28 February 2013

Rethinking How Pandemics Spread

Modern pandemics spread like this video you see below.

The rather random spread is actually much more direct that it appears at first view. What happens when you use a shortest path tree rather than a map?

The Atlantic covers the genesis of this reframing by theoretical physicist and professor of complex systems at Northwestern University, Dirk Brockmann.
"That made me think about, 'what is it that makes these different simulations be so much in agreement?'"Brockmann says. All of those other factors seemed to play little role. "My hypothesis was that much of it is driven by the structure of these mobility networks."

Brockmann’s research ultimately led him to a surprisingly simple conclusion. Diseases spread across the globe today in precisely the same way they did during the time of foot-only travel and the Black Death. We’ve just been looking at the map of the world all wrong.
Read the full article here.

HT Tom Paulson

Sequester Looms Over Global Health Research and Development Funds

Washington DC - Sequestration hits the US federal budget on Friday. The Washington Post features a countdown to Friday on the front page each day. News reports and the talk around town radiates a certainty that the across the board budget cuts will go through on Friday.

That fact is not dissuading global health activists from warning of the harm caused by budget losses. A group of activists descended upon the US capital to meet with lawmakers and issue a congressional briefing on the setback to global health research that the cuts pose.

Among those pushing lawmakers to maintain the US’ leadership in the global fight against the diseases poverty is the Global Health Technologies Coalition (GHTC), which issued a report outlining the ways that the US can continue to be a global health research leader. The group is funded by the Bill & Melinda Gates Foundation and housed within Seattle-based PATH, an organization that specializes in finding technological solutions to health problems in poor countries.

“We know that policymakers are currently facing difficult budget decisions. But any reductions in funds could eliminate essential support for the development of global health tools and slow or halt the progress made against addressing a number of deadly diseases,” said Kaitlin Christenson, MPH, director of the GHTC in a press release.

US funding for neglected disease research and development has declined to $100 million below the peak in 2009. Despite the declines, the report points out that the UN remains the leading funder of such research. “Other reports found that cutting funding for global health and R&D programs would barely make a dent in reducing the US federal deficit but would have a crippling impact on people’s health and lives around the world,” says the report.

27 February 2013

New DR Congo Peace Deal Garners Mixed Reactions

There is a new peace deal in the Democratic Republic of the Congo. However, the outlook is mixed.

11 countries (DRC, Angola, Burundi, Central African Republic, Republic of Congo, Rwanda, South Africa, South Sudan, Tanzania, Uganda and Zambia) signed onto the deal at the EU headquarters in Ethiopia.

The Central African coalition agreed to provide support, including 2,500 troops, to stabilize a country that has been beset by conflict for decades.


It’s not stable yet, and many are uncertain if this negotiated deal will accomplish much.
Secretary General Ban ki-Moon used his remarks at the signing to announce the imminent appointment of a special envoy and stressed the importance and his optimism for a solution. “The situation in the eastern Democratic Republic of the Congo must remain a top priority on the international agenda,” he said. “It is my earnest hope that the Framework will lead to an era of peace and stability for the peoples of the Democratic Republic of the Congo and the Great Lakes region.”

A cautious sentiment was taken by the UN mission head in North Kivu, Alex Queval, who told Al Jazeera, ”I think it would be wrong to have too great expectations because the situation here is very difficult. The conflict has been going on for at least 19 years, so it’s not going to be solved overnight, but I definitely think that this approach can be a new beginning.”

Academic Laura Seay took a more pessimistic stance about the outlook of the peace deal. In aTwitter interview with Mark Goldberg of the UN Dispatch, she explained why. Goma still remains vulnerable to capture by M23 and the plan requires support from the regional players.

“There’s little reason to believe that Rwanda will actually stop funding M23 or stay out. History suggests otherwise,” she tweeted.

continue reading...

25 February 2013

UN Turns Down Haitian Cholera Victim Compensation

The UN continues to deny responsibility for the cholera outbreak in Haiti. It also now claims it is immune from compensating Haitian cholera victims.

UN Secretary General Ban ki-Moon told Haiti’s President Michael Martelly that the UN is both unwilling and not required to compensate the victims.

The United Nations advised the claimants’ representatives that the claims are not receivable pursuant to Section 29 of the Convention on the Privileges and Immunities of the United Nations,” spokesperson Martin Nesirky told reporters in New York.

Evidence that the outbreak came from Nepalese UN peacekeepers is overwhelming, but the UN has yet to claim responsibility. A lawsuit brought against the UN by the Institute for Justice and Democracy in Haiti (IJDH) in November 2011 called for a national water and sanitation system, compensation to the victims and a public apology from the UN to the victims.

Reactions to the announcement were swift. “It is dis­grace­ful that the UN will not even con­sider com­pen­sat­ing the thou­sands of fam­i­lies who have lost their chil­dren, moth­ers, fathers, broth­ers and sis­ters due to the UN’s wrong­do­ing,” said lead counsel of the lawsuit against the UN Mario Joseph, Av. of the Bureau des Avo­cats Inter­na­tionaux, in a press release. The groups associated with the lawsuit pledged to keep up their fight.

The Guardian reported reactions from some Haitians who were affected by the outbreak. Alix MacGuffie from Saint Marc, Haiti was infected with cholera in July 2011 and expressed disappointment in the news.

“I could have died from cholera. The UN caused us much harm and we should get compensation. If we don’t stop cholera, what will happen in the future?” said MacGuffie.

24 February 2013

A Closer Look at Violence in South Africa - What Does the Data Say?

Media are scrambling to cover the story of South African Olympian Oscar Pistorius killing his girlfriend Reeve Steenkamp on Valentine’s Day. Stories include the latest details about the trial. Many have also mentioned that Pistorius was a bit of a gun enthusiast who was also fearful for his own safety. It sets up a story of an athlete living in a country that is characterized by violence.

Pistorius has maintained that he mistook his girlfriend for an intruder and shot her in the bathroom out of fear and in an act of self-defense. Outlets have pointed to a tweet by Pistorius in November when he thought that there was an intruder in his home.

And there are mentions of a New York Times article from early 2012 that features an anecdote where Pistorius grabbed his gun after his security alarm went off by accident one night. The author of the story then related joining Pistorius at the firing range with his 9-milimeter handgun. While facts that do relate to Pistorius’s past, some are saying that the structure of some reports are working to excuse Pistorius.

Gun Violence in South Africa

There is violence in South Africa. Much like their is violence in all parts of the world. However, some commentators are pushing back against the prevalent reporting. Journalist Geoffrey York, a resident of Johannesburg, writes in the Globe and Mail that the depiction by some outlets of South Africa does not represent the country he knows.

23 February 2013

PIH Adviser Calls Out UN on Haiti Cholera Responsiblity

The UN has the responsibility to lead the anti-cholera effort in Haiti, says PIH policy adviser Louise Ivers in the New York Times. She calls on the UN to finance the upcoming vaccination plan that will be unveiled on February 27th by Haiti's ministry of health and looks to the $648 million peacekeeping budget as a source of significant financing.
On Thursday, the United Nations secretary general, Ban Ki-moon, rejected a legal claim for compensation filed in 2011 on behalf of cholera victims in Haiti. Through a spokesperson, Mr. Ban said the claims, brought by a nongovernmental organization, were “not receivable” because of the United Nations’ diplomatic immunity.

Regardless of the merits of this argument, the United Nations has a moral, if not legal, obligation to help solve a crisis it inadvertently helped start. The evidence shows that the United Nations was largely, though not wholly, responsible for an outbreak of cholera that has subsequently killed some 8,000 Haitians and sickened 646,000 more since October 2010. The United Nations has not acknowledged its culpability.

Now, as the cholera epidemic appears to worsen, Mr. Ban and the United Nations have an opportunity to save thousands of lives, restore good will — and, yes, fulfill the mandate that brought the organization to Haiti in the first place: stabilizing a fragile country. The United Nations should immediately increase its financial support for the Haitian government’s efforts to control the epidemic. While that may not satisfy everyone, it will go at least some way toward compensating the people of Haiti for the unintentional introduction of the bacteria that caused the epidemic.
Read the full OpEd

22 February 2013

Good African Coffee and the False Choice of “Trade Not Aid”

The clarion call of “Trade Not Aid!” is a catchy slogan but a false choice, one that provides more heat than light and undesirably narrows the set of options available to development. It attacks a straw man from the past and doesn't contend with the latest in development theory and practice, which is, often, “Trade And Aid.”

Andrew Rugasira, founder of Good African Coffee*, is out with a new book, A Good African Story, and was recently profiled in The Guardian. In the article – and on the company’s website – his philosophy is clear: “We passionately believe that Trade is the only viable strategy for Africa’s economic and social development.”

His is a compelling story to tell. An obviously charismatic and intelligent Ugandan creates a multinational coffee company from nothing, all the while preaching the gospel of self-reliance and home-grown solutions to home-grown problems. In the process, he helps pull a community out of subsistence poverty and through sheer perseverance and will manages to have his coffee distributed to Waitrose, Sainsbury’s, and Tesco. An inspirational entrepreneur in every sense of the phrase.

And he is certainly correct that one way for a country to develop is to engage in industries that allow full-scale, value-additive production; there’s much more value in growing, roasting, marketing, exporting, and selling coffee than in merely growing and selling unfinished beans to Starbucks. The value-added industries mean more money for the country and more jobs for the community.

21 February 2013

John Kerry Defends Aid Budget By Sticking to Obama Administration's Message

John Kerry has only held the office of US Secretary of State for a few weeks but has already made it known that foreign aid is one of his priorities.

Sec State John Kerry; Credit
Kerry says he will fight to maintain the budget of USAID and make the argument for its benefits. Hillary Clinton said much the same when she first came on board, emphasizing that the Obama Administration will build upon and expand upon the government’s established leadership in many areas of foreign aid, and especially in global health.

Didn’t happen. So what might Kerry’s rhetoric mean in reality for foreign aid?

One of the first acts by the nation’s new Secretary of State was to write a letter to Congresswoman Barbara Mikulski (D-MD) to warn about consequences to foreign aid and diplomacy if budget cuts are enacted through sequestration.

If a deal is not reached in Congress, the State Department and USAID will see a $2.6 billion across-the-board cut in their collective budget. “Cuts of this magnitude would seriously impair our ability to execute our vital missions of national security, diplomacy and development,” writes Kerry.

He estimates that sequestration would cost global health programs $400 million and humanitarian assistance $200 million. It comes at a time when the US is providing assistance to regions that are affected by conflict and drought such as Syria, the Horn of Africa and the Sahel. Kerry adds that the global health cuts will harm the efforts by USAID to realize an AIDS-free generation and eliminate preventable child deaths.
He adds further, “Such cuts undermine out efforts to shape the boarder international efforts to fight disease and hunger, invest in global health and foster more stable societies and regions.”
Continue Reading... 

20 February 2013

Getting Mali Right While it's in the Spotlight

While France's effort to liberate northern Mali continues, the recurrent challenges faced by the country give reason to push forward while the world's attention remains on the West African country, says Mercy Corps' Jeremy Konyndyk in the Guardian.
We must also rethink the role of aid in Mali. The humanitarian crisis persists because of what William Garvelink, former US ambassador to the Democratic Republic of the Congo, has called a "resilience deficit". As serious droughts and economic shocks hit more frequently, communities have less time to recover; they lose more ground with each subsequent shock.
That change comes in part through altering donor goals and ensuring security, continues Konyndyk.
A different approach is needed. Donors including the UK (pdf) and US governments are piloting resilience-oriented aid, which mixes elements of the relief and development toolkits to help communities anticipate and adapt to shocks. Such initiatives are making headway under similar circumstances in the Horn of Africa. Yet most aid to Mali remains locked in humanitarian or development silos. UK, US and other donors must shift gears to focus on resilience, starting now.

Even the most effective, thoughtful aid strategy will not make progress without peace and security. The planned UN peacekeeping force will be given the task of restoring security, but there are major questions about its mission and capacity.

19 February 2013

ABBAs Nominees So Far

To keep the nominations rolling and to encourage a more diverse set of finalists, I am sharing below the nominations so far in some major categories. Hopefully you will help identify some gaps and make more suggestions. All will likely not make it to the final vote, but this is where things stand right now.

Best Overall Blog

Chris Blattman; Turtle Bay; Aid Thoughts; Aid on the Edge of Chaos; How Matters; Open the Echo Chamber; Development Impact; Dev Policy; More Altitude; WhyDev; Marc Bellemare; Roving Bandit; From Poverty to Power; A View From the Cave; Kariobangi; Moses Kemimbaro; PesaTalk; Bankelele; CGD Blogs; Find What Works; Leapfrog.io; Aidnography; Blood and Milk; Owen Barder; Ken Opalo's Weblog

Best Twitter Feed

@alanna_shaikh, @richardhorton1, @texasinafrica, @Global_erinh, @tmsruge, @calestous, @viewfromthecave, @wmyeoh, @m_clem, @brettkeller, @rovingbandit, @rachelstrohm, @kenyanpundit, @whydev, @africanarguments, @beyondaid, @clairemelamed, @scott_gilmore, @leapfrogio, @kenyanentrepreneur, @coldtusker, @timharford, @glassmanamanda. @bill_easterly

Best NGO Blog

From Poverty to Power, American Jewish World Service, Impatient Optimists (I lean towards considering Gates a donor)

Best Global South Blog

Udasisi, Bankelele, Ken Opalo, Africa Unchained, White African, Kariobangi, Moses Kemimbaro, PesaTalk, Bankelele, http://superiorw.blogspot.com/, http://wamburu.wordpress.com, Crazy Nairobian, Nairibi Nights,

Best Donor Blog

Africa Can End Poverty (World Bank), Development Impact (World Bank), http://ausaid.govspace.gov.au/, DFID

The Burden of Proof on mHealth Practitioners

There may really be an app for everything.

Cell phones are being used to perform echo cardiograms by American primary care physicians. Pregnant women in Bangladesh are receiving text message reminders to improve maternal health. Here’s a story from SciDev todayabout using phones to diagnose malaria.

The rapidly expanding use of mobile phones in health applications, aka mHealth, is widely touted as a global revolution unfolding. It may yet be, but where’s the evidence in support of the claims?

It is expected that 80% of the people living on the African continent will have access to mobile phones by the end of this year. This technological leap means that information can be communicated to more people in places that were previously hard to reach, or completely isolated. The diffusion of this technology has not been lost on governments, NGOs and the private sector. All are seeking ways to improve health services using phones.

A pair of studies published earlier in the year looked at the evidence base for mHealth interventions. Both found reason for optimism about the benefits of employing mobile technologies in health, but agreed that the evidence base was far too weak.

18 February 2013

The Case for Localizing Aid Stories

How do you get the average Joe to care about or even watch a story that is related to aid? Lawrence Haddad makes the case for telling more accessible and real stories in his blog. He writes:
The story the media frequently tells--aided and abetted by the development industry which needs to raise funds--is centred on disaster, deprivation and disease. This sells newspapers and helps charitable giving. So why try to change it? Because it doesn't reflect the reality. Fatigue and cynicism will set in. Trust will be broken. And most importantly, it is a misrepresentation.

So how to make development interesting to viewers in the 6-7pm television news slot, preferably the local news slots which have even higher ratings than the national news ones? Not easy. First, think like a regular viewer. Why should they be interested? Find some stories that penetrate the lives of busy people who have no professional interest in development. Second, write like a regular person. Don't use jargon. Third, develop a relationship with media professionals (not only those converted about development)--get to know how they think and what they need. Finally, tell the real story--authenticity will win out. 
Localising global stories is not easy, but it surely can be done. We have to change the conversation on development before it is too late.
To play a little bit of the devil's advocate, these kind of stories do already exist. It is essentially the beat of Nick Kristof, who has come under equal criticism for his reporting. It is also what made the problematic video Kony 2012 so popular. ABC did a series, thanks to Gates Funding, on global health that did poorly in terms of viewership.

Kony 2012 was in part successful because it did make the case as to why people should care about a central African warlord. It did get media professionals who do not dip into the humanitarian world to report on it. However, we are nearly a year since the film and little has changed in the media landscape.

Stories are applying the ideas that Haddad recommends. They make sense and may be right. Part of the problem is that the stories are infrequent. A missing ingredient is the fact that people need constant exposure. We care about celebrities because they are inescapable. Stories appear on CNN or are teased in the sidebar of the Huffington Post and GlobalPost. What if development was equally inescapable? What if reporting and stories related to development came up higher on Google News or were listed on Facebook?

More viability will allow for a greater diversity of stories that will reach people. However, if stories being to pop up that follow Haddad's suggestions and are marginalized, does it change anything? 

15 February 2013

Avoiding the Resource Curse with Lessons from Alaska

The great state that gave us Sarah Palin also provides lessons on what to do with oil money. Tina Rosenberg provides fine reporting in the NYT Fixes blog and highlights the book by Todd Moss that covers the topic.
Todd Moss, a senior fellow and vice president for programs at the Washington-based Center for Global Development, believes they might. He points to an unlikely source of inspiration: Alaska. The state of Alaska is bound by law to put at least a quarter of its revenues from oil into the Alaska Permanent Fund, which was established in 1976. The money is invested and each year, every resident of Alaska gets a share of the dividends; for consistency, the amount is calculated using an average of the fund’s earnings over the past five years. The dividend check is considered taxable income. Last year, the check was for $878. In 2008, the high point, every Alaskan got $2,069. 
These payments stimulate the economy and reduce income disparities. They have contributed (pdf, p. 12) to a large reduction in poverty in Alaskan Natives, the state’s poorest group. 
But the fund has other benefits. “I wanted to transform oil wells pumping oil for a finite period into money wells pumping money for infinity,” wrote Jay Hammond, Alaska’s governor at the time. Governments often try to save for lean years by paying a portion of oil revenues into a walled-off, legally untouchable fund. Unfortunately, temptation is often more powerful than the law. Venezuela’s oil fund, for example, has been raided (pdf, p 16) by Hugo Chavez, dropping from $6 billion to $3 million in the last decade — during a time of record-high oil prices. 
The dividend, by contrast, protects the Alaska Permanent Fund. Hammond’s achievement was to “protect against its invasion by politicians by creating a militant ring of dividend recipients who would resist any such usage if it affected their dividends.” (See herefor a quirky summary of criticisms of the fund. )
She is careful to mention that oil-for-cash programs are challenging and relatively new. However, the evidence of cash transfer programs does show that the provision of money can help to reduce poverty.
This is the big advantage of cash payouts — they are much easier for an ill-governed country to do well, and there are fewer opportunities for politicization or corruption. There isn’t a long track record with oil-to-cash programs, but more than 40 countries have some kind of cash transfer programs for the poor. The best known ones, likeBolsa Familia in Brazil and Oportunidades in Mexico, make recipients meet conditions — they need to have their children in school and take their families for regular health checkups to get the money.

India: Pregnant Women Facing Abuse

A fantastic account from reporter Allyn Gaestel and photographer Allison Shelley on the abuse faced by pregnant women in India. They share the story in the Atlantic of a young woman named Devi who struck by her husband while undergoing a cesarean section. Additionally, she worked long and hard days right up to going into labor. Her experiences illustrates one of the problems faced by attempts to reduce maternal mortality in India.

From The Atlantic:
Sugia Devi was spread on the operating table like a martyr, arms wide. But Devi wasn't dead; she was active and flailing in pain. Throughout her caesarean section she responded to each incision, each stitch, jerking her face away and moaning ghoulishly. 
The doctors working on her abdomen, distracted by pulling out the baby and answering a phone call, ignored her cries. But the junior doctor standing next to her face, heard. He held down the thin gauze strip covering her eyes, pressing so strongly he indented the mounds of her cheeks. The cover was ineffective; beneath the thin cloth her eyes were visible, darting in fear. 

14 February 2013

SI Swimsuit Issue Goes to Africa...

I heard about the fact that SI's annual swimsuit issue covered all seven continents after it published this week. My first thought was to check on the Africa pictures to see if they included directly or references to traditional African cultures. They certainly did do that and were offensive along the way. Jezebel with the takedown (the issue also manages to do much the same in Asia):
But even more upsetting are the shots taken in Namibia, in which a black man is a prop. A black model was also shot in the African country, but when the magazine used the man as a prop, they used a white model, for contrast. Photographing Emily DiDonato against the country's stunning sands wasn't enough. A half-naked native makes the shot seem more exotic — even though Namibia is a country with a capital city where there are shopping malls and people, you know, who wear Western clothes. Also: People are not props. 
Africa has long been portrayed as a place of uncivilized, primitive people, despite the fact that it is a very diverse continent with an epic diaspora and considered the birthplace of civilization. From Morocco to Côte d'Ivoire to Ethiopia to Egypt and Nigeria, no one African country is like another. But these shots tap into the West's past obsession/fetishization with so-called savages, jungle comics and the like. Again: In a visit to seven continents, this image is what Sports Illustrated is using to represent the continent of Africa. A model holding a fucking spear.  
Questions: Who is this man? Was he cast? Was he paid? Does he know his ass is in glossy print, all over the United States right now?
Good questions. Though what matters most is if SI is listening. Better yet, are its readers aware of these problems? HT Africa is a Country

Tweets in African Cities Visualized

Hey Kimmel, check this out! Kenyans do Tweet, you silly man.

This map comes to you from Mark Graham and the team at the Oxford Internet Institute via the Guardian. They show geolocated tweets from various African cities to display the differences within and between cities on the continent. Kenyans not only tweet, they even geotag their tweets!

The density of tweets in Lagos and Johannesburg are impressive. 

Meanwhile, Mogadishu, Addis Ababa and Kigali show very few tweets.

Nominate Your Favorites in the ABBAs 2012

Note: Nominations close 28 February and voting on the finalists begins 4 March.

And we are back! I am looking to you for some nominations. There are a few experimental categories at the end there. They may or may not make the final cut. See last year's winners here.

Closer Look at Obama's #SOTU Development Goals

Ten years ago, President Bush used the State of the Union to unveil the President’s Emergency Plan for AIDS Relief (PEPFAR). The program is a lasting legacy of the administration that has won praise from both sides of the aisle.
An initiative of this scale and ambition — the largest effort to fight a single disease in history — was utterly unexpected. Bush’s strongest political supporters had not demanded it. His strongest critics, at least for a time, remained suspicious. The President’s Emergency Plan for AIDS Relief (PEPFAR) existed entirely because of a willing leader, a creative policy team, a smattering of activists and a vast, bleeding need, wrote Michael Gerson in remembering the occasion.
Because of the success of PEPFAR, there have been expectations in development circles that President Obama may too seek to leave his mark in a similar manner. The ten year anniversary, to some, may have been the right moment to make a surprise announcement. What happened was a speech that leaned heavily on rebuilding the American economy, improving education, immigration reform, national security and passing a gun bill.

The President did manage to squeeze in a few lines about international development. In them, he gave quick mention to existing programs and put his support to accomplishing an AIDS-free generation.

13 February 2013

On the Campaign Trail in Kenya

Andrew Green and Will Boase are on the campaign trail in Kenya following Prime Minister Raila Odinga. They raised money to do so through an Indiegogo campaign (to which I contributed). Here is a short section of a recent update of their travels:
We got dropped in a football field off the main road – a quiet, shop-lined street masked by swirling gray dust clouds. Volunteers set up a stage, hung speakers and wrapped a tent around a Port-a-Pot we could only assume was for exclusive prime ministerial use, as we interviewed and photographed early arrivals. Among them were members of a group calling itself the Donkey Team, who had come, donkeys and carts in tow, to demand more and better-paid jobs.

But most people wanted to talk about security. Garcen is located in a region rocked by a slew of tribal killings five months ago, including an attack on a prayer room in a mosque. People had turned up at the rally to find out what the prime minister would do to stop the violence and ease the ethnic tensions that have dominated headlines since the country’s independence 50 years ago.

"Let Your Vote Be Your Weapon"

Charlene Mugo is only 9 years old. She encourages Kenyans to choose peace over violence in the upcoming elections.

HT Dave Algoso

Zero Dark Thirty's Polio Vaccine Error, Does it Matter That Much?

Journalist Rob Crilly rightfully criticizes the film Zero Dark Thirty for getting its facts wrong about the CIA vaccination campaign that sought to confirm the DNA of bin Laden's children.
The truth is dangerous enough. But Zero Dark Thirty risks making a difficult situation worse with a clumsy mistake. The real-life Dr Afridi used the cover of a hepatitis vaccination programme, but in the movie his team wear jackets suggesting they are providing polio drops.
For a movie that has claimed to be as factually accurate as possible in the face of criticisms, this is an error that should not have been made. However, Crilly's larger point is to say that the film gives further ammo to polio vaccine conspiracy theorists.
In a country where polio has made a comeback in recent years, the film provides yet another blow for health workers trying to eradicate the disease and prevent Pakistan acting as a reservoir to reinfect the rest of the world. If you think I'm scaremongering or I'm soft on Pakistan, blaming the CIA for its domestic ills, read this interview in one of the local papers, describing how a father crippled by polio allowed his son to be infected – apparently the first case in Karachi for more than a year…
The question that lingers is whether the mistake in the movie has any real impact. The father who did not immunize his children against polio told the Pakistan Tribune, “We thought that the polio campaign was being run by the Jews and Americans, so I wouldn’t let anyone give drops to my child.” He cited the fear based on the collaboration between the CIA and Dr Afridi.

People have been critical of the CIA's use of a vaccination campaign to capture bin Laden. The ban on polio vaccines by the Taliban and the killing of polio vaccine workers across Pakistan have been linked to the revelation of the plot. However, skepticism of vaccines goes further back than the CIA plot.

A UNICEF report on vaccines from 2011 found that there were 22,000 vaccine refusals in Karachi in the first half of 2011. Refusals declined from 23% to 11% in the higher burden areas of Balochistan and Sindh between January and July of that period. That means that progress was being made against attitudes against vaccine campaigns prior to the revelation of the CIA plot.

12 February 2013

Obama Mentions Global Poverty and Development in #SOTU

From the transcript (emphasis added):
We also know that progress in the most impoverished parts of our world enriches us all. In many places, people live on little more than a dollar a day. So the United States will join with our allies to eradicate such extreme poverty in the next two decades: by connecting more people to the global economy and empowering women; by giving our young and brightest minds new opportunities to serve and helping communities to feed, power, and educate themselves; by saving the world’s children from preventable deaths; and by realizing the promise of an AIDS-free generation.
Immediately followed by democracy and governance:
Above all, America must remain a beacon to all who seek freedom during this period of historic change. I saw the power of hope last year in Rangoon – when Aung San Suu Kyi welcomed an American President into the home where she had been imprisoned for years; when thousands of Burmese lined the streets, waving American flags, including a man who said, “There is justice and law in the United States. I want our country to be like that.” 
In defense of freedom, we will remain the anchor of strong alliances from the Americas to Africa; from Europe to Asia. In the Middle East, we will stand with citizens as they demand their universal rights, and support stable transitions to democracy. The process will be messy, and we cannot presume to dictate the course of change in countries like Egypt; but we can – and will – insist on respect for the fundamental rights of all people. We will keep the pressure on a Syrian regime that has murdered its own people, and support opposition leaders that respect the rights of every Syrian. And we will stand steadfast with Israel in pursuit of security and a lasting peace. These are the messages I will deliver when I travel to the Middle East next month.

Looking Back at Kenya's First Televised Presidential Debate

Kenya held its first ever presidential debate on Monday, an historic event.

The eight candidates* gathered in Nairobi to debate the most pressing issues in the first of two televised debates.The young country’s event was everything that the 2012 US presidential debates were not.

Candidates from minority parties with no chance of making a dent on election day stood side by side with the front runners. The event went over its scheduled 2 hours lasting near 3.5 hours when all was said and done.

However, it was not because the candidates were wasting time or talking too much. An efficient tandem of moderators, NTV’s Linus Kaikai and Citizen TV’s Julie Gichuru, moved the conversation along, kept the candidates to their time limits, interrupted them when the question asked was not answered and provided immediate follow-ups when necessary.

Twitter followed along with the hashtag #kedebate13 and became a worldwide trending topic (Reminder to Jimmy Kimmel: Kenyans do tweet). Ory Okolloh assembled a list of tweeters who would be fact checking the claims made by the candidates. 

The opening topic was related to the issue of the post-election violence and the tribalism that fueled it. Kenyatta and Odinga, both from different tribes, described their previous experiences working together in the government to prove that they were unifying leaders rather than divisive tribalists. Other candidates took on the question rather than deny it being a problem with strong statements from Peter Kenneth and Martha Karua. “We need to look Kenyans in the eye and tell the truth. We must break historical bondage we have been tied to for the last 50 years,” said Kenneth.

Join Me for a Conversation with Sergio Fajardo, Governor of Antioquia, Colombia

**Shameless self promotion alert**

In October, Beyond Access presented a unique event where we discussed practical solutions to development challenges and witnessed how public libraries around the world are supporting development goals through information access, knowledge and community partnership.

On Tuesday, February 26th at 1pm, Beyond Access presents a follow-up event with Governor Sergio Fajardo of Antioquia, Colombia. Governor Fajardo will discuss his development plan “Antioquia: the Most Educated.”

Under his leadership as mayor of Medellin from 2004-2007, the city was transformed from a hub of violence into a model of education reform and good governance. Governor Fajardo pioneered methods of citizen participation, inclusive education and budget transparency for government in Colombia for the first time. Now, as Governor of the state of Antioquia, he works to build on the lessons of that experience at scale.

A cornerstone of this strategy to engage disenfranchised citizens is a network of modern public library parks, where city services are made accessible to those who needed them most. This rethinking of social inclusion using public spaces is now being replicated throughout Latin America.

In a conversation moderated by international development journalist Tom Murphy of A View from the Cave, Governor Fajardo joins us to discuss his approach toward civic transformation.
Lunch will be provided.

Register here

Date - 26 Feb 2013
Time - 1:00 PM - 2:30 PM.

Why the World is Lagging on the Maternal Mortality MDG and How to Do Better

By Mike Miesen*

With two years left, it is highly unlikely that Millennium Development Goal (MDG) 5a – in the clunky verbiage of the UN: “Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio” – will be met worldwide.

But, substantial progress has been made, which in human terms, means that hundreds of thousands of maternal deaths have been prevented. It’s worth taking a step back to understand the scope and scale of the problem, and to think through the interventions that have been successful in myriad developing and developed countries.

The Maternal Mortality Ratio (MMR) is calculated as the number of pregnancy-related deaths (from any point in the pregnancy to 42 days post-birth/termination) per 100,000 live births. In 2010, an estimated 287,000 mothers died from pregnancy-related causes, or 210 deaths per 100,000 live births; it’s an almost 50 percent reduction from 1990, when an estimated 543,000 mothers died, or 400 per 100,000 live births.

Pie Chart

These roll-up figures mask a wide variation in the distribution of maternal mortality. In 2010, an astounding 99% of deaths occurred in the ‘developing world’ (56% in sub-Saharan Africa alone), and the MMR in developing countries is, on average, 15 times higher than in developed countries. According to the World Bank, the country with the highest MMR in 2010 was Chad, the lowest Estonia, at 1,100 and 2 per 100,000 live births respectively. A chart showing the 40 countries with the highest MMR is below, with the United States – at 21 – added for reference:

Scan the list of countries and it becomes clear that the MMR problem is clustered in Africa, with few exceptions. There’s wide variation among these countries too. The question is: why?

Worldwide, the leading direct causes of maternal mortality are: Post-Partum Haemorrhage (PPH); Pre-eclampsia and eclampsia; and sepsis. Together, these three conditions account for 60% of maternal deaths.

Text Box
At the patient-level, interventions to prevent or treat all three are well-understood, cheap, and straightforward:
  • Prevention of PPH is facilitated by following a protocol known as Active Management of the Third Stage of Labor (AMTSL), which involves the administration of an uterotonic (e.g., oxytocin, ergometrine, misoprostol) and massaging/monitoring for two hours post-birth. A Randomized Controlled Trial (RCT) found that women who received AMTSL experienced PPH 6.8% of the time vs. 16.5% with passive/conservative management; almost a 60% decrease
  • Treatment of pre-eclampsia and eclampsia involves the injection of magnesium sulphate, a cheap compound (in the West, the non-pharmaceutical preparation is known as Epsom salt). A highly-regarded RCT found that magnesium sulphate halves the risk of eclampsia in pregnant women
  • Prevention of puerperal fever*, or sepsis more generally, is a matter of maintaining proper sanitation before, during, and after a birth. If a mother develops sepsis, a full course of antibiotics can be administered as treatment.
Here’s what’s clear: the devil isn’t in the details. It’s in the diffusion of pharmaceuticals, health care workers, and knowledge through health systems, and in improving those systems holistically. It goes deeper than the health system of course; to administer AMTSL, for example, requires the drug being available (partially a supply chain/regulation issue), a health care worker who is trained to administer the drug (an education issue), and a health care worker who has the time to administer the massage every 15 minutes for two hours (a financing issue). And keep in mind, that’s only if the mother has a trained health care worker by her side, which in sub-Saharan Africa puts her in the minority, with only about 46% of births attended by skilled health personnel in 2008.

Bar Graph

The complex task of reducing maternal mortality demands a multifactorial solution that draws on a wide coalition of government departments and private organizations; and each country has to find a solution that meshes with its own cultural and structural realities. Nevertheless, there are broad themes that transcend these inter-country differences and show up in the success stories of many positive deviants:
  • Increase access to family planning and contraception
  • Strengthen demand for antenatal check-ins through education campaigns, conditional cash transfer programmes, or easier access to skilled professionals
  • Increase the percentage of births attended to by a skilled professional; ensure skilled professional is able to provide necessary care (e.g., equipment, pharmaceuticals, knowledge) for non-complicated birth and is able to refer complicated cases
  • Ensure Emergency Obstetric and Neonatal Care (EmONC) services are comprehensive and of high quality, and that health centres are staffed with skilled workers; stocked with maternal medicines, antibiotics, and proper equipment; and accessible to remote populations
  • Establish or strengthen monitoring systems to highlight successes and areas of opportunity.
All of which goes a long way towards our understanding of why some countries have already reached MDG 5a and others are unlikely to do so; the interventions require sustained political will, ‘soft’ infrastructure (e.g., regulations, communication), consistent funding, and a systems approach to process improvement. Unfortunately, it may take more than 20 or 25 years to build out this basic scaffolding on which to build sustainable change.

The imminent failure to reach the goal of reducing the MMR by 75% by 2015 shouldn't obscure the fact that there are hundreds of thousands of mothers alive who, without the focus on maternal mortality, may not be otherwise. Much more can – and will – be done in the next two years, and in the next two decades.

In many ways, 2015 is just the start.

*If you’re a public health or history of medicine wonk, you may recall that puerperal fever (or childbed fever, as it was known) was the disease that led Ignaz Semmelweis to call for basic hygiene measures in his Viennese hospital pre-Germ Theory of Disease – and was promptly rejected from the establishment for his heresy. As one contemporary doctor put it, “Doctors are gentlemen, and gentlemen’s hands are clean.”


Mike Miesen is a healthcare consultant and graduate of the University of Wisconsin-Madison. Currently, Mike is a Project Lead at Kissito Healthcare International, working on a maternal mortality initiative and health systems strengthening in Mbale, Uganda. He writes about health policy and development at http://mikemiesen.com and you can follow him on Twitter @MikeMiesen

11 February 2013

Core Failures of Haiti Relief Effort

Haiti is not back to where it was three years prior, agreed a panel at Harvard University last week. The post-earthquake relief and recovery effort is no different than the way that aid and development were conducted in the years leading up to the natural disaster.

Journalist Jonathan Katz used the story of the UN’s role in the cholera outbreak as evidence of the continuing problems. The overwhelming evidence points towards the UN peacekeepers from Nepal as the source of the outbreak. Despite the fact that fecal waste from the camp was making its way into the Latem River, the outbreak followed a path downstream from the camp and the epidemiological research determined the cholera came from Nepal, the UN has yet to claim responsibility for the outbreak.

“It demonstrates an astounding example of a lack of accountability,” said Katz. He said that due diligence was done to prove that the UN was not responsible and all information overwhelmingly showed that the source of the outbreak was the peacekeeping camp. Katz appeared at the event to talk about his new book, The Big Truck That Went By: How the World Came to Save Haiti and Left Behind a Disaster, which covers his experiences during and after the earthquake while reporting for the Associated Press.

For Dr. Rishi Rattan the problems in Haiti go much deeper. He immediately dismissed the idea that good intentions were even OK. “Well meaning is harmful,” said Rattan. “Development and aid are a form of neo-colonialism...they reinforce helplessness.” He argued that NGOs are inherently political because of their funding structures. NGOs must answer to donors first. By moving from grant to grant, NGOs are unable to secure rights for a person, he continued.

In analyzing the UN-backed plan to rid cholera from Haiti, Dr Rattan said that it fails on two levels. First, it takes the approach to the problem that interventions, such as vaccines, must be undertaken to eliminate cholera. Second, the plan itself is led by outsiders rather than the Haitian people.

“The issue here is not cholera, it is a lack of human rights,” said Dr Rattan arguing that access to clean water is a right. The outbreak is the result of a failed government that is unable to secure clean water for its people. The plan to rid cholera that will cost over $2 billion does nothing to address this problem in Dr Rattan’s eyes.

The arguments laid out by Dr Rattan and Katz met little resistance from Senior Policy Advisor for the Office of the UN Special Envoy to Haiti, Nancy Dorsinville. A Haitian, she admitted to take a ‘schizophrenic’ approach to her position that vacillates between radicalism and diplomacy. She spoke slowly and carefully, citing asthma problems, on some of the problems that she has faced in her position.

On the day of the earthquake, she wanted to travel to the main hospital in order to better understand the problem at hand. It happened to be a day that the United Nations Stabilization Mission in Haiti (MINUSTAH) peacekeepers were not supposed to travel to the area where the hospital is located. It was not until she began walking to the hospital that the driver agreed to give her a ride.

For her, one of the greatest problems is one of coordination. “There is a knowledge management gap on needs, priorities, and allocation of resources within the government,” she remarked. It becomes harder because the NGOs have their own ‘compartmentalized views.’ Like Dr Rattan, Dorsinville noted that NGOs were political and politicized because they do not produce their own money and are funded by governments with their own goals and ideologies.

As the conversation continued, the audience wanted to know what actions can be taken to rectify the problems. The panel members were again in agreement that the problem is accountability and the status quo perspective on how to help Haiti.

“Our role is not on the ground in Haiti,” said Dr Rattan. “I am not a savior. My power lies at the UN level.” He and Katz agreed that accountability must mean that the people who are considered beneficiaries must have the ability to hold the groups that affect their lives accountable. A part of that is allowing the government in Haiti to not only grow on its own, but fail on its own.

Author Patrick Sylvain served as the moderator for the discussion and interjected that the answers cannot be determined by the diaspora. They are people with different stakes in the country. “The Haitian people have not had rights since 1802,” he said. They must take on their own rights and gain ownership of their Haitian identity. Dorsinville concurred saying, “We have to be allowed to govern and determine the outcomes of our country.”

08 February 2013

Why the Global Health Council Failed and is Coming Back

The global health community was left bewildered when the Global Health Council suddenly announced last April that it was closing.

Members of the prestigious, decades-old organization were not warned in advance, participants in the upcoming annual meeting had to abruptly cancel their plans and the GHC’s cryptic explanation (scroll down to April) just left everyone scratching their heads:

“Times have changed… Funding that once existed to promote a broad-based health agenda is now focused on specific health issues. The fundamental shifts in the health landscape have led the Board to revisit the relevance of the organization and determine that the Council’s current operating model is no longer sustainable.”

But times have changed again, apparently.

The organization is being resurrected with a new board, a slightly new name (Global Health Coalition) and with purportedly a new and more relevant strategy.

Along with the resurrection of the GHC has come more detailed explanations of the previous collapse and what is intended to distinguish this new iteration. A Seattle-based organization, theWashington Global Health Alliance, is playing a leading role in this revival (and also serving as a model for strategy) as well as a DC-based aid and development organization, Global Impact, which is acting as the interim administration and secretariat.

But first, a bit of history and a description of how too much dependency upon another Seattle organization, a fairly well known philanthropy run by two former Microsoft executives, led to the demise of the GHC.

07 February 2013

Where do Refugees End Up?

Refugee Statistics

Origin countries are purple and host countries are orange. The data is only up to 2009, so many changes (most notably the fact that there are nearing 1 million Syrian refugees) have taken place over the past four years. Anyways, it is still interesting to see the where people are leaving and what countries are taking people in.

HT Tory Starr

06 February 2013

Loewenberg on Hunger and Failure

Just came across this video from journalist Sam Loewenberg. "The Hunger Season, A Cynical Cycle" was delivered last summer at the University of Chicago Center for International Studies. The video provides a pretty succinct summary, "Loewenberg uses case examples in Kenya and Guatemala to illustrate that the increase in the percentage of the population living in hunger since 1974 continues unchecked, despite promises made at past global summits to eradicate the problem."

Found it because of Sam's excellent column in the Sunday New York Times on the importance of true accountability in aid interventions.
The risk is that too few people will follow. Especially in tough economic times, the pressure is on to show that they are getting bang for their buck. Last year an Obama administration official called on the aid community to adopt a “permanent campaign mind-set,” in which fund-raising and promotion are on the front burner. This creates an incentive to go for easy victories, highlight successes and bury failures. Even with the new fad in the aid world for metrics and impact assessments, their public reports are rarely forthcoming about missteps.

That’s bad science. While aid organizations must be accountable for outcomes, that pressure for positive results should not be an encouragement to skimp on the truth. Making a difference in the world is hard, often messy work. Pretending otherwise is no help at all.

05 February 2013

Reflecting on Absurd Reactions to Oxfam's New Campaign

The well-intended but perhaps off-target campaign by Oxfam to spread good news about Africa now has drawn a critical look from the LA Times.

But the real action is in the comments section. The early responses repeat the somewhat tired – and offensive – old refrain that aid is wasted money because Africans are incapable and bound to mess things up. These comments show we still need a lot more discussion about how people view the African continent and its residents.

Yes, that’s offensive.

But why does such ignorance and apathy persist?

Maybe it’s because conversations about poverty alleviation campaigns have been framed in a way that creates misunderstanding, stereotypes and hopelessness. Critics of these depictions are concerned that they perpetuate the idea that Africa is in deep trouble and needs the help of the West if it is to just barely survive. The people commenting appear to believe the continent is in bad shape because of its own doing and that it Africans are inherently incapable of making it better.

04 February 2013

Vaccines are Awesome in One Infographic

via Dr Daniel Flanders

Note: I will add a small caveat since the data used is not cited. However, the evidence of the impact of vaccines on diseases is overwhelming. It is just that these numbers might not be so accurate. Here's hoping the data checks out.

Kenyans Use Twitter? I Had No Idea

Poor Kenyans. They are so poor and disconnected from the world that they don’t even have Twitter. Or at least that is the premise of Jimmy Kimmel’s bit where he has Kenyans read celebrity tweets. The tweets include Justin Bieber’s tweet, “Prepare for more purple outfits coming soon.”

Kimmel introduces the bit by joking that celebrities have important things to say on Twitter. He laments the misfortune of those who do not have Twitter. He continues by plugging his friend’s NGO in Kenya and says that Kenyans are missing out on the wonders of celebrity tweets because “what they don’t have over there is Twitter. Internet access is very limited.” Therefore the segment titled “Kenyan Read Celebrity Tweets.”

01 February 2013

Live Now: WFP Hangout from Damascus

Here are some of the people who will be joining the hangout.

+Abeer Etefa

Abeer Etefa is WFP’s Spokeswoman and Senior Regional Public Information Officer for the Middle East & North Africa region. Before joining WFP, she was the spokeswoman for the UN refugee agency (UNHCR) covering the MENA region. She spent six-years working for the BBC and ABC News as a field TV producer. @AbeerEtefa

+Karen Leigh

Karen Leigh is the managing editor of Syria Deeply, a new media platform covering the Syrian crisis. She has lived and reported in India, West Africa, Europe and the Middle East, covering the 2011 Arab revolutions and writing for publications including TIME and The New York Times. Reporting for Bloomberg News, she traveled with the Clinton, Obama and McCain campaigns during the 2008 elections. @leighstream

+Deborah Amos

Deborah Amos covers the Middle East for NPR News. Her reports can be heard on NPR's award-winning Morning Edition, All Things Considered and Weekend Edition. She  travels extensively across the Middle East covering stories including the rise of well-educated Syria youth, a series focusing on the emerging power of Turkey and the plight of Iraqi refugees. @deborahamos

+Andrew Tabler

Andrew J. Tabler is a senior fellow in the Program on Arab Politics at The Washington Institute, where he focuses on Syria and U.S. policy in the Levant. During 14 years of residence in the Middle East, Tabler served as a consultant on U.S.-Syria relations for the International Crisis Group and as a fellow of the Institute of Current World Affairs, writing on Syrian, Lebanese, and Middle Eastern affairs. @andrewtabler

+Bettina Luescher

Bettina Luescher is the Chief Spokesperson for North America of WFP. Since joining WFP in 2004 she has worked in crisis areas like Darfur, Afghanistan, Gaza, Guatemala, Haiti and the Tsunami region of Indonesia and Sri Lanka. Before joining the UN, Luescher worked for 15 years as an anchor, reporter and field producer for CNN International. @bettinaluescher

ICYMI: Everyday Africa is On New Yorker's Instagram

The fantastic Tumblr/Instagram Everyday Africa founded by photographer Peter DiCampo is at the helm of the New Yorker Instagram feed this week. If you are not already aware of Everyday Africa, then immediately click through to their Tumblr page and follow them on Instagram.