The right to health is acknowledged as a universal human right. Good sexual and reproductive health services enhance public health and improve quality of life. Journalists can play a key role in getting these issues debated publicly. This PANOS media briefing explains some of the key issues and how to use researchers as a journalistic source.

The Sudan Open Archive offers free digital access to knowledge about Sudan. The Archive is an expanding, full-text database of historical and contemporary documents, with a linked analytical guide to internet resources.

AIDS and Rights Alliance for Southern Africa (ARASA) requires an HIV/AIDS and Human Rights Training Co-ordinator. Closing date is 15th April, 2007

World TB Day on March 24 has passed with much fanfare about drug regimes and increases in treatment. But little has been said about the broader health issues that continue to go unaddressed. The symptoms of the health crisis that faces the continent are only partially dealt with.

Health status is influenced by socioeconomic factors as well as health delivery services. In Africa, declining economies and growing poverty levels have led to a drop in the health status of the population. The HIV pandemic, as well as the persistent ravages of diseases such as malaria, has been exacerbated by poverty-associated malnutrition and unhealthy life-styles.

Experiences in Africa thus far continue to manifest the impact of structural adjustment programmes of the past, which failed and were largely discarded, but whose rationale continues to underpin policy-making.

The economic decline, occasioned by these programmes and other systemic factors, has also reduced the resources available for public spending. Along with social services and education, health care has born the brunt of the cut-backs instituted by governments Shrinking budgets, coupled with increased demand for health services and the rising cost of health care have plunged African health care regimes into chaos, necessitating urgent reforms. Sekwat (2003) adds that the inadequate resource mobilization is further complicated by the inefficient use of the existent resources.

The process of privatisation as a means of cutting public spending has an exclusionary effect that runs counter to the drive for equity and social justice. By privatising health services, elements thereof in effect exclude those who are not able to pay for it, and in most instances need it most. Public-private partnerships have met with limited success because of structural incompatibilities between the sectors.

A feature of health care reform in Africa has been the introduction of user fees for services. In this scenario, the cost of health care is shared between the state and the public. The reality is that whereas this has succeeded in raising revenue for the sector, it has placed an even greater burden on the meagre resources of the poor, and completely excluded those without the resources. The fallacy of the approach is evident in studies that have shown an increase in efficiency in health care delivery by measuring the level of waiting lists at health facilities. The reality is that those who cannot afford health care are simply not getting it.

There has been a recent move away from cost-sharing in the form of user fees, which have tended to prevent the poor from accessing health services. Sekwat (2003) points out that user fees have a particularly negative effect on adherence to mid and long-term treatment regimes. This is especially dangerous when dealing with diseases like tuberculosis.

Although a study of health policies in Africa reveals an emphasis on social justice and equity, the realities of implementation have tended to militate against this. Budgetary efficiency has often meant doing only what is possible within budgetary allocations. Health care has frequently received allocations well below the requirements, although countries like South Africa are making positive steps towards improving this. The drive for efficiency in resource utilization has met with limited success because most of the inefficiencies tend to be systemic rather than unique to the health sector.

One noble effort has been to shift more resources to broader basic health-care, with the view to early detection and treatment of health problems before they become more dangerous and costly to treat. However, the problem has been that doing this has necessitated redeploying resources from the secondary and tertiary systems. This problem has recently come up in South Africa where the Western Cape finance department has proposed cutting allocations to two major referral hospitals in order to increase capacity in secondary facilities. Whereas the secondary facilities are better able to serve the community, it substantially strains the tertiary system.

Examples such as the foregoing tend to call into question the ideological underpinnings of health policy. Whereas the provision of basic health care to benefit the poor is beyond reproach as a policy, should it mean that the poor only have access to primary health care? Rather the system should be designed to accommodate all people at all levels. Stierle et al point out the provision of health care to the poor is further hampered by lack of clear definitions of who is 'poor' or 'indigent' and therefore eligible for free health care. These are issues that need urgent attention if the health system is to serve in an equitable manner.

The lack of skilled personnel continues to be a problem in reforming the health sector. Furthermore the ability of the public health sector to retain these personnel is still a major challenge, which can only be overcome through better remuneration and working conditions. Needless to say, this is not achievable unless there is more budgetary allocation to health services.

The process of health care reform requires a multi-sectoral approach and a firm grounding in the broader principles of social justice and equity. Any process of reform needs to be sensitive to the most vulnerable, without creating structural imbalances that negatively impact sustainability.

Futher Reading:

Africa Action position paper: Hazardous to Health

Ambrose,S. 2006. Preserving disorder: IMF policies and Kenya's health care crisis http://www.wpro.who.int/NR/rdonlyres/B2E65CFE-C098-4281-9FF4-967DFEB22069/0/RC53_INFDoc1.pdf

Uganda records an estimated 80,000 new cases of tuberculosis every year, half of them among people infected with the HIV virus that causes AIDS, health officials said.

About 13 Kenyans die of tuberculosis every hour and there is little immediate prospect of improvement, the head of a leading national health organisation said on Saturday which is World Tuberculosis Day.

Tanzanian authorities are disturbed by the increasing number of teachers killed by HIV/AIDS. According to the latest report, between 1996 and 2006, 193 teachers died of HIV and AIDS-related diseases in the country's south-western district of Mbeya alone.

The World Health Organization and UNAIDS are to recommend that circumcision programmes should become part of HIV prevention programmes in countries seriously affected by HIV, following an expert consultation earlier this month.

The Strategies for Hope Trust announces the launch of 'Time to Talk: a guide to family life in the age of AIDS'. 'Time to Talk' is intended for use with church groups by pastors, lay preachers, religious Sisters, catechists, trainers, leaders of Christian men's and women's organisations and other lay church leaders. It is based on a series of workshops for local church leaders and their spouses, run by the Anglican Diocese of Southern Malawi.

Throughout the 18th and 19th centuries Haitians knew exactly who to fight. Their enemies were obvious.

Now Haitians are so high on cheap opium (Karl) and their minds so full of Platonism (Nietzsche) that they can not distinguish their enemies who have cloaked themselves as priests, pastors, Christians, humanists, democrats.

The poor in Cite Soleil face the agents - or demons - of a global system that prey on people. While they are themselves part of a nightmarish matrix resembling the film of the same name.

If the global poor becomes or is made aware of what they face, they may have a better chance of creating a little respite like the one after 1804 in Haiti.

However, if one becomes complacent, one could end up like Toussaint at Fort de Joue or worsee.

Knowledge and information are the only weapons against that colossal ever growing monster that has its tentacles in everything and everywhere. Ignorance is bliss. Knowledge is power. These are the choices in the arsenal.

Health authorities in Burkina Faso have launched a mass vaccination campaign in the capital, Ouagadougou, to combat a rapidly spreading meningitis epidemic that has claimed more than 800 lives. “Ouagadougou has been hit to an extent that we did not expect,” said Jean Gabriel Wango, secretary general of the country’s health ministry.

The number of tuberculosis cases in Tanzania has risen from 39,000 a decade ago to 64,200 in 2005, a trend blamed on high HIV/AIDS prevalence, the Health Minister, David Mwakyusa, said on Thursday. "Research conducted in many parts of the country by the Ministry of Health between 2003 and 2004 established that HIV/AIDS contributes to increased TB cases by about 60 percent," the minister said.

Health workers in Malakal, capital of Upper Nile State in southern Sudan, face great odds in trying to counter the ignorance and stigma that prevents people benefiting from available HIV/AIDS services. Despite the presence of a voluntary counselling and testing (VCT) site in the city, little is known about HIV.

Twelve-year-old Woinishet Wujura's dedication to her gardening duties would be surprising in someone her age, but the land she is tilling has been a lifeline for her and her family because the farm is run exclusively by and for women and children affected by AIDS. The farm, called 'Gordeme', is part of a successful urban gardening project that started in 2004 and now has several farms across Ethiopia, all managed and maintained by about 10,000 women or children.

Aids patients in Zambia are abandoning their life-prolonging drugs in exchange for bogus cures that have hit the market in recent weeks, a leading HIV/Aids advocacy group said on Monday. The Network of Zambian People Living with HIV/Aids (NZP+) said it has received reports that some of its members were stopping the use of antiretroviral drugs (ARVs) for fake cures being promoted in the media.

I have been living in Kenya for almost a year. I did not know that there would be so many cultural and political differences from Uganda, which was once my home for more than a decade. I was only moving across the borders of a East Africa that was definitely uniting, albeit slowly. In any case, for all the years I had been in Uganda, even in the most difficult periods of tensions and suspicions between Museveni and Baba Moi (when Moi could close the border at will), we had no alternative but to pass through Nairobi which was, and still remains, the regional communications and transport hub.

In those days there were not many direct flights from Entebbe, so we had to transit through Nairobi whether we liked it or not. There was a time when many senior members of the Pan-African Movement (PAM) in Uganda (Col Otafiire, Late Lt. Col. Serwanga Lwanga, Late Major Ondoga ori Amaza, Lt. Noble Mayombo, Mzee Chango Machyo, others and myself) were regarded as agents of destabilisation by the Moi/KANU government. In those days you stopped over in Nairobi with anxiety. At one time The Kenya Times, the government/KANU mouth piece, published a series of articles claiming that PAM was created by Museveni to foment troubles among his neighbours and across Africa in general. In my particular case I was not only persona non grata in Nigeria but had been closely associated with the Kenyan exile opposition in the United Kingdom, initially through the Committee for the Release of Political Prisoners in Kenya, and later UMOJA. It was true too that many senior people in the NRM had sympathies and solidarity with different elements of the opposition to the Moi/KANU dictatorship.

A particular kind of understanding of Kenya flowed from these experiences. One had a sense of who were our friends and who were our enemies. Consequently, even as relations between Uganda and Kenya improved, forced by economic realism and the increasing isolation of Moi's regime by its erstwhile foreign backers, and the confidence and perseverance of the democratic opposition, the view from Kampala was that Moi and Museveni were in mutual embrace for reasons of realpolitik only. The bulk of the opposition remained 'our friends'. It was no secret that Uganda supported the NARC opposition in the run up to the 2002 historic electoral revolution that saw off four decades of political monopoly.

We were all jubilant that 'our friends are in power', but since that euphoria, the reality of power and alliances based on the negative unity of 'Moi must go' has shown their limits. You may remove individuals, but dealing with the structural relations of power skewed against the majority of the people requires more than merely getting rid of the incumbent. Within two years of NARC taking power, the unity of the opposition that won the election was cashed in for all kinds of opportunism, factionalism and sectarianism and accusations of betrayal.

So it was not a familiar country that I settled in last year. It is really not clear who our friends and our enemies are anymore. They are all at logger heads. For instance, veteran opposition politician Raila Odinga, son of the even more famous Mzee Oginga Odinga, along with others, including Kalonzo Musyoka and former Vice President George Saitoti, quit KANU because Moi imposed the son of the former president, Uhuru Kenyatta, as the KANU presidential candidate. They teamed up with Mwai Kibaki and others to form the NARC which booted out KANU. Today, Uhuru Kenyatta is part of the ODM-Kenya, an alliance of parties and personalities who were formerly in NARC but are now opposed to Kibaki. Musalia Mudavadi who became Moi's vice president after Saitoti is now in ODM-K too, while Saitoti is firmly with Kibaki.

Are you confused? There is more in store. No one is even sure which party the president belongs to because the DP, which was the basis of his partnership in NARC, is all but dead. But there is another coalition, NARC-KENYA, which is effectively the party of the president while he is still presiding over a NARC 'Government of Unity' that theoretically includes those NARC members who did not flee with Raila and co, such as Charity Ngilu and Ford People. But listening to Ngilu and other ministers who are not part of NARC-Kenya, you wonder what they are still doing in Kibaki's government. Let me stop there because I will not only be confusing you, but will lose the plot myself as the names and parties become incestuously intertwined.

Kenya is the worst example of a farcical multi-party democracy, because political parties have become so easily disposable depending on the personal ambitions of their leaders who own them, and can literally do what they please with them. Essentially they rely on assumed or assured ethnic constituencies, which makes national politics a club of ethnic notables.

The manipulation of ethnicity, religion, region and race by the political elite to secure support from the masses is not uniquely Kenyan or African. Electoral politics involves such manipulation even in the so-called matured democracie. Ask yourself why John F. Kennedy was, and still remains, the only Catholic to have been elected president of the USA? Why is there no labour or conservative party in Northern Ireland rather than Irish parties that are allied to the mainland parties?

My surprise in Kenya - even for a Nigerian where all kinds ethno-religious and regional manipulations are common currency in the battles between different sections of the ruling classes - is the shameless way in which ethnicity is flaunted and ethnic prejudices proclaimed even, especially, among the 'enlightened classes'.

Nowhere is this more prominently in evidence than in the current electioneering campaigns which everybody agrees will be a two-way battle between President Kibaki (standing under NARC-K) and whoever emerges the opposition candidate in ODM-K. In ODM-K the final duel is between the two leading aspirants, Raila Odinga and Musyoka.

If other Africans had a vote in Kenyan elections, Raila would have won hands down because he is the better known figure; not just because of his old man status, but as a veteran opposition figure who spent several years in prison for his political activities. However, come to Kenya and ask many people, aside from his fanatical supporters, and you get a different picture. Unfortunately most of Kenyans who are anti-Raila will give you no other reason why he cannot be president, than the fact he is Luo. The same Kenyans who are hysterical about Barrack Obama, a Luo man running president of America, will not vote for his Luo uncle in Kenya. Why is a Luo good for America but not for Kenya?

* Tajudeen Abdul-Raheem is the deputy director for the UN Millennium Campaign in Africa, based in Nairobi, Kenya. He writes this article in his personal capacity as a concerned pan-Africanist.
* Please send comments to or comment online at www.pambazuka.org

In an article by Thomas Rehle et al. in the March 2007 edition of the South African Medical Journal (SAMJ), an unparallelled large sample of 15 851 blood specimens was analysed to estimate HIV incidence on a national scale for South Africa, indicating that the availability of laboratory-based tests for recent HIV infection now offers a direct measure for tracking the epidemic and evaluating the impacts of prevention interventions.

A new report by the Commonwealth Secretariat summarises the key issues regarding HIV and AIDS and the education sector and is based primarily on a review of published literature and the findings of the recently held regional workshop organised by the Commonwealth Secretariat and the Association for the Development of Education in Africa (ADEA).

Morgan Tsvangirai, leader of Zimbabwe's opposition Movement for Democratic Change (MDC), was on Tuesday taken to hospital after sustaining heavy injuries during torture while in police detention.

After failing to persuade its young people to change their sexual behaviours, the South African government have announced a five-year plan to cut by half the number of new HIV infections in the country. South Africa has one of the world's highest HIV infection rates.