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Archive for March 7th, 2013

Looming food crisis in the Central African Republic

Posted by African Press International on March 7, 2013

Insecurity has displaced thousands affecting cultivation

BANGUI,  – Humanitarian agencies are warning of a looming food crisis in parts of the Central African Republic (CAR), a result of the insecurity that has displaced thousands of people and disrupted cultivation and trade.

Clashes between government and rebel forces in December and early January left some parts of CAR – and an estimated 800,000 people – under the control of the rebel Séléka coalition.

“Between July and September, there will be serious food shortages in the most affected areas. So the first priority is to restart programmes that have been disrupted in these areas,” Jean Martin Bauer, an analyst with the UN World Food Programme (WFP), said.

Food prices are increasing, according to the findings of a recent assessment by WFP and its partners.

“Since December 2012, trade has been interrupted between the area held by the Séléka coalition and the rest of the country, bringing transactions to a halt and leading to sharp price increases. The cost of a food basket has increased by 40 percent in the area under the control of the Central African armed forces. Some of the zones under the control of the Séléka are experiencing food deficits due to price increases,” stated a 15 February statement by WFP.

Humanitarian officials expressed concern over the upcoming cropping season. “We are very concerned about prospect for the 2013 growing season, which is due to start in just a few weeks. Land preparation, which should have begun, is behind schedule in many places due to insecurity,” said Rockaya Fall, the UN Food and Agriculture Organization (FAO) representative in CAR.

The disruption of trade has caused income sources to decline, adds the statement: “The marketing season of the annual cotton crop, a lifeline for the northern part of the country, has yet to start in the Séléka zone, depriving farmers [of] their main income source.”

An estimated 80,538 people in the Séléka zone are at risk of food insecurity in the May-September lean season.

The situation in CAR remains unpredictable despite an 11 January ceasefire, added a report released by the UN Office for the Coordination of Humanitarian Affairs (OCHA) on 18 February, which noted that a lack of humanitarian access due to insecurity, especially in the east, and poor roads are hindering the provision of assistance.


Aid officials are calling for access to Séléka-held areas.

“The main problem is to open a humanitarian corridor in the Séléka-held areas. Once free to move, we will be able to bring the affected population together so as to provide the necessary assistance,” said Kaarina Immonen, the UN deputy special representative for CAR.

Other main humanitarian needs include healthcare and education.

“We must go to those who are suffering. But first we would like to know and to understand the health situation on the ground before we respond to the needs of the population in the areas of conflict,” said Honorat Ouilibona-Cockciss, the chief of staff in the ministry of health.

The number of patients seeking medical care is on the rise. In the area of Damara, 75km from the capital Bangui, for example, health centres are recording up to 200 consultations each day despite inadequate staff.

Almost all of the schools in the Séléka-held areas have been closed, with at least 166,000 children out of school, according to OCHA. Some teachers have also fled, according to Henry Sylvain Yakara, a national humanitarian affairs officer with OCHA.

The Séléka-rebels also destroyed some school facilities and were using some schools buildings as their bases, added Yakara.

Attacks continuing

Despite the 11 January peace accord, and the later formation of a government of national unity integrating the Séléka rebels, attacks are continuing.

In early February, for example, 2,300 people fled the southeastern CAR region of Mobaye for the neighbouring Democratic Republic of Congo (DRC) area of Mobayi-Mbongo after a Séléka attack. Some 4,500 people had previously fled to DRC in the past weeks, with hundreds of others seeking refuge in Chad.

The Séléka rebels comprise militias from the Union des forces démocratiques pour le rassemblement (UFDR), the Convention Patriotique pour le Salut Wa Kodro (CSPK) and Convention des patriotes pour la justice et la paix (CPJP), who were seeking to overthrow the CAR government.

cd-k/aw/rz source


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Weak health systems

Posted by African Press International on March 7, 2013

Weak health systems

JOHANNESBURG,  – The HIV/AIDS epidemic arrived in sub-Saharan Africa after decades of neglect had left healthcare systems dangerously weak, barely able to cope with the onslaught of patients. Then the money started pouring in – funding for HIV programmes rose from 5.5 percent of health aid in 1998 to nearly half of it almost 10 years later.

But the jury is still out on whether the large sums of AIDS funding have made healthcare systems more resilient, whether ” the capacity gains conferred over the past decade will be durable as donors pull out [and whether] previous, pre-aid boom fragilities in service delivery and volatility in public spending would be reduced in the post-donor period,” noted Amanda Glassman, director of global health policy and research at the Washington-based Center for Global Development.

Some have argued that the AIDS epidemic has helped generate an overall increase in health funding and mobilized an international push for more equitable healthcare access. But others maintain that the billions of donor dollars spent fighting HIV/AIDS in the last decade have done little to strengthen fragile national health systems.

In the initial, emergency phase of the epidemic, donors bypassed weak areas of national health systems to set up structures that would yield faster results. On the ground, this meant modern HIV/AIDS clinics, fully staffed and equipped, offering free services in one corner of a public hospital, while the rest of the hospital limped along with inadequate infrastructure, high user fees and staff shortages.

“It was appropriate and inevitable at the time. We had to react the way we did. Now, we need to be responsive to the current situation and what we learned,” said Alan Whiteside, executive director of the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal.

Lessons learned

It is difficult to assess whether donor funding has increased resilience, but gains in health status and HIV/AIDS service coverage – such as the number of eligible people receiving antiretrovirals (ARV) and the number of pregnant women receiving services to prevent mother-to-child transmission of the virus – suggest that health-system capacity has been strengthened, Glassman told IRIN.

Even with its health sector crippled by tuberculosis (TB) and HIV epidemics, South Africa’s antiretroviral programme is now the biggest in the world – over 1.7 million HIV-positive people are treated by the government. And in this year’s budget speech, Finance Minister Pravin Gordhan announced plans to put an additional 500,000 people on treatment each year.

“The [treatment programme] has added staff and resources to the base of the health system, brought in a whole lot of technical assistance from the outside, and, in an intangible way, it has raised hope amongst [healthcare] providers,” said Helen Schneider of the School of the Public Health at the University of the Western Cape.

“The [treatment programme] has added staff and resources to the base of the health system … and, in an intangible way, it has raised hope amongst [healthcare] providers”

HIV treatment programmes have created new regiments of healthcare workers, including lay counsellors and patients with good ARV adherence who assist with adherence counselling through clinics and community outreach. The community outreach approach has been extended to home-based care for patients with extensively drug-resistant TB. In addition, to deal with the scarcity of doctors, nurses have been certified to initiate HIV treatment and to expand access to HIV treatment.

Community health has been positively affected. A recent study conducted in South Africa’s KwaZulu-Natal Province – one of the regions hardest hit by the HIV epidemic – found that increased access to ARV therapy has raised adult life expectancy by more than 11 years since 2004. The observed increase in life expectancy was one of the most rapid in the history of public health, noted the authors of the study, released in the February edition of the journal Science.

But major challenges remain – particularly for countries that are over-reliant on international funding and that still don’t spend enough of their domestic budgets on health.

The real test

As AIDS becomes a chronic and manageable condition, donors are turning their attention to strengthening health systems. The Global Fund to Fight AIDS, TB and Malaria has acknowledged that weak health systems have limited the performance potential of its projects. The US President’s Emergency Plan for AIDS Relief (PEPFAR) is looking at a “deeper integration of HIV services into existing national programs and systems”.

And the real test to measure the resilience of health systems is yet to come. “We won’t really know if that strengthening can be sustained until donors phase out,” Glassman told IRIN.

Savvy recipient countries that have used donor funds earmarked for specific diseases to build their health systems will fare better. Rwanda, for example, used its Global Fund and PEPFAR monies to fund insurance coverage for the poor, including benefits related to HIV, TB and malaria.

“Governments that allowed all the donor spending off-budget on AIDS will have a major problem building resilience, and the transition arrangements [for when donors pull out] in those settings are still vague,” Glassman warned.

kn/rz source

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