Friday, 23 May 2008

The HIV/AIDS response: Co-ordinating chaos

Once again, apologies for the hiatus on the blogging front. In my defence I have been very busy and when I have been ‘relaxing’ I have found myself incapable of arranging the thoughts buzzing around inside my brain on a daily basis into anything coherent enough to post. Instead I have been drinking and singing karaoke, but I won’t bore you with that now.

Over the last month or so I have been engaging with the Global Fund (for AIDS, Tuberculosis and Malaria – GFATM for short…oh yes, another acronym). Of course I’m after their money to fund our projects (that’s my job after all) but the process of working with them has been a very interesting experience in itself.

As many of you will know, HIV/AIDS is a huge problem in Africa. Liberia is not currently in the same situation as some countries in Eastern and Southern parts of the continent where, in some cases, as many as one in three people are thought to be infected with the virus. Estimates are a bit sketchy but the general consensus seems to be that the prevalence here is somewhere in the region of 2.5%. That’s still a pretty shocking statistic and, what’s worse, an antenatal survey showed that the rate in pregnant women was closer to 5%. This is effectively a ticking bomb. If pregnant women are infected there’s a very high chance they will pass on the virus to their children and the pandemic will become even worse in generations to come.

Hopefully most people reading this know how HIV spreads so I needn’t go into details there. However, the problem is often framed purely as a health issue when in fact there’s a huge socio-economic aspect as well. People in poor countries are more likely to become infected. Why? Several simple reasons include the fact that they may never have heard of HIV; if they have they don’t know how it spreads; and if they know they may not have access to condoms.

A range of other factors often go unconsidered. HIV is heavily stigmatised and so it is very uncommon for people to reveal their status if they are HIV positive. This pushes the virus underground. Apparently 90% of people lining with HIV in Africa don’t even know they are positive. Even if they are able to go and get tested they often don’t want to simply because they are afraid of being ostracised by their families and communities if they discover the worst. The common conception is that HIV/AIDS is a death sentence since it is incurable. However, antiretroviral drugs now exist which mean that HIV positive people, assuming they have access to the right cocktail of medicines, can lead a long and relatively ordinary life.

And then there’s the whole gender aspect. HIV is often associated with homosexual men in the West. In Africa there’s actually a higher prevalence among women. There are biological reasons why women are more susceptible to the virus but again, there are also social ones. Rape was commonly used as a weapon of war during the civil conflict. Violence against women is deeply ingrained and continues even after the end of the war. The old mantra to fight AIDS used to be the ‘ABC’ approach – Abstain, Be faithful, use a Condom. You don’t need to be a rocket scientist to understand that none of these are particularly helpful to a woman who is raped. For this reason ActionAid has been campaigning to highlight the link between gender-based violence and HIV.

Unfortunately though there are even more reasons why women here may fall prey to the disease. One quite gruesome example is the practice of FGM – female genital mutilation. This is a form of initiation rite for women and girls in many tribes. I don’t know very much about it but suffice to say it involves sharp implements and delicate regions of the body and infection can be transmitted in a similar way to when drug users share needles. It’s quite horrible to think about I know. It’s also a tradition and a very taboo subject which makes it much harder to advocate against.

So what to do? How do we stop this virus from spreading? The Global Fund is a bit unique as far as donors go in that they ask for a national proposal to be submitted rather than organisations sending in their contributions individually. This has meant a lot of meetings with the various NGOs and government departments doing HIV/AIDS work here to try and reach a consensus about what we want to put in Liberia's proposal.

It actually hasn’t been that difficult to agree on what needs to be done. Health systems are weak and need to be strengthened. Infrastructure must be improved. People living with HIV/AIDS must be supported. Stigma must be reduced and myths about the virus dispelled. Drugs and testing services must be made available for free. Condoms must be distributed. People must be informed of the risks. Women must be empowered to negotiate safe sex and…the list goes on (and on). Obviously each of the organisations involved has been trying to push their own agenda (I’m no exception to that rule) but if the agenda is for a good cause then who can argue? The problem has been trying to arrange all of the ideas into a coherent package with activities that compliment one another and that will (hopefully) be accepted by the donor.

Generally speaking I think this is a very good way to do a proposal though i.e. by consulting with all of the stakeholders involved. One thing I’ve discovered since working here is that the development world is often incredibly uncoordinated. There are probably thousands of NGOs all doing very valuable work but there seems to be a near total lack of communication about exactly who’s doing what sometimes. This results in interventions being carried out on a somewhat ‘ad hoc’ basis. Small ‘islands’ of development are dotted around the country where, for example, health services are available while other areas get completely forgotten.

This general lack of coordination seems to be a recurring theme here but I suppose it’s no surprise. After all, if the government functioned properly and was sufficiently well-organised then Liberia wouldn’t be in such a mess and people like me wouldn’t be here trying to look for order in the chaos!

Tuesday, 13 May 2008

Show us your pics!

Sorry, I know I haven't updated this for ages. I have a million and one things I want to write and I will soon. However, for those of you fortunate enough to be friends with me on Facebook I am attempting to upload some pictures as I write this.

For those of you fortunate enough to not be on Facebook - the link above may work but failing that I will post here again soon!

Thursday, 10 April 2008

The tourist

Instead of trying to write a deep, insight-filled article about poverty, development or Liberian politics I thought this entry should be a bit on the lighter side. I want to appeal to a broad readership after all (and I think at last count I had almost five regular readers). So, this post will be a variation on the classic primary school essay What I Did on My Holidays. Is that broad enough for the five of you?

Last week I received a much anticipated visit from my fiancée Teresa. Since she was already coming to Africa to hold a series of meetings with the organisation she works for it seemed like a good idea for her to pop over to Liberia and see me. However since her meetings were in Mozambique, on the other side of this rather large continent, ‘popping over’ entailed a 28-hour flight via Johannesburg, Nairobi and Accra.

I had been rather un-subtly trying to dampen Teresa’s expectations before she arrived. Liberia is really not a country that is in any way geared-up for receiving tourists. There’s no tourist-infrastructure to speak of (well, there’s hardly any infrastructure period) aside from the fact that, putting it euphemistically, the lodging provided for me by my employer ‘lacks comfort’. You really don’t want to spend any longer inside it than is absolutely necessary!

Rather unsurprisingly Teresa’s luggage didn’t make it on the same flight as her. It wasn’t all bad news though. Fearing the worst she’d packed the essentials in her carry-on bag. What’s more, one of my new friends here had kindly said I could housesit for her while she was back home (thanks again Roisin!). The house in question is rather more comfortable than my place – spacious, bright, three bedrooms all with a/c, fully-equipped kitchen, TV and DVD player not to mention (almost) 24 hour electricity and running water! Oh the luxury….

So what does one do as a tourist in the glitzy and glamourous city of Monrovia? Since she had her laptop and mobile with here we made the decision that Teresa would just work from my office. This would allow us both to take ‘proper’ holiday time when I come back to visit Sweden (probably in June). Her organisation is involved with drafting disarmament legislation and since a hell of a lot of disarmament has been going on in Liberia she took the opportunity to meet with a few contacts she had. The evenings and weekends were more than enough time to see the ‘sights’.

The hardest part of being a tourist in Monrovia is transportation. The city is pretty spread out (not unlike a sprawling American city). If you’re not lucky enough to catch one of the few buses and don’t want to sit crammed in a far-from-roadworthy shared taxi you’ll need to find yourself a driver. Luckily we had Casey, a friendly Nigerian jack-of-all-trades offering, among other things, a 24-hour call-out taxi service.

To do this place justice though it only seems fair to run through some of the activities that Monrovia can offer the intrepid holidaymaker (or visiting partner of a development professional):

Beaches! We managed to make it to two different beaches on opposite sides of the city. Both are clean and pleasant and even have pretty good restaurants. The first beach (Silver Beach) to the north is calmer offering great views of the Monrovian peninsular. The second one to the south (Thinker’s Beach) backs straight onto the Atlantic so the water is rougher (probably good for surfers) and cooler.

Restaurants! Believe it or not we had some of the best sushi ever (twice) at the Royal Hotel just around the corner from where I live. Thinking about it there’s no reason why it shouldn’t be good considering all the raw materials are here – rice, fish etc. Liberia also has a large Lebanese population and so meze is pretty ubiquitous. And then there’s shellfish of course. I did warn Teresa about eating crab but she went ahead and did it anyway. They may be tasty but it’s pretty hard to break into them without one of those nut-cracker things you normally get.

Clubbing! Oh yes indeedy. Thanks to the thriving ex-pat population there is no shortage of bars and clubs in Monrovia. We enjoyed live music and dancing at the roof-top Bamboo Bar (which affords the visitor an open-air panoramic view over the city centre), cheesy tunes at the ex-pat stronghold New Jacks (complete with beachside bonfire) not to mention the Garden Café, another favourite for live music with an unusually high proportion of female revellers (I’ll leave you to read between the lines there).

Relaxing by the pool? I’m not joking actually. Another new friend of mine (cheers Liam) lives in a compound containing mostly UN staff as well as the biggest swimming pool I’ve seen in Monrovia (I’ve seen three for the record).

So it wasn’t all work-work-work. Before she left we even visited my place for a spot of interior decoration to brighten the place up. It’s still a hole but a slightly more colourful one now, with batiks and photos hanging on the wall. And now the rainy season is creeping up (it officially starts on 15th April - why isn’t everything in Liberia that well planned?) I could be spending a lot more time indoors.

Thursday, 20 March 2008

Poverty eradication versus conservation

Last week was both the most taxing and the most interesting since I arrived here in Liberia. A pilot project that ActionAid is implementing for Conservation International was to be reviewed together with a representative from the United States Agency for International Development, the project financiers. Operating under the rather American-sounding title ‘Civilian Conservation Corps’, the project aims to engage with communities living around Sapo National Park in the remote southeast of the country. The objective is to provide incentives for communities in return for their contribution to conservation activities and the enforcement of park protection.

Established as Liberia’s first protected area in 1983, Sapo is a biodiversity hotspot and an important part of the Upper Guinea Forest Ecosystem. Some parts of the forest are thought never to have been entered by humans and the park is home to several rare species, some of which are endemic to the area. Sapo made international news headlines last week when the elusive Pygmy Hippo, once thought to be extinct, was captured on camera by a team from the Royal Zoological Society.

I could tell that tensions were running slightly above their normal levels among my colleagues in the office. The pressure was on to prove to the donor that the project was producing tangible results. This was going to be a challenge given the subtle nature of the intervention. What’s more, the communities are more or less cut off from the rest of the country due to the near total lack of infrastructure. The word ‘road’ is far too generous a term to describe what we drove over to get out there! The journey took the best part of two days. To put this into context, Liberia is roughly one third the size of the UK. We passed numerous vehicles that were stuck and some of the passengers had been waiting by the roadside for several days.

Faced with this isolation people living in the area are forced to engage in illicit activities which undermine the conservation of the park. The area is rich in wildlife and hunting for ‘bush meat’ is rife. The problem is that much of what is caught is endangered. At one stop your correspondent was offered some smoked Colobus Monkey. Identification of the species was made possible by the fact that the arms and hands were still attached! Another activity taking place on a significant scale is mining, mostly for diamonds and gold, and several illegal mining settlements have grown up within the park boundaries. Some are apparently better-equipped than the permanent communities outside the park, with generators and even video stores! The most curious thing about them however is their names: Baghdad, Afghanistan and America. Are these supposed to be ironic in some way?

So how do you go about convincing the locals to stop killing the cute, fluffy animals and prevent miners from entering the park to dig up their habitat? Conservation organisations have traditionally lobbied for the establishment of protected areas and official systems to enforce them. However, the Liberian government simply doesn’t have the resources to effectively police Sapo and the incentives for local communities to undermine park protection are huge considering the lack of alternatives they have. Some of the communities even claim that parts of their traditional forest were ‘grabbed’ by the authorities when the park was established without any form of consultation or compensation. This approach is clearly unfair as well as unsustainable. ActionAid’s strategy on the other hand has been to try and rather innovatively marry poverty eradication with conservation.

The first step in the process is to conduct what we in the business call a Participatory Vulnerability Analysis. In layman’s terms this amounts to sitting down with the communities and discussing why it is that they engage in illicit activities. During the process an attempt is also made to raise their awareness of conservation issues and the value of keeping the park intact. The next step is to get communities to come up with a plan for what they need in order to find alternative means of sustaining themselves. Some of the ideas so far include micro-loan schemes, agricultural activities and road rehabilitation projects. Once communities have been given the chance to take up alternative livelihoods the hope is that they will stop poaching the wildlife. Since most of the illegal miners come from outside the area and the only way for them to enter the park is through the villages in which we are working, it is also envisaged that volunteer watch teams will be set up to address this.

As always, the reality is much less simple. It will be difficult to achieve these goals unless there is long-term engagement in the area. One issue that came up during the review meetings was eco-tourism. This has the potential to be an enormously lucrative enterprise for the Sapo region in the future but the area is currently far from ready to receive environmentally-sensitive holidaymakers. With this in mind, it would be interesting to look at Costa Rica’s development strategy to see how this could be applied in the Liberian context. There are many parallels with the situation here – a volatile region prone to civil conflicts, marginalised local communities, a lack of infrastructure especially roads – but despite this Costa Rica has managed to keep a very high proportion of its land mass protected and is now reaping the economic benefits of an influx of tourists.

Encouragingly, the locals we met did seem to be aware of the reasons why the park was protected and one village had already formed its own watch group. The key to success will be to agree on suitable alternative livelihoods. One suggestion the communities made was to provide support for rubber plantations. However, this may also undermine park conservation due to the amount of forest that would need to be cleared, aside from the fact that it takes seven years before rubber tapping can start.

Most importantly for the continuation of the project was the fact that the donor representative seemed to be largely happy with what he saw. For my part, the trip was exciting but exhausting and it’s good to be back. Monrovia almost feels comfortable compared to some of the places I stayed during the visit!

Oh and in case you’re wondering, I didn’t see a Pygmy Hippo, not even on a barbecue.

Sunday, 16 March 2008

Pandora’s Box

While visiting the toilet at a restaurant in the northern town of Ganta yesterday I observed something which set my mind spinning. It wasn’t the rust-coloured pools of water, the extensive array of insect life or the generally unpleasant smell. Nor was it the fact that there was no lock on the door or, despite getting a lot of practice in, that I still haven’t mastered the art of flushing with a bucket.

Fastened to the wall above the sink was a wooden box. The box was adorned with the logos of various development agencies below which was written “Free condoms. Practice safer sex. Help yourself.”

My initial reaction was one of pleasant surprise. Sub-Saharan Africa has the worst rates of HIV/AIDS of anywhere on the planet. I believe the figure in Liberia is somewhere in the region of 2.5% (although I’m not sure a very thorough survey has been conducted). A lack of access to condoms is one of many factors that have caused HIV to spread with such relentless fervour. In a country where the majority of the population can barely afford to eat every day it would seem like a good idea to give away protection for free.

The box, however, was empty. I later saw an identical one in my hotel bathroom which was in a similarly unfortunate predicament. That’s the problem with uncontrolled freebies. They tend to run out pretty fast and, more often than not, there’s no system to replace them. The same is often said of international aid in general. For the moment let’s leave aside the debate about whose fault it is that certain countries find themselves in such an incredibly tragic state and what moral obligation the richer world may or may not have to help them. What happens when all of us ‘do-gooders’ bugger off back home? Who will ensure that any progress made is sustained in the long-term? In short, who’s going to fill that box back up again and again?

Liberia is enjoying something of a honeymoon period at the moment, at least in comparison to its recent past. Foreign aid is pouring in from all corners of the globe, debt is being written off, 15,000 UN troops are keeping the peace and the main roads into most towns are like Las Vegas-style strips of brightly-painted NGO signs. But it won’t be like this forever. The UN is already starting to pull out and at some point in time emergencies in other parts of the world will force NGOs to focus their resources elsewhere too.

So what’s the answer? Returning once again to our box, an orthodox capitalist might retort that if you charged for the condoms they would be used rationally, rather than being plundered by the first person to find them. What’s more, when they ran out there would be an incentive to replace them because someone could make a profit from doing so. This is all true but is pretty much a moot point. There probably wouldn’t be a need to replace them at all. Nobody in Ganta would be able to pay for them and the sexual act would simply continue unprotected. In the same way, Liberia does not have the money to pay for its own rehabilitation. Without the foreign assistance it is currently receiving there is a high risk that it would simply slide back into civil war.

Instead of leaving the condoms in the box to dispense themselves, and in the absence of a means to pay, it is necessary to develop a strategy to ensure their availability is sustained. Perhaps a locally-staffed clinic or volunteer group could be set up to hand out the condoms together with information on how HIV spreads. This would of course require a sustainable source of funding so it’s important that people don’t come to depend on NGOs to provide such services. The local population must be made to realise that it is their government who is ultimately responsible for their welfare and to whom demands must be directed.

There’s a general tendency in developing countries to accept the sub-standard simply because it has become the norm. I often feel like a whingeing, spoiled foreigner when, for example, I complain that something in my room needs to be fixed. However, if you look at it another way you could say that the act of demanding that my expectations be met will in turn lead to a better provision of services (in this case from my landlord) for future tenants. You could say I'm whingeing for my rights!

Of course it’s not that simple on the national level in reality. People can demand all they like but without the UN and NGOs providing a large proportion of the country’s basic services it would be impossible for the Liberian government to cope with current needs. I am merely raising this point because I think it serves to illustrate the necessity of a rights-based approach to development. When people are made aware of their rights and know who to hold accountable for ensuring their protection there is a much better chance that those rights will be enjoyed in the post-assistance era. After all, there’s no point helping a country rebuild itself if it simply falls apart again when the international community pulls out.

It’s amazing the train of thought that can stem from a visit to the loo.