There are 109 million more hungry people in poor countries now than there were just five years ago. But the answer is not more food aid, writes Pedro A. Sanchez

Sanchez's commentary "A smarter way to combat hunger", is published in tomorrow's issue of Nature

In recent decades, it seemed the struggle against world hunger was finally meeting with some success. But the number of undernourished people is growing again. According to the UN Food and Agriculture Organisation, the number of hungry people in poor countries has increased by 109 million to 963 million since 2004. Unicef estimates that each day 300 million children go to bed hungry.

Some 90% of these people are chronically hungry, meaning that their hunger is not due to a famine or war, but rather that they lack long-term access to sufficient amounts of food. Among its many deleterious effects, chronic hunger compromises the immune system, contributing to the epidemic diseases seen in poor countries. Malnutrition plays a role in the deaths of millions of children in poor countries each year.

For most donor countries, the response is to ship food aid to poor countries. While the impulse is generous, food aid is a quick fix – it fills stomachs but does not provide an enduring solution to hunger and poverty.

New evidence from the Millennium Villages project, which I direct, shows that helping farmers help themselves is more effective than food aid and costs a sixth as much. Farmers were given access to fertilisers, improved seeds, training and markets. Their maize yields more than doubled as a result. Similar results were seen in Malawi after its government provided fertiliser and seeds to farmers. In just two years, Malawi went from being a recipient of food aid to a food exporter.

It costs $812 to deliver one tonne of maize as US food aid to Africa. The fertiliser and seed that Millennium Village farmers need to produce an additional tonne of maize cost $135 on average.

Buying food aid locally, as the UN World Food Programme is increasingly doing, is another important step away from the inefficiency of food aid. Purchasing a tonne of maize in an African country costs approximately $320.

Although estimates on costs may vary, their underlying message is clear. Turning away from food aid and providing subsidies or credit to farmers in poor countries could help millions obtain their own food, begin the escape from poverty, and also meet much of the demand for food aid in developing countries – without costing more.

Fortunately, some donors are starting to shift away from food aid for the chronically hungry. The UN World Food Programme now buys some of its food aid in poor countries. The UN secretary general Ban Ki-moon is leading the development of a fund that would provide support for farmers in poor countries to grow more food. The Spanish government has pledged €1 billion over five years for this initiative, and the European parliament has committed the same amount. What is urgently needed now is an innovative financial mechanism that can deliver the funds rapidly and effectively to African governments that have shown a serious commitment to end hunger.

To paraphrase the popular proverb, giving someone a fish so they can "eat for a day" is only a solution for the most hungry who cannot help themselves or are the victims of war and famine. For most people in poor countries, we must give them the tools to fish so they can eat for a lifetime, and at one sixth of the cost.

With more programmes like this, fewer people around the world will go to bed hungry every night.

Pedro A. Sanchez directs the Tropical Agriculture Programme of the Earth Institute at Columbia University, New York, and is the winner of the 2002 World Food Prize

]]> http://www.guardian.co.uk/science/2009/mar/11/food-aid-hunger-starvation Wed, 11 Mar 2009 18:00:00 +0000 Politics: Development | guardian.co.uk Kenyan businesswoman June Arunga on how negative stereotypes of Africa are hurting investment in Africa (from the recent Aid Watch conference at NYU):

June Arunga on Western Attitudes Towards Business in Africa from DRI on Vimeo.

Gordon Brown yesterday promised that Britain would keep its pledge to raise its overseas development aid budget to an internationally agreed target of 0.7% of national income in spite of the growing budget deficit.

Britain, along with other G8 countries, promised at the Gleneagles summit in 2005 to raise aid spending to that 0.7% level by 2013 and as a result the Department for International Development has the fastest growing budget of any Whitehall department.

"And let me say that whilst there maybe others who are tempted to shy away from their responsibilities, we in Britain will meet them - and we will keep our promises on aid," Brown told a DFID conference on global poverty in London.

Brown has long been an advocate of greater aid flows and debt forgiveness for the world's poorest countries, so reneging on Gleneagles was always unlikely. But many other countries have slipped back on their pledges, something campaigners fear will become a growing problem as governments spend hundred of billions on bailing out their banking systems.

Writing in today's Guardian, the chancellor, Alistair Darling, points to an estimate from the Institute of International Finance that capital flows in 2009 will fall by 80% compared with their 2007 peak.

The IMF has also identified 26 countries which are particularly vulnerable to the crisis, while central and eastern European economies are estimated to face a financing gap of $100bn in 2009.

"While governments understandably are focused on what happens in their own economies, we should not lose sight of the particular problems being faced by emerging market economies and developing countries," writes Darling.

"These countries are most at risk from the global withdrawal of credit. And the response of the international community represents one of the key tests of our resolve to tackle the financial crisis."

The development secretary, Douglas Alexander, said the British government was determined the G20 summit would ensure rich countries kept their pledges on increasing aid flows so that the Millennium Development Goals had a chance of being met.

"We must continue our unwavering support for the MDGs. This must be the focus of the G20 summit," he said.

]]> http://www.guardian.co.uk/politics/2009/mar/10/brown-aid-budget Tue, 10 Mar 2009 00:01:00 +0000 Politics: Development | guardian.co.uk http://www.dfid.gov.uk/news/files/dfid-conf.asp Mon, 09 Mar 2009 14:34:11 +0000 Delicious/tag/DFID http://www.dfid.gov.uk/news/files/kenya-knowzone.asp Mon, 09 Mar 2009 00:00:00 +0000 DFID | News http://www.researchintouse.com/downloads/RIU_policybrief_10.pdf Thu, 05 Mar 2009 13:58:09 +0000 Delicious/tag/DFID

The piece below was written by Harper McConnell, the US Director of Development for HEAL Africa. She spent two years in Goma, DRC, and is now based in Seattle. 

As mentioned before, too many - far too many - posts about rape simply focus on women as passive victims.  This piece is the third in a series by HEAL Africa, which focuses instead on how one aid agency is working with rape survivors and communities to respond to this crisis. Part one is here, and part three is here.

To read more about the causes, consequences and responses to mass rape in Congo, see here.

Community-Driven Responses to Rape in Congo

In addition to peace, the development of human infrastructure is necessary not only to reduce the pervasiveness of sexual violence, but also to cope with the impact the violation imposes on both the woman and the population. By training and investing in community members who can play integral roles in the healing and prevention processes, HEAL Africa aims to make gender-based violence an issue that the community must tackle; not just a problem that a woman must deal with on her own.

Charlotte Riziki fled her hometown of Masisi with her three children and her husband while she was pregnant during the second Congo war. She was a schoolteacher in Masisi and her husband was a tradesman. When they reached Goma, the provincial capital, they had nowhere to stay, no money, and were surrounded by other refugees in the same position. Her husband decided to join the army with the hopes that he could somehow provide for the family. He was sent to a different province and two months later Charlotte received notice that he was killed.

She now had four children and was unable to feed them everyday. Before the war, she and her husband had no problem providing for the basic needs of their family, but now Charlotte did not know how they could survive. A woman in her church told her about a widows’ group that met to encourage and pray for one another. It was there that Charlotte met several widows who were HEAL Africa counselors who had dedicated themselves to helping women who were survivors of sexual violence.

Charlotte impressed the counselors with her gentle, yet determined demeanor despite her tragic circumstances. They asked her to come to a counselor training session at HEAL Africa. After the training, she was hired as a counselor to supervise a Safe House that provides shelter, counseling, literacy, and vocational training for survivors of sexual violence. After 5 years of working with HEAL Africa, Charlotte now owns a house, pays for all of her children to attend school, and is a source of strength and wisdom for women who are treated at the HEAL Africa hospital for rape and labor-induced traumas.

She is one of the 320 counselors trained by HEAL Africa to identify and assist survivors of sexual violence. She now works at the hospital, counseling patients who are waiting for fistula repair surgery. At any given time there are 120-150 women waiting for fistula repair, a condition induced by either brutal rape or lack of pre-natal care and labor complications, causing incontinence. The hospital specializes in fistula repair and orthopedic surgery and performs more than 1000 operations a year with a staff of 18 Congolese doctors and 48 Congolese nurses.

Fistula is an isolating condition, shaming the woman for her inability to give birth and for the obvious hygienic issues associated with incontinence. Not only this, but the majority of women from rural areas support themselves through agrarian means. But, a fistula makes it incredibly difficult to spend hours in the field. So, while they are at the hospital they have the opportunity to participate in a program called Healing Arts that provides sewing classes, literacy classes, and small business and financial training. It provides them with a way to make money during their stay by sewing Healing Arts products which are sold in Congo and North America, equips them with skills that are applicable for their life at home, and most importantly creates a space where physical and emotional healing is possible.

When a woman returns home from the hospital she receives a micro-grant to continue with the skills she learned. She returns not only physically healed but also with confidence in her capacity to support herself. But, just as important is the community’s response to the woman when she returns and what they are trying to do to prevent sexual violence.

The Nehemiah Committees, as mentioned in part one, are community committees made up of 10 leaders from different religious denominations and tribes. HEAL Africa works with 70 committees who are charged with doing what they think is necessary to reduce sexual violence in their areas and direct those who have been violated to appropriate medical care. The Nehemiah Committee members bring this mandate into their respective faith communities and have open dialogue about attitudes and treatment towards women and what needs to change for the health of the community. They refer women to Safe Houses, and even care for women within their own homes and churches.

Enabling the community to be part of the healing and prevention process is the crucial element in fighting sexual violence. The effects of the violation of a woman ripple throughout the whole community and change will come slowly as more and more people like Charlotte Riziki and the members of the Nehemiah Committees come together in solidarity to protect women, the core of the society.

What You Can Do

-Find out more about how to support HEAL Africa’s work at www.healafrica.org

-Ask your representative to support House Resolution 1227 condemning sexual violence in DRC and calling on the international community to respond. Click here for the letter.

[Photo of Charlotte Riziki, HEAL Africa sexual violence counselor]

Our group has campaigned to give the continent's brightest minds more of a say, writes Edith Jibunoh

Dambisa Moyo blames aid for Africa's ills, the subject of her new book Dead Aid ('Everybody knows it doesn't work', 19 February). I do not want to question Moyo's motivation; she argues from a sense of passionate conviction born of frustration at the poverty in our continent. But her polemic ignores or misrepresents many facts.

"Aid has been, and continues to be, an unmitigated political, economic and humanitarian disaster for most parts of the developing world," she says, while dismissing the campaigning efforts of Bono and Bob Geldof as "glamour aid".

We at One, the advocacy group founded by Bono, have never argued that aid is the only answer to Africa's development. Rather we have said that, managed properly with a clear exit strategy, aid has a useful role to play in some countries.

The evidence is out there to see: more than two million people in Africa on life-saving antiretroviral Aids drugs; 34 million more African children going to school for the first time; malaria deaths halved in Rwanda and Ethiopia. All this has happened within the past decade thanks to a combination of increasingly effective aid and improved African leadership.

Moyo argues for all aid to be cut off within five years: "I'm pretty sure most families would be willing to make the sacrifice." Well, I'd like to invite her to some of the villages I've visited recently to see if people there concur.

The irony is that we and many in the development community agree with Moyo on a great deal. Yes, "good governance" and "transparent institutions" in Africa are essential. Yes, trade is more important than aid in the long run. And yes, China is playing an important role in Africa. Moyo is also right to point out that the government aid system needs serious reform to make it more efficient and to give Africans more of a say. These are all things we have campaigned for.

The trouble is, none of Moyo's "alternatives" to aid are panaceas - they are complementary measures at best. She argues that African countries should look towards other sources of finance. "Where private capital trumps aid every time is on the question of governance," she says.

We can only assume that the ink on her manuscript dried before the global economic crisis. The Ghanaian finance ministry, for example, recently had to postpone its bond issue. There is no credit available in Africa. And even if there were, why would finance raised through bonds necessarily be used any more effectively than aid? It comes down to each country's governance.

Moyo goes seriously awry when she suggests that the activism of Bono and Geldof has displaced the voices of "well-spoken, smart African leaders". This is plain nonsense and has angered many Africans. She could talk to our advisory board, which includes some of Africa's brightest minds, including Kenyan anti-corruption campaigner John Githongo.

I wish Moyo could have used her whirlwind book tour to take on the real villains in this piece - such as the arms dealers fuelling Africa's civil wars, or the multinationals fostering corruption by paying massive bribes. Now that would be a polemic worth reading.

• Edith Jibunoh is an economist, and senior Africa manager for the campaign group One
edith.jibunoh@one.org

]]> http://www.guardian.co.uk/commentisfree/2009/feb/25/africa-development-aid Wed, 25 Feb 2009 00:01:00 +0000 Politics: Development | guardian.co.uk

[Afghanistan's Missing Millions - A video report by the Guardian]

I was tempted to title this piece "Journalist Discovers Aid Agency Corruption in Afghanistan, Expresses Shock", but was afraid that title was a wee bit long.  Anyhows, in a recent video produced by the Guardian newspaper (above), their reporter highlights aid agency - and in particular UN - corruption in Afghanistan.

In an appropriately somber voice-over, he uses a decrepit hospital in Kabul to highlight how aid agencies have misspent donor funds, concluding: "This is why hearts and minds are being lost in Afghanistan."

The violins in the background are also a nice touch.

First, credit where credit is due.  Nothing wrong with highlighting the obvious - namely that corruption is a definite problem when it comes to humanitarian and relief work, and one which is all too often swept under the rug.

(I would imagine that, in the hierarchy of NGO management nightmares, a corruption scandal comes in third, just after reports of staff trading aid for sex, or staff running drugs and guns.  Though the latter can occasionally be excused as an innovative source of unrestricted funding.)

According to a 2008 report by Transparency International, "Corruption was generally perceived as an unavoidable part of the emergency environment and the prevention of corruption was often considered as just another routine part of doing business."

Which is really only shocking until you've actually tried to work in a place like Afghanistan.  Not to excuse corruption, but at some point we all make an accommodation with reality, usually of the see-no-evil variety.  Especially if all the paperwork and invoices appear to be in order.

The problem with the Guardian piece isn't that it highlights aid agency corruption - though picking on an Italian NGO (in this case Intersos, which was responsible for the hospital renovation) is a bit like picking on a special-needs student.

At the same time, I'm all for criticizing the UN, which also bore responsibility for the hospital project in Kabul.

That said, pointing out that the UN is inefficient and hypocritical - in this case, decaying hospital contrasted with beautiful new UN offices - is not exactly blazing a new journalistic path.  Sort of like trying to hit the wide side of a barn.

(Further, the fact that the reporter doesn't seem to understand the difference between aid agencies and private contractors is depressing, but so it goes.)

I can live with cliches, and the occasional inaccuracy; naivete bothers me far, far more.  In this case, the reporter's willingness to showcase Afghan Government officials complaining about aid agency corruption without once looking into whether, say, the Afghan Government might be partly to blame.

Perish the thought.

According to the reporter: "The Afghan Government has finally had enough.  They are now openly accusing the United Nations of corruption."

Pot, meet kettle.  Both black.

On a whim, I decided to google "corruption by Afghan Government".

Let's see - the New York Times ran a story in January entitled Bribes Corrode Afghan's Trust in Government.  The article minces few words:

"Kept afloat by billions of dollars in American and other foreign aid, the government of Afghanistan is shot through with corruption and graft. From the lowliest traffic policeman to the family of President Hamid Karzai himself, the state built on the ruins of the Taliban government seven years ago now often seems to exist for little more than the enrichment of those who run it.

A raft of investigations has concluded that people at the highest levels of the Karzai administration, including President Karzai’s own brother, Ahmed Wali Karzai, are cooperating in the country’s opium trade, now the world’s largest...The corruption, publicly acknowledged by President Karzai, is contributing to the collapse of public confidence in his government and to the resurgence of the Taliban, whose fighters have moved to the outskirts of Kabul, the capital."

When the Guardian confronted Bruce McCarron, the Director of UNOPS Afghanistan about the hospital, he blamed the Afghan Government for failing to provide maintenance.  According to McCarron: "What we would question...has there been any maintenance been done on the facility in the last five years?"

A suggestion which the Guardian piece gives short shrift.

Why do I care?  Certainly, the report is right, that there are massive inefficiences and often corruption in UN and NGO activities.  At the least, there's more than enough blame to go around.

Yet these situations are complicated, they're always complicated.  And simplistic analysis - whether it's in Afghanistan (aid agencies bad) or Darfur (Arabs versus Africans) - invariably leads to simplistic recommendations, and simplistic policies.

If we don't even understand the problems, then it's hard to see how things are ever going to improve.

[The video above is a shortened version of the Guardian report - the full version is available here.]

Road and rail infrastructure improvements aim to boost trade and counter growing Chinese influence on continent

Britain is joining the latest scramble in Africa – to reverse decades of decay and even the disappearance of large parts of road and rail systems – with a $1bn (£690m) project to rebuild the transport network across the south of the continent.

The UK today announced an agreement with eight African countries and the World Bank that will see the reconstruction of 5,280 miles (8,500km) of roads and the rejuvenation of 373 miles of railways, including some new track and the upgrading of border posts.

Britain says the decade-long project will boost trade in the region by hundreds of millions of pounds each year by speeding up transport times, including at border crossings where lorries can wait for days to be allowed through.

The initiative is part of a web of investments and reconstruction plans that have taken hold across Africa in recent years, on a scale unseen since the road and rail networks were first laid down by European colonisers. They include massive Chinese construction programmes that have unnerved western countries, which fear loss of trade and influence on the continent.

The international development minister, Gareth Thomas, today told a business conference that trade routes across central and southern Africa could be "revolutionised" by the UK's north-south corridor initiative to rebuild the transport infrastructure in six former British colonies – Zambia, Zimbabwe, Botswana, Malawi, Tanzania and South Africa – as well as two other countries with close trading ties to them, Mozambique and the Democratic Republic of the Congo.

Thomas said that the intiative would initially boost regional trade by 10%, and eventually by 50%.

"Africa's share of global trade fell from 6% to 2% between 1960 and 2002, and high transport costs are a major reason for this," said Thomas.

"Farmers and businesses operating in landlocked countries such as Zambia, Malawi and the Democratic Republic of the Congo face transport costs up to 50% higher than coastal countries.

"As a consequence, their trade volume is 60% smaller. Without a better route out, supermarkets and traders are missing out on quality produce and African communities are missing the chance to trade, create more jobs and, in turn, feed themselves and school their children."

A large part of the road and rail infrastructure inherited by newly independent African countries about 50 years ago has fallen into disrepair. In some states, most notably Congo, it has largely disappeared.

Under Mobutu Sese Seko's negligent and plunderous rule, much of the Belgian-built road system was buried under rainforest or destroyed by heavy lorries and lack of maintenance. Travelling just 60 miles drive from the capital, Kinshasa, can take about eight hours.

Congo, a nation nearly 10 times the size of the UK, has just 1,400 miles of paved roads – less than a tenth of what existed at independence and not enough for even a single road from one side of the country to the other.

The decline has been less marked in countries such as Tanzania and Zambia, but over the years lack of maintenance has seen the road system worn away and the railways becoming increasingly decrepit and unreliable. Zambia has 12,500 miles of paved roads but they are riddled with potholes.

Mozambique's infrastructure was wrecked by civil war, sponsored by apartheid South Africa, while the rail network has fared little better. The famed Benguela railway across Angola ground to a halt because of the civil war and foreign invasion, meaning much of it was destroyed.

Britain is expected to put about $100m into the project initially. It will focus on linking inland trade routes with ports in Tanzania, Mozambique and South Africa, where Durban and Port Elizabeth are the principal gateways for many of the goods moved in and out of southern Africa. China has already had a major impact in other African countries, including Mozambique where it has built thousands of miles of new roads. Other recent initiatives have revived part of the region's railway network – one of the first was the route from Durban, across Zimbabwe and into Zambia at Victoria Falls. It ends at the major mining town of Ndola.

It took a lot of money and nearly a decade to make the three rail networks function together, but the end result is that a freight train now takes about three days to run from Ndola to Durban. It used to take more than a month.

]]> http://www.guardian.co.uk/world/2009/feb/19/africa-transport-network-britain Thu, 19 Feb 2009 09:23:52 +0000 Politics: Development | guardian.co.uk

A new study recently came out, tracking fatal attacks against aid workers from 2002 to 2005.  Which is a rather grim business, to be sure - the research equivalent of slowing down to stare at the scene of an accident.

Of course, I'm little better, as this blog has regularly tracked similar statistics.  And, in a sign of far too much free time, just spent a rainy LA afternoon looking up previous studies on the same topic, to get a sense of overall trends.

Or, put another way, is aid work getting more dangerous?  What's a greater risk - auto accidents on third-world roads, or that kohl-eyed insurgent clutching his kalashnikov?

And, finally, who tends to get shot?  The expatriate from the States or Europe, or the national staff-member who's lived in the area all his life?

First, as to the trends -  in the 1980s and 1990s violent attacks accounted for less than half of all aid worker fatalities; today, they account for more than 50% of all aid worker deaths.

According to the study Deaths Among Humanitarian Workers, from 1985 to 1998 only 39% of all deaths were due to intentional violence.

That percentage rose over significantly over the last decade.  A study by Dennis King - Paying the Ultimate Price: An Analysis of Aid Worker Fatalities - looking at the period from 1997 to 2001 found that "more civilian humanitarian aid workers were killed by acts of violence than died in vehicle and aircraft accidents."

According to the most recent study - "Violence related mortality and morbidity of humanitarian workers" (a powerpoint presentation of which is available here) - looking at the period from 2002 to 2005:

"Intentional violence accounted for 55 percent of all deaths reported, followed by coincidental illness (27%) and accidents (15%)."

(This study also found that 61% of all attacks occurred while staff were traveling to and from project sites.)

So, whereas twenty-five years ago a drunken truck driver was the main menace, now it's the Taliban, or Al Shabab in Somalia, or other similarly wild-eyed insurgents.

According to Providing aid in insecure environments - the most comprehensive report on the subject - the number of "reported major acts of violence" against aid workers increased 92% between1997-2001 and 2002-2005.

(This was somewhat counter-balanced, however, by the fact that the total number of aid workers in the field increased by 77% over the same period.)

Overall last year, at least 89 aid workers were killed - for comparison's sake, Dennis King recorded 141 aid worker fatalities between 1997 and 2001, for an average of just over 35 a year.

That said, the most list of most dangerous countries has changed over the last decade.  The four most dangerous countries for aid workers last year were, in order, Somalia, Afghanistan, Darfur and then Chad.  For the period 1997 to 2001, the four most dangerous countries were Angola, Sudan, Rwanda and Afghanistan.  (Somalia came in fifth, just missing the cut.)

One thing that hasn't changed, however - it's far more dangerous to be national staff than to be an expatriate.

From 1997 to 2001, the vast majority of those killed (74%) were national staff.

If you extend the range from 1997 to 2005, then 78% of all aid worker victims were national staff.  On the other hand, according to the most recent study, expatriate staff were far more at risk from illness than from armed attack.

(Again, though, it's important to add that national staff far outnumber expatriate staff in the field.)

Finally, another thing that hasn't changed is the lack of security training that agencies provide to their staff.  According to In the Line of Fire, a 2004 report by the Centre for Humanitarian Dialogue, only 30% of expatriates and 14% of national staff said that they'd received security training from their organization.

In a completely unscientific poll I conducted earlier this year of aid workers in Afghanistan, Somalia, Sudan / Darfur and West Bank / Gaza, almost none had received any security training before going overseas.  About half had received either training or a security briefing once they arrived in-country.

[Somali militiaman overseeing a food distribution - Photo from AP]

To wit - Battling It Out At the Gym, which appeared in the Guardian back in December, about the dangers of asking recommendations for a western-style gym in Ramallah.

As Seth Freedman wrote in the article:

"Despite inauspicious beginnings, I am generally well-disposed to the legions of aid workers who flock to the occupied territories to alleviate the suffering of the local populace. Their cause is just, their aim is true – regardless of the brickbats hurled their way by the likes of NGO Monitor and other such detractors. Dropping everything in their home countries and relocating halfway round the world to help those who can't help themselves are qualities that ought to be admired by anyone with an interest in promoting global tolerance and goodwill among men.

However, there are occasions when, even with the best will in the world, those who have so selflessly devoted their time and energy to fighting the good fight show their true colours in the most alarming of ways. A case in point is the raging battle that developed on the RamallahRamallah mailing list this weekend, in response to a fairly innocuous, run-of-the-mill inquiry by one of the group's members.

"Is there a proper, western-style gym in Ramallah?" began the query. "If so, where is it?" Nothing too provocative there, although in the uber-sensitive forum of the aid workers' foreign legion, such a turn of phrase was always going to be a red rag to this particular herd of bulls. And so it proved, with a two-pronged attack immediately launched by a pair of disgusted-of-Scandinavia respondents:

"You forgot to add: 'where only white people go,'" spat one girl. "So it can't be 'proper' if not 'western-style'? If you miss western styles that much, get your ass out of here and keep it in your western world." Heady stuff, but nothing compared with the next outburst: "What's a 'proper, western-style gym'? Something like 'proper, western-style democracy'? Anyway, I'm sure/hope you didn't mean to offend – there are lots of nice gyms in Ramallah … and if you adjust your words/attitude you might even make some A-rab friends there."

With the bit between their collective teeth now, more outraged members dived into the fray, determined to stamp out the spectre of racism and colonialism that they feared was haunting their site, and their community at large. "While I am not a historian of gyms, I do think that the TV and machine 'style' of a modern gym could fairly be attributed to the western world," posited another, more contemplative, poster, before attempting some armchair analysis of the original user's mindset. "Quite what a non-western-style gym would be I'm not sure, and it may have been this fear of the unknown that led to the selection of the adjective.""

To read the rest of the article, see here.

[Bodybuilders at the Oxygen gym in Ramallah - Photo from AP]

Jane Alubo, 18, a resident of Ojom village in Katine, is seven months pregnant and has to walk more than 10km to the antenatal clinic. Then 10km back again.

She requires regular check-ups to ensure a normal pregnancy, but cannot get the services from anywhere nearer her home.

At the state-owned Ojom health centre,which Alubo attends, the equipment necessary for a safe delivery is not available and there is only one midwife attending to deliveries each day.

The health unit was built with funds from the World Bank and the Ugandan government five years ago and supports a population of about 15,000 people spread over three parishes.

Another health centre - Tiriri health centre in Katine village - where Alubo could get referral attention in case of complications is about 20km away. But even there the facilities will not be adequate. Gynaecological services at all government centres are insufficient and better attention can only be found at the district hospital in the nearest town of Soroti, about 30km away.

"But how does a pregnant woman with difficulties in giving birth to a baby get referred to the main hospital," asks Alastair Robb, a health adviser from the Department for International Development (DfID) Uganda, who, along with his colleague, George Turkington, visited Katine last week.

An ambulance attached to the Tiriri health centre, where minor ailments are handled, has broken down, putting pregnant women in Katine at a higher risk of stillbirths and death in childbirth if complications arise.

The ambulance was secured through the World Health Organisation as part of the government's safe motherhood programme to improve the care of pregnant women in rural areas. The programme has not lived up to expectations.

"When a complication arises with a pregnant mother, an ambulance is called from the main hospital at a fee that is used for fuelling it," says the nurse in charge of Ojom health centre, Lucy Ariamo. Most people do not have the money to pay for fuel.

"I admire your work. You make the people [of Katine] healthy despite the hard conditions you are going through," Robb told health centre staff.

This year the British government will give Uganda £70m in aid. As a key development partner in the country, Turkington, who is head of DfID Uganda, and Robb were keen to know how local governments were managing decentralised health service and get a better understanding of how the funds they had been contributing towards improvement of health services was being utilised.

The Ugandan government, through its "minimum healthcare package", wants to meet basic healthcare needs at grassroots level, but this has yet to be successfully achieved. The major constraints have been lack of qualified staff at the health centres, inadequate funding for healthcare, lack of accommodation for medical staff and poor pay – health workers can expect to be paid around Ugandan shillings 200,000 (about $100) a month.

"Primary healthcare development grants extended to the districts for purchase of drugs for the village health units have not also been adequate," the district director of health services, Charles Okadhi, told the DfID officials.

Turkington said work in Katine being conducted by the African Medical and Research Foundation (Amref) appeared successful, but added that basic health needs could not be met without a strong partnership between the private and public sectors.

Robb and Turkington said health provision in most parts of the country they had visited was poor.

Both were particularly touched by the fact that ambulance services for most health facilities were either inadequate or completely unavailable.

Robb was also concerned that the Ugandan government had not provided an adequate and sustainable drugs supply to village health centres, like that in Ojom.

Both were keen to advocate for increased funding to enable more drugs to reach the lower end of the health chain – the village centres - especially anti-malaria drugs for expectant mothers and children.

But changes to how drugs are procured will be needed for Katine to benefit from any extra money.

]]> http://www.guardian.co.uk/katine/2009/jan/30/george-turkington-visit Fri, 30 Jan 2009 00:01:00 +0000 Society: International aid and development | guardian.co.uk