Are institutions that tap poor people’s desire for credit, shrinking Third World states’ already beleaguered welfare policies? The role of microfinance in poverty reduction, reducing risk environments for HIV and promoting private health insurance has attracted high profile interest since Muhammad Yunus won the Nobel Peace Prize last December.
Yunus’s Grameen Bank battled backward Bangladeshi patriarchal and religious attitudes to extend credit to millions of people. Poor women were typically arranged in groups of five: two got the first tranche of credit, leaving the other three as ‘chasers’ to pressure repayment, so they could in turn get the next loans. But a decade ago (at a time of lower foundation subsidies, new competitors, adverse weather conditions and a backlash by borrowers who used collective power of nonpayment), Grameen imposed dramatic price increases on loan repayments and resorted to extreme pressure techniques, including removing tin roofs from delinquent women’s houses. This reduced Grameen Bank’s main philosophical position - ‘We consider credit as a human right’ - to merely an argument for access, not affordability. This distinguishes Yunus from all rights-based social movements demanding ‘rights’ to free lifeline access to healthcare, AIDS medicines, education, housing, land, water, electricity, etc.
According to Munir Quddus, chair of the Department of Economics and Finance, University of Southern Indiana, the model needs more investigation: ‘The very nature of setting up groups leaves out the very poor who would be perceived by fellow members to have no ability to generate income and therefore high risk … microcredit simply deepens the exploitation of the women since the rates of interest charged by the bank in real [after inflation] terms are quite high; consequently, credit often worsens the debt situation and gives the husbands even more leverage.’
Evidence on South Asian microcredit and major credit programs suggest that credit does not necessarily have a positive impact on social relations. Many loans targeted at women are appropriated by male family members, leaving women as buffers between their spouses and lending institutions, with often stressful and violent results. Even where women’s incomes have increased, research found women’s work and debt loads also increased. Women’s access to credit does not guarantee improved confidence, mobility, control over assets, or freedom from violence. Therefore, microcredit must be interrogated to determine if it is really about poor people gaining control, or if it leaves structural and often global causes of poverty unaddressed.
For example, in 1998, when an emerging market crisis led to rising interest rates across the Third World, South African microlenders and borrowers were driven into bankruptcy by a 7% increase imposed over two weeks as the local currency crashed. In Zimbabwe, a 1980s US$66 million flood of World Bank financing revitalised the rural microfinance sector (initiated under 1940s Rhodesian rule) and reached 94,000 households. But within a decade, the peasant default rate was 80% - with repayment affordability being a huge factor (a typical lender’s overhead and collection costs on a small loan were 15-22% (including incorporation of a 4% default rate)). Michael Drinkwater’s (1991) detailed study of central Zimbabwe showed peasant farmers faced serious difficulties in servicing loans of just a few hundred US dollars, since average net crop profit was just $0.15/hour of labour, according to a 1989 Agriculture Ministry survey. This was compounded by ‘an overzealous launching of a group credit scheme’ and the ‘doubtful viability of high cost fertiliser packages’, inappropriate for the erratic climate. ‘The increase in credit use means farmers have to market more to stay solvent ... At the household level it is commonly debts not profits that are on the rise.’
This raises the question: ‘Is credit the most useful input for African peasants’ economic and social wellbeing, especially women?’ According to Mohindra and Haddad (2005), women’s health capabilities (opportunities to achieve good health) and health functionings (e.g. being healthy), ‘can be expanded via key determinants of population health, such as access to resources and autonomy’, with microcredit as a primary tool. But is microcredit really a tool for expanding access to health inputs when the structural disempowerment and malfunctioning markets that bedevil credit systems are added to the overall retreat of the Third World welfare state?
The question is important as Grameen-style microcredit is increasingly linked to health services ranging from education to insurance, including: the Niger CARE ‘Microcredit and Health Education for HIV/AIDS-Affected Women and Children in the Valley of the Widows’; the Philippine NGO Innovations for Poverty Action and the Green Bank marketing of health insurance and preventative care through 2000 microentrepreneurs; or
the International Medical Corps microcredit project to support local health programs in Eritrea. The Microcredit Campaign Summit pointed to many new opportunities to substitute microcredit for state or donor assistance in reproductive health education. But such schemes need to be questioned on: whether they deliver on resources and autonomy, how they change local power relations; and their record on arrears, social conflict and defaults.
Few rigorous studies document the relationships between financial vulnerability and health burdens. A study of a Dominican microcredit program, which made small loans to individuals to start or expand small businesses, included three communities: one with health promotion alone; one with microcredit alone; and one with both. The community with parallel microcredit and health promotion programs had the largest changes for ten of eleven health indicators. However, the study also traced health gains to improved ability to purchase commercial water supplies, making a link between microcredit and the demand on poor people to pay for commercial and privatised water. As the UNDP Human Development Report (2006) noted, microcredit is explicitly used to promote the market in essential services and enable poor households to meet the financing requirements.
While not denying the prospect that some microcredit schemes are worthy and effective, the criticisms raised offer warning. Claims made about microcredit as an overarching strategy to end poverty, change power relations, attack structures of inequality or improve vulnerable population’s health education should be treated with caution. Certainly, microcredit cannot stand in for decent social policy when it acts as a safety net, co-existing with and not transforming entrenched structures that generate poverty . In the worst case, microcredit can become an ideology explicitly hostile to state support for healthcare.
‘I believe that “government”, as we know it today, should pull out of most things except for law enforcement and justice, national defense and foreign policy, and let the private sector, a “Grameenized private sector”, a social-consciousness-driven private sector, take over their other functions.’
To illustrate the dangers ahead, those were words uttered in the 1998 autobiography of Nobel Peace Prize winner Yunus.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat at TARSC, email admin@equinetafrica.org. A more detailed analysis of the issues raised in this editorial can be found in Microcredit Evangelism, Health and Social Policy by Patrick Bond, Forthcoming in the International Journal of Health Services, June 2007.
1. Editorial
2. Latest Equinet Updates
This report explores the health equity issues in Malawi, as a country equity analysis and contribution to the regional picture. It explores the current equity situation in Malawi through a review of literature and a meeting of local institutions, and proposes areas of focus for future work. It addresses the potential to promote equity in health through a strong network of equity actors whose voice would advocate for equitable access to basic quality health care in Malawi.
Zimbabwe, like many other countries in the region, is badly affected by a shortage of health workers. Many of the health indicator improvements achieved during the first ten years of independence are on the decline and a major reason for this is shortage of skilled and experienced health workers at a time when demand for services is increasing due to a growing population and the challenges posed by HIV and AIDS. The public sector provides as much as 65% of health care services in the country, so a shortage of public sector health workers affects the majority of the population. Against a background of increasing shortages, the report argues for improved management practices and better distribution of human resources in health care systems. This study presents evidence on the distribution of public sector health workers in Zimbabwe and the impacts on equity objectives in health care.
This study reviewed the available published and grey literature, with a focus on primary health care and the district health systems in sub-Saharan Africa, in order to explore the facilitators and barriers to community participation. Six African countries were selected for deeper review and analysis: Botswana, Lesotho, Namibia, Rwanda, Swaziland and Tanzania. The work signals a need for more culturally informed interventions that draw from indigenous knowledge bases, with evidence-based data that is culturally relevant, and that contextualises poverty, health risks and systems in sub-Saharan Africa. The review identifies a number of challenges, not the least of which is the prevailing perspective of the citizen as an object of health rather than as an active subject.
This study was implemented to identify trends in the health budget in Zimbabwe 2001-2006, assess the equity oriented nature of these trends and make recommendations to strengthen pro-equity dimensions of the health budget. The review examines the budget in three major respects: how far the opportunities for equity in revenue mobilization are being tapped; how far the allocation and expenditure patterns are promoting policy targets, particularly equity; and how far incentives and investments are levering health promoting investments (and penalizing those that undermine health). The study drew evidence from secondary data and national surveys, from reported Ministry of Finance estimates and from the reported budget allocations provided by government, with a focus on the years 2000-2006.
This report prepared under a capacity building programme analyses the relevant provisions of the World Trade Organisation (WTO) Trade Related Aspects of Intellectual Property Rights (TRIPs) and the General Agreement of Trade in Services (GATS) agreements with respect to the provision and accessibility of health services in Malawi. The paper explores the manner in which Malawi's legal and institutional systems are able to ensure access to essential medicines under TRIPS and the implications of GATS for essential health care services and for meeting health obligations.
This report prepared in capacity building programme analyses the relevant provisions of the World Trade Organisation (WTO) Trade Related Aspects of Intellectual Property Rights (TRIPs) and the General Agreement of Trade in Services (GATS) agreements with respect to the provision and accessibility of health services and essential medicines in Zambia.
3. Equity in Health
Hopes, experiences, optimism, evidence, critique, challenge and expectation- we present in this section reports from those at the World Social Forum held in Nairobi in January 2007. We welcome opinion pieces, reports on sessions relating to health issues, position papers or comments on the WSF and would like to hear your experiences and impressions of the sessions that had relevance to health. Please write to us at admin@equinetafrica.org and we will include inputs in our next newsletter.
The World Social Forum first met in 2001 in the city of Porto Alegre, Brazil, as a challenge to the World Economic Forum (WEF) and 'claimed to organize an alternative to capitalist neo-liberal globalisation. The author further describes their experience as they scoured for analysis of the World Social Forum, and came across critiques accusing the WSF of being a glorified discussion group for the emerging class of career activists and NGOs, to an incubator for the domestication of possibly explosive actors.
Women, especially in the developing world, who continue to bear the burden of the negative impact of globalisation, must fight for their rights, a Kenyan civil rights activist said on Monday at the World Social Forum (WSF). Anna Tibaijuka, the executive director of UN Habitat, said globalisation had contributed to the suffering of women as they continued to bear the burden of its negative impact. Participants spoke against violence, saying they wanted the world to continue to hear their voice. A woman from Bangalore, India, who asked to be referred to as Shokun, said violence was a major cause of death for women in India.
Duncan Otieno, 22, lives in Huruma, one of four main slums in Kenya's capital, Nairobi. Otieno has lived there since coming to the city in 2003 after finishing school in Kisumu, in the west of the country. Otieno attended the last day of the World Social Forum. He expressed hope that the gathering will achieve outcomes on issues affecting ordinary people, including access to water, high rentals and insecure jobs. "However, if the forum is just a matter of people talking, just for the sake of gathering, then it will be of no use."
The World Social Forum On Health Policital Agenda was held in Nairobi, Kenya on 21-23 January 2007. The theme for the 7th edition of the World Social Forum is “People’s Struggles, People’s Alternatives”. The 7th edition of the World Social Forum brings the world to Africa as activists, social movements, networks, coalitions and other progressive forces from Asia-Pacific, Latin America, the Caribbean, North America, Europe and all corners of the African continent converge in Nairobi, Kenya.
The first edition of Global Health Watch (GHW) was launched last year, and the Global Health Watch 2007/8 will be published late in 2007 or early 2008. The full edition of GHW and a shorter advocacy document Global Health Action can be downloaded from the GHW website. People's Health Movement (PHM) would like to ensure that indigenous health issues are highlighted in relation to all the areas that will be covered in the second edition of Global Health Watch, and request your assistance and input in this regard. They would like to provide chapter co-ordinating authors with information on indigenous health issues that can be integrated within the various chapters.
The author describes a personal experience in the days of preparation for the World Social Forum 2007. After spending a few days in the company of young people like me from Kenya, Zambia, Zimbabwe and many other African Countries, I discovered that same early spirit of my community. To me the WSF is beginning to be and will be a deeply emotional experience. It’s emotional because we have been working very hard to make this day happen.
Nobel Peace Prize Laureate, Desmond Tutu, the former Anglican Archbishop of Cape Town, has warned it is not possible to win the war on terror as long as conditions that drive people to desperation continue to persist. "There is no way anybody is going to win the war on terror as long as there are conditions in so many parts of the world that drive people to acts of desperation because of poverty, disease and ignorance," said Tutu. Some people attending the forum in the past have questioned whether it has made a difference, but church leaders say it has brought the concerns of poor communities onto the global agenda.
The World Social Forum, which took place in Nairobi, Kenya for the first time in Africa, was supposed to be a forum for the voices of the grassroots. But Firoze Manji writes that, despite the diversity of voices at the event, not everyone was equally represented.
According to global anti-debt organisations, African countries spend about 15 billion dollars per year repaying debts, in a continent where more than half of the population lives on less than a dollar a day. The continent also has been dogged with the highest rates of HIV/AIDS and illiteracy. Analysts argue that this situation could be reversed if governments spent more money on health care, education and other public service sectors, rather than on debt repayment. The issue of HIV/AIDS dominated the addresses at Uhuru Park, as speakers reiterated that it remained the greatest challenge African countries, and offered suggestions for countering the challenge.
4. Values, Policies and Rights
In a country long sickened by the frighteningly high level of sexual violence, one of the greatest challenges facing South Africa is closing the gap between the rhetoric of gender equality and the reality on the ground. The prevalence of gender-based violence is reflected in stark statistics: between April 2004 and March 2005, 55,114 cases of rape were reported to the police. The number of actual cases was likely much higher, considering only an estimated one in nine women report cases of sexual assault, according to the Medical Research Council (MRC). The MRC also estimates that a woman is killed by her intimate partner every six hours.
The WHO Director General, Mr Chan, said in taking WHO forward in the next two years, it was extremely important to pay particular attention to the rights and needs of especially women and the people of Africa, who faced multiple threats in their access to health care. He reiterated the importance of the Millenium Development Goals, and made a strong link between poverty and health: "Poor health anchors large populations in poverty."
5. Health equity in economic and trade policies
Despite a wealth of stakeholder consultations, plans, recommendations, commitments and declarations, food insecurity in Africa remains at unacceptably high levels (27%). There is general concern that the implementation of Maputo and Sirte summit decisions is not moving at the right pace to make a significant contribution to the attainment of MDGs by 2015. In line with the NEPAD philosophy of increasing reliance on Africa's own resources, the challenge facing the 2006 Abuja Food Security Summit is to accelerate reduction of food and nutrition insecurity through fostering mind-set change in mobilisation and utilisation of African resources to implement a few quick wins at national, RECs and continental levels.
World renowned economist and director of the United Nations (UN) Millennium Project, Jeffrey Sachs, is a harbinger of good news. During his visit to Nairobi in mid-January he emphasised that it was still possible to meet the MDGs before 2015. ‘‘We can still achieve the Millennium Development Goals if proper use is made of the powerful tools at our disposal. But two things are necessary: sustained partnerships between governments and civil society and sustained donor resource input’’. UN secretary general Kofi Annan commissioned the Millennium Project to develop an action plan against poverty under Sachs’ leadership.
Not long ago, the expansion of free trade worldwide seemed inevitable. Over the last few years, however, economic barriers have started to rise once more. The forecast for the future looks mixed: some integration will probably continue even as a new economic nationalism takes hold. Although globalisation as a process will continue to sputter along, the idea of unrestrained globalisation will wane in force. Managing this new, muddled world will take deft handling, in Washington, Brussels, and Beijing.
At Christmas, we traditionally retell Dickens's story of Scrooge, who cared more for money than for his fellow human beings. What would we think of a Scrooge who could cure diseases that blighted thousands of people's lives but did not do so? Clearly, we would be horrified. But this has increasingly been happening in the name of economics, under the innocent sounding guise of "intellectual property rights."
Contemporary famines are either deliberately created or allowed to happen. This new book collection argues for a conceptual shift in famine analysis: from understanding famines as failures of food availability or access, to understanding famines as failures of response. New concepts introduced in this collection include ‘famine intensity and magnitude scales’, ‘pre-modern, modern, and post-modern’ famines, ‘hidden famines’, and ‘priority regimes’. Case studies include famines that have occurred since the 1980s in Ethiopia, Sudan, Malawi, Madagascar, Iraq and North Korea, and a ‘near-famine’ in Bosnia.
In an increasingly globalised world, health is ever more affected by international institutions. Over the past 25 years, the World Bank, the International Monetary Fund (IMF), and the World Trade Organization (WTO) have increasingly dominated policymaking in developing countries, leading to substantial effects on health. Furthermore, global threats to health, such as HIV/AIDS, severe acute respiratory syndrome, avian influenza, and climate change, need eff ective collective action at the international level. Therefore the system of global governance is of central, and growing, importance to health. However, global governance is becoming increasingly controversial, particularly in the case of global economic institutions.
6. Poverty and health
Madagascar has called for international aid to help stem a nutritional emergency that has left thousands of children malnourished in the vulnerable south. "Madagascar has sent a message, through the president [recently re-elected Marc Ravalomanana], and called on the international community to help us," Anbinintsoa Raveloharison, Director of the National Nutrition Office (ONN) of the Ministry of Health and Family Planning, told IRIN.
Last month saw the publication of the World Bank’s latest annual Global Economic Prospects report, setting out the Bank’s vision of the global economy until 2030, including its latest projections for poverty. The breathless excitement with which the Bank presents this flight of fancy is quite extraordinary. This document provides an assessment of the latest much-hyped poverty projections from the World Bank.
7. Equitable health services
The next leader of a global organisation that fights major infectious diseases, including AIDS, may come from a group that includes the former health minister of Mexico, France's AIDS ambassador, the former leader of UNICEF, and several leaders of the World Health Organization, according to a list of names obtained by the Globe. The board overseeing the organization, Global Fund to Fight AIDS, Tuberculosis and Malaria, failed to select a new executive director last November and now hopes to name one at a meeting in Geneva early next month.
Hart describes the background of the creation of NHS and its history. Although NHS was relatively under-funded in the 1960s and 1970s, it was still extremely efficient: The UK was under a long period of time the OECD country with the lowest government allocation for health. Despite this, the outcome was impressive: Equal health care for all, evenly distributed throughout the country. The cost for administration was unbeatable: Initially it was 2%, but increased to 6% when the conservative government introduced the principles of ”New Public Management”. Since NHS became subject to privatisation and the introduction of internal markets, the administration cost has risen to 12%. One of Hart’s points is that public health care is cheap, partly because the administration cost is low.
Aggressive immunisation campaigns in Uganda have cut the numbers of children dying of measles from 6,000 to 300 annually over the past 10 years, a Ministry of Health official said. The director of health services, Sam Okware, said on Tuesday the ministry used to record up to 60,000 cases, with 6,000 deaths, 10 years ago, "but now the cases have reduced by 10 times and last year we recorded about 300 deaths, which is a great achievement".
Cholera outbreaks in Tanzania's semi-autonomous island of Zanzibar have continued due to poor hygiene standards, health officials said on Wednesday, while announcing renewed efforts to raise public awareness. "We need to double our efforts of awareness; we also need to strengthen by-laws to make sure that the islands are kept clean," Dr Omar Suleiman, an officer in the Ministry of Health, said in Stone Town, capital of Zanzibar.
8. Human Resources
This paper addresses an important practical challenge to staff management. In 2000 the United Nations committed themselves to the ambitious targets embodied in the Millennium Development Goals (MDGs). Only five years later, it was clear that poor countries were not on track to achieve them. It was also clear that achieving the three out of the eight MDGs that concern health would only be possible if the appropriate human resources (HR) were in place.
The Health and Human Rights Programme at the University of Cape Town, South Africa, in conjunction with the Health Professions Council of South Africa, the South African Nursing Coulncil, the South African Medical Association and the Democratic Nurses Organisation, hosted a conference exploring what are Core Competencies in Human Rights for graduates in the health professions. The conference aimed to provide guidance to those bodies setting standards for our graduates as to what kinds of competencies and skills should be expected of doctors, nurses and other health professionals once they graduate from our training institutions. The conference took place from Wednesday 5th to Friday 7th July and helped to develop recommendations for curriculum standards for graduates in the health professions in South Africa.
The Kenya Medical Association (KMA) received a copy of a petition to the Minister for Health from its members who have been on internship. The immediate consequence to this is that the concerned doctors will have their salaries stopped and asked to vacate their stations as they wait for the positions of medical officers to be advertised. This letter states expands on how and why KMA fully support the petition by the medical officer interns.
Miriam Ahmed's face contorts in pain as her frail and bony fingers clutch her stomach. A sweat breaks on her head as she writhes in pain on her bed. The 16-year-old girl is the latest patient to be admitted to Mandera District Hospital following an outbreak of cholera in the area. The District Medical Officer of Health, Dr Boniface Musila, says the situation is under control. But Mandera District Hospital Medical Superintendent, Dr Muktar Omar, said there was a shortage of nurses at the facility.
More disgruntled Zimbabwean government employees have joined striking doctors and nurses to demand higher salaries as the economy continues to rumble. Lecturers at the country's eight state-owned educational institutions have become the third group of employees - after doctors and power utility workers - to take industrial action this year. Government awarded civil servants across the board a 300 percent salary increase, but this was rejected as too low.
The Mozambican Red Cross will begin training hundreds of volunteer workers to manage antiretroviral therapy (ART) for people in their care living with HIV/AIDS. "This training is extremely important and will improve the work of our carers," Paula Macava, the Red Cross Mozambique coordinator of the HIV/AIDS programme, told IRIN. "We have now finalised an eight-module training package on antiretroviral therapy management, specifically designed for carers."
This paper presents some initial findings from a survey of public sector workers, in a number of countries in Europe, Africa, North America, Latin America and Asia, and how they have been affected by policies of liberalisation in relation to wages, working conditions and other forms of socio-economic security. This survey was a joint initiative between the International Labour Organization (ILO) and Public Services International (PSI), an international trade union. The aim of the survey was to explore three themes: workers’ socio-economic security; quality and accessibility of public services; and relations between government, foreign and domestic capital, trade unions and civil society.
9. Public-Private Mix
Privatisation has been promoted throughout the world for the last 20 years. The advantages are supposed to be increased efficiency, lower prices, greater investment, and greater dynamism than public ownership. It has been seen as a central policy element in transforming former communist states into market economies. It has been promoted wordwide by international institutions including the IMF, the World Bank and the OECD, and by multinational companies. The EU is in principle neutral on privatisation, but in practice encourages PPPs. Privatisation has been made especially attractive because of economic policies aimed at reducing the borrowing of governments at national and municipal level. This dociment discusses futher the impact of reform on industry, workers in health and trade unions.
10. Resource allocation and health financing
Warren Buffett’s donation in early July of $31 billion to the Bill and Melinda Gates Foundation has fed many hopes and expectations. How are we to regard the creation by these extremely rich families of the world’s largest foundation, with resources of over $62 billion at their disposal? On one level, their philanthropy must of course be warmly welcomed. [Yet] this display of unprecedented generosity raises some serious questions about the way we think nowadays about issues such as altruism versus public action, and charity versus human rights. First, private altruism by the rich does not get governments off the hook. Second, in any case, for the poorest countries and the poorest people in any country, escaping poverty is not a matter for charity and altruism. It is an issue of social justice.
Health campaigners and activists led by 2004 Nobel Laureate Prof Wangari Mathai have petitioned the African Union member states for failing to honour their 15 per cent pledge of their annual budgets on health care. This fact became public knowledge as the World Social Forum (WSF) entered the third day. The petition comes ahead of the forthcoming AU Heads of State and Government summit in Addis Ababa. The petition by South African Nobel Laureate Arch Bishop Desmond Tutu, but signed on his behalf by Prof Mathai calls for Africa leaders to act fast and implement their pledges in a bid to reverse the ugly trends of treatable diseases in Africa.
A rise of more than 100 percent in the price of antiretroviral drugs is likely to put the life-prolonging medication beyond the reach of hundreds of thousands of Zimbabweans living with HIV. Pharmacists in Zimbabwe's second city of Bulawayo increased the price of a monthly course of ARVs from an average of Z$30,000 (US$120 at the official exchange rate) to between Z$80,000 (US$320) and Z$100,000 (US$400), telling IRIN the price hike was an inevitable response to the country's economic woes, which has seen inflation surge to 1,281 percent, and foreign currency become a scarce item.
11. Equity and HIV/AIDS
"We have the goal: universal access to prevention, care,treatment and support by 2010. We have the means: the United Nations review session on HIV/AIDS in June declared that the drugs and the resources exist. Do we have the will? The 16th International Conference on AIDS in Toronto, August 13–18, was a testing ground and the jury is very definitely still out. The Toronto conference was the largest and perhaps the best publicized of its kind. It had significant African, HIV-positive and youth participation, but remained predominantly Northern (and North American), professional and male. It needed much more extensive representation from countries facing growing threats in Eastern Europe, Central, Eastern and Southern Asia."
The issue of violence exacerbating the spread of HIV/AIDS, particularly in women, has remained a hot one at the World Social Forum (WSF). From Africa to Asia, activists are reiterating that violence against women remains a threat to the HIV/AIDS fight, and that without governments addressing the matter, winning the war against the disease will be an uphill task.
It is the inequalities between women and men that are driving the global HIV/AIDS pandemic and in turn this pandemic is exacerbating existing gender inequalities. However, it is the women of Africa who are particularly vulnerable and bearing the burden of this pandemic. As Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, so often illustrates, HIV/AIDS in Africa has a female face, and this female face will be eradicated from Africa if we do not respond adequately. As a direct result of these gender inequalities, women and girls are the most vulnerable to infection — 57 per cent of persons who are HIV positive in sub-Saharan Africa are female, according to the AIDS Epidemic Update 2005 — and at the same time it is women and girls who carry the burden of caring for the sick and dying.
The island nation of Madagascar, off the coast of Southern Africa, has so far been spared an HIV/AIDS epidemic, unlike its continental neighbours, but health officials have warned that the country cannot afford to be complacent. The next decade presents a window of opportunity; a chance for the government to take action to prevent HIV prevalence from climbing. Madagascar's National Committee for the Fight Against AIDS (CNLS) has estimated that the country rate in 2005 was 0.95 percent, considerably lower than other countries in the region, where rates hover around 20 percent.
Worldwide some 15.2 million children under 18 have lost one or both parents to AIDS. By 2010, more than 20 million children will have been orphaned by AIDS. The figures reflect the ‘tragically insufficient’ global response to protect and support HIV-infected and AIDS-affected children. However, this is set to change according to a report by UNICEF, the UN children’s agency.
Zambia's attempts to promote paediatric antiretroviral (ARV) drug adherence are being undermined by families and communities who shield children in their care from knowing their HIV/AIDS status, health experts say. "Disclosing their status to an HIV-positive child is a difficult process and it requires specialised skills in paediatric counselling but, unfortunately, many affected communities and families are lacking such counsellors and skills," Canisius Banda, a spokesperson in the Zambian Ministry of Health told IRIN.
12. Governance and participation in health
A study was conducted to explore the views of villagers on the existence and functioning of local primary health-care (PHC) committees, village health workers (VHWs), skilled staff at government health facilities and their responsiveness to community health needs in Mkuranga district, Tanzania. Information was collected through separate group discussions with some members of households, local PHC committees and district health managers and semistructured interviews with individual household members, clinical and nursing staff at peripheral government facilities, and indepth interviews with officers in central and local government departments at district level. See the full report.
13. Monitoring equity and research policy
Rockefeller Foundation president Judith Rodin announced today that Dr Ariel Pablos-Méndez is joining the Foundation as a new Managing Director. Ariel Pablos-Méndez, 45, a physician and epidemiologist, is Director of Knowledge Management & Sharing at the World Health Organization (WHO) in Geneva. He is also an Associate Professor of Clinical Medicine and Public Health at Columbia University. He will assume his new position at the Rockefeller Foundation in April, 2007. Dr Pablos-Méndez, who joined WHO in 2004, has been working there on establishing the principles and practice of knowledge management as a core competence of public health to help bridge the gap between research and implementation.
Disturbing indications that the US is expanding or intending to expand research with smallpox virus outside of WHO control and that WHO may be back-pedalling on some of its previous decisions, have led NGOs to call for a strong resolution on smallpox on the part of the Who Executive Board which meets this week in Geneva.
14. Useful Resources
The ninth edition of The North-South Institute’s flagship publication explores the right to health, why it is important to development and how it might best be achieved. The volume investigates public health care’s role in advancing development and also examines the role Canada is playing and might well play in achieving the global right to health. The CDR 2007 also includes up-to-date statistics and analysis related to social and economic indicators of developing countries, along with statistics regarding the Canadian government’s involvement with such countries.
15. Jobs and Announcements
The Canadian Coalition calls for applications for the 4th Summer Institute for New Global Health Researchers, to be held in partnership with the Centre for Development Studies in Trivandrum, Kerala, India from August 13-20, 2007. By “global health research” we mean research concerning the problems borne by societies in low and middle income countries (LMICs). A limited number of spaces are available for this training opportunity for “dyads” - that is, pairs of researchers with one participant from a low- or middle-income country and one from Canada, who are members of the same project or program team. The deadline for receipt of applications is 1 March 2007.
The Global Forum for Health Research invites you to submit an abstract for Forum 11 in any area of health research relevant to the overarching theme of Equitable Access: Research challenges for health in developing countries. Equitable access, the overarching theme of the Forum, begins with the recognition that all people are entitled – by virtue of their inviolable human rights – to have the opportunity to share in societal resources, to be treated with quality, dignity and respect, to actively participate in decision-making that affects them and to be fully included as active participants in society. The deadline for submission of abstracts is 31 January 2007.
The Faculty of Health Sciences seeks to recruit an internationally respected academic with a background in health systems and/or health policy research at level of Professor or Associate Professor to lead the OTF Programme as Convenor. In collaboration with the GSB, the incumbent will provide overall academic leadership of a refurbished OTF Programme. He/she will engage with senior officials in national, provincial and local Departments of Health to identify skills development needs in high level management training and will lead curricular development reflecting international best practice. Experience in working with senior health officials and policy makers, and familiarity with the South African health system will therefore be advantageous.
The Centre for African Family Studies (CAFS) is pleased to announce its course on 'Managing Reproductive Health Programmes', to be held from 12 to 30 March 2007 in Nairobi, Kenya. This course provides state of the art guidance to Reproductive Health Programme Managers and enhances their capacity to achieve organisational success through modern management techniques. Participants will gain a wide range of management skills and principles including management process and principles, leadership, team building, programme design, proposal writing, participatory facilitative programme supervision, monitoring and evaluation, strategic planning, human resource management, learning organisations, building coalitions and alliances and facilitation skills.
This conference will bring together researchers and practitioners to discuss different concepts and measures of fragility and vulnerability, to analyse causes and consequences of vulnerability, to consider appropriate policy options, and to identify future research directions. Conference topics will include: fragility concepts and measures; trade and financial shocks; weather and other environmental shocks; state failure and governance in fragile states; household vulnerability and fragile groups; poverty dynamics and economic insecurity; strategies for dealing with economic and social vulnerability; linking aid, debt relief, and fragility; and fragility and MDG implementation. Details of how to submit a paper for the conference can be found at the website listed above. The deadline for submissions is 16 March 2007. Final copies of accepted papers are required by 18 May 2007.
World Initiative for Orphans (WIO), a worldwide independent, non-profit human rights organisation for orphaned and abandoned children, organises the World Conference on Children without Parental Care from 21-24 May 2007 in The Hague/Amsterdam, The Netherlands. This international conference, meant for Government Decision-makers, relevant NGO's and Researchers, will provide an open forum for communication and will identify new approaches and model practical solutions. The four-day event will host up to 100 countries, represented by officials, NGOs and scientists. A wide range of distinguished speakers, children's advocates and experts in various fields will discuss the long needed reforms in Child Welfare Policies. This event will also be the official launch of the WIO World Council, the new and very unique practical partnership between UN-Governments, NGO's and the Academical world.
Published by the Regional Network for Equity in Health in east and southern Africa (EQUINET) with technical support from Training and Research Support Centre (TARSC).
Contact EQUINET at admin@equinetafrica.org
To post, write to: equinet-newsletter@equinetafrica.org
Website: http://www.equinetafrica.org/newsletter Web design by Fahamu. To subscribe, visit: http://www.equinetafrica.org or send an email to info@equinetafrica.org
Please send materials for inclusion in the EQUINET NEWS to editor@equinetafrica.org
Please forward this to others.