EQUINET NEWSLETTER 5 : 26 July 2001

1. Editorial

ZAMBIA: Poverty and AIDS forces children onto streets
LUSAKA, 17 July (IRIN)

Pint-sized Edgar was 10 when he left his mother's shack in eastern Zambia to seek his fortune in Lusaka, the bustling capital of 1.3 million people.

The puny but plucky youngster had no inkling about life in the city, but he was not perturbed. Nothing, he thought, could be worse than the miserable life he had led in Lundazi.

It was an existence of few pleasures and endless chores. From morning, when he hauled several bucketfuls of water from a communal well half a kilometre away, to midnight, when the neighbourhood tavern at which he tried to sell his mother's hard-boiled eggs closed, the little boy knew no respite. When business was slow, his mother held him personally responsible and whipped him or denied him his supper, or both.

Two years on, Edgar has given up the quest for his fortune. He starts his day in the central business district, where he alternatively begs and runs errands to raise enough money for the imperative dose of "glue" - an intoxicating concoction of petrol and adhesives that the destitute sniff to dull the harsh realities of life on the streets. At midday, he walks over to Fountain of Hope, a non-governmental organisation outside the city centre that rehabilitates street children, for a free meal.

Edgar's life, multiplied many times over, represents the lot of thousands of the children that swarm the streets of Lusaka in a desperate quest for survival. Their number has risen markedly over the past few years, doubling to 75,000 since 1991.

The conventional wisdom is that the increase in their number is a direct consequence of HIV/AIDS. It is generally assumed that most of the children are forced onto the streets by poverty after one or both of their parents died of AIDS-related complications. According to the ministry of health, Zambia had around 520,000 AIDS orphans in 1999. That number is expected to rise to 895,000 by 2009 and to 974,000 by 2014.

"Perhaps half of all street children are orphaned children, indicating growing pressures on extended families to cope with the rapidly increasing orphan population," the ministry said in a report entitled 'HIV/AIDS in Zambia'.

However, new evidence suggests the HIV/AIDS pandemic is not necessarily the main reason that a growing number of Zambian children are living on the streets. To begin with, around half of the 75,000 street children in Lusaka are not orphans. Moreover, recent studies have revealed the lot of Zambian children with parents is no different from that of orphaned ones.

"There is little difference in economic status between orphan and non-orphan children. Seventy-five percent of orphan children are found in households living below the poverty line and 73 percent of non-orphan children are also living in households below the poverty line," the government's 1999 Situational Analysis of Orphans and Vulnerable Children points out. "These problems (of food shortages, poor health, inadequate education and bedding) actually affect all the children, orphan and non-orphan, and indeed, all the community members," the report added.

Moreover, there is a growing realisation that poverty is not the only factor that forces children to live on the streets. That, at least, has been the experience of Foundation of Hope, which deals with an average 500 street children per day, providing them with food, schooling and shelter.

"A lot of other factors besides poverty, including psychological pressures, force children to leave their homes. Some leave to escape abuse of one sort or another, and others are compelled to go on the streets by peer pressure,"
Fountain of Hope administrative officer Emmanuel Mukanda told IRIN.

According to Mukanda, children who leave their homes for reasons other than economic pressure tend to be more difficult to rehabilitate than those forced on the streets by poverty. "Those children who ran away from home often require intensive counselling. The others, who are forced onto the streets by poverty, are relatively easy to reform. Once their basic material needs are met, their main problems are over," he said.

The realisation that many children end up on the streets because of psychological pressures prompted Fountain of Hope to extend its counselling services to the parents of runaway children. "Many parents come here to look for their missing children, and we try to counsel them along with the children. Sometimes, we succeed in bridging their differences, and the children return home," said Mukanda.

Observers, including the government and UNICEF, see the misconception that destitution among Zambian children is largely AIDS-related as sometimes diverting communities away from effective interventions. They argue that while the plight of orphan and non-orphan poor children is broadly similar, their specific needs can be different.

"There is ... value in distinguishing between orphans and other vulnerable children when considering psychological support, protection of rights, interventions targeted to their specific status as orphans and epidemiological surveys," notes the government's Situational Analysis of Orphans and Vulnerable Children.

Moreover, Zambia, a country of 10 million people, has 19 non-governmental organisations whose core missions are to alleviate the plight of AIDS orphans. Few such organisations exist to address the concerns of destitute non-orphan children. However, there are signs that society is beginning to appreciate the fact that the problem of destitute children goes beyond AIDS orphans.

"Although communities start by looking at the needs of orphans, they soon reformulate their criteria to include other vulnerable children, namely those who are extremely poor," UNICEF notes in a report entitled, 'Children Orphaned by AIDS'.

Further details: /newsletter/id/28754

2. Equity in Health

South African Bishops Consider Condom Use

With millions of Africans dying from AIDS and millions more infected every year, a group of Roman Catholic clergy in southern Africa is debating whether the church should relax its ban on condom use.

South African Court Orders Man to Pay Wife Damages for Infecting Her With HIV

South African High Court acting Judge Naren Pandya last week ordered a man to pay his wife $116,400 (one million rand) in damages for infecting her with HIV, marking the first time in South Africa a woman has "claimed damages" for being "wilfully" infected with HIV by her husband.

UN Examines Conditions Related To Falling Birth Rates

Fertility rates in most high-fertility countries are declining, a UN workshop concluded last week, though some participants questioned whether this trend would continue, saying the decline was driven by crisis-- either by economic conditions or civil strife -- rather than by developments in social and economic conditions.

World Health Experts Fly in With TB Lifeline

World Health Organisation representatives will visit South Africa next month to assess whether the country qualifies for drugs being made available at hugely discounted prices which are effective against drug-resistant tuberculosis.

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3. Human Resources

Cracks in ANC's alliance widening

DIVISIONS within the African National Congress (ANC), and between the Congress of SA Trade Unions (Cosatu) and the SA Communist Party (SACP) over privatisation have been thrown into sharp relief at a top-level meeting called to iron out differences in the alliance on the issue. The meeting came as the ANC tries to head off next month's anti privatisation strike by Cosatu. At the same time it is seeking consensus on the restructuring of state assets in the run-up to a two-day alliance meeting scheduled for August 17- 18.

Health Department to Employ Iingcibi in Bid to Curb Deaths

In a move to curb Xhosa initiate deaths and mutilations the Health Department would employ experienced iincgibi (traditional surgeons) to perform circumcisions said Eastern Cape Health Department spokesperson Mahlubandile Magida yesterday.

Mozambique: Warning On AIDS Risk for Child Labour

UNICEF warned on Monday that child labourers in Mozambique were at a high risk of contracting HIV/AIDS and said it would encourage the government to find ways to stop child labour.

Zimbabwe: Health Services Crippled As Doctors, Nurses Strike

A strike by government doctors and nurses crippled state hospital services in the country's main cities on Wednesday, AP reported. Quoting the Hospital Doctors Association, the agency said about 350 doctors stopped work on Tuesday in the cities of Harare, the capital, and Bulawayo, the second city, demanding better salaries and allowances.

4. Public-Private Mix

MALAWI SUSPENDS PRIVATIZATION PROGRAMME

Malawian authorities said Monday the countrys privatisation programme had been suspended for review following a cabinet decision early this month. "It's a moment of soul searching. We want to look back at what we have done and see whether we are in the right direction," Charles Msosa, principal secretary for privatisation, told AFP. Malawi has privatised 36 of its 100 loss-making parastatals since the program begun in 1995.

Public-private partnerships: illustrative examples

This background paper by Adetokunbo Lucas describes how collaboration between the public and private sectors can be productive and successful, providing opportunities to achieve goals that could not be achieved by either sector working alone.

Putting policy into practice: can local government cope?

Increasingly, the debate over private sector involvement in the delivery of urban water services is addressing pro-poor policies and transactions. Yet, improvements in policy are not being accompanied by support for implementation and little emphasis is being placed on how local governments will cope with such complex processes. What capacity do municipalities need to make policy frameworks work in practice? How do municipalities change from 'providers' to 'enablers' and 'promoters'? How do municipalities focus partnerships on the poor?

Why should governments serve the poor?

Is government responsible for ensuring public health? Is it necessary for public entities to deliver this public good? Who else might serve the unprofitable urban poor?

5. Resource allocation and health financing

Condom gap in Africa: evidence from donor agencies and key informants

Public discussions on combating HIV in Africa seem to be focusing on antiretroviral drugs rather than condoms, which are the mainstay of prevention. In sub-Saharan Africa most condoms are bought with funds from donors, although a few countries (such as South Africa and Botswana) buy them from national funds. We assessed provision of condoms in these countries.

Nigerian Government to Exclude People With HIV/AIDS from National Health Insurance Plan

The Nigerian government has drafted a plan for a national health insurance program that would eventually provide coverage for "all Nigerians," but certain individuals with "[h]igh-cost illnesses" such as HIV/AIDS would not be eligible to join, the Lancet reports.

Services for children with communication disorders
parents and professionals speak out

How can health services meet the needs of children with communication disorders in developing countries? What can health professionals and parents add to the debate? A study by the UK Institute of Child Health sought the opinions of specialist professionals and parents of children with communication disorders in Nigeria.

What mothers do: responses to childhood fever on the Kenyan Coast

Do rural and urban mothers differ in their choice of health providers when their children are ill? How does proximity to different health facilities affect a mother's decision? These questions are important for health planners responding to rising urban poverty and ill health, as sub-Saharan Africa has the highest rates of urbanisation in the developing world.

6. Governance and participation in health

WHO CIVIL SOCIETY INTIATIVE

In a response to pressures from civil society organisations (CSOs) internationally, especially through the People's Health Assembly held in Dhaka in December 2000, the World Health Organisation (WHO) has finally conceded the importance of engaging with CSOs. Commenting on the formation of the WHO Civil Society Intiative, Eva Wallstam, Director, said: "This is a time when the Health for All core values of equity, dignity and human rights, need to be more clearly articulated ... For WHO this means reaching out, beyond the formal health sector to other partners and to a wide range of civil society actors." The full text of her speech is available below.

Further details: /newsletter/id/28765
Contact: skoldm@who.ch

7. Monitoring equity and research policy

Slow progress? Monitoring HIV disease in Uganda

Understanding HIV disease progression is critical for planning healthcare strategies in developing countries. What is the best way to monitor disease progression in the absence of laboratory tests? How does HIV/AIDS in sub-Saharan Africa differ from developed regions? A study by the Liverpool School of Tropical Medicine and the Uganda Virus Research Institute addressed these issues.

8. Useful Resources

ATCnet Database for the African Health and HIV-AIDS Crisis

ATCnet has launched an easily accessible Internet database for the African Health and HIV-AIDS Crisis to consolidate information about organizations and individuals that are working to combat the crisis. There is a growing global appreciation of the enormity of the health and HIV-AIDS crisis in Africa. With this database it will be possible to publicize the enormous amount of work that African organizations and individuals are doing in Africa to address the pandemic.

Further details: /newsletter/id/28733
Global DOTS expansion plan

This report provides the first assessment of the status of TB control financing and the resources needed to expand DOTS coverage in the 22 countries with the highest estimated number of cases. Available from the CDS Information Resource Centre.

Information and resources on hepatitis A and hepatitis E

Overviews of the virus, the disease, surveillance and control, prevention and treatment. A glossary and extensive list of references are also provided.

LoveLife: Working to Protect South African Youth from HIV

This Web site details the loveLife initiative, which attempts to reduce HIV infection among South African adolescents by promoting sexual health and healthy futures for young people. The National Survey of South African Youth is available (you need Adobe Acrobat reader to access the chapters of the report), as well as a resource guide to HIV/AIDS in South Africa. Lastly, information about how the project is reaching out to youth--as well as adults--is detailed.

Search global population and health data

This database contains data on 85 demographic variables for 221 countries in the world, for 28 world regions and sub-regions, for the world as a whole, for the United States as a whole, and for the 50 states and the District of Columbia. Variables include data on family planning, reproductive health, youth sexual activity, breastfeeding, and women's political participation.

9. Jobs and Announcements

29th Annual Conference - The Global Health Council
28-31 May 2002, Washington DC, USA

The Global Health Council invites healthcare providers, community organizers, program managers, policy makers, researchers, and advocates from around the world to submit abstracts for presentation at their 29th Annual Conference, 28-31 May 2002, in Washington, D.C. Abstracts are being solicited to present research and experience (in Panel Sessions, Roundtable Sessions, and/or Poster Presentations)that: 1) Further defines the challenges of global health in times of crisis, and 2) Identifies effective policies and programs to improve the health status of populations, especially of vulnerable groups. For full description refer to the online Call for Abstracts available in the Annual Conference section on GHC's website.

Further details: /newsletter/id/28742
ADMINISTRATIVE OFFICER, HARARE, ZIMBABWE
World Health Organization

Provide administrative support for operation of DPM's office. Contact Human Resources.

CHIEF OF PARTY FOR A PROGRAM OF ORPHANS CARE & SUPPORT

Manage a program to advance the learning and practice of community-based support and care of children affected by HIV/AIDS and oversee the development of relationships with stakeholders.
Contact Jenny Marion.

Global forum for health research 5
Geneva, 9-12 October 2001

The overall objective of Forum 5 is to review progress in addressing the fact that less than ten percent of health research funding tackles 90 percent of the world's health problems. Participants will include policy-makers, researchers, donors and administrators. See the website or email for more information.

LECTURER
SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF THE WESTERN CAPE

UWC's School of Public Health provides health and welfare personnel with the necessary tools to facilitate the process of transformation in the country's health and welfare sectors. The UWC SOPH has established itself as a national leader in public health teaching, research and service development: Its innovative educational and research activities focus on the implementation of district health systems. To qualify for this post, you will need a qualification in the Health Sciences gained at tertiary level, together with a minimum of a Masters degree, preferably in public health, primary health care or a related field. Possession of a doctoral degree would be an advantage. Proven experience in the development and management of health systems and programmes, as well as in health systems research is highly desirable, as is experience in the teaching and supervision of postgraduate students. Closing date: 3 August 2001.

Further details: /newsletter/id/28766
MEDICAL OFFICER/SCIENTIST
World Health Organization, Department of Reproductive Health & Research

11-month appointment. Lead the clinical research program and further develop the network of collaborating centres in developing countries. Contact TMM Farley.