In this report, the World Bank argues that closing persistent gender gaps is important for development, as gender equality is a core development objective in its own right. But it is also smart economics, as greater gender equality can enhance productivity, improve development outcomes for the next generation, and make institutions more representative. Building on a growing body of knowledge on the economics of gender equality and development, the Bank identifies the areas where gender gaps are most significant-both intrinsically and in terms of their potential development payoff-and where growth alone cannot solve the issues. It then sets forth four priorities for public action: Reducing excess female mortality and closing education gaps where they remain; improving access to economic opportunities for women; increasing women's voice and agency in the household and in society; and limiting the reproduction of gender inequality across generations.
Equity in Health
Nearly two decades after the United Nations Conference on Environment and Development (the Rio Summit), the world still needs to alleviate poverty and improve human lives through more equitable access and use of resources and healthier environments. Understanding that human health depends on ecosystems, researchers are cutting a new path toward a more sustainable future. An ecosystem approach to health, integrating research and practice from such fields as environmental management, public health, biodiversity, and economic development, is based on an understanding that people are part of complex socio-ecological systems. Featuring case studies from around the world, Ecohealth Research in Practice demonstrates innovative practices in agriculture, natural resource management, community building, and disease prevention, reflecting the state of the art in research, application, and policymaking in the field. The book demonstrates how ecohealth research works and how it has led to lasting changes for the betterment of peoples’ lives and the ecosystems that support them.
A new High-Level Taskforce on Women, Girls, Gender Equality and HIV for Eastern and Southern Africa was launched at the 16th International Conference on AIDS and STIs in Africa (ICASA). The Taskforce will engage in high-level political advocacy in support of accelerated country actions and monitoring the implementation of the draft Windhoek Declaration for Women, Girls, Gender Equality and HIV, which calls for action in seven key thematic areas including sexual and reproductive health, adopting a multi-stakeholder approach to address violence against women and HIV and the law, gender and HIV. Young women are particularly vulnerable to HIV, accounting for about 70% of young people living with HIV in sub-Saharan Africa. The Taskforce members outlined the directions the group will follow to empower women as well as to hold governments accountable to ensure positive policy development and implementation of legal environments to protect women and girls. Participants outlined the need to engage political leadership to challenge harmful cultural norms and laws such as early marriage and wife inheritance. They argued that the involvement of men and boys in the gender equality equation was equally important.
What have the Millennium Development Goals (MDGs) achieved? And what might their achievements mean for any second generation of MDGs or MDGs 2.0? The authors of this paper argue that the MDGs may have played a role in increasing aid and that beyond aid, development policies have seen some limited improvement in high income countries, but with more limited evidence of policy change in low income countries. There is some evidence of faster-than-expected progress improving quality of life in low income countries since the Millennium Declaration, but the contribution of the MDGs themselves in speeding that progress is difficult to demonstrate, even assuming the MDGs induced policy changes after 2002. The authors reflect on what the global goal setting experience of the MDGs has taught us and how things might be done differently if there is a new round of MDGs after 2015. They conclude that any MDGs 2.0 need targets that are set realistically and directly link external funding flows to social policy change and to results.
Economic indicators suggest that there are adequate global resources to guarantee the essential needs of all of the world's seven billion inhabitants. Nevertheless more than 850 million people in the world are undernourished, according to this new report by Social Watch. To monitor trends in global deprivation, Social Watch developed a basic capabilities index (BCI), which combines infant mortality rates, the number of births attended by trained personnel and enrolment rates in primary school. These indicators are considered as a ‘minimum social floor’. Nevertheless the report notes that the world is far from achieving these basic targets. The BCI rose only seven points between 1990 and 2010, and progress was faster in the first decade than the second. This trend is the opposite for trade and income, both of which grew faster after the year 2000 than in the decade before. The authors warn that the global financial crisis is likely to worsen this inverse trend. The reason for the divergence between the trends in economic and social indicators is posited to be the growing inequality within and between countries.
The primary objectives of this study were to measure within-country wealth-related inequality in the health service coverage gap of maternal and child health indicators in sub-Saharan Africa and quantify its contribution to the national health service coverage gap. Coverage data for child and maternal health services in 28 sub-Saharan African countries were obtained from the 2000–2008 Demographic Health Survey. The researchers found that, in 26 countries, within-country wealth-related inequality accounted for more than one quarter of the national overall coverage gap. Reducing such inequality could lower this gap by 16% to 56%, depending on the country, they argue. Wealth-related inequality was more common in services such as skilled birth attendance and antenatal care, and less so in family planning, measles immunisation, receipt of a third dose of vaccine against diphtheria, pertussis and tetanus and treatment of acute respiratory infections in children under five years of age. In conclusion, the contribution of wealth-related inequality to the child and maternal health service coverage gap differs by country and type of health service, warranting case-specific interventions. Targeted policies are most appropriate where high within-country wealth-related inequality exists, and whole-population approaches, where the health-service coverage gap is high in all quintiles.
Malaria mortality rates have fallen by more than 25% globally since 2000, and by 33% in the World Health Organisation (WHO) African Region, according to latest World Malaria Report. This is the result of a significant scaling-up of malaria prevention and control measures in the last decade, including the widespread use of bed nets, better diagnostics and a wider availability of effective medicines to treat malaria. However, WHO warns that a projected shortfall in funding threatens the fragile gains and that the double challenge of emerging drug and insecticide resistance needs to be proactively addressed. Long-lasting insecticidal nets have been one of the least expensive and most effective weapons in the fight against malaria. According to the new report, the number of bed nets delivered to malaria-endemic countries in sub-Saharan Africa increased from 88.5 million in 2009 to 145 million in 2010. An estimated 50% of households in sub-Saharan Africa now have at least one bed net, and 96% of persons with access to a net use it. There has also been further progress in rolling out diagnostic testing, which is crucially important to separate malaria from other febrile illnesses. The number of rapid diagnostic tests delivered by manufacturers climbed from 45 million in 2008 to 88 million in 2010, and the testing rate in the public sector in the WHO African Region rose from 20% in 2005 to 45% in 2010.
Botaswana’s Minister of Health, John Seakgosing, has announced that Botswana has significantly reduced its burden of malaria from 77,555 unconfirmed cases in 2000 to 12,196 cases in 2010. Malaria deaths have decreased from 35 to seven over the same period. He said this success is due to the country's distribution programme of long lasting mosquito nets and indoor spraying in malaria-prevalent areas. The rolling out of artemisin-based combination treatment (ACT) in 2007 also contributed to the reduction of malaria cases and deaths. Moving towards the total elimination of the disease, Botswana has drafted malaria case based surveillance guidelines. According to the Minister, all malaria cases from disease-free areas will be notified, investigated and all contacts of the case will be screened. The country is committed to ensure an increase in diagnostics and ACT coverage to reach 100% of all malaria cases.
This publication presents in numerical and graphical formats the best data available for key health indicators in the 46 countries of the World Health Organisation’s African Region. It describes the health status and trends in the countries of the African Region, the various components of their health systems, coverage and access levels for specific programmes and services, and the key determinants of health in the region, and the progress made on reaching the United Nations’ Millennium Development Goals (MDGs). A major finding is improvement in progress towards reaching the MDGs – however, most improvements have been small and it does not appear that the continent will meet all the health-related MDGs set for 2015, notably those for child and maternal mortality, which remain very high. Communicable diseases make up the largest part of the disease burden (42.4% of disability-adjusted life years) versus only 15.9% for non-communicable diseases in second place (data from 2004). Utilisation of health services is low for antenatal care (44%) and contraceptive prevalence is a mere 24%, but immunisation coverage for children improved to 72%.
On 16 September 2011, the United Nations (UN) General Assembly unanimously adopted a political declaration at the end of its High-Level Summit on Non-communicable Diseases (NCDs), the response to which has been largely positive. But the authors of this article argue that the declaration missed a number of opportunities to effect real change in the fight against NCDs. They note that the declaration did not establish a special funding mechanism devoted to improving access to treatment of NCDs globally, nor did it commit donors and international organisations to invest more resources in that area, as was requested by developing country members of the Group of 77. Also, the final document did not include a reference to the Doha declaration on TRIPs and Public Health adopted in 2001, which re-affirmed the right of governments to adopt measures to protect health, despite this issue being emphasised during the process by the G77. Likewise, the declaration does not include new specific targets in reducing NCDs or concrete measures to be undertaken by governments, thanks largely to the United States, the European Union, and Canada, which generally opposed mandatory targets. The influence of the private sector was also clearly felt in this regard, as, in various side-meetings during the Summit, private sector companies argued for a voluntary rather than a regulatory approach for industry practices. Next steps include the development of targets and of a monitoring framework by the World Health Organisation by 2012. So far, the 68th session of the UN General Assembly in 2014 does not appear to include any discussion of NCDs.