Over a billion people will continue to face desperate poverty and starvation in 2015 as a result of governments’ failure to crack down on corporate abuses and eradicate global poverty. This warning came today from global justice charity War on Want as British prime minister Gordon Brown joined other international leaders at the UN summit in New York on the anti-poverty Millennium Development Goals.

In China, an estimated 13,000 children have fallen ill since the tainted milk scandal broke. Chinese influence has grown in Africa, as have imports of all kinds products, from running shoes to instant noodles. Bloggers as far afield as Congo and Senegal, concerned about the safety of Chinese products in their countries, are closely following the story.

One month before it will appear before a federal jury in the landmark human rights case, Bowoto v. Chevron, facing charges of torture and wrongful death, Chevron, along with other leading extractive industry companies, will come under the scrutiny of the U.S. Senate’s Subcommittee on Human Rights and the Law. In the hearing, “Extracting Natural Resources: Corporate Responsibility and the Rule of Law,” witnesses will bring to light oil, mining and gas companies’ complicity in human rights abuses perpetrated by public or private security forces in Nigeria, Burma, the Democratic Republic of Congo, and Indonesia.

Things have come a long way since 1973. For a start, many of us now have mobile phones, the most rapidly adopted technology in history. In what amounts to little more than the blink of an eye, mobiles have given us a glimpse of their potential to help us solve some of the most pressing problems of our time. With evidence mounting, Ken Banks asks one question: If mobiles truly are as revolutionary and empowering as they appear to be – particularly in the lives of some of the poorest members of society – then do we have a moral duty, in the ICT for Development (ICT4D) community at least, to see that they fulfill that potential?

Citi and Ashoka's Changemakers are leading the way to unearth the the best solutions to make financial opportunity a possibility for all. The advent of new financing methods - from mobile banking to peer-to-peer lending - are changing the way we access, spend and save our money. "Banking on Social Change: Seeking Financial Solutions for All" aims to unearth the most innovative and cutting-edge methods that allow financial security to become a reality for everyone. The deadline is just days away on October 1st!

With progress towards quality primary health care still slow some thirty years after Alma-Ata, Anthony Seddoh writes that an effective global alliance of global and country actors needs to set positive and realistic paths to implement the declaration’s intentions. In light of the continuing absence of a conceptual framework for addressing longstanding debates and organisational issues, the author considers whether primary health care represents a global orphan in need of fresh guardianship.

Thirty years after the 1978 Declaration of Alma-Ata, it seems the world is still at odds on how best to implement the principles of primary health care. The slow progress in improving health outcomes for all raises questions about the effectiveness of current ways of doing business. A concerted global alliance of global and country actors needs to set positive and realistic paths to implement the intentions of Alma-Ata.

Sixty years ago, the World Health Organization (WHO) stated in its constitution that health is ‘a state of physical, mental and social wellbeing, not only the absence of disease or infirmity.’ Thirty years later, the Alma-Ata declaration on Primary Health Care (PHC) declared among other things that ‘health is a fundamental right’ and created a thirteen-point outline to ensure this right. This outline captured concepts of essential care, universally accessibility and affordability for individuals and families within communities, who would be able to participate fully in a spirit of self-determination. It located PHC as an integral part of a country’s health system involving all related sectors and aspects of national and community development.

The WHO constitution’s definition of health and the Alma-Ata declaration together prompt a diametrical but complementary state to be addressed concurrently in the promotion of good health. The first deals with the clinical determinants of health, pushing for the absence of disease in individuals. The second addresses the determinants of health that predispose or prevent individuals from attaining a state of mental, physical and social wellbeing as a fundamental right. These include appropriate governance, the absence of war, economic and infrastructure development, adequate infrastructure and aid policies. A unique moment occurred in 1978 to bring these complementary understandings together.

Even before the ink could dry on the Alma-Ata declarations it had however already generated polarised antagonism. From a capitalist standpoint, it was a ridiculous proposition, both too costly and defying economic reasoning, and too socialist in its excessive emphasis on state-managed intervention. The conservative duo of J.A. Walsh and K.S. Warren launched the Selective PHC debate, arguing that it would probably more be efficient to save children and limit population growth, while the two main PHC proponents, WHO and UNICEF, soon drifted apart, with UNICEF promoting a selective package of low cost interventions. With resource flows following Selective PHC, Primary Health Care translated in most countries into a basic collection of services to be delivered at district and community levels based on a select number of interventions with some outreach services, with an accompanying watered-down district health package.

Why nobody asked at the time whether there was any moral significance to be attached to a person’s life or pointed out that choices based on state preferences for total health gain can be justified over financial resource allocation efficiency is difficult to comprehend. Aside from efficiency-based arguments being ridiculous propositions founded on utility-based preferences or embodying unattractive equity assumptions, the economic bargain in a healthy population should at least have also appealed to responsible international choice.

Much has since been achieved from the advance in technology in dealing with specific clinical determinants of specific diseases. It could be argued that a saturation point has been reached, where increases in financial and human investments in existing technologies are yielding less than proportional gains. Despite this the selective interventions approach continues to define health and health services delivery. It was given a new lease on life by the World Bank through its 1993 World Development Report, entitled ‘Investing in Health’. This report, which scarcely acknowledged PHC, commoditised and de-linked health from development and moved the world closer to an interventionist approach to health; intervening at a selective point in the epidemiology of a disease or health system.

This approach has since had wide global appeal. Currently there are over thirty WHO resolutions on AIDS, TB or Malaria alone; more than all other subjects. The Millennium Development Goals (MDGs) have further entrenched this disease-specific approach to resource mobilisation. There are over 80 major global health initiatives linked to the health MDGs, providing over US$100 million annually. The Italian Global Health Watch reported in 2008 that the Global Fund has allocated approximately US$3.5 billion to countries for interventions on AIDS, TB and Malaria, mainly in Africa. Together, these initiatives have thrown billions of dollars at addressing diseases and improving clinical health conditions and made up a significant part of health sector budgets.

PHC is hardly mentioned in these initiatives, seldom highlighted by member states outside of anniversaries of the initiatives or occasional references to district health system strengthening. For various reasons the world assumed an emergency mode to address what are considered new and urgent public health issues. Single disease interventions that lend themselves to easily recognisable financial accountability, quantitative monitoring and evaluation held greater appeal for funders, especially when twinned with arguments of weak domestic governance and public policy failures and capacity limitations.

While these initiatives on clinical determinants hummed with measurable outcomes on specific diseases, the nexus of poverty and ill health was exacerbated. On the back of a growing trend in urban slum development, decline in state services, market failures in privatised economies, growing food insecurity and massive deprivation of rights to health care, inequalities in health have deepened to a significantly greater level over the past 30 years.

Hence while a lot has been done to deal with disease in individuals, the unique opportunity provided by the Alma-Ata Declaration to also address the determinants of health have largely been lost. Thirty years later we see the costs of this omission in levels of poverty which belie the levels of knowledge and technological advance achieved globally.

As we approach another anniversary for PHC expectations are high. People expect that their physical and mental health will be promoted in a safe social, economic and political environment. They expect to have quality health systems that provide preventive services, and which diagnose, treat and manage disease injury and reduce the severity and repeated occurrence of disease. They do not expect to see wide social and economic disparities in these basic entitlements. In Africa, the region furthest from delivery on these expectations, the Ouagadougou declaration on Primary Health Care issued on April 30 2008 called for a renewal of the Principles of Primary Health Care and its implementation in developing countries and by the international community.

Such declarations are encouraging, yet their implementation calls for resolution of longstanding debates of the past 30 years. These debates are not academic. In choices made over policy measures, relative allocation of institutional, social and financial resources and complementary systems for dealing with the social determinants of health (mostly dealt with by actions outside the health sector), they present social and economic inequalities that arise due to the burden of disease (mostly dealt with within the health sector). There are no clear answers for how a conceptual framework of Primary Health Care in 2008 will address this.

And while there is a massive coalition of global initiatives dealing with diseases, there is no clear coalition of global institutions supporting or funding the determinants of health, the second factor in the PHC equation. At a global level, the Bretton Woods institutions and OECD initiatives for debt relief and poverty reduction have in some African countries led to short-lived increases in spending on health and education, with no global initiatives so far adequately addressing the determinants of health.

This leaves PHC as an orphan with no global guardian. The WHO’s attempt to foster PHC is inadequate given the pluralistic global environment. The state of poverty and the winds of change in international health resource priorities will make rational choices among the various dimensions impossible and predispose countries to the dictate of new interventions and their implementation. While debates over the conceptual understanding of PHC will not end in 2008, this year could at least mark the turning point for a new institutional response, one that builds a global alliance to generate the momentum and support for countries to implement PHC and that provide policy learning based on practice from the bottom up, reminiscent of another basis for the Alma-Ata declaration.

A WHO or UN resolution creating such a global alliance would be a befitting PHC birthday gift for the millions of people seeking more than another conference. It will squarely put implementation right at the doorstep of a recognisable entity that can mobilise the needed funds and offer effective support to individual countries.

World Health Organization Africa region inter-country support team, Harare, Zimbabwe

* Please send comments to or comment online at http://www.pambazuka.org/

Nigeria has accounted for 10% of the 5.2 million global maternal deaths, research finding released by the United States Agency for International Development (USAID) showed.The report showed that 52,000 Nigerian women die of pregnancy-related complicated annually.

An analysis by Global Fund Observer published this week shows that just under half of the countries eligible to apply to the Global Fund to Fight AIDS, TB and Malaria are providing antiretroviral therapy to less than 25% of those who need it, or still have more than 25,000 in need of treatment despite higher levels of coverage.

The United Nations Children’s Fund (UNICEF) is scaling up existing emergency programmes in eastern Democratic Republic of the Congo (DRC), where increased fighting has forced over 100,000 people to flee their homes, social services to close, and humanitarian organizations to suspend aid.

Five brave and selfless advocates of human rights from Burma, Congo, Saudi Arabia, Sri Lanka and Uzbekistan have been awarded the prestigious 2008 Human Rights Defender Awards, Human Rights Watch has said. All five have been persecuted and threatened for their work. One winner, Saudi lawyer Abd al-Rahman al-Lahim, is under a travel ban, which Human Rights Watch urges the Saudi government lift so that he may receive his award in person in London.

The international cotton trade has been a sad tale for West African countries. The region produces five percent of the world’s cotton and 15 percent of the global cotton fibre trade. Yet West African cotton farmers are among the poorest in the world. Their purchasing power is only five percent that of farmers in Europe, the U.S. and Japan. Purchasing power refers to the value of goods (cotton) compared to the amount of money paid.

The government of Democratic Republic of Congo is planning to privatise some of its most valuable mining assets, as well as take a larger share of any future discoveries made in the mineral-rich country.Victor Kasongo, Congo’s deputy minister of mines, said on Friday that “a major future initiative” for the government was the transformation of state-owned mining companies into commercial entities.

Sierra Leone is reviewing its mining policy while two foreign firms fight over the rights to a potentially lucrative iron ore project, the government of the West African state said on Tuesday. The Marampa iron ore deposit at the centre of a legal battle between London Mining (LOND.OL: Quote, Profile, Research, Stock Buzz) and African Minerals (AMIq.L: Quote, Profile, Research, Stock Buzz) is estimated to be worth at least half a billion dollars, according to one London Mining executive.

The September issue of Alliance, just published, has a special feature on ‘philanthrocapitalism’ and international funding; guest editors are Michael Edwards and Olivier Kayser. The new issue also has an interview with Luis Ubiñas, President of the Ford Foundation, and introduces two new regular columns. One will bring ‘investors’ perspectives’ while the other will offer stories ‘on the grapevine’. We are also happy to announce publication of the first issue of our new Spanish edition of Alliance.

http://www.pambazuka.org/images/articles/395/50481cocoafruit_l.jpgThe World Bank has ordered Ivory Coast to tackle "serious corruption" in its lucrative cocoa industry, saying it will not lend money to the country unless it sees better governance of the sector. Obiageli Ezekwesili, World Bank vice president for the Africa region, said it would be "absolutely unacceptable" to support reducing poverty while the poor were being denied adequate reward for their work.

Below is a sign-on letter initiated by Bretton Woods Project (UK) encouraging Finance Ministers and members of the IMF Board to shut down the Poverty Reduction & Growth Facility (PRGF), with the funds in it handed over to a more suitable institution providing finance to the countries that have been receiving PRGF loans. Sign-ons to [email][email protected] Organisational (preferred) and individual sign-ons will be accepted until 26 September. Please indicate if you are signing as an organisation or individual. Questions can be directed at [email][email protected]

Google is helping develop a system to bring high-speed internet connections to three billion people developing countries in Africa and elsewhere. The 03b Networks system aims to use satellites to provide broadband services at the same speeds as those on offer in rich countries.

This week, ministers from over 100 countries, heads of donor agencies and representatives of civil society organisations are gathering in Accra, Ghana, for a meeting to discuss ways in which rich nations can help “developing countries and marginalised people in their fight against poverty by making aid more transparent, accountable and results-oriented”.

“Aid Effectiveness”, the main theme of this high-level meeting, has, however, come under severe criticism from the most unlikely quarters – the recipients of aid themselves. A leading voice is Benjamin Mkapa, former president of Tanzania, who in a foreword in the just released book, Ending Aid Dependence, by Yash Tandon, urges developing countries to formulate strategies to exit from the aid dependence bandwagon.

Mkapa argues that aid subjects recipient countries to “a discipline of collective control by donors right down to the village level” and that some of the most successful emerging economies, such as China, India, Brazil and Malaysia, developed not through aid, but through strong nationally-oriented investment and trade policies. (Mkapa’s own country, ironically, is one of the most aid-dependant countries in the world.)

The idea that aid is a bad idea has been around at least since the 1980s, when academics and activists began questioning the effectiveness of World Bank-IMF prescriptions, such as Structural Adjustment Programmes (SAPs), which increased poverty levels in almost every country where they were implemented.

In his book, Tandon, the executive director of the South Centre in Geneva, argues that there needs to be a “radical restructuring of the institutional aid architecture” but falls short of calling for a total ban on aid. Aid that imposes ideological positions on countries, for instance, should be shunned completely, according to Tandon, but aid that supports struggles for social justice in the international community is acceptable as long as it is people-centred.

by Yash Tandon is published by Publisher: Fahamu and the South Centre 160pp.

Rapid urbanisation is a fact of life even in the least developed countries where the lion’s share of the population presently lives in rural areas and will continue to do so for decades to come. This paper examines the causes, consequences and policy implications of the ongoing urbanisation in the African less developed countries (LDCs). The authors find that the employment opportunities in either rural or the urban sector are not growing adequately.

In order to measure progress on achievement of the Paris Declaration, the 3rd High Level Forum on Aid Effectiveness called on developing countries to partner with donor communities to ensure good statistics are produced to facilitate development results.