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Crossing over to an Associate Professorship, Focusing on the Development and Monitoring of Regional Challenges and Global Transformations

The professorship outlined here aims to establish a crossover between the tourism and health economies, developing innovative services that fit the changed needs of both inhabitants and visitors on healthy living related services/products and have an economic and social value


by professor Tomas Mainil 1.2.3 

Olaf Timmermans

professor Olaf Timmermans 1.3

1.HZ University of Applied Sciences, Vlissingen, the Netherlands, 2.Breda University of Applied Sciences, Breda, the Netherlands, 3.University of Antwerp, Antwerp, Belgium

Crossing over to an Associate Professorship, Focusing on the Development and Monitoring of Regional Challenges and Global Transformations


Globally, countries need to overcome demographic tensions in their populations. The challenge for the Dutch province of Zeeland is to develop social innovation in response to key societal challenges in tourism and health: Coastal regions are confronted with demographic changes, especially ageing of inhabitants as well as visitors (tourists) and their changing needs health-related issues. A cross-border cooperation, wherein a common approach is developed to explore problems and enhance opportunities, benefits the possibility to address this challenge.


Location of Zeeland in the Netherlands. Coordinates 51°34′N 3°45′E

Therapeutic landscapes feature unique natural assets, wherein inhabitants work and live and visitor (tourist) come over for holidays to recover from working life. Trends in some regions, however, show the aging of both inhabitants and visitors, as well as use of the unique physical environment to enhance healthy behavior. Tourism in these regions originated in exploitation of the environment towards healthy living related services and products. This associate professorship Healthy Region aims to overcome this challenge by establishing a crossover between the tourism and health economies, developing innovative services that fit the changed needs of both inhabitants and visitors on healthy living related services/ products and have an economic and social value. Economic because existing and new initiatives will benefit result in smart, sustainable and inclusive growth in both tourism as well as health economy. The social value relates to the prevalence of innovative services on healthy living for inhabitants. The shared facilities, product and services stimulating an active and healthy lifestyle will be developed by combining the needs of users, Sme’s (Small and medium enterprises) and policy makers and social innovation processes.

Insight in the needs of the users in the cooperating coastal regions to guide the development of shared facilities; Establishment of social innovation processes in the participating regions, wherein shared facilities are developed by multidisciplinary participation and empowerment of users in the quadruple helix; Development by multidisciplinary participation and empowerment of users in the quadruple helix. These might be the urgent strategies to overcome the austerity crisis in the EU. All the points mentioned above need to be steered by an integrative, multi-level organizational platform, which urges the capacity building of the associate professorship.

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Is More Technology Really the Answer to the World’s Global Health Problems?

Although new technology is essential, social change and social progress depend upon people, not on technologies. Social progress relies on understanding complex systems and the people who inhabit them first and foremost

Sara-Gormanby Sara Gorman*, PhD

Department of Health Policy & Management, Columbia University Mailman School of Public Health

Is More Technology Really the Answer to the World’s Global Health Problems?


There is no question that technology, both medical and non-medical, has had a major, transforming effect on the course of global public health over the past few decades. New vaccines have eliminated diseases, antiretrovirals have turned HIV/AIDS from a death sentence into a manageable illness, and portable diagnostics have allowed people to get treatment for illnesses they might otherwise never have known they had. More recently, there has been a lot of excitement around the potential of smartphones to solve global health problems. Everything from SMS medication reminders to novel surveillance techniques have been proposed and attempted in various locations around the world, including some of the least developed regions. Organizations like the Gates Foundation thrive on the notion that more technology is the answer to the world’s global health issues.

But is more technology really the answer to the world’s global health problems? A small yet vocal minority in the global health field is beginning to argue perhaps not. A new book by Kentaro Toyama called Geek Heresy: Rescuing Social Change from the Cult of Technology argues that technology is not, in fact, the main driver of social change, including improvement in global health. Based on his own observations working for Microsoft in India, Toyama persuasively asserts that social change and social progress depend upon people, not on technologies. Social progress relies on understanding complex systems and the people who inhabit them first and foremost.

In a similar vein, Julia Robinson, Director of Advocacy Programs at Health Alliance International, has argued that, although new technology is essential, it is not the sole answer to the world’s most pressing global health issues. Robinson also focuses on people, noting that in her experience, the most common problem in resource-limited health systems is the lack of qualified health professionals. As Robinson notes, health technology is important but even more important are the people needed to implement that technology.

None of this means that new technologies are useless in the quest for better global health. The issue is more that we must continuously evaluate our efforts and collect constant feedback from those benefiting from these technologies. As Robinson points out, simply engaging more deeply with people living in resource-limited settings can yield different insights on the problems actually faced by developing country health systems. These new insights should lead us to different kinds of solutions. These solutions may of course include technology but not without a deep understanding of the human experience of healthcare in resource-limited settings and a commitment to listen to genuine and much-needed feedback on everything the global health community does in these settings.



*Sara Gorman, PhD is an MPH candidate in Health Policy and Management at Columbia University Mailman School of Public Health. She has written extensively about global health, HIV/AIDS policy, and women’€™s health, among other topics, for a variety of health and medical journals, including PLoS Medicine and International Journal of Women’€™s Health. She is currently working as a consultant for Janssen (the pharmaceutical companies of Johnson & Johnson) in Global Public Health division. She has worked in the policy division at the HIV Law Project and as a researcher at the Epidemiology Department at Harvard School of Public Health. She has also analyzed mental health policy under the ACA for the Vera Institute of Justice and researched the effectiveness of semi-mobile HIV clinics in rural Kenya for HealthRight International. 

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China-Africa Agricultural Cooperation: for the Sake of Whom?

 Despite the relevant Chinese commitment in Africa, concern still remains about the actual Chinese efforts, but also about the effectiveness of the Chinese agricultural projects in Africa. These weak points are strengthened by the fact that regional stakeholders often complain about the lack of coordination and governance of the projects financed by China all over Africa. In addition, even if investment in agriculture seems to be intended to solve Africa's hunger issues, many still view China as engaged in a self-interested, exploitative grab for resources to feed its fast-paced growth


by Pietro Dionisio

Degree in Political Science, International Relations

Cesare Alfieri School, University of Florence, Italy

China-Africa Agricultural Cooperation: for the Sake of Whom?


Since the 1960s China has been tangibly present in Africa. This is proved by the fact that the Chinese authorities have implemented approximately 220 agricultural aid projects including several sectors, such as farming, animal husbandry and fishery and farmland water conservation.

This involvement in African agricultural affairs improved considerably after the Forum on Africa and China Cooperation Beijing summit in November 2006[1], that showed the commitments to the agricultural sector and the diversity of Chinese investments in Africa. According to this summit, in accordance with its African partners China agreed to build 14 agricultural centers in 33 countries, to send 100 senior agricultural experts and to train 15000 talents in various fields (1500 of them were to be agricultural technology professionals).

This major Chinese involvement in Africa is in accordance with a general view of the Central government. In fact, the former premier Wen Jiabao announced additional steps to reach UN Millennium Development Goals[2]. He maintained that it was necessary to intensify efforts to provide foreign countries with more agricultural aid [3].

China has become one of the principal players through several agreements signed with various African countries. For instance, the Government invested US$ 800 million in Mozambique to modernize agricultural infrastructure. This modernization should be achieved through the dispatch of 100 Chinese agricultural experts working in several research stations within the country. The duty of these experts is to work in collaboration with local groups to improve field yields and find other ways to increase the overall performance in the agricultural sector.

Despite the relevant Chinese commitment in Africa, concern still remains about the actual Chinese efforts, but also about the effectiveness of the Chinese agricultural projects in Africa. These weak points are strengthened by the fact that regional stakeholders often complain about the lack of coordination and governance of the projects financed by China all over Africa.

In addition, even if investment in agriculture seems to be intended to solve Africa’s hunger issues, many still view China as engaged in a self-interested, exploitative grab for resources to feed its fast-paced growth[4].

Historical Perspective

Especially in the last decade China has strongly increased its presence in African agriculture. Despite this constant presence on the African ground, it is still not clear to what extent the Chinese engagement has produced results in terms of agricultural development in African countries.

In this respect, information on investment and data on actual activities are very difficult to be obtained.

China could play an important role in Africa thanks to its previous experience. In fact, the challenge for food security holds lessons in several areas such as the application of technology and mechanization on agriculture, the improvement of social protection and agricultural and rural development.

China has always made clear that agriculture plays a key role in its aid programs for Africa. However, current discussions between China and African authorities have not produced considerable results due to many reasons. In fact, two main problems are at issue. First of all the presence of a mutual suspicion on both sides. Secondly, China’s preference to directly consult private entrepreneurs instead of a jointly coordinated partnership with regional bodies, such as CAADP[5], is another obstacle in the relations with African authorities[6].

The Chinese involvement dates back to the 1950s. The Bandung Conference of Non-Aligned Nations in 1955 can be considered as the beginning of the Chinese interests towards Africa[7].

At that time China was looking for new partners in Africa so as to become the third pole, thereby counterbalancing the Soviet Union’s hegemony and the Western “imperialism”.

The first event that can be cited as the beginning of the agricultural cooperation between China and African countries is the grant of food aid to Guinea in 1959. After that, China undertook several other agricultural projects on the continent[8].

The history of the Chinese agricultural involvement in Africa can be divided into three main phases:

“Non Reimbursable Assistance” (1959-1969): this period was characterized by Chinese  unilateral assistance and by the support to national liberation movements of African countries.

China’s agricultural assistance was intended as a tool in order to support the consolidation of political independence of the African countries linked with the aim of developing diplomatic relations between China and African countries.

In this period the efforts made were focused on the construction of agricultural technology, experimental stations, promotional stations, large farms and water conservancy facilities.

At the beginning, the projects had a positive impact, but soon after the handover to national governments, they began to deteriorate. This was the consequence of lack of financial inputs and inadequate management experience[9].

“Cooperation Based on Mutual Benefit” (1970-1999): during the 1970s, due to the implementation of the “open-up policy” and the weakening of ideological factors, the Chinese-African relationships no more experienced a unilateral non reimbursable cooperation, but a bilateral beneficial one linked with a gradual introduction of multilateral cooperation.

The principal tools used were technology sharing, talents output and personnel training[10].

In this phase, enterprises became the main bodies to implement plans for assistance. By the late 1970s, several Chinese firms invested in the development of new agricultural projects using funds from China’s foreign aid and preferential loans[11].

“Comprehensive Development” (2000-to date): the rapid economic development of the Chinese economy marks a new impulse in the Chinese-African cooperation. The establishment of the Forum on Chinese-African Cooperation (FOCAC) is an important step in this direction.

This partnership focuses on improving the independent development of agriculture in Africa through a set of comprehensive measures.

In order to favor these plans, China uses several funds including funds for foreign aid and from international organizations, and State funds for Africa.

These comprehensive plans include several projects concerning technology information sharing, the launch of pilot centers for agricultural technologies and the dispatching of agricultural experts with the aim of launching vocational education in agriculture or technological training. This approach is confirmed by China’s African policy as published in 2006:

“Focus will be laid on the cooperation in land development, agricultural plantation, breeding technologies, food security, agricultural machinery and the processing of agricultural and side-line products. China will intensify cooperation in agricultural technology, organize training courses of practical agricultural technologies, carry out experimental and demonstrative agricultural technology projects in Africa and speed up the formulation of China–Africa Agricultural Cooperation Program.”[12]

Agricultural engagement in Africa is defined as “South-south” cooperation[13]. This definition underlines the idea of a reciprocal partnership with mutual benefits. This policy continues to increase political relationships and soft power, developing commercial opportunities for national enterprises and enhancing China’s resource security[14].

For the period from 2012 to 2015, several measures have been established under the China-Africa cooperation:

  1. To support CAADP (Comprehensive Africa Agriculture Development Program) for a ‘growth-oriented’ agricultural agenda for Africa
  2. To send teams to train African agricultural technicians
  3. To support agricultural vocational education system and send teachers
  4. To build more agriculture demonstration centres
  5. To provide technical support for grain planting, storage, processing and circulation
  6. To encourage Chinese financial institutions to support corporate cooperation in planting, processing, animal husbandry, fisheries and aquaculture
  7. To support UNFAO ‘Special Program for Food Security’
  8. To facilitate access for African agricultural products to the Chinese market
  9. US$20 billion credit line for infrastructure, agriculture, manufacturing and African SMEs
  10. To publish and translate agricultural technology materials; joint participation in book fairs in China and Africa[15].
Tools Employed

Several actors play a role in this partnership, the main one being the Chinese Ministry of Commerce backed by the Ministry of Agriculture and the Ministry of Science and Technology.  Altogether, these institutions coordinate agricultural programs.

The patronized plans are implemented afterwards by Chinese institutes, state-owned enterprises and private firms through a competitive bidding process.

The China Development Bank and the Export Import Bank of China are tasked with financing these projects in the form of development commercial finance or export credits.

In 2006, the China-Africa Development Fund was established with the aim of enhancing Chinese-African commercial ties. It is noteworthy that this fund signed an agreement with  the China State Farm Agribusiness Corporation in order to establish joint company financing agricultural investment[16].

The Forum on China Africa Cooperation was implemented in 2000. Meetings are held every three years, allowing discussions among partners about projects and future engagements. Moreover, an increasing number of Chinese NGOs is committed in the implementation of agricultural plans in Africa.

It is not easy to estimate the amount of aid provided. In fact, the Chinese authorities are often more interested in emphasizing the impact on the ground of their action than the loans given[17].

Agricultural aid is mainly provided only to those countries that recognize the “One China Policy”[18], and particularly in two forms: either monetary aid or in kind payment. These loans are designed to support food production, breeding, storage and transport and infrastructure development. Furthermore, aids are given in terms of agricultural equipment, trainings, technical assistance and scholarships[19].

Chinese investment is another increasing factor. Several actors, including state owned enterprises, have a role in this sector, which makes it difficult to figure out the concrete management of the system. According to Scissors and in spite of what we might think, it seems that China is not engaged in large-scale African farming for export. In fact, to our knowledge China seems to have only 54 overseas projects covering 4,9 million hectares of land, of which only 463,792 hectares are in Africa[20].

Chinese Agricultural Investments in Africa

Figure 1: China’s outward FDI stocks in Africa ($10,000), 2003–09

pietro fig 1

Source: MCC, 2009 Statistical Bulletin of China’s Outward Foreign Direct Investment. MCC, National Bureau of Statistics of China & State Administration of Foreign Exchange of China, Beijing, 2010

China has strongly increased its Foreign Direct Investments (FDI) in Africa since the third Ministerial Conference of  FOCAC in 2006[21]. This increasing volume of direct investments has not been interrupted. In fact, it grew from US$ 30 million in 2009 to US$ 82,4 million in 2012.

Despite the fact that the share of Chinese agricultural investment is only 3,1% of the total investment in Africa, this amount is expected to increase considerably in the near future because agricultural cooperation is becoming a priority not only in China but even in some African countries.

Figure 2: China’s outward cumulative FDI stocks in Africa by industry (%), 2009

 Pietro Fig. 2








Source: Helen Lei Sun, “Understanding China's agricultural investments in Africa", 2009

According to the Millennium Development Goal (MDG) n.1 that establishes the eradication of extreme poverty and hunger, the Chinese authorities have supported agricultural investment in Africa, since they consider it as a necessary tool to achieve the MDG n.1[22].

Having laid emphasis on agriculture as an effective tool to reduce poverty, China is focusing its efforts mainly on rural infrastructure.

In fact, the productivity of the African land is usually low due to poor water irrigation systems and water resources. It is noteworthy that in Sub-Saharan Africa less than 4% of renewable water resources are used for agriculture. There are several barriers that have limited the efficiency of agriculture in Africa. These include lack of financial and human resources, poor performance of rural infrastructure and agricultural technology and an inadequate market access.

China has been extremely active in this sector. It has provided several countries, such as Zambia and Nigeria, with loans and implemented over 500 agricultural infrastructure projects[23].

The case of Zambia is relevant. To enhance the country’s storage capacity and consequently food security, the Chinese authorities signed an agreement with the Zambian government for the construction of twelve major grain storage facilities, covering a total area of 30 000 square meters equal to a storage capacity of 100 000 tons.

The Zambian example is just one among many. In fact, the Chinese Ministry of Commerce has signed agreements with 35 African countries for the building of large-scale infrastructure. The bulk of the investment (almost the 70%) is in Nigeria, Angola, Sudan and Ethiopia, but other projects concern Congo, Mali, Mozambique and Tanzania[24].

Moreover, several Chinese professionals, as already mentioned, are dispatched in Africa to build agricultural demonstration bases. Training courses are organized on issues such as rice and vegetable cultivation , meat processing and correct use of agricultural machinery.

Cameroon, Ethiopia, Benin, Liberia, Mozambique, Sudan, Tanzania and Uganda were the first countries in which China began to establish agricultural technology demonstration centers in 2009. In these centers, Chinese experts have to share their knowledge with local people thereby strengthening the African agricultural development. In this respect, 11 rice demonstration areas were established in Guinea-Bissau covering an area equal to 2 000 hectares. The results were really remarkable. For the majority of the products planted the output increased over three times encouraging the expansion of the covered area to 3 500 hectares[25]. Moreover, in this country China State Farm and Agribusiness Corporation collaborated with the China Hybrid Rice Engineering Research Center to introduce high-yielding hybrid rice.

It is noteworthy that the investment of Chinese firms in agriculture has considerably increased grain supplies in Africa, improving the domestic agricultural productivity of those countries included in the agreements.

Several situations can be cited. For instance, in Mozambique, Chinese investment has supported the establishment of 300 hectares of experimental paddy fields. Thanks to the efforts of the Chinese rice experts dispatched there, local farmers have the possibility to increase their yields per hectare by about two tons more than the previous yields. In addition, Chinese firms have invested in the improvement of local farmland, water conservancy systems and agricultural production conditions.

Rwanda is another case in which Chinese efforts have produced some good results. The Rwandan government has signed an agreement for a farmland improvement project aiming at increasing the utilization of water resources. The loans provided come from the African Development Bank and from Chinese enterprises[26].  In Ghana, too, there is a strong presence of Chinese investment. Here the efforts are mainly focused on the development of agricultural infrastructure[27].

Table 1: Chinese-aided agricultural technology demonstration centers in Africa

Country Implementing Organization Main demonstration Field
Benin Republic China National Agricultural Development Group Corn & Vegetables
Cameroon Shaanxi Land-reclamation, Agriculture & Industry and Commerce corporation Rice
Congo (Brazzaville) Chinese Academy of Tropical Agricultural Sciences Cassava
Ethiopia Guangxi Bagui Agricultural Science & Technology Co.,Ltd. Cash Crops
Liberia Yuan Longping High-tech Agriculture Co.,Ltd Rice
Madagascar Hunan Academy of Agricultural Sciences Rice
Mozambique Lianfeng Agricultural Development Corporation Seed breeding & Livestock
Rwanda Fujian Agriculture & Forestry University Paddy and Silkworm
Sudan Academy of Agricultural Science Corn and Wheat
South Africa China National Agricultural Development Group Aquaculture
Tanzania Agricultural Tech Company Rice
Togo Huanchang Infrastructure Construction Company Rice
Uganda Huaqiao Fenghuang Group Aquaculture
Zambia Jilin Grain Group Corn and Wheat
Zimbabwe Research Institute of China agricultural Mechanization Agricultural machinery & Irrigation
Source: Rex Ukaejiofo, “China-Africa agricultural co-operation Mutual benefits or self-interest?”, 2014

However, according to a recent study of AFD-CIRAD[28], it seems that some of the 100 Chinese projects are awarded as grants and the rest as private or public loans covering a small number of countries, namely Benin, Mali, Senegal, Ghana, Zimbabwe, Tanzania and Mozambique[29].

Special Program for Food Security

The Special program for Food Security is an important initiative started in 1994. The goal of this plan is to help low-income countries face food deficit and increase food security. In addition, a second aim is the promotion of the global south alliance in addressing food security. An important element of the plan is the establishment of partnerships through which the member countries should share their experience and knowledge in order to address the food issue also in other contexts.

Since 1996 the Chinese Ministry of Agriculture has managed to sign an agreement with FAO and countries in the global south in order to find a solution for some important issues such as agriculture and food security.

As a result, until now China has dispatched more than 700 agricultural experts mainly to seven countries: Nigeria, Ethiopia, Sierra Leone, Gabon, Mali, Mauritania and Ghana.

According to this program, China committed itself to donate US$ 30 million for the establishment of a trust fund aimed at boosting agricultural production capacity and increasing export and assistance for such countries in Africa.

The program focuses on important issues such as agricultural economy, agricultural planning, agricultural management, crop cultivation, animal husbandry and veterinary, aquaculture, processing of agricultural goods, agricultural machinery and agricultural engineering. Chinese firms have mainly invested in such fields as breeding of improved seeds, grain and cash crop planting, and processing of agricultural products[30].

Important investment was made in Nigeria where, starting from 2004, almost 500 experts and technicians were dispatched. In this country, together with local partners, experts implemented comprehensive techniques such as China’s swine methane-fruit tree ecological agricultural model and the raising of ducks in paddy fields. Moreover, new productive methods were experimented, ranging from a strong rice seedling on upland fields to a reasonable compact planting, regulation and control of moisture and fertilizers through production.

All these experiments and demonstrations were collected in a book, “Booklet on Practical Technologies for China-Nigeria’’, that gained a considerable importance because it became a guideline book for agricultural production not only in Nigeria, but also in other African countries[31].

Sierra Leone is another country which benefits from Chinese investment. Here four country stations were implemented in Kono, Kabala, Moyamba and Makali. In each of these stations a different technology is used. These technological devices include bio-gas digestion, honey bee culture, fish ponds and small scale agricultural mechanization. Moreover, teaching basic skills in rice, vegetable and poultry production is considered another key element of the country project.

Due to language difficulties, experts used different teaching methods. In fact, the “teaching by doing” method, based on practical demonstrations, was quite often applied in order to share practical skills. Moreover, each of the four stations implemented concrete demonstration of high yields.

The team dispatched there also performed some consolidation work: for example, the rebuilding of the irrigation system at Makali farm, a project built through Chinese investment in the 1970s[32].

Chinese Engagement in Mozambique

Chinese engagement in Mozambique began immediately after the independence of this country in 1975. In fact, in that year 120 Chinese agricultural experts were dispatched from the province of Sichuan. The aim was to help Mozambique develop 230 hectares of the Moamba state farm and the Matama farm in the Niassa province.

The partnership was strengthened in the mid 1980s when China decided to send farm machinery and an agricultural team to provide aid for  the implementation of the “Green Zone program”  in Maputo’s urban area[33]

In the same period, Chinese firms began to invest in the country and it was only after the end of the Mozambican civil war in 1992, that the two countries started to talk about the possibility of establishing joint venture. Things went slowly. By 2000 Mozambique received only one investment from China, coming from Anshan Grain and Oil Export Import Company, that invested in 20 hectares near Maputo and US$ 500 000 in the Zhongan vegetable farm[34].

Despite this slow beginning, the partnership went on and, between 2000 and 2011, nine additional enterprises invested in the country.

Two of these nine projects are particularly worth mentioning. The first one was a proposal by China Grains and Oils Group Corporation to invest US$ 6 million. The second one regarded Hubei Liangfeng, a provincial firm, that would invest US$ 1,5 million in the country.

Moreover, the Chinese authorities decided to finance the establishment of an agro-technology demonstration center that was to be built between 2006 and 2012.

In 2005 a joint venture between Mozambican businessman Zaidi Ali and China Grains and Oils Group was established for the implementation of a big project aimed at the production and processing of soybeans in Sofala province. Despite the efforts, the project failed. Unfortunately, there was evidence that the field was not appropriate for this commodity. Additionally, machinery imported from China was not suitable for the conditions of Mozambique and the venture could not secure work for the Chinese dispatched technicians[35].

Table 2: Chinese planned and approved agricultural investment in Mozambique (2000–11)

pietro tab 2

Source: Brautigam D., Ekman SM., "Briefing rumours and realities of Chinese agricultural engagement in Mozambique" (2012)

In 2004 another relevant plan was launched. This project was part of the Chinese “friendship farm” plans. The term friendship pinpoints a plan requested by the hosting country and considered politically important for its authorities. In 2004 the Mozambican government asked its Chinese counterpart to help develop its rice sector. After having studied the feasibility of the plan, China agreed to build a demonstration farm in the Gaza province. The Chinese firm Hubei State Farm Agribusiness Corporation accepted to invest US$ 1,2 million in the project[36]. The plan was based on two main purposes. Firstly, part of the Chinese political task was to solve Mozambique’s food limitations focusing on improving grain and vegetable yields. But the venture made experiments also for other products, such as soybean, tobacco, rapeseed and organic vegetables, in order to sell them in the European and Chinese markets.

At the beginning the farm was quite small. It consisted only of 100 hectares devoted to rice production. In 2008 a joint venture was formed with a Chinese private enterprise,  the Xiangyang Wanbao Group, which helped boost the production of soybeans, vegetables and other cash crops. By December 2011 the planted land reached 200 hectares and Chinese experts and workers were employed to build, develop and maintain the irrigation systems.

It is noteworthy that this plan was implemented with the contribution of the Bill and Melinda Gates Foundation that decided to finance it and use it as a test for the Gates Foundation’s  “Green Super Rice” program[37].

In 2011 the Chinese firms increased their presence in the country. Just to make an example, the Shandong Xinwei Grain and Oil Food Corporation launched Xinwei International Mozambique Co. Ltd. in Nampula. The company employed 130 Mozambicans and mechanized cultivation of 140 hectares of land. The main commodities planted were maize, groundnuts, sesame and mung beans. Moreover, a Chinese cotton company set up operations in Mozambique (and Malawi), buying cotton from contract farmers and processing the cotton locally[38].

Even though China is continuing its investment in Mozambique, its efforts are not easily applicable. In fact, Chinese companies investing in the country face several obstacles in accessing lands, because investors have to consult with local communities and obtain their acceptance, before lodging formal application with the authorities in charge. Nevertheless, it is not easy to negotiate with local communities due to the arising land identification problems. Moreover, especially in some contexts, it is difficult even to identify the legitimate authority representing the tribal communities occupying those lands.  For example, definitely due to these issues, China-Africa  Cotton Mozambique[39] adopted a new method. In fact, through this model, China-Africa Cotton Mozambique provides training and inputs to local peasants and, in return, purchases raw cotton from them. Working this way, it can strongly reduce costs associated with accessing land[40].

Another relevant problem that Chinese investors have to face is the poor condition of infrastructure, especially poor transportation and damaged irrigation systems, that often impede the implementation of activities such as expanding production or the adoption of new technology.

In Mozambique many problems are caused by a poor information system for the investors. In fact, the State is unable to provide correct information about lands in order to ensure the success of investment operations. In 1997 the National Land Cadastre was established in order to improve the situation. Theoretically, the aim of this institution is the collection of information about different types of occupation and land uses, soil fertility, hydraulic reserves and mining exploration zones. In addition, it should organize the use of land, its protection and conservation. In practice, the institution neither can collect information to guide agricultural investors, nor achieve the above tasks[41].

This lack of information produced the failure of the above mentioned China Grains and Oils Group in the Sofala province. Operations failed due to poor planning. In fact, the company did not get correct information about the type of soil. As a consequence, it brought seedling and machinery from China that were not suitable for that field, which caused the company to give up the project.

Chinese investment in Mozambique is still insignificant if compared to other forms of investment related to natural extractive resources. In fact, agriculture accounts only for 1% of China’s FDI to the country and only 12% of the Mozambican export goes to China (data of 2008).

Nonetheless, the two countries could gain more from their relationship; China in terms of imports and Mozambique in terms of agriculture and rural growth policies, farming technologies and institutional capacity building[42].

Unfortunately, Mozambique is still not able to absorb lessons because of its inefficiency. The poor capacity of the Mozambican state to effectively implement agricultural policies, build and conserve agricultural infrastructure and ensure a concrete agricultural development, is considerably jeopardizing the possibility to gain some advantage from this partnership[43].

At the same time, the increasing Chinese interest in agricultural partnerships has raised concerns about potential land grab[44]. This is true especially if we consider the social and economic implications that the hosting country has to face trying to address the increasing vulnerability of traditional subsistence farmers[45]. In this respect it is important to stress that the agreements signed at a governmental level often disregard the interests and the rights of local populations. In fact, the implementation of Chinese interest means the displacement of Chinese workers in rural areas directly damaging the livelihood of local communities. Moreover, other issues can arise. For instance, the increasing competition between Mozambican and Chinese producers in local markets, the increase of cash crop production at the expense of food crop production for local consumption.

Chinese Presence Impact on Africa

As stated above, in the last decade China has improved and differentiated its investment in Africa.

China’s presence in African agriculture has a huge potentiality. First of all, it can contribute to agricultural growth and poverty reduction as well as provide useful lessons through its own experience.

Unfortunately, often potentiality is not matched because of the vulnerability of African institutions. In fact, Chinese investment is hindered by social, economic, political and environmental perspectives. Moreover, indigenous institutions also affect the outcomes of China’s investment in agriculture.

In order to address its food needs, China sources agricultural products and commodities from Africa. This process can produce two main results. On one hand, the demand of the Chinese market can result in growing profit and business for African farmers but, from another perspective, as already analyzed in the case of the Mozambican situation, Chinese presence can result in changes of the livelihood of local communities and in a decreasing role of local peasants in the local markets in favor of Chinese farmers.

Figure 3: Export of Sub-Saharan Africa to China (US$ millions)
pietro fig 3

Source: Shenggen Fan, Bella Nestorova, and Tolulope Olofinbiyi, “China’s Agricultural and Rural Development: Implications for Africa”, 2010[46]

Despite these two relevant main effects, it is definitely sure that Africa needs foreign financial assistance to develop its agricultural sector and that, in this respect, China is an important partner providing knowledge sharing on technology and production.

Moreover, Africa could learn lessons especially on agriculture and rural growth, evidence-base policy making, pro-poor policy and institutions and capacity.

As for the first point, African countries should increase their investment in agricultural infrastructure such as irrigation systems. In addition, investment in agriculture resources must be increased and tailored to the African context in order to be able to concretely address social needs.

As for policy making issue, African countries should gradually implement their policies. First of all, they could test policies in some selected district or community, and after having controlled results, governments could implement them nationwide. In this respect, monitoring and evaluation capabilities must be improved.

Furthermore, policies have to be targeted to the  poor in order to reduce hunger and poverty. In this respect, a community base approach could turn out to be really positive. Programs should target vulnerable people in both rural and urban areas.

Unfortunately, African institutions lack the political power to attain their objectives. For this reason, African leaders should sustain their commitments to reform and provide more power to those institutions willing to cooperate with them. In addition, new institutional arrangements should be experimented to provide new development opportunities.




[2]FOCAC. 2012. The Fifth Ministerial Conference of the Forum on China-Africa Cooperation Beijing Action plan (2013-2015). FOCAC. Source:  [2014, April 17].

[3]These major efforts to foreign countries should be materialized  by increasing the number of agricultural technology demonstration centers in developing countries to 30, doubling the number of agricultural experts and technical personnel dispatched. Moreover, in 2009, at the 4th FOCAC ministerial meeting, Premier Wen Jiabao further announced eight new measures in increasing Chinese investments in African agriculture. These measures entailed the establishment of twenty demonstration centers and fifty agricultural technology groups in Africa to take part in the training of up to 2 000 agricultural technical personnel.

[4]Buckley, L., “Narratives of China-Africa Cooperation for Agricultural Development: New paradigms’?”, Future Agriculture CBAA working papers no 053, 2013.

[5]The Comprehensive Africa Agriculture Development Program (CAADP) was established as part of NEPAD in July 2003 and focuses on improving and promoting agriculture across Africa. CAADP aims to eliminate hunger and reduce poverty through agriculture. It brings together key players – at the continental, regional and national levels – to improve co-ordination, share knowledge, success and failures, to encourage one another, and to promote joint and separate efforts to achieve the CAADP goals.

[6]Rex Ukaejiofo, “China-Africa agricultural co-operation Mutual benefits or self-interest?”, Center for Chinese Studies, Stellenbosch, South Africa, September 2014, p.14

[7]The Bandung Conference of Non-Aligned Nations was a meeting of Asian and African states, most of which were newly independent, and took place on April 18–24, 1955 in Bandung, Indonesia. The twenty-five countries that participated in the Bandung Conference represented nearly one-quarter of the Earth’s land surface and a total population of 1.5 billion people. The conference was organized by Indonesia, Burma, Pakistan, Sri Lanka, and India and was coordinated by Ruslan Abdulgani, secretary general of the Indonesian Ministry of Foreign Affairs. The stated aims of the conference were to promote Afro-Asian economic and cultural cooperation and to oppose colonialism or neocolonialism by any nation. The conference was an important step toward the Non-Aligned Movement. The participating countries were: Kingdom of Afghanistan, Burma, Cambodia, Ceylon, People’s Republic of China, Cyprus, Egypt, Ethiopian Empire, Gold Coast, India, Indonesia, Iran, Kingdom of Iraq, Japan, Jordan, Laos, Lebanon, Liberia, Libya, Nepal, Pakistan,Philippines, Saudi Arabia,Syria, Sudan, Thailand, Turkey, Yugoslavia, Democratic Republic of Vietnam, South Vietnam, Kingdom of Yemen

[8]Jiali, L., “Sino Africa Agricultural Co-operation Experience Sharing”,2014, March 19. Web source:

[9]Brautigam, D., and X. Tang. “China’s Engagement in African Agriculture: Down to the Countryside”. China Quarterly, December, 2009.

[10]Yan, H., and Sautman, B., “Chinese Farms in Zambia: From Socialist to “Agro-Imperialist” Engagement?”, African and Asian Studies, 2010, pp. 307-333.

[11]One example of this can be demonstrated through the China State Farm Agribusiness Corporation utilizing Chinese preferential loans to buy farms in Zambia for agricultural development, primarily in grain, vegetable and livestock production.

[12]Chenchen Wu, “China’s Foreign Policy towards Africa.”, The School of Government and International Affairs, Durham University. United Kingdom. Web source:

[13]South–South Cooperation is a term historically used by policymakers and academics to describe the exchange of resources, technology, and knowledge between developing countries, also known as countries of the global South.

[14]Buckley, L. (2013). Chinese Agriculture Development Cooperation in Africa: Narratives and Politics. IDS Bulletin, 44.4 Web source:

[15]FOCAC (2012), The Fifth Ministerial Conference of the Forum on China-Africa Cooperation Beijing Action Plan (2013-2015), Forum on China Africa Cooperation, July 23. Web source:

[16]Buckley, L. 2013. “Narratives of China-Africa Cooperation for Agricultural Development: New paradigms’?”. Future Agriculture CBAA working papers no 053.

[17]Davies estimated total aid to Africa between 1949 and 2006 to be valued at US$5.6 billion. Davies, P. (2006), “China and the End of Poverty: Towards Mutual Benefit?”, Diakonia Report, Sundyberg, Sweden: Alfaprint Press

[18]The One-China policy refers to the policy or view that there is only one state called “China”, despite the existence of two governments that claim to be “China”. As a policy, this means that countries seeking diplomatic relations with the People’s Republic of China (PRC) must break official relations with the Republic of China (ROC) and vice versa.

[19]GOV (2010), “China-Africa Economic and Trade Cooperation”, Information Office, State Council of the People’s Republic of China. Web source: 12/23/content_1771603.htm

[20]Scissors, D. (2010), “Tracking Chinese Investment: Western Hemisphere Now Top Target”, The Heritage Foundation.  Web source:

[21]Helen Lei Sun, “Understanding China’s agricultural investments in Africa”, South African Institute of International Affairs, Occasional paper n.102, November 2009, p. 9.

[22]Sammis JF, ‘Statement by US Deputy Representative to ECOSOC John Sammis at the First LDC IV Intergovernmental Preparatory Committee’, US Mission to the UN, 10 January 2011. Web source: http://

[23]Chinese Academy of International Trade and Economic Cooperation, China–Africa Trade and Economic Relationship Annual Report, 2010.

[24]Ibid. p.17.

[25]Ibid. p.17.

[26]Ayodele, T., & Sotola, O. 2014. “China in Africa: An Evaluation of Chinese Investment”. IPPA Working Paper Series. Lagos.

[27]Amanor, K. S. 2013. “Chinese and Brazilian Cooperation with African Agriculture: The Case of Ghana”. Future Agriculture CBAA working papers no 052.

[28]It is a French research center working with developing countries to tackle international agricultural and development issues. It works with developing countries to generate and pass on new knowledge, support agricultural development and fuel the debate on the main global issues concerning agriculture.

[29]Rex Ukaejiofo, “China-Africa agricultural co-operation Mutual benefits or self-interest?”, Center for Chinese Studies, Stellenbosch, South Africa, September 2014, p.21.

[30]Li, X., Qi, G., Tang, L., Zhao, L., Jin, L., Guo, Z. And Wu, J., “Agricultural Development in China and Africa: A Comparative Analysis.”, Routledge. 2012.

[31]Li X. 2010. “Comparative perspectives in Development and Poverty Reduction in China and Africa.” IPRCC. Beijing.

[32]Brautigam, D., and X. Tang., “China’s Engagement in African Agriculture: Down to the Countryside”, China Quarterly, December, 2009.

[33]Wolfgang Bartke, “The Economic Aid of the PR China to Developing and Socialist Countries”, K. G. Saur, Munich, 1989, p. 92.

[34]Sérgio Chichava, “China in Mozambique’s agriculture sector: implications and challenges”, Institute of Social and Economic Studies (IESE), Maputo, November 2010, p. 5. Web source:

[35]Brautigam D., Ekman SM., “ Briefing rumors and realities of Chinese agricultural engagement in Mozambique”, Oxford University Press, May, 28, 2012, p.6.

[36]Duncan Freeman, Jonathan Holslag, and Steffi Weil, “China’s foreign farming policy: can land provide security?”, Brussels Institute on Contemporary China Studies, 2009, p. 19.

[37]Chinese Academy of Agricultural Sciences, “Green Super Rice for the Resource Poor in Africa and Asia”, Semi-Annual Report, submitted to the Bill and Melinda Gates Foundation, July 2009.

[38]Brautigam D., Ekman SM., “ Briefing rumors and realities of Chinese agricultural engagement in Mozambique”, Oxford University Press, May, 28, 2012, p.8.

[39]Established in 2009, China-Africa Cotton Development Ltd  joint-ventured by China-Africa Development Fund, Qingdao Ruichang Cotton Industrial Co., Ltd and Qingdao Huifu Textile Co., Ltd, with a plan to invest about $64.72 million US dollars, and actual investment of $52.08 million US dollars as of today. As the parent company, China-Africa Cotton invests in many projects in various African countries, including Malawi, Mozambique, Zambia, Zimbabwe, Chad,Togo and Mali. Company focuses on seed researching, plantation, cotton purchasing and processing, cotton seed oil processing and textile making.


[41]Land law n° 19/97. Web source

[42]Roque, Paula C. (2009) “China in Mozambique: A Cautious Approach Country Case  Study”, South African Institute of International Affairs Occasional Paper No 23.

[43]African East-Asia Affairs, the China Monitor, “China-Mozambique relations: support and governance challenges”, Center for Chinese Studies, issue 72, June 2012, p. 22.

[44]This attitude has induced some scholars to suggest that Chinese land grab would turn Mozambique into the first China’s agricultural colony: Horta, Loro (2008) „The Zambezi Valley: China‟s First Agricultural Colony?‟, Web source

[45]Bräutigam, D. and Xiaoyang, T. (2009) “China’s Engagement in African Agriculture: Down to the Countryside”, The China Quarterly, 199: pp.686-706.

[46]Shenggen Fan, Bella Nestorova, and Tolulope Olofinbiyi, “China’s Agricultural and Rural Development: Implications for Africa”, China-DAC Study Group on Agriculture, Food Security and Rural Development,  Bamako, April 27–28, 2010.

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HIV and TB in Prisons

Prisons are often a catalyst for the outbreak of contagious disease epidemics. Prisoners are, therefore, much more likely to contract and spread many diseases. This article will explore why prisoners are at greater risk for contracting certain infections, why this inequity should not be tolerated, and how this issue is innately connected to the public health of the general population. There will be a follow-up article that explores current programs that seek to significantly minimize the impact of communicable and infectious diseases and how the causes of increased susceptibility of prisoners can be mitigated

Corie Leifer

by Corie Leifer*, MSc.

Supervised by Anke van Dam, MD

AIDS Foundation East-West (AFEW)

HIV and TB in Prisons


Communicable and Infectious Diseases in Eastern Europe and Central-Asia

Despite new technology and advances in treatments and medicines, the growth in the number of new HIV infections in Eastern Europe and Central Asia (EECA) remains steady. In Europe, between 2004 and 2013 the number of new HIV infections increased 80% from 76,000 new cases to more than 136,000. Of these 136,000 new infections in Europe, 105,000 were in EECA. In EECA in this same nine-year period, the number of new HIV cases has doubled. Furthermore, this region has the highest prevalence of injecting drug users. There is a well-established connection between injecting drug use and contracting HIV. In fact, of the 3.7 million injecting drug users in the region, roughly one-quarter are believed to be infected with HIV. Tuberculosis is also prevalent in this region. More and more cases of multi-drug resistant Tuberculosis are diagnosed. This makes that TB has become one of the causes of death in this region. More than 95% of deaths due to TB occur in low- and middle- income countries.

Communicable and Infectious Diseases in Prisons in EECA

The prevalence of HIV in prisons is estimated to be between 2 and 50 times greater than that in the general population. Within EECA, Kazakhstan has the lowest HIV prevalence among prisoners with 2% infected. Tajikistan has the highest rate of HIV infection in prisoners in the region with nearly 7%, accounting for nearly one-fifth of all people infected with HIV in Tajikistan. Additionally, the risk of contracting TB in prison is estimated at 60–100-times higher compared than outside of prison. Within the prison population, there is an increased rate of mortality due to TB infection when compared with that of the general population.

Aids Foundation East-West (AFEW) is one of the few international networks that works in prisons in EECA to help reduce the burden of infectious and communicable diseases such as HIV and TB. As experts in prison health in this region, AFEW continues to play an integral role in developing the necessary links between governmental and civil society organizations to improve the health of prisoners.

Why Does It Matter?

Prison health has no priority on the different, political, global, agenda’s.. It is often assumed that the imprisonment is a result of one or more bad decisions. In many countries, people may be imprisoned for years while awaiting a trial, only to be found innocent of the crime for which they are charged. Regardless of the reason for imprisonment, the punishment of a prisoner should revolve around the lack of freedom, not the lack of healthcare.

Human Rights

It states in the Constitution of the World Health Organization that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”. Whether or not a prisoner belongs behind bars is completely irrelevant to, and should not impede upon, his or her human rights. In 2006, the Council of Europe declared that prison conditions must never infringe upon human dignity. Prisoners do not have the same option as the general population to search for a practitioner with whose services they are happy. Prisoners have no other choices in regards to their medical health except to use the medical staff and resources provided by the prison. Therefore, it has been decided by the Council of Europe that “states are under the obligation to respect the right to health by… refraining from denying or limiting equal access for all persons, including prisoners or detainees … to preventive, curative and palliative health services”. In fact, due to the importance of this responsibility, governments can be held legally responsible “for failure to prevent all forms of avoidable health impairment or damage to the well-being of its prisoners”. Within the context of health, prisons should provide enough space, light, fresh air, clean sanitary facilities, clothing, heating, and adequate nutrition.

Impact on General Population

Prisoners are rarely imprisoned for life. There is a high turnover in prisons, with many prisoners only spending days, weeks, or months behind bars. Before their imprisonment, prisoners are members of the general population. After their release, they return to the community. There are also members of the general population who work in prisons, have relationships with prisoners, or work with prisoners who participate in outside work placement situations. Therefore, the exchange of diseases between the prison population and the general population is inevitable. There are many examples of outbreaks of TB and HIV in prisons tied to increased prevalence of the respective disease in the community in Thailand, Lithuania, Latvia, England, and other places around the world. “Major HIV outbreaks occurred among prisoners in Glenochill, Scotland in 1993 and in the Alytus prison in Lithuania in 2002.”


Before tackling any issue, public health or otherwise, the source of the issue must be understood. Therefore, disease management must first address the how the disease is transferred from one person to another and then investigate how the factors fueling the spread of the disease can be diminished.

HIV and TB have different means of transmission. HIV is spread through the exchange of infected blood or semen. The main methods of transmission are unprotected (voluntary or involuntary) sexual intercourse or through the sharing of needles, which may be used for injecting drugs or applying homemade tattoos. TB is spread much easier through merely inhaling the bacteria.

There are many factors that contribute to the rapid spread of communicable and infectious diseases through prisons. A lack of many factors also contributes to the devastation caused by the disease(s).

Lack of Proper Facilities

Prisons are often lacking appropriate facilities to ensure the health and safety of the prisoners that it houses. It is especially problematic in places where incarceration is punishment for minor crimes such as petty drug offenses because of an increase in the number of prisoners. In many places around the world, the prison population is increasing, but the capacity of prison services is not growing at the same rate. “While overcrowding is a health issue all over Europe, the situation is particularly serious in some of the countries of EECA, where overcrowding goes hand in hand with health problems.” The overcrowding not only leads to a lack of personal space which will inevitably lead to the spread of contagious diseases, but it also overwhelms the plumbing and sanitation services and water and food supply. Additionally, the poor ventilation, minimal access to clean drinking water, non-existent nutritional considerations, and lack of lighting and heating contribute greatly to the susceptibility of prisoners to contracting contagious diseases. Ukraine, for instance, fulfills more than 120% of their capacity for housing prisoners.

Lack of Structure, Procedures and Oversight

In many countries, there is little to no link or alignment of prison health services with national health services or national efforts to address communicable and infectious diseases. Often prison health services operate parallel to, not in conjunction with, national health programs. This creates duplicated efforts, a lack of consistency, and incomplete information. By integrating prison health services and national health services, prisons would be better able to provide medical care comparable to those provided to the general population, the importance of which is discussed above. In fact, prison health is not even regulated by the Ministry of Health in many countries; rather it falls under the jurisdiction of the Ministry of Justice.
Not only are prison health services not aligned with national health services, but in many cases they also do not maintain the same standards and regulations. There are not clear policies or guidelines regarding healthcare protocols, job descriptions of health personnel or quality evaluation. There are also few, if any, infection control measures, medication administration protocols, or systematic screening, counseling or testing for communicable and infectious diseases. This can lead to disconnected, inefficient health services and a decreased quality of care. Without the standards and procedures, clinical decisions may be guided by opinions and feelings, rather than medical criteria. Furthermore, confidentiality and safety may be compromised, as well as the health of the patient.
The lack of standards and protocols leads to poor record keeping, which in turn leads to poor evaluation, quality, and health management. There is minimal, if any, record keeping, monitoring, or evaluation of the health of prisoners. There is a lack of baseline information, morbidity statistics, and status update information. There are not systemized and uniform procedures and forms used for collecting health information. Without this information and standardization, tracking the progress of the health of prisoners is nearly impossible. As a result, prison health statistics are mainly absent from the health data provided by most countries.

Lack of Harm Reduction Measures

Injecting Drug Use (IDU) remains the main cause of the spread of HIV in EECA. This is the case for both the general population and for prisoners. In fact, injecting drug use is the cause of 50–70% of cumulative HIV cases in the region. In prison specifically, this phenomenon is made worse by needle sharing. In Central Asia, it is estimated that 5-25% of prisoners have drug dependence issues and as many as 70% share injecting tools.
Drug users and prisoners are often overlapping populations. There are two main reasons for this, and each exacerbates the other. The first reason is that drug users are overrepresented in prisons and detention centers. This is due to the illegality of drug use. For instance, in Georgia, even trace amounts of drugs in a used syringe can be enough to lead to an arrest. Such strict laws almost guarantee that drug dependence will lead to criminal prosecution. Between 5% and 38% of prisoners in Europe report injecting drugs prior to imprisonment. The second reason that prisoners are more likely to use drugs is due to their incarceration. In fact, between 2% and 56% of prisoners surveyed reported injecting drugs while in prison. Drugs remain available in prisons, despite the confining circumstances. However, safe injecting tools are not as widely available. This leads to an inevitable situation of many people using the same needle to inject drugs. Drug use can lead to incarceration, and incarceration can lead to drug use. As is clear, this is a cycle that is difficult to break.
There is a lack of Needle Syringe Exchange Programs, and therefore clean needles in prisons. Additionally, there is minimal Opioid Substitution Therapy (OST) available to prisoners. “As of 2010, 74 countries worldwide had opioid substitution therapy available in the community. Of these countries, only 39 also had this therapy available in prisons.”

Lack of Proper Medical Care

Limited medical care within the prison setting is a multi-faceted problem. As already discussed, without procedures and standards for screening, counseling, or testing, prisoners may be exposed to avoidable health risks. Additionally, medical care is often not complete, timely, comprehensive or individualized.
There are few to no provisions made to continue to ensure that healthcare and treatment is sought by and provided to prisoners who have recently been released. This is despite the fact that continuity of care has been proven to be essential to ensuring treatment adherence and therefore helping prevent drug-resistant strains of disease from developing.
The absence of proper medical care is also a product of a lack of well-trained personnel. Working within the prison system is often regarded as not prestigious or possibly unsafe. There is minimal training provided and many employees are young and do not have extensive professional experience. This might foster an incompetent workforce and deter highly skilled professionals.
Proper medical care includes offering “access at the right time to a general practitioner or to specialized care.” Specialized care includes reproductive healthcare for women. Even though women make up a small percentage of the prison population, the rate of infection with HIV for incarcerated women is often higher than that in the male prison population. This is in part due to an increased likelihood of drug dependence and injecting drugs in imprisoned women when compared with imprisoned men. In prisons in many countries there are no provisions taken to provide qualified specialized care for female prisoners.


Prison health is public health. Unlike the prisoners, the spreading of a contagious disease is not confined by the walls of the prisons. It is, therefore, not only in the best interest of the prisoners to provide them with healthcare, but it is also in the best interest of society. This is not only the most humane approach, but also the most cost-effective and socially beneficial. In health issues, it is almost always the case that prevention is the most cost-effective method to disease management. Preventing the spread of disease is a much more feasible task than managing an already prolific outbreak. Prevention measures include addressing the “factors related to the prison infrastructure, prison management and the criminal justice system (that) contribute to vulnerability to HIV, TB and other health risks in prisons.” Prisoners have an increased probability of contracting a contagious disease due, in part, to the lack of hygiene, proper medical care, and personal space. Therefore, the epidemics cannot be brought under control until at least some of the many contributing factors are addressed.



Prison and Health Data and Statistics. World Health Organization, 2010. accessed March 25, 2015.

Get the Facts. Common Sense for Drug Policy, 2012. accessed March 25, 2015.



*Corie Leifer (Office Manager since January 2013), was born in 1981 in Connecticut, USA. After earning a bachelor degree in communications and another in nursing in the United States, she moved to the Netherlands in 2011 to earn a Master of Health Science degree with a focus on International Public Health from Vrije Universiteit in Amsterdam. During this study, Corie completed her internship at AFEW and subsequently joined AFEW as Office Manager. As a research intern, she investigated the use of SMS campaigns to reduce the spread of HIV/AIDS. Corie has international marketing and communications experience, having worked at Operation Smile, Inc. and Trader Publishing Company prior to returning to school. Corie is also a Registered Nurse licensed in the Commonwealth of Virginia, USA.

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