MALNUTRITION: SAHEL: Donors learning funding lessons - slowly

DAKAR, 6 February 2012 (IRIN) -

 Photo: ILRI/Steve Mann
Niger is worst-hit by the 2011 Sahel-wide drought

This year donors are stepping up more quickly to meet Sahel’s humanitarian needs compared to 2010, when they were slow to respond. However, they are still at fault for taking a quick-fix approach rather than addressing long-term disaster prevention and resilience needs, say aid groups.
As of now, over US$150 million has been pledged to respond to food insecurity, drought and nutrition needs in the Sahel, whereas at the same point in 2010 donors were doing “almost nothing”, said Amadou Sow in the Africa coordination division of the UN Office for the Coordination of Humanitarian Affairs (OCHA).
As early as December 2011 aid agencies and national governments campaigned for aid, while OCHA released its emergency appeal - whereas in the 2010 crisis this was not released until April, far later in the lean season.
The European Commission (EC) has directed $138 million to the region, according to Cyprien Fabre, head of ECHO (EU aid body) in West Africa, who says there is “great commitment at the EU level”, with the development and humanitarian commissioners working closely together on the Sahel crisis. The EU is also expected to release longer-term funding soon.
The US Agency for International Development (USAID) meanwhile, has channeled $25.5 million to the World Food Programme in Niger and Chad and is standing by to target money to other agencies; France and the UK Department for International Development have each directed $10 million towards five Sahelian countries without yet specifying what is going where; the UN Central Emergency Response Fund has released $16 million of start-up funding; while Sweden, Germany, Austria and other donors have allotted smaller sums.
Most of these figures are not yet reflected in the OCHA financial tracking system which currently states that the Chad and Niger appeals are respectively 7 and 15 percent funded.
While such pledges are welcomed, the EC Humanitarian Commissioner, Kristalina Georgieva, recently said a conservative estimate of the needs over the next six months would be 500 million euros [US$654 million], “so there is clearly a considerable gap to fill,” noted Stephen Cockburn, West Africa campaigns and policy manager at Oxfam.

Avoid repeat mistakes
Donors may fear repeating the mistakes of the Horn of Africa, where everyone responded too late, and may also want to show that they have learned the lessons from past Sahel crises, say aid workers.
“Donors are more interested in the Sahel now,” said Fabre. “They probably want to make sure they don’t miss the opportunity to have a correct, coherent, quality response this time.”
However, some fear donors are waiting too long to specifically allocate their aid by country, positing they are waiting for more detailed figures on needs to be published. An OCHA Sahel strategy paper with specific needs in each country will be launched imminently.
Donors must not fund Chad and Niger to the neglect of other affected countries, including Burkina Faso, Mauritania, Mali, Nigeria, and Senegal, warns OCHA’s Sow.

Longer-term still under-funded
While pledging has been swifter, the long-term aid that Sahel experts have been pushing for for years is still not prioritized, say Sahel experts.
“The argument [for longer-term resilience-oriented aid] has “not been won yet”, said Fabre.
A number of aid agencies are involved in longer-term resilience work, such as Oxfam’s project to give people cash transfers or cash-for-work to help vulnerable families cope with high food prices. “Some donors [the European Union and DFID] are beginning to fund this work, but as an approach it remains under-prioritized,” said Oxfam’s Cockburn.
The prevention and treatment of moderate acute malnutrition is one chronically under-funded sector in the Sahel: While over one million children are expected to face severe and life-threatening malnutrition this year, in a “normal” year the figure hovers around 800,000.
West Africa UN Children’s Fund (UNICEF) nutrition specialist Robert Johnston told IRIN: “It is still difficult to ensure funding from government agencies for long-term preventative activities when there are critical life-saving interventions that they can respond to immediately. It’s much easier [for them] to justify life-saving than long-term.”
Likewise, it can be hard to get national governments on board: “In areas with low levels of education and poor healthcare systems, it is hard to plant the seed of prevention as an idea.”
However, donor attitudes here are slowly changing, he said. UNICEF programmes now come from the point of view that emergency treatment and longer-term prevention of malnutrition are two sides of the same coin. “Everyone is starting to get the message,” he said.
Aid agencies and donors should see their response to the Sahel drought as an opportunity to change their approach, said Kazimiro Rudolph-Jacondo, head of OCHA’s West Africa office in Dakar. “This is a window of opportunity to build on lessons learned from the past and to resolve these problems over the long term,” he told IRIN.
http://www.irinnews.org/report.aspx?reportid=94799

MALARIA: Anti-malarial treatment available to millions of poor Nigerians at a fraction of its normal cost

 January 31, 2012   2 Millions of poor Nigerians will gain access to the most effective combination treatment for malaria at a fraction of its current cost, following the successful conclusion of negotiations between the United Kingdom Department for International Development (DFID) funded Partnership for Transforming Health Systems (PATHS2) and a variety of international and national stakeholders in Nigeria this week.
PATHS2, in collaboration with the Clinton Health Access Initiative (CHAI), will provide life-saving anti-malaria treatments to health facilities based largely in rural communities in the five Nigerian states of Lagos, Kaduna, Jigawa, Enugu and Kano, the latter state recently driven by terrorist bomb attacks.
A course of treatment will be provided for as little as 60 Naira (approximately 25 pence in Sterling), in comparison to previous costs of nearly 20 times as much, making the drugs affordable to even the poorest Nigerians, many of whom still subsist on less than US$1 a day.
The Affordable Medicines Facility for malaria (AMFm) is an innovative financing mechanism to expand access to affordable ACTs—Artemisinin-based Combination Therapies. ACTs are the medicines recommended by the World Health Organisation (WHO) as the most effective malaria treatment.
The AMFm is hosted and managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), with key financial support provided by UNITAID, DFID and the Bill & Melinda Gates Foundation, and with technical support provided by the Clinton Health Access Initiative (CHAI).
International manufacturers of ACTs receive a subsidy directly through the AMFm initiative almost to the tune of 95% which in turn is passed on by Nigerian pharmaceutical manufacturers, the First Line Buyers of ACTs. Acting as second line buyers, PATHS2 will distribute ACTs through primary health centres in the five Nigerian states in which it currently works, which have a total population of approximately 37 million, representing around 22% of the population of Nigeria as a whole.
Artemisinin-based Combination Therapies were introduced in Nigeria in 2005 for the treatment of uncomplicated malaria due to the increased resistance to chloroquine and sulphadoxine-pyrimethamine – also known as mono-therapies - which were older malaria medicines grown less effective due to the development of resistant strains .
PATHS2 has supported the significant reduction in prices of ACTs by bringing First Line Buyers and PATHS2 states together to discuss their requirement and support the signing of annual contracts between the states and First Line Buyers. The First Line Buyers are pharmaceutical companies in Nigeria who buy directly from WHO certified manufacturers outside the country. In Nigeria, there is currently no domestic manufacturer of AMFm drugs.
The First Line Buyer supported under AMFm will sell Artemisinin/ Lumefantrin (Pack of 24) for just 50 Naira to PATHS2 States health facilities and patients will get it for about 60 Naira, compared to its previous cost, which was as much as 2,000 Naira (£8-00). This pricing makes it the cheapest price available anywhere in the country.
It is estimated that 70% of all disease incidence in Nigeria is related to malaria. The World Malaria Report of 2008 recorded 57,506,430 cases of malaria across Nigeria, causing 225,424 fatalities.
http://www.news-medical.net/news/20120131/Anti-malarial-treatment-available-to-millions-of-poor-Nigerians-at-a-fraction-of-its-normal-cost.aspx

MALNUTRITION: Nigeria: Saving a child could be down to a couple of nutrients

Anna Angbazo : July 10, 2011



Poor diets retard children’s growth and their development, including their cognitive development. Photo: REUTERS

Although the federal government has expressed its commitment to meeting the Millennium Development Goals, especially as relates to health, some experts say investment in quick gains projects such as improved nutrition would be cheap but eventually productive for the nation.
In 2000, for instance, the World Health Organisation (WHO) ranked Nigeria’s health system 187th out of its 191 member states, particularly due to problems such as hunger and malnutrition, which have become increasingly severe over the years.
Jane Miller, the country representative of UK’s Department for International Development (DFID), explains the rationale behind Nigeria’s poor ranking rather succinctly.
“Malnutrition, malaria and communicable diseases such as measles, diarrhoea and pneumonia significantly contribute to maternal and child mortality and morbidity,” Miller says, adding that “one million Nigerian children under the age of five die each year.”
Malnutrition has been a serious concern to the WHO, which insists that it is by far the major factor behind child mortality, with underweight births and inter-uterine growth restrictions causing 2.2 million child deaths every year.
The global health agency says mothers’ neglect of infants’ breast-feeding also causes about 1.4 million deaths, while describing malnutrition as the most serious single threat to public health across the world.
Linus Awute, the permanent secretary of the Federal Ministry of Health, concedes that Nigeria is one of the countries that are mostly affected by deaths of children under the age of five years due to factors such as malnutrition.
He stresses that over two-thirds of malnutrition-related deaths of children usually occur within the first year of their existence, adding that the children’s undernourishment is associated with inappropriate feeding practices.
“Appropriate feeding of infants and young children remains a key factor in promoting health and child survival. However, many mothers have yet to imbibe the required child-feeding attitudes and practices, in spite of many public sensitisation campaigns,” he says.
Going from the general to the specifics, the WHO says malnutrition is also responsible for about 14 percent of infants born with low birth weights in Nigeria and more than 75 percent of children, under the age of five, who are anaemic.
Mr Awute, on his part, stresses that babies who undergo exclusive breast-feeding do well in their first six months of life, adding, however, that such babies subsequently need adequate and appropriate complementary feeding for them not to become malnourished.
He also said malnutrition usually crops up because of deficiencies of macro- and micro-nutrients in the babies’ food, adding that these deficiencies induce ”protein-energy malnutrition, iron-deficiency anaemia, iodine-deficiency disorders and Vitamin A-deficiency.”
Lawan Tahir, a paediatrician, also called on new parents to ensure that infants are given healthy, balanced diets after stopping their breast-feeding.
“To reduce child mortality, mothers should feed their children with balanced diets after they have been weaned,” he says.

Killer of young ones
Mr Tahir, a senior registrar at the National Hospital, Abuja, who said two out of every three child deaths are related to malnutrition, adding that a malnourished child is prone to numerous diseases because of the child’s poor immune system which cannot resist infections.
After breast-feeding, the next thing most mothers do is introducing the babies to cereals, as the infants feed on mainly carbohydrate diets.
“Nevertheless, what the child needs at that point is actually not carbohydrates alone but proteins, fats and oils, as well as micro-nutrients to enable him or her to have a balanced nutrition,” he said. “Unfortunately, most children are not given well-balanced diets, probably due to their parents’ poverty or ignorance.”
Mr Tahir adds that poor diets retard children’s growth and their development, including their cognitive development. The paediatrician explains that malnutrition is a health condition which signifies poor nutrition, as well as an imbalance between the intake of nutrients and what the body actually requires.
Experts say rising cases of malnutrition in Nigeria can be attributed to the lack of food security in the country, poor feeding habits, waning exclusive breast-feeding of newborn babies and poor quality complementary feeding of infants after the age of six months.
Another paediatrician, Azeez Ibrahim says micro-nutrients deficiency is a direct cause of child mortality.
“Micro-nutrients such as iron, iodine, and Vitamin A are necessary for the healthy development of children, while their absence in diets can cause serious disorders,” he said He, however, said malnutrition is not a health problem of children alone, adding that “many adolescents are also having malnutrition problems and these affect their learning processes and productivity.”
Mr Ibrahim, nonetheless, insists that some cases of malnutrition in adolescents are due to increased intake of carbonated drinks (soft drinks), as such drinks only provide “empty calories” that are insufficient to meet the body’s requirements for proper growth.
“Malnutrition in a female adolescent is worse because as the young ladies prepare for marriage, they need a balanced diet for them to attain their potential as women,” he says.

All together on safety
As part of efforts to foster improved nutrition in Nigeria, the Global Alliance for Improved Nutrition (GAIN) is working with the federal government via the National Fortification Alliance (NFA). The NFA comprises government regulatory agencies such as National Agency for Food, Drug Administration and Control (NAFDAC) and the Standards Organisation of Nigeria (SON).
Hauwa Keri, NAFDAC’s director of Establishment Inspection, says the aim of the government policy on fortified foods is to get more nutritious staple foods like wheat and maize flour, vegetable oil and sugar into the markets and homes of vulnerable families whose diets lack the essential micro-nutrients.
“The goal of the effort, which began in March 2007, is to change the lives of the citizens by giving them a chance to eat more balanced diets every day,” she says.
Ms Keri stresses that the Federal Government has been leading a national campaign to add essential micro-nutrients to food products such as wheat and maize flour, refined sugar and vegetable oils since 2002.
Besides, Ms Keri said, a pilot programme is underway to fortify table salt with iron so as to provide the needed micronutrients for the people, adding that table salt is already being fortified with iodine.
“The project is at a pilot stage in three zones and it aims at ascertaining whether fortifying salt with iodine and iron will be acceptable,” she says. “It is also at a research and study stage; the outcome of the investigations will determine whether to adopt the iron fortification scheme or not.”
Larry Umunah, the country representative of GAIN, says Nigeria has been identified as one of the countries that are determined to tackle the menace of malnutrition frontally.
He, however, stresses the need to ensure that mothers and children have proper nutrients so as to curb the rising menace of maternal and child mortality in the country.
Umunah said if Nigeria is able to effectively tackle the issue of malnutrition among mothers and children, the country will definitely be in a better position to achieve the health targets of the UN Millennium Development Goals (MDGs).
“Ensuring that mothers and children have proper nutrients is of paramount importance. If Nigerian mothers and children are able to have improved nutrients, the country will move toward achieving the MDGs,” he said.
Dr Orhii, the director general of NAFDAC, however, stresses the need for regulatory agencies to enforce the full compliance of food industries with the extant regulation regarding the fortification of their products.
Mr Orhii bemoans the inability of the vast majority of the rural people to have access to fortified foods, adding that the prevalence of ”hidden hunger” among the rural populace has been a source of public health concern.
The NAFDAC director says that fortified foods contain all the essential vitamins that prevent diseases, adding that lack of iodine in salt, for instance, can make a child dull.
“Iodine deficiency can also interfere with the reproductive system of girls in future,” he said. “We insist on the fortification of foods with essential vitamins to prevent diseases which usually affect vulnerable groups like pregnant women and children below the age of five.”
http://234next.com/csp/cms/sites/Next/Home/5728780-146/saving_a_child_could_be_down.csp

POVERTY: Conceptualizing urban poverty

Conceptualizing urban poverty

Ellen Wratten
DFID, 1 Palace Street, London SW1E 5HE, UK, e-wratten@dfid.gov.uk

Abstract

This paper explores three issues. First it examines how, and by whom, poverty has been defined and measured, contrasting conventional economic and participatory anthropological approaches. Second, it questions the extent to which “urban poverty” differs conceptually from poverty in general, and considers the utility of an analysis of the urban–rural divide in understanding the underlying causes of poverty. Finally, it reviews the principal ways in which urban poverty has been understood in the South and the North, and what these imply for the different policy prescriptions for addressing urban poverty. It concludes by identifying the linkages between alternative definitions of poverty, different antipoverty policy approaches and the choice of measurement techniques.

MALNUTRITION: Yemen: Plumpynut to the Rescue

William Lambers: May 25, 2011
The political unrest and violence in Yemen are not the only battles ongoing in the impoverished country. The smallest children in Yemen have their own struggle against deadly malnutrition. Yemen has one of the highest child malnutrition rates in the world.
That is why three UNICEF trucks with life-saving plumpynut arrived in Sa'ada governorate in Northern Yemen last week. Plumpynut is a special peanut paste which can give small children the nutrition they need to survive.

 (Mohammed Al-Asaadi/UNICEF)

A convoy of three trucks loaded with UNICEF emergency supplies funded by the UK Department for International Development (DFID), makes it through to Sa’ada on 19 May 2011
Children who lack the right foods early in life can suffer lasting physical or mental damage. They may even perish. If enough plumpynut were in Yemen or other needy countries, you could prevent many deaths related to malnutrition. Plumpynut comes in a package and requires no refrigeration or cooking, so it's fairly easy to distribute.
UNICEF says the plumpynut and other supplies "will cover the required treatment of 3,000 children under the age of five suffering severe acute malnutrition. This figure represents about six percent of the total number of severely malnourished children in Sa’ada."
Also, UNICEF reports that a nutritional survey conducted in 2010 showed about 45 percent of children under the age of five are acutely malnourished in some districts of Sa'ada. More investment in plumpynut and other interventions is needed from the international community to save these children.
Geert Cappelaere, head of UNICEF Yemen, says, “The arrival of the convoy is a breakthrough for enhancing humanitarian space and ultimately for delivering the urgent assistance all children in conflict-affected Sa’ada require."
Sa'ada has seen years of conflict between the government and the Al-Houthi rebels. A lasting peace treaty is desperately needed. There has to be a united front against the worst enemy—hunger.
Cappeleare warns, "The supplies will last for one to three months, so we must make sure a continual pipeline of life-saving supplies is secured.” Much more work needs to be done to enhance the lives of children in Sa'ada and other governorates of Yemen. This is an area where we can take action now.
 http://blogcritics.org/culture/article/plumpynut-to-the-rescue-in-yemen/#ixzz1OOjwFNew

MALNUTRTION: UNICEF Yemen has delivered life-saving nutrition supplies (Plumpy'nut)

UNICEF and DFID deliver life-saving nutrition supplies to Saada



21/May/2011

SANA’A, 21 May (Saba)- In cooperation with the UK department for International Development, UNICEF Yemen has delivered life-saving nutrition supplies to the governorate of Saada in northern Yemen.

The three truckloads included life-saving therapeutic food Plumpy Nut, anthropometric scales, antibiotics, micronutrient supplements and other medication and equipment related to the management of acute malnutrition.
The supplies will cover the required treatment of 3000 children under the age of five suffering severe acute malnutrition. This figure represents about six percent of the total number of severely malnourished children in Saada.
“With some of the worse rates of malnutrition in the world, many children are suffering as a result of the humanitarian crisis in northern Yemen. British-funded supplies are now helping to save lives in Saada, thanks to the delivery of this emergency aid, including medicine and food supplements. But the suffering here is extensive and established. That is why we have just confirmed additional British support for UNICEF to tackle malnutrition in tens of thousands more children affected by the conflict”, UK Minister of State for International Development, Alan Duncan said.
The delivery is part of UNICEF Yemen’s emergency response plan, geared to provide all 15 districts in the conflict-ridden governorate of Saada with malnutrition management services. The governorate has long suffered repeated bouts of armed conflict between government-backed and Al-Houthi armed groups, displacing more than 300,000 people, a large number of whom are school-aged children.
The governorate has been inaccessible to humanitarian assistance for several years because of the conflict, and recorded some of the highest levels of acute malnutrition in the world. According to a nutritional survey conducted in 2010, about 45 percent of children under the age of five are acutely malnourished in some districts.
“The arrival of the convoy is a breakthrough for enhancing humanitarian space and ultimately for delivering the urgent assistance all children in conflict-affected Saada require”, says UNICEF Yemen representative Geert Cappelaere. “The supplies will last for one to three months, so we must make sure a continual pipeline of life-saving supplies is secured”.
It is estimated that the supplies will help revive and boost the services of 29 health facilities in the governorate, which have been semi-operational since the recent outbreak of armed conflict. With DFID funding, UNICEF has previously helped train 130 health workers in outpatient therapeutic programmes, therapeutic feeding centres and outreach mobile clinics, kickstarting the delivery of malnourishment services in Saada governorate. However an additional 300 health workers and 2,600 community health volunteers need to be trained to further boost the services in 95 health facilities throughout the governorate.
“Thanks to all involved parties, this life-saving corridor was now made possible”, says Cappelaere, “and with continued commitment of all, malnutrition can be eradicated. But this will require continued investment, commitment and capacity-building”.
http://www.sabanews.net/en/news241775.htm

MALARIA: India: Health workers in Orissa work with rural communities to raise awareness

19 April 2011

Milu Jani and his family under their new bednet. Picture: DFID

Milu Jani lives in Labangi, a small village in a remote area of Western Orissa – one of the poorest states in India. The village is around three hours from the nearest district town of Angul and part of the journey needs to be done on foot. There is no health centre, no electricity and no school in the village. Milu works as a forest guard at the Satakosia wildlife reserve, earning a mere 90 rupees (£1.20) a day.
Like most villagers, Milu has lost a loved one to malaria. His eyes tear up as he recalls his father's death last winter. Milu's father fell ill with a high fever and was tragically diagnosed with malaria only a day before his death, leaving no time for proper treatment. Malaria can be treated effectively with drugs, but treatment is most effective when administered within 24 hours of the onset of fever.
Milu knew mosquito bites can cause malaria but didn't know the deadly mosquitos were breeding in the water pools around the village. After his father passed away, Milu met a local health worker who explained the risks of malaria and how to prevent his family from becoming ill with this deadly disease.

Getting healthcare to rural communities
The DFID supported state health programme in Orissa trains health workers to help raise awareness of malaria prevention and treatment among vulnerable tribal communities like Milu's. Health workers like Suhasini Behera in Milu's village are trained in the use of diagnostic tests and how to administer appropriate medicines. They also distribute bednets and promote the proper use of nets to prevent malaria.
"It was not easy to convince people to use bed nets," Suhasini says. "People feared the nets were poisonous as there had been reports of rashes and itching from the insecticide" – misconceptions that she sought to dispel while visiting their homes.
By working with the community to raise awareness of malaria, Suhasini and her fellow health workers help to prevent people from contracting malaria and help the villagers to understand how to access treatment.

Bednets - a simple prevention tool
DFID's support to the Orissa state health programme has helped Milu and his family purchase bednets that will prevent them from contracting malaria in the future. By subsidising the cost of the nets, DFID enables poor families like Milu's to purchase two bednets for only 20 rupees (25p). The nets are treated with insecticide and last up to five years.
Milu's mother is content with her new net. "I always had disturbed sleep due to the mosquitoes. This new net has brought me a lot of comfort and I also use it for my afternoon nap".
Milu is equally satisfied. "Malaria was a huge problem in our area. Now everyone in the village is using a net. I have lost my father but now I can keep my family safe from malaria".

Key facts
DFID India has committed £100 million over 2007-12 to Orissa's state health programme to tackle malaria, among other health and nutrition initiatives. The programme increases efforts to prevent malaria, improve diagnosis and provide access to treatment for pregnant women and tribal children, who are most vulnerable to the disease.
DFID support has helped provide an extra 300,000 bed nets to young expectant mothers, to prevent anaemia and malaria-related deaths.
Orissa's state health programme has trained 20,000 health workers to use diagnostic tests, administer medicines and distribute bednets.
The state health programme distributed 1.2 million bednets to villages in February and March 2010, supported by the education and awareness activities of health workers.
http://www.dfid.gov.uk/Media-Room/Case-Studies/2011/Battling-malaria-in-India/

MALARIA: Ethiopia: Supporting rural health workers to combat malaria

22 December 2010 Extending the fight against malaria in Ethiopia
Supporting rural health workers to combat malaria


Almaz is 24 years old and has been working as a Health Extension Worker (HEW) for the last three years, in her own village which is more than an hour's drive from the nearest small town.
"The work is very hard, I have to work long hours and walk long distances but I am proud to be serving my community and have seen real changes in their health," she says.
 A health worker in Ethiopia treats a woman and her baby


Almaz is one of more than 34,000 HEWs who have been trained and deployed to deliver a 'package' of basic services to their communities, including the prevention, diagnosis and treatment of malaria, family planning and immunisation.
Ten years ago, only two-thirds of Ethiopians had access to health services. Rural areas, in particular, suffered from a lack of medical facilities and health workers. There was a critical need to bring healthcare to more of Ethiopia's people. And over the last five years, the Health Extension Programme, the flagship programme of the Ethiopian ministry of health, has aimed to do just that.
At the centre of the HEP are female health workers like Almaz who operate within local communities. In each rural "kebele" (a community of about 5,000 people), two women who have completed tenth grade are selected to become Health Extension Workers.
This national programme has helped to deliver real improvements in people's health including reducing the previously devastating impact of malaria. The HEWs teach their communities about how to prevent malaria and to seek help when they have a fever.
They have also been trained and equipped to test people for malaria at the community level, which ensures correct diagnosis and treatment. Additionally, in the last five years more than 35 million insecticide-treated nets have been distributed across the country, which are reducing the numbers of people becoming infected.

Getting healthcare to communities
The UK is supporting the Health Extension Programme through a contribution to the government of Ethiopia district level 'block grant', which pays for the delivery of services. This block grant is used by districts across the country to deliver priority services, including health and education, to its communities.
UK funding is currently supporting more than 3,900 Health Extension Workers to deliver health services to around nine million people. Additionally, the British Government provides direct support to the Ethiopian ministry of health to help it to deliver its ambitious plans to meet all of the health related MDG targets by 2015, including those on malaria.

Facts and stats
The latest World Health Organisation rapid impact assessment in four main regions in Ethiopia shows that between 2001-2004 (annual average) and 2007, confirmed malaria outpatient cases decreased by 67%, malaria admissions by 54%, and malaria deaths by 55%.
The government of Ethiopia's next five year plan includes efforts to further increase utilisation of ITNs and strengthen diagnosis and treatment of malaria.
http://www.dfid.gov.uk/Media-Room/Case-Studies/2010/Extending-the-fight-against-malaria-in-Ethiopia/

MALARIA: Kenya: How scouts are helping in the fight against malaria

Twelve-year-old Aisha Ali really is a well prepared scout. True to the motto of the Scouting movement – 'be prepared' - she is one of more than 21,000 scouts from over 1,000 schools in Kenya who are taking part in a project aimed at preventing the spread of malaria.
"I've always wanted to help others, so joining my school's scouting club gave me great pride." says Aisha.
"When this project was introduced in January 2010, I was very excited at the opportunity to serve my community."
Supported by UK's Department for International Development (DFID) and undertaken in partnership with the Government of Kenya's Division of Malaria Control, the Kenya Scouts Association and Population Services International (PSI) Kenya, the project aims to save the lives of Kenyans living in 36 malaria-prone districts by ensuring people sleep inside well tucked-in, insecticide treated mosquito nets every night, the whole year round.

Members of Kenya Scout clubs in the affected districts 'adopted' some 150,000 homes - equivalent to around 675,000 people - to teach them how to properly hang and use bednets, to avoid being bitten by mosquitoes.

Training
Aisha says 20 scouts from her school were trained about malaria; what causes it, how one can get it and how nets help prevent the spread of the disease. They were also trained on how to hang the mosquito bednets and the importance of sleeping under the nets each night.
"This is where we play an important role in malaria prevention – making sure that everyone in our communities sleeps under a net every night," says Aisha.
Each scout in the scheme is issued with a project booklet containing questions that help them to record how many people live in a home and how many of them sleep under a treated mosquito net.
The scouts are trained to ask to see the sleeping area and ensure the bednets are hung properly. They also show members of each homestead how to hang the nets correctly themselves.
"We were expected to adopt between seven and ten homes and visit them at least once a month to ensure that all the members of the households slept under a net."
One of the homes that Aisha has adopted is that of 'Mama' Hadija Hassan Mwabaha, an elderly widow who lives with four other elderly widows. Aisha recounts how she met Hadija. "I remember the first day I visited Mama Hadija. She is a clever woman and asked me a lot of questions about malaria. I told her about the anopheles mosquito. She was impressed by my knowledge and agreed to be part of our scout's project".
"I showed Mama Hadija how to hang up their nets correctly so that they are not bitten by mosquitoes. I also informed her that pregnant women and children younger than five years are at greatest risk from malaria. I have visited her every month since the first meeting. I like her because not only is she welcoming but she helps me with the project. She is a poor woman but has a very kind heart."
And Mama Hadija has equally good things to say of Aisha. "She has protected us from malaria!" she exclaims.
She goes on to explain that the program has helped to explain the dangers of malaria to the whole community and the importance of everyone using the nets every night.

Serving the community
The whole experience has been very motivating to Aisha: "I am serving my community and that makes me very happy," she says. She also has a certificate of merit from the training, is more enlightened about malaria issues, feels empowered to assist others and is glad that the training has boosted her ranking as a scout.
"When I know that I have helped prevent one more malaria case I feel so proud of my efforts," she concludes with a smile.
Of the ten households that Aisha adopted in January, nine already had the insecticide-treated nets. However not all the homes were using them correctly; over the course of the year, Aisha has assisted her adopted homes to ensure the consistent and proper use of mosquito nets.
http://www.dfid.gov.uk/Media-Room/Case-Studies/2010/Being-prepared-for-Malaria-in-Kenya/

MALARIA: Kenya: How UK aid is helping to save children's lives through a cherry-flavoured malaria drug

20 April 2011 World Malaria Day on 25 April is a chance to mark the efforts that are being made globally to tackle the terrible disease. The UK government is leading the way in pioneering innovative and effective ways of tackling malaria as set out in the recently published framework for results.


Rose and her two-year-old daughter Shanrol have benefitted from a new anti-malaria drug developed thanks to UK aid. Picture: Novartis

A preventable tragedy
Malaria is a preventable and curable disease, yet a child dies of malaria every 45 seconds. Nearly one million people die of malaria every year, mostly infants, young children and pregnant women and most of them in Africa. Malaria does not only kill, it can have long term consequences. Men and women are unable to work for long periods when they or their children become ill. Entire households can be thrown back into poverty. Severe malaria often leads to brain damage, holding back a child’s mental development resulting in lifelong impacts. But malaria can be treated effectively with existing drugs and treatment is most effective if administered within 24 hours of the onset of fever.

Life is no bowl of cherries
Rose Aluoch Ngala lives in the village of Ombeyi, 15 miles southeast of Kisumu, the third largest town in Kenya and also one of the poorest. Ombeyi is on the edge of Lake Victoria - a region where more children die of malaria than any other disease. Like many people in her village, she is a farmer. She has three young children. When her daughter Shanrol, who is two years old, became ill she was afraid. Children under five years of age die from malaria very fast.
"Her body was hot and she was not eating or playing and she was crying all the time. I took her to the hospital, where she was diagnosed with malaria and I was told that she would be admitted for three days. They kept testing now and then to find out how much of the infection was in her blood and how far the disease had gone.
"This is her fourth time to get malaria and she is only two years old. The first time she was only eight months, and I took her to the hospital where she received drip water and medicine. I fear that she could die because of this disease malaria."
Shanrol was treated with Coartem-dispersible, a new cherry flavoured malaria drug and the first to be formulated especially for children. It dissolves easily in a small amount of water or breast milk. The treatment is fast and effective and will increase the use of malaria medicines by children, saving millions of lives.

A sweeter pill to swallow
As mothers like Rose know, getting children to take bitter medicines is always difficult. Children would often spit out or vomit the life saving medications designed for adults. Now Rose and millions of mothers like her can get better treatment for their children, helping to ensure they recover quickly from this life threatening illness.
"This medicine is good because my child can swallow it fast and it doesn't have any side effects, like rashes. The fever also goes down very fast. She could speak and play quickly after taking this treatment. I have seen a big difference."

Access to life saving medicine
Coartem-d was launched in 2009, the result of a public-private partnership between Medicines for Malaria Venture (MMV), a non-profit organisation funded by DFID, and the pharmaceutical company Novartis. With funding from DFID and other international organisations, MMV has been able to rapidly increase access to and availability of the cherry-flavoured drug. In two years, 64 million treatments of this life saving medicine have been delivered to 35 countries.
http://www.blogger.com/post-create.g?blogID=3604033512937490051&pli=1

POVERTY: Malawi: Subsidies not the only answer for farmers

EKWENDENI, 19 April 2011 (IRIN)

 Photo: IITA
Farming subsidies have improved food security in the short-term

 It is almost harvest time in Mzimba district, northern Malawi, but Saliet Nyasulu's maize crop looks dry and stunted and it will be hard to feed herself and her three children this year. "[The maize] won't last until next harvest," she told IRIN. "I'll have to do piece-work and grow some vegetables by the river."
Nyasulu was among the 1.6 million smallholder farmers who received government coupons to buy maize seed and fertilizer for the 2010/11 farming season at a tenth of what they would normally cost.
"The soil is good only if you use fertilizer," she said, but the two 50kg bags of subsidized fertilizer allotted per household were not nearly enough to get a healthy crop of maize from her one hectare of land, especially after a dry start to the year. "I had to use less than recommended."
The government's farm input subsidy programme was first implemented in 2005 after several years of drought and chronic food shortages left nearly a quarter of the population in need of food aid.
Most small-scale farmers, who account for about 80 percent of the country's agricultural production, grow maize, Malawi's main staple crop. President Bingu wa Mutharika hoped to avoid the need for future food handouts by distributing coupons for maize seed and fertilizer to the poorest 50 percent of farmers.
The government has since credited the programme with several years of bumper maize harvests that have given the country a surplus and contributed to strong economic growth. There is little doubt that the subsidies have greatly improved food security and helped reduce the number of Malawians living below the poverty line from 60 percent in 2004 to less than 45 percent in 2009.
However, a number of smallholder farmers IRIN spoke to in Mzimba district said they either did not qualify for the programme, or did not receive enough subsidized fertilizer to make a significant difference to their yields. Several said they received only one 50kg bag this year and had to share it with a neighbour.
As the programme goes into its sixth year, there are also growing concerns about long-term sustainability and the extent to which it has diverted attention and resources from other initiatives that could help farmers like Nyasulu.
"It has really taken people out of hunger," said Elizabeth Sibale, a consultant at the UN Food and Agriculture Organization (FAO) in Malawi, "but it's not a lasting solution."

A costly "band aid"?
The cost of fertilizer and transporting it to farmers all over the country has risen steeply in recent years and by 2008/09 the programme was draining 16 percent of the national budget and nearly 7 percent of GDP.
The government has scaled down the programme in the last two years, but it still cost 23 billion kwacha (US$152.3 million) in 2010/11, according to the UK's Department for International Development (DFID), which is providing 5 percent of funding. In total, about 10 percent of the programme is donor funded.
"Other programmes are not getting as much attention and funding," Sibale told IRIN. "We're forgetting all the other problems that affect farmers and putting a band aid on them."

 Photo: Kristy Siegfried/IRIN
Saliet Nyasula did not receive enough subsidized fertilizer to grow a healthy crop of maize

One of the main problems faced by farmers in Malawi is an increasingly unpredictable climate. Lake Malawi, several other lakes and hundreds of rivers cover a fifth of the country, but only 3 percent of land is irrigated. Most smallholder farmers depend on a good rainy season for their one harvest of the year.
"If the rains are good, I get a good crop," said another farmer in Mzimba district. "If the rains are not good, then it's a disaster."
Sibale said the government had made some efforts to expand irrigation in the last five years by distributing treadle pumps to farmers. However, the Green Belt Initiative, an ambitious plan to irrigate one million hectares along the Shire River in the south of the country has yet to be implemented.
There are other problems too. When Malawi was less densely populated, farmers could leave a field fallow for a year so the soil could recover. But with increasing pressure on land and easier access to fertilizers, “People have completely forgotten how to keep soil healthy," said Sibale. "Now it's so degraded, they have to use more fertilizer every year."
She added that many officials in the Ministry of Agriculture and Food security shared her concerns about soil health.

Looking for alternatives
Victor Mhoni of the Civil Society Agriculture Network (CISANET), a local NGO, said long-term fertilizer use actually contributed to soil degradation by making it dry and acidic unless combined with measures that can restore fertility such as planting nitrogen-fixing trees or growing legume crops.
Programmes promoting agroforestry and growing legumes have already shown impressive results, and farmers eventually need much smaller quantities of fertilizer to produce good yields.
In the last five years, the World Agroforestry Centre, in partnership with government and NGOs, has reached nearly 200,000 farmers with tree seeds and training on how to grow nitrogen-fixing trees, as well as fruit trees and fast-growing trees for firewood.
Mesha Khongolo planted gliricidia, a type of nitrogen-fixing tree, using seed he was given by the Ministry of Agriculture's local Extension Development office. He estimated that incorporating the leaves and branches into his soil had increased his yields by more than 50 percent.
Nyasulu tried planting some tree seeds but they failed to germinate and she is now growing pigeon pea, a tall, leafy legume with a similar effect but quicker results. By 2012 she should see an improvement in her soil and get a healthier crop of maize.

Politically sensitive
DFID's five year commitment to the input subsidy programme ends in June 2011. "We are currently considering options for new support to agriculture in Malawi," wrote Malawi-based Communications Officer Andrew Massa, in an emailed response to questions.
"We believe that Malawi needs a range of programmes that promote economic growth and poverty alleviation," he added.
Attempts to reach the Ministry of Agriculture and Food Security for comment on this story failed. Malawi's input subsidy programme has become politically sensitive, and reports of pockets of food insecurity, especially in the south, have been met by angry denials by Mutharika.
"There's been a lot of rhetoric about food security being solved in Malawi with the input subsidy programme and I just don't think that's true," said Rachel Bezner-Kerr, a Canadian researcher who has worked on a project to promote legume inter-cropping in Mzimba district.
"It's a short-term solution, but in the long term you're really not any further ahead after spending millions of dollars if you haven't found alternative solutions to improving soil fertility."
http://www.irinnews.org/report.aspx?reportID=92520

MALARIA: Counterfeit drugs: Facts & figures

Priya Shetty: 30 March 2011

Journalist Priya Shetty specialises in developing world issues including health, climate change and human rights. She writes a blog, Science Safari, on these issues. She has worked as an editor at New Scientist, The Lancet and SciDev.Net.


 Flickr/Pranjal Mahna
At least a third of medicines available in some parts of the developing world could be fake

Priya Shetty explores the tools and partnerships that help the public health community counter the threat of counterfeit medicines.
Counterfeiting is as old as industrialisation. For as long as the idea of intellectual property or branding has existed, counterfeiters have schemed to cheaply mimic products for profit.
Far from being merely a nuisance, counterfeit medicines can cause serious illness and even death.
The trade in counterfeit drugs has grown into a global industry worth billions of dollars, targeting mostly developing countries [see Table 1]. The World Health Organization (WHO) estimates that 10–30 per cent of the medicines on sale could be fake in the developing world; the proportion is probably higher in some parts of Africa, Asia and Latin America. [2]
But public health experts believe poor regulatory and surveillance systems in the developing world mean the problem is even more widespread than it seems. This has spurred the global health community into action, with agencies including the WHO and Interpol launching initiatives to fight drug counterfeiting.

A key challenge in tackling counterfeiting lies in subtle differences between fake and substandard drugs. [3]
Many fake medicines are dummies deliberately created to resemble genuine drugs. Often they are utterly devoid of any active ingredient — but sometimes they may contain harmful or poisonous chemicals.
Substandard drugs do have some medicinal value, but may contain far lower doses of the active ingredient than they should. They are usually the product of negligent manufacturing and poor quality control rather than malicious criminal activity.
But both fake and substandard drugs have an immediate impact on patients who don't receive the treatment they need. And more so in the case of substandard medicines, they can also have the disastrous side-effect of increasing resistance to treatment for serious diseases.
For instance, if a patient with malaria takes antimalarial drugs that contain a weak dose of the active ingredient, the malaria parasite will only be partially cleared from the body. The parasites that remain will be those that have resisted the drug. When these multiply and go on to infect new individuals, drug resistance spreads.
To complicate matters further, legal definitions of counterfeit medicines are often so broad that they include generic drugs. [4] Generics are non-brand versions of pharmaceutical drugs that are produced cheaply either after the brand exclusivity has expired, or through special licensing laws. Millions of people rely on inexpensive generic drugs to fight potentially fatal diseases such as malaria or HIV/AIDS. Counterfeiting laws that blur the boundary with these essential drugs can seriously threaten access to life-saving medicines.

Why is counterfeiting flourishing?
There are several reasons why counterfeit drugs are most common in developing countries.
Many rural areas have few pharmacies or health clinics, and the ones that exist are often open only irregularly. Many people buy drugs in non-regulated outlets, such as markets, which are more likely to trade in counterfeits.
Fake drugs are often sold more cheaply, appealing to poor people for whom cost is a huge barrier to the healthcare they need. And often, both stolen and 'knock-off' goods are widely and openly sold in markets in countries such as Thailand — so counterfeit drugs may be mistaken for stolen, and therefore cheap, genuine medicines.
The dismally poor legislative and regulatory framework monitoring drug quality and sale in developing countries also allows counterfeiting to thrive. Even when counterfeiters are caught, the penalties tend to be far lower than for smuggling heroin or cocaine, for instance. [5]
Meanwhile, globalisation eases the way for counterfeiting, spreading distribution networks and making them more complex. As a result, drugs are harder to track. And it is no surprise that the Internet has made selling counterfeit drugs far easier, both in developed and developing nations. The European Alliance for Access to Safe Medicines suggests that over 60 per cent of prescription medicines sold through the Internet are fakes. Advances in technology have also made high-quality labels and packaging relatively easy to produce, and pharmaceutical chemicals cheap to mass-produce.

How to spot a counterfeit
There are sometimes very obvious telltale signs of counterfeiting — faulty spelling, for example, incorrect packaging or tablet size.
Yet counterfeiters are fast becoming better at replicating genuine drugs correctly, and are increasingly sophisticated when mimicking specific anti-counterfeit measures such as brand logos. This has pushed manufacturers to enhance anti-counterfeit technology
Medicines can be marked in ways that make it easy even for consumers to identify fakes. For instance, packets and bottles can have tamper-evident seals. And like banknotes and credit cards, medicines can be marked with embossed graphics, or holograms — security inks that change in colour according to the angle they are viewed at.

Invisible markings
These are usually identifiable only to the supplier or distributor, not the consumer. They make use of invisible inks that can be detected in UV light, digital watermarks that encode data in graphics, anti-scan designs that reveal a watermark when copied, or inks imbued with specific micro-encapsulated odours.

Forensic labelling
Manufactures can use 'lock and key' systems, applying specific biological or chemical tags, such as DNA, that are not detectable by standard analysis and can only be revealed by specific reagents. Other forms of tagging can include silicon dioxide micro or nano tags, applied to the surface of a pill, that emit a unique light signature.

Track and trace labelling
In this system, each pharmaceutical package is uniquely labelled either with a barcode or some other non-sequential unique number. The label should then be read at the final point in the supply chain, when a pharmacist dispenses medicines to a consumer. This helps to ensure drugs are genuine and not past their expiration date. A more complex system is radio frequency identity (RFID) tagging, in which the tag is an antenna with a microchip. This means that the data can be read at a greater distance and do not need to be scanned like a barcode.

Who is fighting the counterfeit trade?
In 2006, the WHO set up the International Medical Products Anti-Counterfeiting Taskforce (IMPACT). This Taskforce has been leading international action, offering guidance on how to strengthen legislative and regulatory frameworks. Through IMPACT, the WHO has joined forces with regulatory agencies such as Interpol (panel 2) to uncover counterfeit operations.
In 2010, Operation Pangea III, coordinated by Interpol and IMPACT, collated data from 45 participating countries and uncovered a vast network of counterfeit drug sales on the Internet. The operation revealed 694 websites engaged in illegal activity, 290 of which have now been shut down.
Customs seized over 1 million counterfeit pills worth a total of US$2.6 million. These pills included antibiotics, steroids, anti-cancer, anti-depression and anti-epileptic pills, as well as slimming or food supplement tablets.
This success followed on from Operation Storm II, carried out earlier in 2010, which targeted eight countries across South-East Asia: Cambodia, China, Indonesia, Laos, Myanmar, Singapore, Thailand and Vietnam. That led to the seizure of 20 million fake medicines including antibiotics, anti-malarial and birth control tablets, anti-tetanus serums, aspirin and erectile dysfunction drugs. Over 100 pharmacies and illicit drug outlets were shut down.
The Medicines Transparency Alliance (MeTA) — launched in 2008 with support from the UK Department for International Development (DFID), the WHO and the World Bank — has set up multi-stakeholder forums to examine every aspect of the medicines supply chain in seven pilot countries: Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda and Zambia.
Counterfeiting seriously infringes on intellectual property, and since patents for medicines tend to be held by drug manufacturers, they are heavily involved in fighting the trade in fake drugs.
In some cases, the only way to detect a counterfeit drug is through chemical analysis. Since the pharmaceutical industry has a vested interest in quickly detecting fake drugs, several companies have sent mini-labs around countries in Africa and Asia (especially China) to assess the quality and ingredients in drugs.
The pharmaceuticals industry has also formed an alliance called the Pharmaceutical Security Institute (PSI), which counts 21 R&D-focused drug manufacturers as members. PSI works with the WHO and Interpol to exchange information on counterfeiting operations.
The problem is that strict anti-counterfeiting operations and vague legislation tend to target essential generics too.
Some scientists are very concerned about a new treaty to combat counterfeit drugs, the Council of Europe's Medicrime Convention. Signed in December 2010, this treaty criminalises the manufacture and trade in counterfeit medicines and contains a definition of counterfeiting so broad that most generics could come under its banner. [8]
To fight counterfeit medicines effectively, governments will need to focus on a few key areas.
The foremost of these is inter-country collaboration, since much of the trade in fake drugs occurs across national borders. Pharmacies, hospitals and other points in the supply chain need to keep lines of communication open and to exchange information.
And the entire medical supply chain will need to be tightened to eliminate loopholes in surveillance and monitoring. Legislation will also need to be updated and clarified to keep pace with the scale of the problem, and to provide a sufficient deterrent to criminal activity.
Finally, the global health community and national governments will need to engage with consumers so that patients understand the importance of buying medicines through regulated outlets.
But for any of these initiatives against counterfeit drugs to work, countries need a strong dose of political will — enough to strengthen the legal regulatory framework, improve education and invest in technologies that can detect counterfeit drugs and prevent further damage to public health.
http://www.scidev.net/en/health/detecting-counterfeit-drugs/features/counterfeit-drugs-facts-figures-1.html

MALARIA: DFID paper: Malaria: Burden and Interventions.

Malaria: Burden and Interventions. Evidence Overview. A Working Paper (Version 1.0).

Production Year: 2010
Creator: Elden, S.; Harvey, M.; Cadge, N.; Mulligan, J.; Fajber, L.; Mattholie, T.; Campbell, J.; Jones, I.; Ghandhi, D.; Taylor, A.; Patterson, A.; Watson, J.; Cavill, S.; Whitty, C.

Summary:
Malaria is one of the major diseases of poor people in developing countries and one of the leading causes of avoidable death, especially in children and pregnant women. The UK government has made a major commitment to fight malaria. This paper by DFID staff summarises current evidence relevant to the work of DFID, the UK government and its development partners in combating malaria.
The paper sets out the background epidemiology and the determinants of infection and high risk groups, and then reviews the evidence for various interventions and approaches.

http://www.dfid.gov.uk/r4d/SearchResearchDatabase.asp?OutputID=185824&utm_source=email&utm_medium=newsletter&utm_campaign=Feb2011newsletter

POVERTY: Aid cuts: the poverty competition

 Ros Wynne-Jones guardian.co.uk,  1 March 2011

In the coalition construct aid is set in opposition to the NHS and Africa's poor aren't Britain's concern

And so, once again, the poorest pay for an economic crisis they did nothing to create. At home it's certainly not the bankers who are belt-tightening. And abroad, the world's poorest people are hit twice over. Once, as developing country economies reel from the impact of a global crisis caused by western markets; twice because the west can no longer afford to lend the assistance that was apparently a luxury of boom times.
Some non-government organisations were celebrating yesterday that the cuts to the Department for International Development's budget were not as severe as anticipated, a neat feint the coalition government is beginning to specialise in. The department's budget is to be frozen, we hear. But as anyone whose wages have ever been frozen knows, it amounts to a pay cut – £2.2bn in this case, from the threadbare pockets of some of the poorest people in the world.
In the construct of our straitened times being rapidly assembled by coalition thinkers, overseas aid is consistently defined in opposition to our own domestic needs, as if it is an either/or choice. This is an entirely false dichotomy. DfID's budget accounts for much less than 1% of government spending and has nothing to do with how many doctors or nurses we have in the NHS. But it is a useful illusion.
The question Andrew Mitchell's constituents should be asking is not why is he helping distant poor people instead of them, but why champagne is flowing in the city once more yet there's no money for child benefit in the UK, or to benefit the poorest children abroad.As an alternative, a tiny Robin Hood tax on banks could mean there need be no choice between saving lives abroad and protecting livelihoods at home, while also ensuring the banks clean up their own mess.Who we choose to give to, and how we choose to give, defines us as a nation, and goes to the core of our moral values. In the brave new DfID that has been unveiled, winners and losers in the aid lottery are clearly weighted by the ordering of a new moral universe. Does helping them fit in with our anti-terrorism aims and our strategic economic interests?
The question becomes less about need and more, does helping them help us? (The coalition wants to focus up to 30% of overseas aid on volatile states such as Afghanistan and Somalia.) It also lends itself to further false dilemmas, as Andrew Mitchell – defending continuing aid to India as its economy booms – notes, "In India there are more poor people in three states than there are in the whole of sub-Saharan Africa," as if development spending were an ugly kind of Miss World competition.
In a globalised world, poverty is more than ever all of our problems, yet it has become grotesquely fashionable to knock the whole concept of aid, a beautifully conscience-salving opt-out. Western aid does more harm than good, goes the theory trotted out by dinner-party controversialists. It just simply doesn't work.
I have seen aid work, simply and beautifully, and also in complex, compound ways. I have seen emergency aid from DfID save lives in Mozambican floods and in Sudanese drought. I have watched development aid work in Rwanda, where tiny sums of money lent to farmers are still feeding families. I have seen both state and NGO aid work on other continents besides – in Kosovo, in East Timor, and in Thailand.
It is a lie that aid does not work. The truth is far more human – that sometimes there are failures of imagination or discipline. The answer is not to abandon aid, but to make it work better.
Aid is not the solution to poverty, but it is part of a solution that includes changing the way we trade, dealing with despots and corrupt governments, tackling climate change and the way international debt and finance is structured. But at its best, aid has the power to put books into the hands of children, food into the mouths of the hungry, and to offer suffering people their human dignity. Wouldn't those be the last things any government or any citizen would want to cut?
http://www.guardian.co.uk/commentisfree/2011/mar/01/coalition-aid-cuts-poverty

MALNUTRITION: DFID and Gates team up for agricultural research

28 February 2011: Yojana Sharma

 New funding will help develop wheat varieties resistant to emerging strains of stem rust disease: Flickr/CIMMYT

A windfall of US$40 million to fund global research on a deadly strain of wheat rust that is threatening the world's wheat supply was announced yesterday by the Bill & Melinda Gates Foundation and the UK Department for International Development (DFID).
It is part of a new collaboration between the two organisations that will see US$102 million invested into agricultural research and the rollout of technologies to small farmers to help manage crop diseases and food security over the next five years.
Cornell University in the United States will receive US$25 million from the foundation and US$15 million from DFID over five years, for research on wheat varieties resistant to emerging strains of stem rust disease such as Ug99 which, began in Uganda and is spreading. It is now found in Ethiopia, Iran, Kenya, Sudan, and Yemen.
"Against the backdrop of rising food prices and wheat in particular, researchers worldwide will be able to play an increasingly vital role in protecting wheat fields from dangerous new forms of stem rust," said Ronnie Coffman, principal investigator at Cornell's Durable Rust Resistance in Wheat (DRRW) project.
DRRW, led by Cornell, involves 18 universities and research institutes around the world including national research centres in Ethiopia and Kenya, the Mexico-based International Maize and Wheat Improvement Centre, the International Centre for Agricultural Research in Dry Areas in Syria and the UN Food and Agriculture Organization (FAO).
It also collaborates with scientists and farmers in 40 countries where new stem rust resistant varieties have been distributed for testing and evaluation.
Andrew Bennett, president of the Tropical Agricultural Association, told SciDev.Net: "There is a need to move very quickly. Rusts like Ug99 mutate fast and are carried on the wind. Ug99 has already arrived in Iran and it is not a great distance to get to Pakistan and India, the bread basket of South Asia. It is very important that resistant material is not only developed but deployed."
Leaf and stripe (yellow) rust also threaten wheat crops. But virulent stem rusts such as Ug99 are the most feared because they can quickly lead to the loss of an entire harvest.
The Global Cereal Rust Monitoring System at the FAO in Rome suggests that Ug99 variants are also threatening major wheat-growing areas of southern and eastern Africa, the Central Asian Republics, the Caucasus, the Indian subcontinent, South America, North America and Australia.
George Rothschild, chair of the European Forum for Agricultural Research for Development (EFARD) and a former head of the International Rice Research Institute, told SciDev.Net: "It is an exciting initiative to see substantial resources going into this research at a time when resources are very, very tight."
But he warned that such plant diseases tend to evolve rapidly, because there is a need for a broad range of rust-resistant wheat varieties, both traditional and genetically engineered.
Scientists and policymakers "must make sure they don't end up with a dominant variety or one strain" which would accelerate the development of resistance.
"Getting resistant crops out there is very important but in doing that it is vital that farmers do not give up their traditional varieties. The traditional varieties can be used as basis to cross-breed using the resistant genes to get the anti-rust properties in," Rothschild said.

Andrew Bennett is the chair of SciDev.Net's board of trustees.

http://www.scidev.net/en/news/dfid-and-gates-team-up-for-agricultural-research.html

MALARIA: WHO calls for global action on malaria resistance

Eva Aguilar: 13 January 2011

 Flickr/tonrulkens:
Artemisinin was originally isolated for an Asian plant Artemisia annua:

The WHO has launched a worldwide 'call to action' to governments, agencies, researchers and non-governmental organisations over the malaria parasite's growing resistance to the most potent weapon against it — the drug, artemisinin. If recently discovered resistance spreads, said the WHO, the formidable successes of anti-malaria campaigns in recent years will be threatened. Artemisinin lies at the heart of malaria treatment worldwide and has no obvious successor.
"The consequences of widespread resistance to artemisinins would be catastrophic," WHO director-general Margaret Chan told a press conference held after the launch of the 'Global plan for artemisinin resistance containment' yesterday (12 January).
"We need to maintain this medicine. What is at stake it is not just the goals on malaria but, frankly, the whole related Millennium Development Goals", said Robert Newman, director of the WHO Global Malaria Programme.
Resistance to artemisinin was identified in the Plasmodium falciparum parasite on the Cambodia–Thailand border in studies conducted between 2001 and 2009. It is now reported in other areas of the Greater Mekong Subregion and some fear that the resistance will spread to Africa, where most malaria deaths occur.
GPARC calls for increased surveillance of resistance and improved access to diagnostics and treatment with artemisinin combination therapies (ACTs), and for more research on topics ranging from new methods for containing resistance to mathematical modelling of its spread.
"We don't have all the knowledge and tools we need," said Newman, adding that finding a quick way of testing for resistance should be a priority.
"We need a molecular marker for drug resistance that will allow us to know much earlier where this problem may be emerging."
"The research community must be engaged in the development of new classes of antimalarial medicines that would not fall into the same trap of resistance that we have with ACTs," he added.
But it will not be easy to pin down the parasite's genes responsible for resistance, according to Pascal Ringwald, coordinator of the drug resistance and containment unit of the WHO Global Malaria Programme.
"It took 30 years to find the gene related to chloroquine resistance," he told SciDev.Net. "There are thousands of mutant genes in the parasite and the problem is to find which mutation could be related to artemisinin resistance."
"Now we have better molecular tools," he said. "I don't think it's going to take another 30 years, but it is very difficult and also very expensive."
Call for action also aims to bring in new funds to bridge the estimated US$175 million funding gap for the project. So far, the UK's Department for International Development (DFID) has agreed to fund a project to improve surveillance and map the extent of resistance.
http://www.scidev.net/en/news/who-calls-for-global-action-on-malaria-resistance-1.html

MALNUTRITION: In Somalia, UNICEF-supported programme treats malnutrition before it becomes life-threatening

By Mike Pflanz  

 
© UNICEF Somalia/ 2010/ Pflanz :  Filsan Yusuf, a health worker at the Outpatient Therapeutic Clinic in Hargeisa, hands a mother portions of Plumpy’nut food supplement. Severely malnourished children are monitored on a weekly basis and are treated with the high-energy peanut paste to bring them back to health.


HARGEISA, Somalia, 30 December 2010 – Salman Haji, 4, stands in the corner of a tin-walled hut, solemnly staring at the man in the white coat as he searches through an impressive amount of official looking paper spread across a large table in a seemingly random fashion. Eventually, a yellow medical card is found recording the details of Salman’s last visit to this mobile clinic, located on the outskirts of Hargeisa.
“He was improving, but now there are signs again of malnutrition, and of an underlying chronic respiratory illness,” Ali Mayag Muse explains to Salman’s mother, Hodan Mohamed, as her son struggles to contain a sudden coughing fit.

UNICEF provides support
Mr. Muse is a supervisor at an innovative Outpatient Therapeutic Programme which aims to treat children before malnutrition becomes so severe that other deadly illnesses - tuberculosis, diarrhoea and pneumonia chief among them - can take hold. The project is supported by UNICEF, and is funded by the European Commission Humanitarian Aid Department (ECHO), UK Department for International Development (DfID), Governments of Italy, Spain, and Denmark, as well as the Italian and French National Committees for UNICEF.


 © UNICEF Somalia/ 2010/ Pflanz : A child eats Plumpy’nut after his mother bought him to a mobile clinic in Hargeisa, Somalialand. The high-energy, high-protein peanut paste is formulated to treat severe malnutrition.

The weight and height of the children are measured, as is the circumference of their upper arms, to create a weekly snapshot of each child’s nutrition status, which is then checked against records from previous visits. In addition, Plumpy’nut - a pre-packaged high-nutritional quality peanut paste specially formulated to treat severe acute malnutrition - is handed out, as are Vitamin A supplements and zinc tablets to treat diarrhoea. Children with underlying complaints, like Salman, may be started on a course of antibiotics.
In the first ten months of 2010, 90 per cent of the more than 6,000 children treated in Somaliland for severe acute malnutrition recovered. Unfortunately, UNICEF estimates only half of those in need can be reached.

Measured interventions
Asha Mohamed’s nine-month-old daughter, Ayan, was one of those still beyond the reach of the programme, in their remote village a 24-hour journey to the south of Hargeisa.
“She was sick for a month, and getting worse and worse,” Ms. Mohamed says. “Finally, I made the decision on my own to get a truck to come to Hargeisa. It was a day and a night on the road, and Ayan was so sick and exhausted. We were told to come here, and now she is recovering so fast.”

 © UNICEF Somalia/ 2010/ Pflanz : A baby is weighed at a special ward for critically malnourished children at the Hargeisa Group Hospital in Somaliland. Severely malnourished children with medical complications are provided with round-the-clock special care at the UNICEF-supported stabilisation centre.

Little Ayan received her treatment at a special ward supported by UNICEF in the Hargeisa Group Hospital. It is one of Somaliland’s three ‘stabilisation centres’ for inpatient treatment, the step above the outpatient programme for the most serious cases. The infants must be slowly brought back to strength with measured interventions.
“It can kill a malnourished child to rush in to treat the malnutrition, first we need to treat the complications,” said supervisor Hawale Abdullahi.
Hope for expansion
Approximately forty cases are admitted to the centre each month, but Mr. Abdullahi has hope that those numbers will drop if the outpatient programme can be expanded.
Zivai Murira, UNICEF’s Nutrition Specialist based in Hargeisa, agrees.
“Children can deteriorate so quickly to the point where their severe malnutrition is difficult to manage,” he explains. “That’s why the stabilisation centres are there, but it’s also why we are trying to widen the reach of the outpatient programme, to catch children before complications set in.”
http://www.unicef.org/infobycountry/somalia_57331.html

TUBERCULOSIS: UK accused of 'covering up' G8's failure to cut deaths from TB

 04 January 2011

The UK is today accused of "covering up" the G8's failure to cut the death toll from tuberculosis in south Asia.
In a hard-hitting attack on UK policy, published by the Journal of the Royal Society of Medicine, three experts based in Bangladesh say the UK's strategy against the disease is aimed at preventing its spread to the west, rather than tackling the living conditions in deprived communities where TB is endemic.
Bruce Currey, Professor Quazi Quamruzzaman and Professor Mahmuder Rahman, all based at Dhaka Community Hospital in Bangladesh, accuse the UK's department for international development of glossing over the deaths of nearly half a million people.
The Department for International Development's (DfID) factsheet on progress towards the Millennium Development Goals, issued in December 2008, claims that in southern Asia, "progress in halting and reversing the spread of tuberculosis" is "almost met, or on target". It describes mortality as moderate.
"The Crown's term 'moderate mortality' covers up an annual tuberculosis death toll, estimated by WHO, of almost half a million people (460,003), mostly poor, in south Asia," say Currey and colleagues.
The three experts praise the UK's leadership at the G8 meeting in Okinawa in 2000, which pledged to "Reduce TB deaths and prevalence of the disease by 50% by 2010".
But, they say, the commitment was then watered down. The Millennium Development Goals, formulated by the United Nations in September the same year, put tuberculosis in a category with other infectious diseases and committed to "have halted and begun to reverse the spread" of all of them by 2015‚ " five years later than the target the G8 named".
The efforts of the UK focused on drug treatment‚ "the six-month regime of antibiotics that will cure TB but can be hard to maintain". Currey and colleagues say that insufficient attention has been paid to the poor housing, sanitation and nutrition that underlie TB.
Even when UK-funded drug trials were taking place in the slums of Madras (now Chenai) in the 1950s, they say, nobody stopped to ask why it was such an excellent laboratory for the experiment. And even now, tackling the "immuno-compromising stresses of poverty, migration, poor living conditions, decent employment and food security" are not part of the MDG goal against TB.
DfID's treatment-focused aim, says the paper, is not so much to reduce the incidence as to stop the spread of TB. "Poor men and women, and particularly children who are dying of poverty-induced tuberculosis and other opportunistic diseases of poverty, or couples who are infertile because of reproductive tuberculosis but not potentially contagious, are all occluded from the Crown's health strategy and from the interpretation of the MDG tuberculosis target," they write.
They say it is time to rethink, because the treatment-driven programmes are not succeeding in halting and reversing TB.
"It is now 2010, the deadline for the G8 millennial commitment. The latest WHO report (2009) suggests that the G8 target of reducing tuberculosis deaths by 50% has resulted in only an 11% reduction‚ "neither 'almost met' nor 'on target'," they say.
"The Millennium Development Goals should not be used as a fig leaf for the vertical global programme that is under-funded and failing to eradicate, or root out, the scourge of poverty and the risks underpinning preventable tuberculosis."
A DfID spokesperson said: "The data in this article refers to a factsheet published in 2008. The British government is totally committed to treating and preventing this deadly disease from spreading.
"That is why only last month the secretary of state announced treatment for an additional 56,000 people through the global fund.
"We will continue to help build better medical services in the poorest countries to ensure TB, like other major diseases, is effectively diagnosed and cured."
http://www.u.tv/News/UK-accused-of-covering-up-G8s-failure-to-cut-deaths-from-TB/2b3f5210-0d5b-41d9-86e5-3d319e28f1dc

MALARIA: The DFID plan

   Picture: Vergaard Frandsen / Roll Back Malaria

Malaria is a preventable and treatable disease. Yet more than half of the world's population is at risk of malaria and nearly 250 million people become severely ill with it each year.
In Africa, one in five child deaths is caused by malaria. It is also a disease and cause of poverty; the map of malaria illness and death closely matches that of global poverty.
Malaria has significant direct and indirect impacts; it places a major constraint to economic development and interacts with other health conditions such as undernutrition and HIV to worsen health outcomes.
Malaria is a serious cause of maternal and newborn deaths. Malaria illness limits mental and physical development in children and is an important cause of school absenteeism.
Addressing malaria is one of the main priorities of the UK government. We believe we can make a real difference to reducing the global burden of malaria by doing more of what we know already works, innovate to reach more people with prevention and treatment services and finding new tools to tackle malaria even more effectively in the future.
As part of this we have pledged to contribute to at least halving malaria deaths in at least ten high burden countries by 2014/2015.
Supporting countries to achieve this goal will contribute directly to reaching the Roll Back Malaria Partnership objectives set out in the 2008 Global Malaria Action Plan, targets agreed at the World Health Assembly (2005) and the Millennium Development Goals.

The UK government will:
Focus on the poor and vulnerable populations in high-burden countries in Africa and Asia
Achieve results by supporting national malaria control programmes that are embedded in health sector plans using funding approaches appropriate to country circumstances
Seek opportunities to link malaria with other health and non-health programmes to increase benefits and value for money
Improve the quality and availability of data on malaria so that results are measurable, transparent and strengthen accountability to communities and the UK public
Base investment on evidence of what works and innovate where needed
Work with international partners to ensure that global efforts support countries to tackle malaria as efficiently as possible
http://www.dfid.gov.uk/Global-Issues/Emerging-policy/Malaria/

MALARIA: Malaria Framework for Results (DFID)

The Department for International Development (DFID) conducted a public consultation to seek inputs for the development of its new Malaria Framework for Results. The Framework is part of the UK’s ongoing commitment to supporting progress on Millennium Development Goal 6c, to halt and to begun to reverse the incidence of malaria and other major diseases and a contribution to the goals set out in the Roll Back Malaria Partnership Global Malaria Action Plan (2008).
The 12-week consultation took place from 2 August to 26 October 2010. It gathered views from UK and international experts and the public through an interactive website, individual and group submissions, and technical workshops.
We received over 540 responses through online and technical submissions questionnaires. This report summarises the main messages contained in these responses and identifies how they have been reflected in the Malaria Framework for Results. This report is thus a summary of the wide range of views and ideas presented. It does not attempt to summarise individual responses.
In general, responses showed strong support for DFID’s role and current approach to health and to malaria. There is consensus that malaria needs to be addressed as part of a broader focus on improving health and health services. This includes integrating malaria control services with other health interventions, strengthening health information systems, improving commodity supply chains, building management capacity and human resources for health all with an increased emphasis on the district level.
Specific issues of particular interest included: community based delivery and the role of community; education and participatory approaches for prevention/awareness; and how to work with the private sector. Vector control/management (beyond bednets) and more effective coordination with other sectors were also emphasised. Respondents noted that significant knowledge gaps exist in the malaria field: there was a crucial role for research, both for new products and on how best to deliver services.
The scale and focus of responses to the consultation have confirmed both the potential for increased UK government investment in malaria to deliver results and helped to shape the Framework for how this will be done. In the words of one respondent, ‘build on what DFID has done well in the past and work to your comparative advantage’. Respondents welcomed the responsiveness and flexibility of UK government funding – including the willingness to innovate and develop new instruments; a capacity to focus on the health system; and an ability to partner with different types of organisations, while also supporting governments to take leadership.
DFID is grateful to all those individuals, groups and organisations that contributed submissions and took part in technical meetings. The consultation process was an influential element in the development of the Malaria Framework for Results as a result.
The UK government will publish a mid-term review in 2013 and a framework evaluation in 2015, so that partners and countries can judge what progress has been made in tackling malaria.
http://ht.ly/3wvi0