1. From 14-17 August 2003, we activists from across Africa, representing African civil society organisations, labour unions and other social movements, gathered in Johannesburg, South Africa to evaluate the current state of negotiations in the World Trade Organisation (WTO), and to strategise and make known our positions on the 5th WTO Ministerial Conference due to be held in Cancun, Mexico from 10-14 September 2003.
2. Our stand on WTO's role: We re-affirm our recognition of the WTO as a key instrument of transnational capital in its push for corporate globalisation. We noted the many destructive effects of WTO agreements on the lives of working people and the poor, especially women, in Africa and throughout the world. We renewed our determination to continue resisting corporate globalisation, and the WTO itself until it is replaced by a fully democratic institution.
3. The context of Cancun Meeting: We noted that the forthcoming WTO Ministerial meeting is taking place against a background of a crisis of credibility of neo-liberal policies and global capitalism, that have been deepened by the Enron and other corporate scandals exposing the duplicity and venality of the bosses of transnational capital. At the same time, the world is faced with the aggressive militarism of the United States under a political leadership whose illegal attack on Iraq under false pretences has shown that law and morality are no bar to what it will do to advance the interests of American capital. Across Africa and in other developing countries neo-liberal economic policies are putting basic services, such as health and education, beyond the reach of ordinary people and deepening unemployment, poverty and social inequality. We, however, take heart from the growing strength in the organised expression of all those around the world opposed to militarism and corporate globalisation.
4. Conclusions on the current state of affairs in WTO: After our deliberations on the WTO Doha agenda and related issues, we concluded as follows:
a. The WTO has ignored the continued and growing opposition by popular movements throughout the world to its policies and methods, such as the illegitimate ways by which the Doha Agenda was imposed on developing countries in the 4th Ministerial of the WTO.
b. The failure of the WTO to meet agreed deadlines in various negotiations - notably Agriculture, TRIPS and Public Health, Special and Differential Treatment and the many Implementation Issues is primarily due to the refusal of the Quad (USA, EU, Japan and Canada) to accept the legitimate demands of developing countries.
c. These failures are merely an aspect of the double standards the Quad countries apply in international trade issues; marked by one set of rules for themselves and another that they impose on developing countries, exposing the WTO as a thoroughly undemocratic institution.
d. We particularly condemn both the EU and the US for their role in resisting the fulfilment of the deadlines and undertakings on Agriculture, and their refusal to honour the compromise consensus on TRIPS and Public Health.
e. On the Singapore or New Issues (i.e. Investment, Competition, Government Procurement and Trade Facilitation) we reiterate our total opposition to their inclusion in the WTO, or the initiation of discussions on modalities with a view to the launch of negotiations on these in Cancun. We stand by our demand that these issues should be removed from the WTO's agenda altogether.
f. It is clear that, as Cancun approaches, the Quad are accelerating the deployment of old and new undemocratic practices and pressures both in and outside the WTO so as to force their will on developing countries. In order to limit such illegitimate and underhand practices by the powerful, we endorse the campaign for internal transparency and participation in the WTO recently launched by many NGOs.
g. We note the opposition to the launch of negotiations on these issues expressed by African countries, especially the declaration by African Trade Ministers at the end of their meeting in Mauritius in June 2003. We also note a new initiative taken at the WTO on 13 August by a group of African countries to demand that the official WTO text that goes to Cancun includes proposals for improving the decision-making process in the WTO; as well as repeating their opposition to the new issues. We call on these countries to stand by these positions, as a matter of democratic principle, and also urge other African and developing countries to join them.
5. Call to Action: In the light of the above we have agreed and call on other African civil society organisations, labour unions and other social movements who share our views to join us to:
a. Mobilise the broadest possible sectors of African civil society to express their opposition to the continuing destructive role of the WTO in the lives of working people and the poor, and upon our countries' development aspirations and prospects;
b. Mobilise and sustain strong political pressure on our governmental representatives, in ways best suited to the specific conditions in our countries, before and during the Cancun ministerial meeting; actively holding our governments accountable for the positions they take in the Cancun Ministerial meeting, and expose any attempt to betray the best interests of the African peoples;
c. Pressure institutions of government, and our legislatures, and relevant public officials in our various countries so as to ensure the defence of our peoples' interests in the forthcoming Cancun ministerial meeting. Especially important are i) blocking the launch of negotiations on the Singapore issues and ii) rejecting any attempt by the Quad to manipulate developing countries into accepting negotiations on the Singapore Issues by linking these to issues of concern to developing countries;
d. Pressure our respective governments to endorse the two proposals tabled at the WTO by 11 African countries on 13 August 2003;
e. Be alert to, and therefore resist, the inevitable attempts by representatives of Quad countries and other governments who, between now and Cancun, will be visiting our national capitals under various guises, and contacting groups within our own countries to bully African governments to take positions detrimental to the African people on the issues on the Cancun agenda;
f. Launch an information dissemination campaign in our various countries to publicise what is happening in and around the WTO in the run up to and during the Cancun Ministerial meeting;
g. Mobilise a strong team of African activists to give voice to African perspectives in the activities of civil society organisations who will gather from around the world in Cancun;
h. Affirm our links with our partners in organisations of civil society outside Africa, including in the global North, to pressure their governments (especially of the Quad) in the interest of working people and the poor throughout the world, and in the interest of our planet;
i. Work together across Africa on the WTO, before and during Cancun, under the umbrella of the Africa Trade Network (ATN) to ensure common focus and strength in unity.
We issue this statement, and our call, as part of our commitment to the global movement against neo-liberalism and corporate globalisation, and the struggle for the establishment of alternative systems and institutions for all of humanity and the world. Another Africa is possible! Another world is possible!
Issued in Johannesburg, 17 August 2003
1. Editorial
2. Equity in Health
After two years of wrangling and delays, World Trade Organisation (WTO) members last week finally agreed on a deal that eases access to generic drugs for developing countries. It will enable poorer countries to import generic versions of patented medicines from countries producing the cheaper drugs, such as India or Brazil, without violating patent rules. Yet AIDS activists have called the agreement "flawed", as it still does not provide a "workable solution".
The U.S. government has cut off funds to an AIDS programme for refugees in Africa - six weeks after President George Bush toured the continent promising to fight AIDS and launching a US$15 billion initiative. The U.S. objects to one of the aid agencies involved, Marie Stopes International, which runs family planning programmes in China. Organisations that work on reproductive health and AIDS argue that the decision betrays the Bush administration's wider hostility to abortion. Its commitment to a rightwing Christian agenda has led to its promotion of abstinence rather than condoms as a strategy against HIV/AIDS.
In a July 11th article, the British weekly The Economist recounts the latest grim statistics on AIDS, noting emphatically that the 9,000 people who die each day from AIDS represents three times the number killed in the World Trade Centre attacks. "If all men are created equal, all avoidable deaths should be regarded as equally sad," says the editorial, adding that "common decency suggests that the rich world should do whatever it can to help." The editorial concludes ominously: "Cynics in the West might write Africa off. Are China, India, Indonesia and Russia to be written off as well?" Translation? Africans are poor and black. Thus we (the Economist) realize, dear reader, your greed for profits is not whetted by viewing them as consumers. Nor is your compassion stirred sufficiently by viewing them as fellow human beings. However, be mindful that the fire that has scorched that continent is spreading and is now threatening places populated by people who are prosperous enough - barely, but still above the threshold - to count as potential consumers and pale enough -barely, but still above the threshold - to awaken your caring. Read this commentary from www.zmag.org.
Conflicts, civil unrest, emergence of drug-resistant strains of parasites and insecticide-resistant vectors, mass population movements worsened by the refugee situation, and disintegration of health services, is exacerbating the malaria situation in sub-Saharan Africa. A one week workshop held in Nairobi between July 30 and August 4, bringing together regional heads of malaria control in sub-Saharan Africa, concluded that malaria is still "an unfinished agenda in sub-Saharan African countries, and needs more attention than it has so far received".
Child mortality goals are unlikely to be met in societies which fail to pay attention to the survival of HIV-positive mothers, according to findings from the Uganda General Population cohort published this month in AIDS. The authors note that "the very high mortality of mothers who die within a few years of giving birth suggests that simply reducing vertical transmission might not proportionately reduce the mortality risks in children of infected mothers."
The South African cabinet finally approved the provision of AIDS drugs to HIV-positive citizens through the public health system on 8 August. It instructed the health ministry to act "with urgency". This announcement came after months of a bitter row between South Africa's AIDS activists and the department of health, over the delay in implementing a treatment policy. The following is a chronology of events in the treatment access debate, from December 2001 through to the government's decision this month to introduce a treatment plan.
The South African cabinet finally approved the provision of AIDS drugs to HIV-positive citizens through the public health system on 8 August. It instructed the health ministry to act "with urgency". This announcement came after months of a bitter row between South Africa's AIDS activists and the department of health, over the delay in implementing a treatment policy. The following is a chronology of events in the treatment access debate, from December 2001 through to the government's decision this month to introduce a treatment plan.
The illegal sale of anti-AIDS drugs in Malawi was endangering the lives of many HIV-positive citizens who were desperate to access affordable treatment, a health official told PlusNews. "Our major concern is that people are selling immune boosters and multivitamins, and cheating [HIV] positive people by saying they are antiretrovirals (ARVs)," Dr Bizwick Mwale, director of Malawi's national AIDS commission, told PlusNews.
The Treatment Action Campaign (TAC) welcomes the Cabinet's instruction to the Department of Health to develop an operational plan within one month to provide ARVs in the public sector. The Cabinet endorsed the findings of the Joint Health and Treasury Task Team Report that between 500,000 and 1.7 million lives will be saved with anti-retroviral therapy. It also reaffirmed the science of HIV/AIDS pathogenesis and treatment. The TAC National Executive will formally suspend the civil disobedience campaign and reconsider pending litigation early next week. We welcome Cabinet's bold step today but we also remember the anguish, pain and unnecessary loss of lives over the last four years.
Related Link:
* Full report of the South African ARV task force
http://www.gov.za/reports/2003/ttr010803.pdf
Shortages of essential medicines and medical equipment, a staffing crisis and inadequate infrastructure are undermining the quality of hospital care across sub-Saharan Africa. This could jeopardise plans to provide anti-AIDS drugs to people living with the HI virus, delegates attending the World Health Organisation (WHO) regional committee meeting in Johannesburg, South Africa, heard this week.
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3. Human Resources
Zimbabwe's brain drain has hit the medical profession particularly hard. More than 80% of doctors, nurses and therapists who graduated from the University of Zimbabwe medical school since independence in 1980 have gone to work abroad, primarily in Britain, Australia, New Zealand, Canada and the United States, according to recent surveys.
This paper from Norwegian Church Aid states that established workers' rights are often not followed when facing an HIV positive employee and therefore need to be given a renewed focus. This report concludes that workers are seldom aware of their rights, and are therefore easy victims for unjust treatment from their employers. Workers' rights seldom regulate work in the informal sector. It is probably in this sector that we find the poorest of the poor, often at high risk of contracting HIV. And when infected, they have few or no possibilities of access to proper health care, and only very rarely access to any kind of social welfare.
This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that need to be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organisational base. Although the public health workforce is central to the performance of health systems, very little is known about the composition, training or performance of the workforce. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems.
4. Public-Private Mix
The use of private health care providers in low- and middle-income countries is widespread and is the subject of considerable debate. This article, produced by the Bulletin of the World Health Organisation, reviews a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardised primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In addition, implications for public health policy of the emergence of this new model of private provider are discussed.
In the past decade a growing number of health franchising schemes have emerged in developing countries. Often reaching tens of thousands of poor households, these private schemes currently provide logistical, managerial, and sometimes financial support to small-scale providers (franchisees) of preventive care, such as family planning and maternal and child health services. While franchising has attracted growing interest among governments and donors as a possible way to achieve health objectives, there is some debate about the ability of the model to reach the poorest people and the ability of franchisers to sustain themselves financially.
Many developing countries face a critical gap between the demand for health care services and their supply. Public resources often fall short of what is needed to provide universal health care, and the typical incentive structure in the public sector may not always be conducive to expanding access, improving the quality of care, and ensuring efficient use of limited funding and expertise. This World Bank Note defines options for mobilizing private resources to achieve public health objectives.
Recent international efforts to revive pharmaceutical R&D for neglected diseases have focused mainly on malaria, tuberculosis and HIV/AIDS. These have relied heavily on market-based incentive mechanisms, including public-private partnerships. The DND-WG's analysis clearly shows that this strategy will have limited impact for what we describe as the "most neglected diseases". One strategy to address this fatal imbalance that is currently being pursued is the creation of a needs-driven global drug development network - the Drugs for Neglected Diseases Initiative (DNDi). The DNDi is a not-for-profit research and development organisation that will manage global R&D networks with the goal of producing new, effective, affordable and field-relevant drugs for neglected diseases. The Drugs for Neglected diseases Initiative is the brainchild from Médecins Sans Frontières' Drugs for Neglected Diseases Working Group. The DNDi aims to take the development of drugs for neglected diseases out of the marketplace and encourage the public sector to assume greater responsibility.
5. Resource allocation and health financing
Few areas of public health have generated as much debate, controversy and protest in recent years as the drive to expand access to antiretroviral therapy – the drugs that have transformed AIDS from a death sentence to a chronic condition – in developing countries. Several years ago, it was a futile discussion: with a yearly cost of US$10,000 per patient, there was little possibility of widespread access in developing countries. But, largely as a result of a potent combination of generic competition and activism, prices have plummeted, with triple therapy now being available for as little as US$209 a year, causing a huge shift in the debate about availability. Today, the debate centres on if antiretroviral therapy is possible in severely resource-constrained environments, and, increasingly, on the best ways to deliver these drugs.
This paper looks at the role of public expenditure programmes in the health and education sectors and their impact on poverty. It argues for a closer donor involvement at the sector level. The evidence reviewed shows that progress towards the Millennium Development Goals has slowed in some low income countries, notably in Sub-Saharan Africa. Public expenditure has a much less powerful impact on outcomes than demand-side factors. Policies and practices for making public programmes more effective that have been recognised for some time remain unimplemented.
6. Governance and participation in health
Since 2002, YouthNet has partnered with MTV on the Staying Alive Campaign, which reached over 800 million households worldwide, making it the largest public health campaign ever. The campaign produced five hours of television available to TV and radio stations around the world, and also produced a Web site with HIV/AIDS information, referrals, and programming in English, French, and Spanish. A case study was recently published by YouthNet, detailing the successes and experiences of the 2002 Staying Alive Campaign.
7. Monitoring equity and research policy
The term 'policy process' is based on the notion that policies are formulated and implemented in particular social and historical contexts, and that these contexts matter - for which issues are put on the policy agenda, for the shape of policies and policy institutions, for budget allocations, for the implementation process and for the outcome of the policies. The idea of 'policy process' stands opposed to that of 'policy as prescription', which assumes that policies are the result of a rational process of problem identification by a benevolent agency (usually the state). While the 'policy as prescription' approach is still important - both in much of the public administration literature as well as in the heads of many policy-makers - there is a fast expanding body of literature that analyses, explains or conceptualises the process dimensions of policy. This literature is a blend of political science, sociology and anthropology. It does not assume that policies are 'natural phenomena' or 'automatic solutions' resulting from particular social problems and it does not privilege the state as an actor fundamentally different from other social actors. The why, how and by whom questions are treated as empirical questions; it is only concrete empirical research that can generate the answers. It is this body of literature that is included in this bibliography.
This paper explores the dynamics of the making and shaping of poverty policy. It begins with a critique of linear versions of policy-making, highlighting the complex interplay of power, knowledge and agency in poverty policy processes, arguing that the policy process involves a complex configuration of interests whose interactions are shaped by power relations.
8. Useful Resources
Building Blocks: Africa-wide briefing notes is a set of six locally adaptable resources to help communities and local organisations in Africa support children orphaned and made vulnerable by HIV and AIDS. These resources are based on the experience of the International HIV/AIDS Alliance, its partners and other organisations and have been produced in English, French and Portuguese.
The new Health-E website has print and broadcast stories that contextualise and analyse public health issues, especially HIV/AIDS in South Africa. The website provides easy access to a variety of resources that have relevance for other developing countries. Some of the new features on the website include: Transcripts of all audio reports; Resources page offering reports, speeches and book reviews; News briefs; Webcasts and archives of major events; Picture gallery; Direct email access to authors of Health-e stories; Instant download of audio from website.
The Reproductive Health of Young Adults training module has been updated for 2003. This module is available for either self-study or as a presentation for physicians, nurses, pharmacists, or other trained healthcare personnel. Through slides and activities, this training module is designed to increase the awareness and understanding of the reproductive health needs of young adults among policy-makers, program directors, program planners, and healthcare providers.
The Reproductive Health Outlook (RHO) website is designed for reproductive health program managers and decision-makers working in developing countries and low-resource settings. RHO provides up-to-date summaries of research findings, program experience, and clinical guidelines related to key reproductive health topics.
9. Jobs and Announcements
Equinet and Oxfam would like to invite participants at the ICASA conference to a satellite session on equity and HIV/AIDS. The session is designed to discuss the often misunderstood meaning of 'equity' and how this is relevant to developing countries and their HIV/AIDS crisis. It will discuss if there is a need to develop frames of reference that are equity-based and not just poverty-based; and it will bring to attention the inter-relationships between wealth and poverty; and between justice and aid.
This book is Farmer's account of the disenfranchised poor whose lives so often end in tragic and yet, he contends, wholly predictable ways. They are victims of “structural violence,'' falling prey to treatable illnesses, preventable hunger, and crime, all for the sole reason of having no money.
Oxfam is implementing a global strategy to respond to HIV/AIDS based on programme experience and global analysis. We are recruiting for a programme coordinator to support the integration of HIV/AIDS into Oxfam's programme and to establish and lead a global Centre of Learning based in South Africa.
In international development co-operation there is an increasing demand for regional experts and consultants to conduct formal evaluations and write comprehensive consultancy reports. Despite the expert's professional competence, reports and documents often do not satisfy the expected quality standards of international agencies. These weaknesses result from lack of familiarity with formal expectations and 'unwritten' rules of international agencies. This course intends to improve knowledge and skills in planning, writing, editing as well as how to assess the quality of consultancy reports in the field of international public health.
The Nuffield Council on Bioethics published a Report, the ethics of research related to healthcare in developing countries, in April 2002. The Report recommends that medical research in developing countries which is funded by organisations in wealthier countries is crucial but must be subject to rigorous ethical safeguards. The Report provides an ethical framework for anyone who is designing or conducting externally-sponsored research in the developing world. A follow-up Workshop will be held in February 2004 to explore developments in this area since the publication of the Report.