Friday, November 20, 2009

Promoting health benefits of clean energy at the White House

WASHINGTON, DC -- Today I spent four hours at the White House on a beautiful autumn day being briefed on the public health benefits of clean energy in the U.S. The Obama Administration — ably represented by Secretary of Health & Human Services Kathleen Sebelius, Environmental Protection Agency Administrator Lisa Jackson and other senior officials of both departments — made a strong case for the many health reasons we should move to clean energy as quickly as possible, in addition to the environmental and economic ones we already know about.

As just one example of the price we pay for unclean energy, Administrator Jackson said that one in every 10 American kids suffer from asthma. She connects with this issue in a very personal way: She has a 13-year-old son who has been asthmatic since infancy and could not always go outside because of air quality.

The hundred or so people attending the summit came from all over the country on relatively short notice. There were business and community leaders, advocates, activists, academics and nonprofit leaders from California, Alabama, Louisiana, Michigan, Massachusetts and my home state of Minnesota, among many other places.

I saw only one other person there from my world of global health and wondered whether the White House might have invited me by mistake. But it dawned on me that just about everything that was said about the health benefits for the U.S. also applies to the developing countries that I care about. Secretary Sebelius raised it once, when she said that global warming was increasing malaria, dengue and salmonella.

I wondered whether this new partnership to promote the benefits of clean energy in the U.S. would manifest itself in the Global Health Initiative proposed by President Obama in May. I hope so because just like the most vulnerable Americans are hit hardest by climate change, the most vulnerable and poorest people in developing countries are most affected. These people in the poorest countries in the world would probably benefit even more from clean energy than the poor in the U.S.

My organization and I look forward to working with the Obama Administration to highlight the public health benefits of clean energy not only in the U.S. but in the developing world as well.

Monday, October 5, 2009

Return to Peace Corps village delivers surprises, and a lesson

BAGUIDA, Togo – Falling asleep to African drums and waking up to a torrential rain pounding on the roof, as I did last night, was like going back in time to my 20s, when I lived in this village for two years and my life was more tied to the movements of the sun, than to the movements of the hands of a clock.

I was an agriculture teacher in a secondary school and my job was to make things grow and to teach others to make things grow. At my school, I started a garden, a hog farm and a library. Outside of school, I had my own garden next to my house (and worked with students there) and I helped others start gardens and my prize student, Bada André Kokou, start a rabbit-raising project. The last time I was there, only a year after I had left, everything was working well. But that was 1986 – 23 years ago. Would there be any evidence left of of my two years of work?

Today was the day I was to find out, and I approached it with trepidation and excitement. It proved to be a day of surprises.

I was pretty sure the hog farm and the rabbit-raising project were gone. The school let the hog farm die in 1988, and André had to sell the rabbits when he went into political exile in Nigeria.

Yesterday afternoon, I went to the home of Kofi Mawusi, my former assistant headmaster, and his lovely wife, and had my first surprise. He reminded me that I had brought two grafted mango trees with me from the verdant hills of Kpalimé after I had spent six weeks in training there, and planted one of them in his courtyard and the other at the school.

He had to cut down this tree a few years ago because it had grown so large it was threatening one of their buildings. Madame Mawusi said that the mangos would drop on the roof of the house and make a terrible racket. But it provided their family with delicious fruit for many years. Was the other mango tree I planted at the school still there? They were not sure.

This morning I visited the school. As expected, the hog farm was gone. The school garden was gone. I asked to see the library and the “librarian,” if you can call him that, took me into a room of utter chaos, with books falling off the shelves onto the floor. I suppose some of the books I had ordered and had shipped from the U.S. might have been there but I did not trouble myself to look for them. I was angry that they could not have kept the library going; I considered the librarian a disgrace to the profession. Monsieur Mawusi told me the library was still intact when he retired as headmaster in 1995.

But the mango tree that I had forgotten still lived and was doing well. I was told that the tree provided both mangos for the children to eat and extra income for the school. I had a photo take of myself under my glorious mango tree. I went into one of the classrooms and talked to the schoolchildren. Monsieur Mawusi introduced me to them as the man who had planted the mango tree at the school. One of the male students told me how much he enjoyed eating those mangos.

As we walked around the village, I kept running into my former students and Monsieur Mawusi always reminded them that I was the one who planted the mango tree at the school. They always smiled broadly.

Then I found out that the rabbit-raising project was not dead. When André went into exile, he sold the rabbits to another student of mine. We visited that student’s home and we saw the rabbit project was alive and well, providing good income for his family.

We went to the house where I had lived for two years and where I had started a garden out of sand. Someone was still gardening there commercially. My garden lives on! As I was leaving, I ran into two people (now adults) who used to work with me in that garden when they were children. They told me they had fond memories of those times.

I also found out that a gardening project outside of the village that I had started with the U.S. Ambassador’s Self-Help Fund in 1985 is still going strong, with the same young man – now not-so-young – who had started it. He has become a commercial gardener. Again, I had completely forgotten about this aspect of my work and I was totally thrilled.

What have I learned from all this? I’m still absorbing it but I think it suggests that I was overly optimistic to rely on institutions to make a mark on my village. My institution – my school – let me down. I do not mean to say that institutions should be ignored. Indeed, I believe that one of the major challenges of development is figuring out a way to make institutions efficient and effective and serve the needs of their citizens.

But for me, my school did not make an important contribution to any formal success that I achieved during my Peace Corps service. It came from finding motivated people to work with outside of the school, helping provide resources to realize their dreams and turning them loose.

The exception was that glorious mango tree at my school which the institution managed not to kill. And the handful of 30-somethings who greeted me by name as I walked through the village -- they were my former students, and their beaming faces were my best reward. One of them is the village midwife and delivers all the babies. And for their smiles, I am grateful and blessed.

Here are my photos of my village on Facebook.

Sunday, October 4, 2009

Togo capital is not what it was in 1980s

LOMÉ, Togo – I’m back in Togo, almost exactly 24 years after I left. I lived here for two years as a Peace Corps volunteer teaching agriculture in a secondary school in the seaside village of Baguida just a few kilometers east of here.

As I write this, my former student Bada André Kokou is coming to Lomé to meet me and take me to Baguida. But yesterday was spent rediscovering Lomé, the Togolese capital that I knew well in the 1980s, too see if it has any of traces of the considerable charm and allure I remember from that special time.

This time, I entered the country through the Ghanaian border on the west side of Lomé. My Togolese traveling companion’s claim that the Ghanaian officials would hit us up for bribes and the Togolese would not be a problem turned out not to be true: The Ghanaians were polite and professional and the Togolese authorities were stern and unfriendly. But no one hit us up for a bribe on either side of the border and we arrived on Togolese soil after about 45 minutes.

We jumped into a taxi and I immediately noticed that Lomé’s oceanfront road is being completely rebuilt. My friend told me that ECOWAS, the Economic Community of West African States was paying for the project the entire 50 kilometers from the Ghanaian to the Beninese border. That was pretty much the only sign of progress I saw during my three days in Togo.

The bad news is that the rest of Lomé – or at least the little I saw of it today – is deteriorating and a shadow of its former self. I had planned to spend my first night in the Hotel du Golfe, where I once stayed and have fond memories of it as a charming, colonial place with a lovely pool. When my taxi pulled up to it this afternoon, I immediately knew something was wrong. It didn’t look right outside, or inside. I could not see the pool. And the charm was nowhere to be seen.

I headed over to Hotel Ibis (called Hotel le Bénin in my day). I also have fond memories of it and, unlike the Hotel du Golfe, it still looks pretty much as I remember it. I never stayed here but I used its lovely pool several times, as did many other Peace Corps volunteers of the time, and it all looked vaguely familiar. From my room, I could see the still highest skyscraper in Lomé -- the Hotel 2 Février, once the swankiest hotel in town and now closed and a sad reminder of what Lomé used to be.

I headed for the Grande Marché in search of the Restaurant de l’Amitié, where I used to have a plate of chicken, rice and peanut sauce washed down with a cold bottle of Biere du Bénin most Fridays after finishing at the school. I walked along the coast road and saw that many of the fine old colonial buildings that I remember are being neglected and are falling down.

I saw a man urinating in public, not uncommon in Togo, even in crowded areas. I once had a friend who had lived in Togo and had developed a unique index of development. One of the criteria was degree of public urination and she rated Lomé very high in this regard. Indeed, I think it has increased, if anything, since I left Togo (I later saw full-frontal urination, something I had never seen before).

When I got into the bustling market area, I had the unmistakable sensation that I had gone back in time to the mid-1980s. Everything was exactly the same: The bustle of people buying and selling. The cars and motorcycles weaving their way through impossibly narrow and clogged streets, blaring their horns. The tantalizing smell of Togolese street food. The faint (and sometimes strong) stench of urine. The women calling me “yovo” (white person). Yes, this was all familiar.

But after 30 minutes of trying to find the Restaurant de l’Amitié, I gave up. It was gone. I later found out the Lebanese owner had moved to Mali. I tried to find Le Phenicien, where I learned to love Lebanese food, and its incredibly obese owner Romeo, who always reminded me of a villain in a James Bond movie. I found out later he had died and the restaurant had closed. I came upon a supermarket which I was sure was SGGG, where I used to shop as a volunteer, and went inside. But the Lebanese owner told me that this was not the supermarket I remembered, and that it was in another location and had closed as well.

I also could not find my favorite Lomé restaurant, Relais de la Poste. This was shocking to me as it was a virtual institution, the best place for simple French cooking. I loved their "avocat vinagrette" as an appetizer and their "Lobster Thermidor" and "Steak au poivre" was so good I don't think I ever ate anything else.

I did find one thing I was looking for – great leather sandals. I bought three pair, and was pleased to see that they have survived.

In the evening, I headed over to the eastern side of the Boulevard Circulaire to find Café des Arts, the popular watering hole of the Peace Corps volunteers of my day. I was pretty sure it did not exist anymore and my instincts proved sound: I could not find it but I did find that this part of the Boulevard Circulaire has become a center of Lomé nightlife with dozens of bars, nightclubs and restaurants of all types crowding both sides of the street for a kilometer or more. But none of them could replace the charm and the ambiance of Café des Arts that I remember on a lovely evening in Lomé in the mid-1980s.

See my Lomé photo album on Facebook.

Saturday, October 3, 2009

Accra to Lome: 200 kilometers and 24 years

ACCRA, Ghana to LOME, Togo – Today I traveled 200 kilometers and 24 years, from the booming capital of Ghana with its pothole-free roads and growing economy to the decaying capital of Togo, where I was a Peace Corps volunteer from 1983 to 1985, a place and time that holds an affectionate place in my memories.

During the four hours I was on the road, I experienced a jumble of emotions – hope, fear, nostalgia and sadness.

Hope was what I experienced in Ghana, a country whose economy is growing and which recently experienced a peaceful transfer of power from one party to another, despite a close election, something of a rarity in Africa. This is the hope that brought President Obama here in July on his first presidential visit to Africa. We drove out of Accra on a motorway – the likes of which I have seen in Africa only in Abuja, Nigeria and South Africa – and past a blur of gleaming buildings and a new shopping center. It gave me hope that positive change is possible in West Africa.

The fear came from our driver who, like me, had a Biblical name (Isaac) and succeeded in putting the fear of God in me. He tried to keep the speedometer at 140 kilometers per hour (85 mph) as often as possible, including through villages with a posted speed limit of 50 kph. I said a silent prayer for myself, my Togolese companions and any careless pedestrians who wandered into the road.

It was evident that the driver knew the road extremely well as he braked only for speed bumps and police stops (all the police stops had signs sponsored by a bank that warned “It is an offense to bribe a police officer,” something else that gave me hope). And he knew exactly where to brake. As Isaac was slowing in one village, someone along the road yelled at him and Isaac threw a one-cedi note out the window, perhaps repaying an old debt.

I was astounded by the quality of the Ghanaian roads for the first 170 kilometers. I have never seen such excellent roads outside of an African city except in South Africa. It was only because of the quality of these roads that we were able to maintain such high speeds.

But the closer we got to the Togolese border, the worse the roads got and the more the scenery reminded me of the coastal village in Togo where I spent two years. The last few kilometers to Aflao, the last town in Ghana before the border, were terrible, deteriorating from pothole-pocked roads to no pavement at all.

The nostalgia came as the scenery became prettier and prettier, reminding me so much of the Togolese village of Baguida that I will see tomorrow. I also felt gratitude that I had the good fortune to live in such a charming seaside village for two years.

The sadness came when I arrived in Lome and saw that while Ghana has flourished, Togo has deteriorated. More on that in my next post.

Ghanaian AIDS orphans touch our hearts

ACCRA, Ghana — My heart and those of the members of the International AIDS Candlelight Memorial Advisory Board were moved Wednesday when we visited the AIDS orphans and the HIV-positive adults cared for by the Pathfinders Outreach Ministry, a Ghanaian non-governmental organization working and struggling with minimum resources in a poor area on the outskirts of Accra:

As the adorable toddlers scampered into their arms and our laps, we heard Becklyn Ulzen-Christian, Pathfinders executive director, describe the care she and her staff provide for orphans and vulnerable children and HIV-positive adults in the face of limited resources, great stigma against HIV-positive people and other challenges.

Pathfinders looks after 70 children, 13 of whom lives at the facility, and many HIV-positive adults who have been rejected by their families and friends. We talked to Felicia, a middle-aged woman whose hard life is etched on her face, who has been HIV-positive for 17 years. She said she has found a new life in the warmth of Pathfinders and now has a purpose to her life.

Pathfinders gets its support from three major sources – U.S. Agency for International Development for food aid; Global Fund for AIDS, TB and Malaria for behavior change communication and education in HIV, tuberculosis and malaria; and GHC member Academy for International Development (AED), though AED’s support is ending and Mrs. Ulzen-Christian has no idea how they will carry on without it.

The Advisory Board is in Accra for their annual meeting in which they are examining the Candlelight Memorial event from last May and planning for the next one in 2010. The Advisory Board is made up of two regional coordinators from each of the six regions in the world – North America, Latin American and Caribbean, Europe, West and Central Asia, East and South Asia and Africa.

Sunday, September 27, 2009

Much has changed in Accra but not everything...

ACCRA, Ghana -- The last time I was in Ghana was 1985, when I had just finished two years of Peace Corps service and my wife and I had traveled there from Togo in order to catch an Egypt Air flight to Cairo. Here's what I wrote in my diary on Oct. 13, 1985:

"We didn't particularly enjoy Accra. It's a decaying city where it's hard to find items we would take for granted in Lome. The first night we ate dinner at a Chinese restaurant. Fewer than half the items available on the menu were available. On the second day, we took a taxi into the decaying and filthy downtown and found a decaying hotel on the ocean. We looked down on a once-beautiful swimming pool that was now empty and decaying. We were very thirsty. All they had to drink was beer and tonic. I didn't want beer or tonic so I stayed thirsty. When I asked for a glass of water the water said 'It is finished.' That remark will be one of my strongest impressions of Ghana: 'The water is finished.'"

Note the number of times I used the word "decaying" in that short passage.

Those were the bad old days, when Ghana had a dysfunctional economy and food shortages so severe that Peace Corps Ghana had to truck in food from Togo for its volunteers. Fortunately, those days are gone and Ghana now has a vibrant economy and democracy that recently had a peaceful transfer of power after a closely contested election. That is why President Obama had chosen to make it the destination of his first trip to Africa as president.

I arrived here yesterday for my second visit. The Global Health Council manages the AIDS Candlelight Memorial, the world's largest and oldest AIDS awareness raising event, and we are meeting with our regional coordinators from around the world. I found that many things have changed, and for the better, but a few have not.

On my first night in Accra, my two colleagues and I went out to eat at Buku, an African restaurant in the Osu neighborhood, as the Lonely Planet Guide to West Africa had recommended it for its Ghanian, Nigerian, Togolese and Senegalese food. It was a lovely place but I ran into a similar problem from my first trip, albeit no quite so severe. They had no dressing for my salad, they had run out of guinea fowl and had no ginger beer. But they did have most things and we had a delicious dinner in the open air and under a straw roof. I had groundnut (peanut) stew with goat (instead of guinea fowl!), fried plantains and Star beer. All in all, Ghana is vasty improved and I am thrilled to be back in West Africa.

Friday, September 25, 2009

G20 proves frustrating but Pittsburghers a delight

PITTSBURGH -- I just spent two days at the G20 Summit here trying to keep global health on the leaders' agenda, as it had been in Washington in November 2008 when they pledged to work on achieving the Millennium Development Goals. But it was completely absent from their agenda in Pittsburgh. This was a disappointment, but the incredible graciousness of Pittsburghers helped make up for it. A few examples:

The night before the opening of the summit, I was having a drink with a friend at a bar across the street from Pirates Stadium where the Pirates were playing the Reds. I would have like to have gone but we were headed for a party in a couple of hours. Imagine my delight when a man came by and dropped two free tickets on us. Five minutes later we were inside the stadium with a very sparse crowd (people were not coming downtown because of the G20) on a beautiful September evening sitting in very good seats!

We had to leave early to attend a party hosted by Teresa Heinz Kerry to raise support for the fight against global warming at the Andy Warhol Museum which, by the way is fantastic. There was great New Orleans music - Cajun, rock and jazz -- and great food and drink. Not to mention the art of Andy Warhol. When we were leaving about midnight, we could not find a taxi and when we called were told that one could not come in less than 45 minutes. A lovely couple overheard us and offered us a ride to our hotel -- even though it was in the opposite direction from their house!

And on the last day of the summit, two Save the Children colleagues and I were walking to the media center through downtown Pittsburgh with a very high level of security. Even though it was Friday, very few places were open. But when we spotted a coffee shop with the catchy name of "Crazy Mocha" we had to stop. When we walked into the shop, the two employees cheered and applauded us. They were so bored from the lack of customers, that they had to express their joy at seeing us!

Pittsburgh is a far more interesting city than I every imagined populated by warm, wonderful and quirky people and I would go back anytime. A very underated and very American city! I highly recommend it.

Tuesday, September 22, 2009

Berlin Delegates Demand Adoption of ICPD Agenda

BERLIN, Germany – Four hundred delegates from 130 countries released the “Berlin Call to Action” earlier this month at the NGO Forum on Sexual and Reproductive Health and Development that followed up on the historic International Conference on Population & Development held in Cairo 15 years ago.

After long and sometimes heated discussions, the delegates demanded that donors and governments accelerate implementation of the ICPD Program of Action “as fundamental to achieving equality and equity, human rights and social and economic development.” They urged the following actions to be taken immediately:

1. Guarantee that sexual and reproductive rights, as human rights, are fully recognized and fulfilled. This reflects the delegates’ desire to go beyond the realm of public health and position sexual and reproductive rights as fundamental human rights.
2. Invest in comprehensive sexual and reproductive health (SRH) information, supplies and services as a priority in health system strengthening. The new idea here is to acknowledge the fact that the current aid architecture emphasizes health system strengthening and the delegates belief that associating SRH with health systems can help our cause.
3. Ensure the sexual and reproductive rights of adolescents and young people. Approximately 25% of all of the delegates were under the age of 30 and the focus on youth was a recurring theme of the conference. Jill Greer, chair of the Steering Group, said that it was vital that the movement develop new leaders for the future.
4. Create and implement formal mechanisms for meaningful civil society participation in programs, policy and budget decisions, monitoring and evaluation. The message here is that governments have to bring civil society organizations to the table as meaningful partners.
5. Ensure that donor contributions and national budgets and policies meet the needs of people for sexual and reproductive health and rights. This financial aspect was enhanced considerably from the earlier draft and reflects the delegates’ recognition that their lofty visions will not be realized without the financial resources to carry them out.

Sivananthi Thanenthiran, a co-chair of the Steering Group, recognized that the most intractable hurdle to overcome in finalizing the text was the split between those who preferred ICDP language, and those who preferred the language of the Millennium Development Goals. “We have positioned ourselves in the middle,” said Ms. Thanenthiran. “We want to move beyond Cairo and leverage the MDGs.”

Another key issue was toning down the rhetoric because of the fundamentalism of many countries where the legitimacy of governments is based on religion. To overcome this, the Drafting Committee tried to find language that would not offend.

Monday, August 24, 2009

Markets have a role in malaria treatment

By sheer serendipity, I happened to pick up a copy of The Guardian (link text), my favorite British newspaper, in London last Thursday and saw an interesting piece on the challenges in providing malaria treatment by Sarah Boseley, the Guardian health editor. I thought Sarah captured very well the dire lack of Coartem malaria treatment in most of the country. But I was dismayed by the way she suddenly turned against the role of the market in providing such treatment at the very end of her story, even after admitting the failure of the public sector to do so and praising the ability of companies like Coca-Cola to make their products widely available.

So I felt compelled to challenge her dissing of the potential for markets to contribute to health care in developing countries, and today my letter was published in The Guardian.

And here is the story of my own encounter with malaria treatment in Uganda based on my trip to Uganda in 2008, and which I cited in my letter. 

Saturday, August 8, 2009

AIDS prevention must be more of a priority

Everyone working in HIV/AIDS -- as I have been for 17 years since I founded Society for Family Health, the leading HIV prevention organization in Zambia in 1992 -- has heard the aphorism "We can't treat our way out of this epidemic" and everyone knows that for every person that goes on treatment, there are several more new infections.

Both Randall Tobias and Mark Dybul, the first two PEPFAR coordinators, always said that HIV prevention was a priority. But in reality, prevention was never a priority with PEPFAR and could never be a priority since the law that created PEPFAR hamstrung prevention efforts by limiting them to 20% of the budget. And the bitter political battles swirling around HIV prevention during the eight Bush years prevented an evidence-based formula for measuring the number of HIV infections from being implemented. Instead, PEPFAR was reduced to measuring prevention with process indicators such as messages transmitted and campaigns conducted.

I thought of all of this today when reading the press accounts of the visit of Secretary of State Hilary Clinton to HIV/AIDS programs supported by the U.S. government in South Africa. Treatment dominated Secretary Clinton's visit and understandably so, given the fact that South Africa has more HIV-positive people than any other country in the world. But where is prevention in all of this? After all, even South Africa, with its vastly greater resources as compared to any other sub-Saharan African country, cannot treat its way out of its epidemic.

That is why I was so pleased to see, hidden at the end of today's Washington Post account of Secretary Clinton's visit to South Africa, the following paragraph:

"U.S. Rep. Nita M. Lowey (D-NY), the head of the House Appropriations subcommittee that funds foreign aid programs, said at the ceremony that she hopes to see more assistance going toward prevention, rather than just treatment."

Bless the heart of Rep. Lowey for reminding us of this simple fact: We will never get ahead of the AIDS pandemic until we focus more on prevention, which continues to be grossly neglected. It is so much easier -- although much, much less cost-effective -- to treat people after they have been infected than to prevent the infection in the first place.

And it is awfully messy -- not to mention politically perilous -- to protect injecting drug users, sex workers and the men who patronize them, and even more controversial when we direct efforts at adolescents who most adults would prefer to pretend will be celibate until marriage.

Thanks to Rep. Lowey for reminding us of the importance of prevention, and let's hope Eric Goosby, the incoming PEPFAR coordinator, hears her plea, and directs more PEPFAR resources into prevention, finally. The future of the pandemic depends on it.

Friday, July 10, 2009

My Final Thoughts from L'Aquila

L'AQUILA, Italy -- I found out only eight days ago that I was coming to Italy to promote global health. I know global health and I know communications but I know little about the G8, and even less about how to budge this immense geo-politico-media mountain. But I came up with a plan and started learning quickly as soon as I hit Italian soil. Let me give you my plan, how I think I did and what I learned.

My communications plan was three-pronged: 1) Social media (mostly blogging), 2) major media relations and 3) U.S. government engagement.

1) The social media prong went brilliantly with lots of great support from colleagues in DC and Vermont. Earlier this week, I posted daily blogs. Once the summit began, I started posting multiple blogs per day. As I learned more and saw more, I had more and more ideas for blogs. Today, the last day, I have more ideas than I have time to write. I’ve been advised by the Council’s office in Washington that 700 people looked at my blog on Wednesday and I’ve received a dozen appreciative comments, some with questions, others with ideas. GHC/Vermont also had the idea of putting a link to the blog on our Facebook page, and we’ve received several comments there as well. We’ve also tweeted the G8, both from Italy and the U.S. and we’ve been “retweeted” by several GHC members like White Ribbon Alliance, PATH , Intrahealth, Women Deliver and others. Links to this blog have been placed on a number of other websites covering the G8 like this one put together by the Global Call for Action Against Poverty: link text

2) Major media engagement has been less successful even though all of us who work for non-governmental organizations are working out of the same media centres as the 3,500-some journalists covering this Summit. I heard from the diplomatic correspondent of the BBC the first day who wanted to talk to me about “backsliding” on the Millennium Development Goals. But I haven’t been able to get in touch with him since that first contact. I’ve also been trying to run down the phantom from the Financial Times (the friend of a friend) who staked out a computer in the media centre early on (marked “Financial Times”) but then never showed. Or at least I never saw him. Oddly, my single media success was when New York Times Columnist Nicholas Kristof, who was not at the Summit, wrote a column on the G8 using information supplied by me: link text

3) I failed totally to interact with the Administration except for the climate change briefing I attended by President Obama and five other G8 leaders yesterday which I don’t count because it had nothing to do with health (and, oh yeah, I didn’t actually talk to the President). There was absolutely no contact between the U.S. NGO delegation and the Administration of any kind during the Summit. In fact, we couldn’t get a meeting with them in Washington before the Summit either. The British NGOs met with their government. One member of our U.S. delegation even met with the head of the Japanese delegation. But none of us had any contact with our own government. This was surprising and disappointing.

The other thing that was surprising and disappointing is that neither global health nor water and sanitation came out very clearly in the comments of President Obama and his Administration or in the mainstream media except for two notable exceptions — the Kristof column already mentioned and French First Lady Carla Bruni-Sarkozy, who wrote a commentary in the Guardian of the U.K. Tuesday called “My Message to the G8 Leaders in L’Aquila,” one of them being her husband. As a global ambassador for the prevention of HIV in women and children, she wrote: ”Knowing that millions remain in need while effective interventions exist, I am more determined than ever to add my voice to the global effort to fight Aids and other infectious diseases.As the G8 meets in L’Aquila, leaders should feel proud of the revolution in global health they started eight years ago. I hope they will celebrate their achievements by expanding their investment in saving lives and reducing inequities. It is not only possible – it is happening, it works, and there is much more still to do.” Here is the commentary and check out the first comment following it: link text

As far as I know, that was the most prominent voice at the G8 advocating for global health, and I am grateful to Ms. Bruni-Sarkozy for that.

President Obama left L’Aquila about an hour ago, took a helicopter direct to Vatican City and has now been received with much pomp and pageantry by Pope Benedict II as we can see on the monitors in the media centre. Later tonight, Air Force One will touch down in Ghana, his first visit to sub-Saharan Africa as president. We have heard that the President and First Lady will be visiting a USAID-funded maternal health project at an Accra hospital, and we will be watching carefully in hopes that that visit takes place so that the U.S. First Lady joins with her fellow first ladies Carla Bruni-Sarkozy and Sarah Brown as a global health advocate.

G8 Talks the Talk, but Breaks Prior Promises

L’AQUILA, Italy — The G8 released its communiqué on health, water and sanitation commitments to Africa Wednesday and, as I predicted in an earlier blog, the NGO community here is not impressed. But neither are they surprised. The communique largely reaffirms previous promises, at which the G8 has become quite accomplished.

There are some things I like a lot, especially the G8’s pledge to ”accelerate progress” on combating child mortality and on maternal health, “including sexual and reproductive health care and services and voluntary family planning.” I think those areas of health have been long neglected but regret that the G8 countries did not establish a more formal mechanism from making those laudable goals reality.

I also like a reaffirmation of a $60 billion pledge to fight infectious diseases and strengthen health systems by 2012 and the establishment of a mechanism to monitor health commitments made at the last three summits, which may be the only significant new health commitment made here at L’Aquila.

What I don’t like, and this feeling is widespread among civil society representatives here, is the indisputable fact that the G8 has not come close to meeting past commitments. In fact, The DATA Report, the most credible source of information on this subject link text, says that the G8 had delivered only one-third of all assistance increases it had promised to deliver to Africa by the end of 2010. I write about this more in my last blog.

I must hasten to add, though, that the U.S. is one of the least guilty of the G8 members on this score. The DATA Report points out that the U.S. increased its assistance to Africa by 26% in 2008, a significant increase that outpaced the global average of 16%, and is now on track to meet or even exceed its 2010 target. It may surprise many that former President George W. Bush can take much credit for this development.

However, the NGOs represented at the G8, largely European, were not pleased with the communique’s language on global health, water and sanitation, climate change, education, and the economy as laid out in a letter to Italian Prime Minister Silvio Berlusconi and the other seven G8 leaders earlier this week.

“The communiqué is pretty disappointing with no real new initiatives or recognition of the dire state of the progress to meeting their previous commitments,” said Kel Currah, chair of the Global Call to Action Against Poverty G8 Working Group, which represents a broad cross-section of NGOs at the G8. “On the good side, they did produce an accountability annex but again, this was only for a few of their commitments and there are a lot of holes in the report.”

Thursday, July 9, 2009

Is the G8 Meeting its Targets?

L'AQUILA, Italy -- When I learned I was coming to the G8 Summit to promote global health, I sought advice from friends I thought might know about the arcane machinations of the annual summit. A British friend responded: "I'm rather disillusioned about the G8, to be honest. It seems like a PR event for world leaders to talk about the stuff they would do if only everyone else would get behind them!"

That pretty much reflected my own superficial views but I wanted to get beneath the surface and answer the question, "How is the G8 really doing in meeting the objectives it sets every year?" in an objective and unemotional way.

There is probably no better source of information than "The DATA Book," published annually by the ONE Campaign: link text The 2009 report, just out, analyzes the G8's progress on their commitments to Africa made at the 2005 Gleneagles Summit and since. They have good news and bad but, to my way of thinking, it is mostly bad.

At the end of 2008, the reports says, the G8 collectively had only delivered one-third of the Official Development Assistance increases it had promised by 2010. While the overall view is bleak, progress by specific countries in specific areas brings more cheer.

In 2005, for example, the G8 committed to help Africa by reducing the burden of HIV/AIDS, malaria, TB and polio and improving access to basic health care. In later summits, additional commitments were made to strengthen the disease-specific goals and support health system strengthening, the training and retention of health workers and the control or elimination of neglected tropical diseases.

Perhaps more than in any other sector, the report says, where concentrated investments have been made, measurable results have been delivered: HIV infections are declining and more people living with HIV are receiving care and treatment, rates of new cases of TB are declining, malaria mortality has been reduced in targeted countries and child mortality has declined.

However, Africa is seriously off the rails in terms of meeting the health MDGs especially in maternal and child health.

Similarly in water and sanitation, the G8 committed to a Water Action Plan at the 2003 Evian Summit and this plan was reaffirmed in the 2005 and 2008 summits. Despite this attention, the G8 has set no quantitative targets in the sector. And the report notes that "improvements in access to clean water and sanitation serve as a catalyst for progress in almost every other area of development, providing the foundation for good health, education and economic productivity." Meanwhile, more than 4,000 children die daily from diarrheal diseases, which are spread through dirty water and poor sanitation and hygiene.

The ONE Campaign also analyzed the performance of each country and found that Italy and France "are performing so poorly that they are threatening to cause the G8 as a whole to default." Indeed, in 2008, France fell behind Germany for the first time in terms of the quantity of aid it is delivering to Africa, where it was once a major colonial power.

They also found that the U.S., Canada and Japan were meeting or beating commitments (the U.S. is actually on track to exceed its 2010 target a year ahead of time) while the U.K. and Germany were pushing hard to meet more ambitious goals (the U.K. is on target to be the first G8 country to meet the UN goal of spending 0.7% of national income in ODA).

Wednesday, July 8, 2009

Mood of NGOs at L'Aquila Not Optimistic

L'AQUILA, Italy -- The heads of state are arriving here for the G-8 Summit in the mountains northeast of Rome --- President Obama and Chancellor Merkel are already here and President Sarkozy is arriving as I write this at 3:00 PM -- but the non-governmental organizations are mainly frustrated, angry or both with a few notable exceptions.

This morning I talked to civil society experts in most of the main areas of concern -- global health, water and sanitation, education, food security, climate change and labor -- and all but one expressed varying levels of disquiet. Only a Dutch expert in food security -- who was one of the key speakers on this issue at a civil society meeting in Rome earlier this week -- said he was "slightly optimistic" about the prospects for food at this summit.

When I asked a long-time global health advocate (who has been involved in several G-8 summits over the last several years) how he was feeling about the prospects for global health, he gave me the thumbs down. He cited his opinion that since commiting to an additional $60 billion by 2011 to fight pandemics and strengthen health systems, as agreed at the G-8 Summit in Germany in 2007 and Japan in 2008, the G-8 has not produced even one additional dollar. This point is certainly debatable but this particular advocate apparently chose not to include the Global Fund, PEPFAR or PMI in his calculations.

Steve Cockburn of End Water Poverty UK observed at how one can walk around Rome and admire ancient aqueducts and sewage systems that were providing clean water and sanitary sewage disposal 2,000 years ago, services that are available in 2009 in huge parts of the developing world. He called the current draft of the communique on water and sanitation "very disappointing" and predicted the the Millennium Development Goal for "watsan" will not be met until 2109. The last G8 in Japan committed to concrete results by the end of 2009 and when the officials saw that was not going to happen, he said, they "watered" the language down to merely making "progress" by the end of 2009.

Those fighting against climate change are equally disillusioned after seeing the latest draft of the Summit communique this morning. They characterized the situation as the European Union countries doing the right thing -- and even offering to increase their commitments to reduced emissions -- while the other members of the G-8 -- notably the U.S., Canada, Russia and Japan -- dragging their feet. Furthermore, they say the non-Europeans' recalcitrance is discouraging developing countries like China, India and Brazil from committing than they already have. They don't blame President Obama for this but say his feet are tied by Congress.

Those of us who care about global health (in which we include water and sanitation) are waiting with bated breath to see the final communique on those two issues. We are hearing two rumors on its release -- either this afternoon or on Friday. I will pass along the information here as soon as it becomes available.

The Global Health Council view of the current language in the communique on global health is positive: We like the language on the need to strengthen health systems, the call for a comprehensive and integrated approach, the emphasis on maternal and child health and on sexual and reproductive health which, as I noted in my previous post, is back in the G-8 communique after eight years in the wilderness during the Bush Administration.

In my three days in Italy, I have heard some amazing statistics: One of the most amazing and disconcerting is this provided by Angela McClellan of Transparency International in Berlin: The financial industry has received almost 10 times more in bailout money in the last year than poor countries have received in aid in the last 49 years (source: UN Millennium Campaign).

G-8 Summit Opens Today in L'Aquila

L'Aquila, Italy -- Driving to the site of the 2009 G-8 Summit this morning was an eerie experience. After numerous security checkpoints, there was no more traffic and, other than security personnel, no more people -- except for the tents housing the thousands of local people without homes.

Until April, the summit was going to be held at a luxurious seaside resort in Sardinia. But then a devastating earthquake hit L'Aquila, in the mountains northeast of Rome, killing 300 and leaving tens of thousands homeless.

So the Italian government moved the summit to an out-of-the-way military school here in L'Aquila to draw attention to the plight of the victims and give a boost to the local economy.

As a reminder of the forces of nature at work here, a powerful aftershock hit the town last Friday, just days ahead of the arrival of world leaders.

But there are few hotels here even in the best of times, and this is not the best of times. For that reason, the 3,000 to 3,500 journalists descending on this region to cover the summit -- as well as the 200 or so of us from civil society -- are being housed an hour-and-a-half drive from here in a "Mediterranean Village" built specially for the 2009 Mediterranean Games which just concluded a few days ago. The accommodations are comfortable but spartan -- though undoubtedly far superior to the tents of L'Aquila -- and we have almost round the clock access to computers, food and wine.

Here at the Summit, I am working out of one of several media centers. The one I am in has space for perhaps 200 journalists and is divided by the language of the journalists -- there are Arabic, French, Italian, Portuguese and Chinese sections among others. Initially, I settled in at an Arabic computer but I quickly discovered my mistake.

The summit will focus on the global economic distress but expected to produce more of a progress report than new policy. Iran, climate change, food security in Africa, Middle East peace and trade are also on the agenda.

L'Aquila is the capital of the Italian region called Abruzzo, and was the second most important town in southern Italy after Naples for centuries. This area, in the Abruzzo's desolate interior, is one of the least touristed parts of Italy even though it boasts considerable rewards, particularly if you are in search of wild mountains and villages where strangers a novelty.

Sunday, July 5, 2009

Keeping Health on the G-8 Agenda

ROME, Italy -- Judging by the numbers of people I saw frolicking in Trevi Fountain and on the Spanish Steps as I arrived here today on a sun-drenched summer afternoon, you would not think the industrialized countries of the world are in the throes of the worst economic crisis since the Great Depression. But that is exactly what will be on the minds of the heads of state of the G-8 when they come here later this week for their annual attempt to find some common ground for making the world a better place not only for the rich countries of the world, but also for the poor.

And that is why I am here - - to add the voice of the Global Health Council to other representatives of civil society, largely European, to try to keep global health from getting lost in the many other pressing issues of the day, such as the recession, Iran, climate change, food security in Africa, Middle East peace and trade.

It will not be easy: In the Civil Society Meeting that begins here in Rome on Monday, immediately preceding the Summit which begins on Wednesday, health is hard to find on the agenda. The meeting is comprised entirely of four roundtables on Food, World Economy and Finance, Climate Change and something called "Public Goods" which, presumably, might include something about health. But that is not at all clear, and my job here is to ensure that global health -- and particularly reproductive, maternal and child health - get a fair hearing as access to these health areas -- and lack thereof -- have enormous effects on the poor's ability to make progress in the other areas of concern to this G-8 Summit.

Saturday, July 4, 2009

Mere Rain Does Not Extinguish Flame of Candlelight Memorial

CAP HAITIEN, Haiti, May 16, 2009 -- On my first overseas assignment with the Global Health Council, I was privileged to be part of the opening ceremony of the 2009 International AIDS Candlelight Memorial, originally planned to take place in front of the spectacular ruins of Sans Souci Palace (a World Heritage site) in Milot, Haiti. The Council has been managing this event, the world's oldest and largest AIDS awareness-raising event, since 2000. Last year, for the first time, they took the opening ceremony overseas, to Malawi; this year, they chose Milot, a village a few kilometers from Cap Haitien, the second largest city in Haiti on its northern coast.

Although the Milot event was rained out, the opening ceremony was still a great success when most of the events associated with it were held at the dinner that had already been scheduled for Cap Haitien after the event. The festivities started when Haitian Prime Minister Michele Duvivier Pierre-Louis arrived at Cap Haitien Airport in the afternoon and drove to Milot. She appeared before an enthusiastic crowd of local people at an event promoting the importance of getting tested for HIV.

Abbott Fund, one of the donors of the Candlelight Memorial, announced that it was donating 500,000 rapid HIV test kits as the kick-off of a nationwide HIV testing campaign. The testing initiative is a cooperative partnership between the Haitian government, the U.S. government, the Abbott Fund and Haitian health implementing organizations.

At the dinner, I had the pleasure of sharing a table with Prime Minister Pierre-Louis and her entourage, including the minister of tourism, who told us of his hopes to bring tourism back to the beautiful northern coast of Haiti, where Christopher Columbus landed in 1492 when he discovered America. The candle-lighting ceremony took place after the dinner, when Prime Minister Pierre-Louis and representatives of the two sponsors of the event -- Vice President Kathryn Guare of the Global Health Council and Dr. Myrna Eustache of Promoteurs Objectif Zero Sida (POZ) -- joined people living with HIV and AIDS to light the candles to remember those lost to AIDS, to advocate for improved programs and policies and to celebrate the courage of Haitians living with the disease.