Gates: More Money for Global Health Is Good for the Environment

Thursday, January 28, 2010

Bill Gates gave the PHE community a much-needed upgrade in his foundation’s 2nd Annual Letter, released this week. Unfortunately it still has a few bugs.

"In the long run, not spending on health is a bad deal for the environment because improvements in health, including voluntary family planning, lead people to have smaller families, which in turn reduces the strain on the environment," concludes Gates.

This statement could dramatically raise awareness of and funding for population-environment programs. Any time Bill Gates talks, the world listens, as evidenced by the barrage of coverage from Reuters, AFP, and top IT newswires. For the public, it offers a rare glimpse into development strategy, so Gates' thoughts (and financial commitments) could be seen as representative of the foundation community’s approach to global health problems.

Although it may seem obvious that fewer people place less strain on the environment, this connection has been largely absent from the environmental agenda, including the efforts to combat climate change. Some environmental leaders and organizations have dismissed population as an unimportant distraction from the real business at hand. Others have noted that population growth's impact on climate change is far greater in the rich world than in poor countries, whose per capita emissions are a fraction of developed countries’.

Gates' comment may cause those in the first camp to re-evaluate the importance of family planning, and it is likely to energize the converted. But it will have less impact on those focused on consumption. But if it encourages the environmental community to put population and family planning issues back on the table, it will have gone a long way.

However, Gates could have gone further, by explaining that family planning is a relatively inexpensive way to mitigate climate change, compared to complex and emerging technological solutions. He also could have pointed out that climate change is expected to increase the prevalence of vector-borne diseases such as malaria, or that sick or malnourished individuals may be forced to mismanage natural resources.

Because Gates didn’t make these explicit connections, many in the media missed his point. The wire headlines pit health against environment, when Gates was in fact pointing out how interdependent they are. This distortion is symptomatic of the media's tendency to highlight the horserace. But maybe they would pay closer attention if the Gates Foundation put its money where its mouth is—and funded programs that integrate family planning and the environment.

Perhaps several years from now, we will look back and say that this letter marks the start of the Gates Foundation’s integrated approach to development. But we may need to wait for Letter 3.0 for a complete install.

Photo: Courtesy Flickr User World Economic Forum

Oli Brown on Climate Security and Environmental Peacebuilding

Thursday, January 28, 2010

“Climate change seems to be eclipsing all other environment and security issues, but those issues haven’t gone away,” says Oli Brown, program manager at the International Institute for Sustainable Development (IISD). “There are still problems with illegal timber, still problems with mining, there are still problems with diamonds, there are still problems over land, water, and so on. Climate change encompasses a lot of those issues and makes some of them more difficult and more pressing.”

IISD is working with the United Nations Environment Programme on ensuring that these issues are addressed in UN peacekeeping missions. “What we do with UNEP is to coordinate a group of experts that help to advise the UN family on ways that it should do conflict prevention, post conflict reconstruction, peacekeeping, peace negotiations and peacebuilding more effectively,” says Brown.

Land Grab: Sacrificing the Environment for Food Security

Wednesday, January 27, 2010

According to the United Nations, 74 million acres of farmland in the developing world were acquired by foreign governments and investors over the first half of 2009 -- an amount equal to half of Europe's farmland.

Land Grab? The Race for the World's Farmland, a new book edited by Michael Kugelman and Susan L. Levenstein of the Wilson Center's Asia Program, brings together international organizations, farmers, and agricultural investors to discuss this new phase of the world food crisis.

The book, which grew out of a May 2009 conference (webcast), includes regional case studies from Africa, Asia, and Europe/Former Soviet Union, as well as recommendations for farmland investors, host nations, and the international community.


“So long as the global race for farmland continues, the assault on the environment will as well -- with troubling implications for food security,” Kugelman and Levenstein opine in World Politics Review:
Food-importing nations, with memories of the skyrocketing global food costs and supply shortages of 2008 still fresh, are increasingly fearful about the volatility of world commodities markets. Given their rising populations and disappearing arable land, such countries have good reason to be afraid. As a result, some food importers, particularly in the Persian Gulf and East Asia, are now foregoing imports altogether and instead investing in foreign farmland to use for food production. They are joined by private agri-business firms, which perceive farmland as a wise investment in a food-insecure era.

Meanwhile, nations whose land is targeted, many of them dependent on international food aid, are desperate for agricultural investment. Though blessed with arable land, their farm yields are flat and their agricultural sectors flagging. Heavy doses of foreign capital, they reason, will enhance farming technology, improve crop yields, and ultimately end hunger. Although these hoped-for effects are not guaranteed, many governments in these countries welcome foreign interest in their land, and actively seek out prospective investors by dangling tempting tax incentives. Pakistan has even offered a 100,000-strong security force dedicated to protecting such investments.

This all portends an environmental nightmare. The prime targets of farmland investment -- Central Africa, Southeast Asia, and South America -- are home to most of the world's remaining tropical rainforests. Industrial agriculture could fell considerable areas of this forest land and release vast quantities of carbon into the atmosphere. The world's largest tropical rainforest, the Amazon, is particularly vulnerable. Land investors are increasingly turning their attention to South America, a region boasting a slew of tantalizing qualities, including nutrient-rich soil, water-laden farmland, and ample land for rain-fed crop production.
Read more on World Politics Review.

Eye On:
Peace Through Parks on Israel's Borders - Dream or Reality?

Wednesday, January 27, 2010

In areas fraught with conflict, is it possible to advance conflict resolution through environmental discourse? A recent conference hosted by Tel Aviv University's Porter School of Environmental Studies explored this question through an examination of existing peace parks, as well as possible future preserves.

The wide-ranging discussion sought to apply theories of conflict resolution and environmental peacemaking to local conflict in the Middle East. Touching on conservation, conflict resolution, local history, geography, ecology, and diplomacy, the participants underscored the importance of restoration efforts, local environmental maintenance, and the pursuit of peace through environmental cooperation.

For more, watch these presentations on YouTube (in English; with Timestamps):

Event Part One:

0:15:50

"Conservation to Conflict Resolution: Understanding the Theory and Practice of Peace Parks"
Dr. Saleem Ali, Rubenstein School of Environment and Natural Resources, University of Vermont

1:36:28
"Peace Parks on Israel's Borders: Lessons from South Sinai"
Dr. Dan Rabinowitz, Department of Sociology and Anthropology, Tel Aviv University

1:55:49
"The Jordan River Peace Park: Post-conflict environmental peacebuilding between Israel and Jordan"
Gidon Bromberg, Israeli Director, Friends of the Earth Middle East

Event Part Two:

0:01:12

"The Golan Heights – A critical habitat with global significance"
Dr. Tamar Ron, Ecologist, biodiversity conservation consultant

2:11:01
Session Response:
Valerie Brachya, Director, Environmental Policy Center Jerusalem Institute for Israel Studies

Photo: Golan Heights Panorama, Courtesy Flickr User Vad_Levin.

Dot-Mom:
Watch: Harriet Birungi: Challenges Facing HIV-Positive Adolescents in Kenya

Monday, January 25, 2010

“Services are not necessarily very adolescent-friendly, so when you get children who are HIV-positive they are likely to face discrimination,” says Harriet Birungi, an associate in the Reproductive Health Program with the Population Council in Kenya, in this interview with ECSP’s Gib Clarke following the Global Health Initiative’s Integrating HIV/AIDS and Maternal Health Services panel.

According to Birungi, medical service censoring and targeted exclusion from schools are among the top challenges facing Kenyan adolescents living with HIV/AIDS. She hopes better support systems and intervention strategies, especially for pregnant individuals, will help medical personnel more quickly identify HIV-positive young adults needing critical medical services.

Collier and Birdsall: Plunder or Peace

Friday, January 22, 2010

In a preview of his new book The Plundered Planet: Why We Must - and How We Can - Manage Nature for Global Prosperity, Paul Collier dispelled the common perception that Africa’s indentified resource reserves are the world’s largest. In actuality, it is estimated that up to four-fifths of the value of subsoil assets in the African continent are yet to be discovered. “That is the big story,” Collier remarked. “Here are assets which could finance transformation….but historically haven't.” Instead, these resources have been plundered.

In a recent event hosted by the U.S. Institute of Peace, Paul Collier, professor of economics and director of the Center for the Study of African Economies at Oxford University, and Nancy Birdsall, president of the Center for Global Development, discussed how resource-rich environments in developing countries have been traditionally misused. The two also proposed strategies to disrupt these processes and transform resource “curses” into deeply needed support for peace and stable development.

Conflict and instability in countries whose economies are heavily invested in natural resource have often hindered local development and security. Many of these countries—including Cambodia, Angola, Indonesia, and DRC—have suffered from one of two forms of plunder:

Types of Natural Resources Plunder:

1. Where the few steal from the many:
Natural assets are, by definition, without natural owners, and therefore lie as easily taken common goods. "This process of expropriation opens up a whole array of dysfunctional variants, many of which are violent," Collier noted.

2. Where the present steals from the future:
Intertemporal mismanagement is a possibility, as unlike man-made assets, natural assets belong to all generations.

Operating from a worldview of weak sustainability, where profits from natural assets are reinvested for the benefit of future generations, Collier suggested that natural resource rights are more akin to “rights of stewardship” than traditional property rights. “We may well transform that value into something that is more productive, but if we pull up natural assets from the ground, we should leave to the future something that is equivalently valuable."

Collier argued that the successful harnessing of natural resources for stable and sustainable development depends on the application of a tenuous decision chain:

Natural Resources Decision Chain:

1. Discovery Process:
Failure in this phase stems from poor property rights, and the time consistency problem—uncertainty that conditions and regulations that make expensive upfront investments profitable today will remain in place in the future.

2. Appropriate Taxation:
Currently, as a result of poor negotiations or limited information regarding the status of resources, governments are unable to craft tax regimes which effectively capture resource rent.

3. Avoiding the Delta:
Sustainable management any discovered subsoil assets must avoid a local “Nigerian Delta” catastrophe. Clearly designating the government as the sole responsible agent for resource rents may limit such failures.

4. Saving the money:
To avoid plunder of the future by the present, Collier suggested that, though politically difficult, a proportion of revenue streams must be delineated from general accounts.

5. Building the capacity to invest in the country:
Collier deemed the inability of resource-rich countries to attract diversified investment as the “killer link.” Governments must use returns from subsoil assets to fund "investment in investment"—directing public capital toward transportation and utility infrastructure, education, health, and other short-term projects. Once in place, such projects encourage future public and private investments, thereby multiplying long-term returns.

As with many complex systems, Collier warned that the chain is only as strong as its weakest link. If one link fails, “the chain won't pull the country from poverty to prosperity.” On the other hand, if each link holds, the value is tremendous. ”[Y]ou really can pull the country from poverty to prosperity over the course of a generation. There are no fixes in economics that are faster than that."

Ultimately, Collier and Birdsall emphasized that success depends upon the development of an informed and competent “critical mass” of people. Even the strongest decision chain will fail if it is not underwritten by a majority of the population. Birdsall reiterated the need for public participation in the process, possibly through direct income distribution or responsible interventions by non-vested third parties.


Photo: Courtesy of Oxford University Press

VIDEO—How the World’s Poor Live on $2 a Day

Friday, January 22, 2010

“Most people think that if you’re living on $1 a day or $2 a day, it’s impossible to save,” Jonathan Morduch tells ECSP Director Geoff Dabelko in a discussion of his book, Portfolios of the Poor: How the World's Poor Live on $2 a Day. The Woodrow Wilson Center hosted Morduch and his co-author, Daryl Collins, for presenations at the Center and on Capital Hill last September. “[I]n fact, because of being poor—not despite it—households were spending a lot of time building up for the future.”

“What was really critical about what this new work was showing was that poor households were strategizing, they were making decisions,” says Morduch. “They were, essentially, juggling, active in ways that had been hidden from sight with the bigger surveys.” Now revealed, this knowledge creates opportunities for policymakers to help poor households in new ways, such as reducing regulatory costs for financial institutions seeking to service poor communities.

Morduch says microfinance and microcredit schemes are doing well, but that they are not enough to serve poor communities' entire financial needs. “The next steps involve embracing what’s already going on and making products, devising products, that are even more flexible or even more appropriate,” he says. Households have a diverse range of needs, from food and water to financing health care and education, and Morduch says these diverse needs merit diverse solutions.

From the Wilson Center:
Lessons from the Field: Focusing on Environment, Health, and Development to Address Conflict

Thursday, January 21, 2010

“Even in the hardest moments of conflict there are opportunities for cooperation, and they need to be seized,” said Juan Dumas, senior advisor of Fundación Futuro Latinamericano during the Pathways to Peace: Stories of Environment, Health, and Conflict roundtable event co-hosted by the Wilson Center’s Environmental Change and Security Program and the Fetzer Institute on January 13th.

“Even as you were talking about the conflict potential,” said Aaron Wolf, professor of Geoscience at Oregon State University, “everywhere you looked there were people talking about water uniting together across boundaries and being able to share… [and] people being willing to talk about water when they wont talk about anything else.”

Dumas and Wolf were joined by Gidon Bromberg, co-director of Friends of the Earth Middle East (FoEME); Shewaye Deribe, project coordinator for the Ethio Wetlands and Natural Resources Association (EWNRA); and Joan Regina L. Castro, executive vice president of the PATH Foundation Philippines, Inc. (PFPI) to discuss work that demonstrates the positive impact multi-dimensional development and peacebuilding programs can have on environmental conflict arenas.

Water as an Entry Point


“In the academic world, there’s a growing documentation about the coming wars of the 21st century are going to be about water resources,” said Wolf, discussing how water resources are inherently intertwined with the Arab-Israeli and other regional conflicts. His research, however, suggests the opposite. In recent history, he said, cooperation for the resource, not conflict, was observed in nearly two-thirds of the world’s cross-boundary watersheds.

“Water is a wonderful way to have regional dialogue,” he continued, discussing how technical data and modeling are only part of any successful water conflict resolution. “A language that people have in common, and when we talk about water—because it’s connected to everything we do—we end up talking about our shared vision of the future.”

“We came out with a vision that is a shared vision,” echoed Bromberg in describing the Good Water Neighbors (GWN) project—a FoEME program seeking to improve water scarcity and quality in the Jordan River watershed by fostering cooperation between Israeli, Palestinian, and Jordanian leaders. “The Jordan office advocates that vision to the Jordanian government, the Israeli office to Israeli government, the Palestinian office to the Palestinian authority. That’s proven to be very effective because it’s the same vision.”

While hesitant to say the program could lead to or be a model for peace in the Middle East, Bromberg did underscore how multi-dimensional methods used in GWN could productively serve future peacebuilding efforts in the region.

“By empowering young people to go out and improve their own water reality with their own hands [through rainwater harvesting and grey water collection] they learn together, and then they build the facilities within their own communities,” said Bromberg. “…Not only does it empower the youths but it helps create peacemakers.”

Integrated PHE and Conflict Avoidance

“Water is common for all of us because it is the base of our life, of our survival,” said Deribe, linking ENWRA’s integrated population, health, and environment (PHE) wetland restoration program in Ethiopia to the greater discussion. “I think it is a lack of altruism, a lack of mutualistic thinking which leads us to this kind of conflict.”

Ethiopia’s 12 river basins serve more than 200 million people. Managing local wetlands and waterways with PHE approaches can therefore play an integral role in maintaining environmental quality and productivity for current and future generations while avoiding conditions that contribute to conflict, according to Deribe.

Castro, pointing to her own PHE experience with PFPI, found that multi-sectoral programs promote improved environmental quality and community stability. In the Philippines, her program targeted local youth, fishermen, and policymakers to promote food security through sustainable resource management, improved medical and family planning services, and expanded livelihood training.

Castro found that a PHE program could continue even after funding ran out. “A project can be sustained and can be owned by the local governments and local communities if they are provided the capacity to be able to continue to implement the programs and that they see the value of the programs that they do,” she said.

Lessons in Conflict Resolution

Funding, said Dumas, is the biggest limiting operating factor for organizations that facilitate dialogue in environmental conflict areas. The ability to travel across Latin America on short notice to help resolve conflict has been extremely beneficial to Dumas’ organization; but in an arena where funders require full proposals with specific outcomes and indicators, such availability over the long-term is “not financially sustainable.”

Dumas did, however, suggest ways to reduce the need for conflict resolution while opening accessibility to funding. He recommended that institutions mainstream environmental considerations into all sectors of decision-making, thereby improving capacity to respond to environmental conflicts within the given population. He also suggested the creation of “early action funds” – pools of money that his and other organizations can use on short notice for dialogue facilitation support.

On the Beat:
Challenges to Covering Population

Thursday, January 21, 2010

“We journalists tend to deal with the immediate crisis,” Tim Wheeler, an environmental reporter with the Baltimore Sun, told an October gathering of the Society of Environmental Journalists in Madison, Wisconsin. Because the effects of population growth largely won’t be felt until the future, the subject is challenging for journalists who, as a whole, “tend not to look down the road too far.”

There are, however, other challenges, ranging from funding to ideology. Falling profits have pushed newspapers into expanding “hyperlocal” coverage at the expense of other stories and editorial boards are reluctant to risk increasingly important readership over a topic that, when brought to its logical conclusion, can enflame sensitivities over immigration and abortion.

On the positive side, Wheeler noted an increase in the number of articles covering intersects of population and the environment. As an example, he pointed to a Baltimore Sun series on the Chesapeake Bay citing growing population as a reason that 25-year efforts to restore the Bay have had a limited impact. Nevertheless, he lamented that the majority of articles covering population were op-ed opinion pieces rather than hard news coverage.

Without knowledge of the population-environment connection, Wheeler says, efforts to reduce our environmental impacts will run into the same problem as those to restore the Chesapeake Bay. “We’re going to wake up . . . after 25 years and say, ‘After all that we’ve done and spent, why haven’t we made greater progress?’” He underscored that, to ensure reductions aren’t outpaced by overall growth in population, issue awareness is essential.

Water: The Next Climate Negotiation Tool?

Thursday, January 21, 2010

When the dust settled at the COP15 in Copenhagen, participating parties failed to reach a formal climate change agreement and old divisions between developed and developing countries intensified. Despite such setbacks, there may be a natural building block in formal climate change negotiations between the north and south in the future: water.

Luis Alberto Moreno, president of the Inter-American Development Bank, argues in a recent LA Times op-ed that economic interdependence and, more concretely, basic survival hinge on water in both developed and developing countries alike, most especially in Latin America.

With 31 percent of the world's freshwater resources, Latin America enjoys a competitive advantage in agriculture and energy. But recently, drought has taken its toll. Repercussions were most acutely felt in Argentina in 2008, when 1.5 million head of cattle died and half its wheat crop was ruined. Meanwhile, hydroelectric output in the most populous part of Chile plunged by 34 percent and water-dependent states like Venezuela, Ecuador, Colombia, Paraguay, and Mexico rationed water, cut power, or both.

Water’s importance in the region is obvious, but why should developed countries care about it when negotiating a climate deal? The simplest answer, according to Moreno, is that developed countries can invest in projects that resolve near-term, climate-related problems such as water supply and sanitation as they look for ways to spend the billions in aid they have just pledged for climate adaptation in the developing world. And many international donors, particularly the UN Development Programme, World Bank, and World Wildlife Fund already have invested millions of dollars towards water management and sanitation adaptation projects.

On the other side of the coin, Latin American governments should “start treating water as a truly strategic resource instead of a free and limitless one.” Moreno claims this would mean “prioritizing investments and reforms in basic services in order to reduce waste, closing the coverage gap and eliminating waterborne diseases among the poor” in the short term and would also require “a willingness to make concessions in pursuit of global emission reductions that…could be crucial to ensuring reliable supplies of water.”

While it may seem that Latin America’s water problems are not pressing, it is undeniable that if not properly managed, essential components of the region—such as the vital agricultural economy, the health of the population, and political and economic stability—may be in jeopardy.

Photo: Man drinking water from a pipe in Ecuador. Courtesy Edwin Huffman and the World Bank.

From the Wilson Center:
Water, Conflict, and Cooperation: Practical Concerns for Water Development Projects

Wednesday, January 20, 2010

“Water disputes that can start at the local level—little things—have the potential, in extreme cases, to burgeon into something much bigger,” warned Ken Hackett, president of Catholic Relief Services (CRS), during a discussion at the Woodrow Wilson Center (Webcast) for the launch of CRS’ new publication, Water and Conflict: Incorporating Peacebuilding into Water Development. The report provides guidance to water development practitioners, civil society members, and others striving to incorporate water and peacebuilding into their project frameworks.

In recognition of water’s potential to drive conflict, Hackett—part of a panel featuring Jason Gehrig, Water and Conflict‘s primary author; William Hall, professor of conflict resolution at Georgetown University; and Tjip Walker, team leader of USAID’s conflict management and mitigation office’s warning and analysis unit—urged those working on water to focus attention on identifying and diffusing areas of emerging disagreement while they are still manageable. “We must, in a proactive way, incorporate peacebuilding methodologies in water and sanitation work,” said Hackett.

Looking Beyond Tubes and Tanks

Prior to witnessing violent protests within the Altiplano region of Bolivia, Jason Gehrig assumed that the primary obstacles to successful water development efforts would be found in the technical phase of designing or building delivery systems. Local political developments, however, demonstrated that “we can’t just be looking at development without also looking at the structural issues at play,” said Gherig.

Emphasis on “social infrastructure” and the inclusion of peacebuilding paradigms allows for conflict transformation and the mitigation of future violence through heightened conflict sensitivity by local practitioners. Such understanding and sensitivity to local conflicts and structures, Gehrig asserted, can only be achieved by “listening, winning hearts and minds (beginning with our own) by getting close to the people so that their struggle for life, for dignity, for peace, becomes our own."

Defining the Role of Environmental Conflict Resolution

William Hall noted that conflict sensitive practices apply several elements of environmental conflict resolution (ECR), such as in-depth social participation, context analysis, stakeholder involvement, and the use of neutral parties.

For Hall, the goal of ECR is not only conflict resolution, but "also how people will be involved." Adapting a framework design from the International Association for Public Participation, Hall reminded the audience that decision-makers must clearly communicate both the goals of their intervention as well as the degree of public involvement required and desired. These issues are sensitive; Hall emphasized that, once a commitment has been made, it is extremely important “to be true to [one’s promises.]"

In situations such as those included in the CRS report, successful peacebuilding efforts—which result in high-quality agreements and improved working relationships between the affected parties—must include effective engagement of appropriate stakeholders, proper mediation, and high-quality information. While many of these factors may be seen as additional procedural complications and expenses, Hall countered that recent research has shown that, compared to standard methods, agreements reached within an ECR context grant economic and environmental benefits beyond those afforded by alternative processes.

Peacefully Managing the Commons

Tjip Walker noted that effective governance of water and other common pool resources, often magnets for mismanagement and contention, should be a pivotal concern for peacebuilders in fragile states. Drawing on research on governance and conflict, Walker explained that countries that are more democratic, and allow for greater social participation, are at a lower risk for violent conflict.

With regard to threats posed by common pool resources, Walker reminded the forum that Elinor Ostrom's work demonstrates it is possible—providing a "enabling environment" for governance—to manage such resources without exposure to dire consequences. In many cases, however, Ostrom's requirements for sustainable management are unfortunately difficult to achieve and are further complicated by pre-existing challenges stemming from economic dependencies and political arrangements.

Referring to previous trans-boundary river conflict projects, Walker noted that "most of them have been positive...[which] seems to suggest that we are all in this together." Successes such as these grant hope for the future, yet also demonstrate a need for negotiated agreements across political boundaries. "Under the right circumstances," Walker concluded, "we do have the ability to manage these resources effectively in ways that are perceived as generally being effective and legitimate."

For more information about water, conflict and cooperation, as well as other events and publications under ECSP's Navigating Peace Initiative, please visit www.wilsoncenter.org/water.


Photo: Courtesy David Hawxhurst, Woodrow Wilson Center.

Dot-Mom:
Human Resources for Maternal Health

Wednesday, January 20, 2010

“Pregnancy is not a disease, a woman should not die of pregnancy…it doesn’t need a new drug…it doesn’t need research – we just need skilled workforce at different levels,” argued Seble Frehywot, assistant research professor of Health Policy and Global Health at George Washington University, at the Global Health Initiative’s second event of the Advancing Policy Dialogue on Maternal Health Series.

Research shows that increased access to skilled health workers during pregnancy and delivery, including midwives and other practitioners, can significantly reduce maternal mortality in developing countries. One solution to the current human resource crisis is to expand, and in many cases, acknowledge, the skills and responsibilities of non-physician health workers.


Task-Sharing: Who, What, and How

There are too many preventable deaths…if we look at the data, quality maternal health services are not available,” argued Frehywot, as she presented the following evidence:

  • Countries that have the highest maternal mortality rates are those that also have the greatest worker shortage
  • In Africa, for every 10,000 births, only 2 physicians and 11 nurses or midwives are present at delivery.
  • According to the World Health Organization, there needs to be at least 53 skilled health care workers (nurses, doctors, midwives) per 10,000 births to meet Millennium Goal 5 which seeks to reduce maternal deaths by 75 percent by 2015.

  • There are four common types, or levels, of task-shifting:
    1. Doctors to non-physician health clinicians
    2. Health clinicians to registered nurses and midwives
    3. Nurses/midwives to community health care workers
    4. Community health care workers to expert patients
    “All [task-shifting] needs to be done through a sound regulatory framework…it is very important to match tasks that are needed at the ground level with the competency needed to back it up,” maintained Frehywot. Regulatory issues such as the scope of practice, standard of care, training, licensure, and supervision must be addressed to ensure safe and high-quality treatment. Additionally, political buy-in and commitment from the Ministry of Health, medical universities, and professional councils and associations are necessary for long-term development, argued Frehywot.

    Policies for scaling-up human resources should start at the district level, as these localized hospitals are geographically closest to the need, argued Frehywot. “If one really wants to decrease the maternal mortality ratios, especially by 2015, this is where most of the people live.”

    Applying Task-Shifting in Afghanistan

    Maternal mortality ratios in Afghanistan are the second highest in the world,” declared Jeffrey Smith, regional technical director for Asia at Jhpiego. In 2002, when Smith arrived in Afghanistan, there were limited health workers, most with out-of-date skills, and no functional schools for training. “The most important decision made early in the reconstruction [of] Afghanistan was that midwives would be the backbone of the reproductive health workforce and they would be empowered with the skills to perform the tasks necessary for provision of basic emergency obstetric care,” shared Smith.

    Making the case for task-shifting, Smith discussed the importance of empowering health workers on the front line so that they may provide services in the most peripheral areas. “Task shifting should not be a temporary fix until we have more doctors,” argued Smith, as this framework disenfranchises a cadre of health workers and fails to build long-term solutions for human resources. Instead, Smith advocated for the "Health Center Intrapartum Care Strategy" that makes midwives the foundation of care and includes strategies for training, staffing, and linkages to the overall health system.

    In this post-conflict setting, task-shifting began as an emergency approach. However, it rapidly became a development strategy for professionalizing the workforce and rebuilding the health system. Afghanistan’s Ministry of Public Health was imperative to the success of scaling up midwives as they clearly defined from the beginning what was needed and who would provide care, taking steps to ensure that the midwifery schools maintained legitimacy and received formal accreditation.

    “Keep it clinical and keep it local,” shared Smith. The midwifery schools made efforts to recruit individuals from the provincial level, teaching specific life-saving skills applicable in the field. This framework has successfully retained 86% of its graduates, and many of the women report that the program has provided them with a sense of community and ownership.

    Building a Sustainable Health Workforce

    “We invite the maternal health community to take advantage of the incredible momentum that human resources for health is having right now,” shared Pape Gaye, president and CEO of IntraHealth. While there are many issues within the health system that need to be strengthened, Gaye maintained that “we must pick our battles” and advocated for an emphasis on scaling-up the training and availability of midwives.

    In order to scale-up midwives for maternal health we must avoid the same old traps, particularly the lack of donor coordination shared Gaye. “If we do a better job of improving coordination we will start solving the problem.” Additionally, Gaye discussed the implications for training generation “Y,” emphasizing the importance of including new technologies available for training, including PDA’s and e-learning courses.

    Performance outcomes and training are the two key pillars of effective scale-up, shared Gaye. Task-shifting also requires legal support and the endorsement from medical associations to help legitimize this new health system framework. “This is not simple work; you really need to have a systems approach. What we seek in the end is good integration. Integration across systems, integration across roles, courses, learning processes, and training for maximum adaptability,” shared Gaye.

    Walker's World: From Warming to Warring: A Review of Cleo Paskal's New Book

    Friday, January 15, 2010

    Wilson Center Senior Scholar Martin Walker recently reviewed Global Warring: How Environmental, Economic, and Political Crises Will Redraw the World Map by Cleo Paskal, for his UPI column, "Walker's World."

    Excerpts:

    The Copenhagen summit showed that climate change is as much about geopolitics and power as it is about the weather. China's blunt refusal to accept any binding limits on its carbon emissions, despite the agonized pleas of small island governments facing extinction, demonstrated that this new aspect of the game of nations is going to be played as hardball.

    And yet, as Cleo Paskal argues in her pioneering new book "Global Warring," China is also powering ahead on every aspect of climate change. While protecting its right to pollute (because it depends heavily on coal as its main homegrown energy source), China is using state subsidies to seize the lead in solar power manufacturing....But perhaps Paskal's most striking story is the way that China is also seeking to become a major player in the arctic. China has acquired an icebreaker, a seat with observer status on the Arctic Council and its own arctic research base at Svalbard. (China also has two research bases in the Antarctic.) ...

    Paskal's book is full of such vignettes, illustrating the way that climate change and the intensifying competition for resources is starting to change the nature of power politics. Paskal, a Canadian who is a fellow of London's prestigious Chatham House think tank and a consultant for the U.S. Department of Energy, has been a pioneering scholar of the new terrain where climate change confronts national security, where geopolitics, geoeconomics and global warming all collide. It is not just rivalry for oil and gas supplies and water, but also for fishing rights and undersea mining and mineral rights that may well be up for grabs when some of the lowest-lying Pacific island countries disappear under the rising waves. ...

    "We need to start thinking about the legal and economic implications of these developments now, before we have to start tackling them in the middle of a crisis or a humanitarian emergency," Paskal told a seminar at Washington's Woodrow Wilson Center Friday. ...

    Paskal sees China and Russia taking these issues more seriously that the United States and Europe, and her book is not just a wakeup call for Western leaders but is also an arresting and original work on climate change, probably the most important book on the environment to be published this year.

    "As pressure is put on food, water supplies and national boundaries, famine and war may become more frequent," Paskal concludes. "This instability may make populations more tolerant of autocratic governments, especially nationalistic capitalist ones where the political, economic and military sectors combine to protect existing resources and aggressively try to secure new ones. China and Russia already have a head start on this model."
    Read the full column on UPI.

    Alec Crawford on Climate Change and Conflict in Africa and the Middle East

    Thursday, January 14, 2010

    "Climate change certainly does pose a risk to the world in terms of violent conflict, but there’s a lot of nuance to that argument and a lot of attention and care has to be put into making that case,” says Alec Crawford, project officer at the International Institute for Sustainable Development (IISD) in this video interview with ECSP Director Geoff Dabelko.

    According to Crawford, the argument that climate change will lead directly to violent conflict is overly simplistic, but climate could be one of conflict’s many drivers in both Africa and the Middle East. A recent IISD report discusses the potential security challenges of climate change and how to prevent them.

    Eye On:
    An Island of Peace in a Sea of Conflict: The Jordan River Peace Park

    Wednesday, January 13, 2010

    Saleem Ali filmed this video on his visit to the “peace island” between Jordan and Israel, which Friends of the Earth Middle East (FOEME) is working to convert into an international peace park.

    FOEME co-Director Gidon Bromberg will be at the Wilson Center today to discuss the peace park and other FOEME water cooperation initiatives in more detail as a panelist participating in “Pathways to Peace: Stories of Environment, Health, and Conflict,” an event discussing field-based lessons for addressing environment, health, development, and conflict.

    Video: Filmed by Saleem H. Ali (University of Vermont, editor of the MIT Press book Peace Parks: Conservation and Conflict Resolution) with commentary by Elizabeth Ya'ari (FOEME), January 2010.

    Guest Contributor John Sewell, Wilson Center Scholar:
    Reforming Development: New Year’s Resolutions for Policymakers

    Monday, January 11, 2010

    The foreign policy headlines are dominated by terrorism, Iraq and Afghanistan, the Arab-Israeli dispute, and North Korea and Iran’s nuclear weapons.

    Under the radar, however, a quiet revolution is going on. Policymakers from the Pentagon to Capitol Hill are proposing ways to modernize development policy to meet the demands of foreign policy in the 21st century.

    Development Seeking Its Place Among the Three “D”s—Diplomacy, Development and Defense

    Three major efforts launched in 2009 are expected to be completed in 2010:
    • The State Department’s “Quadrennial Diplomacy and Development Review” of operations at State and USAID is due in Fall 2010; preliminary recommendations are scheduled for this month.
    • The White House’s review of global development policy will involve all government agencies with development programs. Headed by National Security Advisor Jim Jones and NEC head Larry Summers, the team will report out in the next few months.
    • Congress, which for a long time has paid little attention to these issues, also is making development reform a priority. Both the Senate and the House are writing new legislation to replace the current bill, which was last overhauled in 1961.
    Seven Ways to Fix the Broken System

    A new policy framework is long overdue. Everyone agrees that the Obama administration inherited a system that is broken and must be fixed. But how? I propose seven New Year’s resolutions for policymakers trying to revamp development.

    1. Address all the myriad issues that impact American interests and for which development aid could be an important policy tool.

    Promoting development is critical to a diverse range of cross-cutting issues:
    These issues, however, are now stovepiped in separate agencies. Without central coordination, opportunities will be lost and costs will increase.

    2. Lay out a government-wide “national development strategy” that sets clear goals and objectives for US development policy—and doesn’t just tinker with organizations and budgets.

    Development promotion, broadly defined, must be an important part of the solution. But any new strategy must go beyond just reforming the aid program.

    While needed, new policies and programs are costly. The sooner they are put into place, however, the lower the long-term costs of not addressing them will be.

    3. Include all the parts of the U.S. government that are now engaged in promoting development.

    Existing development capacities are spread throughout the executive branch, and, in some cases, the private sector. Currently 25 departments, 25 agencies, and almost 60 offices are involved in making or implementing development policy. There is no central oversight, planning, budgeting, implementation, or evaluation.

    There must be a central point within the government that monitors and coordinates all development programs. Past experience indicates that only the White House, with a strong presidential mandate, can effectively pull off this coordination. Many previous attempts at reform have foundered because the executive branch refused to take congressional initiative seriously.

    4. Reflect on lessons learned over the past 60 years.
    • While liberalized trade and economic openness can improve growth, each country must craft its own strategies.
    • Growth is important, but it alone will not eliminate poverty. Measures that directly address poverty are important for their own sake, and if done right, will enhance economic growth as well.
    • Similarly, good governance and democracy are important for growth, but are also important goals in their own right. Participatory decision-making is critical to program success.
    • Conflict, with its high human costs, is not caused by poverty and lack of development, but makes the solution to other problems much more difficult.
    • Investments in poor people, and particularly poor women, pay high dividends. Measures increasing access to education and health, redistributing productive assets (credit and land), and supporting small-scale rural and urban enterprises are particularly effective.
    5. Take account of the changes that have taken place in the aid “business.”

    The United States is now one of many players in the development game. In fact, in all but a few countries, it is not even the major aid provider. In Southeast Asia, China, Japan, or India are more likely to be the major donors; in Africa, it is the European Union or China.

    Furthermore, many nongovernmental funders have joined the field. The Gates Foundation has spent more than $12 billion on its Global Health Program. Ford and other U.S. foundations are seeking to rebuild African universities, and companies like Mars and FedEx are running technical assistance programs. In addition, American private voluntary agencies have raised over $10 billion in private funds—more than some European aid donors.

    Trade and private financial transactions dwarf official development assistance (ODA). For instance, remittances from migrants to their home countries are approaching US$300 billion a year, nearly 50 percent more than all ODA. Frankly, trade liberalization and financial stability will have greater impact on development than any increase in ODA.

    As a result of these seismic shifts, U.S. development policy needs to be smarter and more strategic, mobilizing new and different ways to engage governments, corporations, universities, foundations, and civil society (as is now being done for with HIV/AIDS).

    6. Make fundamental changes to existing aid structures, which have atrophied over the years.

    Currently, USAID is not equipped to deal with the challenges of the 21st century. It is considerably understaffed and lacks the necessary technical skills, particularly in agriculture and institution-building. The agency has no capacity to think strategically about the global development environment and lacks a voice at policy tables. Furthermore, new independent development agencies, such as the Millennium Challenge Corporation and PEPFAR, have proliferated

    A revamped U.S. aid program needs a strategy that would:
      1. Give responsibility for formulating and implementing development strategies to the user country, thereby transferring ownership and increasing effectiveness. Providers, of course, can then choose whether or not they want to support the country’s strategy.
      2. Agree on a more rigorous, transparent, performance-based approach to allocating ODA.
      3. Give equal priority to global problems, regional needs, and country priorities.
    7. Make a long-term commitment to change not only strategies and policies, but also organizational cultures.
    A long-term commitment is essential because these significant changes will not be implemented overnight. It will take the next three years of President Obama’s tenure (and perhaps longer) to change long-embedded policies and practices. Remember, the Defense Department was established in 1948, but did not fully integrate the three services until the Goldwater-Nichols Act of 1986—almost 40 years later.

    New Year’s resolutions are often broken as the tough work of fulfilling them becomes all too apparent. But breaking these resolutions will adversely affect U.S national interests in the coming decades. As Secretary of State Clinton argued recently, development “is a strategic, economic, and moral imperative – as central to advancing American interests and solving global problems as diplomacy and defense.”

    The administration and Congress now have an opportunity to set development policy on a new course. Let’s hope they take it.

    John Sewell is a senior scholar at the Woodrow Wilson International Center for Scholars.

    Welcome Back, Family Planning

    Friday, January 08, 2010

    “When women and girls have the tools to stay healthy and the opportunity to contribute to their families’ well-being, they flourish and so do the people around them,” Secretary of State Hillary Clinton declared today in a speech renewing U.S. support for universal access to reproductive health services and supplies around the world. “Investing in the health of women, adolescents, and girls is not only the right thing to do; it is also the smart thing to do.”

    Introduced by Melanne Verveer, the first ever ambassador-at-large for global women’s issues, Clinton’s much anticipated statement marked the 15th anniversary of the International Conference on Population and Development (ICPD) and reconfirmed a U.S. commitment to meeting Millennium Development Goals 4 (reducing child mortality) and 5 (reducing maternal mortality and increasing the proportion of births attended by skilled health personnel). Reproductive health and development luminaries Nafis Sadik, UN Foundation President and former Senator Tim Wirth, and newly installed USAID Administrator Rajiv Shah were also in attendance.

    Clinton began with a look back to the ICPD—which she called the “first ever global forum that recognized the connection between women’s health, the quality of women’s lives, and human progress on a broader scale”—and the progress since. Declaring that “we have made measurable progress since 1994 in improving the health and the lives of women and children, especially girls,” she cited a number of improvements, including higher child survival rates, use of modern contraceptives, and female education enrollment.

    Switching from the past to the present, Clinton described how women and girls continue to bear the brunt of a variety of social ills: they have higher rates of poverty, illiteracy, and malnutrition, and are the most adversely affected by conflict, “from the Congo to Bosnia to Burma.”

    After reciting the data on unsafe abortions, STDs and HIV/AIDS, fistulas, and female genital cutting, she declared that “these numbers are not only grim…they are intolerable." She added, "We can not accept it morally, politically, socially, economically.”

    But Clinton’s remarks were not solely focused on health and family planning issues. Echoing arguments made by Nicholas Kristof and others, Clinton described how women’s health and women’s rights directly and significantly impact most major problems in the world, including economics, natural resource conflicts, and national security.

    These challenges will require sustained effort and funding, said Clinton, adding that the Obama Administration’s $63 billion Global Health Initiative would address the health challenges of HIV/AIDS and maternal and reproductive health in an integrated manner. All of the administration’s programs would seek to help countries strengthen their own health systems to meet their unique needs—both of their women and girls, but also their populations in general. In all of these efforts, she said including men and boys as “advocates and allies” remains important.

    Praise for the speech has been swift—a letter of commendation from a number of foundations was sent to the secretary immediately afterwards.

    Maternal and reproductive health have experienced elevated and perhaps unprecedented funding and attention in recent years, especially over the last few months. Secretary Clinton’s impassioned speech is almost certain to keep this momentum alive.

    Photo: Courtesy SEIU International

    Eye On:
    2010: Worldwide Year of the Census

    Wednesday, January 06, 2010

    To kick-off the New Year, we’re highlighting CensusInfo 2010—an initiative to help countries distribute their census data in a format that is free, flexible, and customizable to meet diverse public needs. For us, it’s a new tool to access and visualize census data from around the globe.

    The CensusInfo software (the program must be downloaded and installed) allows users to create tables, graphs, and color-coded maps depicting indicators such as population density, fertility rate, and sex ratio. The data’s resolution—national, regional, district, or smaller—is up to the user, but limited by the information reported by each country’s census bureau. When older data is available, users can also view trends over time.

    The heart of CensusInfo is data presentation. Robust options include: capacity to import new datasets, compatibility with Google Earth and NASA’s World Wind technologies, and the ability to download visualizations as images, “animated flipbooks,” and videos.

    Aside from the relatively steep learning curve to master each of its functions, the software is principally limited by the small number of countries in its database: only 10 countries are included in the software’s pre-installed dataset. That number, however, could increase in the near future.

    In what CensusInfo 2010 hopes will be a trend, the Palestinian Central Bureau of Statistics, as of August 2009, became the first National Office of Statistics to independently incorporate its data into CensusInfo. While a powerful piece of software, CensusInfo’s potential rests on whether others follow suit.

    Photo Credit: CensusInfo's output of population density in India.

    Guest Contributors Cleo Paskal and Scott Savitt:
    How Copenhagen Has Changed Geopolitics:
    The Real Take-Home Message Is Not What You Think

    Monday, January 04, 2010

    A fascinating and potentially game-changing geopolitical pas-de-deux unfolded in Copenhagen. The international media and punditocracy christened the United States and China the new G2 in reference to the expected preeminent leadership roles the two hold among their respective developed and developing country contingents. What increasingly became clear, however, was that a different G2 was influencing the agenda: China and India.

    India demonstrated that, while it wants an alliance with the United States and its Western allies, a subservient allegiance is not an option.

    This was clear in the way India approached a key Copenhagen sticking point—verification. India had been down this road before with the U.S.-India nuclear deal, where Washington’s insistence on external verification was seen by some Indian strategists as undermining India’s sovereignty and security, and as a potential excuse to impose costly sanctions.

    Indian concerns about verification created an opportunity for China which, despite the vastly different mix of emissions in both countries, was able to entice India into an alliance. India brought along its IBSA partners, South Africa and Brazil, and it was this expanded group, meeting in conclave, that President Obama gatecrashed in his search for solutions.

    Two very important messages were delivered in Copenhagen. First, India told the West it could no longer be taken for granted—it had options. Second, China told India it would be open to a new relationship based on mutual interest.

    Going in to Copenhagen, visions for the conference were more varied than many realized. The West primarily thought it was negotiating a trade deal (as evidenced by the drop in EU carbon trading prices after the talks failed to deliver a climate market deal). China, too, was negotiating a trade deal, but remained open to opportunities to gain larger strategic advantages. India, on the other hand, sought a stage to drive home its major geopolitical positions.

    Coming out of Copenhagen, the conference’s narrative is clearer: This was geopolitics pure and simple.

    India—home to the world's most populous democracy, a thriving economy, and one of the world's largest English-speaking populations—is a natural U.S. ally. Its recent experience with the United States on nuclear cooperation, however, has made it wary. Such paranoia gave Beijing an opportunity to entice Delhi into an alliance at Copenhagen. Despite China's development of Pakistan as a nuclear client state, ongoing border disputes and skirmishes, and other conflicts between the two emerging powers, Beijing succeeded.

    If the United States and its Western allies are to coax India (and by extension, a substantial portion of the developing world) into going along with an ambitious emissions reduction program, or indeed any other trade regime, they will need to desist from seeking to impose measures that Delhi regards as protectionist and self-serving.

    For the West, moving the world's most populous democracy to its side, and not China’s, is worth certain concessions. Not just for the sake of a climate deal, but also for larger strategic purposes. At Copenhagen, the West incorrectly lumped India with China, and this mistaken assement proved to be self-fulfilling.

    Analysis of India has long suffered from “hyphenation.” First it was India-Pakistan, now India-China. At the beginning the India-China link was competitive, but Copenhagen has shown it has the potential to become cooperative. India should be assessed on its own terms. If geopolitics abhors a stand alone, however, then the time has come to rehyphenate democratic, economically strong, English-speaking India. It would be in the United States and its allies' benefit to create a new cooperative link: India-U.S.

    A longer version of this article was originally published by UPI-Asia.com.

    Cleo Paskal is a fellow at Chatham House in London and author of Global Warring: How Environmental, Economic, and Political Crises Will Redraw the World Map (Palgrave). Scott Savitt, a former Beijing-based correspondent for United Press International, is the author of the forthcoming memoir Crashing the Party (Atlas). ©Copyright Cleo Paskal and Scott Savitt.

    Photo: Prime Minister of India Manmohan Singh. Courtesy World Economic Forum.

    Making the Connections: An Integration Wish List for Research, Policy, and Practice

    Sunday, January 03, 2010

    New York Times columnist Nick Kristof is likely a well-known voice to New Security Beat readers. His ground-level development stories from around the world expose a range of neglected issues that usually struggle for mainstream media coverage: maternal health, microcredit, human trafficking, family planning, sanitation, micronutrients, and poverty, among others.

    Kristof brought many of these threads together Half the Sky, a book he coauthored with his wife Sheryl WuDunn. I asked about the challenges of addressing these connected problems when I interviewed the couple and two frontline White Ribbon Alliance maternal health practitioners this fall at the Wilson Center.


    Now Kristof is asking readers to suggest topics for him to cover in 2010. My suggestions to him are actually a wish list for the wider development community. In short, how can scholars, policymakers, practitioners, and communities better research and analyze these connected topics and then fashion integrated responses? I posted my comment on Kristof’s blog, On the Ground (and I ask your indulgence for the less than polished writing):
    I’d love for you [Kristof] to explore the challenge of integration from both problem and response perspectives. People in poverty lead integrated lives (just like we wealthier folks do), face connected challenges, and need integrated or multiple responses. Single-sector programs may deliver quicker, more obvious, and/or more countable impacts (or parallel advantages for single-discipline research endeavors). Yet time and time again we see such approaches only partially meeting needs or not meeting them sustainably. There is also a persist danger of undercutting others' efforts and/or creating high opportunity costs.

    So which integrated research, policy analysis, or field-based programs explicitly recognize that trends that appear to be on the periphery are hardly peripheral? At the same time, if programs try to be all things to all people, they can become bloated, unrealistic, and/or unsustainable.

    For example, are the Millennium Villages examples of the former or the latter? How about the much smaller programs under the population-health-environment grouping? What went wrong with Campfire programs to cause so many to abandon the approach? Have the loosened restrictions on what constitutes an appropriate PEPFAR intervention addressed this integration problem, or will politics (exclusion of family planning in PEPFAR, for example) mean we cannot capture the full benefits of integration?

    And the big Kahuna: how is the rhetoric and analytical argument around the 3Ds (defense, development, and diplomacy) made real and practicable in the field (as in the United States we anticipated early this year the results of the Quadrennial Defense Review (QDR), Quadrennial Diplomacy and Development Review (QDDR), and Presidential Study Directive on Global Development Policy (PSD))?

    And finally, does our (read donors') penchant for measuring impact and quantifying results force us to narrow interventions to the point of missing key connections in cause and effect of the problems we are trying to address? Is there a better mix of defining and measuring success that captures the challenges and benefits of integration?
    These questions topped my wish list to Kristof last night while procrastinating on other writing. What would be on your wish list for Kristof, the development community, or even just New Security Beat? We at the Environmental Change and Security Program (ECSP) would love to hear from NSB readers so we can keep covering the questions that interest you.

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