30 November 2011

Condom Facebook Campaign: Innovative or Bad Idea?

Watch and share your thoughts.

It is That Time of the Year: Award Season

The surprisingly popular Aid Bloggers' Best Awards (ABBAs) are back! I will start pulling together the list of nominees and prepare for the voting. A lot has changed this year in the Aid Blog world with the end of Aid Watch and Tales From the Hood. Additionally, the guys at Aid Thoughts have gone on hiatus. All suggestions are welcome, so please make your nominations in the comments section.

Last year, I had an open nomination process and then vote. The process proved to be confusing, so I will be reaching out to the community for suggestions and go straight to the voting process. For anyone who missed last year's edition, I hope that the name and the award sponsors from last year indicate how seriously this is to be taken. It is great to recognize top notch work, but the hope is not to confuse naval gazing with staring into the abyss.

Last year's winners were:
Best Picture - Duncan McNicholl 
Best Debate - 1 Million Shirts
Best News Article - Bill Easterly
Best in Snark - Aid Watch 
Best Twitter - Owen Barder
Best Series - Texas in Africa
Best New Blog - Shotgun Shack AND Find What Works
Post of the Year - Owen Barder 
Blogger of the Year - Chris Blattman

Possible new categories for 2011:
Best Organizational Blog
Best Organizational Social Media
Best Campaign Best Video
Best Conference
 ....any of your suggestions!

Perceptions of Journalism in Somalia

"It looks like the village is just waiting for people to die.  There is nothing you can do," says the reporter. "Everyone always comes here and says that," responds the man, "Death is in God's hands, we're all waiting for death. What else do we do? Everyone who comes here is the same. They come and take pictures, and then they leave. Nothing else, just pictures and then nothing."

Al Jazeera reports on the impact that US foreign policy has had on Somalia over the past two decades.  It is complicated, but the policies do bear some blame.  The first part of a two part series shows the present state of Mogadishu and begins to unpack how aid is impacted by foreign policy.  Bill Easterly argued last week that aid and defense should be untied, and this may be as good of a support as he can get.

Although, what stands out is not the point on foreign policy, but the story people want to be told about Somalia.  The situation remains under-reported and the present incursion by Kenya and Ethiopia has skewed reporting further away from the humanitarian situation.  The AJ reporter gets at this at the end of the episode saying, "As they do what they can to beat back death, the rest of the world is moving on. Casting our gaze and pointing our cameras elsewhere."

The challenge persists in regards to how to tell the stories in a way that will bring about meaningful change to the lives of the people covered. An interviewed women expresses her concern, "All of Somalia has a problem right now. Nothing will be left in the South.  Everyone will die. Tell the world what I am telling you right now. There are journalists coming here all the time taking pictures. Why do they not do anything?

More reporting, action and support is needed in the region.  It is possible that all go hand in hand to a certain extent.

29 November 2011

How Haute Couture Can explain mHealth

This post originally appears on the Health UnBound blog.  I wrote it awhile ago (July-ish), but I am lucky that the timing of it was not pressing.  Fortunately for me, it is posted just ahead of the mHealth Summit in DC that I will be attending.  Be on the lookout for posts and tweets from the event next week.  If there are any speakers that you think I should check out or report on please let me know and I will try to accommodate

mHealth has become one of the latest super models walking down the runway. The ideas are sexy and potential high as innovators develop the latest app to analyze if a person has malaria on a smart phone. However, like fashion, the excitement for what could be must be tempered by what is possible.
Haute couture is stunning when first shown since it is modeled precisely for the body that will wear the piece, but every designer must also offer a prêt-à-porter (ready to wear) version. Although the buzz surrounds the runway events and the discussions gravitate to the couture piece, it is the prêt-à-porter that will bring in the money to the fashion designer. A large audience is reached by reducing price, making it more available and constructing a pragmatic design.

Other industries, like cars, go through the same cycle from proto-type to actual solution. As the mHealth hype grows the focus upon what ideas will lead to actual solutions cannot be lost. Ambition will lead to innovations, but poorly constructed ideas will lead to miserable failures. The graveyard of failed ideas in development and aid projects looks more like a giant dump filled with as much wasted promise as physical parts.

In the ICT world, One Laptop per Child (OLPC) has been the gold standard of failure. The idea preceded the need rather than the other way around. OLPC set out the mission to “provide each child with a rugged, low-cost, low-power, connected laptop.” In doing so, they imagined classrooms transforming from blackboards to a room full of children on alien looking laptops as a way to overcome barriers like not enough books.

An admirable goal, but OLPC started with the assumption that every person needed a laptop and designed a way to make it happen. Unfortunately, the technology led the way rather than the solution. As Linda Raftree points out, “you can be pretty sure that you have things backwards and are going to run into trouble down the road, wasting resources and energy on programs that are resting on weak foundations.” OLPC ran into simple issues like not having adequate power sources. Yes, a power efficient product was designed, but the battery does eventually run out.

In a 2004 article in the Boston Review, Kentaro Toyama addressed the question of whether technology can end poverty. He answered by saying, “technology—no matter how well designed—is only a magnifier of human intent and capacity. It is not a substitute. If you have a foundation of competent, well-intentioned people, then the appropriate technology can amplify their capacity and lead to amazing achievements.” mHealth is a field where well developed solutions can be the magnifier that Toyama describes. Rather than seeing innovations as solutions, mHealth developers will be served by shifting their perspective towards magnifying the abilities which already exist and enable them to be more effectively utilized.

With 5.3 billion mobile phone users, there is no question that there is a significant space for mHealth in addressing poverty and under-resourced areas. However, the majority of people not using smart phones which account for only 23.6% of the global market; certainly lower when high income countries are removed from the data. For the time being, low-tech solutions can more effective than smart phone apps which tell a mother how to care for a newborn.

Sproxil is an example of a solution that utilizes the ubiquity of phones to allow consumers to check if a recently purchased drug is counterfeit. By sending a code found on a scratch off area on the drug’s packaging, a confirmation is instantly received telling the individual that status of the drug.

Though a much less attractive solution, Sproxil should be trumpeted as loudly as others. Counterfeit drugs are rampant throughout sub-Saharan Africa and India and can be hard to catch at the point of entry. By adding a scratch off to the packaging and allowing pharmacists and/or patients to use SMS to check the drug immediately, the problem of counterfeit drugs can be significantly. This is not a major technological advancement. Rather it is a solution to improving health systems. It does not sound as appealing as other ideas, but it could have a further reaching impact.

A way around the problem of balance is to address failure head on. Mobile Active has been one of the leaders in this regard by organizing FailFaires to bring together those in the ICT field and share what they did wrong in order to prevent unnecessary replication. One example of learning comes from Text to Change. The program design was to educate people in Uganda about HIV/AIDS through a SMS quiz. However, when it came the date of launch the program was assigned the SMS number 666. With the connotations to the devil's number, the idea almost completely failed if it were not for a change of the number to 777. Even with a well-designed and planned intervention, an externally assigned number nearly undermined the initiative.

By sharing this small failure, Text to Change can tip off other innovators to consider the minute detail of what number is assigned when designing an SMS-based product. Failure is rampant in any industry, especially technology. By continuing to take part in forums like FailFaire, mHealth developers can lean on a larger pool of knowledge to encourage innovative product design.

The newest couture dresses strutting down the runway or electric car prototypes spinning on display are what get people excited about the respective industries. In the tech world it is 3D television, tablets, faster processers, phones that can do more and apps that can cook; but practicality cannot be ignored. Just like the dress that ends up at Neiman Marcus and the car at your local dealership, the designs have been re-imagined under the constraints of what will most interest the consumer.

With mHealth, the consumers are the clinics utilizing the technologies and the doctors being trained in how to put them to use. Usability is always a concern, but the need for the app and the ability to use it effectively must be considered. Overselling the promise of tech based solutions can allow for sexy ideas like OLPC to continue while practical ones like SMS reminders to be ignored.

28 November 2011

And then there was 'Third World Win'

The meme #firstworldproblems has become quite popular as of late and has lead to a bit of push back from the likes of novelist Teju Cole who wrote a series of tweets pointing out that people in the 'third world' experience many of the same problems that are listed in the meme.

Now, a spin off has been launched that seeks to look at the other side of the coin and illustrate 'Third World Wins.' Playing on blatant stereotypes, this meme illustrates how a lack of understanding can lead to outcomes such as the picture featured.  There is an element of satire, but It is evident that any chance of it has been quickly lost.  What is disappointing is that people will find these genuinely funny and miss the irony. 

Some Better Reporting on the HoA

An OpEd by Samuel Loewenberg in the NYT yesterday discusses the current famine in the Horn of Africa. In it, he explains that the drought is not solely responsible for the famine. Though limited in space, he does a good job of briefly discussing the contributing factors to the current situation.
A common misconception is that hunger crises are about a lack of food. Yet there is food in Kenya and Ethiopia, and even in many parts of Somalia. The real issue is poverty. The people affected are poor to begin with; when things turned bad, they had no recourse. In April the World Bank reported that 44 million people worldwide were pushed over the edge by skyrocketing food prices. 
Such a perspective is largely missing in our food-aid program. It’s like a health insurance system that waits until someone has a full-blown illness before he or she can get treatment. By the end of June, with the crisis in full swing, the United States had committed a total of about $64 million to Kenya, much of it in the form of food supplies (this doesn’t include relief for the Somali refugees). But food aid loses at least half of its value, according to the Government Accountability Office, because we ship actual food instead of sending cash for local purchase, like most countries. And only $5 million was allocated to agriculture, nutrition, water and sanitation — about $1.33 per hungry person — things that would have helped people during lean times. 
Blame politics...And, of course, there is the matter of optics: donors want to see dead babies before they provide significant assistance, one frustrated aid worker told me. 
Blame also lies with the Kenyan and Ethiopian governments. 
Aid officials say they realize that prevention is better than reaction. “We know how to do this,” Rajiv Shah, the head of U.S.A.I.D., told me during a trip he made in July to Kenya’s Dadaab refugee camp. “It is one-tenth the cost to provide effective agricultural support and help communities gain food security than it is to provide food aid at a time of famine.”Our shortsighted response also highlights a misunderstanding about foreign assistance and prevention. 
While recent rain has eased the pressure, much of it will be lost because of a lack of water-collection facilities. And experts warn that so many in Kenya are weakened and destitute that the cycle is expected to start up again in May. In other words, droughts cannot be stopped. But the economics that link drought and famine can be upended, so that next time, the people of Wajir, and dozens of countries around the world, might be able to avoid untold, and unnecessary, suffering.
It is great to see this kind of reporting but disappointing that it took so long for it to appear and that it had to be a part of the Sunday Review section rather than a page 1 article.

22 November 2011

Using Transmedia Change Aid Communications

Dutch organization BrandOutLoud is sick of the status quo when it comes to how Africa is portrayed.
While the images of Africa have remained the same, the image of development has changed. The industry itself has created a negative, stigmatising image of Africa. We must no longer hide behind arguments like 'it brings in the most money’ or ‘the ends justify the means'. How can we change the existing image? By looking into opportunities and learning from young organisations where engagement between the purpose of a project and the donor or volunteer comes first. And above all by showing the power and strength of the people themselves. Remain realistic - situations are often terrible, but those concerned are an essential part of that change. The people on the street are open to this view - listen and talk to them, and take them seriously.
The solution that BrandOutLoud offers is organizational branding.  Relying on single donors is problematic.  The argument of BOL is that branding will allow for a diversification of funding streams that will then allow organizations to be better equipped to do their work.  I have my reservations as to whether this is effective, but pushing aid communications in a different direction is sorely needed.

Last week, I went to the NYC Transmedia meet up group and had the opportunity to learn about the work of  brilliant people, like G Kofi Annan, who are trying to find ways to expand media and communications.  What I find most compelling about transmedia is that it involves multiple forms of media that incorporate traditional with new and social medias to create an interactive experience.

NGOs could greatly benefit from this approach as a way to break the bonds of stigmatization.  Trying to parse out the definition of transmedia can be a bit more confusing that needed.  So, I will use an example of how MSF is employing transmedia with its Urban Survivors campaign.

When entering the site, viewers are taken on a journey to Nairobi, Karachi, Johannesburg, Port-Au-Prince, and Dhaka.  Each city has its own section where the reader is immersed in the sights, sounds and stories of the city.

The white dots that you see will trigger different sounds when the mouse icon is hovered above them.  The 'check in' option links to a Facebook.  From the start, the users are able to participate in a range of media options that are not limited to the site itself.

Scrolling down, stories of Kibera are told and MSF shares the work it is doing.  Down further are a group of audio interviews with two experts talking about work being done in the slum.

The whole experience is interactive and encourages the user to explore and learn with it offered in English, French and Dutch. They even provide an embedable version of the website:

By engaging the users through multiple mediums, MSF has been able to cultivate an experience that can drive learning.  It could certainly do more, but it serves as a strong example of what can be and how organizations can do better.  

I suggest going to the site and clicking around.  Feel free to come back here and share your thoughts about it.  Personally, I wish there were more interviews and stories about people living in the areas profiled, but I highlight this because it shows how transmedia can be used in aid communications.  Stories can live on a platform such as this and garner the interest of people who may not have accessed them further.  Also, social media can play a further role by making the offerings even easier to share.

There are organizations that are forward leaning.  Branding and transmedia are two examples of how communications are changing.  The USAID FWD campaign is an example of how some organizations are staring to dabble.  We will see more begin to explore, but these innovations can and should become a part of traditional communications and not simply projects.

21 November 2011

What is the Role of Advocacy in the LRA Pursuit?

Update: Michael of the Resolve Network wrote in the comments noting a post by the organization that refutes some of the points in the article.  Of note, the Enough and Resolve did not exist in 2004. Read the post here.

Mareike Schomerus, Tim Allen, and Koen Vlassenroot write about Obama's decision to provide support in Uganda's fight against the LRA in Foreign Policy. The article comes with a heavy recommendation from Chris Blattman. It is an excellent read that digs into a lot of the issues that contribute to the present situation and Obama's decision. What stuck out was this section on the influence of advocacy organizations on the present narrative and actions taken in regards to the issue.
During the past decade, U.S.-based activists concerned about the LRA have successfully, if quietly, pressured the George W. Bush and Obama administrations to take a side in the fight between the LRA and the Ugandan government. Among the most influential of advocacy groups focusing specifically on the LRA are the Enough project, the Resolve campaign, the Canadian-based group GuluWalk, and the media-oriented group Invisible Children. Older agencies, from Human Rights Watch to World Vision, have also been involved. In their campaigns, such organizations have manipulated facts for strategic purposes, exaggerating the scale of LRA abductions and murders and emphasizing the LRA's use of innocent children as soldiers, and portraying Kony -- a brutal man, to be sure -- as uniquely awful, a Kurtz-like embodiment of evil. They rarely refer to the Ugandan atrocities or those of Sudan's People's Liberation Army, such as attacks against civilians or looting of civilian homes and businesses, or the complicated regional politics fueling the conflict. 
Thanks to the efforts of those organizations, in 2004 U.S. President George W. Bush placed the LRA on the U.S. Terrorist Exclusion List, a list of groups involved in "terrorist activity" whose members are banned from entering the country. Six years later, after activists camped out for eleven days in front of the house of Oklahoma Senator Tom Coburn, who had objected to U.S. legislation against the LRA due to funding concerns, Obama signed into law the Lord's Resistance Army Disarmament and Northern Uganda Recovery Act, which called for "increased, comprehensive U.S. efforts to help mitigate and eliminate the threat posed by the LRA to civilians and regional stability," and requires regular official reporting to Congress on how the fight against the LRA is proceeding. 
Predictably, activists have claimed Obama's decision to send in troops as a victory, or, more specifically, as "a huge victory for the hundreds of thousands of young Americans who have been lobbying Washington to take action." And, in any event, for congressmen wanting to score a few human rights points with their constituents, making statements opposing a violent faction in Africa is an easy stance to take. Perhaps, too, the administration estimated that potential U.S. losses would be minimal, and that Kony would be a good addition to the list of international thugs removed during Obama's time in office.
It is important to stress that the paragraphs I have excerpted must be take in the full context of the article.  Definitely go read the entire thing.

18 November 2011

Accessing Citizen Journalists to Tell Their Stories

The video is a report told by journalist Stanley Kwenda for Al Jazeera.  He writes about his excitement to finally have the opportunity to step to the front and tell the story himself, rather than work for a foreign correspondent.

After struggling with this for many years, I have now finally had the chance to tell that story in front of the camera. This is unique to me, as like most African journalists, I have become used to our stories being told by foreigners, some with little or no knowledge of the local landscape or culture.  
Often they came with a pre-conceived story idea which they were then forced to change when they were on the ground. And although an experienced journalist in my own right (I have tried several times before to do a story for international broadcasters), they have often been happier to have the story told by their man, and for them to be in control. They fly in reporters, cameramen and producers from Western capitals and use me merely to set up meetings or arrange interviews, to be their driver or even just to act as a human GPS, telling them where to go.

This is what motivates DAWNS. Stories like that of Mr. Kwenda should not be unique, but they are in some places. I cannot say for certain how it will be done, but I want to explore ways to support journalists like Mr. Kwenda so that he can begin to tell the stories of his own country.

Tumbling From The Cave (I'll Tumble for Ya)

The best part of Google Reader is dead. I do a lot of sharing through twitter but the character limit and static nature of the medium leaves plenty to be desired. So, I am going to give tumblr a try. There I will share many of the same things that I usually share, but try to do so in a way that is a little more interesting. Who knows, it might go a bit off topic from time to time. Without further ado, I present Tumbling From the Cave...

17 November 2011

GAVI Takes on Cervical Cancer and Rubella

I originally wrote this post for PSI Healthy Lives Blog.
Big news on the global health front. GAVI announced today that it intends to introduce HPV and rubella vaccines in developing countries. Each year cervical cancer causes 275,000 deaths with 88% taking place in poor countries. It is projected that the number of deaths will rise to 430,000 women each year by 2050 if no action is taken. To reduce the impact, GAVI has set the ambitious goal of vaccinating 2 million women and girls against HPV and thus protecting them against cervical cancer by 2015.
By providing a vaccine against HPV, up to 70% of cervical cancer cases can be avoided. “This initiative has huge potential impact for women and families living in the developing world,” said Seth Berkley MD, CEO of the GAVI Alliance. “The HPV vaccine is critical to women and girls in poorer countries because they usually do not have access to screening to prevent cervical cancer and treatment if they develop it that their counterparts in richer nations take for granted. As a result, they are the most affected. Today, we have taken small but deliberate steps to correct this inequity.”

Ron Paul's Foreign Aid Lies

M.S. strikes again for The Economist.  This time s/he takes on Ron Paul's ludicrous statement, "Foreign aid is taking money from poor people in rich countries and giving it to rich people in poor countries."

Foreign aid is funded out of federal taxes. I'm not sure who Ron Paul would consider "poor", but the lower 40% of households in America pay no net federal income tax. They do pay social-insurance taxes, ie Social Security, Medicare and Medicaid, and a share of corporate taxes and federal excise taxes. Social-insurance taxes don't fund foreign aid; they fund social insurance. Any money that poor people in America might be contributing to the foreign-aid budget would come out of corporate and excise taxes. From 2000-2007, according to the Tax Policy Foundation, the bottom quintile of American households paid combined corporate and excise taxes of 2% to 2.8% of income. For the second quintile, the rate was actually lower, maxing out at 2%. Foreign aid accounted for 1.28% of the federal budget in 2009 and 1.5% in 2010. So the most a household in the bottom quintile might be understood to have contributed to foreign aid would be something like 1.5% of 2.8% of its earnings, or 0.042%. Mean household income for the bottom quintile in 2009 was $11,552. So you're talking about at most 0.042% of $11,552, which is $4.85. For the second-lowest quintile, you're talking 1.5% of 2% of an average income of $29,257, or $8.78. The proportion of America's foreign-aid budget that comes from poor people, rather than middle-class or rich people (all of whom, on a global scale, are extremely rich), is negligible, and it represents a negligible burden on those poor people's incomes. 
But even this is overstating the case. The purpose of the earned income tax credit (EITC) is to make sure that poor people in America don't bear the burdens of the federal budget, especially those programmes that don't benefit them. At the lower end of the income spectrum, income taxes are a significant disincentive to work and tend to push people onto the welfare rolls; the EITC was introduced to compensate. That's the main reason why poor people pay negative federal income tax, and in fact people in the bottom quintile get more back from the EITC than they pay in income, corporate and excise taxes combined. Foreign aid is precisely the kind of federal budget burden that you don't want poor people to have to bear. The rational way to consider this is to think of the EITC as having exempted poor people from paying for foreign aid, among other programmes they shouldn't really be responsible for. But if Mr Paul thinks the EITC is insufficient to spare poor Americans from that burden, since they do still pay a share of corporate and excise taxes, then he is of course free to propose an additional refundable credit to poor people covering their share of corporate and excise taxes, presumably compensating by increasing the rates paid by rich people.* Somehow I don't think that reform is on Mr Paul's agenda.
I am waiting for a debate when the candidates will be challenged on their statements.  It will probably never happen in my lifetime, but that would be nice.

15 November 2011

Republican Presidential Candidates Make Grab for Foreign Aid Steering Wheel

There is one thing that the current batch of Republican candidates can agree on: foreign aid is bad.  They offer different reasons why and how they will cut down the foreign aid budget, but all want to see it go or dramatically shift.  Right now, the kinds of the policies is a sort of play-for-pay scheme where countries have to operate within a specific set of guidelines in order to access the money.  In other words, the candidates want to use foreign aid to exert more direct control over allies and developing countries.  It feels like we are back to fighting communists again!

The Economist does not take the issue lightly.  In the most recent edition, M.S. rips apart the batch of foreign aid policies by the Republican candidates:
I understand why a presidential candidate would say something like this. It's because virtually no American voter has any idea what foreign aid is or how it works. They mostly think "foreign aid" is a kind of cash goody America gives away to countries that are friendly to us. And so it makes sense, from this perspective, to zero out the giveaways each year and only reward countries that have been sufficiently obsequious. In fact, this isn't what foreign aid is at all. Foreign aid is supposed to be dedicated to achieving various generous public-minded goals abroad. In, say, Uganda, we have a lot of foreign-aid programmes aimed at reducing the

14 November 2011

Innovating for the Poor

"I am confident that we will continue to innovate on behalf of the poor," says Bill Gates in his video on development innovation for Gates Notes.  He is often criticized for his top-down approach to development and that statement does little to dissuade critics.  Also note the parachuted safe landing in on the ground.  All seems to indicate that innovation is coming from the outside.

Unfortunately, the video ends when it shows how innovations are being shared between countries like Japan and Brazil.  The recipient, in the end, is an African country. It misses the final step that shows how future innovations will involve countries like Mozambique.  The recipients will not be limited to the developing world.  Accomplishing this, in part, will necessitate a re-configuration of the view that innovation goes in only one direction.  

We continue to do a disservice to the poor if we insist on innovating on their behalf.

11 November 2011

FWD Campaign Review: Why I Should Tweet About the Kardashians More Often

On Wednesday, USAID made a big push to get 13.3 million people to participate in a single day of advocacy through the FWD campaign. I wrote a post about the campaign, raised a few questions, included a short interview with Matthew Johnson of USAID, added a video, and said that I would conduct a bit of an experiment.

During the day, I shared my post and facts about the campaign. I used both Twitter and Facebook, but I will focus on the results from Twitter. Admittedly, I do not use Facebook often, so my messages through that medium did not get very far. Additionally, the audience is mixed compared to my twitter followers who are already engaged in social issues and use it to stay connected and on top of the latest news.

My blog post did about as well as it usually does. I promoted it lightly with only two tweets, and it garnered 8 tweets (as tracked by Disqus) and two comments. In between, I peppered in fact based tweets using the suggested messaging from FWD. Those were largely ignored with a handful of retweets, but nothing of note to report.

By mid-day, keeping track of the discussions, I saw Amanda Makulec tweet, "If you can name the Kardashians faster than the countries affected by the crisis in the #HornofAfrica... usaid.gov/FWD @USAID #FWD." At the time over 20 people retweeted (including myself) it. It made me thing of the fact that people had been using a "Kardashian Calculator" to tell how long their marriage has lasted relative to that of Kim Kardashian and Kris Humphries (72 days for those unaware).

Pakistan's Lady Health Workers: Treating Severe Pneumonia in Children on the Front Lines

Often thought of as a disease of the elderly, pneumonia is the leading killer of children under the age of five. It causes twice as many deaths as malaria and seven times more than AIDS. In many communities accessing care can be a challenge. Of the 1.4 million annual pneumonia deaths for children under 5, 99% occur in developing countries. Many of the most effective interventions include the use of Community Health Workers.

Tomorrow’s World Pneumonia Day celebration means that flurry of new studies are being released. Today, the Lancet has published a groundbreaking study on how Pakistan’s “Lady Health Workers” (LHWs) are more effective in ensuring the recovery of children stricken with pneumonia as opposed to those who are referred to health facilities.

Lady Health Workers in Pakistan reach the homes of roughly 150-200 families every month. Chosen through the community, they only need a few months of training before they are ready to begin serving their communities. While they work, the LHWs are provided ongoing supervision and basic supplies.

Present WHO guidelines do not now allow for children to be cared for by community health workers when pneumonia is defined as severe. There is evidence that community health workers are effective when treating children before this point, but research had not been conducted at the point of the pneumonia being considered severe. Presently, only 50% of children with pneumonia are given antibiotics.

Save the Children, USAID and the WHO have collaborated to test if community health workers can be effective in treating sever pneumonia in children. The study consisted of 3,211 children with severe pneumonia in the Haripur district of Pakistan. Designed as a randomized control trial, the children were split into two groups. The treatment group were provided oral amoxicillin by the LHWs for five days. Prior, the Lady Health Workers had received training on how to treat the children. The control group followed stand procedure by administering a dose of the oral co-trimoxazole and making a referral to a local health facility.

The researchers found that the children in the treatment group were more likely to receive proper care. After five days, 18% of children referred to a facility were still sick, compared to 9% of those treated by LHWs. This study in Pakistan goes one step further. “Not only do oral antibiotics work, but they do when given at home just as well as at a clinic,” said Dr. Elizabeth Mason, WHO Director of Maternal, Newborn, Child and Adolescent Health on Thursday. “Children can be treated earlier and this will make treatment more accessible to poor and isolated communities. Governments can make the best of their limited resources and, most importantly, save more lives.”

The authors of the study conclude by urging the WHO to change its recommendation in regards to the treatment of children under five suffering from severe pneumonia. They argue that the rigor of the study sufficiently proves their point and finish by saying, “Based on previous results of reduced mortality rates with community case management, we postulate that it will contribute further to a reduction in the number of pneumonia deaths and accelerate the process of achieving MDG 4.”

With a known solution, the challenge will be ensuring the proper implementation. The world is short by 3 to 4 million doctors, midwives and nurses. To fill this gap, community health workers are used in many countries, but they are employed both formally and informally. The formal group has the appropriate training and support, like the LHWs in Pakistan, and can dispense antibiotics that will reach more children with pneumonia.

“It is harder when they are volunteers and the movement in and out of the sector is quite considerable,” says Dr Mason. “Having regular figures of this group is quite difficult. Meaning that the WHO has been unable to make recommendations in regards them.” She continued saying, “Since they are not formally included in the system, informal workers can pose a problem in terms of care. We would argue that they are a part of the system, and advocate for that to ensure they get the necessary support and deliver quality care.”

10 November 2011

Pneumonia: Progress Made, Success on the Horizon

The case for vaccines is quite simple: they save lives. Rallying people around them can be a bit tougher. One such example is Pneumonia; responsible for 1.5 million deaths in children in 2008. Of that number, roughly 75% occur in only 15 countries. A new Johns Hopkins University study reviews the 15 countries and finds good news. The authors write, "The speed at which [the newest-generation pneumococcal vaccines(PCV10 or PCV13)] are being introduced in low-income countries is unprecedented and is expected to have tremendous health impacts. It is estimated that by 2013, 11 of the 15 countries profiled will have introduced the pneumococcal vaccines into their national immunization programs."

Vaccines are a powerful and simple solution. The study finds that from 2010 to 2019, costs averted due to direct and indirect effects of the vaccines range from $986 million to $1.2 billion. Roughly 85% of the sum would have been used to treat pneumonia. “Vaccines and antibiotic treatments are like two safety nets that work together – vaccines provide a first line of defense, while antibiotics ensure that children who get through the first net don’t die,” said Orin Levine, JHU professor and executive director of International Vaccine Access Center (IVAC).

09 November 2011

Learning about Boko Haram

If you have been paying attention to the news in Nigeria (or subscribing to the DAWNS Digest), you would be aware of the increasing attacks by the Islamist group Boko Haram. Their latest attack was over the weekend involved bomb attacks that killed over 100 people. As the violence continues to grow, it is important to know more about the group. Fortuantely, the folks at Al Jazeera are top notch journalists and have put together a 25 minute piece that brings the group to light. It is definitely worth watching, especially the points of analysis and discussion.

FWD>Day of Action: What can 13.3 Million Shares Do?

USAID is kicking its FWD (Famine, War, Drought) campaign into high gear. Today is no exception as they are calling it 'FWD Day of Action for the Horn of Africa.' The goal is to get people engaged through awareness and information sharing by reaching 13.3 million people (the same number of people at risk due to the drought in the HoA).

The goal is bold and USAID is pulling out all the stops by creating celebrity-filled videos, interactive maps (see below), a twitter hashtag (#fwd), and a SMS donation mechanism (text 'give' to 777444). Right now, there is a major lull in terms of news coverage in the Horn of Africa relative to the drought and famine. The attention is all on Al Shabaab and news being broadcast by the Kenyan military through twitter. The incursion by Kenya has only made things worse. Somalis are now dealing with a rise in fighting and insecurity in a region that is already unstable and highly food insecure.  The advocacy push could not come at a better time.

I had the chance to ask Matthew Johnson of USAID a few questions about the current situation and the FWD campaign. My first question dealt with the concern of security. I asked how efforts were affected by this and what USAID was doing to ensure that they were continuing to meet the needs of people affected by the famine. He said:
USAID takes seriously our responsibility to ensure the safety and security of our staff while working with partners to help ensure the safety and security of their staff as well. USAID's humanitarian mandate to save lives, alleviate suffering and mitigate the economic impact of a disaster is our priority, and our programs are designed -- to the best of our ability -- to do no harm. The ongoing conflict in Somalia means that we have to become more innovative in the provision of assistance, to assure aid not only reaches intended beneficiaries but does not fuel the conflict. So, for example, instead of sending convoys of food aid into areas of Somalia that are difficult to access, we are providing vouchers to those in need in areas where markets are still operational.
My second questions was in regards to the FWD campaign itself. My concern is that the low barrier to entry might prevent further engagement. It is clear that this is something on the mind of USAID and the FWD campaign based on his response.

DAWNS Digest Top Stories 9 November 2011

IAEA says that Iran is working on Nuclear bomb. Let the Wrangling Over Sanctions Begin!

The much anticipated IAEA report was officially released on Tuesday. And while it probably should not come as a surprise that Iran is in hot pursuit of a nuclear weapon, the fact that the IAEA (as opposed to, say the USA or Israel) is making these allegations is certain to ratchet up the international pressure on Iran. The diplomacy over Iran sanctions begins: “Following yesterday’s report, the administration said it hasn’t abandoned talks. Still, the Treasury Department is drafting new sanctions aimed at commercial banks or front companies that may be imposed this month, while the EU is considering its own financial sanctions, according to U.S. and European officials who spoke on condition of anonymity to discuss measures that haven’t been implemented. The efforts stop short of penalties that would hit Iran’s leadership hardest -- sanctioning the country’s central bank, imports of refined gasoline or oil exports, steps that may rock world markets and hurt the Iranian public, the officials said...Russian officials have said further sanctions would be counterproductive, and Russian and Chinese officials sought to water down the IAEA report before its release, according to U.S. and European officials who weren’t authorized to discuss the diplomatic negotiations. China and Russia, both veto-wielding UN Security Council members, questioned the timing and outcome of the IAEA report.” (Bloomberg http://buswk.co/tRjbzv)

Haitian Cholera Victims Plan on Suing the United Nations

The Cholera outbreak in Haiti has killed over 6,000 people and sickened hundreds of thousands. Now, victims and their families are seeking redress with the United Nations. “The U.S.-based Institute for Justice and Democracy in Haiti (I.J.D.H.) in Haiti delivered the petition to U.N. headquarters last week and presented the U.N. mission in Haiti, known as MINUSTAH, with a copy as well. The group says both entities are liable for the outbreak because they failed to adequately screen and treat peacekeepers arriving from countries experiencing cholera epidemics. The petition also says untreated waste from a U.N. base was dumped into a tributary of the Artibonite River - Haiti’s longest and most important waterway - and that officials then failed to adequately respond to the subsequent epidemic. I.J.D.H. attorney Brian Concannon shared details of the petition with reporters on Tuesday. ‘They are asking for $50,000 for every person who has become sick and did not die, [and] $100,000 for every victim of the U.N.’s cholera that did die,’ he said. ‘In terms of action, it is asking for effective medical treatment for people who do get cholera, but more importantly building the infrastructure that you need, especially clean water and sewage, to stop the epidemic. And third, the victims are asking for acknowledgement and an apology from the United Nations.’ (VOA http://bit.ly/uGbjhq)

Sign up for your free trial for the DAWNS Digest to read stories like these and have all of the day's top humanitarian news delivered to your inbox each morning.

08 November 2011

Uganda: Mobile Phones in 2011 Infographic

HT White African who says Tanzania is next

Human Development Disparities

It is pretty striking to see how far behind the DRC is to India and South Africa let alone Norway up at number 1.  Also of note is the fact that the Human Development Index measured a 101.2% change for Afghanistan since 1980.  That is impressive.  The depressing statistics are seeing that Zimbabwe and the Congo have barely improved since 1980.  Both do not seem to be getting any better with recent problems.  Mugabe is only getting older and fighting between the government and the MDC is flaring up.  All the while, the economy still is in the tank.  The DRC is a whole different conversation, but the impact of Dodd-Frank 1502 is something to watch in addition to the upcoming elections, regional violence and so on.

07 November 2011

How Much will It Cost to Implement 1502?

US Senator Dick Durban's office contacted a pair of Tulane researchers to check in to the financial impact of Dodd-Frank 1502 which is the legislation that was included, through the support of the Enough Project and Global Witness, which addresses conflict minerals. A debate on the impact of the legislation on artisinal miners continues, but this independent piece of research seeks to answer a different set of questions. The main being what will it cost companies who are affected by the legislation to set up systems to certify that the minerals they are using are conflict-free.

Here are the author's conclusions (PDF).
Our model contends that affected companies in the U.S. would need to carry out three principal actions in order to be in a position to comply with the new law: (1.) strengthening internal management systems in view of performing due diligence, (2.) instituting the necessary IT systems, and (3.) commissioning CMR audits. We estimate that the cost of implementing these actions comes to $7.93 billion. However, almost half of the total cost – $3.4 billion – would be met with in-house company personnel time, and the rest – $4.5 billion – would comprise outflows to 3rd parties for consulting, IT systems and audits. Comparing the costs to the issuers vs. the suppliers, the bulk of the total costs – $5.1 billion or 65% – would be incurred by the suppliers (the group not included in SEC‟s analysis), while the smaller portion of the total – $2.8 billion or 35% – would be carried by the issuers. These implementation costs would however be borne by thousands of individual firms in lucrative industries such as the industrial, aerospace, healthcare, automotive, chemicals, electronics/high tech, retail and jewelry industries.

04 November 2011

Who Is Most Committed to International Development

I originally posted a version of this for the PSI Healthy Lives Blog

The Center for Global Development has produced its annual Commitment to Development Index.  Measuring the performance of 22 countries' policies, the index pulls together data to rank the countries based on aid, trade, investment, migration, environment, security, and technology.  Each category is given a score and then are combined to determine who is the most committed to international development.

So, which countries are "the most" committed to international development? Here's the top 10 list:
CGD fellow David Roodman discusses the index:
As we reflect on the 2011 CDI, two issues concern us most. First is the rise of the United States on the strength of its military intervention in Afghanistan. The approach in the security component to military activities is shaped by three ideas: some interventions, such as the NATO-led war to stop the serves from potentially committing genocide in Bosnia, seem like contributions to development; other interventions are much harder to defend; and the rule used to distinguish between the two kinds should be mechanical, to limit bias—”objective,” if you will. It was Michael O’Hanlon who years agosuggested the presence-of-an-international-mandate criterion. (As mentioned, the Afghanistan war has such a mandate.) But even O’Hanlon argued for exceptions, at the time having Iraq in mind. The Security Council did not sanction the invasion of Iraq, but it did sanction post-invasion activities, so a strict implementation of the criterion would have rewarded the latter. O’Hanlon argued against rewarding the occupation of Iraq since it was so thoroughly motivated by national security rationales, not “commitment to development.”

03 November 2011

One Laptop Per Child's Parachute Aid

The founder of One Laptop Per Child, Nicholas Negroponte of MIT, said that he wants to drop the organization's new tablets without anyone on the ground for support or implementation. I would say this is literally an example of parachuting aid but that would be a misuse of the word since it appears parachutes will not be used. From PC Magazine:
"We will literally take tablets and drop them out of helicopters," and return a year later to see if the effort was a success, Negroponte said. A new tablet design can withstand a 30-foot drop, and even be left out in the rain.

"When I say no people, I mean absolutely no people," he added, when asked if he was serious. "When I say I drop out of the helicopters, I mean it... it's like a Coke bottle falling out of the sky," he said, apparently referring to the 1982 movie, The Gods Must Be Crazy. In that movie, however, a bushman is convinced that the Coke bottle's embodiment of the concept of property is evil, and leaves his village to dispose of it.


The new tablets will be preloaded with 100 books, and will be able to connect to the Internet wirelessly. Previous tablets have used a peer-to-peer mesh connection to help establish connectivity.

"Adults may be able to steal it, but they won't be able to use it ... maybe an older brother will get a hold of it, use it for pornography - that's life," Negroponte said.
It is hard to know what to make of this. On one hand there is something exciting about providing the technology and giving people the opportunity to use it as they need. The story from this angle help to illustrate the innovative capacity of all people. On the other hand there is the concern highlighted by the reference to The Gods Must Be Crazy. They might confuse people and go unused or end up something people scramble to grab and sell.

Ethiopia and Drought: 1984 vs 2011

A24 Media and ONE have produced a video on Tigray, Ethiopia that looks at the difference between the 1984 famine that lead to events like Live Aid and the present drought that has contributed to the present famine in South Somalia. The press release says:
The project was led by Salim Amin, Chairman of A24 Media and son of Mo Amin, the Kenyan photojournalist known for his remarkable footage of the Ethiopian famine in the 1980s.

Salim and his film crew travelled to Tigray in Ethiopia, the place hardest hit by the 1984 famine and the place his father captured his best known footage.

What Salim found was a situation in stark contrast to the images his father captured. Long-term investments by governments, donors and local communities have allowed the community to develop agricultural programmes that are resilient to drought and help create a path out of poverty.
Yes, the video does not touch on everything and it is hard to precisely say that aid has lead to the present ability for the region to handle drought, but it is clear that development is taking place. The area is much better prepared to handle drought and the scale of its impact on farmers is significantly less than it was 27 years ago.

The lesson was obvious well before the famine was in full swing in Somalia, but this does drive home the point that agriculture capacity is one of the problems. The challenges in Somalia are many and the Kenyan incursion is not making things easier right now, but talking about how this was preventable is important from the communications side.  A video like this tells the story that self-sustainability in Horn of Africa nations is attainable.

The question is how much is attributed to aid and foreign assistance.

02 November 2011

Visualizing 2010 African Growth Rates

Some data is missing, but a useful infographic. Benin growing 9.2% stands out to me, but that is because I know absolutely nothing about the country except for that it used to have a flag with a person's head being cut off.

I tweeted it out this morning and it seems like people find it interesting, so I am also sharing it here for those who did not already see it.  Do subscribe to the Afrographique Tumblr page, it is well worth it.

Conflict Minerals: Evaluations Desperately Needed

The conflict mineral debate is another one that has been heating up as of late. I will admit that I am still doing a lot of reading and learning about the subject. However, it appears that there is good reason to believe that section 1502 could have negatively affected artisinal miners in the DRC. There seem to be a varied group of voices that make the case for further investigation into the legislation and the situation on the ground. David Aronson has been an a hawkish advocate for rethinking conflict minerals. His article in the NYT a few months ago really stirred the pot, but he has been make some points that are worth considering.

In his blog on Friday, Aronson argues that social impact assessments should take place to try to understand what is happening and how the lives of Congolese are being affected by 1502. Say what you want about conflict minerals, but I have a hard time believing that the questions Aronson poses should not be answered with further research.
A social impact assessment would enable us to develop a clearer sense of what impact the embargo has had. It would focus on such questions as these:

How has the embargo affected the miners, their communities, and the broader economy of the region? If miners have seen their income decline, by how much? What alternate income sources are available to them? What survival strategies did they have in place and have those proven sufficient? Have they been able to make up for their losses, and if so how? If not, how are they surviving? What are the implications for their health? for their diet and nutrition? for the schooling of their children and for access to health care? for the achievement of such life goals as, for example, saving enough to marry or building a better home? for helping non-immediate family members? Has it caused a heightened risk of mortality? How has it affected relationships within the family? Has it brought stress to family relationships and led to increased friction and conflict? Has it had differential impacts on women, men, children, the aged? What is happening in those communities that are no longer served by incoming planes?

What impact has it had on the comparative strength of various rebel groups, militia, or FARDC units? Which groups have suffered a decline in their profit from the mineral trade, by how much, and how have they responded? To what extent, if at all, have they benefited, by moving into the illegitimate or black market trade? To what extent has the embargo encouraged smuggling and other forms of fraud? To what extent have government tax receipts from the trade diminished, and what impact has that had on governance?

What secondary effects has the embargo caused? Given that the mineral trade was one of the region's primary sources of income and foreign currency, how have those who served the economic needs of mining communities been affected? How important was mining to the regional economy as a whole and how big a loss has the embargo been? Given the dearth of reliable statistics, how can this be measured? Who has been most/least affected? What regions or territories? What impact has the embargo had on sectors such as construction or banking?
Defenders will say that they either know the answers or try another tactic to divert the conversation. I am certainly willing to hear more, but the evidence right now does not bear out and I am not convinced that Aronson's questions have been answered. Enough and Global Witness should not be chastised, rather they should be encouraged to pursue more rigorous and independent evaluations. At the very least, doing so will help to understand how to implement future external legislation. A similar situation may present itself in the future and proper evaluations can provide a framework of the outcomes of these actions.

01 November 2011

Aid Comic: "Give all that you have to the poor"

Saturday Morning Breakfast Cereal is one of my favorite comics in my RSS feed (RIP Google Reader's share function).  This one on the economics of aid was published on Sunday and is too good not to share.  Seeing it gave me chuckle and I had to cross post it.

Without further ado:

Who Killed Laurent-Désiré Kabila?

I have no idea what the answer to the question, but this documentary on Al Jazeera was certainly very interesting.

From director Arnaud Zajtman:
I had followed the trial and felt that those condemned were only scapegoats, chosen by former members of Kabila's entourage in a bid to help his son, Joseph, pretend that he had found his father's killers and thus allow him to reassert his power.

I felt that this story was important but that it was overshadowed by another. A major war involving six African nations and various rebel factions was raging in DR Congo. Massacres and rapes were part of daily life for many Congolese and this kept the handful of press correspondents living and working in DR Congo, like myself, busy.


However, after a year-long investigation, my conclusion is that Kabila was killed by his bodyguard, Rachidi Muzele, who was part of a plot that involved a handful of his colleagues, a Lebanese businessman who acted as an intermediary and Rwanda, which masterminded the assassination, knowing that the US was not against it, and gave shelter to those involved.

With no succession plan in place, Rwanda had bet on ensuing chaos that would allow it to continue exploiting the vast mineral wealth of eastern DR Congo.

Kabila was killed, but the rest of the plot did not go according to plan. To the surprise of many, Joseph Kabila was appointed to succeed his father, and a stronger Congo emerged, slowly managing to regain its sovereignty.

This thesis, which is carefully developed in the film Murder in Kinshasa, has recently been confirmed to me by a former leading intelligence official from Rwanda who spoke to me on the condition of anonymity and by a former Rwandan chief prosecutor who spoke to the Belgian press.

The 50 civilians and soldiers who are still locked up in Kinshasa's jail are not part of this plot but are only scapegoats.

To me, the disgraceful thing is that Joseph Kabila, who is running for re-election in a month, clings onto the official version of events and is unwilling to set them free.
I know that there are some experts out there who can weigh in, so please do.