India Poised to Supply Free Drugs to 1.2 Billion People

November 9, 2012 by

Global Geopolitics & Political Economy / IPS

Zofeen Ebrahim

BEIJING, Nov 08 (IPS) – As the northern Indian state of Rajasthan rolls out an ambitious universal healthcare plan, the discontent of the state’s doctors stands in stark contrast to the joys of the 68 million people who will benefit from the scheme.Just a little over a year ago, the state government began supplying free generic drugs to its massive population, effectively stripping doctors of the ability to prescribe more expensive branded medicine.

Some 350 essential generic drugs are now being distributed free of cost. As a result, outpatient visits have jumped 60 percent and inpatient admissions are up 30 percent, despite the fact that public health facilities are overcrowded and understaffed, and many people have to travel long distances to reach one.

According to news reports, over 200,000 people are currently taking advantage of the programme.

“(This) has broken the cosy relationship enjoyed for decades between doctors and (drug) manufacturers,” Dr. Nirmal Kumar Gurbani, advisor to the Rajasthan Medical Service Corporation (RMSC) that was constituted by Chief Minister Ashok Gehlot to run the scheme, said during a presentation at the Second Global Symposium on Health Systems Research in Beijing last week.

Gurbani, a professor at the Indian Institute of Health Management and Research (IIHMR), added that the ‘Rajasthan model’ is being used as pilot for a similar scheme throughout India, which could bring free drugs to the country’s 1.2 billion residents.

One of the programme’s goals is to end price manipulations of private pharmacies and manufacturers.

“Cipla, for example, produces three kinds of ‘cold’ tablets, which all have the same chemical ingredients. It sells the generic drugs to pharmacies at a wholesale price of about two Indian rupees (0.03 dollars) per pack (of ten tablets) but sells the branded drugs for 23 rupees (0.42 dollars) per pack.

“The chemist then sells all three drugs for anything between 27 to 39 rupees (0.50 to 0.72 dollars) as per the printed price. Thus the patient is at the mercy of the doctor or the pharmacy, and will take whichever drug is recommended to him,” Gurbani explained to IPS.

To counter this practice, the government now buys generic drugs directly from the manufacturers and has “developed infrastructure to hand them over to patients through the 13,874 (approved) drug distribution centres,” Gurbani added.

Patients that are obliged to embark on lifelong drug courses – for conditions like diabetes or heart disease – have hitherto struggled to make their payments.

“A particular brand of medicine used for diabetes costs 117 rupees (2.17 dollars), but we purchase 10 tablets of generic medicines for diabetes at 1.97 rupees (0.036) dollars,” said Gurbani, adding that the difference in pricing certainly did not mean a compromise on efficacy and quality.

Changing lives with free medicine

Gurbani, a former secretary of the Essential Drug List Committee for the Rajsathan state government, says medical expenses are the second most common cause of rural indebtedness in India.

Citing official data, he told the audience at the conference that more than 40 percent of those hospitalised in India needed to borrow money or sell assets in order to afford treatment.

The cost of a single hospitalisation has pushed 35 percent of patients below the poverty line. In fact, unaffordable healthcare has prevented over 23 percent of the sick from consulting a doctor.

The scarcity of medical professionals has contributed to healthcare costs reaching astronomical rates. According to the World Health Organisation, India has just 6.5 physicians to every 10,000 patients. By comparison, China has 14.2 doctors, while Britain has 27.4 physicians for the same number of patients.

The expenditure on drugs alone constitutes between 50 to 80 percent of healthcare costs in India. And all this in a country regarded as the “world’s pharmacy”, Gurbani lamented.

India’s pharmaceutical industry is the third largest in the world with annual production of about 25 billion dollars and domestic sales amounting to 12 billion dollars. India exported medicines worth 13.2 billion dollars in the last fiscal and the government plans to double it to 25 billion dollars by March 2014.

And yet, said Gurbani, “two-thirds of the population do not have regular access to essential drugs.”

Dr. Ravi Narayan, an Indian public health academic who is also part of the All India Drug Action Network, was full of praise for the Rajasthan government’s initiative.

“Rajasthan has a very strong people’s movement and with people like Samit Sharma who heads the RMSC, this was bound to succeed,” he told IPS, on the sidelines of the Beijing symposium.

The runaway success of the Rajasthan model, according to Narayan, has proved that “India is going into the Rajasthan experiment”.

Tamil Nadu, a state of 72 million people, is also providing free medicine for all. Even Karnataka is building on these models, Narayan informed IPS.

With India moving towards universal health coverage (UHC) in the next two years, it has budgeted nearly 300 billion rupees (55.9 million dollars) to fund the programme. It hopes to be able to provide free drugs to 52 percent of the population by April 2017.

The central government will fund 75 percent of the programme, with states doling out the rest.

India’s proposed UHC plan contains many of the features of Rajasthan’s model, such as centralised procurement, regulations to ensure that doctors prescribe cheap generic drugs rather than branded medication, a list of “permitted” drugs and distribution limited to official government health centres.

“It’s not just possible in India, it’s possible all over the world,” said Gurbani.

Obstacles can be overcome

“Conceptually the model has a lot of strength, but it’s difficult from a political perspective. There has to be harmony between the central government and the (28 states and seven union territories) in India,” Abdul Ghaffer, executive director of WHO’s Alliance for Health Policy and Systems Research, told IPS.

With the country’s public health system already under resourced and struggling to meet the needs of 1.2 billion people, 40 percent of whom live below the poverty line, there are serious challenges to expanding the programme nationwide.

There have been occasional shortages of medicines, which Gurbani attributes to the early stages of a project finding its bearings in a geographically diverse region.

“There is the tribal belt as well as the desert and then the urban areas, besides large rural pockets. The needs are different, so at times we ran out of stocks. These teething problems were inevitable; in the course of time, these shortfalls will be eliminated,” Gurbani predicted.

Others at the conference raised thorny questions about the mammoth infrastructure this process will require, hinting that some states may not yet be in a position to set up warehouses and cold storage facilities, or test all the drugs made by roughly 12,000 manufacturers across India.

All rights reserved, IPS – Inter Press Service, 2012.

This article may not be republished, broadcast, framed, or redistributed without the written permission of IPS – Inter Press Service. Republication of this material without permission from IPS, the copyright holder, constitutes a violation of United States and international copyright laws and may result in legal action.


Filed Under: Asia, Featured, Health Tagged With: , ,

Europeans Enjoy Best Healthcare – Africans the Worst

July 14, 2011 by

Global Geopolitics & Political Economy / IDN

IDN-InDepth NewsReport     
    
By Richard Johnson

LONDON (IDN) – Whereas poverty and rampant corruption stand in the way of healthcare facilities in most of the developing lands, ageing population in Western Europe is posing a serious challenge to levels which presently make countries of the region outshine, says a new report.

The world’s worst healthcare coverage and social health protection is to be found in ten Sub-Saharan African countries, which are also characterised by poor governance, lack of adequate infrastructure, poverty, ongoing conflicts and systemic corruption, says an index released on July 14.

The index assessing 131 countries on their levels of healthcare coverage and social health protection has rated 32 nations as ‘extreme risk’. These include in order of their poor rating: Democratic Republic of Congo, Central African Republic, Burundi, Guinea, Guinea-Bissau, Sierra Leone, Cote d’Ivoire, Mali, Chad, and Niger – all in Sub-Saharan Africa.

South Asian countries also feature in the ‘extreme risk’ category with Nepal ranked 14th, the worst performer in the region, followed by Bangladesh, Pakistan ranking 27th and India – a heavy weight among the emerging BRIC economies that also include Brazil, Russia and China – at seated at the bottom of the ladder occupying the 32nd place.

The report points out that overwhelming majority of Indians, especially those in rural areas, are not covered by healthcare. The UN’s International Labour Organisation (ILO) estimates that only 6%of the population benefit from formal health protection.

India also stands out for having high out-of-pocket expenditures, constituting 76% of total health expenditure in the country. Out-of-pocket expenditure refers to the obligation to pay directly for services at the moment of need.

An over-reliance on direct payments at the time of need can act as a barrier to people accessing and receiving healthcare when they need it. According to the India Health Report 2010, 7 to 8% of households drop below the poverty line because of medical expenses.

Western Europe, on the other hand, is stated to host nine out of the ten best performing countries. These are Luxembourg that tops the list, followed by Norway, Netherlands, France, Denmark, Germany, United Kingdom, Sweden, and Iceland. Canada (122) is the only non-European country in the ten "lowest risk" countries.

The report points out that Europe, particularly Western Europe, benefits from high levels of healthcare coverage, but many of these countries face challenges such as rising costs, increasing expectations and the impact on government debt of the 2008/09 financial crisis.

However, Europe’s primary risk to healthcare levels comes from an ageing population, which is putting upward pressure on costs as well as reducing the viability of existing funding mechanisms, says the report.

According to the United Nations World Population Ageing Report 2009, on average across Europe, the old-age dependency ratio is forecast to increase from 24 in 2009 to 47 in 2050; an increase of approximately 50%.

"Healthcare coverage is a key issue in most countries both in terms of availability and financial protection," said Maplecroft Analyst Siobhan Tuohy-Smith. "In terms of financial protection, in some countries individuals and their households suffer severe financial difficulties due to the high direct costs of paying for their care. According to the World Health Organisation, about 150 million people globally suffer financial catastrophe every year, while 100 million are pushed below the poverty line due to healthcare costs."

"Effective and universal healthcare can improve the health of the labour market increasing the capacity for income generation, economic growth and development benefiting employers, individuals and governments," added Tuohy-Smith. "The key challenge for countries is to determine how their health financing systems can provide sufficient financial risk protection to all of the population."

Some countries are already working towards solutions to these problems. For example, Germany’s ageing population means wage and salary earners have declined as a proportion of the total population, making it more difficult to fund its social health insurance system from the traditional sources of wage-based insurance contributions. As a result, the government has injected additional funds to shore up the system.

The Healthcare Coverage Index has been developed by risk analysis and mapping firm Maplecroft in Britain "to enable companies to evaluate levels of healthcare, in countries around the world and to derive from this an assessment of the subsequent impacts on the wellbeing of workforces."

The index is calculated using seven indicators grouped around the following three themes: level of coverage and financial protection, availability of healthcare and quality of services, and health outcomes. (IDN-InDepthNews/14.07.2011)

2011 IDN-InDepthNews | Analysis That Matters

This article should not be republished or redistributed without the permission of the original author or copyright holder.


Filed Under: Africa, Europe, Featured, Health Tagged With:

U.S.: Homeless Fall Through Health Care Cracks

July 14, 2011 by

Global Geopolitics & Political Economy / IPS

By Joe Nolan*

NASHVILLE, Tennessee, USA, Jul 14, 2011 (IPS/ The Contributor) – While Americans are taking sides in the ongoing battle about the future of American healthcare, one underrepresented group is especially vulnerable to the change – or lack of change – that may be afoot: the homeless community.

Most people in the U.S. think that everybody living in poverty is eligible for Medicaid, but this is not the case. Poor adults who are disabled or are parents are most often eligible, but for adults who don’t fall in these categories there may be no safety net available.

A non-disabled childless adult – even with ongoing, chronic health concerns – will likely not find relief and assistance through Medicaid. Mothers who have lost their children to foster care and adolescents who have outgrown the foster care system often also face a tight squeeze between the rock-and-a-hard-place that poverty and lack of healthcare represent. A nationwide study in 1996 found that only a quarter of America’s homeless population was enrolled in Medicaid.

The issues of homelessness and healthcare are so interconnected that it’s nearly impossible to consider the former without investigating the latter. Understanding the relationship between physical health, the cost of care and homelessness is in many ways a Rosetta Stone that clarifies the complex snarl of issues that surround homelessness. As soon as one takes the time to pull at the threads of how America’s healthcare system affects the poor, an understanding about homelessness comes into drastic, dramatic relief.

The relationship between healthcare and homelessness is cyclical, severe, relentless and pervasive. Many people find their exit to a life on the street as a direct result of a health crisis. That desperate path is marked by the too-often tread footfalls that pass from untreated illness into disability and unemployment – which, of course, is a leading cause of homelessness.

In addition, whether a person has insurance or not, the leading cause of bankruptcy in America is a crushing wave of medical expenses. Income and illness are completely intertwined in America’s for-profit healthcare model, and when poor people can’t pay, those poor people may lose their homes. And a life on the streets is a life of illness and injury that starts the cycle turning back on itself.

"Life on the streets is brutal and short," says Bill Friskics-Warren. "Studies done in several U.S. cities have shown that the average lifespan of someone living on the streets is more than 30 years shorter than that of their housed counterparts."

Friskics-Warren manages the United Neighborhood Health Services’ (UNHS) homeless programmes in Nashville, including the Downtown Clinic, the evening clinics in the basement of the Nashville Rescue Mission, and the UNHS’ mobile medical unit. In his experience, homeless people are not only vulnerable to health threats from the elements and violence, but also because of lack of treatment for chronic illnesses and conditions.

"Of the nearly 4,000 different people who were treated at the Downtown Clinic in 2010, 44 percent had high blood pressure, 16 percent were diabetic and 36 percent had documented mental health and/or addiction disorders," says Friskics-Warren.

Among other patients, chronic obstructive pulmonary disease, AIDS, tuberculosis and malnutrition were common along with the ubiquitous anxiety or depression that afflict most everyone who lives day-to-day with no place to call home.

UNHS has implemented a creative array of facilities and services to address the special needs of Nashville’s homeless population. The organisation took over operation of the Downtown Clinic in the fall of 2008, and their mobile medical unit is also allowing them to reach into isolated homeless communities, making healthcare available to people who may have no means of making the trip to the downtown facility or one of the satellite clinics.

"The unit enables us to meet people where they are, whether in a shelter or at a congregate meal site or encampment," explains Friskics-Warren. "Having to venture across the Cumberland River to receive services at our Downtown Clinic can be a barrier to someone who might be camping in Shelby Bottoms.

"Sitting in the almost always crowded lobby of the Downtown Clinic can be difficult for someone with fragile mental health or sensory integration issues. Knocking on the door of our mobile unit when it’s parked outside the day shelter where you wash your clothes each week, though, may be less emotionally or logistically daunting for some people who are homeless."

Many may hesitate taking a trip to the doctor out of anxiety or inconvenience, but most in the homeless community make an even more concentrated effort to avoid medical care. With little resources available and few alternatives at hand, most homeless people will only visit a doctor by passing through the emergency room doors.

As a result, a nasty cut becomes a limb-threatening infection and a seasonal cold results in pneumonia. The excessive costs involved in these preventable emergencies are ultimately another symptom of a healthcare philosophy that reacts to trauma and cures illness rather than maintaining health and promoting prevention. And once a person is discharged back out into the dangers on the street, it’s only a matter of time before they make a return trip.

Facing up to these hard facts, many municipalities and hospitals have begun to implement unique solutions that are designed to break the links between healthcare and homelessness by prescribing shelter as part of their cures.

Seattle, Washington’s Downtown Emergency Service Center has made a dramatic impact on the lives of chronic alcoholics on the streets of the city. The centre’s supportive housing project has seen the incarceration rate of its residents cut in half, while the hospitalisation rate has been reduced by a third.

The financial result for both the federal government and the City of Seattle can be sung to the tune of millions of dollars in savings. In Chicago, Illinois, the Chicago Housing for Health Partnership has also shown that homeless patients who received immediate housing and intensive case management were a third less likely to visit a jail cell or a hospital.

In Nashville, Room In The Inn provides a respite care programme which offers a safe place for homeless people to recover from illness or hospitalisation. Shelter, meals and medications are buttressed by needs assessments and advocacy efforts that attempt to connect patients with mainstream medical services. This web of security and support greatly increases the chances for successful recoveries, and severely lowers the costs incurred from emergency room care and incarceration.

The connections between homelessness, healthcare, state and federal budgets, and the health of the country’s social fabric are abundantly clear: homelessness is a healthcare issue, and when housing is a part of the prescription, everybody wins.

At a recent National Conference on Ending Homelessness, Department of Housing and Urban Development Secretary Shaun Donovan stated, "…if we want to tackle healthcare reform – if we want to lower costs – we must tackle homelessness. It’s that simple."

Regarding the connections between homelessness and healthcare, John Lozier couldn’t agree more. "It’s a profound and well-established relationship." Lozier is the Executive Director of the National Healthcare for the Homeless Council (NHCHC), the blanket organisation of which the United Neighborhood Health Services is a member.

Lozier and his group are one reason why a new understanding about the cost-effectiveness of ending homelessness is beginning to gain traction at the federal level. But it’s been a long road.

In 1986 the National Academy of Science published its groundbreaking report "Homelessness, Health, and Human Needs." The report clarified a trinity of relationships between homelessness and healthcare that demonstrated the profound connections between the two issues: 1) Poor health leads to homelessness; 2) Homeless people receive poor healthcare; 3) Homelessness complicates treatment.

Almost exactly a year ago, a quarter of a century after the report came out, the Obama administration enacted Opening Doors: The Federal Strategic Plan to Prevent and End Homelessness, a programme that intends to end child and family homelessness in the U.S. within the next 10 years.

Monitoring and influencing policies that affect the homeless community is a central mission of the National Healthcare for the Homeless Council. "Since our beginning we’ve incorporated policy advocacy into the work we do and the work of the groups we support around the country."

In fact, the NHCHC places much of the blame for the country’s homeless problem on public policy. As NHCHC explains on its website, "Contemporary homelessness is the product of conscious social and economic policy decisions…"

For Lozier, the slippery slope began with federal cuts to the U.S. Department of Housing and Urban Development that began in the late 1970s. "It started in the Carter administration and came to full force under Reagan," he explains. "There was a decision to pull housing supports out from under homeless people."

When it comes to advocating for new policies to help end homelessness, the NHCHC isn’t just fighting for what it perceives to be the needs of people living on the streets. For Lozier and the organisation, healthcare and shelter must be made available to all people regardless of their ability to pay. He supports his argument by citing the United Nations’ Universal Declaration of Human Rights which was adopted on December 10, 1948.

"Human rights are expressions of what is necessary for human beings to live in the first place," he explains. "The first are food, clothing, shelter and medical care. We all have a mutual responsibility to see that we all have these rights." While the U.S. has never endorsed the declaration, Lozier and the NHCHC are spearheading efforts to ensure that programmes like Open Doors continue to move in accordance with its recommendations.

* Published under an agreement with Street News Service.

All rights reserved, IPS – Inter Press Service, 2011.

This article may not be republished, broadcast, framed, or redistributed without the written permission of IPS – Inter Press Service. Republication of this material without permission from IPS, the copyright holder, constitutes a violation of United States and international copyright laws and may result in legal action.


Filed Under: Health, Human Rights, Poverty, Report, United States Tagged With: ,

Cost of Medicare Equivalent Insurance Skyrockets under Ryan Plan

April 26, 2011 by

The plan will lead to seven dollars of waste for every dollar saved by the government.

The Center for Economic and Policy Research
For Immediate Release: April 26, 2011
Contact: Alan Barber 202-293-5380 x115

Washington, D.C.- The budget plan put forth by Representative Paul Ryan has been described by some as a serious, smart plan that will help reinvigorate the economy and reduce the deficit. Ryan’s plan, to revamp Medicare has been described as shifting costs from the government to beneficiaries. A new report from the Center for Economic and Policy Research (CEPR), however, shows that the Ryan proposal will increase health care costs for seniors by more than seven dollars for every dollar it saves the government, a point missing from much of the debate over the plan.

“The Ryan plan does nothing to control private-sector waste in health care costs,” said David Rosnick, an author of the report.  “As a result of the waste in the private system, beneficiaries will end up paying substantially more for Medicare, in effect paying a hefty new tax on their health care.”

The report, “Representative Ryan’s $30 Trillion Medicare Waste Tax,” documents the potential effects of replacing Medicare with a system of vouchers or premium supports and raising the age of eligibility from 65 to 67 as suggested in the Ryan plan, which was passed by the House of Representatives with almost unanimous support from Republicans and no votes from Democrats. The authors note that each voucher under the plan will initially be worth $6,600 for a 65-year-old beneficiary but would be frozen at this amount over the program’s 75-year planning window, paying less and less of a beneficiary’s health care costs over time.

In addition to comparing the costs of Medicare to the government under the current system and under the Ryan plan, the authors also show the effects of raising the age of Medicare eligibility. The paper also demonstrates that while the plan shifts $4.9 trillion in health care costs from the government to Medicare beneficiaries, this number is dwarfed by a $34 trillion increase in overall costs to beneficiaries that is projected based on the Congressional Budget Office’s analysis.

 

About CEPR

The Center for Economic and Policy Research is an independent, nonpartisan think tank that was established to promote democratic debate on the most important economic and social issues that affect people’s lives. CEPR’s Advisory Board includes Nobel Laureate economists Robert Solow and Joseph Stiglitz; Janet Gornick, Professor at the CUNY Graduate Center and Director of the Luxembourg Income Study; and Richard Freeman, Professor of Economics at Harvard University.

Center for Economic and Policy Research, 1611 Connecticut Ave, NW, Suite 400, Washington, DC 20009
Phone: (202) 293-5380, Fax: (202) 588-1356


Filed Under: Budget, Economic Policy, Health, Politics, Report, United States Tagged With:

Q&A: Needing Surgery Shouldn’t Be a Death Sentence

March 13, 2011 by

Global Geopolitics & Political Economy / IPS

Rousbeh Legatis interviews REINOU GROEN of Surgeons OverSeas

UNITED NATIONS, Mar 12, 2011 (IPS) – Surgery saves the lives of millions of people around the world, but only a tiny percent of them live in low- and middle-income countries (LMICs), where a shortage of skills, supplies and infrastructure can turn easily treatable accidents and illnesses into lifelong disabilities and even death.

The world’s poorest receive only four percent of all major surgical operations worldwide, while 75 percent benefit the richest third of the world, according to a 2010 Harvard University School of Public Health study.

In the LMICs, people often "die instead of being operated on", says Reinou Groen from Surgeons OverSeas (SOS), a New York-based group that improves surgical care in resource- poor environments through training and support programmes.

Recognition of these enormous shortfalls in basic and emergency surgical care is urgently needed at the local, national and international level, underscored the surgeon, who has worked in Niger, the Democratic Republic of Congo (DRC) and Sierra Leone.

Groen spoke with IPS about the problem, why women are especially affected, and how this imbalance affects the U.N. Millennium Development Goals (MDGs).

Excerpts from the interview follow.

Q: You have compared the state of surgery in Sierra Leone today with the U.S. Civil War era (1861-1865).

A: Basically we found that the surgical capacity of present- day Sierra Leone is worse off than in the civil war in the 19th century in the USA. Running water was well organised in the U.S., every health facility had a good water supply. In Sierra Leone, we only found two hospitals out of 10 that had running water all the time.

Without running water, sterilisation of surgical equipment and proper hand-washing before operations is impossible. This runs the risks of transmitting diseases. Also electricity is not continuously available in Sierra Leone’s hospitals nowadays.

This means for us that we will never go to work without taking a headlamp, since we have needed that more than once during operations.

In our study we have found also that there are only 0.2 government hospital surgeons per 100,000 people in Sierra Leone compared to 300 surgeons per 100,000 Union Army soldiers. While things like open fractures, limb dislocations, and amputations were commonly employed in U.S. Civil War hospitals, they are rarely managed in Sierra Leone.

Q: What does this mean for patients?

A: Take knowledge of treatment for open bone fractures as an example, where the bones are exposed without overlaying skin. In Sierra Leone, 80 percent of the hospitals cannot perform good care for open bone fractures. This is due to knowledge gaps, lacking human resources and appropriate material.

As a consequence, an infected bone, so-called osteomyelitis, is a common cause of disability and mortality. The treatment for infected bone, which should have been prevented in the first place by good trauma care, is difficult. Long courses of antibiotics and operations to remove the infected bones are needed to first stabilise the critical condition of the patient.

Thereafter the patient often needs subsequent interventions to reduce disability and a long physiotherapy is needed. This full process can take up to months and years. One can imagine the cost which comes with this treatment. An initial good trauma care would have prevented this.

And when it comes to costs, there are actually two types of them: the actual medical costs and the fact that the patient is not able to work in this period of rehabilitation and has no income. This is not affordable for the majority of people in Sierra Leone.

Q: Can you quantify the problem?

A: Well, in Sierra Leone there are only 10 surgeons for 5.3 million women, men and children and in Liberia are only three surgeons for 3.5 million people.

There is no reason to believe that these [same] illnesses are not happening in countries where fewer operations are done, it just tells us that people with these diseases are not taken care of and die instead of being operated on. In developed countries emergency surgery is available for everyone, every hour of the day. In the developing world it is currently simply not available.

Q: Do these shortfalls in emergency and essential surgical care affect overarching development strategies like the U.N. Millennium Development Goals (MDGs)?

A: Yes, definitely. There is a strong need to integrate surgery in the existing MDGs, since there are so many related topics and subtopics: The reduction of poverty (MDG 1), child health (MDG 4), maternal mortality (MDG 5) and the combat against HIV/AIDS (MDG 6) will not be achieved if the surgical capacity is not strengthened. To give you some examples:

Five to 10 percent of [pregnant] women or their child will die in labour if they don’t get their live-saving Caesarean section. This means that you need a hospital with an operating room with anesthesia and skilled personnel to achieve MDG 5.

According to a studies conducted in 2010 in eight low- and middle-income countries (LMICs) – amongst others Sri Lanka, Mongolia, Tanzania, Afghanistan, Sierra Leone and Gambia – this common kind of operation, however, could be done only by 44 percent of rural, community, provincial, or general hospitals and major health centres.

Particularly women will gain from a better surgical care system. If a Caesarean section is available in the hospital, she initially attends to her baby, has more survival chance and she has less risk of developing severe complications when giving birth.

All rights reserved, IPS – Inter Press Service, 2011.

This article may not be republished, broadcast, framed, or redistributed without the written permission of IPS – Inter Press Service. Republication of this material without permission from IPS, the copyright holder, constitutes a violation of United States and international copyright laws and may result in legal action.


Filed Under: Development, Economic Policy, Health, Interview Tagged With: ,

UGANDA: ‘Why Waste ARVs on Sex Workers?’

December 3, 2010 by

Global Geopolitics & Political Economy / IPS

By Evelyn Matsamura Kiapi

KAMPALA, Dec 3, 2010 (IPS) – Sex workers, among the populations most at risk of HIV infection in Uganda, say they are yet to realise their right to health.

Sex workers say they have been left out of national HIV prevention programmes and have difficulty accessing life-prolonging drugs.

"Its not that these [HIV/AIDS] services are not available, it’s about the stigma attached to the sex worker," says Maclean Kamya, a sex worker and human rights defender in the capital, Kampala.

"When we visit health centres, some health workers say, ‘But you are just a sex worker and we are just wasting our ARVs. Why should we give you our treatment? We have to give it to someone who needs it.’ That is total discrimination," she said in an interview with IPS.

According to the latest UNAIDS report, sex workers constituted 10 percent of new HIV infections in 2009. Yet government is using punitive laws to discriminate against the groups considered most at risk, such as sex workers and homosexuals. Activists say this creates stigma and discrimination and leads to denied access to treatment, care and support.

Over the past few months, Uganda’s parliament has been considering several controversial laws, among them the HIV/AIDS Prevention and Control Bill, which human rights activists say can only act as catalysts for the AIDS epidemic by forcing sex work underground. Sex work is already criminal under Uganda’s penal code.

The Prevention and Control Bill criminalises the spread of HIV; far from slowing the spread of the virus, the bill’s opponents say it only makes it more difficult for at-risk populations to get treatment and information about sexual health.

Because of the stigma attached to sex work, Kamya revealed, sex workers who discover their status often become desperate and resort to alcohol and drugs rather than seek help.

"They feel that the world has forgotten them," said Kamya, who is also coordinator of the sex workers’ fraternity in Kampala.

‘Illegal and criminal’

For the sex workers, it’s not just about access to medicines but also striving for the right to assemble, share ideas and forge ways on how to guard against violence, human rights abuses and HIV/AIDS.

Uganda’s government recently prevented the staging of a regional conference on advancing sex workers’ health rights and economic empowerment. The conference, organised by pan-Africanist women’s rights group Akina Mama wa Afrika (AMWA), had attracted sex workers from across the East African Community (EAC) economic bloc and was scheduled to take place in a Kampala hotel.

In a strongly worded letter to the hotel, State Minister for Ethics and Integrity, James Nsaba Buturo, warned that hosting a sex workers conference would be abetting illegality in Uganda.

Buturo later told IPS that there was no way a "prostitutes’ workshop" could take place on Ugandan soil. He defended his actions using provisions in the Penal Code Act and the Uganda 1995 Constitution to justify his actions.

"We have a position as a country which is supported by our laws. So to demand that even when their activities are illegal they should be recognised and supported is criminal really. They should be grounded and reminded about this," he said.

Compromised rights

Kamya said Buturo misunderstood the agenda of the conference which was to focus about leadership skills, building self-esteem and entrepreneurial skills. It also looked at health rights like HIV/AIDS, sexual and reproductive health and economic empowerment.

"Personally I felt really terrible. So ashamed, embarrassed and hurt. We were trying to bring out issues that affect us as sex workers and thought the government would come out and support and appreciate us in our economic empowerment and reproductive health issues. But we were wrong," Kamya said.

AMwA Executive Director Solome Kimbugwe said government’s actions were discriminatory and in violation of women’s rights as the issues for discussion that day were pertinent to women’s health and HIV issues.

"We had a big block around sexual and reproductive health and well-being because we are very conscious of the [HIV] statistics. We are also very conscious of the fact that sex workers have been dying of the HIV epidemic and that they are denied even the inherent rights that all of us abuse; like information, education and health. Many of them are also far away from accessing free ARV’s just because they say they are sex workers," she said.

The sex workers said the minister’s actions were also in contravention of Article 29 the Constitution of Uganda, which guarantees the Freedom of Assembly, Speech and Non-discrimination. They also said the actions were denying them access to information on how to prevent and treat HIV/AIDS amongst them.

"Now we can’t have conversations; we can’t engage. Of course now they are going to go back to hide because it’s very scary. You don’t want to be arrested and wait in any of the jails in this country. The justice process is so long and protracted.

"Most importantly, such conversations allow for sex workers to know that they are active participants in their own journeys, in issues around sexual health, issues around choices and issues around managing the HIV epidemic. The biggest impact is the UNAIDS statistics. It’s very clear," Kimbugwe said.

UNAIDS Country Coordinator Musa Bungudu expressed concern. "The right of an individual to access information, treatment and services should not be compromised for any other thing. We must all be inclusive and not exclusive. By denying the sex workers what they wish to do, we are not being inclusive," he said.

Responding to a statement by Buturo that the current law on prostitution is not strong enough and that the government would want to "draft a new one that responds to the times we are now in," Bungudu cautioned that such a move would need to be in line with international human rights instruments that government has signed up to.

"Whatever [the government] wants to do, it should be in line with the norms of the global community. And whatever human rights commitments Uganda has signed up to, it’s important that they respect it," Bungudu said.

"It’s also important to look at how certain governance policies can support or make a situation worse. Uganda has 1.2 million people living with HIV. As at December 2009, there were 124,000 new infections. Ten percent of these were among sex workers.

"I think we need to be extra careful on doing anything that will help promote these statistics even higher," Bungudu stressed.

All rights reserved, IPS – Inter Press Service, 2010.

This article may not be republished, broadcast, framed, or redistributed without the written permission of IPS – Inter Press Service. Republication of this material without permission from IPS, the copyright holder, constitutes a violation of United States and international copyright laws and may result in legal action.


Filed Under: Africa, Health, Report Tagged With: , , ,

Cancer Treatment Out of Reach for Ugandan Women

November 4, 2010 by

Global Geopolitics & Political Economy / IPS

By Rosebell Kagumire

SOROTI, Uganda, Nov 4, 2010 (IPS) – Josephine Adongo’s heart leapt when she heard that two doctors from Kampala were offering free medical exams in Soroti. She was diagnosed with cervical cancer at a regional hospital more than a year previously, but unable to afford to travel to the capital for treatment.

Adongo, a 68-year-old farmer who lost everything during Uganda’s long conflict against the insurgent Lords Resistance Army, was diagnosed with cancer at the local hospital in May 2009. But the only cancer treatment centre in Uganda was 300 kilometres away.

She was disappointed to find that the visiting doctors had only come to screen women and refer anyone with dangerous signs to Kampala.

The screening, which is rare service to ordinary women across Uganda, was being offered by ISIS-Women’s International Cross Cultural Exchange, as part of the commemoration of ten years of United Nations Security Council Resolution 1325. ISIS is a women’s organisation that seeks to raise attention on the reproductive health of women in post-conflict areas.

Cervical cancer, caused primarily by the human papillomavirus (HPV), is the second most common cancer among women worldwide. In Uganda it ranks as the most frequently occurring cancer among women. According to a World Health Organisation (WHO) September 2010 report titled, "Human Papillomavirus and Related Cancers in Uganda", every year 3,577 women are diagnosed with cervical cancer and 2,464 die from the disease.

Women like Adongo, in remote regions are at high risk.

The number could also be high due to the low level of cancer screening and limited data on the HPV burden in the general population of Uganda. Cancer screening services are only available at regional referral hospitals and many women cannot afford the transport costs to these centres.

Women, particularly from war affected areas, are also at high risk because of massive sexual violence, often gang rapes, they were subjected to.

According to Dr Tom Otim, gynecologist at Mbale Hospital in eastern Uganda, early marriages among rural women also places them at higher risk.

"The other major hindrance to prevention and treatment of cervical cancer is lack of information," said Otim.

"If the women came when the conditions that lead to cancer can be detected it would greatly help. But few women have information about the existence of this cancer."

Most Ugandan women report to health centres with advanced stages of cervical cancer, which include irregular vaginal bleeding and in some cases post menopausal bleeding.

"The outcry of many women is, why do you refer us to Mulago for radiotherapy when we can’t afford it?" Otim said. "It is demoralizing to diagnose a woman and you cannot improve her life. But what is even more painful is when you tell them the service is available but they cannot afford it because they are poor."

The few regional cancer screening and treatment centres are mostly donor funded and once the donor funds are finished, there is little government uptake of the projects.

Helen Angura is a registered midwife trained in cervical cancer screening. The hospital where she works, Mbale regional referral hospital, has been unable to care for women whose tests show early symptoms that could develop into cervical cancer.

The screening project was funded by Women Health initiative under the National Institutes of Health. It was launched in May 2009 but after a year the radiotherapy machine at the hospital is not in operation.

"We have been unable to treat women with lesions that could develop into cervical cancer because the nitrous-oxide gas used to run the machine ran out four months ago," said Angura.

"We have sent letters to the hospital administration since June and we haven’t heard from them. Hundreds of women whom we screened have been waiting."

In a country that spends less than 10 percent of its annual budget on health, issues like reproductive health and especially conditions like cervical cancer are mostly ignored.

Uganda runs a decentralized healthcare system but funding comes from the central government.

Otim says the government must invest in prevention of cervical cancer. HPV vaccines that prevent against HPV 16 and 18 infections are now available but few Ugandans can afford them.

"We have very safe vaccines that have been proven to prevent cervical cancer but one has to pay over 600,000 shillings (US$300) for an entire dose," Otim explained.

There are only two hospitals offering free vaccination. The programmes are all funded by Pathfinder International, an organisation that seeks to ensure that people everywhere have the right and opportunity to live a healthy reproductive life.

The WHO report recommended that government must include HPV vaccines in the national immunization programme if the risk is to be greatly reduced. The report also called for the integration of vaccination and cervical cancer screening programmes so that every woman who is screened is vaccinated. It would also require a countrywide campaign to inform ordinary Ugandans about the disease.

Meanwhile, women like Adongo will have to wait.

All rights reserved, IPS – Inter Press Service, 2010.

This article may not be republished, broadcast, framed, or redistributed without the written permission of IPS – Inter Press Service. Republication of this material without permission from IPS, the copyright holder, constitutes a violation of United States and international copyright laws and may result in legal action.


Filed Under: Africa, Gender, Health, Inequality, Report Tagged With: , , ,

Fake Medicines may Kill a Million a Year

October 28, 2010 by

Global Geopolitics & Political Economy / IPS

By Pavol Stracansky

BUCHAREST, Oct 28, 2010 (IPS) – Central and Eastern Europe is facing "significant challenges" in combating a multi-billion euro, and often lethal, trade in fake medicines, security and pharmaceutical groups have warned.

The region has been identified as a key smuggling route in an illicit trade which is growing every year.

Millions of counterfeit tablets and medicines, some of them containing lethal heavy metals, are smuggled annually. The World Health Organisation (WHO) estimates that 50 percent of medicines sold online are fake.

But while some Eastern European states have brought in strict laws and procedures to fight fake medicine smugglers, criminals in the region are thought to be working with international gangs in neighbouring states to bring contraband medicines into the EU.

Gabriel Turcu, partner at the European anti-counterfeiting organisation REACT, told IPS: "It has been shown that there are people in Central and Eastern European EU member states working with organised gangs in neighbouring countries to bring counterfeit medicines into the European Union and westwards. This is a significant challenge for the region."

Just like the drug and people trafficking trade, the counterfeit medicine industry is estimated to be worth tens of billions of euros per year for crime gangs, and is mushrooming every year.

The United Nations Office on Drugs and Crime has estimated that this year the illegal market in counterfeit medicines will provide more than 75 billion euros in revenues for smugglers — a rise of 92 percent on 2005.

Police forces say that fake medicines, sometimes so well-prepared and packaged that they can fool even healthcare professionals, are being shipped out by crooks in the same illegal consignments as narcotics. Gangs then sell them on to unscrupulous medicine wholesalers or direct to the public online.

Health experts estimate that fake medicines — made from anything from crushed brick to arsenic — cause up to one million deaths a year, and the UN has said they are contributing to growing drug resistance.

Kristian Bartholin, who is involved in drawing up a Council of Europe convention on counterfeit medicines, told IPS: "This trade is potentially lethal and the situation in general is probably worse than we think because so much of the trade is carried out via the Internet. There are a lot of black areas involved where it is hard to get clear information."

India and China are thought to be the main source countries for the fake medicines, but customs officers in central and Eastern Europe have said that they are being brought into Europe on the same smuggling routes used for narcotics and people — through Eastern Europe and the Balkans.

A lack of resources combined with low wages leading to high levels of corruption among customs officers had in the past been identified as making borders in the region invitingly porous for crime gangs.

Although those borders have been ostensibly beefed up and better controlled following Eastern European countries’ accession into the European Union in 2004 and 2007, there are still concerns that criminals could exploit weaknesses in local border controls.

Steve Allen, senior director of global security at the pharmaceutical giant Pfizer, told IPS: "The countries (in Eastern Europe) have extensive land borders, and in general, have great freedom of movement between them, and other neighbouring states. These present challenges to customs and law enforcement in monitoring the movement of any goods.

"It’s also worth remembering that the counterfeit issue is not just about ‘smuggling’ — it’s possible that counterfeits could be manufactured almost anywhere, including Eastern Europe."

Pfizer issued a report earlier this year saying that the market in counterfeit medicines in Europe is worth an estimated 10.5 billion euros annually, with people in Italy and Germany spending the most on what later turn out to be fake medicines — an estimated 3.6 billion and 2.7 billion euros respectively.

EU officials have said that in a two-month period last year 34 million fake tablets were seized by customs officials while the Council of Europe says that in some parts of Europe fake medicines make up between six and 20 percent of the market.

Public awareness of the risks of counterfeit medicines is also low, according to research.

Allen told IPS: "One survey we conducted showed that one in five people in Western Europe were happy to purchase medicines without a prescription, and did not appreciate the potential dangers. We don’t have specifics for the countries (in central and Eastern Europe) but we expect that awareness is pretty similar to what we have seen in other European countries."

While punishments for drug running and people smuggling are severe and risks high, those for counterfeit medicines are generally far less. In some countries production and selling of counterfeit medicines is not considered a crime and in many Western states it was until relatively recently viewed legally as being on a par with trading in fake branded clothes.

"For a long time it was seen more as an economic crime, a matter of copyright infringement. That attitude is changing now and it is being realised for the very serious, and sometimes lethal, crime that it is and hence many countries are now changing their legislation," said Bartholin.

Eastern European states have begun to implement stricter penalties for convicted medicine smugglers — in Romania for instance, prison sentences have been handed down to some smugglers this year. But health experts, pharmaceutical producers and international organisations want clear laws introduced reflecting the severity of the illegal trade.

Turcu, who last week attended a special conference in Bucharest which brought together country representatives and law enforcement officials from across the region to discuss the threat of counterfeit medicines, told IPS: "What is needed is a directive from the EU making it mandatory for countries at national level to qualify counterfeiting as a crime and counterfeiting that harms people as a serious crime."

All rights reserved, IPS – Inter Press Service, 2010.

This article may not be republished, broadcast, framed, or redistributed without the written permission of IPS – Inter Press Service. Republication of this material without permission from IPS, the copyright holder, constitutes a violation of United States and international copyright laws and may result in legal action.


Filed Under: Europe, Featured, Health Tagged With: , ,

HEALTH: Thai Touch in HIV Care Attracts Doctors from Asia, Africa

October 22, 2010 by

Global Geopolitics & Political Economy / IPS

By Marwaan Macan-Markar

BANGKOK, Oct 22, 2010 (IPS) – Northern Thailand’s Chiang Rai province has many charms to draw foreign visitors, from hilltribe communities dressed in colourful ethnic clothes, trips to gentle hills close to the Burmese and Lao borders, excursions to once infamous opium trails and a journey along the Mekong River.

But foreign guests – from neighbouring countries like Vietnam to other nations like China, India, Pakistan, Bangladesh and Papua New Guinea – are also being drawn to the province by a very different attraction – its main provincial hospital.

These visitors, health workers for the most part, spend time at the Chiang Rai Prachanukroh Hospital to learn how Thai health workers have succeeded in reducing the spread of HIV among babies.

"We show them how our team effort, including doctors, nurses, pharmacists and people living with HIV, has been important to bring down the numbers," said Dr Rawiwan Hansudewechakul, chief of the hospital’s paediatric department. "How we train staff in community hospitals to reach out to people in distant areas has been part of this information exchange."

The Chiang Rai hospital’s rise as a learning centre for preventing mother-to-child transmission (PMTCT) of HIV goes back to 1997, when this health facility was chosen by the Thai government for a pilot programme to reduce the number of babies being infected.

It was a natural choice, admits Rawiwan, given that Chiang Rai, close to several of Thailand’s borders with other countries, was in a belt that was severely hit by HIV in the early stages. There were "funerals seen every day and people were feeling helpless," she recalled.

By 2000, when the first foreign doctors started to arrive in Chiang Rai, the local staff had answers to questions how pregnant mothers should be cared for to reduce HIV transmission to their babies. The 55-year-old Rawiwan was among a team of researchers at the hospital who had been grappling with an equally daunting question – "understanding what is the natural transmission of HIV" – since 1991.

Such training courses are part of a broader programme that Thailand’s public health ministry has put into place on the back of its success in curbing the spread of HIV. These have included a 100 percent condom-use campaign and public education initiatives, including care for those living with the disease by offering access to cheaper antiretroviral (ARV) drugs to ensure longer life.

In February this year, the ministry hosted 20 health workers from Bangladesh, Bhutan, Indonesia, Mongolia, Nepal, Pakistan, Sri Lankan and Burma for a 10-day programme in Bangkok on how to manage PMTCT.

In March, health workers from Africa, including Kenya and Uganda, were among a group of 17 who spent a week in the Thai capital to gather insights about ARV therapy.

"These are all part of the South-South cooperation programme that is being promoted by the ministry of foreign affairs," said Surasak Thanisawanyangkoon, head of the international collaboration development section, at the public health ministry. "Treatment and care for mothers and children with HIV is a key area."

"Thai doctors are also sent to the developing countries with which we are cooperating," he told IPS. "They offer knowledge on how to monitor children affected by HIV and how to develop a good surveillance system."

Few Thai public health workers convey this spirit of Thai cooperation more than Dr Krisana Kraisintu. She led researchers in efforts against many odds at the Government Pharmaceutical Organisation (GPO) to locally produce a cheap, generic ARV tablet, replacing the cocktail of three drugs that people with HIV had to take previously.

Since 2002, the 58-year-old Krisana, whose struggles to produce the generic drug GPO-VIR even inspired a play, titled ‘Cocktail’, has been working in Africa to help her counterparts locally produce and distribute the cheaper generics.

Thailand’s efforts in combating the spread of HIV and caring for its citizens living with the disease are reflected in the declining numbers since the first case of the pandemic was reported in 1984. The country has recorded over 1.1 million cases of HIV since the beginning of the pandemic, and 300,000 people among these have died due to AIDS.

Over a third of those infected – close to 400,000 – are women, for whom PMTCT has been pivotal. The percentage of HIV transmission from mother-to-child cases has dropped from 14 percent in the early 1990s in some parts of the country to less than two percent.

In 1991, the number of new HIV cases recorded was 143,000. By 2003, it had 19,000 new cases in a country of nearly 66 million people.

"Thailand’s ability to share its knowledge is not only because it is a middle-income country and wants to be a new global player, but because it has also done a lot to respond to the spread of HIV," said Sompong Chareonsuk, social mobilisation and partnership advisor at the Thai office of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "Many African and Asian countries want to benefit from the knowledge and technical support that the Thais are offering."

Rawiwan’s team of health workers in Chiang Rai is frequently singled out among these kinds of support due to their work in reducing HIV infection rates among children. "We have made the virus go down for 90 percent of children," she pointed out.

All rights reserved, IPS – Inter Press Service, 2010.

This article may not be republished, broadcast, framed, or redistributed without the written permission of IPS – Inter Press Service. Republication of this material without permission from IPS, the copyright holder, constitutes a violation of United States and international copyright laws and may result in legal action.


Filed Under: Featured, Health Tagged With: , ,

ZIMBABWE: Debt Crowds Out Essential Spending on Health

October 18, 2010 by

Global Geopolitics & Political Economy / IPS

By Stanley Kwenda

HARARE, Oct 18, 2010 (IPS) – Zimbabwe’s debt burden of about 8,3 billion dollars, owed to internal and external institutions, is crowding out essential national budget items such as health and basic services, with detrimental effects for particularly women.

Indications are that many Zimbabwean women opt to give birth at home, with some children being born HIV positive because their mothers cannot afford the maternity fees or the fees charged at hospitals and clinics for the prevention of mother to child transmission of HIV, according to the Zimbabwe Coalition on Debt and Development (ZIMCODD).

ZIMCODD is a coalition of organisations working on social and economic justice issues in the politically beleaguered southern African state. Its calculation of Zimbabwe’s debt as being 8,3 billion dollars includes interest costs.

Hospitals and clinics in Zimbabwe’s urban areas charge 250 and 50 dollars respectively in maternity fees. Delivering a baby at state hospitals with the help of a professional midwife costs 173 dollars.

Given that even civil servants mostly earn less than 200 dollars a month, the charges put health services out of reach for most citizens.

Says Tariro Chikwanha: "We cannot get AIDS drugs or drugs for opportunistic infections because they are too expensive." Even the tests to determine whether an HIV-positive person should go on to antiretroviral drugs are out of reach, costing 10 dollars each at state hospitals.

Chikwanha, who has lived with HIV for 13 years, is increasingly worried about the inaccessibility of health services in Zimbabwe. She founded DREAMS, an organisation that works with youths who are living with HIV and AIDS or are affected by it.

"Because of the cost most people give up and wait for death at home," explains Chikwanha.

She blames the country’s unsustainable debts levels for the dearth in state funds for public healthcare. The government has a so-called "social dimension fund" which is supposed to take care of these needs but it is virtually non-existent.

"Government debts are killing us as women. The government should stop getting more loans," Chikwanha told IPS. "We have enough money to look after ourselves. We have diamonds, platinum and gold. They should sell these minerals and get us money to live a better life."

The ZIMCODD ran an awareness campaign against debt and the international financial institutions (IFIs) that ended on Oct 17. The IFIs are the International Monetary Fund (IMF) and World Bank.

ZIMCODD estimates that, at current debt levels, each Zimbabwean owes the IFIs 525 dollars.

According to health ministry statistics, Zimbabwe spends only nine dollars in health fees per person per year. This level of spending is inadequate and the country will not achieve the Millennium Development Goals (MDGs) at this rate.

The awareness campaign’s theme was "responsible lending and borrowing to guarantee people’s social and economic rights" and involved the launch of a "Citizens’ Guide to Debt", theatre plays and a music concert.

"We are using these artistic expressions to help explain the issues of debt and how they affect citizens of Zimbabwe," Dakarai Matanga, ZIMCODD executive director, told IPS.

A play entitled "No loans without us" was performed in Harare, making the connections between national debt and people’s lives and emphasising that the government should consult citizens before taking on loans.

According to the Harare Residents’ Alliance, the channelling of state money to debt repayment means the diversion of money away from basic services such as water. Residents are thus forced to buy water.

Anilia Masaraure, representing the Alternative Business Association (APA), decries women having to work harder because of the perennial lack of water and electricity.

"Women have to spend more time looking for firewood and water instead of operating their market stalls and businesses to earn an extra dollar to fight poverty in their families," Masaraure told IPS. APA is a group of small business enterprises operated by women.

Lovemore Matombo, president of the Zimbabwe Congress of Trade Unions, told IPS that African countries should not repay debt owed to the Washington-based IMF and World Bank.

"In western countries buses and trams move around, transporting two or five people. They can afford to do so because tax is used effectively and transport is subsidised by governments. But when they (westerners) come to Africa they tell us to privatise," argues Matombo.

"They are not doing in Africa what they are doing in their own countries. These (IFIs) are criminal institutions. The debt must not be paid. Paying such debt is like throwing money in a latrine," adds Matombo.

ZIMCODD’s position is that African countries should reject loans that come with conditionalities. It also demands that African governments practise responsible borrowing that is transparent, accountable and channelled towards production rather than consumption.

Furthermore ZIMCODD says parliament and civil society should participate meaningfully in government decisions about loans.

All rights reserved, IPS – Inter Press Service, 2010.

This article may not be republished, broadcast, framed, or redistributed without the written permission of IPS – Inter Press Service. Republication of this material without permission from IPS, the copyright holder, constitutes a violation of United States and international copyright laws and may result in legal action.


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