Journalism from the heart of crises

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  • West African livelihoods weakened by graft

    Poor public services in many West African countries, with already dire human development indicators, are under constant pressure from pervasive corruption. Observers say graft is corroding proper governance and causing growing numbers of people to sink into poverty.

    “If you want to put a human face to corruption… then see how we have kids who walk miles to school because there are no public transport systems,” said Harold Aidoo, the executive director of the Institute for Research and Democratic Development in Monrovia, the Liberian capital.

    “You see women and mothers who give birth and die because there are no basic drugs or equipment at the hospitals, and no qualified or trained health professionals. You realize that many of our impoverished populations do not have access to clean drinking water,” he said.

    More West African countries were perceived to be highly corrupt in 2013 than the previous year due to the effects of political instability in countries such as Mali, Guinea and Guinea-Bissau, according to the corruption index compiled by the global watchdog, Transparency International

    Bribery, rigged elections, shady contract deals with multinational businesses operating in the natural resources sector, and illicit cash transfers out of countries are some of the more common forms of graft. In sub-Saharan Africa, 90 percent of countries are seen to be corrupt, the watchdog said.

    "There is no doubt that corruption affects pure and sustainable development in West Africa, and there is no doubt that it most often affects the poorest and weakest portions of society"

    The region accounts for 11 percent of the world’s population, but carries 24 percent of the global disease burden. It also bears a heavy burden of HIV/AIDS, tuberculosis and malaria but lacks the resources to provide even basic health services, according to the International Finance Corporation.

    Almost half of the world’s deaths of children under five years old occur in Africa, which also has the highest maternal mortality rate, the organization says.
    Parents sometimes have to pay bribes to get their children admitted to good schools, said Pierre Lapaque, the UN Office on Drug and Crime (UNODC) representative for West and Central Africa.

     “There is no doubt that corruption affects pure and sustainable development in West Africa, and there is no doubt that it most often affects the poorest and weakest portions of society.”

    Illicit cash flight

    As much as US$1.3 trillion has been illegally transferred out of Africa in the past three decades, said a report by Global Financial Integrity (GFI), a Washington-based advocacy group monitoring illicit financial flows.

    Nigeria’s oil industry has been plagued by graft allegations that gave rise to complaints of neglect and a rebellion by people in the oil-producing southern regions. A draft report released in May 2013 by Liberia’s Extractive Industries Transparency Initiative noted that nearly all resource contracts signed since 2009 had violated regulations.

    “Economically speaking, when millions of dollars are filtered out every year by corruption, this is very corrosive in terms of its impact on society,” Aidoo said. “It is very corrosive in how it undermines growth and development and the well-being of our population.”

    Corrupt politics

    Many political campaigns in Africa are fraught with allegations of irregularities and malpractice. “Not only are elections prone to corruption in the form of vote-rigging and fraud-monitoring, but by the way in which our political elites become entrenched in power,” said Tendai Murisa, director of TrustAfrica’s Agriculture Advocacy and Financial Flows programme.

    “Corruption creates a way to perpetuate the regime, and one of the ways they perpetuate the regime is to buy votes, so that really affects the quality of democracy,” said Murisa, noting that a government deemed corrupt inspires little trust in the people, whose voices are often silenced or ignored when they speak out against graft.

    Because the poor rely more on public services, they spend the largest percentage of their income on bribes to officials and even school administrators, so corruption pushes the most vulnerable further into poverty. In Sierra Leone, 69 percent of people think the police are corrupt, and in Nigeria the figure rises to 78 percent, said UNODC’s Lapaque.

    Floundering anti-graft war

    Despite efforts to increase transparency and accountability throughout the continent, the war against graft in sub-Saharan Africa has been on the decline over the last decade, according to the World Bank's 2013 World Governance Indicators. With the exception of South Africa and Botswana, sub-Saharan Africa scored in the lowest percentile for the control of corruption worldwide.

    “If a country’s [public] service is staffed by civil servants based in nepotism or bribery, rather than merit and competence, it creates significant problems,” Lapaque said. “Not only are fewer job opportunities made available to those who deserve them, but the rule of law is undermined and economic growth is stifled.”

    Weak governance often undermines security services, which can lead to an increase in local and transnational organized crime, including arms and drug trafficking. It can also undermine human rights. “It’s really very often a failure of our government to be efficient gatekeepers of our resources, and of them allowing leakages within and out of our economies,” Murisa said.


    To fight corruption, governments first need to recognize that it is a real problem. “They need to ensure that national structures in charge of fighting corruption are well resourced, and staff have the capacity to do their work in an independent way, without political interference,” said Marie-Ange Kalenga, Transparency International’s West Africa regional coordinator.

    “They also need to ensure there is an appropriate legal framework, in line with the regional and the international instruments on anti-corruption, and to educate ordinary citizens and promote integrity at the individual level,” she said.

    Lapaque said this could mean creating an independent anti-corruption entity, or giving political independence to judges and prosecutors. Civil society groups and NGOs can help in developing codes of conduct, promoting integrity, and advocating the adoption of appropriate legislation, as well as the training of anti-corruption agencies, added Kalenga.

    Empowering citizens to denounce corruption and to seek redress if they are victims of corruption could also help, as could making budgets more transparent and including people in the participation of public spending, Lapaque suggested.

    “Transparency is an important factor in building democratic governments that are accountable to their people,” said Tom Cardamone, GFI’s managing director. “I think that’s what we need to do to stem the flow of illicit money and stop this corruption.”

    Murisa said, “If we just got back 50 percent of what we are currently losing to corruption, it could mean things like advancements in education or better road systems. We could make sure our children are back at school, we could make sure we are maintaining social welfare systems, and we could make sure our healthcare delivery systems are working properly.”


    Graft worsens West African livelihoods
  • Life-saving hepatitis C drug approved, but cost is high

    Following approvals in the US and Europe this month of a new drug to treat hepatitis C, activists are pushing for the medication to be made available in poor countries, a development reminiscent of the activism that forced down HIV/AIDS drug prices a decade ago in Brazil, South Africa and Thailand.

    The World Health Organization (WHO) estimates that as many as 185 million people are infected with hepatitis C, which is often called a “viral time bomb” because it can exist, undiagnosed, in a person’s body for many years without causing symptoms. 

    According to the Open Society Foundations (OSF), more than 350,000 people die every year from liver disease related to the virus, and every year an estimated three to four million more people are infected.

    Many of these people are co-infected with HIV; the illnesses are both blood-borne and have shared routes of transmission, particularly injecting drug use.

    Unlike HIV, hepatitis C can be cured. But current treatment options have serious side effects, do not always work and are unaffordable for most people. The existing treatment, pegylated interferon, which is manufactured by Roche and Merck, can cost as much as US$18,000 for a 48-week course.

    Interferon, which must be injected, can, in combination with the drug ribavirin, cure 40-70 percent of patients who use it. But its high cost has kept it out of reach for most patients, except in Egypt and Thailand, where the governments were able to negotiate significant price reductions with drug manufacturers.

    “How have we got to a global system where new drugs being developed are out of reach of most of the population?”

    The new drug, sofosbuvir, released by pharmaceutical giant Gilead, promises a leap forward in the hepatitis C treatment. It is orally administered, reduces treatment time to 12 weeks, has fewer side effects, and, if used in combination with other drugs, can achieve a 90 percent cure rate. The hitch? The price tag.

    In the US, which has some of the highest drug prices in the world, Gilead is expected to charge $80,000 for one course of treatment - more than four times the cost of interferon. While the cost of the drug is likely to be lower elsewhere, healthcare advocates fear the price will remain beyond the reach of poor people.


    Médicins Sans Frontières’ director of policy and analysis, Rohit Malpani, says the drug has been priced so high because it cost the company $11 billion to acquire Pharmasset, the original maker of the drug.

    According to one analyst, Gilead has to make $4 billion on the drug annually, to justify the high cost of the buyout. 

    This is not a reflection of the research and development costs; it is an assessment of how much the company can get for it, Malpani adds. “Companies will engage in extensive studies to determine what the market will bear, but that is not the way that life-saving commodities should be priced.”

    Access strategy

    MSF’s Access Campaign, which lobbies for affordable medicines for resource-strapped communities, is waiting for Gilead to finalize its “access strategy” for poor countries after having received input from a range of organizations.

    A Gilead spokesperson told IRIN that it would announce the details of its access programme early next year. The company says it is “committed to making its medicines available to patients, regardless of where they live or their ability to pay”, and that it is “working very closely with advocates in communities that are affected by hepatitis C to develop an appropriate access and pricing strategy”.

    The spokesperson said Gilead wanted to “help ensure access to Sovaldi [the brand name for sofosbuvir] in resource-limited countries, especially countries that have a high hepatitis C burden”.

    However, Malpani is not optimistic that the reduced price will be low enough to make the drug widely accessible. Furthermore, MSF believes Gilead is likely to offer “middle-income” countries - like China, Iran and Ukraine - a higher pricing strategy than that given to poor countries.

    Ironically, 75 percent of the world’s poor reside in middle-income countries, Malpani said. “Our concern with Gilead’s access strategy is that it is likely to be unaffordable and punitive to the countries in that category,” he said.

    MSF would like to set a target price for the drug of less than $500. However, according to an OSF report, "Unfortunately, past experience with HIV suggests that drug companies are unlikely to voluntarily extend significant discounts to middle-income countries, even if they may be open to reducing the price for the world's poorest."

    According to one study, a 12-week course of sofosbovir could cost as little as $62-$134 to produce.

    Asked why the drug was so expensive in the US, the Gilead spokesperson said: “We believe that the price of Sovaldi in the United States is fair, based on the value it represents to a larger number of patients.” A special programme for those unable to afford it would be available, he added.

    “But the starting point is so outrageous, not even halving it would make it accessible,” says Els Torreele, director of OSF’s Access to Essential Medicines Initiative.

    “How have we got to a global system where new drugs being developed are out of reach of most of the population? It’s totally normal today to price drugs at $100,000. Something is wrong with a system where drugs that so many people need are costing so much. This is not sustainable for anyone,” she said.

    Daniel Wolfe, director of the International Harm Reduction Development Program at OSF, said that because of its association with HIV and drug use, hepatitis C is still highly stigmatized. “The experience of HIV has shown us that the combination of expensive medication and social stigma is deadly,” he said.

    He added that companies are pricing their drugs for profit rather than public health concerns. “When governments are confronted by high prices for a stigmatized population affected, they tend to look the other way,” Wolfe said.

    Patent worries

    In India a “patent opposition” has been filed by the Initiative for Medicines Access and Knowledge (I-MAK) to stop Gilead from obtaining a patent on the drug there, which would clear the way for low-cost generics to be manufactured.

    India has long been at the forefront of manufacturing generic life-saving drugs. Under its Patent Act, medications that are not new do not qualify for patent protection; I-Mak argues that sofosbuvir is “old science” stemming from a long line of antiretroviral drugs.

    The World Trade Organization’s 1995 Trade-related Aspects of Intellectual Property Rights (TRIPS) agreement laid down minimum standards for patent laws. There is, however, “some flexibility for countries to determine what is meant under the criteria of patentability”, says Torreele, citing I-MAK’s case against Gilead’s sofosbuvir patent.

    Since social activism helped force down the cost of AIDS drugs with generic alternatives over a decade ago, “the world has changed,” says Torreele. “The solutions to making HIV drugs affordable are not there anymore.”

    While TRIPS makes allowances for governments to override patent laws to protect public health, “there is lots of pressure by the pharmaceutical industry on them to avoid these measures”.

    And negotiations, spearheaded by the US, are currently taking place with 11 other countries to finalize the Transpacific Partnership Agreement, a trade deal that some worry could undermine the flexibility allowed by TRIPS.


    Cost fears over new hepatitis drug
  • Is Africa ready for GM?

    Even as food insecurity continues to afflict impoverished and disaster-affected populations around the continent, African policymakers and consumers remain deeply divided over the potential harms and benefits of genetically modified (GM) foods, which advocates say could greatly improve yields and nutrition.

    A recent study published in the journal Food Policy, titled Status of development, regulation and adoption of GM agriculture in Africa, shows that heated debates over safety concerns continue to plague efforts to use GM crop technology to tackle food security problems and poverty.

    Yet results from the four African countries that have implemented commercial GM agriculture - Burkina Faso, Egypt, South Africa and Sudan - suggest an improvement in productivity. In South Africa, a 2008 study showed an 11 percent grain yield advantage when using GM maize, and in Burkina Faso, the technology has led to a 15 percent increase in cotton.

    “Compared to conventional plant breeding methods, GM technology is less time-consuming and more accurate in acquiring the desired objectives,” said Carl M.F. Mbofung, a professor at the University of Ngaoundere, Cameroon, said at a 2010 conference on agriculture in Africa.

    A 2011 report by the Melinda and Bill Gates Foundation, which strongly supports the use of GM technologies, noted that the average yield of cereal per acre was seven times greater in the US, where GM crops are widely used, than it was in sub-Saharan Africa. While better infrastructure can account for some of this difference, the report argues that a failure to invest in GM crops is partly responsible.

    Still, there remain significant challenges across the continent regarding the need to build robust regulatory frameworks and to bridge the knowledge gap between scientists, policymakers and the public to allow for informed decisions.

    Regulating GM

    The Food Policy report suggests that when effective biosafety regulatory frameworks are in place, GM is more likely to be widely adopted and accepted.

    The authors interviewed 305 respondents from Egypt, Ghana, Kenya, Nigeria, South Africa and Tunisia - countries that are already cultivating GM crops or have large research and development programs devoted to it.

    Only South Africa had European-style risk assessment frameworks, according to the report, and of the six countries, stakeholders there expressed the most support for GM technologies and said that GM crops had a high level of adoption.

    By contrast, a US Department of Agriculture 2012 Agricultural Biotechnology report noted that, “Tunisia still has no legal framework dealing with the introduction, use and marketing of agricultural biotechnology.”

    “In view of the challenges identified in developing and regulating GMOs [genetically modified organisms] in Africa, there is an urgent need for all countries to establish a regulatory framework that will lead to a comprehensive and balanced evaluation of GM products,” said the Food Policy report.

    The Food Policy also study suggested that following the European Union’s (EU) European Food Safety Authority (EFSA) risk assessment model is one possible way to reduce the perceived risks associated with GM crop cultivation. Having a centralized continent-wide agency would reduce the individual cost of each country creating a separate regulatory risk assessment board.

    “Aside from this, I do not see the advantage of copying or adopting the EU model of the EFSA as it has not enhanced the adoption of the GE [genetically engineered] crops in the EU. We are more concerned [with] meeting our food and nutrition insecurity needs in Africa, which are non-issue[s] with the Europeans,” Diran Makinde, director of the African Biosafety Network of Expertise, part of the New Partnership for Africa's Development (NEPAD), told IRIN.

    Issues of political will could also threaten to undermine a continent-wide regulatory project, according to the report.

    Bridging the knowledge gap

    In recent months Kenya has stepped up campaigns on biotechnology education and awareness.

    At a seminar organized by the Open Forum on Agricultural Biotechnology in Africa, Governor Benjamin Cheboi of Kenya’s Baringo County released a statement saying the technology holds great promise for the holistic economic development of a nation.

    “It has become crucial for sustainable development in every biological sector including agriculture, forestry, medicine and environment, yet lack of information undermines its adoption in the country,” his remarks stated.

    Makinde agreed that there are not enough avenues for farmers to get information about GM crops and biotechnology. “Africa needs to put regulations on information resources, training and education that will involve short- and long-term trainings in biosafety, tailor-made workshops, internships and study tours - as seeing is believing - linkages and networking,” he said.

    Gradual adoption

    The Food Policy report notes that some countries, such as Ghana and Kenya, are likely to use a three-step approach - known as Fiber-Feed-Food, or F3 - to adopt GM crops.

    Through this method, Bt cotton will be adopted first, followed by livestock feed, before producing GM foods for human consumption. This allows time for the necessary risk assessments to be carried out.

    “Farmers and consumers need to experience the benefits of the technology in terms of the economic benefits to farmers, and quality of food for human/animals, and environmental benefits with the decrease use of pesticides,” said Makinde.

    He added that so far benefits have been realized from insect-resistant cotton, insect-resistant and herbicide-tolerant maize/soybean for livestock, insect-resistant maize, and nutrient-enriched food commodities like cassava, cowpea, banana, rice and sweet potato for humans.

    “The approach is essentially designed to familiarize farmers and [the] public with the new technology and to allay concerns about potential risks of GMOs,” said the report.

    U-turns on policy

    But it is clear that the adoption of GM crops is still highly contentious. Kenya, under former president Mwai Kibaki, in November 2012, ordered a ban on GM food until the government is able to certify that there have been no negative health effects.

    “The ban will remain in effect until there is sufficient information, data and knowledge demonstrating that GMO foods are not a danger to public health,” said a statement by Kibaki’s cabinet.

    “ In view of the challenges identified in developing and
    regulating GMOs [genetically modified organisms] in Africa, there is an urgent
    need for all countries to establish a regulatory framework that will lead to a
    comprehensive and balanced evaluation of GM products ”

    The ban followed a controversial study linking cancer in rats to GM food consumption; the study’s methodology was criticized as flawed by independent scientists.

    According to the lead agency dealing with the regulation of GMOs in Kenya, the National Biosafety Authority, the ban is only for food and does not include experiments within laboratories or in confined field trials.

    The ban carries fines of up to 20 million Kenya shillings (about US$230,000) and a 10-year jail term for traders failing to comply, and also requires that all GM-derived products be labelled from production to marketing.

    The African Biotechnology Stakeholders Forum (ABSF) maintains that the Kenyan government has put in place structures to ensure GMOs are used safely.

    “The Kenyan government has taken a forward-looking stance in providing an enabling environment for the safe and responsible application of modern biotechnology,” the ABSF report said.

    Mixed perceptions

    In Uganda, too, legislators have been hesitant to pass laws supporting the development of GM technologies. The 2012 National Biotechnology and Biosafety bill, which aims to provide a regulatory framework for the safe development, research and general release of GMOs, was deferred by legislators in February 2013.

    “The whole concept of GMOs has been riddled with fears and misconceptions,” Michael Lulume Bayigga, Uganda’s shadow health minister, told IRIN. “The owners of these GMOs are whites in the US, Europe and China who are looking for market[s] in Africa. They are creating markets and empowering themselves. These GMOs are tools of imperialism.”

    He added: “I will cautiously support GMOs as long as they have been developed, modified and tested by our own [African] scientists. But this engineering is worrisome.”

    “We are going to look at their concerns and have further discussions on it so that [the] bill is re-tabled for debate,” Connie Acayo, the public relations officer at the Ministry of Agriculture, Animal Industry and Fisheries, told IRIN. “We want the bill in order to enable us to regulate the development and application of GMOs. At the moment, we don’t have control over GMOs that enter into the country.”

    The bill, which would set the legal stage for farmers to buy GM seeds and plants and to export GM produce, has been in approval limbo since 2003.

    Uganda is currently carrying out a series of GMO trials at the country’s National Agricultural Research Organization (NARO) centers. These plants are engineered to be resistant to wilt disease, cassava brown streak virus disease and other common bugs.

    Ongoing trials include a vitamin A-enriched banana, disease-resistant cotton, GM cassava plants and drought-resistant maize meant for semi-arid northeastern Uganda, commonly known as Karamoja. These crops take into consideration increasing climate change and global warming.

    “GMOs are not contradictory to food safety. All the commodities being worked on by NARO go through all tests for stability, cost effectiveness and safety,” Emily K. Twinamasiko, director general of NARO, told IRIN. “No doubt people naturally worry about the new and the unknown, but the regulatory framework provided for in the [Biotechnology and Biosafety] bill will take care of all this.”

    Sustainable development

    But the Food Policy report also noted that in South Africa, GM crops had not benefited subsistence farmers, who were not using them because of the cost of the seeds and because of delays in obtaining regulatory approval. “This constraint still represents a significant challenge in developing local GM traits for subsistence farmers,” the report said.

    Some NGOs argue that there are methods to improve agricultural outputs without relying on GM technology.

    The Food Policy report’s authors spoke to a Greenpeace campaign director in Africa, who said the risks of GM were too high for uneducated farmers, and that “ecological farming and traditional knowledge methods should form the basis of promoting sustainable development.”

    She said improving infrastructure and increasing access to regional markets will likely result in greatly increased productivity and enhanced food security on the continent. She further said that empowering women with more efficient methods of farming - provided it is done in a targeted way that accounts for socio-economic context - can also be transformative.


    Is Africa ready for GM?
  • Senegal on the frontline of the battle with Big Tobacco

    Djité Sekou, 32, smokes as he passes his nights guarding one of the many high-rise apartment buildings in Dakar, Senegal. It has been eight years since his first cigarette - a Monte Carlo from Morocco - and when money is available he goes through 20 to 30 per day. It is an addiction that can cost him up to a quarter of his monthly income.

    Like most smokers in Senegal, he rarely buys a full packet, preferring to purchase cigarettes individually - a sales strategy tobacco companies employ to ensure that even those with limited means are able to afford their daily nicotine.

    “If my pocket is heavy, I buy the full packet,” explained Sekou. “If my pocket is empty, I buy four Excellence [cigarettes] at 100 [CFA] francs [US$0.20].”

    Sekou is one of a growing number of smokers across Africa. While reliable, up-to-date figures are unavailable, the 2007 Global Youth Tobacco Survey estimated that up to 20 percent of Senegalese boys and 10 percent of girls aged 13 to 15 used tobacco products - a number believed to be much higher today.

    Oumar Ndao, Senegal’s focal point for tobacco control at the Ministry of Health, says, “This is due to extremely weak legislation that, apart from prohibiting television advertising, demands no restrictions.”

    Tih Ntiabang, Africa coordinator of the civil society Framework Convention Alliance, based in Yaounde, Cameroon, says advertising focuses “on two groups of people - the youth and women. For the youth, they portray smoking as cool. For women, if you smoke you are emancipated.”

    In Senegal, there are almost no restrictions on smoking in public places, and warning labels on packets are small.

    The exception is the holy city of Touba, where smoking has been banned for religious reasons since 1980 (15 years before the US State of California enacted its ban on smoking in enclosed workplaces).

    Yet with Senegal’s parliament due to vote on new anti-smoking legislation, the rest of the country may soon follow suit.

    If passed, the law would ban all tobacco advertising, restrict smoking in public places, and demand health warnings that cover 30 percent of all cigarette packaging.

    Ndao believes that, even if the law could be strengthened further, this would be a “major step forward” and “endow Senegal with one of the strongest [such] laws in the region.”

    Weak tobacco control continent-wide

    With the largest proportion of young non-smokers and the weakest tobacco controls of any other continent, according to the World Health Organization (WHO), Africa is a lucrative market for cigarette marketers.

    Just five African countries have comprehensively banned smoking in public places, according to WHO, while nine - Chad, Eritrea, Ghana, Guinea, Kenya, Madagascar, Mauritius, Niger and Togo - ban all tobacco advertising. Only four African countries - Madagascar, Mauritius, Niger and the Seychelles - meet WHO recommendations for health warnings on packaging.

    “In a number of places, there is no legislation at all,” said Ntiabang. “What is really driving this is the tobacco industry strategy to recruit new smokers.”

    Yet even where laws do exist, enforcement is a major problem. Senegal’s Ministry of Health has banned smoking in all health centres, but according to the government’s own report to WHO, this has had “no practical impact in reality.”

    WHO estimates that, globally, tobacco kills six million people per year, a figure that, without action, could rise to eight million by 2030, with 80 percent of deaths occurring in low- and middle-income countries.

    Taking on the tobacco industry

    Many health advocates believe the tide is turning, however, with Kenya, Mauritius, Seychelles and South Africa all having introduced tighter tobacco control laws in recent years. Ntiabang believes these are symptoms of “a changing trend” - but one under threat by the tobacco industry.

    The 2013 WHO global report on tobacco use accuses the industry of trying to influence public health policy, exaggerating its economic importance, manipulating public opinion, fabricating support from “front groups”, undermining proven science and intimidating governments with litigation.

    “Tobacco industry interference is the number one problem we have in Africa, especially in countries that are in the process of elaborating legislation,” Ntiabang adds. “The tobacco industry interferes in every single stage of this process.”

    A WHO official IRIN interviewed agreed: “Every single country in Africa where there is proposed legislation, you find them there.”

    According to Article 5.3 of the WHO’s Framework Convention on Tobacco Control, tobacco companies are not supposed to be involved in shaping health policy. But the official said many countries have been swayed by “information given by the industry claiming that they are critical to the economy, and yet the reality is they are just profiteers and are not contributing that much to the economy.”

    Senegal has been no exception, says Ndao: “The industry managed to infiltrate the process with strong lobbying of decision-makers.”

    In Senegal, industry officials lobbied to soften the total ban on advertising to allow communications at the point of sale, but the government has not ceded. They also pressed to ensure health warnings need not be in picture form, said Ndao, which has been more successful. But the [Senegalese] authorities are trying to resist industry pressure and are “aligned strongly with the WHO Convention” he told IRIN.

    A spokesperson for Philip Morris, which controls over 40 percent of the tobacco market in Senegal and owns a cigarette factory in Dakar, confirmed that the company has “proactively and transparently” been communicating its opinions to government, “like any other industry”.

    "The [tobacco] industry is losing major markets in Europe and North America, and is seeking refuge in Africa"

    While the company “welcomes the proposal for the implementation of a tobacco-control law in Senegal”, it continues to seek amendments to “a few elements” including “the lack of a transition period, the ban on trade incentives for wholesalers and retailers, and the total ban on advertising.”

    To Ndao, the incentive is clear: “The industry is losing major markets in Europe and North America, and is seeking refuge in Africa, which explains their strong presence in Senegal.”

    Health impact

    Ahmadou Dem, surgical oncologist at Joliot Curie Cancer Institute at the Dantec hospital in Dakar, is already seeing the consequences of smoking. He has noted an increase in cancers of the lung, larynx, pharynx, bladder and pancreas.

    If nothing is done, the future could be more worrying still, he said. “It will be a catastrophe for our country’s health and economy, because our human and financial resources are limited and cancer care is costly.”

    Dem adds that while facilities to treat cancer do exist - offering surgery, radiation therapy and chemo therapy - they remain “largely inaccessible for the majority of patients, who are poor”.

    Any efforts to reduce smoking rates in Senegal must include an “ongoing anti-smoking campaign at schools, in businesses, and in the media,” he told IRIN.

    Weakening the law

    Ndao recognizes that, despite the huge public health improvements the law will bring, there is a lot more work to do.

    Unless amended by members of the National Assembly, smoking areas will still be permitted in restaurants, bars and hotels, and pictures warnings - considered essential in a country where half of the adult population is illiterate - will be voluntary. Ndao believes parliamentarians will strengthen these areas of the law before it passes.

    And the law will not undertake what is commonly regarded as the most effective way of reducing smoking - raising the price of cigarettes. Such a measure has to be dealt with separately through the tax system.

    At just $0.80 a packet for an economy brand, and $1.20 for a premium brand, cigarette prices in Senegal are almost 10 times cheaper than in the UK and among the cheapest in the world.

    Senegal has chosen not to follow the Economic Community Of West African States guidelines allowing countries to tax cigarettes up to 150 percent, instead abiding by the West Africa Economic and Monetary Union rules limiting taxes to just 45 percent.

    According to WHO, a 10 percent price increase for tobacco products reduces consumption by 8 percent in low- and middle-income countries.

    Two years ago, Phillip Morris created a national scandal in Senegal by reducing the price of its Marlboros by one-third. Black market cigarettes from neighbouring countries such as Gambia and Guinea-Bissau also push prices down.

    Sekou believes that both a stronger law and higher taxes are “necessary,” especially for smokers like himself. “Senegal has the right to do it. Everyone wants to quit. The more they smoke, the less they eat,” he said.

    “For me, someone who struggles to get 1,000 CFA [$2.00] per day, if the price went up - and my wife is next to me, my son is next to me - I wouldn’t do it,” he continued. “Even today paying $1.20 [for a packet] is a problem.

    “As of today, I have decided to quit. I got myself into it, and I’ll get myself out of it too.”


    Senegal takes on Big Tobacco
  • Behind China’s aid structure

    China’s role as an aid donor has been met with wariness, both from aid experts and recipients. Confusion over the nature of China’s aid arises because the country uses multiple ministries and agencies to give money, has different strategic priorities than traditional Western donors, and does not release detailed reports about how much aid it provides.

    "China has at least nine kinds of aid," Deborah Bräutigam, a leading scholar on Chinese aid to Africa and a professor at the Johns Hopkins School of Advanced International Studies, notes in her book, The Dragon’s Gift. "Medical teams, training and scholarships, humanitarian aid, youth volunteers, debt relief, budget support, turn-key or ‘complete plant’ projects [infrastructure, factories], aid-in-kind and technical assistance."

    Most of these aid forms have existed since China became an international donor. The country gives money through three mechanisms: interest-free loans; grants; and preferential interest loans or tied loans, according to Xue Lei, a research fellow of Shanghai's Institutes for International Studies. "Most of the foreign aid is provided in the form of project aid," he told IRIN.

    This is a key difference between the way China provides aid and way that the US, UK or other Western powers approach assistance. While the US Agency for International Development (USAID) and the UK’s Department for International Development (DFID) provide large amounts of funding to support government budgets in areas such as education, China prefers to instead to work on a single project, such as building a school, or provide scholarships to students to study in China.

    "Both are very attractive, but there's no doubt that China's is much more... visible than putting money into the budget," Kenneth King, professor emeritus at the University of Edinburgh told IRIN.

    Lessons from China’s development

    There are also changes in the way China looks at the links between aid, development and business.

    "In many contemporary accounts of Western aid and capacity-building in Africa, there would not be a close connection between aid and trade," King writes in his book. China by contrast, sees a very important link between private business and aid. Indeed, this is a core element of China's official view to development.

    "China's job, our responsibility, is to try and help Africa compete with us," said Ambassador Zhong Jianhua, China's special representative on African affairs, in an interview with the African Research Institute, published in August.

    This may be a reflection of the fact that China has been a recipient nation of aid. "Influenced mainly by their own experience of development and by the requests of recipient countries, the Chinese aid and economic cooperation programmes emphasized infrastructure, production and university scholarships at a time when traditional donors downplayed these," wrote Bräutigam.

    "China feels that infrastructure is essential to development. There is a huge call for that, and the West hasn't responded. These same companies that are building roads in Africa, they've also built roads in China," said Ward Warmerdam, a researcher at the International Institute of Social Studies in The Hague and an economic researcher at the think tank Profundo. "Gradually, Africa is becoming a much more stable continent. A lot of the Western donors don’t really understand that."

    Agency overlap

    There are three main organs controlling Chinese aid: the Ministry of Commerce, the Ministry of Foreign Affairs and China's Eximbank. The State Council - China's cabinet - has oversight, and approves the annual budget, grants and aid projects over a certain amount, as well as aid to politically sensitive countries. The Ministry of Finance is also responsible for giving aid to multilateral organizations, such as UN agencies.

    The Ministry of Commerce (MOFCOM) is the principal institution for Chinese aid, and houses the Department of Aid. It is in charge of distributing all zero-interest loans and grants. The Ministry of Foreign Affairs coordinates with MOFCOM to decide aid allocations, and is the on-the-ground diplomatic point of contact for Chinese firms and interests in Africa. But the relationship between the two ministries is often tense, and, as experts have argued, conflicting interests between the multiple agencies sometimes hurts Chinese aid policy.

    In addition, over 23 other government ministries and commissions play some role in providing foreign aid. For example, the Ministry of Education has been responsible for scholarships provided to African students to study in China, and the Ministry of Health runs and funds overseas medical programmes.

    “I do think that in the medium term they will likely set up a separate agency,” Bräutigam told IRIN. “There has been a lot of discussion about this in China.”


    Behind China’s aid structure
  • Untangling China's aid to Africa

    This year, the two most powerful men on the globe, presidents Barack Obama and Xi Jinping, both embarked on Africa tours, pledging to increase aid and investment and work with the continent to improve development.

    While this was Barack Obama's first extended tour of Africa since taking office (he made a one-day stop in 2009 in Ghana), Chinese leaders have been visiting the continent regularly for decades, quietly working on joint development, trade, foreign direct investment and assistance projects.

    "China is the largest developing country in the world, and Africa is the continent with the largest number of developing countries," Jiang Zemin, then-president of China, said in his opening remarks at the first Forum on China-Africa Cooperation (FOCAC) in 2000.

    Since 2000, China has ramped up its aid to Africa, leading to significant interest in and speculation over its motives for doing so. With each FOCAC meeting, China has doubled its pledge to Africa, promising US$5 billion in 2006, $10 billion in 2009 and, at the 2012 summit, $20 billion.

    A long history of aid

    As Chinese officials are at pains to point out, China has a long history on the continent. Its first major project was the 1,860km Tazara rail line. The five-year scheme, completed in 1975, linked landlocked Zambia to the Tanzanian port of Dar es Salaam, ending Lusaka’s dependence on minority-ruled Rhodesia and South Africa.

    "China historically had a robust ideological engagement with Africa, reflecting the revolutionary spirit of its foreign policy under Mao, but it didn't have any substantial economic interests in the continent," Daniel Large, professor at the Budapest-based Central European University (CEU) and a leading expert on China-Sudan relations, told IRIN.

    What is different today is that it now has economic interests, in addition to being an aid donor.

    Experts say China's role in Africa is often misunderstood.

    "Given some of the more inflated claims about the impact of China in Africa, often contained within arguments about a 'new scramble' or 'new imperialism', there is a marked gap between the perceptions and exaggerated projections of an inexorable Chinese rise in Africa and knowledge of how this is actually playing out," wrote Large.

    Some of the confusion, especially relating to aid, may be because China does not release many statistics about how much aid it gives and has a number of agencies responsible for distributing foreign aid to Africa. The structure of China's economy - where many private firms are fully or partly state-owned - and China's approach to assistance also blur the line between investment and aid.

    So how much aid is there?

    Quantifying the China-Africa relationship is a difficult undertaking because China does not break down its statistics or release detailed reports about how much assistance it gives to Africa, and it has a different definition from the Organization for Economic Cooperation and Development (OECD) of what exactly is meant by "aid". For example, China includes military aid in its definition, while the OECD does not, but China does not consider scholarships to students from developing countries as foreign aid when calculating statistics.

    As a result, estimates by experts on just how much China gives to Africa differ widely, ranging from $580 million to $18 billion a year.

    The Chinese government argues that it does not have the capability to make the data available.

    "There is an assumption in some of the Western media - and to a lesser extent the African media - that the Chinese government has lots of data that it refuses to make public. It is important to ask the question - how accurate is the data we have?" said Ambassador Zhong Jianhua, China's special representative on African affairs, in an interview with the African Research Institute, published in August. "The government's statistical capacity is that of a developing country."

    In 2011, the government did, however, publish a white paper that broke down the data by region: 45.7 percent of aid went to Africa in 2009, and between 1950 and 2009 it spent slightly over $41 billion.

    In 2012 and 2013, China AidData, in partnership with the Centre for Global Development, came up with a database to measure how much aid was being dispersed, using media-based sources. It classified Chinese-funded development projects into "official finance", which includes projects in four categories: those similar to Official Development Assistance (ODA), those similar to Other Official Finance (OOF) - both of which OECD indexes use - Official Investment (made up of foreign direct investment and joint ventures), and Military Aid without Development Intent.

    Their database includes 1,673 non-investment projects to 50 recipient countries from 2000-2011, which they classified as ODA- or OOF-like. Over the course of these 11 years, they found these projects totalled $75.4 billion.

    "Chinese development finance was dispersed really widely," Austin Strange, research associate at AidData, told IRIN. "The only outliers are countries that diplomatically recognize Taiwan."

    “In terms of the number of projects, sectors like education and healthcare were at the top of the list," he added. Infrastructure, transport and energy were also areas where China had a very large presence.

    While most academics believe that transparency on Chinese aid is improving, it still falls far short of the OECD, which releases detailed reports.

    "There's still some secrecy in the official statistics," said Xue Lei, a research fellow of Shanghai's Institutes for International Studies, noting that transparency and reform is something being discussed by academics domestically, too. "Maybe we need one structure, and more transparency on the statistical side. I think in the next few years China will release the actual number."

    Those favouring reform point to the need to set up a single agency with responsibility for aid programmes. For inspiration, many look to China's Asian neighbours, arguing that taking a model from Japan, South Korea or India could be successful.

    Non-interference - really?

    As China gets more involved in Africa, non-conditional aid is becoming a hugely important form of soft power for the country. But many are unsure whether China will be able to maintain its principle of non-interference in another state’s affairs should it need to protect its citizens in volatile areas on the continent; it is estimated that there are between 500,000 and 800,000 Chinese migrants residing on the continent.

    Xue believes that the principle of non-interference will not change, and that China's approach will be a long-term, stability-through-development approach. "We want to try to stabilize the fragile states, to maybe prevent the crisis or conflict from happening," he said, while acknowledging that this would not always be possible.

    "This whole mantra of non-interference and mutual cooperation is not unique to China. It is part of a broader south-south cooperation agenda and rhetoric," said Warderdam. Reconciling this in crisis situations, he believes, will be very difficult.

    Underpinning much of the criticism of China's role in Africa is the claim that they are only interested in extractive industries and are plundering the continent's vast resources. They've attracted prominent critics, notably Nigerian Central Bank Governor Lamido Sanusi and South African President Jacob Zuma.

    "Africa is now willingly opening itself up to a new form of imperialism," Sanusi wrote. "China is no longer a fellow under-developed economy - it is the world's second-biggest, capable of the same forms of exploitation as the west. It is a significant contributor to Africa's deindustrialization and underdevelopment."

    Hong Kong University professor Adams Bodomo disagrees with Sanusi, believing that his colonial comparison is flawed. "We are in a world where everybody has their competitive advantages… We have minerals, they have manufactured goods," he told IRIN. "In fact, the presence of Chinese manufactured goods in Africa is an opportunity for African manufacturers to up the ante, to compete. We need competition; we can't talk about free market and then not like competition."

    Kenneth King, professor emeritus at the University of Edinburgh who, for his new book, China's Aid and Soft Power in Africa, travelled across Africa with his wife and interviewed more than 200 people on the continent, also dismisses claims that Africans consider the Chinese to be neo-colonialists. "There are differences in perceptions, but they are remarkably positive," he said, claiming that they had not noticed much antagonism towards China from people on the ground.

    But there is no denying that, at the local level, tensions sometimes run high.

    In 2010, when Chinese managers shot at coal miners in Zambia after a labour dispute, the incident sparked outrage across the country, and Michael Sata, then the opposition leader, used anti-Chinese sentiment to rally support for his presidential campaign. Similarly, in Lesotho, protests and resentment for Chinese migrants have occurred.

    Earlier this year, tensions between China and Ghana increased over allegations about illegal mining, leading to the Ghanaian government deporting more than 4,500 Chinese gold miners.

    "The miners in Ghana - this is very bad for China, and the Chinese government is very upset about this," said Ward Warmerdam, a researcher at the International Institute of Social Studies in The Hague and an economic researcher at the think tank Profundo. He explained that while the government tries to influence the business practices of private Chinese firms in Africa through a series of directives on foreign direct investment, they are unable to influence companies that are not at least in part state-owned or reliant on funding from the government, nor individuals who migrate to Africa on their own.

    "These are companies and actors that it doesn't have an influence over, and this is going to be a big problem for China," he added.

    CEU's Large cautioned that it is necessary to disaggregate core principles of mutual cooperation and non-interference, to see how they meaningfully impact more than just the elites in recipient states. "On win-win and mutual benefit, these should be taken seriously, as constitutive of genuine convictions,” he told IRIN, “but at the same time seen as liable to more instrumental uses.”

    The real question to ask is whether Chinese aid and development policies benefit the population at large, not just leaders. “Just as OECD DAC [Development Assistance Committee] principles or human rights can be subject to all sorts of uses, the same is true of China's principles," he said.

    According to Xue, there is much that China can learn from the West: "Building a tall building is relatively easier compared with more in-depth knowledge of the country and their needs. We can learn from Western experiences in this," he said.

    He believes that China has the opportunity to build a stronger network of NGOs and grassroots projects in Africa that may have more impact on everyday people, something that they have thus far steered away from in favour of larger state-to-state projects: "We are gradually increasing aid provided to other institutions, but a large part of the aid is still provided in bilateral aid."

    But, he said, "China's aid policy is still gradually evolving."

    Warmerdam agrees, but believes that in that process of evolution, it is crucial for African leaders and states to have a greater stake in the decision-making. "The cogs aren't in place, and the dynamics of this relationship aren't set yet," he said. "It's good for African leaders to be careful."


    Untangling China's aid to Africa
  • Rethinking mental health in Africa

    As African countries strive to meet the UN Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill.

    Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries' agendas than other health issues.

    "Everyone is putting their money in HIV, reproductive health, malaria," says Sheila Ndyanabangi, director of mental health at Uganda's Ministry of Health. "They need also to remember these unfunded priorities like mental health are cross-cutting, and are also affecting the performance of those other programmes like HIV and the rest."

    Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity: The World Health Organization (WHO) estimates 75-85 percent of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50 percent in high-income countries. The action plan outlines four broad targets, for member states to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

    In order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues. As it stands, the US Agency for International Development (USAID), the world's biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS. Meanwhile, mental health receives on average 1 percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.

    "Mental health hasn't found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond," Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told IRIN. "Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets."

    The post-MDG era

    According to a May report from the UN Secretary-General's High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, the MDGs have overseen the fastest reduction of poverty in human history.

    "Mental health hasn't found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond"

    Yet it also acknowledges that they have done little to reach the world's most vulnerable. The report says the MDGs were "silent on the devastating effects of conflict and violence on development" and focused too heavily on individual programmes instead of collaborating between sectors, resulting in a largely disjointed approach to health. Experts say without a more holistic approach to global health in the new development era, the world's most vulnerable will only be trapped in that cycle.

    "The MDGs were essentially a set of vertical programmes which were essentially in competition with each other for resources and for attention," said Minas. "We've gone beyond that, and now understand we're dealing with complex systems, where all of the important issues are very closely interrelated."

    Poverty and mental illness

    In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care.

    "The surge of aid [that usually follows an emergency]combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term," say the authors of the report Building Back Better: Sustainable Mental Health Care after Emergencies, released earlier this month.

    In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda - which, starting in the late 1980s suffered a two-decade long war between the government and the rebel Lords' Resistance Army - monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

    "We need to be mentally healthy to get out of poverty," Ethel Mpungu, the study's lead researcher, told IRIN.

    The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30 trillion by 2030, with mental health conditions alone costing an additional $16 trillion over the same time span.

    "It really is around issues of development and economics - those things can no longer be ignored," says Minas. "They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes."

    Putting mental health on the agenda

    As mental health legislation is hard to come by in most African countries, Uganda is ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010. The bill would update its colonial era Mental Treatment Act, which has not been revised since 1964, and bring the country in line with international standards, but is still waiting to be reviewed by cabinet and be voted into law.

    Uganda is also part of a consortium of research institutions and health ministries (alongside Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME - the programme for improving mental health care - was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

    Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems.

    Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere.

    "Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria," said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. "But if people don't care whether they live or die, they're not going to be able to take advantage of these things that are offered."


    Rethinking mental health in Africa
  • African governments still underfunding health

    Twelve years after African governments pledged in the Abuja Declaration to allocate at least 15 percent of their annual budgets to healthcare by 2015, just six countries have met this goal.

    Liberia, Madagascar, Malawi, Rwanda, Togo and Zambia have met the target, and five other countries are spending at least 13 percent of their annual budgets on health, according to data compiled by the UN World Health Organization (WHO).

    While on aggregate spending on health has increased - up to 10.6 percent from 8.8 - about a quarter of African Union (AU) member-states have regressed and are now spending less on health than they were in 2001, adds the WHO data.

    Recently, the AU held another special summit on HIV/AIDS, tuberculosis (TB) and malaria in Abuja, Nigeria, dubbed Abuja +12, which provided an opportunity for African governments and other stakeholders to review progress made and to discuss what should be done to ensure health funding targets are met before 2015.

    The HIV/AIDS experience

    “A renewed and bold commitment here in Abuja is essential as, drawing from experiences in the AIDS response, we know that smart investments will save lives, create jobs, reinvigorate communities and further boost economic growth in Africa,” said Michel Sidibé, the executive director of UNAIDS, in a press statement.

    At present, funding for healthcare remains short of requirements and is very unevenly spread across countries. According to UNAIDS, an additional US$31 billion per year will be needed to meet the continent’s 15 percent health funding targets.

    As of 2011, at least 69 percent of the world’s 34 million people estimated to be living with HIV/AIDS were in sub-Saharan Africa.

    But there are encouraging signs. The number of new HIV infections fell by 25 percent in 2011 compared to a decade earlier.

    “The main challenge in the fight against HIV and AIDS globally is how to ensure universal access to prevention, treatment, care and support, and… ensuring zero transmission of new HIV infections in children,” wrote Ghanaian President John Dramani Mahama in a blog article in May.

    Among 21 priority countries in Africa, the number of children newly infected with HIV has fallen by 38 percent since 2009, according to a joint AU-UNAIDS report launched at Abuja +12.

    Malaria and TB burden

    Africa is also lagging behind in reducing cases of - and deaths from - TB and malaria.

    Globally, Africa is the only region not on track towards halving TB deaths by 2015, and it accounts for almost a quarter of the global caseload, according to WHO.

    Inadequate TB detection and drug-resistant strains of the disease, which can be 100 times more expensive to treat, pose significant challenges in Africa. About 40 percent of TB cases in Africa go undetected, adds WHO.

    Malaria is also a serious health problem. Eighty percent of the world’s cases and 90 percent of malaria-related deaths occur in Africa.

    “We are at a turning point for making historical gains in Liberia's health sector - where no child dies of malaria and every mother living with HIV can give birth to HIV-negative children while living healthy lives themselves,” wrote Liberian President Ellen Johnson-Sirleaf, in a statement to the Global Fund.

    Liberia allocates 18.9 percent of its annual budget to healthcare, the second highest proportion in Africa; Rwanda spends 23.7 percent.

    Health for development

    According to the AU/UNAIDS Abuja +12 report, there is an economic case to be made for further investment in healthcare: For every year that life expectancy rises across the continent, it argues, GDP will increase by 4 percent. The average life expectancy in Africa is 54.4 years, the lowest globally.

    “A sick population cannot generate the productivity needed to maintain the acceleration of our economy,” said Ghana’s President Mahama.

    More funding for health could also mean more jobs within the health sector. In 2012 for example, the AU approved a business plan to increase the output of the local pharmaceutical industry.

    “Focusing on three things that Africa needs to do urgently - decrease dependency by growing African investments, deliver quality-assured drugs sooner to the people who need them, and leadership - the blueprint will help African countries to build long-term and sustainable solutions,” stated Mustapha Sidiki Kaloko, the AU Commissioner of Social Affairs, in a statement, ahead of the Abuja +12 summit. “Africa’s health and our prosperity are inextricably linked.”


    African governments underfunding health
  • Countering Africa’s green revolution

    Civil society groups are taking on the policies of the Alliance for a Green Revolution in Africa (AGRA), which promotes the use of genetically modified (GM) crops and Green Revolution technologies.

    They argue that GM and Green Revolution practices - those aimed at increasing developing countries’ crop yields through specific innovations - will, in the long run, be detrimental to ecosystems across the continent. Earlier this month, a coalition of almost 60 civil society groups across Africa came out to protest AGRA ahead of the G8 Summit in London.

    “Green Revolution technologies benefit relatively few farmers, often at the expense of the majority. These technologies produce concentration of land ownership, increasing economies of scale (production has to be at a large scale to get into and stay in markets), and a declining number of food-producing households in a context of limited other livelihood options,” they said in a letter sent to AGRA’s president, Jane Karuku.

    They also believe that the intellectual property of many plant types may be transferred to large multinational corporations as part of Green Revolution practices.

    “Private ownership of knowledge and material resources (for example, seed and genetic materials) means the flow of royalties out of Africa into the hands of multinational corporations,” they said.

    Technology for the needy

    AGRA was founded in 2006 through a partnership between the Rockefeller Foundation and the Bill and Melinda Gates Foundation. It works with smallholder farmers across the continent by giving them microfinance loans, hybrid seeds and fertilizers to increase their crop yields. In this way, AGRA hopes to alleviate hunger and poverty across the continent.

    The Green Revolution
    A period from the 1940s until the 1970s when, through the use of new technologies such as irrigation, improved seed, fertilizers and pesticides, as well as an economic environment that supported industrial agriculture, a massive increase in agriculture output in developing countries (particularly in Asia) occurred. Norman Borlaug, who won the 1970 Nobel Peace Prize for improving agricultural technologies, is widely considered as the “Father of the Green Revolution”, and is often credited with saving a billion lives through his innovations.

    “There are millions of skilled farmers in Africa who simply need the tools,” said Sir Gordon Conway, a scientist and author of One Billion Hungry: Can We Feed the World?, speaking by video message at an agriculture conference in Nairobi. In his book, he argues that both microcredits - to help smallholder farmers - and macro-investment are needed for farmers to benefit from Green Revolution technologies.

    He believes traditionally marginalized groups - such as women, youth and ethnic minorities - will benefit from the use of new agricultural technologies targeted at smallholders, and that the total number of hungry will be drastically reduced. For example, Conway calculates that by ensuring female farmers have access to the same productive resources as men, the number of undernourished people globally could be reduced by 100 to 150 million.

    “If we are going to feed some 9 billion people by 2050 and do that in environmentally sustainable ways and in the face of climate change, then we are going to need access to the very best that modern science can offer,” said Peter Hazell, a leading agriculture expert who has worked with the World Bank and International Food Policy Research Institute. “All technologies have risks (e.g., cell phones may cause brain cancer) but as these things go, GM crops seem to be doing rather well.”

    Debt and expense

    But civil society groups disagree. “AGRA aims to move farmers in exactly the wrong direction, by encouraging them to take on debt in order to use more agrochemicals and corporate hybrid seeds,” Teresa Anderson of the Gaia Foundation told IRIN.

    “For many years, NGOs across Africa have worked with farmers to encourage them to stop using fertilizers and pesticides, and to improve their soil health, their ecosystems, their seed diversity and their food sovereignty. AGRA is undoing a decade of agro-ecological progress in Africa by getting farmers into debt and back on the agribusiness treadmill,” she said.

    "World over, the same companies that own the seeds also own the chemicals; it is a mafia-like cartel that has proven to be ruthless towards poor small-scale farmers"

    Genetically modified crops are allowed to be used commercially in only three countries in Africa - Egypt, Burkina Faso and South Africa - according to Gareth Jones of the African Centre for Biosafety. Of these countries, only South Africa uses them extensively. Jones believes it is a mistake to think their model could be replicated elsewhere across the continent.

    “The legacies of colonialism and then apartheid left South Africa with a well-resourced and supported white commercial farming sector, many of whom (including maize, cotton and soya farmers) cultivate on large pieces of land, using modern inputs,” he told IRIN via email. “Projects to get smallholder farmers in South Africa to grow GM seed such as in the Makhathini Flats, though much heralded by the biotechnology industry at the time, have been largely unsuccessful.”

    The Makhathini Flats project, which started to grow cotton in 2002, ended after just five years. High loan repayments on the seed and poor climate meant that smallholders were unable to afford to grow the crop. “There is no reason to believe that the introduction of GM seeds would have different results in the rest of the continent,” Jones said. He accuses initiatives such as AGRA of spurring the push for greater use of genetically modified crops on the continent.

    In September 2012, over 350 civil society organizations wrote a statement protesting AGRA’s agricultural approaches.

    “We are concerned that as a result of the AGRA seed program, the rich pool of African indigenous seed varieties will become the property of corporate seed companies, displacing and reducing farmers’ access to indigenous varieties, and locking them into an expensive high-input agricultural system,” they said. Signatories included the African Biodiversity Network, the African Centre for Biosafety, Kenya Biotechnology Coalition, Participatory Ecological Land Use Management, and ActionAid Tanzania and Uganda.

    These groups cite a 2009 study by the International Assessment of Agricultural Knowledge, Science and Technology for Development, conducted with the UN Food and Agriculture Organization (FAO), UN Environmental Programme, World Bank and others, which concluded that industrial agriculture is not likely to be majorly beneficial in mitigating hunger and poverty.

    Patents or people?

    In 2009, the three largest seed companies controlled more than a third of the global seeds market, according to a 2011 study commissioned by the Commission on Genetic Modification.

    Under most current legal frameworks, farmers growing patented seeds are not allowed to use the seeds naturally produced from their crops.  Large firms such as Monsanto routinely sue farmers who propagate their patented crops.

    “World over, the same companies that own the seeds also own the chemicals; it is a mafia-like cartel that has proven to be ruthless towards poor small-scale farmers,” Ruth Nyambura of the African Biodiversity Network told IRIN.

    But Karuku, AGRA’s president, insists the organization tries to collaborate with local partners to develop new breeds of seed. In Kenya, she said, they work with the Kenya Agricultural Research Institute, which then owns the patents to the seeds, not large multinational corporations.

    She also pointed to growing populations and said that scarcity of land meant that African farmers needed to increase the productivity of their crops. With 239 million undernourished people in Africa, according to the FAO’s State of Food Insecurity in the World 2012, she said there is a need for strong action. “If we don’t do anything, it will be way more than that,” she said. “We should be worried.”

    “Nobody forces farmers to grow GM crops, so if they prove less profitable than the alternatives, farmers will simply stop growing them,” noted Hazell. “Farmers have been able to reduce the use of pesticides on many GM crops with significant environmental and health benefits.”


    Countering Africa’s green revolution
  • Digital jobs offer skills, promise to Africa's unemployed youth

    Although Africa’s economy has expanded rapidly in recent years, it has not kept pace with the growth of its youth population or their need for jobs. 

    With almost 200 million people between 15 and 24 years old - a figure that is set to double by 2045, according to the African Economic Outlook’s (AEO) 2012 report - the continent has the youngest population in the world. Yet despite the increasing percentage of Africa’s young people with secondary and tertiary educations, many find themselves unemployed or underemployed in the informal economy. Part of the problem, according to the AEO study, is a mismatch between the skills young jobs seekers have to offer and those that employers need. 

    The world’s increasingly digitalized economy needs workers with the skills to capture and manage the vast amounts of data it generates. With appropriate training, such tasks can be performed anywhere in the world. Data generated by a high-tech company in Silicon Valley, for example, can be processed by youth with smartphones or tablets living in a slum in Nairobi, Kenya. This means that digital work could potentially alleviate the unemployment and poverty hampering development in many African countries.

    Both the private and humanitarian sectors are starting to recognize this potential and find ways to harness it.

    Skills for the future

    The Rockefeller Foundation recently launched Digital Jobs Africa, a seven-year, US$83 million initiative to improve the lives of one million people in six African countries through digital job opportunities and skills training. 

    Eme Essien Lore, the foundation’s Nairobi-based senior associate director, explained that having identified youth unemployment as one of Africa’s most pressing problems, the organization was looking for ways to help young people on the continent gain sustainable, long-term job opportunities. 

    “The reason digital employment really rose to the top for us was because we saw the skills they get from these kinds of jobs as a springboard to other types of employment,” she told IRIN. “We know young people take time to figure out what they want to do. Also, we don’t know what the future labour market is going to look like. So we thought this was a very important sector because it develops skills they can use whether they stay in the digital economy or move into other sectors.” 

    The six focus countries - Egypt, Ghana, Kenya, Nigeria, Morocco and South Africa - share particularly high youth unemployment rates and have rapidly developing information and communications technology (ICT) infrastructures. Some, such as Nigeria and South Africa, have booming ICT sectors in need of labour, while others, such as Morocco, are well-placed to meet demand from Europe and the US, said Lore. 

    Winnie Mwihaki, 24, is among 500 Kenyan youths from poor backgrounds recruited by one of the Rockefeller Foundation’s grantees - San Francisco-based non-profit Samasource. Globally, the company has connected an estimated 3,700 young people in nine countries to paying work and hopes to expand this number to 5,000 by the end of 2013. 

    Samasource secures data- and content-processing jobs from its US-based clients, and then uses its specially developed software to break these large digital projects down into small computer-based tasks it calls “microwork”. This work is then distributed to local partners that are responsible for recruiting, training and managing employees. 

    Unlike most companies in the business process outsourcing (BPO) and information technology outsourcing industry, Samasource only employs people living below the poverty line. Workers must also be between 18 and 30 years old, and preference is given to women, who are less likely to have access to formal employment. 

    "We can bring someone in with virtually no experience, and in a matter of weeks they can start doing small tasks on a computer"

    “Part of the criteria is that people need to be literate in English,” added Lauren Schulte, director of marketing and communications at Samasource. “They don’t have to have any computer skills. We can bring someone in with virtually no experience, and in a matter of weeks they can start doing small tasks on a computer.”

    With her monthly salary of 13,000 shillings [$149], Mwihaki is able to assist her mother, who had been struggling to care for their family of six. “Because of the money I earn from here, I am now able to help my mother [and] to also be a breadwinner in the family,” Mwihaki told IRIN.

    Mwihaki grew up in Korogocho, a sprawling slum in Nairobi, where crime is commonplace. She was unable to proceed to college after secondary school because her parents could not afford it.

    “Now I will use part of what I earn from this job to sponsor myself through college,” she said. 

    A new trajectory

    Samasource is not the only company targeting disadvantaged people in low-income areas with digital employment. Another Rockefeller Foundation grantee, Digital Divide Data, operates on a similar principle and employs more than 1,000 people in Cambodia, Kenya and Laos. Both companies are considered pioneers of impact sourcing, which the Rockefeller Foundation defines as “the socially responsible arm of the BPO and information technology outsourcing industry”.

    A relative newcomer to the sector, and another Rockefeller Foundation grantee, is the Impact Sourcing Academy (ISA) in Johannesburg, South Africa. ISA combines a training and job placement programme with a fully functional call centre that gives its students the opportunity to obtain practical work experience while earning enough money to help support their families. 

    “We’re not so much interested in just giving them a job as a call centre agent,” said ISA head Taddy Blecher. “We really want to make sure they’re doing part-time studies while they’re working, getting access to more knowledge and training so they can move into higher-level jobs.”

    Once graduates are fully employed and earning a decent salary, they are encouraged to fund another student from a similar background. Using this model, the academy is already about 65 percent self-funded and aims to be completely self-funded in the future.

    Blecher described the Rockefeller Foundation initiative as “a massive opportunity” for South Africa, given the need for skilled labour to work in its booming BPO sector and its 51 percent youth unemployment rate. “In a short period of time, you can bring a family out of poverty and put them on a whole new trajectory,” he told IRIN.

    Opening doors

    For now, evidence that impact sourcing really can lift families out of poverty is limited to the small studies the Rockefeller Foundation has conducted with Samasource and Digital Divide Data. “What we want to do next is really measure the impacts on a household level,” said Lore. “Anecdotally, we’re quite convinced, but we need to work on measuring over the next seven years.”

    The Rockefeller Foundation does not stipulate a minimum wage that its grantees must pay, and the line between a living wage and an exploitatively low wage can be a fine one. “This is a sector where companies’ first priority is really around cost savings,” acknowledged Lore. “If you take the example of someone living in a slum, [a job like this] won’t get them into a nicer neighbourhood. But it might be able to buy food for the family and get younger siblings into school,” she said.

    She added that the demand for young people with these skills is such that they are often poached by rival companies offering slightly higher salaries. “We’ve seen that when people move from these jobs, usually after about two years, they go on to better jobs. You rarely see people sitting in these types of jobs indefinitely.”


    Digital jobs for Africa’s youth

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