Showing posts from category Afghanistan.
-
USDA v. Taliban
›May 28, 2010 // By Dan AsinAgricultural development is the “top non-security priority” in Afghanistan, said U.S. Secretary of Agriculture Tom Vilsack, in a recent speech. “Unemployment is the best recruiting tool for the Taliban,” he told the Des Moines Register.
Sixty USDA experts are working with their partners in State, USAID, DOD, and other members of U.S. government to increase agricultural opportunities in rural areas of the country. Embedded in small civil-military units of 15-100 people, USDA experts have worked on projects of all scales: installing windmill water pumps, training veterinarians, refurbishing university research laboratories, stabilizing river banks and irrigation canals, and developing storage facilities.
In his keynote speech at the Feed the Future launch, Vilsack emphasized the need to build markets. In Afghanistan, USDA is focusing on improving infrastructure so farmers can receive deliveries and ship produce, and boosting credit vehicles to help farmers purchase the inputs to grow crops. Opium traders provide seeds to the farmers and pick up the crops at the farms, he said, which makes opium easier to produce than legal crops.
Alternative crops could be just as or more valuable, Vilsack told NPR:Table grapes are in some cases perhaps four and five times more valuable than poppy. Saffron, almonds, pomegranates, a number of fruits are significantly more profitable. What we have to do is we have to establish that the reward of putting those crops in the ground is greater and the risk is equal to or less than poppy production.
On the same NPR program, Vilsack’s counterpart agreed: “Agriculture growth means employment and employment means security. They’re so much related to each other. In places where the military operates, if you do not offer people the future, just by military means, security and stability will be a very far-reaching dream,” said Minister of Agriculture, Irrigation, and Livestock Mohammad Asif Rahimi.
But the Afghan government faces an immense challenge: Afghanistan’s unemployment rate is estimated at 35 percent, which ranks it in the bottom 20 countries in the world. With a population growth rate of 3.5 percent and nearly half the population already under the age of 15, the need for job creation is only set to increase.
While agricultural development and food security are essential, Rahimi acknowledged, alone they are not enough. The Afghan government needs a “whole of government approach,” he said. To win the hearts of its people the government must offer “an alternative to what the Talibans were offering to people…more livelihood and security and education and health, and also a better and more secure future.”
Both Vilsack and Rahimi avoid the common trap of equating hunger with conflict, instead emphasizing agricultural employment and economic opportunities as key to solving that intractable conflict.
But it’s not the only piece of the puzzle. I hope the Feed the Future’s “whole of government” approach in Afghanistan will emphasize not only agriculture, but also the environmental policies and health services, such as family planning, that can ensure that agricultural gains are sustainable even after the troops leave.
Sources: Central Intelligence Agency, Des Moines Register, NPR, United Nations Statistics Division, United Nations Population Division, U.S. Agency for International Development, U.S. Department of Agriculture, U.S. Department of State.
Photo Credit: Colonel Stephen Redman and John Van Horn of the USDA discuss crop plans with local residents while surveying the site of the Arkansas Agribusiness Development Team’s (ADT)demonstration farm plot near Shahr-e-Safa, Afghanistan, courtesy Flickr user isafmedia. -
Human Resources for Maternal Health
›“Pregnancy is not a disease, a woman should not die of pregnancy…it doesn’t need a new drug…it doesn’t need research – we just need skilled workforce at different levels,” argued Seble Frehywot, assistant research professor of Health Policy and Global Health at George Washington University, at the Global Health Initiative’s second event of the Advancing Policy Dialogue on Maternal Health Series.
Research shows that increased access to skilled health workers during pregnancy and delivery, including midwives and other practitioners, can significantly reduce maternal mortality in developing countries. One solution to the current human resource crisis is to expand, and in many cases, acknowledge, the skills and responsibilities of non-physician health workers.
Task-Sharing: Who, What, and How
“There are too many preventable deaths…if we look at the data, quality maternal health services are not available,” argued Frehywot, as she presented the following evidence:
There are four common types, or levels, of task-shifting:- Countries that have the highest maternal mortality rates are those that also have the greatest worker shortage
- In Africa, for every 10,000 births, only 2 physicians and 11 nurses or midwives are present at delivery.
- According to the World Health Organization, there needs to be at least 53 skilled health care workers (nurses, doctors, midwives) per 10,000 births to meet Millennium Goal 5 which seeks to reduce maternal deaths by 75 percent by 2015.
1. Doctors to non-physician health clinicians
“All [task-shifting] needs to be done through a sound regulatory framework…it is very important to match tasks that are needed at the ground level with the competency needed to back it up,” maintained Frehywot. Regulatory issues such as the scope of practice, standard of care, training, licensure, and supervision must be addressed to ensure safe and high-quality treatment. Additionally, political buy-in and commitment from the Ministry of Health, medical universities, and professional councils and associations are necessary for long-term development, argued Frehywot.
2. Health clinicians to registered nurses and midwives
3. Nurses/midwives to community health care workers
4. Community health care workers to expert patients
Policies for scaling-up human resources should start at the district level, as these localized hospitals are geographically closest to the need, argued Frehywot. “If one really wants to decrease the maternal mortality ratios, especially by 2015, this is where most of the people live.”
Applying Task-Shifting in Afghanistan“Maternal mortality ratios in Afghanistan are the second highest in the world,” declared Jeffrey Smith, regional technical director for Asia at Jhpiego. In 2002, when Smith arrived in Afghanistan, there were limited health workers, most with out-of-date skills, and no functional schools for training. “The most important decision made early in the reconstruction [of] Afghanistan was that midwives would be the backbone of the reproductive health workforce and they would be empowered with the skills to perform the tasks necessary for provision of basic emergency obstetric care,” shared Smith.
Making the case for task-shifting, Smith discussed the importance of empowering health workers on the front line so that they may provide services in the most peripheral areas. “Task shifting should not be a temporary fix until we have more doctors,” argued Smith, as this framework disenfranchises a cadre of health workers and fails to build long-term solutions for human resources. Instead, Smith advocated for the “Health Center Intrapartum Care Strategy” that makes midwives the foundation of care and includes strategies for training, staffing, and linkages to the overall health system.
In this post-conflict setting, task-shifting began as an emergency approach. However, it rapidly became a development strategy for professionalizing the workforce and rebuilding the health system. Afghanistan’s Ministry of Public Health was imperative to the success of scaling up midwives as they clearly defined from the beginning what was needed and who would provide care, taking steps to ensure that the midwifery schools maintained legitimacy and received formal accreditation.
“Keep it clinical and keep it local,” shared Smith. The midwifery schools made efforts to recruit individuals from the provincial level, teaching specific life-saving skills applicable in the field. This framework has successfully retained 86% of its graduates, and many of the women report that the program has provided them with a sense of community and ownership.
Building a Sustainable Health Workforce“We invite the maternal health community to take advantage of the incredible momentum that human resources for health is having right now,” shared Pape Gaye, president and CEO of IntraHealth. While there are many issues within the health system that need to be strengthened, Gaye maintained that “we must pick our battles” and advocated for an emphasis on scaling-up the training and availability of midwives.
In order to scale-up midwives for maternal health we must avoid the same old traps, particularly the lack of donor coordination shared Gaye. “If we do a better job of improving coordination we will start solving the problem.” Additionally, Gaye discussed the implications for training generation “Y,” emphasizing the importance of including new technologies available for training, including PDA’s and e-learning courses.
Performance outcomes and training are the two key pillars of effective scale-up, shared Gaye. Task-shifting also requires legal support and the endorsement from medical associations to help legitimize this new health system framework. “This is not simple work; you really need to have a systems approach. What we seek in the end is good integration. Integration across systems, integration across roles, courses, learning processes, and training for maximum adaptability,” shared Gaye. -
Half the Sky, All the Promise: The Personal is Political in NYT Special Issue
›“The world is awakening to a powerful truth: Women and girls aren’t the problem; they’re the solution,” write Nicholas Kristof and Sheryl WuDunn in the lead article of this Sunday’s The New York Times Magazine.
In this special issue devoted to “Saving the World’s Women,” five articles document global failures and personal horrors, but also offer forward-looking solutions from the individual to the institutional. As the subtitle says—“changing the lives of women and girls in the developing world can change everything”— this vital effort can help us not only improve the lives of women, but meet larger goals including international security, global health, and economic development.
In “The Women’s Crusade,” Pulitzer Prize-winners Kristof and WuDunn, whose new book Half the Sky will be published on September 8, outline the ways in which the world’s women and girls are abused, neglected, and overlooked. They use devastating data to detail how women around the world suffer from lack of education, maternal mortality, sexual violence, trafficking, and economic and political oppression, and then bring these figures to life with women’s personal stories.
They argue that elevating women is not a “soft” issue, but rather has the power to transform economies and address security threats—a point echoed in an interview with Hillary Clinton, in which she calls women and girls “a core factor in our foreign policy.”
“I happen to believe that the transformation of women’s roles is the last great impediment to universal progress,” says Clinton, long an informed and passionate advocate for global women’s issues. She encouraged President Obama to create a new ambassadorship for global women’s issues, and filled the opening with Melanne Verveer, a respected activist and former head of the Vital Voices Global Partnership.
Clinton most strongly emphasizes the connection between women’s issues and national security, calling it “an absolute link”: “If you look at where we are fighting terrorism, there is a connection to groups that are making a stand against modernity, and that is most evident in their treatment of women.” She goes so far as to agree that spending taxpayer money on education and healthcare for girls and women in Pakistan would be more effective than military aid to the country.
“A woman who is safe enough in her own life to invest in her children and see them go to school is not going to have as many children. The resource battles over water and land will be diminished,” she says. “And it’s an issue of how we take hard power and soft power, so called, and use it to advance not just American ends but, in advancing global progress, we are making the world safer for our own children.”
Also in the magazine:
The New York Times’ website adds a slide show of Katy Grannan’s portraits of women in South Asia and Africa, and launches a contest soliciting personal stories from the field. Submit your photos and blog posts to Kristof’s blog by September 19.- Dexter Filkins investigates the acid attacks on girl students in Afghanistan in the horrifyingly vivid storytelling he displayed in his best-seller, The Forever War.
- Lisa Belkin takes note of an emerging generation of female philanthropists using their money to “deliberately and systematically to aid women in need,” spurred by the Hunt sisters’ “Women Moving Millions” campaign.
- Tina Rosenberg describes how sex-selective abortion and inadequate health care for young girls has led to a “daughter deficit” in China and India, where, somewhat paradoxically, “development can worsen, not improve, traditional discrimination.”
- Africa’s first female President, Liberia’s Ellen Johnson-Sirleaf, tells NYT that if women ran the world, it would be “better, safer and more productive.”
To me, such vital voices are the most powerful, proving that the personal is political. The quotes in the lead article from academic studies, local NGO personnel, and women themselves map the way forward:- “When women command greater power, child health and nutrition improves” – Esther Duflo of MIT, on micro-finance.
- “Girls are just as good as boys” – An unidentified man who once beat his wife for not having sons, but changed his mind when a micro-loan turned her into the family breadwinner.
- “Gender inequality hurts economic growth” – Goldman Sachs, Global Economics Paper, 2008
- “I can’t talk about my children’s education when I’m not educated myself … If I educate myself, then I can educate my children” – Terarai Trent, a Zimbabwean woman now completing a PhD in the United States.
“Pregnancy is not a disease, a woman should not die of pregnancy…it doesn’t need a new drug…it doesn’t need research – we just need skilled workforce at different levels,” argued Seble Frehywot, 
“
“We invite the maternal health community to take advantage of the incredible momentum that human resources for health is having right now,” shared Pape Gaye, president and CEO of IntraHealth. While there are many issues within the health system that need to be strengthened, Gaye maintained that “we must pick our battles” and advocated for an emphasis on scaling-up the training and availability of midwives.
