Showing posts from category PHE.
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IGWG’s K4Health Gender and Health Toolkit Is a One-Stop Shop for Integration
›November 30, 2010 // By Ramona Godbole
Addressing and analyzing gender norms, roles, and relations is increasingly viewed as critical in the development of equitable, effective, and sustainable health care. However, there has been relatively little integration of gender into health policies, programs, and systems.
The Interagency Gender Working Group (IGWG) – founded in 1997 as a way to bring together NGOs and parts of USAID to share best practices – has partnered with K4Health to create a Gender and Health Toolkit specifically designed to bridge this gap.IGWG’s Gender and Health Toolkit provides access to hundreds of tools, databases, training modules, websites, and publications in one place. Broadly divided into sections including program design, implementation approaches, capacity building, monitoring and evaluation, health systems, best practices examples, and even country-specific case studies, the toolkit provides nearly everything needed to begin integrating gender into new or existing public health programs.
Practitioners can also post questions and comments about the toolkit through an integrated discussion board. The toolkit even has a database to share gender-related photos.
While designed primarily for gender and health specialists and practitioners, the scope of the toolkit extends beyond typical public health issues like maternal health, family planning, HIV/AIDS, and reproductive health. The toolkit links to resources and training modules covering a wide range of cross-cutting topics including gender-based violence; nutrition and food security; integrated population, health and environment; and conflict/post-conflict humanitarian assistance.
The accumulated wealth of knowledge presented in the IGWG Gender and Health Toolkit is an impressively comprehensive resource, and it should be bookmarked by environment, health, and gender specialists and interested policymakers alike.
Image Credit: K4Health. -
Climate-Proofing Development: An Interview With Karen Hardee
›November 29, 2010 // By Hannah MarquseeWhile expectations are deflated for broad international consensus at the UN Climate Change Convention in Cancun, the need to “climate-proof” development efforts has been gaining ground in recent years as a necessary preventative measure to help developing countries adapt to the adverse effects of climate change.
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Watch: Blue Ventures PHE Program in Madagascar
›“All conservation efforts will be in vain if family planning issues aren’t addressed,” says Rebecca Hill, project manager for the Sexual and Reproductive Health Programme at Blue Ventures in a video highlighting their population, health, and environment (PHE) programming in Madagascar.
While primarily a marine conservation group, Blue Ventures also recognizes the need for integrating population into their efforts. They began a family planning program in southwestern Madagascar in 2008 as part of a “holistic approach to conservation.” The project aims to address the high unmet need for family planning, high fertility and maternal and infant mortality, and conserve the coastal environment. “We are directly saving lives,” Hill says.
Rapid population growth is creating an unsustainable strain on natural resources, as Matthew Erdman of Blue Ventures wrote in a previous post on The New Security Beat: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.
Hill describes the situation in the village when she joined the Blue Ventures in 2008 as “alarming,” with women “having up to 17 children despite not wanting children.” Many people in the town had never heard of condoms and had no idea how to use them, she said, and “they are desperate to have access to contraception.”
Today, the initial family planning program has been scaled up to the surrounding region and generated significant community involvement by peer educators teaching community members about sexual and reproductive health. It’s also become the first PHE project to receive support from the UNFPA within Madagascar.
There are currently 18 community-based distributors who give out two types of contraception in their villages. The fact that the community has so fully embraced the project shows that it can be replicated elsewhere, says Hill in the video. “Communities themselves have harnessed the ideas and consider that what we’re doing is vitally important.”
“Addressing family planning needs and issues is inextricably linked with conservation issues,” says Hill. “All conservation efforts will be in vain, if family planning issues are not addressed.”
Video Credit: Blue Ventures Family Planning Project from Alexander Goodman on Vimeo. -
Disease in the Developing World
Poverty, Politics, and Pollution
›November 15, 2010 // By Ramona GodboleA look at the most common illnesses that kill people in the developing world reveals, for the most part, easily preventable and/or treatable diseases and conditions, highlighting the deep disparities between health systems in rich and poor countries. But many of the causes and solutions to these common diseases are also linked to political and environmental factors as well as economic.
Cholera: “A disease of poverty”
Ten months after the earthquake that killed more than 230,000 people, Haiti is facing yet another disaster – a cholera outbreak. The current health crisis highlights broader structural and political issues that have plagued Haiti for years.
Cholera, an intestinal infection caused by bacteria-contaminated food or water, causes severe diarrhea and dehydration, but with quick and effective treatment, less than one percent of symptomatic people die according to the World Health Organization. According to BBC, as of November 15, more than 14,000 people have been hospitalized and over 900 deaths have been attributed to cholera in Haiti thus far.
Even before the earthquake, conditions in Haiti, the poorest country in the Western hemisphere, were bleak. The country has very high maternal and child mortality rates (again, highest in the Western hemisphere), and is in the midst of an ongoing environmental crisis, due to deforestation, soil loss, and flooding.
Less than 40 percent of the Haitian population has access to appropriate sanitation facilities and clean water is scarce, according to UNICEF. Displacement, rapid population growth, and destroyed infrastructure in the wake of the earthquake exacerbated already poor conditions and public health officials warned of the increased risk of cholera and other diarrheal diseases after the disaster.
Today these fears have become reality. While public health messages urging Haitians to wash their hands, boil drinking water, and use oral rehydration salts are working to control the current outbreak, long-term solutions to prevent future outbreaks will require much more systematic changes.
As Partners in Health Chief Medical Officer Joia Mukherjee puts it, cholera is “a disease of poverty.” Citing a joint report from Partners in Health and the Robert Kennedy Center for Human Rights, Mukherjee notes that in 2000, loans from the Inter-American Development Bank to improve water, sanitation, and health (including the public water supply in the Artibonite Valley, where the cholera outbreak originated) were blocked for political reasons by the U.S. government, in an effort to destabilize former President Aristide.
The failure of the international community to assist Haiti in developing a safe water supply, writes Mukherjee, has been a violation of the basic human right to water. To halt the current cholera epidemic and prevent future outbreaks, providing water security must become a priority in the reconstruction efforts of the international community.
Politics and Polio
Recent reports have indicated that the global incidence of polio, a highly infectious, crippling, and potentially fatal virus, is significantly declining and a new vaccine is renewing hopes of eradication. Nigeria, one of the few countries where polio continues to be endemic, has also made major progress over the last few years.
But the situation was very different just a few years ago. In 2003 religious and political leaders in Northern Nigeria banned federally sponsored polio immunization campaigns, citing “evidence” that the polio vaccine was contaminated with anti-fertility drugs intended to sterilize Nigerian women. The boycott led to an outbreak of the disease that spread to 20 countries and caused 80 percent of the world’s cases of polio during the length of the ban, according to a study in Health Affairs.
While the boycott was eventually stopped through the combined efforts of local, national, and pressure, the boycott serves as a useful reminder that global health problems can have political, rather than biological or behavioral, origins.
Combating Climate Change and Pneumonia
Studies from the World Health Organization indicate that exposure to unprocessed solid fuels increases pneumonia risk in children by a factor of 1.8, but today more than three billion people globally continue to depend on coal and biomass fuels for their cooking and heating needs.
Cooking and heating with these fuels creates levels of indoor air pollution that are up to 20 times higher than accepted WHO guidelines, putting people at considerable risk for lower respiratory infections. Women, who are often responsible for collecting fuel and performing household tasks like cooking, and their children, are particularly at risk. Today, exposure to indoor air pollution is responsible for 1.6 million deaths globally including more than 900,000 of the two million annual deaths from pneumonia in children under five years old, representing the most important cause of death in this age group.
A recent study from The Lancet shows improved cooking stoves could simultaneously reduce greenhouse gas emissions and the global burden of disease caused by indoor air pollution in developing countries. Such an intervention, the authors argue, could have substantial benefits for acute lower respiratory infection in children, chronic obstructive pulmonary disease, and ischemic heart disease. The potential health benefits don’t stop there: fuel-efficient stoves can also improve the security of women and children in conflict zones and decrease the risk of burns while improving local air quality.
There would be significant environmental benefits as well. A World Wildlife Fund project in Nepal, which provided loans to purchase biogas units and build improved cookstoves, curbed deforestation for firewood and grazing as well as reduced the incidence of severe cases of acute respiratory infection among under-five children.
Overall, greater access to modern cooking fuels and improved cooking stoves in the developing world could both mitigate climate change and make significant contributions to MDGs 4 & 5, which focus on the reduction of child and maternal mortality.
Prescription for Change
The international community’s experience with cholera in Haiti, polio in Nigeria, and pneumonia around the world shows that health issues in developing countries rarely occur in a vacuum. As these three cases demonstrate, politics, environmental, and structural issues, for better or worse, play an important role in health affairs in the developing world. Yet efforts to combat these conditions often focus only on prevention and treatment.
Antibiotics and vaccines alone cannot provide solutions to these problems. Employing economic, diplomatic and policy tools to address health and development challenges can save lives. More specifically, public health efforts should not only focus on poverty reduction, but also target environmental, political, and structural issues that contribute to disease globally.
Sources: BBC, Bill and Melinda Gates Foundation, CIA World Factbook, Health Affairs, The Lancet, Scientific American, UNICEF, United Nations, USAID, World Health Organization, and World Wildlife Fund.
Photo Credit: “Lining up for vaccination,” courtesy of flickr user hdptcar. -
No Peace Without Women
›November 11, 2010 // By Kayly OberOn October 31, 2000, the UN Security Council adopted Resolution 1325, which calls for women’s equal participation in all efforts to maintain and promote peace and security. The resolution sought to exorcise the demons of the 1990s, when genocide took over 800,000 lives in Rwanda, thousands of women were raped in Bosnia, and millions more were displaced. However, the truth is that little progress has been made over these last 10 years and women remain on the periphery when it comes to post-conflict reconstruction and development.
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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. -
Watch: Population, Health, and Environment in Ethiopia
›Severely eroded and deforested, Ethiopia’s land is increasingly turning to desert, due to the country’s high population growth, unsustainable land use, and lack of land ownership. Featuring footage from my trip to Ethiopia last year, this video looks at the efforts of two projects to combat these devastating trends by meeting the country’s complex challenges with integrated solutions.
Ethiopia’s population is estimated at 85 million. Since 1900, the country has grown by nearly 74 million people, and the United Nations predicts this rapid growth will continue, reaching nearly 120 million people by 2025.
“Family planning is very crucial” to sustainable development, said Gebrehiwot Hailu of the Relief Society of Tigray (REST), located in the northern region of Tigray. “If the family has more children… he can’t feed them properly, he can’t send the children to school, because there is a food gap in the household.” REST uses a watershed planning model jointly developed by the community, health workers, and government agencies.
Realizing there is no silver bullet to development, projects like REST integrate population, health, and environment (PHE) programs to engage these challenges from all angles.
The Ethio Wetlands and Natural Resource Association (EWNRA), located in Ethiopia’s Wichi watershed, uses a combination of techniques to restore the watershed, create alternative livelihoods, strengthen health systems, and improve reproductive health.
“Through this integrated watershed intervention, the wetland is regaining its natural situation,” Shewaye Deribe of EWNRA told me. “The communities with their own bylaws, with their own watershed committee, with their own organization… are protecting these remaining forest patches.”
Sources: Population Reference Bureau. -
Assessing Our Impact on the World’s Rivers
›In a special “Rivers in Crisis” issue of Nature, the lead article, “Global Threats to Human Water Security and River Biodiversity,” presents damning evidence that manipulation of river systems — through the construction of canals, levees, hydroelectric projects, and other infrastructure — has caused serious and lasting biological damage to watersheds throughout both the developing and developed worlds. The authors (all 11 of them!) report that key rivers have become shadows of their former selves in terms of the amount of aquatic life they can support. Without drastically improved stewardship of waterways, “we are pushing these river systems toward catastrophe,” warns Peter McIntyre, an article co-author.The human impact on the world’s river systems will be hard to reverse, says Margaret Palmer, author of a second Nature article on freshwater biodiversity loss, “Beyond Infrastructure.” Human-induced changes to watersheds affect local hydrology at a fundamental level, she contends, weakening rivers’ ability to deliver crucial “ecological goods and services” — such as clean water and nutrient-rich sediment loads — that help maintain the health of local environments and the human populations that depend on them. To fully understand the scope of the problem, Palmer says more research is needed to explore the linkages between biodiversity levels and “ecosystem services” that healthy rivers provide.
