http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbWed, 17 Mar 2010 15:34:08 GMTJOHANNESBURG Wednesday, March 17, 2010 (IRIN) - Ethembeni Enrichment Centre, a school in a run-down part of Port Elizabeth, the largest city in Eastern Cape, South Africa's poorest province, has achieved a remarkable 100 percent pass rate for a dozen years. But officials from the education department, sent on a fact-finding mission to learn from the school's success, are running more than two hours late.JOHANNESBURG Wednesday, March 17, 2010 (IRIN) - Ethembeni Enrichment Centre, a school in a run-down part of Port Elizabeth, the largest city in Eastern Cape, South Africa's poorest province, has achieved a remarkable 100 percent pass rate for a dozen years. But officials from the education department, sent on a fact-finding mission to learn from the school's success, are running more than two hours late.

Irritation is discernible in the voice of school principal Elbe Malherbe - punctuality is one of the few rules that must be abided by teachers and pupils alike. "When ... [it's time to] start, you start," Malherbe told IRIN in clipped replies during a telephone interview. Then, in a sudden change of tone, she said: "I wish you could see through the phone what I am seeing."

It is the first day of applications for the 2011 school year and a woman in traditional Xhosa attire is filling out a form for her child. Ethembeni only accepts pupils whose mother tongue is Xhosa, which generally translates into poor and black. The annual school fees are R3,800 (US$506), excluding stationery.

Many poor parents make sacrifices to keep their children in school, but Malherbe believes in affordable - not free - education, because it is an "investment by pupils, parents and teachers [that] everyone must buy into".

The language of instruction is English. Apart from not brooking tardiness, the school's other non-negotiables are that class attendance is compulsory, home work must be completed, pupils must clean the classrooms and grounds every day, and parents must be involved in their child's education.

"The classrooms were barely furnished. The driveway to the school was a rocky, narrow passage ... The school hall was packed with a few hundred eager faces, the children virtually sitting on top of one another on the floor ... I saw struggle, hunger and poverty etched into each child's countenance," educationist and vice-chancellor of the University of the Free State, Jonathan Jansen, recounted after a recent visit.

"For any child to pass under these difficult circumstances, it would take a miracle," he wrote. Yet nearly two-thirds of the 70 pupils in Ethembeni's 2009 matric, or final year, class achieved a university-entrance pass, while other financially comparable schools hung on at the bottom of the academic achievement ladder.

The school has no library, no science laboratory, although there is a computer that gives the 400 pupils internet access. The government pays for 11 of the 17 teachers; the salary shortfall of the six other teachers has to come out of the school fees.

The compactness of the school is part of its success. "In schools of a thousand [students], how can you know all the parents? If I have a problem with a child, or they have not done their homework, I phone their parents and they are here in five minutes," Malherbe said.

"We're not Einsteins here - we teach. It's nice to be part of a winning team. With nothing, you can still be successful if the heart is right and the spirit is right."

Ethembeni, which means "place of hope", swims against the prevailing national current in education, where standards have been steadily declining - in contrast to school fees.

More money, less education

The government's answer to the malaise is to throw more money into the education system; in the 2010/11 financial year it budgeted R165 billion (US$8.6 billion) for the sector, a 17 percent above inflation increase from the previous year.

The matric, or final high school exam, is used as a benchmark for the state of education in South Africa. Of the 550,227 pupils who wrote their final examinations in 2009, 61 percent passed, and 19.9 percent of those achieved the required marks to qualify for tertiary education.

Marius Roodt, an education analyst at the South African Institute of Race Relations, a policy and research organization, told IRIN the current teaching standard was akin to Bantu education - the system imposed by apartheid prime minister Hendrik Verwoerd, who said blacks should only be educated to be "hewers of wood and drawers of water".

"It is very unlikely that there will be an increase in matric pass rates. In 2004 the pass rate was 71 percent, and it has been on a steady downward trend since then, with each year reflecting a decrease. This is a trend that is likely to continue into the future, at least in terms of the quality of the qualification," Roodt said.

He attributed the decline to the political influence of the 240,000-member South African Democratic Teachers Union (SADTU), the country's largest teacher union and an affiliate of the Congress of South African Trade Unions (COSATU), which is an alliance partner of the ruling African National Congress.

"An example was when the union encouraged members to campaign for President Jacob Zuma prior to last year's general election, instead of teaching," he said.

"Although teachers should be allowed to be unionized - like any profession in any democracy - the influence of SADTU is malignant and not benign. It is possible that SADTU has the interest of only its members at heart, and not that of the pupils in South Africa's schools," Roodt commented.

"The reintroduction of the 'school inspectors' system, which would greatly improve the quality of the country's teaching, has been resisted by SADTU for some time. The union has also opposed systems to monitor teacher performance," he said.

Zuma announced in his 2010 State of the Nation address that a system of oversight would be instituted to monitor schools and ensure that teachers were in class to teach.

SADTU spokesperson Nomusa Cembi told IRIN that the union objected to the reintroduction of school inspectors, and did "not know where the president got the information that teachers are only in class for three hours, or so, a day."

Zuma first made the claim in a speech to school principals in KwaZulu-Natal Province, who gathered at the Durban International Convention Centre in August 2009. "We need to confront certain realities. For example, teachers in former whites-only schools teach in class for an average of 6.5 hours a day, while teachers in schools in disadvantaged communities teach for around 3.5 hours a day. The result is that the outcomes are unequal."

A recent survey published by Tokiso, an independent labour dispute resolution body, found that the teachers' union was responsible for 42 percent of all work days lost through industrial action between 1995 and 2009. Cembi said this gave the impression that SADTU members "strike at the drop of a hat".

Tanya Venter, CEO of Tokiso, told a local newspaper, Business Day, that SADTU's participation in the 2007 public sector strike was the main reason for the union recording such a high rate of absenteeism.

A recent World Bank working paper: No More Cutting Class? Reducing Teacher Absence and Providing Incentives for Performance, found "each additional 5 percent increase in teacher absence reduces learning by 4 to 8 percent of a year’s learning for the typical student."

Cembi said responsibility for the deterioration of education should be shared among learners, teachers, the education department and the government. She was unable to provide any data on whether or not a SADTU teacher had ever been dismissed for poor performance.

Zimbabwe's loss, South Africa's gain

Government has been widely blamed for creating a critical shortage of teachers trained in science and mathematics after it closed teacher training colleges in 2000 and put the onus on universities to produce educators. The government is now considering re-opening the teacher training colleges.

One solution has been to recruit teachers from Zimbabwe. Dickson Masemola, head of education in Limpopo Province, which borders Zimbabwe, said his department had hired 600 Zimbabwean educators to teach maths, science and commercial subjects, resulting in a turnaround in academic performance.

Mbali Thusi, a spokesman for the education department of KwaZulu-Natal, said a number of foreign teachers, especially in maths and science, were working in the province, and more would be hired because of the shortage of qualified teachers in these fields.

"The problem is more severe in rural schools - most maths and science teachers prefer to work in urban areas," Thusi said. "But we are eager to recruit more foreign teachers because of the shortages ... We have sent requesting documents to the national department to give us a go-ahead. We want to recruit hundreds of these teachers to plug the holes in our system."

The head of the KwaZulu-Natal School Governing Bodies Association, Reginald Cheliza, told IRIN: "We would like our children to succeed in school, but it is clear that this is not happening. Some of the problems start at school level, others at provincial or even national level."

cm/go/he http://www.irinnews.org/report.aspx?ReportId=88452JOHANNESBURG Wednesday, March 17, 2010 (IRIN) - Madagascar's history is marked by a struggle for political control. The country gained independence from France in 1960, but since then it has been plagued by assassinations, military coups and disputed elections. Here is a timeline of the major events in the island's turbulent history.JOHANNESBURG Wednesday, March 17, 2010 (IRIN) - Madagascar's history is marked by a struggle for political control. By 1700, France and England had attempted to establish settlements, while the rulers of the island's many kingdoms fought among themselves for dominance.

During the 1700s the Merina ethnic group gained control of the central plateau and established a monarchy; with British help they eventually ruled most of the island. Their reign came to an end when French marines landed on the island in the 1880s and France instituted colonial rule.

Madagascar gained independence in 1960, but since then it has been plagued by assassinations, military coups and disputed elections. Here is a timeline of the major events in the island's turbulent history.

1946 - Madagascar becomes an Overseas Territory of France.

1947 - Thousands are killed when the French put down an armed rebellion in the east.

1958 - Madagascar votes for autonomy.

June 1960 – The Malagasy Republic (Madagascar) gains independence with Philibert Tsiranana as president.

May 1972 - Huge crowds led by students gather in Tananarive, the capital, to demand Tsiranana's resignation. Power is handed to army chief Gen Gabriel Ramanantsoa, who heads a provisional government.

June 1975 - Didier Ratsiraka, a military commander, becomes head of state.

December 1975 – Ratsiraka is elected president for a seven-year term in a national referendum. The country is renamed the Democratic Republic of Madagascar.

August 1991 - Mass demonstrations and civil service strikes start. Over 100,000 people march on the presidential palace and the presidential guard responds with gunfire and grenades.

October 1991 – Ratsiraka remains president but relinquishes power to Albert Zafy, head of the newly established High Authority of the State.

March 1993 – Zafy is elected president, defeating Ratsiraka.

April 1996 – Thousands demonstrate against Zafy amid calls for a military coup in the capital city, Antananarivo.

August 1996 - Zafy is impeached on allegations of corruption.

January 1997 – Ratsiraka makes a political comeback after the constitutional court finds that he won the presidential election in November 1996.

February 1998 – Members of the opposition, including Zafy, make an unsuccessful attempt to impeach Ratsiraka.

December 2001 – Ratsiraka faces Antananarivo mayor Marc Ravalomanana in the first round of the presidential election.

January 2002 - Daily protests pressure Ratsiraka's government for a recount of presidential election ballots. Madagascar's High Constitutional Court certifies that Ravalomanana got 46.2 percent of the votes and Ratsiraka got 40.8 percent - neither has the required majority of 51 percent. A runoff is set within two months but thousands of Ravalomanana's supporters take to the streets in protest. Ravalomanana calls for a national strike.

February 2002 – Ravalomanana declares himself president after two months of dispute. Ratsiraka declares martial law in the capital.

March 2002 - Ravalomanana forms a rival government and seizes the defence ministry - the last ministry controlled by Ratsiraka's government - and calls an end to the national strike. The Organization of African Unity (OAU) calls for a government of "national reconciliation" until a new ballot is held, but Ratsiraka rejects the proposal.

April 2002 - The Supreme Court annuls the disputed results of the December 2001 presidential election and after a recount hands the presidency to Ravalomanana with over 51 percent of the vote. Ratsiraka says he will not abide by the decision.

May 2002 - Ravalomanana is sworn in as president. The international community shows cautious support.

June 2002 - Ratsiraka flees to France. He returns and calls for fresh talks, but Ravalomanana rejects this.

July 2002 - Ratsiraka seeks exile in France, marking the end of the seven-month political crisis. In a show of support for the new administration, donors pledge US$2.3 billion in aid.

December 2002 - Ravalomanana's party, I Love Madagascar, wins 102 of the 160 seats in parliament in key elections, seen as a test of popular support for the president.

February 2003 – A former head of the armed forces is charged with mounting an attempted coup against Ravalomanana.

July 2003 - After a year-long suspension Madagascar is readmitted to the African Union (AU).

December 2003 – Ratsiraka, still in exile, is sentenced to five years in prison for his role in the 2002 political crisis.

May 2006 - Opposition parties boycott talks with Ravalomanana ahead of presidential elections to be held in December.

November 2006 - Tensions flare briefly when an army general's call for Ravalomanana to stand down ahead of presidential elections the following month is "misinterpreted" as a coup attempt.

December 2006 – Ravalomanana wins the presidential election with 55 percent of the votes.

****The most recent crisis****

December 2008 - Andry Rajoelina, Mayor of Antananarivo and owner of the Viva TV station, airs an interview with exiled former president Ratsiraka; authorities promptly shut down the television station.

January 2009 – Thousands take to the streets demanding a new government. Dozens are killed as protests turn violent. Opposition leader Andry Rajoelina calls on Ravalomanana to resign as president and proclaims himself in charge of the country.

February 2009 - Rajoelina is sacked as mayor of Antananarivo. At least 28 people are killed when security forces open fire on an opposition demonstration in the capital. The country's defence minister resigns. Rajoelina and Ravalomanana meet to resolve the crisis but talks stall. The AU warns it will condemn any unconstitutional change of power.

March 2009 - Soldiers in a military camp outside Antananarivo mutiny and say they will defy government orders to repress civilians. Madagascar's army chief issues a 72-hour ultimatum to the feuding political leaders to resolve their disputes or face military intervention. Ravalomanana proposes a referendum as a solution; fearing further unrest he resigns, ceding power to the military. Rajoelina assumes power with military and high court backing. The AU and the Southern African Development Community (SADC) suspend Madagascar.

April 2009 - Security forces clash with supporters loyal to Ravalomanana.

June 2009 - Ravalomanana, in exile in South Africa since March, is sentenced in absentia to four years in prison for abuse of office.

August 2009 - International mediators broker a power-sharing agreement in Mozambique's capital, Maputo, between Madagascar's political rivals who agree to create an interim government to end months of violence. A second round of talks in Maputo ends without agreement on who should be prime minister, or hold other key cabinet posts.

September 2009 - Rajoelina unilaterally names a new "unity" government, amid wide international condemnation.

October 2009 - Madagascar's opposing political factions agree to retain Rajoelina as head of the transitional government, but will not allow him to run in presidential elections. A consensus prime minister is appointed.

November 2009 - Madagascar's political rivals meet in the capital of Ethiopia, Addis Ababa, and agree on a transitional consensus government until fresh polls are held in 2010. Rajoelina retains the presidency but is flanked by two co-presidents.

December 2009 - Rajoelina distances himself from the power-sharing deal, boycotts new talks in Maputo, and announces a plan to hold parliamentary elections in March 2010. Opposition accuses Rajoelina of stalling on implementing a consensus government.

Jan 2010 - Rajoelina snubs the African Union's top diplomat, and again rejects calls for consensus government.

February 2010 - Rajoelina postpones the parliamentary election until May. The AU threatens Rajoelina and his administration with sanctions unless the power-sharing deal is implemented by 16 May 2010.

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http://www.irinnews.org/report.aspx?ReportId=88457NAIROBI Wednesday, March 17, 2010 (IRIN) - God, not global emissions, is to blame for climate change, according to a survey conducted in 10 African countries. A close second, however, came deforestation, underlining the argument that there is information available – just not sufficient or effective enough to help people understand the reasons behind environmental issues.NAIROBI Wednesday, March 17, 2010 (IRIN) - God, not global emissions, is to blame for climate change, according to a survey conducted in 10 African countries. A close second, however, came deforestation, underlining the argument that there is information available – just not sufficient or effective enough to help people understand the reasons behind environmental issues.

“(God) punishes people because we do bad things. He shows his strength with the hurricanes and storms,” said a young Senegalese woman interviewed by the BBC World Service Trust, which, with the British Council, launched Africa Talks Climate in Nairobi on 17 March.

The findings are the result of discussions conducted in 2009 with more than 1,000 citizens and 200 policy-makers, opinion leaders, media and business people in Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Nigeria, Senegal, South Africa, Sudan, Tanzania and Uganda.

While highlighting the information gap similar to the inadequate communication strategy adopted in the initial response to HIV/AIDS, BBC World Service Trust Director, Caroline Nursey, said: “The initial global response to communicate effectively about the HIV and AIDS pandemic was slow and often inappropriate to local needs. The media have had a critical role in helping combat HIV and AIDS in Africa and must be supported to do so again in the case of climate change.”

Prime Minister Raila Odinga of Kenya said an initiative such as Africa Talks Climate was relevant to encourage governments and media to find ways to let people in Africa understand why they were suffering from global effects of climate change, being the result of CO2 emissions worldwide and not some sort of divine punishment.

“Ordinary citizens do not know. We failed to educate our citizens on the effects and causes of climate change,” the Prime Minister said.

“Africans are mainly victims not offenders, and they need to know. But at this stage, it doesn’t matter who is the victim and who the perpetrator, because we all have the shared responsibility to do something to mitigate the effects of climate change.”

Odinga said the Kenyan government was committed to addressing the effects of climate change in the country and helping the millions of food-insecure people because of drought, famines, flooding and other natural disasters.

Among the initiatives taken by the Kenyan government is the planting of 7.6 million trees by 2020, with the support of the French and US governments, boosting forestry from 2 to 10 percent.

“We are willing to host the next Summit for Climate Vulnerable Nations in Kenya before autumn 2010. This would be an eye opener for leaders of other countries to understand that common efforts and collaborations are indispensible to achieve success and open the door for more satisfactory negotiations for the next climate change summit taking place in Mexico in October 2010,” said Odinga.

Environmental policy

Nobel Peace Prize winner Wangari Maathai called on political leaders to take immediate action to reduce vulnerability to climate change through ad-hoc legal frameworks to support environmental policy, which many countries, especially in Africa, still did not have.

“Billions of dollars have been invested already to tackle the effects of climate change on our people. Many African countries may not have funds to allocate, but it is up to us to make ourselves trustworthy, so that other government would be willing to support us. And I have no doubt that they will,” she said.

“Climate change is affecting Africa tremendously,” she said, while reminding the audience that 15 of the 20 countries most vulnerable to climate change are in Africa, according to the World Bank.

“We must find the right way to let our people know why,” she said. “Finding the most appropriate means to reach people and using their own language is the key,” she said.

“We need to simplify messages and let people understand that our actions have an impact on the environment,” Odinga added.

“There is the perception that talking about environmental issues does not sell. We have to get over this belief and understand that we need to talk more about it. Climate change does sell, but it has to be communicated in an easy and more relevant way to make messages accessible,” said Sam Otieno, researcher at the BBC World Service Trust.

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http://www.irinnews.org/report.aspx?ReportId=88459JOHANNESBURG Wednesday, March 17, 2010 (IRIN) - As more HIV-positive people access treatment and live longer, the number of people suffering from HIV-related mental disorders is growing, but mental health remains an ethical, legal and clinical minefield, where many doctors and nurses fear to tread – and fear to test. JOHANNESBURG Wednesday, March 17, 2010 (IRIN) - As more HIV-positive people access treatment and live longer, the number of people suffering from HIV-related mental disorders is growing, but mental health remains an ethical, legal and clinical minefield, where many doctors and nurses fear to tread – and fear to test.

"We're moving away from seeing patients on their death beds towards patients who are living longer, and are being affected by mental disorders that have real impacts on their life and work," said Dr Greg Jonsson, a psychiatrist at the Luthando Psychiatric HIV Clinic at the Chris Hani Baragwanath Hospital, in Johannesburg.

Various studies have shown a higher than average prevalence of mental illness among people living with HIV. A 2005 study by South Africa's Human Sciences Research Council found that about 44 percent of the 900 HIV-positive individuals surveyed suffered from a mental disorder.

The links between HIV and mental illness are complex, but factors include the effects of the virus on the central nervous system, as well as difficulties in dealing with HIV-related stigma and discrimination.

South Africa has the world's largest ARV programme to counter an HIV prevalence rate of about 18 percent, according to UNAIDS, and about 920,000 people are on ARV treatment.

No easy choices

Doctors and nurses in clinics often find it daunting to test mental health patients for HIV. "People who are not trained in psychiatric disorders are scared of getting consent from patients with mental disorders," Jonsson told IRIN/PlusNews. "People should not assume that mentally ill or even psychotic patients are incapable of understanding [testing] and consenting."

However, Jonsson added that there would be times where doctors would need to make tough calls about testing severely mentally ill patients who could not consent to HIV testing and whose families may not be approachable to consent on their behalf.

"If you can't obtain informed consent, you need to weigh up the potential harm and benefit to the patient - ask yourself whether this test is going to change your diagnoses or your treatment," he suggested to health workers at an annual symposium held by the Aurum Institute, a non-profit medical research organization.

"I think if the answer is 'yes' to either, then go for it. It is really the right of the patient to be offered effective HIV treatment," said Jonsson, who pointed out that doctors should be aware of possible interactions between mental health medications and antiretroviral (ARV) drugs.

He advised doctors to document the process and counsel patients throughout, especially about how to reduce risk, given the prevalence of substance abuse among mental health as well as HIV patients.

"Psych is hard because the 'three ticks equal this' approach doesn't really work, and that's why people are so scared of it," Jonsson told IRIN/PlusNews.

No right answers

Once a mental health patient started taking ARVs, healthcare providers would have to evaluate whether mandating a "treatment supporter" – a friend or family member to help the patient adhere to treatment - would be appropriate. Again, there may not be a right answer.

"We need to draw up protocols and put them in primary healthcare, but the problem with protocol-based system is that people don't think outside the box - with mental health patients it really is on a case-by-case basis," Jonsson told the symposium audience.

"I tell most of my patients, 'If you can get treatment support, go for it', but I don't insist on it - disclosing to a patient's family is difficult and ... at my clinic, our patients on treatment are already so stigmatized and victimized."

The Luthando Psychiatric HIV Clinic has a treatment default rate – patients who discontinue ARVs – that is the same as institutions in Johannesburg that mandate treatment supporters, Jonsson added. 

llg/he http://www.irinnews.org/report.aspx?ReportId=88461ANTANANARIVO Tuesday, March 16, 2010 (IRIN) - Madagascar's political deadlock masks an increasingly fragile humanitarian situation that will keep deteriorating if no solution to the ongoing crisis is found. ANTANANARIVO Tuesday, March 16, 2010 (IRIN) - Madagascar's political deadlock masks an increasingly fragile humanitarian situation that will keep deteriorating if no solution to the ongoing crisis is found.

A year after former President Marc Ravalomanana was forced from power by current President Andry Rajoelina and part of the army, the country is still without an internationally recognized government.

The African Union (AU) is set to announce what action it will take against Rajoelina and his administration, known as the Higher Transitional Authority (HAT), should they fail to implement agreed power-sharing measures - signed in 2009 with the leaders of Madagascar's three other main political parties - by March 17, exactly a year after the coup-style change of leadership.

Amid the political turmoil and economic decline, aid organizations are worried about a worsening humanitarian situation and diminishing capacity to respond to emergencies on the disaster-prone island - in the most recent calamity, tropical storm Hubert struck Madagascar's east coast on 10 March, killing at least 36 people and leaving some 37,000 homeless.

Dramatic cuts in public spending by a government struggling to deal with the combined economic impacts of a domestic political crisis and the global financial crisis has meant that basic commitments in sectors like health and education cannot be met.

"The one thing that ... [everyone] should be able to agree upon is that the longer the crisis drags on, the worse the economic situation becomes for the Malagasy people," said John Davis, Madagascar country director of CARE International, which works to reduce poverty.

"What has been difficult over the last year is that food security issues in the south have become more severe, and we have seen tropical storms and flooding affect some areas. As a result, we are seeing signs of declining livelihoods, but it is hard for outsiders to understand these various distinct and recurrent humanitarian crises and separate them from the political situation," he told IRIN.

Economic hardship

It's been a tough year. The World Bank noted in its February Programme Update that "the existing political situation and the global financial crisis are exacting a heavy toll on Madagascar's economy, leading to a decline in economic growth and job losses."

Falling demand for Madagascar's main export products, including vanilla, cloves, coffee and shrimps, has reflected the downturn in global trade. As a direct result of the political crisis, international donors cut non-essential humanitarian aid, which previously accounted for up 70 percent of government spending, the International Monetary Fund noted.

The World Bank put job losses at 228,000, mainly in urban areas and largely as a result of a sharp decline in tourism and the suspension of a preferential trade agreement with the US, on which Madagascar's textile industry had relied heavily. Up to 50,000 jobs are at risk as textile factories that can no longer afford to export to the US start closing.

According to the Bank, economic growth in Madagascar collapsed to just 0.6 percent in 2009, from 7 percent in 2008. The figures suggest that public investment is down by around 30 percent, construction by 40 percent, imports by 22 percent, and energy consumption by 15 percent.

Tax collection was down about a quarter in 2009, and a February brief by the Bank's Lead Madagascar economist concluded that "authorities need to get more out of each dollar they spend. The local economy has certainly been in recession since the second quarter of 2009 and perspectives are even more sombre for 2010."

Social hardship

Nearly 70 percent of Malagasy live below the poverty line, according to the UN Children's Fund (UNICEF). "In this context ... ensuring the basic rights of the population remains crucial," UNICEF said in a report released in February. "The situation presents a risk of increasing vulnerability levels, particularly of children and women."

With social investment estimated to have shrunk by around US$200 million, the corresponding cut in the health budget has brought the provision of basic services into question, in particular common inoculations like measles, tetanus, polio and BCG (Bacillus Calmette-Guérin a vaccine against tuberculosis), up to half of which is paid for by the government.

"Our priority now is to monitor child vulnerability and to respond accordingly, taking into consideration the erosion of essential services for children," Bruno Maes, head of UNICEF Madagascar, told IRIN. The agency projects that expenditure on routine vaccinations will double in 2010 to plug the gap in government funding and ensure that children receive routine inoculations in 2010.

Continued support

Despite some donor disengagement the international community has remained remarkably supportive said Benoit Kalasa, acting Resident Coordinator for the UN system in Madagascar. "They have not abandoned the Malagasy population ... who have already paid a high price for political instability in the past."

The World Bank, Madagascar's largest donor, has processed no fund withdrawal requests since 17 March 2009, but "with a view to minimizing adverse impact on the lives of poor Malagasy citizens", the Bank had resumed disbursements for critical project components with a "direct bearing on human well-being", such as nutrition, HIV/AIDS and food security, the Bank said in its February statement.

USAID, another large donor, halted "development" aid but increased "humanitarian" aid. Richard Marcus, Director of the International Studies Programme at California State University in the US, who has just returned from Madagascar, noted that "very few donors have pulled out" completely.

Besides the money, it was also important that donors stayed "because it is relatively easy to ramp up funding if conditions allow when there is still an operating country office ... it can take years before new funding initiatives can be negotiated and the infrastructure for funding can be established," Marcus told IRIN.

Still, the reduction in project spending by donors is being felt, particularly in social sectors like education and healthcare, and "that pressure will increase dramatically in 2010," Marcus warned.

"The current government is surely under financial pressure", he said, and without external support from donors "It will be increasingly difficult to meet public salary demands. That is a priority in Madagascar, as civil servants are well organized and have a history of leading social action, particularly in the capital."

Breaking the cycle

Resolving Madagascar's political crisis is a long-term project that will take complex political reform and education. Since the beginning of the crisis the international community has taken the winding path of reconciliation between the island's current and three former presidents. An International Contact Group has been formed to broker dialogue between the parties.

"There were several factors that sparked the current crisis: first among them was poor governance, characterized by a collision between public and private interests [under former president Ravalomanana]," said Guy Ratrimoarivony, director of the Centre for Diplomatic and Strategic Studies, based in the capital, Antananarivo.

"This helped spark popular discontent at a time when Madagascar was also suffering from the global economic crisis. Rajoelina was a catalyst, the person that came to represent the opposition." He suggested that political dialogue should include national discussion of issues as complex as federalism and decentralisation.

"To avoid a repeat crisis, I believe the civil society should play a role, and that it is necessary to completely restructure the republic. We need to start from the base, to see what people want and what they attach value to," said Ratrimoarivony, who believes that Madagascar needs a new constitution to lay the foundation of a more stable state.

However, some observers say the strength of the civil society movement in Madagascar has historically been weakened by political bias. "Civil society is not independent, and successive governments have worked only with those groups that support them," Hanitra Rafolisy, president of the National Union of Human Rights, a platform for rights groups, told IRIN.

"The number of people out of work rises every day, the number of children not in school rises every day, and every day the security situation deteriorates," he commented.

Ratrimoarivony said finding a sustainable solution to Madagascar's seemingly chronic political instability could take many years. "Education is fundamental; we need education and time. This may take one or two generations, but we must start now to change the mentality of young people."

Marcus pointed out that "Every president since independence has manipulated the constitution to suit his needs. The populace appears, if anything, sickened by leadership, and perceive the problem as a battle between leaders from which they suffer, but of which they are not a part."

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http://www.irinnews.org/report.aspx?ReportId=88447JOHANNESBURG Monday, March 15, 2010 (IRIN) - New research suggests that the poor knowledge and attitudes of doctors and healthcare workers in South Africa are limiting access to preventative tuberculosis (TB) therapy. JOHANNESBURG Monday, March 15, 2010 (IRIN) - New research suggests that the poor knowledge and attitudes of doctors and healthcare workers in South Africa are limiting access to preventative tuberculosis (TB) therapy.

The qualitative study by the health research non-profit, the Aurum Institute, found that many doctors and health workers shied away from prescribing isoniazid preventative therapy (IPT), in which daily doses of the antibiotic isoniazid are administered for at least six months to reduce TB risk in HIV-positive people.

The reasons most often cited by health professionals for not prescribing IPT included an inability to rule out active TB, little knowledge about IPT's benefits, and little confidence that patients would continue taking the medicine, said Dr Salome Charalambous, HIV/AIDS Programme Director at Aurum, who presented the research at the institute's annual symposium for health workers in Johannesburg.

IPT can reduce the risk of active TB in people living with HIV by about a third, according to the World Health Organization (WHO). South Africa has had national guidelines for administering IPT since 2002, but coverage has been estimated at below 1 percent. Health workers interviewed for the study also said they felt the Department of Health had not done enough to communicate the current IPT guidelines to them.

The WHO lists TB as the leading killer of people living with HIV, and South Africa has an HIV prevalence rate of about 18 percent. The country also shoulders one of the world's highest TB burdens, according to the WHO.

"It's not to say everyone must be started on IPT, but there are a whole lot of people who could benefit from IPT but are not," Charalambous told IRIN/PlusNews.

More about the professionals, less about the patients

International and national guidelines caution doctors to avoid issuing preventative TB therapy in people who have active TB. Charalambous said the difficulty in diagnosing active TB, which can hide in tissue outside of the lungs, deterred many health professionals from using IPT.

"Standard pulmonary TB is not [present in] more than 30 percent of our patients, so sputum, abscess, lymph nodes, x-rays are very often negative. I would never use [isoniazid] on my patients for this reason alone,"  said a doctor quoted in the study.

Other doctors were not convinced of the value of giving IPT to patients already on antiretroviral (ARV) medication. Little research has been done on the effects of IPT on patients taking ARVs, but new findings presented by Aurum at the recent 2010 Conference on Retroviruses and Opportunistic Infections showed that IPT drastically decreased mortality in newly initiated ARV patients.

Aurum's qualitative study showed that health workers' attitudes to patients influenced their willingness to prescribe IPT. "It was interesting that staff felt that patients would not understand the concept of taking medication while feeling well, but when we asked patients they didn't say taking a preventative tablet would be a problem," Charalambous commented.

The researchers recommended that the Health Department clarify the screening process and initiation requirements for IPT, and that patients be educated about treatment options for preventing TB.

llg/kn/he http://www.irinnews.org/report.aspx?ReportId=88432JOHANNESBURG Monday, March 15, 2010 (IRIN) - Zimbabwe's food security has improved but is still "precarious" and "vulnerable to sudden shocks", according to the latest update by the UN Office for the Coordination of Humanitarian Affairs (OCHA). JOHANNESBURG Monday, March 15, 2010 (IRIN) - Zimbabwe's food security has improved but is still "precarious" and "vulnerable to sudden shocks", according to the latest update by the UN Office for the Coordination of Humanitarian Affairs (OCHA).

Food insecurity concerns have been raised, "although the area planted for maize increased by 14 percent - from 1,507,968 hectares in 2008/09 to 1,723,990 hectares in 2009/10 - about 200,574 hectares, representing 11.6 percent of area planted, is a write-off because of the dry spell [from December 2009 to February 2010], according to the First Round Crop and Livestock Assessment, the update noted.

Food shortages peaked in the first quarter of 2009, when nearly 7 million people relied on emergency feeding schemes, but the country remains fragile despite the formation of a unity government in February 2009. The donor community has yet to respond to the 2010 Consolidated Appeal (CAP) for US$378 million, committing only US$5 million - 1.3 percent of the requirement - so far.

OCHA's Financial Tracking Service, which monitors global humanitarian aid flows, on 15 March 2010 showed a continuous flow of pages highlighting unmet requirements in red - rural restocking programmes, seeds for small-scale farmers, local government capacity building, cholera prevention projects - with zero commitment in 99 percent of the pledges column.

go/he http://www.irinnews.org/report.aspx?ReportId=88433JOHANNESBURG Monday, March 15, 2010 (IRIN) - Cholera has claimed the lives of over 40 people in Mozambique and ongoing flooding throughout the central and northern parts of the country could "aggravate" the problem, aid agencies say.JOHANNESBURG Monday, March 15, 2010 (IRIN) - Cholera has claimed the lives of over 40 people in Mozambique and ongoing flooding throughout the central and northern parts of the country could "aggravate" the problem, aid agencies say.

"This is not unexpected," the Chief of Health and Nutrition at the UN Children's Fund (UNICEF) in Mozambique, Roberto De Bernardi, told IRIN. The underlying factors of cholera in Mozambique have been related to pervasive water and sanitation problems, and a chronic lack of access to health facilities.

Mozambique's National Institute for Disaster Management (INGC) noted on 15 March that 2,683 cases of cholera had been recorded since 3 January 2010, mainly in the provinces of Sofala, Nampula, Zambezia, Niassa and Cabo Delgado.

Cholera occurs seasonally, peaking during the rainy season from October through April, but torrential rain over the past few weeks and flooding in large parts of the country were not to blame.

"Until now we have not seen any cholera cases in the flood-affected areas," said De Bernardi, but "the floods could aggravate the cholera situation - it's a structural problem in Mozambique; I can't remember a year without cholera." As a precaution, cholera prevention programmes were being intensified in flood-affected areas.

The World Health Organization (WHO) country profile for Mozambique notes that the disease has been present in the country since 1973. In 1992, '93, '98, '99 and 2004, notified cholera cases in Mozambique represented one-third to one-fifth of all cases reported in Africa.

Cholera is a waterborne intestinal infection that causes severe diarrhoea and vomiting, leading to rapid dehydration. Left untreated it can bring death within 24 hours, but WHO describes it as "an easily treatable disease" that can be cured with rehydration salts.

tdm/hehttp://www.irinnews.org/report.aspx?ReportId=88434JOHANNESBURG Monday, March 15, 2010 (IRIN) - Tropical storm Hubert battered Madagascar on 10 March, cutting off entire communities in the southeast from emergency aid. A limited amount of relief - mainly food items - has been flown in because of damage to infrastructure, and aid agencies are trying to reach people in need of assistance via the river systems.JOHANNESBURG Monday, March 15, 2010 (IRIN) - Tropical storm Hubert battered Madagascar on 10 March, cutting off entire communities in the southeast from emergency aid. A limited amount of relief - mainly food items - has been flown in because of damage to infrastructure, and aid agencies are trying to reach people in need of assistance via the river systems.

Dia Styvanley Soa, spokeswoman for Madagascar's disaster management agency, BNGRC, told IRIN that according to the latest estimates, "36 people lost their lives and some 85,000 have been affected", and eight people lost their lives in mudslides on 15 March.

"We now have a problem with logistics - many roads have been cut off and many communities are now isolated," she said, particularly in the southeastern province of Fianarantsoa.

A statement by the BNGRC on 14 March said 20 tonnes of rice and other relief items, like medicines and tents, had been distributed, but more was needed.

In previous years the BNGRC had managed to store relief items throughout the country in anticipation of the "cyclone season", but this year pre-positioning had not been possible, Soa said.

Madagascar lies in the main path of storms crossing the western Indian Ocean and is battered by cyclones every year; five have struck in the last two years, affecting over 463,000 people.

In November 2009, the UN Country Team raised concern over the approaching cyclone season and appealed for US$6 million in urgent funding to pre-position emergency supplies in the most vulnerable regions of the country. A drought in the south in early 2009 had depleted stocks, but political infighting caused Madagascar's major donors to disengage and funding ran dry.

The cyclone season typically runs from November to April, but this year it has been relatively mild and Hubert was the first storm to cause major destruction. However, the Malagasy Meteorological Service has warned that there might be more severe storms before the season ends.

tdm/hehttp://www.irinnews.org/report.aspx?ReportId=88435LUSAKA Thursday, March 11, 2010 (IRIN) - Parity Zulu, 17, constantly recited a Biblical verse asking God for protection from her persecutors while her mother ferried her to hospital following complications from the teenager's illegal abortion.LUSAKA Thursday, March 11, 2010 (IRIN) - Parity Zulu, 17, constantly recited a Biblical verse asking God for protection from her persecutors while her mother ferried her to hospital following complications from the teenager's illegal abortion.

Her mother, Margaret, was unaware that her daughter had paid K350,000 (US$74) for a back-street abortion three days earlier. "All the way to the hospital I asked my child what happened. She wouldn't tell me. Then she began to sing Psalm 57, a cry for help. I began to suspect she was aborting a pregnancy," she told IRIN.

At the hospital's emergency admission desk, Zulu's medical condition was immediately apparent to Nurse Serephina Moonde. "I can tell a botched abortion as they come in through the doors - on average I see up to ten new patients a day. Women and young girls coming in, bleeding - sometimes we can save them; other times, like in Parity's case, it's too late - their wombs are rotting and they have lost too much blood."

Moonde said she had seen the results of the horrific methods women sometimes used to induce abortion: drinking crushed glass boiled with coca-cola, inserting crudely sharpened wooden sticks into the cervix, taking heavy doses of anti-malaria tablets, and even ingesting poisons such as battery acid.

Zambia's maternal mortality rate of 591 per 100,000 live births is one of the highest in the world, according to the 2008 Demographic Health Survey (DHS), the most recent.

One-third of maternal deaths are thought to be the result of abortion, but a shocking statistic is that 80 percent of the women who die from abortions are under the age of 19.

Abortion law

The Zambian Termination of Pregnancy Act 1972 is based on British colonial legislation, which permits abortion when continuation of the pregnancy can be proved to be detrimental to the mother, or the child, or both.

The law states that those wanting a termination must seek the consent of three physicians, but this requirement may be waived, if the abortion is deemed an emergency, to save the woman's life or prevent grave permanent injury to her physical or mental health.

In 2009 the University Teaching Hospital (UTH) in the capital, Lusaka, the country's largest medical facility, recorded 5,295 abortions, of which 5,246 were a consequence of incomplete abortions; 31 women died as a result of complications.

Only nine terminations of pregnancies were performed at UTH in 2009, according to the provisions of the law, down from the 2008 figure of 126 legally performed terminations.

Dr Peter Mwaba, UTH's managing director, told IRIN that the hospital was a place of last resort, and the statistics did not include women seeking help for complications from an abortion at other public or private clinics.

He said many women did not have access to effective contraception, and there were gender inequalities as well as deeply entrenched stigmas around abortion, which contributed to women practicing self-abortion or seeking other unsafe procedures. Women seeking to terminate pregnancies were also making use of the greater availability of a variety of drugs at pharmacies and private clinics.

It was the attempts to procure abortions this way [unsafely] that brought on the complications - it was basically guesswork, and that was why women arrived at hospitals "half dead", he said.

Holo Hachoonda, a clinical director at the Planned Parenthood Association (PPAZ), told IRIN that many health practitioners did not understand the abortion law, and were reluctant to provide these services.

"People still do not see abortion as a right backed by law. They still also have not gotten used to the thinking that a woman has rights over her own body, and can make decisions about something like abortion," he said.

Mary Beth Jones, 46, decided to seek an abortion after falling pregnant with her fifth child. At the clinic she was asked why, as a married woman who had no health issues, she wanted an abortion. Had she had committed adultery?

"They wanted me to tell my husband, go through couple counselling, etc. I also felt they were judging me, and I was afraid that there would be no confidentiality, as we were being lumped together like naughty children and lectured. I can imagine how horrible it must be for a young girl seeking an abortion," she told IRIN.

Jones resorted to a herbal remedy from a traditional healer to induce a miscarriage. "I haemorrhaged so badly I ended up in hospital and had to have my womb removed. Needless to say, I am now a divorcee."

Religious barriers

In an effort to improve the efficacy of the Act, in June 2009 the government launched the Standards and Guidelines for Reducing Unsafe Abortion Morbidity and Mortality in Zambia, for interpreting the 1972 legislation.

The guidelines provided for abortions to be performed in the interests of a women's physical or mental health; nurse practitioners had been trained to provide medical abortions and first-trimester abortions; women no longer had to stay overnight in hospital after the procedure. Family planning services, including abortion services, have been extended throughout the country.

However, the biggest challenges to abortion are the deeply held religious views that think girls engage in sex when they should not, and see abortion as a sign of promiscuity.

Zambia's more than 11 million people are predominantly Roman Catholic, but conservative evangelical churches have grown considerably in recent years; in combination these represent a formidable degree of social disapproval of terminating pregnancy.

Suzanne Matale, Secretary-General of the Christian Council of Zambia (CCZ), the Catholic Church's mother body in Zambia, told IRIN that life began at conception. "There are no grey areas, no room for discussion. We condemn abortion. It's an absolute no-no."

Government spokesman Ronnie Shipakwasha, a Pentecostal church elder, told IRIN the abortion law would not be touched until there had been wide consultations with medical authorities, policy-makers and religious bodies.

He did not provide a timeframe, and there has been no call for this dialogue; he said the law, read in conjunction with the guidelines, was sufficient to ensure safe abortions.

"We just need to make this information available," he said. "We are a Christian country, so the church's teachings on morality are a major factor in how we deal with the issues of abortions."

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http://www.irinnews.org/report.aspx?ReportId=88393JOHANNESBURG Thursday, March 11, 2010 (IRIN) - Rivers throughout central and northern Mozambique are swollen above flood alert level and thousands of people have been relocated to higher ground, but national disaster management authorities and aid agencies in Mozambique say "the situation is under control".JOHANNESBURG Thursday, March 11, 2010 (IRIN) - Rivers throughout central and northern Mozambique are swollen above flood alert level and thousands of people have been relocated to higher ground, but national disaster management authorities and aid agencies in Mozambique say "the situation is under control".

After weeks of torrential rain in Mozambique and its regional southern African neighbours, Zambia and Zimbabwe, the National Institute for Disaster Management (INGC) indicated that 130,000 people were living in risk zones and could be forced to move if water levels kept rising.

A Red Alert was declared on 9 March for the basins of the Zambezi, Pungue, Buzi and Licungo rivers, but the Representative of the UN Children's Agency (UNICEF), Leila Pakkala, who is responsible for coordination in the Humanitarian Country Team, said the government and aid partners had started moving people pre-emptively.

"Thirteen thousand people have already been moved to secure areas," she told IRIN. Although the rain was expected to diminish, they were still "closely monitoring the situation in affected areas to ensure needs are identified and immediately addressed".

The cholera season in central Mozambique is at its peak; given the large populations moving through cholera-affected areas to get to places of safety, Mozambique's Provincial Health Directorate has warned of possible outbreaks in the new accommodation centres.

Pakkala said cholera prevention and response activities - like the rehabilitation of water systems, water chlorination, and informing people that they should adopt hygienic habits - were already ongoing. "Supplies have been dispatched from the pre-positioned locations by the Red Cross and UN partners," she said.

Watching regional water management

The latest National Hydrological Bulletin, released on 10 March by the National Water Directorate, said water levels in the Zambezi, Africa's fourth largest river, would remain above alert level and keep rising, "possibly aggravating localized flooding".

In neighbouring Zimbabwe, water levels in the Kariba Dam – one of the largest on the Zambezi – have been rising and the Zambezi River Authority had to open one of its flood gates on 9 March.

Downstream in Mozambique, the Cahora Bassa Dam has also increased its outflow to 4,700 cubic meters per second, and will maintain this volume until 15 March.

The UN Office for the Coordination of Humanitarian Affairs warned in its 10 March Southern Africa Floods Regional Update: "While the opening of one Kariba Dam floodgate is not a significant event in itself, any additional flow from the dam may force another increase in discharge from the Cahora Bassa [downstream], increasing the possibility of flooding in Mozambique."

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http://www.irinnews.org/report.aspx?ReportId=88399JOHANNESBURG Wednesday, March 10, 2010 (IRIN) - Mozambique's National Disaster Management Institute (INGC) has raised the flood alert level to "red" and some 130,000 people living along three main rivers in central Mozambique are at risk of possible floods and need to be moved. JOHANNESBURG Wednesday, March 10, 2010 (IRIN) - Mozambique's National Disaster Management Institute (INGC) has raised the flood alert level to "red" and some 130,000 people living along three main rivers in central Mozambique are at risk of possible floods and need to be moved urgently.

"Teams are already evacuating people," Casimo Sande, Acting UN Emergency Coordination Support Officer, told IRIN. Weeks of torrential rains have swollen the Zambezi, Pungue and Buzi rivers in the central provinces of Tete, Manica, Sofala and Zambezia.

Sande said government agencies, NGOs, the Mozambican Red Cross, UN agencies and the local Civil Protection Unit, UNAPROC, were assisting affected communities, and assessments of the damage were underway. The National Water Board (DNA) warned of floods in central Mozambique on 2 March.

Mozambique is flood-prone: in 2000 and 2001 over 800 people were killed and hundreds of thousands left homeless. Up to 300,000 people in river communities throughout central Mozambique were affected by flooding in early 2008, when 29 people died.

The government resettled entire communities when the recurring floods caused hundreds of deaths and the displacement of many thousands almost every year, particularly at the onset of the rainy season. This year a drought in the resettlement areas lured thousands back to the fertile flood plains and river banks.

More sluice gates on Mozambique's biggest dam, the Cahora Bassa, were opened to ease pressure on the structure, and rains in the region eased off during the past week. According to Sande, "In terms of water level trend, the situation has improved."

tdm/hehttp://www.irinnews.org/report.aspx?ReportId=88386JOHANNESBURG Tuesday, March 09, 2010 (IRIN) - An outbreak of Rift Valley Fever (RVF) in two South African provinces has killed one person, while five others have tested positive for the disease, which has also caused "extensive livestock deaths", the National Institute for Communicable Diseases (NICD), said in a statement on 9 March. JOHANNESBURG Tuesday, March 09, 2010 (IRIN) - An outbreak of Rift Valley Fever (RVF) in two South African provinces has killed one person, while five others have tested positive for the disease, which has also caused "extensive livestock deaths", the National Institute for Communicable Diseases (NICD), said in a statement on 9 March.

As of 4 March 2010, the livestock disease - which can be transmitted to humans by handling infected animal tissue during butchering - had been reported on 14 farms in Free State and one farm in the neighbouring province of Northern Cape.

Initial estimates by veterinarians in the affected region are that more than 1,000 livestock have perished. High mortality rates are experienced among young animals and the disease causes pregnancies to be aborted.

NICD director Dr Lucille Blumberg told IRIN the authorities had responded well to the outbreak, but RVF was "difficult to control", and "lots of rain recently" had resulted in ideal breeding conditions for mosquitoes - the vector of the disease.

Investigations were being carried out by the health and agricultural departments, supported by the South African Field Epidemiology and Training Programme, and NICD.

Outbreaks of RVF are common; in 2009 more than 50 animals died in KwaZulu-Natal Province, but the most serious occurrence of the disease in South Africa was between 1974 and 1976, when an estimated 10,000 to 20,000 humans were infected.

"The current outbreak is within the same area, highlighting the importance of timely interventions to prevent further spread," the NICD said.

Blumberg said the disease was "asymptomatic", or mild, in the vast majority of people, but about one percent of those infected could experience a more severe reaction.

According to the NICD website, "complications include: ocular (retinal) disease, meningo-encephalitis, [and] or haemorrhagic fever. Onset of retinal lesions usually occurs one to three weeks after the first symptoms appear, and may lead to permanent loss of vision, necessitating continual follow-up of patients for a one-month period after symptoms resolve. Disease is rarely fatal."

Molefi Sefularo, the deputy minister of health, said in a statement on 8 March that "A 45-year-old patient, who was admitted to a mine hospital on 26 February 2010 with a provisional diagnosis of Congo fever, died a day later and confirmation of RVF was made on the 4th of March."

RVF was first identified by a British veterinary surgeon in Kenya more than 50 years ago, and is endemic to South Africa and the rest of the continent, as well as the Indian Ocean islands of Comoros and Madagascar.

go/he http://www.irinnews.org/report.aspx?ReportId=88367NAIROBI Tuesday, March 09, 2010 (IRIN) - Global funding shortfalls for fighting AIDS could make it impossible for developing countries to implement new World Health Organization treatment guidelines, activists have said. NAIROBI Tuesday, March 09, 2010 (IRIN) - Global funding shortfalls for fighting AIDS could make it impossible for developing countries to implement new World Health Organization treatment guidelines, activists have said.

WHO released new guidelines on antiretroviral therapy (ART) in December 2009, raising the CD4 count - a measure of immune strength - at which HIV-positive people should start ART from 200 to 350. Research has shown that starting ART earlier reduces the rate of death and opportunistic disease.

"WHO's new recommendations are excellent in theory, but they did not give us a practical way of implementing the guidelines - already we have shortages of drugs in trying to put people with CD4s below 200 on treatment," said James Kamau, coordinator of the Kenya Treatment Access Movement.

"How will we now put so many more people on ARVs? The increased number of people on drugs means not just more drugs, but more labs, more health centres and health workers, more general care - the expense is enormous."

An estimated four million people around the world are currently on ART - a 10-fold increase since 2003, when the drugs became widely available - but this figure still represents just over one-third of the people who need the medication.

"If WHO's new recommendations are not implemented, the international community risks subsidising less expensive yet sub-standard care for developing countries," said Sharonann Lynch, MSF's HIV/AIDS policy advisor, in a press release.

"Avoiding this will depend on the willingness of donors to make new commitments. Although this is not easy in today's financial environment, donor countries cannot back away from supporting the promise of universal access to treatment made five years ago."

"The situation is now an emergency"

In Uganda, where the government plans to release new treatment guidelines reflecting WHO's recommendations, officials said the number of people needing treatment would rise from 300,000 to about 750,000. The country recently suffered drug shortages in its public health sector, partially caused by funding problems.

"The numbers will be too great for us to manage," said Dr David Kigawalama, head of prevention services at the Uganda AIDS Commission. "We need to sit with our AIDS development partners to forge a way forward."

Ahead of a high-level meeting between Group of Eight (G8) leaders and AIDS advocates in London on 10 March, AIDS activists met with British International Development Minister Gareth Thomas on 9 March and called on the world's wealthiest nations to honour their 2005 Gleneagles pledge to achieve universal access to HIV prevention, treatment and care by 2010.

"Instead of building on progress, some donor nations and governments of highly affected countries are backing away from the universal access commitment with a series of poorly funded half-measures on AIDS," the executive director of the International AIDS Society, Robin Gorna, said in a press statement.

"The situation is now an emergency: new treatment enrolments in many countries are coming to a standstill, the risk of drug resistance is increasing, and fragile gains made over the last 10 years may soon erode, with potentially serious consequences for future efforts to control this epidemic."

The activists singled out Canada - the only G8 nation firmly opposed to the Financial Transactions Tax, a tiny tax on financial transactions that could raise the billions of dollars needed to fulfil the universal access pledge.

The global economic downturn forced the Global Fund to Fight AIDS, Tuberculosis and Malaria, the world's largest funder, to cut disbursements by 10 percent in 2008, while the US President's Emergency Plan for AIDS Relief (PEPFAR) has flat-lined funding to many countries, limiting the growth of PEPFAR-funded treatment programmes.

kr/kn/he http://www.irinnews.org/report.aspx?ReportId=88368MBABANE Monday, March 08, 2010 (IRIN) - The myriad crises afflicting Swaziland can only be solved with a holistic approach, not a piecemeal one, the World Food Programme (WFP) deputy executive director, Sheila Sisulu, said during a recent tour of the country.MBABANE Monday, March 08, 2010 (IRIN) - The myriad crises afflicting Swaziland can only be solved with a holistic approach, not a piecemeal one, the World Food Programme (WFP) deputy executive director, Sheila Sisulu, said during a recent tour of the country.

Swaziland, a small landlocked country with a population of about one million people, is ruled by King Mswati III - sub-Saharan Africa's last absolute monarch - while contending with the world's highest HIV/AIDS prevalence, food insecurity, poor education systems, extreme poverty and a moribund economy.

Miriam Dlamini, a widowed mother of five living in rural Mliba, about 60km north of Swaziland's second city, Manzini, personifies the plight of many Swazis.

"My husband died of AIDS and left me alone to work the fields, but I am HIV positive. I need food for my children, and for myself so my ARVs work properly, but I cannot do the farm work alone, and I have no money to hire helpers or to pay for seeds and fertilizer and a team of oxen to plough," she told IRIN.

In the largely rural economy, where 70 percent of Swazis survive in a state of chronic poverty, her daily burden - like that of many others - is overwhelming. "I don't know where to begin. I wake up tired and when the day is over, so little has been done, and that makes me more tired," Dlamini said. "I receive [WFP food] packages and ARVs from the clinic, but I must travel to both places with no money for transport."

A change for the better could be on the way. On 3 March 2010, Swaziland became a member of the Common Africa Agriculture Development Programme (CAADP) - an initiative by the African Union (AU) and the New Partnership for Africa's Development (NEPAD) to address food security and agricultural production.

At the signing ceremony in the Swazi capital, Mbabane, Sisulu told a round table discussion that the spill-over of one crisis into another compounded the effects of each crisis, and the country would be hard pressed to meet the UN Millennium Development Goals (MDGS).

Interconnectiions

"Agricultural production, HIV and AIDS, food security and poverty are interconnected and cannot be tackled in isolation of each other. We believe a comprehensive approach is key to achieving the underlying objective of CAADP ... meeting Goal One of the Millennium Development Goals of eradicating extreme poverty and hunger ... at current trends, Swaziland is unlikely to achieve [this] by 2015."

Swaziland is no longer a net exporter of foodstuffs: drought and a population that has tripled since independence from Britain in 1968 have forced people to farm marginal lands, while HIV/AIDS has decimated the agricultural workforce. According to UNAIDS, about 26 percent of Swaziland's sexually active population are infected with HIV.

Membership of CAADP paves the way for the establishment of an Agricultural Development Bank of Swaziland, which could be used to provide loans or grants for subsidising agricultural inputs.

Such an eventuality would necessitate a sea change in relations between the government and non-governmental organizations (NGOs), which provide vital support in most of the country's social and agricultural spheres.

"Laudable as this show of support is, the question remains whether government can indeed work with NGOs, the private sector and the beneficiaries," said a director - who declined to be identified - of an NGO affiliated to the Congress of Non-Governmental Organisations (CANGO), an umbrella organization for NGOs.

"The [government] ministries have always worked independently - they are territorial. It will be interesting to see if they can work together, and if the voices of the rural farmers will be heard, or whether solutions will be imposed," he told IRIN.

UNAIDS Country Coordinator Sophia Monico noted that "All the UN agencies are coordinating our work on AIDS. We're setting an example by forging an alliance between specialties."

She said the UN would adopt a comprehensive approach: food security issues would be handled by WFP, AIDS issues would be handled by UNAIDS, the UN Children's agency (UNICEF) would deal with issues concerning children affected by HIV and AIDS, and poverty reduction issues, under the authority of the UN Development Programme, would be strategically coordinated.

"It's like getting relief supplies to areas hit by disaster - it's not enough to put food on the plane, you have to get the delivery infrastructure working, the beneficiaries' needs sorted out, and rebuild the agriculture sector to make food production sustainable again," said Charles Ndwandwe, a food aid distributor in Mliba.

"That's what must be done in Swaziland," he commented. "It's harder when AIDS complicates things, but this is being factored in."

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http://www.irinnews.org/report.aspx?ReportId=88355NAIROBI Friday, March 05, 2010 (IRIN) - Here are the most popular new articles on the IRIN website over the last 24 hours. Updated hourly. This feature was launched on 18 July, but will display the latest, most popular items of today.NAIROBI Friday, March 05, 2010 (IRIN) - ---http://www.irinnews.org/report.aspx?ReportId=73277JOHANNESBURG Thursday, March 04, 2010 (IRIN) - Delays in registering antiretroviral (ARV) medication may keep cheaper, more patient-friendly drugs out of reach as South Africa prepares to launch the world's largest tender for medicines. JOHANNESBURG Thursday, March 04, 2010 (IRIN) - Delays in registering antiretroviral (ARV) medication may keep cheaper, more patient-friendly drugs out of reach as South Africa prepares to launch the world's largest tender for medicines.

In a letter to Dr Aaron Motsoaledi, the Minister of Health, the South African HIV Clinicians Society called on the country's drug registration body, the Medicines Control Council (MCC), to fast-track the approval of certain ARVs, the generic versions of others, and fixed-dose ARV combinations that combine multiple ARVs into a single pill.

The new ARV tender will allow pharmaceutical companies to bid for supplying the biggest HIV treatment programme in the world, but drugs without MCC approval are unlikely to be accepted. Many activists have said that excluding unapproved drugs will make the tendering process less competitive, push up prices and deprive patients of fixed-dose combination therapy.

"My biggest concern is that the MCC is just not functioning well - they're trying to repair the system but they're not giving priority to these drugs," said Dr Francois Venter, president of the Clinicians Society, who noted that some drugs had been awaiting approval for more than two years due a backlog in the MCC.

"These drugs need to be pushed to the front of the queue; these are not experimental drugs we are talking about here, these drugs have been registered in Europe for more than a year," Venter told IRIN/PlusNews.

According to the HIV Clinicians Society's letter, all fixed-dose combinations, some of which are likely to form part of first-line regimens, and new, heat-stable paediatric formulations are among the drugs awaiting registration.

"I cannot think of another drug that is more important drug than ARVs," Venter said. "If the MCC can't fulfil its role as a registering body then, frankly, it must get out of the way."

South Africa has an HIV prevalence of about 18 percent, and its national ARV programme reaches an estimated 1.7 million people, according to UNAIDS.

Dealing with the backlog

The MCC has taken steps to address the backlog, but the organization remains understaffed said Jonathan Berger, a senior researcher at the AIDS Law Project and a member of the MCC, who spoke to IRIN/PlusNews in his personal capacity.

Long delays in registering new drugs have prompted calls by the Joint Civil Society Monitoring Forum (JCSMF) - a civil society body that monitors implementation of the government's National Strategic Plan for HIV and AIDS - for the government to waive the registration process for drugs already approved by stringent regulatory bodies such as the US Food and Drug Administration and the World Health Organization.

South African law prohibits this, but Berger said the health department might not have ruled out switching to an abbreviated review process for some drugs that have already been approved overseas.

What it means

Andy Gray, a pharmacist at the Centre for the AIDS Programme of Research in South Africa (CAPRISA) at the University of KwaZulu-Natal, said adherence and provision were a lot harder without fixed-dose combinations.

"If these [fixed combinations] aren't registered, we won't be able to take advantage of them as we increase the number of patients on treatment, and as we increase the number of sites providing ARVs, and as we increase the use of nurses to provide treatment," he told IRIN/PlusNews.

"There are great advantages to using fixed-dose combinations – they reduce errors with prescribing them, they're quicker for pharmacies to dispense, and they're easier for patients to comply with."

llg/he http://www.irinnews.org/report.aspx?ReportId=88315JOHANNESBURG Wednesday, March 03, 2010 (IRIN) - The "absurd" claim by Gauteng's police chief that South Africa's richest province was home to as many as three million "illegal" immigrants was part of a pattern by government departments to blame undocumented migrants for their own shortcomings, Loren Landau, director of the University of the Witwatersrand's Forced Migration Studies Programme (FMSP), told IRIN.JOHANNESBURG Wednesday, March 03, 2010 (IRIN) - The "absurd" claim by Gauteng's police chief that South Africa's richest province was home to as many as three million "illegal" immigrants was part of a pattern by government departments to blame undocumented migrants for their own shortcomings, Loren Landau, director of the University of the Witwatersrand's Forced Migration Studies Programme (FMSP), told IRIN.

Simon Mpembe, Gauteng's acting chief of police, reportedly told the police parliamentary portfolio committee in Cape Town on 2 March that there were "more people to police, but we don't have enough officials to do the extra work. We can't say we won't police them because they come from another country."

Landau said statements like this were "worrying", and "we should not let the police commissioners' prevarications and fabrications distract us from the reality that they [police] spend far too much of their time and money on policing non-nationals."

A FMSP study conducted in 2009 - One Burden Too Many? A Cost-Benefit Analysis of Immigration Policing in Gauteng - found that the police spent a quarter of their annual budget, or R350 million (US$48 million) in Gauteng alone, on immigration policing, despite instructions from senior officials that this was not a priority.

The 2007 Community Survey by Statistics South Africa, the most recent and accurate data available, estimated the number of foreign-born residents - including South African citizens - at about 1.2 million people, or 2.79 percent of the population. The number foreign nationals residing in Gauteng was put at 580,000.

"That number has undoubtedly increased in the last three years, but the numbers are still likely to be under 2 million - and that is for the whole country. Unless the police have conducted their own survey, they are evidently fabricating the numbers to suit their purposes," the FMSP said in a statement.

Landau commented that undocumented foreign nationals were "blamed for all their [police] failings, and it's not the first time [government departments had blamed foreign nationals]" for their inadequacies. He cited instances where the departments of housing, home affairs and education had attributed their "non-performance" to foreign nationals in South Africa.

At the same parliamentary briefing, Limpopo chief police Calvin Sengani said the province, which borders Zimbabwe, had to deal with foreign nationals "flooding our towns and cities. They cause a great number of problems with crime; we arrest them and protect them with resources that are intended for our citizens."

Landau said the claim that undocumented foreign nationals were responsible for one of the world's highest crime rates was not borne out by statistics, which showed that most crimes were committed by South Africans.

The police "spend their time looking for foreigners - it helps their own legitimacy [because foreigners are blamed for crime], and this is then seen as fighting crime. It is a spurious logic. They [the police] are not getting the serious criminals, they are getting the guys selling tomatoes on the street without a licence," he said.

The "real issue" was that it was difficult for people to come to South Africa legally; if there was a regional migration system about 85 percent of undocumented foreign nationals would have documentation, Landau commented.

Dangerous talk

Mpilo Shange, an advocacy officer at the Consortium for Refugees and Migrants in South Africa, said statements blaming foreign nationals for crime were "dangerous".

Since May 2008, when xenophobic violence swept through South Africa, killing at least 62 people and displacing 100,000 others, the government had started addressing the issue, but "a lot still needs to be done", she said.

Xenophobic violence has often accompanied service delivery protests, which have mushroomed across Gauteng Province since the beginning of 2010. Attacks on foreign owned shops and businesses have been reported. Shange said, "We are worried about it [protests combined with xenophobic violence]."

go/he http://www.irinnews.org/report.aspx?ReportId=88303NAIROBI Tuesday, March 02, 2010 (IRIN) - Medical male circumcision is now widely recognized as an important HIV prevention tool, and several African countries have included it in their national HIV strategies.NAIROBI Tuesday, March 02, 2010 (IRIN) - Medical male circumcision is now widely recognized as an important HIV prevention tool, and several African countries have included it in their national HIV strategies.

IRIN/PlusNews lists the progress of 13 nations in eastern and southern Africa identified as priority countries for male circumcision scale-up by the UN World Health Organization.

Kenya: An estimated 85 percent of men are circumcised, but just 40 percent of those in Nyanza province, which has the country's highest prevalence, have had the procedure. In 2008 the government launched a national campaign and by the end of 2009 more than 90,000 men had been circumcised, 40,000 of them during a two-month "rapid results" initiative in Nyanza.

The government aims to have all uncircumcised men - an estimated 1.1 million http://www.plusnews.org/Report.aspx?ReportId=87074 - undergo the procedure by 2013. Kenya is the only African country to have successfully rolled out male circumcision on such a large scale.

Zambia: Male circumcision prevalence is 13 percent, and Zambia aims to circumcise about 250,000 men every year. More than 16,000 men were circumcised at 11 sites in 2009, and the goal is to have 300 sites offering the services by 2014.

Swaziland: The Ministry of Health and Human Services plans to provide circumcision to 80 percent of men aged 15 to 24 by the end of 2014 http://www.plusnews.org/Report.aspx?ReportId=86444. Just eight percent of Swazi men are circumcised. The country - which has the world's highest HIV prevalence - developed a male circumcision strategy in 2008; by the end of 2009 more than 5,000 men had undergone the surgery.

Botswana: Five centres of excellence have been identified to scale-up circumcision services, and Botswana's Ministry of Health aims to reach at least 460,000 HIV negative men and boys below the age of 49 by 2012. More than 4,300 men have been circumcised since April 2009.

Zimbabwe: In April 2009 the pilot phase of service delivery began, during which 1,818 men were circumcised at four sites. A national male circumcision policy was launched in November 2009.

Rwanda: Since 2008 the government has been rolling out male circumcision in the army, where prevalence is 4.5 percent compared to a national rate of three percent. A recent study http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000211 suggested that Rwanda should also be scaling up circumcision across a broad range of age groups, especially the very young, where the procedure was found to be highly cost-effective.

South Africa: The government has been criticized for moving too slowly http://www.plusnews.org/Report.aspx?ReportId=87315 in developing a national circumcision strategy. By December 2009 the country had a draft policy but no mechanisms for training, quality assurance, or monitoring and evaluation.
South Africa has the world's largest HIV-positive population.

About 35 percent of men are circumcised. Data from the only site currently providing free circumcision - Orange Farm, near Johannesburg - reveals that 14,253 men were circumcised in 2009.

Namibia: A draft policy was submitted to parliament and training of surgical health professionals is underway. Five circumcision pilot sites have been identified, two of which are in operation. A 2009 field analysis http://www.malecircumcision.org/programs/documents/Namibia11209.pdf showed that the unit cost per procedure was very high: US$88 for adults and $72 for newborns.

Lesotho: About 4,000 men are circumcised annually at government and private clinics. A policy has been approved but is yet to be launched, and formal scale-up has not yet started. The Puisano Outreach Organization, a local NGO, is engaged in male circumcision campaigns throughout the country.

Tanzania: A 2009 situation analysis http://www.malecircumcision.org/programs/documents/TanzaniaMaleCircumcisionSituationAnalysis_September_09.pdf found male circumcision was accepted, even among traditionally non-circumcising communities, and 70 percent of Tanzanian men were circumcised. A national policy is being developed and three demonstration sites have been set up.

Mozambique: No formal policy for male circumcision has been developed, but an existing operational plan for HIV prevention includes circumcision. Five pilot sites have been selected for scale-up in 2010.

A 2008 study found that rolling out adult male circumcision in Mozambique would put undue pressure on health workers, which would limit the scale and effectiveness of the programme.

Malawi: The country is conducting data analysis to inform its male circumcision strategy. A local NGO, Banja la Mtsogolo, http://www.banja.org.mw is providing male circumcision services in its clinics, where it has 19 trained clinicians performing the procedure.

Uganda: This is one of the three countries where studies showed the link between male circumcision and HIV, but only 25 percent of men are circumcised and HIV prevalence is rising. There has been some criticism for failing to start male circumcision quickly enough - the country still has no policy, nor has it started service delivery.

A 2009 situational analysis http://www.malecircumcision.org/programs/documents/MC_situation_analysis_Uganda_full.pdf found that most practitioners would need additional training to perform male circumcision.

kr/he http://www.irinnews.org/report.aspx?ReportId=88286GABORONE Monday, March 01, 2010 (IRIN) - Botswana is adopting a two-pronged approach to tackle abuse of its immigration system by increasing the sophistication of travel documents, visas and work permits, and putting more boots on the ground to apprehend undocumented foreign nationals.GABORONE Monday, March 01, 2010 (IRIN) - Botswana is adopting a two-pronged approach to tackle abuse of its immigration system by increasing the sophistication of travel documents, visas and work permits, and putting more boots on the ground to apprehend undocumented foreign nationals.

Zimbabweans escaping their country's continuing economic, political and social malaise - despite the formation of a unity government more than a year ago - have favoured neighbouring Botswana, one of southern Africa's most prosperous nations.

Letso Mpho, acting spokesman for Botswana's Ministry of Labour and Home Affairs, told IRIN that workplace inspections would be "intensified" from 1 March 2010, and special immigration assistants would accompany police and home affairs officials to help identify undocumented foreign nationals.

The government has also begun introducing electronic online passports (e-passports), and the computerization of work and residence permits for all foreign nationals. The current passport is to be phased out in 2011.

"The ongoing e-passport project will improve the security features of the Botswana passport. The document is machine-readable - it will be difficult to fake or even tamper with it," Mpho said.

Britain, the former colonial power, has issued strong warnings to Botswana to improve its passport security systems or risk its citizens having to apply for visas to visit the UK.

In 2009 Britain withdrew South Africa's visa-on-demand privileges after raising concerns about the security of its identity documents and South Africans now have to apply for a visa ahead of travelling to the UK.

Zimbabwean nationals presenting a passport are allowed a maximum 90-day annual stay in Botswana and extensions can be granted on written requests, but Zimbabwean passports are both expensive and difficult to access, and many people migrating in search of work cannot afford to apply for one.

"From December 15, 2009 to January 15, 2010, in our South Central region, which includes such areas as Mochudi, Sikwane and Gaborone [the capital] we repatriated a total of 195 illegal immigrants," Mpho said.

"[Of these] 147 were males, 45 females and 3 were minors; all were from Zimbabwe. Prior to 15 December 2009 - that is, from January 2009 to December 14, 2009, we repatriated a total of 12,200 illegal immigrants in the same region. The numbers in our other regions like the Francistown region [bordering Zimbabwe] are even more."
 
Most of the undocumented foreign nationals were from Zimbabwe, but other countries of origin included China, Egypt, Somalia, India and Sudan. The number of undocumented migrants in Botswana is unofficially estimated to number in the hundreds of thousands.

"Other than the normal procedure of arresting culprits and handing foreign passports to the embassies of holders of such passports, the Ministry of Labour and Home Affairs, through the Department of Immigration and Citizenship, is engaged in two major projects ... the computerisation of the issuance of residence permits and visa, and the computerisation of passports and border control," Mpho said.

Arrest of permit dealers

The recent arrest of a Zimbabwean "permit dealer", Raymond Dube, who was feted by his fellow countrymen in Botswana for his ability to help many of them get work and residence permits, has created widespread concern.
 
"When I came to Botswana last year [in 2009], he helped me secure a work and residence permit, using my emergency travel document. I had exceeded my days [I was allowed to be in Botswana], but he was so helpful. Now I am afraid they may blacklist all permits he facilitated," Nothando Ncube, a Gaborone hairdresser, told IRIN.

Dube appeared in court early last month facing 11 charges of issuing false documents, including work and residence permits, and those who received false documents have had them withdrawn. In January 2010 Zimbabwean national Peter Elton was charged with possession of counterfeit immigration stamps.

"These ones were unfortunate to have their documents detected and confiscated," Ncube said. "Many of us got our papers through Ray [Dube] and his colleagues, and it will be very hard for us when the authorities manage to detect the serial numbers of the permits and licenses he issued. I can assure you, thousands of people will be affected."

Local citizens are also being implicated in permit scams, including marriages of convenience to foreign nationals, but government has announced that it will review the automatic access to residence papers of non-nationals married to Botswana citizens.

"Many Batswana have been arrested or charged for aiding and abetting illegal immigrants. Some would act as witnesses to help foreigners acquire the national identity document – omang," Mpho said. "With an omang, the foreigner would be able to acquire other documents like the passport."

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http://www.irinnews.org/report.aspx?ReportId=88270JOHANNESBURG Monday, March 01, 2010 (IRIN) - When a crisis strikes, access to antiretroviral (ARV) drugs can be among the first casualties, particularly in countries where many people are on treatment. JOHANNESBURG Monday, March 01, 2010 (IRIN) - When a crisis strikes, access to antiretroviral (ARV) drugs can be among the first casualties, particularly in countries where many people are on treatment.

But experience in Southern Africa has shown that although preventing treatment disruptions may be wishful thinking, preparing for them has become a pressing need.

New research by the Health Economics and HIV/AIDS Research Division (HEARD) at South Africa's University of KwaZulu-Natal compared three recent crises that caused treatment disruption - Mozambique's 2008 floods, Zimbabwe's ongoing public healthcare crisis, and South Africa's 2007 public sector strike – to identify potential strategies for keeping patients on treatment during emergencies.

The HEARD report, Unplanned ARV Treatment interruptions in southern Africa: what can we do to minimise the long-term risks?, identified poor planning as the biggest weakness in responding to gaps in treatment access, and suggested that doctors and patients receive better training on what do during disruptions.

"Despite crises – whether political, economic or environmental – being relatively common in southern Africa, there has been very little systematic planning for them within ARV programmes," said HEARD's Andy Gibbs, who co-wrote the report. The region's weak health systems were often the cause of disruptions.

"Strong health systems have strong planning capacity, an ability to monitor what's happening and [to mobilize] the skills and resources to cope with unexpected issues," Gibbs said. Research has linked disrupted treatment to increased risks of drug resistance and treatment failure.

Weathering the storm

Southern Africa has some of the highest HIV prevalence rates in the world, while droughts, floods and cyclones typically spark humanitarian emergencies in this chronically vulnerable region. The Southern African Development Community (SADC) has pushed member states to integrate ARV treatment into national disaster preparedness planning.

The UNAIDS regional humanitarian response advisor for East and Southern Africa, Mumtaz Mia, said Mozambique, Zimbabwe and Namibia had taken the lead in ensuring that people did not miss ARV doses amid disasters.

Mozambique experienced some of the worst flooding in the country's history in 2007, and more than 56,000 people were affected by floods in 2008, but Mia noted that planning by UNAIDS, the national AIDS council and the National Institute for Disaster Management had helped minimize treatment disruptions.

HEARD found that Mozambique had mapped the location of ARV patients in flood-prone areas, and had educated community outreach workers in the vicinity in ARV provision ahead of the devastating floods in 2008.

Dr Mit Philips, a health policy analyst at the international medical and humanitarian organization, Medicines Sans Frontiers (MSF), pointed out the importance of giving patients information before and during treatment interruptions. MSF has been working in Mozambique, Zimbabwe and South Africa, and also provided ARV treatment during Kenya's 2008 post-election violence.

"When the [post-election violence] happened in Kenya, we set up a free hotline, we used radio spots and peer networks so that patients knew how to find us to pick up their pills and continue treatment," she told IRIN/PlusNews.

"You don't need to go and find patients, you need to make sure patients know how to go and find you. If you can foresee it, it's important that the patients know how to deal  with possible disruptions at their usual health centres – it should be part of treatment literacy."

When the public sector isn't so public

In 2007, South Africa was rocked by a public servant strike that lasted for a month and affected up to half a million employees, including health workers. Data from South Africa's Gauteng Province showed that the number of patients initiated on treatment in areas like Johannesburg's inner city dipped to one of the lowest in four years.

Testimony gathered in the Western Cape Province by Treatment Action Campaign, an AIDS lobby group, showed that during the strike some pharmacies were so short-staffed they were only able to fill 25 percent of orders.

Patients and doctors used varying coping strategies to deal with the treatment disruptions and the South African HIV Clinicians Society released guidance on how to cope with treatment interruptions. Some patients were able to get more than one month's supply of drugs.

HEARD researchers argued that the South African authorities could have foreseen such an interruption and provided both patients and doctors with better training on what to do when ARVs cannot be obtained.

In Zimbabwe ARV treatment in the public health sector has also seen its share of hard times. The economic crisis sparked migration among doctors and nurses as well as patients, while hyperinflation and high levels of unemployment meant the tests required before starting ARVs were often unavailable or prohibitively expensive.

To help migrants continue treatment in other countries, MSF gives patients portable copies of their medical records, including which ARV regimen they are on.

SADC has received funding to implement a similar regional "health passport" system, but national health ministers would have to get draft legislation passed to implement it. Access to treatment, even for documented migrants like asylum seekers and refugees, is problematic.

Funding flows pose their own threat

MSF's Philips said interruptions in financial flows posed as big a threat to ARV programmes as any flood or bout of civil unrest, and might become a threat of increasing importance as HIV and AIDS funding constricted in the global financial crisis.

"What we have been seeing in the last six months to one year are increasing disruptions to programmes ... many of these are due to delays in funding, or delays in the supply chain," she commented. "IN a way, it's more difficult to prepare for these [than for natural disasters] because the information on the risk of treatment disruption isn't always shared with implementing partners in a transparent way ahead of time."

In 2009, South Africa's Free State Province experienced widespread treatment disruption due to a combination of funding problems and allegations of poor management.

Philips noted that several countries including Malawi, Mozambique and Uganda  had experienced problems with funding or drug procurement, and were more vulnerable to disruptions not only because of weak health systems but also because of a heavy reliance on a single funding source. According to an MSF report, Punishing Success, the bulk of Malawi's ARV funding as of 2009 came from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

"What we are seeing is that quite a lot of donors seem to see the Global Fund as a main channel of international funding for HIV treatment. If there is only one channel and something happens, there's nothing you can do," she said. "Countries depend on the timely arrival of supplies; when money for drugs was delayed in Malawi, there was no buffer."

Few countries carry ARV buffer stocks - surplus drugs kept aside and used in the event of a drug shortage. Philips said this strategy was successfully employed in the Democratic Republic of Congo, which put a pool of donor-funded ARVs under World Health Organization management.

Fareed Abdullah, director of the Fund's Africa Unit, said the Global Fund had begun addressing funding delays after the issue was raised at the organization's highest level.

"Clearly, the reasons behind stock-outs are multi-factorial, and responsibility for them lies with various donors and implementing agencies, not least of all, governments," he told IRIN/PlusNews. "Having said that, there are certainly a number of steps within our financing process where the Global Fund considers the risk of drug stock-outs."

The Fund offers countries emergency disbursements to cover unexpected treatment shortages, and allows two years of gap funding to cover ARV treatment specifically, between grant disbursements, Abdullah said. The Fund has also taken on additional responsibilities in an effort to reduce treatment disruptions due to problematic procurement.

"Sometimes we finance drugs that make their way to the central store, and they don't get from the central store to the clinics – that's really for countries to address, alongside implementing partners," Abdullah commented.

"However, in some countries we have a failure of procurement and, even though we have resisted taking over those functions because we believe in country ownership, we now have a mechanism where we will procure drugs for a country."

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http://www.irinnews.org/report.aspx?ReportId=88272PRETORIA Friday, February 26, 2010 (IRIN) - Zimbabwe's still-limping economy can provide few essential services, so children living along the border cross into South Africa to attend school during the day or even to see a doctor, often at great risk to their personal safety.PRETORIA Friday, February 26, 2010 (IRIN) - Zimbabwe's still-limping economy can provide few essential services, so children living along the border cross into South Africa to attend school during the day or even to see a doctor, often at great risk to their personal safety.

The UN Children's Fund (UNICEF) regional child protection advisor for East and Southern Africa, Cornelius Williams, said the movement of unaccompanied child migrants from Zimbabwe was one of the biggest problems confronting humanitarian agencies in the region. Between 3,000 and 15,000 Zimbabwean children are known to move into and out of their country every month.

"Unfortunately, governments continue to devote most of their resources to child trafficking, where much smaller numbers of children are involved," Williams told IRIN at a meeting of officials from 15 countries in Pretoria from 23 to 25 February to discuss ways of strengthening cross-border co-operation to protect children at risk.

William Duncan, deputy secretary-general of the Hague Conference on Private International Law, the Netherlands-based world organization for cross-border cooperation in civil and commercial matters, said an even bigger issue was that "There is no central authority in Zimbabwe to contact to help repatriate the child."

The Chief Family Advocate in South Africa's Department of justice and Constitutional Development, Petunia Seabi, said a solution to the problem was being worked out. "We are in talks with the Zimbabwean authorities to set up protocols to protect these children."

She said neither of the governments would prevent children from accessing services across the border, but would rather try addressing the risks the children took while crossing the border unaccompanied.

Duncan pointed out that the numbers of Zimbabwean children moving around the region only underlined the need for close cooperation between child protection agencies and "between judges in different countries, and the Hague Children's conventions make this possible."

Many African countries have yet to ratify the Hague Conventions pertaining to children, which seek to standardize international legislation and provide a comprehensive legal framework to for the cross-border movement of children; more governments have ratified the African Charter on the Rights and Welfare of the Child and the UN Convention on the Rights of the Child.

Duncan acknowledged that most countries did not have the resources or the capacity to ratify the Hague Conventions, which include treaties on child abduction, inter-country adoption, protection of children and the international recovery of child support. He said the Hague Conference was trying to build capacity.

Delegates at the meeting said the discussion on the need for better cooperation between governments couldn't have come at a better time than on the eve of the FIFA World Cup, which kicks off in South Africa in June.

"We will probably see a flood of child migrants to South Africa, not only attracted by economic benefits but a chance to spot their football hero," said Williams.

The South African government was gearing up for the challenge, he said. They were planning safe areas for unaccompanied child migrants around the various stadia, and an advertising campaign aimed at visitors, which, they hoped, would deter child prostitution.

jk/he http://www.irinnews.org/report.aspx?ReportId=88249JOHANNESBURG Friday, February 26, 2010 (IRIN) - South Africa's Supreme Court of Appeal ordered the Department of Home Affairs on 24 February 2010 to immediately release an Ethiopian asylum seeker from "unlawful" detention after he had languished in repatriation centres for over nine months.JOHANNESBURG Friday, February 26, 2010 (IRIN) - South Africa's Supreme Court of Appeal ordered the Department of Home Affairs on 24 February 2010 to immediately release an Ethiopian asylum seeker from "unlawful" detention after he had languished in repatriation centres for over nine months.

Costs were also awarded against the Minister of Home Affairs and the Director-General of the Department in an order that Gina Snyman, of the Lawyers for Human Rights (LHR) Refugee and Migrant Rights Project, termed a "scathing rebuke".

LHR requested that the identity of the man not be disclosed for fear of retribution should he be deported to Ethiopia. He is a political activist of the Oromo Liberation Front (OLF), a separatist organization "established in 1973 by Oromo nationalists to lead the national liberation struggle of the Oromo people against the Abyssinian colonial rule," according to its website.

The man was first arrested in Port Elizabeth, on the south coast of the country, for being an "illegal foreigner" and then "detained at the Lindela Repatriation Centre for more than 275 days", the LHR said in a statement.

The Lindela centre is in Gauteng Province in the north of the country, about 40km from Johannesburg, and is the main departure point for deporting and repatriating undocumented foreign nationals from South Africa.

"The court found that home affairs had no basis to detain the asylum seeker. Highlighting the clear illegality of the detention, the court suggested that the department either did not understand the law, or had chosen to ignore it," LHR said.

LHR have brought three cases against home affairs for illegal detention of asylum seekers since January 2010. "There are many individuals at Lindela who have been held beyond the 120-day period permitted by law, and many who are held without the department properly obtaining the legally required warrants. The effect is that these detentions are occurring outside of the law," Snyman said.

Bosasa, a private company contracted by home affairs to administer Lindela Repatriation Centre, was named as the third respondent in the court of appeal. The company has been awarded numerous government and provincial contracts, including for transport and at prisons, but persistent allegations of graft have frequently put the company in the headlines.

Gavin Watson, Bosasa's chief executive, is closely linked to the ruling African National Congress as a result of the Watson family's anti-apartheid credentials.

Snyman said the Lindela facilities were "very good in comparison to correctional services [prisons], but psychologically there is a greater impact [on detainees at Lindela], as they do not see themselves as criminals."

They were often unaware of their rights, and Lindela made no provision for communicating in languages other than English or South African vernacular languages, she said. There were no books or recreational facilities, apart from a television that only showed programmes by the state broadcaster.

Home affairs minister Nkosazana Dlamini-Zuma visited Lindela in November 2009 and highlighted delays encountered in the deportation process, but "failed to acknowledge that many deportations are occurring outside of the law", LHR noted at the time of the minister's visit.

"Moreover, asylum seekers detained under the Refugees Act must appear before a judge of the High Court after 30 days. LHR has not come across a single asylum seeker who was brought before a judge after 30 days," LHR said.

Home affairs continued to oppose court applications, "despite the courts consistently finding that any deprivation of liberty in these cases must be in strict compliance with the law," said Snyman.

"The order [releasing the Ethiopian asylum seeker] sends a strong message that the courts will not condone or facilitate the ongoing illegalities in the detention process."

go/he http://www.irinnews.org/report.aspx?ReportId=88250MBABANE Thursday, February 25, 2010 (IRIN) - The High Court of Swaziland ruled on 23 February 2010 that some married women will be allowed to register property in their own name. It has been five years since the new Constitution granted women equal status, after centuries of being classified and treated as minors.MBABANE Thursday, February 25, 2010 (IRIN) - The High Court of Swaziland ruled on 23 February 2010 that some married women will be allowed to register property in their own name. It has been five years since the new Constitution granted women equal status, after centuries of being classified and treated as minors.

Gender activists greeted the ruling as a small victory; despite the 2005 enactment of the Constitution, the second-class status of women in the country ruled by sub-Sahara's last absolute monarch, King Mswati III, has largely remained intact, denying women their inheritance rights and hobbling their progress as entrepreneurs and traders.

"I went to apply for a bank loan, and I was shocked to find that nothing has changed for women in this country. The loan was approved for my business, the bank was in support of my project, but the bank manager asked me, 'Where is your husband? He must sign the loan forms,'" Thabsile Masuku told IRIN.

"The bank did not recognize me as an adult who can enter into a contract. Legally, I am just a minor who is dependant on my husband. He is a good man but the situation is galling - I am not dependant on my husband, I am an independent person, but in Swaziland I don't exist," she said.

A woman who declined to be identified told IRIN that a house she had built from the proceeds of her chicken-breeding business was sold by her husband without her knowledge. In Swaziland the husband remains the legal administrator of the marriage estate, to use as he likes - with or without his wife's knowledge or consent.

Lack of political will

Although the Constitution has granted women equal rights with men, in practice old laws still on the statute books continue to define gender relations. Observers blame a lack of political will for the slow progress in replacing laws that conflict with the Constitution.

Lomcebo Dlamini, director of the Swaziland branch of Women in Law in Southern Africa - one of the legal bodies advising the Mswati-appointed Constitutional Review Commission during the 10 years it took to create the Constitution - told IRIN that gender equality could be partly achieved with a new law that defined modern marriages.

"The Marriage Act No. 47 of 1964 dates from the colonial era before Swaziland's independence [in 1968] and was really written with European residents in mind. Under the law, Swazis are assumed to be wed according to the traditional practice, which falls under the rules of Swazi Law and Custom that Swazis have always lived by," said Lomcebo Dlamini.

When the Constitution took effect, it stated that all laws counter to the Constitution were null and void, yet a recent ruling by the High Court of Swaziland said government must be given time to revise or repeal all non-compliant laws, but failed to provide a timeframe.

Activism has contributed to eroding gender-prejudiced legislation, and this week the High Court amended the 1968 Deeds Registry Act by making it possible for a Swazi woman to register immovable property, like a home or business, in her own name.

Justice Qinisile Dlamini, the High Court's sole female judge, ruled that "Section 151 (2) of the Constitution states that the High Court has jurisdiction to enforce fundamental human rights and freedoms guaranteed by (the Constitution). This includes the right to equality, which is guaranteed by section 20 and 28 of the Constitution."

However, the ruling only applies to women married in a civil ceremony, and with a community of property agreement. About 80 percent of Swaziland's one million people live on communal Swazi Nation Land under customary law administered by chiefs.

"The marriage law must be changed because it assumes that all Swazi women are married the traditional way, which is really arranged marriages that unite two families. A woman is a minor under her parent's homestead until she goes to her husband's homestead, where she is also a minor. The law considers the husband the administrator of the marital property," said Lomcebo Dlamini.

Polygamy

Social historian Anita Magongo told IRIN: "Traditional marriages are polygamous, which is one reason why a man is given administrative control. How do you divide administration of family property amongst any number of wives? ... A traditional homestead is a communal affair, without any real property."

The question of land ownership was also problematic. "The land belongs to the King, and Swazis reside on a piece of land at the pleasure of their chief. There was no wage-earning or commerce, no material objects beyond blankets and pots, and no need for loans or savings - but that was then."

With increasing numbers of women widowed by HIV/AIDS and in need of family property on which to live and raise their children, AIDS activists object to Swazi Law and Custom that results in the family of the deceased husband inheriting all marital property.

Widows are often left destitute, but custom dictates that a widow must mourn for at least six months, during which she is forbidden to leave the home, preventing her from working to support her children and compounding the vulnerability of the family.

"A new Marriage Act is essential," said Lomcebo Dlamini. "Fewer women are entering into traditional marriages, and it is wrong for the law to assume that 21st century Swazi women live as the Colonial-era lawmakers assumed they did long ago."

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http://www.irinnews.org/report.aspx?ReportId=88230ANTANANARIVO Wednesday, February 24, 2010 (IRIN) - Tensions between street traders and the city authorities in Madagascar's capital, Antananarivo, are mounting as hundreds of recently unemployed textile industry workers compete with established informal traders; textile factories have been closing since the country was suspended from a preferential trade agreement with the US.ANTANANARIVO Wednesday, February 24, 2010 (IRIN) - Tensions between street traders and the city authorities in Madagascar's capital, Antananarivo, are mounting as hundreds of recently unemployed textile industry workers compete with established informal traders; textile factories have been closing since the country was suspended from a preferential trade agreement with the US.

"Before, there were just a few stalls here - now there is someone selling something, every step you take," Naina Ravaoarinirina, a cosmetics vendor, told IRIN, hiding her goods from sight as a municipal patrol passed by. "But there is not enough room now for everyone in the official street market."

Factories operating under the African Growth and Opportunities Act (AGOA) - an agreement permitting some African states to export duty free goods to the US - employed about 50,000 people and provided work to a further 100,000 indirectly, according to the government. Madagascar was suspended from AGOA on 31 December 2009.

Preferential access to US markets is determined by democratic practices and good governance, among other things. Madagascar was deemed ineligible after Andry Rajoelina assumed power in March 2009 with the backing of the army, a move widely condemned as a coup.

"The March 2009 undemocratic transfer of power and the inability to establish a return to democracy have violated one of the vital criteria for Madagascar's continued eligibility for these trade preferences," said a statement released by the US State Department in December 2009.

The collapse of a multi-million dollar industry

Madagascar's textile industry accounts for about US$600 million annually; more than half its income is derived from exports to the US, according to industry observers. Contracts placed in 2009 have kept the factories running in one of the world's poorest countries.

"As lead times [expire] on orders placed before the agreement [came to an end], factories are laying off workers and we are facing an explosion in the numbers of unemployed," Jessie Andriamampianina, a director of the Antananarivo-based Association of Free Trade Businesses, told IRIN. "The impact of the loss of the AGOA agreement is very negative for Madagascar."

Robert Strauss, head of the American Chamber of Commerce in Madagascar, told IRIN that a quarter of the jobs in the formal economy were dependent on AGOA, and the reintroduction of US import duties of up to 34 percent had made keeping factories open unprofitable.

The rapid decline of the textile industry was also having a knock-on effect in other countries in the region, including Mauritius, Swaziland, Lesotho and South Africa, where many of the materials used in Madagascar's textile factories, such as zips, were produced, Strauss said.

Unemployed compete with informal traders

The flood of unemployed textile workers now operating as informal traders has forced the city's authorities to turn one of Antananarivo busiest thoroughfares into a pedestrian walkway and designate new areas for markets, but the demand for informal markets is outpacing supply.

"I used to be able to earn 20,000 ariary ($9.30) a day," said Soloniaina Rasoarimanana, who has been selling clothes from a pavement stall for 10 years. "Now, with the political crisis and more competition, I earn around 5,000 ariary ($2.30) a day."

Fabien Rakotonirina, a textile factory machinist who lost his job in December 2010, told IRIN: "Here on the street there is not enough profit. In the factory I earned 10,000 ariary ($4.65) a day, now I earn 6,000 ($2.80)."

The Minister of Economy and Industry, Richard Fienena, told IRIN: "There are projects for those who will be made redundant. There is a project for agribusiness, a project to create high-intensity labour forces for demolition work, a project for public works - all these options are waiting for when people are made redundant."

Andriamampianina dismissed this as "unrealistic". Few states recognize Rajoelina's government, including the Southern African Development Community, the regional body of which Madagascar and 13 other states are members.

Factory owners and workers have called on Rajoelina to reach an agreement with his political opponents so as to bring about a return to legitimate governance in Madagascar that would allow the AGOA suspension to be lifted, but many fear the textile industry may never recover from the effects of the coup-style change of government.

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