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Health

Women of action in Sudan

Kavita Watsa's picture

Working in development, there are some faces you never forget because they come back to you at the end of a long day, time and again. As we recognize International Day of Action for Women, I’ve been thinking about some of these faces from a recent trip to Sudan. Faces of young women who are doing community work that is so important, it is really in a league of its own. I’d like to dedicate this “day” to these women of action, the young graduates of village midwife schools in eastern Sudan.

The doorway to the midwives school in Kassala, a town close to the Red Sea, leads you into a small courtyard crowded with beds, belongings, and cooking utensils gently baking under the desert sun. Passing through this open air dormitory, another door opens into a classroom, in which a group of about twenty young women dressed in soft white are listening to a lecture that involves plenty of gesticulating and a plastic model lying on a bed. These students have already qualified as midwives and are now in town to learn more advanced skills that they can take back to their villages in a few months.

Circumcision and smoking bans: Can policies nudge people toward healthy behaviors?

Patricio V. Marquez's picture

The scaling up of voluntary medical male circumcision, particularly in high HIV prevalence settings, is a highly cost-effective intervention to fight the epidemic—randomized controlled trials have found a 60% protective effect against HIV for men who became circumcised.

But, the supply of this medical service is just one part of the picture. Without active involvement from individuals and communities to deal with social and cultural factors that influence service acceptability, the demand for this common surgical procedure will be low.

Indeed, on a recent visit to Botswana, a country with high HIV prevalence and low levels of male circumcision, my World Bank colleagues and I had a good discussion with the National HIV/AIDS Commission about ways to address the low uptake of voluntary, safe male circumcision services in spite of a well-funded program by the government. It was obvious to all that if the demand for, and uptake of, this service were not strengthened through creative mechanisms that foster acceptance, ownership, and active participation of individuals and community organizations, the program would not help control the spread of HIV through increased funding of facilities, equipment, and staff alone.

So, what do we need to do to ensure that need, demand, utilization, and supply of services are fully aligned to improve health conditions?

Food and nutrition: How do we balance the equation?

Leslie Elder's picture

Although the world produces a surplus of food, we have yet to achieve the right balance between the production of food and achievement of good nutrition. A new World Bank-hosted knowledge platform will generate better understanding of the links between agriculture, food security and nutrition, to help countries reach the Millennium Development Goal on hunger (MDG 1). Read more on the SecureNutrition blog.

Maternal mortality: Why have some regions seen progress while others struggle?

Samuel Mills's picture

New estimates released today by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), and the World Bank show that the number of women dying due to complications in pregnancy and childbirth has almost halved in 20 years—from more than 540,000 in 1990 to less than 290,000 in 2010.

This is good news, but it doesn’t tell the whole story. While substantial progress has been achieved at the global level, many countries, particularly in sub-Saharan Africa, will still fail to reach the Millennium Development Goal (MDG 5) target of reducing maternal mortality by 75% from 1990 to 2015.

Tobacco Kills: So what to do in Africa?

Patricio V. Marquez's picture

The scientific evidence is overwhelming. As Robert Beaglehole and colleagues at the World Health Organization (WHO) pointed out years ago, tobacco is the only consumer product that eventually kills half of its regular users if they follow its manufacturers’ recommendations.

Photo Credit: By AdamCohn, Flickr Given this dire reality, it is clear that Africa is now at a crossroads. On one hand, the countries in this region have become an attractive and under-tapped market as tougher regulations, high taxes, and greater consumer awareness of the dangers of smoking in developed countries are “closing the door” to tobacco imports and leading to significant drops in consumption. And on the other hand, cigarettes are becoming increasingly affordable as incomes rise in several African countries due to the rapid economic growth of recent years. Indeed, African countries are experiencing the highest increase in the rate of tobacco use amongst developing countries--the number of smokers in sub-Saharan Africa is projected to increase 148 percent by 2030, to 208 million smokers or one-fifth of the total population.

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

Maryse Pierre-Louis's picture

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.

Justice in health care delivery: a role for Sierra Leone’s paralegals

Margaux Hall's picture

I recently attended a community paralegal training on promoting accountability in health care delivery in Makeni, Sierra Leone. During the training, a community paralegal named Elizabeth Massalay talked about bringing her niece to a clinic in Moyamba district to receive immunizations that the government provides free of charge thanks to the Free Health Care Initiative (FHCI), which offers free health services to pregnant and breastfeeding women and children under five. Mothers queued for free immunizations, painting a hopeful picture for a country that ranks 180 out of 187 in the 2011 Human Development Index and where almost one in three children die before reaching the age of five.

However, against this promising backdrop, Elizabeth saw that the nurse was demanding six cups of rice from each mother before providing the immunization. Elizabeth was witnessing how breakdowns within state institutions—including absent nurses, improper user fees, and “leakage” of up to 30% of FHCI drugs (according to government and UNICEF statistics)—undermine health care delivery. Responding to such breakdowns requires an understanding of health policy and regulations—what the state must provide and to whom—and knowing where and how to apply pressure when the state fails to do so.

A Story of hope from Kangemi

Miriam Schneidman's picture

“Tuberculosis was a silent killer a few years ago,” says Rogers, a community health worker at the Kangemi Health Center, which assists people living with TB to receive effective treatment in a sprawling settlement on the outskirts of Nairobi.

Peninah, a mother of four, in Kangemi, Kenya Community health workers like Rogers are a vital link between patients and medical providers and are well respected and trusted. They educate, enlighten, and empower patients and people in the wider community. They work with the local area chiefs in mobilizing communities in the fight against TB. Rogers proudly notes that he actively identifies TB cases, provides home-based care, and traces people defaulting on treatment, all critical elements in managing TB at the community level.

Detection and management of TB are critical in Africa, where roughly a quarter million TB deaths were reported in 2010. The continent accounts for about one-quarter of the global TB burden and is facing challenges in meeting the Millennium Development Goal of reducing 1990 TB mortality rates by half by 2015. However, there is also reason for hope on TB control in Africa, as seen in communities like Kangemi. In Kenya, with support from government and partners, including the World Bank (Health Sector Support Project, Total War Against HIV/AIDS Project, East Africa Public Health Laboratory Networking Project), activities are underway to strengthen the availability of drugs, channel funds directly to lower level health centers , and improve access to the latest diagnostic tools for detecting TB. “The state-of-the-art diagnostics will go a long way to turn the tide on this pandemic,” notes Lucy Chesire, Executive Director of the TB Action Group in Nairobi. “Patients will no longer wait months to get results.”

'All People Want to Do Is Live Their Lives'

Elizabeth Howton's picture

"All people want to do is live their lives." Dr. Suneeta Singh made that simple yet powerful statement during a panel discussion on “Empowering Gender Minorities in South Asia” on March 14, 2012 at the World Bank. Singh, a former Bank staffer and CEO of consulting firm Amaltas, spoke via videoconference from Delhi, India, while Nepal’s first openly gay elected official, Sunil Babu Pant, dialed in from Kathmandu. World Bank panel discussion on gender indentity in South Asia

Pant told the story of how he built a grassroots movement of gay, lesbian, bisexual and transgendered (GLBT) people in Nepal, beginning in 2001. A turning point was in 2007, when the Supreme Court ruled that gay and transgendered people “are natural” and mandated certain benefits and an end to discriminatory laws. Today, the country is drafting a new constitution, and Pant said that if passed, it will be one of the most progressive in the world with regard to the rights of sexual and gender minorities.

A recipe for good health: safe water and sanitation

Patricio V. Marquez's picture

Also available in: Français, 中文

On the eve of World Water Day (March 22), there is some good public health news that is unrelated to medical care for the “sick,” but to a critical investment that makes people healthier and more productive, and promises a higher quality of life, particularly among the poor.

The 2012 UNICEF/World Health Organization report, Progress on Drinking Water and Sanitation, says that at the end of 2010, 89% of the world’s population, or 6.1 billion people, had access to improved drinking water. This means that the related Millennium Development Goal (MDG) has been met well ahead of the 2015 deadline. The report also predicts that by 2015, 92% of people will have access to better drinking water.

But, the not-so-good news is that only 63% of the world has improved sanitation access, a figure projected to increase only to 67% by 2015, well below the 75% MDG aim. Currently 2.5 billion people lack improved sanitation. The report also highlights the fact that the global figures mask big disparities between regions and countries, and within countries (e.g., only 61% of the people in Sub-Saharan Africa have access to safe water).

Filling empty stomachs: when enough food is not enough

Leslie Elder's picture

Save the Children’s recent report, A Life Free from Hunger: Tackling Child Malnutrition, reminds us that undernutrition is not a new crisis—and that the crisis will deepen if the global community fails to take serious action. If current trends persist, 11.7 million more children will be stunted in Sub-Saharan Africa by 2025, compared to 2010.

What can we do? Food is part of the answer, but it’s about the right food, at the right time—not just starchy staple foods that fill empty stomachs. According to Save the Children, more than half of children in some countries are eating diets of just three items: a staple food, a legume, and a vegetable (usually green leaves).

Availability of food and access to food are necessary but insufficient to ensure good nutrition. Insidiously, malnutrition (undernutrition) is not hunger, although malnourished children are often hungry. And undernutrition is frequently invisible, but increases the risk of child death; steals children’s growth; decreases cognitive potential, school performance, and adult productivity; and contributes to the development of non-communicable diseases later in life.

AIDS: translating scientific discoveries into sustainable, affordable programs

David Wilson's picture

We’re entering a phase where AIDS is moving from emergency crisis financing to sustainable development financing—which is a major challenge, but one that we’re continuing to tackle, with the goal of stronger national ownership and responsibility.

One of the Bank’s international mandates is to support countries to develop better national health plans and budgets. Today, the Bank released an important study, The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda, which is a part of this mandate. The study helps countries do the long-range planning that we so desperately need in HIV programs.

The Bank has a long-established partnership with ministries of finance and planning, and we understand country systems. We stand ready to help countries integrate HIV into their programs and plan for it in a sustainable way.

We’ve seen extraordinary progress in AIDS. Today, we have more antiretroviral drugs to treat HIV than every other virus in history combined. We’ve reduced treatment costs from tens of thousands of dollars to as little as $100. And we’ve expanded our understanding of effective HIV prevention, including the role of male circumcision and the important role that treatment can play in prevention under the right circumstances.

Many of us involved in HIV remember the days when 70% of beds in health facilities in Africa were occupied by people with AIDS. Our successes in treatment and prevention have removed this specter and have allowed health systems to focus on other important health priorities.

Les « Maman Lumière » de Djibouti donnent l’exemple pour changer de comportement et améliorer la santé

Marie Chantal Messier's picture

Mothers discuss child rearing in Djibouti (credit: Marie Chantal Messier).

Nous étions assises sur des tapis de sol, dans la chaleur et la poussière du quartier Moustiquaire, le plus pauvre de Djibouti, pour parler des pratiques d’alimentation des enfants. Des voix se sont soudainement élevées dans le groupe. Plusieurs femmes insultaient et montraient du doigt l’une d’entre elles qui baissait honteusement la tête.

Mes homologues djiboutiennes m’ont expliqué que la femme embarrassée était critiquée parce que son fils ne parlait pas encore à 5 ans. Au lieu de donner de l’eau à boire à son nouveau-né comme le veut la tradition, elle avait choisi d’allaiter son dernier enfant au sein exclusivement jusqu’à l’âge de six mois. Le groupe pensait que ce choix expliquait les problèmes de développement de l’enfant.

Ma première réaction a été de me dire : « la pression du groupe est un véritable obstacle à la promotion des méthodes d’allaitement optimales à Djibouti ! »

Djibouti’s "Shining Mothers": Role models for behavior change, better health

Marie Chantal Messier's picture

Also available in: Français Mothers discuss child rearing in Djibouti (credit: Marie Chantal Messier).

We were sitting on floor mats in the hot and dusty Quartier Moustiquaire, the poorest neighborhood of Djibouti City, observing a group of new mothers and their children discussing child feeding practices. All of a sudden, there was an uproar in the group. One woman had her head bent down in shame, and several other women shouted and pointed fingers at her.

My Djiboutian counterparts told me the embarrassed woman was being criticized because her 5-year-old son still doesn’t speak. Rather than follow the ancestral tradition of giving water to her newborn, she chose to exclusively breastfeed her last child until he was 6 months old. The group asserted that this choice had led to the child’s developmental problems.

My immediate reaction to the scene was, “Peer pressure is a true obstacle to promoting optimal breastfeeding in Djibouti!”

2012 Social Media as a Tool for Citizen Feedback

Victoire Ngounoue's picture

More often than not, “we” criticize the “system” for being corrupt; yet it is simply a reflection of what we make of it. For example, what would happen if “we” decided never to collect bribes from users in our health service system? Or if we implemented and respected the rule of ‘first come, first served’ instead of paying or collecting bribes for faster service delivery? What would happen when it is brought to our knowledge that there are irregular practices operating within our health centers?

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