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Dawa-Dua: How medical treatment complements prayer for people with mental illness in India

Varalakshmi Vemuru's picture
Devotees at Erwadi Dargah (Photo by DMPH Erwadi)
Devotees at the Erwadi Dargah in Tamil Nadu, India. (Photo: DMPH Erwadi)
Last month I blogged about how mental illness is curable, treatable, and preventable. Today, let me take you to a town in Tamil Nadu called Erwadi, where faith and medicine now go hand in hand to address mental illness.
 
Erwadi is known for its 550-year-old Badusha Nayagam Dargah—“Erwadi Dargah,” one of the biggest shrines in India. Every day, numerous devotees of different faiths visit the shrine from surrounding villages, states, and countries. Among these visitors is a large number of people who suffer from mental illness and have come to pray for a cure. Some of them see the Dargah as their first and only hope—guided by the magico-religious belief that illness is caused by the possession of evil spirits or the performance of wicked magic—while others have turned to the shrine as a last resort after receiving ineffective treatment.
 
When I visited Erwadi Dargah in 2013 and met with a team working on a local program called District Mental Health Project (DMHP), an important partner of the World Bank-supported Tamil Nadu Mental Health Project, they expressed an urgent need to help the devotees affected by mental illness. Their subsequent discussions with representatives of the shrine revealed a lack of information on potential treatment options and strong resistance to medical interventions among the devotees. At that time, the team knew of a similar circumstance in another part of India—the state of Gujarat—so they invited the representatives of Erwadi’s religious community to learn from peers in Gujarat about complementing religious rituals with medical treatment.
 
And thus started a unique experiment called “Dawa-Dua,” or prayer-treatment.

Against all odds - What is driving poverty reduction in Nepal?

SaileshTiwari's picture
Father and son
“Today is the happiest day in my life. I never thought my son would be going to a boarding school in the city.” - Tsering Tejaba, Sankhuwasabha (Photo Credit – Stories of Nepal)


The year 2015 was rough on Nepal. The catastrophic earthquakes that struck the country in April/May caused widespread destruction of life and property and was followed by disruptions in the south that brought cross-border trade with India to a complete standstill for 4 months. As dramatic as these recent shocks have been, Nepal is no stranger to conflict and fragility. A 10-year violent Maoist conflict ended in 2006 but the ensuing years of drafting a new constitution were turbulent; politics often dominating the discourse as opposed to economics. But despite these unfavorable odds, Nepal made rather surprising progress on improving living standards and reducing poverty.

Between 1995 and 2010, absolute poverty – measured as the proportion of people living below the national poverty line of Rs.19,261 per person per year – declined steadily by around 2.2 percentage points a year. This helped the country meet the MDG target of halving income poverty by 2015 quite comfortably. Living standards improvements were realized not just based on income or consumption but also along multidimensional measures of well-being that take into account access to essential services such as education, health and drinking water and sanitation. What was behind this progress on poverty reduction Nepal achieved amidst a violent conflict and a tumultuous post-conflict recovery?

Youth in Pakistan plug into digital jobs of the future

Anna O'Donnell's picture
Omer Ahsan, a program trainee who is now successfully freelanacing online as a professional content writer. Photo Credit/Waleed Abbas

Omer Ahsan is a chartered accountant in the making from Waziristan. He first heard about the Youth Employment Program, a free digital skills program offered by the Khyber Pakhtunkhwa Information Technology Board, from discussions on a group chat over Whatsapp, and applied immediately. Within two weeks of completing the digital skills program, Omer has built an online profile and has successfully earned money as a professional content writer.

Pakistan’s Khyber Pakhtunkhwa province is emerging from decades of instability and conflict, and would seem an unlikely place for digital workers to thrive. But with nearly 16 million youth in the province, and few available jobs locally, there is a pressing need to think outside the box in terms of equipping young people with the skills, knowledge and capabilities to take on the future.

In 2015, together with the World Bank, a series of pilot programs were conducted to test a model of digital skill training for youth. Growing connectivity, cloud technology, and the emergence of new business outsourcing models have lowered the barriers to entry for global employment, even for youth in remote parts of Pakistan. The key ingredients to accessing this employment: access to the internet, basic skills, and awareness, and the pilot program tested different approaches to supporting youth to develop online work skills.

Land records go digital in Punjab, Pakistan

Mary Lisbeth Gonzalez's picture

Pakistan land records

The Government of Punjab started computerization of rural Land Records with the overall objective to improve service delivery and to resolve the overall dispersed nature of land records. The transaction costs were very high for the poor during the old days of patwari system. Women were denied their land rights and the low mobility of land markets contributed to preserving the highly unequal distribution of land and, therefore, opportunities to improve people’s livelihoods.
 
Before the Land Records Management Information System (LRMIS) was set up, the Board of Revenue (BOR),​Government of Punjab, operated a land record maintenance system which involved several levels of administration: the district, Tehsil, Qanungo circle, and Patwar circle. At the lowest administrative level of the records system – the Patwar Circle – are the Patwaris, who were not only responsible for preparing community maps and issuing land records, but also for many social, political, and administrative tasks. Administrative tasks included keeping weather records, collecting crop harvest information, reporting crimes, and updating the voter registry. Imagine 8,000 Patwaris maintaining the land records – usually very small holdings -- of about 20 million land owners. The Patwaris, who were the custodians of these confidential and important records, kept this information in a cloth bag called Basta.
 
LRMIS has been performing really well. The Project was rolled out in all 36 districts of Punjab. The Project has successfully tested linkages between the land records system and the deeds registration system. The biggest achievement of the project is that the time required to complete transactions has been reduced from 2 months to 45 minutes. Land record services are now provided on an automated basis throughout all 150 Tehsil Service Centers. There are many contributing factors to the success of the Project:

How to use evidence to improve student learning

David Evans's picture
Access to education is improving but so must the quality of learning. (Arne Hoel/World Bank)

See if you can spot the pattern:
  • “Although the quantity of schooling has expanded rapidly, quality is often abysmal.” (Kremer et al.)
  • “Between 1999 and 2009, an extra 52 million children enrolled in primary school…Yet the quality of education in many schools is unacceptably poor.” (Krishnaratne et al.)
  • “Progress over the last decade in regards to school access and enrollment has been promising.” But “current learning levels for primary as well as secondary school students are extremely low in much of Sub-Saharan Africa” (Conn)
  •  “The most consistent focus of investment has been on increasing primary and secondary school enrollment rates… More recently, however, attention has begun to swing toward the quality of schools and the achievement of students—and here the evidence on outcomes is decidedly more mixed.” (Glewwe et al.)
  • “Over the past decade, low- and middle-income countries have made considerable progress in increasing the number of children and youth who enroll in school and stay long enough to learn basic skills… Learning in many low- and middle-income countries remains appallingly low.” (Murnane & Ganimian)

Again and again, we hear the refrain: access is improving, but learning lags. Thankfully, an increasing number of studies reveal interventions that work – and those that don’t – to improve learning around the world.

The silent ‘change agents’ in government

Syed Akhtar Mahmood's picture

Sometimes, the drive comes from the senior echelons of government – a reform-minded government leader, an important minister or an agency head. At times, there is pressure from donors. Often, the two combine: The initial idea comes from a donor, which a powerful person in government then takes up as an agenda.

Many reforms happen in this top-down way. But, often, there are questions about their sustainability. Commitment to reforms may not be widespread. Once donor pressure wears off, or once the bold reformer at the top moves on (or loses interest or energy), reform initiatives dissipate. Sometimes, the reforms happen on paper, but implementation remains deficient. Top-down reform initiatives often fail to take on board the front-line officials. Implementation thus suffers, especially when the attention of the top-down driver shifts elsewhere.

The 2015 World Development Report, Mind, Society and Behavior, thus points to the need to understand the motivations and behavioral characteristics of different players, such as politicians and government bureaucrats, and how these affect their decisions and actions. The WDR argues that such an understanding helps design policy interventions and reforms that stand a chance of success even in seemingly intractable situations.

This brings us to a third way of reform, less common but potentially more powerful – one that is driven by the middle tiers of bureaucracy. Reforms initiated in the trenches enjoy, almost by definition, the commitment of those responsible for implementation. Reforms may also be better designed, since the officials know exactly what is feasible and where there are pitfalls. A single bottom-up reform may not be very bold.  But one reform may lead to another, and the cumulative impact may make a big difference.

Donor programs usually don’t regard mid-level officials as key drivers of reforms. It is often assumed that such officials will oppose reforms and they should thus be bypassed or, at best, co-opted in some fashion. Such assumptions lead to many lost opportunities. Mid-level officials can often be good initiators of reform if they are properly inspired and engaged. The attitudes and perceptions of this important tier of the bureaucracy have an important bearing on the formulation of policies and regulations, as well as on their implementation. These attitudes are shaped by an awareness of business-related issues, or a lack of it.

Celebrating a steep poverty drop in Bangladesh

Donna Barne's picture

Bangladesh Prime Minister Sheikh Hasina and World Bank Group President Jim Yong Kim celebrated Bangladesh’s dramatic progress fighting poverty on End Poverty Day, October 17, at a special event in the heart of Dhaka.

 © Dominic Chavez/World BankMore than 20 million people have lifted themselves out of poverty in Bangladesh in the last two decades. By 2010, the extreme poverty rate fell to 18.5 percent, down from 33.7 percent in 2000.
 
Speaking in the Bangla language, the prime minister said Bangladesh’s journey has never been smooth, but strong leadership and the resilience of the population have helped it become a lower middle income country and a model for others to imitate.

Competitive cities for jobs, growth, poverty reduction and shared prosperity?

Soraya Goga's picture
Photo by ecuadorpostales via Shutterstock

We are all aware of the statistics: cities are home to more than 50% of the world’s population, and they are growing so fast that 66 out of 100 people on earth will be urban dwellers by 2050. This, of course, will have major implications for people and poverty, climate change, and service delivery.
 
But did you also know that cities are the key drivers of global and national economic growth?
 
Currently, cities generate more than 80% of global GDP. Since the early 2000s, three-quarters of the world’s 750 largest cities have grown faster than their national economies. One of the key reasons for those cities’ success is higher productivity—as a result of their ability to attract skilled workers—as well as a high concentration of productive entrepreneurs and firms.
 
For decades, national and city leaders have also taken actions to build competitive cities, increasingly facilitating firms and industries to create jobs, raise productivity, and increase incomes over time—especially for the urban poor. They see this as the pathway to eliminate extreme poverty and to promote shared prosperity. This is particularly important in Sub-Saharan Africa and South Asia, where most of the world’s extreme poor live.

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