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Mid Brain Activation

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About Midbrain –http://midbrain-activation.info/midbrain.html
midbrain

The midbrain is the smallest region of the brain that acts as a sort of relay station for auditory and visual information. The midbrain controls many important functions such as the visual and auditory systems as well as eye movement. Portions of the midbrain called the red nucleus and the substantia nigra are involved in the control of body movement.
The midbrain is located between the two developmental regions of the brain know as the forebrain and hindbrain.Within the midbrain is the reticular formation,Which is part of the tegmentum,a region of the brainstem that influences main functions.These two strutures,in addition to the globus pallidus,from the striatum.By inhibiting the action of neurons in the caudate nucleus and the putamen, the dopaminergic cell of the pars compacta influence the neuronal output of the neurotransmitter GABA (gamma-aminobutyric acid).The neurons in turn project to the cell of the pars reticulata,which,by projecting fibres to the thalamus,are part of the output system of the corpus striatum.
The interbrain also called as midbrain, located at the centre of the cerebrum, links and consolidates the functions of each part of the brain. It also allows the work of each file of the brain to appear onto consciousness.The interbrain acts as a sort of control tower of consciousness and is equipped with highly advanced intelligence.If a person develops his interbrain, he will acquire a memory that will allow him to never forget whatever he has seen or heard once.

Midbrain – All about Midbrain

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Mid Brain Activation

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About Midbrain
midbrain-http://midbrain-activation.info

The midbrain is the smallest region of the brain that acts as a sort of relay station for auditory and visual information. The midbrain controls many important functions such as the visual and auditory systems as well as eye movement. Portions of the midbrain called the red nucleus and the substantia nigra are involved in the control of body movement.
The midbrain is located between the two developmental regions of the brain know as the forebrain and hindbrain.Within the midbrain is the reticular formation,Which is part of the tegmentum,a region of the brainstem that influences main functions.These two strutures,in addition to the globus pallidus,from the striatum.By inhibiting the action of neurons in the caudate nucleus and the putamen, the dopaminergic cell of the pars compacta influence the neuronal output of the neurotransmitter GABA (gamma-aminobutyric acid).The neurons in turn project to the cell of the pars reticulata,which,by projecting fibres to the thalamus,are part of the output system of the corpus striatum.
The interbrain also called as midbrain, located at the centre of the cerebrum, links and consolidates the functions of each part of the brain. It also allows the work of each file of the brain to appear onto consciousness.The interbrain acts as a sort of control tower of consciousness and is equipped with highly advanced intelligence.If a person develops his interbrain, he will acquire a memory that will allow him to never forget whatever he has seen or heard once.

 

vishal bedi

Mid Brain Activation

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About Midbrain midbrain-activation.info
midbrain

The midbrain is the smallest region of the brain that acts as a sort of relay station for auditory and visual information. The midbrain controls many important functions such as the visual and auditory systems as well as eye movement. Portions of the midbrain called the red nucleus and the substantia nigra are involved in the control of body movement.
The midbrain is located between the two developmental regions of the brain know as the forebrain and hindbrain.Within the midbrain is the reticular formation,Which is part of the tegmentum,a region of the brainstem that influences main functions.These two strutures,in addition to the globus pallidus,from the striatum.By inhibiting the action of neurons in the caudate nucleus and the putamen, the dopaminergic cell of the pars compacta influence the neuronal output of the neurotransmitter GABA (gamma-aminobutyric acid).The neurons in turn project to the cell of the pars reticulata,which,by projecting fibres to the thalamus,are part of the output system of the corpus striatum.
The interbrain also called as midbrain, located at the centre of the cerebrum, links and consolidates the functions of each part of the brain. It also allows the work of each file of the brain to appear onto consciousness. The interbrain acts as a sort of control tower of consciousness and is equipped with highly advanced intelligence. If a person develops his interbrain, he will acquire a memory that will allow him to never forget whatever he has seen or heard once.

Антон Панов

Физиология

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Схема. Организация ретикулярной формации.

http://www.tryphonov.ru/tryphonov2/terms2/retcfr.htm

p.29 FIGURE 42A RETICULAR FORMATION 1 RETICULAR FORMATION: ORGANIZATION The reticular formation, RF, is the name for a group of neurons found throughout the brainstem. Using the ventral view of the brainstem, the reticular formation occupies the central portion or core area of the brainstem from midbrain to medulla (see also brainstem cross-sections in Figure 65–Figure 67).

 

This collection of neurons is a phylogenetically old set of neurons that functions like a network or reticulum, from which it derives its name. The RF receives afferents from most of the sensory systems (see next illustration) and projects to virtually all parts of the nervous system. Functionally, it is possible to localize different subgroups within the reticular formation:

  • Cardiac and respiratory “centers”: Subsets of neurons within the medullary reticular formation and also in the pontine region are responsible for the control of the vital functions of heart rate and respiration. The importance of this knowledge was discussed in reference to the clinical emergency, tonsillar herniation (with Figure 9B).
  • Motor areas: Both the pontine and medullary nuclei of the reticular formation contribute to motor control via the cortico-reticulo-spinal system (discussed in Section B, Part III, Introduction; also with Figure 49A and Figure 49B). In addition, these nuclei exert a very significant influence on muscle tone, which is very important clinically (discussed with Figure 49B).
  • Ascending projection system: Fibers from the reticular formation ascend to the thalamus and project to various nonspecific thalamic nuclei. From these nuclei, there is a diffuse distribution of connections to all parts of the cerebral cortex. This whole system is concerned with consciousness and is known as the ascending reticular activating system (ARAS).
  • Pre-cerebellar nuclei: There are numerous nuclei in the brainstem that are located within the boundaries of the reticular formation that project to the cerebellum. These are not always included in discussions of the reticular formation. It is also possible to describe the reticular formation topographically. The neurons appear to be arranged in three longitudinal sets; these are shown in the left-hand side of this illustration:
  • The lateral group consists of neurons that are small in size. These are the neurons that receive the various inputs to the reticular formation, including those from the anterolateral system (pain and temperature, see Figure 34), the trigeminal pathway (see Figure 35), as well as auditory and visual input.
  • The next group is the medial group. These neurons are larger in size and project their axons upward and downward. The ascending projection from the midbrain area is particularly involved with the consciousness system. Nuclei within this group, notably the nucleus gigantocellularis of the medulla, and the pontine reticular nuclei, caudal (lower) and oral (upper) portions, give origin to the two reticulo-spinal tracts (discussed with the next illustration, also Figure 49A and Figure 49B). • Another set of neurons occupy the midline region of the brainstem, the raphe nuclei, which use the catecholamine serotonin for neurotransmission.

 

The best-known nucleus of this group is the nucleus raphe magnus, which plays an important role in the descending pain modulation system (to be discussed with Figure 43). In addition, both the locus ceruleus (shown in the upper pons) and the periaqueductal gray (located in the midbrain, see next illustration and also Figure 65 and Figure 65A) are considered part of the reticular formation (discussed with the next illustration).

 

In summary, the reticular formation is connected with almost all parts of the CNS. Although it has a generalized influence within the CNS, it also contains subsystems that are directly involved in specific functions. The most clinically significant aspects are:

  • Cardiac and respiratory centers in the medulla
  • Descending systems in the pons and medulla that participate in motor control and influence muscle tone
  • Ascending pathways in the upper pons and midbrain that contribute to the consciousness system

    Схема. Ядра ретикулярной формации.
    Модификация: Hendelman W. Atlas of Funtional Neuroanatomy, Second Edition, 2006, 15,5 MB. Доступ к данному источнику = Access to the reference.

    p 31
    FIGURE 42B
    RETICULAR FORMATION 2
    RETICULAR FORMATION: NUCLEI In this diagram, the reticular formation is being viewed from the dorsal (posterior) perspective (see Figure 10 and Figure 40). Various nuclei of the reticular formation, RF, which have a significant (known) functional role, are depicted, as well as the descending tracts emanating from some of these nuclei. Functionally, there are afferent and efferent nuclei in the reticular formation and groups of neurons that are distinct because of the catecholamine neurotransmitter used, either serotonin or noradrenaline.

 

The afferent and efferent nuclei of the RF include: • Neurons that receive the various inputs to the RF are found in the lateral group (as discussed with the previous illustration). In this diagram, these neurons are shown receiving collaterals (or terminal branches) from the ascending anterolateral system, carrying pain and temperature (see Figure 34; also Figure 35). • The neurons of the medial group are larger in size, and these are the output neurons of the reticular formation, at various levels. These cells project their axons upward or downward. The nucleus gigantocellularis of the medulla, and the pontine reticular nuclei, caudal, and oral portions, give rise to the descending tracts that emanate from these nuclei — the medial and lateral reticulo-spinal pathways, part of the indirect voluntary and nonvoluntary motor system (see Figure 49A and Figure 49B). • Raphe nuclei use the neurotransmitter serotonin and project to all parts of the CNS.

 

Recent studies indicate that serotonin plays a significant role in emotional equilibrium, as well as in the regulation of sleep. One special nucleus of this group, the nucleus raphe magnus, located in the upper part of the medulla, plays a special role in the descending pain modulation pathway (described with the next illustration). There are other nuclei in the brainstem that appear to functionally belong to the reticular formation yet are not located within the core region.

 

These include the periaqueductal gray and the locus ceruleus. The periaqueductal gray of the midbrain (for its location see Figure 65 and Figure 65A) includes neurons that are found around the aqueduct of the midbrain (see also Figure 20B). This area also receives input (illustrated but not labeled in this diagram) from the ascending sensory systems conveying pain and temperature, the anterolateral pathway; the same occurs with the trigeminal system.

 

This area is part of a descending pathway to the spinal cord, which is concerned with pain modulation (as shown in the next illustration). The locus ceruleus is a small nucleus in the upper pontine region (see Figure 66 and Figure 66A). In some species (including humans), the neurons of this nucleus accumulate a pigment that can be seen when the brain is sectioned (prior to histological processing, see photograph of the pons, Figure 66). Output from this small nucleus is distributed widely throughout the brain to virtually every part of the CNS, including all cortical areas, subcortical structures, the brainstem and cerebellum, and the spinal cord.

 

The neurotransmitter that is used by these neurons is noradrenaline and its electrophysiological effects at various synapses are still not clearly known. Although the functional role of this nucleus is still not completely understood, the locus ceruleus has been thought to act like an “alarm system” in the brain. It has been implicated in a wide variety of CNS activities, such as mood, the reaction to stress, and various autonomic activities.

 

The cerebral cortex sends fibers to the RF nuclei, including the periaqueductal gray, forming part of the cortico-bulbar system of fibers (see Figure 46). The nuclei that receive this input and then give off the pathways to the spinal cord form part of an indirect voluntary motor system — the cortico-reticulo-spinal pathways (discussed in Section B, Part III, Introduction; see Figure 49A and Figure 49B). In addition, this system is known to play an extremely important role in the control of muscle tone (discussed with Figure 49B). CLINICAL ASPECT Lesions of the cortical input to the reticular formation in particular have a very significant impact on muscle tone. In humans, the end result is a state of increased muscle tone, called spasticity, accompanied by hyper-reflexia, an increase in the responsiveness of the deep tendon reflexes (discussed with Figure 49B).

© 2006
Схема. Ретикулярная формация. Система модуляции боли.
Модификация: Hendelman W. Atlas of Funtional Neuroanatomy, Second Edition, 2006, 15,5 MB. Доступ к данному источнику = Access to the reference.

FIGURE 43 RETICULAR FORMATION 3 PAIN MODULATION SYSTEM Pain, both physical and psychic, is recognized by the nervous system at multiple levels. Localization of pain, knowing which parts of the limbs and body wall are involved, requires the cortex of the postcentral gyrus (SI); SII is also likely involved in the perception of pain (discussed with Figure 36). There is good evidence that some “conscious” perception of pain occurs at the thalamic level. We have a built-in system for dampening the influences of pain from the spinal cord level — the descending pain modulation pathway.

 

This system apparently functions in the following way: The neurons of the periaqueductal gray can be activated in a number of ways. It is known that many ascending fibers from the anterolateral system and trigeminal system activate neurons in this area (only the anterolateral fibers are being shown in this illustration), either as collaterals or direct endings of these fibers in the midbrain. This area is also known to be rich in opiate receptors, and it seems that neurons of this region can be activated by circulating endorphins. Experimentally, one can activate these neurons by direct stimulation or by a local injection of morphine.

 

In addition, descending cortical fibers (cortico-bulbar) may activate these neurons (see Figure 46). The axons of some of the neurons of the periaqueductal gray descend and terminate in one of the serotonincontaining raphe nuclei in the upper medulla, the nucleus raphe magnus. From here, there is a descending, crossed, pathway, which is located in the dorsolateral white matter (funiculus) of the spinal cord.

 

The serotonergic fibers terminate in the substantia gelatinosa of the spinal cord, a nuclear area of the dorsal horn of the spinal cord where the pain afferents synapse (see Figure 32). The descending serotonergic fibers are thought to terminate on small interneurons, which contain enkephalin. There is evidence that these enkephalin-containing spinal neurons inhibit the transmission of the pain afferents entering the spinal cord from peripheral pain receptors. Thus, descending influences are thought to modulate a local circuit.

 

There is a proposed mechanism that these same interneurons in the spinal cord can be activated by stimulation of other sensory afferents, particularly those from the touch receptors in the skin and the mechanoreceptors in the joints; these give rise to anatomically large well-myelinated peripheral nerve fibers, which send collaterals to the dorsal horn (see Figure 32). This is the physiological basis for the gate theory of pain. In this model, the same circuit is activated at a segmental level. It is useful to think about multiple gates for pain transmission.

 

We know that mental states and cognitive processes can affect, positively and negatively, the experience of pain and our reaction to pain. The role of the limbic system and the “emotional reaction” to pain will be discussed in Section D. CLINICAL ASPECT In our daily experience with local pain, such as a bump or small cut, the common response is to vigorously rub and/or shake the limb or the affected region. What we may be doing is activating the local segmental circuits via the touch- and mechano-receptors to decrease the pain sensation. Some of the current treatments for pain are based upon the structures and neurotransmitters being discussed here. The gate theory underlies the use of transcutaneous stimulation, one of the current therapies offered for the relief of pain. More controversial and certainly less certain is the postulated mechanism(s) for the use of acupuncture in the treatment of pain.

 

Most discussions concerning pain refer to ACUTE pain, or short-term pain caused by an injury or dental procedure. CHRONIC pain should be regarded from a somewhat different perspective. Living with pain on a daily basis, caused, for example, by arthritis, cancer, or diabetic neuropathy, is an unfortunately tragic state of being for many people.

 

Those involved with pain therapy and research on pain have proposed that the CNS actually rewires itself in reaction to chronic pain and may in fact become more sensitized to pain the longer the pain pathways remain active; some of this may occur at the receptor level. Many of these people are now being referred to “pain clinics,” where a team of physicians and other health professionals (e.g., anesthetists, neurologists, psychologists) try to assist people, using a variety of therapies, to alleviate their disabling condition.

03.01.16

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Francesca Frazzetto: Excelente ….

A.halim Noori

Public

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Brainstem
In the anatomy of humans and of many other vertebrates, the brainstem (or brain stem) is the posterior part of the brain, adjoining and structurally continuous with the spinal cord. In humans it is usually described as including the medulla oblongata (myelencephalon), pons (part of metencephalon), and midbrain (mesencephalon). Less frequently, parts of the diencephalon are included. The brainstem provides the main motor and sensory innervation to the face and neck via the cranial nerves. Of the twelve pairs of cranial nerves, ten pairs come from the brainstem. Though small, this is an extremely important part of the brain as the nerve connections of the motor and sensory systems from the main part of the brain to the rest of the body pass through the brainstem.

 

This includes the corticospinal tract (motor), the posterior column-medial lemniscus pathway (fine touch, vibration sensation, and proprioception), and the spinothalamic tract (pain, temperature, itch, and crude touch). The brainstem also plays an important role in the regulation of cardiac and respiratory function. It also regulates the central nervous system, and is pivotal in maintaining consciousness and regulating the sleep cycle. The brainstem has many basic functions including heart rate, breathing, sleeping, and eating.

Structure
Midbrain
The midbrain is divided into three parts. The first is the tectum, (Latin:roof), which forms the ceiling. The tectum comprises the paired structure of the superior and inferior colliculi and is the dorsal covering of the cerebral aqueduct. The inferior colliculus, is the principal midbrain nucleus of the auditory pathway and receives input from several peripheral brainstem nuclei, as well as inputs from the auditory cortex. Its inferior brachium (arm-like process) reaches to the medial geniculate body of the diencephalon.

 

Superior to the inferior colliculus, the superior colliculus marks the rostral midbrain. It is involved in the special sense of vision and sends its superior brachium to the lateral geniculate body of the diencephalon. The second part is the tegmentum which forms the floor of the midbrain, and is ventral to the cerebral aqueduct. Several nuclei, tracts, and the reticular formation are contained here. The third part, the ventral tegmental area is composed of paired cerebral peduncles. These transmit axons of upper motor neurons.

The midbrain consists of:

  • Periaqueductal gray: The area of gray matter around the cerebral aqueduct, which contains various neurons involved in the pain desensitization pathway.

 

Neurons synapse here and, when stimulated, cause activation of neurons in the nucleus raphes magnus, which then project down into the dorsal horn of the spinal cord and prevent pain sensation transmission.
* Oculomotor nerve nucleus: This is the third cranial nerve nucleus.
* Trochlear nerve nucleus: This is the fourth cranial nerve.
* Red Nucleus: This is a motor nucleus that sends a descending tract to the lower motor neurons.
* Substantia nigra: This is a concentration of neurons in the ventral portion of the midbrain that uses dopamine as its neurotransmitter and is involved in both motor function and emotion. Its dysfunction is implicated in Parkinson’s Disease.
* Reticular formation: This is a large area in the midbrain that is involved in various important functions of the midbrain. In particular, it contains lower motor neurons, is involved in the pain desensitization pathway, is involved in the arousal and consciousness systems, and contains the locus coeruleus, which is involved in intensive alertness modulation and in autonomic reflexes.
* Central tegmental tract: Directly anterior to the floor of the 4th ventricle, this is a pathway by which many tracts project up to the cortex and down to the spinal cord.
* Ventral tegmental area: is a group of dopaminergic neurons located close to the midline on the floor of the midbrain.

Ventral view of medulla and pons
In the medial part of the medulla is the anterior median fissure. Moving laterally on each side are the pyramids. The pyramids contain the fibers of the corticospinal tract (also called the pyramidal tract), or the upper motor neuronal axons as they head inferiorly to synapse on lower motor neuronal cell bodies within the ventral horn of the spinal cord.

The anterolateral sulcus is lateral to the pyramids. Emerging from the anterolateral sulci are the CN XII (hypoglossal nerve) rootlets. Lateral to these rootlets and the anterolateral sulci are the olives. The olives are swellings in the medulla containing underlying inferior nucleary nuclei (containing various nuclei and afferent fibers). Lateral (and dorsal) to the olives are the rootlets for cranial nerves IX (glossopharyngeal), CN X (vagus) and CN XI (accessory nerve). The pyramids end at the pontine medulla junction, noted most obviously by the large basal pons. From this junction, CN VI (abducens nerve), CN VII (facial nerve) and CN VIII (vestibulocochlear nerve) emerge. At the level of the midpons, CN V (the trigeminal nerve) emerges. Cranial nerve III (the occulomotor nerve) emerges ventrally from the midbrain, while the CN IV (the trochlear nerve) emerges out from the dorsal aspect of midbrain.

Dorsal view of medulla and pons
The most medial part of the medulla is the posterior median fissure. Moving laterally on each side is the fasciculus gracilis, and lateral to that is the fasciculus cuneatus. Superior to each of these, and directly inferior to the obex, are the gracile and cuneate tubercles, respectively. Underlying these are their respective nuclei. The obex marks the end of the 4th ventricle and the beginning of the central canal. The posterior intermediate sulci separates the fasciculi gracilis from the fasciculi cuneatus. Lateral to the fasciculi cuneatus is the lateral funiculus.

Superior to the obex is the floor of the 4th ventricle. In the floor of the 4th ventricle, various nuclei can be visualized by the small bumps that they make in the overlying tissue. In the midline and directly superior to the obex is the vagal trigone and superior to that it the hypoglossal trigone. Underlying each of these are motor nuclei for the respective cranial nerves. Superior to these trigones are fibers running laterally in both directions.

 

These fibers are known collectively as the striae medullares. Continuing in a rostral direction, the large bumps are called the facial colliculi. Each facial colliculus, contrary to their names, do not contain the facial nerve nuclei. Instead, they have facial nerve axons traversing superficial to underlying abducens (CN VI) nuclei. Lateral to all these bumps previously discussed is an indented line, or sulcus that runs rostrally, and is known as the sulcus limitans. This separates the medial motor neurons from the lateral sensory neurons.

 

Lateral to the sulcus limitans is the area of the vestibular system, which is involved in special sensation. Moving rostrally, the inferior, middle, and superior cerebellar peduncles are found connecting the midbrain to the cerebellum. Directly rostral to the superior cerebellar peduncle, there is the superior medullary velum and then the two trochlear nerves. This marks the end of the pons as the inferior colliculus is directly rostral and marks the caudal midbrain.

Spinal Cord to Medulla Transitional Landmark: From a ventral view, there can be seen a decussation of fibers between the two pyramids. This decussation marks the transition from medulla to spinal cord. Superior to the decussation is the medulla and inferior to it is the spinal cord.

Development
The adult human brainstem emerges from two of the three primary vesicles formed of the neural tube. The mesencephalon is the second of the three primary vesicles, and does not further differentiate into a secondary vesicle. This will become the midbrain. The third primary vesicle, the rhombencephalon, will further differentiate into two secondary vesicles, the metencephalon and the myelencephalon. The metencephalon will become the cerebellum and the pons. The myelencephalon will become the medulla.

Function
There are three main functions of the brainstem:

  1. The brainstem plays a role in conduction. That is, all information relayed from the body to the cerebrum and cerebellum and vice versa must traverse the brainstem. The ascending pathways coming from the body to the brain are the sensory pathways, and include the spinothalamic tract for pain and temperature sensation and the dorsal column, fasciculus gracilis, and cuneatus for touch, proprioception, and pressure sensation (both of the body). (The facial sensations have similar pathways, and will travel in the spinothalamic tract and the medial lemniscus also.) Descending tracts are upper motor neurons destined to synapse on lower motor neurons in the ventral horn and posterior horn. In addition, there are upper motor neurons that originate in the brainstem’s vestibular, red, tectal, and reticular nuclei, which also descend and synapse in the spinal cord.
  2. The cranial nerves III-XII emerge from the brainstem. These cranial nerves supply the face, head, and viscera. (The first two pairs of cranial nerves arise from the cerebrum).

3.The brainstem has integrative functions being involved in cardiovascular system control, respiratory control, pain sensitivity control, alertness, awareness, and consciousness. Thus, brainstem damage is a very serious and often life-threatening problem

 

Healthy Living Strategies

Abigail Enterprises 4 Healthy Living Strategies

Honoring the Memory of Sergut Araya Sellassie

by

Abigail Mariam Belai and Belai Mariam Habte-Jesus

##

ASA Foundation- A living memory of the life and work of Sergut A Sellassie

 

A short life history of “Sergut Araya Selassie”

1956-2016

 

Mrs. Sergut Araya Selassie was born on May 6, 1956 (Miazia 28, 1948,E.C.) in the city of Harer from her parents (Father: Fitawrari Araya Selassie Zeleke and Mother: Mrs. Zelekawork Mengistu).

 

Sergut Araya Selassie completed her elementary and high school education at the Private Girls Education Center of “Nazareth School” in Addis Ababa. She later went to the United States to complete her higher college education at the University of San Francisco, California where she received her Bachelor of Arts Degree with honors. Sergut worked with a series of Public and Private Institutions in the West and East Coast of the United States with honor and distinction.

 

Sergut was married to Dr Belai Habte-Jesus on September 11, 1992 (Meskerem 2, 1985, E.C.,) in Washington DC, USA and became the mother of her only daughter Abigail Mariam Belai on 12 March 1994, at the Virginia Hospital Center, Arlington, Virginia. Sergut has worked with diligence and dignity in all her responsibilities and was able to raise and educate her daughter with love, respect, and discipline towards a responsible and talented youth that respects life, education and loves her family and her diverse international cultural communities.

 

In line with her noble family upbringing and Christian faith, Mrs. Sergut Araya Selassie has served her immediate family, friends and the larger communities with love, respect and compassion for which she has attained respect and admiration by all her families, friends and colleagues. She was specially admired and honored for character and special gift of respecting and honoring all her friends and associates.

 

Sergut passed away at the age of 60, on Monday 11 July 2016 at 00:00 a.m.4 (Monday, 04 Hamle 2008, E.C.) at the George Washington Hospital in Washington DC. USA. after a short illness and appropriate care by her beloved families, friends and Metropolitan Washington DC area hospitals and specialists. She died of Breast Cancer at the age of 60, when Breast Cancer the second most lethal cancer in women in the USA is usually diagnosed.

 

After a special prayer at the St. Michael Church, Washington DC on Thursday, 14 July 2016 (7 Hamle, 2008, E.C.,) at 10:00 am, her body will travel to Ethiopia accompanied by her beloved family on Friday 15 July 2016 and will be buried at Entoto, Hamere Noah Holy St Mary Monastery, Addis Ababa, Ethiopia on Saturday 16 July 2016 (09 Hamle 2008, E.C.,).

Psalms 23:

 

The Lord is my Shepherd, I shall not want. He makes me to lie down in green pastures; he leads me beside the still waters. He restoreth my soul: he leads me in the paths of righteousness for his name’s sake.

Yeah, though I walk through the valley of the shadow of death, I will fear no evil: for tough art with me; thy rod and thy staff they comfort me. Surely goodness and mercy shall follow me all the days of my life and I will dwell in the house of the Lord forever.

…With love and respect, From her beloved daughter Abigail Mariam Belai,Family and Friends around the world

 

###

 

The Abigail Enterprises for Healthy Living

 

In honor of the memory Sergut A Selassie

 

SAS Foundation/Sergut Araya Selassie Foundation

 

Introduction

 

  • Abigail Belai and Belai Habte-Jesus are establishing “AE4HL/Abigail Enterprises 4 Healthy Living” in honor of Sergut A Sellassie (1956-2016)- The “SAS Foundation”, in memory of the beloved mother of Abigail Mariam Belai who lived a remarkable life of serving others in diversity to sustain our shred universal divinity with Marriott International in East and West Coast of the USA, IMF and World Bank institutions in the Metropolitan Washington DC area.

 

 

  1. Our Vision

 

  • To promote the culture of healthy living for sustainable development and progressive prosperity for all age diverse groups of populations around the world.

 

  1. Our Mission

 

  • To cultivate the culture of healthy living based on the latest scientific and cultural knowledge, evolving scientific discoveries to all communities.

 

  1. Our Goal

 

  • Our goal is to improve the KAP/knowledge, attitude and practice of all people (from conception to old age) towards promoting healthy and productive living in line with the latest scientific and cultural discovery and development respectively.

 

  1. Our SMART Work Plan

 

  • To establish and develop a sustainable public and private enterprise that promotes healthy living and productive life with all sectors of our communities via modern ICT/Information, Communication and Technology and SMN/Social Media Network.

 

 

  • Health Promotion and Disease Prevention Strategies

 

Defining Health Promotion and Disease Prevention

 

Health is positive sense of spiritual, emotional, psychological, mental, behavioral and physical well being. As such, Health is not a mere albescence of disease, injury, inflammation and disabilities. A positive sense of wellbeing is dependent on our positive interaction with integrated individual, group, personal and social relationships with the ecology we live in.

 

Health promotion and disease prevention programs focus on keeping people healthy.

 

Health promotion engages and empowers individuals and communities to engage in healthy behaviors, and make changes that reduce the risk of developing chronic diseases, injury, inflammation, disabilities and other morbidities.

 

 

 

As defined by the World Health Organization, health promotion is:

The process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.”

 

Disease prevention focuses on prevention strategies to reduce the risk of developing acute and chronic diseases, injuries, inflammation, disabilities and other morbidities.

 

Health promotion and disease prevention programs often address social determinants of health, which influence modifiable risk behaviors.

 

Social determinants of health are the economic, social, cultural, and political conditions in which people are born, grow, and live that affect health status. Modifiable risk behaviors include, for example, tobacco use, poor eating habits, and lack of physical activity, which contribute to the development of chronic disease.

 

SAS Foundation Projects and Activities

 

  1. Health Promotion: Choosing a healthy life style all the time!

Integrating restful sleep, balanced diet and leisurely activities

 

Typical activities for health promotion and disease prevention programs include:

  • 1 Interactive Communication: Raising awareness about healthy behaviors for the general public. Examples of communication strategies include public service announcements, health fairs, mass media campaigns, with classical and modern communication tools such as ICT/Information & Communication Technologies, SMN/Social Media Networks and newsletters.
  • 2Education: Empowering behavior change and actions through increased knowledge. Examples of education strategies include seminars, webinars, courses, trainings, and support groups.
  • 3 Policy: Working with public and private organizations to promote regulating or mandating activities by organizations or public agencies that encourage healthy decision-making.
  • 3 Environment: Changing structures or environments to make healthy decisions more readily available to large populations such as schools, churches, social networks, government institutions, etc.

1.4 Training Modules. Health promotion and disease prevention program models are provided in Modules.

 

 

Resources to Learn More

  1. Chronic Disease Prevention and Health PromotionWebsite
  2. Provides information, statistics, tools, and resources related to health promotion and disease prevention program planning.
  3. Organization(s): HHS, NIH, Centers for Disease Control and Prevention, WHO
  4. Milestones in Health Promotion: Statement from Global Conferences
  5. Publication: This publication provides information on the global definition of health promotion and various actions that can help support and improve health outcomes.
  6. Organization(s): World Health Organization
Date: 2009
  7. National Prevention Strategy: America’s Plan for Better Health and Wellness

Website

  1. The overarching goal of this website is to increase the number of Americans who are healthy at every stage of life. The strategy provides evidence-based recommendations through the active engagement of all sectors of society to help achieve four broad strategic directions.
  2. Organization(s): Centers for Disease Control and Prevention
  3. The Power of Prevention: Chronic Disease…the Public Health Challenge of the 21st Century
  4. Publication
  5. A publication covering chronic diseases, what causes them and at what cost. Also includes a vision for prevention and a call to action.
  • Common Preventable Conditions

ABC of Preventable diseases:

 

Headaches: Cluster and Migrain Headaches

 

U.S. National Library of Medicine

Logo ==================================================

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Article

 

A cluster headache is a type of headache.

 

It is one-sided head pain that may involve tearing of the eyes, a droopy eyelid, and a stuffy nose.

 

Attacks occur regularly for 1 week to 1 year. The attacks are separated by pain-free periods that last at least 1 month or longer.

 

Cluster headaches may be confused with other common types of headaches such as migraines, sinus headache, and tension headache.

 

 

 

 

 

Allergic or Histamine or Serotonin Cluster Headaches

 

Causes

Doctors do not know exactly what causes cluster headaches.

 

They seem to be related to the body’s sudden release of histamine (chemical in the body released during an allergic response) or serotonin (chemical made by nerve cells).

 

A problem in a small area at the base of the brain called the hypothalamus may be involved.

 

More men than women are affected.

 

The headaches can occur at any age, but are most common in the 20s through middle age.

 

They tend to run in families.

Cluster headaches may be triggered by:

Alcohol and cigarette smoking

High altitudes (trekking and air travel)

Bright light (including sunlight)

Exertion (physical activity)

Heat (hot weather or hot baths)

Foods high in nitrites (bacon and preserved meats)

Certain medicines

Cocaine

Symptoms

A cluster headache begins as a severe, sudden headache. The headache commonly strikes 2 to 3 hours after you fall asleep. But it can also occur when you are awake. The headache tends to happen daily at the same time of day. Attacks can last for months. They can alternate with periods without headaches (episodic) or they can go on for a year or more without stopping (chronic).

Cluster headache pain is usually:

Burning, sharp, stabbing, or steady

Felt on one side of the face from neck to temple, often involving the eye

At its worst within 5 to 10 minutes, with the strongest pain lasting 30 minutes to 2 hours

When the eye and nose on the same side as the head pain are affected, symptoms can include:

Swelling under or around the eye (may affect both eyes)

Excessive tearing

Red eye

Droopy eyelid

Runny nose or stuffy nose on the same side as the head pain

Red, flushed face, with extreme sweating

Exams and Tests

Your health care provider can diagnose this type of headache by performing a physical exam and asking about your symptoms and medical history.

If a physical exam is done during an attack, the exam will usually reveal Horner syndrome (one-sided eyelid drooping or a small pupil). These symptoms will not be present at other times. No other nervous system (neurologic) changes will be seen.

Tests, such as an MRI of the head, may be needed to rule out other causes of the headaches.

Treatment

Treatment for cluster headaches involves:

Medicines to treat the pain when it happens

Medicines to prevent the headaches

TREATING CLUSTER HEADACHES WHEN THEY OCCUR

Your provider may recommend the following treatments for when the headaches occur:

Triptan medicines, such as sumatriptan (Imitrex).

Anti-inflammatory (steroid) medicines such as prednisone. Starting with a high dose, then slowly decreasing it over 2 to 3 weeks.

Breathing in 100% (pure) oxygen.

Injections of dihydroergotamine (DHE), which can stop cluster attacks within 5 minutes (Warning: this drug can be dangerous if taken with sumatriptan).

You may need more than one of these treatments to control your headache.

 

Your provider may have you try several medicines before deciding which works best for you.

 

Pain medicines and narcotics do not usually relieve cluster headache pain, because they take too long to work.

 

Surgical treatment may be recommended for you when all other treatments have failed. One such treatment is a neurostimulator. This device delivers tiny electrical signals to a certain nerve near the brain. Your provider can tell you more about surgery.

 

PREVENTING CLUSTER HEADACHES

Avoid smoking, alcohol use, certain foods, and other things that trigger your headaches. A headache diary can help you identify your headache triggers. When you get a headache, write down the following:

Day and time the pain began

What you ate and drank over the past 24 hours

How much you slept

 

What you were doing and where you were right before the pain started

 

How long the headache lasted and what made it stop

Review your diary with your provider to identify triggers or a pattern to your headaches. This can help you and your provider create a treatment plan. Knowing your triggers can help you avoid them.

 

The headaches may go away on their own or you may need treatment to prevent them.

 

The following medicines may also be used to treat or prevent headache symptoms:

 

Allergy medicines

Antidepressants

Blood pressure medicines

Seizure medicine

 

Outlook (Prognosis)

Cluster headaches are not life threatening. They usually do not cause permanent changes to the brain. But they are chronic, and often painful enough to interfere with work and life.

 

When to Contact a Medical Professional

 

 

 

 

 

Call 911 if:

You are experiencing “the worst headache of your life.”

You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before.

 

A headache starts suddenly.

Schedule an appointment or call your provider if:

Your headache pattern or pain changes.

Treatments that once worked no longer help.

You have side effects from your medicine.

You are pregnant or could become pregnant. Some medicines should not be taken during pregnancy.

You need to take pain medicines more than 3 days a week.

Your headaches are more severe when lying down.

 

Prevention

If you smoke, now is a good time to stop. Alcohol use and any foods that trigger a cluster headache may need to be avoided. Medicines may prevent cluster headaches in some cases.

 

Alternative Names

Histamine headache; Headache – histamine; Migrainous neuralgia; Headache – cluster; Horton’s headache; Vascular headache – cluster 

 

References

Ferri FF. Cluster headache. In: Ferri FF, ed. Ferri’s Clinical Advisor 2016. Philadelphia: PA: Elsevier Saunders; 2016:347.

Petersen AS, Barloese MC, Jensen RH. Oxygen treatment of cluster headache: a review. Cephalalgia. 2014;34:1079-1087. PMID: 24723673 www.ncbi.nlm.nih.gov/pubmed/24723673.

Silberstein SD. Headache management. In: Benzon HT, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW, eds. Practical Management of Pain. 5th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 30.

Weaver-Agostoni J. Cluster headache. Am Fam Physician. 2013;88:122-128. PMID: 23939643 www.ncbi.nlm.nih.gov/pubmed/23939643.

 

 

Update Date 1/5/2016

Updated by: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

 

Browse the Encyclopedia

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Hypothalamus

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Pain of cluster headache

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Migraine

Serotonin blood test

Patient Instructions

Headache – what to ask your doctor

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Page last updated: 23 August 2016

 

 

 

 

 

 

 

 

Cancer is unlimited growth of abnormal cells in the body due to failure of the normal control mechanisms of the body.

 

Carcinogenesis is the process in which normal cells turn into cancer cells.

 

  • Carcinogenesis is the series of steps that take place as a normal cell becomes a cancer Cells are the smallest units of the body and they make up the body’s tissues.

 

  • Each cell contains genes that guide the way the body grows, develops, and repairs itself.

 

 

  • There are many genes that control whether a cell lives or dies, divides (multiplies), or takes on special functions, such as becoming a nerve cell or a muscle cell.

 

Changes (mutations) in genes occur during carcinogenesis.

 

Changes (mutations) in genes can cause normal controls in cells to break down. When this happens, cells do not die when they should and new cells are produced when the body does not need them. The buildup of extra cells may cause a mass (tumor) to form.

 

Normal Cell

 

In biology, the smallest unit that can live on its own and that makes up all living organisms and the tissues of the body.

 

A cell has three main parts: the cell membrane, the nucleus, and the cytoplasm. The cell membrane surrounds the cell and controls the substances that go into and out of the cell.

 

The nucleus is a structure inside the cell that contains the nucleolus and most of the cell’s DNA. It is also where most RNA is made.

 

The cytoplasm is the fluid inside the cell. It contains other tiny cell parts that have specific functions, including the Golgi complex, the mitochondria, and the endoplasmic reticulum.

 

The cytoplasm is where most chemical reactions take place and most proteins get made.

 

The human body has more than 30 trillion cells.

ENLARGE

 

 

 

 

The stem cell microenvironment is involved in regulating the fate of the stem cell with respect to self-renewal, quiescence, and differentiation.

 

Mathematical models are helpful in understanding how key pathways regulate the dynamics of stem cell maintenance and homeostasis.

 

This tight regulation and maintenance of stem cell number is thought to break down during carcinogenesis. As a result, the stem cell niche has become a novel target of cancer therapeutics.

 

Developing a quantitative understanding of the regulatory pathways that guide stem cell behavior will be vital to understanding how these systems change under conditions of stress, inflammation, and cancer initiation. Predictions from mathematical modeling can be used as a clinical tool to guide therapy design.

 

 

 

Tumors can be benign or malignant (cancerous). Malignant tumor cells invade nearby tissues and spread to other parts of the body. Benign tumor cells do not invade nearby tissues or spread.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Cancer Prevention Strategies

 

Strategies: How to prevent cancer

  1. Understand the enemy, that is cancer
  2. Know the causes of cancer
  3. Identify your risks of cancer
  4. Change your life style
  5. Reduce your risks
  6. Eliminate your threats
  7. Change your challenges into opportunities

 

Cancer is the uncontrolled growth of abnormal cells in the body. Cancer develops when the body’s normal control mechanism stops working. Normal cells grow old and are replaced by new cells.

 

Old cells do not die and cells grow out of control, forming new, abnormal cells. These extra cells may form a mass of tissue, called a tumor. Some cancers, such as leukemia, do not form tumors.

 

What are the most common forms of cancer?

 

Cancer can occur anywhere in the body. In women, breast cancer is most common. In men, it’s prostate cancer. Lung cancer and colorectal cancer affect both men and women in high numbers.

 

There are five main categories of cancer:

1.Carcinomas begin in the skin or tissues that line the internal organs.

2.Sarcomas develop in the bone, cartilage, fat, muscle or other connective tissues.

3.Leukemia begins in the blood and bone marrow.

4.Lymphomas start in the immune system.

5.Central nervous system cancers develop in the brain and spinal cord.

 

When you hear the word “cancer,” what comes to mind?

 

Is it the fear of ever being diagnosed? Or of watching the person closest to you get the news? Maybe it’s the triumphant feeling of having battled the disease until it’s finally in remission.

 

Many people associate cancer with the emotions it evokes: the shock, the sadness, the bravery and the exhilaration. Why cancer develops and why it responds to certain treatments is more of a mystery.

 

About 13 million Americans have cancer and more than 1 million are diagnosed every year.

 

To shed light on the disease, CTCA /Cancer Treatment Center of America, developed The Anatomy of Cancer, a five-minute video that explains cancer in everyday terms. The goal of the video is to answer the key questions so many people have about cancer.

 

What is cancer?

Cancer is the uncontrolled growth of abnormal cells in the body. In the body, there are trillions of cells with various functions. These cells grow and divide to help the body function properly. Cells die when they become old or damaged, and new cells replace them.

 

Cancer develops when the body’s normal control mechanism stops working. Old cells do not die and cells grow out of control, forming new, abnormal cells. These extra cells may form a mass of tissue, called a tumor. Some cancers, such as leukemia, do not form tumors.

 

There are five main categories of cancer:

  1. Carcinomas begin in the skin or tissues that line the internal organs.
  2. Sarcomas develop in the bone, cartilage, fat, muscle or other connective tissues.
  3. Leukemia begins in the blood and bone marrow.
  4. Lymphomas start in the immune system.
  5. Central nervous system cancers develop in the brain and spinal cord.

 

Cancer can occur anywhere in the body. In women, breast cancer is most common. In men, it’s prostate cancer. Lung cancer and colorectal cancer affect both men and women in high numbers

 

How is cancer treated?

The same cancer type—whether it’s liver cancer, stomach cancer or kidney cancer—in one individual is very different from that cancer in another individual.

 

In fact, cancer is not one disease but hundreds of different types of diseases. Within a single type of cancer, such as breast cancer, researchers are discovering subtypes that each requires a different treatment approach.

 

Treatment options depend on the type of cancer, its stage, if the cancer has spread and your general health.

 

The three main treatments are:

1.Surgery: directly removing the tumor

2.Chemotherapy: using chemicals to kill cancer cells

  1. Radiation therapy: using X-rays to kill cancer cells

 

The goal of treatment is to kill as many cancerous cells while minimizing damage to normal cells nearby.

 

Advances in technology make this possible. For example, intraoperative radiation therapy (IORT) delivers a concentrated dose of radiation to a tumor site immediately after surgery. Healthy tissues and organs are shielded during treatment, which allows for a higher dose of radiation.

 

In recent years, doctors have been able to offer treatment options based on the genetic changes occurring in a specific tumor. An innovative new diagnostic tool, the genomic tumor assessment, examines a patient’s tumor genetically to help identify mechanisms that may be responsible for the cancer’s growth.

 

Genomic tumor assessment can result in a more personalized approach to cancer treatment.

 

Learn about our approach to treating cancer.

How to eat for hormonal balance: Nutrition tips for every woman

Faith offers optimism and inner strength during cancer treatment

 

How is cancer treated?

 

Treatment options depend on the type of cancer, its stage, if the cancer has spread and your general health. The goal of treatment is to kill as many cancerous cells while minimizing damage to normal cells nearby. Advances in technology make this possible.

 

The three main treatments are:

  1. Surgery: directly removing the tumor
  2. Chemotherapy: using chemicals to kill cancer cells
  3. Radiation therapy: using X-rays to kill cancer cells

 

The same cancer type in one individual is very different from that cancer in another individual. Within a single type of cancer, such as breast cancer, researchers are discovering subtypes that each requires a different treatment approach.

 

What can you do to manage the side effects of cancer treatment?

 

Integrative oncology services describe a broad range of complementary treatments that combat side effects, boost the immune system and maintain well-being.

 

Treating cancer cannot focus on the disease alone but must address the pain, fatigue and depression that comes with it.

 

Integrative oncology services include:

  1. Nutrition therapy to help prevent malnutrition and reduce side effects
  • Naturopathic medicine to safely strengthen your immune system, boost your energy and reduce side effects
  • Oncology rehabilitation to rebuild strength and overcome some of the physical effects of treatment
  • Mind-body medicine to improve emotional well-being through counseling, stress management techniques and support groups

What does the future hold for cancer treatment?

The future of cancer treatment lies in providing patients with an even greater level of personalization.

 

Doctors are beginning to offer treatment options based on the genetic changes occurring in a specific tumor.

 

An innovative new diagnostic tool, the genomic tumor assessment, examines a patient’s tumor genetically to identify the mechanism that caused the cancer. Genomic tumor assessment can result in a more personalized approach to cancer treatment.

 

 

1.What is nutrition therapy?

Many cancer patients experience gastrointestinal symptoms. The Nutrition Therapy team helps restore digestive health, prevent malnutrition and provide dietary recommendations during treatment. Our goal is to help you stay strong and nourished, so you can continue with your cancer treatment.

 

Every patient is scheduled to meet with a registered dietitian during the first visit to CTCA. During this visit, you are given a full assessment to identify daily goals for calories and protein. Your dietitian will look at your health history, disease type and treatment plan to recommend nourishing foods during your cancer care.

 

Your dietitian will monitor your nutrition status from the beginning to the end of your cancer treatment, making modifications as needed to minimize side effects and treatment interruptions before they arise.

 

Your dietitian communicates regularly with your oncologists and the other members of your cancer team. Working together in close proximity allows for a fully integrated approach to treating cancer. Your dietitian is able to share any specific nutrition challenges with other members of your care team, such as your oncologist. Everyone works together to find solutions that meet your individual needs.

 

We also provide information and classes about healthy eating habits to your caregivers and family members, so you can continue a healthy lifestyle at home.

 

  1. What is naturopathic medicine?

Naturopathic medicine is an approach to health care that uses natural, non-toxic therapies to treat the whole person and encourage the self-healing process. Naturopathic clinicians treat a variety of conditions, including digestive issues, respiratory conditions, chronic fatigue syndrome and cancer.

 

As part of our integrative oncology services, our naturopathic oncology providers focus on reducing the risk of harmful effects from cancer treatments. With a wide variety of natural therapies available, they select and propose the intervention that is appropriate for your health. Your naturopathic oncology provider acts as a consultant to your oncologist to support normal metabolism and digestion during cancer treatment; manage any side effects, such as nausea or fatigue; and boost immune function.

 

As part of the intake process, you’ll meet with your naturopathic oncology provider, who will review your history and make recommendations from a wide variety of natural therapies.

 

Your naturopathic oncology provider also will review current supplements to identify herb-drug-nutrient interactions.

 

Throughout your treatment, your naturopathic oncology provider will recommend natural therapies to support your immune system and reduce any treatment-related side effects, including:

 

  1. Herbal and botanical preparations, including herbal extracts and teas.
  2. Dietary supplements, including vitamins, minerals and amino acids.
  3. Homeopathic remedies, extremely low doses of plant extracts and minerals that gently strengthen the body’s healing and immune response.
  4. Physical therapy and exercise therapy, including massage and other gentle techniques used on deep muscles and joints for therapeutic purposes.
  5. Hydrotherapy, which prescribes water-based approaches like hot and cold wraps, and other therapies.
  6. Lifestyle counseling: Many medical conditions can be treated with exercise, improved sleep, stress reduction techniques, as well as foods and nutritional supplements.
  7. Acupuncture: Your naturopathic oncology provider may also recommend incorporating acupuncture into your treatment plan.
  8. Chiropractic care, which may include hands-on adjustment, massage, stretching, electronic muscle stimulation, traction, heat, ice and other techniques to alleviate pain, headaches, nausea, peripheral neuropathy and stiffness or weakness in the muscles and joints.

 

 

Experienced care team

  • All of our naturopathic oncology providers have extensive knowledge of radiation therapy, chemotherapy and other cancer treatments, in addition to their expertise in the effects of natural therapies. As a part of your care team, they are in regular communication with your oncologists and other clinicians to help guide your treatment plan.

 

Personalized treatment approach

  • We personalize treatment plans to the individual based on each person’s goals and experiences. Your care team would help you decide which naturopathic medicine therapies would help achieve your goals. You may have one or more of the above therapies during the course of your treatment.

 

 

  1. What is mind-body medicine?

The Mind-Body Medicine Program at Cancer Treatment Centers of America (CTCA) supports you and your caregivers before, during and after cancer treatment.

 

Mind-body medicine, an integral part of whole-person care, recognizes the powerful ways in which emotional, mental, social and behavioral factors can directly affect health.

 

Licensed mental health and allied professionals offer caring relationships and therapeutic practices and techniques to help you and your caregivers respond to cancer diagnosis and treatment in empowering and stress-minimizing ways in order to improve your health, relationships and overall well-being.

 

Mind-body services

All of mind-body services are available to patients and caregivers. Each new patient is scheduled to meet with a mind-body therapist at least once to introduce the services. It’s your decision if you would like to continue meeting with a mind-body therapist and/or participate in any of the following services:

 

Individual, couples and family counseling: Meet with your mind-body therapist as an individual, couple or family for help with anything on your mind, work through difficult decisions, cope with cancer and how it affects your life and relationships, discover and use your inner strengths and resources, and explore ways to enjoy life while on this journey.

 

Relaxation and guided imagery: Learn to use positive mental images and focused breathing to increase your physical and emotional comfort. Cancer patients have often found this to help with physical discomfort and stress. It can also help support the immune system.

 

Support groups: Connect with others going through a similar experience.

 

Wellness practices for stress management/reduction: Discover tools and strategies that you can build into your everyday life to help reduce stress and positively affect your well-being.

Therapeutic laughter: Enjoy a distraction from your everyday stresses by joining in laughter exercises. Research has shown that positive laughter and humor can offer many physical and psychological health benefits.

 

Mind-body therapists work closely with your entire cancer treatment team and are here to support you in making ongoing care decisions. In addition, they can try to connect you with qualified practitioners, support groups and counseling services in your area once you return home.

 

 

When you hear the word “cancer,” what comes to mind?

Is it the fear of ever being diagnosed? Or of watching the person closest to you get the news? Maybe it’s the triumphant feeling of having battled the disease until it’s finally in remission.

 

Many people associate cancer with the emotions it evokes: the shock, the sadness, the bravery and the exhilaration. Why cancer develops and why it responds to certain treatments is more of a mystery.

 

  • About 13 million Americans have cancer and more than 1 million are diagnosed every year.

 

To shed light on the disease, CTCA developed The Anatomy of Cancer, a five-minute video that explains cancer in everyday terms. The goal of the video is to answer the key questions so many people have about cancer.

 

What is cancer?

  • Cancer is the uncontrolled growth of abnormal cells in the body. In the body, there are trillions of cells with various functions. These cells grow and divide to help the body function properly. Cells die when they become old or damaged, and new cells replace them.

 

  • Cancer develops when the body’s normal control mechanism stops working. Old cells do not die and cells grow out of control, forming new, abnormal cells. These extra cells may form a mass of tissue, called a tumor. Some cancers, such as leukemia, do not form tumors.

 

There are five main categories of cancer:

  1. Carcinomas begin in the skin or tissues that line the internal organs.
  2. Sarcomas develop in the bone, cartilage, fat, muscle or other connective tissues.
  3. Leukemia begins in the blood and bone marrow.
  4. Lymphomas start in the immune system.
  5. Central nervous system cancers develop in the brain and spinal cord.

 

Cancer can occur anywhere in the body. In women, breast cancer is most common. In men, it’s prostate cancer. Lung cancer and colorectal cancer affect both men and women in high numbers.

 

How is cancer treated?

 

  • In fact, cancer is not one disease but hundreds of different types of diseases. Within a single type of cancer, such as breast cancer, researchers are discovering subtypes that each requires a different treatment approach.

 

  • Treatment options depend on the type of cancer, its stage, if the cancer has spread and your general health. The three main treatments are:
  1. Surgery: directly removing the tumor
  2. Chemotherapy: using chemicals to kill cancer cells
  3. Radiation therapy: using X-rays to kill cancer cells

 

The goal of treatment is to kill as many cancerous cells while minimizing damage to normal cells nearby. Advances in technology make this possible. For example, intraoperative radiation therapy (IORT) delivers a concentrated dose of radiation to a tumor site immediately after surgery.

 

Healthy tissues and organs are shielded during treatment, which allows for a higher dose of radiation.

 

In recent years, doctors have been able to offer treatment options based on the genetic changes occurring in a specific tumor. An innovative new diagnostic tool, the genomic tumor assessment, examines a patient’s tumor genetically to help identify mechanisms that may be responsible for the cancer’s growth.

 

Genomic tumor assessment can result in a more personalized approach to cancer treatment.

Learn about our approach to treating cancer.

How to eat for hormonal balance: Nutrition tips for every woman

Faith offers optimism and inner strength during cancer treatment

 

 

Intraoperative radiation therapy

What is it?

InIN

TRABEAM IORT

What is IORT?

·       Intraoperative radiation therapy (IORT) delivers a concentrated dose of radiation therapy to a tumor

·       bed during surgery. This advanced technology may help kill microscopic disease, reduce radiation

·       treatment times or provide an added radiation “boost.”

Advantages of IORT

·       Typically, standard radiation therapy involves five days of treatment per week, for a total of five to six

·       weeks for some patients.

·       With IORT, our radiation oncologists can deliver a similar dose of radiation in a single treatment session,

·       while also preserving more healthy tissue. This helps to reduce side effects and the time spent going back

·       and forth to the hospital for radiation treatments.

 

IORT offers some of the following advantages:

Maximum effect. IORT delivers a concentrated dose of radiation to a tumor site immediately after

a tumor is removed, helping to destroy the microscopic tumor cells that may be left behind.

The tumor site is typically at high risk for recurrence and traditional radiation therapy requires a recovery

period after surgery, which leaves microscopic disease in the body for longer.

Spares healthy tissues and organs. During IORT, a precise radiation dose is applied while shielding

healthy tissues or structures, such as the skin, that could be damaged using other techniques. This allows a

higher radiation dose to be delivered to the tumor bed, while sparing normal surrounding tissues. Critical

organs within the radiation field, such as the lungs or heart, can also be protected.

 

Shortened treatment times. IORT may help some patients finish treatment and get back to their lives

quicker by reducing the need for additional radiation therapy, which is typically given over five to six weeks.

The IORT treatment itself takes about four to five minutes.

 

A “boost” for traditional radiation patients. Patients who must receive additional radiation therapy

following surgery can receive a boost of radiation during IORT. After they have recovered from

the surgical procedure, they can continue with their radiation treatments, with typically fewer

complications.

A patient must be a surgical candidate in order to be eligible for IORT. This treatment is generally

reserved for individuals with early-stage disease.

 

 

 

Breast Cancer

 

Breast cancer is a group of diseases that affects breast tissue. Both women and men can get breast cancer, though it is much more common in women. Other than skin cancer, breast cancer is the most common cancer among women in the United States. Some women are at higher risk for breast cancer than others because of their personal or family medical history or because of certain changes in their genes.

 

Getting mammograms regularly can lower the risk of dying from breast cancer. The United States Preventive Services Task Force recommends that average-risk women who are 50 to 74 years old should have a screening mammogram every two years. Average-risk women who are 40 to 49 years old should talk to their doctor about when to start and how often to get a screening mammogram.

Most health insurance programs cover mammograms. You can get a screening mammogram without any out-of-pocket costs. If you are worried about the cost or don’t have health insurance, CDC offers free or low-cost mammograms and education about breast cancer.

 

 

Cancer is a disease in which cells in the body grow out of control. Except for skin cancer, breast cancer is the most common cancer in women in the United States. Deaths from breast cancer have declined over time, but remains the second leading cause of cancer death among women overall and the leading cause of cancer death among Hispanic women.

 

Each year in the United States, about 220,000 cases of breast cancer are diagnosed in women and about 2,000 in men. About 40,000 women and 400 men in the U.S. die each year from breast cancer.

 

Over the last decade, the risk of getting breast cancer has not changed for women overall, but the risk has increased for black women and Asian and Pacific Islander women. Black women have a higher risk of death from breast cancer than white women.

 

The risk of getting breast cancer goes up with age. In the United States, the average age when women are diagnosed with breast cancer is 61. Men who get breast cancer are diagnosed usually between 60 and 70 years old.

 

 

 

Cancer Prevention During Midlife

 

CDC’s Division of Cancer Prevention and Control sponsored a supplemental issue of the American Journal of Preventive Medicine about ways to reduce cancer risk during midlife. The authors are experts from many different professions, showing the importance of working together to find effective ways to prevent cancer.

 

Midlife, the time roughly between 45 and 64 years of age, is when the effects of harmful exposures and health behaviors often start to appear.

 

At this age, adults may experience the onset of chronic diseases or other health problems. During this time of unique life transitions and health challenges, adults can make positive changes to reduce their cancer risk and support health during midlife and beyond.

 

Healthy behaviors for healthy living

 

Examples include—

  • Promoting behaviors that are generally healthy may lower individual cancer risk.
  • Getting enough physical activity. 30 to 60 minutes physical activities per day
  • Maintaining a healthy weight. Maintaining a Body Mass Index: 19-25 (wt/htxht)
  • Getting enough Sleeping 7-8 hours per day
  • Seeking appropriate medical care—
  • Blood sugar. Managing chronic diseases such as Maintaining BS (70-100)
  • Inflammation. Testing for hepatitis C virus (HCV) infection. Negative
  • Substance abuse: Alcohol, Drug and Tobacco. Getting help to quit smoking. No smoking
    • Screening for and managing

Screening for certain types of cancer.

 

Cancer Screening Tests

 

  • Screening means checking your body for cancer before you have symptoms. Getting screening tests regularly may find breast, cervical, and colorectal (colon) cancers early, when treatment is likely to work best. Lung cancer screening is recommended for some people who are at high risk.

 

Screening for Breast, Cervical, Colorectal (Colon), and Lung Cancers

CDC supports screening for breast, cervical, colorectal (colon), and lung cancers as recommended by the U.S. Preventive Services Task Force.

Breast Cancer

Mammograms are the best way to find breast cancer early, when it is easier to treat. For more information, visit Breast Cancer: What Screening Tests Are There?

Cervical Cancer

 

Colorectal (Colon) Cancer

  • Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. Screening tests can find precancerous polyps, so they can be removed before they turn into cancer. Screening tests also can find colorectal cancer early, when treatment works best. For more information, visit Colorectal Cancer: What Should I Know About Screening?

Lung Cancer

  • The U.S. Preventive Services Task Force recommends yearly lung cancer screening with low-dose computed tomography (LDCT) for people who have a history of heavy smoking, and smoke now or have quit within the past 15 years, and are between 55 and 80 years old. For more information, visit Lung Cancer: What Screening Tests Are There?

 

Screening for Ovarian, Prostate, and Skin Cancers

  • Screening for ovarian, prostate, and skin cancers has not been shown to reduce deaths from those cancers.

Ovarian Cancer

Prostate Cancer

Skin Cancer

The U.S. Preventive Services Task Force has concluded that there is not enough evidence to recommend for or against routine screening (total-body examination by a clinician) to find skin cancers early. This recommendation is for people who do not have a history of skin cancer and who do not have any suspicious moles or other spots. For more information,

 

Skin Cancer: What Screening Tests Are There?

 

Articles in Supplement

Background: Midlife as a Critical Period for Prevention

  1. Ory MG, Anderson LA, Friedman DB, Pulczinski JC, Eugene N, Satariano WA. Cancer prevention among adults aged 45–64: Setting the stage. American Journal of Preventive Medicine 2014;46(3S1):S1–S6.
  2. White MC, Holman DM, Boehm JE, Peipins LA, Grossman M, Henley SJ. Age and cancer risk: a potentially modifiable relationship. American Journal of Preventive Medicine 2014;46(3S1):S7–S15.
  3. Cancer Risk and Protective Factors During Midlife
  4. Scoccianti C, Lauby-Secretan B, Bello PY, Chajes V, Romieu I. Female breast cancer and alcohol consumption: A review of the literature. American Journal of Preventive Medicine 2014;46(3S1):S16–S25.
  5. Gapstur SM, Diver WR, Stevens VL, Carter BD, Teras LR, Jacobs EJ. Work schedule, sleep duration, insomnia, and risk of fatal prostate cancer. American Journal of Preventive Medicine 2014;46(3S1):S26–S33.
  6. Carter BD, Diver WR, Hildebrand JS, Patel AV, Gapstur SM. Circadian disruption and fatal ovarian cancer. American Journal of Preventive Medicine 2014;46(3S1):S34–S41.
  7. Nelson CC, Wagner GR, Caban-Martinez AJ, Buxton OM, Kenwood CT, Sabbath EL, Hashimoto DM, Hopcia K, Allen J, Sorensen G. Physical activity and body mass index: the contribution of age and workplace characteristics. American Journal of Preventive Medicine 2014;46(3S1):S42–S51.
  8. Amadou A, Mejia GT, Fagherazzi G, Ortega C, Angeles-Llerenas A, Chajes V, Biessy C, Sighoko D, Hainaut P, Romieu I. Anthropometry, silhouette trajectory, and risk of breast cancer in Mexican women. American Journal of Preventive Medicine 2014;46(3S1):S52–S64.
  9. Keum N, Giovannucci EL. Folic acid fortification and colorectal cancer risk. American Journal of Preventive Medicine 2014;46(3S1):S65–S72.
  10. Taking Public Health Action to Prevent Cancer
  11. Holman DM, Grossman M, Henley SJ, Peipins LA, Tison L, White MC. Opportunities for cancer prevention during midlife: highlights from a meeting of experts. American Journal of Preventive Medicine 2014;46(3S1):S73–S80.
  12. Dacus HLM, O’Sullivan GM, Major A, White DE. The role of a state health agency in promoting cancer prevention at the community level: Examples from New York State. American Journal of Preventive Medicine 2014;46(3S1):S81–S86.
  13. Zonderman AB, Ejiogu N, Norbeck J, Evans MK. The influence of health disparities on targeting cancer prevention efforts. American Journal of Preventive Medicine 2014;46(3S1):S87–S97.
  14. Muirhead L. Cancer risk factors among persons with serious mental illness. American Journal of Preventive Medicine 2014;46(3S1):S98–S103.

Conclusion

  1. Gehlert S. Forging an integrated agenda for primary cancer prevention during midlife. American Journal of Preventive Medicine 2014;46(3S1):S104–S109.

 

  1. Kinds of Cancer
  2. How to Prevent Cancer or Find It Early
  3. Data and Statistics
  4. Research
  5. Promoting Cancer Prevention
    1. Reducing Excessive Alcohol Use
    2. Reducing Indoor Tanning Among Minors
    3. How to Reduce Radon in Homes
    4. Guide to Promoting Cancer Prevention in Your Community

 

 

Kinds of Cancer

CDC provides basic information and statistics about some of the most common cancers in the United States.

  • Bladder cancer risk factors include smoking, genetic mutations, and exposure to certain chemicals.
  • Breast cancer is the most common cancer among American women. Getting mammograms regularly can lower the risk of dying from breast cancer. Talk to your doctor about when to start and how often to get a screening mammogram.
  • Cervical cancer is highly preventable in most Western countries because screening tests and a vaccine to prevent human papillomavirus (HPV) infections, which cause most cervical cancers, are available.
  • Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States, but it doesn’t have to be. If you are 50 years old or older, get screened now.
  • Smoking is the most important risk factor for kidney and renal pelvis cancers. To lower your risk, don’t smoke, or quit if you do. Be very careful if you work with the chemical trichloroethylene.
  • To lower your risk for liver cancer, get vaccinated against Hepatitis B, get tested for Hepatitis C, and avoid drinking too much alcohol.
  • Lung cancer is the leading cause of cancer death and the second most common cancer among both men and women in the United States. The most important thing you can do to lower your lung cancer risk is to quit smoking and avoid secondhand smoke.
  • Ovarian cancer causes more deaths than any other cancer of the female reproductive system. But when ovarian cancer is found in its early stages, treatment works best.
  • Prostate cancer is the most common cancer among American men. Most prostate cancers grow slowly, and don’t cause any health problems in men who have them. Learn more and talk to your doctor before you decide to get tested or treated for prostate cancer.
  • Skin cancer is the most common cancer in the United States. Most cases of melanoma, the deadliest kind of skin cancer, are caused by exposure to ultraviolet (UV) light. To lower your skin cancer risk, protect your skin from the sun and avoid indoor tanning.
  • Uterine cancer is the fourth most common cancer in women in the United States and the most commonly diagnosed gynecologic cancer.

Vaginal and vulvar cancers are rare, but all women are at risk for these cancers.

 

 

Prevention is the best way to fight cancer.

 

Policymakers, public health professionals, comprehensive cancer control programs, community groups, doctors, and individuals can help prevent cancer in many ways.

 

 

The Road to Better Health: A Guide to Promoting Cancer Prevention in Your Community

 

This tool kit helps community groups—

  • Educate people on how cancer affects your community.
  • Give people tips on how to lower their cancer risk.
  • Work with other groups and community leaders to make sure people have the information and services they need.
  • Become known as a community leader in the fight against cancer.
  • Use CDC’s tools and materials to spread the word.

 

 

Policies and Practices for Cancer Prevention:

Indoor Tanning Among Minors

 

Indoor Tanning Among Minors Promising Practices Brief[PDF-1.7MB]

 

  • Skin cancer is the most common form of cancer in the United States and has been identified by the Surgeon General as a serious public health problem.

 

  • The most common types of skin cancer—basal and squamous cell carcinoma—are usually treatable but can be disfiguring and expensive to treat.

 

1 Melanoma is a less common but deadly form of skin cancer.

2 Most skin cases of cancer are caused, in part, by exposure to ultraviolet (UV) radiation from the sun or from indoor tanning.

 

Limited UV exposure from the sun can have benefits such as improving a person’s mood and stimulating the body’s production of vitamin D.

 

Excessive UV exposure from indoor tanning and sunbathing offers no additional health benefits and increases the risk of harms from UV exposure.36

 

Indoor tanning in particular may expose users to excessive levels of UV radiation, which are not only harmful but also easily avoidable.7, 8 This excessive UV exposure greatly increases a person’s risk of getting melanoma, as well as basal and squamous cell carcinomas.912

 

 

Estimates from a recent study indicate that each year in the United States, more than 400,000 new cases of skin cancer (245,000 basal cell carcinomas, 168,000 squamous cell carcinomas, and 6,000 melanomas) may be related to indoor tanning.13

 

Indoor tanners are also at increased risk for other adverse effects of excessive UV exposure, including damage to the immune system, premature skin aging, and eye diseases such as cataracts, macular degeneration, and certain eye cancers.1417

 

The public health community plays an important role in educating young people about protecting themselves from the harms of indoor tanning. Many public health efforts focus on educational and messaging strategies.

 

Other efforts focus on providing the scientific evidence that can inform policy approaches, including regulatory or legislative strategies, to reduce indoor tanning among minors.

 

Some of these strategies are happening at the national level, such as regulating tanning devices by the U.S. Food and Drug Administration.18 Most are happening within individual states and local communities and often include restrictions on minors’ access to indoor tanning such as age restrictions, parental consent laws, and parental accompaniment laws.1921

 

Outside the United States, many countries have banned indoor tanning for individuals younger than age 18 years in an effort to prevent skin cancer.21, 22 By incorporating the scientific evidence and lessons learned from local, state, national, and international public health communities, we can coordinate our efforts and best use our resources to protect the future health of today’s youth.

 

Policies and Practices for Cancer Prevention

 

Reducing Excessive Alcohol Use

Alcohol use increases the risk of several cancers. This publication provides information about alcohol use among young people and adults and potential strategies for reducing excessive alcohol use in your community.

 

Reducing Indoor Tanning Among Minors

 

Indoor tanning increases a person’s risk of skin cancer and is especially risky for young people. Public health efforts by state and local agencies can protect young people from the harms of indoor tanning.

 

These efforts range from communication and educational strategies that increase knowledge and awareness to research and surveillance that can support strategies to restrict youth access to indoor tanning.

 

Reducing Indoor Tanning Among Minors provides information about indoor tanning among minors and potential strategies for reducing indoor tanning among minors in your community.

 

How to Reduce Radon in Homes

 

Radon is a radioactive gas that occurs naturally in nearly all soil. It enters homes and other buildings through small cracks and holes in the foundation, where it becomes trapped and accumulates in the air.

 

When people breathe in radon, it damages the lungs, which can lead to lung cancer. According the U.S. Environmental Protection Agency, radon is the leading cause of lung cancer among non-smokers and the second leading cause of lung cancer among smokers in the United States. This promising practices brief explains how to reduce radon in homes, and what states and comprehensive cancer control programs can do about radon.

 

Best Practices for Comprehensive Tobacco Control Programs

 

Tobacco use is the single most preventable cause of disease, disability, and death in the United States.

 

Nearly half a million Americans die from tobacco use each year, and more than 16 million suffer from a disease caused by smoking.

 

Despite these risks, about 42 million U.S. adults still smoke. This evidence-based guide, created by CDC’s Office on Smoking and Health, helps states plan and establish effective tobacco control programs to prevent and reduce tobacco use.

More Information

Cancer Prevention Among Youth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carcinogenesis

 

KEY POINTS

Carcinogenesis is the process in which normal cells turn into cancer cells.

Changes (mutations) in genes occur during carcinogenesis.

 

Carcinogenesis is the process in which normal cells turn into cancer cells.

 

  • Carcinogenesis is the series of steps that take place as a normal cell becomes a cancer Cells are the smallest units of the body and they make up the body’s tissues.

 

  • Each cell contains genes that guide the way the body grows, develops, and repairs itself.

 

  • There are many genes that control whether a cell lives or dies, divides (multiplies), or takes on special functions, such as becoming a nerve cell or a muscle cell.

 

Changes (mutations) in genes occur during carcinogenesis.

 

Changes (mutations) in genes can cause normal controls in cells to break down. When this happens, cells do not die when they should and new cells are produced when the body does not need them. The buildup of extra cells may cause a mass (tumor) to form.

 

Tumors can be benign or malignant (cancerous). Malignant tumor cells invade nearby tissues and spread to other parts of the body. Benign tumor cells do not invade nearby tissues or spread.

 

Cancer prevention: 7 tips to reduce your risk

 

Concerned about cancer prevention? Take charge by making changes such as eating a healthy diet and getting regular screenings.

 

By Mayo Clinic Staff

 

You’ve probably heard conflicting reports about cancer prevention. Sometimes the specific cancer-prevention tip recommended in one study or news report is advised against in another.

 

In many cases, what is known about cancer prevention is still evolving. However, it’s well-accepted that your chances of developing cancer are affected by the lifestyle choices you make.

 

So if you’re concerned about cancer prevention, take comfort in the fact that some simple lifestyle changes can make a big difference. Consider these seven cancer prevention tips.

 

  1. Don’t use tobacco

 

Using any type of tobacco puts you on a collision course with cancer. Smoking has been linked to various types of cancer — including cancer of the lung, mouth, throat, larynx, pancreas, bladder, cervix and kidney. Xhewing tobacco has been linked to cancer of the oral cavity and pancreas. Even if you don’t use tobacco, exposure to secondhand smoke might increase your risk of lung cancer.

 

Avoiding tobacco — or deciding to stop using it — is one of the most important health decisions you can make. It’s also an important part of cancer prevention. If you need help quitting tobacco, ask your doctor about stop-smoking products and other strategies for quitting.

 

 

  1. Eat a healthy diet

 

Although making healthy selections at the grocery store and at mealtime can’t guarantee cancer prevention, it might help reduce your risk. Consider these guidelines:

  • Eat plenty of fruits and vegetables. Base your diet on fruits, vegetables and other foods from plant sources — such as whole grains and beans.
  • Avoid obesity. Eat lighter and leaner by choosing fewer high-calorie foods, including refined sugars and fat from animal sources.
  • If you choose to drink alcohol, do so only in moderation. The risk of various types of cancer — including cancer of the breast, colon, lung, kidney and liver — increases with the amount of alcohol you drink and the length of time you’ve been drinking regularly.
  • Limit processed meats. A report from the International Agency for Research on Cancer, the cancer agency of the World Health Organization, concluded that eating large amounts of processed meat can slightly increase the risk of certain types of cancer.

 

In addition, women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts might have a reduced risk of breast cancer. The Mediterranean diet focuses on mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts. People who follow the Mediterranean diet choose healthy fats, like olive oil, over butter and fish instead of red meat.

 

  1. Maintain a healthy weight and be physically active

 

Maintaining a healthy weight might lower the risk of various types of cancer, including cancer of the breast, prostate, lung, colon and kidney.

 

Physical activity counts, too. In addition to helping you control your weight, physical activity on its own might lower the risk of breast cancer and colon cancer.

 

Adults who participate in any amount of physical activity gain some health benefits. But for substantial health benefits, strive to get at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic physical activity. You can also do a combination of moderate and vigorous activity.

 

As a general goal, include at least 30 minutes of physical activity in your daily routine — and if you can do more, even better.

 

What Is Cancer?

Cancer is a term used for diseases in which abnormal cells divide without control and can invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems. Cancer is not just one disease, but many diseases. There are more than 100 kinds of cancer. For more information, visit the National Cancer Institute’s What Is Cancer?

 

Kinds of Cancer

  • Bladder cancer risk factors include smoking, genetic mutations, and exposure to certain chemicals.
  • Breast cancer is the most common cancer among American women. Getting mammograms regularly can lower the risk of dying from breast cancer. Talk to your doctor about when to start and how often to get a screening mammogram.

 

  • Cervical cancer is highly preventable in most Western countries because screening tests and a vaccine to prevent human papillomavirus (HPV) infections, which cause most cervical cancers, are available.
  • Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States, but it doesn’t have to be. If you are 50 years old or older, get screened now.
  • Smoking is the most important risk factor for kidney and renal pelvis cancers. To lower your risk, don’t smoke, or quit if you do. Be very careful if you work with the chemical trichloroethylene.
  • To lower your risk for liver cancer, get vaccinated against Hepatitis B, get tested for Hepatitis C, and avoid drinking too much alcohol.
  • Lung cancer is the leading cause of cancer death and the second most common cancer among both men and women in the United States. The most important thing you can do to lower your lung cancer risk is to quit smoking and avoid secondhand smoke.
  • Ovarian cancer causes more deaths than any other cancer of the female reproductive system. But when ovarian cancer is found in its early stages, treatment works best.
  • Prostate cancer is the most common cancer among American men. Most prostate cancers grow slowly, and don’t cause any health problems in men who have them. Learn more and talk to your doctor before you decide to get tested or treated for prostate cancer.
  • Skin cancer is the most common cancer in the United States. Most cases of melanoma, the deadliest kind of skin cancer, are caused by exposure to ultraviolet (UV) light. To lower your skin cancer risk, protect your skin from the sun and avoid indoor tanning.
  • Uterine cancer is the fourth most common cancer in women in the United States and the most commonly diagnosed gynecologic cancer.

Vaginal and vulvar cancers are rare, but all women are at risk for these cancers.

 

How Can Cancer Be Prevented?

 

The number of new cancer cases can be reduced and many cancer deaths can be prevented.

 

Research shows that screening for cervical and colorectal cancers as recommended helps prevent these diseases by finding precancerous lesions so they can be treated before they become cancerous.

 

Screening for cervical, colorectal, and breast cancers also helps find these diseases at an early stage, when treatment works best. CDC offers free or low-cost mammograms and Pap tests nationwide, and free or low-cost colorectal cancer screening in six states.

 

Vaccines (shots) also help lower cancer risk. The human papillomavirus (HPV) vaccine helps prevent most cervical cancers and several other kinds of cancer, and the hepatitis B vaccine can help lower liver cancer risk.

 

A person’s cancer risk can be reduced with healthy choices like avoiding tobacco, limiting alcohol use, protecting your skin from the sun and avoiding indoor tanning, eating a diet rich in fruits and vegetables, keeping a healthy weight, and being physically active.

 

 

 

 

  1. Remember to ask!

Common Questions

 

What Should I Know About Screening?

 

Cervical cancer is the easiest gynecologic cancer to prevent, with regular screening tests and follow-up. Two screening tests can help prevent cervical cancer or find it early—

  • The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.

 

The Pap test is recommended for all women between the ages of 21 and 65 years old, and can be done in a doctor’s office or clinic. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to widen your vagina. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are then placed on a slide or in a bottle of liquid and sent to a laboratory. The laboratory will check to be sure that the cells are normal.

How to Prepare for Your Pap Test

You should not schedule your Pap test for a time when you are having your period. If you are going to have a Pap test in the next two days—

  • You should not douche (rinse the vagina with water or another fluid).
  • You should not use a tampon.
  • You should not have sex.
  • You should not use a birth control foam, cream, or jelly.
  • You should not use a medicine or cream in your vagina.

If you get the HPV test along with the Pap test, the cells collected during the Pap test will be tested for HPV at the laboratory. Talk with your doctor, nurse, or other health care professional about whether the HPV test is right for you.

When you have a Pap test, the doctor may also perform a pelvic exam, checking your uterus, ovaries, and other organs to make sure there are no problems. There are times when your doctor may perform a pelvic exam without giving you a Pap test. Ask your doctor which tests you are having, if you are unsure.

If you have a low income or do not have health insurance, you may be able to get a free or low-cost Pap test through the National Breast and Cervical Cancer Early Detection Program. Find out if you qualify.

 

When to Get Screened

 

You should start getting regular Pap tests at age 21. The Pap test, which screens for cervical cancer, is one of the most reliable and effective cancer screening tests available.

 

The only cancer for which the Pap test screens is cervical cancer. It does not screen for ovarian, uterine, vaginal, or vulvar cancers. So even if you have a Pap test regularly, if you notice any signs or symptoms that are unusual for you, see a doctor to find out why you’re having them. If your Pap test results are normal, your doctor may tell you that you can wait three years until your next Pap test.

Prevent Cervical Cancer with the Right Test at the Right Time infographic

 

If you are 30 years old or older, you may choose to have an HPV test along with the Pap test. Both tests can be performed by your doctor at the same time. When both tests are performed together, it is called co-testing. If your test results are normal, your chance of getting cervical cancer in the next few years is very low. Your doctor may then tell you that you can wait as long as five years for your next screening. But you should still go to the doctor regularly for a checkup.

 

If you are 21 to 65 years old, it is important for you to continue getting a Pap test as directed by your doctor—even if you think you are too old to have a child or are not having sex anymore. If you are older than 65 and have had normal Pap test results for several years, or if you have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids, your doctor may tell you that you do not need to have a Pap test anymore.

Test Results

It can take as long as three weeks to receive your test results. If your test shows that something might not be normal, your doctor will contact you and figure out how best to follow up. There are many reasons why test results might not be normal. It usually does not mean you have cancer.

 

If your test results show cells that are not normal and may become cancer, your doctor will let you know if you need to be treated. In most cases, treatment prevents cervical cancer from developing. It is important to follow up with your doctor right away to learn more about your test results and receive any treatment that may be needed.

 

Cervical Cancer Screening Guidelines

 

The Cervical Cancer Screening Guidelines chart[PDF-175KB] compares recommendations from the American Cancer Society, U.S. Preventive Services Task Force, and the American College of Obstetricians and Gynecologists regarding—

  • When to start screening.
  • Screening methods and intervals.
  • When to stop screening.
  • Screening after a total hysterectomy.
  • Pelvic exams.

Screening among women who have been vaccinated against human papillomavirus (HPV).

 

 

Stem Cells International

Volume 2012 (2012), Article ID 367567, 9 pages

http://dx.doi.org/10.1155/2012/367567

 

Review Article

Stem Cell Niche Dynamics: From Homeostasis to Carcinogenesis

 

Kevin S. Tieu,1 Ryan S. Tieu,1 Julian A. Martinez-Agosto,2 and Mary E. Sehl3

1Computational and Systems Biology Interdepartmental Program, School of Medicine, University of California, Los Angeles, CA 90095, USA

2Department of Human Genetics, School of Medicine, University of California, Los Angeles, CA 90095, USA

3Division of Hematology-Oncology, Department of Medicine, School of Medicine, University of California, Los Angeles, P.O. Box 957059, Suite 2333 PVUB, Los Angeles, CA 90095-7059, USA

 

Received 7 June 2011; Accepted 23 October 2011

Academic Editor: Linheng Li

Copyright © 2012 Kevin S. Tieu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

 

Abstract

 

The stem cell microenvironment is involved in regulating the fate of the stem cell with respect to self-renewal, quiescence, and differentiation.

 

Mathematical models are helpful in understanding how key pathways regulate the dynamics of stem cell maintenance and homeostasis.

 

This tight regulation and maintenance of stem cell number is thought to break down during carcinogenesis. As a result, the stem cell niche has become a novel target of cancer therapeutics.

 

Developing a quantitative understanding of the regulatory pathways that guide stem cell behavior will be vital to understanding how these systems change under conditions of stress, inflammation, and cancer initiation. Predictions from mathematical modeling can be used as a clinical tool to guide therapy design.

 

We present a survey of mathematical models used to study stem cell population dynamics and stem cell niche regulation, both in the hematopoietic system and other tissues. Highlighting the quantitative aspects of stem cell biology, we describe compelling questions that can be addressed with modeling. Finally, we discuss experimental systems, most notably Drosophila, that can best be used to validate mathematical predictions.

 

  1. Introduction

 

The hematopoietic stem cell niche is an important regulator of stem cell fate. There are complex signaling pathways, such as Notch, Wnt, and Hedgehog, that carefully regulate stem cell renewal, differentiation, and quiescence [1–3]. Mathematical models can be useful in studying the dynamics of stem cell maintenance.

 

Quantitative models can provide information about cell population dynamics, regulatory feedback of interacting networks, and spatial considerations related to the structural relationships between stem cells and their progeny with cells of the microenvironment.

 

Errors in stem cell division rate or in the balance between self-renewal and differentiation may result in tissue overgrowth or depletion [4]. One novel target of cancer therapeutics is the stem cell niche [5, 6]. Stem cell niche signaling inhibitors are being designed with the idea that regulatory signals that are active in stem cell niche homeostasis may go awry during carcinogenesis [6–8].

 

Understanding the biology and dynamics of stem cell behavior under normal conditions and examining how the dynamics change under conditions of stress is essential to our understanding of how these mechanisms might change during carcinogenesis.

 

Mathematical and physical models have been used to study stem cell population dynamics and the regulation of stem cell fate through niche signaling with great success. We present a review of quantitative approaches to understanding stem cell niche signaling in the hematopoietic system, as well as in other tissues under conditions of homeostasis and carcinogenesis.

 

We explain the benefits of mathematical models in advancing our understanding of the mechanisms of regulation of stem cell fate and how this regulation changes in cancer development. We describe models that incorporate spatial aspects of the regulation of asymmetric division and compare normal conditions to carcinogenesis. We highlight the synergistic relationship between mathematical predictions and experimental validation and illustrate Drosophila as a model system for quantitative studies of the stem cell niche. Finally, we address the potential for mathematical models to predict and optimize therapies targeting the stem cell niche.

 

  1. Quantitative Aspects of the Hematopoietic Stem Cell Niche Hematopoietic stem cells (HSCs) are a dynamically well-characterized stem cell population. The hematopoietic system was the first system in which multipotency, or the ability for a single HSC to regenerate all of the different cell types within the tissue, was described.

 

A second defining characteristic for stem cells, self-renewal, has also been demonstrated in HSCs. Self-renewal is the ability of the HSC to generate a genetically identical copy of itself during cell division. This can occur asymmetrically, giving rise to one identical copy and one partially differentiated daughter cell, or symmetrically, giving rise to two identical copies of itself. Single HSCs have been shown to be self-renewing, multipotent, and to cycle with slow kinetics. Extrapolation from feline and murine data suggests a symmetric birth rate for human HSCs of once every 42 weeks [9].

 

Quiescence, the state of not dividing, allows HSCs to avoid mutation accumulation and contributes to their long lifespan. In contrast to senescence, where the cell loses its ability to undergo division, a cell can reawaken from the state of quiescence to an activated state where it can again undergo self-renewal.

 

The stem cell microenvironment regulates stem cell self-renewal, differentiation, quiescence, and activation. While little in situ information is known about the anatomy and structural relationships of the hematopoietic stem cell and its niche, there is a growing amount of experimental information about the behavior of signaling systems that govern HSC fate.

 

Population dynamics models have been successfully used to model the human hematopoietic system in both health and disease [9–17]. Using stochastic and deterministic models, significant progress has been made in understanding the dynamics of cancer initiation and progression [18, 19] and the sequential order of mutation accumulation [20]. Mathematical models have also been useful in modeling leukemic stem cell and progenitor population changes in response to therapy and the development of resistance [14].

 

An ongoing debate in hematopoietic stem cell biology concerns how much variability exists in hematopoietic stem cell fate [21]. Stochastic models have been used to study the dynamics of clonal repopulation [22] following hematopoietic stem cell transplant.

In these models, trajectories of hematopoietic stem cell counts as well as progenitor and differentiated cell counts are generated and compared with observed cell counts. Rates of self-renewal, differentiation, and elimination of cells are estimated. Stochastic trajectories are found to match experimental results. These models predict that hematopoiesis is probabilistic in nature and that clonal dominance can occur by chance.

 

These models could be enhanced by examining regulators of stem cell fate by the microenvironment. Stochastic simulation can be used to incorporate elements of the stem cell niche, such as surrounding stromal cells and signaling pathways, and model cell-cell and cell-environment interactions. These models could identify regulators of stem cell fate and explore the dynamics of this regulation.

 

Chronic myelogenous leukemia (CML) represents a nice system to quantitatively study hematopoietic stem cell and progenitor dynamics. CML is the first malignancy recognized as a stem cell disorder. The translocation t(9;22) is present in leukemic stem cells, multipotent progenitors, and their progeny of the myeloid lineage. This translocation leads to transcription of the BCR-ABL fusion oncogene which is thought to regulate cell survival.

 

Therapy inhibiting BCR-ABL is one of the first examples where chronic administration of a molecularly targeted therapy has led to a dramatic clinical response. This response is observed in all phases of the disease.

 

Mathematical models have been used to demonstrate that leukemic stem cells are not targeted by imatinib therapy [14], and that successful therapy must target leukemic stem cells [12]. Other models have highlighted the importance of leukemic stem cell quiescence as a mechanism leading to therapeutic resistance [13].

 

In a study of chronic myelogenous leukemia under targeted therapy, Michor et al. [14] describe the dynamics of leukemic stem cells and the development of resistance using a Moran process model. Based on calculated rates of death and differentiation using data of biphasic decline of BCR-ABL transcripts, they conclude that the leukemic stem cell compartment is not sensitive to therapy. An alternative explanation is provided by Komarova and Wodarz [13], using a stochastic model in which quiescence and reactivation of leukemic stem cells are considered. In this work, the biphasic decline of BCR-ABL transcripts is explained by the elimination of active leukemic stem cells, followed by the slower elimination of quiescent leukemic stem cells following their reactivation.

 

This study offers hope that targeted therapy, used in combination with potential therapies that lead to activation of quiescent cells, could eradicate the stem cell-like compartment of a tumor.

 

These models could be expanded by modeling the contribution of the microenvironment that regulates quiescence and activation of stem cells. Validation of these models will require experimental determination of rates of quiescence and reactivation to obtain accurate parameters for modeling.

 

Birth-death process models have been used to study extinction of leukemic and normal hematopoietic stem cells under therapy targeting leukemic stem cells. These models conclude that the killing efficiency of a therapy is a major determinant of the mean time to extinction of leukemic stem cells (optimal duration), while the selectivity of a therapy predicts the average number of normal hematopoietic stem cells at the time of leukemic stem cell extinction (safety) [23]. Incorporating quiescence in these models reveals that a successful therapy needs to target both active and quiescent leukemic stem cells.

 

We extended this model to consider combination of therapy targeting leukemic stem cells, and their niche was considered using stochastic simulation. Because stem cell self-renewal is expected to decrease with Wnt-inhibitor therapy, we modeled the addition of niche-targeted therapy as a decrease in birth rates of leukemic stem cells. We found that this combination can be effective in eliminating the leukemic stem cell compartment, even when the effects of BCR-ABL-targeted therapy on stem cells are modest.

 

We anticipate that extension of these models to include regulatory feedback of the stem cell microenvironment using stochastic reaction kinetic methods would be very helpful in modeling dynamics of niche-targeted therapies.

 

The hematopoietic stem cell niche has been studied in the healthy hematopoietic system. A model based on self-organizing principles demonstrates the importance of asymmetry in determining stem cell fate and concludes that stem cell fate is only predictable in describing populations rather than individual cellular fates [24].

 

Deterministic models are useful in simulating proliferation and differentiation of all populations comprising the stem cell niche [25]. These studies conclude that kinetics are highly variable because of the relatively small number of cells proliferating and differentiating in the niche.

 

Experimental studies have examined the role of Wnt signaling in regulation of normal hematopoietic regeneration [26]. We expect the combination of mathematical modeling with experimental validation to prove useful in modeling the pathways under normal conditions and dysregulation of these pathways during stress, inflammation, and carcinogenesis.

 

Figure 1 describes the elements of the HSC niche and an accompanying schematic representation of a mathematical model of the niche. The model captures the key regulatory components of niche dynamics, including cell population sizes and the signaling pathways that regulate them.

Figure 1: Quantitative aspects of the hematopoietic stem cell (HSC) niche. The left panel provides a structural picture of the niche, while the right panel shows a schematic representation of a mathematical model for the regulation of hematopoietic stem cell fate.

 

The model incorporates population counts and signaling pathways that may play a role in regulating stem cell population dynamics. Cellular populations comprising the bone and vascular niches include osteoblasts (OBs), endothelial cells, HSCs, multipotent progenitors (MPPs), common myeloid progenitors (CMPs), common lymphoid progenitors(CLPs), and differentiated cells. Signaling from Wnt, β-catenin, p21, p18, and bmi-1 regulate self-renewal, while Notch and GSK3 feedback from progenitors inhibit differentiation that usually accompanies self-renewal. Signaling from osteoblasts includes osteopontin (Opn) expression that inhibits HSC self-renewal, parathyroid hormone-related protein (PPR) which increases HSCs, N-cadherin which binds β-catenin, and Tie2/angiopoietin which regulates quiescence.

 

  1. Drosophila as a Classic Model System

Drosophila represents an excellent model system to study stem cells, their microenvironment, and the tight regulation of homeostasis through different signaling pathways.

 

The male Drosophila germ line population is a classic system used to study properties of the stem cell niche [27, 28]. The power of this model includes the ability to quantify cell populations over time, the relatively quick repletion of lost cells with newly differentiated cells, and the ability to experimentally observe spatial effects.

 

These quantitative aspects, as well as its simple, well-characterized lineages, make the Drosophila experimental system ideally suited for the development and validation of mathematical modeling. Finally, vertebrate and invertebrate digestive systems show extensive similarities in their developments, cellular makeup, and genetic control [29].

 

Mathematical and physical models have been used to study regulation of stem cell fate through niche signaling in the Drosophila blood and midgut [30], as well as in the Drosophila eye [31] and the Drosophila embryo [32], with great success. Studies of the stem cell niche in model systems such as Drosophila have revealed adhesive interactions, cell cycle modifications, and intercellular signals that operate to control stem cell behavior [4, 33].

 

These interactions have been studied quantitatively. For example, Wnt and Notch play pivotal roles in stem cell regulation in the Drosophila intestine [30, 34]. In addition, the APC gene has been shown to regulate Drosophila intestinal stem cell proliferation [35]. APC is well known to play a role in human colon carcinogenesis, and mathematical models have shown that stem cell proliferation leads to colon tumor formation in humans [36, 37].

 

 

The spatially patterned self-renewal and differentiation of stem cells has been extensively studied in Drosophila embryonic studies of development [32, 38–40]. The spatial orientation of stem cells has been visualized in Drosophila brain and testes and has recently been shown to be of great importance in experimental models of neuroblastoma growth in Drosophila [41].

 

We anticipate that the combination of spatial effects simulation and direct visualization of the Drosophila midgut through experiment will advance our understanding of the interaction of alterations in signaling pathways and spatial effects in carcinogenesis.

 

  1. Extension to Inflammation and Carcinogenesis across Tissues

Unifying features of stem cell niche regulation are observed across tissues and across organisms [42, 43]. Figures 1, 2, and 3 compare the structural and signaling elements of the stem cell niche across the hematopoietic, intestine, and breast tissues.

 

While little is known about the structural orientation of the human hematopoietic stem cell niche 1, much has been learned about the signaling pathways in both the bone and vasculature that regulate HSC fate. Osteoblasts (OBs) express osteopontin which negatively regulates HSC proliferation.

 

Tie2/angiopoietin signaling regulates HSC anchorage and quiescence, and adherence to osteoblasts. HSCs and OBs are increased via the parathyroid hormone-related protein receptor (PPR) expressed in OBs. OBs express N-cadherin which forms a beta-catenin adherens complex with HSCs. C-myc negatively regulates N-cadherin in differentiating HSCs and promotes differentiation and displacement from the endosteum.

 

OBs express Jagged-1, a Notch receptor that when bound inhibits differentiation that usually accompanies Wnt-induced HSC proliferation. GSK-3 activity enhances HSC progenitor activity and may control asymmetric cell division by modulating Notch and Wnt signaling pathways.

 

 

Figure 2: Structural and dynamic aspects of the Drosophila intestinal stem cell (ISC) niche. The left panel shows a structural picture of the Drosophila intestine, while the right panel reveals population and regulatory elements of a mathematical model for ISC regulation.

 

Populations of the intestinal stem cell niche in the Drosophila include ISCs, enteroblasts (EBs), enteroendocrine cells (EE), and enterocytes (ECs). Wnt signaling from underlying smooth muscle and Notch feedback from EB regulate ISC self-renewal, while Jak/Stat feedback from damaged ECs increases ISC self-renewal.

Figure 3: Model of the breast stem cell niche including structural elements (left panel) and mathematical model (right panel). Key populations of the mammary stem cell niche include mammary stem cells (MSCs), mesenchymal stem cells, endothelial stem cells (ESCs), bipotent progenitor (BPP), luminal progenitor (LP), myoepithelial progenitor (MEP), myoepithelial cells (MCs), luminal epithelial cells (LCs), and stromal cells. Wnt, Notch, and Hedgehog (Hh) signaling play a role in MSC self-renewal. Regulatory signals from growth factors (GFs) secreted by fibroblasts and CCL signaling from mesenchymal stem cells also regulate MSC fate.

 

Figure 2 depicts the intestinal stem cell niche of Drosophila. Here, we see four key cellular populations: intestinal stem cells (ISCs), enteroblasts (EBs), enterocytes (ECs), and enteroendocrine (EE) cells. It has been previously established that ISCs can self-renew under the influence of the Wnt signaling pathway [44] and can asymmetrically divide giving rise to one partially differentiated EB cell and one ISC, under the influence of the Delta/Notch signaling pathway. EBs can then differentiate into either EC cells or EE cells.

 

There is feedback from the EB population to the ISC population, which inhibits self-renewal and differentiation, in order to maintain stable population sizes under the normal conditions of homeostasis [45]. The EC population also interacts with the ISC population via Jak/Stat signaling feedback, which increases self-renewal and differentiation, in conditions when EC loss occurs [45].

 

Finally, both structural and signaling aspects of the breast stem cell niche are shown in Figure 3. The hedgehog (Hh) pathway is required for normal development of the mammary gland and regulates self-renewal of human mammary stem cells (MSCs) [46–48]. Hh also targets endothelial cells and induces angiogenesis by promoting endothelial progenitor proliferation and migration.

 

Wnt signaling regulates proliferation, apoptosis, and differentiation and maintains stem cells in a self-renewing state. Notch promotes self-renewal in normal mammary stem cells [46, 49]. Notch3 is expressed in epithelial progenitors, and Notch4 is expressed in bipotent progenitors. Markers of mammary stem cells include ALDH1 expression, and Sca-1. There is a significant correlation between expression of ALDH1 and HER2 overexpression [50].

 

The common signaling pathways that control stem cell self-renewal in these pathways, such as Notch, Wnt, and Hedgehog, are known to play a role in carcinogenesis [2, 41]. A growing body of evidence from a variety of solid tumors suggests that the first carcinogenic cell within a tumor possesses stem cell properties, including self-renewal, increased cell survival, limitless replicative potential, and the ability to produce differentiating cells [51–60].

 

However, it is unclear whether accumulation of mutations within a tumor cell with stem cell properties or extrinsic factors originating in the tumor microenvironment drive tumor progression [61, 62]. Understanding niche signaling pathways under normal conditions, and in response to inflammation and stress response, is vital to understanding how they may go awry in carcinogenesis.

 

The known link between inflammation and cancer may involve the regulation of stem cell fate by inflammatory cytokines [63]. IL-1, IL-6, and IL-8 are known to activate Stat3/NF-κB pathways in tumor and stromal cells. Positive feedback loops are formed involving further cytokine production which can drive cancer stem cell self-renewal [63]. These networks can be nicely modeled using stochastic reaction kinetics. Predictions from these models could be used to guide therapy design.

Dysregulation of normal homeostatic processes in the human hematopoietic stem cell niche may lead to enhanced self-renewal and proliferation, enforced quiescence, and resistance to chemotherapeutic agents. Leukemic stem cells have been shown to infiltrate the normal HSC niche by direct invasion or secretion of substances such as stem cell factor [6]. Leukemic stem cells may also exhibit dysregulated homing and engraftment, leading to alternative niche formation [6]. Future mathematical models of leukemic stem cell dynamics should take into account the stem cell niche.

 

Cytokine/Jak/Stat signaling has recently been shown to mediate regeneration and response to stress in the Drosophila midgut [45, 64]. Mathematical models of proliferation and differentiation of Drosophila intestinal stem cells have examined the dynamics of Wnt and Notch signaling [30], but have not yet examined the feedback of Jak/Stat signaling from the differentiated enterocytes to intestinal stem cells. Mathematical models of the human intestinal stem cell niche have shown that dysregulated colonic crypt dynamics cases stem cell overpopulation and initiate colon cancer [36]. Symmetric division of cancer stem cells has been shown to be a key mechanism of tumor growth to target in therapeutic approaches [37].

 

In mammalian systems, MyD88 and RAS signaling have been shown to lead to mouse and human cell transformation [65]. These signaling pathways are known to be involved with inflammation and also play a direct role in cell cycle control.

 

The link between inflammation and carcinogenesis needs to be studied quantitatively.

 

Alterations in Wnt signaling contribute to excess proliferation of mammary progenitor cells leading to cancer [66]. Unregulated Notch signaling in the mouse mammary gland leads to tumor formation. Increased expression of Notch in ductal carcinoma is associated with shorter time to recurrence [67].

 

Breast density is an important risk factor for breast tumor development [68], suggesting a role of the stem cell microenvironment in carcinogenesis. Growth factors secreted by fibroblasts influence mammary stem cell behavior. Endothelial cell and adipocytes may also influence stem cell behavior. CCL5 secretion by mesenchymal stem cells influences stem cell self-renewal. Alterations in Notch signaling are thought to play a role in breast cancer development.

 

Combination of theory and experiment has shed light on stromal-tumor interactions in the human breast [69]. In the breast, ductal cells secrete TGF-beta and fibroblasts secrete EGF. During carcinogenesis, TGF-beta then transforms fibroblasts into myofibroblasts, which in turn secrete higher EGF. Mathematical modeling has shown that this feedback system increases proliferation of tumor cells, and theoretical results match experimental validation well.

 

Mathematical models have also shed light on the interactions between the stem and nonstem compartments of solid tumors and their effects on the heterogeneous growth of solid tumors. These models show that apoptosis of nonstem cells paradoxically leads to tumor growth and progression [70, 71].

 

Cancer cell plasticity is an important consideration in the study cancer stem-like cells in oncology. The finding that nonstem cells can dedifferentiate to a stem-like state in mammary cell lines [72] has important implications in defining cancer stem-like cells and identifying therapies to target them. Markov models have recently proven very helpful in calculating rates of dedifferentiation of mammary epithelial cells to stem-like cells [73]. Consideration of microenvironmental signaling that regulates these transitions will greatly enhance these models and their predictions.

 

  1. Spatial Considerations in Modeling Stem Cell Regulation

Spindle orientation is well known to play a role in stem cell fate [74]. Asymmetric division is regulated by maintaining the stem cell orientation, and this is regulated by its spatial relationship with the cells of the niche. Induction of brain tumor growth has been demonstrated by altering stem-cell asymmetric division in Drosophila melanogaster [41].

 

Loss of cell polarity and cancer are tightly correlated [4]. In stem cells, loss of polarity leads to impairment of asymmetric cell division, altering cell fates, rendering daughter cells unable to respond to the mechanisms that control proliferation. The tumor suppressor p53 regulates polarity of self-renewing divisions in mammary stem cells [75]. Figure 4 displays regulation of stem cell asymmetric division under normal homeostatic conditions and the loss of this regulation during carcinogenesis. Labeling of template strands in stem cells of small intestine crypts using tritiated thymidine reveals selective retention of parental DNA strands and loss of newly synthesized strands during stem cell division [76].

 

This mechanism provides the stem cell with protection from DNA replication errors during asymmetric division. Loss of asymmetric division may lead to loss of this protection against chromosomal instability.

Figure 4: Stem cell polarity: homeostasis and dysregulation. Regulation of asymmetric division in the stem cell niche. The left panel represents spatial regulation of normal homeostasis, while the right panel demonstrates the loss of this asymmetry during carcinogenesis.

Mathematical models that allow for the inclusion of spatial effects are necessary in order to study this loss of asymmetry in the stem cell and its relation to carcinogenesis. Classic models of spatial effects on development in Drosophila have examined reaction diffusion equations [38, 39]. While multiscale models are more recently being used to study complex biologic systems and their genetic regulation, most of the methods used assume a well-stirred system and have not allowed for consideration of spatial effects until recently. Incorporating a spatial component into stochastic simulation methods is an exciting frontier in stochastic reaction kinetics [77, 78]. A stochastic reaction-diffusion equation is used in place of the chemical master equation and is sampled in the stochastic simulation. These methods have been shown to be successful in modeling spatial effects in genetic regulatory networks [78].

 

  1. Conclusions

Mathematical models have proven useful in characterizing stem cell and progenitor cell population dynamics, and in understanding the interacting components of the stem cell niche. Identifying quantitative characteristics of the stem cell microenvironment that are generalizable across tissues, as well as those distinct to each system, will be necessary to help define the emerging concept of the stem cell niche.

 

 

 

Modeling the components of the stem cell niche and their interactions will advance our understanding of the tight regulation of stem cell fate. In turn, it will allow us to predict and validate responses to stress, inflammation, and carcinogenesis. In addition to quantifying population distributions and feedback networks, it will be necessary and informative to incorporate spatial aspects that govern asymmetric versus symmetric stem cell self-renewal.

 

We expect that the combination of predictive modeling and experimental validation will prove useful in our understanding of the regulatory components of stem cell maintenance and the changes that occur in response to treatments designed to target the stem cell niche.

 

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Disorders in cell circuitry during multistage carcinogenesis: the role of homeostasis

  1. Bernard Weinstein

+

Author Affiliations

  • Herbert Irving Comprehensive Cancer Center and Departments of Medicine, Genetics and Development and Public Health, Columbia University College of Physicians and Surgeons, 701 West 168th Street, New York, NY 10032, USA
  • Received February 8, 2000.
  • Accepted February 8, 2000.

 

Abstract

The multistage process of carcinogenesis involves the progressive acquisition of mutations, and epigenetic abnormalities in the expression, of multiple genes that have highly diverse functions. An important group of these genes are involved in cell cycle control.

 

Thus, cyclin D1 is frequently overexpressed in a variety of human cancers. Cylin D1 plays a critical role in carcinogenesis because (i) overexpression enhances cell transformation and tumorigenesis, and enhances the amplification of other genes, and (ii) an antisense cyclin D1 cDNA reverts the malignant phenotype of carcinoma cells.

 

Therefore, cyclin D1 may be a useful biomarker in molecular epidemiology studies, and inhibitors of its function may be useful in both cancer chemoprevention and therapy. We discovered a paradoxical increase in the cell cycle inhibitors protein p27Kip1 in a subset of human cancers, and obtained evidence for homeostatic feedback loops between cyclins D1 or E and p27Kip1.

 

Furthermore, derivatives of HT29 colon cancer cells with increased levels of p27Kip1 showed increased sensitivity to induction of differentiation. This may explain why decreased p27Kip1 in a subset of human cancers is associated with a high grade (poorly differentiated) histology and poor prognosis. Agents that increase cellular levels of p27Kip1 may, therefore, also be useful in cancer therapy. Using an antisense Rb oligonucleotide we obtained evidence that the paradoxical increase in pRb often seen in human colon cancers protects these cells from growth inhibition and apopotosis.

 

On the basis of these, and other findings, we hypothesize that homeostatic feedback mechanisms play a critical role in multistage carcinogenesis. Furthermore, because of their bizarre circuitry, cancer cells suffer from gene addiction' andgene hypersensitivity’ disorders that might be exploited in both cancer prevention and chemotherapy.

Key words

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The current paradigm of multistage carcinogenesis

 

A variety of experimental and clinical studies carried out during the past century established the principle that cancers develop through a multistage process which can encompass an appreciable fraction of the lifespan of the species (1–3). Within the past few decades astounding progress has been made in our understanding of the cellular, biochemical and molecular genetic events that occur during this multistage process.

 

A current paradigm is that this stepwise process reflects the progressive acquisition of activating mutations in dominant acting growth enhancing genes (oncogenes) and inactivating recessive mutations in growth inhibitory genes (tumor suppressor genes) (4). It is also apparent that epigenetic abnormalities in the expression of these genes also play an important role in carcinogenesis (1–3).

 

 

Following the initial discovery of oncogenes, ~20 years ago, it appeared that there might be a small number of such genes. However, since then over 100 oncogenes and at least 12 tumor suppressor genes have been identified, and the list keeps growing (5–7). Moreover, a single colon cancer cell frequently contains defined mutations in multiple genes (four or more) plus numerous less well defined mutant and/or aberrantly expressed genes, as well as gross chromosomal abnormalities.

 

Indeed, in human colon tumors ~25% of all loci show loss of heterozygosity, and in cancer cells with defects in DNA mismatch repair thousands of loci can be mutated in a single cancer cell (6,8,9). Presumably, these widespread changes reflect the deleterious effects of mutagens, both exogenous and endogenous, as well as various types of genomic instability acquired during tumor development. In the subset of familial cancers some of these mutations, usually in tumor suppressor genes, are inherited, thus enhancing the multistage process of carcinogenesis.

 

 

Because of the large number and diverse functions of the known oncogenes and tumor suppressor genes we have developed a classification scheme which is based on their specific biochemical functions (Table I) (10). The genes are divided into two broad functional categories, those that control intracellular regulatory circuitry and those that influence cell surface and extracellular functions.

 

The first category is further divided into four subcategories:

(1) genes that play a role in the responses of cells to external growth stimuli (i.e. genes that encode growth factors, cellular receptors, coupling proteins, and protein kinases that transduce information across the cytoplasm to the nucleus) and nuclear transcription factors that then increase or repress the expression of specific genes;

(2) genes involved in DNA replication and repair;

(3) genes involved in cell cycle control, including checkpoint functions; and

(4) genes that determine cell fate, i.e. cellular differentiation, senescence and programmed cell death (apoptosis).

 

Many of the oncogenes, for example ras, are in subcategory 1. Subcategory 2 includes the DNA excision and mismatch repair genes. Subcategory 3 includes the tumor suppressor genes Rb and p53. Recent studies on cyclins and cyclin-related genes and their abnormalities in cancer have rapidly expanded this subcategory (11,12). This subject is discussed in greater detail below. Subcategory 4 includes the bcl-2 family of proteins that regulate apoptosis.

 

This category is of considerable importance since it is now apparent that the increased proliferation of cancer cells reflects a disturbance in the balance between de novo cell replication and terminal differentiation, senescence and apoptosis, rather than simply increased cell replication. The second category includes genes that influence how cells interact with the extracellular matrix and/or neighboring cells. This category includes various cell surface proteins, cell adhesion molecules, extracellular proteases and angiogenesis factors. Alterations in these genes are especially relevant to tumor cell invasion and metastasis.

View this table:

Table I.

Categories of genes targeted during multistage carcinogenesis

 

There are several caveats related to this classification scheme. Thus, some of the above-mentioned genes perform multiple functions that extend across these categories (i.e. p53); there is cross-talk between components in each category and between categories, and the biological effects of some of these genes are dependent upon the context of the specific cell type in which it is expressed, a theme which will be further developed later in this paper. Therefore, the classification scheme shown in Table I is an oversimplification, nevertheless it may provide a useful framework and highlights the diverse functions that are perturbed during carcinogenesis.

 

 

 

 

Abnormalities in cell cycle control proteins in cancer

Subcategory 3 in Table I represents a recent set of oncogenes and tumor suppressor genes, discovered as a result of the recent elucidation of the specific proteins that normally regulate the cell cycle in a variety of eukaryotic cells. As shown in Figure 1, the orderly progression of dividing mammalian cells through the G1, S, G2 and M phases of the cell cycle is governed by a series of proteins called cyclins, which exert their effects by binding to and activating a series of specific cyclin-dependent kinases (CDKs). This process is further modulated by the phosphorylation and dephosphorylation of CDK proteins by specific protein kinases and phosphatases and by a series of specific CDK inhibitor proteins (CDIs), including p16INK4a, p21Waf1 and p27Kip1 (Figure 1B) (11,12).

View larger version:

Fig. 1.

  • Simplified model of the cell cycle indicating the G0 phase of non-dividing cells, the G1 phase when cells enter the cell cycle and prepare for DNA synthesis, which occurs in the S phase, and the G2 and M phases in which cells prepare for and then undergo mitosis. The major cyclin–CDK complexes acting at each phase of the cell cycle are also shown.

 

  • There are two checkpoints during the cell cycle: the G1/S checkpoint (also termed restriction point) at which Rb and p53 exert inhibition on the G1/S transition, and the G2/M checkpoint at which cells are also prevented from progressing through the cell cycle until errors are corrected. (For additional details see text and refs 11,12.) (B) Multiple mechanisms regulate cyclin/CDK activities. This figure indicates the regulation of cyclin D1–CDK4. Phosphorylation on a conserved Thr (Thr-172 in CDK4) and dephosphorylation on Thr-14 and Tyr-15 are required for activation of the complex. A group of CDIs designated p21CIP1, p27Kip1, p16INK4, and other related proteins bind to the cyclin–CDK complex and inhibit kinase activity. Various external factors acting through the CDIs can cause cell cycle arrest.

 

  • Phosphorylation of the Rb protein by the active cyclin D–CDK4 complex can release E2F transcription factors, which enhances the G1–S transition and the onset of DNA synthesis in the S phase. p27Kip1 plays a critical role by binding to and inhibiting cyclin E/CDK2. (For additional details see text and refs 11,12.)

 

In recent years it has become apparent that carcinogenesis is frequently associated with mutations or abnormalities in the expression of various cyclins, CDKs and CDIs, in several types of human cancers (for review see refs 11,12). Thus, the cyclin D1 gene, which acts at the mid-portion of the G1–S transition, is often overexpressed in human breast, colon and squamous carcinomas, and several other types of cancer, and the cyclin E gene, which acts in late G1 is also overexpressed and dysregulated in a variety of human cancers (11,12).

 

Indeed, increased expression of cyclin D1 is one of the most frequent abnormalities in human cancer since it occurs in ~60% of breast cancers, 40% of colorectal cancers, 40% of squamous carcinomas of the head and neck and 20% of prostate cancers (10–13).

 

Furthermore, increased expression of cyclin D1 can be an early event in carcinogenesis, since it is also seen in precursor lesions of the colon, esophagous and breast (14,15 and unpublished data). It may, therefore, be a useful biomarker in molecular epidemiology and chemoprevention studies. It is of interest that the APC/β-catenin pathway regulates the expression of cyclin D1 (16,17), which may explain why cyclin D1 is often overexpressed in colorectal cancers (11,12,14). Amplification and overexpression of CDK4 is also seen in human cancers (11,12). Abnormalities in the expression of CDIs and in the retinoblastoma (Rb) gene, which plays a crucial role in controlling the G1–S transition, are described below.

 

The proteins CDC25A and CDC25B, which are phosphatases that activate cyclin/CDK complexes, are frequently overexpressed in human breast cancers (18), non-small-cell cancers (19) and head and neck cancers (20). Using an MMTV-CDC25B construct we have developed transgenic mice that overexpress CDC25B in the mammary gland and found that this increases susceptibility to induction of mammary tumors by dimethylbenz[a]anthracene (21), thus demonstating a synergistic interaction between a carcinogen and a cell cycle control protein in carcinogenesis.

 

In mechanistic studies we demonstrated that overexpression of cyclin D1 can play a critical role in carcinogenesis since introduction of an antisense cDNA to cyclin D1 into esophageal or colon cancer cells reverts their phenotype towards normal and inhibits tumorigenicity (22,23). This finding has been extended by other investigators, to pancreatic (24) and squamous carcinomas (25). Inhibition of cyclin D1 expression in human pancreatic cancer cells is associated with increased sensitivity to chemotherapeutic agents (24).

 

We also found that overexpression of cyclin D1 can enhance the process of gene amplification (26), and this finding has been confirmed by others (27). Therefore, increased expression of cyclin D1 could enhance the process of tumor progression during multistage carcinogenesis, by causing genomic instability. Taken together, these findings suggest that drugs that inhibit cyclin D1 expression or activity, or the activity of CDK4, may be useful in cancer chemoprevention or treatment (10,22,23).

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Paradoxical overexpression of tumor suppressor genes

Studies on p27Kip1

 

As discussed above, according to the current paradigm carcinogenesis is associated with activation of oncogenes and decreased expression of tumor suppressor genes. Therefore, we were surprised to find relatively high levels of expression of the protein p27Kip1 in a series of human esophageal cancer cell lines (28). This protein inhibits cell cycle progression by binding to and inhibiting the activities of cyclin/CDK complexes (Figure 1B), especially cyclin E/CDK2 and, therefore, it is a putative tumor suppressor gene (29).

 

In addition, genetically engineered mice with reduced expression of p27Kip1 display increased sensitivity to carcinogen-induced tumor formation, even if only one allele is inactivated (30). We found that several human colon and breast cancer cell lines also express high levels of p27K1p1, even during exponential growth, but this protein is expressed at low levels in three normal human mammary cell lines (31–35).

 

Furthermore, we found that whereas in normal mammary epithelial cells the level of the p27Kip1 protein varies during the cell cycle, in breast cancer cell lines the level can remain high throughout the cell cycle (34). The high level of p27Kip1 in these cancer cells is not simply an artefact of cell culture, since we and other investigators have found that p27Kip1 is also expressed at relatively high levels in a subset of primary human breast and colon cancers (34–38). It is also overexpressed in small-cell carcinomas of the lung, despite their high degree of malignancy (39).

 

The increased expression of p27Kip1 in cancer cells seems paradoxical, especially because mutations in this gene have not been found or are extremely rare in various cancers (29). A possible explanation for the paradoxical increase in p27Kip1 in some cancer cells is that they have become refractory to the inhibitory effects of this protein. To address this question, we transfected the MCF7 human breast cancer cell line and the MCF10F human non-tumorigenic mammary epithelial cell line with a vector containing the p27Kip1 cDNA to obtain derivatives that express increased levels of p27Kip1 (40).

 

The increased expression of p27Kip1 in derivatives of both of these cell lines was associated with lengthening of the G1 phase, an increase in the doubling time, a decreased saturation density and a decreased plating efficiency. In the MCF7 cells, anchorage-independent growth and in vivo tumorigenicity were also suppressed. These effects were associated with decreased cyclin E-associated in vitro kinase activity, in both cell lines. Thus, breast cancer cells are still responsive to p27Kip1-mediated inhibition of cell growth despite the high basal level of this protein. These results suggest that therapeutic strategies that further increase the level of expression of p27Kip1 or mimic its activity might be useful in cancer therapy (40).

 

Curiously, we found that cancer cell lines and tumors that had high levels of p27Kip1 also frequently had high levels of cyclin D1 (28, 31–35). Furthermore, ectopic overexpression of cyclin D1 in esophageal (28) or mammary epithelial cell lines (31) was associated with increased expression of p27Kip1, and when an antisense cyclin D1 cDNA was introduced into either esophageal or colon cancer cells to reduce the expression of cyclin D1, this led to reduced levels of the p27Kip1 protein (22,23 and unpublished data). We also found that overexpression of cyclin E in mammary epithelial cells is associated with increased expression of p27Kip1 (33,41).

 

Taken together, these findings suggest the existence of a feedback loop between cyclin D1 or cyclin E and p27Kip1, the purpose of which is to maintain a homeostatic balance between positive and negative regulators of the G1–S transition in the cell cycle (Figure 2).

 

The increased levels of p27Kip1 in cancer cells might protect these cells from potentially toxic effects of increased expression of cyclin D1 and or cyclin E (10,29). This regulation of p27Kip1 appears to occur at a post- translational level which is consistent with the fact that the regulation of its expression is usually regulated at this level by a ubiquitin-protesome mediated mechanism (29). There is evidence that one mechanism by which cancer cells are protected from the inhibitory effects of p27Kip1 is to sequester this protein in the cytoplasm to prevent it from inhibiting cyclin E/CDK2 in the nucleus. It should be mentioned that at low levels of expression p27Kip1 enhances the formation of cyclin–CDK complexes by acting as an assembly factor (29).

View larger version:

Fig. 2.

Schematic diagram indicating that cyclin D1 and cyclin E, when bound to CDKs, stimulate the G1–S transition of the cell cycle. At elevated levels they also can induce (through unknown mechanisms) an increase in cellular levels of the p27Kip1 protein, thus providing feedback inhibition of the activities of these cyclins.

 

Although, as discussed above, a subset of human cancers display relatively high levels of the p27Kip1 protein, including esophageal, breast, colon and small-cell lung cancers, recent studies indicate that another subset of human cancers displays decreased expression of this protein, and that this decrease is associated with high grade (poorly differentiated) tumors and an unfavorable prognosis. This association is remarkable since it has now been seen in a variety of human cancers including carcinomas of the breast, colon, stomach, prostate and oral cavity; as well as non-small cell lung carcinomas, gliomas, endocrine tumors and lymphomas (for review see ref. 29).

 

 

Because we found a correlation between the subset of colon cancers with high levels of p27Kip1 with well and moderately differentiated carcinomas (35) we wondered if p27Kip1 played a role in the differentiation of these cancers. Therefore, we examined the effects of stably overexpressing high levels of p27Kip1 in the human colon cancer cell line HT29, which can be induced to undergo differentiation in response to treatment with sodium butyrate (42). We found that the p27Kip1 overexpressor clones displayed an increase in the amount of the p27Kip1 protein in cyclin E/CDK2 immunoprecipitates and a corresponding decrease in cyclin E-associated kinase activity, when compared with vector control clones, providing evidence that the overexpressed protein was functional. Clones with a high level of p27Kip1 displayed partial growth inhibition in monolayer culture and a decrease in plating efficiency, even though they expressed increased levels of the cyclin D1 protein.

 

Using alkaline phosphatase expression as a marker, we found that the p27Kip1 overexpressor clones displayed a 2–3-fold increase in sensitivity to induction of differentiation by 2 mM sodium butyrate.

 

In contrast with these results, derivatives of HT29 cells that stably overexpressed p21Cip1/Waf1 displayed decreased sensitivity to the induction of differentiation (42). These results may explain why decreased levels of p27Kip1 in certain human cancers are associated with high grade tumors.

 

They also provide further evidence that therapeutic strategies that cause an increase in the level of p27Kip1 may be useful in cancer therapy. Since there already exist several agents that can increase the expression of p27Kip1 in specific cell types, including TGFβ, IFN-β, IFN-γ, cAMP agonists and rapamycin (29), in specific cell systems, this approach may be clinically feasible. Furthermore, adenoviral p27Kip1 gene transfer can induce apoptosis in several types of cancer cell lines (for review see ref. 29).

 

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Paradoxical increase in the Rb protein in colorectal cancer

 

The protein encoded by the Rb gene, pRb, normally plays a key role as a negative regulator of the G1–S transition in the cell cycle by binding the transcription factor E2F and preventing it from activating the transcription of genes required for the S phase (11,12).

 

The Rb gene is inactivated in a variety of human cancers, but in colorectal carcinomas there is frequently increased expression of this gene (43,44). This is paradoxical in view of the known role of Rb as a tumor suppressor gene. In a recent study we compared the levels of expression of pRb in normal human colorectal mucosa, adenomatous polyps, and carcinomas by immunohistochemistry (44).

 

We found that there was a progressive increase in the expression of pRb during the multistage process of colon carcinogenesis. Thus, during the transition from normal mucosa to adenomatous polyps to carcinomas there was a progressive increase in pRb expression.

 

In vitro studies were also done to examine the phenotypic effects of an antisense oligodeoxynucleotide (AS-Rb) targeted to Rb mRNA in the HCT116 colon carcinoma cell line that expresses a relatively high level of pRb (44). Treatment of HC116 cells with AS-Rb decreased the level of pRb by ~70% and also decreased the levels of the cyclin D1 protein and cyclin D1-associated kinase activity.

 

 

This finding is consistent with other evidence of the existence of a feedback regulatory loop between Rb and cyclin D1 (44,45). A striking finding was that AS-Rb inhibited the growth of HCT116 cells and induced apoptosis. Reporter assays indicated an ~17-fold increase in E2F activity. Furthermore, we could mimic the growth-inhibitory and apoptosis-inducing effects of AS-Rb by simply ectopically overexpressing E2F in HCT116 cells. These findings suggest that the increased expression of pRb in colorectal carcinoma cells may provide a homeostatic mechanism that protects them from growth inhibition and apoptosis, perhaps by counterbalancing the potentially toxic effects of excessive E2F.

 

There is, indeed, evidence that the majority of colon tumors have high E2F activity (46). This could reflect the effects of activating mutations in the k-ras oncogene, increased expression of cyclin D1, or other factors that affect E2F levels and/or activity.

 

We found that transfection of our As-Rb into WI38 human lung fibroblasts stimulated rather then inhibited growth (44), which is consistent with previous evidence that in several cell types pRb acts as a growth inhibitor.

 

The seemingly paradoxical effects found in colon cancer are not unique since there is evidence that subsets of human bladder and breast cancers and leukemias can also display increased expression of pRb, and that pRb can protect bladder cancer cells, osteosarcoma cells and hepatic carcinoma cells from apoptosis induced by various agents (44,47).

 

It is also apparent that, whereas E2F can act as an oncogene in some cell systems, in others it can induce apoptosis (44,48). Thus, the effects of altered expression of pRb and E2F, like that of numerous other oncogenes or tumor suppressor genes, is highly context dependent. This subject is discussed in greater detail below.

 

The mechanism by which pRb expression is upregulated in some human cancers is not known. It has been suggested that in some cases this may be due to loss of expression of p16INK4a, since there appears to be a homeostatic feedback regulatory loop between pRb and p16INK4a (44,49,50).

 

Paradoxical increases in other inhibitors of the cell cycle

 

As described above, the CDI p27Kip1 is often expressed at relatively high levels in human cancer cells. High levels of expression of another CDI, p21WAF1, have also been seen in some human tumors, including glial tumors (51), non-small cell lung carcinomas (52), leiomyosarcomas (53) and breast carcinomas (54). Curiously, in breast cancers high p21WAF1 expression was associated with high tumor grade and a poor prognosis (54).

 

In pancreatic cancer cells there was a correlation between high expression of cyclin D1 and p21WAF1 (55). In addition, cyclin D1 can induce increased expression of p21WAF1 through an E2F mechanism (56). This provides another example of a homeostatic feedback mechanism that is retained in many tumors.

 

Human tumors often display loss of expression of the CDI and tumor suppressor p16INK4a, either because of mutations in the gene or transcriptional silencing due to hypermethylation (57). However, recent studies indicate that subsets of gastric and colon cancer can display increased expression of the p16INK4a protein (H.Yamamoto, personal communication). High levels of expression of p16INK4 have also been seen in human neuroblastoma cell lines (58).

 

 

The significance of this finding remains to be determined. It is of interest that loss of expression of pRb is often associated with increased expression of p16INK4a, suggesting the existence of a homeostatic feedback loop between these two proteins, as discussed above (44,49,50).

Overview: the role of homeostatsis in carcinogenesis, when Yin meets Yang

 

The above studies indicate that in several types of human cancer there can be an increase in the expression of the tumor suppressor genes p27Kip1, p21WAF1, p16INK4 or Rb. As discussed above, this may reflect, at least in part, the existence of homeostatic feedback loops in cell circuitry that maintain an appropriate balance between growth promoting and growth inhibitory factors. Figure 3 lists additional examples of what appear to be homeostatic feedback loops in pathways of signed transduction, i.e. examples of a `Yin/Yang’ phenomenon in which a growth enhancing factor induces a growth inhibitory factor or visa versa.

 

In addition, it is now apparent that the biologic effects of oncogenes and tumor suppressor genes are highly context dependent (10,60). Examples include the ability of an activated ras gene or the transcription factor E2F to either enhance apoptosis or induce malignant cell transformation, depending on the cell system (60). Furthermore, the biologic effects of several oncogenes depend on their level of expression. For example, moderate overexpression of cyclin D1 can enhance cell growth but a high level of expression can be toxic to cells (61). The biologic effects of various protein kinases are also dependent on the cell context and their level of expression. We encountered this phenomenon in our studies on the biologic effects of specific isoforms of protein kinase C (62) and their roles in signal transduction (63).

View larger version:

Fig. 3.

Examples in which a factor which enhances growth (Yang') leads to an increase in the expression of a factor that inhibits growth (Yin’) and vice versa. These effects are often cell type specific. For additional details see text and related references. For the effect of p53 on cyclin D1 see Chen et al. (59).

 

Table I illustrates the remarkable diversity in function of the known oncogenes and tumor suppressor genes. It should also be emphasized that many of the respective proteins interact with each other in complex networks, rather than simple linear pathways, that display cross-talk and negative or positive feedback loops, analogous to electronic circuits (10,64–66), and the various pathways of signal transduction can be thought of as interconnecting modules' (66). Therefore, the accumulated effects of the multiple mutations in cancer cells leads to bizarre types of circuitry, i.e. circuits which were not present in the original parental cell, or in any other normal cell type. As a consequence, certain proteins in a cancer cell function within a novel context, since they are linked, either upstream or downstream, to proteins they are not linked to in normal cells. For similar reasons, an increase, decrease or loss of a given protein in a tumor cell might have a differentmeaning’ to a cancer cell than to a normal cell, and the experimental re-introduction of a deleted protein into a cancer cell might exert effects different from those that occur when the same protein is present and expressed in normal cells.

 

This formulation can help to explain certain otherwise unexpected experimental results, and may also provide reason for optimism in the design of cancer-specific therapeutic agents. It has always seemed puzzling why the introduction of a single wild-type tumor suppressor gene, like p53, Rb or APC, into malignant tumor cells that carry multiple mutations can profoundly inhibit growth or induce apoptosis and/or inhibit tumorigenicity (67–69).

 

If, according to the current paradigm, these cells originally evolved into a malignant tumor through the stepwise acquisition of several mutations, then the correction of one of these mutations should have only a small inhibitory effect. We believe that these results reflect the altered or bizarre circuitry of cancer cells, and refer to this phenomenon as `gene hypersensitivity’ (10).

 

In our studies on cyclin D1 we encountered another effect which also seemed puzzling. As mentioned above, we found that stable expression of an antisense cyclin D1 cDNA in a human esophageal cancer cell line, which carries an amplified cyclin D1 gene and expresses high levels of cyclin D1, depressed cyclin D1 expression, and this was associated with a dramatic reversion of the cells towards a more normal phenotype (22).

 

Nevertheless, the residual level of cyclin D1 protein expression in the reverted cells was considerably higher than in other rapidly growing and highly tumorigenic cells in which cyclin D1 was not amplified or overexpressed. These findings suggest that during the original evolution of these cancer cells they became `addicted’ to cyclin D1 (10) and, therefore, require high levels of this protein to maintain their cancer phenotype. A possible explanation is that these cancer cells express relatively high levels of proteins that counteract the effects of cyclin D1, for example Rb or one of the CDIs.

 

Thus, even only a partial decrease in cyclin D1 in these cells would alter the stoichiometry between it and the respective inhibitory proteins, thus resulting in net inhibition of cell growth (10). If this explanation is correct, then cancer cells that are addicted to cyclin D1 might be unusually susceptible to drugs that block the action of cyclin D1. This general model might also apply to other genes that are amplified and/or overexpressed, or constitutively activated, in cancer cells. Indeed, it has been shown that pancreatic cancer cells that carry a mutated and activated k-ras gene are more dependent on the function of the k-ras gene for growth than pancreatic cancer cells that do not carry this mutation (70).

 

 

 

 

Another example of gene addiction is the finding that erB-2 antisense oligonucleotides inhibit the proliferation of breast carcinomas cells with erB-2 amplification but have no specific effect on breast cancer lines that do not have amplification of erB-2 (71).

 

The bizarre circuitry of cancer cells and the phenomena of gene hypersensitivity and gene addition could be the long sought Achilles’ heal of cancer cells. Indeed, they might explain why tumor cells are often more susceptible to the induction of apoptosis than normal cells by some of the currently employed cancer chemotherapy agents.

 

The concept of homeostasis is pervasive in biologic systems and dates back to the 19th century physiologist Claude Bernard who emphasized the constancy of the `interior milieu’ of the body in the face of an ever-changing exterior environment. The term itself was first used by Walter B.Cannon in the 1930s who emphasized the role of the autonomic nervous system in maintaining steady states within the body (72). Subsequent studies of the endocrine system provided further examples. With the more recent elucidation of biochemical pathways of biosynthesis and energy metabolism and current studies on pathways of signal transduction, the concept of homeostasis has been extended to intracellular mechanisms.

 

It seems likely that the principal of homeostasis is also maintained during the process of multistage carcinogenesis, as discussed above. This seems reasonable since, despite its numerous abnormalities, the cancer cell must coordinate highly complex functions in order to survive and replicate. Therefore, the clonal evolution theory of cancer, proposed by Nowell (73), and the current paradigm of oncogenes and tumor suppressor genes (4), requires modification. The multistage process of carcinogenesis does not simply involve the step-wise activation of growth-promoting oncogenes and inactivation of growth inhibitory tumor suppressor genes.

 

The regulatory circuitry of the evolving population of tumor cells must adapt to the stochastic occurrence of these mutations, some of which might on their own inhibit growth or cause apoptosis. Presumably this occurs through homeostatic feedback mechanisms, like those described above, and/or cell selection, thus maintaining a homeostatic balance that favors optimal growth and viability. This concept could help to explain the long latent period in carcinogenesis and the complex and heterogenous phenotypes of cancer cells. It also has implications with respect to novel approaches to cancer chemoprevention and therapy, because of the bizarre circuitry that results from these alterations and the phenomena of gene hypersensitivity and gene addition, as discussed above.

 

 

The concept of cancer as a global disturbance of the network of regulatory circuitry within cells also has implications with respect to the limitations of the current approaches used for characterizing the genotypes and phenotypes of specific cancers. Currently, this is often done by analyzing a few genes, transcripts or proteins. The recent development of microarray methods (74) and proteomics markedly expands our ability to assess complex profiles of gene expression in cancer cells and, therefore, are major advances. However, these methods do not provide a dynamic view of the actual circuitry of cancer cells. A challenging future goal is to develop novel methods to assess this circuitry in living cells, and also to develop mathematical models (for example, see refs 64–66) for analyzing the complex networks and their interactions. Hopefully, the insights obtained from this new level of analysis will provide even more powerful approaches to cancer prevention and treatment.

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Acknowledgments

This paper is dedicated to Anthony Dipple, an outstanding leader in carcinogenesis research and wonderful colleague. I am indebted to several members of my laboratory who made invaluable contributions to this research. For brevity, I have often cited previous review articles or representative research papers. I apologize to other investigators for omitting numerous additional pertinent references. This research was supported by NIH Grant CA63467, AIBS grant DAMRD 17-94-J-4101, and awards from the National Foundation for Cancer Research, the T.J.Martell Foundation and the Alma Toorock Memorial for Cancer Research.

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Headache. Author manuscript; available in PMC 2013 Sep 4.

 

Published in final edited form as:

Headache. 2007 Jun; 47(6): 820–833.

doi:  10.1111/j.1526-4610.2006.00715.x

PMCID: PMC3761082

NIHMSID: NIHMS501945

 

The Cerebellum and Migraine

 

Maurice Vincent, MD, PhD and Nouchine Hadjikhani, MD

Author information Copyright and License information

 

The publisher’s final edited version of this article is available at Headache

See other articles in PMC that cite the published article.

 

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Abstract

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Clinical and pathophysiological evidences connect migraine and the cerebellum. Literature on documented cerebellar abnormalities in migraine, however, is relatively sparse. Cerebellar involvement may be observed in 4 types of migraines: in the widespread migraine with aura (MWA) and migraine without aura (MWoA) forms; in particular subtypes of migraine such as basilar-type migraine (BTM); and in the genetically driven autosomal dominant familial hemiplegic migraine (FHM) forms. Cerebellar dysfunction in migraineurs varies largely in severity, and may be subclinical. Purkinje cells express calcium channels that are related to the pathophysiology of both inherited forms of migraine and primary ataxias, mostly spinal cerebellar ataxia type 6 (SCA-6) and episodic ataxia type 2 (EA-2). Genetically driven ion channels dysfunction leads to hyperexcitability in the brain and cerebellum, possibly facilitating spreading depression waves in both locations. This review focuses on the cerebellar involvement in migraine, the relevant ataxias and their association with this primary headache, and discusses some of the pathophysiological processes putatively underlying these diseases.

Keywords: migraine, familial hemiplegic migraine, cerebellum, progressive ataxia, episodic ataxia

Migraine is a common disease that affects 10 to 12% of the population and is considered by the World Health Organization as one of the most disabling neurological disorders.1 Migraine attacks typically occur in varying intervals, each lasting 4 to 72 hours by definition. The unilateral, mostly side-shifting throbbing pain, located predominantly to the frontal parts of the cranium, may be intense enough to interrupt daily activity and worsens with physical activity. Nausea, vomiting, photo and phonophobia frequently accompany the annoying moderate to severe pain. A series of different neurological focal abnormalities named aura (from the Greek “breath,” gentle breeze), mostly visual in nature, but also sometimes sensory, motor, or dysphasic, may occur in close association with the pain, typically before the headache onset.2 The International Headache Society (IHS) classifies migraine headaches, among other less frequent subtypes, as migraine with aura (MWA), or migraine without aura (MWoA), according to the presence of aura symptoms.3

Pathophysiological Theories in Migraine

The mechanisms underlying migraine attacks remain fairly unknown, although accumulating data have demonstrated that this ailment is a primary brain disorder.4 A dispute whether migraine had either a nervous or a vascular origin, polarizing the 2 so-called “vascular” and “neuronal” theories, has been present for many years,5 but the central nervous system more probably seems be the ultimate source of migraine. The hitherto suitable vascular theory, which popularized the expression “vascular headache,” has been challenged by the information that aura and headache did not parallel changes in the vasculature.6 The possibility that abnormal brain hyperexcitability primarily originates migraine attacks is now widely accepted,7 and the disease threshold, at least partially, seems to be determined by genetic predisposition.8 The hyperexcitability has been confirmed by the relatively higher susceptibility of the migrainous cortex to phosphene induction secondary to transcranial magnetic stimulation.9 It seems, therefore, that the vascular responses take place because of primarily triggered events in the nervous system intimacy.

 

Spreading Depression

Spreading depression (SD) consists of a spreading wave of depolarization associated with a reduction of the cortical activity that lasts for minutes with a propagation speed of around 3 mm/min.

 

The expression “cortical spreading depression” (CSD) is widespread, but since this phenomenon is not exclusively cortical—it has been recorded in various tissues including the basal ganglia and thalamus,10,11 cerebellum,1215 tectum and olfactory bulb,12 retina,1622 and spinal cord23—we believe that “spreading depression” is a better denomination.

 

In 1945, Leão and Morrison suggested for the first time that SD could be related to the pathophysiology of migraine24 and Leão postulated that circulatory changes were in close connection with SD waves.25 SD compatible circulatory changes were subsequently found in migraineurs, making the possibility of SD being an important phenomenon in this disease even more attractive.6 SD is accompanied by an initial hyperperfusion, followed by prolonged and pronounced spreading hypoperfusion.26 The genetically hyperexcitable brain in migraine probably facilitates paroxysms of SD-like phenomena initiating each of them the cascade of events ultimately leading to the attacks. Functional imaging studies support the possibility of SD underlying migraine episodes.27 The trigeminovascular system comprised of the trigeminal fibers innervating meningeal and brain vessels is activated by SD,28 leading to plasma extravasation and vasodilatation (neurogenic inflammation) in the dura mater.29 The ability of triptans, a class of 5-HT1 agonists, to block neurogenic inflammation and neuropeptide release centrally, has supported the defense of its use as effective antimigraine agents.3032

 

The Cerebellum

 

Although Herophilus (335 to 280 B.C.) is usually cited for firstly recognizing the cerebellum (from Latin, “small brain”) as distinct from the brain, Aristotle did so before (“The history of animals” book I, part XVI, 350 B.C.). Galen (131 to 200 A.D.) called the vermis “the worm-like outgrowth,” Luigi Rolando (1773 to 1831) concluded the cerebellum was a motor structure, and Marie-Jean-Pierre Flourens (1794 to 1867) finally linked the cerebellum to coordination.33,34 The relatively simpler structure of the cerebellum is highly specific and uniform, with cells arranged in layers in the cerebellar cortex connected each other by a repetitive microcircuitry.35 The Purkinje cells are the source of cerebellar output. Therefore, malfunction in Purkinje cells severely impairs motor planning and coordination.

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CEREBELLAR DISORDERS IN COMMON MWA AND MWoA FORMS OF MIGRAINE

 

In spite of the fact that balance changes and vertigo have been recognized in migraine, only a few studies have specifically assessed cerebellar function between or during attacks. In migraine, stabilometry studies have revealed ictal and interictal balance abnormalities in treatment-free patients.36,37

 

Vestibulocerebellar function also seems compromised in migraineurs, with abnormal nystagmus in calorimetric testing and decrease in saccadic eye-movement accuracy.38 In addition, subclinical cerebellar impairment expressed as a lack of fine coordination has been shown interictally in migraineurs.39 Altogether, these findings indicate that migraine affects cerebellar function.39

 

It is not surprising that vestibular abnormalities may be detected in migraine patients, as about 2/3 of migraineurs are sensitive to motion and 1/4 may present with paroxysmal vertigo.40,41

Although a positive family history and previous motion sickness in childhood do not contribute to the diagnosis of MWoA, vestibular abnormalities are associated with this type of headache.42,43 Visual dysfunction may also impair coordination and probably impacts balance in migraine.44 Spatiotemporal function and motion processing are reportedly abnormal in migraineurs interictally45,46 and visual fields and contrast functions differ from controls.47

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BASILAR-TYPE MIGRAINE

Cerebellar dysfunction has been recognized in relation to special forms of migraine for many years. The expression “cerebellar migraine” was used in some German48,49 and Czech50 early publications.

 

In 1961, Bickerstaff described what he called “basilar artery migraine,”51 making the expression “basilar migraine” popular in neurology. According to the IHS, BTM is characterized by aura symptoms clearly originating from the brainstem and/or both hemispheres, without motor deficits.3 Symptoms may include dysarthria, vertigo, tinnitus, hypacusia, diplopia, visual symptoms, ataxia, decreased level of consciousness, and bilateral paresthesias.52 BTM has been considered more prevalent in adolescent girls with very positive family histories, but a recent analysis does not support BTM, which presents with ataxia in 5% of the cases, as a distinct migraine subform.53 The pathophysiology of BTM is not known. Circulatory changes and episodes of stroke putatively related to basilar-type migraine have been reported.54 Such infarcts have also been reported in the thalamus55 and the occipital areas.5658 Knowing the genetic mechanisms behind certain forms of migraine, scrutiny indicates that many migraine patients previously described according to their clinical pictures as “cerebellar migraine” or “basilar migraine,” probably carried one of the known ion channel related mutations. A mutation at the FHM2 locus at the ATP1A2 gene has been described in familial BTM without hemiplegia, suggesting a connection between BTM and hemiplegic migraine.59 BTM most probably represents a variation of MWA rather than another migraine subtype, as 95% of the BTM patients experience typical aura as in MWA.53

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FAMILIAL HEMIPLEGIC MIGRAINE AND THE CEREBELLUM-RELATED DISORDERS

FHM is an autosomal dominant disorder characterized by migraine attacks with hemiplegic aura. The diagnosis is based on the presence of aura including motor weakness and at least one first- or second-degree relative suffering from migraine with aura that presents with motor deficits.3 A multitude of associated symptoms may be present, including ataxia, seen in one-third of the families.60 Three types of FHM have been described so far: FHM-1 is consequent to mutations of the CACNA1A gene coding for a P/Q calcium channel;61 FHM-2 is due to the mutation of the ATP1A2 gene coding for the alpha2 subunit of the Na/K astrocytic ATPase;62,63 and FHM-3 follows a mutation of the SCN1A gene coding for a neuron voltage-gated sodium channel.64 The FHM phenotype includes hemiplegic migraine, seizure, prolonged coma, hyperthermia, sensory deficit, and transient or permanent cerebellar signs, such as ataxia, nystagmus, and dysarthria.65

In FHM-1, the CACNA1A gene encodes the α1A (CAV2.1) subunit of the high voltage-gated P/Q type of calcium channel. This channel is expressed throughout the central nervous system, particularly in the cerebellar Purkinje cells, where it mediates depolarization-induced Ca2+ influx into presynaptic terminals and glutamate release.66,67 P/Q calcium channels play a pivotal role in neurotransmitter release68 and influence neuronal excitability.69 The consequences of different missense mutations in the CACNA1A gene may lead to gain-of-function of human P/Q-type calcium channels, although not all studies agree in this respect.70 New animal models may provide important insights in this field. A knockin mouse expressing the human R192Q pure FHM-1 mutation was genetically engineered and recently studied. This mouse shows gain-of-function P/Q Ca2+ channel function as evidenced by opening of calcium channels at lower levels of depolarization, lower threshold for SD and faster propagation speed.71 These findings open the possibility of SD-like phenomena in the cerebellum as a justification for cerebellar dysfunction in migraine patients. Human evidence confirming this hypothesis is however not yet available.

The mechanisms behind the neurological symptom complex linked to CACNA1A, ATP1A2, and SCN1A genes, respectively involved with FHM 1, 2, and 3, remain partially unclear. Noteworthy is the fact that, despite the type of ion channel involved, all mutations result in hyperexcitability and may be related to hemiplegic migraine, epilepsy, and/or ataxic disorders.

Cerebellar symptoms in FHM have been recognized in many families (Table). Such symptoms may be produced by lesion in the cerebellum itself or in structures with afferent or efferent cerebellar connections, such as the brainstem. Thus, the exact origin of symptoms such as nystagmus and ataxia in migraine patients cannot be definitely related to the cerebellum. On the other hand, the atrophy found in FMH and the calcium channel abnormalities in the cerebellum indicate that symptoms are probably cerebellar in nature.

table ft1table-wrap mode=article t1

Table

caption a4

Cerebellar Symptoms in Earlier FHM Descriptions

Around 20% of the hemiplegic migraine patients show permanent mild cerebellar deficits.72 Unconsciousness, fever, and confusion may occur associated with the hemiplegic attacks and ataxia, usually accompanied by cerebellar atrophy.73,74

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SPINOCEREBELAR AND EPISODIC ATAXIAS

The CACNA1A mutations are also involved with cerebellar diseases, namely episodic ataxia type 2 (EA-2) and spinocerebellar ataxia type 6 (SCA-6). Hereditary EAs are genetic conditions typically characterized by recurrent clumsiness triggered by exertion, stress, or fatigue with a favorable response to acetazolamide.75,76 Spinocerebellar ataxias (SCA) are genetic non-paroxysmal, moderate to severe ataxias of late onset characterized by progressive cerebellar degeneration leading to incoordination. Other cerebellar symptoms associated with spinal cord signs, such as motor deficit, as well as vibratory and proprioceptive sensory loss.75 The myriad of cerebellar symptoms include dysarthria, dysmetria, tremor, and nystagmus of various types.77

A series of EA mutations have been found so far,76,7880 and a complete loss of the P/Q function has been suggested to underlie the pathophysiology of EA-2.81 Different nomenclature in successive descriptions have confused the understanding of non-progressive ataxias.8284 SCA-6 has been associated with small expansions of a CAG repeat at the 3′ end of the CACNA1A gene, and point mutations are responsible for the allelic disorders related to EA-2.60,79,8587 The genetics behind these phenotypes, however, may vary.88 Regardless of the mutation type, hyperexcitability seem to stand behind all the different phenotypes. Interestingly, a mutation in the glutamate transporter excitatory aminoacid transporter 1 (EAAT1) is also related to episodic ataxia (EA), seizures, migraine, and alternating hemiplegia.89 EAAT1 is expressed particularly in the cerebellum and brain stem. The mutation in EAAT1 may lead to a reduced capacity for glutamate reuptake, increasing hyperexcitability. This reproduces the pathophysiological conditions present in channelopaties leading to FHM, episodic/progressive ataxias and coma after minor head trauma.

SCA-6 represents the form of progressive ataxia with closest relation to FHM pathophysiology, as this form of SCA is also linked to the CACNA1A gene.90,91 Different mutations have been linked to the phenotype of SCA-6, sometimes associated with FHM.92 There may be marked cerebellar atrophy on MR examination in these patients.93 Not only mutations occur at the same gene, but in 20% of FHM patients permanent cerebellar symptoms are present.94,95

The phenotypes of such disorders may vary between and within families.91,96 EA-2 patients may sometimes have non-hemiplegic migraine, which presents after the onset of the ataxic symptoms.97 Interictally, EA patients may present constant cerebellar symptoms and signs such as nystagmus and cerebellar atrophy. The migraine-progressive episodic ataxias symptoms interchange indicate that the cerebellar disorders related to channelopathies intermingle and may represent different aspects from the same abnormality. Mechanisms behind ataxias in migraine disorders most probably involve membrane dysfunction. Purkinje cells, where P/Q-type calcium channels are mostly expressed, fire according to intrinsic regular spontaneous pacemaking.98 This intrinsic pacemaking activity is irregular in P/Q-mutant Purkinje cells as well as in w-agatoxin IVA-blocked P/Q-type calcium channel in wild Purkinje cells. The defective P/Q calcium current decreases the function of calcium-activated potassium (KCa) channels, which are fundamental for the precision of the Purkinje cells intrinsic firing. EBIO, a channel activator that increases the affinity of KCa channels for calcium, recovers the regular firing in affected Purkinje cells.99 This makes the KCa channel a potential therapeutic target not only for EA-2, but also for related symptoms in migraine disorders.

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COMA, CEREBELLUM, AND MIGRAINE

One of the conditions associated with cerebellar dysfunction, FHM and the CACNA1A gene is fatal coma after mild head trauma.100102 Some mutations have been related to this phenotype. Patients carrying the T666M mutation in CACNA1A gene,103 but not exclusively as the chromosome 1 has also been implicated in this kind of abnormality104—may present coma following relatively mild head trauma, with brain edema and sometimes long-lasting coma.101103,105107 The S218L mutation was shown to produce particularly severe brain edema after trauma.108

As a hypothesis, the mechanisms leading to coma can be understood as follows: minor trauma, a relatively irrelevant depolarizing stimulus in healthy subjects, may elicit SD in patients with a particularly marked Cav2.1 channel gain of function, both in the brain and cerebellum. Further activation may then take place through a positive feedback leading to Cav2.1-dependent glutamate release, activation of NMDA receptors, de novo increase of extracelullar K+, glutamate release, and more NMDA receptor activation.109 SD may disrupt the blood–brain barrier by activating MMP-9, one of the proteases implicated in BBB opening,110 leading to brain edema and coma. Interestingly, the long-lasting edema and coma take place after a time interval following the trauma. This indicates that the process is not dependent on immediate neuronal impulses and neurotransmitters release, but on time consuming progressive changes. Moreover, the resulting pathophysiological state is a self-perpetuating process with a relatively slow recovery rate. Positive SD and calcium waves (see below) feedbacks in particularly excitable subjects would fit with these requirements. Transient global amnesia (TGA), a potentially SD related disorder,111 may also be induced by minor head trauma, just as coma in some patients with genetic forms of migraine where cerebellar abnormalities may be present.112

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THE ACETAZOLAMIDE EFFECT

Acetazolamide, a reversible inhibitor of the enzyme carbonic anhydrase, is a drug known for its benefit in EA-2.79,113,114 Acetazolamide-responsive episodic symptoms, typical of EA-2, have also been shown in SCA-6.115 The effect of acetazolamide in EAs was found in 1978 by chance, when patients received this drug after being erroneously diagnosed as periodic paralysis.114 Acetazolamide response has been described in FHM with associated ataxia74 and in migraineurs without cerebellar symptoms.116

Acetazolamide does not usually diminish the frequency or intensity of FHM, being mostly indicated for use in EA-2. However, there are 2 FHM reports with clear acetazolamide response.74,116 Formal trials using acetazolamide in migraine are few. In an open uncontrolled pilot study, the efficacy and tolerability of acetazolamide were addressed in 22 MWA patients. 68.2% reported a reduction of MA episodes higher than 50%.117 A randomized clinical trial was performed comparing 500 mg oral acetazolamide versus placebo in 53 IHS migraine patients (27 in the placebo group). This study had to be interrupted prematurely due to many side effects related withdrawals. So far, the authors did not find a difference between the active drug and placebo.118 Acetazolamide was also shown to interrupt aura status in 3 patients.119

The acetazolamide mechanism of action in episodic ataxia type 2 (EA-2) is still mysterious. It is interesting that topiramate, an effective antimigraine prophylactic agent, shares with acetazolamide the property of carbonic anhydrase inhibition.120 Besides, it was recently reported to suppress the susceptibility to cortical spreading depression in experimental animals.121 Acetazolamide induces metabolic acidosis. It is possible that this drug increases the extracelullar concentration of free protons in the brain tissue including the cerebellum.113 Since calcium channels are sensitive to pH changes, acetazolamide could restore normal function in mutant calcium channels through acidification. However, acetazolamide does not modify the channel properties through either pH-dependent or pH-independent mechanisms.122 Alternatively, since acetazolamide activate largeconductance KCa channels, which are in normal conditions exclusively activated in Purkinje cells by P/Q-type calcium channels, it is possible that this drug acts by restoring Purkinje cells pacemaking properties.99

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CEREBELLAR CIRCULATORY CHANGES

 

Circulatory changes may take place in the cerebellum during migraine attacks. Following sumatriptan administration, a vasoconstricting antimigraine agent, infarction has been described in the cerebellum, showing that this area was probably predisposed to ischemia as compared to other regions.123 Decreased perfusion and cerebellar symptoms, including dysarthria, ataxia, and dizziness have been described in migraine.124,125 Such circulatory changes can outlast the symptoms.125 Stroke in the posterior circulation has been reported in migraine54,123 including in children,126 mostly diagnosed as “basilar migraine.” The posterior circulation territory, particularly the cerebellum, shows significantly increased risk for infarct-like MRI findings compared to the remaining of the nervous system. The highest risk is in MWA with at least 1 attack per month, in the absence of stroke history.127 According to the CAMERA study, the percent of all these small, infarct-like lesions in the posterior circulation in MWA, MWoA, and controls were 81, 47, and 44%, respectively; the majority was in vascular border zones; and multiple posterior circulation lesions were identified exclusively among the migraine patients.128

 

The nature and pathophysiology of such infratentorial lesions are not known. Since the cerebellar circulation has relatively few anastomoses, it is prone to watershed infarcts.129 SD related reduction in rCBF could, theoretically, induce more infarcts in this territory as compared to areas where collateral circulation is available.

 

Although subjects do not present overt stroke symptoms, it is possible the subclinical cerebellar signs and symptoms in migraine36,38,39 are secondary to small infarcts in the posterior circulation.

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SPREADING DEPRESSION AND THE CEREBELLUM

 

Leão and Martins-Ferreira first published a 24 line note on SD in the cerebellum, quadrigeminal plate, and olfactory bulb12 and mentioned that the cerebellum is naturally resistant to SD. Fifková et al described SD in the rat cerebellum13 and Young wrote on the SD in the elasmobranch fish (Raja erinacea, Raja ocellata).14 As also pointed by Nicholson in 1984, reviewing cerebellar SD in different species,15 the cerebellum does not easily supports this phenomenon, unless some “conditioning” takes place.

 

This may happen by raising the extracelullar K+, removing most of the NaCl, or replacing the chloride with another anion. During SD, extracellular calcium concentration falls, reflecting Ca2+ influx with consequent intracellular Ca2+ overload, that may, if sufficiently high, promote cell death.130

 

Just as in the isolated retina and hippocampus, also in the turtle cerebellum SD occurs in the absence of blood flow, meaning that SD is not dependent on vascular or blood influence.15 If cerebellar SD is related to EA-2, pH changes alone may be not sufficient for explaining the acetazolamide effect. Alternatively, SD could occur in the cerebellum through facilitating mechanisms not involving pH reduction.

 

Other cortical self-propagating waves with potential implications in cerebellar diseases and migraine have been demonstrated. Spreading acidification and depression (SAD) has been observed in the rat cerebellar cortex following suprathreshold electrical stimulation.131 Substantial differences show that SAD and SD are not the same phenomenon.

 

SAD spreads at a greater rate of 50 to 110 m/s, continues for 1 to 2 minutes, is accompanied by a powerful suppression of the pre and postsynaptic responses, with a refractory period of 90 seconds. Differently from SD, SAD induces no extracellular DC shift, do not change blood vessels and has a shorter recovery period. Besides, the conditioning required for SD in the cerebellum is not required to elicit SAD. While SD propagates radially outwards from the initiating point, SAD spreads perpendicularly to an activated beam of parallel fibers, which makes its spreading pattern dependent on the cerebellar cortex neuronal architecture.

 

Pharmacologically, AMPA receptor blocking, which has little effect on SD, affects SAD, the opposite occurring with NMDA receptor blocking. SAD depends on extracellular Ca2+, while SD does not depend that strictly.132 SAD has been implicated in the pathophysiology of EA-1, where pathology is related to a Kv1.1 voltage-gated potassium channel abnormality,133 and is not likely to be involved with the cerebellar symptoms in migraine.

Astrocytes respond to glutamate with rapid calcium influx that propagate as waves from one cell to its neighbors.134

 

The so-called calcium waves (CW) constitute a signaling system that allows astrocytes to rapidly activate adjacent astrocytes and neurons, through gap junctions, and extracellular messengers,135,136 modulating synaptic transmission and neuronal activity.137 CWs are also triggered by neuronal activity138 and may be involved in blood flow regulation.

 

CWs have been implicated in cortical spreading depression. They were demonstrated in cell cultures and tissue preparations in different cell populations,139, 140 and precede SD waves in hippocampal cultures.141,142 Although these 2 forms of waves are related, SD does occur in calcium-free incubated hippocampal slices where CWs are abolished, demonstrating that the latter is not an obligatory requirement for the former.142 Since FHM and the related CACNA1A mutations diseases directly involve calcium fluxing, it is tempting to consider that CWs associated with SD might have a pathophysiological role in this context.143 The glutamate release induced by abnormal Cav2.1 channels in migraine could theoretically lead to not only SD, but also CW activation and further vasodilatation, contributing particularly to the phenotype of brain edema and coma following head trauma. The astrocytes’ role in brain water homeostasis regulation144 also supports this possibility.

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STRUCTURAL CHANGES IN THE CEREBELLUM AND MIGRAINE

Few studies have specifically addressed cerebellar structural changes in migraine. Dichgans et al found Magnetic Resonance Spectroscopy (1H-MRS) abnormalities in FHM-1 with reduced N-acetyl-aspartate (NAA), glutamate and elevated myo-inositol (mI) in the cerebellum, compatible with neuronal damage. Increased pH in the cerebrum and cerebellum, which normalized following acetazolamide treatment, as well as high lactate peak in half of the subjects has been reported in EA-2 patients.145 Autopsy studies have shown pathological abnormalities in SCA including mild atrophy of the cerebellar folia, reduced number of Purkinje cells especially in the vermis, swelling of the Purkinje cell axons, decrease in granular cells, reduced number of dendrites in the molecular layers of Purkinje cells, and cerebellar cortical degeneration with reduced thickness of the molecular layer.100, 146 In FHM, cerebellar vermis atrophy and cortical cerebellar degeneration accompanied with Bergman glia proliferation have been described.147

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FINAL REMARKS

Taken together, the data suggest that the cerebellum is implicated not only with FHM, but also with more typical migraine forms such as MWA and MWoA. The ionic and signaling changes present in migraine may affect also the cerebellum potentially leading to cerebellar dysfunction (Fig.). Cerebellar symptomatology, which does not depend on the presence of headache, may be episodic, suggesting an underlying transitory neuropathological change in the cerebellum such as SD; or present as a constant-progressive disorders. In this case, an increase in Ca2+ influx secondary to defective Ca2+ channels expressed by Purkinje cells would favor apoptosis, possibly in a cumulative, slowly progressive pattern. Alternatively, cumulative microvascular ischemia in watershed cerebellar areas secondary to successive migraine attacks could also impair cerebellar function with time in some cases. The pain may be produced by CGRP-containing sensory nerves activated by SD in the anterior circulation (trigeminal fibers) and/or posterior circulation (C2 fibers). Trigeminal fibers may also be partially activated by SD in some parts of the cerebellum as the rostral third of the basilar artery as well as the superior cerebellar artery are innervated by the trigeminal nerve.148,149

fig ft0fig mode=article f1

  Fig

caption a4

The brain and the cerebellum may share common pathophysiological mechanisms leading to different clinical pictures, which combine in diverse ways, largely varying in severity. Hyperexcitability, the pivotal abnormality in migraine, may be due to inherited

Knowledge on the genetic mechanisms leading to dysfunction in ion channels, ion pumps, and transporters has improved our understanding of migraine and related cerebellar disorders, although puzzling questions still remain. It is unclear how a multitude of phenotypes including minor trauma with edema and coma, fever, pleocytosis, hemiplegic migraine, and cerebellar ataxias, is related to a single mutation. The clinical picture in EA, for example, may vary to a great extent, such as from isolated mild ataxia to a constellation of symptoms suggestive of cerebellum, brainstem, and cortex dysfunction.150 This may indicate that phenotypic pleomorphism is a rule rather than an exception in these ailments. If an SD-like phenomenon underlies this group of diseases, it is likely that it may sometimes either not be clinically expressed, or manifest in different forms or degrees.

Cases reported as “basilar migraine,” “footballer’s migraine” or “cerebellar migraine” do not seem to constitute distinct entities. They may actually correspond to mere variations within the migraine channelopaty spectrum. As the molecular mechanisms implicated in migraine, ataxia, coma after minor trauma, and related disorders are better understood, it seems probable that clinical terms will be reviewed, and classifications will be established on a genetic-biochemical basis.

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Acknowledgments

The study was supported by a NIH grant 5PO1 NS 35611-09. MV is indebted to CAPES–Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Ministry of Education, Brazil; and Fulbright, USA, for a visiting professor scholarship. The authors acknowledge Professor Michael Moskowitz for his reviewing of this manuscript. Suggestions and comments by Dr. Alexandre Façanha daSilva and Cristina Granziera are appreciated.

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Abbreviations

   
IHS International Headache Society
MWA migraine with aura
MWoA migraine without aura
SD spreading depression
GABA gamma-aminobutyric acid
SCA spinal cerebellar ataxia
BTM basilar-type migraine
FHM familial hemiplegic migraine
EAAT1 excitatory aminoacid transporter 1
EA episodic ataxia
TGA transient global amnesia
SPECT single photon emission computed tomography
CW calcium waves

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Footnotes

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Conflict of Interest: None

 

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[Neuropathology. 2005]

 

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[J Anat. 1987]

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[Stroke. 1989]

 

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[Ann Neurol. 1997]

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CMAJ September 11, 2007 vol. 177 no. 6 doi: 10.1503/cmaj.070001

  • Practice

 

A case of intermittent ataxia associated with migraine headaches

 

+

Author Affiliations

  • Yong Loo Lin School of Medicine, National University of Singapore, Department of Medicine, National University Hospital, Singapore

The case: A previously healthy 42-year-old woman had presented to our neurology service 1 year earlier with left-sided temporal headaches that she said typically lasted from a few hours to all day. They were associated with nausea but not with vomiting. Beginning at age 13 years, these headaches had occurred at a frequency of once a month to once every 2–3 months.

 

The woman did not experience visual auras, such as scintillation photopsias (flashes of light), migrating scotomata (patches of blurred or absent vision) or fortification spectra (wavy linear “zig-zag” patterns that resemble the battlements of a medieval fort).

 

She had no history of vertigo or seizures. The headaches tended to occur around the time of her menses. She rated the pain at 3 on a scale of 1–10 (10 being most severe), but she noted that on occasion the headaches could be severe enough to wake her from sleep and merit a pain rating of 8 or 9. Clinical examination was unremarkable during each of her visits.

 

Ten years earlier, atypical migraine had been diagnosed and treated symptomatically; no migraine prophylaxis had been given in view of her infrequent and mild headaches. Magnetic resonance imaging scans of the brain were unremarkable. The diagnosis of atypical migraine was not altered at this time.

One year after her initial visit to our neurology service, the patient was admitted to hospital because of unsteadiness of gait, gaze-evoked nystagmus and truncal ataxia (see video of typical episode, available online at www.cmaj.ca/cgi/content/full/177/6/565/DC1). She did not report experiencing headaches at the time. Her condition resolved spontaneously after about 18 hours, and findings on clinical examination were normal. She had no hearing loss or dysarthria and did not display any myokymia about the eyes, lips or fingers. She recalled experiencing similar mild attacks since the age of 25 that involved clumsiness and occasional falls and that lasted from a few hours to a day. These attacks were not associated with diplopia, hearing loss, weakness, choreiform movements, abnormal posturing, fatigable weakness, cognitive deficits, seizures, stiffness or myotonia. The attacks were not related to head position or change of posture. Her migraine headaches occurred both with and without episodes of ataxia. Similarly, ataxic episodes occurred without migraine headaches. An electroencephalogram appeared normal, as were the results of routine blood tests, including blood count, electrolyte levels and serum glucose level. The patient provided a detailed family history, describing intermittent clumsiness in her father and migraine headaches in 2 of 4 siblings.

A provisional diagnosis of episodic ataxia type 2 was made in view of the patient’s history of migraine, episodes of ataxia with normal examination between episodes and a strong family history.1,2 The patient responded to acetazolamide, 250 mg 3 times a day, but experienced relapses of ataxia once or twice a year when she did not take her medication. With amelioration of her ataxic episodes, she became bothered by her migraine headaches, which responded to prophylaxis with amitriptyline and indomethacin for analgesia. Sumatriptan was efficacious for more severe migraine headaches.

 

The patient underwent genetic counselling and testing. None of the known mutations that cause episodic ataxia was detected in exons 23, 26, 28, 29, 32 and 35 of the calcium-channel gene (CACNA1A) on chromosome 19p13, which codes for the main transmembrane component of the neuronal calcium channel.2

Ataxia can be progressive, stable or episodic and can occur with or without headaches (Box 1). Our patient had migraine headaches and episodes of ataxia, with normal clinical findings between attacks. Her ataxic episodes and migraines may have been distinct but coincidental clinical entities or manifestations of a single disease. A discussion of the differential diagnosis of recurrent and relapsing ataxia follows.

 

View larger version:

Box 1.

 

Episodic ataxias are characterized by spontaneous paroxysmal periods of ataxia that typically last from minutes to hours or days. Between episodes, the patient is normal, except for the presence of gaze-dependent or downbeat nystagmus.1,2 Migraine is associated with episodic ataxia in a variety of conditions, such as basilar type migraine; episodic ataxia types 1 and 2; episodic ataxia with paroxysmal choreoathetosis and spasticity; periodic vestibulocerebellar ataxia; and familial hemiplegic migraine.1 The clinical characteristics and distinguishing features of these conditions are summarized in Table 1.

 

View this table:

Table 1.

 

Our patient likely had episodic ataxia type 2 in view of her history of migraine, fairly long ataxic episodes (lasting minutes to hours), good clinical response to acetazolamide therapy and relevant family history. CACNA1A encodes the α-1A subunit of the voltage-dependent P/Q-type calcium channel, mainly expressed in the Purkinje cells of the cerebellum. Calcium channelopathy is thought to lead to alterations in intracellular pH, which alters the transmembrane potential. Acetazolamide is thought to normalize intracellular pH and thus restore Purkinje cell function.5 The patient’s negative genetic screen for episodic ataxia type 2 does not rule out the possibility that she has the condition, since we screened for only 6 of the mutations described to date. It is also possible, of course, that our patient carries a novel mutation in the CACNA1A gene or carries a mutation in some other gene. For example, a family whose members have the phenotype for episodic ataxia type 2 but who carry the genotype for episodic ataxia type 1 has been described.6

We ruled out basilar type migraine3 on the basis of the temporal dissociation between migrainous and ataxic episodes, as well as the patient’s favourable response to acetazolamide. We also excluded episodic ataxia with paroxysmal choreoathetosis and spasticity as well as familial hemiplegic migraine because of the absence of chorea, stiffness and hemiplegia during the headaches.

Channelopathies, such as paroxysmal kinesigenic dyskinesias, can be associated with migraine and can mimic episodic ataxias. Clinical examination during the attack (see online video, available at www.cmaj.ca/cgi/content/full/177/6/565/DC1) confirmed the presence of truncal ataxia rather than dyskinesia.

Migrainous headaches have also been reported to occur incidentally in patients who have ataxia because of other diseases, such as spinocerebellar ataxia type 6, celiac disease, antiphospholipid syndrome, paroxysmal psychosis and seizures. Similarly, they can occur in patients with cerebellar dysfunction or acutely from drugs (e.g., anticonvulsants) or toxins (e.g., alcohol).

Finally, ataxia may be seen intermittently as part of several recessively inherited diseases, such as Hartnup’s disease, pyruvate decarboxylase deficiency, Leigh’s disease and hereditary hyperammonemias. These conditions are usually associated with other signs, such as mental retardation, seizures and pyramidal dysfunction.

Episodic ataxia type 2 is treated with carbonic anhydrase inhibitors, such as acetazolamide, as well as migraine prophylaxis and therapy with analgesics. Magnetic resonance spectroscopy studies have demonstrated an increase in cerebellar pH in affected patients, which returns to normal on consumption of acetazolamide. The disease runs a relatively benign course, although progression to severe persistent cerebellar ataxia has been described in some cases.2 Our patient has remained well 6 years after initiation of therapy.

 

 

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Footnotes

  • See an online video showing an episode of moderately severe truncal ataxia (available at cmaj.ca/cgi/content/full/177/6/565/DC1). The patient did not have a migraine headache during this episode. This article has been peer reviewed.
Acknowledgements: We thank Soh-Eng Chew and Professor Jean-Marc Burgunder for performing the genetic analysis of the CACNA1A gene mutations. 
Competing interests: None declared.

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AbstractFull TextFull Text (PDF)

Executive Resume & Curriculum Vitae

 

 

Executive Resume

Contents

  1. Executive Resume
  2. Visionary Leadership and Strategic Management
  3. Strategic Business Development and Compliance Evaluation
  4. Organizing Win-Win Team of Leadership
  5. Skills, Knowledge & Expertise/SKE
  6. E.   Summary Work Experience
  7. Leadership Expertise at Public and Private Enterprises
  8. Knowledge, attitude and practice
  9. Value based leadership.
  10. Skills and competencies.
  11. Managing all stakeholders’ perspectives.
  12. Executive managerial expertise – executive core qualifications (Ecqs)
  13. Leading Change & transformations
  14. Transformational Change Competencies:
  15. Win-Win Partnership Team Leadership
  16. Strategic Leadership Competencies:
  17. Results & Calendar Driven leadership
  18. Accountability based Leadership Competencies
  19. Win-Win Business Acumen
  20. Comprehensive Compliance Protocol & Competencies
  21. Building Coalitions/Communications
  22. Effective Communication based Leadership Competencies
  23. Leadership in Marketing and Strategic Business Development.
  • Work Experience
  1. Educational/research and achievement awards
  2. management, administration & technical expertise

Sample achievements over the last ten years

  1. Sample selected books, articles, publications, awards & presentations

VII.          Key sample positions held over the past 20 years

VIII.     Selected awards and distinctions

Summary Skills and Competencies

Innovative

Considers and analyzes a broad range of factors, such as policies, Company practices, and trends to make a decision, etc,.

Result-oriented
Meets challenges consistently and confidently with energy and drive.  Motivated by results, urgency and personal

commitment.  Possesses high integrity and exceptional work ethic. Fosters mutual trust and respect.

Efficient

Effective program management and coordination skills, including highly developed time and project management skill.
Ability to work with minimal supervision and be an effective team player.

Engaged
Applies effective communication techniques, engages in focused dialogue, and demonstrates good listening skills
Outstanding oral, written, budgeting, and communication skills with the ability to present to small and large groups

and deal with unexpected questions and challenges while presenting.

 

  1. EXECUTIVE SUMMARY
  2. Visionary GPS based leadership and Strategic Management. Dr Belai Habte-Jesus is a visionary leader and a highly experienced Public Health Physician and Medical Scientist, with expertise in strategic business development, human resource management, competitive marketing, continuous quality assurance, via consistent and sustainable integrity and compliance evaluation of health and human services. He has a shared prosperity based vision and value system of leadership, supported with skilled competencies in GPS/Good Governance, Progressive Prosperity and Sustainable Security for all stakeholders, via organizational accreditation, credentialing and comprehensive compliance protocol development towards the organizational capacity building for consistent and sustainable compliance to professional, District, State, federal and international standards and regulations. His organizational management expertise is supported with qualitative and quantitative competency based continuous in-service training and marketing strategies and evaluation tools towards providing competitive edge in the public and private health and human serves markets. He has initiated, developed, implemented and led a series of public and private health and human service institutions in four continents that stretch from Africa, Asia, Europe and North America.

 

  1. Strategic Business Development and Compliance Evaluation. He has over 35 years of track record of working in private and public multi-disciplinary and multi-cultural enterprises of health and human services, promoting the culture of safety, security, integrity, quality compliance and excellence towards shared success by all stakeholders. He has strategic business development and Compliance evaluation expertise at corporate, human resources and clinical operations towards leading successful for profit and non-profit business enterprises. He has extensive experience and expertise of working among multi-disciplinary and multi-cultural communities with divergent professional, cultural and linguistic heritage that spans the four continents of Africa, Asia, Europe and North America, with a focus in promoting synergy, innovation, quality, integrity, compliance and success in private and public enterprises across the globe and the multi-cultural communities of Metropolitan Washington DC area.

 

  1. Organizing GPS based Win-win Team of leadership. He believes in developing win-win strategic partnerships and developing a strong team approach for GPS/Good Governance, Progressive Prosperity and Sustainable security based shared success and excellence among all stakeholders. He has founded and led Global Strategic Enterprises, Inc, as its founder and CEO since 1993 to present. He has initiated a series of successful health enterprises in North America that span from outpatient, inpatient, home health, palliative and hospice enterprises. He currently works with a series of public and private health and human services organizations as Executive Corporate Compliance Director. He continuous to work as consultant with African Union, and a series of Diplomatic a d Diaspora public and private institutions across the world towards connecting talent, with resources towards sustainable development and free and fair market based business opportunities by promoting individual and collective self help private and public organizations and enterprises, by providing strategic leadership for sustainable developing and investment opportunities for good governance, progressive shared prosperity and sustainable security for all.

 

  1. Skills, Knowledge and Expertise/KAP


  1. 1. Communication & Presentation expertise. Excellent written and verbal communications skills supported with modern ICT and SMN
  2.  Health and human service expertise. Well-developed international (Africa, Asia, Europe & N America) Medical science and public health expertise and experience at primary, secondary and tertiary health and human service institutions.
  3. Institutional capacity building. Win-win Strategic problem solving, and business development, capacity building, Marketing, operations and Performance Evaluations
  4. GPAD/Goal, Progress, Achievement and Dream Oriented Corporate leadership, with strategic work plan, SMART productivity reports and performance monitoring tools
  5. Continuous quality improvement. Calendar based GPAD compliance monitoring with SMART qualitative and quantitate tools of performance evaluations at weekly, monthly, quarterly and annual SMART productivity reports
  6. Talent & Human resource development. Talent recruitment, retention, in-service training and professional development and competency assessment for success
  7. Organizational development-Article of Incorporation, bylaws, License/Certification, Policy and Procedure Development, Board & Professional Advisory Body development
  8. Standards & Compliance Protocol Development. Accreditation and Credentialing with ACHC, CHAP and Joint Commission, public and private insurance organizations.
  9. Business Plan Development. Strategic Organizational Development with Strategic Business Plan: Vision, Goal, Objectives, Budget and Operational Monitoring Tools
  10. Developing Win-Win Synergy. Conflict management by Integration of Multidisciplinary and Multi-Cultural Stakeholders perspective towards common shared value and prosperity.
  11. Health Care Reform from Cradle to Grave. Mother & Child Health, reproductive health, neonatology, pediatric, adult and geriatric care that includes individual and public health rehabilitation, palliative and hospice care.
  12. GPS Strategic visioning. Value, mission, goal development with marketing and competitive edge practice by integrated wellness centered health and human services towards GPS/Good Governance, Progressive Prosperity and Sustainable Security for all.

 

 

  1. Summary Work Experience

 

  1. Corporate Executive Director, Global Strategic Enterprises, Washington DC, 2011, 1993+
  2. Corporate Compliance Director, American Care Partners and Capital Hospice & Palliative Care,2015+
  3. Corporate Compliance Director Dynamic Health Care Services, Annandale, Virginia, 2010+ present
  4. Corporate Director, Strategic Business Development, ASAP Services Washington, DC, 2014+
  5. Corporate Director, Human Touch Inc, Falls Church, Virginia, 22046, 2014+
  6. Director, HIV Primary Care Center, Washington, DC, 20001, 2003-2004
  7. Director, Community of Hope, Non Profit Clinic Consortium, 2002-2004-2000
  8. Director, Community Medical Center, Non Profit Clinic Consortium, Washington, DC, 20001, 2002-2003
  9. Director, Comprehensive Care II, Washington, DC 20011,2000-2002
  10. Director, ECDC Health Care Services, Arlington, Virginia, 1998-2000
  11. Director, East Capitol Center Neighborhood Enterprises, Washington DC 1997-1998
  12. Director, Koba Associates, Inc, Washington, DC 20001, 1996-1997
  13. Director, Basic Partnerships, Academy for Educational Development, 1995-1996
  14. Deputy Director, Early Childhood Development, Department of Public Health, DC Government, 1993-1995
  15. Manager, Health Services Development, North East Thames Regional Health Authority, London, UK, 1988-1993
  16. Manager, Riverside Health Authority, Department of Public Health, 1987-1988
  17. Manager, Kent Council on Addiction, South East Thames Regional Health Authority, Canterbury, UK, 1986-1987
  18. Research and MPH Fellowship, MPH Program, University of Leeds, 1985-1985
  19. Senior Residency, Christian Medical College and Hospital, 1983-85
  20. Medical studies, Christian Medical College and Hospital, Vellore, South India, 1976-1985
  21. Deputy Director, Mennonite Development Board, Bedenno, Ethiopia, 1974-76

 

 

  1. Education and Training
  2. Membership and Fellowship to Professional Associations.
    • Fellow of the Royal Society of Public Health, London, England, UK, July 1986+
    • Fellow of the Royal Society of Tropical Medicine and Hygiene, London, England, United Kingdom; 1986+
    • Member of the American Association of Public Health. Washington, DC, USA. 1993+

 

  1. Education, Residency, Research & Fellowship
    • Primary and Secondary Education. Grades 1- 12; Mennonite Board of Education at Bedenno & Nazareth, Ethiopia; 1960-1972, first in each class every semester.
    • Premedical Education: Academic Scholarship at Haile Sellassie I University, Addis Ababa, Ethiopia and Udaipur University, India, 1973-76
    • Medical Education & Residency: Academic Scholarship with Indian Council for Cultural Relations Fellowship to study Medicine at Christian Medical College & Hospital, Vellore, and South India, 1977-1985
    • Master of Public Health for International Doctors: Academic Scholarship with TEAR Fund Fellowship to study Advance Degree of Public Health for International Medical Doctors University of Leeds, Nuffield Center, 1985-1986.]
    • Fellow of Royal Society of Tropical Medicine & Hygiene, London, UK, Great Britain, England, since July 1986
    • Fellow of the Royal Society of Public Health, London, England, UK, Great Britain, since July 1986
    • Member of American Public Health Association, Washington, DC, USA, since April 1993.

 

 

 

 

 

 

  1. LEADERSHIP EXPERTISE AT PUBLIC AND PRIVATE ENTERPRISES

 

PERSONAL SKILLS & COMPETENCIES
Customer Focused
1. High level of professionalism, and excellent written and interpersonal communications skills to enable interactions with senior leadership of external non-government stakeholders.
2. Understands the need for change and drives Company participation in change efforts.  Flexibility in leading through change, driving through unexpected challenges to deliver on business imperatives.
3. Creates innovative solutions to solve business issues
4.Drives business results by working with all relevant groups and networks effectively across the Company
5.Strong influence skills
Global
1.Ability to collaborate effectively across functions in a complex organization and business environment
Innovative
1.Considers and analyzes a broad range of factors, such as policies, Company practices, and trends to make a decision
Result-oriented
1.Meets challenges consistently and confidently with energy and drive.  Motivated by results, urgency and personal commitment.  Possesses high integrity and exceptional work ethic. Fosters mutual trust and respect.
Efficient
1.Effective program management and coordination skills, including highly developed time and project management skills
2.Ability to work with minimal supervision and be an effective team player
Engaged
1.Applies effective communication techniques, engages in focused dialogue, and demonstrates good listening skills
2.Outstanding oral, written, budgeting, and communication skills with the ability to present to small and large groups and deal with unexpected questions and challenges while presenting.

 

  1. KNOWLEDGE, ATTITUDE AND PRACTICE.

 

  1. Value based leadership. Dr Habte-Jesus has demonstrated knowledge of the federal statutes, regulations and policies governing personnel and human resources management; strategic planning and program performance evaluation; budget preparation, justification, presentation, and execution; contract administration and small purchasing; information technology management; and space and property management. He has a value based and outcome focused leadership style that generates positive win-win results.

 

  1. Skills and competencies. He has well developed inter-personal management skills and competencies in in managing organizational administrative management programs towards capacity building for a sustained and consistent compliance of professional, state, federal and international standards.

 

  1. Managing all stakeholders’ perspectives. He has unique ability to deal effectively with all interest groups and stakeholders including public and private interest groups such as political appointees, congressional and executive staff as well as the ability to foster effective working relationships with all levels of management and staff of other agencies. He has a unique ability to create a shared vision towards solving short, intermediate and long term challenges among competing and at times potential conflicts of interests among diverse professional and multicultural settings.

 

  1. B. Executive managerial expertise – executive core qualifications (ecqs)
  1. Leading Change & Transformations: Dr Habte-Jesus has a unique expertise and core qualification that involves the ability to bring about transformational strategic changes, both within and outside the organization, to meet organizational goals. He has unique ability to respond to inherent executive core qualifications with the ability to establish an organizational vision and to implement a strategic plan in a continuously changing environment, such as health and human services at home, community, emergency room, inpatient and rehabilitation facilities.

 

  1. Transformational Change Competencies: He has well developed organizational transformational change envisioning, development and implementation expertise based in creative visioning, problem solving innovations, perceptive internal and external awareness, working with flexibility, resilience, strategic thinking and vision towards solution based win-win shared prosperity and opportunities for all stakeholders.

 

  1. Win-Win Partnership based Team Leadership : He has well-developed ability to lead people in winning teams, toward meeting the organization’s shared vision, mission, and goals. He has inherent ability move potentially contending teams towards win-win partnerships by creating shared vision, mission and goal towards win-win Executive Core Qualifications with the ability to provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts. He has served at Board, Professional Development Bodies and Senior Management Team for a series of private and public health and human services in Africa, Asia, Europe and North America.

 

  1. Strategic Leadership Competencies: Strategic Conflict Management, Leveraging Diversity, Perspectives, Developing Others, and Team Building. He has led a series of Multicultural and Multi-disciplinary Diaspora and host country institutions in Asia, Europe, and North America, that included working with Mennonite Mission Development Board, UNHCR, Red Cross, UK Regional Health Authorities, George Washington University School of Public Health, DC Government Department of Health, Catholic Charities, Lutheran Social Services, ECDC, AED, Human Touch, Comprehensive Care II, Life Starts @ Neighborhood Enterprises, Non Profit Clinic Consortia, Community of Hope, HIV-AIDS Primary Health Centers, Capitol View, ASAP Corporation, Palisade Health Partners, American Care Partners, Capital Hospice Care, etc.

 

  1. Results & Calendar Driven leadership: Dr Habte-Jesus has the ability to meet organizational goals and customer expectations. He has a unique ability to make decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks. He has a well developed result oriented and calendar based SMART work plan with qualitative and quantitative evaluation tools reported at weekly, monthly and quarterly intervals.

 

  1. Accountability based Leadership Competencies: He has well developed leadership competencies supported by accountability, customer service, decisiveness, entrepreneurship, problem solving and technical credibility supported by track record of successful experience in the public and private enterprises in Africa, Asia, Europe, North America in the Metropolitan Washington DC area. He has a well developed Performance Evaluation Protocol that utilize qualitative and quantitative tools that include satisfaction surveys, group and individual interviews and minimum data set based productivity reports respectively

 

  1. Win-Win Business Acumen: He has worked in public and private enterprises that include for profit and non-profit entities with well developed business acumen and ability to manage human, financial, material, and information resources strategically at short, intermediate and long term setting.

 

  1. Comprehensive Compliance Protocol & Competencies: As corporate Director of a series of health and human services organizations over the past 20 years or so, he has developed comprehensive set of leadership competencies that includes accreditation, credentialing, certifications, comprehensive compliance protocol, business development, marketing, financial management, technology management and human Capital Management with SMART, Specific, Measurable, Appropriate, Realistic and Time Sensitive Work Plans supported with qualitative and quantitative performance evaluation tools.

 

  1. Building Coalitions/ Responsive Communications: Dr Habte-Jesus has a unique ability to build coalitions among multidisciplinary and multi-cultural communities with unique talent to build coalitions internally and with multiple public and private sector enterprises and community groups. He has well developed compliance management competencies with Federal agencies, State and local governments, nonprofit and private sector organization, foreign governments, or international organizations to achieve common goals.

 

  1. Effective Communication based Leadership Competencies: Dr Habte-Jesus has a well developed interpersonal communication skills towards win-win outcome by using effective communication skills towards influencing/negotiating among all stake holders with well developed oral communication, partnering, and political Savvy communication that attracts a common shared value and vision.

 

  1. Leadership in Marketing and Strategic Business Development. Dr Habte-Jesus has extensive strategic leadership

experience at board, executive and operational level in organizational restructuring, goal setting with SMART Work Pan (that is supported with Specific, Measurable, Appropriate, Realistic, Time Sensitive tools towards strategic budget based resource and proposal development for success. He has well developed competencies risk assessment, option appraisal, root cause analysis and in SMART Work Plan development and   implementation with well developed contract negotiations skills for private and public enterprises. He has led a series of public and private enterprises with well developed strategic management expertise, with highly skilled risk assessment competency, supported marketing and business development communication skills towards developing of win-win relationships between public and private institutions towards a shared desired goal and outcome oriented achievement of success in service and business opportunities. He has well developed CAT/Complete, Accurate and Timely communication and management skills that seeks desirable outcomes towards a measure of success via option appraisals tools of best option, win-win option and compromise options within time, space and person variables across public and private enterprises.

 

  1. Quality Leadership in Public Health & Human Services Enterprises. Dr Belai Habte-Jesus is a Public Health Physician, Public Health Scientist, Strategic Management Consultant and leader in Multi-Disciplinary and Multi-Cultural Empowerment Enterprises, with over 35 years of experience in health and human services in Africa, Asia, Europe and North America. He has established and led several public and private multi-professional and multi-cultural health and human service enterprises that promote quality, integrity, diversity and excellence towards shared success.

 

  1. Multi-disciplinary and Multicultural Empowerment leadership. He has well developed expertise of working with multi-disciplinary professionals and multicultural communities from around the globe, focusing on youth, women and the elderly towards productive integration and empowerment in their newly adopted homes of Africa, Asia, Europe and the United States, towards shared success and excellence.  He has effective leadership communication competency across disciplines, and cross-cultural stakeholders with a calendar based goal oriented and outcome focused leadership for win-win opportunities of success. His organizational management and re-organization competencies have allowed public and private enterprises to be flexible, responsive to the changing market forces and business competency standards. He has well developed management tools integrating the work of with organizations of diverse set of competencies in the Bio-Medical, integrated web based MIS/Management information System, Financial, Marketing professionals so as to respond to the changing needs of their respective stakeholders.

 

  1. Expertise in scientific and business management tools. He utilizes scientific evidence based management of research pyramid tools of root cause analysis of challenges, opportunities, risks and threats towards option appraisals using Needs, Demands and Supply Interaction model of prioritization of resources towards win-win shared success based on safety, security, integrity, quality compliance and excellence with calendar based SMART Strategic Work Plan that is Specific, Measurable, Appropriate, Realistic and Time Sensitive tools.

 

G.Good governance led organizational leadership.  He has well-developed organizational leadership skills and has worked at board, professional advisory committee, executive and operational level with several public and private enterprises using the principles of Good Governance, transparency, accountability and responsiveness to the changing interests of all stakeholders, supported with over 20 years of organizational leadership experience in the Metropolitan Washington DC area.

 

  1. Membership and Fellowship to Professional Associations.
  2. Fellow of the Royal Society of Public Health, London, England, UK, July 1986+
  3. Fellow of the Royal Society of Tropical Medicine and Hygiene, London, England, United Kingdom; 1986+
  4. Member of the American Association of Public Health. Washington, DC, USA. 1993+

 

  1. Education, Residency, Research & Fellowship

 

  1. Primary and Secondary Education. Grades 1- 12; Mennonite Board of Education at Bedenno & Nazareth, Ethiopia; 1960-1972, first in each class every semester.
  1. Premedical Education: Academic Scholarship at Haile Sellassie I University, Addis Ababa, Ethiopia and Udaipur University, India, 1973-76
  2. Medical Education & Residency: Academic Scholarship with Indian Council for Cultural Relations Fellowship to study Medicine at Christian Medical College & Hospital, Vellore, and South India, 1977-1985
  3. Master of Public Health for International Doctors: Academic Scholarship with TEAR Fund Fellowship to study Advance Degree of Public Health for International Medical Doctors University of Leeds, Nuffield Center, 1985-1986.

 

  1. Leadership at Health Services Development Management. After successfully completing his Master of Public Health Degree for senior international medical doctors at the Nuffield Center of the University of Leeds, Dr Habte-Jesus participated in the British NHS Health care reform as a point person at the North East/South East and South West Thames Regional Health Authorities, London England for the reform of National Centers of Excellence and higher specialty medical institutions towards providing accessible, affordable and accountable health care to primary health care needs of the British National Health Service System. He published and edited a series of professional guideline documents for health service reform for each specialty at the National Centers of Excellence ranging from neurosciences (neurology and neurosurgery) Ophthalmology, Otolaryngology, special senses, eye, ear, throat, dental, cardio-thoracic, renal, orthopedics and perinatal and obstetrics and gynecology specialties and general practice or primary care services between 1987-1993.

 

  1. US Health Care Reform. He was invited by First Lady Hillary Clinton to participate and contribute to the US Strategic health care reform discussions and submitted a policy paper entitled “ Cradle to Grave” a Universal Health Care Reform for the USA, an idea whose time has come! To the national health care reform strategic team led by Ms. Hilary Clinton, in April 1993 which is a forerunner to the current ACA (Obama Care), Accountable Care Act while working as a adjunct lecturer at the George Washington University Hospital Master of Public Health Program Development of the Mother and Child Health, MPH Program concentration.

 

  1. Deputy Director at DC Department of Health. He subsequently led the DC effort in the critical health care reform to empower special needs children, with the 0-3, 0-8, 0-11 Early Intervention Program, etc., under the leadership and guidance of Dr Mohammad Ahktar, the Director of Health during Mayor Sharon Pratt Kelly Administration. He worked to improve the Early Intervention Programs that participated in the development of “the Primary Health Home Construct” for each US family, a research project with support from the American Academy of Pediatrics, NIH and also with the DC wide trauma prevention program supported by grant from the National CDC Trauma Prevention and Control program.

 

  1. LEADERSHIP IN PRIVATE HEALTH ENTERPRISES.

Dr Habte-Jesus held a series of key leadership positions that ranged from Board Chairmanship, Executive and operational leadership in several private non-profit and for profit health and human services enterprises in the Metropolitan Washington DC area between 1993- to present that included:

 

  1. Leadership at Non Profit Enterprises.       Director for a series of DC Non Profit clinics that included: leadership at the Outreach program of National Immunization Program at the Academy for Educational Development, developing a strategic health services for a national immigration program at ECDC Health Services, as well as other Health centers at a series of National Refugee Resettlement Centers such as Catholic and Lutheran Church Charities, and with DC Non Profit Clinic Consortia as Director at Community of Hope Health Services, Community Medical Center, Carl-Vogel Primary HIV Care Center, where he worked at Board, Executive, Senior Management and Professional Advisory Committee membership, and leadership positions including Grant reviewing panel for a series of Non Profit Clinics and primary care centers across the Metropolitan Washington DC Area.

 

  1. Leadership at For Profit Private Enterprises. He served as corporate director to a series of for profit clinics and health care agencies that included providing comprehensive care for people with Disabilities at Comprehensive Care II, At-risk Youth Empowerment program at Life Starts program of Neighborhood Enterprises, HIV Primary Care Clinics, and as corporate Director ad Chairperson of Professional Advisory Committees for a series of home health and home hospice agencies located in the states of California, Colorado, Pennsylvania, Virginia and Metropolitan Washington DC area. He was involved in developing home health agencies from the ground as well as acquiring existing ones by developing valuation protocol, contracts, risk assessments tools, policy and procedures, quality assurance protocol, with qualitative and quantitative performance evaluation tools, supported by eHealth enabled and integrated MIS system, and SMART Strategic Calendar Based Productivity reports at daily, weekly, monthly and quarterly interval.

 

 

 

 

  1. Board Chair and Corporate Director. Mobile Health Services such as Home Health and Home Hospice Agencies

 

  1. Expertise in corporate leadership. Dr Habte-Jesus currently serves as Board Member and Corporate Director of a series of health and human services organizations in the Metropolitan Washington DC area and provides leadership council and strategic management consultancy on accreditation, credentialing, human resources recruitment and retention, competency assessment, performance evaluation towards eHealth enabled and integrated Management Information System that promotes the culture of safety, integrity, quality, compliance and excellence towards consistent and sustainable compliance to the changing role of health care reform, CMS conditions of participation and requirements of Accountability Care Act.

 

  1. Quality Assurance led organizational leadership.       Dr Habte-Jesus is involved in developing a series of Quality Assurance Protocols that promotes the culture of integrity and compliance towards a consistent and sustainable compliance to professional, state, and federal regulations, credentialing and accreditation requirements that empowers patients, for profit and non profit institutions in health and human services. He has well developed expertise and experience as a consultant in Deemed status CMS Certifications with the major accreditation institutions such as Joint Commission, CHAP and ACHC, etc.

 

  1. Promoting Female led leadership and ownership of enterprises. He has worked with establishing a series of successful minority owned women enterprises in the Metropolitan Washington, DC. As a direct commitment of his earlier clinical and public health career and MPH research work on “Global Evaluation of Child Health and Perinatal Morbidity and Mortality studies in the mid 1980s”, Dr Habte-Jesus has committed his work and life to the promotion of female education, empowerment and leadership as a tool for multicultural community empowerment and sustainable community development. Dr. Habte-Jesus believes that female education and empowerment is critical for individual and collective community empowerment and as such continues to be involved in multicultural community empowerment activities that promotes female education, leadership and ownership of enterprises that promote sustainable development of several for profit and non-profit multi-cultural organizations and enterprises. He believes passionately in the famous human capital development motto that states, “ If you educate a man, you educate one person, if you educate a female or a woman, you educate a family, a community and society in general.”

 

 

 

 

 

 

 

 

 

 

 

III. OVERVIEW OF EXPERIENCE

 

3.1 Strategic leadership for win-win synergistic partnerships for success. CEO and President of Global Strategic Enterprises, Inc., April 1993 to present- Providing Strategic management consulting to public and private enterprises.

Dr. Habte-Jesus currently works as Strategic management consultant, Chairperson of Governing Board, Professional Advisory Committees of a series of public and private health and human services with Global Strategic Enterprises Inc, Group. He is a public health physician, scientist and strategic management consultant and Fellow of the Royal Society of Public Health and Royal Society of Hygiene & Public Health. He has a well developed and proven leadership skills in strategic business development, health and human services, and community empowerment enterprises, built on strategic visioning, effective communication, efficient implementation strategies and strong team-building efforts to realize a win-win synergistic partnership for success. He has extensive experience in accreditation, credentialing and compliance monitoring and organizational evaluation of health care organizations for effective compliance with defined measure of success towards desired goals and objectives. His vision is building a world of private and public enterprises driven by (IT) 3 -innovation, integrity, investment, and supported by talent, technology, and transparent trade towards sustainable security, diversity and progressive prosperity.

 

3.2 Public Health & Strategic Management Consulting. Dr. Habte-Jesus is a public health physician and Strategic Management Consultant with technical expertise in risk assessment, emergency planning, strategic management, with well developed experience in leadership development, multi-cultural empowerment, health and human services, business development, resource generation, health information systems, and providing insights in community relations and business marketing. He has developed and led a series of successful public, private, non-profit and for profit health and human service organizations with inbuilt appropriate credentialing, accreditations and performance measure of success. He promotes the culture of protecting safety and security, preventing disease, disability and injuries at emotional, psychological, physical and ecological level; and promotes excellence and compliance to stakeholder’s expectation of success. He continues to serve as Board Member, chair of professional Advisory Committees and serves as Corporate Director of a series of health and human services agencies with honor, distinction, integrity and the promotion of diversity in prosperity!

 

3.3 Leadership at Strategic Management Enterprises. He promotes the strategic principle of eliminating threats to integrity, reducing risks of non-compliance and promoting excellence by converting challenges in opportunities for success and prosperity. He utilizes Research Pyramid Tools of Root Cause Analysis that ask the fundamental questions of what, who, when, where, why and how towards CORT Analysis of challenges, opportunities, risks and threats within a framework of the Needs, Demands, Supply Interaction Model of Option Appraisal Decision Science that looks at immediate, short and long term strategies of Best Option, Win-win Option and Compromise Option supported by SMART Work Plan that is Specific, Measurable, Appropriate, Realistic and Time Sensitive with Calendar based SMART Implementation and Productivity report at daily, weekly, monthly and quarterly monitoring of success with qualitative and quantitative tools of perception of care that satisfaction surveys and data based productivity towards a specific measure of success at >90% compliance.

 

3.4 Diversity empowerment based enterprises. He believes in serving others in diversity, as the source of our Divinity -that is biodiversity, socio-economic diversity and ecological diversity as the basis of quality, integrity, and prosperity. He has extensive experience in diversity based Strategic Management Enterprises towards multicultural community empowerment, leadership of strategic management enterprises, business development, continuous quality improvement, promotion of a balanced and pre-emptive public health strategies that promotes a diverse set of balanced physical and psychological clinical and epidemiological prevention and early intervention based medicine, health and human services, supported by interactive eHealth enabled, web based and integrated health information systems. He has specialized expertise in human resources management, recruitment and retention, talent deployment, clinical and epidemiological operations, risk assessment, business planning, budget forecasting, tracking and controlling costs, expertise in international health and global health and medicine with specialty in preventing, managing and controlling disease, disability and injuries with a focus in chronic conditions, infectious diseases, research; program development, planning, implementation and evaluations.  

 

3.5 Leadership at Multicultural Community empowerment. He has well developed expertise in multicultural community empowerment in health and human services as well as the development and promotion of small businesses and non-profit organizations that empower community leadership. He has competent written and spoken communication skills with extensive experience in results/performance oriented management, qualitative and quantitative research, business development and management, with excellent interpersonal and organizational skills supported with expertise in organizational leadership, clinical and epidemiological research, strategic marketing, fund raising, health promotion, teaching and multicultural multimedia hosting & comprehensive health promotion radio and television programming and broadcasting experience.

 

3.6 Practical leadership and training experience. He has proven track record of leadership supported by

Highly developed organizational and interpersonal skills and training expertise in the area of good governance, win-win synergistic partnerships, health and human services with policy and program development, epidemiology, evaluation and participatory strategic planning and management expertise in health, education, human resources, youth development, mental health, mental retardation, and tropical medicine and infectious diseases, home health hospice services as well as public health prevention services.

 

3.7 Excellent track record of organizational leadership. He is visionary, highly driven, detail and results oriented, self-motivated, team player and highly inspired organizational leader with competencies to solve problems in the short and long term.   He believes in developing win-win synergistic partnership among multicultural communities via business enterprises. He has worked as executive officer, director and senior manager with several health and human service institutions in Africa, Asia, Europe and here in North America. His summary experience and additional areas of expertise include:

  1. Visionary and strategic leadership and participatory management, empowering civil societies and multicultural communities.
  2. Good governance and globalization and empowering civil societies. Resource development and management
  • Health Sector Reform and Research: Private, Public and HMO, Managed Care, home health and hospice care.
  1. Strategic Planning, evaluation and sustainable development, policy development and evaluation, extensive qualitative and quantitative analysis, epidemiological research and publication, epidemiology, women’s health, youth development, pediatrics, mother and child health, public speaking, coaching and publications.
  2. Global Health Promotion and prevention and management of Tropical Medicine & Hygiene and Infectious Diseases Management & Control
  3. Reproductive health, STI/HIV/PTSD and   Child development, health, population and nutrition, prevention and early intervention programs, i.e. TB, Malaria, HIV/STD, etc.
  • Quality assurance, (CQI) evaluation and managing change, Good Practice and Policy and Procedures, Business Plans and Strategies
  • Managing Change, Behavioral research, multicultural holistic and integrated health enterprises
  1. Behavioral Science, Mother and Child Health, mental health and mental retardation services, Regional Minority Health, HIV/AIDS Services, etc.
  2. Managing a LifeStarts at community empowerment zones at East Capitol Center for Change
  3. Resource Generation Expertise. Grant Reviewer/Evaluator, Business plan, contract negotiation, strategic multimedia communication, teaching and multicultural community empowerment radio broadcasting, conference planning/chairing and dissemination of evidence based information.

 

  • Leadership and management expertise. His visionary leadership skill is based on character, integrity, commitment, compassion, with win-win synergistic partnership and team building expertise.   He has excellent interpersonal and communication skills with qualitative and quantitative research, health information systems, clinical evaluation, continuous quality improvement and quality assurance expertise, teaching, policy and business development, program management, marketing, strategic planning, visioning, and negotiation skills.

 

  • Multi-Media Computer/Internet based Communications. Highly developed written and spoken communication skills with competency in Epidemiological Health Information Systems as well as Microsoft Vista Ultimate Office 2011, 2007, 2003, 2000, Power Point, Excel, Corel WordPerfect 9 Suite, Epi-Info, Mednotes, Medisoft, VisiTrack, HomeSolutions, CDC Wonder, SAS, SPSSX, Harvard Graphics, Apple based computers and soft wares such as OSX Mountain Lion and OSX Maverick within MacPro, IMac, MacBook Pro, I pad and IPhones systems, Multi-media Internet based ICT and SMN communication and contract development and negotiation skills.

 

  • Broadcasting & Multi-Media Expertise. Excellent skills in vision, voice and data presentation using television, radio and print media: program development, marketing and production and broadcasting. He is fluent in English, Amharic, and Oromifa languages with working knowledge of French, Arabic, Hindi and Tigrinya. He has hosted a weekly radio program with www.wust.com, Voice of the Patriots/Hagr Fikr Broadcast for over 15 years without break.

 

  1. EDUCATIONAL/RESEARCH AND ACHIEVEMENT AWARDS

 

4.1 Academic Merit Scholarship: Master of Public Health. Master of Public health for medical doctors (1986); International Merit Scholarship with special commendation for research, University of Leeds, School of Public Health, United Kingdom, Great Britain. Concentration in epidemiology, health services research, management sciences population, and nutrition, mother and child health with a focus on international medicine and infectious diseases.

 

4.2 Academic Merit Scholarship: Medical Doctor. (1983) General medicine training with specialty in general medicine, general surgery, public health and child development and survival, Christian Medical College and Hospital, Vellore, South India, University of Madras.

 

4.3 Awards: Distinction for Dissertation. Evaluation of Mother and Child Health Services in Developing and Developed Countries with a Retrospective Infant and Perinatal Morbidity and Mortality Studies.” September 1986.

 

4.4 Academic Awards: The Bausch & Lomb Honorary Science Award– for the Best Outgoing Student, for standing first in each class each semester- Grades 9-12, The Bible Academy High School, Nazareth, Ethiopia, May 1972

 

4.5 Service Achievement Awards: Certificate of Distinguished Achievement, LifeStarts @ East Capitol Center for Change, and a Neighborhood Enterprises Program in Washington, DC, USA. Sep 2003.

 

4.6 Service Achievement Awards: Bitwoded of the Imperial Solomonic Crown Without Borders, for Serving Afghan, Iranians, Ethiopians and Africans in the Diaspora at UNHCR, New Delhi, London & The Ethiopian Refugee Helpline, London, England. May 2000.

 

4.7 Service Achievement Award. Founding Chair and Board Member of the African/Ethiopian/Amhara Development Association in North America.

 

4.8 Grand Cross with Collar and Title; “The Lord Belai Habte Jesus”, The Real Ordem Dom Caros I de Portugal for Human Rights Protection, Cross Cultural and International Relations Work of Distinction, London, England, UK 2001.

 

4.9 Certificate of Achievement and Appreciation, Human Touch Inc. January 2010.

 

4.10.Ambassador for Peace, Universal Peace Federation, Seoul, South Korea, February 2006

 

 

 

 

 

 

 

 

 

 

 

  1. MANAGEMENT, ADMINISTRATION & TECHNICAL EXPERTISE

 

Sample achievements over the last ten years

 

5.1. Corporate Director, Continuous Quality Improvement Audit and Strategic Business Development,

     Human Touch, Inc, 100 113 Park Avenue, Suite 300, Falls Church, Virginia, 22046; T: 703.531.05340,

               P: 703.531.0540;www.humantouchhealth.com, a Group of Health and Human Services Agencies, 2000+

 

Areas of Core Competencies.

  1. Strategic Business development. Dr Habte-Jesus has a well developed a prevention and early intervention based national and local health care reform implementation expertise where he has set up a series of for profit and non profit enterprises and organizations from the ground. He has also led a series of successful acquisition, transfer of ownership and leadership, re-organization of several for profit and non profit public and private enterprises that incudes primary health care centers, public health enterprises and home health and home hospice agencies by developing and presenting a strategic work plan that includes Comprehensive Due Diligence and Risk Assessment protocol, with Best Business Practice Guidelines and Checklist and processes to acquire business licenses, Bylaws, Article of Incorporations, policies and procedures, applications and presentations of Certificate of Need, Survey readiness and post survey plan of corrections for Accreditation and CMS Certification with private and public insurance credentialing and contract negotiations to improve and expand businesses.

 

  1. Human Resources/Talent development, recruitment and deployment. Dr Habte-Jesus has a well-developed human resource and talent management expertise where he continues to nurture, develop and recruit professional human resource teams for successful deployment in their preferred areas of expertise. He has a successful talent development and management expertise that includes recruitment, retention, orientation, competency assessment, in-service training, professional development and performance evaluation and deployment to appropriate professional settings.

 

  1. Technology assisted integrated Management Information System & Communication System. Dr Habte-Jesus has a well developed expertise in modern computer and technology assisted communication that includes use of integrated web based MIS/Management Information Systems, towards calendar and evidence based productivity reports supported with the expertise in the utilization of epidemiological data bases such as Epi Info, SAS, SPPSX, Harvard Graphics, homesolutions.net, Visitrack, Microsoft Office, Word, Excel, Power Point, Windows and Apple based systems such as IMac, MacBook Pro, I pad, IPhone and associated ICT and MSN utilities.

 

1.1 Responsibilities. Chair professional Advisory Committee and Governing Board towards SMART Work Plan and Corporate compliance of the organization. Lead the development and expansion of Home Health Care, Home Hospice and Wellness and Rehabilitation Center in the Metropolitan Washington DC area. Lead in the need and risk assessment research, development of quality improvement protocol and strategic business development for the expansion and productivity of staff by developing management training and supervision of staff in establishing the centers. Provide leadership in Continuous Quality Improvement protocol and compliance with the Joint Commission on the Accreditation of Health Care Organizations protocol as well as federal and state standards by developing qualitative and quantitative tools for measuring performance and results.

 

 

 

1.2 Achievements. Developed a series of thriving Home Health Care agencies and prepared the necessary certification and accreditation documents with appropriate staff recruitment, training and performance management tools and quality assurance protocol. Reorganized and centralized the marketing, intake and billing process of the different organizations under one roof and developed strategies for expansion   Organized Infection Control Policy and Procedure and trained skilled professionals on how to deal with infections such as MRSA (Methicillin Resistant Staphylococcus Aureus) infections in the home care setting. Accessing health information systems such as Med soft, Visitrack and Scan health (HomeSolutions.net) soft wares for managing patient information.

  1. 2 Clinical Program Director, Carl Vogel Center, 1012, 14th Street, NW, Suite 700, Washington, DC 20005; Ph: 202 638 0750 ext 18, Fax: 202 638.0749; E-mail: rogramdirector@carlvogelcenter.org

 

5.2.1. Responsibilities. Lead and manage a team of medical doctors, psychologist, mental health specialist, HIV Specialists, medical nutritional therapists, mental health specialists, case managers an marketing/outreach workers. Develop key result areas, set up primary medical HIV clinic, certificate of need, Medicaid/Medicare eligibility, Clinical policies and procedures, HIV work plan, Continuous Quality Improvement, Medical Record System (Med Soft and Mednotes), integrated and comprehensive system of care, clinical personnel issues, manage and chair weekly Clinical Management Team Meetings and Multi-Disciplinary Case Conferences, medical billing system and HIPPA compliance.

 

5.2.2. Achievement. Organized and set up a functioning HIV Primary Medial Care System with appropriate secondary and tertiary referral systems. Developed and submitted Certificate of Need for Primary Medical Care Developed a business proposal for HRSA Capacity Building Grant, developed organizational network for improved governance for board development, MIS and financial accounting system that synchronizes with clinical care protocol, medical records, billing and continuous quality improvement protocol for Primary HIV Care (Prevention, Early Intervention, Therapy and Rehabilitation,

 

5.3. Director, Comprehensive Care II, Inc.   October 2003+ @ 337 Delafield Place, NW, Washington, DC 20011, Voice: 202 291 2586; Fax: 202 291 3104; e-mail; GlobalBJesus777@gmail.com

   5.3.1. Responsibilities. Direct a team of over 40 professionals including doctors, psychologists, nurses, social workers, case managers, and qualified mental health professionals, residential counselors to provide an individualized care plan that includes habilitation and behavior support plan (ISP, BSP) for over 30 consumers of wide range of age groups and behavioral challenges with a mix of disabilities from mild to profound cognitive and mental disabilities, and residing in 6 homes in Washington DC.

 

5.3.2. Accomplishments. Undertook a comprehensive needs assessment and SWOT analysis that looks at the strength, weakness, and opportunities and threats both at internal and external environments. Developed an extensive five years Human Care Agreement for Residential and Respite Services with appropriate budget and negotiated with the Government of the District of Columbia, DHS/Mental Retardation/Developmental Disabilities Administration. Directed a team of professionals to ensure a highly organized services that allowed the re-certification of six group homes with appropriate compliment of health and human services for ICFMR facilities. Prepared regular monthly training with an up-to-date training manual to professionals on a holistic approach in improving the safety and well being of consumers with mental health and mental retardation challenges.

 

 

 

 

 

5.4 Director of Strategic Development & Quality   Assurance -Human Touch, Inc. May 2002   4600 King Street, Suite 4R, Alexandria, VA, 22302, Voice: 703 379 2526; Fax: 703 379 5010.

 

5.4.1. Responsibilities. Responsible for strategic marketing, business development and organization of the marketing and business development of a health and human services agency providing home health care services to vulnerable communities who cannot access primary and secondary care services due to physical limitations.   Initiated and developed free standing home health care, home hospice and wellness and rehabilitation outpatient centers in the Metropolitan Washington DC area.

 

54.2. Achievements. Undertook a comprehensive needs assessment and proposal development towards improving the internal and external market share of the agency towards establishing a strong presence in the Northern Virginia and Washington DC area. Developed successful proposals and presentations for a Certificate of Need Application for Home Health Care, Home Hospice Care and Capitol Wellness and Rehabilitation Centers in the Metropolitan Washington DC area. and made several contacts that yielded profitable contracts with health providers, insurance agencies such as Aetna, Care First, Blue Cross Blue Shield, MAMSI, Options, National Capital Health Care and other agencies.

 

 

  1. SAMPLE SELECTED BOOKS, ARTICLES, PUBLICATIONS,

AWARDS & PRESENTATIONS

 

  1. Habte-Jesus, Belai et.al: Evaluation of Mother and Child Health Services in Developing and Developed Countries- Evaluating the Global Burden of Childhood Morbidity and Mortality with Perinatal Mortality Studies on work done between 1977-1986, University of Leeds, United Kingdom, Great Britain. September 1986.

 

  1. Habte-Jesus, Belai, et.al: North East Thames Regional Health Authority: Good Practice Policy Guidelines for higher Specialties (Neurology and Neurosciences, Cardiology and Cardio-thoracic Services, East Nose and Throat, Ophthalmology, Oral and Dental Services, Renal Services, Accident and Emergency, Pediatrics and Genetic Services, etc. (Work done between 1988-1993). London, England, United Kingdom, Great Britain.

 

  1. Habte-Jesus, Belai, et al, (Clapp & Mayne, Inc.) Interactive Communication Diary—A flexible health information system to assist patient-provider communication with appropriate data sets for institutional, patient – physician health information communication system. A Proposal for NIH Funded Innovative Small Business Research Grant. June 1997.

 

  1. Habte-Jesus, Belai: Presenter at the National Council for International Health 24th Annual Conference: The impact of HIV on future work force- Building Strategic Alliances, Washington, DC. July 1997.

 

  1. Habte-Jesus, Belai: Presenter “Education for Empowerment in the 21st Century Development” at African Institute for Education and Development Inc, July 1996

 

  1. Habte-Jesus, Belai: Letter of Advocacy to Bill Clinton, President of the United States regarding US Africa Policy: Re: Pre-empting the Impending Rwanda Genocide: July 1997.

 

  1. Habte-Jesus, Belai: Protocols for Evaluating HIV/AIDS Prevention Programs in Washington 
DC May 1996.

 

  1. Habte-Jesus, Belai, et.al. Initiating Roll Back Malaria, Lessons learned from USAID Malaria Prevention and Control Program, Academy for Educational Development and USAID, Africa Bureau, March 1997.
  2. Habte-Jesus, Belai: Innovative Community AIDS Education for African American Men and

Women with a focus on the special needs of women, July 1997.

 

  1. Habte-Jesus, Belai et al, Health Needs Assessment of African-Born Residents in the Washington, DC, Metropolitan Area, ECDC, August 1999.

 

  1. Habte-Jesus, et al: Healthy Tomorrows Partnership for Children, A collaboration Program of the DC Linkage and Tracking System, Office of Maternal and Child Health Systems Development Initiative and the American Academy of Pediatrics: Accessing a “Primary Health Care Home through Case Management, May 1994.

 

  1. Habte-Jesus, et al, Parenting Education as a foundation for prevention and early intervention of future PVO Child Survival Program, December 1996.

 

  1. Habte-Jesus, Belai, et al. Cradle to Grave Health Care Reform n the USA: An idea whose time has come. The White House Health Care Reform Task Force, April 1993

 

  1. Habte-Jesus, Belai. A holistic approach in improving the safety and well being of consumers with mental health and mental retardation challenges, September 2004

 

  1. Habte-Jesus, et al, Capacity Building Initiative for HIV Primary Care Services with a focus on Infrastructure development via improved Governance, MIS/Financial System and Continuous Quality Improvement System, April 2005.

 

  1. Habte-Jesus, Belai, “Empowering civil societies series” – Shifting Paradigm of Global Good Governance, the changing role of stakeholders and advocates, Diaspora Dialogue IV, George Washington University Law School, May 2005- Chaired the conference as well as prepared key note address.

 

  1. Habte-Jesus, Belai, et. al; Organizing Global Partnership for Peace, Democracy and Prosperity by Empowering Civil Societies Across the Globe to combat poverty and global terrorism. July 2005

 

  1. Habte-Jesus, Belai, et al. Multicultural community empowerment via Multi-Media Broadcast Network. Weekly Empowerment Radio Broadcasts; on 1390 AM: Immune wise living series addressing prevention and early intervention based cradle to grave optimal health issues from spiritual, emotional, psychological and physical health perspective, Began in 1996 and ongoing. Host of “Voice of the Patriots”, focusing on the synergy of Education, Ecology and Economy for win-win cross cultural partnerships- Millennial Renaissance Network of Voice of the Patriots (Hager-Fikir) Global Connect Multi-Cultural Communications, Inc.

 

  1. Habte-Jesus, Belai, Institutional Challenges of Good Governance, Globalization and Millennium Development Goals in 21st Century Transitional Economies, the experience of the Horn and Ethiopia. Ethiopia: Beyond the Current Crisis Symposium at Washington Times Building, Wednesday, 14 December 2005: 15:00-18:00 Hrs organized by Voice of the Patriots, Voice of Reason, United Press International, Ambassadors for Peace Program& World Media Association.

 

  1. Habte-Jesus, Belai, et al, Unique lessons in developing modern primary care centers in the Metropolitan Washington, DC area. January 2000.

 

  1. Habte-Jesus, Belai, et al, Lessons from establishing modern home health services and accreditation with Joint Commission on Health Organizations. September 2004
  2. Habte-Jesus, Belai, et al, Lessons of developing modern home hospice services in the Metropolitan Washington DC area. March 2005

 

  1. Habte-Jesus, Belai, et al, The unique experience of developing a modern primary health care center and outpatient rehabilitation facility in the Metropolitan Washington, DC area. December 2006.

 

  1. Habte-Jesus, et al, African Diaspora Engagement for sustainable development and investment opportunities, a synthesis report of AUM Consultancies for African Union Mission in Washington, DC, USA.       05 April 2012. The role of Diaspora in investing on African’s 2050 Year vision of Renaissance, African Union Plan.

 

  1. Habte-Jesus, Belai et al, Developing a Diaspora Community Investment Bank, Washington, DC 2013

 

  1. Habte-Jesus, Belai, et al, Acquisition Certificate of Need for a home health agency in the Metropolitan Washington DC in line with DC, federal and Affordable Care Act requirements. 13 June 2014.

 

  1. Habte-Jesus, Belai, et al, Successful presentation and award of Acquisition Transfer Certificate of Need for Palisade HealthCare Partners, Inc acquisition of ASAP Services Corporation, at State Health Planning Division of Department of Health, Washington, DC, 30 July 2014.

 

  1. Habte-Jesus, Belai, et. al. Successful Joint Commission Deemed Status Accreditation of American Care Partners, Inc. Deemed CMS Certification after a survey conducted 14-17 July 2015 with plan of Corrections

 

  1. Habte-Jesus, Belai, et.al. Successful Certification of Capital Hospice Care, A Virginia Palliative and Hospice Care Services

 

  1. Habte-Jesus, Belai, et.al. Development of Global African Legacy Initiative towards integrating community, health and cultural institutions across the world.

 

  1. Habte-Jesus, Belai et.al, Integrated Palliative & Hospice Program Certificate of Need for District of Columbia

 

  1. Habte-Jesus, Belai, et.al. Integrated Palliative Home Health Program, Certificate of Need for District of Columbia.

 

 

VII. KEY SAMPLE POSITIONS HELD OVER THE PAST 20 YEARS

 

  1. CEO & President, Global Strategic Enterprises, Inc. 1993+
  2. Corporate Director- Strategic Business Development & Continuous Quality Improvement- Human Touch, 2005+
  3. Director -Community of Hope Health Services & Community Medical Care Health Services, 2000+
  4. Director of Community Health Center- Non Profit Clinic Consortium, http://www.npcclinics.org, 1999
    1. Director of Health Services @ Ethiopian Community Development Council, 1999 – 2000
    2. Consultant trainer at Lutheran Social Services of the National Capital Area, 1998 – 1999
    3. Consultant USAID-Africa Bureau and Academy for Educational Development, 1997 – 1998
  5. Senior Public Health Advisor, Clap & Mayne, Inc. 1997 – 1998
  6. Executive Director of Professional Network Group, 1511 K Street, NW, Suite 949; 1995 – 1997
  7. Consultant with Basics Partnership for Child Survival Health Inc. 1996 – 1997
  8. Administrator of Family and Maternal Enhancement of Koba Associates, Inc, 1994 – 1995
  9. Assistant Director, At-risk Children (0-8) -DC Commission of Public Health, 1993 – 1994
  10. Lecturer -Master of Public Health Program, George Washington University Hospital, DC, 1993 – 1995
  11. CEO, Global Research and Development Enterprises, Washington, DC, 1993+
  12. Manager, Health Services Development, NE Thames Regional Health Authority, UK, 1989 -1993
  13. Lecturer & Public health manager, St. Mary’s Hospital, SW Thames Regional Health Authority 1988/89
  14. Coordinator, Kent Council on Addiction, South East Thames Regional Health Authority, 1987/88
  15. Senior Fellow and Residence at the William Harvey Hospital, Ashford, Kent, England, 1986/87
  16. Research Fellow at Master of Public Health Program, University of Leeds, UK, 1985 -1986
  17. Senior Resident at St Joseph Hospital New Delhi and Christian Medical College, Vellore. 1984 -1985
  18. Medical Education and Residency Program, Christian Medical College, Vellore. 1977 -19 84
  19. Premedical education and national development campaign, Haile Selassie I University. 1973 – 1977

 

VIII. SELECTED AWARDS AND DISTINCTIONS

 

  1. Best outgoing student at Bedenno Elementary School (First in each class in each grade (1-8), 1964 – 72
  2. Haile Selassie I Gold Medal for Distinction in Ethiopian School Leaving Certificates-1972
  3. The Bausch & Lomb Science Award for the Best Outgoing Student of Class of 72

                 (First in each class in each Semester for grades 9-12.) 1968-1972

  1. Merit Scholarship to undertake Pre-Medical Studies at Haile Selassie I University-1973-1976
  1. Merit Scholarship to study medicine, the Indian Council for Cultural Relations- 1976-1985
  2. Merit Scholarship- Advanced Degree of Public Health for Medical Doctors, University of Leeds, 1986
  3. Fellow of Royal Society of Tropical Medicine and Hygiene, 1986
  4. Fellow of the Royal Society of Public Health, London, England, 1986
  5. Highest Commendations for MPH thesis: Evaluating Global Mother and Child Health Services, 1986 with retrospective perinatal morbidity and mortality studies.
  6. Founder and CEO of Global Strategic Enterprises, Inc, 1993+
  7. Grand Cross of St Mary of Zion Order- Imperial Order of Solomonic Crown without Borders, 2001
  8. Grand Cross Lion of Judah Order. Imperial Order of Solomonic Crown Without Border s, 2000+
  9. Grand cross of the Imperial Order of Menelik, Order of Solomonic Crown Without Borders, 2000+
  10. Chancellor of Imperial Solomonic Enterprises& Bitwoded of the Imperial Solomonic Crown Without Borders 2000+
  11. Gra Cruz Com Collar. Grand Cross with Collar, Real Ordem de Portugal, Dom Carlos I de Portugal, 2001
  12. Board Member, Immigration and Refugee Services of America, Mental Health Initiatives, 1999
    1. Board Member, DC Care Consortium of Providers serving HIV/AIDS populations, 2000+
    2. Board Member, Community Medical Care- Non Profit Clinic, DC, 2000
    3. Advisory Board Member, Ethiopian American Constituency Foundation, 2005
    4. Ambassador for Peace, Universal Peace Federation, Oct 2005
  13. Producer and Broadcaster and Host of “Voice of the Patriots” A Global Multicultural Broadcasting Corporation, Since 2000+
  14. Host of “African Horizon” Ethiopian Broadcasting Service Television Network, 2007+
  15. Board Member and Chair of Professional Advisory Committees for a Series of Home Health Agencies in the Metropolitan Washington, DC area. Since 2000+
  16. Advisory Board Member of National Association for Home Care & Home Hospice Medical Equipment, 2007
  17. Board Member and Chair of Professional Advisory Committees for Minerva Home HealthCare

 

Global Connect 4 Global Enterprises

Vision Africa 2063- Diaspora Engagement for Sustainable Development and Investment Opportunities-Belai Habte-Jesus, MD, MPH, FRSPH

 

African Union Mission, Washington, D.C., USA.

 

AUM Synthesis Report, From Prior African Union Mission Consultancies

 

 

Belai Habte-jesus, MD, MPH, FRSPH 

 

 

Diaspora Engagement

Synthesis Consultancy Report

 

Belai Habte-Jesus, MD, MPH

Global Strategic Enterprises, Inc

 

January 2012

 

 

 

The Contributors to the AUM Consultancies

 

  1. Development of Policy Briefs: Azeb Tadesse
  2. Communication and Media Strategy:             Julia Wilson
  3. AGOA Report: David Shifferaw
  4. Latin America (3 countries):             Alison Moses
  5. Latin America (4 countries):             Gilberto Amaya
  6. Knowledge and Data Management: Mr. James Kwarteng

 

 African Diaspora Map until 1873

by

the late Professor Joseph E Harris of Howard University

 

 

Engaging the African Diaspora

                                                                                                                                                                                   

  1. Introduction……………………………………………………….                         05
  1. Terms of Reference and Policy Framework…………………………….                   08

 

  • Abstract: Motivation, Purpose, Approach, Results, Conclusion 11            
  1. Executive Summary………    ………………………………..                            15
  1. Evaluating the AUM Consultancies: Introduction………………………………………………………                        20
  2.         The African Diaspora in the US; Partners for African Education Sector Development………                                                                                     24
  • Service Delivery and Health Care: Role of Diaspora and Information & Communication Technology 28
  • Brain Drain and Capacity Building in Africa ………………………………………………………………………………               34                                                                                                                                                                                                                              
  1. Understanding the African Diaspora in the USA………………………………………………………………………                 38
  2. The African Diaspora Health Initiative/ADHI……………………………………………………………………..  49
  3. Evaluating AGOA and AUM Trip Reports……………………………………………………………………………   60

XII.             Evaluation of African Growth and Opportunity Act……………     88

XII.            The Synthesis SMART Work Plan and How it was designed 135

  1. The Larger Picture: Global African Diaspora- future research………………. 144
  1. Introduction

1.1 Integration of prior consultancies. This synthesis report integrates a series of prior consultancies undertaken by the African Union Mission in Washington DC, and provides a unique insight into diaspora engagement policy development activities aimed at the sustainable development and investment opportunities available within Member States of the African Union .

1.2 Project focus. The project focus is to provide the African Union Representational Mission with a framework for assessing research-based information; strengths, weaknesses, opportunities, limitations and threats of the various consultations carried out. The Synthesis report is designed to facilitate the development of a coherent strategy for engaging the diaspora.

1.3 Objectives. The African Union Representational Mission seeks to utilize the Synthesis report for analyzing and formulating policies; and to improve the coordination of policies affecting diaspora communities towards Africa’s socio-economic development.

1.4 Expected Output. A policy framework document that integrates input from all consultations carried out into a single insightful report.

1.5 Scope of Work. The scope of work includes reviewing prior consultations that address diaspora issues and will comprise analyzing, integrating and consolidating the content of consultancy reports into a coherent report. .

1.6 Insightful connection of prior consultations. The previous consultations executed include evaluation of the African Growth and Opportunity Act, Latin-America study tour, , mobilization of the African Diaspora in the Americas, data and Knowledge management, development of policy briefs, development and training of African Union Representational Mission staff and volunteer corps on communication and media strategy. This Synthesis report connects themes and ideas as a means of providing meaningful insights and perspectives.

1.7 The Report: The report development process involved review of all consultancy reports and the development of a scientific methodology for analyzing; organizing and integrating information gleaned from past project documents into a single document that provides new insight, information and perspective towards formulating SMART policies and strategies .

1.8 The Approach: The synthesis integration process involved reviewing the best practice in the business of writing such reports, and adopting the most relevant methodology, to match the specific needs of these rather dynamic series of topics covered under the prior consultancy reports. The Synthesis report is not a summary but an insightful integration of the consultancy reports to provide new knowledge and perspective within the terms of reference of AU Mission. The Diaspora Engagement process is expected to utilize a creative win-win partnership approach that responds to the changing needs and expectations of the respective stakeholders within the Diaspora and AU countries communities.

 

1.9 Context of the Synthesis Report. The synthesis exercise is a process of integrating and making insightful connections between different work, reports and consultancies. It is an integration of a series of reports that address diverse topics relevant to the Diaspora and AU Countries such as recent visits to Diaspora communities in the Americas, evaluation of AGOA reports, African Diaspora Health Initiatives, policy recommendations on Diaspora engagement, use of modern multi-media communications tools such as audio-visual, digital, cyber and print based ICT (Information, Communication Technology) and SMN (Social Media Network) means to engage the Diaspora communities and AU countries.

 

1.13 Increasing Diaspora investment in Africa. The Diaspora Africans continue to make a significant contribution to Africa. Besides several institutional development and investment activities, the Diaspora are known to provide about 40 Billion worth of remittances annually to their respective AU communities.  These series of current family support investments need to be strategic and sustainable with possibilities of creating maximum returns to all stakeholders. Therefore, this Diaspora Engagement Consultancy is not working in a vacuum but in an already established process and needs to enhance what is working and give insightful connections and provide new tools for improvement in areas where there is need significant change of direction.
1.12   Enhancing family support systems. One of the most visible and significant contributions to home countries by the diaspora has been the support they provide to their families, relatives, and communities. This support has been in the form of remittances, whose combined total is approaching the $40 billion range. Remittances now make up a significant percentage of GDP in most African countries; Guinea Bissau 48.7%, Eritrea 37%, Cape Verde 34.2%, Burundi 22.8%, Algeria 4.7%, Morocco 11.2%, Ghana 6.6%, and Ethiopia 4.4%. These remittances can be formalized through standardized financial institutions, which encourage the utilization of modem economic investment tools that provide a wider benefit to all stakeholders.

1.14 New perspective of Brain circulations and resource generation. The theme of the synthesis report is promoting Diaspora engagement process for mutually beneficial sustainable development and Investment opportunities that matches the changing global realities. The report examines the changing constituency environment and the role of the Diaspora among their respective host and home communities, and explores both “push’ and “pull” factors from the perspective of new research in the impact of “brain-drain”, “brain-gain” and “brain-circulation” within the context of galvanizing resources, knowledge, technology and investment opportunities. Continuous engagement demands continuous inter-active multi-media communications for improving resource generation and knowledge based technology transfer.

1.15. Integrating with AU and UN perspectives. The Diaspora engagement is considered a unique tool for promoting sustainable development and investment opportunities for AU countries, within the larger MDG (Millennium Development Goals) and Comprehensive Trade and Investment opportunities framework, to access pubic/private institutions and connection with community enterprises. The Synthesis report explores the process of promoting interactive win-win Diaspora engagement partnerships for African development & investment opportunities! There is a need to integrate public and private sector strategies by assimilating the best of each approach to enhance the changing technological and management knowledge and practice.

The report is organized in a format that highlights, terms of reference, the abstract, executive summary analysis, discussions, recommendations and conclusions.

 

  1. Terms of Reference and Policy Framework
  2. Vision & Mission

African Union is a unique Pan African continental body, which is charged with spearheading Africa’s rapid integration and sustainable development.

1.2 The Goal

Strategic partnerships. The goal of the African Union Representational Mission in Washington D.C. is to forge strategic partnerships with the United States government, for profit and nonprofit developmental organizations, and the African Diaspora towards the political, social and economic development of Sub-Sahara Africa. The AUM strives at fulfilling the aspirations of an integrated, prosperous and peaceful Africa, driven by its citizens and representing a dynamic force in the international arena.

1.3 The mandate

Promoting institutional relationships. The mandate of the African Union Representational Mission to the United States is to develop, maintain, and consolidate constructive and productive institutional relationships between the African Union and the government of the United States of America, the Bretton Woods Institutions, non-governmental and academic organizations engaged in Africa issues and policy, and Africans in the Diaspora.

1.4 How the Mission performs its tasks.

Promoting Cooperation & partnerships. It performs these tasks by promoting unity, solidarity, cohesion and cooperation among the peoples of Africa and developing new partnerships worldwide. The Mission’s Headquarters is located in Addis Ababa, capital city of Ethiopia.

1.5 Enactment of effective policies.

Promoting Africa’s development. A critical component of promoting Africa’s development is the enactment of effective policies. Synthesizing inputs from the Consultations into policy briefs will spur the Mission’s decision-making process.

Objectives

Framework for information management. The Synthesis report provides a SMART Framework that is specific, measurable, and appropriate, realistic, and time sensitive framework for managing Diaspora Engagement Information, comprising of the attributes (strengths, weaknesses, or challenges and opportunities and etc.) that will facilitate the policy formulation, analysis and implementation process.

1.6 Approach

The Diaspora Engagement Management Information System uses the standard scientific qualitative and quantitative analysis methodologies, and evidence based approach to explore stakeholder’s perspectives, that include individual and focus group perceptions supported by data collected via interviews, surveys, discussions and analysis of written reports. These factors provide insightful connections with the vision and mission of African Union and it’s stakeholders.

  1. Communication, Media and Information Dissemination Policy framework

The Diaspora Engagement policy framework utilizes a logical structure that is established to organize policy documentation and communication materials into groupings and categories that makes it easier for stakeholders to find and understand the contents of various development and investment opportunity policy, contractual and service documents.   Kindly stick to the objectives specified in the original communication , media and information management consultancy.

2.1 Principles of policy framework. The following 11 principles of policy framework are considered useful tool for utilization of Diaspora Engagement communication resources that improves information ownership, stewardship, quality, integrity, collection, analysis, reporting and dissemination.

The Diaspora Engagement Policy Frame work need to follow the principles of good governance that promotes transparency and accountability that are measured by the process of information collection, storage, processing, availability, coverage, reporting, pricing/budgeting, distribution, copyright, and preservation.


2.2.Availability of information.
Information on Diaspora engagement in sustainable development and investment opportunities of AU countries, should be made available easily, widely and equitably to all stakeholders via modern multi-media based ICT(Information, Communication and Technology ) and MSN (Social Media Network) tools of audio-visual, digital, cyber and print communication outlets.
2.3. Coverage. Diaspora engagement information need to be increasingly available on Multi-Media Communication platforms via print, digital and electronic basis to all constituents and stakeholders.   These include: all published material or material already in the public domain; all policies that could be released publicly; and all information created or collected on a statutory basis (subject to commercial sensitivity and privacy considerations); all documents that the public may be required to complete; corporate documentation in which the public would be interested.


2.4. Collection, Distribution and dissemination.
The Diaspora engagement and other AUM activities should utilize the latest information gathering mechanisms that utilize ICT (Information Communication Technology) and SMN (Social Media Network) based audio-visual, print, electronic and digital tools that include computers, data bases, sound and visual information recording systems, cameras, and radio and TV broadcasting equipment that is appropriate to collect, process, distribute and disseminate to all stakeholders.

Pricing/budgeting. There should be appropriate budgeting to cover the cost of developing, analyzing and distributing and dissemination of Diaspora engagement related information. Free dissemination of AU-held information is appropriate where:

  1. Dissemination to a target audience is desirable for a public policy purpose; or a charge to recover the cost of dissemination is not feasible or cost-effective
  2. Budgeting and Pricing to recover the cost of dissemination is appropriate where there is no particular public policy reason to disseminate the information; and a charge to recover the cost of dissemination is both feasible and cost effective.
  3. Budgeting and Pricing to recover the cost of transformation is appropriate where pricing to recover the cost of dissemination is appropriate; and there is an avoidable cost involved in transforming the information from the form in which it is held into a form preferred by the recipient, where it is feasible and cost-effective to recover in addition to the cost of dissemination.
  4. Budgeting and Pricing to recover the full costs of information production and dissemination is appropriate where the information is created for the commercial purpose of sale at a profit; and to do so would not breach the other pricing principles.

2.5. Ownership. All Diaspora Engagement related AU-held information, created or collected by any person employed or engaged by the AU is a strategic resource ‘owned’ by the AU as a steward on behalf of the public.
2.6. Stewardship. AU departments and Diaspora Stakeholder institutions are stewards of AU-held Diaspora Engagement information, and it is their responsibility to implement good information management.


2.7. Collection.
AU departments involved in Diaspora Engagement should only collect information for specified Diaspora Engagement related public policy, sustainable development, investment opportunities and operational business or legislative purposes.
2.8.Copyright. Information created by departments is subject to AU copyright but where wide dissemination is desirable, the AU should permit use of its copyrights subject to acknowledgement of source.
2.9. Preservation. AU-held Diaspora engagement information should be preserved only where a public business need, legislative or policy requirement, or a historical or archival reason, exists.
2.10. Quality. The key qualities underpinning AU-held Diaspora engagement information include accuracy, relevancy, timeliness, consistency and collection without bias so that the information supports the purposes for which it is collected.
2.11. Integrity. The integrity of AU held information will be achieved when all guarantees and conditions surrounding the information are met; the principles are clear and communicated, any situation relating to AU -held Diaspora engagement information is handled openly and consistently; those affected by changes to AU-held information are consulted on those changes; those charged as independent guardians of the public interest (e.g. the Ombudsman) have confidence in the ability of AU departments to manage the information well; and there are minimum exceptions to the principles.

2.12 Research & development. The future of any enterprises is determined by its ability to conduct research and development for improvement. As such the policy framework should facilitate and encourage research and development opportunities by making information and resources available for academic and operational research institutions. Such collaborative work should be encouraged to be part and parcel of the Diaspora Engagement Programs, so that the process becomes dynamic and changes to the changing needs and opportunities in the future.

                                                                                                    

III. Abstract

(Motivation, Purpose, approach, results, conclusions)

3.1 The motivation. The driving force and motivation for galvanizing the Diaspora connections and engagement is creating win-win partnerships towards Africa’s sustainable development and investment opportunities.

3.2 Perspectives from Regional Bodies. The UN declaration of 2011, as the Year of People of African Descent, is a special milestone and focus, that galvanizes a unique connection of African Diaspora communities, considered the sixth regional AU constituency, and their respective communities across the world; towards the on going sustainable development and investment opportunities in AU countries. The AUM motivation to galvanize the Diaspora connections and engagement towards Africa’s sustainable development and investment opportunities is an idea whose time has come!

3.3 Galvanizing Diaspora Connections. The Synthesis report is designed to assist in the policy statement of intent or commitment towards the formulation of subjective and objective decision-making processes comprising Diaspora engagement.

3.4 Purpose: Sustainable linkages of AU countries with Global African Diaspora communities

The main purpose of this synthesis report is to make insightful connections between prior AUM consultations, that address the critical qualitative and quantitative research, on how best to link Global African Diaspora and their respective public and private institutions, with the sustainable development activities of AU countries, by increasing and integrating the number of potential investors and stakeholders in the continent.

3.5 The target: AUM Global and American Audiences

The key audiences for AUM communication and media strategy include Africans and Africans in the global Diaspora; international organizations and companies that target Africa for trade/business; mainstream and specialty media; US State Department and other US government departments; the Bretton Woods Institutions- World Bank, IMF, UN; other embassies in Washington, D.C.; Global African Diaspora professional and cultural communities.

3.6 Approach & solution: Insightful win-win connections

This synthesis report provides the African Union Mission with insightful connections and integration of prior consultancies, within a framework for assessing information; strengths, weaknesses, opportunities, limitations of the various consultations carried out to facilitate coordination of policies that impact Africa’s sustainable development. Previous consultations include evaluation of the African Growth and Opportunity Act, Latin-America study tour, Knowledge sharing/study tours, The Africa Diaspora Health Initiative (ADHI), mobilization of the African Diaspora in the America’s, Data and Knowledge management, development of policy briefs, development and training of African Union Representational Mission staff and volunteer corps on communication and media strategy.

3.7 The tool: Qualitative and Quantitative Methodologies supported by ICT and SMN

Institutional and enterprise engagement. Engaging the African Diaspora and their respective constituent host communities, via qualitative and quantitative research methodologies, supported by modern ICT (Information Communication Technologies) and SMN (Social Media Network) tools is considered a viable process for linking public and private institutions to the sustainable development activities, such as MDGs; and diverse investment opportunities of the African Union countries. The Diaspora engagement process is expected to be based on developing win-win partnerships, which promote the individual and collective interests and competencies as well as enterprises of the respective communities and stakeholders.

3.8 Key Strategy. The key strategy is to proactively engage African Diaspora and their respective public and private institutions and enterprises, as win-win partners towards investing in the cultural, trade, tourism, infrastructure development and business enterprises opportunities of AU countries. The focus is to promote a series of short and long term strategies for sustainable development and investment opportunities of AU countries via SMART Work Plan that is Specific, Measurable, Appropriate, Realistic and Time Sensitive. Modern multi-media communication tools such as print, audio, visual, digital, and cyber ICT & SMN are considered important mechanisms for effective interactive communication, dialogue, research and presentations and information dissemination with individual and collective stakeholders across time and space. Each strategy needs to be evaluated with qualitative and quantitative tools that promote compliance with the expectations of key stakeholders, with viable evaluation methodologies and circulations of results towards interactive and responsive agenda development that address the changing needs and challenges of future generations. The Diaspora Engagement processes need to be transparent, accountable as well as proactive and competitive with the emerging global challenges and opportunities.

3.9 Result: Converting challenges into Opportunities via proactive participation

Promote proactive participation. The collective information from the consultancy research indicates that, there is a great need for the proactive participation of all stakeholders for an effective engagement of the Diaspora and their respective communities. The proactive engagement process should include a series of wide and in-depth consultations with all stakeholders, via their respective embassies, community and professional associations, etc. The AU countries need to quantify the different development and investment opportunities at their disposal and make them available in a way that is easily accessible by the Diaspora communities. Additionally, they need to develop a data base of the Diaspora communities and their respective interests and potential. The experiences of the various consultancy reports such as the AGOA projects and the AUM field trip reports that explored the current status of African Diaspora populations in the Americas, clearly indicate that Africans and people of African descent have a great opportunity to proactively explore on how best to engage public and private institutions in line with their respective interests and aspirations.  The promotion of modern research and communication tools, such as ICT and SMN are considered a viable tool for effective interactive communication across demographic and professional landscape between the Diaspora and AU countries. It is expected that the outcome of such win-win interaction, can create the impetus and intellectual backdrop for future integrated and insightful connection of all stakeholders.

 

3.10 Understanding the past to charter a better future.                                                                                             

Promoting knowledge based future. It is critical to know and remember the past, and understand the current experiences of people of African descent, to charter a better future for the next and subsequent generations. The memory and perspectives of past the 500 years of African interactions with the international communities, has been by and large, dominated by diaspora slavery, and continental Africa colonialism, except the unique experiences of Ethiopian and Liberian communities in the eastern and western geographic landscape of Africa. Ethiopians sustained its independence from time immemorial, while Liberians returned from exile and slavery and created a new independent state in the west coast of Africa. These are diverse and interesting perspectives of free African societies. These unfair and dishonorable past relationships have produced a unique perspective for ensuring the need to sustain desirable engagement processes that propel the current African generation to appreciate their rightful place in the globalized world.

3.11 Changing African Diaspora. The more recent experience of the new African Diaspora, especially of the past 50 years or so, is changing the old paradigm of slavery/colonialism towards sustainable development and investment opportunities in their respective communities. However, there is active awareness of the continuous challenges of the more recent series of man made and natural disasters, and civil wars that has created a large number of internally and externally displaced people in Africa, and subsequent social, economic and ecological crisis that is forcing younger and unprepared youths to migrate into unfriendly Asian and European territories that needs a collaborative approach to protect these rather vulnerable modern migrating communities. As such, human capital development within the focus and objective galvanizing resources that addresses current and future opportunities is critical to be responsive to the changing needs of AU countries and the Diaspora communities and their respective wider global communities.

 

 

3.12 Opportunities: Interactive engagement for Development and investment

Insightful connections. The key factors that connect the Diaspora and AU countries are the cultural, historical shared interests and heritage towards desired win-win partnerships for sustainable development and investment opportunities. The central themes of each of the AUM consultancy reports are focused towards developing shared values and interests, that are promoted with business enterprises, comprehensive trade and investment opportunities between AU countries and Diaspora Africans and their respective communities; that promote individual and collective enterprises.   This synthesis report provides insightful connections of the critical issues raised in the consultancy reports, focusing on how best to engage the Diaspora, and their respective communities, with AU Countries’ development activities. As the UN Millennium Development Goals for each AU countries and Diaspora communities could be an ideal focus of engagement for sustainable development and investment activities, comprehensive trade and investment opportunities within the global trade agreements that promote good governance, transparency and accountability are considered unique opportunities for public and private sector areas of interactive engagement.

3.13 Replacing past distrust with verifiable engagement process. The consistent theme of all the consultancy reports is that, the overriding challenges of Diaspora Africans and AU counties is that the African stakeholders have not been consulted widely nor negotiated appropriately in their interactions both with the current AGOA projects, and past colonial expeditions into Africa, and the forced slavery migrations out of Africa, and the more recent forced migrations of their vulnerable youths and professionals. The past Diaspora slavery and Continental colonialism experiences did not allow people of African descent to be compensated appropriately for their skills, labors and creativity. The legacy of these exploitative institutions has created the current isolation, marginalization and psychological distress of the African populations across the world.

3.14 Connecting Diaspora and AU countries. Connecting the Diaspora and AU countries to the dyamic globalized world with beneficial and sustainable development and investment opportunity activities can change the past paradigm of isolation, discrimination and disconnection. Current literature is rampant with statistical analysis of the scale of historical and current marginalization of people of African Descent with no option appraisal of what is the best approach to solve them. As such, it is critical to change the perceptions of distrust and potential abuse, which has paralyzed the creativity, innovations and entrepreneurship of the African communities for over five centuries in the Diaspora. However, the more recent mixed and at times positive experiences of modern African Diaspora in North America, especially for the past five decades, can be useful in changing the old paradigms of distrust, that was experienced during past centuries of slavery and colonialism, and the current alarming experiences of African Diaspora in the Middle East and European countries, by replacing it the with new perspective of potentially verifiable trust, for creative business opportunities. A proactive, inclusive, confidence building exercise, and deliberate engagement process of all stakeholders is key for positive engagement of the Global African Diaspora and those in the Americas in particular.

  1. Recommendations & Conclusions

4.1 Win-win engagement.   The effective utilization of modern information communication technologies such as public and private communication channels that include: radio, video, print, online and conferencing avenues, as well the more recent Information Communication Technology & Social Media Networks can be an excellent tool for meaningful and inclusive engagement of all stakeholders. The detailed review of AUM field trips, that explored past Diaspora history, and current global developments, indicate that Continental Africans and Africa Diaspora communities are not proactively and competitively engaged in the process of chartering their future, by participating proactively with all relevant stakeholders in the current global market.

4.2 Integrating with global economies. Modern Africans living and working in the AU countries, and those in the Diaspora, need to integrate with the global technologically advanced economies to access their fair share of the global market. The future green energy technology, and integrating global economy demands to have access to the rich and diverse African natural resources and cultural heritage respectively. The UN declaration of 2011 as the year of people of African descent and AU declaration of the African Diaspora as the sixth constituency have created a new momentum for a series of Diaspora Engagement initiatives.   To harness all these goodwill and well intentioned initiatives, it is critical to appreciate that all future Diaspora and African engagements need to be deliberative, participatory and inclusive from beginning to end, by encouraging opportunities for win-win engagement from conception, design, implementation and evaluation of all AU Countries citizens and African Diaspora and their respective communities for sustainable development and investment activities.

 

 

  1. Executive Summary

 

(Purpose, problem, solution, project overview, approach, recommendation and conclusion)

 

4.1 Introduction

The Executive Summary is designed to summarize the Synthesis Report, by providing an overall definition of purpose, problem identification, solution, project overview, suggested approach, recommendations and conclusions.

4.2 The Purpose: Insightful connections for Diaspora Engagement in investment & development

Activities.

The purpose of this report is to integrate prior AUM consultancies that explore proactive means of engaging African Diaspora and the international communities, with investment opportunities and sustainable development activities of AU countries. The research and evaluation of this synthesis report is in line with the recent African Union declaration that the African Diaspora communities scattered around the world, constitute the Sixth African Union Regional Constituency, and are encouraged to participate actively in the sustainable development activities of AU countries. Most recently the 2010 UN declaration of making “2011 as the Year of People of African Descent” and their eventual full integration in the global socio-economic activities with full participation and engagement gives special meaning and urgency for the policy implication of this report.

4.3 The Problem: Qualitative and Quantitative Research to identify challenges

 

4.3.1 Qualitative and Quantitative methodologies. The prior consultation reports, that are the basis of this synthesis project, have utilized an integrated set of qualitative and quantitative research methodologies in identifying challenges and opportunities, that included individual and focus group interviews, perception/impression surveys and extensive literature reviews supported by the use of highly competent professionals who have first hand active knowledge of the diverse Diaspora communities in the Americas. Past problems of disconnection, isolation, discrimination and negative socio-economic indices aggravated by continued conflicts and poor problem solving skills and competencies with serious long term adverse effects have been identified as critical challenges in both the Diaspora and AU countries. The desire to connect and create positive changes are witnessed among several Diaspora communities as well as inter-governmental activities that promote investment, trade and cultural exchange activities that promote enterprises and good will among the different diverse set of communities. The AGOA Evaluation Report and African Diaspora Health Initiatives provide unique insights from inter-governmental and professional perspectives as to how best to link and connect AU countries with Diaspora and their respective host communities.

4.4 integrates this rather interesting and diverse set of AUM consultancies, that included field trips to Latin American countries with evaluation of an existing US-Africa trade policy referred to as AGOA, which is one of the most creative US-Africa trade policies, that is put in place of a “Comprehensive Free Trade & Investment Agreement” between the US and African countries.   The US government’s African Growth and Opportunity Act is designed to encourage African Countries to promote Free Market Economy.   AGOA seems to follow other US policies that promote, free trade policies among closed communities such as the “most favored nation” status or special trade partnerships promoted by the US – China relationships in the 1980s. The report integrates the main research and evaluation findings of the AUM consultancies into one short document without losing details and focus of the five reports.

4.5 Project overview: Connecting common themes of linkages between Africa and the Diaspora

4.5.1 On going living connections. In depth review of prior consultations show an on going living connection of people of African descent for over 500 years across Africa and the Americas that is sustained to present day. The initial connections were made via an Arab and European led forceful kidnapping or the Slave Trade of African citizens, while the immigrations of the past 50 years or so are willful migrations, by Africans seeking better lives, or running away from conflicts, and civil war in the continent. The AGOA evaluation report indicates that regardless of its mission to encourage African Countries to move towards free market, good governance, global trade, and investment opportunities; the results of the past 11 years have focused on oil and gas export mainly from Nigeria and Angola, leaving behind some 50 states products and infrastructure development. By comparison, the ADHI (African Diaspora Health Initiative) has focused on a participatory process towards achieving maternal and child health, which is part of the focus of the Millennium Development Goals. The linkages project supported by ICT and Social Media Network tools will connect both with individual and collective entities that represent public-private institutions, and enterprises of people of African descent all over the world with a focus in the Americas.

4.6 Approach: Converting challenges into opportunities

4.6.1 Promoting negotiated agreements/contracts. The initial African interactions with the international communities such as the forceful migrations of the Diaspora, and colonialism of the continent were not negotiated freely towards win-win outcome of all stakeholders. As such, both the Diaspora and continental Africans, did not fair well in their international contacts in the past. The core issue was lack of fair, legally binding contract negotiations and mechanism of its implementation, which allowed fair compensations for goods, services, resources, skills, labor, products, and over all contributions of people of African descent. In effect, past transactions were allowed to abuse the interests of Africans be it at home in the continent, or abroad in the Diaspora. The current global market pricing system does not demand appropriate value for the products, skills and resources of of people of African descent. As a result, today, the overall human development indices, and infrastructure development activities, and overall prospect of people of African descent all over the world, are not found to be competitive in the current global market. Progress with the Millennium Development Goals, current global trade agreements, as well as the 11 years experience with Africa Growth and Opportunity Acts (AGOA), all indicate that the overall individual and collective potential of people of African descent needs a structured development and investment strategy in the immediate, short and long term, so as to charter a better future in the post 2007 global financial crisis and subsequent world economic order dominated by a series of austerity measures across the world.

4.7 Promoting structured investment opportunities. The recommendation towards a structured investment and development strategy, which addresses the individual and collective interests and potential of African Union countries and Diaspora populations, and over all people of African descent in the intermediate and long term, is the focus of this report. Focusing in infrastructure development that promotes activities towards knowledge based society using modern ICT and Social Media Network is considered an important tool for accessing sustainable development and investment opportunities.

4.8 Present status: Progress with MDG and Free Market Economy

 

4.8.1 Progress with MDGs by 2015. The common thread of all prior AUM consultancy reports indicate that there is a pressing need to change this paradigm of exploitation, isolation, discrimination and disenfranchisement of people of African descent once for all. The Latin America visit reports clearly show that people of African descent that settled across the Atlantic and Pacific Coasts have integrated with the local populations, and by and large are found at the lowest socio-economic, and development strata of life due to the legacy of the oppressive system they endured during the slavery and subsequent era of discrimination and disenfranchisement. Their respective progress with the eight Millennium Development Goals by 2015 shows a serious lag that demands a more aggressive local and international investment at individual and collective level. Each community has developed its own individual and collective approach for development and yet it is not integrated for effective results.

4.9 Lessons from AGOA and ADHI. The AGOA has a lofty ideal of encouraging African Countries to move towards free market economy, good governance and global trade and investment agreements, etc. It appears to be more the result of the efforts of US interest groups such as the Corporate Council on Africa, and Africanist groups like Constituency for Africa, and pressures from the Congressional Black Caucus, US Civil Rights leaders such as Ambassador Young and Rev Sullivan like groups that supported the series of African Summit projects, rather than inter-governmental partnership between the African and US public and private enterprises. The intentions might be noble, but the impact as measured by the evaluation report indicates that the experience of the past 11 years of AGOA project has gravitated towards oil and gas exports, leaving behind many AU countries and their respective diverse set of trade products. There is a need to make the project more inclusive of public and private constituencies in African Countries and their respective diverse exports. A broad based continental consultations and participation is needed to make it accessible and user-friendlier to the changing needs of African countries. By comparison the ADHI (The African Diaspora Health Imitative) appears to have based its focus on maternal and child health as a response to the challenges faced by many African countries in their progress towards MDG goals. The socio-economic and development indices and progress of Millennium Development Goals by 2015 appear to be lagging among most African populations. Good governance, transparency and accountability, that are considered to be the foundations of all transformative development and investment based global integration activities, are found to be rather behind in these communities. There is a need for a strategic appraisal and adjustment of these activities to ensure appropriate progress to the MDG by 2015.

 

4.10 Towards a solution: Engaging in infrastructure, and enterprises development

Special efforts are made to seek a common thread that integrates the five reports towards focusing on ways of engaging African Diaspora and their respective public and private institutions and communities. Engaging the Diaspora for win-win partnerships in the sustainable development activities and investment opportunities of African Union Countries is considered the common link of all the consultancy reports. Citizens in Africa and Diaspora continue to be the least integrated communities in this globalized world. The current challenges and opportunities of integrating African and global communities within the construct of advancing technologies, and global business enterprises, towards integrating global economy continues to be the challenge and opportunity of our time. Engaging the Diaspora and their respective investment and development communities in the basic and advanced technologies, infrastructure development, such as ICT and Social Media Network, etc. and capacity building activities in human resources, technology transfers and enterprise development activities continue to be the foundation and bridge to the next century.

 

4.11 The methodology- integrating The AUM Initiative Consultancy reports.

The methodology deployed to address the AUM consultancies is based on standard scientific qualitative and quantitative approaches that use individual and group interviews, surveys and use of quantitative data respectively, to explore the different aspects of the development and documentation of the consultancy reports.

The previous AUM consultations used for this synthesis report executed include:

  1. Development of policy briefs
  2. Data and Knowledge management
  3. The African Diaspora Health Initiative
  4. Communication and media strategy
  5. Evaluation of the African Growth and Opportunity Act
  6. Latin-America study tour

 

 

4.12 The Global Perspective

 

4.12.1 Matching the diverse Global Diaspora perspectives. The study tour report shows that the African Diaspora are scattered through out the world, making them a dynamic global community, with significant diverse and untapped individual and collective potential. In the American region alone, it is estimated there are over 250 million people of African descent. They live and work in countries that stretch from Canada to Brazil, on both the Atlantic and Pacific coasts, forming a wide spectrum of rather impressive, at times vulnerable, and yet, dynamic, diverse, cultural, socio-economic and demographic constituencies of their respective countries.

4.13 Engaging the Dynamic Global Diaspora. Engaging this dynamic Global Diaspora population to the continually evolving African Union countries’ sustainable development and investment activities, in a meaningful way, via individual and collective, interactive public and private institutions is the theme of this report. Considering the time that has lapsed and the current global socio-economic developments, Diaspora Engagement in Africa’s development and investment opportunities is an idea whose time has come. The recent UN declaration of the year 2011, as the Year of People of African Descent, in the context of the upcoming deadline of year 2015 – for the UN Millennium Development Goals, makes this synthesis report a fairly interesting project in its context and policy implications as it deals with the idea of how best to engage the sixth African Union Constituency, the Diaspora engagement.

 

4.15 The context of UN and AU priorities.

 

4.15.1 Harnessing the increasing the Diaspora remittances. The Diaspora Engagement idea has got a lot of traction in the current global economic crisis environment, as the resources generated and transferred in transactions such as remittances are second only to Direct Foreign Investment figures. In the United States alone, the world wide international migrants have almost doubled from 76 million to 150 million in 35 years. As migration increased, flows in the form of personal and collective remittances, investments, information and knowledge, tourism, trade have continued to grow at unprecedented rates. In the US alone, remittances are the second-largest twenty five percent (25%) source of financial resources to developing countries just behind foreign direct investment (FDI/Private Capitol Flows) at forty two percent (42%).

4.16 Integrating the Diaspora and diverse resources. Integrating diverse resources such as remittances, public and private flows, such as foundations, corporations, NGOs, religious and university colleges, as well as community investment networks etc. is the focus of this synthesis report. The desired single policy framework document, integrates the diverse Diaspora resources towards linking and engaging with the Diaspora Communities in the Americas in the ongoing sustainable development activities of AU countries and their respective communities. Engaging the Diaspora in the integrated public and private resource flows, and the dynamic enterprise culture of the global economic integration is the focus of this report. The recent global economic downturn and subsequent planned series of austerity measures makes the timing of this report even more urgent. The consistent economic growth of African countries is considered as a special resource that could advance the recovery of the global economy. The Diaspora Engagement program can be a unique engine of this potential win-win global economic recovery process.

  1. Recommendations

 

5.1 Integrating with AU Goals and AUM Mission Objectives.

5.1.1 Forging Strategic Partnerships. The African Union, established as a unique Pan African continental body, is charged with spearheading Africa’s rapid integration and sustainable development. The goal of the African Union Representational Mission in Washington D.C. is to forge strategic partnerships with the United States government, for profit and nonprofit developmental organizations and the African Diaspora towards the political, social and economic development of African countries. As such, this synthesis report enhances the AU role of forging strategic partnerships with the global community via the Diaspora linkages for sustainable development and investment opportunities of AU countries.

5.2 The AU Mission

5.2.1 Integrating a peaceful and prosperous Africa. The African Union Mission strives at fulfilling the aspirations of an integrated, prosperous and peaceful Africa, driven by the active participation of its citizens, and representing a dynamic force in the international arena. As such, the mandate of the African Union Representational Mission to the United States, is to develop, maintain, and consolidate constructive, and productive institutional relationships between the African Union, and the government of the United States of America, the Bretton Woods Institutions, non-governmental and academic organizations engaged in Africa issues and policy, and Africans in the Diaspora.

5.3 African Union Perspective

The African Union performs it tasks by promoting unity, solidarity, cohesion and cooperation among the peoples of Africa, and developing new partnerships worldwide. The Mission’s Headquarters is located in Addis Ababa, capital city of Ethiopia. This Synthesis Project is part of the overall task of engaging the African Diaspora in the activities of AU and AUM in the Americas and around the world in sustainable development and investment opportunities of AU countries.

5.4 Enactment of effective policies

 

A critical component of promoting Africa’s development is the enactment and implementation of effective policies that promote sustainable development and investment opportunities. It is expected that synthesizing inputs from the consultations into policy briefs will spur the Mission’s decision-making process and policy formulations. The lessons from the five consultancy projects revolve around the promotion of win-win partnerships within the principle of good governance, which encourages extensive participation that promotes transparency and accountability of all stakeholders, towards sustainable development activities.  The use of modern multi-media communication tools such as ICT and SMN are considered highly valuable a format that creates inter-active and reliable communication with all key stakeholders.

 

5.5 Institutionalizing Good Governance

The experience of forced migration of Diaspora ancestors and its lingering negative impact on its descendants, demands that all the private and pubic stakeholders among the Diaspora communities, and African Countries, need to be transparent and accountable by actively engaging all stakeholders in all projects from its inception, design, operation and evaluation. As such the Diaspora historic experience of non-engagement in decision process that resulted in their forced exodus out of Africa, and its long term adverse impact on the socio-economic development status and future negative implications, clearly indicate the need to seek their participation in this noble cause of Diaspora engagement today.

5.6 Connecting talent/technology and capacity building. Good governance based capacity building initiatives can assist the Diaspora to invest their time, talent, resources and institutional contacts for sustainable development via public and private investment bonds, professional and community networks. However, one cannot ignore the enormity of the challenge of implementing such a noble objective in an environment where a wide margin of disparities persists between the local and Diaspora communities. It is therefore critical to make the engagement beneficial to all stakeholders in the short and long term basis. The AU countries need to make a list of potential investment areas and development activities with detailed modalities of engagement after consulting widely with Diaspora communities. The approach and process could vary according to the skill and resource mix of potential investors and the competencies of the development partners involved.

 

5.7 Linking with UN MDG Programs

 

Creating a Global Partnership for Development by 2015 is one of the eight Millennium Development Goals that the global community has set for itself. Past experiences and current socio-economic developmental status of people of African descent, and the overall African Diaspora across the world will benefit from the UN Millennium Development Goals. These global challenges expect countries to demonstrate good governance, and commitment to reduce/eliminate poverty, achieve universal primary education, promote gender equality, reduce infant mortality, improve maternal health, combat infectious disease such HIV/AIDS, ensure environmental sustainability and create global partnerships for development by 2015. The synthesis report addresses the progress of these issues among the Diaspora communities in the Americas, by evaluating AGOA, Latin America Tour Reports, and The Africa Diaspora Health Initiative and explores strategies on how to accelerate this process by engaging the Diaspora communities directly with relevant institutions in the AU and their respective countries.

5.8 In line with Millennium Development Goals

5.8.1 Connecting to modern global communication technology. The continuous and evolving development of new technologies, that is matched by improving management expertise, has accelerated the globalization process, by connecting communities, integrating markets, and social institutions worldwide. The African Union and the Diaspora African communities around the world are part of this unique phenomenon of modern global connection. They have a historic opportunity, to galvanize their resources and evolving experiences and expertise, towards win-win partnerships for sustainable development activities that benefit their respective communities. Their visibility and effectiveness, in galvanizing resources to wards achieving the Millennium Development Goals, and sustainable growth opportunities in their respective communities, depend on their ability to access the evolving technology based knowledge transfer tools such as information, technology, communication and SMN-based social media outlets, as well as their ability to participate and engage in the socio-economic and good governance activities in their respective communities.

5.9 Accelerating MDG progress. The Diaspora communities, like their counter-parts in African countries, are at different stages of engagement in the sustainable development activities, and the current focus in 2011 is expected to advance this larger goal. The overwhelming African Diaspora in the Americas, share a long history of disenfranchisement, isolation and disparity in access of socio-economic development activities. Substantial proportions of the Diaspora are way behind in their progress to achieve MDGs in their respective communities. As such, the progress of the respective Diaspora communities in achieving Millennium Development Goals by 2015 needs to be seen in the context of the over all, socio-economic development activities of their respective home countries. There is a need for a proactive focused developmental and empowering activities focused at individual and collective community settings that respect their evolving interests within current global economic trends. Some of the expected future engagement needs to be focused towards accelerating progress of MDG by 2015 and beyond.

 

Evaluating The AUM Consultancies

 

The AU consultancies are a series of reports that address the different perspectives of AU Countries and Diaspora communities towards developing linkages and connections that support the sustainable development and investment opportunities of African countries.

 

5.1. Purpose. Insightful connections with Diaspora communities

In its attempt to understand the past relationships, current trends and future potential relationships, the AUM has initiated a series of consultancies that explored both inter-governmental relationships as well as the current African Diaspora communities in the Latin American countries.

5.2. Broad-based strategy. The five AUM consultancy projects cover a wide spectrum of issues from trade, to community linkages, to exploring effective media communications tools, to and policy development framework. The consultancies reports show that the AUM has embarked on a broad-based process of understanding the challenges and the opportunities of the African- US trade relationships, and potential linkages with African Diaspora communities in the Americas, by commissioning a needs assessment consultancy work as well as the evaluation of the current US-Africa trade policy.

5.3. The Approach

The AUM consultancy projects have all used both qualitative and quantitative research methodologies that included focus group interviews, systemic quantitative surveys, trends and patterns analyzed and reported accordingly. The process involved evaluating current projects such as the evaluation of the African Growth and Opportunity Act of the USA; linkages with Diaspora communities in the Americas; the effective means of data and knowledge management process; and the development of a viable, and effective communication and media strategy needed to fulfill its unique mandate in the Americas. It is hoped that the outcome of this report will contribute significantly to this larger policy framework, and strategic vision of sustainable development in to the future. The reports are fairly detailed and have strong recommendations that are summarized and integrated in this synthesis report. The key research questions of what, who, why, how, when, where are utilized to evaluate the consultancy reports using qualitative and quantitative research methodologies.

 

 

5.4 What? – Synthesizing The AUM Consultancies

The scope of project that seeks to link and connect by engaging the African Diaspora in the sustainable developmental activities of African Union countries, and their respective communities, and the world community at large is truly an idea whose time has come. The Global economic crisis and subsequent series of austerity measures demand unique and create means of connecting with untapped resources and talent such tat of the the African Diaspora communities. The consultancies were broad based, and utilized the skills of highly experienced professionals in the field that utilized both qualitative and quantitative research methodologies.

This synthesis report incorporates the work of five-consultancy projects commissioned by the African Union Mission Representation at Washington, DC, USA. The previous consultations executed include:

  1. Evaluation of the African Growth and Opportunity Act (AGOA),
  2. Latin-America study tour,
  3. Data and Knowledge management,
  4. Development of policy briefs,
  5. Communication and media strategy

 entific Qualitative and Quantities Methodologies.

 

The Synthesis report has integrated the consultancy reports that utilized qualitative and quantitative research methodologies that use individual and group interviews, surveys, and documented literatures, in seeking for common policy framework, which is in line with the terms of reference of African Union Mission. The Synthesis report utilizes scientific risk assessment, and policy appraisal methodologies that addresses changing challenges, opportunities, strength, weakness, risks and threats, etc. The integration of the consultancy reports is supported with root cause analysis tools, that ask questions like what, why, and how, etc., towards providing a scientific approach to policy framework development, that encourages win-win partnerships between Diaspora Communities and their counter parts in African countries. The modern advancing technologies and communication media are very powerful tools for effective communication that could assist a well-integrated Diaspora engagement.

5.6 Why?-Connecting the past, present and the future with common shared value and interest.

Connecting the Past to the future. The challenges and opportunities of the current and future Diaspora Engagement activities stem from the negative experiences of forced migration and colonialism of past generations, and the subsequent disenfranchisement of the current generation and the need to create positive opportunities for the future generations. Creating a common shared value and interests that respects the perspective of the Diaspora and AU countries continues to be the central theme of this consultancy report. These past negative experiences and existing associated culture of discriminations, continue to impact adversely, the current and future generations’ ability to engage in the Global economy.   As such the strategy and process of engaging the Diaspora populations should take into considerations these fundamental factors as potential challenges and opportunities for change within Millennium Development Goal structure or globalization led free market economy that tries to actively integrate the global community in the changing global socio-economic situation.

5.7 Converting challenges into opportunities. The current development status of African and Diaspora communities cannot be seen outside the historical framework of forced migration, and evolving modern African migration due to draught, civil unrest, conflict and resultant social and economic vulnerability that is generating new set of precarious African Diaspora migrations and its uncertain future and potential. These series of adverse events have exposed the African Diaspora to high risks generated challenges, which they have converted into their individual opportunities. It is time now to convert them into collective opportunities; As such the central theme of the findings of the current series of AUM consultancy reports re-iterate these findings in all aspects of the challenges faced by these communities to advance to the expected progress of the Millennium Development Goals. Accordingly, the same issues of the need for active participation and comprehensive engagement will surface in the current project of linkages of the African Diaspora communities with AU sustainable development activities.

5.8 Root cause analysis. The report consistently raises the fundamental questions, as to how the current series of seemingly positive intentions of UN, AU and AUM stand up to the changing aspirations of the target communities both in Africa and the Diaspora. Are the target communities given opportunities for active participation, involvement, and representations in the deliberations of these projects from start to finish; that is at the level of project conception, design, plan, process and implementation, as well as the evaluation process, and future direction. These fundamental questions need to be raised at each level of future deliberations.   The root cause of the Diaspora challenges and opportunities stem from this fundamental question of past forced migration, disenfranchisement, and subsequent disengagement of current generation from the ongoing social and economic activities of their respective communities.   The future progress African Countries and the Diaspora Communities are making with the Comprehensive Trade Agreement and Millennium Development Goals respectively will show how far we are advancing in these larger goals. The reports so far indicate that hey were limited by time and resource constraints.

5.9 Articulating shared interests and aspiration of all stakeholders. The consultancy reports raise a series of questions on the issue of active deliberative participation and engagement of the Diaspora populations, whose main challenges are disengagement and disenfranchisement and isolation that has been passed for generations. Their perceived and real interests in terms of future engagement with AU countries need to carefully taken in to account, so as to articulate the shared interests, aspirations of all stakeholders, supported by qualitative and quantitative research tools for effective formulations of policies and strategies that match the ever changing needs in line with changing global and regional political and economic landscapes. Such deliberate considerations of lessons of past forced immigrations and disenfranchisement of African Diaspora populations, will generate proactive processes for future engagement, and re-integration of their descendants in their respective communities and AU countries, within the framework of the current global socio-economic political order.

5.10 Diaspora’s rightful place in the globalized world. The current barriers faced by the Diaspora populations in terms of their engagement to improve their infrastructural and human capital development activities, i.e., educational, social, health and extended role of citizenship in the governance of their respective communities need to be considered carefully. The Diaspora communities have to own the goal, design, and processes of their respective sustainable development activities. The Diaspora’s rightful place in the globalized world need to be seen within this lager framework of global interconnectedness, and understanding of the social and economic realities of people of African Descent around the world. The UN declaration of “2011 as the Year of People of African Descent”; and the AU consideration of “the Diaspora Africans as the sixth Constituency”, seeking and promoting the engagement and participation of African Diaspora in the African Union local and international development activities, etc. need to be seen with the larger Diaspora presence in the globalized world. What this mean in real terms to African Diaspora populations scattered around the world continues to be a challenge.

5.11 Integrating the aspirations for growth and opportunities. The US AGOA project evaluation and the needs assessment and linkages projects of AUM tours indicate the need to integrate the AU Countries and African Diaspora in the overall global growth and opportunity activities, such as Comprehensive Free Trade Agreements and MDGs, etc.   The evaluation and Diaspora study tours provide a clear evidence for the general understanding that both African Countries and the African Diaspora communities are not effectively engaged in the Global Growth and Opportunity activities. In short, there is enough evidence to show that people of African descent are not playing their fair share in the opportunities of globalized world. There is a lot of space and opportunities for future growth and engagement opportunities in the global market. How much of this reality is appreciated by the key stakeholders, that is Africans and the Diaspora is worth researching further. The fact that the AUM has invested in the research and evaluation projects is key indicator this is an idea whose time has come. The key components of this synthesis report revolves around the central theme of integrating the social, economic growth and sustainable development opportunities of people of African descent at home in Africa and outside in the Diaspora.

VI. The African Diaspora in the US: Partners for African Education Sector Development

6.1 Introduction

6.1.1 Brain drain, gain and circulation. The movement of educated and skilled work force across geographical boundaries is not a new phenomenon, and yet the advent of technologically advanced globalization has accelerated the process of brain gain, brain drain and brain circulation across the world. The communities who gain and lose from this phenomenon or the relative beneficiaries and loser stakeholders, depends on the relative competencies and infrastructure development of each respective constituencies across the globe.

6.2 The global brain drain profile. The International Office of Migration (IOM) defines brain drain, as the emigration of trained and talented individuals, from the country of origin to another country, resulting in a depletion of skills and resources in the former. In 2000, developing countries accounted for 64.5% of total immigrants; and 61.6% of skilled immigrants to the west, 15% higher than in 1990. Globally, brain drain rates are led b Sub-Saharan Africa at 13%, followed by Latin America and the Caribbean at 11%, and the Middle East and North Africa at the rate of 10%. (Docquier, 2007) The flow of skilled Africans to the west has a long history, stretching back centuries, but the nature, form and process has altered remarkably over time. The largest and earliest transfer of African human resources to the west took place during slavery, and although the twentieth century has seen an exodus of Africa’s highly skilled professionals, this voluntary drain does not compare with the forced depletion of human resources some three centuries ago.

6.3 Push and pull factors of the new brain drain. Over the last half century the United States has seen an increase in African migration, which has been a result of both push and pull factors, and this phenomena has progressively increased over time. Mid-nineteenth century African migration was largely driven by the pull factor of education and training. As the colonial era was waning, many Africans were in universities and colleges throughout Europe and the US, getting the essential education and training to enable them to take up administration of their respective countries. During this era, almost all returned to their countries and took up leadership positions. So, these populations of African students were not immigrants in the real sense, but rather temporary residents who eventually returned to their country of origin constituted the first set of brain gain and initiated the real brain circulation process.

6.4 Push and Pull factors of Brain Circulation.

The first significant new wave of voluntary migration from Africa, can be seen in the 1970s and 1980s where refugees, through international resettlement programs, were resettling in the US, Canada and Europe. Hence, African migration in the 1980s was largely due to push factors, forcing refugees and political asylum seekers to flee their land of birth. The second wave of voluntary African migration from the 1990s and this millennium are largely due to a pull factor, with émigrés leaving their home country more seeking new improved opportunities, that is for what is to be found abroad, rather than for what they feared at home. According to the US Immigration and Customs Enforcement (ICE), there were a total of 354,939 immigrants from Africa from 1991-2000, almost a 50% increase from the previous decade. The migrants of this era consist of highly skilled professional African immigrants who are leaving Africa equipped with education and training in search of better opportunities.

 

 

African professionals in United States

 

6.5 The most educated immigrants to the US.   According to the United Nations, an African professional working in the United States contributes about US$150,000 per year to the US economy. The level of training and education of the average African immigrant in the United States is higher than that of any other immigrant group, including those arriving from Europe and Asia.(see table 1)

 

6.6 Exceptional educational attainment. Of the African-born population in the United States aged 25 and older, 87.9% reported having a high school diploma or higher degree, compared with 78.8% of Asian-born immigrants, and 76.8% of European-born immigrants, respectively. (Dixon, 2009)   African born population in the US also outperforms the general population in terms of educational pursuit and attainment in the US. (see table 2) Moreover, various international studies estimate that about 23,000 qualified academic professionals emigrate from Africa to the west each year.

6.7 Challenges of skilled Diasporas. According to the US Census Bureau, the biggest migratory flows from Africa to the United States are from Egypt, Ghana, South Africa, Nigeria and Ethiopia with more than 60% of immigrants from these countries having some level of tertiary education. Studies have also found that despite their higher level of education and training, many African immigrants are unable to obtain positions that commensurate with their training upon arrival. Due to lack of professional networks and transitioning of institution, many begin their working careers in low paying positions and it is only after years in the workforce (securing accreditation and experience) that they secure positions that correspond with their education and training. In effect, wasting their talents and competencies in non matching enterprises, and taking unnecessary lose-lose routes of adjustments among their adopted second home communities. To-date, there are no well-organized institutions developed to address this pressing problem, which continues to stress the Diaspora communities.

6.8 State of education Sector in Africa

 

6.8.1 Almost half African children are out of school.   One of the consequences of the migration of the highly trained and educated people is that the education sector in many of the source countries has stalled. In some cases years of development efforts were reversed as those trained and charged with the next phase of the development departed without replacements in place. A UNESCO report estimates that Sub-Saharan Africa is home to 43% of the world’s out-of-school children and levels of learning achievement are very low. Especially impacted by over a quarter of century of brain drain have been African universities that have been emptied of crucial human capital. The impact of this outflow has resulted in Africa losing the critical human resources essential for economic, social, scientific, and technological progress.

6.8.2 Shortage of skilled manpower. The absence of technically skilled manpower has hampered economic growth and development and has had a particularly negative impact on the expansion and access to education in Africa. The unceasing seepage of skilled personnel from Africa has hindered higher education development and contributed to a widening gap in science and technology between Africa and other continents.   Africa’s share of global scientific output has fallen from a bleak 0.5% in the mid-1980s to 0.3% in the mid-1990s. There are more African scientists and engineers in the USA than in the entire continent (Ainalem, 2005).   Although there are many other mitigating factors for the continent’s anemic performance, the impact the shortage of skilled manpower has had on growth and development of economies and societies cannot be underestimated.

6.9 Current debates

6.9.1 Highest outflow of skilled migrants

Within the context of global migration, Africa has the smallest outflow of immigrants. However, it has the highest flow of its stock of human capital losing an average of 30% to 40% (Ghana 20%, Cape Verde 67%, Kenya 38%, Uganda 35%) of trained citizens annually, higher than any other region in the world. (Easterly, 2008) This constitutes the loss of the most vibrant and entrepreneurial sector of society, loss of those with potential to be leaders and innovators in their countries.

6.9.2 Causes of migrations

The reasons behind the vast migration of highly educated and skilled individuals from Africa are vast and numerous and have not been entirely studied and understood. Among the factors for leaving noted by migrants are professional considerations such as greater employment opportunities, wage differentials, access to cutting edge technology and research as well as job security. There are also personal motivations such as quality of life, educational opportunities for their children and pursuit of personal aspirations. In some instances, political instability, lack of personal freedom and limits on professional activities are factors in their migration decisions. (Mugimu, 2010)

6.9.3 Brain Drain

The phenomenon of brain drain has been the topic of an evolving debate in terms of understanding its impact on Africa. There are opinions and data that indicate that the flight of highly skilled professionals from Africa has irrevocably damaged development efforts and has significantly damaged the continent’s ability to replenish its skilled workforce because of the damage inflicted to the educational sector. Educational institutions in Africa, at all levels, chronically lack qualified academic and professional staff as many have emigrated to institutions in the West. This scarcity has had significant consequences on their ability to teach, conduct relevant research and serve as engines of national development. This brain drain needs to be converted into brain gain, or brain circulation by developing a series of institutional networks between Diaspora and African countries to ensure win-win partnerships of African and Diaspora stakeholders in their respective communities. The advance of ICT as a tool for creating new opportunities for improving connections across disciplines and educational sectors is possible by tapping into local and international resources in effect converting brain drain into brain circulation.

 

6.9.4 Brain Gain & Increased remittances

There are also equally compelling propositions and data that suggest that there are benefits to this outflow. The benefits to source countries can be realized in increased remittances, which have been shown to alleviate poverty. According to the International Fund for Agricultural Development (IFAD) remittance flows to and within Africa in 2009 approach US$40 billion. Annual average remittances per migrant reach almost US$1,200, and on a country-by-country, average represent 5 per cent of GDP, and 27 per cent of exports. There is also a reserve brain gain as those who left return with more advanced skills gained abroad; and those who remain abroad create an intellectual Diaspora network for knowledge exchange and circulation. There is a general view that with rise in globalization, these movements will only intensify, as there is very little that can be done to constraint movement of talent across borders. Therefore, African countries would do better to develop mechanisms for maximizing on the benefits of having an intellectual Diaspora.

6.10 Recommendation

6.10.1 Global Intellectual Diaspora Network. Although long-term impact and future trajectory of the movement of Africa’s highly skilled is nuanced, the creation of a global intellectual Diaspora presents for African countries a unique opportunity. The African Diaspora in the United States can be a valuable partner in educational development in Africa. There are significant number of African intellectuals throughout US universities and science and technology labs who have demonstrated interest and capacity to prioritize Africa within their institutions. Efforts should be geared towards providing assistance to US-based Diaspora professionals and continent based institutions interested in creating professional and institutional linkages and partnerships. Given limited resources and vastness of need it, would be most productive to focus on activities with greatest impact for the valuable time and effort invested.

  1. Institute official visiting educator/scholar programs. A program modeled after US Fulbright scholar program, which serves as facilitator on several levels. Both funded and non-funded visiting scholar programs should focus on placing Diaspora faculty in African country institutions during sabbaticals and leaves. Residency is key to creating long-lasting effective relationships.
  1. Support institutional linkages with US-based institutions facilitated by African Diaspora academics. Modeled on USAID’s Africa Education Bureau’s initiatives of searching for US counterparts for African universities based on existing needs. This would include serving as a conduit for Africa-based institutions seeking academic linkages with US-based institutions. Various studies have found that both African universities and US based institutions lack a clear and comprehensive strategy for building and sustaining effective partnerships with U.S. institutions. Moreover, solid institutional relationships are always based on individual effort and require committed individuals who will advocate for the linkages.
  1. Develop closer relationship with membership organizations focusing on African Education. It’s important to take advantage of existing infrastructure to facilitate partnerships. In the US, Association of African Studies Programs, Africa National Resource Centers and African Studies Programs and in Africa, African Association of Universities (AAU). These organizations consist of African faculty as well as programs (both academic and non-academic) working in Africa. They also have access to local African communities as well as data on Africans in US.
  1. Develop an intellectual Diaspora network. Critical for information distribution and virtually engage members in communication with the Diaspora constituency. This would entail establishing a reliable database of African-born faculty and education experts, which is updated regularly and will serve as a basis of virtual engagement.
  1. Tap into existing African education NGOs/programs. There are numerous programs and NGOs working on supporting K-12 education and/or providing scholarships for students such as Africa Teach, AKIN, etc. Greater coordination would yield greater effectiveness and results and improve educational opportunities.

6.11 Conclusion

6.11.1 Stemming the tide of Migration? Migration of the most productive members of any one society is not a new phenomenon, nor is it limited to Africa. However, the impact of brain drain has been most keenly felt in Africa due to the demographics of the migrant population, and the intense manpower shortage faced by a continent. For the most part, migration is a personal decision, arrived at by each individual after deliberate reflection and careful consideration. Still, there are a s external factors that come to bear on this decision process. Professional considerations, personal and familial aspirations as well as issues related to political reality of home country often factor considerably into an individual’s decision to migrate. Hence, given the myriad of factors involved in an individual’s decision to migrate and the global demand for talent and the increased pace of globalization, stemming the tide is unrealistic.

 

6.12. Encouraging innovative and creative Diaspora engagement. Although, the long-term implications of this trend have yet to be understood, the engagement potential of a large intellectual diaspora for development purposes cannot be overlooked. Two decades into this contemporary phenomenon finds Africa with a reservoir of highly educated, skilled and well placed, and to a large extent disposed, Diaspora in the US. The return benefits of this Diaspora are only now beginning to be realized as stability sets in various parts of the continent; the African Diaspora is leading the innovative and creative engagement with their home countries. Recent trends point to the fact that although initial migrations constitute a drain, as those who left return with new ideas and networks to develop their home countries they are proving to be a gain. This movement commonly referred to as brain circulation, has the potential to be a development tool for home countries as it is the mechanism for diffusion of knowledge and technology. Home countries should invest in channeling the energy, initiative and resources of the intellectual Diaspora as it has accumulated the human, financial, and social capital that is essential for educational sector development.

References:

  1. Ainalem, T, Brain Drain and Capacity Building in Africa, 2005: idrc.ca/en/ev-71249-201-1-DO_TOPIC.html
  2. Dixon, David, Characteristics of the African Born in the United States, Migration Policy, Washington, DC January, 2006
  3. Easterly,WilliamandNyarko,Yaw, Is theBrainDrainGoodfor Africa? Brookings Global Economy and Development Working Paper No. 19, 2008:http://ssrn.com/abstract=1121853
  4. Mugimu, Christopher, Brain Drain to Brain Gain: What are the implications for Higher Education in Africa?, Comparative & International Higher Education 2, 2010
5.     Frédéric, Lohest, Olivier and Marfouk, Abdeslam, Brain Drain in Developing Countries, Developed for the African Union Mission in The United States.

  

VII. Service Delivery and Health Care:

Role of Diaspora and Information & Communication Technology

7.1 Introduction

7.1.1 Effective Service Delivery. There are several essential elements that are necessary for effective service delivery; stable societies, adequate infrastructure and well-trained professionalized public sector. Across the continent, while some countries are emerging from protracted conflict–which has devastated national infrastructure and resulted in uncertain socioeconomic landscape–others are effectively war zones where delivery of service is untenable.

 

7.1.2 Infrastructure development. Lack of infrastructure, shrinking public budgets, geographic remoteness and population shifts hinder African government’s ability to provide equitable distribution of service such as education, health, water, sanitation and electricity. This in turn impedes development efforts thereby continuing the cycle of unmet needs and inadequate resources.

7.1.3 Brain drain, gain and circulation. The large-scale exodus of medical health workers to the west over the last 25 years has served to further cripple an already burdened system. The uncoordinated and haphazard influx of western NGOs with agendas drawn up without consultation has further exasperated the situation and accelerated the deterioration of a crumbling health care system. The brain drain can be converted to brain gain and brain circulation by coordinating a series of Diaspora networks for investment and development.

7.1.4 Disparities in basic development indices. According to The Economist, Africa accounts for over a sixth ~ (17%) of the world’s population, but generates only 4% of global electricity, even though it accounts for 12% of the world’s energy production and 10% of the global proven oil, US has 2%. Only 25% of Africans have access to electricity and it costs 10% of the income of the poorest households to light a small dwelling. Water and sanitation services in Africa have improved over the years but nearly 60% still do not have access to updated and improved sanitation facilities, making the region unable to meet Millennium Development Goals (MDG) targets. Moreover, the continent faces similar difficulties in delivering education services with 43% of children not enrolled in school.

7.1.5 Ethiopia’s Use of ICT enabled enterprises. Many African governments have developed a creative and innovative approach to addressing these obstacles with development of e-government. Deployment of Information &Communication Technology (ICT) in the public sector provides access to information, knowledge and technology, which in turn develops a proactive, efficient, transparent and service oriented public sector. Moreover, ICT reduces transactional costs, directly addresses physical and resource barriers and builds local institutional capacity. For instance, Ethiopia one of the poorest and least developed countries in Africa with a 0.4% internet penetration in 2009 has turned to ICT to enhance its service delivery capacity. ICT based services include WoredaNEt (connects federal, regional and district administrations), HealthNet, (enables health practitioners to access a wide range of health care information) care SchoolNet (connecting schools-urban and rural-to support teaching), EtTHERNET (Ethiopian Educational and Research Network) (connecting public universities for e-learning and e-libraries), AgriNEt (linking agricultural research centers) among other services. (Belachew, 2011)

 

7.2 Health Service delivery

 

7.2.1 Addressing health disparities. The challenges to health care delivery in Africa are numerous including poverty, low national health spending, high disease burden and crisis in medical and public health professionals. However, health spending does not commensurate with the vast need along with and educational and training infrastructure that is insufficient in replenishing the persistent hemorrhaging of human capacity. According to the World Health Organization (WHO), 24% of the global disease burden is in Africa which has only 3% of the health workers and less than 1% of the global financial resources.   Africa bears the heaviest disease burden largely due to prevalence of communicable diseases such as HIV/AIDS, malaria, and tuberculosis as well as non-communicable diseases such as mental illness, malnutrition and conflict induced injuries.   Health promotions and disease prevention strategies based on individual and collective health empowerment activities are the most cost effective tools to address this glaring health disparity in the continent. The Diaspora communities and their respective enterprises and institutions can be a converted into a strong win-win partnerships via interactive Diaspora engagement programs.

7.2.2 Environmental and behavioral challenges. Natural and man-made circumstances such as waterborne and zoonotic diseases and civil unrest generated injuries and disabilities respectively are promoting public health and individual health crisis in Africa. Moreover, Africa is also experiencing an increase in non-communicable disease such as violence, injuries, cancer and other life style related diseases adding to the already burdened health care system. Other factors in the health crisis in Africa include poor sanitation, lack of proper nutrition, lapses in immunization, substandard housing and other factors directly related to socioeconomic conditions.

7.2.3 Social determinants in health. The WHO Commission on Social Determinants of Health in 2008 recommended a set of action plans targeting governance and social and economic factors that are key determinates of health to be addressed as part of the Africa region sustainable health goals. (WHO, 2010)

7.2.4 Communicable endemic diseases. Poor health care has exasperated Africa’s vulnerability to unrestrained proliferation of communicable endemic diseases. Africa has the highest burden of malaria cases with 90% of the worldwide malaria deaths in 2003. In all malaria-endemic countries in Africa, 25-40% of all outpatient clinic visits, and between 20% and 50% of all hospital admissions are due to the consequence of malaria . According to Roll Back Malaria report, several factors have made malaria control difficult in Africa such as limited expenditure on malaria prevention programs, poverty, quality of housing and limited access to health care.

7.2.5 Mitigating Malaria in Africa. Human capacity is key to not only mitigating malaria on the continent but also to addressing the health care deficit in Africa. Building human resources at the national, regional and local levels is necessary to effectively implement malaria control program. However, high attrition rates of health workers, competing demands with other programs and the unwillingness of health providers to be stationed in remote areas have led to critical shortage in effectively managing malaria and providing rural health services. The answer is to build sustainable infrastructure that attracts healthy network of viable human settlements be it for the layman or the professional community. Sustainable communities are built on sustainable infrastructure and human development networks that address all health and socio-economic development opportunities.

7.3 Heath Professionals in the Diaspora

 

7.3.1 Africa’s share of health professionals. Globally, there is an extraordinary shortage of health workers with an estimated additional 4.2million needed, on top of the existing 59 million; to accommodate the health needs of the world’s population. (Blanchet, 2006) In 2011, the fastest growing sector in the United States is the health care industry. As the baby boomer generation ages, there has been growing demand for health care professionals. According to the US Bureau of Labor Statics, more than one in four of the 117,000 new jobs created in the U.S. economy in July were in healthcare.

7.3.2 Converting brain drain to brain gain.   The US is unable to train enough health workers to keep pace with the growing need for medical physicians and has relied heavily on health professionals from developing countries, specifically from Africa. WHO estimates over 50% of highly trained health workers leave for better job opportunities abroad from low-income countries? Between 1986 and 1995, 61% of the graduates of one Ghanaian medical school had left the country. In 2004, Zambia lost over 2,000 nurses and midwives and of the 700 medical doctors trained in Zambia from 1978-1999 only 50 remained in country and practiced in the public sector. One third of Ethiopian medical doctors have left Ethiopia making Chicago and Washington DC, rather than Addis Ababa, where one would encounter an Ethiopian doctor. UNDP in 1993 identified 21,000 Nigerian doctors practicing in the US with and estimated additional 10,000 practicing in Saudi Arabia, the Gulf States, Europe and Australia. There is a need to convert brain drain to brain gain by supporting Diaspora Intellectual Brain Trust and networks to support African investment and development opportunities.

7.4 State of Health Sector in Africa

7.4.1 Promoting positive sense of wellbeing. Sustainable Health is not the mere absence of disease and disability, but a positive sense of wellbeing. The state of health services delivery sector in Africa lacks basic infrastructure and coordinated effective health system. Preventable infectious diseases have become entrenched in the African landscape, hampering Africa’s capacity to combat critical diseases such as HIV/AIDS, malaria and tuberculosis. The ability of states to deliver basic service such as health care directly impact human development and has an impact on growth and development. National development requires healthy well-balanced, disease-free citizens as there is a direct correlation between an individual’s good health and productivity. For instance, malaria prevalence costs Africa and estimated loss of $1.2 billion each year in illness, treatment, premature death and billions more in lost economic growth. In many instances, lack of health services impacts health workers directly. A 2006 UNAIDS report found that Botswana, lost 17% of its healthcare workforce due to AIDS between 1999 and 2005 and found that about 40% of midwives in Zambia were HIV-positive.

7.4.2 Progress towards MDGs by 2015. Africa is also charged with meeting clearly articulated health care goals and is a central actor in addressing the most significant global health issues. Of the eight MDGs, three are related to health: reduce child mortality rates, improve maternal health and combat HIV/AIDS, malaria, and other diseases. Similarly, of the global effort to eradicate malaria and stem the tide of HIV/AIDS Africa, as the epicenter of these epidemics, is a central actor. At the same time, dwindling national budgets have limited the investment African governments can make in a health sector which is already overwhelmed by disease prevalence, chronic shortages of health workers and lack of access to essential lifesaving medicines. The UN Economic Commission for Africa estimates that sub-Sahara Africa needs to triple its health workforce, adding over a million workers to reach the health-related MDGs and meet the demands on the health care system. Therefore, the scaling up of health services to meet these challenges will require mobilization of resources from domestic sources, support diaspora and

7.5 Recommendation

7.5.1 ICT based mobilization. The development of information technology provides Africa with an opportunity to leap forward in the ability to increase health care access. Many of the obstacles related to geographic remoteness can be sufficiently addressed through use of ICT and training of local auxiliary health workers. Increase in local capacity and use of ICT also opens the door for Diaspora engagement.

  1. Engage Diaspora based health experts to recommend a continent-wide health systems development policy. Lack of coordination and control of health polices and priorities by national governments exasperates health care situation in Africa. Foundation to an effective health system begins with national guidelines and priorities that will guide local and international activities. Tap into Diaspora expertise to develop a holistic collaborative service delivery model that includes the Diaspora, approaches for international engagement, national and regional agencies, communities and clients. Parties involved share responsibility and authority for basic policy decision-making.
  1. Create’ adopt a health center’ program for diaspora members. This program will allow medical professionals in the Diaspora to proactively select a hospital and/or clinic to work with exclusively. They would serve in an advisory and when possible organize medical mission of their US-based colleagues. This program can extend to allowing hometown associations to adopt a health center and provide financial support, expertise as well as consul. This will encourage long-term engagement and development of institutional relationships.
  1. Develop a virtual consultation and diagnosis suites. Develop an online consultation portal with diaspora experts for diagnosis and consultation. Diaspora health experts sign-up to review files online and provide consultation on cases. This will improve the quality and accessibility of information available to local practitioners. It will also allow operation of remote health centers by auxiliary health workers who can be guided by experts via the portal. Participating locations would require internet connection, trained health professional (doctor, nurse, midwife, community health worker) and could request assistance in diagnosis anytime.
  1. Create a Health service account and/or bonds for diaspora. Develop a mechanism where Diaspora members could fund health services across the continent. Donors could select a country, city, village or a health issue, such as HIV/AIDS, malaria, mental illness, etc. Program could be administered by African Union who in turn will distribute funds quarterly in accordance with donor specifications.
  2. Engage Diaspora in The Roll Back Malaria Program research agenda. Three areas of research have been identified by RBM as effective for malaria control and elimination. Engage Diaspora members conducting tropical science research with state of the art labs and research facilities.

7.6 Conclusion

7.6.1 Healthy citizens for Service industry. Service delivery in Africa is an essential element to development on the continent. Educated and healthy citizens are more likely to be economically active and productive and they are less likely to require services from already overwhelmed agencies. Availability of service such as electricity, safe drinking water and proper hygiene are also more likely to enhance the productivity of a society and provide exponentially boost for well-being, innovation and creativity.

7.6.2 Promoting healthy communities. Challenges to effective health service delivery in Africa are particularly daunting. Shrinking national budgets, underdeveloped infrastructure and shortage of health workers are among the numerous factors that negatively impact national health systems. However, promoting a healthy community strategy of disease prevention and health promotion activities in line with primary health care system is both cost effective and equitable to all stakeholders.

7.6.3 ICT enabled mobilization. ICT (Information Communication Technology) based mobilization of limited resources is considered a cost effective tool for changing challenges into opportunities. There are numerous seemingly insurmountable continent wide obstacles to government’s ability to provide citizens with healthy outcomes thereby diminishing productivity and economic growth. Moreover, previously eradicated diseases such as Polio have resurfaced with a vengeance further burdening the meager health services. Given, the limitations of physical infrastructure and human resources the engagement of the Diaspora and harnessing of ICT will enable Africa to successfully mitigate the ongoing health crisis. ICT has the dual advantage of increasing health system capacity by health personnel, locally, regionally and nationally, as well as tapping into the vast knowledge and expertise of a large medical professional Diaspora.

References:

  1. Blanchet, K, Keith, R and Shackleton, P., One Million More: Mobilising the African Diaspora Healthcare Professionals for Capacity Building in Africa, Save the Children UK, 2006
  2. Achieving Sustainable Health Development in the Africa Region; Strategic Directions for WHO 2010-2015, WHO Regional Office for Africa, 2010
  3. Akukwe, Chinua, ed., Healthcare Services in Africa: Overcoming Challenges, Improving Outcomes, (A & A: London) 2008
  4. Belachew, M., E-Government Initiates in Ethiopia, presented at the UN The African E-Learning Meeting in Dar es Salaam, Tanzania June 2011 The Global Malaria Action Plan, Roll Back Mal

VIII. Brain Drain and Capacity Building in Africa

Some statistics on Africa’s brain drain

Since 1990, Africa has been losing 20,000 professionals annually.

Over 300,000 professionals reside outside Africa.

Ethiopia lost 75% of its skilled workforce between 1980-91.

It costs US$40,000 to train a doctor in Kenya; US$15,000 for a university student.

35% of total ODA to Africa is spent on expatriate professionals.

Source: International Organization for Migration (IOM)

8.1   Human capital development. “In 25 years, Africa will be empty of brains.” That dire warning, from Dr Lalla Ben Barka of the UN Economic Commission for Africa (ECA), reflects the growing alarm over Africa’s increasing exodus of human capital. Data on brain drain in Africa is scarce and inconsistent; however, statistics show a continent losing the very people it needs most for economic, social, scientific, and technological progress.

8.2 Tapping into the African Diaspora professional. The ECA estimates that between 1960 and 1989, some 127,000 highly qualified African professionals left the continent. According to the International Organization for Migration (IOM), Africa has been losing 20,000 professionals each year since 1990. This trend has sparked claims that the continent is dying a slow death from brain drain, and belated recognition by the United Nations that “emigration of African professionals to the West is one of the greatest obstacles to Africa’s development.” [See box: Some Statistics on Africa’s Brain Drain]. The Diaspora engagement program can tap into this knowledge wealth of African Professional Diasporas.

8.3 The costs of brain drain

8.3.1 Harnessing Diaspora connections.   Brain drain in Africa has financial, institutional, and societal costs. African countries get little return from their investment in higher education, since too many graduates leave or fail to return home at the end of their studies. This can be reversed or allowed to circulate with extended benefits if AU countries develop strategies that can harness the Diaspora institutional and investment connections.

8.3.2 Empowering African institutions.   In light of a dwindling professional sector, African institutions are increasingly dependent on foreign expertise. To fill the human resource gap created by brain drain, Africa employs up to 150,000 expatriate professionals at a cost of US$4 billion a year. The Diaspora can supplement and support AU institutions by providing living connections with their respective home institutions.

8.3.3 Enhancing health and social services.   The departure of health professionals has eroded the ability of medical and social services in several sub-Saharan countries to deliver even basic health and social needs. Thirty-eight of the 47 sub-Saharan African countries fall short of the minimum World Health Organization (WHO) standard of 20 physicians per 100,000 people.   The ADHI can be a very powerful tool in galvanizing African Diaspora resources to enhance health and social institutions. The MDG can be a powerful tool to attract Diaspora resources and investments.

.8.3.4 Bridging the science and technology gap. This continuous outflow of skilled labor contributes to a widening gap in science and technology between Africa and other continents. Africa’s share of global scientific output has fallen from 0.5 in the mid-1980s to 0.3% in the mid-1990s. There are more African scientists and engineers in the USA than in the entire continent. African Diaspora scientists can be encouraged to develop partnerships with African Science and technology institutions to bridge the science and technology gap. Developing a data base of African Diaspora Scientists and their respective competencies and matching them with respective African institutions should be one key role of the Diaspora Engagement Program.

8.3.5 Energizing civil society. The flight of professionals from Africa endangers the economic and political systems in several African countries. As its middle class crumbles and its contributions to the tax system, employment, and civil society disappear, Africa risks becoming home to even greater mass poverty. The African Diaspora Engagement program will have the added benefit of encouraging civil society, good governance, employment and improving tax revenue, if the Diaspora are given opportunities to invest in civil society based enterprises.

8.4 In search of solutions

8.4.1 Encouraging Brain Circulation. Throughout four decades of Africa losing its best and brightest, the world debated the semantics of the issue and focused almost solely on remittances, overlooking the implications of brain drain on human resources, institutional capacity, and health/social services. Diaspora Engagement Program can encourage brain circulation, whereby the Diaspora can bring enterprises that enhance the local educational and institutional capacity building for improved trade and investment opportunities.   AU countries should create special Diaspora Investment and Industrial zones that promote exchange of ideas, talent, information and business development activities towards competing in the global market.

8.4.2 Accessing Diaspora resources and connections. Efforts to stem Africa’s brain drain focusing on repatriation strategies were discouraging.  Studies have shown that repatriation will not work so long as African governments fail to address the pull and push factors that influence emigration. Moreover, the relationship between African governments and the African Diaspora remained a major barrier to finding solutions. It is more practical and beneficial if AU countries create environments to access Diaspora resources and connections, by creating win-win connections with institutions of Diaspora host communities. This will open opportunities for encouraging second-generation Diaspora children to be involved in their ancestral and AU countries development and investment opportunities.

8.3 Virtual participation

8.3.1 ICT enabled Virtual participation.   One potential solution to Africa’s brain drain is virtual participation. Virtual participation is participation in nation-building without physical relocation. It also shows promise as a means to engage the African Diaspora in development efforts. Mercy Brown of the University of Cape Town notes that virtual participation “… sees the brain drain not as a loss but a potential gain… Highly skilled expatriates are seen as a pool of potentially useful human resources for the country of origin… the challenge is to mobilize these brains.”

8.3.2 Diaspora friendly policies.   The development of Diaspora friendly policies that provides either double citizenship rights and responsibilities or Diaspora friendly investment opportunities can easily attract the resources, contacts and expertise of the Diaspora communities.   Questions remain, however. Will virtual participation work in a continent where government–Diaspora relations are adversarial, and information technology almost nonexistent, and where development needs are complex and require a sustained commitment?   Developing ICT based communication in an environment of good governance can attract the Diaspora to play their rightful place in their respective home communities. It is a two way street and AU countries should take the imitative to encourage the Diaspora involvement in policy formulations that will facilitate their active participation.

8.4 The Diaspora as stakeholder

8.4.1 Research based engagement. Recent developments in government–Diaspora relations show positive signs of change. A recent study,Semantics Aside: the Role of the African Diaspora in Africa’s Capacity Building Efforts, revealed emerging Diaspora efforts to assume a more active role in Africa’s development. The study, conducted by the Association for Higher Education and Development (AHEAD), a Diaspora group based in Canada, was funded by the International Development Research Centre (IDRC).

8.4.2 Raising Diaspora Awareness in virtual participation. Semantics Aside examined the potential of virtual participation to facilitate an effective and sustained Diaspora commitment to Africa’s development efforts. The study concluded that virtual participation has tremendous potential to channel the untapped intellectual and material input from the African Diaspora. Moreover, it recorded a growing awareness among the African Diaspora of its moral, intellectual, and social responsibility to contribute to Africa’s development efforts.

8.4.3 SMART Diaspora Engagement Programs. Africa has shown a growing will to reconcile with the African Diaspora. Both the New Partnership for Africa’s Development (NEPAD) and the African Union (AU) have formally recognized the African Diaspora as a key player in the development agenda of the continent. In 2003, the AU amended its Charter so as to “… encourage the full participation of the African Diaspora as an important part of the continent.” The African Diaspora Engagement program can fulfill the AU countries and Diaspora aspirations of involving all African children in their continent’s future. The program needs to be SMART, that is specific, measurable, appropriate, realistic and time sensitive to the interests and benefits of all stakeholders.

8.5 Virtual linkages

8.5.1 Skill and knowledge transfer networks. Another potential area where the talents of the Diaspora could be channeled is virtual linkages. Virtual linkages are independent, non-political, and non-profit networks facilitating skill and knowledge transfer and capacity building. These networks mobilize skilled Diaspora members’ expertise for the development process in their countries of origin. To date, 41 virtual networks in 30 different countries have been identified. Six of these are African, including the South African Network of Skills Abroad (SANSA) with members in 68 countries.

8.5.2 Joint Ventures of knowledge transfer networks. Individuals of the Diaspora also contribute through virtual networks, as visiting scholars, by investing in companies, and assisting in joint ventures between host and sending countries. According to author Damtew Teferra, Africa lags behind: “… This pattern of contributing to scientific and technological development is repeated for many Third World countries, though not… for most of Africa.” The lesson from the experience of Silion Valley South Asia entrepreneurs is worth mentioning here and making an effort to study it and replicate it whenever possible.

8.5.3 MIDA’s example in knowledge transfer. In 2001, IOM launched the Migration for the Development of Africa (MIDA) “to develop the potential synergy between… African migrants and the demand from countries by facilitating the transfer of virtual skills and resources of the African Diaspora to their countries of origin.” Based on the notion of human capital mobility through temporary, long-term, and virtual participation, IOM works with African and host countries and Diaspora members. MIDA has launched pilot projects in a number of African countries.

8.6 Next steps

8.6.1 Mobilizing the African Diaspora.   In November 2004, AHEAD, in collaboration with IDRC, organized an international Stakeholder Roundtable on Mobilizing the African Diaspora toward Development Efforts in Africa. The roundtable, held in Ottawa, Canada, brought together key stakeholders, including the IOM, Canadian government agencies, African missions, non-governmental organizations, and Diaspora groups to discuss brain drain in Africa and potential strategies for mobilizing the African Diaspora. It is critical to galvanize and connect with international resources that have already shown interest in galvanizing the African Diaspora.

Some of the issues identified included the need to recognize the African Diaspora as a key stakeholder in the current dialogue and efforts to address the issues of brain drain and capacity-building in Africa. Effective and sustained Diaspora engagement will require policy and resource commitments by key stakeholders, including international organizations, African governments, and host countries.

The emerging Diaspora movement to become more active in Africa’s development efforts, the growing political will in Africa to recognize the Diaspora’s potential contribution, and the possibilities created by information technology show that the African Diaspora is not, after all, a total loss to the continent.

 

IX. Understanding The African diaspora in the United States

9.1 Introduction

9.1.1 Deciphering The African Diaspora. The term African diaspora has many meanings and can be used to refer to any number of people of African descent that reside outside the continent. Joseph Harris identifies the African diaspora concept as consisting of three basic elements a “global dispersion (voluntary and involuntary) of Africans throughout history; the emergence of a cultural identity aboard based on origin and social condition; and the psychological or physical return to the homeland, Africa….[t]the African diaspora assumes the character of a dynamic, continuous, and complex phenomenon stretching across time, geography, class and gender.” (Harris, 1993) This wide and encompassing definition comes close to identifying the complexity and transnationalism of the African diaspora. However nebulous the concept, there is no other term that can capture the nuances of belonging and identity that can be found in the various communities of African descendant across the globe.

9.1.2 The IOM an AU definition of African Diaspora.   For official purposes, the International Office of Migration defines diaspora as “Members of ethnic and national communities, who have left, but maintain links with, their homelands. The term ‘diasporas’ conveys the idea of transnational populations, living in one place, while still maintaining relations with their homelands, being both ‘here’ and ‘there.’” The African Union defines the African diaspora as “consisting of peoples of African origin, living outside the continent, irrespective of their citizenship and nationality, and who are willing to contribute to the development of the continent, and the building of the African Union.”

9.1.3 East and West dispersal of African people.   Although, a significant spreading of the African descent population was by way of the slave trade, the dispersion of African people throughout the world should not be solely attributed to that heinous era. African civilizations have long had contacts with civilizations in the East before the West discovered Africa and Asia. There is evidence that there was thriving trade between African civilizations and civilizations in Asia such as India and China, dating to the time before Marco Polo’s venture into ‘the Far East’. Civilizations in Africa had contact and trade with what we know today as the Middle East since before the advent of Christianity. It is a well-accepted fact that Africa, the Middle East and Asia were part of a complex trading network going back to 500 C.E. This extended interaction also included cultural diffusion, hence the remarkable cultural similarity between these regions.

 

9.1.4 African migration to the Americas and the Caribbean. The presence and impact of Africa in the Americas and the Caribbean has been examined as part of the triangular trade between Europe, Africa and the Americas. Much of the study has focused on the Eastern coast of the Caribbean within the context of the slave trade. However, recent work has discovered African presence in Mexico, Argentina and countries on the Pacific Ocean side of the continent. There is more and more attention being paid to the legacy of African heritage to contemporary cultural icons such as the Tango and carnival. At the end, what all of these communities, stretching from Asia to Latin America, have in common is their linkage to Africa. No matter how removed in time or space, each has retained a heritage that can be traced back to the continent.

9.1.5 Diaspora Segmentation: (Ancestral/lived/next generation/returning/affinity)

 

Based on these definitions, the contemporary African diaspora is wide, and varied ; therefore, there is a need to segment the diaspora to better understand the unique characteristics of each community. The lived diaspora consists of individuals born in the home country but who now live permanently or temporarily in another country. The ancestral diaspora consists of individuals with ancestral links to the home country. Ancestral diaspora includes second and third generation diaspora members and those with links going back further.

9.1.6   Engaging the future Diaspora. The next generation diaspora consists of younger members of the diaspora typically under the age of thirty-five. Next generation diaspora members are important to engage in order to ensure the sustainability of diaspora engagement. There is also the returning diaspora who are diaspora members who have lived in a host country, and who have come back to the home country. Finally, there is the affinity diaspora, nationals of other countries who worked or studied in the home country but have since re-migrated. (Aikins, 2011) Affinity diaspora includes all those, regardless of heritage, with interest and good will towards the home country.

9.2 African diaspora in the US

9.2.1 Poor Census tracking of Africans in USA. In attempting to understand the African immigrant population in the US, one has to contend with a scarcity of data. There is a limitation on the data available as Census tracking has only recently began to diversify its race/ethnicity options and the process of collecting foreign origin data has been slow in quantifying those from the African continent. Census race/ethnicity options are based on self-identification and respondents, given the limited options, most often opt for selecting a category that comes close to identifying them in the absence of exact matches, while some may skip the question entirely. Recent changes that have increased the sub-category for race/ethnicity options have been aimed at Asian and Latin American classification but the option for Africa remains narrow.

9.2.2 Black or African American.   The option which previously was listed as “Black or African American” now reads “Black, African Am, or Negro”. Hence, the redesigned 2009 census survey offers respondents option of identifying as: 1-White, 2-American Indian or Alaska Native,3-Black, African Am., or Negro 4-Not of Hispanic, Latino, or Spanish origin (with sub-options of Cuban, Mexican, Mexican Am., Chicano, Puerto Rican, another Hispanic, Latino, or Spanish origin – with fill in for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,) 5- Asian Indian, 6- Chinese, 7-Filipino, 8-Other Asian (Print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on) 9-Japanese, 10-Korean, 11-Vietnamese, 12-Native Hawaiian, 13-Guamanian or Chamorro, 14-Samoan, 15-Other Pacific Islander (Print race, for example, Fijian, Tongan, and so on.) and finally respondent is provided with 16-Some other race. Where is the second generation Diaspora African American is the real question?   It is likely to be lost in all these classifications, unless a special effort is made to identify them.

 

9.2.3 Challenges of tabulating future generations of African immigrants.   Census survey provides an opportunity for US born respondents to detail their ancestry, which could be means of identifying second and even third generation African immigrants. However, for the most part, the Census survey only compels those identified as ‘foreign born’ to provide ancestry information. ‘Foreign born’ is defined simply as “people who are not US citizens at birth.” Those born in the US are asked to report the state of their birth while those born outside the US are asked to report the country of birth. Therefore, Census does not have a means of tabulating second-generation African immigrants as they can for Asian and Latin American immigrants as evidenced by options above. However, as the Census survey is continuously evolving there is a window of opportunity to devise a method for capturing this data on second and third generation immigrants in future surveys.

 

9.2.4 About half of African immigrants not documented. In addition to the difficulty in identifying some first and the entire second generation African immigrants, there is also the fact that many undocumented Africans have not taken part in the Census and therefore are not part of this data set. Even though the Census does not include questions on residency status, fear and distrust prevents many undocumented residents from taking part in this exercise. It is estimated that there are almost as many undocumented Africans as those with legal status in the US. This not only underestimates the population count but also impacts the accuracy and quality of sample data of the African immigrant population.

9.2.5 Census underestimation of the African immigration population. Many arrive on tourist and temporary visas and opt to remain in the US to pursue legal residence. In the process, because of lack of funding, proper guidance, and understand of the system, they end up falling out of status and remain invisible. Others are forced to live in the informal undocumented economy and manage to exist for decades without detection by authorities. Antidotal evidence suggests that these undocumented African immigrants add significantly to the overall number of Africans in the US. Weak outreach and education on the Census and lack of advocacy on behalf of the African immigrant population has meant that there is a general lack of understanding among African immigrant groups regarding the importance of responding to the survey as well as the need to correctly fill out the questionnaire. All of these conditions result in a significant underestimation of the African immigrant population in the Census. “Based on national data, the “true” African population in each metro area including immigrants and their descendants might be 25% higher than our count. The African American population may be slightly overestimated for this same reason”. (Logan, 2003)

 

 

 

9.3 The Demographics Paradigm.

Data from the 2010 Census results show that from a total of 39.9 million foreign born in the US 1.6 million were from Africa. Of the total US Black/African-American population, 38.8 million (38,874,625), foreign-born make up 3.3 million (3,312,352). West Africa had the largest number of immigrants with over 500,000 followed by East Africa at about 475,00. Nigeria had the largest number of immigrants with over 200,000, followed closely by other east Africa[1] at 184,040 and Ethiopia at a little over 170,000.

 

9.3.1 Racial breakdown of the African Immigrant. The racial breakdown of the African immigrant population is 20% White Africans, 74% Black Africans and almost 3% Asian Africans. The population is largely male with the median age of 38, with 63% within the highly productive age group of 25-54 years while 44% are in the 24-44 age group. Only 20.8% are under the age of 25 years.

9.4 Education and income

9.4.1 Impact of Diversity Immigrant Visa Program. The level of training and education of the average African immigrant in the US is higher than that of any other immigrant group, including those arriving from Europe and Asia. This is mainly due to the education/ training requirement of the diversity visa lottery – an important visa source for African immigrant population. Established by the Immigration Act of 1990, the US Diversity Immigrant Visa program offers certain persons from countries with low rates of immigration to the United States the opportunity to enter a “green card lottery” administered by the US Department of State.

9.4.2 DV Immigrants from Africa. This program has specific education and training requirements that has significantly impacted the recent development of the African diaspora in the US. [2]In 2010 DV lottery drawing Africa accounted for 48.0% (23,903) of the 49,763 persons who obtained legal permanent residence through this program. Although DV lottery immigrants make up only a small share of persons granted Legal Permanent Resident status each year (4.8% in 2010), DV immigrants from five African countries — Ethiopia (3,987), Egypt (3,447), Nigeria (2,937), Kenya (2,279), and Ghana (2,086) — collectively accounted for 14.5% of all Africans who obtained legal permanent residence in 2010.

9.4.3 Increasing academic professionals emigrate from Africa. The nature of African migration and the DV system account for the high level of education and skill of the African diaspora in the US. Various international studies estimate that about 23,000 qualified academic professionals emigrate from Africa each year. The biggest migratory flows from Africa to the United States are from Egypt, Ghana, South Africa, Nigeria and Ethiopia with more than 60% of immigrants from these countries having some level of tertiary education. In the US, African immigrants have an average educational attainment of 14 years, higher than the 12.6 for Afro-Caribbean or the 12.4 years for African Americans, and higher than Whites and Asians as well.(Logan, 2003)     Of those born in Africa residing in the US 88% have at least a high school diploma (up from 86.4% in 2000 census) nationally its 85.6%, Asia 83.8%, Europe 84.9%.

9.4.4 Gender and race based income disparity.   Income disparity based on gender and race, which can be found in the general US society, greatly impacts the earning ability of African immigrants, even though many possess comparable and even sometimes, higher level of training. African women immigrants bear the brunt of this differentiation with a 23% gap between African born male and female income in 2000, while the gap was 15% in 2010. In the 2010 Census,56% of those born in Africa earned at least $35,000 or more, down from 57.5% in 2000 and only 19% earn over $75,000, down 23.6% in 2000. The median family income in 2010 was $45,926, down from $48,305 in 2000.

9.5 Engagement: Effectively engaging the diaspora

9.5.1 Stakeholder based Action Plan. In developing an action plan for diaspora engagement home countries have to first determine if they will in fact invite this community to the table as a stakeholders. There are many nations that have opted to not engage the diaspora in any capacity due to a number of reasons while others have wholeheartedly embraced theirs. An honest national dialogue needs to take place in which a decision to include the diaspora is reached openly and with attention to transparency.

9.5.2 Shared cultural heritage. Placing such engagement within the national dialogue and stating the nature of the relationship with clarity and with no ambiguity will assist in reducing resentment and friction between nationals and diaspora returnees. There will inevitably be a sense of resentment from nationals who will feel that diaspora community is receiving preferential treatment, even in cases where that is clearly not the case. A process for reducing such resentment is to present the relationship within the context of shared cultural heritage and building confidence among all the parties that this is a common effort for the national good. This would mean that general diaspora engagement decisions should not leave nationals and the diaspora feeling that it was top down decision but rather a communal effort with all parts contributing towards the greater good.

9.5.3 Integrating Diaspora and home population interests. A fundamental component of this confidence building exercise is clearly outlining responsibilities and rights of all stakeholders, the home country, the government, and the diaspora, as this will be a mutually beneficial relationship with each party bringing something to the partnership. Home countries need to clearly state what is desired from the diaspora and it is important that this goal extend beyond activities that treat the diaspora as an ATM/cash machine. This would mean that home countries need to clearly state which areas are available for diaspora engagement. There also needs to be clarity on the level of involvement and inclusion. Is there a desire to maintain cultural ties through a strictly cultural and linguistic heritage interaction or is there an opening for diaspora community to take on full citizenship rights and responsibilities with a dual citizenship option; or is the engagement going to be somewhere in the middle with different levels of engagement.

 

9.5.4 Diaspora as a dynamic group with diverse identity. It is important to be cognizant of the fact that the African diaspora is a community of individuals with personal aspirations endowed with multiple identities rooted both in their home countries and places of residence. Before designing a diaspora engagement policy, home countries should thoroughly understand their diaspora and the needs and assets of their diaspora. Creating an interactive database that classifies the Diaspora asset by talent, resources, connections and potential that can be matched with AU countries’ sustainable development is needed for appropriate matching of interests and competencies, etc. This data base needs to be interactive and   frequently updated as circumstances at both ends can change with time.

 

9.5.5 Diaspora as transnational communities.   This should go beyond numbers to deeper analysis and study to determine if the diaspora community has the capacity to engage as well as to shed light on the important factors such as motivation and willingness. Initial analysis should include an understanding of the transnational character of the community, the socio-economic make-up and most importantly the impact of gender, race, and class in promoting and/or deterring inclusion in host societies. As transnational communities, diaspora members’ affinity to where they come from exists alongside their desire to create a home in their new community. The link to their home country is primarily driven by the need to maintain link with home through keeping abreast of news and situations there as well as making financial investment in making periodic trips home. However, this is not an indication that these communities are able and willing to commit to long term sustained engagement with their home countries.

9.5.6 Social and economic integration. A better indicator of this commitment is the extent to which a diaspora community has ‘settled’ or integrated into a host country. Factors such as gender, race, and class are critical in determining the level of social and economic integration of individuals, which can be central in assessing the bond they feel with their home country. Antidotal evidence suggests that those that are more integrated into their new community are more likely to invest in securing their lives and building a foundation for their children where they reside, leaving very little opening for home country engagement. However, when newcomers are unable to comfortably or fully integrate into their new communities than the homeland ‘pull’, to belong and retain their identity is greater. For instance, a study found that 89% of African immigrant respondents indicated resentment of the racism in the US and 80% felt a sense of isolation from their home country and those they left behind. (Apraku 1991) Therefore, it would be important to understand to what extent members of the African diaspora are fully integrated into their new home.  At times, those who are not well integrated in their new host country could be the most productive Diaspora in their respective home countries. Every one should be assessed according to his or her specific circumstances, etc.

9.5.7 Developing structured engagement paradigm. A structured and individualized engagement perspective would provide a window into understanding the future , specifically if they have mapped out for themselves, and by extension their children’s potential for inclusive home country engagement. It is important to understand how each Diaspora group envisions engagement with their home countries. Will it be solely focused on helping and keeping in contact with relatives, or will it belong to making commitments to national development goals or even return to their country of birth. Understanding these vital elements will allow home countries to develop a tiered and structured engagement paradigm that allows each stakeholder to select a level engagement best suited to their realities.

9.5.8 Promoting win-win engagement options. On the other side of the equation, home countries are still grabbling with the notion of a diaspora; its meaning and national implications. Various countries have tried to engage the diaspora in a number of creative ways but the impact and success of these initiatives have been difficult to quantify. Just as there are pitfalls to generalization and homogeneous identification of the diaspora, a continent-wide uniform engagement model with the diaspora and its role in domestic affairs would be difficult to craft. However, as a primary stakeholder in this engagement, home countries are the drivers of any engagement activities and need a clear understanding of national priorities, developmental, economic, political and social, in order to assess any role, if any, the diaspora would have in domestic affairs. In the end, developing win-win engagement options that satisfies the interests of all stakeholders is critical. Many consider providing opportunities for double citizenship is most useful as it makes their respective benefits and responsibilities similar to every other citizenship, making the movement of people in and out of the continent part of the free movement of ideas, people and products that would bring the true renaissance for Africa and Africans around the world.

 

9.6 Engagement foundation

9.6.1 Diverse models of Diaspora engagement. The foundation for a successful diaspora engagement process is an understanding of the dynamics and diversity of the Diaspora populations and associated basics principles of social interactions. Chief among these is that diaspora is a large encompassing term and many people may fall into this category but not all of them relate to being members of the diaspora. Some do not even want to be associated with the term as it has negative implications in their understanding of the root word that means “scattering and dispersion”.   At present, the term is also used to describe a Disrtributed Social NETWORK SOFTWARE> The African continent is diverse and each country has unique socioeconomic and political conditions, and most importantly, different history and relationship with their diaspora. Below are fundamentals for engagement (Aikins, 2011):

·       Win-win engagement model. Given the wide and diverse nature of the African diaspora it is important to remember that one size does not fit all when it comes to engagement policies. What may work in one project or with one sector of the diaspora will not work with another.

·       Build a mutually beneficial model. Example of mutually beneficial model is networks, which are important for sharing information but also, provide members an avenue for educational, social, cultural, and professional advancements.

·       Define the role of all stakeholders. Most important will be to decide if the state will be implementer or facilitator of diaspora engagement.

·       Engage each interest group. Avoid the echo chamber by expanding circle of diaspora members involved in activities. It is important to involve and include people from outside usual circle of diaspora activists in order to ensure circulation of fresh ideas, new contacts, etc.

·       Build in rewards and recognition (both individual & group). The efforts of the diaspora should be recognized by a rewards system, which could be special conference, annual award, etc.

 

9.7 Engagement model

 

1. Mass Vs. Individualized Engagement Model. Although there are various engagement models for diaspora activities there are two bookend models – one for mass engagement and the other for select individualized engagement – that can be essential to diaspora engagement. (Aikins, 2011) The alumni model consists of mass mobilization. It is based on the university alumni model where universities engender loyalty and raise funds from their alumni who build powerful networks that is beneficial to the members. This approach centers on development (discussed later) and running campaigns is an important model to follow.

2.Alumni Versus elite actors. The second model, the overachiever model, involves targeting elite actors and individuals who can influence decision-making process. Among those that are in this category are Tipping agents who exist largely in the business arena and are those who can nudge (tip) a decision in a certain direction. These are diaspora members who are inspired and passionate individuals who act as ambassadors and are the ‘eyes and ears’ on the ground. They should be engage by keeping in constant contact and informed of developments in home country and made to feel part of the national team.

3. Mobilizing change agents. There are also the first movers who will usually be the first to engage in activities in home country (investment, activism, etc.). They are generally leaders in their industry and their engagement will change expectations and perceptions about home country by their peers both in home country and in the diaspora. Finally there are the change agents who bring new ideas, investment and technology thereby directly contributing to development.(Aikins, 2011) An example of a change agent for the African diaspora is Mohammed Ibrahim who with Celtel impacted mobile phone development and then again with his foundation is impacting philanthropy and governance.

 

9.8 Development model

 

1. Research driven engagement model. The development model (a four-step process) is a powerful tool for engaging key diaspora members and creating a successful network. First step is research which helps to understand who, what, where of individuals and helps to identify and evaluate people who can be leaders. Research should be used to conduct broad outreach, segment individuals by interest as well as rate and screen each contact for future engagement. Research would lead to cultivation, a continuum that moves members from informed understanding, to sympathetic interest, to engagement, to commitment and finally to passionate supporter.

2. Stewardship for Diaspora Networks. This is a campaign to win the ‘hearts and minds’ of diaspora members by building on the emotional bond and building trust relationships. Effective engagement requires ‘an ask’ and that would be in the solicitation stage. This would entail engaging members with specific projects over a limited time in small groups partnered with strong home institutions. Stewardship is an important component of this model. It is important that diaspora participants are appreciated and recognized of their contributions. Such recognition could be in the form of invitations to conferences, hometown visits, special awards, etc. Evaluation and assessment is also another important form of stewardship for diaspora networks. It is important to evaluate the successes and failures of projects and to provide members of the network with evaluative feedback on progress. As retention of key diaspora members ‘engagement is of utmost importance, stewardship is a critical part of this 4-stepprocess. (Aikins, 2011)

9.9 Diaspora advocacy

 

1. Advocacy for AU Countries. Advocacy for home country is the most important role a diaspora community can play. The importance of this role in the US can be illustrated through the diasporas of India, Israel, and the Armenian diaspora who all have pleaded their home country’s case in the halls of congress and the White House. Although all diaspora groups can advocate for the home country two groups have unique positioning to do this successfully: affinity diaspora and ancestral diasporas. This is largely due to the fact that both diaspora groups have intimate knowledge of the home country but they also have unique insights and access in the host country. They have social capital and political capital which makes them uniquely placed to influence government, media, private sectors, and other prominent groups. But this is only effective if done as collaborative effort with the home country.

2. Branding and promoting AU countries. Affinity diaspora members can also play a fundamental role in promoting a country’s interests and branding. They have deep understanding of the core strengths and values of the country because they’ve worked and lived there. They also have greater knowledge of how things work in their own country and therefore can communicate in terms that their peers and countrymen can understand, making them great ambassadors. Among the African diaspora the Ethiopian diaspora has the most influence and the advocacy experience. Although the relationship between the Ethiopian diaspora and the home country is contentious at times, the increased political engagement of the diaspora provides a unique challenge and opportunity for Ethiopia to develop mechanism for collaboration with this diaspora while at the same time responding to its criticism.

 

9.10 Case studies of engagement models

1. The cultural heritage pathway. Currently, the most common method for dealing with diaspora engagement is through an office dealing with expatriate/diaspora affairs located in the Foreign Ministry offices. These minimally staffed offices attempt to manage and facilitate diaspora engagement by filling needs for experts in teaching institutions, facilitating housing and land purchase by diaspora residents, coordinating investment issues as well as developing and maintaining communication with diaspora community. The various models for diaspora engagement that can be found across the continent attest to the fact that the African diaspora is as diverse as the continent from which it originated. While some focus on cultural heritage as pathway to economic engagement and investment others have been selective and structured in channeling diaspora involvement. The success and failure of these various models will require extensive analysis but the mere fact that structured engagement exists across the continent is testament to the importance of the diaspora and the need to constructively involve the community in national affairs.

2. Investment and knowledge transfer model. Ethiopia, within the Ministry of Foreign Affair, has created the Ethiopian Expatriate Affairs (EEA) division charged with building “a warm and constructive relationship between Ethiopians in diaspora and their country.” The office serves as a liaison between different Ministries within the government and Ethiopians in the diaspora to chiefly encourage the active involvement of the diaspora in socio-economic activities of the country. At the same time Embassies in countries where there is a significant Ethiopian diaspora, a consular officer is charged with facilitating diaspora engagement mainly dealing with investment and knowledge transfer issues. This office assists those in the diaspora in establishing a business; property rights issue as well as a myriad of other investment related issues. Ethiopia has not granted dual citizenship rights but has extended all rights, excluding voting and election to political offices, to those that have Ethiopian origin, including those with only one Ethiopian parent.

3. Double Citizenship Model. On the other hand, Morocco, which has the largest diaspora community, with 3.3 million Moroccan living abroad (10% of the Moroccan population) and is the highest recipient of remittances, has developed several vehicles for engaging with its diasporan community. Officially the Ministry in Charge of the Moroccan Community Residing Abroad along several other foundations including Hassan II Foundation for Moroccans Resident Abroad are responsible for diaspora engagement. Official Moroccan efforts are geared towards ensuring that first, second and even third generation Moroccans residing aboard are aware of their cultural heritage and retain some knowledge and understanding of the language.

4. Win-win cultural and economic model. The Foundation regularly dispatches Moroccan Arabic instructors to diaspora communities mainly in Europe, to provide instruction to those in the Moroccan diaspora. It also hosts summer camps for Moroccan ancestry children in Morocco where they will receive instruction in Arabic and Moroccan history. The premise of this engagement is that closer cultural ties will lead to economic engagement and investment by the diaspora. The Ministry in Charge of the Moroccan Community Residing Abroad is the official government arm that facilitates administrative procedures for those residing abroad. It’s charged with recording births, deaths, marriage and channeling property rights issues and other request processed by other ministries in the government. Its important to note that Morocco granted dual citizenship rights to those that have at least one Moroccan parent. Therefore, Morocco has developed a sophisticated multi-faceted system which includes a heritage awareness component for sustained engagement with its diaspora.

5. The Economic Model. Diaspora remittances designed to support families, relative and communities has grown to the tune of $40 billion reaching up to 49% of GDPs in some African countries, higher than Foreign Aid and Foreign Direct Investment figures.

 

 

9.11 Remittances as development aid

$40 Billion Remittances. One of the most visible and significant contributions to home countries by the diaspora has been the support they provide to their families, relatives, and communities.

This support has been in the form of remittances, whose combined total is approaching the $40 billion range. Remittances now make up a significant percentage of GDP in most African countries; Guinea Bissau 48.7%, Eritrea 37%, Cape Verde 34.2%, Burundi 22.8%, Algeria 4.7%, Morocco 11.2%, Ghana 6.6%, and Ethiopia 4.4%.

In 2009 the entire continent of Africa received $38.6 billion in remittances with top 5 recipients, by volume received, being Morocco ($6,116), Algeria ($5,399), Nigeria ($5,397), Egypt ($3,637), and Tunisia ($1,559). Remittances to Africa far exceed developmental aid and for many countries the flow of remittances is also higher than the foreign direct investment. Recent data has shown that this source of funding is more stable than other capital flows and countercyclical, increasing funding during downturns or crisis in receiving countries.

The flow of remittances to Africa has had a significant direct impact on the lives of recipients especially the estimated 40% of recipients who live in the rural areas. These recipients have been able to supplement their household resources to not only increase consumption but to also provide working capital, which in turn has a multiplier effect on the household and the community. Based on limited data, it has been found that those who receive remittance tend to stay in school longer, thus increasing their education level, save twice as much as the general population and have overall higher income then those who do not receive remittance. Hence, this supports the premise that remittances have a direct impact on poverty and that remittances received on the household level tend to stimulate growth. However, the full developmental potential of remittances has yet to be understood and tapped.

9.12 Recommendation

 

1. ICT as a medium for Diaspora engagement. Given the challenges on the ground, economic limitations of many countries across the continent and the vastness of the African diaspora, Information and Communication Technologies (ICT) fits the bill as an accessible scalable and efficient medium for diaspora engagement for development. ICT also provides the support and foundation needed to allow Africa to leapfrog into the information age and address pressing issues of socio-economic development and global integration. Successful deployment of ICTs can bridge the gap between the Africa diaspora and home countries, facilitate development, exponentially improve the lives of millions, and most importantly it is the key to Africa’s ability to be globally competitive and build a knowledge-based economy. Moreover, ICT is a tool that can accommodate the diverse unique needs and goals of each nation while building a common transnational system.

2. ICT as a medium for efficiency, growth and governance.   Development of ICT increases government efficiency, provides access to new markets or services, creates new opportunities for income generation and improves governance and gives people a voice. Moreover, ICT contributes to economic growth through increasing productivity across all sectors; facilitating market expansion beyond borders, lowering costs of and facilitating access to services, notably in administration, education, health and banking; providing access to research, development of ICT products and services; contributing to better governance, a prerequisite to growth, through increased participation, accountability and transparency. By using Africa’s success story with mobile telephone it can be deduced that when ICT becomes affordable to low-income users, new employment, micro-entrepreneurial and social development opportunities emerge. (OECD, 2008)

3. ICT Infrastructure for traditional and new technologies. The challenges for using ICT for development in Africa are many and most are, in large measure, under the domain of government action. ICT “consist of the hardware, software, networks and media for the collection, storage, processing, transmission and presentation of information (voice, data, text, images) as well as related services. Both traditional technologies (telephones, radio and TV) and newer technologies (such as computers and the Internet) are usually included in the concept of ICT infrastructure.” The relative success of using ICT to engage the diaspora will depend on ability to successfully deploy ICT and regulatory policies that will provide for unrestricted ease in accessing the Internet. Some of the challenges include infrastructure, not only ICT infrastructure but also electricity, access, which includes public access points, access to content, adequate capacity and supportive enabling environments which includes regulatory frameworks and an overall policy framework. Additional challenges can be found in finding a balance between technology and the need for local development as well as the ability to meet demands of the local population in other areas while developing technological capacity.

a.     Harness existing ICT to engage diaspora. Home countries can utilize existing infrastructure and systems to begin engaging diaspora and later update their tools and methods as capacity increases. ICT access will enable use of online tools and systems to exponentially increase the impact of each diaspora participants, as a skill multiplier in critical sectors, and simply as a tool for sharing information.

b.     Prioritize implementation of alumni model online diaspora outreach. The AU could develop and online diaspora engagement portal. Primary focus will be to provide information to diaspora members. This would have a web interface that is easy to navigate and download with simple modern design website with multi-lingual capability and will be a source of news from the home country. Website should allow people to register, sign up for email notifications, etc. The added benefit to this is the ability to conduct ‘research’ on diaspora members and identify those that are interested for greater engagement. It allows the diaspora member to determine his/her own level of involvement upon registration. AU and home countries will then have a credible list of individuals who are interested in moving beyond the alumni model to the next level of engagement.

c.      Encourage home countries to create online presence specifically targeting the diaspora. African countries should boost their online presence and provide as much information as possible on their websites. This can be in the form of a special website on diaspora affairs that collates and distributes relevant information to the diaspora in one location. There is also the option of providing a special diaspora section on the websites of relevant ministries and government offices. Information on these pages should be geared towards linking diaspora members to projects or volunteer/employment opportunities in the home country. For instance, opportunities for scholar-in-residence, internships, and consultancies could be announced through such a portal.

d.     Recruit top level IT diaspora experts to advice and secure financing for a continent-wide ICT plan. Once deployed, ICT will be utilized by both the public and private sector that in turn will have differing specifications and needs. Africa’s existing transnational ICT plan could benefit tremendously from input of IT and ICT professional in the diaspora who have decades of experience in rolling out ICT projects in US. This technical knowledge would be key to developing a useable model for Africa and their cultural and linguistic experience would be an added advantage.As many of these professionals are also involved in funding ICT projects they can also be given the mandate to secure funding for the projects they advise on using the resources available to them.

9.13 Conclusion

1. Diaspora as economic powerhouse. The African diaspora in the US is an economic powerhouse and a potential partner for development. The highly selective immigration policy has chosen the brightest and boldest from the home country. Hence, today the diaspora is a reservoir of specialized skills and knowledge that is more valuable than actually dollars they send back. While the sheer magnitude of the remittances flowing into home countries could tempt governments to develop a model of engagement that would only tap into these funds, it is important that diaspora engagement not deteriorate into a one-way economic relationship. Beyond the documented economic and financial impact, diaspora communities can also be the medium for positive social change through adaption of new attitudes that will be more conducive to development.

2. Diaspora for knowledge transfer.   Moreover, knowledge transfer should be a corner stone of any diaspora engagement as it will mitigate previous decades of brain drain and will allow the continent to take advantage of technological developments and leap frog from past obsolete mechanisms to advanced industrial and scientific economy. African countries can take a lesson from India where Silicon Valley versions of tech zone cities and industrial production zones have been developed and built largely based on skills of the Indian diaspora and financed by networks within the global Indian diaspora. Similarly, African countries can also develop a diaspora relationship that will grow industries and attract capital from the larger African diaspora as well as from those within the network of the diaspora constituents.

3. Integrating Diaspora with AU countries. All good policy initiatives start from well-informed data study. Before any policy formation, in some cases adjustment to existing policy, takes place each country should make an effort to know their diaspora, the African diaspora. Home countries should decide the level of integration to be offered to the diaspora community. Early on a firm decision should be reached on whether the diaspora community will be included in all aspects of national affair or if it will be to specific sectors. This would mean understanding the implications of granting dual citizenship, voting rights and access to the national political stage.

4. Interactive Diaspora engagement as key stakeholders. Some nations will be hesitant in extending such overarching rights and these terms should be clearly understood and developed into policy prior to commencing engagement. At the same time, nations should also have a well thought out development plan with a diaspora engagement component. It would be more productive to invite the diaspora to the table and rather than asking ‘how can you help us?’ to providing areas that could benefit from diaspora engagement and ask ‘where can you help us?’ Therefore, it would be far more productive and efficient to provide development areas that the diaspora could engage in rather than relying on the diaspora to match their skills to development agendas they may not be well versed in or understand.

9.14 References:

1.     Harris, Joseph E., Introduction, Global Dimensions of the African diaspora, (Washington, DC: Howard University Press) 1993

2.     Skinner, Elliot P. The Dialectic between Diasporas and Homelands, Global Dimensions of the African diaspora, (Washington, DC: Howard University Press) 1993

3.     Aikins, Kingsley and White, Nicola, Global Diaspora Strategies Toolkit: Harnessing the power of global diasporas (Dublin, IR: Diaspora Matters), 2011

4.     Africa Partnership Forum Support Unit, ICT in Africa:, Boosting Economic Growth and Poverty Reduction, Organization for Economic Co-operation and Development (OECD) 2008

5.     Langmia, Kehbuma “The role of ICT in the economic development of Africa: The case of South Africa,” International Journal of Education and Development using Information and Communication Technology (IJEDICT), 2005, Vol. 2, Issue 4, pp. 144156.

6.     Logan, John R. and Deane, Glenn,Black Diversity in Metropolitan America, Lewis Mumford Center for Comparative Urban and Regional ResearchUniversity at Albany, 2003

7.     Apraku, Konadu Kofi, African Émigrés in the United States: A Missing Link in Africa’s Social and Economic Development, (Westport: Greenwood Publishing Group) 1991

X. The African Diaspora Health Initiative /ADHI

10. 1. African Diaspora Health Initiative. The AUM to the USA launched the Strategic Framework for the Africa Diaspora Health initiative in September 2008 under the patronage of H.E Jean Ping, the Chairperson of the African Union Commission with the participation of high-level representatives from the World Bank, the African Development Bank, the World Health Organization, Africare and the West African Health Organization. These sessions resolved that Africans continue to suffer from a high prevalence of disease burden, stemming primarily from a confluence of factors that has resulted in weak health systems and lack of infrastructure, that includes limited institutional and human resource capacity resulting in overwhelming shortages of skilled healthcare workers at all levels.

10.2. Quality human capital development. The lack of skilled and professional human resource development is aggravated by the chronically under funded, poorly resourced health services, that is undermined with poor coordination, health planning capacity and unreliable financing of health and social programs. The African Diaspora Health Initiative addresses these challenges in creative and win-win strategies by integrating local and Diaspora resources. The use of development and investment experts and lessons from other similar situations can be reviewed for potential direction and policy formulation. The AU mission can compile the lessons learned from other successful Diaspora engagement projects and programs that are in existence in different parts of the world to develop appropriate models that can work for the African Diaspora populations. These resources can be regularly updated and meaningful transformations implemented via ICT (Information, Communication Technology) and SMN (Social Media Network) based digital, cyber and Internet audio-visual and print multi-media research and communications.

10.3. Connecting with AU Countries perspectives.

3.1 Institutional connection. It appears in principle the African ministers are committed to strengthening health systems by developing social protection systems, aimed at promoting greater access to health care services while protecting them from debt traps due to health emergencies. It was also agreed that the African Diaspora, considered the sixth Region of the African continent, is a critical resource for addressing African health challenges. A reliable and forward-looking institution is being designed to address this pressing issue. Connecting Diaspora institutions with other AU institutions is critical to develop a common shared value and interest that is mutually beneficial to all stakeholders.

3.2 Steering Committee for African Health. A steering committee was established consisting of eminent personalities in the fields of health and economic development, with Diaspora representatives from the US, Africa, Canada and the Caribbean. The ADHI would focus on clinical, public health, and health workforce issues, on the continent, and mobilize clinicians, public health experts, dentists, pharmacists, nurses, laboratory technologies, scientists and others, to work and or contribute their skills and connections in Africa. The process can be made mutually beneficial via win-win partnerships that make each party a viable and reliable constituent and stakeholder.

10.4 The Vision

The vision of ADHI is to promote a healthy and prosperous Africa that is free from disease, disability and premature death.

10.5 The Purpose

The purpose of ADHI is to link Diaspora health expertise with specific health needs in Specific geographic locations in Africa.

10.6 The Mission

The mission of ADHI is to advocate for improving health outcomes in Africa, both between the Diaspora and AU Countries, by supporting best practices in clinical, and public health towards reducing the heavy burden of disease, and premature death, and by supporting health promotion and disease prevention activities.

10.7 The Progress

In January 2010, the AU Mission to the US and the ADHI Steering Committee with US Doctors for Africa, initiated the AU Standards and Certification Training Program (AUSCTP) to be implemented by AU Health Ministers by 2011.

10.8 Goals of AUSCTP

The AU Standard and Certification Training Program will contribute to the ability of African nations to realize MDG 3, 4, and 5– namely promoting gender equality, empowering women and promoting maternal and child health (reduce child morbidity and mortality and improve maternal health). It is expected that the AU SCTP will Enhance the capacity of African countries to deliver a set of uniform and sustainable health services with a focus on pre-natal, maternal and child health care; towards achieving universal access to reproductive health and reduce the maternal mortality ratio by three quarters.

10.9 Strategies of AUSCTP

AUSCTP will develop the standards and curriculum by a collaborative action committee consisting of Africans and US based academic/medical institution and Diaspora professionals who will incorporate US and African medicinal practices and standards at institutional level as well as region-to-region Best Local Practices (BLP).

10.10 Standardized curriculum. The certification process will be standardized by using a curriculum that focus on Basic Sciences on safety practices, First Aid, Basic Anatomy, Physiology, Pathology, Microbiology, blood borne and respiratory infections, pathogens, pharmacology; Universal Precautions, Infection control, Clinical Sciences-Body System Review, CPR (Cardio-pulmonary Resuscitation), BLS, Blood borne pathogens, Midwifery, patient history, patient assessment, vial signs, medications, allergies, shock, trauma; Risk Management and Emergencies-common injuries-head and neck, chest, abdominal spinal, pelvic and limb injuries; Basic treatment/care- bandaging/splinting, hemorrhage cessation techniques, sterilization, Emergency childbirth, triage, rapid blood tests and rapid HIV testing; Care for older adults, care of patients with common conditions such as neurological disorders, hypertension, diabetes, levels of consciousness, therapy and rehabilitation services, etc.

10.11 AU Medial Seal of Certification. Upon successful graduation, each participant will be awarded a diploma, and given basic supplies, and equipment for use, as a certified practitioner. The practitioner will be given a professional lab coast with AU Medial Seal of Certification.   The practitioner will be expected to complete annual Continuous in-Service Training to validate the competency needed for maintaining the AU license on an annual basis.

10.12 BLP Research Study

The BLP research study will be conducted by a committee composed of health care professionals and consultants with data from sources such as Ministers of Health, UNFPA, UNICEF, WHO, UNDP and specialized NGOs, consultant team, academic researchers, Planned Parenthood, Family Health International, The World Bank, Local NGOs, local traditional medicine practitioners, and others as needed.

10.13 Assumptions of AU Standards & Certification Program

The AU Midwifery and Traditional Birth Attendants (TBAs) training program will be Africa- wide, Africa owned and led by Africa with the intention of empowering women in a holistic manner consistent with the Millennium Development Goals. There is a strong political commitment to the AU Standards and Certification Training Program. It is considered to be feasible by the Diaspora Scientific Community. This will be a result driven AU Certification that allows cross border coordination of standards of practice and certification, which will respond to the changing needs of member AU countries, African Diaspora and Multilateral agencies in line with Millennium Development Goals 3,4, &5.

10.14 Accessing resources for MDP projects. The challenges faced by MDG are mainly due to limited resources deployed to address the infrastructure development and overall effective coordination of the program across public and private sector. As a result, a more strategic approach that deals with public and private investment and sustainable development activities is considered the best option. Engaging the Diaspora with connections both in the public and private sectors, that improve local skills and competencies with sustainable resource generation competencies and capacities, will improve the opportunities for sustainable development that is transparent, accountable and responsive to respective constituencies and relevant stakeholders.

 

10.15 General Challenges to progress with MDG

  1. Infrastructure development. Weak development systems and lack of infrastructure to monitor progress
  2. Capacity building efforts. Limited institutional and human resource capacity, resulting in shortage of skilled manpower
  3. Infesting in social infrastructures. Under-resourced development activities such as infrastructure, health, social, educational activities
  4. Improved cross-sectorial coordination. Poor or inadequate coordination at local, regional and international level
  5. Improving indigenous manufacturing. Limited indigenous manufacturing capacity to support MDG projects
  6. Community empowerment activities. Inadequate community and multispectral involvement for empowerment
  7. Sustainable financial investment. Non reliable or non sustainable financing for development programs

 

10.16 Towards evolving knowledge-based Societies.

                                                                                                                                                           

The African Union recognizes that the forces of globalization are moving the global communities towards knowledge-based Societies. Advancing technologies and their improving accessibility to the grass roots communities, is forcing the world to move fast into an integrated knowledge based society, where managing data, information and knowledge, is becoming a critical asset, towards a competitive, and yet sustainable development future. There is an evolving information and technology gap between and within communities. There is a consensus among policy makers and public opinion, that the Socio-economic disparities of the past , should not be allowed to create another new information and technological gap, in effect perpetuating new disparities into the future.

 

10.17 Bridging the technology gap. The AU and African Diaspora are in a unique position, to synergize, and integrate their experiences; so as to harness their common shared challenges and opportunities for positive outcome of technology access and integration among the Diaspora and AU countries.  The African Diaspora and AU Countries need focused investment strategies in accessing ICT (Information, communication and technology) in a format and processes that engage their respective populations to utilize the new technology towards solving their emerging problems, and assist them to be competitive in the local and global market. The size and complexity of the new advancing technologies require a much larger investment from international and bilateral institutions for a meaningful access and utilization at local educational, economic and social activities based at schools, community, work, recreation and ecologically friendly tourism activities, etc.

10.18 Converting Diaspora challenges into opportunities. The Diaspora and African communities have access to significant natural and human resources for future green energy and entertainment based tourism markets. Accessing modern technologies and information that utilizes the local resources for effective market openings is a critical issue that provides win-win opportunities for engaging local and international communities. The lessons from AGOA evaluation report and Diaspora linkages project and current experiences indicates clearly that engaging the primary stakeholders in the proposed activities, creates opportunities for sustainable development projects that have lasting and win-win relationships. Such engagement allows maximum participation and involvement of diverse markets, stakeholders and interest groups for successful outcomes.

 

10.19 Policy Implication

The policy implications of the AGOA Evaluation Report and other the AUM tour reports is that active engagement and inclusion of African stakeholders both at home and in Diaspora is critical in all future engagement activities. The AGOA project needs to be transitioned to comprehensive trade agreement that promotes the collective interests of US and African countries. The Advent of rapidly evolving digital communication technologies like ICT (information, communication and technology), social media networks, such as Google+ and Facebook, etc. for people with shared interests, can be used effectively for engaging communities that can be organized as cohorts of age, gender, professional and community groups. The engagement, linkages and inclusion activities need to be participatory via individual and focus group discussions, that allows ownership of the process from, initiating the concept, design, terms of engagement, i.e., content, context, time frame and expected outcome of all activities.

10.20 Policy Recommendations: Brain drain to brain gain and brain circulation

 

  1. The Asian Brain Circulation experience. The policy dialogue about brain drain, brain gain is moving towards brain circulation or more importantly win-win partnerships between individual and collective Diaspora institutions across the world. By 2000, over one-third of Silicon Valley’s high-skilled workers were foreign-born, and overwhelmingly from Asia. These US-based engineers and entrepreneurs are transforming development opportunities for formerly peripheral regions as they build professional and business connections to their hoe countries. In a process more akin to “brain circulation” than “brain-drain”, these engineers and entrepreneurs, aided by the lowered transaction costs associated with digitization, are transferring technical and institutional know how between distant regional economies faster than and more flexibly than most large corporations.
  1. The Silicone Valley Experience. Widely expressed concerns like by African continental based institutions can be converted into potential opportunities for African partnerships, in line with the experience of the Chinese and Indian born Asian Diaspora Silicon Valley Entrepreneurs, etc., who have accelerated the development of the information technology industries in their respective home countries. These Diaspora Entrepreneurs have initially started by tapping the low-cost skill in their home countries, and over time by contributing to highly localized processors of entrepreneurial experimentation and upgrading, while maintaining close ties to the technology and markets in Silicon Valley.
  1. Harvesting the fruits of globalization. African Diaspora Engagement programs should appreciate that global labor markets are being transformed as the falling costs of transportation and communication facilitate greater mobility and as digital technologies support the formalization and long-distance exchange of large amounts of information. International migration, historically a one-way process, has become a reversible choice, particularly for those with scarce technical skills, and it is now possible to collaborate in real time, even on complex tasks, with counterparts located at great distances. AU countries need to learn to harvest the fruits of globalization via their Diaspora communities and create win-win opportunities that foster trust, accountability and mobility within their own and global communities.

10.21 Brain circulation as the wave of the future!

 

  1. Brain Circulation for development and investment opportunities. The traditional perspective of the Diaspora as mere “brain drain”, “brain gain” is moving towards the more dynamic construct of “brain circulation” which appears to reflect the realities on the ground. Diaspora communities are dynamic, intelligent and diverse set of mobile cohorts of adventurous and risk taking resourceful individuals and tend to adapt to changing home and host country socio-economic dynamics.  As such, given the opportunities, they will connect with public and private institution at their respective communities to pursue their interests.   They already invest an average of about $40 Billion per year in their African communities. Tapping into the resource bases and Diaspora connections to access talent, knowledge, technology and infrastructure resources are considered the wave of the future. The lessons of the Korean, Indian and Chinese Diaspora has shown that such perspective of “Brain and Resource Circulation” is an idea whose time has come.
2. The Dynamic Diaspora can enhance African brains.   The wise Ancient Classical Ethiopian/African saying is relevant here. Parents tell their children at the time of transitioning into adulthood, the following statement, remember my child:..”Those who are organized, enlightened and well prepared/resourced will always succeed” , we trust and expect you choose success!   We can expect nothing less from the African Diaspora Engagement as we have the ECA challenge to disprove. The following ECA speculation and projection need to be challenged with a dynamic Diaspora engagement strategies that will transform each other’s expectation. It is stated that if the current trend continues ….“In 25 years, Africa will be empty of brains.” That dire warning, from Dr Lalla Ben Barka of the UN Economic Commission for Africa (ECA), reflects the growing alarm over Africa’s increasing exodus of human capital. Data on brain drain in Africa is scarce and inconsistent; however, statistics show a continent losing the very people it needs most for economic, social, scientific, and technological progress.   This picture is rapidly changing among communities who utilize the dynamic resources of the Diaspora to build a more proactive modern infrastructure that keeps pace with the changing technological and knowledge advances made across the globe.

Some statistics on Africa’s brain drain from International Organization for Migration (IOM)

1.     Since 1990, Africa has been losing 20,000 professionals annually.

2.     300,000 African professionals reside outside Africa

3.     Ethiopia lost 75% of its skilled workforce between 1980-91.

4.     It costs US $40,000 to train a doctor in Kenya; US$15,000 for a university student.

5.     35% of total ODA to Africa is spent on expatriate professionals.

6. The African Diaspora invest some $40 Billion per year into their African Communities.

 

3. Loss of 20,000 professionals per year since 1990. The Economic Commission for Africa (ECA) estimates that between 1960 and 1989, some 127,000 highly qualified African professionals left the continent. According to the International Organization for Migration (IOM), Africa has been losing 20,000 professionals each year since 1990. This trend has sparked claims that the continent is dying a slow death from brain drain, and belated recognition by the United Nations that “emigration of African professionals to the West is one of the greatest obstacles to Africa’s development.” This trend can be reversed if the concept of “brain circulation” is adopted and African countries encourage Diaspora professionals and entrepreneurs to   participate actively in the sustainable development and investment opportunities.

10.22 The costs of brain drain

1. Recovering the cost of brain drain.   It is generally considered that brain drain in Africa has financial, institutional, and societal costs. African countries tend to get little return from their investment in higher education, since too many graduates leave or fail to return home at the end of their studies. However, the experience of Asian Diaspora professionals and entrepreneurs show that brain drain can be converted into brain gain and most importantly into brain circulation by engaging actively Diaspora community resources and expertise.

2. Knowledge and technology transfer. In light of a dwindling professional sector, African institutions are increasingly becoming dependent on foreign and now Diaspora expertise. To fill the human resource gap created by brain drain, Africa employs up to 150,000 expatriate professionals at a cost of US$4 billion a year. The AU countries can creative environments for effective knowledge and technology transfer by using the Diaspora engagement process to access resources and talents from around the globe.

3. Enhancing health and social services. The departure of health professionals has eroded the ability of medical and social services in several sub-Saharan countries to deliver even basic health and social needs. Thirty-eight of the 47 sub-Saharan African countries fall short of the minimum World Health Organization (WHO) standard of 20 physicians per 100,000 people. The African Diaspora Health Initiative can be a central focus of the Diaspora engagement program to address this pressing shortage in the health field.

4. Attracting skilled labor force to Africa. This continuous outflow of skilled labour contributes to a widening gap in science and technology between Africa and other continents. Africa’s share of global scientific output has fallen from 0.5 in the mid-1980s to 0.3% in the mid-1990s. There are more African scientists and engineers in the USA than in the entire continent. The creative use of the Diaspora Engagement program can attract talent and skill to the African continent.

5. Enabling Civil Societies in Africa.   The flight of professionals from Africa endangers the economic and political systems in several African countries. As its middle class crumbles and its contributions to the tax system, employment, and civil society disappear, Africa risks becoming home to even greater mass poverty. The effective use of Diaspora communities by giving them their dual citizenship, can promote the enabling of the civil societies to promote good governance and the culture of transparency and accountability towards progressive prosperity.

10.23 In search of solutions
1. Promoting brain circulation. Throughout the last four decades as Africa is losing its best and brightest citizens to the western continents of Europe and America, as the world debated the semantics of the issue and focused almost solely on remittances, overlooking the long term implications of brain drain on human resources, institutional capacity, and health/social services.   The Asian Diaspora experiences are changing this debate towards brain circulation where professionals and entrepreneurs can transfer the technological infrastructure, and contribute to the ongoing human and capacity development transformations. The key-missing ingredient is creating a proactive investment and enabling environments by potential beneficiary African host countries.   Many African countries are considering giving double citizenship to their respective Diaspora communities making the legal and investment opportunities more attractive to their respective Diaspora communities.

2. Circulation versus repatriation.
As the Diaspora communities have roots and responsibilities in their newly adopted homes, it is critical to circulate their resources than demand their repatriation. Efforts to stem Africa’s brain drain focusing on repatriation strategies have been discouraging, as it is not based on win-win solutions.  Studies have shown that repatriation will not work so long as African governments fail to address the “pull and push factors “ that influence emigration.  Instead it is easier to address the changing relationship between African governments and the African Diaspora by encouraging solutions that promote proactive engagement of all stakeholders that is competitive in the global free market, and make active efforts to remove fundamental barrier to finding solutions. African countries need to change their attitude and practice by giving the best opportunities for creative partnerships between their citizens and Diaspora communities.

3. Technology based strategies

3.1 Virtual participation.   One potential solution to Africa’s brain drain is virtual participation. Virtual participation is participation in nation building without physical relocation. It also shows promise as a means to engage the African Diaspora in development efforts. Mercy Brown of the University of Cape Town notes that virtual participation “… sees the brain drain not as a loss but a potential gain… Highly skilled expatriates are seen as a pool of potentially useful human resources for the country of origin… the challenge is to mobilize these brains.”

3.2 Creating enabling environments

Creating enabling environment for Virtual Win-Win Participation is critical. The often raised questions are, “will virtual participation work in a continent where government–Diaspora relations are adversarial, and information technology almost nonexistent, and where development needs are complex and require a sustained commitment? The AU Countries have to develop creative strategies to engage Diaspora entrepreneurs and their associates to invest their time, skills and resources in sustainable African development efforts. This needs to be initiated with appropriate dialogue and participation of all relevant stakeholders.

3.3 The Diaspora as stakeholder

Recent developments in government–Diaspora relations show positive signs of change. A recent study, Semantics Aside: the Role of the African Diaspora in Africa’s Capacity Building Efforts, revealed emerging Diaspora efforts to assume a more active role in Africa’s development. The study, conducted by the Association for Higher Education and Development (AHEAD), a Diaspora group based in Canada, was funded by the International Development Research Centre (IDRC).

3.4 Channeling the Diaspora good will. Semantics Aside examined the potential of virtual participation to facilitate an effective and sustained Diaspora commitment to Africa’s development efforts. The study concluded that virtual participation has tremendous potential to channel the untapped intellectual and material input from the African Diaspora. Moreover, it recorded a growing awareness among the African Diaspora of its moral, intellectual, and social responsibility to contribute to Africa’s development efforts.

3.5 Proactive Win-win Participation.   Africa has shown a growing will to reconcile with the African Diaspora. Both the New Partnership for Africa’s Development (NEPAD) and the African Union (AU) have formally recognized the African Diaspora as a key player in the development agenda of the continent. In 2003, the AU amended its Charter so as to “… encourage the full participation of the African Diaspora as an important part of the continent.”

10.24 Virtual linkages

1. Expanding Virtual Diaspora linkages.   Another potential area where the talents of the Diaspora could be channeled is virtual linkages. Virtual linkages are independent, non-political, and non-profit networks facilitating skill transfer and capacity building. These networks mobilize skilled Diaspora members’ expertise for the development process in their countries of origin. To date, 41 virtual networks in 30 different countries have been identified. Six of these are African, including the South African Network of Skills Abroad (SANSA) with members in 68 countries.
2. The MIDA experience on human capital mobility
Individuals of the Diaspora also contribute through virtual networks, as visiting scholars, by investing in companies, and assisting in joint ventures between host and sending countries. According to author Damtew Teferra, Africa lags behind: “… This pattern of contributing to scientific and technological development is repeated for many Third World countries, though not… for most of Africa.”

In 2001, IOM launched the Migration for the Development of Africa (MIDA) “to develop the potential synergy between… African migrants and the demand from countries by facilitating the transfer of virtual skills and resources of the African Diaspora to their countries of origin.” Based on the notion of human capital mobility through temporary, long-term, and virtual participation, IOM works with African and host countries and Diaspora members. MIDA has launched pilot projects in a number of African countries.

10.25 Next steps

1. Diaspora as key stakeholders. A former journalist, Ainalem Tebeje is Vice-President of AHEAD reports,   that in November 2004, AHEAD, in collaboration with IDRC, organized an international Stakeholder Roundtable on Mobilizing the African Diaspora toward Development Efforts in Africa. The roundtable, held in Ottawa, Canada, brought together key stakeholders, including the IOM, Canadian government agencies, African missions, non-governmental organizations, and Diaspora groups to discuss brain drain in Africa and potential strategies for mobilizing the African Diaspora towards brain gain and brain circulation.

2. Diaspora engagement policies.
  Some of the issues identified included the need to recognize the African Diaspora as a key stakeholder in the current dialogue and efforts to address the issues of brain drain and capacity-building in Africa. Effective and sustained Diaspora engagement will require policy and resource commitments by key stakeholders, including international organizations, African governments, and host countries.

3. Win-win partners. The emerging Diaspora movement to become more active in Africa’s development efforts, the growing political will in Africa to recognize the Diaspora’s potential contribution, and the possibilities created by information technology show that the African Diaspora is not, after all, a total loss to the continent but a potential creative and innovative resource and win-win partners for sustained development and investment.

  1. Lessons from the AGOA Engagement. Regardless of its good intention, in terms of promoting free market economies, with a potential free/comprehensive trade agreements; the experience so far indicates that the AGOA project ended up promoting mainly Gas and Oil products. In effect, limiting the benefits of AGOA program to few oil resource rich African countries. Even though some garment and textile products were encouraged initially, the short time limits imposed externally, that did not take into consideration the local production and processing capacities, eventually ended up in not having encouraged the development of diverse trade products as expected. Reviewing the purpose, process and outcome of AGOA so far, it appears African countries did not have a fair say, nor could they influence the process and outcome of the AGOA act, as it was mainly designed by the US government with US market in mind, and with little input and potential to change the course of trade towards diverse win-win partnerships that promote a comprehensive free trade agreement for a wider set of products that involved more African communities. More efforts should have been spent on promoting evidence based research that would have assisted some African countries into free market economies with a set of comprehensive trade agreements that promote more capacities for African markets.
  1. Early participation with stakeholders

Maximum participation by a diverse set of interest groups will encourage a larger scope of products, and support a set of more engaged active stakeholders, which could make the project sustainable and accountable. African countries need to prioritize their trade policies and associated capacities to promote appropriate products for trade with the USA. Policy developments that take into consideration the common shared value and interests of Africa and USA need to be developed in formal institutional building structures. Like the AGOA forum, more diverse set of public and private networks will build the necessary capacities that sustain the local and international markets. These institutions and networks, will contribute to the larger goal of integration and connection of the African Diaspora, and AU Countries for sustainable development into the future of knowledge-based society that can be deigned potentially benefits all future stakeholders.

 

  1. Progress towards MDGs by 2015. Africa is also charged with meeting clearly articulated health care goals and is a central actor in addressing the most significant global health issues. Of the eight MDGs, three are related to health: reduce child mortality rates, improve maternal health and combat HIV/AIDS, malaria, and other diseases. Similarly, of the global effort to eradicate malaria and stem the tide of HIV/AIDS Africa, as the epicenter of these epidemics, is a central actor. At the same time, dwindling national budgets have limited the investment African governments can make in a health sector which is already overwhelmed by disease prevalence, chronic shortages of health workers and lack of access to essential lifesaving medicines. The UN Economic Commission for Africa estimates that sub-Sahara Africa needs to triple its health workforce, adding over a million workers to reach the health-related MDGs and meet the demands on the health care system. Therefore, the scaling up of health services to meet these challenges will require mobilization of resources from domestic sources, support diaspora and

10.26 Recommendation

ICT based mobilization. The development of information technology provides Africa with an opportunity to leap forward in the ability to increase health care access. Many of the obstacles related to geographic remoteness can be sufficiently addressed through use of ICT and training of local auxiliary health workers. Increase in local capacity and use of ICT also opens the door for Diaspora engagement.

  1. Engage Diaspora based health experts to recommend a continent-wide health systems development policy. Lack of coordination and control of health polices and priorities by national governments exasperates health care situation in Africa. Foundation to an effective health system begins with national guidelines and priorities that will guide local and international activities. Tap into Diaspora expertise to develop a holistic collaborative service delivery model that includes the Diaspora, approaches for international engagement, national and regional agencies, communities and clients. Parties involved share responsibility and authority for basic policy decision-making.
  1. Create’ adopt a health center’ program for diaspora members. This program will allow medical professionals in the Diaspora to proactively select a hospital and/or clinic to work with exclusively. They would serve in an advisory and when possible organize medical mission of their US-based colleagues. This program can extend to allowing hometown associations to adopt a health center and provide financial support, expertise as well as consul. This will encourage long-term engagement and development of institutional relationships.
  1. Develop a virtual consultation and diagnosis suites. Develop an online consultation portal with diaspora experts for diagnosis and consultation. Diaspora health experts sign-up to review files online and provide consultation on cases. This will improve the quality and accessibility of information available to local practitioners. It will also allow operation of remote health centers by auxiliary health workers who can be guided by experts via the portal. Participating locations would require internet connection, trained health professional (doctor, nurse, midwife, community health worker) and could request assistance in diagnosis anytime.
  1. Create a Health service account and/or bonds for diaspora. Develop a mechanism where Diaspora members could fund health services across the continent. Donors could select a country, city, village or a health issue, such as HIV/AIDS, malaria, mental illness, etc. Program could be administered by African Union who in turn will distribute funds quarterly in accordance with donor specifications.
  2. Engage Diaspora in The Roll Back Malaria Program research agenda. Three areas of research have been identified by RBM as effective for malaria control and elimination. Engage Diaspora members conducting tropical science research with state of the art labs and research facilities.
  1. Service industry. Service delivery in Africa is an essential element to development on the continent.

Educated and healthy citizens are more likely to be economically active and productive and they are less

likely to require services from already overwhelmed agencies. Availability of service such as electricity, safe drinking water and proper hygiene are also more likely to enhance the productivity of a society and provide exponentially boost for well-being, innovation and creativity.

  1. Promoting healthy communities. Challenges to effective health service delivery in Africa are particularly daunting. Shrinking national budgets, underdeveloped infrastructure and shortage of health workers are among the numerous factors that negatively impact national health systems. However, promoting a healthy community strategy of disease prevention and health promotion activities in line with primary health care system is both cost effective and equitable to all stakeholders.
  1. ICT enabled mobilization. ICT (Information Communication Technology) based mobilization of limited resources is considered a cost effective tool for changing challenges into opportunities. There are numerous seemingly insurmountable continent wide obstacles to government’s ability to provide citizens with healthy outcomes thereby diminishing productivity and economic growth. Moreover, previously eradicated diseases such as Polio have resurfaced with a vengeance further burdening the meager health services. Given, the limitations of physical infrastructure and human resources the engagement of the Diaspora and harnessing of ICT will enable Africa to successfully mitigate the ongoing health crisis. ICT has the dual advantage of increasing health system capacity by health personnel, locally, regionally and nationally, as well as tapping into the vast knowledge and expertise of a large medical professional Diaspora.

 

  1. The Media and Communication Consultancy findings. It is recommended that the AUM African Diaspora Engagement Programs should have access to the latest multi-media communication tools that include detailed modern audio, video, print and cyber communication technologies (ICT & SMN) tools such as the latest graphic computers, printers, copiers, cameras, facsimile, radio, TV and other information dissemination and broadcasting tools relevant to their mission and strategic objectives.
  1. The AUM recognizes the value of online social media sites and blogs as vital resources to positively promote its mission, values, operational goals, marketing and recruitment activities. Some of the common SMN (Social Media Network) tools include:
  1. Blog: A blog is a website maintained by an individual or organization with regular entries of commentary, description of events, or other materials such as graphics or video.
  1. Podcast: A collection of digital media files distributed over the Internet, often using syndication feeds. For playback on portable media players and personal computers.
  1. Protected company information. Individually identifiable information (oral, written, or electronic) about the corporations proprietary and business related information.
  1. RSS feeds or Syndication feeds. A family of different formats used to publish updated content such as blog entries, news headlines or podcasts and “feed” this information to subscribers via email or by an RSS reader.
  1. Social media. Includes but are not limited to blogs, podcasts discussion forums, online collaborative information and publishing systems that are accessible to internal and external audiences (i.e. Wikis), RSS feeds, video sharing, and social networks like MySpace, twits, Facebook and LinkedIn,.etc.
  1. Wiki: Allows users to create, edit and link Web pages easily; often used to create collaborative sites, )called “Wikis”) and to power community web sites.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Evaluation of AGOA and AUM Trip Reports

The primary source consultations include Evaluations of the African Growth and Opportunity Act and the AUM field trip outreach research report in the Latin American countries, etc., on how to meaningfully connect, link and integrate the growth and opportunity interests of African Diaspora with the ongoing sustainable development activities in AU Countries.

  1. Evaluation of AGOA- the USA designed African Growth and Opportunities Act
  1. Is AGOA a shared African and US Perspective?

To open economies and build free market. The African Growth and Opportunity Act (AGOA) was signed into law on May 18, 2000 as Title 1 of The Trade and Development Act of 2000. The Act offers tangible incentives for African countries to continue their efforts to open their economies and build free market. The central theme of the project is that opening economies towards building free markets are key ingredients for growth and opportunities of African countries. There are consistent questions raised by interested parties, that regardless of its assumed noble objectives of building free market economies, etc., if these projects have a shared African and American perspectives and proportional interests, specially in its implementation processes for sustainable partnerships. Critics emphasize that the current AGOA is dominated by a series of short-term time limits, that need to be extended perpetually; and associated limitations on appropriate technology and managerial expertise and relevant knowledge transfers. AGOA has focused on very narrow range of products that is dominated by oil and gas that constitute some 93% of overall trade. One wonders if the AGOA is mainly directed at accessing products that the US market need rather than enabling a broad based capacity building that open markets and build free markets.

  1. AGOA as a bridge for a comprehensive Free Trade Agreement.

Since 2000, AGOA has evolved into different stages continuously providing preferential access to imports from beneficiary African countries. AGOA provides reforming African countries with the most liberal access to the U.S. market available to any country or region with which the United States does not have a Free Trade Agreement.

AGOA supports U.S. business by encouraging reform of Africa’s economic and commercial regimes, which will build stronger markets and more effective partners for U.S. firms. However, it does not replace a more Comprehensive Free Trade Agreement that takes into consideration the short and long-term interests of all stakeholders. AGOA as it stands, is too selective, non-sustainable project that benefits very narrow interest groups; where over 93% of the volume of trade involves few African countries that export Gas and Oil. In the end, the Gas and Oil industry could easily compete in the free market without substantial assistance from AGOA.

Figure 2.2. Oil and Gas Exports under AGOA (2001-2010)
  • Improving Oil and Gas Sector. Africa’s oil and gas sector has been AGOA’s biggest beneficiary. In 2010, $36 billion worth of oil and gas entered into the U.S. duty-free under AGOA, i.e., 93.1% of total duty-free under AGOA imports. Figure 2.2 presents oil and gas exports under AGOA between 2001 and 2010.
  • Declining US gas and oil imports.S. imports of oil and gas under AGOA decreased by 10.4% from $40.2 billion in 2007 to $36.0 billion in 2010 (see table 2.8). Underlying this decline was the tempering of U.S. demand, which resulted in a decline in total U.S. imports of oil and gas from an average of 13.5 thousand barrels of crude oil per day in 2007 to 11.8 thousand barrels of crude oil per day.[3]
  1. AGOA appears to be a short term, stopgap or bridging arrangement. In the long term, a Comprehensive Free Trade Agreement, that involves more African countries with more diverse set of products under longer time commitment, might be more beneficial and than a time limited, and Gas & Oil dominated AGOA for all parties concerned. We need to remember, that the lessons from past African and Diaspora populations is that all their multi-lateral engagements have not been considerate of African interests. The Future AGOA, or its replacement, and the African and Diaspora engagement process needs to have the active participation of Africans and the Diaspora via their chosen representatives to ensure equity and parity at the center of all their development activities. AGOA in stages shown below:
  • AGOA I-Opening African Economies and building Free Markets. The African Growth and Opportunity Act (AGOA) was signed into law on May 18, 2000 as Title 1 of The Trade and Development Act of 2000. The Act offers tangible incentives for African countries to continue their efforts to open their economies and build free markets.
  • AGOA II-Preferential access to imports from African countries. President Bush signed amendments to AGOA, also known as AGOA II, into law on August 6, 2002 as Sec. 3108 of the Trade Act of 2002. AGOA II substantially expands preferential access for imports from beneficiary Sub-Saharan African countries.
  • AGOA III-Extension of preferential access for imports and third country fabric/textile provisions. By modifying certain provisions of the African Growth and Opportunity Act (AGOA), the AGOA Acceleration Act of 2004 (AGOA III, signed by President Bush on July 12, 2004) extends preferential access for imports from beneficiary Sub Saharan African countries until September 30, 2015; extends third country fabric provision for three years, from September 2004 until September 2007; and provides additional Congressional guidance to the Administration on how to administer the textile provisions of the bill.
  • AGOA IV-Extension of third country fabric provisions. The Africa Investment Incentive Act of 2006 (signed by President Bush on December 20, 2006) further amends portions of the African Growth and Opportunity Act (AGOA) and is referred to as “AGOA IV”. The legislation extends the third country fabric provision for an additional five years, from September 2007 until September 2012; adds an abundant supply provision; designates certain denim articles as being in abundant supply; and allows lesser developed beneficiary sub-Saharan African countries export certain textile articles under AGOA.
  1. Limitations of the Generalized System Preferences (GSP)- AGOA expands the list of products, which eligible Sub-Saharan African countries may export to the United States subject to zero import duty under the Generalized System of Preferences (GSP). While general GSP covers approximately 4,600 items, AGOA GSP applies to more than 6,400 items. AGOA GSP provisions are in effect until September 30, 2015
  2. Promoting Long-term trade between US &Africa. AGOA can change the course of trade relations between Africa and the United States for the long term, while helping millions of African families find opportunities to build prosperity:
  • By reinforcing African reform efforts;
  • By providing improved access to U.S. technical expertise, credit, and markets; and
  • By establishing a high-level dialogue on trade and investment.
  1. Encouraging substantial new investments in Africa. Since its implementation, AGOA has encouraged substantial new investments, trade, and job creation in Africa. It has helped to promote Sub-Saharan Africa’s integration into the multilateral trading system and a more active role in global trade negotiations. It has also contributed to economic and commercial reforms, which make African countries more attractive commercial partners for U.S. companies.

7. AGOA Implementation Subcommittees.

 

An AGOA Implementation Subcommittee of the Trade Policy Staff Committee (TPSC) was established to implement AGOA. Among the most important implementation issues are the following:

  1. Determination of country eligibility;
  2. Determination of the products eligible for zero tariff under expansion of the Generalized System of Preferences (GSP);
  3. Determinations of compliance with the conditions for apparel benefits;
  4. Establishment of the U.S.-Sub-Saharan Africa Trade and Economic Forum; and
  5. Provisions for technical assistance to help countries qualify for benefits.

 

  1. The limitations of the Act: Active Engagement

 

This appears to be a US largess and generosity with little or limited active engagement of African Countries in the Act. If there is, it is not well documented and appears questionable. If there was African participation, it was not acknowledged nor appreciated in the AGOA communications.

US directed and implemented project. At the outset, the design and implementation process of AGOA appears to be a US directed activity instead of being a multi-lateral cooperative agreement that looks at the interests of all stakeholders from mutually beneficial perspective. The USA through the AGOA Act offers tangible incentives for African countries to continue their efforts to open their economies and build free market. There is little mention whether African countries are consulted, or if they respectively perceive opening their economics, and building a free market in the context of the current set of products and time limitations, is their chosen aspirations and development agenda.  Like their Chinese counterparts, the African countries might have negotiated for knowledge and technological transfer, as well as sustainable market share control, in exchange for their export materials to facilitate African growth and opportunities.

  1. Determination of compliance with the Act

There is no mention or documentation in the Act, if African countries have expressed the desire to agree and support the central theme of the project, which is opening economies towards building free markets, with the specific products and time frame. There is no documentation to show if AGOA is considered part of the key ingredients for growth and opportunities of African countries. The Act itself does not appear to be a joint or multilateral consideration, and yet it claims itself as a potential benefit to African countries. However; the African Countries seem to have limited influence in the determination of country eligibility, and products eligible for zero tariffs. The determination of compliance to the Act appears to have been finalized unilaterally, by the US and with little or no active participation of African countries in its design and formulations. The current statistics of AGOA activities are tilted to Gas and Oil products, exported by few African Countries.

10. COUNTRY ELIGIBILITY

34 African Countries designation. The U.S. Government intends that the largest possible numbers of Sub-Saharan African countries are able to take advantage of AGOA. President Clinton issued a proclamation on October 2, 2000 designating 34 countries in Sub-Saharan Africa as eligible for the trade benefits of AGOA.

The proclamation was the result of a public comment period and extensive interagency deliberations of each country’s performance against the eligibility criteria established in the Act.

  • Swaziland & Ivory Coast. On January 18, 2001, Swaziland was designated as the 35th AGOA eligible country and on May 16, 2002 Côte d’Ivoire was designated as the 36th AGOA eligible country.
  • Gambia and DRC. On January 1, 2003 The Gambia and the Democratic Republic of Congo were designated as the 37th and 38th AGOA eligible countries.
  • On January 1, 2004, Angola was designated as AGOA eligible.
  • Removal of CAR and Eritrea. Effective January 1, 2004, however, the President removed the Central African Republic and Eritrea from the list of eligible countries.
  • Burkina Faso. On December 10, 2004, the President designated Burkina Faso as AGOA eligible.
  • Removal of Ivory Coast. Effective January 1, 2005, the President removed Côte d’Ivoire from the list of eligible countries.
  • Effective January 1, 2006, the President designated Burundi as AGOA eligible and removed Mauritania from the list of eligible countries.
  • Liberia. Effective December 29, 2006, the President designated Liberia as AGOA eligible.
  • Effective June 28, 2007, the President again designated Mauritania as AGOA eligible. Effective April 17, 2008, the President designated Togo as AGOA eligible.
  • Effective June 30, 2008, the President designated Comoros as AGOA eligible.
  • Effective January 1, 2009, the President again removed Mauritania from the list of AGOA eligible countries.

The U.S. Government will work with eligible countries to sustain their efforts to institute policy reforms, and with the remaining nine Sub-Saharan African countries to help them achieve eligibility.

  1. AGOA objectives. The Act authorizes the President to designate countries as eligible to receive the benefits of AGOA if they are determined to have established, or are making continual progress toward establishing the following:
  2. Market-based economies;
  3. The rule of law and political pluralism;
  4. Elimination of barriers to U.S. trade and investment;
  5. Protection of intellectual property;
  6. Efforts to combat corruption;
  7. Policies to reduce poverty, increasing availability of health care and educational opportunities;
  8. Protection of human rights and worker rights; and elimination of certain child labor practices.

Although none is expected to have fully implemented the entire list, the vast majority of African nations, which are striving to achieve the objectives, have embraced these criteria overwhelmingly.

Overlapping GSP and AGOA eligibility. The eligibility criteria for GSP and AGOA substantially overlap, and countries must be GSP eligible in order to receive AGOA’s trade benefits including both expanded GSP and the apparel provisions. Although GSP eligibility does not imply AGOA eligibility, 47 of the 48 Sub-Saharan African countries are currently GSP eligible.

12. GSP PRODUCT ELIGIBILITY

Determination of non-import sensitive articles. AGOA authorizes the President to provide duty-free treatment under GSP for any article, after the U.S. Trade Representative (USTR) and the U.S. International Trade Commission (USITC) have determined that the article is not import sensitive when imported from African countries. On December 21, 2000, the President extended duty-free treatment under GSP to AGOA eligible countries for more than 1,800 tariff line items in addition to the standard GSP list of approximately 4,600 items available to non-AGOA GSP beneficiary countries. The additional GSP line items, which include such previously, excluded items as footwear, luggage, handbags, watches, and flatware were implemented after an extensive process of public comment and review.

AGOA extends GSP for eligible Sub-Saharan African beneficiaries until September 30, 2015. Sub-Saharan African beneficiary countries are also exempted from competitive need limitations, which cap the GSP benefits available to beneficiaries in other regions.

 

13. APPAREL PROVISIONS

13.1 Duty-free and quota free treatment. AGOA provides duty-free and quota-free treatment for eligible apparel articles made in qualifying sub-Saharan African countries through 2015. Qualifying articles include: apparel made of U.S. yarns and fabrics; apparel made of sub-Saharan African (regional) yarns and fabrics until 2015, subject to a cap; apparel made in a designated lesser-developed country of third-country yarns and fabrics until 2012, subject to a cap; apparel made of yarns and fabrics not produced in commercial quantities in the United States; textile or textile articles originating entirely in one or more lesser-developed beneficiary sub-Saharan African countries; certain cashmere and merino wool sweaters; and eligible hand loomed, handmade, or folklore articles, and ethnic printed fabrics.

13.2 Special treatment of low GNP countries. Under a Special Rule for lesser-developed beneficiary countries, those countries with a per capita GNP under $1,500 in 1998, will enjoy an additional preference in the form of duty-free/quota-free access for apparel made from fabric originating anywhere in the world. The Special Rule is in effect until September 30, 2012 and is subject to a cap. AGOA IV continues the designation of Botswana and Namibia as lesser-developed beneficiary countries, qualifying both countries for the Special Rule.

13.3 Determination by International Trade Commission. AGOA IV provides for special rules for fabrics or yarns produced in commercial quantities (or “abundant supply”) in any designated sub-Saharan African country for use in qualifying apparel articles. Upon receiving a petition from any interested party, the International Trade Commission will determine the quantity of such fabrics or yarns that must be sourced from the region before applying the third country fabric provision. It also provides for 30 million square meter equivalents (SMEs) of denim to be determined to be in abundant supply beginning October 1, 2006. The U.S. International Trade Commission will provide further guidance on how it will implement this provision.

13.4 Monitoring preferential treatment for Apparel. Preferential treatment for apparel took effect on October 1, 2000, but beneficiary countries must first establish effective visa systems to prevent illegal transshipment and use of counterfeit documentation, and that they have instituted required enforcement and verification procedures. Specific requirements of the visa systems and verification procedures were promulgated to African governments via U.S. embassies on September 21, 2000. The Secretary of Commerce is directed to monitor apparel imports on a monthly basis to guard against surges. If increased imports are causing or threatening serious damage to the U.S. apparel industry, the President is to suspend duty-free treatment for the article(s) in question. The U.S. Government is now reviewing applications for approval of the required visa and enforcement mechanisms from AGOA eligible countries.

14. OTHER PROVISIONS

14.1 Organizing Trade and Economic Forum. The Act directs the President to organize a U.S.-Sub-Saharan Africa Trade and Economic Forum, to be hosted by the Secretaries of State, Commerce, Treasury, and the U.S. Trade Representative. The Forum is to serve as the vehicle for regular dialogue between the United States and African countries on issues of economics, trade, and investment. The Act also calls for annual reports to Congress through 2008 on U.S. trade and investment policy in Africa and implementation of the Act. As such, the establishment of a Trade and Economic Forum and the provisions of technical assistance are considered as viable engagement tools in the future.

 

B.     AUM Tours Report to Latin Americas

The AUM Tour reports to Latin America consider the The African Diaspora Past and Present in a more critical and aggressive research methodology that involved individual and group interviews and dialogue with key stakeholders.

1. The Past: Dispersal through slavery

The Atlantic and Arab Slave Trades. Much of the earlier African diaspora was dispersed throughout Europe, Asia, and the Americas during the Atlantic and Arab Slave Trades. Beginning in the 9th century, Arabs took African slaves from the central and eastern portions of the continent (where they were known as the Zanj) and sold them into markets in the Middle East and eastern Asia.

Beginning in the 15th century, Europeans captured African slaves from West Africa and brought them to Europe and later to the Americas. Both the Arab and Atlantic slave trades ended in the 19th century.[7]

  • Largest forced migration in history. The dispersal through slaverepresents one of the largest forced migrations in human history. The economic effect on the African continent was devastating. Some communities created by descendants of African slaves in Europe and Asia have survived to the modern day, but in other cases, blacks intermarried with non-blacks and their descendants blended into the local population.
  • Part of the Multi-ethnic society’s in the Americas. In the Americas, the confluence of multipleethnic groups from around the world created multi-ethnic societies. In Central and South America, most people are descended from European, American Indian, and African ancestry. In Brazil, where in 1888 nearly half the population was descended from African slaves, the variation of physical characteristics extends across a broad range. In the United States, there was historically a greater colonial population in relation to African slaves, especially in the northern tier.
  • The One-drop rule. The US RacistJim Crow and anti-miscegenation laws after the Civil War, plus waves of vastly increased immigration from Europe in the 19th and 20th centuries, maintained some distinction between racial groups. In the 20th century, to institutionalize racial segregation, most southern states adopted the “one drop rule“, which defined anyone with any discernible African ancestry as African.[8]
  1. Modern Diaspora-Civil war, and economic migrations

Emigration from Sub-equatorial Africa has been the primary reason for the modern diaspora. People have left the subcontinent because of warfare and social disruption in numerous countries over the years, and also to seek better economic opportunities.

Scholars estimate the current population of recent African immigrants to the United States alone is over 600,000, some of who are Black Africans from the Sub-equatorial region.[12] Countries with the largest recorded numbers of immigrants to the U.S. are Ethiopians, NigeriaGhanaSierra Leone and mostly East and West African Countries. Some immigrants have come from AngolaCape VerdeMozambique (Luso American), Equatorial GuineaKenya, and Cameroon. Immigrants typically congregate in major urban areas, moving to suburban areas over time. There are significant populations of recent African immigrants in many other countries around the world, including European Union countries such as the UK[13] and France, both nations that had colonies in Africa.[14][15]

  1. The African Union Perspective

The sixth regional constituents. The African Union defined the African diaspora as “[consisting] of people of African origin living outside the continent, irrespective of their citizenship and nationality and who are willing to contribute to the development of the continent and the building of the African Union.” Its constitutive act declares that it shall “invite and encourage the full participation of the African Diaspora as an important part of our continent, in the building of the African Union.”

Between 1500 and 1900, approximately four million enslaved Africans were transported to island plantations in the Indian Ocean, about eight million were shipped to Mediterranean-area countries, and about eleven million survived the Middle Passage to the New World.[16] Their descendants are now found around the globe. Due to intermarriage and genetic assimilation, just who is a descendant of the African diaspora is not entirely self-evident.

African diaspora populations outside of Sub-equatorial Africa include:

 

 

  1. Latin America Study Tour.

 

  1. Needs assessment research. The AU Mission initiated a field visit and study tour to several Latin American and Caribbean countries, both in the Atlantic and Pacific coast, to have improved understanding the current situation of the African Diaspora, and design a multi-country approach to empower organizations, and communities in the African Diaspora. Some of the pressing challenges facing the African Diaspora descendants in this sub-region are related to access to basic services, and infrastructure that incudes education, health care, clean water supply, sanitation, appropriate housing, considered the foundation for the well being of the family and future broad based development.
  1. Promoting win-win partnerships. The purpose of the study is to promote and to achieve a greater social inclusion and economic development, while establishing direct links for the exchange of knowledge and sharing of best practices and lessons learned between Civil Society Organizations, businesses and centers of excellence in the Diaspora and their counter parts in Africa.

 

  1. The Diaspora Engagement International Milestones. Some have the historical and international landmark activities that precede this work that have created the background for African Diaspora engagement include the following:
  1. African Union Sixth Constituency – The African Diaspora
  2. President Clinton AGOA Project (Africa Growth & Opportunity Act)
  3. PM Tony Blair Commission for Africa
  4. President Bush, “The Millennium Challenge Account
  5. Sony Bono’s One” Campaign
  6. The World Bank’s African Diaspora Initiative
  7. President Obama –“Development depends on Good Governance” Speech at Accra and Cairo.
  8. Commission of African Union convened an AU Technical Workshop on relations with the Diaspora
  9. Un Declaration of “ 2011 the International Year of People of African Descent”
  10. African Union Study Tour Mission to strengthen ties African Descendant Civil Society Organizations
  1. Common theme: The consistent message of all the above previous work and the five consultancy projects is the promotion of effective linkages, and connection between the Diaspora and African Union. The over aching message is that there is a pressing need to continuously encourage African Diaspora & their descendants to effectively leverage their experience and best practices, so as to participate in Africa’s sustainable development, and in the South-South Cooperation, by actively participating in local and regional civil society organizations that will empower citizenships for sustainable development, where in some instances, they themselves still face many challenges in their respective communities.
  1. General Regional Focus: The mandate of this project and respective consultancy reports encourage the following three issues.
  2. Improved understanding of the Diaspora in Latin America and the Caribbean by using modern communication tools and sustainable private/public institutions.
  3. Forging new partners among relevant stakeholders in public and private settings.
  4. Identify opportunities for the inclusion of African Diaspora Organizations in the socio-economic development of their respective countries and AU Countries.

The South-South Cooperation Framework. Use the South-South framework of cooperation as a rationale for long-term vision of enhancing links and forging partnerships with Diaspora agencies and organizations is helpful. However, the link should be global as the Diaspora communities are scattered all over the world.

  1. Attention to the impact of Demographic distributions. The AU estimates that the African Diaspora in South America and the Caribbean represent approximately 250 million people. It is estimated that about 800 million people live in the Continent of Africa, making a total of about one billion people (1/7 (14%) of Global Population. This is a substantial proportion of the global community whose potential is yet to be realized. Brazil and the USA, the two largest landmasses with substantial global economies respectively in the Western hemisphere also are home to the largest Diaspora populations outside the African continent. As such, these two countries should be priority focus areas for the future Diaspora engagement activities as they are home to some 125 million (greater than 50%) of the total African Diaspora populations. Columbia, Haiti, Dominican Republic and France have each more than 5 million African Americans.

The World’s top 12 Countries with members of the African Diaspora populations.

Estimated Ranking of the Countries with African Diaspora Populations


Country                                                        Diaspora Populations                                       Rank

  1. Brazil 85,783,143                                                 01
  2. United States 38,499,304 02
  3. Columbia 09,452,872 03
  4. Haiti 08,701,439 04
  5. Dominican Republic 07,985,991 05
  6. France 05,000,000 06
  7. Jamaica 02,731,419 07
  8. Venezuela 02,641,481 08
  9. United Kingdom 02,015,400 09
  10. Cuba 01,126,894 10
  11. Trinidad & Tobago 01,047,366 11
  12. Canada 00,783,795 12

Source: http://www.Culturaldiplomacy.org/index.php

  1. Findings and Recommendations.
  1. This Synthesis report recommends the promotion of effective Diaspora engagement, via win-win partnerships that need to be cultivated with public and private intuitions, in all countries where the Diaspora reside, and work; so that the Diaspora will continue to be engaged in sustainable development activities both in their respective countries, and African Union Counties.
  1. The current evaluation of the inter-governmental partnerships such as the African Growth and Opportunity Act shows a determined effort by the government of the USA to engage African countries towards liberalizing their economies and integrating with the Global Free Market System. However, the expected outcome, benefits and processes need to be determined multilaterally, so that the capital, technology and product exchanges are executed following deliberate research, policy development and implementation strategies.
  1. The in-depth qualitative and quantitative study reports from of Latin and Central American indicate that, the Diaspora themselves have historical challenges and opportunities to be actively involved in their respective sustainable developments, which can be supported with the new public and private “ living link”, “diaspora engagement” activities that promotes cultural, historical and economic developments in African countries.
  1. Policy developments. The policy recommendations encourage use of modern multi-media tools such ICT and SMN in Diaspora Engagement with win-win partnerships that encourages proactive communication based on the information provided by AU countries on their respective sustainable development and investment opportunity needs that is matched with the competency and interests of the Diaspora communities.
  1. Effective media and communication strategies. The management information system should access the latest ICT (information, communication and technology) as well as SMN (Social Media Network) for effective and timely communication of AU countries development and investment opportunities and Diaspora competencies and interests.

 

  1. Lessons from AUM Study Tour Reports

 

8.1 Needs assessment research. The AU Mission initiated a field visit and study tour to several Latin American and Caribbean countries both in the Atlantic and Pacific coast, to have improved understanding the current situation of the African Diaspora and design a multi-country prom to empower organizations and communities in the African Diaspora.

8.2 Promoting win-win partnerships. The purpose of the study is to promote and to achieve a greater social inclusion and economic development, while establishing direct links for the exchange of knowledge and sharing of best practices and lessons learned between Civil Society Organizations, businesses and centers of excellence in the Diaspora and their counter parts in Africa.

8.3 Rapid Participatory Appraisal. Participatory Town Hall meetings, supported by primary and secondary sources such as interviews and review of literature including extensive previous experience of consultants was used to collect information, opinion and findings among the Diaspora African populations.

 

9.Challenges and Opportunities

 

9.1 Unique challenges and opportunities. The AUM tour to Latin American and Caribbean countries, has found interesting challenges and opportunities facing people of African descent in the Americas, which provides important insight as to how to link and engage the African Diaspora in the Americas. Although, each African Diaspora community in the Americas have unique challenges and opportunities, relevant to the demographic, socio-economic and geopolitical identity of each country they live in; by and large, their common shared history, identity and culture exposes them to fairly similar challenges in their respective communities. Some of their shared challenges include, social and economic isolation they inherited from the forced exodus from Africa, and migration of their ancestors to the Americas.

9.2 Past historical challenges impacting the future.

  1. Social and economic isolation continues. The AUM- study reports from both the Atlantic and Pacific
  2. countries of Brazil, Guyana Tobago, Trinidad and Suriname, Nicaragua, Honduras and Guatemala etc., respectively indicate that the negative legacies of slavery such as economic and social exclusion, and marginalization, still continues for the majority of African Diaspora, even after more than 120 years of the abolition of slavery.

9.3 Substantial population. The total populations of the African Diaspora and indigenous peoples in the Latin American and Caribbean region are estimated to be about 250 million. Although the African Diaspora and their descendants make up nearly half of the total population which ranges from forty seven to seventy percent (47% – 70%) in the Atlantic Coast; and to fifteen percent to 20 percent (15%- to 20%), in the Pacific Coast of the Americas. Brazil and the USA have substantial populations of people of African descent outside the African continent. Although their respective realities in the different countries is rapidly changing, the AUM consultancy reports indicate that African Diaspora populations, by and large find themselves relegated to the sidelines of social and economic life, that often leads to poverty, discrimination and marginalization.

9.4 Diaspora in Latin America. According to the World Bank estimates, the total population of the Latin American region is 526.7 Million. The current estimate of people of African descent and indigenous peoples in these countries is about is about 250 million, making about 47.5% or nearly half of the overall population. The proportion of African Diaspora in the select four countries of study of Brazil, Guyana and Trinidad & Tobago, ranges from 50-70% Brazilians; greater than half or (>50%) of the Guyana population; and more than fifty eight percent (58%) in Trinidad & Tobago.

9.5 Central America. It is estimated that in most Central American counties the African Diaspora make up between 10 and 15 percent of the total population of about forty (40) million people. Guatemala, Honduras and Nicaragua make up the poorest Central American countries and their respective African Diaspora populations are at risk for being left behind as the region strives to reach the Millennium Development Goals by 2015.   This makes living conditions even more challenging, especially along the Caribbean cost of Central America where the African Diaspora populations are concentrated.

9.6 Democratic governance as the antidote for racial discrimination.

 

  1. Overcoming racial discrimination with good governance tools. In all these countries, racial identity, as represented by the descendants of African Diaspora, is found to be the most consistent predictor of marginalization, discrimination and poverty. The Diaspora civil societies in these four countries, consider the expanded role of citizenship and democratic governance as a tool for long-term solutions to their predicaments of economic and social inequalities. It is expected democratic based good governance structures, that encourages active participation of citizenship in sustainable development activities, that encourages Diaspora African citizen engagement in the governance of their respective communities, is considered a key tool for improved public and private engagement with AU countries.

 

9.7 Empowering Diaspora Civil Societies.

  1. Improving positive self-image. The Civil Society Organizations in these countries address several critical issues such as information dissemination, vocational and other training, self esteem and positive image making, youth initiatives, health and education addressing critical social and gender issues such as women empowerment, minority enterprises, discrimination against racial and gender identity issues, such as gay, lesbian, bisexual and transgender or LGBT communities.
  1. Active investment in sustainable development. Substantial active investment among these Diaspora communities will enhance the existing combination of rich national resources, cultural diversity that could be a springboard to accelerated sustainable development activities that ensures a dignified standard of living for all citizens including the African Diaspora populations. Investments in technological based enterprises that improve the educational and health status of the population will assist them to break out of the current crushing poverty and isolation; towards making a significant positive social, political and economic contributions to their respective countries. The investment strategies should be directed at improving linkages and connections to social and economic opportunities that attracts further investment and sustainable development opportunities to the overall at large population.

 

  1. Improving capital investment for social development. The present lack of access to capital for productive investment, results in vulnerability of their property rights, which is opening their ancestral territories to invasion by Mestizo migrants that is leading to environmental degradation and consistent conflict. Access to basic services and infrastructure such as education, health care, clean water supply, sanitation, and appropriate housing is critical for the wellbeing of future human, economic and social development.
  1. Preventing migration and criminal activities. The present lack of opportunity in the region is fueling emigrations, especially to the United States, and promoting participation in illicit activities including street gangs, trafficking, and consumption of drugs, with associated violence situations and street crime which creates insecurity in the region. Diaspora engagement in positive local sustainable development activities can promote regional peace, security and trade and other legal wealth creation activities.

 

9.8 Best practices and lessons learned.

  1. Common shared identity and sense of history. Uniting efforts around a common sense of history and identity, to self define Diaspora advancement, and partnerships with local, regional and international stakeholders.
  1. Outreach to Diaspora. Creating and giving voice to existing institutional arrangements like civil society organizations will facilitate outreach to African Diaspora and their descendants.
  1. Mobilizing & empowering the Diaspora. Mobilizing and empowering the Diaspora via social mobilization tools can be a strong incentive to force governments and business institutions into creating policy outcomes that address their pressing issues such as enterprise developments, health, education and social inclusions in sustainable development activities, etc.
  1. Improving resources generating mechanisms towards sustainable funding of Diaspora civil societies and enterprises is key to promoting sustainable self-empowerment and business network with AU Countries.
  1. Linkages & Connections. Creating strategic alliances of Pan African linkages, towards designing synergy among civil societies, so as to improve private/public linkages, and win-win engagements towards empowering the connections between Diaspora and their African counterparts is critical.
  1. Capacity building & strengthening. Strengthening existing civil society organizations with comprehensive capacity building structures, which involve human capital and infrastructure development, etc., so that Diaspora institutions become win-win partners with their local and international partners including AU countries.
  2. Sustainable trade activities. Promoting sustainable activities, towards organizational capacity building that promotes viable production and consumption products for trade exchange between African Diaspora populations and their African partners.

9.9 Connecting with UN and AU Vision on the Diaspora. The African Union Mission (AUM) headquartered in Washington, DC, has embarked upon a series of steps to identify and establish Diaspora links through qualitative and quantitative methodologies of direct and indirect focus group interviews and surveys, via town hall meetings, field visits, and direct and indirect exchanges with relevant Diaspora communities, public and private organizations in the Americas.

9.10 Connecting prior consultations and Diaspora work. As the main purpose of a synthesis document or essay is to make insightful connections between the different prior consultancies; it also connects its work with the overall UN and AU general consensus on Diaspora linkages; and engagement, as well as in line with the overall objectives, and vision of the African Union Mission Representation in Washington, DC.

9.11 The Synthesis Report in line with the UN and AU consensus.

  1. The African Union Study Tour Mission was commissioned by the African Union Mission in Washington, DC; as a medium through which, the agenda of South-South Cooperation of ideas and aspirations of developing countries come together, on the basis of equality, and mutual benefit, with the intention of working together, towards actively developing areas of common interest, and complementarities that accelerate their own respective comprehensive and sustainable development agendas.
  2. Historical background

Two significant events at AU and UN have propelled the work of this project. On April 19, 2010 in resolution A/Res/64/169, the United Nations declared the year 2011 as the International Year of People of African Descent“.

Similarly, the African Union (AU) in its Constitutive Act, which sets out the codified framework under which the African Union is to conduct itself, speaks to people of African descent or African descendants in the Diaspora. Article 3(q) of the A.U’s amended constitutive Act, “invites the full participation of the African Diaspora as an important part of our continent, in the building of the African Union”, in effective making the African Diaspora, the Sixth African Union Constituency.

The African Union has been holding consultations with its Diaspora groups in North America, Brazil, the Caribbean and Europe to discuss strategies for designating the African Diaspora worldwide as Africa’s sixth (6th) region (along the lines of the regional economic commissions). For example, a Consultative Planning Meeting of the North American African Diaspora was held in New York, N.Y. in June 2007. These consultations will generate inputs for a high-level AU summit to be held in South Africa in 2008.

  1. Objectives of the consultations. More recently, the African Union Mission (AUM) headquartered in Washington, DC, had embarked upon steps to identify and establish Diaspora linkages through the organization of Town Hall meetings, field visits, and via direct and indirect exchanges with relevant Diaspora communities and organizations in the Americas. A 10-day Study Tour Mission was commissioned by the AUM. One such tour on was made to several Caribbean and Latin American countries to Establish Diaspora Links, that covered the countries of Suriname, Trinidad and Tobago, Brazil and Guyana, etc., with five specific objectives.
  2. Collect and disseminate information to understand and increase awareness about the social and economic development realities of Afro-descendant communities, organizations and institutions in the Diaspora;
  3. Increase awareness and knowledge about Africa in the region;
  4. Identify and establish relationships/partnerships with relevant Diaspora organizations-emphasizing networks, regional umbrella organizations, businesses and business organizations and universities;
  5. Establish relationships with governments, bilateral and multilateral organizations and members of the private sector;
  6. Identify viable opportunities for South-South collaboration, including exchange of knowledge, lessons learned and best practices between organizations in the Diaspora and Africa.

Focus Areas in the regional cohort.

The focus of the study is to identify factors that improve our understanding of the Diaspora and forging new partnerships among relevant stakeholders, by identifying opportunities for the inclusion of people of African descendants, and the Diaspora organizations in the socio-economic development activities of their respective countries and AU countries.

Table 1: Focus Areas in this Regional Cohort

Regional Framework

Better understanding of the Diaspora in Latin America and the Caribbean

 

 

 

 

 

 

Regional/Country Focus

Economic and Social sector Development

o   Community resources: land, human capital, traditional knowledge

o   Labor market: Employment Creation

o   Social Policy and Development Planning-Poverty Eradication

o   Governance reform and institutional development

Environmental and Natural Resource Management

o   Capacity enhancement for sound management

o   Risk reduction and disaster management (pre & post disaster)

Forge new partners among relevant stakeholders ·       Civil society organizations

·       Government agencies

·       Private sector corporations

·       International development community

Identify opportunities for the inclusion of Afro-descendants and the Diaspora organizations in the socio-economic development of their respective countries and AU countries ·       Education

·       Health

·       Agriculture (food production)

·       Enterprise development

·       Income generation

 

AU Study Tour Mission. The AUSTM was tasked with identifying new African descendant stakeholders in civil society and to forge relationships with them. It also focused on engaging in activities geared towards strengthening ties initially made during an earlier AU mission.

  1. Valuation Criteria
  • A detailed framework and guidelines prepared by the staff of the AUM in Washington, DC provided the Consultants with topics, subtopics and lines of inquiry and /or specific questions used in questioning stakeholders in all four (4) countries.
  1. Process and methodology

The following steps were used to plan and feed into implementation of the AUSTM.

  • The Consultants pre-planning before leaving for the field trip
  • Formulation of the questionnaires
  • E-mail questionnaires to English-speakers only
  • The main data and information gathering in the field took place between 3-17 April 2011
  1. Sources of Information. There were two main sources of information:

a). Individuals. Purpose sampling was used to identify a cross-section of informants from African Diaspora civil society organizations, respective country government focal persons; and key informants with academic or other strategic information about specific Diaspora issues, such as education, health, employment, housing and other demographic, personal/community history, daily life in their respective countries.

b). Literature search and Documents. Background documents from earlier AU missions to any of the respective countries and publicly available web site information were consulted.

  1. Data Collection Methods and Process
  • Qualitative methods. The AUSTM employed qualitative data collection methods, including semi-structured interviews (either face-to-face or by telephone), focus group discussions, group interviews and town hall meetings.
  • Information validation. Triangulation was used by the Consultants to validate information from a range of primary and secondary sources.
  • Quantitative analysis. Document content analysis, was used to extract information from written materials.
  1. Challenges and Limitations
  • Generalizing country-specific approaches: The methods and approaches normally used for country-specific missions had to be adapted to the needs of a multi -country process within a limited time frame.

 

  • Lack of centralized Information systems: The main challenge was lack of centralized information systems. Due to a lack of centralized information system in the AU Washington Office, it was difficult to obtain an accurate inventory or historical overview of earlier field trips, and or initiatives and to compile required documentation before the field trip.
  • Addressing challenges of centralized information system. These limitations were addressed in the following ways:
  1. A dedicated administrative support team was available at the AU Washington DC, Office;
  2. The use of a multi-lingual Consultant enabled a wider area to be covered and analyzed within a short time frame;
  3. Individual and group informants were selected based on their availability and time-frame;
  4. Focus group interviews and Town-Hall meetings enabled the Consultant to concurrently access a vast array of civil society organizations and key individuals.
  5. Desk Review:

Findings on the Regional Framework, Understanding the Diaspora in South America and the Caribbean: Suriname, Trinidad and Tobago, Brazil and Guyana (BGSTT)

  • Planning and implementation process. There were challenges in covering all aspects of the daily realities of African Diaspora in the study countries, due to time and organizational constrains.
  • No formal surveys and specialized studies. Additionally, no specialized studies or formal surveys were conducted as part of the research due to time constraints, and the unique nature e of the multicounty study.
  • However, the use of Town Hall meetings enabled the consultants to cover and meet a wide array of civil society organizations and key individuals at the same time.
  1. Common terms of reference.

The African diaspora was the movement of Africans and their descendants to places throughout the world – predominantly to the Americas, and also to Europe, the Middle East and other places around the globe.[1][2][3] The term has been historically applied in particular to the descendants of the Africans who were enslaved and shipped to the Americas by way of the Atlantic slave trade, with the largest population in Brazil (see Afro-Brazilian).

  • A Billion people of African descent. In modern times, it is also applied to Africans who have emigrated from the continent in order to seek education, employment and better living for themselves and their children. People fromSub-Saharan Africa, including many Africans, number at least 800 million in Africa and over 140 million in the Western Hemisphere, representing around 14% of the world’s population.[4][5]
  • Use of social entrepreneurship. It is believed that this diaspora has the potential to revitalize Africa. Primarily, many academics,NGOs, and websites such as Social Entrepreneurs of the African Diaspora[6] view social entrepreneurship as a tool to be used by the African diaspora to improve themselves and their continent.
  • Diaspora in the African context. The term Diaspora which literally means a scattering or sowing of seeds, has described people or ethnic groups, who have left their traditional ethnic homelands by force, and have scattered all over the world. Originally the term Diaspora referred to the populations of Jews, exiled from Judea in 586 BC by the Babylonians, and in AD 135 by the Romans. Since early modern times, the confessional minorities of Christianity were part of a Diaspora.

The living African Diaspora. The concept of the “living” Diaspora was born when an estimated 27,233 slave voyages arrived in the New World during the period of time ranging from 1492 to 1820, each new arrival bearing between 218 to 332 slave This estimate does not account the number of Africans who were taken between African countries, Middle East, India and Europe. The Cambridge Trans-Atlantic Slave Trade Database estimates 482 separate ports of arrival for these voyages in the Americas region.

From Slavery to African Diaspora. Scholars generally agree that at a minimum, between 12-15 million Africans were taken into slavery among societies both foreign and hostile. These early Diaspora Africans found themselves to be considered as human capital to work the land, with no legal or human rights; or compensation for their work, with no voice nor any sovereign right to citizenship in any new land. The current challenges and opportunities that face African Diaspora stem from these significant historical realities that abused the human rights of the African settlers in the Americas.

  1. Global distribution of African Diaspora.

Considering the old slave descendants and new African immigrants to the Americas, Brazil and the USA continue to lead as those countries housing more people of African descent outside the African Continent. The Caribbean, specifically Columbia, Haiti and Dominican Republic are the next most populous region with African Diaspora to be followed by France, Jamaica, Venezuela and the United Kingdom. Cuba, Trinidad & Tobago and Canada continue to host a significant proportion of African Diaspora.

  1. The World’s top 12 Countries with members of the African Diaspora populations.

Estimated Ranking of the Countries with African Diaspora Populations


Country                                                        Diaspora Populations                                                           Rank

  1. Brazil 85,783,143                                                                   01
  2. United States 38,499,304                   02
  3. Columbia 09,452,872                   03
  4. Haiti 08,701,439                   04
  5. Dominican Republic 07,985,991                   05
  6. France 05,000,000                   06
  7. Jamaica 02,731,419                   07
  8. Venezuela 02,641,481                   08
  9. United Kingdom 02,015,400                   09
  10. Cuba 01,126,894                   10
  11. Trinidad & Tobago 01,047,366                   11
  12. Canada 00,783,795                   12

Source: http://www.Culturaldiplomacy.org/index.php?en_the-afrcan-diaspora

10.2 The AUM and the Diaspora Engagement project should seriously consider to engage those regions where the global distribution of African Diaspora indicate substantial populations like Brazil, the USA, Columbia, Haiti and Dominican Republic, France, Jamaica, Venezuela and UK, as well as those regions and countries where the African Diaspora form a significant minority populations with limited opportunities.

1.The Challenge: Social and Economic Disenfranchisement.

  1. Common thread of human rights abuse. The first African Diaspora to the Americas were illegally kidnapped from their homes and villages and were shipped in inhumane conditions from Africa to the Americas. The traumatic voyage marked by consistent human rights abuse, became more costly to African lives, due to the consistent cruelty and torture, supported by lack of food, space and medical treatment. The illegal kidnapping of Africans, converted itself into the abominable slave trade in the shores of Americas, which then became a market for turning human misery into money. This legacy of isolation, abuse and disenfranchisement continues until today in certain Diaspora communities.
  2. Discrimination and destruction of African heritage. The earlier African Diaspora could not speak their mother tongue, nor be able to call upon any government in Africa for support against their oppressive predicaments. They were forced to speak the language of their oppressors- be it English, Portuguese, Dutch and or a mixed “Creole” language. The underlying poverty, inadequate health care and unequal access to opportunity of African Diaspora, all stem from the history of abuse, discrimination, isolation and disenfranchisement that began in the illegal kidnappings in Africa and the trans-Atlantic slave trade voyage and subsequent destruction of their African heritage and civil liberties and human rights that is seen even today.

 

 

  1. The challenges: A COMMON WRENCHING SLAVERY EXPERIENCE:
  2. Diaspora-Descendants of Trans-Atlantic Slave Voyages were scattered around at random, in ways that did not respect their individual and collective interests and potentials. These past negative incidents, and their respective oppressive, disenfranchising practices, and policies that were perpetuated by subsequent generations, contributed to the present day negative realities of Diaspora African descendants in the Americas.
  1. Root causes of current disparities among the Diaspora. Scholars agree that between 12-15 million Africans were taken into slavery, where they were scattered throughout the Americas, and what has become known as “the Slave Diaspora among some circles. This forced negative experience of dispersion, disenfranchisement, and discrimination, has created the foundation for the current series of disparities in social and economic development indexes.  Most of these Diaspora populations feel that they found themselves forcibly transplanted into societies both foreign and hostile, and this unwelcome disenfranchisement process continues until modern times.
  2. Converting challenges into opportunities.
  3. Historical living heritage connections with AU as a tool for empowerment. The concept of a living heritage connection of the Diaspora communities with AU counties can be considered a smart strategy to convert past and current challenges in to future opportunities. The Diaspora communities and AU countries can utilize the concept of “living heritage connections” via public and private institutions, to mobilize their resources, talents and expertise towards a shared common interest. The living heritage connections construct can captivate the imaginations of the current and future Diaspora descendants that enable them to remember and reconcile with the past, to understand the present and propel them to change the future. The sustainable cultural and development activities generated by these linkage and connections can bring investments in different social and economic activities of the respective communities in effect converting their challenges into opportunities for future generations.
  1. Comprehensive approach to future connections. The AU linkages consultancies address critical issues that the Diaspora communities are facing on their day-to-day lives. Most of the challenges stem from the forced migrations of their ancestors to the Americans and subsequent isolation and disenfranchisement imposed on them. The living heritage connection can be designed in a comprehensive manner by involving public private institutions and enterprises from both African and Diaspora communities. The linkages and connections can attract tourism, and investment opportunities to address the education, cultural, health and enterprises needs of the respective communities.
  1. African heritage connection venture. This African heritage connection venture, should be designed to motivate all concerned parties to be involved in a mutually beneficial manner, so as to encourage shared dialogue, linkages and sense of ownership of the future. The future generation can develop creative projects and outlooks in life that ensures such handicapping situations experienced by their ancestors will not take place in the future. History teaches all of us that a society that does not remember the past, cannot learn from the present, and tends to repeat the same mistake in the future.
  1. Learning from the past to charter a better future. The AUM field trip has identified several individual and community challenges faced by African Diaspora populations in different countries in the Americas. Most of the information scanned from the short field trip need to be identified, collected and transcribed in a format that can be useful in the settings of the Diaspora communities. The living heritage connection construct could be used as a tool to remembering the past, understanding the present and create new opportunities to charter a better future by addressing current challenges of and connections to culturally appropriate socio-economic, trade and investment projects.
  1. Institutions to remembering past traumatic Diaspora experiences. Creating living connections via public and private institutions and enterprises, allows remembering and learning from the experiences of past Diaspora ancestors. This heritage connection related activities could provide the foundations for building a better future. Common to the four countries of this report, is that the traumatic passage from Africa to the Americas, became more costly to Diaspora lives, and more terrible in its torments, isolation, disenfranchisements and disparities in social and economic life as time passed. Most importantly, the reports emphasize that these past traumatic experiences continue to be a source of isolation and disenfranchisement of the current and future generations. Public and private institutions can utilize these heritage connections for improving community images, living standards, and most importantly as a tool to transform their respective communities. Using the cultural living connections will assist in understanding the past. Their current predicament stems from this significant but unfortunate history.
  1. Positive image and development efforts. Positive efforts to change the socio-economic barriers, and efforts to promote positive image towards productivity, should be supported by the living connection and linkages enterprises to their continental Africa heritage and current sustainable development efforts. The positive image connection is as critical as the positive inclusionary sustainable development efforts.
  1. Discrimination and social exclusion from available amenities. The worst and consistent challenge is the intricately woven criminal practice of discrimination and disenfranchisement into the social fabric of people of African descendants that continues to be experienced in their daily lives.  The current challenges of Diaspora youth in the Americas that tend to be exploited by drug and violent gangs and illegal immigration activities cannot be ignored and need to be addressed rather urgently.
  1. Expanded citizenship and capacity building. Good governance activities that promote the practice of expanded citizenship and capacity building efforts to empower the Diaspora populations will reverse the negative impact of sustained social exclusion from available amenities and the liberty/rights enjoyed by other citizens. The linkages and partnership efforts need to counterbalance the negative interactions that continue to adversely impact the daily lives of these vulnerable populations of African descendants.

 

  1. CULTURE AND BELIEFS

Preserving cultural values of their origins. Diaspora African descendants are attached to and preserved their cultural values, which was expressive of their origins. This was observed in their folklore, particularly artifacts, music and dance. The future linkage activities with AU countries can enhance the current cultural experiences, via tourism, educational and trade linkages, as well as enrich their perception of self and specific place in their local and international community.

  1. HISTORY’S EFFECTS

Racial discrimination as heritage of slavery. The lingering effects of slavery and race-based discrimination have had an all-encompassing, profoundly negative effect on the descendants of African slaves in the Diaspora. This report seeks to spread awareness about the multitude of issues that currently face Afro descendants in Suriname, Trinidad, Brazil and Guyana. The next generation needs to appreciate their heritage, so that they learn from those experiences and create a better future for themselves and their children. The cycle of poverty can only broken if the next generation is allowed to appreciate the past and learn from its lessons and create institutions to protect their current and future interests.

 

  1. IN-COUNTRY FINDINGS: BEST-PRACTICE: GIVING VOICE TO INSTITUTIONAL ARRANGEMENTS

 

  1. The political role of civil society organizations for Diaspora African Descendants.

 

5.1 Diaspora African voice to social issues: Vibrant civil societies to address developmental challenges! A vibrant civil society existed in the four countries visited. These institutions were made up of NGO’s and Grassroots support organizations (subset of the broad spectrum of NGO’s) and contributed towards the alleviation of developmental challenges facing the communities visited.

5.2 Diaspora African Citizens’ political influence: Racial democracy as the basis of black mass movements. Gilberto Freyre, author of the classic The Masters and the Slaves created an ideology on racial democracy, which was influential in shaping Brazilian national identity, and a mechanism by which thoughts of black mass movements were diffused. Social mobilization authored by the Movimento Negro spawned a vast array of organizations in Brazil that are cross cutting in purpose and actions.

 

  1. Twinning with the federal government:

 

  1. Close linkages to Federal Government impacted by Ethnic rivalries by African and Indian Guyanese. Organizations such as Fundacao Cultural Palmares, founded in 1988 provide close linkages and alignment to the government of Brazil. The Brazilian example of civil society organizations that have linkages to the government is not replicated in Guyana. However, Guyana has a formal democratic system in place, albeit riven by ethnic rivalry between Afro Guyanese and Indian Guyanese.

 

 

  1. Registering functioning civil societies towards capacity building.

The need to register functioning civil societies. It is imperative for the administration of local agencies or provincial governments or that of international organizations, to establish the architecture necessary to tabulate and register functioning organizations of civil society. This is the first step towards capacity building of civil societies in the future.

  1. LESSONS LEARNED FROM INSTITUTIONAL ARRANGEMENTS

Sustainability: Future of South-South Partnerships?

 

  • Who and how will services be provided. In light of future South-South Partnerships, it is crucial to appreciate some of the lessons discovered that centered on who will provide services, and how these services will be financed over time. The stakeholders and their respective relationships and expectations need to be well defined and communicated to the partnerships appropriately.

 

Linkages: Strategic alignment of “contours of synergy”.

 

  • There is an existence of rich and varied “contours of synergy” that strategic alignment can take when overlaid to fit local conditions, assets and challenges.

Capacity building and institutional strengthening:

 

  1. Empowering the role of civil societies. Capacity building initiatives should review the role of civil society organizations, and ensure that they are not seen just as project implementers. This will ensure that programs are narrowly focused on program delivery and program management with shared responsibilities between the emerging partnerships. Good governance can be strengthened by building professional and community support associations that are able to support the good will infrastructure of their respective communities.
  1. Capacity building for sustainable development. The Best Practice of a vibrant civil society in the countries visited, is where emphasis was placed on expanding the role of citizenship, with human capacity and organizational capacity building for sustainable development.
  2. SOCIAL CONTEXT

 

  1. Identifying the issues: Social Exclusion.
  2. Race and color based discriminations continue to be the most menacing experiences of people of African descent in the Caribbean and Latin Americas.
  1. Social exclusion and marginalization is a factor that has affected African Diaspora’s ability to have equal access to economic and social opportunities. In the four countries visited, social exclusion occurred in the form of disenfranchising on the basis of race and color.

 

  1. Image Management: Changing negative stereotypes.
  2. Improving negative images. The issue of a negative public image of Afro descendants in three of the four countries was a leitmotiv (recurrent theme) in the array of concerns expressed to the Consultant.
  1. Positive images of Africans. The Centro Afro Carioca de Cinemas, highlights positive images of Africans and Afro descendants in an effort to counter the predominantly held negative stereotypes of Africans.
  1. Trindad- Positive image in school curricula. In Trinidad, Emancipation Support Committee’s Chair of education expressed his concerns about the self-image of Afro Trinidadians and the lack of positive building blocks or reinforcement of a positive image of Afro Trinidadians in school curricula. The committee “acts in its own right as an umbrella to advance the interests of Africans nationally and internationally”.
  1. Guyana-Promoting Positive Heritage. In Guyana, the President of the AAGC expressed the same misgiving and stated that Afro Guyanese ‘need a sense of belonging’ to something to which they can wrap their identity around and feel proud of.
  1. Suriname- Improving access to health/education/economic development & Infrastructure.
  1. Challenges of The Maroons of Surname. The Maroons of Suriname, with over 300 years of independent history, represent the most highly developed societies and cultures in the history of Africans in the Americas. However, their disadvantaged position in Surinamese society has historically been reflected in unequal access to education, health care, economic development and infrastructure.
  2. Unity- of purpose among Afro descendants Diasporas.
  3. The weakening of unity among Afro descendants in their respective Diaspora was often expressed among informants from the interviews and focus groups conducted. Disunity was credited to one of the consequences of racism.
  1. Diaspora image and unity connected to Africa. African descendant peoples in the region, display consistent realities and are affected by currents concerning image and unity connected to their ethnicity and ancestral continent if origin.
  2. ECONOMIC ACCESS BY WAY OF LAND
  1. Concerns about titling of lands in Brazil. Informants in Brazil and Guyana expressed their concern pertaining to official titling of lands for Brazil’s distinct Afro descendant communities and Suriname’s Maroon communities. Programs such as the Egbe Program offers technical training based on traditional knowledge as well as dialogue to overcome religious intolerance, educational legal advice and the general defense of rights.
  1. Conflicts in land titling for Maroons inn Suriname. In Suriname, informants from the Maroon community complained that land titling for Maroons is still an area of conflict in Suriname.
  2. TRADITIONAL KNOWLEDGE
  • The role of herbal medicine and traditional religion. Religion and the treatment of ailment with traditional herbs comprise traditional knowledge existing among Afro communities. For instance, Animism was developed in Brazil with the knowledge of African Priests that were enslaved and brought to Brazil, together with their mythology, their culture and language.
  1. HEALTH
    1. Challenges of Sickle Cell Disease (SCD) in Brazil. Brazil was the only country in which specific health issues and policies for Afro descendants was extensively discussed. The most common inherited disease that is considered a public health problem is sickle cell anemia and it poses a serious threat to children born with the disease.
  1. Public health campaigns to treat SCD. Proper treatment as a fundamental role in reducing morbidity and mortality of patients with sickle cell anemia was suggested. Additionally circulation of information within the Afro descendant community about the Afro descendant community was recommended.
  1. HEALTH LESSONS LEARNED FROM BRAZIL

 

  • Universalist policies to address racial disparities in health. The strategy used in addressing racial disparities in health and health care or other forms of discrimination against Afro descendants in the Diaspora from both government and civil society will depend on the way laws, ideologies and social context frame race and racism in each country. There is the need to complement Universalist policies with group-based, targeted policies to alleviate disparities in health care for Afro descendants.
  1. Gender Equality and empowerment

                      

The topic of gender, particularly disaggregated outside the framework of African descendants was not broached in great detail. AAGC’s president made repeated efforts to address this issue as it pertains to Afro Guyanese women. The role of women as custodians of African culture and tradition needs to be matched with their economic and social leadership competency that is not best utilized by both the Diaspora and AU countries.

Rationale for South-South Connection

The African Union Study Tour Mission was commissioned by the African Union Mission in Washington, DC as a medium through which the agenda of South-South ideas and aspirations where developing countries may work together on the basis of equality and mutual benefit may work to actively develop areas of common interest and complementarities to accelerate their own development.

BACKGROUND OF THE AFRICAN UNION STUDY TOUR MISSION

  1. UN and AU declarations

On April 19, 2010 in resolution A/Res/64/169, the United Nations declared the year 2011 as the International Year of People of African Descent“.

Similarly, the African Union (AU) in its Constitutive Act, which sets out the codified framework under which the African Union is to conduct itself, speaks to people of African descent or herein after and Afro descendants in the Diaspora. Article 3(q) of the A.U’s amended constitutive Act, “invites the full participation of the African Diaspora as an important part of our continent, in the building of the African Union.”

The African Union Mission (AUM) headquartered in Washington, DC, has embarked upon steps to identify and establish Diaspora links through the organization of Town Hall meetings, field visits, and exchanges with relevant Diaspora communities and organizations in the Americas.

Towards this end, the AUM commissioned a 10-day Study Tour Mission. “Establishing the Diaspora Links Initiative”, a title coined by the author Consultant, is the subject of this report. This study tour covered the countries of Suriname, Trinidad and Tobago, Brazil and Guyana.

  1. Objectives and Focus

There are five (5) specific objectives of the African Union Study Tour Mission (AUSTM):

  1. Collect and disseminate information to understand and increase awareness about the social and economic development realities of Afro-descendant communities, organizations and institutions in the Diaspora;
  2. Increase awareness and knowledge about Africa in the region;
  3. Identify and establish relationships/partnerships with relevant Diaspora organizationsemphasizing networks, regional umbrella organizations, businesses and business organizations and universities;
  4. Establish relationships with governments, bilateral and multilateral organizations and members of the private sector;
  5. Identify viable opportunities for South-South collaboration, including exchange of knowledge, lessons learned and Best Practices between organizations in the Diaspora and Africa.
  6. METHODOLOGY
  7. SCOPE

The Scope of the African Union Study Tour Mission was set out in the TORs. The AUSTM was tasked with identifying new Afro descendant stakeholders in civil society and to forge relationships with them. It also focused on engaging in activities geared towards strengthening ties initially made during an earlier AU mission.

  1. Valuation Criteria

A detailed framework and guidelines prepared by the staff of the AUM in Washington, DC provided the Consultant with topics, subtopics and lines of inquiry and /or specific questions used in questioning stakeholders in all four (4) countries.

  1. Process

The following steps were used to plan and feed into implementation of the AUSTM.

  • The Consultant’s pre-planning before leaving for the field trip
  • Formulation of the questionnaire
  • E-mail questionnaire to English-speakers only
  • The main data and information gathering in the field took place between 3-17 April 2011
  1. Sources of Information

There were two main sources of information:

a). Individuals

b). Documents

  1. Data Collection Methods and Process

The AUSTM employed qualitative data collection methods, including semi-structured interviews (either face-to-face or by telephone), focus group discussions, group interviews and town hall meetings. Triangulation was used by the Consultant to validate information from a range of primary and secondary sources. Document content analysis, was used to extract information from written materials

  1. Challenges and Limitations

General Challenge:

The methods and approaches normally used for country-specific missions had to be adapted to the needs of a multi -country process within a limited time frame.

Information Challenges:

Lack of centralized information systems. Due to a lack of centralized information system in the AU Washington Office, it was difficult to obtain an accurate inventory or historical overview of earlier field trips and or initiatives and to compile required documentation before the field trip.

The limitations were addressed in the following ways:

  1. A dedicated administrative support team was available at the AU Washington DC, Office;
  2. The use of a multi-lingual Consultant enabled a wider area to be covered and analyzed within a short time frame;
  3. Informants were selected based on their availability and time-frame;
  4. Town-Hall meetings enabled the Consultant to concurrently access a vast array of civil society organizations and key individuals.

Desk Review: Findings on the Regional Framework

 

  1. Understanding the Diaspora in South America and the Caribbean: Suriname, Trinidad and Tobago, Brazil and Guyana (BGSTT)

 

  1. A COMMON WRENCHING EXPERIENCE: BEING SCATTERED AROUND IN THE PAST

Slave Diaspora-Descendants of Trans-Atlantic Voyages of Slaves. Past incidents such as the transatlantic voyages of slaves, contributed to the present day reality of Afro descendants in the Diaspora. Scholars agree that between 12-15 million Africans were taken into slavery, where they were scattered throughout what has become known as the Slave Diaspora; it was during this period of dispersion that most slaves found themselves forcibly transplanted into societies both foreign and hostile.

  1. COMMUNAL SOCIAL THREADS

History of torture and death. Common to the four countries of this report is that the passage from Africa to the Americas became more costly of Black lives and more terrible in its torments as time passed.

Discriminator social exclusion from available amenities. Woven into the social fabric of Afro descendants daily life was social exclusion from available amenities and the liberty/rights enjoyed by non-Afro descendants.

  1. CULTURE AND BELIEFS

Preserving cultural values of their origins. Slaves were attached to and preserved their cultural values, which was expressive of their origins. This was observed in their folklore, particularly artifacts, music and dance.

4 HISTORY’S EFFECTS

Racial discrimination as heritage of slavery. The lingering effects of slavery and race-based discrimination have had an all-encompassing, profoundly negative effect on the descendants of African slaves in the Diaspora. This report seeks to spread awareness about the multitude of issues that currently face Afro descendants in Suriname, Trinidad, Brazil and Guyana.

 

BEST-PRACTICE: GIVING VOICE TO INSTITUTIONAL ARRANGEMENTS

 

THE POLITICAL ROLE OF CIVIL SOCIETY ORGANIZATIONS FOR AFRO DESCENDANTS IN THE DIASPORA

 

Afro voice to social claims:

 

Vibrant civil societies to address developmental challenges.. A vibrant civil society existed in the four countries visited. These institutions were made up of NGO’s and Grassroots support organizations (subset of the broad spectrum of NGO’s) and contributed towards the alleviation of developmental challenges facing the communities visited.

Afro Citizens’ political influence:

 

Racial democracy as the basis of black mass movements. Gilberto Freyre, author of the classic The Masters and the Slaves created an ideology on racial democracy, which was influential in shaping Brazilian national identity and a mechanism by which thoughts of black mass movements were diffused. Social mobilization authored by the Movimento Negro spawned a vast array of organizations in Brazil that are cross cutting in purpose and actions.

Twinning with the federal government:

 

Close linkages to Federal Government impacted by Ethnic rivalries by Afro and Indian Guyanese. Organizations such as Fundacao Cultural Palmares, founded in 1988 provide close linkages and alignment to the government of Brazil. The Brazilian example of civil society organizations that have linkages to the government and its ear to make claims is not replicated in Guyana. However, Guyana has a formal democratic system in place, albeit riven by ethnic rivalry between Afro Guyanese and Indian Guyanese.

  1. TABULATIONS AND CAPACITY BUILDING

The need to register functioning civil societies. It is imperative for the administration of local agencies or provincial governments or that of international organizations, to establish the architecture necessary to tabulate and register functioning organizations of civil society with a focus on sustainable development with human capital and continuous capacity building infrastructure development towards win-win partnerships with African Union Countries.

  1. LESSONS LEARNED FROM INSTITUTIONAL ARRANGEMENTS

Sustainability: Future of South-South Partnerships?

 

  • Who and how will services be provided. The first “Lesson” discovered centered on who will provide services and how these services will be financed over time and in the light of future south-south partnerships. Sustainability issues such as sustainable resource generation, human capital and infrastructure development, continue to be issues that need to be addressed in the short and long term.

 

Linkages: Strategic alignment of “contours of synergy.

 

  • There is an existence of rich and varied “contours of synergy” that strategic alignment can take when overlaid to fit local conditions, assets and challenges. The strategic alliances could enhance local capability based on the principle of sharing best practices and lessons from each public/private organizations.

Capacity strengthening:

 

  • Empowering the role of civil societies. Capacity building initiatives should review the role of civil society organizations and ensure that they are not seen just as project implementers. This will ensure that programs are narrowly focused on program delivery and program management.
  • The Best Practice of a vibrant civil society in the countries visited is to emphasize expanding citizenship, human capacity and organizational capacity and development.
  1. SOCIAL CONTEXT- Challenges and opportunities.

 

Challenges-SOCIAL EXCLUSION

 

  • Race and color based discriminations. Social exclusion and marginalization is a factor that has affected Diaspora descendant’s ability to have equal access to economic and social opportunities. In the four countries visited, social exclusion occurred in the form of race and color.
  • Opportunities- Social inclusions and cultural diversity.

Social inclusion activities such as improving positive self-image, supported by skills and competencies that enhance the positive aspects of cultural and social diversity, as a value added community resources, that enhances the overall quality of life of all involved is a step in the right direction towards converting the current challenges of isolation into opportunities of inclusion.

Image: Changing negative stereotypes.

  • Improving negative images. The issue of a negative public image of Afro descendants in three of the four countries was a leitmotiv (recurrent theme) in the array of concerns expressed to the Consultant.
  • Positive images of Africans. The Centro Afro Carioca de Cinemas, highlights positive images of Africans and Afro descendants in an effort to counter the predominantly held negative stereotypes of Africans.
  • Trindad-Positive image in school curricula. In Trinidad, Emancipation Support Committee’s Chair of education expressed his concerns about the self-image of Afro Trinidadians and the lack of positive building blocks or reinforcement of a positive image of Afro Trinidadians in school curricula. The committee “acts in its own right as an umbrella to advance the interests of Africans nationally and internationally”.
  • Guyana-Promoting Positive Heritage. In Guyana, the President of the AAGC expressed the same misgiving and stated that Afro Guyanese ‘need a sense of belonging’ to something to which they can wrap their identity around and feel proud of.
  • Suriname- Improving access to health/education/economic development & Infrastructure.

Challenges of The Maroons of Surname. The Maroons of Suriname, with over 300 years of independent history, represent the most highly developed societies and cultures in the history of Africans in the Americas’. However, their disadvantaged position in Surinamese society has historically been reflected in unequal access to education, health care, economic development and infrastructure.

Unity- of purpose among Afro descendants Diasporas.

The weakening of unity among Afro descendants in their respective Diaspora was often expressed among informants from the interviews and focus groups conducted. Disunity was credited to one of the consequences of racism.

Diaspora image and unity connected to Africa. African descendant peoples in the region, display consistent realities and are affected by currents concerning image and unity connected to their ethnicity and ancestral continent if origin.

1.2 ECONOMIC ACCESS BY WAY OF LAND

Concerns about titling of lands in Brazil. Informants in Brazil and Guyana expressed their concern pertaining to official titling of lands for Brazil’s distinct Afro descendant communities and Suriname’s Maroon communities. Programs such as the Egbe Program offers technical training based on traditional knowledge as well as dialogue to overcome religious intolerance, educational legal advice and the general defense of rights.

Conflicts in land titling for Maroons inn Suriname. In Suriname, informants from the Maroon community complained that land titling for Maroons is still an area of conflict in Suriname.

1.3 TRADITIONAL KNOWLEDGE

 

The role of herbal medicine and traditional religion. Religion and the treatment of ailment with traditional herbs comprise traditional knowledge existing among Afro communities. For instance, Animism was developed in Brazil with the knowledge of African Priests that were enslaved and brought to Brazil, together with their mythology, their culture and language.

1.4 HEALTH

 

Challenges of Sickle Cell Disease (SCD) in Brazil. Brazil was the only country in which specific health issues and policies for Afro descendants was extensively discussed. The most common inherited disease that is considered a public health problem is sickle cell anemia and it poses a serious threat to children born with the disease.

Public health campaigns to treat SCD. Understanding Sickle Cell Disease as a public health agenda with appropriate health education, health promotion and disease prevention with appropriate surveillance, diagnosis, treatment and rehabilitation should be considered a priority among African Diaspora populations. The current trend of morbidity and mortality of patients with sickle cell anemia should be significantly reduced in these populations. Additionally, appropriate information abut the socio-cultural, health and economic issues affecting Diaspora Africans should be shared widely with appropriate strategies on how to improve the challenges in the community towards a shared opportunity in the larger community.

  1. HEALTH LESSONS LEARNED FROM BRAZIL

 

Universalist policies to address racial disparities in health. The strategy used in addressing racial disparities in health and health care or other forms of discrimination against African descendants in the Diaspora vary from country to country. However, the interactions of both government and civil society in addressing the issue of disparities in health will depend on the way laws, ideologies and social context, frame race and racism in each country.

 

Universal access to all. Making universal access to health for all citizens regardless of age, sex, race and culture, with a focus on minorities and those who have economic and social disparities is critical.   It is recommended that promoting a wellness approach to health, with a focus on health education, disease and injury prevention, within the context of universal access to health and the need to complement Universalist policies with group-based, targeted policies to alleviate disparities in health care for African descendants.

 

 

  1. Gender equality and empowerment.

 

Progress of gender equality both within the MDG framework and Diaspora engagement activities has not been given the needed consideration it deserves. The most famous statement…”If you educate and empower a woman, you educate/empower the family, the community and the nation at large”… applies here.

 

The topic of gender, particularly disaggregated outside the framework of Afro descendants was not broached in great detail. AAGC’s president made repeated efforts to address this issue as it pertains to Afro Guyanese women. However, the role of women and their place in African society and their current status needs a proactive empowerment campaign both among the Diaspora and AU countries.

It is recommended that a special study report consultation should be initiated to understand the status of women between both the Diaspora and AU countries. Women empowerment should be considered as the most critical tool that is the key strategy both within the MDG and Diaspora investment activities in future.

 

 

 

XII. Evaluation of African Growth and Opportunity Act (AGOA)

Summary. The AGOA is designed to provide incentives for African countries to continue their efforts to open their economies and build free markets in different stages by providing preferential US access to imports from African countries. These preferential accesses for imports included extensions to third country fabric/textile provisions. AGOA expands the list of products, which eligible Sub-Saharan African countries may export to the United States subject to zero import duty under the Generalized System of Preferences (GSP). While general GSP covers approximately 4,600 items, AGOA GSP applies to more than 6,400 items and Oil and Gas remain represent more than 90% of the items.While AGOA remains to be a great US government Act, it has not lived upto its expectations, as the AU countries have not been able to take advantage of the opportunity due to lack of preparation and involvement by key stakeholders.

12.1 AGOA I-Opening African Economies and building Free Markets. The African Growth and Opportunity Act (AGOA) was signed into law on May 18, 2000 as Title 1 of The Trade and Development Act of 2000. The Act offers tangible incentives for African countries to continue their efforts to open their economies and build free markets.

12.2 AGOA II-Preferential access to imports from African countries. President Bush signed amendments to AGOA, also known as AGOA II, into law on August 6, 2002 as Sec. 3108 of the Trade Act of 2002. AGOA II substantially expands preferential access for imports from beneficiary Sub-Saharan African countries.

12.3 AGOA III-Extension of preferential access for imports and third country fabric/textile provisions. By modifying certain provisions of the African Growth and Opportunity Act (AGOA), the AGOA Acceleration Act of 2004 (AGOA III, signed by President Bush on July 12, 2004) extends preferential access for imports from beneficiary Sub Saharan African countries until September 30, 2015; extends third country fabric provision for three years, from September 2004 until September 2007; and provides additional Congressional guidance to the Administration on how to administer the textile provisions of the bill.

12.4 AGOA IV-Extension of third country fabric provisions. The Africa Investment Incentive Act of 2006 (signed by President Bush on December 20, 2006) further amends portions of the African Growth and Opportunity Act (AGOA) and is referred to as “AGOA IV”. The legislation extends the third country fabric provision for an additional five years, from September 2007 until September 2012; adds an abundant supply provision; designates certain denim articles as being in abundant supply; and allows lesser developed beneficiary sub-Saharan African countries export certain textile articles under AGOA.

AGOA provides reforming African countries with the most liberal access to the U.S. market available to any country or region with which the United States does not have a Free Trade Agreement. It supports U.S. business by encouraging reform of Africa’s economic and commercial regimes, which will build stronger markets and more effective partners for U.S. firms.

12.5 Generalized System Preferences (GSP)- AGOA expands the list of products, which eligible Sub-Saharan African countries may export to the United States subject to zero import duty under the Generalized System of Preferences (GSP). While general GSP covers approximately 4,600 items, AGOA GSP applies to more than 6,400 items. AGOA GSP provisions are in effect until September 30, 2015.

12.6 Long-term trade between US &Africa. AGOA can change the course of trade relations between Africa and the United States for the long term, while helping millions of African families find opportunities to build prosperity:

  • By reinforcing African reform efforts;
  • By providing improved access to U.S. technical expertise, credit, and markets; and
  • By establishing a high-level dialogue on trade and investment.

Since its implementation, AGOA has encouraged substantial new investments, trade, and job creation in Africa. It has helped to promote Sub-Saharan Africa’s integration into the multilateral trading system and a more active role in global trade negotiations. It has also contributed to economic and commercial reforms, which make African countries more attractive commercial partners for U.S. companies.

12.7 IMPLEMENTATION

An AGOA Implementation Subcommittee of the Trade Policy Staff Committee (TPSC) was established to implement AGOA. Among the most important implementation issues are the following:

  • Determination of country eligibility;
  • Determination of the products eligible for zero tariff under expansion of the Generalized System of Preferences (GSP);
  • Determinations of compliance with the conditions for apparel benefits;
  • Establishment of the U.S.-Sub-Saharan Africa Trade and Economic Forum; and
  • Provisions for technical assistance to help countries qualify for benefits.

12.8 COUNTRY ELIGIBILITY

34 African Countries designation. The U.S. Government intends that the largest possible numbers of Sub-Saharan African countries are able to take advantage of AGOA. President Clinton issued a proclamation on October 2, 2000 designating 34 countries in Sub-Saharan Africa as eligible for the trade benefits of AGOA.

The proclamation was the result of a public comment period and extensive interagency deliberations of each country’s performance against the eligibility criteria established in the Act.

  1. Swaziland & Ivory Coast. On January 18, 2001, Swaziland was designated as the 35th AGOA eligible country and on May 16, 2002 Côte d’Ivoire was designated as the 36th AGOA eligible country.
  2. Gambia and DRC. On January 1, 2003 The Gambia and the Democratic Republic of Congo were designated as the 37th and 38th AGOA eligible countries.
  3. On January 1, 2004, Angola was designated as AGOA eligible.
  4. Removal of CAR and Eritrea. Effective January 1, 2004, however, the President removed the Central African Republic and Eritrea from the list of eligible countries.
  5. Burkina Faso. On December 10, 2004, the President designated Burkina Faso as AGOA eligible.
  6. Removal of Ivory Coast. Effective January 1, 2005, the President removed Côte d’Ivoire from the list of eligible countries.
  7. Effective January 1, 2006, the President designated Burundi as AGOA eligible and removed Mauritania from the list of eligible countries.
  8. Liberia. Effective December 29, 2006, the President designated Liberia as AGOA eligible.
  9. Effective June 28, 2007, the President again designated Mauritania as AGOA eligible. Effective April 17, 2008, the President designated Togo as AGOA eligible.
  10. Effective June 30, 2008, the President designated Comoros as AGOA eligible.
  11. Effective January 1, 2009, the President again removed Mauritania from the list of AGOA eligible countries.

The U.S. Government will work with eligible countries to sustain their efforts to institute policy reforms, and with the remaining nine Sub-Saharan African countries to help them achieve eligibility.

The Act authorizes the President to designate countries as eligible to receive the benefits of AGOA if they are determined to have established, or are making continual progress toward establishing the following:

  • Market-based economies;
  • The rule of law and political pluralism;
  • Elimination of barriers to U.S. trade and investment;
  • Protection of intellectual property;
  • Efforts to combat corruption;
  • Policies to reduce poverty, increasing availability of health care and educational opportunities;
  • Protection of human rights and worker rights; and elimination of certain child labor practices.

Although none is expected to have fully implemented the entire list, the vast majority of African nations, which are striving to achieve the objectives, have embraced these criteria overwhelmingly.

The eligibility criteria for GSP and AGOA substantially overlap, and countries must be GSP eligible in order to receive AGOA’s trade benefits including both expanded GSP and the apparel provisions. Although GSP eligibility does not imply AGOA eligibility, 47 of the 48 Sub-Saharan African countries are currently GSP eligible.

12.9 GSP PRODUCT ELIGIBILITY

AGOA authorizes the President to provide duty-free treatment under GSP for any article, after the U.S. Trade Representative (USTR) and the U.S. International Trade Commission (USITC) have determined that the article is not import sensitive when imported from African countries. On December 21, 2000, the President extended duty-free treatment under GSP to AGOA eligible countries for more than 1,800 tariff line items in addition to the standard GSP list of approximately 4,600 items available to non-AGOA GSP beneficiary countries. The additional GSP line items, which include such previously excluded items as footwear, luggage, handbags, watches, and flatware were implemented after an extensive process of public comment and review.

AGOA extends GSP for eligible Sub-Saharan African beneficiaries until September 30, 2015. Sub-Saharan African beneficiary countries are also exempted from competitive need limitations, which cap the GSP benefits available to beneficiaries in other regions.

12.10 APPAREL PROVISIONS

AGOA provides duty-free and quota-free treatment for eligible apparel articles made in qualifying sub-Saharan African countries through 2015. Qualifying articles include: apparel made of U.S. yarns and fabrics; apparel made of sub-Saharan African (regional) yarns and fabrics until 2015, subject to a cap; apparel made in a designated lesser-developed country of third-country yarns and fabrics until 2012, subject to a cap; apparel made of yarns and fabrics not produced in commercial quantities in the United States; textile or textile articles originating entirely in one or more lesser-developed beneficiary sub-Saharan African countries; certain cashmere and merino wool sweaters; and eligible hand loomed, handmade, or folklore articles, and ethnic printed fabrics.

Under a Special Rule for lesser-developed beneficiary countries, those countries with a per capita GNP under $1,500 in 1998, will enjoy an additional preference in the form of duty-free/quota-free access for apparel made from fabric originating anywhere in the world. The Special Rule is in effect until September 30, 2012 and is subject to a cap. AGOA IV continues the designation of Botswana and Namibia as lesser-developed beneficiary countries, qualifying both countries for the Special Rule.

AGOA IV provides for special rules for fabrics or yarns produced in commercial quantities (or “abundant supply”) in any designated sub-Saharan African country for use in qualifying apparel articles. Upon receiving a petition from any interested party, the International Trade Commission will determine the quantity of such fabrics or yarns that must be sourced from the region before applying the third country fabric provision. It also provides for 30 million square meter equivalents (SMEs) of denim to be determined to be in abundant supply beginning October 1, 2006. The U.S. International Trade Commission will provide further guidance on how it will implement this provision.

Preferential treatment for apparel took effect on October 1, 2000, but beneficiary countries must first establish effective visa systems to prevent illegal transshipment and use of counterfeit documentation, and that they have instituted required enforcement and verification procedures. Specific requirements of the visa systems and verification procedures were promulgated to African governments via U.S. embassies on September 21, 2000. The Secretary of Commerce is directed to monitor apparel imports on a monthly basis to guard against surges. If increased imports are causing or threatening serious damage to the U.S. apparel industry, the President is to suspend duty-free treatment for the article(s) in question. The U.S. Government is now reviewing applications for approval of the required visa and enforcement mechanisms from AGOA eligible countries.

(click here for further details on apparel eligibility provisions)

12.11 OTHER PROVISIONS

The Act directs the President to organize a U.S.-Sub-Saharan Africa Trade and Economic Forum, to be hosted by the Secretaries of State, Commerce, Treasury, and the U.S. Trade Representative. The Forum is to serve as the vehicle for regular dialogue between the United States and African countries on issues of economics, trade, and investment. The Act also calls for annual reports to Congress through 2008 on U.S. trade and investment policy in Africa and implementation of the Act.

http://2001-2009.state.gov/p/af/rls/rm/2001/5781.htm

12.12 AGOA Forum

  1. On June 9-10, 2011, Zambia will host the 2011 African Growth and Opportunity Act (AGOA) Forum, the centerpiece of the United States government’s trade policy with sub-Saharan Africa.  The 2011 Forum marks the 10th year that government officials, business leaders, and civil society from African countries and the United States will convene to promote trade, business, and investment opportunities that sustain economic development in Africa.
  2. The 2011 Forum’s theme is “Enhanced Trade Through Increased Competitiveness, Value Addition and Deeper Regional Integration.” During the conference, there will be sessions for the private sector and civil society as well as involvement of participants of the African Women’s Entrepreneurship Program (AWEP).  AWEP is an outreach, education and engagement initiative that aims to empower African women entrepreneurs to become voices of change in their communities.  Young business leaders will also take part in activities around AGOA.  The civil society and private sector participants will hold separate pre-conference meetings on June 6th and then present their findings to the ministerial meetings starting the subsequent day.
  3. The AGOA Forum brings together over 600 participants, including senior U.S. and African officials, as well as U.S. and African members of the private sector and civil society.  AGOA represents a progressive U.S. trade and investment policy toward the continent working to reduce barriers to trade, increase diversified exports, create jobs and expand opportunities for Africans.

4. The First U.S.-Sub-Saharan African Trade & Economic Cooperation Forum

“No nation in our time has entered the fast track of development without first opening up its economy to world markets.  The African Growth and Opportunity Act is a road map for how the United States and Africa can tap the power of markets to improve the lives of our citizens.”

President George W. Bush, October 29, 2001

With these words, President Bush addressed the first U.S.-Sub-Saharan African Trade and Economic Cooperation Forum, more commonly known as the AGOA Forum. The AGOA Forum was held in Washington October 29-30, 2001, and was hosted by the Secretaries of State, Treasury, and Commerce, and the U.S. Trade Representative.

  1. 35 AU Countries participation. Trade, Foreign Affairs, and Finance Ministers from 35 eligible Sub-Saharan African countries participated, along with representatives from African regional organizations.  The focus of the Forum was on discussing further measures that the U.S. and Sub-Saharan African nations can jointly take to stimulate economic growth and trade, enhance democracy and good governance, and combat HIV/AIDS.
  2. The Forum was a resounding success largely because of the broad cabinet-level participation and the interactive format of the plenary sessions.  The participation of President Bush, Secretary Powell, Secretary O’Neill, Secretary Evans, Secretary Veneman, U.S. Trade Representative Zoellick, National Security Advisor Rice, USAID Administrator Natsios, and Members Of Congress of both political parties demonstrated the deep commitment of the Administration and U.S. Government to strengthening trade and investment ties, increading prosperity and combating poverty on the African continent.
  3. During the Forum, U.S. officials emphasized the United States’ strong commitment to Africa and noted the initial success of AGOA.  U.S. and African speakers underscored the necessity of good governance, rule of law, and political freedom to attract investment and achieve growth.  The use of African co-chairs and active question and answer sessions allowed African officials the opportunity to speak openly about the benefits and challenges of AGOA.
  4. In his address to the Forum, President Bush announced the creation of a $200 million Overseas Private Investment Corporation support facility that will give American firms access to loans, guarantees and political risk insurance for investment projects in sub-Sahara Africa.   He also announced the establishment of a Trade and Development Agency (TDA) regional office in Johannesburg and the TDA Trade for African Development and Enterprise Program, both to provide guidance and assistance to governments and companies that seek to liberalize their trade laws, improve the investment environment, and take advantage of AGOA.
6. General Country Eligibility Provision

The U.S. Government intends that the largest possible numbers of Sub-Saharan African countries are able to take advantage of AGOA. President Clinton issued a proclamation on October 2, 2000 designating 34 countries in Sub-Saharan Africa as eligible for the trade benefits of AGOA.

The proclamation was the result of a public comment period and extensive interagency deliberations of each country’s performance against the eligibility criteria established in the Act.

1.     On January 18, 2001, Swaziland was designated as the 35th AGOA eligible country and on May 16, 2002 Côte d’Ivoire was designated as the 36th AGOA eligible country.

2.     On January 1, 2003 The Gambia and the Democratic Republic of Congo were designated as the 37th and 38th AGOA eligible countries.

3.     On January 1, 2004, Angola was designated as AGOA eligible.

4.     Effective January 1, 2004, however, the President removed the Central African Republic and Eritrea from the list of eligible countries.

5.     On December 10, 2004, the President designated Burkina Faso as AGOA eligible.

6.     Effective January 1, 2005, the President removed Côte d’Ivoire from the list of eligible countries.

7.     Effective January 1, 2006, the President designated Burundi as AGOA eligible and removed Mauritania from the list of eligible countries.

8.     Effective December 29, 2006, the President designated Liberia as AGOA eligible.

9.     Effective June 28, 2007, the President again designated Mauritania as AGOA eligible.

10.   Effective April 17, 2008, the President designated Togo as AGOA eligible.

11.   Effective June 30, 2008, the President designated Comoros as AGOA eligible.

12.Effective January 1, 2009, the President again removed Mauritania from the list of AGOA eligible countries.

The U.S. Government will work with eligible countries to sustain their efforts to institute policy reforms, and with the remaining nine Sub-Saharan African countries to help them achieve eligibility.

The Act authorizes the President to designate countries as eligible to receive the benefits of AGOA if they are determined to have established, or are making continual progress toward establishing the following: market-based economies; the rule of law and political pluralism; elimination of barriers to U.S. trade and investment; protection of intellectual property; efforts to combat corruption; policies to reduce poverty, increasing availability of health care and educational opportunities; protection of human rights and worker rights; and elimination of certain child labor practices.

The vast majority of African nations, which are striving to achieve the objectives although none, is expected to have fully implemented the entire list. The majority embraced these criteria overwhelmingly.

The eligibility criteria for GSP and AGOA substantially overlap, and countries must be GSP eligible in order to receive AGOA’s trade benefits including both expanded GSP and the apparel provisions. Although GSP eligibility does not imply AGOA eligibility, 47 of the 48 Sub-Saharan African countries are currently GSP eligible.

Countries Eligible for AGOA Benefits

Angola; Benin; Botswana; Burkina Faso; Burundi; Cameroon; Cape Verde; Chad; Comoros; Republic of Congo; Democratic Republic of Congo; Djibouti; Ethiopia; Gabon; The Gambia; Ghana; Guinea; Guinea-Bissau; Kenya; Lesotho; Liberia; Madagascar; Malawi; Mali; Mauritius; Mozambique; Namibia; Niger; Nigeria; Rwanda; Sao Tome and Principe; Senegal; Seychelles; Sierra Leone; South Africa; Swaziland; Tanzania; Togo; Uganda; Zambia.

Below is a table listing AGOA eligible countries, the effective date of their eligibility, and the effective date of their eligibility for AGOA apparel benefits if applicable.

COUNTRY DATE DECLARED AGOA ELIGIBLE DATE DECLARED ELIGIBLE FOR APPAREL PROVISION SPECIAL RULE FOR APPAREL
(Republic of) Angola December 30, 2003
(Republic of) Benin October 2, 2000 January 28, 2004 Yes
(Republic of) Botswana October 2, 2000 August 27, 2001 Yes
Burkina Faso December 10, 2004 August 4, 2006 Yes
(Republic of) Burundi January 1, 2006
(Republic of) Cameroon October 2, 2000 March 1, 2002 Yes
(Republic of) Cape Verde October 2, 2000 August 28, 2002 Yes
(Republic of) Chad October 2, 2000 April 26, 2006 Yes
(Union of) Comoros June 30 , 2008
(Republic of) Congo October 2, 2000
(Democratic Republic of) Congo * December 31, 2002
(Republic of) Djibouti October 2, 2000
Ethiopia October 2, 2000 August 2, 2001 Yes
Gabonese (Republic) October 2, 2000 No
The Gambia December 31, 2002 April 28, 2008 Yes
(Republic of) Ghana October 2, 2000 March 20, 2002 Yes
(Republic of) Guinea October 2, 2000
(Republic of) Guinea-Bissau October 2, 2000
(Republic of) Kenya October 2, 2000 January 18, 2001 Yes
(Kingdom of) Lesotho October 2, 2000 April 23, 2001 Yes
(Republic of) Liberia December 29 , 2006
(Republic of) Madagascar October 2, 2000 March 6, 2001 Yes
(Republic of) Malawi October 2, 2000 August 15, 2001 Yes
(Republic of) Mali October 2, 2000 December 11, 2003 Yes
(Republic of) Mauritius October 2, 2000 January 18, 2001 Yes
(Republic of) Mozambique October 2, 2000 February 8, 2002 Yes
(Republic of) Namibia October 2, 2000 December 3, 2001 Yes
(Republic of) Niger October 2, 2000  December 17, 2003 Yes
(Federal republic of) Nigeria October 2, 2000  July 14, 2004 Yes 
(Republic of) Rwanda October 2, 2000 March 4, 2003 Yes
(Democratic Republic of) Sao Tome and Principe October 2, 2000
(Republic of) Senegal October 2, 2000 April 23, 2002 Yes
(Republic of) Seychelles October 2, 2000 No
(Republic of) Sierra Leone October 23, 2002  April 5, 2004 Yes
(Republic of) South Africa October 2, 2000 March 7, 2001 No
(Kingdom of) Swaziland January 17, 2001 July 26, 2001 Yes
(United Republic of) Tanzania October 2, 2000 February 4, 2002 Yes
(Republic of) Togo April 17, 2008
(Republic of) Uganda October 2, 2000 October 23, 2001 Yes
(Republic of) Zambia October 2, 2000 December 17, 2001 Yes

 

Trade Leads:

The following websites are just a few of the resources African businesses can use to either search or post information on the products or services they wish to sell.  Unless otherwise noted, the services provided by these websites are free.

1.     African Resources Center – www.africanresourcescenter.com – a forum for business advancement and opportunity identification, and serves as a tool for disseminating information to African businesses. Interested clients can post their company profiles, trade inquiries and tenders on the website.

2.     AfricanTrade.com – www.africantrade.com – an online international trading system designed to facilitate trade for importers, exporters and manufacturers worldwide. The website allows clients to post, view and respond to Trade Leads, Tenders and BTB Auctions. Website visitors can also identify trade opportunities, receive trade alerts and showcase products and services.

3.     BidMix.com – www.bidmix.com – global Business-to-Business import/export services, including trade leads, trade resources, postings of trade information by topic, and a company listing. The website assists in selling clients’ products or services and in locating suppliers and manufacturers globally.

4.     BigEx.com – www.bigex.com – international trade exchange that matches buyers and sellers from around the world. The website contains information on importers, exporters, manufacturers, wholesalers and agents from the United States, Europe, Asia, Latin America and Australia. Members can post products that they wish to buy or sell, receive e-mail inquiries from prospective trading partners, establish new customer and supplier relationships and chat online with other members.

5.     BuySellEx.com – www.buysellex.com – dynamic auction application that provides world-wide business opportunities and e-commerce technology to its clients. The website also provides market research, business news, and company information.

6.     Business Referral and Information Network (BRAIN) – www.brain.org.za – provides small business and medium-sized enterprises with an invaluable gateway to information on starting, managing and growing a business. BRAIN also provides opportunities and support for small business in South Africa.

7.     Cyber Trade Center – www.cybertradecenter.com – the Cyber Trade Center provides information on business opportunities in import and export. The website provides services for importers, exporters and agents and includes trade information, advertisements, trade leads for buyers and sellers, and links to other international trade sites. Entry into the Cyber Trade Center is free.

8.     Export Leads – www.export-leads.com/enter.htm  – monthly international newspaper featuring nearly 10,000 export sales opportunities a year. Most of these export sales leads are generated by direct contact from importers around the world, and through questionnaires sent to major active importing firms, requesting details of their current import requirements. A subscription to the trade leads service costs $135 per year outside of the United States and $95 per year within the United States.

9.     Federation of International Trade Associations (FITA) – www.fita.org  – FITA affiliates include over 450 independent international associations. The associations include: world trade clubs, Chambers of Commerce, international logistics associations, international trade associations, exporter associations, and professional associations. The website also has a trade lead section.

10.   Food Trader Exchange – www.foodtrader.com  – trade leads specific to the food and agriculture industry. The website provides business-to-business marketplace and e-procurement solutions for the food and agriculture industry.

11.   Foreign Trade Online – www.foreign-trade.com – business-to-business web portal which assists manufacturers, exporters and companies planning to export, by providing foreign buyers with product and services information. The website also helps importers to locate their product sourcing from around the world.

12.   Global Trade & Technology Network – www.usgtn.net – GTN is a U.S. Agency for International Development (USAID) program aimed at matching the technological needs of companies in developing countries with technical solutions. GTN facilitates the transfer of technology and services from the U.S. and other regional participants to countries worldwide through the dissemination of trade leads via e-mail. U.S. companies as well as companies in participating GTN countries in Africa and Southeast Europe may register with GTN to receive trade leads for free. GTN operates in 37 countries.

13.   Global Trade Village (GTV) – www.globaltradevillage.com – international sourcing and procurement company linking U.S. and Canadian purchasers with international suppliers and manufacturers. GTV has the ability to source and deliver any product. International suppliers and manufacturers can become members of the GTV database.

14.   Import Export International Business Help Center – http://www.importexporthelp.com/ – B2B resource website providing international business resources, including links to over 100 resources.

15.   Import Leads/Export Leads – www.importleads.com – post trade leads for import or export free of charge. The website also provides a matchmaking service for companies.

16.   Inkorpa – www.inkorpa.com – consulting services (for a fee) geared towards African companies trying to take advantage of AGOA. Inkorpa assists African companies in accessing U.S. government financing and finding U.S. distribution partners for the African private sector.

17.   Intermeding – www.intermeding.com – a wide variety of services including, posting of trade leads, listings for the services industry, employment opportunities, manufacturer and agent database, joint venture and investment opportunities, advertisements, and website hosting.

18.   International Business Forum – www.ibf.com – information about international business opportunities. The website is intended for companies wishing to export or expand into foreign markets as well as for those interested in acquiring products and services from other countries. In addition to business opportunities, the website includes a business directory and information on business resources, business associations, business meetings, and business education.

19.   Mbendi – www.mbendi.co.za – Africa business website which contains extensive reference information on countries and industry sectors, particularly oil and gas, electrical power, chemicals, mining and telecommunications, supported by databases of companies, organizations, personalities, projects, facilities, events and publications. Interactive facilities are available to distribute tenders, trade enquiries, employment vacancies and business opportunities and to apply for finance and trade related services.

20.   1jump.com – www.1jump.com – a company research tool which maintains a database of over 1 million companies. The database can be used to both find suppliers and target sales prospects. There is a $29.95 per month fee for the service.

21.   Selectory – www.selectoryonline.com  –  a number of searchable databases are available on this website, organized by industry and/or state. The website includes marketing and business leads. There is a monthly subscription fee, or subscribers can buy access to one of the specialized databases for a yearly fee.

22.   SignOnAfrica.com – www.signonafrica.com – offers access to a wide variety of African products. Available products are organized by product category, and buyers are able to post products that they are seeking.

23.   Swiss Info Import-Export Bulletin Board – www.swissinfo.net  – members can post leads and access a broad range of offers compiled from a variety of trade lead sources. There is a fee for membership.

24.   Trade Port – www.tradeport.org  – comprehensive trade information, trade leads, and company databases. It is an international trade/defense conversion initiative of Baytrade, which focuses on export expansion in the greater San Francisco Bay area.

25.   Trade World – www.tradeworld.net  – an Africa-specific source of trade leads, government tenders, and trade information that aims to connect African businesses with buyers and suppliers in other countries via the Internet. Fees vary by type of service. 

26.   Trade Zone – www.tradezone.com – international trade services for manufacturers, importers and exporters, trade service businesses and opportunity seekers. The website lists international trade business opportunities, free import and export trade leads, a trade bulletin board, and traders’ websites and website advertising services.

27.   World Trade Point Federation (WTPF) – www.wtpfed.org – WTPF is a non-governmental organization registered in Geneva, Switzerland. It was organized under the auspices of the United Nations Conference on Trade and Development (UNCTAD). Its objective is to facilitate access for small and medium-sized enterprises (SMEs) to international markets. WTPF brings together Trade Points from around the world. A Trade Point is a source of trade related information, a trade facilitation center, and a gateway to the Global Trade Point Network. The website offers trade leads for SMEs through the Electronic Trading Opportunity (ETO) section. 

28.   World Access Network of Directories (WAND) – www.wand.com  – offers trade directory technologies with a classification system of over 60,000 product and service types. The service provides trade leads and trade information for buyers and sellers in 16 languages.

29.   WorldBid.com – www.worldbid.com – online international marketplace designed to help small to mid-sized companies conduct business. The website lists international trade leads from companies and government organizations around the world. Services include offers to buy and sell, e-mail trade notifications, company showroom allowing a company to showcase its product, international company directory, and trade and e-commerce resources.

30.   WorldBizClub – www.wbc.com  – trade leads for buyers and sellers in a variety of sectors. Other services include product showcases, business consulting, general trade information, and trade matching. There are both free and fee-based services.

31.   Matchmaker Programs (back to top):

32.   Corporate Council on Africa (CCA) – www.africacncl.org  – The Corporate Council on Africa organizes two business linkage programs, the South Africa Business Linkage program and the West Africa Business Linkage program.  These programs help match African and American companies in a variety of industry sectors.  For more information, see the CCA website and click on B2B Linkages.

33.   Global Trade & Technology Network – www.usgtn.net – GTN is a U.S. Agency for International Development (USAID) program aimed at matching the technological needs of companies in developing countries with technical solutions. GTN facilitates the transfer of technology and services from the U.S. and other regional participants to countries worldwide through the dissemination of trade leads via e-mail. U.S. companies as well as companies in participating GTN countries in Africa and Southeast Europe may register with GTN to receive trade leads for free. GTN operates in 37 countries.

34.   Interlink Capital Strategies – www.i-caps.com – Interlink Capital Strategies is a Washington, DC based consulting firm specializing in emerging market finance and business development. The company provides expertise in international project financing, trade financing, government advocacy, private equity, business development and marketing.

35.   Uniworld Business Publications – www.uniworldbp.com – publishes directories of U.S. firms operating in foreign countries and directories of foreign firms operating in the U.S.

36.   World Trade Centers Association (WTCA) – www.wtca.org – WTCA is an organization of nearly 300 World Trade Centers in almost 100 countries. The website is a one-stop trade information hub for posting and reviewing trade opportunities, and communicating with newly found business prospects. World Trade Centers can provide matchmaking services and lists of trade leads.

FOR TEXT OF AGOA FORUM PLENARY REMARKS CLICK BELOW:

  1. PRESIDENT BUSH
  2. TREASURY SECRETARY O’NEILL
  3. SECRETARY OF STATE POWELL
  4. USTR ZOELLICK(Press Release)
  5. 1st AGOA Forum News Letter

Resources & References:

  1. AGOA REPORTS
  2. TRADE FINANCE & TECHNICAL ASSISTANCE
  3. GENERAL BUSINESS
  4. COUNTRY INFORMATION
  5. TRADE DATA

AFRICAN GLOBAL COMPETITIVENESS INITITIAVE (AGCI) & AFRICA

TRADE HUBS

TEXTILE & APPAREL

AGRICULTURE

CUSTOMS

  1. AGOA REPORTS
  1. 2005 AGOA Competitiveness Report
  2. 2008 Report to Congress
  3. 2007 Report to Congress
  4. 2006 Report to Congress
  5. 2005 Report to Congress
  6. 2004 Report to Congress
  7. 2003 Report to Congress
  8. 2002 Report to Congress
  9. 2001 Report to Congress
  10. AGOA Implementation Guide – English
  11. AGOA Implementation Guide – French
  12. AGOA Implementation Guide – Annexes
  13. What Every Member of the Trade Community Should Know About the African Growth and Opportunity Act

TRADE FINANCE & TECHNICAL ASSISTANCE (back to top)

  1. U.S. Export-Import Bank (Ex-Im)
  2. U.S. Overseas Private Investment Corporation (OPIC)
  3. U.S. Trade and Development Agency (USTDA)
  4. U.S. Agency for International Development (USAID)
  5. Trade Capacity Building Database
  6. Small Business Administration (SBA)
  1. GENERAL BUSINESS (back to top)
  2. Africa Portal on Export.gov
  3. S. Global Technology Network – Business Linkages for U.S. and African firms
  4. Corporate Council on Africa (CCA)
  5. BuyUSA(International e-marketplace sponsored by the U.S. Commercial Service of the U.S. Department of Commerce)
  6. A Guide to Doing Business with Africa
  7. Foundation for Democracy in Africa

 

COUNTRY INFORMATION (back to top)

  • S. Department of State Bureau of African Affairs
  • S. Embassy Links
  • CIA World Factbook

TRADE DATA (back to top)

  • S. – African Trade Profile – 2009
  • Sub-Saharan Africa: Factors Affecting Trade Patterns of Selected Industries – First Annual Report (USITC April 2007 Report)
  • Sub-Saharan Africa: Factors Affecting Trade Patterns of Selected Industries – Second Annual Report (USITC April 2008 Report)
  • Sub-Saharan Africa: Effects of Infrastructure Conditions on Export Competitiveness – Third Annual Report (USITC April 2009)
  • S. International Trade Commission Monthly and Quarterly Data on U.S. Sub-Saharan Africa Trade
  • S. Tariff and Import Data by Product
  • Sub-Saharan African Textile and Apparel Inputs: Potential for Competitive Production (USITC May 2009)

AFRICAN GLOBAL COMPETITIVENESS INITITIAVE (AGCI) & AFRICA TRADE HUBS (back to top)

  • African Global Competitiveness Initiative (AGCI)
  • West Africa Global Competitiveness Hub
  • East & Central Africa Global Competitivenss Hub
  • Southern Africa Global Competitiveness Hub

TEXTILE & APPAREL (back to top)

  • Office of Textiles and Apparel – AGOA Short Supply Provisions

AGRICULTURE (back to top)

  • S. Animal & Plant Health Inspection Service
  • S. Fish & Wildlife Service
  • S. Food & Drug Administration
  • S. Food Safety & Inspection Service

CUSTOMS (back to top)

  • S. Generalized System of Preferences
  • National Customs Brokers & Forwarders Association of America

Basic Importing and Exporting
Frequently Asked Questions

Q: How does AGOA benefit African countries?

Q: How does it benefit U.S. firms?

Q: Why the need for an AGOA II bill?

Q: What specific changes did the AGOA II legislation make to the original AGOA law?

Q: What specific changes did the AGOA Acceleration Act of 2004 make to the original AGOA law?

Q: What specific changes did the Africa Investment Incentive Act of 2006 (AGOA IV) make to the original AGOA law?

Q: What is the “Abundant Supply” provision?

Q: What benefits are provided for Botswana and Namibia?

Q: What conditions are placed on participation by African countries?

Q: Which countries have been designated as AGOA eligible?

Q: Does the United States have the right to set eligibility criteria for African countries?

Q: What are the provisions governing apparel imports?

Q: Which countries fall under the per capita GNP ceiling for the Special Rule?

Q: When do the apparel benefits take effect?

Q: What does the term “knit-to-shape” mean?

Q: What are the Act’s GSP provisions?

Q: How can African countries become more familiar with the benefits of the Act?
Q: How does AGOA benefit African countries? 

A: AGOA passed as part of The Trade and Development Act of 2000 provides beneficiary countries in Sub-Saharan Africa with the most liberal access to the U.S. market available to any country or region with which we do not have a Free Trade Agreement. It reinforces African reform efforts, provides improved access to U.S. credit and technical expertise, and establishes a high-level dialogue on trade and investment in the form of a U.S.-Sub-Saharan September 10, 2015

Elias Demoz, MD, MBA

CEO/Medical Director

American Care Partners

6521 Arllington Blvd, Suite 410

Falls Church, VA 22042

Joint Commission ID #: 575764

Program: Home Care Accreditation

Accreditation Activity: 45-day Evidence of

Standards Compliance

Accreditation Activity Completed: 09/10/2015

Dear Dr. Demoz:

The Joint Commission would like to thank your organization for participating in the accreditation process. This

process is designed to help your organization continuously provide safe, high-quality care, treatment, and services

by identifying opportunities for improvement in your processes and helping you follow through on and

implement these improvements. We encourage you to use the accreditation process as a continuous standards

compliance and operational improvement tool.

The Joint Commission is granting your organization an accreditation decision of Accredited for all services

surveyed under the applicable manual(s) noted below:

Please be assured that The Joint Commission will keep the report confidential, except as required by law. To

ensure that The Joint Commission’s information about your organization is always accurate and current, our

policy requires that you inform us of any changes in the name or ownership of your organization or the health

care services you provide.

We encourage you to share this accreditation decision with your organization’s appropriate staff, leadership, and

governing body. You may also want to inform the Centers for Medicare and Medicaid Services (CMS), state or

regional regulatory services, and the public you serve of your organization’s accreditation decision.

Please visit Quality Check® on The Joint Commission web site for updated information related to your

accreditation decision.

Sincerely,

This accreditation cycle is effective beginning July 18, 2015. The Joint Commission reserves the right to shorten

or lengthen the duration of the cycle; however, the certificate and cycle are customarily valid for up to 36 months.

Mark G.Pelletier, RN, MS

Division of Accreditation and Certification Operations Africa Trade and Economic Forum. (back to top)

Q: How does it benefit U.S. firms?

A: By creating tangible incentives for African countries to implement economic and commercial reform policies, AGOA contributes to better market opportunities and stronger commercial partners in Africa for U.S. companies. The  Act should help forge stronger commercial ties between Africa and the United States, while it helps to integrate Africa into the global economy. U.S. firms may find new opportunities in privatizations of African state-owned  enterprises, or in partnership with African companies in infrastructure projects. (back to top)

Q: Why the need for an AGOA II bill?

A: The need for AGOA II legislation was developed in part to improve upon and clarify some of the specific provisions that were not addressed in the original AGOA legislation (or AGOA I). AGOA II is part of the Trade Act of 2002 which President Bush signed into law on August 6, 2002. (back to top)

Q: What specific changes did the AGOA II legislation make to the original AGOA law?

A: Click here to view a table comparing AGOA I and AGOA II. (back to top)

Q: What specific changes did the AGOA Acceleration Act of 2004 make to the original AGOA law?

A: Click here to view a summary of the AGOA Acceleration Act of 2004. (back to top)

Q: What specific changes did the Africa Investment Incentive Act of 2006 (AGOA IV) make to the original law?

A: Click here to view a summary of the Africa Investment Incentive Act of 2006 (AGOA IV). (back to top)

Q: What is the “Abundant Supply” provision?

A: AGOA IV provides for special rules for fabrics or yarns produced in commercial quantities (or “abundant supply”) in any designated sub-Saharan African country for use in qualifying apparel articles. Upon receiving a petition from any interested party, the International Trade Commission will determine the quantity of such fabrics or yarns that must be sourced from the region before applying the third country fabric provision. It also provides for 30 million square meter equivalents (SMEs) of denim to be determined to be in abundant supply beginning October 1, 2006. The U.S. International Trade Commission will provide further guidance on how it will implement this provision. (back to top)

Q: What benefits are provided for Botswana and Namibia?

A: AGOA II permits Botswana and Namibia to qualify for the “Special Rule,” which permits lesser developed AGOA beneficiary countries to utilize fabric manufactured anywhere in the world (extended until September 30, 2007 under AGOA III). Since Botswana’s and Namibia’s per capita GNP exceeded $1,500 (the 1998 World Bank level), they were not designated as a lesser developed beneficiary country and were not eligible for the Special Rule under the original AGOA legislation. The Africa Investment Incentive Act of 2006 (AGOA IV) continues to grant lesser-developed beneficiary country status to Botswana and Namibia, qualifying both countries for the Special Rule. While an amendment to the AGOA Acceleration Act of 2004 granted lesser-developed beneficiary country status to Mauritius, AGOA IV did not continue to grant Mauritius lesser-developed beneficiary country status. (back to top)

Q: What conditions are placed on participation by African countries?

A: The President may designate Sub-Saharan African countries as eligible to receive the benefits of the Act if they are making progress in such areas as: establishment of market-based economies; development of political pluralism and the rule of law; elimination of barriers to U.S. trade and investment; protection of intellectual property; efforts to combat corruption; policies to reduce poverty, increase availability of health care and  educational opportunities; protection of human rights and worker rights, and elimination of certain practices of child labor. Progress in each area is not a requirement for AGOA eligibility. (back to top)

Q: Which countries have been designated as AGOA eligible?

A: Click here for a list of AGOA eligible countries.  (back to top)

Q: Does the United States have the right to set eligibility criteria for African countries?

A: The criteria are standards which the Africans themselves have espoused and most are striving to uphold. But Congress never intended AGOA to be a blank check for all African countries, without regard to performance. It was  meant to offer tangible incentives for African governments to improve their political and economic governance, not to underwrite poor policies. (back to top)

Q: What are the provisions governing apparel imports?

A: AGOA provides duty-free and quota-free treatment for eligible apparel articles made in qualifying sub-Saharan African countries through 2015. Qualifying articles include: apparel made of U.S. yarns and fabrics; apparel made of sub-Saharan African (regional) yarns and fabrics until 2015, subject to a cap; apparel made in a designated lesser-developed country of third-country yarns and fabrics until 2012, subject to a cap; apparel made of yarns and fabrics not produced in commercial quantities in the United States; textile or textile articles originating entirely in one or more lesser-developed beneficiary sub-Saharan African countries; certain cashmere and merino wool sweaters; and eligible hand loomed, handmade, or folklore articles, and ethnic printed fabrics. Under a Special Rule for lesser-developed beneficiary countries, those countries with a per capita GNP under $1,500 in 1998, will enjoy an additional preference in the form of duty-free/quota-free access for apparel made from fabric originating anywhere in the world. The Special Rule is in effect until September 30, 2012 and is subject to a cap. AGOA IV continues the designation of Botswana and Namibia as lesser-developed beneficiary countries (click here for further details on apparel eligibility provisions). (back to top)

Q: Which countries fall under the per capita GNP ceiling for the Special Rule?

A: All Sub-Saharan African countries meet the per capita GNP requirements of the Special Rule with the exception of the following: Botswana, Gabon, Mauritius, Namibia, Seychelles, and South Africa. However, countries must meet the general AGOA eligibility requirements and the requirements for apparel benefits in order to qualify for the Special Rule. AGOA II grants Lesser Developed Beneficiary Country status to Botswana and Namibia, qualifying both countries for the Special Rule. The Africa Investment Incentive Act of 2006 (AGOA IV) continues to grant lesser-developed beneficiary country status to Botswana and Namibia. (back to top)

Q: When do the apparel benefits take effect?

A: Although the apparel benefits take effect October 1, 2000, beneficiary countries must first have an effective visa system in place to prevent illegal transshipment and use of counterfeit documentation. They must also institute  enforcement and verification procedures. Details were disseminated to African governments following a cable instruction to all U.S. embassies in Sub-Saharan Africa on September 21, 2000. Countries must also be beneficiary  developing countries under the U.S. Generalized System of Preferences (GSP), which includes 45 Sub-Saharan African countries. (back to top)

Q: What does the term “knit-to-shape” mean?

A: Components that take their shape in the knitting process, rather than being cut from a bolt of cloth. (back to top)

Q: What are the Act’s GSP provisions?

A: AGOA authorizes the President to provide dutyfree treatment under GSP for any article, after the U.S. Trade Representative (USTR) and the U.S. International Trade Commission (USITC) have determined that the article is not  importsensitive when imported from African countries.  On December 21, 2000, the President extended duty-free treatment under GSP to AGOA eligible countries for more than 1,800 tariff line items in addition to the standard GSP list of approximately 4,600 items available to non-AGOA GSP beneficiary countries.  The additional GSP line items, which include such, previously excluded items as footwear, luggage, handbags, watches, and flatware were implemented after an extensive process of public comment and review.  Sub-Saharan African GSP beneficiary countries are also exempted from competitive need limitations.  In order for any Sub-Saharan African country to receive the liberalized GSP benefits it must first be GSP eligible under the existing criteria of that law.

GSP is extended for Sub-Saharan African beneficiary countries until September 30, 2015. (back to top)

Q: How can African countries become more familiar with the benefits of the Act?

A: The U.S. Government has conducted technical assistance seminars in Africa and the United States to explain the benefits of the Act, in order to ensure that African countries are able to take maximum advantage of its provisions. (back to top)

Trade Associations- AGOA

 

  1. What is the name of the association?                             ______________________
  2. In what year was the association established? ______________________
  3. In what city and country is the association located _____________________

 

  1. Under which of the following categories do the association’s business members export duty-free under    

         AGOA?

  1. Agricultural Products
  2. Forest Products Chemicals and Related Products
  3. Textile and Apparel
  4. Footwear Minerals and
  5. Metals Machinery
  6. Transportation Equipment
  7. Electronic Products
  8. Other, please specify: __________________________

 

How do association members rate the following AGOA trade preference issues as obstacles to additional investment?

 

  1. Very Severe Obstacle   b. Severe Obstacle   c. Moderate Obstacle   d. Somewhat Obstacle e. Not an Obstacle

 

  1. AGOA’s expiry in 2015
  2. Costs complying with AGOA
  3. Annual Review of Country’s AGOA eligibility
  4. Possible Extension of AGOA-like preferences to other Developing Countries
  1. [For Textile] Third Country Fabric Provision expiry in 2012
  2. [For South Africa and Mauritius Textiles] Non-inclusion under Third Country Fabric Provision
  3. [For Sugar, Tobacco, and Peanuts] Access associated with U.S. Tariff Rate Quota System

How do association members rate the following infrastructure issues as obstacles to additional investment?

  1. Cost of Transport
  2. Reliability of Transport Infrastructure
  3. Cost of Electricity
  1. Very Severe Moderate b. Somewhat Obstacle           c. Severe Obstacle     d. Obstacle        e. Obstacle

 

  1. Reliability of Electricity Supply
  2. Cost of Water Supply
  3. Reliability of Water Supply
  4. Cost of Telecommunications
  5. Reliability of Telecommunications

 

How do association members rate the following as obstacles to additional investment?

  1. Very Severe Obstacle   b. Severe Obstacle   c. Moderate Obstacle   d. Somewhat Obstacle   e. Not an Obstacle

 

  1. Cost of finance
  2. Availability of finance
  3. Cost of unskilled labor
  4. Availability of unskilled labor
  5. Cost of skilled labor
  6. Availability of skilled labor
  7. Cost of appropriate physical storage
  8. Availability of appropriate physical storage

 

How do association members rate the following macroeconomic and policy issues as obstacles to additional investment?

  1. Very Severe Obstacle   b. Severe Obstacle   c. Moderate Obstacle   d. Somewhat Obstacle   e. Not an Obstacle

 

  1. Access to foreign currency
  2. Foreign currency appreciation/depreciation
  3. Changes in Export Price
  4. Domestic Inflation Levels
  5. Taxation rates
  6. Duties on imports [for inputs]
  7. Duties on exports [for products]
  8. Export process and documentation [for products]
  9. Import process and documentation [for inputs]

AGOA as a US tool for promoting market based economy in Africa

INTRODUCTION

  1. Time sensitive & eligibility limited access to US Market. The African Growth and Opportunity Act [or AGOA] is a U.S. development effort that was enacted into law in May 2000 and provides eligible countries in sub-Saharan Africa with more liberal access to the U.S. market. Initially set to expire in 2008, AGOA was extended through to 2015 in 2006, and currently efforts are underway to extend AGOA through to 2025.
  1. Promoting market based economy. Country eligibility under AGOA is based on a number of criteria that aim to evaluate a country’s progress establishing a market-based economy, the rule of law and political pluralism as well as a country’s efforts protecting intellectual property, combating corruption, reducing poverty, increasing the availability of health care and educational opportunities, protecting human rights and worker rights and eliminating certain child labor practices.[4] In addition, an eligible country is required to not be involved in any activities that undermine U.S. national security. Table 1 lists the countries that were eligible under AGOA for the years 2007 to 2010, inclusive.
  1. Oil and Gas make up 93% Exports. With AGOA’s introduction, eligible countries had duty-free coverage to the U.S., expanded by an additional 1,835 product lines from the 4,650 product lines under the GSP program.[5] However, to date, less than 25% of the additional 1,835 product lines have registered imports.[6] Moreover, the bulk of exports are related to oil and gas [approx. 93%], vehicles [approx. 4%], and textiles and apparel [approx. 2%].[7]

Methodology: Qualitative and Quantitative Review. (Imports, companies, etc.)

  • Identifying duty-free exporting African companies. To identify businesses exporting under AGOA, a two-step process was utilized. Firstly, products entering into the U.S. under AGOA, i.e., duty-free under AGOA, were identified. This process necessitated an examination of the U.S. International Trade Commission’s Data Web so as to derive listings of imports at various HTS levels by country. Thereafter, companies exporting these products to the U.S. during the period of study were identified. Company identification required interviews with African diplomatic missions in the U.S. and an examination of online intelligence platforms. Annex 1 illustrates the identification of AGOA exporters from Ethiopia.
  • Constraints to investment by exporting businesses. With respect to the identification of constraints to additional investment faced by businesses exporting under AGOA, a series of methods were utilized that included the following:
  • Survey administration to various businesses exporting under AGOA;
  • Interviews with representatives from governments and sector associations; and
  • Research on key investment and competitiveness bottlenecks by country from global competitiveness reports.

Challenges: Information gaps due to low survey response.

 

  • Low response by businesses. A key issue faced in conducting the research was the low response rate by businesses to the survey administered. The various reasons provided by individual companies were a company policy that prevented information disclosure and the administration by various other parties of concurrent surveys in the lead up to the AGOA forum in Zambia. However, the complementary interviews with government representatives, trade experts and sector associations as well as literary research more than complemented for any information gaps derived from the low survey response rates.
  • SECTION 2 – AGOA IMPACT ANALYSIS BY SECTOR

Textile and Apparel Sector

Overall Performance of the Textile and Apparel Sector under AGOA

  • Sub-Saharan Africa’s textile and apparel sector[8] has been one of the big beneficiaries of AGOA. Textile and apparel products exported under AGOA grew from $355.8 million in 2001 to its peak in 2004 of $1,615 million (an increase of 353.9%). From 2004 to 2010, however, exports of textile and apparel products under AGOA declined from $1,615 million in 2004 to $726.5 million in 2010 (a decrease of 55%), see figure 2.1 below and table 2.2 at the end of the textile and apparel section.

Figure 2.1. AGOA Exports Apparel and Clothing

Source: USITC database

Table 2.1. Average MFN Duties on Clothing Products

Source: Cornelia Staritz. 2010. “Making the Cut? Low-Income Countries and the Global Clothing Value Chain in a Post-Quota and Post-Crisis World”, The World Bank, 2010, Washington, D.C. page 10.

 

Key Sector Constraints Identified

 

  • Key bottlenecks to increased investments. Notwithstanding the identified exogenous factors above[9] that have constrained trade and investment levels in sub-Saharan Africa’s textile and apparel sector, our research identifies the following additional factors as key bottlenecks to increased investments in the sector:
  • Time limit and competition. Uncertainties inherent in the AGOA preference regimen particularly as related to the following: (i) expiration of the third-country fabric provisions which had been scheduled to expire in September 2012, (ii) expected termination of AGOA in 2015, and (iii) possible extension of AGOA-like, tariff-preferences to other Less Developed Countries such as Bangladesh and Pakistan.
  • Lag in product delivery. Sector’s relatively long time to market, i.e., turnaround time, following a client’s order to product delivery, particularly given the need for apparel producers to order the needed fabrics from East Asia, which takes about 30 days[10], prior to commencing actual work on the order. This lag in product delivery is one key factor that apparel producers in the U.S. are very sensitive to and one that also adds additional financing burdens on Africa’s apparel exporters.
  • Infrastructure deficiencies. Deficiencies in the levels of infrastructure diminish the overall sector’s level of competitiveness. These infrastructures depend on the type of industry – with textile firms requiring significant levels of capital, electricity and water; while apparel firms, on the other hand, requiring a large supply of competitive and capable labor force. Of critical importance, here, is the role of investment promotion offices in taking stock of the sector’s potential competitiveness and tailoring the sector’s cost and incentive advantages to potential investors.

Key Sector’s Recommendations

  1. Critical recommendation to the AGOA program (Time Extension).
    • Extension of third country fabric provisions to 2015. There is a great need to immediately extend the third country-fabric provision, which is scheduled to expire in 30 September 2012. The immediate extension of the third country-fabric provision is necessary as large international buyers plan their sourcing 6 to 12 months in advance.[11] Consequently, the bill being proposed by Jim McDermott, H.R. 2493, which calls for an extension of third country fabric provisions to 2015, is very important.
  • AGOA extension through 2025. Need to extend both AGOA and the third country-fabric provisions beyond 2015 as it will allow for further consolidation of the gains in trade and investment in Africa’s textile sector resulting from AGOA. As a result, the Obama administration’s support of the extension of AGOA through to 2025 and the extension of the third country-fabric provisions through to 2022 is very important. At the country and the firm-level, the following are critical:

Source: USITC database
Agriculture Sector[12]

Overall Performance of the Agricultural Sector under AGOA

  • Disappointing Agricultural sector performance. AGOA’s impact on trade and investments in Africa’s agriculture sector has been recognized by many to be disappointing. [13] In spite of the fact that African countries are principally agricultural based economies, exports of agriculture to the U.S. under the duty-free under AGOA provision represented less than 0.5% of overall AGOA exports and, exports from South Africa alone captured the bulk of these exports.
  • Improved performance of edible nuts, cut flowers, vegetables and fruits. Some bright spots, however, vis-à-vis AGOA’s impact on agriculture include the performance of edible nuts, cut-flowers and preparations of vegetables, fruits and nuts, see table 2.3. Exports of edible nuts under AGOA, for example, increased by 269% from $12.0 million in 2007 to $44.2 million in 2010 while exports of cut-flowers increased by 50% from $1.2 million in 2007 to $1.8 million in 2010. Of significance is the fact that these increases occurred in spite of higher oil prices and the tempering of U.S. demand. See tables 2.4 and 2.5 at the end of the agriculture section for more details on AGOA’s agricultural export performance for selected subsectors.
Table 2.3. Select Agriculture Exports under AGOA (2007-2010)

 

Source: USITC database

  • Impact of volatile Australian weather patterns. Contributing factors to the strong performance of edible nuts and cut-flowers between 2007 and 2010 are the following:
    • Edible nuts:
      • Strong demand in the U.S. for macadamia over the past years[14];
      • Volatile weather patterns in Australia[15], the largest macadamia producer, which has in recent years experienced supply contractions;
    • Significant appreciation of the Australian dollar vis-à-vis the U.S. dollar, which has made it unprofitable in some instances to export Australian macadamia to the U.S.;[16] and
      • Robust growth in macadamia production in South Africa, Africa’s largest producer.
    • Cut-flowers: Africa-Europe-USA, Red Rose Wholesale re-exportation.
      • Ability under AGOA for some rose exporters to capture a share of red-roses that were traditionally exported by African growers to European wholesalers and then re-exported by these European wholesalers to clients in the U.S.[17]

Key Sector Constraints Identified

  • Stringent USDA compliant regimen. A significant constraint vis-à-vis African exporters of agricultural products (and beef) to the U.S. involves the very high sanitary and phyto-sanitary standards (SPS) instituted by the USDA, which in many cases is higher than that of the E.U. Companies in Kenya that export beans and roses to both the E.U. and the U.S. have indicated that the USDA’s compliance regimen is much more stringent than that of the E.U. Moreover, S. bioterrorism laws have made the sending of agricultural product samples to potential clients very difficult.

 

  • Tariff-rate quotas exclusion. The exclusion of key agricultural products that are currently covered by tariff-rate quotas (TRQs) for which some African countries are deemed low-cost producers, such as sugar and tobacco.[18] The increased investments in Mozambique and Sudan resulting from sugar reforms in the EU market provide evidence of the potential effects on investment should the U.S. follow suit and provide AGOA members with preferential access for such commodities.[19]

Table 2.4. Select Agricultural Product Exports by Country under AGOA, 2007 to 2010, $ Thousands

Table 2.5. Exports of Edible Nuts under AGOA by Country, 2001-2010, $ Thousands

 


Raw Hides and Skins, Leather and Footwear

Overall Performance of Raw Hides and Skins, Leather and Footwear under AGOA

  • Quality livestock and requisite infrastructure. Contributing factors to the levels of trade and investment in the raw hides and skin as well as leather [bags and shoes] sector are [i] endowments of quality livestock, [ii] the requisite infrastructure [i.e., water supply, electricity], and [iii] human resources that allow for the production in volume amounts and quality for export.

Key Sector Constraints Identified

  • Deficiencies in Skilled labor requisites. Deficiencies in the skilled labor requisites across all levels of value-added from skinning to tanning and from tanning to the manufacture of finished product.
  • Deficiencies in development of domestic tanneries. Deficiencies in the levels of development of domestic tanneries that make it difficult to meet volume and quality requirements for the U.S. market.
  • Lack of required infrastructure, including access to water supply, electricity, etc. for operators or potential investors resulting in an increase in operating costs and a reduction in efficiency.

 

  • Deficiencies in the regulatory oversight needed to ensure appropriate checks on effluent discharges by tanneries.

Key Recommendations

  1. Need to extend AGOA through to 2025 so as to allow the time horizon needed to effectively develop the productive capacities in the sector.

 

 

 

 

 

 

 

 

 

Table 2.7. Raw Hides/Skins, Leather and Footwear Exports by Country under AGOA, 2007-2010, $ Thousands

end_of_the_skype_highlighting


Oil and Gas Sector

Overall Performance of the Oil and Gas Sector under AGOA

Figure 2.2. Oil and Gas Exports under AGOA (2001-2010)
  • Improving Oil and Gas Sector. Africa’s oil and gas sector has been AGOA’s biggest beneficiary. In 2010, $36 billion worth of oil and gas entered into the U.S. duty-free under AGOA, i.e., 93.1% of total duty-free under AGOA imports. Figure 2.2 presents oil and gas exports under AGOA between 2001 and 2010.
  • Declining US gas and oil imports.S. imports of oil and gas under AGOA decreased by 10.4% from $40.2 billion in 2007 to $36.0 billion in 2010 (see table 2.8). Underlying this decline was the tempering of U.S. demand, which resulted in a decline in total U.S. imports of oil and gas from an average of 13.5 thousand barrels of crude oil per day in 2007 to 11.8 thousand barrels of crude oil per day.[20]

Table 2.8. Oil and Gas Exports, Duty Free Under AGOA, US$ Millions

  • Major Oil Companies investing in Africa. Almost all of the major oil companies have been very active in sub-Saharan Africa. According to company filings, the top 3 oil majors’ investments in sub-Saharan Africa were Exxon-Mobil $4.805 billion[21]; Chevron $3.912 billion[22]; and ENI $3.350 billion.[23] Other investors include British Petroleum, Shell, Perenco, Tullow, Marathon Oil and Hess Energy. Key destinations of development capital expenditures were Nigeria, Angola, Ghana and Gabon; while exploration expenditures were more widespread across sub-Saharan Africa.

 

  • Promising African geology and upswing in oil prices. Contributing factors to the strong levels of trade and investment in sub-Saharan Africa’s oil and gas were the promising geology, particularly in the West Africa region;[24] and the upswing in oil prices, which have trended upward except for the period shortly following the global financial crisis, see figure 2.3 below.
Figure 2.3. Weekly [All Country] Spot Prices FOB Weighted by Export Volume, $ Per Barrel

Source: Energy Information Administration Data, Accessed 8 August 2011.

Key Sector Constraints IdentifiedDisputes over equity transfers or changes in policies can unnerve investors. Recent examples of situations that negatively impacted investor sentiment were the legal dispute [now seemingly resolved] between Kosmos Energy’s and the Ghanaian government over the proposed sale of Kosmos’ equity stake to ExxonMobil as well as the proposed Nigerian Industry Petroleum Bill, which attempts to comprehensively overhaul Nigeria’s petroleum industry.


Automotive Sector (Excludes Railway Cars)

Overall Performance of the Automotive Sector under AGOA

  • South Africa is the only African country that exports vehicles to the U.S. under AGOA. South Africa’s exports of vehicles other than railway cars under AGOA, increased by 229% from $467.4 million in 2007 to 1,538.2 million in 2010, see table 2.9 below.

Table 2.9. Exports of Vehicles under AGOA, 2007-2010, US$ Millions


Source: USITC and data from NAMSA’s Quarterly Review of Conditions Dated 5 May 2011.

Note: Capital Expenditures were converted to US$ from SA Rand using yearly average exchange rates for the period from EIU intelligence unit.

  • Ford & GM Motor Companies in South Africa. Most major car manufacturers are located in South Africa and many have engaged in plant expansions. Ford Motor Company of South Africa, for example, indicated in January 2008 that it would invest more than R1.5 billion [~$180 million] to expand operations for the production of Ford’s compact pickup truck and Puma diesel engine.[25] In addition, GM South Africa was awarded a six year $100 million contract in 2005 to supply, assemble and export the Hummer H3.[26]
  • Benefits to the South Africa MIDP. The automotive sector has strongly benefited from [i] the AGOA preference regimen; [ii] South African government’s Motor Industry Development Program (MIDP)[27], and [iii] South Africa’s relatively strong competitiveness position [ranked 54th in the World Economic Forum’s Global Competitiveness Index 2010-11].

SECTION 3: – AGOA IMPACT ANALYSIS FOR SELECT COUNTRIES (2007-2010)

  • In this section, a brief country analysis on the impact of AGOA on exports and investments over the period 2007 to 2010 will be performed. The countries selected are: Angola, Benin, Botswana, Cape Verde, Ethiopia, Ghana, Kenya and Lesotho. This selection includes three countries from South Africa, i.e., Angola, Botswana and Lesotho; two countries from East Africa, i.e., Ethiopia and Kenya; and three countries from West Africa; i.e., Benin, Cape Verde and Ghana.

Angola [Southern Africa]

Angola’s Overall Export Performance under AGOA

  • In spite of Angola’s rich agriculture and fishery resource-base, Angola’s exports to the U.S. under AGOA were exclusively in the oil and gas sector between 2007 and 2010, see table 3.1.

 

Table 3.1 Angola’s Duty-Free Exports to the U.S. under AGOA, 2007-2010, $ Thousand

 

  • On average Angola’s oil exports under AGOA increased by 32%, from $4.8 billion in 2007 to $6.3 billion in 2010. Over this period, Angola’s exports under AGOA represented approximately 15% of total AGOA exports.
  • Angola’s oil and gas exporters to the U.S. were the local subsidiaries of the major multinational oil companies as well as Sonangol[28], the company responsible for the management of Angola’s oil and natural gas reserves. These exporters include: Cabinda Gulf Oil Company [Chevron subsidiary]; Esso, Angola; Sonangol; Total, Angola; Fina Petroleos De Angola Avenida; Statoil Angola; Eni Angola; Norsk Hydro Dezasette A.S.; Acrep; and Somoil.[29]
  • Angola’s oil and gas exporters to the U.S. invested significantly in exploration and development activities in Angola. Our estimates of attributed investments[30] by the oil majors in Angola provides the following estimates of investments in Angola’s oil and gas sector over the period 2007 to 2010.

Table 3.2. Attributed Investments in Angola’s Oil and Gas Sector by Companies Exporting to the U.S. under AGOA, 2007-2010, $ Thousands

Source: Individual Company Annual Reports.

Key Investment Factors Facing AGOA Businesses in Angola

  • Angola’s significant oil and gas reserves[31] and comparatively strong level of investor protection[32] are key factors that have contributed to the high investment amounts in Angola’s oil and gas sector. These country-specific factors have been complemented by the sustained high prices in oil and gas following the oil and gas price hike of 2005.
  • Outside Angola’s oil and gas sector, however, companies experience significant bottlenecks tied to a very difficult competitive environment. Angola’s ranking of 137 out of 139 countries in the World Economic Forum’s most recent Global Competitiveness Report encapsulates these challenges in investment and business environment.[33]
  • A cursory examination of Angola’s performance in the World Economic Forum’s Global Competitiveness Report 2010-11 indicates that key bottlenecks exist with infrastructure, human resource, government bureaucracy, and financial market development.[34] The Angolan government has attempted to address such bottlenecks through increased financing of sectors outside the extractive industry utilizing a National Development Fund that is managed by the Development Bank of Angola.
  • However, any efforts to build a sustainable and competitive, export-oriented sector in Angola’s fisheries, textile and agribusiness sectors would require sustained efforts by both the central and regional Angola governments in structuring dramatic improvements that address Angola’s competitiveness gaps.

Botswana [Southern Africa]

Botswana’s Overall Export Performance under AGOA

  • Botswana exported only textile and apparel under AGOA over the period 2007 to 2010 in spite of having the potential to export a variety of products such as leather and arts and crafts. Moreover, Botswana’s textile exports declined from $31.3 million in 2007 to $11.6 million in 2010 (see table 3.3).

 

 

Table 3.3. Botswana’s Exports to the U.S. under AGOA

  • Botswana’s textile and apparel exporters under AGOA during this period were Carapparel Botswana, Microlith Ltd., and Cara Fashions.[35] However, Microlith and Cara Fashions stopped shipping to the U.S. in 2008 and 2007, respectively.[36]

Key Investment Factors Facing AGOA Businesses in Botswana[37]

  • In the World Economic Forum’s Global Competitiveness Report 2010-11, Botswana’s ranked 4th in Sub-Saharan Africa and 76th[38] The key areas of Botswana’s competitive advantage included the quality of its institutions, quality of education, quality of road and rail infrastructure, low tax rate and the extent of taxation, and level of financial market development.[39] However, a large government budget balance and a high prevalence of HIV and TB were key areas where Botswana had a competitive disadvantage.[40]
  • During discussions with representatives from the Embassy of Botswana, concerns emerged about the diminished competitiveness of Botswana’s textile and apparel exports under AGOA and the need for significant upgrading in Botswana’s tanneries to jump-start leather exports.
  • The key factors that were identified as contributing to the diminished competitiveness of Botswana’s textile and apparel exporters under AGOA were the following:
  • End of the Multi-Fiber Arrangement in 2005 and the increased competition from Asia;
  • High inland transportation costs[41] in terms of time and money – particularly given that raw materials for the textile and apparel industry are sourced from Asia and the finished product is exported to the U.S.,
  • High cost of finance given the long payment cycles, which on average take 180 days, from the time of payment to the input supplier in Asia to the receipt of payment from the finished product client in the U.S., and the
  • Tempering of U.S. demand following the global economic crisis of 2007.
  • With respect to the leather sector, representatives from the Embassy of Botswana indicated that the domestic tanneries required significant upgrading to meet the quality and volume demands of the U.S. market. Toward this end, Botswana has been soliciting foreign investment in tanneries.

Lesotho [Southern Africa]

Lesotho’s Overall Export Performance under AGOA

·       Lesotho exported an average of $318.9 million worth of textile and apparel products exclusively under AGOA over the period 2007 and 2010. These exports declined by 26% from $379.6 million in 2007 to $280.3 million in 2010, see table 3.4.

Table 3.4. Lesotho’s Exports to the U.S. under AGOA

An examination of online intelligence platforms and discussions with the Lesotho National Development Corporation [LNDC] identified the following textile and apparel companies as AGOA exporters over the period 2007 and 2010:

Lesotho Precious Garments (Pty) Ltd; C & Y Garments; Presitex Enterprises (Pty) Ltd; Tai Yuan Garments (Pty) Ltd; Global Garments Co. (Pty) Ltd; Cgm Industrial (Pty) Ltd; Ever Unison Garments Lesotho (Pty) Ltd; Nien Hsing International Lesotho (Pty) Ltd; San Ti Kon Textiles (Pty) Ltd; Sun Textiles (Pty) Ltd; Tzicc Clothing Manufactures (Pty); Export Unlimited; Shinning Century Ltd; Super Knitting (Pty) Ltd; Jonsson Mfg. (Pty) Ltd; Jw International; J&S Fashions (Pty) Ltd; United Clothing (Pty) Ltd; Eclat Evergood Textiles (Pty) Ltd; Kopano Textiles (Pty) Ltd; Lolita Clothing Co. (Pty) Ltd; Sweat Sun (Pty) Ltd; Wonder Garments Mfg; Lesotho Hinebo Textile (Pty) Ltd; Raytex Garments (Pty) Ltd; Hippo Knitting (Pty) Ltd; Five Eight (Pty) Ltd; Mauri Garments (Pty) Ltd; Lesotho Evergood Textiles; New Epoch Knitting (Pty) Ltd; First Apparel Mfg.(Pty) Ltd; C River Textile (Pty) Ltd; Tern Sportswear (Pty) Ltd; Lesotho P&T Textile (Pty) Ltd; and Formosa Textiles Co., Ltd.

Key Investment Factors Facing AGOA Businesses in Lesotho

  • In the World Economic Forum’s Global Competitiveness Report for 2010 to 2011, Lesotho ranked 128 out of 139 countries. Areas of competitiveness that Lesotho scored strongly in were in the total tax rate [% of profits], number of procedures to start a business, females in labor-force and legal rights index.[42] Areas where Lesotho performed poorly competitively were: business impact of HIV, life expectancy, primary and tertiary education enrollment rates, quality of management schools, availability and affordability of financial services, and domestic market-size index.[43]

·       Discussions with the Lesotho National Development Corporation [LNDC] indicated that between 2007 and 2010, Lesotho’s textile and apparel sector generated an annual average of $1.15 million in new investments. J&S Fashions, a knitting factory that began operations in 1996 indicated that it had invested an average of $704,000 annually over the period 2007 and 2010, see table 3.5 below.

Table 3.5. Investments by Lesotho’s AGOA Exporters, 2007-2010

* Data provided by the Lesotho National Development Corporation and reflect an overview of new investments in the sector.

** CAPEX are capital expenditures by established companies for capital improvements, expansion etc. J&S Fashions was the only company that provided that level of information.

  • Discussions with the LNDC identified the following as key obstacles to additional investment by Lesotho’s AGOA exporters:
    • Uncertainty around AGOA’s expiry in 2015; expiry of third country fabric provision in 2012; the stringent rules of origin and technical barriers to trade (particularly SPS for agricultural exports);[44]
    • Capacity issues at the firm-level that have prevented companies from producing at levels that would generate good returns as well as access to finance, particularly related to working capital so as to cover the period between orders and payment; and
    • Cumbersome border procedures in transit as a result of Lesotho’s landlocked status.
  • Moreover, the LNDC indicated that the following activities would enable Lesotho take better advantage of AGOA in the near to long-term:
    • Investments in science and technology, research and development, youth and women;
    • Investments that enhance skill development in key products so as to ensure that Lesotho competes globally and diversifies its export base.
  • According to our survey of businesses exporting under AGOA from Lesotho, the following were identified as very severe obstacles to additional investments: AGOA’s expiry in 2015; expiration of the third country fabric provisions in 2012; fluctuations in foreign currency; and quality of electricity infrastructure.
  • Meanwhile, AGOA businesses on average identified the following as severe obstacles to additional investment: uncertainty over a country’s eligibility; possible extension of AGOA-like preferences to other developing countries; cost of transport; quality of telecommunications; and availability of skilled labor.
  • The same respondents identified the following as moderate obstacles to additional investment: requirements complying with AGOA; access to foreign currency; domestic price inflation; taxation rates; import and export procedures and documents required; cost of electricity; cost of water supply; cost of skilled labor; availability of land; and the availability of appropriate physical storage.

Ethiopia [Eastern Africa]

Ethiopia’s Overall Export Performance under AGOA

  • Ethiopia’s exports under AGOA increased by 45% from $4.8 million in 2007 to $6.9 million in 2010. Over 97.5% of Ethiopia’s exports under AGOA during this period was related to textiles and apparel; however, Ethiopia did export footwear, tomato paste, red roses, wines and broomcorn as well, see table 3.6.

 

 

 

 

Table 3.6. Exports from Ethiopia to the U.S. under AGOA

  • Ethiopia’s AGOA exporters by sector between 2007 and 2010 were the following:
    • Red Roses:
      • Flowerama PLC and Summit PLC.
    • Tomato Paste:
      • Likely to be Upper-Awash Agro-Industry Enterprise[45]
    • Textile and Apparel:
      • Knit to Finish PLC [aka Kombolcha Share Co.], Novostar Garment, Kebire Enterprises PLC, Nazareth Garment Share Co., Nn Garment Factory, Almeda Textile Plc., Feleke Garment Plc, Mulat Garment Plc, BM Ethiopia Garment & Textiles, Oasis Abyssinia, Gg Super Garment Factory Plc, Koreithi General Textile Plc, Yirgalem Molla Akalie and Addis Garment [aka Augusta].
    • Footwear:
      • Anbessa Shoe Share Co.
    • Beverages and Spirits:
      • Awash Wine Share Co. and National Alcohol & Liquor Factory.

Key Investment Factors Facing AGOA Businesses in Ethiopia

  • In the most recent World Economic Forum’s Global Competitiveness Report, Ethiopia was ranked 119th.[46] Overall, it scored at par with the sub-Saharan African average. Areas where Ethiopia displayed a competitive advantage were in the burden of government regulation, business costs of crime and violence, quality of air infrastructure, total tax rate (% of profits), number of procedures required to start a business, and agricultural policy costs.[47] In terms of competitiveness bottlenecks, Ethiopia ranked very poorly in inflation; capital control restrictions; quality of electricity supply; production process sophistication; and telecommunications.[48]
  • In discussions with textile and apparel managers, they indicated that AGOA exports have required that they undertake significant upgrading of equipment. They indicated that the limited experience of Ethiopia’s entrepreneurs and workforce in textile exports was also somewhat of a problem and, thus, required some handholding [i.e., need for an upgrading of the skill-levels in the industry].
  • In our survey of Ethiopian companies[49] engaged in AGOA exports, the quality of telecommunications was listed as very severe obstacles to additional investment. Textile and apparel companies placed the expiration of the third country fabric in 2012 as a very severe obstacle to additional investment.
  • With respect to obstacles to additional investment deemed to be severe, companies listed the following: AGOA’s expiry in 2015; uncertainty over a country’s continued eligibility; domestic price inflation; cost of transport; quality of electricity; cost of telecommunications; availability of skilled labor; quality of transport; import and export procedures and documents required; fluctuations in foreign currency; and fluctuations in export price.
  • On average, all companies listed the following as moderate obstacles to additional investment: cost of skilled labor; availability of finance; possible extension of AGOA-like preferences to other countries; import duties; requirements complying with AGOA; cost of finance; and availability of unskilled labor.
  • Table 3.7 below depicts the investments in capital costs of AGOA exporters in Ethiopia that agreed to provide the information.

Table 3.7. Investments by Exporters from Ethiopia under AGOA, 2007-2010


Source: Surveys of individual companies

Note: Other companies did not provide details.

Kenya [Eastern Africa]

Kenya’s Overall Export Performance under AGOA

  • Between 2007 and 2010, Kenya exported an average of $232 million worth of AGOA exports annually to the U.S. Approximately 95% of Kenya’s AGOA exports were textile and apparel. However, Kenya also exported relatively significant quantities of pineapple juice concentrate, macadamia nuts and red roses. Macadamia nut exports under AGOA increased by 432% from $2.9 million in 2007 to $6.2 million in 2010. Table 3.8 depicts AGOA’s exports from Kenya between 2007 and 2010.

Table 3.8 Kenya’s Exports under AGOA

  • A listing of Kenya’s AGOA exporters by category is below:
  1. Cut Flowers [red roses and dried flowers]:
  1. Valentine Growers Ltd.; K-net Ltd; Primarosa Flowers Ltd; Oserian Ltd; Flamingo Holdings; and Taly Nofar & Ayal [dried flowers].
  1. Macadamia and Macadamia Seed Oils:
  1. Kenya Nut Co. Ltd; Wondernuts [K] Ltd; Equatorial Nut Processors Ltd; Sawafrica [EPZ] Ltd [aka Jungle Macs EPZ]; and Samar Greens Ltd; Earthoil Kenya [EPZ] Ltd.
  1. Foodstuffs [Wheat flour etc.]
  1. Shree Sai Industries Ltd; Wedo Foods Ltd and Sujaac Ltd.
  1. Juices and Concentrate:
  1. Del Monte Kenya and Kevian Ltd
  1. Textiles and Apparel:
  1. Protex Kenya (EPZ) Ltd; Alltex (EPZ) Ltd; Upan Wasana E P Z Ltd; Kenya Trading (EPZ) Ltd; Africa Apparels (EPZ) Ltd; United Aryan (EPZ) Ltd; Ashton Apparel EPZ, Ltd; Senior Best Garments Kenya (Epz) Ltd; Apex Apparels (EPZ) Ltd; Shin-Ace Garments Kenya (EPZ) Ltd; Rolex Garments (EPZ) Ltd; Blue Bird Garments Kenya (EPZ) Ltd; Emke Garments (Kenya) Ltd; Kenya Knit Garments (EPZ) Ltd; Kapric Apparels Epz Ltd; Leena Apparels Ltd; J A R Kenya (EPZ) Ltd; Apparel Africa Ltd; Mirage Fashionwear(Epz) Ltd; Bedi Investments Ltd; M.R.C Nairobi (EPZ) Ltd; Maasai Collections Ltd; Nodor Kenya [EPZ];
  1. Fishing Flies and Tackle:
    1. Kenya Bamboo Fishing Flies and Hand Tied Fishing Flies [Not yet exporter to U.S., but interested]
  1. Candles:
  1. Peng’s Candles [EPZ]

Key Investment Factors Facing AGOA Businesses in Kenya

  • In terms of competitiveness, Kenya ranked 106th overall in the World Economic Forum’s Global Competitiveness 2010-11 Report with a score that was greater than the sub-Saharan African average.[50] Kenya maintained a competitive advantage in financial market development, quality of educational system, labor market efficiency, and innovation.[51] However, Kenya ranked poorly in public trust of politicians, inflation, basic health, tertiary education enrollment rate, and broadband Internet subscription.[52]
  • During phone interviews with certain AGOA investors, the following obstacles to additional investment were specifically highlighted:
  • In the textile and apparel sector, an interviewee identified logistics from Kenya given long transits and a monopoly of carriers from a shipping perspective as well as a rising annual wage bill as key constraints.
  • In the macadamia nut sector, an interviewee identified the policy issue surrounding the reversal of the ban of exports of raw macadamia, which was instated in 2009 by the former Minister of Agriculture and the subsequently long, yet successful court proceedings to overturn the reversal. During the period when the ban was overturned, the interviewee indicated that many processing companies were operating at very low throughput given that they couldn’t source local macadamia supplies.
  • In the cut-flower sector, an interviewee identified a lack of a direct flight to the U.S., the cost of freight, which was identified as twice that to the EU, and the more stringent phyto-sanitary requirements in the U.S. over that in the EU as key bottlenecks hindering greater exports under AGOA to the U.S.
  • In our survey of Kenyan exporters of AGOA products, on average all companies identified the AGOA’s expiry in 2015 as a very severe obstacle to additional investment. Companies in the cut-flower sector identified the cost and quality of transport infrastructure as well as export procedures and documents required as a very severe obstacle to additional investment.
  • All companies listed on average the following as severe obstacles to additional investment: fluctuations in export price; cost of electricity; fluctuations in foreign currency; domestic price inflation; cost of finance; possible extension of AGOA-like preferences to other LDCs; fluctuations in foreign currency; quality of transport infrastructure; and quality of water supply. Moreover, textile companies listed the expiration of the third country fabric in 2012 and cut flower companies listed availability of land as severe obstacles to additional investment.
  • The following were identified on average as moderate obstacles to additional investment; taxation rates; cost of water supply; cost of land; availability of finance; cost and availability of skilled labor; quality of electricity infrastructure; import procedures and documents required; quality of telecommunications; cost of unskilled labor; and import duties.
  • Table 3.9 presents capital expenditure data for some companies exporting from Kenya to the U.S. under AGOA.

Table 3.9. Investments by Exporters from Kenya under AGOA, 2007-2010

Cape Verde [Western Africa]

Cape Verde’s Overall Export Performance under AGOA

  • Between 2007 and 2010, Cape Verde exported $146,000 worth of canned tuna. These exports were registered in 2010, see table 3.10.

 

 

 

 

Table 3.10. Cape Verde’s Exports to the U.S. under AGOA

  • The canned tuna exports were by Indupesca Limited.

 

Key Investment Factors Facing AGOA Businesses in Cape Verde

  • In the World Economic Forum’s Global Competitiveness Report 2010-11, Cape Verde was ranked 117th, with an overall score exactly the same as the sub-Saharan African average.[53] In terms of obstacles to improved competitiveness, Cape Verde ranked poorly in quality of electricity supply, quality of management schools, prevalence of trade barriers, burden of customs procedures, degree of customer orientation, and local supplier quantity and quality.[54]
  • Our survey of Cape Verdean companies[55] engaged in fish exports revealed that ALL companies identified the cost of electricity as a very severe obstacle to additional investment. While companies that exported to the U.S. included AGOA’s expiry in 2015 as a very severe obstacle to additional investment.
  • Moreover, companies identified as a severe obstacle to additional investment the quality of electricity, the cost and quality of transport infrastructure, cost of telecommunications, import duties, quality of water, and cost of skilled labor.
  • In terms of moderate obstacles to additional investment, companies highlighted the following: fluctuations in foreign currency and export price; domestic price inflation; taxation rates; export duties; procedures and documents required to both export and import; cost of water supply; cost of telecommunications; costs of both skilled and unskilled labor; availability of skilled labor; and costs of land and availability of land.
  • The Cape Verdean Investment Agency identified key constraints facing Cape Verdean exports to the U.S. as logistics, transport, certification, standards, and high costs of inputs [due to geography] and language. In addition, they indicated that U.S. investment levels in Cape Verde would be better promoted through the signing of bilateral investment treaties and double taxation treaties.
  • Table 3.11 depicts the capital cost expenditures of Indupesca, the only Cape Verdean company to export to the U.S. under AGOA over the period 2007 to 2010.

Table 3.11. Investments by Exporters from Cape Verde under AGOA, 2007-2010

 

Ghana [Western Africa]

Ghana’s Overall Export Performance under AGOA

·       Ghana’s duty-free exports under AGOA, declined by 96% from 56.2 million in 2007 to 2.1 million in 2010, see table 3.12 below. These exports were primarily mineral fuels[56] and textiles and apparel. However, it is expected that with the coming online of Ghana’s crude oil from the Jubilee oil fields that Ghana’s mineral fuel AGOA exports will surge.

Table 3.12. Ghana’s Duty Free Exports Under AGOA

A listing of Ghanaian companies that export under AGOA by sector is outlined below:

·       Food Products:

o   Ernimich Ltd and Twintown Enterprise

·       Textile and Apparel:

o   Patex Enterprise [Social Enterprise]; Network Knitwear Fabrics Ltd; Oak Brook Ghana Ltd; PSI Properties/Gold Coast Collect; Sleek Garment Export Ltd; Extex Batix [Ghana]

·       Oil and Gas:

o   Tema Oil Refinery and Ghana National Petroleum Corp. [for Tullow Oil]

Key Investment Factors Facing AGOA Businesses in Ghana

·       In the global competitiveness index, Ghana was ranked 114th overall and performed better than the sub-Saharan African average.[57] Ghana performed well in public institutions and governance indicators and maintained a high investor protection ranking. By regional standards, Ghana’s government efficiency, ports and financial markets are viewed as well-performing.[58]

·       In terms of deficiencies, the education levels in Ghana lag international standards, labor markets are considered inefficient, the country is not harnessing new technologies for productivity enhancements and there is some evidence of inefficiencies in the financial system.[59]

·       In our survey of Ghanaian companies engaged in AGOA exports, the following were listed as very severe obstacles to additional investment: Agoa’s expiry in 2015; quality of electricity infrastructure; and cost of finance. Moreover, textile and apparel companies listed the expiration of the third country fabric provision in 2012 as a very severe obstacle to investment.

·       The following were listed as severe obstacles to additional investment: fluctuations in foreign currency; domestic price inflation; cost of electricity; cost and availability of land; cost and quality of water supply; cost and quality of telecommunications and availability of finance.

·       Table 3.13 identifies capital expenditure investments for Ghanaian companies that export to the U.S. under AGOA and for which data was available.

 

 

Table 3.13. Investments by Exporters from Ghana, 2007-2010, $ Thousands

Benin

Benin’s Overall Export Performance under AGOA

  • Benin did not register any exports to the U.S. under AGOA. Discussions with the Embassy of Benin, however, indicated that Benin has the opportunity to export textile and apparel products, arts and crafts, and agricultural products.

Key Investment Factors Facing Potential AGOA Exporters in Benin

  • In the World Economic Forum’s Global Competitiveness Report 2010-11, Benin ranked 103rd and scored better than that of the sub-Saharan African average. The areas where Benin demonstrated a competitive advantage were in the extent of government regulation, quality of educational system, and hiring and firing practices.[60] However, key bottlenecks existed with respect to infrastructure, market-size and technological readiness.[61]
  • In discussions with officials from the Embassy of Benin, they indicated that two problems faced by potential exporters in taking advantage of AGOA is the challenge of meeting the volume demands and quality requirements of U.S. clients. They, therefore, advocated for greater support toward efforts of building the capacities of businesses in Benin.
  • Given Benin’s market-size bottlenecks, Benin’s competitiveness framework would be better improved within a regional framework, such as within that of ECOWAS. Consequently, the effort by Benin earlier this year to harmonize investment laws amongst ECOWAS member states is positive.[62]


ANNEX 1. Imports under AGOA between 2007 and 2010, $Thousands

ANNEX 2. Overall Competitiveness Performance of

Sub-Saharan African Countries, 2010-11

 

 

Source: WEF, GCR 2010-12

end_of_the_skype_highlighting

 

 

ANNEX 3. AGOA-Eligible and AGOA Non-Eligible Countries, 2007-2010

Sources: 2007 and 2008 Reports by the USTR.

Note: “T” stands for eligible to export textile and apparel under AGOA.

XIII. The Synthesis Report SMART Work Plan and Terms of Reference

AUM Synthesis Report

From

Prior African Union Mission Consultancies

Monday, 25 July 2011

 

AUM Synthesis Report

Table of Contents                                                                                                                                                 

  1. Consultancy Objective
  2. Specifications and focus
  3. Expected outcome
  4. Scope of work
  5. Terms of reference, in line with UN and AU declarations.
  6. Historical significance and international reference.
  7. Reports to be synthesized
  8. Evaluation of the African Growth and Opportunity Act,
  9. Latin-America study tour report,
  10. Data and knowledge management,
  11. Development of policy briefs,
  12. Communication and media strategy

 

  1. Deliverables & Payment Schedule
  2. Draft Synthesis Table of Content
  3. Report and Presentation
  4. Time Frame
  5. Budget and Payment schedule
  6. Attachments: Terms of Reference for Synthesis Consultancy

 

AUM Synthesis Consultancy Work Plan

SMART Work Plan. The following Synthesis SMART Work Plan that is designed to be specific, measurable, appropriate, relevant and time sensitive to the Synthesis Consultancy Terms of Reference, and is provided in line with the contractual requirements of the synthesizing of reports from Prior Consultancies Project of the African Union Representational Mission in Washington DC.

Project Objectives

  1. Engage a short-term consultant with experience in analyzing and formulating policies;
  2. Improve the coordination of policies affecting Africa’s development

Specifications and focus:

  1. This project’s focus is to provide the African Union Representational Mission with a framework for assessing information; strengths, weaknesses, opportunities, limitations and threats of the various consultations carried out.
  2. Provide “A Single Document” comprising of attributes (strengths, weaknesses, etcetera) that will facilitate the formulation and analysis of policies.

Expected Output

  • Policy Framework Document: The consultant will be required to synthesize/integrate input from previous consultations carried out into a single document.

Scope of Work

The nature and scope of work for the consultancy includes the following:

Integration of prior consultations into policy document: The Consultant will review in-depth reports from prior consultations conducted to date. Previous consultations executed include:

  1. Evaluation of the African Growth and Opportunity Act,
  2. Latin-America study tour,
  3. Data and Knowledge management,
  4. Development of policy briefs,
  5. Communication and media strategy.

 

Report

  • Analyzing, organizing and integrating information gleaned from past project documents into a single document.
  • The policy document will be written in a concise format, devoid of redundant information.

 

  1. Deliverables:
  2. A single policy document that integrates the different consultancy works into a policy framework that analyzes the challenges, opportunities, risks and threats with appropriate recommendations for decision makers.

 

  1. Presentation
  2. Time Frame: Flexible and dependent on the availability of initial AUM Consultancy reports
  3. Revised dates
  4. Analysis of reports from previous consultations: 26 July- 16 August 2011
  5. Synthesizing information into one document: 16 August-26 August 2011
  6. Initial proposed dates
I. Analysis of reports from previous consultations July 18th- 27th, 2011 (26 July-16 August 2011
ii. Synthesizing information into one document July 28th – August 8th, 2011

 

 

  1. Budget and Payment Schedule Days    Payments
  2. Analysis and synthesis 7 days
  3. Recommendations and Report 7 days $4,800

iii. Presentation                                                                             2 days                                                           $4,800

Total                                                                                                                    16 days                                       $9,600.

 

Sample Table of Content

  1. Introduction: Terms of reference and topics addressed
  2. Analysis: Strengths, weaknesses, risks and threats, limitations and opportunities
  3. Methodology: integration and synthesizing of reports from consultancies
  4. Discussion: Challenges and opportunities
  5. Conclusions & recommendations

 

 

Attachment: TOR

 

 

African Union Mission Representation in DC

Terms of Reference

Purpose: Consultant to synthesize inputs from consultations into policy document

  1. Introduction

African Union Representational Mission-Washington DC

The African Union, established as a unique Pan African continental body, is charged with spearheading Africa’s rapid integration and sustainable development.

The Goal of AUM

The goal of the African Union Representational Mission in Washington D.C. is to forge strategic partnerships with the United States government, for profit and nonprofit developmental organizations and the African Diaspora towards the political, social and economic development of Sub-Sahara Africa. It strives at fulfilling the aspirations of an integrated, prosperous and peaceful Africa, driven by its citizens and representing a dynamic force in the international arena.

The Mandate

The mandate of the African Union Representational Mission to the United States is to develop, maintain, and consolidate constructive and productive institutional relationships between the African Union and the government of the United States of America, the Bretton Woods Institutions, non-governmental and academic organizations engaged in Africa issues and policy, and Africans in the Diaspora.

How the Mission performs its tasks. It performs these tasks by promoting unity, solidarity, cohesion and cooperation among the peoples of Africa and developing new partnerships worldwide. The Mission’s Headquarters is located in Addis Ababa, capital city of Ethiopia.

Promoting Africa’s development. A critical component of promoting Africa’s development is the enactment of effective policies. Synthesizing inputs from the Consultations into policy briefs will spur the Mission’s decision-making process.

  1. Objectives

Project focus. This project’s focus is to provide the African Union Representational Mission with a framework for assessing information; strengths, weaknesses, opportunities, limitations and threats of the various consultations carried out. A single document comprising the attributes (strengths, weaknesses, and etcetera) will facilitate the policy formulation and analysis process.

Specific Objectives/Expected Achievement. The African Union Representational Mission seeks to achieve the following objectives:

  • Engage a short-term consultant with experience in analyzing and formulating policies;
  • Improve the coordination of policies affecting Africa’s development
  1. Expected Output
  • The consultant will be required to synthesis/integrate input from all consultations carried out into a single document.
  1. Scope of Work

The following will comprise the nature and scope of the Consultant’s responsibilities:

  • Integration of prior consultations into policy document:

 

  • Policy document: The Consultant will be granted in-depth reports from prior consultations conducted. Previous consultations executed include evaluation of the African Growth and Opportunity Act, Latin-America study tour, Knowledge sharing/ study tours to 3 countries in Asia, mobilization of the African Diaspora in the America’s, data and Knowledge management, development of policy briefs, development and training of African Union Representational Mission staff and volunteer corps on communication and media strategy.
  • Report: This stage will involve analyzing; organizing and integrating information gleaned from past project documents into a single document. In addition, the policy document must be written in a concise format, devoid of redundant information.
  1. Delivery schedule
Analysis of reports from previous consultations July 18th- 27th, 2011
Synthesizing information into one document July 28th – August 8th, 2011

 

Duration of Assignment: 16 Days

The estimated duration for the completion of this assignment is two weeks and two days (16 days). However, the number of days and level of effort required may be adjusted by the African Union Representational Mission, should circumstances necessitate changes to the schedule.

  1. Budget
Component and Activity Number of days Allocated Number Of days Used Number of days remaining Rate/day Amount Allocated (USD) Amount Used (USD) Amount Remaining (USD)
Consultant to synthesize inputs from consultations into a policy document 16 0 16 600 9,600 0 9,600
Report 0 0 0 0 0 0 0
Total 0 0 $9,600 $ $9,600

 

  1. Information and Facilities to be provided by the Client

The consultant will be provided access to the African Union Representational Mission’s policy briefs and reports. Furthermore, based on the degree of necessity and availability, working space in the African Union Representational Mission’s offices and access to computers and other equipment (scanners, phones and photocopy) will be granted.

  1. Minimum Qualification and Experience
  • A/ M.A in International Development, International Relations, Public Policy, Communication or related areas;
  • Experience with government, either through direct work experience or analytic experience closely tied to government programs, preferred;
  • Experience related to formulation and analysis of policy;
  • Excellent writing, communication, analytic and organizational skills required;
  • Strong presentation skills;

 

Team work competency. The Synthesis project requires the ability to create and sustain positive working relationships with staff of diverse ethnicities, work independently and collaboratively as required.

 

 

 

 

 

 

 

 

 

 

 

XIV. How to Write Synthesis Reports

  1. What is a Synthesis Essay?

Integrating and making insightful connections between different consultancies.

  • Synthesis essay or report is an integration of one or more works, where insightful connections show the relationships between the different parts and components of one or more previously reported works.

             The Purpose: To integrate and make insightful connections of previous AUM Consultations.

  • The main purpose of a synthesis essay is to integrate and make insightful connections. Those connections can show the relationship(s) between parts of a work or even between two 3or more works.
  1. What are Meaningful and insightful connections?

Seeking win-win partnerships for African development & investment

  • Explain why those relationships are important. In order to write a successful synthesis essay, the author must gather research on the chosen topic, discover meaningful connections throughout the research, and develop a unique and interesting argument or perspective.
  • An opportunity to create new knowledge a unique perspective of AU and Diaspora communities.

 

  1. What is the difference between a summary and synthesis report?

Opportunity to create new knowledge and a unique perspective!

  • A synthesis is not a summary. A synthesis is an opportunity to create new knowledge out of already existing knowledge, i.e., other sources. You combine, “synthesize,” the information in your sources to develop an argument or a unique perspective on a topic.

 

  • What is a thesis statement?

Presenting a perspective that identifies new knowledge!

  • Your thesis statement becomes a one-sentence claim that presents your perspective and identifies the new knowledge that you will create.
  1. What is the Theme?

             Diaspora Engagement for Sustainable development and Investment Opportunities

  • Diaspora engagement as a tool for promoting sustainable development and investment opportunities via MDG and Comprehensive Trade and Investment opportunities !
  1. What type of preparation is needed before writing your synthesis?
  2. Narrow a broad or general topic to a specific topic:    

                  “Diaspora engagement for African development & investment opportunities!”

  • In a short essay, completely covering a large topic is impossible, so picking a specific, focused topic is important. For example, the broad topic of global warming would need to be narrowed down to something more specific, like the effects of automobile exhaust on an ecosystem.
  1. Develop a working thesis statement: “Proactive engagement for development & investment”
  • A working thesis statement should include a rough idea of your topic and the important point you want to make about that topic.
  • Writing this statement at the top of a rough draft or outline and looking at it often can help you remain focused throughout the essay. However, the thesis statement that you begin with is not set in stone. If you find that your essay shifts topic slightly, you can change your thesis in later drafts so that it matches your new focus.
  1. Decide how you will use your sources: “choose those that best support the synthesis statement” (Policy briefs, ADHI, Policy framework, and AGOA Evaluations with ICT & SMN -Media Communication strategies.
  • After completing your research and gathering sources, you may have a large or overwhelming amount of information. However, the purpose of a synthesis essay is to use only the most important parts of your research, the information that will best support your claim. At this point, you must decide which sources, and/or which parts of those sources, you will use.
  1. Organize your research: Abstract, Executive summary and the Report Summary
  • Now, decide the order in which you will present your evidence, the various arguments you will employ, and how you will convince your readers.

The Big Picture: Global African Diaspora

The African diaspora was the movement of Africans and their descendants to places throughout the world – predominantly to the Americas, and also to Europe, the Middle East and other places around the globe.[1][2][3]

The term has been historically applied in particular to the descendants of the Africans who were enslaved and shipped to the Americas by way of the Atlantic slave trade, with the largest population in Brazil (see Afro-Brazilian).

In modern times, it is also applied to Africans who have emigrated from the continent in order to seek education, employment and better living for themselves and their children. People from Sub-Saharan Africa, including many Africans, number at least 800 million in Africa and over 140 million in the Western Hemisphere, representing around 14% of the world’s population.[4][5]

It is believed that this diaspora has the potential to revitalize Africa. Primarily, many academics, NGOs, and websites such as Social Entrepreneurs of the African Diaspora[6] view social entrepreneurship as a tool to be used by the African diaspora to improve themselves and their continent.

XIV. Reference: Further Reading: The LARGER PERSPECTIVE-

The African Diaspora is a dynamic and diverse cohort of highly dynamic populations that has a substantial presence around the globe. The historiography of this interesting population has not been yet fully documented in its appropriate cultural setting by people who have stake in its accuracy, relevancy and implication to future Diaspora generations.

The following Global Diaspora Distribution and natural history is a brief description of current available research in th making to understand other Africans who have immigrated to the different parts of the world and whose history and presence is not yet accounted for. It is recommended for AU to further study and connect with this special population as part of its sixth regional constituency framework tht gives it appropriate place and history. The following documents the different presentations currently available on the global Diaspora population and is by no means complete.

The Global African Diaspora

Table of Contents

·       1 History

o   1.1 Dispersal through slavery

o   1.2 Dispersal through migration

·       2 Definitions

·       3 Estimated population and distribution

·       4 Largest 15 African diaspora populations

·       5 The Americas

o   5.1 North America

§  5.1.1 Canada

o   5.2 Latin America

·       6 Europe

o   6.1 United Kingdom

o   6.2 France

o   6.3 Italy

o   6.4 Netherlands

o   6.5 Russia

o   6.6 Abkhazia

o   6.7 Turkey

·       7 Indian and Pacific Oceans

·       8 See also

·       9 References

·       10 Further reading

·       11 External links

History

Dispersal through slavery. The African Diaspora was initially dispersed along the most heinous crime and human tragedy of slavery. The more recent Diaspora since the late 1960s have left their African seeking by and large safe and better lives and with the intention to return home at the right time.

The Atlantic and Arab Slave Trades. Much of the earlier African diaspora was dispersed throughout Europe, Asia, and the Americas during the Atlantic and Arab Slave Trades. Beginning in the 9th century, Arabs took African slaves from the central and eastern portions of the continent (where they were known as the Zanj) and sold them into markets in the Middle East and eastern Asia.

Beginning in the 15th century, Europeans captured African slaves from West Africa and brought them to Europe and later to the Americas. Both the Arab and Atlantic slave trades ended in the 19th century.[7]

Largest forced migration in history. The dispersal through slave represents one of the largest forced migrations in human history. The economic effect on the African continent was devastating. Some communities created by descendants of African slaves in Europe and Asia have survived to the modern day, but in other cases, blacks intermarried with non-blacks and their descendants blended into the local population.

Part of the Multi-ethinic societies in the Americas. In the Americas, the confluence of multiple ethnic groups from around the world created multi-ethnic societies. In Central and South America, most people are descended from European, American Indian, and African ancestry. In Brazil, where in 1888 nearly half the population was descended from African slaves, the variation of physical characteristics extends across a broad range. In the United States, there was historically a greater colonial population in relation to African slaves, especially in the northern tier.

US-Racist Jim Crow & Anti-miscegenation laws.  he  anti-miscegenation laws after the Civil War, plus waves of vastly increased immigration from Europe in the 19th and 20th centuries, maintained some distinction between racial groups. In the 20th century, to institutionalize racial segregation, most southern states adopted the “one drop rule“, which defined anyone with any discernible African ancestry as African.[8]

Dispersal through migration

From the very onset of Spanish activity in the Americas, black Africans were present both as voluntary expeditionaries and as involuntary laborers.[9][10] Juan Garrido was one such black conquistador. He crossed the Atlantic as a freedman in the 1510s and participated in the siege of Tenochtitlan.[11]

Modern Diaspora. Emigration from Sub-equatorial Africa has been the primary reason for the modern diaspora. People have left the subcontinent because of warfare and social disruption in numerous countries over the years, and also to seek better economic opportunities.

Scholars estimate the current population of recent African immigrants to the United States alone is over 600,000, some of whom are Black Africans from the Sub-equatorial region.[12] Countries with the largest recorded numbers of immigrants to the U.S. are Ethiopians, NigeriaGhanaSierra Leone and mostly West African Countries. Some immigrants have come from AngolaCape VerdeMozambique (see Luso American), Equatorial GuineaKenya, and Cameroon. Immigrants typically congregate in major urban areas, moving to suburban areas over time.

There are significant populations of recent African immigrants in many other countries around the world, including the UK[13] and France, both nations that had colonies in Africa.[14][15]

Definitions

The African Union Perspective

The sixth regional constituents. The African Union defined the African diaspora as “[consisting] of people of African origin living outside the continent, irrespective of their citizenship and nationality and who are willing to contribute to the development of the continent and the building of the African Union.” Its constitutive act declares that it shall “invite and encourage the full participation of the African Diaspora as an important part of our continent, in the building of the African Union.”

Between 1500 and 1900, approximately four million enslaved Africans were transported to island plantations in the Indian Ocean, about eight million were shipped to Mediterranean-area countries, and about eleven million survived the Middle Passage to the New World.[16] Their descendants are now found around the globe. Due to intermarriage and genetic assimilation, just who is a descendant of the African diaspora is not entirely self-evident.

African diaspora populations outside of Sub-equatorial Africa include:

Estimated African Diaspora Population and distribution

 

Continent or region Country population Afro-descendants [18] Black and black-mixed population
Caribbean 39,148,115 73.2% 22,715,518
Haiti 9,719,932 95% (black) + 4.9% (Mulatto) 9,233,935 + 476,277
Dominican Republic [19][20] 10,090,000 11% (black) + 73% (mixed) 1,109,900 + 7,365,700
Cuba[21] 11,239,363 10.08% (black) + 24.86 (mixed – Mulatto) 1,132,928 + 2,794,106
Jamaica[22] 2,847,232 76.3% (black) + 18.5% (mixed) 2,172.438 + 526,738
Puerto Rico[23] 3,725,789 12.4% (black) + 3.3% (mixed) 461,998 + 122,951
Trinidad and Tobago 1,047,366 58.0% 607,472
The Bahamas[24] 307,451 85.0% 209,000
Barbados 281,968 90.0% 253,771
Netherlands Antilles 225,369 85.0% 191,564
Saint Lucia 172,884 82.5% 142,629
Saint Vincent and the Grenadines 118,432 85.0% 100,667
Virgin Islands 108,210 79.7% 86,243
Grenada 110,000 91.0% 101,309
Antigua and Barbuda 78,000 94.9% 63,000
Bermuda 66,536 61.2% 40,720
Saint Kitts and Nevis 39,619 98.0% 38,827
Cayman Islands 47,862 60.0% 28,717
British Virgin Islands 24,004 83.0% 19,923
Turks and Caicos islands[25] 26,000 > 90.0% 18,000
South America 388,570,461 28.70% 111,511,261
Colombia [20] 45,925,397 4.0% (black) + 3.0% (Zambo) + 14.0% (Mulatto) 1,837,015 + 1,377,762 + 6,429,556
Venezuela[26][27] 29,105,632 ~10% (black) 2,910,563
Guyana 770,794 36.0% 277,486
Suriname 475,996 47.0% 223,718
French Guiana 199,509 66.0% 131,676