Showing posts from category poverty.
-
Nancy Lindborg, The Huffington Post
For Yemen’s Future, Global Humanitarian Response Is Vital
›June 12, 2012 // By Wilson Center StaffThe original version of this article, by Nancy Lindborg, appeared on The Huffington Post.
This weekend in Sana’a, I had dinner with a group of young men and women activists who are on the forefront of Yemen’s historic struggle for a better future. They turned out for change with great courage last year, and at dinner, with great eloquence they outlined for me the many challenges facing Yemen during this critical transition period: conflict in the north and south, weak government institutions, cultural barriers to greater women’s participation, an upended economy, and one of the world’s highest birthrates. And, as one man noted, it is difficult to engage the 70 percent of Yemeni people who live in rural areas in dialogue about the future when they are struggling just to find the basics of life: food, health, water.
His comment makes plain the rising, complex humanitarian crisis facing Yemen. At a time of historic political transition, nearly half of Yemen’s population is without enough to eat, and nearly one million children under the age of five are malnourished, putting them at greater risk of illness and disease. One in 10 Yemeni children do not live to the age of five. One in 10. This is a staggering and often untold part of the Yemen story: a story of chronic nationwide poverty that has deepened into crisis under the strain of continuing conflict and instability.
Unfortunately, in communities used to living on the edge, serious malnutrition is often not even recognized in children until they are so acutely ill that they need hospitalization.
Continue reading on The Huffington Post.
Nancy Lindborg is the assistant administrator of the Bureau for Democracy, Conflict, and Humanitarian Assistance at the U.S. Agency for International Development.
Sources: U.S. Department of State.
Photo Credit: Informal settlements near the Haddjah governorate, courtesy of E.U. Humanitarian Aid and Civil Protection. -
Family Planning and Results-Based Financing Initiatives
›“Family planning means healthier moms and kids – and it’s good for development too,” said Lindsay Morgan, a senior health analyst at Broad Branch Associates, a healthcare advocacy group. But any number of hurdles can keep women from accessing family planning services. Morgan spoke at a May 21 discussion about results-based financing (RBF) programs, which aim to address hurdles on both the supply and demand sides of the equation in developing countries by incentivizing the provision of a variety of quality services while removing barriers to access for women in need of those services.
Removing Barriers to Providing and Using Family Planning Services
Incentives in RBF programs can come in a variety of forms – like subsidies or fees paid to clinics or vouchers sold to women, said Morgan. In Burundi, for example, under a pilot program rolled out across three provinces in 2006, health facilities receive payments for each patient that uses a modern method of contraception. In 2009, the government and international partners began scaling up the program to a nationwide level. In addition to expanding the program’s geographic reach, the scale-up incorporated new payment criteria to better incentivize quality of care (as opposed to just quantity) and longer-lasting methods of contraception.
Since the RBF pilot began, maternal and child health indicators have improved. The number of children being fully immunized is up, as is contraceptive prevalence, said Morgan. Additionally, those immediate results can lead to a slew of additional benefits down the line. For instance, improving modern contraceptive prevalence is one of the most cost-effective interventions available for reducing maternal death, she said.
In nearby Kenya, the health ministry leads a voucher system across four districts and two Nairobi slums to help some of the country’s poorest women afford maternal healthcare, family planning, and gender-based violence services.
The program is “written into large policy documents [and] strategic pieces,” including Vision 2030, a long-term government-wide strategy document “unveiled in 2008 as a way to reach middle-income country status by 2030,” said Ben Bellows, a reproductive health associate at Population Council Kenya. The government’s emphasis on the voucher program as more than just a health initiative is an acknowledgment of the downstream impact that improved maternal and reproductive health can have on the country’s development, he said.
“An Equity Gap in Family Planning”
However, the fact that the voucher program is needed at all is evidence of “an equity gap in family planning,” Bellows said. Access to family planning services can be significantly skewed depending on a woman’s income level, he said, pointing to a recent article in The Lancet assessing health inequalities in 12 different maternal and child health services across 54 priority Millennium Development Goal countries.
The equity gap reflects “an interesting problem with development,” said Bellows: Though low-income countries are converging with higher income countries, in terms of economic growth rates and income levels “the benefits of growth aren’t being evenly distributed.” The Africa Progress Panel’s annual report, released last month, echoes that point, he said.
“Governments are failing to convert the rising tide of wealth into opportunities for their most marginalized citizens,” the report concludes, and “unequal access to health, education, water and sanitation is reinforcing wider inequalities.”
Kenya’s voucher system is designed to help shrink that gap. Among the poorest of the poor – those benefitting from the system – inequalities are dropping, even if on a broader scale, inequity still exists between poor and wealthy Kenyans. “We’re seeing lower inequalities of service in areas exposed to the voucher,” said Bellows.
“RBF supports progress on a path towards universal health coverage,” said Beverly Johnston, the senior policy advisor at USAID’s Office of Population and Reproductive Health. And within the context of family planning “the whole idea is to level the playing field” so that all contraceptive methods are equally readily available to the women seeking them.
“A Catalyst for Change” in Family Planning
In addition to addressing equal access concerns, RBF programs can serve as “a catalyst for change…to stimulate quality of care and quality of family planning counseling in particular,” said Johnston.
A commonly cited hurdle to better family planning access is social norms that support large family sizes or otherwise limit a woman’s ability to space or limit her pregnancies. Given community health workers’ unique roles within their communities – “often on the front lines…where many of these social taboos and barriers exist,” as Morgan described – simply strengthening their training, and in turn improving the quality of care that women receive, can help counter norms that might otherwise prohibit access to family planning.
As more women receive higher quality care, norms dissipate even further, said Morgan. “There is evidence that [quality of care] is strongly associated with a woman’s decision to choose a method to use, to continue to use it, and to recommend it to others.”
“Rights Are Tantamount”
One trap RBF programs need to be aware of is over-incentivizing expansion of coverage to the detriment of quality or individual women’s concerns about what makes sense for them, said Johnston.
“Rights are tantamount,” she said. In order to ensure that rights are upheld, programs must reflect and be sensitive to local histories and local needs – particularly given the fact that some countries have had “a history of coercive programs and policies.”
Ultimately, “we really look at RBF as just one tool,” said Johnston. “RBF is not for every place and every context,” and neither is family planning’s place in RBF programming.
As one tool of many, RBF programs are gaining prominence as a way to meet MDGs related to maternal and child health. Bellows sees RBF’s importance lasting long past that 2015 deadline, though.
“The high inequity that we witness across many low-income countries, and the ability of targeted mechanisms [like Kenya’s voucher program] to address that, suggest that this may be a kind of generalized solution,” he said. “Obviously it will be context specific in the way in which it is rolled out, but the strategy of incentivizing clients and providers suggests that there’s some sort of globalized solution that could be considered for this widespread challenge.”
Event Resources
Photo Credit: Sean Peoples/Wilson Center. -
USAID’s New Global Health Framework and Delivering Equity in Health Interventions
›USAID’s new Global Health Strategic Framework, Better Health for Development, lays out the agency’s major health priorities for the next five years. “Core global health priorities” include reducing maternal mortality, ensuring child survival and nutrition, fostering an “AIDS free generation,” and fighting infectious diseases. Family planning and reproductive health is listed as a key area for bilateral engagement. In particular, the strategy hopes to continue to “graduate” countries from the agency’s family planning program, which since the 1980s has transitioned 21 countries into local ownership of family planning support. The strategy also takes stock of the shifting global health environment, noting the rise of the “BRICS” countries as new donors and the need to strengthen public health systems in developing countries. “Already, private payments account for 50-80 percent of total health spending in Africa and Asia, leading to system inefficiencies, inequitable access, and health costs that prove catastrophic to individuals and families,” the report reads. In order to achieve its priorities within this context, the document sets out a number of strategies, including a focus on program sustainability, the empowerment of women, and integrated approaches to development. Health, it says, “cannot be isolated from other development challenges.”Speaking of health interventions, a team of researchers led by Aluisio Barros of the Federal University of Pelotas, Brazil, recently compared coverage data from more than 50 countries against an index of household wealth to estimate the most and least equitable interventions. The study, “Equity in Maternal, Newborn, and Child Health Interventions in Countdown to 2015: A Retrospective Review of Survey Data From 54 Countries,” published in The Lancet, found that “interventions with similar levels of overall coverage often have very different degrees of inequality.” According to the data, “the most inequitable indicator was skilled birth attendant, followed by four or more antenatal care visits, whereas the most equitable was early initiation of breastfeeding.” For example, though the average for attendance by a skilled birth attendant was 53.6 percent across the entire sample, the wealthiest fifth had an 84.4 percent coverage rate and the poorest stood at 32.3 percent. “Interventions that are usually delivered in fixed health facilities…tend to be the most inequitably distributed,” write the authors, with geographical access, financial barriers, and discrimination appearing as likely obstacles for the poor. The authors conclude that, although “concern about inequalities in maternal and child health in poor countries was conspicuously absent from the global agenda in the past,” the availability of new, intervention-specific data provides a means of targeting equity issues in health delivery more successfully. -
Comparing Urban Governance and Citizen Rights in China and India
›Today, according to Xuefei Ren, 129 cities in China and 45 in India have populations of over a million people. Such large-scale urbanization has created major governance challenges. Speaking at a May 23 Asia Program event co-sponsored with the Kissinger Institute on China, United States Studies, and the Comparative Urban Studies Project, Ren, a Wilson Center Fellow, examined two case studies of urbanization-driven governance in China and India and their effect on citizen rights.
Her first case study involved housing demolitions and urban re-development in Shanghai and Mumbai. In Shanghai, nearly a million households were relocated between 1995 and 2008 to make way for hotels, airports, and luxury apartments. City regulations in 1991 and 2001 legalized forced demolitions, and no prior consent from residents was needed.
However, Ren noted that displaced residents “are not quite powerless.” She highlighted the case of a woman who sued the city government after being relocated and was eventually granted the compensation she had requested. In 2003, China’s central government ordered a freeze on large-scale demolitions. Several years later, it passed a “landmark” property rights law.
Meanwhile, in Mumbai, local officials in the early 2000s had their own re-development plans. The Indian city is rife with overcrowded, low-income housing; slums are populated by seven million citizens (40 percent of the city’s total population), and comprise up to 10 percent of Mumbai’s total land area.
In 2004, aware that most of the slums were located in desirable areas – near airports or in central business districts – city planners recognized a major development opportunity. Over the next two years, officials launched a demolition campaign that left 400,000 people homeless. According to Ren, certain categories of residents were theoretically entitled to compensation, but with “legal protections carrying little weight,” most of them received nothing.
Yet, as in Shanghai, Mumbai’s city dwellers successfully fought back. Housing activists staged acts of “direct agitation,” including a series of street protests and road blockages. Such tactics, said Ren, were “disruptive but effective.” The Mumbai courts sided against the activists in 2006, but India’s Supreme Court later issued a ruling in their favor.
Fighting Land Acquisitions: A Comparison
Ren’s second case study compared land acquisition efforts outside the slums.
Last year, residents in Wukan, a village along China’s southeast coast in the province of Guangdong, launched a protest movement against land seizures. They alleged that government officials had sold their land to developers and failed to provide residents with appropriate compensation. The protestors made two demands: the return of their land and the holding of local elections.
Notably, Ren said, protestors in Wukan affirmed their support for the Communist Party, and never framed their movement as an anti-government effort. In March 2012, local elections were in fact held, with two leaders of the protest movement voted into office (one as village chief, the other as his deputy).
Ren also discussed an attempt by India’s Tata Motors corporation to acquire land in Singur, a village about 100 miles from Calcutta in the state of West Bengal. The company wanted to use this land to construct a factory for the Nano, a small, cheap car marketed to India’s urban middle class. In 2005, the West Bengal government, which had been controlled by the Communist Party of India-Marxist (CPI-M) for nearly 30 years, actively wooed the firm. State authorities “went overboard” in offering Tata Motors subsidies and highly fertile land, said Ren. Small landowners were obliged to surrender their plots at low prices, and in 2006 the corporation formally took over the land (nearly 1,000 acres altogether), despite heavy opposition from peasants.
However, violent protests continued and after several months, Tata Motors was forced to pull out of West Bengal. Then, in a state election in May 2011, the Trinomool Congress Party, led by the populist leader Mamata Banerjee, swept the CPI-M from power. Banerjee had run her campaign on a promise to restore the land to Singur’s farmers.
Just weeks after the new government assumed power, West Bengal passed a law that would allow for about 400 acres from the Tata Motors project to be returned to farmers who had refused government compensation for their land.
Ren acknowledged that in both countries, citizenship rights are not enjoyed by all and tend to be unevenly distributed across social groups. Still, she concluded, Chinese and Indian cities “have become strategic sites for reassembling citizen rights.” By asserting their land and housing rights, city denizens “are becoming active citizens.”
Michael Kugelman is a program associate with the Wilson Center’s Asia Program. He can be reached at michael.kugelman@wilsoncenter.org and on Twitter @michaelkugelman.
Photo Credit: Mumbai pipes, courtesy of flickr user lenskap. -
Poor Land Tenure: A Key Component to Why Nations Fail
›The murder of five land rights campaigners during the last two months – one in Colombia, three in Brazil, and one in Cambodia – have not captured many headlines, but they are a reminder of the central role land tenure plays not just in rural economic development but also in sparking broadly distributed economic gains throughout a society.
-
Philippines’ Bohol Island Demonstrates Benefits of Integrated Conservation and Health Development
›In March 2012, I participated in a study tour to the island of Bohol, near the unique Danajon double barrier reef ecosystem – the only one of its kind in the Philippines and one of only three in the Indian and Pacific Oceans. Nowhere is the connection between population dynamics and biodiversity more evident than in the Philippines, one of the most densely-populated countries on the planet, with more than 300 people per square kilometer. Nearly every major species of fish in the region shows signs of overfishing, according to the World Bank.
-
Uganda’s Demographic and Health Challenges Put Into Perspective With Newfound Oil Discoveries [Part One]
›April 26, 2012 // By Kate DiamondUganda’s population is the second youngest in the world, with half of the country younger than 15.7 years old (just older than Niger’s median age of 15.5 years). In the past 10 years, the country – about half the size of France in land area – has added 10 million people, growing from 24 to 34 million. That growth, paired with other factors like poor governance and long-standing insecurity, has made providing basic services a difficult task for a government that is one of Africa’s most aid-dependent.
-
Megacities, Global Security, and the Map of the Future
›“We’re in an urban century, there is no doubt,” said Peter H. Liotta, visiting scholar at the U.S. Military Academy West Point and co-author of The Real Population Bomb: Megacities, Global Security, and the Map of the Future, during a March 20 event at the Wilson Center. Liotta’s book focuses on the geopolitical impacts of poorly managed urbanization on the most vulnerable as well as the security issues such urbanization might create. He was joined by Jaana Remes of the McKinsey Global Institute, who painted a more promising picture of a globally rising, economically prosperous urban middle class, and Stimson Center visiting fellow Peter Engelke, who grappled with the contradictions between these alternative urban realities. [Video Below]
“Urbanization is key to economic development, but it has been, is now, and will continue to be into the future beset by a very large shadow side, wherein the marginalized face grinding poverty, squalor, and despair,” explained Engelke.
Although Liotta and Remes laid out very different “maps of the future,” Engelke suggested three commonalities. First, they both highlight the “unprecedented scale and speed of global change.” Second, they acknowledge that “a global demographic shift is well underway, and has been for some time.” And third, they accept that we have yet to fully integrate cities into the physical and mental maps by which we navigate the world, he said. Despite the economic dynamism of cities, “we live in a world that, I submit, has not yet grasped this reality even in conceptual terms, much less political and policy ones.”
The City as a Source of Vulnerability
People come to megacities “because there’s a chance,” said Liotta. “It looks like a nightmare to us, but people come because they’re waiting for a future.” This chance, however, is often slim, according to Liotta.
The sheer scale of modern urbanization (approximately 200,000 people move every day from rural to urban areas) produces myriad sources of vulnerability for the poorest and most marginalized, said Liotta. “World population growth will occur in the poorest, youngest, and often heavily Muslim states, which lack education, capital, and employment. And for the first time in history the world will be primarily urbanized, with most megacities in the poor states where you don’t have policing, sanitation, and health care.”
This urban shift concentrates young populations presumed to be unstable, exacerbates the risk of disease and climate change, and increases the threat of declining resource availability and food production, Liotta said. In states where “the lights are out” – that is, where urbanization is not met with sufficient economic development – our new urban century may feature significant security challenges, he argued. “Every single security problem we have today, and in the future – whether it’s human security, environmental security, or national security – is [in] the places where the lights are out.”
In The Real Population Bomb, Liotta links these sorts of security issues to what he terms “entangled vulnerability scenarios,” such as scarcity of water for drinking and irrigation, outbreak and rapid spread of disease, or lack of sufficient warning systems for natural disasters or environmental impacts. These scenarios, he argues, deserve a greater showing next to the traditional focus on hard security “threats.”
Fertility rates are generally declining, which will eventually dissipate the youth bulges being experienced by many countries, but the challenge is how to “manage that glide path,” said Liotta. It is about “doing it well collectively, because we are not thinking collectively well about how to do this and places in the world are in serious trouble.”
The City as a Center of Growth
Jaana Remes presented both a broader scale of analysis and a more positive outlook. Urbanization is “the most powerful positive economic force in today’s environment,” she asserted, drawing on the McKinsey Global Institute report, Urban World: Mapping the Economic Power of Cities.
Compared to the historical experiences of the Western world, change in the most rapidly urbanizing of today’s developing states is occurring at “100 times the scale, in one tenth of the time,” said Remes. This change is fundamentally shifting the economic profiles of states such as India and China, which are projected to account for approximately one third of global GDP by 2050.
This growth in economic prominence can be accounted for by the rise of urban populations of middle class consumers not just in megacities, but also in the rapidly growing “middleweight” cities (from 200,000 to 10 million people) explained Remes. The path that these cities take will be “very significant for…how our world is going to look like in the next few decades,” she said. They are where “the lion’s share of global investment is going to be made.”
Engaging Global Urbanization
“That we are seeing cities rise in their profile is nothing new in history,” said Remes, “in fact you can argue that cities are actually some of the longest-lasting assets in the world.” Today, 600 urban centers generate more than 60 percent of global GDP; 400 of these are in emerging markets. So, “even though the scale of the change we expect to see is very dramatic, from the cities perspective, it is probably going to be more evolution than revolution.”
Taking advantage of this growth will require some significant global re-posturing. In terms of commercial diplomacy for instance, most nations continue to distribute their people more according to the “geopolitical power of the 20th century than the economic opportunity of the 21st,” said Remes. She points out, for example, that the city of Wuhan in China is expected to generate 10 times the GDP growth of Auckland, New Zealand, yet the number of foreign service officials stationed in each city is in the opposite proportion.
Policymakers looking to adapt should also look more closely at opportunities to re-develop existing, or “brownfield,” infrastructure. The challenge of accommodating the tremendous pace of urbanization may be great, she said, but “we have not yet seen one piece of infrastructure where you can’t make substantial improvements.”
Summing up the need to work on what he argued has been a shortfall in policy engagement, Engelke concluded that, “we are indeed quite a ways from acknowledging the enormous challenges, but also the opportunities, that global urbanization presents to us.”
Event ResourcesSources: UN Population Division.
Photo Credit: David Hawxhurst/Wilson Center.
