African children are dying of malaria at the rate of one every 30 seconds. Take a minute to try to comprehend that number – and two more die. Malaria kills an estimated million people worldwide every year, 90 percent of them in Africa. That relentless toll saps energy, money and hope from communities all over sub-Saharan Africa. "Malaria is also a major cause of anemia in children and pregnant women, low birth weight, premature birth and infant mortality," the Roll Back Malaria partnership says. "In endemic African countries, malaria accounts for 25–35 percent of all outpatient visits, 20–45 percent of hospital admissions and 15–35 percent of hospital deaths, imposing a great burden on already fragile health-care systems."

Tanzania is one of several low-income countries with a high rate of domestic violence, according to a recent study by the World Health Organization (WHO) on women's health and domestic violence against women. The WHO study, launched in Tanzania's commercial capital Dar es Salaam by Sofia Simba, the minister for community development, gender and children, said 30 percent of victims of violence in the east African country ended up with serious injuries due to severe beating.

IRIN News examined the increasing prevalence of HIV/AIDS in Liberia, which is emerging from 14 years of civil war. "HIV/AIDS is now a serious problem in Liberia," President Ellen Johnson-Sirleaf said recently, adding that HIV prevalence is 12% in the general population and higher among women and children. According to UNAIDS, 5.9% of Liberians were HIV-positive at the end of 2003, just after the end of the war.

The Treatment Action Campaign will reject government's invitation to participate in the United Nations General Assembly Special Session on AIDS (UNGASS) at the end of May unless its ally, the Aids Law Project is also invited. TAC General Secretary Sipho Mthathi confirmed that a delegation from the TAC and ALP had met with Thami Mseleku, the director general of health in an effort to find a solution, after government objected to the TAC and the ALP being accredited for UNGASS.

Ethiopia has launched a five-year malaria treatment and prevention plan at cost of US $447 million in an effort to lessen the burden of the disease, one of the leading causes of illness and death in the Horn of Africa country, the country's health ministry has said. The plan is intended to provide early diagnosis and treatment services and implement mosquito control measures, including the provision of insecticide treated nets and indoor residual spraying. The funds will come from the government budget, the donor community and other partners in the health sector.

More than 60,000 HIV infected people in Kenya have received a major boost after Britain announced it will provide life-prolonging drugs worth millions of shillings. The Sh370 million funding will be used in buying first-line antiretroviral drugs and HIV testing kits, the Department for International Development head in Kenya has announced.

Farmers in Ethiopia, the birthplace of coffee, have announced the birth of a sustainable coffee movement. The group of 678 family farms in the Djimmah region are the first in Africa to win Rainforest Alliance Certification. The news marks the Rainforest Alliance's first coffee partnership outside Latin America, where more than 3,400 farms in ten countries already promote socially responsible and environmentally sustainable agriculture.

Internews Network is currently seeking a resident advisor to lead our Local Voices health reporting project in Kenya; Local Voices is designed to support professional television and radio broadcasters in creating high-quality, locally relevant coverage of HIV/AIDS issues for their audiences.

This crucial role aims at improving access to and quality and relevance of primary healthcare services in Rwanda. Requirements include three years operational experience and a track record of success on advocacy and policy development/research in health; a sound understanding and experience of health economics; experience of work at field/community level; a degree in medicine, public health or other health related science.

Twenty people have died and 16 more are ill in the village of Tandembelo in Bandundu Province, western Democratic Republic of Congo (DRC), from what could be meningitis, government and United Nations officials said on Wednesday. "All the people are showing clinical signs of meningitis," said Dr Benoit Kebela, an epidemiologist for the ministry of health. The 36 people with the illness were all admitted to hospital with the symptoms of high temperatures and severe headaches.

It is ironic to be talking of working together for health in Southern Africa - a region faced with chronic shortages of health workers as a result of massive brain drain, inadequate drugs, inadequate and chronic shortage of infrastructure and equipment. The fundamental question is who will be working with whom given the skeletal health personnel in the region? How can health provision be a reality in situations of collapsing health delivery systems, absence of drugs and medical equipment? Working together for health was this year’s theme for World Health Day, commemorated on the 7th of April.

Nigerian Health Minister Eyitayo Lambo Wednesday in Abuja launched a book documenting efforts in the prevention, care and treatment of HIV/AIDS in Nigeria in the past five years. The book titled "AIDS in Nigeria: A nation on the Threshold," is the brainchild of the US Harvard School of Public Health programme, AIDS Prevention Initiative in Nigeria (APIN). It is the first major comprehensive documentation on the disease in a book form since HIV/AIDS was first reported in 1986 in the country.

Eastern Cape Health MEC Dr Bevan Goqwana was fired by the premier this week, leaving a department which under his stewardship failed to properly account for R18.1 billion out of a total budget of R22.6 billion. Critical staff shortages, severe under spending, dilapidated hospitals and crumbling infrastructure, corruption charges, shortages of essential medical equipment and medicine – are just some of the characteristics that underpinned Goqwana's tenure as Eastern Cape's Health MEC since 1999.

"We, African civil society organizations comprising organizations and networks of people living with HIV, young people, women, religious leaders and community workers at the frontline of the fight against AIDS, met in Abuja, Nigeria on April 10 to 12 2006 to develop a consolidated position for use during the review processes of the Abuja Declaration and Framework Plan for action, and the United Nations General Assembly Special Session on AIDS (UNGASS) Declaration of Commitment (DoC), and to chart a way forward regarding access for all people requiring information and services related to HIV prevention, care, support and treatment. This statement reflects the outcomes of these deliberations, as well as the sentiments of the undersigned African Civil Society Organisations."

"My father died when I was young and my mother died in 2000," said Yomima, 14, one of 250 children known to be orphaned by HIV/AIDS in Juba, the capital of South Sudan. "The economic burden for grandparents of AIDS orphans is so great it can't be described," said Marcellina Denya, formerly a social worker. "Elderly people in Juba are earning nothing, so they are left in an impossible position. Even the small monies we are able to give make a vital difference."

Africa, which has the highest number of HIV infections in the world, must scale up its prevention efforts to reverse this trend, according to the president of the African Union Commission, Alpha Oumar Konare. "The responsibility of HIV prevention is not the one of the World Health Organization [WHO] or of UNAIDS. It is ours - we all have to commit ourselves to that," Konare said. Konare was speaking on the occasion of the official launch of the year of "The Acceleration of Prevention of HIV Initiative in the African Region", an initiative of African health ministers aimed at stepping up the pace of HIV prevention on the continent.

The PLP HIV/AIDS Senior Advisor will focus primarily on Prevention of sexual transmission but will also work closely with and provide support to the Namibia Senior Technical Advisor managing Safe Injection and PMTCT. It is expected that s/he will have a full understanding and be committed to a balanced ABC approach.

A new study in Uganda has confirmed that a combination of co-trimoxazole (Septrin), antiretroviral therapy, and insecticide-treated bed nets reduces the frequency of malaria in adults with HIV. The study aimed at assessing the effect of antiretroviral treatment (ART) on the frequency of malaria in people with HIV, and to measure the effects of co-trimoxazole and insecticide-treated bed nets.

"I am officially announcing that Iran has joined the group of those countries which have nuclear power.” These 17 words were uttered live on television last Tuesday, by President Mahmoud Ahmadinejad of Iran, to a cheering crowd of jubilant compatriots proud that their country had joined this patented club of countries whose wishes may not be ignored by the rest of the world because of their ability or potential to back their power with nuclear technology.

It is a small club of nations that can intimidate the rest of the world. Until recently, that club was almost exclusively White and Western (including the Zionist State of Israel), with the exception of China. But North Korea, India and Pakistan are also members now. All experts agree that Iran has not become a full member yet and may take a few more years to be able to make nuclear bombs but it has now demonstrated its potential.

As Iranians jubilate ‘The World’ or more appropriately those who think
they are ‘The World’ through the global media they control and the rest of us follow, let it be known that our world is made more unsafe by this copycat scientific development in Iran. US State department spokesman, Sean McCormack, said to BBC: “we would have hoped that the Iranian regime would have taken this opportunity to choose a pathway of diplomacy as opposed to the pathway of defiance.”

The same words could have been quoted back to the US for many policies its government, especially under the bellicose George Bush, have pursued since it came to power. And I am not referring only to the foretold tragedy in Iraq. It would be more credible if those who preach to other nations to respect international rules, conventions and etiquettes were themselves impeccable in their observance of the same.

The US government should be the last government to shout foul because it has refused to allow international law or morality to stand in its way in the pursuit of its own interests. If it can obey international rules in a kind of reckless a la carte what right has it got to say other countries should not do the same?

I am not sure if the world feels as threatened by Iran acquiring what all experts know to be a capacity to make nuclear fuels as the US and EU countries are orchestrating. Many Africans openly or secretly jubilated when India detonated its nuclear bomb the same week that Pakistan launched its own.

The only regret many felt was that there was no African country able to do the same and redeem the continent and its peoples from ‘nuclear whitemail’. There were many African scholars and activists who opposed Professor Ali Mazrui’s call for an ‘African Bomb’ in the 1980s who now regretted their ideological opposition to the controversialist scholar.

I was a baby radical then and thought of Mazrui as a reactionary. Now I know better. In those days, Mazrui had ambitions for Nigeria to be able to counter the nuclear threat posed by apartheid South Africa. The idea that nuclear weapons are safe in the hands of Americans and their European cousins only and a danger to the rest of the world is not only patronising but also racist. If George Bush can be trusted with nuclear weapons why not anybody else? The only way to ensure universal nuclear disarmament is for all countries to renounce it and destroy the nuclear arsenal they have acquired. As long as some have it and others do not, those who do not will try to either acquire it, if they can or if they cannot, envy those who do. Iran is not the only country trying to acquire nuclear weapons.

How come nobody is talking anymore about North Korea whose capability is technically ahead of that of the Iranians and whose leaders have also declared their readiness to use it ‘for pre-emptive action’ the principle so beloved by Bush’s America? There is no doubt that the Iranian government under President Ahmadinejad has raised the stakes very high in a game of brinkmanship against American bullying.

Many countries have been cowered into submission but secretly wishing they could also play with the Tiger’s tail and get away with it.

Is it really surprising that the Teheran announcement came the same week when Western media was full of stories about Washington planning ‘pre-emptive strikes’ against nuclear installations in Iran by the US, including using nuclear weapons? Does anyone expect the Iranians to behave like sitting
ducks?

Teheran continues to protest that it is seeking nuclear technology for peaceful purposes. The Americans and many Westerners doubt this intention but many people in the world also doubt Western intentions. The US in particular, has not got a good record in identifying real threat to global peace and security. It was wrong in Iraq, in Afghanistan and why should anyone trust its judgement now? Russia, China, India, Pakistan and Israel have nuclear weapons and these countries are either neighbours of Iran or countries with strategic focus on the country and vice-versa.

Therefore Iran cannot be expected to willingly leave itself so vulnerable. Whether it is Ahmadinejad or any other leader, the nuclear option would have been a serious option in Teheran. Now that Iran has demonstrated its capability it may actually be opened to diplomatic discussions.

Unlike Israel which does not even accept any UN Non- Proliferation treaty and welcomes no inspectors, Iran may return to cooperation with International Atomic Energy Agency (IAEA) but like Israel, it may never fully disclose its capability, just to keep its regional rivals and enemies guessing: do they, don’t they?

How many Africans will really find it objectionable if there is an African state with such potential?

World Health Day 2006 on April 7 addressed the drain of health workers to developed countries, a problem which has had a significant impact on health systems in Africa. Research conducted by the Regional Network on Equity in Health in Southern Africa (EQUINET) argues that the debate over the health worker drain needs to be deepened to address the “significant and dramatically rising flows of resources out of Africa northwards, draining the continent of the important resources needed to address its own development, including in health.”

At this year's World Health Day the WHO will be launching its annual report which focuses on human resources for health. In Africa, as we have raised in previous editorials in this newsletter (the newsletter of Equinet, the Regional Network on Equity in Health in Southern Africa, available at we are experiencing a 'global conveyor belt' of health workers flowing from rural, primary health care level in the public sector to urban, private care; from poor to rich areas and countries in the region and from the continent, with its high health needs and under-resourced health services to developed, high income countries such as USA, Canada, UK and Australia. The loss of public investment and social resources in this outflow is significant and outweighs any returns in remittances or aid for education.

However health workers will certainly continue to go to where they can work in adequately resourced health services, in decent jobs and where they can secure their own family needs. This draws attention to the much wider question of how in Africa we secure the resources to retain and value our health workers, and more widely to meet our population health needs. The latest EQUINET discussion paper, written by Patrick Bond and produced jointly by EQUINET with the Centre for Economic Justice in southern Africa points to a South-North drain of African wealth that undermines the resources for health and development, and that increases our dependency on the global North, and our loss of health workers.

The 2005 Commission for Africa report leaves the impression of a continent receiving a vast inflow of aid, with rising foreign investment, sustainable debt payments and adequate remittances from the African diaspora to fund development. Our discussion paper tells a different story: of significant and dramatically rising flows of resources out of Africa northwards, draining the continent of the important resources needed to address its own development, including in health. The paper synthesizes data about the outflow of Africa's wealth, to reveal factors behind the continent's ongoing underdevelopment, as the basis for proposing policy measures to reverse these flows.

The statistics speak loudly of a continent being progressively dispossessed of its wealth, and thus the resources it needs to improve health and human development:

* A debt crisis with repayments in the 1980s and 1990s that were 4.2 times the original 1980 debt levels, and annual debt repayments equivalent to three times the inflow in loans and, in most African countries, far exceeding export earnings, leaving a net flow deficit of by 2000 of $6.2 billion.

* Unequal exchange in trade and trade liberalisation policies that have lowered rather than increased Africa's industrial potential and exacted an estimated toll in sub-Saharan Africa of $272 billion over the past 20 years.

* Flows of private African finance that have shifted from a net inflow during the 1970s, to gradual outflows during the 1980s, to substantial outflows during the 1990s.

* Falling foreign direct investment (FDI) from roughly one third of FDI to third world countries in the 1970s to less than 5% by the 1990s, and a shift to highly risky speculative investment in stock and currency markets - with erratic and overall negative effects on African currencies and economies.

Africa is commonly and mistakenly represented as the (unworthy) recipient of a vast aid inflow. Aid flows in fact dropped 40% during the 1990s, and the phantom aid that flows back to the source countries in technical and administrative costs was estimated in one study to be $42 billion of the 2003 total official aid of $69 billion, leaving just $27 billion in 'real' aid to poor people.

There is also a perverse subsidy in the extent to which industrialised countries exploit the global stock of non renewable natural resources. This takes place through the extraction of minerals and natural resources from Africa by Northern investors with little investment in return and few royalties provided. It also takes place through use of global goods like the earth's clean air. Forests in the South absorbing carbon from the atmosphere are estimated for example to provide Northern polluters an annual subsidy of $75 billion. A method for measuring resource depletion used by the World Bank suggests that a country's potential GDP falls by 9% for every percentage point increase in a country's dependency on resource extraction. This implies, for example, that Gabon's people lost $2,241 each in 2000, based on oil company extraction of oil resources.

These outflows deplete the resources available for productive and human development. They are felt most heavily by women and poor communities, and undermine progress towards the achievement of human security for the majority of African people.

They imply that the first step to effect genuine growth and to deliver welfare and basic infrastructure is for African societies and policymakers to identify and prevent the vast and ongoing outflows of the continent's existing and potential wealth.

Current global reform agendas do not address these outflows. While they point to debt and unfair trade, they do not seek to reverse the outflow of African wealth.

Campaigns to reverse resource flows and challenge perverse subsidies are emerging from grassroots struggles and progressive social movements, such as those in Africa that are resisting privatisation and commodification of basic services, pressuring for rights to generic anti-retroviral medicines and resisting encroachments on human development through trade and macroeconomic policies that intensify inequities.

These grassroots struggles can be consolidated by national governments and regional co-operation to improve disclosure of financial flows and apply policies within Africa to prevent the outflows and encourage the 'stay' of domestic investment resources. The paper points to some options - systemic default on debt repayments, strategies to enforce domestic reinvestment of pension, insurance and other institutional funds; national-scale regulation of financial transfers from offshore tax havens; clearer identification and renegotiation of tied or phantom aid; and improved calculation and negotiation around of the costs of FDI (not simply the benefits), including natural resource depletion, transfer pricing and profit/dividend outflows.

EQUINET welcomes the focus on this year's World Health Day on one area through which Africa is bleeding - its loss of human resources. We would however urge that to deal with this effectively in the continent, and address the inequity globally in the resources needed for health and human development goals, we need to deepen the debate. In 1998 EQUINET highlighted that a critical dimension of equity is the power and ability people have to make choices over health inputs and their capacity to use these choices towards health. For Africa this must surely include bringing control over the resources for health and development back within the continent.

* This article first appeared in the the April 2007 newsletter of the Regional Network on Equity in Health in Southern Africa (EQUINET), available at www.equinetafrica.org The new EQUINET can be found at http://www.equinetafrica.org/bibl/equinetpub.php
Please send feedback or queries on the issues raised in this briefing to [email][email protected] . EQUINET work on economic policy and health is available at the EQUINET website at www.equinetafrica.org