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Journal of the European Economic Association. 2012 Oct; 10(5):1025-1058.This paper estimates whether exports affect the incidence of HIV in Africa. This relationship has implications for HIV prevention policy as well as for the consequences of trade increases in Africa. I estimate this impact using two sources of data on HIV incidence, one generated based on UNAIDS estimates and the other based on observed HIV mortality. These data are combined with data on export value and volume. I find a fairly consistent positive relationship between exports and new HIV infections: doubling exports leads to a 10%-70% increase in new HIV infections. Consistent with theory, this relationship is larger in areas with higher baseline HIV prevalence. I interpret the result as suggesting that increased exports increase the movement of people (trucking), which increases sexual contacts. Consistent with this interpretation, the effect is larger for export growth than for income growth per se and is larger in areas with more extensive road networks.
Development in Practice. 2012 Apr; 22(2):202-215.Empowerment has become a mainstream concept in international development but lacks clear definition, which can undermine development initiatives aimed at strengthening empowerment as a route to poverty reduction. In the present article, written narratives from 49 international development organisations identify how empowerment is defined and operationalised in community initiatives. Results show a conceptual framework of empowerment comprising six mechanisms that foster empowerment (knowledge; agency; opportunity; capacity-building; resources; and sustainability), five domains of empowerment (health; economic; political; resource; and spiritual), and three levels (individual; community; and organisational). A key finding is the interdependence between components, indicating important programmatic implications for development initiatives.
Strong ministries for strong health systems. An overview of the study report: Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening.
[Kampala], Uganda, African Centre for Global Health and Social Transformation [ACHEST], 2010 Jan.  p.This overview is adapted from the report Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening by Dr. Francis Omaswa, executive director and founder of The African Center for Global Health and Social Transformation (ACHEST) and Dr. Jo Ivey Boufford, president of The New York Academy of Medicine (NYAM). The study and report were commissioned by the Rockefeller Foundation to explore the feasibility of establishing a support mechanism for ministers and ministries of health especially in the poorest countries, as part of the Foundation’s Transforming Health Systems initiative, The study was initially designed to assess the potential value of three proposed programs to strengthen the leadership capabilities of ministers of health: a global executive leadership program for new ministers; an ongoing, regional, in-person and virtual leadership support program for sitting ministers; and a virtual global resource center for ministers and high level ministerial officials providing real-time access to information. During the course of the study, it became clear that it was essential to expand the inquiry to better understand the challenges and needs of ministries as a whole, as they and their ministers provide the stewardship function for country health systems.The content of the report was derived from six major activities:a comprehensive literature review of the theory and practice of effective leadership development and organizational capacity building, and an environmental scan to identify any existing or planned leadership development programs for ministers of health or any that have occurred in the recent past globally; a survey of the turnover of ministers of health; targeted interviews with ministers, former ministers, and key stakeholders who interact with them, conducted between October 2008 and September 2009, to better understand the roles of ministers and ministries, the challenges they face, resources at their disposal, and their thoughts on what additional resources might enhance their personal effectiveness and that of their ministries; a consultative meeting of experts and stakeholders held in Bellagio, Italy part way through the project; participation of the project leaders (Omaswa and Boufford) in relevant global and regional meetings, as well as individual meetings about the project with critical leaders in international and donor organizations and potential champions of this effort; and a consultation with African regional health leaders to discuss the final report, held in Kampala, Uganda. (Excerpt).
Priorities for research on equity and health: Implications for global and national priority setting and the role of WHO to take the health equity research agenda forward.
[Geneva, Switzerland], World Health Organization [WHO], 2009 Sep 9. 36 p. (Discussion Paper)The report of the WHO Commission on Social Determinants of Health was released in August, 2008. Subsequently, a group led by Sweden’s Piroska Östlin, comprising 14 researchers who were actively involved with the Knowledge Networks that supported the Commission, was commissioned by WHO to update an earlier (2005) report on priorities for health equity research. The new (September 9, 2009) discussion paper observes that: "The bulk of global health research has focused on biological disciplines, to develop medical solutions, to be provided through clinical, individual patient care. The past two decades have witnessed a rise in a new public health paradigm, enlarging disciplinary perspectives, stakeholder analysis, and recognition that health systems can be designed more effectively through new knowledge. This paradigm shift represents a second wave of global health research. With the 10/90 gap embraced by many organisations as an objective to be reversed and the CSDH's report widely distributed, among other contemporary efforts, this paper argues that we are on the cusp of a third wave in global health research, one that explicitly links broader social, political and economic determinants with improvements in equity in health, within and across countries".
Eastern Mediterranean Health Journal. 2008; 14 Suppl:S90-6.Now, 28 years after acquired immune deficiency syndrome (AIDS) was first recognised, it has become a global pandemic affecting almost all countries. WHO/UNAIDS (Joint United Nations Programme on HIV/AIDS) estimate the number of people living with human immunodeficiency virus (HIV) worldwide in 2007 at 33.2 million. Every day 68 000 become infected and over 5700 die from AIDS; 95% of these infections and deaths have occurred in developing countries. The HIV pandemic remains the most serious of infectious disease challenges to public health. Sub-Saharan Africa remains the most seriously affected region, with AIDS the leading cause of death there. Although percentage prevalence has stabilized, continuing new infections (even at a reduced Estimated number of people living with HIV globally, 1990-2007, data from UNAIDS rate) contribute to the estimated number of persons living with HIV, 33.2 million (30.6-36.1 million). A defining feature of the pandemic in the current decade is the increasing burden of HIV infection in women, which has additional implications for mother-to-child transmission. In sub-Saharan Africa, almost 61% of adults living with HIV in 2007 were women. The impact of HIV mortality is greatest on people in their 20s and 30s; this severely distorts the shape of the population pyramid in affected societies. Globally, the number of children living with HIV increased from 1.5 million in 2001 to 2.5 million in 2007, 90% of them in sub-Saharan Africa. HIV/AIDS also poses a threat to economic growth in many countries already in distress. According to the World Bank analysis of 80 developing countries, as the prevalence of HIV infection increases from 15% to 30%, the per capita gross domestic product decreases 1.0%-1.5% per year. The powerful negative impact of AIDS on households, productive enterprises and countries stems partly from the high cost of treatment, which diverts resources from productive investments, but mostly from the fact that AIDS affects people during their economically productive adult years, when they are responsible for the support and care of others. This crisis has necessitated a unique and truly global response to meld the resources, political power, and technical capacity of all UN organizations, developing countries and others in a concerted manner to curb the pandemic. AIDS often engenders stigma, discrimination, and denial, because of its association with marginalized groups, sexual transmission and lethality, hence it requires a more comprehensive and holistic approach. During the past 10 years, many developments have occurred in response to this pandemic. WHO has played an important role in this response. This article reviews the major developments in treatment and prevention and the role of WHO in response to these developments.
Bulletin of the World Health Organization. 2008 Jul; 86(7):568–576.The objective of this study was to estimate the financial resources required to achieve the 2015 targets for global tuberculosis (TB) control, which have been set within the framework of the Millennium Development Goals (MDGs). The Global Plan to Stop TB, 2006-2015 was developed by the Stop TB Partnership. It sets out what needs to be done to achieve the 2015 targets for global TB control, based on WHO's Stop TB Strategy. Plan costs were estimated using spreadsheet models that included epidemiological, demographic, planning and unit cost data. A total of US$ 56 billion is required during the period 2006-2015 (93% for TB-endemic countries, 7% for international technical agencies), increasing from US$ 3.5 billion in 2006 to US$ 6.7 billion in 2015. The single biggest cost (US$ 3 billion per year) is for the treatment of drug-susceptible cases in DOTS programmes. Other major costs are treatment of patients with multi- and extensively drug-resistant TB (MDR-TB and XDR-TB), collaborative TB/HIV activities, and advocacy, communication and social mobilization. Low-income countries account for 41% of total funding needs and 65% of funding needs for TB/HIV. Middle-income countries account for 72% of the funding needed for treatment of MDR-TB and XDR-TB. African countries require the largest increases in funding. Achieving the 2015 global targets set for TB control requires a major increase in funding. To support resource mobilization, comprehensive and costed national plans that are in line with the Global Plan to Stop TB are needed, backed up by robust assessments of the funding that can be raised in each country from domestic sources and the balance that is needed from donors. (author's)
Lancet. 2008 Jul 26; 372(9635):333-6.Funds available for HIV/AIDS programmes in low-income and middle-income countries rose from US$300 million in 1996 to $10 billion in 2007. However, a combination of worldwide economic uncertainty, a global food crisis, and publications that indicate discontent with progress in fighting the HIV/AIDS pandemic will not only threaten to restrict increases in the overall availability of both donor and national funds, but will also increase the competition for resources during the move towards universal access to treatment and prevention services. Thus, UNAIDS will be under increasing pressure in its presentation and justification of resources needed for HIV/AIDS programming. Here I discuss UNAIDS' 2007 estimates of resource requirements for fighting HIV/AIDS in terms of their usefulness to both donor and recipient governments for budget planning and for setting priorities for HIV/AIDS programmes. I identify weaknesses in the UNAIDS estimates in terms of financial transparency and priority setting, and recommend changes to improve budgeting and priority setting.
Stakeholders' opinions and expectations of the Global Fund and their potential economic implications.
AIDS. 2008 Jul; 22 Suppl 1:S7-S15.OBJECTIVES: To analyse stakeholder opinions and expectations of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and to discuss their potential economic and financial implications. DESIGN: The Global Fund commissioned an independent study, the '360 degrees Stakeholder Survey', to canvas feedback on the organization's reputation and performance with an on-line survey of 909 respondents representing major stakeholders worldwide. We created a proxy for expectations based on categorical responses for specific Global Fund attributes' importance to the stakeholders and current perceived performance. METHODS: Using multivariate regression, we analysed 23 unfulfilled expectations related to: resource mobilization; impact measurement; harmonization and inclusion; effectiveness of the Global Fund partner environment; and portfolio characteristics. The independent variables are personal and regional-level characteristics that affect expectations. RESULTS: The largest unfulfilled expectations relate to: mobilization of private sector resources; efficiency in disbursing funds; and assurance that people affected by the three diseases are reached. Stakeholders involved with the fund through the country coordinating mechanisms, those working in multilateral organizations and persons living with HIV are more likely to have unfulfilled expectations. In contrast, higher levels of involvement with the fund correlate with fulfilled expectations. Stakeholders living in sub-Saharan Africa were less likely to have their expectations met. CONCLUSIONS: Stakeholders' unfulfilled expectations result largely from factors external to them, but also from factors over which they have influence. In particular, attributes related to partnership score poorly even though stakeholders have influence in that area. Joint efforts to address perceived performance gaps may improve future performance and positively influence investment levels and economic viability.
Nature. 2008 Jul 31; 454(7204):551.The fight against AIDS is losing ground, but the current spate of mud-slinging is far from helpful. The global conversation about AIDS is beginning to sound like a high-decibel exercise in finger-pointing and blame. This dangerous trend should be on the minds of the thousands of attendees convening in Mexico City this weekend for the XVII International AIDS Conference. Thirty-three million people around the world are HIV-positive, and more than 6,800 become infected every day. Tests on microbicides and vaccines have failed, and have put some volunteers at greater risk of HIV infection. Yet critics are attacking the very programmes and people trying to solve these problems, with some even calling for an end to government spending on the search for a vaccine. This is an overreaction. As many scientists point out, the search for a malaria vaccine has seen dozens of failed trials, whereas only three AIDS vaccines have so far been tested in efficacy studies. What is needed are better vaccine candidates to test, so it makes sense that the major backers of HIV vaccine trials, including the US National Institutes of Health, are now focusing on the basic research that could help the field move forward. Meanwhile, two books published last year claim that the United Nations AIDS programme, UNAIDS, has led an ineffective, politically motivated response to the disease and has distorted statistics in an effort to garner more money. And critics such as Roger England, who runs a small think tank in Grenada, argue that spending on AIDS has distorted poor countries' priorities and weakened their health systems. England proposes that UNAIDS be shut down, and the money spent on AIDS programmes shifted to general funding for health systems. Amid the debate on these questions, the founding director of UNAIDS, Peter Piot, announced in April that he would step down at the end of this year, throwing the agency into uncertainty at a crucial time. There is no doubt that many poor countries' health systems are struggling, but it is wrong to say that AIDS aid is responsible. In fact, AIDS programmes have shown how poor countries can use new models to deliver needed care, for instance by providing antiretroviral treatments effectively, putting to rest claims that the costly drugs could not be used correctly outside resource-rich nations. It is also wrong to assume that governments will spend money effectively to fight AIDS if given funds to support health systems overall, as England suggests. Today, many strategies for delivering AIDS treatment target groups such as women, homosexuals and intravenous drug users that have been ignored by governments in the past - neglect that fuelled the spread of the disease. More money should be spent on both AIDS and strengthening health-care systems. And this will be possible if donor governments live up to their promises, such as the pledges of general and disease-specific aid to Africa that were repeated this July at the G8 meeting in Japan. On that front, it is heartening that the US House and Senate have reauthorized $48 billion for the President's Emergency Plan for AIDS Relief ($9 billion of which is for fighting malaria and tuberculosis). If President Bush signs the bill as expected, the programme will also permit the US government to reverse the shameful and embarrassing policy that bans travellers with HIV from entering the country. That might serve as an example to other governments that still sanction discrimination against those who are HIV-positive. The world is still far from achieving the goal adopted in 2000 by UN member states, which pledged to provide universal access to AIDS treatment by 2010. Three million people now receive lifesaving antiretroviral drugs, but 70% of those in low- to middle-income countries who need them don't get them. Indeed, the example of wealthy nations themselves shows what happens when they lose focus on AIDS. In the United States, for instance, reports now indicate that HIV infection rates have begun to rise in Latinos and young gay men. The activists and scientists about to meet in Mexico City must demand that leaders keep their eye on the ball. The world now has models for providing treatment and care in the places that sorely need it, and is in a position to make more tangible gains against AIDS. This is no time to backslide, and the Mexico City meeting must deliver this message loud and clear. (full-text)
Geneva, Switzerland, UNAIDS, ASAP, 2008. 30 p.This ASAP Business Plan sets out the operational direction for 2008-2009 of the UNAIDS AIDS Strategy and Action Plan service. It presents the history of ASAP, explains how ASAP is governed, and describes operational achievements to date. These have included delivery of 15 peer reviews, provision of technical support to 29 countries, development of four technical tools for country use and initiation of a capacity building program. The document also presents conclusions of the ASAP Assessment which found that: ASAP had generally met the expectations set out in the ASAP Business Plan for 2006-07 in terms of the quantity and quality of work and adherence to agreed operating principles; ASAP is on track to meet the quantitative goal for technical support, development of tools, and capacity building; The mix of technical support has been stronger than anticipated on broad strategic planning and less on action planning, reflecting the relatively low demand received by ASAP in this area to date; ASAP outputs have been good, especially the peer reviews, the Self-Assessment Tool, and the planning effort for the capacity building program; The review noted that is was not possible to assess ASAP's impact on the quality of strategic and action planning at this early stage in the program; Finally, the assessment pointed out that since ASAP has already fully committed funds for capacity building and for the MEAN program, there is sufficient funding for new country requests only through the second quarter of 2008. (excerpt)
Estimating the costs of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006 -- 2015.
Bulletin of the World Health Organization. 2008 Jan; 86(1):27-39.The objective was to estimate the cost of scaling up childhood immunization services required to reach the WHO-UNICEF Global Immunization Vision and Strategy (GIVS) goal of reducing mortality due to vaccine-preventable diseases by two-thirds by 2015. A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle-income countries. Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach. Financial costs were estimated by country and year for reaching 90% coverage with all existing vaccines; introducing a discrete set of new vaccines (rotavirus, conjugate pneumococcal, conjugate meningococcal A and Japanese encephalitis); and conducting immunization campaigns to protect at-risk populations against polio, tetanus, measles, yellow fever and meningococcal meningitis. The 72 poorest countries of the world spent US$ 2.5 (range: US$ 1.8-4.2) billion on immunization in 2005, an increase from US$ 1.1 (range: US$ 0.9-1.6) billion in 2000. By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion. Total immunization costs for 2006-2015 are estimated at US$ 35 (range US$ 13-40) billion; of this, US$ 16.2 billion are incremental costs, comprised of US$ 5.6 billion for system scale-up and US$ 8.7 billion for vaccines; US$ 19.3 billion is required to maintain immunization programmes at 2005 levels. In all 117 low- and lower-middle-income countries, total costs for 2006-2015 are estimated at US$ 76 (range: US$ 23-110) billion, with US$ 49 billion for maintaining current systems and $27 billion for scaling-up. In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached. The methods developed in this paper are approximate estimates with limitations, but provide a roadmap of financing gaps that need to be filled to scale up immunization by 2015. (author's)
Bulletin of the World Health Organization. 2008 Jan; 86(1):13-19.Target 10 of the Millennium Development Goals (MDGs) is to "halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation". Because of its impacts on a range of diseases, it is a health-related MDG target. This study presents cost estimates of attaining MDG target 10. We estimate the population to be covered to attain the MDG target using data on household use of improved water and sanitation for 1990 and 2004, and taking into account population growth. We assume this estimate is achieved in equal annual increments from the base year, 2005, until 2014. Costs per capita for investment and recurrent costs are applied. Country data is aggregated to 11 WHO developing country subregions and globally. Estimated spending required in developing countries on new coverage to meet the MDG target is US$ 42 billion for water and US$ 142 billion for sanitation, a combined annual equivalent of US$ 18 billion. The cost of maintaining existing services totals an additional US$ 322 billion for water supply and US $216 billion for sanitation, a combined annual equivalent of US$ 54 billion. Spending for new coverage is largely rural (64%), while for maintaining existing coverage it is largely urban (73%). Additional programme costs, incurred administratively outside the point of delivery of interventions, of between 10% and 30% are required for effective implementation. In assessing financing requirements, estimates of cost should include the operation, maintenance and replacement of existing coverage as well as new services and programme costs. Country-level costing studies are needed to guide sector financing. (author's)
Washington, D.C., World Bank, Human Development Network, Health, Nutrition and Population Team, 2007 Aug. 51 p. (Policy Research Working Paper No. 4295)Tuberculosis is the most important infectious cause of adult deaths after HIV/AIDS in low- and middle-income countries. This paper evaluates the economic benefits of extending the World Health Organization's DOTS Strategy (a multi-component approach that includes directly observed treatment, short course chemotherapy and several other components) as proposed in the Global Plan to Stop TB, 2006-2015. The authors use a model-based approach that combines epidemiological projections of averted mortality and economic benefits measured using value of statistical life for the Sub-Saharan Africa region and the 22 high-burden, tuberculosis-endemic countries in the world. The analysis finds that the economic benefits between 2006 and 2015 of sustaining DOTS at current levels relative to having no DOTS coverage are significantly greater than the costs in the 22 high-burden, tuberculosis-endemic countries and the Africa region. The marginal benefits of implementing the Global Plan to Stop TB relative to a no-DOTS scenario exceed the marginal costs by a factor of 15 in the 22 high-burden endemic countries, a factor of 9 (95% CI, 8-9) in the Africa region, and a factor of 9 (95% CI, 9-10) in the nine high-burden African countries. Uncertainty analysis shows that benefit-cost ratios of the Global Plan strategy relative to sustained DOTS were unambiguously greater than one in all nine high-burden countries in Africa and in Afghanistan, Pakistan, and Russia. Although HIV curtails the effect of the tuberculosis programs by lowering the life expectancy of those receiving treatment, the benefits of the Global Plan are greatest in African countries with high levels of HIV. (author's)
Review and appraisal of the progress made in achieving the goals and objectives of the Programme of Action of the International Conference on Population and Development: the 2004 report.
New York, New York, United Nations, 2004.  p. (ST/ESA/SER.A/235)This report is divided into an introduction and seven sections. The first two sections provide an overview of population levels and trends, and population growth, structure and distribution in the world and its major regions. These are followed by four sections focusing on clusters of issues: reproductive rights and reproductive health, health and mortality, international migration, and population programmes. The final section summarizes the major conclusions of the report. Reflected in the discussions in all the sections, both explicitly and implicitly, are three interrelated factors that affect implementation of all the recommendations of the Programme of Action, namely, availability of financial and human resources, institutional capacities, and partnerships among Governments, the international community, non-governmental organizations and the civil society. The full implementation of the Programme of Action requires concerted action on these three fronts. (excerpt)
Washington, D.C., World Bank, Water Supply and Sanitation Sector Board, 2006 Mar.  p.Over 900,000 people in peri-urban areas (called Ger districts) in Ulaanbaatar, Mongolio lack basic infrastructure services. Since 1997, the World Bank has supported the Government of Mongolia to improve services to Ger dwellers. A 2004 social assessment revealed that on-site sanitation is very high on the list of priorities for residents in the Ger areas. The Government of Mongolia is now addressing this problem supported by a grant from the Japan Social Development Fund (JSDF). As an initial step in advancing sanitation and hygiene in the Ger areas, the World Bank has provided technical assistance to the Mongolian Government through the Sanitation, Hygiene and Wastewater Support Service (SWAT). The technical work and consultations were a first step to pave the way for a more holistic approach to improving sanitation in Ulaanbaatar's urban periphery. (excerpt)
Lancet. 2007 Jul 28; 370(9584):297-298.Several affluent countries have announced donations totalling US$1.5 billion to buy new vaccines that will help eradicate pneumococcal diseases in the world's poorest children. Donations from the UK, Italy, Canada, Russia, and Norway launch what many hope will be a new era to ease the burdens of disease and foster economic growth. Yet only a quarter of the money will be spent on covering the costs of vaccines-three-quarters will go towards extra profits for vaccines that are already profitable. The Advanced Market Commitment (AMC), to which the G8 leaders and the Bill & Melinda Gates Foundation have committed, is the difficulty. An AMC is a heavily promoted but untried idea for inducing major drug companies to invest in research to discover vaccines for neglected diseases by promising to match the revenues that companies earn from developing a product for affluent markets. By committing to buy a large volume of vaccine at a high price, an AMC creates a whole market in one stroke. However, no moneyis spent until a good product is fully developed. (excerpt)
The evolving cost of HIV in South Africa: Changes in health care cost with duration on antiretroviral therapy for public sector patients.
Journal of Acquired Immune Deficiency Syndromes. 2007 Jul; 45(3):348-354.A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. t-Regression was used to analyze total costs in 3 periods: Pre-ART (median length = 30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs. (author's)
Development and Change. 2007 Mar; 38(2):169-199.This article situates the politics of gender in Afghanistan in the nexus of global and local influences that shape the policy agenda of post-Taliban reconstruction. Three sets of factors that define the parameters of current efforts at securing gender justice are analysed: a troubled history of state-society relations; the profound social transformations brought about by years of prolonged conflict; and the process of institution-building under way since the Bonn Agreement in 2001. This evolving institutional framework opens up a new field of contestation between the agenda of international donor agencies, an aid-dependent government and diverse political factions, some with conservative Islamist platforms. At the grassroots, the dynamics of gendered disadvantage, the erosion of local livelihoods, the criminalization of the economy and insecurity at the hands of armed groups combine seamlessly to produce extreme forms of female vulnerability. The ways in which these contradictory influences play out in the context of a fluid process of political settlement will be decisive in determining prospects for the future. (author's)
Indoor air pollution and child health in Pakistan: report of a seminar held at the Aga Khan University, Karachi, Pakistan, 29 September 2005.
Geneva, Switzerland, World Health Organization [WHO], 2006. 29 p.Indoor air pollution (IAP) is one of the major risk factors for pneumonia related morbidity and death in children world-wide. It is also associated with other adverse health outcomes in children such as low birth weight and chronic bronchitis, and with lung cancer, cataract and possibly cardiovascular disease in adults. Biomass fuel (wood, crop residues, animal dung) which is being used in four fifths of all households in Pakistan is the major source of IAP when it is burned for cooking, space heating and lighting homes. Biomass is mostly burned in inefficient three-stone stoves leading to incomplete combustion and high levels of indoor air concentration of smoke. There is a dearth of scientific studies in Pakistan to relate IAP to health effects; consequently IAP is not a recognized environmental hazard at policy level. A one day seminar was held at The Aga Khan University (AKU), Karachi, to raise awareness of household energy issues, indoor air pollution and its effect on child health. Participants discussed global evidence regarding health impacts of IAP, the role of energy utilization in alleviation of poverty, and possible interventions to improve child health outcomes in the context of sustainable development. The seminar was attended by over 400 participants from a wide range of organizations including NGOs involved with dissemination of fuel efficient stoves and health education, policy makers, international agencies and funding bodies. Presentations ranged from topics related to the situation of indoor air pollution and household energy issues globally and in Pakistan, to local initiatives such as fuel-efficient stoves and promotion of liquefied petroleum gas. Fuel-efficient stoves and cooking devices used by various non-governmental organizations in Pakistan were displayed in a related exhibition. During the final session, participants developed follow-up action points to raise awareness about indoor air pollution in Pakistan and develop locally acceptable and sustainable solutions. The event was covered in the press, television and radio. The seminar was followed by a three day workshop for 20 participants from selected NGOs and academic institutions to develop proposals for research projects for selected sites to document the impact of interventions on air pollution on child health and social and economic circumstances of households. (excerpt)
Africa on the edge. The human toll has been appalling, but is the light at the end of the tunnel a little brighter?
Refugees Magazine. 2003 Jun; (131): p..In an era of short wars, 'controlled' numbers of casualties and sanitized images such as those emerging from Iraq, events in Africa seem almost incomprehensible. Deep in the heart of the Congo basin, some three million people, perhaps many more, perished during an ongoing war described as the deadliest documented conflict in Africa's history. And even as American marines mopped up last pockets of resistance in Baghdad in the full glare of thousands of television cameras, hundreds of people were being slaughtered almost unnoticed in the latest atrocity in one remote corner of the Congo region. During the course of the conflict which began in 1998 and which at times involved six armies from surrounding countries, countless militias and homegrown gangs of thugs, 2.5 million people were ripped from their homes and forced to seek shelter in steaming rain forests and neighbouring states. Angola suffered a similar fate. In a civil war lasting almost three decades, an estimated one million people were killed, and anywhere from three to five million were again uprooted from their ancestral villages and towns. They trudged across a destroyed landscape from one temporary sanctuary to another, often forced to eat berries and roots to survive and in constant danger of being killed or maimed, not only by the combatants, but also from millions of mines which made one of the continent's richest countries a vast and deadly booby trap. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006. 32 p. (Moving Towards Universal Coverage. Issues in Maternal-Newborn Health and Poverty No. 3)The aim of this paper is to provide a systematic review of the evidence of the impact on economic growth of investments in maternal--newborn health (MNH). The methodology used for the review includes a systematic search for published literature in relevant electronic databases. In the paper, we review five studies: four empirical and one theoretical. One of the empirical papers measures health by infant mortality. The study finds that a 1/1000-point reduction in the infant mortality rate leads to an increase in the level of State Domestic Product by Indian Rs 2.70 and an increase in the average growth rate per year of 0.145%. Similar results are reported for other health measures in other studies. Our main conclusion, however, is that the area lacks research and that considerably more is needed before any advice can be provided to policy-makers about the contribution to growth of investments in MNH. Specifically, first and foremost, studies are needed that explicitly analyse the impact of MNH on level and growth of output. Second, we suggest the use of more comprehensive MNH measures that consider the health of both mothers and newborns and aspects of ill-health other than death, such as measures of quality of life, functional limitations, mental health and sickness absenteeism. Third, estimates of the effects of MNH on growth need to be controlled for other health dimensions, i.e. aspects that may confound the impact of MNH. Fourth, studies are needed of the effects on determinants of growth in order to understand better the links between MNH and growth. Fifth, studies based on smaller geographical areas within countries and longer time series are needed, in order to obtain more precise estimates and also better estimates of the long-term growth paths. Finally, we suggest compilation of other data sets on microeconomic data, for example, to study effects at firm level of MNH on labour productivity through inability to work, disability, sick days, etc. (author's)
Bulletin of the World Health Organization. 2007 Apr; 85(4):245-324.There is an old saying that "amateurs talk strategy and professionals talk logistics". A professional approach to achieving the health-related Millennium Development Goals (MDGs) requires us to move beyond the discussion of possible strategies that could be used. It requires active planning of the practical actions that need to be taken, including raising the necessary funds to ensure these actions can be financed. This cannot be done without information on the costs of implementing the logistical plans. Without detailed plans, countries cannot be sure if they will meet the MDGs. Without accurate costing, countries and donors do not know the extent of the additional funds that will be required. This is a particularly important issue now that we are nearly halfway between the signing of the Millennium Declaration and the target date for achievement, 2015. All recent assessments suggest that few countries are on track and that intensified efforts to raise and use funds well are needed. How much additional funding is required, and where should it be spent? (excerpt)
Guide to the implementation of the World Programme of Action for Youth. Recommendations and ideas for concrete action for policies and programmes that address the everyday realities and challenges of youth.
New York, New York, United Nations, Department of Economic and Social Affairs, 2006.  p. (ST/ESA/309)The following key policy messages form the foundation of the recommendations contained in this Guide: Recognize, address and respond to youth as a distinct but heterogeneous population group, with particular needs and capacities which stem from their formative age; Build the capabilities and expand the choices of young people by enhancing their access to and participation in all dimensions of society; Catalyze investment in youth so that they consistently have the proper resources, information and opportunities to realize their full potential; Change the public support available to youth from ad-hoc or last-minute to consistent and mainstreamed; Promote partnerships, cooperation and the strengthening of institutional capacity that contribute to more solid investments in youth; Support the goal of promoting youth themselves as valuable assets and effective partners; Include young people and their representative associations at all stages of the policy development and implementation process; and Transform the public perception of young people from neglect to priority, from a problem to a resource, and from suspicion to trust. (excerpt)
Getting down to business. Expanding the private commercial sector's role in meeting reproductive health needs.
Washington, D.C., Population Action International, 1999. 76 p.Around the world, there is an emerging consensus that private enterprise is the engine of economic growth and development. Market forces are widely accepted as the most dynamic and efficient mechanisms for meeting society's demands for goods and services, especially in the productive economic sectors such as agriculture and industry. Even in the social sectors, where governments have traditionally played a greater role, there is growing recognition that the private for-profit sector can help meet the public's demand for education and health care. In reproductive health, as in other areas of health care, the private sector's potential importance lies in the inadequacy of public funding relative to growing needs. New and innovative approaches involving the private sector are required to bridge this gap between stagnating financial resources and the rapidly increasing demand for reproductive health care. Yet in most developing countries, the private sector is not fulfilling its potential to help meet reproductive health needs, often because governments have not created a sufficiently supportive environment. Developing country governments and international donor agencies do not adequately appreciate the private sector's contribution to reproductive health. Most governments and donors lack awareness of how their own policies and programs either encourage or deter the private sector from playing a larger role in reproductive health. (excerpt)
Answering the call: The international donor community's response to the HIV / AIDS crisis in Eurasia.
CommonHealth. 2005 Spring; 19-23.On the occasion of World AIDS Day, December 1, 2003, Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS) had some good news to share: Spending on HIV/AIDS programs rose 50 percent in 2003, from 3.1 to 4.7 billion dollars. In large part he attributed this to the efforts of the international donor community. International donor contributions traditionally stem from UN programs, affluent governments, development banks, and quasiprivate or private organizations, such as the Bill and Melinda Gates Foundation. Various other donor agencies, including The Global Fund to Fight AIDS, Tuberculosis, and Malaria--a partnership between governments, civil society, and the private sector--are providing valuable resources in the fight against HIV/AIDS. The support provided by these groups could not come at a more critical time. According to the latest statistics, 42 million people are living with HIV/AIDS worldwide and UN Secretary-General Kofi Annan has described the pandemic as the greatest threat to the well-being of future generations. Two of the areas most affected by the disease are the World Bank's Eastern Europe and Central Asia sub-regions--which include all of the countries of the former Soviet Union--where the AIDS epidemic is growing at a faster rate than anywhere else in the world. According to a United Nations Report published in February 2004, "One out of every 100 adults walking down the streets of a city in Eastern Europe or the Commonwealth of Independent States carries the HIV virus that causes AIDS." (excerpt)