Showing posts from category global health.
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‘NSB’ Blogs from the 2010 Global Maternal Health Conference in New Delhi
›The 2010 Global Maternal Health Conference kicked off today, perhaps fittingly, in India – one of the world’s fastest growing nations but one that also faces serious reproductive health challenges. The Wilson Center’s Calyn Ostrowski is in New Delhi for the conference and will be providing updates to The New Security Beat throughout the week.
Those interested can also find a schedule of events and list of participants on the conference website as well as live webcasted events on the main page. Stay tuned!
Photo Credit: “Mumbai, India, November 2009” courtesy of flickr user travelmeasia. -
Fire in the Hole: A Look Inside India’s Hidden Resource War
›August 18, 2010 // By Schuyler Null
This month’s Foreign Policy has two features on India’s ongoing internal conflict with Maoist and tribal rebels – perhaps the least known insurgency and resource conflict in the world.
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Misguided Projections for Africa’s Fertility
›By assuming that sub-Saharan Africa’s total fertility rate will decrease to 2.5 children per woman by 2050, the most recent population projections issued by the Population Reference Bureau likely continue to underestimate fertility for Africa. Though northern Africa has significantly lowered fertility, sub-Saharan Africa’s TFR is still 5 children per woman. Achieving the levels projected by PRB or the United Nations will largely depend on whether the conditions that led to past fertility declines for other states can be established in sub-Saharan Africa.
Demographers have identified numerous factors associated with fertility decline, including increased education for females, shifting from a rural agricultural economy to an industrial one, and introduction of contraceptive technology. Sub-Saharan Africa is only making slow progress in each of these areas.
Surveying Obstacles to Development
Primary school enrollment is up, but the pace of improvement is declining. Meanwhile, gender gaps persist: Enrollment for boys remains significantly higher than for girls. Girls’ education is associated with lower fertility, partly because education helps women take charge of their fertility and also because education influences employment opportunities. Increased female labor force participation has been shown to increase the cost of having children, and is therefore associated with initial fertility declines.
Disease is one wildcard for Africa that limits the utility of past models of demographic transition in the African context. HIV/AIDS is decimating sub-Saharan Africa’s adult workforce and creating shortages of teachers that will impede future efforts to boost primary school enrollment. According to the United Nations, the number of teachers in sub-Saharan Africa needs to double in the next five years to reach Millennium Development goals.
Development that would shift the region’s economies from agriculture to industry is also lagging. While several West African countries are seeing some gains, the African continent on the whole faces major structural impediments to development. In The Bottom Billion, Paul Collier points out that many of these countries may have “missed the boat” to attract investment and industry that would pull the region out of poverty, partly because the least developed countries are still not cost-competitive enough when compared with current centers of manufacturing, like China.
Finally, there remains a high unmet need for family planning. One in four women aged 15 to 49 who are married or in union –- and who have expressed an interest in using contraceptives — still do not have access to family planning tools. In general, maternal mortality remains high and adolescents in the poorest households are three times more likely to become pregnant and give birth than those in the richest households, according to the most recent UN Millennium Development Goals report.
Sub-Saharan Africa: Off the Radar?
Sub-Saharan Africa suffers from a lack of attention by the international community and lack of political capacity at home. Many countries in the region are plagued by civil strife and poor governance, and developed countries continue to fall short of development assistance pledges. There is not the same sense of urgency today among developed countries about the global population explosion as there once was. Cold War politics and the environmental and feminist movements motivated much of the study of fertility and funding of population programs during the second half of the 20th century. Attention by governments and NGOs sped the fertility transition among many countries.
Today, the world’s wealthiest countries are not concerned primarily with Africa’s problems, but rather are more concerned with their own population decline and with the national security implications of population trends in areas associated with religious extremism. The recession has further hindered the flow of development funds.
Fertility is the most difficult population component to predict, and demographers must draw on the experiences of other regions to inform assessments of Africa’s population patterns. Demographers seem to be overconfident that Africa’s fertility will follow the pattern of recent declines, particularly in Latin America, which were more rapid than Western Europe’s decline due to the diffusion of technology and knowledge.
Once states begin the demographic transition towards lower fertility and mortality, they have tended to continue, with few exceptions. Therefore, most projections for Africa assume the same linear pattern of decline will hold. Yet, the low priority of Africa’s population issues among the world’s wealthiest states, combined with shortfalls in education, development, and contraception, may mean that the demographic transition in Africa will be slower than predicted.
Projections are useful to give us a picture of what the world could look like if meaningful policy changes are made. In the case of sub-Saharan Africa, prospects for these projections are dim.
Jennifer Dabbs Sciubba is the Mellon Environmental Fellow in the Department of International Studies at Rhodes College in Memphis, Tenn. She is also the author of a forthcoming book, The Future Faces of War: Population and National Security.
Photo Credit: “Waiting,” ECWA Evangel Hospital, Jos, Nigeria, courtesy of flickr user Mike Blyth. -
How Maternal Mortality and Morbidity Impact Economic Development
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“Investing in women and girls is the right thing to do,” says Mayra Buvinic, sector director of the World Bank’s gender and development group. “It is not only fair for gender equality, but it is smart economics.” But while it may be smart economics, many developing countries fail to address the underlying social causes that impact economic growth, such as poverty and gender inequality. Buvinic was joined by Dr. Nomonde Xundu, health attaché at the Embassy of South Africa in Washington, D.C., and Mary Ellen Stanton, senior maternal health advisor at the U.S. Agency for International Development (USAID), at the sixth meeting of the Advancing Policy Dialogue on Maternal Health Series, which addressed the economic impact of maternal mortality and provided evidence for the need for increased investment in maternal health.
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“There Is No Choice:” Climate, Health, Water, Food Security Must Be Integrated, Say Experts
›August 9, 2010 // By Russell SticklorBureaucratic stovepipes plague international development efforts, and aid for pressing environmental and human security concerns—such as climate change, food shortages, fresh water access, and global health threats—rarely matches the reality on the ground in the developing world, where such health and environmental problems are fundamentally interconnected.
Instead, development efforts in the field—whether spearheaded by multilaterals, bilaterals, or NGOs—are commonly devoted to single sectors: e.g., the prevention and treatment of a single disease; the implementation of irrigation infrastructure in a specific area; or the introduction of a new crop in a certain region. The reasons for such a narrow focus can come from multiple sources: finite resources, narrowly constructed funding streams, emphasis on simple and discrete indicators of success, and institutional and professional development penalties for those who conduct integrated work. But some experts argue that integrating problem-solving initiatives across categories would not only improve the efficacy of development efforts, but also better improve lives in target communities.
As part of the USAID Knowledge Management Center‘s 2010 Summer Seminar Series, a recent National Press Club panel on integration featured a frank discussion of both the opportunities and challenges inherent in breaking down barriers within and between development agencies. Panelists from the World Bank’s Environment Department, the White House Council on Environmental Quality, and the Woodrow Wilson Center’s Environment Change and Security Program weighed in on the prospects for cross-sectoral integration.
Addressing the impacts of a global problem like climate change “requires multilevel approaches,” and necessitates that we “think multisectorally along the lines of agriculture, water, transportation, energy, [and] security,” said Loren Labovitch of the White House Council on Environmental Quality. The four topics under discussion—climate change, food security, water, and health—are all Obama administration priorities, as reflected by dedicated programs and special initiatives. Finding ways to practically integrate these interrelated challenges (through efforts like the Feed the Future Initiative or the Global Health Initiative) is getting more attention from policy analysts and policymakers with each passing year.
Integration in Practice: Success Stories
While there may be an emerging willingness to discuss and even experiment with holistic programming, what does it actually look in practice? Panelist Geoff Dabelko, director of the Woodrow Wilson Center’s Environmental Change and Security Program, singled out integrated development programs in the Philippines, the Democratic Republic of Congo, and Asia as examples.
Philippines: The PATH Foundation Philippines’ Integrated Population and Coastal Resource Management (IPOPCORM) initiative uses an integrated approach to address health and environmental concerns in coastal communities. Their “basket of services” includes establishing a locally managed protected marine sanctuary to allow local fish stocks to recover, promoting alternative economic livelihoods outside of the fishing industry, and improving access to local health services and commodities, said Dabelko. To date, IPOPCORM has yielded several notable improvements, among them reduced program costs and improved health and environmental outcomes as compared to side-by-side single sector interventions. A forthcoming peer-reviewed article will appear in Environmental Conservation, and will detail the controlled comparison study of the IPOPCORM project.
Democratic Republic of Congo: Mercy Corps has also successfully pursued cross-sectoral programming as part of a larger effort to be more holistic in its humanitarian and development responses. In war-torn eastern DRC, Mercy Corps brought practitioners with expertise in natural resource management into the fold of what has historically been an emergency relief mission. In particular, the Mercy Corps mission has fused humanitarian assistance with longer-term development efforts such as enhanced environmental stewardship. For example, promoting the use of fuel-efficient cookstoves eases pressure on local forest resources by lowering the need for firewood, and improves respiratory health by lowering air pollution. The project scaled up the effort through resources from further integration, with carbon credits from avoided emissions being sold through a local broker to the European cap and trade market. These resources in turn helped finance more cook stoves, which now total 20,000 for this project.
“The lesson is we have no excuse for not doing this anywhere in the world and saying some place is too unstable,” Dabelko said. “If we can do it [integrated projects] in eastern DRC, we should be able to do it anywhere.”
Asia: Tackling programmatic integration starts with better understanding the interconnections between environmental and health challenges. Dabelko cited a recent effort of the environment and natural resources team within USAID’s Asia Bureau as an example of breaking out of narrow bureaucratic stovepipes.
USAID staff recognized that a wide set of climate, energy, economic, governance, and conflict issues affected their core biodiversity and water portfolios, even if they did not have the time, expertise, or resources to investigate those issues in detail. Trends that appeared to be in the periphery were not viewed as peripheral to planning and designing programs for long-term success.
Working with the Woodrow Wilson Center, the USAID Asia Regional Bureau engaged experts on a diverse set of topics normally considered outside their portfolios. The resulting workshop series and report led to a deeper understanding of the possible impacts of increased Himalayan glacier melt and Chinese hydropower plans on food security and biodiversity programs in the lower reaches of the Mekong River. Bringing analysis from these topically and geographically remote areas into local-level development planning is a process that will require a similar willingness to go outside the typical bounds of one’s brief.
More Integration Ahead?
These case studies provide a glimpse of what integrated programming can look like on the ground. Still, significant hurdles remain standing in the way of regular and effective integration. Cross-sectoral programming demands that old problems be addressed in innovative and perhaps unfamiliar ways, requiring the addition of new capacity in development organizations and better coordination within and between agencies. That can be a complicated process, noted Dabelko, since efforts to pursue greater programming integration can be “hamstrung by earmarks and line items.”
Integration can also prove tricky because it requires a greater willingness to accept multiple indicators of success unfolding over different time frames—health gains may occur quickly, for example, while progress on environmental conservation may unfold less speedily. This means existing programs might need to be reshaped and reoriented to accommodate these divergent time frames, which could prove somewhat difficult. “Integration can be a challenge, both from a programming perspective and from an organizational perspective,” acknowledged moderator Tegan Blaine, climate change advisor for USAID’s Africa Bureau.
Further, the temptation remains strong among appropriators and implementers alike to maintain control over authority and resources in their traditional portfolios. Getting long-time practitioners in particular issue areas to willingly cede some of their turf in the pursuit of greater integration has historically been the “real world” that stands in the way of such integrated work.
But, as shown by the standing-room-only crowd at the seminar, momentum is slowly starting to build in pursuit of breaking down old programming walls and finding new approaches to addressing emerging challenges in human and environmental security.
“There is no choice” but to fuse development agendas with climate change adaptation efforts, asserted Warren Evans, director of the World Bank’s Environment Department. “It can’t be a parallel process anymore.”
Photo Credit: “2010 Summer Seminar Series – July 15th Panel Discussion on Food Security, Climate Change, Water and Health,” used courtesy of USAID and the National Press Club. -
Reform Aid to Pakistan’s Health Sector, Says Former Wilson Center Scholar
›August 5, 2010 // By Wilson Center StaffExcerpt from op-ed by Samia Altaf and Anjum Altaf in Dawn:
WE must state at the outset that we have been wary of, if not actually opposed to, the prospect of further economic assistance to Pakistan because of the callous misuse and abuse of aid that has marked the past across all elected and non-elected regimes.
We are convinced that such aid, driven by political imperatives and deliberately blind to the well-recognised holes in the system, has been a disservice to the Pakistani people by destroying all incentives for self-reliance, good governance and accountability to either the ultimate donors or recipients.
Even without the holes in the system the kind of aid flows being proposed are likely to prove problematic. Over half a century ago, Jane Jacobs, in a brilliant chapter (Gradual and Cataclysmic Money) in a brilliant book (The Death and Life of Great American Cities), showed convincingly how ‘cataclysmic’ money (money that arrives in huge amounts in short periods of time) is a surefire way of destroying all possibilities of improvement. What is needed, she argued, is ‘gradual’ money in the control of the residents themselves. While Jacobs was writing in the context of aid to impoverished communities within the US, she concluded with a remarkably prescient concern: “I hope we disburse foreign aid abroad more intelligently than we disburse it at home.”
Continue reading on Dawn.
For more on U.S. aid to Pakistan, see New Security Beat‘s coverage of the recent U.S.-Pakistani Strategic Dialogue.
Photo Credit: A U.S. Army Soldier with 32nd Infantry Regiment, 10th Mountain Division, hands out medical supplies to Pakistani refugees outside an International Committee of the Red Crescent aid station in Afghanistan’s Kunar province, October 23, 2009. Courtesy of flickr user isafmedia. -
Boosting the U.S. Role in the Global Health Arena
›A new video from the Commission on Smart Global Health Policy, which was established by the Center for Strategic & International Studies, reviews the commission’s progress towards its goal of encouraging the U.S. government to embrace global health as a pillar of U.S. foreign policy.
The video reviews the recommendations from the commission’s March 2010 report, A Healthier, Safer and More Prosperous World: 1) Maintain robust U.S. support for the fight against HIV/AIDS, malaria, and tuberculosis; 2) Prioritize maternal and child health, especially in sub-Saharan Africa and South Asia; 3) Help other nations improve their capacity to prevent and respond to outbreaks of contagious disease; 4) Expand U.S. capacity to fund future global health initiatives by securing long-term investments for such efforts; and 5) Step up U.S. funding for multilaterals engaged in the global health field, including the World Health Organization, Global Fund, UNICEF, the World Bank, and the GAVI Alliance.
In the months ahead, commission members will be participating in public forums throughout the United States to discuss and promote the recommendations included in the report, before gathering in January to review the Obama administration’s progress on global health as the administration begins its third year. To date, the centerpiece of the administration’s health outreach efforts has been the six-year, $63 billion Global Health Initiative, designed to promote an enhanced U.S. role in addressing public health issues overseas.
The CSIS Global Health Policy Center will also be launching a year-long debate series called “Fault Lines in Global Health,” focusing on controversial topics in the global health field. The series’ kick-off event will center on U.S. AIDS funding, and is scheduled for Friday, August 6, 2010, from 9:30-11:00 a.m. -
Interview With Wilson Center Scholar Margaret Wamuyu Muthee: Envisioning a New Future for Kenya’s Next Generation
›July 29, 2010 // By Wilson Center StaffYouth in sub-Saharan Africa constitute a large and growing portion of the region’s population, yet remain underserved by family planning and reproductive health programs. New Security Beat recently interviewed Margaret Wamuyu Muthee, an Africa Program Scholar at the Woodrow Wilson Center, about this problem. Muthee is currently working on a project documenting both the opportunities and challenges for young people growing up in Kenya.
New Security Beat: How do you define youth?Margaret Wamuyu Muthee: The African Union has defined youth as every person between the ages of 15 to 35 years, while the United Nations defines youth as persons between the ages of 15 and 24. I will be concentrating on the age group defined by the African Union.
NSB: What are some opportunities and challenges facing youth in Kenya?
However, I will not only be relying on age. There are other aspects that I must take into consideration. Many children assume the roles of an adult or a care-taker when they are at an early age. Children in African nations face different challenges [compared to children in Western countries], as there are fewer opportunities for transition in Africa.MWM: This is a very important stage for exposing youth to the available support and teaching them about the social economy. Some of the difficulties lie in the lack of resources and corruption, such as misuse of funds that are provided to the government by outside sources.
NSB: Which programs are taking actions to empower youth in Kenya?
On a more positive outlook, youth are very resilient. They have a wide range of potential and capacity that can be utilized right away. African nations, just like China, have an enormous population that can be a human resource. All we have to do is positively tap into their potential to make good changes.MWM: The Youth Enterprise Development Fund (YEDF) works to increase economic opportunities for Kenyan youth in nation-building through enterprise development. YEDF also works to lower the unemployment rate and teach certain skills for future employment. One downside of this fund is that even though it provides money, it does not provide mentorship for the youth who execute the programs.
NSB: Are these programs enough to address youth challenges?
Another program is Yes Youth Can! This $45 million initiative was created by the U.S. ambassador to Kenya and USAID. The program is designed to create local and national networks of youth leaders to advocate peaceful economic and governmental reforms. The wonderful thing about this organization is that it is completely youth-driven.MWM: Sometimes these programs are seen as too small and too late. Youth are seen as violent, and these programs are made to keep them busy. Programs need to address all the facts, from start to finish.
NSB: Are there programs specifically targeted at female youth?MWM: We need programs that address pregnancies, HIV/AIDS, and education for young women. These education programs not only need to teach them about pregnancies and HIV/AIDS, but also educate women about their rights: how to say “no” and object to certain actions.
NSB: Are family planning and reproductive health incorporated into youth education?
However, there are complications when it comes to female rights. There are sexual offense laws that females do not even know about. The implementation of these laws can be non-existent. Either the police system is flawed or accessing lawyers is too expensive for females. And even if a lawyer is hired, the rapist can pay off a judge, so the judge will not convict him.MWM: There are already reproductive health campaigns in Kenya. One example is the ABC program: Abstinence, Be faithful, Condom use. Everyone these days, in rural and urban environments, knows about HIV/AIDS. There needs to be more programs regarding family planning and health; there is only a limited amount of knowledge getting passed around about those two issues.
Margaret Wamuyu Muthee is the Programs Manager for Kenya’s University of Nairobi Center for Human Rights and Peace, and a current scholar in the Woodrow Wilson Center’s Africa Program.
There is a new proposed Kenyan constitution that bans abortion unless a doctor permits the abortion due to health reasons, or if the mother’s health is in critical danger. Many females die because they cannot legally get an abortion and try to abort their baby on their own, or accept services from a backstreet clinic.
We also have cultural practices that put up barriers to the spread of family planning and health. One such example is the practice of early female marriages. Girls as young as 10 years old will be forced to marry a much older man. These girls have not had proper education on reproductive health or family planning.
In addition, adults are still too shy to address youth that are having sex, and are embarrassed to talk about their health if they have HIV/AIDS. We need to educate more youth and provide the means for them to live safer lives.
Josephine Kim and Marie Hokenson are cadets at the United States Military Academy at West Point and interns with the Woodrow Wilson Center’s Environmental Change and Security Program.
Photo Credit: “The Mentees and their mentors,” used courtesy of flickr user The Advocacy Project.
