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Posts Tagged ‘World Health Organization’

Sudan: The killing of two Ministry of Health staff in West Darfur

Posted by African Press International on November 30, 2013

Statement attributable to the United Nations Resident and Humanitarian Coordinator in Sudan, Mr. Ali Al-Za’tari, on the killing of two Ministry of Health staff in West Darfur

KHARTOUM, Sudan, November 29, 2013/African Press Organization (APO)/ The United Nations Resident and Humanitarian Coordinator in Sudan, Ali Al-Za’tari, strongly condemns the killing of two Sudanese Ministry of Health staff, a vaccinator and a driver, who were part of a team vaccinating vulnerable children against measles in West Darfur.

“My deepest condolences go to the family and friends of those killed,” said Mr Al-Za’tari. “I call on all parties to ensure the protection of all personnel working to deliver assistance to populations in need throughout Sudan,” he said.

UNICEF and the World Health Organization are helping to ensure that every child in Sudan is getting vaccinated, whoever they are and wherever they live.





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Norway contributes US$ 10 million to support climate services

Posted by African Press International on November 21, 2013

GENEVA, Switzerland, November 21, 2013/African Press Organization (APO)/– The World Meteorological Organization has partnered with leading research, UN agencies and humanitarian organizations to launch the Climate Services Adaptation Programme in Africa in an effort to increase the climate change resilience of some of the world’s most vulnerable countries.

The programme, funded by a grant of US$ 9 750 000 (NOK 60 000 000) from the Government of Norway, is the first multi-agency initiative to be implemented under the Global Framework for Climate Services (GFCS). It represents a unique approach that includes natural and social scientists as well as large development and humanitarian agencies working on the ground in a bid to ensure that climate services are tailored to the practical needs of the user community.

The challenges are huge. An estimated 70 nations, including many of the Least Developed Countries, have inadequate or no climate services and are ill-equipped to meet the challenges of both natural variations in the climate and human-induced climate change.

WMO Secretary-General Michel Jarraud and State Secretary Hans Brattskar of the Norwegian Ministry of Foreign Affairs signed the agreement today during the annual climate change conference taking place in Warsaw.

“The Climate Services Adaptation Programme in Africa is a model of how a wide range of partners can unite to ensure that the benefits of scientific advances reach those who are most at risk from weather and climate-linked hazards,” said World Meteorological Organization Secretary-General Michel Jarraud. “The funding from Norway will allow us to roll out climate services to help African countries adapt to our changing climate and to increase resilience to droughts and floods and other extremes.”

“Africa is the continent most vulnerable to a wide range of impacts of climate change. Africa is already facing a decrease in food production, floods and inundation of coastal zones and deltas, as well as the spread of waterborne diseases and malaria. Often it is the most vulnerable people that suffer the most, and there is an urgent need for effective and coordinated action. Norway firmly believes that with this multi-agency climate services program, we can deliver climate services to those vulnerable people and also contribute to strengthening the global framework as the knowledge and action hub of climate services,” said Norwegian Minister of Foreign Affairs Mr Børge Brende.

The provision of more and better climate services will allow farmers to fine-tune their planting and marketing strategies based on seasonal climate forecasts; empower disaster risk managers to prepare more effectively for droughts and heavy precipitation; assist public health services to target vaccine and other prevention campaigns to limit climate-related disease outbreaks such as malaria and meningitis; and help improve the management of water resources. These activities all contribute to appropriate adaptation planning to a changing climate.

The main countries to benefit initially will be Malawi and the United Republic of Tanzania. The programme will build on existing climate services in food security, nutrition and health, and disaster risk reduction at national, local and regional level. It is intended that the Climate Services Adaptation Programme will become operational in other African countries in the future and will serve as a model for other parts of the world.

“The Norwegian support for the GFCS project in Malawi will enable consideration of how to better meet user needs in Malawi, and provide opportunity to make progress,” said Mr. Jolamu L Nkhokwe, Director of Climate Change and Meteorological Services in Malawi. “While a great emphasis in Malawi has been placed on the ability to forecast large-scale rainfall patterns, it is a known factor that users often request tailored packages that integrate a variety of information, including more detailed features of the expected rainfall, other climate variables, and information about the consequences of the expected climate. Within this project, a number of simple methods of statistical downscaling of the large scale climate product will be turned into the type of rainfall information requested by many users in Malawi.”

Dr Agnes Kijazi, Director General of the Tanzania Meteorological Agency, said “The Programme will be a significant opportunity for enhancing availability of wide range of data and assuring better access to all available data and information. Furthermore, the programme will empower the meteorological agency to better serve our key customers, in particular the agriculture sector and the authorities responsible for disaster management in the country. This in turn will contribute to improved food security and disaster management for the country.”

The Climate Services Adaptation Programme in Africa is implemented by seven partner organizations: WMO; the CGIAR Research Programme on Climate Change, Agriculture and Food Security (CCAFS); the Centre for International Climate and Environmental Research – Oslo (CICERO); the Chr. Michelsen Institute (CMI); the International Federation of Red Cross and Red Crescent Societies (IFRC); the World Food Programme (WFP); and the World Health Organization (WHO).

There is growing momentum towards the provision of climate services in both developed and developing countries alike within the context of the Global Framework for Climate Services. This is a country-driven initiative to provide accurate and accessible climate services to users such as disaster management authorities, water and energy utilities, public health agencies, the transport sector, and farmers, as well as the community at large.

This new programme is building on achievements made under another Norwegian supported programme. The GFCS Adaptation and Disaster Risk Reduction in Africa programme started in 2011 with the aim of contributing to the amelioration of weather and climate related disasters and to climate change adaptation in Africa through operationalizing the Global Framework for Climate Services. Tangible impacts obtained so far with Norwegian support include the holding of roving seminars for farmers in 17 different African countries, during which the farmers have received information about weather and climate, future climate change and the implications in their region, climatic risk in production of different crops in their region and better risk management.

The World Meteorological Organization is the United Nations System’s authoritative voice on Weather, Climate and Water



World Meteorological Organization (WMO)


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Norway: Government to step up global health efforts

Posted by African Press International on October 19, 2013

The GAVI Alliance (the Global Alliance for Vaccines and Immunization) and the Global Fund to Fight AIDS, Tuberculosis and Malaria will together receive an additional NOK 330 million in the national budget for 2014. The Government wishes to intensify its efforts to promote child and maternal health globally, to fight deadly diseases and to help to eradicate polio.

“Six million fewer children died in 2012 than in 1990. Deaths from malaria have fallen by 25 % since 2000. Deaths from tuberculosis have fallen by more than 40 % since 1990. And deaths from AIDS fell by 30 % from 2005 to 2012 alone. This shows that the global health effort is producing results. But much remains to be done,” said Minister of Foreign Affairs Espen Barth Eide.
Polio is in the process of being eradicated. Norway is increasing its support to this work by more than fourfold, with a total allocation of NOK 240 million for 2014. These funds will be administered mainly by the GAVI Alliance, but also by the World Health Organization (WHO).
“There is a close link between the use of resources and the results achieved. The money is reaching those for whom it is intended, and is being used effectively. This is why we are increasing our support, knowing  that this work is benefiting women and children, as well as men, all over the world,” said Mr Eide.
The fight against the major deadly diseases AIDS, tuberculosis and malaria is being intensified. The Global Fund to Fight AIDS, Tuberculosis and Malaria will receive an additional NOK 50 million. It is planned that this funding should be increased by a further NOK 100 million in 2015. Altogether it is proposed that NOK 1.7 billion should be allocated to the Global Fund for the period 2014–16.
Norway’s allocation to the GAVI Alliance is to be increased by NOK 100 million. So far 370 million children have been vaccinated through GAVI-supported programmes, and the aim is to reach many more. Norway’s contribution now totals more than NOK 1 billion per year.
“The increase in this year’s budget shows that Norway is shouldering its part of the responsibility for bringing the world closer to achieving the health-related Millennium Development Goals by 2015,” said Mr Eide.
In total, Norway now spends more than NOK 4 billion of its international development budget on global health. Norway intends to increase focus on universal health coverage. It is the responsibility of individual countries to provide basic health services to their populations, while the role of the international community must be to provide support for national efforts under national ownership.



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Nearly two million Muslim pilgrims converged on Mecca for the 2012 Hajj

Posted by African Press International on October 7, 2013

Nearly two million Muslim pilgrims converged on Mecca for the 2012 Hajj

DUBAI,  – Public health officials in the Gulf states are playing down fears about an outbreak of the deadly MERS coronavirus among pilgrims travelling to the Hajj in Saudi Arabia this month, though doctors are advising the elderly, people with existing health conditions, pregnant women and young children to stay away.

As of 4 October, according to the World Health Organization (WHO), laboratories in the region had confirmed 136 cases of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), including 58 deaths since April 2012.

Most cases and deaths have been in Saudi Arabia, where two million Muslims are expected to converge in mid-October for the annual Hajj pilgrimage to the holy cities of Mecca and Madinah.

The virus is seen as a cousin of Severe Acute Respiratory Syndrome (SARS), which swept through Asia in 2002-3, killing over 700 people.

MERS-CoV can cause breathing difficulties, diarrhoea, kidney failure, and in extreme cases, death.

Saudi Arabia’s Health Minister Abdullah Al Rabia says his country is ready for an outbreak, but stressed that he was confident there would be no problem, given there were no recorded cases during either July’s Umrah pilgrimage or last year’s Hajj.

The country, which has had 120 cases and 49 deaths since September 2012, has assigned two laboratories for MERS-CoV-specific testing. It will also use existing health surveillance points at borders (set up to ensure pilgrims are vaccinated against Meningococcal Meningitis and Yellow Fever) to be on the look-out for cases.

Health authorities around the Middle East, many of whom already send large health support teams to the Hajj, will also be raising awareness of the virus among pilgrims, with a focus on reminding people what they should do if they return from Saudi Arabia and feel unwell.

Dubai Health Authority in the United Arab Emirates is to launch an awareness campaign for pilgrims travelling to the Hajj although details are yet to be released.

The risks of MERS-CoV transmission were discussed at length during a week-long meeting of the International Mass Gathering Medicine Conference held last month in Saudi Arabia, home to the Global Center for Mass Gathering Medicine run by the Saudi government.

Over 1,000 health officials from WHO, the US government’s Centers for Disease Control and Prevention (CDC) and various governments from around the world attended the event, which focused on MERS-CoV.

One of the difficulties with the virus is that the early symptoms can be easily confused with the common cold. Unless doctors are specifically screening for the virus, it can be hard to pick up.

Another challenge is that despite more than one year of research, scientists remain unsure about the source of the virus and how it is transmitted.

“Until we have a definitive source of infection, it is hard to give targeted advice,” explained Richard Brown, a medical doctor and regional adviser for communicable disease surveillance and epidemiology for WHO’s South East Asia Regional Office.

Brown, who is also focal point for WHO’s International Health Regulations, told IRIN: “There is an assumption that the source is animals, and we have seen some very interesting studies about bats and camels, but if they are a possible source of infection, we don’t really know how it’s getting from those animals to humans, or whether perhaps even these animals are being infected from yet another, undiscovered source.”

He added: “People need to be careful in a very generic way, such as ensuring good hand hygiene. We would normally tell people to avoid very crowded situations, but obviously in this case, with the Hajj, that is unrealistic.”

“We would normally tell people to avoid very crowded situations, but obviously in this case, with the Hajj, that is unrealistic”

Anthony Mounts, a medical doctor and technical lead for the MERS-CoV response with WHO in Geneva, stressed the importance of global awareness about MERS-CoV, not just among countries in the Middle East, or those sending pilgrims to the Hajj.

“The Hajj could possibly be an issue, but actually there are pilgrims that go to sites in Saudi Arabia all through the year. When you look back at our data, we have not seen cases emanating from these people,” he explained.

Global threat? 

“However”, he added, “the concern extends beyond the countries in the immediate region. If you look at the way people travel in the region, in particular the workforce, they come from a lot of poor countries, from places like Pakistan, India and the Philippines, all of which are places which don’t perhaps have the best infrastructure to respond to a virus or even to detect it.”

Mounts said WHO is working globally to ensure all countries are able to test for MERS-CoV and know what to look for.

Brown agrees that while mass gatherings pose a particular risk for MERS-CoV, health actors must always be vigilant.

“The thing that almost makes it easier about Hajj is that you know when people are going and when they are coming back. But if you have migrant workers coming and going the whole time, then it requires constant vigilance,” he explained.

“When people are exiting the country, you should be giving them some basic health advice. And, if they are returning to their home countries, it’s about encouraging them to proactively mention to people where they have been to sensitize the clinician to the possibility of infection.”

In order to track the virus’ spread, WHO has set up the International Health Regulations Emergency Committee on MERS-CoV.

However, at its third meeting last month, the Committee voted unanimously that the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

This means there will not be a global high alert, as was seen over the last decade when there were outbreaks of SARS, Avian Flu H5NI and Swine Flu.

Experts find some comfort in two things: the pace of the disease has not accelerated, nor has the disease mutated.

“Although we have seen human to human transmissions occur in healthcare facilities, between patients, from patients to doctors, among healthcare staff and close family members, we haven’t yet seen that third or fourth level of community transmission,” Mounts said, meaning when the disease is spread more randomly among strangers.

“There have been quite a lot of investigations looking for this [community transmission], they just haven’t found it yet. What’s more, the clusters that we have seen seem to extinguish themselves with relatively modest interventions, which was not the case with SARS.”

What is MERS-CoV? 

MERS-CoV is short for Middle East Respiratory Syndrome Coronavirus. It is a particular strain of the “coronavirus” family that causes illnesses ranging from the common cold to more serious respiratory conditions. It is regarded as a cousin of Severe Acute Respiratory Syndrome (SARS), which claimed more than 700 lives when it hit Asia in 2002-2003. It was initially labelled Novel Coronavirus (nCov).

How widespread is MERS-CoV? 

No one is really sure. It is possibly being under-reported because doctors are mistaking it for the common cold and people who are otherwise healthy are able to fight it off. While the World Health Organization (WHO) is taking MERS-CoV seriously, setting up anEmergency Committee to track its progress and organize the response, experts there do not believe it has met the criteria to be named an in international public health emergency. Nor does WHO advise against travel to any countries or special screening at points of entry.

How fatal is the virus? 

So far 58 people have died. At over 40 percent so far, the death rate of MERS-Cov is high compared to SARS. But it is possible people contracting the virus have been able to fight off the symptoms and therefore have not reported it. As such, only the most serious cases are being identified. The elderly or those who have underlying health conditions, like diabetes and hypertension, are most vulnerable to MERS-CoV. This is one explanation for the high death rate among those who get infected.

How would you know if you had MERS-CoV?

It is hard to tell because the symptoms are very similar to the common cold, though in the case of infection, they will rapidly escalate from a fever and cough to breathing difficulties. Many patients have also had gastrointestinal symptoms, including diarrhoea, and some have had kidney failure.

What is the treatment for MERS-CoV? 

No vaccine is currently available. Treatment depends on the patient’s clinical condition and would involve general supportive medical attention. In advanced cases, patients have been submitted to intensive care units to support their breathing and other organ functions.

Does MERS-CoV come from camels? 

study published in The Lancet Infectious Diseases journal found a high level of MERS-CoV antibodies among camels in the Middle East. This suggests that the virus, or something very similar, has recently been circulating among camels and this may be the source of the infections seen over the last year. However, researchers still do not know how the virus is being transferred from camels to humans. Given that none of the confirmed MERS-CoV patients had a history of direct interaction with camels, an intermediary carrier could be taking the virus from camels to humans. Scientists say it is also possible that the antibodies found in camels could be a very closely related virus, rather than the actual virus itself.

What about bats? 

A team of US and Saudi scientists have looked at bat populations in the Middle East to see if the nocturnal animals may be a source of MERS-CoV. They found that a faecal sample from one bat in Saudi Arabia yielded a fragment that was a 100 percent match for the MERS-CoV, though some have questioned whether the fragment was too small to give an accurate or useful reading. Again, there is still no information about how the virus has been or could be transmitted to humans.

How can you protect yourself from MERS-CoV?

Until more is known about where MERS-CoV comes from and how it is spread, it is hard to give specific advice. The US Centers for Disease Control and Prevention (CDC) recommends general common sense hygiene precautions. These include: washing your hands often with soap and water for 20 seconds, and if water is not available to use an alcohol-based hand sanitizer; covering your nose and mouth with a tissue when you cough or sneeze; avoiding touching your eyes, nose, and mouth with unwashed hands; avoiding close contact, such as kissing, sharing cups, or sharing eating utensils, with sick people; and cleaning and disinfecting frequently touched surfaces, such as toys and doorknobs.

Sources: World Health Organization; Centers for Disease Control and Prevention; The Lancet journal.



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Access to mental health services remains a key challenge in Africa

Posted by African Press International on September 5, 2013

KAMPALA,  – As African countries strive to meet the UN Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill.
Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries’ agendas than other health issues.

“Everyone is putting their money in HIV, reproductive health, malaria,” says Sheila Ndyanabangi, director of mental health at Uganda’s Ministry of Health. “They need also to remember these unfunded priorities like mental health are cross-cutting, and are also affecting the performance of those other programmes like HIV and the rest.”

Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity: The World Health Organization (WHO) estimates 75-85 percent of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50 percent in high-income countries. The action plan outlines four broad targets, for member states to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

In order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues. As it stands, the US Agency for International Development (USAID), the world’s biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS. Meanwhile, mental health receives on average 1 percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond,” Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told IRIN. “Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets.”

The post-MDG era

According to a May report from the UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, the MDGs have overseen the fastest reduction of poverty in human history.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond”

Yet it also acknowledges that they have done little to reach the world’s most vulnerable. The report says the MDGs were “silent on the devastating effects of conflict and violence on development” and focused too heavily on individual programmes instead of collaborating between sectors, resulting in a largely disjointed approach to health. Experts say without a more holistic approach to global health in the new development era, the world’s most vulnerable will only be trapped in that cycle.

“The MDGs were essentially a set of vertical programmes which were essentially in competition with each other for resources and for attention,” said Minas. “We’ve gone beyond that, and now understand we’re dealing with complex systems, where all of the important issues are very closely interrelated.”

Poverty and mental illness

In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care.

“The surge of aid [that usually follows an emergency]combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term,” say the authors of the report Building Back Better: Sustainable Mental Health Care after Emergencies, released earlier this month.

In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda – which, starting in the late 1980s suffered a two-decade long war between the government and the rebel Lords’ Resistance Army – monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

“We need to be mentally healthy to get out of poverty,” Ethel Mpungu, the study’s lead researcher, told IRIN.

The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30 trillion by 2030, with mental health conditions alone costing an additional $16 trillion over the same time span.

“It really is around issues of development and economics – those things can no longer be ignored,” says Minas. “They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes.”

Putting mental health on the agenda

As mental health legislation is hard to come by in most African countries, Uganda is ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010. The bill would update its colonial era Mental Treatment Act, which has not been revised since 1964, and bring the country in line with international standards, but is still waiting to be reviewed by cabinet and be voted into law.

Uganda is also part of a consortium of research institutions and health ministries (alongside Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME – the programme for improving mental health care – was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems.

Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere.

“Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria,” said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. “But if people don’t care whether they live or die, they’re not going to be able to take advantage of these things that are offered.”

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Bolstering access to life-prolonging drugs for people with HIV/AIDS

Posted by African Press International on September 3, 2013

MAE SOT,  – Efforts are under way in Myanmar to bolster access to life-prolonging drugs for people with HIV/AIDS, but tens of thousands will probably still be left out, say health experts.
“All the ingredients are there to make this work, but a comprehensive and integrated plan concerning all actors and activities is needed to ensure a proper and rapid implementation,” Peter Paul de Groote, head of mission for Médecins Sans Frontières (MSF), told IRIN.

In June, the Global Fund to Fight AIDS, Tuberculosis and Malaria pledged more than US$160 million over the next four years to Myanmar to improve access to anti-retroviral (ARV) drugs for patients, including those in neglected border regions and some controlled by ethnic armed groups.

“The challenge is that some of the areas are not directly managed by the government,” Eamonn Murphy, country coordinator for the Joint UN Programme on HIV/AIDS (UNAIDS), explained. “However, I think there is a genuine commitment to provide services in these areas.”

According to UNAIDS, there are about 220,000 people with HIV in Myanmar of whom 120,000 are in need of ARVs. From 2011 to June 2013, ARV treatment coverage climbed from 32 percent of diagnosed patients to nearly 50 percent, inching closer to the government target of 85 percent by the end of 2016.

In 2012, Myanmar officials declared that the availability of ARV treatment had expanded to nearly 100 sites – up from 57 in 2008.

Yet, more than 70 percent of those treated were in the nation’s two largest cities, Yangon and Mandalay, along with Kachin State, while coverage in other areas remained inadequate.

The Global Fund is currently in talks with various stakeholders on access to war-torn border regions and expects to roll out services in 2014.

“We envisage an expansion of services to these areas with life-saving drugs being brought into the conflict zones and other hard-to-reach areas,” said Andrew Hurst, a Global Fund spokesperson.

But despite the Global Fund boost, Myanmar is still looking for other donors to fill a $110 million funding gap in its national response up to the end of 2016, Murphy said.

Furthermore, some health workers claim HIV prevalence – the third highest in the Asia-Pacific region – could be worse than reported as scarce healthcare in border regions, compounded by a fluid migrant population, may have further spread the virus.

“I think that there are thousands of unknown HIV cases,” said Aye Aye Mar, founder of Social Action for Women (SAW), a non-profit group that supports Burmese HIV patients in the Thai border town of Mae Sot. “We will never know if they have the virus and many won’t know themselves because they don’t get tested.”

WHO guidelines could boost ARV demand

MSF, the largest ARV provider in Myanmar, also predicts a greater demand for treatment after the World Health Organization set new guidelines in June stating that adult patients with CD4 (a white blood cell that targets infection) counts of 500 or below should receive ARVs when immune systems are stronger.

Myanmar’s ARV policy of treating adults with CD4 counts of 350 or below will need to be updated, allowing more infected people to access the drugs, MSF officials say.

“For this, many more treatment sites will have to be opened in areas where so far no treatment is available,” de Groote said.

Seeking help in Thailand

Meanwhile, many impoverished Burmese living with HIV/AIDS continue to cross the Thai-Burmese border in the hope of receiving free treatment in Thailand.

Ma Yin Nu left her eastern Karen State village in 2007 when her daughter became severely malnourished after years of being mistakenly treated for tuberculosis.

“She was in very bad shape. I thought she would die and even the doctors expected it,” said Ma Yin Nu, adding that she herself probably transmitted the HIV virus to her daughter at birth after a blood transfusion at a Burmese hospital.

With ARV treatment, her daughter, Phyoe Thandar Win (17), has since seen her CD4 count skyrocket from two to more than 1,000, and is now healthy enough to attend school. She lives at a SAW shelter, which teaches women to sew garments that are sold to pay for their ARVs (about $170 per month).

“I would be happier living in my village,” she said. “But I need to stay here longer to get treatment.”

Under a Global Fund grant, the Thai government offers free ARV drugs to at least 2,700 foreigners nationwide, but many more remain on waiting lists. Only 70 people are eligible in the Mae Sot area, the main hub for Burmese migrants coming into Thailand, health workers say.

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Tun Aung Kyaw says his TB was misdiagnosed

Posted by African Press International on August 22, 2013

Tun Aung Kyaw says his TB was misdiagnosed

WANGPHA,  – Struggling to breathe, Burmese migrant Tun Aung Kyaw sits up slowly in bed for a routine check-up at a Thai tuberculosis (TB) clinic along the 1,800km Thai-Burmese border.

This is the third round of treatment for the 29-year-old, who believes Burmese health workers misdiagnosed him with regular TB twice when he actually had multi-drug-resistant TB (MDR-TB), a form of the infectious disease harder to diagnose and cure.

“Even though I was on TB treatment I got weaker and eventually I was bed-ridden,” Tun Aung Kyaw told IRIN.

After 14 months of treatment, Tun Aung Kyaw’s condition never improved as the disease had destroyed his left lung. He now faces a two-year regimen of care to see if he can finally defeat the MDR-TB strain, which has a treatment success rate of almost 60 percent in South-East Asia, according to the Global Tuberculosis Report 2012 by the World Health Organization (WHO).

Inadequate detection and treatment are major obstacles and can result in cases of drug-resistant TB (DR-TB) such as MDR-TB, say health experts.

“Drug-resistant TB is a very significant health concern for Myanmar,” Peter Paul de Groote, the country’s head of mission for Médecins Sans Frontières (MSF), told IRIN.

Around 8,900 new cases of DR-TB are reported each year, but only 800 patients had access to treatment at the end of 2012, he said.

TB burden

Myanmar is among the world’s top 22 TB-burden countries with a prevalence rate of 525 cases per 100,000 people, more than three times the global average.

It is also a high burden country for MDR-TB, a complex strain immune to first-line drugs that requires two years of treatment, four times longer than non-resistant TB.

MDR-TB treatment costs nearly US$5,000 per patient, roughly 100 times more than the regular strain, according to an October 2012 WHO report.

From 22 to 23 August, WHO, along with MSF and Myanmar’s Ministry of Health, plan to hold a DR-TB symposium in Yangon aimed at ramping up services throughout the country, including neglected border regions.

“There are immense challenges in providing DR-TB treatment, and health care in general, to the remote border areas of Myanmar,” de Groote said.

Health experts fear countless more cases remain hidden in rural eastern Myanmar where armed conflict, rough terrain, lack of awareness and scarcehealth care can discourage TB-infected people from seeking care.

Proposed approaches for battling DR-TB include counselling to help patients cope with long and toxic courses of treatment, decentralized care in home communities, and rapid diagnosis to treat patients correctly and prevent further cases.

To do this, Thandar Lwin, manager of Myanmar’s National TB Programme, has urged the Burmese government to step up efforts to support TB measures, 94 percent of which are donor funded.

TB-infected patients live in these huts for the duration of their treatment at the Wangpha TB clinic

“The government budget is not enough and it is difficult to increase more than the previous year,” she said during an international TB workshop earlier this year. “There is a need for evidence to persuade the government that investment in health is worthwhile.”

In 2013, Myanmar is projected to have a US$22 million funding gap for TB care and control services, the WHO report said. On the other hand, rapideconomic growth may help ease the problem in the longer term.

Border run

Many Burmese are forced to seek TB care at donor-funded clinics along the Thai border, home to roughly one million migrants and displaced persons.

Two health clinics run by Shoklo Malaria Research Unit (SMRU), a Mae Sot-based field station for the Mahidol University-Oxford University Tropical Medicine Research Programme in Bangkok, offer free treatment and are inundated with patients.

From 2010 to March 2013, SMRU supported more than 810 TB patients, but had to refer 70 percent of them, and pay for their care at local Thai hospitals due to limited capacity.

About 18 percent of patients tested for first-line drug susceptibility at SMRU clinics had some form of DR-TB. Almost half have already been successfully treated, with others still on the regimen.

In June 2013, SMRU opened a specialized TB clinic in the village of Wangpha, near the Thai border town of Mae Sot, to handle the overflow. Plans are also under way to expand in-patient care at the second clinic since 60 percent of TB patients, especially those with drug resistance, need to be supervised by clinic staff.

Sein Sein, manager of the TB clinic, said several patients initially came in after showing symptoms for several months, when treatment should be sought if persistent coughing lasts for at least two weeks.

“Many patients only come for treatment when they are really sick, so they stay in the community and continue to spread the disease,” she said.

According to WHO, there were an estimated 650,000 cases of MDR-TB among 12 million TB cases worldwide in 2012.

sk/ds/cb source

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When bullets tore through the streets of Kismayo

Posted by African Press International on August 21, 2013

Still tense… African Union troops captured Kismayo from Islamist insurgents in September 2012 (file photo)

KISMAYO/NAIROBI,  – When bullets tore through the streets of Kismayo in June, leaving over 70 dead as rival militias twice fought for control of the Somali port city, many international aid agencies halted a cautious scale-up of activities.

One of the few to stay was the World Health Organization (WHO).

“For us, conflict means casualties. We are doctors; we have to be there,” Omar Saleh, WHO Somalia’s emergency health coordinator, told IRIN.

But for most international organizations – many of which had just returned to Kismayo after militant Islamists Al-Shabab were driven out late last year – the June violence proved too dangerous.

As stability returned through July, activities slowly resumed. Still, the political and security crises that fuelled the fighting are at risk of deepening.

Jubaland issue

The recent disputes over Jubaland, a state-within-a-state whose leadership and borders are not recognized by the administration in Mogadishu, constitute a test of federal principles outlined in Somalia’s provisional constitution. The central government also seeks control of and revenue from Kismayo, Jubaland’s de facto capital.

Jubaland, which, in its maximum extent, is considered to include the regions of Gedo and Lower and Middle Juba, has 87,000sqkm of mainly fertile land and some 1.3 million people of many different clan allegiances.

Timeline of “Jubaland” disputes
2009-2010 – First discussions of the “Jubaland Initiative”, with local elites and, in part, Kenya identified as the key proponents of the plan to train anti-Al-Shabab militia and establish a regional administration in areas of Somalia bordering Kenya.
April 2011 – Former Somali Defence Minister Mohamed Abdi Mohamed forms Azania group, and is declared president of Azania, another term for the Jubaland region.
October 2011 – Kenya launches incursion into Somalia – Operation Linda Nchi – deploying some 2,000 troops across the border.
May 2012 – Nairobi-based talks charge 32-member technical committee with establishing a Jubaland administration.
August 2012 – Internationally recognized federal administration replaces Transitional Federal Government, not long after constituent assembly backs provisional constitution that outlines federal principles.
August 2012 – Internationally recognized federal administration replaces Transitional Federal Government, not long after constituent assembly backs provisional constitution that outlines federal principles.
September 2012 – Kenyan and Somali troops – partly operating under AMISOM umbrella – seize control of Kismayo from Al-Shabab, with support from the Ras Kamboni militia.
February 2013 – First Jubaland conference held in Kismayo; flag and three-year constitution adopted.
May 2013 – 500-strong conference of clan elders and local leaders elect former warlord and leader of Ras Kamboni militia Ahmed Madobe as “president” of Jubaland, a move opposed by the central government in Mogadishu. Following separate conference, former warlord and Defence Minister Col Barre Hiraale also declares himself “president” of the region. Violent clashes subsequently break out in streets of Kismayo.
July 2013 – Letter from Somali foreign minister to African Union leaked, describing “incompetence” of Kenyans and calling for deployment of “multinational” AU force to the city.
August 2013 – Communiqué issued by regional leaders at Kampala Summit demands that control of Kismayo’s airport and seaport be handed back to the federal government.

The Jubaland issue is also complicating relations between the central government in Mogadishu, regional powers Kenya and Ethiopia, and the African Union (AU) mission in Somalia (AMISOM). And with key players in Kismayo temporarily distracted, the crisis could be giving Al-Shabab a much-needed breather to regroup.

These developments threaten gains made this year by aid agencies and risk extending an already complex humanitarian situation in the city, where 60,000 people are in need of aid, according to estimates by the UN Office for the Coordination of Humanitarian Affairs (OCHA).

“Whenever territory is taken by military operations, there is at least a temporary lag setting up a functioning administration. This hampers the ability of humanitarians to access people in need,” Philippe Lazzarini, the UN’s top humanitarian official for Somalia, told IRIN.

“The change in power can stoke insecurity rooted in competition among rival factions, as we saw in Kismayo and the Juba regions,” he added.

Many years under pressure

For several years, Kismayo, 200km north of the Kenyan border, was a key stronghold and source of income for Al-Shabab. The militants took control of the city in August 2008, after defeating the militia of Barre Adan Shire (widely known as Hiiraale), and remained in control of it until their defeat in September 2012.

Kismayo was a key target in AMISOM’s operation against Al-Shabab – the militants controlled the lucrative charcoal trade out of the port and also taxed imported goods.

While civilians report some stability during Al-Shabab’s control of the city, there were also limited livelihood opportunities, and access to education and healthcare was often difficult. Al-Shabab also banned polio vaccination in Kismayo and elsewhere in south-central Somalia, and according to reports, the group forcibly taxed and recruited the city’s residents.

“Conditions for the population were so precarious under Al-Shabab,” Soldan Haji Aden, director of the Alikar Center for Peace, Human Rights and Democracy in Kismayo, told IRIN. “Residents and internally displaced persons [IDPs] who came to Kismayo could not find healthcare, water, food, shelter or some kind of livelihood.”

Kismayo and the surrounding region were also hit hard by the 2011 food crisis. While famine was not declared in Lower Juba, the situation was classified a humanitarian emergency. Many of those displaced by the food crisis crossed the border to go to the Dadaab refugee camps in Kenya, but tens of thousands of people fled to Kismayo, where many other IDPs have gathered since the early 1990s.

“When Al-Shabab controlled Kismayo, it was very difficult to get food to feed my family,” Fadumo el Moge, a mother of five in Kismayo, told IRIN. “There was no work and Al-Shabab controlled the city and stopped humanitarian assistance. I had to rely on support from my family abroad.”

Glimmer of hope, but serious problems

Kenyan and Somali troops – the former mostly operating as part of the AU mission – attacked Kismayo in September 2012. Supported by local militia Ras Kamboni, the mixed force launched a combined ground, air and naval assault on 28 September and quickly ousted the militants from their last major urban stronghold.

While there remain major concerns about access and security, UN agencies and NGOs have launched or extended a variety of programmes, directly or through partners. Several have sent in short missions involving international staff, and humanitarian needs assessments have also been carried out.

“The challenges in Kismayo largely mirror those found throughout southern and central Somalia,” Lazzarini – who made his first visit to Kismayo as Humanitarian Coordinator in July 2013 – told IRIN. “People lack sufficient health services. They need clean water, sanitation services and education.”

Key humanitarian risks include the possibility of a polio outbreak taking hold given the long ban on vaccination, the spread of waterborne and infectious diseases within densely populated urban areas and IDP camps, and the ongoing threat of conflict in the city and beyond.

Black gold: Al-Shabab made millions exporting charcoal from Kismayo

“The situation in Kismayo is better than before,” said Saleh of WHO, which is running polio vaccination and emergency surgery programmes. “But there are major problems. Kismayo Hospital needs total renovation. We need to establish long logistic lines for supplies and medicine and build up the people who are there after so much capacity has been lost. We are progressing, however, slowly but surely.”

The World Food Programme (WFP) launched two basic programmes in January through local partners: wet feeding at five centres, reaching about 15,000 people each day, and a nutrition programme to treat high levels of malnutrition among women and young children.

Médécins Sans Frontières – which withdrew from Kismayo in 2008 after the murder of three staff members – was also active in the city, but it recentlyannounced plans to close all of its Somalia programmes due to “extreme attacks” on its staff. A number of other agencies are present, but are reluctant to share details of their operations.

Recent setbacks

Kismayo’s uneasy peace was shattered in June, when fighting broke out between rival militias laying claim to the presidency of Jubaland. The violence underscored the fragility of Kismayo’s early recovery and the dangers that remain.

“The tensions have been a setback – in particular, the fighting on 28-30 June, which resulted in more than 70 deaths and hundreds of civilian casualties,” said Lazzarini.

Clashes first broke out in early June and then again at the end of the month, with rival factions battling for control of the city. WHO reported a 44 percent rise in weapons-related injuries in Kismayo in June. The fighting pitted Ahmed Mohamed Islam “Madobe” – who was elected president of Jubaland in May by a conference of clan representatives – and his Ras Kamboni militia against other figures who also declared themselves leaders of the region.

Human Rights Watch criticized the militias for disregarding the safety of civilians, while a leaked letter from Somali Foreign Minister Fawzia Yusuf to the AU accused the Kenyan military of backing Ras Kamboni in the June clashes and of using heavy weapons in civilian areas. Analysts say Kenya has been encouraging the creation of Jubaland, which could act as a buffer zone on its northern border.

On 4 August 2013, in Uganda’s capital, Kampala, regional heads of state decided in a communique that control of Kismayo’s airport and seaport should be handed back to the Federal Government – backing Mogadishu against Madobe.

But the violence had already taken its toll. A critical polio vaccination campaign, which targeted tens of thousands of at-risk children, was halted. Although the effort was restarted in July, the delay is concerning given the 100 cases of polio confirmed in Somalia in 2013.

WFP’s food distribution activities were also disrupted, threatening recent gains in food security since the 2011 crisis. “The port has largely been inaccessible, so for essentially two months we couldn’t get food there,” Challiss McDonough, WFP’s spokesperson, told IRIN. “We did an exchange with another organization but had to suspend cooked meals in late July. We are in the process of getting more food there and hope to be able to resume by mid-August.”

The instability in Kismayo also threatens hopes of early refugee repatriation from Kenya. According to the UN Refugee Agency  (UNHCR), some 96,000 refugees in Dadaab – representing over 35 percent of the camp’s population – have origins in Lower Juba and are unlikely to agree to any negotiated return while significant violence still threatens the region’s capital and civilian population.

Despite the negative humanitarian outlook following June’s violence, some agencies remain upbeat.

“The local authorities told me that they are ready to ensure the security of humanitarian workers,” said Lazzarini. “We are redeploying staff… We will continue to work hard to scale-up our activities, not only in Kismayo but throughout southern Somalia.”

OCHA recognizes that the situation in the city “remains tense”, and as MSF’s recent withdrawal from the country demonstrates, the conditions for humanitarian activity in Kismayo and elsewhere will likely remain precarious for some time

zf/rz source


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Posted by African Press International on August 20, 2013

  • By   Dickens  Wasonga reporting for API,

Leaders issue Beijing Declaration to set priorities for health collaboration at the first meeting of health ministers under the Forum on China-Africa Cooperation (FOCAC)

Today, dozens of African health ministers and Chinese health officials gathered at the Ministerial Forum on China-Africa Health Development to map out new efforts to support Africa’s long-term health progress and shape the future of China-Africa health cooperation.
This was the first-ever meeting of health ministers under the Forum on China-Africa Cooperation (FOCAC) since it was established in 2000, demonstrating the highest level of political commitment to tackle Africa’s most pressing health challenges together.
At the Forum, health ministers and officials launched the Beijing Declaration of the Ministerial Forum on China-Africa Health Development, which sets a road-map for jointly addressing key health challenges across Africa, including malaria, schistosomiasis, HIV/AIDS, reproductive health, immunization and vaccine preventable diseases.
Under the Declaration, China and African countries will embark on new efforts to achieve sustainable, long-term health solutions, such as increasing partnerships on joint research and addressing the shortage of healthcare workers.
China and African countries will engage further with private enterprise to encourage technology transfer and increase access to low-cost health technologies that meet high quality standards. The Declaration emphasizes that such health cooperation efforts will align with African countries’ priorities as well as national and regional development plans.

“China and African countries have enjoyed strong and effective partnerships on health for half a century, based on our common experiences and our shared vision for a brighter and healthier future for all our citizens,” said Hon. Min. Awa Coll-Seck, Minister of Health of Senegal.

“The Beijing Declaration solidifies our governments’ commitments to developing and implementing Africa-led strategies that drive sustainable health progress and improve the lives of people across the continent.”
This year marks the 50th anniversary of China sending medical teams to African countries, with the first team sent to Algeria in 1963. Since then, thousands of medical personnel have served in 43 African countries.
China has also worked with African partners and international organizations to build hospitals and malaria centers, train health workers and increase access to antimalarial treatments and other health technologies. Academic institutions and private companies have also supported these efforts.
Now, China and African countries are exploring opportunities to build on this progress and contribute new resources, innovation and leadership to drive health progress across Africa. “Chinese and African citizens live on the same planet, under the same sky.
China’s partnership with Africa is rooted in humanitarianism. As President Xi described, this love has no borders,” said Hon. Dr. Li Bin, Minister of China’s National Health and Family Planning Commission. “I believe the Chinese Medical Teams will strive to make a greater contribution in the future.”
In this new era of collaboration, Chinese and African government officials and other stakeholders will work closely together to identify sustainable solutions to health challenges.
This will include bolstering human resources capacity in African countries, supporting domestic manufacturing capacity, and increasing access to low-cost, high-quality health products.
These joint efforts will draw on and leverage China’s own experiences with improving public health in a resource-limited setting. China will also share the tools and expertise it has acquired through its investments in health research and development, the production of health technologies, and its current health reform effort to expand healthcare to all citizens.
China and African countries will also work closely with key global health stakeholders to support China-Africa health cooperation, including multilateral organizations, international NGOs and civil society organizations.
Representatives from the World Health Organization (WHO), UNAIDS, UNFPA, UNICEF, African Union, World Bank, GAVI Alliance and Global Fund to Fight AIDS, Tuberculosis and Malaria were observers of the Forum.
These international partners have been critical to the health progress already made in both China and African countries, and their expertise and experiences can support deepened and more effective China-Africa health cooperation.
“The decades of collaboration between China and Africa has long been characterized by friendship and goodwill,” said Dr. Margaret Chan, Director-General of WHO.
“China is now a significant force in Africa’s development, with substantially increased commitments and engagements. This is a south-to-south model of development cooperation based on mutual interests and respect.”
The Ministerial Forum builds on important discussions in Botswana at the 4th International China-Africa Health Cooperation Roundtable, which took place for the first time in Africa in May 2013.
The Forum is held under the Forum on China-Africa Cooperation (FOCAC), and is hosted by the National Health and Family Planning Commission of China, formerly the Ministry of Health.
Together, these meetings have laid the groundwork for continued South-South collaboration between China and African countries on pressing health challenges.


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Cholera resurgent – The need to conduct a vaccination campaign

Posted by African Press International on August 17, 2013

West African cholera cases highest in Guinea-Bissau

DAKAR,  – More than 700 people have been sickened by cholera in Guinea-Bissau, the highest number of cases so far this year in West Africa, which has nonetheless seen a significant drop in cases this year compared to 2012.

Isolated health centres, insufficient medical personnel and detrimental traditional beliefs have contributed to the prevalence, explained Inàcio Alvarenga, an epidemiologist with World Health Organization (WHO).

Guinea-Bissau’s southern Tombali region is the worst hit, with 225 cases and 21 deaths as of late July, said Nicolau Almeida, a health ministry director.

Tombali is the poorest region [in the country] in terms of human resources. There is only one nurse per health centre. The health system cannot properly cater for patients. This is in addition to superstitions by people who don’t believe the scientific explanation of cholera,” Alvarenga told IRIN.

Continuing epidemic

As of 22 July – when the latest data was available – the UN Children’s Fund (UNICEF) reported 742 cases in Guinea-Bissau, 416 in Niger and 368 in Sierra Leone. The outbreak in Guinea-Bissau is a continuation of the 2012 epidemic, when 3,359 people contracted cholera.

“To confirm a new epidemic, the 2012 outbreak should have been declared over” by demonstrating the absence of vibrio cholera in diarrhoea, said Alvarenga.

“For reasons I’m not aware of, the government did not test cases in the first weeks of the year. These cases did not disappear but got spread around,” he continued. “I don’t think we will hit the 2008 level [when 14,204 people were infected and 225 killed], but the disease risks will be lingering for several months like in 1996-1998.”

Most cases have so far been reported in Catungo and Mato Foroba localities in the country’s south. “These are rice-growing areas where vibrio cholera can easily reproduce,” Alvarenga said.

Other cases have been reported in Catio area and in Quinara region – all in the south. Almeida said that the cases in Catio town indicated that the disease was spreading. Two cases have been confirmed in the capital, Bissau, said hospital sources.

“Residents of the city’s old town district are very concerned,” Alvarenga said. The water and electricity company has been unable to supply water to the capital in the past weeks due to financial difficulties, although it recently resumed partial service. “People are seeking all possible means to get water. It’s not rare to see water transporters on the streets.”

Need for medical personnel, drugs

Almeida, from the health ministry, said the government’s priority was to contain the disease in Tombali, where a medical team – comprising an epidemiologist, two doctors, two nurses and a community outreach specialist – has been sent.

“We, however, need to boost the medical team with three more nurses and five doctors to better guide the health sector in the region. We need to set up different teams in the different areas. There is also a huge requirement for medicines,” he said.

In neighbouring Guinea, cholera has infected 146 people and killed 10 since March, according to aid group Action Contre la Faim (ACF). In Sierra Leone, where around 300 died of cholera in 2012, 369 people have been infected so far this year, mainly in Kambia area, near the border with Guinea.

“Fish is often a factor of cholera infection in this region,” said Jérôme Pfaffmann, a health expert with UNICEF; fishermen criss-cross between the islets off the Guinean coast. The movement of people across the borders of Guinea, Guinea-Bissau and Sierra Leone are also factors in transmission, said ACF’s Jainil Didaraly.

Guinea is conducting a vaccination campaign targeting 4,679 people.

Africa – and West Africa in particular – is the only part of the world wherecholera cases are steadily increasing.

cr/dab/ob/rz source



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South Sudan is yet to replicate its success in eradicating polio in eliminating other diseases

Posted by African Press International on August 16, 2013

South Sudan is yet to replicate its success in eradicating polio in eliminating other diseases

JUBA,  – South Sudan is doing its bit for global polio eradication efforts, but huge gaps in immunization against other diseases remain.

Targeted polio immunization efforts started in the area more than a decade before the country’s independence in 2011 and have remained a top priority. There has not been a single case of polio for more than four years.

Health officials and humanitarian groups are trying to build on this success to improve other immunization efforts, including neonatal tetanus and measles, but more funding and a better health infrastructure are urgently needed.

To combat the re-emergence of polio, Anthony Kirbak, the director of the country’s expanded programme on immunization (EMI), said the Ministry of Health and humanitarian organizations have had to figure out how to circumvent low routine childhood immunization rates.

Every child in the country is supposed to be vaccinated against tuberculosis, polio, diphtheria, tetanus, whooping cough and measles by its first birthday. Kirbak said that only happens for about 65 percent of the country’s children due to a scant health infrastructure, poor roads and cyclical violence in some areas of the country.

To bump up the vaccination rates for polio, the Ministry of Health sends thousands of volunteers out across the country four times a year to immunize every child they can find who is under six. Kirbak said they regularly reach more than 90 percent of the children.

He said South Sudan’s specific focus on polio vaccination stems from the international pressure to completely eradicate the disease.

“The emphasis is because the whole world is supposed to eradicate polio,” Kirbak said. “The only way to do that where there is fragile health system and weak routine immunization, it has to go in the form of campaigns so that many children are reached in a short time.”

The global public health community was originally gunning for full eradication by 2000. They missed the deadline, but according to the World Health Organization (WHO) polio cases worldwide are lower than ever before – there were only 223 in 2012, down from nearly 2,000 a decade before. Kirbak said South Sudan has an international obligation to stay vigilant until well after that number hits zero.

Emergency campaign

Meanwhile, health officials are rolling out an emergency vaccination campaign next week following polio outbreaks in Kenya’s Dadaab refugee camp in April, and an outbreak in Somalia in May. There are now 110 confirmed polio cases between the two countries.

“Due to our proximity [to Kenya and Somalia] and the low immunization coverage in the country, we actually made an assessment of the risk areas,” Kirbak said. “It was found that we have four states (out of 10) that are at risk of importation, if at all any wild polio outbreak is brought into the country, then we’ll be in danger.”

So vaccines are being distributed to the four states and an additional county in South Sudan where people travelling from Kenya and Somalia are most likely to arrive. For four days next week volunteer vaccinators will immunize every child they can find.

Awareness up

Kirbak credits the country’s efforts to keep polio at bay with strengthening the health system generally. By training volunteer vaccinators and health workers to immunize against polio, they have increased general awareness about the importance of all immunizations.

That does not mean the routine immunizations are always available, even if people want them, either because they are cut off from health centres or because there are no staff to administer the vaccines. Kirbak said there has been improvement – routine immunization rates were up to 65 percent last year from 20 percent in 2007 – but acknowledges that it is still too low, which is why South Sudan will continue to deploy targeted vaccination campaigns until the health system gets stronger.

Officials are borrowing the polio campaign model for an ongoing neonatal tetanus vaccination campaign that has so far reached seven states and a measles immunization outreach that should start next year.

UNICEF provides almost all polio vaccines

Polio eradication efforts are propped up by the UN Children’s Fund (UNICEF) which provides almost all of the vaccines in the country. WHO covers the logistics of transporting them. The government contributes money to cover some of the health workers’ salaries, but Kirbak said the resources simply are not there for the state to do much more. That is why the measles campaign next year is only tentative as EMI waits to see if funding becomes available.

Meanwhile, Daniel Babelwa Ngemera, an immunization specialist with UNICEF, said that as South Sudan searches for funds to launch campaigns or strengthen routine immunization coverage, it is falling further behind other countries in the region, like Kenya. Their basic immunization package includes vaccines against pneumococcal – a strain of pneumonia – and rotavirus, which can cause severe diarrhoea in infants and children.

“Our children in South Sudan, they are not benefiting on that,” Ngemera said. “We are trying our level best to make sure at least the country is able to catch up, to be moving also with the other countries in the region.”

South Sudan will soon submit a proposal to the GAVI Alliance, a public-private partnership that helps countries access vaccines, asking for money to help strengthen the health system. Kirbak would not say how much they were asking for, but said it should boost the health system enough to “avert the issue of campaigns”.

MSF action in refugee camp

In the meantime, state officials ask NGOs and humanitarian organizations to introduce immunization coverage where they can.

Médecins Sans Frontières (MSF) started a three-part pneumococcal vaccination campaign in Yida refugee camp in South Sudan’s Unity State last month. The camp holds more than 75,000 refugees, mostly Sudanese who have fled violence in Sudan’s South Kordofan region.

“They’re living in makeshift structures,” said Christopher Mambula, MSF’s country medical coordinator. “It’s more densely populated. They’re not living under normal conditions in buildings and structures like that, which makes for easier propagation of pneumococcus from one person to another.”

Roughly a quarter of all in-patient treatment in the camp last year was for lower respiratory infections.

Mambula said in the first round of the campaign vaccinators were able to reach about 4,300 children under two. They will go back out this month to administer the second dose and the third will follow in September.

Kirbak said the pneumococcal vaccine is one of many on the list of vaccines he plans to introduce to the country as soon as he can find the money.

Immunization data in South Sudan is patchy. WHO and UNICEF’s “estimates of immunization coverage” for 2012 note that immunization rates “are based on data and information that are of varying, and, in some instances, unknown quality”.

ag/cb  source

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Polio campaigns – Learning to walk

Posted by African Press International on August 13, 2013

Polio survivor Claudine Muhombe, 7, is learning how to walk again

GOMA, 1 – When Linda Lukambo, 21, asked his parents why they had neglected to get him the polio vaccine, “they told me, ‘we did’. So why have I got polio?” he told IRIN in North Kivu in the Democratic Republic of Congo (DRC). “Maybe they took me for vaccinations, but maybe not for polio.”

Lukambo first started having difficulty walking while at a pre-school in Tchambucha Village, near the North Kivu town of Walikale. After six months he was, he says, “still walking a little bit. And then I started to move on my bottom, and then on my knees, and it got worse and worse.” By the time he was in primary school he was “crawling on all fours”.

Polio, or poliomyelitis, a highly infectious, viral disease causing paralysis and in some cases death, has been eradicated in most countries through large-scale vaccination programmes. According to the UN Children’s Fund (UNICEF) only Nigeria, Pakistan and Afghanistan still have endemic polio transmission. UNICEF, the largest buyer of children’s vaccines in the world, recommends children receive at least three doses of the oral polio vaccine to ensure full immunity against the disease.

DRC is considered an “importation country”, meaning it experiences outbreaks of the disease because of low levels of immunity among the population. Polio eradication campaigns face myriad obstacles, including large-scale population displacements caused by DRC’s persistent conflicts, poor access to isolated communities, religious objections to the vaccine and weak infrastructure.

In 2007, Lukambo had a series of year-long leg-straightening operations at Goma’s public hospital, paid for by local NGO L´Association Congolaise Debout et Fier. (ACDF). ACDF then provided free leg braces, which enabled him to walk upright. He remembers being “very happy – I did not like the ground,” he said.

He has since become the caretaker at the ACDF centre, where polio survivors come for leg brace fittings or to just hang out or sleep over in a non-judgmental environment, as society often treats the disabled with suspicion and prejudice.

Learning to walk

Claudine Muhombe, 7, from Rugare near Masisi, arrived at the centre in April. She now scampers around the centre’s yard, uses the window frames as a climbing frame, and is quickly discovering how to walk with the aid of crutches and braces, also called callipers.

“It’s not difficult to walk,” she told IRIN. “I like walking. My Dad came [in June] to visit. He was very happy when he saw me, and I was happy to see my Dad happy.”

Joseph Kay of StandProud, the international and fundraising arm of ACDF, told IRIN that Claudine’s rapid progress meant she would probably not stay at the centre for long.

Learning to walk with the callipers and crutches can take weeks or months, requiring intensive physiotherapy to regain strength and balance. But even then, not all are able to.

“It was difficult to learn to walk with leg braces. It took a lot of time to learn. I had no strength in my lower back”

Lukambo’s transition from crawling on the floor to standing on his feet was not as swift as Claudine’s. After his leg-straightening operations, the wounds from the surgery continued to weep and would not heal. He had to undergo a skin graft, with skin taken from his thighs for his knees.

The years of crawling also damaged his hip, and an operation was performed to correct it. When he was finally ready to don callipers, it took nearly four months of daily practice to walk upright.

“It was difficult to learn to walk with leg braces. It took a lot of time to learn. I had no strength in my lower back, so I had to wear a corset,” he said.

After a few months of walking, the muscles in his lower back recovered and the corset was discarded, but Goma’s broken streets were an “obstacle course.”

“It’s something you have to get used to… But I am at the same level now as other people,” Lukambo said.

Polio campaigns

The first polio vaccination campaigns in the country began in the mid-1980s. At one stage, after no cases were recorded between 2001 and 2005, polio was considered eradicated in DRC.

In 2008, after an “epidemiological situation evolved in the central African region,” resulting in dozens of new infections in the country, the government and donors announced a polio vaccination programme targeting seven million children.

A polio survivor at l´Association Congolaise Debout et Fier centre in Goma doing chores

Emmanuel Nomo, UNICEF’s DRC polio team leader, recently told IRIN there had been no registered cases of polio in the country since December 2011.

“Authorities, vaccination teams and parents are doing the best they can to reach all children everywhere, including in the Kivus, despite the challenge of insecurity and lacking access,” he said.

This August, during the country’s National Immunization Day (NID), officials will hold a second round of vaccinations targeting 1,374,836 children up to five years old in North Kivu and 1,144,750 in South Kivu. According to independent monitoring by the World Health Organization (WHO), 3.5 percent of targeted children in North Kivu were missed in the July first round of vaccinations, while in South Kivu the number was 5 percent.

“During the July NID, insecurity – active fighting in some health zones – did not allow the vaccination teams to do their job” in the North Kivu health zones of Kamango, in three health areas in Binza, and three health areas in South Kivu’s Molungu, said Nomo.

“Even though the situation remains difficult in both Kivus, the second [round] of the NID is scheduled to take place throughout both provinces,” he said.

Nomo said issues with maintaining the cold chain, the system of temperature controls required to keep vaccines potent, were being addressed through the introduction of solar fridges by the government, with support from UNICEF, the Global Alliance for Vaccines and Immunization (GAVI), and the World Bank. Currently, only 30 percent of the country’s health centres have a functioning refrigerator.

“Providing good quality vaccines at the beneficiary level remains a challenge,” he said.

Calliper production

StandProud (founded in 1998) has established centres in Bunia, Butembo, Goma, Kalemie, Lubumbashi and Kinshasa.

“We’ve made thousands and thousands of callipers. Hard to know exactly how many since 1998, but there are at least 5,000 individuals who have benefited over the years,” Kay said.

“I have made a lot [of leg braces]. I don’t know how many, but many, many, many”

Louis Nwande-Muhala, a calliper technician at the Goma centre, says it takes about two days to construct the custom-made leg braces – if there is electricity and the materials are available. The braces are made of steel, with leather used for the joints and hip support. The workshop also does repairs on braces, which have to deal with the country’s broken streets.

Nwande-Muhala’s left leg was paralysed at the age of five, not from polio, but from a quinine injection into his hip muscles, an old treatment for malaria that is still practised by some nurses despite the availability of safer treatments.

He first encountered the NGO when he wanted to acquire a leg brace. After being fitted for the brace, he decided to give up his tailoring job to make callipers. “I have made a lot [of leg braces]. I don’t know how many, but many, many, many.”

go/rz/cb source


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Mental health problems

Posted by African Press International on August 6, 2013

KATHMANDU,  – Gaps in mental health care for men who have sex with men (MSM), a population disproportionately affected globally by HIV, are limiting effective treatment and care for both HIV and mental illness, experts say. 

Mental health problems are an underappreciated barrier to successful treatment and prevention of HIV, and this is doubly true in low-income countries, and even more so for marginalized populations who are dealing with layers of stigma,” Brian Pence, an epidemiologist at the University of North Carolina (UNC)-Chapel Hill in the US, told IRIN.

“Every additional layer of social marginalization increases complexity and raises barriers to treatment for HIV and mental health,” he added.

According to experts, MSM are disproportionately affected by both HIV and mental illness, including depressive, anxiety and substance-abuse disorders.

Yet HIV prevention and treatment programmes fail to address adequately mental health, while mental health programmes often ignore HIV. HIV programme staff often lack training to spot or discuss the symptoms of deteriorating mental health with clients. Mental health programmes may neglect to see HIV status as a possible trigger for significant mental health conditions such as depression.

Advocates are calling for “wrap-around” care and task-shifting to community-based care providers to bridge the oft-siloed fields of care, experts say.

Heavy hidden burden

“Hidden groups like MSM are in many countries – and it is even worse when they are criminalized in some way – more vulnerable to mental health issues,” said Vikram Patel, professor of international mental health and at the London School of Hygiene and Tropical Medicine and director of the Centre for Mental Health at the Public Health Foundation of India.

The UN special rapporteur on the right to health has written that the criminalization of same-sex conduct contributes to deteriorating mental health for sexual and gender minorities, including MSM.

“State-sanctioned criminalization or pathologization of people for their sexual attractions or behaviour can only be seen as damaging in terms of mental health, and deteriorating mental health can certainly be a risk factor for HIV infection,” Patel said, adding that research on MSM and mental health in many countries is a “blind spot”.

Weak overlap

A 2012 global survey by the Men Who Have Sex With Men Global Forum (MSMGF), a US-based advocacy group, identified competent mental health care as a key aspect of successfully getting MSM to access HIV services.

“Although some men did not name their pain as a form of poor mental health, when other men described feelings of depression, all the men recognized and endorsed an urgent need to address this phenomenon,” the survey reported.

In addition to weak mental health care being a barrier to effective HIV testing and treatment for people living with HIV, mental health problems can also significantly impair their ability to continue treatment, experts say.

“We know that depression has high prevalence in people living with HIV, but the integration of mental health treatment into HIV treatment services, which are often peoples’ principal or even sole health care access point, is often minimal or non-existent,” said Pence from UNC-Chapel Hill.

Research from South Africa, where nearly 10 percent of MSM are living with HIV, suggests these gaps in care may be exacerbated by mental health providers’ stigma against HIV, and similarly, by HIV providers who stigmatize mental health illness.

According to Pence, “Poor referral mechanisms and practices between HIV treatment services and mental health services mean many HIV patients miss out on getting the mental health diagnoses and treatment they need.”


The World Health Organization (WHO) has recommended integrating mental health care into primary care for more than 30 years. However, progress remains piecemeal and even where integration has taken place at a policy level, cross-training is patchy.

But there are signs integration works.

“There is a good evidence base for the integration of psychiatric care – even staff who are not psychiatrists – into a wide range of medical settings, including HIV treatment settings,” explained Pence, referring to a method of integration known as “task-shifting” where primary care and community health workers take on specialized duties.

WHO’s 2013 comprehensive mental health action plan calls for better integration into HIV services and programmes.

According to Patel from the London School of Hygiene and Tropical Medicine, the first step should be to approach civil society groups helping MSM access HIV services “to start a conversation about mental health”.

But, he warned: “Such interventions need to speak the language of the communities they are intended to help. We have to avoid foreign psychiatric labels, for example, and talk about stressors in the environment – that way these men can connect the way they feel to their lives and their environment rather than some sense of shame.”


kk/pt/cb  source

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Have you had your soap and clean water today? .- Study links hygiene and height

Posted by African Press International on August 5, 2013

Have you had your soap and clean water today?

BANGKOK, – Soap and clean water for effective handwashing can help boost a young child’s growth, according to the firstlarge-scale scientific review to link hygiene to height – one measure of child nutrition.

While medical studies have amply proven how improved hygiene can reduce outbreaks of diarrhoea – a leading killer among children under the age of five – they have not systematically measured the impact of water, sanitation and hygiene interventions on a child’s height.

The latest study showed a “small but improved” average growth of half a centimetre among children who received clean water and soap for handwashing as opposed to those who did not. Researchers found clean water and soap reduced stunting by up to 15 percent.

There is growing scientific evidence that repeated bouts of diarrhoea reduce a gut’s ability to absorb life-enhancing nutrients that allow children to develop mentally and physically.

WASH [water, sanitation and hygiene] squarely fits under the heading of an underlying cause of malnutrition,” one of the study’s lead authors, Alan Dangour, a public health nutritionist from the London School of Hygiene & Tropical Medicine, told IRIN.

Researchers identified 14 studies conducted in low and middle-income countries that provided data on the impact of WASH programming on the physical growth of nearly 9,500 children. Included were five studies with control groups of children who did not receive clean water and soap, but who were similar in most other ways to the ones who did.

“This is a scientifically robust study design that largely removes the problems faced by observational studies,” added Dangour.

Chronic malnutrition, as evidenced by stunting (when a child is too short for his or her age group), is a leading cause of preventable mental disability and contributor to three million deaths annually of children who have yet to reach age five (45 percent of all deaths in that age group).

“Until now, we have not had a demonstration of the direct nutrition impact of WASH interventions on nutrition,” said Francesco Branca, the director of nutrition for health and development at the World Health Organization, who was not involved in the study. “This review shows that a multi-pronged approach [to solving undernutrition] is the way to go.”

Researchers noted available studies on which they base their most recent findings were short-term (with none lasting more than one year), and some had data shortcomings.

While Dangour admitted that “we need much more robust evidence to definitely state that WASH is a `cure for stunting’,” the findings are, nevertheless, important, he concluded.

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Unchained Minds: Somalis Mental Health State.

Posted by African Press International on July 21, 2013

  • By Farhia Ali Abdi

Mental health needs a great deal of attention. It’s the final taboo and it needs to be faced and dealt with” Adam Ant.

The past and present capacity:

Given the Somalia political and economic turmoil suffered during the civil war, the country’s mental health system collapsed, and mental health disorder became rampant across the country.  To date, government in Somalia does not have an official mental health plan of action to combat mental illness, rebuild facilities, and grant funding to support programs. The apparent lack of medicine, and adequately trained staff and professionals have forced families, and mental health centers to chain their patients to beds or rocks as it shows in the picture above, leaving them with permanent trauma and physical injuries.

World Health Organization (WHO) indicated in their recent study of Somalia’s mental health care that people with mental illness in Somalia face degrading and dangerous cultural practices such as being restrained with chains, which are not only widespread, but also socially and culturally accepted.  WHO further expressed that Somalia has one of the world highest rates of mental-health disorder. Approximately, one-third of its eight million Somalis are affected by some kind of mental disorder, yet there are only three trained psychiatrists in the entire country who specialize in mental illness. Psychiatry as a profession is heavily stigmatized in Somalia by both the general public and the medical community. Healing for mental problems is provided by religious leaders or by traditional healers, and it has become an ineffective method in the current Somalia society.

Historical Context:

The country established a health care system after its independence in the 1960s; however, in the 1970s, there were few noticeable achievements with the military regime run health care system such as the creation of medical schools in Mogadishu and in Hargeisa (Nursing). Nonetheless, problems within the country’s meager national health care system were exacerbated by the state’s collapse in 1991. At this time, the healthcare system suffered a major setback and forced many Somalis to go without proper health care.

In a conceptual framework, Somali culture considers mental health as one is either “crazy or not crazy.” There is no assortment of health and disease, mental health and mental illness.   People’s beliefs and understanding of mental illness are predominately spiritual and metaphysical: mental illness comes from evil spirits; it can be brought on by another person or oneself through curses or bad behavior. These beliefs, coupled with the lack of a strong plan on mental health in the government at the federal, regional, and local levels, deepen the country’s mental health crisis.  According to, a 2010 World Health Organization report: “A Situation Analysis of Mental Health in Somalia,” medical education and training of health professionals is a key issue for the health sector as a whole. There are no medical institutes, universities and schools that have an internationally recognized and standardized curriculum. The only exception is the Nursing School in Hargeisa, recognized by WHO. They further noted that, there is one private medical school in Gaalkacyo, the Gaalkacyo University, which started in 2006, the first basic training program for Assistant Physicians (three-year course). In the South, the Benadir School covers the whole South-Central Zone. Aside from Somaliland, there has been no effort to introduce curriculum focused on mental health curriculum into the basic teaching package. The lack of resources, including, medical equipment, and administer medications and treat emerging high rates of trauma-related disorders throughout the country, requires an urgent attention.

Contemporary Somali Society:

Since the aftermath of the civil war, there is an apparent change in the perceptions and stigma regarding mental health. The causes of mental illness are now understood as chemical imbalance rather than a bad spirit. Specialized mental health professionals in the diaspora and locals in Somalia brought a new approach of looking at mental illness diagnosis and treatments, and in so doing, reduce the barrier to seeking care. Their efforts are already making a huge difference in how people view mental health disorders and to seek information to improve their conditions. For example, in Mogadishu, there are few mental health facilities run by Abdirsaq Ali Habeeb. Mr. Habeeb is a Psychiatry Nurse by training and operates mental health centers to care for in patients and outpatients with the support of NGOs such as the World Health Organization and other donors. Mr. Habeeb who is living in Mogadishu goes out to the streets of Mogadishu to find chained, mentally ill persons; he unchains them and brings them to his facilities for care, thus restoring their dignity. In Somaliland, there are similar public and private mental health centers with the same patient treatments and outcomes. These facilities are sustained by the support of few donors and NGOs such as the World Health Organizations (WHO).

The new understanding of mental health illness in Somalia is partially due to the contribution from Somali diaspora professionals who are returning home.  Good example is the recent opening of Somalia Mental Health Foundation Centre in Puntland region by Dr. Abas M. Jama and his colleague Mr. Hassan M. Esse. Dr. Jama and his colleague Mr. Esse are Somali diaspora professionals and the founders of The Somalia Mental Health Foundation. Their foundation is a non-profit organization that provides services and guidance for people with mental health conditions. One of the program’s mandates is to develop adequate facilities with highly qualified mental health professionals for the diagnosis and treatment of mental, neurological and psycho-social disorder. Furthermore, the mandate states that the foundation is to set up mental health camps where psychiatric consultation and medicines are provided free-of-charge. What is unique about this particular organization is that, it is initiated and run by Somali diaspora professionals who decided to dedicate their time and effort to support other Somalis inside the country, and one that I hope others follow suit.

Dr. Jama is a well-respected Psychiatrist by training in the United States. He has a private practice in Sandusky, Ohio and specializes in adult psychiatry. He is a member of the Medical Staff of Firelands Regional Medical Center and Firelands Physician Group, Mercy Hospital in Lorain, Ohio and a member of the American Medical Association and American Psychiatric Association.

Dr. Jama recognizes the need to treat individuals who are suffering from mental illness in Somalia as a result of the prolonged civil war, and the absence of proper mental health centers to treat these individuals. Hence, Dr. Jama and his colleagues opened their first office in Qardha, Puntland, and are working their way throughout the country to treat mental illness. The facility is run by Abdiqani Abdullahi Askar who has a Bachelor of Nursing Degree and Medical Psychiatry Training Certificate. Since opening the clinic in 2011, Dr. Jama and Abdiqani have treated over 4000 patients and returned to the region twice to train nurses, educate patients and their family members, and dispense medication.

Dr. Jama’s vision in Somalia is to establish collaborative working relationships with the medical community and hospitals in Somalia in order to facilitate needed medical training to care for mentally ill patients.  The top priority for this year he said is to provide and develop educational training programs. To this end, Dr. Jama (The Somali Mental Health Foundation) in partnership with the existing Mental Health Centers in Somali such as Mr. Habeeb’s run facilities in Mogadishu will conduct a two-four week of educational course on mental illness to nurses, nurse practitioners, and aides who live in Mogadishu and the surrounding region. The training program will be offered in three different cities in Somalia. Moreover, as part of this course, Dr. Jama will train approximately 60-100 nurses and aids in Somalia in the effort to give the participants the necessary tools and knowledge desperately required to treat mental illness.

More than providing education, Dr. Jama and his colleagues are changing societal views on mental illness by helping to lessen the stigma surrounding mental illness in Somalia. By this, they are providing the platform for sufferers to seek needed medical care for their illness. In Puntland regions, the municipal officials are putting requests to Dr. Jama to train the hospital staff in order to care for patients. As seen from video clips on their website: people are lining up for treatments.  A recent interview on Somali TV, the Dr. and his colleague Mr. Esse expressed an overwhelming experience by the new patients who for the first time since their illnesses were released from their chains.Line up in front of The Somali Mental Health Foundation, Qardha center, November, 2011

Though there are no monitoring oversight bodies except for the mental health institutions that regularly monitor patients at health facilities, this is a tremendous achievement on the onset of fighting mental illness in the country.

Advocacy and Public Education and Awareness

In an interview with Al-Jazeera TV, 2011, Mr. Habeeb who runs the Mental Health Centre in Mogadishu said, “I believe there is no one with good mental health in Mogadishu or in the entire South and Central Somalia because of what is going on. Normal people will not kill and maim their own, and for such a long time.” This is true for the entire country and there are dire needs for trained and educated professionals within the field of Mental Health and on the health field in general. The 2001 UN Development Programme’s Human Development Report, ranked Somalia lowest in all health indicators except life expectancy. In its latest report, the country is not even ranked due to the lack of reliable data. Somalia needs human resources for medical health development who can deliver integrated primary health care services. The backbone of any health care system is the mental health and in order to maintain and encourage a culture in which respect and healing for the mentally ill are a priority, there needs to be an education.  The new concept of training medical practitioners as exemplified by Dr. Jama and his colleagues has been successful, and it should be considered as a viable strategy for treating mental illness in Somalia and enhancing community awareness of mental illness.

Due to the long neglect of mental health issues in Somalia, and the long-held beliefs on mental illness, the country needs Somali community organizations, and community health centers such as the one developed by Dr. Jama, Mr. Esse, and Mr. Habeeb. Somali led mental health treatment, and training is the best hope for Somalia. Dr. Jama’s actions will hopefully encourage other diaspora professionals to invest back to the country. The efforts of these professionals have led to many successes, and Somalia continues to benefit from their tireless efforts and much-needed expertise in establishing a comprehensive strategy for battling mental illness in Somalia. Creating community awareness and empowerment in the area of mental health is a key to treating the disease and with the training and support from the international NGO also, will position Somalis to further improve mental illness. The current Somali government also needs to encourage, support, and partner with Somali professionals with mental health expertise to create mutual support, conduct advocacy and influence the policy-making process in line with international human rights standards.

The way forward for mental health policy implementation is to.

  • Establish a centralized public health institution mandated in managing the Mental Health program and services in the country.
  • Integrate mental health into the primary health care services, so mental health care can be seen as an essential aspect of health care.
  • Create a clear, well communicated future vision for the healthcare system, and to consider mental health research findings that can be used most effectively in influencing the delivery of services.
  • Assist in capacity building on the community-level models of care that effectively involved in mental health treatment and delivery of services.
  • Support service providers and users alike to understand and promote human rights, recovery and rehabilitation of mental illness, and to recognize mental health as a crucial component of personal health.
  • Lastly, build and maintain a health care related database in the country.


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