Friday, December 15, 2017

Commentary on The Poposed Non-Governmental Organisation Regulatory Commission Bill

The most topical issue among civil society organisations in Nigeria today is the proposed Non-Governmental Organisation Regulatory Commission Bill. The legislative bill introduced by Mr. Umar Buba representing Kogi State in the House of Representatives has as its main objective the regulation of NGOs in Nigeria. To achieve this purpose, the bill proposed the establishment of an NGO Regulatory Commission with far-reaching powers of oversight and regulation over the affairs of NGOs operating in the country. The strongest argument from the advocates of this bill, one of whom is the Speaker of the House of Representatives, Mr. Yakubu Dogara, is that the bill, when passed into law, will check the excesses of some NGOs who operate without regard for the law and without accountability and transparency in their operations. The bill, which is currently before the House of Representatives, has passed the second reading stage.

The proposed law has, since its introduction, generated lots of hues and cries from civil society organisations who see the bill as a pretext by the government to cage them, and further deepen the culture of impunity by government agencies which pervades the land. To some antagonists of the proposed bill, it is totally irrelevant and a waste of resources, as all the objectives that the bill seeks to achieve are already incorporated within existing laws. For example the opponents of the bill are of the opinion that the Companies and Allied Matters Act, and by extension the Corporate Affairs Commission established under it, already play regulatory role over NGOs in Nigeria. In addition, the tax issues, which the proposed NGO bill seeks to address, are already taken care of within existing tax laws and regulations in Nigeria. This apparent duplicity of purpose inherent in the bill further strengthens the fears of the members of the organised civil society that the proposed bill is nothing but a ruse to gag them and make their activities subject to the whims and dictates of government.

 To have a clearer understanding of the various issues and agitations surrounding the proposed law, it is important to examine its provisions in details. The long title to the bill leaves no one in doubt as to its intentions, as it expressly provides that it is a bill to provide “for the monitoring, co-ordination and supervision of activities of NGOs.” In furtherance of these objectives, the bill seeks to establish an NGO regulatory commission with far-reaching powers. Some of the powers of the commission under the proposed bill are supervision of NGOs (Section 7); power to facilitate and coordinate the activities of NGOs — whatever that means — (Section 8); power to receive and discuss annual reports of NGOs (Section 81c); power to provide policy guidelines to NGOs, power to approve projects of NGOs (Section 26) among others.
In addition, the commission shall have the power to register all NGOs operating in Nigeria, maintain a register of NGOs, their activities, as well as the power to issue certificates of registrations. The bill proposed that certificates of registration are only valid for two years, and that the commission has the power to refuse renewal of registration. In addition, the commission can cancel any registration if it determines that it is in the national interest to do so. The commission has the power under the proposed bill to impose conditions before NGOs are registered, although the proposed bill is silent on what these conditions might be. By virtue of sections 15 and 17 of the Act, the board of the commission has the power to refuse registration of an NGO in the national interest. Again, the proposed law gives the commission the absolute discretion to determine what constitutes national interest.

The proposed bill equally makes it mandatory for NGOs to involve relevant government agencies in their proposed projects in Section 25(b). The bill equally seeks to remove the power of NGOs to determine how to use their property. For example projects of NGOs must be in line with the national policy objectives of the government. It is not stated in the Act whether non-compliance with these objectives may be grounds for refusal to approve projects of NGOs. In addition, the proposed bill expressly provides that properties of NGOs will, from the commencement of the Act, belong to the people of Nigeria with the Federal Government acting as trustees for the people (Section 29(6)). Where the commission cancels the registration of an NGO or an NGO is unable to renew its certificate, its properties will be taken over by government.

These foregoing provisions of the proposed law clearly leave a lot of questions begging for answers. Indeed the impression one gets from the proposed law is that NGOs are one evil entity that needs strong monitoring and constant supervision from the government in order to prevent them from bringing impending doom to the society. These provisions also leave a lot to be imagined about the real intentions of the sponsors. The provisions of the bill clearly betray a lack of understanding of the nature of NGOs, the work they do and the legal framework for their activities in Nigeria. The proposed regulation of NGOs gave the impression of organisations operating outside of the ambit of the law in Nigeria. Nothing can be farther from the truth.

Contrary to the impression created by the proposed bill that NGOs operate outside the scope of the law and government regulatory agencies, virtually all NGOs operating in Nigeria are registered by the Corporate Affairs Commission, either as companies limited by guarantee or limited liability companies. In addition to the incidence of registration and the attendant legal consequence that entails, NGOs are subject to a wide range of regulation and supervision by the government. For instance, NGOs registered as incorporated trustees under the Companies and Allied Matters Act are required to file annual returns every year on their activities. In addition, there are restrictions on how NGOs can use properties at their disposal. The law (both statutory and common law) frowns on the use and conversion of properties of registered organisations for personal purposes by their directors.

Beyond the restrictions provided in CAMA, NGOs are also subject to various tax obligations and regulations under the Nigerian law. For instance, it is mandatory for NGOs to register for tax purposes with the Federal Inland Revenue Service upon registration, and obtain a tax identification number. This is to ensure that they don’t conduct their operations in ways that will make them serve as a conduit for engaging in tax-evasion activities. Also in order to prevent the use of NGOs for illicit financial activities, it is a precondition for their registration at the CAC that they obtain approval and clearance from the Economic and Financial Crimes Commission. In addition, there are a whole range of financial reporting regulations applicable in the banking sector which can be used to track the funds of NGOs particularly donations from abroad.

Foreign and local donors for NGOs also act as checks on their activities. From my personal experience, donors usually request from NGOs evidence of compliance with local and tax laws before committing themselves to giving them financial assistance. In addition, they often request for detailed feasibility report on their proposed project and evidence of their past project to ensure credibility and integrity. With all these safeguards and checks in place, it is thus curious why the government deems it necessary to have another regulatory commission in place which will do exactly what existing government agencies such as the CAC, EFCC and FIRS do.

Perhaps the greatest worry in respect of the proposed law is the various assumptions made therein that the government has the power to take over properties of NGO or to arrogate to itself the authority to direct the manner NGOs are to use their resources. This assumption clearly betrays the lack of understanding of the nature of NGOs. NGOs, by their nature, are private organisations set up by individuals and sometimes corporations to achieve certain social, religious, benevolent or educational objectives of a public character. However, despite the public nature of the activities of NGOs in the society, they remain, at all times, private entities except where they are set up by government agencies. Their finances, management, governing structure and operations are subject to the dictates of the individuals who set them up. To this extent they are entitled – just like in the case of individuals – to carry out a wide range of activities without undue interference from government or any outside influence.

To this extent NGOs enjoy equal level of rights as individuals, most importantly constitutional rights. Nigerian courts have held that juristic persons such as NGOs, companies and cooperative societies enjoy fundamental rights as natural persons. Onyekwuluje v Benue State Govt 2005 NWLR (Pt.928); Tell Communications Ltd v SSS (2000). Thus, NGOs have the right to own property, to determine the societal problem they want to tackle, and the manner in which they will use the resources at their disposal. Section 44 of the 1999 Constitution protects ownership rights of persons (both natural and juristic persons). The constitution goes ahead to prohibit compulsory acquisition of property of citizens by government.

Thus, to the extent that the proposed bill in Section 29(6) seeks to expropriate the assets of NGOs operating in Nigeria, it is null and void and ultra vires the constitution. Properties in the hands of NGOs remain, at all times, their private property which they can use as they deem necessary. The government has no business dictating or directing how such property is to be used as is being proposed by the NGO bill.

In addition, the requirement in the proposed law that NGOs must secure approval from the commission before they can embark on projects is a clear violation of the constitutionally-guaranteed right to liberty and freedom of association. It is no secret that due to the culture of impunity and highhandedness with which government power is used in Nigeria, some NGOs are specifically set up to fight obnoxious policies of government. Examples of such NGOs are Socio-Economic Rights and Accountability Project, the Nigerian Bar Association and Campaign for Democracy. These NGOs are always at the forefront of entrenching the culture of probity, transparency and accountability in governance in Nigeria. Most of their activities consist of organising seminars, road shows, public enlightenment and campaign against repressive government policies. What the government essentially seeks to do with the proposed NGO bill is to make all these impossible as these organisations will have to obtain prior approval from the commission – an agency of the same government they seek to fight – before they can engage in such activities.

To say that the proposed bill is undemocratic and anti-people is to state the obvious. It is strange to see why the government is hell-bent on silencing the voice of the people by all means. Civil organisations, among which are NGOs, have played a key role in fighting for the people in Nigeria, a task in which the government itself has failed abysmally. They have always been at the forefront of protecting the rights of the people. In addition they provide the necessary material support to victims of disaster in crisis-prone areas. Indeed the present humanitarian disaster being witnessed in the northern part of Nigeria today would have been more aggravated in degrees if not for the complementary roles played by NGOs. What NGOs need from the government is encouragement and not the current repressive bill being mooted by the National Assembly.

If the government is convinced that there are NGOs who violate the law, they should punish them in accordance with already laid down laws. There are existing legal frameworks in place to deal with such renegade organisations. All that is required is the strengthening of the capacity of existing government agencies to make them more effective and efficient in the discharge of their functions. The offensive NGO regulatory bill has no place in a democratic society. It is a waste of time and a misplacement of priority.

Monday, August 7, 2017

Proven Step-By-Step Guide for Setting & Achieving Your Goals

Proven Step-By-Step Guide for Setting & Achieving Your Goals: Did you know there are 7 steps to achieving ANY goal?  If you are ready for a powerful mindset shift that can upgrade your life and want t...

Sunday, August 6, 2017

Making Money on Social Media, Social Networking in Abuja

Social networks are here to stay, and they're constantly evolving. Globally, more than 2.8 billion people — or 37% of the world's population — use social media, but the way those users interact with each other, and the platforms they adopt, vary widely. Making Money on Social Media, Social Networking in Abuja: Promote affiliate products. Create and promote your own information products. Promote products and services. Use visual media to promote your crafts. Promote your coaching or consulting services.

Tuesday, February 14, 2017

Bill and Melinda Gates Letter To Warren Buffett

Dear Warren
Our 2017 annual letter is addressed to our dear friend Warren Buffett, who in 2006 donated the bulk of his fortune to our foundation to fight disease and reduce inequity. A few months ago, Warren asked us to reflect on what impact his gift has had on the world.

Dear Bill and Melinda,
Two years ago, I hit the 50-year mark as CEO of Berkshire and used the occasion to write a special report to the company’s owners. I reflected on what had gone particularly well or poorly, what I’d learned, and what I hoped would get done in the future.
As you might guess, I ended up being the prime beneficiary of this effort. There’s nothing like actually writing something out to clarify thinking.
It’s now been ten years since what my children call “The Big Bang,” the day in 2006 when I made pledges to the five foundations, including yours. Having hit that milestone, I thought you might enjoy writing a look backward and forward similar to what I did.
I’m not the only one who’d like to read it. There are many who want to know where you’ve come from, where you’re heading and why. I also believe it’s important that people better understand why success in philanthropy is measured differently from success in business or government. Your letter might explain how the two of you measure yourselves and how you would like the final scorecard to read.
Your foundation will always be in the spotlight. It’s important, therefore, that it be well understood. And there is no better way to this understanding than personal and direct communication from the two whose names are on the door.
Best to you both,

What follows is our answer to him.
It’s a story about the stunning gains the poorest people in the world have made over the last 25 years. This incredible progress has been made possible not only by the generosity of Warren and other philanthropists, the charitable giving of individuals across the world, and the efforts of the poor on their own behalf—but also by the huge contributions made by donor nations, which account for the vast majority of global health and development funding.
Our letter is being released amid dramatic political transitions in these countries, including new leadership in the United States and the United Kingdom. We hope this story will remind everyone why foreign aid should remain a priority—because by lifting up the poorest, we express the highest values of our nations.
One of the greatest of those values is the belief that the best investment any of us can ever make is in the lives of others. As we explain to Warren in our letter, the returns are tremendous.

Dear Warren,
Ten years ago, when we first got word of your gift to the foundation, we were speechless. It was the biggest single gift anyone ever gave anybody for anything.
We knew we owed you a fantastic return on your investment.
Of course, philanthropy isn’t like business. We don’t have sales and profits to show you. There’s no share price to report. But there are numbers we watch closely to guide our work and measure our progress.
Our goals are shared by many other organizations working to save and improve lives. We’re all in this together. So most of the numbers we look at don’t focus just on how we as a foundation are doing, but on how the world is doing—and how we see our role.
Warren, your gift doubled the foundation’s resources. It’s allowed us to expand our work in US education, support smallholder farmers, and create financial services for the poor. But in this letter, we’re going to tell you about our work in global health—because that was the starting point of our philanthropy, and it’s the majority of what we do.
We’ll tell the story through the numbers that drive our work. Let’s start with the most important one:
Our Favorite Number
Bill: If we could show you only one number that proves how life has changed for the poorest, it would be 122 million—the number of children’s lives saved since 1990.
Melinda: Every September, the UN announces the number of children under five who died the previous year. Every year, this number breaks my heart and gives me hope. It’s tragic that so many children are dying, but every year more children live.
Bill: More children survived in 2015 than in 2014. More survived in 2014 than in 2013, and so on. If you add it all up, 122 million children under age five have been saved over the past 25 years. These are children who would have died if mortality rates had stayed where they were in 1990.
Melinda: Here’s one of our favorite charts. It shows that the number of childhood deaths per year has been cut in half since 1990.

© The Economist Newspaper Limited, London, September 27, 2014
Bill: Melinda and I first started following these childhood mortality numbers more than 20 years ago. As you know, we’d taken a trip to Africa to see the wildlife, and we were startled by the poverty. When we came back, we began reading about what we’d seen. It blew our minds that millions of children in Africa were dying from diarrhea, pneumonia, and malaria. Kids in rich countries don’t die from these things. The children in Africa were dying because they were poor. To us, it was the most unjust thing in the world.
Melinda: Saving children’s lives is the goal that launched our global work. It’s an end in itself. But then we learned it has all these other benefits as well. If parents believe their children will survive—and if they have the power to time and space their pregnancies—they choose to have fewer children.
"Saving children's lives is the goal that launched our global work."

Bill: When a mother can choose how many children to have, her children are healthier, they’re better nourished, their mental capacities are higher—and parents have more time and money to spend on each child’s health and schooling. That’s how families and countries get out of poverty. This link between saving lives, a lower birthrate, and ending poverty was the most important early lesson Melinda and I learned about global health.
Melinda: This is why reducing childhood mortality is the heart of the work for us. Virtually all advances in society—nutrition, education, access to contraceptives, gender equity, economic growth—show up as gains in the childhood mortality chart, and every gain in this chart shows up in gains for society.
Bill: Back in 2001, after I gave a talk to a group of your friends about cutting childhood deaths, you told me that the foundation’s values and your values aligned. Saving children’s lives aligns with another one of your deepest values, Warren: using resources wisely and never wasting money when it can be avoided.

Bill: Remember the laugh we had when we traveled together to Hong Kong and decided to get lunch at McDonald’s? You offered to pay, dug into your pocket, and pulled out…coupons! Melinda just found this photo of me and “the big spender.” It reminded us how much you value a good deal. That’s why we want to point you to this number, 122 million. Saving children’s lives is the best deal in philanthropy.
The Best Deal Is Vaccines
Melinda: And if you want to know the best deal within the deal—it’s vaccines. Coverage for the basic package of childhood vaccines is now the highest it’s ever been, at 86 percent. And the gap between the richest and the poorest countries is the lowest it’s ever been. Vaccines are the biggest reason for the drop in childhood deaths.

Melinda: They’re an incredible investment. The pentavalent vaccine, which protects against five deadly infections in a single shot, now costs under a dollar.
Bill: And for every dollar spent on childhood immunizations, you get $44 in economic benefits. That includes saving the money that families lose when a child is sick and a parent can’t work.
"For every dollar spent on childhood immunizations, you get $44 in economic benefits."

Melinda: At the start, we just couldn’t understand why vaccines weren’t available to every child who needed them. We were na├»ve. There were no market incentives to serve people, and we had never seen that before.
Bill: The market wasn’t working for vaccines for poor kids because the families who needed them couldn’t afford them. But this gave us an opening. If we could create a purchasing fund so pharmaceutical companies would have enough customers, they’d have the market incentives to develop and produce vaccines.
Melinda: That’s the magic of philanthropy. It doesn’t need a financial return, so it can do things business can’t. But the limit of philanthropy is that the money runs out before the need is met. That’s why business and government have to play a role if the change is going to last.
Bill: That led us to partner with business and government to set up Gavi, the Vaccine Alliance, with the goal of getting vaccines to every child in the world. Gavi connects companies who develop vaccines with wealthy governments that help with funding and developing countries that get the vaccines to their people. Since 2000, Gavi has helped immunize 580 million children around the world. The United States is a major donor to Gavi—with bipartisan support—along with the UK, Norway, Germany, France, and Canada. It’s one of the great things the rich world does for the rest of the world.
Melinda: But there’s more to do—19 million children, many of them living in conflict zones or remote areas, are still not fully immunized. Their governments have to work harder to reach these kids. It’s crucial to the goal of cutting childhood deaths in half again—down below 3 million by 2030.
Bill: We can get there, but we have to learn more. The childhood mortality chart is a huge success story, but it masks some areas where we’ve not made as much progress. Here’s the big one:
Reducing Newborn Mortality
Bill: Last year, about one million infants died on the day they were born. A total of more than 2.5 million died in their first month of life. As the total number of childhood deaths has dropped, the proportion that are newborn deaths has gone up. Newborn deaths now represent 45 percent of all childhood deaths, up from 40 percent in 1990.

If you look at the pie chart below, you can see at a glance that well over half the newborn deaths fall into one of three categories: sepsis and other infections; asphyxia, which means the newborn isn’t getting enough oxygen; and prematurity, which means the baby was born early.

Melinda: For decades now, health experts have been struggling to treat or prevent these conditions, with disappointing results. When a huge challenge comes up and you have no answer, it’s crucial to ask, “Is anyone doing this well?”

Bill: Right, so here’s a chart I found on Gapminder.com that applies to a lot of work we do in global health. It describes health as a function of wealth. It’s pretty uniform around the world that health gets better as wealth rises. But newborn death rates have this huge variance, and not just according to income. There are some positive outliers: poor countries that are doing a better job than wealthier countries and a far better job than some of their peers.
"From 2008 through 2015…Rwanda cut its newborn mortality rate by 30 percent."

Melinda: It’s super-exciting to find countries that have figured things out. From 2008 through 2015, Rwanda, one of the poorest countries in Africa, cut its newborn mortality by 30 percent, down to 19 deaths per 1,000 births. By comparison, Mali—with a comparable GDP—has a newborn mortality rate of 38 deaths per 1000, twice as high as Rwanda.

What were they doing in Rwanda? A few things so cheap that any government can support them: breastfeeding in the first hour and exclusively for the first six months. Cutting the umbilical cord in a hygienic way. And kangaroo care: skin-to-skin contact between mother and baby to raise the baby’s body temperature. These practices led to big drops in newborn deaths.


Cord Cutting

Kangaroo Care
Rwanda cut its newborn mortality rate by 30 percent by encouraging mothers to breastfeed in the first hour and exclusively for the first six months.
Bill: But it’s not just the practices. We’re funding a study now in India that started with a checklist of practices. That got some improvement, but the real gains came when trained health care workers with the right tools attended the births. Rwanda doubled the percentage of childbirths attended by a skilled worker.
Melinda: I’ve seen how this saves lives. I was in a hospital in Malawi when a nurse rushed in carrying a newborn girl with asphyxia. She was purple, and I watched the staff resuscitate her with a simple five-dollar bag-and-mask device. Then they laid her on a warmer next to a boy who also had asphyxia. The doctor told me the baby girl would live, but the baby boy had been born on the side of the road, and he was dying. I could see him gasping for air. The memory still breaks my heart.
Bill: Birth attendants can save millions of babies. But there are cases of asphyxia that even skilled workers can’t treat, because we don’t know enough about what causes it.
Melinda: Six or seven years ago, Bill upset some health officials by saying “Why can’t we do autopsies on these babies and find out why they’re dying?”
Bill: They said, “Oh, my gosh, you could never do that!” Here was this black hole of health understanding, and they acted as if it would be impolite to find out more. Fortunately, one researcher figured out how to do a minimally invasive autopsy, and when parents were asked if they would allow that procedure for their babies, a huge majority said yes.
Melinda: People in grief will fight for a cure.

Bill: On July 12, 2016, the baby boy in this photograph was born to a family outside Johannesburg in South Africa. Three days later, he died. His parents graciously gave me permission to be present at his autopsy.
Melinda: This site Bill visited is part of the Child Health and Mortality Prevention Surveillance Network (CHAMPS), which gathers data about why children get sick and die. After the doctors there take the tissue samples, they analyze them for things that might have caused the death. They can then send samples to the Centers for Disease Control in Atlanta, where pathologists can use special stains and nucleic acid testing to identify virtually any germ in the world that could kill a baby. Twenty years ago, this technology wasn’t available even to the richest families. Now it could help save babies from the poorest families.

Bill: This research is crucial to saving more newborns. It’s not enough to know that a newborn died from asphyxia or sepsis or prematurity; we need to find out what causes these conditions, so we can find the tools to prevent them. This is the most exciting, high-stakes work we fund, Warren: solving mysteries to save lives.
Ending Malnutrition
Melinda: Here’s another challenging number that’s linked to the childhood mortality chart. Malnutrition is partly responsible for forty-five percent of childhood deaths.

Malnutrition is not starvation. Malnourished children can be getting enough calories, but not the right nutrients. That makes them more susceptible to conditions like pneumonia or diarrhea—and more likely to die from them.

But better nutrition is not just about preventing deaths.
Bill: When I first started traveling to Africa, I would meet kids in the villages I was visiting and try to guess their ages. I was amazed how often I was wrong. Kids I thought were 7 or 8 told me they were 12 or 13. This photo shows a group of 9-year-old boys and girls in Tanzania who stand below the median height for their age. They are stunted, which means they are shorter than their healthy height because they’re missing key nutrients in their diets—or they missed nutrients in the womb because their mother was malnourished.

Bill: Malnutrition destroys the most human potential on the planet. Kids who are stunted are not just below their global peers in height; they’re behind their peers in cognitive development, and that will limit these children their whole lives. Nutrition is the biggest missed opportunity in global health. It could unleash waves of human potential—yet only 1 percent of foreign aid goes to basic nutrition.
"Nutrition is the biggest missed opportunity in global health."

Melinda: There is a lot we can do. Breastfeeding in the first hour and exclusively for six months is the first and simplest intervention. It has long-term benefits for nutrition. Experts are also figuring out how to breed crops with higher nutrient levels and how to get key nutrients in the food supply, in either salt or cooking oil.
Bill: These are promising approaches, but nutrition is still one of the biggest mysteries in global health. Nutrition gets better as a country gets richer, but unlike with newborn survival, there are no significant positive outliers—no poor countries with almost all of their children well nourished. That’s why we’re funding more research in this area and urging governments to do the same. Big discoveries in nutrition are ahead of us. When the researchers find them, the rise in children who achieve their potential will change the world.
The Power of Family Planning
Melinda: This is another number we follow closely. For the first time in history, more than 300 million women in developing countries are using modern methods of contraception. It took decades to reach 200 million women. It has taken only another 13 years to reach 300 million—and the impact in saving lives is fantastic.
Bill: When women in developing countries space their births by at least three years, their babies are almost twice as likely to reach their first birthday. Over time, the ability of women to use contraceptives and space their pregnancies will become one of the largest contributors in cutting childhood deaths.

Warren, you’ve compared your philosophy of investing to Ted Williams’s science of hitting. Williams waits for the right pitch, and you wait for the right deal. This is the right deal, Warren. Like vaccines, contraceptives are one of the greatest lifesaving innovations in history.
Melinda: Contraceptives are also one of the greatest antipoverty innovations in history. When women are able to time and space their pregnancies, they are more likely to advance their education and earn an income—and they’re more likely to have healthy children.
Bill: They are also more likely to have a number of children they can support. This leads to fewer dependents that need government services, a growing workforce that includes more women, and more resources for sending children to school.
"No country in the last 50 years has emerged from poverty without expanding access to contraceptives."

Melinda: When a country sends a generation of healthy, well-educated young people into the workforce, it’s on its way out of poverty. But this doesn’t happen by accident. No country in the last 50 years has emerged from poverty without expanding access to contraceptives.
Bill: When we started the foundation, I underestimated the power of contraceptives to lift families out of poverty. I began to see it because Melinda is a great storyteller—and that includes getting the story. When I was still full-time at Microsoft, she’d go out in the field and come back and tell me what she saw. One time when the data said family planning clinics were “stocked,” Melinda learned they had only condoms, which most women will not ask their partners to use.
Melinda: Most of the women I talk to in the field bring up contraceptives. I remember visiting the home of a mother in Niger named Sadi, whose six children were competing for her attention as we talked. She told me, “It wouldn’t be fair for me to have another child. I can’t afford to feed the ones I have.”

In a Kenyan slum, I met a young mother named Mary who had a business selling backpacks from scraps of blue-jean fabric. She invited me into her home, where she was sewing and watching her two small children. She used contraceptives because, she said, “Life is tough.” I asked if her husband supported her decision. She said, “He knows life is tough, too.”

Bill: Right now, there are still more than 225 million women in the developing world who don’t want to get pregnant but don’t have access to contraceptives. A recent youth survey in the Indian state of Uttar Pradesh showed that 64 percent of married teenage girls wanted to postpone their first pregnancy, but only 9 percent practiced a modern method of contraception.
Melinda: Family Planning 2020, a global partnership that we’re a part of, has set a goal of providing 120 million more women access to contraceptives by 2020. We’re focusing on South Asia, where contraceptives are used by only a third of the women, and on Africa—where they’re used by fewer than one in five.

Bill: The past four years have shown the greatest increase in history, but this chart shows we’re halfway to the deadline and only a quarter of the way to the goal. We need to speed up.
Melinda: The challenge is to provide women access to the widest range of contraceptives so they can find a method that fits their lives.

Melinda: The latest is an injectable that lasts for three months and combines the drug and needle in a tiny device you can hold in your palm. It’s so easy to use that the design itself expands access to contraceptives. I was talking to a woman about taking her kids in for shots, and she said, “What about my shot? Why do I have to walk 20 kilometers in this heat to get my shot?” Now she doesn’t. Instead of getting the shot from a nurse in a distant clinic, she can get it from a health care worker who comes to her village. Eventually, she can give herself the shot at home.
Bill: These changes are rolling out now, and that’s encouraging. But we still face one of the biggest and oldest challenges: making sure people understand the lifesaving, poverty-ending power of contraceptives.
Melinda: Public advocates are important, which is why I’ve taken on that role. But nothing can take the place of a trusted voice in the community. In Senegal a few years ago, I was visiting with a number of imams who were talking about how contraceptives are consistent with Islam. One young imam, whose babies had been very tightly spaced, told us, “My wife died in childbirth because I didn’t let her use contraceptives, and now I’m raising our children alone.” Then he began to weep. Today he’s saving lives by telling his story.
Bill: The support of men is crucial, especially the support of the husband. But there is another thing that’s crucial—and that’s the support of other women.
Poverty Is Sexist
Bill: Poverty is sexist. The poorer the society, the less power women have. Men decide if a woman is allowed to go outside, talk to other women, earn income. Men decide if it’s acceptable to strike a woman. The male dominance in the poorest societies is mind-blowing.
"The male dominance in the poorest societies is mind-blowing."

Melinda: It’s also crippling. Limiting women’s power keeps everyone poor. Fortunately, as a society becomes better off, a woman’s position in that society improves. But what good is that for a young woman in a poor country who doesn’t want to wait? How can she get more power now?
Bill: Melinda and I have seen over and over again that social change comes when people start talking to each other—and that’s the magic of women’s groups. If you go out in the village, you’re rarely going to find a men's group where they all share information. You’ll find a big man of the village, and the key aides to the big man, and people who work for the key aides. That hierarchy stifles conversation. It keeps people from talking about what matters. Women’s groups don’t get as caught up in that, so they’re better at spreading information and driving change.
Melinda: Right now approximately 75 million women are involved in self-help groups in India alone. We want to drive that number higher. The groups might form to help women get loans or share health practices, but after things get started, the women take it in the direction they want to go. That is empowerment!
Bill: The most touching thing we’ve ever done was to help create community groups in India where sex workers had a place to go and talk about HIV prevention. We did it so they could help each other insist on condom use from their clients. But our vision was way too narrow. What the groups did from a human point of view for those women was phenomenal, independent of HIV prevention.
Melinda: One of the first things the groups did was ease stigma. These women were excluded by everyone except each other—and softening the stigma started the healing. That’s why when Bill told me a few years ago that he had scheduled a meeting with a group of prostitutes, I was proud of him. I had done the same. I never imagined, as a Catholic school girl growing up in conservative Dallas, Texas, that I would ever have a meeting with sex workers and come away admiring them. But I did.

Bill: Warren, if Melinda and I could take you anywhere in the world so you could see your investment at work, we probably would take you to meet sex workers. I met with a group in Bangalore, and when they talked about their lives, they had me in tears. One woman told us she turned to sex work after her husband left her—it was the only way to feed her children. When people in the community found out, they forced her daughter out of school, which made the girl turn against her mother and threaten to commit suicide.

That mother faced the scorn of society, the resentment of her daughter, the risks of sex work, and the humiliation of going to the hospital for an HIV test and finding that no one would look at her, touch her, or talk to her. Yet there she was, telling me her story with dignity. The women who emerged as leaders in that community were just tough as hell, and all the women benefited from that.
Melinda: These communities expand their mission to meet the needs of their members. They do everything for each other. They set up speed-dial networks to respond to violent attacks. They set up systems to encourage savings. They use financial services that help some of them start new businesses and get out of sex work.
Bill: There are huge benefits that come from these women getting together and supporting each other. And the original purpose—preventing HIV—was a phenomenal success. It’s well documented that the decision of India’s sex workers to insist on condom use from their clients kept HIV from breaking into the general population. The empowerment of these women benefited everyone.
Melinda: That’s why a big part of our work in global health is including the excluded—going to the margins of society and trying to bring everybody back in. For us, “All lives have equal value” is not just a principle; it’s a strategy. You can create all kinds of new tools, but if you’re not moving toward equality, you’re not really changing the world. You’re just rearranging it.
" 'All lives have equal value’ is not just a principle; it’s a strategy."

Bill: When women have the same opportunities as men, families and societies thrive. Obviously, gender equity unleashes women’s potential, but it also unleashes men’s potential. It frees them to work as partners with women, so they can get the benefits of a woman’s intelligence, toughness, and creativity instead of wasting their energy trying to suppress those gifts.
More Optimistic Than Ever

© The Economist Newspaper Limited, London, June 1, 2013
Bill: Extreme poverty has been cut in half over the last 25 years. That’s a big accomplishment that ought to make everyone more optimistic. But almost no one knows about it. In a recent survey, just 1 percent knew we had cut extreme poverty in half, and 99 percent underestimated the progress. That survey wasn’t just testing knowledge; it was testing optimism—and the world didn’t score so well. Read more...

Wednesday, January 25, 2017

TAG Statement for the Record in Opposition to the Nomination of Tom Price for HHS Secretary

Treatment Action Group (TAG) releases this statement in strong opposition to the nomination of Representative Tom Price (R-GA) for Secretary of Health and Human Services (HHS). We urge critical community action and implore the Senate Finance Committee to challenge his nomination to helm an agency that plays an exceedingly important and complex role in ending the HIV, tuberculosis (TB) and hepatitis C (HCV) epidemics in the United States and ultimately around the world.

Tom Price’s questionable fitness to head a multi-agency cabinet-level department charged with the health of U.S. residents can simply be ascertained from his own record as a Congressional representative to parts of Atlanta’s northern suburbs – a district and metro area with extremely high rates of HIV and a flourishing opioid epidemic. Despite the abundance of epidemiological data illustrating the impact of the HIV epidemic in his own district and in the Southeastern United States, Rep. Price has spent the last eight years undermining efforts aimed at providing health care and social services to communities both living with, and vulnerable to, HIV and other health conditions. These actions include voting to repeal the Affordable Care Act (ACA) multiple times, pushing for the privatization Medicare, threatening to cap and block-grant Medicaid, supporting to defund Planned Parenthood, pledging cuts to social service and safety net programs—all while demonstrating a hostile voting record on lesbian, gay, bisexual, transgender and queer (LGBTQ) issues. Throughout the recent hearing before the Senate Committee on Health, Education, Labor and Pensions (HELP), Price made several indications to continue a trend to dismantling existing systems, without details of a replacement that sustains access to health care and social services.

At a time when we are at the forefront of new science to deliver better antiretroviral therapies for HIV, breakthroughs in cures for HCV, and pathways for making TB treatments shorter and more tolerable, the nomination of Tom Price threatens to impede the progress of both research and implementation. Upon confirmation, Tom Price will, as promised, oversee the dismantling and overhaul of health care systems that are responsible for delivering many of these medical advances to people in the United States, particularly those communities impacted by health, social and economic disparities as well as stigma.

Before the ACA, hundreds of people every year were waitlisted for the AIDS Drug Assistance Program (ADAP). People living with HIV (PLHIV) would need an AIDS diagnosis to be eligible for Medicaid. Pre-existing conditions would also disqualify many PLHIV from gaining insurance. While the ACA is not perfect, thousands of PLHIV have been transitioned onto insurance through marketplaces and have become eligible for Medicaid benefits. This has provided many with access to comprehensive health care for the first time, with profound effects on public health and prevention outcomes. Much of the success we’re seeing in increasing viral suppression rates and reducing the number of diagnoses annually will be put in jeopardy if the ACA is repealed without replacement. Without replacement and stewardship by the incoming Secretary of Health and Human Services, access to treatment, prevention and other services will remain out of reach for many of these communities.

HHS is not just the department that oversees our health care system, but also governs our public health, research, and regulatory agencies, such as the Centers for Disease Control and Prevention (CDC), Indian Health Services (IHS), National Institutes of Health (NIH), and the Food & Drug Administration (FDA). The recent revelation of ethics violations and refusal to clearly answer questions on these issues during the Senate HELP hearing clouds any trust in Price to ensure the sanctity and impartiality of these agencies. Trust in HHS leadership is needed in prioritizing pressing public health challenges, ensuring drug and device safety, and countering emerging threats such as Zika, Ebola, drug-resistant TB and antimicrobial resistance through robust R&D, proactive epidemiology, pharmacovigilance, and accelerated research and response.

Price’s worrisome background as a member of the American Academy of Physicians & Surgeons – an organization that promotes and endorses the theory that HIV does not cause AIDS, despite a substantial evidence base to the contrary – puts into question his capabilities to end an epidemic. Health conditions like HIV thrive on stigma. Yet Price has only perpetuated stigma and marginalized vulnerable communities by voting against bills that afford protections to the LGBTQ community. With attention needed for other neglected populations, such as prisoners impacted by HIV and HCV, it becomes less likely under a Price-led HHS that key populations will be able to access health care and treatment.

Now more than ever, ending the epidemics of HIV, TB and HCV requires a combination of bipartisan federal and state leadership, evidence-based policies, and adequate resources in proper alignment to deliver the promise of biomedical and public health advances. Efforts to lower drug prices for HIV and HCV while sustaining U.S. leadership in R&D for TB and other neglected diseases remain inevitable challenges to the successor of HHS and the Trump administration. Tom Price, however, remains a concerning and unqualified candidate to lead HHS given a track record that only marginalizes communities, raises questions on his ethics and integrity to run an expansive $1 trillion department, and putting forth policy proposals that seek to fast-track the loss of lifesaving health care for 18 million Americans. Ending the epidemics remains impossible by destroying access to health care and treatment. With Price's support of the repeal of ACA and efforts to defund Medicaid, the hopes and vision of providing health care – including ending the HIV epidemic, curbing HCV transmission, eliminating TB – among the poorest, sickest, most disenfranchised, most vulnerable Americans will vanish. ­­­­­

Take Action!

Activists and advocates are highly encouraged to submit similar statements for the record in opposition to the nomination of Tom Price to HHS.
To be considered, statements must be:



No more than 10 pages in length

Have the title and date of the hearing: Senate Finance Committee Hearing to Consider the Nomination of The Honorable Thomas Price to be Secretary of Health and Human Services, January 24, 2017

Full name and address of the individual or organization must appear on the first page of the statement

Statements must be received no later than two weeks following the conclusion of the hearing.

Statements should be mailed (not faxed) to:

Senate Committee on Finance
Attn. Editorial and Document Section
Rm. SD-219
Dirksen Senate Office Bldg.
Washington, DC 20510-6200