Food Security; African farmers need to increase fertilizer use

Africa is facing persistently high food prices and low farm yields, which are weakening its food security and putting the region’s fragile stability and economic growth at risk, according to a group of leading international scientists meeting in Kigali this week.

There is also a polarized debate over the use of organic and inorganic practices to boost farm yields, which is slowing widespread farmer adoption of approaches that could radically transform Africa’s food security situation.

“The ideological divide over approaches to farm production are a distraction from the actions needed to address food security now and ensure it in the future,” said Nteranya Sanginga, director general designate of the International Institute of Tropical Agriculture (IITA).

Over 200 leading African and international scientists met at the first conference of the Consortium for Improving Agriculture Based Livelihoods in Central Africa (CIALCA) in Kigali, Rwanda, this week.

Participants identified several practical solutions that would help move the region towards food security like scaling up farmer adoption of new technologies that improve degraded soils through more efficient use of inorganic fertilizers, new higher-yielding varieties of staple crops that improve nutrition, and mixed farming and intercropping approaches for crops like banana, coffee, and grain legumes.

“For many, fertilizer is a dirty word,” said Bernard Vanlauwe, acting director of the Tropical Soil Biology and Fertility research area at the International Center for Tropical Agriculture (CIAT). “We have to focus on approaches that improve livelihoods.”

Fertilizer use in Africa is by far the lowest in the world. On average, African farmers apply about 9 kg per hectare of fertilizer compared to 86 kg per hectare in Latin America and 142 kg per hectare in Southeast Asia.

“African agriculture is already organic. It’s not working,” said Sanginga. “We need to focus on practical things that help, not ideology.”

Agricultural researchers have found ways to dramatically reduce fertilizer use – while boosting crop yields. These include site-specific recommendations, partly based on detailed satellite images of African soils, and a technique known as micro-dosing, which involves the application of small, affordable quantities of fertilizer during a crop’s growing period.

New research by CIALCA scientists has shown that intercropping banana and coffee can benefit both the environment and farmers’ incomes compared to growing each crop separately.

Banana—a food staple for millions across the region—provides a shaded canopy for coffee plants, which results in higher yields, less soil erosion, and more money for the farmers. Scientists also noted that this approach is ‘climate smart’ because the shade could buffer heat-sensitive coffee crops against the predicted impacts of climate change.

Improved climbing bean varieties being grown by thousands of farmers in the region have been particularly well-received, producing three times the yield of ordinary bush beans.

On tightly packed, small farms, the new bean varieties make valuable use of limited space by growing upwards instead of sprawling outwards. They also improve soil fertility through nitrogen fixation, and when grown in rotation with maize – another crucial African staple - maize yields have increased substantially, and the need for fertilizer reduced.

“It does not have to be a choice between organic or inorganic; both approaches can work well together at different stages in agricultural development,” said Vanlauwe.

Climate change, rapid population growth, and intense land pressure are major challenges for Africa but it is high time it focused on practical, evidence-based solutions that will forever end the cycle of hunger, poverty and civil conflict,” said Sanginga.

African commitments on maternal health

News Release, October 18 - The legislative arm of the African Union, the Pan African Parliament (PAP), has adopted a broad resolution urging speakers of Parliament in the continent to prioritize the implementation of maternal, newborn and child health programs.

The latest development marks a significant milestone in accelerating progress in Africa towards the attainment of the Millennium Development Goals (MDGs) 4 and 5 on child and maternal health, respectively.

In the resolution passed during the 5^th session of the 2^nd Pan African Parliament held on 3^rd-14^th October, in Midrand, Johannesburg, South Africa, PAP members reiterated that maternal, newborn and child health is critical to overall human and social development in Africa.

It also calls for high-level parliamentary support to accelerate implementation of a plan on policy and budget support towards maternal, newborn and child health, agreed by Chairs of Finance and Budget committees of national parliaments in October 2010.

In July 2010, the African Union heads of states and governments made far-reaching commitments towards maternal and infant health at a high-level summit held in Kampala, Uganda.

The latest PAP resolution combines integrated implementation of African maternal, newborn and child frameworks with the United Nations Secretary-General`s Global Strategy for Women and Children’s Health, launched in 2010 to accelerate progress toward the achievement of the Millennium Development Goals.

According to the United Nations, 7.6 million children under the age of five and approximately 350,000 women die each year of pregnancy-related causes, most of which are preventable.

Underlining the need for accelerated global action, UN Secretary-General Ban Ki-moon said: UN Secretary-General Ban Ki-Moon said: “We must, therefore, do more for the newborn who succumbs to infection for want of a simple injection, and for the young boy who will never reach his full potential because of malnutrition.”

Health experts and campaigners said parliaments have a significant role to play in reinvigorating policy and budgetary support towards maternal and infant health in Africa.

Commending the Pan African Parliament Resolution, Rotimi Sankore, Secretary of the Africa Public Health Parliamentary Network, stated: “We welcome this landmark resolution by the Pan African Parliament, which is a significant step towards African parliamentary action to help end the tragic annual loss of an estimated 4.2 million lives of African women and children. The resolution strongly complements the African Union Commission-led Campaign for Accelerated Reduction of Maternal, Newborn and Child Mortality in Africa (CARMMA), launched in 31 countries over the last two years.”

Dr. Carole Presern, Director of The Partnership for Maternal, Newborn &Child Health, underlined that “This PAP resolution demonstrates the vital and positive contribution that parliaments globally can make to saving and improving the lives of women and children, and in particular the commitment of African parliamentarians to their constituents”.

With this resolution, five senior members from each of the 54 African Union member states have pledged to work alongside speakers and relevant committees of national parliaments, to implement the PAP resolution on maternal, newborn and child health.

This latest resolution by the Pan African Parliament will be presented to speakers of African parliaments during their second annual conference to be held on 17^th to 18^th October, 2011.

A partnership involving the Africa Public Health Parliamentary Network, the United Nations Population Fund (UNFPA), and the global Partnership on Maternal Newborn & Child Health (PMNCH) has worked closely with the Pan African Parliament in the lead-up to this resolution.

African commitments to the UN Secretary-General's Global Strategy for Women and Children's Health

Benin will increase the national budget dedicated to health to 10% by 2015 with a particular focus on women, children, adolescents and HIV; introduce a policy to ensure universal free access to emergency obstetric care; ensure access to the full package of reproductive health interventions by 2018; and increase the use of contraception from 6.2% to 15%. Benin will also step up efforts to address HIV/AIDS through providing ARVs to 90% of HIV+ pregnant women; ensuring that 90% of health centres offer PMTCT services; and enacting measures against stigma and discrimination. Benin will develop new policies on adolescent sexual health; pass a law against the trafficking of children, and implement new legislation on gender equality.

Burkina Faso has met the 15% target for health spending, and commits to maintain spending at this level. Burkina Faso will also develop and implement a plan for human resources for health and construct a new public and private school for midwives by 2015. This is in addition to other initiatives being pursued which will also impact on women’s and children’s health, including free schooling for all primary school girls by 2015, and measures to enforce the laws against early and forced marriage, and female genital mutilation.

Burundi commits to increase the allocation to health sector from 8% in 2011 to 15% in 2015, with a focus on women and children’s health; increase the number of midwives from 39 in 2010 to 250, and the number of training schools for midwives from 1 in 2011 to 4 in 2015; increase the percentage of births attended by a skilled birth attendant from 60% in 2010 to 85% in 2015. Burundi also commits to increase contraception prevalence from 18.9% in 2010 to 30%; PMTCT service coverage from 15% in 2010 to 85% with a focus on integration with reproductive health; and reduce percentage of underweight children under-five from 29% to 21% by 2015.

Cameroon commits to implement and expand the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA), re-establish midwifery training to train 200 midwives a year, and pilot a performance-based financing and a voucher system in order to promote access to maternal and child care services. Cameroon further commits to increase the contraception prevalence from 14% to 38%; the proportion of HIV+ pregnant women access to antiretrovirals from 57% to 75%; and the vaccine coverage from 84% to 93%. Cameroon will increase to 60% the proportion of health facilities offering integrated services; increase to 50% the proportion of women with access to Emergency Obstetric Care (EmOC) services; offer free malaria care to children under 5; ensure free availability of mosquito-treated nets to every family; increase funding to paediatric HIV/AIDS; strengthen health information systems management and integrated disease surveillance.

Chad commits to increase health sector spending to 15%; provide free emergency care for women and children; provide free HIV testing and ARVs; allocate of US$10million per year for implementation of the national roadmap for accelerating reduction in MNC mortality; strengthen human resources for health by training 40 midwives a year for the next 4 years, including creating a school of midwifery and constructing a national referral hospital for women and children with 250 beds; and deploying health workers at health centres to ensure delivery of a minimum package of services. Chad also commits to pass a national human resources for health policy; increase contraception prevalence to 15%; ensure 50% of the births are assisted by a skilled birth attendant; and increase coverage of PMTCT from 7% to 80%, and pediatric HIV coverage from 9% to 80%.

Central African Republic commits to increase health sector spending from 9.7% to 15%, with 30% of the health budget focused on women and children’s health; ensure emergency obstetric care and prevention of PMTCT in at least 50% of health facilities; and ensure the number of births assisted by skilled personnel increase from 44% to 85% by 2015. CAR will also create at least 500 village centers for family planning to contribute towards a target of increase contraception prevalence from 8.6% to 15%; increase vaccination coverage to 90%; and ensure integration of childhood illnesses including pediatric HIV/AIDS in 75% of the health facilities.

Comoros commits to increase health sector spending to 14% of budget by 2014; ensure universal coverage for PMTCT by 2015; reduce underweight children from 25% to 10%; increase contraception prevalence rate from 13% to 20%; and the births that take place in health facilities from 75% to 85%. Comoros will also accelerate the implementation existing national policies including the national plan for reproductive health commodity security, the strategic plan for human resources for health, and the roadmap for accelerating reduction of maternal and neonatal mortality.

Congo commits to reducing maternal mortality and morbidity by 20% by 2015 including obstetric fistula, by introducing free obstetric care, including free access to caesarean sections. Congo will also establish a new observatory to investigate deaths linked to pregnancy; and will support women’s empowerment by passing a law to ensure equal representation of Congolese women in political, elected and administrative positions.

Côte d'Ivoire commits to ensure the provision of free health services for all pregnant women during delivery, including free caesarian-sections, for women affected by obstetric fistula, and for children under 5. Côte d'Ivoire also commits to rehabilitate maternity centres, provide insecticide-treated mosquito nets for women and children under 5; to strengthen the integrated management of childhood illnesses programmes; and to integrate HIV and Sexual and Reproductive Health, and community involvement in health management, including training health workers to ensure the provision of family planning at the community level.

The Democratic Republic of Congo (DRC) will develop a national health policy aimed to strengthen health systems, and will allocate more funds from the Highly Indebted Poor Country program to the health sector. DRC will increase the proportion of deliveries assisted by a skilled birth attendant to 80%, and increase emergency obstetric care and the use of contraception. The government will increase to 70% the number of children under 12 months who are fully immunized; ensure that up to 80% of children under 5 and pregnant women use ITNs; and provide AVRs to 20,000 more people living with HIV/AIDS.

Djibouti commits to increase the health budget from 14% to 15%. In terms of service delivery, the Government will ensure that all pregnant women will have access to skilled personnel during childbirth. For this purpose, the Government will increase the number of trained midwives and nurses and will increase access to emergency obstetric care services nationally to 80%. A package of integrated emergency obstetric and newborn care and reproductive health will also be delivered in health services. This will be achieved by ensuring that all health centers are upgraded to deliver a package of emergency obstetric and newborn care and reproductive health services by upgrading them and ensuring that appropriate staff are posted and maintained in those centers. Contraceptive prevalence will be increased to 70%. The mobile health services will be extended to cover all areas of the country and will adopt a mix of outreach services, home visits and community based interventions. The government commits to implement Integrated Management of Childhood Illnesses in all health centers. Vaccine coverage will be 100%. Malnutrition will be addressed through a comprehensive multi-sectoral package in order to reduce the prevalence of stunting to 20% and that of wasting to 10%. Djibouti commits to decrease the HIV/AIDS prevalence to 1.8% in 2015 and to ensure that all pregnant HIV-positive women receive antiretrovirals.

Ethiopia will increase the number of midwives from 2050 to 8635; increase the proportion of births attended by a skilled professional from 18% to 60%; and provide emergency obstetric care to all women at all health centres and hospitals. Ethiopia will also increase the proportion of children immunized against measles to 90%, and provide access to prevention, care and support and treatment for HIV/AIDS for all those who need it, by 2015. As a result, the government expects a decrease in the maternal mortality ratio from 590 to 267, and under-five morality from 101 to 68 (per 100,000) by 2015.

The Gambia commits to increase the health budget to 15% of the national budget by the year 2015; and to implement its existing free maternal and child health care policy, ensuring universal coverage of high quality emergency maternal, neonatal and child health services. Special attention will be accorded to rural and hard-to-reach areas. Efforts will be intensified to increase the proportion of births attended by skilled professionals to 64.5%, ensure reproductive health commodities security, scale up free Prevention of Mother-to-Child Transmission (PMTCT) services to all reproductive health clinics and ensure universal access to HIV prevention, treatment, care and support services, including social protection for women, orphans and vulnerable children. Furthermore, The Gambia will continue to maintain the high immunization coverage for all antigens at 80% and above at regional levels, and 90% and above at national levels, while seeking to increase access of all children, particularly in the most vulnerable communities, to high impact and cost-effective interventions that address the main killers of children under five.

Ghana will increase its funding for health to at least 15% of the national budget by 2015. Ghana will also strengthen its free maternal health care policy, ensure 95% of pregnant women are reached with comprehensive PMTCT service and ensure security for family planning commodities. Ghana will further improve child health by increasing the proportion of fully immunized children to 85% and the proportion of children under-five and pregnant women sleeping under insecticide-treated nets to 85%.

Guinea commits to establish a budget line for reproductive health commodities; ensure access to free prenatal and obstetric care, both basic and emergency; ensure provision of newborn care in 2 national hospitals, 7 regional hospitals, 26 district hospitals, and 5 municipality medical centres; and introduce curriculum on integrated prevention and care of new born and childhood illnesses in health training institutes.  Guinea also commits to secure 10 life-saving essential medications in at least 36 facilities providing basic obstetric care and 9 structures with comprehensive obstetric care by 2012; ensure at least three contraception methods in all the 406 centres of health in the public sector by December 2012; and include PMTCT in 150 health facilities.

Guinea-Bissau commits to increase financial spending from 10% to 14% by 2015 and to implement the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA); to ensure accessible comprehensive emergency obstetric and neonatal care in all regions, and to provide around-the-clock referrals. Guinea-Bissau also commits to ensure that each health center has access to basic Emergency Obstetric Care (EmOC), including strengthening the technical capacity of 95% of the EmOC facilities; increasing the proportion of women giving birth in health facilities from 35% to 60%; ensuring that 75% of the pregnant women are covered by health mutual funds, and that 90% of the most vulnerable are covered by state funds. In addition, Guinea-Bissau also commits to reduce the unmet need for family planning to 10% and to increase contraceptive prevalence from 10% to 20%; to increase pre-natal consultations to 70%, postnatal consultations to 30%, and to reduce the proportion of underweight children from 24% to 10%; and to integrate Prevention of Mother-to-Child Transmission in 90% of the maternity care centers.

Kenya will recruit and deploy an additional 20,000 primary care health workers; establish and put into operation 210 primary health facility centres of excellence to provide maternal and child health services to an additional 1.5 million women and 1.5 million children; and will expand community health care, and decentralize resources.

The Government of Lesotho is committed to meeting the Abuja Declaration Target of 15% expenditure for health, compared to the current 14% expenditure. The Government abolished user fees for all the health services at Health Centre level, while it has standardized user fees at hospital-level. The country has developed the National Health Sector Policy and its Strategic Plan which puts women and children at the centre. The National Reproductive Health Policy and its Strategic Plan also focus on women and children. These documents have been disseminated and their implementation is closely monitored. The Reproductive Health Commodity Security Strategy is in place and ensures that 90% of the women and men in the reproductive age group have access to commodities. The Lesotho Expanded Programme on Immunization Policy has been disseminated in 2010, focusing on under-five children. The Infant and Young Child Feeding Policy focuses on nutrition of children.

Liberia will increase health spending from 4% to 10% of the national budget and will ensure that by 2015 there are double the number of midwives trained and deployed than were in the health sector in 2006. Liberia will provide free universal access to health services including family planning and increasing the proportion of health care clinics providing emergency obstetric care services from 33% to 50%. Liberia will increase the proportion of immunized children to 80%, and address social determinants of ill-health through increasing girl’s education, and the mainstreaming of gender issues in national development.

By 2015, Madagascar commits to increase health spending to at least 12%; ensure universal coverage for emergency obstetric care in all public health facilities; increase births assisted by skilled attendants from 44% to 75%; and double from 35% the percentage of births in health facilities. Madagascar will also address teenage pregnancy by making 50% of primary health care facilities youth-friendly; reduce from 19% to 9.5% the unmet need of contraception by strengthening commodity security;  increase tetanus vaccination for pregnant women from 57% to 80%; and institute maternal death audits.

Malawi will strengthen human resources for health, including accelerating training and recruitment of health professionals to fill all available positions in the health sector; expand infrastructures for maternal, newborn and child health; increase basic emergency obstetric and neonatal care coverage to reach World Health Organization standards; and provide free care through partnerships with private institutions.

Mali commits to create a free medical assistance fund by 2015 and to reinforce existing solidarity and mutual funds for health, and extend the coverage of a minimum package of health interventions. Mali will implement a national strategic plan for improving the reproductive health of adolescents; and will strengthen emergency obstetric care, introducing free caesarean and fistula services, also by 2015. Mali will promote improvements in child health through free vitamin A supplements, and increased screening for and management of malnutrition, and through the extension of the Integrated Management of Childhood Illness Programme. Mali will also distribute free insecticide-treated bed-nets to women making second ante-natal visits, and remove taxes on other ITNs.

Mauritania commits to increasing expenditure on health to 15% by 2015, and including a budget line on reproductive health commodities with a focus on contraceptives; to increase contraception prevalence from 9% to 15%, constructing 3 more schools of public health, increasing access to Emergency Obstetric and Newborn Care in all regional and national hospitals; to increase the proportion of births assisted by skilled personnel from 61% to 75%; and increasing the proportion of health centers offering PMTCT services to 75%. Mauritania further commits to increase proportion of vaccinated children, institute in all districts a program of integrated management of childhood illnesses, and improve the management of human resources including providing incentives for staff to work in isolated areas.

Mozambique commits to increase the percentage of children immunized aged under 1, from 69 to 90 percent by 2012 and to increase the number of HIV+ children receiving ARTs from 11, 900 to 31,000 by 2012. Mozambique will also increase contraceptive prevalence from 24 to 34 % by 2015 and will increase institutional deliveries from a level of 49% to 66% by 2015. Mozambique also commits to establish a centre for the treatment of obstetric fistula in each province by 2015.

Niger commits to increase health spending from 8.1% to 15% by 2015, with free care for maternal and child heath, including obstetric complications management and family planning. Niger will train 1000 providers on handling adolescent reproductive health issues, and to address domestic violence and female genital mutilation (FGM). Niger will reduce the fertility rate from 3.3% to 2.5% through training 1500 providers of family planning, and creating 2120 new contraception distribution sites. Niger will further equip 2700 health centres to support reproductive health and HIV/AIDS education, and ensure that at least 60% of births are attended by a skilled professional. Niger will additionally introduce new policies that support the health of women and children, including legislation to make the legal age of marriage 18 years and to improve female literacy from 28.9% in 2002 to 88% in 2013.

Nigeria endorses the Secretary General’s Strategy on women’s and children’s health, and affirms that the initiatives is in full alignment to our existing country-led efforts through the National Health Plan and strategies targeted for implementation for the period 2010 – 2015, with a focus on the MDGs in the first instance and the national Vision 20 – 2020. In this regard, Nigeria is committed to fully funding its health program at $31.63 per capita through increasing budgetary allocation to as much as 15% from an average of 5% by the Federal, States and Local Government Areas by 2015. This will include financing from the proposed 2% of the Consolidated Federal Revenue Capital to be provided in the National Health Bill targeted at pro-poor women’s and children’s health services. Nigeria will work towards the integration of services for maternal, newborn and child Health, HIV/AIDS, Tuberculosis and Malaria as well as strengthening Health Management Information Systems. To reinforce the 2488 Midwives recently deployed to local health facilities nationwide, Nigeria will introduce a policy to increase the number of core services providers including Community Health Extension Workers and midwives, with a focus on deploying more skilled health staff in rural areas.

Rwanda commits to increasing heath sector spending from 10.9% to 15% by 2012; reducing maternal mortality from 750 per 100,000 live births to 268 per 100,000 live births by 2015 and to halve neonatal mortality among women who deliver in a health facility by training five times more midwives (increasing the ratio from 1/100,000 to 1/20,000). Rwanda will reduce the proportion of children with chronic malnutrition (stunting) from 45% to 24.5% through promoting good nutrition practices, and will increase the proportion of health facilities with electricity and water to 100%.

Sao Tome and Principe commits to increase the percentage of the general budget for health from 10% to 15% in 2012; increase the ratio of births attended by a qualified health personnel from 87.5% to 95%; reduce the percentage of inadequate family planning service delivery from 37% to 15%; increase the geographic coverage of PMTCT services from 23% to 95%; increase the percentage of pregnant women receiving ARVs from prenatal centres from 29% to 95%; and increase the prevalence of contraception from 33.7% to 50%.

Senegal commits to increasing its national health spending from 10% of the budget currently to 15% by 2015.  It also proposes to increase the budget allocated to MNCH by 50% by 2015.  The country commits to improving coordination of MNCH initiatives by creating a national Directorate for MNCH, reinstating the national committee in charge of the implementation of the multi-sectoral roadmap for the reduction of maternal and child mortality and to accelerate the dissemination and implementation of national strategies targeting a reduction of maternal mortality.  Through these efforts the government hopes to offer a full range of high impact MNCH interventions in 90% of health centers, increase the proportion of assisted deliveries from 51% to 80% by increasing recruitment of state midwives and nurses and increasing contraceptive prevalence rate from 10% to 45%, among others.

Sierra Leone will increase access to health facilities by pregnant women, newborns and children under five by 40% through the removal of user fees, effective from April 27 2010. Sierra Leone will also develop a Health Compact to align development partners around a single country-led national health strategy and will ensure that all teachers engage in continuous professional development in health.

The Republic of South Sudan commits to increase the percentage of government budget allocation to the Ministry of Health from 4.2% to 10% by 2015; to increase the proportion of women delivering with skilled birth attendants from 10%- 45%, through the construction of 160 Basic Emergency Obstetric Care facilities by 2015 and training of 1,000 enrolled/registered midwives by 2015; and to establish 6 accredited midwifery schools or training institutions/colleges; increase the contraceptive prevalence rate from 3.7% to 20%, and increase the percentage of health facilities without stock-out of essential drugs from 40% to 100%. South Sudan also commits to reduce the prevalence of underweight among children under five from 30% to 20%; increase the percentage of fully-immunized children from 1.8% to 50%; and increase the percentage of under-fives sleeping under bed nets from 25% to 70%. Finally, South Sudan will develop and implement a range of national policies that will strengthen its response to women and children's health, including policies on national family planning, on provision of free reproductive health services, especially Emergency Obstetric care services, on decentralization of budgeting, planning, management of health services, and on adolescent sexual and reproductive health and rights.

Sudan commits to increase the total health sector expenditure from 6.2% in 2008 to 15% by 2015. Sudan commits to guarantee immediately free universal access to Maternal and Child Health (MCH) services including Immunization, Integrated Management of Neonatal and Childhood Illnesses (IMNCI), Nutrition, Antenatal Care (ANC), delivery care, post-natal care, and child spacing services to target all women and children. Sudan also commits to train and employ at least 4,600 midwives focusing on states with the highest maternal mortality ratios and the lowest proportion of births attended by trained personnel. This will increase the percentage of births attended by trained personnel from 72.5% to 90%, increase quality universal access to Comprehensive Emergency Obstetric and Neonatal Care, and advocate for the elimination of harmful traditional practices like early marriage and Female Genital Mutilation/Cutting.

Tanzania will increase health sector spending from 12% to 15% of the national budget by 2015. Tanzania will increase the annual enrollment in health training institutions from 5000 to 10,000, and the graduate output from health training institutions from 3,000 to 7,000; simultaneously improving recruitment, deployment and retention through new and innovative schemes for performance related pay focusing on maternal and child health services. Tanzania will reinforce the implementation of the policy for provision of free reproductive health services and expand pre-payment schemes, increase the contraceptive prevalence rate from 28% to 60%; expand coverage of health facilities; and provide basic and comprehensive Emergency Obstetric and Newborn care. Tanzania will improve referral and communication systems, including radio call communications and mobile technology and will introduce new, innovative, low cost ambulances. Tanzania will increase the proportion of Children fully immunized from 86% to 95%, extend PMTCT to all RMNCH services; and secure 80% coverage of long lasting insecticide treated nets for children under five and pregnant women. Tanzania will aim to increase the proportion of children who are exclusively breast fed from 41% to 80%.

Togo commits to ensure 95% coverage of vaccination for children under 5, and to implement the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA).

Uganda commits to ensure that comprehensive Emergency Obstetric and Newborn Care (EmONC) services in hospitals increase from 70% to 100% and in health centers from 17% to 50%; and to ensure that basic EmONC services are available in all health centers; and will ensure that skilled providers are available in hard to reach/hard to serve areas. Uganda also commits to reduce the unmet need for family planning from 40% to 20%; increase focused Antenatal Care from 42% to 75%, with special emphasis on Prevention of Mother-to-Child Transmission (PMTCT) and treatment of HIV; and ensure that at least 80% of under 5 children with diarrhea, pneumonia or malaria have access to treatment; to access to oral rehydration salts and Zinc within 24 hours, to improve immunization coverage to 85%, and to introduce pneumococcal and human papilloma virus (HPV) vaccines.

Zambia commits to: increase national budgetary expenditure on health from 11% to 15% by 2015 with a focus on women and children’s health; and to strengthen access to family planning - increasing contraceptive prevalence from 33% to 58% in order to reduce unwanted pregnancies and abortions, especially among adolescent girls. Zambia will scale-up implementation of integrated community case management of common diseases for women and children, to bring health services closer to families and communities to ensure prompt care and treatment.

Zimbabwe will increase health spending to 15% of the health budget or $20 per capita and establish a maternal, newborn and child survival fund by 2011 using the same approach as the successful Education Transition Fund (ETF) led by the Ministry of Education, Sports, Arts and Culture and administered by UNICEF. The fund has raised US$50 million in the first year for the ministry’s priorities, and contributed to donor coordination and harmonization. Zimbabwe will abolish user fees for health services for pregnant women and for children under the age of 5 years by the end of 2011; and will strengthen the Maternal and Newborn Mortality audit system - piloting a new system in two provinces in 2011 before expanding nationwide in 2012.

END.

Uganda and US partner to develop new, low-cost prevention and treatment strategies

NEWS RELEASE                        

          

FOR IMMEDIATE RELEASE

Oct. 11, 2011

FRED HUTCHINSON CANCER RESEARCH CENTER BREAKS GROUND FOR FIRST COLLABORATIVE, COMPREHENSIVE CANCER CENTER IN

SUB-SAHARAN AFRICA

Innovative collaboration between researchers in Kampala and Seattle furthers specialized study and effective treatment of infection-related cancers

SEATTLE and KAMPALA, Uganda – A pioneering international collaboration forged by Fred Hutchinson Cancer Research Center in Seattle, Wash., USA, together with the Uganda Cancer Institute in Kampala, Uganda, has broken ground for the future construction of a state-of-the-art cancer training and outpatient treatment facility in Kampala. The building will be the first comprehensive cancer center jointly constructed by U.S. and African cancer institutions in sub-Saharan Africa.

“Through the collaboration between the Hutchinson Center and the Uganda Cancer Institute, we hope to develop new, low-cost prevention and treatment strategies that will not only stem the rising burden of cancer in sub-Saharan Africa but will benefit millions of people worldwide,” said Lawrence Corey, M.D., president and director of the Hutchinson Center.

Once completed, the Uganda Cancer Institute/Fred Hutchinson Cancer Research Center Clinic and Training Institute will extend patient access to cancer diagnosis and research-based treatment while furthering study on the links between infectious diseases, such as HIV and Epstein-Barr virus, and cancers such as Kaposi sarcoma and the most common life-threatening malignancy among Ugandan children, Burkitt lymphoma.

Ugandan Vice President Edward Ssekandi led the Oct. 4 groundbreaking ceremony and was joined by Harold Varmus, M.D., Ph.D., Nobel laureate and director of the U.S. National Cancer Institute, Ugandan Minister of Health Christine Ondoa and other government officials, international dignitaries, global health experts and community leaders.

“We are gathered here today to celebrate a great example of a partnership between two institutions dedicated to saving lives – the Uganda Cancer Institute in Uganda and Fred Hutchinson Cancer Research Center in Seattle, Washington. I offer my congratulations to the two institutions who have come together, dedicated to improving the health and well being of people in Uganda and worldwide,” Ssekandi said.

“Cancer is being increasingly recognized as an enormously important global health problem that kills more people worldwide than HIV, tuberculosis and malaria combined, and nearly two-thirds of these deaths are in the developing world,” Corey said. “Sub-Saharan Africa has among the highest cancer rates in the world, and these rates appear to be increasing in association with the HIV epidemic. Through the collaboration between the Hutchinson Center and the Uganda Cancer Institute, we hope to develop new, low-cost prevention and treatment strategies that will not only stem the rising burden of cancer in sub-Saharan Africa but will benefit millions of people worldwide.”

Nearly 25 percent of cancers cases worldwide are infection related, and 50 percent of these cancer deaths occur in sub-Saharan Africa, explained Corey Casper, M.D., M.P.H., an associate member of the Hutchinson Center’s Vaccine and Infectious Disease Division and co-scientific director of the UCI/Hutchinson Center Cancer Alliance, which is the name of the collaboration between the Hutchinson Center and the Uganda Cancer Institute. “Our commitment in Uganda is to increase survival rates for common infection-caused cancers from 10 percent to 90 percent over the next three years while pursuing a unique research opportunity to find new ways to prevent infection-associated cancers, which will benefit cancer patients both in resource-poor and resource-rich regions,” he said.

The planned new facility that will enable these lifesaving advances will be three stories and total approximately 5,600 square feet. The building will include adult and pediatric cancer care clinics, including exam rooms, procedure suites, pharmacies and an infusion suite. It also will be equipped with specialized diagnostic laboratories. The facility is funded in part by two grants totaling $1.4 million from the United States Agency for International Development’s American Schools and Hospitals Abroad program and a $900,000 investment from the Hutchinson Center.

The Hutchinson Center’s relationship with the Uganda Cancer Institute dates back to 2004 and the UCI/Hutchinson Center Cancer Alliance was established formally in 2008. The program builds on the Hutchinson Center’s innovative research approach, which is to draw data from a setting where the disease burden is exceptionally high, while reinforcing the organization’s commitment to reduce cancer-related suffering and death.

In 2008, Uganda had just one oncologist who treated more than 10,000 patients annually. In response, the Hutchinson Center spearheaded an extensive medical training program that has increased the number of practicing oncologists in Uganda fivefold.

More than 1.2 million Ugandans are living with HIV/AIDS. According to the U.S. National Cancer Institute, people infected with HIV are several thousand times more likely than uninfected people to be diagnosed with Kaposi sarcoma and at least 70 times more likely to be diagnosed with non-Hodgkin lymphoma. Kaposi sarcoma is the most common cancer in adult Ugandan men; human herpesvirus 8, also a cause of Kaposi sarcoma, is the most common cancer-related infection in women. According to UCI/Hutchinson Center Cancer Alliance researchers, nearly 75 percent of these cases can be treated for less than $800.

Ugandan children are also vulnerable to infection-related malignancies that are not HIV-associated. “Cancer, especially childhood cancer, is a growing threat to Uganda’s next generation and must be addressed with equal vigor as HIV/AIDS,” stated Jackson Orem, M.D., director of the Uganda Cancer Institute and co-scientific director of the UCI/Hutchinson Center Cancer Alliance.

Burkitt lymphoma, both potentially fatal and disfiguring, is the most common cancer diagnosis among Ugandan children and is caused by the Epstein-Barr virus. Burkitt lymphoma has particular connections with Uganda; it first was identified there in 1958 by Sir Denis Burkitt. The first use of combination chemotherapy in the world was used to treat Burkitt lymphoma and initiated by Uganda Cancer Institute physicians in conjunction with the National Cancer Institute at the U.S. National Institutes of Health. This approach is now the most widely utilized therapy for cancer.

Each year in Uganda, 600 new Burkitt cases present for medical attention and the average age at diagnosis is 5. Currently, the five-year survival rate is less than 40 percent, but it is estimated that 85 percent of these children could be cured for less than $600 a case.

When completed, the Uganda Cancer Institute/Fred Hutchinson Cancer Research Center Clinic and Training Institute will be an incubator of research that will dramatically alter the course of cancer diagnosis, treatment and care. The building will serve as a state-of-the-art venue for gathering data and conducting studies to further the prevention and treatment of cancer-related infectious diseases, with far-reaching implications for global health.

Boosting patient access to diagnostic technology and significantly increasing the number of patients who can be treated, the new facility will enhance integration of HIV treatment into cancer care and enable Hutchinson Center experts to devise a model of effective cancer care that could be deployed in other resource-limited areas.

To date, the Hutchinson Center has trained more than 100 individuals in both the United States and Uganda. Of the more than 70 Ugandan trainees, interns and fellows, 15 have traveled to Seattle to study at the Hutchinson Center. Twelve of the 25 Americans have trained in Uganda. The program offers training in a variety of disciplines —hematology, oncology, epidemiology, global health and HIV-associated malignancies, among others. Trainees include postgraduate and postdoctorate fellows, laboratory technicians, medical officers, study nurses and administrators.

Multimedia press kit: For more information, including broadcast-quality video B-roll, high-resolution photos of medical staff and patients, building renderings and researcher biographies, please visithttp://www.fhcrc.org/about/ne/news/2011/10/11/uganda_groundbreaking_release.html

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At Fred Hutchinson Cancer Research Center, our interdisciplinary teams of world-renowned scientists and humanitarians work together to prevent, diagnose and treat cancer, HIV/AIDS and other diseases. Our researchers, including three Nobel laureates, bring a relentless pursuit and passion for health, knowledge and hope to their work and to the world. For more information, please visit fhcrc.org.

CONTACT:

Dean Forbes, Media Relations Manager
dforbes@fhcrc.org
206-667-2896 (desk) or 206-605-0311 (cell)

Dean Forbes

Media Relations Manager

Fred Hutchinson Cancer Research Center

Seattle Cancer Care Alliance

206-667-2896 - office

206-605-0311- mobile

Information for Journalists: http://www.fhcrc.org/journalists

Three stories of my life' : Steve Jobs

Three stories of my life': Steve Jobs

The Jakarta Post, Jakarta | Thu, 10/06/2011 1:00 PM

A | A | A |

Steve Jobs (apple.com) 

“Three Apples changed the world:

The first seduced Eve

The second fell on Newton

And the third one was offered to the world half bitten by him. RIP Steve Jobs ...”

This was among the top comments on a Youtube video on Thursday, displaying Jobs' speech at Stanford University's 114th Commencement on June 12, 2005. Regarded as one of Jobs' most inspiring speeches, the video has been viewed more than 6 million times and has drawn around 10,000 comments, mostly after news of his death at the age of 56 spread in the media. 

The speech, written by Jobs himself, is regarded as some of his best work. In it, Jobs summarized his life into “three stories” and urged others to pursue their dreams and see the opportunities in life's setbacks.

Here is a transcript of the address:

You've got to find what you love, says Jobs
(Stanford Report, June 14, 2005)

I am honored to be with you today at your commencement from one of the finest universities in the world. I never graduated from college. Truth be told, this is the closest I've ever gotten to a college graduation. Today I want to tell you three stories from my life. That's it. No big deal. Just three stories.

The first story is about connecting the dots.

I dropped out of Reed College after the first six months, but then stayed around as a drop-in for another 18 months or so before I really quit. So why did I drop out?

It started before I was born. My biological mother was a young, unwed college graduate student, and she decided to put me up for adoption. She felt very strongly that I should be adopted by college graduates, so everything was all set for me to be adopted at birth by a lawyer and his wife. Except that when I popped out they decided at the last minute that they really wanted a girl. So my parents, who were on a waiting list, got a call in the middle of the night asking: "We have an unexpected baby boy; do you want him?" They said: "Of course." 

My biological mother later found out that my mother had never graduated from college and that my father had never graduated from high school. She refused to sign the final adoption papers. She only relented a few months later when my parents promised that I would someday go to college.

And 17 years later I did go to college. But I naively chose a college that was almost as expensive as Stanford, and all of my working-class parents' savings were being spent on my college tuition. After six months, I couldn't see the value in it. I had no idea what I wanted to do with my life and no idea how college was going to help me figure it out. And here I was spending all of the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out OK. 

It was pretty scary at the time, but looking back it was one of the best decisions I ever made. The minute I dropped out I could stop taking the required classes that didn't interest me, and begin dropping in on the ones that looked interesting.

It wasn't all romantic. I didn't have a dorm room, so I slept on the floor in friends' rooms, I returned coke bottles for the 5¢ deposits to buy food with, and I would walk the 7 miles across town every Sunday night to get one good meal a week at the Hare Krishna temple. I loved it. And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on. Let me give you one example:

Reed College at that time offered perhaps the best calligraphy instruction in the country. Throughout the campus every poster, every label on every drawer, was beautifully hand calligraphed. Because I had dropped out and didn't have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and san serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can't capture, and I found it fascinating.

None of this had even a hope of any practical application in my life. But ten years later, when we were designing the first Macintosh computer, it all came back to me. And we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on that single course in college, the Mac would have never had multiple typefaces or proportionally spaced fonts. And since Windows just copied the Mac, it's likely that no personal computer would have them. If I had never dropped out, I would have never dropped in on this calligraphy class, and personal computers might not have the wonderful typography that they do. Of course it was impossible to connect the dots looking forward when I was in college. But it was very, very clear looking backwards ten years later.

Again, you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.

My second story is about love and loss.

I was lucky — I found what I loved to do early in life. Woz and I started Apple in my parents garage when I was 20. We worked hard, and in 10 years Apple had grown from just the two of us in a garage into a $2 billion company with over 4,000 employees. We had just released our finest creation — the Macintosh — a year earlier, and I had just turned 30. And then I got fired. How can you get fired from a company you started? Well, as Apple grew we hired someone who I thought was very talented to run the company with me, and for the first year or so things went well. But then our visions of the future began to diverge and eventually we had a falling out. When we did, our board of directors sided with him. So at 30 I was out. And very publicly out. What had been the focus of my entire adult life was gone, and it was devastating.

I really didn't know what to do for a few months. I felt that I had let the previous generation of entrepreneurs down -- that I had dropped the baton as it was being passed to me. I met with David Packard and Bob Noyce and tried to apologize for screwing up so badly. I was a very public failure, and I even thought about running away from the valley. But something slowly began to dawn on me — I still loved what I did. The turn of events at Apple had not changed that one bit. I had been rejected, but I was still in love. And so I decided to start over.

I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.

During the next five years, I started a company named NeXT, another company named Pixar, and fell in love with an amazing woman who would become my wife. Pixar went on to create the worlds first computer animated feature film, Toy Story, and is now the most successful animation studio in the world. In a remarkable turn of events, Apple bought NeXT, I returned to Apple, and the technology we developed at NeXT is at the heart of Apple's current renaissance. And Laurene and I have a wonderful family together.

I'm pretty sure none of this would have happened if I hadn't been fired from Apple. It was awful tasting medicine, but I guess the patient needed it. Sometimes life hits you in the head with a brick. Don't lose faith. I'm convinced that the only thing that kept me going was that I loved what I did. You've got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle. As with all matters of the heart, you'll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don't settle.

My third story is about death.

When I was 17, I read a quote that went something like: "If you live each day as if it was your last, someday you'll most certainly be right." It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: "If today were the last day of my life, would I want to do what I am about to do today?" And whenever the answer has been "No" for too many days in a row, I know I need to change something.

Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Because almost everything — all external expectations, all pride, all fear of embarrassment or failure - these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.

About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumor on my pancreas. I didn't even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor's code for prepare to die. It means to try to tell your kids everything you thought you'd have the next 10 years to tell them in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.

I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I'm fine now.

This was the closest I've been to facing death, and I hope it's the closest I get for a few more decades. Having lived through it, I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept:

No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life's change agent. It clears out the old to make way for the new. Right now the new is you, but someday, not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma — which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most importantly, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

When I was young, there was an amazing publication called The Whole Earth Catalog, which was one of the bibles of my generation. It was created by a fellow named Stewart Brand, not far from here in Menlo Park, and he brought it to life with his poetic touch. This was in the late 1960's, before personal computers and desktop publishing, so it was all made with typewriters, scissors, and polaroid cameras. It was sort of like Google in paperback form, 35 years before Google came along: It was idealistic, and overflowing with neat tools and great notions.

Stewart and his team put out several issues of The Whole Earth Catalog, and then when it had run its course, they put out a final issue. It was the mid-1970s, and I was your age. On the back cover of their final issue was a photograph of an early morning country road, the kind you might find yourself hitchhiking on if you were so adventurous. Beneath it were the words: "Stay Hungry. Stay Foolish." It was their farewell message as they signed off. Stay Hungry. Stay Foolish. And I have always wished that for myself. And now, as you graduate to begin anew, I wish that for you.

Stay Hungry. Stay Foolish.

Thank you all very much.

Steve Jobs (February 24, 1955 – October 5, 2011)