Showing posts from category PHE.
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USAID Head Calls for Integrating Health Services in New Global Health Initiative
›July 2, 2010 // By Russell Sticklor
This Tuesday, Dr. Rajiv Shah, administrator for U.S. Agency for International Development gave a major speech at the Center for Strategic & International Studies on USAID’s Global Health Initiative. With $63 billion earmarked for GHI over the next six years, there are high expectations for the program.
Shah laid out some details of GHI’s main priorities, which include improving family planning services, enhancing nutrition initiatives, and building stronger and broader-based healthcare systems across the developing world, with special attention paid to the health needs of mothers and their young children. He offered a number of examples of the benefits of integrating family planning with other health services for women and children, including maternal health and nutrition.
Shah did not, however, mention integrating family planning with environmental programs, the benefits of which USAID-funded programs have amply demonstrated. He also did not delve into the emerging nexus of family planning, population growth, and climate change, a subject of much discussion at last month’s Women Deliver conference in Washington, D.C.
On the other hand, Shah did say that GHI’s emphasis on improving nutrition for the world’s poor will complement another major Obama administration outreach effort, the Feed the Future initiative—repeating a point he made at the recent launch of the food security effort.
Shah also highlighted the need for establishing benchmarks for measuring success that revolve around people, not diseases. He suggested one way of achieving this would be to ensure that clinics—particularly in rural areas—broaden their mandate to offer a variety of health-prevention services, rather than providing resources that treat primarily one type of illness.
For a full transcript of Shah’s speech, click here.
More analysis of Shah’s speech and USAID’s Global Health Initiative to come in the weeks ahead.
Photo Credit: “Statesman Forum: Dr. Rajiv Shah, USAID Administrator,” courtesy of flickr user CSIS: Center for Strategic & International Studies. -
Environmental Impacts of Madagascar’s Coup
Cutting the Head Off Conservation
›June 24, 2010 // By Tara InnesThe coup in Madagascar in early 2009 not only politically destabilized the country, but also damaged its ability to protect its unique environment. A hotspot of biodiversity, Madagascar is the home of many species that exist nowhere else in the world.
Deposed president Marc Ravalomanana, while criticized for prioritizing business interests, was a proponent of environmental conservation who leveraged the natural wealth of his country to promote sustainable development.
The coup caused donors to withdraw aid to the country; destroyed the tourism industry, and changed the priorities of the country’s leadership. The new government, led by President Andry Rajoelina, has failed to help—and has possibly harmed–Madagascar’s rich ecosystem.
Shortly after the coup, the United States suspended all non-humanitarian aid to Madagascar, including aid targeted at conservation efforts. The World Bank and the African Union also cut aid to the country.
Without international aid—which provides 90 percent of the funding for conservation, according to MongaBay—parks and endangered species cannot be preserved and protected. Conservation International documented reports of endangered lemurs being slaughtered and sold for bushmeat by poachers.
Funding for USAID’s integrated population-health-environment programs, which seek to improve health and reduce population pressures in remote communities near protected areas, was also suspended. Prior to the coup such programs were heralded largely as a success.
Instability has also made Madagascar an unattractive vacation destination. The tourism industry – much of it eco-tourism – has taken a massive economic hit, losing 12 percent of its value in 2009 and depriving some communities of a major source of support. The drop in tourist visits to the country’s national parks has “a big impact on the economics of the villages as 50 percent of the park entrance fees are used for village conservation and development projects,” the manager of the Ranomafana National Park told MongaBay’s Rhett Butler earlier this year.
While Ravalomanana tripled the area of protected lands in Madagascar during his tenure as president, he also made several unpopular decisions leading to rising food costs and unrest. Just prior to the coup, South Korea’s Daewoo Logistics Corporation attempted to negotiate a 99-year lease on 3.2 million hectares of farmland, contributing to anti-Ravalomanana sentiment fueled by Rajoelina, who later canceled the deal.
Some—including Ravalomanana–claim that the new government is being funded in part by illegal lumber exports. More recently, members of the transitional government banned trade in rainforest timber, but there are some concerns that this ban will not be enforceable given the continued political instability, reports MongaBay.
The damage already done “demonstrates that long-term conservation success depends on the overall political stability of a country and in turn on the steady improvement of the lives of its citizens,” wrote Rowan Moore Gerety in wildmadagascar.org last year.
“It’s difficult to work without a state,” said Guy Suzon Ramangason, director general of the organization that manages many of the national parks, recently told the New York Times.
Perhaps that situation will be rectified. In May Rajoelina announced that elections will be held in late 2010, in which he will not be running. Until then, it unlikely that conservation will receive adequate attention—from either Madagascar’s government or international donors.
Photo Credit: “Lemur behind the mesh” courtesy of flickr user Tambako the Jaguar -
Coffee and Contraception: Combining Agribusiness and Community Health Projects in Rwanda
›“Population pressures and diminishing land holdings – due to high fertility rates, war and genocide, and subsequent migration – have caused a rapid decrease in the forested and protected areas and increased soil infertility and food insecurity” in Rwanda, USAID’s Irene Kitzantides told a Wilson Center audience.
Kitzantides, a population, health, and environment advisor and global health fellow, said “the population is projected to reach over 14 million by 2025” – nearly one-third more than today, due to the country’s high fertility rate of nearly 5.5 children per women–which could continue to negatively impact forests and food supplies.
In response to these challenges, USAID supported the Sustaining Partnerships to Enhance Rural Enterprise and Agribusiness Development (SPREAD) Project. SPREAD uses an integrated population-health-environment (PHE) approach to develop the coffee agribusiness and bring family planning, HIV/AIDS, and reproductive health services to coffee workers.
Combining income generation with health services was thought an effective way to “fulfill the overall SPREAD goal of improving lives and livelihoods,” said Kitzantides.
A SPREADing Mandate: Integrating Health and Agribusiness
SPREAD follows USAID’s PEARL I and II Projects, which focused exclusively on agricultural development. Coffee is still at the center of SPREAD’s activities, with $5 million of the project’s $6 million USAID budget earmarked for agricultural development.
However, a broader mandate to include health services emerged after recognition that greater income alone does not ensure greater quality of life. The additional health funding leverages SPREAD’s already established relationships with farming cooperatives to bring health services to traditionally underserved rural communities.
“We really tried to build on the existing assets of the cooperative,” said Kitzantides. “We also really tried to complement local and national public health policy and partners.”
The integration of health with agricultural goals, and the use of already established in-country health programs, has made SPREAD extremely cost-effective, with HIV/AIDS prevention education costing less than $2 per person.
Examples of SPREAD’s integrated work include:Combined health and agricultural lessons: Kitzantides and her colleagues trained nearly 400 animateurs de café, cooperative employees running the agricultural education programs, to incorporate public health objectives into their activities. Combining health and agricultural education into one session takes advantage of workers already trained during previous USAID programs. The combination also attracts more male participants, who traditionally shunned HIV/AIDS, family planning, and reproductive health campaigns and services.
Radio programming: SPREAD worked with the agricultural radio program Imbere Heza (“Bright Future”) to incorporate health messaging at the end of each program.
- Mobile clinics: SPREAD works with cooperatives and local health centers to bring convenient services to farmers when they gather at sales or processing stations during harvests.
Community theater: SPREAD hires local theater groups to perform skits on health. The farming communities “really love community theater and always ask for it,” said Kitzantides.
In its relatively short existence, SPREAD’s health activities have reached over 120,000 people with HIV/AIDS prevention messages; nearly 90,000 with messages discussing family planning/reproductive health; and almost 40,000 about maternal and child health. The project counts 347 women as new users of family planning services.
Lessons learned – which will be examined in more detail in an upcoming issue of Focus – include the importance of using community-based approaches to overcome perceived social barriers; the advantages of integrating cross-cutting activities at the outset of a program; and the need for strong monitoring and evaluation systems to measure the effort’s outcomes.Jason Bremner of the Population Research Bureau said PHE projects such as SPREAD go “beyond what the health sector itself can do and find new ways of reaching underserved remote populations.” He presented a soon-to-be-released PRB map plotting the location of more than 40 PHE projects in Africa.
The success of SPREAD and similar projects demonstrates the potential for PHE approaches to bring reproductive health and family planning services to rural areas, Bremner noted, but there is still much work to be done to scale up this integrated approach – and to document its successes.
Sustaining SPREAD
Kitzantides said it took several years to integrate health activities with the already established agricultural programs. Since USAID funding for the program is scheduled to end in 2011, she is uncertain that the time remaining will be enough for SPREAD’s health partners to develop the logistical and financial capacities to become self-sustaining. But SPREAD has changed attitudes and beliefs, two key objectives that do not require sustained funding.
“We used to talk about growing coffee, making money, buying material things like bikes – not about problems like malaria, HIV/AIDS, etc.,” said one SPREAD agricultural business manager during the program’s evaluation. “Someone could have 5 million Rwandan francs in the house but could suffer from malaria where medicine costs 500 Rwandan francs, due to ignorance. You have to teach people about production, you have to also think of their health to improve their lives.”
Photo Credits: Irene Kitzantides, courtesy David Hawxhurst; condom demonstration, courtesy Nick Fraser; community theater group, courtesy SPREAD Health Program; Jason Bremner, courtesy David Hawxhurst. -
Pop-Up Video: Cable News Covers PHE Connections
›It was a bit of a shock to hear population-environment connections being discussed on television, including the Most Trusted Name in News (aka Jon Stewart’s Daily Show), as well as CNN’s Amanpour, late last month.
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Population and Sustainability
›“The MAHB, the Culture Gap, and Some Really Inconvenient Truths,” authored by Paul Ehrlich and appearing in the most recent edition of PLoS Biology, is a call for greater participation in the Millennium Assessment of Human Behavior (MAHB). MAHB was created, he writes, because societies understand the magnitude of environmental challenges, yet often still fail to act. “The urgent need now is clearly not for more natural science…but rather for better understanding of human behaviors and how they can be altered to direct Homo sapiens onto a course toward a sustainable society.” MAHB aims to create an inclusive global discussion of “the human predicament, what people desire, and what goals are possible to achieve in a sustainable society” in the hopes of encouraging a “rapid modification” in human behavior.The BALANCED Project, lead by the Coastal Resource Center at the University of Rhode Island, released its first “BALANCED Newsletter.” To be published biannually, the newsletter highlights recent PHE fieldwork, unpacks aspects of particular PHE projects, and shares best practices in an effort to advance the BALANCED Project’s goal: promoting PHE approaches to safeguard areas of high biodiversity threatened by population pressures. The current edition examines the integration of family planning and reproductive health projects into marine conservation projects in Kenya and Madagascar, a theater-based youth education program in the Philippines, and the combining of family planning services with gorilla conservation work in Uganda. The newsletter also profiles two “PHE Champions,” Gezahegh Guedta Shana of Ethiopia and Ramadhani Zuberi of Tanzania.“Human population growth is perhaps the most significant cause of the complex problems the world faces,” write authors Jason Collodi and Freida M’Cormack in “Population Growth, Environment and Food Security: What Does the Future Hold?,” the first issue of the Institute of Development Studies‘ Horizon series. The impacts of climate change, poverty, and resource scarcity, they write, are not far behind. Collodi and M’Cormack highlight trends in, and projections for, population growth, the environment, and food security, and offer bulleted policy recommendations for each. Offering greater access to family planning; levying global taxes on carbon; introducing selective water pricing; and removing subsidies for first-generation biofuels are each examples of suggestions advanced by the authors to meet the interrelated challenges. -
Philippines’ Bohol Province: Elin Torell Reports on Integrating Population, Health, and Environment
›For 10 years, I have been working on marine conservation in Tanzania with the University of Rhode Island’s Coastal Resources Center. As part of that effort, I’ve helped forge links between HIV/AIDS prevention in vulnerable fishing communities and marine conservation. However, family planning and reproductive health (FP/RH) were relatively new to me. But a recent study tour of an integrated Population, Health, and Environment (PHE) program in the Philippines helped me understand that combining family planning services and marine conservation can help reduce overfishing and improve food security.
Together with developing country representatives from seven African and Asian countries, I spent two weeks in February visiting three PHE learning sites and a marine protected area in Bohol province in the central Philippines, as part of a South-to-South study tour sponsored by the USAID-funded BALANCED Project, for which I work. The tour focused on the activities of the 10-year-old Integrated Population and Coastal Resource Management Initiative (IPOPCORM) project, which is run by PATH Foundation Philippines, Inc. (PFPI).
IPOPCORM has garnered a wealth of lessons learned and best practices to share with PHE newbies like me. Its integrated programs train people to be community-based distributers (CBDs) of contraceptives and PHE peer educators, as well as work with local and regional government officials to build support for family planning as a means to improve food security.
I was most impressed with the ways in which PFPI identifies and cultivates dynamic and motivated local leaders–men, women, and especially youth–to reach out to the members of their community who are highly dependent on marine resources for their survival. My Tanzanian colleagues and I would like to foster the volunteer spirit and “can do” attitudes we experienced through our work in East Africa. (Similar PHE peer educators are successfully working in Ethiopia’s Bale Mountains, as reported by Cassie Gardener in a previous edition of the “Beat on the Ground.”
My favorite part of the tour was a trip to the Verde Island Passage to see PFPI’s efforts in this fragile hotspot. The insights my Tanzanian colleagues and I gained from talking to the field practitioners in the Verde Islands helped us refine our ideas for translating some of the PHE techniques used in the Philippines to the Tanzanian cultural context, including an action plan for strengthening our existing PHE efforts with CBDs and peer educators.
Thanks to the study tour, I now have a better understanding of how to address population pressures in the context of conservation. Overall, my Tanzanian colleagues and I were inspired by the successes we saw firsthand and hope to emulate them to some degree in our own projects.
Elin Torell is a research associate at the Coastal Resources Center at the University of Rhode Island. She is the manager of CRC’s Tanzania Program and coordinates monitoring, evaluation, and learning within the BALANCED project. -
Thinking Outside the (Lunch) Box: Meat and Family Planning
›May 3, 2010 // By Dan AsinJoel Cohen, a renowned population expert and professor at Columbia and Rockefeller universities, recently gave a lecture simply titled “Meat.” As it was co-sponsored by the International Food Policy Research Institute and the Population Reference Bureau, I was hoping for an insightful discussion of meat eating and its implications for feeding a world of nine billion. While I think Cohen avoided the question of whether meat eating is ultimately sustainable, I was pleased that he included two key insights: the potential for family planning services to contribute to food security, and the importance of using multidisciplinary approaches to solve today’s global problems.
Family Planning for Food Security
In working to improve food security, Cohen said policymakers and practitioners need to focus on those who are most vulnerable. To this end, he identified five groups and suggested targeted policies for each:While the healthy eating policies will not surprise food security experts, his recommendations on family planning might. He highlighted what should be–but is not always–apparent: that tackling food security without thought for family planning is like attempting to fill an empty bucket without first plugging the holes.
Feeding the one billion hungry people in the world today is an enormous challenge that cannot be met by any single policy. Instead, it will take an array of partial solutions, and offering family planning services to women and young people is an important part of the package. Such projects can help reduce the number of children being born into hunger by allowing women and couples to assess their economic and food situations and plan according to their needs and wishes. Voluntary family planning services and materials will not solve the food security challenge on their own, but they can make it more manageable, especially in the long run.
Family planning’s potential contribution to food security is just one part of Cohen’s larger take-home message: population, economics, environment, and culture all interact. To meet today’s multidisciplinary challenges, single-sector approaches are not up to task.
The Many Faces of Meat
Cohen offered two competing perspectives on meat eating. On the one hand, average global meat production generates a fraction of the calories and protein, per unit of land, that could be derived from plant sources. It is likely the “largest sectoral source of water pollution,” said Cohen, and is at least partly responsible for the spread of over a dozen zoonotic diseases. It contributes to only 1.4 percent of world GDP while comprising 8 percent of world water consumption.
These hidden “virtual water” costs made headlines in Britain the other week, when a study on global water security published by the Royal Academy of Engineering popularized the Water Footprint Network’s earlier findings that that an average kilogram of beef requires 15,500 liters of water–over eight times the volume needed to produce the equivalent weight in soybeans and greater than 10 times that needed for the equivalent amount of wheat.
On the other hand, Cohen pointed out that meat production provides livelihoods for an estimated 987 million of the world’s rural poor, and has important cultural significance in many societies. And it can provide many essential nutrients, even in small doses.
In one study he cited, children living in Kenya who were provided 1 ounce of meat a day received 50 percent of their daily protein requirements and showed greater increases in physical activity and development, verbal and arithmetic test scores, and initiative and leadership behaviors as opposed to students who received the calorie-equivalent in milk or fat.
The Four Factors: Population, Economics, Environment, and Culture
Clearly, Cohen’s four factors all come in to play when evaluating meat’s role in food security. An analysis of any global health issue that looks at only one factor would miss indispensable parts of the problem.
“Population interacts with economics, environment, and culture,” Cohen concluded. “If you use that checklist when somebody gives you a simple-minded solution to a problem, you can save yourself a lot of simple-minded thinking.”
Photo: Pigs on a farm, courtesy Flickr user visionshare. -
Food Security Comes to Capitol Hill, Part Two: Women’s Edition
›April 30, 2010 // By Schuyler NullThe focus on food security on Capitol Hill continued with Wednesday’s House Hunger Caucus panel, “Feeding a Community, Country and Continent: The Role of Women in Food Security.” According to panel organizers Women Thrive Worldwide, “over half the food in developing countries – and up to 80 percent in sub-Saharan Africa – is grown by women farmers, who also account for seven in ten of the world’s hungry.”
The panel illuminated some of the inequities routinely faced by female farmers that often prevent them from using the same inputs as men (tools, fertilizer, etc.), bar their access to credit, and force them onto less productive land.
“Women around the world face unique economic and social barriers in farming and food production,” said Nora O’Connell of Women Thrive Worldwide. “But they are key to increasing food security and ending hunger, and all international programs must take their needs into account.”
Panelist David Kauck of the International Center for Research on Women (ICRW) cited the State Department’s Consultation Document on the Global Hunger and Food Security Initiative: “Economic output could be increased by 15-40 percent and under-nutrition reduced by 15 million children simply by providing women with assets equal to those of men.”
According to the 2008 ICRW report, A Significant Shift: Women, Food Security, and Agriculture in a Global Marketplace:Women also are more likely than men to spend their income on the well-being of their families, including more nutritious foods, school fees for children and health care. Yet agricultural investments do not reflect these facts. Women in forestry, fishing and agriculture received just 7 percent of total aid for all sectors.
One of the most fundamental problems faced by women in developing countries is a lack of basic education leading to illiteracy and innumeracy, making it difficult for women to understand agricultural policy or the fair market values of their products. Therefore, men are much more likely to control valuable markets.
In addition, women are less likely to learn about and adopt new agricultural technologies and best practices. Lydia Sasu, director of the Development Action Association, said that when she attended agricultural school in Ghana she was one of only three women, compared to more than 40 men, in her class.
Women in developing countries rarely own the land they farm, which can make it difficult to apply for credit and extension services without collateral. According to the ICRW report:In Uganda, women account for approximately three out of four agricultural laborers and nine out of 10 food-producing laborers, yet they own only a fraction of the land. Women in Cameroon provide more than 75 percent of agricultural labor yet own just 10 percent of land. A 1990 study of credit schemes in Kenya, Malawi, Sierra Leone, Zambia and Zimbabwe found that women received less than 10 percent of the credit for smallholders and only 1 percent of total credit to agriculture. Women receive only 5 percent of extension services worldwide, and women in Africa access only 1 percent of available credit in the agricultural sector.
“The fundamental barrier to women in agriculture,” said USAID’s Kristy Cook, “is access to assets.” Cheryl Morden of the International Fund for Agricultural Development (IFAD) said we have reached the “tipping point,” where action on this issue seems inevitable on the international policy level. However, she questions how quickly that momentum can translate to change on the ground.
The State Department has made improving women’s lives an important part of both their Global Hunger and Food Security Initiative and the Global Health Initiative. ”Investing in the health of women, adolescents, and girls is not only the right thing to do; it is also the smart thing to do,” said Secretary of State Hillary Clinton in January.
Reproductive health and family planning services will be key to both initiatives. A policy brief by ICRW’s Margaret Greene argues that poor reproductive health can have negative effects on women’s educational and economic opportunities. As Secretary Clinton said, “When women and girls have the tools to stay healthy and the opportunity to contribute to their families’ well-being, they flourish and so do the people around them.”
Photo Credit: “Transplanting at rainfed lowland rice in Madagascar,” courtesy of flickr user IRRI Images.
