Public Policy and Fiscal commitment key to achieving HIV-free generation

HIV-FREE GENERATION

 

The debate about a prospective HIV-free generation given the advent of WHO Option B+ attracts attention on the surface. A further probing of the whole idea, however, may reveal a distant utopia. To have HIV-free generation, our communities must come to a convergence on reducing new infections.

There is need for deliberate public health policy and unwavering fiscal commitment to this end. Unfortunately, our national spending priorities deprive the masses of critical social services needed to attain acceptable levels of health.

HIV/AIDS is a disease left to wreck havoc among the destitute of the world. The wealthy and educated are surviving the scourge longer. Their children are able to avoid contracting the disease when compared to the children from impoverished communities. This explains why the global burden of HIV/AIDS is most prevalent in underdeveloped countries like Uganda.

To think about a prospect of HIV-free generation, we have to see the big picture of the structure of governance, the quality of public policies and the distribution of critical resources necessary to secure prerequisites of health.  These forbearing conditions also do shape how society places value on containing the HIV virus spread and caring for those living with the virus. The recently passed HIV and AIDS Prevention Bill (2008) is an example of required policy instruments, which must be accompanied with equal funding commitment

The Ugandan government has demonstrated inability to meet most of the MDG goals including reduction of HIV infections. Scientists now agree that at its current pace, Uganda may achieve some of the MDGs in critical areas such as reduction of new HIV infection, eliminating mother to child transmission of HIV, providing services to reduce child-maternal mortality by 2035.

Uganda is a signatory to the 2001 Abuja Declaration, which committed governments to allocate at least 15% of its annual budget on health services. Uganda has achieved barely 8% since 2007 while only Tanzania has achieved this objective. The ratio of healthcare workers to patients remains staggering and yet the WHO Option B+ remains the most promising opportunity to the achievement of this goal.

It is impossible to effectively implement this HIV treatment regiment when government's per capita heath expenditure is far below minimum international threshold. An audit report in 2013 found that Uganda was spending only UShs 2, 500 (US $1) a month on healthcare, which means it's annual per capita health expenditure is about US$12. This is ridiculously below the 2001 Commission of Macroecomics and Health recommendation of US $ 34 per capita.

The HIV treatment has three parts to it: the biomedical aspect, which includes treatment; the psychosocial aspect, which entails the social needs of persons living positively with HIV; and health promotion, which entails preventive strategies. Each of these aspects is complimentary to each other and yet requires specialized skills, commitments, resources, and funding.

The HIV-free generation, health promotion in the context of maternal child health and HIV infection prevention are crucial. This is where our healthcare system is failing. The 380 people who contract HIV on the daily basis in Uganda are among some of the poorest and yet they endure insurmountable challenges in accessing health information and in economic production chains.

Opportunities for health promotion would mobilize distinctive and progressive cultural resources to enhance the quality, relevance, and efficacy of health promotion and the management of health to prevent new infections. Without bringing in relevant cultural resources, communities will shun important services such as family planning. Social and societal discrimination remains amplified and more so where resources are scarce.

Lastly and most importantly, is the understanding that to create HIV-free generation, we have to realize a reduction in new HIV infections. The WHO Option B+ is effective; however, certain cultural practices and beliefs are still retrogressive, oppressive, and predatory. These undermine opportunities for girls and women making them vulnerable to HIV infection. These conditions will continue to block progress towards achieving HIV-free generation.

 

END

Death at Birth is still a reality in Uganda

Maternal Child Death

Death at birth in Uganda is still a daily reality. In fact being pregnant, seeking qualified healthcare services, including Emergency Obstetrics Care (EMOC) are pathways to death.  The UNFPA reported that only 13% of Ugandans actually live in urban areas, implying that Uganda as a whole is majorly rural. And yet, majority of the functional healthcare facilities to support maternal-child health including safe pregnancy and delivery are concentrated in urban areas.

As a consequence of this disparity, only 42% of pregnant women were delivering in health facilities. The figure has improved recently, showing that 57% of women are being delivered by skilled labor in healthcare facilities (according to 2012 data). Uganda’s maternal mortality ratio is 310 per 1000 of live births; 5000 mothers still die at birth annually (from a 2010 source) which has also improved. UNICEF has recently upgraded data which shows some improvements in maternity services consumption. For instance, 93.3% of pregnant women are now attending to at least 1 antenatal visits; 47.6% are attending at least 3 antenatal visits. The WHO recommends at least 4 antenatal visits.

The maternal child health in Uganda could improve if the needed services are taken to rural communities where majority of the women live. This effort requires a political will to commit to the Abuja declaration that government should commit at least 15% of its national budget to health. Currently, Uganda has not fulfilled that commitment as health budget remains staggeringly low while health services expenditures are increasing (Mbonye and colleagues, 2012).

There is also need to increase the density for Midwives, Nurses and Doctors from the current 1.4/1,000 to at least 23 as recommended by WHO, for Uganda to be able to meet its Millennium Development Goals. At the current rate, Uganda will only be able to meet those goals by 2035 or even later.

In my home district of Pader, there has been one doctor for the population of 231,700. Dr Ochaya recently passed on, which means Pader has no Medical Doctor! Given its relatively new status, Pader District is disadvantaged in that it does not have a robust Missionary hospital like its neighboring districts of Kitgum and Agago.

 In Uganda, 42% of functional hospital facilities are in the private hard-to-reach for the poor, the Missionary hospitals and NGO operated health facilities. Most of the government facilities are on steady decline; understaffed with some unqualified personnel attending to medical emergencies.

There are many untapped opportunities in the Ugandan healthcare system. The Village Health Teams offer untapped potential for reach to households in rural communities. This team should comprise of Comprehensive Health Nurses with facilitation to provide instant services in rural hard to reach localities. Instead of employing one Doctor in a rural district like Pader, we should transform the health care system into Public Health Units such that the Doctor becomes the director of various health services with emphasis on preventive healthcare services.

The way sub-Sahara Africa is portrayed in literature is as if it is entirely a place of doom where the males wish their wives and children death. This is arbitrary to the fact on the ground. Every African man strives to have a healthy family and suffers grief when a child or wife dies. Therefore, it is incumbent for us to articulate accurately, those social determinants of health which affect the health of these people in rural communities and work on them collaboratively. We need to pay attention to poverty, rural livelihood and opportunities for earning income, the use of income, investment in communities through functional education to enhance health literacy, transportation, clean and safe water, sanitation, nutrition and security etc.

END

Human trafficking discourse is complex

HUMAN TRAFFICKING

I appreciated reading the DM editorial of July 15, 2014 on this subject and the clarification made by  Jacob Siminyu from the Directorate of Citizenship and immigration Control about concrete actions being taken to curb human trafficking at national level.

Understandably, the discourse of human trafficking is a very complex one and it cannot be effectively resolved at the policy level only although such interventions are imperative.  The global human trafficking and trade in humans for labor or any other purposes formed the basis of one of my Global Health studies. Indeed, the common pre-exposing risk for humans to be harvested for trafficking from any society starts with the social conditions in which they subsist. 

To fully understand the complexity of this problem, one needs to undertake a socio-ecological framework approach to systematically unpack the pervasive nature of this lucrative vice. The socio-ecological framework would allow a critical analysis that focuses on individual level challenges, interpersonal (such as relationships, cultures etc), community level loopholes, societal factors and public policies that make human trafficking possible. Another level of critical analysis would be the supranation level where national, regional and international instruments, policies and efforts can converge to curb human trafficking.

However, it is essential to emphasize that poverty, lack of skills and broken social safety nets – simply put; the social determinants of health are also the determinants of vulnerability to being trafficked. In Uganda today, voluntary trafficking is taking place because of nationwide despair among the elites.

The rate of unemployment among youths and the semi-elite Ugandans inevitably makes them very susceptible to being trafficked.  In 2013 62% of the Ugandan youths were reported unemployed and yet 78% of Uganda’s population is under the age of 30 years. Almost half the Ugandan population is below the age of 24 years. The prospect of experiencing unemployment makes the youths to develop interests for future prospects outside the country. The process of fulfilling such ambitions also makes them a very vulnerable group.

A study by Amy Hagopia and colleagues in Uganda which was published in 2014 in Health Affairs Journal revealed that 1 in every 4 Ugandan health professionals aspired to leave Uganda for any destination where they could improve on their professional outlook. But a much more important study conducted among Ugandan Nursing students was published in 2008 by Lisa Nguyen et al. revealed that 70% of nursing students expressed desires to work abroad after graduation and another 24% revealed ambitions to work elsewhere in Africa upon graduation. In all these studies, participants cited poor pay, poor working conditions and not being valued fully for their services.

A group like these, comprising of the country’s most qualified workforce are the primary victims of human trafficking because they are driven away by chronic failures at home. Most of them are not aware that their credentials are not valued in Europe or North America until they get trapped there. Majority of them voluntarily register with agencies to be ferried abroad for menial jobs which subsequently transforms into forced labor and being held in servitude.

While Mr. Siminyu was upbeat in his enumeration of the high level interventions being developed, there are many gaps beneath policy instruments. There is need for a systematic and collaborative interventions designed with various state and none state actors at all levels to stabilize society.

On top of the agenda should be the redistribution of resources, snubbing corruption, creating conducive work conditions, setting minimum wage, affirmative action for young women to build a pathway to employment, providing vocational training to youths and ensuring that diverse opportunity ventures are opened for youths practice innovation.

Lastly, public policies targeting human trafficking should be formulated with the focus on removing inequalities and inequities at all levels of society. Key among these are building individual skills and community capacity, establishing an inter-agency coordination efforts to curb human trafficking.

END

US-AFRICA Summit 2014: An empty rhetoric

US-AFRICA SUMMIT, 2014

Listening to Obama make a fool of Africa and its leaders was the most scintillating highlight of the US-African summit being hosted in Washington DC. Obama opined, and I quote “We don’t look to Africa simply for its natural resources. We recognize Africa for its greatest resource which is its people and its talents and its potential”. While many Africans clapped their hands in approval, some few clever ones knew that this is an empty rhetorical that dominate global economic policies towards Africa. Available historical accounts of US-Africa relation shows the contrary as this article shall elucidate.

To contextualize the US-African summit 2014, one needs to understand that this conference is a direct counter to the increasing economic influence of China in Africa. The US and its allies are genuinely frightened of the rate at which China is making concrete investment and control over Africa’s crude oil and mineral resources.

By 2009, China was already Africa’s main trading partner, surpassing USA. In 2012, China’s trade volume with Africa hit US$ 198.5 billion mark while US’ was only $99.8 billion. That is twice as much trading already and yet China’s trade with Africa is only 5% of its total globe trade. It is estimated that more than 80% of China’s $98.3 billion of import from Africa in 2011 were in minerals, raw resources and crude oil.

China’s trade with Africa has been soaring in the last decade or so, while USA has been meddling in Africa for centuries. Why then is Obama misinforming the world about US interests and presence in Africa as if US is a new entrant in exploiting the continent?

For many centuries, the developed West sustained very unfavourable trade relations with Africa best described as bullied exploitation and economic repression. For the most, the current predicament of Africa and its lagged economic progress is mainly attributable to these centuries of exploitative bullying from the US, UK, France and most of their colonial apparatuses that continue to meddle in Africa’s internal affairs.

Therefore, Obama’s claim that the US looks beyond oil and mineral resources should be treated with the contempt it deserves. The basis of any positive economic relationship with Africa has been hinged on crude oil and raw materials. The US has footprints in each and every country in Africa, stable or unstable. They are there primarily and precisely for economic benefit, not to develop human resources or African infrastructure. Otherwise, Africa would not have been as poor and deficient in all internal aspects to compete favourably in the international markets.

Obama offers US$ 33 Billion in new trade partnerships to ensure that US goods and services gain access to African markets. This is another baloney. One only needs to read John Perkins’ 2004 book: “Confession of economic hitman”, Jeffrey Sach’s  2005 “End of Poverty: economic possibilities for our times” and Health Poverty Action’s 2014 report, “Honest Account? The true story of African billion dollars losses”, to unpack the worthlessness of this Obama’s US-Africa trade package.

Mr. Perkins is unequivocal in his narration of how the US has always used underhand methods such as assassinations, cultivating civil unrest leading to regime change, paying bribe to influential leaders and where possible, supplying arms and protection of crooked leaders to manipulate co-operations of all kinds from any country in the world. 

Perkins provides numerous examples around the world where the US is still involved or where it left tragic footprints in pursuit of its interests. According to Sachs, the true value of American foreign aid that reached the person in Africa in 2002 was only 6 cents after all deductions. 

Both Perkins and Sachs show that most of the money that the US offers to Africa, either as aid for cooperation or grants go directly to US agencies, paying off “expatriates”, deduction for debts owed and financing infrastructure that serves American interests in those countries.

The Health Poverty Action report shows that for every US$ 30 billion in foreign Aid that Africa receives annually, it losses US$192 billions. The money is lost through loan and debt repaying of $46.5 billion. Other losses include $35.3 Billion in tax evasion and other illicit financial flows facilitated through tax havens; $17 billion in illegal logging; $3 billion in remittances; $46.3 billion repatriation of profits made by multinational companies; $1.3 billion in illegal fishing and Africa incurs a loss of $36.6 billion as a result of climate change and $6 billion as a result of brain drain.

We conclude that this summit could be fruitful if Obama announced at least 85% of US debt relieve to Africa; expanded US market access beyond existing mechanisms such as AGOA, Power Africa Initiatives, a declaration to respect African autonomy over its resources and removal of Agricultural subsidies and protective mechanism to inhibit Agro-based imports to the US markets.

END

Evidence now shows it is Africa donating Aid to rich countries

AID DEBATE

Proponents of aid to Africa will have difficulties convincing the world that Africa really need empathy and financial bailout from rich countries. It has emerged that Africa is indeed the continent that is sustaining and aiding the world with its vast resources and potentials. 

A report by Health Poverty Action released recently shows that Africa is receiving US$134 billion in aid every year and it pays out US$192 billions in return to the wealthy nations. This means every year, Africa donates US$58billions to the West. This is a compelling case which illustrates clearly that donor aid is not meant to develop Africa, but to create favorable environment for mockery and subsequent exploitation.

The situation is made worse by African leaders who are positioned as appendages of these Western government’s mechanisms of securing their national interests. The aid arrangement ensures that African interest is subordinate to the realization of ending poverty and the likes of Prof Jeffrey Sachs should not mislead the world that they have magic formula for ending poverty anywhere using foreign aid. 

Even then, the prevailing aid debate is devoid of a critical assessment of the dynamics of supremacy of foreign control using aid in the realization of foreign interests.

It’s a wonder that Uganda with the highest concentration of NGO per capita in Africa would be presented as a success story by the World Bank and donor community. If the Ugandan economy is indeed growing at 5% per annum, how come Ugandans are not realizing the benefits in critical social services like health care?

Foreign aid is a ploy of hoodwinking the populace so as to soften the ground for resource exploitation. Take for instance that all contracts Uganda signs with direct foreign investors are so shrouded in secrecy and yet Donors are not conditioning aid to foster transparency in natural resource exploitation. 

And, this is surprising given the fact that the British government critically condemned the Chinese- DRC US$6 billion resource – for – infrastructure swap, arguing that it was a bad deal, shrouded in secrecy and in bad faith - claiming that the people of Congo were at the short end of the stick.

To a discerning audience it is clear that the Congolese – Chinese resource deal which truly was similar to the Ugandan - Tullow Heritage oil deal in their lack of transparency was criticized by the British Government because the exploiting parties were not Western based companies.

The report by Health Poverty Action, “Honest Accounts? The true story of Africa’s billion dollar loss - 2014” is a must read.  According to Health Poverty Action, there is unconscionable capital drain to the West from Africa in excess of US $58 billion per year which could service Africa’s foreign debts and bilateral loans sufficiently.  After all, the US aid amounts to only 6 cents per African per year according to Jeffrey Sachs (2005, p.310). 

It is surprising that the so-called economists who claim to be so concerned about Africa are not arguing strongly for plugging these drains.

We may appear too hard on proponents of aid to Africa. But coming from countries benefiting from the capital drain from Africa, they may be fighting not only for their own preservation but for the economic interest of their countries. It is in the realization of Western economic interests that aid is used as bait for compliance of Africans to surrender its resources. 

Certainly, if aid was to develop welfare services for poor communities it is difficult to argue for withdrawing it for political convenience. Why would the aid be withdrawn only when anti-homosexuality bill was passed in Uganda but not the draconian Public Order Management Bill which stifles democratic governance?

A simple conclusion is that the discourse of aid is both racialized and politicized. It is in the political realm that we find strong representation of western scholars blaming all the ills that are associated with Western puppets in Africa on Africans. For instance, President Museveni, with all the numerous reports of gross human rights abuses by reputable agencies such as Human Rights Watch, Amnesty International, the International Red Cross etc, is rewarded with praises and more military aid.

Foreign aid, good as it sounds, has the soft under belly of foreign control and western interests which its proponents tactfully conceal. If the West really itches to give aid to Africa, let them start off by total debt relief for Africa which remains a thorn in the developmental flesh.

END

President Museveni killed the spirit of debate in Parliament

PARLIAMENTARY DEBATES

The revelation by Deputy Speaker that MPs are not doing research and therefore not illustrating depth in their debate is not farfetched. In fact I was shocked that this observation even made its way into headline news in the very first place. Anyone who spares time to read the Hansaard would agree that the quality of debate in Parliament has deteriorated too much. Strangely there are some MPs who felt insulted by this glaring truth. In Uganda, truth has no place in society. To attract enmity and hatred at home and abroad, one just has to tell the truth or a semblance of it.

The genesis of the current problem of lack of depth characteristic of this Parliament goes back a couple of years ago. The danger of this problem is amplified by the surging numbers of NRM Parliamentarians in that House. This problem began with the President’s three step instruction that NRM MPs should enter into the house to sleep, wake up and vote. By these orders, President Museveni single handedly killed the spirit of debate in Parliament.

The President’s instructions simplified the job of MPs and rendered Parliament a lame duck branch of government. Anyone now aspires to become an MP, a position with very attractive remuneration, where the earner just sleeps and wakes up to vote. By far, this is the ideological purview of Parliamentary democracy in Uganda which has attracted peasants and scoundrels into it.

The NRM MPs who are the majority in Parliament live in a herded community like the cows at Kisozi Ranch. The tradition of NRM caucus in Parliament is to enforce abeyance to NRM lines as prescribed by its leader – President Museveni. The Chief Whip always is good at issuing directives and threats for MPs with independent minds to gag independent thinking. The plight of the so-called rebel MPs has illustrated clearly that being independent minded in a herded community can lead to a torturous experience.

The herding of members of Parliament deprives that institution of independence, discourages innovation and exploration of current research evidence to inform debates. In the end, the MPs represent the President and his vested interests which are mutually exclusive to those of the struggling electorates. Being an MP is not rocket science and does not require reasoning, research, reading or critical thinking because the formula is already set into three steps – slumber during debate, wake-up when debate is over and vote. Period!

The cumulative effect is that most of the legislative pieces made under the current Parliament are not pro-Ugandans, they are intended to entrench the life Presidency, albeit, at a very high cost. In addition, the use of bribes to sway voting patterns on contentious issues makes the Parliament stink from lack of credibility even to perform its basic oversights function. They bribed Parliament to remove term limits, offer medical treatment favors, loan baits, scholarships etc to soften hardliners and well informed legislators. The legislative arm of government is the most vulnerable in the mighty hands of the Executive.

The current environment in Parliament and the nature of elected representatives that occupy it makes it very hard for informed debate because no one is there to hold them accountable. I have agreed with analyses made by Andrew Mwenda and Timothy Kalyegira on the subject of shallowness and pettiness among the elite class. In explaining the inability of our elite community to produce and reproduce genuinely independent minded progressives, Mwenda diagnosed prevailing “mediocrity” and Kalyegira believes that “generational inferiority complex” is responsible.

In Uganda generally, reading is a disease which is treated more harshly than HIV and majority of the MPs do not know the content of most of their laws that are passed. As the Americans say, if you want to keep your money safe from a black person, keep it inside the book.

END

Museveni created Gays, can eat their Votes too

ANTI - HOMOSEXUALITY

Had it not been for Rt Hon. Amama Mbabazi to threaten the President’s candidature for 2016, the signing into law of the anti-homosexuality Bill had given the president the stead one needed for a landslide. There was a unanimous consensus among Ugandans against homosexuality. Amama Mbabazi forced Kyankwanzi Resolution which diverted attention temporarily from homosexuals.

It is strange how the whole homophobia thing works so well in favor of President Museveni who created the environment for it to fester. The President pounced on homosexuals after realizing that the Speaker of Parliament, Hon Rebecca Kadaga was becoming too popular with her stand against the same.

The truth be said, the emergence of homosexuals in Ugandan society is not a new thing. Like we say, laws and policies emerge to deal with social deviations from mainstreams. There was already provision against homosexuality in colonial era Penal Code Act section 145, which post independence Uganda inherited. This implied that homosexuality existed, and especially in Buganda (Faupel, 1984.,p.9). According to Adrian Jjuko (2014) homosexuality was also acknowledged among the Iteso (Lawrance, 1957), the Bahima (Mushanga, 1973), the Banyoro (Needham 1973) and the Langi (Driberg 1923) but were suppressed.

The sporadic emergence of homosexuals in Uganda in the last decade is attributable to NRM’s liberal economic policies. The emphasis on foreign investment has given rise to tolerance for foreign cultures and practices. Some of these liberal cultures have permeated the social fabrics of our communities, thereby displacing indigenous traditions and cultures especially around public display of sex and sexuality.

The economy of Uganda now lies in the hands of foreigners; Indians, Europeans, Americans, Chinese and so forth. They own malls, hotels, salons, spas and all sorts of recreational activities. Instead of Uganda becoming an industrialized economy, it has become a feminized services provider industry. Most of the merchandise in Uganda are imported, albeit low quality goods from China, UK, USA and South Africa. These goods influence the mind and mediate western cultures’ dominance over ours.

The liberal media fraternity has witnessed a surge of explicit Tabloids, soap opera, reality shows, pornography and misogyny which have profound bearing on our sex cultures. The real problem with Ugandans is that they always like to copy western cultures; the way they talk, walk, wear, drive and have sex are all primed against western practices.

When it comes to sex and sexuality, now Ugandans sing Jamaican songs and want to dance near-naked like Jamaicans. While Caribbean cultures are explicit in their nudity and sexual expressions, most of them use drugs to achieve those when inebriated. Also, most of them expose their bodies to earn a living; in music videos, movies, brothels and so forth. So when Ugandan youths attempt to mimic some of these cultures, they simply alter our cultures in ways that make them appear paid to be gay!

What then emerges as a surge in homosexuality is all about tolerance and acceptance for it which enables some of these youths to discover their innate sexual orientations. Contrary to people who argue that homosexuality is socialized or superficial mannerism, I find that hard to believe. I have not found anyone who is willing to become gay even for money. But here is a bigger challenge; while we condemn homosexuals, we should examine the pattern of sex in Uganda today.

There are men who use their tongue to pleasure the women and likewise, women who perform blow jobs in the process of having sex. These practices are normalized and its status uplifted as the new normal thing. Everyone almost approves of this; Ministers, MPs, MPigs, musicians, pastors and just any man or woman you interact with on the daily basis, eats the human sexual organ - the very organs which produces them. Section 2(1)(a) of the anti-homosexual Act qualifies most of these Ugandans who eat sexual organs as homosexuals.

END