I sit at a table across Machivei Muzenda, a migrant nurse from Zimbabwe, as she tells me about the hospice she runs at the Central Methodist Church. The room is musty, as though nothing but humid air flows through. Two young women lay side-by-side on old mattresses, bed ridden, while a young man sits by the heater with a blank stare on his face at the other end of the room.

She begins by telling me how she ended up at the church. “ I, myself am a migrant. I came to South Africa in 2007 and found solace at the church. I am professionally trained nurse, and when I saw that no one was caring for pregnant women, I decided to do something ”, she tells me. “ We initially took care of mothers with HIV and children, but with the increasing number of migrants and people seeking health care, we had to make room for patients with TB. “   I was concerned with the risk these patients-especially those with HIV-face by being housed in one room. Surely TB patients are a death trap to the HIV patients, I thought to myself. She points to a light fixture that supposedly attracts bacteria and assures me that they were not in any kind of danger.

She takes me on a tour of their modest hospice, with only the entry area used as the patients sleeping/living area. The kitchen is small, the fridge is empty and the cupboards are bare with one bag of instant brown porridge on the kitchen counter. The Home Based Care receives monthly food packages from the Solidarity Peace Trust-20kg of maze-meal; 1kg margarine; salt and sugar-which is to last them a whole month, and is supplemented by 7 loafs of bread and 2kg of sugar from The Roman Catholic. These are clearly not sufficient to feed all the patients and to give them the desired nourishment, but Machivei tries to make the best of what she has.

All the patients have learnt to share the little resources they have, from sleeping space to the tiny bathroom. Machivei and her stuff do all they can to limit the level of bacterial spread among the patients. They each have a bucket which they use to bath since using the tub directly would spread the bacteria easily. They live in abject poverty with terrible diseases, all crammed up in a small space. With the alternative being the streets, they just have to bare it and hope for better days.

I ask about if they get their ARVs and other meds, “...they do...” she assures me,  and tells me about the clinic downstairs ran by DR. Evans Kuntonda of Doctors without Borders. The clinic provides primary medical care and passes the severe cases on to the more resourced hospitals. They then monitor the patients’ health when the hospitals are over capacitated and they are sent home to die.

  Machivei can’t stop telling me how much they need exercise equipment, a television, blankets, food and a host of other things. True to a care giver. I walk away with a sore heart knowing that African Heads of State still cannot grasp how severely ordinary citizens punished because of their inaction on Health Care issues. 

After two heated debates during the recent African Ministers of Finance meeting in Malawi, national delegations from South Africa, Rwanda and Egypt succeeded in deleting any reference to budgetary targets for education, health, agriculture and water in the Common Position on MDGs and the conference report and resolutions. Their action brings into question the extent to which African Finance Ministers are committed to continental integration, the Millennium Development Goals and the declarations and resolutions of their own Heads of States.

The budgetary targets are embedded in a set of important Declarations and Decisions adopted by Africa’s 53 Presidents as far back as 2003. The Declarations and Decisions include the Dakar Framework for Action-Education For All: Meeting Our Collective Commitments (2000), the Abuja Declaration on HIV/AIDS, Tuberculosis, and Other Related Infectious Diseases (2001), the Maputo Declaration on Agriculture and Food Security (2003) and Sirte Declaration on Agriculture and Water (2008). Among other strategies these Declarations and Decisions commits Governments to devote up to 20% to education, 15% to health, 10% to agriculture and 0.5% to water and sanitation.

The delegations were attending 3rd Joint Annual meetings of the AU and Economic Commission for Africa Conference of Ministers of Finance, Planning and Economic Development in Lilongwe, Malawi held between 29-30th March. The Ministers had met to address progress towards the MDGs and in particular, realizing food security and employment among other issues.

2010 is a critical year for these issues. In September, African Presidents will join their counterparts to report against the Millennium Development Goals in the UN General Assembly. African Governments will challenge the G20 to follow up G8 promises on doubling aid to Africa and global trade reform in June as well as push for the delivery of US$30 billion promised for national adaptation and mitigation efforts in Copenhagen last year. The positions taken by the Finance Ministers in this context seems to undermine African Governments attempts to hold its development partners accountable for the promises reached.

In the heated debates, Cecil Noel, South Africa’s Chief Finance Director set the tone for the debate that followed, stating, ““These targets do not make any sense. I shall be asking my Head of State to propose a review of these targets in the AU Summit in Kampala in July.” He proceeded, supported by Egypt’s Deputy Minister Hany Dimian to argue, “The Heads of States have made a colossal mistake. These targets straightjacket the process of budgeting in our countries.” Rwanda’s Finance Minister John Rwangombwa concurred and was swiftly followed by Zimbabwe and Egypt’s call for the targets to be abandoned. Mozambique’s Vice Finance Minister Pedro Couto called for any reference to 10% budgetary target for agricultural investment to be struck from the resolutions. Ironically, the Declaration is known as the Maputo Declaration. Agriculture Ministers adopted it in a meeting chaired by Mozambique in 2003 in Maputo.

Delegations from Nigeria, Kenya, Ghana, Malawi and Cote D’Ivoire argued for their retention in the drafts prepared by the AU Commission and Economic Commission for Africa. Addis based Ambassador Nkoyo Toyo warned against delegations dismissing Decisions. She referred to their historical importance as standing commitments and cited a number of countries that have raised their budgetary allocations. The Nigerian Head of Delegation further note; “I worry about the precedence we are setting where we make commitments and then drop then when it is expedient.” Kenya’s National Planning Permanent Secretary Edward Sambili reminded the delegations that the targets are aspirational in nature. He further pointed to the 38% that Kenya currently allocates to the four sectors as evidence that it is possible to reach these targets.

Attempts by the meetings Malawian Chairperson Hon Ken Kandodo and AUC Chairperson Jean Ping to remind the Finance Ministers that the Ministers did not have the power to change these Presidential commitments fell on deaf ears. Accordingly, without the consensus needed, the references to the budgetary targets were struck first from the resolutions, then the Common Position on the MDGs and finally the report of the Ministers conference.

There are many consequences that could flow from this. Firstly, this could indicate an abandonment of the bold financing that has gone into reversing vulnerability to food insecurity, disease and denial access to education. According to the NGO African Monitor (www.africanmonitor.org), it is these targets that have inspired the improvements in small-scale farming, primary education enrolment rates and falling HIV/AIDS infection rates. In 2009, they noted that despite this progress, 44 countries continue to import 25% of their food needs, retention of girls in education and overall quality is still weak and huge inequities exist between urban and rural, rich and poor, with most people living positively with HIV/AIDS not having access to life saving medicines.
Secondly, how will Africa now have the integrity to hold the G8 and international community to the commitments that they have made to contribute 0.7% of their gross national product and double development assistance to Africa? Should Presidents backtrack on these commitments in Kampala, will African Union President Bingu wa Mutharika be able to stand before the G20 in June and the UN General Assembly in September and remind the international community of their obligations? I think not.

Thirdly, the dismissive nature with which the Finance Ministers have treated these targets begs the question whether the Millennium Development Goals and all the other Decisions taken under the auspices of the African Union will go the same way. This path would further damage the credibility of Africa’s leaders in the eyes of those African citizens who feel their leaders are unaccountable and self-interested. For this community, it is one more reason to dismiss Africa’s leadership.

Lest you the reader be one of them, consider that behind these Declarations and Decisions are a number of research consultancies, numerous meetings of African Ministers of Education, Agriculture, Water and Sanitation and Health, at least five Summits of Addis based Ambassadors, Ministers of Foreign Affairs and Heads of States and their delegations. At a conservative figure, this could have run into US$10 million over the last ten years. Got your attention? I think so.

Ends

Football in Malawi is conventionally synonymous with hoards of fans crowded around a TV or radio in a bottle store, market or a stall at the side of the road. Before the Flames, Malawi’s beloved national team, were knocked out of the Africa Cup of Nations, the atmosphere recently was electric; the constant city buzz of minibus drivers and vendors calling out to passers-by was unified in a sustained euphoric buzz of cheering and beeping of horns. Every goal brought with it a wave of the branches that were festively adorning vehicles that lined the streets. Even for those largely indifferent to the beautiful game, such as myself, it was impossible not to call out for the score or hurry through the supermarket check out to run and find the nearest television when a jubilant cheer filled the air.

The Flames didn’t qualify for the 2010 World Cup in South Africa but this disappointment has by no means dampened the nation’s passion for the game. In fact civil society firmly believes that there is still hope for the
country in the forthcoming competition. In fact all African nations can be winners in the first World Cup on African soil.

The world will have its eyes on Africa and campaigners in the Fair Play for Africa coalition are determined to use the opportunity to highlight the development needs of some of the poorest nations in the world.

There has been a great deal of progress in Africa in recent years and for the continent to be hosting the World Cup goes a long way to showing this; this is an extremely positive occasion. Yet there is still so much more that needs to be done. Whilst the international community is brought together through sporting entertainment and Africa’s great achievements are recognized, we must ensure that those who cannot join in the festivities are not forgotten. My passion for the cause is echoed by the numerous African-based organizations which have come together with this common goal.

Fair Play for Africa simply calls for a recognition of what is right – that African and international donor governments keep their promises. It is blowing the whistle on injustice. Whilst football fever begins to fade, the African Union Summit will take place in July. This is the time for member states to endorse a Millennium Development Goal (MDG) Acceleration Plan. Malawi is far from meeting some of the most vital targets. Maternal mortality is extremely high by sub-Saharan African standards at 807 deaths per 100,000 live births. The UN MDGs seek a two-thirds reduction in the deaths of children under five, and to reduce maternal mortality rates by three-quarters by 2015. However over the last 10 years, only 5 of Africa’s 53 countries have managed to halve mortality in children under the age of five.

Donor governments must support African nations in the establishment of an African-led plan and they can do so by delivering on the aid commitments they made at the 2005 Gleneagles G8 meeting. AU governments also have outstanding obligations: the Abuja Declaration stated that they would commit a minimum of 15% of their national budgets to health – a commitment that only Botswana, Burkina Faso, Malawi, Niger, Rwanda and Zambia have so far kept.

Yet financial contributions are only the start of improvement – effective spending is of equal importance and significantly more difficult to ensure. In Malawi civil society experts are constantly urging the government to use their resources and specialist knowledge for the betterment of the country. There is a desire to engage not merely criticize common practice.

For many in Malawi, as with their comrades across Africa, the triumph of an African World Cup may be a welcome break from the adversity of everyday life where even basic but essential medicines are unobtainable due to lack of availability and prohibitive costs. In Malawi, children under five suffer on average 10 episodes of malaria a year, therefore to buy them the right drugs would cost guardian’s 50 days salary, an impossible cost to bear, even if they can access them – one in five clinics across the country do not have first line drugs available -  meaning many children go without medicines.

Africa's hosting of the 2010 World Cup is a momentous occasion in football history and we must celebrate Africa’s accomplishments and support its continued development – a development that is equitable and accessible for all. So when that final whistle blows, let’s be sure that sportsmanship is not the only thing we can be proud of. Let’s be certain that we as individuals, governments and civil society alike, have shown poverty the red card.

Maziko Matemba, Fair Play for Africa in Malawi

2010 is here at last, having arrived amid much hype about how the World Cup will benefit the whole of Africa. But who will really benefit? First in line will be big business of course, but it’s not clear what poor people on the continent will gain. In order to leave a true legacy that goes beyond the football stadiums, it is imperative that it serves as an impetus to deal with social issues like poverty, health and education.

Ten years ago, in New York, world leaders committed themselves to the Millennium Development Goals, promising to halve poverty and increase access to health care.

Nine years ago, in Abuja, African leaders promised to spend 15% of our budgets on health, to take personal responsibility and provide leadership on the HIV/AIDS pandemic and other preventable diseases.

Every year since 2001, Africa’s leaders have committed the African Union and their governments to promote and protect the right to health in a series of international and continental declarations. These commitments provide a comprehensive package for addressing the challenges of maternal mortality, child mortality, and HIV/Aids, TB and Malaria. Africa accounts for 22% of births globally, yet half of the 10 million child deaths every year occur in the continent. A woman in sub-Saharan Africa has a 1 in 16 chance of dying in pregnancy or childbirth, compared to a 1 in 4,000 risk in a developing country.
  
It’s not all doom and gloom: some countries are on track to ensure that people have access to quality healthcare, particularly for women, children and people living with HIV/AIDS.

Six countries – Botswana, Burkina Faso, Malawi, Niger, Rwanda and Zambia – have succeeded in meeting the Abuja target of 15% of government spending going on health.

We need to celebrate this and highlight the leadership and determination shown in those countries.
Unfortunately they are the exception, rather than the rule. Most countries on the continent are way off target and 14 countries are actually moving backwards. Only five of the continent’s 53 countries have managed to halve deaths of children under the age of five.
In six countries, child mortality has actually increased. Millennium Development Goal #5 aims to reduce maternal mortality by three-quarters. Yet maternal mortality rates have risen in 23 out of the 49 countries where data is available.

Some strides have been in the fight against malaria, and in TB detection and treatment. But HIV prevalence remains high and continues to rise in many countries with greater needs in terms of anti-retroviral treatment.
Based on current levels of leadership, resources and coordination, most countries will not only fall short of the targets but will have to make a Herculean effort to turn this situation around.

African governments have described the health situation as a “continental state of emergency” – now they need to move beyond rhetoric and urgently adopt an accelerated plan of action with a clear timetable and firm policy and programme interventions.
It is time for honest reflection and for the AU to step up and play a more decisive role. We need a realistic plan for the next five years that is well resourced from national government allocations in the first instance and supported by donor countries.
In a resource-scarce environment, AU governments must review health care delivery systems to ensure they are cost-effective. We cannot afford “business as usual” any longer.

Civil society organisations have started the process of combining their efforts and energies to ensure this happens, by forming the Fair Play for Africa initiative. Organisations from across the continent have come together in a campaign to try to ensure 2010 is not just about the beautiful game, but leaves a legacy of quality health care across the continent. Let’s unify through the passion and power of football and make this tournament an opportunity to reaffirm our common goal, which is health for all.

As our leaders meet at the African Union Summit this week they should be aware that we are watching them, and that the possibility of a healthy future is in their hands. Let’s play fair for Africa.

Vicky Okine is a human rights activist and currently Executive director of the Alliance for Reproductive Health Rights in Ghana. She is on the steering committee of Fair Play for Africa