Water and Sanitation: Probably the Greatest Possible Benefit to Health that Exists

Great to read an article in the New England Journal of Medicine (NEJM) making it quite clear, if it wasn't clear enough already, that the cure for cholera is improving access to safe water and sanitation. The recent massive cholera epidemic in Haiti means that several years and billions of dollars of aid money have not resulted in the provision of safe water and sanitation. The epidemic in Zimbabwe means that provision of water and sanitation, which may have been adequate at one time, collapsed. (It is estimated that about half a million people were infected with some kind of diarrhea in Zimbabwe alone in 2012.)

The good news is that lots of diseases can be wrapped up along with cholera and eradicated; most water-borne diseases. The bad news is that no country has ever eradicated cholera or any other water-borne disease without providing clean water and sanitation. The mere development of a vaccine for cholera or any other single disease misses the point and misses a wonderful opportunity. Half a million cholera infections and thousands of deaths are reported every year, all for want of clean water and sanitation. But the true number of infections is likely to be several million and the number of deaths likely to be 100-200,000.

Institutions such as the Gates Foundation like to boast about how many billions they are putting into vaccines for individual diseases, such as rotavirus. That's admirable in its own way, but why line up a few diseases to be addressed and ignore the conditions that ensure these diseases will remain endemic for the foreseeable future? Especially considering how long lack of access to clean water and sanitation has been one of the most serious issues facing developing countries. If, as the NEJM article claims, the problem is related to rapid urbanization, we're a long time getting around to it; urbanization in many African countries began decades ago.

Access to clean water and sanitation for all may seem like a very long term goal. However, in conjunction with improved health services and education, better water and sanitation will also lead to better health and educational attainment indicators. Even maternal and child health, which are often said to be priorities, would be greatly improved. Rather than targeting various diseases and sectors of developing country populations, improved water and sanitation for all would result in benefits for all sectors. Indeed, progress in health and education provision will be a lot slower without improvements in water and sanitation provision.

In relation to the challenges of such an intervention, NEJM mentions expanded access to antiretroviral treatment to poor people in developing countries. But improved water and sanitation is not at all like antiretroviral treatment; everyone needs access to water and sanitation, not just pockets of people in certain parts of certain countries. Improved antiretroviral treatment does not aim to prevent HIV transmission, though big claims are now made about preventive benefits. Antiretroviral treatment is not like provision of water and sanitation because the former targets one disease, almost entirely ignoring other diseases, and even health, education and other development areas.

Indeed, the parallel is even weaker than that. Lack of access to water and sanitation affects all poor people, especially those living in rural areas and, arguably, affects women and children more, perhaps more directly, than adults and men. HIV is often more common among wealthier people with better education, and certainly among those who live in more urbanized areas. The article concludes that "the current state of development leaves more than a billion of the poorest and most marginalized people at risk of ingesting feces with their food and water". So let's not approach lack of water and sanitation as we did HIV and access to antiretroviral drugs. Access to clean water and sanitation is a basic human right, so why not approach it that way?

What Would Be a Legitimate Role for Western Development Workers in Developing Countries?

There's an interview with Yash Tandon on Pambazuka.org that is well worth reading for people working in development or thinking of doing so. I find it relatively rare to hear what Africans really think of development. My aim in coming to East Africa to work in development was to find out from people working in development here what form development should take. Given that both recipients (as opposed to beneficiaries) of development programs and those working on the programs often agree that things have been going wrong for a long time, how should things be put right?

Tandon criticizes the Paris Declaration on aid effectiveness on the grounds that it was "conceptualized by the donors, and not by the people that were supposed to be assisted". Which is little different from a lot of development decisions, before and after the declaration. Tandon goes on to say that "the so-called development aid never did promote development" and that " The result is that the aid industry has no longer any legitimacy."

It's ironic, considering how often people working in development use the term 'dependency' when referring to recipients of aid, how Tandon turns things around and points out that there are "at least a million people in the Western countries that live off the aid industry". Tandon feels that aid, or whatever term it goes under, was always intended to serve the interests of donor countries. I agree, and Tanzania, with its massive potential for gold, uranium, natural gas, arable land and other resources, is a case in point. The resources remain underdeveloped and underexploited until some wealthy foreign country comes to do the exploiting.

Tandon singles out Oxfam for criticizm as an organization that started out with good intentions but is now part of the very machinery that ensures the smooth operation of aid policies that are intended to benefit Western countries. And he raises a very interesting question: why do we call a lot of 'aid' programming by that name when it is actually just business? The Chinese and the Indians call it business, so why do many Western countries wish to dress it up as philanthropy? It must be a slap in the face to big Western donors to be told that the Chinese do it better when they seem hell-bent on persuading people here that the Chinese are only out for what they can get!

Another couple of sacred cows Tandon slaughters are the imposition of certain 'values', perhaps by church based organizations, which are dressed up as 'solidarity' or some other touchy-feely concept; also the assumption that Western aid agencies have the right to "encourage women who raise their voices against practices that violate their human rights" (for example). Tandon says the latter is not the business of outsiders, that "the initiatives of rural women in Africa against oppression are very strong and very strategic. They know what will work and what will not". I hope his last statement is right; I have not been exposed to initiatives against oppression that are strong and strategic, though I would very much like to be.

These are all perplexing issues for people who wish to work in development without becoming part of the problem, serving as mere instruments of the self-interested Western agenda. Much though I would love to follow Tandon's advice, I have not come across many people who say 'this is what we want and this is how we intend to achieve it'. Rather they tend to say 'how do we get some of this money/assistance/resources'? Perhaps they are now also mere instruments and are currently unable to serve the intersts of those they hope to serve. But how do they change course and set the agenda? If there is an indigenous aid agenda in East Africa, where is it articulated?

I wholeheartedly agree with Tandon's conclusion that "All development is self-development", but I want to work with self-development, with self-developers. I think that the development industry can do a lot more good in developing countries by advocating against certain things, such as land-grabbing, resource theft, imposition of genetically modified organisms and other inappropriate and failed technologies, Western use of cheap labour, exploitation of lax human rights legislation, commodity dumping, unfair trade agreements, etc, something I have called 'Development by Omission' for want of a better phrase. But I wonder if Tandon thinks there is a legitimate role for people who work in development to continue with, as long as they are committed to an agenda set by their adopted country, and if so, what is this role?

Huge Birth Control Programs Don't Work: Time to Give Education a Chance

I recently moved from a job as grant proposal writer for an NGO working in several different development areas to a similar job in a secondary boarding school for girls, which is being built in a country where many girls don't even finish primary school. So I was comforted to find an article entitled 'Women's Education Slows Population Growth'. That women's education can have such profound and positive consequences is not the issue, that has been recognized for a long time, at least by those working in education. But the priority is so often given to population growth, rather than to education or any other development area.

A shocking proportion of 'development' money and a disturbing number of development related insitutions concentrate almost exclusively on population control, in some form or other. They bang on about an unmet need for contraception as if many women will have depleted health or lives as a result of lacking birth control methods, when they are likely to be in far greater need of better nutrition, healthcare, security, governance, equality, infrastructure and, indeed, education. Shovelling contraceptives into rural communities may be a lot easier than providing people with what they need, but without the education and other development areas being addressed, the only gain will accure to the pharmaceutical companies who produce contraceptives.

Similar remarks apply to a lot of other 'health' programs, which target whatever health issue is currently fashionable and well funded; many of them are also necessary, but they would work a lot better if people had the level of education to capitalize on them. Otherwise, they can just go through the motions of attending numerous courses, often for the per diem they may be paid or the free lunch or other minor benefits on offer. I have met people who have been to various 'training courses' only to attend the same course several more times, sometimes provided by the same NGO as before. Training courses are a great way to spend money and it's easy enough to gather data that allows the donor to pronounce the intervention successful. Some health drives pick out some particular disease, perhaps a water borne disease, without addressing water and sanitation in the area. The current drive to 'eliminate' polio is a cases in point; those who attend immunization drives go home to drink contaminated water and contract something else.

Education itself, as we found in my own country, Ireland, is not enough when there are no jobs to go to. And here in Tanzania, women are not considered to be able to do many jobs that they would in fact be well able to do, if they had the education. Sadly, they are considered to be able to do many jobs that are not particularly appropriate for them when they are too young, too old, pregnant, childraising or breastfeeding, but that's another matter. I always feel a bit dishonest when I tell people about how important education is when there is little guarantee many of them will ever get to use it, especially girls and women.

As if there are not enough obstacles, also, school-going girls who become pregnant are excluded from school. In the rare instances where they are allowed to return to school, most do not. This is to 'set an example', we are told. And it does. It shows that girls who get pregnant will be treated very harshly, whereas the boys or men who make them pregnant, generally, will not. The fact that underage girls being made pregnant by older men is a serious crime doesn't get the girls off the hook. Men don't appear to be prosecuted, boys are generally not excluded from school and the strong prejudice against females appears to be practiced by the very institutions that might be in a position to change things.

According to the article, the average birth rate is less than half in regions where education is valued; as I'm working in one of those regions, I'm hoping that birth rates are lower because education is valued. However, even expensive schools with nice, well-funded buildings and facilities, don't always have especially high educational standards. As a fundraiser, sometimes I can see funds for all sorts of things, but not so many that clearly improve education. There is not so much available for good teachers or other provisions that would make a difference. And many fundraisers are tasked with raising money for the buildings, which is important, but often distracts from the ultimate purpose of these buildings.

So, as the article suggests, it's not the correlation between higher standards of education and lower birth rates that is important; it is the priority that is given to education. Proponents of the population control theory of development, so beloved throughout the last fifty years (and still loved by the Rockefeller Foundation, the Gutmacher Institute, the Gates Foundation, Population Services International, Family health Internationa and many more), never appeared to realize what needed to come first, that with development of education, health, infrastructure and the rest, lower birth rates would follow. Similarly, poverty is pervasive in Tanzania, but lower birth rates does not have much direct effect on poverty; rather, lower poverty rates result in improved health, education and the like.

For education to be of benefit, many other things need to be in place as well. But one thing is for sure; reducing birth rates and hoping that other development areas will benefit accordingly has not worked. The funding these charlatans have received urgently needs to be directed towards people's true needs, which are still education, health, a decent standard of living, security, food security and the rest, just as these are the true needs of all people.

How Low Would An NGO Go For the Sake of Money, Even Spite?

The first time I came to East Africa, in mid-2002, I wondered how I could be part of 'development', part of the efforts to change things for the better (despite knowing that some things that go under the name 'development' make things worse, often by design). The changes may be small, but they would make a big difference to some. Etc.

Like anyone else who had similar wishes, I needed to find out what was going on, what was so bad that it needed changing, how to bring about such change, why this sort of change was not already occurring, or if it was, how to do more of that and less of anything that was inimical to development...

I wanted to meet people involved in development, people from East Africa, people not from East Africa, whatever it took. I went back to Europe to save enough money to return and, at the same time, study for a Master's degree that included development, and perhaps some other areas, so I would have some kind of perspective, maybe even some useful skills.

That may all sound very naive, but in some ways I haven't changed that much. Since I've come back I've been working with individuals, community based organizations (CBO), non-governmental organizations (NGO) and the like, hoping to find that some were doing the right thing so I could learn about where I could fit in. Because, as I spend time trying to find out where I fit in, I have to do something. So I do many things, and I hope that continues.

But what do NGOs and others in the developing world do? Well most people know something about some NGO, what might have once been referred to as 'charity'. They do relief work following emergencies, education of various kinds, healthcare work, poverty reduction work and much else. Nominally, they do all the kinds of things that someone 'with a heart' would wish to do, or wish to know that others do or to support, financially and in other ways.

Well, some people do things because they 'have a heart', but not all do. Some make a living out of their work, some make a very good living, some make a fortune, etc. But one expects NGOs themselves to be run, driven perhaps, by 'a heart', whether it's the heart of a person, several people or some kind of community, perhaps a church.

Many organizations in East Africa doing development work are, to a greater or lesser extent, church-based. Now, we all know from experience that being church-based does not guarantee that the work is always well intentioned. Unless the people driving the organization have good intentions, the work will be of little benefit to people who are in need of, say, education, poverty reduction, healthcare, and the like. As I've said, some 'development' work is harmful, and the ideal of 'making things better', however naive-sounding, was never part of the plan.

Perhaps I'm rambling a bit; that is partly my want, but partly my intention, for the moment. But you do come across organizations who say all the right things, tick all the right boxes and go through all the motions, and all that just to survive as an organization. There is nothing else they can do but survive. They look for calls for proposals, find ones they think they can do or ones they can persuade the donor they can do, and apply. If they get money, they do the job, somehow or other, if not they collapse.

So take an organization I shall call whateverisexcellent.or.tz; they are a church-based organization, they do all of the above and everyone says that they are very good proponents of their church's teachings. They 'help' poor people, sick people, vulnerable and abandoned people, people with disabilities, people who are in some way stigmatized, they care for them and look after them, up to a certain point; they are unlikely to do so for the duration of those people's lives, unless those lives are short (and many are); projects are usually a few years and no more.

But that's something, because they are doing what they say they are doing, donors love them, they give them money and every few years, when a project ends, they can apply for more money and say 'look at these children and old people and orphans and vulnerable children and disabled people and stigmatized people, this is what we have been doing, if you give us more money we will keep doing it and even find some more beneficiaries'.

But when it comes down to it, the organization is just part of a bigger community, which is part of an even bigger congregation, which is part of a whole lot of congregations and overlapping groups. And it happens that whateverisexcellent.or.tz has a neighbour, which whateverisexcellent.or.tz's church was able to help out with some land, so that this neighbour could build another NGO, specializing in some of the above needy groups; let's call the neighbour ladlesoflove.or.tz.

Ladlesoflove.or.tz, as an organization, do very well. So well that the church sees the beautiful buildings and, maybe, they  'covet' them. Whateverisexcellent.or.tz may well tick all the right boxes when it comes to applying for grants and, eventually, reassuring donors that they have spent the money well (and asking for more, of course), but they covet the assets of ladlesoflove.or.tz so much that they ignore the vulnerable, poor, disabled, abandoned, stigmatized beneficiaries of ladlesoflove.or.tz; they threaten to evict their neighbours, to whom they were once so sympathetic.

For me, the question is, if whateverisexcellent.or.tz is so concerned about all needy people, some of whom ladlesoflove.or.tz is benefitting, how could they do something that would compromise every single beneficiary? And just for the sake of some assets (plus a fair amount of spite, jealousy, bloody-mindedness, prejudice or anything else that drives such maneuvers)? Shouldn't their donors say 'hey, why do you take our money but continue to impoverish the poor, stigmatize the stigmatized, abandoned again those who have been abandoned?'

If donors don't do that, they are simply accepting that development is just an exercise in identifying some projects that can tick the right boxes, and getting on with the job. So is that all development is? As a person still trying to figure out what development is, I certainly don't accept that it is, effectively, an administrative and PR effort entirely motivated by political and/or commercial interests, with no intentions worthy of a human being as a human being. If development is just another business, and just as unscrupulous as it needs to be, I think many people working in the field will be looking for another way of fulfilling their original intentions.

I'll return to this theme soon and I hope to be clearer about whateverisexcellent.or.tz; are their intentions honorable, or is all the 'we're a church-based organization and we follow the teachings of the bible' just posturing, just a way of keeping the donor funds flowing. Because I've heard many claims about 'following the teachings of the bible' and (sharp intake of breath), some of them sounded quite hollow. But that's just my view.

Who Will Educate the Educators?

After leaving Maker Faire Africa on Friday, inspired by much of what I saw there, I returned to Nakuru, where many of the town's residents stand or sit in the same places every day, staring at passers by, shouting the odd bit of abuse and joining in any commotion that happens to relieve the monotony.

I admit, I was a bit annoyed when I compared how some people do amazing things with their time and others do not. I always have to go through the same thought process; first I get exasperated and then I remember that there can be reasons why some people energetically pursue things that benefit them and others while some people seem condemned to get up every day and stare into the middle distance until it gets dark.

The vast majority of exhibitors that I talked to at Maker Faire were well educated and some were clearly from well off backgrounds. This means nothing on its own. Those with lots of education from well off backgrounds can also end up doing little with their lives. And some from poor families with only a basic education achieve great things.

But some of the exhibitors were also wondering why some of their fellow Africans didn't do what they were doing. And one reason I would suggest is lack of basic education and training in skills that allow people to prosper, or at least to get by better than they do now. When I attempted to demonstrate to people around Nakuru how they could make and use simple technologies, they went through a few phases: they were curious, even surprised; they raised objections; they became silent and sat on their hands.

I admit, they may not have had the best teacher. But I think there is something about education beyond what is imparted by a teacher and embraced by a learner. People didn't sit on their hands because they were unable to cut out shapes using patterns and stick things together with glue. They are well able to do such things and many others. I would guess that most of them could have done much of what the exhibitors at Maker Faire did.

What people gain from education, I hope, is the ability to make what they learn part of their day to day lives, whether this involves various bodies of knowledge or sets of skills. What people with a poor education receive is lists of things to learn off so that they can get the requisite number of ticks in order to graduate to the next class. These ticks are rarely, if ever, of any use to people thereafter. But once people have mastered the pretence of being educated, they have no way of taking their education further.

I'll say it again, people with education and training may not necessarily do much with it. And those with little education and training may spend their lives enhancing what they have got and benefiting themselves and those associated with them. But that seems like leaving things to chance for the majority, while allowing a minority quite an advantage, whether they use it well or not.

Development projects can be very narrowly focused. For example, many education projects focus on a few indicators, often the ones that show the project in a favorable light but give little benefit to the recipients. They might concentrate on enrolment but not attendance, exam results without any evidence of learning or the ability to continue learning after school has finished, gender parity without any change in genuine inequalities, etc. 'Success' in development projects can resemble the 'success' of students who have received a poor education.

HIV projects can involve huge amounts of money and produce amazing statistics about the number of HIV transmissions prevented, the number of deaths averted and the number of condoms distributed. Yet people are suffering from and dying from very ordinary diseases that are easy to prevent and cure. Health is not just a matter of disease or being free of disease and it's even less a matter of one virus (which is still endemic in many countries in the world, despite hundreds of millions having been spent on 'prevention' programs).

There seems to be an emphasis on size and magnitude and the measurement of these development projects, as if there is some great prize to be won on the basis of a few hackneyed quantities. Is the aim of development not to ensure that there are fewer millions of people receiving little or no education, suffering from and dying from preventable and treatable illnesses, unable to afford basic nutrition or water and sanitation? Of course you have to count people, but people are not indicators, nor are health or education.

Many of the projects at Maker Faire were about things that matter to people in their day to day lives, food, water and sanitation, agriculture, communication, income, energy, lighting, raw materials and the like. There was less emphasis on education that I would have expected, unless you count some electronic device that 'helps children learn to read'. But these are all concerns that are raised when you go to villages, slums and isolated areas.

Levels of education, especially among girls and women, can be shockingly bad. Many primary school teachers are said to have a low understanding of the subjects they teach and even those who know more don't manage to impart much. But education is not just a process of 'attaining' a set of facts or skills. It is the preparation that everyone needs in order to ensure the education and health of themselves and their families and to ensure that they grow up to be able to provide for themselves and their families, in turn.

A lot of development is dominated by quantities and measurement, a set of boxes to be ticked, regardless of the irrelevance of such processes to people's lives and livelihoods. The Millennium Development Goals, mentioned several times at Maker Faire, are the epitome of such a lifeless and administrative view of development. People need basic things, education, health, nutrition, income, water and sanitation and infrastructure, but they also need to be able to provide themselves with these and other rights. These are not things you can pack in sacks and send them off in an aid convoy.

Significant feats will not be achieved by hordes of administrators with clipboards (or technological variants of clipboards) recording a handful of indicators as people die prematurely and needlessly, though this is a great way of spending billions of dollars. I suppose development will only achieve anything when it has put people in developing countries in the position where they can do the development. So far, we have not been very good at this (and I include myself, of course).

That development needs to be sustainable, that it needs to give rise to further development, seems clear. But it also seems to matter a great deal who is doing the development, who is able to do it, whether it is outsiders from developed countries or insiders from developing countries. Which is very similar to the conclusion I came up with yesterday! I could go on, but tomorrow is another day.

Development and Sustainability

Back in Mogotio today with Ribbon of Hope Self Help Group. We have to go to five villages and identify four especially needy orphans so that we can support their adoptive families to care for them. Not that it's a difficult job to identify four, we ended up with five today and pleas for several others. Yesterday, also, we had several pleas from mothers who heard there were people assessing orphans in the area. It doesn't take long for the word to get around but it's hard to have to tell people that we only have the funding for a very limited number right now.

Today we went to Alfega (a corruption of Alpha and Omega, reflecting the Greek 'ownership' of most of the land in the area), which is about one hour of difficult cycling from Mogotio. I was given one of the very heavy but resilient Indian 'Avon' bikes and told the brakes were not too good. I would have been surprised if I had been told they were good and I've never cycled on a bike that had two brakes here. But by the time I was on a steep hill trying to check my speed, the one brake had failed. I made various attempts to slow down before preparing myself for a crash landing, which I found in a bank of clay that happened to be at just the right angle to stop me without resurfacing my face.

Without further incident, we took the least muddy route through the kilometres of sisal. It was very hot and there were several places where we struggled to push the bikes through the wet mud, but all in all, it was an enjoyable journey. The area is particularly beautiful in the present, rainy season, just a bit wet sometimes. And in the midst of all the sisal, we spotted some industrial greenhouses and some bright green fields of something other than sisal. I hoped to see food crops but, alas, there was mostly flowers (for the European market) and coffee grown there. The area is owned by one of the sons of the former president, Moi, who was quite acquisitive in his time.

Like Majani Mingi, where we went yesterday, Alfega is pretty isolated. The best roads that surround it are mud roads and impassable during and just after the rain. And it's expensive to make the journey if you really need to. So most people don't leave the village much. In spite of being surrounded by such greenery and wealth, the village is as poor as Majani Mingi and far more populous. The latter has a population of only three or four thousand, Alfega is closer to eight thousand. Of course, I never know whether the population figures we are given count the children or just the adults.

We visited four houses, assessing five orphans in all. They were all in need of assistance and the worst thing is seeing the problems that their families have to cope with. It's amazing that families that are so overstretched will still take on another child to care for, but it does seem to happen a lot. And Ribbon of Hope is fortunate enough to have members who are from the area because otherwise, it would be impossible to tell who is genuine and who is not. Even people who are clearly in need sometimes tell a few white lies to try and have one of their children assessed, which is not really surprising.

And that's another way in which we are fortunate, we have limited funding, so we have to be very careful. I've seen and heard of organisations that have large amounts of funding but they end up using it rather indiscriminately and even losing it to people who are not really in need. Organisations shouldn't have any more cash than they know how to administrate. Our biggest asset right now is the closeness of some of our members to the local community we hope to assist.

Just as it seems unfair to help people who are HIV positive when other people are suffering from all sorts of treatable and curable illnesses, it sometimes seems unfair to single out orphaned and vulnerable children for special assistance when there are others who are in equal need. And this is a dilemma that we face every time we visit such villages. Today and yesterday, we saw people, adults and children, who were suffering, but they probably won't attract the attention of NGOs. We try to do things that benefit communities as a whole as well, but we are small right now. Hopefully, things will change over time.

Incidentally, it's worth pointing out that in this area that is mostly owned by Gideon Moi, there are a lot of public toilets being built. As the houses there don't have good sanitation, this sort of intervention will have major benefits for everyone in the village. Water and sanitation related illnesses give rise to a huge share of the disease burden and deaths in developing countries. The Greek owned area around Majani Mingi didn't have any public toilets that I could see and it is likely that the overall health in Alfega in the near future will be far better as a result. I hope to see more of this kind of public intervention, despite the dominance of private (and highly exploitative) enterprise in the area.

Ideally, Ribbon of Hope Self Help Group won't get much bigger because the things we are doing now will be done by other self help groups. To some extent this is already happening. But there is a certain futility to NGOs and community based organisations (CBO) continually setting up and targeting the people and things they most want to benefit, only to be replaced by more NGOs and CBOs, without an end in sight. It would be nice to think that communities like Alfega and Majani Mingi will one day be able to support themselves, perhaps because of the support they received in the past from various parties.

In fact, if that is not what happens, if the development that we are involved in now is not sustainable, if it doesn't give rise to further development that is greater than what came before, I think it may have failed. But the possibility that what we are doing now may only have a short term benefit and that others may have to come and do the same again and again in the future is no reason to stop doing what we are doing. Unless we are doing some harm, and I hope we are not doing that.

Aid is But a Tiny Fig Leaf

While the Icelandic volcanic cloud means that people in Europe are having to cancel or postpone trips or find alternative ways of returning from trips, Kenyans are worrying about what is going to happen to their perishable produce, such as flowers, fruit and vegetables. Europe is their biggest market. Although owners of these industries make huge profits when things are going well, the employees, who make a pittance, make nothing at all when something prevents produce from getting to market.

At the same time, the BBC comments on a report that finds that the UK imports a lot of its water from other countries in the form of produce such as flowers, fruit, vegetables and other goods. Much of this imported water comes from developing countries, such as Kenya, where clean water and sanitation problems are responsible for high rates of avoidable mortality, especially among infants and children, and numerous treatable and curable illnesses. The report estimates that two thirds of the UK's water use is imported.

The mass production of non-seasonal food and non-food crops by developing countries results in much of the starvation that the UK and other rich countries seem to see as 'natural disasters', to be remedied by a sticky plaster, some handout or even a 'deal' of some kind that is calculated to do more harm than good (it benefits the donor, of course). Yet the industries that claim to be such a great source of foreign currency, fruit, vegetable and flower industries, are mostly foreign owned, British owned, in fact. They pay little or no tax in Kenya and, being offshored, little in Britain either.

When a country like Kenya starts to realise that their 'cash crops', such as tea, sugar or coffee don't make them much money, they seem to reach for another cash crop. The Kenyan cotton industry (along with that of many other developing countries) was wrecked many years ago by the US cotton industry successfully lobbying for subsidies to support them so that no developing country could compete. Subsidies are bad, according to the US, except when they are US subsidies. Sadly, Kenyans are calling for their government to help them return to cotton production. But this is unlikely to fly because US cotton is still subsidised to such an extent that no developing country can produce it as cheaply. And this is despite Kenya having pay and working conditions that would make Bill Gates proud.

But cash crops have always made very little money. Many of them here are grown as part of a kind of agreement that was formed with British land 'owners' after independence. They were allowed to keep their land and those Kenyans producing their (the colonial's) crop, tea, for example, were bound to go on producing tea. The law is slowly changing so that people may be allowed to stop producing tea and produce some food instead (God forbid!). But with sugar, the factories are demanding that even more land be given up to it so they can produce biofuel. Never mind that those whose land the sugar cane is planted on make little or no money from it.

It may well be wondered why farmers produce a non-food crop when they are starving and these crops don't make any profit for them. Well, aside from the promise to keep producing crops that only profit foreign companies, such as Unilever, farmers can't afford the inputs to grow food. They could make a lot of money from growing food and feed themselves at the same time. But as the government does little to support subsistence farmers, only being able to help the rich industrialists with tax breaks and other preferential conditions, farmers have to accept the generous offers from the likes of sugar companies to meet some of the costs involved. In the end, the farmer does all the work and gets little remuneration, if any. And they and their families starve.

Biofuels, like all the other luxury and non-food crops produced in developing countries, effectively export unthinkable amounts of water, along with vast tracts of land. The 'natural' disasters of flooding, drought, famine and the rest, are not as natural as they are painted. Rather, they result from explicit policies and agreements that keep things cheap for people in rich countries, profitable for foreign companies, and if any of those people in developing countries start complaining we can always point to the aid money we send them, whatever aid money even reaches the majority of people.

It's no secret that rich countries steal water from developing countries, preferring to feed ourselves luxuries and run our cars than allow undernourished and starving people to eat. But we steal a lot more than that. The majority of people in Kenya are subsistence farmers or workers. Even those who have jobs usually work for very little so that those in rich countries can afford cheap raw materials and goods. Many people have next to nothing, and that seems to be the way we in the West like it. And in return for extracting what we can, we send a little money every now and again and think of ourselves as very philanthropic indeed.

There is an alternative to rich countries sending ever increasing sums of money to developing countries. That is to identify some of the ways they extract even larger and faster increasing sums of money. That way, Kenya could be assisted to develop its own flower businesses. They could produce and process fruit and vegetables, thereby making more money from them. They could choose what crops to grow and in what quantities, especially crops that could be used to produce high value goods. In fact, the list of things that constitute extraction of wealth by rich countries from countries like Kenya is very long. Then Kenyans will be in a position to tell us what to do with our aid.

Rambling in Kenya

Yesterday, I made the fairly familiar journey from Nakuru in Rift Valley province to Mumias in Western Province. There are many beautiful sights on the way and the weather was good for travelling, sunny but not too hot. The roads for some of the journey have been improved, some are sill in the process of being improved and others are disintegrating and in a very dangerous condition.

Infrastructure conditions in Kenya have a lot to do with structural adjustment policies imposed by the IMF (International Monetary Fund) and the World Bank. These were first imposed in the early 1980s and they are still used, but they go under different names sometimes. Whereas, the road and other infrastructure improvements have a lot to do with Chinese development, which is carried out without the same level of conditionality.

Much of the fertile land in Nakuru is owned by a handful of very rich people, many of whom are members of political families, the Mois and the Kenyattas, for example. And like a lot of rich landowners, they don't feel the need to grow food crops or, at least, not food crops for Kenyans. You might think that wheat, sorghum and millet are food but the large scale producers, apparently, grow these crops to sell to breweries.

A few hours from Nakuru, the next big non-food product is tea, which dominates Kericho. Most of the industry is foreign owned or run and Kenyans make very little from this monoculture. It may be a world renowned product, but employees are paid very little, live in bad conditions and have few labour rights. That applies to those who have real jobs, rather than the far larger number, who have to take whatever bit of work that crops up, however rarely and however badly paid.

One of the big employers there is Unilever. You can read up on their level of corporate social responsibility on the Corporate Watch website. Suffice to say, they tick all the boxes that you'd expect of a multinational; monopolistic practices, unsustainable agriculture, exploiting cheap resources and labour, environmental degradation, appalling health conditions and a whole lot of other things. It's a long and depressing read.

Long before you reach Mumias you begin to see the sugar cane fields, sugar being another of Kenya's handful of monocultures that have played a big part in keeping Kenya poor for many decades. While sugar cane has long been grown in Mumias to be used as sugar, now there are plans to grow even more sugar cane destined for the biofuel market. Yet more land that could be used for food is being sacrificed for the blessed export market. The profits will go to a handful of rich people. Mumias Sugar Company does pay its employees well but the majority of people who work for the Sugar Company are not considered to be employees. They are casuals, contractors, outgrowers, etc. The majority of them make bugger all.

It probably sounds like I have a thoroughly miserable time travelling through Kenya, thinking about how much of the country is dedicated to exploitation. Well, there are still a lot of beautiful sights, if you are in a position to enjoy them. There's a good reason why tourists come to places like Kenya and even the trip to Kakamega Rainforest, Mount Elgon and Lake Turkana can be a great way of seeing the country. But even the tourist industry is another case in point; very few people make most of the money. The majority eke out a living somehow, but much of the tourist revenue doesn't even stay in the country.

Such conditions in developing countries may be, to some extent, influenced by their own governments. There are, indeed, many corrupt politicians and other parties and they have made themselves very rich. But governments, multinationals and other parties in rich countries have also made themselves rich by grabbing much of the wealth to be made in developing countries. And institutions like the IMF and the World Bank (and the World Trade Organisation) are simply some of the tools by which the rich and powerful extract huge amounts of wealth from the poorest and most vulnerable people in the world.

Poverty and underdevelopment are not remote phenomena, far from Western style homes and living conditions. The forces that create and exacerbate poverty also bring to those living in comfortable conditions many of the cheap products that make their lifestyle possible. Tea, chocolate, coffee and other things that come, primarily, from developing countries, are only affordable because of policies created by undemocratic institutions (who, ironically, constantly talk about improving democracy in developing countries). Even Ipods, Iphones and Macs, made by a company that likes to boast about how responsible they are, depend on (high value) materials extracted cheaply from countries like the Democratic Republic of Congo.

Much of Western democracy itself, and much Western wealth, depend on the terrible conditions that are created and maintained by undemocratic international financial institutions, multinationals and powerful governments in developing countres. It doesn't seem possible for every country in the world to end up with the same kind of democracy enjoyed by a handful of the world's people. I don't want to argue that democracy is impossible or that it is wrong. Perhaps, as Amartya Sen has argued, there is not enough democracy. Perhaps it is not widely enough distributed.

But if Sen is right and there were more democracy in the world, I think it would look a lot different. The small number of countries that have enough, too much in fact, use more resources per head of population than the world can provide. The level of choice that some people enjoy, the range of goods and services, necessary and unnecessary, the opportunities to overconsume with impunity, could not be offered to all peoples, equally. But I haven't gone deeply enough into political philosophy yet to figure out what sort of democracy would be sustainable democracy. Perhaps I'm just rambling.

I'm in Mumias to visit a very fine NGO called SAIPEH (Support Activities in Poverty Eradication and Health). Like the community based organisation I work for, Ribbon of Hope, Nakuru, they work with HIV positive people and their families, people suffering from hardship, orphans and vulnerable children. (Except that SAIPEH has been going for about 14 years, Ribbon of Hope is still small and young, not much over a year old.) Anyhow, they run all kinds of income generation schemes, such as growing food crops and livestock, teaching people trades, such as tailoring and computing and various other initiatives.

I'm hoping that SAIPEH will be interested in schemes that reduce spending too, such as solar cookers, cooking baskets and fuel briquettes made from organic waste materials. For lack of a convincing political philosophy, I'll stick to a more Aristotelian form of home economics in the hope that, although people will not end up rich, they may end up with a bit more cash than they had before. After all, for Aristotle, all economics was home economics.

European Protectionist Agreements

Recently, I expressed a sceptical view of the EU's proposed Economic Partnership Agreements (EPA) with African countries. I suggested that while the EU pretends such agreements are for the benefit of Africans, this is just a sham and that they are unashamedly beneficial to rich countries and detrimental to the development of poorer countries. The former president of Tanzania, Benjamin Mkapa, is in agreement with me, warning that EPAs are a form of neocolonialism. The EU have been quick, but unconvincing, in their denial of any underhand intentions.

Their response is unconvincing because they are effectively just offering more of the same. African countries will produce low value goods and raw materials, which the EU will buy for as little as possible. In return, the EU will sell African countries high value products that have been produced cheaply, in part, because of the low raw material costs. Sometimes, these high value goods will even be produced using badly paid Africans, which will further increase the profits for the EU. The EU assures African countries that they will be allowed to phase out some tariffs more slowly than others. But ultimately, the EPAs need to obey the strictures of the WTO (World Trade Organisation), where 'world' means 'rich countries, especially the US'.

While the EU is pumping out the woolly rhetoric about African countries removing barriers, they are piling up the barriers to make it more difficult for African products to reach the EU markets. It's the time honoured process of protecting their markets while accusing weaker economies of protecting theirs, a process particularly relished by the US and UK when it suits them, only to be replaced with a sanctimonious plea for free trade when the conditions are right.

Incidentally, a piece of particularly woolly rhetoric is the 'Agreement on Sanitary and Phytosanitary Measures', which you may need to read several times only to remain totally confused. The EU can insist on certain standards for food coming into the region that make exporting by African countries to the EU too expensive. According to these measures, that is not what is supposed to happen, but it effectively means that most African countries can't export to the EU. And the EU supports those exporting goods to African countries by methods that would be considered to be subsidies if they were implemented by Africans.

Even the private sector in Africa is suspicious of EPAs and they are the people who may be expected to have most interest in them. So if the private sector and other influential people are not about to be hoodwinked yet again by the protectionist West, perhaps there is hope that African countries will have some influence on other trade issues that have, so far, kept most of them underdeveloped.

The Pretence of Aid

Some of the issues this blog is particularly concerned with include unfair trade policies that aim to keep developing countries in their current state of underdevelopment, the use of developing countries to produce low value goods and raw materials, but not high value goods, which they have to import from rich countries, and the use of developing countries for growing monocultures and single resources that are often processed in rich countries, earning poorer countries very little.

Economic Partnership Agreements (EPA) are, to a large extent, behind these and other issues. Rich countries have been busy for a long time trying to persuade African countries to sign up to these EPAs, without much success, yet. But as the number of poor people in African continues to rise, mostly as a result of the 'pro-poor' policies of rich countries, it should be possible to persuade more countries to put the noose around their neck in return for some short term handouts that they need for an emergency.

Perhaps Kenyans think there is no alternative, perhaps there is no alternative for them, but they seem to be getting further and further into the noose of producing cheap primary goods for export. Huge areas of land are being diverted to use for biofuels and other things that people here are not in great need of. At the same time, small farmers, who produce the bulk of what Kenyans eat, are slowly losing access to land as they are pushed off by rich industrial scale agricultural interests and as the prices rise to levels they will never be able to afford.

Rich countries used trade tariffs to get to the position they are in today. Now they want poor countries to remove their tariffs so that the rich countries can expand their markets and compete, under completely skewed conditions, against the poor countries' markets. EPAs are dressed up as being advantageous to African countries but so far, most African leaders have not been fooled.

The East African press generally seem uninterested in non-national matters, so I was surprised to come across an article that discusses the difficult area of EPAs in simple language for a non-political economist like myself to understand. This article sees EPAs as the wrong kind of development model and discusses a number of key points. One of these concerns EPA provisions that are highly detrimental to African countries' development. The EU claims that dismantling tariffs will promote growth, despite the fact that this has never been the case, in any country, or at any time in history. On the contrary, tariff cuts have taken countries in the oppostie direction, leading to stagnation and de-industrialization.

Kenya is typical of the countries who will suffer if they sign up to an EPA. They depend on a handful of low value primary goods that are often produced by farmers at an extremely small profit, even at a loss: sugar, sisal, coffee, tea, fruit, vegetables and the like. It would be extremely advantageous to Kenya to use those primary goods to supply an industrial sector, if they had an industrial sector. But much of the industry they do have is owned by foreigners from rich countries, who are effectively subsidized to be here. They get tax breaks and other incentives so that Kenyan industrialists have no chance of competing with them.

Of course, the EU would not want Kenya to develop an industrial sector, not an indigenous one, anyhow. Their economies depend on cheap goods and cheap labour from developing countries. So they dress  up their policies and 'contributions' as 'aid' and they talk the talk of development. And for the EU and other rich parties, African countries are not just sources of cheap goods and labour, they are also important markets, where very expensive goods, often made with cheap African raw materials and labour, are either sold or dumped on the African market.

It's a disgusting thought, but all the land that has long been used to produce non-food or non-essential food products in developing countries could have been producing food for starving people here in Africa. Instead, starving Africans get a pat on the head and a hand-out from the rich world. Now that some rich countries are unable to produce enough food for themselves, they are buying up African land. Others are buying up African land to produce biofuels. Africans can expect more pats on the head and more hand-outs whenever enough Western attention is drawn to some drought, flood or other 'natural' disaster.

And don't be fooled into thinking that most of the disasters that strike poor countries are wholly natural. Many are not in any sense natural. People starve, become sick and die during what are referred to as disasters, usually, because they don't have access to the food or the water that is being extracted by foreign interests. The 'shortages' of food that Kenya has experienced recently and will continue to experience into the future have been manufactured. The bulk of land, and therefore water, in Kenya is devoted to producing goods for export. Even those goods that consist of food items are destined for Europeans who can afford it, not Kenyans, whose buying power is undermined by various agreements with the EU and other rich countries and zones.

Human Rights Are Not Just for the Rich World

According to Dr Marcos Espinal of the Stop TB Partnership, "TB is not a medical problem. It is a development issue. It is an economic problem. It's a human rights situation." And I applaud him for saying this. If developing countries are not allowed to develop (and I would argue that developed countries are doing all in their power to stop them from developing), diseases like TB will not successfully be treated by drugs alone. People in developing countries are poor, they suffer bad health, they receive little or no education, they live in terrible conditions and their human rights are being denied. It is no wonder that TB and many other diseases are rife and increasing.

I would add that HIV, also, is not just a medical problem, nor is it just a matter of sexual behaviour. Parallel arguments could be used to show that, so far, both HIV and TB programmes have failed to prevent the spread of the diseases and will continue to do so. If you don't deal with the conditions that result in diseases spreading, all diseases, you will not eradicate the diseases. After using little more than expensive pharmaceutical products to treat TB for many years, an estimated 440,000 people are now resistant to commonly used TB drugs. I have not been able to find estimates for the number of people with HIV strains that are resistant to first line drugs commonly used in developing countries, but resistance is a very serious threat.

There's an interesting article on the website of the United Nations Development Programme (UNDP). They have been publishing the Human Development Report for many years now and they are about to reveal some of the main trends over the past four decades. The Human Development Report measures development by criteria other than just economic, such as health, gender, education and other things. This article notes that there has been significant progress in development, but this has come from improvements in education and health, not economics.

It also notes that these improvements have little or nothing to do with globalization. Rather, they have been achieved by expansion of "educational and health systems, coupled by initiatives of the international community to enable access to vaccines and antibiotics." In other words, state intervention.

The research finds that there is no correlation between economic growth and changes in non-income components of human development. It concludes that "the oft-repeated dictum that growth is a necessary condition for increasing human development is simply not true."

So the approach to development and human rights related problem, such as HIV or TB, is to improve education, health, economic circumstances, gender imbalances, employment, infrastructure and many other things. The approach should not be to set up well financed vertical programmes that target single diseases or narrow issues at the expense of other, broader issues.

Throwing eye watering sums of money at a problem, such as HIV or TB, will not even solve the problems of HIV or TB. Especially if most of the money is spent on technologies that are produced in rich countries. That's just taking money out of one pocket and slipping most of it into another. It's time for new thinking on development. Development is not just one thing, it's many things. And if you don't know enough about any of them, just read the Universal Declaration of Human Rights and consider how many of those rights people in developing countries are currently being denied.

More Good News for Big Pharma: Resistant Gonorrhoea

Yesterday, I blogged about the fact that TB is on the rise worldwide. Funding for TB prevention, and even for treatment, are not commensurate with the threat to global health that this epidemic poses. And the rise of TB is often blamed on the current HIV pandemic. I would suggest that there is a TB epidemic of a level that can not wholly be explained by the HIV pandemic and that, like almost every disease and health issue aside from HIV, TB is being ignored.

Those heavily involved in the HIV industry, such as Michel Sidibe, the head of UNAIDS and Michel Kazatchkine, head of the UN Global Fund for HIV, TB and Malaria, deny that high levels of HIV funding have starved other diseases of cash. Kazatchkine claims that 'over a third of of overall funding of the Global Fund is actually going to strengthening health systems'. I don't know how he came up with this estimate but it seems to me that there are only certain aspects of health systems that are benefitting from HIV cash, and those aspects relate to HIV.

Kazatchkine says the money is not just going on condoms and drugs. I sometimes wonder if the money is even going on condoms, along with the logistics of ensuring that people use condoms all the time and properly. Even the claim that a lot of money is being spent on drugs can seem hollow when people supposed to be taking them often cannot do so because of lack of food. And 20% of the new HIV cases in Kenya every year come from vertical infection, from mothers transmitting HIV to their babies.

Treatment of people with HIV may well have exceeded expectations. And I would like to see every HIV positive person who needs treatment receiving the drugs and support they need. But since the recent expansion of HIV treatment, millions more have become infected. Prevention has been forgotten about. People like Kazatchkine and Sidibe like to argue that distinguishing between treatment and prevention is a false dichotomy, but this is not so. If treatment played such a huge role in preventing further infection, transmission rates would be much lower than they are. In fact, the majority of people in Kenya who are HIV positive do not know their status. Perhaps there shouldn't be a dichotomy between treatment and prevention, but there is.

And if you think the programmes to teach people about safe sex and to persuade them to use condoms have been successful, consider the figures for preventable and treatable sexually transmitted infections (STI). There are an estimated 340 million new cases of curable STIs every year. This is after over 20 years of preaching about safe sex in every country in the world. If people were practicing safe sex, transmission of most STIs would also be reduced. Prevention involves taking steps to ensure the infection is not transmitted. In the case of STIs, that could involve the correct use of condoms, minimally.

HIV treatment and care has received much of the money available for the disease. Kenya's official strategy papers make this quite clear. Prevention has received very little money and has been pretty unsuccessful, with 5 new infections for every two put on HIV treatment, globally. And HIV has been treated as if it's just an easy matter to round up people and give them some drugs. As a result, there is growing resistance to the few HIV drugs available in developing countries. This can be compared to TB, where it has long been recognised that you can't just send people away with some drugs and expect them to take them religiously for 9 months and never see them again.

If health solely involves treating sick people, how will you ensure the continuing health of those who are not (yet) sick? In the field of sexually transmitted diseases, gonorrhoea is now also developing resistance to the most commonly available drugs. There has been little recent research into alternative treatments for gonorrhoea (or TB) because, I would suggest, most of the money has been spent on other 'priorities' (Oh, and big pharma are waiting for public funding for their research, a very important component for these (private) companies). One of those priorities is HIV and despite ploughing a lot of money into condoms and safe sex campaigns, prevention has not received the level of funding it needs.

Yet more evidence of the lack of success of HIV prevention work is the level of pregnancies among women receiving HIV treatment. Women with untreated HIV have far lower fertility levels, so treatment should increase fertility. But women on HIV treatment should also be receiving advice about having unprotected sex and about unplanned pregnancies. I don't believe that all these HIV positive women are choosing to have more children, though some of them may be. Because other research has shown that the vast majority of pregnancies among women who are HIV positive were not planned.

Sidibe even seems to think that the global recession and climate change are distractions to the industry's fight against Aids. I would be hard pressed to find an attitude to which I am more opposed. He even has the cheek to suggest that HIV funding has not led to the neglect of other diseases because it has increased attention for TB, the two diseases being 'integrated', and that HIV prevention should take on a 'holistic approach'. Damn right, but I don't think his use of 'holistic' is the same as mine. But when is all this HIV money going to be spent on the many health issues that I and many others would claim have been ignored? Apparently, Sidibe and Kazatchkine think that's already taking place, and Sidibe feels that support from the big pharmaceutical companies is essential. Very funny.

TB on the Rise: Big Pharma Delighted

Although TB is often mentioned along with HIV, it doesn't get nearly as much attention, certainly not as much attention as it deserves. And it gets a fraction of the funding. It happens to be in the news now because World TB Day was just last week. Unlike HIV, TB is easier to catch but also easier to prevent. It's also curable. But like HIV, TB spreads rapidly in populations which face serious and long term economic challenges, have poor and inaccessible health systems, low educational standards and an inadequate infrastructure.

Like HIV, TB will not be eradicated until the determinants of health are tackled. Like HIV, you can spend as much as you like on the disease but as long as people live in terrible living conditions without even basic water supply and sanitation, suffer from poor health and nutrition and face many other stresses that allow any diseases going to spread rapidly, neither will be eradicated. The huge amounts of money spent on HIV over the last three decades has done little to reduce its spread and the far smaller amounts spent on TB have been equally unsuccessful.

Kenya ranks 13th in the 22 high burden TB countries and fifth in Africa, although it is notable that they are only rank 9th for HIV. There were 132,000 new cases last year. It is estimated that there were 2000 multiple drug resistant cases but only 4.1% of these were diagnosed. And only 48% of new TB patients were coinfected with HIV. New cases of TB are declining but the number requiring retreatment, those who either weren't treated successfully or who didn't finish their treatment, is increasing.

I think it is important to note that just over half of the new TB cases were not people who also have HIV. TB is an epidemic in its own right. While high HIV prevalence will increase the spread, TB is spreading independently of HIV too. And why wouldn't it? Most people in Kenya live in the sort of conditions where all diseases spread rapidly. Just as HIV has been treated as if it is exceptional and as if it is possible to eradicate a disease without also dealing with the determinants of health, TB is being treated as if people's living conditions don't matter. But they do matter, very much.

Jeffrey Sachs points out that if Africa had better health systems, HIV would have been identified a decade earlier. This is quite true, the symptoms that were later recognised as those of Aids were not recognised as being out of the ordinary. They were consistent with very poor health, poverty and malnutrition. It was only when people in more developed countries started to be infected that HIV and Aids were identified. By then, it was too late to avert a massive epidemic. Then, as now, the conditions in which people lived were appalling. 

Nigeria has an even more serious TB epidemic, third in the world, with 100,000 new cases last year, although they only rank 21st in the world for HIV (despite being estimated to have the second highest number of people living with HIV, after South Africa). Rwanda and Malawi have the highest rates of TB in the world but Rwanda, at number 14 and Malawi, at number 8, certainly don't have the highest rates of HIV. The point I'm trying to make is that in developing countries, conditions are poor and declining but also, are not being remedied by the pouring of funds into programmes that merely treat sick people (ok, a small amount goes into prevention, but not much).

Aside from neglecting the determinants of health in general, programmes for TB and HIV are mainly targeted at people who are already sick. Most of the money goes to treating people who are already infected. Preventing both HIV and TB has a lot in common, indeed, preventing all diseases has a lot in common. People need good living conditions, water and sanitation, education, health, employment, economic well being, good nutrition, food security and many other things. Instead, most of the aid money going into these diseases is spent on drugs and other technologies.

PRWeb has a cringe-making release about a report on TB theraputics (which costs $3450, in case you are interested. This release enthuses about the "excellent commercial opportunity for existing as well as new companies in this marketplace." The "marketplace" is certainly growing, because if the only solution to TB is to wait until people become infected and then treat them with drugs, resistance is only a matter of sitting back and waiting. People in developing countries with TB are given the drugs and sent home to continue spreading it in their inadequte housing and with their poor nutrition and lack of education and water and sanitation.

These pharmaceutical companies have been humming and hawing because public funding hasn't been forthcoming but now that it looks like that will be made available, they can start raking in the cash. Remember, that's public funding, because the profits certainly won't be public.

All the conditions for the rapid spread of TB are in place and many of them are the same conditions for the spread of HIV. Little has been done to alleviate these conditions and in countries like Kenya, they have been steadily disimproving for several decades. It may be popular to blame the HIV epidemic, for TB and just about everything else that's happened since the 1980s, but this excuse won't wash. Winding down public services and public spending started before HIV was even identified. TB was around before HIV was identified. The opportunity to eradicate TB is still there, but throwing a lot of drugs and money at it will continue to fail.

Developing countries need to be enabled to develop. Diseases are not just inconvenient pathogens that can be eradicated with some extremely expensive drugs. They require an appropriate environment and suitably weakened hosts. Current and past approaches to TB and HIV ignore the existence of appropriate environments and weakened hosts aplenty. That's why HIV and TB are spreading, despite the billions spent on them.

Stop These 24 Crimes Against Humanity

Perhaps people in rich countries like to believe that some of their country’s wealth supports people in developing countries. They may think too much money or too little money goes to developing countries and they may approve of development aid or they may disapprove. But they are less likely to realise that rich countries extract exponentially larger amounts of wealth from developing countries than they give in aid.

So instead of arguing for more aid money or less aid money or different ways of distributing it, people who feel strongly about development could lobby their governments to consider how rich countries could reduce the extent to which they impoverish poor countries. Below, I’ve compiled a list of 24 ways this could be done. This is what I call ‘development by omission’ and it will be noticed that every item in this list represents highly unethical behaviour, perhaps even criminal behaviour.

1. Stop grabbing land in developing countries for food, resources, biofuels, etc, and return the huge tracts of land that have been grabbed during previous imperialist regimes.
2. Stop growing biofuels, which only benefit rich countries (if they benefit anyone at all) and effectively steal water, land and other resources from developing countries. Biofuels mainly use food crops, so this also drives up the prices that people in developing countries have to pay for vital goods.
3. Stop using developing countries as sources of raw materials and natural resources. Monocultures such as coffee, tea, cotton, sisal, cocoa and others keep people in developing countries in penury. They also waste land that should be used for food production.
4. Stop trying to palm off genetically modified (GM) crops on developing countries, especially under the pretext that this will make them more food secure and will solve food shortages. GM crops represent higher costs and lower profits for farmers, even in the rich countries for which they were originally developed. They also make farmers less self reliant and more vulnerable to various hazards, natural and otherwise.
5. Stop using developing countries as sources of cheap labour, especially in the growing of monoculture crops, non-food crops and crops intended for export. Export Processing Zones (EPZ) have been set up so that foreign companies can avoid meeting even minimum labour regulations, as well as avoiding paying tax.
6. Stop allowing foreign companies tax holidays and other benefits that are not available to people in the developing country in question. Tanzanian companies that wish to exploit the country's rich reserves of gold, for example, cannot compete with foreign companies.
7. Stop dumping cheap, subsidised goods, such as sugar and cotton, on developing country markets. Rich countries need to remove subsidies and allow developing countries to compete.
8. Reverse unfair trade agreements, especially bilateral agreements, that allow rich countries to extract goods and services from developing countries so cheaply that the developing countries lose out.
9. Stop aggressively recruiting skilled employees, such as doctors and nurses, which are in very short supply. Compensate adequately the countries who have lost most of their skilled employees over the years.
10. Repeal the various structural adjustment policies and similar World Bank and IMF (International Monetary Fund) strictures that reduce developing countries' ability to develop. Get rid of conditional aid, especially where those conditions are purely for the benefit of rich countries and are harmful to developing countries.
11. Change the terms and conditions for loans so that repayment does not mean that the borrowers are barely able to service the debt each year and will not be free of debt for the foreseeable future.
12. Get rid of ghost aid in its various forms. Much aid never reaches developing countries, some is a de facto subsidy for rich country products and services and some is debt cancellation or some other kind of expedient that makes it look as if aid is much higher than it really is. Get rid of purely supply led aid and interventions that are designed to benefit wealthy companies and NGOs.
13. Stop huge capital projects, such as hydroelectric dams, which cause more damage than good and usually only benefit some western companies who build the structures.
14. Where foreign companies are operating in developing countries, ensure that they pay proper wages and develop good working conditions. Also, ensure that they pay tax, at least at levels paid by people and companies from that company.
15. Stop aid programmes that simply increase dependency and do nothing to improve conditions. Also, aid that destroys local markets, such as food aid that consists of donations in kind from rich countries.
16. Stop selling unnecessary weaponry and other technologies, especially out of date technologies that are no longer of any use. Far from protecting developing countries from this kind of exploitation, many Western governments have been party to the exploitation. Also see ControlArms.org.
17. Stop setting up and supporting puppet regimes and undemocratic, corrupt governments. Stop interfering in the running of countries purely for the benefit of rich countries.
18. Stop encouraging developing countries to privatise public services and public utilities, especially where that involves those services and utilities being taken over by foreign companies.
19. Stop exporting pollution by producing the most polluting products in developing countries, for example, force growing fruit and vegetables in Kenya and flying them to Europe.
20. Stop dumping toxic waste and any other kind of wastes in developing countries, where they are unlikely to be treated responsibly. Stop dumping computers and other used goods where there is no demand for them and no capacity for processing the resulting waste.
21. Stop stealing indigenous knowledge and indigenous crops, genes and plants. Stop putting patents on things that have been stolen from developing countries.
22. Stop using developing countries as military and geopolitical pawns and pretending that this is a form of development.
23. Stop using developing countries as markets for products that are difficult or impossible to sell elsewhere. Stop forcing products on people who can't afford the consequences, such as GM crops, baby milk formula, etc.
24. Stop rich 'philanthropists' from using developing countries and their people for their experiments and their expansionist aspirations.

If rich countries stopped doing all or even some of the above, developing countries would be a lot better off. The paltry amounts of money spent on ‘aid’ would probably no longer be necessary. The number of people who live in poverty, suffer disease and other harm and who die unnecessarily as a result of rich countries’ practices of extracting wealth from developing countries could even seem like genocide. The list is by no means exhaustive.

Do Those Who Pay Lobbyists Get What They Pay For?

The International Policy Network (IPN) is almost beyond belief. The head of the organisation, Julian Morris, has an article on India's recent decision to place a moratorium on the growing of genetically modified (GM) brinjal (aubergine, egg-plant). Morris puts this decision down to their use of the 'precautionary principle', which Morris doesn't approve of. He refers to India's high rates of poverty and malnutrition, implying that their decision to reject GM brinjal (for the moment) will contribute to these problems.

For several reasons well known to Indian farmers, GM crops do not reduce poverty, far from it. For a start, GM seeds and other inputs are much more expensive than conventional ones. Secondly, the usage of these inputs goes up, steadily, the longer the crops are grown in the same place, so profits go down. Thirdly, yields go down, reducing profits even further. Fourthly, none of the other promised advantages of GM crops have materialised. GM has been an expensive waste of money, of land and of people's lives.

As for malnutrition, the previous points make it clear that GM crops are not going to have much positive impact on this. We have been promised crops with higher nutritional value but, in addition to getting less food from GM varieties, there is no nutritional benefit. According to Wikipedia, the precautionary principle "states that if an action or policy has a suspected risk of causing harm to the public or to the environment, in the absence of scientific consensus that the action or policy is not harmful, the burden of proof that it is not harmful falls on those who advocate taking the action".

What could Morris have against such a principle in relation to GM? There is more than a suspected risk of harm, of several kinds, to the public and the environment; there is little or no scientific consensus but nor has there been much scientific research; the burden of proof should lie with the proponents of GM, but they have consistently failed to do any research that could allay fears. Morris says his disagreement is that you can't prove a negative. But proponents are not being asked to prove a negative, they are being asked to carry out adequate research to show that GM crops are safe to humans, animals and the environment, economically viable, politically viable, ethical and many other things. The risks of not doing this research are too great.

The Indian minister in question, Jairam Ramesh, did not simply grab whatever expedient he found handy and place a moratorium on GM brinjal. He held a lengthy and comprehensive consultation. This is something an industry paid lobbyist who runs an institution that pretends to be an educational think tank, such as Morris, would have little understanding of. People who voted for Ramesh were asked their opinion and they said 'no', overwhelmingly. If Morris had his way, Ramesh would have paid large consultancy fees to Morris and his ilk and done what they advised, regardless of what Indian farmers and consumers wanted.

Morris goes on to fault the use of the precautionary principle by the EU to ban animal growth hormones. He sees this decision as flawed (really, read the article!). But his grasp of basic logic is as poor as his knowledge about GM organisms. He argues that water and oxygen would be banned under the EU's interpretation of the precautionary principle 'if they were classified as pesticides'. That's like saying that pedestrians would have to obey speed limits if they were classified as vehicles.

Like many interested parties who have their snouts in the GM gravy train, Morris sees any opposition to GM or any other dangerous technology as anti-science, anti-technology, rather than sensible criticism and protest against health and safety issues being decided purely on the basis of profits for multinationals. He seems to have little time for anything remotely like a scientific argument. He's not too astute politically, either. The "small but politically savvy band of opponents" in India that he refers to are none other than the Indian electorate, people who will be most directly affected by decisions about further exposures to GM risks.

The IPN website claims to have 'ideas for a free society' and to be 'bringing down barriers to enterprise and trade'. It would be more accurate to say 'this is as free as it gets, put up with it'. If I thought Morris was trying to clarify moot points, to analyse certain alternative interpretations of data, to shed light on difficult issues, I would at least defend his right to do that, even if I didn't agree with him. But there is no sense, science, logic, even political clout, behind what Morris writes. He seems to be writing utter nonsence because that's what he gets paid to do. But if the quality of his arguments are anything to go by, he doesn't get paid very much.

Deliberate GM Contamination of Kenya's Maize?

India's notorious genetically modified (GM) cotton plantations, which even Monsanto now admits are a failure, were not established after consultation or adequate research. The GM seed was introduced surreptitiously and spread far and wide and was eventually accepted on the grounds that it was too late to avoid it. Monsanto have profited considerably from this 'accident', having upped the prices for their seeds and other inputs many times over the years. One of the many failures of these GM seeds is that fertilizers and pesticides need to be used in ever increasing quantities.

Now, the pests have developed resistance, no amount of pesticide will control the problem. Yet Monsanto's solution to this is to roll out a new version of their GM cotton seed, with a new set of inputs and even higher prices. The seed has contaminated much of India's cotton growing areas and much of the country's arable land. But no amount of destruction is enough for Monsanto. They want to control what India does with its cotton and, eventually, all its other agricultural products.

I have argued elsewhere that what happened to India could also happen to other countries and whole continents. Well, it seems like someone is already trying to contaminate Kenya's staple crop, maize, with GM maize. 40,000 tonnes of GM maize was imported from South Africa earlier this year, at a time when the country had a surplus of the crop. A Kenyan company called Louis Dreyfus Ltd imported the stuff. It is sitting in Mombasa Port right now.

Questions are being raised about how this could happen and worries are being expressed about some of the possible effects of GM contamination. It is possible that some Kenyans are confused about the dangers that GM contamination poses. If this consignment were distributed and used as seed, farms directly affected would also contaminate farms around them. Maize is the most commonly grown crop here and it's grown for Kenyan consumption.

But other crops, grown for export, could also become contaminated. One of Kenya's top exports is fruit and vegetables and much of it goes to Europe. Europe has fairly strict laws about allowing the importation of GM contaminated foods. Kenya could end up exporting very little. Tea and coffee are also among its top exports but they too could end up being compromised by GM contamination. Anyone who thinks that opposition to GM foods is just anti-scientific, luddite or in any way mistaken should do some reading up on the subject.

One wonders who is behind allowing GM products to enter the country, who could profit from such a move? Has it happened before and is Kenya's maize already contaminated? And will this consignment of contaminated maize be allowed to be distributed or will it be sent back to South Africa, who have already fallen for the GM trick? I don't feel very confident about the future for some of Kenya's most important exports.

Education is Not a Prophylactic, it's a Human Right

When a school girl becomes pregnant here, she is usually excluded from school. Ostensibly, she is allowed to return to school once she has delivered but, in practice, most never return to school. She is excluded on the grounds that she is a 'bad example' to her peers. The boy or man responsible for her pregnancy, apparently, does not set such a bad example. School boys who make school girls pregnant, if identified, are not excluded. Adults who make school girls pregnant can't be excluded, but they are rarely punished. Sometimes the adults who make school girls pregnant are their teachers.

So I was surprised to hear that seven teachers, one of whom is a principal, have been interdicted for such an offence in Bomet and Chepalungu districts, Kenya. In Bomet, 37 girls have become pregnant and have dropped out of school. Whether any of the girls are underage or not is less important than the fact that the teachers have behaved inappropriately for people in their position. It is hard to believe that they have not taken advantage of their position, in addition to breaching the trust of both their pupils and the parents of the pupils.

An official in the district referred to the teachers as 'amorous', which doesn't seem to be the most appropriate term and seems to miss the seriousness of the offences. Amorousness is not a crime but sexual assault and sexual assault on a minor are. Teachers are supposed to educate their pupils to enable them to avoid things like underage sex, sexually transmitted diseases and unplanned pregnancy. The schools may be willing to allow the girls to return to school later but the damage has been done. Some may return, but they will be at a serious disadvantage as a result of their experience.

Another article suggests that education is 'crucial to lowering [HIV] prevalence' because HIV prevalence in Tanzania has dropped among those with secondary education whereas it has remained static among those with little or no education. I object to the suggestion that education is good just because it reduces the risk of HIV. Education is a human right. It is an intrinsic good, not just an instrumental good that reduces HIV prevalence.

However, the article's conclusions must be difficult to establish because primary and secondary students who become pregnant, the ones who were least likely to be using condoms (and therefore at most risk of contracting HIV and other sexually transmitted infections), are excluded from school. They are no longer in the demographic in question. But they can not be excluded from the 'little or no education' demographic. This may skew the figures, somewhat. (I don't have access to the full paper, so the authors may have allowed for this possibility).

I'm glad to hear that education officials are realising that when a girl gets pregnant, a male is involved, either a man or a boy. They are also starting to admit that some teachers are involved and are punishing the perpetrators, rather than just the victims. But education, and education for girls, in particular, still appears to be seen as something less important than education for boys. And it also appears to be seen as a way of reducing HIV prevalence, rather than a human right. Well educated boys and girls, men and women, will be able to ensure their own health and welfare, that's why it is a human right.

Genetically Modified Cotton Has Failed, Says Monsanto

Thanks for telling us after so many people have wasted their time and money and many people have even lost their lives as a result of this failure. Scientists who have not been bought off by the biotech industry have been warning against the use of these crops for years. They have been calling for proper research into what their true consequences are before imposing them on an unprepared world. But now it's too late.

What about all the people who have destroyed their land because of the industry's lies? What about the farmers who have run into such huge debts that they have found no way out but to commit suicide? If anyone knew that these crops were designed to fail, it was Monsanto and the rest of the industry. In some cases they have failed to do proper research, in other cases they have supressed the results of their research. Instead of doing the groundwork necessary, they have simply paid off powerful people to do their dirty work. Who needs salespeople when 'democratically elected' leaders will do the work at a far lower cost?

The president of the European Parliament, Jerzy Buzek, may have been bought off by Monsanto or the industry as a whole. Or maybe he's just brain dead. He has said that he is against GMO (Genetically Modified Organisms) but that they are inevitable. What could he mean by this? That the GM industry is going to do what it wants, regardless of what we insignificant members of the electorate want? That all the people who could possibly prevent GMO from being imposed on us have been bought off?

We can only speculate. Buzek goes on to say that because we can't win the battle, he is not going to fight it. He also said that Europe would lose out on 'competitivity' if we don't accept GMOs. There's a bit of overdetermination here; does he feel that we shouldn't fight something that is advantageous to us or does he feel that we shouldn't fight a battle we cannot win? He only needs to argue for one of these, not both. They could both be true but we don't know which one sways this foolish man. If you object to my calling Buzek foolish, just read the rubbish he comes out with about only genetically modified rice being able to grow in Bangladesh.

Given the evidence for Buzek's small brain, he probably has a short memory and a limited capacity for research and comprehension. But GM cotton was released in India because it had already been passed around unofficially and had already contaminated a large proportion of the cotton sector. It wasn't released after careful consideration and proper consultation (don't be silly!). I'm sure this was not as a result of anything the GM industry did, no doubt it was just an accident. But that is no reason for Europe or any other continent to make the same mistakes.

And just in case Buzek is worried about the silly rumour that the Vatican was pro-GM, that was just bunkum. The GM obsessed cardinal who was so keen on compromising the health and welfare of so many people has been replaced with what must be one of the few Catholic leaders who has a grain of sense. Cardinal Peter Turkson realises that GM crops could be used as "weapons of hunger and poverty". Not only does he realise this, but he actually considers this to be an undesirable outcome. He realises that GM will lead to the greater dependence of the weak and poor on the strong and rich, environmental degradation, higher costs and an increase in the number of food insecure and starving people in the world. Already, the number of starving people has increased steadily as the percentage of GM crops has increased.

Some commentators have wondered about why Monsanto might want to claim publicly that GM cotton has failed. They have pointed out that Monsanto has now produced a new generation of GM cotton. Monsanto knew long ago that the first generation had failed and they now want people to change to the new generation, which employs a second modified gene and requires an enlarged set of inputs in terms of pesticides and artificial fertilizers. It also requires greater expenditure on those wonderful pieces of intellectual property we used to call seeds, those things we used to be able to collect for free at the end of the growing season.

No, you don't have to back out of GM cotton just because the whole live experiment has failed, and you probably can't, anyhow. You just have to buy more expensive seeds and invest in more expensive pesticides and fertilizer. After all, you are part of this experiment. If it goes down the pan, so do you.