Poverty and health

El Niño: Undermining Resilience - Implications of El Niño in Southern Africa from a Food and Nutrition Security Perspective
World Food Programme, February 2016

Southern Africa’s unprecedented El Niño-related drought and weather-related stress has triggered a second shock-year of hunger and hardship for poor and vulnerable people with serious consequences that World Food Programme (WFP) say will persist until at least to the next harvest in 2017, with the 2015-16 maize harvest insufficient to cover full cereal needs for the region without significant importation. El Niño conditions have caused the lowest recorded rainfall between October 2015 and January 2016 across many regions of Southern Africa in at least 35-years. The period also recorded the hottest temperatures in the past 10 years. Short-term forecasts, based on more recent data, (February to May) indicate the high probability of continuing below-normal rainfall across the region, signalling this may become one of the worst droughts in recent history. El Niño’s impact on rain-fed agriculture is severe. Poor-rainfall, combined with excessive temperatures, has created conditions that are unfavourable for crop growth in many areas. In Lesotho, South Africa, Swaziland, Zambia and Zimbabwe, planting was delayed by up to two months or more and is expected to severely impact maize yields. Already by early 2016 an estimated 15.9 million people in southern Africa were highly food insecure, not including a growing number in South Africa. Zimbabwe, Malawi, Lesotho, Madagascar were the hardest hit from the 2015 poor harvest and early impacts from El Niño, with Swaziland, Angola and Mozambique show increasing signs of concern. WFP note that El Niño is usually accompanied by economic slowdown in Southern Africa, associated with reduced agricultural output and contraction in industrial activities. Current macro-economic conditions, including falling international commodity prices and currency depreciations, may inhibit countries’ capacity to secure sufficient food supply. Crop failure and economic contraction threaten both rural and urban livelihoods as it undermines people’s capacity to meet their basic social and economic needs, coupled with increasing levels of livelihood stress and unemployment, El Niño incurs social, economic and political consequences. The WFP note that regional coordination and government leadership of critical contingency, preparedness and response planning is crucial to guarantee sufficient food supply and access for the most vulnerable people.

Namibia: Drought funds to last until month end
The Namibian, 5 July 2016

The N$90 million for drought relief set aside by the government from April 2016 to feed the 595 000 needy people in Namibia will last only until the end of July said Prime Minister Saara Kuugongelwa- Amadhila. In the light of this, she said that the government needs to raise N$659 million for the drought relief programme from 1 August 2016 until March 2017. President Hage Geingob declared a state of emergency in 2016 due to the ongoing drought in the country. This is the second time in three years that the Namibian government has declared a state of emergency. The 2016/17 Rural Food Security and Livelihood Vulnerability Forecast report presented yesterday by Obert Mutabani from the Prime Minister's Office shows that the price of maize meal increased from N$8 per kilogramme in 2012 to N$18 now. Millet now costs about N$14 from N$7 in 2012, while sorghum is at N$29, up from N$7. The report also revealed that about 595 839 people have been affected by the drought, and will need assistance. It gave recommendations that government should set up programmes to help communities become self-reliant.

The political and economic challenges facing provision of municipal infrastructure in Durban
Zikode S: Pambazuka News, 14 July 2016

Started 10 years ago, South Africa’s shack dwellers movement Abahlali baseMjondolo has mounted a remarkable struggle – often at a terrible cost - to protect and promote the rights of impoverished people in the towns. This inspirational story shows what poor people can achieve when they organise themselves. The Abahlali baseMjondolo movement was formed in the Kennedy Road shack settlement in Clare Estate in Durban in 2005. It was formed to fight for, protect, promote and advance the interests and dignity of shack dwellers and other impoverished people in South Africa. At the time of the movement’s formation Kennedy Road was facing eviction. The conditions were very bad in the settlement due to the lack of infrastructure. At the time the government had a policy of ‘eradicating slums’ and promised that there would be no more ‘slums’ by 2014. However the process left some people homeless and others would be taken to tiny and badly made ‘houses’ far outside of the cities. So the Abahlali baseMjondolo movement successfully organised to stop the evictions and the ‘slum eradication’ program. They organised clean ups and brought ’Operation Khanyisa” (self-connection to electricity) which started in Soweto to Durban. Abahlali aims to build the power of the impoverished from below. However they write that they have faced serious repression in their struggle and that basic rights, like the right to protest, have been denied to them. They reject that others should speak for them and that municipalities should work with people in shack settlements to plan participatory upgrades so that the impoverished can live a dignified life.

ZimVAC Rapid Assessment Report
Government of Zimbabwe Food and Nutrition Council, Zimbabwe Vulnerability Assessment Committee: Food Security Cluster, April 2016

In response to the advent of the El Nino phenomena which has resulted in the country experiencing long dry spells, the ZimVAC undertook a rapid assessment focussing on updating the ZimVAC May 2015 results. The process followed a 3 pronged approach which were, a review of existing food and nutrition secondary data, qualitative district Focus Group Discussions (FGDs) and for other variables a quantitative household survey which in most cases are representative at provincial and national level. This report provides a summation of the results for the 3 processes undertaken. The report concludes that there is an urgent need to strengthen and expand current livestock support programmes to prevent further deterioration of livestock condition and deaths; to implement a Drought Relief Policy and Food Deficit Mitigation Strategy through multi-sectoral participation of all relevant Government structures, and to adopt registration, distribution and monitoring strategies that are inclusive. Gender based violence cases were found to be on the increase in most districts, while noting that this may be attributable to an increase in awareness and reporting and not necessarily to an increase in incidents.

Millions of Malawians hungry as food crisis deepens
Henderson P: Pambuzuka News, 16 June 2016

The author reports that Almost four million Malawians are battling severe famine due to poor or no harvests because of the effect of El Nino, which last year affected most of the country’s southern and northern regions, and that this could double by the end of the year. The number of hungry people is expected to rise to eight million by December 2016 and this is exactly half of the population. Torrential rains in the north aggravated the already dramatic situations, and in February a state of emergency was declared. In the meantime food prices continue to rise as Malawi’s Kwacha continues to lose value, forcing the poorest families to further reduce their already precarious daily meals, or to sell goods in order to make ends meet. According to a report by World Food Program (WFP) of May, 2016, in most parts in Southern Africa harvesting was underway, temporarily alleviating some market pressure and allowing for food price improvements in pockets of the region as people consume their own production. The report, however, states that, crop expectations remain poor following one of the driest seasons in 35 years with seasonal rainfall deficits experienced throughout the region, particularly in central and southern Malawi.

For Poor Children, Two Healthy Meals a Day Can Keep Obesity Away
Graham L: NGO Pulse, April 2016

Access to poor quality and inexpensive food that are high in fats and refined carbohydrates have the potential to expose children to obesity. Fighting obesity could translate into a decrease in the number of adults who suffer from non-communicable diseases such as diabetes, hypertension and heart disease. In this edition of NGO Pulse, Lauren Graham, a senior researcher at the University of Johannesburg’s Centre for Social Development for Africa, writes that with the current drought and increased food prices, it is becoming more expensive and difficult for families, especially those in poor communities, to afford and opt for healthier food baskets. Graham, who argues that it is easy and cost effective to prevent obesity and overweight, adds that: “Obesity is not necessarily driven by overeating, as is commonly thought.” She notes that children who grow up in poor communities are at high risk for obesity and ‘hidden hunger’ since they have no option but to consume food that lacks the right balance of nutritious meals.

Is any wheelchair better than no wheelchair? A Zimbabwean perspective
Visagie S; Mlambo T; van der Veen J; Nhunzvi C; Tigere D; Scheffler E: African Journal of Disability 4(1) doi: 10.4102/ajod.v4i1.168, November 2015

Within a rights-based paradigm, wheelchairs are essential in the promotion of user autonomy, dignity, freedom, inclusion and participation. This paper described a group of 94 Zimbabwean wheelchair users’ satisfaction with wheelchairs, wheelchair services and wheelchair function in a mixed method, descriptive study using the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and Functioning Every day with a Wheelchair questionnaire. Qualitative data were collected through two focus group discussions (22 participants) and two case studies with participants purposively sampled from those who participated in the quantitative phase. More than 60% of participants were dissatisfied with the following wheelchair features: durability (79%), weight (76%), ease of adjustment (69%), effectiveness (69%), safety (67%), reliability (67%), and meeting user needs (61%). Similarly, more than 66% of participants were dissatisfied with various services aspects: professional services (69%), follow-up (67%), and service delivery (68%). Although 60% of participants agreed that the wheelchair contributed to specific functions, more than 50% of participants indicated that the features of the wheelchair did not allow in- (53%) and outdoor (53%) mobility. Findings indicate high levels of dissatisfaction with wheelchair features and services, as well as mobility. It is recommended that minimum service standards are set incorporating evidence and good practice guidelines for wheelchair services and management of wheelchair donations in Zimbabwe.

Poverty Remains World’s Biggest Challenge
Commission for Social Development, Forty-fourth Session: United Nations, February 2016

The Commission for Social Development concluded its fifty-fourth session approving three draft resolutions for adoption by the Economic and Social Council. One on Africa’s development, while traditionally endorsed by consensus, required a rare vote to address the United States’ concerns over language around trade issues, and more generally, “the right to development”. The Commission approved a draft on “Social dimensions of the New Partnership for Africa’s Development” by 29 in favour, to 12 against, with no abstentions (document E/CN.5/2016/L.5). This emphasizes that “increasingly unacceptable” poverty, inequality and social exclusion in most African countries requires social and economic policies to be devised through a comprehensive approach. African countries are encouraged to prioritize structural transformation, modernize smallholder agriculture, add value to primary commodities and improve public and private governance institutions.While the United States’ delegate, whose delegation had requested the vote, said her Government would vote against the text, as it viewed the World Trade Organization (WTO) as the main venue for trade negotiation, and could not support a text calling on WTO members to conclude the Doha Round of trade negotiations and improve market and duty-free access, South Africa’s representative, associating with the Group of 77, said South Africa would continue to advocate for social development as part of the global agenda.

Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis
Watkins D; Olson Z; Verguet S; Nugent R; Jamison D: Health policy and planning 31(1) 75-82, 2015

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.

White Paper: National Sanitation Policy
South African National Department of Health: Pretoria, 2016

The sanitation sector in South Africa is currently regulated by three policy documents, namely the White Paper on Water Supply and Sanitation (1994); the White Paper on a National Water Policy of South Africa (1997) and the White Paper on Basic Household Sanitation (2001). These documents provide procedures, rules and allocation mechanisms for sanitation, implemented through laws, regulations; economic measures; information and education programmes; and assignment of rights and responsibilities for providing services. After several years of implementation, a number of challenges and unintended consequences were identified. The regulatory responsibilities were unclear, shifting between departments. Devolving responsibility for implementation to local government resulted in significant changes in the sector. Increased urbanisation is noted to increase stress on urban sanitation systems, but so too is changing human settlement in rural areas placing increased strain on small and limited sanitation systems. The department thus argues for policy review to address these challenges to deliver sanitation.

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