The rural society in Benin is involved in a number of important dynamics: decentralisation, privatisation and the transfer of central state functions to local authorities and the private sector, including farmer's organisations. Other ongoing changes are the search for an adequate access to and delivery of basic services, a better and equitable access to economic markets, migration to urban and coastal areas, increasing pressure on natural resources.

This report was prepared to provide an input in UNESCO's fields of competence to the Working Group of the United Nations Commission on Science and Technology for Development (CSTD) on Information Technology for Development and to the International Telecommunication Union (ITU) Development Study Group 1.

Nelson Mandela delivered his first speech there after leaving prison. The square has also been the scene of anti-apartheid protests and military parades. This coming week (beginning September 30), however, Cape Town's Grand Parade will be a venue for something entirely different: street soccer matches played during the 2006 Homeless World Cup (HWC).

Trial began on Monday (September 25) for a former deputy prosecutor accused of ordering the deaths of Tutsis during Rwanda's 1994 genocide and providing weapons to men at roadblocks set up to facilitate the slaughter. The Arusha-based International Criminal Tribunal for Rwanda (ICTR) charged Simeon Nchamihigo, a former deputy prosecutor in Cyangugu prefecture, with genocide, extermination, and violation of the Geneva conventions protecting civilians during conflict.

A pro-democracy movement is challenging the assertion in Swaziland's new constitution that the people want to be governed by an executive monarch in a court action demanding that the government back its claim by publishing the evidence.

EISA is pleased to announce the official launch of its Election Observer Mission to the 2006 Tripartite Elections in Zambia scheduled for Thursday 28 September 2006. The Mission, which is led by Mr Abel Leshele Thoahlane, Chairperson of the Independent Electoral Commission of Lesotho and of the EISA Board of Directors, is in the country at the invitation of the Electoral Commission of Zambia.

Just like Karura Forest, the bulk of Ngong Forest was irregularly allocated in the 1990’s. The report compiled by the Kenya National Commission on Human Rights says the taxpayer lost over Sh9 billion worth of prime land to crooked individuals who received and sold the land to third parties.

Although Angola is benefiting from a post-war economic boom, far more needs to be done to ensure the benefits are felt by all Angolans, warn humanitarian workers. The 27-year conflict killed one million people and took a massive toll on human development.

A new national assembly was inaugurated in the Democratic Republic of Congo, the first such body to be democratically elected in the country in more than 20 years. "The new parliament can only lead to peace," Jean-Pierre Nemoyato, one of the newly inaugurated parliamentarians, said.

The International Confederation of Free Trade Unions (ICFTU), the World Confederation of Labour (WCL) and the European Trade Union Confederation (ETUC) express their firm support for the leaders and members of the Zimbabwe Congress of Trade Unions (ZCTU).

A top United Nations envoy warned that the Darfur peace agreement was on the verge of collapse and lambasted the Darfur Ceasefire Commission (CFC), which is responsible for monitoring and implementing the accord.

The high death toll and internal displacement resulting from a wave of sectarian violence across the country triggered by Danish caricatures of the Prophet Mohammed in February 2006, coinciding with a dramatic increase in militant violence in the oil-rich Delta region, were clear warning signs that once violence erupts it can quickly take on a momentum of its own.

At a time when asylum applications are falling worldwide, the Swiss government is seeking to raise the obstacles faced by people seeking a country of safe refuge from persecution at home. By rendering access to this landlocked country more difficult, Switzerland is failing not only those fleeing persecution and mortal danger, but is also shifting the burden of their initial reception to its Mediterranean neighbours on the periphery of the European Union.

The Learning programme will be based on the rich development experience of the participants themselves. Participants will be placed in a non-formal, participatory, people centred and process oriented learning framework. Participants will explore together the meaning of human rights in development work and how integration of human rights into development work translates into concrete strategies and development programming at the grassroots and international levels.

Pambazuka News is amongst the list of nominations by PoliticsOnline for those who are changing the internet and politics. Last year we were in the top ten.

This year it would be great to win it!

The awards work according to a voting system - you can click on the link below to cast your vote:

Please cast your vote now, the deadline for voting is 1 October 2006.

REMINDER: Please remember to vote for Pambazuka News at
FEATURE: Ir?ng? Houghton reviews emerging policies on sexual and reproductive health, the reality for women and girls and what governments need to adopt during this Health Ministers and Experts conference in Maputo, Mozambique.
COMMENT AND ANALYSIS: - Baffour Dokyi Amoa argues that it is not an exaggeration to say that small arms have contributed to the political disintegration of many African countries.
- Mandisi Majavu argues against the “Africa Aerospace & Defence 2006” exhibition.
- Patrick Bond argues that the assault against the international civil society has been devastating. He writes that nearly all the major multilateral institutions have been captured by hardliners over the past couple of years.
BLOGGING AFRICA: Sokari Ekine reminds us that this past Sunday marked the Global Day of Action for Darfur. The aim was “to show world-wide support for the Darfuri people and to put pressure on our Governments to protect the civilians.”
Pan-African Postcard: Tajudeen Abdul Raheem argues that Islamic faith replaced Communism in the pantheons of Western phobias
CONFLICT AND EMERGENCIES: Links to news on Sudan, Somalia, Uganda, Ivory Coast and Zimbabwe
HUMAN RIGHTS: Ugandan is the worst place in the world to be a child
WOMEN AND GENDER: Women leaders meet in Maputo
REFUGEES AND FORCED MIGRATION: AU mission extended with Arab and UN support
ELECTIONS AND GOVERNANCE: Number of women contesting the polls low and disappointing
DEVELOPMENT: IMF and the World Bank found guilty
CORRUPTION: State to seize 78 bank accounts with looted money
HEALTH AND HIV/AIDS: Labour urged to demand sacking of health minister
EDUCATION: Higher education and economic growth
RACISM & XENOPHOBIA: How obsession with race stops SA from meeting its challenges
ENVIRONMENT: Africa’s environment under siege
LAND AND LAND RIGHTS: The third Chimurenga
MEDIA AND FREEDOM OF EXPRESSION: In Eritrea, journalists still jailed after five years
DIASPORA: Genealogical quest
INTERNET AND TECHNOLOGY: Zimbabwe internet shuts down
PLUS: e-Newsletters and Mailings Lists; Fundraising and Useful Resources; Courses, Seminars and Workshops; Jobs.

Patrick Bond argues that the assault against the international civil society has been devastating. He writes that nearly all the major multilateral institutions have been captured by hardliners over the past couple of years. Bond postulates that it is from this standpoint that “…We can understand not only the recent debacles of global governance: the inability to expand the UN Security Council in September 2005; the breakdown of the Doha Round of World Trade Organisation negotiations in July 2006; and the planned shrinkage of Africa’s voting power within the IMF board of governors, from 4% to 2%.”

The World Bank and International Monetary Fund (IMF) annual meetings just completed in Singapore were a disaster for the Third World, especially Africans who face a dramatic decline in voting shares on the IMF board, at the same time a few middle-income countries led by China recapitalise the institutions.

For civil society activists, the official welcome in Singapore may not have matched last week’s brutality by Robert Mugabe against Harare trade union leaders or Durban police against shackdwellers. But it more than confirmed Singapore’s reputation as an intolerant police state:

• the regime simply banned the arrival of dozens of social and environmental activists, including many with official Bank/IMF accreditation;
• others who got to the airport were immediately extradited;
• Singapore even asked neighbouring Indonesia to cancel a citizen’s conference critical of the Bank and IMF, held across the bay from the city-state.

Civil society activists replied with a boycott call. According to a petition by Jubilee South, the World Development Movement, Greenpeace, Friends of the Earth International, Oil Watch International and several other groups, ‘Knowing full well the authoritarian character of the Singaporean Government, the Bank and IMF appear to have picked Singapore as the site because they wanted to avoid legitimate and peaceful street protests.’

True, but consider the broader context for the assault on institutions of international civil society. Nearly all the major multilateral institutions have been captured by hardliners over the past couple of years:

• the European Union chose Spanish neoconservative Rodrigo Rato as IMF managing director in mid-2004;
• the new head of UNICEF, chosen in January 2005, was George Bush’s agriculture minister Ann Veneman, although the US and Somalia are the only two out of 191 countries which refused to ratify the United Nations Convention on the Rights of the Child;
• for another key UN post in February 2005, the outgoing head of the World Trade Organisation, Supachai Panitchpakdi from Thailand (who mainly served US and EU interests from 2003-05), was chosen to lead the United Nations Conference on Trade and Development;
• Paul Wolfowitz was appointed by Bush to head the World Bank in March 2005;
• the European Union’s trade negotiator Pascal Lamy won the directorship of the World Trade Organisation a few weeks after that; and
• to ensure that Washington’s directives to Kofi Annan continued to be as explicit as possible, Bush appointed John Bolton as US Ambassador to the UN.

Bolton is illustrative, for he was never confirmed by the US Congress since Bush gave him the job during a mid-2005 recess. As the once-powerful, pro-apartheid former US senator Jesse Helms put it, he is ‘the kind of man with whom I would want to stand at Armageddon.’

Coming from the State Department, Bolton’s main function beginning in 2001 when Bush captured the White House, was to disempower the UN. He also engineered Washington’s withdrawal from or weakening of the anti-ballistic missile treaty, a biological weapons convention protocal, the Organisation for the Prohibition of Chemical Weapons, the nuclear test ban treaty, the UN conference on the illicit trade in small arms and light weapons, and the International Criminal Court.

It is in this context that we can understand not only the recent debacles of global governance: the inability to expand the UN Security Council in September 2005; the breakdown of the Doha Round of World Trade Organisation negotiations in July 2006; and the planned shrinkage of Africa’s voting power within the IMF board of governors, from 4% to 2%.

In addition, at a time of fusion between ‘neoliberalism’ (promoting US/EU corporate and especially financial interests) and ‘neoconservativism’ (promoting US petromilitary profits and religious-extremist values) as the dominant bloc in global geopolitics, we must concede the utter futility of reform proposals being advanced by some in civil society, along with some governments, like Thabo Mbeki’s.

The neolib-neocon fusion is personified by Wolfowitz, close ally of the exceptionally corrupt, brutal Indonesian dictator Suharto during the 1980s and more recently, as deputy Pentagon leader, architect of and apologist for imperial theft and US corporate patronage associated with the illegal Iraq War.

Since January this year, Wolfowitz’s Bank has a new self-declared mission: to stem project graft, whose historical costs to the 62-year old institution are conservatively estimated at $100 billion. Wolfowitz is getting plenty of press ink for his anti-corruption plan by asking its contractors and staff to declare their knowledge of backhanders. If so, an amnesty will be granted and they won’t be prosecuted.

Patricia Adams from the Toronto NGO Probe International condemns Wolfowitz’s strategy because it ‘immunises bribers from debarment, allows the Bank to cover-up its own negligence or complicity, and undermines the administration of justice in countries where it is a criminal offence to bribe a foreign official.’

Lesotho is a good example, because the Maseru government is standing up to the ‘dirty dozen’ corrupt firms and consortiums which bribed top Highlands Development Authority officials – including one now in jail, and another in charge of water for the New Partnership for Africa’s Development.

After a key US Senator, Richard Lugar, supported Lesotho, the Bank finally began some limited debarment in 2004. Pretoria is yet to follow suit (perhaps because some local giants like LTA and Concor were implicated, which would throw off 2010 infrastucture construction timing.)

Civil society groups are used to the runaround. In the case of the Bank’s ill-fated 1998-2001 World Commission on Dams (WCD), chairperson Kader Asmal despaired at the follow-up findings of the (2002-03) World Panel on Financing Infrastructure, led by former IMF Managing Director Michel Camdessus. Asmal wrote: ‘For an esteemed panel to effectively write off the WCD, whose core recommendations have been endorsed by many of its member organisations, is quite remarkable and raises concerns about the value of the report. Failing to address this point effectively takes us back many years.’

Remarked activist Patrick McCully of International Rivers Network, ‘The World Bank’s singularly negative and non-committal response to the WCD Report means that the Bank will no longer be accepted as an honest broker in any further multi-stakeholder dialogues.’

Moreover, ubiquitous Bank/IMF Poverty Reduction Strategy Papers (1999-present) also proved to be a dead end, according to dozens of cases considered carefully by civil society and academic researchers.

Likewise, the (1999-2003) Structural Adjustment Participatory Review Initiative (Sapri) failed when Bank staff walked out of the process near its conclusion. Commented Richard Peet, author of a major book on the Bretton Woods Instituitons, ‘the President of the World Bank did not listen to Sapri, because he could not. For he would hear, and he even might learn, that his finest, most splendid ideas had produced the worst, most harmful effects.’

The crucial Extractive Industries Review (EIR) was similarly constructed as a multi-stakeholder project (2002-04). But the Bank was not serious about tackling problems caused by the mineral, petroleum and timber industries. According to analysts at Friends of the Earth, Environmental Defence and International Rivers, ‘One of the Bank’s most important environmental reforms of the 1990s was its more cautious approach to high-risk infrastructure and forestry projects. This policy is now being reversed.’

Specifically, the environmentalists complained, ‘The World Bank recently announced that it would re-engage in contentious water projects such as large dams in what it refers to as a “high risk/high reward” strategy. In 2002, the Bank dismissed its “risk-averse” approach to the forest sector when it approved a new forest policy. The World Bank is also considering support for new oil, mining, and gas projects in unstable and poorly governed countries, against the recommendations of its own evaluation unit.’

The EIR recommended a phasing out of all Bank fossil fuel investments in late 2003. In February 2004, SA’s then energy minister and now deputy president, Phumzile Mlambo-Ngcuka, explicitly advised the Bank to oppose the ‘green lobbyists’, and six months later the Bank board rejected the EIR’s main proposals.

Ultimately, nearly all civil society initiatives aimed at reforming the Bank and IMF have been disasters. The Civicus World Citizens Assembly withdrew from its controversial 2003-05 initiative to rebuild relations.

The boycott of Bank activities by most forces within civil society launched last week reminds of the calls to stigmatise South Africa before 1994. And why not? After all, Thabo Mbeki has popularized the term ‘global apartheid’ – and now the question is whether to polish the chains or break them.

* (On September 26, Bond – who directs the UKZN Centre for Civil Society – will lead a morning discussion about the Bank and IMF in Durban at Diakonia; two additional presentations will occur on 27 September at the Institute for Policy Studies in Washington from noon-2pm, and on 1 October at the Brecht Forum in New York City, noon-3pm.)

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

According to the Africa Aerospace & Defence newsletter, the AAD 2006 “… is Africa’s showcase event for general and commercial aviation, aerospace and military land, sea and air technology and services.” However, anti-war groups argue that the AAD 2006 will exhibit the largest and greatest in machinery designed for only one purpose - the killing of human beings. This is the harsh truth behind arms expos; they supply arms for countries to go to war.

In Africa, a continent that has been devastated by civil wars, a continent where military weapons have brought nothing but misery and destruction, the last thing one would expect is a weapons fair. Dubbed “Africa Aerospace & Defence 2006”, AAD 2006 is the largest weapons exhibition that has ever been organised in this continent.

As if referring to a flea market, the AAD 2006 websites states that: “Air Force Base Ysterplaat [Cape Town, South Africa], against the backdrop of Table Mountain, will provide the setting for the only exposition of its sort in Africa and will feature more than 400 exhibitors from at least 25 countries.”

The AAD website further informs readers that by taking part in this affair, “trade visitors and the media have the unique opportunity to get in on the ground floor, experiencing and participating in the renaissance of the African aerospace and defence industry.” We are expected to believe that the same military weapons that have perpetuated civil wars in the DRC, Uganda and Liberia are in actual fact what constitute the African renaissance. This would be funny if this were not a matter of life and death.

Commenting on the exhibition, the Ceasefire and Umzabalazo we Jubilee campaigns wrote: “These arms companies will exhibit the largest and greatest in machinery designed for only one purpose, the killing of human beings. Husband, fathers, son, daughter and infants will all die because of this machinery. This is the harsh truth behind arms expos; they supply arms for countries to go to war with other countries and against their own citizens.”

The Cape Town Anti-War Coalition claims that: “Many of the arms companies ‘exhibiting’ at the weapons fair are allegedly involved in dealing weapons through third party front companies with extremely poor human rights records, like America, Saudi Arabia, Pakistan, Egypt, Angola, Eritrea, Sudan and Nigeria. This method involves direct purchases by the foreign aid recipient from a government weapons manufacturer contractor, without directly government involvement in the process. Others are involved in further impoverishing poor countries like Malawi who have no need for military equipment but who are forced by the World Bank into taking out loans to buy weapons in exchange for aid.”

According to the Small Arms Survey 2006, “Applying the doctrinal distinctions outlined…to 166 countries (all countries with a population over 400 000 that have military) permits global estimation of the number of firearms controlled by the state-sponsored armed forces of the world. Combined with formally declared military inventories, this analysis concludes that the world harbours at least 200 million official military firearms. When distributed to compensate for a statistical margin of error (plus or minus 25 percent), the range of global military firearms appears to be between 150 million and 250 million. The estimating used here for People’s War militaries are conservative, which suggest that actual global totals are more likely to be closer to the upper parameter.”

Addressing specifically the issue of small arms, the Global Policy Forum (www.globalpolicy.org) states that: “Small arms and light weapons fuel civil wars and other conflicts, causing harm to millions of people, particularly in Africa. These small weapons are only part of a larger trade that includes heavier and more lethal weaponry, but light arms are often especially baneful because they are cheap, easy to transport and can be handled by ill-trained rebel soldiers and even children. Recent UN reports show how these weapons are illicitly exported, transported with connivance of government officials in many countries and smuggled into war zones.”

To fully understand what the AAD 2006 means for ordinary Africans, one has to take into consideration the role of small arms in African civil wars. As the Global Policy Forum points out, small weapons are a part of a larger trade, like the AAD 2006.

The Small Arms Survey 2006 (SAS 2006) reports that the Lord’s Resistance Army (LRA) depended on small arms to keep the civil war going in Northern Uganda for the past 20 years. As a result, this led to high levels of armament among the civilian population in the region, levels exacerbated by government and military policies of arming sections of society against the LRA and other armed groups.

“The LRA’s primary weapons are Kalashnikov derivatives, and most commonly, the Chinese Type 56 assault rifle. However, the Ugandan military uses a number of weapons, and the same types are also used by the LRA. The most numerous after the Chinese Type 56 are Polish and Romanian AKM assault rifles and AK-47 assault rifles from the former Soviet Union. Some observers claim that NATO weapons, such as the Belgian FN FAL and the German G3, are also in service with some rebels, having formerly been in the arsenals of the Ugandan and Sudanese governments.” (SAS 2006)

Even with perfect case studies, such as Uganda, which illustrate that in the world today, military firearms serve one purpose and that is to terrorise and kill innocent civilians, AAD 2006 is unconvinced. The AAD 2006 newsletter claims that: “The conventional and terrorist threats to security together with increased demands for peace-support operations is prompting many African countries to revisit their defence requirement and to re-evaluate their investments in research and development and procurements.”

However, the Cape Town Anti-War Coalition points out that most of the companies who are exhibiting weapons are “responsible for the deaths of millions of civilians across Africa and the Middle Eats.” For example, Truvelo, one of the companies exhibiting weapons at the fair is “manufacturing a new assault rifle. This company is expert in manufacturing sniper guns.” Eurocipter, another exhibitor, makes 14 different military helicopters, including the “Tiger” which they supply to Israel, among other repressive regimes.

The sad reality is that the manufacturing of arms (instead of building homes for the homeless and feeding the hungry for instance) is not likely to change for a very long time. The projections by the Small Arms Survey 2006 show a world obsessed with military firearms. The SAS 2005 predicts that:

- The world’s militaries procure around 50 million small arms and light weapons over a 50-year period, or around 1 million units annually.
- Not all of this acquisition is of new stocks.
-Global production of military small arms and light weapons over a 50-year period range between 36 and 46 million weapons and averages 0.7 – 0.9 million annually.
- Production is not constant but cyclical and responds to the demands of the world’s wealthier states.
- The world’s poorer states often rely on surplus stocks displayed by wealthy state procurement programmes.
- This trade and transfer of surplus stocks to militaries across the globe could number up to 14 million units over a 50-year period.
- Some of the world’s largest procurers will launch major procurement programmes in the next 10 – 15 years.
- Global military production periodically peaks and id projected to do so in the coming 20 years as wealthy states modernise their small arms.
- Unless measures are taken to remove weapons from circulation, this peak is likely to displace yet more surplus stock to the world’s poorer states.

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

This week, African Health Ministers and Experts meet in Maputo, Mozambique to adopt an action plan which will deliver on the 2005 Gaborone Declaration. The Declaration committed African governments to universal access to comprehensive sexual and reproductive health services in Africa. Ir?ng? Houghton reviews emerging policies on sexual and reproductive health, the reality for women and girls and what governments need to adopt during this Ministerial.

Since 2001, Africa’s leaders have committed the African Union (AU) and their governments to promote and protect the right to health in a series of international and continental legal protocols and declarations. These commitments provide a comprehensive package for addressing the challenges of maternal mortality, HIV/AIDS, violence and disease.

The Promise of the Continental Policy Triangle

On 26 and 27 April 2001, African Heads of States and governments of the Organisation of African Unity (OAU) declared that they would allocate 15% of their annual national budgets to health services in order to meet “the exceptional challenge of HIV/AIDS, Tuberculosis and Other Related Infectious Diseases”. [1] Health issues have been a consistent item on the agenda of meetings of African leaders for the last five years. The adoption of the Continental Sexual and Reproductive Health Policy Framework by 53 African Health Ministers in October 2005 was a landmark moment in the struggle to improve the lives and health of women and girls in Africa. [2] This year, the Africa Common Position on Universal Access for the UN General Assembly Special Session (UNGASS) in New York saw African Governments undertake to ensure; “100% access to sexual and reproductive health services including antenatal care”.

These policy statements received legal underpinning when the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa came into force on 25th November 2005. [3] The Protocol provides a critical framework to access sexual and reproductive health services such as safe abortion, pregnancy, childbirth and HIV, among others. Its provisions state that women’s sexual and reproductive health should be both respected and promoted. [4] This policy triangle of the Abuja Declaration, Continental Sexual and Reproductive Health Policy framework and the Protocol clearly establishes the obligation on African states to address the healthcare needs of all citizens, but in particular the rights of women and girls.

“The reality of sexual abuse and HIV/AIDS must make us rage against women’s oppression. I call on African leaders sitting here to protect and promote the human rights of all people and vulnerable groups, particularly women and girls. We ask you not to fail us again.” (Ms. Nkhensani Mavasa, Deputy Chairperson, Treatment Action Campaign, UN General Assembly, May 2006)

While there has been significant improvement in women’s health globally, none of this progress has benefited mothers in sub-Saharan Africa. Notwithstanding the international and African commitments, inadequate access to quality health services, unsafe abortions and lack of reproductive health care cause the deaths of at least 250,000 women each year in Africa, one of the highest rates in the world. Women in the United Kingdom have a 1 in 5,800 lifetime risk of maternal death, in Ethiopia the equivalent risk is 1:14.

High maternal death rates have multiple causes, but one major underlying problem is the deep-rooted inequalities between men and women. Women have fewer opportunities for education, they do a disproportionate high share of manual work, have less influence on policy making and are disadvantaged in terms of nutrition and access to health care. Lack of access to health care is a major cause of maternal mortality.

Even where there are positive legislative and policy frameworks, women often battle to exercise these rights within the family and the community. Traditional gender norms and practices, along with the unequal status of women, relegate women to being primarily responsible for contraception and childcare, with little power to negotiate when, with whom and why to have sex.

Inequalities in health are exacerbated by unequal access to other public services. For example, the number of years that a girl spends in primary education has a direct and positive correlation with her chances of avoiding HIV, her children surviving, and her subsequent income thereafter. Yet on average, girls in Africa spend only three years in school. [5]

It is within this context that women and girls are more vulnerable to HIV. Women comprise 57% of all adults infected with the virus in sub Saharan Africa. Of these, younger women account for a disproportionately large number of new infections. According to the African Union, AIDS, malaria and tuberculosis threaten life on a scale unparalleled, erases between 1-2% of Africa’s growth rate and reduces life expectancy by 25% for some countries. [6]

Key to the loss of women’s control over their own sexuality is the prevalence of female genital mutilation, domestic violence, and rape. More than 90 million women and girls are survivors of female genital mutilation, a practice outlawed in many national laws across Africa and under the Protocol. [7] Violence against women is a recurrent problem in many countries. In Kenya for instance, despite a relatively peaceful history, 49% of women have experienced violence, with one in four having experienced violence in the previous 12 months. [8]

Putting the money where it is needed

A key precondition for accelerating the provision of universal access to sexual and reproductive health services in Africa is the adequate funding of effective healthcare systems. However, there is a sharp disparity between the stated intention to act and the resources pledged to enable these laudable commitments to be implemented.

Five years after the Abuja Summit, only Botswana and The Gambia have met the 15% target for national expenditure. 15 countries mostly from West and Central Africa spent less than 5% with only 18 Africa states spending more than 10% on healthcare. Yet, since 2000, 85% and 77% of African countries have formed national AIDS machineries and approved relevant health policies. [9]

According the World Health Organisation, the minimum expenditure on healthcare per person per year, necessary to provide an essential package of health services is US$ 34. In 29 countries, government expenditure per person per year was less than US$ 10. This includes Angola that has one of the fastest growing economies on the continent.

The burden of this funding gap invariably falls on the poorest and most vulnerable sections of the population. Inadequate investment in primary healthcare infrastructure, acute shortage of human resources, ineffective or non-existent data collection and information management systems and the lack of inexpensive medicines and basic equipment all combine to disproportionately affect the poorest and most vulnerable. In order to close the financing gap, many countries have been encouraged to impose user fees on healthcare services.

User fees have proved to be a barrier to many poor men and women who simply cannot afford to access healthcare even with minimum fees. Throughout the 1990s, Ugandans faced high costs for fragmented health services. When in the run up to the 2001 presidential election, President Museveni ended user fees for all government health clinics, the public response was phenomenal. Most health facilities saw 50 to 100 per cent increases in patients. This access was particularly significant for poor women in rural areas who could not afford to pay for care.

Oxfam research shows that relatively small investments can yield high returns in terms of saving lives. The cost of providing basic services for mothers and infants averages US$3 per capita in Africa. This year, approximately 63,000 women will die from obstetric problems in Ethiopia, Mozambique, Tanzania and Uganda. An investment of US$411 million would prevent 80 percent of these deaths: – roughly US$700 for every maternal and child life saved.

African governments could reverse the situation by dropping user fees, improving the effectiveness of the health care system and raising their health expenditure to 15%. External development assistance is necessary to expand the financing available, preferably within a predictable and long-term cycle that targets front line services like primary and reproductive health care. It is estimated that an initial immediate investment of $90 billion per annum is required for healthcare personnel, hospitals and other infrastructure, medicines and so forth in Africa, as against the $25 billion promised for Africa by 2010. [10]

Back to the Basics: Engendered Health Services and Access to Essential Medicines

The year 2005 saw an important return to the concept of a developmental state in Africa. This state would enshrine the right to essential services, the fight against poverty and economic growth as core obligations. [11] Recent Oxfam research into Essential Services re-affirms the primacy of governments in the provision of effective, universally accessible and regulated health and services.

There is a crisis of health workers in Africa. At least 10 countries (Liberia, Uganda, the Central African Republic, Mali, Chad, Eritrea, Ethiopia, Rwanda, Somalia and The Gambia) have only enough trained health workers to cover 10% of the population. The African Union should maintain its position that additional financing should be found not only for medical facilities and medicines, but also for the recruitment and remuneration of doctors, nurses and other health cadres.

African governments, parliaments and civil society organisations must guard against public resource diversion away from social services through lack of prioritisation, corruption, misuse of national resources and military expenditure. A number of African countries including Sudan, Angola and Ethiopia are currently experiencing rapid economic growth, yet they continue to spend a paltry 2-5% on health expenditure.

Several African organisations and parliamentarians have cited the IMF/World Bank Medium Term Expenditure Frameworks/Ceilings (three year planning tools) as too restrictive on public expenditure on health and education. African governments should consider carefully all policy advice that undermines their capacity to promote and realise the right to health. [12] The comments of Kenyan Assistant Minister Hon Enock Kibunguchy are relevant for many African countries. In March of this year he said, “The country needs 10,000 health workers to offer improved services… We have to put our foot down and employ. We can tell the International Monetary Fund and the World Bank to go to hell." Kenya urgently needs 7,000 nurses, 600 doctors and 2,000 clinicians and laboratory experts. In the absence of employment, government estimates indicate that 1,000 nurses leave the country every year.

African governments must demand that IMF assistance be modelled on long-term growth rather than short-term sustainability, in order to fulfil internationally agreed commitments to achieve the Millennium Development Goals, rather than the narrow goal of sustaining debt repayments from low-income countries. The Global Call to Action Against Poverty as well as specialist African debt networks such as the Jubilee movement in Africa and AFRODAD have joined the African Union call in 2005 for full debt cancellation to be extended to many more countries. To do otherwise, would be to render sustainable financing for Universal Access in Africa unachievable.

What do Africa’s leaders need to do next?

African governments must deliver on the Abuja Commitment to allocate 15% of the national budget to health services by setting annual funding targets that will finance comprehensive national public health plans that particularly target men and women living and working in poverty. Targeted provision of quality reproductive and health services to women by establishing and strengthen existing antenatal, delivery, post-natal and family planning services for all African women would go a long way in making the lives of women more safe and dignified. To do this would require the recruitment, training, and retention of an adequate healthcare workforce in line with international standards and with special attention to remuneration of female health workers in rural areas.

Further, more countries must remove user fees for primary health care and sexual and reproductive health services and essential medicine. By enacting and implementing national laws that enshrine the AU Protocol on the Rights of Women in Africa especially Articles 5 and 14, governments would demonstrate a clear commitment to end female genital mutilation in Africa and violence against women.

Despite the tremendous investment of development NGOs in the areas of HIV/AIDS, reproductive and primary health, only a small number of civil society organisations are attending the Maputo Ministerial meetings. On their return, they can do no better than to hold their leaders and industrialised countries to account for the global and continental commitments made over the last five years. One way of doing this would be to strengthen citizen representation and state oversight mechanisms in monitoring public services at national and local levels.

* This article is drawn from a policy briefing written by Ir?ng? Houghton, Oxfam Pan Africa Policy Advisor which was developed and presented to the Special Session of Ministers, Maputo, Mozambique, September 18-22th . He can be contacted at [email][email protected]

* Please send comments to [email protected] or comment online at www.pambazuka.org

References:

[1]The OAU officially became the African Union on 9 July 2002 at the Durban Summit.
[2]The AU Special Summit in Abuja reviewed progress since the 2001 Abuja Declarations on HIV/AIDS, Malaria and Tuberculosis.
[3]For an extract of the Protocol on the Rights of Women in Africa, see www.african-union.org
[4]In a few countries like South Africa, the Constitution provides women with more rights than the African Women’s Protocol. However, for others like Zamibia, it is an advance on national legislation. Under Zambian law, a panel of 3 doctors have to agree that the mother’s health is threatened. The law does not provide for termination even in cases of rape, sexual assault or incest. See Mukasa R; (2005): Protocol on the Rights of Women in Africa: Harnessing a Potential Force for Change, Oxfam GB Southern Africa Office.
[5]Oxfam; (2006): In the Public Interest: Health, Education, and Water and Sanitation for All.
[6]African Union; (2005): Progress Report on the Implementation of the Plans of Action of the Abuja Declaration for Malaria, HIV/AIDS and Tuberculosis.
[7]Solidarity for African Women’s Rights Coalition and the African Union Commission;(2006): Breathing Life into the African Women’s Protocol on Women’s Rights in Africa.
[8]UNICEF; (2006): Violence against Women and Girls in the Era of HIV and AIDS in Kenya.
[9]African Union; (2005): Progress Report on the Implementation of the Plans of Action of the Abuja Declaration for Malaria, HIV/AIDS and Tuberculosis.
[10]Oxfam; (2004): The Cost of Childbirth: How Women are Paying for Broken Promises on Aid.
[11]Apart from African Union positions and declarations, other influential development literature such as the Commission for Africa report, 2005, the UN Human Development Report took up this theme squarely in 2005.
[12]Statement from 75 representatives of Civil Society Groups and SADC Parliamentarians to African Heads of States, Health Ministers meeting at African Union/UN meeting on Universal Access to Act Immediately to Save Africa from worsening HIV/AIDS Epidemic, Johannesburg, 3rd March 2006

The African Union (AU) peacekeeping mission in Sudan will be extended until December 31, with regional and United Nations support, Burkina Faso’s President and current AU President, Blaise Comparoré, announced today after a high-level meeting with AU Peace and Security Council members. “There are a certain number of measures that were agreed upon, such as reinforcing the African troops, but also to strengthen the application of the Abuja agreement that was signed to bring all the parties involved to implement its terms.”