Showing posts from category global health.
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Watch: Catherine Kyobutungi on Monitoring the Health Needs of Urban 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 Catherine Kyobutungi, director of health systems and challenges at the African Population Health Research Center in Nairobi.
“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. -
Helping Hands: An Integrated Approach to Development
›Originally featured in the Wilson Center’s Centerpoint, June 2011.
“At the moment, the agendas of the growing population of people and the environment are too separate. People are thinking about one or the other,” said Sir John Sulston, Nobel laureate and chair of the Institute for Science, Ethics, and Innovation at the University of Manchester, in an interview with the Environmental Change and Security Program (ECSP).
“People argue about, ‘Should we consume less or should we have fewer people?’ The point is it’s both. We need to draw it together. It’s people and their activities.”
Many who research and work on population, health, and environment (PHE) issues are increasingly advocating integrated solutions. Such issues as population growth, natural resource management, and food security, are interrelated challenges that, if addressed concurrently, likely will yield better results and community trust.
With this notion in mind, ECSP launched the five-year HELPS (health, environment, livelihoods, population, and security) project in October 2010. The project focuses on integrated PHE programs and demographic security linkages. HELPS also looks at population’s links to global environmental priorities, media coverage of population, and related issues like gender, youth, and equity.
Funded by USAID’s Office of Population and Reproductive Health through its IDEA (Informing Decision-makers to Act) grant, the HELPS project builds on ECSP’s 14-year history of exploring nontraditional security issues.
Population-Environment Connection
A February event in the HELPS series featured Sir John Sulston, who said dialogue between population and environmental communities has received renewed attention and is reappearing on national agendas.
The Royal Society’s People and the Planet study, which will be completed by early 2012, will “provide policy guidance to decision-makers as far as possible” and aims to facilitate dialogue, he said. The HELPS Project is helping the working group gather evidence of population-environment connections and to identify solutions.
“What we should be aiming to do is to ensure that every individual on the planet can come to enjoy the same high quality of life whilst living within the Earth’s natural limits,” said Sulston. People are happier, healthier, and wealthier than ever before, according to human development indexes. But, Sulston said, 200 million women worldwide have an unmet need for family planning, ecosystems are degraded, biodiversity has decreased, and there are widespread shortages of food and water.
“Many times we tackle different development challenges through single sector programs: health programs, agriculture programs, water programs. Those single sector approaches can make sense,” said ECSP Director Geoff Dabelko on the Wilson Center’s Dialogue television program. “But, of course, poor people are facing all those life and death challenges at once. We have to find ways to help them meet those challenges together in an integrated fashion.”
On the same program, Roger-Mark De Souza, vice president for research and director of the Climate Program for Population Action International, said the drive for integrated development stems from the communities being served, not necessarily from outside aid groups. “We’ve seen that there’s a greater impact because there’s longer sustainability for those efforts that have an integrated approach,” he said. “There’s a greater understanding and a greater appreciation of the value that [PHE] projects bring.”
At an April 7 ECSP event, De Souza said rural communities in developing countries understand that high population growth rates, poor health, and environmental degradation are connected. An integrated approach to development, he said, is a “cost-effective intervention that we can do very easily, that responds to community needs that will have a huge impact that’s felt within a short period of time.”
Proponents of integrated development face significant barriers, but the tide may be turning. To fully harness this momentum, former ECSP Senior Program Associate Gib Clarke argues in his FOCUS brief, “Helping Hands: A Livelihood Approach to Population, Health, and Environment Programs,” that the PHE community must solidify its research base, reach out to new partners, and push for flexible funding and programming. He suggested changing the name PHE to HELP – health, environment, livelihoods, and population. By adding livelihoods, the glue that binds population, health, and the environment, he said, the HELP moniker might broaden its appeal to new donors and practitioners.
Case Study: Madagascar
In Madagascar, a key country for integrated PHE programs, “today’s challenges are even greater than those faced 25 years ago,” said Lisa Gaylord, director of program development at the Wildlife Conservation Society, at a March 28 Wilson Center event. As the country’s political situation has deteriorated since 2009, the United States and other donors pulled most funding, and some PHE programs were forced to discontinue environmental efforts.
But other PHE programs are expanding: Based in southwestern Madagascar, the Blue Ventures program began as an ecotourism outfit, said Program Coordinator Matt Erdman, but has since grown to incorporate marine conservation, family planning, and alternative livelihoods. A major challenge is its rapidly growing population, which threatens the residents’ health and food security, as well as the natural resources on which they depend. More than half the island’s population is younger than 15, and the infant and maternal mortality rates are high, Erdman said.
In response, Blue Ventures set up a family planning program. The program uses a combination of clinics, peer educators, theater presentations, and sporting events, such as soccer tournaments, to spread information about health and family planning. The HELPS project will soon publish a Focus brief on Blue Ventures’ family planning efforts, titled: “To Live with the Sea.”
Erdman said, “If you have good health, and family size is based on quality, families can be smaller and [there will be] less demand for natural resources, leading to a healthier environment.”
Demographic Security
A country’s age structure can pose a challenge, said Jennifer Dabbs Sciubba, the Mellon Environmental Fellow with the Department of International Studies at Rhodes College, at a March 14 Wilson Center event. Countries with a large percentage of people younger than 30 “are [much] more likely to experience civil conflict than states with more mature age structures.”
Tunisia’s recent revolution, Sciubba said, could be understood as a “story about demography.” Countries with transitional age structures, such as India, Brazil, and South Africa, face different security challenges. With a majority of their populations between 15 and 60 years old, more people are contributing to the economy than are taking away, which could bolster these countries economically and politically. Global institutions will have to reform and include these countries, she advised, “or else become irrelevant.”
“Understanding population is critical to our success in being able to prevent conflict, and also managing conflict and crises once we’re involved,” said Kathleen Hicks, Deputy Undersecretary at the Department of Defense (DOD). However, the DOD does not “treat demographics as destiny,” she said, but instead as “one of several key trends, the complex interplay of which may spark or exacerbate future conflicts.”
Demography can also help predict political trends. In 2008, demographer Richard Cincotta predicted that between 2010 and 2020 the states along the northern rim of Africa – Morocco, Algeria, Tunisia, Libya, and Egypt – would each reach a demographically measurable point where the presence of at least one liberal democracy among the five would be probable. Recent months have brought possible first steps to validate that prediction.
Mathew Burrows, counselor at the National Intelligence Council, said Cincotta’s work demonstrates that “the demographic tool is essential” to analysts and policymakers. “There is a real appetite among policymakers” for understanding demography, he said, because it gives them more structure than political science narratives.
Yemen is another example of this trend. In March, tens of thousands of youth-led demonstrators demanded that their president resign. While numerous factors have sparked the “Arab Spring,” one driving force is Yemen’s dire demographic and environmental situation. Some experts say Yemen may be the first country to run out of groundwater. The average Yemeni woman has more than five children, and 45 percent of its population is below age 15. On May 18, Yemeni and international experts discussed these issues at the Wilson Center. Upcoming HELPS events include daylong conferences on Afghanistan and Nigeria.
There are solutions that can break the links between “youth bulges” and insecurity. In a recent video interview discussing the connection between demography and civil conflict, Elizabeth Leahy Madsen, a senior research associate at Population Action International, said, “Policies that have a major impact over time are ensuring education, especially for girls, and providing employment opportunities to the large and growing numbers of young people today.”
Dana Steinberg is the editor of the Wilson Center’s Centerpoint.
Photo Credit: Blue Ventures in Madagascar, courtesy of Garth Cripps. -
Watch: Younger Generation Will Prioritize Health, Education, Human Rights, Says Frederick Burkle
›June 7, 2011 // By Schuyler Null“Unfortunately, in the last two decades, when globalization became the mantra, it was primarily an economic mantra,” said Frederick Burkle, a senior fellow with the Harvard Humanitarian Initiative, visiting scientist at the Harvard School of Public Health, and senior public policy scholar at the Wilson Center. “The mantra was, ‘if you can improve the economy,” he said, “health, education, everything will follow.’”
“With the financial crisis, that proved not to be true,” Burkle said, and as a result, net expenditures in health and education have declined and the private sector, unfortunately, has not filled the gap.
“We really need to redefine globalization,” Burkle said. “And certainly economics will be there…but health, education, and human rights need to be just as dominant as the economics.”
Burke said he expects a gradual realignment of global priorities to come as younger generations come into decision-making roles. “They don’t have political clout right now,” he said, “but when they do…I think we’re going to see all these aspects that I mentioned – even the humanitarian profession becoming a career – accelerated.” -
Measuring Ecosystem Vitality and Public Health With the Environmental Performance Index
›The Environmental Performance Index (EPI) is a comparative analytic tool for policymakers created jointly by Yale and Columbia Universities in collaboration with the World Economic Forum and Joint Research Centre of the European Commission. The EPI was created in 2006 and is updated biannually. Data is drawn from 25 performance indicators that fall under 10 well-established policy categories, including the environmental burden of disease, the effects of water on human health, and agriculture. The indicators serve as a “gauge at a national government scale of how close countries are to established environmental [and health] policy goals,” write the authors.
The EPI draws data from a diverse array of sources, such as the World Health Organization, Food and Agriculture Organization, University of New Hampshire, and World Resources Institute. Users can view visualizations of the compiled data via an interactive map and the data is also available in the form of rankings charts, individual country profiles, and country group comparisons. The interactive map also allows users to isolate performance indicators or policy categories in order to compare an individual country’s performance with global trends. Furthermore, indicators may be scaled to visually reflect a country’s performance in relation to drivers of environmental performance, like gross domestic product, level of corruption, and government effectiveness.
This tool is particularly useful because users can effectively leverage points for policy change by identifying linkages between environmental policy and other issue areas, such as public health or sanitation. The EPI enables policymakers to visually conceptualize problematic regions, optimize investments in environmental protection, and identify best practices.
The index’s greatest weakness is its inability to track changes in performance over time. A pilot project was launched last year that tracks whether a country has progressed or deteriorated in an area of environmental performance, but the authors note that the project has “raised more questions than answers,” particularly concerning data availability and interpretation. Additionally, there are gaps in the data. Although these gaps signify a data quality weakness, they also support the continued calls for increased data collection by governments and other organizations to better inform environmental decision-making. -
Health Development: Providing Free Care and Overcoming Gender-Based Violence
›In The Lancet’s “How Did Sierra Leone Provide Free Health Care?,” author John Donnelly of the Ministerial Leadership Initiative attributes the unanticipated success of a free health care program for women and children in Sierra Leone to good organization, transparency, and a high degree of cooperation between the government, donors, and development partners. One distinctive factor that has contributed to the health system’s turnaround is the unusually high level of political will on the part of President Ernest Bai Koroma, writes Donnelly. Similar to Egypt’s health and population initiatives, Sierra Leone’s marked commitment, accountability, and investment as a host country has contributed highly to the success of its program and triggered further investment from donors.In “Systematic Violence: A Barrier to Achieving the Millennium Development Goals for Women,” from the Journal of Women’s Health, authors Joia S. Mukherjee, Donna J. Barry, Hind Satti, Maxi Raymonville, Sarah Marsh, and Mary Kay Smith-Fawzi assert that the elevation of women is integral to the achievement of the Millennium Development Goals, to which structural violence serves as a significant barrier. Murkherjee et al. recommend community-based programs to combat structural violence and prevent disease, such as the Partners in Health (PIH) program in Haiti. PIH trains community health workers, expands health care as a public good, and bolsters social determinants, which include increasing access to family planning and education, providing compensation for medical workers, and improving health infrastructure. -
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. -
USAID Egypt’s Health and Population Legacy Review
›On May 23 the Middle East Program, ECSP, and the Global Health Initiative of the Woodrow Wilson Center, along with the Global Health Technical Assistance Project, hosted a panel of speakers discussing the past 30 years of the U.S. Agency for International Development’s health and population initiatives in Egypt, as outlined in the new Egypt Health and Population Legacy Review. Geoffrey Dabelko, director of ECSP and coordinator of the Global Health Initiative at the Wilson Center, moderated the event. [Video Below]
Peter McPherson, former administrator of USAID during the Reagan administration, and George Laudato, the administrator’s special assistant for the Middle East, presented on the historical context behind USAID in Egypt and the results of their efforts. McPherson pointed to three lessons that can be drawn from the recent report:- “Big payoffs” require long-term efforts; and
- Economic support for a country can have a dramatic impact; but
- The host country’s commitments and investments are still important.
Motaz Zahran, political counselor for the Embassy of Egypt, noted that USAID efforts were “just one sector of a fruitful partnership” between the United States and Egypt that he hoped would continue. He said the success story outlined by the report was reflective of improvements in coordination and addressing specific goals.
Other panelists outlined the successes of USAID in Egypt as related to their own areas of expertise. Leslie B. Curtin, co-author of the review and an expert in demographics and health outcomes, noted the dramatic improvements in a range of health sectors, in particular the rise in contraceptive prevalence and immunization rates and decrease in both maternal and infant mortality rates.
Nahed Matta, MD, senior maternal and newborn health officer at USAID, focused on improvements to the quality of maternal health, which she said were made possibly through better technology and increased fact-gathering to identify the key factors regarding maternal health trends. Sameh El-Saharty, MD, senior health policy specialist at the World Bank and Health Legacy Review Committee member, credited the increased number of health professionals in Egypt, better information gathering on health systems, and restructured models of health insurance, as successful strategies.
Concluding the session, Amie Batson, deputy assistant administrator for Global Health at USAID, discussed the lessons that other development initiatives can draw from the legacy of USAID efforts in Egypt. She highlighted the importance of country ownership, in which the developing country engages with other institutions and religious and political leaders at both national and local levels, and of policies that fund routine monitoring and evaluation. She also outlined the possibilities of innovation and south-to-south sharing on the local and international scale, referencing inroads made by two recent initiatives: the “MAMA” mobile device program, launched by Secretary Clinton in May 2011 to assist with disseminating maternal health information, and the Saving Lives at Birth initiative, launched by USAID in partnership with several other organizations in March 2011.
Laura Rostad is an intern for the Middle East Program at the Woodrow Wilson Center.
Image Credit: Adapted from cover of the Egypt Health and Population Legacy Review, courtesy of USAID; cover photo courtesy of Leslie Curtin. -
Family Planning as a Strategic Focus of U.S. Foreign Policy
›May 11, 2011 // By Wilson Center Staff“Family Planning as a Strategic Focus of U.S. Foreign Policy,” by Elizabeth Leahy Madsen, was an input paper for the Council on Foreign Relations report, The Role of U.S. Family Planning Assistance in U.S. Foreign Policy. Excerpted from the introduction:
Comprehensive policies that incorporate demography, family planning, and reproductive health can promote higher levels of stability and development, thereby improving the health and livelihood of people around the world while also benefiting overarching U.S. interests. U.S. foreign aid will be more effective if increased investments are made in high population-growth countries for reproductive health and family planning programs. These programs are cost-effective because they help reduce the stress that rapid population growth places on a country’s economic, environmental, and social resources.
Family Planning and Reproductive Health Programs
Family planning and reproductive health programs have successfully reduced the world’s population growth rate, propelled economic development, and improved women’s lives across the world. When people, and especially women, are given the opportunity and technology to limit their family size, they often choose to do so.
Population trends are motivated by three demographic forces: fertility, mortality, and migration. Although they can have dramatic effects on national and local populations, mortality and migration in particular have relatively little influence globally. Across the world, mortality rates have declined to a point where most children born today live to reach their own reproductive years, though much work remains to reduce the effect of communicable diseases and improve nutrition among the young. Meanwhile, three percent of the world’s population currently lives outside of their birth-countries. Therefore, while migration is increasing and an important demographic force, it does not occur at a scale large enough to significantly affect global-level demography.
Fertility rates currently are – and in the short-term will remain – the most important driver of global demographic trends. The total fertility rate, or average number of children born to each woman, has been estimated at 2.7 for the period between 2000 and 2005, a decline from 3.6 children per woman in the early 1980s. Given this decline, population projections generally assume future declines in fertility rates. For example, the widely cited “medium-fertility variant,” which is the United Nations’ projection of a world population growing from 6.9 billion in 2010 to 9.1 billion by 2050, relies upon an assumption that the global fertility rate will decline by 24 percent to two children per woman. However, if fertility rates remain constant at current levels, the world’s population would reach 11 billion by 2050. Fertility rates, whether they decline or remain at current levels, are not distributed evenly among countries and regions.
Continue reading or download the full report, “Family Planning as a Strategic Focus of U.S. Foreign Policy,” from the Council on Foreign Relations.
