The current WTO negotiations, headed for the next trade ministers meeting in Hong Kong in December, look set for more protection of corporate rights and a further erosion of health rights in the General Agreement on Trade in Services (GATS) and the Trade Related Intellectual Property Rights Agreement (TRIPs). Outcomes in these discussions depend on a breakthrough in the agricultural negotiations.
While health is a basic human right, the protection of this right still has little recognition in the global trade agenda. The formal recognition of public health interests is in fact subjugated to the interests of corporate profit, with the protection of these corporate interests by rich countries.
While the TRIPs agreement allows violations of patent rights for public non-commercial use, compulsory licensing and parallel importation, these rights are not exercised because political pressure is brought to bear on countries that try to use them. TRIPs are creating a false scarcity of access to pharmaceutical drugs. Developing country governments and civil society campaigned at the 2001 Doha, Qatar World Trade Organisation (WTO) Ministerial Conference to improve access to drugs. This ended with a statement of ministers (restating the rights contained in the 1995 agreement) allowing countries to use flexibilities in the agreement to legally bypass patent rights.
Since achieving this confirmation of rights, global public health has suffered a series of defeats. Flexibilities are still not being used because unseen threats are made against countries that try to use their rights. The practical import of these deceptively generous rights in TRIPS is nullified, while rich countries are still able to exercise them (such as when the US accessed patented drugs to cope with the threat of a terrorist anthrax attack).
Even when flexibilities are exercised, African countries still have a problem that compulsory licensing under TRIPs can be used to produce mainly for local consumption. Countries with low or no local production capacity, cannot access branded drugs because of price. They cannot import generic drugs produced under compulsory licenses in other countries because other countries must comply with the local consumption regulations where up to 49% of production can be exported. Before the 2003 Cancun Ministerial, a settlement was reached allowing countries with limited local production capacity a waiver to import these drugs, but the waiver agreement is so onerous as to be useless. It has not been used once since coming into effect – not even by developed countries who can also take advantage of this flexibility to export drugs to poorer parts of the world.
The WTO Secretariat - supposedly merely international civil servants - also changed the signed text of the waiver, by including a footnote and asterisk after the signature. (The footnote refers to a document that was not part of the agreement, called the Chairman's text, which carries language about sustainable development and the fundamental rights to food, productive assets, development, health, education, economic, social and cultural autonomy, and self-determination but insists that signatories must resort to market mechanisms to claim these rights.) The US insists this footnote should guide the interpretation of the waiver, while developing countries regard it as irrelevant. The WTO Secretariat has refused to remove the asterisk and the footnote, despite the millions of lives affected by its addition.
Africa is pushing for a useable settlement in current negotiations, seeking to amend the TRIPs agreement and remove the onerous conditions in the waiver – so they can access low cost drugs. This has been summarily rejected by the US which wishes to retain current arrangements to protect profits and divert cheaper drugs into their markets. The EU is playing a brokering role, with the same ends as the US, but minimising the ambitions of the Africans in a more diplomatic way.
And with no progress on TRIPs, rich countries are making more demands on developing countries. The draft text on services for the Hong Kong Ministerial negotiations disregards developing countries submissions on domestic regulation and reflects the rich country proposals. It promotes the “list it or lose it” approach to regulations, requiring countries to list restrictive regulations or face losing them if challenged at the WTO. Developing countries have opposed the deception that the draft text reflects a possible consensus position: these objections have been “noted”, but not reflected in the text.
Regulatory measures are major impediments to international services trade. The GATS agreement – which regulates professional health services, health care services and health insurance – places disciplines on the state’s ability to regulate the service sector. Only “necessary” regulations can be validly imposed, with GATS demanding that ‘necessity’ be determined by the WTO and not by nations themselves – effectively outsourcing government regulatory power to the WTO's Dispute Settlement Body in Geneva. Therefore, GATS will seriously limit the ability of states to manage destructive competition and create adequate economies of scale. They will undermine the flexibility to use subsidies to the poor and cross-subsidisation. For poor countries, these commitments are effectively permanent because reversing commitments requires the payment of compensation that poor countries can ill-afford.
To add insult to injury, the EU demands countries in the south liberalise service sectors while giving European civil society “assurance” that their public services will not be put on the table. The EU says there is a crisis in the services talks with too few offers of liberalisation on the table from developing countries. Developing countries contend that offers from the rich countries do not match their export interests, so they cannot take the blame for the lack of progress in negotiations. To improve the liberalisation offers on the table, the EU proposes changes in the GATS negotiations process. Instead of countries volunteering a list of sectors the EU is demanding that target benchmarks be set for liberalisation of sub-sectors. Qualitatively, the EU wants: limits removed with respect to consumption of services abroad; increased access to cross border trade and commercial presence; removal of foreign equity ownership; and the reduction of discriminatory economic needs tests. Developing countries have rejected this aggressive pursuit of GATS.
The most important matter in the WTO remains agriculture, which could unblock all the other negotiations. Rich country subsidies allow produce to be sold at prices below the cost of production. These subsidies (to the tune of US$ 1 billion per day) play havoc with international commodity prices and undermine the export market interests of developing countries. Compounding this are demands for reduced import tariffs in developing countries. The subsidy cuts offered by the EU and US will have little or no impact and leave us far from an international trading system that promotes the type of food sovereignty needed for improved food security and nutrition outlined in earlier EQUINET newsletters.
The current WTO negotiations expose the extent to which proposals from the rich countries will seriously undermine advances in public health. The trade, political and other pressures brought to bear indicate that below a veneer of ‘democratic functioning’ the discussion on global trade continues to be held within institutional arrangements and processes that protect excesses of wealth and hide the exploitation of the poorest nations in the world.
* Riaz Tayob is from SEATINI and represents EQUINET's theme work on trade and health.
* Please send feedback or queries on the issues raised in this briefing to SEATINI at www.seatini.org or to the EQUINET secretariat at TARSC, email admin@equinetafrica.org EQUINET work on trade and health is available at the EQUINET website at www.equinetafrica.org
1. Editorial
There are many occasions during the course of the year to pronounce about the pandemic. On the occasion of this World AIDS Day, I’d like to resist the temptation to run with hyperbole. Rather, I’d like to put two specific proposals which may seem obvious, but which speak, I believe, to the heart of the struggle against the virus.
The first involves dollars. The Global Fund to Fight AIDS, Tuberculosis and Malaria --- the best financial vehicle by far to help break the back of the pandemic --- is in terrible trouble. It is over three billion dollars short for 2006 and 2007, and that shortfall will doom millions to death in the following years unless something drastic is done, and fast.
What has happened was completely unexpected. The G8 leaders met at Gleneagles in July, and emerged with ringing promises of financial assistance for Africa. The first test of those promises came just eight weeks later, in early September, at the replenishment conference for the Global Fund. The G8 flunked the test. The assumption was that the Global Fund would go right over the top given the rhetoric of the Gleneagles Summit, but instead, having requested $7.1 billion, the Global Fund fell billions short.
It’s fair to say that everyone was stunned. It took only eight short weeks for the G8’s signed agreement to fall apart.
I’ve just spent the last three days in Rwanda at the regional conference of the Global Fund for East Africa and the Indian Ocean. It’s absolutely astonishing to see how determined the countries are to achieve the goal of universal treatment by 2010, but they’re frightened by the prospect of not having sustainable resources. They know they can’t interrupt treatment once it’s started, but what guarantee do they have, under present circumstances, that the G8 will be by their side as promised?
All they can count on, for certain, is betrayal.
That must somehow be reversed. The year 2005 showed that treatment is possible in great numbers, and there is a strong sense that if the momentum can be sustained, the back of the pandemic can be broken. But that will depend on a continuing, reliable flow of resources. It depends on the commitments of the G8 being honoured. With the loss of honour goes the loss of life.
However, in addition to keeping the pressure on governments, we need a new source of dollars. That source must be the private sector. It was always hoped -- indeed, even expected -- that private sector money from major multinational corporations would help to keep the Global Fund going. It hasn’t happened. The contributions are negligible. It’s as though most of the private sector doesn’t know the Global Fund exists.
I want to suggest that companies contribute 0.7% of pre-tax profits annually to the Global Fund. To maintain the symmetry with governments and the Millennium Development Goals, they should phase the money in and reach the full target by 2015. Which corporations? Pretty obviously, I think, the big multinational corporations that have exacted such huge wealth from Africa’s mineral, diamond, oil and other resources over the decades, and certainly the pharmaceutical industry, which resisted the lowering of drug prices for an unconscionable length of time.
But there may be an even better and fairer way to select the corporate contributors. The Global Business Coalition on HIV/AIDS has a membership of some two hundred multinational corporations. Many of these corporations deal admirably with their workforces, providing antiretroviral drugs to their workers where necessary, and sometimes to the workers’ partners and children. Others of these corporations make in-kind contributions, or investments in research and training centres. But the true expression of corporate social responsibility would be a 0.7% contribution to the Global Fund. If the principle spread, the dollars would mount unto the billions.
There’s no reason to feel cynical about such a proposition. People mocked when Gordon Brown talked of his International Finance Facility, but now it’s well and truly launched. People mocked when France advanced the idea of a tax on airline travel to fund development, but now President Chirac seems determined to proceed. There’s room for every genuine initiative.
This effort would show the world that the pandemic can be beaten.
Now allow me to switch gears and deal with a particular aspect of children and AIDS which reveals an appalling double standard, and must be dealt with. In fact, it should have been dealt with several years ago.
The overwhelming majority of HIV-positive children are infected by the virus during and following the birthing process. Children infected in early infancy usually die before the age of two. There are more than half a million deaths of children from AIDS every year.
In many countries, primarily in Africa, there are programs in place called PMTCT, Prevention of Mother-to-Child Transmission. Unfortunately, most of these are merely pilot programs: fewer than ten per cent of HIV- positive pregnant women have access to PMTCT. That, in itself, is scandalous.
In most countries the PMTCT program uses what is called single-dose nevirapine … one tablet of that drug to the mother during labour and a liquid equivalent of the drug for the child within 48 hours of birth. Incredibly enough, the transmission is cut by close to 50 per cent! Half the babies who would otherwise be born positive are born negative.
That, of course, is wonderful. But compare it with North America (or anywhere in the western world). North American hospitals do not use the drug nevirapine; they use full antiretroviral triple-dose combination therapy from approximately 28 weeks through to the end of the pregnancy. The result? The transmission rate drops to between one and two per cent!!
Why do we tolerate one regimen for Africa (second-rate) and another for the rich nations (first rate)? Why do we tolerate the carnage of African children, and save the life of every western child? Is it possible to do full therapy in Africa rather than single dose nevirapine? Of course it is. Doctors Without Borders does it in Uganda; Partners in Health does it in Rwanda; Saint Egidio does it in Mozambique. In fact, Rwanda is introducing a formal protocol to make sure that full therapy is provided in every setting where PMTCT is available. They are the first country to do so.
It leaves the mind reeling to think of the millions of children who should be alive and aren’t alive, simply because the world imposes such an obscene division between rich and poor. That’s about to change, but why does it always come after an horrific toll is taken?
There is another aspect of saving children’s lives that is much neglected and much rationalized. Even when transmission is prevented during pregnancy and birth, the virus can still be passed through breast milk. Therefore, we require safe solutions to infant feeding, including secure supplies of formula where feasible, with careful instruction about clean bottles and preparation, and all of it provided free: there’s just no possibility of rural village women in Africa being able to pay for breast milk substitutes.
Research available so far indicates that that, too, must become public policy wherever possible. And where it’s not possible or safe, exclusive breast-feeding for six months is undoubtedly the best course. It’s worth noting that it took almost a decade to finally develop antiretroviral drug preparations for children with AIDS. The time has come to reduce, dramatically, the numbers of children who begin their lives infected.
On this World AIDS Day, 2005, I have the deep impression that if only we could galvanize the world, we’d subdue this pandemic. We’re terrific when it comes to studies and documentation. Reports like the Epidemic Update issued by UNAIDS last week are models of statistical compilation, containing pockets of fascinating material. But the report itself acknowledges that real progress against the pandemic is hard to find.
We need a superhuman effort from every corner of the international community. We’re not getting it. At the present rate, we’ll have a cumulative total of one hundred million deaths and infections by the year 2012. We call ourselves an advanced civilization.
2. Latest Equinet Updates
The regional review meeting brought together steering committee members; theme, process and country co-ordinators; colleagues working in key areas of work central to EQUINET’s agenda; and civil society colleagues. The meeting reviewed EQUINET current work to shape and critically debate the form and content for the annual equity analysis at regional (and country) level.
The workshop aimed to review the work and research papers of the capacity building programme implemented in Tanzania and Zimbabwe to date. The purpose of the workshop was thus to review the training, findings and programme in order to identify issues arising for policy support, future capacity building, extension to other countries in the region and to strengthen linkages with other work on trade and health.
3. Equity in Health
Each year, over 1.6 million people worldwide die as a result of violence. Violence is among the leading causes of death for people aged 15-44 years, accounting for 14% of deaths among men and 7% of deaths among women worldwide. For every person who dies, many more are injured and suffer from a range of physical, sexual, reproductive and mental health problems. Violence can be prevented. Through the Global Campaign for Violence Prevention, WHO and its many partners are contributing to a new way of thinking about violence prevention.
Four people died of dysentery last month in northern Zimbabwe in what appears to be the first outbreak of the disease outside the capital, reports said. An outbreak of the highly contagious diarrhoeal disease was reported earlier this month in Harare and its satellite town of Chitungwiza. Two hundred people were taken to hospital.
The Treatment Action Campaign and the South African Medical Association (SAMA) have filed court papers against the Minister of Health, the Medicines Control Council (MCC), the Western Cape MEC for Health, as well as pharmaceutical proprietor Matthias Rath and several of his employees and associates, including AIDS denialists Anthony Brink, David Rasnick and Sam Mhlongo (Professor of Family Medicine, MEDUNSA). This briefing explains why.
"Health civil society groups in Zimbabwe and east and southern Africa, recognising the initiative of health civil society in the region met in Harare on the 13th of October 2005 to discuss our struggles for health. We agreed on the following resolutions.
We are united, together with health civil society in the region, around the core principles and values of:
- the fundamental right to health and life
- equity and social justice
- people-led and people-centred health systems
- public over commercial interests in health (health before profits)
- people-led and grassroots-driven regional integration."
The World Health Organization will miss its 3 by 5 Initiative target of treating three million HIV-positive people in developing countries with antiretroviral drugs by the end of this year because of a lack of cooperation and coordination internationally and a lack of national leadership, according to a report released by a coalition of HIV/AIDS treatment advocates, the New York Times reports. The International Treatment Preparedness Coalition, a group of 600 treatment advocates from more than 100 countries, produced the report, titled "Missing the Target -- A Report on HIV/AIDS Treatment Access from the Frontlines," which aims to identify challenges to treatment access and provide solutions to overcome them.
Women who suffer physical abuse from intimate partners - the most common form of violence perpetrated against women worldwide - experience serious health consequences, according to a report released in November by the World Health Organization, the AP/Boston Globe reports. The survey of 24,000 women in 10 countries found that women who suffer domestic abuse were twice as likely as other women to suffer health problems, including pain, dizziness, gynecological and mental health problems, which persist after the abuse has stopped, the report says.
4. Values, Policies and Rights
One of the most fundamental human rights is the assumption that each person matters, and everyone deserves to be treated with dignity—this is the tenet from which all other human rights flow. Another is that those who are most vulnerable deserve special protection. However, in many developing countries, vast numbers of children are born but never counted, and their health and welfare throughout their lives remains unknown. And because single-mean measures of population health mask inequalities among the best-off and worst-off, the health of vulnerable populations is not effectively documented and acknowledged. Health information systems can play an important role in supporting these rights by documenting and tracking health and health inequities, and by creating a platform for action and accountability.
A number of African gender advocates in both government and civil society have put up spirited fight to have the United Nations create a Fund to address millennium development goal issues of reproductive health and gender empowerment. To be known as the Millennium Development Goal (MDG) Fund, resources channelled to this Fund are to be used to lower the high maternal and child mortality rates in sub-Saharan Africa and ensure gender empowerment and environmental goals are implemented with speed. But the United States, especially the Bush Administration and other pro-life advocates, are said not to be warming up to the idea, which they see as coded attempts to fund abortion related issues and increase procurement of condoms.
5. Health equity in economic and trade policies
An AU Health Ministers meeting was held in Gaborone, Botswana 13-14 October 2005. On TRIPS, the final statement of the meeting said:
- UNDERTAKE to pursue, with the support of our partners, the local production of generic medicines on the continent and to making full use of the flexibilities in the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPs) and the Doha Declaration on TRIPS and Public Health;
- CALL UPON our Ministers of Trade to seek a more appropriate permanent solution at the WTO that revises the TRIPS agreement and removes all constraints, including procedural requirements, relating to the export and import of generic medicines;
- CALL UPON Member States and Regional Economic Communities to ensure that TRIPS plus provisions which go beyond TRIPS obligations are not introduced in bilateral / regional trade agreements or in economic partnership agreements.
Campaigners from Southern Africa are bracing for the World Trade Organisation (WTO) talks to be held in Hong Kong later this month. Some plan to send representatives to the meeting, to protest against unfair trade legislation – particularly as this relates to agriculture. These representatives will include two cotton farmers from Zimbabwe, says Ntando Ndlovu of the Zimbabwe Coalition on Debt and Development, a non-governmental organisation (NGO) based in the capital, Harare.
"The two farmers will be in Hong Kong and make noise using anything, including the beating of drums," she told a gathering of Southern African activists this week at a conference held in the South African commercial hub of Johannesburg. Ndlovu also urged Mozambique and South Africa to send cotton farmers in support of their Zimbabwean counterparts.
The World Trade Organisation was supposed to conclude a ‘permanent solution’ to the problem facing countries that have no or inadequate drug manufacturing capacity so that they can have access to affordable medicines. The impasse that has taken place in the recent negotiations brings into focus the importance of the issue to the developing countries in the light of the global avian flu threat and the shortage of the anti viral drug to treat bird flu. This Third World Network web page includes a background note on the issue by Sangeetha Shashikant and the report on the talks by Martin Khor.
This new study shows how South Africa's flagship health legislation conflicts with binding commitments the former apartheid regime negotiated under the World Trade Organization's General Agreement on Trade in Services (GATS). This trade treaty conflict threatens to undermine the much-needed legislation and, if left unresolved, would make meeting the health needs of the majority of the population far more difficult. The study explores several options that South Africa has for resolving this conflict in favour of its health policy imperatives, but each entails risk. South Africa's dilemma should serve as a world-wide warning that health policy-makers, governments and citizens need to be far more attentive to negotiations that are now underway in Geneva to expand the reach of the GATS.
6. Poverty and health
Cutting poverty and reducing the burden of disease are major global development goals. Can strategies tackle these tasks in parallel, by focusing on very poor people? The health sector can borrow strategies from welfare services to reduce the risk of health-related shocks, ease their impact and break the vicious cycle of poverty and ill-health. Poor people often have higher risks of adverse events and fewer means to cope with them than wealthier groups. A paper produced for a UK Department for International Development workshop analyses health-related shocks.
Social grants play a critical role in reducing poverty and promoting development in South Africa. This study evaluates the socio-economic impact of various social grants including child support grants, disability grants and state pensions. The paper further examines their effects on the household, the labour market and the economy. The paper begins by assessing the impact of social assistance on poverty reduction. To evaluate the level of poverty, the authors use different methodological approaches including absolute and relative measures. The second section investigates the effects of social grants on households’ access to health care, schooling, housing, water and electricity. The third section examines the impact of social security on employment and productivity. Finally the paper analyses the impact of this public expenditure on macro-economic indicators including national savings and consumption.
Is the water privatization heavily promoted by the International Financial Institutions, a good thing for the poorest in the developing countries? A new report by Nancy Alexander of the Citizen's network on essential services takes a skeptical view. A UN report, "Economic, Social and Cultural Rights: Liberalization of Trade in Services and Human Rights" claimed that increased foreign private investment in public services can upgrade national infrastructure, introduce new technology and provide employment. However, the report also argues that it can lead to negative impacts to the poorest.
7. Human Resources
In the context of the Millennium Development Goals, human resources represent the most critical constraint in achieving the targets. Therefore, it is important for health planners and decision-makers to identify what are the human resources required to meet those targets. Planning the human resources for health is a complex process. It needs to consider both the technical aspects related to estimating the number, skills and distribution of health personnel for meeting population health needs, and the political implications, values and choices that health policy- and decision-makers need to make within given resources limitations.
African countries have a very low density health workforce, compounded by poor skill mix and inadequate investment. Yet trained healthcare staff continue to migrate from Africa to more developed countries. The World Health Organization has estimated that, to meet the ambitious targets of the millennium development goals, African health services will need to train and retain an extra one million health workers by 2010.
International and local delegates to the Scotland-Malawi conference held in Edinburgh, Scotland recently were alarmed with the shortage of health workers in the country which they said has worsened due to brain drain. But the conference failed to reach a consensus to curb the problem. Some delegates suggested that an immediate deportation of the health workers from the United Kingdom while others proposed that the UK should pay back.
8. Public-Private Mix
Each year 100 million people slide into poverty as a result of medical care payments. Another 150 million people are forced to spend nearly half their incomes on medical expenses. That is because in many countries people have no access to social health protection - affordable health insurance or government-funded health services. Paradoxically, people in the world’s poorest countries contribute relatively more for health care than those in wealthy industrialized nations. In Germany, for example, where the average GDP per capita is US$ 32 860 and almost everyone has social health protection, 10% of all medical expenses nationwide are borne by households.
Taking as point of departure the need for a strong public health care sector in developing countries the article firstly outlines how in sub-Saharan Africa enhanced scarcity has characterized the content and quality of health care in the public sector. This has eroded the trust among the public in the government as provider of health care and guardian of public health. Secondly, it describes how workers in the public health domain have dealt with the implications of scarcity by etching out a "puvate" zone in health care provision and how these informal activities need to be interpreted as "muddling through".
This report from the World Health Organization summarises proceedings from an international working group meeting on public-private sector mix (PPM) programmes for expanding DOTS (directly observed treatment, short-course), the internationally recognised TB control strategy. The meeting stressed that effective scale-up of PPM DOTS must ensure access to TB care for all population groups. Key barriers to scaling up PPM DOTS included lack of capacity for technical support at national, regional and global levels, and weak advocacy and promotion.
9. Resource allocation and health financing
Many governments in affected countries have failed to introduce cost-effective approaches to tackle malaria. Researchers from the London School of Hygiene and Tropical Medicine reviewed the literature on malaria control and used economic analysis to assess demand for and supply of malaria control methods. The authors make recommendations for improving both the prevention and treatment of this major public health problem. Governments need to play a role in ensuring access to cost-effective interventions for malaria treatment and prevention. Often such preventions are beyond the means of individuals, and the high costs of treating severe malaria can drive households into poverty.
The issue of appropriate mechanisms for mobilising health care financing resources is once again high on the policy agenda of African governments. The objectives of this paper are to critically evaluate how health services are currently funded, explore recent trends in health care financing and identify lessons from the health care financing experience of African countries. It also considers the implications of this review for policy, advocacy and future research needs.
10. Equity and HIV/AIDS
In theory, preventing HIV/AIDS seems simple enough: give people information on how the disease is spread, and the desire for self-preservation will, naturally, make them adopt safer sexual behaviour. The reality has proved much more complex. Almost 30 years after it was first diagnosed, ignorance about HIV/AIDS still persists. According to the UNAIDS Epidemic Update for 2005, [www.unaids.org] "there is new evidence that prevention programmes initiated some time ago are currently helping to bring down HIV prevalence in Kenya and Zimbabwe" but, overall, prevention efforts have a poor track record, particularly in sub-Saharan Africa, which is home to two-thirds of all people living with HIV.
The world's need for antiretroviral drug (ARV) access is "far from met" due to funding shortfalls, Richard Feachem, executive director of the Global Fund, has said following the release of a UNAIDS epidemic update. Stressing that the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria was still in need of US $3.3 billion to meet its 2006 and 2007 goals, Feachem said the UNAIDS report was an affirmation that global investments and commitment could have an impact on the devastation of the pandemic.
There is new evidence that adult HIV infection rates have decreased in certain countries and that changes in behaviour to prevent infection - such as increased use of condoms, delay of first sexual experience and fewer sexual partners - have played a key part in these declines. A new UN report - Aids Epidemic Update - also indicates, however, that overall trends in HIV transmission are still increasing, and that far greater HIV prevention efforts are needed to slow the epidemic. Kenya, Zimbabwe and some countries in the Caribbean region all show declines in HIV prevalence over the past few years with overall adult infection rates decreasing in Kenya from a peak of 10% in the late 1990s to 7% in 2003 and evidence of drops in HIV rates among pregnant women in Zimbabwe from 26% in 2003 to 21% in 2004. In urban areas of Burkina Faso prevalence among young pregnant women declined from around 4% in 2001 to just under 2% in 2003.
The World Bank states that as of the end of 2004, 39 million people worldwide were living with HIV/AIDS, of which more than 95 per cent were in low- and middle-income countries. Nearly two-thirds are in sub-Saharan Africa, and nearly one in five in South or Southeast Asia. The World Bank has been carrying out efforts to prevent HIV/AIDS and mitigate its impact since the late 1980s. Most efforts have been over the last decade: only 9 free-standing AIDS projects and 22 with AIDS components of at least $1 million have been completed. Nearly two thirds of its global projects and commitments have been launched since 2000, the majority of which are accounted for in the Africa Multi-Country AIDs Programme (MAP).
Is high level HIV and AIDS policy cut off from the reality on the ground? Ingrid Young, editor of the Eldis HIV and AIDS Resource Guide, argues that policymakers need to listen to and learn from each other as well as from communities who are experiencing and responding to the crisis. "The development community needs to focus on what communities and organisations are already doing, not only in their response to HIV and AIDS, but also in terms of how they share their information and experiences and how they collectively identify challenges and solutions," she writes.
"The private pharmaceutical industry remains the most important source for the global supply of ARVs today. While the research-based pharmaceutical companies have been responsible for development of many of the medicines used to treat HIV/AIDS, the generic industry for its part has contributed enormously to making widespread treatment possible in the developing world, because of their innovative fixed dose combination tablets (FDCs) and their more affordable prices relative to their brand-name equivalents. FDCs mean that all the required medicines can be combined into one pill which often patients take just once or twice a day."
11. Governance and participation in health
This paper provides an overview of the role radio broadcasting can play in promoting better health for poor people. It has been conceptualised within the context of global efforts to reduce the burden of disease and ill health on poor people and advocates a people-centred and rights-based approach to health communications that emphasises: working with poor communities to gain an understanding of the full range of epidemiological, behavioural and risk taking factors that drive disease and ill health.
12. Monitoring equity and research policy
Health research is indispensable for improving health and health equity and contributing to overall development. Many developing countries have made substantial investments in building and enhancing their capacities for research in health and related fields, and these efforts have been supported and extended by programmes of development agencies and research institutions located in high-income countries. Despite decades of such efforts, and notwithstanding some notable examples of success, the overall picture of progress is a mixed one.
Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. We recommend that highest priority be given to research in five general areas: (1) global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders; (2) societal and political structures and relationships that differentially affect people's chances of being healthy within a given society; (3) interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health; (4) characteristics of the health care system that influence health equity and (5) effective policy interventions to reduce health inequity in the first four areas.
There are few systematically developed national research priorities for child health that exist in sub-Saharan Africa. Children's interests may be distorted in prioritisation processes that combine all age groups. Future development of priorities requires a common reporting framework and specific consideration of childhood priorities, according to a review of national priorities for child health research published in Health Research Policy and Systems 2005. The research reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them.
13. Useful Resources
This manual aims to assist civil society organisation in campaigning for the Millennium Development Goals (MDGs). The Millennium Development Goals form an ambitious agenda for reducing poverty and improving lives. World leaders formulated the MDGs at the United Nations Millennium Summit in September 2000. Each goal contains one or more targets to be reached by 2015, and each country has to set realistic, time-bound and measurable national development goals in line with these targets.
Alma Mata is a new UK-based information gateway and network for professionals and students interested in careers, training, research and campaigns in international health. You can find us at www.almamata.net.
At the end of 2004, PlusNews introduced a periodically updated Treatment Map to monitor the rollout of antiretroviral treatment in Africa, providing data for each country on the total number of people on treatment, the drug regimens used, and latest funding provided by the Global Fund, World Bank and PEPFAR. PlusNews is pleased to announce updated data for the following countries: Kenya, Cote d'Ivoire, Rwanda, Ethiopia, Uganda, Madagascar, South Africa, Ghana, Botswana, Namibia.
14. Jobs and Announcements
IDS is one of the world's leading organisations for research, teaching and communications on international development. The Institute works with a network of global partners to generate cutting edge knowledge as a basis for bringing alternative ideas and fresh solutions to the real world challenges of development policy and practice. Research at IDS is grouped around five key themes – governance, participation, competing in the global economy, governing science and technology, and managing risk and vulnerability. Much of the work at IDS is multidisciplinary in nature, and most is carried out in collaboration with partners from around the world. The research community at IDS consists of approximately 50 Fellows and 40 other researchers and academic support staff, and is enhanced by Visiting Fellows from many countries.
The Global Forum for Health Research invites you to submit an abstract for Forum 10 in any area of health research relevant to promoting health, combating diseases and improving global health in general and the health of poor and marginalized populations in particular. Papers addressing these areas from a national, sub-national or regional perspective are particularly invited. The Global Forum welcomes submissions from all parts of the world and encourages participation from lower income countries.
This call invites applicants to participate and share experiences in a Workshop on Participatory Methods for for research and training for a people centred health system being held in Bagamoyo, Tanzania, March 1-4, 2006. TARSC and IHRDC under the EQUINET umbrella and with support from CHESSORE have developed a toolkit of materials on participatory reflection and action (PRA) methods for research and training for a people centred health system. The materials provide information on areas for strengthening community voice and roles in health systems and introduce and provide examples of participatory approaches for training and research that supports this. The toolkit provides practical examples that can be used in field work, but also builds broader understanding of the elements of participatory methodologies for health. It aims to support work at national, district and local level with health systems and communities in health, with a major focus on the interactions at primary health care level.
Published for the Network for Equity in Health in Southern Africa by
Fahamu - Networks for Social Justice
http://www.fahamu.org/
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