Africa

Although governments have increasingly become aware of the problem of orphans and vulnerable children in Southern Africa, countries still lacked the capacity to effectively deal with the problem, a regional workshop heard on 10 Nov. 2003. Government representatives and NGOs from Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe met in Maseru, Lesotho, to draw up technical strategies to deal with children affected by HIV/AIDS for the five-day meeting.The objective was to come away with a manual to assist these countries. Some countries like Lesotho were in particular need of guidance. But there had been some movement within government department to strengthen their response to orphans, noted UNICEF representative. One of the delegates attending the workshop, Limakatso Chisepo, a director of social welfare in Lesotho's department of health and social welfare, hoped the meeting would produce an implementable work plan. We've been attending workshops of this nature for some time now, and the main problem is there are still not enough resources to support any projects we come up with. She called for increased political will and practical orphan policies from the region's governments. We need greater support and better coordination of different efforts, otherwise the time we spend attending the workshops will be wasted.(Source: PLUSNEWS 10 November 2003). Links:http://www.plusnews.org/aidsfp.asp?SelectRegion=Southern_Africa

The following report details the endeavours of the Community Mental Health Project (CMHP), in partnership with service providers and community members, to develop a system for integrating mental health into primary health into primary health care in the KwaDedangendlale community in KwaZulu Natal from 1994 to 1996.

Leaders of the world's richest countries agreed at the G8 summit to provide billions of dollars to help fight AIDS in Africa but, under present trade rules, much of that cash will go to multinational pharmaceutical companies. To the disappointment of pressure groups monitoring the summit, the leaders failed to make progress on new trade rules to allow poor countries to buy cheap, generic versions of new medicines - including the drugs which arrest AIDS. US President George Bush made a publicity splash before the summit by announcing that the US would give $15 billion over five years to help to fight AIDS in the world's poorest countries, especially in Africa. EU countries agreed on Sunday to try to match the US offer. The United States, in particular, objects to a dilution of international law on copyright, which would allow Third World countries to buy generic drugs cheaply from developing nations, such as Brazil. Nathan Ford, medical director of Medècins sans Frontières in the UK, said the money was welcome but a change in copyright law would be more useful. Under present rules, he said, a poor country might have to spend $1 500 a year to treat one HIV-infected person with brand name drugs. Generic medicines could reduce the cost to $300. In other words, without a change in trade rules, much of the money offered by the US and Europe would come back to the large US and European pharmaceutical companies. (Source: Reuters via The Cape Times, 3 June 2003) Fact Sheet on G8 Nations' Spending on HIV/AIDS - ---------------------------------------------- The Kaiser Family Foundation has prepared a new fact sheet - Global HIV/AIDS Support from G8 Countries - that provides a snapshot of how much nations are spending to support efforts to address HIV/AIDS in highly affected countries. This fact sheet summarizes bilateral assistance as well as multilateral assistance through the Global Fund to Fight AIDS, Tuberculosis and Malaria to support prevention, care and impact mitigation programs. It compares funding commitments by G8 members, discusses new U.S. commitments being considered by the U.S. Congress, and explains different ways that funds are allocated. The fact sheet, along with other materials about HIV/AIDS, is available at http://www.kff.org/hivaids

Africa's AIDS drugs trapped in the laboratory -Kenya has the pills. Now the fight is on to get them to the people. There is no lock on the door, no phalanx of guards, no visible impediment to the drugs leaving the glass chamber that the laboratory technicians call a stability room. The pills come in little white boxes with labels such as lamivudine, zidovudine and efavirenz, technical names disguising the fact that these tablets are the stuff of life. Take them together and if you have HIV you can stave off death for years. Millions in Africa have the virus but not the pills. A stone's throw from the laboratory AIDS is wiping out communities, yet these pills cannot leave the stability room. This is Nairobi, the factory is Kenyan, and a web of influence spun by the world's pharmaceutical giants encloses its labs, ensuring the AIDS drugs stay inside. For Africa, getting them out would be a milestone in controlling the pandemic. Two things are happening which could untangle the web. Activists are preparing a legal challenge to allow Kenya to make and import generic AIDS drugs. And Nairobi's factories are boosting their capacity to make their own cheap drugs in expectation of that court victory. For decades, African companies have produced generic copies of antibiotics and other drugs, paying royalties to those western companies which developed and patented the formulas. Prices tumbled, making them affordable to the poor. But that has not happened with AIDS. The western companies, fearing for profits and market share, have refused permission for generic copies of drugs known as anti-retrovirals (ARVs). But in the labs of Nairobi manufacturers such as Cosmos they sense change coming. Following World Health Organisation guidelines, they have successfully copied branded AIDS drugs, registered them with health authorities, printed labels for the boxes and stored them in the stability room. Under international patent law, there they must stay unless the makers obtain a licence. There is nothing preventing mass producing. We have the expertise, access to raw materials, the registration, said Prakash Patel, Cosmos's chairman and managing director. By the end of the year we will be producing. I think we will be the first to produce ARVs in Africa. Dr Patel's boast reflects swelling confidence that the multinationals will not block African generics. Another Nairobi firm, Laboratory & Allied, also said it could switch to ARVs within weeks. That optimism stems from a series of victories in recent years which asserted the right of countries facing public health emergencies in the developing world to override intellectual property rights by issuing what is called a compulsory licence to make or import generic drugs. Countries such as Britain issue compulsory licences occasionally, giving> the NHS cheaper drugs, but African states have hesitated: the drug giants have friends in Washington and other capitals who can withdraw investment and trade concessions from uppity African states. But such a threat has now receded. The World Trade Organisation's Doha declaration said that developing-world countries could make or import generics. Even President Bush wants cheaper drugs for Africa. Yet the drugs industry is fighting back, by cutting prices of branded drugs, warning health ministers that national treatment programmes would bankrupt their budgets, and depicting generics as unsafe. John Musunga, commercial director of GlaxoSmithKline's Nairobi office said , the firm had no plan to stop generics, yet pinned on his wall was a strategy apparently advocating the promotion of doubt of generics. Mr Musunga also rejected claims that the industry exerted improper influence over the Kenyan government. Two years ago, an amendment protecting patents was slipped into Kenyan legislation. After an outcry it was removed. The Guardian has obtained a letter from Kaplan & Stratton, a Nairobi legal firm, to the Kenya industrial property office, requesting an amendment for an unnamed client. But the momentum towards African generics is growing. The Consumer Project on Technology (CPTech), a not-for-profit group started by the radical American campaigner Ralph Nader, is coaching groups in South Africa, Ghana, Uganda and Kenya to mount legal bids for compulsory licences. The plan is to reassure African governments that the international climate has changed. The prize is not just lower prices, but more sustainable supplies suited to Africa, such as all-in-one pills. Kenya seems to be moving fastest, with some government officials enthusiastically backing the initiative. The first case you get in Africa is going to have a huge effect on other African countries. If it's a positive decision they'll look to that, it'll have a domino effect, said James Love, of CPTech. We should succeed in Kenya. It would be a crime against patients if we don't succeed. In Nairobi's biggest slum, Kibera, they are waiting. Médecins Sans Frontières has identified candidates for ARVs, people such as Kevin Wanjala, 11, who was born with HIV and has been chronically sick. Shy and small for his age, he was at the top of his class in his favourite subject, English, before dropping out due to illness. When I grow up I'd like to be a car mechanic, he says. Kevin is nearing AIDS, said Florence Olanya, an MSF nurse. Without drugs he is unlikely to last two years. ( Source: The Guardian 21 May 2003). Source:http://www.guardian.co.uk/international/story/0,3604,960106,00.html

About 80 women and children urged 26 African countries on Wednesday to honour promises they made three years ago to help fight malaria. The protesters delivered postcards at a number of embassies in Pretoria, highlighting the need for measures to prevent malaria from spreading. Organiser Junaid Seedat said 43 African leaders promised a number of decisive steps against malaria at a summit they attended in Abuja, Nigeria, in April 2000. They undertook, among other things, to scrap all taxes and tariffs of insecticide-treated mosquito nets (ITNs). Three years later, 26 countries still levy a tax on the purchase of ITNs, said Seedat. The guilty countries include South Africa, Madagascar, Sierra Leone, Angola, Botswana, Burkina Faso, Burundi, Central African Republic, the Democratic Republic of Congo, Ethiopia, Gabon, and Gambia. The others are: Swaziland, Togo, Somalia, Sao Tome & Principe, Rwanda, Niger, Mauritania, Malawi, Guinea-Bissau, Guinea, Eritrea, Equatorial Guinea, Djibouti, and the Congo. The group also delivered a letter, addressed to South African President Thabo Mbeki, to the Pretoria offices of the health department. Seedat described ITNs as a vital tool against malaria, saying these nets had to be made affordable to poor people. Wednesday's protest took place under the banner of a global organisation, Massive Effort Campaign, which seeks to mobilise society against Aids, tuberculosis and malaria. Seedat heads of the South African branch of the organisation. The letter to Mbeki points out that malaria kills millions of children in Africa each year. We now wish to encourage (you) to achieve the targets set at Abuja. The letter says tax-free ITN's in Tanzania more than halved the price of the nets, a move that saved thousands of lives. Seedat said the South African health officials told his organisation they were still negotiating with the finance department over the removal of tax on ITNs. (Source: Sapa, Mail and Guardian, 24 April 2003)

Conservative estimates by Wilma Meeus and David Sanders at the University of the Western Cape’s School of Public Health show that the United States has saved at least U$3,86-million(R30,9 million) in training fees by employing doctors from Nigeria which has lost 21 000 doctors to the superpower. Nigeria in turn incurred a loss of U$420 million (R3,4 million) while Zimbabwe conservatively lost U$16,8 million (R134,4 million) through the loss of 840 doctors. According to the United Nations, 31 of 53 African countries have less than 32 doctors per 100 000 people with 17 of these countries having less than 10 doctors per 100 000 people. In 41 countries there are less than 135 nurses per 100 000 people with 17 countries having less than 50 nurses per 100 000 people. Meeus said researchers had found that Africa was set to become a major source of migrants during the 21st century and that 33 800 people migrated annually from Africa since the beginning of the 1990s, of whom about 20 000 to 23 000 are highly skilled. She pointed out that the available data was incomplete and that it was not possible to establish over what time period the migration occurred. A United Nations document published in 2000 it stated: It can be extrapolated that between 1985 and 1990, on the 60 000 professionals who emigrated, the continent lost U$1,2 billion (R9,6 billion). This represents the reverse of what development aid tries to achieve through transfer of technology and human resources. The document warned that this development paradox, combined with the inability of the African countries in building, retaining and utilising indigenous capacities critical to Africa’s growth and development would deprive Africa of its vital development resources and make it more heavily dependent on foreign expertise. In the 1970s, the US government calculated that it gained U$20 000 (R160 000) for every skilled worker from a developing country. The United Nations Conference on Trade and Development (UNCTAD) estimates that for each professional aged between 25 and 35 years, U$184 000 (R1,5 million) is saved in training costs by developed countries. Meeus said that the 27 richest developed countries have a workforce of about three million professional educated in developing countries. Using the conservative figure of U$20 000 (R160 000) per person educated outside these 27 countries, the transfer of wealth from developing to developed countries is about U$60 billion (R480 billion). The savings to these rich countries is a staggering U$552 billion (R4 416 billion) if the UNCTAD figure of U$184 000 (R1,5 million) is used. The United Nations also found that Africa spent an estimated 35% of overseas donor assistance annually, about U$4 billion (R32 billion), on salaries of 100 000 foreign experts (all sectors, not only health) to replace lost capacity, to build capacity and/or provide technical assistance.(Source: Anso Thom, Health-e, 04-04-2003)

Spoornet has renewed its commitment to keeping the loveLife AIDS education train on track, signing a one-year agreement with loveLife and Legal I on Thursday. The loveLife train, a community project, travels from station to station stopping for six days at each station throughout the country. Its aim is to provide free legal advice, HIV/AIDS awareness and life skills. It also focuses on issues that affect young people in the areas of sexuality, child abuse and teenage pregnancies. In a statement, Spoornet spokeswoman Bintu Petsana said the agreement gave Spoornet the option to renew for a further one year, subject to agreements between Spoornet and loveLife. Spoornet has spent almost R3-million on the refurbishment of the coaches and spends around R800 000 annually on the operation. The train project started off focusing mainly on free legal advice and since its inception in 1998, lawyers have assisted on average 6 000 people a year at 33 stations. Following its success, other community projects focusing on HIV/AIDS and life skills were incorporated. loveLife joined the Spoornet Legal I train in 2001. (Source: SAPA, 13 February 2003)

Health Minister Manto Tshabalala-Msimang lent her weight to this year's World AIDS Day campaign when she donated a pair of shoes, school shirts and stationery in Sea Point, Cape Town. The campaign, which begins on 30 October and runs until November 24, aims to encourage the public to donate items that will be handed to people and communities affected by HIV/AIDS. Donations can be placed at any of the 250 Pick 'n Pay stores countrywide. Due to the difficult living conditions of many of our people and communities who are affected by HIV and AIDS, not only are we calling on South Africans to accept them, but also to help them, and giving is both an act of acceptance and of help, Tshabalala-Msimang said. World AIDS Day, which will be marked in South Africa under the theme I care enough to help, do you? - will be launched in Kimberley on December 1. (Source: SAPA, 31 October 2002)

Nineteen-year-old Khethelwa Msebe had no idea why her eight-month-old daughter, Andisiwe, was suffering from broken skin and an enlarged abdomen when she took her to Mount Ayliff Hospital in the Eastern Cape. Now she knows. Her daughter is one of more than 700 children in the area who have been admitted to hospital with malnutrition.Andisiwe is one of the lucky ones. Two weeks ago in nearby Lusikisiki, Honjiswa Mgeduzo lost her 11-month-old son. He died of marasmus - a condition caused by lack of calories and protein. In the first six months of this year, 166 children - virtually all of them under the age of six - have died of malnutrition in 11 hospitals in the northern reaches of the Eastern Cape. The horrific figure was calculated by the University of the Western Cape, the Department of Health and the Health Systems Trust. Experts blamed malnutrition on: People being unable to get child-support grants because of problems obtaining identity documents; Extreme poverty and lack of food; and High unemployment. The chief executive of the SA Congress for Early Childhood Development, Leonard Saul - who conducted a recent study in seven towns in the northern part of the Eastern Cape - said almost 71% of the 1.7 million people living in the region were unemployed. People don't have access to a well-balanced diet. Malnutrition is a very serious problem, with most families having just one meal a day of pap and potato, he said. Dr Thandi Puoane, a health scientist based at the University of the Western Cape, said nurses were trained to deal with malnutrition, but the attraction of overseas posts meant many of them left the country - taking their expertise with them. We trained about 75 nurses in the Eastern Cape to help prevent children who were admitted to hospital with malnutrition from dying. But the problem is that nurses are leaving to find work in the UK, she said. Puoane said a meeting to improve hospitals' management of malnutrition in the Eastern Cape was being held later this month. Nzwaki Sogaula, who is involved in community nutrition in the area, said research done in 2000 showed that at least two of 30 children who were monitored at home after being treated for malnutrition had died. The province's district health director, Dr Thobekile Mjekevu, admitted this week that malnutrition was a serious problem . It is a social problem and mainly serious in the former homeland areas. The problem of malnutrition is made more difficult by other underlying factors such as HIV. Qaqamba Msweli, director of the Umtata-based Masikhule Project, which provides early childhood development training, said many children were unable to concentrate in class because of hunger. (Thabo Mkhize, Sunday Times, 2002/09/15)

Nurses and doctor organisations have backed the call by Health Minister Manto Tshabalala-Msimang for rich countries to stop poaching the skilled and experienced healthcare professionals of poor nations, but want the government to make staying in South Africa more attractive. Tshabalala-Msimang told a plenary session at the World Summit on Sustainable Development on Monday that developed countries needed to commit to an international code of conduct on the ethical recruitment of health professionals. The Democratic Nurses Association of South Africa (Denosa) has also supported the call, which it said was necessary to manage the flow of nurses to countries like Britain, Saudi Arabia, New Zealand that offer lucrative packages. Denosa president Ephraim Mafalo said the body was concerned with the negative effect of nurses leaving the country on the healthcare system, but did not want the rights of nurses to move to be affected. He suggested that the government needed to explore new strategies to make coming back to the public health sector in South African easier by guaranteeing jobs on return and recognising skills acquired overseas. Tshabalala-Msimang's spokesman Sibani Mngadi said as a member of the Commonwealth, South Africa was pushing hard for the development of a code of conduct between governments to regulate the recruitment of health professionals. He said the ministry was looking at ways of retaining professionals' links with international exchange programmes. Within the next two months Health Department director-general Ayanda Ntsaluba would present a package of incentives to Tshabalala-Msimang to encourage professionals to remain in the country and continue to work in rural areas. Kgosi Letlape, chairman of the SA Medical Association (Sama), said countries losing skilled personnel sought-after overseas, needed to appreciate them and remunerate them accordingly. He said doctors going overseas were motivated by factors like poor working conditions and salaries in state hospitals, inadequate facilities and resources. Another factor was the lack of treatment policies for diseases such as HIV/AIDS in the public sector. (Nazlia Peer: Cape Times 30 August 2002)