The drought that has ravaged parts of northeastern Kenya, killing a large number of livestock, has affected the availability of milk, in turn undermining child nutrition, say officials. Most of the rural population in the areas where Save the Children is working is heavily dependent on relief food and many children are eating only one meal a day, of corn porridge. ‘This poor diet means they are missing out on vital nutrients, which can mean they grow up stunted and their brains and bodies can suffer permanent damage,’ the organisation said. Since July, the number of severely malnourished children seeking treatment at its northeastern emergency feeding centres has increased by 25%. ‘The government and donors need to be aware of the changing climate now and in future, and shape their policies accordingly,’ Philippa Crosland-Taylor, head of Oxfam in Kenya, said in August. ‘Emergency aid is urgently needed now, but in the long term we need to rethink policies to focus on mitigating the risks of droughts before they occur, rather than rushing in food aid when it is too late.’
Poverty and health
Context matters with regard to foreign aid. The implications are only slowly coming to the fore: external funders are realising that they will not find a magic wand or global prescription or best practice by which they can unleash the change that will reduce poverty on a significant and sustainable scale. Context – the institutional, social, political, cultural and economic fabric of society – matters, and its significance is much greater than that of aid from external partners. So, the problem for funders in dealing with context seems to be first and foremost dealing with their own context that forces them to try to do more than they objectively can. The challenge is to find ways to change the political and systemic factors that constrain the capacity and willingness of funders to act with modesty, realism and humility. This requires an environment in which their stakeholders are genuinely happy to be small contributors to processes that mainly depend on everything but funders and aid.
This paper estimates the economic impact of HIV and AIDS on the KwaZulu-Natal province and the rest of South Africa. It extended previous studies by employing: an integrated analytical framework that combined firm surveys of workers' HIV prevalence by sector and occupation; a demographic model that produced both population and workforce projections; and a regionalised economy-wide model linked to a survey-based micro-simulation module. Results indicate that HIV and AIDS greatly reduces annual economic growth, mainly by lowering the long-run rate of technical change. However, impacts on income poverty are small, and inequality is reduced by HIV and AIDS because high unemployment among low-income households minimises the economic costs of increased mortality. By contrast, slower economic growth hurts higher income households despite lower HIV prevalence. The increase in economic growth that results from addressing HIV and AIDS is sufficient to offset the population pressure placed on income poverty. Moreover, incentives to mitigate HIV and AIDS lie not only with poorer infected households, but also with uninfected higher income households. The findings confirm the need for policies to curb the economic costs of the pandemic.
Violence and injuries are the second leading cause of death and lost disability-adjusted life years in South Africa. With a focus on homicide, and violence against women and children, this paper reviews the magnitude, contexts of occurrence, and patterns of violence, and refer to traffic-related and other unintentional injuries. The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement. So far, there has been a conspicuous absence of government stewardship and leadership. Successful prevention of violence and injury is contingent on identification by the government of violence as a strategic priority and development of an intersectoral plan based on empirically driven programmes and policies.
This collection of articles includes an article on food security in Kenya. Since 2006, the rains in Kenya’s Central Highlands have become less reliable. The March and April rains regularly arrive late, and the season is much shorter. In 2008, there were only four days of rain. The seasonal rivers that provide water for irrigation, livestock and domestic uses have mostly dried up, leading to water and food shortages. These burgeoning problems are pointing in one direction – poverty, malnutrition and health problems for the nation’s poor. Declining production, and the limited access and affordability of imported food, mean food security has declined, with many impacts. The government should store grain during bumper harvests to provide food in poor seasons; processing this surplus can also add value and avoid wastage.
If the South African government wants to alleviate poverty, it should increase the number of people accessing social grants, according to recent submissions by a coalition of non-governmental organisations before the South African Human Rights Commission. The coalition, dubbed the National Working Group on Social Security, pointed out that President Jacob Zuma acknowledged that social grants remain the main effective form of poverty alleviation. However, they noted that no extension of the child support grant to children aged 15 to 18 has been announced, despite the importance of secondary school enrolment. Some people with HIV were alleged to be defaulting on their antiretroviral treatment to retain disability grants, because if they regain their health and their CD4 counts improve, social security stops issuing their HIV and AIDS grant. The Steve Biko Centre for Bioethics has called for a basic income grant and other poverty alleviation programmes that will include sex workers.
The consequences of malnutrition for the efficacy of anti-retroviral therapy (ART) are poorly understood, and evidence regarding the impact of food supplementation on ART outcomes is still limited. The World Health Organization and World Food Programme have issued guidance on food support in ART programmes: every newly enrolled patient should have a nutritional assessment that includes measurement of weight and body mass index, along with nutritional counselling and monitoring. Promotion of activity that increases ability to maintain and expand food supplies, either through growing crops or trading (`livelihoods`) may be a more appropriate response to malnutrition in people with less-advanced HIV disease, with cash transfers also being used as a means of addressing food insecurity. Households affected by HIV often experience multiple threats to their livelihoods. All nutritional support programmes need realistic strategies to avoid dependency and promote long-term food security.
The return of cholera to Zimbabwe is not a matter of if, but when, said Rian van de Braak, head of mission of the medical non-governmental organisation, Médecins Sans Frontières. ‘The threat is definitely not over. Everyone expects cholera to be back, at the latest with the next rainy season [in September or October], because the root causes of the outbreak [in 2008] have not been addressed adequately yet,’ he said. The first case of the cholera epidemic that swept through Zimbabwe, killing more than 4,000 people and infecting close to 100,000 others, was reported in August 2008 and lasted almost a year until it was officially declared at en end in July 2009. Broken sanitation and water systems, the cause of Africa's worst outbreak of the waterborne disease in 15 years, are unlikely to be repaired in time. ‘Several aid agencies are drilling new boreholes in cholera hotspots, which is an important contribution to safe drinking water. Dealing with those causes before the next rainy season is a race against the clock,’ said van de Braak.
Increasing the accessibility of health services to poor people requires overcoming the well-known obstacles of travel time, convenient hours and trust. These obstacles differ in importance for urban and rural poor people. For example, spatial obstacles to care are less important for urban poor people, but convenient hours matter more. In rural areas, solutions to increased travel time bring tradeoffs between more clinics in more locations and better clinics in fewer places. There are no universal solutions, but there are universal ways of finding them. Tracking the socioeconomic status of clients served is needed to make poor people were more visible in health system data, contributing to an understanding of how poverty interacts with epidemiology in the course of disease, and also how treatment is sought and complied with. This raises the importance of making solid measurements in future research to show where poor people are and what their barriers to health care access are.
Poor rains have heightened food insecurity in Kenya's northwestern region of Turkana, where malnutrition rates in children under five have risen above the emergency threshold, according to humanitarian officials. About 74% of the population (550,000) already depends on food aid, according to the International Rescue Committee (IRC). It said at least half of child deaths in the region were due to malnutrition or had malnutrition as an underlying cause of death. ‘In [the north-central] Samburu district, the percentage of children under-five considered at risk of malnutrition increased to 29.4% from 21.8% in June. In Moyale [in the northeast], the nutrition status of children below five years declined, with the percentage of children rated at risk of malnutrition rising to 35% in June from 30.6% in April.’ The decline was attributed to higher food prices and reduced availability of food, with pneumonia, malaria and diarrhoea as the three main diseases responsible for deaths among under-fives in Turkana.