http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbThu, 05 Nov 2009 19:33:58 GMTNOUAKCHOTT Thursday, November 05, 2009 (IRIN) - People living with HIV in Mauritania are voicing their concerns about the suspension of HIV/AIDS funding by the World Bank and the Global Fund to fight AIDS, Tuberculosis and Malaria. They feel powerless in the face of the decisions, of which they are suffering the consequences.NOUAKCHOTT Thursday, November 05, 2009 (IRIN) - People living with HIV in Mauritania are voicing their concerns about the suspension of HIV/AIDS funding by the World Bank and the Global Fund to fight AIDS, Tuberculosis and Malaria. They feel powerless in the face of the decisions, of which they are suffering the consequences.

On 14 October dozens of people living with HIV organized a sit-in in front of the World Bank building in the capital Nouakchott to draw the Bank’s and the international community’s attention to their situation.

"By suspending their programmes without consulting us, donors have not taken our distress into account," Fatimata Ball told IRIN/PlusNews. Ball represents people living with HIV at the SENLS (the national AIDS committee) Executive Secretariat, the government body implementing Global Fund and World Bank programmes.

"We, people living with HIV, did not bring about these problems, so should we suffer the consequences?" she added. "The reason donors give millions to Mauritania is that we are a poor country. They gave us hope of a second life when we had given up on that hope; they should not drop us."

US$21 million of World Bank funding through 2009 was suspended in August 2008 following the military coup against President Sidi Mohamed Ould Cheikh Abdallahi.

Shortly afterwards the Global Fund suspended HIV/AIDS funding, $15 million over five years which was granted in 2006, following suspected irregularities in grant management. An audit in September 2009 confirmed “embezzlement” had occurred, which led the World Bank also to carry out an audit.

In accordance with the Global Fund’s terms for reinstating funding the new government, named in September following June presidential elections, began proceedings against four SENLS members suspected of being involved in the embezzlement. The State has also promised to return $1.7 million to the Global Fund and to provide supporting documents on the use of a further $2 million. Finally, the government has also committed to re-structuring the CCM (Country Coordinating Mechanism), the country’s Global Fund funding management body; weakness of the CCM is seen as contributing to the problems.

Commitments

While SENLS members recognize the problems that have occurred over the last few months, they are convinced that the new government is keen to resolve the situation as quickly as possible. "The State has made a strong commitment to clearing up the situation. We asked the state general inspectorate to carry out audits and they are now underway,” Ahmed Aida, the recently appointed interim SENLS national executive secretary, told IRIN/PlusNews.

"Corrective measures have been taken to ensure things go smoothly in the future. We need [partners] to join us,” he urged.

In the meantime SENLS wants to ensure that medical care and support issues are addressed. "The government is willing to take responsibility for treatment,” Aida said. In theory, access to treatment is safeguarded under a law introduced in 2007.

The Global Fund have said they are aware of the government’s commitment and will do all they can to limit the impact the suspension has on people living with HIV. "We are 100 percent committed not to break up treatments and we will do whatever we can … to continue the grant,” Jon Lidén, Head of Communications at the Global Fund in Geneva, told IRIN/PlusNews.

"There is a difficult situation [because of] corruption… but the Global Fund is very committed to continue working in the long term to re-establish a way to deliver services in a safe and predictable way, and to expand them as planned,” he added.

The World Bank reaffirmed it is keen to clear up the situation as quickly as possible, but also that they are available to help people living with HIV overcome this crisis.

"We are aware of the urgent nature of the situation and we continue to look after the sick,” François Rantrua, World Bank representative in Mauritania, told IRIN/PlusNews. In terms of care and support for new patients, "we are well on our way to finding a very short-term funding solution,” he added.

While Global Fund-financed HIV/AIDS programmes have been suspended this has not affected patients who were already on ARVs before the irregularities were discovered – just over 1,000 people have continued to receive their medication; but it has not been possible to add any new patients (totalling around 40 people a month) to the treatment programme.

And other activities in the fight against AIDS funded as part of these programmes have also come to a standstill, such as prevention activities and support (psychological, socio-economic) for people living with HIV.

"We are not against [donors] checking [the accounts] because this will make our lives more secure", said Ball. "But what is affecting us is that things stopped so suddenly. If we had had some warning we would have been able to mobilize to find other solutions. We are already suffering due to AIDS; we don’t want to be victims of procedures too.”

ail/lchttp://www.irinnews.org/report.aspx?ReportId=86904NAIROBI Wednesday, November 04, 2009 (IRIN) - Encouraging the use of traditional African herbal medicines could prevent some of the one million malarial deaths on the continent, according to specialists attending a conference www.mimalaria.org/pamc in Nairobi. Many poor communities, especially in rural settings, cannot afford modern malarial drugs and many people die due to inaccessibility of treatment.NAIROBI Wednesday, November 04, 2009 (IRIN) - Encouraging the use of traditional African herbal medicines could prevent some of the one million malarial deaths on the continent, according to specialists attending a conference www.mimalaria.org/pamc in Nairobi. Many poor communities, especially in rural settings, cannot afford modern malarial drugs and many people die due to inaccessibility of treatment.

“Malaria kills many people in Africa, both children and adults, despite the availability of free treatment in certain African countries. While it is true many governments in Africa, with development partners, give free pediatric treatment for malaria, many still cannot access this facilities and resort to home treatment,” says Merlin Wilcox of the Research Initiative on Traditional Antimalarial Methods and the University of Oxford.

Some specialists at the ongoing 5th MIM Pan African Malaria Conference in Nairobi said medicines drawn from plants that abound in the continent could be utilized to save many people, especially those in poor settings, from malaria.

BN Prakash, a researcher with the Foundation for the Revitalization of Local Health Traditions, based in Bangalore, said Africa could draw on experiences in India where medicinal plants have been used with great success in the control of malaria-related deaths.

“Research in India has shown a 5-10 times reduction in malaria-related deaths among communities who use traditional medicinal plants like Guduchi [tinospore coeditdia], a local medicinal plant found in India,” said Prakash.

Preserving traditional knowledge

Another speaker, Gemma Burford of the Global Initiative for Traditional Systems of Health, said while there had been increased cases of loss of knowledge about traditional medicinal plants, student-led research could be used to preserve knowledge and create a database on these plants.

“When we carried out research involving school children in rural Tanzania about traditional Maasai medicines, we found out that 48 percent of these children already had knowledge about these plants. We used [this knowledge] to create a database for the purposes of preserving the knowledge and these plants too,” said Burford.

“It is important to note that many malarial drugs are still bought from commercial pharmaceutical shops and not many of them are that cheap. Costs also involve how easy or not it is to access these government facilities, especially in Africa where medical facilities are far-flung,” Burford said.

Educating the youth

Speakers at the conference called on African governments to introduce educational programmes that would teach the younger generations about the traditional methods of treating malaria and other diseases plaguing the continent.

“The biggest obstacle to use of traditional medicines is lack of interest from the youth and teaching them about these medicines would be the best way to let them appreciate their values. Evangelical churches and development agencies must also be persuaded to stop fighting traditional African medicine because modernity and tradition can be married to provide a formidable force against malaria,” added Burford.

Effectiveness and dangers

Doumbo Ogobara, director of the Mali Malaria Research and Training Centre, and a lecturer at the University of Bamako, said there should be more research to ensure the effectiveness of traditional medicinal plants in the treatment and management of malaria.

“More research must be directed towards finding out the effectiveness of these traditional medicinal plants and their safety and efficacy because initiatives on using them could be counter-productive if this is not done. More emphasis therefore must be laid on research for plant-based prophylactics for malaria,” said Ogobara.

Mahamadou Sissoko of the Centre called for caution in taking the traditional medicinal route, arguing that many malaria-related deaths have occurred even among communities that have relied heavily on traditional plants for treatment.

“People are dying even in places where there is still widespread use of traditional medicinal plants and unless the efficacy of a traditional plant on malarial treatment can be ascertained through vigorous research, we could have our backs against the wall. Many traditional healers will abuse this and give anything as medicine so long as it is a plant - we must urge caution,” said Sissoko.

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http://www.irinnews.org/report.aspx?ReportId=86866NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - At the health centre in Dar Naim, a working class neighbourhood of Nouakchott, the building for malnourished children is always full: in rural areas the seasons and crops affect malnutrition levels whereas in the capital this phenomenon remains constant throughout the year. NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - At the health centre in Dar Naim, a working class neighbourhood of Nouakchott, the building for malnourished children is always full: in rural areas the seasons and crops affect malnutrition levels whereas in the capital this phenomenon remains constant throughout the year.

The most recent nutrition survey carried out in July by the Ministry of Health and the UN Children’s Fund (UNICEF) using SMART methodology focused on assessing the nutritional situation for children between harvests.

The survey revealed that three regions of the country (southeast, south and centre) had the highest rates of global acute malnutrition (GAM). In central areas the rate was 19.2 percent, well above the World Health Organization’s emergency threshold of 15 percent.

In rural areas there tends to be various causes for malnutrition, notes Mohamed Moustapha Kane, head of the Health Ministry nutrition service.

General poverty levels in the country – more than 46 percent of the population live below the poverty threshold, according to the UN – and the lean season both contribute to malnutrition, but in addition in rural areas, although they are "agropastoral regions, not everyone has [cattle or land]. People also lack knowledge…of [good nutritional practices]. Isolation and lack of infrastructure are also an issue: access to health, drinking water or [hygiene]".

According to the July 2009 study the GAM rate in Nouakchott (7.9 percent) is much lower than in other areas. However the difference is that in the capital, as opposed to in rural areas, the seasons have little influence on the phenomenon: the December 2008 SMART study during a post-harvest period showed a 5.9-percent rate in Nouakchott compared to 11.9 percent in the central region.

Many observers have noted that the time of year does not affect food availability in urban areas. According to Nené Koné, who has been in charge of child nutrition at the Dar Naim health centre since 1991, in large part a lack of money perpetuates the problem in Nouakchott.

When mothers arrive at the centre with their children, "the main issue that comes across is their extreme poverty,” Koné told IRIN. "If the mother is hungry because she has not been able to eat, then she has no milk [to breastfeed]".

"Families are heavily in debt throughout the year,” said Isabel Marco of Communauté des Filles de la Charité, who support the centre. The huge increase in global food prices in 2008 has made the situation even worse for urban families who do not produce any food and have buy everything: 25 litres of milk cost 35,000 ouguiya (US$134), compared to $53 in 2004, said Marco. Today it costs 24,000 ouguiya ($92) – the equivalent of one month’s minimum wage in a country where "traditionally we drink a lot of milk”.

Child malnutrition in urban areas is also linked to the financial situation of many Mauritanians deteriorating over the last few decades. Tahya Sidiekhreye, in her 50s, has brought up "lots" of children. She arrived at the Dar Naim centre at the start of October with her grandson, who is 15 months old and suffering from acute severe malnutrition.

"I never had these problems with my children: my husband and I always managed to get by [to feed them], but now it’s too hard,” she said. "[My grandson] has been ill for four months and I haven’t got the money to care for him. [His mother] doesn’t work and his Dad is unemployed, so they cannot care for him.”

She is looking after her grandson because her daughter does not know what to do, she told IRIN; the child’s mother is 15. When mothers lack nutritional knowledge and do not have enough milk they are unable to breastfeed, many experts have noted. And in urban areas in particular certain practices that lead to malnutrition have become common.

"In the past breastfeeding was highly socially valued, but there is now a trend of using milk substitute,” Brahim Ould Isselmou, communications officer at UNICEF, told IRIN. Despite the cost of this practice – a tin of baby milk that lasts five days is sold for around 1,600 ouguiyas ($6) – it also changes habits. "After a few months some mothers become confused and sometimes you see [some of] them giving meat to six-month-old babies.”

While health services are more accessible in urban areas than rural, the quality of care and support for malnutrition is not always guaranteed, as Sidiekhreye discovered. Before finally getting care for her grandson at the Dar Naim health centre she spoke with a private doctor who referred her to a hospital as the child was showing worrying symptoms. "He was vomiting a lot and was dehydrated but they did not hospitalize him: they just gave me a prescription for [paracetamol] and sent me away,” she told IRIN.

In order to standardize care and support services for malnutrition and among other things improve quality, the authorities developed a national protocol in 2007, which all centres are expected to follow. The protocol called for standardizing how malnutrition is assessed, referred and monitored and how care and support are provided. At Dar Naim and other health centres staff have been trained on this protocol with support from UNICEF.

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http://www.irinnews.org/report.aspx?ReportId=86874NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - Adama Ndiaye, 20, is originally from the Kaédi region in the south of Mauritania – one of the regions worst affected by malnutrition. After losing her first two children she decided to go to the capital Nouakchott to care for her twins and her youngest child.NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - Adama Ndiaye, 20, is originally from the Kaédi region in the south of Mauritania – one of the regions worst affected by malnutrition. After losing her first two children she decided to go to the capital Nouakchott to care for her twins and her youngest child.

"My twins are [21 months] and my baby is one month old. I had two children before; the first died at one year and the other lived a month and a half. They were ill and had fever. They refused to breastfeed and then they passed away [due to complications linked to malnutrition].

"My husband is a farmer [near Kaédi] and he grows millet and peanuts. Sometimes we have food but at other times birds eat the seeds and nothing grows. In our region the majority of people eat only once a day, myself included.

"As I wasn’t eating much I didn’t have enough milk for the twins. [Shortly after they were born] the girls became ill so I decided to come to Nouakchott to look after them. I took them to Dar Naim [a health centre in a Nouakchott suburb managed by the State with support from aid agencies and donors including the UN Children’s Fund] each day.

"After six months my twins had recovered so I went back to my husband. I then became pregnant again. But my twins started to get sick again so I returned to Nouakchott. I’ve been here for five months now staying with [relatives]. I come to the centre nearly every day. The twins get porridge made from rice, fish and vegetables and there’s [baby] milk for the little one.

"As soon as my children get better I will go back to the village. I came here just to care for them but I don’t want to stay. I want to go home. My husband and I will get by with the kids.”

ail/lc/nphttp://www.irinnews.org/report.aspx?ReportId=86876JOHANNESBURG Thursday, October 29, 2009 (IRIN) - An African international agreement has opened the door to a debate on the rights and protection of people displaced by natural disasters, with a nod to migration as a result of climate change. JOHANNESBURG Thursday, October 29, 2009 (IRIN) - An African international agreement has opened the door to a debate on the rights and protection of people displaced by natural disasters, with a nod to migration as a result of climate change.

The Kampala Convention, a ground-breaking treaty adopted by the African Union (AU), promises to protect and assist millions of Africans displaced within their own countries. Significantly, the treaty recognized natural disasters as well as conflict and generalized violence as key factors in uprooting people.

Jean Ping, chairperson of the Commission of the African Union, told IRIN that "more and more people are likely to be displaced" as Africa experiences more frequent droughts and floods brought about by climate change.

He said the inclusion of displacement by natural disasters was informed by the global debate on the need to develop a framework for the rights of "climate refugees" - people uprooted from their homes and crossing international borders - because the changing climate threatened their survival.

The treaty also calls on governments to set up laws and find solutions to prevent displacement caused by natural disasters, with compensation for those who were displaced. Migration expert Etienne Piguet said with the Kampala Convention the AU had "once again" tried to push the envelope.

In 1969 the Convention Governing the Specific Aspects of Refugee Problems in Africa, adopted by the then Organization of African Unity, had gone a step further than the 1951 UN Refugee Convention by using a definition of "refugee" that included not only people fleeing persecution but also those fleeing war or events seriously disturbing public order.

Piguet described the reference to people displaced by natural disasters as an "interesting attempt" to find "adequate answers to the new concern about migration linked to environmental degradation".

In 2008 climate-related natural disasters like droughts, hurricanes and floods forced 20 million people out of their homes, while 4.6 million people were internally displaced by conflicts, according to a recent joint study by the UN Office for the Coordination of Humanitarian Affairs (OCHA) and the Geneva-based Internal Displacement Monitoring Centre.

The Representative of the UN Secretary-General (RSG) on the Human Rights of the Internally Displaced Persons in a submission to the UN Framework Convention on Climate Change noted that people uprooted from their homes by natural disasters enjoyed protection under the existing human rights law and the guiding principles on internal displacement.

However, the Kampala Convention also calls on governments to "prevent or mitigate, prohibit and eliminate root causes" of displacement, and find "durable solutions" to them.

Moussa Idriss Ndele, President of the Pan-African Parliament, the legislative body of the AU, said the debate in Kampala on the rights of people displaced by natural disasters did not "quite evolve properly - we did not address the issue of climate change" because most people still believed conflict was the biggest trigger of displacement.

Can of worms

However, it was unclear which events could be linked to climate change. "More and more people are being displaced by floods, which are becoming more and more frequent and intense," said Rachel Shebesh, chair of the African Parliamentarian Initiative for Climate Risk Reduction.

The RSG said there was a need to clarify or even develop a legal framework to help people who moved inside or outside the country because environmental degradation and slow-onset disasters - like desertification, salination of soil and groundwater - made areas uninhabitable, and if displaced persons could not return to their homes they should be considered forcibly displaced.

The Intergovernmental Panel on Climate Change (IPCC) has projected more frequent and intense floods and droughts in Africa during the next few decades, and the debate is not only set to continue, but to intensify.

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http://www.irinnews.org/report.aspx?ReportId=86805KAMPALA Tuesday, October 27, 2009 (IRIN) - The African Union Convention for the Protection and Assistance of Internally Displaced Persons in Africa is a comprehensive document that will, if ratified, fill a void in international humanitarian law, say experts. KAMPALA Tuesday, October 27, 2009 (IRIN) - The African Union Convention for the Protection and Assistance of Internally Displaced Persons in Africa is a comprehensive document that will, if ratified, fill a void in international humanitarian law, say experts.

Whereas the rights of people who flee across national boundaries are protected under the 1951 Convention Relating to the Status of Refugees and a similar instrument introduced 18 years later by the Organization of African Unity (now the African Union), there has been no international legislation catering specifically for people displaced within their own country (IDPs).

IDPs vastly outnumber refugees in Africa. In just 10 of the 18 countries in east and central Africa, there are more than 10 million IDPs, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA), with Sudan (four million), the Democratic Republic of Congo (2.12 million) and Somalia (1.55 million) heading the list.

In the same region, there are refugees in 16 countries, totalling just less than two million, according to OCHA.

This latest instrument, also known as the Kampala Convention because it was signed in the Ugandan capital, "obliges governments to recognize that IDPs have specific vulnerabilities and must be supported", said Walter Kälin, Representative of the UN Secretary-General on the Human Rights of Internally Displaced Persons.

"It covers all causes of displacement, is forceful in terms of responsibility and goes beyond addressing the roles of states to those of others like the AU and non-state actors."

Signed by 17 African states at the end of summit on 23 October, the convention defines IDPs broadly, irrespective of who is displacing them.

According to the International Committee of the Red Cross (ICRC), the convention provides a solid framework for enhancing the protection and assistance of IDPs in Africa. The ICRC is the custodian of international humanitarian law.

"The crucial challenge now is the same one facing international humanitarian law in general – ensuring that once the convention is signed and ratified by as many states as possible, it is actually implemented and respected," ICRC president Jakob Kellenberger said.

"States must now take concrete steps to implement the convention into their own national legislation and regulation systems, and develop plans of action to address issues of displacement.

"The convention goes further than international humanitarian law treaties in some aspects, for example, in the rules it contains on safe and voluntary return, and on access to compensation or other forms of reparation," Kellenberger added.

Next steps

To become a binding document, the convention has to be ratified by 15 of the AU's 53 member states.

"No international treaty is perfect, and the AU IDP Convention does have a few weaknesses. Concerns over the lack of effective enforcement mechanisms and insufficient guarantees for equality and non-discrimination have been raised," the Brookings-Bern Project on Internal Displacement noted in a statement.

"There is some question regarding the extent to which non-state actors and armed groups called upon by the convention to protect IDPs can be bound by its provisions. Nevertheless, the convention, which has benefited from the input of international experts, is considered to be generally consistent with international standards such as the Guiding Principles on Internal Displacement."

AU officials in Kampala were cautiously upbeat, urging member states to remain engaged. "It is the responsibility of member states that the convention becomes a binding instrument," Jean Ping, AU Commission President, said. "At this point, it is an achievement, but not an end in itself."

Zambian president Rupiah Banda also chose his words carefully. "We have given legal force to the task ahead and Zambia is ready to sign," he said. "Those who are displaced should not be forgotten."

An observer who requested anonymity said progress would require member states to demonstrate greater political will to implement the convention and address concerns about sovereignty and enforcement.

"It is a question of a progressive [AU] Commission versus [conservative] member states," he told IRIN in Kampala. "For example, the inclusion of armed groups in the draft was interpreted by some member states as lending legitimacy to such groups."

The convention emphasizes the sovereignty of member states but spells out the obligations and responsibilities of armed groups. Among others, it prohibits armed groups from carrying our arbitrary displacement, recruiting children and impeding humanitarian assistance.

"Overall, though, the convention has a good chance of getting the necessary signatures rather quickly," the observer added. "In April, SADC’s [Southern African Development Community] 11 members committed to speedy signature."

Political will

Civil society leaders, attending a parallel event, insisted political will and demonstrated commitment were key to progress. The fact that only five presidents came to Kampala, they said, called for an urgent strategy to bring on board more states.

Present were Banda, Ugandan President and host, Yoweri Museveni, Zimbabwe's Robert Mugabe, Somalia's Sheikh Sharif Sheikh Ahmed and Mohamed Abdelaziz of Saharawi, along with high-level UN, INGO and AU delegations.

"It is one thing to have a good convention and another to implement it," Dismas Nkunda of the New York-based International Refugee Rights Initiative told IRIN.

In 2007, the AU adopted the African Charter on democracy, elections and governance, but it has so far been ratified by only two member states.

The basic question of impunity also needed to be addressed. Until African countries learn to respect the law, participants said, the continent would "remain at rock bottom" in its attempts to address the problems of the displaced.

AU officials seemed conscious of these sentiments. "We have come a long way, but a plan of action is now envisaged," Jolly Joiner, AU commissioner for political affairs, told IRIN. "Once member states are on board, we will take this convention forward."

Antonio Guterres, head of the UN Refugee Agency (UNHCR) and representative of the UN Secretary-General at the summit, said solving the question of displacement in Africa required political solutions.

"There is no humanitarian solution to conflict," he explained. "The solution is always political."

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http://www.irinnews.org/report.aspx?ReportId=86762NAIROBI Tuesday, October 27, 2009 (IRIN) - Replacing manual data with electronic health records would significantly improve the quality of care and enable African HIV treatment programmes to be scaled up more efficiently, say the authors of a new article on the subject. NAIROBI Tuesday, October 27, 2009 (IRIN) - Replacing manual data with electronic health records would significantly improve the quality of care and enable African HIV treatment programmes to be scaled up more efficiently, say the authors of a new article on the subject.

"Talkin' About a Revolution", published in the latest edition of the Journal of Acquired Immune Deficiency Syndromes, looked at the Academic Model for Providing Access to Healthcare (AMPATH), a programme that uses electronic health records in care and treatment services for around 100,000 HIV-positive patients at sites across western Kenya.

"Scaling up treatment programmes requires timely data on the type, quantity and quality of care being provided," the authors said. "Health care is an information business; managing patient care requires managing patients' data at many levels ... health care systems the size of AMPATH (or larger) cannot effectively be managed without ... [electronic] data."

More efficient care

The health data system can help programme managers avoid medical errors and stock-outs of key medicines, while enabling clinicians to monitor and care for their patients more effectively.

"Electronic records help us store data efficiently, retrieve it when we need it, and monitor and evaluate the progress of our programmes much more easily than if we were using manual systems," said Erica Kigothe, AMPATH's programme manager in charge of data management.

"When a patient comes to a clinic for a visit, instead of poring over large files, the clinician has one summary sheet that contains all the vital patient information and should he or she need more information, they can always go back to the patient's computerized file," she told IRIN/PlusNews.

A previous study comparing an AMPATH clinic before and after the adoption of electronic health records found that patient visits were 22 percent shorter, provider time per patient was reduced by 58 percent, and patients spent 38 percent less time waiting.

Kigothe noted that assessing disease trends was also easier with electronic records, as was collating data for the purposes of research and new directions in programme development.

Electronic health systems have been successfully used in the care and treatment of HIV in Lesotho, Malawi, Rwanda, South Africa and Uganda, but few African countries have adopted the systems on a large scale.

"Programme implementers in low-income countries sometimes see clinicians' recording of patient data and the management of those data as secondary to providing good care, or even a distraction," the article's authors commented.

Not all smooth sailing

The programme has not been without its difficulties. "In one of our sites in Busia [town on the Kenya-Uganda border] they have very frequent power outages, so they have had to find ways to work around it, inputting data when power is on, even if that is at night," Kigothe said.

Finding people with computer skills is not always easy in the developing world, particularly in rural areas, and "like any equipment, computers break down from time to time and require repair or replacement, which can cause some problems" and incur additional expenses, she said. "In addition, the data collectors are human, and therefore prone to the occasional error."

Electronic systems are not cheap; they require considerable investment in computers, training data collectors and hiring information technology experts. However, according to the study, AMPATH's total cost of care is under US$100 per patient per year, making the system financially feasible even in resource-poor settings.

"You're going to have to spend quite a lot of money to set up the system," Kigothe said. "But looking at the big picture, it saves so much in the long run - for example, each of our data collectors manages 2,000 patients' information, something that would be impossible using manual data collection."

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http://www.irinnews.org/report.aspx?ReportId=86768MIDRAND Tuesday, October 27, 2009 (IRIN) - Disaster risk reduction as a tool for climate change adaptation is a "technical mouthful" said Rachel Shebesh, chair of the African Parliamentarian Initiative for Climate Risk Reduction. MIDRAND Tuesday, October 27, 2009 (IRIN) - Disaster risk reduction as a tool for climate change adaptation is a "technical mouthful" said Rachel Shebesh, chair of the African Parliamentarian Initiative for Climate Risk Reduction.

Members of the Pan-African Parliament thought so too. The legislative body of the African Union met in Midrand, halfway between Johannesburg and Pretoria in South Africa, for a parliamentary debate on climate change in Africa.

Shebesh, the new champion of disaster risk reduction (DRR) in Africa for the UN International Strategy for Disaster Reduction (UN-ISDR) has been given the job of making the subject accessible.

Why?

The UN Special Representative of the Secretary-General for Disaster Risk Reduction, Margareta Wahlström, said DRR was "the first line of defence" against climate risks. Many countries did not have a plan that covered what to do to adapt to the impact of climate change, but drawing up a disaster risk reduction plan was a starting point.

DRR deals with the short-term changes in climate variables, such as temperature; adaptation to climate change is about long-term changes to climate. It is now widely acknowledged that reducing vulnerability to climatic variables could improve resilience to the increased hazards associated with climate change.

What does it mean?

Wahlström acknowledged that trying to explain to countries what this meant, and how to take DRR into account, could sometimes be problematic. Essentially, it is about "disaster-proofing" any plan or programme.

"You take into account the current and future disaster risks. If you are building a bridge in an area, you study the soil, ask the people who live in the area about what they know about the conditions in the area: do they build in the area? What precautions do they take? The easiest thing to do is draw up a check list."

Wahlström said she had come across several cities and towns in developing countries who had already been doing this, and "we are now busy putting all this information together for our next report."

She also said she would not be surprised if "disaster-proofing" became a pre-requisite for sourcing money for any climate change adaptation project, "but I would rather countries took up the initiative on their own." India, she said has made it mandatory for projects costing a certain amount to be disaster-proof so as to qualify for funds.

jk/he http://www.irinnews.org/report.aspx?ReportId=86774KAMPALA Monday, October 26, 2009 (IRIN) - Seventeen countries signed the African Union convention on internally displaced persons (IDPs) after years of preparation culminated in a week of meetings in the Ugandan capital but a lot more hard work remains before it becomes effective, according to observers.KAMPALA Monday, October 26, 2009 (IRIN) - Seventeen countries signed the African Union convention on internally displaced persons (IDPs) after years of preparation culminated in a week of meetings in the Ugandan capital but a lot more hard work remains before it becomes effective, according to observers.

"The most important step now is implementation," Julia Dolly Joiner, AU commissioner for political affairs, said. "We need to move from intentions to actions."

For the Brookings-Bern Project on Internal Displacement,  it is crucial that implementation is carried out "in a timely fashion and in a manner that makes a real difference to the lives of persons affected by internal displacement in the region, including host communities.
 
"The first step forward should involve a process of national dialogue and civic education aimed at securing the Convention's ratification and implementation by the State parties," according to a statement by the project, which monitors displacement issues worldwide to promote best practice among governments and other actors.

Fifteen countries must ratify the convention before it enters into effect.

Organizers of the 19-23 October meetings  insisted that the fact that only 17 signed did not represent a lack of political will and commitment on the part of the African states.

"We debated together and we agreed but when it comes to signing, the person has to have been given the authority by his government to sign," one AU official told IRIN. "Only 17 had such authorization."

Ugandan President Yoweri Museveni, who chaired the summit, praised it as "a very important milestone [that] has gone beyond conflicts to address issues of development.

"We have at least agreed in words, we now have to put our words [into] action," he told a news conference. "The solace for the women in Darfur may not be very immediate, but the fact is that people have come together to discuss the matter."

Partnerships urged

Joiner called for international support. "Africa cannot do it alone; that is why we are calling for partnerships," she told IRIN. "We are optimistic that countries will be faithful to their commitments under the convention.”

The AU will now try to get more signatures, and lobby 15 countries to ratify the convention so it can become a binding document. Observers, however, say much more work needs to be done to generate political will, given that most presidents stayed away from the summit.

The convention addresses the root causes of displacement in Africa, where at least 11 million people are displaced by conflict and climate change-related natural disasters, among other reasons.

According to the Brookings-Bern Project, three of the world's top five countries with the largest populations of conflict-induced IDPs are in Africa.

These include Sudan, with an estimated 4.9 million IDPs, the Democratic Republic of Congo, with at least one million, and Somalia, where the UN estimates 1.5 million are displaced. Hundreds of thousands more are displaced in Cote d'Ivoire, Ethiopia, Kenya, Uganda, and Zimbabwe.

Overall, citizens in at least 20 African states are experiencing internal displacement.

The convention aims to promote regional and national measures to prevent, mitigate, prohibit and eliminate the root causes of internal displacement as well as provide durable solutions.

"People who flee persecution or conflict and cross into another country are categorized as refugees and, as such, benefit from a long-standing and well-oiled international legal protection system, including the 1951 Refugee Convention," the UN High Commissioner for Human Rights, Navi Pillay, said.

"Until now [IDPs] have been more or less excluded from the system of international legal protection, even though they are often displaced in exactly the same way, and for exactly the same reasons, as refugees. At least in Africa, that should no longer be the case."

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The IDP convention obliges states to:

- Prohibit and prevent arbitrary population displacements, respect the principles of humanity and human dignity, as well as aspects of international humanitarian law concerning the protection of IDPs;

- Ensure assistance to IDPs, incorporate obligations under the convention into domestic law and designate a body to coordinate IDP protection and assistance;

- Devise early warning systems on potential displacement and establish disaster risk reduction strategies, protect communities and respect individual rights on protection against arbitrary displacement;

- Respect the mandates of the AU and UN, and the roles of international humanitarian organizations; and

- Take necessary action to effectively organize humanitarian relief and guarantee security; respect, protect and not attack humanitarian personnel or resources, and ensure armed groups conform with their obligations.

It prohibits armed groups from:

- Carrying out arbitrary displacement, hampering the provision of protection and assistance to IDPs and restricting the movement of IDPs;

- Forcibly recruiting, kidnapping or engaging in sexual slavery and trafficking; or

- Attacking humanitarian personnel or resources.


It obliges the AU:

- To intervene in respect of grave circumstances such as war crimes and crimes against humanity;

- To respect the right of members to request such an intervention and support efforts to support IDPs; and

- Strengthen capacity and coordinate the mobilization of resources for protection and assistance to IDPs.

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http://www.irinnews.org/report.aspx?ReportId=86746KAMPALA Friday, October 23, 2009 (IRIN) - With increasing natural disasters, including floods, storms and droughts, hitting the continent, more people in Africa are likely to be displaced, creating a challenge for governments, the UN warns.KAMPALA Friday, October 23, 2009 (IRIN) - With increasing natural disasters, including floods, storms and droughts, hitting the continent, more people in Africa are likely to be displaced, creating a challenge for governments, the UN warns.

Displacement caused by natural disasters, said John Holmes, the UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, promised to be one of the greatest challenges African countries would face.

“As many countries… know from recent painful experiences, climate change is already increasing the frequency and intensity of extreme hazard events, particularly floods, storms and droughts,” Holmes told an African Union (AU) summit in the Ugandan capital, Kampala, on 22 October.

In 2008, Africa reported 104 natural disasters, of which 99 percent were climate-related, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

Over the past 20 years, the population of Africans affected by natural disasters doubled from nine million in 1989 to 16.7 million in 2008. Of all the disasters on the continent, 75 percent were a result of drought.

“By 2020, rain-fed agriculture is expected to have reduced by half because of shifting rainfall patterns, scattering millions of people across the continent in search [of] new livelihoods,” Holmes said.

The meeting is discussing a draft convention for the protection and assistance of internally displaced persons and a declaration on refugees, returnees and the internally displaced.

The convention is the first such global document that aims to comprehensively address the problems of Africa’s 12 million IDPs.

Transitional justice

Before the meeting, civil society leaders called for concrete action on the convention, when adopted. Chris Dolan of the Uganda Refugee Law Project urged delegates to look beyond existing models of protection and assistance to IDP, refugee and returnee populations and draw from creative transitional justice practices around Africa.

“One step towards this would be to ensure that the plan of action that is put in place to implement the decisions adopted at the summit makes links between the African Union’s draft… and the policy on post-conflict reconstruction and development,” he added.

“Another will be to link… to ongoing transitional justice processes on the continent.”

At least 15 countries need to ratify the proposed convention for it to come into force, and diplomats at the summit are confident the signatures will be raised soon. Preparatory work, they added, had shown broad support across the continent.

“It is the responsibility of member states that the convention becomes a binding instrument,” Jean Ping, AU Commission chairman, told the meeting. “It is an achievement, but not an end in itself. It is a beginning.”

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http://www.irinnews.org/report.aspx?ReportId=86716KAMPALA Thursday, October 22, 2009 (IRIN) - Civil society and government officials are gathered in the Ugandan capital of Kampala to discuss the Convention on the Protection and Assistance of Internally Displaced Persons (IDPs) in Africa and a declaration on refugees, returnees and IDPs.KAMPALA Thursday, October 22, 2009 (IRIN) - Civil society and government officials are gathered in the Ugandan capital of Kampala to discuss the Convention on the Protection and Assistance of Internally Displaced Persons (IDPs) in Africa [http://www.irinnews.org/Report.aspx?ReportId=86585] and a declaration on refugees, returnees and IDPs.

“It is a good convention, but the next steps are even more important,” said Dismas Nkunda of the New York-based International Refugee Rights Initiative. “The key test to the continent’s commitment to it will be the implementation.”

Countries such as Cote d’Ivoire, said Traore Wodjo of the Ivorian civil society coalition, needed to quickly implement the convention because political developments there could raise tensions, leading to renewed displacement.

“Some of those who were displaced during the 2003 conflict are yet to recover,” he added. “Forced displacement again, without protection, would completely disrupt their lives.”

The leaders at the summit, including presidents Robert Mugabe of Zimbabwe, Sheikh Sharif Sheikh Ahmed of Somalia, Yoweri Museveni of Uganda and Ruppiah Banda of Zambia, realize just how important is the challenge of displacement in Africa.

“Displacement is a scourge that is blighting the African landscape – and some of us are talking from experience,” said Zainab Bangura, former activist and now Sierra Leone’s foreign minister. “One day you are a minister, the next you are on a boat running for your life – with nothing on your back.”

Uganda’s Prime Minister Apolo Nsibambi, while praising his country’s policies on refugees, said: “The inability to effectively protect, assist and find timely solutions to the problems that created these displacement situations is posing a major threat to Africa’s development."

The convention, the first such global document, aims to comprehensively address the problems of Africa’s 12 million IDPs. It contains provisions on obligations of state parties relating to internal displacement and protection and assistance.

It also contains provisions on obligations relating to armed groups, the African Union, as well as obligations on sustainable returns, local integration or relocation and compensation.

“The concern is that there are already millions of laws that should protect IDPs, but they are not always observed,” Nkunda said. “So we need to ensure that this convention is respected by setting some kind of benchmarks against which we will evaluate its implementation.”

Civil society and AU role

The civil society meeting will make recommendations to the summit, which should strengthen the convention’s implementation processes, Nkunda said, and is keen to work with the AU to ensure it succeeds.

AU officials are upbeat that the summit, whose side events include an exhibition by actors in the humanitarian field, will fully explore the root causes of forced displacement in Africa and ways to prevent it.

“We are here to reflect on the specific challenges facing IDPs and to adopt an instrument that would bridge existing policy and legal gaps,” said Julia Joiner, AU political affairs commissioner.

Delegates include the UN High Commissioner for Refugees, Antonio Guterres, and the UN Under-Secretary-General for Humanitarian Affairs, John Holmes. There is also a big NGO and government presence.

Before the summit, Holmes flew to the northern Ugandan district of Pader where most returnees are resettling in their villages. He visited IDP camps, host communities and met aid workers and local leaders.

“As emergency relief needs reduce, development efforts need to be stepped up,” he said of the Ugandan situation, where about 500,000 out of more than two million IDPs are still in camps.

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http://www.irinnews.org/report.aspx?ReportId=86700NAIROBI Thursday, October 15, 2009 (IRIN) - Forty years after the rights of Africa’s refugees were enshrined in a landmark convention, the continent’s leaders are due to make legal history again by adopting a new instrument to assist people displaced within the borders of their own country.NAIROBI Thursday, October 15, 2009 (IRIN) - Forty years after African leaders adopted the 1969 Refugee Convention under the auspices of the Organization of African Unity, now the African Union, the continent's leaders are due to endorse a convention on internally displaced people.

The African Convention on the Protection and Assistance of Internally Displaced Persons in Africa is the main agenda for the heads of state summit on refugees, returnees and IDPs in the Ugandan capital, Kampala, from 19-23 October.

"It will be the first legally binding international instrument on IDPs with a continental scope, and UNHCR [UN Refugee Agency] hopes that it will translate into better lives for African IDPs," the agency's spokesman Andrej Mahecic told reporters in Geneva on 8 September.

Advocacy groups, including IDP Action, Amnesty International, the International Federation for Human Rights, and Refugees International, have hailed the convention. However, they noted, the initial draft contained elements that were vague or inconsistent with other international human rights standards.

"There are too many IDPs in Africa and their situation is too precarious for the situation to be allowed to drift any longer," says Jeremy Smith of the advocacy group, IDP Action. "The AU needs to move quickly to adopt its IDPs Convention and then invest sufficient resources and political will to see it effectively implemented."

The AU, in a statement, said it demonstrated Africa's leadership in addressing forced population displacement. Observers, however, say action on issues affecting African IDPs has generally been slow.

Over the years, the AU has developed various initiatives, including deployment of peace support operations, appointment of special envoys and special representatives, and mobilizing international support for post-conflict reconstruction.

In some cases, regional blocks have intervened to prevent, de-escalate and resolve conflicts - including the Economic Community of West African States (ECOWAS) in Liberia, Sierra Leone and Cote d'Ivoire; the Southern African Development Community (SADC) in southern Africa; and the InterGovernmental Authority on Development (IGAD) in Sudan's north-south conflict.

In addition, various instruments exist that offer protection to the displaced, such as the African Charter on the Rights and Welfare of the Child.

"Africa has shown the most progress in transforming the [UN] Guiding Principles into binding international instruments," Walter Kälin, Representative of the UN Secretary-General on the human rights of IDPs, said in a report to the General Assembly.

Half of all IDPs in Africa

Africa hosts at least 11 million of the world's estimated 25 million IDPs. The causes of displacement vary, according to the AU, but are largely homegrown and exacerbated by extreme poverty, underdevelopment and lack of opportunities.

"Since the 1990s, African conflicts have witnessed massive brutality against the civilian population," notes Bahame Tom Nyanduga, member of the African Commission on Human and Peoples' Rights, and Special Rapporteur on Refugees, Asylum Seekers and IDPs in Africa.

Calling on African states to accept responsibility for addressing human rights abuses faced by IDPs, he notes that armed combatants in Somalia, Liberia, Sierra Leone, northern Uganda, Darfur and eastern DRC violated the Geneva Conventions' protocol on civilian protection with impunity.

Climate change factors

Climate change has also increased the frequency and intensity of natural hazards in Africa, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA) and the Internal Displacement Monitoring Centre (IDMC).

A study by the two organizations found that natural disasters displaced 284,000 people in Mozambique in 2007, 150,000 in Benin, 72,805 in Ethiopia and 59,000 in Algeria.

However, forced displacement across the continent is mostly attributable to the acts or omissions of the state, such as human rights violations, political and socio-economic marginalization, conflicts over natural resources and governance challenges, according to the AU.

Unable to flee to another country in search of safety, IDPs seek refuge from violence within their own borders, sheltering in makeshift camps, shanty towns or scattered in local communities.

"The number and plight of IDPs in Africa is a scandal," according to IDP Action's Smith. "The African Union has talked the talk - drafting an IDP Convention which lays out the protections IDPs should be accorded - but does not walk the walk."

No global agency

The situation is complicated by the fact that globally there is no agency with a specific mandate to protect and assist IDPs - unlike refugees, who fall under UNHCR.

IDPs in armed conflict have rights as civilians under international humanitarian law. They are also protected - although not expressly referred to therein - by various bodies of law, including, most notably, national law, human rights law and, if they are in a state affected by armed conflict.

"While they are displaced, IDPs are entitled to the same protection from the effects of hostilities and the same relief as the rest of the civilian population," notes the International Committee of the Red Cross (ICRC)

However, while they make up almost two-thirds of global populations seeking safety from armed conflict and violence, they have fewer rights than refugees.

Sudan, for example, has the world's largest IDP population, with an estimated 4.5 million people affected, including 2.7 million in Darfur - of whom 317,000 were displaced this year.

"Since they are living within their own countries, IDPs remain under the legal jurisdiction of their national authorities, which may well be involved in the violence that they are fleeing," the medical charity, Médecins Sans Frontières, notes.

Binding hopes

The Kampala summit was recommended by AU ministers meeting in Burkina Faso in May and the AU Executive Council meeting in The Gambia in July 2006.

In 2007, NGOs meeting in Brazzaville urged the AU to "adopt legally binding instruments for the protection of the rights of migrants... the protection of and assistance to [IDPs] in Africa, based on the [UN] Guiding Principles on Internal Displacement".

The current draft is heavily informed by these principles, whose contents are mainly derived from existing international legal rules and standards. It is, however, a non-binding, soft law.

According to IDP Action, it "offers the hope of African states being held to binding standards by which they are to prevent displacement, respond to the immediate needs of those displaced and create the conditions for sustainable return and resettlement".

Approved by African ministers in November 2008, the convention will become legally binding once endorsed at the Kampala summit.

"The theme of the special summit," notes Tarsis Kabwegyere, Ugandan Minister for Disaster Preparedness, Relief and Refugees, "...fits in well, given the displacement trends on the continent, which have continued without a stop since the days of independence".

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http://www.irinnews.org/report.aspx?ReportId=86585NAIROBI Thursday, October 15, 2009 (IRIN) - Africa hosts at least 11 million of the world's 25 million conflict-affected IDPs. Millions more are displaced annually by natural disasters. NAIROBI Thursday, October 15, 2009 (IRIN) - - Africa hosts at least 11 million of the world's 25 million conflict-affected IDPs- Millions more are displaced annually by natural disasters-

- Sudan has an estimated 4- 5 million IDPs, thanks to the recent civil war in the south, and violence in Darfur and the east-

- At the peak of Uganda's northern conflict, at least 1- 8 million people were displaced- Most have returned home-

- Displacement does not only result from conflict, but also from natural disasters such as floods and drought-

- The Guiding Principles on Internal Displacement restate and compile existing international human rights and humanitarian law and attempt to clarify grey areas and gaps in the various instruments pertinent to IDPs-

- Refugees, after crossing an international boundary, normally receive food, shelter, and a place of safety, and are protected by international laws and conventions-

- IDPs have little protection or help, and remain under the jurisdiction of their government- No specific legal instruments relating to them exist-

- The UN Refugee Agency (UNHCR) has no specific mandate to cover IDP needs, but because many of them face similar problems to refugees, it sometimes oversees their protection and shelter-

- Female IDPs face greater risks because of potentially increased sexual and domestic violence-

- Killings and brutal sexual assaults against women, girls and men massively increased in eastern Democratic Republic of Congo after the start of military operations in January-

- Children face increased risk of abduction and recruitment by rebels or government forces, enslavement and sexual exploitation, and miss out on education-

Sources: IDMC, AlertNet, NGOs, UN agencies-

eo/mwhttp://www.irinnews.org/report.aspx?ReportId=86587NAIROBI Thursday, October 15, 2009 (IRIN) - Most IDPs in Africa have been forced out of their homes by conflict, either between government forces and armed opponents or between communities.NAIROBI Thursday, October 15, 2009 (IRIN) - Most IDPs in Africa have been forced out of their homes by conflict, either between government forces and armed opponents or between communities.

Here are some numbers:

SUDAN:

The country has the largest number of IDPs in Africa with an estimated 4.5 million at the start of the yearAt least 250,000 have been forced to flee their homes by inter-communal violence in Southern Sudan since JanuaryMost IDPs are from the war-ravaged western region of Darfur but there are concerns that with increasing violence, more southerners could become IDPs

SOMALIA:

An estimated 1.3 million displaced mainly by violence, including 700,000 who have fled the capital, Mogadishu, since FebruaryThe IDP camps lack basic facilities, such as schools, healthcare, water and sanitation, leading to widespread acute malnutrition and diarrhoeaWomen and girls are extremely vulnerable

DR CONGO:

Since the start of military operations against militia in the east in January, nearly 900,000 people have fled their homes and live in desperate conditions with host families, in forest areas, or in squalid displacement campsThis brought the total of those displaced across North and South Kivu and Orientale Province to at least two million, as at JulyAccess is a major problem for aid agencies

UGANDA:

The northern conflict between the government and the Lord's Resistance Army displaced at least 1.8 million people from their homesMost have returned home in the past two or three yearsAbout 494,300 still displaced (in camps plus transit sites), down from 710,000 in February

KENYA:

Government ordered all IDP camps to close in early OctoberMost IDPs were victims of post-election violence in 2008, which forced an estimated 600,000 people out of their homesInter-ethnic tensions over pasture have also displaced families in the north, while flooding has affected some communities in the west

COTE D'IVOIRE:

The conflict that erupted in 2002 forced an estimated 120,000 people out of their homes in the west, of whom about 45,000 are still in "transition situations" awaiting their return to their communities

CENTRAL AFRICAN REPUBLIC:

A ceasefire agreement between the government and the armed opposition in 2008 allowed many IDPs to return homeHowever, an estimated 100,000 had still not returned by the end of last yearMost of these live in makeshift homes in the bush, quite close to their villages

CHAD:

At least 168,000 people were displaced as at April, living in 38 sites, mainly in the eastMost of these fled fighting between the Chadian army and armed opposition groups, inter-ethnic violence and the spillover effects of the Darfur conflict in neighbouring Sudan

Sources: IDMC, Congo Advocacy Coalition, UN agencies

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http://www.irinnews.org/report.aspx?ReportId=86588NAIROBI Thursday, October 15, 2009 (IRIN) - The objectives of the ConventionNAIROBI Thursday, October 15, 2009 (IRIN) - - Promote and strengthen regional and national measures to prevent or mitigate, prohibit and eliminate root causes of internal displacement as well as provide for durable solutions;
- Establish a legal framework for preventing internal displacement, where possible, and protecting and assisting internally displaced persons in Africa.
- Establish a legal framework for solidarity, cooperation, promotion of durable solutions and mutual support between the state parties to combat displacement and address its consequences;
- Provide for the obligations and responsibilities of the states parties, with respect to the prevention of internal displacement and protection of, and assistance, to internally displaced persons;
- Provide for the respective obligations, responsibilities and roles of armed groups, non-state actors and other relevant actors, including civil society organizations, with respect to the prevention of internal displacement and protection of, and assistance to, internally displaced persons.

After adoption, a plan of action will be put in place to implement the convention.

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SOURCE: African Union Commissionhttp://www.irinnews.org/report.aspx?ReportId=86589DAKAR Thursday, October 15, 2009 (IRIN) - Cholera outbreaks in West Africa generally trigger extra hand-washings in households and panic-buying of bleach for treating water. But beating the deadly – but easily preventable – illness requires that such hygiene practices become routine, health experts say.DAKAR Thursday, October 15, 2009 (IRIN) - Cholera outbreaks in West Africa generally trigger extra hand-washings in households and panic-buying of bleach for treating water. But beating the deadly – but easily preventable – illness requires that such hygiene practices become routine, health experts say.

Researchers with the London School of Hygiene and Tropical Medicine (LSHTM) say knowing the drivers behind behaviour and tying hygiene messages to those impulses is crucial for preventing cholera, which has become a recurring health emergency in West Africa.

“If we want sustainable change we need to make sure people practice things so they become habits,” Jeroen Ensink of LSHTM’s environmental health group told IRIN.

One way for aid agencies to do so, he said, is to dissociate hygiene messages from cholera – which is seasonal – and link them instead to general diarrhoeal disease.

Ensink also said it might be time to “re-brand” hygiene and health messages, as knowledge of cholera’s causes does not always translate into new habits. “Hand-washing messages need not be just about health; they can be about: if you want to be modern, to smell nice, to be attractive to the opposite sex, use soap.” The use of proper latrines can be linked to privacy instead of just proper hygiene, he added.

LSHTM has studied the impact of government and aid agency prevention and preparedness measures in Guinea and Guinea-Bissau as part of a project funded by the European Commission humanitarian aid department (ECHO).

Coherent

The ECHO project aims to build a more coherent approach to cholera control with sound preparedness and early response. And ECHO says ‘quick impact’ actions in vulnerable communities should be accompanied by longer-term prevention measures.

To date, emergency and development strategies fail to address the disease properly, lacking common objectives and complementary actions, ECHO says.

ECHO is focusing on Guinea and Guinea-Bissau, where cholera has become endemic; during 2007 and 2008 over 23,000 people were infected and 560 died in the two countries.

But all of West Africa is highly vulnerable to cholera and a regional approach is needed; ECHO and its partners will study lessons from Guinea and Guinea-Bissau to see what might be applied more widely.

As part of the ECHO-funded project UN Children’s Fund and NGOs are training local health workers in responding to cholera, boosting communications strategies and developing emergency kits, which include sanitation and water purification materials, to keep outbreaks in check.

“We know that the solution to cholera is an overall improvement in water, sanitation and environmental conditions,” said ECHO water and sanitation expert Francisco Gonzalez. But he said before such significant and permanent changes can be made, proper preparedness and response can save a lot of lives.

But to be effective anti-cholera actions must not be merely reactive, health experts say. LSTHM researchers observed in Guinea-Bissau that while most people could recite verbatim hand-washing and other hygiene messages, they apply them consistently only when cholera strikes. Changing such behaviour takes years, not months, said LSHTM’s Ensink.

The World Health Organization calls cholera a principal indicator of social development. Overcrowding in poor-sanitation urban areas is a main driver of cholera. And the disease hits the poorest of the poor most heavily. With factors like poverty, rapid and unregulated urbanization and poor infrastructure all favouring cholera outbreaks, substantial socio-economic fixes are necessary to eliminate cholera as a cyclical health disaster.

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http://www.irinnews.org/report.aspx?ReportId=86596DAKAR Wednesday, October 14, 2009 (IRIN) - Designed to be safe havens in times of disaster, health facilities are vulnerable to upheaval when catastrophe strikes, according to the UN, which is focusing on hospital safety for International Day for Disaster Reduction.DAKAR Wednesday, October 14, 2009 (IRIN) - Designed to be safe havens in times of disaster, health facilities are vulnerable to upheaval when catastrophe strikes, according to the UN, which is focusing on hospital safety for International Day for Disaster Reduction.

Only half of UN member countries have set aside money for health facility emergency preparedness, according to World Health Organization (WHO).

The world’s 49 least-developed countries house at least 90,000 health facilities, most of which have not been evaluated for disaster preparedness. Latin American and Caribbean countries have created a Hospital Safety Index that has been used in Bolivia, Ecuador, Peru, Oman, Sudan and Tajikistan.

In Burkina Faso September 2009 flooding forced the largest hospital to shut down. The facility is barely functioning six weeks later.  Health Minister Seydou Bouda told IRIN he believes disaster can effect change. “In Burkina Faso nothing will be like it was before. Each [health] sector activity should integrate crisis management into its operations because catastrophe can arrive at any moment.”

UN Special Representative for Disaster Risk Reduction Margaret Wahlström said much has been done to boost hospital safety worldwide, but more investment is needed to brace hospitals for potential disasters.

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http://www.irinnews.org/report.aspx?ReportId=86581BANGKOK Thursday, October 08, 2009 (IRIN) - Africa faces a double burden of obesity and hunger as millions take up increasingly sedentary lives in cities and the global financial crisis hits rural populations’ food security, nutritionists warn. BANGKOK Thursday, October 08, 2009 (IRIN) - Africa faces a double burden of obesity and hunger as millions take up increasingly sedentary lives in cities and the global financial crisis hits rural populations’ food security, nutritionists warn.

Under-nutrition continues to plague sub-Saharan Africa, where 32 percent of the world's hungry people live. However, those migrating from the countryside to cities are eating too much fatty food, leading to rising rates of obesity, diabetes, hypertension and high blood pressure, delegates at the International Congress of Nutrition (ICN) in Bangkok were told.

“The problem in Africa is [that] both under- and over-nutrition are the worst in the world. We really are facing a double burden,” Hester Vorster, of the Centre for Excellence in Nutrition at South Africa's North-West University, told the congress, which runs until 9 October.

“Over-nutrition is much the same thing as what we see in the west. Significant numbers of Africans have migrated to the cities and they are eating the wrong foods. So for Africa, the burden of disease is increasing all the time,” Jean-Claude Mbanya of the University of Yaoundé in Cameroon, and president-elect of the Belgium-based International Diabetes Federation, said.

Both over- and under-nutrition can be caused by poverty and food insecurity, with the urban poor unable to access or afford fresh and nutritious food, Helene Delisle, a nutritionist at the University of Montreal in Canada, told IRIN.

In some northern and southern African countries, over-nutrition has surpassed under-nutrition, but there is a complete lack of awareness about the new problems it brings, she said.

“These countries are not aware of it. In many areas, obesity is seen not as a problem, but as a positive sign that you are doing well in life,” she said.

Meanwhile, lower-income countries continue to suffer mainly from under-nutrition, which has actually increased over the past five years, thanks to the food price crisis of 2008 and the global financial crisis, Delisle said.

Obesity on the rise

Statistics from the World Health Organization (WHO) show how obesity has risen while under-nutrition has persisted in some countries.

In Madagascar in 1992, just 1.6 percent of children were overweight, while 35.5 percent were underweight and 60.9 percent suffered stunted growth. By 2004, 6.2 percent of children were overweight while 36.8 percent were underweight, and 52.8 percent were stunted.

The rate of overweight and obese women also doubled between 1997 and 2004, to 8.1 percent overall.

And in 1987, 5.5 percent of Moroccan children were overweight; by 2004, that figure had increased to 13.3 percent.

Obesity is also on the rise in Uganda, although under-nutrition continues to pose the biggest problem, with about 40 percent of children under five suffering from stunted physical growth and mental development due to a lack of vitamins and nutrient-rich food.

Obesity and other so-called “lifestyle diseases” are widely regarded as a problem only for older people in Uganda but are increasingly prevalent in young men, Elizabeth Madraa, the head of food and nutrition at Uganda's Ministry of Health, and a delegate at the congress, told IRIN.

Anaemia in teenage girls is also increasing due to a lack of iron in diets, she said. And in another new trend, Ugandan mothers are increasingly choosing to give their babies powdered milk rather than breast-feeding them.

“They buy milk powder because they see it advertised, and we have to fight that. We need to address all this as a nutrition problem,” Madraa said.

Greater awareness

Mbanya called for awareness campaigns and legislation to fight the negative effects of a poor diet fuelled partly by advertising. “If we want our people to change their habits we have to make it easy for them to have healthy choices,” he said.

However, progress is hampered by the poor status of nutritional science in Africa, experts say.

Few well-defined job openings, poor salaries and recognition, and a plethora of competing curricula taught by unqualified trainers are among the challenges, said Tola Atinmo, Nigerian president of the Federation of African Nutrition Societies.

"At the moment in Africa, nutrition is everybody's problem but nobody's business," said Atinmo.

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http://www.irinnews.org/report.aspx?ReportId=86490NAIROBI Thursday, October 08, 2009 (IRIN) - When an earthquake strikes a town, or a building is levelled by an explosion, news footage invariably shows search and rescue teams trawling through the rubble looking for survivors. But what does it take to rescue people trapped under tons of concrete?NAIROBI Thursday, October 08, 2009 (IRIN) - When an earthquake strikes a town, or a building is levelled by an explosion, news footage invariably shows search and rescue teams trawling through the rubble looking for survivors. But what does it take to rescue people trapped under tons of concrete?

Step one - coordination

The first thing is to activate search and rescue teams, often highly trained volunteers.

"Most of our members are doctors, ambulance operators, engineers or fire fighters," said John Holland, operations director of Rapid UK [http://www.rapidsar.org.uk/], a charitable search and rescue group.

They go through a rigorous two-year training process before they are allowed to assist in disasters.

"We try to deploy within 24 hours because the earlier we are on the ground, the better the chances of rescuing survivors," Holland said. "During the Pakistan earthquake [in 2005], we were able to deploy in 21 hours."

The International Search and Rescue Advisory Group (INSARAG) [http://ochaonline.un.org/Coordination/FieldCoordinationSupportSection/INSARAG/tabid/1436/language/en-US/Default.aspx] - a global network of more than 80 countries and disaster response organizations under the UN umbrella - has standardized guidelines for rescue missions.

"Once a government has made that call for international assistance, we alert our members, who begin mobilizing to travel to the area," said INSARAG's Winston Chang, a Singapore Civil Defence Force veteran who coordinated the search and rescue efforts following the recent earthquake in Padang, Indonesia. "We run a portal where once a disaster occurs, we pool information and our various teams can input data on their movements - whether they are on standby, mobilizing or have reached the ground."

INSARAG will usually set up an “on site operations coordination centre” where all search and rescue teams get instructions - depending on their area of specialty - on where to go and how to operate; the desk holds regular meetings to update itself and the teams on the progress being made on the ground.

"These operations can be quite large; just now in Padang, there were a total of 21 teams with 668 personnel and 67 search dogs," Chang said. "They need bases of operation where they will fuel their heavy equipment, coordinate their internal logistics and sleep."

"We also ensure that they follow specific standards of operation and remain culturally sensitive, especially since the teams are from such diverse backgrounds," he added.

Step two - analysis

Once in the disaster area, the first step is to analyze the task at hand, said Julie Ryan, a volunteer with the British NGO, the International Rescue Corps. [http://www.intrescue.co.uk/news/index.php/about-us/home]

In a collapsed building, "you need to analyze the building, assess its history and try to establish where in the building people are most likely to be", she told IRIN. "You also need to determine how badly a building has been damaged and whether it is likely to collapse any further, causing damage to [survivors] and rescue teams."

The assessment also involves checking for hazards such as downed power lines, gas leaks, flooding and hazardous materials. Protective gear includes special suits, gloves, masks, and oxygen and carbon monitoring systems for air quality.

Step three - search mode

At its most basic, this involves trying to spot limbs in the rubble, and calling out to survivors to identify their locations.

Rescuers look for "voids", or pockets where people may be trapped when walls collapse or where survivors may have hidden, such as under desks, in bath tubs or stairwells.

"We feed a camera on the end of a flexible pole into the collapsed building - this shows where people are and how much of the building's structure is left," Ryan said.

"Rescuers also use sound location devices connected to a microphone system; the device bangs on the rubble three times and if people tap back or call out for help, they can be tracked and assisted," she added.

Listening is a crucial part of the operation, and search teams will often stop for several minutes to try to hear any calls, scratches or taps.

Other search tools include a thermal image camera system, which shows areas of body heat, and trained sniffer dogs. "We also use a carbon dioxide analyzer, which helps us detect people who might be unconscious but still breathing," Ryan said.

Buildings that have been searched are marked with INSARAG-recognized signs to avoid duplication of searches.

As survivors are found, rescuers try to get them to keep talking to determine their exact location, and dig towards them - the least dangerous way to do this is by hand.

Step four - the rescue operation

If survivors are trapped under rubble, it may need to be stabilized first; a process called cribbing - the construction of a rectangular wooden framework, a box crib, underneath the debris - may be used.

Survivors who are not able to move usually need to be lifted, dragged or carried out of the rubble using special equipment.

"If people cannot be manually dug out, then we can cut them out - there are specialized tools that can cut through concrete, metal and wood to reach survivors," Ryan said. "There is also a process known as `slabbing’, where heavy slabs of concrete are removed in order to free survivors - this is always a very difficult judgment call, because it risks further collapse, which could injure or kill more people."

Concrete saws, jackhammers, chainsaws, bolt cutters, cranes and bulldozers are all part of the tool kit; chains, cables, anchors and rope-hauling systems are used to remove large pieces of masonry. Other equipment may include flat bags that are inserted under heavy objects and inflated with an air pump, and “shoring” equipment, which ensures passageways are stable and safe.

As survivors are removed, their medical condition is determined; patients are prioritized according to triage - based on the severity of their condition.

Search and rescue teams usually start the most urgent medical procedures on site; the most experienced teams may have defibrillators and endo-tracheal equipment to shock people back to life or perform emergency tracheotomies.

Step five - closure

Deciding when to end a rescue operation is always difficult.

"Obviously, the more time passes the less likely you are to find people alive," said Ryan. "But sometimes - especially if they have water available - people can remain alive for many days. In Pakistan, our team rescued two boys five days after the earthquake; they had survived on trickles of rainwater through the rubble."

According to Ryan, finding bodies - cadaver rescue - after the search for survivors is over is a very important part of any operation.

"Even when people haven't survived the collapse of a building, families find that having a body to bury is an important part of getting closure," she said.

According to INSARAG's Chang, the high octane operations can take their toll on rescuers, especially when they have to pull hundreds of dead people out of buildings.

"Most of them are used to dealing with blood and death in their daily professions, but from time to time it can become very difficult," he said. "Many teams are equipped to deal with trauma - the Swiss government's team, for instance, has a psychologist on hand, while doctors in the Singapore team have been trained to search for signs of trauma in team members."

Once the host government officially calls off the search, INSARAG starts the process of withdrawing the teams. A few remain and become part of the humanitarian relief effort, rebuilding hospitals and schools or shelter for families, but most will head back to their day jobs and await the next call to action

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http://www.irinnews.org/report.aspx?ReportId=86493DAKAR Thursday, October 08, 2009 (IRIN) - A landmine survivor in Senegal’s Casamance region on 6 October used the recent report, ‘Voices from the Ground’, based on a survey of mine victims worldwide, to remind aid agencies, Senegal’s anti-mine agency and the media of victims’ needs and governments’ responsibilities. DAKAR Thursday, October 08, 2009 (IRIN) - A landmine survivor in Senegal’s Casamance region on 6 October used the recent report, ‘Voices from the Ground’, based on a survey of mine victims worldwide, to remind aid agencies, Senegal’s anti-mine agency and the media of victims’ needs and governments’ responsibilities.

The Handicap International report, which authors say is the first such compilation of mine victims’ views on assistance, says: “[Landmine] survivors are still too often left to do just that – survive – on the margins of society, when they should be helped to rebuild their lives and thrive in the heart of their communities.”

The report includes input from 1,645 mine survivors in 25 affected countries.

Mamady Gassama of the Senegalese Mine Victims Association highlighted the Senegal portion of the report, which says the government needs to boost national funding for victim assistance rather than depend on donors.

“The government must not leave victims’ needs to – often uncertain – external aid,” said Gassama. Senegal is a signatory to the Mine Ban Treaty, which calls on the international community, and individual governments “in a position” to do so, to assist victims.

Mine survivors surveyed said among their greatest needs is assistance in skills training and employment.

np/mad/pthttp://www.irinnews.org/report.aspx?ReportId=86506BANGKOK Monday, October 05, 2009 (IRIN) - Most migrants do not move from developing to developed countries, and when they do, rather than hurting host economies, they benefit them, according to a new report by the UN Development Programme (UNDP).BANGKOK Monday, October 05, 2009 (IRIN) - Most migrants do not move from developing to developed countries, and when they do, rather than hurting host economies, they benefit them, according to a new report by the UN Development Programme (UNDP).

The UNDP's Human Development Report 2009, launched globally on 5 October in Bangkok, dispels several myths about migration, instead underlining the economic and social benefits for countries.

"Mobility can bring large gains in development," Jeni Klugman, director of the report, told IRIN. "It's presently very much constrained by a whole range of barriers, and reform [of] these barriers could allow much greater potential to be released."

The annual report calls for several migration reforms, including for states to ensure basic rights for migrants, and the mainstreaming of migration into national development plans.

ey/mwhttp://www.irinnews.org/report.aspx?ReportId=86431DAKAR Thursday, October 01, 2009 (IRIN) - According to (yet another) new climate change report, this time from development think-tank CGD, these are the 20 cities where the most people will be at the greatest risk from sea level rise and storm surges in the developing world.DAKAR Thursday, October 01, 2009 (IRIN) - According to (yet another) new climate change report, this time from development think-tank CGD, these are the 20 cities where the most people will be at the greatest risk from sea level rise and storm surges in the developing world.

The report’s basic assumptions were: one metre sea-level rise; 10 percent increase in the intensity of a 1-in-100-year storm; UN medium population projections.

Manila, Philippines

Alexandria, Egypt

Lagos, Nigeria

Monrovia, Liberia

Karachi, Pakistan

Aden, Yemen

Jakarta, Indonesia

Port Said, Egypt

Khulna, Bangladesh

Kolkata, India

Bangkok, Thailand

Abidjan, Cote d'Ivoire

Cotonou, Benin

Chittagong, Bangladesh

Ho Chi Minh, Vietnam

Yangon, Myanmar

Conakry, Guinea

Luanda, Angola

Rio de Janeiro, Brazil

Dakar, Senegal


bp/cbhttp://www.irinnews.org/report.aspx?ReportId=86388NAIROBI Wednesday, September 30, 2009 (IRIN) - Africa's orphans will experience a richer, more wholesome childhood if they are raised within a family rather than in a childcare institution, according to speakers at a conference on family-based care for children in Nairobi.NAIROBI Wednesday, September 30, 2009 (IRIN) - Africa's orphans will experience a richer, more wholesome childhood if they are raised within a family rather than in a childcare institution, according to speakers at a conference on family-based care for children in Nairobi.

"We need to heed the cry of a child's heart for an adult who will care for them and be crazy about them," said Monica Woodhouse, who runs the South African NGO, Give a Child a Family.

According to the UN, there are more than 34 million orphans in sub-Saharan Africa today, 11 million of whom lost parents to the AIDS pandemic.

Traditionally, orphans in Africa are raised by the extended family, and while many families continue to take in orphaned relatives, conventional family structures are buckling under the pressure of caring for additional children; a 2006 study in Korogocho, a Nairobi slum, found that more than half the 436 people surveyed were caring for at least one child orphaned through HIV/AIDS.

Too poor to cope, many families now reject these children, leading to a proliferation of institutional childcare facilities across the continent; in Uganda, for example, government statistics show that the number of children in orphanages nearly doubled between 1998 and 2001.

Separation is hard

"There are plenty of studies which show that raising children in institutions as opposed to families affects their cognitive, social, emotional and even intellectual development," Philista Onyango, regional director of the African Network for the Prevention and Protection against Child Abuse and Neglect (ANPPCAN), told IRIN.

"In Africa, people are not trained to work with these children and often don't know what they are doing, so orphaned children in institutions can wind up being physically or sexually abused," she added. "Many are not even registered and those that are, are not properly regulated."

According to the National Council for Children Services in Kenya, there are 417 charitable children's institutions registered, while another 800 are estimated to be operating unregistered.

"Separation from the family is harmful to children; it doesn't matter if I have grey hair on my head, my mother is still my mother, my family is still my family - children need that sense of belonging," said George Nyakora, regional training director for the SOS Children's Villages, which places children who cannot be connected to their biological families in family environments.

Cost issues

Speakers also said the cost of supporting families to raise orphans was significantly lower than keeping a child in an orphanage; a study from South Africa showed the cost of residential care can be as much as six times that of providing care to children living in poor families.

"All the money donors are pouring into institutions should instead be invested in enabling families to raise these children," Onyango said.

Even HIV-positive children on life-prolonging anti-retroviral medication do better growing up with family, according to Protus Lumiti, chief manager of the Nyumbani Children's Home in Nairobi.

"We run a home with about 110 HIV-positive children, but even we realise this is a last resort," he told IRIN. "We have another facility in Nairobi caring for 3,500 children who are based with their families but come to a centre for drugs and nutritional support - community-based care has worked very well in our experience."

"There are some extreme situations, for instance, where a child's disability is so difficult that it can only be properly managed by professionals in an institution, but there is certainly no need for as many childcare centres as we are seeing on the continent," ANPPCAN's Onyango added.

Protection factors

However, steps - including legislation, screening of families, training of child welfare professionals and setting up monitoring and evaluation mechanisms - are necessary to ensure children are successfully placed with relatives.

"We tend to focus on the moral issue of homeless, orphaned children, but we need to look at the economics of it, and to create minimum standards that families must meet in order to care for children," said Nyakora.

Onyango noted that it was not unheard of for children to be abused within their own families, so mechanisms needed to be in place to ensure families were assessed for suitability and monitored to ensure they were giving children the best possible upbringing.

"Sometimes the relatives are only interested in the deceased's property, and not the child's welfare, when they offer to take in orphans," she said. "Setting up child welfare committees at the community level who can monitor a child's progress would be an excellent idea.

"The people left to care for the children - often their grandparents - also need support beyond ensuring the children are fed, clothed and educated," Onyango said. "They need community support in parenting these children, and structures that will ensure the young children will not wind up looking after their old grandparents instead of living a child's life."

"As long as they have the financial capacity and social support to raise children, a family is the best place for a child," Nyakora said.

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http://www.irinnews.org/report.aspx?ReportId=86363NAIROBI Thursday, September 24, 2009 (IRIN) - Donor-backed user fees for health services were supposed to decentralise primary healthcare and provide revenue for essential drugs: instead, advocacy groups charge, they have ended up killing the poor in the developing world. NAIROBI Thursday, September 24, 2009 (IRIN) - Donor-backed user fees for health services were supposed to decentralise primary healthcare and provide revenue for essential drugs: instead, advocacy groups charge, they have ended up killing the poor in the developing world.

For the vulnerable, even nominal fees can mean a denial of access to basic healthcare – especially among women and children. According to the online research guide Eldis, user fees “appear to have raised less revenue than expected; have acted as a disincentive for both poor and non-poor people to use health services; and have not led to the degree of community participation envisaged”. [http://www.eldis.org/index.cfm?objectId=23545A8C-B7C9-8A9F-533BAD9EE8E4FA8B]

Anti-user fee campaigners have now won powerful international backing from, among others, British Prime Minister Gordon Brown. Six countries - Malawi, Liberia, Sierra Leone, Ghana, Nepal and Burundi – are to receive US$5.3 billion in financing raised by the high level taskforce on International Innovative Finance for Health Systems, to help them extend free healthcare to women and children. [http://www.irinnews.org/Report.aspx?ReportId=86280]

But doing away with user fees alone is no panacea to improving medical access for the poor. “Focusing on user fees may do little to improve access as there are usually other, greater financial barriers such as purchasing drugs, unofficial fees, and transport,” Eldis noted.

In a 14 September policy paper – Your Money or Your Life - http://www.oxfam.org/en/policy/your-money-or-your-life – a group of NGOs and health organizations stated: “The need to make healthcare free and expand access in these and other countries is beyond question, but to do so successfully requires high-level political commitment and sustained additional financial and technical support.”

Donor funding is notoriously unreliable; governments may well eventually have to turn to taxation to cover those costs – or a hybrid mix of free care for the poorest, and national insurance schemes for those who can afford to pay modest premiums. Meanwhile, most African governments are still well short of fulfilling their commitment made in 2001 at Abuja, Nigeria, to allocate 15 percent of their budgets to health.

“Ultimately the decision to abolish or keep fees has to be made as part of broader health sector financing policy,” Eldis concludes.

IRIN looks at the state of healthcare in three of the countries that have won funding:

Sierra Leone

The government plans to make healthcare free for pregnant and lactating women and under-fives by January 2010. But in a country with only about 170 doctors for more than five million people, minimal medical supplies and a health infrastructure still crawling back from 11 years of civil war, an enormous job lies ahead to ensure the free service will be a quality service.

“We must prepare health facilities for the four- to 10-fold increase we can expect from abolishing health fees,” Samuel Kargbo, the Health Ministry's director of reproductive and child health, told IRIN. “When we eliminate health user fees we must have sufficient equipment, manpower and medicines. Otherwise we negate everything we are trying to do.”

A working group – representatives of the Health Ministry, donors, development organisations and NGOs – is studying how to implement free care in a sustainable way. Doctors from Nigeria and Cuba are due in Sierra Leone in the coming weeks, but in the longer term Sierra Leone needs to produce more doctors and retain them, Kargbo said.

“There are many hurdles to overcome,” noted Jan van ‘t Land, head of mission with Médecins Sans Frontières (MSF) in Sierra Leone. “Logistics and human resources are two of the biggest weaknesses of [this country’s] health system.” MSF is a member of the working group.

“The main question is who will pay in the end; it will cost a lot of money. The political will is there. I am hoping the government’s final policy on providing free care for pregnant women and under-five children will not be just another document,” said Van ‘t Land.

Sierra Leone’s free-care policy will be part of a two-pronged approach, with a national health insurance scheme to be introduced in the coming years, according to Health Ministry officials.

Burundi

In 2006, the government introduced free healthcare for maternal deliveries and children under five.

“Before the free medical care measure, 20.4 percent of women delivered at hospital. In 2007, 41 percent of women went to hospital, while in 2008 the number reached 47 percent. We expect to reach 51 percent this year,” Sostène Hicuburundi, in charge of health funding in the Ministry of Public Health, told IRIN. There has also been a significant rise in treatment of under-fives.

But there have been problems with implementation, with the health system unprepared for the rise in demand.

“Our work has doubled, even tripled. Before the measure we did from 35 to 40 caesarean sections per month. We now carry out about 65,” said Spes Ntaconayigize, head nurse of the gynaecology unit at Prince Regent Charles Hospital in the capital, Bujumbura.

A lack of equipment and staff shortages have taken their toll. "A woman can spend 24 hours on a stretcher after delivery for lack of beds. This is painful for us as the patient sometimes does not understand why she remains there. The lack of material adds to the stress on us," said Ntaconayigize.

According to Your Money or Your Life, “The performance of the existing free healthcare policy is compromised by inefficient reimbursement procedures for health facilities and insufficient support from aid agencies.”

Mozambique

Free is not always free. People living with HIV in Mozambique have access to free antiretroviral (ARV) treatment, but they must pay hospital user fees and for medicines to treat common HIV-related infections.

Hospitals charge patients an administrative fee of only 10 Meticais (US$0.37), but according to Alain Kassa, MSF head of mission, even that small amount is a barrier for many people, especially when combined with the cost of transport from distant rural areas.

Drugs to treat opportunistic infections, which are supposed to be free, are also not always available.

"This is commonplace: not to find prophylactics, antibiotics or Paracetamol [pain medication] in those public pharmacies," said Cesar Mufanequisso, coordinator of a local NGO, Movement for Access to Treatment in Mozambique (MATRAM). "People living with HIV get their ARVs free, but other medicines are usually out of stock and they have to buy them."

Those who cannot afford to go to hospital or buy medicines from private pharmacies “often opt to see a traditional healer who will allow them to pay at a later stage”, said Nacima Figia, HIV coordinator for the international anti-poverty NGO, ActionAid.

np/jb/bn/ks/oa/mwhttp://www.irinnews.org/report.aspx?ReportId=86281JOHANNESBURG Wednesday, September 23, 2009 (IRIN) - Climate related natural disasters like droughts, hurricanes and floods forced 20 million people - slightly less than the population of Australia - out of their homes in 2008 alone said a new study, making a strong case for regularly monitoring displacement in the context of climate change.JOHANNESBURG Wednesday, September 23, 2009 (IRIN) - Climate related natural disasters like droughts, hurricanes and floods forced 20 million people - slightly less than the population of Australia - out of their homes in 2008 alone said a new study, making a strong case for regularly monitoring displacement in the context of climate change.

A total of 36 million people were displaced worldwide by sudden-onset natural disasters, including earthquakes and landslides. During the same period 4.6 million people were internally displaced by conflicts.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) and the Geneva-based Internal Displacement Monitoring Centre jointly conducted the study, Monitoring Disaster Displacement in the Context of Climate Change.

"Had it not been for the Sichuan earthquake in China, which displaced 15 million people, climate related disasters would have been responsible for over 90 percent of disaster related displacement in 2008," the study commented.

Using the 2008 data as a test case, the study proposed the ongoing monitoring of disaster related displacement using existing information, such as the Emergency Events Database produced by the Belgium-based Centre for Research on the Epidemiology of Disasters, cross-referenced with various other sources, and individually investigating events to estimate the numbers of persons displaced.

The next step is further research into displacement caused by slow-onset disasters and sea level rise. The study also called for a legal framework to protect people forced to cross a border by a natural disaster.

jk/he http://www.irinnews.org/report.aspx?ReportId=86262