Amekwi Lokana, a mother of six from Kenya, said some years ago 'These days, if you are without money, they leave you to die. If my children are ill, and I have money from selling sisal and firewood, I take them to the nearest town. If there's no money, I use herbs … if God takes them, we have done our best.'
It should never be the case that those without money cannot access health care. The most basic obligations that governments have are to respect and protect the survival and health rights of citizens. For governments in east and southern Africa, this is done in a context of the greatest intensity of AIDS globally, high levels of poverty and many other health challenges.
Meeting this obligation is not simply a matter for Ministries of Health. Increasingly finance and trade sectors are having a powerful bearing on health through the agreements they make. Most recently this issue has emerged in the Economic Partnership Agreement (EPA) currently being negotiated between east and southern Africa (ESA) and the European Union (EU), with the aim of signing a final agreement in December 2007.
The "Cotonou Agreement", signed between the EU and African and Caribbean countries in June 2000 makes clear the two central objectives of EPAs: to eradicate poverty and to enhance global integration. The challenge ESA countries face however is that the “global integration” pursued is through liberalisation and commercialisation measures that threaten poor communities' access to the goods and services essential for their health. In past experience this has increased - not reduced - poverty and poor health outcomes, particularly in an international trading system heavily stacked against African countries.
An EQUINET / SEATINI report released earlier this year points to a number of areas in which the EPA currently under negotiation can affect health and health care, unless specifically dealt with.
Firstly the EPA can affect access to essential medicines. It does not yet clearly make a commitment to give ESA countries rights to make maximum use of flexibilities in the WTO TRIPS agreement. These are essential to ensure access to medicines and medical technologies. Although this commitment has been verbally stated by the EU, it is not yet reflected in the EPA. Prior experience of EU free trade agreement (FTAs) with South Africa on this issue suggests that ESA countries and their parliaments and civil societies need be vigilant. The draft text put forward by ESA countries to provide full TRIPS flexibilities and capacity support for their implementation needs to be written into the EPA before it is concluded.
The EPA has not yet specified provisions for trade in health related services. Although most EU countries rightly protect their own public sector as the major provider of health services, there is pressure for service liberalisation in the EPA. ESA countries may thus be put be under pressure to make commitments to liberalise their health services. However for countries in the region to ensure that the poorest draw an equitable share of resources to meet health needs, governments need to regulate health service provisioning and to redistribute funds for health through public sector services. This contradicts commitments to liberalisation of health services. The EPA should exclude any such commitments to liberalise health care services, and should further include health impact assessments in other sectors prior to commitments being made, where these may have an impact on health.
The EPA promotes market access and reduced tariffs and subsidies in agriculture. In a region where undernutrition is high and increasing, all trade policies in agriculture need to be scrutinised for their health impact. In the context of the extreme and longstanding inequalities between EU and ESA agricultural production systems, it is likely that local and smallholder producers will not benefit from the current proposed measures, unless they are deliberately recognised and invested in under the EPA. Until all subsidies on agriculture in the EU are removed, it would not make sense for African countries to lift their own protective subsidies, particularly if this will lead to a further increase in food imports, further undermine local producers and further increase undernutrition.
The EPA raises a more fundamental issue. In the trade agreement, health and health care are put in the context of tradeable goods and services and treated under the aim of enhancing global integration, rather than as key contributors to the stated priority of poverty eradication. We argue that:
• the health implications of the EPAs need to be explicitly recognised
• health officials should be included in negotiations
• health impact assessments should be carried out where relevant, such as in any areas where service liberalisation may impact on health; and
• EU and ESA countries ensure that the EPA is fully compliant with all regional and international health protocols and conventions before it is concluded.
These calls were also made by Zimbabwe civil society in April this year as part of a wider process of Africa and Europe wide activities on the EPAs on April 19. One recurring point of these events was that EPAs as currently constituted would disadvantage developing countries. The EU negotiates as a bloc, with a powerful functioning bureaucracy and a team of skilled negotiators who will speed the pace of the negotiations. However at stake for ESA countries is a deeper bottom line – the health and survival of their people. ESA states thus have an obligation to apply the “precautionary principle” in the EPA negotiations where potential health impacts exist: countries need to be satisfied through evidence produced that the measure negotiated provides greatest possibility, authority and policy flexibility for protecting health and access to health services, and does not lead to negative health outcomes.
Addressing these issues will surely begin to meet the stated joint commitment to poverty eradication. Alternatively, with people's health at stake, the precautionary rule surely applies: No deal is better than a bad deal!
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat admin@equinetafrica.org. For further information on this issue or the full report referred to please visit SEATINI (www.seatini.org) or EQUINET www.equinetafrica.org.
1. Editorial
What can Africans expect from the World Health Assembly (WHA) on 14 May 2007? Judging from past experience, the Assembly will be a forum where African countries will find issues critical to public health being raised, but not resolved without a struggle.
Kenya, supported by other African countries, proposed in a resolution on Malaria that, countries’ provide legislation to use “to the full” the flexibilities allowed under World Trade Organisation (WTO) agreements to increase access to anti-malarial medicines, diagnostics and technologies for prevention. The US has strongly opposed this. The WHO Executive Board therefore decided in January 2007 to send the draft resolution to the WHA with both the alternate US and Kenya proposals in bracketed text, indicating a lack of consensus. Inexplicably, the draft resolution posted on the WHO website did not reflect the Kenyan proposal and it took many days before it reflected the decision of the Board. The Kenya proposal needs to be supported to protect the legitimate legal rights that countries have under WTO.
Despite the negative US position, at the 2006 WHA many countries recognised that the current intellectual property rights system does not adequately provide for research and innovation on treatments for diseases that disproportionately affect developing countries. To address this, an Inter-Governmental Working Group on Public Health, Innovation and Intellectual Property was established to prepare a global strategy and plan of action. This Working Group will table a report at the WHA.
A resolution will also be tabled on the rational use of medicines, in light of a finding of irrational drug use in over 50% of medicines in developing countries, with weak application of essential medicines, particularly in the private sector. African countries could potentially treat double the number of people within the same budget if this were addressed. The issue of rational use of medicines has been discussed at the WHA since 1985, and countries have urged greater leadership, evidence based advocacy and support from WHO to advance implementation of rational drug use.
While these issues are on the WHA agenda, there is concern about what is happening in practice on intellectual property rights and health. In research on the small pox vaccine, WHO’s relatively open approach to ownership of the research outcomes has enabled private companies to derive exclusive patent rights from such research, such as the US patents have been registered on treatments by the University of California in April 2004 and April 2006. Such patenting could hamper access to vaccines for many countries in the future.
While small pox was eradicated in 1977, many countries still hold unofficial stockpiles of the small pox virus, with only the US and Russia holding official stockpiles. Backed by recommendations of the Committee on Orthopoxvirus Infections, in 1996 African countries pushed strongly for the destruction of the remaining stocks of the virus, given that the risk posed by deliberate or accidental release outweighed any benefits from retention. In a counter initiative, several developed countries including the US and Canada, drawing on recommendations from a new and differently constituted Advisory Committee on Variola Virus Research, are seeking to block the destruction dates so as to retain the right to seek approval for "scientifically interesting" research, including genetic modification of small pox.
WHO is now applying the same open approach to the Avian Flu virus, i.e. sharing specimens without ensuring provider and other countries have adequate access to treatments and vaccines. Countries like Indonesia, who share viruses, have found that they either cannot afford or cannot secure access to the vaccines because of limited production capacity, leaving their citizens vulnerable to infection. The WHO Guidelines (March 2005, listed but not available on the website) state that WHO Collaborating or Reference laboratories will neither share viruses or specimens, nor publish research results without permission from the originating country. Yet the sharing of specimens has not followed these guidelines, allowing private appropriation of the research outcomes.
Indonesia stopped sharing its viruses with WHO in 2007 even though sharing facilitates research into treatments and vaccines. Indonesia took action, not for commercial interest, but because it could not secure adequate access to vaccines for its people, who were offered vaccines at a prohibitively expensive US$20 per dose. Indonesia did say it was willing to share the viruses on more equitable terms, but WHO has thus far not been able to create equitable conditions for either virus sharing or access to Avian Flu treatments for countries in need (in Africa, Nigeria, Djibouti and Egypt have reportedly experienced Avian Flu). These cost barriers to access vaccines or treatment carry massive risk for the countries concerned: according to the US Centre for Disease Control (http://www.cdc.gov/flu/avian/gen-info/facts.htm) the Avian Flu mortality rate can reach 90 to 100% in 48 hours. In 2005, Indonesia experienced this problem when Roche refused to supply Tamiflu because of advance orders from other countries intent on stockpiling, even while Asian countries were experiencing an outbreak. Roche has sought to remain the sole producer of Tamiflu, despite donating some medicine to WHO.
Access to vaccines by developing countries may be further compromised by the limited global vaccine production capacity. Vaccine producers have taken advance purchase orders for vaccines. The resolution on Avian Flu to be considered by the WHA provides an opportunity for countries in Africa and elsewhere to ensure that access to vaccines is not a privilege primarily for wealthy countries, and that WHO facilitates wide access in response to need.
These upcoming issues at the WHA signal both the continued importance of international collaboration on health issues, as signified in the WHO constitution, as well as the need for constant pressure for and vigilance over its practice.
This editorial reflects the author's individual views. Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat at admin@equinetafrica.org.
2. Latest Equinet Updates
This paper is part of a series exploring the role of health systems in promoting food sovereignty in Africa being implemented in EQUINET through Health Science Research Council, South Africa. The paper explores the effect of food aid on Malawi’s food security and on the domestic market for food. The paper highlights the impact of food aid interventions on domestic food markets and argues for food aid interventions to be designed and implemented in a way that takes domestic market operations into account. This needs a supportive policy framework, a social protection programme that responds to both transitory and chronic food insecurity, functional markets that support household food production and strengthened rols of national vulnerability assessment committees to support evidence based identifcication of vulnerable groups.
The second regional training workshop on participatory methods for a people centred health system was hosted by the regional network for equity in health in east and southern Africa (EQUINET) , TARSC and Ifakara HRDC in Bagamoyo Tanzania from February 14-17 2007. It involved 35 delegates from in east and southern Africa and built skills, share experiences and strengthen work on participatory methods for people centred health systems, and particularly for strengthening the relationship between between communities and health workers.
This poster highlights the main findings from a PRA project report. It explains that Health workers are not recognised as a community that requires health care. The link between the health and well being of health workers and the quality of health care that they are able to provide to the community needs to be recognised and positively developed.
3. Equity in Health
The 44th Health Ministers' Conference meeting was attended by Hon Ministers of Health and senior officials from member states in east, central and southern Africa, health experts, and collaborating partners. The theme of the conference was “Scaling up cost effective interventions to attain the Millennium Development Goals”. The conference approved and adopted resolutions based on the sub themes of the conference that are presented in this document.
The last quarter of the twentieth century saw little investment in international health or in the health problems of the world's poor. Over the past few years, as Laurie Garrett notes, "driven by the HIV/AIDS pandemic, a marvelous momentum for health assistance has been built and shows no signs of abating." But after this upbeat introduction, Garrett proceeds to lay out the perils associated with this new momentum, chief among them that an influx of AIDS money has drawn attention away from other health problems of the poor, weakened public health systems, contributed to brain drain, and failed to reach those most in need.
4. Values, Policies and Rights
Gender inequality is killing the women of Africa, a diplomat and international AIDS expert told a Madison audience Monday night. "I have come to the conclusion that the single most important struggle on the face of the planet is the struggle for gender equality," Stephen Lewis said to an audience of about 400 during his UW-Madison Distinguished Lecture Series talk in the Union Theater. He received a rare standing ovation after an impassioned speech. In Africa and in other parts of the developing world, gender inequality needs to be addressed, Lewis said.
This interview report on the launch of the report of the UN Economic and Social Survey of Asia and Pacific makes the more generally relevabnt point that gender related interventions have been regarded as "social" and given little attention until economic numbers have been put to the interventions. Calling for wider gender budget analysis, the report notes that the promotion of breastfeeding, for example, saves lives and saves million dollars on import of baby milk. Economic and social arguments should be used in advancing gender health.
The proposed SADC Protocol on Gender and Development will enhance existing commitments to gender equality by providing accountability and monitoring mechanisms in the region, Assistant Minister for Labour and Home Affairs Gaotlhaetse Matlhabaphiri said on Monday. He told a SADC Stakeholders Consultative Conference that that the draft Protocol on Gender and Development would bring a legally binding regional instrument and address emerging gender issues and concerns.
5. Health equity in economic and trade policies
This research paper draws together analysis of recent trends in food and agriculture from a gender perspective within an analysis of how trade and investment have affected food security and agricultural development. Although a number of case studies exist exploring how women have been affected by changes in global and local food systems, few have situated these case studies and their findings in the more global context of international trade and investment. This paper explores these linkages, pointing to the connections as well as to the need for further research to deepen our understanding of why women, who aremore than half the world’s population and overwhelmingly responsible for child nutrition, must be involved in policy decisions that affect agriculture and food security.
The ability of African countries to respond to HIV and AIDS is dependent on their ability to control the terms of trade, elicit more favourable patent policies on medication and climb out of poverty - all linked to globalisation. While globalisation has brought some benefits to the urban elite in Africa - information, communication and technology - the outcomes have not reached the urban poor and rural folk who form more than 80 per cent of African populations.
This paper argues that Uganda needs a secure and predictable trading regime with their main export market in the EU. This makes an EPA essential. The possible shocks that normally come with any change have been well anticipated and safeguards built into the negotiations and ultimately the EPA. Safeguards include for example designation of certain products as sensitive and therefore not eligible for tariff reduction (liberalization) when imported into Uganda, longer (up to twenty five years) tariff phase-down/reduction periods for products where tariffs may be reduced, and reservation of the right to restrict imports should they threaten to cause injury to domestic industry.
This newsletter looks at the current state of play on EPAs and the global campaign for fair trade.
African Trade Network which brings together Civil Society Organisation dealing with trade in Africa expressed their concern that while there is wide-spread recognition of the dangers posed by EPAs to the economies and peoples of the ACP countries, this has not yet led to fundamental changes in the design of the EPAs and the process of negotiations. Instead the EC simply adopted new rhetoric to continue to impose its parameters, agenda and momentum on African and other ACP groups. It is against this background that this statement of theirs was issued.
Patents, the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and Kenya’s Industrial Property Act, 2001 have been blamed as scapegoats in the problem of accessing AIDS drugs in Kenya. This paper presents the steps taken and limits encoiuntered in the response to AIDS. It proposes that Kenya invest in research and development, strengthen its national health law and policy and patent law, all of which have affected AIDS research and development, to improve care and support.
6. Poverty and health
Improvements in both the quality of South Africa's education system and students'access to it, would contribute to improving people's lives, says Deputy President Mlambo-Ngcuka. "It is required for the shared, sustainable and accelerated growth that we need to eradicate poverty and improve the livelihoods of our people," the deputy president said Wednesday, unveiling the Bokamoso Barona Investment Trust in Johannesburg. The entire investment trust initiative, speaks of the necessity of the strategic partnership required between the public and private sectors to maximise resources to overcome poverty, unemployment and the social ills that afflict South Africa.
The African Union (AU) and the World Food Programme (WFP) have renewed their strategic partnership to fight hunger and enhance food security, education and emergency response across Africa. The agreement has been signed for humanitarian and development co-operation in the hope that the strategic partnership would serve as an important element in the shared commitment to meet the Millennium Development Goal of cutting global hunger by half by 2015.
Conflict and war have long been recognized as determinants of infectious disease risk. Re-emergence of epidemic sleeping sickness in sub-Saharan Africa since the 1970s has coincided with extensive civil conflict in affected regions. Sleeping sickness incidence has placed increasing pressure on the health resources of countries already burdened by malaria, HIV/AIDS, and tuberculosis. In areas of Sudan, the Democratic Republic of the Congo, and Angola, sleeping sickness occurs in epidemic proportions, and is the first or second greatest cause of mortality in some areas, ahead of HIV/AIDS. In Uganda, there is evidence of increasing spread and establishment of new foci in central districts. Conflict is an important determinant of sleeping sickness outbreaks, and has contributed to disease resurgence. This paper presents a review and characterization of the processes by which conflict has contributed to the occurrence of sleeping sickness in Africa.
Governments, civil society and the private sector have been urged to partner with rural women's organisations in order to help the women participate meaningfully in the economy. In a declaration following the 4th World Congress of Rural Women (WCRW), rural women said this partnership was critical for addressing unemployment and hunger as a central focus on development. They said the partnership was also important to undertake the necessary measures to give them full and equal access to productive resources, including ownership of land and other property. The issues of access to credit, start-up capital for emerging businesses, skills development and access to markets for emerging businesses also came across as urgent matters of concern in the declaration.
7. Equitable health services
This paper outlines the main findings on reasons for adherence to TB treatment in Ethiopia, including physical lack of access to the treatment centre as the main cause of failure to adherence to therapy.
As more Africans move from rural areas to the cities the risk of urban malaria increases. City health services need to focus on poor people who are most at risk from the disease. Malaria programmes should operate on a district by district basis as levels of malaria can vary dramatically throughout the city.
Early recognition of symptoms and signs perceived as malaria are important for effective case management, as few laboratories are available at peripheral health facilities. The validity and reliability of clinical signs and symptoms used by health workers to diagnose malaria were assessed in an area of low transmission in south-western Uganda.
The Eastern Cape Department of Health has certified 36 hospitals under the Baby Friendly Hospital Initiative (BFHI). The assessment of hospitals started in 1999 in the province when one hospital received "baby friendly" status. The BFHI is a global strategy implemented by healthcare facilities that render care to both mothers and children worldwide. It aims to increase awareness of the critical role of health services in the romotion of breastfeeding and to give guidelines for appropriate information and support to mothers. It also focuses on maternity care services which involves the holistic care of mother and baby both within the facility.
European executive directors and alternates have written a letter to staff in the World Bank human development network to explain their rejection of the draft health, nutrition and population strategy. Gender and reproductive health groups have been bombarding the directors with complaints over the alleged watering down of the strategy. In their letter, the directors raise concern that the strategy makes virtually no reference to sexual and reproductive health.
Rape survivors are not getting the healthcare they need. Teenage girls who are raped are often scolded or branded liars by healthworkers attending to them, while men, gays and lesbians and sex workers who have been raped are also discriminated against. Other problems facing rape survivors include the denial of healthcare to those who have not reported the rape to police, the lack of privacy for examinations and staff ignorance of basic treatment procedures. This is according to the South African National Working Group on Sexual Offences, a group of 25 organisations including Childline, the Teddy Bear Clinic, People Opposing Women Abuse and the Tshwaranang Legal Advocacy Centre.
In January, PIH launched its newest project, located in Neno, Malawi – an impoverished rural area in one of Africa’s poorest and most densely populated countries, with an HIV infection rate among adults of more than 14 percent. By mid-February, PIH doctors were working with Malawian nurses who had staffed the hospital prior to our arrival to provide care for more than 100 patients a day and treat 129 HIV patients with antiretroviral therapy.
Clinicians often diagnose and treat patients for malaria in Africa when they do not have the disease. Over diagnosis and treatment may be acceptable when the drugs are cheap and safe. However, new more expensive drugs whose side effects are less well known are now being used. Over diagnosis in these circumstances would not be appropriate.
8. Human Resources
The World Health Organization (WHO) and the Office of the US Global AIDS Coordinator (OGAC) convened representatives from HIV Programmes and Human Resources for Health Departments from Ministries of Health, Professional Associations, Academic Institutions and representatives from workers associations in Geneva for a two day technical consultation about the need for a regulatory framework in support of Task Shifting. The meeting signaled the beginning of a new expert partnership for driving forward the Task Shifting Project in the context of the wider HIV/AIDS and health workforce plan “Treat, Train, Retain”.
Recent comments from the inside of the Global Fund suggest an intention to focus more on the three diseases, and to leave the strengthening of health systems and the support to the health workforce to others. This might create "Medicines Without Doctors" situations: situations in which the medicines to fight AIDS, Tuberculosis and Malaria are available, but not the doctors or the nurses to prescribe those medicines adequately.
In rural Kenya, where qualified pharmacists are rare, many people buy medicines from general shops to treat themselves at home. Often they receive incorrect medication or doses. Would the training of shopkeepers, who help treat the majority of children with fevers, be cost-effective in improving malaria treatment in young children?
Thousands of health care professionals have left their homes in developing nations in search of higher paying jobs in wealthier countries, Reuters reports. According to WHO's World Health Report 2006, there is a shortage of more than four million health care workers in 57 developing countries. The report said one-quarter of physicians and one in 20 nurses trained in Africa currently work in 30 industrialized countries included in the Organization for Economic Cooperation and Development. Sub-Saharan Africa has 24% of the global disease burden but only 3% of the health care workforce worldwide and accounts for less than 1% of global health care spending, the report said. The Americas have 10% of the global disease burden, 37% of the health care workforce and account for more than half of global health care spending, the report found.
9. Public-Private Mix
Between 6.5 and 11 million people are in need of antiretroviral therapy (ART) in developing countries. Only 1.3 million are receiving it. With the public sector struggling to expand coverage, how can the private sector play a more significant role? This paper reviews the experiences of franchising and its potential for HIV and AIDS services.
10. Resource allocation and health financing
In 2001, the Tanzanian government changed their malaria treatment policy from chloroquine (CQ) to sulfadoxine-pyrimethamine (SP) as the first-line drug. How much did this policy change cost? Researchers from the London School of Hygiene and Tropical Medicine, UK, assess the costs and make recommendations for other countries undertaking treatment policy change.
The pace of redressing inequities in the distribution of scarce health care resources in Namibia has been slow. This is due primarily to adherence to the historical incrementalist type of budgeting that has been used to allocate resources. Those regions with high levels of deprivation and relatively greater need for health care resources have been getting less than their fair share. To rectify this situation, which was inherited from the apartheid system, there is a need to develop a needs-based resource allocation mechanism.
As part of government's initiatives to help manage the severe tuberculosis strains identified in KwaZulu-Natal, the provincial Health Department has set aside about R506 million writes Nozipho Dlamini. The extremely drug resistant tuberculosis (XDR-TB) strain resists all first level drugs (ordinary treatment given to TB patients) and two of the five major classes of the second-level drugs used to treat patients with multi-drug resistant TB (MDR TB). "For the MDR and XDR TB strains specifically, we are allocating R80 million, which forms part of our TB Crises management Plan," MEC Peggy Nkonyeni said, tabling her department's budget for this financial year.
Policy implementation in the context of health systems is generally difficult and the Kenyan health sector situation is not an exception. In 2005, a new health sector strategic plan that outlines the vision and the policy direction of the health sector was launched and during the same year the health sector was allocated a substantial budget increment. On basis of these indications of a willingness to improve the health care system among policy makers, the objective of this study was to assess whether there was a change in policy implementation during 2005 in Kenya.
11. Equity and HIV/AIDS
2006 marks the tenth anniversary of the development of the International Guidelines on HIV/AIDS and Human Rights. To celebrate this occasion, the AIDS and Rights Alliance for Southern Africa (ARASA) has conducted research to evaluate the extent to which the International Guidelines have been used and implemented in the Southern African Development Community (SADC) region. This report details the findings of that research. It focuses on the guidelines dealing with: • Structures and partnerships to support a multi-sectoral response; • A protective legal and policy framework; • Access to treatment; and • Access to legal services.
It has been hoped that antiretroviral therapy (ART) could be used to combat AIDS on a wide-scale in developing countries. However as treatment allows patients to live longer, healthier lives, they are likely to be sexually active for longer. This could allow the disease to spread more rapidly unless communities receive counselling and practise safe sex. ART has been very effective treatment in the developed world. The drugs not only improve health and prolong the life, but patients are also less likely to infect other people because the drugs decrease their viral load. If ART can prevent the transmission of AIDS it could be a useful tool for fighting the AIDS epidemic in Africa. Imperial College London, UK, carried out a study, using mathematical modelling, to determine the effect widespread ART could have in Africa.
A Gender Baseline Study has revealed that gender is not well integrated into HIV/AIDS coverage. Speaking at the launch of the HIV/AIDS and Gender Baseline Study findings and Media Action Plan (MAP) at the Maharaja Conference Centre in Gaborone last week, Communications, Science and Technology minister, Pelonomi Venson-Moitoi, noted that cross generational sex, gender- based violence and gender power relations, which are significant drivers of the epidemic, received less than six percent each of the total coverage while cultural practices received no coverage during the study's monitoring period.
For years, there has been a battle over the best way to protect babies born to HIV positive mothers living in poor areas from getting the virus which has essentially boiled down to a battle between those who advocate breast feeding and those who advocate bottle-feeding with milk formula. As breastmilk can transmit HIV, global policy was weighted in favour of bottle feeding and HIV positive mothers were discouraged from breastfeeding. But a big study from KwaZulu-Natal led by Professors Jerry Coovadia and Nigel Rollins and published on Friday (30 March) seems to have finally settled the debate in favour of the breast. They found that babies who were exclusively breastfed by their HIV positive mothers were at substantially less risk of becoming infected than babies given both breastmilk and formula milk or solids.
Oxfam and Médecins Sans Frontières (MSF) welcome Abbott’s decision to offer developing countries a further 55% reduction of its price for Kaletra/Aluvia, a key HIV medicine. However, Oxfam and MSF will continue to support the Thailand government in maintaining its compulsory licenses as an alternative channel for accessing affordable life-saving medicines. As a next step Abbott should publish a comprehensive list of all countries eligible for the price cut.
This letter adresses the World Health Organisation's Director General's meeting with representatives of the International Treatment Preparedness Coalition (ITPC) in March 2007. The letter, written by various representatives of the ITPC, expresses their concern that the world has lost the momentum of the 3 by 5 campaign and that WHO is on the brink of squandering its legacy of leadership role in the battle to bring universal treatment access to people living with HIV/AIDS. In this letter they outline five reasons for concern, make six specific demands to be met before the end of 2007 and give four commitments that ITPC will fulfill to do their part in this most critical global effort.
Food parcels are finally being offered to HIV positive mothers in KwaZulu Natal who want to exclusively breastfeed their babies as part of a new government policy. In the past, positive mothers were advised to either exclusively formula feed or, in cases where there was no supply of clean water, to exclusively breastfeed to protect their babies from getting HIV. But while free formula milk was dished out, no practical support was offered to those who wanted to breastfeed. The mothers, particularly those who were poor, tended to see the formula milk as an incentive. They then tended to opt to get the formula milk and feed their babies both breast and formula milk – the most risky feeding choice for passing on HIV. An exuberant Professor Nigel Rollins, head of the Centre for Maternal and Child Health at the University of KwaZulu-Natal, said he was “delighted” that government had chosen to help HIV positive breastfeeding women meet their increased nutritional needs (of breastfeeding) by offering six months’ worth of food parcels.
South Africa's new five-year AIDS battle plan entered the final stage of a lengthy drafting and consultative process. Government officials and representatives from various sectors met in Johannesburg to debate a draft version of the National Strategic HIV and AIDS Plan for 2007 to 2011, with the goal of hammering out a final version by the end of March. South Africa's HIV/AIDS epidemic is one of the worst in the world and continues to grow by an estimated 1,500 new infections a day, according to a report published this week by the Human Sciences Research Council. Government's past efforts to address the problem have been criticised for lacking the necessary urgency.
The infection rate in Senegal is 0.9 percent; similar to the rate in the U.S. (0.6 percent), and far lower than the soaring tolls in African countries such as Namibia (19.6 percent), South Africa (18.8 percent) and Botswana (24.1 percent). What is Senegal doing right, and can those practices be replicated in other countries?
12. Governance and participation in health
President of the Conference of NGOs in Consultative Relationship with the United Nations (CONGO) Renate Bloem said that without the active engagement of civil society organizations (CSOs) the chances of African countries to meet the Millennium Development Goals (MDGs) is minimal. Addressing the African Civil Society Forum 2007 held at the United Nations Conference Centre under the theme "Democratizing Governance at Regional and Global Level to meet the Millennium Development Goals" yesterday, she said that civil societies need to give their unconditional support to sustainable development with a view to exerting maximum effort to achieve MDGs by 2015.
Mayors from eastern and southern Africa who met in Harare recently have recommended that municipalities should work with ratepayers to develop participatory budgets. The concept of participatory budgeting is an annual process of democratic decision-making in which ordinary city residents and other stakeholders decide how to allocate part of a municipal budget.
Members of civil society organizations in Zimbabwe have expressed concern that the on going negotiations on Economic Partnership Agreement (EPAs) are complex without clear outcomes and are between two unequal parties. they have outlined in a position paper areas of concern relating to trade imbalances, agriculture, health service liberalisation and intellectual property rights. the organisations thus call for EU member states to listen to and act upon the concerns of ACP countries, and for African governments to put the needs of the people above those of the markets.
13. Monitoring equity and research policy
The Health Systems Trust recently published the second South African District Health Barometer (DHB II). The report compares the performance on key health indicators for all 53 South African health districts. While the study suffers some limitations of data quality, it nevertheless provides a useful snapshot of health care across the country.
Price continues to be a major barrier to reliable access to medicines in Kenya. To help address this issue, the MOH conducts surveys on a quarterly basis to monitor medicine prices. Information is collected and widely disseminated on availability, affordability, and price variation of a basket of medicines in the public, private and mission sectors. This report highlights the findings of the survey, based on data collected in January 2007. Comparisons are also highlighted between data for January 2007 and previous months (April, July and October 2006) for some key findings of the survey.
14. Useful Resources
Physicians for Human Rights has released a Guide to Using Round 7 of the Global Fund to Fight AIDS, Tuberculosis and Malaria to Support Health Systems Strengthening. This is an extensively revised update to a health systems strengthening guide for Round 6. The Guide points out that successful proposals in earlier rounds have included a wide variety of systems investments cri tical to the fight against the three diseases, such as supporting salaries and expanded training capacity as part of an emergency human resources program, increasing access for the poor to health services, and strengthening primary level health infrastructure. The Guide also provides information on several technical partners who may be able to assist in developing health systems strengthening-related proposals.
A group of NGOs has published guidelines on integrating the provision of sexual and reproductive health services into Global Fund Round 7 HIV/AIDS proposals. The Global Fund has thus far made few grants that deal with sexual and reproductive health (SRH). The guidelines state, however, that the Fund supports SRH-HIV/AIDS integration efforts and has indicated that SRH-based proposals would be acceptable as long as the impact on HIV and AIDS is clearly demonstrated. Seven priority areas are identified in the guidelines.
Partners In Health has recently converted the 2006 edition of 'The Partners In Health Guide to Community-Based Treatment of HIV in Resource-Poor Settings' into an interactive, online version. The new website allows visitors to share insights about the manual and experiences in the field, to ask questions of each other, to answer others’ concerns and to foster a community of care. This interactive manual is distinctly a work in progress. Their long-term goal is to build an online knowledge community, a community where people working to ensure quality health care and social justice for the poor can exchange, comments, questions, lessons and examples drawn from their own experience, both with Partners In Health and with each other. Parners In Health expect this exchange to enrich all of their work, as well as future editions of The HIV Manual.
15. Jobs and Announcements
Participate in the second Global Health Watch, by submitting human interest stories and case studies. GHW are calling on activists, health workers and academics from around the world to submit case studies and testimonies or stories based on individual or group experiences to supplement the second edition of the report and reinforce its main themes. While guides to the various themes can be found at the GHW parent website, the "Food and Globalisation" chapter framework summary can be found at the weblink below.
The Centre for Economic Governance and AIDS in Africa (CEGAA) and the International Budget Project (IBP), kindly sponsored by the FORD Foundation, is offering a two-week training to civil society organizations/research agencies in: "Monitoring of budgets and tracking expenditure for health and HIV/AIDS". The training is to take place from the 18th to the 30th June 2007, venue still to be confirmed. After the training, CEGAA will provide technical support to participating organizations, so as to ensure the fruitful outcome of the research and advocacy projects. More details can be found on the weblink below.
CIESE, an independent research organisation which is in the process of being created, is calling for proposals for papers for its inaugural Conference which will take place in September 2007 in Maputo. IESE's central objective is to promote research from an interdisciplinary and heterodox perspective, bringing together different approaches and research groups in a process of mutual reinforcement. The focus of IESE's research is the analysis and development of public policy. All interested parties are invited to submit, by 15 May 2007, a two-page summary of the paper, clearly indicating the theme, sources of information, the research central questions and the methodology, as well as information on their institutional position and contacts.
The People's Health Movement invites readers to consider writing for Critical Health Perspectives (CHP); either by writing something new, adapt something already written, or comment on a report or paper. Guidelines for submissions can be found at the weblink below and at the People's Health Movement website. CHP is a publication of the People's Health Movement, South Africa (South Africa). It is produced with the aim of offering an alternative, "peoples health" perspective and stimulating debate on critical issues related to health and health care in South Africa and elsewhere.
Activists from all over Southern Africa are invited to apply. Since 2002 the ILRIG annual Globalisation Schools have brought together trade unions and social movement activists from different parts of Africa to engage in education and debate around the many aspects of capitalist globalisation. This year our theme will be Alternatives to Globalisation. All participants are charged a registration fee of R250. This includes materials, accommodation and all meals. ILRIG will not cover travel costs. Space will be allocated on first-come-first-serve basis and ILRIG will ensure a gender balance.
The Institute for Health and Social Justice (IHSJ) – the research, education and advocacy arm of PIH – has launched a campaign to galvanize knowledge, awareness, and action to combat pandemic coinfections of hunger, malnutrition and disease. The first round of activity in this campaign is a series of seminars to be held in the Boston area, organized jointly with the Friedman School of Nutrition at Tufts University and the François-Xavier Bagnoud Center for Health and Human Rights.
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