kitgum, Pader and Abim received vaccinations for yellow fever. Most Ugandan travellers undergo vaccination from health centers where they receive certificates for the disease to aid their travels.

Mr Surma informed the House that in South Africa, he was forcibly immunised because he had forgotten his yellow fever certificate, days after he had been immunised from his home county-Kenya.

“Recently we established a health directory and the regionalisation of all health matters will be considered,” Mr Surma said.

[Courtesy allAfrica.com]

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HIV/AIDS: Global Fund cancels funding

Posted on November 24, 2011 by

JOHANNESBURG, 24 November 2011 (PlusNews) – The Global Fund to Fight HIV, Tuberculosis (TB) and Malaria has cancelled its next round of funding and cut off countries like Russia, China and Brazil after donors failed to deliver US$2.2 billion in previously committed funding. Emergency funding measures will now be put in place for some countries. 

The Global Fund board took the difficult decision of cancelling Round 11 at its latest meeting, which concluded on 22 November in Accra,  Ghana. A reduced pool of eligible countries will now be able to apply for new funding only after the Fund’s next disbursement in 2014. 

A Transitional Funding Mechanism has been established to provide emergency relief to current recipients who will run out of money before 2014. But this will apply only to essential services such as HIV treatment and care, according to a statement issued by the Fund.

However, international medical humanitarian organization Médecins Sans Frontières (MSF) has pointed out that the decision will not allow countries to scale up or improve HIV treatment, and will also limit treatment for drug-resistant forms of TB. 

“The bottom line is that there’s $2.2 billion in outstanding pledges that haven’t been paid by the donors,” said Global Fund board member Shaun Mellors of South Africa’s Foundation for Professional Development. “If those pledges had been turned into contributions we’d obviously be in a very different situation, but there just isn’t enough money for Round 11, or even Phase II renewals of grants.” 

Global Fund grants have usually been disbursed in two phases: in Phase I, countries qualified for two years of initial funding; in Phase II they could apply for an additional three years of funding as part of a renewal. 

In the developing world, treatment for 70 percent of HIV patients is financed by the Global Fund. Countries like Zimbabwe, Malawi and Mozambique, which rely heavily on Global Fund money to support national HIV programmes, will now be encouraged to use their drafted Round 11 proposals as a basis for funding requests in 2014. 

Swaziland’s decision to forgo Global Fund money contributed to shortages of antiretroviral (ARV) medication earlier in 2011 after the government was unable to generate enough revenue to fill the gap. Its country coordinating mechanism, which distributes Global Fund money nationally, called Round 11 a “do or die” moment, and had begun work on its Round 11 application. 

South Africa’s HIV lobby group, the Treatment Action Campaign (TAC), is largely dependent on Global Fund money to sustain its operations. Delays by South Africa’s Department of Health in disbursing US$ 760,000 in Global Fund money to TAC led the group to issue a on 23 November that without this money, TAC will be forced to close its doors and retrench all its employees at the end of January 2

 The group, which recently helped formulate South Africa’s new national strategic plan on HIV, TB and sexually transmitted infections, urged the Global Fund to make sure that all sub-recipients were paid by the first week of January. 

Round 11 had been postponed twice due to insufficient funding, partly because lower interest rates were achieved on the Global Fund’s World Bank account. According to MSF, countries Kenya, Lesotho and South Africa had also been told that they would not be eligible for Round 11 funding due to financial shortfalls despite the fact that none of these countries had yet reached international universal ARV access targets of 80 percent uptake. 

Mellors told IRIN/PlusNews the Fund had also been forced to stop signing Round 10 grants two weeks ago. A funding deficit of up to US$.6 billion meant board members were faced with tough decisions at the meeting, and no one was pleased with having to find what seemed the least painful solutions. 

Cutting Round 11 was not enough. To finance the Transitional Funding Mechanism and some Round 10 applications, the board had to cut deeper, cutting  future funding for upper-middle-income countries without large HIV epidemics such as Argentina, Mexico and China. 

Countries reclassified as upper-middle-income nations will also no longer be afforded a one-year grace period during which they would still have been eligible for support. China has an emerging HIV epidemic and would have been eligible for about $880 million in grant renewals, according to Aidspan’s Global Fund Observer news service. 

More stringent funding requirements – part of the Fund’s new strategy after a high-level panel to review financial oversight – will now apply to Phase II applications of current grants. Money will be disbursed annually to countries qualifying for Phase II renewals, rather than the multi-year instalments originally envisioned as part of these renewals. 

During 2011, several donors – including Sweden, Ireland and Germany – suspended funding to the Global Fund after media reports about grant mismanagement found by the Office of the Inspector General of the Global Fund. Spain made no pledges in 2011 and Italy has not been contributing to the Fund, according to Fund spokesperson, Marcella Rojo. 

Nevertheless, Sweden resumed funding the Global Fund in early November 
2011 and Germany announced on 23 November that it would pay its 2011 
instalment, confirming its full pledge for 2012. Global Fund executive director Michel Kazatchkine noted that the percentage of countries fulfilling their stated commitments has been falling in recent years. 

According to the Global Fund Observer, in 2009 almost 15 percent of donor pledges were not fulfilled. Last year, this percentage nearly doubled. 

MSF has called on the Fund and donors to immediately raise the resources necessary for emergency funding as well as more sustained financial support. 

“Donors are really pulling the rug out from under people living with HIV/AIDS at precisely the time when we need to move full steam ahead and get life-saving treatment to more people,” said Dr. Tido von Schoen-Angerer, executive director of MSF’s Access Campaign in a statement. 

“All governments must chip in to the effort to curb HIV, but especially those with the capacity to really make a difference must urgently step up and support a new funding opportunity for countries by the Global Fund.” 
[Courtesy of IRIN]

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SIERRA LEONE: Fistula Hotline Launched

Posted on November 22, 2011 by

 

FREETOWN, 22 November 2011 (IRIN) – Nurse Zainab Blell’s mobile phone has been ringing all morning at the Aberdeen Women’s Centre, a clinic in Freetown, Sierra Leone’s capital. After explaining to countless callers that this is a hospital line, Blell gets a genuine request for help and tries to get more details. “When did you give birth? When did you start having a problem?”
The woman on the phone is in a remote Sierra Leonean town. She says her sister leaks urine uncontrollably, and suffers from rashes and peeling skin on her inner thighs.

Blell is one of three nurses answering calls on a newly launched “fistula hotline”, a free phone number for women who suffer from this debilitating condition that is seldom spoken about.

Fistula, also known as vesico-vaginal fistula or VVF, is a hole in the birth canal that leaves women with chronic incontinence, and often a stillborn baby. It is usually caused by several days of obstructed labour. It affects an estimated two million women in developing countries; and 50,000-100,000 women worldwide each year.

The fistula hotline, which is run by the centre, is the result of a public-private partnership between the Gloag Foundation, USAID, the United Nations Population Fund (UNFPA) and telecommunications company Airtel.

In the last month more than 8,000 calls have been received, but so far just 0.1 percent have been about cases of fistula.

The Aberdeen Women’s Centre provides the only comprehensive fistula repair service in the country. Despite the small number of calls concerning the condition, Jude Holden, the centre’s Country Director, is pleased with the result. “We have received 90 cases since the hotline opened, and this is a great success,” she told IRIN.

Shortly after the hotline opened in October, radio messages were broadcast in the local Krio language and in English, describing fistula and telling anyone who thinks they are affected to call 555.

“There is very little awareness of fistula and why it happens. Women are stigmatized and often blamed for their condition. Because of this we found it difficult to get women with fistula to the centre for treatment.”

Fistula occur most often in young women (15 to 30 years old), most of whom come from rural areas with poor access to healthcare, according to a 2005 Ministry of Health survey.

In Sierra Leone, some estimates put fistula prevalence at a similar rate to maternal mortality – one in eight women – but there is little research to back up these estimates.

Free healthcare services for lactating mothers and pregnant women were launched in 2010, but the maternal health infrastructure is inadequate and the Ministry of Health is struggling to implement the policy. Only 137 trained midwives practice in the country, and there are just 16 emergency obstetric facilities.

During and after Sierra Leone’s decade-long civil war, widespread rape trauma was a major cause of fistula, according to Sarah Walker, VVF programme manager at the Aberdeen Women’s Centre. Most of the resultant traumatic fistula cases have been dealt with, she said, and the problem now stems mainly from poor ante-natal care and a high level of teenage pregnancy.

“Most of the [women with fistula] are uneducated farmers… They don’t have access to any sort of healthcare, pre-natal or post-natal. We see it a lot in young girls, mostly because their bodies are not developed yet, and so when they’re in labour the child gets stuck in the pelvis,” said Walker.

In Njala town in the Southern Moyamba district, Kadiatu Ngegba’s husband heard the radio advert and called the number. Ngegba, now aged 24, developed a fistula when she was just 15 years old, after being in labour for two days before a doctor came to perform a caesarean section.

“My baby died,” Ngegba says. “After the operation, the doctor pulled out the catheter and I was covered in urine.”

When she got home, Ngegba’s first husband abandoned her and she was sent to live with relatives. “I was really unhappy. Everyone made fun of me. I wanted to go back to school but because of this problem I had, I couldn’t.”

Ngegba had fistula repair surgery in 2006, but when she gave birth to her second child without a caesarean, the fistula reappeared.

Experts say prevention, rather than treatment, is the key to ending fistula. This means providing women with family planning, ante-natal care, skilled birth attendants and emergency obstetric care, according to the UNFPA Campaign to End Fistula.

“We need a preventative as well as a therapeutic approach,” Sas Kargbo, Director of Reproductive Health at Sierra Leone’s Ministry of Health, told IRIN, adding that the free phone line is an important step to finding the women and treating the problem.

Sierra Leone is currently finalizing a strategic plan to tackle fistula and will appoint a focal person by the start of 2012.

At the Aberdeen Women’s Centre, almost 10 years after developing her first fistula, Ngegba waits for surgery. She smiles and hugs Naomi, her two-year-old daughter. “When I get well,” she says, “my husband will send me back to finish school.”

[Courtesy IRIN News]

Posted in Africa Disability Update, Gender Issues, Maternal Health, Women's Health | Tagged , , , , | Leave a comment

AFRICA: Sanitation Targets “two centuries away”

Posted on November 21, 2011 by

It will take two centuries for sub-Saharan Africa to meet the Millennium Development Goal (MDG) to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation, according to NGO WaterAid, which calls on national leaders to commit 3.5 percent of their annual budget to the sector.

Water, sanitation and hygiene (WASH) are being sidelined as governments concentrate on health and education, says the WaterAid report. Meanwhile, people’s lack of access to clean water and basic sanitation services is holding back social and economic development in the region, costing around 5 percent of gross domestic product (GDP) every year.

Inadequate WASH services cost sub-Saharan Africa more than the whole continent receives in development aid – US$47.6 billion in 2009 – according to WaterAid.
The World Health Organization (WHO) estimated the financial impact of inadequate WASH facilities by looking at the health issues linked to poor hygiene, child mortality, waterborne tropical diseases, the time people spend collecting water; and reductions in educational achievement due to illness and girls’ attendance rates at schools.

“Diarrhoea, 90 percent of which is attributable to inadequate sanitation and dirty water, is the single biggest killer of children in Africa, and yet sanitation targets are off-track,” Tom Slaymaker, one of the report’s authors, told IRIN.

Every day, 2,000 children die from diarrhoea in sub-Saharan Africa. Four out of 10 people do not have access to safe water, while seven out of 10 do not have appropriate sanitation facilities.

The disparity between rich and poor is stark. Poor people in sub-Saharan Africa are more than 15 times more likely to practice open defecation due to inadequate or poorly maintained toilets.
“Unless this changes, we won’t see educational progress and it will hold back progress on child health. If you look at development in industrialized countries, sanitation has been key to enabling economic growth and achieving acceptable living standards,” said Slaymaker.

Progress has been slow partly because WASH is not “sexy”, he commented. “On one level it’s just a question of political will. Sanitation is not a sexy topic – politicians much prefer to say they’re opening a hospital or school, rather than building some toilets.”

Most policy-makers in charge of WASH “have access to clean water and good sanitation, so they may not be motivated to address it in a distant rural part of the country,” said WaterAid senior policy analyst John Garret.

Slaymaker noted that “The water ministry is generally less powerful relative to the education and health ministries – which [tend to] have more civil servants and more leverage with the ministry of finance during and after the budget process – [so] in the scramble for funds, the water ministry and sanitation organizations lose out. This all contributes to the sector being a low priority.”

Water and sanitation is not an easy sector to reform, given it is usually spread across different ministries, and there is often “no single unified voice in the national budget process for sanitation”, he added.

WaterAid calls on donors to double the global aid flow to WASH with an additional $10 billion per year in the run-up to 2015, the deadline for achieving the MDGs.

African governments need to commit at least 3.5 percent of GDP to sanitation and water to get back on track, Slaymaker told IRIN. Only Lesotho, Kenya, Niger and Tanzania are currently spending more than 0.9 percent of GDP on WASH. In Côte d’Ivoire, Ghana, Liberia, Madagascar, Nigeria, Uganda and Zambia, the most recent expenditure figures fall well below the original 2009 commitment of 0.5 percent of GDP.

“Despite all the political commitments, we haven’t seen the finances to back it up,” Slaymaker told IRIN. African heads of state met in the Rwandan capital, Kigali, earlier in 2011, and although many of their governments had made a commitment in 2009 to spend 0.5 percent of the annual budget on sanitation, “only one or two countries… realized that,” he said.

Despite this challenge, Slaymaker still thinks the MDG goal can be met if politicians drastically change course. “This is the last chance to make an effort to get back on track,” he told IRIN. “It’s a question of… concerted partnership between donors, governments and the private sector. What’s lacking at the moment is that concerted drive.”
[Courtesy IRIN]

Posted in Africa Healthcare, Cholera | Tagged , | Leave a comment

NIGERIA: Gay Rights Bill Threatens Imprisonment

Posted on November 15, 2011 by

LAGOS, 15 November 2011 (IRIN) – Rights groups in Nigeria fear an anti same-sex marriage bill being discussed in parliament could boost already prevalent discrimination against homosexuals. The bill goes much further than banning same-sex marriage; it threatens to ban the formation of groups supporting homosexuality, with imprisonment for anyone who “witnesses, abet[s] or aids” same-gender relationships, and could lead to any discussion or activities related to gay rights being banned.

Under a colonial-era law, sodomy is punishable by a 14-year jail sentence; and in the country’s mainly Muslim northern states, where a version of Shar’ia law applies, the penalty is death by stoning, although this has never officially been carried out. 
 
The National Assembly began debating the latest version of the Same Sex Marriage (Prohibition) Bill in November. Most high-ranking officials have voiced their approval of the bill, signalling it is likely to pass.

Analysts see the bill, which has been shelved twice in five years, as a potential boost to the popularity of a government whose approval ratings have stalled since elections in April this year.

A 2008 survey by non-profit, Nigeria’s Information for Sexual and Reproductive Rights, of 6,000 Nigerians on their attitudes to homosexuality, found that only 1.4 percent of respondents said they felt “tolerant” towards sexual minorities.

A university student in the northern state of Jigawa was killed in 2002 when classmates set upon him after rumours that he was gay. 

In September 2008, several national newspapers published the names, addresses and photographs of the pastor and congregation of a church in the port city of Lagos that ministered to sexual minorities. A few days later a mob that included policemen attacked the church. Members of the congregation lost jobs and homes and had to go into hiding; others are still harassed and threatened with physical harm, Human Rights Watch said in a statement. 

“Homosexual and lesbian practices are considered offensive to public morality in Nigeria. The… bill is crucial to our national development because it seeks to protect the traditional family, which is the fundamental unit of society, especially in our country,” said the influential newspaper, This Day, in its editorial on 10 November. “It will be difficult to import practices and lifestyles which are alien to our country and the majority of our people.”

Homosexual rights are narrowing across Africa. In Uganda, gay rights activist David Kato was killed in January 2011 after opposing the Anti-Homosexuality Bill in 2009. 

In Malawi a gay couple was imprisoned for “gross indecency”. The United States and British governments have threatened to cut off aid money to African countries seeking to curb gay rights. 
 
Leaders of Nigeria’s main religions – Islam and Christianity – rarely promote tolerance of homosexuality, according to Damian Ugwu, a rights activist at the Lagos-based Social Justice Advocacy Initiative.

“There is no religion that welcomes the same-sex marriage, whether Islam or Christianity,” National Tourism Director Olusegun Runsewe told reporters on 7 November. ”We need to be careful and do all it takes to shun this practice, because same-sex marriage is satanic and it can destroy any system, as well as cause bad image for any country.” 
 
Religious disapproval can have a devastating impact on gay people, said Ugwu. “The church has zero tolerance for homosexuality. The only time they will accept someone being homosexual is if they come to ‘confess’ and ‘repent’ of it, to say they are cured so they can be forgiven.” 

Fear of “coming out” also means many homosexuals – who are at high risk of HIV – are unable to access medical services or receive adequate treatment, as they give incomplete personal information, activists say. 

“Gay people who are courageous enough to come out have reported being humiliated by medical staff,” Ugwu noted. At least two homosexuals who spoke to IRIN on condition of anonymity said they feared even going to hospitals for fear of being “outed” by staff.

NGOs and activists say the bill could have serious implications even for people who aren’t gay. Migrants in search of work in bigger centres are a vulnerable group. “It’s going to give the Nigerian police, who are already known for abusing their power, a license to violate the rights of both gay and non-gay people. It’s going to create an avenue where young men and women, who often live together in big cities for financial reasons, will become targets for extortion,” Ugwu said.

“This is an insidious bill that appears to be limited to same-gender marriage, but is actually an attack on basic rights,” said Human Rights Watch spokesperson Graeme Reid. “The definition of ‘same-gender marriage’ is so broad as to include anyone even suspected of being in a same-sex relationship. And it threatens human rights defenders by targeting people who support unpopular causes.”

Nigerian gay author and campaigner Unoma Azuah told IRIN the government should be focusing on other priorities. “I think it’s a distraction from real issues at hand, and an absolute waste of time and resources… How does what two consenting adults do in the privacy of their spaces provide a solution to the crippling problems of unemployment in Nigeria? There are few major good roads; education is in shambles; there’s extremely poor electricity supply, food and oil have to be imported by the ton – and legislators are busy debating same sex marriage?”

The barriers to acceptance are hard to breach. “Gay people face discrimination from their families, from religious groups and from society,” Ugwu said. “So it’s quite understandable people aren’t speaking out [in support of them].” 
[Courtesy IRIN] 

 

Posted in Gender Issues, Global Health, HIV/AIDS, Human Rights, Sexual Exploitation | Tagged , , , , | Leave a comment