30 July 2012

A View From the Olympics

Here are some pictures from the London Olympics. Events include handball, tennis, beach volleyball, men's cycling and swimming. The slideshow will update as I add more over the week.

27 July 2012

A Vacation From the Cave

From Washington to London. I am on vacation next week. Might kick out a tweet here or there, but am going to do my best to resist blogging. If any London readers are around, I have some time next Thursday and Friday.

Drop me a line!

IAC: A Supposedly Inclusive Event That Falls Short

Brazilian Protester
The massive International AIDS Conference winds down here in Washington DC. Bill Clinton will close the event this afternoon, a bookend to the opening speech from wife Hillary.

Little meaningful stories have emerged from this event. Treatment as prevention continues to be the mantra. Some, like Bill Gates, have added a bit of realism to the attempt to raise hope about the beginning of the end of AIDS by pointing out that the real end will not realized without a cure and a vaccine.

There is plenty of good news. Advances like Truvada that will prevent the spread of HIV between partners and low cost solutions such as voluntary medical male circumcision can reduce the likelihood of spreading HIV. All are exciting and can be combined to significantly reduce the chances of new infections, but the race to zero new infections is extremely challenging.

I noted that UNAIDS says global HIV/AIDS funding falls short by $7 billion each year. Yesterday, the Director of the WHO's HIV Department, Gottfried Hinschall, said that a further $4 billion is needed to meet the needs of marginalized groups, like men who have sex with men (MSM) and sex workers, each year.

The real story is that of the marginalized. The sex workers and drug users who shoulder the burden of HIV in many countries, but were unable to gain access to this conference due to US visa laws. Further, it is the very people who are in fact at greatest risk or are living with HIV that have been largely left out of the major panels and press conferences.

It took a march by Brazilian HIV activists into the press room located in the bottom of the convention center to finally give activists the opportunity to speak in front of the press. That is not to say all have been ingnored. The BBC reported on the problem's in Brazil yesterday morning. However, the very people who are affected by the discussions taking place in Washington DC are not sitting at table.

"Latin American is invisible in this conference because governments and donors think that the AIDS situation is solved in our countries," said one of the protesters yesterday. "Well, it is not."

One exception was yesterday's plenary that featured Hinschall alongside Uganda researcher and HIV rights activist Dr Paul Semugoma, researcher Cheryl Overs and Transgender community activist Debbie McMillian. It brought together the very people who are directly impacted by HIV/AIDS, who work with the populations the marginalized and have research and policy experience.

Paul Semugoma Global Forum for MSM and HIVUgandaAfrica
© IAS/Steve Shapiro
The panel members outlined the importance of reaching out to all people, especially the most vulnerable to infection, need to be included in the very development and implementation of programs aimed at reducing HIV infections. Dr Semugoma said that the international community can play a role in supporting MSM by working with the community rather than exerting direct pressure on governments.

"The way to to go forward is to teach. The way to go forward is to shame," said Dr Semugoma. "I am shaming my country. You can't start doing HIV prevention when you don't have good programs for sex workers and men who have sex with men; simply because you are feel too morally upright to support an HIV prevention program."

What is unfortunate is that examples like yesterday's plenary and the Brazilian activists have proven to be the exception rather than the rule at the IAC. The lively Global Village is meant to serve as a way to counterbalance the problem, but placing it in the netherworld of the basement (next to the media room) prevents a more natural opportunity or conversation with the big players who have their well organized space at the center's top floor with photo booths and frozen yogurt.

The message of the conference has been one of working together to turn the tide of AIDS towards a future where it does not exist. That may be possible, but the collaborative part is important and seemingly absent at IAC. Dr Semugoma summed it up well, "It is possible. We have the tools, but we can be shackled by our own ignorance." 

26 July 2012

What does Aid's Failure in Afghanistan Teach Us?

The front page of Politico features an article, Afghanistan: Example of How Not to Give Aid, that heavily features opinions and information from Human Rights Watch concerning the lack of human rights gains in Afghanistan.
Ten years after the first Western human-rights workers arrived, “honor killings happen on a day-to-day basis,” Ahmad asserted. “It’s gruesome. It’s really, really bad.” As for those Western workers, “I’m not sure the U.S. or Western footprint can help that at all. It’s not going away.” Ahmad is now with the German Marshall Fund of the United States in Washington. 
The world has spent $55 billion in nonmilitary aid on Afghanistan since 2002. More than half came from the U.S. It’s impossible to know exactly what percentage was dedicated to human-rights work because so much of it is for cross-purposes. Is building schools for girls who had none before human-rights work? 
In any case, the U.S. special inspector general for Afghanistan reconstruction said in his most recent quarterly report that, when security for aid workers is figured in, the total nonmilitary funds Washington has appropriated since 2002 “is approximately $100 billion.”
What has all that spending accomplished? “The short answer is not much,” said Masood Farivar, a senior Afghan journalist. “Undoubtedly some of the work” carried out by Western agencies “has had a positive impact on people’s lives. But this has been the exception, not the rule.”
The article posits that the money spent in Afghanistan coupled with the lack of human rights improvements means that aid has failed. That may be a fair assessment, but that is not new news. The question is why aid has failed in Afghanistan.

Author Joel Brinkley delves into that very question towards the end of the article.
There’s no single reason for these manifest human-rights abuses. Islam is often the excuse for abusing women. But Islam strictly forbids homosexuality. 
Eikenberry and others place part of the blame on the foundations of the modern state, settled during the Bonn Conference in 2002, when Afghan leaders, along with American and other Western leaders, settled on the country’s post-Taliban form of government. 
“The state that was constructed in 2002 wasn’t in accord with realities on the ground,” Eikenberry said. The participants settled on a unitary national government, even though “Afghanistan has never had a strong unitary state. That was an error of the international community and an error of the Afghans.” 
Even now, 10 years later, Hoge said, “the government remains all but invisible in much of the countryside.” The provincial and local governments the West has tried to strengthen, he added, “have not responded very well. There’s a government vacuum.” 
So who’s to keep Afghan men from abusing women and children, sabotaging justice initiatives and committing other atrocities? Human-rights workers? 
“Locals see foreign NGOs and human-rights organizations” with suspicion, Farivar said. “They view them as another arm of the American-led occupation pursuing their own vested interests.”
The structure of Afghanistan's government gets a mention, as always, but there is little examination into the way that US aid is being spent, distributed and employed in Afganistan. That matters significantly as part of the effort is being carried out by a non-traditional aid actor, the US Military. Furthermore, the US has relied heavily upon contractors to carry out both military and aid duties in the country.

NGOs do work in country to make it what can appear to be a confusing mix of aid players with different goals, experiences and incentives. It is no wonder that some locals may believe foreign NGOs to be connected with the United States.

There is little doubt many aspects of aid have failed in Afghanistan. To what extent was success possible when the US invaded and toppled the Taliban a decade ago? It appears that the deck was stacked against aid ever really succeeding. A more interesting article would examine what took place to lay the foundation for Afghanistan as it is today and then try to understand to what extent aid could have helped to move the needle forward. From there an honest assessment of where aid in Afghanistan failed can be carried out.

Breaking: Protests in the AIDS Conference Media Room

Two protests came through the media room just now to make noise about two issues. The first concerned Brazil's attitudes towards AIDS. A women spoke explaining that Latin America has been largely ignored at the conference and that Brazil continues to neglect the problem of AIDS.

The second group honed in on the free trade agreement between India and the EU, saying that it was backed by big pharma. They were a bit more creative and held a marriage ceremony between the EU and big pharma that was disrupted when given the opportunity to object.

Here are some pictures and videos I just captured.

An Unlikely Foreign Aid Supporter in Congress

Source: AP
One of yesterday's highlights at the International AIDS Conference (IAC) was an afternoon panel discussion featuring Rep Barbara Lee, Sen Chris Coons, Sen Marco Rubio and Sen Mike Enzi. Lee and Coons are long time supporters of foreign aid and were not surprising to see at the conference panel. Enzi, a person who played an important role in the passage of PEPFAR, fit in well, but Tea Party darling Rubio appeared to be an outlier.

I was keenly interested to hear from Rubio in terms of his attitudes on foreign aid and support for AIDS programs. As a name that makes the rounds for the possible VP pick by the Romney campaign, Rubio's position on foreign policy is important given the recent Republican-led initiatives to de-fund USAID.

Stories today will likely focus on the battle fought between moderator Sen Frist and protesters who chanted during his opening remarks and jeered Enzi and Rubio when the two began speaking. What they will miss is the story of bipartisanship on the issue of AIDS, specifically the success of PEPFAR, and the stance on foreign aid taken by the junior Senator.

“Members of Congress on both sides of the aisle must work towards the goal of an AIDS-free generation. This is possible if we continue to strengthen our most effective programs targeting HIV/AIDS, both here in the U.S and abroad,” said Sen Enzi during his remarks.

The same sentiment was echoed by the respective panel members who remarked on the importance of continuing to support AIDS efforts in collaboration. PEPFAR, the one achievement by President Bush that just about every politician can point to as a tremendous accomplishment, featured as the example of what can be done when both sides work together in harmony. 

While plenty of stories focus on how bitterly divided the US congress is these days, here was an example of cooperation at work. A vote was looming for all panel members, in fact Lee had to leave shortly after her remarks to vote in the house, but there was nothing less that agreement between people who are supposed to be absolute foes.

What this shows is that there are points to rally around where members of Congress can come to an agreement. One person who may be able to achieve that could very well be Senator Rubio. While he has gained some attention for his tweets and remarks concerning President Obama, he strays from many of his Republican colleagues on the issue of foreign aid.

Frist posed a question to Rubio concerning the issue of the budget deficit and funding for programs like AIDS. He wanted to know how Rubio could continue funding programs like PEPFAR while addressing the budget concerns that he has expressed.

Rubio replied with a evidenced based argument pointing out that many Americans believe that as much as 25% of the federal budget is spent on foreign aid. "We don't have a debt because of foreign aid. If you zeroed out foreign aid it would do nothing for the debt, but would be devastating not just to the world but to America's role in it," he said.

Maybe foreign aid is a place where bipartisanship can grow in Congress and it appears that Rubio, given his views and popularity, may be one of the integral people that will form a new sort of coalition.

AIDS: Turning the Tide or Riding the Wave?

The theme for the XIX International AIDS Conference in Washington DC is “turning the tide together.” Panels, organizations and speakers have seized on the theme by discussing the changing tide for just about every subject area that falls under the wide AIDS umbrella. “The technology has never been better to turn the tide toward an AIDS free generation,” said USAID Administer Shah on Tuesday.

A conference that is usually marked by excitement, both the cheers and jeers have been largely absent. What seems to fill the space are vague pleasantries and general calls to end AIDS. Erin Hohlfelder remarked on this after the first day of the conference in the ONE Campaign blog. “I did a quick review of all the speeches I had heard so far, and I realized they had essentially all said the same things, the same platitudes, and the same “inspirational words” over and over again. If I had collected a dollar for every time I heard “we can and must end this disease”; “we must turn the tide together”; “we’ve come so far, but we can’t stop now”; or “we’re at a tipping point” I might be well on my way to filling the current AIDS financing gap,” she wrote.

Funding remains a significant issue and something that gets a small mention in many sessions, yet its mentions are not leading to action. Unlike other high level confabs like the recent London Family Planning Conference and the Childhood Survival Call to Action, the IAC is not filled with splashy financial pledges by governments, the private sector and NGOs.

Activists departed the conference on Tuesday to march on the White House and make noise about AIDS. The loudest calls were for more funding. Activists called on governments to meet their commitments to the Global Fund. Mo Banjay, a Gambian youth, interrupted a panel featuring Senators Rubio and Coons to call on the members of Congress to continue to ensure funding continues to grow.

Bill Gates stands out as one of the few skeptics among a crowd of cheerleaders. He pointed towards the lack of vaccine as evidence that the tools needed to end AIDS are not yet available. “Only when we have these new tools can we seriously talk about moving toward the end,” he said.

Gates told AlertNet that it is necessary to ensure that AIDS funding remains a priority. The burden of HIV rests squarely on low and middle-income countries. $16.8 billion was spent globally for HIV prevention and treatment last year, but spending has largely flattened since 2009. The total funding still falls short of the estimated $22 to $24 billion needed to funding HIV/AIDS programs each year. The 2008 financial crisis and the recent scandal involving the Global Fund are in some part at blame.

The good news is that individual countries are increasing their domestic spending targeted at HIV/AIDS. UNAIDS head Michel Sidibé noted this in his remarks at the IAC, “Around the world, over 80 low- and middle-income countries increased their domestic investments for AIDS by more than 50% between 2006 and 2011. BRICS countries now fund, on average, more than 75% of their domestic AIDS responses. Last year, the South African government contributed almost 2 billion dollars.”

The Robin Hood tax is a solution to the funding gap that is beginning to gain traction. Sidibé restated his support for the mechanism in his IAC remarks and Gates has said many times before that he too supports it as a way to increase global health funding. The idea is that a small tax on the financial sector that can target an industry that is in a better position financially as a mechanism for raising money.

Supporters say that the little cost incurred on the individual will matter little to that person, but can add up to a lot of money in sum. Owen Barder shared his concerns in 2010 that such a mechanism, while effective in raising money, will do little to fundamentally change the problems that lead to the shortfall of aid funding.

“The development industry is right to say we should spend more on aid, but we are losing the argument. Instead of addressing the criticisms by demonstrating how aid is effective (and taking steps to make it more effective where it isn’t) we are turning to a Robin Hood tax apparently in the hope of bypassing public opinion… Building support for development is not merely a communications challenge, as is often implied by the hand-wringing of the big aid agencies: it is a reality challenge. Not only do we have to show people how their aid is used, we actually have to make aid more effective, more transparent and more accountable, so that we drive up performance,” said Barder.

As the conference continues, the issue of funding remains a point that is on the lips of nearly every panel, but has yet to move in a meaningful manner. Hilary Clinton announced $150 million in new funding from the United States, but that has been the biggest announcement thus far. A long way from the estimated $7 billion more needed each year.

25 July 2012

An Emerging Deworming Controversy

Bednets garner attention for being a cheap and effective way to ensure the health of children. Meanwhile, a few other interventions, backed by rigorous evidence, have quietly emerged as potential game-changing health solutions. One example is deworming medication.

A 2004 study in Western Kenya provided combination deworming medication for all children, disregarding whether they did or did not already have worms. Authors Edward Miguel and Michael Kremer observed a near 25% reduction in school absenteeism for students who were received the medication verses those who did not. For a mere $3.50 a student can attend one more year of school. The cheap cost of the medications as compared to other interventions, such as subsidizing school uniforms, made it an effective solution to the problem of student attendance.

The evidence was used by research NGO Innovations for Poverty Action to develop the Deworm the World (DtW) campaign. DtW estimates that “600 million school-aged children are at risk of being infected with parasitic worm.” To maximize impact, DtW has partnered with 27 countries and reached over 37 million children since its founding at the World Economic Forum in 2007.

However, the evidence has recently come under heavy criticism. A systematic review of the efficacy of deworming drugs on improving nutrition, school performance and cognitive test scores published by the Cochrane Collaboration said other studies raised questions concerning the impact of school-based deworming. 

Authors Taylor-Robinson et al. found that previous studies on deworming interventions showed little efficacy in improving education and health outcomes. The review is an update of a previous review from Cochrane that was equally as critical of deworming evidence. GiveWell, a charity rating organization, applauded the update of the review in a blog post last week writing, "We find these responses from Taylor-Robinson et al. compelling and we believe the new review to be a significant improvement over the older Cochrane review of deworming."

The Chochrane review questions the evidence touted by Duflo and others by saying that the Miguel and Kramer study lacked baseline data on school attendance and was done in an area with an unusually high rate of worm infection. These concerns, taken alongside a series of other studies both published and unpublished, form the basis for Cochrane seriously questioning the efficacy of the intervention.

A blog post authored by Miguel, Kremer and others on the Innovations for Poverty Action blog points out flaws in the Chochrane review. They point out that Taylor-Robinson et al. misread their study which in fact included a baseline for two of the groups, one of which transitioned from a control to a treatment group during the study.

Furthermore, the Chochrane review excluded three randomized and quasi-randomized studies on soil-transmitted intestinal worms (STH). 

Bleakley (2004) shows that an early 20th century campaign to eradicate hookworm in the US south improved school attendance, literacy, and income in adulthood. Ozier (unpublished) shows that children under one year of age (and therefore too young to be treated) at the time of mass deworming in their communities in Kenya had significantly improved cognitive outcomes due to spillover effects. Baird et al (unpublished) shows strong long term labor market outcomes of children treated for STH,” point out Miguel, et. al.

As the debate continues, more questions begin to emerge. David McKenzie of the World Bank looks into the debate and emerges from the discussion asking, "whether or not the less impressive evidence found in other studies is because those studies are not designed as well as Miguel and Kremer, or because they were in different settings where the impacts differ, or whether the Cochrane review is not comparing like with like."

"One of our big take-aways from the Taylor-Robinson et al. review is that we should be really worried about publication bias, data-mining, and the representativeness of the research we rely on." says GiveWell. However, the site also concludes that the new review does not fundamentally change their view on deworming as an intervention. GiveWell continues to argue that bednets to protect against malaria remain the most cost-effective intervention, but they say that they continue to recommend the Schistosomiasis Control Initiative as their number 2 charity.

20 July 2012

Where and How Aid is Spent

 AlertNet shares the latest info from Global Humanitarian assistance on top donor and recipient countries.
Here are the preliminary estimates of the top 10 government donors and recipients of international humanitarian aid in 2011.
Top government donors:
  • U.S. - $4.6 billion  
  • EU institutions - $1.7 billion 
  • UK - $1.1 billion
  • Japan - $812 million 
  • Sweden - $715 million 
  • Germany - $685 million 
  • Norway - $472 million 
  • Canada - $464 million 
  • Australia - $439 million 
  • Spain­­ - $408 million
Top recipient countries:
  • Somalia - $1.14 billion
  • Sudan - $858 million
  • Ethiopia - $762 million
  • Afghanistan - $687 million
  • Kenya - $550 million
  • Pakistan - $460 million
  • Haiti - $459 million
  • Democratic Republic of Congo - $431 million
  • Palestine/Occupied Palestinian Territories - $405 million
  • Chad - $335 million
Graphic from Al Jazeera 

Congress to the UN: Cholera in Haiti is your Fault, Now Fix it

A letter from a group of Democratic members of Congress to Ambassador Rice urges her to hold the UN accountable for it having brought cholera to Haiti and ensure that the body takes the lead role in treating the current outbreak, preventing its spread and ensuring that safe water systems are in place so it does not happen again. "As cholera was brought to Haiti due to the actions of the UN, we believe that it is imperative for the UN to act decisively to control the cholera epidemic," they implore. "A failure to act will not only lead to countless more deaths: it will undermine the crucial effort to reconstruct Haiti and will post a permanent health threat to the populations of neighboring nations."

Curious that the letter is only signed by Democrats. This seems like it would have bipartisan support. Any insights from the crowd?

Read the full letter:

HT Jonathan Katz

Jamie Drummond: Crowdsourcing the Post-MDG Agenda

Jamie Drummond, Executive Director and Global Strategy for ONE, delivers a TED talk focused on the much-debated issue of the Millennium Development Goals. More specifically, he discusses what is to come after 2015 and how the new goals will be determined.

"As we gather here in Edinburgh, technocrats appointed by the UN and certain governments, with the best intentions, are busying themselves designing a new package of goals. And currently they are doing that through pretty much the same old late-20th century, top down, elite, closed process."

Drummond explains in a ONE blog post:
What’s exciting is that, unlike in 2000 when the first goals were agreed, internet and mobile phones have spread all around the world. People are more connected than ever. So, I’d like to explore how we could use this technology to involve people from around the world in co-designing an historic first: the world’s first ever truly global poll and consultation on “What the World Wants”. Let’s crowd-source the new Millennium Development Goals. I believe that through this crowd-sourcing we won’t just improve the quality of the goals, we will also increase the quality of support for getting the goals done.
In the talk, he lays out the three steps to move the new agenda forward.
  1. Collecting - Doing public opinion polls wherever possible. Collect a strong baseline survey as a point of comparing the progress countries.
  2. Connecting - Use new media tools to activate and connect with people around the world who can then enforce a level of accountability.
  3. Committing - Achieving the two other steps will compel foreign leaders to commit as determined in the previous steps. It will also require accountability that comes through tools like Ushahidi and Kenya's open data dashboard.
An interesting idea that raises a series of questions: Who will implement the idea? How will the information be collected? Who will be surveyed and how? What are the limits of crowdsourcing? How will this ensure that the goals are in fact right for the people who are affected most by their creation? How is success measured?

I posed a few of those questions to Drummond and asked a few other experts to weigh in as I develop this into an actual story. Feel free to offer some suggestions and ideas.

19 July 2012

The Rise of Antiretroviral and the Fall of AIDS Deaths

The Economist takes the data from the recent UNAIDS report concerning the decline in AIDS-related deaths and compares it against the growing number of people receiving antiretroviral drugs.

Highlights from Jim Kim at Brookings

World Bank president Jim Kim delivered remarks at the Brookings Institute yesterday and even took some time to answer a few questions. Here are a few quick highlights based on the unedited transcript:
The story about transformational change is not just a story about emerging economies, like India and China. It is broad-based and extends to countries that are landlocked, like Rwanda, a country that I’ve visited many times; that are small, like Laos, and large, like India; that don’t have natural resources, like Ethiopia. And it extends even to countries that were once mired in conflict, like Mozambique.
Building Safety Nets
We can help countries in building cost-effective safety nets that can protect people against shocks. What I learned by working in communities around the world is that the poorest are the most vulnerable to sinking even deeper into poverty. When illness afflicts a breadwinner, it compromises the future of the whole family. I’ve seen this happen so many times in my own work. Three out of five vulnerable people lack safety nets in developing countries and four out of five in the poorest countries.

Safety nets must be available on a continuous basis to increase resilience against shocks, such as ill health or financial crisis, and building them requires political will. The good news is that effective safety nets need not be costly. Flagship Mexican and Brazilian programs cost only around 0.5 percent of GDP, much less than what other countries spend on untargeted and less effective programs or fuel subsidies. The World Bank has worked with government to expand safety nets in 40 countries, and our goal is to ensure that every developing country has an effective and sustainable safety net.
Inclusive Growth
Even as an unprecedented number of people in the developing world are ascending into the middle class, segments of the poorest populations are being left behind and other segments of the middle class are at risk of falling back into poverty. As young people in Egypt and Tunisia have reminded us, even in middle-income countries development gains have been uneven and incomplete. Demands for respect of individual rights, the rule of law, and the administration of justice go hand-in-hand with inclusive development, requiring institutions to be more open and accountable. That’s why the World Bank is broadening its partnerships. Informed by the lessons of the Arab Spring, the Bank is creating a global partnership for social accountability. It’s providing seed money from IBRD income and leveraging resources from foundations and bilateral donors. This would be the first time the World Bank is allocating specific resources from its income to support a partnership with civil society.

We will try to do at the Bank what the most successful countries did during the last decade. We will work tirelessly, we will continue to learn about what works and what does not, and we will carry out bold reforms when they’re needed. And more than that, we will hold ourselves accountable to the people we serve so that we are judged by our results, not just our intentions.
Talkin' RCTs
You know, we talk a lot about evidence-based medicine. Evidence based medicine, of course, is everywhere, but it’s only about 30 years old. I mean, I remember when I started medical school in 1982 that it was just the beginning of talking about we can generate evidence around the things that we do and it’s not, you know, any longer the sort of experienced clinician who’s saying to you, well, we do this because that’s what we do.

This is now a revolution that’s happening everywhere. I mean, as you know, the randomized evaluations and data collection methods have expanded, but more generally, I think that there’s a commitment to evidence everywhere.

The other thing that I think is critical is that we have to now focus on actually delivering results on the ground. That’s everywhere, right. So, there is -- the ability to collect more evidence has really focused on results on the ground and one of the things that I was working on before I came to the World Bank was that I thought that there could be a science of how to actually deliver results in the social sector and would say many times that the thing about working in the social sector is that so often we have been very tolerant of poor execution. Great idea, put some money to it, but we haven’t really focused on the science of execution.
Education and Health (based on an audience question)
In terms of health and education, both of those areas are critical and there are two areas of expertise that, again, are areas that I’ve worked on in the past. Let me talk specifically about universal access to health care. So, next week, we have 45,000 people coming for the International Aid Society meeting. There have been enormous investments in HIV, but if you go back and look at the stuff that I was saying in 2003 and 2002 when we first started seeing those investments, what I said over and over again is the investment in HIV is our opportunity to really invest in systems. The critical thing about investing in HIV treatment was that for the first time we invested in chronic treatment, lifelong treatment for disease in the poorest countries in the world that forces you to put systems together. So, I think the discussion is moving in a great direction.

What the HIV people are now saying is well, what about MDGs four and five? What are childhood mortality and maternal mortality? What are we going to do to tackle those particular problems? And I think the most important thing is related to what I said earlier: We have to understand this as a systems and delivery problem and not as a disease problem. The asepcts of this problem that need to be handled by highly-trained physicians are actually quite narrow. The real problems are setting up the delivery systems that can not only protect people from the diseases of today, but from the diseases of tomorrow and there's enough money out there in the world that we can begin moving in that direction. That’s how I would like to see the World Bank engage. We are really good at thinking about systems, we are really good at managing processes at a country level and we’re also really good at thinking about how to set up systems that deliver. So, wouldn’t it be great if we could take all this investment in global health and in every single country build systems?

At Partners in Health, the organization I worked with before, every country we’ve gone into, and Rwanda’s a good example, we’ve gone in and said we’re going to take this money for HIV treatment and turn it into primary health care systems and I think the evidence is overwhelming that it’s both doable and cost effective. And the other thing that we’ve seen that we didn’t expect was that once we built those systems, the economy sprouted up around those health care systems and actually contributed to the economic growth of those countries.

So, one, health and education are critical to economic development in my view. I think the evidence is very good for that. But also, I think the Bank is a very unique and wonderful contribution to make, which is to say hey, folks, these really aren't medical problems, they're partly medical problems, but the big chunk of it that we can help you with is what's going to give you the long-lasting impact, protect you from future disease outbreaks, and also help to build your economy.

In Which The IOC Doesn't Get Conflict

Distance runner Guor Marial is trying to run in the Olympics. The Sudanese refugee was born in Southern Sudan and lost 28 members of his family during the nation's civil war.

South Sudan is now a free and independent state, but lacks a National Olympic Committee. This means that Marial cannot run in the Olympics for his new country. Not deterred, he made an appeal to the International Olympic Committee for permission to run as an independent.

The IOC responded by suggesting that he run for Sudan. They very country that his family and neighbors fought for independence. AlertNet discussed the matter with Marial.
“I lost my family and relatives, and in South Sudan 2 million people died,” he said by phone from Flagstaff, Arizona, where he lives.

“For me to just go and represent Sudan is a betrayal of my country first of all, and is disrespecting my people who died for freedom.”
Marial left Sudan at the age of 14 following an attack when Sudanese soldiers entered his home at night. He was left unconscious after a soldier smashed his jaw with a rifle.

The athlete, who arrived in the United States when he was 16, said he appreciated Sudan’s offer but it was impossible to accept.

“In my situation, the consequences of me representing Sudan are bigger than me going to the Olympics,” he said in the interview late Tuesday.

“At this level, as an athlete, I don’t just represent my family, but the whole of South Sudan. It’s a very heavy responsibility to carry. It’s very important for me to make the right decision,” he added.

“My dream is to represent South Sudan. It’s just a matter of time.”
South Sudan tried to lobby on behalf of Marial to no avail. From the Chicago Tribune:
According to Ciring Hiteng Ofuno, South Sudan’s minister of Culture, Youth and Sports, the country’s president, Gen. Salva Kiir Mayardit wrote IOC president Jacques Rogge on behalf of Marial. 
In an email, Ofuno called the communications with the IOC “fruitless.” 
"It is unfortunate that an independent country is unable to be granted even the symbolic right to participate as a member of the world family of nations," Ofuno wrote. "It is a pity that institutions established by human beings can be so rigid to that extent." 
Ofuno also acknowledged that the ministry’s staff must "redouble their efforts" in the process of joining international bodies like the IOC so the country does not miss such events in the future.
Refugees International is unhappy with the suggestion made by the IOC and wrote a strongly worded open-letter to President Jocques Rogge condemning the suggestion and requesting that Marial have the opportunity to compete.
Count Jacques Rogge

President, International Olympic Committee
Dear Sir:
I write today regarding Guor Marial, a talented runner and a refugee from Sudan. In his first-ever marathon last year, Mr. Marial qualified for the Olympic Games with an ‘A standard’ performance, and wishes to participate in the 2012 Games in London.
Though Mr. Marial’s talent and accomplishments are sufficient to gain an Olympic berth, an unfortunate confluence of factors has so far kept him out of the competition. Born in Unity State, in what is now South Sudan, Mr. Marial may have claim to South Sudanese nationality but has not yet chosen to exercise that claim. Even if he received nationality in time for the 2012 Games, Mr. Marial could not compete for South Sudan because that country has not yet established a National Olympic Committee. He is also unable to race for the United States of America, his country of permanent residency, because the IOC requires that athletes be full citizens of the countries they represent.
The IOC has proposed that Mr. Marial run as part of the Sudanese Olympic team, which has offered to accept him as a member. However, based on his personal experiences and our expert knowledge, we believe such an arrangement would be inappropriate. Numerous members of Mr. Marial’s family have been killed by Sudanese security forces, and he himself has suffered serious physical abuse at the hands of Sudanese police. The threats against him are serious and were recognized as such when he gained refugee status in the United States. Therefore, asking Mr. Marial to submit once again to Sudanese authority as an Olympic athlete is not acceptable. Moreover, Mr. Marial was one of 500,000 individuals effectively stripped of Sudanese citizenship under a discriminatory amendment to Sudan's Nationality Law in August 2011. Allowing Sudan to carve out a special exception for Mr. Marial is inappropriate when hundreds of thousands like him have had their nationalities revoked en masse with no possibility of appeal.
As an alternative, we propose that Mr. Marial be allowed to compete in the 2012 Games as an Independent Participant. This status, which allows athletes to compete under the Olympic Flag, has been granted numerous times by the IOC. Indeed, a number of other athletes at this year’s games will be competing independently. At its 123rd session in July of last year, the IOC granted independent status to athletes from the Netherlands Antilles after its National Olympic Committee was dissolved, in order to “preserv[e] as much as possible the interests of the athletes.” Qualified athletes from South Sudan, including Mr. Marial, deserve equal treatment, and the IOC should act to grant him an Olympic berth without delay.
As the IOC considers this proposal, we encourage it to reflect on the Fourth Fundamental Principle of Olympism, which states that:
The practice of sport is a human right. Every individual must have the possibility of practising sport, without discrimination of any kind and in the Olympic spirit, which requires mutual understanding with a spirit of friendship, solidarity and fair play.
There are few ways of better upholding this principle than allowing Mr. Marial to compete as an equal independent participant in the London 2012 Games.
On behalf of Refugees International, I wish you and the entire IOC a successful Olympic Games. If you require any further information, please know that my colleagues and I are at your disposal.
Michel Gabaudan

18 July 2012

The Life of An Outlaw (aka A Kenyan Matatu Driver)

Anyone who has spent significant time in East Africa will appreciate this documentary. Though the issue of corruption is not at all a secret, it is neat to hear about it from the perspective of a matatu driver in Nairobi. What makes James Kariuki special is that he is not afraid to openly discuss the profession, warts and all, in an open manner. Case and point is his letter to The Daily Nation:
I am one of those you just love to hate. We're the backbone of Kenya's black market, expected to pay off everyone from police to criminal gangs. Perhaps you don't have any idea what it's like to be the black sheep of the country, but let me explain: We wake up at three every morning to bring milk to Nairobi, from there we take cops who have been on night duties home, then pick up newspaper vendors, company drivers, office workers and your school kids. After we are done with you, we take your housewife or houseboy to their secret lovers. Then comes Sunday and the entire Christian community depends on us. The pastors ought to pray for us, seeing we are assisting them in their missionary work, but instead they condemn us for missing the Sunday service. We are lucky that it is not them, but God who judges us, otherwise we could be the most cursed human beings on the face of the earth.
Better yet, James has his own blog. It is a mix of politics, personal reflections and insider information on the matatu business. In May, James discussed the matatu industry from the side of investment.
There is another upcoming management team of ex-matatu drivers that has taken the matatu market by surprise;- Black Eagle transporters is a new entry in the business and for the first time in Kenya; it has attracted foreign investment from our brothers in the new republic of Sudan. Jaffal and his former classmate took over the management of two buses belonging to a Sudanese investor after he terminated a contract with city hopper complaining of not making any profit after several months. Two years later the young entrepreneurs have turned the investor’s dreams of making money in the transport sector into a reality; he has added two more buses and there is talk in the industry that more are coming with two already with the body builders.

Groundbreaking Intervention Will Save Infants' Lives

The application of chlorhexidine on a newborn’s umbilical cord at home and soon after birth can greatly reduce the risk of infection. A recent study in The Lancet looked at the application of this simple intervention in Bangladesh and Pakistan. The effectiveness of the intervention was already known, but the studies confirmed that it could be help save lives in low resource settings.

Data from 54,000 newborns in the two studies and Nepal, where the chlorhexidine solution is already being used showed an aggregate 23% reduction in neonatal mortality, excluding deaths in the first few hours of life, and a 68% reduction in severe infections when comparing the intervention group to the control group. That is stunning.

In Nepal, the price of a packaged product is estimated between US $0.11 and $0.43. Further studies are taking place in Africa to learn more about the behaviors and preferences for the product. For example, studies show that the gel form of chlorhexidine is preferred in Nepal. On the other hand, a Zambian study indicated a preference for the liquid form.

The solution is easy to carry out, effective and cheap. A true win-win-win for global health.

According to the Healthy Newborns Network blog, "Hospitals in the US and other developed countries already use it to prevent umbilical cord infections. But in developing countries, where the majority of births happen at home and in communities where poor hygiene leads to very high newborn infection and death rates, there is little experience with – and evidence for – chlorhexidine cord cleansing. In fact, cord care practices in many developing countries are steeped in cultural and religious traditions, and involve putting a number of different harmful substances on the cord. Unfortunately many of these practices greatly increase exposure of the umbilical cord to bacteria that cause fatal infections."

Both studies employed a 4% chlorhexidine that PSI believes is destined to be the next “major event” in public health. Presently we are advising PSI platforms to assess the value of the product in their country context and determine appropriateness of incorporating the product into their strategic plan.

"The advantage of the intervention is the ease of application. Community health workers, hospital staff, midwives and even mothers can be trained in applying the chlorhexidine solution," said Dr. Abel Irena, PSI Research Advisor on Child Survival. Latest estimates show that neonatal mortality makes up over 40% of global under five child mortality; 29% in Africa and 54% in Southeast Asia.

Presently, the WHO does not recommend the use of 4% chlorhexidine. It says to keep the umbilical cord clean and dry, unless it is tampered with for cultural reasons. In that case, it suggests the application of a 5% chlorhexidine solution. "I expect the WHO to change the guidelines in the near future to reflect the findings from the the two studies," said Dr. Irena. He said studies in Sub-Saharan Africa are wrapping up soon, but expects them to largely confirm the findings of the Lancet-published studies.

Note: I wrote this a few months back for PSI and it got lost in the shuffle. Since I took the time to put this together, I figured it was better late than never.

The Onion Takes on Volunteering

The satirical news site The Onion has a point and counterpoint on the issue of young people teaching under-served kids across America. As someone who did that out of school, the response by the student does quite a good job summing up some of the very problems with the practice.
You've got to be kidding me. How does this keep happening? I realize that as a fourth-grader I probably don't have the best handle on the financial situation of my school district, but dealing with a new fresh-faced college graduate who doesn't know what he or she is doing year after year is growing just a little bit tiresome. Seriously, can we get an actual teacher in here sometime in the next decade, please? That would be terrific.

Just once, it would be nice to walk into a classroom and see a teacher who has a real, honest-to-God degree in education and not a twentysomething English graduate trying to bolster a middling GPA and a sparse law school application. I don't think it's too much to ask for a qualified educator who has experience standing up in front of a classroom and isn't desperately trying to prove to herself that she's a good person.

I'm not some sort of stepping stone to a larger career, okay? I'm an actual child with a single working mother, and I need to be educated by someone who actually wants to be a teacher, actually comprehends the mechanics of teaching, and won't get completely eaten alive by a classroom full of 10-year-olds within the first two months on the job.

How about a person who can actually teach me math for a change? Boy, wouldn't that be a novel concept!

I fully understand that our nation is currently facing an extreme shortage of teachers and that we all have to make do with what we can get. But does that really mean we have to be stuck with some privileged college grad who completed a five-week training program and now wants to document every single moment of her life-changing year on a Tumblr?

For crying out loud, we're not adopted puppies you can show off to your friends.

Look, we all get it. Underprivileged children occasionally say some really sad things that open your eyes and make you feel as though you've grown as a person, but this is my actual education we're talking about here. Graduating high school is the only way for me to get out of the malignant cycle of poverty endemic to my neighborhood and to many other impoverished neighborhoods throughout the United States. I can't afford to spend these vital few years of my cognitive development becoming a small thread in someone's inspirational narrative.

But hey, how much can I really know, anyway? I haven't had an actual teacher in three years.
The applications to volunteering internationally are equally appropriate.

17 July 2012

US Congresswomen Introduces AIDS Resolution

This originally appeard on the PSI Healthy Lives Blog.

This week, Congresswoman Barbara Lee (CA-09) introduced a House resolution, co-sponsored by  Congressional HIV/AIDS Caucus co-chairs Rep. Jim McDermott (D-WA) and Rep. Trent Franks (R-AZ), that acts to support global coordination to end AIDS.

H.Con.Res. 131 "recognizes the XIX International AIDS Conference as a unique opportunity to change the course of the HIV/AIDS epidemic by capitalizing on scientific advances in treatment and prevention, building consensus to maximizing results, facilitating public-private partnerships, and accelerating momentum towards a cure."  Next week, global leaders, scientists, activists and people living with HIV/AIDS will gather in Washington DC for the XIX International AIDS Conference (IAC). An important conference that makes its return to the United States for the first time in 22 years.

“AIDS is still the greatest humanitarian crisis of our lifetime,” said Congresswoman Lee. “As we work to turn the tide together, America’s need for a greater AIDS response underscores that AIDS 2012 is an important and long overdue opportunity for our domestic epidemic to become part of a global effort.”

The resolution reads as follows:
Expressing support for continued international cooperation to combat HIV/AIDS.

Whereas an estimated 34,000,000 people around the world were living with HIV at the end of 2010, up from 8,000,000 in 1990;

Whereas since the beginning of the epidemic, nearly 30,000,000 people have died from AIDS-related causes;

Whereas the annual number of new HIV infections has steadily declined, and due to the significant increase in people receiving antiretroviral therapy, the number of AIDS-related deaths has also declined;

Whereas developing countries continue to bear the brunt of the HIV/AIDS epidemic, with sub-Saharan Africa accounting for 68 percent of all adults and children living with HIV/AIDS;

Whereas 1 in 5 individuals living with HIV/AIDS in the United States is unaware of being infected, and significant disparities persist across different communities and populations with regard to incidence of infection, access to treatment, and health outcomes;

Whereas the engagement of civil society is critically important to the fight against HIV/AIDS;

Whereas the courageous efforts of individuals and communities affected by HIV/AIDS in the United States and worldwide have revolutionized the global response to HIV/AIDS and led to the enactment of bipartisan legislation to address the crisis;

Whereas the United States President’s Emergency Plan for AIDS Relief (PEPFAR), which represents the largest commitment by any nation to combat a single disease, has saved the lives of millions of people around the world by establishing and expanding the infrastructure necessary to deliver prevention, care, and treatment services in low-resource settings;

Whereas the United States has articulated a vision of ushering in an AIDS-Free Generation; and

Whereas the XIX International AIDS Conference offers a unique opportunity to change the course of the HIV/AIDS epidemic by capitalizing on scientific advances in treatment and prevention, building consensus to maximizing results, facilitating public-private partnerships, and accelerating momentum towards a cure: Now, therefore, be it

Resolved by the House of Representatives (the Senate concurring), That Congress--

(1) supports efforts to raise awareness about the ongoing HIV/AIDS crisis;

(2) recognizes the importance of country ownership of the HIV/AIDS response, including participation by civil society;

(3) expresses its support for the achievements of the United States President’s Emergency Plan for AIDS Relief (PEPFAR), in cooperation with international efforts to combat HIV/AIDS;

(4) endorses the call for virtual global elimination of new pediatric HIV infections by 2015;

(5) urges continued United States leadership in the fight against HIV/AIDS; and

(6) calls upon all nations to--

(A) develop and implement effective AIDS strategies that are tailored to local conditions and include specific, measurable targets and evaluation plans;

(B) provide adequate resources that are targeted appropriately to address the epidemic;

(C) promote accountability among all stakeholders engaged at various levels of the response to HIV and AIDS; and

(D) respect the human rights and dignity of persons living with HIV/AIDS.
Congresswoman Barbara Lee will speak at the opening plenary session of the IAC on July 22, 2012. Based on previous concurrent resolutions and the make-up of the sponsors, Govtrack.us predicts that the "resolution has a 9% chance of being agreed to."

The Real Experts

A guest post by Jennifer Lentfer of how-matters.org

The first and most challenging exercise of the day when I took a seminar from The OpEd Project required me to fill in the following blanks and share with the group:

Hello, my name is______________________________________.
I am an expert in_______________________________________.
I am expert because___________________________________.

I delivered specific and clear answers to these questions. But when praised by the facilitators, I minimized my success by stating to everyone that I would surely fail later in the day. I wasn’t the only one in the room who struggled. Every other woman and one man of color who was participating that day, all of whom were highly accomplished in their fields, fumbled.

Many of us have trouble claiming our “expertise” in any one area, let alone claiming our voice, our space, or our rights. But do you know who doesn’t? It shouldn’t surprise you. Most of the “expert” voices we hear in the media are from an extremely narrow group—mostly western, white, privileged, Christian, and overwhelmingly male.

This certainly happens in the fields of international development and global health as well.

An estimated 25,000 participants from more than 185 countries will assemble in my city of Washington D.C. next week for the XIX International AIDS Conference. I wonder of those 25,000 experts, how many have actual “on-the-ground” expertise?

What is undeniable to me during my decade of service in the HIV sector in Africa is that most families are getting by not because of sweeping national-level policy protections or major internationally-funded programs. Rather, those who survive and thrive do so because of the local efforts of people who organize their communities to extend support and services to children not sufficiently reached by government or international agencies.

A study for the Joint Learning Initiative on Children in AIDS at Harvard in 2007 revealed that the prevalence of community-level initiatives for children affected by HIV/AIDS in Uganda was one per 1,300 people. In another example, a UNICEF-sponsored mapping exercise identified over 1,800 of these groups in Malawi (Network of Organizations serving Vulnerable and Orphaned Children of Malawi, 2005).

Clearly these are folks whose knowledge, expertise, and local efforts are invaluable to the multi-billion dollar (though shrinking) fight against HIV and AIDS.

Robert Chambers of the Institute of Development Studies talks about the strong centripetal forces that draw resources and educated people into the ‘core’ where there is mutual attraction and reinforcement of power, prestige, resources, professionals, and the training to generate and disseminate information.

What happens to the periphery then, when it’s those vulnerable children in the periphery that we are trying to serve? When a privileged few frame the conversation about fighting AIDS or reducing poverty, remedies from above are imposed on the excluded. Yet it’s those on the ground who have the most important knowledge, ideas, and resources to deal with the immense and complex problems associated with vulnerable children in Africa.

REPSSI (the Regional Psychosocial Support Initiative) is a pan-African-initiated and -led non-governmental organization based in Johannesburg, South Africa, that has reached “front-line” service providers—community volunteers, teachers, police officers, social workers, traditional leaders, and others—for the past decade. REPSSI’s innovative distance-learning course in community-based work with children and youth is the first accredited course of its kind in Africa. Graduates now number 494 and there are currently over 1000 enrollees in the course.

(If the video does not load, you can watch it on YouTube here.)

This year REPSSI conducted phone interviews with 309 of its graduates from the first certificate cycle in 2009 (64%) and found that REPSSI is reaching the “right kinds of people” with this course—those who work directly with children, which they estimated at approximately 130 children per graduate. Most importantly perhaps, REPSSI found that 18 months after graduation, 70% of REPSSI’s graduates remained in their communities. This indicates the strength of a situated, supported distance learning program. More than two-thirds of graduates were leading psychosocial support initiatives in their agencies and organizations throughout southern and east Africa.

Certainly the International AIDS Conference organizers have made great strides in recent years to include more participants from marginalized communities and developing nations. However, even though grassroots leaders are a crucial part of the "last mile," they continue to be under-represented at the table and under-valued, less understood, and thus overlooked in funding flows, capacity building opportunities, and influence.

This year’s conference theme is “turning the tide together.” Thus we have to ask—what is the cost to all of us when so many of the best minds and perspectives from the community-level are left out?

Here is where we clearly need all the help we can get—on-the-ground experts welcome.

16 July 2012

PSI's Hofmann on the GHI

As I continue to track the latest developments on the GHI, Karl Hofmann, CEO of PSI, weighs in with a short statement on the future of the GHI.
The announcement Friday before the July 4 weekend that the Administration's signature Global Health Initiative (GHI) was being replaced by a new Office of Global Health Diplomacy at State was greeted with withering criticism from many in the global health community.

Here's why this change matters less than one might first think.

GHI was meant to bring coordination and integration to the USG's vast global health bureaucracy, and particularly to drive more integrated health programming in the GHI focus countries. The aim to achieve greater integration of Washington agencies and their individual health appropriations was never as likely nor frankly important as the aim to achieve more integrated health programming at country level. The former is Washington's favorite contact sport, with endless periods on the field and no permanent winners -- it's sensible for the Administration to stop beating its head against this goal post. The latter probably has much more significance to the intended beneficiaries of US global health assistance, and here there has indeed been some country-level progress.

What matters more than org charts is of course appropriations. In truth, the Administration and Congress have done rather well by global health, given our fiscal realities.

As a former US ambassador, I know the challenges of trying to get interagency coordination in Washington. In fact, it's often easier to get on-the-ground coordination in a particular embassy country team than it ever is to get agencies' Washington headquarters to even talk to each other. Putting more emphasis on making global health integration a programmatic reality at the country level is probably the right way for the Administration to bring GHI principles to life.
Disclosure: I write the PSI Healthy Lives Blog where this originally appears. Though I am connected to the organization, my interest in sharing is based on the future of the GHI. 

Increasing Attention on the UN

Recent global events and a pair of documentaries are putting the UN under a bit of a microscope. Baseball in the Time of Cholera touches on the role of UN peacekeepers in bringing cholera to Haiti and UN Me is an attempt to highlight the problems in the international body. Meanwhile, the UN is at the center of attempting to address the problem with Syria, under some more attention in the US because of the arms treaty (which has ruffled the feathers of the NRA), is taking the lead on the Sahel crisis and is at an important point in regards to determining the post-MDG agenda.

I am curious what all of this may mean for the UN. When people in the US hear about the UN the level of approval is much lower as compared to its individual agencies such as WFP and UNICEF. It is not particularly striking, but speaks to a disconnect between the UN and the American public. The UN Foundation, for example, exists to help raise awareness about what the UN is doing and help people to understand that the agencies that do good around the world are in fact a part of the UN.

Part of the problem appears to be a lack of understanding as to what the UN general assembly can and cannot do. Right now I am looking to pull information about some recent instances of UN involvement to provide an avenue for sharing what the UN does and also look at how its theoretical power is put into use. Further, my idea is to see how expectations are set based on what people know, compare that against what the UN can do, and against what actually happens.

On Friday, I spoke with reporter Jonathan Katz about the cholera outbreak in Haiti. He the person who broke the story that somehow has gotten little attention. The evidence against the UN is damning, yet it has denied that the Nepalese peacekeeping troops brought cholera to Haiti. The outbreak is over a year old and the response is well under way, but the issue of accountability remains.

As I gather more information an actual story will begin to take shape. Let me know what, if anything, piques your interest.

How I Learned to Stop Worrying and Love COD Aid

So Nancy Birdsall does not actually use that phrase or title her talk by employing an overused reference to Kubrick's Dr. Strangelove, but I went there.

The video at the top is Birdsall delivering her DevTalk from the Frontiers in Development Conference last month. It is the wonky attempt to bring a TED talk to aid and development. Kidding aside, cash-on-delivery is an interesting idea. Everyone has their thoughts about it, but there is little disagreement with Birdsall's main point that there are too many meetings and too much planning going on.

Birdsall must be a Dave Matthews fan given her push to "pay for what you get." Maybe she listened to the song before the presentation...
Work ourselves, fingers to the bone
Suck the marrow, drain my soul
Pay your dues, and your debts
Pay your respects, everybody tells you
You pay for what you get
Most importantly, COD aid starting to be piloted in some countries. Most notable is the use by DfID in Ethiopia. Give the video a quick view if COD aid is a new topic to you. It's an idea worth noting.

Is Sahel Fundraising Gaining Momentum?

The Sahel crisis continues and it seems like little good news makes its way out of the region. Sectarian violence continues in northern Nigeria, Islamist rebels in northern Mali have assumed control of the region and people are pouring into Chad and Mauritania as the result of fighting and the inability to access food.

All the while, attempts to raise money for the region, as the situation for millions of people worsens, have fallen short. As of last month, the relief needs for Chad were underfunded by over half. Refugee services had 22% of total requested funding according to OCHA.

Toss in WASH, health and education to the mix of areas with little funding and a clear picture of a crisis begins to form.

Major players, like Oxfam and UNICEF, have picked up their efforts to raise awareness and funds. UNICEF has tried to appeal to the younger set by using former Disney Channel star Selena Gomez to activate her some 11 million Twitter followers. “The situation is urgent and these children need our immediate help. I want people to know that together with UNICEF, we have the ability to prevent their deaths,” she said this past April.

With PSAs (above), public events and many tweets Gomez appeared to get some buzz going within her community, but the numbers reflected in the OCHA report point towards little ability to move the needle in a significant way. By last month, UNICEF raised only half of its requested $120 million.

Despite these challenges, good news is now emerging. The World Food Programme announced today that its latest fundraising campaign exceeded its goal. WFP aimed to raise enough money to provide meals for 12,500 mothers and children. The outpouring of support, bolstered by a two to one matching partnership with the Dutch National Postcode Lottery, led to raising enough money to provide meals for 15,000 mothers and children. In total, the campaign raised $750,000.

The numbers are low given the great need, but exceeding a set goal is positive. It may in part be due to the noise being made by organizations who are trying to get attention an much needed funding for the response. Though too early to tell and only a single case, the momentum may be building for support in the Sahel at a critical point.

I asked Sarah Borchers about the recent success and what WFP did in the campaign. She said that WFP did not do anything "revolutionary," but boiled down the campaign to:
  • Positive messaging about the impact that donors’ contributions have on WFP’s work and on our clients is more effective, especially when trying to get people to donate for the first time. Focus on what’s working and tell people how they can replicate that for other people.
  • When you’re dealing with a crisis affecting 10 million people, for example, it’s essential to scale the situation down to a more personal level. In our email communications, we’re asking you to save one woman or child from hunger, not 10 million.
  • Segment and Test -- This might be getting into the weeds a bit too much, but prompting previous donors with a suggested gift amount that’s just slightly above their previous largest donation (and other tactics relating to segmentation by donor level) really does work!
  • Thank EVERYONE! Sending a post-campaign thank you email to not just donors but our entire community is really key. This is something I personally feel we’ve gotten really good at. The email we sent out yesterday linked to a lovely video from Justin -- www.wfp.org/sahel-thanks. Worth noting that while the email went out less than 24 hours ago, we’ve already received enough additional funding to feed 30 more women and children for 100 days. And there was no call to action written into the email.
The overall effort remains severely underfunded. The most up to date numbers from the UNOCHA Financial Tracking Service indicates that the overall response is only 49% funded, coming in at just over $800 million short.

With all the talk of resilience, it seems difficult to imagine how such a poorly funded relief effort can not only meet the immediate needs of the people of the Sahel, but put into place structures that will help to place people in a better position to deal with future food crises. "Obviously no mention of the word “famine” which inevitably causes people to take notice. The message here was equally powerful – preventing serious malnutrition and it’s irreversible effects for new mothers and young children – but it hasn’t resonated as much externally. We haven’t seen nearly as many individuals being driven to wfp.org looking to donate," explains Sarah.

WFP is hoping to reach more people by building its online community. Once someone joins the community, the goal is not to raise money but to provide information. Community members learn about various problems, the responses and the staff who are carrying out the interventions. All this then will hopefully prime the community to want to support WFP.

As Sarah explains, "If we’re doing our jobs correctly, you’re becoming invested in hunger as a cause and convinced that WFP is the best organization to fight it. If we’re doing our jobs correctly, when a major campaign or emergency comes around, you will consider making a donation."

The recent success by WFP is some good news in what has been a disappointing campaign thus far. The approaches are not necessarily new, but the methods for reaching an audience are. While organizations try to build resilience for millions of people in the Sahel, they are also attempting to build a new and informed set of supporters.

I'd love to talk to more organizations about their fundraising efforts for the Sahel to fill out a more complete article on the state of fundraising efforts. Feel free to send along some tips and suggestions or get in direct contact with me.

13 July 2012

Watch Frontline's Special on AIDS in Black America

Above is the 2 special from PBS Frontlines that looks at the burden of AIDS on black Americans and raises the important point that the spread of new infections can be prevented. Give it a watch.

The Family Planning Summit is Over. Now What?

President Yoweri Museveni of Uganda, speaking at the London Summit on Family Planning
President Yoweri Museveni of Uganda, speaking at the London Summit on Family Planning - Credit: DfID
The Lancet is the latest to toss a raft into the very crowded and quickly escalating white water river that is family planning. A special series published earlier this week provides some important critical thinking about the solutions that will be implemented with the money raised.

In the introductory piece for the special Editor Richard Horton and Herbert Peterson lay out what the perceive to be the two challenges to family planning efforts.
We see at least two challenges ahead. First, countries and the global community need the political will and capacity to apply the best available evidence to inform and encourage policymakers to take family planning more seriously. That means addressing often large variations in knowledge about family planning within countries and the sometimes strong sociocultural barriers to its delivery that exist. Second, there need to be national and global commitments to ensure that the evidence we present here is translated into innovative interventions which are, in turn, effectively implemented to achieve the goal of universal access to reproductive health. If these twin challenges can be met—using, in part, the potentially powerful idea of independent accountability—then a judicious fusion of science and advocacy will have been achieved. We pledge to do our best to make sure this Series plays its part in what we believe can be the beginning of a new global movement for family planning.
The commentary section contains a veritable who's who of contributors. One that stands out more for notoriety rather than substance is a co-written piece by Bob Carr, Melinda French Gates, Andrew Mitchell and Rajiv Shah.
Family planning is recognised as a highly cost-effective development intervention to promote healthy families, increase opportunities for economic development, and enable strong and vibrant nations. At a time when value-for-money and cost-effectiveness are the watchwords for development agencies, it is critical that the global community commit to long-term investments in voluntary family planning to meet health and other development goals. The UN recognises that “for every dollar spent in family planning, between US$2 and US$6 can be saved in interventions aimed at achieving other development goals”. Yet global investments have not kept pace with increasing demand.

Engaging all stakeholders was an important part of the summit and is reflected in the special section.  The respective Prime Ministers of Ethiopia and Rwanda co-author a commentary that outlines how their countries have worked to provided family planning services and the way the two percieve the path forward for their own countries and other African nations.
Family planning empowers women to take charge of their lives whilst also enhancing their contributions to family wellbeing and overall national development. Some progress has been made towards improving gender equity so that women have greater involvement in decision-making processes and positions in government. Increasing educational opportunities for girls protects them from premature marriage and childbearing and helps address gender inequalities in economic participation. However, the large annual increase in the number of school-age children each year in our countries dilutes the investments that families and governments are able to make towards universal secondary education. We believe that improving education and improving access to family planning are not alternatives: they are rather complementary policies that African governments and the international community must pursue. 
We recognise these wide-ranging contributions to development and are committed to prioritising family planning and reducing the barriers to contraceptive use. We are proud of the progress that is being made to increase contraceptive use in our countries. In Rwanda, the percentage of married women using contraception rose from 13% in 2000 to 52% in 2010. In Ethiopia, contraceptive use increased from 8% to 29% between 2000 and 2010. But challenges remain. For example, 25—35% of married women in these countries, most of whom are the poorest people in our communities, still have unmet need for family planning.
Tom Paulson asked some important questions in Humanosphere following the summit in regards to what extent the rising political will for family planning will support overall women's health.
[N]ow, with a more nuanced and popular message maker, Melinda, the Gates Foundation has over the past few years shifted much more emphasis to improving maternal health.

A good thing, taken in isolation. But some women’s right advocates wonder:

Does the high-profile attention given to family planning, maternal health, as the new cause célèbre of global health send the wrong message — that the primary concern for women is their ability to make babies (or not), as opposed to women’s health overall?

I hear this grumbling often at meetings or press conferences held to promote reducing maternal mortality or improving women’s reproductive rights. Usually, the women (and they are almost always women) doing the grumbling feel a bit awkward about it — because they don’t want to look as if they are opposed to efforts to fight death in childbirth or family planning.

So they usually don’t say anything, or if they do offer the critique almost as an apology.

But I think it is actually a very important question, and one that should not be ignored.
It is an issue that Kate Gilmore of UNFPA and Ethiopian minister of health Tedros Adhanom Gebreyesus do not ignore. In the face of what might appear to be another example of the further verticalization of international health, the two argue for the strengthening of health systems.

By no means are health systems a new or revolutionary idea, yet active support for systems is a bit of a sideline issue with high profile events like the London Summit for Family Planning, the recent maternal and child health call to action and last year's fundraising event for GAVI. Toss in the clout of PEPFAR and the Global Fund along with the popularity of specific initiatives like bednets, and you end up with a sea of focused health interventions.

The two outline the importance of health systems writing:
Using a health-system-strengthening approach for scale-up, family planning should be made available in every community and in every facility, and round-the-clock maternity services should be offered with at least one basic emergency obstetric and newborn health centre per 100 000 population and one comprehensive emergency obstetric and newborn care district hospital per 500 000 population. Financial restrictions to contraceptive access, especially for the poorest women and those who are pregnant during adolescence, should be addressed by offering free or nearly free services at the point of care.
Then there is the question of how the money will be disbursed. Amanda Glassman raises some possibilities, but ends up advocating for the money to be allocated by USAID's Family Planning Office.
USAID has a well staffed operation of experts managing contracts for service delivery, data collection, logistics, supply chain, procurement, research and development, with constant oversight from the U.S. Congress on their compliance with informed consent. The international NGOs will do the technical assistance to service delivery and other areas. The UNFPA can procure the contraceptives and build the political consensus. The World Bank can do the impact evaluation.
All in all, there are some questions that have emerged from this week's summit. The important announcements and actions will take place in the coming weeks as the money pledged will be put into action.