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

POVERTY: MAURITANIA: Activists’ trial puts spotlight on anti-slavery law

NOUAKCHOTT, 4 January 2011 (IRIN)

 Photo: Contributor/IRIN : Former slave in Mauritania

Six anti-slavery activists are in prison in Mauritania in a case rights experts say points to the challenges of ensuring a 2007 law criminalizing slavery is more than just words on paper.
The six men, members of the Mauritanian anti-slavery group Initiative pour la résurgence du mouvement abolitioniste (IRA), are set to go on trial in the capital, Nouakchott, on 5 January after two postponements. The authorities reportedly said the IRA members attacked security forces; the activists said they were simply demonstrating against slavery.
“We suspected that the 2007 law would not be put into effect,” Romana Cacchioli, Africa expert with Anti-Slavery International, told IRIN. “And indeed its application is not yet a reality. Cases that have been brought are either still in process but taking a long time or have not been pursued.”
The law makes keeping slaves a crime in Mauritania, but the practice continues. The NGO SOS Esclaves says nearly a fifth of Mauritania’s 3.1 million people were slaves as of 2009.
On 13 December the six activists were arrested while protesting in front of a Nouakchott police station; the activists were calling for the group’s leader to attend the questioning of two girls - aged nine and 13 - allegedly kept as slaves.
“Each time a slave is questioned, the police don’t want [IRA president] Biram Oula Dah Ould Abeid to attend,” IRA member Hamady Lehbouss told IRIN. “This way the police are able to manipulate the slaves.”
Leïla Ahmed, IRA member and Ould Abeid’s wife, was at the police station; she said she felt teargas and saw policemen beating IRA members, including her husband.
The Mauritanian authorities have declined to comment on the arrests or the protest in front of the Nouakchott police station.
Ineffective law?
The 2007 law - adopted unanimously by Mauritania’s National Assembly - criminalized slavery. But to date, according to IRA and SOS Esclaves, no one has been prosecuted for keeping slaves.
Human rights and anti-slavery activists expressed concern in 2007 that the law alone was insufficient, saying the government must adopt measures to ensure the law would be effective.
The law says slaveholders could be given 10-year prison sentences and fines ranging from US$2,000 to $4,000. Anyone facilitating slavery can be imprisoned for two years. The law also provides for financial compensation to former victims.
The law does not allow representatives of civil society groups to attend trials.
“No legal measures exist for slaves to claim their rights,” IRA secretary-general Boubacar Ould Mohammed told IRIN.
The deputy head of SOS Esclaves in Mauritania, Mohamed Ould Khalifa, said the authorities generally classify such cases simply as disputes between an employer and his or her employees.

Widely practised
Activists said part of the difficulty in criminalizing slavery is that it is so widely practised. “The authorities themselves keep slaves,” Khalifa said.
But also, former slave Haby Rabah told IRIN, many people in slavery do not know their rights or are afraid to leave.
“My masters told me: ‘The slave depends on his owner and in order to go to paradise he must obey his owner. Otherwise he will go to hell’,” said Rabah who, with IRA’s help, was liberated "three years and four months" ago.
“I knew no one but my masters. I belonged to them and that seemed normal to me. When I was young my owners beat me; when I got older they threatened to take me to the police if I disobeyed them.”
Local experts say slavery continues in cities as well as in rural areas in this Sahelian country which lies geographically and culturally between Arab North Africa and black sub-Saharan Africa. Most affected are the Harratin – black Moors, descendants of slaves – who are generally owned by upper class white Moors, the minority ruling elite of Arab-Berber descent, according to SOS Esclaves. Slaves generally do household work or attend to livestock; they are not allowed to own land.
A common saying among Mauritanians is: “The ground is the slave’s bed, fire his clothing.”
http://www.irinnews.org/report.aspx?ReportID=91528

POVERTY: Mauritania: Slavery

NOUAKCHOTT, 4 January 2011 (IRIN)

 Photo: Contributor/IRIN : Mattallah Ould M'Boirk with his family

MAURITANIA: Mattalla Ould M’Boirk, “I’d rather be shot than return to my owners”
In August 2007 Mauritania’s National Assembly unanimously adopted a law criminalizing slavery. But, according to the NGO SOS Esclaves, 18 percent of Mauritania’s 3.1 million people were slaves in 2009. To date no one has been prosecuted, and the age-old practice continues.
Mattalla Ould M’Boirk works for SOS Esclaves in the Mauritanian capital, Nouakchott. Having spent most of his life as a slave, he knows what slavery and freedom mean. He told IRIN his story:
“When I saw my mother and sister beaten by our owners, I just couldn’t take it. I wanted out. But they beat me too.
“My work was to take care of livestock and make charcoal. I would leave with the camels in the morning, make charcoal and go out looking for drinking water. I would return to our settlement around midnight.
“Our ‘home’ was just an area of the settlement encircled with a cloth. We were given nothing to eat except when our owners had leftovers. We would go into the desert to hunt small animals like lizards to cook and eat.
“We couldn’t just leave. This is the Sahara. If we fled we would die of hunger or thirst. Anyway, our owners would come and find us in their vehicles; slaves who tried to escape were often killed. We know of cases like that.
“We would be beaten if we lost a camel, or if we sat on the same mat as our masters, or disobeyed them. Once, when I lost some camels due to the wind, my owner’s son beat me in the eyes with a club.
“One day I was near a road and some soldiers picked me up, asking me to show them where they could buy a sheep and some milk… I ended up telling the soldiers not to bring me back to my owner’s place.
“Then my owners came by, asking where I was. I told the soldiers I’d rather be shot dead than return to my owners; the soldiers told the men to leave.
“Finally SOS Esclaves heard about me and helped me escape for good. My family still wants to get out but they haven’t found a way.”
http://www.irinnews.org/report.aspx?ReportID=91522

MALNUTRITION: Food and nutrition crisis in Niger and the Western Sahel

31 August 2010 (IRIN) -
The West African Sahel is facing one of the worst food and nutrition crises in recent years. Some 10 million people in Niger, Chad, Mali and Mauritania are at risk of hunger before the next harvest in late September; hundreds of thousands of children are severely malnourished; and people's most precious asset, their livestock, have died in large numbers. In late 2009 the US-based Famine Early Warning Systems Network highlighted signs of the crisis: a major drop in cereal production and poor pastoral conditions due to failed rains, and a dangerous combination of poverty and high food prices. UN agencies, NGOs and governments have been trying to ease the crisis, but say funding has been insufficient and late, given that bringing food to landlocked countries with hardly any infrastructure can take up to five months. The situation in Chad's Sahelian belt running across the centre of the country is especially worrying: While malnutrition figures are alarmingly high - up to 27 percent of under-five children in some areas - the number of organizations on the ground is limited. People have compared the situation there to the crisis in Niger in 2005. A slow-motion catastrophe is unfolding in the Sahel countries, among the poorest in the world. A third of the population of Chad and Niger are chronically undernourished. Each year, 300,000 under-five children die of malnutrition, according to the UN Children's Fund (UNICEF).

POVERTY: How many poor Arabs are there? Call to create poverty map, update data in the region

29 August 2010
Nadim Kawac>
Arab nations need to create a common data network and a map for poverty in their region as part of a strategy intended to upgrade their socio-economic information and combat poverty, according to an official Arab group.
Despite widespread poverty in many regional countries, Arab governments still far lag behind in gathering accurate data on local poverty and need to change criteria used in measuring poverty and preparing indexes in this respect, the Khartoum-based Arab Organization for Agricultural Development (AOAD) said.
In a study released this week, AOAD said a poverty index should be based on family consumption data instead of GDP per capita income.
“To support efforts to fight poverty develop related indicators in the Arab world, regional countries should work on two fronts,” AOAD said.
“The first one should focus on upgrading the mechanisms used in poverty indexes…the second should be aimed at developing and improving the skills of Arab human resources in the field of poverty measurement.”
AOAD, an affiliate of the Cairo-based Arab League, proposed the holding of a regional conference on poverty indicators to pool expertise and exchange views, the creation of a regional poverty data network to be published on AOAD’s website and the preparation of a poverty map in all Arab nations.
“These should include regular publication of poverty indicators in the Arab countries and the preparation of a study on the distribution of wealth,” it said.
“They should also include measurement of poverty in the Arab world using data based on household consumption spending instead of income since this consumption is more associated with the living standards of the family…it also better and more accurately illustrates poverty.”
The study urged all regional funds as well as financial and development establishments to fund training programmes for Arab officials in poverty measurement and in chalking out strategies to combat poverty.
According to another Arab League institution, many regional nations are suffering from poverty because of high population increases and slow economic growth due to poor investment, low exports, flawed economic policies and other factors.
In 2008, poverty rate was above 30 per cent of the total population in such countries as Sudan, Somalia, Mauritania, Djibouti, Yemen, Palestine and Comoros, according to the Abu Dhabi-based Arab Monetary Fund (AMF).
The rate averaged around 19.6 per cent in Egypt, Lebanon, Syria, Bahrain, Jordan, Morocco and Algeria. The AMF said it had no accurate data on poverty in Gulf oil producers but said the rate was relatively low.
Besides those factors, many Arab economies have remained dormant because of conflicts and high defence spending, which was at the expense of development expenditure, according to the Arab League.
Its figures showed defence and security allocation in all nations have averaged as high as 28 per cent of the current expenditure over the past eight years while economic affairs allocations have not exceeded eight per cent.
The figures showed current expenditure totalled around $309 billion in 2007 as it accounted for nearly 72 per cent of the total spending of $430 billion.
At 28 per cent of the current spending, defence and security allocations totalled nearly $86 billion. Economic affairs allocations stood at only $24.7 billion.
“Latest indications point to a decline in poverty rates in some Arab countries but an increase in others…despite the decline in those members, the poverty rates are still considered very high,” said the League’s joint Arab economic report.
The figures showed poverty has declined in Tunisia and Morocco over the past few years but sharply increased in Djibouti, Somalia, Yemen, Iraq and Palestine.
“Poverty in the Arab countries is closely linked to economic growth rates and developments in wealth distribution…economic growth alone is not enough to reduce poverty as wealth re-distribution could not be to the advantage of the poor…Arab states should focus on even and fair distribution of wealth.”
While Arab economies have recorded high growth over the past eight years, it was nominal growth as real growth was relatively weak and much lower than the population growth in some Arab countries, the report said.
High nominal growth over the past few years was mainly a result of a surge in oil prices as the economies of many Arab nations, mainly the Gulf oil producers, recorded low performance and some of them declined during 1990s.
Besides worsening poverty, such developments have resulted in a deterioration of the long-standing joblessness problem in the Arab region, with the number of unemployed persons peaking at nearly 17 million at the end of 2008.
AMF wealth indicators showed Qatar and the UAE were the richest Arab nations in 2008 while Mauritania and Yemen maintained their position as the poorest.
Although it controls more than a fifth of the world’s recoverable oil deposits, Saudi Arabia was the sixth wealthiest Arab country and the least well off in terms of GDP per capita in the six-nation Gulf Cooperation Council (GCC).
The figures showed Qatar’s nominal GDP per capita stood at $70,651 and that of the UAE at $52,574. The report gave no data for 2009 but the per capita income is expected to have receded because of lower oil prices.
http://www.emirates247.com/news/region/how-many-poor-arabs-are-there-time-to-find-out-2010-08-21-1.281752

MALNUTRITION: Sub-Sahara

U.N. officials are pleading for immediate economic assistance for four African countries where people are facing malnutrition in the wake of a drought last year.
The coming weeks ahead will be the toughest for these countries in the Sahel -- the stretch of African countries including Niger, Chad, Mali and Mauritania -- as they make their way into the rainy season and scrape by with the little food they have since last year's harvest, officials said.
Humanitarian agencies and relief organizations pushed for continued economic support from the international community on behalf of the drought-ridden African countries at the United Nations on Tuesday.
"The levels of food insecurity have begun to spiral out of control and affect a number of countries across the region," U.N. Under-Secretary-General John Holmes said.
"Niger is the center of this crisis, it is a country by far the worst affected, some 7 million people are suffering from severe or moderate food insecurity and that's almost fifty percent of the country's population," Holmes said.
Over 10 million people in the Sahel are at risk for food shortages, according to the U.N., and their situation is unlikely to improve until the coming harvest in October.
"We're in the long stretch between last year's harvest and the one coming up," said Josette Sheeran, executive director of the World Food Programme, via telephone from Niger. "We have now six weeks until it is agreed we will be out of the severe danger zone and the ramp-up has to happen not in a few weeks but now, before this very difficult time," Sheeran said.
In Chad, thousands of children are suffering from severe acute malnutrition. The number of severely malnourished children doubled from 2,900 in 2009 to 6,508 this year.
"At the end of the day, what kills children suffering from malnutrition is disease of some kind affecting them in their weakened states. And we're particularly concerned that as the rainy season is starting now, diseases like malaria, diarrhea and respiratory diseases will spread as they always do at this time of year and the death rates for the affected children will go up rapidly," Holmes said.
The World Food Programme is expected to increase the number of health centers from 52 to around 140 in the coming weeks. The centers "will be placed strategically in the most vulnerable areas where we're seeing the highest rates of acute malnutrition," said Sheeran.
As the Sahel enters the rainy season, many of the roads will become impassable. Sheeran said the aim of the assistance is to "go into the most severely affected areas to ensure that we have adequate distribution and can reach those families that are cut off on the roads that are becoming much more difficult."
Leaders from the relief organizations urged the international community to step up its economic support for the people in the Sahel. Eveline Rooijmans, a policy adviser with the aid organization Oxfam, said the assistance is needed now.
"What we need now is urgent action from international leaders and donors to make sure that people have access to food now and in the future," Rooijmans said. "While for the future we should indeed invest in long-term measure to avoid this type of crisis from happening again, at this very moment it is about urgent short-term action."
http://edition.cnn.com/2010/WORLD/africa/07/20/un.africa.food.crisis/#fbid=kV4auybDqyq&wom=false

POVERTY: Sahel: cause of hunger

SAHEL: Short of cash rather than foodDAKAR, 30 June 2010 (IRIN) - The ongoing food crisis in the Sahel is actually a purchasing power crisis: there is food in the markets, but the poorest households cannot afford it. "Cash transfers need to be immediately organized to allow families to buy food," said Bakari Seidou, food security advisor to Save the Children UK.Erratic weather patterns and poor rainfall are affecting the region's poorest - a third of rural households Niger, Mauritania and Mali. "They can only cover one-third of their food needs through their production, except in more fertile areas in the south," said Seidou. "The market is their main source of food, but they need money. Their main source of cash is their labour: they earn an average of 20 cents a day per person; even if there is food available on the markets, they can not afford it." Qualitative household economic surveys by NGOs and national early warning systems from September 2007 to May 2010 in rural areas in Niger, Mali and Mauritania looked at where and how households found their food, their source and level of income, and the proportion used to pay for food and basic services, including health and education.Key findings includeSubstantial wealth gap: in agricultural areas, the richest earn from nine to 15 times more than the poorest; even though they only represent 15 percent of households, the richest own more than half the cultivated land and cattle.Chronic food shortages: the poorest families are unable to meet their food needs, especially during the lean season from May to August, even in years when good rain brought healthy production; moreover, in agricultural areas the protein-deficient cereal diet is poor in nutrition.Insufficient agricultural production: the poorest families have insufficient earning power; more than 50 percent of household income comes from paid labour, but significant numbers are unable to secure work locally and are forced to migrate or sell their land to buy food and pay debts.More than half the income of the poorest goes to food: even in agricultural areas, food purchases eat up more than half of family income; any food price increase means a family may eat less, consume food of poor nutritional value, or cut education and health expenses. Cattle cash: sales of cattle are the main source of income for richer families; milk [http://www.irinnews.org/report.aspx?ReportId=89465] from the cattle provides a more balanced diet. A recent study in Niger by Save the Children UK showed that cattle owners could have a proper diet at half the cost [http://www.cic.ne/IMG/zip/Comprendre_leconomie_des_menages_ruraux_low_res.zip] of what those who did not have animals would have to spend.

GLOBAL FUND: Mauritania fraud

In Mauritania, a full criminal investigation, initiated by the Office of the Mauritanian Inspector General, has led to the arrest of three senior officials in the Executive Secretariat of Mauritania's National AIDS Committee (SENLS), and to the issue of an arrest warrant for a fourth staff member. SENLS is the principal recipient (PR) for Mauritania's Round 5 HIV grant, the only active HIV grant in the country. Meanwhile, investigations have also confirmed systematic fraud by sub-recipients (SRs) in the Global Fund programmes administered by the UNDP, the PR for two malaria grants and two TB grants in Mauritania.

This information is contained in "The Office of the Inspector General Progress Report for October 2009 – February 2010."

Sahel 5 countries at risk of severe malnutrition

The United Nations Children's Fund warns nearly 860,000 children under age five in Africa's Sahel region are at risk of severe malnutrition. UNICEF says five countries in the Sahel are facing a food crisis because of bad harvests brought on by an ongoing drought. Niger is the most seriously affected country. The United Nations Children's Fund reports nearly 380,000 children under age five are at risk of severe malnutrition because of lack of food.But, the agency warns hundreds of thousands of children in Burkina Faso, Mauritania, Mali, and Chad are also threatened by food shortages. Millions of people throughout the region are suffering from the ongoing drought and crop failure. But UNICEF Deputy Director for Emergency Operations Dermot Cartney says children are always the most vulnerable.
http://www1.voanews.com/english/news/Children-at-Risk-of-Severe-Malnutrition-in-Sahel-90496294.html