Swazi Government and the US-based Futures Group lack accountability in failed circumcision programme?
It was an ambitious plan to circumcise the majority of men in Swaziland, an effort to reduce the risk of HIV transmission in a country with the world’s highest HIV prevalence. How could it have gone wrong?
“First they told me that circumcision will not really protect me against HIV. Then they tell me that I cannot have sex for some weeks or months after circumcision. I told them ‘fusaki’ [get out]!” Eric Dlamini, a 22-year-old law student, told IRIN.
These views are at the heart of the failure of the Accelerated Saturation Initiative (ASI) to achieve more than a fraction of its targeted goal, the circumcision of 80 percent of Swazi males between ages 15 and 49 within a year.
The programme, a partnership between the Ministry of Health and Social Welfare and the US-based Futures Group, was launched in 2010, and extended to 30 March 2012 when initial efforts showed a failure to achieve targeted results. But only about 20 percent – or 32,000 – of the targeted demographic were circumcised through the programme.
US$15.5 million was spent on the programme, or $484 per circumcised male.
“We do not believe [ASI] was a failure but an additional prevention measure that is contributing to the overall combination efforts to end the HIV/AIDS pandemic in the country,” US Embassy in Swaziland spokesperson Molly Sanchez Crowe told the local press.
Imposed from outside?
Male circumcision has been scientifically proven to reduce a man’s risk of contracting HIV through vaginal intercourse by as much as 60 percent. Follow-up studies have found that the effectiveness of male circumcision in HIV prevention is maintained for several years.
Government health officials, like Minister of Health Benedict Xaba and Khanya Mabuza, the acting director of the National Emergency Council on HIV and AIDS (NERCHA), have noted that ASI taught the country important lessons and left behind several clinics and other health infrastructure.
But a year after the programme ended, Swazi health officials are still trying to figure out what went wrong. Health workers, who spoke to IRIN on the condition of anonymity, pointed out that the programme was hastily implemented. They wondered why the short implementation time was not extended. Ending the programme, they fear, may suggest to international donors that the country is a hopeless cause.
“We have been struggling with HIV for 20 years, and we see programmes come and go. Some are fads… and some are not well thought out. The Swaziland programme came from the outside. The health ministry was willing to go along because there was money there. But it was imposed,” said Thandi Mduli, an HIV testing officer in Manzini.
Officials with health-oriented NGOs admitted to IRIN they are “terrified” of criticizing an initiative funded by the “mighty” US President’s Emergency Plan for AIDS Relief (PEPFAR) and involving the global population control NGO Population Services International (PSI).
The ASI programme was an attempt to duplicate in Swaziland the circumcision successes seen in Kenya and other countries, without apparently doing the pre-campaign ground work. Kenya has carried out an estimated 477,000 circumcisions since its programme started in 2008, according to the government.
In 2011, UNAIDS and PEPFAR launched a five-year plan to have more than 20 million men in 14 eastern and southern African countries undergo medical male circumcision by 2015.
Reasons for failure
“There were a lot of issues involving male circumcision that were not properly explained to Swazi men, so they rejected it and they talked to their friends, and word of mouth was negative instead of positive. This is the opposite of what a campaign like this needs to work,” said NERCHA’s Mabuza.
Other issues included unfamiliarity of the procedure. “When I heard I would still have to wear a condom, I said, ‘What is the point?’” said Samkelo Mduli, a university student.
A survey commissioned by the Futures Group in 2011 found that although there was a 91 percent awareness of circumcision, nationally, the largest barrier to circumcision was fear of pain. Other barriers included fear of something going wrong, and a general lack of understanding of the procedure.
Another reason for the rejection of circumcision was not anticipated by ASI promoters: belief in witchcraft, which is widespread in Swaziland. Criminals are known to seek “strengthening” potions made with human body parts. Killings associated with “ritual murder” routinely correspond with national elections. Victims, usually children or older people, are found with body parts missing. One attack made headlines in the Swazi press recently.
“That’s also what I wanted to know, and they wouldn’t tell me – what happens to my foreskin once it is cut off?” said Mduli.
Health Minister Xaba alluded to this when he told the Times of Swaziland, “Some men feared that the foreskin could end up in wrong hands, being used by some unscrupulous people for their ulterior motives.”
“This is embarrassing and nobody wants to talk about it,” said the programme director of a faith-based HIV/AIDS initiative in Manzini. “The circumcision initiative failed because of this arrogance on the part of its promoters. It would have been easy to be honest and explain to the Swazi men that their foreskins would be incinerated like all surgical refuse. But the promoters said, ‘Oh, no, we can’t talk about witchcraft. What will the donors say?’”
By Samuel Mungadze
A NATIONAL Strategic Plan for HIV, tuberculous (TB) and sexually transmitted infections has been adopted on Friday, during South African National Aids Council (Sanac) meeting in Secunda, Mpumalanga, which was chaired by Deputy President Kgalema Motlanthe.
The National Strategic Plan has a target to have 3-million people on antiretroviral (ARV) treatment by 2015. South Africa currently has 1.9-million people on treatment.
The plan also aims to eliminate the transmission of HIV infection from mother to child by 2015 and to reduce AIDS-related maternal deaths. The country has in the recent past seen significant changes in the rate of mother-to-child HIV transmission.
Between 2008 and 2012, the rate of mother-to-child HIV transmission dropped from 8% to 2.7%. There was a leap in the percentage of HIV-infected women receiving ARV therapy between 2011 and 2012, from 87.3 % to 99%.
Similarly, 99 % of all infants born to HIV-infected women receive prophylactic ARV medication to reduce the risk of early mother-to-child HIV transmission in the first six weeks.
In this plan “Sanac aims to reduce TB incidence and mortality caused by TB in people living with HIV by 50 % in 2015″, read the statement from the council.
Sanac also approved plans to launch an HIV prevention programme aimed at sex workers. Details of the project were, however, not released with the council saying it would do so closer to the launch.
The National Strategic Plan is one of the many plans the government is implementing. Early, this month, Health Minister Aaron Motsoaledi announced the introduction of fixed-drug combination ARV therapy.
Patients living with both HIV and TB, have started being treated on the new therapy.
Fixed-drug combination therapy is a combination of three crucial antiretroviral medications in one tablet, taken only once a day.
This eliminates the need for patients to take three or more pills at various intervals per day.
19 April 2013
From the Business Day Live
Statement of Human Rights Defenders on the Need for an Integrated and Comprehensive Approach to the Protection of Human Rights related to sexual orientations and gender identities and expressions at the Human Rights Council.
As many of you know, in June 2011, the Human Rights Council began an important process to strengthen the protection of the human rights of people all over the world on the basis of sexual orientations, gender identities and expressions.
This was the outcome of decades of work by social movements and good strategic leadership by both civil society and many states.
A Resolution was adopted on Human Rights, Sexual Orientation and Gender Identity.
This June marks two years since that Resolution was adopted.
What do we want to see at the Human Rights Council in taking forward the work on sexuality, gender and genedr identity?
Below, is a Statement that has been shaped by a group of civil society organisations, coalitions and networks from Africa, Latin America and from the Caribbean.
1. Read the Statement
2. Sign On.
You do this by sending an email to
Mtinkheni Munthali – firstname.lastname@example.org
Eunice Namugwe – email@example.com
You can sign on as an individual or as an organisation.
Please state in your email
NAME OF ORGANISATION [in full]
Then insert into SUBJECT LINE the words:
3. Forward the email to your networks and contacts.
More information will follow in the next days and weeks!
The Teams at the Secretariats:
African Men for Sexual Health and Rights
Coalition of African Lesbians
Statement of Human Rights Defenders on the Need for an Integrated and Comprehensive Approach to the Protection of Human Rights related to sexual orientations and gender identities and expressions at the Human Rights Council
-10 May 2013-
We, the undersigned human rights defenders, working to advance societies that affirm peoples’ diversities, choice, human rights and agency throughout the world, hereby state our position on the role of the Human Rights Council following (HRC) the adoption of Resolution 17/19 on Human Rights, Sexual Orientation and Gender Identity by the United Nations HRC and of the Report of the High Commissioner on Human Rights on Discriminatory Laws and Practices and Acts of Violence Against Individuals based on their Sexual Orientation and Gender Identity [A/HRC/19/41].
Progressing from the OHCHR study and Report, as well as the recent Regional Consultations and the Oslo Human Rights Conference, one of the key questions for the international community is ‘what would constitute an effective institutional response from the United Nations HRC to advance the respect, protection and fulfillment of the human rights of people all over the world based on their sexual orientations and gender identities and expressions?’
Our position is that an intersectional approach is required to address violence and violations based on sexual orientations, gender identities and expressions. Such an approach by the HRC will affirm and strengthen existing work for the full integration of the human rights of people based on their sexual orientations, gender identities and expressions into all existing UN mechanisms, agencies and systems. Such integration should be deliberate, systematic, resourced, coordinated and sustained. We believe that this intersectional and integrated approach will ensure respect, protection and fulfillment of the human rights of people from diverse sexual orientations, gender identities and expressions as integral to a comprehensive human rights agenda, and not present as a separate category of rights.
We believe that effective change in the violence and other violations against persons based on their sexual orientations, gender identities and expressions is dependent on an incremental approach. Such an approach will work to build on and sustain the momentum established by Resolution 17/19 and the Report of the OHCHR [A/HRC/19/41] in a context of dialogue and engagement both within regions and across regions and between states and between states and civil society. Such an approach will also ensure that technical assistance is available to enable states to take measures to address the violence and other violations against people on the grounds of their sexual orientations, gender identities and expressions, and enable stronger accountability for implementation.
The mandate of the HRC is not to mirror the prejudice of Member States but to set standards that member States should be held accountable to and be bound by. The international community has witnessed increasing dialogue among States on violence and other violations based on sexual orientation, gender identities and expressions, demonstrating shifts in prejudice and willingness to engage. The HRC must both continue, through ongoing dialogue, to identify and address the intersecting factors of discrimination which make up the root causes of such violations and tobuild on efforts to sustain these shifts.
We are concerned about calls for a special mechanism which would focus solely on sexual orientation and gender identity. We believe that this is a short cut and an apparent quick win to addressing the societal problems that establish and sustain the violence and violation based on sexual orientations and gender identities and expressions.
We believe that the creation of such a mechanism would pose significant risk of contributing to the process of solidify identities even where they do not exist and creating or reinforcing “an other” category. For some of us the work we do on sexual orientation and gender identity and the way we struggle for recognition of who we are is based on important and sometimes powerful identity categories. Often, these categories are not fixed identities, but standpoints we take in the struggle for dignity, freedom and equality.
As UN special mechanisms are dependent on the cooperation of States either by their own volition or by activation of a treaty obligation, it will be very difficult for a special mechanism on SOGI to function in the absence of an explicit treaty obligation binding States to cooperate with it. Consequently, the UN cannot count on the voluntary cooperation of States with such a mechanism.
We are further concerned that a special mechanism on sexual orientation and gender identity, whether a Special Rapporteur, Independent Expert or Working Group, would for a number of years after its establishment, be immobilized, dismissed or ignored by some states and actively resisted by others. This would have serious consequences for the possibilities of change at a national/country level. It would likely also increase the focus on name, blame and shame processes with the consequences of further polarization within the Council. We anticipate that the creation of such a special mechanism will, in effect reinforce the opposition to the protection of human rights of people based on their sexual orientations and gender identities and expressions. This could set back gains made since June 2011, as an international tussle ensues within the Council and elsewhere. We believe that such an intervention will for some time to come strengthen the divides amongst states on this issue and will narrow the range of effective measures that some states are willing to take to address the violations; It could reduce the possibilities of and/or delay real change at a local, country/national level where it is most needed. It is unlikely to facilitate or enable the kind of change we need as a community at a local and country level.
In the light of the above positions and concerns, we call on the HRC to adopt a resolution which will:
1. Request, to give effect to A/HRC/19/41 paragraph 82, the Office of the High Commissioner for Human Rights to convene an expert meeting to prepare Technical Guidance on the application, at a national level, of a human rights-based approach to the implementation of policies and programmes to eliminate discrimination and violence based on gender, gender identity and sexuality with a focus on sexual orientation, gender identities and expressions. This Technical Guidance should be presented to the HRC at a formal plenary session within two years following the resolution and within one year following the report [see 2 below];
2. Request, in keeping with A/HRC/19/41 paragraph 81, that the OHCHR conduct an in-depth study that demonstrates both the human rights situation in relation to sexual orientation and gender identities and expressions as well as promising and good practices that can serve as a basis for addressing the violence, violation and discrimination facing people all over the world in relation to sexual orientation and gender identities and expressions. The report to make recommendations that can serve as the basis for addressing the implementation/application gap at a country level through the drafting of Technical Guidance
All of this should be located within a process of sustained dialogue at all levels and between states and between states and civil society and supported through properly resourced technical assistance between countries as well as the adequate resourcing of the Office of the High Commissioner on Human Rights.
We further call on the Human Rights Council, subsequent to the adoption of a resolution addressing the above two interventions, to begin a process to encourage existing special mechanisms to identify and make recommendations to address the full range of protection gaps within UN human rights system. These would include but not be limited to protection gaps on the basis of sexual orientation and gender identity.
The Government of Liberia through the Ministry of Gender and Development (MoDG) in collaboration with the National AIDS Commission (NAC),UNAIDS and other institutional partners on Wednesday ended the joint reviewed of the Operational Plan for Women, Girls, Gender Equality and HIV.
The Operational Plan sets the agenda for accelerated country action for women, girls, gender equality and HIV.
But giving an overview of the operational plan, Mr. Isaac Ahemesah, UNAIDS’Liberia Rights, Gender, Country Community Mobilization Adviser, noted that even though Liberia was amongst few countries to develop and launch the operational plan since 2011, but much was not achieved.
According to him, there has been insufficient data on impact of HIV epidemic on women and girls something he said was, “partly because of the limited coordination and sharing between the different ministries collecting relevant data, with limited systematic (cross) analysis.”
Making a PowerPoint presentation, Mr Ahemesah further expressed concern about women and girls limited access to integrated sexual and reproductive health and HIV services, resulting in unmet reproductive health needs, as reflected in the higher HIV prevalence among young women.
Quoiting the 2007 Demographic Health Survey, He emphasized that HIV prevalence was three times higher among girls age 15 to 19 years (1.3%) than for boys (0.4%) in the same age group. Similarly, among young women aged 20 to 22 years HIV have an HIV prevalence rate of 2.1% as against 1.6% for young men.
For his part, Mr. Hh Zaizay, National Programme Officer of Gender and HIV at the Ministry of Gender and Development indicated that even though the plan was develop and launch in 2011 by President Ellen Johnson-Sirleaf, much of the activities in the plan were not implemented due to inadequate resources for the plan implementation. According to Mr. Zaizay, the review will help in addressing the funding and other bottlenecks that have impeded the implementation of the plan.
Closing the workshop, Dr Ivan Carmanor, Chairman of the National AIDS Commission (NAC) urged participants to work together with the Ministry of Gender to eliminate sexual and gender based violence, gender equality and other socio-economic and cultural factors that contribute to high HIV prevalence among women and girls in Liberia.
9 May 2013
By All Africa News
Written by Sonke Gender Justice Network
Sonke Gender Justice Network, the MenEngage Africa Network and the Women’s Health Research Unit at the University of Cape Town are proud to host the second MenEngage Africa Training Initiative course: ‘Masculinities, Leadership and Gender Justice in Sub-Saharan Africa’, to be held from 16-26 September 2013 at the University of Cape Town in South Africa. This follows the highly successful pilot course that took place in August 2012.
To apply for this training course, complete the online application at:www.menengage.org/mati2013application.
For further information, please go towww.mengage.org/mati2013course or refer to the attached document.
About the course
‘Masculinities, Leadership and Gender Justice in Sub-Saharan Africa’ is a short, intensive, ten-day residential course which seeks to expand the skills and knowledge of women and men in the Sub-Saharan Africa region to scale up work on engaging men and boys in gender equality, and build a network of leaders and gender justice advocates. In so doing, it aims to strengthen existing work on the greater involvement of men and boys in the prevention and response to sexual and gender-based violence, sexual and reproductive health and rights, HIV and AIDS, fatherhood, LGBTI rights and other issues pertaining to gender equality.
The course will incorporate a mix of thematic and skills-building sessions – covering both theoretical and practical components – as well as a site visit and daily opportunity for reflection. Thematic sessions will address the topics mentioned above, while the skills building sessions will specifically address leadership (including youth leadership), organisational development, research methods, advocacy, resource mobilisation and monitoring and evaluation.
As part of the training, participants are expected to submit a ‘Project for Change’ proposal, which will be refined during the course and, most importantly, implemented within their respective organisations once the course is completed. The Project for Change is a project or programme that is applicable to engaging men for gender equality. It can focus on sexual and gender based violence, HIV and AIDS, sexual and reproductive health or, LGBTI rights to name a few potential thematic areas. The project can be an existing one that needs to be expanded or strengthened, or a new initiative that must be implemented upon completion of the course. Through the implementation of the Project for Change, it is hoped that participants will be able to practically employ the additional skills and knowledge gained from this training.
To assist participants with the implementation of their Projects for Change, the course incorporates a six month Mentorship Programme. This mentorship component is a critical aspect of the training as it seeks to provide participants with ongoing support and guidance as they implement their projects at the conclusion of the training. Participants can elect their own mentor or have one appointed for them. Ultimately, certification for the MenEngage Africa Training Initiative (MATI) will be based on satisfactory implementation of the Project for Change and thorough engagement in the Mentorship Programme.
The organisers trust that this course will contribute to the strengthening of both individual and organisational capacities, and it is with great pleasure you are hereby invited to apply to attend.
Summary of the first course
From 20-30 August 2012, the first MenEngage Africa Training Initiative course ‘Masculinities, Leadership and Gender Justice in Sub-Saharan Africa’ took place at the University of Cape Town in South Africa. It brought together 23 participants (14 males and 9 females) from 13 African countries. Course content was delivered by global and regional experts and leaders in the fields of gender, human rights and social justice, for example, on topics such as ‘Why Engage Men?’ and ‘Gender, Culture, Tradition and Religion.’ Evaluations from the first course indicated that participants found the training very useful and it increased their knowledge and skills by 41 %. This is a positive outcome demonstrating that the modules on the course were effective in transferring knowledge and skills to participants on how to work with men and boys for gender equality.
The course is intended for gender activists, programme staff and project managers from women’s rights, children’s rights, sexual and reproductive health and rights, HIV and AIDS, and LGBTI organisations, youth leaders, government officials, UN Agency representatives, donors, academics and media advocates.
Who is eligible?
The ideal candidate will:
- Work in a field where they can influence gender justice and gender equality through their positions within non-governmental organisations (NGOs), community-based organisations (CBOs), government, UN agencies, donors, academic institutions, faith based organisations, juridical systems or other relevant organisations in Sub-Saharan Africa
- Have a minimum of 3-5 years work experience in gender, advocacy, human rights, social justice and/or sexual and reproductive health and rights issues
- Demonstrate commitment and interest in strategies and programmes aimed at engaging men for gender equality within Sub-Saharan Africa
- Have proven and demonstrable leadership experience/skills
- Have a basic understanding of gender issues, particularly around gender justice
- Demonstrate an understanding, commitment and willingness to be part of an intense ten day residential course
- Have an innovative proposal for a ‘Project for Change’, to be implemented on completion of the course
- Have the support of their organisation for both participation in the course and implementation of their Project for Change (where applicable)
- Hold a Bachelor’s degree in international relations, human rights, health rights, gender or other relevant fields (practical experience will be taken into account in lieu of an educational background)
- Be fluent in English
- Have interest/experience in running training courses
There are no registration fees. Applicants are requested to cover all travel-related costs in full. Accommodation and course costs will be covered by the hosts.
A very limited number of scholarships to cover the full cost of participation are available. The hosts encourage ALL interested parties to apply.
To apply, please go to http://www.menengage.org/mati2013application to fill out the on-line application form.
Applications are to be completed by no later than 31 May 2013. Once completed, you will receive an email confirming receipt of your application. Successful candidates will be notified by no later than 1 July 2013.
For further information, kindly contact Tanya Charles at firstname.lastname@example.org
9 May 2013
By New Vision
Uganda has been described as the Pearl of Africa. However, in this beautiful land, there are a number of harmful cultural practices that make it a place no child would want to live in. As the third series ofthe Tumaini Awards is launched, Shami lla Kara explores how Uganda Youth Development Link, a nongovernmental organisation, is helping youth find meaningful ways of earning a living as a means of fighting commercial sexual exploitation of children.
Commercial sexual exploitation of children is an insidious cancer that is stealthily spreading and eating deep into the fabric of our society. Cited in the International Labour Organisation’s (ILO) Worst Forms of Child Labour Convention 1999 (No.182) that ILO member states must eliminate without delay, this practice violates the rights of the sexually exploited children, scarring their psychological, physical and social status, thereby relegating them to sub-human living.
ILO defines commercial sexual exploitation of children as “the exploitation by an adult with respect to a child or an adolescent, female or male, under 18 years; accompanied by a payment in money or in kind to the child or adolescent (male or female) or to one or more third parties.”
According to a 2011 study by the Uganda Youth Development Link (UYDEL), an organisation that is involved in fighting and increasing awareness about this practice, commercial sexual exploitation in Uganda is on the increase, with statistics revealing that there are 18,000 children affected, from 12,000 in 2004.
Another study, carried out by the Jinja Network for the Marginalised Child and Youth in 2011, revealed thatcommercial sexual exploitation in Jinja was rampant, with young girls being exploited by trailer drivers, tourists and businessmen, among other abusers.
The UYDEL report, titled, Commercial Sexual Exploitation of Children in Uganda, further shows that the helpless children, who fall in the 14-17 age bracket, endure sexual exploitation for a pittance and risk their lives to earn between sh2,500 and sh5,000 per client.
This exposes them to a high likelihood of unwanted pregnancies, being beaten by the clients or gang-raped and contracting sexually transmitted diseases that include HIV/AIDS.
According to ILO, victims of this practice include “runaways, children from dysfunctional families, children of sex workers, homeless children, AIDS orphans, migrant children, children from ethnic minorities and out-of-school children.”
In Uganda, the UYDEL 2011 report reveals that children, who did not attend school and were engaged in economic activities such as bartending and working in lodges were also vulnerable to being sexually exploited for money.
The report further discloses that the practice is prevalent in urban areas such as Kampala and it has even infiltrated schools.
It adds that victims of the practice are usually trafficked children, orphans, and children coming from economically underprivileged situations.
What the NGO does
Rescuing children from commercial sexual exploitation is one project under the child rights protection programme of the NGO. The programme also covers child trafficking and child labour.
The NGO is involved in other programmes that include HIV prevention among children and a youth programme; the alcohol and substance abuse programme and the adolescent, sexual and reproductive health programme.
It is also involved in social research and has published several publications covering childrelated topics.
Founded in 1993 by Rogers Kasirye, who is also its executive director, the NGO’s mission is “to empower disadvantaged and vulnerable youth with cognitive life and livelihood skills so as to make them useful citizens of Uganda.”
UYDEL’s areas of operation include Kampala, Mukono, Wakiso, Busia and Kalangala.
It employs 57 personnel that include psychologists, social workers, instructors and artisans.
UYDEL’s target beneficiaries are disadvantaged and vulnerable youth aged between 10 and 30 years found living on the streets, in slums, teenage mothers, youth who have dropped out of school and those from poor families.
The organisation also works with parents and other community members for the wellbeing of the youth. In 2011 alone, UYDEL admitted 1,812 vulnerable youth to its programmes
The programmes are implemented through the NGO’s outreach post in Bwaise and its five drop-in centres, four of which are in Kampala and include, Nakulabye, Nateete, Makindye and Kamwokya, as well as one in Mukono district.
Additionally, UYDEL also has a rehabilitation and vocational centre at Masooli parish in Wakiso district, where youth who have no where to live are given temporary accommodation
The centre also trains the youth in skills that include plumbing, hairdressing, catering, welding and metal fabrication and tailoring.
The NGO further finds field placements for at least six months for the youth.
This approach has supported strong and sustained behavioural change and helped withdraw adolescents and youth who were engaged in child labour and other exploitative activities to find meaningful ways of earning a living
Besides vocational skills training, the youth also access psycho-social support services, counselling services, medical care such as the testing and treatment of sexually transmitted infections and therapy at the centre in Masooli.
Through performance therapy, rehabilitated children are empowered to tell their stories, an initiative that has reached out to over 1,000 youth in eight slum communities.
UYDEL also engages the youth in behavioural change communication sessions, which aim at encouraging sustained behavioural change.
These sessions cover topics such as drug abuse, children’s rights, sexual and reproductive health and life skills. These sessions are also conducted in the communities for youth, who cannot come to the centres through community outreach dialogues.
UYDEL is also involved in advocacy activities that include creating awareness about Article 33 of the United Nations Convention on the Rights of the Child and work with parents, children and communities to support prevention programmes advocating for drug-free environments.
The NGO has, of recent, been included in a pilot campaign by the International Olympic Committee to help fight substance use in youth through sports.
7 May 2013
On May 5th, International Day of the Midwife, AAI Commends Increased Accountability to Maternal Health in Malawi.
By Agnes Mizere
As midwives around the world celebrated the ‘International Day of the Midwife’ on Sunday, Malawian chiefs continued their daily campaign to save the lives of expectant mothers to further reduce the country’s maternal mortality rate.
Malawi’s maternal mortality rate has reduced from 675 out of 100,000 to 450 out of 100,000.
With the deadline for the Millennium Development Goals (MDG) rapidly approaching in 2015, the message that “the world needs midwives more than ever” is becoming more urgent including in Malawian villages.
Previously many village women were relying on Traditional Birth Attendants (TBA) during labour and delivery until they were stopped from assisting them. Instead village women are being encouraged to deliver their babies in hospitals and clinics under the supervision of midwives.
Under the Presidential Initiative on Safe Motherhood and Maternal Health, Senior Chief Kwataine explained how chiefs are determined to make sure “no woman dies while giving birth” and that plans are underway for more women to graduate as community midwives to replace TBAs in different villages.
He was speaking after a sensitization meeting in Traditional Authority Mwambo’s area in Zomba where 19 traditional leaders exchanged notes on how best to tackle maternal health.
Among other things, the chiefs agreed to form village committees to target those at grass-root level and another one at T/A level. The idea was to encourage villagers to send expectant mothers to hospitals or clinics.
“If approached TBAs should tell the expectant woman to go to hospitals or clinics where there is trained personnel. The TBAs are not supposed to put their hands on any woman who is pregnant. Gone are those days, we don’t need them to deliver babies so TBAs should find another job. We want young blood, women with a credit in MSCE to graduate as community midwives to replace TBAs in different villages,” stressed Kwataine when asked.
He emphasized the need for pregnant women to deliver safely as the main reason why the traditional leaders as owners and custodians of culture were now playing a leading role to ensure women do not die during childbirth.
According to Kwataine, the rate rose to 1120 per 100,000 some years back but with their Presidential Initiative on Safe Motherhood and Maternal Health, the messages are going down to Traditional Authorities, village heads and “those responsible for the pregnancies including their husbands.”
He also mentioned the need to stop girls under the age of 18 from getting married as statistics show them being vulnerable and facing potential complications during childbirth
5 May 2013
By Daniel Wasonga
Non-communicable diseases (NCDs) are not passed from person to person, and include those such as cancer, diabetes and hypertension. They may be of long duration and slow in progression, or in some instances, result in rapid death. NCDs are categorized mostly by their non-infectious causes and not their duration. Like all diseases that develop slowly and worsen over a long period of time, NCDs require chronic care management.
Expectant mothers, especially those beyond the first 42 days, are uniquely vulnerable to NCDs and require proper maternal care at home or in healthcare facilities. Exposure of these women to any disease is detrimental to their health and that of their unborn babies. Chronic diseases increase the health risks of expectant mothers and without adequate care, maternal mortality will rise beyond the current undesirable levels, especially in the developing economies.
NCDs disproportionately affect the low and middle income countries, where 80% (29 million) of deaths related to these diseases occur. Women in general already bear the burdens of NCDs, which are compounded by myths and misconceptions. Social and cultural taboos often prohibit women from opening up about issues such as family planning and unwanted pregnancies, which impairs the few efforts being made at improving these conditions. Furthermore, the constant “blame game” has not really helped in bringing stakeholders together in finding solutions for the specific issue of maternal mortality related to NCDs.
The cost of treatment is high. For expectant mothers who are the sole breadwinners in their households, getting proper care for NCDs may be difficult. This is especially the case in Africa, where cancer, cardiovascular disease, chronic respiratory disease and diabetes are leading causes of death in women. Worldwide, these diseases kill 18 million women yearly.
The impact of these diseases on society as a whole is enormous – maternal mortality goes beyond its consequences on individuals. The loss of women who are at their prime would leave an economic and social gap in society. Ignoring this aspect of the link between maternal mortality and NCDs is a mistake our decision makers and policy formulators should not make.
The overwhelming emphasis on reproductive and maternal health has pushed the special focus on NCDs to the periphery, an approach that is not effective. Maternal mortality remains the least achieved of the Millennium Development Goals (MDGs) and multi-faceted solutions promise better returns. A comprehensive approach to women’s health that goes beyond the maternal focus is essential and much more sensible. The current interventions are too rigid and limited to the MDGs with little or no focus on post-MDG initiatives.
Although some achievements have been made in Africa on reversing maternal mortality, the progress has been limited and unequally distributed within and among countries. The upcoming Conference of African Ministers of Health should focus on compounding the gains made within countries and ensuring there is no disconnect between government and initiatives taken at the grassroots level. In the push towards achieving the MDGs, Africa needs renewed commitments from the governments and feasible, effective monitoring and evaluation mechanisms. Best interventions should also be shared between countries to underline the collective efforts in eradicating maternal mortality.
23 April 2013
After the March 2013 launch of AAI’s Country Coordinating Mechanisms (CCMs) Community Consultation Report entitled “Who is really affecting the Global Fund decision making process?” AAI has begun conducting advocacy around the findings. The objective is to use the research as an accountability tool, acting as a best-practice and gaps analysis evidence base for improving the meaningful participation processes of women, girls and those marginalized by their sexual orientation in Global Fund processes.
Download the full report: Who is really affecting the Global Fund decision making processes? A Community Consultation Report
Download the survey report: Who is really affecting the Global Fund decision making processes? A Quantitative Analysis of CCMs
Download the media release: AIDS Accountability International on the Global Fund
To achieve this, AAI conducted its Global Fund Advocacy Week at the Global Fund Secretariat in Geneva, Switzerland, from 15-19 April 2013, since engaging Fund Portfolio Managers and Senior Technical Advisors on gender and key populations is critical for holding both the CCMs and the Global Fund Secretariat accountable for their obligations to marginalized populations. AAI also endeavoured to connect with other partners in Geneva, such as the World Young Women’s Christian Association (World YWCA), the International Labour Organization (ILO) along with funding partners and independent stakeholders.
On Monday 15 April 2013, AAI began its Global Fund Advocacy Week in Geneva by meeting with Nyaradzayi Gumbonzvanda (General Secretary) and Hendrica Okondo (Global Programme Manager SRHR & HIV Focal Point for Africa) at the World Young Women’s Christian Association (World YWCA). The discussion focused on reducing the distance for dialogue between young girls and policy makers, creating spaces of “conversational accountability” and “intergenerational dialogues” so that young girls can have the opportunity to engage with decision makers, but in less technical forums. Leadership was also a topic of strategic thinking, with AAI and the YWCA brainstorming around how to redefine leadership so that it does not rest on the pillars of education or income.
The following day, AAI met with a team of senior technical specialists at the Global Fund Secretariat. Speaking with Linda Mafu (Head, Political and Civil Society Department), Sara Davis (Senior Specialist in Human Rights and Equity), Motoko Seko (Gender and Human Rights Specialist) and Mauro Guarinieri (Senior Advisor, Community Systems Strengthening and Civil Society), AAI pushed for greater accountability towards Human Rights in Global Fund processes. It was agreed during the meeting that viewing human rights through a public health lens can often be highly effective in certain contexts where the rights and women, girls and LGBT people can be politically and culturally sensitive. This supports the research findings in AAI’s CCM Report. AAI and the Global Fund also discussed the new CCM guidelines (2010) which say that CCMs should demonstrate effort to include key affected populations in the country dialogue process. In terms of the way forward, it was raised that Fund Portfolio Managers might benefit from capacity building on how to engage better with civil society outside of the CCM, as well as on human rights and key populations issues.
Continuing with Global Fund Advocacy Week, AAI met with two Fund Portfolio Managers (FPMs), Richard Cunliffe (Botswana, Swaziland) and Viviane Hughes-Lanier (Niger). At these two meetings, AAI consulted with the FPMs about how best to strengthen Africa’s CCMs through improved participation of marginalized groups. The result was a recommendation from the Secretariat to build the capacity of civil society to become principal or sub-recipients, train key populations CCM members on how to influence a meeting, and train the CCM Chairs and Co-Chairs on how to run a meeting that includes discussions of strategic thinking around human rights considerations.
At the end of the week, solid plans had been made to move forward with the project in a manner that continues to involve the Secretariat in Geneva. This way, AAI can increase its impact in pushing for greater accountability to women, girls and SOGI groups from both the CCMs in country, and the FPMs and Technical Specialists at the Global Fund in Geneva.
25 April 2013
AAI has distilled the key messages of the Civil Society African Common Position Paper on ICPD into 12 brief points for easy reading.
We will continue seeking endorsements in the coming weeks and have already had over 100 CSOs in Africa and worldwide sign on!
Join us and give more power to the people!
1. Human Rights
The document is fundamentally based on human rights. This means that the main objective of all development policies and programmes and their implementation must be to respect, protect and fulfil human rights for all.
1.1. Demography and population growth: The document clearly addresses the potential abuses of demographic and population growth policies and strategies that ignore the human rights of individuals. It also demands that all population growth and structure, and demographic work is approached with a human rights and gender responsive lens. It requests guarantees that policies to address high fertility and rapid population growth will focus on enlarging, not restricting, individual choices and opportunities. Clear policy guidelines must be developed and implemented so as to ensure that human rights and gender responsive lens is used through to clinic level so that abuse and misinterpretation does not occur.
1.2. All vulnerable people included: The document identifies vulnerable and key affected populations that require better inclusion and more focussed policies, programming and implementation in order to realize their full socio-economic and civil and political rights and freedoms. It acknowledges the role of both the vulnerable and the role of the already empowered and that they need to engage in promoting equality, equity and empowerment for all.
1.3. Duty-bearers and rights-holders: Both duty-bearers and rights-holders are identified throughout the document as a means to better identify the needs and entitlements of the former, and the obligations and duties of the latter. It also speaks to where capacity is lacking in order to empower the latter to hold the former accountable.
2. Accountability and Transparency
The document highlights the need for accountability which can be gained from collective transparency, open dialogue and greater focus on implementation and action with the attainment of human rights for all as the ultimate goal.
2.1. Reporting: To report in a timely manner, accurately and transparently on progress made. To ensure that monitoring and accountability mechanisms adopt a systemic and sustained human rights approach towards the implementation of the ICPD, Maputo Plan of Action (MPOA) and other relevant commitments;
2.2. Quality of data: To improve the quality of reporting by improving data, increasing quality and quantity of responses in reporting documents, using a collaborative process with civil society for the completion of reports, and ensuring appropriately disaggregated data is available and included in reporting.
2.3. Dialogue between government and Civil Society Organisations (CSOs): Use open dialogue between government, civil society and policy organs, to create more discussion around current status, national responses and challenges surrounding the attainment of universal access to sexual and reproductive health and rights (SRHR) and health services on the continent.
3. Focus on Implementation
The document highlights the need for a “less talk, more action” stance. This includes a focus on implementation of budget, human resource development and improved national ownership rather than policy and/or commitment development.
3.1. Budget allocation and spending: To boost funding for health, especially SRHR, by implementing the commitment made in Abuja to dedicate 15% of national budget to health. In addition, the document calls for implementation of the MPOA commitment to allocate 15% of health budget to family planning commodities. It is important to also identify alternative funding sources. There is a need to improve monitoring and evaluation and financial controls of existing budgets and expenditures;
3.2. Focus on African capacity: To allocate budget and implement capacity building for health systems strengthening through improved human resources. This is for health staff as well as national institutions, community systems and Ministry of Health staff. It is necessary to mount evidence-informed and rights-based responses, whilst also working on retaining existing staff, improving the existing quality of training and promoting South-South cooperation.
3.3. Leadership and national ownership: To commit to an all-inclusive and accountable leadership that ensures integration of SRHR into national development instruments. Leaders must also create space for national debate on priorities, strategic investments, social protection and legal measures. Leaders are required to create and adhere to good governance practices in all aspects of health systems strengthening.
4. Future forward
The document highlights the possibilities available to us as well as the need for innovative, modern and cutting edge knowledge, attitudes, decisions and strategies to be used in strengthening African health systems.
4.1. Technology: Use of innovative technologies, up to date knowledge, scientific and evidence-based decision-making to ensure that health systems are modern, sustainable, and intelligent. Decisions must be based on cutting edge philosophies and forward-looking thinking. We should be including newly developed yet proven safe services and commodities.
4.2. Quality and acceptability of services and commodities: ensure that sexual and reproductive health services and commodities are high-quality, available, accessible, and acceptable to all people. Ensure that the widest range of services and commodities and innovative technologies are provided as part of the modern health system.
4.3. Protect the population’s human rights: Prioritise human rights in sexual and reproductive health programmes by guaranteeing that services are designed to respond to individual’s health needs. This includes overcoming barriers faced by marginalized groups. This must be done through service provision that is free from stigma, coercion, discrimination and violence, based on full and informed consent, and that affirms the right to pleasure and thus looks to an African future for health systems based on human rights.