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Ben Ramalingam, Aid on the Edge of Chaos
The Complexity of Scaling Up
›October 11, 2011 // By Wilson Center StaffThe original version of this article, by Ben Ramalingam, appeared on Aid on the Edge of Chaos.
Despite increased prominence and funding of global health initiatives, attempts to scale up health services in developing countries are failing, with serious implications for achieving the Millennium Development Goals. A new paper argues that a key first step is to get a more realistic understanding of health systems, using the lens of complex adaptive systems.
Much ongoing work in development and humanitarian aid is based on the idea of “scaling up” effective solutions. Healthcare is one of the areas where this idea has played a central role – from the World Health Organization’s Health for All in the 1960s to UNICEF’s child healthcare programs, from rolling out HIV-AIDS, malaria and TB treatments to the package of interventions delivered to achieve the Millennium Development Goal on health.
However, despite the fact there are many cost-effective solutions to health problems faced in developing countries, many agencies are still frustrated in their attempts to deliver them at scale. This may be because of a widespread failure to understand the nature of health systems.
Continue reading on Aid on the Edge of Chaos.
Image Credit: Adapted from Table 1, “Understanding pathways for scaling up health services through the lens of complex adaptive systems,” Health Policy and Planning, Oxford University Press. -
Strengthening the Voices of Women Champions for Family Planning and Reproductive Health
›“The health, security, and well-being of families depend importantly on the health of women,” said Carol Peasley, president and CEO of the Centre for Development and Population Activities (CEDPA). “When women have the ability to voluntarily space and limit the number of children they have, maternal and newborn child deaths decrease, as do abortions and abortion-related injuries,” she continued.
Peasley was joined by three panelists on September 28 at the Wilson Center: Dr. Nafis Sadik, special advisor to the UN Secretary General; Tigist Kassa Milko, health communications program coordinator for Panos Ethiopia; and Rosemary Ardayfio, a reporter for the Ghanaian paper, The Daily Graphic.
Ardayfio and Milko both recently participated in a CEDPA-led workshop, which is designed to create effective women champions for family planning and reproductive health.
“The voices of women champions may in fact be the best way to influence policymakers and just average citizens around the world,” said Peasley.
Women’s Rights Essential for Development of All
According to Sadik, women have gained some autonomy over their reproductive health:- Maternal mortality around the world is down by 40 percent compared to 1990 levels;
- Family planning reaches over 65 percent of women who need and want it;
- Many developing countries will achieve parity in girls’ and boys’ education by 2015; and
- Women are increasingly prominent in national and international leadership.
- Women’s literacy rates are still much lower than men’s;
- Pregnancy and childbirth still pose major health risks for women;
- Maternal mortality is the single biggest differential between developed and developing countries;
- We are far from reaching the Millennium Development Goal of reducing maternal mortality by 75 percent; and
- The current unmet demand for family planning (215 million women) is projected to rise by 40 percent by 2050 as the reproductive age population grows.
Local Champions for Local Needs
Although Tigist Kassa Milko and Rosemary Ardayfio come from two African countries hundreds of miles apart, their struggles are eerily similar.
In Ethiopia, the more than 1.5 million women who live in pastoral or nomadic areas shoulder many responsibilities, including walking long distances to fetch food and water for their families. The well-being of these women and their families is further strained by the challenges of climate change and limited health service provision.
To help overcome these obstacles, a number of micro-credit associations now offer female pastoralists alternative livelihood options. Panos Ethiopia also provides “reproductive health, family planning, gender-based violence forums” and “trainings on life skills and saving” to those who come for loans, said Milko.
But “when it’s a choice between walking to get water and walking to get contraceptives, water will win,” said Milko, so it is essential to focus on integrating ways to improve livelihoods, health, and ecosystems – also known as population, health, and environment (PHE) programs.
In Ghana, women also grapple with competing issues of development, poverty, healthcare, and cultural barriers. According to Ardayfio, 35 out of every 100 Ghanaian women want to space or limit births but are not using modern family planning methods. As a journalist, she acknowledged that there are many myths about reproductive health that need to be dispelled. The newspaper she writes for, The Daily Graphic, publishes three articles on women’s health each week.
“The stories of women dying from pregnancy-related causes should continue to be told in a compelling manner until our government makes good on the many international commitments it has signed to,” said Ardayfio. “Our decision-makers should be told again and again that it’s time to scale up family planning.”
Event Resources:
Sources: CEDPA, Guttmacher Institute, Population Reference Bureau, UNESCO, UNICEF, USAID.
Photo Credit: Dave Hawxhurst/Wilson Center. -
Women and Water: Streams of Development
›“One of the things that we consistently learn is that water is a woman’s issue,” said Lisa Schechtman, WaterAid America’s head of policy and advocacy, leading off a September 23 Wilson Center on the Hill panel on gender, water, and development. Schechtman was joined in the discussion by Jae So, director of the World Bank’s Water and Sanitation Program; Christian Holmes, USAID’s Global Water Coordinator; and Geoff Dabelko, moderator and director the Wilson Center’s Environmental Change and Security Program.
Water issues affect everyone, but women often bear the brunt of water collection responsibilities, making them vulnerable to changes in access or sanitation, especially in developing countries. “Studies show that about 26 percent of a rural African woman’s time is spent collecting water,” Schechtman said. “That means that they can’t go to school, they can’t take care of their families, or go to clinics, or spend time generating income, or doing other things in their community like participating in political processes.”
What’s more, as women make the hours-long hike to get water, “they’re risking injury and sexual assault,” Schechtman added. “So there’s a really wide-ranging set of impacts, just out of the actual act of collecting water.”
The Horn of Africa: Severe Problems, Small Changes
In one town in northeastern Kenya, Holmes said women have to travel 12 miles to find water – and even then, they are drawing it from a waterhole shared with wildlife. In Ethiopia, “we have severe problems,” he said, “not the least of which is not just sanitation but also HIV and AIDS,” as HIV/AIDS patients often drink unsanitary water to take their medications. That water gives them diarrheal disease, “so they’re excreting the value of the treatment” – and women, as household caregivers, bear an ever greater burden.
In Somalia, girls drop out of school once they start menstruating because schools do not have latrines that allow them to meet their needs safely and privately. “To think that the lack of a latrine could make you drop out of school and your entire life is going to change overnight – it’s just not acceptable,” said Holmes.
In each of these cases, small changes could dramatically reduce strains on women. Holmes pointed to a USAID project in Kenya that is building wells closer to population centers and empowering women by bringing them into the decisions on developing and managing wells. In Ethiopia, NGOs are working to train women on sanitation and hygiene, which could reduce the burden of illness on women and their families. And in Somalia, the simple addition of women’s latrines at schools would mean girls can continue their education beyond puberty.
Closing the Water Gender Gap
The World Bank’s 2012 World Development Report on Gender Equality and Development recommends that development professionals “look at the gender gaps in basic endowments, like access to health, access to water resources, access to land,” and determine not just how they affect men and women differently but why those gaps exist in the first place, said Jae So.
A CARE and Swiss Development Corporation study of water services in Nicaragua found that when men realized how much of a role water-related activities played in women’s day-to-day lives, “it energized the entire community to really devote their collective resources” towards improving water management, said So.
“Water touches everything else in one’s life,” said Holmes. “You can link it to water and climate change, water and health, water and food, water and conflict, water and education – all are interwoven.”
Event ResourcesSources: The United Nations, UNICEF, USAID, WaterAid America, The World Bank.
Photo Credit: “Repatriated Mamas at the fountain,” courtesy of flickr user Julien Harneis -
Watch: First Impressions From the Inaugural SXSW Eco Conference
›October 6, 2011 // By Schuyler Null
Our director, Geoff Dabelko, provides a brief update from South by Southwest’s (SXSW) first Eco conference, being held in Austin, Texas this week:
Bill Ritter, former governor of Colorado, was impressive in an interview with Bryan Walsh of Time magazine, seamlessly alternating between technical and policy questions about energy security.
Ned Breslin, CEO of Water for People, provided some real talk, challenging the notion that it’s “easy” to provide needy populations with freshwater. It’s not as simple as “$25 saves a life,” he said. Providing long-term, sustainable water and sanitation solutions to people around the world requires a great deal of hard work, particularly on financing and ownership questions.
Finally, Jon Foley of the University of Minnesota’s Institute on the Environment presented a five-step response to what he called today’s three main food challenges: providing enough to feed today’s population, tomorrow’s (an estimated nine billion people by 2050), and doing it all in a sustainable fashion. The Institute on the Environment publishes an almost-quarterly magazine, Momentum, whose work we’ve featured before on New Security Beat (here, here, and here), and, incredibly, is available, delivered to your house, for FREE. Highly recommended.
Stay tuned for more updates from SXSW, including the ECSP-supported panel, “Three Great Ideas That Won’t Be On the Rio+20 Agenda.” -
Watch: Dennis Taenzler on Four Key Steps for REDD+ to Avoid Becoming a Source of Conflict
›The UN Program on Reducing Emissions from Deforestation and Forest Degradation (REDD) provides financial incentives to developing countries to conserve their forests and invest in low-carbon pathways to sustainable development. However, it may also be a potential new source of conflict, says Dennis Taenzler, a senior project manager at adelphi in Berlin, who works on climate and energy policies as well as peace and conflict issues.
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El Niño, Conflict, and Environmental Determinism: Assessing Climate’s Links to Instability
›October 5, 2011 // By Schuyler Null
A recent Nature article on climate’s impact on conflict has generated controversy in the environmental security community for its bold conclusions about links between the global El Niño/La Niña cycle and the probability of intrastate conflict.
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Top 10 Posts for September 2011
›Two Pop Audio interviews – from Rich Thorstein and Karen Seto – joined the top 10 last month (measured by unique pageviews), as well as the launch of Brahma Chellaney’s new book, Water: Asia’s New Battleground, a look at “land grabs” in the context of water access, a crosspost from Edward Carr on food security maps, and Shannon Beebe’s event from last year on his book, The Ultimate Weapon Is No Weapon.
1. Tunisia’s Shot at Democracy: What Demographics and Recent History Tell Us
2. Rich Thorsten on Water Sanitation, Population, and Urbanization in the Developing World
3. In Search of a New Security Narrative: The National Conversation at the Wilson Center
4. India’s Maoists: South Asia’s “Other” Insurgency
5. Guest Contributor Jim Duncan: Redrawing the Map of the World’s International River Basins
6. In the Rush for Land, Is it All About the Water?
7. Karen Seto on the Environmental Impact of Expanding Cities [Part One]
8. Food Security and Conflict Done Badly…, via Edward Carr, Open the Echo Chamber
9. Water: Asia’s New Battleground
10. The Ultimate Weapon Is No Weapon: Human Security and the New Rules of War and Peace -
Weathering Change: New Film Links Climate Adaptation and Family Planning
›“Our planet is changing. Our population is growing. Each one of us is impacting the environment…but not equally. Each one of us will be affected…but not equally,” asserts the new documentary, Weathering Change, launched at the Wilson Center on September 22. The film, produced by Population Action International (PAI), explores the devastating impacts of climate change on the lives of women in developing countries through personal stories from Ethiopia, Nepal, and Peru. Family planning, argue the filmmakers, is part of the solution.
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