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Amazon's tax challenge

Tax Justice Network - 30. Juni 2022 - 19:56

Annual shareholder’s meetings used to be pretty staid and boring affairs. But, as inequality has boomed along with corporate profits, AGMs are becoming sites of protest. In this episode Naomi Fowler speaks to Katie Hepworth of PIRC and Jason Ward of CICTAR about the recent challenge to Amazon on tax transparency from shareholders. How did the challenge unfold and what was the result? What does it tell us about progress on principles that as societies are increasingly important to us?

A transcript available here (some is automated) https://taxjustice.net/wp-content/uploads/2022/06/The-Taxcast-transcript_June_22-1.pdf 

Our website with more podcasts is here: https://www.thetaxcast.com/ 

Further reading:

https://www.statista.com/statistics/272258/percentage-of-shareholders-in-the-total-population-of-selected-countries/

https://www.businessinsider.com/no-the-average-stock-holding-period-is-not-11-seconds-2010-10?r=US&IR=T

The Taxcast in 2014 covering Google's annual shareholder meeting tax transparency challenge: https://youtu.be/lFSfWvdedt4?t=1226 

Amazon’s Tribulations And The Future Of Tax Transparency, Nana Ama Sarfo https://www.forbes.com/sites/taxnotes/2022/05/31/amazons-tribulations-and-the-future-of-tax-transparency/ 

 

 

Kategorien: english

Save lives, support development, and ‘steer our world to safer roads ahead’: Guterres 

UN #SDG News - 30. Juni 2022 - 19:48
Road traffic accidents claim nearly 1.3 million lives each year, cost some countries up to three per cent of their annual GDP, and are the biggest killer of five to 29-year olds globally, the UN General Assembly President told a High-level Meeting on Improving Global Road Safety on Thursday.
Kategorien: english

CONFINTEA - Closing Speeches

UIL UNESCO Hamburg - 30. Juni 2022 - 16:09
Kategorien: english, Hamburg

Panel 6: ALE for climate action

UIL UNESCO Hamburg - 30. Juni 2022 - 16:09
Kategorien: english, Hamburg

Scientific knowledge essential for sustainable oceans, UN Ocean Conference hears

UN #SDG News - 30. Juni 2022 - 16:02
Increasing scientific knowledge, developing research capacity and making the most of new marine technology, are essential to sustainable ocean management, the UN Ocean Conference in Lisbon, Portugal, heard on Thursday.
Kategorien: english

Hostage Diplomacy and the Case of Brittney Griner

UN Dispatch - 30. Juni 2022 - 15:35

Brittney Griner is an American basketball superstar. On February 17th, she was arrested in an airport outside of Moscow allegedly for possession of cannabis oil. She has been held in a Russian jail ever since and her trial is scheduled to begin on July 1.

Brittney Griner’s case is a text book example of what my guest today, Dani Gilbert, calls “Hostage Diplomacy.” Dani Gilbert is an Assistant Professor of Military and Strategic studies at the US Air Force Academy. She is a leading researcher and expert on the causes and consequences of hostage taking in international security.

We kick off discussing the circumstances of Brittney Griner’s arrest and detention in Russia and then have a conversation about how the US government approaches situations in which an American abroad is wrongfully detained. This leads us to a broader discussion about trends in hostage diplomacy around the world.

 

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The post Hostage Diplomacy and the Case of Brittney Griner appeared first on UN Dispatch.

Kategorien: english

Mongolia’s Transition Toward Sustainable Fibres and Textiles – Meet us at the Première Vision Exhibition in Paris from 5 to 7 July 2022!

SCP-Centre - 30. Juni 2022 - 10:17

As a global leader in high quality natural fibres, the Mongolian wool and cashmere sector is a pillar of the country’s economy. Within the CSCP’s STeP-EcoLab project we worked closely with relevant local actors to improve the sustainability of Mongolian fibres and textiles and to make such improvements visible to European consumers. Highlights from our collaborative work will be presented at the Première Vision in Paris, one of the most important exhibitions for luxury textiles on a global level. Meet us there from 5 to 7 July 2022!

Nomadic livestock herding is the backbone of Mongolia’s cashmere production. However, due to a general lack of sustainability standards and criteria, the livelihoods of many herders and the overall ecosystem are threatened by increasing overgrazing, deforestation, and erosion.

The STeP EcoLab Mongolia project focuses on equipping Mongolian cashmere farmers with relevant know-how on social and environmental standards as well as supporting them with implementation.

In order to improve the industry’s sustainability performance in the long term, a Voluntary Code of Practice was first developed with industry stakeholders. The document was signed by 18 companies, including leading Mongolian wool and cashmere producers. The aim of the Code of Practice was to increase the sustainability of cashmere production as well as to adjust business models according to European sustainability standards.

To ensure that the roadmap defined within the code leads to more sustainable value chains, the STeP EcoLab project has been working on improving the acceptance of the new practices in the market. The project team has collaborated closely with relevant stakeholders in developing a label for communicating the efforts of Mongolian cashmere producers to European consumers.

For the first time, key Mongolian stakeholders from the wool and cashmere sector have joined forces to showcase their work at the Première Vision Exhibition in Paris as one entity. The Mongolian Noble Fibre booth will provide information on the country’s efforts to create a traceable, responsible, and ethical value chain for luxury fibres and textiles.

Event: Première Vision Exhibition Paris
Date: 5-7 July 2022
Place: Maison de la Mutualité (Paris), Manufacturing Hall, Booth 6N32

To visit the exhibition, please register here.

Watch the video below to get a glimpse of our collaborative work with Mongolian cashmere and wool producers.

The STeP EcoLab project is funded by the Switch-Asia Programme and focuses on brining value to the Mongolian cashmere and wool sector through sustainability.

For further information, please contact Pawel Zylka.

The post Mongolia’s Transition Toward Sustainable Fibres and Textiles – Meet us at the Première Vision Exhibition in Paris from 5 to 7 July 2022! appeared first on CSCP gGmbH.

Kategorien: english, Ticker

Some poor people depend on garbage scavenging in Islamabad

D+C - 30. Juni 2022 - 9:50
In Pakistan, informal waste pickers manage about 50 % of municipal waste

Every morning, Khushhal Khan walks about an hour to central Islamabad with three of his underage children. In well-to-do neighbourhoods, they collect reusable items from the garbage of prosperous households. With his 13-year-old daughter, he picks plastic bottles, paper, cardboard and other reusable things from municipal waste dumpsters. They collect the items in a big bag. Khan’s sons, nine and 10 years old, do the same kind of work in streets nearby, contributing to the family’s livelihood. Child labour is common in the informal sector and tolerated by government agencies.

Typically, the persons who are doing such environmentally useful work do not wear any protective clothing. Barefoot children often roam garbage dumps. Entire families are exposed to health risks they hardly understand.

In Pakistan’s cities, open spaces and riverbanks often seem to have become waste-disposal sites. Indeed, some places are unplanned, but systematically used disposal sites. Things would be even worse if poor people did not collect considerable amounts of waste which they can sell or otherwise make use of. Organic waste “disappears” from grocery markets this way too. Even on official municipal landfills, informal scavengers are at work. As unintended side-effect, they expand those facilities’ capacities.

In the eyes of Ahmad Rafay Alam, a lawyer who specialises in environmental matters, the informal waste-picking business is most valuable: “The people concerned remove vast amounts of metal, glass, paper, plastic and other materials from the environment”.

Feeding the cows

Khan and his three children work the whole day. In the late afternoon, they congregate and sort what they have gathered. They even have use for organic kitchen waste and left over food. They feed their three cows with it. Khan says that his family drinks some of the milk, but they also sell some in the local market.

On average, he reckons that he makes a daily 500 Pakistani rupees (the equivalent of about € 2.30) from selling non-organic waste items. “It is not enough to make ends meet,” he reports and expresses frustration with municipal waste workers who keep the most valuable items to themselves in order to earn some extra money on top of their monthly salary. “I have no other choice than to do this work because I am illiterate,” Khan points out. He says he would rather work hard than beg.

According to a recent study prepared by the multilateral Asian Development Bank (ADB), Pakistan generates about 30 million tonnes of municipal waste per year. Formally registered institutions are only estimated to manage 50 % of it, so informal waste pickers are playing a crucial role in reducing garbage volumes and feeding reusable material back into the economy. The ADB authors bemoan the lack of reliable statistics, but estimate that “more than 80 % of the valuable recyclables (paper, plastic, glass, metal and rubber) are taken away by the informal sector before they reach the dump sites.”

It is known, moreover, that many garbage scavengers are refugees from neighbouring Afghanistan. For decades, refugees have been living in Pakistan, with some residing in official camps and others in urban slums. Their incomes are low and typically do not suffice to properly feed families. The Khans are internally displaced people from the Khyber Pakhtunkhwa province which is on the Afghan border and has suffered civil unrest in recent decades. They live in an informal Islamabad refugee settlement, where many Afghans have found shelter too.

Complex supply chains

There are complex supply chains for waste paper, used metals, rags etc. Like the waste pickers, most middlemen are not formally registered. Zeeshan Ali’s shop depends on deliveries from people like Khan and his kids. His small shop is in central Islamabad. His clients see him there. He further sorts items before selling them on to his customers.

He estimates that he makes 1500 Pakistani rupees per day and complains that the amount is barely enough to cover his costs. He says his business is risky: “Whatever we buy, might be stolen after all. Whenever someone reports thievery in our area, the police come here to interview us.”

And still, Ali would like to expand his business. To do so, he would need more space – plus money for investments. Both space and money are out of reach, however. His profit margins are tiny and Pakistan’s economic situation is difficult. Inflation has been hurting small businesses for quite some time. In this regard, it makes no difference whether they are formal or informal. Sovereign default is looming. The new government (see Marva Khan on www.dandc.eu) is currently renegotiating to revive its stalled $ 6 billion loan programme with the International Monetary Fund (IMF).

The merits of informal waste management were appreciated in 2020 in an essay in the academic Journal of Cleaner Production (Yousafzai et al.). Benefits were said to accrue in regard to food safety, public health and the environment, for example. The authors also stated that the persons concerned have no understanding of what they collectively contribute to social life in general: “A whopping 99 % majority of such workers (in Pakistan) pretend as if none of their kind exist, possess dual identities and are stigmatised due to refugee backgrounds.”

Unrecognised heroes

Those, who make their money this way, suffer a triple hardship: Their incomes are very low, they have no occupational-health provisions and, in cases of need, do not benefit from social-protection systems (see Hans Dembowski on www.dandc.eu). They are exposed to heat, wind and rain as well as various toxic substances. Whoever falls ill, entirely depends on their family. In hygienic terms, informal waste collection is awful.

The people concerned live in poverty and are looked down upon, even though their work serves both society and the natural environment in important ways. “Our cities benefit from these unrecognised heroes,“ says environmental lawyer Alam, “but they get nothing in return.”

Links

ADB, 2022: Solid waste management sector in Pakistan: A reform road map for policy makers. Manila, Asian Development Bank.
https://www.adb.org/sites/default/files/publication/784421/solid-waste-management-pakistan-road-map.pdf

Yousafzai, M. T., Nawaz, M., Chunlin, X., Sang-Bing, T. and Chien-Hung, L., 2020: Sustainability of waste picker sustainopreneurs in Pakistan’s informal solid waste management system for cleaner production. In: Journal of Cleaner Production, Vol. 267.
https://www.sciencedirect.com/science/article/abs/pii/S0959652620319600

Imran Mukhtar is a journalist based in Islamabad.
imranmukhtar@live.com
Twitter: @imranmukhtar

Kategorien: english

The strategic relevance of Ukrainian grain

D+C - 30. Juni 2022 - 9:16
Why negotiations regarding shipping routes across the Black Sea are unlikely to deliver results soon

Even before the war, food security was precarious for millions of people, but now food price inflation is making things more difficult. The World Food Programme (WFP) sees an additional 345 million people in 82 countries at severe risk of hunger.

The war is not the only reason. The Covid-19 pandemic has had negative impacts on agricultural production and supply chains. The climate crisis matters too. Harvests are increasingly failing because of extreme weather.

Worried about satisfying their own nation’s demand, moreover, some governments have discontinued grain exports. As a result, global prices keep rising, adding to the problems in countries that depend on imports.

Stored grain

More than 20 million tonnes of grain are currently being stored in Ukraine and not available to international buyers. Ukrainian farmers lack storage capacity for the next harvest. Moreover, Russian attacks are making farm work difficult or impossible in Ukraine. All of this will reduce international cereals supply in the not so distant future (see Claudia Isabel Rittel on www.dandc.eu).

Compounding problems, fertiliser has become more expensive around the world. Much of it is produced in Russia. Agriculture is affected in many developing countries and emerging markets. Higher fuel prices have similar detrimental impacts.

Access to 20 million tonnes of grain from Ukraine would reduce – though not end – the current stress on the world market. Turkey is hosting negotiations in Istanbul and acting as a mediator with an eye to ending the blockade of the Black Sea. Both warring parties are involved, and so is the UN. Success would be a good omen for international cooperation.

No solution?

Unfortunately, success does not look likely for both political and practical reasons. There are some proposals, such as the British navy accompanying merchant vessels through the Black Sea or the Turkish navy checking those ships for weapons. So far, however, such ideas have been rejected either by Ukraine or Russia. Moreover, Moscow wants Ukraine to demine its ports, but Kiev refuses to do so. That would make attacks by Russian warships easier. For good reason, the Ukrainian government does not trust the Russian regime. After all, Russia has broken international law by invading Ukraine.

Demining, moreover, would take too long for quick relief. It also matters that private companies, not governments, ship commodities. These companies would have to run the risk of operating in a war zone. Their insurance premiums would rise, further adding to the costs.

To some extent, the underlying problem is logistics. There is no realistic alternative to maritime transportation. Theoretically, land routes can be considered, for example via Poland. Existing infrastructure, however, is insufficient for transporting such large volumes of grain by train and truck. Moreover, customs issues would arise at borders. Grain exports from Ukraine would thus take longer and become more expensive.

It probably matters even more that Moscow may not really be interested in a negotiated agreement. The regime of Vladimir Putin is exploiting the narrative of European adventurism causing global shortages and inflation. According to Moscow’s propaganda, NATO and the EU are to blame for increasingly desperate need. It is doing its best to deflect attention from three basic facts:

  • Russia, previously a major grain exporter itself, has stopped supplying this commodity to the world market.
  • It is preventing Ukrainian exports.
  • And it is benefiting from higher energy prices.

It is true, however, that western sanctions have contributed to the increase of fertiliser prices.

Western governments cannot prevent Russia from using hunger in ways that destabilise international relations, but they must respond competently. They should do whatever they can to get a grip on the food-security crisis. Dennis J. Snower of the Kiel Institute for the World Economy has a point when he praises the G7 summit in Bavaria for unambiguously siding with Ukraine, but also admonishes the leading western powers to pay close attention to famines and food security internationally.

Jane Escher is a public-relations trainee at Engagement Global.
jane.escher@engagement-global.de

Kategorien: english

State of the global economy

Brookings - 29. Juni 2022 - 21:58

More than two years after the COVID-19 pandemic transpired into a global polycrisis, the path to economic recovery remains precarious. Furthermore, Russia’s invasion of Ukraine and its spillover effects on global commodity markets, supply chains, and financial conditions have significantly deteriorated the growth outlook. Inflation rates have reached levels not seen in decades in many countries. In response, central banks have begun to raise interest rates even as the global economic recovery remains incomplete in most countries. This response could increase the cost of capital, precipitate sovereign debt crises, and further undermine the recovery of emerging markets and developing economies.

Is the global economy entering an imminent recession or stagflation? Can policymakers rein in inflation while avoiding a recession? What are the risks of widespread sovereign debt crises in the developing world? What should policymakers do to navigate this complex set of challenges and lay the foundations for a more resilient and inclusive recovery?

On Wednesday, July 13, the Global Economy and Development program at the Brookings Institution will convene a panel of experts to answer these pressing questions. This event will feature introductory remarks by the president of the World Bank Group, David Malpass, followed by a presentation on the findings of the World Bank Group’s latest Global Economic Prospects report. Brahima S. Coulibaly, vice president of the Global Economy and Development program, will then moderate a conversation among leading experts from both the public and private sectors.

Viewers can submit questions by emailing events@brookings.edu or via Twitter using hashtag #GlobalEconomy.

      
Kategorien: english

Flight from cities due to COVID-19 short-lived, says flagship UN-Habitat report

UN #SDG News - 29. Juni 2022 - 18:12
A new United Nations report says that rapid urbanization was only temporarily delayed by the COVID-19 pandemic, with the global urban population back on track to grow by another 2.2 billion people by 2050.
Kategorien: english

Flight from cities due to COVID-19 short-lived, says flagship UN-Habitat report

UN ECOSOC - 29. Juni 2022 - 18:12
A new United Nations report says that rapid urbanization was only temporarily delayed by the COVID-19 pandemic, with the global urban population back on track to grow by another 2.2 billion people by 2050.
Kategorien: english

Women are particularly disadvantaged in the informal sector

D+C - 29. Juni 2022 - 16:32
Gender equality matters in both the formal and the informal economy, for example when it comes to finance

They often have a lower level of education, even though in Africa, for example, the gender gap is closing somewhat among the younger generation. In many places, moreover, women are socially subordinate to men and thus do not get the same opportunities in economic life (see Mireille Kanyange at www.dandc.eu on inequality in Burundi).

Traditional gender roles, however, are also prevalent in the formal economy. In Africa’s financial industry, for example, most loan officers are still men. In countries like Nigeria, that is the case both for banks and mobile-money companies. Across Africa, mobile money is facilitating innovative and more inclusive financial services. Where a husband’s consent is requested for the approval of a loan, as is the case in Uganda, women are at a disadvantage nonetheless. Husbands often gain undue control over their wives’ finances. It rarely happens the other way around.

Examples like these show that gender inequalities need to be consciously addressed. Overall, the expansion of the formal sector is already benefiting women. In many ways, the women themselves are a major force of making change happen.

Oliver Schmidt is a senior project manager at the Bonn-based consultancy AFC (Agriculture and Finance Consultants). AFC is the competency centre for financial sector development of the GOPA Consulting Group, which provides advice to international development agencies.
oliver.schmidt@afci.de

Kategorien: english

Bringing businesses out of the informal sector

D+C - 29. Juni 2022 - 16:10
Governments and donor agencies worldwide do a great deal to strengthen the formal economy – but not all their efforts are crowned with success

The informal economy does not have a good reputation in western industrialised countries like Germany. A fundamental reason is that it operates outside the realm of taxes and social-protection systems. Many critics see it as a shadow economy, with actors illegally sidestepping the paying of taxes and social security contributions. On the other hand, many informal workers view government institutions and state structures with scepticism.

In most low-income countries, state structures tend to be young and typically often go back to authoritarian colonial rule. They are widely considered to be artificial – in contrast to long-established sociocultural traditions and norms. According to the World Bank, the informal sector in emerging market and developing economies accounts for around a third of gross domestic product (GDP) and about 70 % of employment (World Bank 2021). Many of the people concerned are self-employed.

One would intuitively expect informal employment to move in counter-cyclical ways to formal employment. When the formal economy weakens, after all, people lose their jobs and are forced to earn money informally. In an economic upswing, on the other hand, there are new opportunities to switch from the informal to the formal sector.

In reality, however, things are more complex. For example, the informal sector can provide additional growth impulses in an economic upswing. The potential differs from country to country however. Among other things, the dynamics depend on:

  • how flexible formally regulated markets are and
  • what levels of demand for informal labour are prevalent.

It is striking that, according to the International Monetary Fund (IMF) informal businesses and workers were particularly hard hit by economic downturns which the Covid-19 pandemic caused.

Exploitation and meagre pay

Many workers in the informal sector endure poor working conditions. In some cases, they are severely exploited and may even live in slavery-like conditions (see Markus Loewe at www.dandc.eu on the issue of social security). The pay gap between the formal and informal sectors is considerable. A major reason for the different pay levels is that the productivity of formal enterprises can be up to twice as high as what informal businesses achieve. This is largely due to higher levels of education, and that applies to the workforce as well as the management.

In sub-Saharan Africa, the informal economy is more pronounced than in any other region of the world, accounting for around 34 % of economic output (IMF 2020) (see Karim Okanla at www.dandc.eu on the informal sector in Benin). Even people with formal jobs are often involved in some informal activities too – ­either personally or through family members. In Latin America and South Asia, the informal economy accounts for significant shares of GDP too. However, it has been shrinking across all regions mentioned here.

South of the Sahara, most micro-, small- and medium enterprises (MSMEs) are not formally registered; most of their workers do not have an employment contract – let alone a job description. Many are paid late or irregularly. The tasks they perform depend largely on their relationship to the owner-manager, who will often be a relative.

Enterprises often unsuccessful

Some informal entrepreneurs are quite successful – but most businesses do not last long. Statistics tend to be of dubious quality, since informal businesses neither have an official paper trail. Nonetheless, it is safe to say that most MSMEs in sub-Saharan Africa do not survive five years.

Many governments in Africa are keen on formalising informal enterprises. The reasons include that they wish to:

  • support businesses more effectively in pursuit of growth and jobs,
  • benefit from more tax revenues and
  • make production more environmentally and socially sustainable.

To achieve such things, governments cooperate with donor agencies. In joint efforts, they support enterprises with capital grants, loans and skills training. Both the KfW Development Bank and the European Investment Bank expect every financial institution they support to set up an Environmental and Social Management System (ESMS). The idea is to channel funding to borrowers that comply with environmental and social standards.

The skills training donor institutions provide typically addresses various areas of management, including business and investment planning, financial management, human resources management as well as sales and marketing. Competencies in these areas help an enterprise to grow. Gaps regarding relevant skills often make businesses stall.

Formal business competences, moreover, are often a prerequisite to securing loans. Formalised financial institutions, after all, are accountable to regulators, so they need a clear understanding of their debtors’ situation – and only those clients’ financial reporting can provide that kind of knowledge.

Better business training needed

According to a review of the literature on the effectiveness of training efforts geared to enhancing business skills (McKenzie and Woodruff 2014), the impact tends to be rather limited. One reason is that the participants are too heterogeneous. In practice, the efforts to formalise enterprises often do not amount to much more than issuing certificates of registration. Some financial institutions, moreover, seem quite happy to refuse loans on the pretext that a business lacks formal status, for example, because they prefer to invest without risk in government bonds.

The larger the informal economy of a country is, the lower is its ratio of tax revenue to GDP. Many African governments have reformed their tax laws to address this problem. Nonetheless, many of them still hesitate to enforce fair taxation stringently. Part of the problem is that these governments find it easier to obtain donor funding than to collect taxes.

Despite all criticism, donor agencies often play a positive role in terms of enabling enterprises to obtain suitable loans. For example, they may incentivise financial institutions to accept movable assets as collateral. Furthermore, they help financial institutions extend their range of services, which is particularly helpful with regard to financial products that have proven useful for MSME promotion elsewhere. On the other hand, donor agencies also have a tendency to push financial institutions to grant loans even when they are either unwilling or strategically positioned to do so.

Ultimately, what is needed to improve the interaction of the informal and formal sectors is a sound macroeconomic policy. It should prioritise creating incentives for private-sector investments – especially in capital goods, skills training and business formalisation. Donor organisations should constantly reassess what role they are playing in this context and – whenever necessary – adjust their policies.

Sources

IMF, 2020: What is the informal economy?
https://www.imf.org/Publications/fandd/issues/2020/12/what-is-the-informal-economy-basics

World Bank, 2021: The long shadow of informality – challenges and policies. Edited by Ohnsorge, F., and Yu, S., Washington, DC.
https://www.worldbank.org/en/research/publication/informal-economy

McKenzie, D., Woodruff, C., 2014: What are we learning from business training and entrepreneurship evaluations around the developing world? The World Bank Research Observer, vol. 29, no. 1.

Oliver Schmidt is a senior project manager at the Bonn-based consultancy AFC (Agriculture and Finance Consultants). AFC is the competency centre for financial sector development of the GOPA Consulting Group, which provides advice to international development agencies.
oliver.schmidt@afci.de

Kategorien: english

Why many Africans must rely on informal health care

D+C - 29. Juni 2022 - 12:30
Traditional medicine is often inadequate, though it does work in many cases and is comparatively cheap

Access to affordable modern health care remains a huge challenge in sub-Saharan Africa. Masses of people are too poor to afford treatment at hospitals. Most African countries spell out integrated universal health coverage as a goal. Unfortunately, that goal still seems somewhat utopian in many places. Where government hospitals are supposed to provide services at heavily subsidised rates or even free of charge, facilities tend to be overwhelmed. Indeed, black markets have emerged, as patients often have to pay bribes to get treatment at public health centres.

It matters very much that most Africans do not have any kind of health insurance. There is a great need to develop both private insurance (see Dirk Reinhard on www.dandc.eu) and governmental social-protection schemes (see Markus Loewe on www.dandc.eu). So far, however, most health expenditures are paid out of pocket in Africa.

In the few African countries where national medical insurance schemes exist, they serve only a minority, according to the World Health Organization (WHO). In Ghana, only a third of the population receives medical insurance under the country’s National Health Insurance Scheme. In Nigeria, which has among the highest out-of-pocket health expenditures and the poorest health indicators in the world, 75 % of health expenditures were paid out-of-pocket in 2016, according to the WHO.

While there is at least some access to scientifically trained doctors in cities, things tend to be worse in rural areas. Most village communities rely entirely on traditional medicine, and many urban people do so too. The practitioners are easily accessible and their services are comparatively cheap. However, they sometimes fail to diagnose an illness properly or suggest treatments that do not work. Malperformance of this kind can lead to the loss of lives.

Age-old practices

Traditional medicine is also known as ethno-medicine, folk medicine, native healing or complementary and alternative medicine. It is based on millennia of – mostly orally transmitted – experience. Traditional healers are often quite competent when it comes to dealing with standard situations. Bone setters know how to deal with broken bones, for instance, and traditional midwives help women give birth. However, they are not always able to deal with difficult situations. Caesarean sections, for example, are beyond their competence.

A comparative study in Nigeria showed that maternal and child mortality were higher for women who relied on traditional medicine in pregnancy and labour than for those who could afford professional care. Similar studies in Niger and South Africa yielded the same results.

Even faith healers often deliver results, though their practices often have no scientifically explainable base apart from boosting patients’ confidence. When cases are complicated and traditional healers cannot help, it would be good if they referred patients to modern health centres. Unfortunately, that only happens rarely. To a large extent, modern and traditional medicine co-exist without much exchange between them.

What patients like about traditional medicine

According to research done in Malawi, the traditional healers are not to blame for this state of affairs. “Traditional healers were more enthusiastic than biomedical practitioners, who had several reservations about traditional healers and placed certain conditions on prospective collaboration,” is a finding reported in a joint publication by Fanuel Lampiao, Joseph Chisaka and Carol Clements (2019). While traditional healers clearly had confidence in modern practitioners’ competencies, the reverse was not true.

The study confirmed that one reason traditional healers were so popular was that many live and work in villages, so people need not travel long distances to see them. However, they pointed out that costs and travelling distances were not all that mattered. The researchers found that traditional healers were considered to be more respectful and approachable than their scientifically trained counterparts. They estimated that 80 % of Malawi’s people seek treatment from traditional healers.

Far too often, however, traditional medicine is inadequate. In 2015, malaria, tuberculosis, and HIV-related illnesses killed about 1.6 million Africans according to the WHO. Timely access to appropriate and affordable medicines, vaccines and other health services would have saved many of these lives. The full truth, however, is not only that many patients never saw a professional doctor, but that even if they had done so, they would have been unable to afford the prescribed medications. Over 98 % of the drugs consumed in Africa are produced outside the continent. They are quite expensive, and counterfeit drugs are a problem in their own right (see Assane Diagne’s contribution of 2019 on www.dandc.eu).

The problem with herbal medications

Accordingly, herbal medicine is one of the most important forms of traditional medicine. Once again, it has its limits, even though it often works. Serious issues include that:

  • dosage is difficult, so both under- and over-dosage happen,
  • sometimes, the wrong plant is used, and
  • contamination with toxic substances is common.

Efforts are being made to align traditional and modern medicine better. Over the past two decades, the WHO has been providing financial resources and technical support to ensure safe and effective traditional medicine development in Africa. In a series of clinical trials, 89 traditional products met international and national requirements for registration.

Fourteen countries have thus issued marketing authorisation for herbal medications. About half of these traditional products are now included in national lists of essential medicines. They play their part in treating diseases such as malaria, opportunistic infections related to HIV, diabetes, sickle cell disease and hypertension.

Jean-Baptiste Nikiema is a WHO adviser who specialises in essential medicines. In his eyes, two things are slowing down progress regarding the scientific approval of traditional medicine. One is political interference, the other is researchers’ hesitancy to share insights for which intellectual-property protection is not available.

In most cases, traditional medicine thus remains unregulated in Africa. It is thus not monitored by any institutions of oversight either. Patients deserve better.

Reference
Lampiao, F., Chisaka, J., and Clements, C., 2019: Communication between traditional medical practitioners and western medical professionals. In: Frontiers in Sociology
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022779/

Ben Ezeamalu is a senior reporter who works for Premium Times in Lagos.
ben.ezeamalu@gmail.com
Twitter: @callmebenfigo

Kategorien: english

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