Inter Press ServiceHealth – Inter Press Service http://www.ipsnews.net News and Views from the Global South Tue, 21 Aug 2018 16:14:52 +0000 en-US hourly 1 https://wordpress.org/?v=4.8.7 Old Age Is a Curse in Indiahttp://www.ipsnews.net/2018/08/old-age-curse-india/?utm_source=rss&utm_medium=rss&utm_campaign=old-age-curse-india http://www.ipsnews.net/2018/08/old-age-curse-india/#respond Tue, 21 Aug 2018 10:19:37 +0000 Pratima Yadav, Vani Kulkarni, and Raghav Gaiha http://www.ipsnews.net/?p=157285 The swift descent of the elderly in India into non-communicable diseases could have various disastrous consequences.

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Old age morbidity is a rapidly worsening curse in India. The swift descent of the elderly in India (60 years+) into non-communicable diseases (NCDs e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) could have disastrous consequences in terms of impoverishment of families, excess mortality, lowering of investment and consequent deceleration of growth

Credit: Neeta Lal/IPS

By Pratima Yadav, Vani S. Kulkarni, and Raghav Gaiha
NEW DELHI, Aug 21 2018 (IPS)

Old age morbidity is a rapidly worsening curse in India. The swift descent of the elderly in India (60 years+) into non-communicable diseases (NCDs e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) could have disastrous consequences in terms of impoverishment of families, excess mortality, lowering of investment and consequent deceleration of growth.

Indeed, the government has to deal simultaneously with the rising fiscal burden of NCDs and substantial burden of infectious diseases. As a recent Lancet report (2018) points out, failure to devise a strategy and make timely investment now will jeopardise achievement of SDG 3 and target 4 of a one-third reduction in premature mortality from NCDs by 2030.

NCDs are chronic in nature and take a long time to develop. They are linked to ageing and affluence, and have replaced infectious diseases and malnutrition as the dominant causes of ill health and death in much of the world including India. The four NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) share a set of modifiable risk factors: unhealthy diet, physical inactivity, smoking, excessive use of alcohol and failure to detect and control intermediate risk factors such as high blood pressure, high cholesterol, high blood sugar and excess weight (Bloom et al. 2014).

Of the 56 million deaths worldwide each year, 38 million (68%) are due to non-communicable diseases (NCDs), and 16 million (more than 40%) of these deaths are premature (before 70 years of age).

The burden of NCDs rose sharply among the old. It doubled among 61-70 years and 71-80 years and nearly tripled among 80 + years. In sharp contrast, prevalence of communicable diseases also rose but only slightly

The four NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) account for 42% of all deaths in India. These diseases contribute to 22% of disability-adjusted life-years in India (or DALYs—the combination of years lived with serious illness and those lost due to premature death). So the cost in terms of lives lost is horrendous.

Our analysis with National Sample Survey (NSS) data for 2004 and 2014 highlights some of these concerns in a striking way.

The burden of NCDs rose sharply among the old. It doubled among 61-70 years and 71-80 years and nearly tripled among 80 + years. In sharp contrast, prevalence of communicable diseases also rose but only slightly. So there are strong grounds for an epidemiological transition away from communicable diseases to non-communicable diseases among the old that require longer-term and more expensive solutions.

Between rural and urban areas, the latter had higher prevalence of NCDs and the disparity grew. This gap is largely attributable to greater dependence on processed food, and environmental pollution.

Comparison by gender yields an interesting reversal. In 2004, aged women had higher prevalence of NCDs than aged men, but there was a reversal in 2014. Part of the explanation lies in difference in health-seeking behaviour, with women more restricted in their access to medical care.

Highest prevalence of NCDs was observed among the widowed, followed by the divorced/separated and lowest among never married. Each of these groups recorded higher prevalence except never married who recorded a decline. Ostracised by society, widows often seek solace in slow death.

Does education make a difference? It does. Among the illiterates and those below primary, the prevalence rose while in all other categories of education it declined. The decline was sharpest among the graduates, followed by those with middle to higher secondary education.

NCDs are often associated with affluence and associated sedentary lifestyle and diets rich in carbohydrates and fats. So we examined the association between per capita income quintiles and NCDs. One striking feature is that both in 2004 and 2014, prevalence rose steadily across these quintiles except in the lowest/least affluent. Besides, prevalence rose more than moderately among the more affluent fourth and fifth quintiles. So the characterisation of NCDs as diseases of affluence is accurate.

Typically, socio-economic hierarchy comprises: the most disadvantaged STs, followed by SCs, OBCs and Others. Prevalence of NCDs was lowest among the STs, higher among the SCs, still higher among the OBCs and highest among the Others in 2004. This pattern remained unchanged in 2014. While the STs experienced a slight reduction, all other groups recorded increases in prevalence of NCDs—especially OBCs and Others.

While the recent National Health Policy 2017 and Niti Aayog have ambitious agenda for curtailing premature death and morbidity due to NCDs, the measly increase in this year’s budget is ironical. Indeed, the neglect of NCDs is worse than tragic given the prediction that cumulative losses in output between 2012 and 2030 due to NCDs may be as high as one-and-a half times of India’s GDP.

 

Pratima Yadav is an independent researcher; Vani S. Kulkarni is Lecturer in Sociology, University of Pennsylvania; and Raghav Gaiha is (Hon.) Professorial Research Fellow, Global Development Institute, University of Manchester, and Visiting Scholar, Centre for Population Studies, University of Pennsylvania.

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Excerpt:

The swift descent of the elderly in India into non-communicable diseases could have various disastrous consequences.

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Take Charge of Your Food: Your Health is Your Businesshttp://www.ipsnews.net/2018/08/take-charge-of-your-food-your-health-is-your-business/?utm_source=rss&utm_medium=rss&utm_campaign=take-charge-of-your-food-your-health-is-your-business http://www.ipsnews.net/2018/08/take-charge-of-your-food-your-health-is-your-business/#respond Fri, 17 Aug 2018 10:22:03 +0000 Sunita Narain http://www.ipsnews.net/?p=157235 Sunita Narain is Director-General of the Centre for Science and Environment (CSE) & Editor of Down to Earth magazine in New Delhi

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Credit: IPS

By Sunita Narain
NEW DELHI, Aug 17 2018 (IPS)

The minimum we expect from the government is to differentiate between right and wrong. But when it comes to regulating our food, it’s like asking for too much. Our latest investigation vouches for this. The Centre for Science and Environment (CSE)’s pollution monitoring laboratory tested 65 samples of processed food for presence of genetically modified (GM) ingredients.

The results are both bad and somewhat good. Of the food samples tested, some 32 per cent were positive for GM markers. That’s bad. What’s even worse is that we found GM in infant food, which is sold by US pharma firm, Abbott Laboratories, for toddlers with ailments; in one case it was for lactose intolerant infants and the other hypoallergenic—for minimising possibility of allergic reaction.

Sunita Narain. Credit: Center for Science and Education

Sunita Narain. Credit: Center for Science and Education

In both cases, there was no warning label on GM ingredients. One of the health concerns of GM food is that it could lead to allergic reactions. In 2008 (updated in 2012), the Indian Council of Medical Research issued guidelines for determining safety of such food, as it cautioned that “there is a possibility of introducing unintended changes, along with intended changes which may in turn have an impact on the nutritional status or health of the consumer”.

This is why Australia, Brazil, the European Union and others regulate GM in food. People are concerned about the possible toxicity of eating this food. They want to err on the side of caution. Governments ensure they have the right to choose.

The partial good news is that majority of the food that tested GM positive was imported. India is still more or less GM-free. The one food that did test positive is cottonseed edible oil. This is because Bt-cotton is the only GM crop that has been allowed for cultivation in India.

This should worry us. First, no permission has ever been given for the use of GM cottonseed oil for human consumption. Second, cottonseed oil is also mixed in other edible oils, particularly in vanaspati.

Under whose watch is GM food being imported? The law is clear on this. The Environment Protection Act strictly prohibits import, export, transport, manufacture, process, use or sale of any genetically engineered organisms except with the approval of the Genetic Engineering Approval Committee (GEAC) under the Ministry of Environment, Forests and Climate Change.

In fact, they will say, there is no GM food in India. But that’s the hypocrisy of our regulators–make a law, but then don’t enforce it. On paper it exists; we are told, don’t worry. But worry we must.

The 2006 Food Safety and Standards Act (FSSA) reiterates this and puts the Food Safety and Standards Authority of India (FSSAI) in charge of regulating use. The Legal Metrology (Packaged Commodities) Rules 2011 mandate that GM must be declared on the food package and the Foreign Trade (Development and Regulation) Act 1992 says that GM food cannot be imported without the permission of GEAC. The importer is liable to be prosecuted under the Act for violation.

Laws are not the problem, but the regulatory agencies are. Till 2016, GEAC was in charge–the FSSAI said it did not have the capacity to regulate this food. Now the ball is back in FSSAI’s court. They will all tell you that no permission has been given to import GM food.

In fact, they will say, there is no GM food in India. But that’s the hypocrisy of our regulators–make a law, but then don’t enforce it. On paper it exists; we are told, don’t worry. But worry we must.

So, everything we found is illegal with respect to GM ingredients. The law is clear about this. Our regulators are clueless. So, worry. Get angry. It’s your food. It’s about your health.

What next? In 2018, FSSAI has issued a draft notification on labelling, which includes genetically modified food. It says that any food that has total GM ingredients 5 per cent or more should be labelled and that this GM ingredient shall be the top three ingredients in terms of percentage in the product.

But there is no way that government can quantify the percentage of GM ingredients in the food—this next level of tests is prohibitively expensive. We barely have the facilities. So, it is a clean chit to companies to “self-declare”. They can say what they want. And get away.

The same FSSAI has issued another notification (not draft anymore) on organic food. In this case, it says that it will have to be mandatorily “certified” that it does not contain residues of insecticides. So, what is good needs to be certified that it is safe.

What is bad, gets a clean bill of health. Am I wrong in asking: whose interests are being protected? So, take charge of your food. Your health is your business.

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Excerpt:

Sunita Narain is Director-General of the Centre for Science and Environment (CSE) & Editor of Down to Earth magazine in New Delhi

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Joint Action Needed to Reform our Food Systemhttp://www.ipsnews.net/2018/08/joint-action-needed-reform-food-system/?utm_source=rss&utm_medium=rss&utm_campaign=joint-action-needed-reform-food-system http://www.ipsnews.net/2018/08/joint-action-needed-reform-food-system/#respond Wed, 15 Aug 2018 11:57:08 +0000 Carol Gribnau http://www.ipsnews.net/?p=157220 Carol Gribnau is director of the Hivos global Green Energy and Green Food programs

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Smallholder coffee farmers. Credit: SAFE Platform

By Carol Gribnau
Aug 15 2018 (IPS)

While participating in this year’s High-level Political Forum (HLPF), one thing became crystal clear to me. Come 2030, we will not have healthy and affordable food if we continue with business as usual. But no one institution can single handedly change the course of our food system. The key to ensuring a sustainable food system is involving a diverse group of actors – from smallholder farmers to government – to generate ideas for change, together.

 

Save our coffee

Look at the coffee sector. Everybody loves their cup of coffee, but will we still be able to drink it in the future? Our recently launched 2018 Coffee Barometer, which measures the sector’s sustainability, finds that coffee has a global retail value of USD 200 billion, but less than 10 percent of it stays in producing countries. Without increased investments in sustainable coffee production and a living wage for the 25 million smallholder farmers who produce that coffee, our future supply is at risk.

This is why Hivos works in multi-stakeholder partnerships in Latin America (the SAFE Platform) and East Africa (the 4s@scale program) which together – through targeted support to both male and female farmers – have already benefited over 200,000 coffee farmers.

Carol Gribnau

Carol Gribnau

How multi-stakeholder collaboration works

Everyone recognizes the need for multi-stakeholder collaboration, but it’s good to understand exactly what we’re talking about. Connecting multiple stakeholders with various interested parties within a food system allows us to look at the challenges from a whole new perspective and address them in a way we never could if everyone worked independently to solve a problem. This sort of collaboration works best with:

Tailor-made approaches

There’s not one food system but multiple, very context-specific food systems. This requires a tailored approach for each scenario, where different actors work together to gain a deep understanding of local circumstances before designing solutions. The “Lab” approach, which Hivos applies in several countries, allows for exactly that and helps the actors move from global to national and local platforms. Given the complexity of food systems, local platforms are likely to be the most effective.

 

The right people at the table

The transformation towards sustainable food systems requires involving key actors, especially those whose voices are rarely heard in policy making: small-scale producers, (low-income) consumers and women. Making their food system visible to policymakers is crucial to ensure that policy and local realities are on the same page and power imbalances are addressed. Multi-stakeholder platforms that do not truly involve these key actors are not well designed. The choices of the convener who brings everyone to the table are critical.

One Plan for One Planet

Engaging multiple actors to transform the food system was in fact a hot topic from 9 to 17 July at the HLPF. It was a significant event for us to showcase our work on SDG 12 (“Ensure sustainable consumption and production patterns”). Together with the World Wildlife Fund and the governments of Switzerland and South Africa, Hivos co-leads the Sustainable Food Systems (SFS) program, one of the six programs within the One Planet Network, the official multi-stakeholder network putting SDG 12 into action.

 

 

Changing the food system in Zambia

Hivos promotes local multi-actor platforms – so called Food Change Labs – in several countries through our Sustainable Diets for All program. I presented one of these at the HLPF as a concrete example of using multi-stakeholder partnerships to support implementation on the ground.

The Zambia Food Change Lab brings together low-income consumers, traders, traditional leaders, producers, and government authorities, among others, to address the limited crop diversity on Zambian farms and in local diets. It’s a facilitated, safe space for them to build a collective understanding of Zambia’s current food system, generate ideas for change, and test these innovations on the ground. It fosters long-term engagement, collective leadership, and joint initiatives. When they work together, the impact is far-reaching and long-lasting. Outcomes such as strengthened capacities, networks and trust between actors have the potential to positively influence the system for many years to come.

 

 

Food Lab campaign for food diversity in Zambia. Credit: Hivos - Joint action needed to reform our food system

Food Lab campaign for food diversity in Zambia. Credit: Hivos

 

Call to action

On our last day at HLPF 2018, Hivos Director Edwin Huizing called on national governments to speed up their transitions, the private sector to bring a business case for a more solid, sustainable, and inclusive food system, and civil society organizations to build bridges with local communities and showcase best practices. Securing the active participation of Southern actors is particularly vital.

 

This opinion piece was originally published here

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Excerpt:

Carol Gribnau is director of the Hivos global Green Energy and Green Food programs

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Let Food Be Thy Medicinehttp://www.ipsnews.net/2018/08/let-food-thy-medicine/?utm_source=rss&utm_medium=rss&utm_campaign=let-food-thy-medicine http://www.ipsnews.net/2018/08/let-food-thy-medicine/#respond Tue, 14 Aug 2018 10:10:59 +0000 Adelheid Onyango and Bibi Giyose http://www.ipsnews.net/?p=157204 Adelheid Onyango is Adviser for Nutrition at the World Health Organization’s Regional Office for Africa and Bibi Giyose is Senior Nutrition and Food Systems officer, and Special Advisor to the CEO of the New Partnership for Africa’s Development (NEPAD).

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Health is more than the absence of disease: adequate nutrition is a critical part of the equation

Typical food store in Brazzaville, Congo. Credit: WHO

By Adelheid Onyango and Bibi Giyose
BRAZZAVILLE, Congo, Aug 14 2018 (IPS)

When faced with a crisis, our natural reaction is to deal with its immediate threats. Ateka* came to the make-shift clinic with profuse diarrhoea: they diagnosed cholera. The urgent concern in the midst of that humanitarian crisis was to treat the infection and send her home as quickly as possible. But she came back to the treatment centre a few days later – not for cholera, but because she was suffering from severe acute malnutrition. Doctors had saved her life but not restored her health. And there were others too, who like Ateka eventually succumbed to severe malnutrition.  

This scene could have taken place in any of the dozen or so African countries that have suffered a cholera outbreak this year alone. Experience from managing epidemics has shown that when the population’s baseline nutritional status is poor, the loss of life is high.

Beyond malnutrition’s damaging impact on bodily health, it weakens the immune system, reducing the body’s resistance to infection and resilience in illness.

Most of the diseases that entail catastrophic costs to individuals, households and national healthcare systems in Africa could be avoided if everyone was living actively and consuming adequate, diverse, safe and nutritious food. After all, a healthy diet not only allows us to grow, develop and prosper, it also protects against obesity, diabetes, raised blood pressure, cardiovascular disease and some cancers.

On the flipside, integrating the treatment of malnutrition in the response to humanitarian crises assures survival and recovery better than an exclusive focus on treating diseases.

As countries across the continent commit themselves to Universal Health Coverage (UHC), the same lessons need to apply. UHC is ultimately about achieving health and wellbeing for all by 2030, a goal that is inextricably linked with that of ending hunger and all forms of malnutrition.

With 11 million Africans falling into poverty every year due to catastrophic out-of-pocket payments for healthcare, no one can question the need to ensure that everyone, everywhere, can obtain the health services they need, when and where they need them, without facing financial hardship.

As wealth patterns and consumption habits change, the African region is now faced with the triple burden of malnutrition – undernutrition coupled with micronutrient deficiencies and increasing levels of obesity and diet-related non-communicable diseases.

In 2016, an estimated 59 million children in Africa were stunted (a 17 percent increase since 2000) and 14 million suffered from wasting – a strong predictor of death among children under five. That same year, 10 million were overweight; almost double the figure from 2000. It’s estimated that by 2020, non-communicable diseases will cause around 3.9 million deaths annually in the African region alone.

Yet most of the diseases that entail catastrophic costs to individuals, households and national healthcare systems in Africa could be avoided if everyone was living actively and consuming adequate, diverse, safe and nutritious food. After all, a healthy diet not only allows us to grow, develop and prosper, it also protects against obesity, diabetes, raised blood pressure, cardiovascular disease and some cancers.

To tackle malnutrition, achieve UHC and ultimately reach the goal of health and wellbeing for all, governments need to put in place the right investments, policies and incentives.

As a starting point, governments need to assure the basic necessities of food security, clean water and improved sanitation to prevent and reduce undernutrition among poor rural communities and urban slum populations in Africa. For example, reduction in open defecation has been successful in reducing undernutrition in Ethiopia, parts of the Democratic Republic of Congo, Mali and Tanzania.

Then, to influence what people eat, we need to do a better job at improving food environments and at educating them about what constitutes a healthy diet. Hippocrates asserted that “all disease begins in the gut,” with the related counsel to “let food be thy medicine.”

Current research on chronic diseases is reasserting the health benefits of consuming minimally-processed staple foods which formed the basis of traditional African diets. This information needs to be communicated to the public through the health and education sectors and complemented by agricultural innovation to increase production of the nutrient-rich grains, crickets, herbs, roots, fruits and vegetables that were the medicine for longevity among our hardy ancestors.

But until that awareness is in place, policies and programmes are urgently needed to protect and promote healthy diets right from birth. This includes regulating the marketing of breast milk substitutes and foods that help establish unhealthy food preferences and eating habits from early childhood.

In South Africa, for example, the country with the highest obesity rate in Sub-Saharan Africa, the government has introduced a ‘sugar tax’ that is expected to increase the price of sugary soft drinks. The hope is that this will encourage consumers to make healthier choices and manufacturers to reduce the amount of sugar in their products.

Finally, governments must create incentives – and apply adequately dissuasive sanctions when necessary – to help food manufacturers collaborate in promoting healthy diets through reformulation and informative labelling, for example. In cases of food contamination, we are very quick to take products off the shelves. Yet we are much slower to react to the illnesses caused by processed foods containing high quantities of salt, sugars, saturated fats and trans fats.

A shortcut to achieving Universal Health Coverage is to reduce the need for costly treatments. And there is no better way to do that than to ensure that everyone, everywhere, preserves their health and has access to safe and nutritious food: let food be thy medicine.

*name has been changed

 

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Excerpt:

Adelheid Onyango is Adviser for Nutrition at the World Health Organization’s Regional Office for Africa and Bibi Giyose is Senior Nutrition and Food Systems officer, and Special Advisor to the CEO of the New Partnership for Africa’s Development (NEPAD).

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Children and Women with Disabilities, More Likely to Face Discriminationhttp://www.ipsnews.net/2018/08/children-women-disabilities-likely-face-discrimination/?utm_source=rss&utm_medium=rss&utm_campaign=children-women-disabilities-likely-face-discrimination http://www.ipsnews.net/2018/08/children-women-disabilities-likely-face-discrimination/#comments Mon, 13 Aug 2018 06:46:05 +0000 Carmen Arroyo and Emily Thampoe http://www.ipsnews.net/?p=157190 This article is part of a series of stories on Disability inclusion.

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Women with disabilities in Afghanistan protest for their rights. Credit: Ashfaq Yusufzai/IPS.

By Carmen Arroyo and Emily Thampoe
UNITED NATIONS, Aug 13 2018 (IPS)

Children with disabilities are up to four times more likely to experience violence, with girls being the most at risk, according to the United Nations Children’s Fund.

“Children with disabilities are among the most marginalised groups in society. If society continues to see the disability before it sees the child, the risk of exclusion and discrimination remains,” Georgina Thompson, a media consultant for UNICEF, told IPS.

According to the World Health Organisation, 15 percent of the global population lives with disabilities, making it the largest minority in the world—with children and women numbering higher among those disabled.

Last month, more than 700 representatives of non-governmental organisations, private companies and governments got together to address the systemic discrimination that exists against people with disabilities at the Global Disability Summit in London.

“Creating a more equal world where children with disabilities have access to the same opportunities as all children is everyone’s responsibility,” Thompson said.

More than 300 organisations and governments signed an action plan to implement the U.N. International Convention on Disability, which included 170 commitments from multiple stakeholders to ensure disability inclusion. The summit was organised by the governments of Kenya and the United Kingdom, along with the International Disability Alliance. The most important topics discussed during the meetings included passing laws to protect disabled citizens and promoting access to technology for people with disabilities.

Women and children face the most discrimination within the disabled community. A report presented to the U.N. Secretary-General on the situation of women and girls with disabilities stated that while 12 percent of men present a disability, a slightly higher amount of women—19 percent—have a disability.

In addition, girls are much less likely to finish primary school than boys, if both present disabilities. And girls are more vulnerable to sexual violence.

According to the U.K.’s Department for International Development, mortality for children with disabilities can be as high as 80 percent in states where child mortality has significantly decreased.

There is a strong consensus regarding the risk that both children and women face. “Women with disabilities are especially vulnerable to discrimination and violence (three to five times more likely to suffer from violence and abuse that the average [female] population),” André Félix, external communications officer at the European Disability Forum, told IPS.

When asked what to do to address this issue, A.H. Monjurul Jabir, co-lead of the U.N. Women’s Global Task Team on Disability and Inclusion, explained his viewpoint on establishing a targeted gender agenda: “The implementation of strategy requires a bottom-up approach by offices, colleagues, and partners on the ground.”

According to Jabir, U.N. Women’s strategy is “to support U.N. Women personnel and key stakeholders to facilitate the full inclusion and meaningful participation of women and girls with disabilities.”

“This would be done across all U.N. Women’s priority areas through our operational responses and internal accessibility to achieve gender equality and empowerment of all women and girls with disabilities,” he said.

Thompson suggested the following strategy for UNICEF: “We must increase investment in the development and production of assistive technologies. Assistive technologies, such as hearing aids, wheelchairs, prosthetics, and glasses, give children with disabilities the chance to see themselves as able from an early age.”

The aforementioned strategy was one of the goals of the Global Partnership for Assistive Technology, a collaboration launched during the summit to accomplish the sustainable development goals and offer technology to those who with disabilities. “And yet, in low-income countries, only five to 15 percent of those who need assistive technology can obtain it,” Thomson added.

And, as 80 percent of the population with disabilities live in developing countries, emergency situations and lack of education are also crucial issues to be addressed when launching policies for disability inclusion.

“We must make humanitarian response inclusive. In emergency situations, children with disabilities face a double disadvantage. They face the same dangers as all children in conflicts or natural disasters do, including threats to their health and safety, malnutrition, displacement, loss of education and risk of abuse.

“But they also face unique challenges, including lack of mobility because of damaged infrastructure, difficulty fleeing harm and the prejudices that keep them from accessing the urgent assistance they need,” Thompson said.

According to the U.N. Educational, Scientific and Cultural Organisation, 90 percent of children who live in developing countries that have educational opportunities available do not attend school.

“We must make education inclusive. Around half of all children with disabilities do not go to school because of prejudice, stigma or lack of accessible learning. Of those who do go to school, about half do not receive quality education because of a lack of trained teachers, accessible facilities, or specialised learning tools,” Thompson urged. “Excluding children with disabilities from education can cost a country up to five percent of its GDP due to lost potential income.”

But, who is responsible?

As was seen during the summit, member states are not the only stakeholders taking responsibility for disability inclusion. U.N. agencies, NGOs, and private firms are constantly launching programmes to reduce the gap and erase discrimination.

However, Félix explained what each stakeholder would be responsible for: “Member States are the policymakers. They need to guarantee that all the population is included and benefits from international development and inclusive policies. They also need to make sure that they consult civil society in the process.”

As for civil society, he said: “Civil society’s role is to monitor and advise the project and while they need to be included and part of international development (especially local civil society), the resources should come from member states.”

Thus, their work is intrinsically linked: “Structures of support for persons with disability must be community-based, which means no support for institutions that segregate persons with disabilities.”

Thompson added that those actors must work so closely that it would be hard to separate roles.

Agreeing with her, Jabir concluded: “It is the responsibility of everyone, all actors and stakeholders, we must work together, cohesively, not separately. The days of only standalone approach, or silo mentality is over.”

The post Children and Women with Disabilities, More Likely to Face Discrimination appeared first on Inter Press Service.

Excerpt:

This article is part of a series of stories on Disability inclusion.

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How the Lack of Affordable Vegetables is Creating a Billion-Dollar Obesity Epidemic in South Africahttp://www.ipsnews.net/2018/08/lack-affordable-vegetables-creating-billion-dollar-obesity-epidemic-south-africa/?utm_source=rss&utm_medium=rss&utm_campaign=lack-affordable-vegetables-creating-billion-dollar-obesity-epidemic-south-africa http://www.ipsnews.net/2018/08/lack-affordable-vegetables-creating-billion-dollar-obesity-epidemic-south-africa/#respond Fri, 10 Aug 2018 10:51:04 +0000 Nalisha Adams http://www.ipsnews.net/?p=157170 Every Sunday afternoon, Thembi Majola* cooks a meal of chicken and rice for her mother and herself in their home in Alexandra, an informal settlement adjacent to South Africa’s wealthy economic hub, Sandton. “Vegetables is only on Sunday,” Majola tells IPS, adding that these constitute potatoes, sweet potato and pumpkin. Majola, who says she weighs […]

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The number of young South Africans suffering from obesity doubled in the last six years, while it had taken the United States 13 years for this to happen.

Fruit and vegetable prices in South Africa have increased to the point that poorer people have had to remove them from their grocery lists. Credit: Nalisha Adams/IPS

By Nalisha Adams
JOHANNESBURG, Aug 10 2018 (IPS)

Every Sunday afternoon, Thembi Majola* cooks a meal of chicken and rice for her mother and herself in their home in Alexandra, an informal settlement adjacent to South Africa’s wealthy economic hub, Sandton.

“Vegetables is only on Sunday,” Majola tells IPS, adding that these constitute potatoes, sweet potato and pumpkin. Majola, who says she weighs 141 kgs, has trouble walking short distances as it generally leaves her out of breath. And she has been on medication for high blood pressure for almost two decades now.“It is precisely a justice issue because at the very least our economy should be able to provide access to sufficient and nutritious food. Because, at the basis of our whole humanity, at the very basis of our body, is our nutrition." -- Mervyn Abrahams, Pietermaritzburg Economic Justice and Dignity Group

“Maize is a first priority,” she says of the staple item that always goes into her shopping basket. “Every Saturday I eat boerewors [South African sausage]. And on Sunday it is chicken and rice. During the week, I eat mincemeat once and then most of the time I fill up my stomach with [instant] cup a soup,” she says of her diet.

Majola is one of about 68 percent of South African women who are overweight or obese, according to the South African Demographic and Health Survey. The Barilla Centre for Food and Nutrition’s Food Sustainability Index (FSI) 2017 ranks 34 countries across three pillars: sustainable agriculture; nutritional challenges; and food loss and waste.  South Africa ranks in the third quartile of the index in 19th place. However, the country has a score of 51 on its ability to address nutritional challenges. The higher the score, the greater the progress the country has made. South Africa’s score is lower than a number of countries on the index.

Families go into debt to pay for basic foods

Many South Africans are eating a similar diet to Majola’s not out of choice, but because of affordability.

Dr. Kirthee Pillay, lecturer of dietetics and human nutrition at the University of KwaZulu-Natal, tells IPS that the increase of carbohydrate-based foods as a staple in most people’s diets is cost-related.

“Fruit and vegetable prices have increased to the point that poorer people have had to remove them from their grocery lists.”

The Pietermaritzburg Agency for Community Social Action (Pacsa), a social justice non-governmental organisation, noted last October in its annual food barometer report that while the median wage for black South Africans is USD209 a month, a monthly food basket that is nutritionally complete costs USD297.

The report also noted that food expenditure from households arise out of the monies left over after non-negotiable expenses, such as transport, electricity, debt and education needs have been paid first. And this resulted in many families incurring debt in order to meet their food bills.

“Staples are cheaper and more filling and people depend on these, especially when there is less money available for food and many people to feed. Fruit and vegetables are becoming luxury food items for many people given the increasing cost of food. Thus, the high dependence on cheaper, filling staples. However, an excessive intake of carbohydrate-rich foods can increase risk for obesity,” Pillay tells IPS via email.

Majola works at a national supermarket chain, with her only dependent being her elderly mother. She says her grocery bill comes to about USD190 each month, higher than what most average families can afford, but agrees that the current cost of fruit and vegetables are a luxury item for her.

“They are a bit expensive now. Maybe they can sell them at a lesser price,” she says, adding that if she could afford it, she would have vegetables everyday. “Everything comes from the pocket.”

Monopoly of Food Chain Creating a System that Makes People Ill

David Sanders, emeritus professor at the school of public health at the University of the Western Cape, says that South Africans have a very high burden of ill health, much of which is related to their diet.

But he adds that large corporates dominate every node of the food chain in the country, starting from inputs and production, all the way to processing, manufacturing and retail. “So it is monopolised all the way up the food system from the farm to the fork.”

“The food system is creating, for poor people anyway, a quite unhealthy food environment. So for well-off people there is sufficient choice and people can afford a nutritionally-adequate diet, even one of quite high quality.

“But poor people can’t. In most cases, the great majority, don’t have a kind of subsistence farming to fall back on because of land policies and the fact that in the 24 years of democracy there hasn’t been significant development of small scale farming,” Sanders, who is one of the authors of a report on food systems in Brazil, South Africa and Mexico, tells IPS.

According to the report, about 35,000 medium and large commercial farmers produce most of South Africa’s food.

In addition, Sanders points out that a vast majority of rural South Africans purchase, rather than grow, their own food.

“The food they can afford tends to be largely what we call ultra processed or processed food. That often provides sufficient calories but not enough nutrients. It tends to be quite low often in good-quality proteins and low in vitamins and minerals – what we call hyper nutrients.

“So the latter situation results in quite a lot of people becoming overweight and obese. And yet they are poorly nourished,” Sanders explains.

The Sugar Tax Not Enough to Stem Epidemic of Obesity

In April, South Africa introduced the Sugary Beverages Levy, which charges manufacturers 2.1 cents per gram of sugar content that exceeds 4g per 100 ml. The levy is part of the country’s department of health’s efforts to reduce obesity.

Pillay says while it is still too early to tell if the tax will be effective, in her opinion “customers will fork out the extra money being charged for sugar-sweetened beverages. Only the very poor may decide to stop buying them because of cost.”

Sander’s points out “it’s not just the level of obesity, it is the rate at which this has developed that is so alarming.”

A study shows that the number of young South Africans suffering from obesity doubled in the last six years, while it had taken the United States 13 years for this to happen.

“Here is an epidemic of nutrition, diet-related diseases, which has unfolded extremely rapidly and is just as big and as threatening and expensive as the HIV epidemic, and yet it is going largely unnoticed.”

Overweight people have a risk of high blood pressure, diabetes and hypertension, which places them at risk for heart disease. One of South Africa’s largest medical aid schemes estimated in a report that the economic impact on the country was USD50 billion a year.

“Even if people knew what they should eat there is very very little room for manoeuvre. There is some, but not much,” Sanders says adding that people should rather opt to drink water rather than purchase sugary beverages.

“Education and awareness is a factor but I would say that these big economic drivers are much more important.”

Sanders says that questions need to be asked about how the control of the country’s food system and food chain can “be shifted towards smaller and more diverse production and manufacture and distributions.”

“Those are really the big questions. It would require very targeted and strong policies on the part of government. That would be everything from preferentially financing small operators [producers, manufacturers and retailers]…at every level there would have to be incentives, not just financial, but training and support also,” he says.

Pillay agrees that the increase in food prices “needs to be addressed as it directly influences what people are able to buy and eat. … Sustainable agriculture should assist in reducing the prices of locally-grown fruit and vegetables and to make them more available to South African consumers.”

Mervyn Abrahams, one of the authors of the Pacsa report, now a programme coordinator at the Pietermaritzburg Economic Justice and Dignity Group, tells IPS that the organisation is campaigning for a living wage that should be able to provide households with a basic and sufficient nutrition in their food basket. The matter, he says, is one of economic justice.

“It is precisely a justice issue because at the very least our economy should be able to provide access to sufficient and nutritious food. Because, at the basis of our whole humanity, at the very basis of our body, is our nutrition. And so it is the most basic level by which we believe that the economy should be judged, to see whether there is equity and justice in our economic arena.”

*Not her real name.

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States Must Act Now to Protect Indigenous Peoples During Migrationhttp://www.ipsnews.net/2018/08/states-must-act-now-protect-indigenous-peoples-migration/?utm_source=rss&utm_medium=rss&utm_campaign=states-must-act-now-protect-indigenous-peoples-migration http://www.ipsnews.net/2018/08/states-must-act-now-protect-indigenous-peoples-migration/#respond Wed, 08 Aug 2018 19:13:13 +0000 UN experts on Indigenous Peoples http://www.ipsnews.net/?p=157142 States around the world must take effective action to guarantee the human rights of indigenous peoples, says a group of UN experts. In a joint statement marking International day of the World’s Indigenous Peoples, the experts say it is crucial that the rights of indigenous peoples are realised when they migrate or are displaced from […]

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Indigenous men and women of Nuñoa in Puno, Peru, spin and weave garments based on the fiber of the alpacas. Credit: SGP-GEF-UNDP Peru/Enrique Castro-Mendívil

By UN experts* on Indigenous Peoples
GENEVA/NEW YORK, Aug 8 2018 (IPS)

States around the world must take effective action to guarantee the human rights of indigenous peoples, says a group of UN experts. In a joint statement marking International day of the World’s Indigenous Peoples, the experts say it is crucial that the rights of indigenous peoples are realised when they migrate or are displaced from their lands:

“In many parts of the world, indigenous peoples have become migrants because they are fleeing economic deprivation, forced displacement, environmental disasters including climate change impacts, social and political unrest, and militarisation. Indigenous peoples have shown remarkable resilience and determination in these extreme situations.

We wish to remind States that all indigenous peoples, whether they migrate or remain, have rights under international instruments, including the UN Declaration on the Rights of Indigenous Peoples.

While States have the sovereign prerogative to manage their borders, they must also recognise international human rights standards and ensure that migrants are not subjected to violence, discrimination, or other treatment that would violate their rights. In addition, states must recognise indigenous peoples’ rights to self-determination; lands, territories and resources; to a nationality, as well as rights of family, education, health, culture and language.

The Declaration specifically provides that States must ensure indigenous peoples’ rights across international borders that may currently divide their traditional territories.

Within countries, government and industry initiatives, including national development, infrastructure, agro-business, natural resource extraction and climate change mitigation, or other matters that affect indigenous peoples, must be undertaken with the free, prior, and informed consent of indigenous peoples, such that they are not made to relocate against their will. States must recognise that relocation of indigenous peoples similarly triggers requirements including free, prior and informed consent, as well as restitution and compensation under the Declaration.

We are concerned about human rights violations in the detention, prosecution and deportation practices of States. There is also a dearth of appropriate data on indigenous peoples who are migrants. As a result of this invisibility, those detained at international borders are often denied access to due process, including interpretation and other services that are essential for fair representation in legal processes.

We call on States immediately to reunite children, parents and caregivers who may have been separated in border detentions or deportations.

In addition, States must ensure that indigenous peoples migrating from their territories, including from rural to urban areas within their countries, are guaranteed rights to their identity and adequate living standards, as well as necessary and culturally appropriate social services.

States must also ensure that differences among provincial or municipal jurisdictions do not create conditions of inequality, deprivation and discrimination among indigenous peoples.

We express particular concern about indigenous women and children who are exposed to human and drug trafficking, and sexual violence, and indigenous persons with disabilities who are denied accessibility services.

We look forward to engagement in the implementation of the Global Compact for Safe, Orderly, and Regular Migration regarding indigenous peoples’ issues.

On this International Day of the World’s Indigenous Peoples, we urge States, UN agencies, and others, in the strongest terms possible, to ensure indigenous peoples’ rights under the Declaration and other instruments, and to recognise these rights especially in the context of migration, including displacement and other trans-border issues.”

(*) The experts: The Expert Mechanism on the Rights of Indigenous Peoples is a subsidiary body of the Human Rights Council. Its mandate is to provide the Council with expertise and advice on the rights of indigenous peoples as set out in the United Nations Declaration on the Rights of Indigenous Peoples, and to assist Member States in achieving the ends of the Declaration through the promotion, protection and fulfilment of the rights of indigenous peoples. It is composed of seven independent experts serving in their personal capacities and is currently chaired by Ms Erika Yamada.

The Permanent Forum on Indigenous Issues is an advisory body to the Economic and Social Council, with a mandate to discuss indigenous issues related to economic and social development, culture, the environment, education, health and human rights. The Forum is made up of 16 members serving in their personal capacity as independent experts on indigenous issues. Eight of the members are nominated by governments and eight by the President of ECOSOC, on the basis of broad consultation with indigenous groups. It is currently Chaired by Ms Mariam Wallet Aboubakrine. 

The Special Rapporteur on the rights of indigenous peoples, Ms Victoria Tauli-Corpuz, is part of what is known as the Special Procedures of the Human Rights Council. Special Procedures is the general name of the Council’s independent fact-finding and monitoring mechanisms that address either specific country situations or thematic issues in all parts of the world. Special Procedures experts work on a voluntary basis; they are not UN staff and do not receive a salary for their work. They are independent from any government or organization and serve in their individual capacity. 

The United Nations Voluntary Fund for Indigenous Peoples was established by the General Assembly in 1985. The Fund provides support for indigenous peoples’ representatives to participate in sessions of the Permanent Forum on Indigenous Issues, the Expert Mechanism on the Rights of Indigenous Peoples, the Human Rights Council, including its Universal Periodic Review, and UN human rights treaty bodies. Its Board of Trustees is currently Chaired by Mr. Binota Dhamai.

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Transforming Food Systems: Today’s Realities and Tomorrow’s Challengeshttp://www.ipsnews.net/2018/08/transforming-food-systems-todays-realities-tomorrows-challenges/?utm_source=rss&utm_medium=rss&utm_campaign=transforming-food-systems-todays-realities-tomorrows-challenges http://www.ipsnews.net/2018/08/transforming-food-systems-todays-realities-tomorrows-challenges/#respond Wed, 01 Aug 2018 15:37:30 +0000 Alice Lloyd http://www.ipsnews.net/?p=157007 The world’s food systems face two immense challenges today. One, to produce enough food to nourish a global population of seven billion people without harming the environment. Two, to make sure food systems deliver nutrition to everyone, particularly the world’s poorest, many of whom suffer from chronic under-nutrition. Like the Economist’s 2017 Food Security Index, […]

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Radish production at West Africa Farms, in Northern Senegal. Credit: Sarah Farhat / World Bank

By Alice Lloyd
WASHINGTON, Aug 1 2018 (IPS)

The world’s food systems face two immense challenges today. One, to produce enough food to nourish a global population of seven billion people without harming the environment. Two, to make sure food systems deliver nutrition to everyone, particularly the world’s poorest, many of whom suffer from chronic under-nutrition.

Like the Economist’s 2017 Food Security Index, a new report released earlier this summer looks at the complex connections between the ways we organize and produce our food, and the implications for the environment, human health, and social wellbeing.

With input from over 150 experts from 33 countries, The Economics of Ecosystems and Biodiversity (TEEB) for Agriculture and Food: Scientific and Economic Foundations Report, a United Nations Environment Programme (UNEP) project, makes the case for a global agri-food systems transformation. It argues that our agri-food systems today are being viewed and evaluated through a narrow, incomplete and distorted lens by focusing on per-hectare-productivity. To fix our food system, our food metrics need to be fixed.

The way we are currently producing food is negatively impacting climate, water, top soil, biodiversity and marine environments. If we do not change course, we will seriously undermine our ability to deliver adequate food for future populations. In addition to the negative environmental impacts, we are struggling to deliver nutritious and healthy diets in an equitable way. Diet-related chronic diseases are on the rise even as we fail to deliver nutritious food to millions of poor people around the world.

The consequences of our current food systems outlined in the report include:
• Agricultural production alone contributes over one-fourth of global GHG emissions.
• However, when considering the entire ‘agri-food value chain’ (including agriculture-related deforestation, farming, processing, packaging, transportation and waste), this number climbs to a staggering 43 to 57 percent of GHG emissions.
• 70 to 90 percent of global deforestation is from agricultural expansion.
• If women had the same access to resources (land, credits, education, etc.) as male farmers, they could raise yields by 20 to 30 percent, and lift as many as 150 million people out of hunger.
• Approximately one-third of the food produced in the world for human consumption every year gets lost or wasted, enough to feed the world’s hungry six times over.
• Around 40 percent of available land is used for growing food, a figure that would need to rise to an improbable 70 percent by 2050 under a “business-as-usual” scenario.
• 33 percent of the Earth’s land surface is moderately to highly affected by some type of soil degradation mainly due to the erosion, salinization, compaction, acidification, or chemical pollution of soils.
• Diets have become the main risk for human health. Six of the top eleven risk factors driving the global burden of disease are diet-related.
• The World Health Organization estimates the direct costs of diabetes at more than US$827 billion per year, globally.
• Unsafe food containing harmful bacteria, viruses, parasites, or chemical substances causes more than 200 diseases. An estimated 600 million people fall ill after eating contaminated food, while 420,000 die every year.
• 61 percent of commercial fish populations are fully fished and 29 percent are overfished.
• In a “business-as-usual” scenario, the ocean will contain more plastic than fish (by weight) by 2050.

The agricultural revolution is still very strongly influencing our food production. While food production has successfully been increased, the environmental impacts have received a lot less attention. They have been either been ignored or been considered as a necessary trade-off.

The Economist’s 2017 Food Security Index for example, in considering how resilience to natural resource and climate related risks pose long term threats to food systems across countries, includes a tool to explore how individual countries perform on a natural resources and resilience adjustment factor.

“If you look at food production only from a price perspective, and the old paradigm of the cheaper the better, you run into a trap because the long-term sustainability of our food production system is not a given,”says Alexander Müller, Study Leader of TEEBAgriFood.

“The task for agriculture and food systems in the years to come is huge, says Muller: ‘feeding a population projected to reach 10 billion in 2050, achieving the four dimensions of food security (FAO 1996) for all people by providing healthy food, drastically reducing the impacts of different types of agricultural production on the world’s ecosystems, reducing greenhouse gas emissions to limit climate change and to adapt to it, developing rural areas to create jobs and to improve livelihoods of poor people, maintaining ecosystem services such as clean water and air for a rapidly urbanizing planet are only some of the challenges.”

Tackling these challenges requires a systematic approach. This report looks at all the impacts of the value chain, from farm to fork to disposal, including effects on livelihoods, the environment, and health. It identifies theories and pathways for transformational change in government, business, farming, and consumer contexts while providing a framework for evaluation that supports the comprehensive, universal and inclusive assessment of eco-agri-food systems.

Recognizing the interlinkages, in terms of impacts and dependencies that food systems have with our economies, societies, health, and environment is a crucial first step. Using the report’s Framework and its language can allow for the next generation of agricultural and food research to provide a more comprehensive basis for decision-making and together with the 2017 Food Security Index, provides a comprehensive assessment of food systems as well as natural resource availability and resilience.

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Q&A: Leprosy Increases as World Gives Attention to Newer Endemic Diseaseshttp://www.ipsnews.net/2018/07/qa-leprosy-increases-world-gives-attention-newer-endemic-diseases/?utm_source=rss&utm_medium=rss&utm_campaign=qa-leprosy-increases-world-gives-attention-newer-endemic-diseases http://www.ipsnews.net/2018/07/qa-leprosy-increases-world-gives-attention-newer-endemic-diseases/#respond Mon, 30 Jul 2018 14:38:45 +0000 Elisio Muchanga http://www.ipsnews.net/?p=156945 IPS correspondent Elisio Muchanga spoke to the World Health Organisation goodwill ambassador for leprosy elimination, Yohei Sasakawa, during a recent visit to Mozambique to evaluate the country’s progress in treating leprosy patients.

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A young boy from the Philippines with leprosy. The chronic disease is curable, and if treated in time disabilities related to the disease can be averted. Courtesy: moyerphotos/CC By 2.0

By Elisio Muchanga
MAPUTO, Jul 30 2018 (IPS)

In the first six months of this year, the southern African nation of Mozambique has already registered 300 more cases of leprosy, some 951 cases, than it registered for the whole of 2017.

The country, which had previously eliminated the chronic disease in 2008, is receiving funding from the Nippon Foundation—a non-profit philanthropic organisation from Japan that is active in many countries across the globe in eliminating leprosy—to provide free multi-drug therapy (MDT) to leprosy sufferers. Leprosy is curable, and if treated early enough disabilities related to the disease can be averted. But treatment can take between six to 12 months.

The chair of the Nippon Foundation and the World Health Organisation (WHO) goodwill ambassador for leprosy elimination, Yohei Sasakawa, recently visited the country to assess Mozambique’s progress in identifying and treating leprosy.

He told IPS that the increased attention by health authorities on relatively new endemic diseases such as Malaria, HIV and Tuberculosis (TB) may have contributed to the increase of new leprosy cases in the world.  This is despite the fact that treatment for the disease remains free. The WHO has provided MDT for free since 1995 thanks to initial funding from the Nippon Foundation.

Sasakawa said that while the WHO has indicated that a prevalence rate of one leprosy case per 10,000 inhabitants indicates elimination of the disease, “this indicator is simply a milestone. Eradication has not yet been achieved, so we must continue to work towards eradication and elimination.”

Excerpts of the interview follow:

Inter Press Service (IPS): There has been a massive decline in the prevalence of leprosy following the global implementation of MDT in the 1980s by the WHO. However, there are still over 200,000 new leprosy cases recorded every year. And we have seen the emergence of multi-drug resistant leprosy in recent years. How has this affected the prevalence rate?

Yohei Sasakawa (YS): Both in the past and now, MDT is supplied by our foundation and distributed free of charge. Although the medication continues to be distributed free of charge, there are many patients with HIV, Malaria and TB, and these diseases get more attention from ministries of health than leprosy. This fact increases new cases of leprosy. There was a complication caused by multi-drug resistant leprosy, which also contributes to the increase in the number of patients, but it is a very small number, a much lower percentage.

IPS: How can Zero Leprosy be achieved?

YS: It starts from talking about the disease by using a social approach, because leprosy is a social problem. So the leaders of a country, teachers in schools etc, must work to spread the knowledge that leprosy is a curable disease. It is possible to cure with the correct treatment, which starts with the diagnosis of the skin. (Initial symptoms are patches of skin that are paler than normal.) If this message is spread exhaustively, for sure leprosy will be zeroed.

IPS: Do you find it difficult to reach the level of Zero Leprosy?

YS: Achieving Zero Leprosy is not such a difficult process. As I have said, we just need an exhaustive dissemination of the message that it is possible to treat the disease and that the medication is free at health centres. This is the only way that Zero Leprosy will be reached because this disease is not so difficult to diagnose, it is easy to identify.

IPS: Treatment of leprosy costs nothing. But we are seeing a shift towards complacency about the disease among government policy makers, and hence an increase in the prevalence of the disease in some areas. This is unfortunate. Why is this the case? And how do we address this?

YS: Leprosy is not a medical disease it is a social problem. This disease has no symptoms like pain, and this fact alone makes some people chose not to go to hospital when they come across spots on their skin etc. But with time, deformation takes place and then the person feels ashamed to go to hospital because of discrimination… For a long time, history has shown that people with leprosy were highly discriminated against.

And this discrimination still exists quite strongly amongst almost every population…I had the opportunity to see in Nampula (northern Mozambique) that those recovered from leprosy work as volunteers in the search for other people with leprosy in need of treatment. I think this is very good and would be even better if it were spread throughout the country.

The chairman of the Nippon Foundation and the World Health Organisation (WHO) goodwill ambassador for Leprosy Elimination, Yohei Sasakawa, recently visited the country to assess Mozambique’s progress in identifying and treating leprosy. Credit: Elisio Muchanga/IPS

IPS: What concrete actions is your foundation carrying out, especially in Africa, to eliminate leprosy.

YS: Over the last 40 years the foundation has been working to provide the necessary assistance to people with leprosy through the WHO, and we will continue providing this assistance.

In Africa, specifically in countries with cases of leprosy, I try to talk to the top leader, the president. I explain the situation to them in order for them to take action. I think in talking to presidents it makes it easier for a ministry of health to get a bigger budget and carry out its activities.

The number of people with leprosy is much lower than those with HIV, Malaria and TB. So it is very difficult for the government to allocate a larger amount to the ministry of health to tackle this disease, and this is not prioritised. So I go to these countries and ask the government to increase funding to the ministry of health to combat the disease.

IPS: Your foundation has given support to many countries towards eliminating leprosy. What is the feedback from these countries and what can be taken as model or case for success?

YS: The feedback is very positive. We are experiencing a significant reduction in cases of leprosy with countries declaring themselves free from leprosy, although there are new cases. India is a great example, the country has the greatest number of leprosy sufferers in the world—about 70 percent of the world’s cases of leprosy are in India—and the work that has been developed there is positive.

However, one concrete case of success was in Indonesia where I met a girl who developed the disease at 18 and was cut off from her family. I had the opportunity to have a meal with this girl, and that gesture demystified that leprosy was a cursed disease.

IPS: As part of efforts to sustain the quality of leprosy services and reduce the burden of leprosy in the world, the WHO has recognised the important contribution that people affected by leprosy can make. What have some of the contributions that you have seen that have positively affected leprosy services?

YS:  Well, India, you know that this country has a massive number of people with leprosy, and many of those who have been treated and recovered from leprosy have nothing to live on and end up begging on the streets.

I spoke to the Dalai Lama to see what we can do for these people. He wrote a book, sold it and donated the money from the sale of the book to our foundation. Later we created an association to support people affected by leprosy by giving them a small pension. We also provide microfinance and teach people how to make their own living.

We also offer university scholarships to the children of people who have recovered from leprosy, but this type of support, unfortunately, only happens in Ethiopia and India.

IPS: Why only in these countries?

YS: I don’t know. What a pity (it is limited). We also wanted to do the same in Indonesia. Now here in Mozambique, from what I understand, there is no a colony where only people with leprosy live. But if people get together and form an association, maybe we can offer support. I understand that those recovering from leprosy want to work but do not have the opportunity. We can help create this opportunity.

IPS: Your foundation managed to lobby the United Nations to pass a resolution for the “elimination of discrimination against persons affected by leprosy and their family.” How do you measure the result of this lobbying today with regards to the commitment and actions from member states?

YS: It is true that we have been able to mobilise countries and pass this resolution, but what happens is that this rule contains its principle and guideline but has no penalty. Some countries have included this rule in their policies but unfortunately there are only a few countries that have done that.

Recently, a leading rapporteur was elected by the Directorate of Human Rights (in the U.N. Human Rights Office of the High Commissioner), and will have to visit countries and see why they are not complying with the U.N. recommendation of 2010.

IPS: There still remains significant stigma attached to the disease. And the stigma placed upon people with leprosy has been considered one of the greatest social injustices. In some parts of Africa people with leprosy are still separated from society, when research and science proves there is no need to. How do we overcome this?

YS: In fact there is discrimination against leprosy sufferers and this is difficult to remove from people. Stigma and discrimination are ancient and deeply rooted. So it is not only with my efforts that we are going to end this stigma, we need to have the participation of all of us working together to change this situation.

The post Q&A: Leprosy Increases as World Gives Attention to Newer Endemic Diseases appeared first on Inter Press Service.

Excerpt:

IPS correspondent Elisio Muchanga spoke to the World Health Organisation goodwill ambassador for leprosy elimination, Yohei Sasakawa, during a recent visit to Mozambique to evaluate the country’s progress in treating leprosy patients.

The post Q&A: Leprosy Increases as World Gives Attention to Newer Endemic Diseases appeared first on Inter Press Service.

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Eradicating Leprosy in Mozambique, a Complicated Taskhttp://www.ipsnews.net/2018/07/eradicating-leprosy-mozambique-complicated-task/?utm_source=rss&utm_medium=rss&utm_campaign=eradicating-leprosy-mozambique-complicated-task http://www.ipsnews.net/2018/07/eradicating-leprosy-mozambique-complicated-task/#respond Sat, 28 Jul 2018 12:14:02 +0000 Elisio Muchanga http://www.ipsnews.net/?p=156930 It takes Faurito António, 42, from Lalaua district, Nampula Province, two hours to reach his nearest health centre in order to receive the drugs necessary for his treatment of leprosy. António, whose foot has become affected by the muscle weakness that occurs when leprosy goes untreated, says this long walk while ill is the reason […]

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World Health Organization goodwill ambassador for Leprosy Elimination and chair of the Nippon Foundation, Yohei Sasakawa (left), holds the hand of a leprosy patient. Sasakawa visited Mozambique’s rural Namaita Centre to assess the progress of leprosy patients. The Nippon Foundation has been providing funds and medication in order to eliminate leprosy in Mozambique. Credit: Elísio Muchanga/IPS

By Elisio Muchanga
NAMPULA PROVINCE, Mozambique, Jul 28 2018 (IPS)

It takes Faurito António, 42, from Lalaua district, Nampula Province, two hours to reach his nearest health centre in order to receive the drugs necessary for his treatment of leprosy. António, whose foot has become affected by the muscle weakness that occurs when leprosy goes untreated, says this long walk while ill is the reason why many don’t continue treatment – which can take between six to 12 months.

“There are people who drop out of treatment for alleged fatigue from going long distances to gain access to a hospital,” he tells IPS of the rural distribution of Mozambique’s health centres.

In the deeply rural and poor northern province of Nampula, some six million people, according to the Mozambique ministry of health, are serviced by one health centre in each of the 23 districts.

The lack of development—many of the villages in the region do not have electricity or even paved roads—also often makes these centres difficult to access.

This southern African nation was in a 16-year civil war that ended in 1992 and ranks 181 out of 188 countries on the United Nations Development Programme’s Human Development Index, sharing its place with conflict-ridden South Sudan. World Bank data shows that more than half, 63 percent, live below the poverty line of USD1.90 a day.

A source in the health ministry says that on average, about 5,000 people are treated in Nampula’s health centers, leaving the remaining population without access.

Distances to Health Care Centres

Nampula Province was ranked in a study as one of the areas with the highest number of villages located 60 minutes away from a health centre. The province’s main 500-bed Nampula Central Hospital, in Nampula City, serves a population of approximately 8.5 million from the three provinces of Nampula, Cabo Delgado and Niassa.

This province has the most cases of leprosy in the country. In the first half of this year, the ministry of health registered a total of 553 cases, most of them from the districts of Lalaua, Meconta, Mogovolas and Nampula, in Nampula Province. This was followed by Zambezia and Cabo Delgado with 121 and 84 new cases respectively.

Leprosy is a chronic disease. Initial symptoms are patches of skin that are paler than normal, and this makes the disease difficult to diagnose. But if left untreated, the World Health Organization (WHO) says it “can cause progressive and permanent damage to the skin, nerves, limbs, and eyes.”

Last year, Mozambique’s national director of public health, Francisco Mbofana, raised concern that the disease was still going undiagnosed and untreated. Club Mozambique quoted him as saying that often patients appeared for the first time at health centres already suffering from second degree malformations “where mutilations of their fingers and toes are evident.”

The disease, which is transmitted via droplets, from the nose and mouth, during close and frequent contact with untreated cases, is curable with multidrug therapy (MDT), and early treatment averts most disabilities. The WHO has provided MDT for free since 1995 thanks to intial funding from the Nippon Foundation. The Nippon Foundation, a non-profit philanthropic organisation from Japan, is active in many countries across the globe in eliminating leprosy, including here in Mozambique.

The MDT treatment that António is on was donated by the Nippon Foundation and is available for free for all leprosy patients across the country.

António has been on the therapy for two weeks now, and says that he can report an improvement.

A community in Mozambique’s Nampula Province listen to a talk about identifying and treating leprosy. This province has the most cases of leprosy in the country. In the first half of this year, the ministry of health registered a total of 553 cases, most of them from the districts of Lalaua, Meconta, Mogovolas and Nampula, in Nampula Province.Credit: Elisio Muchanga/IPS

Promoting early identification of the disease through education

Unlike António, Ermelinda Muelete, 23, was fortunate enough to have been diagnosed early on when white patches appeared on her body. But Muelete, who had been on medication for the disease for some weeks, stopped the treatment because she felt that the patches on her skin were not going away quickly enough.

But she regrets the decision.

“I want to return to the treatment,” she tells IPS from the Namaita Centre, a small clinic in Mozambique’s district of Rapale, Nampula province. Muelete says that while members of the small rural community here have not rejected her outright, she felt that some of their attitudes and actions discriminated against her.

But this Thursday Jul. 26, as a small rally was held in the area to sensitise people about the disease, she felt more confident.

The WHO goodwill ambassador for Leprosy Elimination, Yohei Sasakawa, visited Namaita Centre to evaluate how funding from the Nippon Foundation, of which he is chair, has been able to assist treating Mozambicans with leprosy.

The foundation has been on the forefront of combatting the disease. In 2013, along with WHO, Nippon Foundation held a leprosy summit during which 17 countries that reported more than 1,000 new cases a year issued the Bangkok Declaration to reaffirm their commitment to achieve a leprosy-free world.

Here in Mozambique, the foundation has provided both funds and medication to the health ministry to implement post-elimination interventions at community level in the endemic districts of the central and northern parts of the country, especially for the active search for patients for early diagnosis and treatment. The Nippon Foundation initiative, which began last year, will continue until 2020.

According to Sasakawa, the process of diagnosis of this disease has been difficult, because the symptoms can take a significant time to present and they are not specifically painful. This long incubation period, on average five years, but in some cases up to 20 years according to WHO, means that people don’t always seek treatment immediately.

However, he challenged communities to be vigilant, and to try to identify if their relatives have any skin discoloration so that they can be referred to a hospital for screening and treatment.

“In fact, the appearance of white patches on the patient’s body is one of the main forms of suspicion that may lead to a specific diagnosis to determine the disease,” he says.

“Do not take long with symptoms of leprosy you have to see a doctor in the nearest health centre to get treatment, which is free.”

In addition to providing money and MDT, Nippon Foundation also support public awareness campaigns that sensitise local populations about leprosy, how to identify it and where to receive treatment.

In rural areas, poor understanding of the disease makes it difficult for people to identify it and obtain necessary treatment. Only nine percent of the country’s 28 million people have internet access, according to the World Bank data.

So the education rally made a difference to Muelete.

“Now I don’t feel rejected because of my situation. I feel strong to overcome discrimination and go ahead with the treatment,” she says.

The struggle to eliminate leprosy

Sasakawa says that Nippon Foundation has been struggling to eliminate the disease. There over 210,000 new leprosy cases registered globally in 2016, according to official WHO figures from 145 countries.

Mozambique had been declared free from leprosy in 2008. However, a few years later, it experienced an outbreak of the disease.

The country’s health minister Nazira Abdula, says that just in the first six months of this year, Mozambique registered about 951 new cases of leprosy, compared to 684 cases in 2017.

“The cases may increase, but mini-campaigns are foreseen in the provinces that register some cases of leprosy,” she says from her office in Maputo as she received the foundation delegation.

Manuel Dias, a community leader in Namaíta reiterated the request for support to combat leprosy.

“We ask Mr. Sasakawa to continue bringing the leprosy drug here in Namaíta, because there are many people suffering from this disease.”

Sasakawa reaffirmed his commitment to continue supporting communities with a view to eradicating the disease, particularly in rural areas.

  • Additional reporting by Nalisha Adams in Johannesburg

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No Time to Slow Down While HIV/AIDS is Threatening a New Generationhttp://www.ipsnews.net/2018/07/no-time-slow-hivaids-threatening-new-generation/?utm_source=rss&utm_medium=rss&utm_campaign=no-time-slow-hivaids-threatening-new-generation http://www.ipsnews.net/2018/07/no-time-slow-hivaids-threatening-new-generation/#respond Fri, 27 Jul 2018 11:49:12 +0000 Dr Chewe Luo http://www.ipsnews.net/?p=156916 Dr Chewe Luo is Global Chief of HIV/AIDS for UNICEF

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Credit: UNICEF

By Dr Chewe Luo
AMSTERDAM, Jul 27 2018 (IPS)

As the 22nd International AIDS Conference wraps up in Amsterdam, I can’t help but reflect on how far we have come on this journey with the AIDS epidemic.

When I first qualified as a pediatrician in Zambia some 30 years ago, Southern Africa was only just awakening to the magnitude of the AIDS crisis starting to play out in the region. Some governments famously refused to acknowledge the severity of the epidemic and questioned even the existence of HIV and its connection to AIDS.

Zambia had its moment of shocked awareness when the 30 year-old son of President Kenneth Kaunda died, and his father announced that the cause had been AIDS.

Around us, the epidemic was taking its toll on the able-bodied as mothers and fathers fell ill and died, leaving their children – sometimes infected, sometimes not – in the care of grandmothers, or aunts, or orphanages, or to fend for themselves any way they could.

We are a long way from that place now. What has made the difference? Availability and accessibility of treatment, of course, but perhaps even more importantly, concerted action from entire segments of society focused on bringing the epidemic under control.

Among the heroes in the fight against the epidemic, I would single out:

• Activists like ActUp, GMHC, South Africa’s Treatment Action Campaign, and others, who galvanized global outrage at the glaring disparities between global North and the global South.

• The Governments of Brazil, South Africa, and India, which asserted the right to access for medicines by all, persisting in the face of implacable corporate resistance, till the pharmaceutical industry allowed generic versions of the treatments which inhibit HIV.

• The numerous researchers who tested combinations of drugs, and adapted them for different populations, such as young children and lactating mothers.

• The generic manufacturers who were able to combine drugs into fixed dose combinations that were affordable and accessible to poor countries.

• And ordinary health workers, intergovernmental and to civil society organizations who believed that the epidemic could be defeated.

 

Where are we now? UNICEF’s latest report, Women: At the heart of the HIV response for children allows optimism. Take Southern Africa as an example. Some 57,000 babies became newly infected with HIV in 2017 in the region. This is still far too many, but infections in the region peaked in 2002 at 170,000, so this is a massive decrease in 15 years. Deaths in the region are also coming down, from a peak of 110,000 in 2004 to 33,000 last year.

However, if there is one thing that came across very clearly in Amsterdam this week, it is that we cannot afford to let up. This is especially crucial for the children and young people who are now face to face with the virus.

The child population is set to rise in sub-Saharan Africa, from 560 million in 2018 to 710 million by 2030. The region still has the overwhelming share of HIV/AIDS cases, and it is not coming down in key groups such as adolescents. So ‘youth bulge’ is about to meet HIV/AIDS – and that could be a cataclysmic crash.

HIV/AIDS is not under control in West and Central Africa, which we project will overtake Eastern and Southern Africa by 2050 as the region with the highest number of new HIV infections – without urgent action now.

What we know is that despite the progress, what has brought us here is not enough to take us all the way. We need passion and leadership, which served us well in the past, but we also need innovative technology – like the promising HIV self-testing which removes some of the barriers for adolescents.

We need advances in treatment and prevention. We need to strengthen the human rights approach to HIV. All people, whatever their age, should have the right to the service that will keep them free of HIV or keep them healthy if they get it. And we need continued investment in programmes and people.

Finally, we need bold and inspired leadership, infused with creativity, energy and optimism — a new generation of activist leaders, to tackle these challenges directly.

The post No Time to Slow Down While HIV/AIDS is Threatening a New Generation appeared first on Inter Press Service.

Excerpt:

Dr Chewe Luo is Global Chief of HIV/AIDS for UNICEF

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Bringing Health Microinsurance to Kenyans via Mobile Phonehttp://www.ipsnews.net/2018/07/bringing-health-microinsurance-kenyans-via-mobile-phone/?utm_source=rss&utm_medium=rss&utm_campaign=bringing-health-microinsurance-kenyans-via-mobile-phone http://www.ipsnews.net/2018/07/bringing-health-microinsurance-kenyans-via-mobile-phone/#respond Thu, 26 Jul 2018 14:13:50 +0000 Lauren Braniff and Michel Hanouch http://www.ipsnews.net/?p=156897 Lauren Braniff & Michel Hanouch, Consultative Group to Assist the Poor. The CGAP, which is housed at the World Bank, is a global partnership of more than 30 leading organizations that seek to advance financial inclusion.

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Credit: Sarah Farhat / World Bank

By Lauren Braniff and Michel Hanouch
WASHINGTON DC, Jul 26 2018 (IPS)

Households in developing countries spent $148 billion out-of-pocket for healthcare expenses in 2015, and each year 100 million people are pushed into extreme poverty because of the high cost of healthcare.

Particularly for major inpatient expenses, health insurance is the most effective way for people to reduce their out-of-pocket costs and avoid having a major medical emergency plunge them deeper into poverty.

However, insurance providers often have difficulty convincing low-income customers to pay insurance premiums now for needs that may or may not arise later.

Fortunately, digital financial services (DFS) has made it easier to bundle insurance with other financial products in ways that address a range of inpatient and outpatient health services and that introduce people to the benefits of insurance.

As discussed in a previous CGAP blog post, “A Digital Finance Prescription for Universal Health Coverage,” various DFS are helping patients pay for medical treatment in many developing countries. Digital credit is enabling patients to obtain instant loans for healthcare, even in remote areas.

In fact, CGAP research in Kenya found that paying medical bills was one of the most common reasons people cited for borrowing from digital lending platform m-Shwari. Digital savings is another example. Savings products allow people to save and easily withdraw funds from dedicated health savings accounts.

Still, obtaining insurance is the best way to prepare for major health expenses, yet too few low-income people are insured. About 75 percent of the world’s population is not adequately protected by insurance, and 40 percent have no coverage at all.

While there are many reasons for this, paying monthly premiums is a significant challenge to consumers with irregular sources of income. Another key issue is that low-income consumer value liquidity, so they hesitate to commit funds to any one destination ahead of immediate need.

This makes insurance a difficult sell on its own. But digital channels enable providers to more effectively bundle insurance with other services that meet a wider range of short- and long-term healthcare needs.

MicroEnsure’s Fearless Health product in Kenya is a good example of bundling’s potential. MicroEnsure has more than 50 million registered users in 15 countries. The company provides free basic life, accident and hospital insurance via mobile phone to many of its customers, through partnerships with mobile network operators.

However, these models are only able to cover catastrophic needs, rather than the day-to-day risk events that are more tangible for consumers. To provide a solution that addresses a broader range of potential health events, MicroEnsure designed Fearless Health, which integrates insurance with other products designed to help customers get the inpatient and outpatient care they need without delaying treatment because of the costs.

The Fearless Health pilot launched in 2016 with three key features: on-demand loans for primary healthcare at outpatient clinics, medical advice by phone (whereby customers text their health questions by SMS and receive a call from a doctor) and insurance for inpatient care that provides a cash payout if a customer or family member suffers a health emergency requiring three or more nights at a hospital.

Limiting the insurance component to inpatient care only, while offering loans for outpatient needs, allowed MicroEnsure to keep premiums low because administrative costs related to outpatient claims tend to drive up premiums.

By bundling financial products in this way, MicroEnsure hoped customers could experience the benefits of insurance without having to make costly, separate insurance premium payments.

MicroEnsure viewed the loans as the key way to introduce customers to Fearless Health’s other features. It marketed the loans at participating clinics to help patients cover the cost of their treatments.

During borrowers’ loan repayment periods, they were insured and had access to the telephone health information service. Mobile money was essential to Fearless Health, and all payments to and from customers were digital.

From MicroEnsure’s perspective, cash was not viable given the potential for multiple payouts per client in addition to receiving loan repayments on a regular basis. For customers, receiving loans and hospital cash payouts quickly via digital channels was critical so they could pay for immediate expenses.

Banner reads: “Receive treatment today, pay later.” MicroEnsure promoted Fearless Health at clinics around the country. Credit: Michel Hanouch

The Fearless Health pilot confirmed that there is a high demand for the product among customers who do not have enough funds for outpatient care. Further, Fearless Health customers spent more at the clinics than noncustomers, providing a business case for clinics to welcome the product and reducing the potential negative impacts of undertreatment due to patient liquidity constraints.

However, it also showed that MicroEnsure’s plan to offer the credit to patients when they were at the clinics and needed it most should be reconsidered. Most patients at clinics had already brought enough cash to cover minor outpatient expenses.

The target market for Fearless Health did not bother coming to clinics because they lacked funds. The pilot suggested that MicroEnsure would need to find ways to market the product outside of clinics.

To understand the features of Fearless Health that were most valued by customers, researchers from CGAP and Busara Center for Behavioral Economics asked them what mattered most to them: amount of coverage, duration of coverage or the number of family members covered.

Customers indicated that duration of insurance coverage was the most important. The other factors were also considered important, however, and a desirable combination of all three increased people’s willingness to pay for the Fearless product.

This suggests that the preferred solution should cover family members and offer a reasonable coverage amount, but that extending the duration of coverage should be emphasized.

MicroEnsure’s Fearless Health is an example of how providers can approach health insurance for poor people. Although our research uncovered areas where the product could be improved, it is clear that digital channels have an important role to play for insurance providers looking to create microinsurance products that are scalable and sustainable but also add real value to customers’ lives.

The link to the original article follows:
http://www.cgap.org/blog/bringing-health-microinsurance-kenyans-mobile-phone?utm_source=CGAP+Reader+%2807.23.18%29&utm_campaign=CGAP+Reader+%2807.23.18%29&utm_medium=email

The post Bringing Health Microinsurance to Kenyans via Mobile Phone appeared first on Inter Press Service.

Excerpt:

Lauren Braniff & Michel Hanouch, Consultative Group to Assist the Poor. The CGAP, which is housed at the World Bank, is a global partnership of more than 30 leading organizations that seek to advance financial inclusion.

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HIV-TB Connection: Key to Ending Infectionshttp://www.ipsnews.net/2018/07/hiv-tb-connection-key-ending-infections/?utm_source=rss&utm_medium=rss&utm_campaign=hiv-tb-connection-key-ending-infections http://www.ipsnews.net/2018/07/hiv-tb-connection-key-ending-infections/#respond Tue, 24 Jul 2018 13:33:21 +0000 Tom Maguire http://www.ipsnews.net/?p=156854 Tom Maguire is the Communications Manager at RESULTS UK

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Michelle, a transgender peer educator, walks through her village in Joyce Bay, Port Moresby. Credit: Tom Maguire

By Tom Maguire
LONDON, Jul 24 2018 (IPS)

A group of teenage boys huddle around Michelle in the mangroves behind Joyce Bay, a spot frequented by men who have sex with men (MSM) in Port Moresby, Papua New Guinea (PNG).

She asks them how regularly they have sex and whether they have been tested for HIV or tuberculosis (TB). Her questions are met with giggles, intrigue and confusion. It turned out that none of the eight present have been tested for either disease. Michelle is a peer educator working to test key populations in her community for HIV, and more recently TB as well.

Five key populations— sex workers, MSMs, transgender people, people who inject drugs, and people in prison and confined settings are disproportionally affected by HIV, but are also the least likely to have access to preventative care, diagnostics, and treatment. One in two new HIV infections worldwide are in these populations.

They face a number of barriers that limit their access to essential health services or exclude them all together. Many are subjected to significant levels of stigma, discrimination, abuse and violence. In many settings, laws that criminalise behaviours such as drug use, sex work, and same-sex relationships further marginalise young people and perpetuate their exclusion.

Fearing discrimination and possible legal consequences, they are hesitant to accessing testing and treatment services. They are also often reluctant to disclose their HIV status to their family and community in fear of revealing their identity or sexual orientation. The outcome is that they remain hidden from the services and support networks they need.

Same-sex relationships are illegal and punishable by up to 14 years in prison in Papua New Guinea. While some coastal communities in the National Capital District are increasingly accepting of same-sex relationships, tolerance across this predominately Catholic country remains low and impacts the number of MSM who get tested.

Balou Chabart Rasoananaivo speaks with local MSM in a safe space in Tamatave, Madagascar. Credit: Tom Maguire

A new report on key populations, commissioned by PNG’s National Department of Health, says more than half of gay men, other men who have sex with men, and transgender people have never been tested for HIV.

To overcome the myriad and interconnected barriers, civil society organizations are introducing programs to increase awareness about HIV among those groups who are often missed by national programs.

In Papua New Guinea’s capital Port Moresby, a cadre of volunteer peer educators, like Michelle, have been trained to go out to clubs, pick-up spots for sex workers, and safe spaces where LGBTQ+ people meet and socialize, to distribute condoms and encourage people to get tested.

In Madagascar, Solidarité des MSM Madagascar, set up by transgender activist Balou Chabart Rasoananaivo, targets men who have sex with men with HIV sensitisation programmes at local social events. This approach aims to support young MSM to think of themselves as part of a community, and to strengthen community norms for sexual health. Dispelling myths around using condoms is another important part of the organisations work.

For example, many Malagasy’s believe that the gel on the tip of a condom is tap water. Madagascar’s water supply is so polluted that this seemingly unimportant detail can make the difference between people choosing to use condoms or not.

While good progress has been made, many so-called ‘key populations’ are still unable to access treatment. In some countries drug-stocks outs are regular occurrences. Drug stock-outs can have a devastating and life-threatening impact for everyone completing treatment for HIV, but key populations are often worse affected as they typically access treatment outside of the national healthcare system.

Just recently, the amount of antiretroviral medicine available in Papua New Guinea has fallen to such low levels that the country has started to eat into its buffer stock. Health Secretary Pascoe Kase admitted in a statement to local media that stocks were low, but that the Department of Health was working with donors to figure out a solution. Madagascar found itself in a similar predicament in 2015.

Interruption of treatment can weaken the immune system of people living with HIV and increase their susceptibility to other infectious diseases such as TB, which is the biggest killer of people living with HIV, causing approximately one in four deaths.

According to the 2017 Global TB Report, more than one million people infected with HIV contract TB annually, and 374,000 people die from it.

Globally, progress is being made to integrate TB-HIV services. Papua New Guinea’s capital, Port Moresby, has the highest rate of TB in the world; all patients are now being tested for both HIV and TB whenever they visit a health facility and display symptoms of either disease.

The recent integration of the two programs is already helping to identify more cases of both disease and ensure those that are living with TB/HIV co-infection are put on an appropriate course of treatment.

According to David Bridger, the UNAIDS Country Director for Papua New Guinea: “Only when we ensure that Papua New Guinea’s HIV programming reaches the right people in the right way and place, and at the right time, will the increasing HIV infection rates amongst key populations be slowed”.

Civil society organisations (CSOs) and peer educators like Michelle and Balou play a leading role in the fight to end the world’s two deadliest infectious disease and ensuring no group or individual gets left behind. But their efforts are futile unless governments and donors ensure those that need treatment can access it.

This is the message that CSOs conveyed to the AIDS 2018 Conference in Amsterdam, July 23 -27.

On the road to the first-ever United Nations High Level Meeting on TB, advocates are using the AIDS conference to highlight the deadly link between HIV and TB that is so obvious in places like PNG, and to make it clear that attaining the Sustainable Development Goals rests heavily on how well societies understand and treat these diseases.

The post HIV-TB Connection: Key to Ending Infections appeared first on Inter Press Service.

Excerpt:

Tom Maguire is the Communications Manager at RESULTS UK

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Sustainable Agriculture To End World Hungerhttp://www.ipsnews.net/2018/07/sustainable-agriculture-end-world-hunger/?utm_source=rss&utm_medium=rss&utm_campaign=sustainable-agriculture-end-world-hunger http://www.ipsnews.net/2018/07/sustainable-agriculture-end-world-hunger/#respond Tue, 24 Jul 2018 10:26:29 +0000 Carmen Arroyo http://www.ipsnews.net/?p=156834 Significantly more investment is needed to lift hundreds of millions rural poor out of poverty and make agriculture environmentally sustainable, according to Rob Vos, director of the markets, trade and institutions division at the International Food Policy Research Institute (IFPRI). With a growing world population, hunger and undernutrition are on the rise, and governments are […]

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The weakness of poor farmers and the growth of low-nutrition crops have been, until now, some of the deterrents of efficient agriculture. Esmilda Sánchez picks string beans on the Finca de Semillas farm. Credit: Jorge Luis Baños/IPS

By Carmen Arroyo
UNITED NATIONS, Jul 24 2018 (IPS)

Significantly more investment is needed to lift hundreds of millions rural poor out of poverty and make agriculture environmentally sustainable, according to Rob Vos, director of the markets, trade and institutions division at the International Food Policy Research Institute (IFPRI).

With a growing world population, hunger and undernutrition are on the rise, and governments are looking for private alliances to alleviate these issues.“The world has over-invested in low-nutrition staple crops, driving up the relative price of nutrition rich-foods. Empty calories is the food system of the poor." -- John Coonrod, executive vice-president, the Hunger Project.

During the 2018 High-Level Political Forum on Sustainable Development at the United Nations Headquarters in New York, this July, IFPRI organised a side event called “Investing for Reshaping Food Systems”.

Speakers included Claudia Sadoff, director general for the International Water Management Institute; Nichola Dyer, from the Global Agriculture and Food Security Programme at the World Bank; Gerda Verburg, coordinator at the Scaling Up Nutrition Movement (SUN); and Chantal-Line Carpentier, chief at the U.N. Conference on Trade and Development.

They all emphasised the urgency of investing in sustainable agriculture, defined by the Barilla Centre for Food and Nutrition as “the efficient production of safe, healthy, and high-quality agricultural products, in a way that is environmentally, economically, and socially sustainable.”

While the world population will reach over eight billion people in 2025, the amount of cultivable land will remain the same. Decimated by pesticides, non-sustainable agricultural techniques, and water waste, healthy nutrients will become harder to access for the growing population. This issue, along with food waste (20 percent of every food purchase is wasted), is a major concern for Verburg, who highlighted the need to rethink food systems and stop blaming agriculture.

The relationship between the private sector and agriculture isn’t new. On the contrary, many farmers-especially the poorest ones-are members of the private sector.

“The majority of poor and hungry people are small-scale farmers. They are in fact members of the private sector, albeit the weakest. And some corporate investments in agriculture can hurt them,” John Coonrod, executive vice-president at the Hunger Project, told IPS.

The weakness of poor farmers and the growth of low-nutrition crops have been, until now, some of the deterrents of efficient agriculture.

“The world has over-invested in low-nutrition staple crops, driving up the relative price of nutrition rich-foods. Empty calories is the food system of the poor. To overcome malnutrition, we need to increase the dietary diversity of the poor to include many more fruits and vegetables, which means increasing their local production and reducing their price to local consumers,” Coonrod explained.

How can private investment develop sustainable agriculture? Vos from IFPRI said that a first priority should be to provide incentives for investments beyond farms “in infrastructure like roads, electricity and cold transportation and agri-food processing.”

“This will help provide better and more stable market conditions for farmers, create lots of new jobs, and limit the risks of investing in agriculture itself,” he said.

He also added that “the second priority is to provide incentives for investing in sustainable practices and crop diversification, including towards fruits and vegetables.”

Brian Bogart, senior regional programme advisor for South Africa to the U.N. World Food Programme, agreed with Vos.

“Key areas for investment to equity in food systems include rural infrastructure, access to markets, knowledge and technology, and improved storage and transport capacity to reduce post-harvest losses,” Bogart said.

What about governments?

During the event, Verburg, from SUN, pointed out the importance of political commitment and leadership within countries to reduce hunger and reshape food systems.

When asked about the role of national governments, Bogart said: “Member states have a responsibility to lead such efforts by developing effective partnerships with the private sector and fostering an enabling environment for investment.”

“With shrinking public investment in agriculture (according to the Secretary General’s progress report on the SDGs, government expenditure as a percentage of GDP declined from .38 to .23 between 2001 and 2016 and international aid allocations for agriculture declined by 20 percent between the mid-1980s and 2016), the question is how public-private partnerships can unlock opportunities for private investment to complement public resources and capacity to generate improved food security, particularly for the most vulnerable populations,” he added.

Some countries are already doing this. The Barilla Centre for Food and Nutrition’s Food Sustainability Index on sustainable agriculture; nutritional challenges; and food loss and waste which ranks 34 countries according to eight categories, which are in turn divided among 35 indicators, reveals that France, Japan, Germany score highest.

However, responsibility does not lie solely with the state, but with civil society also. Coonrod, from the Hunger Project, explained what his organisation does in this regard: “We promote good nutrition through education, promoting better local farming methods, increasing local food processing and, in indigenous communities of Latin America, we’ve opposed junk food and helped communities reclaim their nutritious traditional foods.”

Finally, Vos highlighted the importance of research in reducing hunger.

“We undertake research to better understand the causes underlying the deficiencies in the present food systems and test out the effectiveness of interventions that aim to overcome these shortcomings. We know far too little on what is driving food system change, not just in agriculture, but in all stages of the food chain, from farm to fork.”

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Bad career choice?http://www.ipsnews.net/2018/07/bad-career-choice/?utm_source=rss&utm_medium=rss&utm_campaign=bad-career-choice http://www.ipsnews.net/2018/07/bad-career-choice/#respond Mon, 23 Jul 2018 05:46:08 +0000 Rukhsana Shah http://www.ipsnews.net/?p=156877 As with so many other professions, nursing remains a neglected line of work, despite its practitioners being responsible for the treatment, safety and quick recovery of patients, as well as post-op management and specialised interventions. Doctors need them because no doctor can care for each patient. According to the latest Economic Survey, there are 208,007 […]

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By Rukhsana Shah
Jul 23 2018 (Dawn, Pakistan)

As with so many other professions, nursing remains a neglected line of work, despite its practitioners being responsible for the treatment, safety and quick recovery of patients, as well as post-op management and specialised interventions. Doctors need them because no doctor can care for each patient.

Rukhsana Shah

According to the latest Economic Survey, there are 208,007 doctors and 103,777 nurses in the country. This reflects a ratio of one doctor to less than 0.5 nurses, while the recommended ratio is 1:4. This should not be surprising as 90 per cent of nurses here are females working in a highly misogynist culture, encountering sexual harassment and being treated as inferiors by doctors and hospital administrators.

They have long working hours and low wages. Their career trajectories are poor as they are inducted in Grade 16 after BSc in nursing, with prospects of promotions and perks like their officers in the public sector with similar qualifications. Many nurses are qualified from abroad but are not integrated at policymaking levels.

Nurses in Pakistan work in a highly misogynist culture.

In the private sector, nurses are paid between Rs12,000 to Rs20,000 per month with frequent double shifts due to shortage of staff. The quality of their qualifications varies as some nursing teaching institutions exist only on paper, while many others lack basic infrastructure. There is poor monitoring of benchmarks and discipline as the Pakistan Nursing Council is often hampered by the health bureaucracy and even by executive district officers who interfere in nursing recruitment, training, inspection and examination. Even transfers and postings of nurses are not controlled by directors generals of nursing in the provinces.

According to an Aga Khan University study, there is a highly skewed physician-centred culture in Pakistan with most nurses not being recognised as medical professionals in their own right. “The low socioeconomic status of nurses, unsafe work environment, lack of respect from doctors, and the very nature of nurses’ work create a dichotomy in society’s attitude towards the nursing profession.” It was noted that nursing shortage and the image of the profession had a reciprocal relationship: while most people appreciated the critical role of nursing in healthcare, very few considered it a suitable profession for their daughters or sisters, and even television portrayed nurses as handmaidens of doctors.

This is in complete contrast with the more feasible and affordable nurse-centred culture in developed countries, where public health is embedded in the nursing profession to reduce healthcare costs. Nurses work in a variety of settings in primary, secondary, community and social care services in hospitals, health centres, hospices and teaching institutions. They serve local communities in emergencies, work as midwives, nurse the sick and old, and also cater to persons with disabilities and mental illnesses. In the UK, despite NHS budget cuts, there are 300,000 nurses, while in the US, the ratio is one doctor to four nurses.

In India, high-powered institutional mechanisms such as the Bhore and Kartar Singh Committees have brought about major changes in the nursing culture, improving their working hours and recommending a minimum of Rs20,000 per month as starting salary. From 2000 to 2016, BSc colleges increased from 30 to 1,752 and MSc colleges from 10 to 611 in India. There are also eight institutions offering PhD programmes in nursing. Florence Nightingale Awards including medals and cash are given every year on International Nursing Day to 35 nurses for outstanding services.

In Pakistan, neither the legislators nor health professionals have effectively addressed the problems faced by nurses in the country. According to a Pakistan Medical Association office-bearer, it is an emergency situation and a special commission has to be put in place to review the entire system of nursing and align it with the requirements of not only the SDGs but the entire public health system. The number of nursing teaching colleges needs to be increased manifold and PhD programmes introduced. In order to improve the dismal doctor to nurse ratio, the government must take affirmative action to support nurses with higher salaries, a proper service structure and improve their image by publicly acknowledging through the media their services as a critical component of healthcare.

It is imperative that the bureaucracy of the health sector provide respect and space to the Pakistan Nursing Council to fulfil its mandate of training, inspection and protection of nurses without interference, providing modernised curricula, and ensuring access to foreign trainings which are usually used up by bureaucrats based in Islamabad. Other bodies such as the Pakistan Nursing Federation and Pakistan Nursing Association should also play their due role in empowering nurses, providing leisure facilities and encouraging the use of social media such as Twitter and WhatsApp to communicate with patients.

The writer is former federal secretary.

This story was originally published by Dawn, Pakistan

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How Prison Conditions Fuel the Tuberculosis Epidemichttp://www.ipsnews.net/2018/07/prison-conditions-fuel-tuberculosis-epidemic/?utm_source=rss&utm_medium=rss&utm_campaign=prison-conditions-fuel-tuberculosis-epidemic http://www.ipsnews.net/2018/07/prison-conditions-fuel-tuberculosis-epidemic/#respond Thu, 19 Jul 2018 16:01:57 +0000 David Bryden http://www.ipsnews.net/?p=156787 David Bryden is the TB advocacy officer at RESULTS. He coordinates US advocacy, and co-chairs the TB Roundtable

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Inmates at the National Penitentiary in Port-au-Prince, Haiti. Credit: David Bryden

By David Bryden
WASHINGTON DC, Jul 19 2018 (IPS)

Dozens of grown men peered from behind the barred doorway of a crammed window-less prison cell, eyes pleading desperately from sweaty faces.

Their physical discomfort was so palpable, I could almost feel it. Because of my work, I also knew of at least one serious unseen risk facing them – that of contracting tuberculosis in the cramped, poorly ventilated space.

Touring the largest prison in Port-au-Prince was part of a research visit I made there in 2106. Two years later, the image of those men still haunts my memories—more so now that the first ever United Nations High-Level Meeting (UNHLM) on Tuberculosis (TB) approaches in September and the global spotlight gets set to turn on this neglected disease and conditions that continue to influence its spread.

At the upcoming 22nd International AIDS Conference, in Amsterdam July 23 – 27, civil society organizations will seek to put the spotlight on vulnerable populations and deepen collaboration to ensure a united position on key issues such as the link between HIV/AIDS and TB and the need for an integrated approach to diagnosis and treatment.

A special session, Friday, July 27, titled “Seizing the moment for TB: Current challenges in TB care and in TB and HIV integration,” will feature Eric Goosby, the United Nation’s Secretary General’s Special Envoy on TB; Paul Farmer, co-founder of Partners in Health; and Carol Nawina Kachenga, of the Zambian-based group CITAMplus. Former US President Bill Clinton will give the special sessions opening keynote.

The scale of the prison problem is particularly staggering. In 2016, The Lancet published a study by Kate Dolan and her colleagues at the University of New South Wales explaining that of the total global incarcerated population of 10.2 million, 2.8 percent or 286,000 have active TB.

A further 3.8 percent or 389, 000 also have HIV. The Stop TB Partnership estimates that, the risk of TB in prison on average, is 23 times higher than in the general population.

The high rate of HIV in prisons is exacerbated by a lack of prevention options as well as sexual violence. However, even prisoners living with HIV who can overcome barriers to treatment, face a much greater risk of TB.

Data from sub-Saharan Africa show a prevalence of HIV infection among prisoners from 2.3 percent to 34.9 percent and of TB, from 0.4 to 16.3 percent.

Overcrowding seems to be the single biggest root cause of the prison TB epidemic. Dolan et al lay the blame on the practice of mass incarceration of people who inject drugs. They urge decriminalization, alternatives to incarceration, and access to opioid agonist therapy.

Another driver of overcrowding is the use of pre-trial detention and the slow process of adjudication. Slow judicial processes have been blamed for the massive overcrowding in jails in the Philippines, a country with a high level of TB, including drug resistant TB.

In Port-au-Prince, the National Penitentiary was built for 800 prisoners, but now houses 4600; the rate of tuberculosis is 17 times that of the general population of the country. There is no prison hospital in which patient can be appropriately isolated and treated.

The prisoners are poorly fed, with only one or two meals a day and little or no protein, making tuberculosis – caused by an airborne bacterium- even more likely. The state of the world’s prisons ensures they are “factories” for TB transmission, including drug resistant TB—now the single biggest infectious disease killer in the world. Tackling prison conditions, therefore, is essential to ending the disease.

Some countries are directly addressing the issue. Mongolia, for instance, reported a two-thirds reduction from 2001 to 2010 of TB among prisoners through active TB case finding and upgrading health services and living conditions. Reducing prison populations and improved nutrition was important to this success.

In a project in Zambia, supported by TB REACH, peer educators have been trained from among the prison population to support TB screening as well as HIV counseling. This approach was found to be highly effective and sustainable, since the peer educators knew the prison culture and were enthusiastic and committed.

Experts on TB also point to the need for screening and treatment, not only for active TB, but also for latent TB infection, which is very widely prevalent among prisoners, to support better TB prevention. TB preventive therapy, a course of antibiotics, has been proven highly effective but is still not widely used in high burden countries.

At the penitentiary in Port-au-Prince, I saw the dedicated work of an NGO, Health Through Walls, to provide TB and HIV services, despite adverse conditions. With USAID and Global Fund support, they are providing HIV and TB diagnoses, including using the latest methods, as well as treatment and nutritional supplementation, in eleven prisons in Haiti. With a tiny budget, they are saving many lives.

During a civil society hearing on TB held earlier this year at the United Nations, Assembly in preparation for the UNHLM, Donald Tobaiwa, from Jointed Hands Welfare Organization, Zimbabwe, called for urgent action to address TB in prisons, as well as in the mining industry.

“What are countries doing about this?” he asked. “The question, he said, was not what it costs to find people with TB, but what it will cost us if we fail to find them.”

Advocates gathering at the UNHLM plan to make this their rallying cry to heads of state. With a strong commitment to finding TB cases, including those hiding in plain sight in prison populations, and support from member states for an independent and regular progress assessment, the meeting cane be a turning point in the drive to end this disease.

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Excerpt:

David Bryden is the TB advocacy officer at RESULTS. He coordinates US advocacy, and co-chairs the TB Roundtable

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Despite Progress, South Asia Faces Daunting Challenges in Water & Sanitationhttp://www.ipsnews.net/2018/07/despite-progress-south-asia-faces-daunting-challenges-water-sanitation/?utm_source=rss&utm_medium=rss&utm_campaign=despite-progress-south-asia-faces-daunting-challenges-water-sanitation http://www.ipsnews.net/2018/07/despite-progress-south-asia-faces-daunting-challenges-water-sanitation/#respond Mon, 16 Jul 2018 15:16:16 +0000 Vanita Suneja http://www.ipsnews.net/?p=156725 Vanita Suneja is Regional Advocacy Manager, South Asia, for WaterAid

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A girl washes her hands and face with soap and water at a water tap, installed with the support of HSBC and WaterAid, in Sylhet District, Bangladesh. Credit: WaterAid/Abir Abdullah

By Vanita Suneja
NEW DELHI, Jul 16 2018 (IPS)

In 2030, when I would be turning sixty, I’d like to tell my grandchildren the story of how – once upon a time – the lives of poor people in South Asia were transformed: that leaders came together to bring economic prosperity and social development to people that until then had lived in an unequal and polluted world.

What I am more likely to tell them, is how – even with the knowledge that nearly 800,000 children under five die every year from diarrhoeal diseases caused by poor water and sanitation – governments failed to act and people remain locked in a cycle of ill-health and poverty.

Ending the cycle of poverty absolutely by 2030, without leaving behind a single person, is the most ambitious promise made to date by world leaders in 2015 when they adopted the sustainable development goals: which included the provision of universal access to water and sanitation that is essential for achieving significant progress in health, education and equality.

When people have access to clean water and decent sanitation, their wellbeing increases: women and girls have time to go to school because they don’t have to fetch water for their families – this responsibility often falls on the female members or a family, and with better health comes increased productivity both in school and at work.

For every £1 invested in WASH at least £4 is returned in increased productivity, primarily based on improved health and more time to work or study.

With floods and droughts affecting the region at different times of the year, it is important that climate-resilient services are set up. This includes managing resources responsibly and minimising the effects of climate change.

Governments in South Asia have taken steps in the right direction. Nepal has taken a rights-based approach to water, sanitation and hygiene in its constitution, which sets the bar for accountability at the highest political level. The constitution states peoples’ right to live in healthy and clean environment as well as the right to access to safe water and sanitation.

Through its Clean India Mission, an incredible story emerges from India, where considerable progress has been made on sanitation. The Indian government aims to ensure that the entire population will have access to a decent toilet by 2019, so that nobody has to go in the open after that.

Bangladesh has shown the way on inclusion, having achieved the Open Defecation Free status before 2015. The government of Bangladesh has since adopted an inclusive approach to water as well, and is working to connect all those living in makeshift houses in the capital’s slums to a piped network.

Despite this progress, South Asia faces daunting challenges. Governments, donors and the private sector must be held accountable if they are not doing enough. While 88 percent of South Asia’s population has access to at least basic water, still more than half the population of South Asia lacks access to even basic sanitation.

Disparities are large between cities and rural areas: while 5.6 percent of the urban population in South Asian nations defecate in the open – having no other option as no decent sanitation is available to them – yet in rural areas, this is as high as 45 percent.

For all nations to deliver on their commitment to provide universal access to water and sanitation by 2030, governments need to prioritise WASH – the NGO term for water, sanitation and hygiene – and ensure that finances are directed towards achieving those goals.

Sanitation, water and hygiene have a bearing on health, education, nutrition, equality and poverty eradication. WASH is thus crucial to breaking the cycle of ill-health and poverty in which too many people still live today.

An important part of the promise to deliver water and sanitation to everyone, everywhere, is to leave no one behind. This requires renewed focus on addressing the equity challenge.

The private sector and civil society groups have an important role to play in partnering with the government to reach out to marginalized and vulnerable populations.

This week, world leaders are coming together at the United Nations in New York to discuss the progress made on sustainable development goal 6 – to provide universal access to clean water and decent sanitation.

This is an important moment to highlight the urgency of having clean drinking water and a proper toilet, and to ensure that the lives of people in South Asia and beyond will be transformed within a generation.

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Excerpt:

Vanita Suneja is Regional Advocacy Manager, South Asia, for WaterAid

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Age Appropriate Sexuality Education for Youth Key to National Progresshttp://www.ipsnews.net/2018/07/age-appropriate-sexuality-education-youth-key-national-progress/?utm_source=rss&utm_medium=rss&utm_campaign=age-appropriate-sexuality-education-youth-key-national-progress http://www.ipsnews.net/2018/07/age-appropriate-sexuality-education-youth-key-national-progress/#respond Wed, 11 Jul 2018 05:52:36 +0000 Josephine Kibaru and Siddharth Chatterjee http://www.ipsnews.net/?p=156636 Fifty years ago at the International Conference on Human Rights, family planning was affirmed to be a human right. It is therefore apt that the theme for this year’s World Population Day is a loud reminder of this fundamental right. It is a right that communities especially in Africa have for long held from its […]

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A community health volunteer informs community members about various methods of family planning. Photo Credit: UNFPA Kenya

By Dr. Josephine Kibaru-Mbae and Siddharth Chatterjee
NAIROBI, Kenya, Jul 11 2018 (IPS)

Fifty years ago at the International Conference on Human Rights, family planning was affirmed to be a human right. It is therefore apt that the theme for this year’s World Population Day is a loud reminder of this fundamental right.

It is a right that communities especially in Africa have for long held from its youth, with parents shying off from the subject and policymakers largely equivocal. The result is that the continent has the highest numbers of teenagers joining the ranks of parenthood through unintended pregnancies.

The statistics are disquieting: as per the Kenya Demographic and Health Survey (KDHS 2014), one in every five adolescent girls has either had a live birth, or is pregnant with her first child. Among the 19-year olds, this doubles to two out of ten. In a recent study, six out of ten girls surveyed in two Nairobi slums reported having had an unintended pregnancy.

Among sexually active unmarried adolescents, only about half use any form of contraceptives, yet only one in three women and one in four men, per the same study, knew the correct timing regarding when a woman is likely to get pregnant.

The World Population Day should awaken us all to the critical role of those in authority in ensuring children grow up not only in an atmosphere of love and understanding, but also that they live to their full potential.

Young mothers are four times more likely than those over 20, to die in pregnancy or childbirth, according to the World Health Organization. If they live, they are more likely to drop out of school and to be poor than if they didn’t get pregnant. And their children are more prone to have behavioral problems as adolescents, which means they are also more likely to stay poor. This cycle of poverty has to be stopped.

Unfortunately, ideological and cultural fault lines appear every time discussions about teaching the youth about taking responsibility for their sexual and reproductive health.

As debates continue, the toll is unrelenting, with complications in pregnancy and childbirth being the leading cause of death among adolescent girls in developing countries. The rate of new HIV infections among adolescents is rising, from 29% in 2013 to 51% in 2015.

The traditional role of families and communities as primary sources of reproductive health information and support has dissipated, replaced by peers and social media. Though the National Adolescent Sexual and Reproductive Health Policy of 2015 aims to address young people’s health and well-being, help realise gender equality and reduce inequalities, much remains to be done to implement the good intentions of the policy.

Yet evidence from many countries has shown that structured, age appropriate sexuality education provides a platform for providing information about sexuality and relationships, based on evidence and facts, in a manner that is positive, that builds their skills.

Scientific evidence shows that when young people are empowered with correct information they are less likely to engage in early or in unprotected sex. This is attributable to the fact that they can undertake risk analysis and make informed decisions.

The ultimate goal for Kenya’s population programmes should be anchored on the demographic dividend paradigm. In short, in which areas should we invest our resources so that we can achieve the rapid fertility decline that can change the age structure to one dominated by working-age adults?

Countries such as the Asian Tigers, that have achieved rapid economic growth have strong family planning programmes that help women to avoid unplanned pregnancies and have the smaller families. Family planning is a key tool for reducing poverty since it frees up women to work and leads to smaller families, allowing parents to devote more resources to each child’s health and education.

First, we must make the obvious investments in reproductive health information and services for all who need them. The other key enablers for the demographic dividend window of opportunity include quality education to match economic opportunities, investing in the creation of new jobs in growing economic sectors and good governance

Second, education, especially for girls, increases the average age at marriage and lowers family size preferences. However, it must also be education that aims to promote the supply of a large and highly educated labour force, which can be easily integrated into economic sectors.

Third, Kenya must therefore identify the skills that are specific to the country’s strongest growing economic sectors, such as agriculture and manufacturing.

Finally, combining sound health and education policies with an economic and governance environment that favours capital accumulation and investment will move Kenya closer towards experiencing the economic spur of the demographic dividend.

As the country takes strides towards the achievement of Agenda 2030 on Sustainable Development Goals targets, all stakeholders including the United Nations, the government of Kenya, faith based communities, parents and others should all work together to empower adolescents and young people for positive health outcomes.

Young people are the backbone of this country and we owe them the best investment for the future through a multi-sectoral approach. Failure to do that means any national transformative agenda, including the SDGs and the Big Four, will be difficult to achieve.

Josephine Kibaru-Mbae
(@NCPDKenya) is the Director-General, National Council for Population and Development, Govt of Kenya. Siddharth Chatterjee is the United Nations Resident Coordinator in Kenya.

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Keep Water Out of the Reach of Childrenhttp://www.ipsnews.net/2018/07/keep-water-reach-children/?utm_source=rss&utm_medium=rss&utm_campaign=keep-water-reach-children http://www.ipsnews.net/2018/07/keep-water-reach-children/#respond Tue, 10 Jul 2018 11:47:49 +0000 Behailu Shiferaw http://www.ipsnews.net/?p=156632 Behailu Shiferaw is communications specialist for WaterAid in the East Africa region.

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Mukakibibi, 50, is a two-term village chief in a village in Rweru, Bugesera, Rwanda. Credit: WaterAid/ Behailu Shiferaw

By Behailu Shiferaw
KIGALI, Rwanda, Jul 10 2018 (IPS)

To many of us, ‘keep out of the reach of children’ is a phrase we see printed on labels for medicines and chemicals. To mothers in Rweru Sector, Rwanda, it’s a daily principle to live by.

“Once we collected the water, we wouldn’t just leave it anywhere until it is boiled and safe to drink. We always put it at a height the younger ones couldn’t reach. We feared they might accidentally drink it,” 50-year-old Mukakibibi Priscile told me.

In the village, mothers like Mukakibibi could not afford to be complacent. A slip-up could have serious consequences. Only a few years ago, Mukakibibi’s neighbour and close friend, Zebuliya, lost her three-year-old child to diarrhoea, high fever and vomiting, all of which, the doctor told her, are directly linked to drinking unclean water.

Three years later, the village is transformed now that its 6,000 people have access to clean water close to their homes. WaterAid Rwanda’s collaboration with DfID made it possible to dig two new boreholes in an area with proven underground water potential. Those two boreholes give a combined yield of 3.4 litres per second, which is enough for such a small village.

A solar-powered pump that needs little maintenance and has zero running cost for the communities pumps the water into two 40,000 litre tanks, which is then used to supply the village, the school and the health centre with water. Rural households access the water through five water kiosks, one of which happened to fall right in front of Mukakibibi’s house.

Mukakibibi could not be happier; instead of walking for an hour-and-a-half to get dirty water from the lake, she now needs only a few minutes to fetch clean water to cook, drink, or wash with. No longer does she need to hide the water from her grandson.

The Nzangwa Health Centre in the village has also undergone a transformation; the head of the centre, Ndamyuwera Edison, told me he had not heard of any child who died of waterborne diseases over two years, since the villagers have access to clean water.

In addition to a constant clean water supply, the health centre has also got a new waste burner, a placenta pit and a medical waste disposal chamber. The clinic also has a fully revamped and functioning block of showers and toilets.

Ndamyuwera explained that before the health centre had a clean water supply, the janitors were so busy fetching water that none of the delivery rooms were cleaned in between births, at great risk of mothers and their babies.

When I met one of the janitors, Eric, in 2016, he was barely around to do any cleaning work. Instead, he was constantly transporting water in jerry cans on his run-down bike. I once followed him on one of his water runs; when we got down to the lake – after a good 30 or 35-minute biking up and down a zig-zagging dirt road – he got off the bike, unstrapped the jerry cans, took off his sleepers, folded up the legs of his trousers and walked straight in. No dipping his toes first.

When I saw him again now, after WaterAid had brought water into the health centre, I found Eric in blue overalls, rubber boots and safety gloves. He is a full-time janitor now.

On one side of his bedroom in his house hangs one of his old jerry cans – covered and embellished in a fertiliser sack. In the middle is a hole out of which shows a speaker connected to his radio set. Eric crawled over his bed to connect two thin wires, and music filled the room. Now that is transformation – I thought.

Across the world 844 million people still do not have access to clean water, and 1 in 3 people still live without adequate sanitation facilities. In Rwanda alone 43% of people live without basic access to water, while 38% of people do not have a decent toilet. Each year, over 900 children under 5 die from diarrhoea.

World leaders have come together at the United Nations headquarters in New York for the High Level Political Forum (HLPF), 9 July-18 July, to review the progress that has been made on Sustainable Development Goal 6 (SDG 6) – to provide clean water and sanitation to everyone, everywhere.

On current progress, Rwanda is on course to have universal access to clean water by 2082 and to give everyone access to a decent toilet by 2047.

To achieve the transformation that Mukakibibi’s village has gone through all around Rwanda, efforts on health and nutrition need to be integrated with action on water and sanitation. Global goal 6 on water, sanitation and hygiene for all underpins progress towards the global goal on ending malnutrition and providing health for all.

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Excerpt:

Behailu Shiferaw is communications specialist for WaterAid in the East Africa region.

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New & Resurgent Infectious Diseases Can Have Far-reaching Economic Repercussionshttp://www.ipsnews.net/2018/07/new-resurgent-infectious-diseases-can-far-reaching-economic-repercussions/?utm_source=rss&utm_medium=rss&utm_campaign=new-resurgent-infectious-diseases-can-far-reaching-economic-repercussions http://www.ipsnews.net/2018/07/new-resurgent-infectious-diseases-can-far-reaching-economic-repercussions/#respond Tue, 03 Jul 2018 10:55:13 +0000 David E. Bloom and JP Sevilla http://www.ipsnews.net/?p=156522 DAVID E. BLOOM is the Clarence James Gamble Professor of Economics and Demography, DANIEL CADARETTE is a research assistant, and JP SEVILLA is a research associate, all at Harvard University’s T.H. Chan School of Public Health.

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DAVID E. BLOOM is the Clarence James Gamble Professor of Economics and Demography, DANIEL CADARETTE is a research assistant, and JP SEVILLA is a research associate, all at Harvard University’s T.H. Chan School of Public Health.

By David E. Bloom, Daniel Cadarette and JP Sevilla
WASHINGTON DC, Jul 3 2018 (IPS)

Infectious diseases and associated mortality have abated, but they remain a significant threat throughout the world.

We continue to fight both old pathogens, such as the plague, that have troubled humanity for millennia and new pathogens, such as human immunodeficiency virus (HIV), that have mutated or spilled over from animal reservoirs.

Some infectious diseases, such as tuberculosis and malaria, are endemic to many areas, imposing substantial but steady burdens. Others, such as influenza, fluctuate in pervasiveness and intensity, wreaking havoc in developing and developed economies alike when an outbreak (a sharp increase in prevalence in a relatively limited area or population), an epidemic (a sharp increase covering a larger area or population), or a pandemic (an epidemic covering multiple countries or continents) occurs.

The health risks of outbreaks and epidemics—and the fear and panic that accompany them—map to various economic risks.

First, and perhaps most obviously, there are the costs to the health system, both public and private, of medical treatment of the infected and of outbreak control. A sizable outbreak can overwhelm the health system, limiting the capacity to deal with routine health issues and compounding the problem.

Beyond shocks to the health sector, epidemics force both the ill and their caretakers to miss work or be less effective at their jobs, driving down and disrupting productivity.

Fear of infection can result in social distancing or closed schools, enterprises, commercial establishments, transportation, and public services—all of which disrupt economic and other socially valuable activity.

Concern over the spread of even a relatively contained outbreak can lead to decreased trade. For example, a ban imposed by the European Union on exports of British beef lasted 10 years following identification of a mad cow disease outbreak in the United Kingdom, despite relatively low transmission to humans.

Travel and tourism to regions affected by outbreaks are also likely to decline. Some long-running epidemics, such as HIV and malaria, deter foreign direct investment as well.

The economic risks of epidemics are not trivial. Victoria Fan, Dean Jamison, and Lawrence Summers recently estimated the expected yearly cost of pandemic influenza at roughly $500 billion (0.6 percent of global income), including both lost income and the intrinsic cost of elevated mortality.

Even when the health impact of an outbreak is relatively limited, its economic consequences can quickly become magnified. Liberia, for example, saw GDP growth decline 8 percentage points from 2013 to 2014 during the recent Ebola outbreak in west Africa, even as the country’s overall death rate fell over the same period.

The consequences of outbreaks and epidemics are not distributed equally throughout the economy. Some sectors may even benefit financially, while others will suffer disproportionately.

Pharmaceutical companies that produce vaccines, antibiotics, or other products needed for outbreak response are potential beneficiaries. Health and life insurance companies are likely to bear heavy costs, at least in the short term, as are livestock producers in the event of an outbreak linked to animals.

Vulnerable populations, particularly the poor, are likely to suffer disproportionately, as they may have less access to health care and lower savings to protect against financial catastrophe.

Economic policymakers are accustomed to managing various forms of risk, such as trade imbalances, exchange rate movements, and changes in market interest rates. There are also risks that are not strictly economic in origin.

Armed conflict represents one such example; natural disasters are another. We can think about the economic disruption caused by outbreaks and epidemics along these same lines. As with other forms of risk, the economic risk of health shocks can be managed with policies that reduce their likelihood and that position countries to respond swiftly when they do occur.

Several factors complicate the management of epidemic risk. Diseases can be transmitted rapidly, both within and across countries, which means that timely responses to initial outbreaks are essential. In addition to being exacerbated by globalization, epidemic potential is elevated by the twin phenomena of climate change and urbanization.

Climate change is expanding the habitats of various common disease vectors, such as the Aedes aegypti mosquito, which can spread dengue, chikungunya, Zika, and yellow fever. Urbanization means more humans live in close quarters, amplifying the transmissibility of contagious disease.

In rapidly urbanizing areas, the growth of slums forces more people to live in conditions with substandard sanitation and poor access to clean water, compounding the problem.

Perhaps the greatest challenge is the formidable array of possible causes of epidemics, including pathogens that are currently unknown. In December 2015 the World Health Organization (WHO) published a list of epidemic-potential disease priorities requiring urgent research and development (R&D) attention.

That list has since been updated twice, most recently in February 2018 (see table).

Beyond this list, diseases that are currently endemic in some areas but could spread without proper control represent another category of threat. Tuberculosis, malaria, and dengue are examples, as is HIV.

Pathogens resistant to antimicrobials are increasing in prevalence throughout the world, and widespread pan-drug-resistant superbugs could pose yet another hazard. Rapid transmission of resistant pathogens is unlikely to occur in the same way it may with pandemic threats, but the proliferation of superbugs is making the world an increasingly risky place.

Epidemic risk is complex, but policymakers have tools they can deploy in response. Some tools minimize the likelihood of outbreaks or limit their proliferation. Others attempt to minimize the health impact of outbreaks that cannot be prevented or immediately contained. Still others aim to minimize the economic impact.

Investing in improved sanitation, provisioning of clean water, and better urban infrastructure can reduce the frequency of human contact with pathogenic agents.

Building strong health systems and supporting proper nutrition will help ensure good baseline levels of health, making people less susceptible to infection. Of course, strengthening basic systems, services, and infrastructure becomes easier with economic growth and development; however, policies to protect spending in these areas even when budgets are constrained can help safeguard developing economies from major health shocks that could significantly impinge upon human capital and impede economic growth.

Investment in reliable disease surveillance in both human and animal populations is also critical. Within formal global surveillance systems, it may be beneficial to develop incentives for reporting suspected outbreaks, as countries may reasonably fear the effects of such reporting on trade, tourism, and other economic outcomes.

The SARS epidemic, for instance, might have been better contained if China had reported the initial outbreak to the WHO earlier.

Informal surveillance systems
, such as ProMED and HealthMap, which aggregate information from official surveillance reports, media reports, online discussions and summaries, and eyewitness observations, can also help national health systems and international responders get ahead of the epidemiological curve during the early stages of an outbreak.

Social media offers additional opportunities for early detection of shifts in infectious disease incidence.

Collaborations for monitoring epidemic readiness at the national level, such as the Global Health Security Agenda and the Joint External Evaluation Alliance, provide information national governments can use to bolster their planned outbreak responses.

Additional research into which pathogens are likely to spread and have a big impact would be worthwhile.

Countries should be ready to take initial measures to limit the spread of disease when an outbreak does occur. Historically, ships were quarantined in port during plague epidemics to prevent the spread of the disease to coastal cities. In the case of highly virulent and highly transmissible diseases, quarantines may still be necessary, although they can inspire concerns about human rights.

Likewise, it may be necessary to ration biomedical countermeasures if supplies are limited. Countries should decide in advance if they will prioritize first responders and other key personnel or favor vulnerable groups, such as children and the elderly; different strategies may be appropriate for different diseases.

Technological solutions can help minimize the burden of sizable outbreaks and epidemics. Better and less-costly treatments—including novel antibiotics and antivirals to counter resistant diseases—are sorely needed. New and improved vaccines are perhaps even more important.

There is a significant market failure when it comes to vaccines against individual low-probability pathogens that collectively are likely to cause epidemics. Given the low probability that any single vaccine of this type will be needed, high R&D costs, and delayed returns, pharmaceutical companies hesitate to invest in their development. The profit-seeking interest does not align well with the social interest of minimizing the risk posed by these diseases in the aggregate.

Farsighted international collaboration can overcome this market failure—for example, the Coalition for Epidemic Preparedness Innovations, which is supported by the governments of Australia, Belgium, Canada, Ethiopia, India, Japan, Germany, and Norway, as well as the European Commission and various nongovernmental funders.

Its goals include advancing candidate vaccines against specific low-probability, high-severity pathogens through proof of concept to enable rapid clinical testing and scale-up in the event of outbreaks of those pathogens.

It also aims to fund development of institutional and technical platforms to speed R&D in response to outbreaks for which there are no vaccines. Similar funding models could support the development of a universal influenza vaccine.

Of course, new vaccines will be less useful if governments do not ensure that at-risk populations have access to them. Assured access could also motivate developing economies to participate actively in the vaccine R&D process.

In 2007 Indonesia withheld samples of the H5N1 influenza virus from the WHO to protest the fact that companies in wealthy countries often use samples freely provided by developing economies to produce vaccines and other countermeasures without returning any profit or other special benefits to the donors.

Beyond funding R&D, international collaboration could boost epidemic preparedness by supporting centralized stockpiling of vaccines and drugs that can be deployed where they are most needed. Such collaboration has obvious advantages over a system in which each country stockpiles its own biomedical countermeasures.

While some countries are more likely to need these countermeasures than others, the global public good of living without fear of pandemics should motivate cooperation and cost sharing.

In addition, wealthy countries at relatively low risk of suffering massive health impacts from most epidemics could suffer disproportionately large economic losses—even from faraway epidemics—given the size of their economies and reliance on foreign trade.

If outbreaks do occur and impose a substantial health burden, there are tools to limit the risk of economic catastrophe. As with natural disasters, insurance can help distribute the economic burden across sectors of the economy and regions.

Prioritizing personnel such as health care workers, members of the military, and public safety employees for distribution of biomedical countermeasures during an outbreak can help protect critical economic resources.

We cannot predict which pathogen will spur the next major epidemic, where that epidemic will originate, or how dire the consequences will be. But as long as humans and infectious pathogens coexist, outbreaks and epidemics are certain to occur and to impose significant costs.

The upside is that we can take proactive steps to manage the risk of epidemics and mitigate their impact. Concerted action now at the local, national, and multinational levels can go a long way toward protecting our collective well-being in the future.

http://www.imf.org/external/pubs/ft/fandd/2018/06/economic-risks-and-impacts-of-epidemics/bloom.htm?utm_medium=email&utm_source=govdelivery

Opinions expressed in articles and other materials are those of the authors; they do not necessarily reflect IMF policy.

The post New & Resurgent Infectious Diseases Can Have Far-reaching Economic Repercussions appeared first on Inter Press Service.

Excerpt:

DAVID E. BLOOM is the Clarence James Gamble Professor of Economics and Demography, DANIEL CADARETTE is a research assistant, and JP SEVILLA is a research associate, all at Harvard University’s T.H. Chan School of Public Health.

The post New & Resurgent Infectious Diseases Can Have Far-reaching Economic Repercussions appeared first on Inter Press Service.

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