Mombasa Tea Auction to go Digital

By Esther Nakkazi

After years of refusing to go digital, East Africa tea traders and growers have accepted to replace the current manual open outcry system, with the computerized electronic auction.

Today, East Africa Tea Trade Association (EATTA) signed a financing agreement with TradeMark East Africa (TMEA) to provide financing provide of US$ 1.5 million that will enable automation of the tea auction in Mombasa.

A statement from TMEA says the automation is expected to reduce the tea trading cycle by about 65% from the current 45 - 60 days to less than one month. Reduced delays will also ensure that farmers receive timely payments negating need to take loans to finance their producer operations.

The Mombasa tea auction is the world’s largest black tea auction and handles about 75% of tea exported through the port of Mombasa covering shipments from the EATTA member countries of Burundi, Kenya, Rwanda, Uganda, DRC, Tanzania, Ethiopia, Malawi, Madagascar and Mozambique.

In 2015, the auction handled more than 350 million kilos of tea, providing a platform through which more than one million farmers in Africa could sell their tea, before shipping it across the world.

The proposed integrated Tea Trading System (iTTS) will encompass the entire tea export processes including pre-auction, auction, post-auction and a Business to Business marketing network says a statement from TMEA.

“This portal will simplify the tea auction with the added benefit of increasing transparency and thus gaining stakeholder confidence in the auction,” said Mr. Nicholas Munyi, EATTA chairperson, at the signing ceremony.

“TMEA is committed to boosting intra- Africa trade and also East Africa’s trade with the world by reducing the barriers to trade. Automation of key trade systems is one way that has enabled us move closer to achieving this vision,” said Frank Matsaert TMEA CEO.

“I am excited to see that tea, a major forex earner for the region, will reach the breakfast tables across the world in an efficient and cost effective way and that the farmers working hard on their farms will regain confidence in the trading process as a result of the transparency and accountability the system will give,” explained Matsaert.

Once fully implemented, the platform, will ensure that, stakeholders of the tea auction including farmers, buyers and sellers, receive real time information on what is happening on the auction bourse.

Further, the automation will reduce delays and paper work, which is synonymous with the manual systems. The tea brokers will benefit from an automated and streamlined trading platform that reduces complex and bureaucratic trading processes and physical movement of documents to various players.

The tea producers both in Kenya and other countries in the region will have real time access to information on the tea sales as well as have lower logistics costs as they will be able to access the information online eliminating the need for travel to Mombasa.

Automation for the Mombsa auction was supposed to be implemented by 2013 using the Indian tea e-auction model, the only country in the world using it. A team from EATTA left for India on a fact-finding mission but found that despite it operating for eight years, the Indians still preferred the manual open outcry system.

The report presented by the team to EATTA said the Indian government imposed the e-auction on them in order to collect more taxes from tea but they were unhappy with it because it was not interactive and it was too commercialized without meeting in the auction room.

So EATTA stakeholders, overwhelmingly, voted against it in a meeting saying the auction, which basically, is a ‘public sales’, would lose its transparency, competition and risk technology failure without a guaranteed power supply at Mombasa.

The traders and growers said using the e-auction would be a health hazard if buyers were to sit uninterrupted through the 8 hours looking at computer screens and the auction would lose its gusto.

It is interesting that these now don’t see it as a health hazard and are willing to move with the times embracing technology.

New research establishes storage temperature for East African highland bananas

By Esther Nakkazi

Margaret Nalujja a trader at Bugolobi market a suburb in Kampala can now earn about 80 percent more from selling East African highland cooking bananas locally known as matooke in Uganda.

“From a cluster of peeled matooke I earn Ush 5,000 while the unpeeled sells for Ush 3,000,” said Nalujja.

Unlike the older generation that has for centuries been preparing matooke through long hours of peeling and steaming in banana leaves most of Nalujja’s clientele who are hotels, bachelors and the young generation want already peeled matooke that they just boil. Supermarkets also prefer it.

Market research under the RTB-ENDURE project has established that Uganda consumers prefer peeled matooke even when it has been under cold storage, said Dr. Enoch Kikulwe, an associate scientist at Biodiversity International of Uganda.

One of the questions that Ugandan farmers also wanted to know under the project was the temperature under which the matooke could be stored without getting spoilt, said Dr. Kikulwe also the team leader of the banana sub-project of RTB-Endure.

“This research has answered this fundamental question for East African highland cooking bananas.”

Scientists have found that both the peeled and unpeeled East African highland cooking bananas can stay for 12 days with no taste or color changes under cold storage of 12-18 degrees centigrade. Most standard fridges offer cold storage of 5-8 degrees centigrade.

Without cold storage the matooke can only stay for 3 days without ripening or rotting.

Bananas occupy 1.3 million hectares nationwide and are grown mainly by subsistence and semi-commercial farmers and it is a staple food for the rural communities. The matooke is a key source of livelihood for over 13 million farmers and a major staple food in Uganda.

A lot of research has been done on increasing the shelf life of other banana varieties like the Cavendish but we did not know what to do with the matooke said Dr. Kephas Nowakunda, the head of the food biosciences and agribusiness research program at the National Agricultural Research Organisation (NARO)

Dr. Nowakunda explained the other benefits of peeled bananas including leaving the waste on the farm to make manure and reducing rubbish.

The RTB-ENDURE research project has focused on innovations for improved postharvest management and expanded use of the cooking banana, cassava, potato and sweetpotato with an aim to improve food availability and income generation for roots, tubers and bananas producing communities.

RTB crops are essential staple foods in developing countries. They have high nutritional value, they generate income, and they contribute to the sustainability of cropping and production systems.

The RTB-ENDURE project is implemented in Uganda by the CGIAR Research Program on Roots, Tubers and Bananas (RTB), led by the International Potato Center (CIP), as part of a larger three year project funded by the European Union with technical support of IFAD.

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A forty-year walk with Ebola – it hasn’t been a 'walk in the park'

By Esther Nakkazi

40 Years ago, around September, the first Ebola blood samples were carried by a Congolese woman in her handbag from Zaire to Belgium on Sabena airlines. Yes, you read that correctly.

Currently, with an Ebola outbreak anywhere, travelers not even remotely near the source have to fill in forms, temperatures have to be taken, suspects quizzed and isolated or even denied access to places. It is the drill.

The fascinating 40-year history of Ebola since the first outbreak in Yambuku, a small village in the DRC, was told at the 8th international symposium on filoviruses in Antwerp, Belgium.

Nothing is the same anymore. Zaire is now the Democratic Republic of Congo, Sabena airlines - then the national carrier for Belgium - closed in 2001, its succeeded by Brussels Airlines.

As you know, this last Ebola outbreak was vastly different from all the ones before. Ebola has become a household name now, 40 years after Yambuku.

Forty years ago, though, Ebola was unknown.

In 1976, in Yambuku, a small village in Mongala Province in northern DR Congo, a young doctor Jean-Jacques Muyembe was ordered by the minister of health to make investigations about a disease that had killed some people.

Muyembe arrived with a medical assistant. The health workers suspected typhoid or yellow fever. Muyembe examined some sick people and collected blood samples without gloves. His hands and fingers were stained with blood but he just washed it off with water and soap. In addition, he collected liver samples from 3 nurses who had died.

When a nurse who he knew was vaccinated from typhoid and yellow fever said she had a fever the alarm bells started to ring. The trio (Muyembe, the medical assistant, and nurse) flew to Kisansha to further investigate the samples.

The disease was nothing they knew. Sadly, the nurse and medical assistant died in the next few days but Muyembe was saved - not by the ‘moon suit’ but by washing his hands with water and soap.

A Congolese woman who was traveling to Belgium on Sabena airlines was asked to drop the samples off at the Institute of Tropical Medicine (ITM) in Antwerp, where Muyembe’s friend was working.

The Ebola samples arrived in Belgium in September 1976. Dr. Guido van der Groen picked them up on his bicycle. They were packed in used containers. He took them for proper storage at ITM.

Here the team tried to identify the virus and found that it was close to the Marburg virus isolated from monkeys in Uganda by the Germans, but clearly, it was not the same. Muyembe was informed about it and warned that it concerned a very dangerous new virus. They then tried to give the new virus a name.

At first, they opted for Yambuku where the index case was discovered but they soon realized that if you use the name of a town it will cause too much stigma. Then they looked for any landmark near Yambuku and found the Ebola river which is why Ebola is now named after a river near Yambuku.

The Ebola forty-year journey has seen 25 outbreaks by now, 30,900 cumulative cases and 12,800 deaths. A new book ‘on the trail of Ebola’ by Dr. Guido van der Groen details this history.

Frontline health workers have been most affected by Ebola over the years, but right now it is a serious public health threat. Many ongoing efforts in terms of policy, diagnostics, and research are being discussed at this symposium.

Clearly, the Ebola journey hasn’t been a ‘walk in the park’.

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Uganda off WHO list of yellow fever risk countries

By Esther Nakkazi

After a month of no evidence of active transmission, Uganda has now been declared yellow fever free.

The ministry of Health says between the 1st to the 30th of June 2016 there were no cases of active transmission in the country. A vaccination coverage of 94 percent, which is above the World Health Organisation (WHO) recommended coverage of 90 percent was achieved in the three affected districts of Masaka, Rukungiri and Kalangala.

Following the successful yellow fever vaccination campaign in the affected districts, no new cases have been confirmed, said Professor Anthony Mbonye, the acting director of general health services, Ministry of Health.

A total of 627,706 residents (aged six months and above) were vaccinated including 273,447 in Masaka district and 304,605, 49,654 in Rukungiri and Kalangala districts respectively.

Thereafter, the Public Health Emergencies Operations Centre Network (PHEOC) coordinated a one month enhanced Yellow Fever surveillance in 17 districts surrounding the three districts with no confirmed cases.

However, disease surveillance to detect any other possible outbreak and heightened efforts to prevent the risk of transmission through international travel is still ongoing, said Prof. Mbonye.

It is mandatory that individuals travelling from yellow fever high risk countries into Uganda are fully vaccinated against it before entry into Uganda. Unvaccinated travellers from Uganda are also advised to access the yellow fever vaccine from accredited centres.

On 7th April 2016, yellow fever was confirmed by Uganda Virus Research Institute (UVRI) on 3 samples from Masaka by serology. This diagnosis was re-confirmed on 21st April 2016 by CDC Fort Collins (WHO Collaborative Centre for Yellow Fever)

Intensification of yellow fever Surveillance activities also confirmed yellow fever in Rukungiri and Kalangala districts on 13th April 2016 and 4th May 2016 respectively.

From 24th March to 4th May 2016, a total of 65 suspected yellow fever cases were reported from districts in the greater Masaka region and 7 cases were confirmed from Masaka (5), Rukungiri (1) and Kalangala (1). Three of confirmed cases died.

With support from World Health Organization (WHO), the CDC, ICG, GAVI, UNICEF and other partners, the Ministry of Health conducted a reactive yellow fever vaccination in the three districts that had confirmed outbreaks.

The vaccination campaign was implemented from 19th May 2016 to 22nd May 2016 in Masaka and Rukungiri districts and from 4th June 2016 to 7th June 2016 in Kalangala district.

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Sex education in Uganda schools was a bad move?

By Esther Nakkazi

It was at the celebrations of the 2016 World population day held in Isingiro district that I first heard President Yoweri Museveni talk about the unessential need for Uganda to have sex education in schools.

The theme was ‘invest in teen girls’ and in his speech, Museveni juxtaposed high teenage pregnancy with teaching sex education in schools.

“I want to discuss with all stakeholders about sex education in schools. There is a time for everything,” he said meaning he actually wanted to fix what he started.

Sex education started being taught in primary and secondary schools in 2001 when Uganda was preaching abstinence-only. It was an official program of President Museveni under the Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY).

PIASCY was launched by President Museveni in 2002 to promote abstinence and life skills education among school children. It was funded by the US lead government agency USAID and the Centres for Disease Control and Prevention (CDC). It was later bounced to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). 

The main aim of PIASCY was to empower young people to delay their sexual relations until marriage through abstinence. Thus, materials of instruction were made and distributed in primary and secondary schools and at youth rallies.

For kids aged 5-12 years the message was mainly abstinence and its benefits and as they grew older the subsequent message was correct condom application and uses. For kids 13-18 years it was upgraded to also include age sensitive subjects like masturbation, abortion, homosexuality but there was also some misleading and inaccurate information on condoms and HIV prevention.

Fifteen years down the line, after pumping kids with comprehensive sex education in schools, this is the scenario.

Uganda teen pregnancy incidence rates are sky high compared to its neighbors, HIV rates among adolescents are growing, teens spend happy moments exchanging porn and according to Parliamentarians the God-fearing Nation- read Uganda- is getting ‘more gay’.

Of course, there are positive contributions that sex education has made to Uganda's teens but the policymakers are adamant about them. All that is cited are these bad stats.

Latest stats from United Nations Population Fund (UNFPA) say 140 per 1,000 teenage girls get pregnant annually in Uganda compared to 41, 101 and 128 in Rwanda, Kenya, and Tanzania respectively.

The Ministry of Health reports that 25 percent of Uganda teenagers become pregnant by 19 years and face four times the risk of maternal death compared to women older than 20 years plus their rates of neonatal death are about 50% higher.

According to the 2011 Uganda Demographic Health Survey (UDHS), many of the pregnancies in female adolescents aged 15-19 years are neither desired nor planned and those who had a child five years prior to the survey did not want to have it at that time.

Abortion is illegal in Uganda except under exceptional circumstances that include saving the life of the woman or preserving her physical and mental health. Studies show unplanned pregnancies in adolescents coupled with high teen pregnancy rates contribute to the high incidence of abortion and its related deaths.

A study done at the national referral hospital, Mulago, showed that almost 50% of the women who died from abortion complications were adolescents. But these also tend to seek an abortion later than others and are more likely to use unskilled providers.

In mid-August, a month after President Museveni who signed onto this program complained, the Uganda parliament debated the motion to withdraw sex education in schools.

Lucy Akello, a Member of Parliament, Amuru district moved a motion, which appreciated that ‘comprehensive sexuality education lacks defined approaches to guide children at their tender age and to uphold Uganda with its morals, virtues of an Africa setting and a God fearing Nation.

It was agreed that the ministry of education halts dissemination of comprehensive sexuality education training materials and conduct of such programs in any schools in Uganda until a policy has been laid out in Parliament. 

Also, the National Curriculum Development Center in conjunction with relevant stakeholders would develop a comprehensive sexuality education curriculum in line with Uganda’s cultural values and practices.

During the debate, every member who spoke supported the motion. They blamed sex education in schools for the widespread 'immorality' inclusive but not limited to early sex, abortions, homosexuality and teen disobedience.

Of course, there should be other things to blame like the increasing exposure to porn and ‘raw and uncensored material’ on the Internet but in the meantime according to our legislators adopting this motion will fix everything.

Here is another scenario from a highly educated Ugandan.

So last year, I was attending the Makerere University Walter Reed Project (MUWRP) stakeholders meeting in Kampala thematized ‘Mitigating disease threats of Public Health Importance: 13 years of MUWRP in Uganda’.

Prof Vinand Nantulya, the Chairman of the Uganda Aids Commission (UAC) was the key speaker. He juxtaposed Uganda’s HIV new infections increase to the vulnerability of young women who are increasingly getting lured into sexual activities. He said it is worse.

UNAIDS estimates that 380 new HIV infections occur in Uganda making it the third leading contributor to new HIV infections in Africa after Nigeria and South Africa.

Prof Nantulya said one of the ways this would be fixed was to have more education about HIV in schools, which is also part of the comprehensive sexuality education package. He said more funds needed to be provided for PIASCY.

“PIASCY, which was good and helpful to educate the youth is not as good as it used to be. I want PIASCY back,” he said.

So its either that Uganda children and adolescents do not need sex education at all or that the PIASCY project got it wrong. Whatever it is we are not going back to the era when Uganda’s children got sex education from their grandparents, parents or relatives as Museveni suggested. No one has that time anymore. It is easier done in schools with the right messages and at an appropriate age. So since it cannot just be blown away, fix it.

Is a malaria free Africa by 2030 possible?

By Esther Nakkazi
Is a malaria free Africa by 2030 possible? The glass is half full.

Forty-seven World Health Organisation member states in the African Region unanimously adopted a new malaria framework with specific actions to reach ‘an African Region free of malaria’ by 2030.

In a meeting held in Addis Ababa on 21st August, they came up with a framework to guide member countries towards attaining targets of the Global Technical Strategy (GTS) for malaria (2016-2030) within a given time frame.

The GTS was founded in May 2015 at the 68th World Health Assembly on the vision of a world free of malaria and consists of four goals and related targets to be achieved by 2020, 2025 and ultimately by 2030.

It for instance aims to reduce malaria mortality rates and case incidence by at least 90% by 2030 as well to eliminate malaria from at least 20 malaria endemic countries. It also aims to prevent re-establishment of malaria in all Member States that are malaria-free.

A press release from WHO AFRO says this framework's priority interventions and actions have been organized according to programme epidemiological strata in order to engender evidence-based targeted interventions.

The GTS has guiding principles like country ownership and leadership with involvement and participation of communities within a multisectoral context. It also encourages mobilizing and working with other sectors in malaria control and elimination.

To an extent some of these goals are achievable.  Some projects have demonstrated it. Six countries; Algeria, Botswana, Cape Verde, Comoros, South Africa, Swaziland have the potential according to the WHO to eliminate local transmission of malaria by 2020.

Meanwhile, two countries, the Democratic Republic of the Congo (DRC) and Nigeria alone account for more than 35% of the global estimated malaria deaths so if efforts are concentrated here that would give a lot of mileage I suppose.

But how possible is it that the Africa region can be malaria free by 2030?

Well, there is some impressive progress so far in controlling it. Since 2000, malaria death rates have plunged by 66%, translating into 6.2 million lives saved, most of them children. Between 2000 and 2015, the number of malaria cases and deaths within the African Region declined by 42% and 66%, respectively says the WHO.

In addition, more people with suspected malaria get tested before treatment and many more are sleeping under insecticide-treated mosquito nets. In 2014, 65% of the suspected malaria cases got tested before treatment compared to only 41% in 2010. In 2015, two in three households in Africa had their own insecticide-treated mosquito net, compared to only 2% back in 2000.

And like Dr Matshidiso Moeti, the WHO Regional Director for Africa said, “Malaria is no longer the leading cause of death among children in sub-Saharan Africa. More and more children get to sleep under a net.”

Malaria is also still on top of the global and regional agenda and so it remains a priority, identified in target 3.3 of the Sustainable Development Goals (SDGs) which commits to end it by 2030. The WHO also reaffirms to end it by then.

However, despite the significant progress made, malaria continues to be a major health and development problem in the Africa Region as it still bears the biggest malaria burden with about 190 million cases (89% of the global total) and 400 000 deaths (91% of the global total) in 2015 alone.

We cannot talk about a malaria free Africa without talking funding which the World Malaria report 2005 says increased substantially by 410% between 2005 and 2013 for programme financing. Overall, international financing for malaria control increased from US$ 100 million to US$ 1,640 million in 2013.

But the report also shows that even with these increases the annual investment per person at risk remained low at US$ 2 in the year 2013 and this funding situation is further threatened by low domestic financing.

So in the period 2005-2013, the proportion of total malaria funding contributed by national governments in Africa stagnated at less than 10% and these rely on external funding.

Meanwhile, based on GTS cost estimates and at a fixed 2013 population at risk of malaria in Africa of about 830 million, the total cost of malaria elimination in Africa by 2030 is US$ 66 billion.

There is thus a funding gap which is not new because most health projects are suffering from low aid.

Furthermore, implementation of the GTS will necessitate addressing some key challenges like weak health systems (which were tested during the Ebola outbreak).

As well there is the threat of resistance to the medicines combined to a lack of a vaccine and the adverse effects of climate variability and change.

One of the reasons for reversing the malaria deaths as mentioned earlier was as said by Dr Moeti; ‘more children slept under a net but there is need to continue to invest in changing people’s behaviours.’ She also said more people with suspected malaria got tested before treatment.

It is only if people in the region change their behaviour and sleep under treated nets and also seek treatment within 24 hours after testing. These are some of the sustainable ways to keep the gains achieved and also move forward.

Otherwise, the glass really remains half full as the balance for the gains and the challenges for implementing the GTS remains glaringly odd.

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Anne Merriman Hospice Africa Foundation launched

By Esther Nakkazi

The 2014 Nobel Peace Prize nominee Professor Dr. Anne Merriman's efforts to improve palliative care for Africans are starting to pay off. She is also an advocate of a good death, which is a basic human right.

While in 1993 only three African countries had palliative care now 35 have support care and 20 have affordable oral morphine based on Merriman’s formula which she developed in 1980. Hospice Africa Uganda (HAU) the model she founded for Africa is also producing enough oral liquid morphine for all in need in Uganda, with the support of the Ugandan government.

Since its founding, Hospice Africa Uganda has cared for more than 27,000 patients. It currently provides family centred care for up to 2,000 patients across its three centres in Kampala, Mbarara and Hoima. 

 “An Africa where Palliative Care reaches whoever needs it is a very big vision. This vision can only be achieved if impeccable clinical services, like the ones offered at Hospice Africa Uganda, are spread all over the continent and are integrated into the health service delivery system of every country, said Dr. Eddie Mwebesa, the Chief Executive Director of HAU.

Also recognising the shortage of morphine prescribing doctors,  Merriman’s work has changed the law in Uganda to allow specially trained nurses to also prescribe morphine. 

So Uganda is the only country in the world where nurses can prescribe morphine, hence it was in 2015 ranked by the Economist, Quality of death Index as the second country in Africa (35th worldwide) for the highest quality of death.

It is estimated that 50 percent of people in Africa will not access a health worker in their lifetime, and less than 5 percent reach chemotherapy or radiotherapy.

On Wednesday, 17 August the Anne Merriman Hospice Africa Foundation was launched in Kampala by Dr. Jane Aceng,  the Uganda minister of health during the 5th International African Palliative Care Association Conference. 

“Every human being on the planet no matter their colour, creed or social background should expect a pain free, peaceful, end of life. Unfortunately in Africa this is not the case for most," said Merriman.

"I have worked with dedicated teams for the last 23 years to change this and now that I am 81-years-of age, our loyal supporters and I, want to ensure that this work continues, until the vision is a reality. Together we have achieved a lot - but so much more needs to be done.”

She appealed to world leaders and policy makers to take note and to do all in their power to ensure that people in Africa experience a good death. “We need strong and powerful advocates to support this cause.”

“We are here because we want to move the ethos of care: compassionate, team oriented, and patient centred, forward together. It's for this purpose that the Anne Merriman Hospice Africa Foundation will thrive in its vision," said Mrs Shelley Enarson, a founding advisor to the Foundation, at the launch.

"The AMHA Foundation will promote the spirit of keeping the patient at the center of our care, and ensuring that the ethos of organisational partnerships are encouraged” said Dr. Mwebesa.

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