Showing posts by Ramona Godbole.
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Accessing Maternal Health Care Services in Urban Slums: What Do We Know?
›“Addressing the needs of urban areas is critical for achievement of maternal health goals,” said John Townsend, vice president of the Reproductive Health Program at the Population Council. “Just because there is a greater density of health services does not mean that there is greater access.”
Townsend moderated a discussion on the challenges to improving access to quality maternal health care in urban slums as part of the 2011 Maternal Health Dialogue Series with speakers Anthony Kolb, urban health advisor at USAID; Catherine Kyobutungi, director of health systems and challenges at the African Population Health Research Center; and Luc de Bernis, senior advisor on maternal health at the United Nations Population Fund (UNFPA). [Video Below]
Mapping Urban Poverty
“Poverty is becoming more of an urban phenomenon every day,” said Kolb. With over 75 percent of the poor in Central Asia and almost half of the poor in Africa and Asia residing in cities and towns by 2020, “urban populations are very important to improving maternal health,” he added.
Collecting accurate data in informal settings such as slums can be very challenging, and there is often a “systematic undercounting of the urban poor,” said Kolb. Data often fails to capture wealth inequality in urban settings, and there is often a lack of attention to the significant variability of conditions between slums.
Kolb also warned about the risk of generalization: “Slums and poverty are not the same.” In practice, there is not a standardized definition of what constitutes a slum across countries, he said. “It is important to look at different countries and cities individually and understand how inequality is different between them.” Slum mapping can help to scope out challenges, allocate resources appropriately, and identify vulnerability patterns that can inform intervention design and approach, he said.
Maternal Health in Nairobi Slums
Addressing the maternal health needs of the nearly 60 percent of urban residents who live in slums or slum-like conditions will be a critical step to improving maternal health indicators of a rapidly urbanizing Kenya, said Kyobtungi.
Only 7.5 percent of women in Kenyan slums had their first antenatal care visit during their first trimester of pregnancy and only 54 percent had more than three antenatal care visits in all – rates significantly lower than those among urban women in non-slum settings.
“In some respects, [the urban poor] are doing better than rural communities, but in other ways they are behind,” said Kyobtungi. But, she said, there are many unique opportunities to improve maternal health in slums: “With these very high densities, you do have advantages; with very small investments, you can reach many more people”
Output-based voucher schemes – in which women pay a small fee for a voucher that entitles them to free, high-quality antenatal care, delivery services, and family planning – have been implemented to help poor, urban women access otherwise expensive services. But poor attitudes towards health care workers, transportation barriers, and high rates of crime still prevent some women from taking advantage of these vouchers, said Kyobtungi.
The majority of maternal health services in slums are provided by the private facilities, though size and quality vary widely. “There is a very high use of skilled attendants at delivery, but the definition of skilled is questionable,” said Kyobtungi
“Without supporting the private sector,” Kyobutungi said, “we cannot address the maternal health challenges within these informal settlements.” Combined with an improved supervision and regulation system, providing private maternal health facilities with training, equipment, and infrastructure could help to improve the quality of services in urban slums, she concluded.
Reducing Health Inequalities
“While we have evidence that health services, on average, may be better in urban areas than in rural areas, this often masks wide disparity within the population,” said de Bernis. “Reducing health inequities between and within countries is a matter of social justice.”
When it comes to family planning, total fertility rates are lower in cities, but “the unmet need…is still extremely important in urban areas,” explained de Bernis. Many poor women in cities, especially those who live in marginalized slum populations, do not have access to quality reproductive health services – a critical element to reducing maternal morbidity and mortality rates.
Economic growth alone, while important to help improve the health status of the poor in urban settings, will not solve these problems, said de Bernis. To reduce health disparities within countries, de Bernis advocated for “appropriate social policies to ensure reasonable fairness in the way benefits are distributed,” including incorporating health in urban planning and development, strengthening the role of primary health care in cities, and putting health equity higher on the agenda of local and national governments.
Event Resources:Source: African Population Research Center, United Nations Population Fund.
Photo Credit: “Work Bound,” courtesy of flickr user Meanest Indian (Meena Kadri). -
The U.S. Government’s Response to Disasters: Myth, Mistakes, and Recovery
›“Major crises and disasters have massively changed over the last generation,” said Dr. Frederick Burkle, senior public policy scholar at the Woodrow Wilson Center and senior fellow and scientist at the Harvard Humanitarian Initiative. “We have to start a new narrative of what we need to do to address [them].”
To discuss the emerging and persistent challenges of disaster prevention, preparedness, response, and recovery, Burkle was joined by Paul Born, co-founder and director of the Tamarack Institute for Community Engagement; Leonard Doyle, Haiti country spokesperson at the International Organization for Migration; Arif Hasan, adviser at the Orangi Pilot Project and founder and chairman at the Urban Resource Centre; and Dr. Eliane Ubalijoro, adjunct professor at McGill University and member of the Presidential Advisory Council for Rwandan President Paul Kagame.
“Retrieving the Wisdom of Those in Need”
Unfortunately, disaster responses often fail to “listen and gain a corner on the obvious,” said Born, discussing the need for community engagement and healing in times of disaster and conflict.
After Hurricane Katrina, for example, the formal disaster response failed to use hundreds of available buses to evacuate people, leaving thousands of people stranded in the floods. “If people were engaged, had a role to play, knew what to do, were part of a team, would this have made a difference? Would those buses have been deployed to help people?” asked Born.
Effective disaster response must utilize “the assets, the skills, and the knowledge that are present,” concluded Born. For example, when the systems in place by the Philippine government in the village of Talba failed to give proper warning to evacuate from a volcanic eruption, “it was a parallel warning system, developed by the community, that warned people, on time, to vacate the area and avoid any loss of life,” said Born. Community preparedness and engagement led to better utilization of available humanitarian assets and mitigated what could have been a much more severe disaster.
The Changing Nature of Humanitarian Emergencies
Increasingly, humanitarian crises are the result of unconventional warfare, causing major challenges for the humanitarian community, said Burkle. Rather than refugees, “what we are beginning to see today is an unprecedented number of internally displaced people.”
Many of the displaced migrate to urban settings, contributing to rapid urbanization which is straining water, sanitation, and public health infrastructure. In these settings, he said, there is sometimes only one latrine for every 200 people, new and infectious diseases are rampant, and high rates of violence and rape are common, putting women particularly at risk.
“It is a lot more than population size – it’s really density of population,” said Burkle. In Mumbai, for example, there is an average of 30,000 people per square kilometer, but there are major areas of the city with over one million people per square kilometer.
“People moving to the cities are still remaining in extreme poverty,” said Burkle. While the majority of the poor once lived in low-income fragile states, recent population data indicates that 72 percent of the world’s poor now live in middle income countries like India, Indonesia, and China. “It’s a total reversal – we’ve spent almost 20 years crafting our foreign aid budgets and policy around this…we have to start a new narrative about what we are going to do.”
“The other issue that I don’t think we hear about, but certainly the young people in the audience will be dealing with on a daily basis, are the biodiversity crises,” said Burkle. “Of the 34 biodiverse areas, 23 have experienced prolonged conflict,” which has had major impacts on the availability of water, food, and energy in these regions, said Burkle.
Moving forward, “we have to change the humanitarian community; we have to have more accountability and more accreditation, leading to a blueprint for professionalizing the humanitarian field,” concluded Burkle.
Community and Communication in Haiti
A little over one year after the devastating earthquake in Haiti, 680,000 people remain internally displaced, said Doyle. “About half the population has moved out of the camps, and there is some congratulations to be given to the humanitarian community for organizing that,” he said. “But, when you look at the statistics…only a tiny fraction of these people have reached what you would call durable solutions such as sustainable housing.”
“There is clearly a problem… why has more progress not taken place given the number of international organizations there and the generosity of the funding?” asked Doyle.
“People have a right to communicate and there is a benefit in that communication,” said Doyle. To help make this possible in the Haitian displacement camps, he and his colleagues at the International Organization of Migration (IOM) set up 140 suggestion boxes. The response was amazing, he said, and with the help of a local Haitian organization, IOM has begun broadcasting some of the over 5,000 letters received on a daily radio show.
“We need to help create respectful conversations in countries where we do so much hard work but see so much of it go nowhere,” said Doyle. Information from the letters has been compiled into reports detailing the major challenges faced by people including a lack of jobs, education, and housing. These letters are being used as a monitoring and accountability mechanism through which Haitians can tell NGOs and donors the successes and failures of projects being implemented in their communities. “Through this communication you can see what the community needs, rather than what the experts tell you the community needs,” he said.
Engaging Local Communities
“Regions are sometimes so badly devastated [after a disaster], that to rehabilitate their agriculture, transport, water supply systems, is a very daunting task,” said Hasan. His home country of Pakistan faced all of these challenges after heavy rains and subsequent flooding wiped out 3,000 villages and affected over 20 million people last year.
“Without a governance system, you cannot provide rehabilitation or relief,” Hasan said, citing an added challenge for disaster response in many developing countries. Often the needs of the people are not translated in to policy actions, he said, and “there is a big difference between what people want and what politicians want.”
Hasan offered some insights on how the development community can work with local communities to improve disaster response, pointing out that “pre-disaster situations determine the effectiveness of relief and rehabilitation.” Existing mechanisms to provide development assistance can be used to efficiently deliver goods and services in emergencies, he said. By fostering “true partnerships” international NGOs can help communities and governments should manage reconstruction and relief efforts after disasters using local materials, labor, and technologies, he said. Engaging communities in reconstruction “can be a really important healing process.”
Recovery and Resilience
“When you have a community that has been reduced to ashes, how can you retrieve hope so that transformation can happen?” asked Ubalijoro, stressing the importance of building community resilience after disasters. “We’ve been talking about disasters, but it’s important to remember how we learn to dream again together.”
Baskets of Hope is a project that aims to help Rwandan women recover from the genocide by providing training and jobs weaving baskets that are sold internationally. In addition to providing a source of income, the project also provides information about health and nutrition. With this multi-pronged approach, Baskets of Hope helps families to recover and move forward. “There’s an interesting relationship between weaving these baskets that are allowing these women to have economic empowerment and what it requires after a time of trauma to reweave the fabric of society,” said Ubalijoro.
Youth who have survived man-made or natural disasters are particularly vulnerable, said Ubalijoro. She and her colleagues work to link Rwandan youth with Holocaust survivors so that they can share their memories, pictures, and stories with one another. “Retrieving the wisdom from those who have gone through the unimaginable and having them share their experiences shows youth that even though they’ve lost everything, there are ways to move forward.”
Sources: Conservation International, Institute of Development Studies, International Organization for Migration, USAID.
Photo Credit: “Pakistan Floods” courtesy of flickr user IRIN Photos. -
Is Universal Access to Family Planning a Realistic Goal for Sub-Saharan Africa?
›“What do we require to ensure universal access to family planning services that are appropriate, affordable, accessible, and of good quality?” asked Michael Mbizvo, director of the Department of Reproductive Health and Research at the World Health Organization at the Wilson Center last month. [Video Below]
To talk about this difficult question and present research and programmatic evidence for sub-Saharan Africa, Mbizvo was joined by panelists Fred Makumbi, senior lecturer and head of the Department of Epidemiology and Biostatistics at Makerere University, Uganda; Oladosu Ojengbede, director of the Center for Population and Reproductive Health, University of Ibadan, Nigeria; and Frank Taulo, director of the Center for Reproductive Health and senior lecturer of obstetrics and gynecology at the University of Malawi.
Integrating Family Planning and HIV Services
Makumbi shared a number of findings on fertility preferences, behaviors, and contraceptive uptake in the context of HIV infection and care in Uganda. “Integrating family planning services into HIV services could help address the family planning needs of both HIV infected and uninfected,” he said.
According to new research conducted as part of the Rakai Community Cohort Study, despite significant gains in family planning use over time, there is still a high unmet need for contraception, irrespective of HIV status, in the Rakai district of central Uganda, said Makumbi. Male partner’s fertility desires were found to play an important role in pregnancy rates, and compared with previous studies conducted in the Rakai district, researchers saw an increase in pregnancy incidence and prevalence among HIV positive women, especially those on anti-retroviral therapy. HIV care that included voluntary counseling and testing was associated with significant increases in the use of family planning, and in particular, the use of condoms.
To effectively promote universal family planning in sub-Saharan Africa, “there is a need to strengthen family planning services in HIV care programs, with promotion of modern contraceptive methods, and with particular attention to women on anti-retroviral therapy,” said Makumbi. “Strategies to address desire for high fertility need to be developed, especially with regard to male involvement,” he added.
Multi-Pronged Approach to Universal Family Planning
“Family planning success in sub-Saharan Africa is a must for the region’s sustainable development,” said Ojengbede. “Poor commitment to women’s health in sub-Saharan Africa” has not only resulted in high fertility rates and poor maternal health indices but has also negatively impacted economic and human development in the region, said Ojenbede.
To increase access to and use of family planning, Ojengbede stressed the need to generate and sustain government commitment, promote legislation to support women’s autonomy, and implement policies to improve access to quality reproductive health services.
At the community level, Ojengbede said, the public health community must work to integrate family planning services into all reproductive health programs, including prevention of mother to child transmission; accelerate female empowerment programs; actively engage males in family planning access and uptake; and address social and cultural barriers that prevent widespread adoption of family planning.
“Traditional rulers can occupy a critical position to enact positive change in their communities and at the national level,” said Ojengbede. In Nigeria, for example, providing education about the health and economic benefits of family planning has helped traditional leaders embrace family planning and develop their own strategies to promote birth spacing in their communities.
“Universal family planning access must be achieved through a multi-pronged approach that should be colored with socio-cultural sensitivity, solid evidence, and sustainability,” concluded Ojengbede.
Eliminating Unmet Need: “Yes, We Can”
“It is time to prioritize issues that are affecting women and family planning is a very critical area,” said Taulo.
There are still many challenges to overcome before Malawi can achieve universal family planning access, including poverty, misconceptions and myths about family planning, lack of availability of reproductive health supplies, poor infrastructure, shortage of trained professionals, and religious and cultural barriers.
“Commodities are also very much dependent on the donor,” said Taulo, pointing to the challenges of insufficient funding and political will. “Failure to connect family planning to economic development and political stability is one of the main areas that we are struggling with,” he added.
“We have lots of challenges, but also many achievements,” said Taulo. Malawi has made important strides in expanding access to family planning by implementing community-based strategies and youth-friendly programs, developing public-private partnerships, engaging policymakers and traditional leaders, and encouraging media coverage of family planning issues.
“Education is another family planning product,” said Taulo. Moving forward, a “deliberate focus on girl child education” and promotion of women’s welfare can have a major impact on fertility reduction, he said.
“We can eliminate unmet need for family planning in Malawi, if we put our heads together, our thoughts together, and our energy together,” concluded Taulo.
Source: World Health Organization.
Image Credit: “Women’s Health Clinic” courtesy of flickr user advencap. -
Working With the Private Sector to Improve Maternal, Newborn, and Child Health
Innovations From Development to Delivery
›“Challenging and dynamic partnerships [with the private sector] are difficult to pull together, but when you look at sustainability, impact, and effectiveness, they can also be great levers of change,” said Kari Stoever, senior advisor for global advocacy at the Global Alliance for Improved Nutrition (GAIN) at the Wilson Center on March 22. [Video Below]
Stoever was joined by panelists Laura McLaughlin, environmental engineer at Cascade Designs, Inc., Hugh Chang, director of special initiatives at the NGO PATH, and Laura Birx, senior food security and nutrition specialist at the U.S. Agency for International Development (USAID) for a discussion of the private sector’s role in developing innovative health technologies to increase access to safe water, prevent infectious diseases, and improve maternal health nutrition.
Collaborating to Provide Safe Water
“NGOs have different strengths and different perspectives from the private sector, and we’ve found an area where we can really complement each other,” said McLaughlin. Cascade Designs, Inc., collaborated with PATH to create a smart electrochlorinator, which produces a chlorine solution to purify water using just salt water and a simple battery, because “we wanted to make a bigger difference than we could do with philanthropy alone,” said McLaughlin.
“Products need to be designed specifically for the end user, particularly for women and children, who are often times left out of the design process,” said McLaughlin. Cascade’s smart electrochlorinator was designed with this in mind. One charged battery can treat up to 40,000 liters of water, 200 liters at a time. The device is easy to use, requires simple resources, is significantly more affordable than existing solutions, and lends itself to an entrepreneurial business model that can deliver safe water to small community households. The current prototype is being field-tested in 10 countries globally, with the aim of providing safe water in resource-poor communities while generating income for local entrepreneurs.
The PATH-Cascade partnership was successful in part because it combined “private-sector expertise in efficiency, cost-effectiveness, and meeting market demands” with knowledge about the health needs in developing countries, said McLaughlin. By “pushing each other to a common end goal, this partnership really multiplied our strengths.”
Engaging the Private Sector
“One of the reasons we work closely with the private sector…is because we recognize an efficiency of resource usage that comes with building bridges between the public sector and the private sector,” said Chang of PATH’s work with Cascade and others. Engaging the private sector to advance health technologies can complement PATH’s goals, like encouraging healthy behaviors and strengthening health systems, he said. “But, we are not averse to profits,” he added, stressing that partnerships with NGOs can be mutually beneficial. “We understand for this to be sustainable, these companies need to make a profit.”
PATH is working with the private sector to develop injection and vaccine technologies that “produce a product that not only benefits the recipient of the vaccine but also produces a revenue stream,” said Chang. The SoloShot, for example, is a low-cost, disposable syringe that locks after a single injection, preventing needle reuse and contamination that can increase the risk of HIV, hepatitis B, and other infections. To address the challenge of maintaining the proper refrigeration of vaccines in low-resource settings, private sector collaboration has helped to develop the vaccine vial monitor (a sticker that changes color when a vaccine has been exposed to too much heat) and to create more stable vaccine formulas that are less vulnerable to extreme temperatures. “By combining innovation with on-the-ground presence,” concluded Chang, “private sector engagement can be a powerful tool for global health.”
A “Win-Win Partnership”
“There is a tremendous role for the private sector to play in the intersection of agriculture and health as they relate to nutrition,” said Birx. Engaging the private sector can be a “win-win partnership,” she said. The Obama Administration’s hunger initiative, Feed the Future, for example, uses the resources, expertise, and innovation of the private sector to encourage sustainable, market-driven approaches to reducing poverty and food insecurity, said Birx.
USAID sees innovation as a “research-to-use continuum,” said Birx. “When we look at innovation, it’s not just about the development of a specific product, but about the entire system that goes around that product,” she added. New technologies must not only respond to a major development challenge in poor and rural communities but need to be affordable, culturally appropriate, gender sensitive, easy to use, and durable.
But solutions don’t have to be complicated. “Often times it’s about a really simple technology that can improve accessibility,” said Birx. The nevirapine pouch, for example, a simple foil packet that allows health care workers to give women single doses of nevirapine syrup, can reduce the risk of mother-to-child transmission of HIV by more than half.
“There’s a lot of excitement, but we need to do some serious work to capitalize on [it],” said Birx. Moving forward, health, development, and private-sector organizations must work together to create innovative financing mechanisms, build institutions in developing countries, and encourage enabling policy environments.
Sources: PATH.
Photo Credit: “Mission to Ouanda Djallé,” courtesy of flickr user hdptcar. -
Managing the Planet’s Freshwater
›“The impact of human activities on the planet and on its biology has risen to a scale that deserves a commensurate response,” said Tom Lovejoy, professor at George Mason University, introducing a discussion on “Managing the Planet’s Freshwater,” the second of a monthly series led jointly by George Mason University and the Woodrow Wilson Center. Karin M. Krchnak, director of International Water Policy at The Nature Conservancy (TNC), and Dann Sklarew, sustainability fellow at George Mason University, joined Lovejoy to discuss the increasing stress placed by population growth, urbanization, and environmental change on freshwater resources and potential solutions to global water insecurity. [Video Below]
Water: “A Global Crisis”
Water insecurity and pollution is “a global crisis,” said Sklarew. Water scarcity is growing and aquatic biodiversity is declining around the world. According to the World Water Council, over one billion people do not have safe drinking water.
Inadequate water management contributes to these problems, said Sklarew. But, human activities “impact water connectivity, quality, and flows” at all scales, he said, and combined with climate change, have fundamentally altered the global water cycle.
“The water-rich and the water-poor are intimately connected,” said Sklarew. National, international, and global trade “water transfers” often move water from dry rural areas to urban centers, he said. “We’re taking from areas that don’t have [water] and moving water, by itself or via food products, to places where they might actually have more water in their local environment.”
But there are many opportunities – from the incremental to the bold, exciting, and revolutionary – to address these problems, said Sklarew, including growing more food with less water, reducing destructive subsidies, restoring natural river flows via dam re-design or removal, encouraging greener infrastructure in urban areas, and supporting participatory decision-making about water. He also pointed to promoting lower population growth and allowing migration that “brings the people to the water rather than the water to the people” as additional ways to improve water security. In the future, “bio-mimicking and techno-fixes,” may also provide promising solutions, he said.
Clear national goals and a global-scale response are critical to making these solutions a reality, said Sklarew: “Even though these challenges are often local, in the end, we have one interconnected water system.”
Watershed Protection: Innovative Solutions
“I know we all wish that there was a silver bullet for global water challenges,” said Krchnak, “but there’s not just one solution.”
As population grows by an additional 2 billion people before 2050, “solutions must take population growth into account,” said Krchnak. One-third of the world’s population is now subject to water scarcity, which is expected to double in the next 30 years
More water will be necessary to meet growing demands for food, energy, and other commodities, said Krchnak. In particular, “the poor in urban centers will be the dominant challenge for us in the next decades.”
Krchnak described three possible strategies to protect watersheds: market-based mechanisms, integrated water resource management, and incentive approaches.
Water funds, a market-based mechanism in which downstream water users pay for protection of the upper watershed, are one possible way to better manage freshwater, said Krchnak. With the help of local partners, TNC’s Quito Water Fund, for example, creates a sustainable finance mechanism and protects watersheds that supply 2 million people. Similar programs “can be taken to other geographies and replicated across the globe,” she said.
Another TNC program, the Great River Partnership, uses an integrated water resource management strategy that focuses on stakeholder collaboration and working with public and private partners to help create “one vision” for major rivers like the Mississippi, Magdalena, Paraguay-Parana, Yangtze, and Zambezi, said Krchnak.
The Alliance for Water Stewardship uses an incentive-based approach to promote “responsible use of fresh water that is socially beneficial and environmentally and economically sustainable.” One of the main objectives of the Alliance is to develop performance standards and create a certification program that recognizes water providers who work to protect freshwater resources.
Strategies like these may not be appropriate everywhere, and programs need to be adapted to make local implementation possible, said Krchnak, but effectively managing the planet’s freshwater is vital for human health, spiritual and cultural well-being, ecosystems and biodiversity, and economic opportunity.
Sources: World Water Council, UNDP.
Photo Credit: “Rio Magdalena,” courtesy of flickr user Esparta. -
USAID’s Role in National Security: Development Matters and It’s Cheaper Than You Think
›February 22, 2011 // By Ramona Godbole“Development is not and cannot be a sideshow,” said U.S. Agency for International Development (USAID) head Rajiv Shah, in a speech at the Center for Global Development on January 19. This year marks the 50th anniversary of USAID, and there are some promising changes in the works for the agency as it transforms itself into a “modern development enterprise.”
Over the past year, the Obama administration launched the Quadrennial Diplomacy and Development Review (the QDDR – see our full set of reviews on this first-of-its-kind document), Feed the Future, and the Global Health Initiative. In accordance with these new strategic initiatives, USAID has launched USAID Forward to implement a series of reforms to strengthen its capacity to meet the world’s development challenges effectively and efficiently. The agency has tried to foster a “spirit of innovation, science, technology, and smarter strategic thinking to each of [its] areas of core focus: gender, education, water, and climate,” said Shah. In his speech at CGD, he announced a new, re-worked evaluation policy and outlined a number of cost-saving actions, including graduating countries that no longer need aid, promoting procurement and contracting reform, and eliminating some costly senior positions in the agency.
Value to Shareholders
Moving forward, USAID is working to further reduce inefficiencies and increase transparency, said Shah, and is “focused on delivering the highest possible value for our shareholders – the American people and the congressional leaders who represent them.” He added that “like an enterprise, we’re relentlessly focused on delivering results and learning from success and failure.”
These are exciting changes for the development community. But, if Congress significantly cuts funding, by, for example, passing a plan similar to one endorsed by 165 Republican representatives a few weeks ago, these changes might not see the light of day – the plan proposed to save $1.39 billion by eliminating agency operating expenses. Putting that in perspective, the USAID operating budget for the past fiscal year was $1.69 billion. (Strangely, while the plan all but eliminates the agency that administers them, it does little to cut actual outgoing foreign assistance monies.)
The plan, however, may reflect the views of much of the American public. A World Public Opinion poll showed that Americans believe the government spends up to 25 percent of its budget on foreign aid and want to cut back to 10 percent, while in fact, aid represents just one percent of the federal budget (compared with more than 20 percent for defense).
What the proposed plan fails to take into account is development’s role in promoting peace, security, and prosperity globally. Said Shah at CGD, “as the President and the Secretaries of State, Treasury, and Defense have all made abundantly clear, development is as critical to our economic prospects and our national security as diplomacy and defense.”
A More Efficient Investment
Shah elaborated on this idea in an interview with Foreign Policy last month: “In the military they call us a high-value, low-density partner because we are of high value to the national security mission but there aren’t enough of us and we don’t have enough capability,” he said. “This is actually a much, much, much more efficient investment than sending in our troops, not even counting the tremendous risk to American lives when we have to do that.”
Chad Briggs, a professor for the USAF Air University, pointed out the multiple benefits to the military that increased State and USAID agency in the field could provide in his review of the QDDR:Considering the existing responsibilities of the United States overseas and the potential for future risks and crises that will need to be addressed, the QDDR’s recommendations to strengthen engagement abroad can only be a positive step for U.S. interests. If the various hurdles enumerated above and elsewhere can be addressed, the QDDR’s focus on emerging risks may also ease the burden on DOD resources and force deployments, recognizing that not every engagement abroad should be resolved by the military alone.
If done right, development can provide both economic growth and democratic governance and help stabilize countries before, during, and after conflict or crisis in a cost-effective way while simultaneously addressing transnational human and environmental security issues like hunger, poverty, disease, and climate change (see Yemen for an example where the application of soft power now could reduce the chance of deploying more hard power later).
Policymakers should support USAID’s current efforts to make smarter investments, “which over time will save hundreds of millions of dollars, as opposed to trying to save a little bit now by cutting our capacity to do oversight and monitoring,” said Shah in Foreign Policy.
Sources: Center for Global Development, The Economist, Foreign Policy, USAID, U.S. Department of State, World Public Opinion.
Photo Credit: “Pallets of food, water and supplies staged to be delivered,” courtesy of flickr user USAID_Images. -
Health, Demographics, and the Environment in Southeast Asia
›“Health and Health-Care Systems in Southeast Asia: Diversity and Transitions,” launches a series in The Lancet on health in Southeast Asia. While social, political, and economic development have paved the way for substantial health improvements in some countries, demographic transitions are taking place at among the fastest rates in the world, including reductions in fertility, population aging, and rural-to-urban migration. An epidemiological shift is occurring as well, from infectious to chronic diseases. Rapid urbanization and population movement can not only affect the emergence and spread of new infectious diseases directly, but can also exacerbate environmental changes that indirectly contribute to the burden of waterborne and vector-borne diseases. The series, available early online, addresses these concerns in more detail. Moving forward, the authors advocate for “enhanced regional cooperation in the health sector to share knowledge and rationalize health systems operations, leading to further public health gains for the region’s diverse populations.”In “A Stormy Future for Population Health in Southeast Asia,” author Colin D. Butler responds to the series, stressing that the health of the future generation is dependent on actions today. Environmental change will likely bring sea-level rise that threatens urban centers and food bowls, causing regional food scarcity, exacerbating diseases like dengue fever, increasing the number of extreme weather events, and contributing to resource scarcity throughout the region. With increasing need for sustainable development in the region, Butler concludes that “stronger human factors will be essential to counter the increased physical stresses that seem to be the inevitable destiny of Southeast Asia, largely as a result of the actions of people who have never seen its shores.” -
Reality Check: Challenges and Innovations in Addressing Postpartum Hemorrhage
›Heavy bleeding after childbirth, also known as postpartum hemorrhage (PPH), is one of the leading causes of maternal deaths worldwide. Globally, approximately 25 percent of all maternal deaths are caused by postpartum hemorrhage, and many mothers bleed to death due to delays in seeking health care services. On January 25th, 100 representatives from the maternal health community – a majority working directly in developing countries – convened for an all-day meeting at the Wilson Center to discuss experiences in the field and perform “reality checks” on the challenges and successes of PPH programs.
