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Health

A path toward better health for India’s women

Parvati Singh's picture
 World Bank
In India, Members of a self-help group (SHG) like this one discuss women’s  health issues with female health workers. Credit: World Bank

A little over six years ago, Neelam Kushwaha’s first daughter was born weighing 900 gm at birth, severely underweight. Neelam went into labor while working at the local construction site in Jori village, Rewa, Madhya Pradesh, India. Many people work at such local construction sites in rural areas for daily wages ranging from INR 150-280 (about $2- 4$) per day. Her daughter Manvi, was preterm, and Neelam spent months recovering from child birth complications.

Three years later, when Neelam was pregnant with her younger daughter, Sakshi, she quit wage labor and sought employment at an incense manufacturing unit established by World Bank’s Madhya Pradesh District Poverty Intervention Project (MPDPIP) in 2011. At her new role, she earned more and did not engage in labor intensive work during the final months of her pregnancy. Sakshi was born a healthy 3 kilos.

In the course of my field work supported by South Asia Food and Nutrition Security Initiative (SAFANSI) in 2015, I came across several similar stories.

MPDPIP’s livelihood based approach offered several opportunities towards income supplementation for women self-help groups (SHGs) and rural households through agriculture, dairy/poultry farming and local enterprises, among others.

As evident by Neelam’s experience, MPDPIP’s benefits went beyond income and spilled over into health improvement as well.

I learnt that prior to MPDPIP, childbirth in hospitals was difficult due to prohibitively high costs of travel and hospital stay. Pre-existing government schemes such as the Janani Suraksha Yojana (JSY) offer about INR 1,400 ($20) to rural women who opt for hospital deliveries. However, this payment occurs post-partum, and pre-delivery costs have to be borne upfront by pregnant women.

Post MPDPIP, women were able to opt for hospital deliveries with greater ease due to access to credit from their SHGs. This is particularly relevant for Madhya Pradesh as it has consistently fared poorly with respect to institutional deliveries.

Local communities combat climate change in Bangladesh

Shilpa Banerji's picture
Mahfuzul Hasan Bhuiyan/World Bank
Bangladesh is among the most vulnerable countries to flooding and climate change impacts. Photo Credit: 
Mahfuzul Hasan Bhuiyan/World Bank

How can a country vulnerable to natural disasters mitigate the effects of climate change? In Bangladesh, resilient communities have shown that by using local solutions it is possible to combat different types of climate change impacting different parts of the country.
 
Every year, flash floods and drought affect the north and north-west regions. Drinking water becomes scarce, land becomes barren and people struggle to find shelter for themselves and their livestock. In the coastal districts, excessive saline makes it impossible to farm and fish.
 
The Community Climate Change Project (CCCP) has awarded grants to around 41 NGOs to address salinity, flood and drought-prone areas. With the help from local NGOs, communities innovated simple solutions to cope up with changing climate and earn a better living benefiting at least 40,000 people in the most vulnerable districts.
 
Raising the plinths of their homes in clusters has helped more than 15,000 families escape floods, and they continued to earn their livelihoods by planting vegetables and rearing goats on raised ground. Vermicomposting has also helped to increase crop yields. In the saline affected areas, many farmers have started to cultivate salinity tolerant crabs with women raising their income level by earning an additional BDT 1500 a month from saline tolerant mud crab culture in high saline areas.
 
Watch how communities use these three solutions to tackle climate change impacts.

A roadmap to reintegrate displaced and refugee Afghans

Shubham Chaudhuri's picture
Also available in: دری | پښتو
A displaced family has taken shelter in a ruined house on the outskirts of Kabul. Photo: Rumi Consultancy/ World Bank


As the world marks World Refugee Day on June 20, we must remember that it is not only the refugee crisis that is hampering development efforts in many countries. There is also a silent emerging crisis of people driven from their homes to another part of their own country, people known as internally displaced persons (IDPs). It is a growing issue that several countries are facing, with enormous social and political pressures to address.

In Afghanistan, there are an estimated 1.2 million people who are internally displaced because of insecurity or are being forced to leave their homes due to natural disasters. This is in addition to the nearly 6 million people who have returned to Afghanistan since 2002, making one in five Afghans a returnee. In 2016, more than 620,000 Afghans returned from Pakistan alone.

The massive influx of returnees and IDPs is placing tremendous pressure on Afghanistan’s already fragile social and economic infrastructure and is a threat to regional stability.

When I first took up my position as Country Director of the World Bank for Afghanistan, I was struck by the plight of returnees and IDPs and by how hard-pressed the Afghan government was in dealing with them. During my first days in office, back in November 2016, I visited a United Nations High Commissioner for Refugees (UNHCR) center on the outskirts of Kabul. The center serves as the first entry point for returnees where they can receive assistance—including cash—and attend awareness and safety sessions to help them better integrate in their new communities.  

Our commitment to the people of Afghanistan stays strong

Annette Dixon's picture
Also available in: دری | پښتو
Despite government efforts with support from the international community, Afghanistan's development needs remain massive. Photo Credit: Rumi Consultancy/ World Bank

I am still shaken and saddened by the many lives lost to the attacks in Kabul two weeks ago and since then there has been more violence. As we grieve these tragedies, now is the time to stand strong with the people of Afghanistan and renew our commitment to build a peaceful and prosperous country.

To that end, we announced this week a new financing package of more than half-a-billion dollars to help Afghanistan through its struggle to end poverty, increase opportunity to help stabilize the country, and ensure all its citizens can access basic services during a time of economic uncertainty.

Afghanistan has come a long way since 2001 and achieved much progress under extremely challenging circumstances. Life expectancy has increased from 44 to 60 years, maternal mortality has decreased by more than three quarters and the country now boasts 18 million mobile phone subscribers, up from almost none in 2001.

Yet, the development needs in Afghanistan remain massive. Nearly 40 percent of Afghans live in poverty and almost 70 percent of the population are illiterate. The country needs to create new jobs for about 400,000 people entering the labor market each year. The situation is made more challenging by the return of around 5.8 million refugees and 1.2 million internally displaced people.

Our new support is in line with our belief that Afghanistan’s economic and social progress can also help it address security challenges.  Our financing package meets the pressing needs of returning refugees, expands private-sector opportunities for the poor, boosts the development of five cities, expands electrification, improves food security, and builds rural roads.

New Zealand has much to offer the world

Annette Dixon's picture
 
New zealand - World maps on line
New Zealand Map.  Photo Credit: Academia maps GeoAtlas


When people think about New Zealand’s most famous son, Sir Edmund Hillary, they mostly think about the quiet Auckland bee-keeper who conquered Everest in 1953.

Of course, there’s much more to the man. He raised money for the Sherpa communities in Nepal that built schools, hospitals and much more. His commitment to the people of South Asia was also reflected in his successful term in the 1980s as New Zealand’s High Commissioner to India.

As the most senior New Zealander in the management of the World Bank, I have come to appreciate Sir Edmund’s commitment to the people of South Asia and believe it shows how much New Zealand can offer the world.  This will not only make the world a better place but can also help New Zealand too.

The unheard voices of women caregivers for people with mental illness

Varalakshmi Vemuru's picture
SHG meeting of people with mental illness and caregivers. (Photo: TNMHP)

Thirty-year old Vijaya (name changed) spent 10 years of her life not talking to anybody. Her parents were daily wage laborers, scraping together a sparse living in India’s southern state of Tamil Nadu. Unaware of any treatment, and afraid of being stigmatized or shunned by their community, they did not disclose their daughter’s illness to anyone. Instead, Vijaya suffered in silence, confined to the house, and hidden from public view.
 
It was only when the Tamil Nadu government’s Mental Health Program (TNMHP) reached out to their community that Vijaya’s life underwent a dramatic change. After six months of working with the program’s community facilitators, Vijaya’s parents took her for treatment, and within a year, the young woman began interacting with others more frequently.
 
Poor mental health places a huge burden on individuals, families, and society. From developed countries to emerging market economies, mental disability – ranging from common mental disorders such as depression to severe mental illnesses and retardation – has profound impacts on people’s economic and social well-being.
 
As cited in “Out of the Shadows: Making mental health a global development priority” in 2010 alone, depression cost an estimated US$800 billion in lost economic output. What’s worse, these costs are expected to double by 2030.
 

Celebrating 15 Years of reengagement in Afghanistan

Raouf Zia's picture
Also available in: دری | پښتو




Shortly after the Soviet invasion in 1979, the World Bank suspended its operations in Afghanistan. Work resumed in May 2002 to help meet the immediate needs of the poorest people and assist the government in building strong and accountable institutions to deliver services to its citizens.

As we mark the reopening of the World Bank office in Kabul 15 years ago, here are 15 highlights of our engagement in the country:

In India, eliminating tuberculosis isn't just a health issue — it's an economic one

Jorge Coarasa's picture



On February 1st, India’s finance minister presented the Union Budget for 2017-2018, and announced the government’s plan to eliminate tuberculosis (TB) by 2025. This is a welcome move. While ridding people of the burden of any disease is a worthy goal by itself, TB elimination provides perhaps one of the strongest cases for public intervention from an economic point of view.

All communicable diseases present what economists call externalities: infectious people can infect other people who in turn infect others and so on. In fact, economist Phillip Musgrove used TB in particular to illustrate this: “no victim of tuberculosis is likely to ignore the disease, so there is no problem of people undervaluing the private benefits of treatment. Rather, the cost of treatment--and the fact that they may feel better even though the disease has not been cured-- may lead people to abandon treatment prematurely, with bad consequences not only for themselves but for others. The rest of society therefore has an interest in treating those with tuberculosis, and assuming at least part of the cost.” Reducing TB incidence could generate benefits of $33 per dollar spent, prompting The Economist to put TB among their list of ‘no-brainers’. According to the Stop TB Partnership, ending TB globally could yield US$ 1.2 trillion overall economic return on investment.

Women can play a greater role in realizing South Asia’s potential

Annette Dixon's picture
Mumbai Train
The suburban train system in Mumbai is used by millions of women and men everyday, who rely on safe transport to access education and job opportunities. 

Last week, I took a journey on Mumbai’s suburban train system, which carries a staggering 8 million women and men, equivalent to the entire population of Switzerland, every day to where they live, work, and spend time with family and friends. Although stretched, the system has reduced mobility constraints and increased independence for millions of women who rely on safe transport to access education and job opportunities; contributing to the city’s dynamism and growth. There are similarly inspiring examples from all countries in South Asia.

As we mark International Women’s Day, we celebrate the progress made in improving women’s inclusion and empowerment, while seeking to better address continuing challenges, which are estimated to cost South Asian economies $888 billion, through devising and implementing solutions that will bridge remaining gaps.

Much to be proud of­a lot more remains to be done

South Asian countries have seen encouraging increases in greater access and gender parity in education. At the same time, the region has achieved substantial decreases in maternal and child mortality. Countries have made great strides in healthcare access through training more female healthcare workers while providing affordable care for mothers and children. The region also boasts many inspiring female leaders and role models, as well as the countless individuals positively contributing to their communities and societies against difficult odds. 

However, much more needs to be done in order to nurture all women and men to realize their potential. As South Asian countries become more prosperous, their growth trajectory will be less assured if hundreds of millions of women remain excluded from education and employment opportunities. South Asian countries will need to substantially expand their workforce in order to meet their economic growth goals and, at the same time, adequately support their increasingly large populations. Studies show that only around 1 out of 4 women in South Asia participate in the labor force, about half of what is typical in middle-income countries in other regions. Too many women face restrictions in decision-making, mobility, public safety; and far too many experience gender-based violence—the most egregious cases making headlines around the world. What can help bridge these gaps?

In Bangladesh, changing behaviors for better health

Rokeya Ahmed's picture
A toilet in Chunarughat, Hobigonj reduces fecal contamination for this family (World Bank/M. Monir)
A toilet in Chunarughat in the Habiganj district in Bangladesh has helped reduce fecal contamination for Amena Begum and her family. Credit: World Bank/M. Monir

Amena Begum resides in a village in the Habiganj district in Bangladesh and is a mother to three young children.  Last year Amena spent US$100 to construct a toilet to ensure her three children were hygienically protected from feces.
 
Even though her family members have adapted to using the toilet, exposure to fecal contamination can occur anywhere.  For example, while playing outside, a child may accidentally ingest soil with animal feces, or the child could be exposed when he or she eats food off of dishes washed with pond water.  
 
It is also not uncommon for families without toilets to throw feces into a nearby bush, which remains exposed in their living area. These actions can lead to the contraction of hazardous, lethal diseases and create a traumatizing effect on the lives of many children, not to mention the unfavorable impact on the environment.
 
A new study on early childhood diarrhea in rural Bangladesh found that despite high on-site latrine access, frequent fecal contamination was present along all environmental pathways investigated. Human fecal markers on children’s hands and in soil, and rotavirus in stored water, soil and on hands had been detected. Animal (particularly ruminant) fecal markers were highly prevalent in water, soil and on hands.

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