Uganda children ailing with nodding Disease

It is quite interesting that for several years the nodding disease has been existent in Uganda but very little is known about it in the medical world here. This reminds me of a ‘strange disease’ as described in the media, which was killing especially children only to be discovered as malnutrition.

Uganda has no disease historians, otherwise why would we have a disease running through the community for several years and every time no one knows how to diagnose it. It is a ‘strange disease.’  

According to Wikipedia, ‘Nodding disease or nodding syndrome’ is a new, little-known disease which emerged in Sudan in the 1980s. It is a fatal, mentally and physically disabling disease that only affects young children typically between the ages of 5 and 15.

It is currently restricted to small regions in South Sudan, Tanzania and Uganda says Wikipedia.

This time round, the ‘nodding’ disease initial assessments by the Uganda Ministry of Health, local authorities and Civil society Organisations have found that in 2011, over 2000 children have been infected. Over 60 young of these have died while hundreds have dropped out of school.

With no laboratories to carry out tests in Uganda, samples from children have been sent to Atlanta, USA, the Ministry of Health says. But being a festive season, they are unlikely to be returned on time.

The ripple effect on the family is even bigger. Mothers who are supposed to tend their gardens stay at home to now look after sick children, so food security is threatened at the household level, and they are stigmatized. At the community level, the affected families are shunned so discussion about it is limited.

According to experts, the "nodding disease" causes seizures, and affected children become physically and mentally stunted, which can lead to blindness and even death. It has been linked to Onchocerciasis and epilepsy because it has similar symptoms.

Despite this scenario, the budget for health research for this financial year was reduced and no special provisions have been put into place to ensure additional and necessary medicines and personnel for places affected with ‘nodding disease’.

This year, Uganda has had record economic growth rates and an increasing revenue base over the past decade, yet we find that investment in health as a percentage of the national budget declined during this period and stagnated at around 8 to 9% says the ‘Right to health group’ in Uganda. Per capita investment in health in Uganda today is about 7 US$ per person when the WHO minimum recommended rate is 41 US$.

Press statement on the Ministry’s campaign against the Nodding Syndrome

                           

24^th January 2012

Ministry of Health develops Emergency Response Plan to tackle Nodding Syndrome in Northern Uganda

The Ministry of Health has developed a comprehensive Emergency Response Plan to tackle the increasing cases of Nodding Disease in the northern districts of Kitgum, Lamwo and Pader. The Plan provides an integrated response to the disease through a coordinated mechanism that will ultimately identify the cause and control of the disease syndrome to the level where it is no longer of public health importance.

The disease is characterized by head nodding, mental retardation and stunted growth. It was first reported to the Ministry of Health by Kitgum District Health Office in August 2009. Currently, over 3000 children in the northern districts have been affected by the disease. This is not a new disease. Similar cases were also reported in Tanzania and Southern Sudan.

Since 2009, the Ministry of Health has been undertaking a number of measures to control its spread. Among these is the provision of supportive treatment to the children, training of health workers, massive sensitization and conducting research on the cause and control of the disease.   

Initial studies conducted by the Ministry of Health in collaboration with the Centre for Disease Control (CDC) did not indicate any conclusive cause of the disease. However, the new response plan will see an extensive research programme about the cause and spread of the diseases. This research programme will be undertaken by the Ministry of Health, CDC, universities in Uganda and other Health Development Partners.

Initial activation funding has been mobilised from the Ministry of Health budget. The National Taskforce on Epidemic Preparedness and Response chaired by the Ministry of Health is currently in the process of mobilising resources from its partners. The Ministry will in addition submit a Supplementary Budget request to the Ministry of Finance, Planning and Economic Development to support the Response Plan.

The Response Plan that has also been shared with the Acholi Parliamentary Group, provides for the procurement and distribution of medicines and other supplies to affected communities. The medicines will be dispersed to hospitals and health centres that are easily accessible to the affected communities. 

The Ministry will in addition set up screening and treatment centres in affected districts. These centres will be beefed up with supplementary staff consisting of at least a psychiatric clinical officer, psychiatric nurse, nutritionist and counsellor. The designated centres will be opened by end of February. These are; Padibe Health centre IV for Lamwo district, Kitgum Hospital for Kitgum while Pajule Health Centre IV will cater for Padre District. These centres will be supported by monthly outreach programs to the affected communities.

Psychiatry experts shall also be engaged from Mulago and Butabika National Referral Hospitals, as well as other regional hospitals, to train the screening teams at the designated centres.

The Implementation of the Response Plan will be multi-sectoral involving various stakeholders at district and central level. These include; Ministries of; Agriculture, Animal Industry and Fisheries, Gender and Labour, Local Government, Education and Sports and Office of the Prime Minister as well as Universities and Research Institutions. The Ministry of Health has so far sent a request to the Office of the Prime Minister to supply emergency nutritional supplements to the designated screening and treatment centres.

The Ministry is working closely with the affected local governments and political leadership to mobilise communities to seek medical assistance from the designated screening centres. Districts have also been requested to incorporate the activities into their district plans and budgets.

The Minsitry of health is in addition working with a number of Development Partners to implement this plan. These include World health Organisation, Centre for Disease Control (CDC), UNICEF, USAID and MF-Spain.

I appeal to the Members of Parliament and district leaders from the Acoli sub-region to work with the Ministry of Health to ensure proper coordination and implementation of the Response Plan.

I appeal to affected communities to stay calm as we find a lasting solution to this problem.

The Ministry of Health informs the public that it is doing everything in its control to manage the spread of the disease in northern Uganda. I assure the public that we continue our commitment to the prevention and fighting of disease throughout Uganda.

FOR GOD AND MY COUNTRY

Hon. Christine Ondoa    

Minister of Health 

Save and Conserve the Sweet potato

 The Rome-based Global Crop Diversity Trust and the International Potato Center (CIP) in Peru are finalizing a US$1 million five-year renewable grant to support, maintain, conserve and make available sweet potato varieties. 

Sweet potatoes produce more edible energy per hectare per day than wheat, rice or cassava. Research in Uganda has shown that sweet potato is effective in preventing vitamin A deficiency, which is a major cause of sickness and death among young children in Africa. Esther Nakkazi spoke to Dr. Robert Mwanga the sweet potato breeder for sub-Saharan Africa at International Potato Center about it.

1. Why the sweet potato and not another crop for this grant?

Sweet potato is a major food crop yet it has had little funding for research and development compared to other major staples. Its contribution to food and nutrition security in the developing world is increasingly being recognized. Conserving available farmers’ varieties is urgent for exploitation for traits such as drought tolerance in the face of climate change.

2. Will a particular type of sweet potato be promoted in sub-Saharan Africa under the project?

Each active nationals sweet potato program conducts experiments on its sweet potato breeding materials or ‘varieties’ to select the best performing and preferred varieties for farmers, and the market. In general it is desirable for countries to promote high yielding varieties which have advantages for example high in beta-carotene (Vitamin A) to reduce the high prevalence of vitamin deficiency on the continent; varieties with high resistance to weevils, because if weevils are not controlled there will be total loss of storage roots; varieties with resistance to diseases such as sweet potato virus disease and Alternaria blight which can be devastating to the crop, and varieties with drought tolerance to obtain substantial root yields under harsh drought conditions.

3. Sweet potatoes have several flaws like perishability. What sort of technologies will the project develop to address these?

This project addresses constraints to do with conservation of farmers’ varieties and wild relatives of the cultivated sweet potato. Constraints (flaws) such as perishability and processing quality can be addressed indirectly by this project by conserving sweet potato varieties, which have such characteristics, which are important to farmers and consumers. Farmers can use varieties with the desirable characteristics directly as varieties or in breeding by research institutes to produce new improved varieties.

4. What will be the role of local institutions you will work with? Which ones are you targeting in Uganda, Rwanda?

In general with other CIP projects, the local institutions collaborate with CIP as partners to accomplish the goals of the projects. In Uganda on this project, the National Crops Resources Research Institute (NaCRRI) of the National Agricultural Research Organization (NARO) is the partner. In Rwanda, Rwanda Agriculture Board (RAB), Southern Agriculture Zone Division (formerly ISAR at Rubona), hosts our related projects. When activities on this project are extended to Rwanda RAB will be the partner.

5. How will the project enable the smallholder farmers who grow sweet potatoes improve their incomes?

CIP works with national programs to improve the farmers’ varieties in different countries. The national sweet potato programs can access sweet potato varieties from CIP/Lima or the regional Sub-Saharan Africa offices. The national programs can use those varieties directly or use them in their breeding programs to improve their local varieties to produce improved varieties better suited for the market and home consumption or for livestock feed or processing. Improved varieties in terms of nutrition -high beta-carotene or Vitamin A-, and yield can lead to self-sufficiency for food and sell of excess leading to improved nutrition and income.

6. What will this project add to cancer research on the sweet potato?

This project is not directly working on cancer research. Sweet potato, particularly varieties with purple-fleshed roots are a rich source of compounds called anthocyanins, which have medicinal value as anti-oxidants and cancer preventing agents. Linkage of this project to any potential project on cancer research would be to provide appropriate sweet potato germplasm if required.

7. What challenges do you envisage with this project?

Collection of sweet potato varieties from countries where there are unique farmers’ varieties, but resources are limiting for those countries to collect those varieties for long-term conservation. Some countries may not have realized the threat of loss of sweet potato varieties due to different factors such wars, floods, drought and climate change, so may not see the urgency of conservation, especially long term conservation.

Also published on Africa STI http://www.africasti.com/interview/us-1-million-to-save-the-sweet-potato-in-perpetuity

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Mama Great Lakes leaves peace and security abound

Q&A:
Ambassador Liberata Mulamula (Mama Great Lakes) is the outgoing Executive Secretary of the International Conference of the Great Lakes Region (ICGLR). She was in Kampala to attend the 4th ordinary Summit of the Heads of State and Forum of Parliaments for the eleven member States. Esther Nakkazi spoke to her about her five-year term at the helm of ICGLR and how she realized the goal of keeping peace and security in the region.

QN: What has been most challenging in your job at ICGLR?
I was the first Executive Secretary of ICGLR and I had to establish it from scratch. I have seen it grow within its mandate of establishing peace and security.

QN 2; What were your achievements during your five-year tenure in office? The region was very unstable, there was rebellion in Burundi, guns in the Democratic Republic of Congo but we have seen some of this end like Burundi is stable and they had elections. Through this framework we were also able to contain rebel leaders like Congolese rebel leader Laurent Nkunda.

In my tenure, nine countries have undergone elections under the last two years. I had to deploy election observers because as ICGLR we had to see to it that elections are held in a peaceful manner, we bring in politicians and engage all the parties prior.

We have deployed former leaders like Olusegun Obasanjo of Nigeria and Benjamin Mkapa of Tanzania. We deploy different people depending on the mandate but people identify themselves with past leaders and they also mobilize political will. Even if we still have challenges of armed groups; what we have achieved so far has given me a lot of satisfaction.

QN 3: What makes ICGLR different from other similar organisations?
The convening power and the ability to address issues which are unique to the Great Lakes region. By convening power, I mean, the Conference brings together everybody; civil society sits on the same table as government; women and youth play an equal role. No body can cry that they are left out.

QN 4. There are concerns that the resolutions you make may not be legally binding. What should be done to enforce them?
We have legally binding resolutions since we operate under a pact but implementation of the commitments is lacking in the sense that Heads of State take decisions but when they go back, it is left to the secretariat to push for implementation.
We also need implementation at the institutional level. There are weaknesses of follow up. For instance we talk about Sexual and Gender Based Violence but there are places with no police stations. Women are raped and they cannot report it. There is a vacuum.
You also need a lot of political will. I have seen it. To get it you have to do a lot and get the political leaders to commit and make resources available so that we implement whatever decision is taken.

QN: How are member states performing in terms of funding ICGLR?
We have had 80 percent contribution, so member States are doing very well and they fund most of our operations. With other funding, partners are earmarked for specific activities.
You know ICGLR is on good track. Countries are here because they believe in corporation, integration, consensus building, dialogue and good relations. It brings me hope that as we continue like this, it will bring us peace and stability in the region.

QN: Isn’t there duplication of efforts with other agencies like IGAD, the East African Community to which member States also belong?
We have a specific mandate as ICGLR, which is peace and stability to enable economic growth for communities. Usually, however, our roles are complementary although that is not what the public see. There is no duplication as such but what happens is organizations make competing decisions, which is where we find problems. Fortunately, we have signed Memorandum of Understandings with other regional organizations.

QN: How have you managed all of this with your family?
It is a balancing act as a mother and wife I have responsibilities. There is also so much sacrifice. You have no life of your own. By now I should be planning a birthday party for my son but I am here. There is a lot of understanding from my two children and my husband.
But my father modeled us in this way. In terms of leadership, he said, you have to be respected but live to your commitments and integrity.

QN: What about as a woman working with Heads of State and rebel leaders- has training and experience helped?
I am a political scientist by training and I have a Masters degree in Governance. I have worked in the Ministry of Foreign Affairs in Tanzania and Foreign Service.
My relationship with Heads of States has been extremely good, they were all ready for my engagements and there is no single country in the region whose Head, I have not met in their own capital.
I helped build confidence with some rebel leaders. For instance I went to see Nkunda and he listened. When such people see me, they see themselves in me. They said I am not intimidating, they see mama who can listen and carry their message. This has helped build confidence. That is why they call me ‘mama Great Lakes’.

QN: Any departing words as executive secretary?
I am leaving a foundation for achieving peace and stability in this region.

Museveni dry HIV messages incapable of revamping public response

By Esther Nakkazi

Civil society and People living with HIV in Uganda want the Uganda AIDS Commission (UAC) and Ministry of Health to jointly launch a costed national strategy for rolling out a comprehensive HIV prevention and treatment response and correctly advise on messages to the public.

They want the response to have concrete deliverable by 2015 like getting at least 80% male circumcision coverage among adult men, rapid and strategic scale up of ARV treatment to all people with HIV with CD4 cells greater than 350 but even earlier for serodiscordant couples, pregnant women, and other key populations.

The government should increase domestic funding and available funds should be accounted for transparently to ensure that funding is not wasted, diverted, abused or stolen as well as strategic implementation of pre-exposure prophylaxis project in vulnerable populations.

“President Obama just put forward a powerful down payment toward the end of the AIDS crisis,” said Lillian Mworeko, the Executive Director of the International Community of Women Living with HIV East Africa. “But we are deeply concerned that Uganda will not seize this opportunity—Government should also double its investments in life saving treatment to turn the tide of HIV in Uganda.”

U.S. President Barack Obama on World AIDS Day announced that the U.S. would scale up treatment access to reach a total of 6 million people on antiretroviral treatment by 2013 through the President’s Emergency Plan for AIDS Relief (PEPFAR)—doubling the pace of scale up for the programme. Obama committed the U.S. to using emerging science to “begin to end” the global AIDS crisis—a concept unimaginable just a few years ago.

Uganda activists also say, although there is various proven new research showing that expanding access is essential to getting ahead of the epidemic the president, Yoweri Museveni has not been advised correctly, accurately and based on scientific evidence.

For instance Museveni’s World AIDS Day message was negative, inaccurate, harmful and showed the continued lack of political will to revamp the national response to the HIV/AIDS crisis that has gone completely off track.

Ultimately, the message did not promote use of the new approaches to HIV prevention and treatment that scientists and policymakers are describing as key to bringing about an end to the AIDS pandemic, the activists said.

In his 1 December 2011 speech, delivered by Vice President Hon. Edward Ssekandi, the President argued that the country should be “careful” of implementing “new medical tools” against HIV, because such innovations “can lead to laxity in behavior.”

The President argued that “eliminating negative sexual behaviors” should be the fundamental priority in the country. Activists say this message is not only inaccurate but also harmful, and

“Of course reaching communities, particularly most at risk populations, with accurate and high impact behavior-change interventions is important—but it is just not enough,” said Leonard Okello of the International HIV/AIDS Alliance in Uganda. “We want a prevention and treatment revolution.”

Unprecedented new research findings have shown that antiretroviral treatment for HIV not only saves lives, but it also reduces the risk of sexual transmission by 96%- http://bit.ly/uXYm00, making HIV treatment an incredibly powerful HIV prevention tool.

The “Partners PrEP” study, conducted in Uganda and Kenya, also found that antiretroviral drugs reduced the risk of infection by as much as 73% when taken by HIV-negative people in serodiscordant relationships http://bit.ly/u59g3x

Safe medical male circumcision, and access to ARV treatment for HIV positive pregnant women are other crucial biomedical prevention interventions that urgently need to be taken to national scale in Uganda. Expanding investments in these interventions will not only save lives—they will also substantially reduce the costs of the AIDS response over time, according to experts.

“These data have provided hope that through accelerated scale up of treatment, as well as other proven prevention and treatment strategies, the end of AIDS could be possible,” says Richard Hasunira, Coordinator of Uganda Civil Society HIV Prevention Working Group.

According to the activists, technical experts in the Ministry of Health are supportive of these new approaches—but the backward-looking message from the President appeared designed by advisors who are not keen on expanding government investments in the fight against the HIV epidemic.

Uganda’s response to HIV is faltering badly, according to experts. Uganda is one of the few countries in the world with rising HIV infection rates, with an estimated 132,500 infections annually. More than 50% of Ugandans in urgent need of HIV treatment currently do not have access to treatment to save their lives and prevent new infections. One in five new HIV infections in Uganda are from mother to child.

“We have no time for equivocation as a country,” said Dr. Stephen Watiti, Board Chair of NAFOPHANU. “Our people are dying; incidence rates are rising. Shaming people with talk of negative sexual behaviors is not helpful at all, since as we all know many people are getting infected without practicing what the President calls ‘negative sexual behavior.’

At this critical time, no one should be talking as if they have the moral high ground; it is not helpful. Moreover, all Ugandans need access to effective prevention and treatment services—not stigma and exclusion.”

Activists also expressed concern that Uganda was not making use of public health flexibilities that would make it easier for Uganda to gain access to low-cost, generic medicines, particularly in the future.

“Uganda needs to be forward looking—instead of making excuses, the government should take advantage of flexibilities other countries are already using to reduce the price of essential medicines,” said Moses Mulumba, Executive Director of Centre for Health, Human Rights and Development (CEHURD).

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Mobile phones use could spur access to contraception among youth

By Esther Nakkazi

Access to mobile phones across the world is expanding and so is their use in bridging the gap in service delivery and education for family planning for over 215 million women who have no access.

Through innovative new programs, clinics in Tanzania are using mobile phones to track family planning supplies and avoid stockouts and in Nigeria, over 300,000 text messages were sent by youth about reproductive health to experts to inquire about contraceptives.

Increasingly, young people are utilizing mobile technologies to meet their sexual and reproductive health needs wherever they are, whenever they need help according to case studies in east and west Africa.

In Uganda, software programmers working in the ‘cloud’ were able to solve coding challenges for building the text message quiz functionality. Family planning supervisors in low resources organizations are now able to download the resulting platform, FrontlineSMS for use for free.

In Kenya and Tanzania, the M4RH -mobile for reproductive health- text message program provides basic information about nine different family planning methods as well as the locations of clinics where services are offered. 



Respondents in the study said they used m4RH so they could make informed decisions about reproductive health and learn about contraception to prevent unwanted pregnancies. 

These are some of the mobile phone technologies being presented at the international family planning conference in Dakar, Senegal, which prove the innovative ways of how mobile phones are being used for family planning awareness and education.

These case studies bring into focus the nascent but promising role of mobile technologies to foster behavior change in Family Planning for providers, clients, and program implementers said researchers.

The technologies are especially helpful for reaching the ‘mobile generation’ in the developed world that give birth before 20 years, basically because they have low access to reproductive health information, supplies and education.

In one of the case studies in Tanzania and Kenya, ‘Family planning in a Digital world: Using Technology to promote family planning among young people’ it says mobile phones are regarded as a “high-impact practice” that can support the provision of family planning services and they offer a new mechanism for delivering health information in a highly relevant, private, and cost-effective manner.

In the Nigeria case study, since the launch in 2007 of ‘Learning about living’ analyses of more than 300,000 ‘screen hits’ showed that the most frequently accessed topic was natural family planning, followed by information about condoms, implants, and emergency contraception.

According to the researchers, it demonstrated that emerging technologies could provide a simple, cost-effective way to reach young people in developing countries with sensitive information they need and want.

They concluded that technology provides an anonymous way to address difficult subjects and engages young people more than traditional communication methods. The social nature of these tools also encourages the rapid spread of accurate, positive sexual and reproductive health messages.

With the use of mobile phones, Tanzania has been able to deliver family planning commodities to service delivery points in a timely manner. This was proven in a six month pilot study ‘Improving family planning commodity availability using mHealth technologies,’ that ended mid 2011 in four districts which were initially consistent with stock outs for commodities.

In the 75 Tanzania facilities, at scheduled time intervals, facility staff used their personal mobile phones to send text messages to report stock on hand, losses and adjustments of ten essential medicines- Copper T IUD, Depo-Provera, implants, condoms, Microgynon and Microvial - supervision frequency, delivery of goods, and report and request submissions.

The facility staff sent text messages to a toll-free short code, data was merged and displayed on an interactive web-based interfaced that prompted decision-making. Monthly reports were also emailed to decision makers at all levels.

It was found that mobile phone technology using cheap and readily available cell phones offers a possible sustainable solution to making quality logistics data for decision-making readily available in real-time.

All the users also indicated they preferred SMS based reporting compared to the paper-based system, they improved their reporting rates and adherence on reporting which in turn improved their timeliness of ordering and stock management.

Mobile phones successfully reduced stockouts of family planning commodities; improved the frequency and quality of supervision provided by supervisors at all levels; and improved the timeliness and accuracy of ordering and reporting deliveries to health facilities.

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Minus Global funds Uganda may at last raise own HIV funding

By Esther Nakkazi

Cancelation of the Global Fund funding may finally achieve what the Uganda government has for long failed to do -increase its funding for HIV activities.

Two weeks ago, (22nd November) the Global Fund Board cancelled Round 11 after some donors failed to honor their pledges so that funding amounted to only half of the anticipated $1.6 billion for this Round.

In a country were HIV activities are 90 percent donor funded and Round 11 was particularly meant to fund HIV activities, activists say this is a wake up call to Ugandans that they should pay for their HIV medicines. 

The Uganda Aids Commission says it has already prepared a position paper to start a levy on some items like beer, but Uganda has to start treating its people.

Dr. Lydia Mungherera an HIV activist says Uganda has been relying on donor funding for a long time, but now is the time for the government to start treating and investing in its own people.

“During the World Aids Day the message should be definite that our people are going to die. The donors are already sending a straight message which we ought to heed to,” said Dr. Mungherera.

“We have been warning our government, donors are unreliable and that they are jumping out is not new. Government should find the money or prepare to deal with a national disaster,” said Richard Hasunira an advocate for HIV prevention and health rights.

A statement released after the Global Fund Board meeting in Ghana two weeks ago said that with no money for Round 11, the next opportunity for countries to apply for new grants would be during the 2014-2016 period.

IT further said that countries would now apply for grants using a new funding model developed under a different strategy. The GF supports globally programs on malaria, TB and HIV as well as strengthening the national health systems through free grants.

Since the establishment of the Global Fund, Uganda has successfully applied for eight grants from the Global Fund For Aids, Tuberculosis and Malaria (GFATM) all totaling US$ 426,763,257.

But in regards to HIV/Aids, Uganda has unsuccessfully submitted requests to the Global Fund several times including rounds 4,5,6,9 and most recently 10 where the country appealed against the TPR decision without success.

Before Round 11 was cancelled, Uganda was busy drafting its application, whose funds were exclusively for HIV. And, the Uganda Aids Commission says they are going ahead to write the proposal, mainly to give ‘clear numbers’ for the funding gap.

Prof Vinand Nantulya, the chairman of the Uganda Country Coordinating Mechanism (CCM) ScieGirl that they were suspecting that Round 11 would either be delayed or it would not take place.

However, in the meantime Uganda has the necessary resources to buffer interventions in the areas of malaria, Tuberculosis, HIV/Aids and health systems strengthening for the next 3-4 years, said the Uganda Global Fund secretariat.

According to the CCM secretariat, Uganda has over $300 million to intervene in the four disease problem areas but activists and civil society insist it should come up with alternative funding other than donors funding HIV activities.

“I think we may need a supplementary budget but most importantly we need to come up with other funding sources. We cannot expect the donors to do everything for us. I mean Mugabe has done something,” said Dr. Mungherera.

In 1999, Zimbabwe introduced an AIDS levy consisting of a 3 percent tax deducted from salaries of formally employed workers and companies to compensate for the declining donor support.

“It is unfortunate that Round was cancelled but we have to try to mobilize domestic resources,” said Prof. Nantulya also the Chairman of Uganda Aids Commission (UAC). The plan for mobilization of domestic resources is already under way for Uganda. So far, a position paper on alternative avenues of domestic funding has been developed and is under scrutiny by the ministry of Finance.

“We may come up with a levy on items like beer, soda e.t.c. We have examined everything and given the options to the Ministry of Finance,” said Prof Nantulya.

The initiative to impose an AIDS levy on some items could be the only way out for funding Uganda’s HIV/AIDS activities amidst the declining donor support. But it is an initiative for the long term.

With a low tax base and a high burden on the taxpayers, the CCM requires mobilization, education and public support, the only means out of a tight rope.

“It is going to be a long, meticulous process and a public good. But we shall put in place what works,” said Prof. Nantulya. “We hope to explore every possible way to get treatment.”


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When Mama Tlou and Mama Museveni talked zero HIV

By Esther Nakkazi

When mama Tlou visited Uganda recently, she called on mama Museveni. The two chatted away about children, goats, rain, harvest, the normal chitchat that African women usually engage in. 

But the conversation then got serious, as mama Tlou or officially Prof. Sheila Tlou, is the UNAIDS director of the Regional Support Team for East and Southern Africa and Mrs. Janet Kataaha Museveni, is Uganda’s first lady, minister for Karamoja Affairs and Ruhaama county MP.

Mama Tlou appealed to mama Museveni to champion prevention of pediatric HIV infections particularly the Prevention of Mother to Child Transmission of HIV (PMTCT). One of the key issues to halting the epidemic is leadership but lately it has waned both nationally and internationally.

In Africa leadership made a difference earlier on in Uganda and in Botswana. In South Africa new leadership has given rise to a much expanded and effective AIDS treatment and care program.

So Tlou's mission was to revitalize the leadership in the context of getting to: Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths with special focus to elimination of Mother To Child Transmission.

“We should strive to keep the mothers alive so that we do not create more orphans. We should also enroll them on antiretroviral therapy as soon as possible so that they can safely continue breastfeeding and ensure that the babies are healthy,” Tlou pleaded.

Studies show that new HIV infections among children have already been virtually stopped in high-income countries, with the number of new infections among children falling dramatically due to the effective use and availability of antiretroviral drugs.

Comparable results can be achieved in low- and middle-income countries. Transmission of HIV infection from mother to child can be reduced to less than 5 percent if pregnant women living with HIV have access to health programs involving antiretroviral drugs.

“Mama,” Tlou urged, “Uganda was one of the countries that inspired US even before the advent of ARVs. The leadership is still right here. We need you to champion PMTCT like you have done with the youths.”

Mama Museveni is recognized for her programmes among the youths, which have greatly reduced HIV prevalence and new infections in this group. She founded Uganda Women’s Initiative to Save Orphans, and is the patron for the National Youths Forum plus several youth’s initiatives in HIV and sexual reproductive health. Her campaigns have focused much on Abstinence and Being Faithful.

In Uganda, 150,000 children below 15 years in Uganda are HIV positive, with 98,000 needing treatment but only 24,000 are accessing it. Of the ones on treatment, 38% do not return after being diagnosed or after the first treatment.

Mama Museveni decried complacency calling on government leaders to ‘re-energise their efforts in the prevention response.’ “I think the campaign relaxed and people forgot that HIV is still with us. We need to continue drumming HIV prevention messages, especially regarding PMTCT, so that people wake up,” she said assuring that she was also talking to papa Museveni about it.

“I have been speaking to the president to talk about HIV. He used to and it worked.” “My traditional area was the youths. But now I’m scattered. It has really distracted me from my calling but I know we really have a challenge. I’m willing to come back on board,” she pledged.

Mama Tlou’s visit to Uganda was to engage in high-level advocacy with Government of Uganda leadership, to revitalize the national HIV and AIDS response.

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First Microsoft Innovation Centre opens at Makerere University

By Esther Nakkazi

A new Microsoft centre designed to promote the development of innovation and growth of the Ugandan software economy has been opened in Makerere University. 

The facility, an extension of the global Microsoft Innovation Centre network, is the result of a partnership agreement between United Nations Industrial Development Organization (UNIDO) and Microsoft.

The Microsoft Innovation Centre will act as incubator for innovation; technology training and industry skill transfer and actively contribute to economic growth and prosperity in Uganda.

“I am pleased to note that this Centre is yet another deliverable within the UNIDO–Microsoft partnership. I am confident that prospective employers from both, the public and privates sector, will value the contribution that this Centre can make to skill development, particularly for the youth,” said the UNIDO Regional Director for East Africa, David Tommy.

The centre will provide assistance and resources to small and medium sized enterprises to create new and innovative products and services, bring those products to the market and improve their business competitiveness. 

It will also provide support to small and medium enterprises and independent software vendors, as well as develop better student collaboration, provide support for new start-up companies, and act as the test laboratory Centre for the development of software projects.

“Offering these opportunities to the local community is an important step to encouraging innovation and entrepreneurship,” said Louis Otieno, General Manager for Microsoft East and Southern Africa.

“We envision that the Centre will boost the local software developer industry, driving increased availability of highly skilled and proficient ICT users as well as developer skills in the country. By fostering innovation, together we can ultimately drive growth in the local and regional economy.”

Microsoft works globally with partners from the public sector, academic institutions and industry to promote innovation. The Microsoft Innovation Centres- more than 90 of them world-wide- are a central component of this innovation drive, which provides effective support for the local software markets.

They do not carry out research themselves but offer a research and development platform for partners working in innovative sectors, helping to foster innovation in their local country, in their region and across the globe.

Uganda’s first Microsoft Innovation Centre will focus on skills development, aiming to educate local students to help improve their professional IT knowledge and gain real project experience before graduating.

“It will provide young entrepreneurs, students, developers and researchers in the local community access to expert information and high-tech equipment for testing and developing the latest technologies built on the Microsoft platform,”said Otieno.

Another key goal of the Centre will be helping developers and IT professionals learn about the latest technologies, stimulating technology innovation and driving the local software economy to boost national competitiveness.

“This is a major milestone for our country particularly for the young people who now have a world-class facility to hone their ICT skills. Uganda has continued to experience significant growth in terms of GDP, investment, employment and tax revenue in the ICT sector and the Microsoft Innovation Centre is definitely going to play a big role in bolstering the continued growth of the sector.” said the Minister of Information and Communications Technology, Ruhakana Rugunda.

Ends-

Global Fund Board Cancels Round 11 and Introduces Tough New Rules for Grant Renewals

GFO Newsletter  Issue 167


The Global Fund Board has cancelled Round 11 in light of the Global Fund's financial difficulties. This difficult decision was made at a stressful two-day Board meeting in Accra, Ghana, that ended yesterday evening, 22 November.

The original decision to launch Round 11 in August 2011 was made at a Board meeting in December 2010. At its meeting in May 2011, the Board did not make any changes to its plans for Round 11, having been told by the Secretariat that sufficient funding (an estimated $1.6 billion) would be available for that round. But the estimate of funds available for Round 11 declined to $0.8 billion in September 2011, and then to a negative amount this month. The decline was caused primarily by some donors changing their minds regarding their so-called pledges, and other donors saying that they would delay payment of their pledges.

The Global Fund has long had a policy that the financing of Phase 2 renewals of existing grants has a higher priority than the financing of new grants. As a result, the Board concluded that almost all of the $8.2 billion in revenues that is now projected to arrive by the end of 2013 will be needed for renewals, leaving no money for Round 11.

The next replenishment period will be 2014-2016. Given that there is no money for Round 11, the next opportunity for countries to apply for new grants will be during the 2014-2016 period. They will be able to do so using a new funding model that is called for in the Fund's new Strategy 2012-2016, also approved at this Board meeting.

Some countries have existing grants that will reach the end of Phase 2 well before 2014. Many of those countries have been hoping to be approved for Round 11 grants. Because that will not be possible now, the Board has agreed to put in place a Transitional Funding Mechanism that will provide for continuation of essential prevention, treatment and/or care services by current grantees. Details of this mechanism will likely be announced in the coming weeks.

However, even with the cancellation of Round 11, the Global Fund did not have enough money to pay for the Transitional Funding Mechanism, and for some Round 10 grants, unless further savings could be found. (The Fund stopped signing Round 10 grant agreements about a week ago because of its financial problems.)

The Board decided to find some of the required savings in the following ways:
The one-year Grace Period provision for changes in country income classification will be rescinded. (See explanation in GFO 80.)
The "counterpart financing" and "focus of proposal" requirements that already apply to new grants will also apply to Phase 2 renewals. (See description in GFO 146.)
Instead of Phase 2 financial commitments being made in two tranches (i.e., the first two years, and then the third year), they will be made one year at a time ("1+1+1").

But even more money had to be freed up. The Board discussed two options for this. One was to say that all eligibility rules that apply to new proposals would also apply to Phase 2 renewals. The other was to say that countries are not eligible for Phase 2 renewal of their current grants if they are Group of 20 (G-20) upper-middle-income countries "with less than an extreme disease burden." Following a difficult discussion, the Board chose the second option. This means, for example, that Argentina, Brazil, China, Mexico and Russian Federation will not be eligible for Phase 2 renewal. (South Africa is a G-20 country, but it has an "extreme" disease burden, so it will be allowed through.)

China is, by far, the country that will suffer most from this decision, because China had been expecting to be eligible for some $880 million in grant renewals.

Now that the above measures have been agreed, the Fund will temporarily be able to resume signing Round 10 grant agreements. However, because the signing of new grant agreements can only be done when the required funds have been received by the Global Fund from its donors, and because Phase 2 renewals take priority over new grants, it is always possible that the signing of Round 10 agreements will be put on hold again. It all depends on whether donors deliver their 2011 pledges during 2011, and whether at least some of them deliver their 2012 pledges earlier rather than later in 2012.

The Global Fund Board's decisions concerning Round 11 are contained in the decisions point document for the Accra meeting, which is due to be posted at www.theglobalfund.org/en/board/meetings/twentyfifth.

Family Planning Access Will Deliver for Women In Uganda BY: Dr. Jotham Musinguzi

BY: Dr. Jotham Musinguzi, Regional Director, Partners in Population Development; Jill Sheffield, President, Women Deliver

Next week, leaders from across Africa and around the world will meet at the 2011 International Conference on Family Planning in Dakar, Senegal . This meeting comes at a critical time, as we examine how to navigate a world with increasingly constrained resources and create a future that fosters health and development worldwide. The meeting also occurs during World AIDS Day. Women now comprise the majority of those living with HIV in Africa, and access to male and female condoms to prevent both HIV and unwanted pregnancy is crucial.

The benefits of family planning are plentiful and powerful. Simply put, family planning saves lives. Currently, more than 215 million girls and women who want to avoid or delay pregnancy don’t have access to family planning. Each year, 358,000 women die from pregnancy- and childbirth-related complications. Universal access to family planning could reduce these deaths by up to one-third.

Providing girls, women, and their partners with family planning information and services empowers them to decide the number, timing, and spacing of their children – and whether they want to become pregnant at all. Wanted pregnancies are safer and healthier pregnancies. Access to family planning prevents up to 1 in 3 maternal deaths and 1 in 11 child deaths, and is a critical strategy to reaching Millennium Development Goals 4 and 5.

In Uganda, a woman will have an average of six to seven children in her lifetime. This poses a serious health risk to her and her children, and has financial implications for families. When couples manage their own fertility they can better plan to care for their family by investing their resources in education, health, savings, and business opportunities. This is how we can end the cycle of poverty.

At the national and global levels, family planning is immensely cost-effective: satisfying the unmet need for contraceptives would reduce overall health costs, saving over US$1.5 billion a year. The cost of protecting a couple from unintended pregnancy ranges between US$10-$15 per year, making it one of the most affordable and effective life-saving solutions available.

The Ugandan Minister of Health, Dr. Christine Ondoa, will be present at next week’s meeting. Joined by numerous health and finance ministers from across Africa, Dr. Ondoa will discuss the importance of increased access to family planning in Uganda and region wide. Currently, only 18% of married women in Uganda report contraceptive use. This number can and should be higher.

The good news is that we have family planning solutions; we just need to make them more accessible. Providing variety is critical: voluntary family planning works best when women have a full range of contraceptive options and can choose, access, and afford the method best suited to their needs. We need strategies to reach marginalized and remote communities, and for that reason community health workers need to be supported. And finally, knowledge is power: we need to provide girls, women, and their partners with the information they need to make informed decisions.

The time is now to put words into action. Our world’s population recently reached a staggering seven billion. As we debate how to handle a world of this size in the face of growing global inequity, one thing is clear: we must empower girls and women everywhere. According to the World Bank’s 2012 World Development Report, gender equality is critical to improving development results. Research shows that engaging women’s skills and talents around the world will lead to significant productivity and economic gains. Uganda should continue to lead in efforts to demonstrate this in reality.

In March, Partners for Population and Development and Women Deliver will convene regional experts, policymakers, researchers, and activists in Kampala to share success stories and lessons learned around women’s health. The conversations will include a variety of voices, as every sector has a role in making a difference for girls and women in Uganda and worldwide.

At the International Conference on Family Planning , we will discuss ways we can accelerate action to deliver life-saving results for women and girls, with far-reaching benefits. Reproductive rights, including family planning, are a fundamental stepping stone to gender equality. It is now more important than ever to ensure that all children are wanted, and all citizens have the resources they need to realize their full potential.

The Global Fund troubles

COMMENTARY: The Most Important and Difficult Global Fund Board Meeting Ever
by Bernard Rivers
Snapshot from 2002: The Global Fund's Framework Document describes the Fund as "simplified," "rapid," "innovative" and "efficient." The goal is to raise billions of dollars and then disburse it rapidly to implementers, telling them, in effect, "OK, get on with the job."
Fast forward to 2011: The Fund's bureaucracy is far from "simplified" and "efficient." The Fund's image has been tarnished by findings of corruption among grant implementers. And the Fund's donors have become alarmed by significant weaknesses in Global Fund systems and among senior Global Fund management - and, of course, have been suffering from their own economic problems. The net result is that some donor pledges have been cut and the delivery of others has been delayed. Money is tight. Round 11 is in danger of being cancelled.

This morning, (Nov 20th) the Global Fund starts the most important and difficult Board meeting it has ever held. The only options for action involve causing pain. And the "no action" option will merely compound the problems.

There are five problems that the board needs to deal with. Some must without question be tackled at this meeting. Others could be deferred; but the sooner they are tackled, the better.

The first problem is that some donor countries have cancelled or delayed their disbursements to the Global Fund, partly because of their own economic problems, but also because of the corruption that the Fund's Office of the Inspector General (OIG) has identified and that the Fund's transparency policy has caused to become public. The situation is dire. Donors used to honour 100% of their pledges to the Fund. In 2010 this went down to below 80%. This year, the figure is lower still. The "confirmed pledges" that donors had said they would deliver during 2011 through 2013 have gone down from $9.7 billion to $8.2 billion, as a result of about $1 billion having been "un-confirmed" and about $0.5 billion now projected to arrive after 2013.

As a result, estimated funds available for Round 11 have declined from $1.6 billion (in May 2011), to $0.8 billion (in September), to negative $0.6 billion today. Yes, negative. This means that the current prediction is that there will be no money to pay for Round 11, and possibly not enough to pay for some as-yet unsigned Round 10 grants.

The second problem is that two admirable components of the Global Fund model - an OIG that is determined to root out corruption, and a world-class transparency policy - have produced, when combined, some unanticipated consequences. The OIG discovered fraud among certain grant implementers; the Global Fund posted the findings at its website rather than hiding them in a safe; the press went wild; donors worried about how their taxpayers would feel about funding grants for corrupt implementers; donor pledges were reduced or delayed; and Global Fund growth suddenly stalled.

The third problem is that the OIG got carried away, chasing down not only corruption, but also anything else that could be defined as "loss," and then demanding that the loss be returned to the Fund. These "loss" determinations included, for instance, that a principal recipient (PR) in Swaziland must return over $1 million to the Global Fund because the PR, when asked to document how the money was used, could only produce photocopies of invoices rather than originals. Quick, all of you - raise your hands if you have ever been guilty of this "crime." I have.

Thus far, the OIG has identified $17 million in fraud across all grants that it has audited and investigated. But it has identified almost three times as much - $48 million - in other forms of "loss" that must be refunded, including that $1 million in Swaziland.

This has been bad enough for the PRs who are required to return the money - money which they often no longer have because it was long ago passed to sub-recipients who were responsible for the loss. But, again, there has been an unanticipated consequence. PRs are now nervous to pass money to sub-recipients (SRs), and SRs are nervous to spend the money when they receive it, for fear that some determination of loss will be made, possibly years in the future. This paranoia has led, if not to paralysis, at least to a slowing down and disruption of grant implementation. This represents a huge cost for the people that the grants are supposed to benefit.

The impact of this second problem upon the entire Global Fund system, from Geneva headquarters to sub-sub-recipients, is roughly what the impact would be upon your family or mine if government officials, anxious to ensure that we don't mistreat our children or engage in tax-evasion, placed video cameras in every room of our homes, and issued press releases from time to time based on the worst things that those cameras revealed. Not many families would survive the tensions that this would engender.

The Fund has rightly recognised, after a very difficult year, that it must identify, mitigate and manage risk. But it hasn't done enough thinking about the way in which its risk management policies are, at least at present, slowing down the delivery of services and thus the saving of lives.

The fourth problem is that John Parsons, the Inspector General, head of the OIG, has shown, on a number of occasions over a prolonged period of time, a remarkable ability to shoot himself - and therefore the Fund - in the foot. As discussed in Article 4, below, UNDP, the largest implementer of Global Fund grants, is now essentially refusing to work with him; and many other PRs have also expressed serious criticisms. (See the GFO Commentary "Auditing the Auditor," and subsequent letters to the editor here and here.) The Global Fund Board, to whom John Parsons reports, will discuss this evening the year-end evaluation of his work performance that it has just completed.

The fifth problem is that the Fund has some serious management weaknesses at the senior level. This has led to some unpleasant in-fighting, with allegations floating around that range from the worrying to the ridiculous. A year ago, the Board renewed the employment contract of Michel Kazatchkine, the Executive Director, giving him a final three-year term (following his initial term of four years). But, as with the Inspector General, the Board specified that Kazatchkine must undergo an annual evaluation. The first such evaluation has just been completed, and the findings will be discussed by the Board this evening. (Both this evaluation and that of John Parsons were "360 degree reviews" conducted by external professionals under the guidance of the Chair and Vice-Chair. Structured feedback was obtained from dozens of people in each case.)

So: The Fund's growth has stalled. Over the past ten years, Global Fund financing has contributed to the saving of 7.7 million lives. Every one percent increase or reduction in funding or effectiveness will lead to multiple further lives saved or not saved. The Board's decisions today and tomorrow will be crucial; they will ultimately determine the up or down curve in money, effectiveness and lives.

Bernard Rivers (bernard.rivers@aidspan.org) is Executive Director of Aidspan and Editor of GFO.

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.