I was glad to be able to pay a short visit to Zambia from 5-9th May 2006, which focused mainly on issues of health. It brought back vivid memories of past visits - a Presidential State visit in the mid 1990s and a trip during my term as United Nations High Commissioner for Human Rights for meetings of the African Union and the Zambian Human Rights Commission.

Zambia today, with a population of 11.3 million, places 166th on the list of 177 countries included in the UN?s Human Development Index. 63% of the population lives on less than $1 a day, 1 million live with AIDS and 1 million children have been orphaned by AIDS. Life expectancy is 37.5 years. (For further details see attached presentation by Irish Aid: ? Zambia at a glance?.)

Despite these realities, Zambia has a stable democratic government and a strong commitment to achieving the Millennium Development Goals with the support of donor governments, a number of whom are working together on a joint assessment strategy.

I took part in the 6th Annual Stakeholder Meeting of the Medicines for Malaria Venture (MMV). MMV is a public private partnership involving the World Health Organization, pharmaceutical and other private sector partners and academics. It was funded to develop and deliver new, affordable anti-malarial drugs, and is now managing the largest ever portfolio of malaria drug research. With the expectation of launching three or four inexpensive new drugs over the next three years, a key focus of the meeting was on access: that is, how to make treatments available to the poorest, with a cost target of $1 per adult and 50 cents per child.

Shortly after my arrival, I was encouraged to join a sunset cruise on the Zambezi River. This brought back memories of a cruise on the Zambezi during the State visit, but also brought home the extent of tourist development in recent years as Zambia has exploited the natural wonder of the Victoria Falls. As others marveled at the elephants coming down the water to feed, and the hippos yawning in the shallows, I availed of the opportunity to learn more about the hopes and aspirations of MMV from its key staff members, and to hear the assessment of where the world is in combating malaria from other experts attending the conference with me.

The opening dinner of the MMV meeting took place the following evening. I missed the reception and setting sun as I had paid a courtesy call on Zambian Vice President Lupando A. Mwape, who was the guest of honour, and so instead I arrived to the excitement of African dancers illuminated by bonfires and torches. Prior to the speeches there was a compelling and witty dramatic sketch about a family coming to terms with malaria and resisting some of the traditional myths.

I emphasized what a human rights approach to health meant in practice, and - given the high prevalence of malaria in Zambia and many other developing countries - that it was essential to ensure that the drugs being developed by MMV would be low-cost and accessible to the poorest. My reception was made warmer by the fact that the Irish government had just announced support of $9 million over three years to MMV!

Early next morning I flew to Lusaka to spend the next few days as guest of the Irish Embassy in Zambia, which had prepared an intensive but very welcome program that included site visits to projects supported by Irish Aid. The first meeting was with the following group of remarkable women representing women?s organizations working on education, health and income generation:

Judy Mulenga, Executive Director, Zambia Civic Education Association ZCEA; Christine Munalula, National Coordinator, Women in Law and Development in Africa; Annie Fellows, Chairperson, Mumbwa Development Association, representing Women for Change; Mulenga Kapwepwe, Elizabeth Mbewe, Programme Manager, Forum for Women Educationists in Zambia; Margaret Chimanse, Women and the Media; Matilda Musonda Chowa, Site Coordinator?, Lusaka Home Based Care; and Catherine Chirwa, Coordinator, Kamuza Munjile Community Group (Chipata Compound).

Over the next two hours I learned of their concerns, including the need to improve the quality of education and improve the teacher/pupil ratio which was often as high as 1:90. They told me of the development of local community schools for vulnerable children, many of them AIDS orphans. They were concerned about the lack of facilities in these schools which were not part of the State system, and the drop-out rate of girls upon reaching puberty or even earlier. They spoke of the lack of clear definition in Zambian law of who is a child, which if clarified, could prevent the very young marriages currently taking place. Despite the fact that Zambia has ratified the Convention on the Rights of the Child, traditional law allows early marriage. This in turn adds to the high level of maternal mortality. The conversation kept returning to the reality of poverty, the care burden of women in the context of HIV/AIDS, and the very high unemployment rate. Despite this, they told me of initiatives in home-based care, in training women in income generation and their advocacy for changes in law and policy.

The next event was a reception at the Irish Embassy to meet the Irish community. There was a large and enthusiastic turnout, and I was struck by the number ? mainly nuns and priests ? who reminded me we had met during the earlier State visit. A significant number of them have worked with poor communities in different parts of Zambia for 30 or more years, and were full of wisdom about where the country has progressed and where more needs to be done.

This discussion continued over an informal dinner that evening with the Irish Ambassador to Zambia Bill Nolan. Zambia is one of a small number of countries Irish Aid focuses on, and the relationship has been long and sustained. We discussed the greater donor coordination under the Paris Principles, and I learned that under the Joint Assessment Strategy Ireland will take particular responsibility for donor coordination in education, and Sweden will lead on health. Early next morning I met the Irish Aid country team and received a PowerPoint presentation on their work in Zambia.

We also visited Lilanda, a poor area outside Lusaka, to see a home-based care project and visit a community school and project for children orphaned by AIDS. We were greeted with songs by the 80 care volunteers and learned about the medical, counseling and food support for people living with HIV/AIDS. In the same premises I visited a class for children orphaned by AIDS who would not otherwise go to school, and saw another group learning basic skills. Later we drove to a nearby community school. I was impressed by the efforts to make the school self-financing through sugar cane production and the beginnings of market gardening.

I then went with Ambassador Nolan to meet the Zambian Foreign Minister, Reverend Lieutentant General Ronnie S. Shikapwasha. I briefed the Foreign Minister on the work of Realizing Rights on trade, health and migration. We focused particularly on our efforts to inform the work of the WTO task force on Aid for Trade, and on how to address problems of the brain drain of health workers, which the Foreign Minister said continued to be a serious problem for Zambia. I explained our plans for a meeting on migration and health workers in New York on September 12th, just prior to the High-Level Dialogue in the General Assembly on Migration and Development.

On our return to the Embassy, Ambassador Nolan hosted another lunch reception, this time for the diplomatic corps, as well as other official representatives from the Zambian government, the United Nations and the wider civil society. In a very short time I was meeting a wide cross section of Lusaka society and doing so in the pleasant context of Irish hospitality!

After lunch there was a brief press conference at the Embassy. Then we paid a courtesy call on the Vice President at the State House. (President Mwanawasa is currently recovering from a recent illness and has not fully resumed his duties.) The country is due to have presidential and parliamentary elections in the autumn.

From the State House we traveled to Kalingalinga hospice on the outskirts of Lusaka. It is a modern and well-planned facility with in-patient capacity of 22 beds and a wide catchment of very poor people. I was impressed by the quality of care - spiritual, medical and physical - available, under the direction of an English num, Sister Maria Crucis.

That evening, my last in Lusaka, I had a working dinner with Minister of Health Sylvia Masebo MP and Ambassador Nolan. It was an opportunity to learn of her priorities and challenges, and to listen as she and Bill Nolan discussed the new donor role in health under the joint Assessment Strategy. We discussed the high level of maternal mortality and I gave the Minister a copy of a Realizing Rights concept paper on seeking to strengthen midlevel human resources in the health systems of four countries, of which one would be Zambia. She was in complete agreement about the importance of strengthening the health system through training of midlevel health workers and providing them with an appropriate enabling environment. The Minister said she plans to attend the World Health Assembly in Geneva later in the month, and we hope to meet again at the working lunch of the Network of Women Health Ministers on May 23rd.

As I flew out early next morning ? to New York via London ? I had a sense of having covered quite a lot of ground in a short time! It was a genuine pleasure to return to Zambia, and to see the efforts of both government and civil society organizations to redress the setbacks of recent years and ensure that the country is on course to achieve the Millennium Development Goals. On two of those goals, improving maternal and child survival, I hope Realizing Rights will be able to engage actively in Zambia with our partners, which would give me an excuse for a further visit in the not too distant future!