Azerbaijan

Thriving Cities Will Drive Eurasia's Growth

Cities have always been the driving forces of world civilizations. What Niniveh was to the Assyrian civilization, Babylon was to the Babylonian civilization. When Peter the Great, third in the Romanov Dynasty, became Russia’s ruler in 1696, Moscow’s influence began to expand. Peter strengthened the rule of the tsar and westernized Russia, at the same time, making it a European powerhouse and greatly expanding its borders. By 1918, the Russian empire spanned a vast territory from Western Europe to China.

As Peter the Great and his successors strove to consolidate their reign over this empire, major social, economic, cultural, and political changes were happening in the urban centers. Moscow led these changes, followed by St. Petersburg, which was built as a gateway to filter and channel western civilization through the empire. By fostering diversification through connectivity, specialization, and scale economies, these cities started the structural transformation of the Russian empire away from depending on commodities and limited markets in a way that more effectively served local demand.

The Soviet era altered this dynamic.

Women in the Workforce – a Growing Need in Emerging Europe and Central Asia

Emerging Europe and Central Asia (ECA) is an interesting region because what you expect is not always what exists. Since this is written in honor of International Women's Day, discussing women’s labor market participation seems appropriate. The standard indicator used for this is the “female labor force participation” (LFP) rate, which is the proportion of all women between 15-64 years who either work or are looking for work.

Since much of the region has a common socialist legacy, you would expect to see similar labor market behavior among women. However, the proportion of women who work ranges from a low of 42 percent in Bosnia and Herzegovina to 74 percent of adult women in Kazakhstan. And it wasn’t 20 years of social and economic transition that led to this divergence. Even in 1990, the range was about the same. The exception was Moldova which saw a 26 percentage point decline.

Gas Flaring: Let’s Light Up Homes Rather than the Sky

Gas flaring. Credit: ShinyThings/Creative Commons

Ten years ago, the World Bank and the government of Norway launched an ambitious project to drastically reduce greenhouse gas emissions from a source few people thought much about. If you’ve driven past oil fields at night, you’ve seen the flames from gas flaring. But you might not have realized just how much greenhouse gas was being pumped into the dark – and how much of a natural energy resource was being wasted in the process.

Half a dozen major oil companies joined us in 2002 in creating the public-private Global Gas Flaring Reduction partnership, and we began working together to reduce the flaring. More than 30 government and industry partners are on board today.

Together, we have achieved a great deal in just the first decade.

An analogy about cars, trust and financial capability

Imagine you need a car to commute long distances to your workplace or the closest supermarket, to visit your parents and to bring your child to school. Therefore, you want to spend the money you have been able to put aside on a large purchase: a new and reliable car. However, you do n Financial education enables the unbanked to participate in financial markets. (Credit: The Advocacy Project, Flickr Creative Commons) ot know how to drive, nor how do you have even a basic understanding of any technical aspects of a car, not to mention any knowledge about how to maintain a car.
Also, imagine that everything you have heard so far about car dealers from your family, friends and neighbors is that they have a very bad attitude, do not act in your best interest and try to sell you overpriced vehicles with hidden fees and features you do not need. Given your lack of knowledge of how to choose and use a car and your lack of trust, would you still feel confident about approaching a car dealer? Most probably not.

This analogy also applies to one’s participation in financial markets. Especially in developing economies, where most globally unbanked people live. If you do not have knowledge of features and risks associated with financial products, do not know how to choose and use these products, lack any basic understanding of inflation, interest rates and compound interest, it is unlikely that you will participate in financial markets, or that you will benefit from them if you do. A lack of trust in financial service providers will do the same.

Health information systems in developing countries: Star Wars or reality?

In the late 1990s, an international consultant told me that a proposed electronic health information system in the Dominican Republic was “like Star Wars and will not work in this country.”

Our objective was to improve service delivery by virtually connecting health providers to share medical records with one another as patients moved from health centers to hospitals. We learned that this was much more than an overnight task, requiring a sustained medium-term effort by the government to get the system fully up and running.

In recent years, I’ve seen similar efforts realized in the Russian Federation, Georgia, Azerbaijan and Botswana. In two Russian regions, Chuvash Republic and Voronezh Oblast, for example, electronic records are helping coordinate the flow of clinical and financial information across the health systems as facilities, departments within hospitals, and health insurance agencies have been “virtually” connected through broadband networks. The electronic records are supporting clinical decision-making, facilitating performance measurement and pay-for-performance initiatives, and ultimately the continuity of care as patients move across the health system. Inter- and intra-regional medical consultations and distance learning activities are also being supported by telemedicine networks that connect specialized hospitals with general facilities.

Malaria is a preventable and treatable disease, but for how long?

www.worldbank.org/malaria

This year, on World Malaria Day, April 25, the global health community has reason to celebrate. Indeed, thanks to substantial investments from partners and countries over the last decade, the scorecard on malaria reports good news: a reduction of more than 50% in confirmed malaria cases or malaria admissions and deaths in recent years in at least 11 countries south of the Sahara, and in 32 endemic countries outside of Africa. Overall, the number of deaths due to malaria is estimated to have decreased from 985,000 in 2000 to 655,000 in 2010.

The fact that an estimated 1.1 million African children were saved from the deadly grip of malaria over the last decade is an extraordinary achievement. By the end of 2010, a total of 289 million insecticide-treated nets were delivered to sub-Saharan Africa, enough to cover 76% of the 765 million persons at risk.

Over the past 5 years, four countries were certified as having eliminated malaria: Morocco, Turkmenistan, the UAE and Armenia. In southern Africa, health ministers of eight countries -- Botswana, Namibia, South Africa, Swaziland, Angola, Mozambique, Zambia, Zimbabwe--have developed a regional strategy to progress towards E8 malaria elimination status.

Out-of-pocket in the Caucasus

I am partway through a trip to the countries of the South Caucasus (Armenia, Azerbaijan and Georgia), where winter is settling in—snow in Tbilisi and Yerevan, and a raw wind on Baku’s seafront.

It is a diverse region at the proverbial crossroads, but one common trait is a bleak health financing environment. All three countries rely on out-of-pocket (OOP) expenditures for about two-thirds of total health spending, well above their peer groups, including other countries of the former Soviet Union or middle-income countries around the world. As a result, the incidence of “impoverishing” and “catastrophic” health spending by households—both common indicators of financial protection—are among the highest in the world. Besides costing some households dearly, OOP expenditures also keep many others away from the hospital or clinic: Utilization rates are among the lowest in Europe and Central Asia.

How did the Caucasus become such OOP outliers? The proximate causes are clear enough: large formal or informal payments for health care and high prices and overconsumption of pharmaceuticals. Many of these issues, in turn, can be traced to low levels of government spending on health, around 1.8% of GDP in all three countries, roughly half the regional average. Health spending is low as a share of government budgets, as well. As a result, providers recover costs directly from patients, and can have more latitude to engage in rent-seeking in the absence of stronger pooling and purchasing mechanisms.

An imperative: reforming medical and public health education

My recent work in Azerbaijan convinced me that reforming medical and public health education programs is critical to revamping clinical processes and public health practices for effective prevention, diagnosis and treatment of diseases and injuries. In this small Caspian Sea country, improving physicians, nurses and public health specialists’ educational programs—which are hampered by outdated conceptual and methodological structures and practices—is starting to receive priority attention in the country’s quest to improve health system performance.

The challenge is shared globally, as different countries are struggling to sufficiently staff their health systems with well-trained, deployed, managed and motivated physicians and nurses to provide quality medical care, and competent staff to manage service delivery and carry out essential public health work such as disease surveillance.

With few exceptions, such as the 2010 Lancet commission report*, medical, nursing and public health education reform has failed to appear in the international health agenda—yet we continue to focus on employment and remuneration of existing personnel. This has to change. Why? Simply because the adoption of and adaptation to local conditions of new knowledge, country experiences and good practices help accelerate social and economic development.

Making a public health case for safer roads

Also available in: Русский

On recent visits to Moscow and Tbilisi, and driving from Baku to the Sheki and Agdash regions in Azerbaijan, I observed challenges and progress in making roads safer. Why should this matter to public health folks? Or should this be only the concern of engineers?

If one of the goals of development is to improve health outcomes by reducing premature mortality, injuries and disability, then unsafe roads are a key public health challenge.

In Eastern Europe and Central Asia (ECA) the problem is acute. Road traffic deaths rank among the ten leading causes of death: people are 2-3 times more likely to die from road injuries than people in Western Europe. For every death, many more people have injuries that require medical care.

What is causing this problem? For sure, more people are driving because the number of cars has increased significantly due to rising incomes—the traffic jams in some ECA cities vividly reflect this change. Poor road conditions and spotty enforcement of speeding, drunk driving, and seatbelt and helmet laws are leading culprits. “Distracted driving,” due to the growing use of cell phones and texting, is also resulting in more car crashes.

Coalitions, Norms, and Extractive Industries

My last blog post addressed progress made in the extractive industries, in terms of fighting corruption, and in particular the new U.S. law (the Dodd-Frank Act) that will impact some of the largest gas, oil and mining companies in the world when it goes into effect in 2011. I also mentioned a few initiatives that have played an important role in advocating for this law and for a global norm on transparency. Another important player in this field is the Extractive Industries Transparency Initiative (EITI), as rightly pointed out by a reader and colleague. Launched in 2002, EITI advocates for transparency in the extractive industries through the publishing of financial information and promoting a culture of transparency that involves dialogue, empowering civil society, and building trust among stakeholders. A fundamental principle of the EITI is the development of multi-stakeholder initiatives to oversee the implementation and monitoring process, which is supported through a multi-donor trust fund, managed by the World Bank.

Overcoming Negative Stereotypes in the South Caucasus

Photo © Global Voices In the 16 years since a 1994 ceasefire agreement put the conflict between Armenia and Azerbaijan over the disputed mainly-Armenian populated territory of Nagorno Karabakh on hold, peace remains as elusive as ever. The war fought in the early 1990s left over 25,000 dead and forced a million to flee their homes, leaving ethnic Armenian forces, backed by Armenia proper, in control of over 16 percent of what the international community considers sovereign Azerbaijani territory.

The situation, perhaps, is typical for many frozen conflicts, but what makes this dispute even more complicated is the almost constant rhetoric of hatred from both sides. Nearly two decades after the troubles broke out, new generations of Armenians and Azerbaijanis are unable to remember the time when both lived side by side together in peace. Armenia's last president, Robert Kocharian, for example, declared that the two were 'ethnically incompatible' while his Azerbaijani counterpart, still incumbent Ilham Aliyev, regularly threatens a new war.

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