By Tamira Gunzberg
BRUSSELS, Jul 18 2015 (IPS)

Today Jul. 18 is Mandela Day, the annual international day in honour of the late Nelson Mandela, the first democratically-elected President of the Republic of South Africa.

The day was instated by the United Nations after Nelson Mandela made a call for the next generation to take on the burden of leadership in addressing the world’s social injustices. Mandela said, “It is in your hands now”.

Tamira Gunzburg

Today, then, is a moment to reflect on whether we are indeed rising to that occasion. One of the scourges of humanity today, in Mandela’s own words, is poverty. And 2015 is a year rife with opportunities to make historic strides in the fight against extreme poverty. Halfway through the year, what have our leaders made of this potential?

Many of them will have just arrived home from an international summit held in Addis Ababa, Ethiopia, this week. The summit was meant to land an international agreement on how to finance development going forward. Against difficult odds, world leaders indeed signed up to an agreement that could start to reshape how developing countries are supported in their progress towards growth and prosperity.

But over the months of negotiation preceding the summit, some key areas were watered down. For example, one measure to curb illicit financial flows, involving the public disclosure of multinational companies’ tax reports, was weakened.

A proposed commitment to prioritise the poorest countries by directing half of development assistance there suffered the same fate.

The result is a final agreement that, as it stands, is not ambitious enough to be able to successfully end extreme poverty.“Like slavery and apartheid, poverty is not natural. It is man-made and it can be overcome and eradicated by the actions of human beings” – Nelson Mandela, Trafalgar Square, 3 February 2005

Mandela Day is perfectly timed because his legacy reminds us that now is not the time to give up. Indeed, in just two months’ time, another historic opportunity will be within reach.

At the U.N. General Assembly in New York, world leaders will come together once again, this time to adopt a new set of Global Goals that will shape the future of our planet and its people.

The previous set of anti-poverty goals, the Millennium Development Goals, set in 2000 and due to expire this year, indeed played a critical role in drastically bringing down global average levels of hunger, child mortality, and extreme poverty.

But this time around, the Global Goals are all about finishing the job. In order to reach the very last person at the end of the very last mile, leaders will have to put the most vulnerable at the centre of their efforts from the get-go.

When this new blueprint is unveiled in September, we expect leaders to underpin the goals and objectives with the means and actions needed to actually achieve them by the 2030 deadline.

It would be the perfect opportunity for big donors like the European Union to prioritise the poorest countries by announcing they will direct half of their development aid to the least developed countries.

There are plenty more ways in which individual countries can step up and guarantee that the Global Goals are launched with the best chances of succeeding. I, for one, am optimistic about the prospects of that happening.

Part of that optimism I derive from my South African heritage. My mother, who grew up in South Africa under the cloud of apartheid, always tells me that she grew up convinced the world as she knew it would never change. And then one day it did.

We have Nelson Mandela to thank for that. But also many others who believed that a better world was possible, and who worked tirelessly to change the status quo.

In the year 2015, our generation faces formidable challenges of its own, but looking back at incredible transformations like South Africa’s shows that anything is possible.

In the last twenty years, we already halved the proportion of the world’s population living in extreme poverty, and virtually eliminating it by 2030 is entirely possible if our leaders get it right.

There is no better day than today to contemplate the role each and every one of us can play in making sure we do not fail on that count.

Edited by Phil Harris   

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

Excerpt:

Sanitation infrastructure in India’s sprawling slums remains a massive challenge. Credit: Malini Shankar/IPS

By Neeraj Jain
NEW DELHI, Feb 24 2015 (IPS)

Prime Minister Narendra Modi’s call to action for a 100 percent Open Defecation Free (ODF) India by 2019 was announced as part of the Swachh Bharat Mission (SBM) or Clean India Campaign last year.

With 60 percent of all those practising open defecation globally residing in India, this task is particularly crucial, yet also challenging.We need to think how we are going to engage and influence the behaviour of such a massive audience. It probably requires the most ambitious behaviour change campaign ever attempted in the history of any nation.

Inadequate waste management leads to the contamination of water sources, contributing to diarrhoeal diseases that claim the lives of 186,000 children every single year.

With nowhere safe to go to the toilet, women and girls are often put in a vulnerable position as they seek somewhere private to relieve themselves.

A lack of adequate sanitation also has a substantial impact on economic development, with money repeatedly being lost due to workers being sick or taking time off to care for sick family members, not to mention the cost of medical treatment.

So is the 2019 target actually achievable?

It may sound like a tall order but we won’t know until we try. We need to look at the ways to make it work – implement this seemingly ambitious plan in an effective manner to make the target achievable. Not just admit defeat before we start.

The recent pace of the activities under the SBM suggests that India would become clean by 2070. To achieve the target around 50,000 toilets need to be built every day, without compromising on quality.

So it’s high time that we stop focussing on the problems and start discussing possible solutions.

With this in mind, WaterAid India organised an India WASH Summit in New Delhi last week. It was the first of its kind and was aimed at devising solutions to India’s sanitation crisis and shaping future collaboration to achieve Swachh Bharat’s ambitious target of a toilet for every household by Oct. 2, 2019. 

This landmark event, organised in partnership with the Ministry of Drinking Water & Sanitation and Ministry of Urban Development, brought together the government, the private sector and civil society groups working to make clean India a reality.

The summit concluded with the creation of a concrete set of recommendations to be shared with the government of India to help in the effective implementation of the SBM across a number of themes including behaviour, equity and inclusion, gender, water security, institutional transformation, technology, research, and convergence of nutrition, health and education.

Collaboration emerged as a key theme at the summit, both within the sector as well as with organisations focussing on nutrition, health and education. Participants at the summit stressed the importance of capacity building and the need for effective monitoring.

It was agreed that sanitation should be acknowledged as a basic human right. To ensure success in getting sanitation for all, programmes need to be equitable and inclusive and should include behaviour change at its core.

Previous initiatives have taught us that just building toilets is not enough. To stimulate demand for toilets, hygiene education and collective initiatives are key.

We need to think how we are going to engage and influence the behaviour of such a massive audience. It probably requires the most ambitious behaviour change campaign ever attempted in the history of any nation.

The overall budget of the programme (rural as well as urban) as estimated by the government is almost Rs. 3 lakh crores (50 billion dollars).

I believe that answers to all hurdles identified above do exist but the entire WASH (water, sanitation and hygiene) sector need to come together to find the most suitable answers as well as the most effective ways to implement it, in record time.

WaterAid has been working in the WASH sector in India since 1986 and is committed to supporting the government of India in realising the ambitious but much needed goal of making India open defecation free by Mahatma Gandhi’s 150th birth anniversary in October 2019.

Edited by Kitty Stapp

Excerpt:

Community-based volunteer Zainab Abubakar (r) administers the first dose of amodiaqune to one-year-old Inusa as he sits on his mother, Ayishetu Hamdellah. Credit: Albert Oppong-Ansah/IPS

By Albert Oppong-Ansah
ZANDUA, Ghana, Apr 29 2014 (IPS)

Zainab Abubakar saves children’s lives. A few years ago she was just an ordinary woman with no medical training living in rural Kpilo in Ghana’s Northern Region. 

Here the nearest medical clinic is a 12-km walk away and serves the 20 to 40 communities within this electoral area. Across Northern Region, less than 10 percent of communities have a local clinic. However, in the region’s capital, Tamale, 19.4 percent of communities have local clinics.

Now, instead of making the long journey to a crowded health centre, mothers bring their sick children to Abubakar. When she sees children with symptoms of sweating, weakness and a high temperature she’s able to differentiate between a case of pneumonia and malaria. She’s also able to correctly treat and provide medication for these illnesses. “Since these CBVs started working in this community the health of children here has improved. We no longer record deaths.” -- chief of Kpilo, Mahama Abdullah

“In a situation like that I bathe the child and then I dissolve one tablet of amodiaquine in a small clean cup and give it to the child to drink,” Abubakar tells IPS.

She then provides the mother with medication. “In order that the medication is administered at the right time, I do a follow-up to ensure that the child is given the drug,” she adds.

Abubakar is one of 16,500 community-based volunteers (CBVs) trained by the Ghana Health Service (GHS) to manage common childhood diseases in their communities which lack access to healthcare facilities. GHS also supplies them with medication to treat these illnesses. While medication is free, most people pay about 20 cents as a token payment for the drug administered.

This rural health initiative, called the Integrated Community Case Management (ICCM), is supported by the United Nations Children’s Fund (UNICEF) and is funded by the United States Agency for International Development.

Since 2007, volunteers from the four provinces here that have limited healthcare facilities — Northern, Upper East, Upper West and Central Regions — have been trained to reduce the high rate of child mortality. Pneumonia, diarrhoea and malaria account for two out of five child mortality cases.

Alhassan Abukari, ICCM assistant project coordinator in GHS’s Northern Regional Health Directorate, says they are unable to provide medical care to most communities due to lack of resources and personnel.

In Ghana’s Northern Region it was harder to provide services, Abukari says, because communities are hard to reach and usually are cut off because of flooding during the rainy season.

“A sizeable number of people in peri-urban communities of the region do not have access to health facilities so these volunteers are really bridging the very wide gap that existed,” he tells IPS.

“We seriously lack personnel; for instance in the case of a community in Saboba district in the Northern Region of Ghana, there is only one community health nurse taking care of 20 communities and she is supposed to visit these communities,” he says. 

The CBVs promote health literacy and behaviour during house-to-house visits. During the visits Abubakar explains the importance of exclusive breastfeeding, sleeping under a mosquito net, and washing one’s hands with soap. She refers all severe or complicated cases to the nearest health facility.

Abubakar and the other volunteers are not paid for their work. But, she says, she feels happy saving lives. She says she is motivated by the fact that every child belongs to the community and it’s her passion to serve the community.

According to UNICEF, community management of childhood pneumonia could result in a 70 percent reduction in under-five mortality.

ICCM believes that malaria can also be reduced through the initiative. It is estimated that malaria-specific under-five mortality can be brought down by 40 to 60 percent, and severe malaria morbidity by 53 percent.

Abukari says that the timely intervention of these volunteers, who serve as “doctors” in their various communities, has helped prevent cases of child deaths.

Ayishetu Hamdellah, a widow and mother of four, from Kpilo says having Abubakar around is a huge assistance. It means she no longer has to walk long distances to get treatment for her one-year-old son, Inusa, who used to contract malaria frequently.

Now, Inusa is able to receive immediate treatment if he gets malaria.

The chief of Kpilo, Mahama Abdullah, tells IPS that initiative is so successful he would like it extended to include treatment for adults as well.

“Since these CBVs started working in this community the health of children here has improved.

“We no longer record deaths.”

An eight-month-old boy with pneumonia is examined by a doctor at Amana Hospital in Dar es Salaam, Tanzania. Credit: Kristin Palitza/IPS

By Lucy Westcott
UNITED NATIONS, May 22 2013 (IPS)

PATH, a Seattle-based global health development organisation, is aiming to save two million lives by 2015 by jointly tackling diarrhea and pneumonia, the leading killers of children globally.

Steve Davis, president and CEO of PATH, delivered the message at the ninth annual PATH Breakfast for Global Health held in Seattle on Tuesday.

“Today we placed a bold stake in the ground, with partners around the world, to save two million lives by the end of 2015,” Davis told IPS.

PATH will begin its efforts in India, Cambodia and Ethiopia, where intervention is most urgently needed and PATH has resources. While all three countries have seen their child mortality rates from diarrhea drop, India’s pneumonia death rate remains stagnant, accounting for 24 percent of deaths of children under five, the same as in 2000, according to 2013 World Health Organisation statistics.

“No parent should have to bury a child because of something we can help prevent or treat,” Davis said.

Diarrhea and pneumonia are two diseases that overwhelmingly affect children in African and Asian countries, Davis said, with diarrhea claiming around 760,000 lives a year. And while the number of children dying in Africa before the age of five has decreased, it still vastly outnumbers all other parts of the world, according to the 2013 WHO statistics.

Melinda Gates, philanthropist and founder of the Bill and Melinda Gates Foundation, which helps fund health development and vaccines world wide, spoke at the breakfast of the importance of vaccinating children as well as “appropriate” science that meets the needs of communities in the developing countries.

“[The] developing world is littered with pilot programmes,” Gates said.

As he took to the stage, Davis pointed to a tool belt around his suit jacket. A visual aid, the belt allowed Davis to show and carry some of the tools that can prevent the deaths of so many children from diarrheal disease, tools that will be used to achieve PATH’s life-saving goal.

Clean water, soap, zinc tablets for oral rehydration therapy and the rotavirus vaccine, which stops some diarrheal diseases before they start, were all included.

But it’s not just science and vaccines that can improve the lives of communities ravaged by diarrhea. Deeply held cultural traditions and ideas about the disease have to be altered as well.

Dr. Alfred Ochola, PATH’s Technical Advisor for Child Survival and Development in Kenya, spoke about educating Kenyans on how to reduce the risk of diarrhea in their communities through hygiene practices like hand washing.

But Ochola, who lost a brother and sister to a diarrhea outbreak in Kenya as a child, has found that at first, people are reluctant to embrace change.

“A big [challenge] is combatting old beliefs that diarrhea is a curse and not an infection, and that the death of a child is an inevitable part of life. ‘God will give you another one’ is a common saying in Kenya,” Ochola said.

Many people believe a child who has diarrhea is cursed, Ochola said. Vomiting and diarrhea are welcomed because it rids the body of the evil inside it, while it should be taken as a sign that something is seriously wrong.

Poverty is another challenge in combatting the diseases. Although heart disease and diabetes are becoming the new illnesses of poverty, according to Davis, diarrhea and pneumonia still adversely affect children of developing countries in Africa and Asia.

In Africa and Southeast Asia, the percentage of child deaths are higher than the global average and have not significantly decreased in 10 years. Both regions have seen child mortality from diarrhea fall from 13 percent to 11 percent of deaths from 2000 to 2010, but in Africa, the rate of death from pneumonia has actually increased, from 16 percent to 17 percent.

“Too many people lack the financial means to seek care when it’s most needed, like paying for transportation to get to a health facility far from home… We often reach women and their children too late,” Ochola said.

Ochola told the story of Jane Wamalwa, a Kenyan woman who came to understand the reasons behind making a change in long-held practices in treating and preventing diarrhea. Wamalwa lost three children to the disease, and has now become a trusted source of information on good anti-diarrhea practice in her community, Ochola said.

“It has become her calling,” he added.

South Africa is leading in the scaling up of Kangaroo Mother Care, a lifesaving intervention that mothers can easily practice. Pictured here are Charlene Paul and her baby in front of their house, next to Athlone Training Stadium in Cape Town. Credit: Ann Hellman/IPS

By Stanley Karombo
JOHANNESBURG, Apr 23 2013 (IPS)

A young mother – who only wants to be identified as Karren – beamed as she nursed her newborn baby at the University of Witwatersrand’s Reproductive Health and HIV Institute, in Hillbrow, South Africa. 

It is her first pregnancy and Karren had to learn, from a qualified nurse, how to hold and care for her baby.

While Karren will soon be counting her baby’s happy milestones – first smile, first tooth, first step – each year three million children die within their first month of life from largely preventable causes such as prematurity, birth complications and infection, according to international charity Save the Children.

It is a major reason why, at the end of the year, South Africa will launch Global Newborn Action Plan, which aims to reduce the number of newborn deaths here.

But South Africa is leading in the scaling up of Kangaroo Mother Care (KMC), a lifesaving intervention that mothers can easily practice, according to Dr. Gary Darmstadt, director of family health at the Bill & Melinda Gates Foundation.

“This was a paradigm-changing idea just a few years ago. No longer could we ignore the newborn period – excuses were gone. We now know of a number of simple interventions that have great potential to avert the top causes of neonatal death,” Darmastadt told IPS.

Kangaroo Mother Care is the act of holding a newborn with skin-to-skin contact. It usually facilitates breastfeeding, reduces the risk of serious infections and keeps the baby warm, thus reducing mortality of preterm infants by about half.

But these are some of the things that first-time mother Karren had to be taught. Studies estimate that if KMC was used widely with preterm babies, it could save more than 1,500 lives around the world each day.

Another critical intervention is the use of antenatal corticosteroids to help develop a preterm baby’s lungs so that he can breathe on his own. It is widely used in high-income countries with an estimated 90 percent coverage of indicated cases of women in preterm labour. If its use spreads in middle and low-income countries, it can save more than 1,000 newborn lives across the globe daily.

Darmstadt said that despite remarkable changes in the levels of understanding of newborn mortality and prevention methods, newborns continue to die and now account for more than 40 percent of all under five deaths.

“The number of newborns who die in sub-Saharan Africa has actually gone up in recent years, even while child and maternal deaths have fallen.”

In fact, an increase in preventing mother-to-child transmission and in paediatric HIV care and treatment services has made significant inroads in reducing under five mortality in South Africa.

But progress is hampered by weak health systems in heavily-affected countries, according to Dr. Lee Fairlie, a paediatrician at the Wits Reproductive Health and HIV Institute (WRHI).

“HIV prevention has received increased attention. Child mortality has also benefited from progress in addressing HIV. However, more attention to postnatal feeding support is needed,” Fairlie said.

She also noted that there was a reduction in colliding epidemics such as HIV and tuberculosis; chronic illness and mental health; injury and violence; and maternal, neonatal, and child health. She also added that there was a 3.5 percent reduction in the mother-to-child transmission of HIV.

South Africa now has the world’s largest programme of antiretroviral therapy, and some advances have been made with the implementation of new TB diagnostics, and treatment scale-up and integration.

Dr. Vivian Black of the WRHI told IPS that the country’s health system still faces many challenges, including a shortage of health staff and an ineffective data collection system by health officials that could result in deaths going unrecorded. She pointed out that South Africa’s health authorities were negligent in failing to collect appropriately detailed information about maternal mortality that could guide policy.

“Some of the women don’t know their rights as patients. We have to encourage women to know their rights,” said Black.

But what can South Africa learn from other Sub-Saharan Africa countries?

Koki Agarwal, director of the Maternal and Child Health Integrated Program (MCHIP), a programme funded by the United States Agency for International Development, told IPS that South Africa can learn from the successes of other countries like Rwanda and Malawi in terms of reducing infant mortality. These countries have also introduced community health workers who monitor pregnant women and collect data on pre- and post-neonatal deaths.

South Africa needs to accelerate progress in newborn survival by galvanising efforts to mobilise governments, donors, local partners and communities to make newborn deaths a top priority.

Darmstadt concurred. He said Malawi’s health delivery system had the support of President Joyce Banda, who has “done a lot in providing primary health care as well as supporting KMC.”

Rwanda has also had great success in reducing maternal and child deaths. Because of a programme that encourages Rwandan women to seek antenatal care with skilled health practitioners and interventions like KMC, Rwanda is on track to meet the United Nations Millennium Development Goals (MDGs) to reduce child mortality and improve maternal health.

There are eight MDGs, which were adopted by all U.N. member states in 2000 in order to curb poverty, disease and gender inequality.

Agarwal, an internationally renowned expert in safe motherhood and reproductive health who is also vice president of Jhiego, an affiliate of John Hopkins University, said nutrition interventions helped improve the chances of newborn survival.

“A woman’s nutritional status before and during pregnancy helps to define her own health, nutritional status and the survival of her baby at birth and beyond,” she said. “We know that encouraging women to come into care early in their pregnancy, ensuring they know their HIV status, and having them linked to appropriate interventions is the first step in eliminating mother-to-child transmission.”

Agarwal added that in Kenya, MCHIP was working to “guide mobilisation of community health workers in bringing pregnant women – and later their infants – into care.”