Inter Press Service » Health News and Views from the Global South Sun, 22 Jan 2017 17:49:36 +0000 en-US hourly 1 360 Million of 625 Million People Are Overweight in Latin America and Caribbean Fri, 20 Jan 2017 18:36:14 +0000 Orlando Milesi FAO acting regional representative Eve Crowley (C) during the launch of the Panorama of Food and Nutrition Security in Latin America and the Caribbean 2016, at FAO headquarters in Santiago. The report , where it was warned that overweight affects 360 million people in the region. Credit: FAO

FAO acting regional representative Eve Crowley (C) during the launch of the Panorama of Food and Nutrition Security in Latin America and the Caribbean 2016, at FAO headquarters in Santiago. The report , where it was warned that overweight affects 360 million people in the region. Credit: FAO

By Orlando Milesi
SANTIAGO, Jan 20 2017 (IPS)

In Latin America and the Caribbean 360 million people are overweight, and 140 million are obese, warned the United Nations Food and Agriculture Organisation (FAO) and the Panamerican Health Organisation (PAHO).

“The rise in obesity is very worrying. At the same time the number of people who suffer from hunger has diminished in the region. We need to strengthen our efforts and have food systems with improved nutrition based on sustainable production methods to reduce those figures,” Eve Crowley, FAO acting regional representative, said Thursday at the organisation‘s headquarters in Santiago.

At the regional FAO office in Santiago on Thursday Jan. 19 the two organisations launched the Panorama of Food and Nutrition Security in Latin America and the Caribbean 2016, which sounded the alarm about the phenomenon in this region of just over 625 million people.

The problem, highlighted the report, largely affects children and women, increasing chronic diseases, driving up medical expenses for countries and individuals, and posing a threat to the quality of the future labour force that national development plans will require.

At the same time, the region has considerably reduced hunger: today only 5.5 per cent of the population of Latin America and the Caribbean is undernourished, the Caribbean being the area with the highest prevalence (19.8 per cent), largely because Haiti has the highest malnutrition rate in the world: 53.4 per cent.

Chronic child malnutrition (low height for age) in Latin America and the Caribbean also dropped, from 24.5 per cent in 1990 to 11.3 per cent in 2015, which translates into a decrease of 7.8 million children.

Despite the progress made, currently 6.1 million children still suffer from chronic malnutrition: 3.3 million in South America, 2.6 million in Central America, and 200,000 in the Caribbean. About 700,000 million children suffer from acute malnutrition, 1.3 per cent of them under the age of five.

Asked whether the difficulty of access to natural, good quality foods is due to the high prices or to a flawed production and distribution system, Crowley told IPS that it is “a combination of factors“.

“We talk about a food system because it involves a set of factors – from supplies to which foods are available at a national level. For example in Latin America there is a great availability of sugary foods and meat. But ensuring physical availability and access to nutritious, healthy, affordable fresh food in every neighborhood is still hard to achieve,” she said.

“There is evidence that food high in bad calories, from ultra-processed sources, is less expensive than healthy food, and this poses a dilemma to guaranteeing good nutrition for the entire population, particularly people in low-income households,” she said.

Crowley said there are changes in consumption patterns, with people shifting away from their traditional diets based on legumes, cereals, fruits and vegetables toward super-processed foods rich in saturated fats, sugar and sodium, which are backed by extensive advertising.

A girl wearing traditional dress from Bolivia’s highlands region shows a basket with fruit during a school exhibit in La Paz to promote good eating habits among students.. Programmes to promote healthy eating are spreading through schools in Latin America, to address problems such as malnutrition and overweight. Credit: Franz Chávez/IPS

A girl wearing traditional dress from Bolivia’s highlands region shows a basket with fruit during a school exhibit in La Paz to promote good eating habits among students.. Programmes to promote healthy eating are spreading through schools in Latin America, to address problems such as malnutrition and overweight. Credit: Franz Chávez/IPS

She called for better information, nutrition warnings, taxes on unhealthy foods, and subsidies for healthy foods necessary for the population.

With the exception of Haiti (38.5 per cent), Paraguay (48.5 per cent) and Nicaragua (49.4 per cent), overweight affects more than half of the population of the countries in the region, with Chile (63 per cent), Mexico (64 per cent) and the Bahamas (69 per cent) showing the highest rates, states the report.

Erick Espinoza, a physical education teacher in a private school in a middle-class neighborhood in Santiago, sees the problem of the change in eating and behavioural habits of his students, aged six to 10, which is a reflection of what is happening throughout the region, and in particular in the countries with the highest overweight and obesity rates.

“As snacks, they don’t bring fruit, only potato chips, crackers or cookies, fizzy drinks, juice or milk high in sugar. And they don’t just bring a small package, but sometimes two or three packages or even a big one,” he told IPS, referring to the snack during recess.

Since 2016, kiosks that sell food in Chilean schools have been prohibited from selling foods high in sugar, sodium or fat. “They have to sell fruit, but the kiosk is not doing well because the children don’t buy fruit or yoghurt, but bring other things from home,“ said the teacher.

Alexandra Carmona, a teacher at a municipal school for children aged four to 17 in a low-income neighborhood in Santiago, pointed to a different problem.

“There was an obese boy who was really bullied. Everybody would say ‘hey fattie‘, ‘hey grease ball‘. So I called the parents to tell them what was happening, but they didn’t give it any importance,“ she told IPS. The boy ended up in a special school even though he had no learning disability.

At her school, the school provides meals, but many children won‘t accept the legumes and balanced diet that is offered.

The Panorama reports that 7.2 per cent of children under five years old in the region are overweight, which means a total of 3.9 million children, including 2.5 million in South America, 1.1 million in Central America and 200,000 in the Caribbean.

The countries with the highest rates of overweight in children under five years old are Barbados (12 per cent), Paraguay (11.7 per cent), Argentina (9.9 per cent), and Chile (9.3 per cent).

The report also points out that several countries have adopted taxes on sugary beverages, including Barbados, Chile, Dominican Republic and Mexico, while others such as Bolivia, Ecuador, Peru and Chile have laws on healthy nutrition which regulate advertising and labeling of food products.

With respect to the countries that stand out in sales per person of ultra-processed products, the report says that Argentina, Chile, Mexico and Uruguay exceed the regional average of 129.6 kilograms per inhabitant. Mexico ranks first, with 214 kg per inhabitant, and Chile is second with 201.9 kg.

In 30 of the 33 countries studied , more than half of the population over 18 is overweight, and in 20 of them obesity among women is at least 10 percent higher than among men.

According to PAHO Director Carissa F. Etienne, “the region is facing a two-fold burden of malnutrition, which has to be fought with a balanced diet which includes fresh, healthy and nutritious foods, produced in a sustainable manner, besides addressing the main social factors that lead to malnutrition.”

In addition to the lack of access to healthy foods, she mentioned the difficulty of access to clean water and sewage services, education and health services, and social protection programmes, among others.

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Why Polio Campaigns Must Reach Every Last Child in Kenya Fri, 20 Jan 2017 09:23:32 +0000 Rudi Eggers and Werner Schultink Credit: ©UNICEFKENYA/2011/MODOLA


By Rudi Eggers and Werner Schultink
NAIROBI, Jan 20 2017 (IPS)

For a long time, no person in Kenya suffered the devastating disability that is caused by polio. In fact, the only reminder in the early 2000s was the victims in the streets of Nairobi, many of whom had been paralyzed as children and adults. Their lives were ravaged by this terrible, vaccine-preventable disease.

A five-day polio campaign that started on 18 January, 2017 targets more than 2.9 million children below the age of 5 years in fifteen counties. Children in high-risk areas -- some of whom have never had access to immunization services before -- will have an opportunity to be vaccinated against polio.
Sadly, in 2013 a large outbreak of polio in Nigeria spread across the continent, affecting several countries on its way east. Kenya was not spared.  Fourteen new polio cases were confirmed. The polio virus struck those that were unvaccinated – the most vulnerable and the most excluded — children in areas with poor access to health services, refugees, and nomadic communities.  Fortunately, a rapid response by the Kenyan Government brought the polio outbreak under control, and the last case was reported in July 2013.  At that time, it seemed that the country was well on the road to being declared polio-free.

However, recently, concerned scientists have pointed to the increasing risk of polio, particularly the large numbers of children who remain unvaccinated, especially those in vulnerable populations in the northern part of the country and in the informal settlements of Nairobi and Mombasa.  Furthermore, the notion that the African continent was free from the polio virus was shattered when four new polio cases were reported in northern Nigeria. Given the previous experience, health experts and Ministries of Health recommended that the areas with low vaccination rates should be targeted with vaccination campaigns, specifically designed to reach those that missed out on the routine vaccinations.

Since the establishment of the Expanded Programme of Immunization (EPI) in 1980, Kenya deserves credit for reaching majority of the children with life-saving vaccines. But there is still a lot more work that needs to be done; progress in the country is very uneven and many children remain unvaccinated. It is estimated that 400,000 (3 out of 10) children still do not receive all the required scheduled doses of vaccines by their first birthday. This build-up of under-immunized children has previously contributed to outbreaks of polio. Most of these children come from poor families, the urban informal settlements and the hard-to-reach parts of the country, particularly arid and semi-arid (ASAL) regions where access to health services is limited.

A child receives vaccination against polio in a Mother and Child Health (MCH) Clinic at Mukuru Health Centre, in Nairobi, Kenya.  Credit: ©UNICEFKENYA/2016/NOORANI

A child receives vaccination against polio in a Mother and Child Health (MCH) Clinic at Mukuru Health Centre, in Nairobi, Kenya. Credit: ©UNICEFKENYA/2016/NOORANI

As long as there is a child out there who has contracted this disease, no matter where they live or who they are – all children everywhere are not safe. The four cases confirmed in October 2016 in the current polio outbreak in Nigeria place other African countries, including Kenya, at risk of importing the wild polio virus, due to the unaccounted number of unvaccinated children across the continent as well as the high population movement.

In the final push towards eradicating polio by 2018, Kenya with its strict monitoring system for the safety and quality assurance of vaccines, has already proved that it has the capacity to make the whole country polio-free. A five-day polio campaign that started on 18 January, 2017 targets more than 2.9 million children below the age of 5 years in the fifteen counties of Bungoma, Busia, Garissa, Isiolo, Lamu, Mandera, Marsabit, Nairobi, Samburu, Tana River, Trans Nzoia, Turkana, Wajir, West Pokot and Uasin Gishu. Children in high-risk areas — some of whom have never had access to immunization services before — will have an opportunity to be vaccinated against polio.

To ensure that all vulnerable children are reached, the exercise will be relying on the steadfast commitment of vaccination teams and the communities they serve. These heroic women and men in most cases walk long distances from house-to-house, often in the most dangerous of circumstances to reach all children. Communities where the polio campaign is backed and encouraged by religious and community leaders have much higher rates of protection than those that lack this support.

As part of the worldwide campaign to eradicate polio, there is need for everyone to rally behind this polio vaccination campaign, to reach each and every child regardless of their geographical location of their status in society. We have a responsibility to protect hundreds of thousands of children in Kenya from being paralyzed for life; from being excluded from their communities; and from being denied their right to a full and productive life.

In 2017 and beyond, no child in Kenya should suffer the consequences of a vaccine-preventable disease, for every child deserves to live in a polio-free world.

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A Women’s March on the World Fri, 20 Jan 2017 04:27:24 +0000 Tharanga Yakupitiyage Participants in the 2015 New York March for Gender Equality and Women's Rights. Credit: UN Photo/Devra Berkowitz.

Participants in the 2015 New York March for Gender Equality and Women's Rights. Credit: UN Photo/Devra Berkowitz.

By Tharanga Yakupitiyage
NEW YORK, Jan 20 2017 (IPS)

Just one day after the inauguration of President-elect Donald Trump, hundreds of thousands of women are expected to attend one of the largest demonstrations in history for gender equality.

Starting out as a social media post by a handful of concerned women, the Women’s March on Washington quickly transformed, amassing over 400 supporting organisations representing a range of issues including affordable and accessible healthcare, gender-based violence, and racial equality.

“It’s a great show of strength and solidarity about how much women’s rights matter—and women’s rights don’t always take the front page headlines,” Nisha Varia, Advocacy Director of Human Rights Watch’s Women’s Rights Division told IPS.

Despite the variety of agendas being put forth for the march, the underlying message is that women’s rights are human rights, Executive Director of Amnesty International USA Margaret Huang told IPS.

“All people must be treated equally and with respect to their rights, no matter who is in positions of authority and who has been elected,” she said.

Organisers and partners have stressed that the march is not anti-Trump, but rather is one that is concerned about the current and future state of women’s rights.

“It’s not just about one President or one candidate, there’s a much bigger banner that we are marching for…our rights should not be subject to the whims of an election,” Kelly Baden, Center for Reproductive Rights’ Interim Senior Director of U.S. Policy and Advocacy told IPS.

The health system also risks returning to a time when many insurance plans considered pregnancy a pre-existing condition, barring women from getting full or any coverage.

“It’s about women, not Trump,” she continued.

The rhetoric used during the election is among the concerns for marchers as it reflects a troubling future for women’s rights.

During his campaign, President-elect Trump made a series of sexist remarks from calling Fox News host Megyn Kelly a “bimbo” to footage showing him boasting of sexual assault. Though Trump downplayed his remarks as “locker room talk,” his rhetoric is now being reflected in more practical terms through cabinet nominations.

Huang pointed to nominee for Attorney-General Jeff Sessions who has a long and problematic record on women’s rights including voting against the reauthorisation of the Violence Against Women Act, rejecting anti-discrimination protections for lesbian, gay, bisexual and transgender (LGBT) people, and opposing the Lilly Ledbetter Fair Pay Act of 2009 which addresses pay discrimination.

During her confirmation hearing, Nominee for Secretary of Education Betsy DeVos wouldn’t say if she would uphold title IX which requires universities to act on sexual assault on campuses.

According to the National Sexual Violence Resource Center, one in five women and one in 16 men are sexually assaulted while in college.

The new administration has also recently announced cuts to the Department of Justice’s Violence Against Women Grants, which distribute funds to organisations working to end sexual assault and domestic violence.

“There is no question that we’re going to have some challenges in terms of increasing protections for women’s rights over the next few years,” said Huang to IPS.

Meanwhile, Varia pointed to other hard fought gains that risk being overturned including the Affordable Care Act (ACA). The ACA, which U.S. Congress is currently working to repeal, provides health coverage to almost 20 million Americans by prohibiting insurers from denying insurance plans due to pre-existing conditions and by providing subsidies to low-income families to purchase coverage.

If repealed, access to reproductive services such as contraception and even information will become limited. The health system also risks returning to a time when many insurance plans considered pregnancy a pre-existing condition, barring women from getting full or any coverage.

“Denying women access to the types of insurers or availability of clinics that can help them get pre-natal checks and can help them control their fertility by having access to contraception—these are all the type of holistic care that needs to be made available,” Varia said.

The U.S. is one of the few countries in the world where the number of women dying as a result of child birth is increasing, Varia noted.

In Texas, maternal mortality rates jumped from 18.8 deaths per 100,000 live births in 2010 to 35.8 deaths in 2014, the majority of whom were Hispanic and African-American women. This constitutes the highest maternal mortality rate in the developed world, closer in numbers to Mexico and Egypt than Italy and Japan, according to World Bank statistics.

A UN Working Group also expressed their dismay over restrictive health legislation, adding that the U.S. is falling behind international standards.

Though the ACA repeal and potential defunding of Planned Parenthood, another key reproductive services provider, threatens all women, some communities are especially in danger.

Francis Madi, a marcher and Long Island Regional Outreach Associate for the New York Immigration Coalition, told IPS that immigrant and undocumented immigrant women face additional barriers in accessing health care.

Most state and federal forms of coverage such as the ACA prohibits providing government-subsidised insurance to anyone who cannot prove a legal immigration status. Even for those who can, insurance is still hard or too expensive to acquire, making programs like Planned Parenthood essential.

“I can’t even do my job as an organiser asking for immigrant rights if I’m not able to access the services I need to live here,” Madi told IPS.

Madi highlighted the opportunity the march brings in working together through a range of issues and identities.

“I’m going because as a woman and an immigrant and an undocumented immigrant as well…it’s very important to attend this march to show we can work together on our issues,” she told IPS.

“If we don’t organize with each other, we can’t really achieve true change,” she continued.

In its policy platform, organisers of the Women’s March on Washington also stressed the importance of diversity, inclusion and intersectionality in women’s rights.

“Our liberation is bound in each other’s,” they said.

This includes not only women in the U.S., but across the world.

“There’s definitely going to be an international voice in this, not just U.S. activists,” Huang told IPS.

Marching alongside women in Washington D.C. on January 21st will be women in nearly 60 other countries participating in sister marches from Argentina to Saudi Arabia to Australia.

“Women are concerned that a loss of a champion in the U.S. government will have significant impacts in other countries,” Huang said. Of particular concern is the reinstatement of the “global gag rule” which stipulates that foreign organisations receiving any U.S. family planning funding cannot provide information or perform abortions, even with funding from other sources. The U.S. does not fund these services itself.

The policy not only restricts basic right to speech, but analysis shows that it has harmed the health of low-income women by limiting access to family planning services.

The US Agency for International Development (USAID) is the world’s largest family planning bilateral donor.

Though the march is important symbolic act of solidarity, it is just the first step.

“We are also part of a bigger movement—we need to come together and be in solidarity on Saturday and then we need to keep doing the hard work [during[ the long days and months and years of organising that we have ahead of us,” Baden said.

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Kenya Can Lead the Way to Universal Health Care in Africa Mon, 16 Jan 2017 11:14:21 +0000 Siddharth Chatterjee The UN in Kenya works with the Keyan Government and partners to ensure health services are delivered where they are most needed. (Credit: UNDP Kenya/James Ochweri)

The UN in Kenya works with the Keyan Government and partners to ensure health services are delivered where they are most needed. (Credit: UNDP Kenya/James Ochweri)

By Siddharth Chatterjee
NAIROBI, Jan 16 2017 (IPS)

Consider this: every year, nearly one million Kenyans are pushed below the poverty line as a result of unaffordable health care expenses.

For many Kenyan families, the cost of health care is as distressing as the onset of illness and access to treatment. A majority of the population at risk can hardly afford the costs associated with basic health care and when faced with life threatening conditions, it is a double tragedy-inability to access health care and lack of resources to pay for the services.

According to the World Health Organisation, a large percentage of poor households in Kenya cannot afford health care without serious financial constraints as most are dependent on out of pocket payments to pay for services.  Nearly four out of every five Kenyans have no access to medical insurance, thus a large part of the population is excluded from quality health care services.

In 2015, UN Member States endorsed the 17 Sustainable Development Goals (SDGs), expected to guide the development agenda through 2030. The endorsement of the SDG 3 – Good health and wellbeing; formally enshrined Universal Health Coverage (UHC) as a development priority for all countries.

UHC has the potential to transform the lives of millions of Kenyans—guaranteeing access to lifesaving health services while helping individuals and families avoid crippling health expenses and the poverty trap.

Nearly four out of every five Kenyans have no access to medical insurance, thus a large part of the population is excluded from quality health care services.
The situation is not unique to Kenya, but also a case in point for many other developing countries. As a result, UHC has been identified as a key development goal for enhancing countries’ health systems globally.  It is an all-encompassing development issue, including as it does, the full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation as well as palliative care.

Protecting people from the consequences of out-of-pocket health expenditure, which in Kenya forms about a fifth of family spending, is critical. It reduces the risk of people using up their life savings, selling of assets, or borrowing, threatening the financial future of their families as out of pocket health expenditure is also the most inequitable and inefficient.

However, achieving UHC is a formidable challenge because Africa as a continent requires about 50 percent more doctors to achieve UHC, compared to Europe which needs only about 3 percent more. The continent still lags far behind the rest of the world in provision of basic health care services such as immunisation, water and sanitation as well as family planning.

Much of the problem lies with the low prioritisation of health. Less than ten countries in Sub-Saharan Africa have met the Abuja declaration committing to allocate 15 percent of their annual government spending on provision of health care.

Kenya is one of the countries that is yet to reach the Abuja threshold, but several indicators show that the country can be an inspiration for the rest of the continent in achieving UHC by 2030.

One of the steps in the right direction is the government’s move to eliminate payments for primary and maternal health services in public facilities. This has led to tangible improvements in maternal and child health, with maternal mortality ratio falling from 488 to 362 deaths per 100,000 live births between 2008 and 2014.

With consensus that maternal health is a major driver of overall health and economic development, the Government of Kenya in partnership with the United Nations family and the World Bank, with strong support from the governments of the United States of America, United Kingdom, Japan, Germany, Denmark and Norway who have focussed on counties with the highest maternal and child deaths. Significant gains have also been made as a result of the First Lady of Kenya’s Beyond Zero campaign.

Arnaud Bernaert, Head of Global Health and Health Care at the World Economic Forum, remarked that, “Kenya’s efforts has led to an innovative public-private partnership mechanism that has the potential of building business models that will offer the best of both public and private sector in scaling-up the delivery public health services in low-resource settings”.

Another positive direction is the devolution of health – a constitutional change that shifted responsibility for healthcare provision to county governments. This seeks to achieve universal coverage by bringing health decisions closer to citizens, ensuring efficient and equitable resource distribution, thereby improving access to health facilities as well as services.

Recent changes to the National Health Insurance Fund (NHIF) has expanded the coverage for formal sector employees by adding outpatient care and a new initiative specially targeting informal sector has recently been introduced. The new national scheme offers a comprehensive family cover for US$ 60 (6000 Kenyan Shillings) covering both outpatient and inpatient services. New initiatives such as health insurance subsidies for the poor, severely disabled and elderly will help to bring more vulnerable people under comprehensive health insurance cover.

Kenya is already a leader in technological innovation.  This is a capability that must be harnessed to improve health systems to help bring down costs of delivering health care services through telemedicine, reducing inefficiencies in provider payment systems and generating better data.

These improvements could significantly help ameliorate the financial stress that is currently the most significant barrier to achievement of UHC. Some studies have shown that technical efficiency is a big flaw in Kenya’s health facilities, with one reporting that public dispensaries are operating at only 47 percent efficiency.

Kenya is part of various initiatives for developing sustainable financing for health services such as the Global Financing Facility, a partnership that will catalyse greater investments in health services, with a particular focus on women, adolescents and children.

The momentum is already with the country and in keeping with the spirit of the SDGs, Kenya must lead in the moral imperative of ensuring that none of the people who cannot pay for health care are left behind.

Kenya can undoubtedly lead the way in achieving universal health care.

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Is Cash Aid to the Poor Wasted on Tobacco and Alcohol? Sat, 14 Jan 2017 21:07:11 +0000 Baher Kamal Zambia’s Social Cash Transfer Programme is implemented by the Ministry of Community Development, Mother and Child Health and has been operating since 2003. As of December 2014, it reached 150,000 households and there are concrete plans to scale it up nation-wide in the near future. Photo: FAO

Zambia’s Social Cash Transfer Programme is implemented by the Ministry of Community Development, Mother and Child Health and has been operating since 2003. As of December 2014, it reached 150,000 households and there are concrete plans to scale it up nation-wide in the near future. Photo: FAO

By Baher Kamal
ROME, Jan 14 2017 (IPS)

Not at all. Or at least not necessarily. The fact is that cash transfer programmes –regular money payments to poor households—are meant to reduce poverty, promote sustainable livelihoods and increase production in the developing world. One in four countries on Earth are applying them. But are they effective?

That depends. In some countries, like Brazil, the so-called Bolsa Família is cited as one of the key factors behind the positive social outcomes this Latin American giant has achieved in recent years.

The programme is an innovative social initiative taken by the Brazilian Government, says the World Bank (WB), which has provided technical and financial support to it.

In fact, Bolsa Família reaches 11 million families, more than 46 million people, a major portion of the country’s low-income population. The model emerged in Brazil more than a decade ago and has been refined since then.

Poor families with children receive an average of 70.00 R (about 35 US dollars) in direct transfers. In return, they commit to keeping their children in school and taking them for regular health checks.

And so Bolsa Família has two important results: helping to reduce current poverty, and getting families to invest in their children, thus breaking the cycle of inter-generational transmission and reducing future poverty.

Although relatively modest in terms of resources when compared with other Brazilian social programs, such as Social Security, the Bolsa Família programme may be the one that is having the greatest impact on the lives of millions of low-income Brazilians, according to the WB.

But what about other countries and regions?

The Food and Agriculture Organisation of the United Nations (FAO) on Jan. 4 reported that during the past decade, an increasing number of governments in sub-Saharan Africa have launched cash transfer programmes that target the most vulnerable groups, including subsistence farmers, people with disabilities and HIV/AIDS, as well as families caring for elderly and disabled.

But “although local economies and numerous households have benefited from this social protection measure, critics remain doubtful.”

Five Common Myths

Whatever the case is, there are at least five common myths about cash transfers.

FAO elaborated the following list aimed at evaluating how they play an important role in improving food and nutrition security and reducing rural poverty, based on evaluations carried out in seven African countries – Ethiopia, Ghana, Kenya, Lesotho, Malawi, Zambia and Zimbabwe.

Myth: Cash will be wasted on alcohol and tobacco

Reality: Alcohol and tobacco represent only 1 to 2 per cent of food expenditures in poor households. Across six countries in Africa where FAO and partners carried out evaluations of cash transfer initiatives, no evidence of increased expenditures was found.

In Lesotho, for example, alcohol expenditures have actually decreased after the introduction of cash transfer programmes.

Myth: Transfers are just ‘hand-outs’ and do not contribute to development.

Reality: In Zambia, cash transfers increased farmland by 36 per cent, and with that the use of seeds, fertilisers and hired labour, which resulted in stronger market engagement, and prompted the use of more agricultural inputs.

The country recorded an overall production increase of 36 per cent. Furthermore, the majority of programmes show a significant increase in secondary school enrolment and in spending on school uniforms and shoes.

Cash transfers... are they more than just hand-outs?. Photo: FAO

Cash transfers… are they more than just hand-outs?. Photo: FAO

Myth: Cash causes dependency and laziness.

Reality: In several countries, including Malawi and Zambia, research shows a reduction in casual wage labour and a shift to more productive and on-farm activities.

In fact, in sub-Saharan Africa cash transfers lead to positive multiplier effects in local economies and significantly boost growth and development in rural areas.

Thus, cash does not create dependency, but rather spurs beneficiaries to invest more in agriculture and to work more.

Myth: Transfers lead to price inflation and disrupt local economies.

Reality: Ethiopia, Ghana, Kenya, Lesotho, Malawi, Zambia and Zimbabwe were all part of the Protection to Production project, which, among other things, analysed the productive and economic impacts of cash transfer programmes in sub-Saharan Africa.

None of the seven case study countries experienced inflation.

Beneficiaries represent only a small share of the community (15 to 20 per cent), and because they come from the poorest households and have a low purchasing power, they do not buy enough to affect market prices, thus enabling local economies to meet the increased demand.

In Ethiopia, for every dollar transferred by the programme, about 1.5 dollars are generated for the local economy.

Myth: Child-focused grants increase fertility.

Reality: In Zambia, cash transfers showed no impact on fertility. In Kenya, adolescent pregnancy even decreased by 34 per cent and in South Africa by over 10 per cent.

Meanwhile, FAO, together with its partners, continues to generate evidence on the impacts of social protection interventions to reduce poverty and hunger.

Findings have shown that the implementation of such programmes leads to increased food consumption, better nutrition, improved school enrolment, reduced child labour, economic development, agricultural investment and many other benefits, it says.

“Cash transfer programmes have become an increasingly important tool in finding the path out of poverty and have contributed to making a long-term impact on the lives of many families.”

So far, so good.

The fact, however, is that there are still almost a billion people who still live in extreme poverty (less than 1.25 US dollar per person per day) and 795 million still suffer from chronic hunger, according to this UN leading agency in the filed of food and agriculture.

“Most of the extreme poor live in rural areas of developing countries and depend on agriculture for their livelihoods… They are so poor and malnourished that their families live in a cycle of poverty that passes from generation to generation.”

What About Women?

The case of women is particularly flagrant – although representing nearly half of all rural workers worldwide, with peaks of up to 60 per cent in some developing countries—they have always been among the poorest of the poor.

FAO informs that their main goal is economic growth rather than the economic empowerment of their beneficiaries –-who are usually ultra-poor people; however, evidence of their development impacts is contributing to a shift in how policy-makers perceive these programmes.

On the specific case of women, it says that in many countries, the majority of cash transfers beneficiaries are poor and vulnerable women.

“As a result, it is often claimed that cash transfers have an empowering effect on women based on the assumption that, as the main recipients of the transfers, women gain greater control over financial resources.

Nevertheless, “available evidence on empowerment outcomes is far from being conclusive, particularly as to whether cash transfers actually improve women’s bargaining power and decision-making in the household.”

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Tobacco Industry Misleads Developing Countries Over Regulations Fri, 13 Jan 2017 21:34:35 +0000 Lyndal Rowlands A cigarette vendor in Manila sells a pack of 20 sticks for less than a dollar. Credit: Kara Santos/IPS

A cigarette vendor in Manila sells a pack of 20 sticks for less than a dollar. Credit: Kara Santos/IPS

By Lyndal Rowlands

Low and middle-income countries have far fewer tobacco regulations than high-income countries and are paying the price – with bigger health and economic impacts.

Yet, according to new wide-ranging research published by the World Health Organization (WHO), tobacco companies are misleading governments, telling them that tobacco regulations will potentially harm their economies.

The research was compiled in a new monograph titled The Eonomics of Tobacco and Tobacco Control, published jointly by the WHO and the National Cancer Institute of the US-based National Institutes of Health.

Frank Chaloupka, who edited the monograph, told IPS that when low and middle income countries do implement regulations, there is usually a much bigger pay off.

“We present some new evidence in the monograph on tobacco advertising bans that shows they have a bigger effect in low- and middle-income countries than they do in high-income countries,” said Chaloupka who is also Distinguished Professor of Economics & Public Health at the University of Illinois.

"Tobacco advertising bans ... have a bigger effect in low- and middle-income countries than they do in high-income countries" -- Frank Chaloupka

“I think it’s partly because of the fact that in a lot of low- and middle-income countries they haven’t been exposed to the same information about the health consequences of tobacco use, people are more susceptible to the industry(’s positive) portrayals of tobacco,” noted Chaloupka.

For example, says Chaloupka, graphic warning labels have proven more effective in low- and middle-income countries.

“People can really see the damage caused by tobacco through the graphic warnings.” For those who have had less exposure to these warnings from other sources of information, the warnings have an even bigger impact.

Taxes on tobacco sales in low and middle countries also have a bigger impact than in high-income countries, Chaloupka added.

“Given people’s lower incomes, people are more responsive to changes in the price,” he said.

There are several reasons why low- and middle-income countries have less tobacco regulations than high-income countries, said Chaloupka, but one problematic cause is misleading arguments made by the industry:

“The industry’s arguments around things like illicit trade, impact on jobs and the broader economic impact, the impact on the poor, the impact on their tax revenues, really the economic arguments that the industry uses against tobacco control are really misleading, and for the most part, false.”

This has contributed to a widening gap between regulations in low and middle-income versus high-income countries. The gap has also widened because of how quickly high-income countries moved to implement control measures:

“We’ve seen governments get serious and really take action, and adopt strong tobacco control measures, push up taxes, ban smoking in public places, ban tobacco marketing as a result we’ve seen tobacco use falling for at least a few decades in most high-income countries.”

While some low and middle-income countries may lack the capacity to implement complex regulations, Chaloupka noted that often simpler policies can be more effective.

“The Philippines (had) a complicated tax system where we had different rates on different brands,” he said. “Over time they moved toward a significant reform in their system and they’re in the process of moving to a single uniform tax which is a lot easier to administer and much better at deterring tax avoidance and tax evasion.”

However although so-called excise taxes on tobacco products can act as a deterrent worldwide they are far from helping governments recoup the costs of tobacco use to economies and society.

“The estimate we have for the global cost is about $1.4 trillion, and less than $300 billion being generated in tax revenues,” said Chaloupka, adding that less than $1 billion of tobacco-related tax revenues is being used for tobacco control.

Chaloupka also pointed to Turkey as an example of a middle-income country that has successfully regulated tobacco use.

“If you go back a few decades the Turkish government used to be the tobacco industry in Turkey. They used to be one of the biggest growers of tobacco leaf in the world, and over time they’ve completely moved in the other direction.”

“They privatised their tobacco industry (and) they didn’t make any promises to the tobacco companies that moved into their markets, and really then did move forward with strong tobacco control policies.”

Correction: An earlier version of this article referred to “$300 million being generated in tax revenues” and “$1 million of tobacco-related tax revenues…” it should have read billion(s) not million(s).

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When Your Healers Become Your Killers Wed, 11 Jan 2017 14:10:46 +0000 Baher Kamal Since the introduction of penicillin in the middle of the 20th century, antimicrobial treatments have been used not only in human medicine but in veterinary care as well. But their excessive use in livestock (and aquaculture) contaminates the environment and contributes to a rise of resistant microorganisms, posing threats to human health, animal health, food security and people’s livelihoods. Photo: FAO

Since the introduction of penicillin in the middle of the 20th century, antimicrobial treatments have been used not only in human medicine but in veterinary care as well. But their excessive use in livestock (and aquaculture) contaminates the environment and contributes to a rise of resistant microorganisms, posing threats to human health, animal health, food security and people’s livelihoods. Photo: FAO

By Baher Kamal
ROME, Jan 11 2017 (IPS)

There is a major though silent global threat to human and animal health, with implications for both food safety and food security and the economic well-being of millions of farming households. It is so-called anti-microbial resistance.

The problems arises from the indiscriminate, excessive use of synthetic products, such as anti-microbial medicines, to kill diseases in the agricultural and food systems, which may be a major conduit of the anti-microbial resistance (AMR) that causes 700,000 human deaths each year and has the potential to raise this number to up to 10 million annually.

AMR is a natural phenomenon of micro-organisms such as bacteria, viruses, parasites and fungi that are no longer sensitive to the effects of antimicrobial medicines, like antibiotics, that were previously effective in treating infections.

Nevertheless, commercial practices meant to increase benefits have been leading to the dramatic fact that these drugs are more and more used to practically solely promote animal growth. "Anti-microbial Resistance has the potential to be even more deadly than cancer, to kill as many as 10 million people a year" – UN

“The world is in the midst of a different kind of public health emergency, one that is just as dramatic but not as visible. Except for the headline-grabbing ‘superbugs’, anti-microbial resistance (AMR) doesn’t cause much public alarm,” the heads of three international organisations dealing with human and animal health have warned in a joint article published in the Huffington Post.

AMR Could Be More Deadly than Cancer

“But AMR has the potential to be even more deadly than cancer, to kill as many as 10 million people a year and, according to a recent review undertaken by the United Kingdom, to cost the world economy as much as 100 trillion dollars annually,” added the Directors-General of the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), and the World Organisation for Animal Health.

According to them, if left unchecked, AMR will make chemotherapy and common dental and surgical procedures increasingly risky, as infectious complications become difficult or impossible to treat. The gains in health and longer lives of the 20th century are at stake.

In addition to the growing high number of human deaths each year that are estimated to be related to anti-microbial resistant infections, the AMR further poses a major threat to food safety and security, livelihoods, animal health and welfare, economic and agricultural development worldwide, warn United Nations specialised agencies.

FAO's Action Plan on Antimicrobial Resistance

FAO’s Action Plan on Antimicrobial Resistance

The global use of synthetic products to indiscriminately kill bacteria, viruses, parasites and fungi in agricultural and food systems requires a concerted effort to map, understand and mitigate the risks of AMR, says FAO.

While anti-microbial resistance was first described in 1940, scientific understanding of the myriad of pathways by which resistance emerges and spreads remains in its infancy, according to its report titled Drivers, Dynamics and Epidemiology of Antimicrobial Resistance in Animal Production.

AMR may be a natural genomic process for bacteria, but it was very rare in clinical isolates predating the introduction of antibiotics, the 67-page technical report notes.

Food Contaminated with Antibiotic Resistants

“As foods from around the globe are today frequently contaminated with antibiotic resistant E. coli and Salmonella, measures which encourage the prudent use of antimicrobials are likely to be extremely useful in reducing the emergence and spread of AMR.”

In view of this growing health challenge, three international organisations –FAO, WHO and the World Organisation for Animal Health — held last November a World Antibiotic Awareness Week to raise awareness of one of the biggest threats to global health.

The report summarises the magnitude of AMR in the food and especially the livestock sector, which is expected to account for two-thirds of future growth in antimicrobial usage.

The need to support and pursue more research — involving both molecular sequencing and epidemiological analyses — into factors influencing how and why resistant bacteria become incorporated into human and animal gut micro-biomes as well as the need to create standardised monitoring procedures and databases so that adequate risk-assessment models can be built, are some of the report’s recommendations.

Use of anti-microbials solely to promote animal growth should be phased out, the UN agency stressed. Instead, alternatives to antibiotics to enhance animal health — including enhanced vaccination programmes — should be more vigorously pursued.

Antimicrobial Residues in the Environment

Antimicrobial residues in the environment, especially in water sources, should be tracked in the same way as other hazardous substances, the report urges.

“Given our current limited knowledge of transmission pathways, options to mitigate the global spread of AMR involve controlling its emergence in various environments, and minimizing the opportunities for AMR to spread along what may be the most important routes.”

While cautious about how much remains unknown, the report’s authors — experts form the Royal Veterinary College in London and FAO experts led by Juan Lubroth — highlight compelling evidence of the scale of the threat.

For instance, U.S. honeybees have different gut bacteria than is found elsewhere, reflecting the use of tetracycline in hives since the 1950s.

Fish farms in the Baltic Sea show fewer AMR genes than aquaculture systems in China, which are now reservoirs of genes encoding resistance to quinolones — a critical human medicine whose use has grown because of increasing resistance to older anti-microbials such as tetracycline.

The recent detection of resistance to colistin, until recently considered a last-ditch antibiotic in human medicine, in several countries also underscores the need to scrutinise livestock practices, as the drug has been used for decades in pigs, poultry, sheep, cattle and farmed fish.

What to Do?

The report focuses on livestock because future demand for animal-based protein is expected to accelerate intensive operations — where animals in close contact multiply the potential incidence of AMR pathogens.

A poultry operation in Egypt. Good hygiene on farms can help stem the rise of AMR due to over-reliance on anti-microbials. FAO

A poultry operation in Egypt. Good hygiene on farms can help stem the rise of AMR due to over-reliance on anti-microbials. FAO

Poultry, the world’s primary animal protein source, followed by pork, are important food-based vehicles of AMR transmission to humans.

Cases in Tanzania and Pakistan also demonstrate the risk of AMR coming from integrated aquaculture systems that use farm and poultry waste as fish food.

As animals metabolise only a small fraction of the antimicrobial agents they ingest, the spread of anti-microbials from animal waste is an important concern, it says.

While smallholder systems may rely less on anti-microbials, they often use over-the-counter drugs without veterinary advice. Inappropriate, sub-lethal, dosing promotes genetic and phenotypic variability among the exposed bacteria that survive.

Finally, the report says that working collaboratively across all sectors and aspects of food production, from farm to table, will provide an essential contribution to an integrated one-health approach to combat AMR.

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Threat of Famine Looms in Yemen Fri, 06 Jan 2017 20:27:44 +0000 Tharanga Yakupitiyage On 6 May 2016 in Yemen, a baby is screened for malnutrition at the UNICEF- supported Al-Jomhouri Hospital in Sa’ada. Credit: UNICEF/UN026928/Al-Zekri

On 6 May 2016 in Yemen, a baby is screened for malnutrition at the UNICEF- supported Al-Jomhouri Hospital in Sa’ada. Credit: UNICEF/UN026928/Al-Zekri

By Tharanga Yakupitiyage

Millions of Yemenis could soon face widespread famine if no action is taken to improve food access through humanitarian or trade means, an early warning system has said.

Up to eight million Yemenis are severely food insecure while another 2 million are facing food insecurity at emergency levels, just one phase below famine, the Famine Early Warning Systems Network (FEWS NET) has found. The World Food Programme (WFP) estimates that the food-insecure population in the Middle Eastern nation could be even higher at up to 14.4 million, representing half of the population.

This has contributed to rising acute malnutrition and risk of mortality. According to the UN Children’s Fund (UNICEF), almost 4.5 million are in need of treatment for malnutrition, including over 2 million children.

The ongoing conflict between a Saudi-led coalition and the Houthis has largely driven the food crisis in Yemen, which FEWS Net describes as the “largest food security emergency in the world.” The two-year civil war has left thousands dead and 3 million displaced, limiting humanitarian access and food availability on the market.

The U.S. Agency for International Development (USAID)-funded system highlighted the need to improve humanitarian access in order to continue and increase much needed food and nutrition assistance.

Prior to the conflict, Yemen imported approximately 90 percent of its food.

Though current food assistance from organisations such as the World Food Program (WFP) is helping mitigate the crisis, FEWS NET noted that such operations alone have been insufficient to meet the country’s needs.

Action is also needed to ensure sustained commercial food trade. Prior to the conflict, Yemen imported approximately 90 percent of its food. The unrest has since disrupted the government and private sector’s ability to import food. Most recently, wheat imports were suspended in December, a staple grain for Yemenis.

Without such imports, humanitarian actors will also be unable to ensure local food availability.

Though food is still available on local markets, increased prices and reduced income have limited access to goods. WFP found that prices of red bean, sugar and onion were respectively 48 percent, 24 percent and 17 percent higher in November than in the pre-crisis period.

A major reduction in food import levels will only serve to worsen food security in the country.

“In a worst-case scenario, where food imports drop substantially for a sustained period of time or where conflict persistently prevents the flow of food to local markets, famine is possible,” FEWS NET reported.

In 2016, the UN requested almost $1.7 billion towards Yemen’s Humanitarian Response Plan. Approximately 40 percent remains unfunded.

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Immunisation and Inequality in 2016 Fri, 30 Dec 2016 18:59:28 +0000 Andy Hazel A child receives an oral polio vaccine in Peshawar, Pakistan. Credit: Ashfaq Yusufzai/IPS.

A child receives an oral polio vaccine in Peshawar, Pakistan. Credit: Ashfaq Yusufzai/IPS.

By Andy Hazel

Childhood immunisation is one of the safest and most cost-effective health interventions available, yet many of the world’s most vulnerable children continue to miss out.

A World Health Organisation report entitled State of inequality: childhood immunisation was released last week. While the report is mostly good news, immunisation rates are up and many countries have eradicated diseases entirely, a large population of children remain unimmunised.

To better reach these children the authors also looked at another metric: disease as a marker of inequality. Or, in the words of Robin Nandy, Principal Adviser and Chief of Immunisation at UNICEF, “a virus doesn’t lie”.

“The presence of disease is the best indicator of where a bigger problem is,” he explains. “Diseases tend to show up where there are weak systems of health coverage and in areas of conflict.”

“It is very likely that where there is low immunisation coverage there are multiple deprivations.”

“The nutritional status of the kids in these areas could be compromised, they could lack water or sanitation, common childhood illnesses such as diarrhoea or pneumonia could be present.”

Using data from 69 countries, the study examined inequality amongst rates of childhood immunisation and measured changes in rates of immunisation over the last ten years. The most prominent inequalities recorded were those of household economic status and the level of maternal education.

"Political will is extremely important to shift the mindset from wide coverage to wide coverage with equality," -- Robin Nandy.

While the report showed that rates of immunisation for diseases such as measles, polio and yellow fever are around 85 percent globally, progressing beyond this number is hard and the biggest barrier to progress is political willpower.

“Once you’ve hit 80 percent the remaining 15 to 20 percent tend to be in remote locations, in underprivileged populations,” says Nandy. “In many countries the communities that want immunisation are marginalised. Political will is extremely important to shift the mindset from wide coverage to wide coverage with equality.”

“There are some areas that are right under our noses that we tend not to prioritise because we’re focused elsewhere, like urban slums. Often they don’t show up in population data and that is why they’re not prioritised in health services.”

Nandy points to a rapidly urbanising world and the growing population of children living in refugee camps or moving between regions as key examples of the complex operating environments. “There has to be a proactive and deliberate attempt to reach these populations and it won’t happen by delivering services in a normal way. We need tailored approaches for each country to make sure these populations are reached.”

Polio, which has neared complete eradication but setbacks in 2015-16, illustrates the difficulty of reaching children most in need.

“Where are we still seeing polio transmission?” Nandy asks rhetorically. “It’s on the Pakistan / Afghanistan border, places like Baluchistan and Waziristan, places that have security issues. These limit the access of health workers into that area.”

“You will get increases in rates of diseases like polio when parents cannot bring their kids to clinics.”

The current situation in many countries shows that further improvement is needed to lessen inequalities, and data such as this may prove invaluable.

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How the US Government Subsidizes Obesity Thu, 29 Dec 2016 17:48:36 +0000 Jomo Kwame Sundaram Jomo Kwame Sundaram was United Nations Assistant Secretary-General for Economic Development, and received the Wassily Leontief Prize for Advancing the Frontiers of Economic Thought in 2007.]]> 8976878849_a17eba627c_z

By Jomo Kwame Sundaram
KUALA LUMPUR , Dec 29 2016 (IPS)

Until the turn of the century, the United States of America (US) was the country with the highest share of overweight and obese people. Soon after the former president of Coca-Cola Mexico became the new president of his country, Mexico overtook the US.

In late 2014, the McKinsey Global Institute announced that 2.1 billion of the 7.3 billion people in the world were overweight or obese. This represented a fifty per cent increase over the previous WHO estimate of 1.4 billion less than a decade earlier. The Institute also estimated that about 2.8 percent of world income is spent dealing with the consequences of associated ill health.

While almost 800 million people are estimated to be ‘chronically hungry’, higher real incomes for many as well as globalized lifestyles, including food consumption, have changed micronutrient deficiencies and increased diet-related non-communicable diseases, many associated with overweight and obesity. With the United Nations General Assembly calling for a global Decade of Action against malnutrition from 2016, there is greater interest in the role of food systems in contributing to various dimensions of malnutrition.

A recent study found that those who most consume government subsidized foods had a 37 percent greater risk of being obese. They were significantly more likely to have belly fat, abnormal cholesterol and high blood sugar. While it could not prove cause and effect, this strong association is consistent with other research showing that diets higher in subsidized foods tend to be of poorer quality and more harmful to health.

American junk food
Almost three-quarters of the US population is overweight or obese. Junk foods are the largest source of calories in the American diet, with sweet desserts, bread, pizza, pasta and sweetened drinks the major culprits. These foods are largely products of seven food items heavily subsidized by the US government, namely maize, wheat, rice, soy, sorghum, milk and meat. Hence, such foods are cheap and plentiful.

Between 1995 and 2010, the US government paid out US$170 billion in agricultural subsidies to produce these foods. While many such foods are not inherently unhealthy, only small shares are eaten as produced. Most are used as feed for livestock, converted into biofuels or processed into cheap products such as sweeteners, industrial oils, processed meats, refined carbohydrates and other processed foods.

While the US government’s latest dietary guidelines recommend that people eat much more fruits and vegetables, only a very small fraction of its subsidies actually support fresh produce. Most agricultural subsidies go to crops processed into foods linked to obesity. Thus, such subsidies damage health and raise medical costs to treat the effects of overweight and obesity.

US farm subsidies
US farm subsidies were introduced decades ago to secure its food supply and to support struggling farmers. Since 1995, the US government has provided American farmers with almost $300 billion in agricultural subsidies. Typically, these have been included in the US farm bill, besides financing its food stamps program. The US farm bill is renewed by Congress every five years, with the 2014 bill approving US$956 billion in expenditure.

But the subsidies program no longer serves its original intent. Instead of supporting small farmers who grow fruits, nuts and vegetables – considered ‘specialty crops’ by the US government – the program now primarily subsidizes large commodity crop producers.

Small, including ‘specialty’ farms use three-quarters of the country’s cropland, but receive only 14 percent of government subsidies. Large agribusinesses specializing in growing the major commodity crops represent 7 percent of cropland, but receive half of all subsidies.

Thanks to public awareness and pressure, the 2014 farm bill allows farmers who grow commodity crops to use 15 percent of their farmland to grow fruits, vegetables and other specialty crops. It now supports organic farmers, including US$100 million for research to improve such production.

A ‘healthy incentives’ program encourages food stamp recipients to consume more fruits and vegetables by increasing the value of food stamps used to buy fresh produce at retail stores or farmers’ markets. However, such funding is still paltry compared to the billions in subsidies for commodity crops.

Of course, many factors influence what people eat. While it is impossible to prove that farm subsidies directly cause obesity, they clearly contribute as agriculture and food policies are not aligned with public health goals.

A national food policy should ensure that farm laborers gets decent incomes, everyone has affordable access to healthy foods and is effectively discouraged from consuming unhealthy foods, and that governments coordinate their nutrition goals with their food and agricultural policies.

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Family Planning in the Philippines: Stalled Again Wed, 28 Dec 2016 20:25:47 +0000 Barry Mirkin 0 Bio-Product Targeting Deadly Toxin Holds Hope for Africa’s Food Tue, 27 Dec 2016 11:40:15 +0000 Ini Ekott Application of Aflasafe in groundnut field. Photo courtesy of

Application of Aflasafe in groundnut field. Photo courtesy of

By Ini Ekott
ABUJA, Dec 27 2016 (IPS)

As food contaminants, aflatoxins are amongst the deadliest. Between 2004 and 2007, contaminated maize killed nearly 200 people in Kenya, left hundreds hospitalised and rendered millions of bags of maize unfit for consumption.

On average, 25 to 60 percent of maize – a staple in many African countries – has high levels of aflatoxins in Nigeria, warns the International Institute of Tropical Agriculture (IITA). And with that comes the risk of liver cancer, suppressed immune system, stunted growth in children, and death.In the first year of the aflasafe trial, farmers recorded 13 percent average sales price over market rate, which is a 210 percent return on investment.

But despite such toxic potency, aflatoxins are hardly popular. Now, a made-in-Africa biocontrol product, Aflasafe, is taking on the poison, and is offering hope to millions across the continent who rely on vulnerable crops like maize.

“Aflatoxins are some of the most carcinogenic substances. But for four years that we have worked with farmers, we have seen great results in the use of aflasafe,” said Adebowale Akande, an aflasafe project lead at IITA, the institute that developed the product.

A four-year trial of aflasafe in Nigeria has yielded an impressive 80 to 90 percent reduction of aflatoxins, Akande said. “You will agree with me that four years is enough to know whether something is working or not,” he said.

Aflatoxin contamination is a global problem. But while developed countries regularly screen crops and destroy food supplies that test over regulatory limits, lax control and low awareness in developing countries mean billions of people face the risk of being exposed to the toxin daily.

The U.S-based Centre for Disease Control estimates that 4.5 billion people in developing countries may be chronically exposed to aflatoxins through their diet.

The toxins contaminate African dietary staples such as maize, groundnuts, rice either in the soil or during storage.

Countries in latitudes between 40 degrees north and 40 degrees south—which includes all of Africa—are susceptible to this contamination, the Partnership for Aflatoxin Control in Africa, PACA, an African Union body, said.

Besides health, aflatoxin also has serious economic implications.

“The direct economic impact of aflatoxin contamination in crops results mainly from a reduction in marketable volume, loss in value in the national markets, inadmissibility or rejection of products by the international market, and losses incurred from livestock disease, consequential morbidity and mortality,” said PACA in a 2015 paper.

Aflasafe production quality check after colonisation and drying. Photo courtesy of

Aflasafe production quality check after colonisation and drying. Photo courtesy of

Pull Mechanism

Aflasafe works by preventing the growth of aspergillus, the fungus that produces aflatoxin. It does so by stimulating the growth of large quantities of a harmless specie of aspergillus instead.

Developed over a decade by IITA, U.S. Department of Agriculture-Agricultural Research Service, University of Bonn and University of Ibadan, aflasafe is applied by hand on soil two to three weeks prior to crop flowering. It works only for maize and groundnuts for now, amid ongoing researches for other crops.

Within two to three days of application, the anti-toxigenic strain of the fungus builds up rapidly on the crop, colonizes it and stops the toxic strain from developing. With that, over 90 percent of aflatoxins can be eliminated.

Despite such promise, there are challenges. Low awareness of the dangers of aflatoxins means low demand for aflatoxin-free maize. Also, poor regulation has limited investments in the control of aflatoxin.

The IITA set up the “pull mechanism” to ultimately expand the use of aflasafe by providing economic and technical incentives to smallholder farmers, who work in groups through intermediaries called implementers. It features per-unit payments based on the number of kilograms of maize treated with aflasafe.

Premium payments equal to 18.75 dollars are paid for every metric ton of high-aflasafe maize delivered to designated collection points. This corresponds to a premium rate of 5 percent to 13 percent depending on the current price of maize.

The pull mechanism began in 2012 in Nigeria, with four implementers and 1,000 farmers. By 2016, the number has grown to 25 implementers and 15, 000 farmers, Mr. Akande said.

Abubakar Yambab, 43, is one of such farmers. At Abaji, a suburb of Abuja where he lives, Mr. Yambab grows maize on a 1⅟2 hectare of land. He told IPS he first used aflasafe in 2015, and his yields have since improved in quantity and quality.

“Using aflasafe has a multiplier effect,” he said. “It removes the coloured particles (aflatoxin) we used to notice in the harvested maize and I don’t think I can grow maize now without aflasafe.”

Yambab said he receives subsidized fertilizers, farming equipment, tractors and chemicals from IITA, and has relied on his farm proceeds to feed his six children and two wives, in addition to recently completing a block home.

Receiving premium payment on aflatoxin-reduced maize makes business sense for the farmers despite investment in the aflasafe technology.

IITA said in the first year of its trial, farmers recorded 13 percent average sales price over market rate, which is a 210 percent return on investment. In 2015, average sales price stood at 15 percent over market rate, translating to 524 percent return on investment.


Nigeria was chosen as pilot location for aflasafe as it is the leading producer and consumer of maize in sub-Saharan Africa and up to 60 percent of its maize may be affected. The country is for now the only developing country in which aflasafe is ready for use by farmers.

But similar work is going to Senegal and Kenya. A manufacturing plant capable of producing 5 tons of aflasafe per hour is operational at IITA headquarters in Nigeria, Ibadan. Another is under construction in Kenya and a third is underway in Senegal.

The institute is also working on transferring the technology to allow companies produce and distribute aflasafe to millions of farmers throughout sub-Saharan Africa.

“It is slated to cover 500,000 hectares in 11 countries where aflasafe will soon be registered,” Matieyedou Konlambigue, who leads IITA’s Aflasafe Technology Transfer Commercialization Project, said at the launching of the project on Dec. 1 at Ibadan, Nigeria.

The targeted countries are Burkina Faso, Ghana, Kenya, Malawi, Mozambique, Nigeria, Senegal, Tanzania, Gambia, Uganda and Zambia, Konlambigue was quoted by the News Agency of Nigeria as saying. The project is to last from 2016 to 2020.

Yamdab said he would advise other farmers to use aflasafe for their crops. “If all farmers in the FCT (Federal Capital Territory) use aflasafe, it will really improve the quality of food products here,” he said.

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New Ebola Vaccine Trial Results Offer Hope Fri, 23 Dec 2016 05:20:33 +0000 Lyndal Rowlands Two health care workers clean their feet in a bucket of water containing bleach after they leave an Ebola isolation facility during an Ebola simulation at Biankouma Hospital in Côte d’Ivoire. Credit: Marc-André Boisvert/IPS

Two health care workers clean their feet in a bucket of water containing bleach after they leave an Ebola isolation facility during an Ebola simulation at Biankouma Hospital in Côte d’Ivoire. Credit: Marc-André Boisvert/IPS

By Lyndal Rowlands

A new Ebola vaccine may be the first to successfully protect against one of the world’s most lethal pathogens, according to a trial involving over 11,000 participants in Guinea.

The results of the trial – which was led by the World Health Organization together with Guinea’s Ministry of Health, Medecins sans Frontieres (MSF) and other international organisations – were published in British Medical Journal The Lancet Thursday evening.

“Ebola left a devastating legacy in our country,”said Dr KeÏta Sakoba, Coordinator of the Ebola Response and Director of the National Agency for Health Security in Guinea. “We are proud that we have been able to contribute to developing a vaccine that will prevent other nations from enduring what we endured.”

Alongside Liberia and Sierra Leone, Guinea was one of the three West African countries most affected by the Ebola outbreak of 2013 to 2016, which killed more than 11,000 people.

The vaccine was trialled in Basse-Guinée in Western Guinea beginning in 2015 when the disease was still occurring in the region. Of the over 5,800 people who received the vaccine, none were recorded as having Ebola 10 days or more after vaccination. By comparison, among those who did not receive the vaccine, 23 cases of Ebola were recorded.

"We are proud that we have been able to contribute to developing a vaccine that will prevent other nations from enduring what we endured.” -- Dr KeÏta Sakoba, Coordinator of the Ebola Response and Director of the National Agency for Health Security in Guinea.

Known as rVSV-ZEBOV – Vesicular Stomatitis Virus–Ebola Virus Vaccine – the vaccine was first developed by the Public Health Agency of Canada, an arm of the Canadian government.

Although rVSV-ZEBOV offers new hope that future Ebola outbreaks can be prevented, eradicating the disease will require much more than a successful vaccine trial.

For the three countries most affected by Ebola – Liberia, Sierra Leone and Guinea – a much broader response is required.

This response must include training – and retaining – a skilled health workforce.

Liberia, for example, with a population of 4.1 million people, has less than 50 physicians, or just one doctor per 100,000 people, according to data compiled by

By contrast, one of the main reasons Nigeria is considered to have been able to prevent the disease from spreading widely, is because of that countries relatively high number of skilled health workers.

The possibility of using rVSV-ZEBOV to stop future outbreaks is still some distance in the future. The vaccine is yet to be submitted for regulatory review – although it has been granted special status by US and European drug administrations which will allow it to pass through this process faster.

Should the vaccine pass the regulatory process it will then need to be widely administered – another challenge.

Many diseases which are vaccine curable, such as yellow fever and polio, have persisted for decades despite the availability of an affordable vaccine. According to MSF Access, governments and pharmaceutical companies could be doing much more to ensure that existing vaccines reach those most in need.

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Resilient People & Institutions: Ecuador’s Post-Earthquake Challenge Thu, 08 Dec 2016 09:52:09 +0000 Carlo Ruiz Carlo Ruiz, is the Recovery Unit Coordinator, UN Development Programme, Ecuador]]> Group of participants community emergency work for debris management, Las Gilces. Credit: UNDP Ecuador

Group of participants community emergency work for debris management, Las Gilces. Credit: UNDP Ecuador

By Carlo Ruiz
QUITO, Ecuador, Dec 8 2016 (IPS)

No one is really prepared for an emergency until they’ve had to live through one. And the 16 April earthquake in Ecuador put us to the test.

With the drawdown in the humanitarian response phase that is providing relief to survivors and victims, the hustle and bustle is dying down. Remnants of the disaster can be seen everywhere, and an idea of what the near future will bring and people’s resilience – their capacity to cope – is taking shape.

During tours of the affected areas, I saw that people have, to a greater or lesser extent, a natural conviction that pushes them to overcome the situation they are in. Shortly after a catastrophe hits, whether from the need to survive or from attempts to recover the normality that has been ripped from them, men and women begin to help each other out.

After the earthquake, small merchants relocate and rebuild their outlets on the outskirts of the city of Manta. Credit: UNDP Ecuador

After the earthquake, small merchants relocate and rebuild their outlets on the outskirts of the city of Manta. Credit: UNDP Ecuador

They get together and cook, and they care for, console and support each other. In places such as Pedernales, one of the hardest hit areas, just days following the tragedy, people had set up cooking hearths and places to prepare food to sell outside destroyed businesses. They organized games of ecuavoley (Ecuadorian-style volleyball) in streets where rubble was still being cleared.

Disasters hit poor people the hardest. This is why it is crucial to work on recovery of livelihoods starting in the emergency response period. People who can manage to earn a living can overcome the psychological impact of adversity more quickly. This has been a key factor in the post-earthquake process in Ecuador.

The institutional structure is another element that affects how fast communities recover. Having a response system, with mechanisms to quickly and strategically identify needs, makes recovery efforts more effective.

Communities are more vulnerable if local authorities are absent and exercise less authority to ensure, among other things, compliance with building and land-use standards.

Nationally, strong institutions and clarity in carrying out specific roles have enabled timely and appropriate disaster relief to affected communities. This undoubtedly will influence how quickly the country will recover the human development gains and how well it will design mechanisms to alleviate poverty caused by the earthquake.

The third important element is coordination. The extent to which organizations and institutions contribute in an orderly and technical fashion to response and recovery efforts reflects directly on the effectiveness of relief efforts.

Starts emergency community work for the management of rubble, Las Gilces. Credit: UNDP Ecuador

Starts emergency community work for the management of rubble, Las Gilces. Credit: UNDP Ecuador

This is evident even now, seven months after the earthquake. Coordination to identify needs and rebuild is vital in the reconstruction process. The event has been a wake-up call about the importance of supporting and strengthening local governments in their role as land-use planners and construction-quality inspectors.

As a result of all these efforts, UNDP has helped 533 families to get their businesses financially back on their feet in Manta, Portoviejo and Calceta (Manabí Province), and 490 people—half of them women—obtained emergency jobs on demolition and debris removal projects under our Cash-for-Work programme. Through this initiative, some 20,000 m3 of debris has been removed.

Additionally, 300 rice farmers and their families benefited from the repair of an irrigation canal; 260 families will restart farming, fishing and tourism activities; and 160 shopkeepers will get their businesses up and running again with the support of economic recovery programmes.

With regard to construction, UNDP supported development of seven guides for the assessment and construction of structures, to build back better and incorporate disaster risk reduction into urban development plans. And in Riochico Parish (Manabí Province), UNDP trained 500 affected homeowners on the principles of earthquake-resistant construction.

Poor people who have been hit by an earthquake live on the edge, where one thing or another can lead them to either give up or to survive. Therefore, it is crucial for actions to be fast, but also well thought-out.

Resilience is something that permeates survivors and is passed down to future generations. Building resilience should be one of our main objectives and responsibilities as institutions in a country such as Ecuador, where we live with the constant threat of natural disasters.

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Europe to Decide on Use of Mercury in Dentistry Tue, 06 Dec 2016 07:25:56 +0000 Tharanga Yakupitiyage By Tharanga Yakupitiyage

Europe will soon decide the future of a common but controversial dental practice: mercury in tooth fillings.

Three major European institutions, namely the European Commission, Parliament and Council, are due to meet on 6 December to discuss regulations on mercury, particularly its use in dentistry.

Mercury fillings removal

Mercury fillings removal

Mercury makes up 50 percent of amalgam, which is commonly used for dental fillings. Europe is currently the world’s largest amalgam user.

A coalition of over 25 international non-governmental organisations launched a global campaign in July to end the use of mercury in dentistry, citing health and environmental risks.

“Mercury is globally one of the 10 chemicals of major public health concern, yet the Commission proposes we maintain the status quo,” said Health Care Without Harm Europe’s Chemicals Policy Advisor Philippe Vandendaele

Amalgam is often the largest source of mercury releases in municipal wastewater and is also an increasing source of mercury air pollution from crematoria.

Mercury entering water bodies can contaminate fish and other animals, further exposing consumers to dangerous levels of secondary poisoning.

Though direct health risks from amalgam are still uncertain, mercury is known to cause damage to the brain and nervous system of developing fetuses, infants and young children.

As a result, the European Commission’s health advisory committee recommended a ban on mercury-based fillings in children and pregnant women.

“An ambitious regulation is needed to reduce the use of mercury in the European Union and phase it out of dentistry…over 66 percent of dental fillings in the EU are now made without mercury and it is now time that this becomes the norm,” said European Environment Bureau’s Elena Lymberidi-Settimo.

The European public also voiced their concerns over amalgam.

Following consultations, the European Commission found that 88 percent of participating Europeans recommended to phase out the toxic material while 12 percent called for its use to be phased down.

Some countries such as Sweden, Norway and Denmark have already banned or restricted the use of mercury-based dental fillings.

“European dentists know the end is near for amalgam. Alternatives are available, affordable, and effective. It is time for Europe to say good-bye to amalgam, a material clearly inferior to composite or ionomers,” said German Dentist Hans-Werner Bertelsen.

Composites and ionomers are both alternative dental restorative materials that use various glass and plastic compositions.

There is a growing consensus on the issue within the European Parliament as members have received over 17,000 signatures on petitions calling to ban amalgam in Europe.

According to the United Nations Environment Programme (UNEP), the use of mercury in tooth fillings represents approximately 10 percent of global mercury consumption, making it the largest consumer uses of mercury in the world.

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UN “Profoundly Sorry” for Haiti Cholera Outbreak Fri, 02 Dec 2016 00:53:08 +0000 Tharanga Yakupitiyage Secretary-General Ban Ki-moon addresses the General Assembly during a briefing on the United Nations’ New Approach to Cholera in Haiti. Credit: UN Photo/Eskinder Debebe

Secretary-General Ban Ki-moon addresses the General Assembly during a briefing on the United Nations’ New Approach to Cholera in Haiti. Credit: UN Photo/Eskinder Debebe

By Tharanga Yakupitiyage

For the first time, the United Nations issued a formal apology for their role in the cholera outbreak in Haiti and announced new steps to alleviate the ongoing health crisis.

Speaking to the members of the UN General Assembly, Secretary General Ban Ki-moon made an emotional statement, expressing his deep regret for the suffering and loss of life that resulted from the cholera epidemic.

“On behalf of the United Nations, I want to say very clearly: we apologise to the Haitian people. We simply did not do enough with regard to the cholera outbreak and its spread in Haiti. We are profoundly sorry for our role,” said Secretary General Ban Ki-moon Thursday.

Ban first delivered the apology, which was broadcast live on television in Haiti, in Creole, before switching to French and English.

The cholera outbreak, which occurred soon after the earthquake in 2010, killed nearly 10,000 and has to date infected close to 800,000, roughly one in twelve, Haitians.

We simply did not do enough with regard to the cholera outbreak and its spread in Haiti. We are profoundly sorry for our role,” Secretary General Ban Ki-moon.

Numerous reports including one by the U.S. Centres for Disease Control and Prevention pinpointed the appearance of the first cholera cases to the arrival of UN peacekeepers from Nepal.

Just one month before leaving office, Secretary General Ban Ki-moon noted that the cholera outbreak has created a “blemish” on the reputation of both UN peacekeeping and the organisation as a whole.

The UN first admitted its role in the cholera crisis in August when, during a briefing, spokesman Farhan Haq said that the that international organisation became “convinced that it needs to do much more regarding its own involvement in the initial outbreak.”

Desir Jean-Clair from Boucan Care, a cholera survivor whose mother died from cholera described the apology as a “victory.”

“We sent thousands of letters and were in the street to get this victory for them to say today that they were responsible,” he told The Institute for Justice & Democracy in Haiti. “They said that and we thank them. But it can’t end here. Because today there is still cholera in the whole country.”

While U.S. Senator Edward Markey, who had called for the apology, stated that it was “overdue” and is an “important first step for justice” for Haitians.

“The people of Haiti have long deserved more than just acknowledgment for the pain and sacrifice they have suffered in great part due to UN negligence,” said the top Democrat on the U.S. Senate Subcommittee on Africa and Global Health Policy.

Though it does represent a shift after over six years of denial of involvement or responsibility on the part of the UN, the apology stops short of explicitly acknowledging the responsibility of the UN in introducing cholera into Haiti.

“We now recognise that we had a role in this, but to go to the extent of taking full responsibility for all is a step that would not be possible for us to take,” said Deputy Secretary General Jan Eliasson during a briefing.

He noted the major reason for the limitation is to ensure the continuation of peacekeeping and humanitarian operations.

“We have to continue to do this work, There might be tragic mistakes in the future also, but we have to keep that long-term perspective,” he said.

The apology also comes after a U.S. appeals court upheld the UN’s immunity in August from a lawsuit filed on behalf of thousands of Haitian cholera victims.

Eliasson noted that the court decision helped protect key UN peacekeeping and humanitarian operations. It was therefore a “triggering” point for the apology and roadmap, he added.

“That is the reason we can now move forward to take this position of accepting moral responsibility and go to the extent that we express an apology…that is a way for us to send a message of support,” Eliasson stated.

However, words can only go so far, both Eliasson and Ban Ki-moon said.

“For the sake of the Haitian people, but also for the sake of the United Nations itself, we have a moral responsibility to act, and we have a collective responsibility to deliver,” Ban said.

In a report, the Secretary-General lays out a new two-track approach in order to reduce and end cholera transmission and long-term development of the country’s water, sanitation and health sectors respectively. Though work on track one is already underway, including the deployment of rapid response teams and vaccination programs, track two still is yet to be determined as consultations are ongoing.

Ban proposed a community approach for track two, working directly with the most affected Haitians. Though individual reparations could still be an element, Ban noted the difficulties to carry out such a program including the identification of deceased individuals and ensuring the provision of a meaningful fixed amount per cholera death.

The organisation has requested a total of $400 million over two years for the program, and has set up a voluntary funding system for both tracks. So far, an estimated $150 million has been received.

In order for the UN to achieve its ambitious program, it requires UN member states to make voluntary contributions.

“UN action requires member state action. Without your political will and financial support, we have only good intentions and words,” Ban said.

“With their history of suffering and hardships, the people of Haiti deserve this tangible expression of our solidarity,” he concluded.

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Ending AIDS Needs Both Prevention and a Cure Thu, 01 Dec 2016 15:13:43 +0000 Lyndal Rowlands A poster about stigma in a HIV testing lab in Uganda. Credit: Lyndal Rowlands / IPS.

A poster about stigma in a HIV testing lab in Uganda. Credit: Lyndal Rowlands / IPS.

By Lyndal Rowlands

Eighteen million people, just slightly under half of the people living with HIV and AIDS globally, are now taking life-saving medication, but global efforts to end the disease still largely depend on prevention.

While efforts to expand antiretroviral treatment have been relatively successfully, prevention efforts have been more mixed.

With the help of treatment, mother to baby transmission has dropped significantly. Transmission between adults aged 30 and over has also dropped.

However, transmission rates among adolescents have risen, causing concern, particularly about the high number of new cases among young women between the ages of 15 to 24.

According to UNAIDS, a new report published last week, “shows that the ages between 15 and 24 years are an incredibly dangerous time for young women.”

The report included data from six studies in Southern Africa, which showed that “southern Africa girls aged between 15 and 19 years accounted for 90% of all new HIV infections among 10 to 19-year-olds.”

“Young women are facing a triple threat,” said UNAIDS Executive Director, Michel Sidibé. “They are at high risk of HIV infection, have low rates of HIV testing, and have poor adherence to treatment. The world is failing young women and we urgently need to do more.”

The report also noted the countries that have increased their domestic funding for HIV prevention, “including Namibia, which has committed to investing 30% of its HIV budget in preventing HIV among adults and children.”

“Of course we all hope that this is a bi-partisan consensus but the fact that we, the U.S. government, continue to pay directly for service delivery in some countries is a huge risk,” -- Amanda Glassman

Ensuring the continued and renewed domestic and international funding for both treatment and prevention was the subject of discussion at the Center for Global Development in Washington D.C. on Monday.

The event, held ahead of World AIDS Day on 1 December, focused on a U.S. government initiative aimed at involving government finance departments, as well as health departments, in the HIV response.

Currently over 55 percent of the HIV response in low and middle-income countries comes from the governments of low and middle income countries.

However a significant amount of international support, roughly one third overall funding, comes from the U.S. government, which has made tackling HIV and AIDS a priority through the President’s Emergency Plan for AIDS Relief (PEPFAR).

However while U.S. funding for the HIV and AIDS response is considered bipartisan HIV and AIDS support, like any U.S. government program may change under Presidency of Donald Trump.

IPS spoke to Amanda Glassman, Vice President for Programs and Director of Global Health Policy at the Center for Global Development after the event:

“Of course we all hope that this is a bi-partisan consensus but the fact that we, the U.S. government, continue to pay directly for service delivery in some countries is a huge risk,” she said. “On the one hand I think maybe it makes it harder to cut, but on the other hand if it does get cut it’s a disaster.”

Of the 18 million people currently on antiretroviral treatment globally, “4.5 million are receiving direct support,” from the U.S. while an additional 3.2 million are receiving indirect support through partner countries.

While there remains broad consensus over treatment, prevention efforts are considered more politically contentious.

Previous Republican administrations have supported abstinence programs, which studies have shown to be ineffective at preventing HIV transmission.

Glassman noted that while there is more political consensus over treatment programs “you need prevention really to finish this.”

However she noted one positive example from incoming Vice-President Mike Pence’s home state of Indiana.

“(Pence) actually eliminated (needle exchange) programs and then saw HIV / AIDS go up and so he reversed his position, so I think that sounds good, he listens to evidence and action,” said Glassman.

However Pence’s record on women’s reproductive rights and his reported comments that in 2002 that condoms are too “modern” and “liberal”, may not bode well for overall prevention efforts, especially considering that addressing higher transmission rates among adolescent girls also requires addressing gender inequality and sexual violence. Update: In 2000, Pence’s campaign website also said that a US government HIV/AIDS program should direct resources “toward those institutions which provide assistance to those seeking to change their sexual behavior,” a statement many have interpreted as support for gay-conversion therapy.

Reducing the high rates of transmission among adolescent girls will not be easy. It involves increasing girls economic independence as well as helping them to stay in school longer.

“It’s a discussion of investment in secondary school … so the discussion is bigger than health,” said U.S. Global AIDS Coordinator, Deborah Birx at the event.

This is one of the reasons why involving government finance departments is important.

However finding additional funds for both education and health in the “hardest hit countries” will not be easy, said Glassman.

“(These countries) are coming in with growth projections that are much lower, they have pretty low tax yields meaning that the amount that they get from their tax base is pretty low.”

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Debate Roils India Over Family Planning Method Tue, 29 Nov 2016 21:34:55 +0000 Neeta Lal A family in New Delhi. Given India's high infant mortality rate, one of the highest in the world, many women are not keen on sterilisation since they feel that it shuts out their option of having children later if required. Credit: Neeta Lal/IPS

A family in New Delhi. Given India's high infant mortality rate, one of the highest in the world, many women are not keen on sterilisation since they feel that it shuts out their option of having children later if required. Credit: Neeta Lal/IPS

By Neeta Lal
NEW DELHI, Nov 29 2016 (IPS)

The Indian government’s decision to make injectable contraceptives available to the public for free under the national family planning programme (FPP) has stirred debate about women’s choices in the world’s largest democracy and second most populous country.

The controversial contraceptive containing the drug Depot Medroxyprogesterone Acetate (DPMA) is currently being introduced at the primary and district level. It is delivered in the form of an injection and works by thickening the mucous in a woman’s cervix which stops sperm from reaching the egg, thereby preventing pregnancy. It is also much cheaper than other forms of contraceptives available across the country.

Injectables have been part of family planning programs in many countries for the last two decades. They have also been available in the private sector in India since the early 1990s though not through government outlets. Advocates of injectable contraceptives say that their inclusion in the government’s programme will now offer women more autonomy and choice while simultaneously whittling down the country’s disquieting maternal mortality rate (MMR).

Nearly five women die every hour in India from medical complications developed during childbirth, according to the World Health Organization (WHO). Nearly 45,000 mothers die due to causes related to childbirth every year in India, which accounts for 17 percent of such deaths globally, according to the global health body. The use of injectable contraceptives is also backed by the WHO, which has considered the overall quality of the drug with evidence along with the benefits of preventing unintended pregnancy.

However, Indian civil society seems splintered on the issue. Several bodies like the Population Foundation of India and Family Planning Association of India support the government’s move. The Federation of Obstetric and Gynaecological Societies of India (FOGSI), an apex body of gynaecologists and obstetrics in the country, is also supportive of their use based on scientific evidence.

However, women right activists have opposed the initiative as a part of the national programme. They point to a report by the country’s premier pharmaceutical body — Drugs Technical Advisory Board (DTAB) — which has noted that DPMA causes bone loss. The report emphasizes that the osteoporotic effects of the injection worsen the longer the drug is administered and may remain long after the injections are stopped, and may even be irreversible. The DTAB had advised that the drug should not be included in the FPP until discussed threadbare with the country’s leading gynaecologists.

Several health groups, women’s organizations and peoples’ networks have also issued a joint statement protesting the approval of the injectable contraceptive. As far back as 1986, Indian women’s groups had approached the Supreme Court regarding serious problems with injectable contraceptives. based on a study by the country’s premier medical research organization — the Indian Council of Medical Research

Advocates of women’s health and reproductive rights add that the contraceptive is harmful to women as it leads to menstrual irregularity, amenorrhea, and demineralization of bones as a result of its long term use. Users have also reported weight gain, headaches, dizziness, abdominal bloating as well as decreased sex drive, and loss of bone density. The latest evidence from Africa now shows that the risk of acquiring HIV infection enhances because the couple is less likely to use a condom or any other form of contraception to minimise infection.

However, experts iterate that the real issue isn’t just about women’s health but about a human rights-based approach to family planning.

“Why should we control women’s access to choice? Is it not time to re-examine the issue and initiate a fresh debate?’’ asks Poonam Muttreja, Executive Director of the Population Foundation of India, who has opposed the introduction of DMPA.

Others say that while they are all for enlarging the basket of choices for women, and empowering them, pushing invasive hormone-based technology upon them is hardly the way to go about it. Besides, with the incidents of arthritis and Vitamin D deficiency in India already worrisome, demineralization of bones caused by DPMA will make matters a lot worse.

The total Contraceptive Prevalence Rate (CPR) in India among married women is estimated at 54.8 percent with 48.2 percent women using modern methods. This is comparatively lower than neighbouring countries like Bhutan, Bangladesh and Sri Lanka whose CPR stands at 65.6 percent, 61.2 percent and 68.4 percent, respectively.

In India, the primary method of family planning is female sterilization – at 65.7 percent, which is among the highest in the world. One of the key reasons for this is the limited availability of a wide range of contraceptive methods in the public health sector in the country, say family planning experts. Some fear that the new method might also result in poor women being used as guinea pigs for public healthcare.

“Women’s reproductive health has always been contentious and has had a fraught history, plagued by issues of ethics, consent, and the entrenched vested interests of global pharma companies and developed nations,” says Mukta Prabha, a volunteer with Women Power Connect, a pan-India women’s rights organization. “So we need to tread with caution on DPMA so that women can make informed choices and their health isn’t compromised.”

Indian women suffer from a host of problems associated with unwanted pregnancies from unsafe abortions to maternal mortality and life-long morbidity. The paucity of trained medical personnel in the public health system adds to their woes.. Besides, India has always had a troubled history of sterilisation. In 2014, over a dozen women died as the result of contaminated equipment in a sterilisation camp in the central Indian state of Chhattisgarh.

The resulting media uproar pressured the government to re-examine its policies and its long-held dependence on sterilisation. But in 2015-16 again there were 110 deaths due to botched sterilisation procedures. Given the high infant mortality rate, many women are wary of sterilisation. They also feel it restricts their choice of having children later if required. Despite this, over 1.4 m Indian women were sterilised in 2014 as against 5,004 men.

Worse, the controversial DPMA — which is aimed only at women — isn’t gender sensitive either. What should be pushed instead, say women activists, is male sterilisation which is a far simpler and minimally invasive procedure which also minimizes health risks for women.

As Prabha puts it, “Indian men’s participation in family planning has always been dismal even though they’re the ones who determine the number of children a women has. The current debate is a good opportunity to involve the men in the exercise and set right the gender skew.”

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Why Kenya’s Engagement with the UN Is a Big Deal Wed, 16 Nov 2016 17:27:41 +0000 Siddharth Chatterjee Siddharth Chatterjee is the UN Resident Coordinator and UNDP Resident Representative in Kenya.]]> The President meets Mrs Jumwa Kabibu who after 50 years of misery underwent a successful UN supported fistula surgery. Photo Credit: Newton/UNIC

The President meets Mrs Jumwa Kabibu who after 50 years of misery underwent a successful UN supported fistula surgery. Photo Credit: Newton/UNIC

By Siddharth Chatterjee
NAIROBI, Kenya, Nov 16 2016 (IPS)

President Uhuru Kenyatta warmly welcomed dozens of U.N Agencies, development partners and senior Government officials to the State House on 02 November 2016 to discuss the joint development plan from 2014 – 2018.

He is perhaps the only head of state in Africa to take on this responsibility personally and believes in the transformational power of the Government-UN partnership to address national priorities for sustainable development. (Speech/audio)

The United Nations Development Assistance Framework (UNDAF) is a critical document that guides government and U.N, partnership, ensuring the UN system is fit for purpose and contributes effectively to national development priorities.

The framework is nurturing a partnership grounded in dialogue and learning, leading to concrete action and progress. Important progress has been made in areas like HIV/AIDS, clean water, energy, food security, and the environment during the past 2 years of this UNDAF(PDF document).

“I am impressed by the progress achieved since our last meeting in August, 2015. It is truly encouraging to see the Vision turn to Action,” he said during this year’s review.

He was alluding to progress resulting from a joint Government-UN approach to addressing issues such as poverty and various vulnerabilities; progress coming from commitment to joining up efforts and pooling respective expertise and resources to make an impact on Kenyans.

Testimonials abound regarding this impact. (Watch UNDAF video). They include a 70 year-old lady who received treatment after suffering fistula for 50 years; matatu (public transport vehicle) owners who have improved the terms and conditions of matatu drivers and conductors as per international labour and a women’s community group bordering the Amboseli National Park who are part of conservation efforts through livelihood programmes.

The UNDAF has leveraged the devolved system of government with tremendous results in some counties. The innovative Governments of Kenya-Ethiopia Cross-border Program on Peace and Socio-economic Development supported by the UN has potential of being replicated in other parts of the world.

These are the kind of stories coming out of the UNDAF review process, whose emphasis is on accountability for results. The stories tell of impact across most of the major pillars of the country’s Vision 2030, which also overlap with UN priorities such as peace, security, and poverty reduction.

The UNDAF in Kenya is recognized by the UN Development Group as a best practice in creating an alliance shaped by common interests and shared purpose, and bounded by clear principles that encourage autonomy and synergy.

The Framework was developed according to UN Delivering as One principles (DaO) aimed at ensuring Government ownership, demonstrated through UNDAF’s full alignment to Government priorities and planning cycles, and internal coherence among UN agencies and programmes operating in Kenya.

The partners have also been able to jointly recognize and agree on the national, regional and global realities that should inform their interventions. For instance, both the Government of Kenya and the UN are aware of Kenya’s looming youth bulge with 1 million young people joining the work force annually and the need to turn it into a demographic dividend, lest it turn into a demographic disaster.

“We must focus on our youth and provide alternatives to crime, violent extremism and despondency,” the President said during the review.

Kenya is on a journey to realizing Vision 2030 and the Sustainable Development Goals. The UNDAF has demonstrated that it presents the best opportunity for powering the implementation of Kenya’s development agenda. Kenya’s engagement with the United Nations Country Team and indeed all development partners brought together under a solid framework is therefore a plus for the people of Kenya.

The UN and Government must not relent in pursuing more gains. New realities are bringing about new threats to social and economic development, calling for new approaches, but also creating new opportunities for collaboration.

These new approaches may for instance involve deepening private-public partnerships to engage a third force – private companies – that have unique innovation and implementation capabilities. This engagement can only develop better and more integrated solutions to important national challenges. (RC Speech Audio)

Ultimately, this framework is not about the UN or the Government or non-state actors, but is aimed at achieving a transformation in the lives of every Kenyan and ensuring that “no one is left behind”.

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Actions Needed Urgently to Tackle Air Pollution – Part 2 Mon, 14 Nov 2016 09:38:24 +0000 Martin Khor Martin Khor is Executive Director of the South Centre, a think tank for developing countries, based in Geneva. ]]> Panoramic view of a neighbourhood in southern Mexico City, with buildings semi-hidden by air pollution. Credit: Emilio Godoy/IPS

Panoramic view of a neighbourhood in southern Mexico City, with buildings semi-hidden by air pollution. Credit: Emilio Godoy/IPS

By Martin Khor
PENANG, Nov 14 2016 (IPS)

As evidence mounts on the threats posed by air pollution to both human health and the environment, action must be urgently taken to address this problem.  

At the global level, the Paris Agreement that came into force on 10 November aims to get countries to significantly reduce Greenhouse Gas emissions and to better cope with climate change.

In May 2016, Health Ministers approved a global “roadmap” to address air pollution at the World Health Assembly.  And the United Nations’ sustainable development goals, adopted in 2015, contain accompanying targets for reducing air pollution.

But much more needs to be done, especially at the national level, to seriously tackle this crisis.

The adverse health effects of air pollution have been growing worse with a 8% increase from 2008 to 2013 in deaths globally caused by urban air pollution, according to World Health Organisation data. Although the situation has improved in developed countries, it has deteriorated in most developing countries.

Countering air pollution should thus be a top priority. What should be done?   First, more details and data should be collected in all countries, through improvements in monitoring air pollution and its adverse health effects.

Second, a public education campaign is needed to make the public more aware of the dangers of air pollution so they can take actions to prevent the pollution and to avoid being exposed.

Third, and most important, the causes of the pollution must be identified and action plans drawn up to eliminate or reduce the factors these sources.

Martin Khor

Martin Khor

Outdoor air pollution is caused by transport vehicles that emit pollutants, coal-fired power plants, industrial factories, burning of wastes and fires in forest and agricultural areas.  Indoor pollution is mainly caused by the use of fuels that are based on wood and coal.

Besides the direct effects on human health, the pollution is also a major cause of global warming, which in turn also affects health.

It is thus doubly important to tackle these causes.  Actions should include the following:

  • Reduce vehicle emissions through better energy-efficiency and air-pollution standards for vehicles and control of private transport.
  • Give priority to public transport and promote clean transport such as railways, bicycles and walkways
  • Phase out of coal powered plants, shift to clean modes of power generation, and promote renewable energy
  • Impose strict air pollution controls in industry and phase in clean low-emissions technologies.
  • Promote energy efficiency in the design of buildings.
  • Phase out the use of wood and charcoal as household fuels used in traditional stoves, and replace them with safe and efficient stoves.
  • Reduce waste through recycling and reuse, introduce alternatives to open incineration of solid waste and stop the open burning of household wastes.
  • Stop the burning of forests, mangroves and in agriculture; this is the most important to prevent the South-east Asian “haze.”
  • Take measures so as to adhere to the WHO guidelines for outdoor and indoor air pollution. (The WHO guideline for particulate matter (PM) outdoor pollution is 10 microgram per cubic meter annual mean for particles below the size of 2.5 microns in diameter, and 20 microgram for particles below 10 microns in size).

Drastically reducing air pollution would be tackling the world’s biggest health and environmental problems, as air pollution is the major source of deaths and diseases, as well as the main cause of climate change
Air pollution reduction measures should become part of wider health and environmental strategies and be given priority and resources in the country’s development plans.

The problem must also be given the global attention it deserves.  In May 2016, the World Health Assembly for the first time adopted a road map to tackle air pollution and its causes. (WHA Document A69/18;  6 May 2016).  The four-point road map calls on the health sector to:

  • Expand the knowledge base on air pollution, its health effects and effectiveness of policies;
  • Increase monitoring of air pollution locally and assess the health impacts of its sources;
  • Take on a leadership role in national policies to respond to air pollution and at the global level;
  • Build its own capacity to influence policy and decision making processes to take joint action on air pollution and health.

The UN’s Agenda 2030 and its Sustainable Development Goals, adopted by world leaders in September 2015, also has goals and targets relevant to air pollution.   These include goals and associated targets relevant to health (Goal 3); cities (Goal 11) and household energy (Goal 7).   The three indicators most relevant to air pollution are:

  • SDG Indicator 3.9.1 for goal 3 on health (mortality rate attributed to household and ambient air pollution);
  • SDG Indicator 11.6.2 for goal 11 on cities (annual mean levels of fine particulate matter (PM) in cities; and
  • SDG Indicator 7.1.2 for goal 7 on energy (proportion of population with primary reliance on clean fuels and technologies).

Cutting down on air pollution, which is closely related to emissions of Greenhouse Gases, is one the major actions (if not the very top action) countries are expected to take to fight climate change, and thus most relevant to the implementation of the Paris Agreement of the UN Climate Change Convention adopted in December 2015.

Indeed, drastically reducing air pollution would be tackling the world’s biggest health and environmental problems, as air pollution is the major source of deaths and diseases, as well as the main cause of climate change.

Action plans on air pollution are thus urgently needed at both national and global levels.

“Fast action to tackle air pollution can’t come soon enough,” said Dr Maria Neira, WHO Director, Department of Public Health, Environmental and Social Determinants of Health. “Solutions exist with sustainable transport in cities, solid waste management, access to clean household fuels and cook-stoves, as well as renewable energies and industrial emissions reductions.”

We are only at the starting phase of understanding the huge health problem that air pollution causes.  We have however been made conscious of the grave crisis that it has caused to the environment.

While the actions needed are quite clear, getting them implemented will be an immense challenge, as the causes of air pollution are presently so embedded in modern lifestyles and economic structures.

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