HIV rates in Uganda’s Karamoja region are rising fast. Non-governmental organizations (NGOs) are well placed to tackle the problem through medical and public health services. Many of these organizations have been dealing with HIV for decades. They have the resources and experience to make a great, positive difference. However, in the case of Karamoja there is not much anyone can do.
Karamoja is the Afghanistan of Africa: tribal, pastoral, violent, and without infrastructure. Government control, let alone health services, in the region is minimal. In this environment NGOs have been largely forced out by instability.
Most aid organisations function with only essential personnel on the ground, if at all, because of the region’s insecurity – cattle raids on neighbouring communities are common, and increasingly fatal with the introduction of modern arms – while the difficulty of travelling between districts forces non-governmental organisations (NGOs) either to manage their programmes in Karamoja remotely or give the region a wide berth.
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“We can’t invest more money because of the limited capacity for absorption; loads of money can go into Karamoja, but if no infrastructure or conducive policy environment is built, then the possibilities are limited,” said Savio Carvalho, Oxfam’s country programme manager. “There needs to be a framework.”
Carvalho is talking about system disruption. The roads, energy, social services , security, political control, and social network of a region are all part of its ’system’. Conflicts disrupt these systems. The role of IGOs/NGOs is to repair or strengthen areas of systems through various methods. These include building new infrastructures (wells, clinics, schools) and providing health services. The problem in Karamoja is that the region’s system is below the threshold necessary for NGOs to operate. NGOs are designed to build upon existing systems, not create them from scratch. Carvalho refers to the existing system as the needed “framework”.
HIV health services are particularly vulnerable to system disruption. Antiretrovirals (ARVs), which make HIV a chronic (opposed to fatal) disease, must be taken regularly for the entire lifespan of the patient. When the system is disrupted (through road blocks, population movements, looting, etc…) and access to ARVs is interrupted, there is the very real risk the virus will become resistant to the treatment. Thus, ARVs are highly dependent on a stable system enabling the medical/logistical operation required to deliver and distribute the drugs throughout the region.
The takeaway point: The provision of health services requires a certain level of ’system’ in place. When conflict is the primary disruptor of a region’s system, the ability to provide long term security (either from national or international sources) is a prerequisite to successful health interventions.
Christopher R. Albon is a political science Ph.D. specializing in armed conflict, public health, human security, and health diplomacy.
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