Showing posts from category global health.
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The Feed for Fresh News on Population
›June 9, 2010 // By Wilson Center StaffChanging Chinese demographics of labor force connected to worker protests from today’s
New research on desired family size and child mortality in Reading Radar on @NewSecurityBeat. From #USAID and The #Lancet http://ow.ly/1UgYj
Congrats to Suzanne Ehlers as new head of #PAI. Hoping for cont’d demography & security and population-environment work http://ow.ly/1TAzA
Practical maternal health lessons in transportation and referral w/ examples from #India, #Bolivia, & #Ghana @MHTF #UNFPA http://ow.ly/1TzQZ
Columbia University’s Grace Kodindo on @NewSecurityBeat with video interview on family planning in conflict zones http://ow.ly/1TzQg
Grace Kodindo of “Grace Under Fire” talks family planning in conflict zones. #Chad #refugees #conflict #WilsonCenter http://ow.ly/1TuN1
Follow Geoff Dabelko on Twitter for more population, health, environment, and security updates -
Women Deliver 2010: First Impressions
›Delivering Solutions for Girls and Women
“We know how to intervene; there does not need to be a magical solution,” said Søren Pind, Denmark’s minister for development cooperation, at the June 7 opening ceremony of Women Deliver 2010.
In its second year, the conference has gathered delegates from 146 countries representing hundreds of non-governmental organizations (NGOs), governments, and civil society organizations under the theme “Delivering Solutions for Girls and Women.” Delegates are working to share projects, policies, successes, and innovations in the field of maternal health and to develop strategies to meet Millennium Development Goal 5.
“Recent trends show great progress and this is very encouraging,” said Gamal Serour, president of the International Federation of Gynecology and Obstetrics (FIGO), speaking of a recent study by the Institute of Health Metrics and Evaluation (IHME). The study found that annual maternal mortality has dropped 34 percent–from 526,000 to 342,900–between 1980 and 2008. Nevertheless, Serour maintained that “we are far away from our goal for 2015.”
Overcoming Tradition and Religious Barriers
Investing in women’s health is not only the right thing to do, it is also economically advantageous. When women are healthy, they provide tremendous benefits to their families, communities, and countries. Women contribute to a majority of the small businesses and agricultural activities of developing countries and their unpaid work at home accounts for almost 33 percent of the world’s GDP. Unfortunately, over 215 million of these women do not have access to family planning services, resulting in unwanted pregnancies, childbirth, and maternal deaths.
There are many barriers to family planning in developing countries, not the least of which are cultural and social traditions that can uphold negative gender-based norms. Tailoring campaigns to address these gender inequities was the subject of discussion at the “Cultural Agents of Change Delivering for Women” session, where panelists acknowledged that collaboration and partnership with a wide-range of actors–from members of the local legislature to civil society organizations and actors in the health sector–are necessary to facilitate change.
Graciela Enciso of the Centro de Investigaciones y Estudios Superiores en Antropología Social-Sureste in Mexico, added that advocacy campaigns to increase support for family planning should be “linked with research.” In many traditional societies, strict interpretations of religion are used to control and disempower women; donors and NGOs “need to think outside the religious box at every point,” said Mary E. Hunt, co-director at the Women’s Alliance for Theology, Ethics, and Ritual.
Male Contraception, Gender Roles, and Family Planning
“I think it is important not to hide behind our cultures and religion,” said Ngozi Okonjo-Iweala, managing director of the World Bank. “We need to work with men and work together to overcome gender inequality.” “Male participation” has been a key theme echoed throughout Women Deliver and is often highlighted as a strategy for reducing maternal mortality.
At the “Men Deliver: Men’s Role in Family Planning” breakout session, experts addressed how new and existing technologies in male contraception and shifting gender roles can help to scale up family planning interventions. “Reducing unwanted pregnancies can also be carried out through male contraception,” said John Townsend, vice president of the reproductive health program at the Population Council.
Condoms are traditionally the main method of contraception for men, but usage rates quickly fall over time and to wear a condom “becomes the women’s responsibility,” said Townsend. To address issues around condom usage, development of alternative family planning technologies, such as gels and implants, is underway. As these technologies are being developed, however, it is important for program managers and donors to consider existing gender norms and the willingness of men to utilize new methods.
In researching gender roles in family planning in Zambia, Holo Hochanda, the chief technical administrator of the Planned Parenthood Association of Zambia, determined that there are many entry points for male intervention and increased family planning. “Men are clients, policymakers, and service providers. Each of these roles provides an opportunity to discuss utilization of male contraception and gender inequities in family planning,” he said. “Men can be key mobilizers and agents for change.”
For more coverage on Women Deliver 2010 click here and to learn more about the Wilson Center’s Maternal Health Dialogue Series visit the Global Health Initiative’s website here. -
Improving Transportation and Referral for Maternal Health
›“Referral has been called an orphan cause,” said Patricia Bailey, public health specialist for Family Health International and Columbia University, because it is “everybody’s responsibility and therefore nobody’s responsibility.”
As part of the Maternal Health Dialogue Series the Woodrow Wilson International Center for Scholars’ Global Health Initiative convened a small technical meeting on May 19, 2010, with 25 experts from five countries to discuss their experiences and share lessons, challenges, and recommendations for improving transportation and referral for maternal health. Following the technical meeting, a public dialogue was held on May 20, 2010, to share the knowledge gaps and recommendations identified. The formal report from the technical meeting will be available in the near future.
Mobilizing District Communities in Rural GhanaTo improve maternal health care in Ghana, “we needed to shift [services] to the community level, where 70 percent of our population lives,” said Dr. John Koku Awoonor-Williams, the east regional director of Ghana Health Service. The “Community-based Health Planning and Services” (CHPS) program was created to galvanize local leadership and empower communities to engage in health outreach activities.
Through this approach, “community health officers and nurses are trained and delegated to distant village locations called CH[I]P zones, in which they are responsible for health education, treatment of minor illnesses, maternal and antenatal care, and referral to district hospitals for emergency care,” said Awoonor-Williams. Community health officers use two-way Motorola walkie-talkies to communicate with traditional birth attendants and referral centers. Pregnant women are given the phone numbers so they can call in the event of complications.
1-0-8 Emergency Number for Improving Maternal Health in IndiaMany parts of the developing world do not have a 911-style emergency response service. To address this gap, the GVK Emergency Management & Research Institute in India developed the toll-free 1-0-8 telephone number for all medical, police, and fire emergencies.
“We assure every citizen that wherever you are, [if] you call us we will be there,” said Subodh Satyawadi, chief operating officer of GVK. In order to reach the 433 million people covered by GVK, they have:
“Although we address all kinds of emergencies, we heavily focus on maternal health…31 percent of emergencies are pregnancy-related,” said Satyawadi, who said that GVK’s emergency response system has helped save more than 200,000 mothers. Institutional deliveries have increased in the state of Gujarat by 92 percent. “We have been able to reduce maternal mortality by 20-25 percent in different geographies,” he said.- 19,623 EMTs and 10,000 doctors and other healthcare professionals
- 2,710 ambulances
- 16,300 call-center employees
Pre-Hospital Barriers: Reducing Maternal Morbidity in BoliviaWomen in Bolivia receive free maternal care. In cities like La Paz, emergency obstetric care is often available within a short distance. However, “37 percent of our maternal deaths [occur] at our hospitals,” said Víctor Conde Altamirano, OB/GYN of CARE Bolivia.
To better understand this mortality rate, Altamirano evaluated whether pre-hospital barriers and routine antenatal care are associated with near-miss morbidity. He found that women who are older, have lower levels of education, lack antenatal care, are pregnant for the first time, or live in rural areas are at a greatest risk of illness or death
“We are trying to organize our communities and service facilities, and promote improved health management by the municipalities. If our authorities can be sensitive and invest in health; invest in fuel, drugs, and human resources; we can improve near-miss morbidity rates,” said Altamirano.
Strategies and Recommendations for Improving Transportation & ReferralThe workshop participants agreed on six key topic areas for improving transportation and referral:
1. Multi-sectoral collaboration
The group called for improved multi-sectoral engagement and continuous dialogue among key ministries: Health, Finance, Communication, Social Welfare, Security and Defense, Transportation, and Public Works.
2. Mobile phone technology
3. Public-private partnerships
4. Referral for newborns
5. Indicators for referral
6. Sharing evidence
Private-public partnerships, such as those demonstrated by GVK in India and the CH[I]P program in Ghana, create opportunities for collaboration. “Cell-phone technology can reduce delays in transport and treatment by identifying which facilities might be the most appropriate for referral,” said Bailey.
The final recommendation by the group calls for increased pooling and use of existing evidence to move the transportation and referral agenda forward. Updated synthesis papers on existing evidence are needed, said Bailey. “We have a lot of data that is perhaps less than perfect, but this should not be a barrier for further action,” she said. -
VIDEO: Family Planning in Conflict Areas
›“Displaced people are like every other human being, they want, they need the advantage of family planning. They are asking only for services to be available for them, affordable for them, and acceptable for them,” said Dr. Grace Kodindo in a recent interview with ECSP about the challenges of family planning in conflict regions. The OB/GYN from Chad calls for family planning services to be included in the provisions made for displaced and refugee communities.
Kodindo identified five key barriers to family planning for displaced people, including a lack of coherent policies for displaced people in host countries and a lack of awareness and attention by donors to family planning. Other barriers include the lack of access in remote areas, and a lack of knowledge and therefore demand.
However, in many cases family planning services are very much in demand. One refugee mother compared herself to a “hen being followed by many chicks,” said Kodindo, who “ask[s] the government and the donors to give and to make policy that can really facilitate the provision of services and to provide funding so that services can be available to all these people.”
Kodindo, who recently spoke at a Wilson Center panel on “Family Planning in Fragile States,” is also speaking in DC on Thursday, June 3 at a showing of the documentary about her work in the Democratic Republic of the Congo, Grace Under Fire. -
Voices of World Water Day: Water and Health
›“Inadequate access to water supply, sanitation, and hygiene cause the deaths of over 1.5 million children each year,” Secretary of State Hilary Clinton said at the National Geographic Society and Water Advocates’ “World Water Day 2010” event. Her address marked a warmly welcomed recognition by the U.S. government of the strong connections between water and health.
“Voices of World Water Day” is a video capturing highlights of the discussion on water and health. Created by PATH and Water Advocates, it seeks to keep the messages and momentum from World Water Day alive and to share them with others.
Importantly, Clinton was not alone in her recognition, and her sentiments were widely shared among the event participants representing both the public and private sectors. Congressmen, Clarissa Brocklehurst of UNICEF, and William Asiko of the Coca-Cola Africa Foundation – to name a few – all weighed in on the necessity of clean, available water for public health. -
‘Frontlines’ Interviews John Sewell: “Promoting Development Is a Risky Business”
›May 31, 2010 // By Wilson Center Staff
Q: Foreign assistance has had major achievements over the past 50 years. What are some examples?
SEWELL: There have been many but off the top of my head I can think of three. First, the Green Revolution where the combined efforts of American aid and private foundations revolutionized agriculture in Asia. As a result, many more people lived a much longer time. Second, the efforts put into improving education, particularly of women and girls. The third is population growth. When I started working on development, the best predictions said that global population would rise to over 20 billion at the end of the 20th century. Now we know it will not go much above 9 billion and perhaps lower. That wouldn’t have happened without American leadership and funding.
Q: What are the major failures of foreign assistance?
SEWELL: Failures have occurred either because countries were not committed to development, or because aid agencies designed ineffective programs. But most major failures came about because aid was provided for political reasons— for Cold War purposes in Southeast Asia or the Middle East, not for economic and social development. And we should remember that promoting development is a risky business. If there were no failures, development agencies were being too cautious.
But the more important failures are at the strategic level. Assistance really is only effective when governments and leaders want to speed economic growth, improve health and education, and address poverty. When the government isn’t committed to development, a lot of aid is wasted.
That’s why the choice of countries is so important. Korea is one example. Korean leaders knew how to use foreign aid effectively to build agriculture and industry. Part of that assistance funded investments in health and education. We all know the result.
Egypt, on the other hand, also has received large amounts of American assistance since 1979. But its growth rates are low and they still have one of the highest rates of adult illiteracy in the world.
Perhaps the largest failure has been in Africa. Except for a small number of countries, Africa lags far behind other regions. The blame lies not just with African leaders but also with aid donors who have continued to provide assistance in ways that hinder development.
Q: In what ways can global poverty be reduced quickly in the next three to four years?
SEWELL: In the short term, it won’t happen. The global financial crisis makes that a certainty.
The best estimates are that up to 90 million people will fall back into poverty because they will have lost jobs and livelihoods. The most important thing the U.S. can do in the near term is to continue to lead the reform of the international financial systems that are essential to restarting global economic growth, particularly in the developing world.
Q: That’s the way to reduce poverty?
SEWELL: In the short term, yes. But the U.S. can target aid to build poor peoples’ capacities and can make a great difference. That means aid for education, especially women, and to enable poor people to improve their health. And jobs are critical.
I think the right goal is to empower people to move into the middle class.
That means helping to provide technical assistance and in making low-cost credits for both farmers and small scale entrepreneurs. They will be the generators of jobs that enable men and women to move out of poverty.
Q: Why do you say in one of your papers that economic growth alone will not eliminate poverty?
SEWELL: Because it’s true. Growth does not automatically diminish poverty; it has to be complemented by government actions to share the gains from growth by investing in better health and education. For this you also need a competent state. That’s how the East Asian countries managed to develop so successfully. On the other hand, many Latin American countries have grown at decent rates but have lousy income distribution. But now countries like Brazil are starting to change. For instance, the Brazilian government now pays mothers to keep their children in school where they can get education and health care.
Q: USAID has restrictions that inhibit advertising. How can the public and Congress be informed about the successes and importance of development assistance?
SEWELL: USAID has been very timid about educating the public and Congress. I am not even sure that the earlier successful programs of development education exist anymore. Some steps are easy.
USAID staff knows a lot about development. Why not send them out to talk to public groups around the country? USAID staff doesn’t even participate actively in the yeasty dialogue on development that goes on in the Washington policy community and they should be encouraged to do so. Other changes may require funding and perhaps legislation and the administration should work with the Congress to get them.
Informing the public is particularly important now when there are two major processes underway to modernize U.S. development programs and Congress is rewriting the development assistance legislation.
Q: Since China and Vietnam have both developed without democracy, how important is it to push for democracy and good governance? Are they really necessary?
SEWELL: We need to separate democracy and governance. Very few of the successful developing countries have started out as democracies; India is the big exception. On the other hand, all of the successful countries have had effective governments to do what governments should do: provide security and public goods like health and education, establish the rule of law, and encourage entrepreneurship.
We need to face the fact that no outsider, including the U.S., can “democratize” a country. But it can play an important role in helping to improve governance in committed poor countries. And one of the important parts of successful development is what a Harvard economist calls “conflict mediating institutions” that allow people to deal with the inevitable conflicts that arise within successful development.
Q: You have said that we need to make markets work. How can we help poor people begin to trade when Europe, Japan, and the United States either block imports or subsidize exports?
SEWELL: If you are serious about development, you have to give high priority to trade policy. Unfortunately, USAID seems to have very little voice in trade decisions.
The U.S. needs to focus its development trade policy on the poorest countries. The highest priority should be dropping the remaining subsidies for U.S. production of highly subsidized agricultural products like cotton that can be produced very competitively in very poor countries.
But many of these countries have difficulty selling goods in the U.S., not only because of subsidies, but also because they are not equipped to export. Transport costs are high as are the costs of meeting U.S. health and quality standards, and knowledge of marketing in America is scarce.
Here’s where USAID can play an important complementary role. U.S. companies are already providing technical assistance, some with USAID support. But USAID can expand its trade capacity building programs and focus them on the poorer countries.
Q: What about microcredit?
SEWELL: Microcredit is a very important innovation, especially for empowering poor people, particularly poor women. It’s part of the solution to ending poverty.
But there are other needs. In most poor countries, there are large groups of poor entrepreneurs who are not poor enough to get microcredit but who can’t get commercial banks to lend to them. These are people who produce products for sale— handbags, for instance—that employ 10 to 20 people, but they need capital and advice in order to grow. In the U.S., small businessmen used to borrow money from local banks.That’s how America grew. But similar institutions don’t exist in many poor countries.
Q: We are involved in so many different programs—20 or 30 different federal agencies do some sort of foreign assistance— why not just invest in education and health and let each country figure out what their own development plan should be?
SEWELL: A very good idea. I have long advocated that the U.S. should focus its programs on a few major development issues but I would go beyond just health and education. I add climate change and dealing with global health threats. We dodged the bullet on SARS [severe acute respiratory syndrome] and avian flu but we may not be so lucky in the future. And strengthening governance and strengthening weak states is essential.
The real need now is for some mechanism that oversees and coordinates the multiplicity of agencies that have programs and expertise on these critical issues. Let’s hope that emerges from the current administration’s reviews of development policy
John Sewell a senior scholar at the Woodrow Wilson International Center for Scholars, was interviewed by FrontLines Editorial Director Ben Barber. Originally published in USAID FrontLines, April 2010.The Contradictions That Define China
›As a China follower who has visited the country numerous times over the past 40 years, I have an enduring love affair with the “old” China, which prided itself on balancing the harmony of nature with its decision-making. It is tragically ironic that despite this impressive historical and cultural backdrop, current choices have pushed the country’s harmony with nature beyond the tipping point.
The atmosphere in Chengdu, the capital of Sichuan Province in central China, tells a cautionary tale of China’s current emphasis on economic growth at the expense of its citizens’ health. With lower annual sunshine totals than London, Chengdu’s perpetually grey, cloudy horizon graphically illustrates the massive industrial waste and coal-fired pollution that plague this booming city.
In April, global health experts convened in Chengdu at the 5th International Academic Conference on Environmental and Occupational Medicine, which was co-sponsored by the U.S. Centers for Disease Control and Prevention and Chinese CDC offices, to report on the impact of climate change on public health.
Because of its geography, the mountain-encircled basin in which Chengdu sits is the natural point of release for daily deposits of air pollutants and dust blown in from India and other countries to the west. A rapid series of satellite views presented by John Petterson, director of the Sequoia Foundation, brought gasps from conference attendees, as these accumulated industrial wastes were shown concentrating against the massive southern Tibetan mountain range, then turning grey and black as they moved east, before being deposited on Sichuan’s vulnerable (and already heavily polluted) basin.
Environmental risk factors, especially air and water pollution, are a major–and worsening–source of death and illness in China. Air quality in China’s cities is among the worst in the world, and industrial water pollution is a widespread health hazard.
And although air pollution is clearly a complex global problem, individual nation-states continue to approach this dilemma as though it lies between its borders alone.
Luckily, this conference was prefaced by a number of timely scientific articles on China in the Lancet. The predominantly Chinese authors clearly take the critical risks that we expect from the Lancet, which is a defender of accountability and transparency in global health. This issue brings shame to other publications who still consider their “place” to be protecting the conventional politico-economic emphasis on decision-making inherent to most industrialized countries.
At the conference, public health and climate experts openly voiced their frustration at the blatant privileging of economic priorities over the health of unknowing populations. China–the fastest growing economy in world history, with unprecedented growth driven by external “demand” and precipitous acceleration of domestic consumption–has become the poster-child for global ignorance. However, the West is an equal and essential partner, having moved their manufacturing to China for cheap labor, lax environmental regulations, and higher profits.
Dr. Mark Keim, senior advisor for the CDC’s National Center for Environmental Health, presented irrefutable evidence that root structure erosion from advancing saltwater has led to starvation in Polynesia, the first recorded evidence-based outcome measure of climate change’s public health effects.
At Mark’s request, I presented evidence on the worsening health impacts of rapid urbanization, specifically within urban enclaves that expand due to dense population growth before protective public health infrastructures and systems are in place (forthcoming in Prehospital and Disaster Medicine). Currently, the megacities in Asia and Africa–where sanitation is ignored and infectious disease is prevalent–now have the highest infant and under-age five mortality rates in the world.
Today, we face the largest gap in health indices between the haves and have-nots since the alarming days before the Alma-Ata Declaration. This new health data was an uncomfortable surprise to many conference attendees, most of whom were experts in the physical and environmental sciences.
We have become too “vertical” in our research over the past 50 years, and thus we fail to recognize that solutions to problems facing the global community must be trans-disciplinary and multi-sectoral, and serve multiple ministries and decision-makers.
If not undone by human decisions, global climate change and climate-warming greenhouse gases will rapidly intensify. This effort requires the best collaboration between science and the humanities, as well as the harmonious lessons of the “old” China.
Frederick M. Burkle, Jr., MD, MPH, DTM, is a senior public policy scholar at the Woodrow Wilson Center and a senior fellow of the Harvard Humanitarian Initiative at the Harvard School of Public Health.
Photo Credit: Chengdu skyline in smog, courtesy Flickr user lonely radio.USAID’s Shah Focuses on Women, Innovation, Integration
›May 20, 2010 // By Wilson Center StaffWomen in developing countries are “core to success and failure” of USAID’s plan to fight hunger and poverty, and “we will be focusing on women in everything we do,” said USAID Administrator Rajiv Shah at today’s launch of the “Feed the Future” guide.
But to solve the “tough problem” of how to best serve women farmers, USAID needs to “take risks and be more entrepreneurial,” said Shah, as it implements the Global Hunger and Food Security Initiative.
“A lot of this is going to fail and that’s OK,” Shah said, calling for a “culture of experimentation” at the agency. He welcomed input from the private sector, which was represented at the launch by Des Moines-based Pioneer Hi-Bred.
In one “huge change in our assistance model,” Feed the Future will be “country-led and country-owned,” said Shah, who asked NGOs and USAID implementing partners to “align that expertise behind country priorities” and redirect money away from Washington towards “building real local capacity.” USAID will “work in partnership, not patronage,” with its 20 target countries, he said.
To insure that the administration’s agricultural development efforts are aligned to the same goals, Shah said USAID will collect baseline data from the start on three metrics: women’s incomes, child malnutrition, and agricultural production.
“Whether it is finance, land tenure, public extension, or training efforts, it does not matter whether it is an ‘agricultural development’ category of program,” said Shah. All programs will “provide targeted services to women farmers.”
While Shah briefly mentioned integrating these efforts with the administration’s Global Health Initiative, he only gave one example. Nutrition programs would be tied to health “platforms that already exist at scale” in country, such as HIV, malaria, vaccination, and breastfeeding promotion programs, he said.
Targeting Food Security: The Wilson Center’s Africa Program Takes Aim
If “food supplies in Africa cannot be assured, then Africa’s future remains dismal, no matter how efforts of conflict resolution pan out or how sustained international humanitarian assistance becomes,” says Steve McDonald, director of the Wilson Center’s Africa Program, in the current issue of the Wilson Center’s newsletter, Centerpoint. “It sounds sophomoric, but food is essential to population health and happiness—its very survival—but also to productivity and creativity.”
The May 2010 edition of Centerpoint highlights regional integration, a key focus of U.S. policy, as a mechanism for assuring greater continuity and availability of food supplies. Drawing on proceedings from the Africa Program’s “Promoting Regional Integration and Food Security in Africa” event held in March, Centerpoint accentuates key conclusions on building infrastructure and facilitating trade.
Photo Credit: “USAID Administrator Shah visits a hospital in Haiti” courtesy Flickr user USAID_Images.
