Thursday, February 18, 2010

IN THE RACE TO TREAT GLOBAL AIDS ARE WE PUTTING THE CART BEFORE THE HORSE?

‘The drugs are now expiring in our stores across the country because we seem to be pushing to have them but don’t have the expertise to clinically dispense them to the multitude who need them’ a medical doctor in the busy national referral hospital of Mulago in the Ugandan capital, Kampala tells this reporter as he struggles to clear a seemingly endless queue in front of his office in the biting Kampala sun.
Due to increasing international partner funding, anti retroviral drugs are increasingly becoming available in the developing world. International funding such as that from the Global Fund on HIV/AIDS,TB and malaria , the billion-dollar United States President Emergency Fund of AIDS relief programme and access initiatives such as those supported by the Clinton Foundation have made anti retroviral drugs widely available albeit at mostly urban health centres in the developing world.
In Uganda, despite reaching 42% of the population in need of Anti Retroviral Therapy in 2005, the number of those in need of Anti Retroviral Therapy continues to grow each year. It is estimated that there were 270,000 HIV-infected people eligible for anti retroviral therapy in 2007; this number is projected to reach 332,000 in 2012 . The most current figures as of September 2008, from the Ugandan Health Ministry are: 1.1 million infected; 357,000 in need; 43% on active treatment.
But in countries such as Uganda, questions remain regarding the capacity of the health care systems to scale up access to anti retroviral drugs. A few years ago it was reported in East African newspaper that $ 700,000 worth of drugs had expired in Uganda’s National Medical Stores and similar reports, more recently have run in the government-owned daily ’The New Vision’ with reports that some government drug stores across the country were reporting expiry of stocked anti retroviral drugs when thousands of clinically –eligible patients in Uganda are still waiting their turn to access these life-prolonging drugs.

Several recent studies in academic journals suggest that fiscal funding for AIDS treatment is no longer the most important barrier to access to antiretroviral drugs and that health systems in developing countries are the gravest impediment to accessing anti-AIDS drugs to the millions who need them. The notion that financial resources alone will not bring about accelerated access to AIDS treatment in resource-limited settings was emphasized further in a survey conducted in July of 2008 in six countries including Uganda by the International Treatment Preparedness Coalition (ITPC).
Some observers contend that even if these drugs were suddenly sufficiently available, there wouldn’t be sufficient capacity to absorb them and dispense them to those who need them as concluded in a study led by Dr Konde- Lule a renowned Ugandan AIDS researcher based at Makerere University

Analysts suggests that there are two conflicting schools of thought with one suggesting that scaling up access to ARVs is possible like has happened in Brazil while the other school argues that health care systems in developing countries don’t have the capacity to mount ambitious national AIDS treatment programmes due to institutional resource constraints. It is shown for example that there is a severe deficit in the health workers available to manage Anti Retroviral Therapy in developing countries which has compounded an already existing shortage of medical workers owing to many factors which include brain drain and uncompetitive reward systems.
It has been estimated that while Africa has 25% of the world’s disease burden, it has only 1.3% of the world’s health work force.

The absence of national laboratory networks to manage disease diagnosis-the first step of AIDS treatment, as well as unavailable CD 4 count machines all pose questions as to the feasibility of implementing ambitious AIDS treatment regimes in the developing world .An ART adherence study conducted in Botswana and Tanzania led by University of Amsterdam’s Dr Anita Hardon found a lack of laboratory facilities to conduct CD4 counts at the study sites visited . There was a lack of prescribing capacity in several health centres since they didn’t have diagnostic equipment .The study found that patients had to wait two weeks before they could be put on therapy owing to delays in diagnostic tests.

Interviews with regular clinicians at the fore front of treating AIDS in Uganda suggest the need to question the institutional assumptions underlying contemporary international AIDS treatment funding priorities. Should ARV drugs themselves be the current focus of drugs access initiatives or should the institutional resource base for administering them be the prerogative? A question whose answer would be critical to international bodies such as WHO,UNAIDS,UNICEF,PEPFAR,The Global Fund, The World Bank etc. As well as national governments in AIDS- ravaged countries,NGOs,HIV/AIDS advocacy networks and of course the millions living with HIV/AIDS .In the race to treat global AIDS, are we putting the cart before the horse? Drugs or health systems which should come first?

Tuesday, December 22, 2009

ARE REPORTS OF THE DECLINE OF U.S. GLOBAL POWER EXAGGARATED?

‘More than any other nation, the United States of America has underwritten global security for over six decades-a time that, for all its problems, has seen walls come down, markets open, billions lifted from poverty, unparalleled scientific progress, and advancing frontiers of human liberty’ President Obama, in a recent speech ,reflected on the US’s role in the world in the past half century.
But is the United States’ global power, influence and leadership on the decline? Persistent voices from strategic think tanks around the world and from within the United States it self suggest that there is an emerging consensus that US global leadership and its global hegemony in general is severely under threat and slipping steadily.
British academic, Martin Jacques has authored a new book with a telling title When China Rules the World: The End of the Western World and the Birth of a New Global Order he estimates that over the next half-century, China will emerge as the world’s leading power and that there is a shift of power from the west to the East. Analysts project that by 2025, Asia will be home to three of the five largest economies in the world.
In another thoughtful piece, Japanese analyst Hitoshi Tanaka, author of The Crisis of Global Governance and the Rise of East Asia argues that US leadership of the world has slipped for reasons that include the disastrous foreign policy of former US president George W. Bush, including the costly invasion of Iraq, the continuing costly war in Afghanistan in military and economic terms which Newsweek’s Fareed Zakaria estimates will cost $ 2 Trillion by the end 2011, have taken their toll. Nobel Prize economist Joseph Stiglitz puts the cost of the US debacle in Iraq at $ 3 trillion.
One would add that the current global financial crisis and the declining US economy have not helped matters either and exposed the vulnerability of the US economy which has reportedly shrank – the engine of US geopolitical capability and prestige.
‘The US’s net external debt climbed by more than $1.3 trillion in 2008 alone and is expected to reach almost $ 3.5 trillion by the end of this year. ..Unless the U.S. quickly achieves and maintains a sustainable economic position, its ability to pursue autonomous economic and foreign policies will become increasingly compromised’ notes Fred Bergsten in Foreign Policy.
The US has borrowed excessively from China to finance President Obama’s stimulus measures to shore up the US economy which is showing faint signs of revival.
TIME magazine reports that the US owes China $ 763.5 billion in US Treasury department debt.
Signaling an emerging new world order, China has publicly called for the replacement of the United States dollar as the world’s reserve currency owing to perceptions of a long-term weakening US economy. China has threatened to introduce a new global reserve currency called’ the renminbi’ to replace the US dollar. China’s increasing importance is exemplified in its influence in the current global financial crisis. it is viewed as the ’primary driver of global economic growth’. Indeed recently reported economic growth in China was interpreted as a more optimistic outlook for the rest of the world economy.
According to Newsweek China is slated to surpass Japan this year as the second largest economy in the world.
The rise of China, analysts suggest, has altered the world order and will see the declining influence of the Group of 8 countries (G8) of US, UK, Canada, France Germany, Italy, Japan and Russia and in their place the G2, China and US. President Obama has said that Washington and Beijing will shape the 21st Century.

In regard to the U.S. and China, Daniel Drezner talks of the former and later respectively as ‘a declining hegemony with the willingness but not the capability to act as the global leader, combined with a rising power with the capability but not the willingness to act as a global leader’.
I would add that the rise of Arab states such as United Arab Emirates and Qatar with their burgeoning financial muscle from oil wealth and astute economic policy have added another dimension to the global balance of power scene. Arab financiers have bought a handful of English Premiership football clubs such as Manchester City and Portsmouth. It was reported that an Arab consortium bought a 25% stake in Germany’s Mercedes Benz group. In Uganda, telecom giants Zain and Warid are testimony to the growing financial influence of the orient in world business.
So, is US power really on the decline? Mark Twain, a writer, was prematurely announced dead and on reading his obituary remarked thus ’The reports of my death are greatly exaggerated’.

Monday, November 30, 2009

The Dream of One East Africa is a Distant one

The East African common market was signed in Arusha,Tanzania a few days ago but as I noted during my travels through East Africa recently the road to one East Africa is still a long one.
The East African community doesn’t apply here, the immigration official at this Northern Tanzanian airport barked out at my attempt to seek a more East African reception with my Ugandan passport as I processed my entry into Tanzania recently. My illusion of a concretising vision of one East Africa was swiftly and rudely dashed. I decided to take a road trip back from Arusha to Kampala on return to see for myself how the dream of one East Africa is shaping up and was instead greeted with four immigration desks within Kenya and Tanzania. Waiting at any of these desks doesn’t make you feel any less foreign than say, the Australian standing next in line. The sense you get travelling in East Africa particularly in Kenya and Tanzania is that ordinary citizens in these countries don’t share the passion of their national leaders or at least their rhetoric when it comes to integrating into one East Africa.Even the strategic importance of one East Africa and that this drive for one East Africa is largely a top down vision which hasn’t yet found popular acceptance among your regular East African. Mobilising popular support among the citizenry of the member countries will be critical to any integration efforts. It should not be taken for granted that East Africans are for one East Africa. The current leaders are transitory and for this vision to be sustainable it has to take root within the populations of the member countries. The East African, in its latest issue, reports that Uganda manufacturers are making efforts to stall the East African common market for as long as they can because they loath the ‘blue band’ effect or the avalanche of Kenyan products in their domestic markets once the East African common market comes into effect. Tanzania has already put road blocks on the proposal for an East African common market. The future is in integration because small states are not viable and can no longer compete in an integrating world with countries the size of India and China which is why the Europeans are pushing for the highest possible union among themselves amidst these global blocks. I often find it ridiculous that a country the size of Uganda will compete on the same terms with countries such as the United States or China at the Olympics, the World Cup and yes, at the World Trade Organisation or at the United Nations given their clearly superior resource pool, economic, human and otherwise. That a country with the clout of Germany or France will seek strength in the wider European Union only tells you that countries like Uganda or Kenya need the East African community because on their own they can’t compete favourably. The current African political boundaries were established as a colonial convenience during the scramble and partition of Africa and countries such as Rwanda and Burundi were carved out as tokens to Belgium and in the case of DR Congo, as personal property of Belgian King Leopold. Most current African states have small markets that can’t support their home industries.Travelling in East Africa also illuminates the infrastructural impediments that stand in the way of the realisation of the full potential of integration. Only a leadership failure to grasp the strategic questions confronting their countries would explain why the road from the border town of Namanga in northern Tanzania to the now regional town of Arusha is not tarmacked. This road is clearly a lifeline for north-eastern Tanzania. For starters, Nairobi, in geographic proximity terms, is nearer Arusha than Dar-es-Salaam. On the way to Arusha, you meet several petroleum and other goods' trailers from Nairobi pointing to the economic importance of this route but you will be surprised that this route is not tarmacked. Paradoxically, it is easier to call Britain from our countries than say Burundi. In the words of Martin Luther King, ‘I have a dream’ that one day East Africans will walk the same road as fellow countrymen and realise that their destiny is one and the same.

Monday, November 2, 2009

Michael Jackson's 'This is it'-A Review

Even the high end on-line movie reviewer Rottentomoes.com didn’t have an advance review. I had heard that the movie was coming out and that AEG the guys who had hired Michael Jackson for the mind-boggling 50 shows in London had sold their rights to SONY pictures. My first instinct was that Sony wanted to make a buck on the back of the global outpouring of emotion that followed Michael Jackson’s untimely death.
I always trust Rottentomatoes whenever I need a quick opinion on a new movie. They even award percentage scores and declare a movie fresh or otherwise depending on the verdict of their several seasoned reviewers.
But not even Rottentomatoes had prior knowledge of ‘This Is It’.
I then decided I had to check it out –this ’musidocumentary’.
Even in Kampala where you hardly find a full capacity movie theater on a day like monday it was full house.’This Is It’ has been declared a two-week release since 27th October and there will not be the traditional prolonged play at theatres.
And there he was, doing his thing like only he could. Vintage Michael Jackson in a series of rehearsals at the Staples centre in Los Angeles under the master direction of Kenny Ortega with whom they worked back in the day.
‘This is It’ is no movie or even autobiography. It is simply a testament of Michael Jackson’s rehearsals for the sold-out scheduled July 2009 London shows just a few days before his tragic death. It offers a uniquely intimate portrait of Michael Jackson. A portrait we have not seen anywhere before. Besides being an exceptionally gifted performer- the ‘king of pop’, a perfectionist who is never satistified with a perfomance he turns in,we see that Michael was also a creative genius and he is very much part of the creative drive behind the shows.
We see Michael Jackson keep up with dancers half his age with incredible physical stamina for a 50 year old man. His vocal ability is clearly not what it used to be at his peak but he still recalls all the lines to his greatest hits.
This is supposed to be a rehearsal but he gets carried away on a couple of occasions when he gets lost into the music and he is in his element.
‘This is It’ is clearly a film made for the true Michael Jackson fan. Its a parting gift from a master showman. There will never be another Michael Jackson.

Saturday, October 17, 2009

Have NGOs replaced the State in African Health Care Provisioning?

At the time of independence, many African countries aspired to provide western-style welfare state social provisions by providing free medical care and free university education and other social services to their citizens.
The prevailing political currents of socialist ideology around the globe in the 1960s occasioned by the cold war brought to birth the idea of ‘African socialism’ which in its crudest forms emphasized the sense of ‘African community’ and therefore the concept that ‘everybody’s welfare was everybody’s business’. In East Africa, Ugandan Prime Minister Milton Obote unveiled the ‘common man’s charter’ a socialist manifesto for newly independent Uganda. In Tanzania, President Julius Nyerere gave credence to ‘ujaama’ villages or communal villages that provided an all embracing community.
Social services were freely provided and medical services at government hospitals were free as were other social provisions.
However in the early 1980s the idea of an ‘African’ welfare state came under serious threat as being unsustainable owing to failing economies under hardship due to falling international prices of the cash crops on which many African countries depended coupled with chronic political turmoil and ethnic tensions ubiquitous in post independence Africa.
African countries, and Uganda in particular, sought budget deficit financing from the World Bank and the International Monetary Fund (IMF).
The Breton Woods institutions prescribed the hugely unpopular Structural Adjustment programmes (SAPs) that called for radically reduced social spending in the social sectors of health and education by the introduction of ‘user fees’ and ‘cost sharing’ in social service provision as well as the full-scale marketization of social provisioning.
The introduction of market liberalization reforms, including privatization of the social sector, has turned citizens into client-consumers rather than social provision beneficiaries with millions falling through the cracks.
The prolonged diminished fiscal ability of the Ugandan state to provide social welfare has seen an increasing importance of non -governmental agency providers of health care. In sectors such as HIV/AIDS health care and treatment in Uganda, non governmental and civil societal organizations dominate. Hence the failure of the state and the market in Uganda has seen the emergence of new service providers and the expansion of space for alternate players. The central question would therefore be that has the ‘pluralism’ of social welfare providers in Uganda called into question the need for a paradigm shift to a tri-model of state, market and civil society?

Wednesday, September 2, 2009

Deng Xiaoping And The Cultural Revolution: A Daughter Recalls The Critical Years: A Book Review.




Deng Xiaoping and the Cultural Revolution is an autobiographical book about the trials and tribulations of Chinese leader, Deng Xiaoping during the ten-year disastrously tragic ‘cultural revolution’ in Mao Tse Tung’s 1970’s China. Deng Rong, Deng’s daughter, provides an exceptionally intimate first-hand account of China’s ‘reign of terror’ under Chairman Mao Tse Tung. In many ways it comes off as a therapeutic book Deng Xiaoping himself would have ordered to recount his pain and humiliation but also to defend and protect his place in the communist party and China’s history as a whole.
On a human interest level, it is simply the story of an extra ordinary man who weathered political storm after storm. He was twice ‘over thrown’ and stripped of all his elite positions and status in the Chinese government under Mao’s orders and evicted out of his official residences. After being ‘overthrown’ he worked for many years as an ordinary fitter in a tractor factory hundreds of miles away from the capital Beijing and the second time he lived under virtual house arrest after his second ‘overthrow’. Each time he fell, he got back on his feet much like the proverbial cat with ‘nine lives’. Deng Xiaoping had an incredibly indomitable spirit and even in his darkest day waited patiently for the tide to turn.
Reading this book reminded me of Nelson Mandela’s Long Walk to Freedom another tale of an extraordinary life and a man who defied adversity and rose to the highest office of his land, just like Deng Xiaoping in China.
Deng Xiaoping was the paramount leader of China after Mao Tse Tung’s death in 1976 , having previously served as Vice Premier of China. With his experience in China’s war of liberation and steady rise in the China’s communist party, he was widely viewed as the successor to Chinese Premier Zhou Enlai, who died of cancer in 1976, leaving a gaping leadership gap at the highest level. Some even viewed him as a possible successor to Mao Tse Tung himself who in his 80’s was ailing and nearing his end as China’s paramount leader.
But there was one problem. Deng Xiaoping, who for a time lived in France in a ‘work-study’ arrangement, was not ideologically aligned to Mao’s extreme Marxist line of ‘class struggle’ and ‘dialectic materialism’. Although a member of China’s communist party of long standing, a hero of the China’s war of independence and an experienced administrator, many of the extremists in his party viewed him as a closet capitalist or to use their own term ‘a capitalist in-roader’.
In all fairness, Deng Xiaoping‘s ideological leanings were not strictly Marxist and asking what he was doing in a communist party is a decent question. He seemed more concerned with the pragmatic questions of state such as reviving the Chinese economy after the dysfunction occasioned by the cultural revolution, alleviating poverty in the country side, revitalizing industrial production, modernizing China etc. He once said he didn’t care whether a cat was black or white as long as it caught mice.Mao in fact had anointed the younger Lin Biao as his successor who in his estimation was closest to him in ideology and would preserve his beloved cultural revolution.
Mao installed Hua Guafeng as his successor whom Deng out manouvered after Mao's death and started China on its socialist market economy. In many respects, Deng Xiaopeng is the father of modern China. The China that is set to overtake Japan this year as the world's second largest economy.

Thursday, August 13, 2009

The New Global World Order: The Emergence of China and the Decline of U.S.Power

Is United States’ global power, influence and leadership on the decline? Voices from Strategic think tanks around the world and from within the United States itself suggest that there is an emerging consensus that US leadership of the west and its global hegemony in general is severely under threat and slipping steadily.
British academic, Martin Jacques has authored a new book with a telling title 'When China Rules the World: The End of the Western World and the Birth of a New Global Order' he estimates that over the next half-century, China will emerge as the world’s leading s power and that there is a shift of power from the west to the East.
In another thoughtful piece, Japanese analyst Hitoshi Tanaka, author of The Crisis of Global Governance and the Rise of East Asia argues that US leadership of the world has slipped for two reasons. The disastrous foreign policy of former US president George W Bush ,including the costly invasion of Iraq, without United Nations Security Council approval and a continuing costly war in Afghanistan in military and economic terms. Nobel Prize economist Joseph Stiglitz puts the cost of the US debacle in Iraq at $ 3 trillion.
The failure by the US to exercise global environmental leadership on the Kyoto protocol has irked many of the US’s own allies including Japan and the United Kingdom.
One would add that the current global financial crisis and the declining US economy have not helped matters either and exposed the vulnerability of US economy which has reportedly shrank - a major cornerstone of US geopolitical capability and prestige. The US has borrowed excessively from China to finance President Obama’s stimulus measures to shore up the US economy.
TIME magazine reports that the US owes China $ 763.5 billion in US Treasury department debt.
Signaling an emerging new world order, China has publicly called for a replacement of the United States dollar as the world’s reserve currency owing to perceptions of a long-term weakening US economy. China has threatened to introduce a new global reserve currency called’ the renminbi’ to replace the US dollar. China’s increasing importance is exemplified in its influence in the current global financial crisis., it is viewed as the ’primary driver of global economic growth’. Indeed recently reported economic growth in China was interpreted as a more optimistic outlook for the rest of the world economy.
According to Newsweek China is slated to surpass Japan this year as the second largest economy in the world with India not far behind.
The rise of China, analysts suggest, has altered the world order and will see the declining influence of the Group of 8 countries (G8) of US, UK, Canada, France Germany, Italy, Japan and Russia and in their place the G2, China and US. President Obama has said that Washington and Beijing will shape the 21st Century.
‘At the time of its formation in 1976,the G7 members accounted for 64% of global GDP, that number has now fallen to 56%. Meanwhile the economies of the so called G5 nations-Brazil, China ,India Mexico and South Africa have expanded and now account for approximately 12.7 % of global GDP. A figure that will continue to rise in the coming years’ writes Hitoshi Tanaka.

In regard to US and China, Daniel Drezner talks of the former and later respectively as ‘a declining hegemon with the willingness but not the capability to act as the global leader, combined with a rising power with the capability but not the willingness to act as a global leader’.
I would add that the rise of Arab states such as United Arab Emirates and Qatar with their burgeoning financial muscle from oil wealth have added another dimension to the global balance of power scene. Arab financiers have bought a handful of English Premiership football clubs such as Manchester City and Portsmouth. It was reported that an Arab consortium bought a stake in Germany’s Mercedes Benz group. In Uganda, telecom giants Zain and Warid are testimony to the growing financial influence of the orient in world business.

So, is US power really on the decline? The death of giants is often prematurely called.
Mark Twain was prematurely announced dead and remarked thus 'The reports of my death are greatly exaggerated’.