Wednesday, April 29, 2009

Affirmative Action For Women In Politics!

About 50 years ago when the late Nigerian female politician Olufunmilayo Ransome-Kuti called for ‘at least 50 percent representation of women in politics’ people especially the male politicians took her very unserious. But little did they know that same issue would be a hot political issue about 50 years later.

In a Special Session of the UN General Assembly held in June 2000 to review the 1995 Beijing Platform for Action, governments all over the world made a commitment to "set and encourage the use of explicit short and long-term time-bound targets or measureable goals, including where appropriate, quotas to promote progress towards gender balance, including women's equal access to and full participation on a basis of equality with men in all areas and at all levels of public life especially in decision-making positions, in political participation and political activities in all government ministries and at key policy-making institutions as well as in local development bodies and authorities".

Today all over the world women representation in politics has become an issue that generates a lot of controversy and hotly debated about. Nigeria is not an exception. In fact today in Nigeria a good number of non-governmental organisations devotes much of their time to pursuing equal representation of men and women in politics. Even though the Nigerian National Policy on Women called for at least 30 percent representation of women in public offices, the Nigerian government has not deemed it necessary to put necessary machineries in place to implement and actualise that. This is despite efforts being made by our sister African countries to bridge the gap between men and women in politics.

For instance while Rwanda has 48.8 percent of women in their national parliament, Nigeria has only 6.7 percent. Tanzania has 22.3 percent, Uganda 24.7 percent, South Africa 29.8 percent and Mozambique 30.0 percent. From these five examples there is no doubt then that Nigeria is ranking very low in terms of women representation in the parliament and obviously has a hard work to do to reach the 35 percent recommended by the United Nations. A closer look at the present republic may expatiate the scenario well. After the 2003 elections three women made it to the 109 member upper house while 21 were elected in 320 member lower house. Six women ministers were appointed with only three as full ministers. This is not too good for a nation like Nigeria who is supposed to be a role model for others especially in Africa.

On the wider world the Nordic and Scandinavian countries are reputable for their record of having a good number of women representatives in their parliament and public offices. According to Berit Lindeman, a Scandinavian and consultant to the International Foundation for Electoral Systems, "the truth is the success was gained through hard labour from courageous women during a time-span of 80 years and during this period of time, a change in the traditional patriarchal attitude took place. There is not really any magic formula related to the Scandinavian success of around 40 percent representation in parliament. It is true that measures like quotas have been introduced, but only voluntary ones introduced by the political parties themselves and only after the main battles of representation had been won in the 1970s".

Here in Nigeria a lot of factors are responsible for hindering women's political participation. These include cultural, party barriers, socio-economic, religious, violence and many others. The more traditional a society is the more difficult it would be for women representation in the system. In patriarchal societies men are traditionally expected and favoured to be the dominant rulers not only by men themselves but also by women who believe that power and decisions are matters meant for men to tackle. In fact this group of women belong to the school of thought that strongly agrees that men are better equipped mentally, emotionally and physically to make decisions and tackle problems. Due to this majority of women lack confidence in themselves necessitating the men not considering them at all for any elective post because she is more likely to fail.

Berit Lindeman quoted earlier also opined that, "unemployment and economic instability tend to affect women harder than men. In turn it influences the women's mobilisation in a negative way as there is a connection between women's unemployment and political activity. Women have on the hand twice the share of unpaid work than men most significantly of course domestic work, child care and other social care. In Nigeria women work in average more than 16 hours a day according to the Nigerian CEDAW (Convention on the Elimination of All Forms of Discrimination against Women) implementation report. How can they possibly find time for going into politics?”

Even though a lot of international conventions have been ratified for women inclusion in politics, women are still not being listed on the political parties' ballots and one mechanism which has been a stumbling block to women's representation in politics is the type of electoral system on ground. Unfortunately this is taken for granted in Nigeria. If a study of last 50 years of statistics concerning women's representation by type of electoral system is analysed, it seems clear that the choice of electoral system is highly relevant for the share of seats being won by women.

A woman is twice as likely to be elected under a Proportional Representation System compared to the First-Past-The-Post System currently in use in Nigeria. As Nigeria practices the First-Past-The-Post System, only one candidate is almost always elected from each district which makes it necessary for the party to find the single one candidate that is most likely to win the seat. Because there is a tendency for the candidate to be a man, the system works to the disadvantage of the women. But in Proportional Representative System the reverse becomes the case as there is always an opportunity to elect a candidate from a disadvantaged group. With this system it would be a lot easier to elect women.

The rational underpinning all Proportional Representative System is to consciously reduce the disparity between a party's share of the national votes and its share of the parliamentary seats. For example if a party wins 40 percent of the votes, it should win approximately 40 percent of the seats. Proportionality is often seen as being best achieved by the use of party lists, where political parties present lists of candidates to the voters on a national or sub-national basis and where there are many members to be elected from each constituency thus enabling the representation of even small minorities.

According to Nkoyo Toyo, the founder of Gender and Action Development, a non-governmental organisation involved with gender equality in politics, "many factors favour the election of women in Proportional Representation System. The more candidates from each district, the more women have a chance of taking a seat because the party will search for different types of candidates to nominate in order to attract different voter groups. The parties have a chance of competing for several seats allowing them to go further down on the list where women normally are".

Alternatively the government could codify into law the reservation of some seats for women who are interested in politics. By election law several countries have a certain number of seats reserved for women. Some of these countries include Rwanda, Uganda, Tanzania, Pakistan and Bangladesh. The new Iraqi and Afghanistan constitutions both have considerations for women. These reservation options ensure that women are not isolated in political life. Nigeria can borrow a leaf from these countries.

On a realistic point of view, how would this system work for women who are obviously in the minority? This is where the Principle of Affirmative Action comes in. What is the principle all about? According to a report of the National Forum on Affirmative Action for Nigerian Women in Politics, "It can be summarised to mean the creation of representativeness as a means of achieving equality in participation, with major emphasis on the need to create an environment for its existence and be acceptable rather than imposed. This will mean that to ensure the increased participation of women in politics certain representations should be preserved for women, the environment within which this could strive could be in form of legislation, policies or laws as well as constitutional provisions that stipulates these".

To achieve this we have to begin with the amendment of our electoral system to accommodate the plight of these women. That means that we have to retouch the Section 77 of the 1999 Constitution of Nigeria and Section 60 of the 2002 Electoral Act of Nigeria to reflect the Proportional Representation System which is the only method that would be able to accommodate the interest of women.

Former President Olusegun Obasanjo in a paper he personally delivered at an Independent National Electoral Commission/Civil Society Organisations Forum lent credence to this idea when he said, "it is a wise decision to start by examining the very foundation of our electoral system which determines winners and losers as well as their respective fate. Those who framed our Constitution and the Electoral Act must have had their reasons for adopting the First-Past-The-Post system which bestows on the winner by even the narrowest of margin of vote’s victory and the loser virtually nothing".

"I believe it will be right to examine the advantages and drawbacks of the current system in the context of our own experiences. I believe it is possible to identify a system which spreads the benefits of winning elections and limits the damage to looser so that the political system itself can grow from each successive election", he concluded.

Monday, April 27, 2009

Stigma Against HIV/AIDS Victims: A Big Shame On All Of Us!

Shola was only six years when she lost her parents to the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS). She was then forced to live with her aged grandmother just like many other kids in the same condition as hers. But things were not as easy as she thought they would be.

First she was asked to leave the school because pupils in the same school with her are being withdrawn for fear of being infected. She went home broken-hearted and disappointed. But that is not the end. Her church treated her with contempt opining that it is a punishment from God for her parent’s lifestyle while her childhood friends began to distance themselves from her one by one.

At the age of nine when her HIV metamorphosized into AIDS, she was admitted into the nearby government hospital as a last resort in the battle to save her life. But the place she thought was a haven for her proved not to be. She was quarantined from other patients in the hospital in the name of special treatment. She was kept in a separate room, fed with special utensils, treated with double gloves and above all had no free interaction with either the health workers or other patients in the hospital.

Whenever they see her they felt very uncomfortable and at a stage told her that she is not welcomed to interact with them due to her status. That was the last straw that broke the camel’s back. She died one month later after this bad news not as a result of her AIDS but primarily because of the way she was treated with stigma and discriminations from the people who were supposed to be friendly and act as a pillar of support for her.

Shola’s case is not a peculiar one but just a fragment of what numerous other people out there with the virus go through on daily basis right from their family members to the public health workers who are supposed to be the last resort in the fight against this virus. This situation has led to a lot of people with the virus preferring not to disclose their status for the fear of being stigmatised and ostracised.

According to a recent report from the Joint United Nations Programme on HIV and AIDS (UNAIDS), “openness about one’s sero-status to family, community or work place is more difficult in some countries or cultures than others. In some cases precautions are needed to protect people who disclose their positive serostatus since this can create serious repercussions for them in their jobs and within their families and communities. Discriminations show up in different ways from almost invisible types of social behaviour on the one hand to physical violence on the other. Similarly PWHA’s (People with HIV/AIDS) fears may range from purely personal and not always accurate perceptions of discrimination all the way to objectively based fears of rejection and violence”.

For instance the pathetic case of a 45 year-old Nigerian, Frederick Ibikunle Adegboye is still very fresh in the mind of the international community. The Nigerian Institute of Journalism as a result of his HIV positive status terminated his offer of provisional admission. This is despite the fact that he passed all the entrance examinations and paid all the necessary fees. In fact he confided his serostatus to the school provost so as to be allowed time to be going for his anti-retroviral treatment as and when needed. The provost betrayed the confidence reposed on her.

This is just one part of the problem, another part of it is that the life-saving anti-retroviral therapy to manage the virus is still eluding vast majority of the victims of the virus in the sub-Saharan Africa. In the early 1990s when antiretroviral drugs became available, AIDS was transformed from a certain death sentence to a manageable chronic disease but only for some. The expense of the drugs and their distribution prevented 95 percent of those living with HIV from getting access to them.

International outrage that millions were dying because of economic disparity helped reduce drug prices and to create the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002. Through the Global Fund and the US President’s Emergency Program for AIDS Relief, the world began to invest in a massive rollout of antiretroviral treatment in more than 100 developing countries. Doctors and healthcare workers around the world have adapted complicated procedures to settings where people often could not access even the most basic care. Already, millions of lives which otherwise might have been lost are being saved. Equally important, providing treatment is becoming a central part of the efforts to prevent further spread of the disease.

Today three million people around the world are alive thanks to antiretroviral treatment for AIDS. This is a sharp increase from 350,000 just about five years ago. By 2010, more than five million people are likely to have been given access to these drugs. Yet there is a long way to go before all the people with HIV who need these life-saving drugs can have access to them. Today the need is for 10 million people, but until we can stem the growth in new HIV infections, that number will continue to grow. Africa is obviously the place this attention needs to be focused as a result of the havoc the virus is causing there and the inability of the victims to access the anti-retroviral therapy. Poverty is the main factor for this ugly situation.

In 2003 at the opening ceremony of the 11th International Conference for People Living with HIV/AIDS held in Kampala, Uganda, Ben Plumley, Chief Executive Officer at the UNAIDS decried that it is, “serious injustice to see that only one percent of the 4.1 million people in sub-Saharan Africa who need anti-retroviral therapy have access to it”.

He charged the conference to look for ways to close this vast treatment gap even as he opined that they are under a moral obligation to also tackle the intolerance and fear that prevents people from accessing the service they need. Same charge was also repeated recently at the Monthly Journalists Roundtable Talk of the Local Voices Project of the Internews Network in Abuja where journalists and stakeholders in attendance spoke in unison in condemnation of the stigma and discriminations facing the people living with the virus.

The first salvo was fired by Esther Agyo the Chief Nursing Officer of Wuse General Hospital in Abuja who expressed dismay over the way people living with the virus are treated and wondered aloud where our virtues of love, caring and charity in times of need has gone to. She condemned in clear terms the mandatory HIV/AIDS testing being imposed on patients by some health establishments before treatments are given opining that they are not only against the fundamental human rights of patients to choose their own form of treatment but also very unethical, inhumane and cynical.

“HIV test should be voluntary and not mandatory but health workers force it on patients. This is unethical and demoralises the patients by making them loose absolute faith in both the treatment and care given to them. This is one thing we do not do in Wuse General Hospital and that has endeared our patients to us and strengthened the faith they have in us”, she said.

She made a passionate call for patients opinion and consent to be taken into consideration and respected before carrying out any test on them even as she called for heartfelt love and caring for people living with the virus noting that the next victim may likely turn out to be our relative who is obviously going to receive same treatment we meted out on others.

Olufemi Dada the Chair of Nyanya General Hospital also in Abuja concurring with Esther Agyo noted that people living with the virus are not apes or beasts but humans who are in need of our help. Explaining that since the virus could not be contacted through shaking of hands, hugging or discussing with the victims we should endeavour to afford them that opportunity.

Taking a theological angle Peter Ikiti an evangelist and the coordinator of the United Care and Productivity, a non-for-profit devoted to counselling and caring for people with the virus noted with disgust that people living with the virus have been enduring the barbarity of the godless behaviours of our health workers with fortitude, having been kept in semi-quarantine without prospect of change. He explained that once a person living with the virus arrives at the hospital he faces the usual behaviours of the health workers which ranges from stigma to discrimination and lack of attention.

“Some of them at present are in a very bad condition. Everything that has to do with them is separated including their bedside. It is difficult to notice tuberculosis patients in the hospitals but people living with HIV/AIDS are very conspicuous because of the way they are usually quarantined by health workers. Separate seating arrangements, separate departments for treatment and special doctors without special training. The brown envelopes and polythene bags used for the packaging of their drugs are special. Once a person living with virus comes out with a brown envelope or bag every other person will know he is a victim. All these in the name of special attention! But it is rather a special way of stigmatising, discriminating and humiliating the victims”, he claimed.

The Roundtable participants observing that the recent UNAIDS progress report reported a huge progress in the fight against the virus regretted that critical gaps continue to exist particularly in access to HIV medicines and efforts to combat stigma and discriminations and protect the rights of people living with the virus.

They called for compulsory nametag and number on the uniform of all health workers for easy identification and reporting to appropriate authorities for necessary punitive measures against the erring ones. This is in addition to their suggestion that the government should take it as a responsibility to organise frequent workshops for health workers on HIV/AIDS prevention and control, support and management and the care of the people living with the virus.

For over 25 years, AIDS has ravaged the lives and livelihoods of millions of people. Since the early 1980s, nearly 30 million people have died from AIDS. That is about half of the UK population. But over the past few years, a quiet global revolution has enabled millions of people infected by HIV to live healthy lives. More are still to be done though. For instance in Haiti with a population of 9.6 million, 115,000 people are living with the virus while only 13,586 are on anti-retroviral treatment. India has a population of about 1.13 billion with 2.5 million living with the virus while only 126,400 are on the treatment. Mali with a population of 12.2 million has 130,000 people living with the virus with only 15,450 on the treatment.

In Peru with a population of 27.9 million, 10,400 are on the treatment out of 93,000 living with the virus. Russia has 31,000 people on the treatment out of 940,000 living with the virus in a population of 143.2 million. In Rwanda out of 150,300 people living with the virus only 44,400 are on the treatment in a population of 9.2 million. South Africa has a population of 47.4 million out of which 5.5 million people are living with the virus but it is only 488,739 that are receiving the treatment. In the neighbouring Swaziland with a population of about 1 million, about 20,610 are on treatment out of 220,000 living with the virus while in Vietnam with a population of 84.2 million, 132,628 people are living with the virus while 14,180 receives the treatment. Nigeria with a population of about 145 million people has about 3.5 million of the population infected with the virus while only about 124,572 are on the anti-retroviral treatment. In fact India, South Africa and Nigeria are the countries bearing the highest burden of the virus in the world.

Free antiretroviral treatment is saving millions of lives and that alone is enough reason to continue to widen access to it. But the main challenge in the fight against AIDS today is preventing new HIV infections. Worldwide 2.5 people are infected by HIV for every person that begins treatment. To win the fight, we must turn those numbers around. Antiretroviral treatment helps in this struggle by turning a certain death sentence into merely a chronic disease. In doing so, fear and stigma is reduced, more people will dare to be tested for HIV, and it will become easier to talk openly about how it spreads and how to protect against infection.

There are other challenges. Even where those infected have access to antiretroviral treatment and their immune systems begin to recover, infections and illnesses they have already developed because of HIV may take their lives. Tuberculosis continues to be the leading cause of death among people living with HIV/AIDS, and hepatitis, liver diseases and HIV-related cancer also take their toll. Nonetheless ARV treatment is generally successful. After two years on treatment, eight out of every ten people who started are still alive.

The success in rolling out antiretroviral treatment against formidable odds should inspire us to go for the test and since there is no cure yet testing remains the only way to stem the tide of the spread.

Friday, April 24, 2009

War Against Iodine Deficiency Disorder

There is a big problem at the moment in Nigeria and the consequence of that problem could be catastrophic because it is a health problem. The bad news however is that Nigeria is still lagging behind in tackling the problem head-on and according to experts the shock this problem would leave on the nation could be double compared to that of HIV and AIDS.

The problem is called the Iodine Deficiency Disorders (IDD) and even though Nigeria is very susceptible to these especially in areas where the soil is deficient in iodine it seems not to have been doing enough to nip this problem on the bud.

The target to eliminate the problem by 100% in the shortest possible time is still eluding Nigeria and the situation has led to the widespread of Iodine Deficiency Disorders especially goitre, cretinism, reproductive failures and hypothyroidism in the four most endemic states of Ebonyi, Taraba, Nasarawa and Benue.

Apparently because of the calamitous situation, the National Agency for Food and Drug Administration and Control (NAFDAC), launched a media sensitisation campaign to enlighten both the media and the public on the dangers of using non-iodized salt as well as the negative health implication of overusing and under using the substance.

Iodine deficiency is often characterised by neurological changes which amongst other things can also cause permanent damage to the cognitive development in children, severe mental retardation and impaired mental function in adults while the severest form manifests as goitre. However the most frightening aspect of iodine deficiency in babies and children is inability of the brain to be fully developed for maximum Intelligent Quotient (IQ).

For instance, a recent survey revealed that children born in iodine deficient areas are more likely to have a low IQ. A similar survey conducted in Nigeria in 1993 concurred with this finding and also indicated a 20 percent prevalence for IDD with an estimated 25 to 35 million Nigerians at risk. At the time of the survey, less than 40 percent of table salts sold in Nigerian markets were iodised.

Following the bolt from the blue of this finding, the Nigerian Government in 1993 demonstrated its commitment to eliminate the IDD through salt iodization by promulgating legislation that made iodisation of edible salt mandatory in the country. It also set clear iodine fortification levels in the salt.

Obviously accepting that the idea is not sinking into the bone marrow of the major players in the iodisation sector, the Federal Ministry of Health teamed up with the National Agency for Food and Drug Administration and Control, the United Nations Childrens Fund and Standard Organisation of Nigeria on an aggressive Universal Salt Iodisation campaign as a vehicle to ensure that people are not only aware of the need to use iodised salt but also to patronise only iodised ones.

As a show of commitment the Nigerian Government recently passed an Act mandating the iodisation of all edible table salt and to provide a legal backing for more effective regulation, NAFDAC formulated and got the Government to sign into law the Food Grade (Table or Cooking) Salt Regulation No. 14 of 1996, which stipulates that table salt shall be iodised and have a minimum level of iodine ex-factory/at port of entry of 50mg iodine/kg and at retail or household end of 30mg iodine/kg.

According to the Nigerian Industrial Standard for Food Grade Salt, NIS: 168/1992, Potassium Iodine which is a more stable compound than the cheaper iodised form is also recommended for use as a fortificant and it is against this backdrop that the NAFDAC underscored the importance of media involvement and assistance in the efforts to control IDD and enlist Nigeria as USI compliant.

Iodine Deficiency Disorders constitutes the single greatest cause of preventable brain damage in infant and of retarded development in young children. It is also a threat to both health and development worldwide. IDD as noted at outset results in goitre, stillbirth, miscarriage, mental retardation and impaired capability, amongst other consequences.

Bearing this in mind, one cannot over emphasise the urgent need for all hands to be on deck to nip this problem on the bud. It requires our collective commitment and pressure on the government of the day to do more to ensure that all households in Nigeria consume iodised salt. This calls for a team work and more than what one agency of the government can achieve within a short time hence my revisiting this issue five years after I wrote on the issue for the first time.

Iodine is very important to the body just like the air or water. On daily basis, at least 150 microgram (ug) is needed for healthy development of the body. The recommended daily intake of iodine is at least 150 micrograms (ug). Ingested iodine which the body does not utilise is normally passed out of the body through urine. This makes the urinary iodine level a reliable index of the iodine status of an individual.

A urinary iodine level less than 50 ug per day indicates iodine deficiency. A mean daily urinary iodine excretion in a given population which is less than 25mg indicates severe deficiency of iodine in the area. Though the initial proposal of the Nigerian Government was to embark on iodine supplementation through the distribution of Lipipodol capsules to all women of childbearing age living in the IDD endemic areas, the strategy of enriching salt, water and flour with iodine was also considered.

However the option of salt iodisation was chosen by the World Health Organisation (WHO), due to its feasibility and cost-effectiveness, in addition to its universal acceptance and affordability. The wisdom behind this choice was that since salt is a condition sine qua non in homes in Nigeria, the option of using that which is common to them becomes not only wise but also viable and handy.

It should also be noted that risks are also associated with this method if it is not used with moderation. The excessive intake of salt is a major factor in High Blood Pressure otherwise called the hypertension while the low intake could result in cretinism also known as stunted growth, low IQ in growing children, poor brain development and similar problems.

Since the early 1990s, Nigeria has been implementing the national programme on the eradication of IDD through the USI. The result obtained so far indicates that Nigerians are very comfortable with this method. Part of the reason as I mentioned earlier includes its availability, cost effectiveness and a very simple fortification process. If the present trend continues, Nigeria would soon be enlisted as USI compliant nation.

An impact evaluation of some previously IDD endemic sentinel sites indicated drastic reductions in total goitre rate and more significantly increased urinary iodine excretion rates. Goitre rate which was 20 percent in 1993 was found to have dropped to 11 percent in 1999.

In the same trend collated reports of the December 2002 IDD task force survey indicated the following iodine level;
• 97.3 percent at Household level
• 98 percent at Retail level
• 100 percent at Distributor level
• 100 percent at Factory level compared to 40 percent in 1993.

Though this may sound a good news but bearing in mind how long it took the government to get this far and the fact that the battle is yet to be over in eliminating the problem at household and retail level by 100% in the shortest possible time, we need to ask the Nigerian Government to show more dedication and seriousness in fighting this problem.