Yearly archive for 2010.
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Women Deliver 2010: First Impressions
›Delivering Solutions for Girls and Women
“We know how to intervene; there does not need to be a magical solution,” said Søren Pind, Denmark’s minister for development cooperation, at the June 7 opening ceremony of Women Deliver 2010.
In its second year, the conference has gathered delegates from 146 countries representing hundreds of non-governmental organizations (NGOs), governments, and civil society organizations under the theme “Delivering Solutions for Girls and Women.” Delegates are working to share projects, policies, successes, and innovations in the field of maternal health and to develop strategies to meet Millennium Development Goal 5.
“Recent trends show great progress and this is very encouraging,” said Gamal Serour, president of the International Federation of Gynecology and Obstetrics (FIGO), speaking of a recent study by the Institute of Health Metrics and Evaluation (IHME). The study found that annual maternal mortality has dropped 34 percent–from 526,000 to 342,900–between 1980 and 2008. Nevertheless, Serour maintained that “we are far away from our goal for 2015.”
Overcoming Tradition and Religious Barriers
Investing in women’s health is not only the right thing to do, it is also economically advantageous. When women are healthy, they provide tremendous benefits to their families, communities, and countries. Women contribute to a majority of the small businesses and agricultural activities of developing countries and their unpaid work at home accounts for almost 33 percent of the world’s GDP. Unfortunately, over 215 million of these women do not have access to family planning services, resulting in unwanted pregnancies, childbirth, and maternal deaths.
There are many barriers to family planning in developing countries, not the least of which are cultural and social traditions that can uphold negative gender-based norms. Tailoring campaigns to address these gender inequities was the subject of discussion at the “Cultural Agents of Change Delivering for Women” session, where panelists acknowledged that collaboration and partnership with a wide-range of actors–from members of the local legislature to civil society organizations and actors in the health sector–are necessary to facilitate change.
Graciela Enciso of the Centro de Investigaciones y Estudios Superiores en Antropología Social-Sureste in Mexico, added that advocacy campaigns to increase support for family planning should be “linked with research.” In many traditional societies, strict interpretations of religion are used to control and disempower women; donors and NGOs “need to think outside the religious box at every point,” said Mary E. Hunt, co-director at the Women’s Alliance for Theology, Ethics, and Ritual.
Male Contraception, Gender Roles, and Family Planning
“I think it is important not to hide behind our cultures and religion,” said Ngozi Okonjo-Iweala, managing director of the World Bank. “We need to work with men and work together to overcome gender inequality.” “Male participation” has been a key theme echoed throughout Women Deliver and is often highlighted as a strategy for reducing maternal mortality.
At the “Men Deliver: Men’s Role in Family Planning” breakout session, experts addressed how new and existing technologies in male contraception and shifting gender roles can help to scale up family planning interventions. “Reducing unwanted pregnancies can also be carried out through male contraception,” said John Townsend, vice president of the reproductive health program at the Population Council.
Condoms are traditionally the main method of contraception for men, but usage rates quickly fall over time and to wear a condom “becomes the women’s responsibility,” said Townsend. To address issues around condom usage, development of alternative family planning technologies, such as gels and implants, is underway. As these technologies are being developed, however, it is important for program managers and donors to consider existing gender norms and the willingness of men to utilize new methods.
In researching gender roles in family planning in Zambia, Holo Hochanda, the chief technical administrator of the Planned Parenthood Association of Zambia, determined that there are many entry points for male intervention and increased family planning. “Men are clients, policymakers, and service providers. Each of these roles provides an opportunity to discuss utilization of male contraception and gender inequities in family planning,” he said. “Men can be key mobilizers and agents for change.”
For more coverage on Women Deliver 2010 click here and to learn more about the Wilson Center’s Maternal Health Dialogue Series visit the Global Health Initiative’s website here. -
‘The Plundered Planet’: A Discussion With Paul Collier
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Who owns the planet’s natural wealth found underwater, below ground, and in the air? How do we reconcile our use of these assets with that of future generations? Such questions are the subject of Oxford Professor Paul Collier’s latest book, The Plundered Planet: Why We Must–and How We Can–Manage Nature for Global Prosperity, which he discussed at a recent Wilson Center event.
The author of The Bottom Billion and Breaking the Conflict Trap, Collier called Plundered Planet “the most important book I’ve written.” Resources are a “one-shot game,” he said; if we waste them, they’re gone. The next 10-20 years are “vital” to preserving natural assets as new technologies for removing them proliferate. We’re sucking fish up like “hoovers,” he said, and a combination of technology and economic growth are rapidly pushing mineral extraction into the few remaining frontiers.
Because time is short, Collier hopes his work will bring economists and environmentalists together. He said the two groups are largely at each other “cat and dog,” yet their objectives–environmental preservation and economic development–are not fundamentally opposed. In fact, to overcome polarization and produce key policy decisions, development and conservation must become partners.
Becoming Custodians, Not Curators
Collier said resource plunder can take one of two forms: “Where the few expropriate what belongs to the many”; and “where nature is expropriated by the present generation and burned up rather than benefiting future generations.” Both forms of plunder not only impede development, but are also unjust, he said.
Unlike other assets–such as books or records, which are typically owned by their authors or artists–natural assets have no human creators. A system whereby “natural assets are owned by the people who are lucky enough to live on top of them” creates “staggering inequality,” said Collier. Instead, resources must be shared equally among all citizens of a nation, including those not yet born.
Yet sharing nature’s wealth with generations to come does not mean leaving all fish in the sea, all trees on land, or all minerals underground. “We are not curators of natural artifacts,” Collier said. “We’re custodians of natural value.”
For the one billion people living in poverty, the development of natural resources can provide a path toward development, growth, and better lives, Collier argued, when properly and justly managed.
Filling the Gaps in Governance
Why have we largely plundered, rather than invested in, our resources thus far? What can be done to change the current principles of resource management? Collier’s short answer: governance.
For the poor countries in the “bottom billion,” Collier said the “broken decision chain” must be mended. The chain has six steps:- Discovering natural assets;
- Avoiding appropriation by a few at the expense of the many;
- Ensuring local inhabitants receive generous compensation for unavoidable environmental damage;
- Consuming in a way that benefits both the present and the future;
- Investing in the absorptive capacity of government; and
- Investing in domestic development.
Igniting a Movement
“There is no substitute…for building a critical mass of informed opinion,” Collier said. While technology enables plunder, it also creates a way for people to share knowledge at tremendous speeds and with wide audiences. The challenge, he said, “is to ignite the information transformation process.” A shift from plunder to sustainable management of transnational and developing country resources is a historic opportunity to benefit the world’s poor. “If these resources are harnessed for sustained development,” he said, “they can drag themselves decisively from poverty to prosperity.” The window of opportunity, however, is closing. -
Book Review: ‘Climate Conflict: How Global Warming Threatens Security and What to Do About It’ by Jeffrey Mazo
›June 8, 2010 // By Dan AsinThe heated back-and-forth over climate conflict in the blogosphere and popular press prompts the questions: In the debate over the security threat of a warming planet, who is spewing the hot air? Does climate change precipitate conflict, and if so, who is most at risk?
In Climate Conflict: How Global Warming Threatens Security and What to Do About It, Jeffrey Mazo unabashedly argues that weak–but not yet failed–states are at the greatest risk of climate-driven conflict. Packed into only 166 pages, the book takes readers on a crash course through climate science; 10,000 years of human-environmental history; case studies of the pre-modern South Pacific and modern-day Colombia, Indonesia, and Darfur; and analysis of geopolitical instability and stressors. This tour d’horizon all builds up to one point: Global warming and climate change threaten our security.
Key to Mazo’s work is the important but oft-overlooked insight that it is not the magnitude of climate change, but the difference between the rate of climate change and a society’s ability to adapt that threatens stability. He also confronts the all-too-common assertion that accepting climate change as a threat multiplier absolves individuals of culpability, and is explicit that intrastate–rather than interstate–conflict is the norm.
The Weakest Are Not the Greatest Threat
Mazo weaves threads of non-traditional and human security throughout the text, asserting that “there is no real contradiction between humanitarian and security goals” (pg. 132). However, his primary concern is the security of the nation-state and the international system. He argues that the next two to four decades are the most relevant time for strategic planning.
Within this context, Mazo claims global warming’s central security challenge will be the threat it poses to stability in states that are either unable or unwilling to adapt. Few will be surprised, therefore, when he says weak, fragile, and failing states appear the most vulnerable.
Mazo suggests that already fragile or failed states lying in climate-sensitive areas–namely a handful of states in sub-Saharan Africa, plus Haiti, Iraq, and Afghanistan–are the most likely to experience increased volatility as a result of warming-induced climate change. Yet he departs from received wisdom when he suggests that global warming’s greatest threat to international security is actually how it will impact more resilient states like Burkina Faso, Colombia, and Indonesia.
Precisely because they are less at risk, the onset of instability in these states would have a greater impact. Exacerbating conflict or instability in a fragile or failed state, such as the Democratic Republic of Congo, would not ripple through the international security framework in dramatically new ways. But the results of new conflict or instability in relatively stable states, such as Colombia, would. Mazo believes that the greater quantitative and qualitative impact of conflict in more resilient states renders them greater areas of concern.
Climate Factor Is One of Many
In no instance will climate change be the sole factor in conflict or state collapse. In already fragile or failed states, such as Sudan, instability is the product of a complex range of factors–political, social, and economic–many of which are non-environmental. “No single factor is necessary or sufficient,” writes Mazo (p. 126).
As it becomes increasingly pronounced, climate change may play a larger role in contributing toward volatility and instability. It is unlikely, however, to precipitate conflict where other risk factors do not already exist.
Adaptation Is Key
To address the threat to otherwise stable countries, Mazo advocates improving their latent capacity for adaptation. Good governance, rule of law, education, economic development: each is a key factor in a state’s ability to adapt. Variations across these factors may explain why death tolls from natural disasters in Bangladesh have fallen in recent years while those in Burma have risen.
Adaptation efforts should prioritize weak or recovering states that “have proved able to cope but are at particular risk,” Mazo writes (p. 133). Failing or failed states are either too susceptible to other conflict factors or too far advanced along the path of instability for adaptation to be of use to forestalling threats to international security. His argument is not to consign those in the most dire circumstances to a perpetual state of misery but, from a security perspective, to focus constrained resources on states where they will have the greatest impact. In states with the capacity to effectively absorb inflows, adaptation can preempt conflict, not simply reduce it.
Mazo does not ignore mitigation, and recognizes that it works in tandem with adaptation: Mitigation “is the only way of avoiding the most dire consequences of global warming, which would exceed the capacity of individuals, nations or the international system to adapt,” he notes (p. 124). Nevertheless, he argues that mitigation strategies “take much longer to bear fruit,” and that a certain amount of warming in the short- to medium-term is inevitable (p. 133). Against this warming, resilient adaptation is our best defense.
Case in Point: Indonesia
One otherwise stable state whose stability is threatened by climate change is Indonesia. Having suffered political and social unrest following the Asian financial crisis in 1997 and sectarian violence following Timor Leste’s independence in 1999, Indonesia avoided both failure and collapse to emerge as a flawed but vibrant democracy and Southeast Asia’s largest economy.
Indonesia is now home to the largest Muslim population in the world and is a key to regional security, yet its success “is potentially threatened by climate change,” writes Mazo; “food insecurity will be the greatest risk” (pg. 116).
Annual mean temperatures in Indonesia rose by 0.3°C between 1990 and 2005, and are predicted to rise an additional 0.36-0.47°C by 2020. The rainy seasons will shorten, increasing the risk of either flooding or drought. El Nino weather patterns–which in 1997 damaged over 400,000 hectares of rice and coffee, cocoa, and rubber cash crops–are expected to become more extreme and frequent in the future.
Climate change will further widen the substantial wealth gap between Indonesia’s rich and poor and, when it has differential impacts in different regions, “could lead to a revival of separatism” (pg. 117). While Mazo says threats from climate change will not be enough to push Indonesia into instability by themselves, he warns that if other destabilizing factors begin to emerge, “the added stress of climate change could accelerate the trend” (pg. 117).
Short and Sweet
Unlike some popular commentators on climate and security, Mazo does not confound brevity with hyperbole. While its concise format best lends itself to policymakers, students, and curious readers who are short on time, Climate Conflict’s content and its compendium of more than 320 citations make it deserving of a spot on everyone’s bookshelf. -
Rare Earth: A New Roadblock for Sustainable Energy?
›June 7, 2010 // By Wilson Center Staff
The 2010 National Security Strategy emphasizes that energy independence is part of a larger strategy for national security, stating, “As long as we are dependent on fossil fuels, we need to ensure the security and free flow of global energy resources.”
However, the alternatives to fossil fuels–such as wind energy, hybrid vehicles, and energy-efficient light bulbs–could also lead to dependence on international resources. They require minerals known as rare earth elements or minerals (REEs). REEs are required for producing the magnets necessary for a variety of goods, including precision-guided munitions, computer hard drives, lasers, communication and radar systems, satellites, and color televisions.
But China has a virtual lock on the production of REEs. In response, U.S. policymakers requested the GAO produce a detailed assessment of REEs in the U.S. defense supply chain as part of the 2010 National Defense Authorization Act. At the same time, the Pentagon is changing its policies regarding acquiring and stockpiling REEs.
Demand for Rare Earth Predicted to Rise
CEO Mark Smith of Molycorp Minerals, a U.S. rare earth mining operation, told HardAssetsInvestor.com:Today the largest use of these magnets is in hard disk drives… We believe that may be changing as hybrid cars become more popular and the use of wind turbines becomes more widespread. Clearly, on a volumetric basis, these two new clean energy technologies could easily overtake hard disk drives in terms of the volume of permanent rare earth magnets required.
Despite their name, REEs are not necessarily rare–known stocks and demand vary widely by element–but supplies of some key elements are short, reports Robin Bromby of The Australian.
China Corners the Rare Earth Market
The growing attention paid to REE supply stems more from the location of mining and production facilities rather than pure scarcity concerns. According to the GAO assessment, China produced 97 percent of rare earth oxides in 2009, and it has established economic protections on rare earth exports. The United States Magnet Material Association has estimated that China’s consumption of rare earth materials will outpace its supply between 2012-2015.
“What we need to be careful of is that we don’t unknowingly change our dependence on foreign oil to a new dependence on Chinese rare earths,” Molycorp’s Smith told HardAssetsInvestor.com. While new technologies may change the type of battery used in hybrids, “the one thing that cannot change in electric vehicles or hybrid vehicles is the use of permanent rare earth magnets in the motors and generators. There is simply no substitute for those magnets,” said Smith.
U.S. Seeks Secure Supplies
Given the lack of substitutes, the United States is attempting to secure access to REEs. Known deposits exist in the United States, Australia, Brazil, India, Canada, South Africa, and Greenland. However, in order for the United States to procure secure access to REEs, they must both acquire mines and processing facilities for the multi-stage production process, which today takes place almost entirely in China.
The GAO estimates it may take up to 15 years for the United States to produce a finished product. In that time, Chinese consumption is expected to have vastly increased and demand for certain REEs may be very high.
Washington is taking this threat seriously. As pointed out by CNAS’ Christine Parthemore, the 180-day turnaround time on the GAO’s rare earth assessment was considerably shorter than for other assessments, including a plan for operational use of biofuels.
The Pentagon is revamping its stockpiling practices, reducing bureaucratic barricades to changing quotas, broadening buying options, and growing the array of stockpiled resources, the Wall Street Journal reported, adding:The rising competition for raw materials has sparked fears in the U.S. military that some materials that once seemed abundant could suddenly become hard to get at any price. In 2008 the military suspended or limited sales of 13 commodities it had previously considered excess. Last year it added 14 materials to its list of resources it considers for stockpiling, including specialty steels, lithium and some rare-earth elements, taking the total to 68. More additions are expected, said Ms. Stead of the Defense National Stockpile Center.
While it seeks secure supplies of REEs, the United States, and the defense community in particular, should take heed of the long history of minerals and conflicts around the world. Global demand for certain minerals has supported combatants in conflict areas; for example, control of coltan mines in the Democratic Republic of Congo, while producing only 1 percent of global supply, played a significant role in that country’s civil war.
The switch to alternative transportation fuels could similarly produce new patterns of global resource demand that spur or support conflict–a phenomena that will be explored in an upcoming ECSP event, “Backdraft: The Conflict Potential of Climate Mitigation and Adaptation.”
On the other hand, done correctly, mineral extraction could be a way to break the “resource curse” and increase cooperation rather than conflict. In Pakistan, “development and maintenance of an extractive mineral industry could revolutionize the Waziristan economy and infrastructure in the long-term,” says Natural Security, which could provide “an incentive for local cooperation.”
Ultimately, the way that the United States seeks to slake its hunger for resources will determine whether it can stockpile its way to security.
Tara Innes is a PhD student at the University of Maryland, studying conflict-environment linkages and an intern with ECSP.
Photo Credit: Adaptation of Periodic Table, courtesy Flickr user Destinys Agent -
New Security Challenges in Obama’s Grand Strategy
›June 4, 2010 // By Schuyler NullPresident Obama’s National Security Strategy (NSS), released last week, reinforces a commitment to the whole of government approach to defense, and highlights the diffuse challenges facing the United States, including international terrorism, globalization, and economic upheaval.
Following the lead of the Quadrennial Defense Review released earlier this year, the NSS for the first time since the Clinton years prominently features non-traditional security concerns such as climate change, population growth, food security, and resource management:Climate change and pandemic disease threaten the security of regions and the health and safety of the American people. Failing states breed conflict and endanger regional and global security… The convergence of wealth and living standards among developed and emerging economies holds out the promise of more balanced global growth, but dramatic inequality persists within and among nations. Profound cultural and demographic tensions, rising demand for resources, and rapid urbanization could reshape single countries and entire regions.
By acknowledging the myriad causes of instability along with more “hard” security issues such as insurgency and nuclear weapons, Obama’s national security strategy takes into account the “soft” problems facing critical yet troubled states – such as Pakistan, India, Afghanistan, and Somalia – which include demographic imbalances, food insecurity, and environmental degradation.
Not surprisingly, Afghanistan in particular is highlighted as an area where soft power could strengthen American security interests. According to the strategy, agricultural development and a commitment to women’s rights “can make an immediate and enduring impact in the lives of the Afghan people” and will help lead to a “strong, stable, and prosperous Afghanistan.”
The unique demographic landscape of the Middle East, which outside of Africa has the fastest growing populations in the world, is also given intentional consideration. “We have a strategic interest in ensuring that the social and economic needs and political rights of people in this region, who represent one of the world’s youngest populations, are met,” the strategy states.
Some critics of that strategy warn that the term “national security” may grow to encompass so much it becomes meaningless. But others argue the administration’s thinking is simply a more nuanced approach that acknowledges the complexity of today’s security challenges.
In a speech on the strategy, Secretary of State Clinton said that one of the administration’s goals was “to begin to make the case that defense, diplomacy, and development were not separate entities either in substance or process, but that indeed they had to be viewed as part of an integrated whole and that the whole of government then had to be enlisted in their pursuit.”
Compare this approach to President Bush’s 2006 National Security Strategy, which began with the simple statement, “America is at war” and focused very directly on terrorism, democracy building, and unilateralism.
Other comparisons are also instructive. The Bush NSS mentions “food” only once (in connection with the administration’s “Initiative to End Hunger in Africa”) and does not mention population, demography, agriculture, or climate change at all. In contrast, the 2010 NSS mentions food nine times, population and demography eight times, agriculture three times, and climate change 23 times – even more than “intelligence,” which is mentioned only 18 times.
For demographers, development specialists, and environmental conflict specialists, the inclusion of “new security” challenges in the National Security Strategy, which had been largely ignored during the Bush era, is a boon – an encouraging sign that soft power may return to prominence in American foreign policy.
The forthcoming first-ever Quadrennial Diplomacy and Development Review by the State Department will help flesh out the strategic framework laid out by the NSS. It is expected to provide more concrete policy for integrating defense, diplomacy, and development. Current on-the-ground examples like USDA embedding in Afghanistan, stepped-up development aid to Pakistan, and the roll-out of the administration’s food security initiative, “Feed the Future,” are encouraging signs that the NSS may already be more than just rhetoric.
Update: The Bush 91′ and 92’ NSS also included environmental considerations, in part due to the influence of then Director of Central Intelligence, Robert Gates.
Sources: Center for Global Development, CNAS, Los Angeles Times, State Department, USAID, White House, World Politics Review.
Photo Credit: “Human, Food, and Demographic Security” collage by Schuyler Null from “Children stop tending to the crop to watch the patrol” courtesy of flickr user isafmedia, “Combing Wheat” courtesy of flickr user AfghanistanMatters, and “Old Town Sanaa – Yemen 49” courtesy of flickr user Richard Messenger. -
VIDEO: Paul Collier On Romantics and Ostriches
›June 4, 2010 // By Dan Asin“I’m trying to build common ground between environmentalists and economists. Those two groups are being cat and dog for a long time,” author and Oxford professor Paul Collier, speaking about his new book The Plundered Planet, tells ECSP.
Collier says the interests of the two groups have thus far been dominated by their “fundamentalist” wings: On one side the environmental “romantics,” who value nature over people, and on the other the economic “ostriches,” who deny that nature’s a priori existence endows it with unique characteristics.
Work toward resolving two of the world’s most pressing challenges, environmental degradation and poverty, demands collaboration and mutual recognition by both sides. “If you take that romantic view of nature,” says Collier, “we will never feed a world of 9 billion people–we will never lift the poorest people out of poverty.” At the same time, nature does not belong exclusively to those living today, and its value must be preserved for future generations. “Those rights of the future have to be respected,” he says.
“The romantics and the ostriches, between them at the moment, are winning,” says Collier. “[I]t’s very important they start to lose.” -
Shrinking Desired Family Size and Declining Child Mortality
›Desired Number of Children: 2000-2008, a report prepared by Charles Westoff of Princeton University for USAID, reviews family size preferences in 60 countries. Taking its data from a series of Demographic and Health Surveys (DHS), the report found that “the number of children desired is declining in most of the developing world.” The noted exception is western and middle sub-Saharan Africa where, in some countries, 6.0 children remains the desired number. The report found that desire for smaller family sizes, rather than a reduction of unwanted births, was the primary factor behind the declining Total Fertility Rates (TFR) exhibited in most of the countries studied. It noted that men’s preference is close to, but larger than, that of women, and that preference sizes were declining even among women without formal education. The report concluded that preferred family size broadly depended upon “child mortality, Muslim affiliation, women’s education and empowerment, and exposure to the mass media.”In an article appearing in the latest The Lancet, researchers from University of Washington and University of Brisbane found that global child mortality has declined 35 percent since 1990, outpacing initial forecasts. Neonatal, Postneonatal, Childhood, and Under-5 Mortality for 187 Countries, 1970—2010: A Systematic Analysis of Progress Towards Millennium Development Goal 4 found that 31 developing countries are on track to achieve Millennium Development Goal 4 and that in certain regions, including sub-Saharan Africa, declines in mortality are actually accelerating. The report concludes that the positive trends in child mortality “deserve attention and might need enhanced policy attention and resources.” -
Improving Transportation and Referral for Maternal Health
›“Referral has been called an orphan cause,” said Patricia Bailey, public health specialist for Family Health International and Columbia University, because it is “everybody’s responsibility and therefore nobody’s responsibility.”
As part of the Maternal Health Dialogue Series the Woodrow Wilson International Center for Scholars’ Global Health Initiative convened a small technical meeting on May 19, 2010, with 25 experts from five countries to discuss their experiences and share lessons, challenges, and recommendations for improving transportation and referral for maternal health. Following the technical meeting, a public dialogue was held on May 20, 2010, to share the knowledge gaps and recommendations identified. The formal report from the technical meeting will be available in the near future.
Mobilizing District Communities in Rural GhanaTo improve maternal health care in Ghana, “we needed to shift [services] to the community level, where 70 percent of our population lives,” said Dr. John Koku Awoonor-Williams, the east regional director of Ghana Health Service. The “Community-based Health Planning and Services” (CHPS) program was created to galvanize local leadership and empower communities to engage in health outreach activities.
Through this approach, “community health officers and nurses are trained and delegated to distant village locations called CH[I]P zones, in which they are responsible for health education, treatment of minor illnesses, maternal and antenatal care, and referral to district hospitals for emergency care,” said Awoonor-Williams. Community health officers use two-way Motorola walkie-talkies to communicate with traditional birth attendants and referral centers. Pregnant women are given the phone numbers so they can call in the event of complications.
1-0-8 Emergency Number for Improving Maternal Health in IndiaMany parts of the developing world do not have a 911-style emergency response service. To address this gap, the GVK Emergency Management & Research Institute in India developed the toll-free 1-0-8 telephone number for all medical, police, and fire emergencies.
“We assure every citizen that wherever you are, [if] you call us we will be there,” said Subodh Satyawadi, chief operating officer of GVK. In order to reach the 433 million people covered by GVK, they have:
“Although we address all kinds of emergencies, we heavily focus on maternal health…31 percent of emergencies are pregnancy-related,” said Satyawadi, who said that GVK’s emergency response system has helped save more than 200,000 mothers. Institutional deliveries have increased in the state of Gujarat by 92 percent. “We have been able to reduce maternal mortality by 20-25 percent in different geographies,” he said.- 19,623 EMTs and 10,000 doctors and other healthcare professionals
- 2,710 ambulances
- 16,300 call-center employees
Pre-Hospital Barriers: Reducing Maternal Morbidity in BoliviaWomen in Bolivia receive free maternal care. In cities like La Paz, emergency obstetric care is often available within a short distance. However, “37 percent of our maternal deaths [occur] at our hospitals,” said Víctor Conde Altamirano, OB/GYN of CARE Bolivia.
To better understand this mortality rate, Altamirano evaluated whether pre-hospital barriers and routine antenatal care are associated with near-miss morbidity. He found that women who are older, have lower levels of education, lack antenatal care, are pregnant for the first time, or live in rural areas are at a greatest risk of illness or death
“We are trying to organize our communities and service facilities, and promote improved health management by the municipalities. If our authorities can be sensitive and invest in health; invest in fuel, drugs, and human resources; we can improve near-miss morbidity rates,” said Altamirano.
Strategies and Recommendations for Improving Transportation & ReferralThe workshop participants agreed on six key topic areas for improving transportation and referral:1. Multi-sectoral collaboration
The group called for improved multi-sectoral engagement and continuous dialogue among key ministries: Health, Finance, Communication, Social Welfare, Security and Defense, Transportation, and Public Works.
2. Mobile phone technology
3. Public-private partnerships
4. Referral for newborns
5. Indicators for referral
6. Sharing evidence
Private-public partnerships, such as those demonstrated by GVK in India and the CH[I]P program in Ghana, create opportunities for collaboration. “Cell-phone technology can reduce delays in transport and treatment by identifying which facilities might be the most appropriate for referral,” said Bailey.
The final recommendation by the group calls for increased pooling and use of existing evidence to move the transportation and referral agenda forward. Updated synthesis papers on existing evidence are needed, said Bailey. “We have a lot of data that is perhaps less than perfect, but this should not be a barrier for further action,” she said.
