Senate Appropriations Committee Increases 2010 Funding for Global Health Programmes

Last Thursday the U.S. Senate Appropriations Committee passed a $48.69 billion draft bill to fund the State Department and foreign affairs activities for this 2010 fiscal year. With a final vote of 29-1, Senator Leahy explains how "this bipartisan bill goes a long way to emphasize the importance of enhancing the capacity of the Department of State and U.S. Agency for International Development to carry out diplomacy and development programmes in areas of critical importance to the United States."

Of the $48.69 billion allotted, global health programs will receive $7.8 billion for their continued efforts. This amount is not only $434 million above the 2009 fiscal year request, but also $178 million above this years request, emphasizing a realization of the need for substantial funding in order to continue and improve efforts to address issues of global health. Within the $7.8 billion budget, $555 million will be allotted to child survival and maternal health, $628.5 million for family planning and reproductive health programmes, which includes an allocation of $50 Million for the UN Population Fund, $5.709 billion to combat HIV/AIDS, and an additional $700 million for the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In addition to increased funding for family planning, the Senate Appropriations Committee went a step further and adopted an amendment proposed by Rep. Frank Lautenberg, D- New Jersey, which "would make permanent Obama's decision earlier this year to revoke a policy prohibiting U.S. aid to overseas organizations that promote or perform abortions." Under George Bush, U.S. taxpayer money, in the form of family planning funding, was banned from going to any international family planning groups that either performed abortions, or offered any sort of information, counseling or referrals which supported abortion. Also known as the "Mexico City Policy" or the "Global Gag Rule" this policy was introduced by the Reagan administration in 1984, overturned by President Clinton in 1993, restored by President Bush in 2001, and most recently overturned by President Obama earlier this year. By agreeing upon this new amendment, further administrations would be forced to accept the most recent stance adopted by President Obama, and must continue to allow funding for family planning organizations that promote abortions, regardless of any future leader's opinion on this issue.

To read more about the Senate Appropriations Committee's funding breakdown, you can access their FY 2010 Department of State Foreign Operations and Related Programs Appropriations summary at: http://appropriations.senate.gov/News/2009_07_09_Summary_of_FY_2010_State_and_Foreign_Operations_Appropriations.pdf?CFID=3878437&CFTOKEN=11326390

African HIV/AIDS Program Drastically Affected by Global Financial Crisis

The global financial crisis has forced most African countries to slash their HIV/AIDS program budgets, according to a recent report by Black Star News.

Botswana, South Africa, Zambia, the Democratic Republic of Congo and Zimbabwe are some of the countries hardest hit by the economic downturn. These countries' export revenues have dropped, severely affecting revenue flow for government expenditure on critical HIV/AIDS programs.

Program cuts have already been announced throughout the region. Tanzania introduced a 25% cut to its annual HIV/AIDS budget, and the Botswana government declared that it will not include new patients in its free antiretroviral treatment program from 2016 onwards.

Major international donor organizations are also being hit by the financial crisis. The Global Fund to Fight AIDS, Tuberculosis and Malaria announced a $4 billion dollar budget shortfall for essential services in 2010. In addition, the group faces a $10.7 billion funding gap for the regional implementation of their Global Plan to Stop TB.

Health advocates are pressing African governments and international aid organizations to stick by their commitments to improve HIV/AIDS care, arguing that the right to heath treatment is non-negotiable.

“In the last few months, we have seen trillions of dollars spent on financial bailouts to stimulate economic recovery,” said Nonkosi Khumalo, a women's health program coordinator at the South African Treatment Action Campaign, speaking at a recent meeting of HIV/AIDS coalitions in Cape Town. “A tiny portion of this sum could have bought quality, sustainable healthcare for millions of people.”

According to the 2009 World Bank report, "Averting a Human Crisis During the Global Downturn", countries in Eastern and Southern Africa are the most vulnerable. Researchers estimate the negative impact of this crisis will affect 70% of people on ARV treatment in Africa within the next 12 months. Apart from countries such as Botswana and South Africa, most countries have limited fiscal space they can use to cushion the impact of a decline in international aid, the World Bank says.

The complete article "Global Financial Woes Roil AIDS Fight" by Sifelani Tsiko can be found here: http://blackstarnews.com/news/126/ARTICLE/5724/2009-05-28.html

The World Bank has more information on the impacts of the Global Financial Crisis at: http://www.worldbank.org/html/extdr/financialcrisis/

Update, 23 June 2009:
World Bank Report Predicts Contracting Global Economy Will Hurt Poorest Countries

The World Bank released a report Monday, projecting "a 2.9 percent contraction in global GDP this year, as rich countries contract by 4.5 percent," the Wall Street Journal reports. "The crisis of the past two years is having dramatic effects on capital flows to developing countries, and the world appears to be entering an era of lower growth," World Bank Chief Economist Justin Lin said (Burns, Wall Street Journal, 6/22).

The report -- which was issued at a conference in Seoul, South Korea -- forecasts more dire predictions than those the World Bank made just months ago and contrasts with the views of "its sister organization, the International Monetary Fund (IMF) ... which is forecasting a global contraction of only 1.3 percent this year and growth of 2.4 percent in 2010," Bloomberg/Los Angeles Times reports. "[W]hile a global recovery may begin this year, impoverished economies will lag behind rich nations in benefiting," the newspaper writes. "The lender called for 'bold' actions to hasten a rebound and said the prospects for securing aid for the poorest countries were 'bleak'" (Bloomberg/Los Angeles Times, 6/22).

CNN reports, "Developing countries will be hit hard by falls in private investment ... seeing nearly $1 trillion less in foreign investment this year than they did two years ago" (CNN, 6/22). "The real challenge is going to be to manage going through this period of very slow growth, to keep government programs that are critical for longer term growth (infrastructure, health and education policies)," Andrew Burns, acting manager of the World Bank's Global Trends Team, told VOA News. Burns said that in response to the growing need, the World Bank "is stepping up lending to the region" -- with plans to lend about "$33 billion this year and next year" (DeCapua, VOA News, 6/22).

UNAIDS and World Bank Release Report Detailing an Interconnectedness Between Prevention Efforts and Transmission

A recently released report from UNAIDS and the World Bank finds that national HIV prevention strategies are not reaching at risk groups in at least 5 African Countries. The study was conducted from 2007 to 2008 and focused on determining where most HIV cases were occurring in each country, and whether these statistics were a result of inadequate prevention programs or under-funding issues.

If national HIV prevention strategies are to succeed, countries must first understand the character and drivers of their epidemic and focus on effective interventions. Kenya, Lesotho, Mozambique, Swaziland and Uganda were all determined to have inadequate HIV prevention strategies, and the report determined that this was in large part due to the failure of prevention initiatives to address the most common forms of transmission. For example, in Lesotho most new infections occur because of concurrent sexual relationships, both before and after marriage, but the prevention efforts in this country tend to focus on unsafe sex with multiple partners instead of prevention methods for those in long term monogamous relationships. Mozambique presents another example of the interconnectedness between prevention and transmission of the disease. An estimated 19% of new HIV infections are transmitted as a result of commercial sex work, but Mozambique has very few programs that target the specific category of sex workers.

In the wake of the current financial crisis, many African countries' budgets have been drastically reduced, and essential programs have been cut. In many of the surveyed countries, spending on HIV prevention has dropped, leading countries to concentrate their efforts on general prevention, instead of targeting specific at risk groups. In Lesotho, only 13% of the national HIV/AIDS budget is spent on prevention, and these efforts may not even be completely effective. Even though budget spending is being cut, an emphasis must be placed on prevention programs in order to address the problem from the beginning. If prevention efforts are stepped up, the country will have to deal with fewer cases, which means less funding for medical treatments and other problems associated with high infection rates in society. There is often a mismatch between HIV prevention efforts and the actual factors driving new infections, which can lead to significant resources being invested in programmes of limited effect. In order to reach those most at risk, spending must be focused on effective spending efforts.

The report also provided recommendations for those countries surveyed on how to better implement evidence-based prevention efforts. Based on collective evidence, the report determined that Lesotho should revise its prevention messages to address multiple concurrent partnerships and integrate the subject into future initiatives, and Mozambique should focus condom promotion on groups such as sex workers.

To read other country specific recommendations, you can access the report in its entirety at: http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2009/20090512_UNAIDS_WB_epi.asp

Online Forum: FP and HIV Service Integration: Experiences and Evidence

Online Forum: June 1-5, 2009

Register for free at http://my.ibpinitiative.org/public/fphivintegration

Please join us in a global discussion forum on family planning (FP) and HIV service integration. This forum will review the experiences of, and evidence for, integrating FP and HIV services. Share your experiences, challenges, and lessons learned, and pose questions and discuss with experts including:

*Rose Wilcher, Senior Technical Officer, Family Health International
*Betty Farrell, Senior Technical Advisor for Integration, EngenderHealth
*Heidi Reynolds, Senior Technical Specialist HIV/AIDS, MEASURE Evaluation

To register, go to http://my.ibpinitiative.org/public/fphivintegration and click on “register” in the upper left corner of the screen and fill in the required information. If you are already a member of the FP/HIV Integration Community in the Implementing Best Practices (IBP) Knowledge Gateway, click “login” in the upper left corner of the screen. Questions? Send an e-mail to info@ibpinitiative.org.

During the week long forum, you will receive no more than two emails per day; one email to introduce the day’s topic and questions and one daily digest, with all contributions screened and presented as a single, well-organized digest. You will be able to participate in the forum simply by responding to this daily digest via e-mail or by logging into the IBP Knowledge Gateway at http://my.ibpinitiative.org/public/fphivintegration.

This online discussion is sponsored by Family Health International (FHI), EngenderHealth, MEASURE Evaluation, and the Knowledge for Health (K4H) Project, based at the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs in collaboration with the Implementing Best Practices (IBP) in Reproductive Health Initiative and WHO.

A Proposal for a Global Health Fund

A recent article published in The Lancet calls for "bold action to streamline the global aid architecture for health" through the creation of a global fund for the Health MDG's. In May and June of this year, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance will hold their annual board meetings. These meetings provide an occasion to propose recommendations for an expansion of the Global Fund and the GAVI Alliance toward becoming a broader global health fund to address the lack of progress toward the MDG's.

Maternal mortality has remained stagnant for far too long, child mortality is declining at too slow a pace, HIV/AIDS remains a huge problem throughout the world, and inequalities are continuing to widen. In order to address these problems and work toward reaching Millennium Development Goals in time, radical action must be taken immediately. Increased funding and efficient spending are the two most imperative reforms that must be addressed.

In the past 10 years funding for global health has been unable to meet the demands of modern societies. Attention to HIV/AIDS has lead to increased funding, yet it is still inadequate in addressing the multitude of new infections occurring every day. Resources for other health needs have remained stagnant, or in some cases, have declined. In the past, developing countries heavily relied on international funding to combat health problems in society, but lately there has been a shift toward national financial autonomy. Such a concept requires that nations receiving assistance should eventually be able to finance their own health services through a reliance on their domestic revenues. Such a model has thus far proven to be ineffective, and serves as a major constraint to "scaling up service provisions in countries where public services rely heavily on international resources."

Increasing prevalence of diseases and other health related problems, such as maternal mortality, combined with the lack of commitment to a national financial autonomy based approach, has shifted reliance back to the international community. More specifically, the GAVI Alliance and the Global Fund, who have themselves admitted that “It is time to take a comprehensive approach with the necessary support from key donors to refocus on all of the health-related MDGs."

Health systems in many countries lack the capacity to implement many of the programmes or assistance plans provided for them, Unable to take full advantage of funding provided is a complete waste and unravels the entire global health funding process. It is thus essential that health systems themselves be strengthened before any further funding in doled out to communities unable to reap the benefits in their entirety. By overcoming structural challenges to service delivery the results will be much more effective, and progress toward the MDG's will in theory speed up.

The Lancet article recommends that the Global Fund should sustain successful programmes while expanding the effective approaches already put in place by the Global Fund and the GAVI Alliance. Eventually, the hope is that such a fund would allow for the prevention and treatment of specific diseases through revamped health services as well as a reduction in costs and a streamlining of the global health architecture.

Radical action must immediately be undertaken in order to achieve the Millennium Development Goals by 2015, and more importantly to save millions of lives that are lost to treatable and often preventable health problems.

You can access the entire article that appeared in The Lancet and learn more about the recommendations for the Global Fund and the GAVI Alliance at: http://www.familycareintl.org/UserFiles/File/Lancet_Global%20Fund%20Health%20MDGs_web.pdf

Evaluation of World Bank Support for Health, Nutrition, and Population

Between 1997 and mid-2008 the World Bank Group's support for health, nutrition, and population (HNP) provided $17 billion for government-run projects in the fields of nutrition, health, and family planning. An additional $873 million was invested in private health and pharmaceutical investments. Although these numbers may seem high, a report issued last week by the bank's Independent Evaluation Group revealed that one third of the 220 projects undertaken by the World Bank HNP had failed to achieve their goals. Furthermore, the emphasis on HIV/AIDS related projects has resulted in unsatisfactory outcomes, and progress in the nutrition and family planning sectors have greatly been inhibited by such unequivocal funding measures.

According to the evaluation, 7 out of 10 AIDS projects financed by the bank had failed to achieve satisfactory outcomes. In Africa, the epicenter of the AIDS pandemic, 8 out of 10 AIDS projects had unsatisfactory outcomes, one of the bank's worst records worldwide. The report insinuated that the failure is not a result of incompetent or ineffective programmes, but rather the inability of inexperienced or weak bureaucracies to carry out such complex projects (ironically, which were encouraged by the donor). Julian Schweitzer, the World Bank’s director of health, nutrition and population, admitted that inexperience and weakness was not just at the country level, but also "sometimes our own".

To improve the effectiveness of such programmes, the report suggested a simplification of projects, a reduction in the number of government ministries involved, and a focus on more modest objectives. Also addressed, was the need to improve programmes in developing nations, with a specific focus on Africa. Middle income countries ranked adequately in their ability to carry out such initiatives, but in Africa, more than three-quarters of the projects were deemed ineffective. The World Bank Group's support for health, nutrition and population needs to make an immediate effort to concentrate resources where they are most crucially needed, and more importantly to ensure that programmes are being carried out appropriately within these regions.

Aside from the issue of programme efficiency, the report detailed another important trend in global health, namely, the disproportionate attention and funding allotted to AIDS programmes in the last decade. Since 1997, foreign assistance for global health has increased, with a specific focus on HIV and AIDS. Although it is incredibly important to deal with such a deadly disease, the focus on family planning has greatly declined as a result of this relatively new emphasis on AIDS funding. In reaction to the report, Professor William Easterly of New York University stated that the evaluation of the World Bank confirmed "a fear that many of us have had for some time: that hugely disproportionate attention to AIDS has had a negative effect on aid efforts for all other health problems."

Since 1997, nearly 60% of World Bank HNP projects have focused on AIDS, while efforts aimed at tuberculosis, malaria and leprosy were granted significantly fewer resources (malaria made up only 3% of the projects, and tuberculosis only 2%). Family planning has also been negatively affected by the disproportionality of funds, and leaders of the evaluation group have realized the implications of this. Martha Ainsworth, lead author of the report, reaffirmed the groups commitment to increase funding for family planning by stating, "helping women control the number of children they bear is essential to reducing the high rates at which they die in childbirth in the poorest nations, the fact that no one’s been paying attention to reducing high fertility is critical for Africa."

Mr. Schweitzer, of the World Bank, strongly agreed with the evaluators call for greater efforts in family planning and nutrition, and reaffirmed the necessity of donors and recipient countries working together to coordinate projects and achieve targeted results. In recent years, PPD has advocated against global decrease in population and family planning funding, and it is our hope that such an internal evaluation will be a call to action for the World Bank Group's support for health, nutrition, and population to change their efforts. And as PPD has long recognized, an emphasis on the African region and family planning efforts are crucial to achieving progress worldwide.

To view an executive summary of the report, visit:

http://siteresources.worldbank.org/EXTWBASSHEANUTPOP/Resources/exec_summary.pdf

Or you can access the entire evaluation at: http://go.worldbank.org/EI6ARNQKX0

Interested in reading more about specific countries project performance assessment reports? Then check out: http://go.worldbank.org/3764K5QNI0

Bongaarts and Sinding on International Family Planning Programs: Myths v. Facts

Bongaarts and Sinding (a "founding father" of PPD) published "A response to critics of family planning programs" in the recent issue of International Perspectives on Sexual and Reproductive Health.

In this article, the authors argue that funding for international family planning programs in developing countries has declined by 30% since the mid-1990s. Decisions by policymakers and donors to reduce investments in contraceptive services and supplies were based on plausible-sounding—but misguided—arguments. “Donor fatigue” and persistent opposition from conservative governments and institutions, in particular the Bush administration and the Vatican, contributed to this decline. Family planning programs were placed on the back burner as other pressing problems, such as the AIDS epidemic, rose in prominence.

Myth: Family planning programs have little or no effect on fertility.

Fact: Decades of research show that comprehensive family planning and reproductive health services lead to sharp rises in contraceptive use that help women avoid unwanted pregnancies. Over a thirty-year period (1960–1990), fertility declined in the developing world from more than six to fewer than four births per woman, and almost half of that decline—43%—is attributable to family planning programs.

Myth: Fertility declines are under way everywhere, so the population problem has largely been solved and family planning programs are no longer needed.

Fact: Population will keep growing even if fertility could immediately be reduced to the replacement level of 2.1 births per woman, because:

• Current birthrates still leave fertility above the level needed to bring about population stabilization.
• People live longer as higher standards of living, better nutrition, expanded health services, and greater investments in public health measures have reduced death rates, and further improvements are likely.
• The large number of young people entering their childbearing years will result in population growth for decades to come. For example, in sub-Saharan Africa, 43% of the total female population was younger than 15 years in 2005.

Myth: The death toll of the AIDS epidemic makes family planning undesirable and unnecessary.

Fact: Despite the substantial mortality from AIDS, UN projections for all developing regions predict further large population increases. Despite a severe epidemic in sub-Saharan Africa, the region’s population is expected to grow by at least one billion between 2005 and 2050. This is because the annual number of AIDS deaths (two million) is equivalent to just 10 days’ growth in the population of the developing world.

Myth: Family planning programs are not cost-effective.

Fact: The World Bank estimates the cost of family planning at $100 per life-year saved. This is of the same order of magnitude as other health interventions, such as basic sanitation for diarrheal disease, a short course of chemotherapy for tuberculosis, and condom distribution for HIV prevention. All these interventions, including those for family planning, are much more cost-effective than antiretroviral treatment of AIDS, which currently receives a large proportion of health-related development aid.

Myth: Family planning programs at best have made women the instruments of population control policies and, at worst, have been coercive.

Fact: Today, nearly all programs around the world respect the right of couples to make informed reproductive choices, free from undue persuasion or coercion. An important exception is China, however, where the one-child policy continues to violate reproductive rights standards.

Population growth and what to do about it has been the subject of controversy since the 1700s. Perhaps because at its most fundamental level the subject deals with sex, it has been a peculiarly incendiary topic of public policy debate. Yet much of today’s discussion about family planning programs, a principal instrument through which population policies have been implemented over the past 50 years, is based on faulty perceptions and misinformation. Large-scale national family planning programs have, for the most part, been remarkably successful.

Why does this matter? Because women and children continue to suffer and die as a consequence of unwanted and unintended childbearing. Beyond that are renewed concerns about a variety of environmental issues and about the security of nations and the stability of governments, as well as deepening worries about food security and pervasive poverty.

“In the face of declining political and financial commitment to family planning programs, we must address head-on the faulty criticisms that have held back efforts to satisfy the unmet demand for family planning services,” say Bongaarts and Sinding. “High fertility and rapid population growth remain real problems that merit our attention and action.”

Read the entire article online at: http://www.popcouncil.org/pdfs/JournalArticles/IPSRH_35_1.pdf

The journal International Perspectives on Sexual and Reproductive Health can be read online for free at: http://www.guttmacher.org/journals/toc/ipsrh3501toc.html

International Women’s Day: The Status of Women’s Health and Rights

Of the 8 Millennium Development Goals (MDGs), Goal 3 explicitly calls for empowering women and promoting gender equality, specifically setting targets to eliminate gender disparity in all levels of education by 2015, with additional indicators on employment of women and the proportion of women in parliaments. However, gender equality is an essential cross-cutting component for meeting all the targets. According to Kofi Annan, Former Secretary-General of the United Nations, "In our work to reach those objectives, as the Millennium Declaration made clear, gender equality is not only a goal in its own right; it is critical to our ability to reach all the others . . . Study after study has shown that there is no effective development strategy in which women do not play a central role".

Gender gaps in access to and control of resources, in economic opportunities and in power and political voices are widespread. To date, only four countries (Sweden, Denmark, Finland, and Norway) have achieved a combination of approximate gender equality in secondary school enrolment, at least a 30 per cent share for women of seats in parliaments or legislatures, and an approximate 50 per cent share of paid employment in non-agricultural activities for women. In most countries, women continue to have less access to social services and productive resources than men. While the last two decades have seen some progress in many parts of the world in gender inequalities in schooling (as of 2006, the world was on track to meet the primary target of MDG 3: Gender Parity in School). Yet, women remain vastly under-represented in national and local assemblies, on average accounting for only 14 per cent of the seats in national parliaments.

And of particular concern to women’s health and rights is maternal mortality, MDG target 5. Pregnancy should be full of hope and joy--yet for so many women in Africa, pregnancy come with unnecessary danger. As a result, women in sub-Saharan Africa have a 1 in 16 chance of dying from complications of pregnancy or childbirth during their lives; comparatively, the lifetime risk to women in developed countries is 1 in 3,800.

Unfortunately, despite global progress on many of the MDGs illustrated in the Figure: Progress Against Targets to Meet the MDGs, less than 1/10th of the distance to be covered to meet the MDG 5 of reducing maternal mortality has been made. The chart shows how far behind the world is on MDG 5. The MDG target for maternal mortality will unlikely be met globally, and particularly in sub-Saharan Africa, without concerted efforts. The Maputo Plan of Action (PoA) for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights 2007- 2010 states that that “African countries are not likely to achieve the Millennium Development Goals (MDGs) without significant improvements in the sexual and reproductive health of the people of Africa.”

On International Women’s Day, PPD encourages its member and collaborating countries to support implementation of MDG 5 by advocating for improved reproductive health services. Universal access to reproductive health (as called for by the ICPD PoA) is essential to achieve gender equality, combat HIV/AIDS, and reduce maternal and child mortality.

Find out more information (including what you can do) by reading PPD ARO’s policy brief on RH in the MDGs:
In English: http://ppdafrica.org/docs/RH-MDGs.pdf
In French: http://ppdafrica.org/docs/RH-MDGsf.pdf

More information on the MDGs is online at:
UN: http://www.un.org/millenniumgoals/
MDG Indicators: http://mdgs.un.org/

South-South Cooperation in Maternal Health and HIV/AIDS

“The Tunisia – France – Niger: The Kollo Project for safe motherhood and reproductive health project” was presented by Mr. Fethi Ben Messaoud, PCC for Tunisia and Senetaire General, Office National de la Famille et de la Population at the September 2008 PPD Partner Country Coordinators' Meeting for the Africa Region.

South-South Approaches to Innovative Health Solutions
MediaGlobal: Voice of the Global South
By Lucy-Claire Saunders

22 December 2008 [MEDIAGLOBAL]: At the United Nations Development Programme (UNDP) Special Unit for South-South Cooperation’s first ever Global South-South Development (GSSD) Expo, experts presented four successful projects on HIV prevention and maternal health that exemplify South-South cooperation.

Among the four projects, Campaign to End Fistula was recognized as a model for championing collaboration between countries in the Global South, receiving an award of excellence from the United Nations Development Programme.

“Fistula requires our attention because it is a condition that takes away the dignity and the self-esteem of those who are affected by it,” Bunmi Makinwa, the Africa regional director for the campaign said. “It leaves women incontinent, ashamed and isolated from their communities. Fistula is a stark example of our failure in the public health system in poor countries.”

Fistula is a condition where a woman cannot control the flow of her urine and/or feces due to an injury brought about by prolonged labor. The Campaign to End Fistula, which aims to makes the debilitating condition as rare in developing countries as it is in the industrial world by 2015, is active in more than 45 countries in Africa, Asia and the Arab world.

“We are casting the net wider to incorporate more countries,” Makinwa said. “Recent training sessions in Mali highlight country-level efforts to develop the capacity of fistula service providers though South-South cooperation.”

For example, in Liberia’s surgical wards, they use specialized nurses to assist the surgeon during the operation. This is a service that does not exists in Mali so the program had a Liberian specialist train counterparts in Mali so that hospitals can introduce the new technique in the way they do business.

Three other projects exemplifying South-South cooperations in the health sector were also featured at the afternoon session. Dorcus Phiri, coordinator of the Teacher Capacity Building Project, gave an update on a program that uses live television broadcasts to reach out to teachers and students about HIV/AIDS in Botswana. Using a Brazilian model, the daily television program empowers teachers to break down the silence associated with HIV and AIDS by facilitating an open dialogue in a classroom setting.

“The program increased levels of conversation between teachers, pupils and parents on sexual reproductions health,” Phiri told MediaGlobal. “If we empower teachers with the skills, knowledge and the relevant attitudes for addressing HIV, then they would be better placed to deal with HIV issues in the classroom.”

Named, “Live Talk Back,” the program features a different panel every day who talk about HIV/AIDS and other reproductive health issues. Teachers, students and parents across the country are invited to participate in a live discussion using phone-ins, Short Message Services and e-mails.

Speaking about another project across the world that also deals with AIDS, Mariangela Simao, director of the National STD/AIDS Programme in Brazil, described a multi-country program that address HIV prevention throughout Latin America.

“For us in Brazil, the words of the famous archbishop, Dom Helder Camara, summarize how we think of South-South cooperation: ‘No one is so poor that he has nothing to offer. No one is so rich that he never needs help,’” she said.

The program, which is called, “Lacos –Sul-Sul,” works with partnering countries to ensure universal access to prevention treatment, HIV prevention with adolescents and children, generate demand for services and mobilize participation of those who use the service.

The results have been encouraging, said Simao. In two of the more remote regions in Nicaragua, where LSS support has been provided, HIV testing for pregnant women has increased from 20 per cent to 42 per cent and from 5.3 per cent to 24 per cent. On a side note, Simao mentioned that in regions where LSS is not active, this rate has actually dropped form 3.4 per cent to two per cent.

As well as addressing AIDS, the South-South cooperation projects also addressed maternal and child health. Niger, for example, has one of the lowest life expectancies in the world. The infantile mortality rate is 247 for 1,000 live births while the maternal mortality rate is about 700 for 100,000 live births.

Source: MediaGlobal: Voice of the Global South at http://www.mediaglobal.org/article/2008-12-23/south-south-approaches-to-innovative-health-solutions

Linking RH and HIV/AIDS: Good Practices in Kenya

Linking sexual and reproductive health and HIV/AIDS policies and services presents many challenges for those on the front line of health care planning and delivery. A case study in Kenya of Family Health Options Kenya (FHOK) details a number of “lessons learned” in integration including:

• FHOK has demonstrated that providing antiretroviral therapy within sexual and reproductive health settings is plausible, possible and practical.
• Providing services for HIV/AIDS at sexual and reproductive health clinics attracts new clients and creates opportunities for promoting sexual and reproductive health to a wider population.
• In order to achieve their core aims, and to maximize the public health impact, sexual and reproductive health and HIV programmes should take specific steps to meet the needs and concerns of men as well as women in providing services.
• The best way to promote sexual and reproductive health among young people and to raise awareness of HIV is to make information and services available as part of a wider programme that addresses their social needs, and helps empower them to make healthy choices.
• By providing space for community groups to meet, or a base for their activities, clinics can strengthen the links with their client population to their mutual benefit.
  

Find out more about Kenya’s good practices here: http://www.who.int/reproductive-health/hiv/ippf_linkages_kenya.pdf

For more information on linkages between RH and HIV/AIDS policy and programming, a number of tools prepared by IPPF, UNFPA, UNAIDS and WHO offer guidance on how to link sexual and reproductive health with HIV/AIDS.

• Sexual and Reproductive Health and HIV/AIDS: A Framework for Priority Linkages, WHO, UNFPA, UNAIDS & IPPF, 2005.
• Linking Sexual and Reproductive Health and HIV/AIDS. An annotated inventory. WHO, UNFPA, UNAIDS & IPPF, 2005.
• Sexual and Reproductive Health of Women Living with HIV/AIDS, Guidelines on care, treatment and support for women living with HIV/AIDS and their children in resource constrained settings, UNFPA & WHO, 2006.
• Integrating HIV Voluntary Counselling and Testing Services into Reproductive Health Settings, Stepwise guidelines for programme planners, managers and service providers, UNFPA & IPPF, 2004.
  
• Meeting the Sexual and Reproductive Health Needs of People Living with HIV. Guttmacher Institute, UNAIDS, UNFPA, WHO, Engender Health, IPPF, ICW & GNP+, In Brief, 2006 Series, No. 6.
  
• Reproductive Choices and Family Planning for People Living with HIV – Counselling Tool, WHO, 2006.
  
• Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages: A Generic Guide, ICW, GNP+, IPPF, UNAIDS, UNFPA, WHO, Young Positives, 2008.