Showing posts from category *Blog Columns.
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Top 10 Posts for December 2010
›Pop Audios from Roger-Mark De Souza and John Bongaarts, water conflict on the Mekong river, a take on Restrepo from one of this summer’s West Pointers, and demographic security on the Hill topped the list last month:
1. Pop Audio: From Cancun: Roger-Mark De Souza on Women and Integrated Climate Adaptation Strategies
2. Managing the Mekong: Conflict or Compromise?
3. Pop Audio: John Bongaarts on the Impacts of Demographic Change in the Developing World
4. Restrepo: Inside Afghanistan’s Korengal Valley
5. Demographic Security Comes to the Hill
6. The Future of Sub-Saharan Africa’s Tentative Fertility Decline
7. On the Beat: Where Have all the Malthusians Gone?
8. Bringing Cambodia Back from the Brink: Audio Interview with Suwanna Gauntlett
9. COP-16 Cancun Coverage Wrap-up: An Integrated Climate Dialogue
10. India’s Maoists: South Asia’s “Other” Insurgency -
Minister Izabella Teixeira at the Wilson Center
A Review of Brazil’s Environmental Policies and Challenges Ahead
›Stressing the need for concrete, tangible institutional policies, Izabella Teixeira, Brazil’s Minister of the Environment, discussed the challenges and goals of her ministry at the Wilson Center on October 20. Sustainable development, not just conservation, must be the focus, and that requires bringing lots of different players to the table, taking into account not only environmental but also social and economic agendas. To do this, she argued, one must take the rather ephemeral and hypothetical notions of environmental stewardship and put them into the realm of a practicable, institutionalized framework, built on a social pact that engages all sectors of society.
The foundation of sustainable development and environmental policy must be biodiversity, according to Teixeira. Central concerns, such as food and energy security and combating climate change, all rely on a diverse array of natural resources. These need to be conserved, but they must also be developed in a responsible, sustainable way. A legal international framework toward this end, covering access to biodiversity and genetic resources, has yet to be implemented. Developing and developed countries need to find a middle ground on allocating the benefits that accrue from the use of genetic resources found in areas such as the Amazon, and this agreement must then be linked into existing political institutions.
Teixeira noted the strides Brazil has made toward protecting its environment – including having set aside the equivalent of 70 percent of all protected areas in the world in 2009 and the establishment of the Amazon Fund. Nevertheless, Brazil must continue to protect and maintain these nature preserves, not just establish them. Creating a program that pragmatically implements international goals in a national context is an ongoing process, and countries like Brazil now need to focus on the “how” of implementing these goals, rather than just the “what.”
Teixeira also highlighted the complexity of formulating environmental policy that integrates all the various points of view that must be taken into consideration. At recent meetings to discuss transitioning to a low-carbon economy, 17 different cabinet ministers had to be present to coordinate government positions and policies. The complexity is due in part to the need to create alternatives, not just to prevent certain activities. For example, one must not only use legal enforcement to stop illicit deforestation, but also create paths to legal, sustainable logging. Once again, attempting to balance environmental, social, and economic concerns is difficult, to say the least, but crucial for long-term effectiveness.
Also a unique challenge for Brazil is the natural diversity that exists within such a large country. While much of the attention paid to the environment goes (rightly so) to the Amazon, there are many other biomes and local environments that must be taken into consideration, Teixeira observed.
The cerrado, Brazil’s enormous savanna, requires a different strategy than the Amazon, which is different than the coastal Atlantic forest. Furthermore, urban areas need their own environmental policies that can take into account issues of human development and population density.
To illustrate the need for an inclusive, well-thought-out policy, Teixeira discussed–rather frankly–the controversy surrounding the recent proposed amendments to the Forest Code. She argued that the proposal makes blanket changes that do not take into consideration differences in biomes, differences between large agribusinesses and family farms, and between historic, settled communities and recent developments. The implications of this proposal, according to the minister, could have enormous social costs. Teixeira said she believes that it would be virtually impossible to enforce the amended Forest Code if it was approved by Congress. She used this example to underscore her role in offering legislative alternatives that seek to provide a more nuanced, and ultimately more effective, institutional framework that can use Brazil’s many natural resources to help its population to the greatest extent possible.
J.C. Hodges is an intern with the Brazil Institute at the Wilson Center; Paulo Sotero is the director of the Brazil Institute.
Photo Credit: “Rio Jurua, Brazil (NASA, International Space Station Science, 05/29/07),” courtesy of flickr user NASA’s Marshall Space Flight Center, and David Hawxhurst/Wilson Center. -
The Cholera Quandary
›The original version of this article first appeared in the Stimson Center Spotlight series, November 19, 2010.
Cholera is usually seen as one of the most devastating infections of the 19th century. Trade routes carried cholera from India to the great cities of Europe and the United States. Disease, fear, and political unrest spread in great waves that cost millions of lives. After much destruction, it was only with science and resources that certain populations were able to curb the epidemic.One of the most celebrated lessons in the history of public health involves a cholera outbreak in London in 1854 and efforts by John Snow – celebrated as the father of epidemiology – to control it. At the time, it was not clear that cholera was a waterborne bacterial infection that caused severe diarrhea and vomiting, and sometimes fatal dehydration. Snow proved that the outbreaks decimating communities spread from contaminated water. Water and sanitation services had virtually eliminated cholera epidemics in the developed world by the early 1900s.
Today, cholera has been nearly eradicated in the developed world, but continues to be endemic in poorer countries. Risks seem to be rising as larger populations are crowded into unsanitary conditions. The World Health Organization (WHO) estimates three to five million illnesses and 100,000-200,000 deaths from cholera each year. If caught early, infections are treatable with inexpensive oral rehydration solutions. For much of the world, these options are unavailable or underused – the mere presence of cholera serves as an indicator of a country’s socioeconomic status and health system capabilities.
The cholera epidemics that are currently menacing countries on three different continents – Asia, Africa, and North America – raise tough questions about what is required to protect the world’s vulnerable populations. We know how to predict the crisis of cholera, prevent outbreaks, and contain them when they occur. To control cholera, what is needed is not cutting-edge technologies, but will, transparency, and resources – and where cholera appears, at least one of these three factors has failed.
Currently, cholera outbreaks in Pakistan, Haiti, and Nigeria are piling misery upon misery. Cholera in post-flood Pakistan comes as no surprise. When floodwaters left millions homeless and without access to clean drinking water in a region where cholera remains endemic, health officials could have reasonably assumed infected human waste would seep into water supplies and spread disease. The inability of health networks on the ground to prevent and then detect cholera demonstrates cracks in the country’s health system. What is apparent here is a lack of will and resources. Disease surveillance is especially vital in a post-disaster scenario where steps can be taken, such as treating water with chlorine, to prevent an outbreak.
Haiti had been free of cholera for at least 50 years, but the disease struck and spread rapidly 10 months after the devastating January 2010 earthquake. It reached Haiti’s capital and spread to its neighbor, the Dominican Republic. Since October, more than 114,000 people have become ill and more than 2,500 have died (Editor’s note: updated since original publication).
Haiti lacked resources for basic infrastructure even prior to the earthquake; the cholera crisis is not only costing lives, but also diverting aid from “building back better.” But regardless of the source of the cholera strain, if basic infrastructure and resources to protect Haiti’s vulnerable populations had been in place, cholera’s re-emergence would have been far less devastating.
This particular outbreak draws attention to the practical and political challenges of identifying health risks in humanitarian workers and peacekeepers, many of whom come from developing countries themselves. Evidence suggests that peacekeepers from Nepal, housed at a UN base, may have been the source of the outbreak clustered around the Artibonite River. Cholera outbreaks frequently exacerbate frictions between communities and aid workers – suspicions that have led to riots and murder more than once in recent years. At least two people were killed in Haiti in riots with peacekeepers during November.The delayed decision by the UN to investigate whether the outbreak originated with peacekeepers may have conserved resources for the race to stave off more cases, but did little to build trust between communities and foreign workers. Further violence and protests surrounding the recent disputed presidential election in Haiti do little to ease the devastation and in fact, threaten the relief effort. There has been discussion in Congress of cutting direct aid and suspending visas for Haitian officials until the dispute as been resolved. The Organization of American States is now reviewing the results.
In Africa, Nigeria is experiencing its worst cholera outbreak since 1991, and the disease is crossing borders. An onslaught of cases raised the 2010 death toll to more than 1,500 fatalities out of 40,000 cases. This mortality rate is three times higher than the seasonal cholera outbreaks of 2009, and seven times higher than 2008. Despite Nigeria’s oil wealth, most of the population is impoverished. Two-thirds of rural Nigerians lack access to safe drinking water and fewer than 40 percent of people in cholera-affected areas have access to toilet facilities, according to the Nigerian Health Ministry. A combined lack of will, transparency, and resources mean that cholera epidemics occur annually, and in clusters throughout sub-Saharan Africa.
A century and a half after John Snow’s discovery, we know how to control cholera. Globally, the resources exist, but the question of a collective will remains. For those who lack clean water to drink, to wash, or even proper toilets, the gap between knowing and doing is not easily closed. The international community has shown repeatedly that it can confront cholera outbreaks like those in Haiti, Pakistan, and Nigeria in the midst of crisis. The question remains as to how those efforts can eliminate the conditions that fostered outbreaks in the first place. The answer is not as riveting as the causes that often receive funding: basic infrastructure and resources. Roads, wells, clean water, toilets, education, and the willingness to recognize that if the foundation is not sound, nothing will be able to stand. Sometimes the simplest problems are the most difficult to solve.
Sarah Kornblet is a research fellow at the Global Health Security Program at the Stimson Center. Her research focuses on the International Health Regulations, health systems strengthening, global health diplomacy, the intersection of public health and security, and the potential for innovative and dynamic health policy solutions in developing countries.
Sources: Agence France-Presse, BBC, Washington Post, World Health Organization.
Photo Credit: “UN Peacekeepers Provide Security During Port-au-Prince Food Distribution,” courtesy of flickr user United Nations Photo. -
Evidence, Links, and Solutions
Maternal Undernutrition
›“Maternal undernutrition is often overlooked as a strategy for reducing poverty and as a key intervention to reduce maternal mortality and morbidity,” said Mary Ellen Stanton, senior maternal health advisor at the U.S. Agency for International Development. Stanton was joined by Dr. Doyin Oluwole, director of the Africa’s Health in 2010 program, and Amy Webb Girard, assistant professor at the Emory University School of Public Health, in the final meeting of the Advancing Policy Dialogue on Maternal Health series on December 15 where they addressed the linkages between poverty, undernutrition, and poor maternal health outcomes.
The Cycle of Malnutrition and Poverty
Many factors contribute to a woman’s nutritional status, including lack of capital, access to land, and poverty; thus, said Oluwole, “we must adopt a multi-pronged and multi-sectoral response.”“General malnutrition is usually associated with iron-deficiency anemia, which leads to poor cognitive function and educational achievement, poor health, and fatigue.” Oluwole said. “These three factors lead to low worker productivity, and low worker productivity leads to income poverty.”
“All of these aggravate malnutrition and so the vicious cycle of malnutrition and poverty continues,” said Oluwole. To break this cycle, she pointed out that countries like Malawi and Mexico have implemented various multi-sectoral interventions that have “stimulated economic growth; implemented targeted social, health, and nutrition programs; and put in place safety nets.”
“In the window of opportunity during pregnancy and the first two years of life, we can make a big difference,” Oluwole said. She advocated for an “integrated anemia package” that provides anti-malarials, de-worming medicine, iron folic acid tablets, and extra food during pregnancy. She also noted the importance of family planning and targeted high-coverage interventions, such as salt iodization, vitamin A supplementation, and breastfeeding promotion.
In conclusion, Oluwole provided several recommendations for the development community to improve maternal mortality rates and undernutrition of women:
Maternal Undernutrition: Our Global Disgrace- Promote universal primary and secondary education, especially for girls
- Stimulate economic growth with a focus on gender and equity
- Invest in infrastructure to reduce transportation time to hospitals
- Postpone age of marriage and of first pregnancy
- Provide targeted and effective nutrition and health interventions
- Encourage private sector participation and government leadership
- Integrate the maternal health and nutrition communities and services
“We don’t tend to look at maternal nutrition and its impacts on the woman herself,” said Girard. The lack of data on the relationship between nutrition and maternal health outcomes “hampers our ability to move maternal nutrition onto the health and development agenda,” she added.“Anemia is widespread; worldwide, it is a significant public health burden, both in women of reproductive age as well as in pregnant women,” said Girard. Studies have shown that moderate anemia increases risk of hemorrhage and may also increase the risk of sepsis, while severe anemia has been shown to directly contribute to maternal mortality. Targeted interventions can help reduce these risks greatly. “For every one gram per deciliter increase in hemoglobin level, you can reduce maternal mortality by approximately 25 percent, but the mechanisms by which this occurs are not well elucidated,” noted Girard.
“We need to include women not as just targets of nutritional interventions, but as beneficiaries in their own health,” said Girard. Key nutritional interventions such as micronutrient supplementation, fortification, and behavior change communication can help to improve not only fetal, infant, and child health, but can also reduce maternal morbidity and mortality. In addition, Girard recommended the following strategies to achieve greater impact:
Together, these strategies can help improve access to nutrition and health services, as well as adequate food for women throughout their lives. “We need to integrate health and nutrition – they are actually the same pillar, complementing each other,” Girard concluded.- Improve nutrition throughout the life cycle, not just during pregnancy
- Look for alternate strategies for micronutrient delivery
- Integrate maternal nutrition into food security and agricultural strategies
- Collect indicators specific to women’s health impacts
- Recognize and address gender bias
Photo Credit: “Bangladesh mothers, kids,” courtesy of flickr user Bread for the World. -
Judith Bruce on Empowering Adolescent Girls in Post-Earthquake Haiti
›“The most striking thing about post-conflict and post-disaster environments is that what lurks there is also this extraordinary opportunity,” said Judith Bruce, a senior associate and policy analyst with the Population Council’s Poverty, Gender, and Youth program. Bruce has spent time this year working with the Haiti Adolescent Girls Network (HAGN), a coalition of humanitarian groups conducting workshops focused on the educational, health, and security needs of the country’s vulnerable female youth population.
Gender-based violence has long been an issue in Haiti, but the problem became even more pronounced in the wake of the January earthquake. HAGN has sought to address the problem by concentrating its community-based programming on “high priority” groups, including girls who are disabled, serve as de facto heads of households, or are aged 10-14.
Bruce asserted that protecting and empowering young girls is critical because upon reaching puberty, “their access to a safe world shrinks dramatically.” With the post-disaster environment adding another layer of challenge, she said “there could be no ambiguity in anyone’s mind that we have to create dedicated spaces for girls who, at least for a few hours a week, feel secure to be themselves and to plan for their long-term safety as well as their development.”
The “Pop Audio” series is also available as podcasts on iTunes. -
Rebuilding Stronger, Safer, Environmentally Sustainable Communities After Disasters
The GRRT Toolkit for Humanitarian Aid
›Natural disasters present an immediate humanitarian crisis but are also an opportunity to rebuild societies to be more resilient and environmentally sustainable than they were before. The “Green Recovery and Reconstruction Training Toolkit” (GRRT), created by World Wildlife Fund (WWF) and the American Red Cross and launched at the Wilson Center on November 19, will help future humanitarian efforts integrate principles of environmental conservation into their disaster recovery strategies. This strategic partnership has been “an incredible effort and marriage between organizations that have different operating styles, different approaches to situations,” said WWF Chief Operating Officer Marcia Marsh. While implementing the GRRT may not be easy, “we need integrated solutions for integrated problems,” said Erika Clesceri, bureau environmental officer at USAID.
A Critical Partnership
In the midst of a crisis, humanitarian workers on the ground often do not have the time, skills, or funding to incorporate environmental concerns into relief efforts, said Robert Laprade, senior director for emergencies and humanitarian assistance at CARE. Humanitarian workers are “going a hundred miles an hour, they’re going on adrenaline and they’re there to save people’s lives – and the environment is just of secondary importance,” he said.
But “environmental sustainability is critical to the achievement of long-lasting recovery results,” said Roger Lowe, senior vice president of communications at American Red Cross. The Red Cross Principles of Conduct state that “relief aid must strive to reduce future vulnerabilities to disaster as well as meeting basic needs” and “avoid long-term beneficiary dependence upon external aid,” he said.
From Damnation, Purgatory, and Armageddon to Redemption
For many crisis-stricken regions, lack of an emphasis on environmental sustainability during disaster recovery efforts can mean “damnation in the present, purgatory in the near future, and Armageddon in the long term,” said Peter Walker, director of the Feinstein International Center at Tufts University. Stress on the environment caused by climate change or unsustainable resource consumption can often contribute to conflict, he explained.
In Darfur, “the environmental change was part and parcel of what led to that conflict,” Walker said. At one time an “environmental Eden” of diverse ecological zones, Darfur gradually became an environment that could not support a society of livestock herding. As the environment changed, some former herders became salaried, armed gunmen, known as the Janjaweed who felt they faced “a choice of no choice,” Walker said, to either “die as pastoralists or become pariahs as mercenaries.”
The challenge for humanitarian aid organizations is to not only help communities recover from disasters, but help them adapt to future environmental stress caused by globalization, climate change, or other factors. “If you cannot adapt,” Walker said, “that’s going to lead to violence.” To avoid aid dependency or resurgence in conflict it is critical to integrate environmental sustainability into disaster relief efforts from the beginning, he said:We used to believe that our world in the aid business was divided between relief on the left and long-term development on the right, and one would gradually go into the other in this relief-development continuum. But the reality is that you have a significant population – a population of millions of people – who are effectively trapped in a form of aid purgatory. They’re basically on a drip feed. Humanitarian assistance does not get you forward, it keeps you alive.
The GRRT offers organizations guidelines for implementing integrated disaster relief to provide a sustainable solution. While every crisis is different, the GRRT’s guidelines should be as applicable to “flooding in Boston as they are to flooding in Aceh,” said Walker.
Implementing Integrated Solutions
Securing funding for this integrated approach will be a challenge, as a significant portion will go towards staffing and training people on the ground, said Clesceri. A stand-alone, dedicated budget for environmental issues within humanitarian assistance programs must “be fought and re-fought for on a continual basis,” she said.
Local partnerships are essential. “Replicate” should be “stricken from the lexicon,” said Marsh. “You can’t replicate, and this toolkit isn’t meant to be a one-size-fits-all.” Instead, she said, the goal of the GRRT is to “create very practical approaches with communities.”
The key to helping communities recover from disasters is to form the kinds of strategic partnerships demonstrated by WWF and the American Red Cross in the creation of the GRRT. “Interdisciplinary groups are always, in my mind, going to get you a better solution in the end, but the risk is that they take more time…but it’s absolutely worth it,” she said.
Photo Credit: “Dark Clouds from Haiti’s Hurricane Tomas Loom over Camps,” courtesy of flickr user United Nations Photo. -
The World’s Toilet Crisis
›Forty percent of the world’s population – 2.6 billion people – do not have access to toilets, and some in the international aid community are finally dispensing with the euphemisms and calling this sanitation crisis what it is: “shit.”
In “The World’s Toilet Crisis” (trailer above), Adam Yamaguchi sets off in an episode of Current TV’s Vanguard program to tell the story of “the deadliest killer in the world…something no one wants to talk about.” All around the developing world, thanks in part to rapid population growth and poor development and environmental standards, “people are literally eating their own shit,” he said.
His journey takes him to India, where more people own cell phones, than toilets. The 55 percent of Indians who practice open defecation have contributed to another grim statistic: an estimated 840,000 children under the age of five die in India each year from diarrheal diseases.
India’s water quality is especially affected by lack of sanitation. In the documentary, Yamaguchi visits the Yamuna River, which is Delhi’s primary source of drinking water, and has become a “giant toilet” literally bubbling with methane gas. This phenomenon is not unique to India. Approximately 80 percent of sewage in developing countries goes untreated, polluting local water resources.
But it is women who feel the effects of lack of access to clean water and toilets most keenly. In 72 percent of households around the world, women are the primary water collectors, often travelling long distances for drinkable water. They face shame and harassment when going to the bathroom, causing them to suppress their need until dark, causing negative health effects. Waiting until nightfall also means that when women openly defecate, they often face molestation, violence, and rape. Teenage girls also often drop out of school once they begin to menstruate because toilets are not private, unsafe, or are simply nonexistent.
Reflecting on his motivations for making the documentary, Yamaguchi said that in order to expose this “global public health crisis,” he needed to be as graphic, shocking, and disgusting as possible.If you’re not grossed out by, or incensed by the fact that there is shit everywhere, you’re not really moved to act or change your ways. And that’s ultimately what’s happened in many places in the world. It’s a normal fact of life. You see it everywhere, and you think nothing of it. There are causes out there that are deep sexy causes or marketable causes. Shit or toilets – not the most marketable thing in the world.
“The World’s Toilet Crisis” forms part of a broader trend among sanitation advocates to use crude language to address a problem the international health and development community has traditionally shied away from talking about directly.
Tales of shit: Community-Led Total Sanitation in Africa, published shortly before World Toilet Day by the International Institute for Environment and Development, takes an equally direct approach to sanitation.
Community-Led Total Sanitation (CLTS) is an approach begun with great success by Dr. Kamal Kar in Bangladesh that relies on “triggering” to change community behavior. The report, which is prefaced by a three-page “International Glossary of Shit” listing the words for shit in other languages, emphasizes the need to “explicitly [talk] about and [make] visible the shit that is normally hidden beneath taboos and polite language.” By almost literally thrusting people’s shit right under their noses, communities learn what they have been ignoring: that they are “eating each others’ shit.”
Traditional sanitation programs often fail because “a high proportion of latrines constructed with subsidies are never used as toilets, but as storage space, animal shelters, or prayer rooms – the buildings are too high quality to be wasted on toilets!” says the report. CLTS, on the other hand, focuses on changing behavior at the community, rather than the individual level to create sustainable change that responds and adapts to a community’s distinct culture and needs.
“The World’s Toilet Crisis” shows the promise CLTS has of meeting the needs of the billions without toilets. In East Java, Yamaguchi joins a community leader to collect a “specimen” from a well-traveled river bank near the town, which he proceeds to show to a group of women in the town who are, predictably, revolted. The community then takes collective action to become “open-defecation free” and invest in toilets.
“The World’s Toilet Crisis” is not easy to watch, nor was it easy to film – seven minutes in, Yamaguchi vomits on the banks of the polluted Yamuna River. Disgust, however, is central to raising awareness and affecting change on both the community and global levels. As Yamaguchi explains, “You’re going to get grossed out by seeing this piece, and that’s part of the point.”
Sources: Community-Led Total Sanitation, Current TV, Earth Times, IIED, Water.org, World Toilet Organization, WHO, United Nations University.
Video Credit: “The World’s Toilet Crisis – Vanguard Trailer,” courtesy of Current TV’s Vanguard. -
Expanding Access to Maternal Health Commodities
›“This is not just about getting quantities of drugs out, this is about saving women’s lives with really simple products that work,” said Julia Bunting, team leader of AIDS and reproductive health at the UK Department for International Development and coalition chair of the Reproductive Health Supplies Coalition, at the ninth meeting of the Global Health Initiative’s 2009-2010 Advancing Policy Dialogue on Maternal Health series. Joined by panelists Melodie Holden, president of Venture Strategies Innovations (VSI), and Elizabeth Leahy Madsen, senior research associate at Population Action International (PAI), the panel discussed the challenges and strategies for expanding access to maternal health commodities.
Integrating Maternal Health and Family Planning Supply Chains“It is often said that the family planning and the maternal health communities have very different views of supplies… but actually [both communities] recognize that we need to explore the continuum,” said Bunting, addressing the need to integrate maternal health commodities into existing reproductive health supply chains. “I really think the stars are aligned right now for advancing this agenda,” added Bunting.
“Many of the commodities that we talk about in terms of reproductive and maternal health cost tiny amounts to deliver, but actually save lives and are some of the most cost-effective interventions we have both in public health and in broader development,” said Bunting.
No Product, No Program
“Supplies are a key element in programs to improve maternal health and they are also a tangible and visible hook to increase awareness and commitment,” said Madsen. “Policymakers whose eyes glaze over when they hear the term ‘health systems strengthening’ can grasp… much better when they learn that supply shelves in clinics are bare and that women are making great efforts to reach facilities, only to leave empty- handed,” said Madsen.
Presenting research conducted by PAI, Madsen discussed the availability of four key maternal health medicines and products in Bangladesh and Uganda including:
By focusing on supplies that target the three leading causes of maternal mortality, Madsen and her colleagues identified factors that inhibit access to these commodities and developed recommendations for strengthening maternal health supply chains.- Oxytocin: used to prevent post-partum hemorrhage
- Misoprostol: used to prevent post-partum hemorrhage
- Magnesium Sulfate: used to treat pre-eclampsia
- Vacuum Aspirators: used for treatment of early and incomplete abortion
Madsen identified several strategies to strengthen supply chains for maternal health commodities including forecasting and preparing for growing demand, advocating for government and donor support, encouraging scaling-up of community-based approaches, promoting family planning, and focusing on human resource training.
“In maternal health, if a supply to prevent or treat a life-threatening complication is in stock, there must also be a way for a woman to reach it in time… and in most cases a provider who knows how to administer it,” said Madsen.
“This research is intended to lay the groundwork for future advocacy and policy initiatives by providing an evidence base that is informed by local expertise,” said Madsen. “We hope that this information will inform program implementation, funding decisions, and awareness raising.”
Getting the Product to People: The Case of Misoprostol
“The story of Misoprostol is still being written. The goal is to invest in creating access to interventions that are low-cost and relatively simple to use,” said Holden. By sharing lessons learned, Holden described VSI’s experience registering and procuring Misoprostol and demonstrated how community mobilization is imperative to overcoming major challenges for large-scale implementation.“Making products available is not without challenges,” said Holden. To increase access to Misoprostol in rural communities, maternal health experts must work to “engage communities, educate and mobilize women, train providers at all levels of the health care system, and provide support to distributors to jump start sales,” said Holden. “By looking holistically across entire health systems, bringing in great interventions, addressing the components of supply and demand, and working with local partners, we can have lasting impact.”
While the price of Misoprostol has decreased significantly, Holden stressed the need to identify creative ways along the supply chain that reduce costs to the end user. Additionally, “establishing policies around this new intervention not only establishes its reach, but also makes its use institutionalized, which means it will be part of the system even if governments or individuals change,” said Holden.
“If there is a gap between what could be achieved with Misoprostol and what is being achieved, we need to go back to the model and figure out what pieces aren’t working,” concluded Holden. “The work is complex and takes time, but it’s worth it.”
Photo Credit: “Rapid HIV testing,” courtesy of flickr user DFID – UK Department for International Development.
