Gates to Unleash Destructive Agricultural Technology on Unsuspecting Tanzanians

An article in The Citizen opens with the statement: "Tanzania will not make significant gains in its endeavours to eradicate poverty through increased agricultural productivity if the doors to Genetically Modified Organisms (GMOs) are not opened." It seems he was quoting the minister of agriculture, who is a professor of some kind, but is also quite uncertain about the population of Tanzania.

The minister wishes for "more efficient use of resources, enhanced food production and higher farm incomes" and other nice things. He notes that three quarters of the working population are only contributing to 27% of the gross domestic product and says that low productivity is associated with poor agronomic practices and limited use of improved seed, fertilisers as well as lack of sustainable control of pests and diseases".

But Justin Sandefur of the Center for Global Development takes quite a different view. He criticizes the Bill Gates annual letter for what the man has to say about research that his Foundation is funding in Tanzania, probably the same research the above minister is welcoming, certainly a similar kind of research. Sandefur is entitled to have a view on this as he carried out some agricultural research funded by the Foundation in Tanzania. Perhaps I was wrong in suggesting that Gates doesn't have advisers who have the balls to stand up to him; perhaps he just doesn't listen to them.

Gates' optimism about innovation being enough to lift Tanzanian farmers out of poverty is contrasted with the fact that people leaving agriculture altogether has been the main source of poverty reduction. Sandefur finds that innovation is not very popular and most farmers don't use modern farming technologies. And as income levels in agriculture are much lower than those outside of agriculture, leaving agriculture is probably the best way of reducing poverty levels. This has been a trend for some time, apparently.

Sadly, Sandefur doesn't have much to say about the kind of technology Gates is particularly interested in, GMOs. These were not developed with lifting Tanzanians, or anyone else, out of poverty in mind. They were designed so those who controlled them would also control the people who grow them and the land and water where they are grown. Those who produce the GMOs also produce the agricultural technologies. That's what Gates is attracted by; I don't understand why he keeps mentioning poverty and the like but I assume it's a form of spin.

Sandefur also takes Gates up on his use of the terms 'population bomb' and 'global food supply shortages'. But Gates and his views on population are infamous; he thinks there are too many people in the world; especially poor people, whom he believes should have fewer children. But as his flunkies should be able to tell him, local food shortages are not due to a lack of food. It's just that poor people can't afford it, especially if it's being grown for export, by foreigners, for a big profit, on land that has been taken from small farmers.

I agree with Sandefur that there are limits to technological fixes but not that Gates should continue with what he is doing. GMOs are destructive to the food supply, to food security, to the economy and to the environment. Other Gates technological fixes, such as in health, can also be destructive. If more people leave agriculture, that may improve conditions for GMOs to take over, as they need very large amounts of land, a lot of technology and very few employees. But this doesn't improve the prospects of those leaving agriculture, nor does it address the problems of poverty and underdevelopment for Tanzanians as a whole. People who are poor and whose income is stagnating will only become less and less able to afford what they need to survive.

Gates doesn't have a plan for all those who stand to lose out under his proposed GMO technocracy, which is all Tanzanians, whether they work in agriculture or not. But non-GMO agriculture is in a far better position to increase food supply, ensure food sovereignty, improve nutrition, protect the environment and provide various advantages without compromising the current, very weak economy. The minister of agriculture may not wish to turn down Gates' philanthrophy but there's a good reason why Gates wants to do things in Tanzania and it has nothing to do with improving the lives of Tanzanians.

For more about GM and non-GM crops, see GMWatch.

What Has Gates Learned About Development Since Last Year?

Bill Gates' 'Annual Letter' always makes depressing reading. That someone so single minded about making money and controlling as much as possible [good article in the English Guardian on this issue] should understand so little about development is not as surprising  as the fact that, for all his money, he doesn't appear to be able to find advisors who have the balls to stand up to him and get him to at least fake an understanding.

Yet again, to Gates and his cronies, 'innovation' in agriculture in developing countries means wresting the little control left to small farmers out of their hands and putting it in the hands of multinationals, who can squeeze whatever blood is left in the farmers that hasn't already been squeezed out by other means. Technology, as Gates knows, is the preserve of the rich; the rich benefit from it, the poor pay for it. Genetically modified organisms (GMO) and various other technologies that impress Gates so much, and I don't believe he is unaware of this, are not designed to benefit small farmers in developing countries, nor will they ever do so.

In health, also, Gates obsesses about technologies, such as vaccines, single, headline-grabbing diseases such as polio and HIV and issues such as family planning. Yet, over and over again, research shows that it is not just technologies that allow substantial reductions in transmission of common preventable diseases, it is also things like sanitation, water and living conditions. There is no mention in his speech of sanitation and the only mention of water is in relation to GMOs. Polio, which Gates hopes to get credit for 'eradicating', is an example of a disease that will not go away just because everyone is immunized; people need access to clean water and good sanitation. That will help eradicate a whole host of diseases, not just the fashionable ones.

Gates, like a large chunk of the development industry as a whole, thinks that reducing birth rates in developing countries will magically mean that everyone has enough money and enough food. But people need a decent standard of living, gainful employment and food sovereignty. His policies of flying in technologies, whether in health or agriculture, actually increase dependency, poverty and insecurity. If lower birth rates are to occur at all, they will occur as a result of better health, a better economy, better education and the like, not the other way around. And talking of education, Gates is silent on the matter, except for education in the US.

As for HIV, the connection between this disease and enormous profits for Big Pharma is pretty obvious, even to Gates. His foundation has been instrumental in setting up a parallel health infrastructure for this, instead of trying to comprehend how existing conditions in health facilities in high prevalence countries, which are appalling, may have a lot of influence on how the virus spreads. Much of the foundation's money has gone into facilitating the sale of drugs and other technologies and much of the money has never left the US, except to go to US institutions, purpose built in high prevalence countries. Sometimes, the foundation sticks some of the few well qualified health professionals to be found in African countries into a Gates funded institution, just to make the whole thing more African. (For a good example, check out AGRA, the Alliance for a Green Revolution in Africa).

Against the above technocentricity, it's difficult to see why the man should share the HIV industry's obsession with male circumcision. But Gates does mention things like PrePex and the Shang Ring, which will make fat profits for a couple of medical device companies. He seems to think that male circumcision reduces HIV transmission by 'up to 70%', but I think even the most rabid circumcision enthusiasts wouldn't claim that; most would even concede that the up to 60% figure  claimed by the HIV industry is from carefully controlled trial conditions with carefully massaged results (though they might not use the word 'massage').

In addition to advocating male circumcision in countries where conditions in health facilities are dreadful and where there are many far higher priorities, Gates goes on to advocate technologies such as injectible hormonal contraceptives, which have also been associated with increased HIV transmission (male circumcision has been associated with higher HIV transmission in as many countries as it has with lower). Unsurprisingly, genuine improvements in health facilities are not part of the Gates Final Solution. And just to demonstrate his fragile grasp on public health, on the subject of antiretroviral drugs to reduce HIV transmission, he says "In studies where the patients used the tool as they were supposed to, the results were quite good." If people don't 'use the tool as they are supposed to', maybe the problem is with the tool.

And the letter goes on and on, with Gates demonstrating his global imperialist ambitions in every sentence, as well as his ignorance of the lives of the people who will suffer as a result. It seems like every year that passes other institutions with imperialist ambitions, such as the UN, World Bank and WTO, also align themselves with this man. Don't expect too many changes over the next year.

Gates 'New' Model of Development is the Old One, But With Higher Returns

The biggest producer of genetically modified organisms (GMO) in the world is the US, by a very long shot. The EU doesn't produce them comercially at all. So why is the number of tons of cereal per acre the same for both geographic regions? If GM is the answer, yield per acre should surely be a lot higher in the US. Of course, the figures could be rubbish, I got them from the Gates Foundation site.

The figure comes from one of Gates' sick-making speeches about Nora's goat, Tommy's piles or some happy, healthy (but African) toddler's ambitions to be prime minister. But behind the sugar coating there is, apparently, a pill; a pill to cure all of Africa's problems.

You might think that pill is GMO, but that's just one of a range of pills that have something in common: intellectual property rights have that not expired.

The strategy starts with "Innovation in seeds [which] brings small farmers new high-yield crops that can grow in a drought, survive in a flood, and resist pests and disease".

Some comments are in order. The majority of crops that have all, or even any of these advantages, are not genetically modified. So, no sugar for them. And these crops, whether GM or otherwise, are not developed, despite Gates' constant reference to them, for small farmers.

The few GM crops that have any of these advantages, none of them have all the advantages, also have some serious disadvantages, what Gates might call 'challenges'. For example, the seeds cost a lot more than conventionally bred seeds, resistance to pests gives rise to resistant pests, giving rise to further costs, etc. I say 'etc' because no commercially available GM crop has been developed with resistance to flooding or drought.

"Innovation in markets offers small farmers access to reliable customers." Now, what markets would he be talking about? The World Food Program and it's 'Purchase for Progress initiative, supported by Gates, which purchases a proportion of food aid from developing countries, or aims to. Apparently one of the Noras or Tommys quadrupled their income in one year as a result of this program.

Or perhaps Gates is talking about the US and EU markets, which subsidise some of their farmers so heavily that cotton and sugar, for example, can be grown more cheaply in the richest countries in the world than they can be in the poorest? Could the US and EU become 'reliable customers'? As things stand, the EU will cease to be customers as they don't accept any GMO contaminated foods for human consumption. So they say, anyhow.

"Innovation in agricultural techniques helps farmers increase productivity while preserving the environment – with approaches like no-till farming, rainwater harvesting, and drip irrigation." No-till farming may or may not require the use of GMOs. But rainwater harvesting and drip irrigation neither requires nor excludes them. The question is, will the Foundation require GMOs or, at least, crops that involve rich country protectionism, in the form of intellectual property rights? I'm guessing that not a lot of money will be spent on these 'challenges'.

"Innovation in foreign assistance assistance means that donors now support national plans that provide farming families with new seeds, tools, techniques and markets." So the rich countries that are making so much money screwing poor countries are going to suddenly concentrate their efforts on alleviating poverty that they have gone to so much effort to create? Keep dreaming Bill.

Following 'Purchase for Progress', there is now 'Feed the Future', of which Gates is also a keen supporter. And why wouldn't he be, with some of the top names in agriculture and food multinationals behind it?

Bill says his strategy has nothing to do with the "old aid model of donors and recipients". Actually, it has everything to do with the old aid model: it guarantees that the model of giving to people from whom you know you can extort a hell of a lot more will work far better if you also take control of the recipients' means of production. That's what's wrong with GMOs and with Gates.

Imposition of Genetically Modified Organisms Will Destroy Tanzanian Economy

A study of research articles about genetically modified organisms (GMO) finds that much research is highly influenced by commercial interests. Those funded by the industry or carried out by people connected with the industry almost always have conclusions that are in favor of further commercialization. Studies without these conflicts of interest tend not to favor further commercialization.

Of course, many 'studies' and articles don't declare their interests and it is beyond the scope of most people to figure out that much of what is available is profoundly biased. But where funding sources are declared, there is unlikely to be any close connection between the authors and the GMO industry.

A common tactic when writing about GMOs is to use some kind of scare story that has been put about by a media that sees news as a form of entertainment, rather than a source of potentially vital information. One of these scare stories is about GMOs 'saving' humanity from disaster, especially where shortages of food may be involved.

Thus, an article claims that the banana is in danger of extinction in Ecuador within ten years because of a serious disease. I believe the ten year claim has already been around for about ten years and the banana is not yet extinct. But the article says genetic engineering is the only hope. Similar remarks have been made about bananas in Uganda and about other staple crops elsewhere.

There are also claims about GMO crops giving higher yields than conventionally or organically bred crops. Often, slight increases in yields are only temporary. More frequently, higher yields are not realized in real-life situations. Agricultural inputs, including the seeds, are far more expensive. And quantities of fertilizer and pesticides required have tended to creep up until the soil and the water are seriously contaminated and resistance results in GM crops ceasing to be feasible.

Monsanto and others in the industry have been trying to sneak their sub-standard and very expensive products into developing countries for a long time, with a lot of help from their well lobbied and well paid political friends. It may sound tempting when you hear about a high yield crop that does well even when there is a drought, when the soil is poor, etc. But such magic crops don't actually exist, except in the publicity material of GMO manufacturers.

Despite the industry's lack of success in producing anything that performs better than conventionally bred seeds, 'drought resistant' corn is being approved by the US Department of Agriculture. The destructive tactic of GMO manufacturers, designed to make farmers entirely dependent on the manufacturer, is also being championed by well known philanthropist, Bill Gates, who can't resist anything where intellectual property is involved.

Considerable opposition has been raised against the imposition of GMOs on Tanzanians, who have been blasted with unfounded claims about their virtues. But it remains to be seen how successful a country like Tanzania can be in resisting something that will probably be distributed free at first. This technique, said to be favored by drug pushers, may be enough to allow GMOs a foot in the door. If that happens, it is unlikely the country will be able to reverse the process.

Tanzania is not in need of a technology that costs substantially more than other alternatives. Farmers do not need more expensive inputs, especially not inputs that need to be increased every year, or ones that increase in price every year. The country does not need its land to be taken over by foreigners or its millions of small farmers to be replaced by a handful of rich landowners.

The majority of Tanzanians live in rural areas and depend directly on agriculture for their food and their income. The imposition of GMOs would wipe out the biggest source of employment and subsistence in the country. It would also destroy the country's ability to sell their products in Europe, one of their biggest markets. The only people to profit from GMOs are those connected with pushing them; everyone else loses out.

Technology is the Preserve of the Rich

Every time I see an article talking up technology in Kenya and in Africa in general, I wonder which aspect of people's lives will be transformed. Over the last few weeks myself and my colleagues from Ribbon of Hope Self Help Group have been visiting families who never complain about having little access to technology. They have very little money and little access to loans. They are often surrounded by mud roads, living a long way from the sealed roads, which are often in bad repair. There is little or no affordable public transport.

Their children sometimes have very little food, no access to clean water or improved sanitation, decent clothing, books and other basic things that they need just to be able to attend school. If children become sick, their parents have to decide between taking them out of school and treating them or leaving them in school and hoping for the best. Hospitals are a long way off, they are expensive and they are poorly equipped and staffed.

Distance education would be great for children who had basic education. But only about three quarters of children even enroll for primary school, let alone finish. And just over 40% enroll for secondary school. Even at university or tertiary level, something few ever reach (despite some great official figures), elearning cannot replace teachers, books and indeed, access. Those who have got to university are already a small percentage of Kenyans who have not been denied any of the many things that poorer children will always be denied.

One of these idiotic sites that produces lots of puff about technology says "Kenyan Universities are increasingly turning to e-learning as tool to facilitate improved education". Will this improve education? It may be a new medium for some educational content but I'd like to see research that shows that education is in any way better for being delivered by electronic means. Computers are also in short supply and skills can be non-existent, especially among those who rarely have access to a computer.

Young children, especially in rural areas, where about 80% of Kenyans live, often don't have electricity or a private place to study, or even their own personal copy of the necessary text books. Some, especially girls, have to do chores around the house and farm when they should be studying. And many have to do work in the fields and in other jobs when the need arises. These are not technology related problems.

Technologies, I suspect, work when other infrastructures are in place. A farmer can, as these fatuous articles often claim, find out the market price of a commodity by mobile phone. But if there is no road, or if the road is impassible, or transport unaffordable, what's the point? Another claim is that medical stocks and medicines can be monitored electronically. The biggest problem in a lot of hospitals is the shortage or staff and medicines. Who is going to do the stocktaking and what stock are they going to monitor if there is not an adequate supply of drugs?

If the problems that most people experience can be relieved by various technologies, great. If everyone has access to these technologies and things in Kenya can change radically, wonderful. But if all these articles want to show is that some people use and like and even profit from technology, they are pointless articles, only useful to people who are already convinced that technology will pull everyone out of every problem them currently face. Technology will not solve problems of inequalities between rich and poor, between males and females, between rural and urban dwellers. Technology seems, at present, to be the preserve of the rich. And if their past behaviour is anything to go by, it will stay that way.

How Many Mobile Phones Does it Take to Change a Bandage?

Photo: This donkey is more likely to save lives than a mobile phone.

The media never tire of writing self-satisfied articles about how brilliant technology is and how so many things can be done now because of technological advances. No doubt, there have been remarkable advances and we can now do things that were never dreamed of a few decades or even a few years ago.

Despite this, there is an increasing number of poor and undernourished people. Most, if not all the Millennium Development Goals are going to be missed by most developing countries. People are dying of preventable and curable diseases. Yes, preventable and curable. They can be prevented and they can be cured but, for some reason, they are neither prevented nor cured.

There is a whole rash of articles on the use of mobile phones for HIV care and prevention, articles written with all the confidence you would expect of suit-wearing, job-holding academics and consultants. But all these articles appear to be based on anecdote rather than on comprehensive data. You can support adherence, send prevention and health messages, even diagnose diseases and perhaps issue prescriptions.

But that's only if there is some kind of infrastructure available. There's little point in issuing a prescription to people who can't afford the medicine or the trip to the pharmacy or where the pharmacy has run out of supplies or if there's no public transport or if there is no clean water to take pills or...etc, etc. Even where the infrastructure is in place, Kenya is not blessed with adequate numbers of trained health personnel.

I'm not running down technology, I agree mobile phones are great, as are handheld computers, laptops, mobile internet and anything else that can be dreamed up. But ultimately, people also need the basic things that the survival of the human race up till now has depended on.

That's what's missing, food, water, sanitation, basic health, basic education. Missing are the education, health and social service facilities and, more importantly, the trained, skilled and well equipped people who provide services.

All of the health care workers I've met recently have mobile phones. Notably, they are also all volunteers, with very little training. There are not too many people they can call, least of all skilled medical personnel, as they are in very short supply. And if someone calls them late at night, most of them don't even have a bicycle to get to the client. If the client needs to be moved, they might have a wheelbarrow or a cart to get the client to the nearest public transport vehicle. This is not a joke.

There is also a shortage of electricity here and a shortage of money for credit. Many handsets don't work or don't work very well because of the heat and dust or because they are cheap handsets that don't function for very long. True, people can use solar energy to charge their phones but most don't because this particular technology is too expensive.

Mobile services could even be paid for by the state. But the state doesn't provide the few pennies necessary to treat and prevent intestinal parasites that stunt the physical growth and mental development of vast numbers of children every year.

I'm sure people are very happy that we 'can' do all these marvelous things with technology but they'll be a whole lot happier if their immediate needs are attended to, whether they require technology or not.

Why are we so Averse to Basic Needs?

Further to earlier postings on this blog about mass male circumcision (MMC) as a strategy to reduce HIV transmission, a recent mathematical model shows that the use of condoms and antiretroviral therapy (ART) would have a far greater impact. The data used was for South Africa so it does not necessarily apply directly to other African countries.

The lead researcher expressed surprise at how little effect MMC would have. I have long been curious to know why anyone would think MMC would have such a profound effect. In Kenya, where there has been much talk of MMC, circumcision rates are already much higher than in South Africa, so they have even less to gain from such a strategy.

The percentage of people on ART in Kenya is also higher, as is condom use, though they are nowhere near as high as they need to be. But this paper gives a lot of support to people who are questioning the wisdom of rolling out MMC as a HIV reduction strategy for developing countries.

The results are preliminary but it is good to see the MMC orthodoxy challenged and found wanting.

Meanwhile, I have also raised questions about proposals to test everyone and treat everyone found to be HIV positive. Another piece of mathematical modelling shows that if such a strategy were to be implemented in Washington, DC (which has the highest HIV prevalence in the developed world), it would be unlikely to halt the epidemic.

Even assuming that 100% of people were tested, that they returned to be tested at regular intervals and that anyone found to be HIV positive was put on ART immediately, HIV transmission would not be reduced enough to eradicate the disease and the rate of transmission would eventually return to present levels. And these are big assumptions.

Again, these results would not be directly applicable to African countries such as Kenya. But one the main problems in Africa would be the difficulty of getting large numbers of people, not just to test, but to test regularly. There would also be the problem of getting large numbers of people on treatment and keeping them on treatment in countries that are seriously resource poor.

There is plenty of evidence to show that reasonable standards of health, education, infrastructure, water and sanitation and other social services would have a great impact on all diseases, not just HIV. People need assured livelihoods, food security and good governance. No large scale, expensive and high technology HIV intervention will have much impact until all these other issues are addressed.

Healthy People Have Needs Too

The aim to roll out antiretroviral treatment (ART) for everyone who needs it was always dogged by (usually tacit) questions about sustainability. In Uganda, for example, ART is 95% donor funded. For various reasons, much of that funding is now being reviewed or cut.

Many people who are put on ART will, sooner or later, need a course of second line drugs because of resistance to the first line drugs. This increases the cost of the drugs by 6 or even 10 times. And resistance can also develop to second line drugs.

The drugs themselves are only one cost involved in treatment but as the drug companies are getting the lion's share of HIV related money, there is little pressure for money to be spent on other treatment costs. The fact that the drugs are bought, paid for and delivered to the country in question doesn't mean that the country has the capacity to distribute them and actually treat people.

But the most unsustainable aspect of aiming for universal ART rollout is that little is being done to reduce the rate of new infections. The rate of new infections continues to exceed the number of people being put on treatment.

The trend towards putting people on ART earlier may have some impact on the rate of new infections. The idea of testing everyone and treating everyone found to be HIV positive may also have an impact. And the idea of putting everyone thought to be at risk of being exposed to HIV on ART, called pre-exposure prophylaxis or PrEP, should also reduce the rate of new infections further.

But all of these measures together will not cut HIV transmission to a sufficiently low level for the epidemic to be effectively eradicated. I know, mathematical modelling has shown that *if* around 80% of sexually active people opt for testing once a year, the epidemic could be more or less eradicated by 2050.

However, that’s a very big if. This sort of modelling has no bearing on the practicalities of how the sort of decrepit health and social service levels found in high prevalence countries will ever persuade large numbers of people to test regularly. At present, testing is between 10 and 20% of populations and that's after many years of trying to persuade people to test.

Epidemics are inherently unpredictable and we have been, consequently, fairly poor at predicting which direction the HIV epidemic will take. In the US, which hasn't lacked funding, high levels of circumcision and concentration on abstinence only education has resulted in the highest HIV prevalence in the developed world.

HIV spread rapidly in developing countries, especially among people in densely concentrated populations with low levels of education, health and social services and very high levels of gender and economic inequality. But well educated and wealthy people were, at least at one time, more at risk than poor and less well educated people.

Now, HIV is spreading in less densely populated areas and the effects of having such low levels of education, health and social services are clearly felt in that most HIV prevention efforts are failing. They are failing because, unsurprisingly, they require good education, health and social services; what a surprise!

Yes, people who are infected with HIV need to be treated, and they need a lot more than just drugs. They should be entitled to this treatment and care and that should also cut transmission considerably. But for widespread treatment to effectively cut transmission, we also need to target the people who are presently being infected with HIV and those who are at risk of being infected.

The process of identifying all infected people is too big a job to effect quickly enough to protect people who are presently uninfected. Targeting those who are presently uninfected means providing everyone with adequate health, education and social services. This means *not* spending all available money on drugs, mass male circumcision, PrEP, trying to test every sexually active person, etc, and providing people with the basics that they need just to survive.

I agree with those who are calling for more money for HIV but no amount of money will make up for the fact that people lack the most basic things. The current approach to HIV appears to assume that HIV is independent of the overall environments in which people live. HIV is not independent of each aspect of people’s day to day lives; no disease is. On the contrary, HIV is transmitted rapidly where people work and travel and behave much as they have been doing for as long as anyone can remember.

HIV transmission is reckoned to be low at the moment in Zimbabwe (although prevalence is high) because people’s day to day lives have been disrupted. The same thing is said to have happened in other countries that experienced wars and civil disturbances, such as Ethiopia and Angola. But that doesn’t mean that rates of HIV transmission will stay low in those countries.

Like all diseases, HIV is part of everyday life; it affects people who are rendered vulnerable by decades of falling public spending. A bigger chunk of the money needs to be spent on healthy people. I know that doesn’t fit in with the plans of the pharmaceutical companies and others who make a lot of money out of disease but healthy people need the means to stay healthy. If all the money is spent on drugs, healthy people will continue to suffer, as they are doing right now.

(For further discussion of PrEP, see my other blog, pre-exposureprophylaxis.blogspot.com)

Belt and Braces but no Trousers

On a number of occasions on this blog, I have expressed scepticism about technical solutions to the HIV epidemic. Such solutions include mass male circumcision (MMC), universal testing and treatment (UTT) and universal condom distribution. I am not suggesting that these technical solutions do not work, on the contrary, they are effective. But there are two major problems; no single solution is likely to work on its own and structural conditions in developing countries mean that technical solutions face serious, often insurmountable, barriers to success.

Even condom distribution requires some level of infrastructure, education and communications. MCC faces the problem of seriously scarce, under funded and understaffed health facilities. Large scale testing has been dogged by the fact that many facilities are static and centralised, whereas the majority of Kenyans live in rural areas. Recently, it was demonstrated that many people are receiving incorrect results, either false positives or false negatives. This results from lack of training and quality control and probably many other things. And treatment has had problems as a result of disruptions such as food shortages, civil disturbances and economic problems.

A recent survey carried out in Bungoma, Western Kenya, showed that even in clinical settings, around 17% of people circumcised suffered adverse effects. The figure was about double that for circumcisions carried out in traditional settings. So this would not make circumcision a tempting option for Kenyans unless a huge amount of money is spent on developing health facilities. I don't oppose circumcision as long as it is an elective operation but I don't think circumcision in traditional settings will ever be a wise option.

Testing facilities in Kenya, as well as being in short supply, are just not reaching enough people. Some Kenyan policy documents mention mobile testing units, but they don't seem to be common yet. There continues to be a problem with testing facilities being in urban and semi urban areas. This means that many will not be able to access them, for various reasons. Cost is one factor but people are also less likely to know about HIV and testing when they are isolated from what are highly centralised and relatively inaccessible services. There is also talk about door to door testing and similar methods but this has only been carried out to a limited extent so far.

Those already being treated for HIV have, in many cases, had their treatment interrupted because of post election violence in Kenya, because of ongoing civil disputes in Zimbabwe, because of an economic crisis in Botswana, because of political disputes in South Africa and because of war in Sudan. There are, doubtless, many other instances where treatment has been shown to lack sustainability and this is often a problem with technical solutions.

The history of the epidemic in Kenya shows that there were many factors in the spread of HIV, relating to health, the economy, the environment, infrastructure, labour practices, gender and many other areas. Given this, it is no wonder that a single solution will have little chance of reducing HIV transmission. Condoms will remain in warehouses or on shelves, stay unused or be used incorrectly. Drugs, too, will be unused or misused because lack of support, education or other enabling conditions.

All of these technical solutions are good and together, along with any other strategies, could see HIV decline significantly in the next few decades. But if we ignore the overall development of countries like Kenya, each solution will have little success, perhaps none. Kenya is suffering from underdevelopment, many development indicators are moving in the wrong direction. This has been going on for decades and has been obvious for decades.

Developing health, education and other social services may seem too expensive or too difficult. But this is not an optional extra, it is a prerequisite to the success of any of the currently popular technical solutions.

Water: the hi-tech and the low-tech

For many years before coming here I was employed as a consultant, working on IT projects. I'm not a computer expert but the work related to the information and data rather than the technology. The work was often interesting but many of the projects seemed to be rather pointless or to miss the point.

For example, there were too few social workers in a local authority and they had too much work to do. Therefore, a lot of mistakes were made and the people who were supposed to benefit from social work either didn't benefit or suffered adverse consequences.

Another example, people didn't have enough money to pay certain bills or they had the money but they hadn't received the services. The result was that the authority didn't get the revenue they expected, but they also didn't know that their constituents were not getting the services and that that is why they were not getting the revenue.

You might think that more social workers and better investigation services would help with both of these problems. But a number of years ago, someone must have told the UK government that all their problems would end if they were to 'e-enable' everything. All they needed was ‘e-delivery’, 'e-government', 'e-payments' and anything else that you put 'e-' before would be miraculously transformed and would never cause problems again.

Well, I accept that you can do a lot with technology but only with certain sorts of problem. And it’s just one tool, depending, like any tool, on how it is used. Now, water services in some parts of the UK are terrible, not because people can't report faults in their area using their palm top. The people who live in the worst affected areas were unlikely to have palmtops. The problem was with the infrastructure.

If technology is a solution to administration and communication problems, why is it not a solution to infrastructure problems? Some of the water infrastructure in the UK dates back more than a century and the technology goes back a lot further than that. Apparently the water companies like spending money on certain sorts of technology, it makes for great publicity. But they are not so keen on other sorts of technology. So pipes continue to leak, bills continue to go up and more and more people have problems with their water supply.

Well, there is little comparison between London and Nairobi. Indeed, there are far worse places than Nairobi, but as a densely populated city where more than half of the inhabitants live on less than 2 dollars a day, the problems here are extreme enough. The water infrastructure is not as old as that in London but it was built for a much smaller population and doesn't even extend to many of the most densely populated areas. Most of these places have no running water, no electricity and no proper roads.

Other infrastructures are similarly dilapidated and oversubscribed. There are some fortunate (and relatively posh) areas where there is always water at the turn of a tap. But there are other areas where water is an expensive commodity that requires either a lot of work, a lot of money or both. Of course, if you have the money, you can avoid the work. But if you don’t have the money, and many people don’t, then you are in big trouble.

So, I didn't know whether to laugh or be angry when I heard the Prime Minister, Raila Odinga, announcing his plans for 'e-government'. This is the PM suspected of trying to rig the last elections. Perhaps he and the President, Mwai Kibaki, who was 'e-lected' under highly suspect circumstances think that 'e-government' is one where there can be no rigging or gerrymandering? Odinga went on to talk about the many possibilities of ‘e-enabling’ and the benefits people could expect.

I don't know whether the election chaos was caused by politicians, the police, the army, civil servants (and the Electoral Commission of Kenya is certainly getting a lot of the flack), business people or other interested parties. But 'e-enabling' the election process, or any other aspect of the administration of the country, will not cut corruption, inefficiency, lack of resources, accessibility or anything else that matters.

And if people don't have water, there is no abstruse technological process that will give them access to it. The technology required is so simple that it is not even called technology. I'm not saying there are no complications, just that Nairobi is not waiting for some spoddy geek to come along and sort it all out. There is a water authority here already, with engineers and other experts. They need to be enabled, whatever that involves, not 'e-enabled'.

When people have adequate access to water, food, education and other social services, then it will be time enough for the 'benefits' of high technology. That high technology, also, can wait until the country is able to afford it. If there is not enough money to improve the water supply, nor is there enough money for technological frippery.

I'm quite sure there are Western companies falling over themselves to supply technical equipment and services, there always are. No doubt they were behind Odinga’s speech. Well, they are finding it increasingly hard to palm their innovations off on Western countries, who are just beginning to realise that they have long been hoodwinked by glossy brochures. I hope the leaders of Kenya are not swayed by promises of modernisation and technological enhancements when there are far more basic and more important things to worry about.

Finally, I hope that these leaders will not be hoodwinked into believing that privatisation will solve all their problems with public utilities and services. They only need to ask some of their neighbours about their experiences of privatisation. The word Biwater springs to mind when anyone mentions water privatisation in developing countries, but other words spring to mind too.

PS: I got completely distracted from what I wanted to talk about! There is a cheap and simple method of purifying water in areas where there is plenty of sun. It’s called the Sodis technique (Solar Water Disinfection). It costs little or nothing, it’s accessible to most people, no matter how poor, it’s sustainable and it provides many benefits. Just check out the manual!

Exposing water in clear plastic water bottles to the sun for up to six hours reduces or eliminates micro organisms because of the effects of ultraviolet radiation and the rise in temperature. In strong sunlight, where high temperatures are reached, the water can be purified in as little as one hour.

Of course, you need to be careful about certain things. Small bottles need to be used, no bigger than about two litres, the bottles need to be kept clean and when they get too scratched they need to be replaced. Also, you cannot remove chemical contamination by this method.

But it is a true empty pocket scheme in a place like Kenya, where many areas are strewn with used plastic bottles. Now that they have a value when kept clean and usable, perhaps there won’t be so many of them thrown out along with other household rubbish.

I was pleased to see an item about the Sodis technique on national television yesterday, just after I returned from a meeting about water and sanitation in Kibera. There isn’t much space in Kibera, (unless you include the well watered golf course next door) but there is enough scope to put bottles out in the sun to provide drinking water for the family. The only problem is that it is so simple, people are not very impressed with it!