Ann-Louise Colgan, Research Associate, Africa Action April, 2002.
Health is a fundamental human right, recognized in the Universal Declaration of Human Rights (1948), and the Constitution of the World Health Organization (1946). Health is also an essential component of development, vital to a nation's growth and internal stability. Over the past two decades, the World Bank and International Monetary Fund (IMF) have undermined Africa's health through the policies they have imposed. The dependence of poor and highly indebted African countries on World Bank and IMF loans has given these institutions leverage to control economic policy-making in these countries. The policies mandated by the World Bank and IMF have forced African governments to orient their economies towards greater integration in international markets at the expense of social services and long-term development priorities. They have reduced the role of the state and cut back government expenditure.
While many African countries succeeded in improving their health care systems in the first decades after independence, the intervention of the World Bank and IMF reversed this progress. Investments in health care by African governments in the 1970s achieved improvements in key health indicators. In Kenya, for example, child mortality was reduced by almost 50% in the first two decades after independence in 1963 [1]. Across sub-Saharan Africa, the first decades after independence saw significant increases in life expectancy, from an average of 44 years to more than 50 years [2].
In the 1980s and 1990s, however, African governments had to cede control over their economic decision-making in order to qualify for World Bank and IMF loans. The conditions attached to these loans undid much of the progress achieved in public health. The policies dictated by the World Bank and IMF exacerbated poverty, providing fertile ground for the spread of HIV/AIDS and other infectious diseases. Cutbacks in health budgets and privatization of health services eroded previous advances in health care and weakened the capacity of African governments to cope with the growing health crisis. Consequently, during the past two decades the life expectancy of Africans has dropped by 15 years [3].
Africa Action calls for an end to World Bank and IMF policies that undermine health. This requires canceling the debts that prevent African governments from making their full contribution to addressing the health crisis. It also requires ending the imposition of harmful economic policies as conditions for future loans or grants. This position paper provides a brief background overview of World Bank and IMF policies. It focuses particularly on their impact on health.
1. The World Bank and IMF in Africa The World Bank and IMF were created at the Bretton Woods Conference in New Hampshire, U.S.A., in 1944. They were designed as pillars of the post-war global economic order. The World Bank's focus is the provision of long-term loans to support development projects and programs. The IMF concentrates on providing loans to stabilize countries with short-term financial crises. The World Bank and IMF became increasingly powerful in Africa with the economic crisis of the early 1980s. In the late 1970s, rising oil prices, rising interest rates, and falling prices for other primary commodities left many poor African countries unable to repay mounting foreign debts. In the early 1980s, Africa's debt crisis worsened. The ratio of its foreign debt to its export income grew to 500% [4]. African countries needed increasing amounts of "hard currency" to repay their external debts (i.e.
convertible foreign currencies such as dollars and deutschmarks). But their share of world trade was decreasing and their export earnings dropped as global prices for primary commodities fell. The reliance of many African countries on imports of manufactured goods, which they themselves did not produce, left them importing more while they exported less. Their balance of payments problems worsened and their foreign debt burdens became unsustainable.
African governments needed new loans to pay their outstanding debts and to meet critical domestic needs. The World Bank and IMF became key providers of loans to countries that were unable to borrow elsewhere. They took over from wealthy governments and private banks as the main source of loans for poor countries. These institutions provided "hard currency" loans to African countries to insure repayment of their external debts and to restore economic stability. The World Bank and IMF were important instruments of Western powers during the Cold War in both economic and political terms. They performed a political function by subordinating development objectives to geostrategic interests. They also promoted an economic agenda that sought to preserve Western dominance in the global economy. Not surprisingly, the World Bank and IMF are directed by the governments of the world's richest countries. Combined, the "Group of 7" (U.S., Britain, Canada, France, Germany, Italy and Japan)
hold more than 40% of the votes on the Boards of Directors of these institutions. The U.S. alone accounts for almost 20% [5]. It was U.S. policy during the Reagan Administration in the early
1980s, to expand the role of the World Bank and IMF in managing developing economies [6]. The dependence of African countries on new loans gave the World Bank and IMF great leverage. The conditions attached to these loans required African countries to submit to economic changes that favored "free markets." This standard policy package imposed by the World Bank and IMF was termed "structural adjustment." This referred to the purpose of correcting trade imbalances and government deficits. It involved cutting back the role of the state and promoting the role of the private sector. The ideology behind these policies is often labeled "neo-liberalism," "free market fundamentalism,"or the "Washington Consensus." From the 1970s on, this orientation became the dominant economic paradigm for rich country governments and for the international financial institutions. The basic assumption behind structural adjustment was that an increased role for the market would bring benefits to both poor and rich. In the Darwinian world of international markets, the strongest would win out. This would encourage others to follow their example. The development of a market economy with a greater role for the private sector was therefore seen as the key to stimulating economic growth. The crisis experienced by African countries in the early 1980s did expose the need for economic adjustments. With declining incomes and rising expenses, African economies were becoming badly distorted. Corrective reforms became increasingly necessary. The key issue with adjustments of this kind, however, is whether they build the capacity to recover and whether they promote long-term development. The adjustments dictated by the World Bank and IMF did neither.
African countries require essential investments in health, education and infrastructure before they can compete internationally. The World Bank and IMF instead required countries to reduce state support and protection for social and economic sectors. They insisted on pushing weak African economies into markets where they were unable to compete with the might of the international private sector. These policies further undermined the economic development of African countries.
2. What is Structural Adjustment? Structural adjustment refers to a package of economic policy changes designed to fix imbalances in trade and government budgets.
In trade, the objective is to improve a country's balance of payments, by increasing exports and reducing imports. For budgets, the objective is to increase government income and to reduce expenses. In theory, achieving these goals will enable a country to recover macroeconomic stability in the short-term. It will also set the stage for long-term growth and development. The structural adjustment programs of the early 1980s were meant to provide temporary financing to borrowing countries to stabilize their economies. These loans were intended to enable governments to repay their debts, reduce deficits in spending, and close the gap between imports and exports. Gradually, these loans evolved into a core set of economic policy changes required by the World Bank and IMF. They were designed to further integrate African countries into the global economy, to strengthen the role of the international private sector, and to encourage growth through trade. Typical components of adjustment programs included cutbacks in government spending, privatization of government-held enterprises and services, and reduced protection for domestic industry. Other types of adjustment involved currency devaluation, increased interest rates, and the elimination of food subsidies. The underlying intention was to minimize the role of the state.
World Bank and IMF adjustment programs differ according to the role of each institution. In general, IMF loan conditions focus on monetary and fiscal issues. They emphasize programs to address inflation and balance of payments problems, often requiring specific levels of cutbacks in total government spending. The adjustment programs of the World Bank are wider in scope, with a more long-term development focus. They highlight market liberalization and public sector reforms, seen as promoting growth through expanding exports, particularly of cash crops. Despite these differences, World Bank and IMF adjustment programs reinforce each other. One way is called "cross-conditionality." This means that a government generally must first be approved by the IMF, before qualifying for an adjustment loan from the World Bank. Their agendas also overlap in the financial sector in particular. Both work to impose fiscal austerity and to eliminate subsidies for workers, for example. The market-oriented perspective of both institutions makes their policy prescriptions complementary.
Adjustment lending constitutes 100% of IMF loans. In 2001, approximately 27% of World Bank lending to African countries was for "adjustment." In the World Bank's total loan portfolio, adjustment lending generally accounts for between one-third and one-half [7]. The remainder of World Bank loans are disbursed for development projects and programs. The project portfolio of the Bank covers such areas as infrastructure, agricultural and environmental development, and human resource development. In some cases, the projects supported by World Bank loans do make useful contributions to development. But these occasional successes must be weighed against the negative effects of increasing debt, imposed economic policies and their consequences. The past two decades of World Bank and IMF structural adjustment in Africa have led to greater social and economic deprivation, and an increased dependence of African countries on external loans. The failure of structural adjustment has been so dramatic that some critics of the World Bank and IMF argue that the policies imposed on African countries were never intended to promote development. On the contrary, they claim that their intention was to keep these countries economically weak and dependent. The most industrialized countries in the world have actually developed under conditions opposite to those imposed by the World Bank and IMF on African governments. The U.S. and the countries of Western Europe accorded a central role to the state in economic activity, and practiced strong protectionism, with subsidies for domestic industries. Under World Bank and IMF programs, African countries have been forced to cut back or abandon the very provisions which helped rich countries to grow and prosper in the past. Even more significantly, the policies of the World Bank and IMF have impeded Africa's development by undermining Africa's health. Their free market perspective has failed to consider health an integral component of an economic growth and human development strategy. Instead, the policies of these institutions have caused a deterioration in health and in health care services across the African continent.
3. Poverty and Health Care Cuts Health status is influenced by socioeconomic factors as well as by the state of health care delivery systems. The policies prescribed by the World Bank and IMF have increased poverty in African countries and mandated cutbacks in the health sector. Combined, this has caused a massive deterioration in the continent's health status.
The health care systems inherited by most African states after the colonial era were unevenly weighted toward privileged elites and urban centers. In the 1960s and 1970s, substantial progress was made in improving the reach of health care services in many African countries. Most African governments increased spending on the health sector during this period. They endeavored to extend primary health care and to emphasize the development of a public health system to redress the inequalities of the colonial era. The World Health Organization (WHO) emphasized the importance of primary healthcare at the historic Alma Ata Conference in 1978. The Declaration of Alma Ata focused on a community-based approach to health care and resolved that comprehensive health care was a basic right and a responsibility of government. These efforts undertaken by African governments after independence were quite successful. There were increases in the numbers of health professionals employed in the public sector, and improvements in health care infrastructure in many countries. There was also some success in extending care to formerly unserved areas and populations. Across the continent, there were improvements in key health care indicators, such as infant mortality rates and life expectancy. In Zambia, the post-independence government expanded public health care services throughout the country. The number of doctors and nurses was also significantly increased during this time. Infant mortality was reduced from 123 per 1,000 live births in 1965, to 85 in 1984 [8]. In Tanzania, during the first two decades of independence, the government succeeded in expanding access to health care nationwide. By 1977, more than three-quarters of Tanzania's population lived within 5 km of a health care facility [9]. While the progress across the African continent was uneven, it was significant, not only because of its positive effects on the health of African populations. It also illustrated a commitment by African leaders to the principle of building and developing their health care systems.
With the economic crisis of the 1980s, much of Africa's economic and social progress over the previous two decades began to come undone. As African governments became clients of the World Bank and IMF, they forfeited control over their domestic spending priorities. The loan conditions of these institutions forced contraction in government spending on health and other social services. Poverty and Health The relationship between poverty and ill-health is well established. The economic austerity policies attached to World Bank and IMF loans led to intensified poverty in many African countries in the 1980s and 1990s. This increased the vulnerability of African populations to the spread of diseases and to other health problems. The public sector job losses and wage cuts associated with World Bank and IMF programs increased hardship in many African countries. During the 1980s, when most African countries came under World Bank and IMF tutelage, per capita income declined by 25% in most of sub-
Saharan Africa [10]. The removal of food and agricultural subsidies caused prices to rise and created increased food insecurity. This led to a marked deterioration in nutritional status, especially among women and children. In Zambia, for instance, following the elimination of food subsidies, many poor families had to reduce the number of meals per day from two to one [11]. Malnutrition resulted in low birth weights among infants and stunted growth among children in many countries. It is currently estimated that one in every three children in Africa is underweight [12]. In general, between one-quarter and one-third of the population of sub-Saharan Africa is chronically malnourished. The deepening poverty across the continent has created fertile ground for the spread of infectious diseases. Declining living conditions and reduced access to basic services have led to decreased health status. In Africa today, almost half of the population lacks access to safe water and adequate sanitation services [13]. As immune systems have become weakened, the susceptibility of Africa's people to infectious diseases has greatly increased. A joint release issued by the WHO and the Joint UN Programme on HIV/AIDS (UNAIDS) in April 2001 reports that the number of cases of tuberculosis in Africa will reach 3.3 million per year by 2005 [14]. The WHO reported in 2001 that almost 3,000 Africans die each day of malaria. Each year in Africa, the disease takes the lives of more than 500,000 children below the age of five [15]. Most devastating of all has been the impact of the HIV/AIDS pandemic. The spread of HIV/AIDS in Africa has been facilitated by worsening poverty and by the conditions of inequality intensified by World Bank and IMF policies. Economic insecurity has reinforced migrant labor patterns, which in turn have increased the risk of infection. Reduced access to health care services has increased the spread of sexually transmitted diseases and the vulnerability to HIV infection.
1. Editorial
2. Equity in Health
Organized by the Rockefeller Foundation in collaboration with the World Bank and the World Health Organization. The growing efforts to combat HIV/AIDS, malaria and tuberculosis have the potential to bring major benefits to the disadvantaged, as well as produce an important reduction in overall disease burden. However, realizing this potential and securing better health among less favored populations will require a determined effort. There is need both to modify the inequitable patterns of disease risks and consequences and to pursue aggressively a more equitable distribution of benefits from programs dealing with HIV/AIDS, malaria and tuberculosis.
The Global Fund to Fight AIDS, Tuberculosis and Malaria announced its first round of grants to country programmes to prevent and treat the three diseases on Thursday.
Three high-profile organisations are throwing their weight behind the Treatment Action Campaign (TAC) in its protracted legal battle with the government to widen access to the anti-HIV drug, Nevirapine. Cotlands, one of SA's best-known baby sanctuaries, the Institute for Democracy in SA (Idasa) and the Community Law Centre (CLC) are hoping to add their arguments to next month's Constitutional Court case, which will settle the long-running dispute between TAC and the government over the provision of Nevirapine to HIV-positive pregnant women in public healthcare facilities.
A new effort to assess the quality of HIV medicines could make treatment services more accessible to poor countries. The World Health Organization (WHO) has evaluated several HIV-related medicines and has published the first list of products which were found to meet WHO recommended standards. This initial phase of the project includes forty products from eight branded and generic manufacturers. Managed by WHO, the initiative counts on the expertise of UNICEF and the UNAIDS Secretariat, and is supported by the UN Population Fund (UNFPA) and the World Bank.
President Thabo Mbeki and his cabinet have at last backed off from their controversial stance on antiretroviral drugs, with a high-powered government delegation announcing before journalists that the health department is working on a universal roll-out plan of nevirapine. In a first admission of the efficacy of the drugs, Health Minister Manto Tshabala-Msimang read from the executive's statement: "Cabinet noted that they (antiretrovirals) could help improve the conditions of people living with AIDS if administered at certain stages in the progression of the condition, in accordance with international standards."
THE Medicines Control Council says it is to go ahead with an investigation into the safety of nevirapine, the drug that prevents motherto-child transmission of HIV. The council's investigation comes a month after nevirapine's manufacturers, Boehringer Ingelheim, informed the council that it had withdrawn its application to register the drug with the US Food and Drug Administration (FDA) for use in the prevention of mother-to-child transmission of HIV.
United Nations HIV/AIDS experts believe HIV/AIDS prevalence in Zanzibar is on a steady increase, but are worried that currently available data could be underestimating the actual magnitude of the pandemic in the semi-autonomous islands.
A shipment of 10 million condoms, imported by the United Nations Fund for Population Activities (UNFPA) for free distribution across Tanzania, is currently being held in Dar es Salaam harbour, awaiting clearance after confusion as to whether they have passed quality control requirements.
Despite flaws in documentation and reporting in clinical trials of HIVNET 012 found by the United States' National Institute for Health, the World Health Organization and UNAIDS say they will still back prevention of mother to child transmission with the use of Nevirapine.
22 April 2002, Geneva. In a decisive move to strengthen action against AIDS in developing countries, WHO today announced the first treatment guidelines for HIV/AIDS in poor settings. Parallel to that, WHO has endorsed the inclusion of AIDS medicines in its Essential Medicines List. The action is a breakthrough in a comprehensive ?prevention through care? package that could contribute to drastically widening access to treatment over the coming years. The Guidelines for Scaling Up Antiretroviral Therapy and the 2002 WHO Model List of Essential Drugs are available on the WHO web site.
Pages
3. Human Resources
In an earlier article, the authors outline some reasons for the disappointingly small effects of primary health care programs and identified two weak links standing between spending and increased health care. The first was the inability to translate public expenditure on health care into real services due to inherent difficulties of monitoring and controlling the behavior of public employees. The second was the "crowding out" of private markets for health care, markets that exist predominantly at the primary health care level. This article presents an approach to public policy in health that comes directly from the literature on public economics. It identifies two characteristic market failures in health. The first is the existence of large externalities in the control of many infectious diseases that are mostly addressed by standard public health interventions. The second is the widespread breakdown of insurance markets that leave people exposed to catastrophic financial losses. Other essential considerations in setting priorities in health are the degree to which policies address poverty and inequality and the practicality of implementing policies given limited administrative capacities. Priorities based on these criteria tend to differ substantially from those commonly prescribed by the international community.
4. Public-Private Mix
Bowling Alone. The collapse and revival of American community. RD Putnam. New York: Simon & Schuster, 2000, pp.544, ISBN: 0 684 83283 6. Carles Muntanera, Department of Behavioral and Community Health, and Department of Epidemiology and Preventive Medicine, University of Maryland-Baltimore, USA. John Lynchb, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor Michigan, USA. International Journal of Epidemiology Vol;31:261-267 - 2002. The authors present an overview of Putnam's claims, their supporting evidence, and several consequences of the BA hypothesis for epidemiology and public health. They argue that the omission of class, race and gender relations and political variables from research on community trust and norms of reciprocity limits the usefulness of social capital as framework for social epidemiology. Next, they link the current theoretical emphasis on social cohesion to earlier social science attempts at advancing the beneficial effects of lack of conflict in Europe and the US.
US Secretary of Health Tommy G. Thompson signed a cooperative agreement that will provide nearly $1 million from the Centers for Disease Control and Prevention to fight HIV/AIDS in a public-private partnership in South Africa. The agreement with the American Center for International Labor Solidarity reflects the department's commitment to continue the HIV/AIDS employee outreach programme at the Ford Motor Company's operations in South Africa. The signing of the agreement came during Thompson's week-long trip to Africa that included stops in Mozambique, South Africa, Botswana and Cote d'Ivoire. Thompson's visit builds upon the Bush administration's strong support for the Global Fund to Fight AIDS, Tuberculosis and Malaria. For more information, please contact Richard Delate.
Anne Mills, Health Policy Unit, London School of Hygiene and Tropical Medicine. Ruairi Brugha, Kara Hanson, Barbara McPake. Bulletin of the World Health Organization 2002;80(4):325-330. April 2002. Available on PDF. A very large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. How can the activities of the private sector in these countries be influenced so that they help to meet national health objectives? Although the evidence base is not good, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behaviour of providers and on what might be the necessary conditions for success. There is much less evidence, however, of effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments.
5. Resource allocation and health financing
Tim France, Gorik Ooms and Bernard Rivers (21 April 2002).
Nearly one year ago, the majority of the world's nations resolved at `UNGASS', a major UN conference on AIDS, to increase annual expenditure on the AIDS epidemic to $7-10 billion by 2005, with much of this money to be raised and disbursed by a new global fund. When the fund was eventually set up, its mandate was extended, and it was named the Global Fund to Fight AIDS, Tuberculosis and Malaria. AIDS, an unprecedented and accelerating emergency, is already having a devastating impact in Africa, with similar impacts unfolding on other continents. Every day, 8,000 die, and 13,000 more become infected. Experts agree that reasonable expenditures on prevention and treatment of AIDS, tuberculosis and malaria can be of dramatic benefit not only to human health, but also to economic development. Thus far, efforts have been made to raise the money needed by the Global Fund through ad hoc voluntary donations. These efforts have failed. Governments have pledged a mere $1.8 billion. Contributions from the private sector have been even more disappointing, with not a single meaningful pledge since the Bill & Melinda Gates Foundation offered $100 million ten months ago. It's time for a new approach.
6. Governance and participation in health
Narayan, Deepa and Patti Petesch, 2002. Voices of the Poor: From Many Lands. New York, N.Y: Published for the World Bank, Oxford University Press. "From Many Lands," the third and last volume of the Voices of the Poor series, presents 14 country case studies in Africa (Ghana, Malawi, Nigeria), South and East Asia (Bangladesh, India, Indonesia), Europe and Central Asia (Bosnia, Bulgaria, Kyrgyz Republic, Russia), and Latin America and the Caribbean (Argentina, Brazil, Ecuador, Jamaica). Using participatory and qualitative research methods, the study presents the realities of poor people's lives directly through their own voices, with a concluding chapter on an empowering approach to development.
25 April 2002 | Geneva | To meet the 2010 target of cutting malaria deaths in half - agreed in Abuja by African leaders on this day two years ago - community mobilization is essential in controlling the disease and providing prompt access to treatment. Powerful new combination therapies, including the Chinese herb derivative artemisinin, are highly effective against malaria and the parasite does not easily develop resistance to them. New financial arrangements are needed so that developing countries can make use of these medicines, which are much more expensive than conventional, increasingly ineffective ones.
The Third Forum of the World Alliance of Cities against Poverty (WACAP) held in Huy, Belgium, from 10-12 April, provided an opportunity for representatives to develop partnerships. Participants from 96 countries shared experiences on how they are becoming increasingly involved in addressing the impact of HIV/AIDS, particularly on women. The Alliance of Mayors Initiative for Community Action on AIDS (AMICAALL), set up with support from UNAIDS to help translate the goals of the IPAA into concrete actions, is multisectoral and emphasises partnerships between local government, civil society, including the private sector and communities, mayors and municipal leaders in Africa. Through their strategy they are working through exiting cities' networks as well as with other partners and networks to ensure that HIV/AIDS is integrated into municipal agendas. For more information please contact Mina Mauerstein-Bail.
With the support of the Robert Wood Johnson Foundation, Health Services Research (HSR) is planning a special issue focusing on the social determinants of health, to provide a forum for presenting the latest research and policy analysis to a broad audience of researchers, practitioners, and policymakers. There is ample evidence that most health policymakers, both at state and federal levels, do not understand how policy relating to non-medical determinants of health can be incorporated into health policy. Conversely, policymakers in such fields as education, transportation, or housing rarely see that there are major health implications to the choices that they make. Education is needed in both directions. Topics of interest include but are not limited to social inequalities in health by socioeconomic position, race/ethnicity, gender, etc.; the role of a broad range of psychosocial factors in health at the level of individuals, neighborhoods, and communities, and broader sociopolitical units; the interconnections and interactions between and among social and biological-chemical-physical determinants of health; and implications of social determinants of health for health care or health services research, practice, and policy. Jim House, Nicole Lurie, and Catherine McLaughlin will serve as co-editors of the special HSR issue. September 1, 2002 is the deadline for submission. The planned publication date is July 2003.
Claudio Schuftan
The People's Charter for Health (PCH), The PHM's manifesto, is one and a half years old. It has been disseminated quite widely world-wide.
2. The world has moved on since. But, clearly, for the worse in almost all fronts the PHM has strong feelings about. Most worrisome is the fact that most of the world's shifts for the worse have become so depressingly predictable, and nobody seems to be succeeding in doing much about them.
3. The PCH's 'Call for Action' predicted much of what we are witnessing; we were "on the dot". So, to continue to be "on the dot", we simply have to reassess where we are and what we have, and have not, achieved. Just to make yet further predictions of doom would be to utterly fail all that and those we stand for.
7. Monitoring equity and research policy
"As scientists and clinicians, we share a deep commitment to our patients and the public health of our nation. We have conducted and/or supported research aimed at decreasing vertical transmission. We remain fully committed to the implementation, within the broader government programme for AIDS prevention and care, of a national programme against vertical transmission, and to do further research in support of this goal. There is strong evidence in support of the use of antiretrovirals to reduce vertical transmission. The challenge remains in translating these research findings into policy and practice in South Africa."
8. Useful Resources
This new website from the John Hopkins Centre for Communication Programmes is an update and expansion of the Condoms CD-ROM first published in 1999 by JHU/CCP's POPLINE Digital Services. The website has ideas on designing condom promotion campaigns and putting together condom counselling information. You will also find calendars, flipcharts, kits and manuals, novelties, pamphlets, posters, research abstracts, and audio-visual materials from around the world.
The International HIV/AIDS Alliance is an international development non-governmental organisation which was established to respond to the need for a specialist, professional intermediary organisation which would work in effective partnership with non-governmental and community-based organisations in developing countries, as well as with governments, donors and the UN system. The Alliance's mission is to support communities in developing countries to play a full and effective role in the global response to AIDS. In some countries the Alliance supports linking organisations, in others the Alliance supports field partners. The Alliance currently has three field offices: in India, Ukraine and Zambia. The secretariat is based at Queensberry House, 104-106 Queens Road, Brighton BN1 3XF, United Kingdom, and the Alliance website has a number of useful links, updates and publications.
EngenderHealth, a nonprofit agency working to improve women's health worldwide, today (9 April, 2002) released two online minicourses to support the international network of family planning and sexual and reproductive health providers in their efforts to prevent the transmission of HIV/AIDS and other sexually transmitted infections (STIs). The two new courses, entitled Sexually Transmitted Infections and HIV and AIDS, are part of EngenderHealth's Web-based series Topics in Reproductive Health (the first course in the series, Sexuality and Sexual Health, was released last fall). They will provide health care providers, especially those in resource-poor settings, with knowledge and strategies for addressing HIV/AIDS and STI prevention, management, and counseling with their clients. Developed by EngenderHealth through a grant from the Bill & Melinda Gates Foundation, the courses are now available online or on CD-ROM. For more information, contact Carrie Svingen, EngenderHealth, NY, at 212-561-8538 or by email.
The Editors of the Journal of Epidemiology & Community Health are pleased to inform authors and reviewers of its new online submission and review system. Bench>Press is a fully integrated electronic system which uses the internet to allow rapid and efficient submission of manuscripts, as well as the entire peer review process to be conducted online. Authors can submit their manuscript in any standard word processing software. Graphic formats acceptable are: .jpg, .tiff, .gif, and eps. Text and graphic files are automatically converted to PDF for ease of distribution and reviewing purposes. Authors are asked to approve their submission before it formally enters the reviewing process. Full instructions can be found on Bench>Press, and JECH Online. Please contact Natalie Davies, Project Manager, for further information.
The first phase of the new MASSIVE EFFORT CAMPAIGN website was recently launched. The site will soon be featuring: 1) World reports, photos and interviews from World TB Day activities around the world. 2) Opportunities to lobby decision makers about the importance of controlling TB. 3) A means to involve others in a global campaign against AIDS, TB, malaria
and other diseases of poverty. 4) Background on the new global campaign to mobilise society against diseases that keep people in poverty.
The Open Society Institute (OSI) teamed with EBSCO Publishing to launch the Electronic Information For Libraries Direct (EIFL Direct) project in october of 1993. With funding from the Soros Foundation, EIFL Direct provided a variety of the world's finest full text and bibliographic databases to Public and Academic libraries in 39 participating countries, including 10 countries in Southern Africa. But funding for continuation of this project was not made available for several Southern African countries in 2001. Recently, however, OSISA (Open Society Initiative for Southern Africa)'s ICT Program has provided the necessary funding to once again allow these libraries to enjoy access to these large collections. Moreover, the number of developing nations now accessing these databases is even larger than the original group that participated in EIFL Direct. For further details and enquiries on how your NGO can access Electronic journals, do contact Colleen Mills at EBSCO.
The Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa (AMICAALL) website was launched this month to facilitate information dissemination and the sharing of experiences. The website is available in French and English. It includes information on AMICAALL strategy, the UN/AMICAALL Partnership Programme, country activities, Alliance contacts, documents and publications. For more information, please contact Milica Tomasevic.
The South African Health Review 2001 was launched on the 26th of March 2002. It consists of 17 Chapters dealing with various aspects of the Health Care System. Also, the section on Health Indicators has been updated and is also available for searching purposes.
9. Jobs and Announcements
ATTN MARCH FOR LIFE July 7 2002 at 4:00pm in Barcelona, Spain. We ask for your and your organization's endorsement of the July 7th 2002 ATTN(AIDS Therapeutic Treatment Now) March to take place in Barcelona, Spain immediately prior to the opening ceremonies of the WorldAIDS Conference. If you are able to do so, please complete the endorsement information and respond via email. GOAL: To secure a global commitment for the treatment of 2 million people living with and dying from HIV/AIDS before the next International AIDS
Conference in Bangkok, Thailand in 2004. Please join us, through your endorsements, your presence in Barcelona on July 7, and through your ongoing contribution and commitment to this struggle for AIDS Therapeutic Treatment Now.
Arusha, Tanzania. Global Forum launches invitations to Forum 6 - a policy meeting on the 10/90 gap - will bring together decision-makers in the field of health, health research, development, foreign aid and media to present their latest results and contribute ideas for the next stages of work in health research for development and the fight against poverty.
18-20 September 2002, The Barbican Centre, London UK.
The second annual conference and exhibition of the International eHealth Association (IeHA), eHealth2002 promises to be the most significant international eHealth event to date with presentations from more than 80 eminent leaders in global health, health technology, research and education and participants from 40 different countries. The IeHA is a non-profit organization whose mission is to improve the health and quality of life for all through the effective electronic support of healthcare, on-line medical education, health information and medical research. The eHealth2002 programme will consist of three tracks, eHealth in Practice, eGlobal Health, and Research & eLearning, and will include a three-day accredited course on Applying Technology to Healthcare Management.
The Pfizer Foundation is launching the International HIV/AIDS Health Literacy grants initiative. The Pfizer Foundation will award a total of up to US $1,000,000 in 2002 to support five to eight organisations with one year grants. Final decisions will be made in July 2002. The goal of the Pfizer Foundation International HIV/AIDS Health Literacy grants initiative is to strengthen existing health promotion programmes and develop new programmes to improve patients’ and communities’ understanding of their health, self management of health, treatment adherence, health outcomes and quality of life. The Foundation will support programmes that use creative approaches to effectively convey key messages regarding HIV/AIDS prevention, care and treatment.
[HEARD, University of Natal, Durban] One of a series of International Policy Research Workshops held over the last eleven years in the UK, East Asia and Africa, the 5th HEARD HIV/AIDS workshop focuses on the need to anticipate the medium and long-term social and economic consequences of HIV/AIDS. We offer participants a unique opportunity over two weeks, to exchange ideas, review their experiences with strategies and tactics, and identify interventions appropriate to their local situation. In response to much demand, the 2002 workshop will include an optional third week which aims to provide participants with the tools to project the impact of HIV/AIDS using computer modelling. The workshop is designed for senior professionals concerned with planning for the economic, social, demographic and human resource implications of the HIV/AIDS epidemic. Previous workshop participants have included economists and planners from government ministries; AIDS programme managers; donors; NGO programme managers; private sector representatives; local government officers; academics and other special interest groups. A maximum of 40 places are available. The closing date for applications is 27 September 2002. There is the possibility of sponsorship of the course fee in a few instances.
An application form can be requested: 1)By phone: +27(0)31 260 2592. 2)By fax: +27 (0)31 260 2587. 3)By mail: The Course Coordinator, HEARD, University of Natal, 4041, Republic of South Africa. 4)By email: freeman@nu.ac.za. 5)By Download from website.
May 17 & 18, 2002, Victoria College - University of Toronto, Canada. Keynote Speaker: Lawrence Gostin, Professor of Law, Georgetown University, Professor of Public Health, the Johns Hopkins University, Director, Center for Law & the Public's Health, CDC Collaborating Center Promoting Health Through Law. This interdisciplinary symposium and workshop is the first of its kind to bring together those involved in public health, bioethics, law and policy-making. With plenary sessions by key figures followed by participatory workshops, the symposium aims to (1) explore major issues in public health ethics; and (2) identify a research agenda for this emerging field. This meeting represents a unique opportunity to forge an international dialogue about public health ethics that will continue well into the new millennium. Enrolment is limited; kindly register early to avoid disappointment. For more information and registration materials, please contact Alison Thompson.
The AIDS Law Unit of the Legal Assistance Centre in Windhoek, Namibia, is planning to host a meeting of organisations in sub-Saharan Africa which work on HIV/AIDS, human rights and law with a view to providing a forum for sharing experiences and ideas, and to establishing a regional network of organisations working in this field. Organisations in the region which are interested in getting involved, should contact: Michaela.