Africa's medical crisis, ID cards and others

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The Independent Online

Rich countries can help Africa to stop the medical brain drain

Rich countries can help Africa to stop the medical brain drain

Sir: The UK may be playing its part in enticing health workers from sub-Saharan Africa to work in the UK (report, 27 May), but rich nations must also play a proactive role in helping developing countries create training courses, systems and an environment that health workers require to remain in their own countries.

Amref, the African Medical and Research Foundation, has nearly 50 years experience in providing health care in sub-Saharan Africa. Amref is tackling the various issues which lead Africa's medical professionals to leave the continent. These are issues such as badly run and isolated health clinics with no telecommunications, no fellow professionals to consult with, no refresher or training courses, no continued medical support.

Amref has found that by providing health workers with the support and information they need, they are far more likely to remain in Africa. For example, it is vital that Africa develops its own health curricula. Often, curricula are inaccessible, irrelevant, and not linked to the community's culture, common ailments or pressing needs.

Amref develops curricula that are relevant, and include practical training in the field. We have also developed and run refresher courses that ensure trained health workers stay motivated and up-to-date, and we are developing a tele-medicine programme that will create virtual consulting rooms.

Our curricula are pertinent to the African context only, making it impossible for newly trained health staff to immediately transfer abroad. For example, in Uganda, Amref developed the concept of the "comprehensive nurse". Whereas in other countries medical personnel specialise early on, in Uganda there was a pressing need to create a general health worker. A shortage of medicines, equipment and personnel meant that nurses needed to remain "all-rounders" and a course was developed by Amref that was quickly taken on by the Ugandan Ministry of Health. The comprehensive nurse remains a key position in thousands of Ugandan villages but while they are indispensable in Uganda, they are unemployable in Europe.

Without real investment in strengthening African health systems and providing ongoing training, the problem of brain drain from developing to developed countries will not improve.



Data on ID cards must be secure

Sir: Your report on the US interest in the ID Card Bill ("US wants to be able to access Britons' ID cards", 27 May) informs us that Michael Chertoff, the newly appointed US Secretary for Homeland Security, has already discussed with ministers the aim of the UK and the US getting the same microchip technology to ensure compatability in screening terrorist suspects. Any measure which gives another state direct access to a database of information about UK citizens compromises our democratic control and would be completely unacceptable. I am opposed to the introduction of an ID card and national database/register in the UK. If the plans do go ahead, we must ensure that we have a system that is not directly accessible by other states. Requests for information from the database from other states should have to go through the UK Government as the democratic body accountable to the citizens on that database.



Sir: Janet Street Porter (Opinion, 26 May) claims that criminals are able to subvert any ID card schemes.

Indeed, a lot of schemes are fallible. But there are some which are not. "Chip and PIN" is a good example. With the new readers banks can now guarantee that the chip and PIN card itself is not forged. However, the banks cannot verify the person entering the PIN is the owner, or that they are entering it of their own free will. In the case of ID cards, police could be issued with mobile card readers which would definitely validate the ID card. So the technology is possible.

What this means is a re-emergence of ghettos and a substantial black market, as undocumented people avoid uncrackable validation. With all the legitimate avenues closed off, the black market would be composed of people entirely off any record.

They could be so stigmatised that some would fight tooth-and-nail to silence anyone who discovers them, as discovery could lead to deportation. If a child is born to someone off the record, would its registration give away an entire family? If so, a new generation could be off the record. The ID card technology works, but the system does not.



Sir: A couple of years ago, in circumstances which need not detain us here, my wife's car required a new front number plate.

I eventually obtained one from a local supplier, but only after producing the registration document, a utility bill, my driving licence and passport, and practically swearing on my mother's grave that I was who I said I was. The checking and recording process took longer than production of the replacement plate. When I queried the reason for this, I was told that it was the Government's system for preventing vehicle identity fraud. I said that I therefore supposed this to be worthwhile but received the reply: "Oh, no! It has no effect on the criminals; they have their own machine!"

I suggest that this experience might usefully be taken into account when deciding whether identity cards should be introduced.



Sir: This government intends to introduce identity cards in 2008 at a suggested cost of £93 each. It is hoped they will be a safeguard against terrorism and fraud.

Within two years of the government passing a National Registration Act on 1 September 1939, 700,000 identity cards were reported lost or stolen. They had been issued free of charge. In a West London Magistrates Court case on the 9 December 1942 it was stated that identity cards exchanged hands for as little as £4 - £160 in today's money. In the same month the Ministry of Labour confessed the illegal sale of ID cards was "particularly rife at the moment".

Theft, forgery and counterfeit have always been at the heart of the criminal's trade. Costly biometric ID cards will be no more successful in helping to achieve this government's aim than were the wartime stiffened-paper identity cards.



Sir: Prime Minister Tony Blair is said to be most concerned about his place in history now that 36 per cent of the electorate have given him a third term in office. Given that in his previous terms he has attached his personal capital to major blunders such as the Millennium Dome and the Iraq war, I fully expect him to repeat history and endorse a third blunder, namely ID cards.

Mr Blair's place in history could well be shared with his heroine Mrs Thatcher: a prime minister who sinks with their pet project. Mrs Thatcher was sunk by the poll tax, will Mr Blair sink with ID cards?



EU laws have made business easier

Sir: What is Tony Blair playing at?

On 26 May he made a speech stating that "about 50 per cent of regulations with a significant impact on business now emanate from the EU. And often it seems to want to regulate too heavily without sufficient cause."

This is total nonsense. I was a Member of the European Parliament in 1986 when the Single Market was established and certainly there was a large proportion of EU-originating legislation at that time, but what ministers failed to explain to the public was that one set of laws was being agreed to replace 12 different sets of laws, thus making it much easier for companies exporting to the Continent. Remember the long queues of lorries we used to see at customs posts so that drivers could have all their forms checked when going from one country to another? Now companies have only to fill in one form instead of one for each country.

All that happened a long time ago. Now it is clear that, in terms of primary legislation - laws placed before Parliament as bills and debated in the normal way - nothing like 50 per cent comes from the EU. As for secondary legislation, the proportion which originates from the EU is around 9 per cent.

Other reports out this week show that Britain is most guilty of gold plating EU legislation. What have Tony Blair and his ministers done to curb their civil servants' enthusiasm for writing unnecessary regulations? If Tony Blair is as anxious as he says to make a success of the British presidency of the EU this year, he had better get his facts right and tell us something positive and, dare I say, truthful.



Hoodies are for the good guys too

Sir: I've followed with interest the debate that has followed Bluewater's decision to ban hoodies in their complex.

When I was 14, I wore hooded tops frequently, as did most of the people I knew and hung out with. Many of my friends were skaters; unarguably the most benign category of teenager, yet skaters are also the most likely to wear hoodies. A couple of times I was robbed by other teenagers who also wore hoodies; "rudeboys" as they were known.

My friends and I never robbed anyone, "tagged" a bulding with spray-paint, or gave anyone any reason to feel intimidated by us. We all know hoodies can be used to shield one's face from public view and CCTV footage, but did you know they can also be used to prevent rain falling on your head?



Let's go to court over election reform

Sir: In view of the Government's reluctance to countenance reasonable requests for a referendum on proportional representation, can I suggest another approach?

Article 3 of the First Protocol of the European Convention on Human Rights obliges the parties, of which the UK is of course one, to hold "free elections ... under conditions which will ensure the free expression of the opinion of the people in the choice of the legislature". The first-past-the-post system hasn't been tested against these criteria, but if it was, it might fall down if the phrase "free expression" could be interpreted as implying the idea of an "effective" choice of the legislature.

The Commission could be seized of this hugely important issue by any public interest campaign (such as your excellent Campaign for Democracy). This would be the start of a long and, for the Government, deeply embarrassing process which, in the absence of a friendly settlement (such as an agreement to hold a referendum), would end in court.



Sir: Why does The Independent keep touting Peter Hain as a supporter of electoral reform?

Back in 1986, Mr Hain published a book called Proportional Misrepresentation in which he argued vehemently against the introduction of any form of PR for parliamentary elections. His sole concession to "reform" was support for the alternative vote, the single-member constituency preferential electoral system used for the Australian House of Representatives, but this is no more proportional than first-past-the-post.

Indeed, New Labour's majority would have been even larger had AV been used for the general election on 5 May and minority parties would have found it even more difficult to challenge the near monopoly enjoyed by the big three.



Sir: In your campaign for electoral reform you keep quoting the percentage of voters who voted for Labour to bolster your case. I'm afraid you are using flawed assumptions.

There was a lot of tactical voting across the country to try to keep out particular parties in particular places. In Guildford, where I managed the Labour Party campaign, we know that many Labour supporters opted to hold their noses and vote Lib Dem to try to keep out a Tory. Equally, there were many Labour seats so safe that supporters felt they need not bother to vote as the party was bound to win. Just look at the decline in turnout across the Labour heartlands.

Under a PR system the Labour vote would be higher and the Lib Dem vote would be lower.



Cheap air travel

Sir: Congratulations to The Independent for highlighting the impact of air travel on climate change ("Revealed: The real cost of air travel", 28 May). May I ask when you will be dropping your travel supplement, with its adverts for cheap flights?



An enlightened legacy

Sir: I would like to take issue with Sheridan Gilley's assertion that "the Enlightenment" was a theistic occurrence (letter, 27 May). While it is indeed the case that "the Enlightenment" was a complex occurrence and that it was not entirely atheistic in nature, including as it did some religious reformers, it is a fact that its legacy is effectively atheistic: materialist, liberal and socialist.



Missing the pressure

Sir: The new BBC weather forecast is a betrayal of Reithian ideals (report, 27 May). In the past we were considered educable enough to be offered a pressure chart such as invited the imaginative prediction of how the weather might be. Now we get the televisual equivalent of a particularly crass computer game.



Liverpool all stars

Sir: In view of the Tory leader Michael Howard's claim to be a Liverpool F.C. fan, isn't it ironic that Liverpool's European Cup triumph largely came courtesy, to quote your columnist Terence Blacker (27 May), of a "wonderful rainbow coalition" of economic migrant players and team manager?



Amazon connection?

Sir: Thank you for your arresting report on the savaging of the Brazilian rainforests (20 May). I was intrigued by the name of the perpetrator you singled out: Blairo Maggi. I wonder whether a number of our woes this side of the Atlantic can be laid at the door of his near-namesake, Blair O'Maggie?