According to IRIN News, new cases of leprosy have been reported from clinics in Antalaha, a remote area of Madagascar. The driving force behind the outbreak of the disease is increased malnutrition, the article reports, caused by dramatic increases in the price of rice. And while people are becoming poorer and more susceptible to illness, the public healthcare system is receiving less money from the government. According to the United Nations Children's Fund (UNICEF), government spending for health dropped to US$2 a person in 2010, compared to $5 in 2009 and $8 in 2008. Clinics in remote places like Antalaha are the most likely to suffer from shortages of drugs and medical supplies. Six to 12 months of treatment with multidrug therapy - a combination of two antibiotics and an anti-inflammatory (medicines that the World Health Organisation distributes for free) - stops the disease from spreading, but there are other obstacles to overcome. The main one, according to medical workers, is that the Malagasy authorities declared that leprosy had been eradicated from the country in 2010. Medical workers are reported to be afraid to report new cases to the authorities as this will contradict the official position on the disease. Diagnosing the illness can also be tricky in a tropical climate that causes many dermatological problems, and basic items like bandages – which are needed to dress the wounds – are usually lacking in health centres.
Poverty and health
Swaziland's parliamentarians recently debated the social safety net covering children, the elderly and the disabled. Recipients often depend on these small grants and pensions for survival. The debate on the future of social services was prompted by submissions from the Deputy Prime Minister, Themba Masuku, on the suspension of grants to the elderly. A number of Members of Parliament (MPs) supported the call for a constitutional amendment to abolish these government grants when government had no money to pay for them. The article reports that many pensions were suspended in the first quarter of 2011. In June 2011 only 6,480 pensions were reported to be paid, while at least 40,000 pensioners without bank accounts were reported to have received no benefits, so that OVC grants could be paid instead. The Deputy Prime Minister did not respond to parliamentary questions as to when regular pension payments would resume. The non-payment of social grants is expected to have a knock-on effect on health of the country’s population, particularly those living in extreme poverty.
According to the United Nations Food and Agriculture Organisation’s (FAO) Food Price Index, overall food costs rose by 39% in 2011, while grain prices went up by 71%. The authors of this article point to investor speculation in commodity futures as the main culprit for price increases, as the more the price of food commodities increases, the more money pours into the sector and the higher prices rise. Although the volume of index fund speculation increased by 2,300% between 2003 and 2008 alone, the FAO estimates that today only 2% of commodity futures contracts result in the delivery of real goods. The problem is particularly glaring in Ethiopia, the authors note, where 5.7 million Ethiopians are dependent on international food aid, while the government sells or leases large tracts of fertile land to foreign investors. They, in turn, export most of the food they produce to other countries. Since 2007, the Ethiopian government is reported to have approved 815 foreign-funded agricultural projects. Given the threat posed by climate change, the authors call for a radical departure from agricultural mass production, as well as an end to large-scale monocultures and the massive use of pesticides. They argue that this type of agriculture contaminates water and dries up the soil, and that the export-oriented agricultural industry destroys markets in developing countries. What is needed is a re-orientation toward a system of agriculture driven by small farmers who grow their crops at the local level, using both sustainable and environmentally compatible methods. However, governments and economists continue to push for large-scale agriculture as the solution to poverty and hunger, even though it is actually a contributing factor to the problem, the authors argue.
Is job creation really the best way to seek wellbeing for all in countries with chronic, high unemployment? No, according to the author of this article, especially not in a wealthy middle-income country like South Africa, where very high unemployment combines with high poverty rates. A universal income grant, he argues, makes much more sense. He points out that earning a decent secure wage is not a prospect for millions of South Africans, especially with the global economic crisis having hit the country and unemployment standing at 35%. Having a job does not automatically prevent poverty, as most workers earn very low wages and have minimal labour protection, a situation exacerbated by the shift towards the use of casual and outsourced labour and the related decline in real wages for low-skilled workers. Although the current social grant system separates millions from destitution, he notes that it is ill-suited to today’s realities, as it hinges on the fiction that every worker, sooner or later, will find a decent job. In addition, targeted and means-tested social protection is burdensome, costly and humiliating. The author argues that a universal income is developmental and would boost wellbeing and health, referring to studies that show reduced stunting in children, better nutrition levels and greater school enrolment. He notes that a universal grant as small as US$12 per month could close South Africa’s poverty gap by 74% and lift about six million people above a poverty line of US$50 per month.
Failure to achieve desired human development outcomes in the water supply and sanitation sector over the last decade has prompted this re-assessment of sector strategies and a focus on issues of governance and political economy. The authors assess the applicability of the various political economy analysis (PEA) frameworks for the water and sanitation (WATSAN) sector, drawing out five key points to take into account when developing a sector level PEA framework. First, the sector’s diversity (both the sub-sectors of water supply, sanitation and geographical locations of sub-sector service delivery contexts urban, rural, peri-urban) does not mean that different elements of the WATSAN sector require the application of separate frameworks, but the different historical, institutional and political contexts do need to inform the tailoring of questions and areas of focus across the subsectors. Second, a multi-sector and multi-scalar analysis can help to identify actions and decision making influenced by external processes and actors operating at various scales. Third, a combined sector governance and political economy analysis for the sector is not recommended: a joint analysis requires considerable time and research, and leads to overly normative and prescriptive mindset preventing consideration of a full scope of non-obvious opportunities for intervention. Fourth, a PEA framework for WATSAN requires flexibility in its application to the sector. Fifth, a PEA WATSAN framework needs to focus on both process and outcomes: the majority of PEA and governance studies have failed to drive forward change in the water and sanitation sector.
On 2-3 March 2011, Partners in Health, Harvard University and other organisations met to discuss the non-communicable diseases (NCDs) of the world’s poorest billion people. The Conference was held in Boston, United States, and attended by a wide range of government, civil society and academic organisations who have advocated for the inclusion of NCDs as a priority on the global health agenda. This Statement allies itself with a number of World Health Organisation (WHO) and United Nations (UN) agreements and resolutions, such as the WHO’s Framework Convention on Tobacco Control and its Global Strategy on NCDs and the UN Resolution ‘Keeping the Promise: United to Achieve the Millennium Development Goals’. The Statement calls on all UN member state Heads of Government and Heads of State to take urgent action to address NCDs amongst the world’s billion poorest people by: leading at global and national levels for NCDs; strengthening health systems and NCD prevention, treatment and care; strengthening research and data systems; and addressing poverty, vulnerability and discrimination.
South Africa's high child mortality rates have forced the government to rethink its policy on infant feeding and move to discontinue the free provision of formula milk at hospitals and clinics, as well as promote an exclusive breastfeeding strategy for all mothers, including those living with HIV. Minister of Health Aaron Motsoaledi made the announcement on 23 August 2011 after a two-day national consultation on breastfeeding, where participants unanimously recommended the changes. Until now, the country's health system has not supported the practice of breastfeeding and mothers are often discharged as soon as six hours after birth, with no or little counselling on infant feeding, the Minister of Health acknowledged. Formula milk manufacturers and distributors have also promoted their products aggressively, because of the absence of legislation to regulate the marketing of formula milk, according to UNICEF. In December 2009, the UN World Health Organisation (WHO) issued guidelines recommending that infants born to HIV-positive women be exclusively breastfed for the first six months, but South Africa's programme to prevent mother to child HIV transmission has continued to provide free formula to HIV-positive mothers. Representatives of WHO in South Africa are calling on government to implement the guidelines.
The food crisis in the Horn of Africa is affecting people in informal urban settlements, but they remain largely overlooked by the aid community, according to IRIN. IN Kenya, emergency relief efforts are focused on the arid north, yet over the past five months, Concern Worldwide has recorded a 62% increase in cases of severe acute malnutrition (SAM) at clinics it supports in Nairobi slum areas, while estimating that the need is much greater. The UN Children's Fund (UNICEF) concurred that the food crisis is probably affecting people in urban areas more than in the north. Part of the reason malnutrition in urban slums is paid relatively scant attention is that it rarely reaches the emergency level of 15% global acute malnutrition (GAM) rate, at which point government is obliged to take action. In Turkana in the north, 15% GAM would translate to 13,000 children. But in Nairobi district, 13,000 malnourished children would reflect just a 3.45% GAM rate. Currently, the estimated GAM rate is 2.3% in Nairobi's slums.
Arguments about the most effective and equitable approach to distributing insecticide-treated nets (ITNs) centre around whether to provide ITNs free of charge or continue with existing social marketing strategies. In this study, researchers in Tanzania examined the equity implications of ownership and use of ITNs in households from different socioeconomic quintiles in a district with free ITNs (Mpanda) and a district without free ITN distribution (Kisarawe). They found that ownership of ITNs increased from 29% in the 2007/08 national survey to 90% after the roll out of free ITNs in Mpanda, and use increased from 13% to 77%. Inequality was considerably lower in Mpanda. In Kisarawe, ownership of ITNs increased from 48% in the 2007/08 national survey to 53%, with marked inequality. The results suggest that inequality in ownership and use of ITNs may be addressed through the provision of free ITNs to all.
Exclusive breastfeeding (EBF) is reported to be a life-saving intervention in low-income settings. In this study, researchers evaluated the effectiveness of breastfeeding counselling by peer counsellors in Africa. Twenty-four communities in Burkina Faso, 24 in Uganda and 34 in South Africa were included in the study. Of the 2,579 mother-infant pairs assigned to the intervention or control clusters in the three countries, EBF prevalences were recorded along with prevalence of diarrhea. The researchers found that, although it does not affect diarrhoea prevalence, low-intensity individual breastfeeding peer counselling is an achievable target and they urge governments in low-income countries in sub-Saharan Africa to scale up EBF counseling to increase the prevalence of EBF.