Showing posts from category global health.
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Zo Zatovonirina, PHE Champion
Improving Human Health and Conservation in Madagascar’s Forest Communities
›This PHE Champion profile was produced by the BALANCED Project.
Madagascar is one of the world’s most unique ecosystems, with a total of eight plant families, five bird families, and five primate families that live nowhere else on Earth. Madagascar’s tropical forests and marine environments are home to endemic species of flora and fauna, although tragically 15 species are now extinct. At the same time, Madagascar is rich in freshwater resources, yet more than 60 percent of the island’s 19.7 million people do not have access to safe drinking water.Since 2003, Zo Zatovonirina has worked for Conservation International (CI) in Madagascar, and he has seen up-close the challenges of reaching remote forest communities, often requiring one- or two-day hikes over treacherous roads. As coordinator for USAID’s Healthy Families, Healthy Forests Program, Zo worked with two Malagasy nongovernmental organizations (NGOs), MATEZA, and the Association for Health Action and Security, to implement integrated population, health, and environment (PHE) approaches in response to community needs in the Ankeniheny Zahamena forest corridor in eastern Madagascar.
From 2003-2008, CI and partners reached more than 25,000 village residents with PHE messages; increased contraceptive prevalence in target zones from 17 percent in 2005 to 30 percent in 2008; constructed 3,000 latrines; and improved environmental health in all priority sites.
Today, biodiversity in Madagascar is under increased pressure, in light of political instability since 2009 and continued population pressures. Recognizing CI and partner experience and investments in conservation efforts to improve human well-being, USAID Madagascar and World Learning recently awarded a new 15-month grant to CI Madagascar and two Malagasy NGO partners – Voahary Salama and Ny Tanintsika – to implement an integrated PHE project in the southeastern Ambositra Vondrozo forest corridor. All three organizations have implemented PHE projects in Madagascar, and they have established trusting relationships with the people living in these fragile ecosystems.
Madagascar has a rich history of implementing successful PHE projects, and this project represents a new PHE pilot phase in the midst of political uncertainty. According to Zo, PHE approaches remain constant – simultaneously addressing several complex and linked problems such as poverty, child survival, and unsustainable dependency on natural resources. In Zo’s experience, CI’s PHE approach touches on all these aspects and delivers a pragmatic, integrated package of interventions designed to increase community capacity to better manage their health and environment. Utilizing PHE approaches, CI, Voahary Salama, and Ny Tanintsika will strive to reach communities for the first time ever with family planning, water, sanitation, and hygiene services while helping them conserve their biological heritage.
This PHE Champion profile was produced by the BALANCED Project. A PDF version can be downloaded from the PHE Toolkit. PHE Champion profiles highlight people working on the ground to improve health and conservation in areas where biodiversity is critically endangered.
Photo Credit: The forests of Madagascar, courtesy of Conservation International/Russ Mittermeier, and Zo Zatovonirina, courtesy of Conservation International. -
Jay Ulfelder, Dart-Throwing Chimp
Public-Health Campaigns as Outsized Threats to Authoritarian Rule
›August 17, 2011 // By Wilson Center StaffThe original version of this article, by Jay Ulfelder, appeared on his blog, Dart-Throwing Chimp.
Are certain forms of popular activism more likely to hasten the fall of dictatorships than others? This question occurred to me after reading a recent Washington Post story describing how one Russian woman, Darya Makarova, has turned her own frustration with the poor health care given to her (now dead) young son into a wider campaign that’s has caught Moscow’s eye:Thousands have turned out for her rallies, written letters, signed petitions or joined in Internet forums. Since Maxim’s death in November, she has raised money to reopen a children’s clinic, with an emergency room, in her community. She has shamed the city into buying three new ambulances, with proper equipment. She has launched a nonprofit organization, Health Care for Children, that has national ambitions. Politicians have sought her out. Pavel Astakhov, who holds the newly created title of children’s ombudsman, came from Moscow to see her – and then appointed her his unpaid deputy, giving her more access and clout. Even officials from the sprawling and notoriously indifferent Health Ministry started to pay attention.
I can see why government officials would be nervous about this still-modest and outwardly apolitical campaign. Popular activism around matters of public health and safety seems like it should pose a special challenge to authoritarian regimes, like Russia’s, that stake their right to rule on paternalistic claims about their ability to deliver both social welfare and social protection.
Movements organized around failures of public health and safety are threatening to these regimes because they call out the paternalistic state for failing at its own game. Whatever the form of government involved, one of the modern state’s fundamental roles is to protect its citizens from public health threats. Even when they serve this function poorly, most autocrats claim to be trying, and these campaigns reveal that they are not succeeding.
Continue reading on Dart-Throwing Chimp.
Photo credit: “Your Health rests with…,” courtesy of flickr user okeos. -
Russell Sticklor, World Politics Review
The Hungry Planet: Global Food Scarcity in the 21st Century
›August 16, 2011 // By Wilson Center StaffThe original version of this article, by Russell Sticklor, appeared on World Politics Review.
At the dawn of the 20th century, the world population was inching toward a modest two billion. In the 111 years since, notwithstanding the impact of war, genocide, disease, and famine, the global population has soared, reaching three billion around 1960 and now quickly approaching the neighborhood of seven billion. By 2050, the planet will likely be home to two billion more.
We may not be witnessing the detonation of the “population bomb” that Paul Ehrlich warned of in his seminal 1968 book, but such rapid demographic change is clearly pushing the international community into uncharted territory. With a limited amount of arable land and a finite supply of fresh water for irrigation, figuring out how to feed a planet adding upward of 70 million people each year looms as one of the 21st century’s most pressing challenges.
The push to ensure global food security transcends the desire to avoid repeating the famines that devastated the Soviet Union, China, North Korea, Ethiopia, and so many other corners of the world during the past century. Instead, aid and development organizations today rightly view food insecurity problems as deeply intertwined with issues of economic development, public health, and political stability, particularly in the developing world. To maintain order in the international community and prevent the emergence of new failed states in the decades ahead, it will be critical to find innovative means of feeding the rapidly growing populations of sub-Saharan Africa, the Middle East, and South and East Asia.
Continue reading on World Politics Review.
Note: World Politics Review has graciously white-listed all entrances from NSB for this article, so as long as you use the above link, you should be able to read the full article for free.
Russell Sticklor is a consultant for the Environmental Change and Security Program.
Photo Credit: “Crowded market street,” courtesy of flickr user – yt –. -
Benefits of Integrating Population, Health, and Environment
›“Mainstreaming Environment and Climate Change: Health,” a joint publication from the International Institute for Environment and Development and Irish Aid, is part of a series that aims to show the links between the environment, climate change, and key development sectors, while suggesting key solutions to move into national policies. This health-focused briefing asserts that “nearly one quarter of the global disease burden can be attributed to the environment.” While anyone is prone to the negative effects of climate change, the poor are especially vulnerable because they often live in some of the most precarious environmental conditions. Consequently, the briefing argues that “improving environmental health – raising its profile at national, state and local levels, and integrating environmental health issues into development plans and activities – is critical if we are to reduce poverty and meet the Millennium Development Goals.”In An Assessment of the Benefits of Integrating Family Planning and Environmental Management Activities in the Visayas Region of the Philippines, a study from the University of Rhode Island’s Coastal Resources Center, authors Richard B. Pollnac and Kira Dacanay argue that benefits can be reaped from integrated population, health and environment (PHE) development, but only under certain conditions. Factors influencing the level of benefits include “levels of participation in integrated projects [both by individuals and communities], and how NGOs implement these projects.” Thus, it is important to “tailor strategies based on place-based context and personal characteristics of different participants,” write Pollnac and Dacanay. In the Philippines, the authors suggest that one of the actions future PHE initiatives should take is to “stimulate more project participation, with special efforts in larger, less dense communities and tailor strategies better to different targeted populations within the community.” -
Fistula, Stigmatization, and Development
›Although obstetric fistula may not be as widely recognized as other maternal health issues, the Fistula Foundation estimates that over two million women and girls in developing countries suffer from this condition today. The World Health Organization has labeled it as “the single most dramatic aftermath of neglected childbirth.”
Obstetric fistula is a devastating condition often resulting from obstructed labor that can cause infections, incontinence, and even paralysis. The condition largely afflicts poor, rural, and illiterate women in developing countries who lack resources and access to emergency care and surgery, and sufferers often face an additional burden of social stigma.
Economic Development and Social Standing
Poor infrastructure and poverty significantly increases the occurrence rate of obstetric fistula. Lewis Wall, in an article for The Lancet, writes that “poverty is the breeding-ground where obstetric fistulas thrive.” Wall cites early marriage, low social status of women, malnutrition, inadequately developed social and economic infrastructures, and lack of access to emergency obstetric services as being major contributors of fistulas in developing countries.
Additionally, “postponing the age of marriage and delaying childbirth can significantly reduce the risk of subjecting young women to the arduous labor that induces fistulas,” wrote Sonny Inbaraj of Inter Press Service News Agency (IPS) in an article about how fistula makes social outcasts of child brides.
In most developing societies where child marriage is common, the social standing of women is defined largely in terms of marriage and childbearing. Child marriages are typically arranged without the knowledge or consent of the girls involved. The norms emphasize a girl’s domestic roles and de-emphasize investments such as education.
Stigmatization of Fistula
There is an undeniable link between fistula and social stigmatization. Rather than receiving assistance from their families and communities, women are often ostracized and in many instances exiled from their communities. This is especially true in developing countries where “the role of women is merely limited to providing sexual satisfaction for their husbands, [and] producing children,” said Dr. Catherine Hamlin, founder of the Addis Ababa Fistula Hospital, in an interview with IPS.
“Many women and girls with fistula endure lives of shame, misery, violence, and poverty,” said Agnes Odhiambo, Africa women’s rights researcher and author of ‘I Am Not Dead, But I Am Not Living‘: Barriers to Fistula Prevention and Treatment in Kenya, in a Human Rights Watch article. Human Rights Watch has focused on fistula, recognizing that birth is a human rights issue. Ignoring the issues of women and girls only diminishes progress on human rights and sends a message that says the rights of women do not deserve adequate attention.
Prevention Efforts
Thus far the fight to end fistula has attracted various government agencies and organizations including USAID, UNFPA, EngenderHealth, Maternal Health Task Force, and the Human Rights Watch. Outstanding individuals have also played a key role in fistula prevention efforts, like Drs. Reginald and Catherine Hamlin, Australian gynecologists who came to Addis Ababa in 1959 for temporary medical work, but after hearing heart-breaking stories from fistula patients, they decided to move to Ethiopia permanently and open the Addis Ababa Fistula Hospital. As the only hospital dedicated exclusively to women with obstetric fistula, the hospital provides care free of change, and has done so since 1974.
Although fistula has gotten some support and attention, the need to scale-up the prevention initiatives has never been greater. As a result of the “poverty and the stigma associated with their condition, most women living with fistulas remain invisible to policy makers both in their own countries and abroad,” wrote Inbaraj on IPS.
“Preventing fistula and restoring women’s health and dignity requires more than good policies on paper,” said Odhiambo at Human Rights Watch. Seriously tackling the issue will require much more than traditional medical and public health interventions – prevention efforts must also take into account underlying social issues, food and economic security.
Sources: The Addis Ababa Fistula Hospital, Campaign to End Fistula, The Center for Global Development, The Fistula Foundation, Human Rights Watch, The Lancet, World Health Organization.
Photo Credit: “Hauwa’u, 25, mother from Rogogo community,” courtesy of flicker user DFID-UK Department for International Development. -
What’s the Impact of Family Planning in the Developing World? ‘Science’ Magazine’s Population Issue
›“Does Family Planning Bring Down Fertility” in Science’s special July issue on population, author Jocelyn Kaiser engages various experts to explore whether family planning programs actually help to reduce high fertility. Social demographer Amy Tsui of Johns Hopkins University argues that surveys indicating “unmet need” in family planning “don’t tell us anything about causation.” On the other hand, Martha Campbell, a lecturer at the University of California, stressed that in countries such as Niger where the population could soar from 16 million today to 58 million by 2050, “You can’t expand [schools] fast enough.” Thus, focusing on family planning is indispensable and “the benefits [will] far outweigh the costs.”In “Population Policy in Transition in the Developing World,” also published in the population issue of Science, authors John Bongaarts and Steven Sinding explain why there has been renewed interest on family planning in developing countries. Since rapid population growth in the poorest countries is hampering development, “economists, once notably skeptical, increasingly acknowledge that fertility decline has beneficial economic effects for nations and families,” they write. Moving forward, Bongaarts and Sinding suggest family planning needs to be at the forefront of population and development discussions. Not only is family planning “cost effective,” they write, but it is responsible for “relieving population pressures, stimulating economic development, improving health, and enhancing human freedom.”
See the full line-up of articles from Science’s population edition here. -
Population, Health, and Environment Approaches in Tanzania
›“Quality of life, human health, food security, and biodiversity are all connected,” said Elin Torell, research associate for the BALANCED Project and the University of Rhode Island Coastal Resource Center. Torell was joined at the Wilson Center on July 19 by Patrick Kajubili from the Tanzania Coastal Management Partnership, and Alice Macharia, director of the East Africa Program at the Jane Goodall Institute to discuss the importance of integrated population, health, and environment (PHE) initiatives that work to simultaneously improve health and livelihoods, manage natural resources, and conserve ecosystems in Tanzania.
Building Resilient Coastal Communities
The Coastal Resources Center’s work in Tanzania’s Saadani National Park provides an example of an integrated PHE approach that sustains the flows of environmental goods and services, maintains biological diversity, and empowers and improves the wellbeing of local residents, said Torell. Since 1996, the CRC has focused on protecting sea turtles, promoting energy-saving stoves, and tracking elephants, while at the same time improving livelihoods through savings and credit associations, eco-tourism, and beekeeping.
“Adding family planning makes a whole lot of sense,” said Torell. There is a high unmet need for family planning in Tanzania and the population is growing rapidly with an average number of 5.6 children per woman. Family planning not only helps families limit and space births but indirectly works to improve food security and human health, reduce demand for scarce natural resources, and empower women, she said.
“Integration is key,” concluded Torell: A coordinated and synergistic approach that meets the varied needs of local communities will be more effective and sustainable than if interventions were delivered independently.
Effective Integration in the Field
“Conceptual linking is not enough,” said Kajubili. “Integration also needs to happen at the organizational and field levels.”
On the ground, the Tanzania Coastal Management Partnership integrates family planning education and services into conservation work, said Kajubili. Peer educators deliver information about family planning, health, and coastal resources management; and community-based distributors deliver family planning services and supplies.
“Now people easily access reproductive health services,” said Kajubili. To date, the program has increased referrals to health centers, promoted contraceptive use, and reduced the distance that women need to travel to receive family planning services.
“Integration makes sense and cents,” said Kajubili. By combining resources, health and natural resource management organizations can potentially reach a broader population while sharing costs.
But “reinforcing the linkages between PHE of course takes time and education,” said Kajubili, highlighting a major challenge to implementing integrated approaches. “Advocacy is needed to overcome cultural and institutional barriers.”
“What About Our Needs?”
“Socio-economic development; family planning and AIDS education; sustainable forestry and agriculture practices; and water and sanitation all underpin and support sustainable natural resource management,” said Macharia.
The Lake Tanganyika Catchment Reforestation and Education Project (TACARE) led by the Jane Goodall Institute was initiated in 1994 to arrest the rapid degradation of land through tree planting and forest degradation, said Macharia. “But at some point, the communities raised the question: What about our own needs?” she said.
Community members prioritized the need for health services, education, clean water, and financial capital. But environmental degradation was not seen as a major issue, suggesting a need for a more integrated approach to TACARE’s conservation efforts.
“Integrated programs including population, health, and environment activities are cost-efficient and add value to conservation goals,” said Macharia. By responding to the needs of the community, the integrated approach adopted by TACARE has gained more credibility among local people, while a strong focus on building local capacity has helped to ensure sustainability of the program.
While there are many challenges to implementing and maintaining integrated PHE programs, “partnerships at the local, district, and national level are key to making this a success,” concluded Macharia.
Sources: Population Reference Bureau.
Photo Credit: “Environment near Vumari Village,” courtesy of flickr user treesftf. -
Reducing Health Inequities to Better Weather Climate Change
›In an article appearing in the summer issue of Global Health, Dr. Margaret Chan, director-general of the World Health Organization (WHO), brings to light what she calls the starkest statistic in public health: the vast difference in the mortality rates between rich and poor countries. For example, the life expectancy of a girl is doubled if she is born in a developed country rather than in a developing country. Chan writes that efforts to improve health in developing countries now face an additional obstacle: “a climate that has begun to change.”
Climate change’s effect on health has increasingly moved into the spotlight over the past year: DARA’s Climate Vulnerability Monitor measures the toll that climate change took in 2010 on human health, estimating some 350,000 people died last year from diseases related to climate change. The majority of these deaths took place in sub-Saharan Africa, where weak health systems already struggle to deal with the disproportionate disease burden found in the region. The loss of “healthy life years” as a result of global environmental change is predicted to be 500 times greater in poor African populations than in European populations, according to The Lancet.
The majority of these deaths are due to climate change exacerbating already-prominent diseases and conditions, including malaria, diarrhea, and malnutrition. Environmental changes affect disease patterns and people’s access to food, water, sanitation, and shelter. The DARA Climate Vulnerability Monitor predicts that these effects will cause the number of deaths related to climate change to rise to 840,000 per year by 2030.
But few of these will be in developed countries. With strong health systems in place, they are not likely to feel the toll of a changing environment on their health. Reducing these inequities can only be achieved by alleviating poverty, which increases the capacity of individuals, their countries, and entire regions to adapt to climate change. It would be in all of our interests to do just this, writes Chan: “A world that is greatly out of balance is neither stable nor secure.”
Sarah Lindsay is a program assistant at the Ministerial Leadership Initiative for Global Health and a Masters candidate at American University.
Sources: DARA, Global Health, The Lancet, World Health Organization.
Image Credit: Henry J. Kaiser Family Foundation and the World Health Organization.
