International Trade and Gender Network Bulletin, Volume 2, No. 7, July 2002
There are many opportunities and challenges facing women in the upcoming World Summit on Sustainable Development. Perhaps it is worth reflecting on the whole notion of what our forefathers and foremothers meant when they conceptualised what freedom and emancipation for the African people would mean to future generations in Africa.
The most common word we heard in terms of development during the independence explosion, and the fight to decolonise and kill apartheid in South Africa, was self-determination. Where has this discourse gone? What is the difference between sustainable development and self-determination? It is critical to reflect on this in order to locate the gender perspectives in the upcoming summit.
Self-determination is the right to determine our future, to shape it, nurture it in ways that reflect our desires, goals and aspirations as African people. Self-determination opens the space for us to innovate, experiment with new ideas, to fail and from these failures reconceptualise our destiny until it fulfils the vision we have as a people. The vision and hope of preserving the sky, the land, and placing adequate food for everybody to consume not just a few, security of body, mind and soul above everything a peaceful stable environment where everybody can earn a living. Some people call this idealism and are skeptical about attaining this equilibrium.
Sustainable development is a new term. It takes on different nuances depending on who happens to be articulating this concept. How do women fit into this agenda? What sort of development are we sustaining? Is this notion of sustainable development an environment that can promote gender equality?
In reading through the Chairperson’s text towards the summit on sustainable development a number of concerns arise. I want to flag just a few issues that need to be interrogated by gender activists in general and feminists specifically.
1. The concept of sustainable development as framed in for WSSD repositions development perspectives within economic globalisation. This is extremely problematic for women because research is emerging that women have experienced globalisation more negatively than other sectors of society. There is increased feminisation of poverty. Increased flexible labour among women and more women have entered the informal sector. The privatisation of services like water, electricity, healthcare and education has increased rather than decreased women’s work as more people fall through the social safety net. Repositioning development within globalisation introduces a new form of sustainability - sustaining poverty, not eradicating it, and sustaining debt relief, not debt cancellation.
2. The Chairperson’s text reinterprets sustainable development within the neoliberal trade paradigm and the liberalised trade system. This is happening with the background of Africa experiencing the worst terms of trade. For example, industrialised countries control 68.4% of global trade with 15% of the world population.
3. Developing countries control 27.5% of global trade with a world population of 75%. Africa’s share of this is 1.6% with 11% of world population. Africa produces the bulk of raw materials in the world. Women produce sugar, corn, coffee, cotton, tea and many other products yet, the prices of these products has declined steadily in terms of the way they are traded. It is not the producers who set the prices, but the stock exchange in London and New York. There is no access for women farmers to these institutions. Women have no power to negotiate the price of these products. The returns on their products in monetary terms are not sufficient to sustain livelihoods nor bring about development in the true sense.
It is critical to note that the repositioning of development in the WSSD also creates a relocation of development issues from the United Nations to other institutions. This is an important shift for gender activists to study. The World Bank and the World Trade Organisation specifically are the two institutions that are in explicit and implicit ways taking over the development agenda as we once knew it. Under the new term of global governance the World Trade Organisation in particular is attempting to take on issues of environment, labour, and agriculture to name a few. In the meantime, the World Bank is whittling away the power of the state through its’ policy advise. It is advising countries to privatise basic social services through, for example, introducing user fees to healthcare services and education. It is advising countries to sell water, electricity and telecommunications to the private sector. Using the efficiency argument it is convincing governments that the state has no capacity to provide basic services and that this function should be taken over by the private sector. After all, the World Bank claims the private sector has a tradition of running business more efficiently than governments and governments, it says, are corrupt. This dysfunctional ideology of placing profit before people’s development, and gender equality particularly reinforces the exclusionary manner in which the state treats women.
Linked to NEPAD, the New Partnership for Africa’s Development, the new development framework offers the same market-oriented economies that are not compatible with the protection of women’s rights, nor do they promote gender equality in Africa. Framed with a neoliberal stance, this plan strengthens the principle of private property. African women have never had any entitlements under this paradigm. NEPAD, like the new development framework being put forth at the upcoming World Summit on Sustainable Development, does not address the social relations within the market in terms of women’s access to and control of resources in this space. The World Summit on Sustainable Development must be a space that allows for the self-determination of peoples and nation states and promotes sustainable development that incorporates human development and gender equality into its definition and implementation. However, as it currently stands the WSSD further pushes the Northern trade agenda and role of the International Financial Institutions while marginalizing the role of the United Nations. This process will further threaten national sovereignty and further marginalize women.
1. Editorial
2. Equity in Health
Some activists have begun encouraging African nations to stop paying debt payments and instead spend the money on health, education and social programs, such as anti-AIDS efforts, the Boston Globe reports. Although development specialists have suggested that the debt of sub-Saharan African nations be forgiven, others doubt that such a move will happen and have suggested a "more provocative" solution for the nations. Both Poland and Bolivia in the 1980s stopped paying their debts and later had their debts cancelled because they used the money to fund "social causes," according to the Globe.
Access to treatment, women and young people, those were the key points of the 14th International Conference on AIDS held in Barcelona, Spain. More than half of new infections occur among young people between the ages of 15 and 24 worldwide, yet young people's needs and concerns are rarely taken into account when planning strategic interventions to halt the spread of HIV. This was clear in regards to the number of young people attending the conference; out of the 15,000 delegates only 200 were young people.
The European Union will grant 32 million euros, or about $31.8 million, to the United Nations Population Fund and the International Planned Parenthood Federation in an effort to "fill the gap" left by the Bush administration's decision to withdraw the United States' $34 million contribution to UNFPA. The funding will go to reproductive health care projects operated by UNFPA and IPPF in 22 developing nations. The money will be used to fund pre- and postnatal care programs, family planning services, sexually transmitted disease prevention, counseling on "avoiding [unintended] pregnancies and unsafe abortion".
The most up-to-date WHO publication on the subject, the report attempts to help WHO Member States to ensure that genome technology is used to reduce rather than exacerbate global inequalities in health status.
A new report released by the Joint United Nations Programme on HIV/AIDS (UNAIDS) warns that the AIDS epidemic is still in an early phase. HIV prevalence is climbing higher than previously believed possible in the worst-affected countries and is continuing to spread rapidly into new populations in Africa, Asia, the Caribbean and Eastern Europe.
The coming of the rains in Southern Africa in the next few months will end the region's drought but usher in a new threat - an upsurge in malaria, Africa's number one killer. "Our past experiences from the '92 drought and other droughts is that after the drought breaks and the first rains fall there is a natural biological response from the mosquitoes. They move in large numbers. We must prepare to keep malaria down when the rains come," said Shiva Marugasampillay, chairman of the World Health Organisation's (WHO) 2002 Southern Africa Malaria Control Conference.
Following recent confusion over the potential side effects of a new malaria drug - Sulphadoxine-Pyrimethamine (SP)- the Tanzanian health ministry has reiterated its faith in the drug as the most effective method of treating the deadly disease.
The female condom could reduce the spread of HIV by increasing the prevention options available to sexually active adults. Marketing of the female condom at subsidised prices began in Lusaka, Zambia, in 1997. How effective has this been? Do people know about female condoms and are they likely to use them?
The Treatment Action Campaign (TAC) on Monday threatened to challenge the Medicines Control Council (MCC) in court if it decided to ban the anti-Aids drug, nevirapine. "We haven't decided on an exact legal route yet but we will make sure that any reverse decision is heard. We're not going to quietly sit by if this is a serious threat," the TAC's Mark Heywood told reporters in Johannesburg. He was reacting to newspaper reports at the weekend that the MCC was reviewing its approval of nevirapine because it had concerns about its effectiveness and toxicity.
Police are investigating the rape of a one-week-old South African baby girl, the youngest child ever to be raped in the country, Reuters/Toronto Star reports. The attack occurred on Sunday in the city of Kwaminya in KwaZulu-Natal province. The infant is seriously injured but is in stable condition, Police Superintendent Lawrence Zondi said. It is not known who committed the rape. The incident is the latest in a "spate of child rapes fueled by the myth that sex with a virgin" can cure HIV/AIDS.
Pages
3. Human Resources
Plans to make HIV testing compulsory for foreign health workers aiming to work in Britain are "discriminatory" and insulting to African nurses, nursing unions said on Tuesday. "We are strongly opposed to mandatory testing because this will exacerbate the stigma of HIV positive nurses. We are worried about what will happen to them when they are found to be positive," the President of the Democratic Nursing Organisation of South Africa (DENOSA), Ephraim Mafalo, told PlusNews.
Stella Zengwa, President of Zimbabwe Nurses Association.
Zimbabwean nurses face difficult decisions in their day-to-day work. Health Services are now client centred and are being provided by a workforce, which is performance driven. A shortage of nurses means that at present all our new nurse graduates are bonded for 3 years, but experienced nurses continue to be lost to neighbouring countries and abroad. Hospital wards are still run with only one or two nurse per shift for a 40-bedded ward with the result that nurses continue to be overworked. Lack of transport has become a critical issue and poses a risk to nurses’ lives when arriving or knocking off duty given the shift work. Lack of accommodation at institutions is making retention of nurses very difficult since in some areas, rented accommodation is not available. Nurses have been pushed out of the traditional nurse’s residences. Inadequate and erratic supplies of drugs, surgical sundries and equipment including protective clothing like gloves are exposing nurses to HIV infection. Burnout syndrome is widespread with nurses overwhelmed with the stress of nursing a full ward of very ill patients with so little support. Unlike other health workers who are visitors to the ward, nurses spend long hours with patients. This requires ways of dealing with burnout so that nurses continue to provide quality health care services.Upholding of nursing ethics is critical building a positive image as desired by the communities that we serve. As a professional association, ZINA aspires to ensure that the services nurses provide in support of public protection and health care are exemplary and community driven.
4. Public-Private Mix
L Rychetnik, M Frommer, P Hawe and A Shiell
Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.
Faced with the devastating impact of an HIV/AIDS epidemic compounded by abject poverty, Malawians have eased the pressure on state hospitals by caring for chronically ill family and neighbours at home. A home based care (HBC) project in Northern Malawi has assembled 225 young volunteers in the region's nine districts to provide community based support to homes and guardians looking after people living with AIDS (PWAs). The aim is to ease their suffering and prolong their lives.
What checks should municipalities make before signing up to public private partnerships (PPPs) in solid waste management (SWM)? How can they judge the merits of technologies touted by international operators? Can private operators be persuaded to target the poor? How can the poor be involved in the collection of solid waste?
5. Resource allocation and health financing
New approaches to healthcare funding often rely on outdated attitudes to gender. How can donors ensure that gender analysis is effective? Should they move beyond a narrow focus on women as a separate group? Researchers from the UK University of Manchester argue for a new approach to gender in healthcare funding. In many countries, donors are changing the way they finance health programmes. They are moving away from funding individual health projects and now encourage aid for government-managed health sector programmes. This new form of funding requires innovative forms of gender analysis and gender-sensitive interventions in the health sector.
What are the implications for reproductive health of health reforms in low and middle-income countries? The last decade has seen a change in approach from supply-side health sector reforms to an emphasis on demand-driven and anti-poverty interventions. But has this increased access to reproductive healthcare and have services improved as a result? A report from the UK Institute of Development Studies argues that the impacts of health reform depend heavily on the local context in different countries. This includes economic, political, demographic and epidemiological factors. Different strategies are therefore needed to ensure further improvements in reproductive healthcare.
Dr Godfrey Swai, Tanzania Public Health Association.
HIV/AIDS, Tuberculosis and Malaria are diseases of poverty or deprivation. Effective rolling back of the three diseases must also roll back poverty. The intimate link between equity in health and poverty reduction cannot be ignored by the international community and poses the challenge for effectiveness of the Global Fund. The share of the global burden of the three diseases for Sub Sahara Africa is unacceptably high, and increasing, deepening poverty and threatening human survival. This region deserves special consideration under the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).
6. Governance and participation in health
I Rusike, R Loewenson, CWGH, TARSC.
Equity in health is a long stated policy goal in Southern Africa, and some significant advances were made often through joint and complimentary action between the public health sector and communities. However, the health and health care gap between communities is still wide or widening, with differences based on gender, geographical area, income, access to public or private services, education and other factors. More recently,the combined impact of AIDS, structural adjustment, and real reductions in the health budget and in household incomes, has reversed many health gains. The quality of health care has declined and health workers and their clients have become demoralised. While these issues demand technical responses, reversing inequities depends in the main on social and political factors. This goes beyond the fact that social networking is important for service outreach and health seeking behaviour, and that social exclusion as a dimension of deprivation or poverty affects health outcomes. What we argue is that unless people affected by ill health have greater control over the resources needed for health care or to be healthy, equity goals will remain a dream. Equity without this socio-political dimension is not equity.
7. Monitoring equity and research policy
Beyond health care, the economic evaluation of social welfare programmes is rare but the demand for such evaluation is rising. To encourage greater use of economic evaluation, undoubtedly social welfare researchers need to gain a better understanding of the philosophy behind such evaluation and the methodologies necessary to carry these out in practice.
Author(s): Winch, P.J.; Wagman, J.A; .Malouin, R.A.; Mehl, G.L.
This guide is designed for program managers, researchers, funders of health programs, and others who are considering using qualitative research methods to help them design more effective health programs and/or evaluate the strengths and weaknesses of existing programs. It is assumed that the reader already has some familiarity with the basic methods in the "qualitative research toolbox" such as in-depth interviews, focus groups, and participant observation. This guide describes some of the existing manuals for conducting qualitative research on health and provides information to help would-be users select the manuals that are most appropriate to their needs. This guide does not attempt to review the available qualitative research tools related to prevention and treatment of chronic and non-infectious diseases, including tobacco control, obesity prevention, or management of such diseases as diabetes or epilepsy.
8. Useful Resources
Child-to-Child (CTC) is an innovative approach to health education practised in more than 80 countries worldwide. Relying, as it does, on the promotion of children as agents for change, the book asks how successful CTC can be in developing country contexts where children are often the least powerful members of their communities. A new book from the Institute of Education reviews the CTC approach in which children are seen as active promoters and not just passive receivers of health information. Comparing theory with practice, it examines how far CTC can work in cultures where people do not necessarily share current Western assumptions about the role of the child in society. Demonstrating the rich diversity of practice that characterises CTC, the book concludes with lessons to strengthen the approach.
What are the best strategies for HIV treatment delivery in developing countries? What barriers prevent poor people from accessing care? What role should the international community play in treatment programmes? In the run-up to the 14th International AIDS Conference, id21 asked participants to consider these and related questions.
More than 120 individuals from many countries and diverse backgrounds joined the discussion list. The debate covered a broad range of topics, focusing particularly on:
HIV treatment as a priority relative to other health and development issues
strategies for delivering treatment in resource-poor settings
the role and operation of the new Global Fund to Fight AIDS, Tuberculosis and Malaria
stigma as a barrier to access.
The discussion provided a unique opportunity for a variety of stakeholders to share their views and contribute to this important and topical debate.
As part of its effort to encourage research on the economics of HIV/AIDS, IAEN prepares a newsletter featuring updates to this site and news of interest on the topic. The information is gathered from a variety of sources, including online electronic databases. The newsletter is sent approximately once per month, and helps us carry out one of our missions: To provide data, tools, and analysis on the economics of HIV/AIDS prevention and treatment for compassionate, cost-effective responses to a global epidemic.
The re-designed and up-graded website is designed to keep concerned members of the public, international organisations and policy makers up to date on MSI's sexual and reproductive health programmes in 38 countries worldwide, as well as its advocacy and policy activities.
UNICEF, UNAIDS, WHO and Medicins Sans Frontieres have produced an updated list of HIV medications, HIV testing kits and suppliers of HIV/AIDS-related products designed to help procurement agencies and national governments obtain such products for the best value.
9. Jobs and Announcements
The editorial board of the Journal of Health, Population and Nutrition has decided to publish a special issue in March 2003 on Health and Equity. The special issue on health and equity may include original research articles on concepts, measurement and other methodological issues, empirical findings on the situation of health equity, and interventions to reduce health inequity. Reports on global, national, or sub-national pro-equity activities and the experiences gained by way of impact and the process of implementation are also of interest. Potential authors are requested to express their interest to contribute by writing a note with tentative title of the paper to jhpn@icddrb.org by 30 June 2002. The final manuscript should be available by end of September 2002. While preparing the manuscript, please follow the Vancouver Style. Information for Contributors can be seen at or downloaded from the website of the Journal (http://www.icddrb.org/jhpn). The enclosed brochure will provide additional information about the Journal. JHPN is a peer-reviewed quarterly journal and is indexed by the major international indexing systems. The Journal is freely available through the Internet (http://www.icddrb.org/jhpn). For any further information or queries, please do not hesitate to contact our Guest Editor Dr. Abbas Bhuiya (abbas@icddrb.org) for this special issue.
To provide a forum for practitioners, researchers, educators, policy makers and community mobilizers, interested in health and development issues, to share knowledge, experience and promote innovation and collaborative action. Each day's plenary will focus on a different theme (e.g. Day 1 - Challenges; Day 2 - Research; Day 3 - Innovation and Action). In addition, this year's CCIH will offer three streams running all three days of the conference. The Capacity Building stream will feature workshops and symposia aimed at knowledge and skills transfer (e.g. workshops on participatory evaluation techniques and how to build effective partnerships). The Knowledge Development stream will include a variety of papers and presentations on topics such as research with developing countries, using appropriate and innovative methodologies; and evidence-based decision-making. The Action stream will feature papers, presentations and workshops on innovative programs, projects and policy-related activities with disadvantaged groups in the developed and developing world.