A woman walks by an Ebola awareness sign in Freetown, Liberia. © Tanya Bindra/UNICEF
As the spread of the Ebola virus in West Africa shows, the importance of reducing inequality could not be more clear. The battle against the virus is a fight on many fronts — human lives and health foremost among them.
But the fight against Ebola is also a fight against inequality. The knowledge and infrastructure to treat the sick and contain the virus exists in high- and middle-income counties. However, over many years, we have failed to make these things accessible to low-income people in Guinea, Liberia, and Sierra Leone. So now thousands of people in these countries are dying because, in the lottery of birth, they were born in the wrong place.
If we do not stop Ebola now, the infection will continue to spread to other countries and even continents, as we have seen with the first Ebola case in the United States this past week. This pandemic shows the deadly cost of unequal access to basic services and the consequences of our failure to fix this problem.
The virus is spreading out of control in Guinea, Liberia, and Sierra Leone. As a consequence, our ability to boost shared prosperity in West Africa — and potentially the entire continent — may be quickly disappearing.
The Ebola outbreak in West Africa started with just one case. More than nine months later, it’s now outrunning the ability of fragile countries and relief organizations in the three most-affected countries to contain it. Clinics and hospitals are overloaded. Sick people are being turned away. Things could get much worse unless something changes.
… until you dig deeper.
People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.
Ebola virus is experiencing a break out summer. The latest outbreak in Guinea, Liberia and Sierra Leone is the worst ever, resulting in the death of almost 900 lives and infecting more than 1603 people across West Africa. The virus is also experiencing unexpected popularity on the dance floor.
A new song, "Ebola in Town," recorded by a trio of West African rappers, warns of the dangers of Ebola over a catchy electronic beat. Residents of Monrovia and Conakry, the capitals of Liberia and Guinea, and have created a dance to go along with the song. The lyrics warn "don't touch your friend" and "no eating something, it's dangerous," and the dance, fittingly, does not include any touching.
This advice is technically incorrect (you cannot contract Ebola virus from simply touching another person but rather through contact with bodily fluids) and may increase the social stigma that people recovering from Ebola face, an issue health workers are attempting to adress. While the song is off-message, it may nonetheless be helpful in raising awareness. Many people in West Africa are not sure of the actual danger level, which may be exacerbated by illiteracy- 43.3% of adults in Sierra Leon, 42.9% in Liberia and only 25.3% in Guinea's are literate. In these countries, music, theater, and radio are popular media to spread public information.
A couple months ago while stationed in Ghana, I was approached by colleagues and friends with questions on how to prevent contagion from the deadly Ebola virus. Their concern was stoked by reports in media outlets about the rising number of confirmed cases and deaths in neighboring countries.
In last week’s post, I asked whether Governance and Public Sector Management (GPSM) projects are having much large scale impact. It is tempting to reduce this to the question of why don’t development projects which focus on this work more often (although their track record is perhaps not as limited as some reviews of donor assistance might suggest). From this starting point, recent thinking suggests that donor rigidity and project designs which fix the visible form without improving the underlying public management function are the problem.
The remedy, as set out most prominently in “Problem Driven Iterative Adaptation” and in the World Bank’s own Public Sector Management Approach, suggests that we should focus on the de facto rather than the de jure and adapt the nature of our support as project implementation unrolls. Problem-driven iterative adaptation (PDIA) approaches are referred to in recent reforms of Ministries of Finance in the Caribbean and reform approaches in Mozambique and in Burundi. Bank interventions in Sierra Leone and in Punjab have been cited as examples of this approach in practice.
- On a global level, the rate of under-five child mortality has been cut in half, from 90 deaths per 1,000 live births in 1990 to 48 per 1,000 in 2012. The estimated annual number of under-five deaths has fallen from 12.6 million to 6.6 million over the same period.
- Since 1990, 216 million children worldwide have died before their fifth birthday — more than the current total population of Brazil, the world's fifth most populous country.
- Disparities between children in the high-income and low-income countries have narrowed, but many gaps still remain. Case in point: In Luxembourg, the under-five mortality rate is just 2 deaths per 1,000 live births; in Sierra Leone, it is 182 deaths per 1,000 births.
As we stand a year away from the Millennium Development Goal (MDG) 4 – which aims to reduce the global under-five child mortality rate by two-thirds between 1990 and 2015 – the pace of reduction would have needed to quadruple in 2013-2015 to achieve this goal, according to the United Nations Children's Fund's (UNICEF's) Committed to Child Survival: A Promised Renewed – Progress Report 2013.
A closer look at regional rates
Now let's take a look at the regional and country level data by viewing the World Development Indicators (WDI) 2014 and the indicator under-five mortality rate. The WDI also features a short progress report on MDG 4, which complements the detailed analysis of the World Bank Group's Global Monitoring Report. This report uses the same methodology to assess whether countries are on track or off track to meet the 2015 targets.
Sub-Saharan Africa (SSA), where one in ten children die before the age of five, faces the biggest challenges in achieving MDG 4, followed by South Asia. The SSA region reduced its child mortality rate by 45% during 1990 to 2012, the only region to reduce its under-five mortality rate by less than half during this time. SSA also lags behind other regions in its pace of decline in the total number of under-five deaths.
From “filling deficits” to “working politically”
When most people talk about capacity, they actually mean either “stuff” – resources and equipment – or hard skills in some technical discipline. This is the obvious starting point: without proper medical facilities or trained staff, how can a local health clinic do its job? Which is probably why so many capacity building programs try to fill deficits by giving stuff and providing technical training. But often the real problems confronting service providers have nothing to do with what's available in a tangible or technical sense – this might be a symptom, but it's not the root of the problem. So what do we then do in terms of thinking about capacity?
The expansion of household surveys in Africa can now show us the number of poor people in most countries in the region. This data is a powerful tool for understanding the challenges of poverty reduction. Due to the costs and complexity of these surveys, the data usually does not show us estimates of poverty at “local” levels. That is, they provide limited sub-national poverty estimates.
For example, maybe we can measure district or regional poverty in Malawi and Tanzania from the surveys, but what is more challenging is estimating poverty across areas within the districts or regions (known as “traditional authorities” in Malawi and “wards” in Tanzania).
To address this shortfall, several years ago a research team from the World Bank developed a technique for combining household surveys with population census data, and poverty maps were born. Poverty maps can be used to help governments and development partners not only monitor progress, but also plan how resources are allocated. These maps depend on having access to census data that is somewhat close in time to the household survey data. But what if there is no recent census (they are usually done every 10 years) or the census data cannot be obtained? (I will resist naming and shaming any specific country): we are left with no map. Can we fill in the knowledge gaps in our maps?