Ghana has taken a major step towards reducing its under-five mortality rate by becoming the first African country to introduce two new vaccines for rotavirus and pneumococcal disease.

Gladys Otabil holds her son Gabriel as he receives the pneumoccocal vaccine at La General Hospital in Accra. Credit: Jamila Akweley Okertchiri/IPS

But a United Nations Children’s Fund (UNICEF) official in the West African country says this measure will not be sufficient to meet the fourth United Nations Millennium Development Goal (MDG) to reduce the under-five mortality rate by two thirds by 2015.

Currently, 80 children out of 1,000 do not make it past the age of five in Ghana. According to UNICEF, Somalia has the highest infant mortality rate, at 180 deaths per 1,000 live births, and Sweden and Finland have the lowest at three deaths per 1,000 live births. (source: http://www.childinfo.org/mortality_ufmrcountrydata.php). In order to achieve the fourth MDG, Ghana would have to cut its under-five mortality rate down to 40 deaths per 1,000.

“Ghana is doing a lot, but I don’t think it’s enough,” said Dr. Anirban Chatterjee, UNICEF’s chief of health and nutrition in Ghana. He was referring to this country’s efforts with the new vaccines and the Health Service’s campaign to educate mothers on nutrition. “I think there is definitely scope and need for more improvement.”

Rotavirus and pneumococcal disease are the leading causes of diarrhoea and pneumonia in young Ghanaian children. Together they account for close to 25 percent of under-five mortality and are behind only malaria as the leading causes of child deaths here.

Now both the vaccines for rotavirus and pneumococcal disease are being given to young children before they reach four months of age. The measure is currently being rolled out across the country and to select hospitals in Accra. The GAVI Alliance, a public-private global health partnership, has helped fund the vaccines, which will be available for free to all Ghanaian children. More than 400,000 children in this country of 25 million people are expected to be immunised against both diseases.

The two new vaccines are expected to prevent 12,000 pneumonia-related deaths and another 10,000 deaths from diarrhoea, said Dr. Antwi Adjei, head of the expanded programme on immunisation at the Ghana Health Service.

On Apr. 26, Ghana’s Health Minister Alban S. K. Bagbin said in a press statement that the new vaccines would give this country the extra push it needs to meet the fourth MDG by 2015.

But for UNICEF, efforts to improve the nutritional health of children and provide them with vaccinations need to happen in tandem to reduce the under-five mortality rate. Chatterjee said malnourishment can sometimes double or triple the chances of dying from a condition like diarrhoea or pneumonia.

“Malnourished children are more susceptible to contracting the disease, having severe forms of the disease, and also dying from the disease,” he said.

Exclusive breastfeeding for the first six months of a child’s life is one way to prevent malnourishment in that crucial period. UNICEF has promoted the practice because it also helps create immunity to early childhood killers like pneumonia and diarrhoea.

In Ghana, 63 percent of children are exclusively breastfed during that period, which is relatively high compared to other developing countries. However, many women do not breastfeed their children because they are not aware of the benefits, or they work in an environment – such as the informal sector – where it is difficult to do so.

Adjei said that the Ghana Health Service has regular cooperation between departments such as vaccinations and nutrition. The service’s various departments are currently meeting for Child Health Promotion Week to develop new strategies and programmes related to child health.

One big challenge for the Ghana Health Service will be to reach all children with the rotavirus and pneumococcal disease vaccines. About 87 percent of children under one in Ghana have been immunised for tuberculosis, poliomyelitis, tetanus, hepatitis B, measles and several other childhood diseases. But reaching the last 13 percent has proven difficult.

“Wherever a person is, we have a responsibility to reach them and vaccinate them,” said Adjei. “Rising costs also make it more and more difficult.”

Some isolated communities around Lake Volta in central Ghana, for instance, can only be reached by boat. It is much more expensive for the Ghana Health Service to reach these small communities than to serve urban populations.

A small number of Ghanaians also do not take vaccinations due to religious or traditional beliefs. Adjei said, for example, that the local Twi dialect has only one word for “medicine,” and it does not differentiate between preventative vaccines and drugs used to treat diseases. He said it is difficult to overcome such beliefs.

“Fortunately for us these are isolated cases,” he said.

La General Hospital in Accra was one of the first institutions to offer the vaccines in the capital on Friday, May 4. About 40 mothers were gathered at the hospital with their crying infants in tow, as they waited for their turn for their children to be inoculated.

Gladys Otabil was at La General Hospital with her two-month-old son Gabriel.

“All I understand by the addition of the two vaccines is that they will protect my child from any disease and sicknesses,” she said. Otabil added that she was also advised to breastfeed her son for the first six months of his life.

The roll out will expand to other hospitals in Accra, and across Ghana, in the coming weeks.

Fifteen-year-old Aicha is one of the many spice vendors hawking their wares in the Dantokpa market, in Benin’s economic capital, Cotonou. But a closer look at her tidy stall reveals a disturbing detail: the powdered spices are packaged in recycled medicine vials.

“My mother often gets bottles from the National University Teaching Hospital (CNHU) or other health centres where we have friends,” Aicha told IPS. “We wash them, then refill them with condiments like powdered shrimp, hot pepper, ginger…”

But these vials and small bottles are medical waste that should be properly disposed of. Raymond Da Silva, inspector general at the CNHU, said: “We do what we can to incinerate our waste. But the question of the serum vials is a tough one for all health facilities in Benin.”

He warned that these containers, even emptied and cleaned out, are not safe for re-use. “Never accept snacks or spices packed in these vials.”

Biomedical waste consists of solid, liquid or laboratory waste of biological origin or generated by medical or paramedical activity. It must be properly managed to protect the general public.

Amina Sylla, the head of biomedical waste services at the non-governmental organisation Bethesda, frowns at the lack of interest by health centres in managing their waste properly. “They don’t recognise the need to spend money on waste disposal, yet we manage waste for around 40 hospitals (in and around Cotonou).”

The Regional Medical Centre (CHD) in Parakou in the northeast of the country is a happy exception to this rule. The centre has its own incinerator, Issa Mama Djibril, director of the centre, told IPS.

“We try to manage our waste as best we can and our facilities are also heavily used by the hospitals around us. The big problem is how to ensure that our staff do the work up to the required standard.”

But this conscientious attitude is rare. Environmentalist Nikita Topanou, the president of Flambeau du Progrès, a local NGO responsible for collection of household waste in the Abomey-Calavi administrative region in the south of Benin, says the group finds large amounts of biomedical waste mixed into the refuse they work with.

“It’s an irresponsible attitude that we are trying to discourage. We are working to raise awareness, so that all health facilities manage their waste properly.”

Bethesda has bought a large plot in Hêvié, a suburban area some distance from Cotonou, to comply with regulations requiring that incineration facilities be sited at least 200 metres from the nearest homes, where they consolidate all the waste they collect and destroy it.

“I burn eight 50-kg containers when the incinerator is working well. But when it’s malfunctioning, I can only manage three,” said Célestin Houndjo, the site manager.

Bethesda has another incineration site at Pahou, about 26 kilometres from Cotonou, but this one is now surrounded by residential areas that have sprung up since the facility was built. “We work in the night,” Pahou site manager Yaovi Koffi told IPS. “During the day, people complain about the smoke and gases emitted by the incinerator.”

These gases can be very toxic, according to Eustache Houéto, director of the Précis Plus laboratory: “When combustion is incomplete, it can produce carbon monoxide. When the environment is carbon monoxide-rich, then it is very oxygen-poor.”

People living in such areas can develop respiratory problems, he said. “You could even say that the poor management of biomedical waste can reduce people’s life expectancy.”

Dr Agossou Sènami, an ear-nose-throat specialist, says that improper incineration and disposal of waste can damage the mucous membranes lining the nose and throat. “Individuals exposed in this way can develop rhinitis, sinusitis and even cancer. Careless handling of liquids can quickly lead to nosocomial infections – highly dangerous infections typically contracted in hospital settings.”

Aware of the many challenges in this sector, the Health Ministry is trying to assume its proper role through its Department of Hygiene and Sanitation. “Basically, we’re running training sessions, raising awareness and carrying out monitoring in all 34 health districts, in a total of more than 1,000 public and private health facilities,” said Pie Djivo, one of two people responsible for the management of biomedical waste at the ministry.

A national guide to sound management of biomedical waste in Cotonou, produced in cooperation with the Canadian government in December 2008, recommends clarification of the roles and responsibilities of the actors involved to ensure a smoothly functioning system of disposal of this hazardous waste.

They survived floods and witnessed the horrific scenes of their houses, livestock, household items and gardens being swept away at the end of January. Now, the people of the Nsanje and Chikhwawa districts on Malawi’s southern border with Mozambique are facing another menace; a cholera outbreak, which has already killed one child and infected up to 103 people.

Sewage from the latrines has contaminated water sources in Nsjane, including boreholes and dug-out wells thereby escalating the cholera incidents. Credit: Claire Ngozo/IPS

Government officials have attributed the outbreak to the declining sanitation conditions compounded by the floods; up to 550 pit latrines were washed away in Nsanje alone; a district hardest hit by the floods.

Sewage from the latrines has contaminated water sources in the district including boreholes and dug- out wells thereby escalating the cholera incidents, according to the assistant Disaster Management Officer for Nsanje, Humphrey Magalasi.

“Almost every household in the rural parts of the district only uses a pit latrine. Everything that was in the latrines in the flooded areas has gone into the water sources,” Magalasi told IPS.

Boreholes, dug-out wells, rivers and streams are the main water-sources in the rural parts of Malawi and people use them for all household chores. There are no taps in many villages.

Lucy Mateyu, 46, a single mother of seven children from Mulolo village in Nsanje, told IPS that the floods hit her village as she was preparing lunch for her family on Jan. 23, 2012.

“It had been raining hard and continuously for three days and I was alerted by my eldest child that he had just seen our toilet tumbling down. Before I even went to inspect, the main part of our house crashed. I think we were saved just because all of us were sitting in the kitchen as I was cooking while the other six kids were huddled around the fire to keep warm,” said Mateyu.

She said the family scampered uphill and they watched a raging waterway forming across their homestead washing away everything in its wake. The family ended up at a camp for flood victims set up by the government.

Up to 6,000 people experienced a similar ordeal like Mateyu’s family. In some instances, the Malawi Army had to intervene and airlifted many villagers who were trapped in their flooded homesteads. They were whisked ofg them to the camps.

But the camps are now congested and the survivors are living in unhygienic conditions. Now school classrooms and government offices are being used as rooms to accommodate the flood victims.

“There are 21 of us staying in one small room and we have to share one toilet, which is rarely cleaned,” said James Masitala, 51, who is at the same camp as Mateyu and her children.

“Some people are resorting to defecating in bushes near the camp and this is compounding the problem of lack of cleanliness,” Masitala told IPS. Records at the Ministry of Health indicate that up to 103 people from in Nsanje and the neighbouring Chikhwawa district have been infected with cholera since the beginning of the rainy season in November.

“There are so many other diarrhoeal diseases that are being reported from the camps,” said Magalasi.

He said government is now distributing chlorine to the flood victims, to villages hit by the floods and to neighbouring villages around the camps.

“We want the people to drink treated water since most of the water sources are contaminated. We are also carrying out sensitisation campaigns on the importance of hygiene and working on improving the sanitation situation in the camps by constructing more temporary toilets,” said Magalasi.

There were a few incidents of flooding in Nsanje and Chikhwawa during the rainy season last year and the entire country recorded 76 cholera cases only.

District Commissioner for Nsanje Rodney Simwaka told IPS that government has been building the capacity of villagers in flood preparedness for the past three years since the area is flood prone.

Nsanje and Chikhwawa lie in the lowest part of Malawi and the Ruo River, which comes from Malawi’s highest point, Mulanje Mountain, usually brings with it raging water that flood the two districts. The Ruo flows into Malawi’s largest river, the Shire, a tributary to the Zambezi River in Mozambique.

“We have water level monitoring gadgets and have involved village committees in working with these but the floods took us by surprise this year,” Simwaka told IPS.

He said government also advises people living in flood-prone areas to move to higher ground just before the rains commence but that many resist the move.

“The people are usually reluctant to live their homes and fields and they are only forced to move when the floods come. This makes the situation difficult to handle,” said Simwaka.

Meanwhile there is a massive tree planting campaign going on in the area as one of the flood mitigation measures. There has been a lot of deforestation in the two districts since one of the major livelihoods for the people is the production of charcoal, which they sell to neighbouring Blantyre, Malawi’s main commercial capital.

The country’s rainy season usually ends in April and the risk for more floods is still there for Chikhwawa and Nsanje, according to forecasts from the Department of Climate Change and Meteorological Services, which has warned of tropical cyclones that will bring more heavy rains this month.

If the United Nations Children’s Fund (UNICEF) had 1.28 billion dollars it could help 97 million people around the world.

UNICEF's funding shortfall could leave millions of children like these searching for a living in garbage. Credit: Ashfaq Yusufzai/IPS

It could relieve five million drought-affected children in Ethiopia, give 360,000 children in Kenya access to quality education and treat 16,000 children for acute malnutrition in Madagascar. It could provide 2.2 million Somalis with safe drinking water and give a million children in the Republic of South Sudan basic health care.

And those figures are for Eastern and Southern Africa alone, just two regions of the world that UNICEF aims to reach.

Sadly, the U.N. agency secured less than 50 percent of its funding in 2011, suggesting that it will meet only half its expected goals this year.

Each January UNICEF releases its Humanitarian Action for Children report, which identifies children around the world in the most acute need of aid as a result of humanitarian emergencies – be they “natural disasters, human conflicts or chronic crises.”

The report is rife with pictures of children clinging perilously to survival; high-resolution images depict the protruding ribcages of malnourished boys and girls and the harsh realities of whole populations that are slowly starving to death.

Everything about the report is a desperate call for help. But help comes at a price, which, in this case, is a high one.

Released this year on Jan. 27, the appeal – 80 pages long and spanning 25 countries across seven regions – called for 1.28 billion dollars in aid, and breaks each country’s needs into categories such as nutrition, health, water sanitation and hygiene, education, child protection, HIV/AIDS and others.

UNICEF initially appealed for 1.4 billion dollars to be dispersed among 38 countries but revised its request mid-year to account for unprecedented crises like the famine in the Horn of Africa, among other disasters.

According to the report, 44 percent of funding for 2011 was funneled into the Horn of Africa, for which UNICEF activated its highest level of emergency response.

Meanwhile, other countries present new and equally dire needs. For example, UNICEF has appealed for more than 289.1 million dollars for Somalia in 2012, the largest funding requirement for a single country. The organisation has also called for 143.9 million dollars for the Democratic Republic of Congo (DRC) and 98.1 million dollars for Sudan.

The report adds that, as of October 2011, UNICEF had only received 48 percent of its projected needs, amounting to 854.7 million dollars, for all its humanitarian activities. Final numbers for the entire year are expected to be higher, but only moderately so.

For UNICEF, this means making heart-breaking decisions about which children to provide with life- saving services.

“Sadly, we never really (manage) to respond to all of the humans that are in need,” Marika Hofmeister, an emergency specialist at UNICEF told IPS.

Though a depleted resource pool is a setback for any organisation, a dearth of funding for UNICEF will have particularly severe repercussions, some bordering on disastrous for at-risk populations.

For example, South Sudan received just 36 percent of its projected needs last year, leaving its goal of providing 500,000 people with clean drinking water only partially met. Over 130,000 were excluded from planned supply since many water schemes could neither be rehabilitated nor constructed on the agency’s limited budget.

Meanwhile, armed with just 18 percent of its expected funding for the region, UNICEF’s plan to provide 75,000 children in the Philippines with schools supplies that had been lost or damaged due to floods failed woefully, leaving over 50,000 students without supplies.

Madagascar, Uganda, Congo, Iraq and Iraqi refugees, and Tajikistan were among several countries that received less than 10 percent of their planned funding, according to an October 2011 report.

Despite funding shortfalls, UNICEF reported helping millions of people worldwide during 2011, including providing de-worming, vitamin A supplementation and vaccinations for more than 36 million children; treating 1.2 million children for acute malnutrition; providing nutritional support for 19 million women and children; providing access to sanitation and hygiene facilities and safe drinking water for 16 million people and providing access to improved education for four million children.

Funding for UNICEF runs in two parallel streams, one of which contributes to development and programming for the achievement of long-term goals, while the other focuses on humanitarian action. Country offices have some “wiggle room” to divert funds from one stream to another, depending on specific needs.

Hofmeister explained this allows for flexibility in the event of an emergency.

“The import part is to strike the balance between huge emergencies that draw media attention… and the “silent emergencies” that very rarely hit the media and go unfunded for years and years,” Hofmeister said.

However, UNICEF’s efforts are not universally applauded.

In a Jan. 18 report entitled, “A Dangerous Delay“, Oxfam and Save the Children argue that governments, the U.N., NGOs and private donors need to change their approach to drought situations by “managing the risks, not the crisis.”

Referencing the famine in the Horn of Africa, the report claims, “It is clear that the opportunity to avert a crisis was missed.”

Oxfam and Save the Children further noted that the drought and subsequent famine, which has impacted 13 million people, displayed clear warning signs that indicated an impending crisis, including clues from measured rainfall and weather conditions linked to La Niña.

“If an early response had saved even a small proportion of these lives, then thousands of children, women and men would still be alive,” the report stated.

Hofmeister refuted the claim, asserting that unexpected disasters often lay waste to even the best laid plans.

UNICEF’s Global Support section in the funding requirements for 2012 – appealing for 21.9 million dollars – aims to scaffold a degree of preparation against such uncertainties by maintaining a reserve pool of funds that is not earmarked for a particular country or cause, but can be drawn upon for severely under-funded areas.

But this measure, too, is contingent on fund-raising. Last year, Global Support obtained only three percent of projected total funds.

As of October 2011, UNICEF’s 10 largest donors had contributed 74 percent of total donations, according to the report. The European Commission stood as the largest contributor, with 115.8 million dollars, followed by the government of the United States at 98.2 million dollars, the Japanese government with 97.4 million dollars and the U.N. Central Emergency Response Fund with 97.1 million dollars.

Hofmeister said that UNICEF is encouraging donors to increase or maintain their commitments, in order to protect the basic rights of women and children.

“We are aiming for 100 percent funding, (which is) the only way we can achieve the results that we have planned,” Hofmeister stressed.

Nadine Mbwol suffers from konzo, an epidemic paralytic disease that affects the lower body. “I lost my marriage because of this disability,” she says sadly.

Many people in the Democratic Republic of Congo (DRC) believe that this disease, which affects many young, female victims like 20-year-old Mbwol, is caused by witchcraft.

“But it’s not true,” says Dr Pierre Makadi-Nkeni, who works at the hospital “Le bon berger”. “Konzo is not caused by a curse or witchcraft as many people believe in all the provinces where the disease occurs,” he says. In the DRC, many rural territories like Kahemba, Feshi or the province of Bandundu are severely affected by konzo.

“Konzo is a spastic (sudden and painless) paralysis which causes permanent and incurable paralysis of the lower body,” says Dr Banea Mayambu, the director of the National Nutrition Programme (PRONANUT).

The disease occurs mainly during the dry season when the rural population is primarily eating a bitter form of insufficiently processed cassava. The first outbreak of the epidemic disease was reported in 1936.

According to Dr Emery Kasongo, head of the konzo study project at the NGO “Action contre la faim” (ACF), about 60 percent of total daily energy in the DRC is provided by fufu, a cassava-based pasta.

Konzo is caused by the regular consumption of cassava, which exposes the human body to cyanide, a poison contained in cassava. Up to now, this disease has reportedly affected about 70,000 people.

Dr Makadi-Nkeni explained that konzo is not an infectious disease caused by a virus or a bug of some kind. “There is no medical treatment or any traditional healing. It is currently incurable and the only way to stop the disease is prevention.”

Unfortunately, “the local belief that considers konzo a disease caused by witches is a real barrier to effective action against the disease,” says Damien Nahimana, head of the surveillance and research division at PRONANUT. As a result, konzo remains a major public health problem in the areas where it occurs.

Speaking about the nutritional situation in the DRC, Cesarine Kuwa, konzo nutrition expert at PRONANUT who worked previously with ACF to conduct a study in Bandundu province, underlined that the situation is worrying, particularly for children under five.

“Eleven percent of children suffer from acute malnutrition, 43 percent from chronic malnutrition, while 24 percent are underweight. These deficiencies are the result of insufficient calories, and especially a lack of micronutrients and protein due to poorly diversified meals based on cassava.”

Bernard Masukidi, a shopkeeper, adds: “For economic reasons, the cassava chips we buy in some villages are not very well treated.” Indeed, people usually shorten the duration of steeping (putting cassava in water to remove toxic elements), which should be four days during the rainy season and five days during the dry season.

“By means of an epidemiological survey and interviews about eating habits, I have established a link between the occurrence of konzo and the consumption of cassava.

“Thus, of the 6,764 people surveyed, we identified 110 konzo patients, and 24 deaths could be directly attributed to this disease,” says Dr Kasongo.

“It all started in 1974 with the paving of the road from Kinshasa to Kikwit, about 900 km east of Kinshasa,” local pastor Bernardin Mutombo told IPS. The new asphalt road cut the journey from Kikwit to Kinshasa from one week to just one day.

The road resulted in an immediate increase in demand for cassava. Facing the pressure of the market, traders have forced the villagers to change their working methods.

“Konzo disease often affects children and women of childbearing age since the ethnological and sociological considerations surrounding the distribution of food, through their standards and taboos, maintain too many privileges for men,” says Kuwa.

Habits and taboos in some areas exclude women and children from the consumption of certain foods such as meat which may provide protein.

“To prevent konzo, it is important to consume foods rich in protein and other nutrients,” advises ACF expert Paul Bahati. Unfortunately, farmers in need of cash prefer to sell their products without keeping anything for their own households.

Bahati says the solution to nutritional deficiencies in the villages where konzo remains a major problem depends on development and diversification of agricultural systems and economic growth.

Better Aid Can Save Millions of Lives in Africa. Credit: Miriam Gathigah/IPS

By Miriam Gathigah and - -
BUSAN, South Korea, Nov 29 2011 (IPS)

Although there has been considerable progress towards reducing maternal and infant mortality, millions of women and children in Africa are still in need of better health services, food and sanitation.

Better Aid Can Save Millions of Lives in Africa. Credit: Miriam Gathigah/IPS

Statistics by Save the Children, an international non-government organisation, reveal that African countries claim nine out of ten bottom places in a worldwide maternal health ranking that involves 164 countries.

Ben Philips of Save the Children says, “These reductions are not at the rate envisaged when the Millennium Development Goals (MDGs) were launched in 2000. Eleven years later, many countries are still a long way behind the set targets.”

As a consequence of the outcry provoked by high maternal and infant deaths, the 2000 United Nations summit bound every member state to achieve the MDGs – eight development targets.

Towards this end, MDGs 4 and 5 are geared towards reducing infant mortality and improving maternal health, respectively. Consequently, these countries were mandated to reduce by two-thirds the mortality rate among children under five and reduce by three-quarters the maternal mortality ratio.

This has not happened. In fact, Philips says, “African governments need to prioritise women’s and children’s health. They also need to speed up by four times the rate at which these deaths are declining in order to achieve MDGs 4 and 5 by 2015.”

As the Fourth High Level Forum on Aid Effectiveness (HLF 4) takes shape in Busan, one question is if women and children in Africa can expect any tangible results from the conference in this South Korean port city.

According to Philips, there is little for them. “Unfortunately, the Busan Outcome document, which basically summarises the Forum’s platform for action beyond the conference, isn’t ambitious enough to improve aid effectiveness. For instance, there is no strong commitment to untie aid.”

Experts on aid in Busan say that if donors had shown a strong commitment to untie aid as an outcome of the ongoing conference, this would have increased aid by 15 to 30 percent, consequently increasing the value of aid.

And this is not the only way in which donors are letting African women and children down. Although the G-8 countries, comprising the world’s richest nations, committed to ensuring that 0.7 percent of their budget goes to aid. None of them has actualised this commitment.

Britain has, however, promised to meet this commitment by 2013.

“There’s a clear aid deficit that makes it difficult for poor countries to channel money into sector budgets towards improving health services by employing qualified nurses and even having more health facilities in areas where the poor can easily access them,” said Dan Badoo, a policy researcher.

But donors are not the only ones letting women down. Eleven years since the Abuja declaration, where African heads of states committed themselves to allocate at least 15 percent of their national budgets to lighten the disease burden that women carry, there is little to show on the ground.

According to Save the Children, only six out of 53 African Union member states have so far met this commitment. They are: Rwanda, Botswana, Niger, Malawi, Zambia and Burkina Faso.

Despite the devastating impact that genocide had on the Rwandans, the country has become a model example of prioritising the health of women and children.

Consequently, according to UNFPA, the maternal mortality rate in Rwanda dropped from 750 per 100,000 live births in 2005 to 540 in 2008. Government statistics now show 383 deaths per 100,000 live births.

Philips says, “Malawi is one of the pioneer countries devoting 15 percent of its budget to health, saving an estimated 13,000 lives.”

Kenya is one of the countries lagging behind in this commitment with a paltry budget allocation of about five percent and the results are as expected. In the recent MDG progress report of 2010, Kenya is one of the countries which has made the least progress in achieving MDG 5.

Say Badoo: “Against this background, the connection between aid and saving lives is clear. Aid effectiveness is about delivering social services that enable people to live decent lives and exploit their potential.”

Mothers dying while giving birth in a shanty in Old Fadama or the Jamestown slums in Accra, Ghana or Kibera slums in Kenya or Kyalisha in South Africa is a reflection that African heads of state are not taking the health of women and children seriously.

“When we say that this is the HLF 4, it all sounds so technical and elitist, but what the ordinary, poor persons really need is to experience how healthy aid can improve their lives, can give them better quality livelihoods and save dying mothers and infants,” Philips said.

Excerpt:

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Credit: Paul Carlucci/IPS

By Paul Carlucci, Henrietta Abayie, and - -
GREATAER ACCRA WEST DISTRICT, Ghana, Nov 24 2011 (IPS)

For the past 10 years, Buruli ulcer has been eating Benjamin Essel’s leg. The skin above his ankle is totally gone, and a swollen, pulpy and reddish wound rises almost up to his knee and wraps around his calf. Even still, this is an improvement over recent years.

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Credit: Paul Carlucci/IPS

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Medical professionals say it is little known in afflicted communities and among staff at local hospitals, even though its early stages are easy to treat. It occurs in wet, rustic areas, and, consequently, its victims tend to be the rural poor.

Researchers know that it is caused by mycobacterium ulcerans, the same thing that causes leprosy and tuberculosis, but they are not sure how it is transmitted, which makes prevention very difficult.

Catching and curbing the disease in its early stages inevitably leads to full recovery with medication like antibiotics, but poverty, ignorance, spiritual beliefs, and underfunded health facilities conspire to stall treatment.

About 50 to 60 percent of this West African country’s victims end up with lesions like Essel’s or larger.

Disfiguration, disability, and amputation are common outcomes. Doctors and nurses are calling for more resources to educate endemic communities and train local health care providers.

“This disease affects rural poor, whose voices are not heard anywhere,” says Dr. Edwin Ampadu, the country’s national Buruli ulcer chief. “The public has very little knowledge about this. When we had opportunities to bring this to the media or TV, people shied away. That is very sad, because when you talk to people, they think the disease is far away. But it is very close to this place.”

According to the World Health Organization (WHO), Buruli first surfaced in Uganda in 1897. Fifty years later, Australian researchers provided the first full description of the disease, and, in 1960, a rash of cases broke out in Buruli County, Uganda, giving the disease its modern handle.

Since 1980, it has spread across West Africa, and, in 1998, WHO began addressing it on a global scale. The disease is present in 30 African countries, as well as the Americas, Asia, and the Western Pacific. In Ghana, there have been 11,000 cases recorded since 1993.

Buruli comes in four progressive stages: nodule, plaque, oedema, and ulcer. The first stage is just a lump in the skin, while the fourth phase can produce wounds several times as dramatic as Essel’s.

While prevention remains a puzzle – some researchers in Australia think the disease may be transmitted by mosquitoes – early treatment could not be easier. According to a 2003 survey, all it takes is 20 to 50 dollars worth of antibiotics. On the other end of the treatment spectrum is a price tag of nearly 1,000 dollars, not to mention the social fallout from that degree of illness.

“Education is ongoing,” says Martin Oppong, the Buruli ulcer programme coordinator for the Ga West District, where Amasaman Hospital is located. “But it’s a disease that no one can pinpoint as to the mode of transmission, so people’s perception as to the cause determines where they seek help.”

Some, like 50-year-old Ama Foa, think they have been cursed. Others, like 50-year-old Victoria Oppong, think it is a boil. Like Essel, both women let the disease progress before getting treatment. Now none of the three can work, and Essel and Victoria Oppong live in the ward.

Ghana’s National Buruli Ulcer Control Programme was struck in 2002, almost 30 years after the disease was first detected in the coastal province of Greater Accra Region. But doctors complain that it is grossly underfunded.

Amasaman Hospital’s ward exists mostly with the help of World Vision, the Christian relief, development and advocacy non-governmental organisation. In 2005, World Vision introduced a three-year programme to help with dressings, surgery, drugs, and general care, all of which are allocated from the government, but only every four months, and not in sufficient quantities.

World Vision also helps feed patients, who would otherwise have to fend for themselves, as the hospital does not pay for food. In 2008, the NGO renewed the programme. This September, it expired.

“Maybe they will renew,” says Oppong. “Maybe they won’t.”

Meanwhile, Ampadu is trying to build capacity in other endemic jurisdictions. He wants to train more local health care providers on detection, so the disease can be caught and stopped in its early stages. He also wants to build surgical capacity, so doctors can perform skin grafts and other surgeries with minimal damage to the patient.

So far, capacity is spotty. While Amasaman has one doctor who can assist in operations with the guidance of a surgeon from Korle Bu Teaching Hospital, one of the country’s central medical facilities, larger places like Nsawam in Eastern Region have no one. Ampadu chalks this up to professional interest.

“The gaps are many in terms of capacity building,” he says. “We have very few doctors who have shown serious interest. The cases are not many if you compare to tropical diseases.”

And then there are the financial limitations. Ampadu frames the whole thing as an issue of corporate responsibility. As it happens, many of the afflicted rural areas are also hotspots for Ghanaian industries like farming and mining. He’s calling on more companies to provide funds for education and outreach so the disease can increasingly be stopped in its early stages, which is currently the closest thing to prevention available. It should be an easy fix.

“If we invest seriously in early prevention,” he says, “maybe in three years time I can assume that we will not see this ugly lesion.”

Excerpt:

Doctors in Mogadishu are warning that famine victims in internally displaced camps have become vulnerable to contagious diseases like cholera and measles, as conditions here are ripe for an outbreak. This comes as internally displaced persons complain that relief aid to some camps has dwindled or stopped.

A four-year-old girl with meningitis sleeps in a makeshift tent in Sigale camp. Her parents left her to go beg for aid. Credit: Shafi'i Mohyaddin Abokar/IPS

The leader of a group of Somali volunteer doctors aiding the famine victims living in camps outside of Mogadishu, Dr. Abdi Ibrahim Ahmed, told IPS that sanitation in the camps was of concern and that many did not have access to clean drinking water.

“Conditions in the camps are very ripe for killer diseases. Doctors are ready to contribute their time, knowledge and energy, but we call on the Somali government to take our warnings seriously,” Ahmed told IPS.

He said people at IDP camps have contracted various diseases including upper and lower respiratory infections, measles, malaria and meningitis.

Ahmed said that standby medical units need to be established in the camps, adding that improved sanitation was needed to help prevent the spread of disease.

“If torrential rains fall and there are no mobile teams operating at the camps, I am afraid that contagious diseases will kill many,” the doctor told IPS.

While international aid continues to be delivered to Somalia, relief efforts at some camps have dwindled or stopped.

The Sigale camp on the outskirts of Mogadishu holds more than 3,000 people, according to the camp chairman Mohamed Hassan Sheik Abdi. However, they have not received relief aid since early August.

“We received our last food assistance from Qatar in the early days of Ramadan. Since then no one has come to us. We only heard on the radio that assistance from the international community is coming daily and that food distribution is continuing at some IDP camps,” Abdi told IPS.

He said that every morning mothers and fathers from the camp go to the city where they beg for food and charity.

“They return with what they get in the evening and feed their children who don’t eat all day,” he added.

The living conditions here are deteriorating rapidly.

While the United Nations Children’s Fund built a few toilets in Sigale and other IDP camps, they are not sufficient to meet the needs of the increasing population of these camps. While adults form long queues to use the few toilets at Sigale, children opt to defecate outside.

Also, there is a severe lack of water and women are forced to walk vast distances to find water.

It is no wonder that the drinking water is contaminated and has led to a number of watery diarrhoea cases, now one of the main causes of death at the camps.

According to Abdi, 10 persons, mostly children under the age of five, died from watery diarrhoea, whooping cough and diphtheria at Sigale since late September.

Since August, at least 38 people from Sigale and four other surrounding IDP camps have died from watery diarrhoea and other diseases.

The non-governmental relief organisation Qatar Charity was one of the first agencies to arrive in Somalia with aid for famine and drought victims. The drought has been described as the worst in the East African region in over 60 years.

Duran Ahmed Farah, Qatar Charity country director for Somalia, told IPS said that his agency has provided food aid to thousands of Somalis and now intends to tackle sanitation and health issues at the camps.

“We first tried to do a life-saving campaign because people were dying of hunger and wanted something to eat. Now we are going to establish mobile medical teams that will be responsible for health care at IDP camps,” Farah told IPS.

He added that aid agencies had not stopped their relief efforts but were feeding the new arrivals to Mogadishu.

“The huge need here cannot be met within a short time,” he said.

Meanwhile, the relief organisation Usmani Community Centre has started digging wells at some camps.

“We dug the wells at two camps in Hamar-Weyne and Abdel Aziz districts. In January we intend to dig wells at the seven camps that have the highest number of IDPs in Mogadishu,” Abdulaahi Mohamed Saneey, the Somali representative of the charity, told IPS.

The Somali government’s Mogadishu spokesman Mohamed Abdullahi Arig told IPS that the government needed help to prevent a possible cholera outbreak and to prevent other communicable diseases from spreading in the camps.

“The government is more vigilant, but our capacity is too little. We need the international community’s assistance in this sector,” Arig said.

Malawi is experiencing a drug shortage as the country’s international donors remain reluctant to release aid meant for the health sector.

Malawi is experiencing a drug shortage. Credit: Claire Ngozo/IPS

About 60 million dollars in funding has been withheld amid allegations of pilfering and corruption in the procurement of drugs at the government’s Central Medical Stores. The Central Medical Stores procures and distributes drugs to government health facilities.

The lack of aid has had a significant impact on the country’s health sector as international donors fund up to 90 percent of Malawi’s medical budget.

While some donors are supplying key medical facilities with life-saving drugs, this is not sufficient to meet the widespread demand as the supplies are mainly for the country’s three main referral hospitals located in Blantyre, Lilongwe and Mzuzu.

Throughout the country, patients seeking medical treatment at government-run medical facilities are unable to access medication such as anti-retrovirals (ARVs), anti-malarial drugs and even painkillers.

Health facilities are also experiencing a shortage of medical equipment such as gloves, and malaria and HIV/AIDS testing kits.

Agnes Makwasa, a 45-year-old HIV-positive patient from the country’s commercial capital, Blantyre, is struggling to obtain free ARVs. For five years, she received a free one-month supply from her local government clinic, until recently.

“They told me that they could not give me my whole dosage because the clinic had limited stock. I had to return for more drugs after a week, but by then the clinic had run out,” Makwasa told IPS. She said she ended up paying 50 dollars for the medication at a private pharmacy.

“I am a widow with five young children, and I am not employed. I make a living selling doughnuts and only make about 90 dollars a month. This means that my family is living on a very tight budget. This is also a threat to my health now that I cannot afford a balanced diet, which HIV patients are advised to be on while on treatment,” said Makwasa. Up to 60 percent of Malawi’s 13.1 million people live below the poverty line.

The situation has also caused concern in rural Malawi as some health facilities have run out of basic painkillers like aspirin.

Malita Nalikata from Mulanje, southern Malawi, told IPS that medical staff at her local hospital told her that they and the other medical facilities in her district did not have anti-malarial drugs to treat her malaria. They advised her to buy painkillers for treatment, as they did not even have that in stock.

“I don’t have money, so I ended up going to see a traditional healer who gave me some herbs to eat with porridge,” said Nalikata. She gave the medicine man a chicken as payment.

“That is all I could afford and traditional healers accept such kind of payment,” Nalikata said. ? It is common practice in rural areas for poor people to patronise traditional healers when they cannot access medical care from government health centres.

About 80 percent of Malawians use public health facilities, according to the Malawi Health Equity Network, a group of civil society organisations in the health sector.

The Malawi Health Donor Group, a network of international donors including Britain, the United States, Germany and United Nations agencies, have refused to release assistance until the government cleans up the health sector.

Chairperson of the Health Donor Group Athanase Nzokirishaka told IPS that the international donors want the government to work on the shortcomings facing the health sector, especially the way medical drugs and supplies are managed by the Central Medical Stores.

The donors, according to Nzokirishaka, are also concerned with poor record management for the country’s drugs and delays in auditing the process of drug procurement.

“Government has a long way to go towards restoring the trust of the international community, and of Malawians, in the national drug system,” said Nzokirishaka.

“Malawi will need to demonstrate that it can fully resolve issues to do with inefficiency, leakage and corruption at all levels of the system. Indeed weaknesses in the supply chain have already been a major factor in reduced or delayed funding for some donors in the past,” said Nzokirishaka.

For the past year, the donors have left the government to procure drugs for the country’s health facilities, a situation which has led to the critical drug shortage.

For many years, up to 40 percent of Malawi’s national budget has been dependent on donors and 80 percent of the country’s development budget was provided under the Common Approach to Budget Support.

This included contributions from Britain, Germany, the African Development Bank, Norway, the European Union and the World Bank. However, the British and German governments have refused to release up to 400 million dollars this year accusing the Malawian government of bad governance.

The government of Malawi has acknowledged the shortcomings in the health system.

Responding to the concerns by the Health Donor Group, Minister of Health Jean Kalirani admitted to IPS that the lingering weaknesses in the Central Medical Stores and the supply chain of drugs have affected the supply of medicines in health centres and hospitals across the country.

“Government is addressing the drug crisis by strengthening the capacity of the Central Medical Stores as a long term solution. In the short term, we are procuring drugs through an emergency tender while resolving issues that have been raised by the donors,” said Kalirani.

She explained that the government is working on establishing a viable financial model, which will be used to track the flow of drugs efficiently.

When Aisha Diis* and her five children fled their home in Somalia seeking aid from the famine devastating the region, she could not have known the dangers of the journey, or even fathom that she would be raped along the way.

New arrivals at Dadaab wait for a medical check up. Credit: Isaiah Esipisu/IPS

Diis left her village of Kismayu, southwest of the Somali capital of Mogadishu, for the Dadaab refugee camp in Kenya’s North Eastern Province in April.

“I was in a group of many women and children, but four of us had come from the same village, hence, we related (to each other) as one family. Along the way, we stopped to make some strong tea since the children were feeling very tired and hungry. One woman remained behind with the children and the three of us went to search for firewood,” Diis told IPS through a translator.

“We were ambushed by a group of five men who stripped us naked and raped us repeatedly,” she said as tears rolled down her cheeks. “It is something I have not been able to forget. But I wouldn’t like my children to know about it.”

But the trauma Diis and the other two women had to undergo is not an isolated incident.

As hundreds of tired, weak and malnourished women and children stream into Dadaab from famine-hit Somalia daily, the journey, for many of the women, would have been a harrowing one.

Tired and dusty, most women carry their babies tied to their backs. For many this precious cargo is the only possession they have managed to save from their homes in Somalia. Some, however, are slightly more fortunate and come with their children and what few belongings they have packed onto donkey carts.

They rarely talk about what has happened to them on the way here, when they arrive.

Instead, most register as refugees and undergo medical screening with their children. Then they are allocated a tent and basic household equipment.

The tents have no lockable doors, no windows, and no furniture, not even a bed. But all the same this is a place that the refugees can call home – for now, and perhaps for many years to come. (Some of the refugees were born here in 1991 when the camp was first established, and have not known any other home.)

But even after the women have settled in, many do not come forward to speak about the violence they experienced on their way to the camp.

“Gender-based violence is a hidden side of the famine crisis,” said Sinead Murray, the gender-based violence (GBV) programme manager for the International Rescue Committee (IRC) at Dadaab.

“As per the rapid assessment done on GBV in Dadaab released by the IRC in July, rape and sexual violence were mentioned as the most pressing concerns for women and girls while fleeing Somalia and as an ongoing, though lesser concern, in the camps,” Murray told IPS.

“Some women interviewed during (the IRC) survey said they witnessed women and girls being raped in front of their husbands and parents, at the insistence of perpetrators described as ‘men with guns.’ Others were forced to strip down naked, and in the event they were raped by multiple perpetrators,” said Murray.

But Diis, and the two women who were raped with her, are some of the few Somali women who reported the violence they have been subjected to on their journey to Dadaab. In Diis’ case, she was brave enough to do so because she is a widow, and does not fear recrimination from her family as other women do.

“I did not fear to disclose my case to the medical officer because I did not have a husband,” said the widow whose husband was gunned down in Somalia by unknown assailants seven months ago.

“Many women are assaulted on their way to the refugee camp by unknown armed men, especially when travelling in a group without men,” said Ann Burton, a senior public health officer at the United Nations Refugee Agency (UNHCR) at Dadaab.

“However, most of them are reluctant to report such cases since they fear that their families will blame them, communities will reject them or simply because they feel ashamed to talk about it.”

Diis was given post exposure prophylaxis, a short-term antiretroviral treatment used to reduce the likelihood of HIV infection, after she reported her rape.

“After I reported my case I was given some medicine, and I was monitored for three months after which I was informed that I had not contracted HIV. That was one of my biggest concerns,” said Diis. She also received counselling.

The other two women who were raped with Diis were also counselled and received post exposure prophylaxis.

Diis said that she is aware of other women who were raped before their immediate family members and did not report it to the medical staff at the camp.

Not reporting the rape just adds to the suffering of the women. Burton said: “Survivors often do not get critical life-saving care because of keeping it a secret.”

So far, only 30 cases of rape were reported between January and July 2011 according to the UNHCR at Dadaab. But medical experts at the camp say that this is a small fraction of a huge problem faced by women.

Once they arrive at Dadaab some women continue to experience gender-based violence from their intimate partners. Murray said this includes early marriages and survival sex – where women are forced to exchange sex for access to basic needs.

Though such GBV incidents are said to be less frequent within the camps, some women told IPS that they feel insecure and scared at night while sleeping in the makeshift shelters.

“The camps do not have fences and at the same time we are not able to lock our shelters throughout the night. Anything can happen in the dark hours,” said Amina Muhammad who lives in Dadaab.

The biggest risk at the camp, according to the women IPS spoke to, is when they travel long distances in search of firewood.

*Not her real name

By IPS Correspondents
KINSHASA, Sep 27 2011 (IPS)

“Every quarter, more than a hundred women with fistulas – including many younger than 20 years old – are admitted for surgery in Maniema province,” says nurse Julie Mawazo. “The number of affected women who don’t have the means or awareness to come in must be far greater.”

Each year, sexual violence, early marriage and complications in childbirth lead to some 12,000 recorded cases of vaginal fistulas – in which a hole develops between either the rectum and vagina or between the bladder and vagina – according to the Democratic Republic of Congo’s Ministry of Public Health.

“A quarter of the national total is recorded in the province of Maniema alone, in the east of the DRC,” says Jules Mulimbi Kaboyi, who directs the United Nations Fund for Population office in Kinshasa, the Congolese capital. UNFPA works to provide medical care and support for these women.

This assistance is badly needed: just 3.5 percent of the DRC’s national budget is allocated to health, and in a country facing massive challenges from diseases like malaria, tuberculosis and AIDS, this leaves scant resources to treat women suffering from this debilitating and stigmatising condition.

Bernadette Kabukulu is a shopkeeper in the Bandalungwa neighbourhood of Kinshasa. “For nearly two years, I had persistent pain in my abdomen, and a reddish discharge from my vagina. And a smell, especially when I went to the toilet or if I remained seated for even a few minutes,” she told IPS.

“I had to wash all the time. I avoided drinking or eating in order to avoid going to the toilet. I was ashamed to go out, I felt as though people could smell the odour that I carried with me.”

“Vaginal fistulas are accompanied by the deformation, followed by abnormal swelling, of the private parts of a woman and the creation of openings – in the form of small abnormal ulcers – between the vagina and the anus, creating a connection between the pathways for urine and faecal matter,” says gynaecologist Elie Makuza.

“These ulcers and deformations produce strong, persistent odours in the lower parts of the sufferer,” Makuza adds. “This smell is often the cause of rejection or stigmatisation by the community.”

Fistulas can be caused by extended pressure against soft tissue in the pelvis during childbirth – young women or girls giving birth are particularly vulnerable – or by extreme sexual violence.

Relief for the afflicted

Germain Musombo, a human rights defender with the non-governmental organisation Maniema Libertés, says poor education plays a key role, particularly in Maniema where he estimates that nearly half of women have little or no formal education. “In Maniema Province, the increase in the number of affected women is essentially due to four causes. Poverty, early pregnancy, sexual violence, as well as women’s poor education and ignorance (of factors that put them at risk).”

“Thanks to awareness campaigns organised by the UNFPA, in collaboration with the government, women are becoming more aware of the dangers of this condition,” says Jean Bertin Epumba, Director of Research and Planning at the Ministry of Public Health. Modeste Shabani, a campaigner at the Sauti Ya Mkaaji community radio station in Kasongo (the name means “voice of the peasants” in Swahili) is less upbeat.

“Here in Maniema there is a practice against which public education can make little headway: early marriage. And once a little girl is married, often as the second or third wife, it is difficult to speak to her about the negative effects of this issue.”

Mawazo, who works at the general hospital in Kindu, Maniema’s provincial capital, says she herself developed a fistula after the birth of her first child. She was only 15, and went through the delivery without medical assistance. She went through reconstructive surgery two years ago at the Kindu hospital, thanks to doctors brought in with support from the UNFPA.

“I’m happy to serve other women who suffer from fistula now, and help them to quickly get screening and care, so they can avoid the worst consequences,” she told IPS.

“Too often, poverty and ignorance puts young girls without resources in a position of weakness with regards to men or young boys…, to the point where many get pregnant or marry early, or give birth in dangerous conditions which can be at the root of fistulas.”

Excerpt:

By Rosebell Kagumire and - -
LIRA, Uganda, Aug 12 2011 (IPS)

Ester Abeja has experienced both physical and emotional atrocities. She was captured by Uganda’s feared rebel group the Lord’s Resistance Army (LRA) and was forced to join them. But not before the soldiers made her kill her one-year- old baby girl, by smashing her skull in, and then gang raped her.

Ester Abeja, who was abducted by Lord's Resistance Army says it is important for sexual violence survivors to have a face. Credit: Rosebell Kagumire/IPS

In Ogur, Lira in northern Uganda, Abeja has come to a temporary medical camp run by Isis-Women’s International Cross Cultural Exchange (Isis-WICCE), a women’s organisation working with women in conflict and post-conflict settings.

The camp is specifically for women with reproductive health complications, which they have mostly sustained from being raped during the almost two decades of war.

For most of the women here it is the first time they have been offered special medical attention since the war ended in 2006, and for many it is the first time they have been treated by a doctor. It is also the first time that many of these women have ever spoken out about the violence they had to endure.

Abeja is one of the many women struggling to survive the horrors of the war. Her home is a few kilometres from Barlonyo, where the LRA massacred over 200 people in a single attack in February 2004.

The LRA fought in the north and north eastern parts of Uganda for 23 years. The war, which forced close to two million people into internally displaced persons camps for decades, was the most brutal that Uganda has faced since independence from Britain in 1962.

Thousands of people died as a result and the war was characterised by its use of child soldiers and the conscription of civilians into the rebel group. The LRA were forced out of the country in 2006 and are currently operating in the Democratic Republic of Congo, the Central African Republic and western South Sudan.

Abeja was captured in 2002. She was a wife and a mother of six children when the LRA abducted her with her youngest daughter and her son.

“When they abducted me I had my one-year-old baby girl and the boy. A few kilometres away from home, they forced me to kill my child,” she says tearfully. “I hit her head on the tree and she died. The rebels immediately began to rape me.”

Abeja can’t remember how many men they were; she says there could have been 10 to 15.

“The group that captured me raped me right after (I killed) my child. They even pushed different objects inside me as they raped me. Others were cutting (me) with machetes as some raped (me),” Abeja says as she shows the scars that remain on her arms and thighs.

She doesn’t know what happened to her son or if he’s still alive.

Abeja was sick for many weeks in the bushes of what is now South Sudan. Once she recovered she had a man waiting to be her ‘husband’. Like many abductees, Abeja had to kill or be killed. In her four years with the LRA she tells IPS she can’t recollect the number of people she was forced to kill, but she puts the number at more than 40.

Abeja was one of the lucky few that escaped. She returned home in 2006 with a boy who is now about five years old.

Since the war ended in 2006, people went back to their original homes and depended on emergency aid.

A recovery and development plan was put in place in 2009 by the Ugandan government but this has not covered the emergency medical needs of the population. Most of the money went into building new blocks of health units and rehabilitating the destroyed ones.

It is not surprising that of the 400 women screened here at the Isis-WICCE medical camp, many are found to have pelvic inflammatory diseases.

Dr. Tom Charles Otim, a lead gynaecologist at the camp, says Abeja has lived with a prolapsed uterus for years now.

Uterine prolapse – the descent of the uterus into the vagina or beyond – is one of the long-term complications associated with sexual violence.

In Abeja’s case, her uterus is hanging out. But she allows her photo to be taken saying it is important for sexual violence survivors to have a face.

She and 39 other women are referred for further treatment to a regional hospital many kilometres away. She will need surgery, which costs about 200 dollars, to remove her uterus.

Like the many women who were raped during the war, Abeja not only has to live with the physical scars of the rapes but the psychological effects as well. She and women like her have to endure intense stigma from the community.

Her husband rejected her after she returned, and left her to raise their four surviving children and her child from the war.

As Abeja struggles to narrate her story, fighting back the tears she wonders: “Do they think I wanted to be abducted and raped by the rebels? Do they think I wanted to kill my own child?”

Otim tells IPS that women like Abeja need more support than just surgery.

A majority of the women seeking medical treatment at the camp have chronic pelvic pain as a result of pelvic inflammatory infections.

“The infections are high here; because of the war, the women were not able to access medical care early,” says Otim.

“This has had an effect on the women’s sexual lives and the majority of them have painful sex, and sometimes they don’t want to have sex but they have to because their husbands don’t allow (them to refuse).”

Many women who have come to the camp have fertility problems. Otim says pelvic pain takes a long time to cure and the women will need about 40 dollars for more follow-up visits at regional health centres, which are usually more than 40 kms away.

“Women cannot claim to have peace if their reproductive health is still an issue they are trying to contend with and struggle with on a daily basis,” Isis-WICCE’s programme manager Helen Kezie-Nwoha tells IPS.

She says because of the sexual violence behind these reproductive health complications, women in northern Uganda need a specialised programme to provide them with the needed health services.

“Reproductive health issues are not easily spoken about, it is not something women will come out in public and speak about,” Kezie-Nwoha says. But “we have built confidence over years of working with these women; that’s why the women can be able to open up and talk about the wartime rapes.”

She says government needs to rethink its approach in post-conflict northern Uganda by putting human security needs first.

The district health officer in Lira, Nelson Opio, tells IPS that most of the reconstruction in the health sector has largely concentrated on building structures, and cannot address the immediate medical needs of a post-conflict community.

“When war ends, there’s a silent war that has to be fought,” he says. “Politicians here think they will just put up structures so they can say ‘This is what I did during my time’ and ignore people’s real needs.”

Most health centres in the district have no medical officers, while the entire district has only two gynaecologists.

Excerpt:

West African health experts are calling for governments to take the prevalence of hepatitis B and C more seriously, and to act to reduce the cost of treatment as part of more effective control of the disease.

Hepatitis vaccines are a key element in controlling the disease. Credit: Bios/Wikicommons

The hepatitis B virus is responsible for more than 80 percent of liver cancers in Africa, said the coordinator of Senegal’s National Programme Against Hepatitis, Aminata Sall Diallo, during an international meeting held in the Senegalese capital, Dakar, from Jul. 27 to 29.

Hepatitis refers to swelling and inflammation of the liver, which can be caused by numerous factors, including a family of five viruses. The Dakar conference was concerned with the three most common viral strains, which can cause fatal liver damage and cancer.

The hepatitis A virus spreads via contaminated food or water. The B strain is transmitted through bodily fluids like blood or semen, while type C spreads via blood-to-blood contact, such as transfusions. The latter two viruses produce a long-term illness, while type A hepatitis runs its course much faster – many infected people experience only mild symptoms.

The conference aimed to share the issues and challenges facing each country, to identify the best practices for Francophone Africa as a whole, and define common strategies and arguments.

“The idea is to push governments, who have committed themselves, to make hepatitis a priority so that treatment will be accessible to all,” said Diallo.

“The cost is beyond our resources. It requires a million CFA francs (around 2,250 dollars) for a month’s treatment; our grants are not sufficient,” she stressed.

“Our fight is for a focus specifically on long-term carriers of the virus, to offer them treatment, to fight effectively to be able to detect the illness in Africa. It’s the only way to prevent transmission of the disease.”

According to official statistics released in June, 17 percent of the Senegalese population are carriers of one or another form of the hepatitis virus, including 12 percent of children under five and 22 percent of pregnant women. Some 5,000 people die from hepatitis B in Senegal each year.

Pape Saliou Mbaye, coordinator of medical services at Dakar’s Hôpital Principal, urges care to prevent transmission of hepatitis B and C viruses through contact with infected blood.

“It’s necessary to be careful when handling sharp or pointed objects such as those used by tattooists and barbers – shaving equipment, piercing equipment, tools for acupuncture, excision, circumcision and nail clipping…” Mbaye told IPS.

Diéynaba Samaké, the president of SOS Hépatites Mali, a local association, said that nearly one in five Malians are carriers of the hepatitis B virus – 2.6 million people, or half of all young people between 18 and 25 years of age.

“Treatment for hepatitis B [in Mali] remains relatively expensive. At 600,000 CFA (around 1,348 dollars) per month, the cost of treatment is equivalent to several times the monthly salary of an average Malian,” Samaké told IPS.

“There is not, at this stage, any framework for specialised care for hepatitis B, but in the past three years, the government has supported prevention, testing and treatment of hepatitis B and C.”

To reduce the incidence of the disease, Samaké recommends vaccination as the most effective weapon against the strains that predominate in Africa.

The president of the Scientific Council of Cameroonians Against Viral Hepatitis, Njoya Oudou, says his country’s prevalence rate for hepatitis B stands at over 10 percent, and 12 percent for hepatitis C. He believes governments should show greater political will to fight the disease.

“Our network operates with its own resources to educate people, organise refresher courses for doctors, run campaigns and negotiate with pharmaceutical firms. For the moment, we have only moral support from the government,” he told IPS.

Ali Djibo, director general of health at the Ministry of Public Health in Niger, said that the fragmented studies into this disease in his country show a general prevalence rate of up to 14 percent of the population. This places Niger in the group of countries with strong endemicity, he told IPS.

“The precautions to be taken to prevent transmission are, among others, the systematic use of prophylactics and avoiding the exchange of used syringes, scarifications, piercing, group circumcision with poorly sterilised instruments, and excision,” said Djibo.

In Mauritania, some 500,000 people are infected with hepatitis B and around 600,000 others are infected by hepatitis C, according to the secretary general of the country’s health ministry, Sidi Ali Ould Sidi Boubacar. Around 3,500 people die from the two forms of hepatitis each year, he told IPS.

“To better fight against viral infections, the government several months ago initiated an Expanded Programme of Immunisation and implemented a policy guaranteeing treatment after a diagnosis of the virus,” he said.

By IPS Correspondents
BAMAKO, Aug 2 2011 (IPS)

Tuberculosis remains a leading cause of death in Mali despite the availability of free treatment. The resurgence of the illness, linked to poverty and HIV infection, could be reduced by changing behaviour, doctors say.

“I know people who have died of tuberculosis,” Ramata Guindo told IPS.

“In this market, a vendor of kitchen utensils died of it last year. He didn’t go to a health centre in time. When they discovered what was wrong with him, it was too late,” says the vegetable vendor at Bamako’s Lafiabougou market.

This teeming market of hastily-constructed wooden sheds perfectly illustrates the overcrowding that supports the transmission of contagious diseases like TB. Between the merchants’ stalls, shoppers trample muddy soil mixed with spittle. “If you don’t pay attention, you risk being caught full in the face by someone’s spit, because around here, people are used to spitting anywhere, even in public places,” says Guindo.

Dr Faran Sissoko, a lung specialist at the Pape Clinic in Bamako, explained to IPS that this kind of behaviour plays an important role in the prevalence rate of tuberculosis which remains a public health problem in developing countries because it is so highly contagious.

“Tuberculosis continues to be an important cause of mortality in Mali. According to estimates by the World Health Organisation in 2009-2010, the prevalence of this disease in Mali is 142 per 1,000 residents,” says Sissoko.

Some 6,840 cases of tuberculosis, counting all forms of the disease, were recorded in 2009 in Mali, including 5,163 cases of highly contagious pulmonary tuberculosis, according to the medical authorities.

Vaccinations administered to children at birth seem to be failing to prevent the disease. “We’re seeing many cases of tuberculosis, and it’s affecting all age categories. The specialists explain the return of tuberculosis by pointing to HIV and the vulnerable conditions (of poverty) that many people are living in,” said Boubacar Diarra, a nurse in Commune V (the Fifth Commune) of Bamako District.

While the diagnosis of tuberculosis can require sophisticated and costly techniques, there are simple tools within the means of developing countries with which to detect the disease.

In Mali, the community health centres which are found even in the most rural areas can do bacteriological analyses. “To diagnose tuberculosis, one does a bacteriological survey of the sputum of the patient. If the sick person is found to have tuberculosis, they get six months of treatment for free,” Diarra told IPS.

But in the popular imagination in Mali, tuberculosis is a terrifying and incurable illness. People with the illness feel rejected by others.

Salif Traoré, a trader living in Bamako, is living testimony that tuberculosis need not be fatal. “I had heard on the radio or on the television that when a cough lasts more than 15 days, one has to go for a tuberculosis test, so I didn’t hesitate. I think that I owe a lot to the awareness messages,” he told IPS. He tested positive and was treated for six months before his health was restored.

“It is bad when you notice that people are uncomfortable near you. Even after I had recovered, I noticed that people were still afraid to shake my hand,” says Traoré.

The awareness campaigns can help to correct or eliminate dangerous behaviour that can spread the bacillus bacteria that causes the illness.

“If a person who has tuberculosis doesn’t get medical care within a month, they can contaminate ten other people. That’s why in the fight against tuberculosis, it is not only the disease and the doctor who matter. There is also the community that needs to become aware. And to achieve this, strong political will is needed to reinforce national programmes,” says Sissoko.

Mali has adopted this approach to prevention and control, although awareness campaigns were threatened by the suspension of finance from the Global Fund for the Fight Against AIDS, Tuberculosis and Malaria.

The Malian courts are currently investigating a corruption scandal involving misappropriation of money from the previous round of funding. Fourteen people were arrested, including the former health minister, Oumar Ibrahim Touré, charged with involvement in fraud in public procurement with the Global Fund’s grant.

The country’s health authorities will resume popular awareness campaigns thanks to new financing for 2011 and 2012 agreed in June.

Excerpt:

By Abdurrahman Warsameh
MOGADISHU, Jul 28 2011 (IPS)

As the first of food aid from the United Nations World Food Programme was airlifted into Mogadishu on Wednesday, it came too late for Qadija Ali’s two- year-old son Farah.

A mother and daughter who survived the dangerous journey from south Somalia to an aid camp in Mogadishu. Credit: Abdurrahman Warsameh/IPS

He died in his mother’s arms as Ali and her eight other children made the 16-day epic journey from their drought-stricken village in Wanlaweyn district, Lower Shabelle, in southern Somalia to Mogadishu.

“I carried him a whole day while he was dead thinking he was alive and just asleep. We did not have anything to give him. No water or food for three days,” an emotional Ali tells IPS at Badbado Camp on the outskirts of the Somali capital.

Ali’s family had 50 head of cattle, 20 goats and five camels before the onset of the current drought in southern Somalia that has raged for two years. Her family was one of the well-off ones in the region, where ownership of numerous livestock, the mainstay of a rural economy, is a sign of wealth.

“It started with (a) shortage of rains for the first three seasons and then no rains followed. Grass dried up, wells and rivers dried up. Our animals began dying one after another as there was no pasture or water for them,” Ali recalls as she carries one of her remaining three young sons who is weak and malnourished.

Camp Badbado, which in Somali means ‘rescue’, is the city’s largest settlement for the drought displaced people from southern Somalia. The U.N. Refugee Agency (UNHCR) says that it is currently home to an estimated 28,000 people, approximately 5,000 families.

Ali’s entire family is not with her, however. Her husband remained behind in their village to look after the family’s remaining belongings. Ali is not aware of her husband’s fate. But she made the arduous journey along with hundreds of other families to escape the severe drought and famine in search of aid.

But aid has come too late for some.

Many children arrive at the camp too weak and malnourished to be saved by doctors. Some children have gone for days without food and water.

Most of the children are too small for their age with a three-year-old having the frame and stature of a one-year-old.

“They come here very weak from hunger and exhaustion. Two or three children and adults die every week in Mogadishu, but we have no exact statistics as camps are located in diverse places in the town,” Muna Igeh, a nurse at Badbado, tells IPS as she weighs one of the dozens of malnourished children at the camp.

Daahir Gabow, a father of seven, had to watch as two of his children succumbed to severe malnourishment just after they arrived in Mogadishu.

He says doctors and nurses at Banadir Hospital, one of Mogadishu’s main health centres, did everything they could to save the life of his second child, a girl, but “fate had its way”.

He says his family had tried to “weather” the drought but could not this time and had to leave their home in search of aid.

“We tried to weather the drought as we did many other times but our livestock could not survive until the rains arrived. Many of our neighbours began leaving after losing all their livestock, so we decided it was time to go,” says Gabow as he prepared for the burial of his daughter who died of malnutrition complications.

“We walked for 21 days. (We) ate (and) drank what we could find and slept where the sun set on us. This is not what I have seen or (what) my father told me happened in his lifetime. (These are) testing times so we have to be patient and strong,” Gabow says.

Elhadji As Sy, the regional director of UNICEF (the U.N. children’s fund) for eastern and southern Africa, called the famine “a child survival crisis”.

Somalia is the country worst affected by a severe drought that has ravaged the Horn of Africa, leaving an estimated 11 million people in dire need of humanitarian assistance. Kenya, Ethiopia and Djibouti are all also facing a crisis that is being called the worst in 60 years. Last week the U.N. declared a famine in parts of southern Somalia.

The agency estimates that in total 2.23 million children in Somalia, Kenya and Ethiopia are acutely malnourished. The U.N. says it has delivered 1,300 metric tonnes of supplies to southern Somalia, including therapeutic supplies to treat over 66,000 malnourished children.

Meanwhile, people are still fleeing their homes in southern Somalia. The U.N. says almost 100,000 displaced people have arrived in Mogadishu, with nearly 40,000 of those in the past month.

“Over the past month, UNHCR figures show that nearly 40,000 Somalis displaced by drought and famine have converged on Mogadishu in search of food, water, shelter and other assistance,” says Vivian Tan, UNHCR spokesperson in a statement on Tuesday.

The U.N. estimates that the number is growing by the day, with daily arrivals averaging 1,000 in July.

Local non-governmental organisations are providing much-needed humanitarian aid but camp residents say the aid is limited and Somali government officials are echoing calls for more assistance.

The U.N. World Food Programme (WFP) on 27 Jul. began its first airlift of food aid to Mogadishu, the first such shipment since the Islamist extremist group, Al Shabaab, banned international aid agencies from operating in regions it controls.

The WFP flew in 14 tonnes of ready-to-use food supplements for malnourished children at the camps in Mogadishu.

Spokesman for the agency, David Orr, told reporters at Mogadishu airport that more aid will be flown in over the coming days.

Excerpt:

By Miriam Gathigah
NAIROBI, Jul 27 2011 (IPS)

On the road between the Kenyan and Somali border lie the dead bodies of children who have succumbed to the famine and the hardships of making the journey from their drought-stricken villages to Kenya.

A child from drought-stricken southern Somalia who survived the long journey to an aid camp in the Somali capital Mogadishu. Credit: Abdurrahman Warsameh/IPS

And it is the story of these children who die between Somali’s southern town of Dobley, which is the last border town before crossing into Kenya, that is yet to be told, aid workers say.

Ahmed Khalif, who works for a local non-governmental organisation in Kenya and regularly crosses the border between the two countries for his work to aid people in Somalia, talks of seeing the bodies of numerous children on the roadside.

“I am a regular on the route between the Kenyan and Somali border, anyone who has used this route will narrate horrific stories of dead bodies, mostly children.

“Their mothers are dying too. It’s not a heartless mother leaving a child behind, just a mother who wants to survive for the sake of living,” attests Khalif.

He says he sees droves of mostly women and children attempting to cross the border to Kenya. But when the children become too weak to walk any longer, they just fall down on the roadside while their mothers and families, half dead with starvation, continue to walk on in an attempt to reach the border and hopefully, aid.

“It is a shocking image to see (children) on the brink of death, their skin sagging from extreme dehydration, their frame too small for their height, their lips dry. They don’t talk, they just lie there.

“(Their) eyes sink into their sockets, but still they stare back at you. It is very disturbing. You think the others are heartless for abandoning them, but they too are in the same physical shape. Only the will to reach Dadaab keeps them going,” Khalif explains.

Those children who die along the way are not buried.

“Who has the extra strength to do so? Those moving on are very weak too, they just keep going…at the camp, that’s where they get buried. When they die there,” Khalif says adding that Dadaab has a makeshift graveyard.

Those Somali children who have survived and make it to the Dadaab refugee camp in Kenya have done so after enduring unimaginable levels of hardships, walking for at least 10 days in intense heat, through a hyena-infested no-man’s land, to get to the camp.

“The Al Shabaab (extremist group that controls much of southern Somalia) continues to make it difficult for people to access Kenya and Dadaab by making Dobley, the last border town in Somalia, inaccessible to Somalis who come from Al Shabaab-controlled regions,” Khalif says.

This is despite the fact that the town is now controlled by Somali government forces, who seized control from Al Shabaab three months ago.

So instead of walking 15 kilometres from Dobley to Kenya, many have to take a route that bypasses the town and walk an additional four to nine days just to get to the border.

But this longer route is dangerous. Roaming bandits rape women and steal the meagre possessions of those trying to find aid.

But at Dadaab, which has now become the largest refugee camp in the world with over 380,000 people, life is still difficult, especially for children. Four children die daily as almost 1,300 Somalis fleeing the drought continue to arrive everyday. This is according to United Nations (U.N.) agencies, which say over 300 million dollars are needed over six months to help save the children affected by the drought.

“The children are too small, too light for their age. Their condition has exceeded the global acute malnutrition rate. This drought is reversing gains made in reducing child mortality,” says Oliver Yambi, the United Nation’s Children’s Fund’s (UNICEF) representative in Kenya.

Yambi adds that U.N. agencies are now encountering malnutrition levels of up to 35 percent, a severe form of malnutrition characterised by extreme weight loss and children having a very small frame for their age.

The World Health Organisation has set a 15 percent threshold against which the extent of malnutrition is measured. Anything above the 15 percent mark shows an advanced state of acute malnutrition and children in this stage rarely survive. They are 10 times more likely to die before age five.

According to UNICEF, the number of acutely malnourished children under five years in Somalia increased from 476,000 in January to 554,550 in July.

And their mothers are not faring any better.

“Children are not the only ones dying at Dadaab. Maternal mortality is very high. We estimate that for every 100,000 live births, at least 298 women will die. But these figures are moderate. The numbers are rising due to the extreme anaemia as well as the ratio of patients to nurses. On average, there is one health facility for every 1,700 refugees and counting,” explains a source from OXFAM. Eighty percent of the refugees in the region are women.

The U.N. said in a statement on Jul. 27 that the famine can lead to complications during pregnancy and childbirth and increases the risk of maternal deaths and infant illnesses.

“Experts estimate that eliminating malnutrition among mothers can reduce disabilities in their infants by almost one third.

“UNFPA (the United Nations Population Fund) country offices in Somalia, Kenya, Ethiopia and Djibouti are carrying out emergency measures to distribute reproductive health care supplies, medical equipment and dignity kits to affected populations. This will ensure life saving treatment for mothers and their children, while also facilitating safe deliveries of newborns,” the statement said.

Excerpt:

By Aimable Twahirwa
KIGALI, Jul 22 2011 (IPS)

When Callixte Munyabikari, a potato farmer from Gakenke in northern Rwanda, was rushed to a regional hospital after he fell ill with diarrhoea, he thought it was just a bad case of food poisoning.

A contaminated stream in Kimicanga, a suburb in Kigali. A majority of people in rural Rwanda still consume polluted water from rivers. Credit: Aimable Twahirwa/IPS

Since 2007, the issue of hygiene and sanitation in rural areas has been of major concern as Rwanda’s government reduced spending on medical care for patients affected by poor hygiene and sanitation diseases across the country.

“It is important to eradicate the persistent behaviour among rural communities. A number of households used to have access only to a shared latrine,” said Rwanda’s minister of infrastructure, Colette Ruhamya, while underlining the role of proper sanitation and hygiene as the main component of sustainable development.

“Everybody can dig, and the latrine (and) the roof are lower cost material(s),” she said. Government’s aim is that each household, wherever possible, should have access to its own sanitation facility. Rwanda seeks to be a model of hygiene and sanitation for other African countries.

In fact, it is one of only four countries in Africa which look set to achieve Millennium Development Goal 7 to ensure environmental sustainability, which includes halving the proportion of the population without sustainable access to safe drinking water and basic sanitation. The other three countries are Mozambique, Ghana, and Sierra Leone.

Delegates at the Africa Sanitation and Hygiene Conference (AfricaSan 3), which was held from 19 to 21 Jul. in Kigali, were divided on whether poverty was the main cause of poor sanitation facilities and waterborne diseases currently affecting millions of people across the continent.

“There is an urgent need for African countries to address the issue of sanitation and hygiene without relying on donors’ aid,” declared Rwandan President Paul Kagame.

According to him, the only inclusive solution to promote measures to prevent waterborne diseases is from local initiatives and without having to rely on foreign assistance.

Kagame’s comments came at a time when experts from several African praised the initiatives undertaken to promote hygiene across the Central African nation.

Since 2001, Rwanda has embarked on strong measures aimed at wiping out unhygienic practices, while sensitising local communities in urban and rural areas to change behaviour and bad habits that relate to poor hygiene.

Other initiatives taken to prevent waterborne diseases include the installation of toilets for each household across the country, while ensuring potable water supply systems in several remote areas across the country. Official statistics show that 61 percent of Rwanda’s rural population have access to improved drinking water sources, while 20 percent has access to improved sanitation.

However, some participants expressed pessimism arguing that there is still a long way to go as only four countries across the continent are on track with providing access to safe drinking water, compared to the rest their counterparts.

“It’s better to be realistic about commitments made (by governments) toward sustainable solutions, but this implies going along with proposed actions, by ensuring that the majority of rural communities are benefiting (from a) potable water supply and adequate sanitation infrastructure,” said the Zimbabwean minister of water resources development and management, Samuel Sipepa Nkomo.

“It is still unbelievable that only four African countries are on track toward achieving (the) MDG on sanitation,” Nkomo deplored. He blamed inadequate policies to mobilise financial resources in some African nations as a reason.

Speaking on the fringes of the joint summit by the United Nations and African Ministers Council on Water, Nkomo urged governments in countries still lagging behind achieving the MDG for concrete actions, while identifying that priority was need at grassroots level.

However, civil society is still optimistic that Africa could finally be turning a corner in the sanitation crisis; officials say the big challenge is more about adopting adequate policies in this area to curb the consequences of waterborne diseases.

According to Lydia Zigomo, the head of the environmental non-governmental organisation WaterAid, the challenge (in policy decision-making) remains formidable.

“A total of 584 million people in Africa do not have an improved sanitation, and the poorest are 18 times more likely to practice open defecation,” Zigomo said. She said that the issue of hygiene has always been the most neglected and off-track of the MDGs, with little funding, resources or political will to address the crisis.

But some representatives of African governments say that necessary resources are available, and that what was most needed was not money, but educating communities on how they can change bad habits with regards to hygiene and sanitation.

“This includes providing toilets after it has been noticed that hundreds of thousands of Africa’s rural population still practice open defecation, while ignoring the worst consequences of hygiene-related diseases,” Nkomo told IPS.

Official statistics show that diarrhoea, malaria, schistosomiasis, trachoma and intestinal helminths, are major diseases caused by poor hygiene practices and contamination of water across several developing countries, especially in sub-Saharan Africa.

“In general, 1.8 million people die every year from diarrhoea diseases, which includes cholera, while 90 percent are children under five, mostly in developing countries,” a World Health Organization report said.

Northern Rwanda is a region described by health experts as having the highest number of hygiene- related diseases. Here a majority of people consume polluted water from neighbouring rivers, which run across the mountainous region.

Government, in collaboration with local administrative leaders, has implemented a number of measures, including sensitising the population to changing bad habits, and not consuming polluted water.

Since 2004, the International Committee of the Red Cross has implemented 23 clean water supply projects in several rural areas in northern Rwanda as a way to prevent against contracting waterborne diseases.

Excerpt:

By Ignatius Banda
BULAWAYO , Jul 18 2011 (IPS)

Thomas Njini is used to working with burst sewers and water pipes. It is a daily experience for him to respond to calls where he has to shovel human waste to clear blocked sewers. It is a job he continues to do with unenviable dedication in this city of two million people.

“It’s my job, what can I do?” asks Njini who is one of the municipality’s staff who work around the clock to clear blocked water and sewer works around the city.

But, according to municipality officials, the work is slowly easing a year after the city embarked on the ambitious Bulawayo Water and Sanitation Emergency Response (BOWSER) project.

The BOWSER project was launched in 2010 under the Australian government’s overseas aid programme, AusAid. The 4,6 million dollar grant has been used to replace and also unblock old pipes that were built before Zimbabwe’s independence in 1980 and which have become part of the urban landscape here.

Raw sewage and flowing treated water have, over the years, become a daily occurrence, and there are constant concerns about the spread of waterborne diseases. In 2008 a cholera outbreak claimed around 4,000 lives across the country.

According to council officials and implementing partners, World Vision, the city was losing up to 50 percent of its purified water due to leaks and burst pipes. But thanks to the project this has been reduced to around 20 percent as of April. In an statement earlier this year, World Vision’s national director Edward Brown said sewer blockages in the city had decreased from about 250 per day to around nine a day in the first quarter of this year.

“The project seeks the removal of excrement from blocked sites for appropriate disposal and we will clear the blockages through mechanical jetting. We will also seek to clean water through the city’s piped water system,” said council spokesman Bongiwe Ngwenya in a statement to local journalists.

The project is located in high-density areas that have been the most affected by burst sewers and old water mains, Ngwenya said.

While the municipality has not quantified the cost of the water lost through leaks, the mending of leaks and replacement of old pipes is welcome news for a city that remains under water stress. Supply dams are constantly under threat of running dry and are unable to provide enough water to residents of the city.

For Njini and those on the frontline of dealing with these water, sanitation and hygiene challenges, this is a positive step forward. “I think this is welcome news, as honestly, not many people love a job where contact with human waste is part of the job,” Njini said.

“This is a long term exercise as we hope this (the replacement of old pipes) to stretch beyond the 18 months BOWSER is expected to run,” said a municipality official who did not wish to be named.

“Bulawayo is an old city and working on a complete rehabilitation of water works and sewer systems will need much more than the Australian grant,” the official said.

City Mayor Thaba Moyo says the city will need around 100 million dollars for a total overhaul of the city’s water and sewer works. It is money that the local authority can only source from donor agencies.

Bulawayo is one of many African cities that the United Nations Settlements Programme, UNHABITAT, says have seen an exponential growth of urban populations in the past few years. But this has not been matched by infrastructure development. An audit by the Bulawayo municipality notes that constant burst sewers are a result of the stagnant development of sewer networks despite the continued growth of the city.

And it has created problems for town planners who seek to develop new housing projects for home seekers.

Over the past two decades the city of Bulawayo has seen the creation of new residential areas. But the council has issued housing lots in areas where there are no sewer and water works. It has forced new homeowners to turn to the bush for ablutions and to neighbouring residential areas for water.

Burst sewers and water works have, however, become a nationwide problem as municipalities struggle to maintain ancient infrastructure amid low budgets and long-running disputes with ratepayers.

Residents say the mending of Bulawayo’s sewers is overdue as they have been living with the threat of diseases, such as cholera, for a long time.

“This has always been one of our major concerns with the municipality – that they demand rates from us when we continue to live with burst sewers right on our doorsteps. We hope this project is indeed making a difference,” said Tholani Mkhwananzi of the Bulawayo Progressive Residents Association.

“Residents will only pay for a service they are getting, and it is our hope that the city saves water from these leakages from old pipes as water is something this city cannot continue losing,” he said.

The project is yet to be replicated across the country.

Excerpt:

By Joshua Kyalimpa
KAMPALA, Jul 15 2011 (IPS)

In pharmacies in the heart of Kampala men and women line up to buy drugs that you usually need a prescription for, like Coartem, a drug used to treat malaria.

Edna Nakyanzi had malaria symptoms, so she bought the antimalarial drug, Fansidar, without a prescription. According to Dr. Emmanuel Semugabi of Hope Clinic, Fansidar should only be prescribed to patients after the first line treatment of Coartem fails.

But Nakyanzi said that she prefers this drug because she has to take fewer doses of it. “I only take three tablets of Fansidar and go to bed and the next day I am fine. But with Coartem you have to swallow many tablets and I hate that,” said Nakyanzi.

But Nakyanzi’s story is a common one. In Uganda patients can easily buy drugs you normally need a prescription for over the counter as government has been lax in stopping the illegal practice. Under the Pharmacy and Drugs Act of 1970 sale of prescription drugs over the counter is prohibited. Those doing so could loose their pharmacy license and also face a jail term. While National Drug Authority inspectors are mandated to regulate this, they have never been effective.

And increasingly people are resorting to self-medication to treat themselves for malaria and other ailments, either to save the money they will have to spend on costly doctors fees, or because some areas lack health officers.

Thelma, another advocate of self-medication, told IPS she regrets spending the equivalent of 10 dollars in consultation fees when she was ill recently because doctors could not adequately diagnose what was wrong with her.

“They told me that I was suffering from fatigue because of over work and advised me to rest and gave me some painkillers. Imagine, I spent close to two hours there after a day at work,” Thelma said. The Uganda Medical Association warns that this commonplace unregulated self-medication is responsible for growing drug resistance in the country.

“Some drugs, like antibiotics, are (bought over) the counter and abused, which causes serious problems. Really those loopholes should be checked,” said Dr. Margaret Mungherera president of the Uganda Medical Association and a member of the Medical Council.

In many cases patients use strong combinations of drugs for minor illnesses, sometimes drugs are taken in inappropriate doses and sometimes the incorrect drugs are used.

Dr. Peter Langi of the malaria control unit at the Mulago National Referral hospital said self-medication is one of the reasons why the fight against malaria has not succeeded.

“When people self-medicate, they fail to take the adequate doses they need to cure malaria, which causes some to develop resistance against the drugs and hence (results in) their eventual death,” said Langi.

A report by the ministry of health says that in some districts resistance to malaria treatment is more than 60 percent. However, the national average of resistance to malaria treatment stands at 11.7 percent.

Aggrey Mubaale said he often suffers from bouts of malaria but swallows several doses of antimalarial tablets without going to a doctor.

“When I was still studying I would carry some antimalarial tablets just in case and still do, even after I left school. It (taking antimalarial tablets) has become a part of me,” said Mubaale.

Mungherera said her association has now teamed up with the Pharmaceutical Society of Uganda, the National Drug Authority and the Association of Nurses and Midwives to address the growing problem. They intend to inspect pharmacies to find those that are dispensing prescription drugs over the counter. Those found to be doing so will have their licenses withdrawn or could face arrest.

“Most of the people dispensing medicine (in) most pharmacies are not trained and will not insist on getting a prescription. In fact, some cannot even read or understand the documents,” said Mungherera.

But this does not mean that all pharmacies in Uganda sell prescription medication over the counter. John Mukama, a dispenser at a pharmacy in Kampala, insists they do not sell prescription drugs to people without a doctor’s prescription.

Excerpt:

By IPS Correspondents
JUBA, Jul 8 2011 (IPS)

Mother of eight, Jessicah Foni, 36, hopes that independence will mean a hospital will soon be built in her village. Foni, who has travelled from a remote village in South Sudan to the state’s capital to celebrate independence, lost two babies at birth because of the lack of medical facilities in her area.

“I come from a very remote village that is far away from any medical facility. I have lost two children due to problems related to delivery. Our new government should build hospitals close to us so that we can access medication,” she said.

South Sudan has one of the highest maternal and child mortality rates in the world. Out of 100,000 live births, 2,054 women die.

Dr. Abdinasir Abubakar, the medical officer in charge of the World Health Organization (WHO) office for South Sudan, said the harsh and unfavourable living conditions, coupled with very limited access to basic health services, contributes to the poor health status of the population

According to the Sudan Household Health Survey and the World Children’s Status Report 2008 by UNICEF, out of 1,000 live births in health institutions, 102 infants die.

It also found that only 48 percent of Sudanese women visit medical facilities during pregnancy while only 13 percent deliver at hospitals, attended to by skilled workers who constitute only 10 percent.

Grace Joan, 26, a mother of five says she has never delivered any of her children in hospital.

“When my time is due, I just call a neighbour who helps me deliver my children. But I am happy that we have our freedom, which will enable the government to provide health facilities to all people so that women and children do not die of preventable diseases,” she said.

Abubakar says only 25 percent of South Sudanese have access to medical facilities, making it hard to provide services to the population.

“Preventable infectious diseases like malaria, presumed pneumonia and diarrhoea account for the majority of the reported diagnosis in health facilities for all health groups combined. Preventable infectious diseases and malnutrition are the most common causes of morbidity and mortality for children under five years of age,” he said.

But as South Sudan prepares to celebrate its independence on Jul. 9, experts and policy makers all agree that urgent steps have to be taken to address the health sector in the country.

Dr. Olivia Lomoro, the Under Secretary in the ministry of health says government is aware of the situation and has put in place systems to address the problem.

“For the past five years since the Comprehensive Peace Agreement, the government has taken over the payment of salaries to all the workers in the health sector. The government also procures and distributes all essential drugs for all the medical facilities. We had our first ever health symposium last month to discuss ways to improve the health sector,” she said.

Robert Kimani, who owns a small pharmacy in Juba, said life is very expensive in the city and residents would rather buy food than drugs – even if they are sick.

Dr. Meshack Adan, who works at the Juba Referral Hospital, the country’s biggest and only referral facility, said government should encourage people to use existing medical services.

“Where are the 75 percent of our people who don’t get medical services?” he asked.

Lomoro said government, in collaboration with WHO, have drafted a five-year National Health Framework which commits government to addressing the health situation in the country. The policy framework will allow government to address the acute shortage of personnel by training health personnel to improve services.

Abubakar said only 10 percent of the staffing needs are filled by qualified health workers and there is an urgent need to train doctors, clinical officers, and midwives, among others, to offer the best services to the people.

He called on government to reconstruct the country’s dilapidated medical facilities and to improve infrastructure so that medical staff can respond to emergencies.

Excerpt:

By Isaiah Esipisu
NAIROBI, Jun 22 2011 (IPS)

People in Western Kenya are now able to buy effective anti-malarial drugs at low prices thanks to the success of the Global Fund’s subsidy programme, and thanks to honest pharmacists who are reselling the drugs at the recommended low prices.

The drugs subsidised through the Affordable Medicines Facility - malaria. Credit: Isaiah Esipisu/IPS

Early findings from a survey conducted by the Kenyan government show that 80 percent of pharmacies in Nyanza Province in Western Kenya have stocked the subsidised drugs. The study is yet to be released but it also found that most locals have taken advantage of the subsidy to access the highly effective medicine. Unsubsidised, the drugs cost about seven dollars.

“We recorded anomalies in prices, where some pharmacists were selling the subsidised drugs slightly higher than the recommended price of 40 Kenyan Shillings (Ksh) (50 cents), but most of the prices were within affordable limits,” says Dr Elizabeth Juma, the managing director for the Division of Malaria Control in Kenya.

Artemisinin Combination Therapy (ACT) is subsidised through the Affordable Medicine Facility – malaria (AMFm) programme, which is hosted and managed by the Global Fund. The Fund is an international financing institution that invests in the fight against HIV/Aids, tuberculosis and malaria.

Since the launch of the subsidised anti-malarial drug distribution in August 2010, the private sector has ordered 13 million doses. According to Juma, eight million doses were delivered by May. They Kenyan government has placed orders for 12.2 million doses for the subsidised ACTs.

According to Juma, the Division of Malaria Control partnered with the Pharmacy and Poisons Board to conduct a survey covering 270 private pharmacies in all districts within Nyanza Province (a malaria endemic zone) during March.

“We found out that all the surveyed pharmacies had stocked the recommended ACT drugs for malaria, while 80 percent (216) had the subsidised ACTs,” says Juma. “The mode and median price was Ksh 40 (50 cents) while the average price was Ksh 49 (above 50 cents). In only one pharmacy did we find the subsidised drugs being sold at more than Ksh 100 (2.50 dollars),” adds Juma.

It is a significant success in a country where 25 million of the 34 million Kenyans are at risk of contracting malaria.

And the slight overpricing of the ACTs did not seem to have a huge impact on those in need of the drugs. “The average of Ksh 49 was found to be far better than Ksh 600 (7.50 dollars) people were paying for the same (unsubsidised) dose,” she says.

Dr Olusoji Adeyi, the director of AMFm in Geneva, echoes her sentiments. Adeyi was optimistic that prices of the subsidised drugs will eventually drop with time.

“When the AMFm started, the government of Kenya set a recommended retail price of Ksh 40 (about 50 cents) for AMFm co-paid ACTs. In our understanding, this was set as a desirable target, not a decree, because the AMFm in the private sector works through markets. Yet with the ongoing public information campaigns to make both buyers and sellers aware of these recommended prices, the cost of ACT will soon go down,” Adeyi tells IPS.

There is no legislation of price control in Kenya, hence shopkeepers, including pharmacists, usually decide on what price to mark the subsidised ACTs, despite government’s price recommendation.

However, Josephine Akinyi, a resident of Kisumu city in Nyanza Province appreciates the fact that the subsidised drugs are available despite anomalies in the prices. “Though I am aware of the recommended price of these drugs, I find it far easier to part with double the recommended price for a dose, which is several times cheaper than what we used to pay for the same dose of (unsubsidised) medicine,” says the mother of six.

Adeyi says that the project’s success means people will no longer be forced to buy cheaper anti- malarial drugs that are not effective.

“Nyanza province has already achieved its strategic objective of reducing the retail price of ACTs to about the same range as those of SP (Sulfadoxine-pyrimethamine–based) and amodiaquine (anti- malarial drugs that are no longer effective in treating the disease). This means that high prices will no longer force people to buy ineffective medicines. Instead they can easily buy quality-assured ACTs for about the same price or even cheaper,” he says.

Though the SP drugs, which include Fansidar and Metakelfin, are banned in treating malaria because of their ineffectiveness, many people in Kenya still buy them because they cannot afford alternative effective drugs. The banned drugs retail at about Ksh 100 (2.50 dollars).

“I receive customers on a daily basis who seek to buy Fansidar because they know it is cheaper than the (unsubsidised) ACTs. But upon realisation of the availability of the subsidised ACTs, they usually change their options and go for the highly effective alternative,” says Willis Otieno, a pharmacist in Kisumu city.

In Kenya, the AMFm program has reduced the retail price of ACTs by up to 92 percent. According to the program’s plan, the private sector is entirely responsible for all costs of distribution, storage, staff salaries and overheads. It is a strategy, Adeyi says, that has never been attempted in global health financing for malaria treatment.

He says there was a need to increase the availability of ACTs and to reduce variations in their retail prices. Adeyi says this will happen when the supply of ACTs is large enough to meet the demand everywhere.

Excerpt:

By Joshua Kyalimpa
KAMPALA
, Jun 21 2011 (IPS)

The nurse at Najembe Health Centre in Buikwe district says the centre’s supply of malaria drugs will be finished in two days. A malaria epidemic has hit the area and the demand for the drugs is high. But the centre, which serves the entire sub-county, will have to wait up to six weeks before their supply will be replenished.

The health centre gets supplies from the Kawolo district referral hospital every two months and last received supplies at the end of May. The next supply will only be delivered at the end of July. Meanwhile, staff from the centre cannot make a special request to either the district hospital or the National Medical Stores for drugs that are in short supply. So those patients in need of anti-malarial drugs will have to go without or will have to privately purchase the drugs.

“They give us the same quantities of drugs irrespective of the needs and this means we are always running out of some drugs, while other drugs expire because nobody is using them,” says the nurse who prefers not to be named.

The Ugandan government changed the policy of distributing drugs to parish and sub-county health centres in 2009 by implementing a policy where the National Medical Stores decides what drugs to supply and in what quantities. (A parish health centre is a clinic that provides medical treatment for up to 12 villages.) Previously heads of these health centres requisitioned the drugs, depending on their needs. The National Medical Stores supply 70 percent of the drugs in public health centres and district health officials locally procure the remaining 30 percent.

Hamis Kaheru, spokesperson of the National Medical Stores, says the policy change was necessary because there was a lack of competent personnel at lower levels to handle the old system.

“Personnel at the health centres (at parish and sub-county level) had no capacity to ascertain their needs and were not sending their requests on time. In the end the National Medical Stores was not sending drugs on time and some items would be missing because they were omitted from the list,” Kaheru says. He adds that they have been reviewing the policy every six months and is convinced it is working.

But the system is not working according to Denis Kibira medicines advisor at the Coalition for Health Promotion and Social Development (HEPS) a civil society organisation campaigning to stop the shortage of drugs. Kibira says the policy is wrong and should be reviewed.

“Drugs are out of stock most of the time and the moment people learn that some have been brought at their health centre they rush to get as much as possible to keep some for use during a shortage. This means the drugs will be always out of stock,” Kibira says. He says this is possible because most nurses at the parish and sub-county health centres do not test patients to identify their illnesses but instead treat them based on symptoms. He says most people fake symptoms to get the drugs that are in short supply.

Kibira says the HEPS have conducted research in at least 20 districts since government first revised the drug distribution system and found the system is not working, despite government’s assurances. At one health centre in Kayunga district villagers told IPS they did not have medicine for over two months and there was no nurse on duty.

Government implemented the current system in an attempt to reduce chronic shortages of essential medicines that were experienced by the parish and sub-country health centres from 2008 to 2009. Kibira, however, says those shortages were largely due to mismanagement of supplies, deficiencies in the procurement process and inadequate funding.

“We were under the impression that the original shortages were because of no money. Our expectation was that when the budget allocation to the National Medical Stores went up, the services would (improve). But what we are seeing is the reoccurrence of the disease we hoped to heal,” says Kibira.

In the 2009/2010 national budget the National Medical Stores received an allocation of almost 90 million dollars compared to a previous allocation of only 20 million dollars.

Kibira says with this kind of money the National Medical Stores should be in a position to supply vital drugs to health centres across the country without resorting to a policy change. Previously the National Medical Stores was not allocated funding through the national budget and would supply drugs on credit and then invoice the ministry of health and other health facilities for payment. This caused terrible delays.

But Kaheru says the policy has already been reviewed twice after consultations with the district medical officers, who should know the needs of their areas of jurisdiction.

“This policy solves more problems than it creates, the reason why drugs run out is because health officials at the lower levels are just giving people drugs under the clinical treatment based on symptoms and without testing. This (leads) to shortages and not because the policy is bad,” says Kaheru.

But HEPS have asked government to review the policy and increase funding. Currently government supplies about 400 dollars worth of drugs to each parish health centre monthly. Sub-county health centres receive about 800 dollars worth of drugs each.

Kibira says HEPS have met with ministry of health officials who have assured them that they will revert to the old system. The National Medical Stores, however, denies this will happen.

Meanwhile, the nurse at Najembe Health Centre has no option when the drugs run out. She will have to give her patients prescriptions for the anti-malarial drugs and hope that they will have the money to buy them.

Excerpt:

By Kristin Palitza
CAPE TOWN , Jun 17 2011 (IPS)

Access to treatment for drug-resistant tuberculosis (DR-TB) remains compromised, especially in developing countries, because too few pharmaceutical companies manufacture quality-assured drugs. Lack of competition has led to skyrocketing prices and this means that public health budgets are quickly spent.

Prices for DR-TB drugs remain too high worldwide. Credit: Kristin Palitza/IPS

The situation is particularly severe in countries with high numbers of HIV infections, especially where access to antiretroviral treatment is patchy and HIV-TB co-infections are common. South Africa is one of them.

One of the key access barriers to treatment is the limited availability and high cost of quality-assured medicines to treat DR-TB. For some medicines, there is only one quality-assured manufacturer or a single source of the active pharmaceutical ingredient required to produce the drug.

“There has been little investment in research and development of TB drugs, because TB is seen as a disease of the poor and therefore not a lucrative market for the pharmaceutical industry,” explains MSF South Africa medical coordinator Dr. Eric Goemaere.

This has led to extremely high prices for most DR-TB medications. One patient’s treatment can thus cost up to 9,000 dollars, says MSF – nearly 475 times more than the 19-dollar treatment course for drug-sensitive TB.

Alarmingly, prices have increased even further in recent years. “While drug prices usually go down with increased demand, prices for DR-TB drugs have gone up, some by 600 to 900 percent. That’s simply wrong,” says Goemaere, who heads a HIV and TB treatment project in South Africa’s third-biggest township Khayelitsha.

The exorbitant pricing is less an issue of patents, he explains, but rather caused by the lack of a working mechanism to control prices as well as the termination of subsidies that kept prices lower. High prices are also reflection of insufficient market competition. Only six products (for five different DR-TB drugs) have been prequalified by WHO, and only four sources (for two different medicines) are recommended for purchase in 2011.

The World Health Organisation (WHO) responded to the growing need for affordable DR-TB drugs in 2000 by creating the Green Light Committee (GLC), which reviews governmental and non-governmental treatment projects and ‘green-lights’ them for access quality-assured drugs at reduced prices.

Although the GLC is theoretically a helpful initiative, its highly bureaucratic application process has prevented many treatment programmes around the world to become part of it. In 2010, only 12,000 patients were enrolled in GLC-approved treatment programmes, compared to 440,000 new cases and 150,000 deaths, according to MSF. Only 13 percent of the estimated DR-TB drug market is currently channelled through the WHO Global Drug Facility.

“The WHO has a responsibility in this disaster,” believes Goemaere. He says it took years of pressure from NGOs like MSF until the WHO agreed to establish the GLC. But the commission’s strict conditions and long-winded administration processes prevent many health care providers from benefiting from it.

“The GLC offers little incentive because its quality approval process is far too bureaucratic and centralised. The rules are self-limiting, making the WHO a gatekeeper instead of offering support,” says Goemaere.

WHO medical officer for TB in South Africa, Dr. Kalpesh Rahevar, acknowledges the GLC’s administrative barriers, but points out that the WHO has started a process to reform the GLC in early 2010. One of the planned modifications is to make participation in the GLC easier, he promises.

“We are looking at simplifying the GLC application process”, says Rahevar. “The WHO is also planning to broaden its mandate to monitor TB programmes worldwide, not only those participating in the GLC.” But until then, hundreds of NGOs and health departments have to continue purchasing DR-TB drugs from pharmaceutical companies that may offer uncertain quality and substantially higher prices. The South African Department of Health (DoH) belongs to this group. Instead of applying for GLC membership, the DoH purchases drugs at fixed prices directly from South African subsidiaries of American drug manufacturers Sanofi Aventis and Sandoz.

According to DoH acting director for TB advocacy, communications and social mobilisation, Garvon Molefe, the health department decided to purchase drugs exclusively locally, even if at a higher price, to benefit the country’s economy.

“The reason why the DoH is not following the GLC initiative is because, as South Africa is already facing alarming rates of unemployment, the DoH doesn’t want to disadvantage pharmaceutical companies (that employ South Africans) by procuring TB treatment from other countries,” he told IPS.

The DoH currently pays 4,400 dollars for the DR-TB treatment of one patient. Goemaere says, MSF, through the GLC, pays about 30 percent less for those drugs. That means that the humanitarian organisation can treat many more patients for the same amount of money.

Political will – or lack thereof – seems to be another deciding factors for the success of the GLC. “Applying to the GLC is the political decision of each government,” says Rahevar. “As WHO advisor to the South African government, I can only advise and encourage, not impose.” He is hoping the GLC reform measures, which he says will be announced within the next couple of months, will change the South African government’s mind.

Excerpt:

By Poindexter Sama and Jessica McDiarmid
FREETOWN, Jun 16 2011 (IPS)

Bubble-wrapped pills are scattered across the crude table in a busy market beside crumpled boxes of lubricant, paracetamol and anti-fungal powder.

Regulators say many of the drugs sold on the informal markets in Sierra Leone are fake or substandard, posing a huge risk to the public. Credit: Poindexter Sama/IPS

A young man approaches and mutters a few words. The proprietor shuffles through the piles of sexual aids that cover the table – generic viagra, ‘man-woman’ cream (lubricant), dubious-looking condoms – before cutting a section containing two antibiotic capsules off a sheath. He hands them over, collecting in return 600 Leones, the equivalent of about 15 cents.

So-called “drug peddlers” ply the streets of cities and villages across Sierra Leone and much of West Africa, selling pharmaceuticals, often counterfeit or substandard, at reduced rates.

Strides have been made over the past few years to ensure drugs are safe and effective, but medical practitioners still cite these drugs as one of the largest obstacles in their fight to save lives. In Sierra Leone, still struggling to overcome the devastation of an 11-year war that left the nation in ruins, efforts remain beset by hurdles such as weak infrastructure, a lack of regulatory regimes in neighbouring countries, and few resources stretched in many directions.

Pharmacies in Sierra Leone are regulated under its Pharmacy and Drugs Act. Enforcement has been stepped up substantially in recent years, but what to do about those peddling on the streets remains elusive.

Drug peddler Abubakarr Keai says the majority of his supply comes from Guinea, where drugs are sold at cheaper prices and easily smuggled in over West Africa’s infamously porous borders. Other times, he buys them from local pharmacies.

He’s been selling since the war – when the formal healthcare system disintegrated and peddlers were the only option – and says he’s never had a complaint about his products. He recommends drugs and describes how to take them, though he can’t read most of what’s written on the packaging.

Keai says police frequently harass drug peddlers. Occasionally, authorities seize his drugs and arrest him. Sometimes he even goes to jail for a while.

“But there are no job opportunities, so even if we are arrested, we’ll start selling the drugs again when we are released,” says Keai. “We are doing this to survive.”

The registrar of the Pharmacy Board of Sierra Leone, Wiltshire Johnson, tasked with regulating drugs in the country, says about half the drugs sold in Sierra Leonean pharmacies three years ago were fake or substandard. Now, Johnson estimates more than 95 percent of products from pharmacies tested by the board are real.

Johnson says Sierra Leone is left vulnerable, however, because while it has beefed up its monitoring and enforcement of the formal sector, the country imports all its pharmaceuticals – some 30 to 40 million dollars worth a year. A crackdown on formal imports has been largely successful.

“The people involved in the formal sector realise you can no longer bring bad drugs to Sierra Leone,” says Johnson. “Our big challenge is the informal sector, the illegal sector, the drug peddlers.”

Liberia and Guinea, which neighbour Sierra Leone, have virtually non-existent drug regulations. The borders between countries are porous, allowing traffickers to move supplies in with relative ease, and customs and border officials are poorly paid. It doesn’t take a large percentage of profits from a lucrative drug trade to convince someone to overlook a few cartons of packages of – supposedly – penicillin.

Johnson says the pharmacy board works with police and the judiciary to enforce the pharmacy act, but argues that tougher punitive measures are needed to deal with drug peddlers.

The current law tops the time in prison at two years and the fine at five million Leones, about 1,200 dollars.

But the actual punishments meted out are usually far lower – between 100,000 and 300,000 Leones, or 20 to 60 dollars – doing little to discourage the practice, says Johnson.

“It’s a mafia, they just pay the monies and go back to the street and sell,” he says. “Tougher penalties are the only way we can really change.”

The regulatory laws on pharmaceuticals are currently under review.

Umaru Kamara, a pharmacy technician at Connaught Hospital in Freetown, says many, if not most, of the drugs for sale on the streets are substandard or fake.

It’s a regular occurrence in the hospital for staff to notice that medication – which patients will buy outside for cheap prices instead of at the hospital pharmacy where drugs are sold on a cost-recovery basis – isn’t working. Investigations reveal that the drugs the patients bought aren’t what they should be.

The dangers of substandard and counterfeit drugs are many, says Kamara. For example, fake antibiotics lead to worsening infections and complications, while substandard antibiotics cause drug resistance.

“(Drug peddlers) either give the wrong dose, give the insufficient dose so it will have no effect, or give an overdose,” says Kamara. “They can kill thousands of people.”

While education campaigns seek to inform the public of the risks of fake or substandard drugs, poverty gets in the way. Drug peddlers often offer lower prices and will sell a single dose, rather than having to buy a course of treatment all at once.

“Drug peddling is directly poverty related,” says Johnson. “It’s a social issue of survival.”

From the peddlers on the street to the patients buying their products to the people smuggling cartons of weak amoxicillin through the jungle, crippling poverty – some 70 percent of Sierra Leoneans live on less than one dollar a day – means there are few other options.

In April of last year, Sierra Leone introduced free health care for pregnant and nursing women, and children under five, including free medicines, in a bid to improve one of the world’s highest rates of maternal mortality and infant death. The ambitious program has seen a huge rise in the number of women and children accessing treatment, but drug supply remains a challenge, driving many to the streets to find medicines even when they’re covered by the program.

“You can have all the doctors, all the free health care, but if you don’t have the medicines, people are still going to die,” says Johnson.

Excerpt:

By Wambi Michael
KAMPALA , Jun 15 2011 (IPS)

Just a week after a group of civil society organisations petitioned Uganda’s constitutional court demanding that the government’s non-provision of essential services for pregnant mothers was a violation of the right to life; Margaret Nabirye lost her baby in childbirth.

Rose Nakanjako, the chairperson of Mama Club, a group of women Living with HIV/AIDS said she did not receive proper antenatal care. Credit: Wambi Michael

“I was roughly handled but when I complained, they told me to stop crying saying no one goes to the maternity ward when they are young” she said.

Her husband, Benjamin Schaf a German national who had flown back to Uganda for the birth, said he was disappointed by the health care services at the hospital.

“Coming to hospital is to ensure life is safe but that is not the case in that hospital. We lost our baby because of negligence by the nurses on duty. The only time we got attention from this hospital is after the baby passed on,” Schaf said.

“I just hate the whole thing. I bought everything since the hospital did not have the needed items to facilitate delivery. Now someone tells me if I want a post-mortem I have to give the pathologist transport,” he added in anger.

For many Ugandan mothers, childbirth continues to be dangerous and even deadly – for both mother and child. Uganda is facing a maternal health crisis. Maternal mortality rates have remained high in the last 15 years, with no significant decline. Sixteen women die of pregnancy-related complications every day – an estimated 6,000 women each year.

A group of civil society organisations have now petitioned the Ugandan Constitutional Court demanding a declaration that government’s non-provision of essential services for pregnant mothers and their newborns violates the fundamental obligation of the country to uphold, protect and promote the right to life and health services.

The petitioners; who include women activist groups, health experts, people with living HIV, want the court to force government to compensate all Ugandan families of mothers and children who have died due to negligence and non-provision of basic maternal health care. They have not asked for a specific sum.

The petitioners have also demanded that government adequately equip maternity wards and health facilities with drugs and personnel in order to provide better services.

The petitioners are using the deaths of two mothers, Sylvia Nalubowa and Jennifer Anguko, who both died in childbirth to argue their case. Sylvia Nalubowa died while giving birth to twins in 2009 at a government hospital in central Uganda. Nalubowa was allegedly taken to theatre where there was no medical doctor to attend to her. One of the twins also died.

Geoffrey Kisiga (21), Nalubowa’s son, has joined the coalition for better maternal health. “I lost my mother due (to) negligence and I don’t want that to happen to other mothers. All we are telling our leaders is to allocate more money and staff in hospitals to stop deaths.”

Jennifer Anguko, a local politician in Uganda’s West Nile region, also died due to neglect at a regional referral hospital.

Rose Nakanjako, the chairperson of Mama Club, a group of women Living with HIV/AIDS in Uganda told IPS that she also did not receive proper antenatal care. “My first born is HIV positive because I delivered from home. I was always insulted whenever I went for antenatal (services) so I stopped going there,” she said.

Kaitiritimba Robinah, the executive director of Uganda National Health Consumers told IPS that many mothers prefer to deliver from home because of inadequate or poor services offered at government hospitals.

“I don’t think any mother can refuse to deliver from hospital if everything (is) there and free of charge. Most of the mothers refuse to go to hospital because nothing is there. And if medicine is there, it is to be paid for,” she said.

Such cases are commonplace in Uganda’s government hospitals said Lillian Mworeko, an activist with the International Community of Women Living With HIV/AIDS.

“Health is a right but in this country, you would wonder whether we have any right to health when we have 16 mothers dying per day due neglect by health workers and lack of essential maternal health needs in hospitals,” said Mworeko.

David Kabanda, the petitioners’ lawyer said he was confident that the court will order government to devise and implement, within its available resources, a programme to realise the rights of pregnant women and their newborn children to access health services.

Kabanda told IPS that the government of Uganda has an obligation to allocate funding in priority areas in the health sector.

Richard Nduhura, Uganda’s minister for health told IPS that there are few ambulances in communities to respond to needs of women who need to deliver in hospital.

“I agree that provision of maternal health services has been one of the biggest challenges to our health system. But I think we are addressing that in the next financial year with substantial amount of money allocated to maternal health,” he said.

Maria Kiwanuka, the finance minister in June removed value added tax on the importation of ambulances. She also allocated 24 billion Uganda shillings for maternal health for the coming financial year.

Joachim Saweka, the World Health Organization country representative was happy that the government was finally responding to the call for better funding of maternal health. “I’m very happy became key issues like health, particularly maternal health have in the past not been squarely addressed by government. At least with 24 billion shillings in the budget, maternal health will be addressed.”

Excerpt:

Three-year-old David bolts up from his feverish stooper as a needle pricks his thumb, producing a tiny bead of blood. He looks down horrified but is too exhausted to cry and falls back into his mother’s lap as the blood is wiped away

Juane K. Nabieu, a community health officer in the district's main Peripheral Health Unit. Credit: Meena Bhandari/IPS

Juane K. Nabieu, a community health officer in the district’s main Peripheral Health Unit (PHU) drops the specimen of blood onto a strip. Within seconds two fine lines appear and David’s mother Naomi Sam is told that her son has malaria.

Malaria is endemic in the country – it is one of the biggest killers of children. David is lucky. He is treated with the last batch of Artemisinin-based Combination Therapies (ACT) that Nabieu has just collected from the neighbouring district government drug storeroom.

But poor record keeping, wastage and theft may be responsible for the loss of a quarter of vital aid drugs that have gone missing, denying other children like three-year-old David the chance of survival.

The regular UNICEF stocktake found a preliminary figure of 25 percent of the aid was unaccounted for, UNICEF said in a statement on Jun. 14. The drugs are thought to include vital life-saving drugs like ACT.

A UNICEF representative said that the internal stock take began at the end of 2010, and has just been completed. It reviewed stocks from the rural health posts across the country in a bottom-up check of drugs.

It also follows reports from district hospitals across the country and PHUs about an ongoing shortage of ACT, vital in the treatment of malaria. At the Khailahun PHU there are only two more packets of ACT left – serving 156 PHUs. When the remaining doses run out, Nabieu, will refer his patients to the government district hospital.

“Most of the people who come here will not be able to afford the ACT sold privately – they rely on the free drugs,” he says sitting behind a desk with an array of medicine bottles all lined up in front of him. “You can see we have many drugs, but the supply of fast moving essential ones like ACT always arrives in spurts – every month there is a shortage, and every month there will be people who suffer because of it.”

Sierra Leone’s government took a massive step when it announced last April that health care for children under five and pregnant women would be free. The Free Health Care Initiative is 90 percent funded by international donors like the UK’s Department for International Trade and Development, the African Development Bank, UNFPA and 10 percent is funded by the government of Sierra Leone.

In Khailahun district, drugs that were given as aid by the Global Fund and UNICEF are reported to be found in private drugs shops and sold by street market traders.

“We have patients who come from neighbouring Liberia, which puts a strain on our resources, but the drugs in the local market may also be drugs that have come from Liberia or Guinea – the aid that comes into West Africa is generic and that makes it easy to sell anywhere,” Nabieu explains.

On the other side of Khailahun town, at the district hospital, things are no better. In the paediatric ward, tightly packed with mothers and babies all eerily quiet, nurse Alice Mansaray has a stack of paperwork and a new baby with complications from malaria to admit.

“Most children come to us with severe anaemia or convulsions – sometimes their mothers suppress their child’s fever with paracetamol, when there are no free stocks of ACT in their PHUs, and they can’t afford the private drugs.

“When I run out of ACTs I send them to a private drug store. They have to go because they can’t see their children die. We have seen more cases of malaria and more children with complications,” she says as she holds up a strip of ACT.

Though the government’s hospital monitors say malaria cases have decreased compared to last year in Khailahun, there is no record kept of how many patients come back with complications. There is also no record of those who were entitled to free drugs, or who had to purchase them from the private sector because of the shortage of aid.

The civil society organisation, Health for All Coalition (HFAC), implemented a monitoring system, parallel to the government’s. Alhassan Kamara at HFAC estimates that 45 to 50 percent of the aid that comes in disappears finding its way to the market – though no survey has been conducted to substantiate this.

“Our monitors travel in drug delivery trucks. We insist community and district hospital representatives receive the consignment.” This has reduced the “leakages” Kamara calls the thefts. “Transportation from district to the PHU needs to be strengthened. There is less transparency, and scope to sell on route.”

This is not the first time such irregularities have been discovered in Sierra Leone. In 2008 a BBC report discovered UNICEF’s malaria drugs in Kono (Eastern Province) were being re-sold in private pharmacies.

“If there was such mass pilfering, the system would collapse,” says Dr Amara Jambai, director of Disease Prevention and Control at the ministry of health and sanitation. “The community are very active and watch supplies very closely.”

Jambai admits that the capacity of the government is too weak to deliver the drugs to each PHU. “The cause of the shortage is not because there are thefts, but because demand is great, and the system is new.”

The district hospitals in Khailahun, Pujehan in the South, and Bo in Central Sierra Leone, say that when they have approached Freetown for ACT, they still have supply issues. Pujehan hospital said they had not received a delivery since February – though they had a small supply remaining of ACT, other essentials like antibiotics and paracetamol had long been unavailable.

Mahimbo Mdoe, UNICEF country representative says that UNICEF is due to take over the operation to run the logistics of the distribution of Free Health care drugs and supplies themselves. “We are in the process of hiring transport companies who will be responsible for the distribution of drugs and supplies from the District Medical Stores to the peripheral health units.”

“A year ago 80 percent of people didn’t go to the doctors because of the cost. Sierra Leone is a fragile state. The numbers of people accessing the aid for the first time is an important step forward,” Mdoe said.

Meanwhile, Naomi Sam says that she could not have gone to the private drug store to buy the ACT that has just saved David’s life if it were unavailable, because “I have no money,” she says simply. She knows that coming to the PHU means that David will get free treatment. But, the 20 or so women with sick babies waiting outside may not be so lucky today.

(*The story contained a number of errors. The original story stated that vital aid drugs have gone missing from the central government warehouse, they had in fact gone missing between districts and PHUs. Also, the Free Health Care Initiative is not funded by UNICEF but by international donors which operate through UNICEF and other United Nations agencies. UNICEF will be taking over the operation to run the logistics of the distribution of Free Health care drugs and supplies themselves and will not manage the central warehouse.)

By Joshua Kyalimpa and Terna Gyuse
KAMPALA, Jun 14 2011 (IPS)

GAVI, the Global Alliance for Vaccinations and Immunisation, secured pledges of 4.3 billion dollars from donors in London on Jun. 13 with the aim of securing funding to ensure life-saving vaccinations for every child on the planet.

As many as two million children – overwhelmingly in low-income countries – die each year from diseases which could be prevented by vaccinations such as pneumonia and diarrhoea. GAVI’s programmes have already immunised well over a quarter million children in the past 10 years, and if the pledges from the London conference are honoured, the money will allow the alliance to reach a further 243 million by 2015.

Entering an age of immunisation

Thanks in large part to GAVI, the past decade has seen renewed attention to developing vaccines against diseases affecting the world’s poorest, including meningitis, pneumococcal disease and malaria.

Among the organisations whose investments have supported a breakthrough in prevention of one of the world’s most dangerous diseases is the Malaria Vaccine Initiative (MVI), a global programme of the independent non-governmental organisation PATH.

Malaria vaccines are a long-overdue means to prevent infection and work towards eradication of the disease. The eradication of malaria in the developed world has been cited as one reason developing a vaccine previously received little attention from pharmaceutical companies or government research facilities.

The debut of a first vaccine against malaria, for example, could now be less than five years away – final testing is under way in seven countries.

Yet developing an effective vaccine is only part of the challenge – effectively integrating it into public health will require careful planning and execution.

The recent history of Africa’s immunisation programmes – from the re-emergence of polio in West and Central Africa, to the persistence of meningitis and infant pneumonia – is littered with promising solutions that have failed to have the expected impact. Against a background of poverty and conflict, vaccination campaigns have been hampered by weak infrastructure, insufficient staff or funding, and even popular resistance to vaccinations.

Across the continent, there is new attention to the practical requirements of effective immunisation campaigns. Dr Seraphine Adibaku, head of Uganda’s malaria control programme, says his country has already started raising popular awareness of the coming availability of a malaria vaccine, with the most recent meeting of officials from the ministry of health and developers of the vaccine and other stake holders held in May.

“We are conscious not to cause excitement because it can lead to undesirable consequences but we have to tell the people that a vaccine could be here sooner than later,” says Adibaku.

Uganda is banking on using infrastructure like ware houses and refrigerators from the Uganda National Expanded Program on Immunisation, which is already in place and has been used on previous immunisation programmes, to roll out the malaria vaccine. Adibaku says training will be given to vaccinators on handling the new vaccine with funding from GAVI, all of which shall be in line with the national vaccination policy.

Adibaku has questions about the vaccine: “We do not know yet for how long the vaccine will offer protection. Do you get protection for six months, one year, or for the rest of your life? These are some on the questions not answered yet.”

He says for a vaccine to be effective, it should offer a high level of protection – between 80 and 90 percent – provide long-lasting resistance, and be affordable.

New resolve to get it right

The London conference on funding for vaccines is an important signal that the value of immunisation programmes is understood by both donors and governments seeking assistance.

“When GAVI got started, it was something that had never been tried before,” says Dr Helen Saxenian, from the Results for Development Institute.

“The idea was that prices would fall (once large-scale demand for vaccines was created) and so some countries would be able to afford them without assistance. GAVI quickly realised prices were not – and are not – falling fast enough, and realised the alliance would need to be involved with subsidising vaccines for a longer period of time.”

The reasons vaccine prices have not fallen include the cost and complexity of producing newer vaccines, as well as limited competition between a very small number of producers; but Saxenian points out that there have been some successes, notably for the rotavirus and pentavalent vaccines.

In 2008, GAVI introduced a requirement for recipients of assistance to co-finance the procurement of vaccines. The Results for Development Institute recently evaluated GAVI’s policy on co-payment, to assess the ability of countries receiving assistance to cover their share of the costs.

“The finding,” says Saxenian, “is that low-income countries will not be able to pay the full cost of vaccines any time soon. However co-payments (from national budgets) at 20 cents per dose would be affordable for almost all countries.”

Shared responsibility maximising impact

She argues that the co-financing requirement has been a valuable learning process for all involved. It has strengthened forward planning by national health ministries, communication between health ministries and finance ministers who must make appropriate and timely allocations from national budgets, and between various countries and the UNICEF Supply Division, through which all of Africa’s GAVI aid recipients purchase vaccines to meet their obligations.

Aid recipients have said that they prefer to contribute part of the cost of paying for vaccines, says Saxenian. “Immunisation managers would like to see national budgets for vaccinations grow. It’s a key priority for healthcare, and since one can’t assume that donor assistance will last forever, they would like to see national budgets for it grow,” she told IPS over the phone from the United States.

“A basic way of thinking about this is that if something is completely free, there’s not as much of a sense of ownership as when you’re paying for even part of it. When it’s free, then countries may think, I’ll take it, whether they’re ready or not to adopt it.”

Adibaku says that when one considers the cost of Malaria to the national economy, Uganda should be able to contribute to the vaccination programme but if it is within the range of what they have been spending on the disease

Alongside the pledges from public and private donors to support immunisation, developing countries also renewed their commitments to co-financing in London, with GAVI estimating their contribution will reach 100 million dollars a year by 2015.

Developing countries could be required to make substantial contributions towards a malaria vaccine but this could be a worthwhile investment considering the amount of money the economy looses because of their illness.

Excerpt:

By Isaiah Esipisu
NAIROBI, May 19 2011 (IPS)

On the streets of Nairobi James Odhiambo goes from one pharmacy to the next in search of anti-malarial drugs marked with the Global Fund’s logo of a green leaf. He is looking for this specific brand because he understands that it is more than ten times cheaper than the same drug produced by different manufacturers.

The drugs subsidised through the Affordable Medicines Facility - malaria. Credit: Isaiah Esipisu/IPS

“My brother was yesterday evening diagnosed with malaria at a private clinic in Dandora suburb upon his arrival from a two week holiday in the Lakeside City of Kisumu. That is why I have come to town to search for drugs,” says Odhiambo holding a prescription from the Samaritan Health Clinic – where his brother was diagnosed.

However, Odhiambo says his brother could not buy anti-malarial drugs from the clinic where he was tested because the available drugs were expensive costing 400 Kenyan Shillings (KES) (five dollars). This is the average price of anti-malaria drugs in Kenya.

“We have always seen these subsidised drugs being advertised all over in the media. We were not going to waste the entire 400 KES – equivalent to two days wages – on a similar dose,” said Odhiambo, who works as a casual labourer in the city.

The drugs Odhiambo is referring to are subsidised through the Affordable Medicines Facility – malaria (AMFm). All drugs manufactured under the scheme have the logo of a green leaf. It is managed by the Global Fund with support from the United Nations, the UK Department for International Development and related donors.

Kenya was one of the very first countries in Africa to implement the scheme in August 2010, where a dose for an adult was supposed to retail at 40 KES or 50 cents, and a dose for children under the age of five would cost 10 KES.

However, many pharmacies across the country took advantage of the subsidy to maximise profits. “Two months ago, we requested our reporters from different parts of the country, including rural areas, to check on retailing prices of the subsidised anti-malarial drugs. As a result, we discovered that pharmacists sold them at varying prices ranging from 80 KES (one dollar), to 240 KES (three dollars),” says Gatonye Gathura, the chief science reporter at the Nation Media Group in Kenya.

A pharmacist at a private pharmacy in Buruburu Estates in Nairobi told IPS that she had to inflate the price simply because if she sold the drugs at the recommended retail price, it would not make any economic sense to her – considering her costs of transporting it from the distributors, and other inputs.

According to Harley’s Ltd, the distributor of one of the brands recommended for subsidy, a dose for an adult should be sold to retailers for 26 KES (over 25 cents) to be sold to consumers at the recommended price of 40 KES (50 cents).

But like many other pharmacists, Linda Atieno’s pharmacy did not stock the subsidised drugs. “If I sold a dose of unsubsidised Coartem drugs for example, I make a profit of up to 200 KES (over two dollars). This compares poorly with the profit I would make from a dose of the subsidised version of Coartem – which is 14 KES,” she says.

In order to reduce instances where pharmacists are inflating the cost of the subsidised drugs, the Kenyan government has embarked on awareness campaigns through the media to inform Kenyans of the availability of the drugs, and the recommended prices per dose.

According to Dr John Logedi, the deputy program manager at the Division of Malaria Control, the awareness campaign will help consumers make an informed choice and enable them to seek outlets that sell the drugs at the right price.

Technically, the government of Kenya does not have control over drugs sold in pharmacies in the private sector because the pharmaceutical market in the country is based on ‘a willing seller, willing buyer’ concept.

So far, the subsidised drugs in Kenya are distributed through both the public and the private sector.

However, despite difficulties in searching for pharmacies that stock the subsidised drugs and sells them at the correct prices, Odhiambo admits that the subsidy program is a great relief to many people with a meagre income like his. “Most of us cannot afford the unsubsidised drugs that cost up to 600 KES (over seven dollars). The subsidy is therefore good news to most of us,” he said.

In marginalised rural areas such as Turkana, private pharmacies are yet to begin stocking the subsidised drugs, despite the launch of the program several months ago. “We have the subsidised drugs in public health centres within Turkana Central. But not in private pharmacies,” said Dr Gilchrist Lokoel, the Turkana Central Medical Officer of Health at the Lodwar District Hospital.

Phase one of AMFm is already under implementation in nine pilots in eight countries. They include Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (mainland and Zanzibar) and Uganda.

Excerpt:

By IPS Correspondents
KINSHASA, May 18 2011 (IPS)

More than 3,000 cases of measles have been recorded in the past three months in two districts of Maniema Province, in the eastern part of the Democratic Republic of Congo.

Provincial statistics seen by IPS for the districts of Kibombo and Kindu, show that since mid-April, a measles epidemic has caused more than 15 deaths at health facilities, and three or four times as many have died at home, in cases where families did not take stricken children to medical centres.

“The villages further upstream along the Congo River are the worst affected by measles,” says Dr Théo Katako, interim head of the Provincial Inspectorate of the Ministry of Public Health. “Meanwhile, the province was only able to organise a vaccination campaign against polio, for lack of resources to take on these two epidemics at once.”

“The total number dying of measles at home in April, could have been more than 60; for lack of a way for these families to bring these patients to the hospital because of the distance to health facilities,” says Germain Musombo, a member of civil society in Maniema.

“The fear is even greater because the measles vaccination campaign, planned for last week, did not take place for reasons no one has explained,” says Julie Bibi Bin Kito, a small trader and mother of a six-year-old who died of measles last week. “We who don’t have money would have benefited from these vaccinations to protect the lives of our children.”

She told IPS it would take more than four hours to walk to the nearest hospital to her home. She has no access to a car, and that hospital requires patients to pay to open a medical file before they can receive care. Neither she nor her husband had any money on the evening their child died.

Dying of poverty

“The question of poverty is critical throughout the province of Maniema,” says Musombo. “A large majority of the population lives on rice and cassava leaves grown in small gardens near the family home. There is also the fact that the province is landlocked and doesn’t benefit from commerce with the rest of the country.”

The province is generally underdeveloped, with few people enjoying access to clean drinking water and just 52,000 of the provinces’ estimated population of two million having access to electricity.

“With the population living under these conditions, there is cause for concern,” says Martin Bila Omari, who is responsible for epidemiology at the provincial inspectorate of the health ministry.

“The provincial authorities have outlined a plan to end the epidemic and prevent new cases,” says Bila Omari, “which will cost 180,000 dollars. But there is an acute shortage of financial resources to carry it out. The modest provincial budget will not allow for an urgent response.”

For the moment, the authorities are trying to raise awareness. “Several weeks ago, the government launched and awareness campaign for the population, and families in particular, on the necessity of vaccinations for children between six and 59 months and urging them to bring children in from time to time for their routine vaccinations,” Dr Benoît Kebela Ilunga, director of the campaign against measles at the national health ministry, told IPS.

He said the government has also strengthened monitoring of new cases with a view to arresting the present outbreak of measles.

“Happily the province is benefiting from the support of UNICEF [the United Nations Children’s Fund] and other international humanitarian organisations like Médecins Sans Frontières – France,” says Bila Omari, adding that a measles vaccination campaign could be organised almost immediately as these partners already have the necessary vaccines in hand.

While the province of Maniema struggles with epidemics of measles and polio, non-governmental organisations warn of 80 cases of measles in the territory of Bukama, in Katanga province, in the southeast of the DRC.

Excerpt:

By Servaas van den Bosch
WINDHOEK, May 12 2011 (IPS)

A new film explores the real complexities of relationships for young people in Namibia, and the effects of gender inequality and culture on the choices people make about their sexual lives.

"Sex and Chocolate" delivers messages about sexual health in the context of real pressures on young people. Credit: Rachel Coomer/LAC/IPS

The plot of “Sex and Chocolate”, a movie produced by the Legal Assistance Centre (LAC) and youth organisation Ombetja Yehinga Organisation (OYO), aims to capture the intricacies of young people’s sexual networks.

“Relationships in the 21st century are not easy, they are complex,” the LAC’s Yolandi Engelbrecht told an audience of 75 or so University of Namibia students at the launch of the movie on May 11. “The choices we make in our relationships have consequences. What if you are just a 21-year old student faced with Lucy’s problem? Do you have the courage to walk away?”

The dilemmas faced by the protagonists in Sex and Chocolate are very real. The impact of risky behaviour, including multiple concurrent partners and failure to use condoms, is reflected in the 2010 Sentinel Survey finding that HIV is again on the increase in Namibia, after years of steady decline. The country’s prevalence rate is now 18.8 percent, up from 17.8 percent in 2008.

HIV is not the only risk. Last year alone, 1,493 high school learners dropped out of school because of pregnancy.

“The story in the film is something that happens in everyday life. Girls love someone, who doesn’t love them back and they give up everything,” says El-Juanita Philander who plays Lucy. “It is important that young people make the right decision. There are always two choices in life.”

While a lot of effort has gone into raising awareness around HIV and AIDS in Namibia and elsewhere, NGOs are realising they haven’t penetrated the core of the issue.

“We talk a lot about HIV/AIDS, but we find it difficult to talk about the dynamics in relationships,” says the movie’s director, Philippe Talavera, who also runs the youth organisation, OYO.

“Often we focus on issues like HIV or sexual violence. We don’t ask the question what is the essence of a relationship, what is the point of being together?” adds producer Dianne Hubbard, head of the LAC’s Gender Research and Advocacy Project.

Namibian women frequently accept cheating by their male partners, and feel unable to insist on condom use in order to preserve their relationships says Hubbard.

“Particularly women still need to learn that they don’t have value just as the partner of a guy. We want to fight against that idea. A relationship should be a place where two people that are comfortable with themselves meet because they want to be together.”

Examining gender roles

The film tries to deconstruct prevailing ideas on masculinity in Namibian society by juxtaposing the attitudes of David and his best friend Peter.

“There is this idea that a man must be a player, but Peter who is faithful to his girlfriend Candy is a very masculine type. With this, we want challenge the myths surrounding masculinity,” says Talavera.

“The story is also about communication. Lucy envies the bond that Peter and Candy have, which is about more than sex. She would like to have a relationship like that with David, but she never tells him, she doesn’t communicate.”

“You bring me chocolate,” murmurs Lucy to herself at one point in the film. “Why can’t our relationship be about more than sex and chocolate? Why can’t you make me happy, David?”

Rather than trying to drive home message of safer sex, the film focuses on the underlying dynamics of peer pressure, friendship, support networks, assertiveness and the right priorities.

The film drew mixed reactions – roughly along gender lines – at its premiere. While the men in the audience sometimes sympathised with the player David, the women applauded Lucy for choosing to leave him.

“So many of the issues this society is faced with boil down to a lack of gender equality and mutual respect,” explains Hubbard. “It gets boring to talk about domestic violence: let’s talk the underlying issue, the relationship. We also feel that drama is much better way to convey the message.”

According to Hubbard and Talavera, the gap between knowledge about HIV and actual behavioral change remains huge in Namibia.

“And we are not getting any closer to closing that gap,” says Hubbard. “If an educated guy like David, with access to free condoms, doesn’t use them, we have to ask ourselves what is the next step [in stopping HIV]?

“So the film is about more than just deciding whether or not to date a particular guy. It’s about how social norms and culture can affect the decisions we make. Can a young girl who is socialised to be submissive find the assertiveness to say no in a relationship? Are informal sexual networks the new polygamy in Namibia?”

These are questions the cast struggled with while making the movie. The actor who plays David, for example,is Himba, a culture in which polygamy is widespread. He might personally support Lucy’s right to walk away from the relationship, but his cultural background says something else.

“It led to a lot of discussion on these practices. And it’s a real issue in society. Young men ask themselves, ‘If my father had four wives, why should I satisfy myself with one?” says Hubbard.

“It is an interesting issue that is still debated heavily in society, all the way up to parliament.”

The movie has two endings. In the first, Lucy leaves David before any harm is done. In the other – shot in  sombre black and white – she stays with him and grows increasingly depressed, fails her final exams and worries constantly about her health status.

Sex and Chocolate is part of a package called Think Twice. The second movie Teddy Bear Love, which deals with relationship issue in a high school will be released in June.

Excerpt:

By IPS Correspondents
ISTANBUL, May 11 2011 (IPS)

“Women in LDCs bear the brunt of economic and social hardships,” said Wubitu Hailu, managing director of an Ethiopian NGO, the Kulich Youth Reproductive Health and Development Organisation. The failure to provide access to basic services like clean water and electricity is a major factor preventing women from realising their full potential.

Indigenous women hauling water in Chiapas, Mexico. Credit: Mauricio Ramos/IPS

She said a cycle of poverty continues to be perpetrated because of this. “These chores are hampering the social and economic development of women around the world and especially in the LDCs.”

Hailu said access to water and energy should be basic human rights. She said these services are currently being denied to the people of LDCs.

Up to 2.5 billion people worldwide find basic daily tasks like lighting their homes, cooking a meal or heating water a challenge, according to delegates to the civil society forum at the Fourth United Nations Conference on the Least Developed Countries (LDC-IV) currently taking place in Istanbul, Turkey.

A supply of clean water must be guaranteed for everyone and not conditioned on the ability to pay, according to Maria Lourdes Tabios Nuera, a campaigner for Jubilee South-Asia/Pacific Movement on Debt and Development.

“Water sources must be shared equitably by all and need to be protected and managed properly, democratically and sustainably. Control over water resources and services must be in the public domain and should not be privatised,” said Nuera.

In the last two decades, there has been a vigorous movement to privatise water, with a few global water corporations dominating control of water resources and services.

But Nuera said privatisation has led to reduced access for marginalised and impoverished communities and the violation of the human right to water.

“We are fighting for the transformation of states and the establishment of democratic governments so that they become true instruments of people power. These are vital requirements towards sustainable and democratic management of water resources and services.”

She called on governments worldwide to address water injustices and oppose policies that take advantage of water crises to justify and push for privatization and turning water into a commodity.

“We are demanding that the U.N. declaration on the right to water should be incorporated into national legislation,” said Nuera.

The demand for electricity is also urgent. The LDC conference should affirm people’s right to energy that is adequate, reliable, affordable, safe, clean and sustainable, according to Nuera.

“We are calling for the restructuring of ownership of resources, of production, of consumption and towards the transformation of the global economic and financial system,” she said. “This is in recognition that this is the only strategic solution to ensure that the power industry is managed well, is shared equitably and democratically.”

Uma Chowdhury Director of Sushasoner Jonny Procharavizan, a local NGO for good governance in Bangladesh told IPS that electrification has significant positive impacts on households’ income expenditure and educational outcomes.

“The gain in total income due to electrification can be as much as 30 percent,” Chowdhury said.

She worried that energy scarcity is one of the main reasons for poverty and accompanied environmental hazards in Bangladesh and other LDCs.

More than 8,000 people – representatives of governments, international agencies, development partners and civil society – are attending LDC-IV. They are expected to produce a plan to lessen the burden of poverty, hunger and disease on the world’s most vulnerable people by May 13.

The representatives for the women are hoping to see issues of water and energy access included in the Istanbul plan of action.

Excerpt:

By Miriam Gathigah
NAIROBI, May 9 2011 (IPS)

Sub-Saharan African countries have claimed nine of the ten bottom places in a ranking of maternal health around the world. “The Mothers’ Index”, a new survey of motherhood by Save the Children, analyses health, education and economic conditions for women and children in 164 countries.

Motorcycle ambulance in South Sudan - distance to a healthcare facility and a shortage of trained personnel are key factors in maternal deaths. Credit: Peter Martell/IRIN

Contributing factors

Some 250,000 maternal deaths occur in Africa each year. There are several factors that make childbirth in Africa so dangerous. Millions of early marriages and teenage pregnancies mean riskier births to young women whose bodies have not developed to fully stand the rigors of childbirth.

Africa’s health systems are inadequate to serve the needs of pregnant women, a majority of whom give birth without a skilled health worker present.

Across the continent, particularly in rural areas, a hospital or clinic with a trained midwife or doctor and facilities to deal with complications is often far away. The lack of good roads and transport – and the cost of transport – means a pregnant woman in trouble is unlikely to reach help in time.

Cost is also a factor for women and their families – even at highly subsidised public hospitals, the cost of giving birth can be beyond the reach of a woman living on a dollar or two a day. Many decide to give birth unaided at home, or with the help of an untrained attendant whose more modest fee can be paid in kind, with farm produce for example.

“Due to various factors such as poor infrastructure, most women deliver at home with no professional assistance and this leads to fatalities in many instances, because in case of a complication such as excessive bleeding, the woman will die,” says Ousmane Hadari, a reproductive health consultant in Niger.

In Niger, cultural factors also lead many women to choose to give birth at home, regardless of the risk. “The trend has been that many women will attend the antenatal clinic – in fact, the percentages of pregnant women attending clinic has gone up in many countries – but most of them prefer to deliver at home for various cultural reasons.”

Giving birth at home is seen as proof of a woman’s fearlessness in the face of pain, says Hadari, adding that women also prefer to give birth at home so that they can carry out a custom to bury the placenta soon after birth.

James says cultural factors are also at work in South Sudan. “For many women the thought of being delivered by a male health attendant is taboo.”

Birth attendants

But the shortage of skilled birth attendants is a key problem. James is one of roughly 2,000 TBAs registered by South Sudan’s Ministry of Health who form the wafer-thin support for births in a population of 10 million. These TBAs have no formal qualifications, but James points out that TBAs have vast experience with deliveries acquired over years of practice. Traditional attendants enjoy the confidence of women in the community, and she says there are efforts to integrate TBAs into the health system as a means of drawing more women to hospitals for delivery.

“We are registered because we are not working in an ideal situation. There is a serious shortage of well-qualified nurses and midwives: what other options are there besides us?” says James.

Traditional birth attendants remain indispensable in a country where, according the Directorate of Nursing and Midwifery, there are barely more a thousand nurses – and only 40 who hold a diploma indicating basic knowledge of midwifery.

The World Health Organization (WHO) recommends that a skilled attendant be present at every birth, but in South Sudan there are only 10 nurses for every 100,000 births and just four adequately qualified registered nurses for every million children born.

South Sudan’s Ministry of Health reports 2,037 maternal deaths for every 100,000 births. Hadari says Niger is not much better.

“The picture is not so different in Niger which has a staggering maternal mortality and morbidity rate particularly among the rural women and especially those with little or no education and consequently low or no income.”

Niger ranked 163 in the Safe Motherhood Index, with 1,800 deaths per 100,000 births. One in seven Nigerien women will die from a pregnancy-related complication.

Models of success

Initiatives to improve maternal health are under way all over the continent, in an effort to meet Millennium Development Goal commitments to reduce maternal mortality by three-quarters from 1990 levels. Many countries seem unlikely to meet that target by 2015, but there are some positive models.

According to a 2010 World Health Organization report, maternal mortality in Ghana has fallen by a quarter in the last decade, to 560 per 100,000 births. Ghana has achieved this by revamping training, now adding 500 new midwives each year. The government has also made efforts to post health professionals to the areas with the worst maternal health statistics.

Mozambique is another success story. Mozambique’s national health data shows maternal deaths fell from 1,000 deaths per 100,000 births in the 1990s, to 473 per 100,000 in 2007. This success has been built on the establishment of “waiting houses”, which permit at-risk pregnant women to move to a temporary home near a local hospital in order to facilitate quick access to skilled health care once labor begins.

As 2015 draws nearer, these and other measures will need to be adopted and adapted across the continent if MDG targets are to be met.

Although Sudan is faring poorly, the country may be moving in the right direction with the continued development of maternal care at the Juba Teaching Hospital, where an initiative to train more nurses and midwives is based.

Janet Michael of the South Sudan Ministry of Health says the emphasis is being placed on the “need for trained birth attendants, high contraceptive prevalence, improved infrastructure to enhance access for women in need of various
institution based services and a budget that can sustain these initiatives.”

Excerpt:

By Erna Curry
CAPE TOWN, May 3 2011 (IPS)

Every minute, somewhere in the world, a child goes blind according to the World Health Organization. Three in five poor children who go blind are likely to die within two years of losing their sight – yet half of cases of childhood blindness are avoidable.

Blessjah Adegoke had cataracts removed at an ORBIS clinic in Ilorin, southwest Nigeria. Credit: Clare Louise Thomas/Image Incubator

“In the East African countries of Kenya and Uganda, as well as Zambia for example, the commonest cause of childhood blindness is cataracts,” says Dr Daniel Etya’ale, executive director for Africa for the International Agency for the Prevention of Blindness’s (IAPB) and a member of the Africa Initiative Steering Committee of ORBIS, a non-profit organisation committed to saving sight worldwide.

It has worked in 88 countries since its inception in 1982, including establishing 28 paediatric eye care clinics in India since 2007.

Blind children in sub-Saharan Africa face three major challenges: “Firstly, many are not being reached early enough for successful intervention; secondly these children are extremely vulnerable – about half are likely to die within two to three years of becoming blind; thirdly there is very little infrastructure and specialised medical help available to them.”

Etya’ale says the high mortality rate of blind children may be linked to the medical conditions that cause their blindness. Xerophtalmia, for example, is caused by a vitamin A deficiency which is also associated with diminished ability to fight infections.

WHO recommends one paediatric ophthalmic centre per ten million people. But sub-Saharan Africa has far fewer. South Africa only has one such centre – at the Red Cross Children’s Hospital in Cape Town; only 11 other countries can boast any facilities for children’s eye care.

Professor Colin Cook, Head of Opthamology at the University of Cape Town and the Red Cross Hospital, says prevention measures for childhood blindness vary in different regions, sometimes requiring surgery, sometimes children need glasses, or even community and primary health interventions such as immunisation and improved nutrition.

Congenital cataracts have been linked to the childhood disease rubella in a significant percentage of cases of cataracts in children in South Africa, Zambia and Kenya; in response, immunisation programmes have been stepped up to ensure girls are vaccinated against the disease before reaching childbearing age. Vaccinations serve both to avoid loss of eyesight and to minimise other risks rubella poses to developing fetuses, like deafness and cardiac malformation.

Early detection and correction of problems with children’s vision calls for a more inclusive and holistic system to check eye health at community, district, provincial levels; for example training community health groups to do simple eye tests.

“Whenever they see evidence of a cataract, they can immediately send the child for a proper assessment which can be the difference between a life of misery, or even premature death, and a full life,” says Etya’ale.

ORBIS uses flagship tools such as its Flying Eye Hospital, a mobile ophthalmic training hospital aboard a DC-10 airplane, and Cyber-Sight, an online telemedicine mentoring and teaching resource. It relies on 450 expert medical volunteers to bring eye care and training to partners in developing countries – more than 12 million people have received care and 260,000 health care professionals have benefited from training.

Dr Hunter Cherwek is the Medical Director of the Flying Eye Hospital and agrees that early screening is essential, with children examined annually as part of a routine paediatric checkup. “School screenings are important, but a lot of places we go to, there is no mechanism to screen vision, even for glasses. Nothing is in place.”

Orbis is hosting 58 delegates from 15 countries at a two-day conference in Cape Town on May 4 and 5. Lene Øverland, Director of Programmes for ORBIS in Europe, the Middle East and Africa said, “All these people have an interest to provide eyecare services on a very high level to children on a primary and tertiary level. We want to define a plan of how to work together in the next five years on a comprehensive model to address childhood avoidable blindness in line with Global Vision Goals by 2020.”

“Blindness and poverty create a very vicious cycle,” said Cherwek. “It’s like a double hit, and it’s almost impossible for someone to overcome both as a child. Vision restoration and visual rehabilitation help break that cycle for quality of life, and for financial repercussions.”

Excerpt:

By Mantoe Phakathi
MBABANE, Apr 6 2011 (IPS)

The fight against tuberculosis in Swaziland will be reinforced on two fronts this month. A new tool for the quick and accurate diagnosis of TB will begin its roll out and a monthly stipend for treatment supporters will help ensure patients get through the lengthy and unpleasant course of TB drugs.

Treatment supporter Zodwa Mhlabane talks to a patient. Credit: Mantoe Phakathi/IPS

TB is the leading cause of mortality in the country. It is also one of the primary opportunistic diseases that aggravates the AIDS pandemic.

“Government has received a 40 million dollar grant from the Global Fund to help intensify the response against TB now that the disease is declared a national emergency,” said National TB Programme manager Themba Dlamini.

The financial support from the Global Fund against AIDS, TB and Malaria will be used to implement a newly-developed multi-drug resistant-TB test which returns a result within two hours.

Better testing

One of the factors that drives the spread of TB is the many undiagnosed cases. A TB test result can be returned in a day, but it presently takes up to two months to get results for drug-resistant TB.

People are at their most infectious while they are not on a course of treatment; the long delay between a TB test and a result often results in poor follow-up with patients to begin anti-TB drugs, leaving them to pass on the disease – which is readily transmitted when an infected person coughs, sneezes, talks or spits.
 
The new test, which the World Health Organisation announced in March, will not only assist with swift detection, it will help the Swazi government in its effort to decentralise TB services throughout the country.

“The new MDR-TB test called Gene Xpert test will also be used at clinics because it doesn’t have a lot of bio safety requirements,” he said. “It is also very reliable when used correctly.”

Currently, the TB case detection rate in the country is 88 percent while WHO sets a target of 100 percent. The TB treatment success rate at the moment stands at 68 percent against the 85 percent requirement by the world health body.

Presently, only 32 out of the country’s 182 health facilities – 17 hospitals and health centres and 162 clinics – have the capacity to diagnose and initiate TB treatment.

“Before the end of the year, government will have accredited 31 more clinics to diagnose and initiate TB treatment,” said Dlamini.

The new test is also cheaper than the current test: it will cost 16 dollars per patient versus 58 dollars for the present laboratory test.

“It is hoped that Gene Xpert test and other technological developments that are in the pipeline offer a renewed hope for transforming the fight against TB from control towards elimination,” said WHO country representative Dr Owen Kaluwa.

Better treatment

The Global Fund money will also be used to support community counsellors like Albertina Nyatsi.

Nyatsi, along with about 40 other community health motivators WHO volunteer to support and monitor TB patients taking medication, faces a challenging task.

People dislike taking the medication because of the side effects including nausea, fatigue, swollen feet, blindness and some patienst suffer mental problems. Health motivators have to visit drug-resistant TB patients twice a day to observe them taking their medicine. She often has to travel long distances at her own cost to visit patients.

“Most patients take their medication in the evening and it’s dangerous for us to walk back home,” said Nyatsi. “I need money for transport.”

Treatment supporters are often as poor as the people they serve, and Nyatsi confides that with no income every month, she cannot even afford an umbrella to protect herself when she must make her rounds in the rain.

But if she misses her appointments, it can be serious, she says. “It’s very critical that a treatment supporter observes the patient while they take drugs daily because the medication is very irritating and sick people often stop taking it if there is no one to encourage them.”

While the National TB Programme assigns family members to support their relatives suffering from TB, dedicated people are needed when it comes to drug resistant TB which has become a serious concern in the country.

“We have to control the spread of MDR-TB by all means because this is a very complicated TB strain which is very difficult and expensive to diagnose and treat,” said Dlamini.

While it takes six months to treat normal TB, MDR-TB can only be successfully be cured after a period of 24 months.

The government will now have the resources to ensure that treatment supporters receive a stipend of 60 dollars each month. Dlamini said government wants to ensure that every MDR-TB patient has a trained community health motivator to see them through.

“We’re going to start with MDR patients because supporting them tends to be labour intensive given that they take medication twice a day,” said Dlamini.

Excerpt:

On Apr. 5, the United Nations Children’s Fund will launch a report on teenage pregnancy in Sierra Leone. Teenage pregnancies account for 40 percent of maternal deaths in the country, and the report comes as public health authorities recalibrate strategy to address a problem that endangers both mothers and children.

This young woman from Makeni dropped out of school when she had her first child at 16. Credit: Anna Jeffreys/IRIN

Seventy percent of teenage girls in Sierra Leone are married, according to a 2008 survey by the World Health Organization, in a country where early marriage is supported by traditional practice.

The United Nations Children’s Fund’s (UNICEF) report, “A Glimpse Into the World of Teenage Pregnancy in Sierra Leone”, states that “such importance is given to girls marrying as virgins that the age of marriage often coincides with the first occurrence of female menstruation”.

Drawing on research conducted in four regions, UNICEF’s report finds the typical consequences of teen pregnancy are social stigma, unstable marriages, poverty and the end of a girl’s education. UNICEF cautions that comprehensive evidence-based data on the phenomenon is still limited, but the issue has become a focus of concern for educators, doctors, politicians and parents alike.

Poverty and stigma

Kadiatu – not her real name – lives in Kissy Mess Mess, in the eastern part of the capital, Freetown, with her three children. Now 27, she recalls how she became pregnant with her first child.

“We were a poor family and I was really in want for virtually everything, from food, clothing, to even paying school charges… so I got this man that was ready to provide all of these, so i yielded to him,” she told IPS.

Her boyfriend was 30; she was just 15 at the time, preparing to take her Basic School Certificate Examination. She was taken to the doctor with what was suspected to be appendicitis – it turned out that she was three months pregnant.

“I told my boyfriend immediately,” Kadiatu recalls.

His reaction? “You have to get an abortion! Just get rid of it!”

“The man – who had been showering me with gifts and telling me all kinds of loving words – denied that he was responsible for the pregnancy,” Kadiatu recounts. She had the baby, but like many others in her position, she dropped out of school.

“I became pregnant again at 17 for almost the same reasons as the first pregnancy. Now I have three children, I am still a single mother and my only means of survival is to hawk fruits in the market and rely on favours from men who promise love,” she says, “but what they really want is to sleep with you and run away afterwards.”

In 2009, village chiefs in one northern province passed bylaws that require that when a schoolgirl falls pregnant, she and the father must both drop out of school. This scheme quickly drew criticism for only compounding the problem of stigma and a high dropout rate.

In Koinadugu District, also in the north, the Biriwa Youth Association for Development took the opposite tack, offering school-age girls between the ages of 12 and 16 the chance to win scholarships to attend university – if they passed regular examinations by a community nurse to “prove” they were virgins. This initiative too was quickly scrapped.

Stigma aggravates problems

In a draft report for the World Health Organisation, Dr Helenlouise Taylor noted that few teens have ante-natal checkups, instead trying to hide their pregnancy or try to abort. This makes early detection of potential problems in a high-risk group very difficult.

For her research, directed towards developing strategies to reduce Sierra Leone’s maternal mortality rate, Taylor visited 14 districts of the country, observing conditions, interviewing health workers and using a questionnaire to collect information about patterns and trends of maternal care as well as training and equipment in health facilities.

In the draft report’s recommendations for teenage pregnancy, Taylor says measures to reduce coerced sex and unsafe abortion and increase access to contraception for adolescents are all important, and makes several important suggestions regarding information and reducing social stigma to encourage young mothers to make use of available health care.

She urges a review of life skills and biology in the school curriculum, as well as tighter links between schools and antenatal clinics – possibly even offering antenatal care at schools. She also calls for appropriate training for health personnel and teachers to help both groups communicate accurate and effective information on sex and birth control to teens.

Maud Droogleever Fortuyn, child protection director for UNICEF in Sierra Leone, told IPS that bringing about changes in behaviour and attitudes will take time. She said UNICEF has been supporting local NGOs conducting baseline surveys to improve understanding of the extent and nature of teenage pregnancy, developing modules to improve knowledge, as well as working with traditional authorities to develop effective bylaws that will support teen mothers, especially with completing school.