Showing posts from category global health.
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Watch: Frederick Burkle on Lessons from Haiti and Professionalizing Humanitarian Assistance
›April 20, 2011 // By Schuyler Null“Haiti – in terms of coordination – was a debacle,” said Frederick Burkle, senior fellow with the Harvard Humanitarian Initiative and a visiting scientist at the Harvard School of Public Health. Burkle, who is also a senior public policy scholar at the Wilson Center, said that after the 2010 earthquake, “the large majority of people who showed up were under the age of 30 and this was their first disaster event.”
As a result, “best practices did not necessarily occur,” Burkle said. “Ninety-five percent of the work is probably done by 45 of the major NGOs,” but, he said, the number of “mom-and-pop shows” and other small NGOs in “The Republic of NGOs” is in the thousands.
Non-healthcare providers ended up providing services that they were not trained to provide – even amputations, Burkle said. “We certainly relish the humanitarian spirit of those who show up, but we have to have some coordination to ensure that best practices occur and that it goes in the right direction.”
“The professionalization blueprint really calls for courses, curriculum, and best practice standards,” said Burkle. The Harvard Humanitarian Initiative is working with the UN Office for the Coordination of Humanitarian Affairs, World Health Organization, and others to provide these resources.
“There’s a movement afoot within the humanitarian community itself to finally professionalize the humanitarian profession,” Burkle said, spurred on, in part, by the poorly coordinated responses to events like the Haiti earthquake. -
Integrating Development: A Livelihood Approach to Population, Health, and Environment Programs
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Rural communities in developing countries understand that high population growth rates, poor health, and environmental degradation are connected, said Population Action International’s Roger-Mark De Souza at a recent Wilson Center event. An integrated approach to development – one that combines population, health, and environment (PHE) programs – 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,” said De Souza. “This is how we live our lives, this makes sense to us – it’s completely logical,” community participants in PHE projects told him.
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In Search of a New Security Narrative: National Conversation Series Launches at the Wilson Center
›The United States needs a new national security narrative, agreed a diverse panel of high-level discussants last week during a new Wilson Center initiative, “The National Conversation at the Woodrow Wilson Center.”
Hosted by new Wilson Center President and CEO Jane Harman and moderated by The New York Times’ Thomas Friedman, the inaugural event was based on a white paper by two active military officers writing under the pseudonym “Mr. Y” (echoing George Kennan’s “X” article). In A National Strategic Narrative, Captain Wayne Porter (USN) and Colonel Mark Mykleby (USMC) argue that the United States needs to move away from an outmoded 20th century model of containment, deterrence, and control towards a “strategy of sustainability.” [Video Below]
Anne-Marie Slaughter of Princeton University, who wrote the white paper’s preface, summarized it for the panel, which included Brent Scowcroft, national security adviser to President Ford and President H.W. Bush; Representative Keith Ellison (D-Minn.); Steve Clemons, founder of the American Strategy Program at the New America Foundation; and Robert Kagan, senior fellow for foreign policy at the Brookings Institution.Framing a 21st Century Vision
We can no longer expect to control events, but we can influence them, Slaughter said. “In an interconnected world, the United States should be the strongest competitor and the greatest source of credible influence – the nation that is most able to influence what happens in the international sphere – while standing for security, prosperity, and justice at home and abroad.”
“My generation has had our whole foreign policy world defined as national security,” said Slaughter, “but ‘national security’ only entered the national lexicon in the late 1940s; it was a way of combining defense and foreign affairs, in the context of a post-World War II rising Soviet Union.”
As opposed to a strategy document, their intention, write Porter and Mykleby, was to create a narrative through which to frame U.S. national policy decisions and discussions well into this century.
“America emerged from the Twentieth Century as the most powerful nation on earth,” the “Mr. Y” authors write. “But we failed to recognize that dominance, like fossil fuel, is not a sustainable source of energy.”It is time for America to re-focus our national interests and principles through a long lens on the global environment of tomorrow. It is time to move beyond a strategy of containment to a strategy of sustainment (sustainability); from an emphasis on power and control to an emphasis on strength and influence; from a defensive posture of exclusion, to a proactive posture of engagement. We must recognize that security means more than defense, and sustaining security requires adaptation and evolution, the leverage of converging interests and interdependencies. [italics original]
Prosperity and Security a Matter of Sustainability
The “Mr. Y” paper is similar in some respects to other strategic documents that have promoted a more holistic understanding of security, such as the State Department’s Quadrennial Diplomacy and Development Review, which was partially authored by Slaughter during her time in State’s Policy Planning Office. But there’s a markedly heavy focus on economics and moving beyond the “national security” framework in Porter and Mykleby’s white paper. They outline three “sustainable” investment priorities:
“These issues have come in and out of the security debates since the end of the Cold War, but they have not been incorporated well into a single national security narrative,” Geoff Dabelko, director of the Wilson Center’s Environmental Change and Security Program, told The New Security Beat. “This piece is a positive step toward achieving a coherent and inclusive national security narrative for the United States.”- Human capital: refocus on education, health, and social infrastructure;
- Sustainable security: use a more holistic, whole-of-government approach to security; essentially, expand the roles of civilian agencies and promote stability as much as ensuring defense; and,
- Natural resources: invest in long-range, sustainable management of natural resources, in the context of expanding global demand (via population growth and consumption).
To provide a “blueprint” for this transition, Porter and Mykleby call for the drafting of a “National Prosperity and Security Act” to replace the national security framework laid by the National Security Act of 1947 (NSA 47) and followed by subsequent NSAs.A New Geostrategic Model?
The panel unanimously praised the white paper’s intentions, if not its exact method of analysis and proposed solutions. All agreed that globalization and technology have helped create a more interconnected and complex world than current foreign policy and national security institutions are designed to deal with. Scowcroft called the 20th century “the epitome of the nation-state system” and said he expects an erosion of nation-state power, especially in light of integrated challenges like climate change and global health.
Kagan disagreed, saying he’s less convinced that the nation-state is fading away. “If anything, I would say since the 1990s, the nation-state has made a kind of comeback,” he said, adding that the paper lacks “a description of how the world works, in the sense of ‘do we still believe in a core realist point that power interaction among nation states is still important?’” In that sense, he said, “I’m not at all convinced we’ve left either the 20th century or the 19th century, in terms of some fundamental issues having to do with power.”
“I think there are three things that really are new,” said Slaughter. “The first [is the] super-empowered individual…the ability of individuals to do things that only states could.” We saw that with 9/11, with individuals attacking a nation, and we’re seeing that with communications as well, she said. “I can tell you, Twitter and the State Department’s reporting system, they’re pretty comparable and Twitter’s probably ahead, in terms of how much information you can get.”
Second, there is a “whole other dimension of power that simply did not exist before and that is how connected you are,” Slaughter said. “The person who is the most connected has the most power, because they’re the person who can mobilize, like Wael Ghonim in Egypt.”
Third, there are a greater number of responsible stakeholders. “What President Obama keeps telling other nations is ‘you want to be a great power? It’s not enough to have a big economy and a big army and a big territory, you have to take responsibility for enforcing the norms of a global order,’” Slaughter said. Qatar’s willingness to participate in the international community’s intervention in Libya, she said, was in part an example of a country responding to that challenge and stepping up into a role it had not previously played.
These new dimensions to power and security don’t entirely replace the old model but do make it more complex. “It’s on top of what was,” Slaughter said, and “we have to adapt to it.”
Photo Credit: Colonel Mark Mykleby (USMC), Captain Wayne Porter (USN), and Wilson Center President and CEO Jane Harman, courtesy of David Hawxhurst/Wilson Center. -
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. -
Integrated Approach Helps “Model Farmers” Increase Productivity in Ethiopia
›March 24, 2011 // By Schuyler NullTo reach the village of Grar Gaber from Addis Ababa, you drive up over the Entoto Mountains overlooking the capital then motor down two hours of new Japanese-built highway to the town of Fiche. From there it’s 20 minutes on a broken dirt road across rocky hills. I was joined there by about 20 others from the PHE Ethiopia Consortium’s general assembly (see day one and day two coverage here) and Population Action International, to visit an integrated population, health, and environment (PHE) development program run by LEM Ethiopia.
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USAID: Maternal Deaths in Bangladesh Decline by 40 Percent in Less Than 10 Years
›The original version of this article, by the USAID Global Health Bureau, appeared on the USAID Impact blog.
Bangladesh is on track to meet the 2015 deadline for UN Millennium Development Goal 5 (50 percent reduction in maternal deaths). The Bangladesh Maternal Mortality and Health Service Survey, jointly funded by the Government of Bangladesh, USAID, Australian Aid (AusAID) and the United Nations Population Fund (UNFPA), found that maternal deaths in Bangladesh fell from 322 per 100,000 in 2001 to 194 in 2010, a 40 percent decline in 9 years.
The decline in direct obstetric deaths is most likely the consequence of better care seeking practices and improved access to and use of higher-level referral care. The decline in total fertility rate due to the successful family planning program has reduced exposure to high risk pregnancies and has thus prevented a large number of maternal deaths.
Continue reading on USAID’s Impact blog.
Sources: Directorate General of Health Services – Bangladesh, UN.
Photo Credit: Adapted from “Mother & Son,” courtesy of flickr user Anduze traveller. -
Congressional Hearing: Clean Water Access Is a Global Crisis, Human Right, and National Security Issue
›March 17, 2011 // By Hannah MarquseeUnsafe drinking water causes nearly 1.8 million deaths each year from diarrhea, “a number that dwarfs the casualties associated with violent conflict,” said U.S. Representative James McGovern at a congressional human rights commission hearing earlier this month on water as a basic right. Nearly all of these deaths are children under the age of five, he said. “This is a war against families, children, and women on an ongoing basis,” said Representative Earl Blumenauer, also speaking at the hearing, titled “Realizing the Right to Safe Water and Sanitation.”
There are currently 884 million people in the world without access to safe drinking water, according to UNICEF, and 2.6 billion without improved sanitation. As population growth and climate change place added stress on fresh-water systems, by 2025, two thirds of the world’s population will live in water-stressed conditions, according to the Food and Agriculture Organization. “This is a severe global crisis,” said McGovern.
“A Human Right”
With 2011 World Water Day only weeks away, the hearing harkened back to Secretary Clinton’s widely quoted statement from World Water Day 2010, marking a commitment by the Obama administration to address global water issues:It’s not every day you find an issue where effective diplomacy and development will allow you to save millions of lives, feed the hungry, empower women, advance our national security interests, protect the environment, and demonstrate to billions of people that the United States cares. Water is that issue.
Four months after that statement, the UN passed a resolution to make access to water and sanitation a human right, not just a development priority. Said Catarina de Albuquerque, a UN independent expert who testified at this month’s congressional hearing, the resolution stipulates that water must be “available, accessible, affordable, acceptable and safe.” A “right to water” is an important “sign of political will,” that will place increased obligations on governments to improve access to water and sanitation, she said. But in the meantime, for the millions without access to safe water, “there is no change.”
According to the UN, the world is on track to meet the Millennium Development Goal target of halving the number of people without access to an improved water source by 2015. But de Albuquerque noted that the reality is not quite so optimistic. On a UN fact-finding mission, she encountered at least one family who by UN definitions had access to an “improved drinking water source,” yet their tap water was literally black. “Water quality is not being monitored” and for many of the people who do have access, it is simply “undrinkable,” she said.
In developed countries as well, there are significant barriers to access, especially for marginalized communities. On a recent mission to the United States, de Albuquerque found that America’s “voiceless” – people of color, Native Americans, and the homeless – face significant discrimination in access to water. “Society closes its eyes to them,” she said. Thirteen percent of Native Americans lack access to safe water, in comparison to 0.6 percent of non-native Americans, she said in a statement to the press releasing her findings. And in Boston, “for every one percent increase in the city ward’s percentage of people of color, the number of threatened cut-offs increases by four percent.” To make the necessary improvements to fill these gaps in America’s aging water infrastructure would cost $4 to $6 billion annually, she said.
A National Security Issue
Water “is a security issue as well as a human development issue,” said Blumenauer. Since, according to UNEP, 40 percent of the world relies on river basins that share two or more political boundaries, water management has enormous potential for both conflict and cooperation. Echoing Clinton’s World Water Day statement, McGovern championed the cross-cutting nature of water:The right to water is inextricably linked with other basic rights…including the right to food, the right to health, and the right to education.
The burden of collecting water in underdeveloped countries often creates a gender gap and exposes women and girls to violence and rape, he said. And it “has been the basis for many territorial and violent disputes between various peoples and even nations.”
Last month, a staff report by the Senate Foreign Relations Committee expressed a similar sentiment with the publication of their report, Avoiding Water Wars: Water Scarcity and Central Asia’s Growing Importance for Stability in Afghanistan and Pakistan. The report commends the Obama administration for recognizing the importance of water: “For the first time, senior government officials are recognizing the critical role that sound water management must play in achieving our foreign policy goals and in protecting our national security.” However, by exclusively focusing on Pakistan and Afghanistan’s water issues and “neglecting the interconnectivity of water issues between Central and South Asia, the U.S. approach could exacerbate regional tensions,” the report says.
To be more strategic about water assistance, the report recommends the United States: (1) provide technical support in data collection to better manage water; (2) help increase water efficiency and reduce demand for water; (3) recognize the transboundary nature of water issues and “provide holistic solutions;” and (4) “safeguard institutions against shocks to water supply and demand.”
Moving Forward
The Obama administration’s commitment to water issues, the UN’s recognition of water as a human right, and the 2005 Water for the Poor Act have all been important steps towards fulfilling the pledge of making access to safe water a human right. “We’ve come a long way,” Blumenauer (who authored the Water for the Poor Act) said at the hearing, but there is still significant work ahead.
“We’re going to have to be more strategic moving forward” in order to meet global water shortages, said Aaron Salzberg, special coordinator for water resources for the U.S. Department of State who testified at the hearing. Salzberg recommended that the U.S. government take steps to integrate water management with the food and health sectors; build political will; mobilize financial support; promote science and technology; and form partnerships with other governments and aid organizations. The United States must also “be smarter” about allocating funds based on the dual criteria of “need” and “opportunity.” Balancing efforts with partners to find out which countries have the greatest need and the least resources will allow limited U.S. funds to make the deepest impact, he said.
John Oldfield, managing director of the WASH Advocacy Initiative, urged Congress to increase funding for foreign assistance, continue appropriations for the Water for the Poor Act, and improve the effectiveness of existing water, sanitation, and hygiene (WASH) assistance. “Each dollar invested in water and sanitation leads to an 8:1 return from reduced healthcare costs and time savings,” he said. “The world does not need to bury millions more of its children in the coming years when we know how to prevent waterborne disease today.”
Sources: FAO, UNEP, UNICEF, United Nations, WHO.
Image Credit: Adapted from “School girl drinks water from new handpump,” courtesy of flickr user waterdotorg. -
Watch: Roger-Mark De Souza on the Scaling Advantages of Population, Health, and Environment Integration
›March 11, 2011 // By Schuyler NullBy integrating population, health, and environment (PHE) efforts, development programs can make a difference in people’s lives in a real and meaningful way – one which they understand, appreciate, and desire, said Roger-Mark De Souza in this interview with ECSP. De Souza is the vice president of research and director of the Climate Program at Population Action International.
The PHE approach “allows itself to be applied at different levels,” said De Souza. “It’s easily implemented at the level of a village, or a town, or a city where a number of individuals can say ‘these are concrete results and outcomes that we want in our lives and that we want to live our lives in an integrated way.’”
PHE interventions not only provide tangible results to individuals, said De Souza, but they also help accomplish broader policy objectives, including improving health and alleviating poverty.
“There are lessons to be learned from different areas of integration, not just population, health, and environment,” De Souza said. For example, initiatives that integrate food security and HIV/AIDS deal with issues “similar to the ones we deal with in integrating population, health, and environment,” he said. Lessons and experiences need to be shared between these communities, but they also share similar advantages: From a cost-efficiency stand point, integration simply provides greater “bang for the buck,” he said.
