My name is Nomfundo Dubula. I am a person living with HIV. I am from the Treatment Action Campaign in South Africa and I also represent the Pan African Treatment Access Movement.
I want to say that as communities and people living with HIV we are angry. Our people are dying unnecessarily.
African leaders, the ball is in your hands. You have to decide whether you want to lead a continent without people. So, stop playing hide and seek whilst people are dying.
The World Health Organisation has declared antiretroviral therapy a state of global emergency and our leaders are still in a state of denial.
The Doha and the UNGASS declarations have opened the way to decide about the future of Africa, so, when is your action? The Doha declaration on health is hope, and it must be implemented.
Two years ago, the Abuja declaration promised 15% of the budget on health but up to now that has not happened. How many people must die? Please, move from talks to real action.
Give women powers to decide and lead and they will overcome this epidemic.
African leaders, lead us. Don't divide people living with HIV, as we all want to assist in this fight.
We need CCM's in each country with positive attitudes towards treatment, especially ARV's, so that we have effective and unequivocal treatment plans.
We need you to speak out about nutrition and not confuse us with the debate about nutrition versus ARVs. Nutrition goes hand in hand with ARVs!
I also want to address the WHO. WHO has promised to give technical assistance in the procurement of drugs. Now we need your assistance in our countries to ensure that cheaper generic drugs reach every country, with or without manufacturing capacity.
You also have a key role in ensuring resources for poor countries. The 3 by 5 plan should also ensure that all treatment programmes include treatment literacy efforts. On our side, we commit ourselves in educating our people and ensureing adherence.
We need real leadership in the implementation of effective strategies to reach the 3 by 5 goal. We will assist you in this effort if you show commitment and independence in prioritising people's health over any other interest.
I want to refer to the drug companies, whose bags are full with profits. Stop squeezing poor Africans which only represent 1.3% of your global market.
Don't delay access by giving exclusive licenses that are only transferring the monopoly to local companies blocking competition.
Your diagnostics are still too expensive and inaccessible.
Provide low prices and allow our governments to bring us life-saving drugs and the necessary monitoring systems.
I want to say to the donors that they should donate more money to the Global Fund. We welcome the US initiative led by president Bush. But we want money that is free of hidden agendas. Put more money in the Global Fund and stop blocking our government's rights to import generic drugs.
The IMF and World Bank should cancel the debt, as Africa is fighting for its life. Don't even pinch the last drop of its blood.
And where was the Global Fund in this conference? How can you communicate with our brothers and sisters, and what is going on with their countries proposals? We need you to have a booth in the GNAP+ conference so that you can be visible, and we can ask questions.
The Pan African Treatment Access Movement - PATAM - is fighting for the lives of Africans. So, we will continue to mobilize our people as we did in the court case of the Pharmaceutical companies against the South African Government.
We will continue to mobilize our people as we South Africans did in the PMTCT court case against our government.
We will continue to mobilize our communities to ensure access to treatment and care.
We will continue giving treatment literacy workshops to ensure adherence, promote VCT, prevent new infections and promote openness.
We will be watchdogs in ensuring real implementation.
AMANDLA, AMANDLA POWER, TO THE PEOPLE.
1. Editorial
All concerned with international trade should work for salvaging the WTO from the debris of the Cancun collapse. Even those considering the WTO framework as anti-development would certainly see the powerful signals emitted from Cancun indicating a new identity of the developing countries. It will be some time before the WTO recovers from the shock of Cancun collapse. And that too only if the main actors make sincere efforts for its recovery.
Cancun was qualitatively different from Seattle. In Cancun, the deep difference between the developed countries and the developing countries was at the core of the failure of the conference, whereas the chaos at Seattle was due to various other reasons. Though the developing countries, particularly those of Latin America and Africa-Caribbean-Pacific, publicly expressed frustration and disgust at the Seattle process, the final failure was because of other factors, like handling of the conference by the chairperson, public insistence of the host country on some new issues like social clause, deep difference between the two majors, viz., the US and the EU and the chaotic atmosphere outside the conference venue due to several demonstrations. There was really no intense engagement among the countries at the negotiating table. In Cancun, on the other hand, there was engagement of the countries, but there were grave differences among the developed countries and the developing countries.
The problem started because the Chairman of the General Council, and later the Chairman of the Ministerial Conference too, presented texts for the Ministerial Declaration that had almost fully included the proposals of the major developed countries and totally ignored the specific and firm proposals of the developing countries. The US-EU were not ready to eliminate/substantially reduce their subsidies in agriculture, while demanding from the developing countries to cut their tariffs in agricultural products and industrial products significantly. The EC was insistent until the near end that negotiations should start on the Singapore issues. The developing countries finally got fed up with the unreasonable and unfair demands of the major developed countries when they themselves were not prepared to make material concessions.
The collapse did appear to be sudden; but there was grave simmering discontent among the developing countries right from the final phases of the preparatory process in Geneva. It all boiled over in Cancun. One may be tempted to diagnose the reason for collapse in some sudden move here and there; but the reason appears to be more deep rooted. Over the years, the major developed countries have followed the strategy of squeezing maximum concessions from the developing countries, but it cannot continue indefinitely. The developing countries, if pushed to the wall, are bound to resist. The governments of the developing countries cannot go on explaining to their people indefinitely that they have been pressurized into accepting one-sided and harmful results. Their people will soon ask them firmly to resist pressures. Cancun gave us a glimpse of this trend.
Pressures on the developing countries by the developed countries in Cancun and in preparation to Cancun were no less than at the time of Doha. But the imperatives on the developing countries gave them strength to resist these pressures. This situation also worked as a cementing factor in the cohesion of some groups of the developing countries. Moreover the developing countries are fast improving their understanding of the WTO and its processes. They have been effectively aided in it by some dedicated NGOs.
The Cancun collapse is a symptom of the instability of the GATT/WTO system as it has been emerging lately. A multilateral system has to be based on the perception among its members of the shared benefits. Once the large membership feel that the system demands only “give” from their side without any possibility of “take”, the system is bound to be unstable. And instability in the system will hurt all the countries, big and small.
The much publicised parting statement of the U.S. Trade Representative in Cancun that they would follow different alternative tracks like bilateral and regional arrangements in the wake of the Cancun collapse has a certain emptiness in it. The U.S. may have a multitude of bilateral and regional arrangements, but when it comes to enforcement of commitments in the areas of goods, services and Intellectual Property Rights, it has to take shelter in the WTO framework. After all it has had tremendous gains in the Uruguay Round in all these areas and it continues to enjoy those gains. In that background, its threat to give up or underplay the WTO route does not appear serious. What is needed is to understand the deep-seated malady in the system and to take corrective measures quickly before it is too late. All parts of the system, viz., the developed countries, the developing countries and the institutional machinery, have to play active role in it. The developed countries should consider the following approach.
1. They should lower their sights and ambitions in the WTO. They have already got a lot in their favour in the Uruguay Round. They should consolidate these gains and stop demanding new concessions from the developing countries.
2. They should allow the system to settle down and not destabilize it by insisting on introducing new subjects in the negotiations.
3. They should be constructive in the area of agriculture and try to understand the sensitivity and importance of this sector in the economics and politics of the developing countries. Positive action in this area is likely to result in spread of gain among the weak sections in the developing countries. Hence agriculture is generally perceived as a test case for assessing the intentions of the developed countries.
4. They should give up their old mind set of monopolizing the management of the GATT/WTO and realize that this organization has to keep in the forefront the interests of a large number of its membership, i.e., the developing countries.
5. More basically, they should realize that their own growth will be helped by the development of the developing countries, because it is there that the prospect of future fast growth of demand lies. They should come out of the thick shell that they have built around themselves over the last two decades or so, thinking that they can sustain their growth on their own without counting on the role of the developing countries. In this mind set, their linkage with the developing countries is limited to their targeting them for extracting more and more concessions.
The institutional machinery of the WTO, including the Chairpersons and the Secretariat, have also to change their approach and style of functioning. Some points are important for them to note.
1.They should realize that the strategy of “clean text” is not always the best. It is not the “clumsy” and “overburdened” text that hinders agreement, as is often alleged about the text for Seattle which accommodated the diverse view points and put them in square brackets. Even the cleanest text, as for example the two texts for Cancun, can result in disaster, if the process of preparation has not been fair and objective. A “clean text” can facilitate negotiations only if the process of preparation has been open and transparent and it is a fair and objective balance between the differing positions. The General Council Chairman’s text for Doha which was confidently taken as a model for the Cancun text also suffered from similar defects as the latter. But there was a big difference in the two situations. While the GC Chairman’s text for Doha was mainly in the nature of a framework in most of its part (except Singapore issues), the texts for Cancun contained specificities of obligations which had been widely opposed by a large number of the developing countries and the alternative suggestions given by them had been totally ignored by the Chairmen of the General Council and the Conference.
There was also the difference in the environment. A large number of the developing countries got confused in Doha by the tactics of the US-EU, whereas, after having learnt their lesson in Doha and later, the developing countries could not be deviated from their determined track in Cancun. Also, during the two years passage between Doha and Cancun, the developing countries had gone through a process of introspection and consolidation. The NGOs of the world had a big role in it.
2.The institutional machinery of the WTO has to show without a trace of doubt that it is not influenced by the major developed countries. It has to be neutral and objective and clearly appear to be so. Much damage has been done by the perception that the machinery is being used by the major developed countries for advancing their own narrow interests. The machinery should work for the system and not for individual countries, howsoever powerful.
The developing countries have found a new identity in Cancun. They showed they could not be pushed around any more. The following steps may help them in future.
1.The various groups of the developing countries that became effective in Cancun should interact with one another to forge a broader and deeper alliance. They should try to identify their common interests and also differences, if any. It may be possible for them to build upon their commonness and smoothen their differences through the process of mutual understanding. After all, one common factor with all of them is that they have all been serious losers in the Uruguay Round and have been the target of the major developed countries for squeezing concessions out of them even later. Though it may be possible for these individual groups to stop some thing here and there and thereby reduce damage, their combination is essential for getting positive benefits.
2.They should counter the divisive tendencies among them. For example, often the division among them is promoted by urging that they should cut their tariffs on industrial and agricultural products in the interest of expanding south-south trade. Though expansion of south-south trade is a laudable objective, undertaking obligation of tariff reduction in the WTO is not an appropriate way to go about it.
A preferred path should be to use the framework of Global System of Trade Preferences (GSTP) for reduction of tariffs among the developing countries. It has two special benefits for the developing countries over reducing the tariffs in the WTO framework. Firstly, a developing country while reducing its tariffs under the GSTP does not have to extend this benefit to the developed countries; thus there is less revenue loss for the committing importing developing country.
Secondly, the beneficiary exporting developing country will face less competition from the developed countries as the latter will not get the advantage of this lower tariff in the developing countries. Over a course of time, this process is likely to enhance investment in the developing countries in manufactures and agriculture, because of larger market access opportunities among the developing countries. The developing countries should give fresh impetus to the GSTP framework which is administered in the UNCTAD and is dormant at present.
This is not to suggest that the developing countries should not engage in the tariff reduction exercise in the WTO framework at all. Of course, they may engage in this exercise there, but only with the objective of getting tariff concessions from the developed countries. An attempt should be made by all to usher in a reformed WTO process. International trade is important for all including the developing countries. And a multilateral framework is useful for that purpose. It is not practicable to create a totally new framework in the current international environment that is characterised by mutual suspicion, lack of goodwill and erosion of confidence. It should be a much-preferred choice for all concerned to work for a reformed and improved WTO. Foundation should be laid for it even before reverting to the Doha work programme in the post-Cancun phase.
http://www.twnside.org.sg/title/twninfo78.htm
'NO LONGER DINNER': AFRICAN ACTIVISTS SPEAK ON CANCUN
“Yea, we are sick and tired of being dinner, we should make dinner for a change,” declared Crystal Overson, a media activist with the Alternative Information and Development Centre-South Africa. Overson was participating in a discussion with five other African activists about the recently collapsed WTO Ministerial meeting in Cancun. The interview delves into the nuts and bolts of the African position at Cancun, the thrills and spills and the way forward to the next Inter-ministerial. Read the full transcript of the interview at www.pambazuka.org
2. Equity in Health
The UN Secretary General and the Joint United Nations Program on HIV/AIDS (UNAIDS) has released a report, which clearly states that the current pace of country activity on HIV/AIDS is insufficient to meet the 2005 goals agreed by all nations at the Special session on HIV/AIDS in 2001. The report was released at the international conference on AIDS and sexually transmitted diseases that took place in Nairobi Kenya.
A new UNAIDS global HIV/AIDS performance scorecard released at the ICASA conference in Nairobi, Kenya, has revealed that although most African countries have developed strategic frameworks for HIV prevention, only a fraction of people at risk still have meaningful access to basic prevention services. Unless efforts are dramatically scaled up, many African and other member-states of the United Nations will be unable to meet their basic HIV/AIDS prevention and care goals as stated in the declaration adopted at the 2001 meeting of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS).
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3. Human Resources
Botswana has the highest rate of HIV prevalence in the world and AIDS has now reached crisis proportions in the country. Among the initiatives implemented as a response to promote sexual behaviour change, is the Peer Education HIV/AIDS Prevention Program (PEHAPP) at the workplace. This paper assesses the impact and outcome of the PEHAPP. It concludes that the PEHAPP is having a measurable positive impact in the key areas of improving knowledge, attitudes, and practices related to risky sexual behaviour which, in turn, should reduce the incidence of transmission of HIV/AIDS and other STDs over the long-term.
4. Public-Private Mix
Privatisation is being pushed by international governance institutions, the governments that control them, and the corporations that lobby both groups, even though the dangers that privatisation entails can seriously - and permanently - harm the livelihoods of the world's poorest people. The position of "privatise first and ask questions later" and the naïve confidence in the processes and outcomes of market reform have imposed hardship on precisely the groups those organisations are entrusted to protect. It is time to shift the burden of proof from those who question risky solutions to those who propose them, says this article.
In response to shortages in public budgets for government health services, many developing countries around the world have adopted formal or informal systems of user fees for health care. In most countries user fee proceeds seldom represent more than 15 percent of total costs in hospitals and health centres, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial or full waivers to the poor often results in inequity in access to medical care. The dilemma, then, is how to make a much-needed system of user fees compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence than countries that have improvised such systems (Ghana, Kenya, Zimbabwe).
5. Resource allocation and health financing
Many health inequalities are due to unequal access to society's resources. In theory, they are avoidable - but how? The international community tends to define health equity as 'equality of health status'. But is this the most useful approach in developing countries? Researchers working with Namibia's Ministry of Health and Social Services (MHSS) think not.
The researchers suggest that developing countries should focus on improving fairness in the allocation of healthcare resources.
6. Governance and participation in health
This paper addresses the lack of monitoring and evaluation (M&E) procedures within HIV/AIDS programme design. It offers a practical guide to developing, monitoring and evaluating practice in HIV/AIDS-related programmes for young people, based on the experience of projects around the world. It focuses on recent learning from work with young people in peer education, school-based education, clinic-based service delivery reaching especially vulnerable children, and working with children affected by HIV/AIDS. Good examples of practice are included throughout.
7. Monitoring equity and research policy
A gap often exists between research findings and the desired outcome of putting them into use to improve health service delivery, policies, and practices. But this issue of Network highlights several factors that can facilitate the speed and ease of moving research to practice. How various factors can coincide to produce rapid utilization of research findings is illustrated by acceptance of the antiretroviral nevirapine to prevent mother-to-child transmission of HIV in the developing world.
The growing global burden of non-communicable diseases in poor countries and poor populations has been neglected by policy makers, major multilateral and bilateral aid donors, and academics. Despite strong evidence for the magnitude of this burden, the preventability of its causes, and the threat it poses to already strained health care systems, national and global actions have been inadequate. A full range of policy responses is required from government and non-governmental agencies, but unfortunately the capacity and resources for this response are insufficient, and governments need to respond appropriately.
Uganda is widely regarded as an HIV/AIDS success story, but the reality of this claim has rarely been critically investigated. Although evidence-based medicine is increasingly important, analysis of the Ugandan epidemiological situation shows that the so-called proof accepted for policy recommendations can be subject to creative interpretation. There are several policy lessons that can be learned from the response to HIV/AIDS in Uganda. (registration needed)
8. Useful Resources
"The Pop Reporter," The INFO Project's weekly e-zine for the world's reproductive health care professional, has announced the launch of a new customized edition. This state-of-the-art feature allows subscribers to customize their subscriptions, tailoring issues to both topic and delivery preferences. Now subscribers may choose from among 17 categories of the most important concerns of the world's reproductive health community today.
The GFO Newsletter is an independent source of news, analysis and commentary about the Global Fund to Fight AIDS, TB and Malaria. The GFO Newsletter is emailed to subscribers once or twice a month.
Rural and Remote Health, is an international, electronic journal of rural and remote health education, practice and policy. The journal's aim is to provide an easily accessible, peer-reviewed, international evidence-base to inform improvement in health service delivery and health status in rural communities.
"The purpose of the discussion group is to enhance positive living through proper nutrition care and support for people living with AIDS (PLWA) and create a constructive dialogue among PLWA, front line workers, researchers, HIV/AIDS specialists, and policymakers," said Eleonore Seumo, HIV/AIDS senior program officer with the AED Food and Nutrition Technical Assistance project and moderator of the forum. Dorcas Lwanga, a nutritionist with the Support for Analysis and Research in Africa project, is co-moderator.
The Centre for Reproductive Rights invites you to subscribe to our monthly electronic newsletter, the Reproductive Freedom News. The Reproductive Freedom News reports on the latest developments on Capitol Hill, in the U.S. and around the world that affect reproductive rights. Just reply to rfn@reprorights.org with subscribe in the subject heading to receive the Reproductive Freedom News.
This booklet provides an overview of the Equity Gauge Strategy. The Strategy supports policy and action for health equity using a three-pronged approach of Assessment & Monitoring, Advocacy, and Community Empowerment. The document shows how the Strategy can be used to develop a comprehensive plan for identifying priorities, produce empirical information on health inequities, relate health to socioeconomic and political environments, work with policy makers, and support the involvement of communities to promote health equity.
The GEGA Newsletter is designed to provide information and resources to those working to support health equity through information collection and analysis, advocacy, and support for community empowerment, especially in countries of the South. To unsubscribe send a blank email to leave-geganews 135173M@lists.gega.org.za This list is hosted by the Health Systems Trust: http://www.hst.org.za
Health Action International (HAI) has produced this 7-page fact sheet, "Assured Quality and Lowest Prices: What the Global Fund Requires for Buying Medicines," to give guidance to countries and organisations that are involved in the process of applying for and receiving funds to procure medicines from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).
9. Jobs and Announcements
In April 2003, IICD (International Institute for Communication and Development), Cordaid and CEDHA (Centre for Educational Development in Health Arusha) jointly organised a conference to explore ways in which ICTs (information and communication technologies) can be used to develop and deliver continuing medical education to rural healthcare workers in Kenya, Malawi, Tanzania, Uganda, and Zambia. The overall aim of the meeting was to identify concrete strategies and approaches where ICTs can be used to develop and deliver continuing medical education to healthcare workers in rural areas.
With 42 million people now living with HIV/AIDS, expanding access to antiretroviral treatment for those who urgently need it is one of the most pressing challenges in international health. Providing treatment is essential to alleviate suffering and to mitigate the devastating impact of the epidemic. It also presents unprecedented opportunities for a more effective response by involving people living with HIV/AIDS, their families and communities in care and will strengthen HIV prevention by increasing awareness, creating a demand for testing and counselling and reducing stigma and discrimination.
The South African Medical Research Council (MRC) and the South African AIDS Vaccine Initiative (SAAVI) invite applications for one-year travelling research fellowships in health research, with preference given to proposals which address the MRC's research priorities (see below) and particularly to those addressing HIV/AIDS research.
This new journal from the Faculty of Medicine, Makerere Medical School in Kampala, was started in August 2001. It has rapidly grown in reputation as a leading publication on health issues in Africa. Just in March 2003 the journal was accepted for citation on MEDLINE, INDEX MEDICUS and PUBMED. It is abstracted by African Journals online (AJOL).
The Municipal Services Project (MSP) (www.queensu.ca/msp) is a multi-partner research, policy and educational initiative examining the restructuring of municipal services in Southern Africa. Research partners are the International Labour Research and Information Group (Cape Town), the University of the Witwatersrand (Johannesburg), the Human Sciences Research Council (Durban), Equinet (Harare), the South African Municipal Workers Union, the Canadian Union of Public Employees, and Queen's University (Canada). The project is funded by the International Development Research Centre (IDRC) of Canada. During the first phase of the project (2000 - 2003), the primary focus of our research was on the impact of policy reforms such as privatization and cost recovery on the delivery of basic municipal services (specifically water, sanitation, waste management and electricity). Most of this research was conducted in South Africa. We are now entering a second phase, which will focus more specifically on the impact of policy ‘reform’ on health and will expand the research to include more countries in Southern Africa.
LWR is now recruiting for a Program Manager for HIV/AIDS Projects - based in South Africa - to support churches and related ecumenical or faith-based organisations in Southern Africa to develop programs to address the AIDS crisis in impoverished communities - based on need rather than on race, ethnicity, religion, or creed. This is a temporary position with a two-year contract with no possibility of renewal.
The Pauline Jewett Institute of Women's Studies at Carleton University and the Institute of Women's Studies at the University of Ottawa, with the support of the Canadian International Development Agency (CIDA) and the International Development Research Centre (IDRC), are launching a four year project to allow scholars from the developing world, working in the field of “Gender and Development”, to spend a research term at their institutions. The “Visiting Scholar in Feminist Perspectives on Globalization” will contribute in facilitating the expansion of gender and development research at both universities, and also provide a unique opportunity for collaboration between feminist scholars in Canada and the developing world.