Photo: Keishamaza Rukikaire/IRIN

Decentralizing health care has been the key to Rwanda’s success

KIGALI,  – The tiny nation of Rwanda has emerged as the unlikely star of central Africa in making progress towards achieving universal access to HIV treatment, prevention and care.

More than 70 percent of its people who need life-prolonging antiretroviral (ARV) drugs have access to them, prevention of mother-to-child transmission (PMTCT) services reach 60 percent of women requiring them, and 60 percent of children needing ARVs are on treatment.

“Of pregnant women who come to our health facilities, 99 percent are accepting testing,” said Jules Mugabo, head of the government’s Treatment and Research AIDS Centre. “Now, with the participation of the [male] partners, 76 percent of partners have come to be tested in antenatal clinics … we were able to test around one million last year.”

Rwanda is extremely poor and still struggling to rebuild a health system decimated by the 1994 genocide, but larger and wealthier countries in the region, like Kenya and Uganda, are providing ARVs to fewer than half the people in need of them.

Unlike many other African countries, Rwanda’s almost 10.5 million people speak only one indigenous language and are broadly culturally homogenous, making it easier to coordinate HIV-related media campaigns.

Between 1999, when the first PMTCT site was opened, and 2001, just over 11,000 Rwandan women were tested for HIV; by 2006 the number had grown to well over 200,000 annually.

Experts put these successes down to political commitment at the highest level, which has enabled HIV actors to expand programmes nationally; both President Paul Kagame and First Lady Jeanette Kagame have talked openly about HIV, encouraging the population to behave in sexually responsible ways.

One health worker noted that Rwandans have a “culture of obedience”, which has contributed to the numbers of women attending antenatal clinics, accompanied by their male partners.

“Rwanda has a strong administrative structure right down to very ground level,” said Aksa Leslie, a senior programme officer at the NGO, Family Health International. “Within this context the health system is trying to decentralize.”

Each of Rwanda’s 30 districts has at least one “one-stop” health centre providing HIV counselling, testing and treatment. Patients who test positive immediately give a blood sample and return a week later to receive the results of their CD4 count, which indicates immune system strength.

“When the patient receives the CD4 count he has to consult a doctor,” said Jean Paul Balinda, a nurse at a clinic in the capital, Kigali. “If the patient has a 350 CD4 count under 350, he has to start ARVs.”

Patients return to the clinic for counselling and monitoring once during the first week of treatment and then once a month. Each village has two community healthcare workers trained in HIV care and support at the local level.

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Yet experts say Rwandans living with HIV still experience severe stigma, which could hinder the race to universal access by preventing people from seeking testing or treatment.

Stigma, prevention still problematic

The results of a survey in May 2009 by the Association of Vulnerable Widows Infected and Affected by HIV/AIDS, and the Network of People Living with HIV, found that HIV-positive people faced most discrimination in society; other groups included sex workers and asylum seekers.

“If there is no stigma, more people come to testing, and with more people coming to testing we can put more people on ART [antiretroviral therapy],” said Dr Fulgence Africa, director of planning, coordination, monitoring and evaluation of HIV programmes at the National AIDS Control Council, CNLS.

Prevention is also a persistent problem; acceptance of condoms is low because they are still associated with promiscuity, while condom distribution is geographically uneven, and especially inadequate in rural areas.

Rwanda uses a broad prevention strategy of Education, Abstinence, Be faithful and correct and consistent Condom use, but there is scant knowledge about HIV among those most at risk, such as men who have sex with men, sex workers and truck drivers.

The latest universal progress report notes that the country needs to investigate the factors driving the pandemic to ensure that prevention efforts are coherent with HIV transmission patterns.

“Focus should be placed on ‘knowledge of the epidemic’ so as to be able to develop appropriate tailored interventions for the most at-risk populations,” the progress report said. “In-depth analysis should also encompass the links between HIV, drugs and alcohol.”

hh/kr/kn/he source.www.irinnews.org

Photo: Phuong Tran/IRIN

Farmer literacy class in Magaria, Niger

MAGARIA,  – Yaou Sadi, a farmer in south-eastern Niger, can remember almost exactly how much millet and sorghum he has cultivated, going back for years. Not knowing how to read or write, his memory is the most reliable record he has - until now. For the past three months, he has attended evening classes after working in the fields to learn how to write.

With US$30,000 from the Spanish government, Food and Agriculture Organization (FAO) launched 26 village literacy classes in March 2009 with hundreds of farmers in the central Tahoua and south-eastern Zinder regions.

More than 11 percent of the population in Tahoua lives in severe food-insecurity, according to the government’s most recent anti-poverty plan. “Many households are small subsistence producers and their domestic production cannot cover their food needs for more than three to five months a year,” according to the government. Nationwide, almost three million people are food-insecure, with nearly one-third facing a severe shortage.

FAO’s national food security coordinator, Moutari Souley, told IRIN that by becoming literate, the farmers have a better chance to survive with agriculture. “Basic literacy allows them to manage better their harvests and services.”

Checking market prices, negotiating with buyers and keeping records have been impossible, Sadi told IRIN.

If I forget, I lose all the numbers, all the information

In a thatched classroom in Magaria, 85km north of Zinder - the second largest city in Niger after the capital Niamey - Sadi crouched on the dirt floor to write slowly his name on the blackboard, deliberately pressing the chalk stub with each letter. “I started coming to classes three months ago,” he said, “Because I feared forgetting. If I forget, I lose all the numbers, all the information.”

Speaking in Hausa, the predominant language in his village Magaria, the farmer said his four children, all of them in school, help him when he runs into problems. He told IRIN he can now write numbers.

FAO’s Souley told IRIN the literacy courses, half of which are for women exclusively, also help women have more of a voice.

Rural women are responsible for more than half the food production in sub-Saharan Africa, yet have little access to time-saving equipment or profitable innovations, according to the 2008 multi-agency Gender in Agriculture Sourcebook.

pt/aj source.www.irinnews.org

By Kiplang’at Jeremiah

The world’s oldest pupil, Stephen Kimani Maruge, is dead.

Maruge, 89, a symbol of hope for the free primary education programme initiated by the Narc Government in 2003, died yesterday at Chesire Home in Kariobangi North, Nairobi.

The man who demonstrated a rare spirit of resilience enrolled as a pupil at Kapkenduiywa Primary School in Eldoret in 2004.

He was recognised by the Guinness Book of Records as the world’s oldest pupil and was set to achieve his dream of achieving higher education and be able to read the Bible before the 2007 post-election violence rooted him from Eldoret.

World’s oldest pupil Stephen Kimani Maruge

Yesterday, his colleagues at Chesire Home were shocked by the news of his death.

Ms Donatila Ekuyi said Maruge was a jovial and co-operative old man. She said he lived well with other members in the home for the old and he would be dearly missed.

“We are shocked to lose Maruge,” said Ekuyi, a matron at the home.

Maruge’s granddaughter, who had lived with him after being displaced from Eldoret last year, said Maruge, had an ear for everyone even though he was battling stomach cancer, which was diagnosed last year.

“He was ready to listen to everyone. I will dearly miss his advice,” she told The Standard on Saturday. Ekuyi said Maruge’s health deteriorated from April when he was operated on at Kenyatta National Hospital.

“He could hardly take solid food. He drank milk, sodas and fruit juices,” she said.

source.standard.ke

WASHINGTON, Aug. 14 (Xinhua) — Despite its willingness to engage Pyongyang, the United States will continue to exert sanctions to make the regime pay a “significant price” for its provocative behavior, said U.S. State Department on Friday.

The Obama administration wants to have dialogue with the Democratic People’s Republic of Korea (DPRK) and Iran in order to address “not only concerns that we have about those countries, but the concerns that they may have about U.S. policy,” spokesman Philip Crowley told reporters at the daily press briefing.

“We are willing to engage North Korea. We are willing to talk to North Korea. But we will continue to use sanctions to enforce the UN Security Council resolution and to have North Korea pay a significant price for its current activities,” he said.

Regardless of strong opposition from the international community, the DPRK conducted an underground nuclear test on May 25 and since then has fired at least seven ballistic missiles. It also boycotted the six-party talks on its nuclear program.

Responding to Pyongyang’s behavior, the Obama administration decided to extend economic sanctions by prolonging the national emergency on the DPRK and has vowed to enforce sanctions against Pyongyang set in the UN Security Council Resolution 1874.

At the press briefing, Crowley dismissed the speculation that a U.S.-DPRK bilateral dialogue mechanism would replace the six-party talks participated by other four countries — China, South Korea, Japan and Russia.

“We want to see North Korea come back to the six-party process,” said the spokesman, adding that the Obama administration believes that the process is “the most effective way to deal with the issues that we have with North Korea.”

“Within the six-party process, there can be bilateral discussions, not just with the United States, but other countries, as well,” he stressed.

“We would like to see North Korea return to the six-party talks and to begin to take irreversible steps, consistent with the agreement it made in 2005 and move aggressively toward a denuclearization,” said Crowley.

“There’s no mystery here as to what we expect North Korea to do. We are just waiting to see if North Korea is actually going to follow the path that the international community has laid out for it,” he added.

NEW DELHI, Aug. 14 (Xinhua) — India has regretted a decision by the United States Commission on International Religious Freedom to put it on a list of states which failed to protect religious minorities.

“India, a country of 1.1 billion people, is a multi-ethnic and multi-religious society. Aberrations, if any, are dealt with promptly within our legal framework, under the watchful eye of an independent judiciary and a vigilant media. The reported move referred to in the news reports is regrettable,” India’s Ministry of External Affairs spokesman Vishnu Prakash told the media Thursday.

The United States Commission on International Religious Freedom said Wednesday that India earned the “watch list” designation due to the “disturbing increase” in communal violence against religious minorities — specifically Christians in Orissa in 2008 and Muslims in Gujarat in 2002 as well as the largely inadequate response from the Indian government to protect the rights of religious minorities.

Last year, Kandhamal district in Orissa witnessed weeks of anti-Christian violence after a Hindu leader was shot dead. The clashes erupted after Hindu groups blamed Christians for the killing.

More than 1,000 people, mostly Muslims, died in the riots in Gujarat which began after 60 Hindus died in a fire on a train in 2002.

Meanwhile, Orissa Christian leaders have categorically rejected the report of the United States Commission for International Religious Freedom for questioning India’s secular credentials and putting India in its “watch list”.

President of the Orissa Minority Forum, in a written statement, has called the report as “most unfortunate,” and one that “lacks a proper understanding of the secular character of the country.”

LAGOS, Aug. 14 (Xinhua) — The Nigerian Labor Congress (NLC) has said in Ibadan, southwest Nigeria’s Oyo state capital that the nation may relapse into another regime of nationwide strike if the current national rally by the Congress fails to persuade the government to yield to labor demands on some national issues.

Abdulwaheed Omar, NLC national president, stated this shortly before the commencement of the Southwest section of the nationwide rally organized by the congress and human rights groups.

He listed the demands to include upward review of workers’ salaries, deregulation in the petroleum sector and reforms of electoral systems.

“The government will be making a mistake if it does not respond positively to our demands which led to this peaceful rally,” the Lagos based-This Day newspaper quoted him as saying.

“This rally will not be the end of the agitation, particularly on our demands for a minimum wage that is decent enough to take care of us,” he added.

The union leader called on the government not to increase the prices of petroleum products, saying Nigerians are poor and, as a result, could not avoid a hike in the prices of the products.

He also demanded for a living minimum wage that would enable the workers to live a meaningful life.

BRUSSELS, Aug. 14 (Xinhua) — An appeal has been lodged against the International Criminal Court (ICC) decision to release Jean-Pierre Bemba, former vice president of the Democratic Republic of Congo (DRC), pending his trial for war crimes, the court said on Friday.

ICC Prosecutor Luis Moreno-Ocampo lodged the appeal, saying Bemba, who is still in detention in The Hague, should stay in prison. The Appeals Chamber of the court will review whether the decision to conditionally release Bemba is correct, said the court in a press release.

The prosecution will present its arguments on Aug. 24.

“The judges of the ICC have confirmed that Mr. Bemba must stand trial to answer the very serious charges that have been brought against him,” said Moreno-Ocampo. “Victims and witnesses can be confident that the trial will take place in the near future and that the Court will continue to guarantee their safety.”

The ICC Pre-Trial Chamber II decided on Friday to grant Bemba interim release under conditions pending his trial. The implementation of this decision is deferred pending a determination of the country in which Bemba will be released and which set of conditions shall be imposed. There is no prospect of immediate release.

The pre-trial chamber invited those countries to which Bemba requested to be released to provide observations on the questions of his interim release onto their territory and any possible set of conditions restricting liberty to be imposed. Bemba’s trial hearings are expected to take place between Sept. 7 and 14, 2009.

The ICC, based in The Hague, is an international tribunal to prosecute individuals for genocide, crimes against humanity and war crimes.

Bemba is charged with three counts of crimes against humanity and five counts of war crimes. He was arrested in May 2008 in Brussels and then transferred to the ICC for trial.

Bemba was a rebel warlord before becoming vice president of the DRC. His Movement for the Liberation of Congo rebel group was accused of atrocities against civilians in the Central African Republic in 2002.