Showing posts with label Mali. Show all posts
Showing posts with label Mali. Show all posts

Friday, 30 March 2012

POVERTY: MALI: Holy wars and hostages – AQIM in the Maghreb

DAKAR, 29 March 2012 (IRIN)

 Photo: US Army Africa
The cycle of violence between north and south has been going on for decades (file photo)This is part of a series of reports on the crisis in northern Mali exploring the MNLA rebellion, and the impact of AQIM

Mopti in central Mali had a thriving tourism industry a few years ago, but Issa Ballo, a private tour operator, says the city built at the confluence of two rivers and often described as the ‘Gateway to the North’ still has everything in terms of “adventure, discovery and culture”.
The cliff-dwelling Dogon people with their distinctive culture are a few hours’ drive away; Timbuktu, a centuries-old centre of Islamic learning, was receiving a steady stream of visitors. “Now, you can count the tourists on the fingers of one hand”, Ballo complained. “It is only… the really courageous who come here.”
He blames the embassies in Bamako, the capital, for issuing security alerts and declaring “no go zones” for their nationals. He accuses the media of exaggerating the problems in the north, “making out there is a gun pointed at your head everywhere you go.” But his strongest contempt is for Al-Qaeda in the Islamic Maghreb (AQIM, known as AQMI in French), the radical Muslim group that appears to have a stranglehold over parts of northern Mali and beyond, despite its modest numbers and murky agenda.
“They are bandits, thieves, criminals… murderers”, Ballo says. “Ninety-five percent of people in Mali are Muslims… and we have never read in the Koran that you should take someone’s life to gain money. Al-Qaeda, AQIM, I don’t consider these people to be Muslims - they are just a kind of mafia with very long arms.”

Threat or fake?
AQIM’s military and commercial activities, religious orientation, size, composition and leadership have been the subject of many research papers, newspaper articles and conspiracy theories. Direct media access to AQIM, except for a few interviews with leaders, has been limited, with journalists often dependent on the testimony of released hostages and security sources, occasional amateur footage posted on YouTube by defectors, or leaked police interviews with terror suspects.
Sceptics say the threat has been gravely overplayed by the United States and France for their own strategic reasons, and by countries like Algeria and Mauritania, whose military and political elites are keen to be identified as front-line fighters against international terrorism. One academic observed, AQIM can be seen as a “small shop with a very big sign”, using its Al-Qaeda ‘franchise’ in the Sahara and Sahel to generate headlines and huge cash injections through deftly organized kidnappings, but with limited reach.
Opinions are often sharply divided. The International Crisis Group (ICG) in its March 2005 report, Islamist Terrorism in the Sahel: Fact or Fiction? commented that “Fundamentalist Islam has been present in the Sahel for over 60 years without being linked to anti-Western violence.” The authors warned that “a misconceived and heavy-handed approach could tip the scale the wrong way”.
Others say the presence of an expanding transnational terrorist force could turn parts of the Sahel into a Somalia or even an Afghanistan. They point to a movement that has transcended its Algerian roots, recruiting in the Sahel and further afield, with the possibility of stronger ties in the future with organizations like Boko Haram in Nigeria and the emerging Jamaat Tawhid wa’l-Jihad fi Garbi Afriqqiya (Movement for Oneness and Jihad in West Africa - MOJWA).
The UN mission sent to the Sahel in late 2011 to assess “the impact of the Libyan crisis on the Sahel region” hinted at AQIM’s ability to find an accommodation with local communities in the poorest parts of the Sahel, noting reports “that in some areas, the humanitarian vacuum is being filled by AQIM and/or criminal elements who are reportedly providing services and humanitarian assistance in remote areas where State presence is reduced or non-existent”.
The mission warned that AQIM could use this situation “to develop recruitment and local support networks for gathering information, supplying arms and ammunition, and other logistics”. It noted that AQIM, like Tuareg combatants leaving Gaddafi’s Islamic Legion in Libya, may also have stocked up weaponry, including Semtex explosives, anti-aircraft artillery, and rocket-propelled grenades.

Out of Algeria
AQMI’s origins are usually traced back to the crisis in Algeria in 1992. As the military authorities annulled elections, depriving the radical Islamic Salvation Front (FIS) of probable victory, a bloody domestic conflict took hold. The future leaders of AQIM first found a niche in the Islamic Armed Group (GIA), but left it to found the Salafist Group for Call/Preaching and Combat (GSPC). The Salafists hold to a conservative traditional view of Islam.
The Algerian conflict in the 1990s saw atrocities committed by all sides. Human rights activists, academics and others repeatedly questioned the role of Algeria’s intelligence service, the Département du Renseignement de la Sécurité (DRS), and accused it of not only infiltrating armed movements, but controlling key terrorist operatives.
In September 2006, the GSPC announced its formal affiliation to Al-Qaeda and in January 2007 changed its name to AQIM. Much of AQIM’s activity still centres on Algeria. In April 2007, AQIM used car bombs against the prime minister’s office and a police precinct in Algiers, the capital, killing 33 people. A subsequent attack in December 2007 on the Algerian Constitutional Council and the United Nations office in Algiers killed 63 people. There have been repeated attacks on military bases in the north and south of the country.
AQIM’s leadership is overwhelmingly Algerian. The man named in the UN Al-Qaeda Sanctions List in 2007 as the ‘Emir’ of AQIM is Abdelmalek Droukdel, 41, an engineer thought to have combat experience in Afghanistan. Interviewed by The New York Times in July 2008, Droukdel took responsibility for several bombing campaigns and pledged to “liberate the Islamic Maghreb from the sons of France and Spain… and protect it from foreign greed and the Crusaders’ hegemony.”

The ‘Marlboro Man’
In a recent interview with the website Al Wissâl, one of AQIM’s senior brigade commanders, Mokhtar Belmokhtar, aka Khaled Abou Al-Abass, reminded Muslims that “selling or trafficking drugs, even in infidel countries, is outlawed by the laws of Allah, and that is clear and beyond discussion”. AQIM has well-established links with a burgeoning trans-Saharan trade in arms, migrants, narcotics and cigarettes, and Belmokhtar’s interest in the latter earned him the nickname “Marlboro Man”.
Like Droukdel, both Belmokhtar and Abud al-Hamid Abu Zeid have long been identified as the key figures in AQIM south of Algeria and have been given heavy sentences in absentia by Algerian courts. Both reportedly head significant commercial empires, and both have taken Tuareg wives, seen as an obvious way of securing favours from Tuareg communities.
Abud Zeid’s brigade, or katiba, is reportedly operating in Mali and Niger, while Belmokhtar’s is found in the west of the Maghreb. Mauritania appears to be more of a priority target than Mali. Belmokthar reviles Mali for hosting an Israeli embassy, its close ties with US intelligence services and its tough stance on Islamic militants.

Kidnappings and killings
AQIM’s notoriety, particularly in the Western media, is derived mainly from its involvement in kidnappings. The forerunner GSPC abducted 32 tourists from Algeria in 2003, releasing the 31 survivors several months later. AQIM has targeted smaller groups. The most high-profile abductees were Canadian UN diplomats Robert Fowler and Louis Guay, taken from Niger in December 2008, moved to Mali and released after four months in captivity in April 2009.
Among other abductees have been seven employees of the French company, AREVA, aid workers and tourists. Those executed or who died in captivity include British citizen Edwin Dwyer, one of a group of tourists kidnapped in 2009, and French humanitarian worker Michel Germaneu.
The governments of abductees have given out few details, particularly on the size of ransoms, or AQIM’s precise demands, but have included the withdrawal of French troops from Afghanistan and the release of senior Al-Qaeda prisoners.
Ransoms in millions of dollars and payment have been a source of division among the governments whose nationals have been taken (France, Britain and Italy, for example), and the African governments involved in negotiations. Algeria and Mauritania have been highly critical of Mali for releasing known AQIM operatives in return for hostages.

Mali – the weakest link
Recently ousted President Amadou Toumani Touré had repeatedly rejected accusations that Mali’s public commitment to fighting terrorism was not matched by actions. Touré, a keen defender of US-backed anti-terrorism initiatives, noted the vastness of the country’s 1.24 million square kilometres, and constantly appealed for stronger regional military cooperation.
Mauritanian President Mohamed Ould Abdel Aziz recently warned: “The north of Mali is a region left open for terrorism,” and said AQIM combatants were stocking up at will on food and fuel in places like Gao and Timbuktu, using easily identifiable vehicles. AQIM has attacked embassies in the Mauritanian capital, Nouakchott, targeted garrisons and killed tourists. The Mauritanian army has conducted hot pursuit operations inside Mali, and joint Mauritanian-Malian operations have occasionally been conducted.
A senior French official, quoted in the French weekly, L’Express, in November 2011, confirmed: “We are very angry with the Malians. Whether with regard to AQIM cells… their links with the Tuareg, or the trade in Latin American cocaine on its way to Europe, it’s no longer passiveness, but complicity. We have irrefutable proof.”

Tuaregs and terrorists – allies or adversaries?
Defenders of Mali’s failure to engage AQIM say the security vacuum in the north is the result of successive peace accords between the government and Tuareg rebel movements, which have forced a scaling-down of bases and troop numbers.

 Photo: Emilio Labrador/IRIN
Tourists used to flock to experience the unique architecture, landscape and culture of northern Mali (file photo)

Bamako accuses the Tuaregs of lending support to AQIM by sharing their desert expertise and navigational skills, acting as auxiliaries, opening up their trade networks. It would be impossible for AQIM to operate in northern Mali without some sort of acceptance by the Tuaregs, say Sahel researchers.
There may be little spiritual affinity between AQIM’s Salafists and nomads in the north, but former hostages like Robert Fowler say AQIM’s fighters are respectful of local needs and customs. They also offer important fringe benefits. A Bamako-based peace activist with extensive research in the Kidal region, explained. “What are the alternatives for young [Tuareg] people? It’s not difficult to put yourself in their place, to see the temptations of getting involved in drugs trafficking or some other kind of adventure.”
Tuareg leaders, not least from the MNLA (Mouvement National pour la liberation de l’Azawad, or National Movement for the Liberation of Azawad), which is fighting to carve out an independent state in the north, have consistently called for the expulsion of AQIM from Malian territory, and accuse the authorities of giving free rein to criminal elements.
Alliances have shifted constantly in the north over the past 20 years, but a recurring figure is veteran Tuareg leader Iyad Ag Ghali, founder of the MPLA (Mouvement Populaire pour la Libération de l'Azawad, or Popular Movement for the Liberation of Azawad) in 1988. He has been used by the government as a mediator and could win over hardliners.
Sent as a diplomat to Saudi Arabia, Iyad famously converted to the Pakistan-based Tablighi Jam’at faith while in Jeddah. He now heads the Ansar dine movement, which has a nominally pacifist orientation. Iyad is thought to have been involved in hostage releases in the past, giving him a wide range of contacts and the opportunity to interact with key individuals in AQMI. In recent statements, MNLA has distanced itself from Iyad, suggesting that Ansar dine is more of an irritant than an ally.

Arguments over Aguelhoc
The government’s contention that there is an MNLA-AQIM link grew stronger after a Commission of Enquiry confirmed reports of a massacre of over 70 government soldiers at Aguelhoc (in Kidal) when it was overrun by rebels in late January, and said this was the work of “Salafist extremists” in cahoots with the MNLA.
The MNLA accused Malian intelligence services of staging an elaborately fake by rearranging the corpses to make it look as if they had been slaughtered using AQIM methods. An MNLA communiqué warned: “There is no relationship between us and any kind of Islamic movement. Our mission is clear and we don’t intend to be distracted.”
http://www.irinnews.org/Report/95208/MALI-Holy-wars-and-hostages-AQIM-in-the-Maghreb

Friday, 23 March 2012

POVERTY: MALI: Rebellion claims a president

BAMAKO, 22 March 2012 (IRIN)

 Photo: Eskinder Debebe/UN Photo
Just-ousted President of Mali, Amadou Toumani Touré

Former Malian President Amadou Toumani Touré, overthrown this morning by mutinous soldiers, said recently that tackling recalcitrant Tuareg rebels in the north is going to be an ongoing task for future governments.
“The problems of the north have been with us for 50 years now… Our elders dealt with them; we are tackling them, and the younger generation will continue to do the same. This is not going to be over tomorrow,” he told Radio France Internationale.
Touré’s successor government, the Comité national pour le redressement de la démocratie et la restauration de la démocratie et la restauration de l’état (CNRDRE), led by army captain Amadou Sango, has dissolved state institutions, suspended the constitution, reportedly arrested several ministers, taken over the state broadcaster, and announced a curfew.
CNRDRE says it has brought an end to “an incompetent regime” and singled out Touré’s “incapacity to manage the crisis in the north of the country… and to fight terrorism”.
There have been persistent complaints from soldiers of inadequate supplies and military hardware, poor direction and strategic planning and a sense of abandonment for those on the frontline, fighting a war that could and should have been prevented.
Touré, 63, having first taken power aged 42, had planned to retire gracefully, leaving after a second-five year term, as stipulated in the constitution. Until recently, he had been adamant that presidential elections scheduled for the end of April would take place, that there was no question of the military situation forcing an emergency transitional government, and that he was looking forward to retirement and more time with his family.
The current situation has an ironic symmetry. Touré’s first period in office after overthrowing military ruler Moussa Traoré in March 1991 began against a background of revolt in the north and ended in June 1992 just after a Pacte Nationale was signed by the government and representatives of Tuareg resistance movements fighting for a separate territory.
Twenty years later, the long-term solutions put forward in that agreement - decentralization, reconciliation and bringing resources and development to some of the country’s most isolated regions - have not taken hold.
Many Malians from different communities believe Touré responsible for the current crisis, alleging that the promises did not turn into concrete developments, too many projects were left on the drawing board, and too much of the funding was never accounted for.

Arsenal from Libya
Having dealt messily with an earlier insurgency, signing an inconclusive peace agreement in February 2009, Touré’s beleaguered army found itself up against a much better organized rebel movement, flush with an arsenal taken from Libya.
The new, largely Tuareg force, the Mouvement National pour la liberation de l’Azawad (MNLA), initiated hostilities with an attack on Ménaka in the far east of the country on 17 January, following this up with a series of strikes on small towns spread across a vast expanse of the north: Léré, Niafunké, Aguel-hoc, Tessalit.
While Touré reorganized his senior command, and military communiqués pointed to a rapid recovery of lost territory, there has been little evidence in recent weeks of the national army gaining ground.
There was a serious warning for the government when widows of soldiers killed in the north demonstrated in the garrison town of Kati, 15km outside the capital, on 1 February, marching with the clear support of sections of the military.
Civil society activists have talked of the need for Malians to come together and draw on a long history of peaceful coexistence, but have warned the situation is much more complex than before, not least because parts of the north now dominated by a flourishing illicit economy that appears strongly linked to Islamist “terrorist” networks, notably Al-Qaeda in the Islamic Maghreb (AQIM).
“This only confirms what I have believed all along”, said Mohamed Ag Ossade, reacting to the overnight coup in Mali. “All Mali’s children have to come and sit down together. We need to talk to each other now more than ever.” For three years, Ag Ossade has run TAMUST, the Tuareg Cultural Centre in Bamako, the capital.
TAMUST plays host to curious visitors, but has also been a successful concert venue and the site is dominated by a vast tent housing Tuareg cultural artefacts, swords and jewellery.

Mixing
Ag Ossade is proud of his Tamsheq heritage, but also a firm champion of the concept of `brassage’ (mixing), pointing out that Mali’s ethnic groups have lived together and intermarried for centuries, and that one of the country’s abiding strengths is its diversity. “No culture can thrive in isolation,” Mohamed told IRIN. “People have to know each other.”
He says he has found the events of the past few months distressing and frustrating. “I have friends and family fighting on both sides. They should put an end to this wretched piece of cinema now.”
One of the major fears since even before the conflict began is that revived tensions in the north would lead to inter-ethnic violence in the south. Both Tuareg and Arab communities in the capital have expanded significantly in recent years, partly because of the prevailing poverty and lack of opportunities in the north. Many have fled, Mohamed acknowledged, but stressed that: “nobody has been killed as far as I know and people should be wary of rumours and exaggeration”.

 Photo: Nancy Palus/IRIN
A Tuareg clinic in Kati, outside Bamako, that was recently ransacked. Turmoil erupted 21 March in Mali when Defence Minister Sadio Gassama visited a military camp in Kati

There were ugly demonstrations in early February, particularly in Kati, as anger over government troop casualties spilled over into attacks on prominent Tuaregs. Malians have bitter memories of rebellions in the 1960s and 1990s, and of how easily armed attacks in one location could bring on a cycle of reprisals and counter-reprisals in another.
People watch out for echoes of the mid-1990s when Ganda Koye (“masters of the land”), a self-defence militia drawn mainly from the Songhai community, took up arms, targeting Tuaregs and Arabs. The latest rebellion has not, so far, triggered that kind of confrontation, although there have been hints of an anti-Tuareg backlash in areas like Gao with a past history of inter-ethnic tension.
Politicians from Touré down spoke out against `les amalgams’, or half-truths that can be used by troublemakers to stir up hate campaigns, using the rebellion as a pretext for ethnic pogroms.
Presidential candidate Ibrahim Boubacar Keita, known to Malians as IBK, made sure that his condemnations of the rebellion were combined with appeals for moderation, pointing out that “the overwhelming majority of communities in the north live in peace and want to contribute to the development of the nation”. IBK called for a special conference on the north, a proposal which has been endorsed by other politicians, religious leaders and civil society organizations.
The faith in dialogue is shared by some outsiders. Prior to the events of 21 March, a Western diplomat confidently observed that: “sorting things out, finding a consensus, that’s in Mali’s DNA”.
But there were concerns too about the potential for breakdown.”People often say: “enough is enough, no more peace conferences, we must see this thing through until the end”, said Jean de Dieu Dakouo, Director-General of the Centre Djoliba, in Bamako, which specializes in conflict resolution. “But they don’t think through what they are saying”.
With a curfew in place and the capital in shutdown mode, it is difficult to gauge the impact of the coup. “Our main priority for now is working out what is going on”, a Bamako-based diplomat acknowledged.

Displacement and food insecurity
Watching with particular concern are aid agencies. The coup comes at a critical time in terms of food assistance. The north, west and several other parts of the country are experiencing severe food insecurity due to erratic rains and a poor harvest in 2011.
As the conflict goes into a third month, relief organizations like the UN Refugee Agency (UNHCR), the International Committee of the Red Cross (ICRC) and Médécins Sans Frontières (MSF) have consistently highlighted the need for food, shelter, water and medical care for the 100,000 who have fled across the borders, while stressing the pressure placed on the regions taking in the influx. Northern Burkina Faso, southern Mauritania, western Niger and parts of Senegal are all grappling with serious food insecurity and malnutrition that are likely to escalate in the coming months.
But there has also been massive internal displacement inside Mali, with 93,500 making it to provincial centres, like Gao, Tomboctou and Kidal, while others remain on the fringes of conflict areas, like Aguel-hoc and Tessalit, according to UNHCR.
Germain Mwehu of the ICRC, speaking to IRIN from Niamey, capital of Niger, Mali’s southern neighbour, cited the example of Ménaka, in eastern Mali, the first target of a rebel attack on 17 January and now held by the MNLA.
“Many people made for the border with Niger,” Mwehu told IRIN. “Many of those who stayed are living on the periphery of the town. Food and shelter are our priorities and this in an area very vulnerable to drought.” The ICRC has serious concerns about access to people in the more isolated areas and for the security of its staff. Mwehu also talked of the psychological burdens facing the target population.
“People in Ménaka are very stressed about not knowing what to do. Should they try to leave for Niger? Should they stay put? Will the conflict resume? Will the government look to stage an offensive?”

Aid agencies
Even before the rebellion, international and national NGOs operating in the north faced security scares and access issues, sometimes being forced into a temporary suspension of activities or the withdrawal of expatriate staff.
Médecins du Monde (MDM) was forced to scale down its activities in response to worsening security in February 2012, but was able to resume in early March.
François Fille, MDM’s Security Focal Point, says his organisation, like other NGOs in Mal, is still taking stock of the coup.
“At the moment, our teams in displacement camps in the north are working”, File emphasized. “There has been no harassment. They are able to access our beneficiaries. That is the situation as of now”. But he said nothing could be taken as guaranteed. "We are very concerned about the situation and what could happen now with the coup in Bamako."
MDM has been able to run its nutritional and medical activities unimpeded, gaining access to populations in both MNLA and government-held areas. "Until now, we haven't noticed extra controls from both sides and hope it won't change in the future".
NGOs often have to prioritize humanitarian operations ahead of development work, and there are longer-term concerns too: how will the costs of military campaigns affect government budgets in a year of huge food security problems? “There are going to be three million people affected by the food security problems in Mali come April [2012],” warned Abdoulaye Samoura, advocacy officer with Oxfam in Bamako. “There is a danger that the government will put all its political, financial and decision-making capacity into sorting out the crisis in the north.”
Numerous small-scale development projects, covering everything from irrigation to governance, operate in isolated, war-affected zones like Kidal. “If there is no security in the north, how can the projects they need there be made to work?” asked Mohamed Ag Ossade. “Resorting to arms will never help a country to develop.”
http://www.irinnews.org/Report/95127/MALI-Rebellion-claims-a-president

Wednesday, 21 March 2012

POVERTY: MALI: Unrest hinders fight against fistula

DAKAR, 20 March 2012 (IRIN)

 Photo: Phuong Tran/IRIN
This woman has undergone multiple fistula repair surgeries (file photo)

 The turmoil in northern Mali is thwarting efforts to treat and prevent obstetric fistula, say health experts and local NGO workers.
It is just one example of the fallout from the latest fighting between Tuareg rebels and the Malian army, triggered when rebels began attacking northern military posts in January. Since then, some 195,000 people are estimated to have been displaced by fighting, according to the UN Office for the Coordination of Humanitarian Affairs.
Obstetric fistula - a tear in the birth canal caused primarily by prolonged labour, resulting in chronic leakage of urine and/or faeces - is both preventable and treatable, and for years health workers in Mali have been working on both tracks.
The latest instability in the north has had both an immediate and a potential long-term impact on efforts to address fistulas, primarily in nomad communities: Many women in northern areas who were to have operations in early March did not, while prevention and training activities also took a hit.
One component of a project backed by the US Agency for International Development (USAID) in northern Mali is the quarterly “fistula care week”, in which women from northern districts are assisted in coming to the regional hospital in Gao, eastern Mali, for treatment. For the latest campaign running from 25 February to 3 March, about a third of the 30 women scheduled for operations did not show up and could not be reached, health workers said.
“We have lost contact with all the women we were following in Ménaka [one of the first areas attacked by rebels],” said Fatimata Touré, head of Gao-based NGO GREFFA whose work includes educating communities about prevention and treatment of fistula. She said fistula prevalence is highest in nomad communities and most of the women GREFFA assists are in Ménaka, a sub-region of Gao populated mostly by nomadic and pastoralist communities. “We don’t know where they are today - people from that area have fled in all directions.”
“Granted, we’re talking about communities who move regularly,” Touré said. “But when things are stable we know exactly where to find them during this or that period of the year.”
Ibrahim Oumar Touré, GREFFA’s coordinator for the prevention of early marriage and fistula, told IRIN NGO workers could not transport the women as they normally would because of the security situation.
“God alone knows how much these women with fistula suffer, and beyond that now we can’t get to many of them for treatment,” he said. “It pains me just to think about it…. It’s atrocious.”
Long-term impact
GREFFA, which receives support in reproductive health and other programmes from Norwegian Church Aid, has also lost contact with the local women who collaborated with the NGO in year-round outreach efforts, Mr Touré said.
Mali, with the support of several donors and NGOs, has made significant strides in incorporating fistula prevention and care into local and national health structures, and health workers say the conflict threatens to set back some of this progress in northern communities.
They noted a number of concerns, including the suspension of education and prevention efforts in some nomad areas, and the loss of contact with women who have had fistula treatment in the past and need close attention especially in childbirth.
Demba Traoré, coordinator of the fistula care project at NGO Intrahealth, said prevention is a major component of the work. “We know that early marriage [and thus childbirth] and excision are two major contributors to fistula,” he told IRIN. “We regularly talk with local authorities and traditional and religious leaders, who have a huge role to play in prevention. But with the current security situation we can’t continue this outreach in some areas.”
He said there is a concern that the incidence of fistula could rise because health services in some areas have been interrupted. “Even if under normal circumstances many of these women did not go to health centres, we had started to see an improvement there. Fistula is linked to a lack of obstetric care. Now we fear we could see a rise in new cases in these affected communities.”
A 2009 Malian Health Ministry strategy on fistulas says while the exact prevalence of the condition is unknown, it is estimated that 600 new cases occur per year. For years the aid agency Médecins du Monde has supported fistula care in Mali; it has a programme to support corrective surgery as well as post-operation psychological care in Mopti.
Obstetric fistula is a distinctly difficult condition to bear and to quantify, say experts. Women with fistulas are generally shunned by their families and communities. An indispensable component of any fistula care effort - including in Mali - is helping women post-operation to reintegrate into their communities and re-establish a livelihood.
Outreach in safer areas continues, as does fistula treatment at the Gao regional hospital, Touré of GREFFA said, though all the current patients are from Gao communities not affected by fighting. A principal aim of the fistula care project has been to make treatment available on a regular basis at the hospital, where three trained surgeons are based. “Even as we speak, women are receiving treatment,” he said.
http://www.irinnews.org/Report/95113/MALI-Unrest-hinders-fight-against-fistula

Wednesday, 29 February 2012

POVERTY: NIGER: Malian refugees flee to hunger zone

GAOUDEL/TILLABERI, 27 February 2012 (IRIN)

 Photo: Jaspreet Kindra/IRIN
For each day over the past three weeks at least 187 Malians fleeing fighting in their country have sought refuge in Gaoudel village, Niger

No babies cry and the children are not even curious about the presence of strangers. “It is hunger and they are shy - they are not used to strangers,” explained one of the mothers, who is among a couple of thousand Malians who have crossed into southwestern Niger and sought refuge in the windswept village of Gaoudel, Ayorou District, after fleeing clashes between Malian government troops and Tuareg rebels.
At least 10 children are among those sheltering in silence from the relentless sun under scraps of fabric tied to sticks in the ground. They are 10km from the Malian border.
During their two-day desert journey here they have had little to eat. Many had no time to pack anything and fled with just the clothes they were wearing. Some managed to come with their animals.
The host population - Tuaregs like the refugees - share their scarce food and water, but are stretched: The refugees now outnumber the villagers.
“They are the same people as us - black Tuaregs. Some are relatives, separated only by the border. We are all fighting drought and do not have enough food,” said Gaoudel village chief Echec Ahmad.
Their only water source - an uncovered well - will run dry in two months, he said, adding that repeated droughts had decimated their herds and that they depended on the few green beans they had managed to grow in a dried-up stream.
Some of the Malian men have arrived with animals, hoping to sell them in Ayorou town (30km away) in Niger’s Tillaberi Region, one of the worst-affected by drought in Niger. But the livestock trade in Ayorou is in poor shape. “There are a lot of animals in the market but not enough buyers,” said Biga Beidari with the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Tillaberi.
The closure of Niger’s border with Nigeria, after attempts by militant group Boko Haram to set up a base in the drought-stricken country, has had an impact on the local economy: The absence of Nigerian livestock buyers in local markets seems to have hit pastoralists across the region hard.
“If I sell three goats, I will be able to buy only 100kg of millet - enough for my family [two wives and seven children] to eat for 10 days,” said Mohammed Warimagalis, a Malian refugee and pastoralist who has picked up English on his travels. He arrived in Niger two days ago with 30 goats, which he fears will help his family survive for only about three months.

No jobs, little food
The refugees are our neighbours and they need assistance now
Most towns in the region are awash with people from food-scarce areas looking for work. An assessment by French NGO Agency for Technical Cooperation and Development (ACTED) found 94 percent of the villages in the districts of Tillaberi, Ouallam and Filingue do not have enough food; 89 percent of the population, or more than a million people, are affected.
The Mali clashes come at an unfortunate time, said Oumarou Sadou, prefect of Tillaberi. “But they [the refugees] are our neighbours and they need assistance now.”
Fighting in eastern Mali has spread to areas closer to the northwestern corner of the Tillaberi Region, prompting an influx of Malians into this part of Niger. Some aid workers fear the numbers could rise, as most arriving up to now had taken pre-emptive action. "We left as we heard the clashes were going to begin," said Warimagalis.
Plan Niger, an NGO operating in the area, says the number of refugees has been increasing rapidly and more resources are urgently needed to support them.
Plan Niger spokesperson Maman Farouk said that over the past five days another 932 refugees had been recorded in Gaoudel. The NGO has been registering Malian refugee children in local schools. They need more food, tents, medicine, bed nets, blankets and mats. They also hope to drill wells to support the host community with water.
Based on local authority figures, IRIN estimates at least 187 Malians sought refuge in Gaoudel village every day in the past three weeks.
Thousands of Malian refugees have trekked across the border to small towns and villages like Mangaizé, Chinégodar, Koutoubou and Yassan in Tillaberi, since mid-January, according to the Malian Ministry of Foreign Affairs.
Most of them - more than 9,000 - ended up in Chinégodar, which is usually home to 1,500 people. However, the number arriving here, where the Niger government and aid agencies have been providing support, has levelled off, said Benoit Kayembe, head of Médecins Sans Frontières Swiss in Niger.
Fighting between the Tuareg liberation movement MNLA (Mouvement National de Liberation de l’Azawad) and government forces resumed in Mali in mid-January, after the Tuareg rebellion was officially declared over by the government in 2009.
http://www.irinnews.org/report.aspx?reportID=94971

Saturday, 11 February 2012

POVERTY: SAHEL: Thousands of Touaregs flee into Burkina Faso

OUAGADOUGOU, 10 February 2012 (IRIN)

 Photo: Tugela Ridley/IRIN
A group of Tuareg men in traditional dress silhouetted on the crest of a sand dune at an oasis, west of Timbuktu, Mali

At least 8,000 Touaregs fleeing fighting in neighbouring Mali have found refuge in Burkina Faso, having arrived “in a dire humanitarian condition”, the government said yesterday.
It said it would set up a coordination committee to bring the refugees - currently spread between the western and Sahelian parts of the country - to a centralized location and provide education and sanitation.
“The humanitarian situation is alarming because most of them are sleeping in the open air despite the hospitality of their host,” said Modeste Konkobo, humanitarian officer with the Burkina Faso Red Cross.
“With the current bad weather [harmattan winds] this means looming health problems when added to the precarious food, sanitary and drinking water situation for such a huge group,” Konkobo said.
He said the refugees needed immediate “survival assistance” since they had arrived empty-handed. Other needs included blankets, cooking materials, mats and tents. The Red Cross is deploying some 40 volunteers.
Konkobo said refugees were still arriving in “large numbers” in Inabao and Deou (Oudalan Province), and Mentao (Soum Province). Some 4,000 refugees arrived in the region on 8 February.
“We are afraid this will aggravate the already bad food situation with the deficit we are facing,” said Boureima Yiougo, governor of Sahel Region.

The Touareg
The Touareg are nomads who once controlled ancient caravan routs across the Sahara Desert. They inhabit the Southern regions of North Africa – Algeria, Burkina Faso, Libya, Mali, Niger and Nigeria. Touareg is an Arabic term meaning abandoned by God. However, they call themselves variously Imohag (translated as free men), Kel Tamasheq or Kel Tamajaq. No one knows where they came from or when they arrived in the Sahara. Their true numbers are unknown but estimates vary between 300,000 and 1.5 million.
The government said 146 of the country’s 350 communes had experienced much lower rains this year and could face “famine”, and that it would subsidize cereals to lessen the impact on residents of the region.
The National Commission for Refugees and the local UNHCR office are due to conduct a joint assessment mission in Sahel Region, which borders Mali.
“They urgently need shelter since they caught us by surprise. We have only five tents,” said Hima Barke, a UNHCR official in Soum Province. “Just a week ago there were 40 refugees in the province, now there are 1,127.”

Mali
Meanwhile, the International Committee of the Red Cross (ICRC) reported on 9 February that at least 30,000 displaced people in Mali were in a dire condition because of fighting in the north of the country since mid-January.
In Aguelhoc (150km northeast of Kidal in northeastern Mali), it said, fierce fighting had forced some 4,000 people to flee their homes. Most had little food and were living in improvised shelters in the semi-desert region. A few have been sheltered by host families.
The ICRC said it and the Mali Red Cross were preparing to distribute millet, rice, oil and salt; as well as tarpaulins, blankets, sleeping mats, buckets, kitchen utensils and hygiene items to the displaced.
“The Mali Red Cross has already made an emergency delivery of food for 600 displaced people whose situation was particularly worrying,” the ICRC said.
In Ménaka, Gao Region, clashes prompted almost 26,000 people to flee their homes in search of safety, both within and outside the town, according to ICRC and Mali Red Cross estimates. The ICRC is also assessing the situation in Tessalit (Kidal Region) and Léré and Niafunké (Timbuktu Region), which have also been affected by fighting in the north of Mali. ICRC quoted “local sources” as saying there could still be 20,000 displaced people in these areas.
The fighting that took place in Ménaka and Andéramboukane also prompted over 15,000 people to seek refuge in Niger, in the northern Tillabéry Region just across the border from Mali.
http://www.irinnews.org/report.aspx?reportID=94829

Thursday, 1 December 2011

MALARIA: Vac-4-All and MRTC

Vac-4-All and MRTC : Launch multi-centre Malaria Vaccine Efficacy Trial in Mali
Vac-4-All, a new vaccine development initiative, and the Malaria Research and Training Centre (MRTC), a public research and training facility of the University of Bamako in the Republic of Mali, have completed the immunizations of Malian children with MSP3, a malaria vaccine prototype which recently produced promising results in a small scale trial in Burkina Faso 1.
Malaria is one of the most prominent public health problem affecting children and pregnant women in developing countries, with nearly 2.5 Billion individuals exposed, a few hundred Millions infected, and close to 1 Million deaths per year.
The trial capitalizes on the knowledge of host-parasite immune interactions and the clinical expertise accumulated by the two groups. The partnership forged between the groups intends to develop affordable vaccines against malaria and this trial is the first of a series of trials being planned to investigate several novel malaria vaccine candidates.
800 children aged 12 – 42 months are enrolled in the multi-centre double-blind, randomised, controlled Phase IIb efficacy trial. It is designed to provide a clear-cut demonstration of the efficacy of the target antigen, MSP3, in preventing clinical malaria episodes, and the underlying immunological mechanism. With an average incidence of 3 malaria attacks per person per year in the study areas, 2,400 malaria episodes are expected in the study population each year. The children are distributed across 8 villages, which are located in 2 regions which differ by their exposure to malaria, one with seasonal transmission and the other with perennial transmission, both at very high level.
Cases will be actively followed-up over 2 years post-vaccination by a large Medical team, headed by M.Sissoko and I.Sagara, with staff stationed in dispensaries in each hamlet. Particular attention has been given to the conditions of community-based and individual informed consent and participation2, to the design and organisation of the trial, to the definition criteria for clinical malaria, and to the identification of surrogate markers of protection.
About Vac4All: Vac-4-All is a private venture dedicated to malaria vaccine development, created in 2010 by P. Druilhe, formerly Head of the Malaria Vaccine Development Laboratory at the Institut Pasteur in Paris. Its mission is address urgent public health needs by developing vaccines that can be produced in a straightforward manner and that will be affordable to the populations in under-developed countries that need it most. The Vac-4-All approach follows a rationale that capatilizes on the analysis of immunological interactions between P.falciparum (the microbe that causes Malaria) and human beings which has led to the identification of several vaccine candidate molecules, explore potential surrogate markers of protection identified by clinical investigations in humans, and uses state-of–the–art research tools to analyse results from clinical trials to rationally guide product development.
About MRTC: the Malaria Research and Training Center, at the University of Bamako, in the Republic of Mali, is one of the widest malaria research facilities on the African continent and one with long-standing experience in conducting malaria clinical trials. Headed by Professor Ogobara Doumbo, its mission is to train and promote promising Malian and African doctors and scientists to work on state-of-the-art human malaria research projects and to conduct GCP/ICH-standard clinical trials with promising prophylactic and therapeutic novel compounds which could contribute to solving the problem of malaria in Africa. It is a partnership initiative, created by the MoE and MoH of Mali with technical and funding support from diverse partners including the US NIAID/NIH, TDR/WHO, the Rockfeller Foundation, and different universities (France, Italy, USA). MRTC works in close collaboration with Mali’s National Malaria Control Program and other national public institutions and with a large number of research groups over the world. Its past contributions in this field have gained international recognition.

Further information-----------------------------------------------------------------------------------------------------------------------------------
Prof. Ogobara Doumbo, Malaria Research and Training Center (MRTC), University of Bamako, BP 1805, Point G, Bamako, Republic of Mali. Mail : okd@icermali.org Phone : +223-222-8109 Fax: +223-222-8109

Saturday, 16 July 2011

MALNUTRITION: Mali: Ancient wisdom, new knowledge

DAKAR, 11 July 2011 (IRIN)
 Photo: Séga Cissé/IRIN
Women turn to traditional healer Fatoumata Kané when their children are ill

 No one can tell 64-year-old Fatoumata Kané anything new about the plants and tree bark around her town of Banamba in western Mali, but the traditional healer recently learned how to measure a child’s upper arm to detect malnutrition.
Scores of families bring ailing children to Kané each week. She is renowned in the region for her healing powers, but now refers suspected malnutrition cases to the public health centre. The collaboration, initiated by local health agent Oumou Sangaré of Helen Keller International (HKI), is an example of how NGOs are tapping into the influence of traditional healers and local elders to fight under-nutrition.
Across sub-Saharan Africa health experts commonly train traditional healers to detect conditions needing something other than indigenous medicine; the fact is that when illness strikes many people’s first move is to go to the local healer.
“It is always people’s first choice here,” said a doctor in Sierra Leone who requested anonymity. “It’s a custom people are addicted to.”
It is custom, but often it is also the only health care people can afford or physically access. In some countries in Africa and Asia 80 percent of people depend on traditional medicine for their primary health care, according to the World Health Organization.
Often traditional medicine is the answer. Africa has tens of thousands of plant species, many therapeutic, and the basis for effective remedies. Kouamé Koffi Samuel, a chauffeur in Côte d’Ivoire, said he has first-hand experience of women who are expert at healing closed fractures with massage, herbs and incantations. “I’ve seen it - it’s far more rapid and effective than a cast.”
But child under-nutrition is one of the conditions untreatable by such means, health workers say. If a parent does not understand the signs, symptoms and causes, various conditions could be suspected. The Sierra Leonean doctor said some families think immediately of a spell.
“When a child is malnourished people think it’s a witch. When a child is very anaemic they say a witch has drawn all the blood from the child.”
He added: “We need to do more education on this.”
Health experts say one strong conduit for that education are the traditional healers and elderly women who already have people’s confidence.
Traditional healers and grandmothers are the first-line healers in a community
“If [Banamba healer Kané] were to tell a woman not to take a child to the health centre, the woman wouldn’t do it, no matter what,” HKI’s Sangaré told IRIN. “Such is the women’s trust in her.”
Sangaré said she first approached Kané when she noticed that too many malnourished children in Banamba were not getting the medical attention they needed.

Collaborating with local healers
She said initially Kané, who makes her living as a healer, was hesitant but then agreed to talk. They met several times to talk about children’s health; Sangaré explained to Kané the role she could have in detecting malnutrition and helping children get the care they need. “Now she’s had training and she’s helping us detect cases of malnutrition.”
Kané, from her home in the Hamdallaye neighbourhood of Banamba, told IRIN traditional and modern medicine can function well together. “I have practiced for more than 20 years now; the gift I have for healing is not going anywhere. But modern medicine can complement it, and vice-versa.”
Vanessa Dickey, senior nutritionist with HKI Mali, said collaborating with local healers means more children who need medical care will get it.
“Targeting just mothers can get us only so far,” Dickey told IRIN. “People are going to listen to a traditional healer or a grandmother.” HKI also has a project in Burkina Faso to boost maternal and child health through the influence of older women, to whom young women invariably turn for advice on pregnancy, motherhood and feeding their families.
“Our object is to screen as many children as we can to see who needs attention,” Dickey said. “And traditional healers and grandmothers are the first-line healers in a community.”

Traditional plus modern
Nurses and doctors told IRIN it is common to see families consult both a traditional practitioner and a doctor.
Soro Awa, holding her nephew whose mother had recently died in childbirth, talked to IRIN at a Côte d’Ivoire nutritional centre in Korhogo: “Without this centre my sister’s son would not be alive,” she said. Still, she plans to see the local healer once she returns to the village “to protect the child from sorcery”.

 Photo: Aly Ouattara/IRIN
Some people go to hospital and a traditional healer, to cover all possible causes

“Often, people assume someone has cast a spell on a child, not knowing that a child is malnourished or has an illness that can be easily treated at hospital,” said Soro Pènè, from Korhogo’s Waraniené village. “Anyway, I am all for traditional healers because they do have their place in our customs and they are very effective in some cases.”
Salimata Koné, who runs the Korhogo centre, says some parents bring their children in directly without going to a local healer. But as the Sierra Leonean doctor explains, family pressure often weighs in later. “A parent could have a child treated at hospital, then a friend or family member will come round advising that it’s best to also consult the traditional healer.”
“It can be OK if people go to both,” he said. “But only if the traditional healer is competent and knows the limits of his or her capabilities.”
It is not a question of ruling out traditional practitioners, said Dickey. “They can continue to do follow-up. We do urge them not to give malnourished children herbs or teas to consume. The body of a malnourished child is really in chaos; these kinds of plants, which might not harm another person, could be dangerous for a child in this state.”
As in so many circumstances, the hard evidence of a healthier child is the most powerful message, Koné in Korhogo told IRIN. “It’s important not to condemn the practice of going to a traditional healer; we don’t want to frustrate people. But the fact is once a malnourished child regains health after proper diagnosis and treatment, that recovery is concrete proof and has a huge influence on others.”
Recovery is the common objective. “My role is to lighten mothers’ hearts, by helping heal sick children," said Kané. "When a child is healthy, the mother is relieved and things go better in the household.”
http://www.irinnews.org/report.aspx?reportID=93199

Saturday, 2 July 2011

POVERTY: SENEGAL: Poorly-trained midwives pose danger

DAKAR, 30 June 2011 (IRIN)

 Photo: Tiggy Ridley/IRIN
Midwives need better training on how to cope when things go wrong (file photo)

 Poorly-regulated, privately-run training schools in Senegal are churning out midwives who do not have a solid grasp of birthing or ante- and post-natal care, causing women and babies to die needlessly, according to the UN Population Fund (UNFPA).
Other basic competencies, as defined by the World Health Organization, include referral in high-risk pregnancies or births; addressing miscarriages; and family planning.
Most women who die during labour in Senegal do so because of post-partum haemorrhaging, according to UNFPA’s joint Senegal director, Edwige Adekambi.
“We know the causes of maternal mortality; we know that if a haemorrhaging woman does not get care within two hours she is likely to die, but many private training schools don’t even include this care in their curriculum,” she told IRIN.
Some 401 women died per 100,000 live births in Senegal, according to the latest government health survey in 2005, ranking 144 out of 181 countries studied; and only 52 percent of births in 2005 were accompanied by a qualified birth attendant, though for the poorest 20 percent of women this drops to 20 percent. While performing better on maternal mortality than most of its West African neighbours, Senegal still has a lot of work to do to reach the Millennium Development Goal on maternal mortality, according to UNFPA.
These and other issues were discussed at the Senegal launch of UNFPA’s State of the World’s Midwives report on 29 June.

Unregulated
Senegal has dozens of private midwife training schools which are in theory, regulated, but with just two government inspectors to do this, many get away with low standards, said Adekambi.
Bigoué Ba, vice-president of the National Association of Midwives, told IRIN “Anyone can open a school in Senegal. There’s no monitoring.”
While there is a national test that all midwives must pass to be recruited into a public hospital or clinic - and generally those who pass have been trained in public institutions, according to UNFPA - many who fail the exam can still obtain a diploma and find a job in a private clinic, said Adekambi.
The government has tried to improve regulation of schools, but cannot be expected to do it all, Health Minister Modou Diagne Fada told journalists at the report launch. “We are committed to improving maternal mortality rates and addressing the midwife problem, but partners have to help with this too,” he said.
UNFPA is working with the government, the National Association of Midwives, and aid groups to improve the national curriculum; it calls on the government to impose stricter regulation across the sector.
The current curriculum, while thorough, excludes vital aspects of birthing support, including how to administer antibiotics, to give oxytocin to stimulate uterine contractions; and using ventouse (a vacuum device) during birth to ease delivery. UNFPA teaches these techniques in “post-training” for midwives in several regions including Kolda and Tambacounda in central Senegal.

Rural shortage
As well as better training, more midwives are needed across the country: Senegal has just two midwives per 1,000 population, which is one-third of the recommended international norm, according to WHO.
Density of midwives, nurses and doctors per 1,000 population : Mali 0.3; Niger 0.2; Nigeria 2.0;
Liberia 0.3; Senegal 0.5; Sierra Leone 0.2

Shortages are particularly acute in rural areas: Matam, on the eastern border, has just 14 state-trained midwives and requires 389; Tambacounda has 38 (only one of whom is trained in family planning) and requires 515; while Dakar has 445 but requires a further 1,566, according to 2008 statistics from the Ministry of Health and Prevention’s human resource unit.
There is no gynaecologist or obstetrician at all in Kolda, so for complicated births women have to travel to Tambacounda, which takes more than the precious two-hour window, if something goes wrong.
To reach Millennium Development Goals four and five to improve child and women’s mortality and health, Senegal needs to recruit 250 additional midwives per year, according to UNFPA.

Recruitment drive
In 2010 the government did a countrywide recruitment push, hiring hundreds of additional midwives to work in rural areas.
While partially successful, half of all midwives recruited to rural areas “found a reason why they had to return to Dakar within the year,” said Health Minister Fada.
He puts the onus on them to stay. “It is their duty if they accepted this profession, to work where the needs are,” he told journalists at the report launch in Dakar, and he also called on the Midwives’ Association to encourage midwives to stay.
But the government also needs to think of more creative ways to encourage midwives to work in rural areas, said Ba of the National Midwives Association. Incentives have been discussed but few yet put into practice. These include providing midwives with lodging, a vehicle, health insurance for their families, or career development training.
The Health Ministry should also consider training up the hundreds of traditional birthing attendants, known as “matrones”, who work in villages throughout the country, said Ba.
More also needs to be done to make midwifery an “attractive” career, according to Ba. Midwives are paid on average US$200-300 per month at first but, given that there is very little career development, this could rise by just $100 over two decades of work. Career development training would also incentivize women to commit over the long term, she said.
All recognized the progress the Health Ministry has made since 2010: trying to regulate training more carefully; requiring the minimum of a baccalaureate certificate to enter midwife training; and delegating more medical tasks to midwives.
Most significantly, the government made all births, including Caesarean sections, free of charge in all regions of the country, except Dakar.
Further improvements will cost more than recent additions to the health budget will allow, said Fada. New income sources for the health sector, such as additional taxes on cigarettes and other goods, are being considered.
http://www.irinnews.org/report.aspx?reportID=93111

Saturday, 18 June 2011

MALNUTRITION: West Africa: Mapping the Risk of Anaemia in Preschool-Age Children: The Contribution of Malnutrition, Malaria, and Helminth Infections

June 9, 2011 : Matt Artz
Ricardo J. Soares Magalhães and Archie C. A. Clements

“Background: Childhood anaemia is considered a severe public health problem in most countries of sub-Saharan Africa. We investigated the geographical distribution of prevalence of anaemia and mean haemoglobin concentration (Hb) in children aged 1–4 y (preschool children) in West Africa. The aim was to estimate the geographical risk profile of anaemia accounting for malnutrition, malaria, and helminth infections, the risk of anaemia attributable to these factors, and the number of anaemia cases in preschool children for 2011.
Predictive geographical risk of anaemia in children aged 1–4 y, based on a model-based geostatistical Bernoulli model.

“Methods and Findings: National cross-sectional household-based demographic health surveys were conducted in 7,147 children aged 1–4 y in Burkina Faso, Ghana, and Mali in 2003–2006. Bayesian geostatistical models were developed to predict the geographical distribution of mean Hb and anaemia risk, adjusting for the nutritional status of preschool children, the location of their residence, predicted Plasmodium falciparum parasite rate in the 2- to 10-y age group (Pf PR2–10), and predicted prevalence of Schistosoma haematobium and hookworm infections. In the four countries, prevalence of mild, moderate, and severe anaemia was 21%, 66%, and 13% in Burkina Faso; 28%, 65%, and 7% in Ghana, and 26%, 62%, and 12% in Mali. The mean Hb was lowest in Burkina Faso (89 g/l), in males (93 g/l), and for children 1–2 y (88 g/l). In West Africa, severe malnutrition, Pf PR2–10, and biological synergisms between S. haematobium and hookworm infections were significantly associated with anaemia risk; an estimated 36.8%, 14.9%, 3.7%, 4.2%, and 0.9% of anaemia cases could be averted by treating malnutrition, malaria, S. haematobium infections, hookworm infections, and S. haematobium/hookworm coinfections, respectively. A large spatial cluster of low mean Hb (95%) was predicted for an area shared by Burkina Faso and Mali. We estimate that in 2011, approximately 6.7 million children aged 1–4 y are anaemic in the three study countries.

“Conclusions: By mapping the distribution of anaemia risk in preschool children adjusted for malnutrition and parasitic infections, we provide a means to identify the geographical limits of anaemia burden and the contribution that malnutrition and parasites make to anaemia. Spatial targeting of ancillary micronutrient supplementation and control of other anaemia causes, such as malaria and helminth infection, can contribute to efficiently reducing the burden of anaemia in preschool children in Africa.”

http://gisandscience.com/2011/06/09/mapping-the-risk-of-anaemia-in-preschool-age-children-the-contribution-of-malnutrition-malaria-and-helminth-infections-in-west-africa/

Sunday, 12 June 2011

GLOBAL FUND: Mali: Corruption report

Michel D. Kazatchkine : Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria
June 6 2011
 
This week, the Global Fund to Fight AIDS, Tuberculosis and Malaria released its investigation report on some of our grants in Mali. It is truly sobering to read how a few individuals, who were tasked with managing two malaria and two tuberculosis programs that should save the lives of thousands of their countrymen and -women, instead systematically worked to defraud these programs, stealing $5 million over several years.
The Global Fund is a $21-billion war chest against AIDS, tuberculosis and malaria that has saved more than 6.5 million lives in its nine-year history. Bill Gates described its creation as "one of the best things human beings have done for one another." I find it deeply distressing that people can steal from those who are most in need, and it is hard to understand how the perpetrators can live with themselves. But given that 15 suspects are now in jail awaiting trial, they will, if found guilty, have a lot of time to contemplate why they chose greed over the chance to save lives.
Six months ago, when the Global Fund's own investigations made it clear that money had been lost, we stopped all payments to these grants in Mali -- except for lifesaving drugs -- and demanded that those managing the grants be replaced. Only when new, solid management is in place can we resume transfers of money to these grants. The establishment of new management is well under way.
In this, we are working with the Mali government, and President Amadou Toumani Touré has been the strongest voice for rooting out and cleaning up corruption in his country.
Our investigation also revealed that the Global Fund could have been more vigilant in Mali. But we have learned our lesson. In fact, the Mali case has contributed to the largest reform of grant management at the Global Fund since its inception. We believe that, as a result of these efforts, the Global Fund is now considerably stronger and better prepared to prevent and quickly detect fraud and misuse.
By nature of its mandate, and in order to reach some of the world's most vulnerable populations, the Global Fund works in many countries with governance systems and financial controls that are fragile. In tackling mismanagement, the Global Fund is driven by two core principles: full transparency and zero tolerance for fraud.
The Global Fund stands by full transparency because we believe that our uncompromising attitude to exposing misuse will become a deterrent. People will think twice about stealing from an institution that exposes such thieves publicly. Transparency can be painful, since the world rarely rewards bad news. But as a doctor I know very well that what hurts badly at first will make you stronger. In our case, it will save lives.
http://www.huffingtonpost.com/michel-d-kazatchkine/transparency-saves-lives_b_871073.html

Wednesday, 8 June 2011

GLOBAL FUND: OIG Says Failure to Spot Warning Signs in Mali Was Widespread

PR, auditors, LFAs, CCM and Global Fund Secretariat all experienced system failures Accountant hired to oversee grants had a history of financial crime
For six years, no one spotted the corruption that was occurring in some Global Fund grants to Mali, despite the fact that there were five "checkpoints" in place to detect such problems. This is one of the conclusions of the Global Fund's Office of the Inspector General (OIG) in its final report on the investigation into TB and malaria grants in Mali. The investigation was conducted between February 2010 and April 2011.
As previously reported in GFO, the OIG found that a significant proportion of the funds distributed to the Ministry of Health (MOH), principal recipient (PR) for all TB and malaria grants in Mali, were misappropriated. Most of the fraud was perpetrated by individuals associated with two sub-recipients (SRs), the main implementing entities, which submitted thousands of fraudulent invoices, created false bid documents, forged signatures and over-charged for goods and services - primarily in connection with purported "training events."
Five grants were included in the investigation, which covered the period from early 2004 until May 2010. The OIG said that the misappropriation started in May 2004, shortly after the first grant started.
The OIG identified the five checkpoints - referred to as "components of the fiduciary framework" - as (1) the Department of Administration and Finance (DAF), the entity most directly responsible for the fiduciary aspects of the grants within the MOH; (2) external auditors; (3) the local fund agents (LFAs); (4) the country coordinating mechanism (CCM); and (5) staff at the Global Fund Secretariat.
The DAF was itself implicated in the OIG's findings of fraud. The OIG said that the DAF had failed to implement proper segregation of duties and basic accounting tasks, which contributed to an increased risk of fraud; and that the accountant hired by the DAF to oversee grants had a past history of financial crime. The OIG said that although the LFAs and the Secretariat were aware of the weaknesses of the DAF ever since the PR assessment was conducted for the first grant, the DAF was repeatedly utilised to manage new grants, and "no one identified these weaknesses as indicators of possible fraud and abuse."
(There were two different LFAs during the period covered by the audit. A second LFA replaced the first LFA as a result of the contract being re-tendered in 2008. The decision to re-tender was not related to the OIG investigation. Both LFAs used the same finance professional to do the in-country LFA work.)
According to the OIG, the LFAs failed to exercise proper financial oversight, and were negligent in failing to identify the pervasive fraudulent invoicing scheme, and failing to notice the "plethora of false documents" submitted to trigger payments. Furthermore, the OIG said, the LFAs failed to notice obvious deletions and inconsistent calculations on bank statements, all of which concerned funds that the OIG ultimately found had been misappropriated.
The OIG said that the LFAs, the CCM and the Secretariat failed to identify that many of the purported training events financed through grant funds may not have actually occurred.
(Despite the criticism of the LFAs by the OIG, the OIG commended the current LFA for its recent excellent cooperation during the investigation, and for its continuing efforts to detect possible misuse of grant money.)
The OIG stated that Secretariat staff lacked the means and the capacity to detect the risk of fraud and other misuse of funds, and were not "properly incentivized or prepared" to respond appropriately when signs of risk did appear.
With respect to the CCM, the OIG said that there was no evidence that the CCM ever mentioned that, in its view, there was a risk that grant funds were not being used for their intended purposes - and, further, that "the CCM had neither the capacity, nor the self-perceived responsibility, to identify such risks."
The OIG said that many of the required internal and external audits were not performed or were severely delayed. None of the audits that were carried out identified any risk of fraud.
In its report, the OIG provided updated numbers on the results of its investigation in Mali, as shown in the table below.

Table: Losses identified in Mali TB and malaria grants
Amount of grant funds examined: $9.7 million
Of which, losses identified: $5.2 million
Of which, due to criminal acts of fraud and misappropriation: $4.1 million
Of which, due to insufficient documentation or improper use of funds: $1.1 million
Concerning the $4.1 million lost through fraud and misappropriation, the methods used included (a) misappropriation of grant funds from programme bank accounts through false statements, false documents, and unauthorised and improper transfers; (b) fabrication of false supporting expenditure documentation; (c) overcharging and widespread misappropriation of programme assets; and (d) fraudulent procurement practices.
About 10% of the $1.1 million lost due to insufficient documentation or improper use of funds was for a TB laboratory, the purchase of which, according to the OIG, was contrary to what it termed "procurement rules." In addition, the OIG said, the laboratory is sitting idle and vacant, and does not conform to safety standards. The OIG also said that equipment purchased for the laboratory has sat in boxes in a storage shed for more than a year "and may well now be unusable."
The OIG noted that its team spent the equivalent of one person working for a year full-time investigating the TB and malaria grants in Mali. The OIG said that due to substantial deficiencies in accounting and record-keeping, it had to expend significant time and money recreating an electronic record of programme disbursements and expenditures. In the process, the OIG organised, scanned and computerised, and analysed over 50,000 pages of programme documentation. According to the OIG, this documentation was found in loose form, often contained in trunks maintained in the basements of offices. It said that many of the documents were soiled, and had to be manually scanned in order to be reviewed in detail.
As a result of the OIG's findings, in December 2010 the Global Fund terminated one TB grant and suspended two malaria grants (see report in GFO). As of that same date, as a result of criminal investigations launched in Mali, authorities had arrested and imprisoned 15 people in connection with the fraud.
The report recently released by the OIG dealt only with the investigation into the TB and malaria grants. However, the OIG is also investigating HIV grants in Mali. Although that investigation is not yet complete, the OIG said that it was finding patterns of fraud similar to those described above for the TB and malaria grants. In March 2011, the Global Fund announced that it had suspended one of the HIV grants (see report in GFO).
In its report on the TB and malaria grants, the OIG makes several recommendations, including that the Global Fund Secretariat strengthen the grant agreement to require all PRs to record key expenditure information (such as vendor names) within "an acceptable accounting system"; and bar cash expenditures unless there is a critical need for them. Finally, the OIG recommended that the use of the amount and pace of grant fund disbursements as a key performance indicator for Secretariat staff be reconsidered. In the OIG's opinion, the emphasis should be placed on "quality rather than the quantity of disbursements," and on "ensuring (through continuous monitoring) that grant funds are in fact used for grant purposes."
In a statement accompanying the final report on the OIG's Mali investigation, the new Global Fund Board Chair, Martin Dinham, said that "it is important to stress the separation between the wrong doing of some individuals and the laudable efforts of the majority of the health work force in Mali."
Dinham said that "this case has contributed to the largest reform of the grant management of the Global Fund since its inception." He also said that "the fact that this fraud was in part identified by an audit and fully uncovered through the vigilance of the Global Fund's own Inspector General's Office, as well as the fact that the perpetrators are now being brought to justice, will serve as a deterrent to others."
In a blog posted on 6 June 2011 on the web site of the Huffington Post, Global Fund Executive Director Michel Kazatchkine said, "I find it deeply distressing that people can steal from those who are most in need, and it is hard to understand how the perpetrators can live with themselves. But given that 15 suspects are now in jail awaiting trial, they will, if found guilty, have a lot of time to contemplate why they chose greed over the chance to save lives."
When the Global Fund suspended disbursements to the Mali grants (except for lifesaving drugs), Kazatchkine said, the Fund "demanded that those managing the grants be replaced. Only when new, solid management is in place can we resume transfers of money to these grants. The establishment of new management is well under way."
Both Dinham and Kazatchkine praised Mali President Amadou Toumani Touré for his efforts to detect and end fraudulent practices in his country.

Tuesday, 10 May 2011

MALNUTRITION: Africa: Food Prices Rise to Highest Levels Since 1984

5 May 2011 An excerpt from the Africa Progress Report 2011:
Even though several African countries are on the verge of meeting their MDG targets for hunger reduction, the continent as a whole continues to be the world's most food-insecure region. Hunger and malnutrition remain pervasive in many countries, and rising food prices are compounding the situation for millions across the continent, particularly in zones of protracted conflict and in fast-growing urban areas.

Volatility of Food Prices
Food prices are higher now than at any time since 1984. Even though the World Bank's Food Price Watch sees Sub-Saharan Africa less exposed to risks related to soaring food prices as domestic food production is increasingly replacing imports and recent harvests have been good, the price spikes have deepened existing macro and micro vulnerabilities. On the macro level, countries with a high share of food imports and limited fiscal space like Burundi are driven deeper into current-account deficits and the possibility of social unrest as they become unable to use subsidies and price controls to shield their populations from inflation.

Africa Progress Panel

This graph published in the Africa Progress Report 2011 shows how steady African growth was interrupted by the global financial crisis in 2009 but is expected to regain its momentum through 2011.

On the micro level, higher prices make life even more difficult for Africa's poorest, who already spend between 60 to 80 per cent of their income on food. Faced with reduced access to food and increased vulnerability to the seasonality of local food prices and markets, households are forced into unavoidable compromises, such as choosing cheaper (often less nutritious) food, selling productive assets, withdrawing children from school, forgoing healthcare, or simply eating less than they need.
The recurrence of food-related crises over the last few years has focused international attention on the tragic state of food security in Africa and given rise to a number of supportive initiatives such as the G8's L'Aquila Food Security Initiative, the Global Agriculture and Food Security Program, and the World Bank's Global Food Crisis Response Program. The French G20 Presidency has also prioritized food security, and especially the moderation of speculative trading in food commodities, for the 2011 Summit in Cannes. It is planning to host the first ever meeting of the Group's Ministers of Agriculture before the Summit. In addition, there are attempts to create more transparency of food stocks held by large exporters to avoid panic caused by market uncertainty about the availability of essential commodities.

Structural Barriers to Food Security
At the same time, the fact that the number of Africans suffering from hunger had already been on the increase well before prices spiked suggests that chronic and structural problems rather than mere price fluctuations continue to underlie much of the continent's food insecurity. These problems include: disadvantageous international trade rules and subsidy regimes; a debilitating lack of essential infrastructure such as irrigation and storage systems; inadequate agricultural research; a lack of improved seeds, fertilizers, and plant protection material; poor soil and water management systems; poor access to credit and marketing services; as well as inefficient and wasteful agricultural value chains.
Agricultural productivity is also affected by social realities such as persistent poverty and insufficient access of women to land and other essential resources.
These structural barriers are increasingly compounded by global trends. In the short-term, the gap between the continent's domestic food supply and demand will widen as global consumption patterns continue to shift towards meat products, and more profitable bio-fuels supplant food crops. In the mid-to-long- term, the continent's food system will experience an unprecedented confluence of pressures, including through the reinforcing impacts of population growth, climate change and environmental degradation.

Agricultural productivity
Over the last year, African countries and their partners have increased their commitment to raise agricultural productivity on the continent, including through multi-stakeholder partnerships. For example, the Comprehensive African Agriculture Development Programme (CAADP) now has 25 signatory countries (seven more than last year) committed to spending at least 10 per cent of their national budgets on agriculture, to accelerate growth in the sector to at least 6 per cent a year. Nineteen countries have finalized Agricultural Investment Plans.
Practical efforts to boost agricultural production are beginning to yield results in many countries, including Ghana, Malawi, Mali, Mozambique and Tanzania. Focused international assistance and innovative partnerships, like the Alliance for a Green Revolution in Africa (AGRA), have helped governments to intensify production. Methods include: the introduction of high-yielding varieties of crops and improved techniques such as micro-dosing of fertilizers and drip irrigation; increased accessibility of production- enhancing inputs, credit and other financial services such as weather-indexed crop insurance; and improved markets and information.
The increasing engagement of the private sector, including through the promotion of agricultural growth corridors and agro-industrialization, will help to increase resources available for agricultural investments.
These successes remain too small to feed the continent. Global food production will have to increase by 70 per cent over the next 40 years to keep pace with population growth, and a significant part of that increase will have to come from Africa. There is an urgent need to scale up successful interventions, focus on Africa's army of smallholder farmers and increase emphasis on staple food crops. There is also a need to ensure that the growing foreign investments in Africa's arable land, sometimes referred to as "land grabs", are transparent, add to the continent's food security, benefit local farmers and communities, and avoid undermining social, environmental and governance systems.
The dire social consequences of the recent food crises have shown that efforts to improve agricultural productivity and connectivity on the supply side need to be complemented by better risk management, efficient social safety nets and targeted nutritional programmes on the demand side.
As with the implementation of agricultural development plans, national governments ultimately bear responsibility for this.
http://allafrica.com/stories/201105050350.html

Monday, 21 February 2011

POVERTY: COTE D'IVOIRE: Cocoa ban latest worry for growers



 Photo: Monica Mark/IRIN
Growing conditions have been ideal for a good harvest

ABIDJAN, 17 February 2011 (IRIN) - An embargo on the export of cocoa beans in Côte d’Ivoire is curbing income for the country’s 900,000 growers, the latest to be caught in the crossfire of the political fallout.
Presidential claimant Alassane Ouattara on 23 January called for a month-long ban on cocoa exports, one of several tactics being deployed by his internationally recognized government to increase pressure on Laurent Gbagbo, who refuses to quit office.
Analysts say most of the estimated US$120 million needed to run a skeleton economy - paying salaries at the expense of infrastructure and development - usually comes from the key sectors of cocoa and petroleum. Cocoa brought in US$1 billion in foreign exchange receipts in 2006, versus $1.3 billion from oil and other refined products, according to the International Monetary Fund (IMF).
About six million Ivoirians rely on cocoa production to survive. The country exported 1.2 million tons last year, roughly 40 percent of global supply, according to the International Cocoa Organization (ICC). But as the Ivoirian economy continues to be hit by political turbulence, any targeted financial measures will require a delicate balancing act to avoid squeezing vulnerable farmers.
Many growers said they support the ban, but remained anxious about how long it would last. Although the main cocoa harvest is collected from September to March, another smaller crop is gathered between March and August.
“The majority of us are smallholders from the north or centre of the country. These are the people who feel the ban is all part of the process of a revolution,” Maurice Savadogo, a cocoa farmer in the eastern town of Abengourou, told IRIN.
It’s just a shame that ordinary citizens have to suffer the brunt of a political crisis that should have been over by now
Ouattara’s popular support is strongest in the north of the country. His November win was the result of an alliance with former president Henri Konan Bédié, who garnered large pockets of votes in central-eastern regions of the country.
“But if the ban is extended until March, things will be enormously difficult for us. At the end of the day we are just planters; we feel very vulnerable,” Savadogo said.

Latest headache
Gbagbo’s government has described the ban as an attempt by Ouattara’s government to illegally impede growth in a vital industry where production is on the rise. “Forecasts for this season’s harvest could top 1.2 million tons,” Gbagbo spokesperson Ahoua Don Mello told reporters, saying Ouattara’s request to ban cocoa exports was “disastrous”.
The current financial squeeze means growers have not been able to benefit from the tail end of a bumper crop forecast this year. Cocoa beans registered for export at the country’s ports were up 16 percent year-on-year, reaching 905,000 tons in the week ending 30 January, figures from the cocoa and coffee board (BCC) show.
“Growing conditions this year have been ideal for a good harvest”, farmer Blaise Ouraga from the western growing belt of San Pedro told IRIN. “But the cost of fertilizers and weed-killers is unaffordable for us these days. And that’s not surprising when you see that the cost of transport, food, everything has gone up in the last couple of months. A ban is the latest headache.”

Black market
Meanwhile, middlemen who buy the beans from farmers have used the ban to undercut the BCC recommended farmgate price - the price farmers are paid for their produce, set at roughly two US cents per kilo. A black market has sprung up for those wanting to cash in on the jumbo crop, Fulgence N’Guessan, president of the Union of Cooperatives of Côte d’Ivoire (Ucopexi), told IRIN.
N’Guessan said 2,000 tons of cocoa had been transported out of the bush in the last two weeks, with farmers being forced to accept prices of around one US cent per kilo of beans.
“Farmers don’t have the conditions to keep beans for more than about three weeks. Some prefer to sell at a low price rather than risk not being able to sell mouldy beans at all later.”
“And the buyers factor in the risk they are taking, the fact they’re using their own personal money and so on, to push down the prices,” N’Guessan, who also runs export company Kavokiva, told IRIN.
Official BCC figures put average farmgate prices at 1.7 US cents per kilo for the week ended 31 January.
In Abidjan’s usually bustling port, dozens of lorries are parked - the most visible sign of European Union financial sanctions. Their drivers, who transport produce inland as well as to landlocked neighbouring countries Burkina Faso, Mali and Niger, sleep underneath the vehicles as they wait for business to pick up again.
“It’s just a shame that ordinary citizens have to suffer the brunt of a political crisis that should have been over by now,” said Adamu (not his real name), an official at an international cocoa company, gesturing at the eerily quiet port. Most multinationals have respected Ouattara’s request and are laying low, he added.
“The industry is worth billions, so of course beans are still being bought. There are big warehouses at the port that can store beans for a long time, but because it’s all unofficial farmers aren’t being paid a good price.”
Cocoa continues to leave the country via established smuggling routes to the east in Ghana or northwards to Burkina Faso, Adamu added, echoing reports from other farmers and cooperative owners.
“It is those farmers who are feasting at the table of those dominating politics who are benefiting from this situation,” said a grower in Daloa, the heart of the cocoa belt. “They’re a minority, but they’re the ones crying loudest for the ban to end while benefiting,” he told IRIN.

http://www.irinnews.org/report.aspx?ReportID=91950

Friday, 4 February 2011

POVERTY: Putting fraud in global health spending in context


By Michael Gerson michaelgerson@washpost.com

February 4, 2011

Digging in the garden of a health official in Mali, investigators discover more than 30 counterfeit "stamps" used to validate fraudulent invoices to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The inspector general of the fund reports serious corruption in the programs of four countries - Mali, Mauritania, Zambia and Djibouti. A breathless Associated Press story concludes that "as much as two-thirds" of some Global Fund expenditures are being misspent. Germany and Sweden suspend their support. Some conservatives run with the story, which reinforces their preconceptions about foreign aid and fits the need for budget cuts. After all, in this view, two-thirds of Global Fund money is thrown down a rathole of corruption.
When scandals fit preexisting ideological narratives, they assume a life of their own. This particular narrative - the story of useless, wasted aid - is durable. It is also misleading and might be deadly.
The Global Fund controversy illustrates the point. The two-thirds figure applies to one element of one country's grant - the single most extreme example in the world. Investigations are ongoing, but the $34 million in fraud that has been exposed represents about three-tenths of 1 percent of the money the fund has distributed. The targeting of these particular cases was not random; they were the most obviously problematic, not the most typical. One might as well judge every member of Congress by the cases currently before the ethics committee.
The irony here is thick. These cases of corruption were not exposed by an enterprising journalist. They were revealed by the fund itself. The inspector general's office reviewed 59,000 documents in the case of Mali alone, then provided the findings to prosecutors in that country. Fifteen officials in Mali have been arrested and imprisoned. The outrage at corruption in foreign aid is justified. But this is what accountability and transparency in foreign aid look like. The true scandal is decades of assistance in which such corruption was assumed instead of investigated and exposed.
The Global Fund has a difficult challenge. It gathers resources from governments, foundations and individuals but relies on local partners to implement programs. When providing relatively expensive commodities - anti-retroviral treatments or combination drugs for malaria - through relatively unsophisticated structures, there are opportunities for corruption. So the fund audits every grant it makes, requires measured outcomes, cuts off ineffective programs and encourages whistleblowers. It was the United States - the fund's largest supporter - that pushed in 2005 for the appointment of a strong inspector general to fight fraud. He is now doing his job. It would be difficult to make similar claims of accountability for most domestic programs in America.
The response of the fund to these cases of corruption has been, so far, serious. With fraud concentrated in training programs, all training activity has been suspended. Tighter expensing procedures are being implemented. The fund is double-checking expenditures in high-risk countries. It is also proposing an independent review of its financial-control mechanisms. The corruption in places such as Mali is not representative, but it is also not unique. There will, no doubt, be more cases exposed and more reforms needed.
But American policymakers should keep two things in mind. First, the fund is not expendable. It supports about two-thirds of the global effort against malaria and tuberculosis, and about a quarter of the fight against HIV/AIDS. Since 2002, it has helped detect and treat 7.7 million cases of TB, distribute 160 million insecticide-treated nets and put millions of people on AIDS treatment. These are not the results of a fundamentally dysfunctional program.
Second, the fund is the primary method by which America spreads the burden of encouraging global health to other nations. About a third of its funding comes from the United States. The rest is raised elsewhere. If the fund was diminished or discontinued, American health commitments around the world would need to dramatically increase - at least if we want to avoid complicity in a global tragedy.
In a scandal, the first response is anger. In global health, corruption kills. The most important response, however, is to make sure the right people get punished - not an African child who needs a bed net, or the victim of a cruel and wasting disease. They had no part in the controversies surrounding the Global Fund, but depend, unknowingly, on their outcome. An overreaction to corruption can also cost lives.

http://www.washingtonpost.com/wp-dyn/content/article/2011/02/03/AR2011020305176.html

Monday, 27 December 2010

Global Fund - timely oversight or trigger happy

Bill Brieger : 26 Dec 2010

In the past year the Global Fund to fight AIDS, TB and Malaria (GFATM) has suspended grants in Mauritania, The Philippines, Zambia, and Mali. In fact one grant to Mali was terminated. Efforts to identify high risk grants are underway.
Some are saying that the Office of the Inspector General (OIG) of GFATM is finally showing some teeth, while others worry that actions to suspend and terminate will harm the very persons that the Global Fund was set up to help. At the recent 22nd GFATM Board Meeting the Executive Director provided the following comments based on OIG work:
Based on recent OIG findings in a number of countries, activities involving cash transfers for training events and associated costs, including per diems, travel, meal and expense payments, are in many cases posing a high risk of misuse
The OIG has identified five countries where measures to protect Global Fund-financed drug shipments from theft need to be implemented
The Secretariat and OIG agree that LFAs have not been sufficiently focused on the identification of fraud risks and actual fraud in Global Fund-financed programs, and may not currently have the capacity to address these risks
Prior to the recent Board meeting, one wonders whether the communication between the Secretariat, the Executive Director and the Office of the Inspector General were clear and efficient. A 6th December 2010 memo entitled “Joint communication on Inspector General matters” mentioned that, “The Inspector General and the Executive Director of the Global Fund have initiated sincere effort towards collaboration to follow up on recent findings by the Inspector General as well as to take steps to permanently strengthen grant oversight.”
The memo concluded that, “The Global Fund, by nature of its mandate, sometimes has to work with entities with weak programmatic and financial capacity, and to operate in environments where there may be a paucity of financial controls and lack of oversight systems. The Global Fund’s risk management systems are constantly improving. Recently discovered fraud has made the Secretariat determined to redouble its efforts to improve these systems.”
In some cases of suspended grants the Global Fund is looking for alternative Principal Recipients to manage the funds or find alternatives to ensure services to those in need do not cease to be served. The concern about the Local Fund Agents is valid since the Global Fund, unlike other international agencies, does not have country offices or provide technical assistance.
Several years ago I worked with a team in Nigeria to design and deliver adolescent and youth peer education on reproductive health through community based organizations (CBOs). The initial effort focused on how to organize and train peer educators and the technical aspects of reproductive health. Eventually it became obvious when one CBO leader was using her personal bank account to keep project funds that the local CBOs needed as much technical assistance in establishing and maintaining proper financial and accounting procedures as they did in organizing peer based reproductive health education.
The Global Fund operates in a scale thousands of times larger that our small peer education projects, but the basic principle remains. Don’t condemn local organizations for poor financial performance if you did not try to help them develop better financial and accountability procedures in the first place.
Currently 22% of grants are considered to be poor performers. Too much is at stake in reaching 2015 and beyond to simply say to poor performers, “sorry, your funds are suspended.”
http://www.malariafreefuture.org/blog/?p=1135