Comments needed on WHO business plan
Please read the article below for initial comments made by ICW East Africa trustee, Dorothy Onyango and ICW chair Alice Welbourn to WHO at a meeting in Geneva, where WHO launched its draft business plan. We welcome all ICW members' additional comments on this WHO business plan, so that we can forward them to WHO HQ.
Below are initial comments made by ICW East Africa trustee, Dorothy Onyango and ICW chair Alice Welbourn to WHO at a meeting in Geneva, where WHO launched its draft business plan. We welcome all ICW members' additional comments on this WHO business plan, so that we can forward them also to WHO HQ. Please send comments to: info@icw.org or registered users may comment this article.
17th May 2004
ICW: Initial responses to the WHO 3x5 draft business plan:
1) Thank you to WHO for sharing this with us and for starting to engage in
a consultation process. Thank you also for starting to take on board a
number of the issues which we have raised
2) However, as usual the devil is in the detail! As you know, ICW has been
asked by UNAIDS to act as the convening agency for the access to treatment
arm of the Global Coalition on Women and AIDS, of which WHO is a member.
Therefore we request WHO to incorporate the following issues into your
business plan, on the basis of ICW members' own background and experience
of these issues around the world. First and foremost we would like to
propose to WHO that the UN should lead by example:
a) EMPLOY HIV positive people and RETAIN and support your HIV positive
staff, many of whom fear that they may lose their jobs if they are known
to be HIV positive.
b) Develop HIV awareness training progammes from top to bottom of the
organisation, to ensure that ALL staff members and their partners are
aware of how HIV can affect us all
c) Ensure that the UN has an effective and operative workplace policy,
which ensures access to ARVs and OI drugs for all staff and dependents,
and includes health insurance provision for all staff etc.
3) Many of our members experience very judgmental attitudes from health
workers (many of whom are overworked, underpaid, female, worried about
their own HIV status because of their own family situations). Until
attitudes of health workers change, our members are very unlikely to want
to seek ARVs from health centres. Moreover, only a limited group of women
attend ante-natal clinicis at a certain point of their lives: older women,
younger women and girls and women who are not having children are not
reached. And many pregnant women may not need to go on long term ARVs yet,
once they have given birth. Because of these issues of lack of
confidentiality, trust and access, we request WHO to ensure that HIV
positive women ourselves can be trained as lay ARV and OI treatment
providers, so that we can be licensed to distribute these drugs and
correct info about them through our own self-help networks.
4) Monitoring and evaluation of who is accessing ARVs should include a
breakdown by at least gender, age, rural or urban location, and
socio-economic status. Participatory and interactive M+E approaches should
be used to complement more formal methods, to ensure maximum participation
of positive people's networks in their own monitoring of who is accessing
treatment and in monitoring the effects of the treatment on their health
(eg monitoring supply problems, compliance problems, side-effects,
resistance build-up etc.)
5) The numbers of women affected in some parts of Africa are as much of
60% of all infections. Therefore in some cases, access to treatment by at
least 50% of women may not be enough. This needs to monitored carefully on
a country by country basis.
6) "Community" involvement - WHO should ensure that this means involvement
of positive men's AND women's networks at global policy level AND at
national policy level, as well as at district and local policy and
implementation levels.
7) Whilst first line drugs are rolled out in the first countries, WHO
needs to ensure that 2nd line drugs are in place for those for whom 1st
line drugs do not work. On-going research is needed to develop these
drugs, together with vaccine and microbicide trials. ALL trials should be
GENDER and GENERATION specific - is should recognise that drugs and
vaccines for women and for children may need to be of a different dosage
and may have different side-effects - and researchers should no longer
assume that one size fits all.
8) WHO should ensure that all staff deployed by WHO to roll out 3x5 should
be aware of and take account of all these social, economical and
physiological gender and generation issues in their policy and
implementation work. Moreover drugs alone are not the answer: all staff
should also be aware that alongside the roll out of drugs, there is still
an on-going need for good nutrition and for psycho-social support, often
best carried out by positive people's networks and their carers. This work
needs continued and on-going financing.
9) The current business plan does not adequately address the parallel and
complementary roles played by the private sector, the NGO sector and FBOs.
No doubt representatives of these organisations will speak for themselves
however.
10) Last but not least, now that the Canadian government has pledged $100
million US to the 3x5 funds there remains $70 million US uncovered. We
call upon other donors to come forward and follow the lead that the UK and
Canadian governments have made in funding this important initiative.
Below are initial comments made by ICW East Africa trustee, Dorothy Onyango and ICW chair Alice Welbourn to WHO at a meeting in Geneva, where WHO launched its draft business plan. We welcome all ICW members' additional comments on this WHO business plan, so that we can forward them also to WHO HQ. Please send comments to: info@icw.org or registered users may comment this article.
17th May 2004
ICW: Initial responses to the WHO 3x5 draft business plan:
1) Thank you to WHO for sharing this with us and for starting to engage in
a consultation process. Thank you also for starting to take on board a
number of the issues which we have raised
2) However, as usual the devil is in the detail! As you know, ICW has been
asked by UNAIDS to act as the convening agency for the access to treatment
arm of the Global Coalition on Women and AIDS, of which WHO is a member.
Therefore we request WHO to incorporate the following issues into your
business plan, on the basis of ICW members' own background and experience
of these issues around the world. First and foremost we would like to
propose to WHO that the UN should lead by example:
a) EMPLOY HIV positive people and RETAIN and support your HIV positive
staff, many of whom fear that they may lose their jobs if they are known
to be HIV positive.
b) Develop HIV awareness training progammes from top to bottom of the
organisation, to ensure that ALL staff members and their partners are
aware of how HIV can affect us all
c) Ensure that the UN has an effective and operative workplace policy,
which ensures access to ARVs and OI drugs for all staff and dependents,
and includes health insurance provision for all staff etc.
3) Many of our members experience very judgmental attitudes from health
workers (many of whom are overworked, underpaid, female, worried about
their own HIV status because of their own family situations). Until
attitudes of health workers change, our members are very unlikely to want
to seek ARVs from health centres. Moreover, only a limited group of women
attend ante-natal clinicis at a certain point of their lives: older women,
younger women and girls and women who are not having children are not
reached. And many pregnant women may not need to go on long term ARVs yet,
once they have given birth. Because of these issues of lack of
confidentiality, trust and access, we request WHO to ensure that HIV
positive women ourselves can be trained as lay ARV and OI treatment
providers, so that we can be licensed to distribute these drugs and
correct info about them through our own self-help networks.
4) Monitoring and evaluation of who is accessing ARVs should include a
breakdown by at least gender, age, rural or urban location, and
socio-economic status. Participatory and interactive M+E approaches should
be used to complement more formal methods, to ensure maximum participation
of positive people's networks in their own monitoring of who is accessing
treatment and in monitoring the effects of the treatment on their health
(eg monitoring supply problems, compliance problems, side-effects,
resistance build-up etc.)
5) The numbers of women affected in some parts of Africa are as much of
60% of all infections. Therefore in some cases, access to treatment by at
least 50% of women may not be enough. This needs to monitored carefully on
a country by country basis.
6) "Community" involvement - WHO should ensure that this means involvement
of positive men's AND women's networks at global policy level AND at
national policy level, as well as at district and local policy and
implementation levels.
7) Whilst first line drugs are rolled out in the first countries, WHO
needs to ensure that 2nd line drugs are in place for those for whom 1st
line drugs do not work. On-going research is needed to develop these
drugs, together with vaccine and microbicide trials. ALL trials should be
GENDER and GENERATION specific - is should recognise that drugs and
vaccines for women and for children may need to be of a different dosage
and may have different side-effects - and researchers should no longer
assume that one size fits all.
8) WHO should ensure that all staff deployed by WHO to roll out 3x5 should
be aware of and take account of all these social, economical and
physiological gender and generation issues in their policy and
implementation work. Moreover drugs alone are not the answer: all staff
should also be aware that alongside the roll out of drugs, there is still
an on-going need for good nutrition and for psycho-social support, often
best carried out by positive people's networks and their carers. This work
needs continued and on-going financing.
9) The current business plan does not adequately address the parallel and
complementary roles played by the private sector, the NGO sector and FBOs.
No doubt representatives of these organisations will speak for themselves
however.
10) Last but not least, now that the Canadian government has pledged $100
million US to the 3x5 funds there remains $70 million US uncovered. We
call upon other donors to come forward and follow the lead that the UK and
Canadian governments have made in funding this important initiative.