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Integrating HIV/AIDS and Maternal Health Services
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Integrating maternal health and HIV/AIDS services “includes organizing and providing services that meet several needs simultaneously…focusing not only on the condition, but also the individual,” argued Dr. Claudes Kamenga, Senior Director of Technical Support and Research Utilization at Family Health International, during the first event of the Advancing Policy Dialogue on Maternal Health series co-convened by the Wilson Center’s Global Health Initiative, Maternal Health Task Force (MHTF), United Nations Population Fund (UNFPA), and technical support from U.S. Agency for International Development (USAID). Joined by Michele Moloney-Kitts, assistant coordinator at the Office of the U.S. Global AIDS Coordinator, and Harriet Birungi, a program associate with the Population Council in Kenya, the panelists discussed how integration of HIV/AIDS and maternal health services not only improves health outcomes, but also increases program efficiencies, strengthens health systems, and saves money.
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Climate Combat? Security Impacts of Climate Change Discussed in Copenhagen
›Leaders from the African Union,the European Union, NATO, and the United Nations have agreed unanimously that climate change threatens international peace and security, and urged that the time for action is now.
In Copenhagen Tuesday, Anders Fogh Rasmussen, the secretary-general of NATO; Jean Ping, the chairperson of the Commission of the African Union; and Helen Clark, the administrator of the UN Development Programme, were joined by Carl Bildt and Per Stig Møller, foreign ministers of Sweden and Denmark respectively, to take part in a remarkable public panel discussion organized by the Danish Ministry of Foreign Affairs.
The leaders agreed climate change could hold serious implications for international security, both as a “threat multiplier” of existing problems and as the cause of conflict, under certain conditions.
Møller suggested there is evidence that higher temperatures in Africa could be directly linked to increases in conflict. Ping emphasized that African emissions make up only 3.8 per cent of the climate problem, though Africa will likely suffer some of its most serious impacts. Fogh Rasmussen warned of the dangers of territorial disputes over the Arctic as the sea ice recedes. “We need to stop the worst from happening,” said Clark.
While there was broad agreement on the seriousness of the challenge, the participants differed on what should be done. Responding to a question from the audience, Bildt argued that Europe should not necessarily throw open its doors to climate migrants, but that the bloc needed to help countries deal with climate change so people can stay at home. Clark argued that enlightened migration policy could meet two sets of needs: reversing declining populations in the North while providing a destination for unemployed workers from the South.
Fogh Rasmussen said militaries can do much to reduce their use of fossil fuels. He noted that 170 casualties in Afghanistan in 2009 have been associated with the delivery of fuel. There is no contradiction, he argued, between military efficiency and energy efficiency.
However, the real significance of the climate-security event lay not in what these leaders said, but that they were there to say it at all. Not many issues can gather the heads of the AU, NATO, and the UNDP on the same platform, alongside the foreign ministers of Sweden and Denmark. This event proved that climate change has become a core concern of international policymakers.
The only way to tackle global problems, as Ping argued, is to find global solutions. And a clear understanding of the potentially devastating security implications of climate change might be one way to bring about those global solutions.
“We are all in the same ship, and if that ship sinks, we will all drown,” said Ping.
Oli Brown is senior researcher and program manager at the International Institute for Sustainable Development (IISD). Read more of IISD’s postings on its blog.
Photo: Courtesy United Nations Photo. -
Google’s Fight Against Climate Change
›After erroneous reports last January that “two Google searches generate the same carbon dioxide as boiling a kettle for a cup of tea,” Google is making environmental news for the right reasons, with the launch of its Google Earth-integrated climate change “tours.”
Narrated by the “Governator” himself, the most recent tour combines stunning graphics, images, and data to illustrate how climate change will impact California over the next century and outlines current and future mitigation and adaptation efforts.
Other Google Earth tours delve into how climate change projections work; climate and health connections in Africa; and projects to reduce deforestation in Borneo, the Amazon, and Madagascar.
In addition, Google has partnered with CNN to create a COP15 YouTube Channel where users can explore behind-the-scenes videos from the Copenhagen summit and watch highlights from a December 15 debate featuring world leaders, climate activists, and user-generated questions.
For up to the minute information on Google’s environmental work and initiatives, check out the following sites:- Google’s Official Blog: Sorted by the “green” tag for all news on Google tools, events, and technology related to the environment
- Google Earth Outreach Showcase: Home to Google Earth tools and tours created by third-party organizations working on climate, the environment, disease, and other issues
- The Unofficial Google Earth Blog: A source for all things Google Earth, with a dedicated section to the environment.
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The Ambivalent Security Agenda in Copenhagen
›To communicate a sense of urgency, the security paradigm is being used to push for self-sufficiency in energy, and hence “national security,” at COP-15. Such a connection, if configured with carbon-free energy sources, could provide a win-win outcome for many.
This argument has been embraced both by the left and the right of the political spectrum in the United States. But compelling as it may be politically, there is a discomforting insularity and isolationism embedded in this approach, as emphasized by the delegations from some countries that export fuels (e.g., OPEC members, emergent oil and gas economies, and uranium exporters such as Namibia and Niger).
The Canadian delegation, which was targeted by activists with a “fossil of the day” award, used the security argument to show how it could send relatively “conflict-free” fuels to the United States by developing its oil, uranium, and bituminous tar sands.
Australia played a similar security card behind the scenes. The former Environment Minister Robert Hill also served as defense minister and is now head of Australia’s Carbon Trust–connections which he suggested were very valuable in an onsite interview with journalist Giles Parkinson.
Nuclear energy was prominently discussed as a solution by numerous delegations. At a side event organized by the Danish Federation of Industries, Energy Secretary and Nobel physicist Steven Chu indicated that his biggest concern about nuclear energy was not the waste problem but rather, the potential dangers to national security from the proliferation of radioactive materials.
The other security connection that environmentalists like to make–but is empirically more tenuous–concerns the increased pressures on existing strife in resource-scarce communities potentially inflicted by climate change. I attended a presentation by an OECD research team that empirically considered the impact of climate change on the security of the vulnerable states of the African Sahel. While generally rejecting the direct linkage between climate change and the threat of violent conflict, the OECD study, launched with UK Rear Admiral Neil Morisetti, identified three hotspots where existing resource scarcity and population pressure could be exacerbated by climate change, especially agropastoralist communities, who are highly sensitive to any climatic fluctuations.
So far, the rather meandering encounter with the security agenda I’ve witnessed here in Copenhagen could greatly benefit from further integrative work such as that offered by the Wilson Center.
Saleem H. Ali is associate professor of environmental planning at the University of Vermont and the author most recently of Treasures of the Earth: Need, Greed and a Sustainable Future. -
Development Seeking its Place Among the Three “Ds”
›December 15, 2009 // By Dan Asin“By one count, there are now over 140 goals and priorities for U.S. foreign assistance,” Senator John Kerry said during the nomination hearing for USAID Administrator-designate Rajiv Shah. If Shah is confirmed, his principal tasks will be moving development out from the shadow of defense and diplomacy and bringing definition to USAID’s mission.
“USAID needs to have a strong capacity to develop and place and deploy our civilian expertise in national security areas,” Shah said at his nomination hearing. USAID “has a responsibility to step up and offer very clear, visible, and understood strategic leadership,” as well as clarify “the goals and objectives of resources that are more oriented around stability goals than long-term development goals.”
A difficult task—and whether Shah wants it or not, he’ll get plenty of help from State, the Obama Administration, and Congress.
State Department Reviews Diplomacy and Development
The State Department’s Quadrennial Diplomacy and Development Review (QDDR)—launched in July by Shah’s impending boss, Secretary of State Hilary Clinton—will certainly inform his USAID vision. Modeled after the Defense Department’s Quadrennial Defense Review (QDR), the QDDR is designed to enhance coordination between USAID and State.
Anne-Marie Slaughter, director of policy planning at the State Department and co-leader of the review process, laid out the QDDR’s specific goals at a recent event hosted by the Center for American Progress:- Greater capacity for, and emphasis on, developing bilateral relationships with emerging nations, working within multilateral institutions, and working with non-state actors
- Capability to lead “whole-of-government” solutions to international challenges
- More effective coordination between top-down (diplomatic) and bottom-up (development) strategies for strengthening societies
- Greater capacity to launch on-the-ground civilian responses to prevent and respond to crises
- Flexible human resource policies regarding the hiring and deployment of contractors, foreign service officers, and development professionals
Obama Administration, Congress Also Join In
Details on the Presidential Study Directive (PSD) on Global Development Policy—outside its broad mandate for a government-wide review of U.S. development policy—are similarly sparse. The directive’s fuzzy parameters leave open the potential for its intrusion into the QDDR’s stated objectives.
But from what little is available, both the QDDR and PSD appear to be part of complementary efforts by the Obama administration to elevate development’s role in U.S. foreign policy, using whole-of-government approaches.
Lest Congress be left out, each chamber is working on its own development legislation. Senators John Kerry and Richard Lugar’s Foreign Assistance Revitalization and Accountability Act of 2009 (S. 1524) seeks “to strengthen the capacity, transparency, and accountability of United States foreign assistance programs to effectively adapt and respond to new challenges.” The act would reinforce USAID by naming a new Assistant Administrator for Policy and Strategic Planning, granting it greater oversight over global U.S. government assistance efforts, and strengthening its control over hiring and other human resource systems.
Congressmen Howard Berman and Mark Kirk’s Initiating Foreign Assistance Reform Act of 2009 (H.R.2139) would require the president to create and implement a comprehensive global development strategy and bring greater monitoring and transparency to U.S. foreign assistance programs.
Successful legislation in the Senate and House could pave the way for the reformulation of the Foreign Assistance Act of 1961, whose message has been rendered complicated and sometimes contradictory by decades of amendments.
And all these ambitious efforts are complicated by the involvement of 25 independent government agencies in U.S. foreign assistance—a formidable challenge to any administrator.
Photo: Courtesy of the USDA. -
NATO Says Don’t Fight the Planet
›Climate and security are under discussion today in Copenhagen at the Danish government’s side event, which brings together heavyweights such as NATO Secretary-General Anders Fogh Rasmussen, Swedish Foreign Minister Carl Bildt, African Union Chair Jean Ping, and Danish Foreign Minister Peter Stig Møller.
Fogh Rasmussen, the former prime minister of Denmark, delivered his remarks the new-fashioned way: today’s Huffington Post. He says NATO is ready to “do its part” by lowering its own carbon bootprint and responding to the increasing humanitarian challenges of a warmer world. He suggests the threat of climate change does not allow powerful institutions like NATO the luxury of sitting on the sidelines.
The post even includes this embedded “Climate Change and NATO” video with an unfortunate screen grab that reads “Fighting the Planet.” Not exactly a reassuring message for those who argue that framing climate change as a security issue will militarize the environment rather than green security (to paraphrase an excellent 1994 edited volume by Finn Jyrki Kakonen).
The video’s actual message is that some security threats can be fought and others shouldn’t be. Climate change will present a security threat, but “Fight the planet and we all lose,” says NATO. Even when the video makes all the right points, those pesky screen grabs can undermine your case! -
Tackling the Biggest Maternal Killer: How the Prevention of Postpartum Hemorrhage Initiative Strengthened Efforts Around the World
›On Friday, November 20th, 120 representatives from the maternal health community, the U.S. and around the world, gathered for an all day meeting at the Woodrow Wilson International Center for Scholars to discuss the report, Tackling the Biggest Maternal Killer: How the Prevention of Postpartum Hemorrhage Initiative Strengthened Efforts Around the World. This report describes the challenges and successes of the U.S. Agency for International Development (USAID) funded Prevention of Postpartum Hemorrhage Initiative (POPPHI).
The five-year POPPHI project was executed through the support of many partners whose main goal was to catalyze the expansion of active management of the third stage of labor (AMTSL) worldwide. The conference convened experts and advocates in the field of maternal health, to share best practices, new innovations, and future challenges for tackling maternal health’s leading killer: postpartum hemorrhage (PPH). Panelists included POPPHI field partners such as International Federation of Gynecology and Obstetrics, The International Confederation of Midwives, the World Health Organization, and international researchers.
Preventing Postpartum Hemorrhage: AMTSL
“We need to work on women postpartum–after birth we leave them,” argued Deborah Armbruster, POPPHI Project Director. Due to the fact that many women in the developing world give birth at home or in local clinics that lack the sufficient resources to prevent postpartum hemorrhaging, approximately 132,000 women die annually. Fortunately, effective and feasible interventions such as those established by POPPHI have been proven to save lives.
Active management of the third stage of labor (AMTSL) includes three factors that, when used together, can avert postpartum hemorrhage, including:1. Administration of uterotonic drugs (including oxytocin – the most preferred drug)
POPPHI’s “BOLD” Approach
2. Controlled cord contraction
3. Uterine massage after the delivery of the placenta
In collaboration with its partners, POPPHI implemented country-level and global programs to scale up AMTSL. Driven by the “BOLD” approach, Armbruster described how the initiative provided overall frameworks and approaches for strengthening PPH interventions by Building on evidence, Obtaining consensus, Linking partners, and Demonstrating to policymakers AMTSL’s feasibility.
Additionally, POPPHI provided learning materials such as toolkits, fact sheets, posters, and guides that were used to train providers and increase their use of AMTSL. A pilot project on Uniject (a single use needle pre-prepared with oxytocin) was also executed in Mali. Uniject was shown to be acceptable and successful with birth attendants there, and the study is now being replicated in Honduras.
Voices from the Field
Representatives from Argentina, Bangladesh, Ghana, Guatemala, Peru, and Mali presented their country results with the POPPHI project–concluding that the initiative served as a catalyst for upscaling AMTSL. Dr. Abu Jamil Faisel, Project Director and Country Representative of EngenderHealth in Bangladesh, discussed how the project helped to break through misperceptions that often prevented women from wanting to use misoprostol. In Ghana, policymakers worked with program managers and drug suppliers to register misoprostol in the country’s essential medicine list and updated guidelines to reflect best practices. While each country’s experiences were unique, the importance of partnerships was common to successfully upscaling AMTSL in all locations.
Partnerships: Critical to Success
Integrating maternal health indicators directly into program design is imperative to upscaling AMTSL, argued Niamh Darcy, Director of POPPHI Monitor and Evaluation. Additionally, Darcy argued that the success of POPPHI is due to the project’s emphasis in working with all levels of partners, particularly facility providers. Working with the supportive supervisors at facilities is necessary according to Darcy because this group is ultimately responsible for executing active management and recording project outcomes.
Identifying African experts who have taken leadership and ownership of the project has been instrumental in POPPHI successfully disseminating results at the regional, national and international levels argued Doyin Oluwole, Director, Africa’s Health in 2010. Partnering with local champions as well as policymakers has enabled many of the country projects to build capacity and upscale AMTSL.
Building on Lessons Learned
“A key lesson we have learned is that, when there is political commitment, AMTSL is rapidly scalable,” stated Lily Kak, Senior Maternal and Newborn Health Advisor, USAID. Changing behaviors and practices takes significant amount of resources and time commitment, however, POPPHI demonstrates that partnerships and research can be used to upscale AMTSL and change policies more efficiently.
Photo: Women wait outside a maternity ward in Chad. Courtesy of Flickr user mknobil. -
Climate Reporting Awards Live From COP; Revkin To Quit NYT
›It’s a good news/bad news day for climate-media watchers. The Earth Journalism Awards honor some of the best climate coverage from around the world, while arguably the world’s most respected climate reporter announces he’s leaving journalism.
Earth Journalism Awards
Tune in now to watch the Internews Earth Journalism Awards webcast live from Copenhagen. The spectacularly impressive winning entries span the globe from Kenya, Brazil, Pakistan, and Papua New Guinea.
Two top-notch stories illustrate how nuanced, in-depth reporting can compellingly and accurately portray climate-security links: Lisa Friedman’s 5-part series on Bangladesh for ClimateWire untangles the knotty problem of climate-induced migration, while William Wheeler writes in GOOD Magazine about the increasingly difficult role of Indus Water Treaty in mitigating conflict between India and Pakistan.
The 15 winners are blogging from the summit, as well 40 reporters from 26 developing nations, as part of the Climate Change Media Partnership.
Revkin Frustrated With Journalism; Will Leave NYT
On the bad news side, Yale Forum on Climate Change and Media announced this morning that Andrew Revkin, the NYT’s climate reporter, will leave the paper on December 21. He cites “frustration with journalism,” but will continue writing his popular DotEarth blog.
Maybe Revkin’s frustration is with the disintegration of environmental coverage in the mainstream media? The Internews winners demonstrate the high quality of climate coverage at niche publications like ClimateWire or funded by non-profits like the Pulitzer Center on Crisis Reporting.
Let’s hope Revkin finds a more comfortable home and continues his pioneering work on DotEarth, specifically his efforts to cover population, poverty, consumption, and development connections to climate.
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