World TB Day marks a major turning point
World TB Day, which is observed on 24 March each year, marks a major turning point in public health history. On that day in 1882, Dr Robert Koch of Germany identified the bacillus that causes tuberculosis, an infectious disease so devastating that it was then known in Europe as "the white plague". It took another 60 years before antibiotics rendered the disease
curable; and even today, with effective treatment available, the World Health Organization reported there were 9.2 million new cases and 1.7 million deaths in 2006.
World TB Day was launched in 1982 to mark the 100th anniversary of Koch's discovery. Countries around the world use marches, street theatre, murals, media workshops, government briefings and other events to educate people about the symptoms of TB; build awareness of the need for resources, including new TB diagnostic tools and drugs; and celebrate the survival of those who have recovered.
For organisations such as the 89-year-old International Union Against Tuberculosis and Lung Disease (The Union), World TB Day serves an important purpose. "It's a reminder to everyone that the fight against tuberculosis is ongoing. It hasn't been won yet," says Dr Nils E Billo, Executive Director of The Union.
The theme for World TB Day, "I am stopping TB", emphasizes the wide-ranging effort required to prevent, treat and control TB. "To be successful, we need commitment at every level from government ministers and international donors to health care professionals, researchers, patients and families affected by TB," says Billo.
The Union, with headquarters in Paris, as well as regional offices and members in more than 100 countries, provides direct field assistance to some 80 countries each year, conducts research and organises international conferences and courses.
Billo notes that, since the first World TB Day, global tuberculosis control efforts have seen both significant successes and difficult new challenges:
* Since 1995, more than 31.8 million patients in 184 countries have been treated through the WHO-approved Stop TB Strategy, which is based on a treatment model originally developed by Union researchers.
* The Stop TB Partnership formed in 2000 by the World Health Organization, The Union and other TB organisations has grown into a formidable advocate for a disease that disproportionately affects the poor and voiceless. Today more than 1,000 organisations are members of the Partnership, which has developed the Global Plan to Stop TB 2006 – 2015 and meet the UN's Millennium Development Goals.
* Increased awareness has generated more resources. Funding for TB has increased from less than $1 billion in 2002 to more than $3.3 billion in 2008. The Union recently received a 5-year grant for up to US$ 80 million from the US Agency for International Development for its TREAT TB initiative. Dr I.D. Rusen, Director of The Union's Tuberculosis Department, calls this level of funding "unimaginable" a few years ago.
Other developments illustrate that tuberculosis remains a continuing threat to public health:
* The increasing incidence of extensively drug-resistant tuberculosis (XDR-TB) makes clear that without effective well-funded TB control programmes and the development of new drugs and diagnostic tools, incurable strains of tuberculosis will emerge.
* Tuberculosis is now the number one cause of death among people infected with HIV, and integrated services to address this TB-HIV co-epidemic are critically needed, according to Dr Paula I Fujiwara, Director of The Union's HIV Department.
* The spread of TB, including multidrug-resistant TB, is facilitated by today's highly mobile populations. TB control policy has to take into account not only issues of public health, but also of human rights. For example, a Union Working Group has studied the problem of reaching and treating undocumented immigrants with TB. Its recommendations stress the need for patient confidentiality, free diagnosis and treatment, and recognition of the problems created if patients can not or do not finish their treatment.
* Despite the significant increase in resources for TB, approximately $1 billion more funding per year is needed to implement the Global Plan to Stop TB.
The current economic crisis is also expected to have an impact on TB. The 22 countries with the highest burden of the disease — nearly 80% of the cases — are also among the world's poorest.
This and other issues will be discussed at the 40th Union World Conference on Lung Health, on 3-7 December in Cancún, Mexico, where the theme will be "Poverty and Lung Health".
Useful links:
World TB Day 2009
WHO 2009 Global Tuberculosis Report
Court rules in favour of multi-disabled destitute children in UP
Court rules in favour of multi-disabled destitute children in UP
The Allahabad High Court Lucknow Bench on 24 March 2009 directed the state government to show cause and file Counter Affidavit stating therein as to what steps have been taken by the state Government for care and protection of multi-disabled destitute children within three weeks.
The above direction was passed by a division bench of Hon'ble Mr Justice Pradeep Kant and Hon'ble Justice Shabihul Hasnain in a public interest litigation (PIL) filed by Saaksham Foundation an organisation sensitising and highlighting child rights issues specially for the multi-disabled destitute children [writ petition no. 2825 (M/B) of 2009]. The PIL was filed through its Director Ms Anjali Singh.
In the petition it has been stated by the counsels Mr Padmesh Jain and Mr Amit Jaiswal that while abandoned children with multidisablities have been given the right to care and protection promised to them under Article 21 in the Indian constitution not a single child of this nature has been given his right when campaigned for by Saaksham Foundation. These children have also been deprived of their constitutional right to education as provided in Article 21 A of the constitution of India.
To give an idea of the alarming incidences of abandoning children, in the last two months ie January- February 2009, more than 25 children have been found abandoned by their parents out of which 22 were girls. This petition has been listed for hearing after three weeks.
For further information, please contact:
Anjali Singh, Director, Saaksham Foundation, phone: 9335924192
Legal Counsels: Amit Jaiswal: 9415010088, Padmesh Jain: 9415462734
The Allahabad High Court Lucknow Bench on 24 March 2009 directed the state government to show cause and file Counter Affidavit stating therein as to what steps have been taken by the state Government for care and protection of multi-disabled destitute children within three weeks.
The above direction was passed by a division bench of Hon'ble Mr Justice Pradeep Kant and Hon'ble Justice Shabihul Hasnain in a public interest litigation (PIL) filed by Saaksham Foundation an organisation sensitising and highlighting child rights issues specially for the multi-disabled destitute children [writ petition no. 2825 (M/B) of 2009]. The PIL was filed through its Director Ms Anjali Singh.
In the petition it has been stated by the counsels Mr Padmesh Jain and Mr Amit Jaiswal that while abandoned children with multidisablities have been given the right to care and protection promised to them under Article 21 in the Indian constitution not a single child of this nature has been given his right when campaigned for by Saaksham Foundation. These children have also been deprived of their constitutional right to education as provided in Article 21 A of the constitution of India.
To give an idea of the alarming incidences of abandoning children, in the last two months ie January- February 2009, more than 25 children have been found abandoned by their parents out of which 22 were girls. This petition has been listed for hearing after three weeks.
For further information, please contact:
Anjali Singh, Director, Saaksham Foundation, phone: 9335924192
Legal Counsels: Amit Jaiswal: 9415010088, Padmesh Jain: 9415462734
Private medical practitioners are equal partners in TB control
Private medical practitioners are equal partners in TB control
When close to 70 per cent of patients go to a private medical practitioner on their first visit, limiting directly observed treatment shortcourse (DOTS) in India to public sector healthcare services will not have desired patients' outreach, said members of the Indian Medical Association (IMA) at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.
The involvement of private healthcare providers is seen as crucial to effective TB control and care, particularly in high-burdened countries. In India, 75% of all anti-TB drugs given to patients are administered by the private sector.
WHO's Stop TB Strategy envisages the engagement of all care providers using public-to-private and public-to-public approaches in line with the International Standards for Tuberculosis Care and the Patients' Charter for Tuberculosis Care.
When close to 70 per cent of patients go to a private medical practitioner on their first visit, limiting directly observed treatment shortcourse (DOTS) in India to public sector healthcare services will not have desired patients' outreach, said members of the Indian Medical Association (IMA) at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.
The involvement of private healthcare providers is seen as crucial to effective TB control and care, particularly in high-burdened countries. In India, 75% of all anti-TB drugs given to patients are administered by the private sector.
WHO's Stop TB Strategy envisages the engagement of all care providers using public-to-private and public-to-public approaches in line with the International Standards for Tuberculosis Care and the Patients' Charter for Tuberculosis Care.
Dr Balasubramanian Muthiah from IMA said that the reach of IMA is extensive in India, with 1676 branches and more than 180,000 members across the country. IMA has also been working with a range of issues including polio and other immunization, HIV/AIDS, blood safety, family planning, female foeticide, blindness control and tuberculosis control too.
In 2007, IMA got financial support from the Global Fund to fight AIDS, TB and Malaria (GFATM) and the project IMA-GFATM-RNTCP-PPM commenced. This was in collaboration with the revised national TB control programme (RNTCP) on public-private mix. In 2007, the project began in five states of India covering 167 districts.
By 2009, the project was scaled up to 15 states covering 850 million population in 406 districts in India.
IMA believes in providing no financial incentives to doctors and encouraging one-to-one peer sensitization on TB control.
The doctors were sensitized, trained, as a significant number of private medical practitioners don’t practice DOTS, said Dr Balasubramanian. So it was a process to mobilize them to accept DOTS and to encourage them to establish DOTS centres in their private healthcare settings.
By February 2009, under this IMA led project, 489 continuing medical education sessions were held reaching out to 21,788 private medical practitioners. District TB programmes were started in 120 districts and 2,532 private medical practitioners were trained. 557 DOTS centres were also opened in private healthcare settings by end of February 2009.
The new TB case detection rates have gone up, said Dr Balasubramanian.
In India, national programs collaborate with the Indian Medical Association, Indian Academy of Paediatrics, Federation of family Physicians of India and several other healthcare associations.
Efforts are also being made to link these associations to groups working at a district rather than national level and training programs and continued medical education sessions are often organized to encourage doctors to become involved in TB care and control.
- Bobby Ramakant
Rio 2009: TB patients' groups are strengthening TB responses in Congo
TB patients' groups are strengthening TB responses in Congo
The Patients' Charter for Tuberculosis Care (The Charter) is a part of national TB strategy in Democratic Republic of Congo (DRC) but hasn't been implemented yet officially. However the people with TB, particularly those who have successfully completed the TB treatment, have organized themselves in form of TB patients' groups or clubs for years now, and are working closely with the healthcare providers to strengthen TB responses as equal partners.
Maxime Lunga from World Care Council, Africa, who is attending the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil, is also representing a network of TB patients' groups in DRC called 'CAD' (Club Amis-des Damien). "We started forming TB patients' groups in 1999" said Maxime. "Our motivation was the responsibility we felt towards those newly diagnosed with TB, because we had experienced TB, and we didn’t want to suffer again"
The supportive attitude of healthcare providers also helps motivate TB patients' support groups, feels Maxime. The TB patients need to work with dignity and healthcare providers need to respect them as equal partners in TB care and control, says Maxime.
Presently Maxime has a network of 50 TB patients' groups in health centres of the DRC's capital Kinshasa, and 5 TB patients' groups each in Bukavu (eastern part of DRC), Kindu and Equator.
These TB patients' support groups provide support to those newly diagnosed or currently undergoing TB treatment, engage them and help share their own experiences with each other. Providing medical, social, and psychological support is crucial, feels Maxime. Sharing of experiences of having TB, benefits of completing the treatment, or conducting home visits to support, can radically improve TB treatment outcomes, believes Maxime. TB patients' support groups are the anchors for those who are newly diagnosed of TB, says Maxime.
The Charter, although is a part of the national TB strategy in DRC, is yet to be implemented in the country. It needs to be adapted for DRC, translated into local languages, and then used as a tool to scale up the standards of TB care.
The Charter is a great tool, believes Maxime. However the governments and donors need to invest more resources to print the Charter in local languages and disseminate it widely. The awareness levels about the Charter and the rights and responsibilities of people with TB it advocates for, is abysmally low.
"We need to raise awareness about the rights and responsibilities of people with TB, use the Charter as a tool for empowering the communities and mobilizing them to advocate for enhancing the standards of TB treatment and care in their localities" asserts Maxime.
In South Africa, a MSF report released today on World TB Day (24 March) shows how community-based approaches to drug-resistant TB have improved treatment outcomes considerably.
The people with TB, particularly those who have successfully completed the anti-TB treatment, is central to improving the TB response. The communities have a key role in increasing TB case detection, reducing TB-related stigma, partnering with healthcare staff, community awareness, screening of household contacts, encouraging rapid diagnosis to decrease the delay before starting treatment, improving treatment protocols, providing education and adherence counselling for patients and implementing infection control measures in clinics, patients' homes, and in the community, believes Maxime.
- Bobby Ramakant
The Patients' Charter for Tuberculosis Care (The Charter) is a part of national TB strategy in Democratic Republic of Congo (DRC) but hasn't been implemented yet officially. However the people with TB, particularly those who have successfully completed the TB treatment, have organized themselves in form of TB patients' groups or clubs for years now, and are working closely with the healthcare providers to strengthen TB responses as equal partners.
Maxime Lunga from World Care Council, Africa, who is attending the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil, is also representing a network of TB patients' groups in DRC called 'CAD' (Club Amis-des Damien). "We started forming TB patients' groups in 1999" said Maxime. "Our motivation was the responsibility we felt towards those newly diagnosed with TB, because we had experienced TB, and we didn’t want to suffer again"
The supportive attitude of healthcare providers also helps motivate TB patients' support groups, feels Maxime. The TB patients need to work with dignity and healthcare providers need to respect them as equal partners in TB care and control, says Maxime.
Presently Maxime has a network of 50 TB patients' groups in health centres of the DRC's capital Kinshasa, and 5 TB patients' groups each in Bukavu (eastern part of DRC), Kindu and Equator.
These TB patients' support groups provide support to those newly diagnosed or currently undergoing TB treatment, engage them and help share their own experiences with each other. Providing medical, social, and psychological support is crucial, feels Maxime. Sharing of experiences of having TB, benefits of completing the treatment, or conducting home visits to support, can radically improve TB treatment outcomes, believes Maxime. TB patients' support groups are the anchors for those who are newly diagnosed of TB, says Maxime.
The Charter, although is a part of the national TB strategy in DRC, is yet to be implemented in the country. It needs to be adapted for DRC, translated into local languages, and then used as a tool to scale up the standards of TB care.
The Charter is a great tool, believes Maxime. However the governments and donors need to invest more resources to print the Charter in local languages and disseminate it widely. The awareness levels about the Charter and the rights and responsibilities of people with TB it advocates for, is abysmally low.
"We need to raise awareness about the rights and responsibilities of people with TB, use the Charter as a tool for empowering the communities and mobilizing them to advocate for enhancing the standards of TB treatment and care in their localities" asserts Maxime.
In South Africa, a MSF report released today on World TB Day (24 March) shows how community-based approaches to drug-resistant TB have improved treatment outcomes considerably.
The people with TB, particularly those who have successfully completed the anti-TB treatment, is central to improving the TB response. The communities have a key role in increasing TB case detection, reducing TB-related stigma, partnering with healthcare staff, community awareness, screening of household contacts, encouraging rapid diagnosis to decrease the delay before starting treatment, improving treatment protocols, providing education and adherence counselling for patients and implementing infection control measures in clinics, patients' homes, and in the community, believes Maxime.
- Bobby Ramakant
Life-long contribution of Smitu Kothari to people's movements
Life-long contribution of Smitu Kothari to people's movements
Resolves to carry forward his vision for a just and pro-poor development
The Narmada Bachao Andolan (NBA) joined other people's movements in expressing its shock and grief at the most untimely demise of Smitu Kothari, one of the most active, progressive and consistent voices against the neo-liberal anti-poor agenda of privatization, globalization and liberalization in recent times. A widely respected scholar, visiting academic at the Cornell and Princeton Universities, author of several publications on contemporary socio-political and economic discourses and above all an indomitable activist, Smitu Kothari, 59 passed away early this week owing to a cardiac attack after having undergone a heart surgery at All India Institute of Medical Sciences (AIIMS) in Delhi. The cremation was held at Lodi Road electric Crematorium in South Delhi at 4pm on the 23rd March 2009.
The most unexpected stroke came when Smitu was at a meeting of the Delhi Solidarity Group and Himalaya Niti Abhiyan to discuss strategies for strengthening the people's struggles in Himachal Pradesh against displacement, mining and environmental destruction on the 20th afternoon, from where he was rushed to the AIIMS and was discharged the same day as his ECG was found to be normal. However he was again hospitalized a day later due to arterial complications and succumbed during the post-operative care.
One of the founders of Lokayan ("Dialogue of the People"), and Intercultural Resources, two centres in Delhi promoting exchange between non-party political formations and concerned scholars and other citizens from India and the rest of the world, he was actively involved in ecological, cultural and human rights issues striving to collectively forge a national and global alternative that is socially just and ecologically sane and in this capacity has been vigorously pursuing multifarious academic and activist initiatives. Development induced displacement, people’s governance and social-environmental movements were some of his core concerns. He was also one of the striving spirits behind the Independent People's Tribunal on the World Bank Group in India held in 2007.
Smitu has also been a long time vocal supporter of the struggle of the thousands of adivasis, farmers, labourers, fishworkers, potters and all the project-affected people in the Narmada valley and articulated their concerns at various fora both within India and across continents.
A truly loving person, Smitu continues to be a source of inspiration not just for people's movements and struggles in India, but also to voices of dissent and alternatives across the globe. NBA expresses its heartfelt condolences to Smitu's extended family of activists, supporters and all peace and justice loving people. We salute his decades of invaluable contribution to diverse people's movements and resolves to take forward his message and commitment to come together and be united against all odds and strengthen our collective force for justice.
Medha Patkar
Narmada Bachao Andolan (NBA)
Resolves to carry forward his vision for a just and pro-poor development
The Narmada Bachao Andolan (NBA) joined other people's movements in expressing its shock and grief at the most untimely demise of Smitu Kothari, one of the most active, progressive and consistent voices against the neo-liberal anti-poor agenda of privatization, globalization and liberalization in recent times. A widely respected scholar, visiting academic at the Cornell and Princeton Universities, author of several publications on contemporary socio-political and economic discourses and above all an indomitable activist, Smitu Kothari, 59 passed away early this week owing to a cardiac attack after having undergone a heart surgery at All India Institute of Medical Sciences (AIIMS) in Delhi. The cremation was held at Lodi Road electric Crematorium in South Delhi at 4pm on the 23rd March 2009.
The most unexpected stroke came when Smitu was at a meeting of the Delhi Solidarity Group and Himalaya Niti Abhiyan to discuss strategies for strengthening the people's struggles in Himachal Pradesh against displacement, mining and environmental destruction on the 20th afternoon, from where he was rushed to the AIIMS and was discharged the same day as his ECG was found to be normal. However he was again hospitalized a day later due to arterial complications and succumbed during the post-operative care.
One of the founders of Lokayan ("Dialogue of the People"), and Intercultural Resources, two centres in Delhi promoting exchange between non-party political formations and concerned scholars and other citizens from India and the rest of the world, he was actively involved in ecological, cultural and human rights issues striving to collectively forge a national and global alternative that is socially just and ecologically sane and in this capacity has been vigorously pursuing multifarious academic and activist initiatives. Development induced displacement, people’s governance and social-environmental movements were some of his core concerns. He was also one of the striving spirits behind the Independent People's Tribunal on the World Bank Group in India held in 2007.
Smitu has also been a long time vocal supporter of the struggle of the thousands of adivasis, farmers, labourers, fishworkers, potters and all the project-affected people in the Narmada valley and articulated their concerns at various fora both within India and across continents.
A truly loving person, Smitu continues to be a source of inspiration not just for people's movements and struggles in India, but also to voices of dissent and alternatives across the globe. NBA expresses its heartfelt condolences to Smitu's extended family of activists, supporters and all peace and justice loving people. We salute his decades of invaluable contribution to diverse people's movements and resolves to take forward his message and commitment to come together and be united against all odds and strengthen our collective force for justice.
Medha Patkar
Narmada Bachao Andolan (NBA)
Community-based approach to drug-resistant TB treatment in South Africa
Community-based approach to drug-resistant TB treatment in South Africa
Experience shows that providing treatment and care with dignity in homes of people with drug-resistant TB, particularly for those who are also co-infected with HIV, radically improves treatment outcomes.
Experience shows that providing treatment and care with dignity in homes of people with drug-resistant TB, particularly for those who are also co-infected with HIV, radically improves treatment outcomes.
Not only for today, the World TB Day (24 March), but also for the ongoing 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil (23-25 March 2009) and the forthcoming high-level ministerial meeting on M/XDR-TB (multi and extensively drug-resistant TB) in Beijing, China (1-3 April 2009), this is undoubtedly a food for thought.
"Experience in fighting drug-resistant TB globally comes mainly from Eastern Europe, but what we face in Khayelitsha (South Africa) is a radically different situation requiring a radically new approach," said Dr Eric Goemaere, Medical Coordinator for Médecins Sans Frontières (MSF) in South Africa.
"The number of patients with drug-resistant TB are much larger and the majority are HIV co-infected. We are applying lessons learnt in providing HIV/AIDS treatment to tackle this complex medical challenge, for example de-centralisation of treatment to the primary care level, integration of HIV and drug-resistant TB care, promotion of earlier diagnosis of drug-resistant TB, and reinforcement of treatment adherence and infection control using a patient-centred, community-based approach."
The current national policy in South Africa is one of centralised care and treatment for drug-resistant TB in regional, specialised treatment centres. Patients often spend at least six months in congregate wards. As these centres are often far from patients' homes, they are usually cut-off from their families and their livelihoods and feel abandoned. Consequently, there is a high rate of default, with up to a third of patients refusing to remain in care. There is also a waiting list for beds for drug-resistant TB patients in eight of South Africa's nine provinces.
"We are convinced that more patients will be diagnosed and successfully treated if they are supported to follow treatment in their homes and communities, rather than being isolated in specialised hospitals," said Dr Virginia Azevedo, Khayelitsha Sub-District Manager for the City of Cape Town Health Department. "Our main objectives in this project are to increase diagnosis of drug-resistant TB, improve treatment outcomes for drug-resistant TB patients, and contribute to decreasing drug-resistant TB transmission at the community and facility level in Khayelitsha."
Key aspects of the model of care include increasing drug-resistant TB case detection through staff training, community awareness, and screening of household contacts; encouraging rapid diagnosis to decrease the delay before starting treatment; improving treatment protocols; providing education and adherence counselling for patients and implementing infection control measures in clinics, patients' homes, and in the community. A small 12-bed inpatient facility to provide sub-acute care, Lizo Nobanda, is in the process of being set up in Khayelitsha.
The MSF, the City of Cape Town, and the Provincial Government of the Western Cape Department of Health released a new report to mark World TB Day, on a joint pilot project, launched in late 2007, to provide decentralised, patient-centred care, support and treatment for people with drug-resistant tuberculosis in Khayelitsha, a large township of approximately 500,000 people outside of Cape Town with one of the highest burdens of both HIV and TB in South Africa.
The TB incidence rate in Khayelitsha is at least 1,500 per 100,000 people per year – among the highest in the world. Of the nearly 6,000 people diagnosed with TB in Khayelitsha in 2008, 196 were diagnosed with drug-resistant TB and 74% of these were also HIV-infected. However, if all TB patients were to be tested, close to 400 patients would be diagnosed with drug-resistant TB each year in Khayelitsha. This would give an incidence of drug-resistant TB of around 60 per 100,000 people each year – one of the highest rates of drug-resistant TB in the world.
"The Province is very pleased to support this successful collaboration between MSF, the Provincial Department of Health, and City Health, which has produced an innovative model of care for drug-resistant TB patients in one of the highest burden areas in South Africa and the world," said Dr Giovanni Perez, Director of Metro District Health System for the Khayelitsha and Eastern sub-districts of the Cape Metro. "The development of this new model for managing drug-resistant TB care and treatment in a high HIV prevalence setting will produce valuable lessons for other areas where needs are also immense."
The drug-resistant TB treatment is long and arduous. Patients have to take up to six drugs, which are difficult to tolerate, and treatment lasts for 24 months. The development of a patient-centred approach to adherence has therefore been crucial. The project focuses intensively on counselling, education, and support to patients and their families to empower them to understand the disease, observe infection control measures, and take responsibility for their treatment.
"I am a living example that drug-resistant TB can be cured, just like normal TB, even for people living with HIV," said Busi Beko, MSF's drug-resistant TB Adherence Counsellor. "But it was not easy and I know firsthand the difficulties that people experience in trying to complete the full course of treatment. People need to feel supported and encouraged, not blamed for their disease."
While significant progress has been made in some programme areas, challenges remain: patients will still have to wait too long for their diagnosis and will have difficulties with adherence to lengthy and difficult treatment for the foreseeable future.
"Our experience in Khayelitsha tells us that the majority of drug-resistant TB transmission is occurring before patients are even diagnosed and started on treatment," said Dr Goemaere. "Patients can definitely be cured of drug-resistant TB treatment despite the fact that it is complex and resource-intensive. But it is an uphill battle. In addition to new models of care, like the one we have developed in Khayelitsha, we urgently need better rapid diagnostic tools to detect drug-resistant TB earlier and less toxic, better tolerated, and more affordable drugs to treat patients."
The Patients' Charter for Tuberculosis Care (PCTC, The Charter), which is part of the global TB strategy, stresses on the rights and responsibiltiies of people with TB - and certainly needs to be implemented so that most affected communities can take more leadership in advocating for increasing the standards of TB care and treatment.
- Bobby Ramakant
Unified action: The only way forward to control TB
Unified action: The only way forward to control TB
"We simply must stop TB. This succinct but compelling message implies a shared responsibility for unified action at all levels, by health-care providers, national and international partners and communities to control and eliminate TB", said Dr. Samlee Plianbangchang, World Health Organization (WHO)'s Regional Director for South-East Asia.
The strong call for unified action at all levels to control TB, is significant, and echoes the responses to concerns raised by many other people on what should be done to improve TB responses in these times of global economic meltdown. At the first day of the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil, a day before the World TB Day (24 March 2009) and a week before the high-level ministerial meeting on X/MDR-TB opens in Beijing, China (1-3 April 2009), the call for unified action at all levels from WHO regional office in South-East Asia, adds to underlining the urgency needed for TB control.
Progress in reducing the number of tuberculosis (TB) cases stands at a crossroads today. While over 87% of the two million TB patients in the South-East Asia Region are being treated successfully every year, multi-drug resistant TB (MDR-TB), TB-HIV co-infection and the global economic crisis pose a serious threat to the gains achieved so far.
For instance, the Global Fund to fight AIDS, TB and Malaria (GFATM) falls short by USD 5 billion of its 2009-2010 budget of USD 8 billion. Countries instead of keeping their promises to the GFATM, are instead disbursing many times more of bail-out money to banks (which banks are disbursing to their employees as holiday bonuses). It is clear that TB care and control is not yet a development priority for most countries - and the need to engage these stakeholders as equal partners was never so compelling.
Annually over 10% of the estimated 3.6 million people living with HIV (PLHIV) in the south-east Asia Region are likely to develop active TB. Hence, it is critical that both HIV/AIDS and TB control programmes ensure that the benefits of expanding access to HIV counselling, testing and care, including access to antiretroviral therapy (ART), reach TB patients who also have HIV.
Levels of drug-resistance in TB patients in most parts of the South-East Asian Region are still low at less than 3%, due to good implementation of basic directly-observed treatment short-course (DOTS). However, given the large number of TB patients, this represents over 150,000 new patients with MDR-TB every year. "Widespread unregulated use of anti-TB drugs outside of national programmes is our major concern in the context of drug resistant TB," stressed Dr Plianbangchang.
Increasing investments in health-care systems are essential to ensuring that all TB patients have equitable access to free and quality care at all health care facilities at the primary level. What is also urgently required is that all health professionals, from both the public and private sectors, adhere strictly to internationally recommended standards for TB care, and that appropriate measures are duly implemented to contain unregulated use of anti-TB drugs to prevent the emergence of drug resistance.
- Citizen News Service (CNS)
Will genuine partnerships improve TB responses despite of economic recession?
Will genuine partnerships improve TB responses despite of economic recession?
In these times of global meltdown, it is all the more critical to focus on how can TB care and control, be still seen as a smart investment to governments, private sector and other stakeholders.
There is enough evidence to substantiate that TB care and control is a smart investment. In December 2007, a World Bank report had revealed that high burden TB countries can earn significantly more than they spend on TB diagnosis and treatment if they signed onto the Stop TB Partnership's Global Plan to Stop TB. This study made it clear that the economic benefits of TB control are greater than the costs. Most highly affected countries could gain nine times or more their investments in TB control.
In these times of global meltdown, it is all the more critical to focus on how can TB care and control, be still seen as a smart investment to governments, private sector and other stakeholders.
There is enough evidence to substantiate that TB care and control is a smart investment. In December 2007, a World Bank report had revealed that high burden TB countries can earn significantly more than they spend on TB diagnosis and treatment if they signed onto the Stop TB Partnership's Global Plan to Stop TB. This study made it clear that the economic benefits of TB control are greater than the costs. Most highly affected countries could gain nine times or more their investments in TB control.
However, when the 3rd Stop TB Partners' Forum is about to begin in Rio de Janeiro, Brazil (23-25 March 2009), World TB Day (24 March 2009) is hardly few hours ahead, and the high-level Ministerial meeting on M/XDR-TB will commence during 1-3 April 2009 in Beijing, China, it is certainly a food for thought on how can we still salvage TB care and control programmes in these times of economic recession.
Just few days back, the American International Group (AIG) was in the news for disbursing nearly half a billion US dollars as bonuses of the bail-out money.
In most countries, leaders are resorting to extreme cost-cutting measures that threaten funding for TB treatment and control measures across the globe. The cuts will be made, and the investment will only occur in 'smart' areas.
Clearly more needs to be done to convince the world that TB care and control is a smart investment. In the past months, the indications have been worrisome. While the Global Fund to fight AIDS, TB and Malaria (GFATM) continues its search for the US$ 5 billion in funding still needed for 2009-2010, Wall Street corporations gave themselves $18 billion in holiday bonuses.
The money for these bonuses came from tax payers but would tax payers rather fund holidays for bankers, or save lives in countries hit hard by the three diseases - AIDS, TB and Malaria? The Merrill Lynch bonuses alone would have paid off GFATM's funding short-fall in full.
Jeffery Sachs, Director of Columbia University's Earth Institute and a Special Adviser to the UN Secretary General, had called on the US government to take back the $18 billion and use the money to help buy antiretroviral drugs and mosquito nets.
Calling the bonuses, "unbelievably egregious" Sachs said, "Those bonuses are being paid out of our bailout funds . . . I suggest the US government reclaim that funding and put the money into the Global Fund immediately."
The GFATM provides a quarter of all international funding for the response to HIV, two-thirds of all the money that goes to tackling TB and three quarters of all money spent on stopping malaria.
But GFATM has only collected $3 billion of the $8 billion needed to fund projects around the world in 2009 and 2010. Sachs says the $5 billion funding short-fall faced by GFTAM is less than half a percent of the money G8 countries have spent on bailing out failed banks in the past three months.
The US has failed to keep its promises to GFATM and has not handed over 0.7% to 1% of its annual gross national product as agreed. The US is at 0.16 of 1% of its income for development assistance. It's the lowest level of all 22 donor countries.
It is clear that unless the TB advocates reach out to decision makers to impress upon them the urgency of strengthening TB care and control programmes, the global economic meltdown is likely to threaten to reverse the gains made in TB care over past decades. "I believe we should not lower our sights one bit. Rather, we should broadcast far and wide irrefutable arguments for more and better TB control now. The fight against TB is more than a humanitarian cause – it is also a smart investment, at a time when many investments seem insecure" said Dr Marcos Espinal, on the Stop TB Forum's blog.
Time is running out. How can the world begin to see TB care as a smart investment?
Unless those who are not yet convinced that TB care is a smart investment, get convinced that they are equal partners in TB programmes, the situation will not radically change.
The answer might be in partnerships - genuine partnerships - not just between TB stakeholders, but with a broad range of partners. This will also mean that people will have to step beyond the mandates of their institutions and organizations to synergize as effectively and genuinely as possible. It is not only the TB advocates, but other potential partners who need to be convinced that TB care is a smart investment.
TB needs to be seen more than a medical or health issue, it is in all earnestness, a development challenge threatening sustainable development in most hard-hit communities.
- Bobby Ramakant
Relevance of Bhagat Singh cannot be ignored by modern India
Relevance of Bhagat Singh cannot be ignored by modern India
The Kalam Vichar Manch ( thinkers’ association) recently organized a thought provoking seminar to commemorate the death anniversary of freedom fighter Shaheed Bhagat Singh, who was ‘hanged to death’ on 23 March 1931.
On this occasion, noted historian Dr. Irfan Habib spoke on the relevance of Bhagat Singh in the present times. It was a real treat to hear the renowned professor dwell on the various facets of the personality of the great revolutionary, in his characteristic style.
Bhagat Singh is indeed a unique character of Indian history. his life is what legends are made of. Several films have been made on him and his photo is still garlanded by various political parties (though sadly for their own dubious interests).
Although termed as a terrorist by the then British Empire, Bhagat Singh rightly wanted to be called a revolutionary and a soldier in the war against imperialism. He believed that his retaliation against oppression could not be termed as anarchy. His ideas reflect his deep understanding of the Indian milieu and his thought provoking writings make him a class apart from his contemporaries. Though he died at the young age of 24 years, he had a clear vision of an India which was not only politically free, but also free from poverty and social injustices. In one of his speeches, less than 2 months before his death, he stressed the need for a Socialist Revolution, through a political revolution. Else, he said that it did not matter whether Purushottam Das Thakur ( a wealthy industrialist of his times ) ruled India or the Britishers. So for any movement to succeed, it was (and still is) imperative that the masses be involved in it.
Dr. Habib lauded the scientific temperament of Bhagat Singh, which is very relevant in today’s scenario. More than any other nationalist of his times, Bhagat Singh stressed the importance of being rational. He believed in ideological firmness and said, ‘Religion has no connection with the National Movement.’ Bold sentiments indeed, but very true. It is distressing to see that today Nationalism is being touted in the garb of religion and caste. This has resulted in fragmentation of society and in communal riots. Instead of insisting on religious instructions to our children, it would be better if we instruct them in the values of love and peaceful co existence.
Bhagat Singh also believed in a ‘realistic socialism’. He dreamt of social equality and prosperity. His vision of a Communist Society was very similar to that of Marx and Lenin--- a society where there were equal opportunities for all and a just distribution wealth according to one’s capabilities, and where even the lowliest could live comfortably. His brand of socialism was not a utopia, but a reality which could be brought about with non violent and peaceful methods. He knew that in this quest for socialism, one would have to make compromises at times, without losing sight of the main aim. In any such compromise, both parties gain some and lose some. But the onward, non violent march towards socialism should continue. Nothing worth while can be achieved by being a hardliner.
During his trial in the court, Bhagat Singh said that India ’s struggle for freedom cannot be carried out in isolation. It will have to be linked and influenced by other international movements and happenings. This concept of International Solidarity is very important today, when we talk of the world as a global village. Yet our leaders are sadly lacking in ideological condemnation of anti people regimes. We tend to be guided more by economic self gains rather than by valued principles.
It is time we paid just more than lip service to the dreams of Bhagat Singh. There relevance in modern day India cannot be ignored.
Shobha Shukla
The author writes extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).
The Kalam Vichar Manch ( thinkers’ association) recently organized a thought provoking seminar to commemorate the death anniversary of freedom fighter Shaheed Bhagat Singh, who was ‘hanged to death’ on 23 March 1931.
On this occasion, noted historian Dr. Irfan Habib spoke on the relevance of Bhagat Singh in the present times. It was a real treat to hear the renowned professor dwell on the various facets of the personality of the great revolutionary, in his characteristic style.
Bhagat Singh is indeed a unique character of Indian history. his life is what legends are made of. Several films have been made on him and his photo is still garlanded by various political parties (though sadly for their own dubious interests).
Although termed as a terrorist by the then British Empire, Bhagat Singh rightly wanted to be called a revolutionary and a soldier in the war against imperialism. He believed that his retaliation against oppression could not be termed as anarchy. His ideas reflect his deep understanding of the Indian milieu and his thought provoking writings make him a class apart from his contemporaries. Though he died at the young age of 24 years, he had a clear vision of an India which was not only politically free, but also free from poverty and social injustices. In one of his speeches, less than 2 months before his death, he stressed the need for a Socialist Revolution, through a political revolution. Else, he said that it did not matter whether Purushottam Das Thakur ( a wealthy industrialist of his times ) ruled India or the Britishers. So for any movement to succeed, it was (and still is) imperative that the masses be involved in it.
Dr. Habib lauded the scientific temperament of Bhagat Singh, which is very relevant in today’s scenario. More than any other nationalist of his times, Bhagat Singh stressed the importance of being rational. He believed in ideological firmness and said, ‘Religion has no connection with the National Movement.’ Bold sentiments indeed, but very true. It is distressing to see that today Nationalism is being touted in the garb of religion and caste. This has resulted in fragmentation of society and in communal riots. Instead of insisting on religious instructions to our children, it would be better if we instruct them in the values of love and peaceful co existence.
Bhagat Singh also believed in a ‘realistic socialism’. He dreamt of social equality and prosperity. His vision of a Communist Society was very similar to that of Marx and Lenin--- a society where there were equal opportunities for all and a just distribution wealth according to one’s capabilities, and where even the lowliest could live comfortably. His brand of socialism was not a utopia, but a reality which could be brought about with non violent and peaceful methods. He knew that in this quest for socialism, one would have to make compromises at times, without losing sight of the main aim. In any such compromise, both parties gain some and lose some. But the onward, non violent march towards socialism should continue. Nothing worth while can be achieved by being a hardliner.
During his trial in the court, Bhagat Singh said that India ’s struggle for freedom cannot be carried out in isolation. It will have to be linked and influenced by other international movements and happenings. This concept of International Solidarity is very important today, when we talk of the world as a global village. Yet our leaders are sadly lacking in ideological condemnation of anti people regimes. We tend to be guided more by economic self gains rather than by valued principles.
It is time we paid just more than lip service to the dreams of Bhagat Singh. There relevance in modern day India cannot be ignored.
Shobha ShuklaThe author writes extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).
Involving TB patients in TB programmes will help in Turkey
Involving TB patients in TB programmes will help in Turkey
Involving the TB patients in TB control programmes - particularly those who have successfully completed the TB treatment - might help in Turkey, says Professor (Dr) Nazmi Zengin from Toplum Sagligi Arastirma ve Gelistirme Merkezi (Centre for Research and Promotion of Health) in Konya, Turkey (www.toplumsagligi.org). Dr Nazmi is representing a civil society organization in Turkey, which is a member of the Stop TB Partnership, and attending the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.
Turkey was very successful in TB control in 1970s, says Dr Nazmi. By mid 1970s, there was a prevailing sense in government that Turkey has almost eradicated TB (less than 1% incidence) and TB seized to be counted a problem in the country, says Dr Nazmi.
Involving the TB patients in TB control programmes - particularly those who have successfully completed the TB treatment - might help in Turkey, says Professor (Dr) Nazmi Zengin from Toplum Sagligi Arastirma ve Gelistirme Merkezi (Centre for Research and Promotion of Health) in Konya, Turkey (www.toplumsagligi.org). Dr Nazmi is representing a civil society organization in Turkey, which is a member of the Stop TB Partnership, and attending the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.
Turkey was very successful in TB control in 1970s, says Dr Nazmi. By mid 1970s, there was a prevailing sense in government that Turkey has almost eradicated TB (less than 1% incidence) and TB seized to be counted a problem in the country, says Dr Nazmi.
In 1970s, internal migration in Turkey was also alarmingly high with many people from East Turkey moving towards West Turkey which was a more industrialized and rich part. Those who migrated, were hoping to find jobs but the quality of their life and living conditions upped their vulnerability to infectious diseases, particularly TB. TB is indeed a disease of the poor and those who became unemployed in west Turkey were further at risk of TB.
This situation was aggravated by the transformation in health systems where TB dispensaries or clinics were being closed down because government was not allocating enough money to TB. Rather the Turkish government's emphasis was to promote community medicine, and encourage family practitioners instead of TB physicians. Dr Nazmi feels this is where Turkey began to lose the war against TB - and now nearly 3000 deaths are attributed to TB in Turkey every year, an alarming numbers of which occur due to multi-drug resistant TB (MDR-TB).
The health system transformation is not good every time, believes Dr Nazmi. He says that the TB treatment literacy is alarmingly low, and many TB patients who begin the treatment, stop going to the TB clinic for medicines once they start feeling better. This is one area where people who have successfully completed TB treatment, can help in raising treatment literacy and provide support to those who are tested positive for TB, or begin the treatment. These are key reasons why anti-TB drug resistance is increasing in Turkey.
Unless the programme performance of DOTS (Directly Observed Treatment shortcourse) is improved and the reasons due to which people develop resistance to first line anti-TB drugs are duly addressed, the anti-TB drug resistance will continue increasing.
The number of drug-susceptibility laboratories (DST) is also not adequate. Most laboratories only test the anti-TB drug resistance for 4 first-line drugs. To test the anti-TB drug resistance for 10 classes of anti-TB drugs, the patients need to go to the university hospitals, the cost of which is often prohibitive and beyond the reach of the patients.
TB-HIV co-infection is not yet an alarming issue in Turkey.
"DOTS is a good tool but we can't apply it strictly" says Dr Nazmi. There is a need to do a lot more to reach out to those people who are not able to seek TB care services from DOTS programme. "But government doesn’t hear the voices of the civil society, rather keep on saying that TB control in Turkey is very successful" says Dr Nazmi. Involving TB patients in TB control programmes and listening to these voices with dignity in Turkey, will help, believes Dr Nazmi.
The high-level ministerial meeting on multi-drug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) is about to open in Beijing, China (1-3 April 2009). Let us hope that the Ministers are listening to the concerns raised above.
- Bobby Ramakant
Water Water Everywhere, But Not A Drop To Drink
World Water Day special
- 22 March 2009 -
Water Water Everywhere, But Not A Drop To Drink
Water constitutes about three fourths of the earth’s surface, but only less than one percent of it can be used by its inhabitants. Most of it is salt water oceans (about 97%) and 2% of it is contained in glaciers. With every country seeking to satisfy its ever increasing water needs from shrinking and limited water resources, there could be a future of conflict. As the UN Secretary General, Ban Ki Moon remarked recently that water scarcity is the potential fuel for wars and conflict. But cooperation, not conflict should guide us in our quest for a solution to this crisis.
In 1992, the UN General Assembly designated March 22, as the World Water Day (WWD) to draw international attention to the critical lack of clean, safe drinking water worldwide. The theme for this year’s WWD is ‘Shared Water—Shared Opportunity’, with the focus on transboundary water management and sharing. There are about 263 transboundary lakes and river basins, which include territories of 145 countries and cover nearly half of the earth’s land surface.
Despite an apparent abundance of clean water in most of the developed nations, more than 1 billion people around the world lack clean safe drinking water and more than 2.6 billion lack adequate sanitation services. One third of the earth’s population lives in ‘water stressed’ countries. The crisis is worst in sub Saharan Africa and South Asia .
Lack of clean drinking water and basic sanitation is a big obstacle to progress and development. The worst sufferers are women and children who have to trudge long distances to retrieve meager amounts of water for domestic use. This prevents them from pursuing an education and earning more or doing any thing more productive. The quest for water can drive one mad..
India faces a rapidly worsening water crisis in urban and rural areas. A soaring population, a speedy sprawl of cities, a vast and thirsty farm belt and indiscriminate use of water has left water, in our country, too scarce in some places, contaminated in others and in useless surfeit for others who are flooded every year. . The result is there for all of us to see and ponder. More than 700 million Indians do not have adequate sanitation, let alone safe drinking water. According to a UN report, about 2.1 million children die every year, largely for lack of clean water.
Changing life styles and dietary habits, private control over water resources and climate changes (resulting in floods and droughts) are all worsening the water crisis and wreaking an economic and ecological havoc on our blue planet. Poor countries, like India , are at a greater risk as water scarcity threatens the health and livelihood of their populace.
Ground water depletion is a major environmental concern in our country and calls for an immediate and effective agenda in ground water management. Coca cola bottling plants are contributing largely to this in regions where they are situated. Over use of pesticides/chemicals has added to ground water pollution in rural areas. People in some regions of India are compelled to drink water polluted with an excess of fluoride leading to dental fluorosis and arthritis. Water borne diseases are still a bane of our society.
To get a bucket of drinking water is a struggle for many rural women. The cost of fetching water in India is almost equivalent to 150 million women days each year, which amounts to 10 billion rupees. In Rajasthan, the desert state of India , a rural woman walks, on an average, 14,000 km. a year just to fetch water. Their urban sisters are slightly better off, standing in long queues for hours together, to collect water from public taps or lorries. There is a grim rural saying in one water starved region of India which translates into—‘Let the husband die, but the earthen pot of water should not be broken.’
Even in metropolitan cities like Delhi , Chennai, Bangalore , Hyderabad , intense water rationing takes place and the residents are relying more and more on private water tankers to meet their daily requirement of this very precious commodity.
It is ironic that even as India is touted as a global power to reckon with, the Indian government has failed to deliver the most basic of all needs to its citizens. In fact water should not be a demand or a need, but a basic human right, just like clean breathing air. Yet, it has become a commercial product, like oil, thanks to a lack of political will and citizens’ apathy.
The need of the hour is rain water harvesting, judicious use of water for domestic use and, above all, the political will to tackle the problem.. I remember that in my childhood, the domestic taps rarely went dry and none of us ever used private water purifying systems at home. Now the scenario is reversed. The taps seem to be there just for decorative purposes, unless there is a booster pump (which is usually connected to the main supply and still works at specific hours). The water thus obtained is not fit for human consumption till it is boiled, filtered or chemically purified. So basically the supply of clean, potable water is a business which is in private hands. This will have to go. . Public- private partnership will have to be replaced by public- public (government) partnerships. In Thailand , I was appalled to see the concept of just buying bottled water for drinking purposes. In India , too, the trend is catching on, but most of the urban households still resort to purifying water obtained from taps/ private tankers.
Of course, we are as much to blame as the government. Our daily domestic requirement of this scarce commodity has increased by leaps and bounds over the years. Clothes/dish washer machines, flush toilet systems, shower baths, water hose watering of house plants and car washes are just some of the areas which use water insensitively. In the city of Delhi alone 4.5 crore litres of potable water is used every day to wash its 30 lakh odd cars. The city also boasts of 300,000 private tube wells.
What can we do at our level to reduce this global water crisis? Well for starts, let us solemnly resolve not to waste water and, if possible, limit its use. Children, as well as adults will have to realize the impact of water shortage. Only if we would:
1. Not use the toilet as an ash tray or a waste basket to flush avoidable trash. Every time we use the flush, we actually use about 12 litres of water.
2. Turn off the tap while brushing our teeth in the morning and at night. This will save about 20 litres of water everyday.
3. Fix up leaking taps as one drip per seconds amounts to wasting 30 litres of water per day.
4. Wash our cars and bikes with a bucket of water and sponge, instead of a hose which wastes around 15 litres of water per minute if left running.
5. Use the shower in the bathroom judiciously. A 4 minute shower uses more than 60 litres of water.
6. Use clothes/dish washer for full loads for optimum utilization.
All this will go a long way in contributing our mite towards solving this global problem. And we really do not have to go out of our way to do any of these things.
Let the governments and international bodies seek solutions at a more global platform. As for us, just let us, be a bit more sensitive and sensible, so that water does not blush and turn into wine.
Shobha Shukla
The author writes extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).
Published in
- 22 March 2009 -
Water Water Everywhere, But Not A Drop To Drink
Water constitutes about three fourths of the earth’s surface, but only less than one percent of it can be used by its inhabitants. Most of it is salt water oceans (about 97%) and 2% of it is contained in glaciers. With every country seeking to satisfy its ever increasing water needs from shrinking and limited water resources, there could be a future of conflict. As the UN Secretary General, Ban Ki Moon remarked recently that water scarcity is the potential fuel for wars and conflict. But cooperation, not conflict should guide us in our quest for a solution to this crisis.
In 1992, the UN General Assembly designated March 22, as the World Water Day (WWD) to draw international attention to the critical lack of clean, safe drinking water worldwide. The theme for this year’s WWD is ‘Shared Water—Shared Opportunity’, with the focus on transboundary water management and sharing. There are about 263 transboundary lakes and river basins, which include territories of 145 countries and cover nearly half of the earth’s land surface.
Despite an apparent abundance of clean water in most of the developed nations, more than 1 billion people around the world lack clean safe drinking water and more than 2.6 billion lack adequate sanitation services. One third of the earth’s population lives in ‘water stressed’ countries. The crisis is worst in sub Saharan Africa and South Asia .
Lack of clean drinking water and basic sanitation is a big obstacle to progress and development. The worst sufferers are women and children who have to trudge long distances to retrieve meager amounts of water for domestic use. This prevents them from pursuing an education and earning more or doing any thing more productive. The quest for water can drive one mad..
India faces a rapidly worsening water crisis in urban and rural areas. A soaring population, a speedy sprawl of cities, a vast and thirsty farm belt and indiscriminate use of water has left water, in our country, too scarce in some places, contaminated in others and in useless surfeit for others who are flooded every year. . The result is there for all of us to see and ponder. More than 700 million Indians do not have adequate sanitation, let alone safe drinking water. According to a UN report, about 2.1 million children die every year, largely for lack of clean water.
Changing life styles and dietary habits, private control over water resources and climate changes (resulting in floods and droughts) are all worsening the water crisis and wreaking an economic and ecological havoc on our blue planet. Poor countries, like India , are at a greater risk as water scarcity threatens the health and livelihood of their populace.
Ground water depletion is a major environmental concern in our country and calls for an immediate and effective agenda in ground water management. Coca cola bottling plants are contributing largely to this in regions where they are situated. Over use of pesticides/chemicals has added to ground water pollution in rural areas. People in some regions of India are compelled to drink water polluted with an excess of fluoride leading to dental fluorosis and arthritis. Water borne diseases are still a bane of our society.
To get a bucket of drinking water is a struggle for many rural women. The cost of fetching water in India is almost equivalent to 150 million women days each year, which amounts to 10 billion rupees. In Rajasthan, the desert state of India , a rural woman walks, on an average, 14,000 km. a year just to fetch water. Their urban sisters are slightly better off, standing in long queues for hours together, to collect water from public taps or lorries. There is a grim rural saying in one water starved region of India which translates into—‘Let the husband die, but the earthen pot of water should not be broken.’
Even in metropolitan cities like Delhi , Chennai, Bangalore , Hyderabad , intense water rationing takes place and the residents are relying more and more on private water tankers to meet their daily requirement of this very precious commodity.
It is ironic that even as India is touted as a global power to reckon with, the Indian government has failed to deliver the most basic of all needs to its citizens. In fact water should not be a demand or a need, but a basic human right, just like clean breathing air. Yet, it has become a commercial product, like oil, thanks to a lack of political will and citizens’ apathy.
The need of the hour is rain water harvesting, judicious use of water for domestic use and, above all, the political will to tackle the problem.. I remember that in my childhood, the domestic taps rarely went dry and none of us ever used private water purifying systems at home. Now the scenario is reversed. The taps seem to be there just for decorative purposes, unless there is a booster pump (which is usually connected to the main supply and still works at specific hours). The water thus obtained is not fit for human consumption till it is boiled, filtered or chemically purified. So basically the supply of clean, potable water is a business which is in private hands. This will have to go. . Public- private partnership will have to be replaced by public- public (government) partnerships. In Thailand , I was appalled to see the concept of just buying bottled water for drinking purposes. In India , too, the trend is catching on, but most of the urban households still resort to purifying water obtained from taps/ private tankers.
Of course, we are as much to blame as the government. Our daily domestic requirement of this scarce commodity has increased by leaps and bounds over the years. Clothes/dish washer machines, flush toilet systems, shower baths, water hose watering of house plants and car washes are just some of the areas which use water insensitively. In the city of Delhi alone 4.5 crore litres of potable water is used every day to wash its 30 lakh odd cars. The city also boasts of 300,000 private tube wells.
What can we do at our level to reduce this global water crisis? Well for starts, let us solemnly resolve not to waste water and, if possible, limit its use. Children, as well as adults will have to realize the impact of water shortage. Only if we would:
1. Not use the toilet as an ash tray or a waste basket to flush avoidable trash. Every time we use the flush, we actually use about 12 litres of water.
2. Turn off the tap while brushing our teeth in the morning and at night. This will save about 20 litres of water everyday.
3. Fix up leaking taps as one drip per seconds amounts to wasting 30 litres of water per day.
4. Wash our cars and bikes with a bucket of water and sponge, instead of a hose which wastes around 15 litres of water per minute if left running.
5. Use the shower in the bathroom judiciously. A 4 minute shower uses more than 60 litres of water.
6. Use clothes/dish washer for full loads for optimum utilization.
All this will go a long way in contributing our mite towards solving this global problem. And we really do not have to go out of our way to do any of these things.
Let the governments and international bodies seek solutions at a more global platform. As for us, just let us, be a bit more sensitive and sensible, so that water does not blush and turn into wine.
Shobha ShuklaThe author writes extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).
Published in
Is it ethical to provide TB treatment without quality counselling?
Is it ethical to provide TB treatment without quality counselling?
How ethical is it to providing treatment for anti-TB drug resistance without quality counseling? The treatment literacy, infection control, toxicity and side-effects related to the treatment, adherence and a range of other issues need to be addressed in counseling sessions, believes the activist from the West Bengal Network of people living with HIV (BNP+) in India. This indeed provides a food for thought for delegates of the 3rd Stop TB Partners Forum (Brazil: 23-25 March 2009) and the high-level ministerial meeting on drug-resistant TB (Beijing, China: 1-3 April 2009).
For instance, a member of BNP+ (name withheld) was diagnosed of TB in 2004, but due to anti-TB drug-stock out for a week at the DOTS centre, he was asked to buy medicines from the pharmacy, which were beyond his economic means. Due to treatment interruptions possibly, only later he found out in a hospital where he was admitted for AIDS-related care, that he is suspected to having developed resistance to anti-TB drugs. The drug susceptibility tests later confirmed that he had multi-drug resistant TB (MDR-TB) now.
He could have, possibly, successfully completed the treatment for drug-susceptible TB through DOTS - only if quality counseling and regular supply of drugs among other issues were addressed. He didn’t intend to develop drug resistance to anti-TB drugs, then why is that the blame, often comes to people with TB, for not 'complying' to DOTS and fueling drug-resistant TB? Let us not forget that the other stakeholders in TB care including the clinicians are equal partners.
He legitimately needed information on TB treatment adherence, related side-effects, drug toxicity and other related issues. Being living with HIV, he had relatively much more AIDS-related treatment literacy and awareness about his rights and responsibilities than he had on TB-related care.
He later ended up buying drugs for MDR-TB treatment for 2 years (2005-2007), at a cost of Rs 3,600 (USD 72) per month. Along with his MDR-TB drugs, anti-retroviral treatment (ART) and other drugs for AIDS related opportunistic infections, he was taking 53 drugs daily - for 2 years. The side-effects were too strong and really hard for him to bear - and it was only due to strong determination to complete his treatment, he continued. He felt extremely irritated, reactive, had lower abdominal pain, developed ulcers in oral cavity, and then had eye-sight related problems after 12-14 months of MDR-TB treatment.
It was not the treating physician who provided him much-needed counseling but his private doctor who helped him understand the disease, the treatment and related issues. No one explained him about infection control measures.
Also the high-levels of HIV-related stigma rampant in TB related care settings, is alarming. Before he got diagnosed for TB, the moment the DOTS staff came to know about his HIV status, he got referred to another hospital. Mostly the reasons given were 'no instruments' to conduct biopsy. Only when he didn't reveal his HIV status, his biopsy could be performed and he tested positive for TB.
The real issues that are threatening to reverse the relative gains India has made on TB control are best-known to the affected communities who had to deal with these issues on daily basis. Time is running out before TB programme managers shift gears from clinical approaches to community-centric approaches to TB care and control.
Unless the healthcare workers and people with TB/ drug-resistant TB or TB-HIV co-infection interact as equal partners of TB care and control, how else are we going to improve the responses to TB and HIV?
The AIDS and TB pandemics have alarmingly joined forces long ago, particularly in high-HIV settings. But those working to address TB and HIV, are yet to work much more closely together on the frontlines than they are doing presently.
The initial steps have been taken in Delhi for example, where healthcare workers and community representatives are coming together to forge a Community Care Club, so as to strengthen healthcare in general, particularly for people with TB in the region. This initiative is being led by the members of Delhi Mahila Samiti (DMS), a women's forum of Delhi Network of people living with HIV (DNP+) and World Care Council (WCC).
The people from affected communities have a critical role to play as equal partners. The need to raise awareness about the rights and responsibilities of people with TB (or drug resistant TB) or TB-HIV co-infection, and opportunities for them to contribute in strengthening TB and AIDS-related care services is compelling. The members of the affected communities need to be respected with dignity as equal partners in TB care and control. Quality counseling is certainly just one of the many areas where they can potentially play a vital role with dignity.
The Patients' Charter for Tuberculosis Care (PCTC, The Charter) has been identified in the global Stop TB Strategy as a tool to achieve the International Standards for Tuberculosis Care (ISTC). Many country programmes also recognize the Charter, including the revised national TB control programme (RNTCP) of India, which enlists the Charter as part of the national TB control strategy.
However, clearly lot more needs to be done to achieve the goal of people with TB, particularly those who are at a higher risk of contracting active TB or drug-resistant TB, like people living with HIV, to embrace the Charter and advocate for raising standards of TB care in their communities.
- Bobby Ramakant
Privatising water is denying people a human right: UN President
Privatising water is denying people a human right: UN President
Questions raised on the legitmacy of the corporate-controlled World Water Forum
The President of the United Nations General Assembly has told delegates at the 5th World Water Forum (WWF) in Istanbul, Turkey, that, "those who are committed to the privatization of water, making it a commodity like oil, are denying people a human right as basic as the air we breathe."
In a speech delivered by his senior advisor on water Maude Barlow, UN president Miguel d'Escoto Brockmann said, "We must work quickly to guarantee that access to drinking water constitutes a fundamental right of all peoples..."
"Water belongs to the people, to the ecosystem and the species and it belongs to the future" had said Maude Barlow earlier this week in Istanbul.
Ms Barlow, who is also the national chairperson of the Council of Canadians, delivered the president's message to the People's Water Forum, a counter-forum being held by hundreds of civil society members from nearly 70 countries whose voices have not been at the WWF. The speech was later released to the World Water Forum, which is being attended by 20,000 delegates from 150 countries.
The UN president also questioned the legitimacy of the forum itself. His speech stated, "The forum's orientation is profoundly influenced by private water companies. This is evident by the fact that both the president of the World Water Council and the alternate president are deeply involved with provision of private, for-profit, water services."
He added that future forums should, "conduct their deliberations under the auspices of the United Nations."
D'Escoto Brockmann also criticized the World Water Forum's draft Ministerial Declaration, which sees water as a "human need" rather than a human right. He said, "As it stands, this important statement undermines the efforts of those who are struggling for access to clean water and sanitation."
"Global water justice movement advocates welcome this being the last World Water Forum in its present format," adds Barlow. "There is an urgent need for an accountable and legitimate global water forum to be held regularly to address the grave threats facing our blue planet."
Earlier last week, a group of 118 organizations from 33 countries had signed and issued a letter to United Nations Secretary General Ban Ki-Moon that calls on him to withdraw his support for the 'CEO Water Mandate', a corporate driven water initiative under the 'UN Global Compact' that facilitates corporate control of water resources. Representatives of the letter's signatories had delivered a copy of the letter to the Deputy Director of the UN Global Compact, Gavin Power at the 5th World Water Forum.
The CEO Water Mandate's leading endorsers currently include water bottlers Coca-Cola, Nestlé, and Pepsi, as well as Suez, one of the world's largest privatizers of water services and systems.
"All of these corporations have a vested interest in controlling water resources and profiting from water scarcity, so there is a great danger in leaving international water policy in such hands," said Richard Girard, researcher for the Polaris Institute.
"Those who are dealing with corporate control of water's manifold downsides – water takings, water shut-offs, price hikes, short cuts on water treatment – are people deeply affected by the water crisis and corporations' actions," said Mark Hays from Corporate Accountability International. "Yet these same people, who are going thirsty, don't have a true voice at these meetings – their voices need to be heard, and they should be in the drivers' seat."
The Global Water justice Movement activists are calling on the United Nations to take the lead in creating transparent, democratic space to decide international water policy. But to date, the UN continues to be in a contradictory position by, on the one hand, raising awareness about the world water crisis and calling for needed change, and on the other housing the CEO Water Mandate. Groups like the Polaris Institute and Corporate Accountability International are challenging the CEO Mandate because it allows corporations to undermine democratic control of water under the aegis of the United Nations.
- Citizen News Service (CNS)
Questions raised on the legitmacy of the corporate-controlled World Water Forum
The President of the United Nations General Assembly has told delegates at the 5th World Water Forum (WWF) in Istanbul, Turkey, that, "those who are committed to the privatization of water, making it a commodity like oil, are denying people a human right as basic as the air we breathe."
In a speech delivered by his senior advisor on water Maude Barlow, UN president Miguel d'Escoto Brockmann said, "We must work quickly to guarantee that access to drinking water constitutes a fundamental right of all peoples..."
"Water belongs to the people, to the ecosystem and the species and it belongs to the future" had said Maude Barlow earlier this week in Istanbul.
Ms Barlow, who is also the national chairperson of the Council of Canadians, delivered the president's message to the People's Water Forum, a counter-forum being held by hundreds of civil society members from nearly 70 countries whose voices have not been at the WWF. The speech was later released to the World Water Forum, which is being attended by 20,000 delegates from 150 countries.
The UN president also questioned the legitimacy of the forum itself. His speech stated, "The forum's orientation is profoundly influenced by private water companies. This is evident by the fact that both the president of the World Water Council and the alternate president are deeply involved with provision of private, for-profit, water services."
He added that future forums should, "conduct their deliberations under the auspices of the United Nations."
D'Escoto Brockmann also criticized the World Water Forum's draft Ministerial Declaration, which sees water as a "human need" rather than a human right. He said, "As it stands, this important statement undermines the efforts of those who are struggling for access to clean water and sanitation."
"Global water justice movement advocates welcome this being the last World Water Forum in its present format," adds Barlow. "There is an urgent need for an accountable and legitimate global water forum to be held regularly to address the grave threats facing our blue planet."
Earlier last week, a group of 118 organizations from 33 countries had signed and issued a letter to United Nations Secretary General Ban Ki-Moon that calls on him to withdraw his support for the 'CEO Water Mandate', a corporate driven water initiative under the 'UN Global Compact' that facilitates corporate control of water resources. Representatives of the letter's signatories had delivered a copy of the letter to the Deputy Director of the UN Global Compact, Gavin Power at the 5th World Water Forum.
The CEO Water Mandate's leading endorsers currently include water bottlers Coca-Cola, Nestlé, and Pepsi, as well as Suez, one of the world's largest privatizers of water services and systems.
"All of these corporations have a vested interest in controlling water resources and profiting from water scarcity, so there is a great danger in leaving international water policy in such hands," said Richard Girard, researcher for the Polaris Institute.
"Those who are dealing with corporate control of water's manifold downsides – water takings, water shut-offs, price hikes, short cuts on water treatment – are people deeply affected by the water crisis and corporations' actions," said Mark Hays from Corporate Accountability International. "Yet these same people, who are going thirsty, don't have a true voice at these meetings – their voices need to be heard, and they should be in the drivers' seat."
The Global Water justice Movement activists are calling on the United Nations to take the lead in creating transparent, democratic space to decide international water policy. But to date, the UN continues to be in a contradictory position by, on the one hand, raising awareness about the world water crisis and calling for needed change, and on the other housing the CEO Water Mandate. Groups like the Polaris Institute and Corporate Accountability International are challenging the CEO Mandate because it allows corporations to undermine democratic control of water under the aegis of the United Nations.
- Citizen News Service (CNS)
Delhi's new initiative to improve healthcare in the community
Delhi's new initiative to improve healthcare in the community
Less than a week before the 3rd Stop TB Partners' Forum is about to begin in Brazil, a unique partnership is being forged in a community of India's capital to improve TB responses.
The residents of south Delhi and healthcare providers in this area are holding an ongoing dialogue to identify key challenges that people face in accessing the health services, and to come up with effective solutions that can potentially improve the quality of care for all residents.
The new Community Care Club in the Lado Sarai area of South Delhi (India), is working to improve the health of people in the diverse district by bringing together consumers and care-providers in a dynamic 'partnership in health'. Led by local former TB patients and people living with HIV, this is an initiative to empower not only themselves, but also to empower and mobilize a broad base of the community including the private and public sectors.
Residents and workers are now organizing to collectively address their problems, improve access and raise the standards of care in the neighborhood - to exercise their rights and take responsibilities for a healthier community.
The first series of public meetings of the Community Care Club will be held on the coming World Health Day (7 April 2009) in different 'high-volume' public spaces. At the same time, a team of people living with the diseases will be conducting a 'streetwise' survey to further ascertain what the community considers a priority for action. It is being organized by the Delhi Mahila Samiti - the Women's Forum of Delhi Network of People Living with HIV (DNP+), and the World Care Council.
The Revised National Tuberculosis Control Programme (RNTCP) of the Government of India, now includes the Patients' Charter for Tuberculosis Care (PCTC, The Charter). The Charter is also a part of the global Stop TB Strategy, and lays out the rights and responsibilities of people with TB, and how the Charter is a tool to effectively achieve the implementation of the International Standards of Tuberculosis Care (ISTC).
However, implementing the Charter on the frontlines of TB care, raising awareness about rights and responsibilities, and using it as an empowering tool for people with TB and their community in order to improve the quality of care services, is certainly a daunting task.
Just last year, at a South East Asia regional meeting on TB in New Delhi, the National TB Programme Manager of India (RNTCP) was questioned by the people from affected communities on why the Charter is not a part of the RNTCP - the next day the Charter went up on the website of RNTCP. A major step forward for people with TB, and their communities.
People committed to improving TB care and related services are organizing themselves to mobilize communities to genuinely partner with the healthcare providers, to implement the Charter effectively and advocate for scaling up the quality of TB and TB-HIV care. This initiative is powered by two principles of greater involvement of people living with HIV (GIPA) and the greater involvement of people with TB (GIPT).
A new day dawns for the community on World Health Day in India's Capital.
- Bobby Ramakant
Less than a week before the 3rd Stop TB Partners' Forum is about to begin in Brazil, a unique partnership is being forged in a community of India's capital to improve TB responses.
The residents of south Delhi and healthcare providers in this area are holding an ongoing dialogue to identify key challenges that people face in accessing the health services, and to come up with effective solutions that can potentially improve the quality of care for all residents.
The new Community Care Club in the Lado Sarai area of South Delhi (India), is working to improve the health of people in the diverse district by bringing together consumers and care-providers in a dynamic 'partnership in health'. Led by local former TB patients and people living with HIV, this is an initiative to empower not only themselves, but also to empower and mobilize a broad base of the community including the private and public sectors.
Residents and workers are now organizing to collectively address their problems, improve access and raise the standards of care in the neighborhood - to exercise their rights and take responsibilities for a healthier community.
The first series of public meetings of the Community Care Club will be held on the coming World Health Day (7 April 2009) in different 'high-volume' public spaces. At the same time, a team of people living with the diseases will be conducting a 'streetwise' survey to further ascertain what the community considers a priority for action. It is being organized by the Delhi Mahila Samiti - the Women's Forum of Delhi Network of People Living with HIV (DNP+), and the World Care Council.
The Revised National Tuberculosis Control Programme (RNTCP) of the Government of India, now includes the Patients' Charter for Tuberculosis Care (PCTC, The Charter). The Charter is also a part of the global Stop TB Strategy, and lays out the rights and responsibilities of people with TB, and how the Charter is a tool to effectively achieve the implementation of the International Standards of Tuberculosis Care (ISTC).
However, implementing the Charter on the frontlines of TB care, raising awareness about rights and responsibilities, and using it as an empowering tool for people with TB and their community in order to improve the quality of care services, is certainly a daunting task.
Just last year, at a South East Asia regional meeting on TB in New Delhi, the National TB Programme Manager of India (RNTCP) was questioned by the people from affected communities on why the Charter is not a part of the RNTCP - the next day the Charter went up on the website of RNTCP. A major step forward for people with TB, and their communities.
People committed to improving TB care and related services are organizing themselves to mobilize communities to genuinely partner with the healthcare providers, to implement the Charter effectively and advocate for scaling up the quality of TB and TB-HIV care. This initiative is powered by two principles of greater involvement of people living with HIV (GIPA) and the greater involvement of people with TB (GIPT).
A new day dawns for the community on World Health Day in India's Capital.
- Bobby Ramakant
Thailand strengthening alliances in South East Asia for tobacco control
Thailand strengthening alliances in South East Asia for tobacco control
Jittima Jantanamalaka
Thailand had relatively strong tobacco control policies for years but for effective implementation, it was vital to seek cooperation and strengthen tobacco control initiatives in other countries in the South-East Asia (SEA).
“After working with Action on Smoking and Health (ASH) foundation in Thailand for 15 years, we believed that Thailand had quite strong policy on tobacco control and we should support and strengthen the cooperation between countries in South East Asia to achieve the goal together so we had set up South-East Asia Tobacco Control Alliance (SEATCA). By this way SEATCA acts as supportive base for government and non- government tobacco control workers and other health advocates in the SEA region, through regional forum, SEATCA fellowship programmes and cooperate with researcher from several universities” said Bungon Ritthiphakdee, Director of South East Asia Tobacco Control Alliance (SEATCA).
Bungon further explained about how Thailand is expanding its role in forging alliances in other ASEAN countries to fight against tobacco.
“The cooperation between ASEAN countries on tobacco control helps us to see the whole picture, we can also share resources, skills, best practice, and the compare programmes between different countries” said Bungon.
“The main campaigns that SEATCA is working on at the moment are pushing forward until all ASEAN countries have pictorial warning labels on the tobacco products and also increase taxes on tobacco products. Raising taxes on tobacco helps to reduce tobacco consumption but right now only Thailand and Singapore have high taxes. We also would like to campaign for more smoke-free cities in SEA region. Many countries like Philippines, Laos, Indonesia, Vietnam and many countries already have smoke-free cities, and in Thailand, we have Mukdaharn and there is some smoke-free movement building up in Sukhothai as well” further added Bungon.
The biggest challenge in SEATCA’s work is the interference of tobacco industry in implementation of tobacco control policies in different nations in the SEA region.
“Fortunately we are now having the guidelines of World Health Organization Framework Convention on Tobacco Control (WHO FCTC) Article 5.3 on protection of public health policies from tobacco industry interference, which asked the government of each party to have clear policy of not allowing the tobacco’s industry’s interference” said Bungon.
The guidelines of Article 5.3 of the WHO FCTC were adopted at the third conference of parties (COP 3) in Durban, South Africa (November 2008).
In response to a question on how effectively can the WHO FCTC Article 5.3 be enforced in SEA countries, Bungon responded: “there is no punishment even for the government which is not following FCTC but the biggest damage that will come to such countries will be the damage of their own nation, when their people, their youth and new generations will increasingly turn to tobacco use, and these nations will lose money in treating diseases attributed to tobacco use.”
At the recently concluded 14th World Conference on Tobacco or Health (WCTOH), Thailand has been credited as one of the countries that have achieved significant success in tobacco control in Asia. The increase in tobacco taxes, the new smoke-free law that came into effect in 2008 banning smoking in public places including bars, restaurants and workplaces, and effective pictorial health warnings on tobacco products, are some of the measures that Thailand gets global recognition for. The first Bloomberg Award for Tobacco Control on effectively implementing pictorial health warning labeling on tobacco products was also conferred upon Dr Prakit Vathisathokit, Executive Secretary of Action on Smoking and Health (ASH), Thailand.
The Asia and the Pacific accounts for 57% of the global cigarette consumption by region in 2007. According to World Health Organization’s MPOWER report 2008, in the 20th century, the tobacco epidemic killed 100 million people worldwide. During the 21st century, it could kill 1 billion.
SEATCA’s work is certainly critical in protecting Asians from diseases, disabilities and deaths attributed to tobacco use.
Jittima Jantanamalaka, Citizen News Service (CNS)
(The author is the Director of Jay Inspire Co. Ltd)
Jittima Jantanamalaka
Thailand had relatively strong tobacco control policies for years but for effective implementation, it was vital to seek cooperation and strengthen tobacco control initiatives in other countries in the South-East Asia (SEA).
Bungon further explained about how Thailand is expanding its role in forging alliances in other ASEAN countries to fight against tobacco.
“The cooperation between ASEAN countries on tobacco control helps us to see the whole picture, we can also share resources, skills, best practice, and the compare programmes between different countries” said Bungon.
“The main campaigns that SEATCA is working on at the moment are pushing forward until all ASEAN countries have pictorial warning labels on the tobacco products and also increase taxes on tobacco products. Raising taxes on tobacco helps to reduce tobacco consumption but right now only Thailand and Singapore have high taxes. We also would like to campaign for more smoke-free cities in SEA region. Many countries like Philippines, Laos, Indonesia, Vietnam and many countries already have smoke-free cities, and in Thailand, we have Mukdaharn and there is some smoke-free movement building up in Sukhothai as well” further added Bungon.
The biggest challenge in SEATCA’s work is the interference of tobacco industry in implementation of tobacco control policies in different nations in the SEA region.
“Fortunately we are now having the guidelines of World Health Organization Framework Convention on Tobacco Control (WHO FCTC) Article 5.3 on protection of public health policies from tobacco industry interference, which asked the government of each party to have clear policy of not allowing the tobacco’s industry’s interference” said Bungon.
The guidelines of Article 5.3 of the WHO FCTC were adopted at the third conference of parties (COP 3) in Durban, South Africa (November 2008).
In response to a question on how effectively can the WHO FCTC Article 5.3 be enforced in SEA countries, Bungon responded: “there is no punishment even for the government which is not following FCTC but the biggest damage that will come to such countries will be the damage of their own nation, when their people, their youth and new generations will increasingly turn to tobacco use, and these nations will lose money in treating diseases attributed to tobacco use.”
At the recently concluded 14th World Conference on Tobacco or Health (WCTOH), Thailand has been credited as one of the countries that have achieved significant success in tobacco control in Asia. The increase in tobacco taxes, the new smoke-free law that came into effect in 2008 banning smoking in public places including bars, restaurants and workplaces, and effective pictorial health warnings on tobacco products, are some of the measures that Thailand gets global recognition for. The first Bloomberg Award for Tobacco Control on effectively implementing pictorial health warning labeling on tobacco products was also conferred upon Dr Prakit Vathisathokit, Executive Secretary of Action on Smoking and Health (ASH), Thailand.
The Asia and the Pacific accounts for 57% of the global cigarette consumption by region in 2007. According to World Health Organization’s MPOWER report 2008, in the 20th century, the tobacco epidemic killed 100 million people worldwide. During the 21st century, it could kill 1 billion.
SEATCA’s work is certainly critical in protecting Asians from diseases, disabilities and deaths attributed to tobacco use.
Jittima Jantanamalaka, Citizen News Service (CNS)
(The author is the Director of Jay Inspire Co. Ltd)
International tobacco control award for Dr Mira Aghi
International tobacco control award for Dr Mira Aghi
Noted tobacco control advocate and a United Nations consultant Dr Mira Aghi was conferred upon the International award in recognition of her lifetime contribution to advancing tobacco control initiatives for women.
The International Network of Women Against Tobacco (INWAT) presented its Tribute for Outstanding Service to Women award to Dr Mira Aghi (65 years) at the recently concluded 14th World Conference on Tobacco or Health (WCTOH) in Mumbai, India.
Dr Mira Aghi (65 years) is a behavioural scientist and an inspiration for many activists and crusaders working against tobacco. She has been involved with the Advocacy Forum for Tobacco Control (AFTC) since its inception. Dr Aghi has been working with the anti-tobacco movement since 30 years. She has not only made an outstanding contribution, but has also created benchmarks in women’s leadership against tobacco.
Encouraging women leadership among health workers at the grassroots will motivate others to be a part of it, said Dr Aghi. She proposes a formal training to engage women health workers at all levels.
“Women leadership can be developed by educating about the ill-effects about the tobacco in a skilled manner that will motivate them to work against tobacco. However, it is the supportive environment that will finally lead to the eradication of tobacco epidemic” said Dr Aghi.
"A woman will continue to stay vulnerable till she takes it upon herself to change the situation. Society feels at ease to maintain the status quo. Young girls are beginning to feel that society is hard to change so they are changing themselves. We have to ask ourselves what would be better. Should we bend or stand erect?" says the tireless crusader Dr Aghi.
Dr Aghi, who has been a United Nations consultant on HIV/AIDS, drug abuse and adolescent issues, holds a PhD from the Loyola University, Chicago in US. “I am very concerned about today’s generation which tends to get influenced by tobacco advertising tactics and considers that tobacco is a fashion statement. This issue needs to be addressed uniformly” she said.
Busy with anti-tobacco movement, her first brush with the issue happened 30 years ago when she happened to work with an educational film production. “I wasn’t much aware about the happenings on the issue and other global movements taking place until I worked and researched on it for the film.”
“The research results moved me deeply and I passionately felt like saving people from the tobacco addiction. I therefore stayed put and took a full-time plunge into this social cause” said Dr Aghi, in a daily newsletter of the 14th WCTOH. In the late eighties, Dr Aghi led a campaign against an Indian tobacco company, which had plans to promote a women’s cigarette, said a 14th WCTOH newsletter.
Over the past years, there is a growing consensus to integrate tobacco control with existing development initiatives at all levels - however Dr Mira Aghi had sensed the cross-cutting issues of tobacco control with gender-based inequalities and how the power imbalance a woman faces in her life at all stages, exacerbates her vulnerability to substance abuse. The foresight and vision of Dr Aghi deserves a special mention and INWAT's International Award is a well-commanded tribute to her ongoing and sustained contribution to public health over decades.
- Citizen News Service (CNS)
Published in
Pakistan Christian Post, Karachi, Pakistan
Citizen News Service (CNS)
Two Circles
Media for Freedom, Kathmandu, Nepal
Bihar and Jharkhand News Service (BJNS)
Hindi Citizen News Service (CNS)
Noted tobacco control advocate and a United Nations consultant Dr Mira Aghi was conferred upon the International award in recognition of her lifetime contribution to advancing tobacco control initiatives for women.
The International Network of Women Against Tobacco (INWAT) presented its Tribute for Outstanding Service to Women award to Dr Mira Aghi (65 years) at the recently concluded 14th World Conference on Tobacco or Health (WCTOH) in Mumbai, India.
Dr Mira Aghi (65 years) is a behavioural scientist and an inspiration for many activists and crusaders working against tobacco. She has been involved with the Advocacy Forum for Tobacco Control (AFTC) since its inception. Dr Aghi has been working with the anti-tobacco movement since 30 years. She has not only made an outstanding contribution, but has also created benchmarks in women’s leadership against tobacco.
Encouraging women leadership among health workers at the grassroots will motivate others to be a part of it, said Dr Aghi. She proposes a formal training to engage women health workers at all levels.
“Women leadership can be developed by educating about the ill-effects about the tobacco in a skilled manner that will motivate them to work against tobacco. However, it is the supportive environment that will finally lead to the eradication of tobacco epidemic” said Dr Aghi.
"A woman will continue to stay vulnerable till she takes it upon herself to change the situation. Society feels at ease to maintain the status quo. Young girls are beginning to feel that society is hard to change so they are changing themselves. We have to ask ourselves what would be better. Should we bend or stand erect?" says the tireless crusader Dr Aghi.
Dr Aghi, who has been a United Nations consultant on HIV/AIDS, drug abuse and adolescent issues, holds a PhD from the Loyola University, Chicago in US. “I am very concerned about today’s generation which tends to get influenced by tobacco advertising tactics and considers that tobacco is a fashion statement. This issue needs to be addressed uniformly” she said.
Busy with anti-tobacco movement, her first brush with the issue happened 30 years ago when she happened to work with an educational film production. “I wasn’t much aware about the happenings on the issue and other global movements taking place until I worked and researched on it for the film.”
“The research results moved me deeply and I passionately felt like saving people from the tobacco addiction. I therefore stayed put and took a full-time plunge into this social cause” said Dr Aghi, in a daily newsletter of the 14th WCTOH. In the late eighties, Dr Aghi led a campaign against an Indian tobacco company, which had plans to promote a women’s cigarette, said a 14th WCTOH newsletter.
Over the past years, there is a growing consensus to integrate tobacco control with existing development initiatives at all levels - however Dr Mira Aghi had sensed the cross-cutting issues of tobacco control with gender-based inequalities and how the power imbalance a woman faces in her life at all stages, exacerbates her vulnerability to substance abuse. The foresight and vision of Dr Aghi deserves a special mention and INWAT's International Award is a well-commanded tribute to her ongoing and sustained contribution to public health over decades.
- Citizen News Service (CNS)
Published in
Pakistan Christian Post, Karachi, Pakistan
Citizen News Service (CNS)
Two Circles
Media for Freedom, Kathmandu, Nepal
Bihar and Jharkhand News Service (BJNS)
Hindi Citizen News Service (CNS)
The Taliban is not only Pakistan's problem
The Taliban is not only Pakistan's problem
Dr Sandeep Pandey
Published in Rediff News
It was a refreshing but frightening trip to Pakistan. It was heartening to note the optimism among people and politicians but disturbing to note the underlying fear of the worst. There is unmistaken concern about a creeping Talibanisation in Pakistan among its civil society and the political parties. People are unsure about which way the deal with the Taliban in Malakand and Swat will go.
I accompanied a 13-member delegation recently, before the attack on Sri Lankan players in Lahore, to Pakistan with veteran journalist Kuldip Nayar, who is immensely popular in Pakistan too. We got an opportunity to meet the political leaders of all major parties, business people, students, press and civil society. Although this was my sixth trip to Pakistan in as many years, it was a revelation to me that all major political parties there actually desire peace and friendship with India. It remains an enigma to me that two societies which feel emotionally so close to each other and are culturally entwined have managed to sustain animosity for 60 long years. And no sign of truce is in sight.
The people and politicians of Pakistan are seriously worried about the threat of Taliban taking over. People don't know whether human rights will remain preserved and the politicians don't know whether democracy, once again, will be eclipsed in Pakistan. The governments of the North West Frontier Province and Pakistan seem to have capitulated to the fundamentalists. The governments simply don't know how to tame the monster which it once helped create at the behest of the US. It is an irony that a sovereign state like Pakistan continues to be bombarded by US to target the militants and the government of Pakistan is a mute spectator.
The foreign minister of Pakistan, Shah Mehmood Qureshi, was pleading with the US authorities to hand over the control of unmanned aircrafts called 'drones to Pakistan instead of these attacks being engineered from the US. The dependence of Pakistan on the US government and its aid has eroded the economy and legitimacy of government in Pakistan. In spite of everybody in Pakistan realising that its association with US has created problems for itself, they find themselves in a bind. There doesn't seem to be a way out. It is also in the army's interest, which tends to dominate the civilian elected government, that the association with US continues so that it can continue to play this dominating role. The army projects itself as the sole counterbalancing force to the jehadis and hence will continue to play a role larger than that of the government so long as the threat of Taliban and Al Qaeda is looming large.
It is a known fact that militants have gained an upper hand during the military regime. Nawaz Sharif doesn't seem to remember any 'suicide bombers' during his time as prime minister. He is sceptical of the deal with the Taliban. He blames military directly for weakening democracy in Pakistan. He said that problem of terrorism originating from Pakistan doesn't affect India alone, it affects Pakistan much more.
In a meeting held in Benazir Bhutto's house with Asif Ali Zardari's sister Faryal Talpur, she mentioned that about 6000 people in Pakistan have died at the hands of jehadis. She said India was applying pressure on Pakistan to take action against the terrorists. But probably Pakistan needed India's help to put its house in order. Asfayandar Wali Khan, the grandson of Khan Abdul Gaffar Khan, and leader of the Awami National Party -- the party in power in the NWFP, articulated this sentiment as for India to feel safe a strong stable central government was required in Pakistan.
With military and intelligence soft towards the jehadis, if not completely hand in gloves with them, it will have to be the civilian elected government supported by the judiciary which will have to assert its supremacy over any other body -- state or non-state -- if normalcy is to be restored in Pakistan. This implies the democracy must take roots and flower to full bloom. It has been Pakistan's misfortune that democracy was strangulated time and again.
In this light the latest moves by President Asif Ali Zardari to finish off his political rival, Nawaz Sharif, easily the most popular mass leader in Pakistan today after Benazir Bhutto's assassination, are unfortunate. For democracy to remain firmly rooted the ruling party as well as the opposition must be strong. A healthy respect for other parties is must if democracy is to unfold in Pakistan in the interest of its people. Sharif's demand to reinstate the judges dismissed by former President Pervez Musharraf and to make the judiciary independent are politically very prudent demands. Zardari has reasons to fear an independent judiciary. He has made an amendment in the Constitution to remove the requirement of being a graduate to be made the President of Pakistan. This will be challenged as soon as judiciary is no longer under his control. But he must realise that if Pakistan's long term interest is his objective, then he may have to make some sacrifices to ensure that military never returns to centre-stage in Pakistani politics. The army has already issued him initial warnings.
It was heartening to hear Khurshid Kasuri, the foreign minister of Pakistan during Musharraf's regime, reveal that a solution to the Kashmir problem has probably been arrived at. No wonder, the recent elections in J&K passed off so peacefully and with a huge turnout by Indian standards. If it was not for the pro-democracy movement started by lawyers in Pakistan and then the elections there and now the impending elections in India, Manmohan Singh [Images] was due to visit Pakistan to announce this to the world. If a solution to Kashmir imbroglio is found to the satisfaction of the Indians, Pakistanis and most importantly the Kashmiris, it'll pave the way for a more permanent peaceful relationship between the India and Pakistan.
Indian will have to work with the elected government of Pakistan to deal with the advancing menace of Taliban. As one TV anchor pointed out while we were in a talk show in Islamabad, all attacks on India in its long history have taken place from its north-western border. Hence we must not take the threat of Taliban lightly or consider it only as Pakistan's problem.
Dr Sandeep Pandey
(The author is a Ramon Magsaysay Awardee (2002) for emergent leadership, heads the National Alliance of People's Movements (NAPM) and did his PhD from University of California, Berkeley in control theory which is applicable in missile technology. He taught at Indian Institute of Technology (IIT) Kanpur before devoting his life to strengthening people's movements in early 1990s. He can be contacted at: ashaashram@yahoo.com, www.ashaparivar.org)
Published in Rediff News
Courtesy: Telhelka.com
Dr Sandeep Pandey
Published in Rediff News
It was a refreshing but frightening trip to Pakistan. It was heartening to note the optimism among people and politicians but disturbing to note the underlying fear of the worst. There is unmistaken concern about a creeping Talibanisation in Pakistan among its civil society and the political parties. People are unsure about which way the deal with the Taliban in Malakand and Swat will go.
I accompanied a 13-member delegation recently, before the attack on Sri Lankan players in Lahore, to Pakistan with veteran journalist Kuldip Nayar, who is immensely popular in Pakistan too. We got an opportunity to meet the political leaders of all major parties, business people, students, press and civil society. Although this was my sixth trip to Pakistan in as many years, it was a revelation to me that all major political parties there actually desire peace and friendship with India. It remains an enigma to me that two societies which feel emotionally so close to each other and are culturally entwined have managed to sustain animosity for 60 long years. And no sign of truce is in sight.
The people and politicians of Pakistan are seriously worried about the threat of Taliban taking over. People don't know whether human rights will remain preserved and the politicians don't know whether democracy, once again, will be eclipsed in Pakistan. The governments of the North West Frontier Province and Pakistan seem to have capitulated to the fundamentalists. The governments simply don't know how to tame the monster which it once helped create at the behest of the US. It is an irony that a sovereign state like Pakistan continues to be bombarded by US to target the militants and the government of Pakistan is a mute spectator.
The foreign minister of Pakistan, Shah Mehmood Qureshi, was pleading with the US authorities to hand over the control of unmanned aircrafts called 'drones to Pakistan instead of these attacks being engineered from the US. The dependence of Pakistan on the US government and its aid has eroded the economy and legitimacy of government in Pakistan. In spite of everybody in Pakistan realising that its association with US has created problems for itself, they find themselves in a bind. There doesn't seem to be a way out. It is also in the army's interest, which tends to dominate the civilian elected government, that the association with US continues so that it can continue to play this dominating role. The army projects itself as the sole counterbalancing force to the jehadis and hence will continue to play a role larger than that of the government so long as the threat of Taliban and Al Qaeda is looming large.
It is a known fact that militants have gained an upper hand during the military regime. Nawaz Sharif doesn't seem to remember any 'suicide bombers' during his time as prime minister. He is sceptical of the deal with the Taliban. He blames military directly for weakening democracy in Pakistan. He said that problem of terrorism originating from Pakistan doesn't affect India alone, it affects Pakistan much more.
In a meeting held in Benazir Bhutto's house with Asif Ali Zardari's sister Faryal Talpur, she mentioned that about 6000 people in Pakistan have died at the hands of jehadis. She said India was applying pressure on Pakistan to take action against the terrorists. But probably Pakistan needed India's help to put its house in order. Asfayandar Wali Khan, the grandson of Khan Abdul Gaffar Khan, and leader of the Awami National Party -- the party in power in the NWFP, articulated this sentiment as for India to feel safe a strong stable central government was required in Pakistan.
With military and intelligence soft towards the jehadis, if not completely hand in gloves with them, it will have to be the civilian elected government supported by the judiciary which will have to assert its supremacy over any other body -- state or non-state -- if normalcy is to be restored in Pakistan. This implies the democracy must take roots and flower to full bloom. It has been Pakistan's misfortune that democracy was strangulated time and again.
In this light the latest moves by President Asif Ali Zardari to finish off his political rival, Nawaz Sharif, easily the most popular mass leader in Pakistan today after Benazir Bhutto's assassination, are unfortunate. For democracy to remain firmly rooted the ruling party as well as the opposition must be strong. A healthy respect for other parties is must if democracy is to unfold in Pakistan in the interest of its people. Sharif's demand to reinstate the judges dismissed by former President Pervez Musharraf and to make the judiciary independent are politically very prudent demands. Zardari has reasons to fear an independent judiciary. He has made an amendment in the Constitution to remove the requirement of being a graduate to be made the President of Pakistan. This will be challenged as soon as judiciary is no longer under his control. But he must realise that if Pakistan's long term interest is his objective, then he may have to make some sacrifices to ensure that military never returns to centre-stage in Pakistani politics. The army has already issued him initial warnings.
It was heartening to hear Khurshid Kasuri, the foreign minister of Pakistan during Musharraf's regime, reveal that a solution to the Kashmir problem has probably been arrived at. No wonder, the recent elections in J&K passed off so peacefully and with a huge turnout by Indian standards. If it was not for the pro-democracy movement started by lawyers in Pakistan and then the elections there and now the impending elections in India, Manmohan Singh [Images] was due to visit Pakistan to announce this to the world. If a solution to Kashmir imbroglio is found to the satisfaction of the Indians, Pakistanis and most importantly the Kashmiris, it'll pave the way for a more permanent peaceful relationship between the India and Pakistan.
Indian will have to work with the elected government of Pakistan to deal with the advancing menace of Taliban. As one TV anchor pointed out while we were in a talk show in Islamabad, all attacks on India in its long history have taken place from its north-western border. Hence we must not take the threat of Taliban lightly or consider it only as Pakistan's problem.
Dr Sandeep Pandey
(The author is a Ramon Magsaysay Awardee (2002) for emergent leadership, heads the National Alliance of People's Movements (NAPM) and did his PhD from University of California, Berkeley in control theory which is applicable in missile technology. He taught at Indian Institute of Technology (IIT) Kanpur before devoting his life to strengthening people's movements in early 1990s. He can be contacted at: ashaashram@yahoo.com, www.ashaparivar.org)
Published in Rediff News
Courtesy: Telhelka.com
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