Showing posts from category Nepal.
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Stronger Evidence Base Needed to Demonstrate Added Value of PHE
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It is well known that public health issues that affect the world’s most vulnerable populations – food insecurity, maternal and child health, water- and sanitation-related disease, and resource scarcity – are inextricably linked. Where these linkages are strongest, experience on the ground has shown that community-based integrated approaches to development provide more effective and sustainable solutions over vertical, sector-based programs. But so far, there are very few comprehensive evaluations providing strong quantitative evidence of this advantage.
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Programmatic and Policy Recommendations for Addressing Obstetric Fistula and Uterine Prolapse
›Obstetric fistula is “not just a medical issue, but a human issue,” said Dr. Luc de Bernis, senior maternal health advisor at UNFPA, during a September 27 panel discussion at the Wilson Center. Obstetric fistula, a hole in the birth canal that can develop between the vagina and the bladder and/or rectum during prolonged labor without proper medical intervention, is preventable and treatable but continues to affect more than two million women worldwide, mostly in developing countries where women lack access to cesarean services. Women stricken with it face severe pain and suffering, social stigmatization, and usually give birth to a stillborn child.
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Russell Sticklor, Stimson Center
The Race to Harness Himalayan Hydropower
›October 11, 2012 // By Wilson Center StaffThe original version of this article, by Russell Sticklor, appeared at the Stimson Center.
Spend a day in Kathmandu, Nepal’s sprawling capital of four million people, and you’ll quickly notice what has long been a fact of life in this landlocked Himalayan country, and many other South Asian nations – no reliable electricity supply exists. Up to eight times a day, neighborhoods throughout the city suffer rolling power cuts due to load shedding, causing residents and businesses alike to either carry on in the darkness or rely on expensive, diesel-consuming generators to keep the lights on. Although the country’s civil war ended in 2006, carrying the promise of restored domestic stability and accelerated economic development, Nepal’s economy has remained hamstrung by an inconsistent energy supply, with only 40 percent of the population having access to electricity. This situation persists despite the fact that the country sits on top of a virtual goldmine – an estimated 80,000 megawatts (MW) of untapped hydroelectricity, of which it has harnessed a scant 700 MW.
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What Would It Take To Help People ‘and’ the Planet?
›February 1, 2012 // By Geoffrey D. DabelkoThe original version of this article first appeared in the “Scientist’s Soapbox” column of Momentum magazine’s special issue on “what would it take” to craft solutions to some of the Earth’s toughest challenges.
People living in the most biodiverse areas of the world tend to be poor, isolated, and dependent on natural resources. They often lack reliable access to alternative livelihoods and health services and thus can place stress on these ecologically unique regions.
Conservation efforts will merely slow habitat loss if they don’t fundamentally address the living conditions of the human residents as well as the flora and fauna. But programs to assist these communities have commonly focused on one problem at a time, reflecting the interests of the funders: Environmental groups focus on conservation, while health organizations concentrate on disease. We must ask whether investments to protect biologically rich areas are effective and sustainable if they don’t respond to the many needs of the people who live there.
But the problems faced by people in these remote areas don’t fit our traditional sectors. The way we disburse our funds, divide our bureaucracies, demarcate our disciplines, and measure success ignores the reality of intersecting needs. Such stovepiping can disrespect the communities’ scarce resources, especially their time. It can waste development aid on duplicate supplies and staff. And it can lead us to miss how the solution to one problem (e.g., providing antiretroviral drugs to treat HIV/AIDS) can be undercut by another (e.g., lacking access to safe water with which to take the pills).
So, what would it take to help particularly vulnerable populations while protecting particularly important ecological systems?
We need to strategically target our help by addressing HELP – health, environment, livelihoods, and population – through a truly integrated approach to sustainable development in these areas. Evidence suggests tackling problems concurrently can be more efficient and effective. Key donors such as the U.S. Agency for International Development are increasingly prioritizing integrated responses, providing some funding for sustainable development innovators and supporting evaluation of the results. But we need more evidence that these efforts can achieve results that match or exceed the outcomes of single-sector projects. To rigorously test this approach, more projects must be funded, implemented and analyzed, over longer periods of time and at bigger scales.
To date, some promising projects and research in diverse locations – Ethiopia, Nepal, Madagascar, Rwanda, the Philippines, and Uganda – suggest that the HELP approach offers greater benefits than traditional programs.
In the Philippines, for example, the PATH Foundation Philippines’ Integrated Population and Coastal Resource Management (IPOPCORM) program addresses pressing needs for both family planning services and sustainable environmental stewardship in densely populated coastal communities, where local fisheries have been depleted because of increased demand for food. IPOPCORM helps create marine protected areas and promotes alternative economic livelihoods such as seaweed harvesting, thus allowing critical local fish stocks to recover. Concurrently, the initiative mitigates human-induced pressures on the environment and lowers the vulnerability of this underserved population by providing voluntary family planning services. Since its launch in 2001, the IPOPCORM program’s approach has yielded measurable benefits, simultaneously reducing program costs and improving health and environmental outcomes – and outperforming compartmentalized, side-by-side sector interventions.
How can we bring HELP to biodiversity-rich communities? First, we can encourage scholars, practitioners, and policy-makers to step outside their stovepipes by producing and distributing manuals, for example, based on lessons learned from existing cross-disciplinary projects. Second, we must bridge the gap between analysis and field-based programs by developing new metrics that better assess the impact of integrated programs. Third, we must open up bureaucratic funding structures by demonstrating not only the short-term savings but also the synergies that bolster long-term sustainability.
The challenges are significant, but I see promising new opportunities for overcoming them. For example, the new Pathfinder International-led projects around Lake Victoria in Uganda and Kenya mark the entry of a respected health organization into the environmental arena and the return of a leading private funder – the MacArthur Foundation – to HELP programs. With some of Africa’s highest population densities, poverty, ethnic diversity, and biodiversity, the Great Lakes region is one of the most volatile intersections of human development and environmental change.
Through these and other community-based, integrated projects, we can truly help people and the planet at the same time.
Photo Credit: “Boy on road east of Addis,” courtesy of Geoff Dabelko/Wilson Center. -
Lessons From Peru to Nepal
Glacial Lake Outburst Floods: “The Threat From Above”
›“We have never experienced so many potentially dangerous lakes in such a short period of time,” said Alton Byers of The Mountain Institute (TMI) during a roundtable discussion on glacial melt, glacial lakes, and downstream consequences at the Wilson Center on October 26. “There have always been glacial lake outburst floods,” said Byers. What has changed is how quickly these lakes now grow. “Suddenly, you wake up in the morning, and now there are hundreds and hundreds of these lakes above you – the threat from above,” he said.
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Healthy People, Healthy Ecosystems: Results From a Public-Private Partnership
›“A lot of people probably don’t think that an organization with a name like ‘World Wildlife Fund’ would have a program on population, health, and the environment,” said WWF’s Tom Dillon at the Wilson Center, but actually it is very natural. “Most of the people we work with are in rural areas, and they depend on their natural resources for their own livelihoods and for their own well-being. Of course, if you are in that situation, in order to be a steward of the environment, you’ve got to have the basics. You have got to have your own health.”
Dillon was joined by staff from WWF, as well as Scott Radloff, director of USAID’s Office of Population and Reproductive Health, and Conrad Person, director of corporate contributions at Johnson & Johnson, to talk about the results of a three-year partnership between USAID, WWF, and Johnson & Johnson. The joint effort, a formal Global Development Alliance, provided health and family planning services, clean water, and sanitation to communities in three of WWF’s priority conservation landscapes: The Salonga National Park in the Democratic Republic of Congo (DRC), the Lamu Archipelago in Kenya, and the Terai Arch Landscape in Nepal.
By creating an innovative public-private partnership that linked health objectives, particularly related to family planning and maternal and child health, to environmental and conservation activities, “this alliance was ahead of its time,” said Radloff.
Human Health Linked to Environmental Health
The project had four objectives, said Terri Lukas, WWF’s population, health, and environment (PHE) program manager: improve family health; reduce barriers to family planning and reproductive health services; improve community management of natural resources and habitat conservation; and document and promote successful approaches.
“Human health cannot be separated from environmental health anywhere,” Lukas said, “but most especially when we are working with very poor people who live very close to nature.”
Projects Provide Integrated Services
The Salonga National Park in the DRC is home to many endangered species, including the bonobo, one of the four great apes. Local communities are very isolated, and lack access to safe drinking water and sustainable livelihoods, as well as basic health and family planning services, according to Lukas. The PHE project was able to train 135 voluntary community health workers in family planning and maternal and child health care, including 55 women. One year after the training, health workers were distributing contraception to more than 300 new users per month, Lukas said.
The alliance has also integrated health and family planning services into conservation programs in Kenya’s Kiunga Marine National Reserve, in part, “to demonstrate to the people that we care about them as well as the environment, and also to show them the synergies that exist between the health issue and the environment issue,” said WWF Program Coordinator Bahati Mburah. The region has been suffering through a year-and-a-half-long drought, and has one of the highest population growth rates in east Africa, placing considerable pressure on natural resources.
“We talk to [the fisher folk] about health and family planning, and how they are related to the management of fisheries,” said Mburah. With improved transportation and mobile outreach services provided by the project, 97 percent of women are now able to access family planning services within two hours of their home, she said.
The third site is in the Terai region along the southern border of Nepal. In this lowland region, the alliance is attempting to safeguard and restore forest areas in order to allow wildlife to move and breed more freely, while at the same time improving the health and economic prospects of the people. By linking these goals, support for conservation efforts increased from 59 percent to 94 percent of households, with 85 percent attributing positive attitude changes to increased access to health services and safe drinking water, according to Bhaskar Bhattarai, project coordinator for WWF-Nepal.
Documenting and Promoting Successful Approaches
Cara Honzak, WWF’s senior technical advisor on population, health, and environment, said the global objective of the alliance was to document and promote successful PHE approaches. Comprehensive baseline and endline surveys provided critical evidence that integrated PHE programming increases family planning use in remote areas, improves conservation buy-in within communities, and leads to increased participation of women in community leadership and decision-making.
“We have played a key role in producing some of the evidence that has been used throughout Washington [D.C.], especially to provide information to government bodies that are making decisions about bringing more money into family planning, health, and particularly in the environmental sector,” said Honzak.
“After two decades in the field, and working in this area, I wasn’t expecting many surprises. I couldn’t have been more wrong,” Lukas said. “These three years have changed almost everything about the way I now view health development…I have long called myself a conservationist, but now I say to my international health colleagues: we are all conservationists, and if we aren’t, we should be.”
Event Resources- Bhaskar Bhattarai presentation
- Cara Honzak presentation
- Terri Lukas presentation
- Bahati Mburah presentation
- Photo gallery
- Video
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Michael Kugelman for Seminar
Safeguarding South Asia’s Water Security
›November 4, 2011 // By Wilson Center StaffThe original version of this article, by Michael Kugelman, appeared in the public policy journal Seminar.
In today’s era of globalization, the line between critic and hypocrite is increasingly becoming blurred. Single out a problem in a region or country other than one’s own, and risk triggering an immediate, yet understandable, response: Why criticize the problem here, when you face the same one back home?
Such a response is particularly justified in the context of water insecurity, a dilemma that afflicts scores of countries, including the author’s United States. In the parched American West, New Mexico has only 10 years-worth of drinking water remaining, while Arizona already imports every drop. Less arid areas of the country are increasingly water-stressed as well. Rivers in South Carolina and Massachusetts, lakes in Florida and Georgia, and even the mighty Lake Superior (the world’s largest fresh-water lake) are all running dry. According to the U.S. Environmental Protection Agency, if American water consumption habits continue unchecked, as many as 36 states will face water shortages within the next few years. Also notable is the fact that America’s waterways are choked with pollution, and that nearly twenty million Americans may fall ill each year from contaminated water. Not to mention that more than thirty U.S. states are fighting with their neighbors over water.
Such a narrative is a familiar one, because it also applies to South Asia. However, in South Asia, the narrative is considerably more urgent. The region houses a quarter of the world’s population, yet contains less than five percent of its annual renewable water resources. With the exception of Bhutan and Nepal, South Asia’s per capita water availability falls below the world average. Annual water availability has plummeted by nearly 70 percent since 1950, and from around 21,000 cubic meters in the 1960s to approximately 8,000 in 2005. If such patterns continue, the region could face “widespread water scarcity” (that is, per capita water availability under 1,000 cubic meters) by 2025. Furthermore, the United Nations, based on a variety of measures – including ecological insecurity, water management problems and resource stress – characterizes two key water basins of South Asia (the Helmand and Indus) as “highly vulnerable.”
These findings are not surprising, given that the region suffers from many drivers of water insecurity: high population growth, vulnerability to climate change, arid weather, agriculture dependent economies, and political tensions. This is not to say that South Asia is devoid of water security stabilizers; indeed, its various trans-national arrangements, to differing degrees, help the region manage its water constraints and tensions. This paper argues that such arrangements are vital, yet also incapable of safeguarding regional water security on their own. It asserts that more attention to demand-side water management within individual countries is as crucial for South Asian water security as are trans-national water mechanisms.
Continue reading on Seminar.
Michael Kugelman is a program associate for the Asia Program at the Woodrow Wilson Center.
Sources: The American Prospect, Jaitly (2009), The New York Times, UNEP, UN Population Division, Washington Post.
Video Credit: “Groundwater depletion in India revealed by GRACE,” courtesy of flickr user NASA Goddard Photo and Video. For more on the visualization, see the story on NASA’s Looking at Earth. -
Weathering Change: New Film Links Climate Adaptation and Family Planning
›“Our planet is changing. Our population is growing. Each one of us is impacting the environment…but not equally. Each one of us will be affected…but not equally,” asserts the new documentary, Weathering Change, launched at the Wilson Center on September 22. The film, produced by Population Action International (PAI), explores the devastating impacts of climate change on the lives of women in developing countries through personal stories from Ethiopia, Nepal, and Peru. Family planning, argue the filmmakers, is part of the solution.
