In pre-Internet times, peer-reviewed journals were the best way to disseminate research to a broad audience. Even today, editors and reviewers cherry-pick papers deemed the revelatoriest and dispatch them to interested subscribers worldwide. The process is cumbersome and expensive, but it has allowed experts to keep track of the most prominent developments in their respective fields.

The Intellectual Network for the South (INSouth) is now launched in the public domain. A pre-launch was done by H.E Mr. Benjamin W. Mkapa during the last meeting of the South Intellectual Platform project on 8th August 2008 attended by almost 60 delegates from various Missions of developing countries to the UN in Geneva. The Network brings together intellectuals from the global South amongst policymakers, research and academia, the media, the private sector and civil society.

The Kenyan Equity Bank, One of the world’s first cellphone-to-cellphone cash-transfer systems, intends to expand its activities to southern Sudan by the end of the year. The system, called M-PESA, allows customers to transfer cash via their mobile phone, through an agent or store which supplies the cash. To send cash, a customer has to buy E-money which is then loaded on to his account and then he can send to a recipient who receives a text message with a code telling him to go and collect money from an agent within his proximity.

The International Institute for Environment and Development (IIED) is pleased to announce that we are recruiting for the post of Senior Researcher in Forestry and Land Use.We are looking for an inspiring forestry leader to develop and manage a programme of research and partnership building to improve the sustainability and local livelihood benefits of forestry. If you believe that forestry involves multiple goods, services and stakeholders and that locally-owned decision-making and international support are vital to improve forest investment and stakeholders empowerment, by joining the team you will be able to directly influence the setting up of a global forest partnership initiative.

Gender equality and advancement of women is addressed by the Commission on the Status of Women of ECOSOC, and dozens of other governmental and non-governmental organizations. Nevertheless, disparities continue worldwide, from the glass-ceiling in the nations claiming equality principles, to more stringent issues as unequal access to education, health care and decisionmaking positions in many cultures and world regions. This study is designed to collect judgments about the answers to a list of questions.

Archived, online coverage of the XVII International AIDS Conference (AIDS
2008) is now available from kaisernetwork.org, the official webcaster of AIDS
2008.

The distorted world trade regime is an obstacle to development, the leader of the Seychelles told the General Assembly, calling for increased justice and fairness to recognize the specific needs of small island nations. “We should abandon ‘solutions’ which continue to enrich the rich and impoverish the poor and the vulnerable,” President James Alix Michel told the body’s annual high-level event.

Open source software (OSS) has now become a well recognised and utilised brand. A brand that, if we were to get a broad sweeping perception poll on, would generally stand for free, fair and cost effective. However, despite this growth, the battle between open source and traditional software still rages on whereby the pros and cons for each can be endlessly debated.

For the last two months, investors at the Nairobi Stock Exchange (NSE) have watched in horror as the market dropped to a three years low. The NSE 20 shares index, which is used to gauge the general performance of the market, dipped to a 4,000 low from about 5,400 in mid July (a 26% decline).

Over a billion people will continue to face desperate poverty and starvation in 2015 as a result of governments’ failure to crack down on corporate abuses and eradicate global poverty. This warning came today from global justice charity War on Want as British prime minister Gordon Brown joined other international leaders at the UN summit in New York on the anti-poverty Millennium Development Goals.

In China, an estimated 13,000 children have fallen ill since the tainted milk scandal broke. Chinese influence has grown in Africa, as have imports of all kinds products, from running shoes to instant noodles. Bloggers as far afield as Congo and Senegal, concerned about the safety of Chinese products in their countries, are closely following the story.

One month before it will appear before a federal jury in the landmark human rights case, Bowoto v. Chevron, facing charges of torture and wrongful death, Chevron, along with other leading extractive industry companies, will come under the scrutiny of the U.S. Senate’s Subcommittee on Human Rights and the Law. In the hearing, “Extracting Natural Resources: Corporate Responsibility and the Rule of Law,” witnesses will bring to light oil, mining and gas companies’ complicity in human rights abuses perpetrated by public or private security forces in Nigeria, Burma, the Democratic Republic of Congo, and Indonesia.

Things have come a long way since 1973. For a start, many of us now have mobile phones, the most rapidly adopted technology in history. In what amounts to little more than the blink of an eye, mobiles have given us a glimpse of their potential to help us solve some of the most pressing problems of our time. With evidence mounting, Ken Banks asks one question: If mobiles truly are as revolutionary and empowering as they appear to be – particularly in the lives of some of the poorest members of society – then do we have a moral duty, in the ICT for Development (ICT4D) community at least, to see that they fulfill that potential?

Citi and Ashoka's Changemakers are leading the way to unearth the the best solutions to make financial opportunity a possibility for all. The advent of new financing methods - from mobile banking to peer-to-peer lending - are changing the way we access, spend and save our money. "Banking on Social Change: Seeking Financial Solutions for All" aims to unearth the most innovative and cutting-edge methods that allow financial security to become a reality for everyone. The deadline is just days away on October 1st!

With progress towards quality primary health care still slow some thirty years after Alma-Ata, Anthony Seddoh writes that an effective global alliance of global and country actors needs to set positive and realistic paths to implement the declaration’s intentions. In light of the continuing absence of a conceptual framework for addressing longstanding debates and organisational issues, the author considers whether primary health care represents a global orphan in need of fresh guardianship.

Thirty years after the 1978 Declaration of Alma-Ata, it seems the world is still at odds on how best to implement the principles of primary health care. The slow progress in improving health outcomes for all raises questions about the effectiveness of current ways of doing business. A concerted global alliance of global and country actors needs to set positive and realistic paths to implement the intentions of Alma-Ata.

Sixty years ago, the World Health Organization (WHO) stated in its constitution that health is ‘a state of physical, mental and social wellbeing, not only the absence of disease or infirmity.’ Thirty years later, the Alma-Ata declaration on Primary Health Care (PHC) declared among other things that ‘health is a fundamental right’ and created a thirteen-point outline to ensure this right. This outline captured concepts of essential care, universally accessibility and affordability for individuals and families within communities, who would be able to participate fully in a spirit of self-determination. It located PHC as an integral part of a country’s health system involving all related sectors and aspects of national and community development.

The WHO constitution’s definition of health and the Alma-Ata declaration together prompt a diametrical but complementary state to be addressed concurrently in the promotion of good health. The first deals with the clinical determinants of health, pushing for the absence of disease in individuals. The second addresses the determinants of health that predispose or prevent individuals from attaining a state of mental, physical and social wellbeing as a fundamental right. These include appropriate governance, the absence of war, economic and infrastructure development, adequate infrastructure and aid policies. A unique moment occurred in 1978 to bring these complementary understandings together.

Even before the ink could dry on the Alma-Ata declarations it had however already generated polarised antagonism. From a capitalist standpoint, it was a ridiculous proposition, both too costly and defying economic reasoning, and too socialist in its excessive emphasis on state-managed intervention. The conservative duo of J.A. Walsh and K.S. Warren launched the Selective PHC debate, arguing that it would probably more be efficient to save children and limit population growth, while the two main PHC proponents, WHO and UNICEF, soon drifted apart, with UNICEF promoting a selective package of low cost interventions. With resource flows following Selective PHC, Primary Health Care translated in most countries into a basic collection of services to be delivered at district and community levels based on a select number of interventions with some outreach services, with an accompanying watered-down district health package.

Why nobody asked at the time whether there was any moral significance to be attached to a person’s life or pointed out that choices based on state preferences for total health gain can be justified over financial resource allocation efficiency is difficult to comprehend. Aside from efficiency-based arguments being ridiculous propositions founded on utility-based preferences or embodying unattractive equity assumptions, the economic bargain in a healthy population should at least have also appealed to responsible international choice.

Much has since been achieved from the advance in technology in dealing with specific clinical determinants of specific diseases. It could be argued that a saturation point has been reached, where increases in financial and human investments in existing technologies are yielding less than proportional gains. Despite this the selective interventions approach continues to define health and health services delivery. It was given a new lease on life by the World Bank through its 1993 World Development Report, entitled ‘Investing in Health’. This report, which scarcely acknowledged PHC, commoditised and de-linked health from development and moved the world closer to an interventionist approach to health; intervening at a selective point in the epidemiology of a disease or health system.

This approach has since had wide global appeal. Currently there are over thirty WHO resolutions on AIDS, TB or Malaria alone; more than all other subjects. The Millennium Development Goals (MDGs) have further entrenched this disease-specific approach to resource mobilisation. There are over 80 major global health initiatives linked to the health MDGs, providing over US$100 million annually. The Italian Global Health Watch reported in 2008 that the Global Fund has allocated approximately US$3.5 billion to countries for interventions on AIDS, TB and Malaria, mainly in Africa. Together, these initiatives have thrown billions of dollars at addressing diseases and improving clinical health conditions and made up a significant part of health sector budgets.

PHC is hardly mentioned in these initiatives, seldom highlighted by member states outside of anniversaries of the initiatives or occasional references to district health system strengthening. For various reasons the world assumed an emergency mode to address what are considered new and urgent public health issues. Single disease interventions that lend themselves to easily recognisable financial accountability, quantitative monitoring and evaluation held greater appeal for funders, especially when twinned with arguments of weak domestic governance and public policy failures and capacity limitations.

While these initiatives on clinical determinants hummed with measurable outcomes on specific diseases, the nexus of poverty and ill health was exacerbated. On the back of a growing trend in urban slum development, decline in state services, market failures in privatised economies, growing food insecurity and massive deprivation of rights to health care, inequalities in health have deepened to a significantly greater level over the past 30 years.

Hence while a lot has been done to deal with disease in individuals, the unique opportunity provided by the Alma-Ata Declaration to also address the determinants of health have largely been lost. Thirty years later we see the costs of this omission in levels of poverty which belie the levels of knowledge and technological advance achieved globally.

As we approach another anniversary for PHC expectations are high. People expect that their physical and mental health will be promoted in a safe social, economic and political environment. They expect to have quality health systems that provide preventive services, and which diagnose, treat and manage disease injury and reduce the severity and repeated occurrence of disease. They do not expect to see wide social and economic disparities in these basic entitlements. In Africa, the region furthest from delivery on these expectations, the Ouagadougou declaration on Primary Health Care issued on April 30 2008 called for a renewal of the Principles of Primary Health Care and its implementation in developing countries and by the international community.

Such declarations are encouraging, yet their implementation calls for resolution of longstanding debates of the past 30 years. These debates are not academic. In choices made over policy measures, relative allocation of institutional, social and financial resources and complementary systems for dealing with the social determinants of health (mostly dealt with by actions outside the health sector), they present social and economic inequalities that arise due to the burden of disease (mostly dealt with within the health sector). There are no clear answers for how a conceptual framework of Primary Health Care in 2008 will address this.

And while there is a massive coalition of global initiatives dealing with diseases, there is no clear coalition of global institutions supporting or funding the determinants of health, the second factor in the PHC equation. At a global level, the Bretton Woods institutions and OECD initiatives for debt relief and poverty reduction have in some African countries led to short-lived increases in spending on health and education, with no global initiatives so far adequately addressing the determinants of health.

This leaves PHC as an orphan with no global guardian. The WHO’s attempt to foster PHC is inadequate given the pluralistic global environment. The state of poverty and the winds of change in international health resource priorities will make rational choices among the various dimensions impossible and predispose countries to the dictate of new interventions and their implementation. While debates over the conceptual understanding of PHC will not end in 2008, this year could at least mark the turning point for a new institutional response, one that builds a global alliance to generate the momentum and support for countries to implement PHC and that provide policy learning based on practice from the bottom up, reminiscent of another basis for the Alma-Ata declaration.

A WHO or UN resolution creating such a global alliance would be a befitting PHC birthday gift for the millions of people seeking more than another conference. It will squarely put implementation right at the doorstep of a recognisable entity that can mobilise the needed funds and offer effective support to individual countries.

World Health Organization Africa region inter-country support team, Harare, Zimbabwe

* Please send comments to or comment online at http://www.pambazuka.org/

Nigeria has accounted for 10% of the 5.2 million global maternal deaths, research finding released by the United States Agency for International Development (USAID) showed.The report showed that 52,000 Nigerian women die of pregnancy-related complicated annually.

An analysis by Global Fund Observer published this week shows that just under half of the countries eligible to apply to the Global Fund to Fight AIDS, TB and Malaria are providing antiretroviral therapy to less than 25% of those who need it, or still have more than 25,000 in need of treatment despite higher levels of coverage.

The United Nations Children’s Fund (UNICEF) is scaling up existing emergency programmes in eastern Democratic Republic of the Congo (DRC), where increased fighting has forced over 100,000 people to flee their homes, social services to close, and humanitarian organizations to suspend aid.

Five brave and selfless advocates of human rights from Burma, Congo, Saudi Arabia, Sri Lanka and Uzbekistan have been awarded the prestigious 2008 Human Rights Defender Awards, Human Rights Watch has said. All five have been persecuted and threatened for their work. One winner, Saudi lawyer Abd al-Rahman al-Lahim, is under a travel ban, which Human Rights Watch urges the Saudi government lift so that he may receive his award in person in London.

The international cotton trade has been a sad tale for West African countries. The region produces five percent of the world’s cotton and 15 percent of the global cotton fibre trade. Yet West African cotton farmers are among the poorest in the world. Their purchasing power is only five percent that of farmers in Europe, the U.S. and Japan. Purchasing power refers to the value of goods (cotton) compared to the amount of money paid.