An International Monetary Fund staff mission led by Mr. Tsidi Tsikata visited The Gambia during the period May 11th – 25th, 2008, to conduct discussions for the 2008 Article IV consultation and the third review under the Poverty Reduction and Growth Facility (PRGF) arrangement.  The mission met with the Secretary of State for Finance and Economic Affairs, Mousa Gibril BalaGaye, Governor of the Central Bank of The Gambia (CBG), Momodou Bamba Saho, Chairman of the National Planning Commission, Alieu Ngum, other senior officials of the government, the CBG, the Speaker and other members of the National Assembly, representatives of the business community, civil society, and The Gambia’s development partners. At the conclusion of the visit, the mission issued the following statement:

Since the last Article IV consultation in 2006, the authorities’ policy strategy has been successful in maintaining macroeconomic stability and sustaining high growth. Fiscal performance has been good, and monetary policy has been geared to maintaining low inflation.

Real GDP growth has been strong at over 6% a year, a performance that compares favourably with the record of other countries in the region. Growth has been led by the construction, tourism, and telecommunications sectors, facilitated by a steady inflow of foreign direct investment and remittances. A relatively tight monetary policy stance and appreciation of the Dalasi have helped contain the impact of rising world food and oil prices on inflation in The Gambia. Inflation rose to 6-7% percent during most of 2007 from less than 1% in December 2006, but has been falling thus far in 2008. However this trend may be reversed if world prices remain high. The mission commended the government for adjusting the pump price of petroleum products in order to safeguard the budget from the heavy burden that would be associated with subsidising these products, which would tend to benefit the better-off segment of the population more than the poor. In this connection, the mission understands the government’s recent decision to remove the sales tax on rice imports in order to provide some relief, especially to poor households. Possible further mitigation measures for the most vulnerable households could include the expansion of existing social programs such as school feeding programs. The mission recommended that the authorities avoid generalised subsidies, which tend to be ineffective and have created budgetary problems in neighbouring countries.

The marked appreciation of the Dalasi over the last year appears to have reduced the profitability of the tourism industry and the re-export trade and would likely contribute to slower growth in 2008. The main factors affecting The Gambia’s international competitiveness, however, include weak infrastructure, lack of access to long-term financing, and the burden of a multiplicity of taxes and local government charges. These problems will need to be addressed through further structural reforms.

The mission welcomed the government’s intention to use the savings from debt relief to boost poverty reducing expenditures in line with the priorities in the PRSP and also to pay down domestic debt in order to put downward pressure on interest rates. The mission urged the authorities to speed up the preparation of a national debt strategy to help the country avoid falling back into debt distress.

With regard to the PRGF-supported program, the mission found that performance against the quantitative financial targets has been strong. However, progress has been slower than expected in implementing some structural reform measures such as establishing a fully functioning credit reference bureau.

The Executive Board of the IMF is tentatively scheduled to discuss the report of the mission in early August 2008. The mission wishes to express its gratitude to the authorities for their hospitality and the very constructive spirit in which the discussions were held.

A handing over ceremony for 10 Global Fund Toyota Pick-ups to RHTS and their partners was recently held at the National Malaria Control Programme Office in Kanafing. The vehicles were distributed to all regions of the country.

In his opening remarks, the Programme Manager for the National Malaria Control Programme, Mr. Malang Fofana, said that this donation will support the health system. According to him, over 2,523 health workers were trained to improve their Malaria disease management and prevention skills from both public and private health facilities.

Speaking about national efforts, the programme manager pointed out that President Jammeh demonstrated the highest political commitment in the fight against malaria in The Gambia.

For his part, the Director of Operations for Health, Mr. Omar Jah, revealed that by providing such valuable support to the Health Sector, the Global Fund has once again demonstrated its commitment to the complete the development of the Department of State for Health (DOSH). It has a strong drive to maintain and uphold an effective and efficient Health Service. This noble objective was the premise of the relationship between DOSH and the RFH, which resulted in the outsourcing of the operation and maintenance of all the sector’s transport since 2002.

Mr. Jah expressed his pride in mentioning that the ambulances, the MCH trekking vehicles and the drug supply vehicles have been enjoying unprecedented attention. He said that RFH’s main strength is not only the maintenance of the vehicles and the equipment but it’s driving training also. He added that the RFH have endeavoured to include a sense of responsibility in all the vehicle drivers and managers because they are trying to make a group of vehicles that are free from accidents and breakdowns.

Other speakers during the programme included Mr. Bernard Mendy, CCM Chairman and the Permanent Secretary for DOSH, Mr. Sulayman Samba, did the handing over of the vehicles to the beneficiaries.

Decentralised HIV/AIDS services are slowly being rolled out with the backing of donors and the government, but in many remote areas of this huge country (nearly 1.3 million square kilometres, with a population of less than 10 million), these have yet to become a reality.

In Danamadji, an area in the southeast of Sahr, the third largest city in Chad, near the border with the Central African Republic (CAR), the poorest people cannot afford an HIV test that should be free, said Randjita Beoudoum, 42, coordinator of the United Association for Sustainability and Action for Positive Life (UPAV+), a network of HIV-positive people.

"There is no electricity, so when someone wants a test we ask them to pay 150 CFA francs [US$0.33] because we need fuel to start up the generator set," said Beoudoum, who has been living with the virus for about 20 years. "We've appealed on radio until we're blue in the face to at least get a mobile testing centre, but nobody comes to help."

UPAV+ has around 400 members in the region and assists people with HIV/AIDS, most of whom live in villages in the bush. "We do home visits in each village, using our cow-drawn cart, and ... if [a patient] cannot stand up, we pick them up ... When we have two or three people we set off for the hospital in Sahr," he told IRIN/PlusNews.

It takes a day and a half to cover the 125km between Danamadji and Sahr, the only town in the area where antiretroviral (ARV) drugs are available. "We [can] lose people along the way because they are too [weak]," Beoudoum said. His organisation lost five people in 2007.

The journey can also be dangerous. "There are lots of elephants in the region and they can attack you. To escape from them we have a sound system on the cart and we put music on really loud to scare them off into the forests," he said. "Once, when we didn't put the music on, the elephants attacked us. We abandoned the cows and ran. People from the villages came to our rescue."

The "axis of death" in the south

With HIV infection rates as high as 9.8 percent (compared to 3.3 percent nationally), the south is one of the areas worst affected by the epidemic. A road that many Chadians call the "axis of death" runs for hundreds of kilometres from the CAR to N'Djamena, capital of Chad, through the oil-producing regions of the south.

The strong economic activity attracts traders and people from other countries, but also brings an increased risk of spreading HIV/AIDS in an area where treatment services are scarce, according to AIDS workers.

Denial and ignorance in other regions

The situation is not any easier for patients in Oum-Hadjer, administrative centre of the central Batha-est region. Those needing ARVs or CD4 tests (to assess the immune system's resistance) have to travel to Abéché, around 150km to the east. Most of these patients live in extreme poverty.

"ARVs are free now [since 2007] but this is theoretical for us because it costs 5,000 CFA francs [$1.00] to do the return journey to Abéché. On top of this you have to pay for accommodation, food, and treatments for opportunistic infections. Few make the journey," said Giscard Sirrobe Ignabaï, president of ANNIDAL, which means "combat" in Arabic, a youth association for people living with HIV, established in March 2007.

"When we come across someone who is sick and weak, and we still have some money left in the organisation's fund, we help them with their medical treatments," he said. In spite of their efforts, he felt that the huge obstacles to obtaining treatment were causing the health of HIV-positive people to decline and their life expectancy was falling.

In the largely Muslim eastern and northern areas of Chad, AIDS organisations have noted that it is much more difficult to raise awareness of issues linked to sexuality and AIDS.

"It seems that people ignore the fact that bad things happen," said Sirrobe Ignabaï. "For many people here, it is blasphemous to speak of sexuality and AIDS. We are trying to raise alarm bells, but people refuse to listen to us."

Of the 16,415 people screened across the country in 2006, only 3 percent took the test in the east and north, compared to 66 percent in the south and 31 percent in the capital, according to official statistics.

Difficulties recognised

The government has also found it difficult to decentralise healthcare. Besides problems with the management of HIV/AIDS funding from the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria, which led them to suspend funding for many months during 2006 and 2007, and delayed the expansion of HIV/AIDS services in the provinces, Chad is also struggling with a lack of health workers.

"There are no more than 300 doctors in the whole country and less than 200 of them have received ARV prescription training," said Dr Djouater Barou, coordinator of the National Programme to Fight AIDS (PNLS). "And they are not everywhere: at the general hospital in N'Djamena there are thirty-odd, but in certain areas [of the provinces] they only have one."

To alleviate staff shortages and inadequate training in the provinces, PNLS and its partners have started training nurses to write repeat ARV prescriptions, while those managing ARV stocks will be trained this year.

PNLS is also attempting to combat myths about the illness and develop infection prevention programmes in high-risk areas of the south, and in the isolated areas of the east and north, which are most exposed to insecurity due to tensions with neighbouring Sudan.

People living with HIV in Chad risk becoming victims of the explosion of violence in the capital, N'Djamena, in early February. During clashes between the army and groups of rebels from the east of the country, health services were damaged and many organisations working to fight the epidemic were looted.

FOSAP, a social support fund that manages HIV/AIDS money from the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria, and AMASOT, a local social marketing organisation working to reduce HIV infections, did not escape unscathed: their offices were emptied of computer equipment, supplies and even furniture and doors.

"We had [just] installed computers to allow young people to go on various [internet] sites ... to get information on AIDS and STIs [sexually transmitted infections]," Dr Kadah Dokblama, internal controller and interim director at AMASOT, told IRIN/PlusNews.

"We have lost everything; they only left us boxes of condoms and Orasel [water for rehydration]," said one of the organisation's employees.

The National General Reference Hospital in N'Djamena, which provides HIV/AIDS services, was hit by artillery shells and automatic weapons fire during the fighting. Although the shots were not intentionally directed at the facility, the intensity of the fighting drove patients out of the hospital in panic and some did not return.

Insecurity is an ongoing obstacle to the fight against AIDS in Chad, which has an official prevalence rate of 3.3 percent. The country has experienced regular explosions of violence for several decades, distracting attention from anti-AIDS efforts, but over the last few years the political engagement of the authorities and the arrival of donors have made it possible for HIV/AIDS programmes to be launched.

"The government has made an incredible effort by trying to mobilise resources and including it [the fight against AIDS] in their budget ... [but] insecurity remains a constraint - it prevents decentralisation [of HIV/AIDS services]," said Claire Mulanga Tshidibi, UNAIDS country coordinator in Chad.

Enock Nodjikwambaye, FOSAP's administrative manager, is well aware of this problem. "Insecurity holds us back," he told IRIN/PlusNews. "We don't dare send staff [into risk areas], where we could lose people and vehicles. We have already lost one vehicle [stolen by armed fighters]; we cannot risk sending someone into a living hell."

He said around 240,000 Sudanese refugees and 180,000 displaced Chadians were living in the east of the country, but ongoing insecurity in the area was a major obstacle to the development of FOSAP's programmes.

"We finance an HIV/AIDS sub-project in Abéché [the main town in eastern Chad, about 150km from the Sudanese border] but we haven't got anyone to go and supervise it."

The Gunjur Environmental and Protection Development Group (GEPADG) recently kick-started a bee-keeping project. The project is funded by the Integrated Coastal and Marine Biodiversity Project to the tune of D182,000.

Speaking to The Point, the Director of GEPADG, Mr. Badena Njie Bajor, said the aims and objectives of the project are to provide employment opportunities for Gunjurians and non-Gunjurians alike.

He revealed that the project will contribute immensely towards the employment and empowerment of the youth of Gunjur and its environs.

He hailed the management and staff of the Sifoe bee-keeping project and expressed optimism that the project will aid the community and help with development.

“I am delighted to express my sincere thanks to the Integrate Coastal and Marine Biodiversity Project for sponsoring the project and I assure them that the funding will be put to good use,” he said.

The widowed Gogo (SiSwati for "granny") Thwala, 72, lives a life that relies heavily on her survival skills as she single-handedly raises three grandchildren, but not a trace of resignation or despair clouds her smile.

"Yes, when the Lord took my son and his wife, and I was left with two little girls and a boy to look after, it was hard to go back to work but I am not without my resources!" said Thwala.

Her small hillside farm on communal Swazi Nation Land in Elwandle is only five kilometres south of the country's main commercial hub, Manzini, but few visitors tread the stony goat paths to reach it and she might as well be living in a remote rural village.

Stones are the bane of farming Thwala's small plot, where nothing grew last year because of drought. "Look now, how the maize is high!" said Thwala, the sweep of her hand showing a field of healthy, bright green maize stalks standing tall under blue skies.

Those skies have yielded consistent rain without any ruinous hailstorms so far this year. "With this crop I can feed these children. I can sell some extra for their school needs," she said.

Inside one of two mud huts on the property she opened a sewing kit and set to mending one of her granddaughter's school uniform skirts, which must again see service when the new academic year starts next week.

Thwala's two granddaughters are classified as orphaned and vulnerable children (OVC), and therefore eligible for government payment of their school fees. Her grandson, 5, will also qualify when he is old enough to attend primary school.

Although slow and backed by insufficient funding, the government's welfare services are gradually shifting from an almost exclusive focus on OVC to recognise the needs of their elderly and often desperately poor caregivers.

"I never thought I would have to raise children again. I thought that part of my life was over. But what can I do? What can these children do without me? I love them, and being with them helps soothe the loss I feel at the death of my son and his wife," said Thwala.

Mkuluza Zwane, director of the Umtfunti Old Age Association, finds Thwala's attitude commendable, but rare. "So many of these elderly are simply worn out by the burdens they face in their old age. By custom, they are supposed to be supported at this time ... by their children. Now, because of the AIDS crisis, government must step in and provide such support. It's a matter of humanity and respect for our older generation."

Zwane's association has lobbied government to increase its monthly pension for the elderly and last year succeeded in obtaining about US$30 per retired person, up from a paltry $15 a month.

"No one can live on that, but it is supplementary income, based on a belief that there still is some sort of family support. Most elderly are not homeless. In Swaziland, the extended family can still be found to assist, and neighbours."

However, some elderly people are truly alone, a recent phenomenon caused by the social upheaval wrought by AIDS. In his policy speech earlier this month, Prime Minister Themba Dlamini mentioned government's desire to improve the lot of the elderly, and acknowledged the plight of pension recipients who had to travel long distances to receive their monthly cheques.

For ailing people forced to endure daylong bus trips, collecting government allowances is a mixed blessing. Although Swaziland's cash-strapped government is unlikely to further increase stipends for the elderly, Dlamini promised action to facilitate payments.

The Queen Mother, who by tradition rules in conjunction with her son, King Mswati III, has set up a charity called Phila EmaSwati to provide assistance to the elderly. Last winter they distributed donated clothing and blankets, but the government has not provided funding for more extensive programmes.

While there is universal agreement that the elderly are essential to mitigate the effects of the AIDS epidemic, their needs are not high on the agendas of non-governmental organisations, other than the Umtfunti Old Age Association.

"In Swaziland there are only a few orphanages. It is the [extended] families who look after their orphaned relations, and this means…it is the grannies who are doing the work of the social welfare institutions," said Wilma Bhembe, a welfare worker in Manzini.

"They must be supported. If not, what will the children do, and what will we do with the children? It is not enough to give children emergency food rations and pay their school fees."

Despite its poverty, the nation prides itself on its fidelity to traditional African values, including respect for family and tribal elders. But this week many Swazis were jolted into realising they were in danger of losing this part of their heritage.

Real estate developers in the upscale suburb Ezulwini, on the eastern edge of the capital, Mbabane, unveiled plans for Swaziland's first retirement community. Although intended for unusually affluent retired people, the gated housing estate struck many people as unSwazi and somehow threatening to a national way of life.

"This place is apartheid for the aged. It is for foreign countries where they want to shut off their old people. We love and honour our elders, and we want them with us in our family circle every day," said James Mhlongo, a handicraft vendor at one of Ezulwini's tourist hotels. "But, maybe if this place makes us think about our old folks we will do more to keep them with us."