Marking a New Dawn – Historic Arms Trade Treaty Signed at U.N


By Lucy WestcottReprint |
Anna MacDonald of Control Arms speaks at the start of the ceremony for the signing of the Arms Trade Treaty at United Nations headquarters in New York, Jun. 3, 2013. Credit: Keith Bedford/INSIDER IMAGES (UNITED STATES)Anna MacDonald of Control Arms speaks at the start of the ceremony for the signing of the Arms Trade Treaty at United Nations headquarters in New York, Jun. 3, 2013. Credit: Keith Bedford/INSIDER IMAGES (UNITED STATES)

UNITED NATIONS, Jun 4 2013 (IPS) – The United Nations witnessed a historic moment Monday with the signing of the Arms Trade Treaty, first adopted in April by the General Assembly, and the first time the 85-billion-dollar international arms trade has been regulated by a global set of standards.

Negotiations took place between 193 countries, 63 of which signed on Monday. More countries are expected to sign by the end of the week.

“We all know about history, so [the U.S. has] a big responsibility.” — Alex Gálvez of Transitions Foundation of Guatemala

The treaty will regulate all transfers of conventional arms and ban the export of arms if they will be used to commit crimes against humanity.

The treaty also calls for greater transparency and for nations to be held more accountable for their weapons trading. States will undergo rigorous assessment before they move arms overseas and have to provide annual reports on international transfers of weapons.

But some of the world’s major arms importers and exporters, whose inclusion is crucial for the treaty’s success, have abstained or declined to give their signatures. Syria, North Korea and Iran were the only three countries to fully oppose the treaty, while Russia, China and India abstained.

The United States, the world’s largest arms exporter, did not sign, but is expected to by the end of the year. Technicalities in the language of the treaty were the reason for not signing; while U.S. support for the treaty is “strong and genuine,” there were inconsistencies in comparison between the English-language and translated versions of the treaty, said Daryl G. Kimball, executive director of the Arms Control Association.

“All other countries are looking to what the United States does,” Kimball added.

Ray Offenheiser, president of Oxfam America, said it is “critical” that the United States sign the treaty, which has been “10 years in the making.”

In a statement released by the State Department Monday morning, Secretary John Kerry welcomed the treaty, ensuring that the U.S.’s signing would not infringe on the fiercely debated Second Amendment rights of U.S. citizens.

“We look forward to signing [the treaty] as soon as the process of conforming the official translations is completed satisfactorily,” Kerry’s statement said.

The treaty is a crucial step towards ending the deaths of the 500,000 people Oxfam estimates perish from armed violence each year.

“The most powerful argument for the [treaty] has always been the call of millions who have suffered armed violence around the world,” Anna Macdonald, head of Arms Control, Oxfam, said in a statement. “Their suffering is the reason we have campaigned for more than a decade,” she added.

When asked if the treaty could prevent atrocities like those which have occurred in Syria, Macdonald said she believed it could, if implemented correctly.

With such vast negotiations taking place, disagreements were bound to arise.

“Items [such as] the scope of weapons covered by the treaty and the strength of human rights provisions preventing arms sales in certain circumstances are not as strong as we would have wished,” Jayantha Dhanapala, president of the Pugwash Conferences on Science & World Affairs and former under secretary general for disarmament affairs, told IPS.

Nevertheless, he believes the treaty is a “long overdue step” in realising Article 26 of the U.N. Charter, which calls for the “establishment of a system for the regulation of armaments”.

And considering the treaty was adopted just weeks ago, 63 signatures is an “excellent number,” Macdonald said.

The treaty will go into force after it receives 50 ratifications from states that have signed. This is expected to take up to two years, but some states, including the United Kingdom, have agreed to already start enforcing the rules of the Treaty.

One victim of gun violence was at the U.N. to witness the signing, the first step on the path to the treaty’s ratification.

Alex Gálvez, 36, was 14 years old when he felt a bullet course through his right shoulder, exiting through his left one. Buying sodas for lunch in Guatemala, Gálvez was caught up in a territorial dispute. The bullet perforated his lungs, but Gálvez said he was too young at the time to realise that he was dying.

Gálvez is now executive director of Transitions Foundation of Guatemala, an organisation that helps Guatemalans living with disabilities, many of whom have been injured by small weapons.

“They left a lot of small weapons without control” after three decades of violence in Guatemala, Gálvez told IPS.

“Unfortunately not everyone had had the opportunity to get treated in time, to get educated [about arms],” Gálvez said. “It’s not just Guatemala that is suffering [from armed violence]; many other countries are suffering too.”

While he received his medical treatment in the United States and understands that it’s a complex process, Gálvez would like to see the country sign, especially as it has provided small arms to many countries, including his own.

“We all know about history, so they have a big responsibility,” Gálvez said.

 

Private health providers are NOT more efficient, accountable or medically effective #healthcare


POSTED BY ANNA MARRIOTT ON MAR 28TH, 2013 globalhealthcheck.com
 
 

In 2009 Oxfam published “Blind Optimism: Challenging the Myths about Private Health Care in Poor Countries,” to help redress what we saw as an international health discourse increasingly dominated by unchallenged private sector advocates.  Some of those same advocates accused Oxfam of being purposefully selective with the evidence.

The health team at Oxfam were therefore very pleased to see the recent publication of a thorough and balanced independent appraisal of peer-reviewed evidence on this topic in PloS Medicine. The study supports many (not all) of our conclusions about both the public and private sector.

In their research Basu et al. assess the comparative performance of the private and public sectors in health across a range of health system performance areas. They are clear that comparative evidence is often lacking and that distinctions between what is public and private are often difficult (for example when public facilities act more like commercial operators by charging fees). With these limitations acknowledged, the authors’ own conclusion states:

‘Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector; however, the public sector appears frequently to lack timeliness and hospitality towards patients’.   

Like Oxfam, the authors of this comparative study make special note of the World Bank as an influential advocate of public-private partnerships in health, but one whose claims are often unsubstantiated by their own data. The authors raise concerns about a conflict of interest for the World Bank that may undermine the validity of their research and analysis on this topic.

Some highlights from the paper are listed below (though I recommend reading this important article in full – especially for interesting country examples):

Access and responsiveness

  • A significant proportion of services in some developing countries are provided by the private sector but figures vary enormously by country and by income level. When informal or unlicensed providers are excluded, the public sector provided the majority of care in 19 out of 22 low- and middle-income countries for which World Bank data is available.  
  • Studies that measured utilization by income levels tended to find the private sector predominately serves the more affluent. In Colombo, Sri Lanka, where a universal public health service exists, the private sector provided 72% of childhood immunisations for the wealthiest, but only 3% for the poorest.
  • Waiting times are consistently reported to be shorter in private facilities and a number of studies found better hospitality, cleanliness and courtesy and availability of staff in the private sector.

Quality

  • Available studies find diagnostic accuracy, adherence to medical management standards and prescription practices are worse in the private sector.
  • Prescribing subtherapeutic doses, failure to provide oral rehydration salts, and prescribing of unnecessary antibiotics were more likely in the private sector, although there were exceptions.
  • Higher rates of potentially unnecessary procedures, particularly C-sections, were reported at private facilities. In South Africa for example, 62% of women delivering in the private sector had C-sections, compared with 18% in the public sector.
  • Two country studies found a lack of drug availability and service provision at public facilities, while surveys of patients’ perceptions on care quality in the public and private sector provided mixed results.

Patient outcomes

  • Public sector provision was associated with higher rates of treatment success for tuberculosis and HIV as well as vaccination. In South Korea for example, TB treatment success rates were 52% in private and 80% in public clinics. Similar figures were found for HIV treatment in Botswana.

Accountability, transparency and regulation

  • While national statistics collected from public sector clinics vary considerably in quality, private healthcare systems tended to lack published data on outcomes altogether. Public-private partnerships also lacked data.
  • Several reports observed significant public spending being used to regulate the private sector in order to improve patient care quality, and with limited effectiveness.

Fairness and equity

  • Financial barriers to care exist in the public and private sector.
  • Private sector services tend to cater for higher income groups with studies showing exclusion and discrimination against poorer patients and women.
  • Several studies suggested the process of privatizing existing public services increased inequalities in the distribution of services.
  • Private contracting and social franchises showed potential for reaching impoverished groups, though findings are tentative because comparisons to the public sector are unavailable.

Efficiency

  • Contrary to prevailing assumptions, the private sector appeared to have lower efficiency than the public sector, resulting from higher drug costs, perverse incentives for unnecessary testing and treatment, greater risks of complications, and weak regulation.
  • The evidence is mixed (and often weak) on the cost of contracting to private providers – increasing expenditure in some countries whilst reducing it in others.

Other important findings

  • Rather than adding resources, several studies reported that growth of the private healthcare sector, whether independently or via public-private partnerships, directly reduced public funds and staff available for public provision.

And on the World Bank….

  • The World Bank has made strong claims that investing in public-private partnerships will improve efficiency and effectiveness in the health sector, yet several of its publications revealed that these assertions were either unsupported by data or the data was not provided in sufficient detail to pass minimal inclusion criteria for this review’.
  • Despite the lack of data about private sector performance, recent initiatives by the World Bank’s International Finance Committee (IFC) are underwriting the expansion of private sector services among low- and middle-income countries. For example in sub-Saharan Africa, the IFC has created a private equity fund to make 30 long-term investments in private health companies. These conflicts of interest pose a potential threat to the validity of World Bank-sponsored studies and raise the need for independent scrutiny.

The evidence from this study shows that while public health systems are often weak and under-resourced they still deliver better quality of care, more equitably and with greater efficiency than the private sector.  The study highlights the tendencies of private providers to serve higher socio-economic groups, have higher risk of low-quality care, create perverse incentives for unnecessary testing and treatment, and suffer from weak regulation. It also suggests there are a number of ways public health systems can do better.  They must be more responsive to patients and more accountable to citizens, improve systems for distributing essential inputs like medicines, and address financial barriers to accessing care (such as formal and informal fees).

These are legitimate challenges that deserve thoughtful attention and action, but they should not be used as evidence of the superiority of private sector approaches. Instead, the policy response to these findings should be very clear: far more effort and resources must be mobilized to maximize the clear advantages of public health systems, rather than further starving them of the resources and support they need to deliver equitable and quality health care for all.

 

Needless hysterectomies on poor women rampant across India: Study #Vaw #womenrights


Malathy Iyer, TNN Feb 10, 2013, 01.12AM IST
(Oxfam said that unnecessary…)

MUMBAI: Is India witnessing a spurt in unnecessary hysterectomies? Data released by international charity organization Oxfam on February 6 says as much. The agency said that unnecessary hysterectomies were being performed in Indian private hospitals to economically exploit poor women as well as government-run insurance schemes.

A right to information ( RTI) request filed by one of Oxfam’s local NGOs in the Dausa district of Rajasthan showed that 258 of 285 women—65%—investigated over six months had undergone hysterectomies. Many of these women were under 30, with the youngest being 18 years old.

An editorial in the British Medical Journal quoted Oxfam’s global spokesperson Araddhya Mehtta as saying that the “trend is seen all over India but is particularly disturbing in Rajasthan, Bihar and Chattisgarh where doctors simply abuse their power of being a doctor”. In 2010, the Andhra Pradesh government tweaked its state-sponsored insurance scheme to disallow hysterectomies in private hospitals after surveys revealed that uteruses of a number of beneficiaries were removed merely to claim higher insurance amounts (the state insurance scheme is only available for the economically poor sections).

Dr Duru Shah, former president of FOGSI (Federation of Obstetric and Gynaecological Societies of India), said that modern medicines could fix 95% of woman’s menstrual problems without the need for surgery.

However, experts fear the trend of unnecessary hysterectomies possibly exists in urban centres such as Mumbai as well.

Indeed, an audit performed by insurance companies in Chennai in 2009 had shown that more than 500 women in the 25-35 age group had undergone hysterectomies. A Central government study in the wake of the Andhra Pradesh scam had said that women under 45 rarely needed hysterectomy.

A 2011 research paper in medical journal Reproductive Health Matters, conducted by SEWA Health Cooperative doctors in Ahmedabad, showed that insured women—both in urban and rural areas—had higher rates of hysterectomy. “Among insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women,” said the study.

The OXFAM report, in fact, says that India should end its public-private partnership programmes (that allow poor women with government insurance plan to undergo a hysterectomy in private hospitals) until better regulation is in place.

Oxfam official Mehtta has been quoted as saying, “When women came with abdomen pain, doctors prescribed hysterectomy to women from poor economic backgrounds, telling them that it might be a cancer or a hole or a stone in the uterus without doing any thorough necessary investigations.”
Dr Duru Shah said that unnecessary hysterectomies affected the concerned woman’s health. “A young woman who has undergone hysterectomy may suffer early menopause (stoppage of periods) and the accompanying health problems of increased risk of cardiac diseases and fractures due to brittle bones,” she said.

Dr Rekha Daver who heads the gynaecology of J J Hospital, Byculla, said, “Generally speaking, there may be a marginal increase over the years. But this may only be because women from rural areas who travel to referral centres in cities don’t want to prolong their suffering.” She said it wasn’t feasible for these women to return to cities a second time for any treatment that may be required.

Incidentally, Maharashtra doesn’t allow hysterectomies in private hospitals under the insurance scheme launched last year for the economically weaker sections, called the Rajiv GandhiJeevandayee Arogya Scheme. “We have learnt from the Andhra Pradesh experience,” said Dr K Venkatesam, CEO of the arogya scheme.

However, not all agree that hysterectomies are on the rise. Gynecologist Dr Rakesh Sinha from Mumbai said, “It would be wrong to say there is an epidemic of hysterectomies in Mumbai or India. What has changed over the past few years is that we have facilities such as USG to make early and accurate diagnosis. Moreover, there are procedures available that allow women to go home within a day or two.”

 

Oxfam says world’s 100 richest people could end #poverty #mustshare


 
UK-based charity says the world’s 100 richest people earned enough in 2012 to end global poverty four times over.
 

The world’s richest one percent have seen their income increase by 60 percent in the last 20 years [EPA]
The world’s 100 richest people earned enough money last year to end world extreme poverty four times over, according to a new report released by international rights group and charity Oxfam.

The $240 billion net income of the world’s 100 richest billionaires would have ended poverty four times over, according to the London-based group’s report released on Saturday.

The group has called on world leaders to commit to reducing inequality to the levels it was at in 1990, and to curb income extremes on both sides of the spectrum.

The release of the report was timed to coincide with the holding of the World Economic Forum in Davos next week.

The group says that the world’s richest one percent have seen their income increase by 60 percent in the last 20 years, with the latest world financial crisis only serving to hasten, rather than hinder, the process.

“We sometimes talk about the ‘have-nots’ and the ‘haves’ – well, we’re talking about the ‘have-lots’. […] We’re anti-poverty agency. We focus on poverty, we work with the poorest people around the world. You don’t normally hear us talking about wealth. But it’s gotten so out of control between rich and poor that one of the obstacles to solving extreme poverty is now extreme wealth,” Ben Phillips, a campaign director at Oxfam, told Al Jazeera.

‘Global new deal’

“We can no longer pretend that the creation of wealth for a few will inevitably benefit the many – too often the reverse is true,” said Jeremy Hobbs, an executive director at Oxfam.

“Concentration of resources in the hands of the top one per cent depresses economic activity and makes life harder for everyone else – particularly those at the bottom of the economic ladder.

“In a world where even basic resources such as land and water are increasingly scarce, we cannot afford to concentrate assets in the hands of a few and leave the many to struggle over what’s left.”

Hobbs said that “a global new deal” is required, encompassing a wide array of issues, from tax havens to employment laws, in order to address income inequality.

Closing tax havens, the group said, could yield an additional $189bn in additional tax revenues. According to Oxfam’s figures, as much as $32 trillion is currently stored in tax havens.

In a statement, Oxfam warned that “extreme wealth and income is not only unethical it is also economically inefficient, politically corrosive, socially divisive and environmentally destructive.”

 

UN adopts historic ‘land grab’ guidelines


Man next to a pile of hay
In recent years large-scale acquisitions of farmland in developing countries have caused concern
11 May 2012 Last updated at 15:23 GMT,  BBC NEWS

The United Nations has adopted global guidelines for rich countries buying land in developing nations.

The voluntary rules call on governments to protect the rights of indigenous peoples who use the land.

It is estimated that 200m hectares, an area eight times the size of Britain, has been bought or leased over the past decade, much of it in Africa and Asia.

But aid agencies warn it will be very difficult to ensure the guidelines are implemented everywhere.

AFP quoted Clara Jamart from Oxfam as saying this was just a first step and urging caution.

“Governments have no obligation to apply these measures,” she said.

There has been growing concern about so-called land grabs, when foreign governments or companies buy large areas of land to farm.

In Africa countries such as Ethiopia, South Sudan, Democratic Republic of Congo and Sierra Leone have all signed major land deals with foreign investors.

Responsible investment

It is hoped this new agreement will secure access to land, fisheries and forests for millions of poor people who have historically used the land.

The document took three years to draw up and calls on governments to be transparent about land deals, consult local communities and defend women’s rights to own land.

It also emphasises the responsibility of businesses and multinational corporations to respect human rights when they move in to an area.

Problems can arise because in many parts of Africa local farmers, herders and gatherers do not have any formal documents for the land they use, which is often owned by the state.

Authorities often argue that big international deals bring investment and new technology to a region, benefiting local people.

But this is not always the reality and human rights organisations have highlighted cases where tens of thousands of people have been forcibly removed from their ancestral homelands to make way for foreign investors.

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