In order not to cause controversy during his presidency, President Obama has decided to exclude visiting Kenya.

The president is well aware that any visit to Kenya and especially during an election year will jeopardise his chances for re-election. This is so, because many Americans have all along demanded to know where he was exactly born.

There has been claims that he was born in Hawaii while other inquisitive Americans insist that he is born in Kenya and if this is agreed upon, it will force the law-makers to indict the president for having hidden his real identity by birth.

The American constitution states that one must be born American to qualify to become the country’s president.

The speculations therefore on Obama’s birthplace will continue until he personally swears an affidavit and publicly show the American people his genuine birth certificate.

Already, some States in the USA are planning not to include his name on the ballot paper.

End

Photo: Guy Oliver/IRIN

Many health care workers have moved to cities and better paying jobs

ANTSOHIHY,  – The Basic Health Centre or Centre de Santé de Base (CSB) II in Anjalajala, near Antsohihy, the capital of Madagascar’s northern Sofia Region, is housed in a recently renovated building and its status as a CSB II promises the availability of a trained doctor. But the doctor left for Antananarivo, the capital, in 2002 and has not been replaced, and whenever the remaining nurse is absent, services stop.

A guard sweeping the courtyard explains that currently the health worker is away visiting his mother and will only return in a week.

The situation at this clinic is not unique in Madagascar, where an already weak healthcare system has been in a state of decline since 2009 when the international community branded Andry Rajoelina’s ousting of President Marc Ravalomanana a coup, and donors halted all but emergency aid.

In the absence of donor support, the Malagasy government made dramatic cuts to its budget for social services. In 2010, expenditure on health care fell by 30 percent compared to the year before, while the health budget for 2012 is half what it was in 2011.

One of the consequences of these cuts has been the closing down of many community health centres. According to figures from the UN Children’s Fund (UNICEF), 214 health centres had closed by January 2011, in most cases due to a lack of health workers.

In the provinces, health workers often do not receive their salaries, and many have migrated to the cities where they get better paying jobs in the private sector.

The community health centres were part of a national health programme started in the 1980s which dispatched health workers to remote areas of the country with the goal of achieving universal health care by the year 2000. By 2004, the Health Ministry listed almost 3,000 such centres, known as CSBs, on its web site.

These centres were supposed to be staffed by a qualified nurse and, in some cases, a midwife and all staff were to receive a higher level of training via the Health Ministry than in the past.

The goal of health for all was never met, but in the years before the crisis, there was progress. Following findings in 2006 that many of the CSBs were understaffed and insufficiently equipped, 197 of them were renovated and re-equipped.

According to the World Health Organization (WHO), average life expectancy went up, polio was on the verge of being eradicated, and infant mortality decreased from 98 deaths per 1,000 in 1993, to 58 in 2006.

Pre-2009 gains lost

However, even before the crisis, the health system only reached an estimated 60 to 70 percent of the population – those living in regions served by roads – while many people still had to travel 10km or more to get treatment. As health centres close down, people have to travel even further and many of the gains made before 2009 have been lost.

We often hear that patients tried to see a doctor at a public health post first, but there was no one there

“We often hear that patients tried to see a doctor at a public health post first, but there was no one there,” said hospital director and surgeon Adrien Ralimiarison of the Baptist Good Hope Hospital in Mandritsara, also in Sofia Region. “On the other hand, because of the crisis, people wait until they’re really sick before they go to see a doctor.”

According to Achu Lordfred, a technical adviser on reproductive health with the UN Population Fund (UNFPA), many health centres function poorly due to a combination of systemic issues, including lack of training. “Health workers do not have adequate training in community health, so they will just sit there and wait for patients to come to the health facilities,” he said. “If the health centre has no supplies or medicine, and the only thing the health worker can do is refer patients to the hospital in town, people will stop visiting the CSB.”

Footing the bill

Although treatment is free for the poor, reaching a distant hospital costs money and once a patient arrives, there are other costs. As hospitals struggle to function with insufficient funding, patients and their families must foot the bill for basics like bed sheets, bandages and food, and there is also a social expectation that the treating doctor be rewarded with a gift.

Despite its status as the main referral facility for a region of one million inhabitants, the hospital in Antsohihy lacks the most basic supplies, like food and mattresses for patients, and its maternity ward relies on supplies donated by UNFPA.

Director of the hospital Briand Zafinandriamanalina said the government had also recently stopped sending money for a social equity fund used to provide free health care to the poor. “We now have US$3,000 left [in the fund] for this year,” he told IRIN. “Normally, this could last us for a few months when we count the usual amount of emergencies and the accidents on the road here, but in case of a big accident, the fund could be used up in days.”

Zafinandriamanalina added that hospitals also lacked specialists, with many regional hospitals having only one surgeon to handle all operations. “Specialist doctors are in the capital, and they don’t want to come to the provinces and regions to work,” he said.

Lordfred of UNFPA noted that Madagascar’s general practitioners were not trained to perform lifesaving procedures like Caesarean sections. “This makes them much less effective in the provinces,” he said.

Health Ministry lacks funds

With no end to the political crisis and the lifting of sanctions in sight, international NGOs have taken on the task of keeping Madagascar’s health system going, with mixed results. UNICEF, WHO and UNFPA are all involved in training health workers and supplying health centres with essential drugs so that they can stay open. According to the World Bank, external financing of the health sector went up from US$92 million to US$160 million between 2008 and 2010.

However, without a national policy to set priorities, coordinate efforts and drive initiatives, aid efforts have been fragmented and the health system has continued its decline. As a result of the sanctions, aid has had to go directly to individual health centres and hospitals or to local NGOs rather than to the Health Ministry.

UNFPA set out to recruit 50 midwives last year to send into the provinces, but ended up finding only 28, as trained midwives also prefer to work in the cities and the government agencies that used to regulate their training and postings no longer function. “There are many ways to encourage and retain doctors to work in remote areas,” said Lordfred, “but it needs appropriate training and improved working conditions.”

ar/ks/cb
source www.irinnews.org

Photo: IRIN/Anthony Mitchell

The number of food-insecure people could increase (file photo)

ADDIS ABABA,  – Aid agencies are calling for more food assistance for areas in southern and northeastern Ethiopia where erratic rains have adversely affected the mid-February to May `Belg’ crop.

“We have a very significant shortage of food in much of [the] `Belg’ season dependent areas of the country particularly in SNNPR, [Southern Nations, Nationalities and People's Region]” Mike McDonagh, head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Ethiopia, told IRIN.

Other affected areas include parts of the northeast in the Amhara, Oromia and Tigray regions.

The `Belg’ harvest, which accounts for up to 40 percent of annual food production in some areas, is expected to reduce in 2012 due to the late onset and below-average performance of the mid-February to May rains, which were 2-8 weeks late.

“The situation is of concern and is being monitored closely,” said Judith Schuler, spokesperson of the UN World Food Programme (WFP) in Ethiopia, adding that the number of food-insecure people could increase.

At present, an estimated 3.2 million people are food insecure in Ethiopia, down from a peak of 4.5 million during the 2011 Horn of Africa drought. Revised figures are expected in mid-July.

WFP requires US$183 million by the end of 2012, to support 2.5 million of the 3.2 million people in need of emergency food assistance.

The situation in SNNPR, which borders Kenya and South Sudan, is of particular concern.

The `Belg’ crop harvest there accounts for 35-40 percent of production, with root crops, mainly sweet potatoes, contributing 50 percent of the harvest in some districts. But the extended dry period had resulted in an almost total failure of the crop – and others such as haricot beans, potatoes and maize, which were expected to fill the food gap between March and June – according to the government’s latest (May) Early Warning and Response analysis.

Aid agencies say a lack of sufficient recovery time after the 2011 drought could aggravate the situation for vulnerable households whose assets and other coping mechanisms were depleted.

Malnutrition rising

Already, the number of malnourished people is rising, said OCHA’s McDonagh.

According to OCHA, close to 90,000 children, pregnant women and nursing mothers in SNNPR alone are moderately malnourished at present, and the number is increasing.

“March was worse than February, April was worse than March and we expect May to be worse than April,” said McDonagh. “So it gets worse for a period and then maybe around July and August… it could reduce again.”

“We need general rations, what we call relief food. We need more supplementary food. We need therapeutic foods and we need also inputs such as seeds.” 

The number of severely malnourished children in therapeutic feeding programmes is increasing, with earlier and greater increases than in 2011, according to the Agriculture Ministry’s Emergency Nutrition Coordination Unit.

For example, from January to February, admissions to the programmes increased by 15.3 percent and went up a further 27 percent from February to March. The March to April figures are not available.

According to Mitiku Kassa, Ethiopia’s minister of agriculture, the agriculture and health ministries are monitoring the food insecurity situation.

“Irregularity in rainfall seasons resulting [in] problems of such [a] kind is not a new thing to us,” Mitiku said. “We faced it last year and a year before that and we are managing it so far… The country has enough resources and mechanisms in place to deal with it this time, though.”

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source www.irinnews.org

Almost 60 percent of its people have been affected by food shortages – one million of the 1.7 million population are in need

Coverage of the food crisis in the Sahel has ramped up in the past few months, but attention has eluded The Gambia. Ezeala reasoned that perhaps the crisis in The Gambia was still developing into an emergency, and so had not yet caught the attention of the international media.

Aid workers say the government issued warnings early enough – the first one jointly with UN agencies in October 2011. In January 2012, the government declared the 2011/12 agricultural season a failure and drew up a $23 million plan with a list of actions to prepare farmers for the 2012/13 agricultural season.
In rural areas, 409,000 people (of whom 67,500 are children under 15
years) are seriously affected by the poor harvests. “Overall, vulnerability to food insecurity will continue to rise in the country,” UN agencies are warning.

Another about 192, 850 people living in the poorest urban areas are still recovering from floods in previous seasons and are vulnerable to food insecurity, rising food prices and additional economic pressure from helping relatives in affected rural areas.

Shocks and funding issues

Though farming is the main source of livelihood for some 75 percent of the population, especially rural women, Gambian farmers have to rely on rainfall – only six percent of agricultural land is irrigated, mostly for growing rice in the Central River region. Food production has fallen short of the country’s consumption needs for decades, according to FAO.

The gap has widened further in the past few years because of climatic shocks and “international donors’ reluctance to support a government accused of using strong-arm tactics in the face of opposition”, the agency said.

As in other parts of the Sahel zone, rains in The Gambia have been thin. Many climatologists have published data suggesting that the Sahel zone has not really recovered from a severe drought in the in the 1960s.
 
Can rains be thin?

Climate scientist Chris Funk, of the US Geological Survey, has been studying rain and temperature data for the Senegal from 1900 to 2009.

“If the Gambia follows the general trend for Senegal (which seems
likely) our analysis would suggest large increases in air temperatures and more-or-less flat rainfall since 1970, indicative of a failure to recover from the steep post-1960s rainfall decline,” he said.

There has not been much outside help. Donor grants averaged only about two and a half percent of the gross domestic product (GDP) per year from 2007 to 2010, the International Monetary Fund (IMF) reported in December 2011. “Some potential donors have expressed concern over human rights and freedom of the press,” it noted.

The Gambian government has been accused by several international rights groups, including Amnesty International, of constraining people’s right to freedom of expression and political freedoms.  

The Gambia does not have enough money to invest, as income from tourism, its main revenue earner, dropped because of the global recession in recent years. The government has been borrowing heavily – Gambia’s domestic debt was just over 29 percent of GDP in 2010, and interest consumes nearly one-fifth of revenues.

In 2010, the government launched the ambitious five-year National Agriculture Investment Plan (GNAIP), a $266 million strategy to drive agriculture-led growth. The plan, scrutinized by the African Union’s Comprehensive Africa Agriculture Development Plan, hoped to push up the contribution of its cash crop, groundnuts, to 30 percent of export earnings.

Almost every household in the rural areas grows groundnuts, but farmers are extremely vulnerable to price variations on international markets and the weather. Poor rains in 2011 also affected groundnut production.
The IMF noted in March 2012 that while tourism seemed to have picked up in 2011, GDP growth fell because of sharp contractions in the rice, groundnut and millet harvests.

Various UN agencies have received about $4.8 million from the UN Central Emergency Response Fund to respond to the crisis in The Gambia.

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source www.irinnews.org