Editorial

The social and economic impact of the adjustment programmes of the International Monetary Fund (IMF) and the World Bank in developing countries has been a source of heated debate over the last two decades. Research on the effects of these policies has led to contradictory conclusions.

A number of World Bank evaluations indicate that 'adjuster countries' generally succeed in improving health, education, and social welfare programmes compared to 'non adjusters' (1-3). Based on such studies, the World Bank concludes that adjustment programmes do not necessarily adversely affect vulnerable populations. Furthermore, the World Bank believes that reforms that include these reforms are necessary for poverty eradication in developing countries.

On the other hand, publications from UNICEF and from representatives of academic institutions and non-governmental organizations (NGOs) indicate that adjustment policies may be particularly harmful for the most vulnerable populations. In "Adjustment with a human face", UNICEF reports studies from several developing countries which indicate that adjustment policies have negatively affected the health status of women and children (4).

Evidence suggests that the adjustment programmes may also create conditions favouring societal vulnerability to HIV/AIDS (5). Unfortunately, no study, to date, has systematically evaluated the relationship between IMF/World Bank economic reforms and the vulnerability of women and children to HIV/AIDS.

This paper reviews what is known regarding the social and economic consequences of adjustment policies on maternal and child welfare and explores the potential impact such consequences may have on the vulnerability of women and children to HIV/AIDS. We approach the impact of macroeconomic adjustment policies from a conceptual perspective. Our theoretical framework illustrates how adjustment policies may influence the predisposing factors for impoverishment of women and exposure of children to HIV/AIDS in sub-Saharan Africa.

The underlying assumption is not that adjustment is the only cause of vulnerability of women and children to HIV/AIDS. Antecedent predisposing factors, such as poverty and inequality, are responsible for the vulnerability of women and children to HIV/AIDS in the first place. However, adjustment policies may further contribute to a socioeconomic environment that facilitates the exposure of women and children to HIV/AIDS, especially when their implementation is not accompanied by specific measures protecting the most vulnerable populations.

AIDS in sub-Saharan Africa directly and indirectly devastates the lives of millions of women and children. According to the joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization, 19.2 million women and 3.2 million children aged less than 15 years are living with HIV/AIDS in the world. Almost two-thirds of them reside in sub-Saharan Africa. In 2003, over one million women and approximately 610,000 children died from AIDS.

Socioeconomic conditions of women and children are determined by a series of hierarchical factors that interact with one another at different levels of their ecosystem. These factors correspond to the household level (i.e. income of the family), the meso level (i.e. food prices, real wages, employment opportunities), and the macro level (i.e. economic policies, health policies, social welfare systems). The latter level is particularly important: macroeconomic changes modify the meso-economic conditions that, in turn, are transmitted down to the household level. Macroeconomic measures, such as adjustment policies, may have an impact not only on macroeconomic indicators, such as gross domestic product (GDP) growth and the external debt rate, but also on social indicators, such as access of women and children to shelter, food, healthcare, and education. Since poor access to basic human needs may facilitate the exposure of children to HIV/AIDS, economic policies at the macro level may ultimately be related to the socioeconomic conditions that reduce or facilitate the spread of HIV/ AIDS among infants and youths.

Economic reforms that decrease access to basic needs for poor households will eventually result in increased exposure of women and children to HIV/AIDS. Conversely, economic growth that leads to increased access to basic goods and services for the most vulnerable families may significantly reduce their exposure to the infection.

Since 1980, most sub-Saharan African countries entered into one or more adjustment programme(s) of the IMF/ World Bank. Many of these programmes have not been implemented as prescribed by the World Bank and IMF, but as implemented, these policies have not produced the expected results in terms of economic growth and reduction of unsustainable debt. A World Bank study of 26 African countries that implemented adjustment policies concluded that six countries had a large improvement in macroeconomic indicators, nine had a small improvement, and 11 had a deterioration (3). Moreover, Africa's external debt increased from US$ 120 billion in 1980 to US$ 340 billion in 1995 (14).

Adjustment policies mainly consist of currency devaluation and financial liberalization; privatization of government corporations; trade liberalization (including import liberalization and export promotion); elimination or reduction of subsidies for agriculture and food staples; and reductions in government spending (including expenditure for health, education, and social services).

Analyses of the effects of currency devaluation on prices for basic items, such as food, housing, and transportation, lead to controversial conclusions. Prices for basic commodities rise after the adoption of the adjustment policies because currency devaluation increases the cost of imports. In Zambia, devaluation increased the cost of bread from 12 kwacha a loaf in 1990 to 350 kwacha in 1993 (21). In Senegal, after currency devaluation, inflation rates dramatically increased especially for daily food and health products (22). In Kenya, the real price for maize rose by 29% between 1982 and 1983 (23). In Tanzania, commodity prices skyrocketed as a result of devaluation (24).

Despite these results, there is also evidence that currency devaluation may be an appropriate solution to prevent a further collapse of a failing economy (13). A study conducted in cocoa-growing areas of Ghana concluded that even the poorest smallholders benefited from the improved producer prices resulting from devaluation (25).

If currency devaluation produces mixed effects, removal of food subsidies has a more direct impact on access to food and basic commodities, especially among low income groups. In Zambia, after the removal of subsidies in 1985, the price of maize meal rose by 50% (26). In Zimbabwe, after eliminating food subsidies, the cost of living for lower-income urban families rose by 45% between mid-1991 and mid-1992. The increased cost of food items results in a sharp reduction of low-income household expenditure on other basic commodities.

Sharp increases in the cost of living and impoverishment of women not only increase the vulnerability of infants to HIV/AIDS, but also have a negative impact on vulnerable young people. Children of poor mothers are more likely to be exposed to predisposing factors for HIV (10). Socioeconomic constraints force these children to leave school and search work to support their families. Children may also be abandoned. Youths and children living in impoverished families are more likely to live and work on the street, where they may be forced into prostitution to exchange sex for money, goods, food, or shelter (31).

Privatization results in significant job losses in the public sector without necessarily increasing employment in the private sector (34-36). To improve efficiency and keep production costs low, public enterprises reduce costs of labour by freezing wages and reducing employment.

This results in a decline of real wages or an increase in unemployment, especially among low-income workers. During the 1980s, average real wages declined in 26 of 28 African countries (34). In Ghana, between 1984 and 1991, after privatization of the 42 largest state enterprises, more than 150,000 workers lost their jobs (31).

These cutbacks in public-sector employment disproportionately affect women (4,37,38) who traditionally hold positions, such as clerical workers, cleaners, nurses, or teachers. In Ghana, the least skilled women working in the public sector lost job protection, security, and benefits as a consequence of policies aimed at increasing efficiency, while others lost employment altogether (39). Privatization not only affects women in urban areas, but also impacts those in rural areas since informal land privatization is linked to a reduction in access of women to subsistence food production (40).

Unemployment, low wages, and job insecurity caused by privatization not only increase women's adoption of survival strategies, including prostitution, but also modify existing gender-related relationships. Employed women tend to be more empowered by having more opportunities for education, more experience in public life, more self-confidence and self-esteem, all basic prerequisites for negotiating safe sex with male partners (41). Conversely, unemployment, job insecurity, and reduced purchasing power increase the exposure of women to sexual harassment and sexual abuse, especially among those working in low-earning jobs (42).

Reduced employment opportunities resulting from privatization may also increase the proportion of African children forced to live on the street or work to support their families (43). In Zambia, due to privatization and retrenchment of government employees, 72,000 people lost their jobs and child labour increased nine folds among females aged 12-14-years (44).

In regions where a significant proportion of population live in miserable conditions, indiscriminate cost-recovery measures disproportionately affect those who cannot afford to pay user-charges. The World Bank and other organizations which support the implementation of user-fees for health services insist that even poor households are willing to pay for higher quality, more reliable health services. In a household survey conducted in Rwanda, most respondents, regardless of income, indicated a preference for higher fees to assure the availability of medications (59).

However, populations living on less than a dollar per day can rarely afford to pay user-fees and their inability to pay may negate their 'willingness' to pay (60). The literature repeatedly shows that introducing user-charges at STI clinics result in a dramatic drop in women's use of services (61-64). Access to free STI treatment and condoms increase their use (65-66), and the introduction of user-charges creates an obstacle to HIV-preventive behavioural practices among women. Women and youth without access to AIDS education, HIV screening, STI treatment, and reproductive health services have little control over their AIDS-related risk factors. Untreated STIs increase the risks of HIV transmission (67) as shown in Uganda where over 90% of new HIV infections were attributable to other STIs (68). The introduction of user fees for health clinics is likely to increase the number of untreated STIs consequently producing high HIV susceptibility in women (66). These HIV-infected women infect their children through vertical transmission of the virus.

Following the prescriptions for structural adjustment and stabilization policies, many sub-Saharan African countries reduced public expenditure on education and introduced school fees limiting access to education, especially among those children who cannot afford to pay such charges (4,36). The introduction of school fees causes a dramatic fall in primary school enrollment rates and increases the number of children who drop out of school. Sub-Saharan Africa has the lowest primary school enrollment ratio in the world. This ratio fell from 77.1% in 1980 to an estimated 66.7% in 1990 (69).

Certain components of adjustment reforms, such as currency devaluation and trade liberalization, may produce mixed effects on the vulnerability of women and children to HIV/AIDS. Other reforms, such as financial liberalization, removal of food subsidies, and introduction of user fees for healthcare and education have a negative impact on the spread of the epidemic among poor women and children. In most cases, adjustment policies create synergies making it extremely difficult to identify their net social effects. Clearly, there is, currently, no single study capable of demonstrating a causal link between adjustment policies and the exposure of women and children to HIV/AIDS. However, this analysis provides some evidence that adjustment policies may inadvertently facilitate societal conditions that increase the vulnerability of women and children to HIV/AIDS in sub-Saharan Africa.

It must also be acknowledged that the World Bank is, at present, the largest single investor in health in sub- Saharan Africa. Such investment may reduce the HIV epidemic through some mechanisms. However, the unintended consequences of adjustment policies may have greater negative effects on the same health outcome.

Given the potential for adjustment policies to exacerbate the AIDS pandemic among women and children, there is an urgent need to either demonstrate that such measures are not harmful to maternal and child welfare or to modify policies. The present buffering mechanisms designed to protect the most vulnerable segments of the population during macroeconomic stabilization and structural adjustment are not sufficient. The IMF and the World Bank need to provide adequate scientific evidence demonstrating the effectiveness of their policies. Failure to do so may undermine their international credibility and further exacerbate the already tragic social conditions of marginalized women and children at risk of HIV/AIDS in the developing world.

* This article is composed of extracts from the original review paper, done with permission of the author. For the full paper and list of references visit http://www.phishare.org/documents/icddrb/3205/

* Roberto De Vogli is with the Department of Epidemiology and Public Health, University College of London. Gretchen L. Birbeck is with the African Studies Center and Departments of Neurology and Epidemiology, Michigan State University.

* Please send comments to admin@equinetafrica.org

The mass media hype about “a new deal between rich and poor”, in response to the powerful Group of Eight industrialised countries’ plan to cancel multilateral debts owed by 18 mainly African countries, has led many people to believe that a new era of international social justice has dawned. The deal is expected to be ratified by G8 leaders in Scotland on July 6-8. The uncritical endorsement of the plan by large international aid agencies like Oxfam, the driving force behind the Make Poverty History (MPH) coalition of non-government organisations, and big-name celebrities like Bob Geldof and Bono, has reinforced this hope. Unfortunately, celebrations to mark what British deputy PM Gordon Brown described as “the intention of world leaders to forge a new and better relationship between the rich and poor countries of the world” are premature.

* Text of a speech by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, delivered at the University of Pennsylvania's Summit on Global Issues in Women's Health, Philadelphia, April 26, 2005

I well realize that this is a conference on women's global health, and everything I'm about to say will apply to that generic definition. But the more I thought of the subject matter, the more I want to use HIV/AIDS in Africa as a surrogate for every international issue of women's health, partly because it's what I know best; partly because it's an accurate reflection of reality.

I've been in the Envoy role for four years. Things are changing in an incremental, if painfully glacial way. It's now possible to feel merely catastrophic rather than apocalyptic. Initiatives on treatment, resources, training, capacity, infrastructure and prevention are underway. But one factor is largely impervious to change: the situation of women. On the ground, where it counts, where the wily words confront reality, the lives of women are as mercilessly desperate as they have always been in the last twenty plus years of the pandemic.

Just a few weeks ago, I was in Zambia, visiting a district well outside of Lusaka. We were taken to a rural village to see an "income generating project" run by a group of Women Living With AIDS. They were gathered under a large banner proclaiming their identity, some fifteen or twenty women, all living with the virus, all looking after orphans. They were standing proudly beside the income generating project ... a bountiful cabbage patch. After they had spoken volubly and eloquently about their needs and the needs of their children (as always, hunger led the litany), I asked about the cabbages. I assumed it supplemented their diet? Yes, they chorused. And you sell the surplus at market? An energetic nodding of heads. And I take it you make a profit? Yes again. What do you do with the profit? And this time there was an almost quizzical response as if to say what kind of ridiculous question is that ... surely you knew the answer before you asked: "We buy coffins of course; we never have enough coffins".

It's at moments like that when I feel the world has gone mad. That's no existential spasm on my part. I simply don't know how otherwise to characterize what we're doing to half of humankind.

I want to remind you that it took until the Bangkok AIDS conference in 2004 - more than twenty years into the pandemic - before the definitive report from UNAIDS disaggregated the statistics and commented, extensively, upon the devastating vulnerability of women. The phrase "AIDS has a woman's face" actually gained currency at the AIDS conference in Barcelona two years earlier, in 2002, and even then it was years late. Perhaps we should stop using it now as though it has a revelatory dimension. The women of Africa have always known whose face it is that's withered and aching from the virus.

I want to remind you that when the Millennium Development Goals were launched, there was no goal on sexual and reproductive health. How was that possible? Everyone is now scrambling to find a way to make sexual and reproductive health fit comfortably into HIV/AIDS or women's empowerment or maternal mortality. But it surely should have had a category, a goal, of its own. Interestingly, the primacy of women is rescued (albeit there's still no goal) in the Millennium Project document, authored by Jeffrey Sachs.

And while mentioning maternal mortality, allow me to point out that this issue has been haunting the lives of women for generations. I can remember back in the late 90s, when I was overseeing the publication of State of the World's Children for UNICEF, and we did a major piece on maternal mortality and realized that the same number of annual deaths - between 500 and 600 hundred thousand - had not changed for twenty years. And now it's thirty years. You can bet that if there was something called paternal mortality, the numbers wouldn't be frozen in time for three decades.

I want to remind you that within the UN system, there's something called the Task Force on Women and AIDS in Southern Africa. Permit me to tell you how it came about, and where it appears to be headed ... and I beg you to see this as descriptive rather than self-indulgent.

In January of 2003, I traveled with the Executive Director of the World Food Programme, James Morris, to four African countries beset by a combination of famine and AIDS: Zimbabwe, Zambia, Malawi and Lesotho. We had surmised, at the outset, that we would be dealing primarily with drought and erratic rainfall, but in the field it became apparent that to a devastating extent, agricultural productivity and household food security were being clobbered by AIDS. We were shocked by the human toll, the numbers of orphans, and the pervasive death amongst the female population. In fact, so distressed were we about the decimation of women, that we appealed to the Secretary-General of the United Nations to personally intervene.

And he did. He summoned a high level meeting on the 38th floor of the UN Secretariat, with TV conferencing outreach to James Morris in Rome and to the various UN agencies in Geneva, and after several agitated interventions, the Secretary-General struck a Task Force on Gender and AIDS in Southern Africa, to be chaired by Carol Bellamy of UNICEF.

If memory serves me, Carol Bellamy determined to focus on seven of the highest prevalence rate countries: studies were done, recommendations were made, costs of implementation were estimated, monographs were published. And here's what festers in the craw: the funding for implementation is not yet available. The needs and rights of women never command singular urgency.

There's an odd footnote to this. Within the last two months, a number of senior students at the University of Toronto Law School, compiled papers dealing with potential legal interventions on a number of issues related to HIV/AIDS in Africa. One of the issues was, predictably, gender. Not a single student, over the course of several weeks, whether on the internet or wider personal reading, came across the Secretary-General's Task Force (although one student said that she had a vague recollection that such a thing existed). The Task Force findings are clearly not something the UN promotes with messianic fervour.

I want to remind you that as recently as March, there was tabled, internationally, the Commission on Africa, chaired by Prime Minister Tony Blair ... indeed established by Tony Blair. It has received nothing but accolades, particularly for the analysis and recommendations on Official Development Assistance, on trade and on debt. The tributes are deserved. The document goes further down a progressive road than any other contemporary international compilation.

With one exception. I want it to be known - because it's not known - that the one aspect of this prestigious report which fails, lamentably, is the way in which it deals with women. There is the occasional obligatory paragraph which signals that the Commission recognizes that there are two sexes in the world, but by and large, given that women are absolutely central to the very integrity and survival of the African continent, they are dealt with as they are always dealt with in these auspicious studies: at the margins, in passing, pro forma. And it's not just HIV/AIDS; it's everything, from trade to agriculture to conflict to peace-building.

Maybe we should have guessed what was coming when there were only three women appointed out of seventeen commissioners. They had the whole world to choose from, and they could find only three women ... it doesn't even begin to meet the Beijing minimum target of thirty percent. We're not just climbing uphill; we might as well be facing the Himalayas.

I want to remind you, finally, of the arrangements we've made within the United Nations itself. HIV/AIDS is the worst plague this world is facing; it wrecks havoc on women and girls, and within the multilateral system, best-placed to confront the pandemic, we have absolutely no agency of power to promote women's development, to offer advice and technical assistance to governments on their behalf, and to oversee programmes, as well as representing the rights of women. We have no agency of authority to intervene on behalf of half the human race. Despite the mantra of 'Women's Rights are Human Rights', intoned at the International Conference on Human Rights in Vienna in 1993; despite the pugnacious assertion of the rights of women advanced at the Cairo International conference in 1994; despite the Beijing Conference on women in 1995; despite the existence of the Convention on the Elimination of Discrimination against Women, now ratified by over 150 countries; we have only UNIFEM, the UN Development Fund for Women, with an annual core budget in the vicinity of $20 million dollars, to represent the women of the world. There are several UNICEF offices in individual developing countries where the annual budget is greater than that of UNIFEM.

More, UNIFEM isn't even a free-standing entity. It's a department of the UNDP (the United Nations Development Programme). Its Executive Director ranks lower in grade than over a dozen of her colleagues within UNDP, and lower in rank than the vast majority of the Secretary-General's Special Representatives.

More still, because UNIFEM is so marginalized, there's nobody to represent women adequately on the group of co-sponsors convened by UNAIDS. You see, UNAIDS is a coordinating body: it coordinates the AIDS activities of UNICEF, UNDP, the World Bank, UNESCO, UNFPA, WHO, UNDCP (the Drug Agency), ILO and WFP. UNIFEM asked to be a co-sponsor, but it was denied that privilege.

So who, I ask, speaks for women at the heart of the pandemic? Well, UNFPA in part. And UNICEF, in part (a smaller part). And ostensibly UNDP (although from my observations in the field, "ostensible" is the operative word).

Let me be clear: what we have here is the most ferocious assault ever made by a communicable disease on women's health, and there is just no concerted coalition of forces to go to the barricades on women's behalf. We do have the Global Coalition on Women and AIDS, launched almost by way of desperation, by some international women leaders ... like Mary Robinson, like Geeta Rao Gupta, but they're struggling for significant sustainable funding, and their presence on the ground is inevitably peripheral.

I was listening to the presentations at the dinner last night, and thinking to myself, when in heaven's name does it end? Obstetric fistula causes such awful misery, and isn't it symptomatic that one of the largest - perhaps the largest -contributions to addressing this appalling condition has come not from a government but from Oprah Winfrey?

I was noting, just in the last 48 hours, that Save the Children in the UK has released a report pointing out that fully half of the three hundred thousand child soldiers in the world are girls. And if that isn't a maiming of health - in this case emotional and psychological health - then I don't know what is. And perhaps you notice the rancid irony: women have achieved parity on the receiving end of conflict and AIDS, but nowhere else.

Female genital mutilation, the contagion of violence against women, sexual violence in particular, rape as a weapon of war - Rwanda, Darfur, Northern Uganda, Eastern Congo - marital rape, child defilement, as it is called in Zambia, sexual trafficking, maternal mortality, early marriage ... I pause to point out that studies now show that in parts of Africa, the prevalence rates of HIV in marriage are often higher than they are for sexually active single women in the surrounding community; who would have thought that possible? ...

The overall subject matters you're tackling at this conference strike to the heart of the human condition. All my adult life I have accepted the feminist analysis of male power and authority. But perhaps because of an acute naiveté, I never imagined that the analysis would be overwhelmed by the objective historical realities. Of course the women's movement has had great successes, but the contemporary global struggle to secure women's health seems to me to be a challenge of almost insuperable dimension.

And because I believe that, and because I see the evidence month after month, week after week, day after day, in the unremitting carnage of women and AIDS - God it tears the heart from the body ... I just don't know how to convey it ... these young young women, who crave so desperately to live, who suddenly face a pox, a scourge which tears their life from them before they have a life ... who can't even get treatment because the men are first in line, or the treatment rolls out at such a paralytic snail's pace ... who are part of the 90% of pregnant women who have no access to the prevention of Mother to Child Transmission and so their infants are born positive ... who carry the entire burden of care even while they're sick, tending to the family, carrying the water, tilling the fields, looking after the orphans .... the women who lose their property, and have no inheritance rights, and no legal or jurisprudential infrastructure which will guarantee those rights .... no criminal code which will stop the violence ... because I have observed all of that, and have observed it for four years, and am driven to distraction by the recognition that it will continue, I want a kind of revolution in the world's response, not another stab at institutional reform, but a virtual revolution.

Let me, therefore, put before the conference, two quite pragmatic responses which will make a world of difference to women, and then a much more fundamental proposal.

Many at the conference will not know this, but the Kingdom of Swaziland recently made history when it received from the Global Fund on AIDS, Tuberculosis and Malaria, money to pay a stipend - modest of course, but of huge impact - to ten thousand caregivers, looking after orphans, the vast majority being women. The Swaziland National AIDS Commission (that may not be the precise name), reeling from the exploding orphan population, made the proposal for payment to the Global Fund, and it swept through the review process with nary a word. The amount is roughly $30/month, or a dollar a day .... not a lot to be sure, but clearly enough to make a great difference.

My recommendation is that this conference orchestrate the writing of a letter, to be signed by people like Mary Robinson, Geeta Rao Gupta, and prominent women from academia, and have that letter sent to every African Head of State and Minister of Health, urging them to ask for compensation for caregivers, using the Swaziland precedent.

And the second pragmatic proposal? I would recommend, with every fibre of persuasion at my command, that the conference collaborate directly with the International Partnership on Microbicides, whose remarkably effective Executive Director, Dr. Zeda Rosenberg, will be here on campus on Thursday. She will tell you what she needs and how to go about getting it. The prospect of a microbicide, in the form of a gel or cream or ring, which will prevent infection, while permitting conception - the partner need not even know of its presence - can save the lives of millions of women. The head of UNAIDS, Dr. Peter Piot, who will be known to many of you, recently suggested that the discovery of a microbicide may be only three to four years off. That's almost miraculous: short of a vaccine - and we must never stop the indefatigable hunt for a vaccine - a microbicide can transform the lives of women, and dramatically reduce their disproportionate vulnerability. What's needed is science and money. You can help with both.

On the more fundamental front, I want to suggest that the process of UN reform, now urgently underway, be confronted with arguments that spare no impatience.

I have heard the President of Botswana use the word extermination when he described what the country is battling. I have heard the Prime Minister of Lesotho use the word annihilation when he described what the country is battling. I sat with the President of Zambia and members of his cabinet not long ago, when he used the word holocaust to describe what the country is battling.

The words are true; there's no hyperbole. The words apply, overwhelmingly, to women. That being the case, there has to be a proportionate response. It seems to me that the response should proceed on two simultaneous fronts.

First, let me say that I was thrilled by the suggestion from Mary Robinson, and others, that Penn State act as a kind of coordinator for the surprising numbers of initiatives, unrelated one to the other, occurring under the auspices of many universities. The practice of twinning, the practice of using various Faculties as training centres, the practice of American and Canadian universities bridging the gap in capacity until the developing country can take over ... all of that is to the good, and it needs coordination. But there's more, I would submit, for you to do. Within multilateralism, that is within the UN system, wherein lies the best hope for leadership, there must be a change in the representation of women. There must emerge, for Women's Global Health, and certainly for HIV/AIDS, an agency, an organization, a powerful Think Tank, whatever the entity --- it can start on the outside, and then claim equal presence amongst the co-sponsors of UNAIDS, and thrust its advocacy upon the Secretariat, the Agencies, the member states, in unprecedented volume and urgency. Nor does this entity confine itself solely to women's global health, although that is the entry point. It insists on the 50% rule ... just start your evidence-gathering by identifying the numbers of senior women, agency by agency, secretariat department by secretariat department, diplomatic mission by diplomatic mission, and when you've recovered from the shock of learning that the multilateral citadel knows nothing of affirmative action, then begin your unrelenting advocacy. This must become a movement for social change. It needs leadership. Why not this University, why not this conference? And let me emphasize; there's nothing limiting about this concept. We're looking towards the day when governments are finally made to understand that women constitute half of everything that affects humankind, and must therefore be engaged in absolutely everything. Why would it not be possible to build a movement, committed to the rights of women, in the first instance amongst nursing and medical faculties across the world, and take the world by storm? You have resources, knowledge and influence available to no others. The terrible problem is that you've never marshalled your collective capacities.

Second, a similar movement must be directed, I would submit, to Africa itself. I'm hesitant here, because there are enough neo-colonial impulses around without my being presumptuous in making recommendations for Africa, and indeed for women. But I must bring myself to say what I know to be true: the African leadership, at the highest level, is not engaged when it comes to women's health. There's so much lip service; there's so much patronizing gobble-de-gook. The political leadership of Africa has to be lobbied with an almost maniacal intensity on the issues of this conference, or nothing will change for women.

That, too, will take a monumental effort. In my fantasies, I see a group of African women, moving country to country, President to President, identifying violations of women's health specific to that country, and demanding a change so profound that it shakes to the root the gender relationships of the society. I know that African women leaders like Wangari Matthai and Graça Machel and many prominent cabinet ministers, committed activists and professionals think in those terms; what is needed is a massive outpouring of international support from their sisters and brothers on the planet.

I'm 67 years old. I'm a man. I've spent time in politics, diplomacy and multilateralism. I know a little of how this man's world works, but I still find much of it inexplicable. I don't really care anymore about whom I might offend or what line I cross: that's what's useful about inching into one's dotage.

I know only that this world is off its rocker when it comes to women. I must admit that I live in such a state of perpetual rage at what I see happening to women in the pandemic, that I would like to throttle those responsible, those who've waited so unendurably long to act, those who can find infinite resources for war but never sufficient resources to ameliorate the human condition.

I'm excited of course about the Millennium Development Goals, and I'm equally excited that with the leadership of the British, this next G8 Summit in the summer might just possibly spawn a breakthrough. And there are countless numbers of people working to that end.

But I have to say that I can't get the images of women I've met, unbearably ill, out of my mind. And I don't have it in me either to forgive or to forget. I have it in me only to join with all of you in the greatest liberation struggle there is: the struggle on behalf of the women of the world.

1. AFRICA MUST ACT WITH GREATER URGENCY ON HIV/AIDS AND THE RIGHT TO HEALTH

Statement by CSOs at the Fourth Ordinary African Union Summit of the Heads of States, 24-31st January 2005, Abuja, Nigeria

Signed by the African Network for the Campaign on Education for All (ANCEFA), African Womens Development and Communications Network (FEMNET), African Centre for Democracy and Human Rights (ACDHR), Center for Democracy and Development (CDD),
Pan African Movement (PAM), Pan African Development Education and Advocacy Programme(PADEAP), West African Students Union (WASU), Womens Rights Advancement and Protection Alternatives (WRAPA), Development Network of Indigenous Voluntary Agencies (DENIVA), Fahamu, ActionAid International, Oxfam GB

Summary

The fourth Ordinary African Union Summit of the Heads of States takes place at a time when the consequences of poorly financed and collapsing public health services across the continent can only be described as a public health emergency. Returning to Abuja where four years ago they committed themselves to accelerate the fight against HIV/AIDS, Tuberculosis and other related infectious diseases, it is clear that key obstacles continue to prevent hundreds of millions of Africans from realising the right to health. African Governments and the African Union must reinvigorate the fight against the violation of HIV/AIDS and health related rights.

Recommendations

- African Governments must commit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%.
- African government should ensure that treatment of AIDS and infectious diseases is provided free, reaches vulnerable groups and in an accountable manner.
- African Governments, who have to yet ratify the AU Protocol on the Rights of Women, must do so. It is a major instrument in securing the right to health for Africa’s women and girls.
- The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and measures from industrialised countries to compensate for the brain drain of African health workers.
- The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and securing measures from industrialised countries to compensate for the brain drain of African health workers.
- African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005.

Situational analysis

Across our continent the health status of women remains precarious and in many instances, worsening, not only because of HIV but also because of the many unacceptable inequalities that exist in women’s health, the limited choices that are made available to women and finally, the lack of accountability for their health.
- Pascal Mocumbi, Prime Minister, Mozambique, 2003.

The majority of Africa’s 800 million citizens continue to remain locked out of health facilities across the continent. By the time the Summit opens, Africa will have lost 20 million people to the plague of AIDS. Behind them, they would have left 12 million orphans to fend for themselves. While our leaders meet, outside the doors of the Abuja International Conference Centre, 80% of the 40 million people currently living with HIV/AIDs across the world will be struggling to fight a debilitating disease that in some parts of the industrialised world is no longer a killer disease. 55% of these will be women.

By the time the Summit opens on the 24th January, 90 million African women and girls will have been forcibly circumcised or had their genitals mutilated. Between the opening and the closing Summit ceremonies, 77,000 women and girls will have undergone unsafe abortions in countries where restrictive abortion policies ensure that no standards can be maintained or monitored. As a result of this and other factors, a staggering 47/48 sub-Saharan African countries will not meet the goal of reducing maternal mortality and one in ten babies will not survive child birth due to poor and inadequate health infrastructure in Africa.

Yet, this is sadly no longer news in a continent numbed by the domestic stories of neglect, blocked access to life-saving drugs and poverty. What could be news is the scaling up of international and African public resources into expanding access to health-care services.

Expand public financing for health and education

When African Heads of States met in Abuja in April 2001, they correctly declared HIV/AIDS, Tuberculosis (TB), and other related infectious diseases (ORID) as a state of emergency. Recalling and reaffirming their commitment to all relevant decisions, declarations and resolutions in the area of health and development and on HIV/AIDS, particularly the "Lomé Declaration on HIV/AIDS in Africa" (July 2000) and the "Decision on the adoption of the International Partnership against HIV/AIDS" (Algiers 1999) they stated;
“WE COMMIT OURSELVES to take all necessary measures to ensure that the needed resources are made available from all sources and that they are efficiently and effectively utilized. In addition, WE PLEDGE to set a target of allocating at least 15% of our annual budget to the improvement of the health sector.”

Now known as the “Abuja 15% commitment” this target was seen as a critical contribution to the fight against HIVAIDS and other diseases. Shockingly, despite this public commitment, four years on many countries continue to spend less than 10% of the revenue on health. African Governments must commit in this Summit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%.

New research published by the Global Campaign for Education and endorsed by UNAIDS, shows that a complete primary education makes a strong and direct impact on HIV infection rates, especially among young women. Girls with a complete primary education are 2.2 times less likely to contract HIV than those with some or no primary education. Education equips young people to understand and apply facts and gives them the status, clout and confidence to avoid unsafe and exploitative relationships. Investing in free primary education for everyone but especially for girls, is one of the most effective and urgently needed measures to fight the epidemic. Investing in secondary education would bring additional benefits. Consequently, the AU needs to give priority to free, universal and compulsory basic education with gender equity, both in its own strategies for development and poverty reduction, as well as in its dialogue with forums such as the G8.

Debt cancellation is pre-requisite for progress

The heavy external debt burden …continues to mortgage African economies and cast a shadow over our People’s’ future. To date, the proposed remedies are ad hoc.
- Secretary General of the Organisation of African Unity, July 2002

A comprehensive AIDS plan for Africa would cost US$10 billion per year, yet African nations spend one and a half times this amount in debt servicing. In many countries, more is spent on debt servicing than on education and health or is received in aid grants and foreign direct investment. For the same money, the global fund against HIV/AIDS, Malaria and Tuberculosis could stop these diseases and provide Anti-Retrovirals (ARVs) for the three million people living with HIV in all developing countries not just Africa.

This absurdity can only be seen from the experience of one country. Tanzania for instance, currently pays US$39 million dollars per annum in debt servicing while receiving only US$27 million in aid. It is revealing to recall that after the second world war, Germany was considered to be harshly penalised for having reparations set at 7% of its exports, yet in 2005 Tanzania is supposed to “adjust” and grow with debt servicing set at 60% of its exports.

Yet, this Summit occurs at a time when momentum has built once more around the necessity for debt cancellation. Several G8 countries have bi-laterally cancelled debts owed by African countries. In February 2005, the G7 Finance Ministers will consider proposals to underwrite debt cancellation by committing additional bi-lateral financing or by re-valuing IMF gold reserves. The benefits of this would be immense. Debt cancellation would enable countries like Ethiopia to expand access by doubling its expenditure on health and thus reaching beyond the 60% who are currently reached by health services.

There is precedence in Africa for successful re-channeling of debt relief into basic social services. At least six countries in Africa offer insight into the possibilities debt cancellation could create. In Benin for example, 54% of HIPIC relief monies was channeled into improving health programmes by recruiting health staff for rural clinics, implementing HIV/AIDS and anti-malarial programmes and improving access to safe water and increasing immunisation. Malawi has been able to allocate a 30% cut in debt servicing per year to enhance their HIV/AIDs health care system. US$1.3 million of debt relief money has been critical to resourcing Uganda’s National HIV/AIDS plan. Cameroon was able to launch a comprehensive national HIV/AIDS strategic plan funded to the tune of US$114 million with help from debt savings. In Niger, a special programme that focuses on rural education, health, food security and water systems has been fully financed through HIPC. This has mainly been used so far in building classrooms and rural clinics. In Burkina Faso, HIPC relief has been spent on health (33%), education (39%) and rural roads (28%).

As Jubilee Zambia coordinator Teza Nchinga notes, "Respect for the basic human rights (food, health care and education) of millions of Zambians should take priority over repayment of debts to comparatively wealthy creditors especially when capital on these debts has already been paid a number of times over." The African Union Commission must lead on behalf of African countries by aggressively demanding debt cancellation from the G8 in 2005. African Governments on the other hand, must follow the example of these six countries who have had re-channeled monies freed up from debt relief into strengthening health systems including the retention of health workers.

Industrialised countries must deliver on their aid commitments

Currently, despite the increases pledged in the UN Financing For Development Conference in Monterrey, rich countries spend half of the foreign assistance they did in 1960. If they were to meet the OECD targets of 0.7% of their GNP this would increase aid levels from US$70 billion to US$190 billion dollars. Yet, only the UK and Spain have set dates to meet these targets. 12 other countries are far from this and do not seem to be in a hurry.

Compared to expenditure on defense or domestic agricultural subsidies, this would be a very small amount. Looked at in terms of the cost to individual taxpayers, it would cost an additional US$80 dollars per person per year or put more simply, the average price of one cup of coffee a week.

G8 countries continue to prioritise aid to countries where they have geo-political interests rather than fighting poverty. Over 2004, America set aside US$ 65 billion dollars for fighting the war in Afghanistan and Iraq. This could have financed the exact annual budget deficit for the entire continent of Africa. Put another way, six months of US funding for the war in Iraq (US$ four billion) could have met the annual budget deficit for the global fund against HIV/AIDS, Malaria and Tuberculosis. Yet increasing aid is only one measure, improving its quality is another. For instance, nearly 30% of aid is tied to goods and services from donor countries. In the case of the US, this figure is as high as 70%.

The quality of foreign assistance also continues to be undermined by IMF and World Bank fiscal and macro-economic models, which act to constrain expenditure on basic social services. In a study of twenty Poverty Reduction Strategies, sixteen were found to contain fiscal targets for inflation and the budgetary envelope that had not been subjected to public discussion. They were targets that had been established by the World Bank or the IMF. Last year for instance, Ethiopian and Tanzanian Governments will have to meet 85 and 78 policy conditions respectively.

The AU clearly sees itself providing leadership, monitoring states performance and accountability, advocacy with states and beyond, setting up standards, harnessing new continental initiatives, and as a knowledge hub. This clear emphasis on harmonising the plethora of new initiatives and monies that are offered for flooding Africa and which are, in many cases, confusing national plans and programmes, is welcome.

To this end, the AU must challenge the proliferation of uncoordinated initiatives such as the US PEPFAR Presidential Initiative. Bilateral initiatives such as PEPFAR may reinforce donor-driven approaches, increase the administrative burdens of recipient countries and drain resources away from existing, experienced, multilateral initiatives. Such initiatives create parallel systems where the national government using inexpensive generic fixed dose combinations and that of PEPFAR using expensive brand names. This leads to confusion of both patients and health providers.

The African Union must take a more vigorous lead in engaging the international community to deliver the Monterrey promises and improve the volume and quality of foreign assistance to Africa. It is vital that donors’ initiatives and programmes should implement nationally defined policies especially regarding access to medicines.

Improving Access to Care and Support

The major challenge facing the people living with AIDS and people affected by AIDS is the issue of access to treatment and care. The World Health Organization (WHO) in December 2003 came up with an initiative to treat three million people by 2005. This is believed to be approximately half of the estimated six million people in dire need of antiretroviral therapy. This is the popular 3 by 5.

Despite the fact that some African governments have subsidized distribution programmes, less than 1% of Africans in need of ARV treatment had access to ARVs, compared to 85% in developed countries in 2004. South Africa has committed to providing free treatment to 53,000 people by March 2004. This is a fraction of South Africa's HIV positive population, estimated to be over five million. The Nigerian government began a treatment programme to provide ARVs for 10,000 people in November 2002. At a conservatively estimated number of 3 million people living with HIV&AIDS in Nigeria in 2004, this is quite clearly inadequate.

Access to ARVs is also determined by power within and between households. Findings from CSO participatory research studies in Zambia and Nigeria suggest that intra-household power relations conspire to constrain women’s access to ARVs. Women in Zambia have a disproportionate access to ARVs (30%) despite comprising of 50% of the population. In January 2004, less than 30% of people who had access to ARVs were women in Zambia. In many families who cannot afford to have more than one person on ARV, it is the male head of household that is chosen. At another level, scanty or total ignorance of prevalent diseases, the weak bargaining position of women and the pervasive cultural endorsement of male liberty to have free and multiple sexual relationships (in and out of marriage) has escalated the distributive impact of STDs and led to the high prevalence of HIV/AIDS across communities all over Africa.

In many countries across Africa the right to health is not enshrined in either the constitution or laws. It is in this context that the African Union Protocol on Women’s Rights and in particular the provisions in articles 14 and 15 significantly contribute to grounding the obligations of Governments. Yet, despite encouragement by the African Union Commission under the leadership of President Konare and civil society campaigning, only seven Governments have ratified the Protocol, a further 33 have signed but not ratified. To this end, African Governments who have not yet done so must re-commit to ratify with urgency, the AU Protocol on the Rights of Women, as a major instrument in securing the right to health for Africa’s women and girls.

Class equities also affect the distribution of ARVs. Interviewed recently, a 29 year old father of three kids in Nigeria said;

“The ARV that come to the center are not given to those of us who have come out to declare our status, but to those BIG men who bribe their way through and we are left to suffer and scout round for the drug. “

Attempts to bring down the costs of ARVs are obviously the way forward. In Nigeria, Malawi and Zimbabwe, tariffs on essential drugs have been removed. The Governments of Zambia and Mozambique have issued compulsory licensing for ARVs for their treatment programmes. Zimbabwe has also allocated precious foreign currency to a local company to manufacture generic ARVs, and is currently running trials on AZT at two of its largest hospitals. However, Zimbabwe’s lack of foreign currency has made it difficult to secure an adequate supply of drugs. In Kenya and Malawi also many public hospitals have no drugs for treatment of HIV/AIDS-related infections.

Access to essential medicines rests on African countries being able to domestically produce or source cheap drugs from southern based generic drugs industries. The AU should consider initiating dialogue with WHO, UNCTAD and the EC to explore the feasibility of establishing African centers of excellence in the producing of high quality local production of medicine especially ARVs. African states should be encouraged to influence both public and private health service providers to dispel misinformation about generic drugs being inferior to brand products, eliminate the costs of ARVs to users and actively target the rural poor with special emphasis on gender equity. Key to this will be the replication of policies that cut taxes and tariffs and promote price regulation to countries that have not already done so.

We welcome existing plans for a continental conference on the rights of people with HIV/AIDS to raise the profile of rights abuses and to chart a new chapter in the evolution of national laws and standards consistent with the spirit of the African Charter of Human and Peoples Rights. We call on the AU Commission to extend an invitation to People with AIDS organizations and networks across the continent to help design this process.

African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005. The AU must ensure that new trade agreements especially Trade Related Aspects on Intellectual Property Rights (TRIPS), bilateral and regional trade agreements do not undermine access to medicines in Africa.

The absence of effective conditions to fight HIV/AIDS and other infectious diseases such as malaria, tuberculosis and polio conditions and poor remuneration of African health workers has led to an exodus of trained health personnel. Calculating the cost of training, every doctor that leaves the continent costs Africa US$60,000. This results in a staggering subsidy to G8 countries of US$500 million every year just for health personnel.

To increase access to medicines African governments should redirect aid and debt money towards investing in basic health services including retention of health workers. Donors’ initiatives should follow national medicines policies especially using inexpensive generic fixed dose combinations. The AU should advocate with states, donors and the pharmaceutical industry to decrease the prices of second line treatment for HIV.

Conclusions

As African Governments meet once again in Abuja, they must embrace the opportunity of an invigorated African Union Commission to turn words into further deeds and directly confront the state of emergency. The temptation to simply re-affirm the 2001 Abuja Declaration must be avoided in order for the costs of this Summit to be justified. Increasing domestic resourcing, improving the quality of health programmes particularly to rural communities and delivery on debt cancellation are key to preventing hundreds of millions of Africans from being denied the right to health.

Recommendations

- African Governments must commit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%.
- African government should ensure that treatment of AIDS and infectious diseases is provided free, reaches vulnerable groups and in an accountable manner.
- African Governments, who have yet to ratify the AU Protocol on the Rights of Women, must do so. It is a major instrument in securing the right to health for Africa’s women and girls.
- The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and measures from industrialised countries to compensate for the brain drain of African health workers and stop recruiting more workers.
- African Governments must prioritise monies saved by debt relief for strengthening health systems that ensure the retention of health workers.
- African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005.

* Useful Reading Materials
- African Union, Report of the African Summit on HIV/AIDS, Tuberculosis, and other related infectious diseases. Abuja Nigeria, April 2004
- African Union, HIV/AIDS Strategy 2005-2007
- ActionAid International, Responding to HIV/AIDS in Africa, a comparative analysis of responses to the Abuja Declaration in Kenya, Malawi, Nigeria & Zimbabwe, June 2004
- ActionAid International, 3 by 5: Ensuring HIV/AIDS Care for All. June 2004
- Fahamu/SOAWR, Pambazuka News 190: Special Issue on the Protocol on the Rights of Women in Africa: A pre-condition for health & food security, January 2005
- Oxfam International, Paying the Price, January 2005

2. SUMMARY OF DECISIONS OF THE AFRICAN UNION FOURTH ORDINARY SUMMIT, ABUJA, NIGERIA JANUARY 2005
Compiled By: Eve Odete, Pan Africa Policy Officer, Oxfam GB
Summary of Decisions of the African Union Fourth Ordinary Summit, Abuja, Nigeria Jan 2005

Key Meetings

Assembly of the African Union, Fourth Ordinary Session
30-31 January 2005
Assembly /AU/Dec.55-72 (IV)
Assembly/ AU/ Dec. 1-2 (IV)
Decisions and Declarations

Executive Council
Sixth Ordinary Session, 24-28 January 2005
EX. CL/Dec. 165-191 (VI)
Decisions
EX. CL//Rapt/ Rpt (VI)
Rapporteur’s Report of the Sixth Ordinary Session
Of the Executive Council

Permanent Representatives Committee
Ninth Ordinary Session

PRC/Rpt (1X)
Report of the Ninth Ordinary Session of the Permanent Representatives’ Committee

Rationale for this compilation and the policy cycle it documents

This summary has been prepared for policy analysts working for Oxfam, international, continental and regional networks and allies to inform us on the key deliberations and decisions of the most important decision-making organ of the African Union. It captures key decisions, upcoming dates and opportunities for continental policy development.

The sequence of the Summits is as follows; one week of intense meetings starting with the Permanent Representatives Council (Addis based Ambassadors), Council of Ministers (National Ministers) and the Assembly itself (Heads of States). While the Assembly is the supreme decision making body, the discussions from Ambassador level are important to understand the issues being prioritized and deliberated. Opportunities for policy influencing decrease as the meetings go on. Indeed, even lobbying space becomes more difficult to secure particularly with the Commissioners.

1. Health and HIV/AIDS

Permanent Representatives Committee
Ninth Ordinary Session
PRC/Rpt (1X)

On HIV/AIDS, tuberculosis, malaria and other related infectious diseases, the PRC observed;

The need for Africa to take the lead in Trade Related Intellectual Property Rights (TRIPS) negotiations to promote access to affordable generic drugs - Africa has to plan properly for dialogue at TRIPs negotiations and other fora;

Assembly of the Africa Union
Fourth Ordinary Session
Decisions and Declarations

Assembly/ AU /Dec. 55 (1V)

CALLS UPON the international community, especially the rich industrialized countries,
to fully fund the Global Fund in line with previous commitments made in this regard, and taking into account the magnitude of the health emergency presented by these diseases in Africa;

URGES Member States to:
Take the lead in TRIPs negotiations and in implementing measures identified for promoting access to affordable generic drugs;
Ensure that every child receives polio immunization in 2005;
Prepare inter-ministerial costed development and deployment plans to address the Human Resources for Health crisis;
Prepare health literacy strategies to achieve an energized continent-wide health promotion endeavour;

URGES Member States to intensify efforts towards more effective and well-coordinated implementation of national programmes to promote health systems development as well as improve access to prevention, treatment, care and support; along the “Three ones initiative”; the “3 by 5 Strategy” and Global “Child Survival Partnership”;

RESOLVES to take all the necessary measures to produce with the support of the international community, quality generic drugs in Africa, supporting industrial development and making full use of the flexibility in international trade law and; REQUESTS the AU Commission within the framework of NEPAD to lead the development of a Pharmaceutical Manufacturing Plan for Africa;

CALLS UPON the International Community to match the US$19 billion gap in health financing which the WHO has determined that Africa is not in a position to self finance;

2. Trade

Permanent Representatives Committee
Ninth Ordinary Session
PRC/Rpt (1X)

On on-going WTO negotiations the Commissioner for Trade and Industry

highlighted the need for Africa to send a strong political message to the international community to find a solution to the cotton initiative which affects more than 10 million African producers living below the poverty line. She further pointed out the issue of the unfair behaviour of the Northern countries with regard to agricultural subsidies and the need to lay emphasis in the political message on the importance for Africa to meet food security objectives, rural development and poverty reduction. In conclusion, she stressed the need for the African Group to maintain solidarity and unity with the G90 on issues of substance within the WTO.

The PRC recognized the importance of the WTO negotiations for the socio-economic development of Africa and emphasized the need for capacity building in Member States and RECs and for better coordination of efforts among New York, Geneva, Brussels, African Groups and the AU Commission in Addis Ababa. It agreed with the recommendation for a fast-track approach to the cotton issue while emphasizing the need to come up with a common position on cotton, springing from the outcome of the recently held Bamako meeting. It further called for the document to be enriched with more information on the roadmaps finalized in Geneva and the reaction of the RECs on the issue as well as with the outcome of the Bamako meeting on cotton. It highlighted the importance of coming out with concrete proposals on the issue of Special and Differential Treatment; on the possibility for African countries to have access to required drugs for public health inclusion in national legislations as decided by the WTO Council. The PRC also emphasized the need to pursue the proposal for support to cotton producers in their exports and for the creation of a fund to compensate losses. In this regard, the PRC also called for other commodities to be part of the list of tradable goods for negotiations at the WTO.
It also called for a meeting on services in order to deal with African concerns in that sector. It recommended that, in addition to other partners, the expertise of ECA should be tapped for capacity building purposes. The PRC recommended that the AU Commission take the necessary measures to implement the proposal to send a strong political message to the international community to fast track negotiations on the cotton issue.

On Negotiations of the Economic Partnership Agreements:

The Commissioner recalled the provisions of the Cotonou Partnership Agreement (CPA) which aim at making EPAs, instruments for the promotion of rapid and sustainable development, the eradication of poverty and the smooth and gradual integration of Africa into the global economy. She quoted in particular Article 37.3 which provides for the strengthening of capacity in the public and private sector during the preparatory phase through measures that increase competitiveness and support regional integration initiatives such as assistance to budgetary adjustment and reform, infrastructure development and investment promotion. She added that the first phase of negotiations was not sanctioned by a formal agreement and that all 48 ACP African countries had embarked on the second phase within four groupings without any country expressing desire to remain outside the process. She then drew the attention of the Committee on the major challenges involved in the negotiations for African countries as raised by the RECs during the first meeting of the coordination mechanism between the AU and the RECs. These are: (i) geographical configuration of the EPAs, (ii) the issue of compatibility between WTO and EPA Rules; (iii) the reciprocal relationship between the EU and ACP countries given the gap between their levels of development, (iv) the imbalance in the present multilateral trading system, (v) the heavy procedures of access to EDF resources and additional resources to African countries to face direct and indirect adjustment costs.

She stressed the fact that, although EPAs were about to enter into force in three years’ time, the provisions of Article 37.3 were still not implemented. In this regard, she highlighted the need for RECs to remain united and proposed that Council calls on the EU to allow the AU Commission as an integration Organisation to access EDF resources for the implementation of the NEPAD programme.

The PRC expressed concern about the geographical configuration for the negotiation of EPAs which does not coincide with the RECs as organised within the AU. It called for the AU to develop capacity for the coordination of EPA negotiations to ensure that Africa speaks with one voice although EPAs divide Africa into RECs/negotiating groups and that the North African countries are part of the Barcelona process.

On the issue of resources, the PRC pointed out that EU resources were categorised into programmable and non-programmable resources and that the AU not being a party to the CPA was not eligible under the first category but should be able to access the non-programmable resources. In conclusion, the PRC stressed the need for African countries to build capacity not only for market access but above all in order to face supply-side constraints so that they can make good use of whatever agreement they will enter into in 2007.

The Executive Council
Sixth Ordinary Session
Decisions

Doc. EX.CL/151 (VI)

Decision on WTO negotiations

RECALLS the Doha Ministerial Declaration in which the international community undertook to place the needs and interests of developing countries at the heart of the WTO Work Programme;

COMMENDS the African Group for its efforts aimed at bringing to the Doha Work Programme back on track and for remaining engaged in the WTO negotiations in accordance with the technical guidance and policy framework provided under the Kigali Declaration and Consensus on the post-Cancun Doha Work Programme ;

RECALLS ALSO the outcome of the Special WTO General Council session held in Geneva from 27 July to 1 August 2004;

TAKES NOTE of the July Package adopted by the WTO General Council on 1st August 2001;

RECOMMENDS the speedy adoption of an approach to resolve the cotton issue based on the results of the meeting held in Bamako from 12 to 13 January 2005;

ALSO RECOMMENDS the early consideration of the issue of agricultural subsidies and the adoption of an Africa Common Position on commodities in general;

CALLS UPON the African Group in Geneva to continue to engage fully and actively in the negotiations with a view to achieving a pro-development outcome from the Doha Round;

ALSO CALLS UPON the same to finalise the Tunis roadmap and Work Plan in order to engage collaborative research and capacity building efforts from regional and international organizations on specific areas to enable Africa to positively contribute to the modalities stage of the negotiations leading up to the 6th Session of the WTO Ministerial Conference;

URGES Member States to continue to coordinate efforts both at the technical and political levels with like-minded groups, in particular, the G90;

WELCOMES Egypt’s invitation for a meeting to be held in Cairo, in May 2005, to discuss ways to deal with the challenges facing cotton producing countries in Africa;

REQUESTS the Commission to convene a Ministers of Trade meeting to chart the way forward as far as Africa’s Agenda is concerned.

FURTHER REQUESTS the Commission to report on progress to the 7th Ordinary Session of Council.

Executive Council-Rapporteur’s Report

With regard to the on-going WTO negotiations, Council recommended that special attention should be given by the AU to the crucial issues of agricultural subsidies and commodities, particularly cotton.

Decision on the negotiations of ACP-EU economic Partnership Agreements

COMMENDS the Commission and the RECs for concluding the establishment of an informal Coordination and Information Exchange Mechanism on EPA Negotiations with the European Union (EU) for which the Commission has been entrusted the coordinating role and also for holding the first meeting of the mechanism successfully;

ENDORSES the recommendations of the Commission/RECs meeting and URGES the Commission to:

Develop institutional capacity building programmes for the Commission and the RECs so as to make work synergies viable and reliable and accelerate the integration process in Africa;

Prepare, in close collaboration with the RECs, requests to the European Union and other development partners for financing of projects that will enhance continental integration;

Identify thecommon supporting programmes relative to implementation of EPAs at the level of the RECs;

Mobilize African research institutes, including the ECA, to appraise the adjustment and other costs of EPAs on African economies.

STRONGLY RECOMMENDS that efforts between the Commission and the RECs be further strengthened and coordinated in the second phase of negotiations, especially with regard to priorities and roadmaps set for negotiations so as to ensure that the process of continental integration in Africa is deepened in accordance with the Constitutive Act of the African Union;

WELCOMES the establishment of the Joint AU-EU Monitoring Mechanism whose objective is to ensure, through exchange of information and discussion of key issues, the consistency and coherence of the EPA process with Africa’s plans and aspirations for regional and continental integration and the establishment of a Pan-African Market and the promotion of synergies between the EPA process and ACP-EU cooperation, notably in the context of regional indicative programmes;

URGES the Commission and the EU to operationalise the mechanism in an effective manner so as to ensure that EPAs indeed enhance the regional integration process and development in Africa as well as the building of regional markets through the effective removal of production, supply and trade constraints;

ALSO URGES the EU to grant access to the Commission as an integration organization to EDF resources for projects of a continental nature;

REQUESTS the Commission to report on progress made on the EPA negotiations to the 7th Ordinary Session of Council in July 2005.

ENDORSES
Candidature of Hon. Jaya Krishna Cuttaree, Minister of Foreign Affairs, International Trade and Regional Co-operation of Mauritius, to the post of Director General of the World Trade Organization, at elections scheduled to be held in 2005.

3. Food Security

Permanent Representatives Committee
Ninth Ordinary Session
Report (1X)

Follow-up on Maputo, Sirte and Ouagadogou Declarations on Food Security:

The Commissioner concluded by proposing the creation of an African Food Security Committee to serve as a platform of exchange on matters of food security in the continent, and the establishment of an African Union representational office in Rome to coordinate Africa’s food security matters with relevant world bodies mandated with the issue.

Executive Council
Sixth Ordinary Session
Rapporteur’s Report

Follow-up of Maputo, Sirte and Ouagadogou Declarations on Food Security

On the status of food security in Africa, the following observations were made:

A reliable early warning system be established as it constitutes the preferential tool for combating food insecurity – the early warning system should be capable of anticipating the emergence of food crises, taking stock of production and available resources, and monitoring phenomena such as natural disasters (floods; droughts; invasion or outbreak of endemic diseases affecting animals, crops and plants);

Once established, the early warning system together with continued monitoring should be relied on to generate a steady flow of situation reports as this would facilitate the generation and communication of relevant information to Member States and all stakeholders in time for them to take appropriate measures;

Special attention should be given to the Southern Sahelian region as this area constitutes the main locust corridor between the Sahara and the countries further north;

Regional strategic desert control measures should be implemented by the concerned Member states;

There was need to strengthen the capacity of Member States in the area of fighting migratory pests and animal diseases that pose a threat to food security, and in so doing
to make use of recent technological methods in veterinary science and pest control.
Dakar-Agricultural Initiative

The Senegalese delegation informed Council of the holding in Dakar, Senegal from 4 to 5 February 2005, of the Dakar-Agricultural Initiative which would be a Forum at which agricultural issues would be discussed. It indicated that various key figures from Africa and the rest of the world would be taking part in this meeting and, in this regard, invited all countries of the African Union to participate in this Forum.

Meeting of Ministers of Agriculture
The Egyptian delegation highlighted the importance of agriculture for African economies and underscored the need for Africa to meet to discuss strategic issues such as cotton. It informed Council that Egypt was organizing in May 2005 a meeting of African Ministers of Agriculture with the participation of UNCTAD and other institutions to examine the situation and come up with a Common Position for the defence of African agricultural products.

Assembly of the Africa Union: Decisions and Declarations

Assembly /AU/Dec.59 (IV)

NOTES WITH GRAVE CONCERN the serious economic and social impacts of the 2004 desert locust invasion of the Northern, Western and Eastern regions of Africa;

REQUESTS the Commission and Member States to take all necessary measures to implement the Maputo, Sirte and Ouagadougou Declarations and their relevant Plans of Action;

Agriculture

Decision on allocation of 10% national budgetary resources to agriculture and rural development over the next 5 years

REQUESTS the Chairperson of the Commission to define, in collaboration with Member States and the NEPAD Secretariat, the core areas of agriculture and rural development relevant to the 10% allocation adopted in the Maputo Declarations;

CALLS UPON Member States to implement the present Decision in order to improve the financing of agriculture.