[afro-nets] A message about safe injections...

[Peter Burgess <Profitinafrica@aol.com>]

A message about safe injections... and the need for management
information
--------------------------------------------------------------

Dear Colleagues

A few weeks back I sent a message to SIGN (Safe Injections
Global Network) because of my concern about the apathy of the
global development community when it comes to a holistic and
systemic approach to the issues of failed development. And this
week in Bangkok, everything sounds just as it did 2 years ago
and 4 years ago.

I am frustrated because I cannot find the sort of information
that will tell me that this project used US$ 50,000 and did a
really great job, and this project took US$ 5 million and it is
tough to find anything they did but cash in salary checks. The
management information that is needed so that there is account-
ing and accountability is totally missing. Until there is a sys-
tem for accounting and accountability, and indeed an independent
system, we are going to waste scarce money in perpetuity.

Which would be a pity, and is totally unnecessary.

Of course implementing strong accounting and accountability is
not going to suit everyone..... but it absolutely has to be
done. I am reminded of my early corporate career. Nobody in
"management" wanted to have the accounting information "open
book" and visible to a lot of the staff. No accounts and it was
possible to be very ineffective and stay employed. But eventu-
ally good companies implemented good systems.... and everyone
was ahead (except the ineffective and the crooks).

Now its time for development to get its management information
organized, and the sooner the better.

Sincerely

Peter Burgess
in New York
Tel: +1-212-772-6918
mailto:Profitinafrica@aol.com

--
1. Re: Letters Unsafe Injections and Xmission of HIV-1 in sub-
Saharan Africa

Peter Burgess, Afrifund, responds to the recent discussion and
exchange of letters in the Lancet and in SIGNpost. References
are appended by the moderator after Peter's message. Peter
rightly points out:

"The SIGN dialog about safe injections raises several sets of
questions. These are: (1) the pervasive double standard that
there is in the global health sector, one standard for the rich
NORTH and another for the poor SOUTH; (2) the terrible poor data
that are being used to debate and decide about very important
issues; and, (3) the ongoing lack of urgency in the official de-
velopment assistance (ODA) community about the SOUTH's health
crisis, and the absence of solutions."

"In terms of death, the SOUTH's present health crisis is a kil-
ler that compares with the worst of the death events of history.
Frankly, I don't care whether Gisselquist et al. or Schmid et
al. are right. The underlying issue is that lack of action to
improve health sector performance now and in the past several
years has been and still is a disgrace. Resources flowing into
the health sector are too little, and often earmarked for the
wrong things." and he asks "Why?"

--
From: Profitinafrica@aol.com
Date: Tue, 15 Jun 2004
Subject: Re: Letters Unsafe Injections and Transmission of HIV-1
in sub-Saharan Africa
To: sign@uq.net.au

Dear SIGN

The SIGN dialog about safe injections raises several sets of
questions. These are: (1) the pervasive double standard that
there is in the global health sector, one standard for the rich
NORTH and another for the poor SOUTH; (2) the terrible poor data
that are being used to debate and decide about very important
issues; and, (3) the ongoing lack of urgency in the official de-
velopment assistance (ODA) community about the SOUTH's health
crisis, and the absence of solutions.

In terms of death, the SOUTH's present health crisis is a killer
that compares with the worst of the death events of history.
Frankly, I don't care whether Gisselquist et al or Schmid et all
are right. The underlying issue is that lack of action to im-
prove health sector performance now and in the past several
years has been and still is a disgrace. Resources flowing into
the health sector are too little, and often earmarked for the
wrong things. Why?

And why are basics like healthy potable water, adequate nutri-
tion and reasonable sanitation unavailable for billions of the
world's people. Poor health services on top of poor hungry peo-
ple is a formula for failure and humanitarian crisis. What has
gone wrong?

There are answers, and there are solutions. Unfortunately each
of the ODA institutions and their leadership and staffs have a
narrow agenda, and there is little coordination or collabora-
tion. Planning is simplistic at best. Efforts at financing are
unimaginative, to say the least.

During the Second World War there was a lot of concern that af-
ter the war the global economy would return to the depression of
the 1930s. Keynes spearheaded the creation of two new institu-
tions, the Bretton Wood Institutions (World Bank and IMF) that
would help post-war reconstruction and development and serve to
stabilise the global monetary system. 60 years later their role
in making a success of the NORTH is obvious, and their ineffec-
tiveness for the SOUTH is equally apparent. The ODA community as
a whole and the policies and practices of NORTH governments have
contributed enormously to the SOUTH's failure.

There are success stories in development. New Institutions are
needed that will allow success to get replicated without being
stiffled by the prevailing NORTH's policy and procedures and
controls, nor run foul of local government rules, regulations
and constraints. Dr. Yunus's Grameen Bank in Bangladesh is a
success story, and it is not over yet. The idea of encouraging
poor people to improve their economic performance is being rep-
licated elsewhere. Each and every person has to have a chance to
improve their own individual economic circumstances through
their own efforts and with some enabling assistance like a small
loan.

When people are a bit better off, they can choose to have better
health services, or they can choose to fund other priorities.
Their choice. An institution is needed that will ensure that
they have choice, and opportunity to create wealth and to have
access to choices. The GFATM was an attempt to get resources
into health, but what is needed is an institution that is going
to get funds into productive value adding economic activities
ALL OVER THE SOUTH.

The bottom line is you cannot have good health in a rotten econ-
omy. So as the medical profession advocates for health priori-
ties, please remember that economic health is the enabling foun-
dation without which there cannot be much decent health.

Sincerely
Peter Burgess
____________
Peter Burgess
in New York
Tel: +1-212-772-6918
Email: mailto:peterb@afrifund.com
http://www.afrifund.com
http://www.afrifund.com/wiki/index.pcgi?page=DevelopmentDialog

Schmid GP, Buve A, Mugyenyi P, et al. Transmission of HIV-1 in-
fection in sub-Saharan Africa and effect of elimination of un-
safe injections. Lancet 2004; 363: 482-488.

Gisselquist DP. Estimating HIV-1 transmission efficiency through
unsafe medical injections. Int J STD AIDS 2002; 13: 152-159.

Gisselquist D, Potterat JJ. Review of evidence from risk factor
analyses associating HIV infection in African adults with medi-
cal injections and multiple sexual partners. Int J STD AIDS (in
press).

Gisselquist D, Potterat JJ, Brody S. HIV transmission during pe-
diatric health care in sub-Saharan Africa: risks and evidence. S
Afr Med J (in press).

Global Programme on AIDS. 1992-1993 Progress Report, Global Pro-
gramme on AIDS. Geneva: WHO, 1993. 6. US Census Bureau. HIV/AIDS
Surveillance Data Base, June 2000 release. Washington DC: US De-
partment of Commerce, 2000.

Gisselquist D, Rothenberg R, Potterat JJ, Drucker E. HIV infec-
tions in sub-Sahara Africa not explained by sexual or vertical
transmission. Int J STD AIDS 2002; 13: 657-666. Available from:
http://www.catchword.com/rsm/09564624/v13n10/contp1-1.htm