Monthly Archives: December 2011

AID POLICY:New Deal for Developing Nations

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]


Measles Immunization:1.7 million Children Targeted

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]

INDONESIA: HIV traps women and girls in poverty

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]

AFRICA: HIV-positive women infant-feeding confusion

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]