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Tuesday, June 28, 2011

Early Indicator of a Turning Tide?

The Center for Global Development shares a video of Liberia’s President Ellen Johnson Sirleaf. In her speech, President Sirleaf announces the intention to lead her country to be free of foreign assistance within a decade.

That may be a tall order, a long journey (pick your metaphor), fraught with challenges and unwanted effects. But I see this as a first furtive sign on the horizon that big changes are going to come. I remember the head of a bilateral agency in one of the poorest countries on us telling me: "we will align when they make us."

The transition to country ownership--whatever this means (hopefully not again government domination over civil society)-- is unlikely to be smooth and linear, when we have created self-replicating systems and institutions. There might be some turbulence before more functional inter-workings are found. But no matter what, it will start by countries and their governments raising a voice and taking charge.

Not sure it will always be pretty, but I think it's necessary.

Eric

Thursday, June 23, 2011

Can Health Systems Adapt to Global Demographic Changes?

Last week I had the privilege of attending the Global Health Council’s 38th Annual Conference in Washington, D.C. The conference focused on global demographic changes, which naturally result in a shift in the burden of disease as populations grow older. The key acronym of the week was “NCD,” or non-communicable diseases. As someone who has spent most of his professional life exploring ways to scale up proven interventions to fight infectious diseases in children (some of which are known as “NTDs,” or neglected tropical diseases), my first reaction was that the focus on NCDs would polarize the conference participants – NCDs vs. NTDs. One of my primary concerns was related to the scarce resources for global health and the concern that a focus on NCDs would divert resources – both human and financial – away from infectious diseases. In addition, I assumed that resources for NCDs would go to those who were living longer and more financially secure, which would overlook the poorest and most marginalized populations.
Recognizing the tension between the NCDs and NTDs, one of the conference co-chairs, Dr. Felicia Knaul (Director of the Harvard Global Equity Initiative), redefined the “NCD” acronym to represent the changing burden of disease by referring to “new challenge diseases.” Instead of focusing on the difference between communicable and non-communicable diseases, Dr. Knaul and the other co-chairs urged us to consider common obstacles and solutions that we all face. In particular, one problem that everyone encounters, regardless of the disease, is equitable access to healthcare. Those who are most marginalized have limited access to life-saving treatment and often die from preventable causes. This is true for both communicable and non-communicable diseases. For example, a child who is suffering from acute lymphoblastic leukemia has the same right to healthcare as a child who is suffering from acute diarrhea. Although the type of treatment may be very different, we should not evaluate a child’s right to quality healthcare based on the type illness. There is a need to strengthen health systems to provide quality, affordable, accessible healthcare that benefits all people who are suffering from all types of diseases. However, this will not happen by chance. Equity must be intentional. This is especially true when there are limited resources to address these new challenge diseases without neglecting the existing diseases that cause thousands of preventable deaths every day. We live in a world where the burden of disease is constantly changing and health systems are expected to adapt to these changes. In order to move towards a comprehensive, adaptable approach to health systems strengthening, we need to consider all health system components, processes, and relationships simultaneously and not as disaggregated parts. Although the solutions will be complex, they cannot be ignored.
How does this all apply to sustainable human development? As we consider the sustainability of health systems strengthening interventions, we must consider the fact that health systems, and the populations they serve, are not static. As populations change -- demographically, epidemiologically, and economically -- health systems must be positioned to adapt to the changing health needs of the population in a way that is equitable. This includes the health services provided at the facility-level as well as the household-level. Therefore, adaptive responses by the health facility must be matched by an equivalent response by the community so that treatment and prevention are accessible to all. This will certainly look different as countries go through demographic and epidemiological transitions at different points in time.
--Will

Friday, June 10, 2011

Link to Uganda New Food Price Crisis

As we've seen in a number of pieces of work, and most recently for us in 2007-2008 in the Middle East, food security--notably food prices have a direct negative impact on the poor even the middle class of a society. But the indirect effects accrue exponentially to the poorest: first they lack the "buffers" of economic resiliency which others can use, but then government responses tend to be self-protective and aimed at helping the urban middle class first. Nothing is lost, nothing is created: those responses tend to cost money and the money then comes short when it's time to maintain, for example, the health service infrastructure to remove and poor areas. Donor money also runs out...

This explains why there is so much current focus on food security, and why we feel it has to be an area of emphasis if we look at sustaining health outcome and human development.

Here's an updated blog from Bethany Duffield on Will's own blog page -- focused on today's situation in Uganda. A good read.

Tuesday, June 7, 2011

Wandering Thoughts on Sustainability, Conflict, and Social Capital

Last week, I had the opportunity to participate in a workshop at the Cyprus Institute on "Advancing Research and Science in Conflict Areas." This was organized by IPSO (the Israeli Palestinian Science Organization), Al Quds University (Palestine), Sapir College (Israel), the Cyprus Institute and our colleagues of RTI.

The three days were dedicated to developing a joint-research agenda on four main themes:
  • Health, essentially psycho-social health—the area of my involvement as you may have guessed; but also 
  • Water; Science Education; and Water History. 
We got exposed to the current situation in Cyprus, with presentations by Cypriot researchers involved on the two sides of the separation line (the "Green Line") between the Greek Cypriot (Republic of Cyprus) and the Turkish Cypriot (occupied by Turkey) zones. We got quite a taste for what researchers, as members of civil society, can do to advance intelligent dialog among people that have been alienated by conflict, notably through presenters from the Home for Cooperation / Association for Education and Research, a research association housed on the no-man's land / Green Line of Nicosia.

So - what does any of this have to do with sustainability?

Much, I'm afraid. And I won't go into all of it now. But I want to underline two main lessons, which actually hit me between the eyes on the first day of the workshop:
  • [1] The ubiquitous importance of social capital to advance and sustain any social progress.
We speak a lot about social capital at CEDARS. It comes back again and again in the Sustainability Framework (Component 5), even if we usually use a less academic language a speak of 'Community Capacity.' We've mentioned before three types of social capital: bonding: bringing people together within a community (simplifying here)-- bridging: bringing communities together across a geographical or other divide-- and linking: linking community groups to authorities.
  • During the workshop,stories made clear the erosion or destruction of 'bridging capital' through the Cypriot conflict; and of course the current situation in Israel-Palestine, where walls and check points keep communities almost totally apart except for "security" encounters.
  • But the issue of 'linking capital' also came up, in conversations with people reporting progress in trying to work together on water management issues, or dealing with advocacy for peace initiatives, but identifying the next bottleneck of progress in reaching out to policy and decision makers.
So, end or mean, social capital and the processes that foster it are probably going to remain central to our--at least my interests for quite a while.
  • [2] The progress achieved in Cyprus--while imperfect and with a long road ahead--illustrated to me another way in which complexity plays out between social, political, and development processes.
While our development efforts can create processes of social change, which can allow people to push for political and policy changes when needed; the acceleration of progress in Cyprus in very recent years also shows how political decisions are central in allowing more progressive, sustainable and scalable social and development processes to happen.

Situation of conflict or post-conflict just put a magnifying lens on these virtuous or negative spirals.


No simple take-home message, but the increased conviction that accepting to work on processes within complex systems is a necessity for all of us aiming to not just achieve results now, but be part of advancing sustainable human development, as researchers, implementers, policy agents, donors, partners, technical specialists, evaluators, and others.

--Eric