Category Archives: HEALTH
Fast facts about the drought in the Horn of Africa
 IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs, has an interesting article about the ongoing food crisis in the Horn of Africa.
photo credit: Matt and Kim Rudge
HORN OF AFRICA: Fast facts about the drought
NAIROBI, 5 August (IRIN) – The Horn of Africa is facing what has been called the worst drought in 60 years, with an estimated 12.4 million people urgently needing food.
Here are some points about the ongoing food crisis:
When to use the “F” word – Although some media reports have described the food crises in Kenya and Uganda as a famine, the UN says only five areas [ http://www.irinnews.org/report.aspx?reportid=93422 ] of southern Somalia are at that stage. The UN uses a system called the Integrated Food Security Phase Classification (IPC) [ http://www.ipcinfo.org/attachments/02_IPCBrief_EN.pdf ], which is a standardized tool.
The IPC uses five phases to classify the different levels of food insecurity:
- Â Level one is generally food secure;
- Â Level two is moderately/borderline food insecure;
- Level three refers to an acute food and livelihood crisis;
- Level four is a humanitarian emergency – severe lack of food access, death due to hunger, malnutrition and irreversible livestock asset stripping;
- Level five – famine or humanitarian catastrophe – occurs when there is a complete lack of food access and mass starvation, death and displacement.
According to the UN World Food Programme (WFP), Kenya is facing a humanitarian emergency, but is not at the famine phase. Parts of northern and northeastern Uganda [ http://reliefweb.int/sites/reliefweb.int/files/resources/uganda_ol_2011_07_final.pdf ] are in phase two. Much of southern Ethiopia [ http://reliefweb.int/sites/reliefweb.int/files/resources/Full_report_188.pdf ] is in the emergency phase, while central and northern areas of the country are divided between phases two and three.
Looking back – There have been 42 droughts [ http://www.globalhumanitarianassistance.org/wp-content/uploads/2011/07/gha-food-security-horn-africa-july-20111.pdf ] in the Horn of Africa since 1980, affecting an estimated 109 million people; with 47 million people experiencing drought in the region in the last decade alone. The most well-known famine took place in Ethiopia in 1984; some estimates put the death toll as high as one million.
 Surprisingly fertile – Somalia’s Lower Shabelle region, one of the areas now hit by famine, is traditionally the country’s bread basket, its main maize-producing area. In the past, the country produced enough grain to meet its basic market requirements. However, a combination of conflict – leading to displacement of many farmers and traders – and poor rains in recent years has drastically reduced production. In 2010, for instance, despite good Gu rains – from April to June – local cereals only supplied [http://www.fsnau.org/downloads/Somalia_Market_Functioning_July_2011.pdf ] about 40 percent of national consumption needs.
 Charity begins at home – While most of the US$2.4 billion required to feed people affected by the food crisis will come from rich countries, local populations and the diaspora are also doing their bit. Just one week after it began, the Kenyans for Kenya [http://www.kenyans4kenya.co.ke ] initiative has already raised more than $1.3 million from private citizens using mobile cash transfer services [ http://www.irinnews.org/report.aspx?reportid=79594 ] and taking donations of as little as $0.10; the first consignment of food was sent from the capital, Nairobi, on 31 July.
According to media reports, remittances [Â http://www.irinnews.org/report.aspx?reportid=54469Â ] from the Somali diaspora to the worst-hit areas in the south of the country are up by 10 percent.
Feeding the malnourished – By the time help reaches them, many adults and children require therapeutic feeding to regain their strength and get back to a healthy weight. Some of the products WFP [ http://www.wfp.org/nutrition/special-nutritional-products ] uses to improve the nutritional intake of drought-affected people are:
- Â Fortified blended foods: Blends of partially pre-cooked and milled cereals, soya, beans, pulses fortified with vitamins and minerals. These are usually mixed with water and cooked as porridge and provide about 380 Kcal per 100g. The most commonly used FBF is corn soya blend.
- Ready-to-use foods: According to WFP, these are better suited to meet the nutritional needs of young and moderately malnourished children than fortified blended foods. Mainly used in emergency operations and designed to be eaten in small quantities as a supplement to the regular diet, ready-to-use foods such as Plumpy’doz [Â http://www.irinnews.org/report.aspx?reportid=82307Â ] contain peanut paste, vegetable fat, skimmed milk powder, whey and sugar; 100g provides more than 500 Kcal.
- High-energy biscuits: These wheat-based biscuits, which provide 450 Kcal per 100g, are fortified with vitamins and minerals and are usually used early on in emergency feeding programme, before cooking facilities are widely available.
- Sprinkles – This is a tasteless powder containing the recommended daily intake of 16 vitamins and minerals for one person; it can be sprinkled on to home-prepared food after cooking.
- Â Compressed food bars – made from baked wheat flour, vegetable fat, sugar, soya protein concentrate and malt extract, these bars are used in disaster relief operations when local food cannot be distributed or prepared. They can be eaten as a bar straight from the package or crumbled into water and eaten as porridge, and contain 250 Kcal and 8.1g of protein per 56g bar.
This report on line:Â http://www.IRINnews.org/
© IRIN. All rights reserved. More humanitarian news and analysis: http://www.irinnews.org/
[This item comes via IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or itsMemberStates. Reposting or reproduction, with attribution, for non-commercial purposes is permitted. Terms and conditions: http://www.irinnews.org/copyright.aspx]
Suggested Books
Famine Crimes: Politics & the Disaster Relief Industry in Africa
Adapting to Drought: Farmers, Famines and Desertification in West Africa
Rwanda : Partners in health guide to chronic care integration for endemic NCDs
photo credit: www.fearghalonuallain.ie
Partners in health guide to chronic care integration for endemic NCDs – Rwanda edition
Authors: Bukhman,Gene
Produced by: Partners in Health (2011)
This guide, published by Partners in Health, is written for district-level health care providers and policy makers dealing with noncommunicable diseases (NCDs) in rural Rwanda or similar settings.
The guide is focused mainly on ambulatory care performed by advance nurses, clinical officers, and generalist physicians. It describes protocols focused on the essential internventions often deemed too complex to be delivered to the rural poor as well as comprehensive technical strategies shown to be both effective and efficient for managing chronic disease.
Based on the experiences and collaboration between Rwandan and international health specialists over four years, this guide covers the following topics:
- integration of chronic care services in Rwanda.
- palliative care and chronic care.
- role of community health workers, family planning, mental health, and social services in the treatment of chronic disease.
- heart failure.
- cardiac surgery screening, referral, anticoagulation, and postoperative management.
- chronic kidney disease.
- diabetes.
- hypertension.
- rheumatic heart disease prevention.
- chronic respiratory disease.
- epilepsy.
According to the authors, this manual offers a starting point for the creation of a system of care for non-communicable diseases: one blueprint for fulfilling , in Rwanda, an essential part of a fundamental human right.
PDF available online at:Â Partners in health guide to chronic care integration for endemic NCDs – Rwanda edition
 Suggested Books
Africa Health : Ancient wisdom, new knowledge
DAKAR, 11 July (IRIN) – No one can tell 64-year-old Fatoumata Kané anything new about the plants and tree bark around her town of Banamba in western Mali, but the traditional healer recently learned how to measure a child’s upper arm to detect malnutrition.
Scores of families bring ailing children to Kané each week. She is renowned in the region for her healing powers, but now refers suspected malnutrition cases to the public health centre. The collaboration, initiated by local health agent Oumou Sangaré of Helen Keller International (HKI), is an example of how NGOs are tapping into the influence of traditional healers and local elders to fight under-nutrition.
Across sub-Saharan Africa health experts commonly train traditional healers to detect conditions needing something other than indigenous medicine; the fact is that when illness strikes many people’s first move is to go to the local healer.
“It is always people’s first choice here,” said a doctor in Sierra Leone who requested anonymity. “It’s a custom people are addicted to.”
It is custom, but often it is also the only health care people can afford or physically access. In some countries in Africa and Asia 80 percent of people depend on traditional medicine for their primary health care, according to the World Health Organization. [Â http://www.who.int/mediacentre/factsheets/fs134/en/Â ]
Often traditional medicine is the answer. Africa has tens of thousands of plant species, many therapeutic, and the basis for effective remedies. Kouamé Koffi Samuel, a chauffeur in Côte d’Ivoire, said he has first-hand experience of women who are expert at healing closed fractures with massage, herbs and incantations. “I’ve seen it – it’s far more rapid and effective than a cast.”
But child under-nutrition is one of the conditions untreatable by such means, health workers say. If a parent does not understand the signs, symptoms and causes, various conditions could be suspected. The Sierra Leonean doctor said some families think immediately of a spell.
“When a child is malnourished people think it’s a witch. When a child is very anaemic they say a witch has drawn all the blood from the child.”
He added: “We need to do more education on this.”
Health experts say one strong conduit for that education are the traditional healers and elderly women who already have people’s confidence.
“If [Banamba healer Kané] were to tell a woman not to take a child to the health centre, the woman wouldn’t do it, no matter what,” HKI’s Sangaré told IRIN. “Such is the women’s trust in her.”
Sangaré said she first approached Kané when she noticed that too many malnourished children in Banamba were not getting the medical attention they needed.
Collaborating with local healers
She said initially Kané, who makes her living as a healer, was hesitant but then agreed to talk. They met several times to talk about children’s health; Sangaré explained to Kané the role she could have in detecting malnutrition and helping children get the care they need. “Now she’s had training and she’s helping us detect cases of malnutrition.”
Kané, from her home in the Hamdallaye neighbourhood of Banamba, told IRIN traditional and modern medicine can function well together. “I have practiced for more than 20 years now; the gift I have for healing is not going anywhere. But modern medicine can complement it, and vice-versa.”
Vanessa Dickey, senior nutritionist with HKI Mali, said collaborating with local healers means more children who need medical care will get it.
“Targeting just mothers can get us only so far,” Dickey told IRIN. “People are going to listen to a traditional healer or a grandmother.” HKI also has a project in Burkina Faso to boost maternal and child health through the influence of older women, to whom young women invariably turn for advice on pregnancy, motherhood and feeding their families.
“Our object is to screen as many children as we can to see who needs attention,” Dickey said. “And traditional healers and grandmothers are the first-line healers in a community.”
Traditional plus modern
Nurses and doctors told IRIN it is common to see families consult both a traditional practitioner and a doctor.
Soro Awa, holding her nephew whose mother had recently died in childbirth, talked to IRIN at a Côte d’Ivoire nutritional centre in Korhogo: “Without this centre my sister’s son would not be alive,” she said. Still, she plans to see the local healer once she returns to the village “to protect the child from sorcery”.
“Often, people assume someone has cast a spell on a child, not knowing that a child is malnourished or has an illness that can be easily treated at hospital,” said Soro Pènè, from Korhogo’s Waraniené village. “Anyway, I am all for traditional healers because they do have their place in our customs and they are very effective in some cases.”
Salimata Koné, who runs the Korhogo centre, says some parents bring their children in directly without going to a local healer. But as the Sierra Leonean doctor explains, family pressure often weighs in later. “A parent could have a child treated at hospital, then a friend or family member will come round advising that it’s best to also consult the traditional healer.”
“It can be OK if people go to both,” he said. “But only if the traditional healer is competent and knows the limits of his or her capabilities.”
It is not a question of ruling out traditional practitioners, said Dickey. “They can continue to do follow-up. We do urge them not to give malnourished children herbs or teas to consume. The body of a malnourished child is really in chaos; these kinds of plants, which might not harm another person, could be dangerous for a child in this state.”
As in so many circumstances, the hard evidence of a healthier child is the most powerful message, Koné in Korhogo told IRIN. “It’s important not to condemn the practice of going to a traditional healer; we don’t want to frustrate people. But the fact is once a malnourished child regains health after proper diagnosis and treatment, that recovery is concrete proof and has a huge influence on others.”
Recovery is the common objective. “My role is to lighten mothers’ hearts, by helping heal sick children,” said Kané. “When a child is healthy, the mother is relieved and things go better in the household.”
Via IRINÂ http://www.irinnews.org/report.aspx?reportid=93199
© IRIN. All rights reserved. More humanitarian news and analysis: http://www.irinnews.org/
[This item comes via IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States. Reposting or reproduction, with attribution, for non-commercial purposes is permitted. Terms and conditions: http://www.irinnews.org/copyright.aspx]
Africa : 50 interesting things (2010)
These interesting facts are from the World Bank. A lot of them are, as you would expect from that source, economic, but there is a fair sprinkling of social issues. (NB SSA = sub-Saharan Africa)
- Africa
[Photo credit: duncan]
- The largest population in SSA is 151.3 million in Nigeria; the smallest is 0.1 million in Seychelles.
- South Africa’s and Nigeria’s GDP in nominal prices comprised over fifty percent (51.4 percent) of total SSA’s GDP.
- SSA GDP growth was 5.1 percent. Angola had the largest growth at 14.8 percent while the lowest was Botswana with a negative growth (-1.0 percent).
- South Africa has SSA’s largest real GDP ($183 billion); the smallest is Guinea Bissau ($202 million).
- Equatorial Guinea has SSA’s highest GNI per capita ($14,980); Burundi has the lowest ($140).
- The total GDP per capita of the richest 10 African countries was 25.2 times of the poorest 10.
- Between 1990 and 1999 PPP GDP per capita growth was 15 percent ($1,158.9 to $1,327.8) for Sub-Saharan Africa; in between 2000 and 2008 it was 54 percent ($1,372.9 to $2,113.9).
- Exports rose from $319.0 billion in 2007 to $413.7 billion in 2008, a 29.7 percent rise; conversely, imports rose less than exports, from $305.3 billion in 2007 to $372.1 billion in 2008, a 21.8 percent rise.
- Total trade as percentage of GDP is the highest in Seychelles, 283.4 percent and lowest in Central Africa Republic, 37.5 percent.
- In two thirds of SSA countries, one or two products are responsible for at least 75 percent of the country’s total exports.
- On average, the merchandise export within trade blocs is 8.4 percent of total bloc exports.
- Cape Verde receives the highest net ODA per capita ($438.2); Nigeria receives the lowest ($9.5).
- The highest private sector fixed capital formation as share of GDP is Cape Verde at 33.7 percent; the lowest is Angola at 1.8 percent.
- In Guinea-Bissau, the agriculture value-added as percentage of GDP is 51.5 percent; in Botswana it is 1.6 percent.
- South Africa uses the most electric power per person (4,809.0kW/h); Ethiopia uses the least (38.4 kW/h).
- In 2007, Burundi has the highest proportion of women in its labor force (90.2 percent); Sudan has the lowest (32.8 percent).
- Equatorial Guinea has the highest proportion of men in its labor force (93.8 percent); Namibia has the lowest (60.3 percent).
- In 2007, almost one in every three 15-49 year olds in Swaziland has contracted HIV (26.1 percent); the rate is one in every thousand in Mauritania.
- For the period 2007-08, Seychelles has the highest life expectancy (73 years); Mozambique has the lowest (42 years).
- In the decade (1997-2007) Rwanda and Sierra Leone have made the greatest gains in life expectancy: 11 and 8 years respectively. Conversely, life expectancy has decreased 13 years in Lesotho, and 10 years in South Africa and Swaziland.
- For the period 2007, Zimbabwe has the highest adult literacy rate (91.2 percent); Mali and Burkina Faso have the lowest (28.7 percent).
- In Seychelles, 92 percent of women are literate; the figure is 13 percent for Chad and 15 percent for Niger.
- Cape Verde has the highest gross enrolment rate in secondary education (90 percent); Niger has the lowest (11 percent).
- In Mauritius there are 22 children per primary school teacher; there are 91 in Central African Republic.
- In Burundi, 63.1 percent of children under the age of 5 are short for their age; in Senegal it is 20.1 percent. Same fact than below – to be removed
- The highest connection charge for a business phone is $366.6 in Benin; the lowest is in Ghana at $0.7.
- South Africa has 924 mobile phones per 1000 people; Eritrea has 22 per 1000 people.
- South Africa has the longest rail lines of 24,487 km and Uganda has the shortest of 259 km.
- In 2010, starting a business in Guinea requires 213 days for each procedure; it takes 3 days in Rwanda.
- In 2010, Sudan has the highest number of procedures to enforce contracts of 53; Rwanda has the lowest of 24.
- It takes 16.6 days average time to clear customs on direct exports in Cote d’Ivoire and 3.8 days in Gabon; conversely for imports it takes 31.4 days in the Republic of Congo and 4.4 days in Lesotho.
- Firms indentifying corruption as a major constraint was highest in Côte d’Ivoire at 75.0 percent, whilst the lowest is Ghana 9.9 percent
- The percentage of firms expected to give gifts to secure a government contract is highest in Congo Republic are 75.2 percent and lowest for Mauricia at 8.8 percent.
- Djibouti has the most urbanized population (84.6 percent); Burundi the least (10.4 percent).
- For the period 2000-07, the share of poorest 20 percent in national consumption or income was lowest in Angola at 2 percent; in Ethiopia it was 9.3 percent. (MDG 1)
- In Burundi, 38.9 percent of children under the age of five are underweight. In Gabon they are 8.8 percent. (MDG 1)
- On average, between 2004 and 2006, South Africa and Gabon had less than 5 percent of population below the minimum dietary energy consumption; conversely Democratic Republic of Congo had the highest at 75 percent. (MDG1)
- Thirty seven percent of children who start first grade reach grade five in Chad, while in Mauritius 99 percent reach fifth grade. (MDG 2).
- The lowest net primary enrolment ratio is found in Liberia (30.9 percent); the highest is in Sao Tome and Principe (97.1 per cent). (MDG 2).
- Youth literacy (ages 15-24) is highest in Gabon at 97 percent and lowest Burkina Faso at 39.3 percent. (MDG 2)
- Women in national parliament total seats are the highest with 56.3 percent in Rwanda and the lowest with 1.8 percent in Sao Tome and Principe. (MDG 3)
- In Sierra Leone 155 out of 1,000 children die before the age of one; in Seychelles the rate is 12 per 1,000. (MDG 4)
- In Sierra Leone 272 children per 1,000 die before the age of five; in Seychelles, the rate is 13 per 1,000. (MDG 4, IDA 2)
- Skilled personnel attend 5.7 percent of births in Ethiopia; they attend 98.4 percent of births in Mauritius. (MDG 5, IDA 4)
- Contraceptive use (any method) is highest in Mauritius at 75.8 percent; lowest is Chad at 2.8 per cent. (MDG 6)
- In Chad, 9 percent of the population has access to improved sanitation facilities; in Mauritius 94 percent have such access. (MDG 7)
- In Somalia, 29 percent of the population has access to a safe source of water. In Mauritius, it is 100 percent. (MDG 7)
- Gabon has the highest forest area as a percentage of total land area at 84.4 percent, whilst Djibouti has the lowest at 0.2 percent. (MDG7)
- South Africa has the highest carbon dioxide emissions of 414,649 metric tons, whilst Comoros has the lowest of 88 metric tons. (MDG 7)
- In Sierra Leone 3 persons per 1,000 are Internet users; there are 371 in every 1,000 people in Seychelles, which also had 212 computers per 1,000 people for the period 2005-07. (MDG 8).
(Reference: 50 things you didn’t know about Africa – World Bank)
Meningitis vaccine designed specifically for the African continent
Pilot in Burkina Faso for MenAfriVac immunization campaign.
[Photo credit: The global health nonprofit PATH]
AFRICA: New vaccines key to lowering child mortality
KIGALI/NAIROBI, 7 December 2010 (IRIN) – Burkina Faso has become the first country to introduce a meningitis vaccine designed specifically for the African continent, where up to 450 million people are at risk from the disease.
It is hoped that MenAfriVac – developed by the UN World Health Organization (WHO) and the international health NGO, PATH – will help to eliminate meningococcal A in 25 countries in Africa’s meningitis belt, which stretches from Ethiopia to Senegal.
“With a one-time investment to vaccinate populations in all countries of the meningitis belt, nearly 150,000 young lives could be saved by 2015, and epidemic meningitis could become a thing of the past,” Margaret Chan, WHO Director-General, said in a statement. “This is within reach. We must not fail.”
In 2009, 14 African countries reported more than 88,000 cases and 4,000 deaths from meningitis. The worst-affected patients usually die within 24 to 48 hours of the onset of symptoms and up to 20 percent of survivors suffer brain damage, hearing loss or learning disabilities.
The MenAfriVac vaccine is the latest in a group of new vaccines that could result in a significant drop in infant mortality in Africa. In 2009, a handful of countries, including the Gambia and Rwanda, introduced the pneumococcal conjugate vaccine into their national immunization programmes; pneumococcal disease kills an estimated 800,000 children under five annually, most in the developing world.
South Africa introduced a vaccine for rotavirus  [ http://irinnews.org/Report.aspx?ReportID=87363 ] – a diarrhoeal disease that kills an estimated 500,000 children globally every year – in 2009. Several African countries are also considering introducing routine vaccination of young girls against human papillomavirus (HPV), which can predispose them to cervical cancer later in life.
Financing vaccines
Vaccine stakeholders have had to devise innovative ways to cut costs. MenAfriVac costs just US$0.50 per dose; according to its developers, a public-private partnership model enabled the development of the vaccine at less than one-tenth the $500 million usually required to develop and bring a new vaccine to market.
The GAVI Alliance – which supports 72 poor countries with vaccines – has raised more than $5 billion through traditional fundraising mechanisms and innovative financing, such as the sale of capital market bonds and Advanced Market Commitments, where donors commit money to guarantee the price of vaccines once they have been developed, assuring producers a viable market.
Competition has also played a role in lowering vaccine prices; for instance, the price of hepatitis B vaccine has declined from $0.59 per dose in 2000 to $0.20 today. The price of a five-in-one vaccine has also recently dropped significantly thanks to increased demand and the entrance into the market of a new manufacturer.
The alliance also works through co-financing, where developing nations pay for part of the vaccines being used in their countries; for example, between 2008 and June 2010, Rwanda co-financed GAVI’s support with nearly $1.9 million.
Five-year plan
The GAVI Alliance’s new five-year strategy, which includes plans to vaccinate more than 240 million children – including 90 million against pneumococcal diseases and 53 million against rotavirus – will cost $6.8 billion until 2015.
The organization has raised $3.1 billion, but needs $3.7 billion, which it says could potentially save as many as four million lives by 2015.
The GAVI Alliance has contributed more than $85 million to the effort to eliminate meningococcal A meningitis in Africa, but requires another $475 million to protect the entire meningitis belt. According to its developers, the introduction of MenAfriVac and the resulting reduction in meningitis could save over $120 million up to 2015.
Broader benefits
According to Saad Houry, deputy executive director of the UN Children’s Fund, it was important to continue to fund vaccines and build on the progress of vaccine programmes, especially as they often brought additional benefits to health systems in developing countries.
“Vaccines have been very important in reducing mortality from infectious diseases, but they have also been useful in strengthening health systems,” he said. “In countries like Rwanda where vaccine coverage is over 90 percent, health systems are able to take advantage of the contact made during vaccination to provide vitamin A, provide ante- or post-natal care, bed nets and nutritional advice.”
Houry stressed the need to begin to think of vaccination as more than just an intervention, but as an investment in the future of the developing world.
“So we know how to deliver a vaccine – how do we build on this? Once we have enabled a child to live past the age of five, there is now a responsibility to ensure that they are given the chance to develop to the best of their ability – to ensure they have good nutrition, continued access to health and access to good education,” he added.
“Vaccination is just the beginning.”
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[This item comes to you via IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States. Reposting or reproduction, with attribution, for non-commercial purposes is permitted. Terms and conditions:Â http://www.irinnews.org/copyright.aspx
Sudan : Health Issues as Tension Builds Ahead of Referendum
Image by JCKole via Flickr
A short while ago I wrote a review of a National Geographic article, Sudan’s shaky Peace, which appeared in their November issue. As the referendum on the division of Sudan draws closer tensions are increasing. The following report from the IRC highlights the health issues involved as people flee their villages because of insecurity and localised violence.
IRC Aids Thousands in Southern Sudan Who Fled Recent Sudanese Army Bombings, As Tension Builds Ahead of Referendum
JUBA, Dec 8, 2010 — An International Rescue Committee medical team is delivering emergency health care services to more than 3,500 newly displaced people, mostly women and children, who fled to the state of Northern Bahr el Ghazal in Southern Sudan after their villages in South Darfur were hit by Sudanese Army bombers.
The displaced started crossing the border into the district of Aweil North after the November 12 attack and have been arriving in waves at a makeshift camp in the town of Jaac  – following a nearly two day journey across rivers and through thick forest. The new arrivals are ethnic Dinka, originally from this area, who had been living in border villages in South Darfur.
The IRC’s mobile medical team launched a vaccination campaign for children under five, women of child-bearing age and pregnant women last week and vaccinations continue this week. They are also treating the displaced for upper respiratory tract infections, malaria and diarrhea.
“We’re vaccinating hundreds of children against polio, diphtheria, TB and measles, after learning that none had been previously immunized,†says the IRC’s Dr. Vincent Kahi. “Epidemics can spread quickly among displaced populations, so this is an easy intervention that saves lives.â€
Dr. Kahi says the area remains tense. During a multi-agency needs assessment last week, Sudanese Army planes circled above, but there was no attack.
“The overflying planes caused additional fear and alarm among a group already traumatized by last month’s bombings,†says Dr. Kahi.
The IRC plans to continue emergency medical services for the displaced while continuing maternal and primary health care services for the host population. Other groups are distributing food and household supplies.
“The latest violence and displacement are troubling,†says Susan Purdin, the IRC’s country director in southern Sudan. “With the referendum a month away, these incidents raise political tension and distrust on both sides of the border.â€
Purdin says the IRC has been preparing for all scenarios – putting contingency plans in place in the event of violent outbreaks that cause modest or significant displacement.
“We’re hoping for the best, but preparing for the worst,†Purdin says. “However, we don’t believe that small-scale incidents will impact the outcome. Sadly, localized violence has become part of life in Southern Sudan.â€
The IRC has been delivering humanitarian aid in Southern Sudan for 20 years. IRC teams provide some 500,000 people with lifesaving medical and reproductive health programs and specialized health assistance for children under five. IRC aid workers also run education services and sexual violence aid and prevention programs. The IRC formerly supported 800,000 people in Darfur and 1.1 million in North and East Sudan with health, water, sanitation, education, women’s health, protection and livelihoods services. In March 2009, the IRC was one of 13 international agencies expelled from these regions.
About the International Rescue Committee: A global leader in humanitarian assistance, the International Rescue Committee works in over 40 countries, offering help and hope to refugees and others uprooted by conflict, oppression and disaster. During crises, IRC teams provide health care, shelter, clean water, sanitation, learning programs for children and special aid for women. As emergencies subside, the IRC stays to revive livelihoods and help shattered communities recover and rebuild. The IRC also helps resettle refugees admitted into the United States. A tireless advocate for the most vulnerable, the IRC is committed to restoring hope, dignity and opportunity.
For more information, visit theIRC.org
Suggested Books
- Sudan: Darfur and the Failure of an African State
- Six Months in Sudan: A Young Doctor in a War-Torn Village
Related articles
- South Sudan in withdrawal demand (bbc.co.uk)
- SUDAN-SOUTH SUDAN: What the analysts are saying post-secession (IRINnews.org)
- China Tries to Mediate Sudan Oil Impasse (abcnews.go.com)
Ethiopia : Yale Expands Premier Degree Program for Healthcare Administration
Yale Expands Premier Degree Program for Healthcare Administration in Ethiopia
New Haven, Conn. Press Release 1 Dec  2010 – The Yale Global Health Leadership Institute (GHLI) has launched the expansion of its pioneering Masters in Hospital and Healthcare Administration (MHA) degree program to Addis Ababa University (AAU) in Ethiopia.
The program, initiated in 2008 at Jimma University, has already provided 23 senior Ethiopian health care professionals with the necessary leadership skills and management tools to improve the quality of health care for the people of Ethiopia. Eighteen students have been admitted into the new AAU MHA degree program. Â Through training and research programs at both participating universities, students learn how to improve efficiency and the quality of health in hospitals and other health facilities.
“The MHA program is integral to improving the quality of health care for the Ethiopian people.  Students learn new skills that enable them to better manage challenges and help our hospitals and health care delivery systems better treat patients and save lives,†said Tedros Adhanom Ghebreyesus, Ethiopian minister of health.
The MHA is a two-year educational program that provides each student with innovative techniques for managing hospitals and other health facilities through courses ranging from operations to financial management. The goal of the program is to produce a network of professional chief executive officers committed to improving hospital quality in Ethiopia. Individual hospitals with CEOs in the program have already reported substantial improvements including reduced length of stay from 10 to 7 days and reduced post-surgical infection rates from 10% to 2%, highlighting greater efficiency and quality of care. Â The expansion of the MHA program is supported by the U.S. Centers for Disease Control and Prevention (CDC).
“Funding from the CDC speaks volumes to the fact that our government, in partnership with the Ethiopian Ministry of Health, understands the importance of good management. The MHA program is making a difference in the quality of health care, and Yale is honored to help lead the way in these efforts,†stated Elizabeth Bradley, faculty director of GHLI and director of the Yale Global Health Initiative. Bradley also noted that GHLI is viewing the success of the Ethiopian partnership as a template for similar collaborations with other countries, including Rwanda.
The Global Health Leadership Institute at Yale was launched to develop the next generation of global health leaders around the world through innovative education and research programs.
More Info
For more information on the GHLI and the Ethiopia program, visitwww.yale.edu/ghli.
MALI: Disabled seek jobs, not charity
Koné Draman loves his new job as a water-seller
[Photo credit: Anna Jefferys/IRIN]
BAMAKO, 18 October 2010 (IRIN) – Mali’s disabled have access to some free healthcare options, and are supported by a number of associations and charities, but what they really want is to find work and contribute to the national economy, says NGO Handicap International (HCI). ”I want to control my work, my life myself,” said Koné Draman, who was paralysed from the waist down in a 2001 car accident. “I want to be a part of the community that way.”
A lot of progress has been made on this front, said Moctar Ba, president of the Malian Association of Handicapped People (FEMAPH), but many disabled people still lack the necessary education or skills to earn a living other than through begging.
While the World Health Organization estimates 10 percent of the Malian population is disabled, Ba thinks the percentage is much higher because of road traffic accidents and illnesses left untreated.
Government jobs
Most of the employment progress has taken place in the public sector. Government ministries practice positive discrimination to hire people with disabilities, encouraging disabled people to take the entrance exam for civil servant employment. Some 241 young disabled graduates were accepted into the civil service in 2009, said Ba. The Ministry of Social Affairs has been particularly proactive in hiring people with disabilities, said HCI.
The government has signed the International Labour Organization Convention on Decent Work, which addresses employment rights of disabled people; and Mali is the seventh African country to sign the Convention on the Rights of Persons with Disabilities.
Private sector lagging
But stigma runs rife in the private sector, where companies shun hiring disabled people, said Ba. “Employers tend not to see the intrinsic value of a person… but only see their disability, which is a shame,” he told IRIN. Barthélemey Sangala, FEMAPH coordinator, backs this up: “Most disabled can’t find private sector jobs as most companies think they can’t work.”
The attitudes of employers, educators and disabled people themselves must be changed, said HCI head in Mali Marc Vaernewyck. “We don’t push for charity, but to help disabled people access existing institutions… to help them build self-confidence and self-esteem and drop stigma,” he told IRIN. “Even when armed with a diploma, most disabled people lack the confidence to go out and seek a job because of these attitudes,” he told IRIN.
One way to change attitudes is to encourage proactive disabled citizens to set up their own businesses, said HCI project coordinator Sidy Ahmed Adiawiakoy, by helping them access micro-credit loans.
Draman applied for a loan to set up a water pump in Bamako’s run-down neighbourhood of Sablibougou, where most residents live in mud houses, with no electricity or running water.
“I knew getting water was difficult, so I went to the association in 2009 to see if I could set up a water pump,” Draman told IRIN. HCI donated US$425 towards the pump and helped Draman get a bank loan for the remaining $638. He has since paid off the loan in full.
He charges the equivalent of five US cents for 10 litres of water, taking home US$6-10 in profit per day. Before the pump was installed, residents paid water deliverers 42 cents to bring 10 litres of water to their houses, he said.
The change Draman has gone through is remarkable, said Adiawiakoy. “He used to do little, asking his neighbours to pass on meals… Now he is actively contributing to improving life in the neighbourhood.”
Adiawiakoy is confident that larger companies are starting to be more open to hiring disabled people. In a recent study of 200 businesses, some 120 of them employed people with some form of disability.
Education
But change can only come about on a wider scale if disabled children are actively encouraged to attend school, said HCI’s Vaernewyck. Too often, they are either not sent, or they drop out after primary level as teachers are not equipped to meet their needs.
Specialist private schools for those with sight problems, hearing problems and learning difficulties, operate in the capital, and FEMAPH subsidizes some children’s school fees. But they, the UN Children’s Fund (UNICEF), and HCI want more disabled people to be included in regular schools. “We want inclusive schools where disabled people are trained the same way and under the same environment as all other children,” said FEMAPH’s Ba. Inclusive education is the key to dismantling stigma, he told IRIN.
There has been some success: Enrollment of disabled children in regular schools has increased; and the Education Ministry now runs a project teaching secondary school teachers brail, but such programmes need to be expanded to reach more children, said Ba.
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Innovation of the Week : Providing an agricultural answer to the call of nature
Guest post by Danielle Nierenberg http://www.nourishingtheplanet.org
It’s hard to believe, but an estimated 2.6 billion people in the developing world—nearly a third of the global population—still lack access to basic sanitation services. This presents a significant hygiene risk, especially in densely populated urban areas and slums where contaminated drinking water can spread disease rapidly. Every year, some 1.5 million children die from diarrhea caused by poor sanitation and hygiene. It is in these crowded cities, too, that food security is weakened by the lack of clean, nutrient-rich soil as well as growing space available for local families.
But there is an inexpensive solution to both problems. A recent innovation, called the Peepoo, is a disposable bag that can be used once as a toilet and then buried in the ground. Urea crystals in the bag kill off disease-producing pathogens and break down the waste into fertilizer, simultaneously eliminating the sanitation risk and providing a benefit for urban gardens. After successful test runs in Kenya and India, the bags will be mass produced this summer and sold for U.S. 2–3 cents each, making them more accessible to those who will benefit from them the most.
In post-earthquake Haiti, where many poor and homeless residents are forced to live in garbage heaps and to relieve themselves wherever they can find privacy,SOIL/SOL, a non-profit working to improve soil and convert waste into a resource, is partnering with Oxfam GB to build indoor dry toilets for 25 families as well as four public dry toilets. The project will establish a waste composting site to convert dry waste into fertilizer and nutrient-rich soil that can then be used to grow vegetables in rooftop gardens and backyards.
In Malawi, Stacia and Kristof Nordin’s permaculture project (which Nourishing the Planet co-director Danielle Nierenberg visited during her tour of Africa) uses a composting toilet to fertilize the crops. Although these units can be expensive to purchase and install, one company, Rigel Technology, manufactures a toilet that costs just US$30 and separates solid from fluid waste, converting it into fertilizer. The Indian non-profit Sulabh International also promotes community units that convert methane from waste into biogas for cooking.
On a larger scale, wetlands outside of Calcutta, India, process some 600 million liters of raw sewage delivered from the city every day in 300 fish-producing ponds. These wetlands produce 13,000 tons of fish annually for consumption by the city’s 12 million inhabitants. They also serve as an environmentally sound waste treatment center, with hyacinths, algal blooms, and fish disposing of the waste, while also providing a home for migrating birds and an important source of local food for the population of Calcutta. (See also “Fish Production Reaches a Record.â€)
Aside from cost and installation, the main obstacles to using human waste to fertilize crops are cultural and behavioral.UNICEF notes in an online case study that a government-run program in India provided 33 families in the village of Bahtarai with latrines near their houses. But the majority of villagers still preferred to use the fields as toilets, as they were accustomed to doing their whole lives. “It is not enough just to construct the toilets,†said Gaurav Dwivedi, Collector and Bilaspur District Magistrate. “We have to change the thinking of people so that they are amenable to using the toilets.â€
Suggested Books (US)
- Toilets That Make Compost: Low-Cost, Sanitary Toilets That Produce Valuable Compost for Crops in an African Context
- Social Perspectives on the Sanitation Challenge
Malawi : Tackling the human resources crisis
Public health services in Malawi
Tackling the human resources crisis in Malawi’s public health system, Debbie Palmer; Department for International Development, UK,  id21 Development Research Reporting Service, 2007
Since the late 1990s, Malawi’s public health services have appeared to be heading for collapse due to declining staffing levels. The government launched the Essential Health Package in 2004 to help improve the health of the population, which includes scaling-up HIV and AIDS-related services. The biggest challenge facing the initiative is improving human resource levels.
The Commission for Macroeconomics and Health has highlighted how vital improved health is for economic growth and human development. As a result, the international focus has been on providing more cost-effective funding to improve health services and to strengthen national health systems. The link between staffing levels and improved health has been highlighted as the main ingredient that holds health systems together.
Malawi is one of Africa’s poorest countries. Although its health infrastructure is fairly well developed, this is in very poor condition. The public health sector has battled a rising demand for services caused by population growth and a high HIV and AIDS rate. Yet its health staffing levels, the lowest in sub-Saharan Africa, are not enough to maintain even a minimum level of care.
In 2004 the Malawian government declared the human resources shortage a crisis. The Ministry of Health launched an Essential Health Package initiative to tackle the 11 main causes of death and illness. Donors responded to the crisis by helping the country develop a complementary Emergency Human Resources Programme. A study by the UK Department for International Development’s Malawi office examined this human resources crisis. It assessed progress made within a year of implementation of the programme in April 2005.
The study found that:
- Salary top-ups introduced to improve staff recruitment and retention helped reduce the flow of staff, especially nurses, from the public sector.
- Good progress had been made with the recruitment and re-engagement drive, with 591 staff recruited externally by the end of 2005 and over 1,100 promoted internally.
- The recruitment of stop-gap expatriate support included 19 people in place and the deployment shortly of a further 51 doctors and 15 nurse tutors.
- Of the 1,000 Malawian health professionals who had left the public sector, 700 were willing to return due to top-ups, more flexible deployment and further training.
- However, overseas migration of the most senior and experienced nurses continued in 2005.
In the past, donors have been unwilling to contribute to salaries and incentive packages for staff, due to concerns about donor dependency and project sustainability. However, this new approach has been successful in Malawi and has provided a number of lessons:
- After it was shown that insufficient human resources prevented the success of donor-funded projects, two donors agreed to a comprehensive, outcomes-based approach for Malawi that included tackling staffing. Other African countries could also benefit from this approach.
- The improvement of working conditions and management practices is as important as pay when it comes to improving staff morale and retention.
- It is important to combine both short-term and long-term measures to ensure commitment to the programme. Salary top-ups, for instance, had an immediate effect.
This case illustrates the importance of management of industrial relations.
Malawi, and other African countries, will need to produce an excess of nurses to account for the ongoing migration of nurses overseas, and to track these trends.
The achievement of the Millennium Development Goals (MDGs) by 2015 will only be possible if we can successfully strengthen the capacity of health systems in middle and low-income countries.
http://www.eldis.org/id21ext/Insightshealth12art6.html
How to get a copy
Download the Full text of Tackling the human resources crisis in Malawi’s public health system
Suggested Books
- Contemporary Issues in Human Resource Management: Gaining a Competitive Advantage (Oxford Southern Africa)
- Malawi, 4th: The Bradt Travel Guide
- Malawi in Pictures (Visual Geography. Second Series)
Major measles outbreak in Eastern & Southern Africa
Measles vaccination Africa
Measles vaccination Africa
[Photo credit: Julien Harneis under a Creative Commons license]
FUNDING GAP LEADS TO MAJOR MEASLES OUTBREAK IN EASTERN AND SOUTHERN AFRICA
New York, Jun 18 2010 Â 6:05PM, http://www.un.org/news
Gaps in the implementation of measles control strategies as a result of inadequate financial commitments from governments and partners have led to a dramatic increase in cases of measles in Eastern and Southern Africa. This shortage in donor support could reverse recent gains that had been made in reducing mortality from this highly contagious disease.
As of mid-June 2010, this latest resurgence has affected more than 47,907 children in 14 countries, resulting in 731 deaths. The most recent confirmed outbreaks are in Malawi, Mozambique and Zambia.
Measles, which is easily spread through coughing and sneezing, can cause severe complications, including pneumonia, diarrhoea, encephalitis and death. Yet a programme of supplemental immunization activities has been found to stem the deadly tide.
To ensure protection from measles outbreaks, at least 90 per cent of all children in each district and at national level need to be vaccinated through routine immunization. Two doses of the vaccine are recommended to ensure immunity, since about 15 per cent of children vaccinated at 9 months, fail to develop immunity from the first dose.
The African Region of the World Health Organization had attained 92 per cent reduction in measles mortality between 2000 and 2008 through the implementation of these strategies, with the support from the Measles Initiative. Founded in 2001, the Measles Initiative is led by the American Red Cross, the UN Foundation, the US Centres for Disease Control and Prevention, WHO, and the United Nations Children’s Fund.
“Measles are easily preventable”, said UNICEF Regional Director for Eastern and Southern Africa, Elhadj As Sy. “In order to sustain our efforts and successes in combating the disease, we urgently need to fill the funding gaps. Otherwise, we will again see more measles deaths in the near future.”
“To eliminate the risk of resurgence”, WHO Regional Director for Africa Dr Luis Gomes Sambo said, “countries must continue follow-up vaccination campaigns every two to four years until their health-care systems can routinely provide two doses of measles vaccination to all children and provide treatment for the disease.”
In the aftermath of that lost opportunity, affected countries are doing what they can – conducting proper outbreak investigations, providing appropriate case management, carrying out response vaccination campaigns to the degree possible, and working to strengthen routine immunization and disease surveillance.
These efforts, in the face of the crisis, are made possible with technical support from UNICEF, WHO and other partners, and generous financial assistance from the Central Emergency Response Fund, the UK Department for International Development, the European Union and other international and local partners.  But none of it replaces the value of prevention.
As of 15 June 2010, the toll taken by the current outbreak of measles in Eastern and Southern Africa is as follows:  Zimbabwe  (8,173 cases, 517 deaths), Zambia (817 cases, 33 deaths), Tanzania (20 cases, 1 death) , Swaziland ( 529 cases,  0 death), South Africa (15,520 cases, 18 deaths), Namibia (3,722 cases, 58 deaths), Mozambique (434 cases, 0 death), Malawi (11,461 cases, 68 deaths), Lesotho (2,406 cases, 28 deaths), Kenya (295 cases, 0 death) Ethiopia (2,108 cases, 8 deaths), Botswana (1,048 cases, 0
death).
________________
For more details go to UN News Centre at http://www.un.org/news
Africa Health : Community-Led Total Sanitation
UDD toilet South Africa
[Photo credit: Sustainable sanitation under a Creative Commons license]
There are several new publications by the Water Supply and Sanitation Collaborative Council (WSSCC) which look like they could be of interest to African NGOs.
Community-led Total Sanitation (CLTS) is a new approach to the problem of open defecation which blights many communities with limited sanitary facilities. It recognises that just providing toilets or encouraging individual household toilet construction is not enough. It focusses on behaviour change through community ownership and leadership. Although pioneered in Bangladesh the principles are very applicable to Africa too. It uses the participatory methods of intense community mobilisation to enable local people to analyse their own situation and use collective decision-making to bring about change.
Water Aid has produced an animation film which explains the 10 step process to Total Sanitation.
Facilitating `Hands On Training’ Workshops for Community-Led Total Sanitation: A Trainers’ Training Guide
Community-Led Total Sanitation (CLTS) is spreading fast in many countries in different regions, and there is growing demand for facilitators and trainers of facilitators. This guide, produced by WSSCC and the CLTS Foundation, and authored by the distinguished Kamal Kar, fulfills the need for a resource that will support the creation of a strong cadre of trainers for front-line CLTS work. 40 pages.Download a PDF of the publication Facilitating Hands on Training Workshops for Community-led Total Sanitation
Hygiene and Sanitation Software: An Overview of Approaches
Since the 1970s, sanitation and hygiene professionals have strived to find ways to engage target groups (individuals, households, communities, institutions or even organisations) in development programmes that facilitate sanitation and hygiene behaviour change, or create a demand for related services. These are `software’ methods or approaches, as opposed to `hardware’ such as toilets and pipes. This new resource presents in one place the latest thinking and most common software approaches for improving the political, legal, institutional, financial and economic, educational, technical and social conditions within which hygiene and sanitation programmes operate. 144 pages.Download a PDF of the publication Hygiene and Sanitation Software
WSSCC 2009 Annual Report
The annual report describes the many ways in which the members, coalitions and Geneva-based secretariat of WSSCC worked in 2009 in pursuit of sanitation, hygiene and water supply for all people around the world. 32 Pages.Download a PDF of the WSSCC 2009 Annual Report in English, French or Spanish
Suggested Books (US)
- Water and Sanitation Africa
(Bi-Monthly Magazine)
- The Governance of Water and Sanitation in Africa: Achieving Sustainable Development through Partnerships (International Library of African Studies)
- Hygiene Behaviour Change through the Community Health Club Approach: A cost-effective strategy to achieve the Millennium Development Goals for improved sanitation in Africa
