Category Archives: News

South Africa, Which Once Led On Promoting LGBT Rights Abroad, Could Become A Roadblock

SA mandela LGBTI Ntsoaki NhlapoAdvocates fear South Africa might turn against an LGBT rights resolution at the UN that it sponsored three years ago.

South Africa was once the essential nation to advancing LGBTI rights in international diplomacy. Now it has become a potential roadblock.

Back in 2011, South Africa sponsored a resolution before the United Nations Human Rights Council (HRC) that, for the first time, recognized LGBTI rights as human rights. Other nations, especially from Latin America, had been working to advance LGBTI rights in less high-profile ways for several years before, but South Africa’s leadership was critical to taking the effort to the level of a formal resolution. Such a proposal had to have at least one prominent African backer, its supporters believed. Otherwise, it would play into the hands of LGBTI rights opponents in Africa and other parts of the world that had once been colonized who argue that homosexuality was a Western perversion brought by colonial powers.

An updated version of the resolution was tabled Thursday at a Human Rights Council meeting underway in Geneva. It was sponsored by Brazil, Colombia, Chile, and Uruguay. A vote is expected next week.

Not only is South Africa’s name not on it, but some LGBTI rights supporters tell BuzzFeed News that South Africa’s diplomats are behaving so strangely in negotiations that they worry the country could even turn against the resolution. A South African defection might not only help torpedo the proposal, it would also be a stunning symbolic reversal for a country that set the standard for protecting LGBTI rights. When South Africa adopted its first post-apartheid constitution in 1993, it became the world’s first nation to protect LGBTI rights in its fundamental rights declaration. This came out of a commitment to fighting a broad range of oppression, and it commanded even greater moral authority because it was rooted in the experience of fighting white supremacy.

So some LGBTI rights supporters are looking at South Africa’s reluctance to clearly support the new resolution as a fundamental betrayal.

“We currently have leadership that fails to represent the ethos of what the constitution says and the equality principles they have to uphold,” said Mmapeseka Steve Letsike, a lesbian activist who chairs the South African National AIDS Council’s Civil Society Forum. “We have leadership going out of this country putting their personal beliefs before its own people. We have leaders that fail to protect their own.”

South Africa’s pullback on LGBTI rights internationally comes as homophobia has become an increasingly common political tool across Africa, framed as a form of standing up to the West. Nigeria and Uganda both passed sweeping bills criminalizing LGBTI rights advocacy this winter, the governments of The Gambia and Chad both have pending proposals to stiffen laws against homosexuality, and LGBTI people are being targeted by police from Zimbabwe to Egypt to Senegal.

“Silence in the context of the African Bloc suggests a kind of complicity with the homophobic rhetoric,” said Graeme Reid, a South African who directs Human Rights Watch’s LGBT program. “It speaks of a kind of misplaced solidarity … not aligning with the [LGBTI] people who are the victims of human rights abuse, but with the perpetrators under the rhetoric of supporting our ‘African brothers and sisters.’”

LGBTI rights supporters were also hopeful that some smaller African countries could be persuaded to abstain on the vote — a kind of soft yes — and one or two might even be convinced to back it. This could tip the balance if the vote is close. The 2011 resolution was a nail-biter, passing 23-19 with three abstentions. But that becomes very hard if South Africa can’t counterbalance conservative continental heavyweights that might be lobbying the smaller countries.

“As soon as [South Africa] pulls back, it gives countries like Nigeria and Egypt room to bully and push the smaller countries,” said an LGBTI rights advocate from another southern African country who asked to speak anonymously in order to avoid a backlash in negotiations. “We need South Africa to maintain the same position if not better” than in 2011.

gay rights is humn rights

It’s hard to see why this resolution is so important by reading the plain language — all it really does is order a bi-annual study of LGBTI rights by the United Nations High Commissioner for Human Rights. But there are only a few places where language referring to LGBTI rights exists in any international agreements. This small resolution is a way of giving U.N. staff authority to work on LGBTI issues and means that it will be a regular focus of discussion in Geneva. And it will be a precedent that can be used to broaden the inclusion of LGBTI rights in other human rights agreements.

Most LGBTI rights supporters came into the negotiations that began last week assuming that South Africa would be supportive even if it no longer wanted its name on the resolution. Regional coalitions are very important in the U.N., and other major powers within the Africa bloc, especially Nigeria and Egypt, have been at the forefront of pushing anti-LGBTI policies. South Africa had taken a lot of heat for the 2011 resolution, and many LGBTI supporters might have understood if officials chose not to take a public role in support this year.

But they’ve withheld their support even in private discussions, say sources familiar with the negotiations. The head of South Africa’s Geneva delegation, Ambassador Abdul Samad Minty, took the unusual step of coming personally to an informal meeting on Wednesday, something usually left to staff. But he said virtually nothing in the meeting, said a source in the room, which showed other nations that South Africa isn’t about to go to bat for the proposal.

This posture follows a move by South Africa’s ruling African National Congress party to block a parliamentary motion to condemn anti-LGBTI legislation enacted by Uganda in February (which has since been struck down by the court). It also comes after a vote by South Africa during the June HRC session that stunned LGBTI rights supporters: South Africa joined with conservative nations on a procedural vote to exclude a sentence stating “various forms of the family exist” in an Egyptian-led resolution on the “Protection of the Family.” The resolution passed without this language, and LGBTI rights supporters were concerned that the language could be used as precedent for excluding families from protections under international law if they are not led by a heterosexual couple.

“In the room they’re being a little bit weird,” said a diplomat from a Western country working on the resolution, referring to South Africa’s behavior in the negotiations. But this isn’t entirely new. “They’ve been behaving weird for two or three years on this,” the diplomat said.

The diplomat attributed that more to a change in personnel than an intentional shift in policy: Jerry Matjila, who was South Africa’s ambassador to the Human Rights Council when work began on the 2011 resolution, has since returned to Pretoria to take a senior post in the Department of International Relations and Co-operation. His replacement, Ambassador Minty, lacks his personal commitment to the issue, say sources who have worked with the delegation.

South Africa’s Geneva mission and the Department of International Relations and Co-operation in Pretoria did not respond to requests for comment.

But some South African activists see this dilution of South Africa’s commitment to LGBTI rights internationally as part of a larger trend in the country’s leadership. The late Nelson Mandela and other leaders of the African National Congress embraced LGBTI rights as part of a commitment to fighting a broad range of oppression as they brought South Africa out of apartheid — Matjila is seen as part of that school. But that commitment is not as strong among the younger generation of leaders, most notably President Jacob Zuma, who called same-sex marriage “a disgrace to the nation and to God” around the time the unions won legal recognition in the country.

The shift doesn’t mean South Africa has done a 180 on LGBTI rights. Rather, it’s led to a kind of schizophrenia that is frustrating to LGBTI rights supporters. The lack of support for this resolution is all the more confusing because it comes at a time that there is a new commitment from the government to fighting anti-LGBTI hate crimes inside the country, spurred by a series of horrific rapes and murders of black lesbians.

“Domestically, there is a sense of a real commitment and energy and political will,” said Human Rights Watch’s Graeme Reid. But the international stance is incoherent — the Latin Americans only introduced the resolution at the last minute because South Africa wouldn’t let go of its ownership of the issue until just before the Human Rights Council session began earlier this month.

“There is an air of uncertainty about their position because they have been dragging their feet on this for the last three years, not moving on the resolution and not dropping it,” Reid said.

The resolution’s supporters are optimistic that they will have the votes to pass the resolution if it gets an up or down vote next week, and no one who spoke to BuzzFeed News for this story said they thought it was possible that South Africa would vote against the resolution on the final vote. It could abstain on a final vote, a possibility that some of the resolution’s supporters fear is more likely as the negotiations wear on. Or it could vote for a procedural motion that would kill the resolution by denying an up or down vote — exactly what it did to keep the inclusive language out of the Protection of the Family resolution in June.

“It would be unacceptable, incomprehensible, and almost unconscionable for a relatively new democracy like South Africa to support shutting down debate at the UN’s human rights body [to affirm a principle] that’s in its own constitution,” said Marianne Møllman, program director of the International Gay and Lesbian Human Rights Commission, in an interview from Geneva.

draft resolution

By J. Lester Feer

Source: http://www.buzzfeed.com/lesterfeder/south-africa-which-once-led-on-promoting-lgbt-rights-abroad?utm_term=9vaowf#2dmkbjy

#YouthEngage tweetathon: join the worldwide Twitter chat on 24 October

twitter-testYoung people and youth advocates: find your region, tweet your interest, and on the day, join the conversation!

Young people, who understands them?

 

When David Cameron delivered a speech in 2006 calling for people to “hug a hoodie”, the British Prime Minister was trying to say that he got young people; that he saw them as loveable adolescents and not an urban menace.

 

“We – the people in suits – often see hoodies as aggressive, the uniform of a rebel army of young gangsters,” he said.

 

Whether it’s about crime or immigration, education or identity it seems that people in suits the world over are increasingly preoccupied by youth. And they have good reason to be.

 

Africa has the youngest population in the world with 200 million young people between the ages of 15 and 24. Though better educated than ever, and living in countries that are stronger economically than ever, many young people are “left behind” and “frustrated”.

 

That frustration is also shared by young people in the developed world. In a 2013 study from the International Labour Organisation, youth unemployment stood at 54% in Greece.

 

And so the suits continue to gather, trying to figure out what to do about joblessness and the ‘youth bulge’, publishing interminable reports and recommendations, but what do young people have to say for themselves?

 

On Friday 24 October, in an event that will span 24 countries in 24 hours, we intend to find out. The Guardian Global Development Professionals and the Guardian Public Leaders networks will be organising a global tweetathon. This is an opportunity for young people and their advocates to give their own answers to the question: “How do we better engage young people socially, economically and politically?”

 

Starting in Fiji at noon local time and finishing on the west coast of the USA (4pm there), each leg of our worldwide relay will have a national or regional host. Their details will be added soon.

 

To participate, here’s what you need to do:

Go to: http://www.theguardian.com/global-development-professionals-network/2014/oct/16/youthengage-tweetathon-employment-future?CMP=twt_gu

Locate your part of the world in the map above

Make a note of the time of the conversation you intend to join

Start tweeting to tell us and the world that you are taking part. Here is one tweet you could use: I’m joining @GuardianGDP’s #youthengage tweetathon in [insert nearest country] on 24 Oct. To me engaging young people means [...]

On the day, as your chat is about to start, take a picture of yourself and tweet it to @GuardianGDP

Still not sure how it works or what time the #YouthEngage discussion will be happening where you are, send an email to globaldevpros@theguardian.com

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.

 

Editor’s note: Morocco, our hub for a debate that includes francophone Africa, will be added tomorrow. 

Source: http://www.theguardian.com/global-development-professionals-network/2014/oct/16/youthengage-tweetathon-employment-future?CMP=twt_gu

Ebola crisis: Vaccine ‘too late’ for outbreak

How bad can it get 9UK pharmaceuticals firm GlaxoSmithKline says its Ebola vaccine will "come too late" for the current epidemic.

 

GSK is one of several companies trying to fast-track a vaccine to prevent the spread of Ebola in West Africa.

 

But Dr Ripley Ballou, head of GSK's Ebola vaccine research, said full data on its safety and efficacy would not be ready until late 2015.

 

The World Health Organization (WHO) says more than 9,000 people have been infected and more than 4,500 have died.

 

Health workers are struggling to contain the spread of the virus, which is mostly affecting people in Liberia, Guinea and Sierra Leone.

 

The WHO has warned there could soon be 10,000 new cases a week.

 

Leading experts who have previously tackled Ebola believe the only way to contain the outbreak is with a vaccine.

 

Several trials

Prof Peter Piot, director of the London School of Hygiene and Tropical Medicine, first discovered Ebola in 1976. He is worried that the outbreak could last well into next year.

 

"Then only a vaccine can stop it, but we still have to prove that this vaccine protects, we don't know that for sure," he said

 

There are several vaccine trials under way. The Public Health Agency in Canada has started human testing, and a Russian project is planning to do the same.

 

At GSK's vaccine research laboratories outside Brussels, they are trying to compress trials that would normally take up to 10 years into just 12 months.

 

They have already given the vaccine to volunteers taking part in the trial in Africa, the US – where they are working alongside the National Institute of Health – and the UK.

 

'Small sacrifice'

Volunteer Nick Owen was injected two weeks ago at the centre for Vaccinology and Tropical Medicine in Oxford and will have regular check-ups for the next six months.

 

He said he had not hesitated to take part.

 

"It's a horrific disease, it's unimaginable what people are going through and it seemed like a really small sacrifice to make," he said.

 

In the next phase of the trial, the company hopes it will have 20,000 doses ready to be tested by health workers early next year.

 

When the outbreak was first declared in March, GSK had discussions with the World Health Organization about accelerating the development of the Ebola vaccine, Dr Ballou said. But they had decided, together, not to.

 

"No-one anticipated we would need a vaccine," said Dr Ballou. "And so both internally and, I think at the WHO, we felt the best approach was to watch very closely".

 

Seven months on, with the virus out of control, he now concedes: "I think in retrospect we should have pulled that trigger earlier.

 

"But, you know, it is what it is and we are working very closely with WHO.

 

"There shouldn't be any finger pointing around this."

 

Dr Ballou said it would now take some time to assess all of the data to establish the correct dosage and for how long the vaccine was effective. He said that could not be done in time for this latest epidemic.

 

"At the same time we have to be able to manufacture the vaccine at doses that would be consistent with general use, and that's going to take well into 2016 to be able to do that," he added.

 

"I don't think this can be seen as the primary answer to this particular outbreak," he said, but the trials under way could help in the future.

 

"If it does work then to be able to be prepared so that we don't have to go through this again in five years, or whenever the next epidemic is going to break out."

 

Even if GSK's vaccine does not work, other Ebola vaccines being developed by researchers in Canada and Japan could provide hope for future outbreaks.

 

By Simon Cox

17 October 2014

Source: http://www.bbc.com/news/health-29649572

The importance of national funding for health in Africa

20141014_morocco_632To raise the funds needed to achieve transformative impact against AIDS, tuberculosis and malaria and other diseases, partners are coming together in a spirit of shared responsibility. Governments, the private sector, private foundations, individuals and implementing countries can each play a part.

 

On 13 October, partners from UNAIDS, the United Nations Economic Commission for Africa, African Union, African Development Bank and the Global Fund gathered in Marrakech, Morocco to examine and discuss this issue. Organized at the side lines of the African Development Forum, the meeting focused on urging low and middle income countries to raise more domestic finances for health. Participants called for a new paradigm in health financing.

 

Michel Sidibé, Executive Director of UNAIDS, gave the keynote address and said that as more and more low income countries transition into the middle income status, they should reconsider their investments in health. In the same spirit of shared responsibility and solidarity, Sidibé said, rich nations should also maintain their commitments to financing health programs.

 

Abdalla Hamdok, Deputy Executive Secretary of the United Nations Economic Commission for Africa, said that investments in health form a critical pillar of economic growth and should be strongly linked to other sectors. Unless Africa focuses on health in its totality, the continent cannot achieve economic transformation. "Health is at the heart of development," he said.

 

Itai Rusike of African Civil Society Platform made a passionate call for a country-level movement of partners for domestic financing for health made up of the civil society, parliamentarians, private sector and all other stakeholders. Such an effort, coupled with stronger governance mechanisms, would mean great African solutions to African health, he said.

 

Shu-Shu Tekle-Haimanot, Senior Specialist for Advocacy and Partnerships at the Global Fund, said the Marrakech meeting was a significant step toward better health in Africa. “Partnerships hold the key to progress,” she said. “With implementing countries leading the way, this partnership can achieve our goals of raising funds and saving many lives.”

 

14 October 2014

Source: http://www.theglobalfund.org/en/blog/2014-10-15_Global_Fund_News_Flash/

Health Systems Support Needed for Enhanced Global Disease Prevention

How bad can it get 8

The Ebola epidemic in West Africa has taught us many lessons, among them that weak health services anywhere are a potential threat to everyone everywhere. While even the most advanced countries have been challenged by the virus, the fact that the outbreak is occurring in some of the frailest health systems in the world led to the enormous size, scope, and death rate associated with the crisis.

 

Health systems strengthening has been paid a lot of lip service over the years, but little progress has been made in many places that need the most help. Blame often falls on donors who tend to concentrate funding on specific diseases, like HIV or malaria, or, to a lesser extent, populations, like women and children. Frequently this funding establishes separate units and programs that just address their own specific issue, not the health burden at large or the system needed to treat it. These “vertical” programs show more immediate, tangible results that can be counted in numbers of individuals receiving treatment or giving birth with a qualified attendant.

 

Cause and effect are less clear when dealing with health systems. If donors invest in health worker training, for example, there is no guarantee the worker will finish the course or remain in his or her country of origin. Even harder to quantify are results from investments in critical system components like drug safety and information networks.

 

But the problem goes beyond donor preferences for tidy measurement tools. Health systems need adequate personnel and supplies, good governance, infrastructure, information systems, financing, and effective service delivery. Each element is in itself a difficult endeavor. While building a clinic may be relatively easy, more complicated is ensuring it has sustained, adequate staff, electricity, and a reliable supply chain. Ensuring proper administration and management is even harder.

 

Engaging adequate numbers of health personnel is notoriously challenging. Those trained to a high enough level are courted by richer countries and frequently leave, especially if their home countries face instability. Liberia, the hardest hit of the countries now facing the Ebola epidemic, was estimated to have fewer than 50 physicians for a population of 4.3 million.

 

Beyond the health system itself, building functional service delivery in poor countries can be stymied by lack of an adequate tax base, frequent turnover in government positions, lack of accountability and corruption, poor transportation, and general infrastructure weaknesses–daunting challenges all.

 

All that said, the problem deserves heightened efforts to provide resources and expertise if we are to avoid the devastating consequences we are now seeing in West Africa. The challenge is more complex than just providing funding since countries must develop management skills and create complex systems. Some innovative approaches are being tried. The Harvard School of Public Health and the Kennedy School sponsor a Ministerial Leadership in Health program that has involved 56 health and finance ministers from 40 countries to increase domestic political commitment for health systems improvements as well as enhancing efficiency and quality of services. Global movement toward universal health coverage focuses on improving access to quality health services at a price all can afford, an advance that requires functional health systems. New tools are being applied there too, including peer-to-peer learning for ministerial staff so they can share successful approaches (see the Joint Learning Network for Universal Health Coverage).

 

While the major push for systems improvement has to come from the countries themselves, the international community has a stake and a role too. International organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, offer systems strengthening support generally focused on bolstering elements related to their primary missions; the Global Fund provides funding primarily to enhance provision of services related to its three-disease focus while Gavi offers support to improve immunization system functions such as cold chain capacity and vaccinator training.

 

 The U.S. has long supported health systems strengthening through provision of technical assistance and funding, but these efforts pale in comparison to the need, and agencies responsible are hampered in their efforts by congressional mandates to produce results in the short term.  Similar to many other donors, Congress appropriates funds largely based on infectious diseases, maternal and child health, and reproductive health. Money often must be siphoned off those accounts to support broader systems efforts. Despite the lack of specific funding, the U.S Agency for International Development (USAID) has developed an Office of Health Systems to coordinate efforts. The agency begins by assessing a system’s current capacities, including its ability to properly use any external funds given to it. It then offers what aid it can in areas such as health financing arrangements and governance, promoting quality medicines, and improving access to pharmaceuticals and services. 

 

The United States can and should do more.  These are not glamourous activities, and they have long been a difficult sell to Congress. They are hard to explain and quantify and lawmakers are under constant pressure to justify foreign aid to a deeply skeptical public. But the Ebola outbreak provides a glaring example of the need.  While the global health appropriations process is not likely to reform itself out of its current funding methodology, Congress can act to send a strong message that health aid can be used more broadly and with a focus on long term results. This would give USAID and other agencies the authority they need to give health systems strengthening the priority it deserves and provide an extra layer of health protection for citizens in developing countries as well as here at home.

 

By Nellie Bristol

The Ebola epidemic in West Africa has taught us many lessons, among them that weak health services anywhere are a potential threat to everyone everywhere. While even the most advanced countries have been challenged by the virus, the fact that the outbreak is occurring in some of the frailest health systems in the world led to the enormous size, scope, and death rate associated with the crisis.

 

Health systems strengthening has been paid a lot of lip service over the years, but little progress has been made in many places that need the most help. Blame often falls on donors who tend to concentrate funding on specific diseases, like HIV or malaria, or, to a lesser extent, populations, like women and children. Frequently this funding establishes separate units and programs that just address their own specific issue, not the health burden at large or the system needed to treat it. These “vertical” programs show more immediate, tangible results that can be counted in numbers of individuals receiving treatment or giving birth with a qualified attendant.

 

Cause and effect are less clear when dealing with health systems. If donors invest in health worker training, for example, there is no guarantee the worker will finish the course or remain in his or her country of origin. Even harder to quantify are results from investments in critical system components like drug safety and information networks.

 

But the problem goes beyond donor preferences for tidy measurement tools. Health systems need adequate personnel and supplies, good governance, infrastructure, information systems, financing, and effective service delivery. Each element is in itself a difficult endeavor. While building a clinic may be relatively easy, more complicated is ensuring it has sustained, adequate staff, electricity, and a reliable supply chain. Ensuring proper administration and management is even harder.

 

Engaging adequate numbers of health personnel is notoriously challenging. Those trained to a high enough level are courted by richer countries and frequently leave, especially if their home countries face instability. Liberia, the hardest hit of the countries now facing the Ebola epidemic, was estimated to have fewer than 50 physicians for a population of 4.3 million.

 

Beyond the health system itself, building functional service delivery in poor countries can be stymied by lack of an adequate tax base, frequent turnover in government positions, lack of accountability and corruption, poor transportation, and general infrastructure weaknesses–daunting challenges all.

 

All that said, the problem deserves heightened efforts to provide resources and expertise if we are to avoid the devastating consequences we are now seeing in West Africa. The challenge is more complex than just providing funding since countries must develop management skills and create complex systems. Some innovative approaches are being tried. The Harvard School of Public Health and the Kennedy School sponsor a Ministerial Leadership in Health program that has involved 56 health and finance ministers from 40 countries to increase domestic political commitment for health systems improvements as well as enhancing efficiency and quality of services. Global movement toward universal health coverage focuses on improving access to quality health services at a price all can afford, an advance that requires functional health systems. New tools are being applied there too, including peer-to-peer learning for ministerial staff so they can share successful approaches (see the Joint Learning Network for Universal Health Coverage).

 

While the major push for systems improvement has to come from the countries themselves, the international community has a stake and a role too. International organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, offer systems strengthening support generally focused on bolstering elements related to their primary missions; the Global Fund provides funding primarily to enhance provision of services related to its three-disease focus while Gavi offers support to improve immunization system functions such as cold chain capacity and vaccinator training.

 

 The U.S. has long supported health systems strengthening through provision of technical assistance and funding, but these efforts pale in comparison to the need, and agencies responsible are hampered in their efforts by congressional mandates to produce results in the short term.  Similar to many other donors, Congress appropriates funds largely based on infectious diseases, maternal and child health, and reproductive health. Money often must be siphoned off those accounts to support broader systems efforts. Despite the lack of specific funding, the U.S Agency for International Development (USAID) has developed an Office of Health Systems to coordinate efforts. The agency begins by assessing a system’s current capacities, including its ability to properly use any external funds given to it. It then offers what aid it can in areas such as health financing arrangements and governance, promoting quality medicines, and improving access to pharmaceuticals and services. 

 

The United States can and should do more.  These are not glamourous activities, and they have long been a difficult sell to Congress. They are hard to explain and quantify and lawmakers are under constant pressure to justify foreign aid to a deeply skeptical public. But the Ebola outbreak provides a glaring example of the need.  While the global health appropriations process is not likely to reform itself out of its current funding methodology, Congress can act to send a strong message that health aid can be used more broadly and with a focus on long term results. This would give USAID and other agencies the authority they need to give health systems strengthening the priority it deserves and provide an extra layer of health protection for citizens in developing countries as well as here at home.

 

By Nellie Bristol

The Ebola epidemic in West Africa has taught us many lessons, among them that weak health services anywhere are a potential threat to everyone everywhere. While even the most advanced countries have been challenged by the virus, the fact that the outbreak is occurring in some of the frailest health systems in the world led to the enormous size, scope, and death rate associated with the crisis.

 

Health systems strengthening has been paid a lot of lip service over the years, but little progress has been made in many places that need the most help. Blame often falls on donors who tend to concentrate funding on specific diseases, like HIV or malaria, or, to a lesser extent, populations, like women and children. Frequently this funding establishes separate units and programs that just address their own specific issue, not the health burden at large or the system needed to treat it. These “vertical” programs show more immediate, tangible results that can be counted in numbers of individuals receiving treatment or giving birth with a qualified attendant.

 

Cause and effect are less clear when dealing with health systems. If donors invest in health worker training, for example, there is no guarantee the worker will finish the course or remain in his or her country of origin. Even harder to quantify are results from investments in critical system components like drug safety and information networks.

 

But the problem goes beyond donor preferences for tidy measurement tools. Health systems need adequate personnel and supplies, good governance, infrastructure, information systems, financing, and effective service delivery. Each element is in itself a difficult endeavor. While building a clinic may be relatively easy, more complicated is ensuring it has sustained, adequate staff, electricity, and a reliable supply chain. Ensuring proper administration and management is even harder.

 

Engaging adequate numbers of health personnel is notoriously challenging. Those trained to a high enough level are courted by richer countries and frequently leave, especially if their home countries face instability. Liberia, the hardest hit of the countries now facing the Ebola epidemic, was estimated to have fewer than 50 physicians for a population of 4.3 million.

 

Beyond the health system itself, building functional service delivery in poor countries can be stymied by lack of an adequate tax base, frequent turnover in government positions, lack of accountability and corruption, poor transportation, and general infrastructure weaknesses–daunting challenges all.

 

All that said, the problem deserves heightened efforts to provide resources and expertise if we are to avoid the devastating consequences we are now seeing in West Africa. The challenge is more complex than just providing funding since countries must develop management skills and create complex systems. Some innovative approaches are being tried. The Harvard School of Public Health and the Kennedy School sponsor a Ministerial Leadership in Health program that has involved 56 health and finance ministers from 40 countries to increase domestic political commitment for health systems improvements as well as enhancing efficiency and quality of services. Global movement toward universal health coverage focuses on improving access to quality health services at a price all can afford, an advance that requires functional health systems. New tools are being applied there too, including peer-to-peer learning for ministerial staff so they can share successful approaches (see the Joint Learning Network for Universal Health Coverage).

 

While the major push for systems improvement has to come from the countries themselves, the international community has a stake and a role too. International organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, offer systems strengthening support generally focused on bolstering elements related to their primary missions; the Global Fund provides funding primarily to enhance provision of services related to its three-disease focus while Gavi offers support to improve immunization system functions such as cold chain capacity and vaccinator training.

 

 The U.S. has long supported health systems strengthening through provision of technical assistance and funding, but these efforts pale in comparison to the need, and agencies responsible are hampered in their efforts by congressional mandates to produce results in the short term.  Similar to many other donors, Congress appropriates funds largely based on infectious diseases, maternal and child health, and reproductive health. Money often must be siphoned off those accounts to support broader systems efforts. Despite the lack of specific funding, the U.S Agency for International Development (USAID) has developed an Office of Health Systems to coordinate efforts. The agency begins by assessing a system’s current capacities, including its ability to properly use any external funds given to it. It then offers what aid it can in areas such as health financing arrangements and governance, promoting quality medicines, and improving access to pharmaceuticals and services. 

 

The United States can and should do more.  These are not glamourous activities, and they have long been a difficult sell to Congress. They are hard to explain and quantify and lawmakers are under constant pressure to justify foreign aid to a deeply skeptical public. But the Ebola outbreak provides a glaring example of the need.  While the global health appropriations process is not likely to reform itself out of its current funding methodology, Congress can act to send a strong message that health aid can be used more broadly and with a focus on long term results. This would give USAID and other agencies the authority they need to give health systems strengthening the priority it deserves and provide an extra layer of health protection for citizens in developing countries as well as here at home.

 

By Nellie Bristol

Source: http://www.smartglobalhealth.org/blog/entry/health-systems-support-needed-for-enhanced-global-disease-prevention/

AHF Mourns Liberia’s Dr. Taban Dada; Urges African Union and W.H.O. to Accelerate Ebola Response

AHF

KAMPALA, UGANDA (13 October 2014) The AIDS Healthcare Foundation (AHF) mourns the loss of another Doctor, Dr. John Taban Dada who died due to Ebola Virus Disease (EVD) in West Africa. Dr. Dada, a Ugandan national, succumbed to the Disease on 9th October 2014 in Monrovia, Liberia. By the time of his death, Dr. Dada was working at Liberia’s largest hospital, JF Kennedy Memorial Center, and was consulting with the AIDS Healthcare Foundation partner in HIV service provision, People Associated for People’s Assistance (PAPA).

 

The Ebola outbreak in West Africa has continued a persistent spread pushing the death toll over 4,000 as of 9th October 2014. Having been declared an international public health emergency by the World Health Organization, Ebola Virus Disease has infected over 370 health workers and killed 216 doctors and nurses. In July, Dr. Sheik Humarr Khan, 39, who served as Medical Officer for AHF’s Sierra Leone Country Program, succumbed to the disease after being quarantined and cared for by medical providers from Médecins Sans Frontières at the isolation unit in the Kailahun District in Eastern Sierra Leone for several days. In Liberia, Dr. Dada’s death brought to four (4) the number of Doctors who have died since the outbreak.

 

“Our brothers and sisters in West Africa need accelerated action by commissions such as the African Union and the World Health Organization to expand provision of appropriate and adequate personal protective equipment, mobilize and deploy more health workers in the region, and increase and equip more isolation centers specifically established to cater for infected health workers,” said Dr. Penninah Iutung Amor, the AHF Bureau Chief for the African Region. “All these are achievable – but only if the commissions and the World Health Organization prioritize and scale up addressing obstacles that are holding us back in the response.”

 

There was hope late September when President Obama pledged support to the EVD response in the region however the actualization of this support has been delayed due to logistical challenges — inadequate human resources for health, poor state of the runway at the airport, and delays in setting up new isolation centers. “Since we have few isolation centers, we are seeing some people suffering from Ebola re-circulating into the community and therefore driving the infection further,” said Chinnie Sieh, Program Manager with People Associated for People’s Assistance (PAPA). “This is a crisis that requires all the Africa Commissions, the United Nations, all African governments and non-government actors to respond.”

 

“It is high time that the containment of this outbreak became a reality in the West African Countries of Sierra Leone, Guinea and Liberia,” said Dr. Lydia Buzaalirwa, the Director for Quality Management with AIDS Healthcare Foundation Africa Bureau. “Everybody needs to take part in the control of Ebola. We need to cut the chain of new transmissions, get in more volunteers, more logistics, and communities should be involved in building new isolation units. We demand that the African Union step up its leadership and exponentially accelerate its response to the Ebola outbreak in the region.”

 

By The AIDS Healthcare Foundation

South Africa: Pregnant women and girls continue to die unnecessarily

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Hundreds of pregnant women and girls are dying needlessly in South Africa. In part, this is because they fear their HIV status may be revealed as they access antenatal care services, according to a major report published by Amnesty International today.

 

Struggle for Maternal Health: Barriers to Antenatal Care in South Africa, details how fears over patient confidentiality and HIV testing, a lack of information and transport problems are contributing to hundreds of maternal deaths every year by acting as barriers to early antenatal care.

 

“It is unacceptable that pregnant women and girls are continuing to die in South Africa because they fear their HIV status will be revealed, and because of a lack of transport and basic health and sexuality education. This cannot continue,” said Salil Shetty, Amnesty International’s Secretary General.

 

“The South African government must ensure all departments work together to urgently address all the barriers that place the health of pregnant women and girls at risk.”

 

South Africa has an unacceptably high rate of maternal mortality. There were 1,560 recorded maternal deaths in 2011 and 1,426 in 2012. More than a third of these deaths were linked to HIV. Experts suggest that 60% of all the deaths were avoidable.

 

Antenatal care is free in South Africa’s public health system. However, Amnesty International’s research found that many women and girls do not attend clinics until the later stages of their pregnancy because they are given to believe that the HIV test is compulsory. They fear testing and the stigma of being known to be living with HIV. Nearly a quarter of avoidable deaths have been linked to late or no access to antenatal care.

 

Worryingly, these fears are not without foundation. Amnesty International’s report, based on field research conducted in Mpumalanga and KwaZulu-Natal provinces, contains testimonies from women and girls who say that health care workers inappropriately discuss HIV test results with others.

 

“The nurses are talking about people and their status”, a woman from KwaZulu-Natal explained.

 

Amnesty International also found that several clinics it visited use processes for pregnant women and girls living with HIV that disclose their status, including separate queues for antiretroviral medication, different coloured antenatal files and different days for appointments.

 

“[I]f I go for antiretroviral, my line is that side. All the people in this line they know these people are HIV. That’s why people are afraid to come to the clinic,” one woman in Mpumalanga told Amnesty International.

 

“During antenatal care, if women come out of the counsellor’s room with two files, then everyone knows they are HIV positive,” said another woman.

 

Women and girls said they feared discriminatory treatment even from partners and family members as a result of testing positive for HIV and that HIV-related stigma remained a problem in many communities.

 

“While HIV testing is an important public health intervention it must be done in a manner that respects the rights of women and girls and does not expose them to additional harm. It is deeply worrying that the privacy of pregnant woman and girls is not respected in health facilities. The South African government must take urgent steps to correct this,” said Salil Shetty.

 

“It is vital that health care workers in South Africa receive additional training on providing quality care that is both free of judgement and stigma and that women and girls accessing sexual and reproductive health services are able to trust that their confidentiality will be respected.”

 

Lack of information about sexual and reproductive health

 

Amnesty International’s report also identifies that a lack of information and knowledge about sexual and reproductive health and rights increases risks of unplanned pregnancies and HIV transmission, especially among adolescents. Likewise women and girls are often unaware of the importance of early antenatal checks.

 

Persistent problems relating to transport

 

The report also documents the lack of progress made in KwaZulu-Natal and Mpumalanga to ensure that women and girls can physically access health services. Problems persist relating to shortages of public transport and poor road infrastructure. The roads in some areas visited by Amnesty International are of such poor quality that they become impassable when it rains. Even when it is dry, ambulances will not go beyond a certain point on some roads. Amnesty International had documented the same problems in both provinces in a 2008 report.

 

“The South African government must build better road networks in these rural provinces to guarantee access to healthcare facilities. The government must also ensure that ambulances are always available to transport those who are in need,” said Salil Shetty.

 

Amnesty International is also calling on the government to:

 

  • Ensure that all health system procedures uphold patient privacy, particularly for people living with HIV.
  • Improve knowledge about sexual and reproductive health and rights, including through comprehensive sexuality education that involves men and boys.
  • Urgently address the persistent lack of safe, convenient and adequate transport, and the poor condition of transport infrastructure.

 

Additional information

 

This report builds on Amnesty International’s 2008 report, ‘I am at the lowest end of all’: Rural women living with HIV face human rights abuses in South Africa, in which the organisation documented gender, economic and social inequalities as barriers to health care for women living with HIV.

 

9 October 2014

By Amnesty International

Source: http://www.amnesty.org/en/news/south-africa-pregnant-women-and-girls-continue-die-unnecessarily-2014-10-09

Tell World Leaders it’s Time to #ENDEBOLA

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Ebola is tearing through West Africa, killing up to 70% of those infected and spreading fear through their communities.

 

Children are in danger of catching the virus, or of losing their parents to it. Their long-term futures are also suffering from the knock on effects of prevention measures: schools are closed; vaccines can’t be administered because of the fear of infection.

 

We must act now to stop this epidemic spreading before it destroys the futures of an entire generation of West Africa’s children.

 

As 20 of the world’s biggest countries in terms of both economy and population, the members of the G20 are ideally placed to deliver the resources desperately needed for the international response on Ebola. According to the UN, if states have committed and deployed the required resources by the time of the G20 meeting in November the transmission rate will be on track to decline by the end of the year.

 

Join our call on leaders of the G20 to ensure all people, equipment and funding needed to halt the outbreak are in place by the 15th November.

 

Source: http://www.savethechildren.net/ebola

African Civil Society Response to Ebola: Join AAI for teleconference

AAI is inviting you to attend an international tele-conference that will help to initiate a process of supporting a co-ordinated African civil society response to the Ebola epidemic.

 

The tele-con will be held on Wednesday 8th October 2014 at 1pm (Central Africa Time).

 

The proposed process comes largely due to the fact that it seems that in recent weeks the Ebola epidemic in Africa has continued to rise and is increasingly overwhelming the current response. There is thus an urgent need to ensure there is accountability in the response, and transparency about what governments, civil society and all others are doing, and that human rights and access to health remain central.

 

In this regard, AAI is now pushing strongly for a co-ordinated African civil society response to the Ebola epidemic.

 

AAI believes that once civil society is more organised, it will also help to develop a broader co-ordinated African response that will include all relevant stakeholders such as governments, business, relief/aid agencies and donors/funders, among others.

 

Of particular concern are the following two crucial issues:

 

1. In West Africa: It seems the relief efforts and response so far is coming mostly through international initiatives from outside Africa. There is not much clarity at the moment on how far the Africans are owning and co-ordinating the response to the Ebola epidemic.

 

2. Rest of Africa: Even though the Ebola epidemic is yet to adversely affect the rest of the continent, there are some question marks as to the level of preparedness in the event that it eventually breaks out across Africa. Even worse, to date it seems very little has been done to massively invest in public/awareness campaigns about Ebola. Ignorance about Ebola is still a major concern.

 

What is AAI Proposing as the Way Forward?

 

We would like to start by ensuring there is transparency by doing a proper mapping process of all the relevant civil society organisations across Africa that could be mobilised to join a common platform for a co-ordinated response to the Ebola epidemic.

 

Secondly, we would like to initiate action by ensuring there is a co-ordinated civil society to take the lead in mobilising resources/commitment for an Ebola epidemic awareness campaign especially across the affected countries.

 

What Can You Do For Now?

 

Can you please at least ask your various contact offices and networks especially at country level to help us with African civil society contacts they know are actively involved with the Ebola response.

 

You can also join this process especially by confirming your participation at the initial tele-con that AAI is planning to host for African civil society on 8th October because the situation seems to be getting dire with each passing day.

 

Email Daniel Molokele at daniel at aidsaccountability.org to join the call.

Leaving no one behind in the post-2015 development agenda: young marginalized people claim their space

missionbrazil_632The sexual and reproductive health rights of young marginalized populations are often neglected and their collective voice in this critical area not always heard. To try to redress this imbalance young people from marginalized communities and key populations in Bangladesh, Ethiopia, Puerto Rico and Uganda met in New York this week to discuss how to put these rights issues firmly on the post-2015 development agenda, leaving no one behind. 

 

Taking place on 25 September, the General Assembly side event which took the form of a panel discussion, examined the vital role of community engagement, advocacy and service delivery in protecting the rights and meeting the needs of young key populations. These include men who have sex with men, sex workers and young people living with HIV.   

 

Young speakers, who were peer educators, directors of national and regional NGOs, actors and community leaders, argued that universal access to HIV services and health coverage could not be achieved without prioritizing the needs of the most marginalized. They also noted the contribution of comprehensive sexuality education to improving young people’s health and the role that communities can play in both promoting rights and challenging stigma and discrimination.

 

The event was hosted by the Government of Brazil and organized by the International HIV/AIDS Alliance, GESTOS, the Global Youth Coalition on AIDS, ATHENA, ICASO, International Civil Society Support, STOP AIDS NOW!, Stop AIDS Alliance, the HIV Young Leaders Fund, the African Services Committee, and the Global Forum on MSM and HIV, in collaboration with UNAIDS.

 

Quotes

"Setting goals is only part of the story. Where we should look for change is the way that we will implement the goals. We need to change the way we are doing business and craft the space for civil society in the new post-2015 agenda."

Luiz Loures, UNAIDS Deputy Executive Director

 

“We are talking about development here and sexual and reproductive rights are development."

Pablo Aguilera, HIV Young Leaders Fund

 

By UNAIDS

26 September 2014

Source: http://www.unaids.org/en/resources/presscentre/featurestories/2014/september/20140925csyoungpops/