FROM a Great Canadian and World Statesman

"A great gulf... has... opened between man's material advance and his social and moral progress, a gulf in which he may one day be lost if it is not closed or narrowed..." Lester B Pearson http://nobelprize.org/nobel_prizes/peace/laureates/1957/pearson-lecture.html

Friday, 15 June 2012

CANADA RENEGES ON REFUGEE HEALTH

PREAMBLE: On June 30th, 2012, refugees in Canada will face drastic cuts to their health insurance coverage.  Numerous professional organizations have launched a National Day of Action, in protest to this dereliction of duty by the federal government, currently controlled by the Conservative Party of Canada.  It appears, that the “Harper government” is losing its social conscience, demonstrating a failure of authentic leadership.

By selecting this topic for the June 2012 blog, Pacific Health & Development Sciences (PacificSci) adds its support to this protest. 

We acknowledge the sources cited for the factual content presented, but take responsibility for our reconstruction of the situation.

The Situation: CHANGES TO CANADA’S REFUGEE HEALTH CARE COVERAGE

Canada’s federal government recently announced major changes to the Interim Federal Health (IFH) program, including substantial cuts to health services for refugees, to come into effect on June 30, 2012.  These include reduction of ‘basic’ coverage, including primary and preventive care, and ‘supplemental’ coverage similar to that available to many low-income Canadians.

These changes are extremely short-sighted. They will result in diverting care for people in greatest need to urgent care settings, and may even give rise to public health threats such as tuberculosis especially if diagnosis is delayed or the condition left untreated. To deny health care to refugees is to inappropriately burden both Canada’s health system and the health of Canadians.

Refugees have often fled situations that involved trauma and significant health impacts. Canada should provide care that facilitates health and well-being throughout the settlement process. The impact on pregnant women, children, and those with chronic diseases, is of particular concern.

It should be obvious to any fair-minded observer that the proposed changes will complicate the refugee settlement process, exacerbating barriers and inequities in access to health care and the potential for good health outcomes among an already disadvantaged group. This is both socially unjust and contradicts the principles of the Canada Health Act.

Resolution: PacificSci thus joins with all organizations now calling for the Federal government to rescind these proposed changes before they are implemented. The refugee health program should continue to provide basic benefits similar to provincial/territorial health care plans and supplemental benefits similar to what provinces and territories provide under social welfare.

References:
1.      PHABC Position on Changes to Health Care Coverage for Refugees. http://www.phabc.org/userfiles/file/PHABCPositiononChangestoHealthCareCoverageforRefugees(1).pdf    Accessed June 15, 2012.
2.       Press Release. Canadian Doctors for Refugee Care,  Reading Page.  http://www.doctorsforrefugeecare.ca/further-reading.html    Accessed June 15, 2012.
3.    Brindamour M, Meili R. Treat Refugees with care. Star Phoenix, June 15, 2012. http://www.thestarphoenix.com/health/Treat+refugees+with+care/6785828/story.html#ixzz1xvQdbfO2   Accessed June 15, 2012.

Wednesday, 16 May 2012

PUBLIC HEALTH IN THE MIDDLE EAST Reconnaissance of Issues and Developments

PREAMBLE: Over the past 15 years, PacificSci principals have had the opportunity to be involved in aspects of public health development in countries grouped within the Eastern Mediterranean Regional Office of the World Health Organization (WHO/EMRO), specifically Kuwait, Pakistan and the United Arab Emirates (UAE). This has been by virtue of both full time geographically-based work (1998-2003), as well as short term consultancies and collegial links.

These countries and their neighbours in the region face many common and similar challenges in terms of social and economic development, status of women, environmental control and regulation, a highly mobile migrant workforce and other demands of competing in a globalized economy.

Over the past decade especially, the region as a whole has also been dealing with social and political unrest, much of this of an extreme nature, largely resulting from a lack of good governance combined with negative geopolitical dynamics that have given scant regard to the wellbeing of the general populace.

Good public governance, referring to how public institutions function responsively, transparently, and with accountability, is a key mechanism through which the values of development are secured for people. These values include equality of treatment, freedom to choose, opportunities to participate in the process, and not least of all - justice. Such governance recognizes the integrity, rights, and needs of everyone within the state, and is essential to reducing poverty and stimulating growth.[1]

Good governance also embodies the value of “healthy public policy”, characterized by explicit concern for health and equity in all areas of policy and by accountability for health impact. The main aim of health public policy is to create a supportive environment to enable people to lead healthy lives. Such a policy makes health choices possible or easier for citizens. It makes social and physical environments health-enhancing. In the pursuit of healthy public policy, government sectors concerned with agriculture, trade, education, industry, and communications need to take into account health as an essential factor when formulating policy. Healthy public policy benefits populations, communities and individuals.[2]

This brief Reconnaissance consists of two sections: first, the published perspectives of the World Bank and WHO/EMRO, and secondly, our own observations of the emergence of two important networks: public health associations, and membership of national public health institutes in a new global organization.
Note: Minor edits were made to this posting on May 17 and 18, 2012.

PUBLIC HEALTH IN THE MIDDLE EAST
– Regional Perspectives
A DECADE AGO, the World Bank supported a regional conference in Beirut which led to a major report entitled Public Health in the Middle East and North Africa – meeting the challenges of the twenty-first century.[3]

Based on discussion elaborated in chapters of this report, six priorities emerged: 1. Leadership and Political Will 2. A New View of Public Health 3. Data and Surveillance 4. Partnerships and Collaboration 5. Emerging Health Problems 6. Public Health “Best Buys”

The report stated that “the status of public health practitioners is a significant problem. One of the main challenges facing public health in the... region is the recruitment and retention of appropriate skills and expertise, in terms of both quality and quantity.”

The persistence of an outmoded view of public health therefore is part of the challenge in this region, and could be the greatest obstacle to change: a view of public health as an adjunct to the health care system, rather than as a strategic force for a healthy population.

The challenge therefore is to envision what public health throughout the region could become within a reasonable period, say 15-20 years, then determine how to take it there. Insightful leadership with political support can lead this change.

It is on this particular issue regarding outmoded concepts of public health that the following selected extracts from the 2002 World Bank summary of priority issue #2 (above) justify consideration (bullets added and sequence adjusted for emphasis) and are highly applicable to the region:

A New View of Public Health:
Countries should undertake assessments of their public health functions and capacity in the near future…. steps should be taken to build capacity and broaden the scope of public health beyond the activities of physicians….
• Public health infrastructure should not be an adjunct to curative health systems. Rather it should be part and parcel of a comprehensive health system that blurs the boundaries between curative and public health services.
• There must be greater multisectoral commitment to healthy public policies; this can be accomplished by developing objectives and targets for healthy populations and lifestyles, including the necessary laws and regulations.
• Developing community based health promotion programs can be an effective way to increase the health literacy of communities.

Now moving to a more recent review by World Bank regional specialists [4], disease-surveillance systems as reviewed by the WHO Regional Office WHO/EMRO) were considered mostly inadequate, with insufficient commitment, lack of practical guidelines, overwhelming reporting requirements, lack of transparency, shortage of human resources, and poor analysis of data. It is stated that: “this deficit in the capability to assess and monitor population health will have to be addressed if effective plans for public health capacity building are to be put in place”.

Equally critical, the World Bank reviewers considered that, while many public-health services are well-established, management functions such as inter-sectoral policymaking, public information and education, and quality assurance, are underdeveloped.

Further, when compared with other world regions, the limited interaction between governments and civil society is considered likely to reduce the social dividend by not meeting rising expectations in the population.

The review argued that higher health sector spending will not translate into effective results if investments are not well managed or directed towards cost-effective solutions, and concludes that new institutional capacities and governance structures are needed.

New Public Health Networks
In some countries, there are organized public health professional and lay networks. These are generally found in larger countries, although with varying levels of vitality e.g., national public health associations exist in Egypt, Ethiopia, Iran, Lebanon, Pakistan, Sudan and Yemen. At the other extreme, the Gulf states so far generally lack this type of non-governmental support for public health; these entities typically have much smaller national populations (with the exception of Saudi Arabia with 27.4 million people, of whom some 19 million are nationals).  Such associations have the opportunity to affiliate with a long-standing and reputable international body: the World Federation of Public Health Associations (WFPHA).[5]

Note: The six Arab states bordering the Arabian Gulf: Saudi Arabia, UAE, Qatar, Kuwait, Bahrain and Oman form the Gulf Cooperation Council (GCC). Although Iraq is an Arab state and shares a small border with the Gulf, it is generally not included within this grouping.

Interestingly, national public health institutes are also reaching out among themselves, by affiliating with a recently formed International Association of National Public Health Institutes (IANPHI).[6] Among EMRO countries, these include Afghanistan, Iran, Jordan, Morocco, Pakistan and Saudi Arabia. Turkey and Israel are also members of IANPHI, but not included within the WHO-EMRO group of countries (they are considered within WHO-EURO).

In other words, these governmental public health agencies are starting to link up within an international network. According to their website, IANPHI spearheads improvements in national public health systems through a peer-assistance evaluation, grant support and efforts focused on NPHI advocacy, collaboration, and sustainability. It provides direct funding to governments in low-resource countries to build and strengthen national public health capacity through development of NPHIs. It does this through grants to support NPHI to NPHI evaluations, longer term capacity building initiatives, and seed grants to assist particular research agendas.

All this may make it attractive for other Middle Eastern countries to consider both supporting the development of public health associations and also joining this global intergovernmental agency network, particularly those who need to build capacity... and (when it comes down to it) who doesn't? 

Developing a national public health association, especially, is a  way of strengthening the role of civil society in a domain that can only be in the best interests of the population.

Envoi –Springtime for Public Health in the Middle East?
Prerequisites for health and social development everywhere are peace and justice; nutritious food and clean water; education and decent housing; a useful role in society and an adequate income; conservation of resources and the protection of the ecosystem. These increasingly appear to be the aspirations of Middle Eastern peoples, and indeed throughout the greater Eastern Mediterranean Region.

The vision of healthy public policy is the achievement of these fundamental conditions for healthy living. The achievement of global health rests on recognizing and accepting interdependence both within and between countries. Commitment to global public health will depend on securing the means of international cooperation, especially to act on issues that cross national boundaries.[6]

While the road ahead will have its challenges, and will require new forms of leadership, the international networking that is starting to emerge in the Middle East may well be a forerunner of an “Arab Spring for public health”. If so, this can only be to the ultimate benefit of all who live in the region.

References
1. World Bank. Better Governance for Development in the Middle East and North Africa: Enhancing Inclusiveness and Accountability. 2011. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/MENAEXT/EXTMNAREGTOPGOVERNANCE/0,,contentMDK:20261216~pagePK:34004173~piPK:34003707~theSitePK:497024,00.html Accessed May 14, 2012.
2. Report on the Adelaide Conference. Healthy Public Policy. 2nd International Conference on Health Promotion April 5-9, 1988 Adelaide South Australia. http://www.who.int/healthpromotion/conferences/previous/adelide/en/index1.html Accessed May 14, 2012.
3. Pierre-Lousie AM, Akala FA, Karam HS. Public health in the Middle East and North Africa: meeting the challenges of the twenty-first century. World Bank Institute. WBI Learning Resources Series. The World Bank 2004.
4. Akala FA, El-Saharty S. [The aWorld Bank, Middle East and North Africa Region, Human Development Sector, Washington, DC] Public-health challenges in the Middle East and North Africa. The Lancet (2006) 367: 961-4.
5. World Federation of Public Health Associations. http://www.wfpha.org/  Accessed May 16, 2012.
6. Public Health Institutes of the World (IANPHI). http://www.ianphi.org/  Accessed May 13, 2012.

Saturday, 14 April 2012

APOLOGIES FOR PAST WRONGS AND GRIEVANCES

PREAMBLE: Disputes over past conflicts often overshadow present and future relations of peoples and states for generations.

Contemporary political debates concerning recent and past conflicts are extensive in number, demonstrating that perceptions matter in today’s politics, and that conflicts do not necessarily resolve by ending a war or signing a treaty.

Negotiating an agreement can send a positive signal to the parties involved that they are willing to end the injustices and violence, but the emotional issues created can set the stage for resumption of hostilities even after a negotiated settlement is reached. Thus, in order for a conflict to be truly resolved there needs to be a lengthy process of reconciliation aimed at eradicating the emotional barriers between those involved and resuming trust between the victims and perpetrators.

In this blog we offer an overview of the underlying issues, mostly from a generic standpoint, keeping in mind that there are numerous conflicts of this nature around the world. In preparation, references 1, 2 and 3 were used extensively, while references 4 and 5 also gave additional valuable perspective.

We also include extracts from a Case Study by Frank Brennan S.J. (reference 1) as Visiting Presidential Scholar, Santa Clara University. He is a professor of law in the Institute of Legal Studies at the Australian Catholic University and officer of the Order of Australia (AO) for services to Aboriginal Australians, particularly as an advocate in the areas of law, social justice and reconciliation.

APOLOGIES FOR PAST WRONGS AND GRIEVANCES
Disputes over a common history after past conflicts often overshadow the present and future relations of peoples and states for many generations. Contemporary political debates concerning conflicts in the recent as well as the more distant past are extensive in number, demonstrating that past perceptions matter in today’s politics, and that conflicts do not necessarily resolve by ending a war or signing a treaty. Negotiating an agreement can send a positive signal to the parties involved that they are willing to end the injustices and violence, but the emotional issues created can cause a danger of resuming hostilities even after coming to a negotiated settlement. Thus, in order for a conflict to be truly resolved there needs to be a lengthy process of reconciliation aimed at eradicating the emotional barriers between those involved and resuming trust between the victims and perpetrators.

But what measures can most effectively bring about reconciliation and accommodate the process of restoring trust? Justice generally demands that the perpetrators are punished, and that victims are restored to the position they were in before the injustice occurred. Often this is done either by restoring a stolen property, or, when this is impossible, victims should receive compensation equal to the value of what was unjustly taken from them, possibly accompanied by compensation for the harm resulting from the wrong. This is considered to be sufficient enough to address the moral trauma incurred by the victim and satisfy feelings of vengeance. But what if the initial perpetrators and the victims cannot be clearly identified because they no longer exist? Who should be held accountable for past injustices, what measures should be taken to correct the wrongs committed in the past, or indeed should anything be done at all?

National apologies serve as official acknowledgments of collective responsibility for historical injustices delivered by states to other states or communities. An apology is usually delivered by individuals representing the state, but having a distinctly political character is perceived to be indicative of the opinion of the collective – usually, the nation. National apologies have received a great deal of attention in a variety of academic disciplines such as law, sociology, psychology and philosophy, triggered by the large number of apologies issued lately as well as the perception that they could in a way repair the past thus contributing to settling the emotional issues brought about by historic injustice. However, have apologies become too commonplace, such that what it means to deliver or receive a national apology is likely to be vague and ambiguous? Further, are we in an “age of apology” for nations and other institutions, or is there a greater historical consciousness operating; or, are we witnessing simply a trend of a “culture of confession”, which at another level, accessible media sites and celebrity hosts bring to the forefront?

Happily, or at least optimistically, we are progressing towards ensuring emerging human rights globally and a role for morality in international affairs. In recent decades, aggrieved groups have made claims for the recognition of past or present victimization, seeking apologies as the means by which their history is officially acknowledged, and their identity reclaimed. As the distance between event and apology lengthens, the “apology moment” is made more possible as present leaders who were not personally implicated in past policies enable the separation of the personal from the political.

The collective or political apology has emerged as a rhetorical tool in international relations, national politics, truth commissions, and the self-reflective practice of a range of institutions, including churches. The stated purpose is usually reconciliation, though damage control or self-justification may also be suspected. Yet how do we make sense of what is happening, and develop an accounting of the possibilities and limits of such apologies?

There are many examples of political leaders expressing regret, remorse or apologising to the victims or their descendants for past wrongdoings. The Vatican remains the leader in the number of apologies issued by a political body, having delivered more than 300 apologies for the crimes perpetrated by the Catholic Church throughout years; Queen Elisabeth II apologised for the wrongs done to Maoris in New Zealand; British Prime Minister Tony Blair apologised for the lack of help during the potato famine in Ireland in 1840s; German Chancellor Willy Brandt in 1970 acknowledged responsibility for the Holocaust; In 1988, the US Congress apologised to Japanese Americans for their internment and discriminatory treatment during World War II. In 2008, the US Senate passed the Indian Health Care Improvement Act acknowledging "a long history of official depredations and ill-conceived policies by the United States Government regarding Indian tribes" and offering "an apology to all Native Peoples on behalf of the United States." Following a number of separate apologies by states, the US congressional apologised for slavery in June 2009; in Australia 2008, the national Parliament apologised to the Aboriginal people; in 2008 an apology was made by Canadian Prime Minister Stephen Harper to former students of Indian Residential Schools.

To the extent that representatives of institutions view apologies as a sign of strength rather than weakness, residing in a moral universal larger than the narrow interests of any one group, then collective apologies are likely to proliferate. Yet, political apologies may also reflect a particular historical moment. What are political apologies about, at root - justice, or reconciliation? Are they about collective memories, or psychological healing? Are complicated calculations of self-interest involved? Are they about meeting a need for a victimized group? How have particular apologies affected a situation? What does effectiveness look like? And do they provide previously unrecognized windows into the nature and function of the institution apologizing? Clearly, further work needs to be done when constructing, analyzing and determining the outcomes of an “apology”.

For some, national apologies are seen as empty symbolic politics, a way of winning favour without paying a real price with (practical) monetary restitution. Others perceive symbolic gestures such as apologies as an important element in acknowledging responsibility, but insist that they ought to be followed by material commitments.

In the academic literature, an apology is perceived as the central and most important element in rectifying past injustices, without which attempts to renew the relationship between the parties involved remains focused on retributive means, based on punishment and easing the feelings of vengeance. Ideally, rectification and reconciliation should be aimed towards establishing positive relations in the future, rather than settling the debts with the past and instituting punishment. Therefore attaching worth to only practical and financial means of rectification can contribute to justice but is not sufficient to eliminate the emotional barriers between the victims and the perpetrators. What is crucial for any conflict to truly be resolved is the phase of reconciliation, which morally accommodates the victims and the perpetrators, establishing new relations of trust, not tainted by past misconducts.

If closely examined, how far do national apologies go towards the “ideal”, and how much does self-interest motivate the act, with little necessary dialogue from both sides, and diminished moral meaning?

Reparative action should only be motivated by the wish to repair the implications of injustices, instead of being means of achieving a potentially favourable result: using a theoretical framework of “virtue ethics”, it expresses the agent’s moral character and acts as the starting point for further discussion.

One of the basic reasons for scepticism about national apologies, transgenerational responsibilities and reparative action in general is the objection that they misidentify the victims and the perpetrators, with the present players “standing in” those acting out and being on the receiving end of past transgressions. However, ignoring past wrongdoings simply because the perpetrators or the victims are no longer alive seems blind to the role historic debates and outcomes play in contemporary politics and life. The basic moral principles of responsibility should apply to all transgenerational searches for justice alike. In order for apologies to be taken seriously, certain guiding principles or standards to follow would enhance their effectiveness.

Until more consideration and discussion is devoted to this research, the debate around national apologies will remain contested and divided, and past discriminations and injustices will continue to hinder progressive relationships beneficial to all.

Extracts - A Case Study by Frank Brennan
In Australia 2008, "the Parliament of Australia" uttered the performative "sorry", and only after all State and Territory Parliaments, churches and other social welfare agencies had done the same. It apologised in its own name acknowledging that earlier parliaments and governments had "inflicted profound grief, suffering and loss" on persons who were their "fellow Australians." The parliament saw its apology as a first step acknowledging the past followed by a second step: "laying claim to a future that embraces all Australians." The parliament pledged itself and future parliaments to "a future based on mutual respect, mutual resolve and mutual responsibility." This apology by the elected parliament came eleven years after individual citizens had started a concerted national campaign of personal apologies for past wrongs and present ongoing consequences.

Brennan suggests the following lessons from the Australian experience:
1. A national apology must be a response to sustained requests by identifiable victims.
2. A national apology must build upon individual apologies and apologies by agencies involved in previous wrongdoing, and not substitute for them.
3. The "we" who apologise must not speak on behalf of the living who are not willing parties to the apology.
4. The "we" who apologise must not presume to speak on behalf of the deceased, applying contemporary moral standards to past behaviour which was legal and judged justifiable at the time.
5. The "we" who apologise must intend to express through their performative utterance of the word "sorry" not only sympathy and regret but also collective responsibility for the ongoing effects of past actions, which "we" now have cause to regret, offering sympathy and entitled assistance to the victims still living and their descendants who have also been affected by those past actions.
6. The "we" who apologise should identify with the collective "we" of the past, who, being the same agent in the polity, approved these past actions or who, at least, failed to counter these past actions when having a duty to act in the interests of the victims.
7. The victims and their descendants should be willing to accept the apology.
8. The "we" (binding the future collective "we") and the victims and their descendants should be prepared to commit themselves to putting the past behind them and working together for a new future.
9. The apology should be backed by a firm commitment by the "we" to make resources available to put right the ongoing adverse effects of past actions, while also leaving open the possibility of payment of compensation (reparations) in proven cases of wrongs committed on identifiable persons.

REFERENCES
1. Brennan F. Stepping Forward to Right Historical Wrongs: National Apologies - Lessons From Down Under. Markkula Center for Applied Ethics. Santa Clara University. March 2008 http://www.scu.edu/ethics/practicing/focusareas/global_ethics/apologies.html Accessed April 14, 2012.
2. Kaleja A. The Role of National Apologies in Rectifying Historical Injustices. MSc International Political Theory University of Edinburgh. August, 2010 PDF document http://www.google.ca/#hl=en&sugexp=frgbld&gs_nf=1&cp=66&gs_id=4&xhr=t&q=The+Role+of+National+Apologies+in+Rectifying+Historical+Injustices&pf=p&sclient=psy-ab&site=&source=hp&oq=The+Role+of+National+Apologies+in+Rectifying+Historical+Injustices&aq=f&aqi=&aql=&gs_l=&pbx=1&bav=on.2,or.r_gc.r_pw.,cf.osb&fp=1d8e567df3a74d9a&biw=1280&bih=822 Accessed April 14, 2012.
3. Bergen JM. Reconciling Past and Present. A Review Essay on Collective Apologies.
Journal of Religion, Conflict, and Peace. Volume 2. Issue 2, Spring 2009
http://www.religionconflictpeace.org/node/52 Accessed April 14, 2012.
4. Pettigrove G. Apologies, Reparations and the Question of Inherited Guilt. Public Affairs Quarterly (2003), 17,4: 319-348. http://www.jstor.org/discover/10.2307/40441363?uid=3739400&uid=2129&uid=2&uid=70&uid=3737720&uid=4&sid=56037396173 Accessed April 14, 2012.
5. Human Rights and Equal Opportunity Commission, Bringing Them Home: The Stolen Children Report. Australian Government Publishing Service, 1997. http://www.hreoc.gov.au/social_justice/bth_report/index.html Accessed April 14, 2012.

Friday, 16 March 2012

GLOBAL DRINKING WATER GOAL MET FIVE YEARS AHEAD OF SCHEDULE

PREAMBLE: One of our most visited blogs is entitled “Drawing attention to a global pandemic – diarrhoeal disease” (October 15, 2009). This addresses one of the more neglected issues on the international and global public health agenda, especially when compared with AIDS, Tuberculosis and Malaria and Vaccine Preventable Diseases (all of which are also important priorities). Compared to these, diarrhoeal disease strangely receives much less attention by many donor health agencies and their information outlets. Perhaps this is because some of the solutions so capital-intensive that some donors prefer to look the other way. Or perhaps it is because the problem is perceived to be “local” and does not significantly threaten developed countries with importation: onward transmission is not likely to occur in nations with advanced water and sanitation infrastructures. Yet diarrhoeal disease is one of the most severe burdens for many low income countries, vying with acute respiratory infections as the leading cause of child mortality, and simultaneously causing serious morbidity across the age spectrum.

In this issue of PacificSci Global Perspectives, we are therefore pleased to give visibility to real progress in addressing the long-standing lack of portable drinking water in many developing countries. Our source is a new report from WHO and UNICEF entitled Progress on Drinking Water and Sanitation 2012 Update. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), reports every two years on access to drinking water and sanitation worldwide and on progress towards related targets under Millennium Development Goal 7 (environmental sustainability). This 2012 report is based on data gathered from household surveys and censuses, including both recent and older data sets that have come to the attention of the JMP. The estimates presented here describe the situation as of end-2010 and supersede those of the JMP update published in March 2010.

Despite real progress however, challenges remain for some regions, particularly sub-Saharan Africa, especially in rural settings where the burden of poor water supply falls most heavily on girls and women. Equivalent progress also is not being made with regard to sanitation. At the other end of the spectrum (the world’s rich nations) we also need to take note of the recognition by the UN General Assembly, in 2010, of “water and sanitation as a human right" provides additional political impetus towards the ultimate goal of providing everyone with access to these vital services. Unfortunately, there were a number of abstentions, including Canada (Harper government). See: GA/10967 http://www.un.org/News/Press/docs/2010/ga10967.doc.htm This abstention is curious, to say the least, given that Canada’s indigenous people suffer disproportionately from poor water and sanitation.

PROGRESS ON DRINKING WATER AND SANITATION: 2010 UPDATE
Published jointly by UNICEF and World Health Organization 2012, the full report is available online as a PDF file [66p.]. The full reference and URL are supplied at foot of this page.

The report brings welcome news:
the Millennium Development Goals (MDG) drinking water target, which calls for halving the proportion of the population without sustainable access to safe drinking water between 1990 and 2015, was met in 2010, five years ahead of schedule.


However, the report also shows why the job is far from finished. Many still lack safe drinking water, and the world is unlikely to meet the MDG sanitation target. Continued efforts are needed to reduce urban-rural disparities and inequities associated with poverty; to dramatically increase coverage in countries in sub-Saharan Africa and Oceania; to promote global monitoring of drinking water quality; to bring sanitation ‘on track’; and to look… towards universal coverage.

Since 1990, more than 2 billion people have gained access to improved drinking water sources. This achievement is a testament to the commitment of Government leaders, public and private sector entities, communities and individuals who saw the target not as a dream, but as a vital step towards improving health and well-being. Of course, much work remains to be done. There are still 780 million people without access to an improved drinking water source. And even though 1.8 billion people have gained access to improved sanitation since 1990, the world remains off track for the sanitation target. It is essential to accelerate progress in the remaining time before the MDG deadline (2015).

As we approach the 2015 target date for the MDGs, WHO and UNICEF are addressing current monitoring challenges and those that lie ahead. The safety and reliability of drinking water supplies and the sustainability of both water supply sources and sanitation facilities are not addressed by the current set of indicators used to track progress. Accordingly, this report details work under way to refine both indicators and methods of monitoring, as part of the 2010-2015 JMP strategy. It also discusses the beginnings of a process to develop new water, sanitation and hygiene goals, targets and indicators beyond 2015, in alignment with the human right to water and sanitation and the mandate of the UN Special Rapporteur on the Human Right to Water and Sanitation.

OTHER HIGHLIGHTS
Huge disparities exist. While coverage of improved water supply sources is 90 per cent or more in Latin America and the Caribbean, Northern Africa and large parts of Asia, it is only 61 per cent in sub-Saharan Africa. Coverage in the developing world overall stands at 86 per cent, but it is only 63 per cent in countries designated as ‘least developed’. Similar disparities are found within countries – between the rich and poor and between those living in rural and urban areas.

Complete information about drinking water safety is not available for global monitoring. Systematically testing the microbial and chemical quality of water at the national level in all countries is prohibitively expensive and logistically complicated; therefore, a proxy indicator for water quality was agreed upon for MDG monitoring. This proxy measures the proportion of the population using ‘improved’ drinking water sources, defined as those that, by the nature of their construction, are protected from outside contamination, particularly faecal matter. However, some of these sources may not be adequately maintained and therefore may not actually provide ‘safe’ drinking water. As a result, it is likely that the number of people using safe water supplies has been over-estimated.

More than 780 million people remain unserved. Although the MDG drinking water target has been met, it only calls for halving the proportion of people without safe drinking water. More than one tenth of the global population still relied on unimproved drinking water sources in 2010. The last two decades have seen impressive increases in the use of both piped connections to a dwelling, plot or yard and other improved sources, such as protected dug wells, boreholes, rainwater collection and standpipes.

Wide variations are found in the rate at which regions have improved coverage. In general, regions in which coverage was already high have made more modest gains, rising by only a few percentage points over 20 years. Of note are the impressive gains in Eastern Asia, which added 23 percentage points, and the small decline in coverage in the Caucasus and Central Asia and in Oceania. The results show that the majority of countries lagging behind on the drinking water target are in sub-Saharan Africa. In fact, only 19 out of 50 countries in that region are on track to meet the target by 2015.

Regarding the number of people who have gained access to an improved drinking water source since 1990, the progress of India and China not only dominates their respective regions, but represents nearly half of the global progress towards the drinking water target. If only the developing world is considered, China and India represent more than half of the people who have gained access.

For the first time, data on the use of unimproved sources have been disaggregated into two categories: surface water and other unimproved sources. The latter includes unprotected dug wells, unprotected springs and water delivered by cart or tanker. Surface water includes water collected directly from rivers, lakes, ponds, irrigation channels and other surface sources. The use of surface water stands at a surprisingly high 3 per cent of the global population, or 187 million people. Most of these people – 94 per cent – are rural inhabitants, and they are concentrated in sub-Saharan Africa. In fact, 19 per cent of rural dwellers in sub-Saharan Africa and 39 per cent of rural residents in Oceania rely on surface water for drinking and cooking.

Source: UNICEF & WHO. Progress on Drinking Water and Sanitation: 2010 Update. Released 2012. http://www.who.int/water_sanitation_health/publications/2012/jmp2012.pdf Accessed March 16, 2012.

Saturday, 18 February 2012

MAJOR PROGRESS IN MALARIA CONTROL: THE ROLE OF THE GLOBAL FUND, ITS DETRACTORS AND SUPPORTERS.

PREAMBLE: Over the past two issues we have taken note of decisions by several European entities (Germany, Ireland, and Sweden and the European Commission itself) to suspend funding to the Global Fund on AIDS, Tuberculosis and Malaria (GFATM). In part, this decision was made ostensibly due to concerns about corruption in recipient countries, even though this was limited to only 4 countries (among over a hundred recipients) and was discovered, investigated and openly reported by the Global Fund itself. This level of corruption, independently analysed, is significantly lower than that of the EURO block.

The truth behind this decision is that Europe has been financially mismanaged, with bank failures in some countries, and problems of corruption and mismanagement. European captains of industry (like their Americans counterparts) walked away with fortunes under their belts in the form of self-awarded bonuses, even as their operations have been bailed out by their taxpayers. Several governments are now at risk of unprecedented financial defaults.

The decisions of these European entities smack of old style colonialism: arrogance from the top down. It damages their hard won (or restored) reputations for being global leaders.

To use developing countries and the Global Fund as a scapegoat for this is unconscionable: at least be honest! Instead, these particular European entities should have had the integrity to own up and say “sorry, we cant afford this now, because we ourselves are in such a mess”.

Thankfully, the Bill and Melinda Gates Foundation, being evidence-based, has stepped in to shore up Global Fund finances due to this donor default. Also, former Japanese prime minister Naoto Kan said his country would contribute $340 million to the fund this year. Two years ago, Japan contributed $200 million, but it gave only $110 million last year because of domestic needs from the earthquake and tsunami. Of course many other countries are honoring their pledges, even as many of them also have financial challenges at this time.

“These are tough economic times, but that is no excuse for cutting aid to the world’s poorest,” Bill Gates said in announcing the $750 million contribution.

We congratulate the Gates Foundation, and the government of Japan, a nation that knows more than most the meaning of hardship and tragedy, and apparently has a high sense of integrity.

We dedicate this issue to the major successes now taking place in malaria control, largely thanks to support from the Global Fund. With this purpose, we have partially extracted verbatim the report below which appeared in the Health and Development Global Update published by the HLSP Institute in June 2011.

Reference: Brown D, Gates Foundation gives $750 million to Global Fund. Washington Post January 27, 2012. http://www.washingtonpost.com/national/health-science/gates-foundation-gives-750-million-to-global-fund/2012/01/26/gIQAHKw5TQ_story.html Accessed February 18, 2012.

MALARIA: A GLOBAL UPDATE
The latest WHO World Malaria Report in April 2011 documents impressive increases in intervention coverage and reductions in malaria morbidity and mortality. WHO estimates that the number of malaria cases has fallen by more than 50% in 43 countries over the past decade. Eleven countries in Africa have shown a reduction of more than 50% in either confirmed malaria cases or malaria admissions and deaths in recent years. In Asia, four countries saw a decrease in the number of malaria cases of more than 50% since 2000.

Africa in particular has seen tremendous progress in increasing access to insecticide-treated nets (ITNs) in past 3 years. However, given an estimated lifespan of three years, nets delivered in 2006 and 2007 are already due for replacement and those delivered between 2008 and 2010 will soon be. The challenge is in ensuring that the high levels of coverage achieved are maintained.

We still have incomplete information on access to treatment in general, and particularly for the significant proportion of patients treated in the private sector. We do know that the number of procured rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACTs) is increasing globally yet, especially in African countries, most patients are receiving ACTs without confirmatory diagnosis. This continues to represent a significant financial, technical and personal challenge for many patients, health care providers and national malaria control programme managers. One exception is Senegal, which has introduced RDTs on a national scale in public facilities and, with high levels of adherence to diagnostic results, achieved dramatic reductions in ACT consumption . On the other hand, another study in urban Tanzania shows that the introduction of RDTs also had the unintended consequence of increasing inappropriate antibiotic prescription (from 49% to 72%) – a behaviour ascribed to clinicians’ insufficient knowledge and training on other causes of fever. This is why RDTs able to diagnose a range of common illnesses are high on the malaria community’s R&D ‘wish list’.

Coverage with intermittent preventive treatment for pregnant women (IPTp) remains far from target levels – ranging from 2.4% in Angola to 62% in Zambia. No country has yet adopted a national policy of intermittent preventive treatment for infants (IPTi), as recommended by WHO.

In the countries with greatest progress, the decreases are associated with intense malaria control interventions. But this progress is fragile. The resurgence of the disease in 2009 in Rwanda, Sao Tome and Principe, and Zambia shows that control programmes need to be maintained even if numbers of cases have been reduced substantially.

Source: HLSP Institute. Health and Development Global Update. July 2011. http://www.hlsp.org/LinkClick.aspx?fileticket=VxUphqNpW_w%3D&tabid=1575

Envoie: The prevention and control of AIDS, Tuberculosis and Malaria represent moving targets. Only with sustained international support from both public and private sectors, and perseverance by the countries mostly affected, will eventual success be achieved. The results as reported in the above extract are extremely encouraging and should be taken into account by the European entities mentioned in our preamble, when they eventually reconsider their support: which they surely will.

Sunday, 15 January 2012

INTERNATIONAL & GLOBAL DEVELOPMENT - YEAR IN REVIEW 2011

PREAMBLE: This is our 5th annual review of topics we covered over the preceding year. As is also our custom, not restricted to topics covered, we lead off with praise (“flowers”) and criticism (“fertilizer”) within 3 categories: global stewardship, international development, and human rights. A synopsis of monthly blog themes follows.

1. Global Stewardship
For 2011, our flowers for leadership go to The Occupy Movement. While it had no singular leader, it represented collective leadership: like the “Arab Spring”, a democratic awakening around the world. More than a protest, and while controversial for some (especially the mainstream media, much of which is beholden to the status quo), it had the support of millions of people: the so called “99 percent” (a slogan) who see, feel and experience the steadily growing economic and social inequality growing around them, fostered by corrupt collusion between established political and financial interests.

The fertilizer goes emphatically to our own Canada, foot-dragging at the Durban Conference on Climate Change. With once mild mannered reporter Peter Kent, interestingly now Minister of the Environment for the environmentally discredited Harper government, Canada is intent fighting a rearguard action. Harper`s Canada has no coherent climate change policy, but is full of nostalgia over fossil fuel that can be extracted from our precious tar sands and money to be made from it, even as glaciers calve ever more rapidly and their beds recede steadily upstream. Canada is on the wrong side of this issue, and poorly represented.

2. International Development
Continuing the theme of climate change, flowers for this category go to the Alliance of Small Island States (AOSIS), a 42 member coalition drawn from all oceans and world regions, sharing similar development challenges and concerns about vulnerability to climate change. AOSIS is an advocate for global sanity: an impressive five percent of the global population, 350 million people (ten times Canada, equal to the USA) but under existential threat not of their own making.

To receive a deposit of rather smelly fertilizer, we must select the EU entities (Germany, Ireland, Sweden and the European Commission itself) who reneged without honour on their commitment to support the Global Fund for AIDS, TB and Malaria, even as major unprecedented success of this initiative is just emerging. “Without honour”, for the reason they gave: alleging corruption when it was the Fund itself that unearthed this in a small minority of recipient countries. This really is hypocrisy of a high order: corruption on a larger and more complex scale underlies the current economic morass of the EU, the real reason for their backsliding: pot calls kettle black, while sitting in a bully pulpit.

3. Human Rights
We offer flowers (flowering plants in this instance because they come with roots) to Myanmar (also known as Burma) for their movement towards democracy. It seems the five decades old military despotism is receding, and genuine efforts being made by those in power to join the international community: let the flowers bloom!

The fertilizer this year belongs to Iran. Despite the impressive quality of people who emerge from the Iranian diaspora, and relatively advanced aspects of Iran’s education and public health systems (when compared with most other countries in central Asia), these are otherwise dismal days for human rights in that country.

Consider the following quotation from Human Rights Watch:
Since Iran’s crackdown against anti-government protests following the 2009 presidential election, the human rights crisis in the country has only deepened. Human Rights Watch is particularly concerned about the broad-based targeting of civil society activists, including lawyers, students, women’s rights activists, and journalists, and a sharp increase in the use of the death penalty… Iran continues to refuse access to UN (observers) despite their longstanding and repeated requests for invitations to visit….
Source: Human Rights Watch. Iran`s deepening human rights crisis. Human Rights Issues regarding the Islamic Republic of Iran. 2011. http://www.hrw.org/middle-eastn-africa/iran

2011 AS WE RECORDED IT...
January: THE VIENNA DECLARATION - Evidence-Based Drug Policy and the Need for a Paradigm Shift
This issue focused on Canada’s minority Conservative government`s Bill S-10, the Penalties for Organized Drug Crime Act, including the introduction of mandatory minimum prison sentences. Unfortunately, this legislation is ideological and not evidence-based. Research indicates that Bill S-10 will only serve to create greater health and social harms.

For the purpose of more objective information, the issue drew attention to the Vienna Declaration (www.viennadeclaration.com). The Declaration is a scientific statement seeking to improve community health and safety by calling for the incorporation of evidence based research into the development of illicit drug policies. Since its launch on June 27, 2010, the Vienna Declaration has been endorsed by six Nobel Laureates, thousands of scientific experts, law enforcement leaders, and former heads of state from Brazil, México and Colombia. In Canada, the declaration was signed by five chief provincial medical health officers, the Canadian Public Health Association, the Health Officers Council of British Columbia, and a growing number of municipalities which deal with these issues first hand. PacificSci also has signed.

February: REGULATORY CAPTURE – A CASE STUDY FROM CANADA: Dietary Sodium Regulation
This month`s blog focuses on regulatory capture recently facilitated by Canada’s Conservative government in favour of the food industry in the context of Dietary Sodium Regulation.

The theory of regulatory capture was set out by Richard Posner, an economist and lawyer at the University of Chicago, who argued that "Regulation is not about the public interest at all, but is a process, by which interest groups seek to promote their private interest ... Over time, regulatory agencies come to be dominated by the industries regulated." More descriptively he referred to this as "Gamekeeper turns poacher, or at least helps poacher".

March: COMPARATIVE RISKS OF NUCLEAR ENERGY : Need for Objectivity in light of Japan’s Emergency.
The situation of Japan, following the world’s 5th largest recorded earthquake since 1900 and resulting tsunami, was catastrophic: tens of thousands drowned, swept away with coastal infrastructure. Hundreds of thousands, were displaced, lost family members and livelihoods. The catastrophe also gave rise to a new emergency as a result of damage to several nuclear power plants, and eventual reactor meltdown.

Although there was comprehensive coverage of Japan’s humanitarian disaster, media monitored the nuclear sub-story with an intensity disproportionate to the overall catastrophe. Even some mainstream media (e.g., CTV) appeared to hype this aspect of the disaster, seemingly appealing to populist fear about nuclear power, rather than objectively placing this in the perspective of the far greater human impact of a massive earthquake and tsunami. PBS did a better job.

In light of these observations, we searched for up to date sources of scientific information on nuclear safety, and selected for reference a recent Organization for Economic Cooperation and Development (OECD) report Comparing Nuclear Accident Risks with Those from Other Energy Sources.

In conclusion, risks are associated with every energy source and decisions must be made in every context regarding the viability of available choices. As the OECD report pointed out: There is little value in rejecting one source if that which replaces it presents even greater hazards.

April: WHY IS CANADA FOLLOWING FAILED U.S. PRISON POLICIES? And What It Could Learn from NAACP's "Misplaced Priorities" Report
Canada’s Conservative government is copying failed US prison policies even as its favoured role model, the US Republican Party, repudiates them: policies that lead the US to having the highest incarceration rates in the world. In Canada, a $2-billion prison-building bonanza is about to spawn more than two dozen new prisons.

The motivations behind Prime Minister Harper’s prison obsession once again appear ideologically driven and politically motivated. There is no evidence of increasing crime in Canada (the overall trend is actually down), nor is there good scientific evidence that incarceration is an effective solution to most of the crime that does occur.

These ill-considered legislative measures are creating a level of overcrowding that contravenes international standards on treatment of prisoners. It does nothing for rehabilitation, even as it displaces resources away from measures that could prevent crime in the first place.

We then offered a review of a just released and acclaimed NAACP policy report from the USA.

May: CANADIAN OIL SPILL THREATENS INDIGENOUS PEOPLE
On April 29, 2011, there was a major oil spill from a pipeline in Northern Alberta, Canada. This adversely affected the Lubicon Cree people living in the area, wildlife, forests, streams and lakes.

Global Perspectives drew attention to the estimated $14 billion in revenue generated on Lubicon lands, even as traditional water sources have been contaminated since the onset of resource exploration. Despite this, Lubicon houses lack running water and plumbing. Within 3 years of the first oil wells the number of people dependent on social assistance increased from 10 to 90%. As a matter of human rights, action is required to alleviate these appalling health conditions.

It is now clear also that a competent, independent health team must be provided to the community to address new concerns about the headaches, nausea and other illness experienced since the April 29 spill. In this regard we supported Amnesty’s call for both federal and provincial (majority Conservative) governments to ensure that such an assessment is carried out with results fully available to the community as a whole, and to the general public.

June: EXTREME WEATHER, CLIMATE CHANGE AND HUMAN DISPLACEMENT
In this issue we reported on the Nansen Conference on Climate Change and Displacement in the 21st Century, Oslo Norway, June 6-7, 2011. As summarized by IISD reporting services:

Climate change is the world’s most serious threat to sustainable development, with adverse impacts projected for the environment, human health, food security, economic activity, natural resources and physical infrastructure. While global climate varies naturally, rising concentrations of anthropogenically-produced greenhouse gases in the earth’s atmosphere are leading to changes which, over the short- and long-term, lead to an increase in the severity of droughts, land degradation, desertification, salinization, riverbank and coastal erosion, sea-level rise and the intensity of floods, tropical cyclones and other geophysical events. This in turn will negatively affect crop yields and food production, water supplies, livelihoods and human settlements.

An impact of particular concern is the potential for human displacement and migration: the implications for human welfare and security, and for strategies for adaptation, DRR, humanitarian aid and protection of displaced people, could be far-reaching.

However, a more positive scenario still appears to be largely a matter of choice, even as most of our current political “leaders” remain negligent in not making a serious decision to come to grips with this potentially terminal threat. To quote again from the conference summary:

“Responding to climate change has the potential for millions of green jobs, to transform societies to energy systems that are safe, that are stable and that are based on renewable energy and energy efficiency. Moving away from fossil fuels and towards renewable energy is being embraced now by more and more countries, although funding for alternative systems pales in comparison to subsidies for oil, gas and coal.”

July: DISASTER RISK REDUCTION: REVISITING THE HYOGO FRAMEWORK FOR ACTION (2005-15)
Continuing from last month’s theme, linking extreme weather patterns to longer term climate change and impacts on human displacement, this month we focused more broadly on the phenomenon of disasters. Our primary sources for this material are IDMC, the Internal Displacement Monitoring Council of the Norwegian Refugee Centre, and the 2011 United Nations Global Assessment Report on Disaster Risk Reduction, both referenced.

August: REVITALIZING PHILANTHROPY IN INTERNATIONAL DEVELOPMENT:... The Bellagio Initiative
Our focus this month was on a recently announced initiative, jointly led by the Institute of Development Studies (University of Sussex UK), the Resource Alliance Ltd (London UK) and The Rockefeller Foundation (new York City, USA). The “Bellagio Series on the Future of International Development and the Role of the Philanthropic Sector: Promoting Human Well-being in a Challenging Global Context” is designed to explore future relationships between philanthropy and international development including a convening to be held at the Rockefeller Foundation Bellagio Center (Lake Como, Italy), November 2011.

Our view at PacificSci is that, given the continued lagging of donor countries in meeting their long standing financial commitments to development, particularly the G7 group of nations, the role of private philanthropy has become even more important in filling this gap than ever before.

September: CASE STUDY: The Costs of 9/11 and the Creation of a National Security Establishment in Canada
Earlier this month the world took note of the 10th anniversary of the terrorist attacks on the World Trade Center, New York, that took place on September 11, 2001. While memorial events honored those killed and injured, their loved ones, the rescue teams, and all who were affected, there is no doubt that the event was felt everywhere as one that destabilized the world.

Canada is an interesting case study of some of the unintended consequences of over-reaction: the Rideau Institute has released a new report that tabulates, for the first time, the number of additional dollars spent on national security since the terrorist attacks of September 11, 2001, as well as observations on the opportunities costs that this has entailed. According to the report, the sum already spent in the post–9/11 build-up could have provided significant benefits to Canada. The nearly 100 billion dollars could have rebuilt transit systems in each of Canada’s ten largest cities, it could have provided a national childcare program, or eliminated all payments for prescription medications. Any of these programs could have been fully implemented if the money spent on a national security establishment since 2001 had been used differently.

We agree with the report’s conclusion that “It is time to re-evaluate whether the dramatic post–9/11 spending on national security could be more appropriately spent over the next ten years.”

October: SUPERVISED INJECTION FACILITY WINS LEGAL BATTLE IN CANADA
The purpose of supervised injection facilities is to reduce the harms associated with injection drug use. This said, the way forward is decidedly uphill for any society that pits the perceived interests of “law and order” against public health interests. Insite, a supervised injection facility in British Columbia, Canada’s western most province, illustrates this struggle.

In May 2008, the British Columbia Supreme Court struck down the provisions of the Controlled Drugs and Substances Act that deal with possession and trafficking but suspended the declarations of invalidity for one year to allow Canada`s Parliament to bring the law into compliance with the Constitution, and the Court’s reasons, which ensure Insite a permanent constitutional exemption. The Attorney General of Canada (the Harper government) appealed the decision. On January 15, 2010, the BC Court of Appeal dismissed the appeal by the Attorney General of Canada, allowing Insite to continue operations. The Attorney General filed a further appeal with the Supreme Court of Canada. Early in 2011, it was announced that the Supreme Court of Canada would hear the appeal from Attorney General of Canada.

On September 30, 2011, the Supreme Court of Canada ordered the federal Minister of Health to grant an exemption to Vancouver’s supervised injection facility under the Controlled Drugs and Substances Act. By ruling that addiction-related drug use is a health issue and not simply a criminal justice issue, the Supreme Court decision upheld Canada’s constitutional rights to life, liberty and security of the person and the role of public health interventions of this nature.

Under Canada’s Conservative government, an unremitting effort had been made to close the facility down, despite support from the provincial government. Their objections were based on political ideology. In stark contrast, the decision made by the Supreme Court, was based on a careful reading of Canada’s Charter of Rights, and scientific evidence that the facility was saving lives, and not promoting the drug culture as the federal Conservatives had claimed.

November REVISITING REGULATORY CAPTURE 1) Government- Sponsored Gambling, and 2) Government-Industry Oil Sands Emissions Monitoring
As introduced in our February 2011 blog, “regulatory capture” (RC) is the process by which regulatory agencies eventually come to be dominated by the very industries they were charged with regulating. It happens when a regulatory agency, formed to act in the public's interest, eventually acts in ways that benefit the industry it is supposed to be regulating, rather than the public. As portrayed by The Economist (citing Posner) "Regulation is not about the public interest at all, but is a process, by which interest groups seek to promote their private interest ... Over time, regulatory agencies come to be dominated by the industries regulated."

Recent work by Frederic Boehm throws new light upon this phenomenon: he presents an array of measures to reduce different types of corruption in regulatory processes, preventing capture and ultimately safeguarding the independence, effectiveness and efficiency of regulation.

This blog highlighted two examples: 1) the extraordinary phenomenon of governments in many countries (including several Canadian provinces) both sponsoring yet also charged with regulating the gambling industry, even as it exacts an enormous toll on health (a provincial responsibility in Canada, therefore an obvious conflict of interest); and 2) a government-industry advisory group charged with examining emissions from the Alberta oil sands industry, shown to have been ignoring substantive evidence from reputable independent sources.

December: EUROPEAN COUNTRIES RENEGE ON COMMITMENTS TO THE GLOBAL FUND
Until recently, there was optimism that most would honor their commitments to support the Millennium Development Goals (MDGs). Last year’s UN Special Session on MDG outcomes provided an important reminder: in relation to Goal 8 (Develop a Global Partnership of Development) there was a message for all donor countries, namely that, without more reliable support from developed countries, several Goals are likely to be missed in many developing ones.

However there is now serious concern regarding the 6th Goal, which comes within the remit of a “Global Fund to fight AIDS, Tuberculosis and Malaria”. Tragically, in November 2011, several European entities (Germany, Ireland, Sweden and the European Commission itself), ostensibly in response to fraud in a small number of developing nations (4 out of >120 recipient countries), have frozen or drastically cut back on their funding support to the Global Fund as a whole with the effect that it will not be able to take on any new commitments for a 3 year period.

The documented fraud amounted to $34 million, 0.03% of the Fund’s whole portfolio, and all the evidence of fraud cited in the press was uncovered by the Fund itself after it undertook investigations. And, the Fund had publicly announced these findings as they were uncovered. There was never any duplicity or attempts to cover up the losses. It would be interesting indeed to see how this compares with the extent and impact of fraud in the European Community itself, especially on the heels of various banking collapses, and national defaults. Pot calls kettle black?

The ethics of the European Community need to be called into question. It appears that they have held the Global Fund to a higher standard than they themselves could meet. At least one should expect Europe to be honest about this. Why not lay the blame for reneging on commitments on their own mismanagement, and by extension accept responsibility for any reversals that will result from funding shortfalls in global efforts to combat these diseases over the next 3 years?

ENVOI: PacificSci`s regular blogs will continue next month.

Thursday, 15 December 2011

EUROPEAN COUNTRIES RENEGE ON COMMITMENTS TO THE GLOBAL FUND

PREAMBLE:
The track record of developed countries honoring their aid commitments is not impressive (especially the G8 nations)[1]. However, until recently, there was optimism that most would honor their commitments to support the Millennium Development Goals (MDGs).

To briefly revisit the MDGs for those readers who may not recall what they were about, here is a thumbnail sketch: at a United Nations conference in 2000, governments around the world pronounced the MDGs, to be achieved by 2015. Eight goals were constructed (listed below), reflecting the world's main development challenges and responding to the calls of civil society.[2] Within these goals there are 18 targets, complemented by 48 measurable indicators to measure progress towards the MDGs.

Goal 1: Halve Proportion of People in Extreme Poverty and Hunger
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality and Empower Women
Goal 4: Reduce Child Mortality by 2/3
Goal 5: Reduce Maternal Mortality by 3/4
Goal 6: Combat HIV/AIDS, Malaria and other diseases
Goal 7: Ensure Environmental Sustainability
Goal 8: Develop a Global Partnership of Development

Last year’s UN Special Session on MDG outcomes provided an important reminder: in relation to Goal 8 (Develop a Global Partnership of Development) there was a message for all donor countries, namely that, without more reliable support from developed countries, several Goals are likely to be missed in many developing ones.[3]

However there is now serious concern regarding the 6th goal, which comes within the remit of a “Global Fund to fight AIDS, Tuberculosis and Malaria”. Tragically, in November 2011, several European entities (Germany, Ireland, Sweden and the European Commission itself), ostensibly in response to fraud in a small number of developing nations (4 out of >120 recipient countries), have frozen or drastically cut back on their funding support to the Global Fund as a whole with the effect that it will not be able to take on any new commitments for a 3 year period.

Although it is understood around the world that the entire European Union is now under existential threat, and therefore unable to make good on their commitments, in our view it is a “bit rich” (to use the vernacular, no pun intended) that these rich nations, whose own financial mismanagement and fraud in some instances led to their own current morass, feel free to tar recipient countries with the same brush.

The documented fraud amounts to $34 million, which represents 0.03% of the Fund’s whole portfolio, and all of the evidence of fraud that was cited in the press was uncovered by the Fund itself after it undertook investigations. Furthermore, the Fund had publicly announced these findings as they were uncovered. There was never any duplicity or attempts to cover up the losses. It would be interesting indeed to see how this compares with the extent and impact of fraud in the European Community itself, especially on the heels of various banking collapses, and national defaults. Pot calls kettle black?

For this issue of PacificSci Global Perspectives, we extract from an objectively critical situation analysis as presented by Results UK, an NGO registered in England, Wales and Scotland.[4]

NOTE: This is our last issue for 2011. Our Year in Review will appear as the first issue for 2012.

References:
1. White F. Development assistance for health – donor commitment as a critical success factor. Can J Public Health (2011)102,6:421-3
2. United Nations Development Programme. About the MDGs: Basics - What are the Millennium Development Goals? http://www.undp.org/mdg/basics.shtml Accessed December 15, 2011.
3. UN General Assembly. 65th Session Agenda Items 115. Special Session on the MDGs. Outcome Document: New York. September, 2010.
4. Supporting the Global Fund – making the case for immediate intervention. Background Sheet 1: RESULTS – the power to end poverty. December 11, 2011. http://results.org.uk/sites/default/files/December%202011%20Background%20Sheet%201%20Supporting%20the%20Global%20Fund.pdf Accessed December 15, 2011.

THE GLOBAL FUND TO FIGHT AIDS, TB AND MALARIA (GF)
Note: This report is extracted verbatim from the work of Results-UK (citation #4 above). While we fully endorse what they have stated, the originality of this analysis belongs entirely to them. We recognize that it was written for a primarily UK audience, but we feel that it deserves global recognition and readership.

The GF is a multilateral agency founded in 2002 and is the world’s largest financer of anti-AIDS, TB and Malaria programs. It operates as a partnership between governments, civil society, the private sector and affected communities. It draws its funding from donor governments, trusts and foundations and distributes that money to implementing agencies. To ensure that GF money goes to where it is needed most, it prioritises countries with low incomes and high disease burdens. Importantly the GF is guided by the principles of accountability and transparency. It focuses explicitly on results and has an outstanding track record for delivering real impacts on the ground.

At the end of 2010 the GF has approved funding of $22 billion for more than 600 programs in 150 countries. Because it has such clear monitoring mechanisms the Fund states that it has distributed 190 million insecticide treated nets to treat malaria, provided TB treatment for 8.2 million people and provided antiretroviral drugs and holistic care for some 3.2 million people, saving 7.7 million lives.

How funding works: the replenishment process
The fund is predominantly bankrolled by contributions from the governments of developed nations. Since it was created in 2002, 95% of pledges have been from these governments (totalling $28.3bn), with the other 5% coming from private sector and philanthropic givers like the Gates Foundation. From 2001-2010 by far the largest contributor to the fund has been the USA, followed by France, Japan, Germany and the UK. In terms of giving as per cent of GNI, Sweden gives the largest proportion, followed by France, Norway, Holland and Spain.

After the initial funding it received for 2002-2004 the GF has gone through a replenishment cycle every three years, with the last of these events taking place in 2010 in New York. The GF went into the New York conference seeking $20 billion to fully fund the fight against the three diseases. Whilst this represented a doubling of contributions from the 2007 replenishment, it was considered as absolutely vital to avoid losing ground to the diseases. Unfortunately, pledges and projections at the conference only ended up totalling $11.68 billion. The result was that the GF needed to seek new funding, could not fund certain high cost programs and had to slow the pace of scale up.

The UK contribution
The UK government has been a strong historic supporter of the Fund. In 2001 the Labour government made a pledge to give £1.36 billion between 2001-2015 and has delivered £1.06bn thus far. After coming to power the new coalition undertook a review of all UK giving to multilaterals and the Fund came out very well, rated in the highest category as providing ‘Very Good’ value for money, which was only given to 9 organisations. In giving the Global Fund a top score, the Multilateral Aid Review (MAR) found its “quality and depth of reporting” were very high, and reported that “standards for financial management and audit” were very high as well. Overall it found the Global Fund to be critically important in the delivery of the MDGs.

As such, the new government has committed to continued giving to the fund at the same levels as the previous administration. The UK has not made a new pledge recently, however, our historically strong stance puts us ahead of many European countries. Civil society organisations across the UK and Europe have been calling on the UK to make a contribution of £840 million between 2011-2013, a figure that would represent a ‘fair share’ of the $20 billion that the GF requested to fill financing needs of partner countries.

What went wrong?
There have been several competing factors that have led to countries withdrawing or withholding their payments to the Global Fund.

1. The financial crisis: The global economic downturn of 2008 has severely hit the GF. With aid budgets being squeezed more tightly than ever before, many countries have chosen to hold back or renege on their commitments to the Fund, citing a variety of causes. As the crisis has continued the ratio of pledges to money actually delivered has steadily worsened, with countries including Spain, Holland, Denmark, Italy, Belgium and the US seriously behind on their commitments. Countries are finding the crisis a convenient excuse not to meet their commitments.

2. Global Fund Corruption: In January this year, corruption in GF programmes was inaccurately and sensationally reported by the Associated Press. Citing losses of $34 million dollars across several countries, the media created a situation in which Germany, Ireland, the European Commission and Sweden all announced that they were withholding funding until investigations into the causes of the losses and how they occurred were carried out.

3. A victim of its own success: Ironically, the Fund’s success up until 2010 has partly led to these problems. The Fund introduced new paradigms in the global health and international development arenas. It established a mechanism which channels resources to fund demand through the submission of evidence based, technically sound TB/Malaria/HIV proposals, and as a result has regularly met and exceeded its targets. As such, scale up in demand has been steep, leaving the Fund needing increasingly more and more funding. When global economics were good, this was a curve that could continue. Now this is clearly no longer the case.

The issue of corruption
Stories began to circulate in January 2011 about money going missing from GF supported programs in nine different countries. The total sums that were misappropriated or unaccounted for totalled around $34 million dollars. As a reaction, Germany, Ireland, Sweden and the E.C all stated that they were withholding money to support pledges. They all cited slightly different reasons – and had slightly different motivations – but all called for the Fund to conduct an investigation into its activities.

The media reports of corruption have been very damaging to the Fund, but it’s important to look at this in detail and put the figures into perspective. All of the evidence of fraud that was cited in the press was uncovered by the Fund itself after it undertook investigations. Corruption was found in 9 out of 33 investigated programs (of 145 the fund administers). In Mali, the country with the greatest losses, the Fund has reclaimed a large amount of that money and secured the convictions of nine civil servants involved in its theft. The Office of the Inspectorate General (OIG) is a completely independent body within the Fund that carries out these investigations. What’s more, the Fund had publicly announced these findings as they were uncovered. There was never any duplicity or attempts to cover up the losses. Joe Liden, a spokesman for the Fund stated that they felt they had been “treated very badly by the media.”

Within the whole of the Fund’s portfolio, the $34 million represents 0.03% of the Fund’s whole portfolio (although only 33 countries were investigated). However, these 9 programs were investigated for the very reason that they were some of the riskiest grants the Global Fund provided. Looking at the most recent set of reviews from the OIG, which analysed over $1b of grants, indicates that across the whole portfolio, no more than 1% of funds have been lost to fraud. This is substantially less than is lost by the UK’s DWP every year.2 However, the sensationalist language used by the media has stuck and the Fund’s reputation as been damaged. The Fund has been through a process of self-evaluation and produced a High Level panel report discussing the problems it faced around fiscal accountability, auditing and investigation practices and has addressed many of the criticisms made by concerned donors.

OUR COMMENT: The ethics of the European Community need to be called into question. It appears that they have held the Global Fund to a higher standard than they themselves could meet, especially given the evidence of everything from bank fraud to gross mismanagement of national finances in several of their own members (Ireland is one of the countries that have reneged on their GF commitments, but isnt this also one of the so-called “PIGS” that have exhibited financial mismanagement?), leading to the current crisis in the Euro. At least one should expect Europe to be honest about this and not play “bully in the pulpit”. Why not lay the blame for reneging on commitments on their own mismanagement, and by extension accept responsibility for any reversals that will result from funding shortfalls in global efforts to combat these diseases over the next 3 years?

We wish all readers the very best for the Holiday Season, and a Happy New Year.

INSPIRATIONAL WELCOME ............................... from T.S.Eliot's "Little Gidding"

If you came this way From the place you would come from... It would be the same at the end of the journey... If you came, not knowing what you came for, It would be the same... And what you thought you came for Is only a shell, a husk of meaning... From which the purpose breaks only when it is fulfilled If at all.