Access to artesunate-amodiaquine, quinine and other anti-malarials: policy and markets in Burundi

BACKGROUND: Malaria is the leading cause of morbidity and mortality in post-conflict Burundi. To counter the increasing challenge of anti-malarial drug resistance and improve highly effective treatment Burundi adopted artesunate-amodiaquine (AS-AQ) as first-line treatment for uncomplicated Plasmodium falciparum malaria and oral quinine as second-line treatment in its national treatment policy in 2003. Uptake of this policy in the public, private and non-governmental (NGO) retail market sectors of Burundi is relatively unknown. This study was conducted to evaluate access to national policy recommended anti-malarials. METHODS: Adapting a standardized methodology developed by Health Action International/World Health Organization (HAI/WHO), a cross-sectional survey of 70 (24 public, 36 private, and 10 NGO) medicine outlets was conducted in three regions of Burundi, representing different levels of transmission of malaria. The availability on day of the survey, the median prices, and affordability (in terms of number of days' wages to purchase treatment) of AS-AQ, quinine and other anti-malarials were calculated. RESULTS: Anti-malarials were stocked in all outlets surveyed. AS-AQ was available in 87.5%, 33.3%, and 90% of public, private, and NGO retail outlets, respectively. Quinine was the most common anti-malarial found in all outlet types. Non-policy recommended anti-malarials were mainly found in the private outlets (38.9%) compared to public (4.2%) and NGO (0%) outlets. The median price of a course of AS-AQ was US$0.16 (200 Burundi Francs, FBu) for the public and NGO markets, and 3.5-fold higher in the private sector (US$0.56 or 700 FBu). Quinine tablets were similarly priced in the public (US$1.53 or 1,892.50 FBu), private and NGO sectors (both US$1.61 or 2,000 FBu). Non-policy anti-malarials were priced 50-fold higher than the price of AS-AQ in the public sector. A course of AS-AQ was affordable at 0.4 of a day's wage in the public and NGO sectors, whereas, it was equivalent to 1.5 days worth of wages in the private sector. CONCLUSIONS: AS-AQ was widely available and affordable in the public and NGO markets of hard-to-reach post-conflict communities in Burundi. However greater accessibility and affordability of policy recommended anti-malarials in the private market sector is needed to improve country-wide policy uptake

Contingent spaces for smallholder participation in GlobalGAP: insights from Kenyan horticulture value chains

Private standards initiatives (PSIs) in agri‐food value chains raise questions of democratic governance and accountability relating to the voice and agency of those whom the standards are designed to benefit or whom they most affect. We employ the concept of ‘spaces for participation’ to analyse participation in a particular PSI, GlobalGAP, and assess how, and to what extent, it opens up a space for debate about what constitutes good practice in agri‐food chains and for whom. We draw on focus groups with smallholders, together with semi‐structured interviews and workshops held with actors at the national and international scales to examine PSIs operating in Kenyan export horticulture to examine good agricultural practice (GAP) standards. Our analysis suggests that despite public announcements that these initiatives promote the voice of the farmer, the direct participation of farmers is largely absent from these policy spaces at present. This is related to the way in which invitations to the spaces for participation are constructed, what is deemed to be appropriate subjects for discussion in PSIs as well as the practical challenges associated with the organisation of farmers across spatial scales. The spaces for participation are located largely at the international and national scales with few connections to the local scale. This paper contributes to an extension of value chain analysis that re‐asserts the importance of institutional context and how value chains are embedded in particular socio‐economic and political systems

Smoke and mirrors: some reflections on the science and politics of geoengineering

This article identifies and explores some of the political issues that will need to be addressed in the governance of geoengineering. It is argued that the diversity of different possible geoengineering techniques—encompassing solar radiation management (SRM) and carbon dioxide removal (CDR), and further divided into territorial techniques and commons-based techniques—rules out a single mode of geoengineering governance. Whereas some geoengineering techniques may be effective when implemented by a small number of countries, others would need to be implemented around the globe and involve most countries of the world, with different countries having different comparative advantages in the various geoengineering techniques. Such an enterprise would generate collective action problems related to implementation and disagreements over who should pay for the financial and nonfinancial costs of geoengineering. Nonetheless, a more coherent system of geoengineering governance is possible and is necessary if international conflict is to be avoided and the risks of unintended consequences are to be minimized. Any new international institutional design on geoengineering will need to address some pressing political and scientific questions, including the desired mean temperature of the world’s climate, the possible role of CDR technologies in carbon offsets and emissions-trading schemes, and whether there should be differentiated obligations between different groups of states

Changing times and strategies: Shell's contribution to sustainable community development in the Niger Delta, Nigeria

Sustainable development and poverty are pervasive problems in the Niger Delta, mainly due to lack of significant Nigerian government commitment to the development of the region. As a corporate citizen, Shell has contributed in various ways to local community development in the area. Based on a critical analysis of the changes in its strategies and policies, the paper contends that Shell's previous approaches to community development in the Niger Delta encouraged unsustainable development and a culture of dependency. It concludes that the recently launched sustainable community development strategy has the potential to succeed where others failed, if it is implemented within a tri-sector partnership framework involving Shell, the Nigerian government and civil society. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment.

Decision Support Model and Visualization for Assessing Environmental Phenomena, Ecosystem Services, Policy Consequences, and Satellite Design Using Earth Observation Data

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