The World Summit on Sustainable Development included a strong civil society presence, although one, tellingly, kept separate from the governmental proceedings of the main conference. In hosting their own Peoples Summit, civil society groups drafted proposals that were aimed to feed directly into the governmental discussions on a daily basis.
Groups at the Peoples Summit were gathered according to geographic or issue commonality. Equinet was represented in the health, womens and Africa caucus. As the summit drew to a close it became increasingly apparent that whilst NGOs achieved a great deal in their own deliberations, these discussions were becoming increasingly irrelevant in relation to influencing the outcomes within the main Sandton-based governmental discussions. This drew a great deal of anger from civil society groups, with many feeling forced to disassociate themselves from the event. At the same time others, under the banner of the Summit Civil Society Secretariat, seemed to display greater willingness to concede success for the summit, despite clear indications that the critical issues for civil society and sustainable development were being blatantly ignored.
For the Africa caucus, this division paralleled differing views held on the effectiveness of NEPAD. Despite much discussion and agreement on a number of priority areas, their declaration, printed in full below, failed to agree on a unified position and it was eventually agreed that, where NEPAD is mentioned, the draft should contain both points of view.
The Johannesburg Declaration of African Civil Society Organisations
We representatives of African Civil Society organisations meeting during the World Summit on Sustainable Development reaffirm our demand for commitment to the achievement of sustainable and equitable development in Africa.
The Rio Summit marked international commitment to providing political, financial, and technological support for its version of achieving the interlinked goals for human centred, environmentally sustainable and culturally sensitive development, and, poverty reduction.
A decade later, it is evident that the development situation particularly, poverty in Africa has escalated. There has been insufficient commitment by African governments to the ideals of Rio and inadequate financial and technological support by development partners for Africa’s development priorities. The capacity of the people of Africa to lift themselves out of poverty, food insecurity and illiteracy has been undermined by many factors, including declining levels and terms of trade, increasing debt burden, declining overseas development assistance and private investment flows, increasing marginalisation in world relations from globalisation, unfavourable prescriptive donor policies, environmental deterioration, partly from increased exploitation of the natural resource base of the continent, HIV/AIDS prevalence, and, conflict and wars.
We resolve to fully utilise the opportunity offered by the Johannesburg commitment on sustainable development to work towards ensuring urgent and renewed commitment, by African governments and development partners, backed by time bound implementation actions, monitorable deliverable and identified sources and levels of resources, that will assure the achievement of the Millenium Development Goals and Targets in Africa and accelerate the realisation of our sustainable development vision for Africa within ten years.
We, civil society organisations of Africa, envision an African society, characterised by unity in diversity, equality, equity and justice that guarantees the fundamental needs of its people, is participatory and accommodates the interests of all stakeholders in decision-making processes, including the empowerment of women in all areas, and ensures democracy and human rights in which poverty is reduced to a minimal level through knowledge based, culture sensitive and people centred development that is environmentally, socially and economically sustainable..
We recognise the UN secretary General Kofi Annan’s WEHAB initiative as a contribution to the Draft Plan of Implementation of the Johannesburg summit for the WSSD while it seeks to provide focus and impetus to action in the key thematic areas of Water, Energy, Health, Agriculture and Biodiversity that are integral to a global approach to the implementation of sustainable development.
We call for clear processes and transparent criteria to be defined and adopted through the participation of stakeholders in the implementation of partnerships emerging from the Johannesburg Summit
We urge all African Governments to commit themselves to the challenges posed in the “Earth Charter”.
We acknowledge that for the WSSD to ensure the achievement of our vision of Africa it should address the following issues:
a) poverty eradication, b)emergence of African regional groupings and alliances, including the Africa Union and NEPAD c.)human resource development including education, health and combating HIV/AIDS, TB, Malaria and avoidable diseases of poverty, d)Africa and globalisation, e.)sustainable agriculture and food security, f.) water and sanitation, g)natural resource management, including desertification and land degradation, h.)energy, I) science and technology including indigenous knowledge systems and the legal recognition of the rights of local communities, j) democratic governance, k) rule of law, respect for human rights and freedoms, l) gender equity, m) armed conflict and warfare
We call for a commitment by all Governments to reach agreement for a timetable for the phasing out of harmful subsidies of fossil fuels and agree on targets and timeframes for increasing the share of renewable energy supply for Africa.
We recognise that achieving our sustainable development goals requires a supportive international environment, particularly in the areas of macro-economic policy, market access and fair trade, debt relief, ODA and conditions for leveraging private capital flows, human development, technology transfer, capacity development and full implementation of multilateral environmental and sustainable development Conventions and their Protocols. We call for strong and immediate action.
We recognise that while globalisation may bring new opportunities and challenges for sustainable development in Africa, the uneven distribution of wealth and apparent benefits further marginalizes the continent’s role in the world economy. Special attention should be given to grassroots communities where such benefits do accrue.
We acknowledge that peace is a prerequisite for sustainable development and call on African Governments and the international community to adopt measures to ensure a peaceful and stable environment for Africa’s sustainable development.
We reaffirm our engagement with NEPAD, despite our insufficient involvement in its formulation, and urge African leaders to partner with African Civil Society organisations in all processes for its refinement, implementation and monitoring. We are concerned that NEPAD does not replicate structural adjustment programmes, which have increased poverty and inequality on the Continent.
We reaffirm that sustainable development requires active participation of women and men on equal footing at all levels of decision making, implementation. Monitoring and evaluation. We call for the integration of gender equity in all aspects encompassed within Agenda 21, the Millenium Development Goals and the Johannesburg commitment on Sustainable Development.
We reaffirm the unconditional need for African Governments themselves to initiate appropriate steps to ensure good governance as a major prerequisite for sustainable development.
We commit ourselves to the monitoring of the implementation of Agenda 21, the Millenium Development Goals and the Johannesburg commitment on Sustainable Development through existing and newly formed African regional, National and Local NGO coalitions on sustainable development.
1. Editorial
2. Equity in Health
Drought and famine stricken nations in southern Africa should not reject donations of genetically modified food, officials from the United States, the UN Food and Agriculture Organization and the World Health Organization argued at the WSSD last week. The statements come in response to recent decisions by Mozambique, Zambia and Zimbabwe to reject offers of U.S. aid due to concerns about biotechnology.
Dr Gro Harlem Brundtland is to stand down as director general of the World Health Organization (WHO) in July 2003, after only one term. This will be the first time that a WHO director general has not been in office for at least two consecutive terms. In an interview with the BMJ immediately after the announcement, she said that her decision reflected the fact that she would be 69 at the end of a second term. "I don't want to get into a situation in my life where I'm not fully energetic and able to do my job," she said.
Joint UN Programme on HIV/AIDS (UNAIDS) Executive Director, Peter Piot, attended the World Summit on Sustainable Development in Johannesburg to deliver a simple message: until HIV/AIDS is brought under control, initiatives to promote sustainable development will be a waste of time. He spoke to IRIN about the need for political leadership, and the progress being made by African countries in dealing with the epidemic.
The 1990 World Summit for Children pledged to provide universal access to safe water by the end of the century. Why then do 2.2 million people still die each year from preventable diseases associated with a lack of safe water, inadequate sanitation and poor hygiene?
Ruling party Swapo has asked Government to set aside more funds to buy drugs to prolong the lives of people infected with HIV - the virus that causes AIDS. The recently concluded Swapo Congress said all patients with AIDS-related illnesses should have access to AIDS drugs.
Globalisation has fuelled impoverishment, ill health and marginalisation of the world’s poor and in its wake many of the human development gains for poor countries have been reversed. The powers of international monetary and trade institutions that drive the globalisation agenda and supersede policies of national governments such as the WTO, IMF and World Bank need to be checked in line with human rights and social development goals. Particular, agreements such as TRIPS pose a dire threat for the health of millions of people by making it legal for access to live saving drugs to be blocked as with HIV/AIDS/STIs/TB. Declining health status under structural adjustment programmes provides ample evidence of the costs for humanity as national and government capabilities have been eroded.
The link between climate and cholera outbreaks has become stronger in recent decades, say researchers from the University of Michigan in the United States, the University of Barcelona in Spain, and the International Center for Diarrheal Disease Research in Bangladesh. In a previous study published in the journal "Science," the researchers found evidence that El Nino-Southern Oscillation (ENSO), a major source of climate variability from year to year, influences cycles of cholera. They looked only at climate and disease data from Bangladesh for the past two decades.
EFFORTS to combat three of Africa's most devastating diseases HIV/AIDS, tuberculosis (TB) and malaria have been given a major boost, with the announcement of a à 600m European Union (EU) programme to fund clinical trials in sub-Saharan Africa.
WHO Director-General, Dr Gro Harlem Brundtland, told a meeting of health ministers from ten famine struck southern African countries that, based on available evidence, genetically modified grain being provided as food aid is not likely to negatively effect human health.
The head of the United Nations AIDS programme has warned that meaningful sustainable development cannot be achieved if the AIDS epidemic is allowed to devastate human resources and capacities. "If we continue to allow AIDS to drain human resources at an increasing rate, sustainable development will be impossible," said Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "Quite simply, if you do not survive, you cannot develop."Dr Piot was speaking to the plenary session of the World Summit on Sustainable Development (WSSD), taking place from 26 August to 4 September.
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3. Human Resources
Produced by the WHO Transforming Health Systems is a training resource for health trainers to use with health managers, policy-makers and others with responsibilities in reproductive health. It offers a training curriculum designed to equip participants with the analytical tools and skills to integrate the promotion of gender equity and reproductive rights into their reproductive health policies, planning and programmes.
In many developing countries, the outpatient departments of national referral hospitals are swamped by patients from the local urban population. Do these people bypass primary health centres and go straight to outpatient departments when seeking care? Are perceptions of limited and poor quality primary level health services to blame?
Hygiene education for women is a standard component of water supply projects. However, evaluations frequently reveal little change in hygiene and sanitation behaviour and so water-borne illnesses persist. Why is it so hard to convey water-related health messages? Researchers from UK University of Bradford tackle this issue in an assessment of Ghana’s Upper Region Water Supply Project (URWSP). They argue for a more rigorous analysis of the cultural and gender-related factors that influence women's acceptance and understanding of these messages.
4. Public-Private Mix
The Civil society health caucus at the WSSD Global Forum hosted a Commission to discuss the Role of the of the state and water, sanitation and primary health care in the context of globalisation. The discussion included analysis of the situation which raised the following points.
• Debt and globalisation impact negatively on the distribution of all resources, including environment and health through their destruction and privatization.
• Environmental degradation increases the burden of ill health
• Lack of knowledge about environment and health and hygiene are sorely lacking amongst many citizens, especially children.
• Environmental services are a basic right which every citizen should enjoy
• Privatisation of services, including through public private partnerships, has been a very negative experience for many poor people, especially women and children, in countries as diverse as the UK and Argentina
• War and military occupation both severely restrict access to health and basic services, and conflict and psychological stress are also increasingly a result of struggles for access to these services.
The concept of 'managed competition' to improve efficiency has been common in health sector reform in wealthy countries. It has also been exported to health systems in the South, involving privatisation and marketisation. Research from the UK Institute of Development Studies questions whether this competitive approach is appropriate in a sector where ethical behaviour, altruism and co-operation are essential for good quality services.
Presented to the commission on health hosted by civil society at WSSD by BUPENDRA MAKAN of The Equity Project.
Development is inextricably linked to social justice & equity. Health is a basic human right.
“It should never be that the anger of the poor, should be the finger of accusation pointed at all of us because we failed to respond to the cries of the people for food, for shelter, for the dignity of the individual” former President of South Africa, Nelson Mandela to US Congress in 1990. Poverty in a world of plenty is the greatest barrier to health as shown in the huge inequities in health status.
The British government and its EU allies were accused at the WSSD of pushing privatisation as a one size fits all model for delivery of vital basic services such as water, despite considerable evidence that it has failed to deliver affordable, clean water to poor communities around the world.
5. Resource allocation and health financing
UN Habitat estimates that by 2025 over a third of all people in developing countries will be living in informal urban settlements. How can municipalities and governments do more to provide the most marginalised of the urban poor with adequate sanitation services? Can linkages and dialogue between policymakers and residents be fostered? A paper from the University of Southampton’s Institute of Irrigation and Development Studies (IIDS) reports the results of a study looking at policies, current service levels, attitudes, practices and expectations of residents and officials in 12 slums and shanty-towns in South Africa, Zambia and Zimbabwe. Resultant guidelines suggest that unless agencies learn to be more responsive to the needs, demands and interests of poor communities, urban environments are likely to become ever more unsanitary.
The working group report that by rapidly scaling up existing, successful prevention programmes, it will be possible to contain and ultimately reverse the HIV/AIDS epidemic. The paper reviews successful prevention strategies but points out that such programmes reach less than one in five of those who are vulnerable. A number of scientific studies that measure the effectiveness of programmes in preventing infection via all forms of transmission are reviewed. The report discusses the major obstacles to the upscaling of effective prevention methods, which it identifies as:
limited resources
lack of local capacity
stigma
lack of political commitment
the need for greater access to treatment
the need for new treatments and technologies
Recommendations are made to tackle these obstacles through building capacity, increasing resources and accelerating research into new prevention technologies.
Robert Guest, The Economist
Last year, a group called the Commission on Macroeconomics and Health (CMH), which is backed by the World Health Organisation, called for rich nations to donate an extra $27 billion a year towards grappling with poor countries' health problems. It is an excellent idea, but there seems to be little chance that such a vast sum will actually be raised. All hope is not lost, however. A recent experiment in Tanzania has shown that a small health budget can go a long way, provided that the money is spent with care. The results are so striking that they are worth examining in detail.
The first section explores the role of economics in addressing the HIV/AIDS epidemic. Essays address use of resources, globalisation and HIV and economic evaluations of social interventions. Papers in section two consider the impacts of the disease, especially economic impacts, and consider methods of measuring those impacts. The final part of the document considers how economics can be used to respond to the pandemic, through assessment of resource allocations, economic evaluation and cost effectiveness as well as analysis of trials looking at prevention and treatment options.
6. Governance and participation in health
We representatives of diverse civil society groups gathered in Johannesburg, affirm the value of the process of the Earth Summit, but we disassociate ourselves with deep concern from the outcomes of the world summit on Sustainable Development. We are alarmed that the governments of the world continue to show a tragic unwillingness to translate the RIO principles into concrete action and to display an appalling lack of determination to commit themselves to the objectives of Agenda 21. Instead they have shown an irresponsible subservience to corporate led globalisations and have made attempts to role back the commitments they reached in Rio.
Against the backdrop of the World Summit on Sustainable Development (WSSD) in Johannesburg, South Africa, over 70 African AIDS activists from 21 countries met in Cape Town from 22-24 August to inaugurate the Pan-African HIV/AIDS Treatment Access Movement (PHATAM). PHATAM's co-founders are two of the world's leading AIDS activists, Zackie Achmat of the Treatment Action Campaign (TAC) in South Africa and Milly Katana, lobbying and advocacy officer of the Health Rights Action Group in Uganda and member of Board of the Global Fund to Fight AIDS, TB, and Malaria. PHATAM is dedicated to mobilising communities, political leaders, and all sectors of society to ensure access to antiretroviral (ARV) treatment, as a fundamental part of comprehensive care for all people with HIV/AIDS in Africa.
7. Monitoring equity and research policy
Of the US$73 billion spent globally every year on health research only about 10% is actually allocated for research into 90% of the world’s health problems. This is what is known as the 10/90 gap. This third landmark report of the Global Forum for Health Research underlines the crucial role that health and health research funding plays in breaking the cycle of poverty.
8. Useful Resources
United Nations Secretary General Kofi Annan commissioned five papers on Water, Energy, Health and Agriculture from the relevant United Nations bodies for consideration at the World Summit on Sustainable Development in August 2002. These papers are intended to describe the current situation in a particular focus area, identify key gaps and challenges and highlight action where further action is needed.
The International HIV/AIDS Alliance has produced a report to share experiences and lessons learnt from its work in with its partners in a number of countries. As well as describing the experiences, the report looks at the different elements that contribute to good practice in HIV/AIDS-related treatment and concludes with an exploration of the key issues around improving access to treatment.
Source has been designed to meet the information needs of those working in health, disability and development worldwide. It is a collaboration between two international NGOs, Healthlink Worldwide and Handicap International UK and an academic institution, the Centre for International Child Health. It is aimed at health workers, researchers, rehabilitation workers,non-governmental and governmental organisations and disabled peoples' organisations worldwide and has a unique collection of over 20,000 health and disability related information resources. Source opens in September in London.
At the last ICASA in Ouagadougou, UNAIDS, the Union Economique et Monetaire de l'Afrique de l'Ouest (UEMOA), and GTZ, co-hosted a Satellite Conference on the theme: "Concrete Experiences with Mainstreaming HIV/AIDS across Development Sectors in Africa". Starting from the material presented at the Conference, we have co-edited a document under the title "Mainstreaming HIV/AIDS: A Conceptual Framework and Implementing Principles" with the assistance of JSAConsultants, Ghana. To obtain a copy of the document please contact us at gtzrap@ghana.com
The World Summit on Sustainable Development will set the agenda for the coming decade on improving people's lives, conserving our natural resources and safeguarding our common future. In its presentation on the Summit's first day, WHO presented a road map for how health can be used as a powerful and undervalued tool for sustainable development.
9. Jobs and Announcements
Request for Proposals August 2002
The Child Health and Nutrition Research Initiative (CHNRI) is a recently formed network of interested partners supported by the Global Forum for Health Research. CHNRI is actively working on methodological issues of priority setting on child health, nutrition and development research, and on a life-cycle approach to child health and nutrition research. It aims at increasing the level of communication and discussion among players working on research on child health and nutrition, such as nutritionists, child health specialists and child development specialists. It further stimulates research and supports the expansion of research into priority child health and nutrition problems on a global basis, especially in low and middle income countries. This request for proposals invites institutions, particularly in low or middle income countries, to express their interest in hosting the Secretariat for the Child Health and Nutrition Research Initiative for an initial period of two years, renewable by the CHNRI Board. The deadline for receipt of proposals is 30 September 2002.
Please find below a survey that has been developed to support the southern NGO representatives to the Board of the Global Fund to understand better the involvement of the civil society community in the process of accessing resources. Since its inception, the Global Fund has recognized civil society as a key partner in the fight against HIV/AIDS, tuberculosis and malaria. Along with governments and the private sector,civil society representatives were involved in the Transitional Working Group (TWG),are on the Board, and are now integral to the Country Coordinating Mechanisms (CCMs). As countries prepare proposals for the Second Round, we would like to learn more about civil society experiences with CCMs in the First Round and in the current Round.
The world's first non-profit pharmaceutical firm has been launched. The Institute for OneWorld Health has been set-up to develop drugs for a range of parasitic diseases, including malaria, hookworm and African sleeping sickness. It is collaborating with the WHO and other non-profit organisations, and has received nearly $4.7 million from the Bill and Melinda Gates Foundation.
Nairobi will be the venue of the Second International Youth and Students Conference on HIV/AIDS (IYSCA 2003). The Conference will bring together youth, students, researchers, and NGOs from different parts of the world to reflect on the pandemic and expand the quality and scope of youth and student-based HIV/AIDS strategies through sharing, identifying; promoting and applying best practices in short -term and long-term risk-reduction strategies and actions.