Showing posts by Ramona Godbole.
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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. -
Quality and Quanitity: The State of the World’s Midwifery in 2011
›Each year, 350,000 women die while pregnant or giving birth, as many as two million newborns die within the first 24 hours of life, and there are 2.6 million stillbirths. Sadly, the majority of these deaths could be prevented if poor and marginalized women in developing countries had access to adequate health facilities and qualified health professionals. In fact, according to the new UNFPA report, State of the World’s Midwifery 2011: Delivering Health, Saving Lives, just doubling the current number of midwives in the 58 countries highlighted in the report could avert 21 percent of maternal, fetal, and newborn deaths.Launched last week, the report is the first of its kind, using new data from 58 low-income countries with high burdens of maternal and neonatal mortality to highlight the challenges and opportunities for developing an effective midwifery workforce.
“Developing quality midwifery services should be an essential component of all strategies aimed at improving maternal and newborn health,” write the authors of the report. Qualified midwives ensure a continuum of essential care throughout pregnancy and birth, and midwives can help facilitate referrals of mothers and newborns to hospitals or specialists when needed:Unless an additional 112,000 midwives are trained, deployed, and retained in supportive environments, 38 of 58 countries surveyed might not met their target to achieve 95 per cent coverage of births by skilled attendants by 2015, as required by Millennium Development Goal 5.
There is a total shortage of 350,000 skilled midwives globally, with some countries, like Chad and Haiti, needing a tenfold increase to match demand, according to the report. But quantity isn’t the only issue; there has also been an insufficient focus on quality of care. Additionally, most countries do not have the capacity to accurately measure the number of practicing midwives, and national policies focusing on maternal and newborn health services often do not view midwifery services as a priority.
To help overcome these challenges, the report outlines a number of “bold steps” to be taken by governments, regulatory bodies, schools, professional associations, NGOs, and donor agencies in order to maximize the impact of investments, improve mutual accountability, and strengthen the midwifery workforce and services. Of course, the needs of each country are unique, and the report ends with individual country profiles that highlight country-specific maternal and neonatal health indicators.
While this report does much to highlight the critical importance of midwives in promoting the health and survival of mothers and newborns, real impact will only come when governments, communities, civil society, and development partners work together to implement these recommendations.
Sources: UNFPA.
Video Credit: UNFPA. -
Watch: Richard Matthew at TEDxChange on Natural Resources, Conflict, and Environmental Peacemaking
›“It’s not surprising that about half the time, efforts to try to stabilize countries as they come out of war fail,” said Richard Matthew, associate professor at the University of California at Irvine and founding director of the Center for Unconventional Security Affairs, at a recent TEDxChange event. “Wars today are very destructive. They may not be as big as the wars of the last century, but they do a lot of damage.”
Matthew’s work focuses on the environmental dimensions of conflict and peacebuilding. Conflict can be spurred by competition over natural resources but it also contributes to further scarcity in many cases, creating a feedback loop. The natural resource aspect of conflict is particularly important in areas where livelihoods depend directly on access to land, water, and forests, he said.
In addition to discussing the benefits of including the environment in peacemaking efforts, Matthew also touched on the need for an increased proportion of national security spending to be spent on peace and development rather than defense. “It is in our interest to grow people out of the conditions that foster terrorism and extremism and infectious disease and crisis,” he said.
In particular, Matthew remains confident that an emerging group of leaders will find new and creative ways to support peacebuilding, natural resource management, and adaptation activities in the future: “Social entrepreneurs – people willing to combine their passion to make a better world with sound business tools – are developing truly innovative ways of taking daunting social problems and making them manageable.” -
New Oxfam Report Tackles Broken Food System
›June 17, 2011 // By Ramona Godbole“The global food system is broken,” reads a new report from Oxfam International. While much of Growing a Better Future: Food Justice in a Resource-Constrained World essentially reviews the major factors that contribute to food insecurity, Oxfam’s call to transform the food system is certainly timely, given this year’s high food prices (blamed in part for inflaming popular revolts in the Middle East) and fears of another global food crisis.
Despite producing enough food for everyone, one in seven people globally face chronic under-nutrition and almost one billion people are food insecure. Hunger is concentrated within rural areas in developing countries, and within families, women are often disproportionally affected, having serious implications for maternal and child health.
“We face three interlinked challenges in an age of growing crisis: feeding nine billion without wrecking the planet; finding equitable solutions to end disempowerment and injustice; and increasing our collective resilience to shocks and volatility,” write the authors of the report.
A “Perfect Storm” for Hunger
If current trends continue, population growth, natural resource scarcity, and climate change will put increasing stress on the food system in the future and create a “perfect storm” for more hunger, says Oxfam.
In the short term, oil price hikes, extreme weather, and speculative trading in markets have caused food prices to rise. With global population slated to grow to 9.1 billion and the global economy projected to be three times as big, demand for food may increase by as much as 70 percent by 2050. Food scarcity will also be deeply affected by the depletion of other natural resources including water, oil, and land.
According to the report’s predictions, child malnutrition levels in sub-Saharan Africa are expected to grow by 8 million by 2030. This estimate is before taking into account the effects of climate change, which could reduce agricultural yields by 20 to 30 percent in sub-Saharan Africa by 2080. The latest UN Population Division projections over that same time period predict an additional two billion people will be living in the region.
The Broken Food System
Up until now, many governments in developed countries have either ignored rising food prices or made it worse by imposing trade restrictions or encouraging the production of biofuels, says Oxfam. Thirty to fifty percent of all food grown is wasted, at least in part, as the result of poor consumer and business practices in rich countries, write the authors, and national governments are not doing enough to address climate change and manage scarce resources, especially water.
Another major challenge that contributes to global hunger is equitable access to land, technology, and markets, says Oxfam. In Guatemala, for example, less than eight percent of agricultural producers hold almost 80 percent of the land, and in developing countries, despite sharing an equal or larger burden of the work, women account for only 10 to 20 percent of landowners. Large companies, rather than local farmers, make the majority of decisions regarding key resources such as land, water, seeds, and infrastructure, while ignoring the technological needs of small-scale farmers.
“Growing a Better Future”
The report concludes that “from the failing food system to wider social and ecological challenges, the dominant model of development is hitting its limits.” The authors recommend three ways to effectively reduce hunger and fix the broken food system:1) Make food security a top priority for national and international governing bodies;
To make this a reality, write the authors, governments must invest in climate adaptation, disaster risk reduction, and social protection, while international governance of trade, food aid, financial markets, and climate change must work to reduce risks of future shocks and respond quickly and effectively when shocks do occur. The policies and practices of both governments and businesses should support the needs and interests of small-scale farmers, ensuring access to natural resources, technology, and markets.
2) Support small-scale food producers in developing countries; and
3) Set clear global targets for the equitable distribution of scarce resources.
While not exactly novel or ground-breaking ideas, these reforms certainly are lofty and the report avoids sugarcoating issues of food security, directly calling out governments and the private sector for their role in supporting food injustice. But, some argue that simpler solutions, like promoting fertilizers and new technologies among poor farmers, might be more effective at fighting malnutrition. Others question the validity of the reports assertion that the average food prices will more than double in the next 20 years.
Despite criticisms, this report and the corresponding GROW campaign will hopefully help further highlight the importance of food security and the need to move towards a more sustainable future.
Image Credit: “Thriving in Africa,” courtesy of flickr user Gates Foundation. -
Book Launch: ‘Human Population: Its Influence on Biological Diversity’
›Measurements of “human population density and growth can be used to identify changes in the viability of native species, and more directly, in changes in ecological systems or habitat quality,” said Richard Cincotta, consultant at the Environmental Change and Security Program and demographer-in-residence at the Stimson Center, speaking at the book launch of Human Population: Its Influence on Biological Diversity.
Cincotta was joined by coeditor L.J. Gorenflo, associate professor of landscape architecture at Penn State University, and contributing author Christopher Small, research professor at the Lamont-Doherty Earth Observatory and adjunct professor at Columbia University, to discuss the book’s objectives, its diverse and multidisciplinary contributors, and its policy implications. [Video Below]
Establishing a Handbook for the Field
“Human Population: Its Influence on Biological Diversity establishes a handbook for the field,” said Cincotta. While the scientific volume is specifically geared towards researchers and conservation managers rather than policymakers, “there are a few Washington-type policy messages that are useful,” he added.
Human population affects biological diversity in multiple ways. While population density alone can be strongly indicative of the viability of different populations of native species, human activities and their chemical and energetic byproducts can also have a strong impact, even when human population density is low, said Cincotta.
Conserving Biodiversity in Different Settings
“Planned solutions, based on strategic actions, increasingly are essential,” said Gorenflo, a professor at Penn State University. “The days of letting nature take care itself are probably gone.” Gorenflo presented results from the two chapters he worked on: “Human Demography and Conservation in the Apache Highlands Ecoregion, U.S.-Mexico Borderlands” and “Exploring the Association Between People and Deforestation in Madagascar.”
“Population density seems to be a reasonably good indicator of biodiversity loss,” said Gorenflo. Data from the Apache Highland Ecoregion (a 12 million-hectare area located along the U.S.-Mexico border) indicate that biodiversity tends to drop off at population densities of more than 10 people per square kilometer. Conservation efforts in areas within the ecoregion that are at, or close to, this density threshold will likely encounter challenges to maintaining biodiversity, he said.
Human mobility is a major consideration, said Gorenflo: “Whereas high fertility can create population growth over generations, high mobility can create population growth in a matter of months or years.” In the Apache Highlands, for example, the 40 percent increase in population between 1990 and 2000 was largely caused by migration into U.S. cities in the region.
In Madagascar, Gorenflo and colleagues examined whether population growth and poverty were systematically driving deforestation and loss of biodiversity. Using data from the 1990s, they found that higher population density only slightly raises rates of deforestation and large increases in income only modestly decrease deforestation.
Not surprisingly, they found that the likelihood of deforestation decreased dramatically in protected areas. In addition, proximity to roads or footpaths was associated with significantly higher rates of deforestation. “Roads, footpaths, and protected areas are all policy decisions,” Gorenflo pointed out. “So when bilateral or multilateral organizations decide to invest in development in a place like Madagascar, they can look at these sorts of investments as being important.”
While there are some similarities to be drawn between regions’ experience with population and biodiversity, said Gorenflo, “every locality likely has a slightly different story; you need to do context-specific studies to get a real handle on what is going on.”
The Human Habitat
In his chapter, “The Human Habitat,” Christopher Small of the Lamont-Doherty Earth Observatory said his goal was “to set the stage for some of the more detailed studies by taking a look at the global distribution of human population.”
Using census data and satellite-derived maps of night lights to serve as a “proxy for development,” Small found that “people are everywhere, but they are not evenly distributed.”
At least half the world’s population lives on less than three percent of the inhabitable land, and most people live at densities between 100 and 1000 people per square kilometer. At both local and global scales, population density and city size are dominated by extremes: There are large numbers of small groups of people, and small numbers of large groups of people, he said.
“The environments where people live are more strongly correlated with features of the landscape than they are with climatic parameters,” said Small. While humans have effectively adapted to a range of climates, the majority of people tend to cluster close to rivers, at low elevations, and close to coastlines. Although it was once thought that three-quarters of the world’s population lived in coastal regions, Small’s results show that the actual number is close to half of these previous assumptions.
Understanding the spatial and environmental distribution of population and managing population growth may therefore help minimize negative impacts on specific habitats and biomes, said Small.
Image Credit: “View from a Madagascar Train,” courtesy of flickr user cr01. -
Save the Date: “Maternal Health Challenges in Kenya: What Research Evidence Shows”
›June 8, 2011 // By Ramona GodboleThe Woodrow Wilson Center’s Global Health Initiative, Africa Program, and Environmental Change and Security Program, in coordination with the Maternal Health Task Force and UNFPA, invite you to a livestreamed discussion of:
Maternal Health Challenges in Kenya: What Research Evidence Shows
Tuesday, July 12, 2011, 10:00 a.m. – 12:00 a.m
Woodrow Wilson Center, Washington DC
6th Floor Flom Auditorium
Please RSVP to globalhealth@wilsoncenter.org with your name and affiliation.
The Wilson Center’s Global Health Initiative is traveling to Nairobi to co-host a two-day workshop on July 12-13 with Kenyan policymakers, community health workers, program managers, media, and donors who will discuss Kenya’s maternal health challenges and identify solutions for moving the maternal health agenda forward.Concurrent with the event in Kenya, the Wilson Center will also be holding a meeting with participants livestreaming in from the Nairobi workshop to present new research and highlight lessons learned from the in-country event. Washington-based participants will also have the unique opportunity to interact with the Nairobi workshop and provide feedback to policymakers via live video conference. A full agenda will follow shortly.
About the 2011 Maternal Health Policy Series
As one of the few forums dedicated to maternal health, the Woodrow Wilson Center’s 2011 Advancing Policy Dialogue on Maternal Health series brings together senior-level policymakers, academic researchers, media, and civil servants from the U.S. government and foreign consuls to identify challenges and discuss strategies for advancing the maternal health agenda.
In order to promote greater voices from the field, the 2011 dialogue is partnering with the African Population Health Research Center in Kenya to co-host a two-part dialogue series with local, regional, and national decision-makers on effective maternal health policies and programs. These in-country dialogue meetings will create a platform for field workers, policymakers, program managers, media, and donors to share research, disseminate lessons learned, and address concerns related to policy, institutional, and organizational capacity building.
The Wilson Center’s Global Health Initiative is pleased to present this series with its co-conveners, the Maternal Health Task Force and the United Nations Population Fund (UNFPA), and is grateful to USAID’s Bureau for Global Health for further technical assistance.
Photo Credit: Mother and Child, courtesy of flickr user The.Rohit. -
Yemen Beyond the Headlines: Women’s Health and Well-Being, Foundations of a Fragile State
›Part one of the “Yemen Beyond the Headlines: Population, Health, Natural Resources, and Institutions” event, held at the Wilson Center on May 18.
“Ultimately, whether Yemen is able to achieve its goals for social and economic development, will to a large extent depend on its future population growth and size,” said Gary Cook, senior health advisor at the U.S. Agency for International Development, in his opening address on Yemen’s population and development challenges at the Woodrow Wilson Center. [Video Below]
Cook was joined on the opening panel of the all-day conference, “Yemen Behind the Headlines: Population, Health, Natural Resources, and Institutions,” by Dalia Al-Eryani, former project officer for Pathfinder International’s Safe Age of Marriage Project, and T.S. Sunil, professor of sociology at the University of Texas San Antonio, to discuss issues related to population, reproductive health, and child marriage. Drawing speakers and participants form the Middle East, Europe, and the United States, the conference was part of the Wilson Center’s HELPS Project, a multi-year effort to deepen understanding of links among health, environment, livelihoods, population and security.
Yemen’s Population and Development Challenges
Since 1950, the population of Yemen has increased from 4.3 million to 24 million, with an annual population growth rate above three percent, Cook said. High fertility drives Yemen’s rapid population growth, with an average total fertility rate (TFR) of 5.5 births per woman. Rates are even higher in rural areas and among women with limited or no education, he said.
Future population growth will have tremendous impacts on the country’s economy, education, health, and natural resources, said Cook, and “there is a very large gap between the high fertility assumption and the low fertility assumption.”
An additional 1.5 million new people will be added to the labor force and 29 percent less income per person will drop by 29 percent by 2035 if current fertility rates persist, said Cook. Though Yemen has a national population policy that outlines TFR targets of 3.3 in 2025 and 2.1 by 2035, the latest UN Population Division projections suggest these expectations are optimistic. Education and health demands and expenditures will increase greatly, while per capita arable land and water will decrease, exacerbating ongoing land and water scarcity in Yemen.
“We do not have enough local and external resources to address the needs of a rapidly expanding population,” said Cook. “Helping couples who want to limit and space their births will also help the nation,” he added.
Law, Culture, and Child Marriage
“Enforced by law and culture alike,” early marriage in Yemen is common, said Al-Eryani, with over 50 percent of Yemeni women married before they are 17 years old, and 14 percent before they turn 14. Opponents of child marriage argue that children are neither emotionally nor physically ready for marriage and that the practice increases health risks and lowers educational opportunities for girls.
Currently, Yemen has no minimum age for marriage law, and recent attempts to pass such a law have failed, said Al-Eryani. “The practice never really has been questioned.”
“There is a belief that child marriage is a good thing – both for the girl and for the family,” she said. Early marriages are a way to build family honor and tribal ties, and many poor families see opportunity for financial gain in the form of a dowry. “These families see no socially acceptable alternatives for the girl…and all of this is supported by the belief that Islam condones child marriage,” she said.
Through awareness sessions, health fairs, and school plays, the community-based Safe Age of Marriage Project has helped to change social norms around child marriage in two districts in Yemen.
After participating in the program, community members were significantly more likely to believe that delaying marriage gives girls more educational opportunities, empowers them to make decisions, and promotes healthy pregnancy and children, Al-Eryani said. Child marriage was banned in one of the communities, and the marriages of 53 girls and 26 boys were canceled as the result of the project. In the future, she hopes involving more religious and local leaders could further increase the program’s impact.
Youth and “The Reproductive Health Transition”
“When we talk about fertility transition, we only talk about the number of children born,” said Sunil. “A reproductive health transition takes into account not just total fertility rate, but a number of different dimensions.”
Women should have the freedom to decide if, when, and how often to reproduce, said Sunil, through access to safe, effective, affordable, and acceptable family planning methods. They also should have access to quality maternal health care throughout pregnancy and birth, he said.
“It’s a popular belief that Islamic societies with poor and limited resources are not compatible with a reproductive health transition,” said Sunil. “But the onset of a reproductive health transition is underway in Yemen.”
While the transition in Yemen is progressing more slowly than in other countries in the region, many positive trends can be seen among the country’s youth, said Sunil. Trends indicate a drop in fertility rates, especially among younger women; marriage of girls under 15 years old has declined; and contraceptive use among young women age 15 to 24 has increased significantly.
Government and international donor agencies “must capture the growing momentum among the younger cohort” and meet demands for better education, postponement of marriage, and healthcare services, said Sunil. Continued focus on adolescent reproductive health will be the key to achieving the reproductive health transition, he concluded. “From an economic and human perspective, the growing young population in Yemen is potentially a tremendous asset.”
See parts two and three of “Yemen Beyond the Headlines: Population, Health, Natural Resources, and Institutions” for more from this Wilson Center event.
Sources: Population Reference Bureau, UNICEF, U.S. Agency for International Development.
Image Credit: “Young girl with her mom – Sanaa,” courtesy of flickr user fveronsei1. -
Designing Health and Population Programs to Improve Equity: Moving Beyond the Rhetoric
›“There needs to be ongoing flexibility and creativity in our ways of approaching health equity,” said John Borrazzo of the U.S. Agency for International Development (USAID) at a recent Global Health Initiative event at the Wilson Center. Borrazzo is the chief of the Maternal and Child Health Division in the Bureau for Global Health. He moderated a discussion on practical strategies to improving access to health services for the world’s poor and other marginalized groups, with panelists Mickey Chopra, chief of health and associate director of programmes at UNICEF; Davidson Gwatkin, senior fellow at the Results for Development Institute and senior associate at Johns Hopkins Bloomberg School of Public Health; Cesar Victoria, professor of epidemiology at the Federal University of Pelotas in Brazil; and Jennifer Luna, senior monitoring and evaluation adviser for the Maternal and Child Health Integrated Program (MCHIP). [Video Below]
MDG 4: An Equity Approach
“Massive benefits can be gained by reaching the poorest and most marginalized,” said Chopra. “It’s actually more cost effective to have an equity-based approach; it’s not just right in principle, it’s right in practice.”
While there has been some progress in reducing the rates of mortality for children under five (the UN’s Millennium Development Goal 4), Chopra said “there has to be a change” if they are going to be achieved completely. Most of the 30 percent decline in child mortality so far has been in Asian countries, while Africa as a whole remains stagnant. Further, two-thirds of the 35 countries that have made significant progress to meet MDG 4 show worsening inequalities between the highest and lowest income brackets of the population.
In the majority of countries, the “rich are still capturing most of the benefits of new investments and interventions,” said Chopra. “The challenge at the program and policy levels is to understand why there is this gap between the richest and the poorest in terms of uptake of critical interventions.”
Delivery channels are faced with “bottlenecks” that prevent services from reaching marginalized communities, said Chopra. Clinic-based services often lack adequate human resources, consistency in the quality of service, and can be very expensive. Population-oriented services, which include government and NGO-led outreach and scheduled services at health facilities, are often challenged with low demand and lack of continuity, while availability and cost of health commodities are barriers for community-based interventions delivered through local organizations or social marketing campaigns.
Shifting delivery of services within channels, appropriately shifting delivery to different channels, or improving the performance of an established delivery channel could help increase uptake of treatment and prevention among poor and marginalized communities, concluded Chopra. He stressed that progress need not come at the expense of the poor. According to a UNICEF report, Ghana, Eritrea, Nepal and Malawi have all reduced under-five mortality and inequality by prioritizing providing essential services to the most marginalized communities first.
Designing Equity-Based Health Programs
“Performance variability in terms of equity across countries is very large,” said Gwatkin. “In some places a given technique can work well and in others it can be a complete flop.”
To pick the right technique for the right place, Gwatkin advocated for an iterative approach to program design and implementation, beginning with setting targets in terms of the poor population group of concern. After fully assessing country-specific conditions, a set of potential pro-poor interventions can be selected, based on an analysis of current interventions and suggested alternatives as well successful interventions in other countries. Each of these interventions should be delivered to a large, representative area, he said.
“The next step is to find out how well you have done,” said Gwatkin, stressing the importance of assessing and monitoring interventions with a specific focus on the marginalized target group. Successful approaches should be expanded, while those that are not having the intended benefits of helping the poorest communities should be modified or abandoned.
In sum, said Gwatkin, “It’s more promising to focus on designing a process to fit techniques to individual country settings than to focus on the techniques themselves.” Doing this helps effectively integrate equity concerns into the design and implementation of programs, and as a result, he said, can have a major impact on improving the lives of the poorest people in developing countries.
Analyzing Equity to Maximize Impact
“It’s always possible and useful to include equity in monitoring and evaluation, however, it has to be planned ahead of time,” said Victoria.
The Countdown to 2015 Initiative is an effort to monitor progress made towards the health-related Millennium Development Goals globally. The Countdown’s efforts not only aim to promote access to health services at the aggregate level but also specifically to ensure the equitable distribution and uptake of health services among disadvantage populations, said Victoria.
Generally, in countries with high coverage of preventative and treatment services, like Brazil, there is “bottom inequity,” said Victoria, in which the poor are much worse off than everyone else. Targeting the poor specifically in such countries is therefore essential to improving equity.
Alternately, Victoria continued, countries with low coverage at all levels, like Cambodia or Haiti, suffer from “top inequity,” in which the rich are typically much better off the rest of the population. These countries should work towards increasing coverage for all people and focus on the poor after there are some universal gains, he said.
“Analyzing the shapes of inequity curves can help drive decisions about delivery channels and targeting…and can lead to practical strategies for maximizing the impact of interventions,” concluded Victoria.
Health Equity: From Evidence to Practice
“Projects often state that they are really interested in equity, but when you read the project descriptions, you don’t see exactly what they mean by equity or how they plan on addressing it,” said Luna, speaking of her work at MCHIP.
Luna presented the Health Equity Guidance Document that outlines a systematic, six-step process for professionals who design and implement community-oriented projects to ensure equity is effectively integrated into their programs:1) Understand the equity issues in the project area
Luna stressed that there is no “one size fits all” strategy: “This approach is not a prescriptive one; it presents a series of concepts and approaches to take into consideration and then make decisions.” But for program implementers on the ground, she said, these guidelines and tools “should help lead to a coherent health equity strategy and can serve as a basis for dialogue among stakeholders.”
2) Identify the disadvantaged group on which to focus
3) Decide what is in the project’s manageable interest to change
4) Define equity goals, objectives, and a project-specific definition of equity
5) Determine equity strategies and activities
6) Develop equity-focused monitoring and evaluation
Sources: UNICEF, United Nations Development Programme, World Health Organization.
Image Credit: “Malaria prevention, Kenya,” courtesy of flickr user DFID.
