New Book: Critical Elements for Improved Global Health
------------------------------------------------------
I have been forwarding the following book review (I have not yet
read the book) which I think should be of interest to AFRO-
Netters!
Ruth Hope
mailto:RHope@s-3.com
UK 'crippling Africa healthcare'
--------------------------------
http://news.bbc.co.uk/1/hi/health/4582283.stm
The UK is crippling sub-Saharan Africa's healthcare system by
poaching its staff, UK doctors have warned. With the UK taking
over the chair of the G8 in July, there is an ideal opportunity
to stop the brain drain from poor to rich countries, they said.
The UK should encourage more home-grown doctors and limit the
time period that overseas recruits can train and work in the
country, they told the Lancet.
Financially compensating nations for lost staff will not work,
they warned.
Brain drain
Nor will strategies that split the training of healthcare staff
between developed and developing countries, according to Dr John
Eastwood and his colleagues from St George's Medical School in
London.
"Industrialised countries like America and Britain must recog-
nise that they have some responsibility for this crisis" Dr
Edwin Borman of the British Medical Association
He said: "One basic measure would be an agreement in consulta-
tion, with the World Health Organization, to establish a basis
in developed countries for minimum annual numbers of health pro-
fessionals in training.
"This would help to reduce developed country reliance on the in-
vestment in training made by developing countries."
Ethics
The UK does have an ethical code which means it will not ac-
tively recruit from certain developing countries, which includes
sub-Saharan Africa.
However, healthcare professionals from these countries are free
to apply for jobs in the UK.
In 2003, 5,880 UK work permits were approved for health and
medical personnel from South Africa, 2,825 from Zimbabwe, 1,510
from Nigeria and 850 from Ghana.
Push and pull factors
PUSH
Lack of postgraduate training opportunities
Poorly funded work facilities
Lack of work posts
Low pay
Civil unrest
PULL
Training and career opportunities
Attraction of centres of medical excellence
Better pay and working conditions
Availability of posts
Nearly a third of the doctors practising in the UK were trained
overseas.
In comparison, only 5% of doctors in Germany and France are not
home grown.
Dr Edwin Borman, chairman of the BMA's International Committee,
said: "Shortages of doctors and nurses are having a devastating
effect in the developing world."
"Sub-Saharan Africa alone needs around a million more healthcare
workers, and unless the situation improves drastically rates of
HIV will spiral, disability from childhood disease will rise,
and thousands more lives will be lost."
"Industrialised countries like America and Britain must recog-
nise that they have some responsibility for this crisis."
"At least the UK now has an ethical recruitment code, and we
hope other countries will follow suit - but we also need to re-
move the financial barriers we have imposed on developing coun-
tries which are preventing them from investing in basic health-
care and training."
Progress
A spokeswoman from the Department of Health said: "The NHS leads
the way in the ethical recruitment of healthcare professionals."
"The Department of Health has brokered a groundbreaking volun-
tary ethical recruitment agreement with the major players in in-
dependent sector healthcare."
"However, if healthcare professionals are determined to come
here to work we cannot legally deny them that opportunity."
She said the government had provided £560 million over the last
five years to support health and health systems development in
Africa, including the training of nurses and doctors.
She said they were also putting huge investment into the expan-
sion of UK medical schools.
Published: 2005/05/26 23:42:44 GMT © BBC MMV
Why Oxfam is failing Africa
---------------------------
Cover story: http://www.newstatesman.com/200505300004
Katharine Quarmby
Monday 30th May 2005
Inside the Make Poverty History movement, there is a growing
fear that its aims are being diluted and taken over by the gov-
ernment. Fingers are being pointed at Oxfam. Katharine Quarmby
reports
In just over a month's time, up to 200,000 people will converge
on the G8 summit in Scotland for a rally organised by Make Pov-
erty History. This will be one of the high points of the 2005
campaign to draw attention to the plight of Africa and to re-
draft the political agenda of the wealthy nations. Make Poverty
History, a coalition of roughly 450 non-governmental organisa-
tions, has on one level been spectacularly successful, drawing
in celebrities as diverse as Nelson Mandela, Claudia Schiffer
and Dawn French. But inside the movement there is discontent.
Fears are growing that MPH has been co-opted by new Labour. The
finger is being pointed at Oxfam, the UK's biggest development
organisation, for allowing the movement's demands to be diluted
and the message to become virtually indistinguishable from that
of the government.
One senior NGO official familiar with the negotiations of the
past few months describes the relationship as "far too cosy". He
says: "They have incredible access, and what that has meant is
that Oxfam are the ones who are always asked to speak for the
whole development movement. And they differ on policy from other
groups. They have decided that, in the longer term, their lot is
best served by being in with Labour and they go out on a limb to
endorse the government."
The dilemma is acute: to what extent should NGOs not just co-
operate with Whitehall but be seen to be integral to a govern-
ment campaign? This question is all the more difficult to answer
given the mixed motives of the government. It may be the case
that any shift in the positions of the rich countries, such as
the deal doubling the European Union's aid budget by 2010, will
produce a better outcome for poorer nations. But to what extent
is the Prime Minister's renewed enthusiasm for the development
cause dictated by his desperate attempt to salvage something for
his foreign policy, after Iraq? Oxfam was one of the first
charities to welcome the EU announcement. Other development
groups were more cautious, fearing that it would deflect atten-
tion yet again from the thornier issues of debt and trade.
Christian Aid's Jonathan Glennie says: "If Gordon Brown thinks
doubling aid will end poverty he has been reading the wrong lit-
erature."
Both Blair and Brown have been keen to be associated with Make
Poverty History, using political events as a forum. When Bono
spoke at last year's Labour party conference, he congratulated
the PM and Chancellor on their work for the campaign, dubbing
them the "Lennon and McCartney" of poverty reduction. Some
groups involved in MPH were horrified. John Hilary, director of
campaigns and policy at War on Want, was in the audience. "When
Bono said that, many NGO leaders who were there put their heads
in their hands and groaned," he recalls. "It's just not useful,
that kind of celebrity endorsement. In fact, it's a killer blow
for us. To see the smiles on the faces of Gordon Brown and Tony
Blair! This is exactly what they want - they want people to be-
lieve that this is their crusade, without actually changing
their policy." Oxfam's Adrian Lovett admits: "It was a bit
cheesy, but there were tough passages in the speech as well. You
have to capture people's imaginations."
Part of the closeness is in the exchange of personnel. This is
not new. Frank Judd, a former director of Oxfam, became a Labour
peer and spoke for the party on international development in the
Lords in the 1990s. But the links have become more intimate un-
der this government. Shriti Vadera, who advises Brown on inter-
national development, is an Oxfam trustee. Justin Forsyth was
director of policy and campaigns at Oxfam before joining the
Downing Street Policy Unit to advise Blair on the issue. When
Oxfam recently advertised for Forsyth's successor, two of the
four candidates called for vetting were either current or former
special advisers. Vadera was on the interview panel. This proc-
ess worries the likes of Mike Sansom, co-ordinator of the social
justice organisation African Initiatives: "NGOs have been
rightly critical of the revolving door between business and gov-
ernment, but the same has now become true of NGOs and govern-
ment."
Links are similarly friendly on policy. On issues such as trade,
Oxfam's position is much closer to the government's than other
groups. When it published a report three years ago that advo-
cated liberalisation of markets in wealthy nations and identi-
fied market access as a key mechanism for eradicating poverty,
the line was strikingly similar to Gordon Brown's. Many NGOs
were appalled, particularly as this was in the run-up to the
crucial World Trade Organisation meeting in Cancun in 2003. Mar-
tin Drewery, head of campaigns at Christian Aid, explains: "The
reason Oxfam got a bad press in the NGO world was not because
anyone disagreed that northern markets should be opened, but it
was not the most important thing - and in practice the richest
countries would not grant that access unilaterally and poor
countries would pay a massive price for it."
Leading international campaigners such as Professor Walden
Bello, who runs the highly respected NGO Focus on the Global
South, based in Bangkok, publicly attacked Oxfam's line. He now
says: "We felt that derailing the ministerial meeting was the
key objective owing to the minimal possibilities of getting vi-
able reforms." On that occasion, Oxfam lost. The talks were de-
railed. Negotiators reached no agreement on trade liberalisation
at Cancun.
When, in January 2003, Brown launched his proposal for the In-
ternational Finance Facility, a way of front-loading aid pay-
ments in the short term, again Oxfam came out in favour. Many
other development organisations took a different view, express-
ing concerns about the threat the IFF poses to aid levels in fu-
ture. One senior development official says: "Most groups in Make
Poverty History have strong reservations about this, and wanted
to hold out for changes in the way the finance facility was or-
ganised. But Oxfam came straight out and said they supported it,
end of story . . . We have spent so much time hammering out
agreed lines between the organisations, and then Oxfam just de-
parts from the hymn sheets. Once you have drawn up agreed posi-
tion papers you need to stick to the line - you cannot opt in or
out. But Oxfam does, and we have had to discipline it on trade
justice several times."
The UK government has finally committed itself to reaching the
UN target of spending 0.7 per cent of national income on aid and
development, but only by 2013. Many in the Labour Party and in
the NGO movement wonder why it has taken so long, but again, Ox-
fam was a signatory to an open letter congratulating the govern-
ment on taking the action. While other Oxfam employees accept
that it raised hackles among partner NGOs, Adrian Lovett defends
the letter. "You can't mount a big campaign, and try and get
politicians supportive, and then not recognise their support
when they do what you want them to do," he argues.
Lovett calls it the "inside/outside strategy" and insists that
it yields concrete results. A debate is raging in the develop-
ment movement in general, however, about both Oxfam's strategy
and the power the organisation wields. One protagonist compares
it to "Tesco negotiating with a local grocery". Christian Aid's
Drewery says: "Oxfam has clearly invested more in that insider-
track lobbying approach, and that brings both pros and cons. It
might be the case that, because Oxfam has more direct lobbying
contact, it might have to be less critical less frequently - but
when it is critical, it stings more. But I would have to say
that a number of organisations wish Oxfam would be more radical
and critical of the government, although it brings other things
to the movement." Tony Juniper, director of Friends of the
Earth, says that the twin-track approach can work, but he points
to the potential for trouble: "If you just work on the inside
you can be really weakened as an NGO." The construction of such
a broad church in Make Poverty History has, he believes, led to
the demands becoming too general. "Everybody can agree with it,
and nothing much actually changes at a specific level of policy.
The danger is that ministers have signed up to the demands but
are not actually doing anything."
Access in Whitehall has certainly not been a problem. It is a
measure of the influence the Make Poverty History coalition has
that when it recently demanded a meeting with all the main min-
isterial advisers on the issue, diaries were cleared. To what
effect, though? Some of the most intriguing criticism of the
softly-softly approach has come from within the government it-
self. One senior government source suggests that Oxfam has
failed to learn one of the essential techniques of negotiation -
if you agree on the basics too early you forfeit real influence.
As a result, demands on aid, trade and debt may have weakened.
There are poignant parallels with Blair signing up to war in
Iraq a year early, and gaining nothing in return. "The Make Pov-
erty History group made one big strategic mistake," says the
ministerial source. "They made no domestic demands of note on
the UK government."
One view from within Whitehall is that, without MPH, there would
not have been such an emphasis on development, and that Africa
would not be on the agenda for the G8 summit at all. A bigger
problem is lack of support from other governments, particularly
in relation to trade. Andy Atkins of Tearfund, a leading devel-
opment charity, points to the compromises that the UK has made
on economic partnership agreements, softening its pro-
liberalisation stance to protect the emerging markets in poor
countries. The UK has even been criticised by other EU countries
for this shift, and the European Commission's director general
of trade, Peter Carl, has said that Britain's approach is influ-
enced by "celebrities and NGOs who are now pressing for action".
It was striking how Oxfam leapt to the government's defence,
saying in a statement: "This is an example of the EC gagging
pro-development member states. Tony Blair is trying to do some-
thing to help the world's poor and is being hampered by the
self-interest of Europe as a trading bloc." Other NGOs such as
War on Want are more sceptical about the government's adherence
to trade justice. John Hilary says that British officials at the
World Trade Organisation told him: "You have to get real. The
development agenda does not go very far. We have to be pro-
business and pro-trade."
Has Oxfam become a kind of meta-NGO, believing that it should
have a place at the top table with politicians, speaking on be-
half of the movement as a whole? The organisation has let others
in the movement know privately that it does not want to be seen
challenging the government this year, and that others should
follow suit. Some refuse to fall into line. Peter Hardstaff,
head of policy for the World Development Movement, says: "We
need to emphasise the differences between us and the government.
Up to now, the focus of MPH has been profile-raising. Now there
is a real need for us collectively to explain where the UK gov-
ernment is doing good things and where there are real differ-
ences."
The dilemma is summed up by one senior source close to Oxfam:
"Do you piss in the tent, or do you crap in the woods?" He says:
"I personally was concerned about the close relation-ship be-
tween the organisation and Blair and Brown. The trouble about
politics is that you take a gamble and you only know when you
get the result whether you have gambled your reputation too far.
Oxfam has positioned itself as a constructive organisation that
can work with people and get things done, but the price you pay
is that some people will think that Oxfam has got too close to
Labour." And he asks: "Have we become involved in the
Blair/Brown battle, as each man looks to his legacy, wanting to
be the saviour of Africa?" This article first appeared in the
New Statesman. For the latest in current and cultural affairs
subscribe to the New Statesman print edition.