Showing posts from category global health.
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“There Is No Choice:” Climate, Health, Water, Food Security Must Be Integrated, Say Experts
›August 9, 2010 // By Russell SticklorBureaucratic stovepipes plague international development efforts, and aid for pressing environmental and human security concerns—such as climate change, food shortages, fresh water access, and global health threats—rarely matches the reality on the ground in the developing world, where such health and environmental problems are fundamentally interconnected.
Instead, development efforts in the field—whether spearheaded by multilaterals, bilaterals, or NGOs—are commonly devoted to single sectors: e.g., the prevention and treatment of a single disease; the implementation of irrigation infrastructure in a specific area; or the introduction of a new crop in a certain region. The reasons for such a narrow focus can come from multiple sources: finite resources, narrowly constructed funding streams, emphasis on simple and discrete indicators of success, and institutional and professional development penalties for those who conduct integrated work. But some experts argue that integrating problem-solving initiatives across categories would not only improve the efficacy of development efforts, but also better improve lives in target communities.
As part of the USAID Knowledge Management Center‘s 2010 Summer Seminar Series, a recent National Press Club panel on integration featured a frank discussion of both the opportunities and challenges inherent in breaking down barriers within and between development agencies. Panelists from the World Bank’s Environment Department, the White House Council on Environmental Quality, and the Woodrow Wilson Center’s Environment Change and Security Program weighed in on the prospects for cross-sectoral integration.
Addressing the impacts of a global problem like climate change “requires multilevel approaches,” and necessitates that we “think multisectorally along the lines of agriculture, water, transportation, energy, [and] security,” said Loren Labovitch of the White House Council on Environmental Quality. The four topics under discussion—climate change, food security, water, and health—are all Obama administration priorities, as reflected by dedicated programs and special initiatives. Finding ways to practically integrate these interrelated challenges (through efforts like the Feed the Future Initiative or the Global Health Initiative) is getting more attention from policy analysts and policymakers with each passing year.
Integration in Practice: Success Stories
While there may be an emerging willingness to discuss and even experiment with holistic programming, what does it actually look in practice? Panelist Geoff Dabelko, director of the Woodrow Wilson Center’s Environmental Change and Security Program, singled out integrated development programs in the Philippines, the Democratic Republic of Congo, and Asia as examples.
Philippines: The PATH Foundation Philippines’ Integrated Population and Coastal Resource Management (IPOPCORM) initiative uses an integrated approach to address health and environmental concerns in coastal communities. Their “basket of services” includes establishing a locally managed protected marine sanctuary to allow local fish stocks to recover, promoting alternative economic livelihoods outside of the fishing industry, and improving access to local health services and commodities, said Dabelko. To date, IPOPCORM has yielded several notable improvements, among them reduced program costs and improved health and environmental outcomes as compared to side-by-side single sector interventions. A forthcoming peer-reviewed article will appear in Environmental Conservation, and will detail the controlled comparison study of the IPOPCORM project.
Democratic Republic of Congo: Mercy Corps has also successfully pursued cross-sectoral programming as part of a larger effort to be more holistic in its humanitarian and development responses. In war-torn eastern DRC, Mercy Corps brought practitioners with expertise in natural resource management into the fold of what has historically been an emergency relief mission. In particular, the Mercy Corps mission has fused humanitarian assistance with longer-term development efforts such as enhanced environmental stewardship. For example, promoting the use of fuel-efficient cookstoves eases pressure on local forest resources by lowering the need for firewood, and improves respiratory health by lowering air pollution. The project scaled up the effort through resources from further integration, with carbon credits from avoided emissions being sold through a local broker to the European cap and trade market. These resources in turn helped finance more cook stoves, which now total 20,000 for this project.
“The lesson is we have no excuse for not doing this anywhere in the world and saying some place is too unstable,” Dabelko said. “If we can do it [integrated projects] in eastern DRC, we should be able to do it anywhere.”
Asia: Tackling programmatic integration starts with better understanding the interconnections between environmental and health challenges. Dabelko cited a recent effort of the environment and natural resources team within USAID’s Asia Bureau as an example of breaking out of narrow bureaucratic stovepipes.
USAID staff recognized that a wide set of climate, energy, economic, governance, and conflict issues affected their core biodiversity and water portfolios, even if they did not have the time, expertise, or resources to investigate those issues in detail. Trends that appeared to be in the periphery were not viewed as peripheral to planning and designing programs for long-term success.
Working with the Woodrow Wilson Center, the USAID Asia Regional Bureau engaged experts on a diverse set of topics normally considered outside their portfolios. The resulting workshop series and report led to a deeper understanding of the possible impacts of increased Himalayan glacier melt and Chinese hydropower plans on food security and biodiversity programs in the lower reaches of the Mekong River. Bringing analysis from these topically and geographically remote areas into local-level development planning is a process that will require a similar willingness to go outside the typical bounds of one’s brief.
More Integration Ahead?
These case studies provide a glimpse of what integrated programming can look like on the ground. Still, significant hurdles remain standing in the way of regular and effective integration. Cross-sectoral programming demands that old problems be addressed in innovative and perhaps unfamiliar ways, requiring the addition of new capacity in development organizations and better coordination within and between agencies. That can be a complicated process, noted Dabelko, since efforts to pursue greater programming integration can be “hamstrung by earmarks and line items.”
Integration can also prove tricky because it requires a greater willingness to accept multiple indicators of success unfolding over different time frames—health gains may occur quickly, for example, while progress on environmental conservation may unfold less speedily. This means existing programs might need to be reshaped and reoriented to accommodate these divergent time frames, which could prove somewhat difficult. “Integration can be a challenge, both from a programming perspective and from an organizational perspective,” acknowledged moderator Tegan Blaine, climate change advisor for USAID’s Africa Bureau.
Further, the temptation remains strong among appropriators and implementers alike to maintain control over authority and resources in their traditional portfolios. Getting long-time practitioners in particular issue areas to willingly cede some of their turf in the pursuit of greater integration has historically been the “real world” that stands in the way of such integrated work.
But, as shown by the standing-room-only crowd at the seminar, momentum is slowly starting to build in pursuit of breaking down old programming walls and finding new approaches to addressing emerging challenges in human and environmental security.
“There is no choice” but to fuse development agendas with climate change adaptation efforts, asserted Warren Evans, director of the World Bank’s Environment Department. “It can’t be a parallel process anymore.”
Photo Credit: “2010 Summer Seminar Series – July 15th Panel Discussion on Food Security, Climate Change, Water and Health,” used courtesy of USAID and the National Press Club. -
Reform Aid to Pakistan’s Health Sector, Says Former Wilson Center Scholar
›August 5, 2010 // By Wilson Center StaffExcerpt from op-ed by Samia Altaf and Anjum Altaf in Dawn:
WE must state at the outset that we have been wary of, if not actually opposed to, the prospect of further economic assistance to Pakistan because of the callous misuse and abuse of aid that has marked the past across all elected and non-elected regimes.
We are convinced that such aid, driven by political imperatives and deliberately blind to the well-recognised holes in the system, has been a disservice to the Pakistani people by destroying all incentives for self-reliance, good governance and accountability to either the ultimate donors or recipients.
Even without the holes in the system the kind of aid flows being proposed are likely to prove problematic. Over half a century ago, Jane Jacobs, in a brilliant chapter (Gradual and Cataclysmic Money) in a brilliant book (The Death and Life of Great American Cities), showed convincingly how ‘cataclysmic’ money (money that arrives in huge amounts in short periods of time) is a surefire way of destroying all possibilities of improvement. What is needed, she argued, is ‘gradual’ money in the control of the residents themselves. While Jacobs was writing in the context of aid to impoverished communities within the US, she concluded with a remarkably prescient concern: “I hope we disburse foreign aid abroad more intelligently than we disburse it at home.”
Continue reading on Dawn.
For more on U.S. aid to Pakistan, see New Security Beat‘s coverage of the recent U.S.-Pakistani Strategic Dialogue.
Photo Credit: A U.S. Army Soldier with 32nd Infantry Regiment, 10th Mountain Division, hands out medical supplies to Pakistani refugees outside an International Committee of the Red Crescent aid station in Afghanistan’s Kunar province, October 23, 2009. Courtesy of flickr user isafmedia. -
Boosting the U.S. Role in the Global Health Arena
›A new video from the Commission on Smart Global Health Policy, which was established by the Center for Strategic & International Studies, reviews the commission’s progress towards its goal of encouraging the U.S. government to embrace global health as a pillar of U.S. foreign policy.
The video reviews the recommendations from the commission’s March 2010 report, A Healthier, Safer and More Prosperous World: 1) Maintain robust U.S. support for the fight against HIV/AIDS, malaria, and tuberculosis; 2) Prioritize maternal and child health, especially in sub-Saharan Africa and South Asia; 3) Help other nations improve their capacity to prevent and respond to outbreaks of contagious disease; 4) Expand U.S. capacity to fund future global health initiatives by securing long-term investments for such efforts; and 5) Step up U.S. funding for multilaterals engaged in the global health field, including the World Health Organization, Global Fund, UNICEF, the World Bank, and the GAVI Alliance.
In the months ahead, commission members will be participating in public forums throughout the United States to discuss and promote the recommendations included in the report, before gathering in January to review the Obama administration’s progress on global health as the administration begins its third year. To date, the centerpiece of the administration’s health outreach efforts has been the six-year, $63 billion Global Health Initiative, designed to promote an enhanced U.S. role in addressing public health issues overseas.
The CSIS Global Health Policy Center will also be launching a year-long debate series called “Fault Lines in Global Health,” focusing on controversial topics in the global health field. The series’ kick-off event will center on U.S. AIDS funding, and is scheduled for Friday, August 6, 2010, from 9:30-11:00 a.m. -
Interview With Wilson Center Scholar Margaret Wamuyu Muthee: Envisioning a New Future for Kenya’s Next Generation
›July 29, 2010 // By Wilson Center StaffYouth in sub-Saharan Africa constitute a large and growing portion of the region’s population, yet remain underserved by family planning and reproductive health programs. New Security Beat recently interviewed Margaret Wamuyu Muthee, an Africa Program Scholar at the Woodrow Wilson Center, about this problem. Muthee is currently working on a project documenting both the opportunities and challenges for young people growing up in Kenya.
New Security Beat: How do you define youth?Margaret Wamuyu Muthee: The African Union has defined youth as every person between the ages of 15 to 35 years, while the United Nations defines youth as persons between the ages of 15 and 24. I will be concentrating on the age group defined by the African Union.
NSB: What are some opportunities and challenges facing youth in Kenya?
However, I will not only be relying on age. There are other aspects that I must take into consideration. Many children assume the roles of an adult or a care-taker when they are at an early age. Children in African nations face different challenges [compared to children in Western countries], as there are fewer opportunities for transition in Africa.MWM: This is a very important stage for exposing youth to the available support and teaching them about the social economy. Some of the difficulties lie in the lack of resources and corruption, such as misuse of funds that are provided to the government by outside sources.
NSB: Which programs are taking actions to empower youth in Kenya?
On a more positive outlook, youth are very resilient. They have a wide range of potential and capacity that can be utilized right away. African nations, just like China, have an enormous population that can be a human resource. All we have to do is positively tap into their potential to make good changes.MWM: The Youth Enterprise Development Fund (YEDF) works to increase economic opportunities for Kenyan youth in nation-building through enterprise development. YEDF also works to lower the unemployment rate and teach certain skills for future employment. One downside of this fund is that even though it provides money, it does not provide mentorship for the youth who execute the programs.
NSB: Are these programs enough to address youth challenges?
Another program is Yes Youth Can! This $45 million initiative was created by the U.S. ambassador to Kenya and USAID. The program is designed to create local and national networks of youth leaders to advocate peaceful economic and governmental reforms. The wonderful thing about this organization is that it is completely youth-driven.MWM: Sometimes these programs are seen as too small and too late. Youth are seen as violent, and these programs are made to keep them busy. Programs need to address all the facts, from start to finish.
NSB: Are there programs specifically targeted at female youth?MWM: We need programs that address pregnancies, HIV/AIDS, and education for young women. These education programs not only need to teach them about pregnancies and HIV/AIDS, but also educate women about their rights: how to say “no” and object to certain actions.
NSB: Are family planning and reproductive health incorporated into youth education?
However, there are complications when it comes to female rights. There are sexual offense laws that females do not even know about. The implementation of these laws can be non-existent. Either the police system is flawed or accessing lawyers is too expensive for females. And even if a lawyer is hired, the rapist can pay off a judge, so the judge will not convict him.MWM: There are already reproductive health campaigns in Kenya. One example is the ABC program: Abstinence, Be faithful, Condom use. Everyone these days, in rural and urban environments, knows about HIV/AIDS. There needs to be more programs regarding family planning and health; there is only a limited amount of knowledge getting passed around about those two issues.
Margaret Wamuyu Muthee is the Programs Manager for Kenya’s University of Nairobi Center for Human Rights and Peace, and a current scholar in the Woodrow Wilson Center’s Africa Program.
There is a new proposed Kenyan constitution that bans abortion unless a doctor permits the abortion due to health reasons, or if the mother’s health is in critical danger. Many females die because they cannot legally get an abortion and try to abort their baby on their own, or accept services from a backstreet clinic.
We also have cultural practices that put up barriers to the spread of family planning and health. One such example is the practice of early female marriages. Girls as young as 10 years old will be forced to marry a much older man. These girls have not had proper education on reproductive health or family planning.
In addition, adults are still too shy to address youth that are having sex, and are embarrassed to talk about their health if they have HIV/AIDS. We need to educate more youth and provide the means for them to live safer lives.
Josephine Kim and Marie Hokenson are cadets at the United States Military Academy at West Point and interns with the Woodrow Wilson Center’s Environmental Change and Security Program.
Photo Credit: “The Mentees and their mentors,” used courtesy of flickr user The Advocacy Project. -
Stephanie Hanson Reports on PHE in Agricultural Development and Rwanda’s ‘One Acre Fund’
›Driving from Kigali into rural Rwanda, the hills that flank either side of the paved road are covered with bananas, maize, coffee, and beans under cultivation. Most Rwandans are farmers, using any bit of available land to feed their families and generate income. In this country—the most densely populated in Africa—little arable land is left untended.
My organization, One Acre Fund, offers loans and education to smallholder farmers in Kenya and Rwanda. We work with 18,000 farmers in three districts in the southwestern and western part of Rwanda, where we are know as Tubura, which means “multiply” in Kinyarwanda.
Though One Acre Fund is not a traditional population, health, and environment (PHE) project, agricultural development work inherently is PHE work, particularly in Rwanda, which faces significant population and environment challenges.
Our farmers have small plots of land because Rwanda’s population density is so high—375 people per square kilometer, higher than Japan—leaving only .13 hectares of arable land per person. They struggle to grow enough food because it’s difficult to support a big family on a small piece of land, especially without access to high-quality seed and fertilizer.
When farmers don’t grow enough to ensure basic food security for their families, their children are malnourished, which makes them more susceptible to illness.
Finally, agriculture both depends on and affects the environment. Farmers need favorable growing conditions—good soil and adequate rainfall—for a good harvest. Sustainable agriculture practices, such as composting and preventing soil erosion, ensure the environment remains healthy to support future farming.One Acre Fund is acutely aware of the challenges that our farmers face due to high population density, food insecurity, and environmental degradation. We offer a service model that addresses all the needs of a smallholder farmer: financing, farm inputs, education, and market access.
When a farmer enrolls with One Acre Fund in Rwanda, she joins as part of a group of 6-15 farmers. She receives an in-kind loan of seed and fertilizer, which is guaranteed by her group members. One Acre Fund delivers this seed and fertilizer to a market point within two kilometers of where she lives. A field officer provides in-field training on composting, techniques to prevent soil erosion, land preparation, planting, fertilizer application, and weeding.
Over the course of the season, the field officer monitors the farmer’s fields. At the end of the season, he trains her on how to harvest and store her crop. One Acre Fund also offers a harvest buyback program that farmers can choose to participate in.
On average, One Acre Fund farmers double their farm income per acre in one growing season. Ninety-eight percent of our farmers repay their loans, which are due several weeks after harvest.
With their increased harvests, One Acre Fund farmers are able to feed their children, which reduces malnutrition. Anecdotally, we also know that One Acre Fund children experience less illness; this year, we are working to incorporate health indicators into our monitoring and evaluation work.
At a harvest buyback last month, I met many farmers who had benefited from One Acre Fund’s services. One woman, Tamar, had sold 400 kilograms (880 pounds) of beans at the previous season’s buyback, which earned her roughly 132,000 Rwandan francs ($235 USD). She told me that she was using the money to build a bigger home for the six of her ten children who lived at home.However, Tamar really wanted to buy a cow, but she knew that she would not earn enough money this year to afford one. With so many children, she struggled to earn enough money to invest in something that might generate additional income for her and her family.
Another woman, Medeatrice, had also made $235 USD from the sale of her beans. With that income, she had opened a small shop with her husband in a nearby market. Unusually for Rwanda, where the average woman has 5.5 children, Medeatrice only had one, a three-year old boy named Prince. I asked her if she planned to have more children.
“I only want one more child,” she told me. “If I only have two children, it is easy to educate and to take care of them.”
The Rwandan government has invested in educating its population on family planning, but it will take time for birth rates to drop. For now, families with five, six, or nine children are not uncommon.
However, research shows that when women have increased access to economic opportunities, birth rates drop. One Acre Fund is focused on helping Rwanda’s families increase their harvests so that they not only have enough to eat, but they can start investing in their futures.
Guest Contributor Stephanie Hanson is the director of policy and outreach at One Acre Fund.
Photo Credit: Rwanda’s hills and Medeatrice, courtesy of Stephanie Hanson. -
In Pakistan, Clinton Calls for Human Security; USAID’s Shah Commends Birth Spacing
›July 20, 2010 // By Russell SticklorIn Islamabad yesterday, Secretary of State Hillary Clinton acknowledged longstanding Pakistani concerns that the U.S.’s ongoing mission in the country is solely military in nature. However, Clinton asserted at the opening of the second U.S.-Pakistan Strategic Dialogue that the “future demands a comprehensive human security, a security based on the day-to-day essentials like jobs, schools, clinics, food, water, fuel, equal access to justice, [and] strong, accountable public institutions.” To that end, she announced a $500 million assistance package earmarked largely for new agricultural and hydroelectric infrastructure development, as well as the construction of new hospitals and other health infrastructure.
Family planning was another key element in this week’s U.S-Pakistani talks. A U.S. delegation headed by USAID Administrator Rajiv Shah met with top Pakistani health officials to discuss the strategic importance of birth spacing. Both sides agreed that encouraging women to extend the interval between bearing children would not only improve maternal and child health, but also start to bring Pakistani’s population growth rate down to a more sustainable level—a goal fully explored at a recent Wilson Center conference on Pakistan’s population challenge.
As Pakistani demographer Zeba Sathar told New Security Beat in an interview at the conference, educating young women and empowering them to control their own reproductive health will allow them to “take care of their fertility and their family size themselves”—a development that could ease Pakistan’s resource crunch and reduce traditional gender inequities in the years to come.
Sources: Daily Times (Pakistan), International Business Times (U.K.), Los Angeles Times, Times of India, U.S. Agency for International Development.
Photo Credit: “Secretary Clinton Travels to Pakistan,” courtesy of the State Department. -
In Kampala, African Leaders Discuss Maternal Health While Attacks Renew Concern over Somalia
›July 19, 2010 // By Schuyler NullLeaders from 49 African countries are meeting today in Kampala, Uganda, at the start of a scheduled week-long African Union (AU) summit on maternal and child health. Uganda is a fitting location, as it faces some of the toughest health and demographic challenges in Africa, including a very young and rapidly growing population and poor maternal health services. However, with the memory of last week’s twin bomb blasts still fresh, peace and security issues will surely be on the agenda as well.
Somalia’s lead insurgency group, Al Shabab, took responsibility for the attacks in Kampala, which killed more than 70 people. Al Shabab’s first prominent cross-border attack is only the latest sign that Somalia’s issues – which also include a very young and rapidly growing population – are starting to spill over its borders. For more on Somalia’s deepening crisis and its effects on the East African region, see New Security Beat’s recent analysis: “As Somalia Sinks, Neighbors Face a Fight to Stay Afloat.”
Sources: AP, Washington Post.
Photo Credit: Adapted from “Ugandan African Union contingent in Mogadishu, Nov. 25, 2007” courtesy of flickr user david axe. -
An “Aye” for an “Aye”: Everyone Has a Right to Be Counted
›July 12, 2010 // By Kayly Ober
Around the world, countries from Afghanistan to Papua New Guinea to the United States are taking part in their decadal census, leading the UN Population Fund (UNFPA) to select the theme “Everyone Counts” for World Population Day 2010, which was celebrated on July 11.
Everyone has the right to be counted, because “censuses and population data play a critical role in development and humanitarian response and recovery,” said UNFPA Executive Director Thoraya Ahmed Obaid in her World Population Day message. Obaid added that “with quality data we can better track and make greater progress to achieve the Millennium Development Goals, and promote and protect the dignity and human rights of all people,” especially among vulnerable populations like women, girls, the poor, and the marginalized.
USAID similarly supports quality data collection, which it says plays a critical role in advancing voluntary family planning in the developing world. For the last 25 years, USAID has funded the Demographic and Health Surveys (DHS) program, which collaborates with national health ministries to collect data on family planning, child and maternal health, disease prevalence, and other health indicators.
This invaluable data is made freely available for public use, which can foster new research in the field and stimulate innovative approaches to addressing public health issues. Praising the DHS program, Gapminder Foundation Director Hans Rosling told a Wilson Center audience last year that “statistics should be the intellectual sidewalks of a society, and people should be able to build businesses and operate on the side of them.”
Accurate census counts are also important elements of “good governance, transparency and accountability,” said UN Secretary-General Ban Ki Moon in his World Population Day message. “Population data helps leaders and policy-makers to make informed decisions about policies and programmes to reduce poverty and hunger, and advance education, health and gender equality,” he said.
But no one is suggesting that coming up with reliable population data is an easy task. As Sean Peoples and Elizabeth Leahy point out in the May/June 2009 issue of World Watch magazine, issuing population projections can be a risky business:In the 2008 Revision of World Population Prospects, the UN Population Division projects that our planet will grow to 9.15 billion people by 2050. Yet this medium-variant projection is just one of several possible scenarios released in this latest round of number crunching. The low- and high-variant projections—7.96 billion and 10.5 billion, respectively—could instead become reality, given uncertainties in the developing world due to factors such as inconsistent data collection, weak health system infrastructure, and low government capacity.
The goal, then, is to make sure everyone counts.
