<?xml version="1.0" encoding="UTF-8"?><rss xmlns:content="http://purl.org/rss/1.0/modules/content/" version="2.0"><channel><title>IRIN - Ghana</title><link>http://www.irinnews.org/</link><description>Updated everyday</description><language>en-gb</language><lastBuildDate>Wed, 08 May 2013 18:30:51 GMT</lastBuildDate><item><title>Analysis: Sending the right message on mHealth</title><pubDate>Wed, 08 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2008/2008070834t.jpg" />]]>NAIROBI 08 May 2013 (IRIN) - We’ve read the stories: From bedridden patients sending text messages to their health workers, to young people receiving HIV prevention messages via SMS, the mobile phone seems to have morphed from communications device to essential life-saver. But is the evidence there yet that mHealth is an effective and suitable health delivery intervention in the developing world?</description><body><![CDATA[NAIROBI 08 May 2013 (IRIN) - We’ve read the stories: From bedridden patients sending text messages to their health workers, to young people receiving HIV prevention messages via SMS, the mobile phone seems to have morphed from communications device to essential life-saver. But is the evidence there yet that mHealth is an effective and suitable health delivery intervention in the developing world? 
  
IRIN, like others, has been reporting for years on mHealth’s potential: This communication technology could provide the answer to distant and under-resourced health services, in particular for Africa’s poor. Kenyan health workers have recounted [ http://www.irinnews.org/Report/88653/KENYA-R-U-OK-2day-SMS-check-up-takes-off ] how mobile phones have made it easier to track their patients’ progress; there have been anecdotal reports of lower maternal mortality rates as a result of Ghanaian mothers [ http://www.irinnews.org/Report/87261/GHANA-Cell-phones-cut-maternal-deaths ] being able to call for ambulances during labour. 
  
In Africa, with some 63 mobile phones per 100 inhabitants (compared to Asia and the Pacific’s 89 per 100 inhabitants), the cell in your pocket can become a direct channel [ http://www.irinnews.org/Report/91287/AFRICA-Mobile-phones-for-health ] for receiving public health messages, improving communication between patients and health providers, boosting data collection and, increasingly, assisting in diagnosis. 
  
But a systematic review - published in January in PLOS Medicine [ http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001363 ] - into the effectiveness of mHealth technology in improving health delivery found mixed results from 42 trials of mHealth interventions. SMS appointment reminders, for example, were found to have modest programmatic benefits, while using phones to send digital images for diagnosis actually led to a drop in the correct analysis in two trials examined. 
  
A 2012 study by the mHealth Alliance [ http://mhealthalliance.org/images/content/baseline_evaulation_report2013.pdf ], which advocates the use of mobile technologies in health care, found that sub-Saharan Africa had a higher number of mHealth projects compared to Asia and Latin America, with more than half of all mHealth projects related to communicable diseases such as HIV and malaria. 
  
Insufficient evidence 
  
Despite the rapid growth, "there is currently a gap in terms of evidence linking mHealth to improved health and operational benefits, and this is particularly true when it comes to studies in low- and middle-income countries," Patricia Mechael, executive director of the mHealth Alliance, told IRIN. 
  
The PLOS review found that “none of the trials were of high quality - many had methodological problems likely to affect the accuracy of their findings - and nearly all were undertaken in high-income countries.” 
  
Rajesh Vedanthan, an assistant professor at New York’s Mount Sinai Medical Centre who is currently working with AMPATH [ http://www.ampathkenya.org/ ], an academic health programme involved in research and health care in Kenya, told IRIN via email that some of the practical challenges with the use of mHealth technology included “optimizing the user interface, ensuring that users have an easy and error-free working experience with the mHealth device, not impeding the workflow of clinicians, issues related to network connectivity, access to a central server, coordination of individual devices with a central coordinating office, systems integration, etc… 
  
“mHealth has the potential to assist with several aspects of the ‘supply chain’ of care for non-communicable diseases - including screening/diagnosis, linkage to care, treatment/decision support, retention and follow-up, systems coordination, etc.,” he added. “Whether mHealth will be effective in all of those arenas is still not robustly known, and rigorous research is still required.” 
  
A need for standards 
  
The mushrooming of mHealth pilot projects has caused concern around monitoring. Uganda has declared a moratorium on pilot mHealth initiatives as it seeks to bring them in line with national health policies. 
  
“We first needed to study them [mHealth and mHealth initiatives]… Some of these people are duplicating what is already there,” Asuman Lukwago, the permanent secretary in Uganda’s Ministry of Health, told IRIN. “As a ministry, we only implement innovations that have been tested and approved. At the moment, we are suggesting reforms to put into practice for these new innovations.” 
  
The mHealth Alliance recently released a review [ http://www.mhealthalliance.org/images/content/state_of_standards_report_2013.pdf ] of standards in the use of mHealth among low- and middle-income countries, which found that as mobile health systems “move towards scale, existing guidelines and strategies will need to be revised to reflect new demands on executive sponsorship; national leadership of eHealth programmes; eHealth standards adoption and implementation; development of eHealth capability and capacity; eHealth financing and performance management and eHealth planning and architecture maintenance”. 
  
Scaling up mHealth 
  
Mechael noted that mHealth could only meet its potential if it was fully integrated into general health programmes, becoming “so much a part of health systems that we no longer need to use ‘m’ as a designation”, something that cannot happen unless mHealth projects move beyond the pilot phase and really reach scale at a national or regional level. 
  
Importantly, experts say, the use of mHealth and other humanitarian technology should be allowed to be driven by the communities who benefit from it. 
  
“There has been a recognition - belatedly, in some cases - of the ways beneficiaries are using technology, voting with their wallets and their feet... We can see that the most innovative models of humanitarian technology are driven by communities themselves,” Imogen Wall, the coordinator of communications with affected communities for the UN Office for the Coordination of Humanitarian Affairs, told IRIN. 
  
She noted that humanitarian agencies would increasingly need to increase their engagement with the private sector as partners in preparedness and response, recognizing that the private sector is no longer merely a support system, but a humanitarian service provider as well. 
  
OCHA recently released a report, Humanitarianism in the Network Age [ https://ochanet.unocha.org/p/Documents/WEB%20Humanitarianism%20in%20the%20Network%20Age%20vF%20single.pdf ], which stresses the importance of information and communication in humanitarian work and urges new ways of thinking that adapt to the changing realities of communities around the world. 
  
“In order for humanitarian technology to meet its full potential, there must be a willingness - an openness - to innovate, to think outside the box, to test new ideas and to risk failure and success in both the processes and the deliverables - essentially, a willingness to accept change,” Wall said. 
  
kr/so/oa/cb 

]]></body><link>http://www.irinnews.org/Report/98001/Analysis-Sending-the-right-message-on-mHealth</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2008/2008070834t.jpg"/></td><td valign="top">NAIROBI 08 May 2013 (IRIN) - We’ve read the stories: From bedridden patients sending text messages to their health workers, to young people receiving HIV prevention messages via SMS, the mobile phone seems to have morphed from communications device to essential life-saver. But is the evidence there yet that mHealth is an effective and suitable health delivery intervention in the developing world?</td></tr></table>]]></content:encoded></item><item><title>In Africa, corruption dirties the water</title><pubDate>Thu, 14 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201302011339570855t.jpg" />]]>NAIROBI 14 March 2013 (IRIN) - Collusion among government officials, unscrupulous water vendors and large farm owners results in diverted water supply lines, misappropriated funds, and failure to implement laws on protecting water sources from encroachment and pollution. These are just some of the ways corruption is denying millions of poor people in Africa access to safe and clean drinking water, experts say.</description><body><![CDATA[NAIROBI 14 March 2013 (IRIN) - Collusion among government officials, unscrupulous water vendors and large farm owners results in diverted water supply lines, misappropriated funds, and failure to implement laws on protecting water sources from encroachment and pollution. These are just some of the ways corruption is denying millions of poor people in Africa access to safe and clean drinking water, experts say.

“The impact of corruption on the water sector is manifested by lack of sustainable delivery, inequitable investment and targeting of resources, and limited participation of affected communities in developmental processes,” Bethlehem Mengistu, regional advocacy manager at the NGO Water Aid, told IRIN.

In a 2010 report, the UN World Health Organization (WHO) [ http://www.who.int/water_sanitation_health/publications/2012/jmp_report/en/index.html ], estimated that around 780 million people around the world, including 343 million in Africa, did not have access to an “improved drinking water supply”, meaning a running water network, public drinking fountains, protected wells or springs, or rainwater tanks.

Globally, an estimated 3 million deaths result from water-borne diseases annually, according to WHO.

According to the World Bank, 20 to 40 percent of public finances worldwide meant for the water sector are lost due to corruption and dishonest practices.

Denied water

In Africa, climate change and burgeoning populations have caused competition over scarce water resources, at times leading to communal conflicts. Experts say corruption exacerbates Africa’s water problems.

“More specific examples of how corruption denies poor people access to water include situations where wealthy or politically connected people use their position to unduly influence the location of a water source at the cost of the poor,” Maria Jacobson, programme officer at the UN Development Programme’s Water Governance Facility (WGF), at the Stockholm International Water Institute, told IRIN.

According to Jacobson, the poor “don’t have the resources to participate in a corrupt system that relies on bribes”, and therefore “lose out in terms of poor water services”.

“Poor people also have few, if any, means to enter alternative markets when corrupt public systems fail to deliver,” she added.

A 2008 report [ http://www.transparency.org/whatwedo/pub/global_corruption_report_2008_corruption_in_the_water_sector ] by Transparency International (TI), a global corruption watchdog, estimated that corruption denied more than a billion people access to safe drinking water and kept 2.8 billion from accessing sanitation services.

In Tanzania, a 2012 study [ http://www.water-alternatives.org/index.php?option=com_docman&task=doc_download&gid=173 ] published in the peer-reviewed journal Water Alternatives revealed that a large-scale agricultural and livestock farming project - on a 14 hectare plot of land in the Iringa area leased out by the government to a private company, allegedly without following the legal process - led to contamination of nearby water sources serving some 45,000 people.

The study, conducted by the Italian NGO ACRA (Cooperazione Rurale in Africa e America Latina), said fertilizers, pesticides and animal waste from the farm washed downstream to the water points.

“While there are mechanisms within Tanzanian law to limit potentially polluting activities, establish protected zones around water sources, and empower water-user organizations to exercise control over activities that damage the quality of water, in practice, in the Iringa region, these were not effective as many procedures were not followed,” the authors said.

In developing countries, corruption is estimated to, according to the TI report, “raise the price for connecting a household to a water network by as much as 30 per cent,” which leads to an inflation of the “overall costs for achieving the Millennium Development Goals for water and sanitation, cornerstones for remedying the global water crisis, by more than US$48 billion.”

In Kenya, for instance, poor people in the capital, Nairobi, pay 10 times more for water than their wealthier counterparts, according to TI.

Incompetence

The incompetence of national and local authorities, too, is to blame.

“Because the revenue that is collected from the water sector is not ring-fenced, it is not ploughed back in to improve services. It is not uncommon to see leaking and broken pipes and water pumps in many parts of urban and rural regions of Africa countries,” Barrack Luseno, a Kenyan water sector analyst, told IRIN.

In Malawi, according to the TI report, water collection points constructed between 1988 and 2002 were mostly placed in areas where such facilities already existed, largely due to “political patronage.”

“The key drivers [of corruption] are limitations of participation, transparency and accountability. It is usually the case that the details of sector resourcing is confined, there is limited participation of right holders in critical issues of development, and the checks and balances to key decision-making roles are weak,” Water Aid’s Mengistu added.

Water Aid recommended in a 2012 report [ http://www.wateraid.org/what%20we%20do/our%20approach/research%20and%20publications/~/media/Publications/WaterAid_Keeping_Promises_Synthesis_Report.ashx ] that governments invest more but also put measures in place to fight the runaway graft in the water sector.

“Governments and donors must ensure that rigorous checks and balances are in place to tackle corruption and minimize waste,” said the report.

It gave the example of the Ugandan government and donors moving quickly to tackle the misappropriation of funds that occurred in the country’s water sector at the end of 2012.

“There is a continuing need to enhance the accountability of governments in delivering services and fulfilling their obligations as duty bearers. Community service organisations have an important role to play as watchdogs to ensure rights holders receive their entitlements,” it added.

Involving communities in decision making and putting more investment into the sector are some of the ways to ensure access for more people.

“We must ensure integrity by ensuring more openness in dealing with issues of land and water. Remember, for rural communities, access to land is commensurate with access to water. This explains the conflict between pastoralist and farming communities,” Luseno added.

Privatization?

Some have advocated for the privatization of water services. In Africa, Senegal and Cote d'Ivoire are cited as privatization success stories. But critics, fearing increased prices, say that putting life-sustaining resource in the hands of for-profit companies would be dangerous.

Karen Bakers says in her 2010 book Privatizing Water: Governance failure and the world’s urban water crisis, “an increasing consensus has developed that private sector participation in water supply will not be able, as some proponents has hoped, to succeed where governments have failed to provide water for all.”

According to the WGF [ http://www.watergovernance.org/ ], the ideological debates over the privatization of water services “do not benefit those lacking sustainable drinking water supply and sanitation.”

The World Bank estimates by 2007, some 160 million people were being served by private water operators globally [ http://www.ppiaf.org/sites/ppiaf.org/files/FINAL-PPPsforUrbanWaterUtilities-PhMarin.pdf ]. About 50 million of these people are served by public-private partnerships that can be considered successful.

But privatization has produced different results for different countries.

In Mozambique, a World Bank study revealed that access to water in the capital, Maputo, had improved since the delegation of water management to private companies.

In Uganda, water sector reforms included more funding from the government and better management of the National Water and Sewerage Corporation - a privately managed but publicly owned water company responsible for the 15 largest cities in the country. According to Water Aid, in just five years after the reforms, it had transformed from being a highly inefficient, underperforming and loss-making body to a healthy and financially sustainable public corporation. Service coverage grew from 48 to 74 percent between 1998 and 2010. The same period witnessed household connections increase from 53,000 to 246,259.

Still, corruption has been a challenge.

“In a study of corruption in Uganda’s water sector, private contractors estimated the average bribe related to a contract award to be 10 percent [of the total cost]. The same study showed that 46 per cent of all urban water consumers had paid extra money for connections,” said WGF’s Jacobson.

Kenya, on the other hand, abandoned plans to open up Nairobi’s water supply to private companies, fearing it would inflate water prices.

In 2008, Mali experienced anti-privatization protests that left one person dead and five others injured in the capital, Bamako.

In Ghana, water tariffs increased by 80 percent after privatization [ http://www.vitensevidesinternational.com/projects/ghana/case-study-book-ghana-5.pdf ], and a third of the country’s population still has no access to safe and clean water.

“Experience suggests that to make private sector engagement work, effective government regulatory powers are required,” says WGF.

Ending corruption in the sector, experts like WGF’s Jacobson say, would require diagnosing the effectiveness of anticorruption interventions, creating legal and financial reforms, and building public sector capacity.

ko/rz

]]></body><link>http://www.irinnews.org/Report/97642/In-Africa-corruption-dirties-the-water</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201302011339570855t.jpg"/></td><td valign="top">NAIROBI 14 March 2013 (IRIN) - Collusion among government officials, unscrupulous water vendors and large farm owners results in diverted water supply lines, misappropriated funds, and failure to implement laws on protecting water sources from encroachment and pollution. These are just some of the ways corruption is denying millions of poor people in Africa access to safe and clean drinking water, experts say.</td></tr></table>]]></content:encoded></item><item><title>African migrants pay high prices to send money home</title><pubDate>Wed, 27 Feb 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2009/200909291220100610t.jpg" />]]>JOHANNESBURG 27 February 2013 (IRIN) - New data from the World Bank has revealed that African migrants pay more to send money home to their families than any other migrant group in the world.</description><body><![CDATA[JOHANNESBURG 27 February 2013 (IRIN) - New data [ http://sendmoneyafrica.worldbank.org/ ] from the World Bank has revealed that African migrants pay more to send money home to their families than any other migrant group in the world. 

While South Asians pay an average of US$6 for every $100 they send home, Africans often pay more than twice that - and in South Africa, which has the highest remittance costs on the continent, nearly 21 percent of money set aside for family members back home is spent on getting it there.

With an estimated 120 million Africans depending on remittances from family members abroad for their survival, health and education, the World Bank argues that high transaction costs are cutting into the impact remittances can have on poverty levels. 

To address this, the Bank is partnering with the African Union Commission and member states to establish the African Institute for Remittances [ http://sendmoneyafrica.worldbank.org/african-institute-remittances-air-project ], which will work towards lowering the transaction costs of remittances to and within Africa. It will also leverage the potential of remittances to influence economic and social development. 

“The World Bank’s approach supports regulatory and policy reforms that promote transparency and market competition and the creation of an enabling environment that promotes innovative payment and remittance products,” said Marco Nicoli, a finance analyst at the Bank who specializes in remittances.

Costly and difficult

Owen Maromo, a 33-year-old farmworker who lives in De Doorns, a grape-growing region in South Africa’s Western Cape Province, told IRIN that his family in Zimbabwe relies on the money he sends home every month. 

“I’ve got a house there and I need to pay rent. I’m also taking care of my youngest brother - since my mum died four years ago - and my wife’s family.

“Almost every Zimbabwean here is budgeting to send money back home,” he added. “If they could, they would send money home on a weekly basis.”

In a 2012 report by the Cape Town-based NGO People Against Suffering Oppression and Poverty (PASSOP), interviews with 350 Zimbabwean migrants revealed some of the reasons sending money home from South Africa is both costly and difficult [ http://www.passop.co.za/news/featured/press-statement ].

A key impediment is the stringent regulatory framework that governs cross-border transfers from South Africa. Exchange control legislation, for example, requires money transfer operators (MTOs) to partner with a bank. According to PASSOP, this has had the effect of stifling competition that would likely reduce transaction costs.  

Legislation intending to counter money laundering and terrorist financing requires that customers provide proof of residence and proof of the source of their funds before they can access financial services. This effectively excludes the many migrants living in informal settlements and those who are paid in cash. 

PASSOP found that even among migrants who do have access to banks and MTOs like Western Union and MoneyGram, many lack the financial literacy to make use of them. 

“Some have just come from rural areas in Zimbabwe, so it takes time for them to know about such things,” said Maromo, adding that lack of documentation was another major obstacle. “If you’re undocumented, you can’t go through the banks.”

Three-quarters of the Zimbabwean migrants interviewed by PASSOP relied instead on “informal” remittance channels, such as giving money or goods to bus drivers, friends or agents to send home. This is often not much cheaper than using banks or MTOs, and it is significantly riskier. Of the respondents who used such methods, 84 percent reported negative experiences, including theft of their money, loss or destruction of their goods and long delays in remittances reaching intended recipients. 

Maromo relayed his own experience sending money home through an agent who charged a 15 percent commission to channel the money through his South African bank account before handing it over to Maromo’s relatives in Zimbabwe. “Some time ago, I nearly lost 2,000 rand ($225) because I deposited it in [the agent’s] account and he was saying he didn’t have it and giving excuses. In the end, we got the money, but it cost us nearly 1,000 rand ($113) in airtime calling Zimbabwe,” he said.

“Some are using bus drivers or those people who are going home, and you have to trust them because you’re desperate, but there can be a lot of problems,” he added. “There are a lot of people whose money just disappears. Almost on a daily basis, you hear those stories.”

Lowering transaction fees

Now, Maromo uses a UK-based online transfer service called Mukuru.com, which is popular with many Zimbabweans living overseas. The proof of residence and source of funds requirements are the same as for traditional MTOs, but the site charges 10 percent on transfers from South Africa to Zimbabwe - less than most banks. 

The South African Reserve Bank and the treasury have committed to bringing the cost of remittances down to 5 percent by relaxing regulations for smaller money transfers, negotiating with regulators in the Southern African Development Community on exchange control regulations, and removing the requirement that MTOs partner with banks.

However, at the time of writing, the Reserve Bank has not yet responded to questions from IRIN about how these changes will be implemented and within what timeframe.

Rob Burrell, director of Mukuru.com, said achieving the 5 percent target would be tough considering the numerous costs that MTOs have to cover, including fees paid to the companies that collect and pay out the money, the cost of supporting transactions through a call centre, and licensing and reporting requirements. “We would need everyone pulling together,” he said.

Burrell noted that less stringent laws governing MTOs in the UK mean more competition but much weaker anti-money laundering controls. To operate in South Africa, Mukuru.com has to comply with the regulation that they partner with a local banking license holder.

“In the UK, it’s easier to obtain your license. There are 4,000 [MTOs operating in the UK] compared to 12 in South Africa, but the downside is that it’s very difficult to police them all,” he told IRIN. “My last audit in the UK was four years ago because they can’t handle the volume of licenses.”

ks/rz

]]></body><link>http://www.irinnews.org/Report/97557/African-migrants-pay-high-prices-to-send-money-home</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2009/200909291220100610t.jpg"/></td><td valign="top">JOHANNESBURG 27 February 2013 (IRIN) - New data from the World Bank has revealed that African migrants pay more to send money home to their families than any other migrant group in the world.</td></tr></table>]]></content:encoded></item><item><title>Mali a “wake-up call” for drug trafficking, says think tank</title><pubDate>Tue, 05 Feb 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201210101110200256t.jpg" />]]>ACCRA 05 February 2013 (IRIN) - At the launch of a Ghana-based Commission on the Impact of Drug-Trafficking on Governance, Security and Development in West Africa, its chair, former Nigerian President Olusegun Obasanjo, said the situation in Mali should serve as a “wake-up call” to the perils of allowing organized crime to escalate out of control.</description><body><![CDATA[ACCRA 05 February 2013 (IRIN) - At the launch of a Ghana-based Commission on the Impact of Drug-Trafficking on Governance, Security and Development in West Africa, its chair, former Nigerian President Olusegun Obasanjo, said the situation in Mali should serve as a “wake-up call” to the perils of allowing organized crime to escalate out of control.

He described the country’s north as a “den of drug trafficking, extremism and criminality”.

Several research groups have reported that traffickers have linked up with extremist groups in the Sahel region, who use the profits to purchase weapons and fund radical activities. Al-Qaeda in the Islamic Maghreb (AQIM) has partially funded its activities in northern Mali over the past decade through profits from drug and cigarette trafficking and hostage ransoms, according to a 2012 report by the African Center for Strategic Studies [ http://africacenter.org/acss-publications/security-briefs/ ].

Analysts estimate around 60 tons of cocaine are trafficked through West Africa each year, while the UN Office on Drugs and Crime (UNODC) estimates 400kg of heroin was trafficked through the region in 2011. The trade [ http://www.unodc.org/unodc/en/frontpage/2012/February/executive-director_-west-africa-challenged-by-rapidly-evolving-transnational-threats.html ] brings in an estimated US$900 million per year to criminal networks, says UNODC.

Some 15 percent of the cigarettes smoked in the region are bought on the black market and trafficked through West Africa, according to UNODC. AQIM and to some extent splinter-group Movement for Oneness and Jihad in West Africa (MUJAO) have been taxing traffickers in return for safeguarding their passage.

“Organized criminal networks are deeply involved in the trafficking. Experience elsewhere in the world suggests that these groups will try to infiltrate political, security and financial institutions to secure their profits,” former UN Secretary-General Kofi Annan told the audience at the launch of the Commission in Ghana’s capital last week.

Over the last decade many West African states have made gains to consolidate peace and economic growth: the region is set to provide the US with 25 percent of its oil needs in 2015 - but drug-trafficking threatens this progress, said Annan.

Most of the cocaine is transported from South America to Europe, using air and sea routes; while opiates tend to come from Pakistan and Afghanistan.

Drugs are also increasingly being manufactured in the region. The police recently discovered methamphetamine laboratories [ http://www.unodc.org/documents/scientific/ATS_West_Africa_final_2012.pdf ] in Nigeria, according to UNODC. 

Growing drug dependency

There are now as many as 2.3 million cocaine users in West and Central Africa, and methamphetamine and heroin use are on the rise, UNODC reported in 2012. “The evidence points to a growing problem of dependency that needs urgent attention in our region,” Obasanjo said.

Annan pointed out: “West Africa initially was seen as a transit point but no country remains a transit point for long. The population begins to use it.”

The 10-member Commission intends to raise awareness of the impact of the drug trade, advise political leaders, and develop policy recommendations to help leaders deal with drug-trafficking.

West Africa is an ideal environment for drug traffickers with its extensive porous borders, weak and easily corruptible institutions, and pre-existing criminal networks. In these poor nations it is easy to buy off low-paid and disenchanted officials and security personnel: “The police are bribed. Now, in a fairly poor African country, US$100 to a police constable is a lot of money. All he has to do is turn his eyes,” said Obasanjo.

He added that criminal networks can easily smuggle goods through the region, buying off officials and security personnel at borders, as they move through remote regions of the Sahel and the Sahara desert.

Fluid networks

Criminal trafficking networks are international and very mobile, which makes it difficult to crack down on them, says the UNODC. Local and foreign criminal networks with access to massive resources work together to transport drugs through the region, adapting their operations in response to law enforcement efforts, according to an April 2012 joint report [ http://kofiannanfoundation.org/sites/default/files/Final%20Report%20of%20WADW%208%20Juin%202012.pdf ] by the Economic Community of West African States (ECOWAS), the Center on International Cooperation, the Kofi Annan Foundation and the Kofi Annan International Peacekeeping Training Centre. 

“West African organized criminal networks operate cells worldwide to facilitate the supply of goods, with Diaspora communities playing important roles (e.g. Nigerian Diaspora in Brazil). Like criminal groups elsewhere, they infiltrate or threaten political elites and dispirited public servants to protect and expand their business,” the report said.

As the myriad abandoned construction sites in many West African states make clear, traffickers also extensively operate fronts to launder their profits, creating “shell companies” in the construction and mining sectors, as well as rental car companies.

The government and security forces of Guinea-Bissau have already largely been taken over by drug trafficking networks, earning it the moniker of “narco-state.” [ http://www.irinnews.org/Report/80865/GUINEA-Drug-trade-potentially-more-dangerous-than-Guinea-Bissau ]

AQIM members reportedly met Colombian drug lords in Guinea-Bissau, according to a 2010 report [ http://www.sahel-intelligence.com/2417-article145.html ] by France-based research group Sahel Intelligence. While the trade allegedly continues to flourish in Guinea-Bissau, networks have also gradually moved along the coast and inland through the Sahel, Annan said. “We didn’t act early enough when the problem started in Guinea-Bissau. That was the entry point and it’s now spread along the coast - and through the Sahel to Europe and by ship and by plane,” Annan told reporters. Other initiatives are way to try to quell the impact of drug-trafficking in the region, including an ECOWAS plan to address the challenges of trafficking.  

UNODC recently teamed up with the World Customs Organization to improve communications between police and airports.

The Commission will deliver a report and submit policy recommendations to regional leaders by the end of 2013.

lb/aj/cb

]]></body><link>http://www.irinnews.org/Report/97412/Mali-a-wake-up-call-for-drug-trafficking-says-think-tank</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201210101110200256t.jpg"/></td><td valign="top">ACCRA 05 February 2013 (IRIN) - At the launch of a Ghana-based Commission on the Impact of Drug-Trafficking on Governance, Security and Development in West Africa, its chair, former Nigerian President Olusegun Obasanjo, said the situation in Mali should serve as a “wake-up call” to the perils of allowing organized crime to escalate out of control.</td></tr></table>]]></content:encoded></item><item><title>In Brief: Staples, not export crops, key to tackling Africa’s poverty – report</title><pubDate>Fri, 18 Jan 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201202241255060114t.jpg" />]]>NAIROBI 18 January 2013 (IRIN) - Africa could reduce its poverty levels faster by focusing more on the production of staples rather than export crops, according to a study by the International Food Policy Research Institute (IFPRI).</description><body><![CDATA[NAIROBI 18 January 2013 (IRIN) - Africa could reduce its poverty levels faster by focusing more on the production of staples rather than export crops, according to a study [ http://www.ifpri.org/sites/default/files/publications/ib73.pdf ] by the International Food Policy Research Institute (IFPRI).

Authors of the study, conducted in 10 countries south of the Sahara, noted, “One important finding is that producing more staple crops, such as maize, pulses and roots, and more livestock products tends to reduce poverty further than producing more export crops such as coffee or cut flowers.”

According to the study, while more public resources would be required to generate more agricultural growth, “such public investment in staple sectors is probably cost effective”.

The authors argued that growth in the staple sector was more likely to benefit the poor than growth in the agricultural export sector.

Enoch Mwani, an agricultural economist at the University of Nairobi, concurred. “The agricultural export sector is generally associated with large corporations, but the poor rely predominantly on staples to survive.”

Mwani added that growth in staples had the effect of not only reducing poverty but also ensuring food security.

“[Governments that] invest in staples have the opportunity to increase food availability and, at the same time, create wealth for smallholders,” Mwani told IRIN.

To spur development in sub-Saharan Africa, the study’s policy conclusions call for a focus on accelerating agricultural growth; promoting growth in large agricultural subsectors; supporting growth across several agricultural subsectors; and promoting growth in subsectors with strong linkages to the overall economy and the poor.

ko/rz

]]></body><link>http://www.irinnews.org/Report/97278/In-Brief-Staples-not-export-crops-key-to-tackling-Africa-s-poverty-report</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201202241255060114t.jpg"/></td><td valign="top">NAIROBI 18 January 2013 (IRIN) - Africa could reduce its poverty levels faster by focusing more on the production of staples rather than export crops, according to a study by the International Food Policy Research Institute (IFPRI).</td></tr></table>]]></content:encoded></item><item><title>HEALTH: How we live and die</title><pubDate>Fri, 14 Dec 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2011/201112300914140084t.jpg" />]]>LONDON 14 December 2012 (IRIN) - We all know we are going to die, but how and when it happens depends largely on who we are and where we live. We think we know the major risks - perhaps malaria or AIDS-related diseases in Africa, or stroke, cancer and heart disease in North America and Western Europe. But, in fact, patterns of mortality and morbidity are rapidly changing around the world.</description><body><![CDATA[LONDON 14 December 2012 (IRIN) - We all know we are going to die, but how and when it happens depends largely on who we are and where we live. We think we know the major risks - perhaps malaria or AIDS-related diseases in Africa, or stroke, cancer and heart disease in North America and Western Europe. But, in fact, patterns of mortality and morbidity are rapidly changing around the world. 

This was the revelation of more than five years of data collection and analysis, which culminated in the recent publication of the Global Burden of Disease Study 2010 [ http://www.thelancet.com/themed/global-burden-of-disease ]. Led by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), the study involved 486 authors from 50 countries. 

Peter Piot, the director of London’s School of Hygiene and Tropical Medicine, said the speed of change has taken researchers by surprise. “It’s going much faster than I think that we all thought. But there is also enormous diversity.” 

Good and bad news 

The study reveals that people can expect to live longer - in some cases, dramatically longer. Overall life expectancy worldwide has increased by more than a decade since 1970. The Indian Ocean island nation of Maldives has shown the most striking improvement: a woman there in the 1970s lived on average to 51; now the average lifespan increased by three decades. 

But there were also disappointments. The big one, said Chris Murray, IHME’s director, is that health gains have been uneven. 

“These rapid transformations in health don’t seem to translate into a change in the leading causes of [disease] burden in sub-Saharan Africa. We have quantified considerable progress there. Child mortality rates are down quite substantially. There’s progress - especially since 2004 - in reducing HIV-related death. There’s progress in reducing malaria due to the scale-up of bed nets and artemisinin-combination therapy. But despite that progress, 65 to 70 percent of the burden of ill-health is still related to MDGs [Millennium Development Goals] four, five and six,” he said, referring to the MDGs to significantly reduce child mortality, improve maternal health, and combat HIV, malaria and other diseases by 2015. 

“For me,” Piot told IRIN, “the key is: let’s not assume that the MDGs, as they are now, will all be achieved by 2015, that we can drop that and then move on with a completely blank sheet. That would be a disaster. And that’s what’s in the pipeline, I am sorry to say.” 

Changing trends 

The researchers noted a shift away from infectious diseases as a cause of death towards non-communicable [ http://www.irinnews.org/Report/95570/HEALTH-Fighting-non-communicable-diseases ] diseases such as cancer, stroke and heart disease - often called “lifestyle” diseases. Among communicable diseases, only AIDS and, to a lesser extent, malaria have increased since 1990, primarily in sub-Saharan Africa. 

Now only 25 percent of deaths globally are due to infectious diseases and maternal, neonatal and nutritional causes. More than 65 percent are due to non-communicable conditions, and just under 10 percent are related to injuries, the bulk of them happening on increasingly deadly roads in the world’s poorest places [ http://www.irinnews.org/report/96498/SOMALIA-Grappling-with-road-accidents-toll ].

Irene Agyepong, from University of Ghana’s public health school, said countries in Africa are increasingly facing the dual burden [ http://www.irinnews.org/Report/86490/AFRICA-Fighting-the-double-whammy-of-obesity-and-hunger ] of fighting “old” as well as “new” diseases. 

“Two years ago, we looked at the data from Greater Accra [the capital area]… which is about 90 percent urban now. And we realized that hypertension had moved to number two among the common causes of outpatient attendance and was a leading cause of death, which is very different from the rest of the country,” she said. “And I was discussing with a colleague that we should start research into cardiovascular disease in low- and middle-income countries, and he was still saying, ‘Why on earth would you do that? It’s not a problem.’” 

Data 

Data-keeping has surfaced as one of the biggest challenges countries face in setting targets to reduce non-communicable diseases. 

Only about two-thirds of the world’s countries have “vital” registration systems that record births and deaths sufficiently to estimate death rates from various causes, according to World Health Organization (WHO). WHO noted in March that 74 countries lacked data on cause of death, while another 81 countries had only lower-quality data. 

The IHME-led team said that while researchers have, until now, only occasionally conducted such global disease burden studies [ http://www.who.int/topics/global_burden_of_disease/en/ ], they hope to keep the database updated and freely available. They have also provided a set of interactive tools [ http://www.healthmetricsandevaluation.org/tools/data-visualizations ] that present information by different categories, including region and population segment. They plan to add a country filter next year. 

eb/pt/rz 

]]></body><link>http://www.irinnews.org/Report/97048/HEALTH-How-we-live-and-die</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2011/201112300914140084t.jpg"/></td><td valign="top">LONDON 14 December 2012 (IRIN) - We all know we are going to die, but how and when it happens depends largely on who we are and where we live. We think we know the major risks - perhaps malaria or AIDS-related diseases in Africa, or stroke, cancer and heart disease in North America and Western Europe. But, in fact, patterns of mortality and morbidity are rapidly changing around the world.</td></tr></table>]]></content:encoded></item><item><title>WEST AFRICA: Defining piracy in the Gulf of Guinea</title><pubDate>Mon, 10 Dec 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2011/201111011217240688t.jpg" />]]>LONDON 10 December 2012 (IRIN) - In July last year President Boni Yayi of Benin sent a worried letter to the UN secretary-general. His country was being threatened by the activities of pirates, who were scaring shipping away from the ports on which his country&apos;s revenues depend. He wanted international help of the kind which had been deployed against piracy off the coast of Somalia.</description><body><![CDATA[LONDON 10 December 2012 (IRIN) - In July last year President Boni Yayi of Benin sent a worried letter to the UN secretary-general. His country was being threatened by the activities of pirates, who were scaring shipping away from the ports on which his country's revenues depend. He wanted international help of the kind which had been deployed against piracy off the coast of Somalia.

His letter put the issue of piracy off the West African coast onto the world agenda. The attacks continue and still cluster in the vicinity of Benin and its neighbour, Nigeria [ http://www.icc-ccs.org/piracy-reporting-centre/live-piracy-map ], but despite UN missions and a Security Council debate, the international community is still unsure of the best way to proceed.

On 6 December Coventry University organized a conference on Maritime Security in the Gulf of Guinea, in collaboration with London's Chatham House. One thing which emerged very clearly from the sessions was that what is being called piracy in this area is very different from piracy off the East African coast, and the kind of international naval deployment used against Somali pirates is unlikely to help.

In fact Chris Trelawny, deputy director of the Maritime Safety Division at the International Maritime Organization (IMO), suggested that most of what was going on in West African waters was not really piracy at all, within the meaning of the international conventions. "Piracy is defined as happening `outside the jurisdiction of any state', so outside 12 miles is piracy. If it's inside 12 miles we classify that as armed robbery against ships. The difference is jurisdiction. Piracy is a universal crime and states have an obligation to intervene. Inside 12 miles it is the coastal state's responsibility." 

Of the attacks which have been reported to IMO over the past 10 years, only a minority, 108, have happened in international waters: 170 were within territorial waters and 270 actually took place in port. So these are crimes taking place within national jurisdiction, and even though some of the coastal states of West Africa have states and judicial systems which are quite weak, there is no void of authority, like that in Somalia.

Few prosecutions

Using an international naval task force to address the problem is inappropriate in other ways too. Navies can be very good at deterring pirates, or chasing them and recovering stolen weapons and cargo, but they are not designed or trained to collect evidence and process criminals for prosecution. 

One of the speakers at Chatham House was Tony Attah from Shell Nigeria, a company which has suffered severely from maritime crime, sometimes losing whole cargoes of crude oil to pirates. Nigeria has a joint military task force which is now mandated to tackle oil theft but Attah is frustrated by the results. "We are aware that over 1,000 illegal refineries have been destroyed through the efforts of the navy, and a number of tankers full of stolen crude have been seized in high profile raids, but despite the increased focus to date, we are not aware of a single thief being prosecuted or convicted. The big barons behind this criminality walk free."

The oil industry, much of it offshore, is one of the main lures for maritime criminals in the area. And, says Attah, this is not petty crime. "I can tell you this is a well-financed criminal phenomenon, a parallel industry, with a well-developed supply chain and growing sophistication. It includes trained engineers who weld valves to high pressure pipelines, boatyards which construct and supply barges."

Oil is also the reason why the issue is of wider international significance. The region supplies around 40 percent of Europe's oil and 29 percent of that consumed by the USA. Keeping these shipping lanes open and safe is vital for world supply. The outside world is ready to offer some help - both the British Navy and the US Africa Command were represented at the meeting. Both have offered training and capacity building to West African navies and coast guards. 

For these national forces to work together is clearly important because the criminals are so mobile. One speaker likened fighting piracy in the region to sitting on a balloon - push down on one side and it pops up at the other; push on the other side and it pops up somewhere else. Joint military patrols by the Nigerian and Beninois navies reduced attacks in their own waters, but moved the pirates' attention to Togo and Côte d'Ivoire. 

So far that has been the only joint action; apart from that, regional cooperation has mostly involved meetings and seminars, held by regional bodies.

Information gap

One of the major gaps is a lack of information, highlighted at the meeting by Lt-Cmdr Stephen Anderson of the UK's Royal Navy whose ship, the Dauntless, recently returned from a patrol in the Gulf of Guinea, and who had clearly been very struck by the near impossibility of finding out which ships were meant to be there, and which were suspect vessels.

There is a sense at the moment that the region and its international allies are still feeling their way. Piracy off the west coast of Africa is not yet at the same level as that that off Somalia to the east, but there is a clear concern that it could escalate. 

The deputy executive secretary of the Gulf of Guinea Commission, Ambassador Florentina Ukonga, addressed a heartfelt appeal to all those concerned. "With the right combination of efforts. to achieve a common legal framework for the arrest and prosecution of criminals, adequate financial investment and capacity building - piracy can be reduced to a bare minimum.

eb/cb

]]></body><link>http://www.irinnews.org/Report/97004/WEST-AFRICA-Defining-piracy-in-the-Gulf-of-Guinea</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2011/201111011217240688t.jpg"/></td><td valign="top">LONDON 10 December 2012 (IRIN) - In July last year President Boni Yayi of Benin sent a worried letter to the UN secretary-general. His country was being threatened by the activities of pirates, who were scaring shipping away from the ports on which his country&apos;s revenues depend. He wanted international help of the kind which had been deployed against piracy off the coast of Somalia.</td></tr></table>]]></content:encoded></item><item><title>IDPs: African IDP Convention comes into force</title><pubDate>Thu, 06 Dec 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2008/200807227t.jpg" />]]>NAIROBI 06 December 2012 (IRIN) - The African Union Convention for the Protection and Assistance of Internally Displaced Persons (IDPs) 2009, also known as the Kampala Convention, came into force on 6 December; it is the world’s first legally binding instrument to cater specifically to people displaced within their own countries.</description><body><![CDATA[NAIROBI 06 December 2012 (IRIN) - The African Union Convention for the Protection and Assistance of Internally Displaced Persons (IDPs) 2009, also known as the Kampala Convention, came into force on 6 December; it is the world’s first legally binding instrument to cater specifically to people displaced within their own countries.

Adopted at an AU summit in the Ugandan capital, Kampala, the Convention [ http://www.africa-union.org/root/au/Conferences/2009/october/pa/summit/doc/Convention%20on%20IDPs%20(Eng)%20-%20Final.doc ] required ratification by 15 member countries before it could enter into force; Swaziland became the 15th country to do so on 12 November, joining Benin, Burkina Faso, Central African Republic, Chad, Gabon, Gambia, Guinea-Bissau, Lesotho, Niger, Nigeria, Sierra Leone, Togo, Uganda and Zambia. At least 37 AU members have also signed [ http://www.internal-displacement.org/8025708F004BE3B1/(httpInfoFiles)/979113CFF0292E97C1257ACB006315D4/$file/map-au-signed-ratified-countries-with-numbers.pdf ] the Convention but have yet to ratify it.

Among other things, the Convention aims to "establish a legal framework for preventing internal displacement, and protecting and assisting internally displaced persons in Africa".

UN High Commissioner for Refugees Antonio Guterres hailed the development as "historic" and said in a statement that the Convention "puts Africa in a leading position when it comes to having a legal framework for protecting and helping the internally displaced".

Stephen Oola, a transitional justice and governance analyst at Uganda's Makerere University Refugee Law Project, noted that the most important parts of the Convention were the clauses relating to the prevention of internal displacement. "The principle requiring the prevention of IDPs is absolutely necessary and should be the guiding principle for all state and non-state actors implementing the Convention," he said.

Just the beginning

Oola also stressed the need for the letter of the law to be translated into practice.

"In Uganda, we have had an IDP policy since 2004, but in many cases we find that the government still seems ill-prepared to deal with displacement," he said. "The existence of a law is rarely the conclusion of a policy... It will be important for this continental commitment to be matched by action on the ground for people who, for one reason or another, find themselves displaced," he said.

Africa has 9.7 million IDPs, according to the UN Refugee Agency, UNHCR. The Democratic Republic of Congo, Somalia and Sudan collectively have more than five million IDPs.

Noting that the situation of IDPs can affect the stability of states, UN Special Rapporteur on the Human Rights of Internally Displaced Persons Chakola Beyani said the Convention could "contribute to stabilizing displaced populations through the specific obligations it sets out to states and other actors, such as obligations relating to humanitarian assistance, compensation and assistance in finding lasting solutions to displacement as well as accessing the full range of their human rights".

"The unique 'added value' of this Convention stems from how comprehensive it is and the manner in which it addresses many of the key challenges of our times and, indeed, of Africa," he said in a statement. "If implemented well, it can help states and the African Union address both current and potential future internal displacement related not only to conflict, but also natural disasters and other effects of climate change, development, and even megatrends such as population growth and rapid urbanization."

The International Displacement Monitoring Centre (IDMC) [ http://www.internal-displacement.org/kampala-convention ] noted that, while the Convention signalled an important step in addressing the plight of IDPs, many countries were not legally bound by it.

"The countries which have not yet adopted the Convention must do so, as a legal framework is the very basis of ensuring the rights and well-being of people forced to flee inside their home country," Sebastian Albuja, head of IDMC's Africa department, said in a statement.

According to Nuur Sheekh, board member of the Kenya-based Internal Displacement Policy and Advocacy Centre [ http://www.idpacafrica.org/ ], some states expressed reservations about signing the Convention because "the issue of displacement is highly politicized, and some states saw it as a criticism of their human rights and governance records". He noted, however, that the Convention would have an influence, even on those countries that have not signed or ratified it.

"The AU will now also be able to use the Convention for advocacy, to encourage member states - even those who have not ratified it - to implement its principles... Kenya, for instance has not signed it but has developed an IDP policy that borrows heavily from the Kampala Convention," he told IRIN. "States now need to domesticate the Convention and develop IDP policies that reach from the central government to all lower levels of government so that the Convention can work in practice."

kr/rz

]]></body><link>http://www.irinnews.org/Report/96984/IDPs-African-IDP-Convention-comes-into-force</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2008/200807227t.jpg"/></td><td valign="top">NAIROBI 06 December 2012 (IRIN) - The African Union Convention for the Protection and Assistance of Internally Displaced Persons (IDPs) 2009, also known as the Kampala Convention, came into force on 6 December; it is the world’s first legally binding instrument to cater specifically to people displaced within their own countries.</td></tr></table>]]></content:encoded></item><item><title>HEALTH: Breaking out of the cold chain</title><pubDate>Tue, 20 Nov 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2009/200904201848030218t.jpg" />]]>DAKAR 20 November 2012 (IRIN) - Health workers currently immunizing thousands of children and young adults against Meningitis A in Benin are currently doing so without having to spend days preparing ice packs and sourcing generators and fridges to load on trucks because the vaccine has now won approval for being kept at up to 40 degrees Celsius for as long as four days.</description><body><![CDATA[DAKAR 20 November 2012 (IRIN) - Health workers currently immunizing thousands of children and young adults against Meningitis A in Benin are currently doing so without having to spend days preparing ice packs and sourcing generators and fridges to load on trucks because the vaccine has now won approval for being kept at up to 40 degrees Celsius for as long as four days.

Before, like almost all vaccines, the Meningitis A vaccine (marketed in Africa as MenAfricVac) was only licensed for use if kept at temperatures of 2-8 degrees Celsius.

The breakthrough follows years of rigorous testing of the effect of heat on the vaccine by the regulator Drugs Controller General of India, Health Canada [ http://www.hc-sc.gc.ca/ahc-asc/index-eng.php ], and the World Health Organization (WHO) Vaccines pre-qualification programme [ http://apps.who.int/prequal/ ].

As a result, very remote populations will access the vaccine more easily, the logistics of vaccine campaigns will be simpler, and vaccine campaign costs will drop both for partners and for national governments, said Michel Zaffran, coordinator of WHO’s Expanded Programme on Immunization (EPI) [ http://www.who.int/immunization_delivery/en/ ], and Marie-Pierre Preziosi, director of the meningitis Vaccine Project, a partnership between international NGO PATH [ http://www.path.org/ ] and WHO.

Costs will not drop significantly immediately, but will diminish as more vaccines are relicensed, says WHO. Cost implication studies are under way in northern Benin and Chad. 

While cold chain limitations do not tend to limit coverage, they do overburden health workers, says WHO. 

Even industrialized country vaccine campaigns have trouble sticking to the cold chain, and each year thousands of vaccines are thrown away due to cold chain failure, even if the vaccine might still have been unaffected, according to WHO. 

“This is a breakthrough,” said Zaffran. “It is the first vaccination ever to be licensed for use in a developing country with the flexibility to take us out of the rigid temperature structure. It is a great simplification of logistics. And it opens the door for other manufacturers to follow suit.”

Why so long?

But the vaccine is nothing new - merely the license has changed following analysis of years of data on the vaccine’s stability - that is, how well it can withstand temperature rises and other conditions.

“The potential for some vaccines to remain safely outside the cold chain for short periods of time has been widely known for over 20 years,” said Zaffran in a recent communiqué. “But this is the first time a vaccine intended for use in Africa has been tested and submitted to regulatory review and approved for this type of use.”

It took decades to get here because agencies got stuck in a mindset, said Zaffran. The EPI was set up in the 1970s to immunize as many children against diseases as quickly as possible, and put in place simple rigid rules to avoid risk: one of which was to keep vaccines cold. “It was quite difficult to move away from this mentality,” said Zaffran.

Regulators and manufacturers are “very conservative in order to protect the population,” said Preziosi. “It took a while for all the documentation to be gathered to convince them to go ahead.” 

Strict controls remain: “This is not a “green light to do anything with a vaccine - it still needs to be kept… at no more than 40 degrees, for any more than four days," stressed Zaffran.

Hepatitis B next?

“The momentum is there. I am quite confident that within the next year or two, we’ll have one or two more re-licensed in this way,” he said.

Analysis on the heat stability of Hepatitis B and HPV [ http://www.cdc.gov/hpv/whatishpv.html ] (human papillomavirus) vaccines is under way; next on the list are yellow fever, rotavirus and pneumococcal disease. 

Even the oral polio vaccine - one of the most heat-sensitive vaccines - was shown to be stable when the cold chain broke down in a part of Chad, according to a recent study though WHO was emphatic that rather than licensing the vaccine it will gradually be phased out as progress towards eradication inches along. 

Meningitis progress

The MenAfricVac, which costs just under 50 US cents per dose, was designed for use in the 26 countries that span the African meningitis belt, from Senegal to Ethiopia. 

Some 100 million people aged 1-29 across 10 countries have been vaccinated thus far; a further 16 countries are planned between now and 2016. 

Early results have been very positive: Burkina Faso [ http://www.irinnews.org/Report/92985/WEST-AFRICA-Meningitis-cases-dramatically-down ] has had the lowest level of epidemic meningitis in 15 years, and the campaign is achieving “herd immunity” - that is, those either too old or too young to have received the vaccine have also been shown to be clear of the bacteria. 

Meningitis A could be eliminated in the meningitis belt if the mass campaign continues, says Preziosi, and if governments then incorporate it in their routine immunization programmes. 

But more funding beyond the US$160 million from the GAVI Alliance [ http://www.gavialliance.org/ ], and contributions from national governments, will be needed to complete the campaign, she warns. 

aj/cb

]]></body><link>http://www.irinnews.org/Report/96827/HEALTH-Breaking-out-of-the-cold-chain</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2009/200904201848030218t.jpg"/></td><td valign="top">DAKAR 20 November 2012 (IRIN) - Health workers currently immunizing thousands of children and young adults against Meningitis A in Benin are currently doing so without having to spend days preparing ice packs and sourcing generators and fridges to load on trucks because the vaccine has now won approval for being kept at up to 40 degrees Celsius for as long as four days.</td></tr></table>]]></content:encoded></item><item><title>SECURITY: Is Africa&apos;s maritime strategy all at sea?</title><pubDate>Mon, 22 Oct 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2011/201103250926300595t.jpg" />]]>JOHANNESBURG 22 October 2012 (IRIN) - The African Union’s (AU) deadline for securing the continent’s territorial waters - the world’s last major geographical region without a maritime strategy - has been set at 2050, a target that may prove untenable.</description><body><![CDATA[JOHANNESBURG 22 October 2012 (IRIN) - The African Union’s (AU) deadline for securing the continent’s territorial waters - the world’s last major geographical region without a maritime strategy - has been set at 2050, a target that may prove untenable. 

Without a comprehensive strategy to police, patrol and promote the maritime economy and resources along its 42,000km coastline, Africa loses billions of dollars in revenue annually and leaves itself vulnerable to myriad criminal activities. 

“Africa remains the continent that suffers most from illegal and unregulated fishing, maritime terrorism, piracy and armed robbery at sea, poor legal and regulatory maritime regimes, illegal drugs, arms and human trafficking, a lack of effective communication and other technological maritime requirements, and last but not least, unsuitable ships and ports,” Annette Leijenaar, Head of the Conflict Management and Peacebuilding Division at the Institute for Security Studies (ISS), a Pretoria-based think tank, said in a recent policy brief titled Africa Should Wake up to the Importance of an Integrated Maritime Strategy [ http://www.issafrica.org/iss_today.php?ID=1552 ]. 

A meeting on the Africa Integrated Maritime (AIM) strategy was held earlier this month in the Ethiopian capital Addis Ababa. Leijenaar told IRIN, “It is the right direction, however, action is required through implementable plans that are well coordinated and have the political commitment of African leaders.” The AU will also address management of riverine systems, dams and wetlands. 

“Like the rest of the world, more than 90 percent of Africa’s imports and exports are carried by sea. If one includes the illegal market in military arms and logged forest products, Africa has a maritime economy estimated at US$1 trillion a year, representing 90 percent of its overall commerce,” the policy brief said. 

Of Africa’s 54 states, 38 are either coastal or island nations. Johan Potgieter, a former captain in the South African navy and senior ISS security sector researcher - referring to neglect of maritime opportunities and risks - told IRIN, “Sea blindness is our [Africa’s] biggest threat.” 

No defence 

Some 70 percent of the continent’s rapidly growing population - which currently stands at over one billion people - depend on fish, both inland and coastal, for protein, highlighting the importance of policing and managing the continent’s territorial waters. 

“I said to a politician, don’t look at what it’s going to costs you to run a navy. You need to say, ‘What is it going to cost me to feed this population when there are no more fish? Where I am going to get the food from?’” Potgieter said. 

An October report by the Environmental Justice Foundation, Pirate Fishing Exposed: The Fight Against Illegal Fishing in West Africa and the EU [European Union] [ http://ejfoundation.org/sites/default/files/public/Pirate%20Fishing%20Exposed.pdf ], observed, “Global losses due to Illegal, Unreported and Unregulated (IUU) or ‘pirate fishing’ are estimated to be between $10 billion and $23.5 billion per year. West African waters are estimated to have the highest levels of IUU fishing in the world, representing up to 37 percent of the region’s catch.” 

Foreign trawlers have been known to illegally haul up hundreds of tons of fish per day for export to Europe, while local fishermen’s catch is typically limited to what they can bring up with 8m-long pirogues. 

Anti-piracy operations off the Horn of Africa in 2011 cost an estimated $6.9 billion, or about two-thirds the annual GDP of Madagascar, an island country that has no naval capacity to speak of. 

Potgieter said the relative success of anti-piracy operations off East Africa is having a “balloon effect of pushing the pirates further and further away [to], we suspect, the east coast of Madagascar, [which] is fairly unpopulated, and the pirates will find a safe haven there to set up bases.” 

Building and maintaining a navy is both a costly and politically fraught exercise. Navies operate out of the sight of the electorate and are easily used by opposition parties in “guns versus butter” debates. Additionally, the procurement of defence systems in Africa has been mired in corruption issues. The price of a naval vessel can start in the hundreds of millions of dollars, and keeping ships on operational duties often requires a compliment of three. The annual running cost for three 80m British Royal Navy patrol vessels is $32 million. 

Helmut Heitman, a defence analyst and correspondent for Jane's Defence Weekly, told IRIN that Mozambique does not have a naval capacity. The “Comoros has nothing. On the west coast [of Africa], there is very little.” 

Expanding navies 

But increasing piracy in the Gulf of Guinea has prompted several countries to acquire patrol vessels in a piecemeal fashion to bolster maritime capacity. Nigeria’s navy has requested the procurement of 49 ships and 42 helicopters over the next decade. Earlier this year, the country commissioned its first locally built 31m patrol craft, the NNS Andoni. 

Neighbouring Ghana acquired two former German Navy fast attack crafts in July, after commissioning four new Chinese patrol boats earlier in the year. Namibia brought in a 100m refurbished Chinese patrol vessel earlier this year, adding to a naval compliment that includes harbour and inshore patrol boats. 

There is also a growing trend towards aerial reconnaissance over the ocean, especially in West Africa, with Ghana and Nigeria acquiring aircraft for monitoring and addressing piracy. 

Heitman said, “It’s not just about buying ships. It takes three generations of officers to build up a competent navy. So 30 years [the 2050 AIM goal] is a reasonable timeframe. [However,] a ship without an aircraft is pointless. An aircraft without a ship is also pointless.” 

The use of unmanned aerial vehicles, or drones, is also finding greater currency as an option for policing territorial waters. Potgieter said, “You don’t need a warship to fight a pirate... If you use a drone, you can have 18 to 24 hours of flight time. But it is not necessarily cheap.” The price tags for drones range from hundreds of thousands to tens of millions of dollars. 

“But you still have to send a boat out to make the arrest, and this is where the problem starts. If we detect something on the other side of Madagascar - collaboration becomes important - and maybe the French are better suited to help… But we have to start talking to one another,” he said. 

Aligning legislation 

Developing coastal security is one step toward protecting continental waters. Creating the required legislation for individual AU members states to cooperate on a continental level presents another set of time-consuming complications. 

“Maritime security and policing management is an inter-departmental/agency function that is extremely difficult to coordinate and achieve. Among other [issues], it requires good governance, an industrial infrastructure, technological competence, effective information-sharing mechanisms and political commitment. Few African countries, if any, meet these requirements,” the ISS policy brief said. 

Leijenaar said developing a domestic maritime strategy involves numerous government departments, from environmental affairs to tourism and defence, and these ministry’s first have to be aligned at a country level, then at a regional level and finally at the continental level. 

Each country has to sift through memoranda of understanding and protocols signed by each department and then change conflicting legislation, “a small task that can take five to ten years,” Potgieter said. “Then [to] get it through [each country’s] parliament - some of these things will take you ten years.” 

And that’s before countries can begin to address the issue of “hot pursuit” through neighbouring territorial waters. “Most countries will still not allow your ships to go through their waters unless you have permission in advance,” Potgieter said. 

“The importance of assuming collective responsibility for Africa's maritime domain (ADM) is essential - within national governments, regions and Africa,” he said. 

go/rz 

]]></body><link>http://www.irinnews.org/Report/96608/SECURITY-Is-Africa-apos-s-maritime-strategy-all-at-sea</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2011/201103250926300595t.jpg"/></td><td valign="top">JOHANNESBURG 22 October 2012 (IRIN) - The African Union’s (AU) deadline for securing the continent’s territorial waters - the world’s last major geographical region without a maritime strategy - has been set at 2050, a target that may prove untenable.</td></tr></table>]]></content:encoded></item><item><title>GHANA: Misery of “prayer camps” for mentally ill</title><pubDate>Thu, 04 Oct 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201210031513410871t.jpg" />]]>ACCRA 04 October 2012 (IRIN) - Doris Appiah, 57, has bipolar disorder. In her early twenties, she was sent to an overcrowded psychiatric hospital followed by a “prayer camp” to be treated. She stayed there for five years, at times tied to a wall or forced to fast. Her story is mirrored by thousands of mentally ill people across Ghana, according to a 2 October Human Rights Watch (HRW) report entitled Like a Death Sentence.</description><body><![CDATA[ACCRA 04 October 2012 (IRIN) - Doris Appiah, 57, has bipolar disorder. In her early twenties, she was sent to an overcrowded psychiatric hospital followed by a “prayer camp” to be treated. She stayed there for five years, at times tied to a wall or forced to fast. Her story is mirrored by thousands of mentally ill people across Ghana, according to a 2 October Human Rights Watch (HRW) report entitled Like a Death Sentence [ http://www.hrw.org/node/110318/section/4 ].

The government is trying to update the country’s mental health care laws, starting with the passing of the 2012 Mental Health Act. The act is supposed to improve access to mental health services and prevent abuse. But HRW says the law does not go far enough as it only addresses the formal health sector rather than community-based mental healthcare needs.

Patients with mental health problems are often kept against their will in overcrowded and unsanitary psychiatric institutions.

Ghana has only three public psychiatric hospitals (all of them in the south), 12 practising psychiatrists, and 600 psychiatric nurses. In one ward of Accra Psychiatric Hospital in the capital, there are just 26 functional beds for 205 in-patients, according to HRW. Nurses, lacking cleaning equipment, “instructed patients to clean the wards and toilets, including removing other patients’ faeces without gloves”, said the researchers.

Without enough staff to properly restrain aggressive patients, staff routinely turn to violence, patients told HRW. Patients reported physical abuse in the form of beatings, forced seclusion and involuntary electro-shock therapy.

One 25-year-old pregnant woman told a group of HRW researchers who visited three institutions and eight prayer camps earlier this year, that while kept in a seclusion room for 12 hours she was beaten by nurses.

Health Ministry spokesman Daniel Osman said he acknowledges that Ghana’s psychiatric hospitals are overcrowded, understaffed, and difficult to access for many people in need, but said progress was being made. “We are making an effort to decentralize [the system] so every regional hospital has a psychiatric unit,” he told IRIN.

The World Health Organization has estimated some 2.8 million people have mental disabilities in Ghana, 650,000 of them severe. The most common problems are schizophrenia, bipolar disorder and major depression, Akwasi Osei, director of Accra Psychiatric Hospital, told HRW. Less common, but prevalent, are drug-related psychosis and epilepsy.

Community stigma

Families send their relatives to such institutions when a mental health crisis becomes acute and often because they feel they have few alternatives: There is little-to-no community care for mental illness in Ghana.

“It is so stigmatizing even to be seen entering the gate of a psychiatric hospital. People will brand you," said Medi Ssengooba, a disability rights research fellow with HRW in New York. “If services were provided in the community, people would go in and seek them freely,” he said, acknowledging it would take time for attitudes to change.

Mental disability in Ghana is widely considered to be caused by evil spirits or demons. When “orthodox” psychiatric treatment does not work, some resort to prayer camps which enact so-called spiritual healing.

Bondage and fasting

In reality, many residents of prayer camps face severe abuse. Aggressive residents are chained up, according to Ssengooba. “Almost everyone we met… was chained to trees or to walls,” including children as young as nine.

Residents are regularly denied food and drink for a three-day period or required to fast 12 hours a day for up to 40 days, as this is thought to rid the body of evil spirits. “I’m really, really hungry and they won’t feed me. I don’t understand… Why can I not eat? They give me porridge at night, but that’s not enough food,” a woman identified as Afia at Mount Horeb Prayer camp in Ghana’s Eastern region told researchers.

Doris Appiah spent 19 years in prayer camps and psychiatric hospitals before being discharged in 1989. “They kept moving me because they were not seeing results, and they were not seeing results because the right thing was not being done,” she told IRIN.

“You think you are human, but people no longer think you are human,” she added.

Residents of both hospitals and prayer camps are often kept against their will”: Prayer camp leaders say they must wait for messages from God before releasing residents, said Ssengooba.

The Ministry of Health’s Osman said the government had little oversight of prayer camps, as they are run by churches.  

Improvements

The situation is improving slowly. Thanks to the disabilities act, people can now challenge their detention in institutions. Access to appropriate medication has also improved over the past 30 years, and several advocacy organizations now lobby to improve the quality of services for the mentally ill.

Appiah has learned to manage her illness with the right medicine and the help of international NGO Basic Needs. [ http://www.basicneeds.org/ ] She now works as the treasurer of the Mental Health Society of Ghana.

But parts of the act still transgress the 2006 Convention on the Rights of Persons with Disabilities (which Ghana has ratified), as it still enables forced admission and treatment in psychiatric hospitals. And there is not enough emphasis on community-based care (providing the mentally ill with housing and health care, for instance) or on monitoring the quality of hospital care, warns HRW.

If quality monitoring worked, some institutions would be forced to cease taking on patients altogether. “If you don’t have the means to house them [mentally ill patients], or to feed them - if the only means you have to constrain an aggressive person is to chain them, that person should not be a service provider,” Ssengooba told IRIN.

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]]></body><link>http://www.irinnews.org/Report/96458/GHANA-Misery-of-prayer-camps-for-mentally-ill</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201210031513410871t.jpg"/></td><td valign="top">ACCRA 04 October 2012 (IRIN) - Doris Appiah, 57, has bipolar disorder. In her early twenties, she was sent to an overcrowded psychiatric hospital followed by a “prayer camp” to be treated. She stayed there for five years, at times tied to a wall or forced to fast. Her story is mirrored by thousands of mentally ill people across Ghana, according to a 2 October Human Rights Watch (HRW) report entitled Like a Death Sentence.</td></tr></table>]]></content:encoded></item><item><title>GHANA-LIBERIA: Limbo for ex-Liberian refugees</title><pubDate>Wed, 03 Oct 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201210031301230244t.jpg" />]]>BUDUBURAM 03 October 2012 (IRIN) - Nathan Pajibo, like thousands of his fellow Liberians, has been living in Buduburam refugee camp near the Ghanaian capital Accra for over two decades after fleeing the civil war in 1990. In June 2012 he lost his refugee status alongside 11,000 Liberians across the region and the camp will soon be handed over to the district assembly, but lingering fear prevents Pajibo from returning.</description><body><![CDATA[BUDUBURAM 03 October 2012 (IRIN) - Nathan Pajibo, like thousands of his fellow Liberians, has been living in Buduburam refugee camp near the Ghanaian capital Accra for over two decades after fleeing the civil war in 1990. In June 2012 he lost his refugee status alongside 11,000 Liberians across the region and the camp will soon be handed over to the district assembly, but lingering fear prevents Pajibo from returning.

“There are people [in Buduburam] who played a major role in the war, some ex-soldiers, ex-rebels. Some hurt a lot of people, some were hurt and they lost hope in Liberia as a country. If all your relatives were killed, the fear is there of returning, no matter who is in power,” he told IRIN. 

Pajibo, now a school headmaster, said a lot of people at Buduburam, 44km west of Accra, remain traumatized by the war. “Take, if an individual’s entire family was wiped out. Even if the UN promises US$500 to go home, it is not an easy thing to get in the plane and go,” he told IRIN.

One of at least 6,000 Liberians still living at Buduburam, he is waiting for the Ghana Refugee Board to process his application. Some 4,000 ex-refugees have applied for local integration, around 1,000 will return to Liberia, and about 1,000 are applying for exemption to remain as refugees, according to the Ghana Refugee Board (GRB).

Frederic Johnson, 43, who fled to Ghana in 1990, is among the minority who feel ready to return. On a recent afternoon he and hundreds of Liberians lined up outside the camp's gate to have their baggage weighed before flying home. “Ghanaians have been very good to us, some of them. Now is the time to go home to rebuild our nation. Liberia is yearning for all her citizens,” he told IRIN.

President Ellen Johnson Sirleaf told global leaders at the UN General Assembly last week that “Liberia has turned the corner,” noting that with 10 years of sustained peace it is no longer a nation of war, fear, destruction and conflict. 

Liberia “safe enough”

GRB programme coordinator Tetteh Padi agrees and is clear about boundaries. “Every refugee situation must come to an end. No one remains a refugee indefinitely,” he told IRIN. “In the case of the Liberian refugees, the international community decided… that conditions back in Liberia were safe enough for those who fled the war [to return home].”

But major problems remain in Liberia, where youth unemployment is skyrocketing and poverty rates are over 75 percent, according to the European Union, and basic services such as health care, education and electricity remain fragile.

Pajibo, echoing the fears of Liberian ex-refugees in western Côte d’Ivoire, [ http://www.irinnews.org/Report/95936/SLIDESHOW-Liberian-refugees-future-uncertain ] sees the ongoing presence of UN peacekeepers in Liberia (UNMIL) as a sign Liberia is not really safe. “If there is no war, why should we have peacekeepers in the country?” he said. 

While anyone without a criminal record is eligible to stay and work in Ghana, it is unlikely that more than a handful of the 1,000 Liberians seeking resettlement in a third country will be successful, said Padi. “It’s simply not an option.”

William Tarloe, now 32, was 16 when he fled his village in eastern Liberia after he witnessed fighters kill his father and try to rape his mother. The attackers spared him his life but stabbed his hand. “They told me they wouldn’t kill me but they would mark me,” he said. He found his sisters and mother in Côte d’Ivoire and they moved as a family to Ghana in 1998 due to insecurity on the Liberian-Ivoirian border. With no education, he mashes and sells cassava leaves to get by. "I want to go somewhere where I can rest my head," he said.

Invisible

A significant number of people in the camp have little choice but to stay as they have no identification cards or paperwork, said Padi. They had either returned to Ghana once they had been repatriated, arrived too late for the initial registration process, or arrived more recently to join relatives or find work. 

Many are Sierra Leonean refugees who stayed in Ghana but were never offered a local integration package as the GRB did not exist at that time. 

Living on the margins of Ghanaian society, there are few opportunities to find work. Nowadays Buduburam no longer resembles a refugee camp but is like any poor Accra suburb, with dilapidated houses, and shops selling clothes and cheap Chinese goods. 

The neighbourhood became associated with crime and lawlessness over the years and police carry out periodic raids to arrest criminals. An unregistered orphanage at the camp was closed down in June 2012 and its managers allegedly arrested for prostituting girls.

Even so, some prefer to stay on the sidelines of Ghanaian society than to return to the past. "All my children grew up here, and I have lived here for more than 20 years," said ex-refugee Regina Johnson. "We want to stay."

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]]></body><link>http://www.irinnews.org/Report/96440/GHANA-LIBERIA-Limbo-for-ex-Liberian-refugees</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201210031301230244t.jpg"/></td><td valign="top">BUDUBURAM 03 October 2012 (IRIN) - Nathan Pajibo, like thousands of his fellow Liberians, has been living in Buduburam refugee camp near the Ghanaian capital Accra for over two decades after fleeing the civil war in 1990. In June 2012 he lost his refugee status alongside 11,000 Liberians across the region and the camp will soon be handed over to the district assembly, but lingering fear prevents Pajibo from returning.</td></tr></table>]]></content:encoded></item><item><title>NIGER: Agencies scramble to repair schools after floods</title><pubDate>Wed, 26 Sep 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201209261300400518t.jpg" />]]>NIAMEY 26 September 2012 (IRIN) - The government of Niger and aid agencies are scrambling to clean and repair thousands of schools that were damaged in the flooding from rains in July and August, which displaced over 500,000 people and killed over 80, in an effort to return children to school as soon as possible.</description><body><![CDATA[NIAMEY 26 September 2012 (IRIN) - The government of Niger and aid agencies are scrambling to clean and repair thousands of schools that were damaged in the flooding from rains in July and August, which displaced over 500,000 people and killed over 80, in an effort to return children to school as soon as possible. 

The worst-hit areas were Dosso in the southwest, Tillabéri in the west and Niamey Region, which includes the capital. Altogether, 150 of the country’s 366 communes were affected, making the floods the worst the country has seen in 80 years, according to Oxfam. [ http://reliefweb.int/report/niger/worst-flooding-more-80-years-affecting-half-million-people-niger ]

The humanitarian response, from both the government and aid agencies, was swift, with thousands of food packages and non-food items distributed, says Modibo Traoré, head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Niger, but recovery needs are now underfunded.

Some 1.5 million people were displaced or had their homes damaged in flooding across West Africa this rainy season, according to OCHA. 

Early recovery needs

The government has an early recovery plan, “but it needs funding,” said Traoré.

Some US$2.5 million from the Central Emergency Response Fund (CERF) has been released for flood response, but none of it has gone to rehabilitate schools, as education is not considered to be “life-saving”.

The UN Development Programme (UNDP) is being given $1 million to rehabilitate 1,000 damaged health centres, most of them in Dosso and Tillabéri.

Schools are supposed to re-open on 27 September, but this will likely be delayed - some by as much as several weeks - say aid workers. “There is lots of work to do. Two weeks is not enough to do it all,” Weifane Ibrahim, Oxfam’s Niger education coordinator, told IRIN.

Displaced families fled to some 80 schools and other public buildings following the floods, but most of these buildings have since been vacated, with families receiving cash vouchers, basic supplies and encouragement to stay with host families. 

“The sooner our schools are freed up, the quicker we can continue class,” said Hima Achana, communication secretary at the National Teachers Union in Niger. 

“Early recovery is the priority now - houses, schools, health centres, community centres, mosques and water points all need to be rebuilt,” stressed Traoré. 

Floods also destroyed some 7,000 hectares of crops, leaving farmers in need of tools and seeds so they can start again. 

Forced resettlement

Too many families have settled in floodplains along the Niger River and must be relocated, says the government. Many block run-off water from the river, exacerbating floods, while some families in the Niamey region have settled on the riverbed itself, which is dry for most of the year.

Niamey Governor Aichatou Boulama Kane has announced that families will be relocated in coming months, noting that the government has designated appropriate locations for them. 

This approach has not worked in the past; in 2010, some 900 families were given $1,000 to relocate, and then ended up just moving back to their original site, which was near the river and thus aided irrigated agriculture. But the government, then transitional, is now more firmly installed and should have more success this time around, Traoré predicted. 

Thousands of Niamey families who lost their homes are calling on the government to help them with temporary shelter and rebuilding. 

At Saga 1, a riverside village on the outskirts of Niamey, many homeless families have settled in with extended family or friends and are waiting for help. “They asked us to leave the schools where we were sheltering, but as of now no one has shown us the site where we’ll be moving,” said Mahamane Issa, 40. 

The government has promised to do so, with the help of its partners.

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]]></body><link>http://www.irinnews.org/Report/96395/NIGER-Agencies-scramble-to-repair-schools-after-floods</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201209261300400518t.jpg"/></td><td valign="top">NIAMEY 26 September 2012 (IRIN) - The government of Niger and aid agencies are scrambling to clean and repair thousands of schools that were damaged in the flooding from rains in July and August, which displaced over 500,000 people and killed over 80, in an effort to return children to school as soon as possible.</td></tr></table>]]></content:encoded></item><item><title>AFRICA: Religious leaders rally for environmental conservation</title><pubDate>Tue, 25 Sep 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201209251205440662t.jpg" />]]>NAIROBI 25 September 2012 (IRIN) - Faced with environmental degradation that threatens the livelihoods of many people in Africa, a group of 50 religious leaders met in Nairobi earlier this month and pledged to take concrete steps to mitigate the effects of climate change.</description><body><![CDATA[NAIROBI 25 September 2012 (IRIN) - Faced with environmental degradation that threatens the livelihoods of many people in Africa, a group of 50 religious leaders met in Nairobi earlier this month and pledged to take concrete steps to mitigate the effects of climate change.

In Kenya, the Anglican Church, with an estimated five million followers, committed to increase the country’s forest cover by 10 percent over the next four years, and to promote soil conservation in 100,000 households.

The Hindu Council of Africa, with an estimated 1.7 million followers, pledged an environmental audit ofits buildings. Other pledges included the development of tree nurseries and adoption of green principles to save energy, made by the Qadiriyyah, Nigeria’s largest Islamic sect and the Anglican Province of South Africa, respectively.

The leaders, drawn from Muslim, Christian and Hindu faiths, launched an action plan to be implemented over the next seven years, which includes, among other things, developing workshops on environmental conservation, ending the use of plastic bags, conducting trainings on sustainable land management and rainwater harvesting, and promoting the conservation of forests.

The leaders came from Cameroon, Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zimbabwe.

Together, the three faiths have an estimated 184 million followers living in some of the world’s poorest regions, where people are particularly vulnerable to the effects of climate change.

One Earth

The three-day meeting, themed ‘Many Heavens, One Earth, Our Continent’ was organized by the Africa Biodiversity Collaborative Group and funded by the World Bank, the US Agency for International Development and the Norwegian government.

Mounkaila Goumandakoye, director and regional representative of the UN Environment Programme, said, “We could be more successful, we could be more relevant to the needs and aspirations of the continent, we could have more impact in all African countries, if we can work with you [the faiths] hand-in-hand. Working with religions will go to the top of United Nations Environment Program agenda in Africa."

Religious groups have often played a role in environmental conservation. In the US, for instance, acoalition of Christian and Jewish groups are promoting an end to the cutting of old-growth forests and to commercial logging in public lands [ http://www.ecostewards.org/rcfc.htm ] while the Oxford Biodiversity Institute has partnered with the Alliance of Religions and Conservation (ARC) and the World Database on Sacred Natural Sites to map religious forest sites globally for conservation [ http://www.biodiversity.ox.ac.uk/customary-conservation/rfs ]. Religious groups own an estimated 5 to 10 percent of forests globally.

The close attachment of some religions to water and forests, experts say, make it easy to engage them in environmental conservation.

“People use forests as shrines, and rivers and lakes and, particularly, trees have been used as symbols of power by many religions around the world. They have a genuine interest in their conservation,” Bethwel Murunga, who teaches African religion at Maseno University, told IRIN.

Martin Palmer, the secretary general of the UK-based ARC, which works with religious groups in environmental conservation based on their core teachings, beliefs and practices, said religious groups are a critical force in conserving the environment.

“We are realistic, but also optimistic… This cannot be done by the faiths themselves, but I can [say they can do] two-thirds of it… We have asked our partners, the World Bank, World Wide Fund for Nature, the Norwegian government and [others], to come here and see where we now need help,” he said.

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]]></body><link>http://www.irinnews.org/Report/96387/AFRICA-Religious-leaders-rally-for-environmental-conservation</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201209251205440662t.jpg"/></td><td valign="top">NAIROBI 25 September 2012 (IRIN) - Faced with environmental degradation that threatens the livelihoods of many people in Africa, a group of 50 religious leaders met in Nairobi earlier this month and pledged to take concrete steps to mitigate the effects of climate change.</td></tr></table>]]></content:encoded></item><item><title>HEALTH: Global South leads the way towards universal healthcare coverage</title><pubDate>Tue, 11 Sep 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201208241145350026t.jpg" />]]>JOHANNESBURG 11 September 2012 (IRIN) - An increasing number of developing countries are introducing universal healthcare coverage - and creating new models to do it - according to research published in The Lancet. Lessons learned from countries like Ghana, India and Rwanda are already shaping the way countries like South Africa are beginning to pilot their own bids for universal coverage.</description><body><![CDATA[JOHANNESBURG 11 September 2012 (IRIN) - An increasing number of developing countries are introducing universal healthcare coverage - and creating new models to do it - according to research published in The Lancet. Lessons learned from countries like Ghana, India and Rwanda are already shaping the way countries like South Africa are beginning to pilot their own bids for universal coverage. 

In the early 20th century, two models of universal healthcare coverage emerged in the United Kingdom and Germany. The UK uses general taxes to fund publicly provided healthcare in its one risk pool model, while Germany’s multiple risk pool model relies on household premiums and payroll taxes, and relies on private healthcare providers. Industrialized countries like Japan, Canada and France have all implemented variations of these two models. 

But countries from the global South are creating their own models, according to research [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961147-7/abstract ] by the Results for Development Institute and others, published in The Lancet as part of its universal healthcare coverage series. [ http://www.thelancet.com/themed-universal-health-coverage ] 

The research, which surveyed nine developing countries in Africa and Asia (which are now part of a joint learning network [ http://www.jointlearningnetwork.org ] on the issue) found that the new models vary considerably but have several common characteristics, including increased revenue and health budgets, larger risk pools and use of the private sector. 

The rationale for moving to universal healthcare is also largely the same, according to lead author Gina Lagomarsino, a managing director at the Results for Development Institute. “In most cases, the move to universal coverage is a response to people feeling like they’re paying too much out of pocket for healthcare that they can’t afford or can’t even get because it’s too expensive,” she told IRIN/PlusNews. 

Finding the funds 

Nigeria used revenue freed up by debt relief to fund pilot universal coverage programmes for expecting mothers and children, while Ghana increased value-added taxes by about 3 percent in 2003 to fund its programme. Ghanaian policy makers noted that earmarking the increase for health expenditures made it an easier sell to voters. 

“For Ghana, it became a major issue in the [2004] elections,” Lagomarsino said. “People were tired of what, in Ghana, had come to be known as the ‘cash and carry’ system of healthcare where people had to pay a lot out of pocket, so it became very political to create a system where everyone could have access.” 

On average, countries had to increase government spending on health by as much as 11 percent to fund universal coverage efforts. Only in the Philippines did the government decrease spending, according to the research. 

International aid accounted for more than a quarter of funding in only three countries - Mali, Kenya and Rwanda - where almost half of universal healthcare coverage was donor-funded, according to the research. 

However, authors in an accompanying paper caution that increases in revenue have to be accompanied by better governance and population targeting to make a real difference. [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961039-3/abstract ]

Bigger pools and the public-private mix 

While two-thirds of countries surveyed had multiple risk pools, which some argue foster inequality and increase administration costs, researchers found many countries were consolidating these pools into larger ones. 

“Successful countries have been moving towards broader, larger risk pools where you have more of the population under one system rather than a fragmented one that, for instance, has separated pools for civil servants, the formal sector, the poor,” Lagomarsino said. 

“Bringing everyone into one pool can make healthcare more equitable because everyone is entitled to the same set of benefits.” 

Most countries are also choosing to include the private sector. Of the nine countries surveyed, only Rwanda and Vietnam rely solely on public health providers. The majority of countries surveyed purchase health services from public and private service providers, allowing for varying degrees of patient choice in providers. Most reliant on the private sector is federalist India, where private health insurers bid to implement state health coverage. These companies are then tasked with enrolling people in healthcare plans, receiving state money based on the number of people enrolled. 

According to Lagomarsino, advocates of the controversial system argue that because companies are paid per enrolled member, they are motivated to reach out to the previously uninsured in poor and rural communities. Detractors argue that it may also create a perverse incentive to poorly educate people on the package of services they are entitled to, ensuring that services remain underutilized and that companies’ payments to healthcare providers are limited. 

Lagomarsino and her co-authors warn against the total exclusion of the private sector insurance in universal healthcare coverage, arguing that this can lead to two-tiered systems, in which poor people go to public facilities perceived to be of lower quality and those who can pay use private care. A mixed public-private system, by contrast, can use subsidies or other mechanisms to extend private care to the poor. 

Although not included in the study, South Africa provides one of the world’s best examples of such a two-tiered system, Lagomarsino told IRIN/PlusNews. According to the Democratic Nursing Organisation of South Africa, 8.1 million South Africans pay to utilize the better resourced private sector while about 41 million rely solely on the public healthcare system in which some treatments, like renal dialysis, are rationed. 

Brian Ruff, CEO of South Africa's largest private health insurance, Discovery Health, co-authored a commentary on inequalities in South Africa's health system in 2011 [ http://www.palgrave-journals.com/jphp/journal/v32/n1s/full/jphp201131a.html ]. In it, he and his co-authors characterized the health system as deeply divided, with stark and growing differences in access and quality between public and private care - mirroring the inequalities between rich and poor in almost every aspect of South African life. 

South Africa latest to join expanding club 

But measures are underway to change this. Shortly after his 2009 inauguration as South African Health Minister, Aaron Motsoaledi began to move the country toward universal healthcare coverage through a national health insurance (NHI), convening a ministerial advisory committee of health experts on the matter [ http://www.doh.gov.za/show.php?id=2010 ]. In 2011, the country issued its first draft policy document on the NHI, and in April 2012 launched the initiative in ten pilot districts nationally [ http://www.scribd.com/doc/99300733/NHI-Green-Paper ]. While these pilot sites have been funded through a conditional grant, the NHI will eventually be funded through a dedicated fund. 

South Africa’s Treasury Department had promised to release a policy paper in April of this year, outlining how the NHI would be funded, but it has yet to do so. In this paper’s absence, speculation remains rife as to how the government will fund its move to universal coverage. 

llg/kn/rz 

]]></body><link>http://www.irinnews.org/Report/96280/HEALTH-Global-South-leads-the-way-towards-universal-healthcare-coverage</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201208241145350026t.jpg"/></td><td valign="top">JOHANNESBURG 11 September 2012 (IRIN) - An increasing number of developing countries are introducing universal healthcare coverage - and creating new models to do it - according to research published in The Lancet. Lessons learned from countries like Ghana, India and Rwanda are already shaping the way countries like South Africa are beginning to pilot their own bids for universal coverage.</td></tr></table>]]></content:encoded></item><item><title>WEST AFRICA: Cleaner toilets to save slums from cholera</title><pubDate>Thu, 16 Aug 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201208151606380006t.jpg" />]]>FREETOWN/CONAKRY/ACCRA/DAKAR 16 August 2012 (IRIN) - Aid agencies are scrambling to treat thousands of cholera patients in Sierra Leone’s capital, Freetown, where the number of infections is mounting by over 250 per day. Most patients are from the city’s various urban slums, where open defecation is rife, toilets are rare, sewage is improperly disposed of, and awareness of cholera is very low. Water and sanitation specialists say unless these problems are addressed, cholera will continue to flourish both in Sierra Leone and throughout West Africa.</description><body><![CDATA[FREETOWN/CONAKRY/ACCRA/DAKAR 16 August 2012 (IRIN) - Aid agencies are scrambling to treat thousands of cholera patients in Sierra Leone’s capital, Freetown, where the number of infections is mounting by over 250 per day. Most patients are from the city’s various urban slums, where open defecation is rife, toilets are rare, sewage is improperly disposed of, and awareness of cholera is very low. Water and sanitation specialists say unless these problems are addressed, cholera will continue to flourish both in Sierra Leone and throughout West Africa.

By 15 August, 19,370 people had contracted cholera in West Africa, the most affected countries being Sierra Leone (9,613 cases), Ghana (5,121 cases), Niger (5,023 cases), and Guinea (802 cases), according to the UN Children’s Fund (UNICEF). 

“There is a massive failure to take cholera seriously in this region, and to publicize it,” said a West Africa cholera specialist. “Ultimately, if you want to get rid of cholera you need to address the structural issues that cause it.” The money is there, “it is a question of tapping into it and taking responsibility for your citizens.”

Take cholera seriously

Most West African countries are falling far short of their Millennium Development Goal to double the proportion of citizens with access to proper sanitation facilities - just 37 percent of inhabitants can access a clean toilet, according to the World Health Organization (WHO). [ http://www.who.int/water_sanitation_health/monitoring/jmpfinal.pdf ]

As in Freetown, a high proportion of the cholera cases in Conakry, the Guinean capital, and Accra, Ghana’s capital, are concentrated in urban slums, where there are few clean toilets and most people openly defecate, often dangerously close to open wells that are the source of water for most residents.

The cholera outbreak now has a caseload of 60 per week in Conakry and Accra and is thought to be past its peak, when there were 90 to 100 cases per day in each city, but Charles Gaudry, head of Médecins sans Frontières in Guinea, warned that “We must still be on our guard.”

Governments tend to clean up the cholera mess once it is in full swing rather than working on prevention, said an independent water and sanitation (WASH) specialist in West Africa. “It is government’s responsibility to address the very basic sanitation rights of its citizens.”

Donors, too, prefer to fund reactively, hence “UNICEF’s ‘Sword and Shield’ [response-prevention] strategy is more sword than shield,” noted Patrick Laurent, West Africa WASH coordinator at UNICEF.

When aid agencies approached the African Development Bank in 2011 for cholera prevention support in the Central African Republic, the response was: "When you report a cholera case, we’ll give you the money."

In Guinea, just one or two aid agencies - Action against Hunger and UNICEF - work on cholera prevention with the government, while one - MSF - is doing the bulk of the treatment and transmission containment.

Ghana: prosecution over publicity

In Greater Accra, with 77 percent of the country’s cholera cases, at least 20,000 people have no toilet or use bucket latrines (a pot that is periodically dumped outside), according to Accra health department director Simpson Boateng. Those living near the sea simply defecate on the beach.

The Ghanaian government banned open defecation and bucket latrines in 2010, and arrests all perpetrators, said Boateng. “We need to continue to educate them [people], but more importantly, you will be arrested when caught,” he told IRIN. “As I speak, over 1,000 landlords have been prosecuted for still using pan latrines in their houses.” The city council is establishing a ‘sanitation court’ to try the culprits. “We are simply enforcing the by-laws which frown upon this conduct,” he said.

Rather than crackdowns, more awareness-raising is needed, suggested Accra residents, including journalists, who had no idea there was a cholera outbreak in their city.

Unlike in neighbouring Guinea and Sierra Leone, where the governments are weak and rely on aid agencies to drive the response, the Ghanaian authorities are leading the cholera response but have “underplayed it” for political purposes, said WASH specialist Laurent.

The recent death of President John Atta Mills and the approaching parliamentary elections have drawn the attention of most government officials for weeks.

Give them an alternative

Arrests may be a temporary deterrent, but people will continue to defecate in the open as long as they have no alternative, say aid agency staff. Just 17 percent of Accra’s residents, and 8 percent of rural Ghanaians, have access to an adequate toilet, according to the government’s 2008 health survey.

The key is to get communities all over West Africa to want to use and maintain clean toilets. In Sierra Leone, UNICEF is pushing “community-driven total sanitation”, in which communities move away from open defecation once they understand its consequences, and go on to build and maintain clean toilets themselves.

In this model, UNILEVER, which manufactures cleaning products, has worked with UNICEF and local partners in Gambia, and with Water and Sanitation for the Urban Poor, a non-profit group, in Ghana to form The Clean Team. The process is: trigger a demand for toilets through behaviour change; arrive at a price that works for everyone; and then make clean toilets available.

An ongoing project in Kumasi, south-central Ghana, targeted 100 families, most of whom were sharing dirty latrines. Each was given a free chemical toilet with a sealed waste container that was exchanged two to three times per week. A family of five pays about US$15 per month for the service, which is less than it costs to use the public toilet.

The waste is processed in the city’s septic tank system, but the municipality hopes to use it to produce biofuel in the future. Thus far the scheme has improved hygiene, lowered household costs and reduced the use of plastic bags for defecation, otherwise known as "flying toilets", said Clean Team manager Asantewa Gyamfi. The plan is to expand it to 1,500 families. 

Keeping toilets clean

Transferring such an intensive approach to an urban slum setting in Freetown is a challenge, said UNICEF’s Sierra Leone communications, Gaurav Garg. Most of Freetown’s flood-prone slums are hemmed in by the ocean and/or mountains, and there is simply no room to build new toilets - public latrines are the only option.

An urban WASH consortium - made up of NGOs Oxfam, Action against Hunger, Save the Children, GOAL, and Concern - charged with helping the government improve sanitation in Freetown’s slums, has decided that improving and rebuilding public toilets is the only option, but keeping them clean is the real challenge, said Marc Faux, the group coordinator.

Community committees have been set up to run the toilets. Each is given four roles: collect money for their use (usually 100-200 leones per person [2 to 4 US cents] use the money to clean and repair the toilets; communicate the community’s sanitation concerns to political decision-makers; and make sure waste is dumped safely. Health officials say until each of these jobs is done well, use will continue to be low.

To date, most of the waste from public latrines has been dumped in nearby rubbish tips or into the sea. The NGO consortium is currently experimenting with a low-technology device that pumps waste into containers that can then be taken to trucks. Another method being tested is a device used to separate urine from faecal matter, which can then be turned into compost over an 18-month period.

These and other innovations are an important start to addressing the myriad challenges in unsanitary, densely populated, coastal cities such as Freetown, Conakry and Accra. But they will only make a dent in cholera prevention. The issue must be addressed, “not on a project-by-project basis, but holistically, involving education, health systems, water and sanitation infrastructure - the lot,” said Mariamme Dem, West Africa head of NGO Wateraid in Senegal. 

That looks a long way off. For now, NGOs like MSF are hastily setting up treatment centres to care for the cholera victims who come their way - as they have done every few years since the 1980s.

aj/js/ic/bb/sda/he

Fact Box

Cholera in Niger

In Niger, the situation is different in terms of topography and humanitarian context. Some 99 percent of the cholera cases are in the Tillaberi Region in the southwest of Niger, on the Niger River. The rest are in refugee camps in Ouallam, in southwestern Tillaberi.

Cholera has broken out against a backdrop of high rates of malnutrition and food insecurity, and large numbers of refugees who fled the takeover of northern Mali. The rains and insecurity make it difficult to access some cholera-hit villages, said UNICEF’s Patrick Laurent.

“If you add all of the above conditions, plus the rainy season, floods and poor sanitation, it’s not surprising to see a cholera outbreak,” he noted.

The government has a low capacity to respond to cholera but is willing to collaborate with the many relief and aid agencies working to alleviate the emergency there, said Laurent. “For me, this is half the battle.”

]]></body><link>http://www.irinnews.org/Report/96112/WEST-AFRICA-Cleaner-toilets-to-save-slums-from-cholera</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201208151606380006t.jpg"/></td><td valign="top">FREETOWN/CONAKRY/ACCRA/DAKAR 16 August 2012 (IRIN) - Aid agencies are scrambling to treat thousands of cholera patients in Sierra Leone’s capital, Freetown, where the number of infections is mounting by over 250 per day. Most patients are from the city’s various urban slums, where open defecation is rife, toilets are rare, sewage is improperly disposed of, and awareness of cholera is very low. Water and sanitation specialists say unless these problems are addressed, cholera will continue to flourish both in Sierra Leone and throughout West Africa.</td></tr></table>]]></content:encoded></item><item><title>WEST AFRICA: Cholera - what&apos;s working?</title><pubDate>Tue, 10 Jul 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2010/201009141728560425t.jpg" />]]>FREETOWN/DAKAR 10 July 2012 (IRIN) - After years of cyclical cholera outbreaks in West Africa, water and sanitation standards are still notoriously low in most of the affected countries, but in some areas the cholera response is working better now than in the past. IRIN spoke to governments and aid agencies about innovations and traditional wisdom for preventing cholera. </description><body><![CDATA[FREETOWN/DAKAR 10 July 2012 (IRIN) - After years of cyclical cholera outbreaks in West Africa, water and sanitation standards are still notoriously low in most of the affected countries, but in some areas the cholera response is working better now than in the past. IRIN spoke to governments and aid agencies about innovations and traditional wisdom for preventing cholera.

By the end of June 2012, cholera had killed nearly 200 people in West Africa and infected 10,330 according to the UN Children’s Fund (UNICEF). Numbers are continuing to rise, particularly in the Sahel zone, where a recent upsurge has killed 60 people and infected 2,800. On 2 July 34 cases and two deaths - both children - were reported in northern Mali near Gao, on the edge of the Niger River.

Elsewhere in West Africa case numbers are rising, but are lower than this time in 2011, when 82,070 people had contracted cholera, or in 2010 when 60,000 West Africans in the Lake Chad Basin, which includes parts of Chad, Niger, Nigeria and Cameroon, were infected.

But West Africa is just at the start of its rainy season – cholera usually peaks between August and December.

Cholera is characterized by diarrhoea and vomiting, and can cause death within hours if it is particularly virulent, or hits weak victims like children.

The victims: children

Francois Bellet, the West Africa water, sanitation and hygiene (WASH) programme specialist at UNICEF, worries that people who are hungry or malnourished as a result of the food crisis in the region are particularly vulnerable to infection. UNICEF is particularly concerned about the Sahel, where the spread of cholera is aggravated by a massive displacement of people fleeing the conflict in northern Mali.

In some areas - such as Niger’s regions along the Niger River - the Ministry of Health reports nearly three times as many cholera patients this year as in 2011.

An estimated 400,000 children in Niger are suffering from severe malnutrition this year. “A child below the age of five who has recovered from severe and acute malnutrition will be back for treatment in a matter of days or weeks if he or she is drinking contaminated water,” Guido Borghese, UNICEF’s advisor on Child Survival and Development, said in a communiqué.

The transmitters: fish

Cholera spreads along West Africa’s waterways - coastal regions, rivers and lakes - where busy fishing and trade routes run. The coast is “like a cholera highway”, said Bellet, as are major waterways such as the Niger River, which flows through Guinea, Mali, Niger, Benin and Nigeria.

The bacteria build up under the scales of fish and are often still there if the fish on sale in the markets have not been properly cleaned.

Given the role of women role in cleaning, descaling, smoking and selling fish in most of West Africa, it is they and their children who are particularly vulnerable to infection. Children make up some 80 percent of the cases in Sierra Leone’s Port Loko district, according to UNICEF.

The Guinea-Sierra Leone outbreak started on the island of Yeliboya in Sierra Leone’s Kambia district before spreading to islands off the coast of Guinea and into Forecariah prefecture. Islands in Boffa prefecture are known for their poor sanitation services and high levels of trade - perfect conditions for cholera to spread, said Bellet.

Vaccine: a new approach

The cyclical nature of cholera and the fact that immunity builds after large-scale epidemics are some of the reasons for this year’s lower caseload, said practitioners.

In Chad - which so far has zero cases this year compared to 5,000 in 2011 - widescale prevention efforts have paid off. And in Guinea the response has been much quicker and more coordinated this year.

In addition, a new approach has been tested in Guinea - notably a cholera vaccine used by Médecins Sans Frontières-Switzerland (MSF) for the first time in Africa to stem an epidemic.

The vaccine has had good results so far. In the Boffa and Forecariah prefectures of Guinea, where 77 percent of the population were given the double dose, and 95 percent received a single dose, there have been no cases reported since, said Iza Ciglenecki, innovation coordinator for diarrhoeal diseases at MSF-Switzerland. It is too early to know the full results, she said, but when used in other regions the vaccine has been 65-75 percent effective in stemming the spread of the disease.

This is potentially a huge step forward, but at US$3.70 for two doses the vaccine is expensive. The World Health Organization (WHO) and NGOs are discussing guidelines for when to use it in response to future epidemics. “If we multiply these interventions in the future, we could even create regional stocks to make it cheaper, but it is too early to say - we need to learn more first,” said Francois Verhoustraeten, Guinea programme officer at MSF-Switzerland. 

All responding agencies, including MSF, stressed that the vaccine is not a standalone solution and should be seen as a supplementary activity. “We put a lot of effort into all the strategies at once,” Ciglenecki told IRIN, referring to the need to raise awareness of public hygiene, targeting cholera hot spots, setting up early warning systems, and treating water. Agencies such as MSF, UNICEF and Action contre la faim (ACF) - Action against Hunger - an international NGO, have been implementing these measures for years in West Africa's cholera-prone areas.

Modern medical breakthroughs should not replace important basic hygiene practices: wash your hands after defecating, before cooking or eating, and try to disinfect water that may be dirty, say aid agency staff. Neither should they negate the usefulness of age-old techniques, said Bellet.

Speed

Guinea’s response has been quick this year. People have learned lessons from the 2007 and 2008 outbreaks, the latter of which took one and a half years to clear up, said Grant Laeity head of emergencies for UNICEF in West Africa.

The Sector Chief of Khounyia in Kaback Island, Forecariah, told UNICEF that this year’s cholera strain was particularly virulent (he has witnessed six outbreaks on the island). But the local health clinic managed the cases within a couple of hours, and the next day sent samples for confirmation to Conakry, the capital, 35km away. A full water and sanitation package was sent to the island four days later.

In late June Guinea reported 997 cholera infections and 41 deaths, with about 50 cases in Conakry.

Monitoring has also improved. Six surveillance posts have been set up in high-risk zones across the country to detect potential cases and respond to them immediately, said Beatriz Navarro Rubio, head of ACF in Guinea.

“In Guinea we saw good surveillance plus an early declaration by the authorities, leading to prompt action by all, which was encouraging,” said Laeity “If we could have what we had in Guinea across the region it would mean… when cholera broke out we could go and nip it in the bud.”

Coordination between the responding actors has been “very good” said Rubio. Inter-agency disaster simulation exercises had taken place shortly before the outbreak, so everyone was ready to step into gear when cholera hit.

Guinea’s Ministry of Health has taken a strong lead in bringing the Ministries of Education, and Energy and Water Resources on board to agree on simple countrywide messaging that is spread in schools and on local radio said Guarav Garg, a communications specialist at UNICEF in Sierra Leone. The messages have reached an estimated one million of Guinea’s six million people. “Coordination ebbs and flows, but they [the Health Ministry] are in control,” said Garg.

“Most of the cases have been addressed, which shows that the individual and collective prevention measures that we have taken are starting to work,” said Dr Hawa Touré, national director of the Ministry of Health.

Sierra Leone: slow

In Sierra Leone the response has been less efficient. UNICEF said some 2,742 cases have been reported since February, starting in Kambia and Port Loko in the north, then moving to Pujehun in the south.

A spike in the number of cases in Kambia town in late May “set off alarm bells”, said Garg, as it is just a 2.5 hour drive from the capital, Freetown. “Rains have come early and a lot of people live close to rivers and openly defecate - this is a bad combination,” he noted.

So much untreated sewage has been pumped into Sierra Leone’s rivers and coastal waters that much of the water itself is contaminated with the cholera bacteria, UNICEF said.

The Ministry of Health has tested and chlorinated water points since December 2011, but most people use private wells, so it is not known whether they have been chlorinated or not, Garg told IRIN.

Innovations in cholera prevention here include UNICEF’s community-led approach to improved sanitation - which has vastly improved public hygiene in parts of the six districts where it has been implemented, but Kambia is not among them. [ http://www.irinnews.org/Report/83127/SIERRA-LEONE-Communities-take-charge-one-latrine-at-a-time ]

Sierra Leone has two things in its favour, said Garg: improving WASH services is a strong pillar in the government’s upcoming poverty reduction strategy, and elections will be held in December. “The last thing you want is a cholera outbreak before the elections - they’re [the government] realizing you can keep on responding, or you can start to prevent,” he commented.

Priorities

As well as improving surveillance, better understanding the region’s cholera hot spots, and speedier government declarations of an outbreak, in a region with high volumes of cross-border trade and people-movement, coordinated prevention and response now needs to be a priority, say aid agencies.

In Côte d’Ivoire for instance, the current outbreak spread from Ghana; in 2011 cholera spread from Nigeria to Chad to Cameroon; cholera regularly passes between Guinea and Guinea-Bissau.

The governments of Sierra Leone and Guinea should quell further cross-border spread by quarantining the disease and creating a “protective shield” in the forested area between the countries, says UNICEF. 

And all affected countries need to carry out cross-border simulation exercises – as recently took place in the Lake Chad Basin – so agencies understand their role as soon as an outbreak hits. 

aj/js/he

]]></body><link>http://www.irinnews.org/Report/95837/WEST-AFRICA-Cholera-what-apos-s-working</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2010/201009141728560425t.jpg"/></td><td valign="top">FREETOWN/DAKAR 10 July 2012 (IRIN) - After years of cyclical cholera outbreaks in West Africa, water and sanitation standards are still notoriously low in most of the affected countries, but in some areas the cholera response is working better now than in the past. IRIN spoke to governments and aid agencies about innovations and traditional wisdom for preventing cholera. </td></tr></table>]]></content:encoded></item><item><title>AFRICA: Donor fatigue forces WFP to cut refugee rations</title><pubDate>Tue, 19 Jun 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201204161157350475t.jpg" />]]>JOHANNESBURG 19 June 2012 (IRIN) - The UN World Food Programme (WFP) has halved food rations to refugees living in camps in at least four African countries citing a funding shortfall.</description><body><![CDATA[JOHANNESBURG 19 June 2012 (IRIN) - The UN World Food Programme (WFP) has halved food rations to refugees living in camps in at least four African countries citing a funding shortfall.

The cuts have already affected 16,000 refugees in Malawi’s Dzaleka camp who have been on half rations since March, while a further 120,000 refugees in Uganda began receiving half rations of cereals in May. 

According to WFP, another 100,000 refugees in Tanzania saw their maize rations cut by 50 percent starting from last week, and rations for some 54,000 refugees living in Rwanda are expected to be cut in August unless donors come forward with more funding.

“Even the full ration wasn’t enough,” said Sanky Kabeya, a 24-year-old resident of Dzaleka who spoke to IRIN at the end of March. [ http://www.irinnews.org/Report/95259/EDUCATION-Online-learning-inspires-refugees ] “I haven’t taken breakfast this morning and many are in the same situation.”

Gustave Lwaba, another resident of the camp, said the usual monthly ration of 13kg of maize had gone down to 7kg, while rations of cooking oil, pigeon peas, sugar and salt had also been cut by half. "There are people in the camp who rely on relatives who've been resettled," he said. "The rest really starve because the rations can't last a month."

Michelle Carter, country director for the Jesuit Refugee Service in Malawi, which runs a number of educational and other programmes in the camp, said the cuts were “clearly leading to a fair amount of hunger… I know children are coming to school hungry,” she told IRIN. 

“The food is only lasting two weeks and if they’re on their own it’s much worse because they can’t combine rations.”

Noting that only a very small percentage of the refugees had any source of income, she said single mothers, unaccompanied minors and the elderly and disabled had been particularly hard hit by the reduced rations.

A protection officer with the UN Refugee Agency (UNHCR) in Malawi, Gavin Lim, said his agency planned to carry out an assessment in the coming months to determine the full impact of the ration cuts but that reports of more women in the camp turning to survival sex were already coming in.

Difficult to become self-reliant

Most countries in southern and eastern Africa have an encampment policy for refugees which restricts their freedom of movement and reduces their chances of becoming self-reliant. Some earn a small income running informal businesses outside the camps but competition with often equally impoverished locals is fierce and has led to outbreaks of violence. 

In May, a number of refugees who were selling goods at a small trading centre outside Dzaleka were assaulted by local traders who accused them of undermining their businesses. According to Carter, the Malawian government plans to withdraw trading licenses for refugees from July.

Many of Dzaleka's residents have lived in the camp for over a decade. Indeed, an increasing proportion of refugees today live in what UNHCR describes as "protracted" exile (in 2011, more than seven million refugees had lived outside their country for more than five years). Donors are increasingly reluctant to shoulder the burden of feeding these long-term refugees.

Commenting on the funding shortfall, WFP spokesperson for east and southern Africa David Orr said: "There is inevitably some donor fatigue regarding longstanding or protracted refugee loads; these funding issues affect more than just food."

ks/cb

]]></body><link>http://www.irinnews.org/Report/95597/AFRICA-Donor-fatigue-forces-WFP-to-cut-refugee-rations</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201204161157350475t.jpg"/></td><td valign="top">JOHANNESBURG 19 June 2012 (IRIN) - The UN World Food Programme (WFP) has halved food rations to refugees living in camps in at least four African countries citing a funding shortfall.</td></tr></table>]]></content:encoded></item><item><title>GHANA: The growing wealth gap</title><pubDate>Mon, 18 Jun 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201206181527500502t.jpg" />]]>ACCRA 18 June 2012 (IRIN) - Booming construction, a burgeoning middle-class, gleaming shopping malls. Ghana’s oil-driven economic expansion is transforming the country, but uneven development also means many are being outpaced and slipping further into poverty.</description><body><![CDATA[ACCRA 18 June 2012 (IRIN) - Booming construction, a burgeoning middle-class, gleaming shopping malls. Ghana’s oil-driven economic expansion is transforming the country, but uneven development also means many are being outpaced and slipping further into poverty.

"The economic boom, especially in Accra [the capital], is obvious, but inequalities are widening as all the prices have gone up," said Eugenie Maiga, an economist at the African Centre for Economic Transformation, a policy think-tank. The economy grew by 14 percent in 2011, one of the fastest rates in Africa, and much of southern Ghana has prospered.

"The northern part of the country has clearly benefited less from the growing economy in the past 10 years than the central and southern parts," Maiga noted. "Even if rural poverty declined, the land in the north is not as fertile as in the south… the difference between the quality of houses in the north and the south of the country is obvious to see."

Since 2000, the economy has recorded an average growth of five percent per annum, but it shot up in 2010 when oil production began. Per capita income has more than tripled in from $400 in 2000 and is likely to reach $1,400 in 2012, said Samir Gadio, a West Africa analyst at Standard Chartered Bank.

Boosted by oil, cocoa and gold revenues, Ghana has initiated economic reforms to spur growth and in 2011 became a middle-income country, the ninth in Africa to attain this status. Significant off-shore oil reserves were discovered in 2007.

The proportion of people living in poverty dropped from 51 percent in 1992 to 30 percent in 2006, according to the UN Development Programme (UNDP), which noted that that Ghana was the first country in the region to meet the Millennium Development Goal of halving poverty by 2015.

However, a similar rate of growth has eluded the northern provinces, where there are fewer roads and less infrastructure, poorer housing and not nearly as many modern businesses as in the south. The World Bank noted in a 2011 report that while 2.5 million people in the south shook off poverty between 1992 and 2006, in the same period almost a million people in the north slipped into poverty.

Inequality is also widening in Accra, where many people from the countryside, especially the youth, come in search of jobs, but development in the capital has pushed up the cost of living and many fall further into poverty, said Maiga.

Inflation, currently around nine percent, has been climbing for 14 months – partly due to the weakening of the local currency the cedi – which has eroded purchasing power.  "It is surely a good thing to see the capital booming like it is, but as far as I am concerned, life is still as tough as it was before," said Augustine, 45, a taxi driver.

The cost of food and rent has gone up across the country. "This is negatively affecting access to food in the north, where the proportion of food-insecure people is the highest in the country," the UN Food and Agriculture Organization (FAO) said in a March 2012 report. Many in the northern countryside can no longer afford basic foods.

Rental prices in Accra are becoming prohibitive, with civil servants and other middle-class workers compelled to a take loan to secure a rented house. "Most [landlords] are now asking tenants to pay their rent for one or even two years in advance," said Maiga.

Roads have improved in the capital but power cuts and a steady water supply are still a problem. Sanitation services in the capital and rural areas are equally poor. Just 13 percent of Ghanaians have access to clean sanitation, according to the UN Children’s Fund (UNICEF), while 80 percent of all childhood diseases are caused by unsafe water, says NGO Water Aid. [ http://www.unicef.org/sowc2012/pdfs/SOWC-2012-TABLE-3-HEALTH.pdf ]

"Service provision has lagged behind growth," Razia Khan, Dubai-based West African analyst for the Standard Chartered Bank, told IRIN. " Infrastructural concerns will remain simply because the pace of growth exceeds the capacity of the authorities to put in place the necessary infrastructure."

Under the Petroleum Revenue Management Act, 70 percent of oil revenue, which contributed $444 million to the budget in 2011, must be spent on developing infrastructure and agricultural modernisation, a move that has earned praise.

The government spent most of its budget on building roads and mechanising agriculture in 2011, Emma Tarrant Tayou of the Revenue Watch  Institute, an extractive industries watchdog, told IRIN.

"This law is a great example of attempting to manage petroleum revenues in a way which will affect the nation’s development in a positive manner," she said, "and take into account the special attention which natural resource revenues require."

om/ob/aj/he

]]></body><link>http://www.irinnews.org/Report/95677/GHANA-The-growing-wealth-gap</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201206181527500502t.jpg"/></td><td valign="top">ACCRA 18 June 2012 (IRIN) - Booming construction, a burgeoning middle-class, gleaming shopping malls. Ghana’s oil-driven economic expansion is transforming the country, but uneven development also means many are being outpaced and slipping further into poverty.</td></tr></table>]]></content:encoded></item><item><title>REFUGEES: Moving out of the shadows</title><pubDate>Thu, 31 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2009/200904242107480456t.jpg" />]]>JOHANNESBURG 31 May 2012 (IRIN) - When night falls in the Dadaab refugee complex in eastern Kenya, nearly half a million refugees are plunged into darkness. The lack of light robs schoolchildren of the possibility of studying and provides perfect cover for thieves and rapists.</description><body><![CDATA[JOHANNESBURG 31 May 2012 (IRIN) - When night falls in the Dadaab refugee complex in eastern Kenya, nearly half a million refugees are plunged into darkness. The lack of light robs schoolchildren of the possibility of studying and provides perfect cover for thieves and rapists. 

“There are robbers who take advantage of the dark to rob people of their phones,” said Ifo Camp resident and freelance journalist Moulid Hujale. “Even when there’s a full moon, there’s less crime.”

For many households who cannot afford candles or kerosene lamps, let alone a generator, the only source of light is that produced by cooking fires. But firewood is an increasingly scarce and contentious commodity in an arid region where an ever growing refugee population has been competing with locals for dwindling natural resources since the first camp was established there in 1991.

The UN Refugee Agency (UNHCR) trucks in firewood at a cost of US$600,000 a month, but only enough to meet about 30 percent of each household’s monthly needs, forcing refugee women to walk up to 10km outside the camps to gather wood for cooking. These excursions expose them to the risk of violent attacks from resentful locals and even other refugees. 

“The incidents of gender-based violence against them are quite common,” said Njuki Venanzio, an associate environment officer with UNHCR based at Dadaab. “Our protection colleagues document about three cases per week.”

Even inside the camps, levels of sexual and gender-based violence have increased significantly in the past 18 months as the camp’s population has swelled and poor lighting has made new arrivals living on the outskirts of the camp particularly vulnerable. [ http://www.plusnews.org/Report/93682/KENYA-SOMALIA-Refugees-at-risk-of-sexual-violence ] 

Although the scale of Dadaab’s camps have magnified its security and environmental problems, refugee camps all over Africa face similar challenges. Seventy-two percent have no electricity (while only 30 percent of sub-Saharan Africa's general population has electricity) and many are located in fragile environments where wood is in short supply or completely unavailable. 

The area around Dzaleka Camp in Malawi is so heavily deforested that refugees often resort to selling a portion of their monthly food rations to buy firewood or charcoal, while women living in Touloum Camp in Chad say they spend four days a week searching for firewood. 

Eco-friendly technologies

A UNHCR initiative to bring solar-powered lights and fuel-efficient stoves to 920,000 refugees in Africa over the next three years could address many of the security, environmental and education challenges faced by refugees if donors can be persuaded to come up with the necessary $15 million in funding. 

The Light Years Ahead Initiative [ http://www.unhcr.org/4c99fa9e6.pdf ] has already been piloted in seven African countries with good results, according to Amare Egziabher, a senior environmental coordinator with UNHCR in Geneva. 

“We’ve had very positive feedback from the field,” he told IRIN. “Many believe it lowers the incidence of crime, and also gender-based violence for women and girls.” 

The initiative also has the potential to lower drop-out rates at camp schools. Children who lack light to do their homework in the evenings tend to fall behind with their studies, while girls often miss classes while helping their mothers collect firewood.

At Dadaab, the pilot phase of the project has already brought solar-powered lanterns to 140 schoolchildren preparing for exams and street lights to several areas of Hagadera Camp identified by residents as particularly unsafe at night. 

“It has had a major impact on security in those few areas,” said Venanzio. “But we’re talking about a camp with over 120,000 refugees so the coverage has been small.”

Each solar lantern costs $39 while a solar street light that can make a neighbourhood safer for up to 300 refugees costs $1,200. 

“So far we’ve had some promises of funding but nothing concrete yet,” said Venanzio.

Saving fuel, saving the environment

The fuel-efficient stove favoured by UNHCR is called Save80 because it uses up to 80 percent less wood than cooking over a traditional stove, but several NGOs and agencies working at Dadaab are distributing different types of energy-saving stoves. They have so far managed to reach about 48 percent of the refugee population, but as kerosene has been deemed too expensive and ethanol in too short supply, all of the stoves distributed still use firewood.

“We need something more sustainable,” conceded Venanzio. “There is a lot of environmental degradation within a 10km radius of the camps and the Kenyan government is insisting that we look for a viable alternative [to wood] soon.”

Increasing local production of ethanol from sugarcane is one option. Another is finding entrepreneurs willing to produce sufficient quantities of fuel briquettes from agricultural by-products like coffee or risk husks. 

In the meantime, UNHCR’s environmental management programme is distributing free saplings to refugee and host communities in an effort to reforest the area. “But the environment here is very dry so the survival of the trees is a bit challenging,” said Venanzio. 

Awareness-raising campaigns aimed at teaching refugees how to use firewood more economically, recycle garbage and grow vegetables using waste water are also aimed at mitigating the camps’ impact on the local environment but Venanzio said the programme struggled with insufficient funding. “Environmental programmes get a very small budget compared to other sectors that are considered life-saving like water, food, health,” he explained.

Private donors including churches and corporations gave $1.4 million towards the Light Years Ahead Initiative in 2011, but “we still have a long way to go,” admitted Egziabher. “The demand is so high.”

ks/cb

]]></body><link>http://www.irinnews.org/Report/95558/REFUGEES-Moving-out-of-the-shadows</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2009/200904242107480456t.jpg"/></td><td valign="top">JOHANNESBURG 31 May 2012 (IRIN) - When night falls in the Dadaab refugee complex in eastern Kenya, nearly half a million refugees are plunged into darkness. The lack of light robs schoolchildren of the possibility of studying and provides perfect cover for thieves and rapists.</td></tr></table>]]></content:encoded></item><item><title>HEALTH: Airdrops to fight schistosomiasis in Ghana</title><pubDate>Tue, 15 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201205151052110632t.jpg" />]]>KPONG 15 May 2012 (IRIN) - At the Kpong airfield, a few kilometres from Lake Volta in northern Ghana, Patricia Mawuli, pilot and co-founder of Medicine on the Move (MoM), a local NGO, is preparing her plane for takeoff. She is one of four health workers who fly weekly to isolated communities around the lake to raise awareness of the dangers of schistosomiasis, also called bilharzia.</description><body><![CDATA[KPONG 15 May 2012 (IRIN) - At the Kpong airfield, a few kilometres from Lake Volta in northern Ghana, Patricia Mawuli, pilot and co-founder of Medicine on the Move (MoM), a local NGO, is preparing her plane for takeoff. She is one of four health workers who fly weekly to isolated communities around the lake to raise awareness of the dangers of schistosomiasis, also called bilharzia.

Schistosomiasis is a parasitic disease caused by a flatworm that enters the skin and is found in infected water. Snails - common in Lake Volta - often act as an intermediary host for the worms before they get into humans, where they eat away at the internal organs. The symptoms include fever and passing blood in urine and faeces, and are often detected very late. Bilharzia can stunt children’s growth and affect their cognitive development.

Classified as a neglected tropical disease by the World Health Organization, some 200 million people across Africa, Asia and South America are thought to be infected, but less than 15 percent are being treated, according to Lester Chitsulo, a research scientist in the Neglected Tropical Diseases department of the World Health Organization (WHO).

WHO is trying to help governments put in place more effective prevention programmes by training community health workers like Mawuli, pushing hygiene and public health awareness, and negotiating drug donations with major suppliers.

Around the lake many people are unaware of the disease or its symptoms, said MoM’s other co-founder, Jonathan Porter. Many men see having blood their urine as a sign of virility he said, but doctors say it is a sign that the disease has eaten its way through the lower intestine.

Each week MoM air-drops leaflets in four languages over villages - particularly schools, so teachers can explain the contents - to inform people about how they can catch, prevent, and treat the illness.

Air drops are considered the most effective way of reaching the hundreds of isolated communities around the lake, where many are three hours from a hard-surfaced road, said Porter.

Progress
Ghana has made progress in controlling bilharzia with its national prevention programme, run in partnership with USAID, WHO and NGOs. In 2008 it treated 300,000 children, which escalated to 1.7 million in 2010.

Efforts to control bilharzia are also picking up globally. According to WHO, some 12.4 million people were treated for the disease in 2006, and this rose to 33.5 million in 2010.

Drug manufacturer Merck pledged in 2000 to produce 20 million Praziquantel tablets - the drug most commonly used to treat bilharzia - over the next decade, and in 2012 to increase output to 250 million.

Some national programmes have seen dramatic results. China, Cambodia, Egypt, Uganda and Burkina Faso have all pushed health education and access to Praziquantel, making the disease almost non-existent, WHO said.

International efforts to combat neglected tropical diseases are also picking up steam, with governments, the World Bank, major drug companies and international NGOs signing the London Declaration on Neglected Tropical Diseases in January 2012, in which signatories pledged to bring bilharzia and 10 other neglected tropical diseases under control by 2020. [ http://www.unitingtocombatntds.org/downloads/press/ntd_event_london_declaration_on_ntds.pdf ]

But many sub-Saharan African nations are lagging behind - just 21 out of 40 affected countries have prevention programmes, and in Nigeria, Ethiopia and the Democratic Republic of Congo the lack of assistance means sufferers will be treated only if an NGO or UN agency is there to do so.

Health experts told IRIN that the roadmap in the London declaration will be only achieved with far more concerted efforts at the national level.

rc/aj/he


More on neglected diseases

South Sudan: High hopes for treating “neglected” diseases
[ http://www.irinnews.org/Report/94930/SOUTH-SUDAN-High-hopes-for-defeating-neglected-diseases ]
HEALTH: Leishmaniasis vaccine trial underway
[ http://www.irinnews.org/Report/95431/HEALTH-Leishmaniasis-vaccine-trial-underway ]
HEALTH: Yaws treatment study prompts WHO review
[ http://www.irinnews.org/Report/94621/HEALTH-Yaws-treatment-study-prompts-WHO-review ]
Counting the cost of neglected diseases
[ http://www.irinnews.org/Report/90772/HEALTH-Counting-the-cost-of-neglected-diseases ]

]]></body><link>http://www.irinnews.org/Report/95450/HEALTH-Airdrops-to-fight-schistosomiasis-in-Ghana</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201205151052110632t.jpg"/></td><td valign="top">KPONG 15 May 2012 (IRIN) - At the Kpong airfield, a few kilometres from Lake Volta in northern Ghana, Patricia Mawuli, pilot and co-founder of Medicine on the Move (MoM), a local NGO, is preparing her plane for takeoff. She is one of four health workers who fly weekly to isolated communities around the lake to raise awareness of the dangers of schistosomiasis, also called bilharzia.</td></tr></table>]]></content:encoded></item><item><title>FOOD: Power to the people!</title><pubDate>Tue, 15 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2011/201104051041120547t.jpg" />]]>JOHANNESBURG 15 May 2012 (IRIN) - The UN Development Programme (UNDP) launched its first Africa Human Development Report today, stressing food security as a means to a better quality of life for all.</description><body><![CDATA[JOHANNESBURG 15 May 2012 (IRIN) - The UN Development Programme (UNDP) launched its first Africa Human Development Report [http://www.undp.org/content/undp/en/home/librarypage/hdr/africa-human-development-report-2012/ ] today, stressing food security as a means to a better quality of life for all.  

The argument is straightforward: Most people in Africa depend on agriculture, and better nutrition is good for human development. More food production means more food and income in people’s pockets, which has spin-offs which are beneficial for health and education. 

The report is not another exhortation to farmers to grow more food. Pedro Conceicao, chief economist with the UNDP Regional Bureau for Africa, explained that exclusively looking at linkages between small-scale farmers and agriculture or gender empowerment and agriculture were “piecemeal approaches” and not helpful. “We have to move beyond silver bullet obsessions [such as agricultural subsidies] or attention-grabbing headlines.” 

He reasoned that high economic growth rates in Africa had not necessarily resulted in a reduction in poverty and food insecurity - which points to accessibility to food and purchasing power as key factors. The report emphasizes “empowerment” and participation as important levers for change. 

It argues that countries need to implement a more strategic vision of food security. An approach to emulate would be what Ethiopia had done to beef up its agriculture sector by setting up a separate Agricultural Transformation Agency (ATA) [ http://www.ata.gov.et/about/our-mandate/ ] right next to the prime minister’s office. It is modelled on similar initiatives in Asia which helped accelerate economic growth in South Korea and Malaysia, for instance. ATA addresses bottlenecks in areas such as soil management, research and extension services. 

The report calls for new approaches covering multiple sectors - from rural infrastructure to health services, to new forms of social protection and empowering local communities. It calls for action in four critical areas: 

1. Increasing agricultural production: It acknowledges that boosting production would be integral to any approach to becoming food secure, and calls for investment in research, infrastructure and inputs and a Green Revolution in Africa; 

2. More effective nutrition: Develop coordinated interventions which boost nutrition while expanding access to health services, education, sanitation, and clean water; 

3. Building resilience: Investment in crop insurance, employment guarantee schemes, and cash transfers to shield people from risks and make them less vulnerable to shocks; 

4. Empowerment and social justice: Gender empowerment, access to land, technology and information are important to make people food secure. 

IRIN interviewed two leading experts on the issues. 

Steven Wiggins, research fellow with the UK’s Overseas Development Institute, who has been studying agriculture and rural development in Africa since 1972: 

Africa is not one unitary entity: “There are 56 countries in Africa... When Africa is considered as a single unit, there is a great danger that it is compared to other similar units, above all Asia, leading to analyses that suggest that if only Africa were more like Asia, then things would improve. Well, I’m not sure that Botswana has very much to learn from, say, Afghanistan, thank you very much. Hyperbole aside, the point is this: in Africa we have several, if not many, cases of admirable progress in food and nutrition security, but we overlook this.” 

Real progress takes time: “A longstanding issue in African policy debates is the search not only for growth, but for growth that is `transformative’. Even when an African economy grows, the pessimists say `yes, but where is the transformation?’ usually noting that in Asia growth is transformative. Well, yes, where that has apparently happened in Asia... it is the result of 30 or 40 years of sustained progress. Yet damning judgments are made about African countries after less than 10 years of sustained and high economic growth." 

Too complicated and demanding: It would have been better had it [the overview of the report] stuck to a few fundamental propositions that are well supported by the evidence, namely: smallholder development plus primary health plus clean water will almost always reduce child malnutrition. Yes, let’s add girls in secondary school to the list: that will strengthen these links. But it’s that simple. 

Peter Gubbels, the West Africa co-coordinator for Groundswell International, a global partnership of local farming communities, has 30 years of experience in rural development, including 20 years living and working in West Africa. He is based in Ghana. He says: 

Move beyond the Green Revolution: “The report… seems to embrace the Green Revolution approach to agricultural improvement, citing... the results... in Asia, and seeking to now apply those lessons to Africa. The report suggests implicitly, that one reason Africa still has hunger is because Africa has not benefited from `science-based, input-intensive’ support. This is highly misleading. There have been many efforts to promote Green Revolution in Africa. Almost all have failed.” 

Missing bits: “There is no mention of Conservation Agriculture, or of the Brown Revolution [to promote soil fertility and conserve water].” 

Under-funding in agricultural research: “This is true but is also misleading. There has been a great amount of funding in the CGIAR [Consultative Group on International Agricultural Research] system in Africa, including IITA [International Institute of Tropical Agriculture] in Nigeria, from the 1970s onwards. One reason donors reduced funding in the 1990s was because it was not generating good production results. 

“But this report seems to assume that investing in new seeds, fertilizers, tractors, irrigation and training is what is needed... And how many very poor small-scale farmers can afford tractors?” 

Understanding resilience: “Equally disturbing is the suggestion that long-term resilience measures can enable risk averse, poor small-scale farmers to adopt riskier, but more productive, agricultural technologies. This is twisting my understanding of resilience. The aim is to reduce (or at least manage risk), using low external inputs and local ecological systems, not to increase risk by creating dependence on external expensive inputs (insurance, etc) for poor, vulnerable farm families working in marginal conditions. The way forward would be to develop crops and technologies that both increase food production and reduce risk by conservation agricultural techniques.” 

"Subsuming” nutrition into food security: “There is not just food insecurity in Africa. There is both food insecurity and nutrition insecurity. Currently in the Sahel, there is both a food crisis and a nutrition crisis. They may be linked, but the causes are quite different, and the solutions that are [rooted] in food security are almost always inadequate. 

“Just as we need to change the strong association of agriculture with food security, we also need to move nutrition out of the confines of food security. There is still a very strong tendency to believe that food aid, and increasing food production, solves most of malnutrition. It does not. It only helps prevent major spikes in the already existing emergency level of chronic and acute malnutrition.” 

Controversial issues side-stepped: “The report also almost completely sidesteps... genetically modified seeds... the role of agribusiness in land-grabbing, control of seeds, pushing pesticides and herbicides.” 

jk/oa/cb 

]]></body><link>http://www.irinnews.org/Report/95459/FOOD-Power-to-the-people</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2011/201104051041120547t.jpg"/></td><td valign="top">JOHANNESBURG 15 May 2012 (IRIN) - The UN Development Programme (UNDP) launched its first Africa Human Development Report today, stressing food security as a means to a better quality of life for all.</td></tr></table>]]></content:encoded></item><item><title>WEST AFRICA: Giant anti-polio drive threatened by insecurity</title><pubDate>Fri, 23 Mar 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201201311207110246t.jpg" />]]>DAKAR 23 March 2012 (IRIN) - Health volunteers, aid agency and health authority staff are trying to immunize 111.1 million children under five across 20 countries in West and Central Africa against polio. The four-day campaign started today, but instability in some of the target countries could hamper the effort.</description><body><![CDATA[DAKAR 23 March 2012 (IRIN) - Health volunteers, aid agency and health authority staff are trying to immunize 111.1 million children under five across 20 countries in West and Central Africa against polio. The four-day campaign started today, but instability in some of the target countries could hamper the effort.
 
Parts of Nigeria are highly unstable due to ongoing attacks by Boko Haram; [ http://www.irinnews.org/Report/94691/NIGERIA-Timeline-of-Boko-Haram-attacks-and-related-violence ] a rebellion is currently under way in northern Mali, [ http://www.irinnews.org/Report/95127/MALI-Rebellion-claims-a-president ] while security in the capital Bamako is also precarious with a military junta having ousted the president. 
 
Over half of the children targeted - some 57.7 million, are in Nigeria, which is West Africa’s only polio-endemic country.
 
Meanwhile parts of Niger (for instance Tillabéri in the northwest) are difficult to access, as are parts of eastern Chad, with some aid agencies working only with armed escorts.
 
“Access to children [in some of these places] can be a serious problem,” said UN Children’s Fund (UNICEF) regional health specialist Halima Dao. 
 
“Vaccinators’ safety can be compromised, or insecurity means the whole population of a village may flee at a moment’s notice, or there may be far more people than we expected in an area, due to displacement,” she told IRIN. 
 
The conflict in northern Mali has, for instance, led to about 195,000 people being displaced either within the country or when they fled to Algeria, Mauritania, Niger, Burkina Faso and Senegal, according to the UN Refugee Agency (UNHCR), but these numbers are constantly changing as people return or move from camps to host villages, meaning reaching them could be complicated.
 
Dao admits some children in the Tombouctou  and Kidal regions of northern Mali may not be reached, though they are discussing with NGOs working there, including Médecins Sans Frontières and the Malian Red Cross, to see how to reach as many as they can. “We have to work with authorities and NGOs who are used to accessing these insecure areas,” she said. 
 
For a polio immunization campaign to be effective, 100 percent of the children must be reached, says the World Health Organization (WHO), while the long-term fight against polio will only work if routine immunizations are consistently kept up, for at least 90 percent of children under five, for several years running.
 
Last year, election-related in violence in Côte d’Ivoire hampered efforts to quash a polio outbreak affecting 36 children, according to aid agencies. 
 
Thus far, only Ghana, Cape Verde, Burkina Faso, Gambia and Togo have achieved the required 90 percent coverage, according to UNICEF.
 
Children in the hardest-to-reach areas are often the most vulnerable, said Dao, as they do not have access to regular health services. Agencies will try to give Vitamin A and de-worming medicine to these children where possible. 
 
Weak health systems
 
Human error and weak health systems also play an important role in sub-optimal immunization reach: In Chad, [ http://www.irinnews.org/Report/94769/CHAD-Why-polio-is-so-hard-to-eliminate ] for instance, where the health system is broken, just 60 percent of children have been covered, according to UNICEF. 
 
The campaign involves hundreds of thousands of health workers, though it will not lead to eradication in one fell swoop, said Dao. “We hope the exercise will bring us closer to reaching our goal of interrupting wild polio virus transmission in our region in 2012,” said Luis Sambo, West Africa director of WHO in a 22 March communiqué. [ http://www.unicef.org/media/media_62054.html ]
 
Despite a resurgence of the virus in West Africa, the global fight against polio has made progress: since 1988, when the Global Polio Eradication Initiative [ http://www.polioeradication.org/ ] was launched, polio has reduced by over 99 percent. At the time some, 350,000 children were paralysed by polio each year but in 2011 the reported caseload was 650, according to UNICEF.
 
An intense effort to stamp out polio in India led to no new cases being reported in 2011. India alongside Pakistan, Afghanistan and Nigeria is one of the world’s four polio-endemic countries. “If India can do it, then so can these African countries,” said Dao. “We’ve reached 99 percent of the world - we need to reach that final 1 percent; the whole programme is at risk,” she said.
 
aj/cb

Polio in West Africa
- 62 cases of polio were reported in Nigeria in 2011; thus far 10 have been reported in 2012
- 132 cases of polio were reported in Chad in 2011; while 2 have been reported so far in 2012
- No cases have as yet been reported in other West African countries
Source WHO: [ http://www.polioeradication.org/Dataandmonitoring/Poliothisweek/Wildpolioviruslist.aspx ]

]]></body><link>http://www.irinnews.org/Report/95145/WEST-AFRICA-Giant-anti-polio-drive-threatened-by-insecurity</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201201311207110246t.jpg"/></td><td valign="top">DAKAR 23 March 2012 (IRIN) - Health volunteers, aid agency and health authority staff are trying to immunize 111.1 million children under five across 20 countries in West and Central Africa against polio. The four-day campaign started today, but instability in some of the target countries could hamper the effort.</td></tr></table>]]></content:encoded></item><item><title>HEALTH: Yaws treatment study prompts WHO review</title><pubDate>Wed, 11 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201201110749170559t.jpg" />]]>BANGKOK 11 January 2012 (IRIN) - Findings that a one-time oral treatment to cure yaws, a neglected tropical disease, is as effective as the currently recommended penicillin injection have prompted the World Health Organization (WHO) to convene a meeting on how the disease may be wiped out.</description><body><![CDATA[BANGKOK 11 January 2012 (IRIN) - Findings that a one-time oral treatment to cure yaws, a neglected tropical disease, is as effective as the currently recommended penicillin injection have prompted the World Health Organization (WHO) to convene a meeting on how the disease may be wiped out. 
 
 "We may be closer now than we have been in decades," Kingsley Asiedu, a yaws expert with WHO's Department of Neglected Tropical Disease Control, told IRIN, calling the study [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61624-3/abstract ] on the bacterial skin disease, which leads to chronic disfiguration and disability in 10 percent of untreated cases, the most significant in half a century. 
 
 After a UN-led worldwide control programme cut infections from 50 million to 2.5 million in 1964 in 46 countries, the disease re-emerged in the 1970s when control efforts lagged, affecting an estimated 460,000 people - mostly children - in poor, tropical rural areas mainly in Africa and Asia, according to the most recent figures reported to WHO in 1995. 
 
 In 2010, the Lihir Medical Centre in Papua New Guinea (PNG), where the disease is still endemic, gave the one-time oral dose of the antibiotic azithromycin to about half of 250 infants and children from six months to 15 years infected with yaws. 
 
 Follow-up exams in 2011 showed the treatment was as effective as penicillin injections, which - unlike oral antibiotics - require trained health staff and equipment often scarce in areas most in need of treatment, wrote the researchers. 
 
 In a recent index of health workers' outreach [ http://www.savethechildren.org.uk/sites/default/files/docs/HealthWorkerIndexmain_4.pdf ] by the NGO Save the Children, PNG ranked in the bottom 20 of 161 surveyed countries. 
 
 The meeting of yaws experts convened by WHO in Geneva from 5-7 March will "fully define how we are going to embark [on a new yaws treatment regimen] using azithromycin", said Asiedu. 
 
 WHO's yaws treatment guidelines date back to the 1960s and there have been no alternatives since, he added. 
 
 In Southeast Asia, WHO set the goal for regional eradication by 2012 in two remaining endemic countries - Indo¬nesia and Timor-Leste. PNG, the Solomon Islands and Vanuatu have also reported cases. 
 
 Sub-Saharan Africa was the most heavily affected based on earlier estimates, but the "picture is not entirely clear now", said Asiedu. Cameroon, Central African Republic, Congo, Côte d'Ivoire, Democratic Republic of Congo, Ghana, Sierra Leone and Togo have all reported cases. 
 
 More studies are needed to ensure resistance to azithromycin treatment does not develop, said David Mabey from the London School of Hygiene and Tropical Medicine. 
 
 While penicillin "has stood the test of time" - still as effective fighting the bacteria causing yaws after roughly 60 years - he noted mass azithromycin had only been used in developing countries for about a decade to treat trachoma [ http://www.irinnews.org/report.aspx?reportid=89568 ], another bacterial disease prevalent in poor rural areas. 
 
 Discussions at the upcoming WHO meeting will include a measure to monitor antibiotic resistance, said Asiedu. "Antibiotic resistance is a risk in any treatment and we always have to be vigilant." 
 
 pt/mw

]]></body><link>http://www.irinnews.org/Report/94621/HEALTH-Yaws-treatment-study-prompts-WHO-review</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201201110749170559t.jpg"/></td><td valign="top">BANGKOK 11 January 2012 (IRIN) - Findings that a one-time oral treatment to cure yaws, a neglected tropical disease, is as effective as the currently recommended penicillin injection have prompted the World Health Organization (WHO) to convene a meeting on how the disease may be wiped out.</td></tr></table>]]></content:encoded></item><item><title>WEST AFRICA: Call for more coordinated approach to child protection</title><pubDate>Wed, 04 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201201041152580355t.jpg" />]]>DAKAR 04 January 2012 (IRIN) - A new report on child migration in West Africa says thousands of children are being sold, exchanged or transported out of their communities each year in violation of internationally-recognized rights of the child, and calls on the Economic Community of West African States (ECOWAS) to persuade governments to better protect these children.</description><body><![CDATA[DAKAR 04 January 2012 (IRIN) - A new report on child migration in West Africa says thousands of children are being sold, exchanged or transported out of their communities each year in violation of internationally-recognized rights of the child, and calls on the Economic Community of West African States (ECOWAS) to persuade governments to better protect these children.
 
 Among the recommendations identified were: the need to align social norms, national laws and international standards of protection; the need to improve the development of children within their locale; the promotion of community mechanisms for child protection; the inclusion of children’s views in any protection regime; and joint initiatives to protect children from unlawful cross-border movement.
 
 The 79-page report [ http://www.tdh.ch/en/documents/which-protection-for-children-involved-in-mobility-in-west-africa ] drawn up by representatives of several national and international NGOs, entitled Quelle protection pour les enfants concernés par la mobilité en Afrique de l’Ouest? (What Protection for Child Migrants in West Africa?) looked at the problem in Benin, Burkina Faso, Guinea and Togo in 2008-2010.
 
 “At the governmental level measures are generally limited to passing national laws. Joint action might simply amount to police intercepting and repatriating children,” said Moussa Harouna, programme coordinator for NGO the African Movement of Child and Youth Workers, stressing that greater unity of action was required by governments and international organizations to support village development initiatives and set up child protection measures. 
 
 The report calls on states and development agencies to integrate child migration into their development and child protection strategies. It wants any future ECOWAS action on the movement of people, particularly children, to be an essential part of a “coherent and pragmatic policy” against human trafficking and child labour.
  
 In addition, it calls on individual states to boost their ability to find victims of child trafficking and to differentiate this practice from other forms of mobility. 
  
 Push factors
 
 Children may leave their communities because of conflict within the family, or the desire for education, apprenticeships or job opportunities to help their families. Some parents force their children to leave, but often departure is voluntary and motivated by the quest for a better life.
  
 Zelmet Fatimah and Zeydata Amina from Niger, two girls who beg along the Teteh Quarshie Interchange, a busy highway in the Ghanaian capital Accra, say they left home because of hunger. “There is no food there,” said Zeydata, “I come here every day with my sisters and my parents to beg for money. I beg because we don’t have money and I am hungry.”
  
 However, push factors are many and varied: “The children’s motivations are rooted in the current changing world… It is misleading to believe that a state, civil society and development partners have the capacity and sufficient legitimacy to end, simply, this many-sided practice of child mobility,” said the report. 
  
 Positive outcomes
  
 While no one knows the precise scale of child migration, the report says outflows of children are generally from Mali, Niger and Guinea-Bissau, and their destinations are Benin, Cote d’Ivoire, Ghana, Nigeria and Togo.
  
 Outflows north are less intense. The report says just 10 percent of the total number of children seeking to reach the Maghreb and Europe are from West Africa. Many are seasonal travellers, leaving for short or medium periods at the end of the farming season. 
  
 The migration of children is not always a negative phenomenon: migrant children send money home. Those from the same community might collectively fund a project. 
  
 Harouna said this had been the case in some villages in the Niger region of Makalondi, near the border with Burkina Faso, where migrant children had jointly paid to build a school for their community. The effect had been to encourage those who were too young to migrate to remain in their communities, at least for much longer, and others to return. 
  
 “The objective is no longer to stop migration at all cost,” Haround said. “It is also to improve conditions in the communities so that children do not have to leave to seek fortunes and a better life. Yet, even if they do, then organized protection must be provided within their host states or new communities in their own countries.” 
  
 oss/cb
 
 ]]></body><link>http://www.irinnews.org/Report/94582/WEST-AFRICA-Call-for-more-coordinated-approach-to-child-protection</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201201041152580355t.jpg"/></td><td valign="top">DAKAR 04 January 2012 (IRIN) - A new report on child migration in West Africa says thousands of children are being sold, exchanged or transported out of their communities each year in violation of internationally-recognized rights of the child, and calls on the Economic Community of West African States (ECOWAS) to persuade governments to better protect these children.</td></tr></table>]]></content:encoded></item></channel></rss>