The oil-rich seed of a poisonous shrub that thrives in arid climates with poor soil lies at the heart of plans by Kenya to reduce its dependence on imported fossil fuels without threatening food security.

“We are definitely focusing on the jatropha plant for oil production,” Faith Odongo of the Ministry of Energy told IRIN.

In May 2008, the ministry unveiled a five-year strategy to develop the bio-diesel industry to “enable more Kenyans to enjoy and derive comfort from the supply of bio-diesel for agricultural production, employment creation, rural-urban balance and blending in the motor vehicle industry”.

The strategy includes detailed proposals for the cultivation of the jatropha curcas shrub as well as the processing of its seeds, also known as Barbados nuts or Physic nuts, and the distribution of the resulting bio-diesel for transport and power generation.

Odongo said the key objectives of the government strategy included the diversification of rural energy sources by promoting the replacement of kerosene -commonly used for domestic use - by bio-diesel.

She said the outlook was “positive” and that pilot cultivation projects in various parts of the country had been encouraging. “Research trials in Mpeketoni, Lamu [a coastal town] where there is no power [have shown] people using the little oil they got from the seeds to light their lamps.”

Odongo said the oil extracted from the seeds could be used in community managed bio-diesel electricity generators.

The government predicts that as a result of biofuel development, by 2012, Kenya’s imports of diesel will have fallen by five percent and the proportion of Kenyans who use kerosene for lighting will have dropped from three-quarters to half of the total population.

Cultivation of jatropha in arid areas brings another benefit, according to the strategy paper – the improvement of the existing forest cover would help counter “the effect of deforestation and degradation as well as serving as carbon sink”.

The strategy adds: “The use of marginal land ensures that the high potential areas are not converted to energy production areas and therefore it guards against competition between biofuels and food production.”

Setting up the Kenya Biodiesel Association, which brings together all the stakeholders in the sector, is also part of the strategy, as a “one-stop shop” to coordinate the industry’s various sectors.

In recent years, various organisations and individual farmers have been experimenting with jatropha production.

Elijah Ndogo, a coffee farm manager in Ruiru, central Kenya, has planted six hectares with jatropha.

“We use a lot of diesel in the factory, sometimes we pollute the environment, we were looking for an alternative to cut costs,” he told IRIN.

It has been an educational experience for Ndogo, who initially expected near-miraculous results from his new crop, but now realises he has to wait another three years before his plant reaches maturity and will produce enough seeds for oil extraction. “We thought it would reach full maturity after two years,” he said.
“It is too cold here, the rate of growth is lower, the results will be belated,” he said, adding that he had also lost some of the seedlings to cutworms and millipedes in 2007.

The prices of seeds have also gone up, he said: “In 2006, a kilo seeds went for 1000 shillings (US$15), today half a kilo of seeds goes for 3000 shillings ($46), it’s very expensive.”

According to Miyuki Liyama, an economist with the International Center for Research in Agroforestry (ICRAF), when farmers began planting jatropha in 2006, “they did not have enough scientific knowledge and they did not know the agronomy of jatropha”.

She also said the government would have to do more to make its strategy viable. “There is no ready market for biofuel in Kenya yet,” she said.

According to media reports, this hasn’t stopped a Japan-based company, Biwako Bio-Laboratory Inc, from announcing a 10-year, US$19.4 million commercial bio-diesel project using jatropha seeds grown over an eventual 100,000 ha of land.

IRIN 

The risk of an HIV-positive mother infecting her child through breastfeeding can be significantly reduced by antiretroviral treatment (ART), say health officials in Kenya.

"HIV-positive mothers on ART lower the risk of transmission through breastfeeding from 20 [percent] to five percent," said Linda Beyer, an official in charge of Nutrition and HIV/AIDS at the UN Children's Fund (UNICEF).

In developing countries the nutritional and other health benefits of breastfeeding over formula feeding have generally been thought to outweigh the risks of HIV infection. Recent clinical trials have found that putting nursing HIV-positive mothers on ART can suppress viral load and minimise the chances of transmission.

"Breastfeeding for the first six months of a child's life reduces up to 13 percent of under-five deaths," Beyer said at the start of World Breastfeeding Week on 1 August.

According to the World Health Organisation, every year 10 million children younger than five die worldwide, often as a result of malnutrition.

Beyer said that promoting breastfeeding was vital to achieving the Millennium Development Goal of a two-thirds reduction in childhood mortality rates by 2015.

Terry Wefwafwa, an official in Kenya's ministry of health, said her department was already providing ART to breastfeeding HIV-positive mothers through its prevention of mother-to-child transmission [PMTCT] programme. "They are available at all health facilities for the women at no cost," she told IRIN/PlusNews.

HIV-positive mothers should stop breastfeeding their babies after six months and introduce other foods, Wefwafwa said. She also warned that there was a risk of infection if other foods and liquids were mixed with breast milk before the baby was six months old.

The world breast week campaign will be used as a platform to sensitise the public to the importance of breastfeeding.

PlusNews

Tens of thousands of people are facing food scarcity in the areas of Baringo and East Pokot in Kenya's north Rift, a humanitarian official said.

"There is an acute food shortage and the situation has been rated as alarming," Anthony Mwangi, public relations manager with the Kenya Red Cross Society (KRCS), said.

At least 64,000 people were affected in East Pokot and another 32,000 in Baringo.

Mwangi said the food scarcity was attributed to poor rainfall and drought, which had led to crop failure. High food prices had exacerbated the situation.

In addition, prolonged drought was contributing to environmental degradation, he said.

Absenteeism in schools had also been reported, with at least 5 percent of children missing school. "They are staying behind to support their parents," he said.

Livestock health has been affected due to a lack of pasture and water. The two areas have a large pastoralist population.

"The livestock are in poor condition and are fetching low prices in the markets," said Mwangi. Milk production had also fallen.

He said some of the affected population was feeding on wild fruits and rodents to cope with the food shortage.

The worst-affected areas include the localities of Sacho, Margat, Makutani, Tenges, Koloo, Tangul bei and Nginyang.

The KRCS has launched relief food aid distribution targeting at least 68,000 people in the affected areas. So far, the KRCS had distributed 1,246 tonnes of assorted food stuff, including 1,152 tonnes of cereal, Mwangi said.

IRIN 

Recurrent outbreaks of cholera in the western province of Nyanza are caused by widespread water contamination, including seepage from latrines, health officials said.

"The major contributor to the recent outbreaks in the area was unsafe water," Shahnaaz Sharif, the senior deputy director of medical services in Kenya's health ministry, said. "In Kisumu, many wells are built near the latrine; eventually the sewage seeps into the wells."

The high water table in the area was a contributing factor, Sharif said. Tests done on water samples from Kisumu and Nyando, two of the most affected districts in the province, indicated that 75 percent of sources were contaminated.

"People need to be made aware of water safety, by fetching their water from a safe source and boiling it," Moses Atuko, the emergency health manager at the Kenya Red Cross Society (KRCS) said. At least 80 percent of cholera transmissions are attributed to a lack of access to safe water.

"Sanitation is health; you have poor sanitation you have poor health," Atuko said.

In addition to encouraging the proper use of latrines, there was a need to increase the number of latrines in households, not only for hygiene but also for cultural reasons, as local customs did not allow men and women to share toilet facilities, he added.

The KRCS, in partnership with the Ministry of Health and other NGOs, was sensitising people in the affected areas to the importance of good sanitation and discouraging practices such as bathing and washing clothes in the rivers.

According to Atuko, this "was a tall order", since many people in the region used Lake Victoria and the rivers as their main sources of water.

However, he added, the number of cholera cases had fallen. "Last week, we only reported four cases; four weeks ago, there were more than 100 cases," he said.

The health ministry is enforcing public health laws by discouraging hawking of food in open markets and streets. It also conducted mapping of water sources for chlorination and was promoting the use of water purifiers.

"We have to enforce proper eating standards," Sharif said. "We are discouraging roadside cooking."

According to the World Health Organization (WHO), inadequate food safety and hygiene are also major contributors to the sporadic outbreaks of the disease.

Cholera is caused by the bacterium Vibrio cholerae and is characterised by watery diarrhoea, vomiting, muscle cramps and severe dehydration. Treatment is mainly by rehydration and up to 80 percent of cholera cases can be treated successfully using oral rehydration salts.

IRIN

A public inquiry should be set up into “torture and war crimes” committed by the Sabaot Land Defence Forces (SLDF) militia and the military in Mt Elgon District, human rights activists said.

"We need an independent civilian inspectorate of the police and military ... to restore trust in the security forces," Ben Rawlence of Human Rights Watch (HRW) Africa Division said in Nairobi at the launch of a report, All the Men Have Gone: War Crimes in Kenya's Mt Elgon District. 

The report documents two years of “abuses” by both the SLDF and security forces. The SLDF, it alleges, were responsible for killing at least 600 people, terrorising thousands and torturing hundreds since 2006.

The police, paramilitary and military, on the other hand, are alleged to have tortured hundreds of men detained in mass round-ups since March in response to the militia activities.

Police spokesman Eric Kiraithe refuted the claims, saying the Kenyan police had followed international practice while performing their duties in the district.

"We have done our own investigations [on the allegations] and will be releasing a comprehensive report in due course," he told IRIN, describing the reports as "very inaccurate and far-fetched".

Blaming both the SLDF and government security forces for serious human rights abuses, the report said: "The Kenyan government has a responsibility to promptly and impartially investigate and prosecute the individuals responsible for these crimes."

"This is not an acceptable way of dealing with an insurgency ... It should be within the law," Rawlence said. The SLDF was formed in 2006 to seek redress for alleged injustices during land distribution in a settlement scheme known as Chebyuk, with the conflict pitting two main clans of the Sabaot against each other.

At least 37 people have “disappeared” after being taken into custody by security forces, according to the human rights group, and residents had remained wary of retributions from SLDF militias.

"The military and the police have a responsibility to protect the people from any regrouping by the SLDF," HRW said.

HRW's Africa director, Georgette Gagnon, said the “successful” operation to tackle the rebellion in Mt Elgon had come at a terrible cost.

The group called on foreign governments providing military aid and other assistance to Kenyan security forces to review that support in light of the mounting evidence of torture.

"Right now there is calm in Mt Elgon; people are pleased with what the military is doing but not the impact of the first three weeks of the [military] intervention," Job Bwonya, executive director of the Western Kenya Human Rights Watch, said.

"The government should also come up with a land policy to prevent further suffering of the people of Mt Elgon," Tiger Wanyanja, a human rights activist, said.

Hassan Omar Hassan, a commissioner with the Kenya National Commission on Human Rights called for a "stop to the strategy of intimidation of humanitarian groups" working in the district.

On 21 July, the charity Médecins Sans Frontières said its staff had been stopped at roadblocks and prevented by local authorities from providing medical assistance to civilians in the district.

IRIN 

Keeping Kenyan girls in school and ensuring they have access to HIV and sex education has a dramatic effect on lowering future levels of HIV, according to experts.

"Young people do not have the information they need, and the dropout rate, particularly for girls, is still too high," said Rosemarie Muganda-Onyando, executive director of the Centre for the Study of Adolescence (CSA), which conducts research into teen behaviour and implements programmes for them.

"Dropping out of school ensures a life of poverty for these girls, and many of them also wind up HIV-positive because the male-female power dynamics become even more slanted against them."

Although the government introduced free primary school education in 2003, an estimated one million children of school-going age are not attending school. Up to 13,000 Kenyan girls drop out of school every year as a result of pregnancy, and around 17 percent of girls have had sex before they turn 15. HIV prevalence in Kenyan women aged between 15 and 24 is about 5 percent, compared with just one percent for their male counterparts.

The Kenya Demographic and Health Survey of 2004 found that better educated girls were less likely to marry early, more likely to practice family planning, and that their children had a higher survival rate.

According to the United Nations Children's Fund, uneducated girls are also more likely to contract HIV/AIDS, which spreads twice as quickly among them than among girls who have had even some schooling.

The Ministry of Education has an HIV/AIDS prevention and sex education curriculum that focuses on upper-primary and secondary school, but no specific time is set aside for this, leaving teachers and school heads to fit in the subject at their discretion.

"I would like to see compulsory comprehensive HIV and sex education - and not just the bare bones, but something that goes further and teaches kids to become responsible for their actions and take greater control of their future," Muganda-Onyando said. "Not enough teachers have been trained for this type of education, so children are leaving school with academic qualifications and not many life skills."

These were not the only obstacles: the strong influence of fundamentalist Christians in HIV funding to Kenya had also played a part in preventing sex education from being taught in schools; and "There is also resistance from parents, many of whom feel school is not the place to learn about sex," she said.

This lack of information meant girls were not practising safe sex; a 2003 government survey noted that just 25 percent of women aged 15 to 24 reported using a condom the last time they had sex with a non-marital, non-cohabiting partner.

Schools ill-equipped for sex education

Schools in remote, rural areas and deprived urban areas are often ill-prepared to handle sex education; many have not seen the government's curriculum.
"We don't have sex education or HIV education; the government hasn't given us any materials or training so we don't know where to start," said Christopher Barassa, principal of Genesis Joy Primary and Secondary School in Mathare, Nairobi's second-largest slum.

Although registered with the Ministry of Education and the Nairobi City Council, the school is considered as 'non-formal' because of its location and lack of facilities; it has no playing ground or toilets, so the school is surrounded by 'flying toilets' - faecal matter wrapped in plastic bags and thrown away - and garbage. All the students are from the slum, and Barassa says keeping them in school can be difficult.
"Our drop-out rate is not very high, but teen pregnancy is a real problem," he told IRIN/PlusNews. The school's policy is to encourage girls to return to school after they give birth, but many felt too stigmatised or had no help to look after their children and therefore stayed away.

"When we investigate the pregnancies, it is almost always an older man ... over twenty and sometimes over thirty," he said. "We work with the local police to prosecute them - we recently had a 31-year-old man arrested for marrying one of our students who was just 15."

He noted that many parents in the slum had inadequate control because work kept them away from their children, sometimes for days. As a result, children learnt about sex from the wrong sources, such as the numerous video halls that allowed children to view pornographic films.

"The girls also have to live in one room with their parents until they are mature, and many of them witness their parents having sex, so they learn about it early," Barassa said. "Sometimes they get a man when they are still young in order to get out of that situation."

More sex education, less sex

The CSA runs projects aimed at lowering the drop-out rate for girls and teaching them about sexual and reproductive health, including HIV. "The projects train teachers to impart life skills, create safe spaces in schools where girls can freely discuss the issues they are facing, and foster mentor-protégé relationships between older and younger students, so the younger ones have somewhere to turn," CSA's Muganda-Onyando said.

"One of the big problems has been the breakdown of our traditional African systems, where an aunt or grandmother was responsible for sex education ... people say discussions about sex are taboo in Africa, but this is not true," she said. "We lost those systems through colonisation and modernisation, and they haven't been replaced; these projects are trying to give children back that support system."

The CSA also establishes ties with the community, encouraging parents to take an active role in teaching their children about sex, and to behave more responsibly themselves.

The initiative, which is being implemented in more than 100 schools around the country, has had positive results so far: participating schools have noted a significant drop in teen pregnancy, higher retention and completion rates of school education, and improved self-esteem and confidence among girls, which in turn has led to higher scores in exams.

"Girls also need to be supported with uniforms, books, and other material necessities for school," said Principal Barassa. "If a girl has everything she needs for school, she can stay in school and concentrate on her studies, and she will not look for an older man to buy them for her in exchange for sex."

PlusNews 

Erratic rainfall, soaring farming costs, and a shortage of materials in the western district of Mt Elgon could compromise food security in the region.

"The rains came in mid-February and stopped. The next rains were in April and early May and this has not helped the maize crop," Wilson Keya, a farmer in the Cheptais division of the district, told IRIN.

According to the UN Food and Agriculture Organization’s (FAO) Crop Prospects and Food Situation report published on 18 July, below-average March-May rains in Northern Rift Valley and Northwestern provinces had further reduced water availability, which was already inadequate after a poor October-December 2007 season.

"Right now we are expecting four [90kg] bags of maize per acre instead of the usual 20 as we could not afford to use any fertiliser," Keya said.

A 50kg bag of Calcium Ammonium Nitrate (CAN) fertiliser was selling at KSh2,400 shillings (US$40), up from KSh1,300 ($21.60) in 2007, while Diammonium Phosphate (DAP) fertiliser cost KSh4,100 ($68.30) up from KSh1,600 ($26.60) in the stores visited by IRIN in the district. CAN is used for top dressing (adding dry fertiliser to the soil next to the plant), while DAP is applied at the planting stage.

Bernard Sabila, who runs a fertiliser shop in Kaptama, said sales had gone down from about 500 bags a month during the planting season to 200.

"The fertiliser prices should either be reduced or the price of a bag of maize increased to help the farmers," Sabila said. "Right now people are suffering and are planting less maize or switching to other crops."

The cost of using ox-drawn ploughs had also gone up from KSh800 ($13.30) to KSh1,200 ($20) per acre of land.

No surplus

According to the district agricultural officer Sammy Cheminingwa, the acreage of the land under crop production in the district was 30 percent less than normal. "Most of the land was also prepared late because people had run away," Cheminingwa said.

A long-standing dispute over land ownership led to inter-communal violence in the district towards the end of 2006, displacing thousands of people and leaving hundreds dead. See: [Land dispute spawns violence, displacement ]

The main returnee needs were shelter and food, a relief officer with the Kenya Red Cross Society (KRCS) in the district, Maurice Anyango, said. The KRCS was targeting 12,000 households in its food aid distribution.

Cheminingwa said farmers were likely to sell their harvest to meet other urgent livelihood needs because the majority had lost assets during the conflict, further contributing to a drop in the amount of food available.
The district, one of the key grain-producing areas in western Kenya, normally has a surplus of 418,500 bags of maize for sale to neighbouring districts. Cheminingwa said the district cereal bank had been depleted.

The price of 2kg of maize has increased to an average of KSh80 ($1.33) from KSh30 ($0.50) in 2007.

Helping the returnees

Mohammed Biriki, the district commissioner, said returnees needed farming support. "This will help the farmers to produce short-season crops such as tomatoes, onions, and potatoes instead of relying on relief aid." The district has an estimated 5,000 returnee families.

Phyllis Chesha, a returnee living at the Elgon Bible College in Kopsiro division, told IRIN she had not yet been able to plant any crops on her farm due to a lack of seeds.

"We also do not have jembes [hoes] to help us prepare the land," Chesha said. A lack of shelter material was also preventing the returnees from settling back on their farms.

Biriki said at least 97 guns and 1,300 rounds of ammunition had been recovered since the start of a military operation to end militia activity in the district in March. The Kenya National Commission on Human Rights released a report in May accusing the military of committing serious human rights violations during the operation, which were denied.

On 21 July the humanitarian organisation Médecins Sans Frontières said its staff had been stopped at roadblocks and prevented by local authorities from providing medical assistance to the affected civilian population in the district. The district commissioner declined to comment.

IRIN 

Recurrent outbreaks of the viral livestock disease peste des petits ruminants (PPR), which affects goats and sheep, are exacerbating poor food security in the mainly pastoralist Turkana region of northwestern Kenya.

Community leader Morris Lichokwe told IRIN he had lost 300 goats from a herd of 800 in three months to PPR. The disease, locally known as “Lomoo”, had killed thousands of heads of livestock.

"Lomoo has really brought us down," said Lichokwe, a resident of the division of Kaaling, in Turkana North district.

“Before,” he said, “I could sell some of my goats but that is no longer possible. Goats in good health can retail for up to 3,000 shillings [US$50] each but the price has dropped to as low as 300 shillings [$5] in some areas.” This was due to the closure of the external market as a form of quarantine.

PPR symptoms include lassitude, fever, discharges from the eyes and nose, sores in the mouth, laboured breathing and diarrhoea.

"There is a need for quick vaccination and deworming to avoid ruining our livelihoods as we have no agricultural land to sustain us," he said.

"Lomoo clears half the herd. With no medicine we are forced to leave the goats to die," John Ichom, a resident, said. Most of the veterinary stores are in the main towns of Lokichoggio and Kakuma, far from the pastoral areas.

Turkana Central District Commissioner George Ayonga said the disease had lowered the purchasing power of the pastoralist community. "You cannot sell a sick goat and even an animal that looks a bit healthy cannot be sold." PPR has been recorded in 16 districts in the north.

"Right now people are not selling their livestock," Ali Abdi, a livestock trader, in the Oropoi area, said. “Occasionally when someone brings a goat, I exchange it for a bag of maize flour,” Abdi, who also runs a food kiosk, told IRIN. A 50kg bag of maize sells for 1,300 ($21.60) shillings. Few centres in the district were stocking food when IRIN visited.

"Most people cannot buy, they come to the kiosk to borrow the flour. What can I do?" he asked. "The people here persevere, it is a hard life. There is no work, no food and no water. Before they used to make roads to get money but now there is nothing to do."
Water shortages

Failed rains in the district forced the movement of livestock from the drier northern and central areas to the southern areas of Kakong and Kainuk in search of water and pasture. The southern areas are insecure, with livestock theft and banditry rampant.

According to George Omori, a veterinary officer, the watering sources are far away, unreliable and few have been recharged, reducing the number of times livestock are watered. Dehydration is a risk among PPR-affected livestock.

Livestock convergence could also increase the risk of PPR, Omori said: "The animals that have moved south could wipe out the rest in case of an outbreak." Most of the affected were the young not covered by past vaccinations.

Omori said there was a need for continuous vaccination for at least three years to control the spread of the disease. The three million goats and sheep in the region were at risk, with at least five outbreaks reported in several areas, he said.

Smaller ruminants have a high turnover and thus require frequent disease prevention and control interventions. The PPR vaccine provides protection for about three years for small ruminants.

So far, at least 61,000 sheep and goats have been vaccinated, with another 70,000 expected to be vaccinated in August. This represents a shortfall of at least two million doses in order to cover the entire region, according to Omori.

At least 1.5 million goats and sheep were vaccinated in 2007 after an outbreak. Since 2006, PPR has led to the deaths of at least 400,000 sheep and goats, he said.

Food costs

Pastoralists have also had to grapple with rising food prices due to lowered livestock productivity and the failed rains, according to the district crop officer, Vincent Morara.

In the past year, the prices of commodities such as maize, posho (maize meal flour) and sorghum have doubled to 60 shillings ($1) per kilo.

In the agro-pastoral regions along the Kerio and Turkwell rivers, most farmers have also not planted, while crop losses were expected for those who had due to low water flow, Morara said. The rivers provide water for six to eight months each year, allowing for the growth of crops such as cowpeas, maize and millet.

"Little crop production could be sustained," he said.

From January to June this year, only 81.2mm of rain has fallen in the region compared with 366.2mm in the same period last year.
The number of people receiving food aid in the Turkana region has risen to 215,000 from 160,000 in response to the deteriorating food security and nutrition situation, according to a report covering 3-9 July by the UN Office for the Coordination of Humanitarian Affairs (OCHA).

Turkana Central recorded the highest rates of global acute malnutrition at 28.9 percent. At least 6,759 pregnant and lactating women were moderately malnourished in April, according to the district nutrition officer, Francis Kidaki.

"We eat wild fruits and other taboo foods when we run out of food aid," Lochur Apochor, a local resident, said.

“The children eat the uji [porridge] we eat, there is no special food for the children,” a resident of Kanakurdio, Pauline Asinyen, said.

“Right now there is no goat milk as the flocks have moved away in search of pasture,” Asinyen said.

Poor access to markets due to a dilapidated road network and insecurity, coupled with inward and outward migrations, have also contributed to the deteriorating food security in the region.

IRIN 

Quality healthcare is a luxury often beyond the reach of those who live in Nairobi’s slums, such as mother-of-seven Grace Awour Opondo.

"When you are sick you buy medicine from the local shops," Opondo told IRIN. "If you are lucky you recover because the medicine is not usually the right one.

"Sometimes there is no medicine even in the hospitals, so they send you out with a prescription," she said. "Then the chemists are expensive so often one has to make do without the medicine."

According to Sakwa Mwangala, a programme manager with the African Medical and Research Foundation (AMREF), the fact that people are squatting on government land often prevents them from accessing essential services. Slums are regarded as informal illegal settlements, which means they are underserved in terms of infrastructure development and access to basic amenities.

"Government health facilities are also not easily accessible for most slum residents," said Mwangala, who heads AMREF's Kibera integrated healthcare programme. Kibera, on the southwestern edge of central Nairobi, is one of the largest and most densely populated slums in sub-Saharan Africa.

Most people operating health “facilities” in the slums are quacks, he said. “There is a lack of quality control, with the people in most of these clinics lacking skills."

The urban poor fare worse than their rural counterparts on most health indicators, according to a report, Profiling the burden of disease on the residents of Nairobi slums prepared by the African Population and Health Research Center (APHRC).

Pneumonia, diarrhoeal diseases and stillbirths account for more than half the deaths of children under-five, while HIV/AIDS, tuberculosis, interpersonal violence injuries and road traffic accidents account for more than two-thirds of deaths among people aged five years and older, stated the report.

The poor health status of slum children is in part due to continuous exposure to environmental hazards coupled with a lack of basic amenities.

"The chances of one becoming sick are high because of the poor sanitation; most of the houses are also poorly ventilated," according to Leonard Wawire, a teacher in the Mathare slum.

"Here, there are no trees to clean the air; any plant growing is usually growing out of waste," Wawire said.

Prevention measures

Eliya Zulu, APHRC’s deputy director of research, told IRIN it was important to adopt a holistic approach to healthcare for the urban poor, one that focused as much on prevention – through improved nutrition and immunisation against major childhood diseases – as on treatment.
“Increasingly, most people in the urban areas are living in deplorable conditions yet it is generally assumed that the better hospitals and schools are in the urban areas,” Zulu said.

When conducting general health surveys, urban areas tend to rank better than rural areas in terms of the health indicators. This, however, failed to bring into focus the health situation of the urban poor, he said.

The problems of the urban poor have often been overlooked while rural areas are seen as more vulnerable to shocks.

"In the rural set-up there is a sense of normalcy; you can have your toilet, the community also has a stream from which they draw their water - this is not the case in the slums," Mwangala of AMREF said.

Many deaths in the slums are caused by preventable and treatable conditions, according to the APHRC report; inadequate sanitation encourages the spread of skin and waterborne diseases.

In a bid to improve sanitation in Kibera, a Kenyan NGO, the Umande Trust, is running a project that not only provides quality toilets for residents but also transforms human waste into biogas and liquid fertiliser.

Residents in areas such as Katwekera and Laini Saba in Kibera, pay two shillings (three US cents) to use the toilets and showers, according to Josiah Omotto of the Trust. For a subscription of 80 shillings ($1.19) a month, households get unlimited access to the facility.

The buildings’ basements house bio-digester domes, which turn human waste into methane and liquid fertiliser.
According to Omotto, these help reduce the local use of firewood. Already, he said, the methane from the facility in Laini Saba was being used for fuel by a local nursery school. There are plans to construct similar facilities in other slums to supply the gas to residents living near the facilities.

So far, at least 500 residents are benefiting from each facility.

The division of environmental health in Kenya's Ministry of Health is finalising policy documents aimed at ensuring that 90 percent of households have access to, and make use of, hygienic, affordable, functional and sustainable toilet and hand-washing facilities.

The policies also aim at reducing the national rate of preventable sanitation-related diseases by half.

IRIN 

HIV/AIDS funding to low- and middle-income countries reached a record level in 2007, according to a new report by UNAIDS.

AIDS spending by the G8 group of wealthly nations, the European Commission and other donors hit US$ 6.6 billion last year, up from US$ 5.6 billion in 2006. However, despite the largesse, UNAIDS said a US$8.1 billion gap in funding for essential HIV/AIDS programmes remained.

The United States was the largest grant-giver, providing 20 percent of resources in 2007, followed by the United Kingdom. Some non-G8 nations also provided significant assistance, including the Netherlands, Sweden, Australia and Ireland.

The report comes as the G8 - made up of Britain, Canada, France, Germany, Italy, Japan, Russia and the United States - reiterated a commitment they made at the 2005 summit in Gleneagles, Scotland, to spend US$60 billion to fight disease in Africa; the repeated commitment added a five-year timeline to the initiative.

At the G8 summit this week in Hokkaido, Japan, leaders also announced that they would provide 100 million insecticide-treated mosquito nets by 2010 to control the spread of malaria on the African continent, and would work towards increasing the health workforce in countries experiencing a critical shortfall in health staff.

"The G8 will take concrete steps to work toward improving the link between HIV/AIDS activities and sexual and reproductive health and voluntary family planning programmes, to improve access to health care, including preventing mother-to-child transmission, and to achieve the MDGs [United Nations Millennium Development Goals] by adopting a multisectoral approach and by fostering community involvement and participation," a statement from the G8 said.

The announcement of the funding comes as a relief to organisations working to combat disease and poverty in Africa; several press reports had hinted that a draft communiqué scheduled to be released by the G8 would omit HIV/AIDS targets.

However, some organisations felt the commitments still fell short of expectations, with the anti-poverty NGO, ActionAid, describing the summit's statement on Africa as "as a mixture of recycled promises and failed remedies".

And although they welcomed the five-year timeframe for the disbursement of the $60 billion for health, "there is still no indication of who will pay up and exactly when".

"The proposals for strengthening health services are also seen by ActionAid as flawed, unless more is done to stem the exodus of skilled staff from African countries," a press statement said.

Getting the funding to where it's needed

"Training more health workers is pointless if the brain drain continues," said ActionAid Malawi's food security specialist. "There are more Malawian doctors in the city of Manchester than in the whole of Malawi."

"It's good progress that they will provide the promised levels of funding," Leonard Okello, head of ActionAid's international HIV/AIDS team, told IRIN/PlusNews. "However, we hope they will fulfil these pledges, because one of the big problems with health funding is lots of money promised and only part of it ever being paid."

"The G8 and other leaders of the developed world usually work on a political timetable, so their funding is suited to when they arrive and exit office, not around the needs of the people they are targeting," he added.

"The other problem with HIV/AIDS funding is that it rarely reaches the people who need it most, who are at the community level," Okello said. "Research shows that in Africa, more than 70 percent of the work in the HIV field is done by community-based organisations, but only 11 percent of the funding goes to them."

"In addition, the organisations the money goes to have to meet strict standards - usually only large international organisations without a good idea of the landscape in which they are working can meet the criteria, so the money winds up being spent where it is not needed," he added.

He noted that large sums of money were spent at luxury hotels in high level meetings - money that could be better used if it were channelled directly to the community.

"It's no wonder that despite all the funding, the response is still lagging behind the epidemic," Okello said.

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