Showing posts from category development.
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Sustainable Development
›Are Women the Key to Sustainable Development?, by Candice Stevens and appearing in Boston University’s Sustainable Development Insights series, asks whether gender-conscious development strategies are the missing link in the three pillars–social, economic, and environmental–of sustainable development. She points out that “An increasing number of studies indicate that gender inequalities are extracting high economic costs and leading to social inequities and environmental degradation around the world.” In the policy world gender-conscious initiatives are often more effective as well. “United Nations and World Bank studies show that focusing on women in development assistance and poverty reduction strategies leads to faster economic growth than ‘gender neutral’ approaches.” Stevens finds that achieving greater gender parity may be the key to better governance, increased growth, and a safer environment.
The Role of Cities in Sustainable Development, by David Satherwaite and also appearing in Boston University’s Sustainable Development Insights series, argues that traditional depictions of cities as dirty and unsustainable are inaccurate. Instead, “…with the right innovation and incentives in place, cities can allow high living standards to be combined with resource consumption that is much lower than the norm in most cities today,” he finds. Satherwaite contends that high-density living arrangements can reduce per capita energy consumption, transportation emissions, and costs of public service provisions like hospitals and schools. However, he warns that none of these potential advantages are guaranteed, and city planners must utilize effective local governance in order to make cities safe, clean, and sustainable. -
Protect Nature to Protect Us: Biodiversity and Adaptation to Climate Change
›June 17, 2010 // By Dan Asin“We believe that changes in biodiversity, either through local extinction or biological invasions, is the single most important and dramatic problem in contemporary ecology,” reads the mission of the Naeem Lab, led by Professor Shahid Naeem of Columbia University and editor of Biodiversity, Ecosystems Functioning, and Human Wellbeing: An Ecological and Economic Perspective. As Naeem told a group of USAID employees last week, this problem is even more important today, because biodiversity is a key factor in determining the resilience of life–and could be an important ally in the fight against the impacts of climate change.
At the talk, Naeem described an experiment funded by the National Science Foundation that tested the effect of carbon dioxide, nitrogen, and diversity of plant species on rates of plant growth. The scientists found both carbon dioxide and nitrogen exposure to increase plant growth, but the impact of biodiversity to be even greater.
In the monoculture trials, exposure to carbon dioxide, nitrogen, and both increased vegetation growth by by 7 percent, 2 percent, and 17 percent, respectively. When the plot was expanded to include 16 species, however, rates of plant growth jumped to 22, 25, and 36 percent.
Real-World Implications
Naeem’s message aligned with an earlier World Bank report, Biodiversity, Climate Change, and Adaptation, which in 2008 noted that “Climate change is already impacting on ecosystems and livelihoods, but enhanced protection and management of biological resources can mitigate these impacts and contribute to solutions.”
The report, which examines the importance of biodiversity to mitigating and adapting to climate change, cites real-world examples, such an analysis of a forest management project in Madagascar that would cost $97 million but generate $150-180 million in revenue from direct payments for conservation activities, ecotourism, and watershed protection.
Another example focuses on a farmer in South Africa’s Bokkeveld Plateau, who 30 years ago switched from cultivating cereals and pasture crops to nurturing indigenous vegetation. “With the diversity of indigenous plants, McGregor was able to maintain productivity for much longer through the dry summer season,” the report says. Further, he was able to eliminate the need for pesticides and increase the productivity of sheep grazing. The flowering of the natural plants attracted tourists to his farm, generating greater income for both himself and his district, and has since become South Africa’s ninth botanical garden.
Bringing Science to Bear on Policy
Still, Naeem said that although the scientific evidence connecting biodiversity, resilience, and adaptation has long been established, it is in large part failing to affect environmental and development policy. Naeem said scientists have completed their leg of the race but aren’t able to reach the policymakers who need to carry-on the baton. Along the chain connecting research and policy-making the message becomes lost or diluted.
“How do we translate the science?” Naeem asked the USAID practitioners in the audience. The knowledge of biodiversity’s important role in climate adaptation is available, but how can scientists ensure that it impacts policy? Members of the audience cited both Congressional funding mandates and departmental silos as significant barriers to efforts to address the link between biodiversity and adaptation.
One promising avenue could be programs that already work across departmental silos to integrate environment and health initiatives in areas of the world with high biodiversity. These population-health-environment (PHE) programs, which seek to preserve biodiversity while improving community livelihoods and human health, could be effective mechanisms for exploring the contribution of biodiversity to climate adaptation.
Photo credit: Wildflowers bloom in Namaqualand, South Africa, courtesy Flickr user Martin Heigan. Near the Bokkeveld Plateau, the wildflowers in the two regions are resilient to changes in rainfall and temperature patterns and each year attract tourists from all over the globe. -
Defusing the Bomb: Overcoming Pakistan’s Population Challenge
›According to the UN’s latest mid-range demographic projections for Pakistan, the country’s population–currently about 185 million–will rise to 335 million by 2050. This explosive increase, however, represents the best-case scenario: Should fertility rates remain constant, the UN estimates this figure could approach 460 million. Such soaring population growth, coupled with youthful demographics, a dismal education system, high unemployment, and a troubled economy, pose great risks for Pakistan. Predictably, many observers depict Pakistan’s population situation as a ticking time bomb.
At the same time, some demographers contend that the country’s population profile can potentially bring great benefits to the country. If young Pakistanis can be properly educated and successfully absorbed into the labor force, such experts explain, then the country could experience a “demographic dividend” that boosts social well-being and sparks economic growth. On June 9, the Wilson Center’s Asia Program, Environmental Change and Security Program, and Comparative Urban Studies Project, along with the Karachi-based Fellowship Fund for Pakistan, hosted a day-long conference to examine both the challenges and opportunities of Pakistan’s demographics, and to discuss how best to tackle the former and maximize the latter.
Pakistan at a Crossroads
In her opening address, Zeba A. Sathar of the Population Council declared that Pakistan is “at a crossroads.” Demography will play a key role in determining the country’s future trajectory, she said, yet there is presently little discussion about demographics in Pakistan. Sathar’s presentation traced Pakistan’s recent demographic trends. Despite its high population growth, Pakistan’s fertility rates have actually been in decline since the early 1990s–a fact that Sathar attributed to progressively higher ages at marriage (for both men and women), but also to the “reality” of abortion. However, Pakistan’s pace of fertility decline has slowed in the last few years–a consequence, Sathar argued, of Islamabad’s failure to promote social development (particularly education) and of the international donor community’s prioritizing of HIV/AIDS funding over that of family planning since 2000. Sathar concluded that achieving Pakistan’s “demographic dreams” will require more educational and employment opportunities (particularly for women) and better access to family planning in rural areas.
In the following panel, Wilson Center Senior Scholar Shahid Javed Burki noted the long-standing failure of demographers and economists in Pakistan to work together on the country’s population issues. This failure, Burki asserted, has resulted in poor choices and bad policy. He also criticized officials and scholars for being reactive in their population proposals, rather than proactive. Burki emphasized that good policy choices can produce favorable results. If, for instance, the population policies launched in Pakistan’s early decades had been sustained to the present, the country today would have 30 million fewer people. Similarly, had Pakistan followed the Bangladeshi approach and concentrated on the economic empowerment of women, today there would be more than 40 million fewer Pakistanis. Good policies matter, Burki repeatedly asserted, and Pakistan’s large and growing population, if dealt with wisely, can be an asset rather than a burden.
Development Through the Bangladeshi Model and Education
Like Burki, Yasmeen Sabeeh Qazi of the Packard Foundation pointed to Bangladesh as a relative success story. She highlighted Bangladesh’s reproductive health services system, which has served to increase the health of Bangladeshis and reduce their poverty. Indonesia and Iran, whose fertility rates are one-half Pakistan’s, provide other examples in the Muslim world where official policy has made a significant difference. Qazi’s presentation emphasized the linkages between family planning, reproductive health, and development. Noting that one-third of pregnancies in Pakistan are unplanned, she underscored the correlation between smaller family size and higher gross national income. She urged the government to fashion a population policy that expands access to reproductive health services, strengthens the health system generally, promotes education (especially for girls), and creates more jobs.
Moeed Yusuf of the U.S. Institute of Peace examined the prospects for radicalization of Pakistan’s youth. Pakistan’s stratified education system, Yusuf cautioned, is not training productive, employable members of society. Only graduates of elite private schools or of foreign schools are prepared for the economy of the 21st century. Meanwhile, the economy is not producing the quality jobs the young expect, leading to an “expectation-reality disconnect” that fosters not only un- or underemployment, but also anger and alienation. Moreover, the state, by deliberately cultivating the ultra-right elements in Pakistani society who most want to radicalize the country’s youth, is part of the problem. Still, Yusuf added, echoing the hopefulness of other speakers, it is not too late. These disturbing trends can be reversed, with help from outside friends like the United States, which, Yusuf counseled, should focus on assisting Pakistan’s education system, support rural private schools, and allow more Pakistani students to study in the United States.
Plugging Public Sector Holes with Private Initiatives
Saba Gul Khattak focused her luncheon address on the work of the Pakistan government’s Planning Commission, of which she is a member. In recent years, Pakistan’s population programs have been devolved from the federal to the provincial and sub-provincial levels. This decentralization, she averred, has opened the way for a genuine reform agenda. But it has also contributed to a situation where no one at the federal level feels any “ownership” over the country’s population programs. Implementation has always been the most vulnerable point in the policy process–and the lack of “ownership” only accentuates this problem today. Khattak emphasized the linkages between population, health, education, and development. Today, she asserted, children are seen by their parents as a source of old age security. Only when the government fills this void through the establishment of an effective social security structure will Pakistan be able to reduce its fertility rates. Development must accompany a truly effective population program.
In the afternoon panel, Sohail Agha of Population Services International discussed the role of the private sector in family planning in Pakistan. He argued that this sector has made a “substantial contribution” to Pakistan’s increased use of condoms: In 2006-07, a period when condom use spiked by nearly 8 percent, about 80 percent of this increase was covered by contraceptives provided by the private sector. Additionally, he noted that a 2009 survey found that urban Pakistanis exposed to social marketing campaigns about condom utilization increased their use of the contraceptive by 10 percent. Furthermore, he described private-sector-led health financing plans for women’s fertilization–a method of contraception that, like condoms, has increased over the last 30 years in Pakistan.
Engaging Youth and Political and Religious Leaders
Shazia Khawar of the British Council discussed the “Next Generation” report, a 2009 Council study about Pakistan’s youth. The report, based on a survey of 1,500 young people across both rural and urban Pakistan, concludes that young Pakistanis are deeply disillusioned about their country and its institutions, with three-quarters of those surveyed saying they regard themselves as “primarily” Muslims, not Pakistanis. The report’s “critical point,” said Khawar, is that Pakistani youth participation in policy development is nonexistent. To this end, the British Council has spearheaded several initiatives to engage the country’s youth in Pakistani politics and to spark dialogue between young Pakistanis and policymakers. Khawar concluded, however, that success is possible only if Pakistan’s top political leaders “pledge themselves to this agenda.”
Mehtab S. Karim of the Pew Research Center offered a comparative perspective, discussing demographics in the broader Muslim world, with particular emphasis on Bangladesh and Iran. Why, he asked, has Pakistan experienced less fertility decline than most of its fellow Muslim-majority nations? He suggested that the answer lies in the failure of Pakistan’s political and religious leaders to make early and sustained commitments to family planning. In Bangladesh, he explained, the country’s very first government made lower population growth rates a “prime goal.” And in Iran, spiritual leader Ayatollah Khomeini issued a fatwa in support of contraceptive use soon after the Islamic Revolution. Yet in Pakistan, according to Karim, religious figures have consistently opposed Islamabad’s family planning efforts, and the government has proven unwilling or unable to combat this resistance.
Scott Radloff of USAID discussed his agency’s family planning and reproductive health (FP/RH) projects in Pakistan. FP/RH aid to Pakistan was largely cut off during much of the 1990s due to the Pressler Amendment–a 1985 modification to the U.S. Foreign Assistance Act that banned most U.S. military and economic assistance to Pakistan unless the U.S. president certified that Pakistan had no nuclear weapons. President George W. Bush waived this prohibition in 2001, and since then USAID FP/RH assistance has risen to nearly $45 million. Current interventions focus on strengthening services within Pakistan’s Ministry of Health and Ministry of Population Welfare; improving contraceptive supplies and logistics; expanding community-based services; and increasing awareness and commitment, including among religious leaders.
Participants concurred that Pakistan’s demographic situation is fraught with risk. Yet they also highlighted a series of hopeful signs. Yusuf noted the absence of an “imminent” danger of youth radicalization; Khawar pointed to the testimonies of “many young leaders determined to do their part” that flow from the “Next Generation” report; and both Karim and Qazi cited Bangladesh and Iran as proof that successful family planning programs are possible even in countries marked by deep poverty or conservative Islam. The presenters were also in accord about the necessary policies moving forward: more extensive family planning and reproductive health services, better education, and more job opportunities (particularly for women). At the same time, speakers repeatedly underscored the profound challenges facing the implementation of such policies. Still, for all the talk about major obstacles and challenges, there was recognition that more modest and simple steps can be taken as well–such as promoting more discussion about demographics within Pakistan, and especially among experts from different disciplines.
Michael Kugelman is program associate and Robert M. Hathaway is director of the Wilson Center’s Asia Program.
Photo credit: Traffic in downtown Karachi, courtesy Flickr user Ali Adnan Qazalbash. -
Afghanistan’s Mineral Wealth: Gold Mine, Curse, or Illusion?
›June 15, 2010 // By Schuyler NullAccording to The New York Times, U.S. officials have discovered a veritable bonanza of heavy metals and rare earth minerals in Afghanistan that have the potential “to fundamentally alter the Afghan economy and perhaps the Afghan war itself”:The previously unknown deposits — including huge veins of iron, copper, cobalt, gold and critical industrial metals like lithium — are so big and include so many minerals that are essential to modern industry that Afghanistan could eventually be transformed into one of the most important mining centers in the world, the United States officials believe.
Reaction to the announcement has been mixed, with both Foreign Policy and Wired bloggers expressing skepticism about the timing of the announcement – in the midst of a difficult period of the war – and pointing out that the “discovery” is old news.
Others have expressed hope that the find, worth an estimated $1 trillion, might provide an injection of much-needed capital into one of the world’s worst economies. Environmental security expert Saleem Ali of the University of Vermont told Public Radio International’s The World that “there’s an opportunity now for the country to develop outside of a predominantly drug-dependent economy and if properly managed the minerals could provide a catalyst for all kinds of other activities as well.”
Afghanistan’s rare earth minerals in particular might prove to be extremely valuable as global demand continues to grow for these critical components of renewable energy technology and advanced electronics. The New York Times reports that an internal Pentagon memo says Afghanistan has the potential to become the “Saudi Arabia of lithium”:Just this month, American geologists working with the Pentagon team have been conducting ground surveys on dry salt lakes in western Afghanistan where they believe there are large deposits of lithium. Pentagon officials said that their initial analysis at one location in Ghazni Province showed the potential for lithium deposits as large of those of Bolivia, which now has the world’s largest known lithium reserves.
The existence of mineral reserves in Afghanistan is not new news, nor is foreign interest in them (see our coverage of Chinese copper investments at Aynak earlier this year). But the size of these resources warrants attention and raises new questions about the possibility of the unstable country falling victim to the natural resource curse – remaining mired in poverty while generating billions of dollars for an elite few.
Mineral wealth has a long history of fueling conflict in unstable countries, such as Sierra Leone, Nigeria, and the Democratic Republic of Congo. The DRC’s mining laws – which, like Afghanistan’s, were designed by the World Bank – have not prevented violent struggle to control the country’s valuable resources, as described by John Katunga in ECSP Report 12.
How can Afghanistan’s newly discovered mineral resources be developed without funding insurgents or fueling new conflicts? USAID’s Minerals and Conflict Toolkit offers a start with a set of recommendations and discrete steps that development agencies should take to avoid exacerbating the links between mining, valuable resources, and violent conflict.
Stay tuned for more analysis on Afghanistan’s development, resource curse dynamics, and what this all means for the continuing conflict.
Sources: Foreign Policy, National Public Radio, The New York Times, Public Radio International, Wired.
Photo Credit: “Remote Sensing Survey 2006” courtesy of the U.S. Geological Survey. -
‘The Plundered Planet’: A Discussion With Paul Collier
›Who owns the planet’s natural wealth found underwater, below ground, and in the air? How do we reconcile our use of these assets with that of future generations? Such questions are the subject of Oxford Professor Paul Collier’s latest book, The Plundered Planet: Why We Must–and How We Can–Manage Nature for Global Prosperity, which he discussed at a recent Wilson Center event.
The author of The Bottom Billion and Breaking the Conflict Trap, Collier called Plundered Planet “the most important book I’ve written.” Resources are a “one-shot game,” he said; if we waste them, they’re gone. The next 10-20 years are “vital” to preserving natural assets as new technologies for removing them proliferate. We’re sucking fish up like “hoovers,” he said, and a combination of technology and economic growth are rapidly pushing mineral extraction into the few remaining frontiers.
Because time is short, Collier hopes his work will bring economists and environmentalists together. He said the two groups are largely at each other “cat and dog,” yet their objectives–environmental preservation and economic development–are not fundamentally opposed. In fact, to overcome polarization and produce key policy decisions, development and conservation must become partners.
Becoming Custodians, Not Curators
Collier said resource plunder can take one of two forms: “Where the few expropriate what belongs to the many”; and “where nature is expropriated by the present generation and burned up rather than benefiting future generations.” Both forms of plunder not only impede development, but are also unjust, he said.
Unlike other assets–such as books or records, which are typically owned by their authors or artists–natural assets have no human creators. A system whereby “natural assets are owned by the people who are lucky enough to live on top of them” creates “staggering inequality,” said Collier. Instead, resources must be shared equally among all citizens of a nation, including those not yet born.
Yet sharing nature’s wealth with generations to come does not mean leaving all fish in the sea, all trees on land, or all minerals underground. “We are not curators of natural artifacts,” Collier said. “We’re custodians of natural value.”
For the one billion people living in poverty, the development of natural resources can provide a path toward development, growth, and better lives, Collier argued, when properly and justly managed.
Filling the Gaps in Governance
Why have we largely plundered, rather than invested in, our resources thus far? What can be done to change the current principles of resource management? Collier’s short answer: governance.
For the poor countries in the “bottom billion,” Collier said the “broken decision chain” must be mended. The chain has six steps:- Discovering natural assets;
- Avoiding appropriation by a few at the expense of the many;
- Ensuring local inhabitants receive generous compensation for unavoidable environmental damage;
- Consuming in a way that benefits both the present and the future;
- Investing in the absorptive capacity of government; and
- Investing in domestic development.
Igniting a Movement
“There is no substitute…for building a critical mass of informed opinion,” Collier said. While technology enables plunder, it also creates a way for people to share knowledge at tremendous speeds and with wide audiences. The challenge, he said, “is to ignite the information transformation process.” A shift from plunder to sustainable management of transnational and developing country resources is a historic opportunity to benefit the world’s poor. “If these resources are harnessed for sustained development,” he said, “they can drag themselves decisively from poverty to prosperity.” The window of opportunity, however, is closing. -
Rare Earth: A New Roadblock for Sustainable Energy?
›June 7, 2010 // By Wilson Center Staff
The 2010 National Security Strategy emphasizes that energy independence is part of a larger strategy for national security, stating, “As long as we are dependent on fossil fuels, we need to ensure the security and free flow of global energy resources.”
However, the alternatives to fossil fuels–such as wind energy, hybrid vehicles, and energy-efficient light bulbs–could also lead to dependence on international resources. They require minerals known as rare earth elements or minerals (REEs). REEs are required for producing the magnets necessary for a variety of goods, including precision-guided munitions, computer hard drives, lasers, communication and radar systems, satellites, and color televisions.
But China has a virtual lock on the production of REEs. In response, U.S. policymakers requested the GAO produce a detailed assessment of REEs in the U.S. defense supply chain as part of the 2010 National Defense Authorization Act. At the same time, the Pentagon is changing its policies regarding acquiring and stockpiling REEs.
Demand for Rare Earth Predicted to Rise
CEO Mark Smith of Molycorp Minerals, a U.S. rare earth mining operation, told HardAssetsInvestor.com:Today the largest use of these magnets is in hard disk drives… We believe that may be changing as hybrid cars become more popular and the use of wind turbines becomes more widespread. Clearly, on a volumetric basis, these two new clean energy technologies could easily overtake hard disk drives in terms of the volume of permanent rare earth magnets required.
Despite their name, REEs are not necessarily rare–known stocks and demand vary widely by element–but supplies of some key elements are short, reports Robin Bromby of The Australian.
China Corners the Rare Earth Market
The growing attention paid to REE supply stems more from the location of mining and production facilities rather than pure scarcity concerns. According to the GAO assessment, China produced 97 percent of rare earth oxides in 2009, and it has established economic protections on rare earth exports. The United States Magnet Material Association has estimated that China’s consumption of rare earth materials will outpace its supply between 2012-2015.
“What we need to be careful of is that we don’t unknowingly change our dependence on foreign oil to a new dependence on Chinese rare earths,” Molycorp’s Smith told HardAssetsInvestor.com. While new technologies may change the type of battery used in hybrids, “the one thing that cannot change in electric vehicles or hybrid vehicles is the use of permanent rare earth magnets in the motors and generators. There is simply no substitute for those magnets,” said Smith.
U.S. Seeks Secure Supplies
Given the lack of substitutes, the United States is attempting to secure access to REEs. Known deposits exist in the United States, Australia, Brazil, India, Canada, South Africa, and Greenland. However, in order for the United States to procure secure access to REEs, they must both acquire mines and processing facilities for the multi-stage production process, which today takes place almost entirely in China.
The GAO estimates it may take up to 15 years for the United States to produce a finished product. In that time, Chinese consumption is expected to have vastly increased and demand for certain REEs may be very high.
Washington is taking this threat seriously. As pointed out by CNAS’ Christine Parthemore, the 180-day turnaround time on the GAO’s rare earth assessment was considerably shorter than for other assessments, including a plan for operational use of biofuels.
The Pentagon is revamping its stockpiling practices, reducing bureaucratic barricades to changing quotas, broadening buying options, and growing the array of stockpiled resources, the Wall Street Journal reported, adding:The rising competition for raw materials has sparked fears in the U.S. military that some materials that once seemed abundant could suddenly become hard to get at any price. In 2008 the military suspended or limited sales of 13 commodities it had previously considered excess. Last year it added 14 materials to its list of resources it considers for stockpiling, including specialty steels, lithium and some rare-earth elements, taking the total to 68. More additions are expected, said Ms. Stead of the Defense National Stockpile Center.
While it seeks secure supplies of REEs, the United States, and the defense community in particular, should take heed of the long history of minerals and conflicts around the world. Global demand for certain minerals has supported combatants in conflict areas; for example, control of coltan mines in the Democratic Republic of Congo, while producing only 1 percent of global supply, played a significant role in that country’s civil war.
The switch to alternative transportation fuels could similarly produce new patterns of global resource demand that spur or support conflict–a phenomena that will be explored in an upcoming ECSP event, “Backdraft: The Conflict Potential of Climate Mitigation and Adaptation.”
On the other hand, done correctly, mineral extraction could be a way to break the “resource curse” and increase cooperation rather than conflict. In Pakistan, “development and maintenance of an extractive mineral industry could revolutionize the Waziristan economy and infrastructure in the long-term,” says Natural Security, which could provide “an incentive for local cooperation.”
Ultimately, the way that the United States seeks to slake its hunger for resources will determine whether it can stockpile its way to security.
Tara Innes is a PhD student at the University of Maryland, studying conflict-environment linkages and an intern with ECSP.
Photo Credit: Adaptation of Periodic Table, courtesy Flickr user Destinys Agent -
VIDEO: Paul Collier On Romantics and Ostriches
›June 4, 2010 // By Dan Asin“I’m trying to build common ground between environmentalists and economists. Those two groups are being cat and dog for a long time,” author and Oxford professor Paul Collier, speaking about his new book The Plundered Planet, tells ECSP.
Collier says the interests of the two groups have thus far been dominated by their “fundamentalist” wings: On one side the environmental “romantics,” who value nature over people, and on the other the economic “ostriches,” who deny that nature’s a priori existence endows it with unique characteristics.
Work toward resolving two of the world’s most pressing challenges, environmental degradation and poverty, demands collaboration and mutual recognition by both sides. “If you take that romantic view of nature,” says Collier, “we will never feed a world of 9 billion people–we will never lift the poorest people out of poverty.” At the same time, nature does not belong exclusively to those living today, and its value must be preserved for future generations. “Those rights of the future have to be respected,” he says.
“The romantics and the ostriches, between them at the moment, are winning,” says Collier. “[I]t’s very important they start to lose.” -
Improving Transportation and Referral for Maternal Health
›“Referral has been called an orphan cause,” said Patricia Bailey, public health specialist for Family Health International and Columbia University, because it is “everybody’s responsibility and therefore nobody’s responsibility.”
As part of the Maternal Health Dialogue Series the Woodrow Wilson International Center for Scholars’ Global Health Initiative convened a small technical meeting on May 19, 2010, with 25 experts from five countries to discuss their experiences and share lessons, challenges, and recommendations for improving transportation and referral for maternal health. Following the technical meeting, a public dialogue was held on May 20, 2010, to share the knowledge gaps and recommendations identified. The formal report from the technical meeting will be available in the near future.
Mobilizing District Communities in Rural GhanaTo improve maternal health care in Ghana, “we needed to shift [services] to the community level, where 70 percent of our population lives,” said Dr. John Koku Awoonor-Williams, the east regional director of Ghana Health Service. The “Community-based Health Planning and Services” (CHPS) program was created to galvanize local leadership and empower communities to engage in health outreach activities.
Through this approach, “community health officers and nurses are trained and delegated to distant village locations called CH[I]P zones, in which they are responsible for health education, treatment of minor illnesses, maternal and antenatal care, and referral to district hospitals for emergency care,” said Awoonor-Williams. Community health officers use two-way Motorola walkie-talkies to communicate with traditional birth attendants and referral centers. Pregnant women are given the phone numbers so they can call in the event of complications.
1-0-8 Emergency Number for Improving Maternal Health in IndiaMany parts of the developing world do not have a 911-style emergency response service. To address this gap, the GVK Emergency Management & Research Institute in India developed the toll-free 1-0-8 telephone number for all medical, police, and fire emergencies.
“We assure every citizen that wherever you are, [if] you call us we will be there,” said Subodh Satyawadi, chief operating officer of GVK. In order to reach the 433 million people covered by GVK, they have:
“Although we address all kinds of emergencies, we heavily focus on maternal health…31 percent of emergencies are pregnancy-related,” said Satyawadi, who said that GVK’s emergency response system has helped save more than 200,000 mothers. Institutional deliveries have increased in the state of Gujarat by 92 percent. “We have been able to reduce maternal mortality by 20-25 percent in different geographies,” he said.- 19,623 EMTs and 10,000 doctors and other healthcare professionals
- 2,710 ambulances
- 16,300 call-center employees
Pre-Hospital Barriers: Reducing Maternal Morbidity in BoliviaWomen in Bolivia receive free maternal care. In cities like La Paz, emergency obstetric care is often available within a short distance. However, “37 percent of our maternal deaths [occur] at our hospitals,” said Víctor Conde Altamirano, OB/GYN of CARE Bolivia.
To better understand this mortality rate, Altamirano evaluated whether pre-hospital barriers and routine antenatal care are associated with near-miss morbidity. He found that women who are older, have lower levels of education, lack antenatal care, are pregnant for the first time, or live in rural areas are at a greatest risk of illness or death
“We are trying to organize our communities and service facilities, and promote improved health management by the municipalities. If our authorities can be sensitive and invest in health; invest in fuel, drugs, and human resources; we can improve near-miss morbidity rates,” said Altamirano.
Strategies and Recommendations for Improving Transportation & ReferralThe workshop participants agreed on six key topic areas for improving transportation and referral:1. Multi-sectoral collaboration
The group called for improved multi-sectoral engagement and continuous dialogue among key ministries: Health, Finance, Communication, Social Welfare, Security and Defense, Transportation, and Public Works.
2. Mobile phone technology
3. Public-private partnerships
4. Referral for newborns
5. Indicators for referral
6. Sharing evidence
Private-public partnerships, such as those demonstrated by GVK in India and the CH[I]P program in Ghana, create opportunities for collaboration. “Cell-phone technology can reduce delays in transport and treatment by identifying which facilities might be the most appropriate for referral,” said Bailey.
The final recommendation by the group calls for increased pooling and use of existing evidence to move the transportation and referral agenda forward. Updated synthesis papers on existing evidence are needed, said Bailey. “We have a lot of data that is perhaps less than perfect, but this should not be a barrier for further action,” she said.
