This report highlights how building strong public services is key to transforming the lives of people living in poverty. The authors show that developing countries will only achieve healthy and educated populations if their governments take responsibility for providing essential services.
Poverty and health
To achieve maximum impact on food and nutrition security, knowledge and research policy should focus on local agriculture and food sectors - this means including small-scale farmers in regional food chains as well as making investments in the food system work for the rural poor by taking into account local environmental and cultural values. This article focuses on what a knowledge agenda on food and nutrition security should look like and what actors should be involved. The author argues that one of the main causes of current economic growth without food security is that small-scale farmers are not included in the formal food system and do not benefit from investments in agriculture and food, especially in sub-Saharan African. They also lack access to knowledge to improve their situation. To help create resilient and inclusive food markets, the author recommends strengthening cooperatives and producer organisations, developing comprehensive business models, designing a framework for public-private partnerships that include small-scale farmers and takes into account local cultural and environmental values, taking away the constraints to access knowledge by farmers, and pursuing coherent policies.
Burundian state hospitals are reported to routinely detain patients who are unable to pay their hospital bills, the Human Rights Watch and the Burundian Association for the Protection of Human Rights and Detained Persons said in a report released in September. The patients can be detained for weeks or even months in abysmal conditions. This practice is reported to highlight broader problems of the health system in Burundi, where patients have to pay for their own treatment. The organisations called on the Burundian government to end the practice and to make access to health care for all Burundians a central part of its new Poverty Reduction Strategy Paper.
The campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) was launched at Osindisweni Hospital in Ethekwini District, KwaZulu-Natal Province on 4 May 2012. CARMMA aims to accelerate the implementation of activities to stem maternal and child mortality and meet Africa’s targets for Millennium Development Goals four and five - to reduce by three quarters the maternal mortality rate and to reduce by two thirds the child mortality rate between 1990 and 2015. South Africa has a rising maternal mortality rate, yet it is one of the last countries in southern Africa to implement the campaign since it was started in 2009. In many of the countries, the national champions of CARMMA or the national authorities have committed to follow-up activities to intensify the reduction of maternal mortality in their countries, including Malawi, Zambia, Rwanda and Swaziland.
A plan to boost food production in developing countries and provide urgent food aid was discussed by the Development Committee on 10 September 2008. The food price index rose by more than 40% last year, which has had catastrophic consequences for people in the developing world who are already suffering from malnutrition. It has been estimated that to deal with the problem in the medium term it would probably require an extra €18 billion. The EU has committed to finding €1.8 billion over the next two or three years from unspent agricultural money to be matched by money from the Member States. Some of this will be used for direct food support, given the massive fall in grain stocks. Most will be used for seeds, fertiliser and irrigation to help countries to develop and grow their own food.
Informal employment makes up more than half of non-agricultural employment in most developing regions, according to Women in Informal Employment Globalising and Organising (WIEGO). In three major regions (South Asia, sub-Saharan Africa, Latin America and the Caribbean) plus urban China, informal employment is a greater source of non-agricultural employment for women than for men. Elsewhere in East and Southeast Asia, these shares are roughly the same. WEIGO advocates made this case at Habitat III, urging national and local governments to support the urban informal economy. The group released a paper listing the sector-specific needs of urban informal workers from local and national governments, noting that despite their contributions, informal workers’ lives and livelihoods continue to be vulnerable in many cities. Many myths persist about the informal economy in the minds of policymakers and the general public, such as the conflation of the informal economy with illegal activities. Sally Roever, urban policies programme director for WIEGO, pointed to ‘micro-innovations’, which can make a huge difference....Like a municipality issuing identity cards to waste pickers. Residents view a waste picker with an ID card as legitimate entity and are more likely to be cooperative. This enhances the productivity of waste pickers.” She gave the example of Bogota, where recyclers are formally recognised stakeholders in the city's waste-management system. WIEGOs efforts also have prompted the creation of two labour groups — the Association of Recyclers of Bogotá organisation that represents the city’s 3,000 informal recyclers, while the National Association of Recyclers in Colombia represents 12,000 members. These are argued to serve as precedent and inspiration for other informal workers globally.
To keep its mostly maize-growing small farms productive through cycles of drought, Malawi spends 60% of its agricultural budget subsidizing fertilisers. But the findings of this 12-year study suggest farmers in Malawi and elsewhere could increase yields consistently without applying fertilisers, using instead 'fertiliser trees'. To thrive, maize requires phosphorus and nitrogen, large quantities of which have been depleted from African soils. The 'fertiliser tree' or gliricidia, a leguminous tree, has the ability to draw nitrogen from the air and fix it into soil, changing it into a form that plants can use. The trees also restore some amount of phosphorus to the soil, according to the study. In addition, the leaves shed by gliricidia return organic matter to the soil, increasing its structural stability, erosion resistance and capacity to store water. Three consecutive experiments, begun in 1991 in Malawi and Zambia, showed that when gliricidia was planted in rows between maize plants, maize yields were good year after year.
The South African Government recently set targets to reduce cardiovascular disease (CVD) by lowering salt consumption. The authors conducted an extended cost-effectiveness analysis to model the potential health and economic impacts of this salt policy. They used surveys and epidemiologic studies to estimate reductions in CVD resulting from lower salt intake; the reduction in out-of-pocket (OOP) expenditures and government subsidies due to the policy and the financial risk protection (FRP) from the policy. The authors found that the salt policy could reduce CVD deaths by 11%, with similar health gains across income quintiles. It could save households US$ 4.06 million (2012) in OOP expenditures (US$ 0.29 per capita) and save the government US$ 51.25 million in healthcare subsidies (US$ 2.52 per capita) each year. The cost to the government would be only US$ 0.01 per capita, so the policy would be cost saving. If the private sector food reformulation costs were passed on to consumers, food expenditures would increase by <0.2% across all income quintiles. Preventing CVD could avert 2000 cases of poverty yearly. The authors concluded that, in addition to health gains, population salt reduction can have positive economic impacts—substantially reducing OOP expenditures and providing financial protection, particularly for the middle class. The policy could also provide large government savings on health care.
For people to be hungry in Africa in the 21st century is neither inevitable nor morally acceptable. The world’s emergency response requires an overhaul so that it delivers prompt, equitable, and effective assistance to people suffering from lack of food. More fundamentally, governments need to tackle the root causes of hunger, which include poverty, agricultural mismanagement, conflict, unfair trade rules, and the unprecedented problems of HIV/AIDS and climate change. The promised joint effort of African governments and donors to eradicate poverty must deliver pro-poor rural policies that prioritise the needs of marginalised rural groups such as small-holders, pastoralists, and women.
Food security in Central Africa has been worsening over the last two decades. To address this challenge, Central African states have embarked on a process to develop a common agricultural policy and to put the Comprehensive Africa Agriculture Development Programme (CAADP) into practice. Farmers’ organisations from all member states are now shaping up to influence these policy-making processes at national and regional level in the coming months. The main challenge for them is to identify proposals that respond to the needs and priorities of all the farmers they represent, and to ensure that policy makers will take them into account during negotiations. In doing so, they could learn from their counterparts in West Africa, argues the writer of this blog, the Deputy Programme Manager for Food Security at ECDPM. West African farmers managed to play an important role in the formulation of the region’s common agricultural policy through their regional farmers’ network ROPPA. Key to ROPPA’s success was its participation in decision-making organs and meetings, but more so, its preparations for these events, which included consultations of ROPPA’s members at regional, national and local levels, analytical work to check and back their arguments, and a continuous search for allies among national and regional authorities and non-state actors.