Usain Bolt of Jamaica drives a Ferrari. Bolt will meet with President Mwai Kibaki and Prime Minister Raila Odinga in Nairobi on Monday as part of a busy four-day schedule. Photos/ REUTERS

Also travelling with Bolt is his manager, Ricky Simms, of Pace Management, who also handles a number of Kenya’s leading athletes including the world 10,000 metres champion Linet Masai.

source.irinnews.org

International Criminal Court (ICC) Prosecutor Luis Moreno Ocampo. PHOTO/FILE

“The court is really helping to establish a new idea in the world with state parties and non-state parties. It will take time. In 30 years, all the world will be a member of the court but in the meantime we are progressing,” he said.

source.nation.ke

Photo: Siegfried/IRIN

DOTS has been used to successfully manage TB in many of the world’s poorest countries

NAIROBI, 29 October 2009 (PlusNews) – Malawi’s successful use of a well-known tuberculosis (TB) treatment system to scale up antiretroviral treatment (ART) for HIV could improve chronic disease management in other African nations, experts say.

Directly observed treatment short course (DOTS), has been used to successfully deliver tuberculosis treatment in some of the world’s poorest countries.

The main elements of DOTS include political commitment, case detection, standardized treatment with supervision and patient support, an effective drug supply and management system, and a monitoring and evaluation system.

“The key to rapid and massive scale-up [in Malawi] was to keep the principles and practices of ART delivery as simple as possible,” said the authors of an article on scaling up antiretroviral therapy, in the latest edition of the Journal of Acquired Immune Deficiency Syndromes.

Solid systems

“A standardized system was put in place so that the same system of assessing patients for ART eligibility, initiating treatment, and registering and reporting cases and outcomes was followed wherever ART was being delivered – from central hospital to health centre, and from public health facility to private clinic,” the authors said.

Malawi began its national ART rollout in 2004 with just nine health facilities providing the medication to about 3,000 people. Using the DOTS framework, by the end of 2008, 170 health facilities in the public health sector had registered 215,449 patients.

A study published in 2008 in the British medical journal, The Lancet, found that rapid scale-up of free ART in rural Malawi had led to a decline in adult mortality that was detectable at the population level.

The article’s authors attribute the success of Malawi’s ART scale-up to government commitment and leadership; clear national ART guidelines, with emphasis on the system of registration, monitoring and recording of results; intensive training of clinical officers and nurses in ART guidelines, with practical experience at ART sites; an efficient drug-supply chain to prevent stock-outs.

Taking DOTS further

They note that with the rise in prevalence – even in resource-poor sub-Saharan Africa – of non-communicable diseases such as heart attacks, strokes, cancers, diabetes and respiratory diseases, there is a need to put in place simple yet effective systems to give people access to treatment.

The World Health Organization (WHO) forecasts that deaths from non-communicable diseases are likely to increase by 17 percent globally over the next 10 years, with the greatest increase projected in Africa.

“Although patients with these non-communicable diseases usually need chronic care and treatment over their lifetimes, it is simply not provided in most resource-poor countries, outside a few centres of excellence, and there are no systems to monitor patient access or outcomes,” they stated.

“The system put in place in Malawi to facilitate the management and monitoring of lifelong ART can also be used for patients with non-communicable diseases.”

If handled properly, HIV and chronic disease management systems could be used to strengthen health systems in resource-poor nations, particularly by improving laboratory infrastructure and service delivery, monitoring, supervision, quality assurance, and rational drug forecasting and procurement.

“Any attempt to better the management and monitoring of special diseases must include a vision of how the work will improve the health sector and health care delivery as a whole,” they said.

kr/he source.irinnews.org

Photo: Kate Holt/IRIN

Hitting the treatment target

WINDHOEK,  – In Onamutenya village, northern Namibia, the Shigwedha household leaves their homestead at the crack of dawn to make the monthly four-hour walk to fetch antiretroviral (ARV) medication from the local clinic.

Wilbard Shigwedha, 9, who is HIV-positive and an old hand at this early-morning routine, willingly gets up at 4 a.m. to make it in time to the clinic. By the time he and his mother Krestina, 35, who is also living with the virus, get to the packed health facility in Onayena after walking 20km, his brown pin-striped three-piece suit is coated in dust.

A return trip by minibus-taxi would have cost them 40 Namibian dollars (US$5) – too expensive for an employed widow and mother of four, two of whom are HIV-positive – and the sandy roads are tricky to negotiate by car, so taxis are also infrequent.

Distance and transportation are among the major challenges in rolling out HIV treatment in Namibia, a vast country, with wide open spaces and a population density of less than 2 people per square kilometre.

About 15 percent of the 2.1 million people in the country are estimated to be living with the HI virus.

The long distances compelled the team of healthcare workers running the Shanamutango HIV clinic at the Onanjokwe Lutheran Mission hospital, in the Oshikoto region, to launch their outreach project to bring HIV services to remote clinics like the one in Onayena.

Northern Namibia is one of the poorest and most isolated parts of the country, where social services, employment opportunities and infrastructure are thin on the ground.

“Our patients travel as far as 100km. We don’t provide transport … a trip to come here can cost them 30 to 50 Namibian dollars one way, so our outreach programme is bringing the service closer to them,” said Tutaleni Shilyomunhu, acting nursing manager at Shanamutango.

The Shanamutango HIV Clinic – funded by the US President Emergency Plan for AIDS Relief (PEPFAR) – is one of the largest treatment sites in the country, providing ARVs to 8,000 of its 12,500 HIV-positive patients.

“[The country] is doing pretty well. The government has managed to roll out ARVs in a relatively short period of time … it’s a major achievement,” Dr Robert Bennoun, the UNAIDS country coordinator, told IRIN/PlusNews.

The government set out to treat 70 percent of all HIV-positive adults in need of ARVs as part of its goals to provide universal access to care, treatment and prevention; over 55,000 Namibians – more than 80 percent of those in need – are now receiving the life-prolonging medication.

Food, floods and alcohol

The programme still has many obstacles, with lack of food security and transport among the biggest. At the Onanjokwe Lutheran mission hospital, principal medical officer Dr Sithembile Chinyoka commented: “We see it on a daily basis; the great distances our patients travel … most of the children we admit are chronically malnourished.”

Things are not much better in the rest of the country. “Everywhere we go the HIV-positive people we meet are crying of one thing – hunger,” said Bernard Kamototo, who works for Lironga Eparu, the national network of people living with HIV/AIDS.

Most Namibians live on less than US$2 a day; having enough to eat is a constant burden, while water scarcity, erratic rainfall and poor soils have made subsistence agriculture even harder in recent years.

Chronic malnutrition is rising: figures from a recent demographic health survey indicate that 30 percent of Namibian children under five are so malnourished that their growth is stunted – in 2000 the stunting rate was 24 percent.

Dr Agostino Munyiri, chief of health and nutrition at the UN Children’s Fund (UNICEF), noted that “nutrition is an area we are all grappling with … the health system doesn’t know how to approach this subject.”

The worst floods to hit Namibia in four decades have also hampered crop production, affecting more than 350,000 people in six regions with some of the highest HIV-prevalence rates in the country.

Photo: Laura Lopez Gonzalez/IRIN

Northern Namibia is one of the poorest and most isolated parts of the country

Bennoun told IRIN/PlusNews that the treatment of HIV-positive people in the flood-affected regions had been interrupted because they were cut off from health facilities and had no money to travel.

In the Caprivi Strip, a finger of territory bordered by Zambia in the north and Botswana in the south, widespread flooding when the Zambezi River burst its banks meant the only option was to go through Zambia to access ARVs, but most people had no travel documents or cash, he said.

Floods and lack of food were not the only reasons people defaulted on their therapy: colourfully-painted shebeens (unlicensed bars) are a common sight in Namibia’s towns and townships, where they sell cheap local brews that have led to high levels of alcohol abuse.

“Too many people are unemployed and struggling, and the only thing they can do to make themselves feel better is to drink … but that is when the problems start,” said Kamototo, who visits shebeens to raise awareness about how to prevent HIV and treatment adherence.

Prevention: the weakest link

The country’s treatment success story has been largely due to external funding. Two-thirds of the treatment programme is financed by key donors such as PEPFAR and the Global Fund to fight AIDS, Tuberculosis and Malaria, while the rest of the bill is picked up by the ministry of health. “[The government] is moving towards sustainability, but they’re not picking up as much as they can,” Bennoun acknowledged.

Namibia is classified as lower-middle-income country, causing it to lose out on some much-needed donor funds; in the current global economic crisis, the country’s health budget was going to be placed under even more pressure, he warned.

With the number of new infections still stubbornly high, the treatment programme might not be successful for very much longer. “This is one of the many reasons for the urgency of doing a hell of a lot better on prevention,” Bennoun pointed out.

Implementing a treatment programme was always going to be easier than dealing with more complex human behaviour. For instance, the numbers of people being tested for the HI virus are still well below the universal access targets, and there has been no significant decline in HIV prevalence.

There is hope that the new national strategic plan covering 2010 to 2015, which is “very much evidence-based and results focused”, will address inadequate prevention efforts.

“[The treatment programme] is a major achievement; the ministry of health is extremely active, vocal and visible,” Bennoun told IRIN/PlusNews. “They haven’t done well on prevention, but recognise that and are taking steps to lift their game.”

kn/he source.irinnews.org

Photo: Phuong Tran/IRIN

Mozambique is also increasing its number of trained physicians

NAIROBI,  – The use of mid-level health workers rather than doctors to prescribe antiretroviral treatment (ART), a strategy called task-shifting, has enabled Mozambique to triple the number of facilities providing medication within six months, according to a new study.

The report, published in the in the latest edition of the Journal of Acquired Immune Deficiency Syndromes, by Kenneth Sherr from the University of Washington and officials in Mozambique’s Health Ministry, found that patients from rural and disadvantaged areas could also access quality ART services as a result of the task-shifting.

Shortly after independence in 1974, the majority of physicians – mostly Portuguese nationals – departed from Mozambique, leaving fewer than 80 physicians to care for a population of 10.6 million.

Since then the country has largely relied on ‘técnicos de medicina’ – non-physician clinicians who undergo training for 30 months – to provide the clinical and managerial tasks ordinarily carried out by doctors.

Political instability and economic structural adjustment programmes in the 1980s hit Mozambique’s health system hard, forcing the closure of up to 50 percent of public health centres. HIV prevalence reached 15 percent in 2003, yet only one percent of people had access to treatment; the government again looked to técnicos to fill the gap.

Rapid expansion

“Because the numbers of existing physicians were inadequate to cover the large number of facilities in the rapid scale-up, the national plan included a renewed effort to train new técnicos as an essential element of workforce expansion for HIV care,” the report noted.

By mid-2006, the first wave of newly graduated técnicos had been deployed at health facilities; about a year later 167 health centres covering 147 Mozambican districts and municipalities were providing treatment.

The scale-up also integrated ART into public healthcare, so physicians and técnicos would attend to all patients, not only those infected with HIV.

“Deployment of newly trained técnicos provides opportunities to staff rural and smaller urban clinics with clinical cadres that are more likely to continue to work in public healthcare. Furthermore, training, salaries, and benefits cost less for técnicos than for physicians,” the authors said.

More on Task-shifting

More training needed for task-shifting to work

Government empowers nurses to boost ARV treatment

Nurse-led model can work

Solving health worker shortages

“Supported by the integrated care approach, the number of facilities with ART tripled over a six-month period, including predominately small, rural, and peri-urban health centres, 45 percent of which were managed by a técnico de medicina.”

A continuing effort

Mozambique is also increasing its number of trained physicians; student intake at the country’s main medical school has doubled, and two new medical schools have been opened. According to the study, the quality of care provided by técnicos is equivalent to or better than that provided by medical doctors.

However, an evaluation of the técnicos’ training found that they were not sufficiently prepared for actual clinical responsibilities, especially where health system resources were inadequate, and the health workforce would have to be multiplied several-fold to achieve the United Nations Millennium Development Goals.

Nevertheless, the report concluded that “Using a mix of physicians and responsible task-shifting to non-physician providers, the Mozambique health system can maintain its momentum in ART scale-up while strengthening the wider public healthcare system.”

kr/kn/he source.irinnews.org

Photo: Shervorn Monaghan/IRIN

The Kampala Convention could affect the global debate on “climate migrants”

JOHANNESBURG,  – An African international agreement has opened the door to a debate on the rights and protection of people displaced by natural disasters, with a nod to migration as a result of climate change.

The Kampala Convention, a ground-breaking treaty adopted by the African Union (AU), promises to protect and assist millions of Africans displaced within their own countries. Significantly, the treaty recognized natural disasters as well as conflict and generalized violence as key factors in uprooting people.

Jean Ping, chairperson of the Commission of the African Union, told IRIN that “more and more people are likely to be displaced” as Africa experiences more frequent droughts and floods brought about by climate change.

He said the inclusion of displacement by natural disasters was informed by the global debate on the need to develop a framework for the rights of “climate refugees” – people uprooted from their homes and crossing international borders – because the changing climate threatened their survival.

The reference to people displaced by natural disasters is as an interesting attempt to find… answers to the new concern about migration linked to environmental degradation

The treaty also calls on governments to set up laws and find solutions to prevent displacement caused by natural disasters, with compensation for those who were displaced. Migration expert Etienne Piguet said with the Kampala Convention the AU had “once again” tried to push the envelope.

In 1969 the Convention Governing the Specific Aspects of Refugee Problems in Africa, adopted by the then Organization of African Unity, had gone a step further than the 1951 UN Refugee Convention by using a definition of “refugee” that included not only people fleeing persecution but also those fleeing war or events seriously disturbing public order.

Piguet described the reference to people displaced by natural disasters as an “interesting attempt” to find “adequate answers to the new concern about migration linked to environmental degradation”.

In 2008 climate-related natural disasters like droughts, hurricanes and floods forced 20 million people out of their homes, while 4.6 million people were internally displaced by conflicts, according to a recent joint study by the UN Office for the Coordination of Humanitarian Affairs (OCHA) and the Geneva-based Internal Displacement Monitoring Centre.

The Representative of the UN Secretary-General (RSG) on the Human Rights of the Internally Displaced Persons in a submission to the UN Framework Convention on Climate Change noted that people uprooted from their homes by natural disasters enjoyed protection under the existing human rights law and the guiding principles on internal displacement.

However, the Kampala Convention also calls on governments to “prevent or mitigate, prohibit and eliminate root causes” of displacement, and find “durable solutions” to them.

Moussa Idriss Ndele, President of the Pan-African Parliament, the legislative body of the AU, said the debate in Kampala on the rights of people displaced by natural disasters did not “quite evolve properly – we did not address the issue of climate change” because most people still believed conflict was the biggest trigger of displacement.

Can of worms

However, it was unclear which events could be linked to climate change. “More and more people are being displaced by floods, which are becoming more and more frequent and intense,” said Rachel Shebesh, chair of the African Parliamentarian Initiative for Climate Risk Reduction.

The RSG said there was a need to clarify or even develop a legal framework to help people who moved inside or outside the country because environmental degradation and slow-onset disasters – like desertification, salination of soil and groundwater – made areas uninhabitable, and if displaced persons could not return to their homes they should be considered forcibly displaced.

The Intergovernmental Panel on Climate Change (IPCC) has projected more frequent and intense floods and droughts in Africa during the next few decades, and the debate is not only set to continue, but to intensify.

jk/he source.irinnews.org

Photo: Sarah Simpson/IRIN

A market vendor in N’zérékoré (file photo)

DAKAR, 3 – Local civil society activists say Guinea’s latest political crisis has taken on an ethnic dimension in N’zérékoré – junta leader Moussa Dadis Camara’s home region – which has an ethnically mixed population and has experienced communal clashes before.

The 28 September killing of over 150 civilians by security forces in the capital Conakry triggered tension in the southeastern Forest Region.

NGOs and local authorities are trying to rein in ethnic dissension and establish dialogue among the various communities in the region.

This week the regional capital, the city of N’zérékoré, remained relatively calm but with underlying tensions, residents told IRIN. They said the days ahead would be crucial for maintaining peace.

Immediately after the Conakry killings rumours emerged in N’zérékoré that local members of the Peulh ethnic group would demonstrate against Camara and that the Guerzé, the junta leader’s ethnic group, would react violently against anyone participating.

On 10 October civil society organizations and religious and traditional leaders held a “day of dialogue”, amid what a report from the meeting called “a national crisis that compromises stability”.

“At the meeting people from the Peulh and Guerzé communities said there was no truth to the rumours,” said Béatrice Kolié, facilitator in conflict resolution with the NGO Réseau de Femmes du Mano pour la Paix (REFMAP). REFMAP and a local traditional communicators’ NGO initiated the meeting, with the support of the NGOs Faisons Ensemble and World Education.

Kolié said after the talks tensions had eased considerably. “But we don’t yet know where these rumours originated.”

The meeting report said: “It is important to note that even though the rumours were groundless they were about to set ablaze the region, and beyond that the country.”

After the events of 28 September political conflict took on an ethnic tone in N’zérékoré, Kolié said. Another observer, who requested anonymity, said there is palpable tension between Guerzé and Peulh youths. One day in mid-October some N’zérékoré neighbourhoods were strewn with flyers that read in part: “If Dadis leaves power, the Peulhs leave N’zérékoré”.

N’zérékoré is no stranger to ethnic tensions: In the past there have been clashes between Malinké and Guerzé.

Ethnic dimension

Guinea’s ethnic makeup consists of Peulh (a majority at about 40 percent), Malinké, Soussou, and several smaller groups from the Forest Region. From independence in 1958 to the 2008 coup bringing Camara to power, the country had two presidents – one Malinké and one Soussou. Observers say many Peulh think it is “their turn”. Meanwhile Camara supporters are seen as playing on the exclusion of Forest Region ethnic groups, according to International Crisis Group (ICG).

“No matter how you look at it, in Guinea the ethnic dimension constitutes a very prominent element in every socio-political aspect,” Mohamed Jalloh, Guinea expert with ICG, told IRIN.

One man who said he was beaten by soldiers on 28 September in Conakry told IRIN every soldier he came in contact with asked him his ethnicity. Youths in Conakry said in the following days soldiers harassed and threatened Peulh people. The current defence minister, Sekouba Konaté, has links with rebel and militia groups from Guinea’s and neighbouring Liberia’s recent past, according to ICG, who says in its latest report that the junta is training militias in the southeast.

Kola nuts and caravans

In opening the 10 October meeting in N’zérékoré – after a moment of silence for the 28 September victims – a sage presented 10 kola nuts each to community representatives as a sign of welcome and brotherhood.

Members of several ethnic groups discussed the situation, with traditional and religious leaders reminding participants that they are all part of one Guinea and if the nation suffers, all suffer.

A Peulh Islamic leader at the meeting, who has lived in the region for more than 40 years – “in perfect harmony with my Guerzé hosts” – urged participants to work for national unity.

One of the recommendations from the meeting was that citizens and authorities go after rumour-mongers. “Identify, denounce and interrogate those propagating rumours,” the report recommends, adding: “This assumes the effective involvement of the authorities, defence and security forces and the judiciary.”

The participants also recommend using local radio to defuse rumours, reviving local structures aimed at preventing conflict, holding more dialogue days, organizing youth prayer days, and forming interethnic and religious committees.

In another initiative local civil society groups conducted a “peace caravan” in which people gathered and visited representatives of various ethnic communities, to shake hands and talk.

“This was to reinforce national unity,” said Auguste Impérial Théa of a N’zérékoré peace and development coalition; he helped organize the caravan. “There was a serious tear in the social fabric and that is dangerous.”

He added: “We plan to expand the caravan to the rest of the region. This is giving people a chance to talk about the fear that is in their hearts.”

Intra-ethnic threats

One Guerzé man who requested anonymity said ongoing peace-building efforts must immediately be concentrated on the youth, claiming that young Guerzé reject – often violently – the slightest criticism of junta leader Camara. He said he knows a woman market vendor who was recently beaten by some youths for selling goods to Peulhs.

Photo: Nancy Palus/IRIN

Road to the airport in N’zérékoré

One day he heard a group of Guerzé youths alleging that the international media were paid by the Peulh to spread bad information about Guinea. “When I spoke up and simply asked them if they could say that Dadis’s actions up to now have really been noble, they roughed me up and threatened me with a knife, calling me a traitor and a bastard – saying that I must not be a true Guerzé. I was completely taken aback.”

When he went to a lawyer about the confrontation the lawyer said that given the current conditions in Guinea it was best to keep quiet. “The lawyer told me, ‘Otherwise you’ll give up your life for nothing.’”

ICG in its report expresses concern over inter-communal violence in the region, noting that a top junta official recently on a visit to N’zerekore declared, “Dadis or death”.

The Guerzé man told IRIN on another occasion he was threatened again when he tried to ease hate talk against the Peulh.

“I heard a group of Guerzé youth saying they would have to eliminate some Peulhs to diminish their number in Guinea. After the initial incident I had vowed I would keep quiet, but this disturbed me so much; I just had to say something.” He said he told the youths that hurting or killing Peulh would solve nothing.

“Later that night the group – with a few additional people – came to my home… two people in the group who have known me for a long time urged the others not to harm me.”

He added: “But I live in fear. Every day I fear they could come to my home and attack me.”

Conflict resolution worker Kolié said communities must continue to meet and talk. “In conflict prevention we cannot say, `we’ve done this and that and now we’re finished’. It must be ongoing.”

np/ci/cb/bp source.irinnews.org

Written By:PPS   , Posted: Wed, Oct 28, 2009