Showing posts from category community-based.
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Blue Ventures’ Integrated PHE Initiative in Madagascar
›In the small coastal village of Andavadoaka, Madagascar, the village elders offer a bottle of rum and two cigarettes to their ancestors before the men and their sons launch their wooden dugout canoes into the sea. Leaning over the side, their masked faces scour the water for their prey.
Meanwhile, the women – with babies on back and spears in hand – set out on foot into the shallow waters. One probes a small hole with her spear, and a tentacle reaches out to grapple with it. After careful coaxing, she pulls out an octopus, kills it, and adds it to her collection, which she tows on a string behind her.
In total, more than 1,850 pounds of octopus are collected on the opening day of the octopus harvest, a seasonal occurrence in Velondriake, the Indian Ocean’s first locally managed marine area.
Velondriake, which means “to live with the sea,” stretches along more than 40 km of southwestern Madagascar’s coast. The region encompasses 25 villages and is home to more than 8,000 people of the Vezo ethnic group, who are almost entirely dependent on marine resources, such as octopus, fish, and mangrove forests, for subsistence and income. But these resources are quickly disappearing due in large part to over-harvesting.
Blue Ventures Conservation – the London-based NGO I work for – has been working in the area since 2003 to protect the region’s coral reefs and mangroves, as well as their biological diversity, sustainability, and productivity, while also improving the quality of life of the local community.
To this end, Blue Ventures helped the community create a series of coastal marine reserves. Several permanent reserves protect the biodiversity of the coral reefs and mangroves, and help fish populations recover; while nearly 50 temporary reserves have increased the productivity of the octopus and crab fisheries. Octopuses reproduce quickly and juveniles grow at a nearly exponential rate, so a brief harvesting hiatus can lead to significant increases in yield. Increased yields translate to increased profits – something greatly welcomed by the people of this impoverished region.
The people of the region are also reproducing quickly: the average total fertility rate in Velondriake is 6.7 children per woman, according to our data. On average women are only 15 years old when they first conceive. To compound this problem, a majority of the population is under the age of 15 – at or approaching reproductive age. At the current growth rate, the local population will double in only 10 to 15 years. The local food sources, already heavily depleted, barely feed the current population, let alone twice that amount. Without enabling these coastal communities to stabilize their population growth, efforts to improve the state of marine resources and the community’s food security are considerably hindered.
In August 2007, Blue Ventures launched its Population, Health, & Environment (PHE) program as a weekly family planning clinic in Andavadoaka, which provided access to ingestible and injectable birth control options, as well as condoms. The clinic increased the village’s contraceptive prevalence rate (CPR) from 9.4 percent to 36.3 percent, and the Velondriake region’s CPR from 11.0 percent to 15.1 percent, in its first two years. (CPR data for the third year is not yet available, but should be notably higher, especially at the regional level.)
In 2009, Blue Ventures opened two more clinics and began holding quarterly outreach clinics in all Velondriake villages. We started offering long-acting, reversible contraceptive options, including Implanon and IUDs. Most recently, we have implemented a community-based distributor (CBD) program to provide wider access to contraceptives around the region, particularly for villagers that could not easily reach one of the clinic sites. These expansions paid dividends: the number of patients increased almost four-fold between the second and third years, with a cumulative total for all three years of just under 1,700 patients.
Recently, the PHE program began a partnership with the UN Population Fund (UNFPA), becoming the first PHE project to receive support from the UNFPA within Madagascar. The UNFPA funds will allow us to add new regional clinics; launch a behavior change campaign, including a regional theater tour and educational events; and further develop the CBD program.
UNFPA’s support of this initiative represents an important endorsement of Blue Ventures’ integrated approach to the challenges of marine sustainability, food security, reproductive health, and population growth. Funding applications to focus on improving maternal and infant health and to conduct a full health-needs assessment of the Velondriake region are pending.
In taking a population, health, and environment approach, Blue Ventures creates synergies that allow for the more effective achievement of health and conservation outcomes. Through providing family planning and health options – services the community really wants – Blue Ventures generates more support for all of its other initiatives, such as conservation and aquaculture programs.
This integrated multi-pronged approach also helps speed up the move towards a more sustainable future. By empowering and enabling couples to take control of their fertility, couples are able to have the size family they want. The use of family planning helps lower the population growth rate, and lower growth rates decrease pressures on natural resources. Decreased pressures on natural resources lead to healthier ecosystems; healthier ecosystems mean more natural resources available; and more resources lead to healthier families.
Through recognizing this inextricable link between communities, their health, and the environment they live in, Blue Ventures hopes to preserve not just the local coral reefs and mangroves, but the Vezo seafaring lifestyle. This way, the sons on the boats and the babies on the women’s backs may still have enough octopus and fish to harvest when they take their own children out to sea.
Matthew Erdman is the PHE coordinator for Blue Ventures. For more information about Blue Ventures’ PHE activities, please contact phe@blueventures.org, or visit their website at www.blueventures.org.
Photo Credit: Adapted from “07,” courtesy of Blue Ventures. -
Mobile Phones for Maternal Health in the Developing World
›With rising use in the developing world, cell phones and mobile technologies can create “connected and coordinated health systems that save more lives,” said Josh Nesbit at the GHI event “New Applications for Existing Technologies to Improve Maternal Health,” on October 27. Capitalizing on these new technologies could increase efficiency, cost-effectiveness, and efficacy of public health programs. Nesbit, executive director of FrontlineSMS: Medic, was joined by Alain Labrique, assistant professor at the Johns Hopkins School of Public Health, and David Aylward, executive director of the mHealth Alliance at the United Nations Foundation, to discuss the role of Information and Communication Technologies (ICTs) in the prevention of maternal mortality.
Collaborations for mHealthWhile “cell phones can’t save lives, the lack of information does kill,” said Aylward. Using technology that many people already own and use, mobile technology is an appropriate tool for disseminating health data and information. Existing technologies such as mobile phones and SMS text messaging can revolutionize healthcare by improving data collection and disease tracking, expanding patient diagnostics, and advancing education and awareness among health workers and patients.
With 64 percent of all mobile phone users located in the developing world, the use of mobile devices to improve health services in low-income countries is especially promising.
Aylward hopes that mobile health technology (mHealth) will help combat maternal mortality in the developing world. With approximately 350,000 women dying in childbirth each year, and only marginal progresses towards achieving Millennium Development Goal 5, finding such innovative solutions to improve maternal health is crucial.
Public-private partnerships are particularly important when considering the long-term sustainability of mHealth programs. “This didn’t happen because of the World Bank, it happened because people who are very poor voted with their very limited funds to have access to information,” said Aylward.
Aylward is hopeful that government and donor support will continue to become more supportive of mobile technology and coordinated in their implementation of mHealth programs globally.
Mobile Health Solutions in the Developing World
“Through mobile tools, we can act as quickly as possible to improve access to skilled birth attendants, emergency obstetric care, and access to reproductive health commodities,” said Nesbit.Nesbit’s organization, FrontlineSMS: Medic, is working to eliminate barriers created by the lack of resources and infrastructure in the developing world using mobile health technology. Now working in 20 countries, the organization uses free software “that enables large-scale, two-way text messaging using only a laptop, a GSM modem, and inexpensive cell phones,” explained Nesbit.
“One of the best measures is whether people continue to use your tools, and they will if it impacts their lives positively and they won’t if it doesn’t—sometimes it’s as simple as that,” said Nesbit on why communities in the developing world are eagerly embracing mobile technology.
Moving forward, Nesbit hopes to “scale and replicate, both vertically and horizontally, models that we’ve shown can work, but also to build new tools” and work with the health community “to help identify the needs and the gaps in these systems.”
However, Nesbit stresses that “these are very much tools and not solutions; they become solutions when they are paired with people on the ground who use them.”
Compressing the Time Between Crisis and Care
“The opportunities for mobile phones to act synergistically with existing health systems in low- to middle-income countries are many,” said Labrique. The current challenge is to harness this technology to improve health outcomes in the developing world, where disease burden is disproportionately high.
In the developing world, “decisions influenced by the lack of resources, such as poverty, or lack of information have led to highly convoluted patterns of care-seeking,” said Labrique.“Delayed decision-making compounded by delayed transport can have tragic consequences for maternal mortality,” said Labrique, and the most immediate use of mobile technology is “getting the necessary care, on time, to where these deaths are taking place.” Cell phones can help women, their families, and local health workers to seek timely, appropriate medical help for an obstetric emergency.
“Addressing equity and access to phones when evaluating the impact or success of mHealth interventions is critical,” Labrique said. Although cell phone use is high and steadily increasing, social and cultural norms in some countries might prevent women from using them. Further, Labrique notes, in Bangladesh, cell phone use among the poorest families is noticeably less than those with higher socioeconomic status.
“ICT and mHealth solutions have tremendous promise to improve maternal health in resource limited settings; however, it’s important not to let the technology guide the public health agenda,” said Labrique. More data is needed to determine how these tools might strengthen and enhance health systems and a clearer research agenda can help ensure evidence-based solutions guide programming.
For more from David Aylward and mHealth, be sure to see “Watch: David Aylward on How Wireless Technology is Changing Global Health and Empowering Women.”
Sources: Lancet, United Nations Foundation.
Photo Credit: “‘SMS till you drop’ — mobile phone ad on van in Kampala, Uganda,” courtesy of flickr user futureatlas.com. -
UNFPA State of World Population 2010
›Today marks the release of the United Nations Population Fund (UNFPA) annual State of the World Population Report. But the 2010 edition, “From Conflict and Crisis to Renewal: Generations of Change,” is unlike those that have come before. In lieu of the traditional statistic-driven report, this year’s edition has enlisted another tool to document living conditions across the world — storytelling. In addition to demographers, the UNFPA looked to journalists to fan out across the world to gather stories on the ground and paint a portrait of the challenges and opportunities facing today’s global population that goes beyond the numbers, with particular focus on gender issues and human insecurity.
For more on the UNFPA report, be sure to listen to The New Security Beat’s interview with one of its authors, Barbara Crossette, who talks about her experiences dealing with family planning around the world, as part of our ongoing Pop Audio series.
Video Credit: UNFPA. -
GMHC 2010: Maternal Health Realities: Accountability and Behavior Change
›Four days ago a young woman died giving birth in a bustling marketplace in New Delhi. Just steps away from Parliament, this woman was left to die and no emergency care was sent to her – no midwives, nurses, or doctors; just people walking around her accepting the situation as normal and an uncontrollable way of life. But this is Delhi…not a remote tribal village where the nearest health clinic is hours away (on foot).
This juxtaposition lingers on in me as I sit in the plenary session of day two at the Global Maternal Health Conference and listen to Syeda Hameed, member of the Indian Parliament Planning Commission, discuss her recent visit to a remote village where every house has 10 children living in filth, flies, and emptiness.
Although I have been working on such development issues for the last five years I do not work in the field, nor do I visit the developing world on a regular basis. Hearing these stories, coupled with my firsthand experience of witnessing poverty here in Delhi reminds me of the daily reality of those 342,900 women who die every year. This is their way of life and I think it’s poignant that today’s sessions emphasize community based care, family planning, accountability, behavior change, and culture.
“Context, context, context,” said Wendy Graham of IMMPACT at yesterday’s plenary session. I agree, the context of social and cultural norms is an underlying factor that must be taken into consideration when implementing maternal and child health (MNCH) programs. With a background in psychology, I appreciated when Dr. Zulfiqar Bhutta, of Aga Khan University, recognized the toll of poverty on the imagination and the mentality of fatalism.
That is why it is so essential to “ask the people how they feel and bring their voices into the forums where policy decisions are made,” said Hameed. It is also important to hold key players accountable and include men in MNCH activities.
During the side session Male Involvement in Reproductive and Maternal and Newborn Health six field experts (in which half the panelists and audience members were men!) discussed effective methods for increasing male participation in family planning, vasectomies, gender equality, and hospital care.
The key findings from this discussion include:- Targeted interventions that educate men about danger signs and pregnancy complications correlates with behavior change and increased facility births.
- Many young married men feel pressured to prove their fertility. A sample of men was evaluated and those who had increased education and income were more likely to delay first pregnancy.
- Vasectomy is not something men want to talk about with family planning fieldworkers; however, official recognition of the vasectomy benefits by the government did increase referrals.
- Puppet and theater shows that demonstrate gender equity behaviors provide an opportunity for dialogue. Women in this study reported increased gender equity in family planning decision-making.
Originally posted at Maternal Health Task Force, by Calyn Ostrowski of the Woodrow Wilson International Center for Scholars, Coordinator of the Maternal Health Dialogue Series in partnership with the Maternal Health Task Force and UNFPA.
Photo Credit: “Parliament Street” courtesy of flickr user ~FreeBirD®~. -
Water, Power, Trash, and Security: Interview with Mishkat Al Moumin, First Iraqi Minister of the Environment
›August 31, 2010 // By Schuyler NullAs the final American combat brigade pulls out of the country, the prevailing opinion in the United States about Iraq at the moment seems to be one of “bad politics are better than no politics,” and that despite continued violence (albeit significantly lessened from 2006-2007 levels), the American mission is largely finished. However, serious challenges remain, one of the most significant being the government’s continued inability to supply basic services to a growing population.
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Interview With Wilson Center’s Maria Ivanova: Engaging Civil Society in Global Environmental Governance
›August 13, 2010 // By Russell SticklorFrom left to right, the five consecutive Executive Directors of the United Nations Environment Programme: Achim Steiner, Klaus Toepfer, Elizabeth Dowdeswell, Mostafa Tolba, and Maurice Strong, at the 2009 Global Environmental Governance Forum in Glion, Switzerland.
In the eyes of much of the world, global environmental governance remains a somewhat abstract concept, lacking a strong international institutional framework to push it forward. Slowly but surely, however, momentum has started to build behind the idea in recent years. One of the main reasons has been the growing involvement of civil society groups, which have demanded a more substantial role in the design and execution of environmental policy—and there are signs that environmental leaders at the international level are listening.
On the heels of the UN Environment Programme’s Governing Council meeting earlier this year in Bali, a call was put out to strengthen the involvement of civil society organizations in the current environmental governance reform process. To that end, UNEP is creating a Civil Society Advisory Group on International Environmental Governance, which will act as an information-sharing intermediary between civil society groups and regional and global environmental policymaking bodies over the next few years. (The application deadline has been extended; applicants interested in joining the Advisory Group should submit their materials via e-mail by Sunday, August 15, 2010—full instructions are listed at the end of this post.)
Maria Ivanova, a fellow at the Woodrow Wilson Center and director of the Global Environmental Governance Project, played a key role in ensuring civil society engagement in the contemporary political process on international environmental governance reform. Ivanova recently sat down with the New Security Beat to talk about the future prospects for global environmental governance, the Rio+20 Earth Summit in Brazil in 2012, and how to foster a more open and sustained dialogue between the worlds of environmental policymaking and academia.
New Security Beat: What are the pitfalls of a regional approach to addressing climate change and other environmental issues, as opposed to an international approach?
Maria Ivanova: Global environmental problems cannot be solved by one country or one region alone, and require a collective global response. But they can also not be addressed solely at the global level because they require action by individuals and organizations in particular geographies. The conundrum with climate change is that the countries and regions most affected are the ones least responsible for causing the problem in the first case. We cannot therefore simply substitute a national or regional response for a global action plan, as more often than not, it would be a case of “victim pays” rather than “polluter pays”—the fundamental principle of environmental policy in the United States and most other countries. Importantly, however, our global environmental institutions do not possess the requisite authority and ability to enforce agreements and sanction non-compliance.
NSB: What are some of the inherent difficulties in getting countries to see eye-to-eye and collaborate on the development of institutions for global environmental governance?
MI: The most important difficulty is perhaps the lack of trust and a common ethical paradigm accompanied by a pervasive suspicion about countries’ motives. Secondly, there is a perceived dichotomy between environment and development that has lodged in the consciousness of societies around the world. Thirdly, there’s the inability of current institutions to deliver on existing commitments. The resulting blame game feeds suspicions and restarts the whole cycle again.
NSB: Do you see the 21st century’s various environmental challenges as being a driver of international conflict or cooperation?
MI: After the fall of the Berlin Wall, it was expected that global environmental (and other) issues would be a driver for cooperation. A green dividend was expected, and the 1992 Rio Earth Summit fostered much hope. But quite the opposite happened. Global environmental challenges such as climate change, for example, have caused more conflict than cooperation. Other concerns, such as whaling and biodiversity loss, have also triggered conflicts as governments have become fiercely protective of their national sovereignty. On the other hand, civil society groups and even individuals around the world have come together in new coalitions and formed new alliances. So while at a governmental level we observe increased tension, at a civil society level, we witness unprecedented mobilization and collaboration, especially through social media. Obviously, we live in a new world.
NSB: There has been a lot of talk about bridging the gap between the academic and policy worlds—two communities that do not typically have much interaction, but likely have a lot to learn from one another. What steps do you think can be taken regarding environmental governance that might facilitate a sustained dialogue and interaction between the two sides?
MI: Many academics have thought, debated, and written about global environmental governance. Fewer have presented their analysis to policymakers and politicians. At the Global Environmental Governance (GEG) Project that I direct, we seek to bridge that gap and provide a clearinghouse of information, serving as a “brutal analyst,” and acting as an honest broker among various groups working in this field. Moreover, we are in the process of launching a collaborative initiative among the Global Environmental Governance Project, the Center for Law and Global Affairs at Arizona State University, and the Academic Council on the UN System to collect, compile, and communicate academic thinking on options for reform to the ongoing political process on international environmental governance. We are creating a Linked-In group where we hope to engage in discussions with colleagues from universities around the world with the purpose of generating ideas, developing options, and testing them with policymakers. Moreover, we are engaging with civil society beyond academia. The GEG Project is sponsoring five regional events on governance in Argentina, China, Ethiopia, Nepal, and Uganda that are taking place in August and September. Led by young environmental leaders in those countries who attended the 2009 Global Environmental Governance Forum in Glion, Switzerland, these consultations are generating genuine engagement in thought and action on governance. So, new initiatives are certainly emerging and the results could be visible by the Rio+20 conference in May 2012.
NSB: What are your expectations for Rio+20?
MI: Given that governance is a major issue on the agenda for Rio+20, my hope is that the conference will bring about a new model for global governance, which reframes the environment-development dichotomy, cultivates shared values, and fosters leadership. Indeed, I am convinced that leadership is the most important necessary condition for change. We need to encourage more bold, visionary, entrepreneurial behavior rather than conformity.
My hidden hope for Rio+20 is that it will dramatically shift the narrative and move us from sustainable development to sustainability. Sustainability builds on sustainable development but goes further than that. As a concept it allows for new thinking, new actors, and new politics. It avoids the North-South polarization of sustainable development, which is so often equated with development and is therefore understood as what the North has already attained and what the South is aspiring to. By contrast, no one society has reached sustainability, and learning by all is necessary. Moreover, much of the innovative thinking about sustainability is happening in developing countries, which are trying to improve quality of life without jeopardizing the carrying capacity of the environment. Progressive thinking is also taking place on campuses in industrialized countries, which are creating a new sense of community and collaboration. Indeed, young people around the world are engaging in finding new ways of living within the planetary limits in a responsible and fulfilling manner.
Maria Ivanova is director of the Global Environmental Governance Project, a fellow at the Woodrow Wilson International Center for Scholars, and an assistant professor of global governance at the McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston.
If you wish to nominate yourself or someone else as a candidate for the Civil Society Advisory Group on IEG, you need to submit materials to civil.society@unep.org by Sunday, August 15, 2010 (please copy info@environmentalgovernance.org). You can find the nomination form and the Terms of Reference for the group at the Global Environmental Governance Project’s website.
Photo Credit: “UNEP Leadership,” courtesy of the Global Environmental Governance Project. -
How Maternal Mortality and Morbidity Impact Economic Development
›“Investing in women and girls is the right thing to do,” says Mayra Buvinic, sector director of the World Bank’s gender and development group. “It is not only fair for gender equality, but it is smart economics.” But while it may be smart economics, many developing countries fail to address the underlying social causes that impact economic growth, such as poverty and gender inequality. Buvinic was joined by Dr. Nomonde Xundu, health attaché at the Embassy of South Africa in Washington, D.C., and Mary Ellen Stanton, senior maternal health advisor at the U.S. Agency for International Development (USAID), at the sixth meeting of the Advancing Policy Dialogue on Maternal Health Series, which addressed the economic impact of maternal mortality and provided evidence for the need for increased investment in maternal health.
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Land, Education, and Fertility in Rural Kenya
›August 10, 2010 // By Wilson Center StaffExcerpted from a summary on the Population Reference Bureau‘s website, by Karina Shreffler and F. Nii-Amoo Dodoo. The original version of this article appeared in Population and Environment 30, no. 3 (2009): 75-92.
Little is known about the role of land inheritance in the link between land availability and fertility. The recent transition from high to lower levels of fertility in some African countries presents an opportunity to clarify the underlying causes of this decline, since the individuals involved in the transitions are still alive.
Using data from focus group discussions with people whose childbearing occurred before and during the rapid and unexpected fertility decline in Nyeri District in rural Kenya, we examined the impact of diminishing land availability, farm size, and inheritance patterns on fertility decisionmaking and behavior. The results shed new light on the role of education, long considered the key determinant of fertility transition.
Our research suggests that rather than inheritance being an external factor affecting fertility behavior, parents in Nyeri District chose to educate their children after realizing they would not be able to bequeath a sufficient amount of land. Our work provides evidence of the importance of considering the influence of environmental factors on demographic processes, particularly in regions of resource dependence.
Continue reading on PRB.
For more on Kenya’s youth, see New Security Beat‘s interview with Wilson Center Scholar Margaret Wamuyu Muthee.
Photo Credit: “Olaimutiai Primary School (Maasai Land, Kenya),” courtesy of flickr user teachandlearn.
