Despite the publicity given to ‘reform’ of the EU’s Common Agricultural Policy and Doha round of trade negotiations, we are not about to see anything resembling liberal trade in agriculture. EU ‘liberalisation’ aims to sustain European production but to reshuffle the subsidies and taxes to make them less costly to the European budget and more easily defensible in the WTO, concludes research from the UK's Institute for Development Studies that reviews trade agendas and implications for food policy and food security in Africa. The research notes that patterns of agricultural trade and policy are changing rapidly. Africa is being squeezed not by formal World Trade Organisation (WTO) negotiations but through the rearrangement of agricultural subsidies in developed countries, changes in trade preferences and Africa’s inability to participate in setting standards. Africa faces the prospect of paying more for the cereals it imports and earning less from its agricultural exports.

Nurses and doctors are refusing to return to work in the Liberian countryside because their salaries are too small and often late and the transitional government's promise to pay 18-months of salary arrears has failed to materialise. "The government cannot force us to go into the interior and work, because in the end, we will have nothing to live on," Klomah Seblee, president of the National Health Workers Association told IRIN. "We have families whose needs we have to meet."

Wealthy countries "deliberately" enlist doctors and nurses from poor nations, costing developing states US $500 million a year in lost training, Ndioro Ndiaye, deputy director-general of the International Organisation for Migration, said. According to Ndiaye, the UK drafted more than 8,000 nurses and midwives from outside of Europe in the year 2000. This was in addition to the 30,000 hired over previous years. Some 21,000 Nigerian doctors were working in the US the same year, while there were more doctors from Benin working in France than in their own country, she said.

Global food companies are aggravating poverty in developing countries by dominating markets, buying up seed firms and forcing down prices for staple goods including tea, coffee, milk, bananas and wheat, according to a new report. As 50,000 people marched through Porto Alegre, in southern Brazil, to mark the opening of the annual World Social Forum on developing country issues, the report from ActionAid was set to highlight how power in the world food industry has become concentrated in a few hands. The report will say that 30 companies now account for a third of the world's processed food; five companies control 75% of the international grain trade; and six companies manage 75% of the global pesticide market.

For women on the continent of Africa, the upcoming 6the Ministerial Conference of the World Trade Organisation (WTO) in Hong Kong in December will stand out as the apogee of failure for the globalisation project.

Women and social movements have articulated the need for economic democracy. This involves the equitable participation of all people in the ownership of the productive assets on which livelihoods depend upon.

Some of the key messages African women are sending to the Hong Kong meeting centre around research of the lived experiences of women, which indicate that agricultural trade liberalisation measures can create starvation and famine when tariff barriers are removed. These measures allow the flow of cheap food, which displaces poor women and men and destroys their entitlements.

Lowering of import barriers and flooding of the market with imported food grains sold at low prices is the result of the many levels of hidden subsidies of the rich countries. These have been shown to contribute to hunger and starvation in agricultural societies, which predominate in African countries. What the Agreement on Agriculture aims to achieve is the replacement of women and other subsistence producers with agribusiness as the main providers of food. Behind the obfuscation of terms such as ‘market access’, ‘domestic support’, is a raw restructuring of power around food: taking it away from people and concentrating it in the hands of a handful of agro-industrial interests.

The agriculture negotiations when taken up by our governments are treated as gender neutral. These discussions do not take into account the 75% contribution women make to agricultural production. They assume a common myth that separates affluence from poverty. If you produce what you consume, you do not produce. This is the basis on which the production boundary is drawn for national accounting that measures economic growth.

This myth is perpetuated in the WTO contestation and contributes to the mystification of growth and consumerism. It also hides the real processes that create poverty. The WTO agriculture negotiations are inimical to people’s interests. They have become a space for protecting the interest of agribusiness corporations and commercial farmers whose priority is not food security but profit. Their profit distribution is a monopoly. They are the sellers of inputs to farmers, the buyers of agricultural commodities from farmers, and the sellers of processed foods to consumers. Women do not see the agreement on agriculture as a conflict between farmers of the North and those of the South, but between small farmers everywhere and agribusiness multinationals. In Africa the small farmers are women, even though their role has remained invisible and has been neglected in the official trade discussions.

In the upcoming Hong Kong meeting women will fight against the free export and import of agricultural products because this translates into the destruction of small farmers and local food production capacities. By locating food in the domain of international trade, women recognise that this will dislocate its production in the household and community.

Trade liberalisation through the WTO is aimed at removing all restrictions for trade and trading interest and results in the removal of food security by removing the legal and policy instruments that protect the entitlements of poor women and men who have little to no purchasing power and are therefore excluded from the market.

African women find trade negotiations a rather strange place for products of the mind to be discussed. Yet, that is precisely what has happened. Trade and plunder merge in what is called Trade- Related Intellectual Property Right (TRIPs). This is another instrument, which will dispossess rural women of their power, control and knowledge. Land, water, forests, rivers, indigenous medicines, plants are regarded as commodities. Even more obscene women are fighting against TRIPs intention to take seeds out of the custody of women and make it private property of multinational corporations. By adding ‘trade related’ to intellectual property right, the WTO has forced issues of ownership of genetic resources and life forms on to the agenda of international trade.

The construction of ‘intellectual property’ in the WTO is linked to multiple levels of dispossession for women. The preamble of the TRIPs agreement states that intellectual property rights are recognised only as private rights. This excludes all kinds of knowledge, ideas and innovations that take place in the intellectual commons, in villages, farmers, indigenous people. TRIPs is a mechanism to privatise the intellectual commons and de-intellectualise women, so that in effect, the mind becomes a corporate monopoly. TRIPs critique by women stems from the Latin root of private property, privare, and means to deprive. The laws of private property which rose during the 15 -16th centuries eroded people’s common right to the use of forests and pastures, while creating the social condition for capital accumulation through industrialisation. These new agreements in the WTO are created to protect individual right to property as a commodity, while destroying collective rights to water, land, food, health and the basis of sustenance.

Economic democracy is fundamental to the essential and efficient functioning of economies and sound public regulation. Today’s markets respond only to money, they are obsessed with the wants of the rich and neglect the most basic needs of poor women and men. Economic democracy is a necessary foundation of individual, community, and national economic self-determination – the right to determine one’s own economic priorities and the rules of one’s economic life – because it helps secure a political voice for each person.

* Mohau Pheko is the coordinator for the Gender & Trade Network in Africa, based in Johannesburg, South Africa ([email protected])

* Please send comments to

Statement by CSOs at the Fourth Ordinary African Union Summit of the Heads of States, 24-31st January 2005, Abuja, Nigeria

Signed by the African Network for the Campaign on Education for All (ANCEFA), African Womens Development and Communications Network (FEMNET), African Centre for Democracy and Human Rights (ACDHR), Center for Democracy and Development (CDD),
Pan African Movement (PAM), Pan African Development Education and Advocacy Programme(PADEAP), West African Students Union (WASU), Womens Rights Advancement and Protection Alternatives (WRAPA), Development Network of Indigenous Voluntary Agencies (DENIVA), Fahamu, ActionAid International, Oxfam GB

Summary

The fourth Ordinary African Union Summit of the Heads of States takes place at a time when the consequences of poorly financed and collapsing public health services across the continent can only be described as a public health emergency. Returning to Abuja where four years ago they committed themselves to accelerate the fight against HIV/AIDS, Tuberculosis and other related infectious diseases, it is clear that key obstacles continue to prevent hundreds of millions of Africans from realising the right to health. African Governments and the African Union must reinvigorate the fight against the violation of HIV/AIDS and health related rights.

Recommendations

- African Governments must commit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%.
- African government should ensure that treatment of AIDS and infectious diseases is provided free, reaches vulnerable groups and in an accountable manner.
- African Governments, who have to yet ratify the AU Protocol on the Rights of Women, must do so. It is a major instrument in securing the right to health for Africa’s women and girls.
- The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and measures from industrialised countries to compensate for the brain drain of African health workers.
- The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and securing measures from industrialised countries to compensate for the brain drain of African health workers.
- African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005.

Situational analysis

Across our continent the health status of women remains precarious and in many instances, worsening, not only because of HIV but also because of the many unacceptable inequalities that exist in women’s health, the limited choices that are made available to women and finally, the lack of accountability for their health.
- Pascal Mocumbi, Prime Minister, Mozambique, 2003.

The majority of Africa’s 800 million citizens continue to remain locked out of health facilities across the continent. By the time the Summit opens, Africa will have lost 20 million people to the plague of AIDS. Behind them, they would have left 12 million orphans to fend for themselves. While our leaders meet, outside the doors of the Abuja International Conference Centre, 80% of the 40 million people currently living with HIV/AIDs across the world will be struggling to fight a debilitating disease that in some parts of the industrialised world is no longer a killer disease. 55% of these will be women.

By the time the Summit opens on the 24th January, 90 million African women and girls will have been forcibly circumcised or had their genitals mutilated. Between the opening and the closing Summit ceremonies, 77,000 women and girls will have undergone unsafe abortions in countries where restrictive abortion policies ensure that no standards can be maintained or monitored. As a result of this and other factors, a staggering 47/48 sub-Saharan African countries will not meet the goal of reducing maternal mortality and one in ten babies will not survive child birth due to poor and inadequate health infrastructure in Africa.

Yet, this is sadly no longer news in a continent numbed by the domestic stories of neglect, blocked access to life-saving drugs and poverty. What could be news is the scaling up of international and African public resources into expanding access to health-care services.

Expand public financing for health and education

When African Heads of States met in Abuja in April 2001, they correctly declared HIV/AIDS, Tuberculosis (TB), and other related infectious diseases (ORID) as a state of emergency. Recalling and reaffirming their commitment to all relevant decisions, declarations and resolutions in the area of health and development and on HIV/AIDS, particularly the "Lomé Declaration on HIV/AIDS in Africa" (July 2000) and the "Decision on the adoption of the International Partnership against HIV/AIDS" (Algiers 1999) they stated;
“WE COMMIT OURSELVES to take all necessary measures to ensure that the needed resources are made available from all sources and that they are efficiently and effectively utilized. In addition, WE PLEDGE to set a target of allocating at least 15% of our annual budget to the improvement of the health sector.”

Now known as the “Abuja 15% commitment” this target was seen as a critical contribution to the fight against HIVAIDS and other diseases. Shockingly, despite this public commitment, four years on many countries continue to spend less than 10% of the revenue on health. African Governments must commit in this Summit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%.

New research published by the Global Campaign for Education and endorsed by UNAIDS, shows that a complete primary education makes a strong and direct impact on HIV infection rates, especially among young women. Girls with a complete primary education are 2.2 times less likely to contract HIV than those with some or no primary education. Education equips young people to understand and apply facts and gives them the status, clout and confidence to avoid unsafe and exploitative relationships. Investing in free primary education for everyone but especially for girls, is one of the most effective and urgently needed measures to fight the epidemic. Investing in secondary education would bring additional benefits. Consequently, the AU needs to give priority to free, universal and compulsory basic education with gender equity, both in its own strategies for development and poverty reduction, as well as in its dialogue with forums such as the G8.

Debt cancellation is pre-requisite for progress

The heavy external debt burden …continues to mortgage African economies and cast a shadow over our People’s’ future. To date, the proposed remedies are ad hoc.
- Secretary General of the Organisation of African Unity, July 2002

A comprehensive AIDS plan for Africa would cost US$10 billion per year, yet African nations spend one and a half times this amount in debt servicing. In many countries, more is spent on debt servicing than on education and health or is received in aid grants and foreign direct investment. For the same money, the global fund against HIV/AIDS, Malaria and Tuberculosis could stop these diseases and provide Anti-Retrovirals (ARVs) for the three million people living with HIV in all developing countries not just Africa.

This absurdity can only be seen from the experience of one country. Tanzania for instance, currently pays US$39 million dollars per annum in debt servicing while receiving only US$27 million in aid. It is revealing to recall that after the second world war, Germany was considered to be harshly penalised for having reparations set at 7% of its exports, yet in 2005 Tanzania is supposed to “adjust” and grow with debt servicing set at 60% of its exports.

Yet, this Summit occurs at a time when momentum has built once more around the necessity for debt cancellation. Several G8 countries have bi-laterally cancelled debts owed by African countries. In February 2005, the G7 Finance Ministers will consider proposals to underwrite debt cancellation by committing additional bi-lateral financing or by re-valuing IMF gold reserves. The benefits of this would be immense. Debt cancellation would enable countries like Ethiopia to expand access by doubling its expenditure on health and thus reaching beyond the 60% who are currently reached by health services.

There is precedence in Africa for successful re-channeling of debt relief into basic social services. At least six countries in Africa offer insight into the possibilities debt cancellation could create. In Benin for example, 54% of HIPIC relief monies was channeled into improving health programmes by recruiting health staff for rural clinics, implementing HIV/AIDS and anti-malarial programmes and improving access to safe water and increasing immunisation. Malawi has been able to allocate a 30% cut in debt servicing per year to enhance their HIV/AIDs health care system. US$1.3 million of debt relief money has been critical to resourcing Uganda’s National HIV/AIDS plan. Cameroon was able to launch a comprehensive national HIV/AIDS strategic plan funded to the tune of US$114 million with help from debt savings. In Niger, a special programme that focuses on rural education, health, food security and water systems has been fully financed through HIPC. This has mainly been used so far in building classrooms and rural clinics. In Burkina Faso, HIPC relief has been spent on health (33%), education (39%) and rural roads (28%).

As Jubilee Zambia coordinator Teza Nchinga notes, "Respect for the basic human rights (food, health care and education) of millions of Zambians should take priority over repayment of debts to comparatively wealthy creditors especially when capital on these debts has already been paid a number of times over." The African Union Commission must lead on behalf of African countries by aggressively demanding debt cancellation from the G8 in 2005. African Governments on the other hand, must follow the example of these six countries who have had re-channeled monies freed up from debt relief into strengthening health systems including the retention of health workers.

Industrialised countries must deliver on their aid commitments

Currently, despite the increases pledged in the UN Financing For Development Conference in Monterrey, rich countries spend half of the foreign assistance they did in 1960. If they were to meet the OECD targets of 0.7% of their GNP this would increase aid levels from US$70 billion to US$190 billion dollars. Yet, only the UK and Spain have set dates to meet these targets. 12 other countries are far from this and do not seem to be in a hurry.

Compared to expenditure on defense or domestic agricultural subsidies, this would be a very small amount. Looked at in terms of the cost to individual taxpayers, it would cost an additional US$80 dollars per person per year or put more simply, the average price of one cup of coffee a week.

G8 countries continue to prioritise aid to countries where they have geo-political interests rather than fighting poverty. Over 2004, America set aside US$ 65 billion dollars for fighting the war in Afghanistan and Iraq. This could have financed the exact annual budget deficit for the entire continent of Africa. Put another way, six months of US funding for the war in Iraq (US$ four billion) could have met the annual budget deficit for the global fund against HIV/AIDS, Malaria and Tuberculosis. Yet increasing aid is only one measure, improving its quality is another. For instance, nearly 30% of aid is tied to goods and services from donor countries. In the case of the US, this figure is as high as 70%.

The quality of foreign assistance also continues to be undermined by IMF and World Bank fiscal and macro-economic models, which act to constrain expenditure on basic social services. In a study of twenty Poverty Reduction Strategies, sixteen were found to contain fiscal targets for inflation and the budgetary envelope that had not been subjected to public discussion. They were targets that had been established by the World Bank or the IMF. Last year for instance, Ethiopian and Tanzanian Governments will have to meet 85 and 78 policy conditions respectively.

The AU clearly sees itself providing leadership, monitoring states performance and accountability, advocacy with states and beyond, setting up standards, harnessing new continental initiatives, and as a knowledge hub. This clear emphasis on harmonising the plethora of new initiatives and monies that are offered for flooding Africa and which are, in many cases, confusing national plans and programmes, is welcome.

To this end, the AU must challenge the proliferation of uncoordinated initiatives such as the US PEPFAR Presidential Initiative. Bilateral initiatives such as PEPFAR may reinforce donor-driven approaches, increase the administrative burdens of recipient countries and drain resources away from existing, experienced, multilateral initiatives. Such initiatives create parallel systems where the national government using inexpensive generic fixed dose combinations and that of PEPFAR using expensive brand names. This leads to confusion of both patients and health providers.

The African Union must take a more vigorous lead in engaging the international community to deliver the Monterrey promises and improve the volume and quality of foreign assistance to Africa. It is vital that donors’ initiatives and programmes should implement nationally defined policies especially regarding access to medicines.

Improving Access to Care and Support

The major challenge facing the people living with AIDS and people affected by AIDS is the issue of access to treatment and care. The World Health Organization (WHO) in December 2003 came up with an initiative to treat three million people by 2005. This is believed to be approximately half of the estimated six million people in dire need of antiretroviral therapy. This is the popular 3 by 5.

Despite the fact that some African governments have subsidized distribution programmes, less than 1% of Africans in need of ARV treatment had access to ARVs, compared to 85% in developed countries in 2004. South Africa has committed to providing free treatment to 53,000 people by March 2004. This is a fraction of South Africa's HIV positive population, estimated to be over five million. The Nigerian government began a treatment programme to provide ARVs for 10,000 people in November 2002. At a conservatively estimated number of 3 million people living with HIV&AIDS in Nigeria in 2004, this is quite clearly inadequate.

Access to ARVs is also determined by power within and between households. Findings from CSO participatory research studies in Zambia and Nigeria suggest that intra-household power relations conspire to constrain women’s access to ARVs. Women in Zambia have a disproportionate access to ARVs (30%) despite comprising of 50% of the population. In January 2004, less than 30% of people who had access to ARVs were women in Zambia. In many families who cannot afford to have more than one person on ARV, it is the male head of household that is chosen. At another level, scanty or total ignorance of prevalent diseases, the weak bargaining position of women and the pervasive cultural endorsement of male liberty to have free and multiple sexual relationships (in and out of marriage) has escalated the distributive impact of STDs and led to the high prevalence of HIV/AIDS across communities all over Africa.

In many countries across Africa the right to health is not enshrined in either the constitution or laws. It is in this context that the African Union Protocol on Women’s Rights and in particular the provisions in articles 14 and 15 significantly contribute to grounding the obligations of Governments. Yet, despite encouragement by the African Union Commission under the leadership of President Konare and civil society campaigning, only seven Governments have ratified the Protocol, a further 33 have signed but not ratified. To this end, African Governments who have not yet done so must re-commit to ratify with urgency, the AU Protocol on the Rights of Women, as a major instrument in securing the right to health for Africa’s women and girls.

Class equities also affect the distribution of ARVs. Interviewed recently, a 29 year old father of three kids in Nigeria said;

“The ARV that come to the center are not given to those of us who have come out to declare our status, but to those BIG men who bribe their way through and we are left to suffer and scout round for the drug. “

Attempts to bring down the costs of ARVs are obviously the way forward. In Nigeria, Malawi and Zimbabwe, tariffs on essential drugs have been removed. The Governments of Zambia and Mozambique have issued compulsory licensing for ARVs for their treatment programmes. Zimbabwe has also allocated precious foreign currency to a local company to manufacture generic ARVs, and is currently running trials on AZT at two of its largest hospitals. However, Zimbabwe’s lack of foreign currency has made it difficult to secure an adequate supply of drugs. In Kenya and Malawi also many public hospitals have no drugs for treatment of HIV/AIDS-related infections.

Access to essential medicines rests on African countries being able to domestically produce or source cheap drugs from southern based generic drugs industries. The AU should consider initiating dialogue with WHO, UNCTAD and the EC to explore the feasibility of establishing African centers of excellence in the producing of high quality local production of medicine especially ARVs. African states should be encouraged to influence both public and private health service providers to dispel misinformation about generic drugs being inferior to brand products, eliminate the costs of ARVs to users and actively target the rural poor with special emphasis on gender equity. Key to this will be the replication of policies that cut taxes and tariffs and promote price regulation to countries that have not already done so.

We welcome existing plans for a continental conference on the rights of people with HIV/AIDS to raise the profile of rights abuses and to chart a new chapter in the evolution of national laws and standards consistent with the spirit of the African Charter of Human and Peoples Rights. We call on the AU Commission to extend an invitation to People with AIDS organizations and networks across the continent to help design this process.

African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005. The AU must ensure that new trade agreements especially Trade Related Aspects on Intellectual Property Rights (TRIPS), bilateral and regional trade agreements do not undermine access to medicines in Africa.

The absence of effective conditions to fight HIV/AIDS and other infectious diseases such as malaria, tuberculosis and polio conditions and poor remuneration of African health workers has led to an exodus of trained health personnel. Calculating the cost of training, every doctor that leaves the continent costs Africa US$60,000. This results in a staggering subsidy to G8 countries of US$500 million every year just for health personnel.

To increase access to medicines African governments should redirect aid and debt money towards investing in basic health services including retention of health workers. Donors’ initiatives should follow national medicines policies especially using inexpensive generic fixed dose combinations. The AU should advocate with states, donors and the pharmaceutical industry to decrease the prices of second line treatment for HIV.

Conclusions

As African Governments meet once again in Abuja, they must embrace the opportunity of an invigorated African Union Commission to turn words into further deeds and directly confront the state of emergency. The temptation to simply re-affirm the 2001 Abuja Declaration must be avoided in order for the costs of this Summit to be justified. Increasing domestic resourcing, improving the quality of health programmes particularly to rural communities and delivery on debt cancellation are key to preventing hundreds of millions of Africans from being denied the right to health.

Recommendations

- African Governments must commit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%.
- African government should ensure that treatment of AIDS and infectious diseases is provided free, reaches vulnerable groups and in an accountable manner.
- African Governments, who have yet to ratify the AU Protocol on the Rights of Women, must do so. It is a major instrument in securing the right to health for Africa’s women and girls.
- The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and measures from industrialised countries to compensate for the brain drain of African health workers and stop recruiting more workers.
- African Governments must prioritise monies saved by debt relief for strengthening health systems that ensure the retention of health workers.
- African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005.

* Please send comments to [email protected]

* Useful Reading Materials
- African Union, Report of the African Summit on HIV/AIDS, Tuberculosis, and other related infectious diseases. Abuja Nigeria, April 2004
- African Union, HIV/AIDS Strategy 2005-2007
- ActionAid International, Responding to HIV/AIDS in Africa, a comparative analysis of responses to the Abuja Declaration in Kenya, Malawi, Nigeria & Zimbabwe, June 2004
- ActionAid International, 3 by 5: Ensuring HIV/AIDS Care for All. June 2004
- Fahamu/SOAWR, Pambazuka News 190: Special Issue on the Protocol on the Rights of Women in Africa: A pre-condition for health & food security, January 2005
- Oxfam International, Paying the Price, January 2005

South African generic AIDS drug manufacturer, Aspen Pharmacare, has become the first African firm to win approval from the US Food and Drug Administration (FDA) for its production plant. The FDA conducted a pre-operational review and close inspection to ascertain good manufacturing practice at Aspen's Port Elizabeth facility in September last year. As a result of this approval, funds from the US President's Emergency Plans for AIDS Relief (PEPFAR) can be used to purchase Aspen-manufactured drugs for use in countries where the local drug regulatory agency has approved them.

Uganda has expressed concern over the rising demand for anti-AIDS drugs, which is outstripping available resources. According to Ministry of Health officials, the number of HIV-positive people reporting daily to the Infectious Diseases Institute at Mulago Hospital in the capital, Kampala, was "overwhelming", having shot up from 100 before Christmas to 300 at present.

The typhoid outbreak in Gabon has spread to the capital Libreville, which has been grappling with water shortages for the past two weeks, Health Ministry officials said on Tuesday. The outbreak of this highly infectious water-borne disease began in the northern town of Oyem in December, but officials said there were now more than 100 cases nationwide, including 12 in Libreville.

Nigeria is to phase out malaria-resistant drugs such as chloroquine immediately and switch to the more effective but more expensive artemisinin-based drugs, Health Minister Eyitayo Lambo said on Tuesday. With the mosquito-borne disease responsible for 30 percent of all childhood deaths, Nigeria has adopted a World Health Organisation (WHO) recommendation to use artemisinin-based combination therapy.

Officials from UNAIDS, the World Bank and the British and Norwegian governments on Monday following a two-day visit to Kenya said the country deserves "kudos" for its decline in HIV prevalence but said that international donors need to do a better job of coordinating HIV/AIDS programs with the Kenyan government and nongovernmental organizations, VOA News reports. UNAIDS Executive Director Peter Piot said the Kenyan government has made "great strides" in reducing the country's HIV prevalence rate from nearly 14% in 1997 to about 7% in 2004.

The Ghanaian government has issued tough new guidelines for medical practitioners as it prepares for a big hike in health spending. It has ordered a switch to more expensive, but more effective drugs for treating malaria and a big increase in antiretroviral (ARV) treatment for people living with AIDS. The 517-page guidelines, along with a new list of essential medicines, aim to deliver efficient treatment at least cost as the government prepares to boost its expenditure on drugs from the estimated 2004 level of US $6million.

This Association for the Development of Education in Africa study examines the impact of HIV/AIDS on governance in the education sector. It specifically aims to: establish the impact of staff illness on the daily activities and governance function of the sector, establish how staff mortality affects sector governance, examine the resources drawn out of the sector due to HIV/AIDS-related illness and death, and examine how the sector sees itself to be coping with absenteeism and attrition among staff.

A packed courtroom echoed to the chants of furious South African demonstrators yesterday as a white farmer went on trial, accused of murdering a black worker by feeding him to a pride of lions. Mark Scott-Crossley, 37, pleaded not guilty to all charges, drawing hostile glares from the public benches on the opening day of the most racially charged court case in South Africa's recent history.

The Centre for African Family Studies (CAFS) has announced its course on 'Transformational Leadership in Reproductive Health and HIV/AIDS' to be held from 11 to 15 April 2005 in Nairobi, Kenya. This course is being launched in response to the increasingly fast moving Reproductive Health and HIV/AIDS environment, which requires transformational leaders able to assess the environment, articulate and disseminate strategic goals that motivate their stakeholders, lead and manage change within the organisation. Contact [email protected] or [email protected] for further information on this course.

The University of Kwazulu-Natal's DISA Collaborative Digital Archive of Anti Apartheid Periodicals, 1960 – 1994 is free and contains approximately 55000 pages of fully searchable text from 40 anti-apartheid journals. DISA is Digital Imaging South Africa - a non-profit initiative for cooperation among research libraries and archives in Southern Africa. It aims to make Southern African material of high socio-political interest, which would otherwise be difficult to locate and use, accessible to scholars and researchers worldwide.

It was with good reason that Mozambican Prime Minister Pascoal Mocumbi highlighted the poor state of women’s health care in Africa at a conference on women’s reproductive and sexual health rights in 2003.

Referring to what he called an “unfortunate truth”, Mocumbi said: “Across our continent the health status of women remains precarious and in many instances is worsening, not only because of HIV but also because of the many unacceptable inequalities that exist in women’s health, the limited choices that are made available to women and finally, the lack of accountability for their health.” (First conference dedicated to African Women’s Sexual & Reproductive Health & Rights, Johannesburg, South Africa February 4 – 7, 2003, www.amanitare.org/)

In making his statement, Mocumbi would have considered the statistic that 55% of adults with HIV/AIDS in Sub-Saharan Africa are women. Women with HIV/AIDS are less economically secure and are often deprived of their rights to housing, property, inheritance and access to adequate health services. Mocumbi would have been aware that 90 million African women and girls are victims of female circumcision and other forms of female genital mutilation. He would have known that many countries in Africa have restrictive abortion policies, with 11 000 unsafe abortions taking place every day. Apart from these facts, he would have known that women’s rights suffer in the many situations of conflict on the continent. Lastly, he would have known that decades of market reforms and structural adjustment policies in Africa have often marginalised women and had a detrimental impact on their access to health care.

So where does the idea of these rights come from? And how is the idea of women’s sexual and reproductive health rights supposed to improve the situation of women? According to a history of sexual and reproductive health rights on www.choike.org, a website that functions as a portal for civil society worldwide, the term "reproductive rights" first arose during an International Meeting on Women and Health in Amsterdam (1984) which was seen as the starting point of efforts by women to expand the scope of the concept of human rights.

At the World Conference on Human Rights held in Vienna in 1993, participant States agreed to regard any violation of the specific rights of women as a human rights violation. In the Programme of Action of The Cairo Conference in 1994, the acknowledgement of rights enjoyed or denied inside the home won increasing ground in the conception of human rights. It was also established that post-abortion counselling, education and family planning services should be established. The Programme of Action further called on governments to regard unsafe abortions as a major public health concern, improve family planning services to avoid abortions, provide health care and guidance for women who have unwanted pregnancies, and urge the implementation of policies and changes in the approach to abortion.

The Beijing platform for action in 1995 was the most comprehensive document produced by a United Nations conference on the issue of women's rights, as it incorporated the achievements of previous conferences and treaties, such as the Universal Declaration of Human Rights, the CEDAW (Committee on the Elimination of Discrimination Against Women), and the Vienna Declaration. It reaffirmed the definitions adopted at Cairo. The Third Special Session of the UN General Assembly, known as "Women 2000: Gender Equality, Development and Peace in the 21st Century", took stock of the advances made in the implementation of the Beijing Platform for Action's recommendations (WPA or Beijing + 5).

On a regional level, the Protocol on Women's Rights in Africa adopted by the African Union in Maputo in 2003 affirms state responsibility to protect sexual and reproductive health and reproductive choice, and to combat violence against women and discriminatory cultural norms. The Protocol requires states to prohibit and condemn female genital mutilation, while women and men must have equal rights in relation to marriage. The reproductive rights of women must be protected and abortion provided in certain circumstances. Under the Protocol, women must be guaranteed the right to protection against sexually transmitted infections and HIV/AIDS.

This international and regional human rights framework is not sufficient in itself to protect the sexual and reproductive health rights of women. In order to be effective many things need to happen. Laws have to be passed by individual countries so that commitments to international treaties can be enforced. These laws in turn have to be the subject of public awareness and education campaigns so that they are popularized. This education does not only apply to making women aware of their rights, but also involves educating men to treat women as equals. Resources will therefore have to be prioritized for women’s sexual and reproductive health and health services will need to be equipped to be able to deal with the increased needs of their populations and to incorporate a reproductive rights perspective into their daily functioning. Perhaps most importantly, the protections offered to protect rights must be enforced. (Source and further reading: http://www.unfpa.org/intercenter/reprights/needs.htm)

Sadly, the kind of political commitment needed for this kind of action is completely lacking in many countries. Women continue to be treated as unequals in society. In recent years the attitude of the Bush Administration has threatened to erode the gains that the reproductive rights movement has made over the last two decades. A conservative, fundamentalist Christian element in the US has dictated that the US will withhold funds from organizations around the world who are involved in providing abortion services, dealing a blow to the funding of reproductive health services in developing countries.

Governments who haven’t taken the sexual and reproductive health rights of women seriously should wake up. Taking these rights seriously will lead to healthier populations and contribute to the fight against HIV/AIDS. It will reduce poverty and contribute to sustainable development. It makes sense. And besides, in future years, women may well have a case for reparations against their governments and the male population at large for the continued violation of their basic human rights. Perhaps its a case that should be made.

* Please send comments to [email protected]

References and further reading:

http://ipsnews.net/interna.asp?idnews=26492
http://www.whrnet.org/docs/issue-sexualities.html
http://www.eldis.org/hivaids/abstinence.htm
http://www.ipas.org/english/default.asp
http://www.reproductiverights.org/pdf/pdf_BreakingThrough_04.pdf
http://www.choike.org/nuevo_eng/informes/1197.html
http://www.ipsnews.net/interna.asp?idnews=25397
http://www.unfpa.org/intercenter/reprights/reproductive.htm
http://www.wits.ac.za/whp/sexualrights_beijing.pdf
http://www.unfpa.org/rh/index.htm
http://www.unfpa.org/intercenter/reprights/sexual.htm
http://www.feministafrica.org/fa%202/02-2003/amanitare.html

Close your eyes. Imagine a farmer working in a field, back bending, arms swinging up above the head and then down towards the earth as a hoe slices into the ground. In your mind, what is the gender of the farmer? If the image is of a man, you’d probably be wrong. Male stereotypes dominate the world of farming, but it is women who account for 70-80 percent of household food security in Sub-Saharan Africa.

Despite women being the base of food security in African countries, their role has in the past been ignored by policy makers. The result is that gender inequalities have gone unchecked, conspiring against food security for women and preventing them from playing a fulfilled role in the food security situations of their communities.

The consequences of food insecurity are dire. Lack of food means poorer nutrition for mothers and their children and thus a deteriorating health situation. It leads to the breakdown of communities and family structures, as families are forced to migrate in search of livelihoods. Food insecurity may force women into prostitution and lead to a rise in child trafficking.

Many factors conspire against food security for women. Discrimination against women in laws governing access to land is one of these factors. According to a 1995 International Food Policy Research Institute paper, although land laws vary widely, some religious laws forbid female land ownership. When civil law does give women the right to inherit land, local custom may rule otherwise. In Sub-Saharan Africa, where women have prime responsibility for food production, they are generally limited to user rights to land, and then only with the consent of a male relative. The consequence is that women have limited economic choice and are exposed to homelessness, poverty and violence. (Sources and further reading: http://www.fao.org/newsroom/en/news/2004/38247/print_friendly_version.h…; http://www.ifpri.org/pubs/fps/fps21.htm)

Damaging economic policies cause or exacerbate gender inequality and food insecurity. While trade agreements are presented as gender-neutral, trade and economic policies are formulated within a social context that enables or disables women to gain access to and control over productive resources, according to a 2002 Aprodev conference. “Failure of decision makers to recognize the central role of women in food production and the nutritional well being of their families and communities and the impact of trade liberalization has led to the gradual erosion of the prime source of food security and sustainable development,” said the conference report. Marginalisation of small-scale farmers accentuates gender inequalities by pushing poor and women farmers into the background and reducing their market space. “People everywhere lose control over their means of survival, and become dependent on world market forces of trade and finance. They are excluded from progress, by being first integrated into the world market and then alienated from their means of survival,” states the Aprodev report.
(Source and further reading: http://www.aprodev.net/files/gender/2002GOODConf.pdf)

A devastating HIV/AIDS epidemic has accentuated a food security crisis, with food production reduced by up to 60 per cent in some cases because women's time and energy turns to caring for HIV/AIDS-infected family members. HIV/AIDS, food security and poverty are linked. The combination makes people poorer because they can’t work due to sickness and thus lose income. Expenses for medical bills and related costs skyrocket. Malnutrition resulting from poverty enhances the onset of progression to full blown AIDS. In the worst situations there is population displacement and increased sexual violence.
(Sources and further reading: http://www.odi.org.uk/Food-Security-Forum/docs/Shumba%20Ja03.pdf; http://www.sarpn.org.za/documents/d0000118/page5.php)

The United Nations Universal Declaration of Human Rights in 1948 formally recognised the right to food as a basic right. More recently, the international community has identified the reduction of poverty and hunger as crucial for development goals. At the 1996 World Food Summit, reducing hunger and food insecurity was declared an essential part of the international development agenda. Leaders from 185 countries and the European Community reaffirmed, in the Rome Declaration on World Food Security, "the right of everyone to have access to safe and nutritious food, consistent with the right to adequate food and the fundamental right of everyone to be free from hunger." They further pledged to cut the number of the world's hungry people in half by 2015.

In 1999 the United Nations Committee on Economic, Social, and Cultural Rights, in the text of the International Covenant on Economic, Social, and Cultural Rights stated that the right to food is realized "when every man, woman, and child, alone or in community with others, [has] physical and economic access at all times to adequate food or means for its procurement." (Source and further reading: http://www.ifpri.org/pubs/ib/ib29.pdf)

In Africa, Article 15 of the Protocol on the Rights of Women in Africa specifically recognises the right of women to food security. The article places an obligation on states to ensure that all women have the right to nutritious and adequate food by providing women with access to clean drinking water, sources of domestic fuel, land and the means of producing nutritious food. States are further obliged to establish adequate systems of supply and storage to ensure food security.

How do the ideals and declarations translate into food on the table? Like the image of the farmer doing backbreaking work with a hoe, it requires hard work of a different kind. Political commitment, consultations with communities, shared decision making, transparency and education are some of the criteria needed to make food security a reality and decrease the estimated 800 million people globally who are undernourished and food insecure. But all of this will in itself be useless unless there is recognition of the damaging role that factors like unfair trade terms and high debt burdens play in militating against food security.

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As African women celebrate the rising numbers of ratifications towards the attainment of the statutory number of fifteen ratifications to bring into force the Protocol to the African Charter on Women’s Rights in Africa (Nigeria is the latest member state to ratify the Protocol), it is relevant for us to embark on a simplification of the obligations on Member States and the potential benefits of its provisions for women. Linkages must also be drawn between the principles of the provisions of the Protocol and those in other national and international instruments of law or policy that many of the African Union (AU) member states are signatories to.

Once the Protocol comes into force its implementation by member states (subject to internal processes of domestication), places an obligation on governments to establish institutions and mechanisms that assure women of protection from practices and attitudes that allow for the perpetration of violence and discrimination, including differential opportunities in education, political participation and access to justice.

The provisions of Article 14 (Health and Reproductive Rights), and Article 15 (Right to Food Security) of the Protocol provide some bench marks that we may aspire to attain once the Protocol is domesticated in Nigeria. The health and reproductive rights of women and their right to food security is a contingent factor to their fundamental right to life. The two together cover the extent and quality of the lives of women in Nigeria. Statistics from the 2003 Demographic and Health Survey (NDHS) indicate a direct relationship between women’s education status, economic disposition, and access to nutritional diet or micronutrient supplements to their fertility rates, their access to clean drinking water, antenatal and postnatal care - thereby underscoring the high rates of maternal mortality registered by Nigeria in the last ten years.

The right of women to control their fertility in respect of defining the number and spacing between their children is obscured by the dictates of patriarchy where the decision lies with the man. In many instances the issue of male-child preference pushes many women into multiple deliveries, mostly in close succession or in competition with other wives, in search of the preferred child. Even where women are able to negotiate some respite, they may loose out in the proposal for family planning or the method of contraception they choose to use. Women’s right to health is further undermined by poor nutritional indices in the value content necessary for normal body function and good health.

Social and gender taboos typify foods that men and women can or cannot eat at all times or during specific conditions such as pregnancy and breastfeeding. The penalties for ‘violation’ are disproportionately high while the women’s incapacity to meet with the cost of the items of appeasement keeps them ‘unattracted’ to high value content food items. Food supplements are available largely in urban centres with hardly any reaching rural women who may go through a pregnancy without the basic iron supplement meant to prevent anaemia, which is a confirmed factor of disorders in the foetal development and is usually a reason for premature delivery or low birth weight. Anaemia is also an underlying cause of maternal and perinatal mortality.

At another level scanty or total ignorance of prevalent diseases, methods of contraction and what to do or where to go for help remain a bottleneck in women’s access to protection and treatment of sexually transmitted diseases (STDs) including HIV/AIDS. Many women, apart from being ignorant about their health status, have limited ways of determining the health status of their partners and the results are devastating for families and communities in most of the member states of the AU. Aggressive initiatives have not yielded the desired results due to the absence of a strong political will or due to societal and individual denial of the existence or scale of some of the diseases. This is compounded by the weak bargaining position of women in power relations and the pervasive cultural endorsement of male liberty to have free and multiple sexual relationships (in and out of marriage) thereby escalating the ‘redistribution’ impact of STDs and leading to the high prevalence of the HIV/AIDS epidemic ravaging communities and nations all over Africa.

Land ownership for the average subsistence female farmer is an important right that would give her food security, and enhance her capacity for food production and an economic base. The tens of miles women trek to get water (never mind the quality they find) and domestic fuel is a factor that tasks their physical and mental capacity and pre-occupies them to the extent that they are absent from decision making and in most instances reduced to being ‘beasts of burden’.

In Nigeria, Chapter II Sections 13 to 24 of the Constitution of the Federal Republic of Nigeria provide for the Fundamental Objectives and Directive Principles of State Policy. The provisions, which for now are not justiciable draw a lot from the United Nations Charter of Social and Economic Rights, and provide a framework that impacts significantly on the quality of the fundamental human rights of citizens as guaranteed by Chapter IV of the same Constitution. Specifically, section 13 states clearly and unequivocally that:

‘It shall be the duty and responsibility of all organs of government, and of all authorities and persons exercising legislative, executive or judicial powers to conform to, observe and apply the provisions of this Chapter of the Constitution.’

The implication of this provision is the imposition of an obligation on the Nigerian State to take positive action for creating socio-economic conditions that uplift the dignity of citizens, makes it real and accessible to all especially the weak and vulnerable. Therefore the provisions of the Protocol in Articles 14 and 15 go a long way in concretizing the obligations of the Nigerian government and upon domestication make the rights in the key areas of health, reproductive rights and food security for women justiciable. Petitions, especially for redress against violations or non implementation, can be initiated at national level and where desirable can go up to the African Court for Human and Peoples’ Rights.

Furthermore, our collective campaign and advocacy should tie government delivery on the provisions of the Protocol to the basic deliverables of good governance. This is to provide a framework that defines for women, the quantity, quality and the means of accessing the indicators in the implementation of the Protocol.

The number and quality of basic healthcare structures, especially at rural levels, will be an indicator while the services rendered must cover the spectrum of detection and medication for simple ailments, health intervention initiatives such as iron fortification programmes, prenatal and postnatal services, training and retraining of rural/traditional birth attendants (TBAs), family planning services, information on sexuality as well as voluntary testing and counselling for STDs and HIV/AIDS.

Other indicators include provision of quality drinking water using simple and affordable technology and government’s commitment to the development of alternative energy for domestic purposes. At the legislative level, laws aimed at prohibiting social and cultural constructs that deprive women of control over land must be enacted while extensive reorientation and advocacy is embarked upon to support implementation of the laws and a shift in the right direction. The most important indicator is a demonstrated political will to eradicate the barriers and impediments affecting the quality contribution of women to the development of their communities and nations.

* Saudatu Mahdi is from the organisation Women’s Rights Advancement and Protection Alternative (WRAPA) in Nigeria

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Violence against women has devastating health consequences on the victims and undermines women’s control over their own reproductive health. In dealing with survivors of violence against women at the Coalition on violence’s Against Women (COVAW) counseling and legal aid clinic, what has emerged is that most women undergoing violence perpetrated by intimate partners also present with reproductive health risks and problems.

These can broadly be categorized into fatal outcomes and non fatal outcomes suffered as a result of violence. The fatal outcomes could be death as a result of homicide, suicide by the victim, maternal mortality and HIV/ AIDS. The non fatal outcomes include poor physical health as a result of the injuries, poor mental health like depression, consequences related to reproductive health like unwanted pregnancies, unsafe abortions and sexually transmitted infections, including HIV/ AIDS.

The psychological consequences are even more long term and devastating. The 2001 world health report identified gender based violence as one of the factors contributing to the disproportionate rates of depression amongst women. It further points out that recurrent abuse can erode women’s resilience and places them at risk of other psychological problems such as post traumatic stress disorder, suicide, and alcohol and substance abuse.

The right to access basic health care services and information is a basic human right enshrined in several international conventions and instruments like the Convention on the Elimination of all Forms of Violence Against Women (CEDAW), the Universal Declaration of Human Rights, and the International Conference for Population and Development (ICPD).

Despite this research from several countries has shown that women in violent relationships often do not have adequate access to reproductive health services yet they are among the most vulnerable and seek health services more frequently than non abused women.

Within the health sector systems violence against women remains highly invisible and there are glaring gaps within the health sector as well at the community level for dealing with violence against women. Most health providers have consistently failed to recognize and consider violence against women an important part of their work. Some health workers, being products of a culture that condones violence against women, view it as a normal way of life and do not feel obligated to pay attention to women who present with signs and symptoms of abuse. They do not feel that caring for women suffering violence is part of their professional profile. Their attitudes about violence are also largely shaped by prevailing cultural norms. Owing to this disinterest, women living in violent situations also rarely reveal their situations to health care providers.

One doctor interviewed in an intimate partner violence survey conducted by Family Health International captured the situation thus:

“Health workers – doctors, nurses clinicians are men first before they are health workers. As a result they cannot escape from the mashismo socialization that all men receive from their environment”.

Many providers also express attitudes that blame the victim rather than the aggressors. Such attitudes pose a serious challenge to transforming the culture of silence and complicity on issues of violence against women. The situation is further compounded by the lack of legislative and policy frameworks that require health programs to integrate policies and national plans to address gender based violence. The establishment of health sector policies on addressing violence is a key step towards institutionalizing violence against women programs and raising awareness amongst health providers on their role in addressing violence. Policy frameworks within the health system are important as they create a mechanism of holding the health sector responsible in addressing violence against women.

Governments are responsible for upholding women’s reproductive health and rights yet they consistently fail to live up to that duty. This has meant the use of international normative frameworks as a strategy to build pressure on governments to abide by universally acceptable standards of promoting women’s rights to reproductive health.

The protocol to the African Charter on women’s rights is one such instrument. Lauded as one of the most progressive instruments of promoting the rights of women on the African continent, it provides a comprehensive and useful framework for safeguarding women’s sexual and reproductive health and rights while upholding the bodily integrity of women. Article 14 of the protocol obligates state parties to undertake several kinds of duties relating to sexual and reproductive health and rights of women. Among the obligations it places on states are:

- The duty to protect the reproductive rights of women which requires states to take all necessary measures to ensure that no acts of omission and commission results in any violation of women’s reproductive rights.

- The duty to fulfil the reproductive rights of women which calls upon states to take all appropriate measures including legislative, administrative, budgetary allocations and other measures that will ensure the realization of women’s reproductive rights.

The duty to respect which entails that the government upholds a woman’s right to choice, information, and control over her sexual autonomy and bodily integrity. It further prohibits states from interfering with the protection and promotion of reproductive health and rights.

It is interesting to note that Article 14 has proved the most contentious in a number of countries yet it is one of the most liberating in terms of providing choice for women in matters of bodily integrity and autonomy. Women on the continent must not let the politics of control gain prominence over their rights to choice.

Once countries sign and ratify the protocol they become duty bound to uphold these rights. With glaring gaps that exist on legislative and policy frameworks in matters of reproductive health, it is necessary to continue building pressure for African governments that have not ratified the protocol to do so. Its passage will stimulate the enactment of national policies on violence which are strategic tools for stimulating greater sensitivity that violence against women is a public health issue. It will also create the political space for dialogue between civil society and the state while at the same time committing governments to a discourse that encourages sanctions against violence.

In a continent characterized by oppressive gender relations the passage of the protocol will anchor issues of women’s health within a human rights framework, thus creating duty bearers who can be held accountable for the realization of rights. Women’s rights activists must therefore not relent in their struggle to have governments move beyond lip service to securing serious commitments on issues of women’s reproductive health and rights.

* Anne Gathumbi is a women's rights activist and the outgoing coordinator of the Coalition on Violence Against Women (COVAW) in Kenya.

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