Showing posts from category global health.
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Watch: Joel E. Cohen on Solving the Resource-Population Equation in the Developing World
›December 14, 2010 // By Wilson Center Staff“It’s very hard to put a number on a quantity that depends on future events, processes we don’t understand, and values that may change over time,” said Joel E. Cohenof the Rockefeller University in this interview with ECSP. “That doesn’t mean we have no problems and it doesn’t mean there’s nothing we can do.”
There are three schools of thought or proposed “panaceas,” when it comes to balancing natural resources and population, said Cohen: a bigger pie (new technology to increase productivity), fewer forks (reduced consumption), and better manners (reduced irrational market inequities and better governance).
In the 15 years since his book How Many People Can the Earth Support? was published, Cohen’s approach has changed. While the 1996 book lacked a definitive policy recommendation, he is now analyzing options. “The evolution of my thought has moved from ‘how many people can the Earth support?’ to ‘what do we need to solve problems?’” he said.
You need adequate child and maternal nutrition to produce potential problem solvers and you need education to give them the tools to do it with, said Cohen, who studied the impact of universal primary and secondary education with colleagues at the American Academy of Arts and Sciences.
“If you look at a map of stunting in the world, there are parts of South Asia and sub-Saharan Africa where more than half the children are stunted – that means two standard deviations [of] height below normal for their age,” said Cohen. “Those populations are handicapped at the starting gate because they don’t have the problem solvers.” -
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. -
Hans Rosling Double Feature: ‘The Joy of Stats’ on BBC and Population Growth at TED
›Hans Rosling, creator of Gapminder and professor of international health at Sweden’s Karolinska Institute, hosts a new documentary on the BBC called The Joy of Stats that takes a look at the breadth and depth of data available today to analysts and private citizens alike.
In the clip above, Rosling demonstrates his primary interest in world health, tracking life expectancy and income over the last 200 years to show both the remarkable progress that has been made but also the tremendous gap that remains between those at the top (the very rich and healthy) and those at the bottom (the very poor and sick).
Rosling has been a vocal (and visual) advocate for expanding people’s knowledge of the world by presenting statistics in innovative ways. “Statistics should be the intellectual sidewalks of a society, and people should be able to build businesses and operate on the side of them,” he said at a discussion at the Wilson Center in May 2009.
In particular, Rosling’s focus has been on health, poverty, and the developing world, where he’s advocated for increased focus on child and maternal health and education. “The role of the old West in the new world is to become the foundation of the modern world – nothing more, nothing less,” he said during a TED talk on population growth (see below) where he broke from his more flashy visuals and went analog – using IKEA boxes to illustrate population and consumption growth. “But it’s a very important role. Do it well and get used to it.”
Rosling’s Gapminder software has been incorporated into Google’s Public Data Explorer, where many development indicators from the World Bank, World Health Organization, and others can now be easily tracked by anyone. For more on Google Data and to see an example set of indicators (agriculture as a percentage of GDP vs. fertility rates over the last 50 years), check out this previous Eye On, on The New Security Beat.
Video Credit: “Hans Rosling’s 200 Countries, 200 Years, 4 Minutes – The Joy of Stats – BBC Four,” courtesy of BBC, via YouTube, and “Hans Rosling on global population growth,” courtesy of TED. -
International Responses to Pakistan’s Water Crisis
›December 6, 2010 // By Michael KugelmanExcerpt from the executive summary of the NOREF Policy Brief, via the Norwegian Peacebuilding Centre:
Pakistan faces a multidimensional water crisis that claims hundreds of thousands of lives every year. The root causes of the crisis are twofold:- Circumstantial, which are linked to poor water-resource management policies (including water-wasting flood irrigation);
- Structural, tied to factors deeply ingrained in politics and society such as the obsession with India, inequitable rural land-ownership and endemic water misgovernance (for example, exploitation of the rotational irrigation system to the detriment of the poor).
However, international responses must be measured. They should actively target the circumstantial causes but, at the same time, recognize that their ability to take on the structural ones is limited. While the international community can help mitigate the effects of the underlying structural drivers, Pakistan itself must take the ultimate steps to eliminate them.
Circumstantial causes can be addressed through international aid provision and international exchanges. Aid provision must be generous enough to meet Pakistan’s prodigious needs but modest enough to respect the country’s limited absorptive capacities. It should emphasize the restoration of infrastructure and distribution systems, be more responsive to the needs of Sindh and Baluchistan provinces, and be channeled through both government agencies and civil society.
Despite the challenges the international community faces in addressing the structural causes, opportunities do abound. These include embarking on back-channel diplomacy to bring Pakistan and India closer together and cooperative projects with Pakistanis to make water distribution more equitable. To be effective, international responses must target all affected parties and be sensitive to ground realities. They should also be mindful of indigenous success stories and the factors that bring about that success.
The full report, “International Responses to Pakistan’s Water Crisis: Opportunities and Challenges,” is available through the Norwegian Peacebuilding Centre.
Michael Kugelman is program associate with the Asia Program at the Woodrow Wilson International Center for Scholars.
Image Credit: Adapted from “USG Humanitarian Assistance to Pakistan for Floods in FY 2010 and FY 2011 (as of 30 Nov 2010),” courtesy of USAID and ReliefWeb. -
World AIDS Day 2010: Not Yet in a Position to Say “Mission Accomplished”
›December 1, 2010 // By Schuyler NullToday is World AIDS day. More than 33 million people are currently living with HIV around the world, according to the UN, and the vast majority of them (22 million) are located in sub-Saharan Africa.
“We have halted and begun to reverse the epidemic. Fewer people are becoming infected with HIV and fewer people are dying from AIDS,” said Executive Director Michel Sidibé in the 2010 edition of UNAIDS’ annual report.“However we are not yet in a position to say ‘mission accomplished.’ Growth in investment for the AIDS response has flattened for the first time in 2009. Demand is outstripping supply. Stigma, discrimination, and bad laws continue to place roadblocks for people living with HIV and people on the margins.”
Particularly in sub-Saharan Africa, “people on the margins” often means women and children. As a result, there has been more and more integration of HIV/AIDS programs with gender and maternal health. The environmental community has also worked closely with HIV/AIDS interventions in places where the destruction of natural resources makes certain populations more vulnerable than others and valuable conservation efforts are threatened.
As development efforts become more cross-sectoral, it’s important to keep in mind and maximize these connections between community, economic, and environmental health.
Check out The New Security Beat’s coverage of HIV/AIDS integration with other health and environment programs including coverage from the Global Health Initiative’s “Integrating HIV/AIDS and Maternal Health Services” event last year, a sit-down interview on the challenges facing HIV-positive adolescents with Harriet Birungi of the Population Council in Kenya, and an examination of how gender-based violence contributes to women’s vulnerability to HIV.
Sources: Population Reference Bureau, UN, World Wildlife Federation.
Map Credit: World AIDS Campaign. -
Developing a Blueprint for Addressing Glacier Melt in the Region
Changing Glaciers and Hydrology in Asia
›“Glacier melt is part of larger hydrologic and climate systems, so effective programs will be cross-sectoral and yield co-benefits,” said Elizabeth L. Malone, senior research scientist at the Joint Global Change Research Institute and Pacific Northwest National Laboratory, speaking at the Wilson Center on November 16. “Looking more closely at glacier melt, we come to understand that upstream actions and choices have a potentially huge effect on downstream communities,” added Kristina Yarrow, health advisor at the U.S. Agency for International Development’s Asia and Middle East Bureaus.
Malone and Yarrow were joined by Mary Melnyk, senior advisor for natural resource management at USAID’s Asia and Middle East Bureaus, to discuss the agency’s new report, “Changing Glaciers and Hydrology in Asia: Addressing Vulnerabilities to Glacier Melt Impacts,” prepared by Malone in collaboration with CDM International and TRG. “This report is a move towards mainstreaming climate change across the development portfolio to ensure enduring success of our investments,” Melnyk said.
Mainstreaming Climate Change
Providing information about the science, vulnerabilities, and current efforts to respond to environmental change and glacier melt in Asia, the new report also features a number of practical, cross-sectoral approaches to addressing glacial retreat in Asia that, if implemented well, could produce multiple benefits. The report highlights the complexity of the issues surrounding glacier melt in the region, and the critical need to prepare today for future environmental changes.“Climate change in general, and glacier melt specifically, can potentially impact all sectors: economic growth, governance, and health,” Melnyk said. Because there is a lack of scientific knowledge on glacial retreat in Asia and limited financial and human resources to address these issues, it is critical to maximize results through programs that will provide environmental, health, and development co-benefits.
“The challenge is that, in practice, addressing issues of climate change and other environmental security issues still are not a part of the day-to-day business across sectors,” Melnyk said. This report is a first step in the right direction to raise awareness and action on these issues and “although there is uncertainty, we need to move forward – the time to act is now,” she concluded.
Multiple Sectors, Multiple Benefits
“Cross-sector collaboration and programs, when done correctly, can have a much greater impact than when doing a vertical program within a specific sector,” Yarrow said, stressing the importance of multidisciplinary approaches to address environment, health, and development issues. Understanding the health impacts of climate-related environmental change now can help prepare us to address these specific impacts in the future.“On a global scale, there is indeed a relationship between population growth, environmental change, and development,” Yarrow said. In Asia, stress on water resources due to climate change and rapid population growth will likely exacerbate health problems caused by lack of clean water. Proactively expanding and improving programs that address the causes and effects of diarrheal disease and under-nutrition can help address these vulnerabilities and make communities more resilient.
“Finding innovative ways to improve access to and integrate family planning messages and services into climate adaptation programs will also yield some important co-benefits,” Yarrow said. Family planning can slow population growth, which could help reduce projected demand for water supplies, as well as potentially reduce the amount of water pollution.
Yarrow also added that “population growth affects glacier melt indirectly through the consumption of resources that exacerbate black carbon.” Black carbon, which is produced by cooking and heating with biomass fuels, contributes to regional climate change and severe health problems, including respiratory illness and pneumonia. Accompanied by efforts to promote alternative fuels, family planning could reduce black-carbon emissions, significantly improve health, and strengthen community resilience to climate change.
“Though challenging, integrating across sectors is absolutely essential – we’re not experts yet, but we’re definitely getting better,” Yarrow said. “Understanding and addressing the multiple issues like climate change, poor health, poverty, dependence on natural resources, and governance challenges that these communities are dealing with in a comprehensive and holistic fashion will improve results.”
Responding to Glacier Melt
“We simply do not have the kind of broad-scale knowledge that we would like to have,” Malone said. Current data on glacier melt is scarce and very few direct measurements of glacier volume exist, making calculations of glacier retreat difficult. Moving forward, it is critical to respond to this lack of information by improving regional scientific cooperation on glaciers, snowpack, and water resources in High Asia, and strengthening climate and water monitoring capacity.“Even the smallest amounts of glacier-melt contribution correspond to the regions of the highest population, so any change in water supply has large implications,” Malone said. Glaciers may not be disappearing as fast as had been previously thought, but “climate change is happening in the Himalayas and is having an effect.”
“If systems – both human and ecological – are already stressed, they are less able to be resilient in the face of changes. But the good news is that we can take actions now that will be crucially important to how societies can respond in the future,” Malone said.
Implementing cross-sector projects can help to target places where environmental, economic, health, and even security issues overlap. Focusing on water resource management, ecosystems, and the needs of high-mountain communities, as well as mitigating climate change by reducing emissions of black carbon, can help reduce both direct and indirect vulnerabilities and improve resilience to future changes.
“The results of this report allow USAID and others to grasp the complexity of these issues, understand the critical gaps, and to respond to the changes in the glaciers to come,” Melnyk said. The next step is applying the knowledge gathered in the report to practitioners in the field and in policy discussions.
“A crucial role USAID can play is to link partners in the government and private sectors to build capacity and spark synergies among new initiatives to really integrate new initiatives with concerns about glacier melt,” Malone concluded.
Photo Credit: “Nepal Sagamartha Trek,” courtesy of flickr user mckaysavage. -
IGWG’s K4Health Gender and Health Toolkit Is a One-Stop Shop for Integration
›November 30, 2010 // By Ramona Godbole
Addressing and analyzing gender norms, roles, and relations is increasingly viewed as critical in the development of equitable, effective, and sustainable health care. However, there has been relatively little integration of gender into health policies, programs, and systems.
The Interagency Gender Working Group (IGWG) – founded in 1997 as a way to bring together NGOs and parts of USAID to share best practices – has partnered with K4Health to create a Gender and Health Toolkit specifically designed to bridge this gap.IGWG’s Gender and Health Toolkit provides access to hundreds of tools, databases, training modules, websites, and publications in one place. Broadly divided into sections including program design, implementation approaches, capacity building, monitoring and evaluation, health systems, best practices examples, and even country-specific case studies, the toolkit provides nearly everything needed to begin integrating gender into new or existing public health programs.
Practitioners can also post questions and comments about the toolkit through an integrated discussion board. The toolkit even has a database to share gender-related photos.
While designed primarily for gender and health specialists and practitioners, the scope of the toolkit extends beyond typical public health issues like maternal health, family planning, HIV/AIDS, and reproductive health. The toolkit links to resources and training modules covering a wide range of cross-cutting topics including gender-based violence; nutrition and food security; integrated population, health and environment; and conflict/post-conflict humanitarian assistance.
The accumulated wealth of knowledge presented in the IGWG Gender and Health Toolkit is an impressively comprehensive resource, and it should be bookmarked by environment, health, and gender specialists and interested policymakers alike.
Image Credit: K4Health. -
Climate-Proofing Development: An Interview With Karen Hardee
›November 29, 2010 // By Hannah Marqusee
While expectations are deflated for broad international consensus at the UN Climate Change Convention in Cancun, the need to “climate-proof” development efforts has been gaining ground in recent years as a necessary preventative measure to help developing countries adapt to the adverse effects of climate change.
