Showing posts from category *Blog Columns.
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Health and Harmony: Population, Health, and Environment in Indonesia
›Borneo’s Gunung Palung National Park is a microcosm of both the island’s ecological wealth and vulnerability. More than half of the park is undisturbed forest; the remainder, however, “is being torn down day after day” at an alarming rate, said Health in Harmony’s Nichol Simpson at an event on integrated approaches to population, health, and environment (PHE) programs in Indonesia. Alene Gelbard of the Public Health Institute’s Company-Community Partnerships for Health Indonesia (CCPHI) program joined Simpson on September 29 at the Wilson Center. Both speakers emphasized that no matter what issue a group works on, engaging local communities is essential for success.
The Destructive Cycle: Poor Health, Poor Environment
For Simpson, “the intersection between human and environmental health” is at the heart of Health in Harmony’s work. Health in Harmony opened Clinic ASRI in 2007, aiming to provide improved healthcare to villagers throughout Gunung Palung National Park while ending their dependence on illegal logging as a means of financial survival.
The area’s inhabitants were all too easily trapped in what Simpson called “the destructive cycle.” When faced by an unexpected medical emergency, families would go into debt to pay their medical bills. Health in Harmony found that of 232 local households surveyed, 13 percent had recently experienced a major medical emergency, at an average cost of $360. Most households in the area only hold around $260 in emergency savings, so to make up the difference, about a third turned to illegal logging to pay down their debt.
By deforesting the park, illegal logging worsens the health of nearby communities. For example, Simpson said that Clinic ASRI has seen a rise in cases of malaria and tuberculosis in the surrounding communities, in part because deforestation has increased the level of mosquito activity. The link between human and environmental health is clear, said Simpson: the people ASRI serves are “living it every day. They know the cause of this. And…they want it to stop.”
Protecting Natural Resources By Improving Health
The Health in Harmony clinic located in Sukadana, a small village sandwiched between Borneo’s coast and Gunung Palung Park, helps break the destructive cycle by treating patients regardless of their ability to pay. If patients do not have cash, they can barter for their care. In one case, a girl named Yani came to ASRI after her family incurred $500 over two months of visiting hospitals and traditional healers, none of whom could treat her condition. ASRI diagnosed and treated Yani for scabies. In exchange, her mother signed a pledge to protect Gunung Palung from logging and made the clinic a floor mat to cover the $1.50 bill.
By providing affordable, high-quality healthcare that is contingent upon pledging to protect the environment, Clinic ASRI improves human and environmental health in one fell swoop, said Simpson. “Because the infant mortality rate has decreased and you’re not overcompensating,” said Simpson, families can choose to have fewer children, using free birth control provided by ASRI.
“When you have fewer and healthier children, you’re investing in your education,” said Simpson. “When you’re investing in your education, you’re investing in your country and your community. This is the virtuous cycle. I didn’t invent it, but we are proving it in Sukadana.”
The communities around the clinic have embraced ASRI’s work, partnering with them to expand their services to address additional community needs, like training farmers in more productive organic methods and providing mated pairs of goats for widows, who pay ASRI back with kid goats and manure for fertilizer.
All but one of the 23 villages that ASRI services have been consistently free of illegal logging, according to monitors who visit them on a regular basis. “We’re proving the theory that we can protect natural resources by improving health,” Simpson said.
“Health Is Key to Sustainable Development”
Gelbard took a step back to talk about CCPHI’s experience establishing multi-sector partnerships among NGOs and corporations by building trust and enabling dialogue between the communities.
With corporate responsibility becoming more popular, “everyone’s talking about partnerships these days, and everybody’s partnering with everyone,” said Gelbard. “I don’t care what they call it – I care what they’re doing” and what results they achieve, she said. A successful partnership involves “all partners doing something more than just giving money.”
Gelbard said the 2004 tsunami reinforced the notion of corporate responsibility for a lot of companies operating in Indonesia. They saw that unless they branched out beyond their own walls and “did things to help strengthen communities,” efforts at corporate responsibility simply “would not benefit them in the long-run,” she said.
Through CCPHI, companies and NGOs have partnered on a wide range of efforts, including improving access to and funding for reproductive health services, improving sanitation by increasing access to water, and combating human trafficking by empowering girls and women.
Achieving the Millennium Development Goals will require increasing access to health care in a manner that reflects the needs of communities, she said. At its core, CCPHI’s work and the partnerships it facilitates are “based on the knowledge that health is key to sustainable development,” said Gelbard.
Event Resources
Sources: Alam Sehat Lestari, American Journal of Tropical Medicine and Hygiene, Company-Community Partnerships for Health Indonesia, ExxonMobil, The Guardian, Health in Harmony, National Geographic, PBS News Hour, Public Health Institute, Republic of Indonesia Ministry of Forestry, United Nations, World Wildlife Fund
Photo Credit: Used with permission courtesy of ASRI and Nikki See, Under-told Stories. -
Panetta: Diplomacy and Development Part of Wider Strategy to Achieve Security; Will They Survive Budget Environment?
›Leon Panetta – newly minted secretary of defense and former director of the CIA – gave one of his first public policy addresses yesterday at the Woodrow Wilson Center addressing national security priorities amidst a constrained budgeting environment (see video here). Under the debt ceiling agreement recently agreed to by Congress, the Pentagon is expected to achieve around $450 billion in spending cuts over the next 10 years.
Most of Secretary Panetta’s speech focused on “preserving essential capabilities,” including the ability to project power and respond to future crises, a strong military industrial base, and most importantly, a core of highly trained and experienced personnel.
But he also touched on the other two “D” s besides defense – diplomacy and development: “The reality is that it isn’t just the defense cuts; it’s the cuts on the State Department budget that will impact as well on our ability to try to be able to promote our interests in the world,” Panetta said in response to a question from ECSP Director Geoff Dabelko:National security is a word I know that we oftentimes use just when it comes to the military, and there’s no question that we carry a large part of the burden. But national security is something that is dependent on a number of factors. It’s dependent on strong diplomacy. It’s dependent on our ability to reach out and try to help other countries. It’s dependent on our ability to try to do what we can to inspire development.
Panetta’s backing of diplomacy and foreign aid as an extension of U.S. national security strategy is a continuation of vocal support by former Chairman of the Joint Chiefs of Staff Mike Mullen, former Secretary of Defense Bob Gates, and others at the Pentagon, but the bigger issue remains convincing Congress, where the State Department has become a popular target for budget cutters.
If we’re dealing with Al Qaeda and dealing with the message that Al Qaeda sends, one of the effective ways to undermine that message is to be able to reach out to the Muslim world and try to be able to advance their ability to find opportunity and to be able to seek…a better quality of life. That only happens if we bring all of these tools to bear in the effort to try to promote national security.
We’ve learned the lessons of the old Soviet Union and others that if they fail to invest in their people, if they fail to promote the quality of life in their country, they – no matter how much they spend on the military, no matter how much they spend on defense, their national security will be undermined. We have to remember that lesson: that for us to maintain a strong national security in this country, we’ve got to be aware that we have to invest not only in strong defense, but we have to invest in the quality of life in this country.
Perhaps the more useful question going forward is one of priorities. Clearly there will be (and already is) less money to go around, and the Defense Department is one of the largest outlays, while State is much smaller – the military’s FY 2012 budget request was $670.9 billion; the State Department’s, $50.9 billion. So the question is: when push comes to shove, will Secretary Panetta be able to sustain his support for diplomacy and development budgets if it means larger cuts at DOD?
Sources: Government Executive, Politico, U.S. Department of Defense, U.S. Department of State.
Photo Credit: David Hawxhurst/Wilson Center. -
Lisa Hymas on Envisioning a Different Future With Family Planning in Ethiopia
›ECSP caught up with Lisa Hymas, senior editor at Grist, last week during the first South by Southwest (SXSW) Eco conference and she spoke about her recent visit to Ethiopia to see the country’s community health extension program in action. “Ethiopia has a big challenge around population,” Hymas said, “but the government is committed to bringing that down.”
The government extension program places health-workers – young women, for the most part, who have received basic training – directly into each community, where they are able to give out immunizations, provide advice on nutrition, teach families how to properly hang bed nets to prevent mosquito-borne illnesses, and provide family planning services and advice.
Thanks to the program, these health workers and those in the communities they service can “envision very different lives for themselves than their mothers had,” Hymas explained. For instance, one woman recounted that her mother gave birth to 10 children, “and almost died giving birth to the last one, because there was no access to birth control, and there was no good access to health care.” In contrast, she is now able to have a career and to use family planning to delay and space her own childbearing.
For more on Ethiopia’s health extension program, see Schuyler Null’s report on visiting a village health clinic near the town of Fiche last spring. -
Silent Suffering: Maternal Morbidities in Developing Countries
›Maternal morbidities – illnesses and injuries that do not kill but nevertheless seriously affect a woman’s health – are a critical, yet frequently neglected, dimension of safe motherhood. For every woman who dies, many more are affected acutely or chronically by morbidities, said Karen Hardee, president of Hardee Associates at the Global Health Initiative’s September 27 panel discussion, “Silent Suffering: Maternal Morbidities in Developing Countries.” Hardee was joined by Karen Beattie, project director for fistula care at EngenderHealth, and Marge Koblinsky, senior technical advisor at John Snow, Inc., for a discussion moderated by Ann Blanc, director of EngenderHealth’s Maternal Health Task Force.
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Strengthening the Voices of Women Champions for Family Planning and Reproductive Health
›“The health, security, and well-being of families depend importantly on the health of women,” said Carol Peasley, president and CEO of the Centre for Development and Population Activities (CEDPA). “When women have the ability to voluntarily space and limit the number of children they have, maternal and newborn child deaths decrease, as do abortions and abortion-related injuries,” she continued.
Peasley was joined by three panelists on September 28 at the Wilson Center: Dr. Nafis Sadik, special advisor to the UN Secretary General; Tigist Kassa Milko, health communications program coordinator for Panos Ethiopia; and Rosemary Ardayfio, a reporter for the Ghanaian paper, The Daily Graphic.
Ardayfio and Milko both recently participated in a CEDPA-led workshop, which is designed to create effective women champions for family planning and reproductive health.
“The voices of women champions may in fact be the best way to influence policymakers and just average citizens around the world,” said Peasley.
Women’s Rights Essential for Development of All
According to Sadik, women have gained some autonomy over their reproductive health:- Maternal mortality around the world is down by 40 percent compared to 1990 levels;
- Family planning reaches over 65 percent of women who need and want it;
- Many developing countries will achieve parity in girls’ and boys’ education by 2015; and
- Women are increasingly prominent in national and international leadership.
- Women’s literacy rates are still much lower than men’s;
- Pregnancy and childbirth still pose major health risks for women;
- Maternal mortality is the single biggest differential between developed and developing countries;
- We are far from reaching the Millennium Development Goal of reducing maternal mortality by 75 percent; and
- The current unmet demand for family planning (215 million women) is projected to rise by 40 percent by 2050 as the reproductive age population grows.
Local Champions for Local Needs
Although Tigist Kassa Milko and Rosemary Ardayfio come from two African countries hundreds of miles apart, their struggles are eerily similar.
In Ethiopia, the more than 1.5 million women who live in pastoral or nomadic areas shoulder many responsibilities, including walking long distances to fetch food and water for their families. The well-being of these women and their families is further strained by the challenges of climate change and limited health service provision.
To help overcome these obstacles, a number of micro-credit associations now offer female pastoralists alternative livelihood options. Panos Ethiopia also provides “reproductive health, family planning, gender-based violence forums” and “trainings on life skills and saving” to those who come for loans, said Milko.
But “when it’s a choice between walking to get water and walking to get contraceptives, water will win,” said Milko, so it is essential to focus on integrating ways to improve livelihoods, health, and ecosystems – also known as population, health, and environment (PHE) programs.
In Ghana, women also grapple with competing issues of development, poverty, healthcare, and cultural barriers. According to Ardayfio, 35 out of every 100 Ghanaian women want to space or limit births but are not using modern family planning methods. As a journalist, she acknowledged that there are many myths about reproductive health that need to be dispelled. The newspaper she writes for, The Daily Graphic, publishes three articles on women’s health each week.
“The stories of women dying from pregnancy-related causes should continue to be told in a compelling manner until our government makes good on the many international commitments it has signed to,” said Ardayfio. “Our decision-makers should be told again and again that it’s time to scale up family planning.”
Event Resources:
Sources: CEDPA, Guttmacher Institute, Population Reference Bureau, UNESCO, UNICEF, USAID.
Photo Credit: Dave Hawxhurst/Wilson Center. -
Women and Water: Streams of Development
›“One of the things that we consistently learn is that water is a woman’s issue,” said Lisa Schechtman, WaterAid America’s head of policy and advocacy, leading off a September 23 Wilson Center on the Hill panel on gender, water, and development. Schechtman was joined in the discussion by Jae So, director of the World Bank’s Water and Sanitation Program; Christian Holmes, USAID’s Global Water Coordinator; and Geoff Dabelko, moderator and director the Wilson Center’s Environmental Change and Security Program.
Water issues affect everyone, but women often bear the brunt of water collection responsibilities, making them vulnerable to changes in access or sanitation, especially in developing countries. “Studies show that about 26 percent of a rural African woman’s time is spent collecting water,” Schechtman said. “That means that they can’t go to school, they can’t take care of their families, or go to clinics, or spend time generating income, or doing other things in their community like participating in political processes.”
What’s more, as women make the hours-long hike to get water, “they’re risking injury and sexual assault,” Schechtman added. “So there’s a really wide-ranging set of impacts, just out of the actual act of collecting water.”
The Horn of Africa: Severe Problems, Small Changes
In one town in northeastern Kenya, Holmes said women have to travel 12 miles to find water – and even then, they are drawing it from a waterhole shared with wildlife. In Ethiopia, “we have severe problems,” he said, “not the least of which is not just sanitation but also HIV and AIDS,” as HIV/AIDS patients often drink unsanitary water to take their medications. That water gives them diarrheal disease, “so they’re excreting the value of the treatment” – and women, as household caregivers, bear an ever greater burden.
In Somalia, girls drop out of school once they start menstruating because schools do not have latrines that allow them to meet their needs safely and privately. “To think that the lack of a latrine could make you drop out of school and your entire life is going to change overnight – it’s just not acceptable,” said Holmes.
In each of these cases, small changes could dramatically reduce strains on women. Holmes pointed to a USAID project in Kenya that is building wells closer to population centers and empowering women by bringing them into the decisions on developing and managing wells. In Ethiopia, NGOs are working to train women on sanitation and hygiene, which could reduce the burden of illness on women and their families. And in Somalia, the simple addition of women’s latrines at schools would mean girls can continue their education beyond puberty.
Closing the Water Gender Gap
The World Bank’s 2012 World Development Report on Gender Equality and Development recommends that development professionals “look at the gender gaps in basic endowments, like access to health, access to water resources, access to land,” and determine not just how they affect men and women differently but why those gaps exist in the first place, said Jae So.
A CARE and Swiss Development Corporation study of water services in Nicaragua found that when men realized how much of a role water-related activities played in women’s day-to-day lives, “it energized the entire community to really devote their collective resources” towards improving water management, said So.
“Water touches everything else in one’s life,” said Holmes. “You can link it to water and climate change, water and health, water and food, water and conflict, water and education – all are interwoven.”
Event ResourcesSources: The United Nations, UNICEF, USAID, WaterAid America, The World Bank.
Photo Credit: “Repatriated Mamas at the fountain,” courtesy of flickr user Julien Harneis -
Watch: Dennis Taenzler on Four Key Steps for REDD+ to Avoid Becoming a Source of Conflict
›The UN Program on Reducing Emissions from Deforestation and Forest Degradation (REDD) provides financial incentives to developing countries to conserve their forests and invest in low-carbon pathways to sustainable development. However, it may also be a potential new source of conflict, says Dennis Taenzler, a senior project manager at adelphi in Berlin, who works on climate and energy policies as well as peace and conflict issues.
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Top 10 Posts for September 2011
›Two Pop Audio interviews – from Rich Thorstein and Karen Seto – joined the top 10 last month (measured by unique pageviews), as well as the launch of Brahma Chellaney’s new book, Water: Asia’s New Battleground, a look at “land grabs” in the context of water access, a crosspost from Edward Carr on food security maps, and Shannon Beebe’s event from last year on his book, The Ultimate Weapon Is No Weapon.
1. Tunisia’s Shot at Democracy: What Demographics and Recent History Tell Us
2. Rich Thorsten on Water Sanitation, Population, and Urbanization in the Developing World
3. In Search of a New Security Narrative: The National Conversation at the Wilson Center
4. India’s Maoists: South Asia’s “Other” Insurgency
5. Guest Contributor Jim Duncan: Redrawing the Map of the World’s International River Basins
6. In the Rush for Land, Is it All About the Water?
7. Karen Seto on the Environmental Impact of Expanding Cities [Part One]
8. Food Security and Conflict Done Badly…, via Edward Carr, Open the Echo Chamber
9. Water: Asia’s New Battleground
10. The Ultimate Weapon Is No Weapon: Human Security and the New Rules of War and Peace
