Thursday, 28 February 2013

TUBERCULOSIS: U.S. Cuts to Global Health Budget “Mass-scale Malpractice”


Carey L. Biron

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The impact of the budget cuts would be felt in communities around the world almost immediately. Credit: Fahim Siddiqi/IPS
The impact of the budget cuts would be felt in communities around the world almost immediately. Credit: Fahim Siddiqi/IPS
WASHINGTON, Feb 26 2013 (IPS) - Public health workers, activists and policymakers are stepping up a last-minute campaign to highlight the global health impact of historic, sweeping cuts to the U.S. federal budget due to go into effect Friday if Congress doesn’t act.
While some are suggesting that the automatic reductions, known here as the “sequester”, could set back health-related research and outcomes by a generation, others are warning that NGOs and project implementers, long working on the assumption that the cutbacks would be averted, are now finding themselves massively underprepared for how to operate on slashed budgets.
“While these budget cuts would affect a huge number of national and international programmes, global health is one of the few in which people’s lives are actually at risk,” Ali Escalante, a volunteer with the ONE campaign, an advocacy group, told IPS.
This has caught academics and the intelligentsia by surprise, and by the time they woke up and understood, it was too late.
“Thanks to U.S. leadership, we’ve made huge advances in fighting poverty and preventable diseases over the past decade. But we’ve come too far to turn back now – risking that progress would be a tragedy for both the United States and the world.”
Along with around 150 concerned citizens from across the country, Escalante was in Washington on Tuesday to meet with members of Congress and underscore the sequester’s impact on global health.
The United States is currently by far the world’s largest supporter of global health research and interventions, a role that has only expanded since the 2008 global financial crisis led most other international donors to roll back their own foreign aid programmes.
Yet due to disagreements within the U.S. Congress over how to shrink the national debt, involuntary spending reductions are scheduled to go into effect on Mar. 1. Purposefully nonsensical, these would eliminate 85 billion dollars of federal spending this year and 1.2 trillion over the next decade, which some estimate could slash more than five percent from all federal programmes.
According to Escalante and others, the impact would be felt in communities around the world almost immediately.
“For instance, there are currently over eight million people being treated for AIDS, up from 200,000 just 10 years ago,” she says. “So we project out that if these cuts happen, 170,000 people would stop receiving U.S.-funded treatments. And we also know that those people will die.”
These reductions alone, she suggests, could directly lead to 37,000 AIDS-related deaths, many of parents who could leave behind upwards of 74,000 orphans.
And that’s just the AIDS-related impact. According to a new report released Tuesday by the Global Health Technologies Coalition (GHTC), a U.S. umbrella group, sequestration could shrink global health spending at the State Department and USAID (the country’s main foreign aid arm) by 484 million dollars this year.
Further, the National Institutes of Health, responsible for overseeing much of the country’s health-related research, could lose almost two billion dollars, on top of reductions to several other federally funded research programmes.
GHTC researchers suggest that these budget reductions could “jeopardise” up to 200 new global health tools that are currently in the research process. These include drugs, vaccines and other products to counteract HIV, tuberculosis, African sleeping sickness, dengue fever and others.
“The US commitment must be renewed,” the report states. “There is too much to lose if the United States pulls back from this legacy now, as US investment has driven the creation of the largest global health product development pipeline in history that is poised to become the next generation of lifesaving products.
Hundreds of thousands of lives
Amidst the confounding political spectacle of the U.S. debt negotiations leading up to the sequester, what has particularly frustrated many observers is the miniscule impact that foreign aid-related cutbacks would have on the United States’ broader deficit problems.
Contrary to the belief of many in the country, foreign spending makes up less than one percent of the national budget. Of that, just a tenth goes into health spending.
“We’re not talking about much money in terms of the country’s budget, but in terms of impact it’s enormous,” Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, a Washington think tank, told IPS.
“Further, in terms of public giving the United States is responsible for 52 percent of all global health support. There is just no one prepared to step into that breach.”
While it is unclear exactly how deeply programme heads would need to slice, estimates run anywhere from three to eight percent.
“At eight percent, now you’re talking about dead bodies,” Garrett says. “The way I look at it, that’s mass-scale medical malpractice. One thing a physician is trained to do is not to end treatment until a patient doesn’t need it any more. Cutting off this funding now means hundreds of thousands of lives.”
Previous attempts to roll back U.S.-funded AIDS medications saw almost immediate public demonstrations outside of U.S. embassies in Africa, and Garrett notes that similar reactions should be expected if the current reductions take place, as well.
Congress can still tweak or undo the sequester entirely, though President Barack Obama and Congressional Republicans remain firmly entrenched in their positions, with no public negotiations taking place whatsoever.
Regardless of the eventual timeframe, however, Garrett says that public health groups are notably unprepared for the impacts, whether long or short term.
“This has caught academics and the intelligentsia by surprise, and by the time they woke up and understood, it was too late – some health groups have only now started to ask what it will mean for their programme,” she says.
“The most important thing everyone can do right now is to start providing seriously reliable metrics that can show the impact of sequestration – not a lot of hand-waving and hysteria. Every group out there needs to take this as seriously as possible and be responsible about it. If actual lives are lost, this needs to be documented
- See more at: http://www.ipsnews.net/2013/02/u-s-cuts-to-global-health-budget-mass-scale-malpractice/#sthash.E3L3j4vi.dpuf
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POVERTY: Somali government to relocate IDPs, welcome returning refugees



Photo: Kate Holt/IRIN
IDPs in Somalia often live in appalling conditions (file photo)
MOGADISHU/NAIROBI, 27 February 2013 (IRIN) - The Somali government plans to relocate thousands of internally displaced persons (IDPs) currently living in Mogadishu to camps on the outskirts of the city, but there are concerns over inadequate government capacity as well as security and access to services in the proposed relocation areas. 

There are an estimated 369,000 IDPs or people living like IDPs in Mogadishu, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA). Of these, about 270,000 could be relocated to three camps on the outskirts of the capital, helping to decongest the city, according to Mohamed Ahmed Nur Tarsan, Mogadishu’s mayor.

“Honestly, no mayor in the world would tolerate IDPs form[ing] shanty shelters in the capital city. This issue touches [on] the security of the city and remains a threat to the sanitation of the city,” Tarsan said, adding that there are no security problems on the outskirts of Mogadishu.
 
“I am not saying that we should put these people in faraway isolated places, but what I am saying is that we should get better places for them since these people are currently living in appalling conditions.”

IDPs in Mogadishu live in difficult conditions, under threat of extortion and eviction. Providing aid to them has also been difficult in the past due to security constraints. 

But in reaction to the relocation plan, IDPs expressed concerns about security and the availability of basic services.

“If we are provided with security and health services, we will obey the government plans. But if we do not feel safe, we will just wait [for] our God here,” Abdullahu Olow Dhere, an IDP in Mogadishu’s Darwish camp, located next to Somalia's parliament, told IRIN.

Another concern is the distance of the proposed relocation sites from livelihood opportunities. 

Voluntary relocation key

Some of the IDPs may be unwilling to relocate from Mogadishu or to return to their original homes. Somalia has a relatively youthful population, meaning that, for some, Mogadishu is the only home they have known. “Those who may be unwilling to return to their previous locations should be relocated to camps on the outskirts of Mogadishu,” said Tarsan.

IDPs in Mogadishu grapple with insecurity, including rape and other forms of sexual and gender-based violence, raising concerns that violence will be a problem in the proposed new locations as well. “If we just simply resettle people from one location to another, I don’t think we should expect any improvement in the security [or] protection of those people, especially the single-female [headed] households. Unless we put in place the conditions for success, success is not assured at all,” Justin Brady, the head of the OCHA office in Somalia, told Radio Ergo in a recent interview.

But according to Tarsan, “Rapists will be killed, as the President said, and we anticipate Mogadishu to [have] zero rape within the coming three months.”

He added, “We are providing security as well as the land, and it is the responsibility of aid organizations to provide services like health and water.”

Aid agencies are getting ready.
“What we are looking at is how the government plan can be assisted by the partners… to make this as ethical and humane a resettlement - and voluntary, that being the key part for the IDPs - going forward,” Brady told Radio Ergo.

“We need to review exactly what is required… It is not simply a shelter issue or a protection issue, but all of the service providers across the spectrum of clusters need to be involved.”

Photo: Contributor/IRIN
Security concerns have fuelled Somali refugee repatriation calls in Kenya (file photo)
According to Brady, the Somali government hopes much of the relocation will happen this year. “The government’s plan has a very ambitious timeline. They wish to see a good portion of it done by the 20th of August, which is obviously a very symbolic date in Somalia. We will be engaging with them to see… the key points where effort needs to be put in to ensure that the conditions are right for resettlement.”

On 20 August 2012, the mandate of Somalia's transitional government ended, paving way for a new parliament and the subsequent presidential election, the first in more than two decades. The successful election led to growing optimism about the future of Somalia, prompting thousands of people to return to Mogadishu.

Refugees returning

Some refugees are also returning from the Dadaab refugee complex in northeastern Kenya, which is home to close to half a million refugees. 

The returns have been, in part, driven by growing pressure by the Kenyan government on Somali refugees to return to Somalia. 

“Almost 20,000 Somali refugees have voluntarily left Kenya since repatriation calls started,” states Hasty Repatriation: Kenya’s attempt to send Somali refugees home, a recent report by the Heritage Institute for Policy Studies, a Somali-based think-tank.

“Vacancy rates of houses and apartments in Eastleigh [a heavily Somali district in Kenya’s capital, Nairobi] have rocketed and, subsequently, rent rates have plummeted… Schools in the area have reported considerably reduced student numbers.” 

Speaking at the launch of the report, the Somalia ambassador to Kenya, Mohamed Ali Nur,  said that while the Somali government is willing to welcome back the refugees, “and we want them to come back to help in rebuilding the country, we want the refugees to go back in a coordinated manner.” 

According to the report, the Somali government is not prepared to accommodate the almost 600,000 Somali refugees living mainly in Kenya and Ethiopia. Still, “the Somali government is devising an ambitious plan to establish large camps inside Somalia, near the Kenyan border. It hopes to move hundreds of thousands of refugees to the new camps before the end of 2013. Not only is the implementation of this plan unrealistic, but it could also expose vulnerable refugees to dangerous conditions.”

The report’s author, Anab Nur, said, “To send such a large number of refugees back at this time, I think, will be destabilizing. They are already dealing with an IDP issue.”

The report recommends that Kenya and Somalia work closely through their Joint Cooperation Committee to find a satisfactory solution, and for the Somali government to “capitalize on recent security gains by establishing state institutions that can absorb the influx of refugees”.

“Key to this,” it states, “is addressing the emotive issue of land in Somalia. Unresolved land disputes will likely lead to a re-eruption of violence in southern Somalia. An orderly, well-timed return of refugees would, however, solidify recent gains made and lay the foundations for a stable Somalia.”

amd-aw/rz
- See more at: http://www.irinnews.org/Report/97552/Somali-government-to-relocate-IDPs-welcome-returning-refugees#sthash.fZ6Zq3qT.dpuf
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MALNUTRITION: Groups Applaud Potential Reforms to U.S. Food Aid


 Carey L. Biron

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WASHINGTON, Feb 27 2013 (IPS) - Advocacy groups working on global hunger and poverty are hailing rumoured proposals that would change the way the United States distributes its international food aid.

A child receives food aid in Ghana from FMSC Distribution Partner – Health and Humanitarian Aid Foundation. Credit: FMSC/cc by 2.0
The news comes just as President Barack Obama is finalising his highly anticipated national budget proposal for fiscal year 2014, the most specific indicator yet of the president’s policy vision as he starts his second term in office.
Meanwhile, sweeping budget cuts are set to go into effect on Friday, without action from the U.S. Congress. These automatic reductions, thought to make up three to eight percent of most federal budgets, would have particularly inordinate ramifications for foreign aid, development and global health programmes.
Yet the rumoured changes in food aid appear to be in line with reforms that advocates have urged for decades, aimed at increasing efficiency and halting market distortions brought about by the arrival of cheap U.S. grains. The United States is the world’s largest provider of food aid, meant to function as a stopgap measure of last resort.
“What we’re hearing is that instead of cuts, the president could be proposing a shift to local or regional procurement of U.S. food aid, rather than the ‘in kind’ giving we’ve done for years – which would be terrific news,” Karen Hansen-Kuhn, international programmes director with the Institute for Agriculture and Trade Policy (IATP), a think tank, told IPS.
“That would be a common sense move, and it would be about 50 years overdue. Purchasing this food locally would be a far more efficient use of food aid, while it would also benefit small-scale farmers in the community or region.”
IATP, together with 11 other humanitarian and advocacy organisations, on Tuesday released a statement welcoming unofficial reports of these proposed changes. They also called on President Obama’s administration to “include a bold reform proposal that builds upon the United States’ historic leadership as the world’s most generous donor of food aid.”
The joint statement is not calling for an outright end to in-kind food aid, but rather for greater flexibility in how the programmes operate.
According to several of these groups, it appears that the administration will propose shifting responsibility for food aid programmes from the U.S. Department of Agriculture to USAID, the country’s central foreign aid agency. (Neither the USDA nor the White House have publicly discussed these details.)
The administration is also reportedly considering ending the practice of food aid “monetisation”, a process by which Washington gives U.S.-grown grains to local organisations, which can then sell them for cash. Critics say this process is notably inefficient, a finding corroborated by a 2011 report by the Government Accountability Office (GAO), the U.S Congress’s main investigative arm.
Over the past half-century, the United States has become the world’s largest food aid donor. Last year, the Congress appropriated some 2.5 billion dollars for such programmes, including nearly 1.5 billion dollars for the largest, called Food for Peace.
When it was established in 1954, Food for Peace was able to tap into the United States’ massive grain reserves, redistributing these to the needy around the world even while offering some financial fillip for U.S. farmers and shippers (the programme was also aimed at countering communism). Among other requirements, 75 percent of U.S. food aid must still be transported on U.S.-flagged ships.
And yet, the United States’ grain reserves were largely discontinued in the late 1990s, and critics say that, for the most part, the purchases do not amount to enough to actually sway U.S. agricultural prices in favour of farmers.
Today, the United States is the only major donor country that continues to send actual food items to humanitarian crisis spots, rather than offering money with which to procure locally produced grains and other products.
Critics say the practice increases aid prices by 50 percent for the U.S. government. Amidst ongoing and highly polarised budget negotiations here in Washington, advocates are now hoping that such efficiencies will be widely welcomed by lawmakers.
Missing a third
The idea of local procurement is not new. President George W. Bush proposed changes that would have allowed for a quarter of U.S. food aid to be locally procured, while leaders of USAID have also come out forcefully in favour of such changes.
Beyond a small pilot project on local procurement, however, no major reforms have been adopted. (Recent reports on the feasibility of that pilot programme were positive, available here and here.)
While this inertia can in part be attributed to lobbying on behalf of certain farming and transport interests, Hansen-Kuhn suggest that “many today are concerned that if we tinker with the current system, then support for funding levels more generally will go away.”
Yet many advocates are increasingly urging that the debate over food aid – or any foreign aid – be concerned less with dollar figures than with the number of beneficiaries reached.
According to some estimates, if the United States were to switch completely to local procurement for its food aid, “it would be able to reach 17 million more people – so we’re only getting to about two-thirds of the people we could be,” Timi Gerson, with American Jewish World Service, an advocacy organisation, told IPS.
“So what I’m looking to see from the administration is their math: How many beneficiaries are they going to reach, and could they reach as many or more because they are using funding more efficiently? Ultimately, this is not just about money but also about what that money is doing.”
Beyond arguments over lower costs for donors and higher response speeds for crisis-hit communities, reforms in favour of local procurement could have an important long-term impact.
“One of the things we are hopeful for is that any new reforms, by providing cash, would be able to empower local economies,” Blake Selzer, a senior policy advocate at Care, a relief agency, told IPS.
For decades, Care has implemented U.S. food aid and other development programmes, among others. In 2006, it unilaterally decided that it would massively scale back its use of aid monetisation.
“Today we’re at a point where this is about reaching as many people with less money, or reaching more people with same amount of money,” Selzer continues.
“But at the same time, local procurement could go a long way towards empowering these communities and building long-term economies – so they don’t have to rely on international assistance and, rather, can develop their own markets and assistance programmes.
- See more at: http://www.ipsnews.net/2013/02/aid-groups-applaud-potential-reforms-to-u-s-food-aid/#sthash.wOgIyJ16.dpuf
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Wednesday, 27 February 2013

TUBERCULOSIS: 5,000 badgers to be killed as minister announces pilot culls this summer


A cull of around 5,000 badgers is set to go ahead this summer in a bid to tackle tuberculosis in cattle, the Environment Minister has announced.

12:09PM GMT 27 Feb 2013
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Pilot culls in west Gloucestershire and west Somerset, which will see the killing of 70 per cent of badgers in each area, were authorised by the Government after final licence conditions were met.
A third scheme in Dorset is being prepared as a reserve to prevent any further delays.
Around 5,000 badgers are expected to be killed across the two areas over a four-year period as part of the cull.
The two pilot culls were delayed last year in the face of bad weather and the discovery that there were more badgers in the areas than previously estimated.
Around 5,000 badgers are expected to be killed in the pilot culls (PA)
Environment Secretary Owen Paterson told farmers at the National Farmers' Union conference in Birmingham that he was committed to making sure the pilots went ahead.
He said tackling bovine TB had cost the taxpayer £500 million in the past 10 years, and costs could reach £1 billion over the next decade if the disease was left unchecked.
He said that research in the UK had shown that culling badgers, which can transmit TB to cattle, could reduce the levels of the disease in herds, and that Britain had to learn from experience elsewhere that tuberculosis could not effectively be curbed without tackling the problem in wildlife.
He said he wanted to see effective and affordable vaccines deployed for both cattle and badgers as quickly as possible but it was likely to take another decade before the deployment of a cattle vaccine which is validated and legal under EU regulations could take place.
Mr Paterson said: ''Bovine TB is spreading at an alarming rate and causing real devastation to our beef and dairy industry. ''
He said Natural England issued authorisation letters which confirmed culling could proceed this summer, as an important step towards taking the action needed to tackle the spread of TB in wildlife.
"I am determined that there are no further delays this year. That is why we have taken the sensible step with the farming industry to elect a reserve area that can be called upon should anything happen to prevent culling in Somerset or Gloucester.
"These pilot culls are just one part of our approach to control and eradicate this dreadful disease."

The move was welcomed by National Farmers' Union president Peter Kendall who said it would have been easy for the Environment Secretary to let TB slip down the list of priorities after last year's delay.
He backed Mr Paterson for working to ensure that the pilots were up and running this summer and that there would be a full roll-out of the cull next year.
The move was criticised by Labour, which has consistently opposed a badger cull.
Shadow environment secretary Mary Creagh said: "The Government is pressing ahead with a badger cull despite 150 000 people signing a petition against it last year and scientists warning against this 'untested and risky approach'
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Tuesday, 26 February 2013

MALNUTRITION: Filipino farmers - a dying breed?


Photo: Jason Gutierrez/IRIN
Still farming -- but for how much longer?
MANILA, 26 February 2013 (IRIN) - Historically, as countries have industrialized, the number of small farms has dwindled, with workers opting for city life. But the Philippines government is concerned that this trend could exacerbate food insecurity in an import-dependent country already struggling to meet current food demand. 

“The average age of the Filipino farmer is 57. Assuming an average life span of 70, we might reach a critical [shortage] of farmers in just 15 years,” said Asterio Saliot, director of the Department of Agriculture - Agricultural Training Institute (DA-ATI). 

“The average level of education of a farmer is grade five only,” he added. 

According to Saliot, farmers’ age and limited education make them less receptive to new farming technologies that can boost yields in the face of growing losses from volatile weather. 

Weak government policies and programmes, an excessive reliance on agricultural imports, and corruption, have taken their toll on the agricultural sector, say experts. 

According to the 2012 Bureau of Agricultural Statistics, the agricultural sector employs an estimated 12 million people, making up 33 percent of the country’s labour force. About 70 percent of the rural poor are farmers and fishermen. 

Though the sector contributes about 11 percent to the country’s GDP with US$14.7 billion, 2011 government investment in the sector was only 4 percent of the national budget. 

That year total government spending on agriculture was $1.6 billion, almost 24 percent lower than the previous year.  

“We didn’t pay enough attention to the agricultural sector because we thought that we could always import our food if we couldn’t grow it ourselves,” said Kala Pulido-Constantino, advocacy campaigns and communications coordinator with Oxfam in the Philippines. 

In 2010, the Philippines imported 2.45 million tons of rice, making it the biggest rice importing country worldwide that year.  

Compounding the problem is the country’s population, which is growing at about 2 percent per year and is projected to reach 120 million by 2025.  

“We cannot meet local demand as it is,” Francis Pangilinan, a senator and chairman of the Congressional Committee on Agricultural and Fisheries Modernization (COCAFM), told IRIN. Boosting imports is not a reliable option, he added. “The world food crisis of 2008 taught us that while we may have the money to import rice, rice-exporting countries may not be willing to sell the rice to us.” 
“Being a farmer is like being a priest; you take a vow of poverty and make a pact with the lord that no typhoon will come and destroy your crops."
Past government policies have provided few incentives to farmers, the senator noted. “Admittedly, [previous] government policies have had a bias for white-collar jobs. Policies were focused on yield, without enough consideration for the quality of life of the farmer,” he added. 

The average daily wage of a farmer is $6, versus the national average of $10.

Risky business 
But a major typhoon can easily wipe out earnings, small-scale farmers have learned. The archipelago, ranked as one of the most disaster prone countries in the world, experiences an average of 20 typhoons annually. 

“Being a farmer is like being a priest; you take a vow of poverty and make a pact with the lord that no typhoon will come and destroy your crops,” said Pangilinan. 

A 2009 survey by the Canada-based International Development Research Centre (IDRC) showed that all regions in the Philippines are vulnerable to extreme weather events, some of which are linked to climate change. ] 

The Global Climate Risk Index (CRI) of German Watch ranked the Philippines among the countries that experienced the greatest loss from weather disturbances in 2011.  

In the past two years tropical storms have battered the southern island of Mindanao, a region largely untouched by natural disasters in recent decades. 

Last December, the eastern coast of the southern island of Mindanao, where 80 percent of the population relies on subsistence farming, was hit by the Category 5 (winds of at least 250km per hour) Typhoon Bopha, which caused an estimated $663 million worth of damage to agriculture.  

“I lost my home, my crops - everything,” said Armando Banudan, 48, a farmer from the coastal Davao Oriental Province who used to plant coconuts on a small patch of land that he also called home. 

“It takes 8-10 years for my coconuts to grow. What will happen to us in the meantime?” Banudan asked. 

The International Fund for Agricultural Development counts residents of the archipelago’s mountainous regions and the island of Mindanao among the country’s poorest. 

Photo: Ana Santos/ IRIN
Typhoons decrease farmers job appeal

A private research institution, Social Weather Stations, reported involuntary hunger in Mindanao rose from 16.7 percent of surveyed families in March 2011 (795,000 families) to 21.7 percent three months later (one million families). 

Young people leaving rural areas 
Compounding the problem is a younger generation that is, largely, leaving rural areas nationwide, depleting the pool of potential agricultural workers. 

“The problem with farming is that it is associated with poverty. So no farmer would want their children to become farmers,” said Jocelyn Alma Badiola, executive director of COCAFM. 

Most rural families instead want their children to pursue more lucrative jobs in commercial centres near Manila. 

“It is too late to do something about our current farmers. We must now change the mind-set of the younger generation and make farming appealing for them,” said Jose Rene Gayo, president of local NGO Foundation for People Development. 

The foundation is working with the government to offer scholarship programmes that combine classroom lectures and field training in farming to young people with the right skills and motivation who have dropped out of school. 

as/pt/cb 
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