Editorial
Fabrice Coffrini/Staff
WHO AFRO: in need of new leadership
For the Atlas of African Health Statistics 2012 see http://www. aho.afro.who.int/sites/default/ files/publications/63/AFROStatistical_Factsheet.pdf
The past 6 months have shone an unprecedented spotlight on health in Africa. Although now is not the time for a detailed review of the failures that led to the current Ebola outbreak in west Africa, enough is known to say that WHO’s Regional Office for Africa (WHO AFRO) failed catastrophically in its mandate to monitor emerging health threats on the continent and to signal those threats to the wider international community. It is already known that some WHO country offices in west Africa simply did not recognise the importance of Ebola or act quickly enough to scale up the agency’s global response. Geneva’s frustration with its senior officials in Brazzaville is palpable. Senior WHO leaders have expressed fears that the failure of its Regional Office puts the credibility of the entire organisation at risk. The upcoming election of a new Regional Director for WHO AFRO in Cotonou, Benin, is therefore of more than passing interest. The election of a competent, respected, politically skilled, and technically able leader is a critical test for the agency. Voting to nominate a
candidate as the new Regional Director by the Regional Committee will take place between Nov 3 and 7, and the name of that person will then be submitted to WHO’s Executive Board for approval. The appointment is for 5 years, with the opportunity for a second term. Five names have been put forward for the post. The candidates include: Dorothée Kinde-Gazard (Benin), Matshidiso Rebecca Moeti (Botswana), Thérèse Ndri Ayo-Neman (CÔte d’Ivoire), Jean-Marie Okwo-Bele (Democratic Republic of the Congo), and Fatoumata Nafo-Traoré (Mali). This election is nothing short of crucial. According to the Atlas of African Health Statistics 2012, AFRO is the only WHO region to see an increase in its adult mortality rate from 366 to 383 per 1000 people between 1990 and 2009. African countries must carefully examine the experience and vision of the candidates presented to them. This most important of continents to the future of global health cannot afford another era of failed leadership. The Lancet
UNICEF Cambodia/2014/Sofia Ollvid
Violence against children in Cambodia: breaking the silence
For Cambodia’s Violence Against Children Survey see http://www. unicef.org/cambodia/UNICEF_ VAC_Full_Report_English.pdf
1550
“When we arrive at school and it is early and we are alone, it is quiet and we are afraid…”, admits a 13-yearold Cambodian girl. School should be a familiar and welcoming place; however, findings from the first-ofits-kind Cambodia’s Violence Against Children Survey, coordinated by UNICEF Cambodia, reveal that many children are subjected to violence at the hands of people they know and should trust in places that should feel safe. More than half of children experience physical violence before 18 years of age, with more than 20% facing emotional violence, and 5% sexual abuse. Parents, neighbours, family members, and friends are responsible, and many children remain silent, with 40% of girls and less than 6% of boys seeking help after sexual abuse. One 16–17-year-old girl explained that she did not tell anyone because the abuse was “embarrassing and shameful”, adding that “we are afraid that others will stop being our friends, or liking us; they will hate us, criticise and scorn us”. The violence affects the children’s health, causing mental distress and suicidal thoughts, and increases the likelihood of contracting sexually transmitted infections
through later unsafe sexual behaviour. An estimated 1% of Cambodia’s GDP is lost because money that could be spent on other social needs is spent combating the violence, and the children are prevented from reaching their full potential and contributing to society. What can be done about this appalling situation? The report provides recommendations in four key areas: prevention, response, laws and policies, and monitoring and evaluation. Core commitments have been developed and adopted by all ministries and government agencies involved, which have been translated into priority actions for 2015, and will form the basis of a national action plan to prevent and respond to the violence. “…the survey will ultimately be seen as a critical turning point in national efforts to address violence in Cambodia”, according to UNICEF Cambodia representative Rana Flowers, because it provides information about the issue for the first time. The next step is action. The silence needs to be broken, attitudes changed, and violence ended so that children in Cambodia can lead the lives they deserve. The Lancet www.thelancet.com Vol 384 November 1, 2014
Fabrice Coffrini/Staff
WHO AFRO: in need of new leadership
For the Atlas of African Health Statistics 2012 see http://www. aho.afro.who.int/sites/default/ files/publications/63/AFROStatistical_Factsheet.pdf
The past 6 months have shone an unprecedented spotlight on health in Africa. Although now is not the time for a detailed review of the failures that led to the current Ebola outbreak in west Africa, enough is known to say that WHO’s Regional Office for Africa (WHO AFRO) failed catastrophically in its mandate to monitor emerging health threats on the continent and to signal those threats to the wider international community. It is already known that some WHO country offices in west Africa simply did not recognise the importance of Ebola or act quickly enough to scale up the agency’s global response. Geneva’s frustration with its senior officials in Brazzaville is palpable. Senior WHO leaders have expressed fears that the failure of its Regional Office puts the credibility of the entire organisation at risk. The upcoming election of a new Regional Director for WHO AFRO in Cotonou, Benin, is therefore of more than passing interest. The election of a competent, respected, politically skilled, and technically able leader is a critical test for the agency. Voting to nominate a
candidate as the new Regional Director by the Regional Committee will take place between Nov 3 and 7, and the name of that person will then be submitted to WHO’s Executive Board for approval. The appointment is for 5 years, with the opportunity for a second term. Five names have been put forward for the post. The candidates include: Dorothée Kinde-Gazard (Benin), Matshidiso Rebecca Moeti (Botswana), Thérèse Ndri Ayo-Neman (CÔte d’Ivoire), Jean-Marie Okwo-Bele (Democratic Republic of the Congo), and Fatoumata Nafo-Traoré (Mali). This election is nothing short of crucial. According to the Atlas of African Health Statistics 2012, AFRO is the only WHO region to see an increase in its adult mortality rate from 366 to 383 per 1000 people between 1990 and 2009. African countries must carefully examine the experience and vision of the candidates presented to them. This most important of continents to the future of global health cannot afford another era of failed leadership. The Lancet
UNICEF Cambodia/2014/Sofia Ollvid
Violence against children in Cambodia: breaking the silence
For Cambodia’s Violence Against Children Survey see http://www. unicef.org/cambodia/UNICEF_ VAC_Full_Report_English.pdf
1550
“When we arrive at school and it is early and we are alone, it is quiet and we are afraid…”, admits a 13-yearold Cambodian girl. School should be a familiar and welcoming place; however, findings from the first-ofits-kind Cambodia’s Violence Against Children Survey, coordinated by UNICEF Cambodia, reveal that many children are subjected to violence at the hands of people they know and should trust in places that should feel safe. More than half of children experience physical violence before 18 years of age, with more than 20% facing emotional violence, and 5% sexual abuse. Parents, neighbours, family members, and friends are responsible, and many children remain silent, with 40% of girls and less than 6% of boys seeking help after sexual abuse. One 16–17-year-old girl explained that she did not tell anyone because the abuse was “embarrassing and shameful”, adding that “we are afraid that others will stop being our friends, or liking us; they will hate us, criticise and scorn us”. The violence affects the children’s health, causing mental distress and suicidal thoughts, and increases the likelihood of contracting sexually transmitted infections
through later unsafe sexual behaviour. An estimated 1% of Cambodia’s GDP is lost because money that could be spent on other social needs is spent combating the violence, and the children are prevented from reaching their full potential and contributing to society. What can be done about this appalling situation? The report provides recommendations in four key areas: prevention, response, laws and policies, and monitoring and evaluation. Core commitments have been developed and adopted by all ministries and government agencies involved, which have been translated into priority actions for 2015, and will form the basis of a national action plan to prevent and respond to the violence. “…the survey will ultimately be seen as a critical turning point in national efforts to address violence in Cambodia”, according to UNICEF Cambodia representative Rana Flowers, because it provides information about the issue for the first time. The next step is action. The silence needs to be broken, attitudes changed, and violence ended so that children in Cambodia can lead the lives they deserve. The Lancet www.thelancet.com Vol 384 November 1, 2014
