Showing posts from category livelihoods.
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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. -
Emily Puckart, MHTF Blog
Maternal Health in Kenya From a Human Rights Perspective
›The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog. This is the second post about MHTF and the Woodrow Wilson Center’s trip to Nairobi, Kenya to host a cross-Atlantic web-cast meeting on “Maternal Health Challenges in Kenya: What New Research Shows.” The first is available here along with video of the conference.
“Do you want to be a pregnant woman or a prisoner in Kenya?” asked Dr. Margret Meme, one of speakers in Nairobi at the recent policy dialogue “Maternal Health Challenges in Kenya: What New Research Shows.” She explained that the last prisoner killed in Kenya through capital punishment was over 20 years ago, yet pregnant women continue to die of treatable causes not just in Kenya, but globally.
As Dr. Meme addressed maternal health through the lens of a human rights perspective she highlighted a number of recommendations in order to more adequately address maternal health challenges in Kenya. She was concerned that pregnancy was treated more like a medical disease with purely medical solutions. Dr. Meme urged maternal health advocates to also focus on the cultural, social, gender, and economic factors that influence maternal health and asked that these factors be addressed along with medical solutions in order to truly address maternal health challenges.
Naturally, addressing maternal health challenges can come with a monetary price. However, instead of viewing that cost as a cost that must come after more immediate government priorities such as infrastructure and defense, Dr. Meme argued that cost should be borne as the government would bear any other cost for public goods. As pregnancy builds a nation, Dr. Meme argued that maternal health is a public good, in the same vein as defense. Therefore maternal health should have a budget allocation that is just as important as the budget line for defense.
Of course, pushing for more public funding of maternal health can lead to other complications. If advocates successfully encourage politicians to increase funding for maternal health programs, the work of maternal health advocates cannot simply end there. Advocates should hold governments accountable; not just in putting aside funding for maternal health, but also for actually making sure that the money reaches the intended beneficiaries. Therefore budget accountability tracking mechanisms should go hand and hand with pushing for increased public funding to maternal health programs.
Finally, Dr. Meme addressed the need for men to be more involved in maternal health. As she clearly stated; the role of men in maternal health shouldn’t stop at conception. Men focused programs which clarify reproductive and sexual health rights, as well as educate men on issues of maternal mortality and morbidity should encourage men to respect the rights of women to space their pregnancies and deliver their babies safely.
Emily Puckart is a senior program assistant for the Maternal Health Task Force (MHTF).
Photo Credit: Jonathan Odhong, African Population and Health Research Center. -
Second Generation Biofuels and Revitalizing African Agriculture
›In “A New Hope for Africa,” published in last month’s issue of Nature, authors Lee R. Lynd and Jeremy Woods assert that the international development community should “cut with the beneficial edge of bioenergy’s double-edged sword” to enhance food security in Africa. According to Lynd and Woods, Africa’s severe food insecurity is a “legacy of three decades of neglect for agricultural development.” Left out of the Green Revolution in the 1960s, the region was flooded with cheap food imports from developed nations while local agricultural sectors remained underdeveloped. With thoughtful management, bioenergy production on marginal lands unfit for edible crops may yield several food security benefits, such as increased employment, improved agricultural infrastructure, energy democratization, land regeneration, and reduced conflict, write the authors.The technological advancements of second-generation biofuels may ease the zero-sum tension between food production and bioenergy in the future, writes Duncan Graham-Rowe in his article “Beyond Food Versus Fuel,” also appearing last month in Nature. Graham-Rowe notes that current first-generation biofuel technologies, such as corn and sugar cane, contribute to rising food prices, require intensive water and nitrogen inputs, and divert land from food production by way of profitability and physical space. There is some division between second-generation biofuel proponents: some advocate utilizing inedible parts of plants already produced, while others consider fast-growing, dedicated energy crops (possibly grown on polluted soil otherwise unfit for human use) a more viable solution – either has the potential to reduce demand for arable land, says Graham-Rowe. “Advanced generations of biofuels are on their way,” he writes, it is just a matter of time before their kinks are worked out “through technology, careful land management, and considered use of resources.” -
Emily Puckart, MHTF Blog
Maternal Health Challenges in Kenya: An Overview of the Meetings
›The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog.
I attended the two day Nairobi meeting on “Maternal Health Challenges in Kenya: What New Research Evidence Shows” organized by the Woodrow Wilson International Center and the African Population and Health Research Center (APHRC). [Video Below]
First, here in Nairobi, participants heard three presentations highlighting challenges in maternal health in Kenya. The first presentation by Lawrence Ikamari focused on the unique challenges faced by women in rural Kenya. Presently Kenya is still primarily a rural country where childbearing starts early and women have high fertility rates. A majority of rural births take place outside of health institutions, and overall rural women have less access to skilled birth attendants, medications, and medical facilities that can help save their lives and the lives of their babies in case of emergency.
Catherine Kyobutungi highlighted the challenges of urban Kenyan women, many of whom deliver at home. When APHRC conducted research in this area, nearly 68 percent of surveyed women said it was not necessary to go to health facility. Poor road infrastructure and insecurity often prevented women from delivering in a facility. Women who went into labor at night often felt it is unsafe to leave their homes for a facility and risked their lives giving birth at home away from the support of skilled medical personnel and health facilities. As the urban population increases in the coming years, governments will need to expend more attention on the unique challenges women face in urban settings.
Finally, Margaret Meme explored a human rights based approach to maternal health and called on policymakers, advocates, and donors to respect women’s right to live through pregnancies. Further, she urged increased attention on the role of men in maternal health by increasing the education and awareness of men in the area of sexual and reproductive health as well as maternal health.
After these initial presentations, participants broke out into lively breakout groups to discuss these maternal health challenges in Kenya in detail. They reconvened in the afternoon in Nairobi to conduct a live video conference with a morning Washington, DC audience at the Woodrow Wilson Center. It was exciting to be involved in this format, watching as participants in Washington were able to ask questions live of the men and women involved in maternal health advocacy, research and programming directly on the ground in Kenya. It was clear the excitement existed on both sides of the Atlantic as participants in Nairobi were able to directly project their concerns and hopes for the future of maternal health in Kenya across the ocean through the use of video conferencing technology.
There was a lot of excitement and energy in the room in Nairobi, and I think I sensed the same excitement through the television screen in DC. I hope that this type of simultaneous dialogue, across many time zones, directly linking maternal health advocates around the globe, is an example of what will become commonplace in the future of the maternal health field.
Emily Puckart is a senior program assistant at the Maternal Health Task Force (MHTF).
Photo Credit: MHTF. -
Edward Carr, Open the Echo Chamber
Drought Does Not Equal Famine
›July 27, 2011 // By Wilson Center StaffThe original version of this article, by Edward Carr, appeared on Open the Echo Chamber.
After reading a lot of news and blog posts on the situation in the Horn of Africa, I feel the need to make something clear: The drought in the Horn of Africa is not the cause of the famine we are seeing take shape in southern Somalia. We are being pounded by a narrative of this famine that more or less points to the failure of seasonal rains as its cause…which I see as a horrible abdication of responsibility for the human causes of this tragedy.
First, I recommend that anyone interested in this situation – or indeed in food security and famine more generally, to read Mike Davis’ book Late Victorian Holocausts. It is a very readable account of massive famines in the Victorian era that lays out the necessary intersection of weather, markets, and politics to create tragedy – and also makes clear the point that rainfall alone is poorly correlated to famine. For those who want a deeper dive, have a look at the lit review (pages 15-18) of my article “Postmodern Conceptualizations, Modernist Applications: Rethinking the Role of Society in Food Security” to get a sense of where we are in contemporary thinking on food security. The long and short of it is that food insecurity is rarely about absolute supplies of food – mostly it is about access and entitlements to existing food supplies. The Horn of Africa situation does actually invoke outright scarcity, but that scarcity can be traced not just to weather – it is also about access to local and regional markets (weak at best) and politics/the state (Somalia lacks a sovereign state, and the patchy, ad hoc governance provided by Al Shabaab does little to ensure either access or entitlement to food and livelihoods for the population).
For those who doubt this, look at the Famine Early Warning System Network (FEWS NET) maps I put in previous posts here and here (Editor: also above). Famine stops at the Somali border. I assure you this is not a political manipulation of the data – it is the data we have. Basically, the people without a functional state and collapsing markets are being hit much harder than their counterparts in Ethiopia and Kenya, even though everyone is affected by the same bad rains, and the livelihoods of those in Somalia are not all that different than those across the borders in Ethiopia and Kenya. Rainfall is not the controlling variable for this differential outcome, because rainfall is not really variable across these borders where Ethiopia, Kenya, and Somalia meet.
Continue reading on Open the Echo Chamber.
Image Credit: FEWS NET and Edward Carr. -
Leona D’Agnes on Evaluating PHE Service Delivery in the Philippines
›“By reducing population growth, we are going to have a better chance of sustaining the gains of an environmental conservation project,” said Leona D’Agnes in this interview with ECSP. D’Agnes, a technical advisor to PATH Foundation Philippines, served as lead author on a research article published late last year in Environmental Conservation titled, “Integrated Management of Coastal Resources and Human Health Yields Added Value: A Comparative Study in Palawan (Philippines).” The study provided concrete statistical evidence that integrated development programming incorporating population, health, and the environment (PHE) can be more effective in lowering population growth rates and preserving critical coastal ecosystems than single-sector development interventions.
“What set this research apart from earlier work on integrated programming was the rigorous evaluation design that was applied,” said D’Agnes. “What this design aimed to do is to evaluate the integrated approach itself. Most of the previous evaluations that have been done on integrated programming were impact evaluations — they set out to evaluate the impact of the project.” This most recent research project, on the other hand, sought to evaluate the effectiveness of cross-sectoral interventions based on “whether or not synergies were produced,” said D’Agnes.Although it took her team six years to generate statistically significant findings in Palawan, D’Agnes reports that the synergies of PATH Foundation Philippines’ PHE intervention took the form of reduced income poverty, a decreased average number of children born to women of reproductive age, and the preservation of coastal resources, which helped bolster the region’s food security.
Going forward, D’Agnes said, an integrated approach to environmental conservation should also prove appealing because of its cost effectiveness. “This has huge implications for local governments in the Philippines, where they are struggling to meet the basic needs of their constituents in the face of very small internal revenue allotments that they get from the central government,” she said. “They can really pick up on this example to see that at the local level, if somehow they can do this integrated service delivery that was done in the Integrated Population and Coastal Resource Management (IPOPCORM) model, that they’ll be able to achieve the objectives of both their conservation and their health programs in a much more cost-effective way, and, in the process, generate some other [positive] outcomes that perhaps they didn’t anticipate.”
D’Agnes expects the study’s results will prompt a fresh look at cross-sectoral PHE programming. “I hope that this evidence from this study will help to change the thinking in the conservation community about integrated approaches to conservation and development,” she said.
The “Pop Audio” series is also available as podcasts on iTunes. -
Vik Mohan, Rebecca Hill, and Alasdair Harris
In FOCUS: To Live With the Sea: Reproductive Health Care and Marine Conservation in Madagascar
›July 12, 2011 // By Wilson Center StaffDownload FOCUS Issue 23: “To Live With the Sea: Reproductive Health Care and Marine Conservation in Madagascar,” from the Wilson Center.
Christine does not know how old she is. She has 16 children and lives on a remote island off the southwestern coast of Madagascar. She and her children, like other members of the Vezo ethnic group, depend entirely on the ocean for their survival. Her husband, a fisherman, struggles to catch enough to feed his family.
In this isolated area, most girls have their first child before the age of 18, and families with 10 children or more are commonplace. But since the marine conservation NGO Blue Ventures launched a family planning program in 2007, couples and women like Christine are able to make their own reproductive health choices.
Blue Ventures’ Vik Mohan, Rebecca Hill, and Alasdair Harris argue that their integrated approach, which combines reproductive health care and education with conservation and alternative livelihoods, offers these communities – and the marine environment on which they depend – the best possible chances of survival.
