While individual organisations in civil society in South Africa are known for their struggles to ensure access to medicines, access to water, land shelter and other rights, September 2010 provided an opportunity for civil society across platforms and constituencies to build wider solidarity around poverty and inequality.
Since 1997, civil society in South Africa has gathered every two years to learn from each other, dialogue and debate, propose input into government policies and programmes and strengthen civil society’s role in challenging poverty and inequality. In 2010, this ‘NGO Week’ was on 20th-25th September in Cape Town under the banner of “Building Solidarity to Fight Poverty and Inequality” starting on Monday, 20th September 2010, ending with a Heritage Day Festival on Friday, 24th September 2010.
The week brought together a range of existing civil society campaigns, such as The Right to Health Campaign, The Peoples’ Budget Campaign, 16 Days of Activism for No Violence against Women and Children, Amplifying Feminist Voices and Building a Popular Education Movement. amongst others. The organisations that came together involve and work with a range of constituencies, including women, organised workers, health workers, people living with HIV and religious groups. The organisations included those that advanced issue based campaigns, like the Treatment Action Campaign, Feminist Forum, Women on Farms and the Learning Network, broad sectoral movements like Popular Education Movement and People’s Health Movement and membership based umbrella organisations like the South African Council of Churches (SACC), or the Congress of South African Trade Unions (COSATU). The gathering provided an opportunity for dialogue, self-organized workshops and sharing of case studies across the different groups, to build shared understanding on challenges and approaches to dealing with socio-economic rights. For example the campaign for the right to health, that includes the right to healthy living and social conditions and to access health care, was adopted by all groups as a common cause for all.
Over five hundred and fifty participants from civil society used the discussions and interaction to build and strengthen the kind of cross-cutting civil society platforms needed to tackle the multidimensional nature of poverty and inequality. Resolutions were made on actions that would benefit individual platforms but also have wider and more general impact, such as ensuring an enabling environment for the non-profit sector, or strengthening community action and participation around rights to health. These wider platforms call for strong networking across sectors, with strong leadership and accountable, transparent, democratic governance. Civil society organisations (CSOs) agreed that this calls for partnerships to build knowledge and learning between civil society and other institutions. Hence civil society was encouraged to partner with the twelve Higher Education and Research Institutions in the country, particularly the five in the Western Cape Province.
As a result of the deliberations of the week, the CSOs involved developed a number of resolutions on joint action (see http://www.sangocowc.org for the full resolutions). For example, as one outcome, CSOs are now interrogating and making input to the African Peer Review Mechanism (APRM) Report from South Africa. These reports have been adopted at African Union level to report on developments in governance on the continent. The CSO contribution in South Africa will feed into the draft of the Second Report on the Implementation of South Africa’s APRM Programme of Action, and through this into the wider continental discussion. Civil society resolved on a range of platforms to strengthen their role as a watchdog, to widen networks, to include champions from key stakeholder groups and to support and monitor our own programmes of action. The week ended with a cultural festival on the final day to commemorate ‘Community House’, which has a rich history as a hub of radical civil society organisations and trade unions.
The South African Non-Governmental Organisation Coalition (SANGOCO) was tasked to co-ordinate and monitor the implementation of the resolutions. SANGOCO is a coalition of civil society networks and organisations. It originated in 1997 to re-build civil society and the society at large within the context of a world where social justice and civil liberties are under attack. It aims to establish a strong and vibrant civil society that has capabilities and policy influence in the interests of people, especially poor people. SANGOCO seeks to hold government programmes and policies accountable for the extent to which they effectively serve the needs and interests of poor people. SANGOCO was mandated by the CSOs to coordinate sectoral and cross-sectoral working groups to take forward the resolutions over the next two years 2012.
It was important for us that civil society representatives from other countries in east and southern Africa participated in the events of the week, including groups from Namibia, Mozambique, and Malawi, as well as people from civil society centres as far afield as Denmark, USA and India. The lunchtime cultural events provided an interactive marketplace where people from civil society from across different countries discussed and exchanged experiences on common struggles. The South African organisations urged their counterparts in other countries in the region to also strengthen their umbrella bodies and networking on common platforms.
Poverty has many dimensions and inequality exists across a range of social and economic factors. South African civil society has recognized that while issue specific platforms help to raise profile and draw attention to specific areas of deprivation, we need to bring civil society together around common agendas to address the many dimensions of poverty and causes of inequality. Even more so do we need to bring together civil society across East and Southern Africa to tackle the much deeper levels of poverty and inequality in the region, given the degree to which our economies, societies, labour markets and trade are interlinked. The policy dialogues and debates that were held during NGO Week 2010 in South Africa have helped strengthen these cross cutting coalitions in South Africa. We hope that they spread throughout the region.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. For further information on SANGOCO or the NGO Week please contact sangocowesterncape@telkomsa.net or visit www.sangocowc.org
Editorial
Archbishop Ndungane, president of the African Monitor, commented after the United Nations (UN) Summit on the Millennium Development Goals (MDGs) in September 2010 on the gap between the concrete commitments made and clear plans for how they will be implemented. A bottom line for this is money.
Even before the Summit the UN Secretary-General in his March 2010 report had observed that unpredictable and insufficient international financing was blocking progress on the MDGs. Health needs alone at global level have been estimated to cost up to US$76 billion annually by 2015. The UN Non government Liaison Service reported this year that the financial deficit on resources to meet the MDGs could reach between US$324 - $336 million in 2012-2017, including a shortfall of about US$168-$180 million in official development assistance (ODA).
Which country and community you live in and what income group you are borne into affects your chances for health and for accessing the resources for health. This leads to an unacceptable global inequity. African countries, with the highest rates of mortality and ill health globally, are also most disadvantaged by widening gaps between rich and poor countries, by diminishing commodity prices and by outflows of key resources, such as skilled personnel. The financial crisis triggered by the US and European banking crisis has exacerbated this shortfall, creating a budget revenue hole of $65 billion in low and middle income countries. According to Development Finance International, aid has filled only one-third of this hole in revenue.
So African countries and people have a significant interest in debates on how global commitments will be financed.
ODA has been one way of releasing immediate resources for global priorities. Almost all low income countries could absorb much more aid without negative economic consequences, whereas they have much less space to borrow or to raise taxes. Attention has thus grown on how far the international community has fulfilled long-standing aid promises and improved aid effectiveness. A 2009 Mutual Review by the UN Economic Commission for Africa and OECD noted the welcome increase in commitments made at G8 and other summits. These include commitments to 0.7% of Gross national income to ODA in 2002; to an increase of $25 billion annually in aid to Africa in 2005; to an additional US$60bn to fight infectious diseases and strengthen health systems in 2006; to US$22bn to raise productivity of smallholder farming and $30bn for climate change mitigation in 2009; and to support for Universal access to HIV prevention and treatment. At the 2010 UN Summit an additional $40bn was pledged for the Global Strategy on Women’s and Children’s Health. The UN ECA and OECD report also noted that while progress was being made to the target of 0.7% ODA, it was still at 0.43% of combined GNI, with improved ODA largely related to debt relief flows in 2005/6. OECD reports indicate that less than half the $25bn promised in 2005 has been delivered and shortfalls exist on other pledges made.
The UNECA / OECD report points out that the most significant source of development finance in Africa is domestic revenue, making up 75% of its development financing. It indicates therefore that for African countries to raise the domestic revenue to deliver on development commitments, multilateral trade negotiations need to yield more substantial and faster improvements in market access and returns, and progress needs to be made in investment in areas such as energy access, technology transfer, infrastructure and climate adaptation. A further response to the resource gap is to reverse the net transfer of financial resources out of Africa. For example, Global Financial Integrity (2010) estimated that between 1970 and 2008 the outflows from Africa due to trade mispricing alone were as great as ODA inflows.
Unpredictable, inadequate aid flows and the slow progress in improved returns from the global economy have raised doubt whether business as usual will be enough to raise the funds needed to meet global goals. President Nicolas Sarkozy of France and Prime Minister Jose Luis Rodriguez Zapatero of Spain both raised in their addresses to the 2010 UN Summit the need for new approaches to financing global commitments, especially through a new tax on international currency transactions. President Sarkozy stated in his address to the Summit: “We can decide here to implement innovative financing, the taxation of financial transactions. Why wait? Finance has been globalized. Why shouldn’t we demand that finance contribute to stabilizing the world through a minuscule tax on each financial transaction?”
When a similar call was made by Nobel prize-winning U.S. economist James Tobin in 1972, and by UN panel chair Ernest Zedillo in 2000, it met strong opposition. However since then, a range of innovative development financing options based on levies have been established: UNITAID, an international facility for the purchase of drugs to combat HIV/AIDS, malaria and tuberculosis launched by Brazil, Chile, France, Norway and the United Kingdom in 2007, has raised US$1.5 billion in three years, 65% of which came from a micro-tax scheme on air tickets. In 2009, as a result of a Task force in Innovative Financing, a number of new facilities were introduced, including a US$1 billion expansion of the International Finance Facility for Immunisation (IFFIm); a new mechanism for making voluntary contributions when buying airline tickets, expected to raise up to US$3.2 billion by 2015; US$360 million worth of debt conversions in the Global Fund's Debt2Health Initiative; a VAT tax credit pilot scheme called De-Tax, expected to raise up to US$220 million a year in VAT resources; and a commitment to explore a second Advance Market Commitment for life-saving vaccines. In March 2010, the UN with country partners and the American Society of Travel Agents, launched ‘MASSIVEGOOD’ an offshoot of UNITAID, that provides travellers in the United States the option of making a voluntary contribution of up to $50 when purchasing tickets, booking a hotel room or renting a car online. This is expected to bring in up to US$1 billion in four years to support treatment for children with HIV, for tuberculosis and insecticide treated bed nets. Such funds bring significant new resources, and raise challenges for how they support the financing of systems and improve the production of domestic revenue.
These financial innovations, the impending deadlines for action on global commitments and a funding gap that is not being met through current approaches has brought new demand for the introduction of an international multi-currency transaction tax. Sixty countries in the Leading Group on Innovative Financing for Development (LGIFD) support it, and the potential financial contribution is significant. Financial flows have increased sevenfold since 2000, with a volume of transactions worldwide of about $3.6 trillion daily for foreign exchange, of $210 billion daily for bonds and $800 billion for stocks. At a session on 21 September at the Summit, Bernard Kouchner, foreign minister of France, held up a five-cent coin saying: ‘This will be the tax on a 1000-dollar transaction. It is impossible not to accept that. Especially when you have in mind that the result of such a tax would be 40 billion dollars a year..'.
An approaching deadline to account for global goals and an economic crisis may be a challenging situation for global social commitments, but it may also be an opportunity to implement the possible - to advance sustainable and equitable ways of financing them.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. Further information on this issue and the UN 2010 Summit can also be found in the Health Diplomacy Monitor www.ghd-net.org.
The editorials in this newsletter comment on two global events, two months apart. The first is the 18th International AIDS Conference held in Vienna in July, and the second the UN Summit on the Millennium Development Goals being held in New York in September. Both conferences have triggered a wealth of ideas, debates and publication, some of which we include in the newsletter. Both deal with heads of state commitments, made in prior conferences: The first to universal access to treatment for AIDS, the second to the eight MDGs. In the first editorial Sharonann Lynch reminds that after the “talk and spectacle”, many conference participants go back to work in impoverished realities. She suggests concrete people-centred strategies for delivering on treatment commitments in these conditions. In the second, Ranga Machemedze asserts that many living in the most impoverished realities have not yet benefited from the MDGs, even when progress has been made at national level, and asks what the UN Summit will do to close the gap. For both, the test of the global talk is the concrete local improvement it produces for the most disadvantaged communities.
After the 18th International AIDS Conference (IAC) has wound down in Vienna, the word in the hallways is that the science is in: earlier initiation of treatment and improved antiretroviral (ARV) drug regimens are better for individual patients and communities, and may even ultimately reduce transmission of HIV. Some of the new data presented at the conference come from MSF's project in Lesotho, where I worked from 2006 to 2009. In a two-year study of 1,128 patients from rural Lesotho, where the government has adopted new World Health Organization (WHO) guidelines, patients starting treatment earlier (at CD4 count <350) were 70% less likely to die, 40% more likely to remain in care, and >60% less likely to be hospitalized compared with those started when their disease was already advanced (CD4 <200).
After all the talk and spectacle, many of us—people with HIV/AIDS, clinicians, researchers, and activists—will have to go back to reality: to townships and rural villages still ravaged by the virus; to congested clinics with waiting lists for treatment; and to rich country capitals where donors are ignoring the science and retreating from their commitment to fully fund universal access to treatment, telling us to get used to this new reality—we are in the midst of global economic recession, after all.
At the conference there was a lot of talk about cost-effectiveness and efficiency as a means to mitigate funding shortfalls. Sure, we need to avoid waste and the obscene number of consultants and reports that sit on shelves in Washington, Geneva, and London. But how do the actual people fit in to these crude calculations? What is the cost-benefit to their lives, families, and communities?
We are advocating for a different vision: for patient-centered efficiencies that will increase access to treatment and reduce the burden on patients in taking toxic drugs, reporting excessively to health facilities, and traveling great distances to seek care. We also want efficiencies to reduce the requirements on the health system, for example through task-shifting and community-based, out-of-facility approaches to drug dispending and social support. And economists are telling us these sorts of efficiencies will even be cost-saving in the long run.
So how do we build on Lesotho's example and get more patients on treatment? Here are some forward-looking ideas that could change the game:
* Invest in rigorous research and pilot projects to explore the feasibility and impact of "treatment as prevention." Treatment is increasingly understood to have major prevention benefits, in addition to reducing HIV- and TB-related illness and death.
Support research to radically simplify and optimize the package of ARV treatment, including:
* Dose optimization: If shown to be effective, reducing the dose of some ARVs could potentially treat up to one-third more patients without a cost difference.
* New drug development: Develop new ARV drug delivery platforms and slower-releasing drugs, which could help to decrease the burden on patients as well as the cost per patient per year.
* Accelerate commercialization of point-of-care diagnostics: new instrument-free, point-of-care CD4 cell count blood tests, once available, could be rapidly deployed to the field for use in identifying more patients at the lowest levels of care, while we redouble efforts to develop a point-of-care viral load test.
And additionally;
* Create and implement a financial transaction tax (FTT): billed by some as the "Robin Hood tax" (including activists at IAC dressed up in feathered green hats and bows and arrows), a tiny tax of 0.005% on foreign currency transactions could generate an estimated $33 billion per year for global health needs and other issues affecting the developing world. Such a "tax and treat" strategy could deliver the sufficient, regular, and predictable funding to pay for scale-up, provided donors make good on their existing commitments to the Global Fund and other financing mechanisms.
* Ensure an enabling policy environment to usher in these new innovations, including aggressive use of Trade-Related Aspects of Intellectual Property (TRIPS) flexibilities and an effective patent pool.
If we want to bend the curves of the HIV epidemic, we should seriously consider and put into action radical game-changers such as these.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. This article is Open Access and was reprinted freely under a Creative Commons license. http://speakingofmedicine.plos.org/2010/07/23/msf-beyond-vienna-possible-game-changers-for-scaling-up-optimal-aids-treatment. For more information on the issues raised in this op-ed please visit the EQUINET website at www.equinetafrica.org or see MSF's website at http://aids2010.msf.org.
According to UN reports, sub-Saharan Africa has the world’s highest rate of child mortality, with one in seven children dying before their fifth birthday. The region has witnessed a 22% decline in the under-5 mortality rate since 1990, although significant variation exists between countries. Although rates of infant mortality have declined since 1990, 17 of the 20 countries with the highest infant mortality rates are African. Maternal mortality is the health indicator that shows the widest gaps between rich and poor, both between and within countries. While data is scarce, WHO estimates that 900 women die per 100 000 live births in Africa. The continent, with the exception of Namibia, is identified by the UN as experiencing high or very high maternal mortality. Sub-Saharan Africa is also the region most affected by the HIV/AIDS epidemic, with over two thirds of all people living with HIV worldwide, and nearly three-quarters of AIDS-related deaths. There are some positive signs: the rate of new HIV infections has slowly declined, and 44% of adults and children in need of antiretroviral therapy had access to treatment, up from 2 % five years earlier. Efforts to combat malaria have progressed: the use of insecticide treated nets by children in 26 African countries rose from 2% in 2000 to 22% in 2008.
African countries have developed numerous strategies to reach the goals. In 2006, the African Union endorsed the Maputo Plan of Action on Sexual and Reproductive Health and Rights, and 22 countries have since set Maternal and Newborn Health Road Maps to improve sexual and reproductive health through laws, policies and health systems. The AU’s African Health Strategy 2007-2015 proposes to strengthen equitable health systems; the AU’s 2005 Gaborone Declaration commits to universal access to HIV prevention, treatment and care; the 2001 Abuja Declaration commits African states to allocate 15% of their national budgets to health and the 2008 Ouagadougou Declaration commits to advancing Primary Health Care and Health Systems in Africa. The 2010 African Union summit held in July in Kampala, passed a number of resolutions, including a renewed commitment to the 15% budgetary allocation to health; and CARMMA- the Campaign for the Accelerated Reduction of Maternal Mortality in Africa.
The African Union and its member states must, however, go beyond rhetoric to implement the promises set out in their declarations and produce tangible results. For example, the Global Fund has reported that as of 2007, out of 52 African countries (no data was available for Somalia), only three (Botswana, Djibouti, and Rwanda) had met the 15% target for health budgets, while three more (Liberia, Malawi and Burkina Faso) surpassed this target.
The UN report, Keeping the Promise – United to Achieve the Millennium Development Goals for the 2010 MDG summit being held in late September in New York has a paragraph on Africa stating that the continent is lagging behind on many of the MDGs, that progress has been made in some African countries but that the poorest ones remain “a grave concern, especially in the wake of the hard hitting financial and economic crisis”. The UN note in the report that while aid to Africa has increased in recent years, it still lags far behind commitments made. Will the Summit produce the resources called for by the UN through delivery of these commitments? Will the UN MDG Summit in September go beyond rhetoric to action? Will it unleash the resources to move from the many strategies to practice?
After all is said and done in September, one sign of that must be the extent to which whatever is said is translated into local level interventions and reaches vulnerable groups. This needs to be tracked, but the UN only collects MDG data aggregated at the national level, making it difficult to track how far this is being achieved. There is no provision in country reports for disaggregation of country-level data to assess sub-national progress on the MDGs. The reports do not therefore capture the stark inequalities among different regions, socio-economic, ethnic, racial and cultural groups within countries on accessing the resources for health or achieving the MDGs.
And should we be measuring targets or rates of progress? The World Bank noted in 2010 that uniform goals like reducing infant mortality by two-thirds, maternal mortality by three-quarters can underestimate progress in poor countries and communities. Why? Because the greater the distance to the goals from low starting points in poor countries, the greater the improvement needed to reach the targets. Is it the rate of progress, or the likelihood of achieving the targets that should be evaluated? While the target is the outcome we are aiming for, Fukuda and Greenstein argued in 2010 that the rate of progress tells more about the likelihood of achieving it along the way, and would place more pressure on governments to do more.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. This editorial has been edited from the original that appeared in the Health Diplomacy Monitor Special Issue on the UN Summit on the Millennium Development Goals, Vol 1 Issue 3. For more information on the issues raised in this op-ed please visit the EQUINET website at www.equinetafrica.org or see the Global Health Diplomacy website at www.ghd-net.org.
In this issue we bring news of cause to celebrate, but also a call for action on an expanding IP enforcement agenda that challenges our rights to health. In the section on 'Resource allocation and health financing' we welcome the heads of state restatement of their 2001 Abuja commitment to allocate at least 15% of annual budgets to health. EQUINET was part of this campaign (have a look at Newsletter #113) and while we recognise that 15% of government's own spending may not be sufficient resources for health, it does signal a prioritisation of the domestic and public sector role in health. This newsletter editorial draws our attention to an issue that needs attention, and more than that, action. In the competition between social rights to health, and private rights to intellectual property, our dependence on medicines purchased from outside Africa makes us weak defenders of rights to health.
The 18 to 23 July International AIDS Conference held in Vienna this year, subtitled “Rights Here, Right Now” was a platform to raise, yet again, the values based universal and indivisible human rights and the political commitments that inform our response, globally, to the unacceptable level of new HIV infection and mortality from AIDS. At the same time the shrinking provision of aid to low income countries and persistence of avoidable inequities globally in the progressive realisation of these rights starkly raises the reality of the competition between social rights to health, and private rights to intellectual property.
International aid to developing countries has declined in the past two years, with a fall of $1.1 billion in high income country support for developing country AIDS programmes between 2008 and 2009, according to UNAIDS and Kaiser Foundation. At the same time rich countries continue to pursue with vigour stronger protections for intellectual property rights (IPR) – in what is now known as the ‘IP Enforcement Agenda”. The effects of strong IPR protection may have been abated in earlier years by aid support for purchase of patented medicines, but low income countries seeking to meet needs in the current financial squeeze by procuring cheaper options or initiating their own local production of medicines, including of anti-retrovirals, face an unabated challenge to their implementing even those measures that are legal under the World Trade Organisation's (WTO's) Trade-Related Intellectual Property Rights (TRIPs) agreement.
The fall in funding to AIDS has itself been challenged by many, including the President of the International AIDS Society, Dr. Julio Montaner, and Stephen Lewis (former UN special envoy for HIV/Aids in Africa). As Dr Montaner said: “International governments say we face a crisis of resources, but that is simply not true: The challenge is not finding money, but changing priorities. When there is a Wall Street emergency or an energy crisis, billions upon billions of dollars are quickly mobilized. People’s health deserves a similar financial response and much higher priority.”
At the same time the fall in funding has made very clear the need to implement long-standing calls by progressive civil society to put in place more predictable means of global financing, and for African countries to maximise use of TRIPS flexibilities and to advance local production of pharmaceuticals. Yet is it precisely in this arena that measures are being taken to strengthen and enforce intellectual property rights and reduce the flexibilities needed by developing countries. There have been numerous examples of this, included those reported in prior issues of the EQUINET newsletter.
Measures to reinforce IPRs include in regional and bilateral agreements provisions that exceed TRIPs requirements and reduce the flexibilities provided by TRIPS (TRIPS plus); and also pressures on African countries not to exercise rights to compulsory licensing or parallel importation. The EU, which stated its commitment to access to medicines, has pursued measures that exceed TRIPs obligations in its trade agreements with developing countries including with India, in spite of an EU Parliamentary resolution on 12 July 2007 (P6_TA(2007)0353) urging it not to do so. There have been seizures in the EU of generic medicines in transit, not destined for Europe, performed at the insistence of EU pharmaceutical companies for allegedly being counterfeit. The EU has contributed to work on anti-counterfeiting legislation in East African countries that has raised new IPR restrictions on legitimate generic medicines, defining them within the scope of counterfeits (see EQUINET Newsletter 111). Similar seizure laws are being supported through a global initiative called IMPACT.
Significantly at the July AIDS conference, attention was also drawn to the use by the USA of its ‘Special 301’ law which it uses to list and “shame” countries for violating US commercial interests by not providing sufficient protection to IPRs. Health Gap, the Foundation for AIDS Rights and the Thai Network of People Living with HIV/AIDS with others have filed a complaint with the UN's Special Rapporteur on the Right to Health, Anand Grover, alleging that use of this law reduces access to medicines in low and middle income nations and violates international human rights obligations.
Global institutions appear to be offering weak protection to developing countries in their efforts to assert their rights, and the rights and flexibilities provided for in global treaties. In the 2006/7, during the WHO's negotiations on Public Health, Innovation and Intellectual Property (for so-called “neglected diseases”) efforts were made to contain the challenge to IPRs from neglected diseases by including a proposal to limit the scope of the discussion to only 14 diseases, a due process violation as no country proposed this for inclusion in the negotiating text. The IMPACT programme referred to earlier has had an association with WHO that was heavily criticised at the 2010 World Health Assembly. The WTO Dispute Settlement Body (DSB), instead of the defending the flexibilities provided in its own instruments through multilateral measures, has allowed the US room for unilateralism on its Special 301 law in a January 1999 dispute raised by the European Community. This was a decision that Chakravarthi Raghavan of the South-North Development Monitor termed as blatantly based on politics, rather than legal interpretation.
Almost a decade since the 2001 Doha Declaration on TRIPS and Public Health made the important step of asserting more clearly the rights countries already enjoyed to promote access to medicines, few countries have been able to use the rights enshrined in it. The Declaration was needed then because poor countries were precluded from using these rights by the rich countries. The cases cited in this editorial suggest that the last decade has been one of countless efforts to restrict and reverse those rights.
This is in a context where the latest WHO treatment guidelines recommend that people with HIV should start treatment earlier, bringing treatment for people in developing countries in line with treatment in wealthy nations, to help prevent transmission of HIV. Of the 14 million people needing treatment, only 4 million currently receive it. While private rights to IPRs are being vigorously enforced, who is vigorously enforcing the rights to life and health of these 10 million people, or the millions more who need medicines for other common diseases, including chronic conditions like diabetes and hypertension?
And where will we be ten years from now, with an unabated and expanding IP enforcement agenda?. The evidence from recent years outlined here suggests that basing future access to medicines on a benevolent global market, or even one that prioritises human rights in one region over commercial rights in another may be wishful thinking. There seems to be no alternative but for African countries to set a vision, and to develop, negotiate, build space for and implement strategies for their own local production of medicines, to meet their own market and population needs, while simultaneously fending off an IP enforcement agenda that does not meet their interests, in all its guises.
A quarter of the population in Sub-Saharan Africa are young people between the ages of 10 and 19 years. These young people carry the hopes and dreams of their families, their communities and their nation. They are the future leaders and, perhaps as important, the future parents of the next generation.
They live in a world where to be an adolescent is increasingly risky. Adolescents typically take risks, but with the AIDS epidemic, risk-taking can be fatal. When adolescents have unplanned and unprotected sex, sexually transmitted infections can cause infertility or cervical cancer, and pregnancy in adolescents is more risky, with higher rates of death in both adolescent mothers and their babies than in adults. Unsafe abortions amongst adolescents are unacceptably high, and early sexual activity may limit educational attainment and deprive young people of the opportunity to form mature, loving relationships. So it’s a tragic and unacceptable sign that most new HIV infections in sub-Saharan Africa occur among adolescents and young adults.
Adolescents grow up today in a different world. High rates of urbanization, extended periods of schooling and growing poverty contribute to a challenging social context for young people.
Traditional ways of preparing young people for adulthood, which relied on extended family members, are less practiced and might not be adequate to address the pressures that adolescents face. In the past, sexual maturity was closely followed by marriage. Today, young people reach puberty at younger ages and wait longer to marry. Because the aunt or uncle may not be available, or may not be considered relevant, many adolescents turn to other sources. Today, many young people learn from peers or the media. Much of this information is inadequate and sometimes it is just plain wrong.
Schools are an ideal setting in which to reach large numbers of young people with the information they need, including reproductive knowledge and life skills. Yet, wherever it has been introduced, the teaching of reproductive health in schools has generated controversy. Debate exists around what information should be given and how much, especially regarding sexual intercourse, pregnancy and disease prevention. Some adults are resistant to even acknowledging that teenage sex is taking place. Others are concerned that sex education will lead to sexual activity. These viewpoints are often based more on values and beliefs than on facts. Hence the same arguments are repeated again and again, year after year, despite contrary evidence. Its very likely these same views will continue to be expressed into the future.
Nevertheless, facts do help. Studies have shown, both regionally and internationally, that comprehensive sex education is effective in improving knowledge and reducing sexual risk behaviours, and that it does not increase sexual activity. In 1997, a UNAIDS study reviewing 53 sex education programmes globally found that 22 had a positive effect of safer adolescent sexual behaviour, and 27 had no impact. In the 3 studies where there was an increase in sexual activity, there were concerns about the design of the assessment and the validity of conclusions.
Such studies suggest that rather than sex education causing young people to have sex, the opposite is more likely to be the case: Giving young people more complete and accurate information, and more opportunities to discuss issues in an open and non-judgemental environment enables them to make more responsible choices.
Clearly the design and quality of the programme matters. Strengthening sex education programmes can be difficult in resource-strained countries. However some aspects of effective programmes that have been identified from reviews can be applied across different settings, including those where resources are scarce. These include:
• adopting school curricula that provide comprehensive, accurate sexual and reproductive health information;
• supporting teacher training;
• reaching young adolescents with information early, before they leave school and before they begin sexual activity;
• strengthening health and other community services for young people and ensuring that these services are youth-friendly, and
• helping adolescents stay in school. Even if they do not receive sex education, young people who stay in school are less likely then their peers to have sex.
Successful reproductive health programmes are not simply a matter of education. They involve youth issues, gender issues, human rights issues, and health issues. They involve and give a central role to youth themselves. They encourage young people to articulate and discuss issues, to talk about their lives, to understand their options, and to get the skills and support they need for healthy choices. And of course, for young people, they must also be fun.
Our efforts towards reducing maternal mortality or new HIV infection cannot be said to be successful as long as we have not made significantly more progress in reducing the risk for adolescents. Achieving this and reaching young people can’t be left to teachers alone. Parents, civic leaders, health providers, other government ministries all have a role to play. Support of youth is a multi-sectoral effort. As adults planning for a better future for our young people, we are all their parents.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. For more information on the issues raised in this op-ed please visit the EQUINET website at www.equinetafrica.org or see as an example of resources for adolescent reproductive health the Auntie Stella materials on the TARSC website at http://www.auntiestella.org/
With the World Cup football taking place in South Africa absorbing attention, its possible to miss two important meetings taking place at the same time. The first is the 36th G8 and G20 summits taking place in Canada in late June under the theme 'Recovery and New Beginning', and the second the 15th African Union Summit on 19–27 July in Kampala, Uganda, under the theme ‘Maternal, infant and child health and development in Africa’. This newsletter flags concern over these leaders keeping the promise: G8 leaders to their development and aid commitments and African leaders to the Abuja commitments on health, including for 15% of their budgets to go to health. In this issue, a 63rd World Health Assembly resolution points to the need for strengthened health systems to address the relatively slow progress in Africa towards the health MDGs. Geoffrey Njora cautions leaders on taking the advice of finance ministers’ to reverse on the commitments they made at Abuja. Médecins Sans Frontières call the G8 to account over the 'flatlining' of AIDS funding and Oxfam over the inadequate resources allocated for maternal health. African civil society through the Africa Public Health Alliance & 15% Plus Campaign are petitioning AU Heads of States on the grave concerns of African citizens to meet crucial commitments on health and social development in Kampala, in particular the 2001 Abuja pledge on health financing, while the Civil Society Forum on the African Charter on the Rights and Welfare of the Child call for the G8 and African leaders to meet their promises on funding health as we get closer to 2015. What governments deliver at these two summits is worth keeping an eye on- it affects millions of lives.
African civil society through the Africa Public Health Alliance & 15% Plus Campaign are petitioning AU Heads of States through Malawi President Bingu wa Mutharika, Chairperson of the African Union on the grave concerns of African citizens that some Heads of State are being advised to repudiate crucial commitments on health and social development, in particular the 2001 Abuja pledge on health financing. They note that despite some recent progress, healthy life expectancy in Africa is at a low of 45 years resulting in un-fulfilled personal, national and continental potential and aspirations, and the loss of billions of dollars in productivity. They note that it would be a historic setback for African governments to drop health and social development commitments, or suggest in anyway that the health of African economies exists in isolation from the overall health of African citizens. Giving evidence to support the need for adequate health sector financing, the petition urges heads of state to ensure that the July 2010 AU Summit restates the Abuja commitments; and supports the AU Commission in working with governments and civil society to monitor and report on health gains, and ensure a 10th year review of the 2001 Abuja commitments by April 2011.