Monthly Archives: February 2012

Global: Measuring women’s empowerment in agriculture

Washington, 28 February 2012 (IRIN)

The global anti-poverty movement has added a new tool to its arsenal with the launch of an index that measures women’s empowerment in agriculture.
“Agriculture is the most effective way to drive inclusive economic growth of the poorest communities”, which too often include women and children, said Sara Immenschuh of the International Food Policy Research Institute (IFPRI), a partner in compiling the index.

The Women’s Empowerment in Agriculture Index is a partnership between the US government’s Feed the Future initiative, US Agency for International Development (USAID), IFPRI and Oxford University’s Oxford Poverty & Human Development Initiative (OPHI). It uses five criteria to measure the empowerment of developing country women in agriculture, and in their own households.

Pilot programmes in Bangladesh, Guatemala and Uganda studied how engaged women were in decision-making about agricultural production, what sort of access they had to resources and how involved they were in resource-related decision-making; the extent to which they controlled how income was used; whether they were able to have a leadership role in the community; and how they used their time.

If a woman scored well on four out of five indices, she was considered empowered. The results differed from country to country, and the reasons for low or high levels of empowerment also varied.

In Bangladesh, just less than a third of women were empowered, with lack of control over resources, weak leadership and influence in the community, as well as lack of control over income the main reasons.

In Guatemala, the number was less than 25 percent. The less educated a woman was and the younger she was, the more likely she was to be lagging behind in empowerment. On the other hand, the more empowered a Guatemalan woman was in agriculture, the greater the influence she had in other key areas of daily life.

Lack of leadership in the community and control over use of income were the two biggest factors contributing to disempowerment in Guatemala, the report says.

In Uganda, 37 percent of women were empowered in agriculture and more than half enjoyed gender parity at home.

However, many women in Uganda said widowhood empowered them – because they did not have to waste time asking their husband’s permission to do things but just got on with them.

Ugandan women “who are empowered in agriculture also reported significantly greater decision-making and autonomy with respect to almost all domains”, says the report.

Surveys were conducted in 450 households in southern Bangladesh, and 350 each in the western highlands of Guatemala and northern, central and eastern Uganda, between September and November 2011.

One aim of the project is to help US government agencies and anti-poverty organizations to measure just how successful their programmes are at fighting hunger and poverty.

“We want to improve gender parity not by disempowering men but by bringing women up to the level of men,” said IFPRI senior research fellow, Agnes Quisumbing.

Although they make up 43 percent of the agricultural labour force, women in developing countries own less land, are limited in their ability to hire farm workers and have less access to credit, among other issues.

“Without addressing those inequities, women will be unable to effectively contribute to reducing global poverty and hunger,” said Immenschuh.

The Women’s Empowerment in Agriculture Index was launched on 28 February at the UN in New York.

[Courtesy of IRIN News]


HEALTH: Malaria Deaths “Underestimated”

DAA-7 February 2012

A new attempt to quantify malaria deaths over the past 30 years suggests the death toll, especially among adults, has been greatly underestimated. The figures also show the fragility of the gains made in fighting the disease.

Collecting data on malaria deaths is notoriously tricky; the countries where the disease is most prevalent have the weakest statistics. And even where causes of death were recorded, the researchers found many deaths were simply attributed to “fever” – probably malaria, but possibly not. In addition, a malaria infection is often a contributory cause of death along with other health problems.

However, after some complicated number-crunching, researchers, based at the Institute for Health Metrics in Seattle, believe they have produced the best estimates so far of how many people in the world die of malaria.

The figures, published in the London-based medical journal, The Lancet, some surprises, principally because they are significantly higher than those issued last year by the World Health Organization (WHO) – more than eight times higher in the case of older children and adults in Africa, where most of the deaths occurred. The difference was smaller in the case of children under five, but the researchers said they believed malaria was a more important cause of death in under-fives than the 2011 World Malaria Report estimated, causing 24 percent of child deaths in Africa.

Christopher Murray and his colleagues said they believed the fact that almost half a million extra deaths occurred in adults and older children each year had practical implications. “Traditional teaching in most medical schools argues that acquired immunity [in endemic areas] means that adults have clinical malaria, but are not likely to die from it. Inspection of the basic… data, however, clearly shows a substantial percentage of malaria deaths in individuals aged 15 years and over, even in endemic areas such as sub-Saharan Africa.”

In the light of this they suggest a shift of control strategies to pay more attention to all adults, not just women and children, in the distribution of insecticide-treated bed nets.

The research also tracked malaria deaths through time, from 1980 to 2010. Global malaria deaths almost doubled between 1980 and 2004; child deaths in Africa almost tripled over the same period. The researchers suggest the HIV/AIDS epidemic and resistance to chloroquine as probable causes, along with an increase in population in malaria-endemic areas.

After that the number of deaths started to fall, although they are still not down to 1980 levels. The results of hard-fought campaigns, and the resources provided by the Global Fund to fight AIDS, Tuberculosis and Malaria, do show up in the figures. The authors say “the risk of malaria death in several countries that have scaled up control efforts, such as Zambia, Tanzania, Kenya and Ethiopia, has decreased between 2000 and 2010 figures”.

The reverses of the 1980s and 1990s signal the fragility of the gains in the war against malaria, and the researchers say this underscores the danger posed by the world economic crisis, and the slowdown in health funding. They conclude: “The announcement by the Global Fund [in November] that their next round of funding would be cancelled raises enormous doubts as to whether the gains in malaria mortality reduction can be built on or even sustained.”

Sarah Kline, executive director of Malaria No More UK, told IRIN this fragility of funding, especially from the Global Fund, was a big source of discussion and anxiety for the whole malaria community. “The total funding gap for malaria, from all sources, if we are going to meet our 2015 targets, is around US$3 billion a year, although we did have some positive announcements at Davos about extra funding from the Gates Foundation, and the governments of Saudi Arabia and Japan.”

The funding gap was also addressed by the Liberian President Ellen Johnson Sirleaf when she was elected to head the African Leaders’ Malaria Alliance on 2 February, and urged African countries to step up their own funding for control campaigns and find innovative sources of finance to close the gap.
[Courtesy IRIN]

CHAD: Polio Outbreak


DAKAR, 5 February 2012
Poor-quality emergency immunization campaigns and low routine polio immunization coverage are helping the polio virus to spread in Chad, with 132 cases reported in 2011 – five times the number in 2010. More commitment is needed across the board, especially from local health authorities, to try to get immunizations right, say aid agencies.
The current outbreak in Chad has been ongoing since 2007, classifying Chad as a “re-established transmission zone” according to the World Health Organization (WHO). Polio is endemic in Nigeria, Pakistan, India and Afghanistan – in other words, transmission of the disease in these places has never been broken.

While a dysfunctional health system is linked to poor routine immunization coverage, “the primary reason [for the upsurge] is operational,” said Oliver Rosenbauer, spokesperson for the Global Polio Eradication Initiative at WHO in Geneva. “It is not to do with insecurity or lack of infrastructure… The outbreak response has not been sufficient to stop it [the outbreak]… They continue to miss too many children.”

Immunizers have missed children for a variety of reasons: In some cases government and agency staff or volunteers inaccurately mapped out where they lived; or may have ordered too few vaccines or too few ice packs to cover each district, said WHO. Often communities are not well-sensitized in advance so families remain reluctant to bring their children forward, some resist on religious grounds, or they simply may not know that they can immunize a child even if he or she is sick, said WHO and UNICEF’s West Africa communication for development specialist Irina Dincu.

Human error also plays a role, added Dincu, explaining that an ill-trained vaccinator may rest en route, breaking the cold chain, or a team may miss a few houses in a village.

An outbreak of the polio virus would not spread so far if routine polio immunization coverage was better, said Rosenbauer. Polio immunizations are rigorous to administer: vaccinators must go house-to-house, and must give each child four doses over a 6-12 month period, reaching 90 percent of all children to eliminate polio, according to WHO.

Coverage rates are estimated to be 60 percent at most in Chad, partly due to a poor-quality health system: Just 30 percent of health clinics are operational across the country; access to health care is poor; and routine immunization strategies are poorly planned.

To ensure fewer children are missed, immunizers need to make better use of “social data” to find out why and where a campaign is not working, says Dincu. Agencies used to take a purely medicalized approach to polio immunization but this has now changed. “Immunization campaigns are not just a medical intervention. You need to address campaigns from a medical, political and societal angle,” said Rosenbauer.

Social data has been used creatively in India and Nigeria to help vaccinators reach more children, according to UNICEF. In Nigeria’s Kebbi State households were assigned “godmothers” who came regularly pre-immunization day to discuss the disease and why vaccination was important. When poring over the data afterwards to find missed children, the “godmothers” could identify them by place, name and age, making them much easier to re-trace.

These are the kinds of approaches that could be adopted in Chad, say practitioners, where despite its weak health system, polio should not be too challenging to control, says Rosenbauer. “We don’t face the same high-population challenges that we do in Nigeria, or insecurity as is the case of Afghanistan and Sudan. Here it is more a question of political and societal will.”

In his view, polio could be eliminated in six months if the government committed to doing so at all levels. 

International efforts to combat polio are mounting: the Centers for Disease Control (CDC) has established an Africa-based emergency operations centre which will tackle public health crises, including polio.

Meanwhile, the Polio Eradication Initiative – made up of WHO, UNICEF, CDC, the Bill and Melinda Gates Foundation and the Rotary Foundation – has designated polio a “programmatic public health emergency” until eradication is achieved.

The Chadian government appears to be taking polio seriously: President Idriss Déby has emphasized the importance of fighting it, and catalyzed the development of a six-month polio emergency action plan (which will then be renewed for a further six months). This includes targeting high-risk areas and analyzing what is and is not working.

But commitment at the district and sub-district level in some parts of the country is weak, say aid agency staff. National authorities need to hold “sub-national” staff accountable for their performance, said Rosenbauer. “The virus doesn’t respect district boundaries so we need high commitment in every single one,” he told IRIN.

Without local-level government commitment, elimination efforts will fail, says Rosenbauer. The number of cases in Nigeria rose from 21 to 57 between 2010 and 2011 partly due to local authorities focusing on presidential elections; while election-related violence also distracted from efforts to quash 36 cases that broke out in Côte d’Ivoire in 2011.

And until polio is eliminated in Nigeria and in Chad, all West African countries are at high-risk, according to WHO. “There are immunization gaps in many countries – it can strike in the most unexpected places… that is why it is such a dangerous disease.”

[Courtesy IRIN]

HEALTH: Pledge to eradicate “neglected” diseases

Ten little-known but debilitating diseases will be high on the agenda of the world’s pharmaceutical chiefs, health ministers and donor governments after they pledged their support for a World Health Organization (WHO) initiative to wipe out guinea worm, river blindness, trachoma, leprosy, bilharzia and intestinal worms, among other “neglected” diseases.

Caroline Anstey, a managing director of the World Bank, told the delegates at the meeting in London: “We are not really talking about neglected diseases; we are talking about neglected people. I think that is very key, and it is all about how and if and whether we value them.”

The participants on 30 January pledged to support the WHO programme for controlling or eliminating these diseases by 2020, promising more research and an increased supply of free drugs.

In turn, donor governments and private philanthropists, including Bill Gates, promised to support the delivery of the drugs and strengthen the health systems of the affected countries to run control and eradication programmes. Health ministers from Mozambique, Bangladesh and Brazil attended the meeting.

Working on these diseases has been frustrating because they are not incurable. Drugs to treat them exist. But these drugs have been too expensive or in short supply, or only available in a form that is difficult to use. The key to this initiative is that the organizers, especially Gates, have brought the drug companies on board.

“The drug suppliers are willing to be generous,” he said, “But they need to know there is a road map which comes from the WHO; they need to know that there is delivery funding which comes from people like DFID [UK Department for International Development] and USAID; and they need to know that the countries involved are going to orchestrate their health systems to make sure that all the drugs really get to the people in need.” The Bill and Melinda Gates Foundation pledged US$340 million over the next five years, partly to fund research into better treatment and partly to support delivery programmes.

Gates managed to persuade the companies to do things they would never normally consider, like giving away their products for nothing. Haruo Naito, president and CEO of the Japanese company Esai, which produces drugs for Lymphatic Filariasis, commonly known as Elephantiasis, set out the problem: “Our company is going to spend something like $35 million for this project. How can we persuade our shareholders? Well, we tell them it is a long-term investment for the people, for societies and for the economies of developing countries, to lift them up to become middle-income countries in the future.”

The issue of collaborative research was even trickier. Christopher Viebacher, head of Sanofi, which is researching improved drugs for sleeping sickness, said: “We are competitors. It’s not that easy for us to work together commercially. And now you are talking about research and development, which is really where the core secrets of companies are. Sharing our libraries of compounds is extraordinarily difficult and it is only because of the great need that we have been able to get together, and this is where Bill Gates has played such a critical role in catalyzing it.”

However, there were warnings that even an unlimited supply of free and suitable drugs would not in themselves be enough. Daniel Berman of Médecins sans Frontières said that while his organization was delighted these neglected diseases were finally getting more attention, “We are concerned that the challenges for some of these diseases are being glossed over.” MSF cited the example of sleeping sickness, which was virtually eliminated in the early 1960s but returned with a vengeance in the 1990s as elimination efforts were not sustained. It wants to see more emphasis on programme support and surveillance capacity in affected countries.

And in a letter to the London-based medical magazine, The Lancet, two academics, Tim Allen of the London School of Economics, and Melissa Parker of Brunel University, raised another issue – the practical problems associated with mass medication. The control or eradication of many of these diseases would entail treating whole villages, even those not infected, sometimes many times over, to wipe out the pool of infection. They found people in Tanzania, where this kind of programme was introduced, were suspicious and often hostile.

“After multiple rounds of mass drug administration for Lymphatic Filariasis, the vast majority of the people interviewed… were unaware of the link between the disease and mosquitoes, and at best had a very limited understanding of the rationale for mass treatment. They asked why people with no visible symptoms should take tablets… It is hardly surprising that rumours circulate about the real purpose of the drugs.” Some of those involved in administering the programme were chased and beaten and had to be rescued by police.

“The provision of free and subsidized drugs,” they conclude, “creates a window of opportunity to make a massive difference.  But the availability of tablets is not enough.”

[Courtesy IRIN]

DRC: HIV/Aids Funding Crisis

The lives of thousands of HIV-positive people in the Democratic Republic of Congo (DRC) are at risk as the country faces declining donor funding and a severe shortage of HIV treatment, according to Médecins Sans Frontières (MSF).

MSF recently launched a year-long advocacy campaign to raise awareness of the DRC’s HIV crisis.

“The problem is quite old in the DRC; the country has always been minimized by donors who have not seen it as a priority, mainly because HIV prevalence is relatively low at between 3 and 4 percent,” Thierry Dethier, advocacy manager for MSF Belgium in the DRC, told IRIN/PlusNews. “But look at the indicators: more than one million people are living with HIV, 350,000 of whom qualify for ARVs [antiretrovirals] but only 44,000 – or 15 percent – are on ARVs.” 

Dethier said the main reason for the ARV crisis was the end of six years of World Bank funding in 2011. International health financing mechanism UNITAID, which provides funding for paediatric and second-line ARVs, is also ending its funding to the DRC in December 2012; the cancellation of Round 11 funding by the Global Fund to fight AIDS, Tuberculosis and Malaria is only likely to worsen the situation.

Seventy-five percent of HIV funding in the DRC is from the Global Fund, 25 percent is from UNITAID through the Clinton Health Access Initiative – which provides funding for paediatric ARVs and second-line ARVS – and from the US President’s Emergency Plan for AIDS Relief (PEPFAR), which funds prevention of mother-to-child HIV transmission.

“The country is currently using funds from round seven and eight of the Global Fund; these funds are due to be consolidated but have also been cut – round seven by 30 percent… round eight may also be cut,” Dethier said. “We expect that the consolidated funds will last through 2014, after which there is no funding for DRC.”

The DRC did not qualify for funding under the Global Fund’s ninth and 10th round.

According to the director of an NGO in the capital, Kinshasa, who preferred anonymity, funding problems mean many of his patients’ lives are at risk.

“In Kinshasa alone we have shut two out of the three health centres we used to run, a situation which leaves us [caring] for only 1,800 out of 3,000 people living with HIV,” he told IRIN/PlusNews. “Today we are running the one remaining health centre for HIV-positive people by charging each of them US$5 per month.

“When the funding was available patients could come for checking whenever they were feeling unwell… we do give them treatment but today we receive them once a month unless their health condition has deteriorated,” he added. “We are now appealing to the government to intervene in filling the gap that Global Fund is leaving in funding interventions for people living with HIV.”

Dethier noted that there were also problems with HIV testing. “Since there is no treatment people feel it’s pointless to test,” he said. “As many as 15,000 people have tested HIV-positive and qualify for treatment but are not receiving it,” he said.

The Global Fund says it is reviewing a request for continued funding, and no life-saving programmes will be cut as a result of funding shortages.

“In terms of future additional funding, Round 11 was cancelled and replaced by a transitional funding mechanism that will allow countries to apply for funding for essential services for continuation of prevention, treatment and/or care services currently financed by the Global Fund,” said Marcela Rojo, Global Fund spokeswoman. “Countries that face significant programme disruption between January 1 2012 and March 31 2014 may apply for up to two years of funding.

“This means that no recipient will be forced to suspend any essential services as a consequence of the round 11 cancellation,” she added.

According to Rojo, with Phase 2 funding, the country aims to scale up treatment to 67,000 people by end-2014.

MSF’s Dethier noted that other donors would have to step up their funding.

“With funding from the Global Fund, only 15 percent of people have access to ARVs, so we need others to contribute and we need the existing partners – UNITAID and PEPFAR – to honour their commitments to the people they are already supporting and to expand their programmes,” he said. “The government aims to have 160,000 people on ARVs by 2014, which means putting roughly 3,500 people on ARVs per month – with money, this can be done.”
[Courtesy IRIN]

SOMALIA: Sexual Gender Violence on rise in IDP camps

Hargeisa Somalia, 1 February 2012 (IRIN) – Cases of sexual and gender-based violence (SGBV), as well as domestic violence, are increasing in camps for internally displaced persons (IDPs) in Hargeisa, capital of the self-declared independent Republic of Somaliland, with social workers attributing the trend to hard economic times made worse by recent drought in the region.

“Numbers of the displaced have increased in recent months, with many families coming to town to escape drought; lack of a police presence within the camps and inadequate lighting have contributed to the increase in some of these cases,” Shukri Osman Said, an SGBV coordinator for an NGO, Comprehensive Community-Based Rehabilitation Somaliland (CCBRS), told IRIN at the Stadium IDP camp in Hargeisa.

The Stadium IDP camp, home to an estimated 5,000 families (30,000 people), is one of several IDP camps in Hargeisa where humanitarian organizations such as CCBRS have ongoing programmes aimed at addressing SGBV among vulnerable communities.

According to Said, CCBRS has been running the SGBV programme in the IDP camps since 2006 with funding from the UN Refugee Agency, UNHCR.

“On average, CCBRS handled between 15 and 20 cases of SGBV per month; however, we have noticed that the cases of domestic violence have increased dramatically; in 2011 alone, we had over 500 cases of domestic violence,” Said told IRIN. “Our SGBV prevention programme has helped somewhat because the SGBV cases have started reducing; our concern is the rise in domestic violence, which is mostly due to men not coping well with economic hardship and ending up venting their frustration on their wives.”

The CCBRS programme, she said, had a component targeting those with physical disabilities and provided orthopaedic aids – such as disability wheelchairs – to some of the affected IDPs. SGBV coordinators from CCBRS also made home visits for physiotherapy sessions, provided counselling and psycho-social support and referred those requiring specialized treatment and/or legal aid to relevant institutions.

“Most of the victims of SGBV are poor and cannot afford treatment in private hospitals; some cannot even afford the transport to public hospitals, so we help by referring them to the Sexual Assault Referral Centre in the main hospital in Hargeisa,” Said told IRIN. “We also refer those requiring legal aid to organizations that help women seek justice.”

Hawo Yusuf, a member of the management committee at the Stadium IDP camp, said the committee supported SGBV survivors by helping them be accepted by society. “We help construct shelter for those in need of a place to stay, especially those who become pregnant; we help by tracking and [apprehending] the perpetrators, although our efforts are frustrated when these people are freed without being charged with any offence.”

According to UNHCR Somaliland, Hargeisa is home to approximately 85,000 displaced people who have fled their homes mostly from south and central regions of Somalia, due to various reasons, including drought, limited livelihood opportunities and increased violence.

“IDPs often live in difficult conditions, more often than not with limited access to basic facilities such as adequate healthcare, good shelter and clean water and sanitation amenities, ample security as well as employment opportunities,” the agency said. “UNHCR engages IDPs in Hargeisa in various projects like solar lighting or animal husbandry that will equip them with the necessary skills to start up their own businesses and provide a better life for their families.”

CCBRS is implementing an income-generating project, funded by UNHCR, aimed at empowering woman in the IDP camps. Started in 2008, the project has helped transform the lives of the IDPs by providing them with better livelihoods.

Fouzia Hassan, mother of eight and one of the beneficiaries, told IRIN: “All my children are now in school, thanks to the US$600 grant I received to boost my bread-making business. My business has expanded and I now make between 55 and 65 loaves a day, something I could not have dreamt of doing before the start of this project.”

Hassan said she can now take care of her family better: “I can meet their medical bills, I have built a latrine for the family’s use and I have installed a water tank, this is now my home. It has changed my life and my family’s.”
[Courtesy of IRIN}