The ongoing extraction of minerals and biodiversity from Africa is not only a contributor to climate change. It leaves us less able to respond to climate change and is generating a social, health and natural resource debt burden for current and future generations.
That is why in the recent 2020 Alternative Mining Indaba (AMI), delegates from trade unions, ex-mineworkers, civil society and technical institutions who came together in Extractives and Health Group claimed that any framing of a just transition to address climate change must at the same time address the legacy of past health burdens and prevent such burdens now and into the future.
What are these ‘debts’? They don’t appear in the balance sheets of banks, ministries of finance or international finance institutions. They appear in the form of lead poisoning in children living in the shadow of mines, undermining their development; as mercury poisoning in communities living near mine dumps; or as chronic silicosis in thousands of ex- mineworkers across the region. They appear in the displacement of people away from fertile land, in contamination of drinking water, land and air and in the cancers, respiratory and other diseases this causes. The debt grows as an opportunity cost when mining companies do not contribute to local infrastructures, economies and services, or to skills and capacities for technological innovation, or when taxes collected do not return to develop local communities. The debt is there in the absence of information and voice given to communities in decisions and claims that affect their lives.
Sometimes part of the debt is translated into a number. In July 2019, the South Gauteng High Court approved a class action settlement worth at least 5 billion Rand (approximately USd350 million), to be paid as compensation for injury and illness for eligible ex-mineworkers and their dependents in Southern Africa. However, the Southern African Miners Association (SAMA), who organise ex-mineworkers, told the AMI that this figure is only the tip of the still buried level of occupational illness in ex-mineworkers.
At a regional workshop held before the AMI, convened by EQUINET with the regional trade union body, SATUCC and with SAMA and Benchmarks Foundation, delegates from organisations representing or working with mineworker, ex-mineworker, community, health and economic justice constituencies identified a shared concern over the way mining is affecting our current and future environments for health. It was perceived that we are not getting the current or future economic and social benefit we should get from mining and that rights are not being protected and claims ignored.
From the work that different organisations are already doing on these issues and from work in the region on HIV, TB and occupational health, it was evident that we have a platform to build on to address this. The meeting identified the building blocks of what needs to be done, not as isolated pockets of activity, but in a more integrated way across all countries of the region.
We must prevent the harms. The information, tools and capacities to map, assess and report on the conditions affecting health should be in the hands of communities, workers and ex-mine workers across the region, to be able to bring conditions affecting health to wider attention. While environment impact assessments are done in many countries, this is not enough. There should be a legal duty to carry out health impact assessments before licensing and during mine operations in all countries. These assessments should ensure, implement and monitor plans to prevent risks to health from mining. They should also assess the living conditions, the potential impacts on displaced communities and post closure and set plans to prevent negative impacts. They should be done jointly with workers and communities and publicly reported.
The rights of current and future generations should be protected. In many of our countries the laws are outdated, have gaps, or are not well enforced. As the AMI declaration stated, the right to life and to health for current and future generations must be central in whatever laws, policies and practices we design and implement. Health cannot be left to voluntary corporate social responsibility. There are over 25 international standards from United Nations and other institutions on the social obligations of the sector. SADC itself said in 2006 that it should set harmonised health standards in mining and that ‘member States should develop, adopt and enforce appropriate and uniform health, safety and environmental guidelines for the sector as an immediate milestone area’. It is time we implemented this commitment, not just for TB, HIV and occupational diseases, but for all the public health issues being faced in the sector.
The regional meeting shared information on efforts underway to inform and organise affected communities in the region. They included health literacy activities and the Tunatazama action voices alert where community activists share their knowledge and experiences on mining on a website at http://communitymonitors.net/. There are efforts underway to identify clean energy and green technologies that can limit health damage at source and measures to promote recycling and reuse of metal products. Accessing such information, building capacities for healthy innovation and having a voice in decisions is a right and an investment, especially for the young people whose futures depend on the choices we make today. The trickle of resources that goes to this in comparison to the flow of investment funds that go to the extraction of materials suggest that we have an imbalance that needs to be addressed in the value we are placing on the relative contribution of economic, social and natural resource inputs to our future wellbeing.
The regional meeting and the AMI highlighted many practical things we can do to meet the health and natural resource debt and to rebalance future policies and practices. We know that the right to life and health supersedes all other claims and that the natural resources of the region are ours to guard for future generations. We also know, as stated in the 2020 AMI declaration, that these rights “have been won through social struggle and are a source of social power and organization”. The formation of an Extractives and Health Group that crosscuts different constituencies and disciplines recognises the need to work collectively if we are to advance alternatives that meet past debts and that prevent the current and future liabilities of extraction.
Please send feedback or queries on the issues raised in this oped to the EQUINET secretariat: firstname.lastname@example.org. You can read the meeting report and further information on this work on the EQUINET website. Please also find further information on the websites of the partner institutions named in the oped and of the Alternative Mining Indaba.
Comrades, colleagues, citizens
As we prepare to host the UN Habitat 4 it is timely to reflect on the declarations made and the journey we've taken since the last conference in Quito, Ecuador in October 2016. (Is really it only the fourth conference - many of us weren't even born when the first was held in 1976!) We are fortunate here in Harare to be part of a regional movement, together with our strategic partner cities, towards more equitable and inclusive urban environments. Habitat 3 gave early voice to many of the changes that were nascent in our cities at the time: greater networking between cities, space for people to influence urban design in their cities, a consciousness of climate challenges and an awareness of the intertwined fortunes between urban and rural areas. Our cities today are not isolated. Whilst retaining their unique qualities and idiosyncrasies, they are part of highly globalised, networked ecosystems where our futures are deeply connected.
Our archives reveal that the atmosphere in Quito was aspirational. From the records excavated after the Great Data Crash of 2025, we reconstructed video footage of Habitat 3. The voice in it of the then Secretary-General of United Cities and Local Governments Africa, Jean Pierre Elong Mbassi still rings clear: “Local authorities are now on the map, what we want next is to be around the table…we hope that people will realise that without local authorities, there’s no way we can implement the global agendas adopted in 2015 and 2016”. This was echoed by the World Mayor’s Assembly who asserted two key demands: The first that city, metropolitan and regional governments be involved in UN negotiations, with powers to make decisions independent of national government; and the second that mayors have access to international finance and that instruments such as a Green Climate Fund also be allocated to and handled directly by cities.
In 2036, with collective, participatory urban budgeting now commonplace and seamless networks between cities, it is easy to forget that only a few decades ago cities were primarily considered national hubs, managed by nation states. We in East and Southern Africa have especially benefited from the Ore to Information Fund through which finance raised from the last mining operations was invested in open access technology infrastructure. This has allowed us to have the fastest data connectivity in the world, bringing huge benefits for technological innovation and education, access to health information, for the reach of health and economic services and capacities and new resources for community dialogue and action.
This month we celebrate 68 years since the principle of the ‘right to the city’ was first proposed by Henri Lefebvre. UN Habitat 3 was a critical marker for those campaigning for this right. We take it as commonplace today, but respect that those early struggles were not easily won.
Championed by Brazil and Ecuador, the ratification at Habitat3 of a New Urban Agenda (NUA) made this the first internationally negotiated document to reference the right to the city and encourage nation states to enshrine it in their laws. Under the slogan “Cities for people, not for profit!” civil society from various campaigns against gentrification, privatisation of public space and criminalisation of homeless and vulnerable citizens lobbied for the inclusion of the right. They called for governments to put citizens before private sector interests in the city, building on the 2004 World Charter on the Right to the City and the 2010 UN World “Right to the City” Urban Forum in Brazil.
At that time, Brazil and Ecuador were the only two countries to have this right enshrined in law. Still the Habitat3 negotiations saw large parts of the right to the city excluded from the final document. It did not mention the ‘social function of land’ or ‘participatory approaches at all stages of the urban policy and planning processes’. These clauses were struck off during the drafting. The NUA was also non-binding. As we look back in 2036, we owe a debt to the global Right to the City movement that brought together civil society, local government and other actors around the world, including from health, who picked up the baton after Quito, to implement the principles of equity and inclusivity in the 2016 NUA. Women in Informal Employment Globalizing and Organizing had already by 2016 publicised the economic, social and environmental contribution to cities of women informal sector workers and Colombia’s waste pickers had already won a court ruling to block a waste management contract that did not provide opportunities for informal recyclers. We have seen others follow suit, including those living in slums, health activists from communities affected by pollution and urban waste, increasingly bringing previously excluded groups to the policy making and planning table, affirming their rights to a city that ensures wellbeing for all. This has not been easy, especially given the legacies we inherited from the early years of the 21st century of unpredictable weather, rising sea levels, pollution and waste threatening the ecosystems of all in our cities, of massive socio-economic inequalities, of destructive wars and of big population movements across countries. However we now fully understand that inclusion and investment in wellbeing is not only as a matter of rights and justice, but is vital for our collective survival.
We were fascinated to find in our excavated websites an account by Barcelona's first female Mayor (to think - that city is now on its fifth female mayor!). Writing after Quito, Ms Colau said that Habitat 3 saw women coming to the forefront of political change. She noted that “the 21st Century is the century of cities - in part because this is a moment of great political uncertainty at many levels. But within that uncertainty, we see empowered citizens asking to be protagonists, and the city is the place to do this.”
We are looking forward to hosting Habitat 4 this year here in our region in real and virtual space. We welcome all joining us in our increasingly inclusive understanding of ‘the city’ with all the people and connected spaces that are critical to healthy urban life. As we gather to debate new challenges, we are fortunate to reflect on the debates, advances and still unresolved issues from Habitat 3 that we have found, to reflect on where we reached in 2030 with our sustainable development goals, and to bring in the voice of all to craft our Agenda for Habitat 4.
This oped was sent in response to our invitation for reflections post Habitat III. This issue provides a range of resources and publications related to urban health. Please send feedback or queries on the issues raised to the EQUINET secretariat: email@example.com.
We have a shorter newsletter and no editorial this month as we carry out essential review and maintenance work on our site. We hope the papers and content included still provide you with interesting materials for your work and analysis in and beyond the region. We have appreciated editorial contributions from a range of experiences and invite you to send us editorials written by you, and any links to videos, blogs, papers or other online resources you want to share on your perspective on the opportunities that we should be tapping in east and southern Africa for making immediate or longer term advances in equity in health.
In line with data protection requirements we've asked you in May to confirm that you would like to receive the newsletter from us. Thanks to all those who have responded! We are updating the subscriber lists in June, so if you don't want this issue of the newsletter to be the last emailed to you please take a minute to confirm your subscription by completing the form at http://www.equinetafrica.org/content/subscribe. You are free to unsubscribe at any time and you can read our privacy statement on the EQUINET website.
Hermann Biggs, a pioneering public health practitioner, said in 1894 that countries get the public health outcomes they invest in. “Within natural limitations, every community can determine its own death rate”. In this newsletter there are many facets of the choices made around this. The papers in all sections reveal a tension between the possibilities for significantly improved health, through new technologies and examples of promising practice, and of the resource and other barriers to their application. At national level, Charlotte Muheki Zikusooka questions in her editorial whether, for example, Ugandans are making adequate investment in “health for all” to get to “prosperity for all”. Other inputs focus on how the limited resources available are being allocated and spent. In 1894, when Hermann Biggs made his comment, global policies and practices had a less significant influence on health. Today their influence is growing. Various contributions in this newsletter recognise this, for example in the country call for WHO leadership in ensuring coherence in global health and for predictable innovative and mandatory international financing for health. The recently passed UN Resolution on the right to water and sanitation recognises both national and international roles in progressively realising the right to these profoundly important determinants of health. So if today we are adding to Biggs’ comment “… and we can globally determine the death rates of us all”, what rights and duties towards meeting public health costs does that imply?
This month's editorial comes from the lens of a health worker at a rural hospital, with an appeal for policy to test itself against whether it supports and has involved those working at the frontline and reflects ground realities. In a few days time a global meeting will be held in Botswana to review the health dimension of global development goals. In the newsletter is a resolution from a meeting of local governments and communities in Guatemala that urges, as we would, for a reminder of the faces, voices, wisdom and importance of the local in that discussion. As evident from the many reports EQUINET has produced, national averages hide significant subnational and within area inequalities, many of which are growing, and social agency, community systems and frontline health services need to be given significantly greater profile in policies and goals seeking to deliver on rights to health.
Many children across Malawi experience severe diarrhoea caused by a virus called rotavirus. Rotavirus kills more than 500 000 children under the age of five years around the world each year—almost 1 400 deaths each day—the vast majority of them in sub-Saharan Africa and South Asia. In Malawi alone, rotavirus was estimated by Ministry of Health in Malawi to be responsible for nearly 5 000 deaths every year. Rotavirus attacks our families and threatens our nation’s future by targeting our most precious resource—our children. It spreads through the faecal-oral route, via contact with contaminated hands, surfaces and objects, but is not easily eliminated by improved sanitation. Those with the diarrhoea require oral rehydration and if properly rehydrated have a good chance of recovery. Death is usually through dehydration. .
The tragedy is that much of this death and suffering could be prevented right now, if children in Malawi had the same access to life-saving vaccines as children in industrialised countries. In the United States, rotavirus vaccines have been widely available for five years. Before the vaccine was introduced over 2.7 million cases of rotavirus gastroenteritis occurred annually, 60,000 children were hospitalised and around 37 died from the results of the infection in the USA. After the vaccination programme was introduced these rates went down dramatically. In Malawi, where the need is much greater, this vaccination is not yet widely available for children.
Vaccines are one of the best long-term investments to prevent disease and give children a healthy start to life —a few shots or drops can protect a child for a lifetime. And they are one of the most cost effective interventions to prevent illness in a country like ours Malawi many competing health priorities. With rotavirus (A), existing oral vaccines have been shown to provide significant protection against the disease. It is estimated that broad access to rotavirus vaccines in low-income countries could save up to 225 000 children annually. In fact, the World Health Organization strongly recommends including the rotavirus vaccine in all immunisation programmes because of its potential life-saving impact. But even the most effective vaccines will only have an impact if they are made available to people who need them. Yet rotavirus vaccines have been too expensive for low income countries, where health resources are scarce, and external funders have been hesitant to support the vaccine until costs come down.
In June, there has been new cause for optimism. Children in African countries could finally access the same vaccines for rotavirus as children living in high income countries. On June 6, the GAVI [the Global Alliance for Vaccines and Immunisation], an international organisation that supports the rollout of vaccines to low-income countries, announced it had been offered a significant price reduction for rotavirus vaccines from a pharmaceutical company, reducing the cost by a third to US$2.50 a dose. By comparison, measles vaccine still costs a lot less, at 19 to 30 cents a dose. So the cost is still relatively high. GAVI, which supports vaccine programmes in Malawi, now plans to rapidly accelerate its financial support for rotavirus vaccines, to scale up access. Malawi was one of the handful of countries that hosted clinical trials demonstrating that rotavirus vaccines save lives. The country is now planning to roll out new vaccines for pneumonia later this year—with the potential to give children protection against another big childhood killer. These signs of leadership give cause for optimism in a situation where the longer we wait, the more lives are lost.
At the same time, if this is to be sustainable, costs must be brought down even further. There is report of new, more affordable rotavirus vaccines on the horizon that will sustain our efforts to save children’s lives for the long-term. When GAVI announced the price cut for the existing rotavirus vaccine, it disclosed that an Indian rotavirus vaccine candidate – which should be available around 2015 – will cost US$1 per dose. While manufacturers in other parts of the South like India are developing vaccines that will assist in improving access and affordability, we should also be asking what we are doing to expand capabilities for vaccine production in Africa. Vaccines alone will not eliminate rotavirus or solve all of our persistent health problems. We still need to focus on long-term challenges such as improving sanitation, adequate water and strengthening health systems, to prevent faecal borne disease, and ensuring wide knowledge on and access to oral rehydration to prevent child mortality from diarrhoea. But in my view, ensuring access to rotavirus vaccines is a simple prevention measure that we can and should take today.
An earlier version of this oped appeared in the Daily Times-Malawi 13 June 2011 and the New Era Press Namibia 2 June 2011. Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat firstname.lastname@example.org. For further information on this issue or the full please visit Health Rights and Education Programme (www.hrep.org.mw/) or EQUINET (www.equinetafrica.org).
Google the words “universal health” and in under 3 seconds you’ll get 165 million results. There is a crescendo of talk on universal health coverage. But has it been translated into terms that can engage social debate? The two editorials in this month’s newsletter and several of the papers suggest that such debate across all of society is critical, given how deep the consequences for society of the choices made. In the first editorial, Latin American social medicine and health scientists warn of the negative impacts of segmented insurance options. The second editorial, drawn more from African experience, argues a similar case. Both urge for exploration of tax funding, particularly given that universal systems are a right of all citizens not a benefit of particular employees or contributors. There are clearly debates and choices- are they reaching the people who will be most affected by them?
Two meetings took place in the last month.
On 18-20 April, the Southern Africa Development Community (SADC) held an international conference on poverty and development in Pailles, Mauritius. Background material for the conference prepared by SADC showed the threat posed by critical levels of HIV and AIDS, TB and Malaria to achievement of the Millennium Development Goals (MDGs). Countries were recommended to reprioritise their spending to curb the spread of diseases and other health problems impacting on development, including by meeting commitments to the 2001 Abuja Declaration commitment of 15% of national budgets on public health.
The AU Ministers of Finance and Planning and Economic Development meeting held in Addis Ababa- Ethiopia from 26 March to 2 April also noted with concern the necessity for long-term sustainable financing of and investment in health created by AIDS and other diseases. However, they were publicly silent on the commitment made by African heads of state in 2001 to allocate 15% of their annual national budget to health as a means towards this. Indeed, there are unconfirmed reports from people attending the meeting that some Ministers of Finance argued for the Abuja target adopted by their heads of state in 2001 to be abandoned.
That the region needs to increase its public sector investment in health is not in dispute. Poorer groups continue to have considerably worse health than the better off; economic growth and achieving the Millennium Development Goals (MDGs) in the region is seriously undermined by the prevalence of HIV and AIDS, TB, Malaria and other diseases. Eleven of the sixteen countries in east and southern Africa spend less in their public sectors than the US$34 needed for the most basic interventions for these conditions, let alone the US$60 or more needed for more comprehensive health services. So far, only three countries in the SADC Region have reached the Abuja target, although more are moving in a positive direction. Ten of the sixteen countries in the region would, if they met the Abuja target, increase their public financing to health above the basic level of US$34/capita needed for these basic health programmes.
There is significant potential gain when such increased spending is directed towards primary health care and district services, providing improvements in early detection, access and treatment for disadvantaged groups and in under-served areas. Many of the actions that improve health in poor communities are indeed taken outside the health sector, to improve physical, economic and social environments. However, evidence and experience shows that levering such actions for health across a range of sectors still calls for strong public health leadership, with adequate resources and political support to encourage shared mandates and co-ordinated action for health across all sectors.
The SADC meeting documents made it clear that a public sector led response is vital: Governments have the primary and most important role, responsibility and means for implementing systemic changes and sustaining them in the long run. Government action to reprioritise spending on health and develop sustainable, progressive strategies for financing health care is thus essential to create a basis for complementary strategies and inputs from other sources.
In contrast, diluting or failing to meet commitments to public funding for health undermines the necessary response to a major development challenge with greatest cost to poor households. As the SADC conference on poverty and development was informed, SADC Member States account for 35% of the people living with HIV globally and there are over 5.2 million orphans in the region. The region has the world’s worst TB infection rate and the rate has increased in the last 15 years, while the resources needed to cope with the epidemic have dwindled. New epidemics of multi-drug resistant tuberculosis (MDR-TB) and extreme drug-resistant tuberculosis (XDR-TB) pose grave and rising public health threats, particularly where health resources are limited. There are an estimated 30 million cases of malaria and 400 000 deaths from malaria in the region, with particular risk for children and pregnant women.
Such illness impacts on household income, diverting time and money for caring - sometimes at the expense of food consumption or school enrolment in children - with longer term consequences for poverty and production, especially for agricultural production and food security. Ill health places particular demands on women and children to provide or pay for care. As public funding for health has fallen, the region has also experienced rising charges and out-of-pocket payments for health care. When public services are under-funded or inaccessible and out-of-pocket payments for health increase, this has a particularly impoverishing effect on women, lower income and socially marginalised groups.
So meeting the heads of state commitment in Abuja is important to directly address significant and rising disease burdens; provide the necessary public and health sector leadership to lever other contributions to health; and protect against rising impoverishment and inequality resulting from unaffordable levels of household spending on health care in the lowest income households.
This is clearly not only a matter of increasing resources for health, but of redirecting resources towards greatest health needs. However review of experience in African countries shows that equitable allocation of public sector health care resources is more likely in a situation of increasing resources to health, backed by a policy commitment to equity and explicit mechanisms for achieving reasonable allocation targets.
Not surprisingly therefore, the paper produced by the SADC secretariat for the conference on responses to the economic impact of the three communicable diseases was clear and unequivocal: ‘SADC Member States and governments have committed themselves to many declarations including Abuja 2001 on the three communicable diseases, the Maputo Declaration of 2005 on declaring TB an emergency and UNGASS to name a few. They need to fulfill these obligations and put a mechanism in place to monitor and evaluate them.’
The commitment made by the heads of state in Abuja 2001 towards allocating 15% of their national budgets for health was an important contribution to poverty reduction and equity, and a challenge to international partners to eliminate debt and meet their own commitments to overseas development aid. We would expect a similar level of explicit commitment to the goal from the Ministers of Finance in the region, and more than that delivery on the 15% government funding to health.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat, email email@example.com. EQUINET calls for “Abuja plus” i.e. 15% government spending to health, increased local and international per capita funding, debt cancellation, abolishing user fees, increasing the share of progressive tax funding, and 50% of government spending to district levels and primary health care. EQUINET work on fair financing in health is available at www.equinetafrica.org.
Dr LEE Jong-wook, Director-General of the World Health Organization, died on 22 May 2006 following a short illness. EQUINET joins the many who have paid tribute to Dr Lee for his contribution to global public health, and send deep condolences to his family and colleagues.
Dr Lee was a national of the Republic of Korea and a world leader in public health. His contribution to global health has been commended from a wide spectrum of the global community: Treatment and health activists have recognized his decisive and bold leadership in declaring AIDS a global emergency in 2003 and in mobilising WHO organizational resources to deliver on the global commitment to provide 3 million people with Ante-retroviral treatment by 2005. While many challenges remain in this, the over 700% increase in the number of people in Sub-Saharan Africa on treatment between 2003 and 2005 is testimony to this leadership.
According to the WHO website (http://www.who.int/dg/lee/tribute/en/), Dr Lee, in explaining his vision of "universal access" to staff a few days before his death, indicated that there could be no 'comfort level' in the fight against HIV, and that the commitment to universal access to treatment by 2010 would be measured by an outcome in 2010 that no-one dies because they can't get drugs. In another editorial in this issue we explore some of the issues this poses globally, and for the region.
The United Nations Secretary-General Kofi Annan declared " The world has lost a great man today. LEE Jong-wook was a man of conviction and passion. He was a strong voice for the right of every man, woman and child to health prevention and care, and advocated on behalf of the very poorest people."
In his very first speech to WHO staff as Director-General, Dr Lee vowed that WHO would do the right things, in the right places. The WHO tribute makes clear that to him, the right places were the countries that most needed WHO's support. He considered WHO's job as one of huge responsibility to its 192 Member States, and the health needs of their people. This country focus sharply raised a glaring issue: that of equity and the inequalities within and across countries in health and health care. In his address to the Fifty Seventh World Health Assembly in 2004 Dr Lee noted “We have yet to get to grips with the links between health, equity and development. The underlying theme of my first year as Director-General is equity and social justice”.
To support work in this area, WHO set up a Commission on the Social Determinants of Health to gather evidence on the social and environmental causes of health inequities, and how to overcome them. EQUINET values the focus that Dr Lee gave to these inequities in health and health care, and the wider responsibility he articulated for action on the conditions and policies causing them within the whole global community. As he noted in 2004: “Hopes of peace and security in the world fade where these inequities prevail”. We pay tribute to Dr Lee for his championing, at the helm of the WHO, these values and goals of equity and social justice. They are deeply shared by EQUINET.
Under the Rules of Procedure of the World Health Assembly, and in accordance with the decision of the Director-General, WHO has indicated that Dr Anders Nordström - currently Assistant Director-General for General Management - will serve as Acting Director-General.
For information on the institutions in the EQUINET Steering Committee see www.equinetafrica.org or contact EQUINET through firstname.lastname@example.org
While working on this month's issue we got news of the passing of an inspiring African thinker, Samir Amin, and then later in the month of the previous UN Secretary General Kofi Annan and pay our respects to both. In different ways and forums they challenged thinking and agendas from an African and southern lens. From Dakar, Senegal, where Samir Amin led the Third World Forum, Vijay Prashad notes that Amin explored and wrote about both the dangers and possibilities of our current world. In the face of a "world system with finance in dominance and people whipping from one precarious job to another" he pointed to both the need and possibility of Africa making different choices and creating and advancing an alternative. "As long as we are resisting, he would say, we are free." We include one of the many articles published on his work and ideas in this issue.
Back to our editorial this month on waiting mother shelters. Papers included in this issue point to a continuing research debate on their effectiveness, with one review finding no evidence of this from randomised control trials. Yet the evidence from experience of their use in Zimbabwe in the editorial suggests a need to think beyond measured service and morbidity outcomes to understand their value for improving wellbeing, and to understand how, beyond individual interventions, different elements of comprehensive primary health care come together to improve health and wellbeing.