Author Archives: CGDev

A Healthy Dose of Good News in Global Health

Good news stories in global health rarely dominate the headlines; it can be easy to lose sight of the progress being made by global health investments and efforts around the world. So I was pleased that Science Magazine chose to report on some of the case studies from CGD’s forthcoming book Millions Saved (third edition) in their recent special issue on global health. These cases document large-scale efforts in low- and middle-income countries that have successfully improved health and saved lives (and they have evidence to back them up).

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“We Are Running Out of Time” – A Letter from the Front Lines of Ebola

The US Government has taken action to respond to the devastating Ebola epidemic in West Africa: about 100 CDC staffers have been deployed, $100 million spent on medical supplies and training, and an additional $75 million planned for 1,000 beds and 130,000 protective suits. But unfortunately these resources aren’t reaching Liberia and other affected countries quickly enough to slow the spread of the disease. Engineers, logisticians and biohazards specialists are urgently needed to move quickly.

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Harmonizing Global Health Data Collection: We’re Detecting a Pulse!

Another year, another attempt at harmonizing global health data collection. This time around, the effort comes from a multiagency working group comprised of representatives from donor agencies and international organizations, in collaboration with IHP+.

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Three Illicit Flows Targets for the Post-2015 Framework

money

There is broad consensus on the need for the post-2015 successor framework to the Millennium Development Goals to respond to the challenge of illicit financial flows (IFF). Typically IFF involve the hidden movement of profits, hidden transfers of ownership, or hidden income streams. The main motivations are tax evasion (corporate and individual); laundering the proceeds of crime (largely human trafficking and drug trafficking); and corruption (including the theft of state assets and the bribery of public officials).  Current proposals reflect the need for international action to counter IFF, since the damage done by IFF in one jurisdiction is typically dependent upon the financial secrecy provided by another. But they are framed only at the most general level in terms of reducing IFF (without saying who should do this, or how), or of “international support to improve domestic capacity for tax collection” (without outlining the international obstacles that prevent domestic progress).

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Death and Poverty Are Avoidable; Tobacco Taxes Shouldn’t Be

“Death and poverty are avoidable, but not tobacco taxes.” With this challenging statement, Prabhat Jha, Founding Director of the Centre for Global Health at St. Michael’s Hospital in Toronto laid out the most simple, cost-effective, and powerful intervention for charting a healthier future. Dr

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Unpacking WHO’s Shocking Ebola Maps–Mead Over

As the Ebola epidemic continued to spread in West Africa, with more than 3,000 cases and 1,500 deaths, I invited CGD senior fellow Mead Over, a health economist and one of the world’s top experts on the economics of HIV/AIDS, to discuss newly released maps from the World Health Organization (WHO) and measures for limiting the economic fallout from the epidemic.

“Ebola is much more like Avian Flu and SARS than AIDS,” Mead tells me. Its gestation period is very rapid, and that stirs a panic that creates an economic impact.

In the case of the SARS epidemic, he notes, there were only about 800 deaths but the economic impact of reduced trade, tourism and investment was estimated at about $40 billion—the equivalent of $50 million per death.

In the case of the Ebola epidemic, where cases will far exceed those of SARS, the economic impact could be far greater, he says.

He emphasizes however that the Ebola epidemic so far is tiny compared to the toll of malaria, tuberculosis, and HIV, “all of which are many multiples more deadly on a continuing basis.”

Our conversation then turns to two maps that the WHO released late last week, one showing the location and spread of the Ebola virus (Figure 1), the other showing the location of laboratories and treatment centers (Figure 2). 

Figure 1:  Location of cases throughout the countries with most intense transmission

Location of cases throughout the countries with most intense transmission

Figure 2: Response Monitoring

Response Monitoring

These maps are very helpful to those of us who are trying to grasp what’s happening in real time in West Africa. What they show is that we have a long way to go, Mead says.

He adds that it is “shocking” how few laboratories able to confirm the diagnosis are shown in the map. While there may be some additional laboratories that are not shown, the WHO maps are presumably the best information available, so either the data or the labs themselves are alarmingly lacking.

“Labs are necessary to confirm a diagnosis of Ebola. The inability to confirm a diagnosis makes it much harder for the physicians and nurses to protect themselves. It means there’s a need to quarantine people who would not otherwise need to be quarantined. And quarantining is extremely difficult,” he explains. 

Released along with the two maps last week was WHO’s “Ebola Response Roadmap” which outlined steps for affected countries and the international community to contain the epidemic. 

WHO projects that if all recommended measures are taken the epidemic may be contained within 6-9 months with perhaps more than 20,000 cases.

Noting that most of the cases shown on the WHO map are recent, Mead says that the toll may be much higher.

“That’s an indication that this epidemic is growing very rapidly in the countries of Liberia, Sierra Leone, and Guinea. The reported cases do not seem to be close to the border of Senegal or Guinea-Bissau, but there are cases close to the borders of Mali and Cote d’Ivoire,” he says.

So while this epidemic has been confined primarily to three countries, the governments of Cote d’Ivoire, Mali, and Guinea-Bissau are all on the alert.

“There’s a need for all those countries to strengthen their health infrastructure at the borders,” Mead says.

Mead concludes by discussing the international community’s response to minimize the economic fallout, an issue he addresses in greater detail here

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Five Steps to Reduce the Economic Impact of Ebola

It’s too early to know how large the economic impact of Ebola will be on West Africa and the world. Past experience, including the 2002-03 Severe Acute Respiratory Syndrome (SARS) epidemic, suggest it could be very large indeed, especially in the African countries that have been hardest hit. Fortunately, actions that the US and other donor countries take now could help not only to control the epidemic but also to minimize the economic fallout.

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Post-2015 Development Goals Need to Address Migration

World map

Government officials across the world will sit down in conference rooms over the next year to rebuild the global development policy agenda. For the last 14 years their lodestar has been the Millennium Development Goals or MDGs. Those goals will expire next year. As you read this, the United Nations is running a vast process to write the sequel, a new set of global development policy goals for many years to come. Something surprising and exciting is germinating in that process

Posted in Aid & Development, Featured Content, General Global Health, Human Rights, MDGs, Policy & Systems, Politics, Poverty, SDGs | Tagged , , , , , , | Comments closed

Data Revolution from the Bottom-Up

Data revolutionaries around the world (myself included) are using every forum possible to call for more and better data that is disaggregated, produced more frequently, more open, and more useable. Recently, my colleague Alex Ezeh at the African Population and Health Research Centre wrote me: “We cannot address data system challenges in Tanzania or Nigeria by holding high level meetings in New York or London.” He’s right: The path to more, better, timely, and open data starts with strengthening country governments’ core data collection, analysis, and use, whether it’s routine economic statistics or sustainable development goals. Country action should drive the revolution, bottom-up not top-down.

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One Lesson for Ebola from HIV: Donors Must Help Protect Health Workers

As the Ebola epidemic in West Africa endures, some parallels are being drawn between the virus and HIV/AIDS.  Both are spread by quite specific human behavior which is under conscious control: HIV by unprotected sex, Ebola by unsanitary burial practices, and both by contact with the bodily fluids of an infected person.

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A Surprising Indigenous View of REDD+ – Mina Setra and Frances Seymour

Mina Setra, the deputy secretary general of the Indonesia’s Indigenous Peoples’ Alliance of the Archipelago (AMAN), recently visited CGD to speak at an event about Indonesia’s efforts to prepare to participate in REDD+, the UN program for Reducing Emissions from Deforestation and Forest Degradation that would offer payments from rich countries to keep tropical forests standing. Afterwards I invited Mina and CGD senior fellow Frances Seymour, the former head of the Center for International Forestry Research to join me on the Wonkcast. Our controversial topic: the complex relationships linking Indonesia’s forests, its indigenous peoples, and REDD+.

REDD+ aims to provide incentives for forest protection. That’s nothing new to Indonesia’s 70 million indigenous peoples, who, Mina tells me, “have been protecting the forests for decades” because “for us, for indigenous peoples, forests are everything.”

Though much of Indonesia’s land has belonged to and been managed by indigenous peoples for centuries, formal documentation of such ownership has typically been lacking. Mina tells me about a 1999 forestry law that claimed traditional indigenous forest as “state forest” to be managed by the ministry of forestry. As a result Indonesia’s indigenous peoples lost millions of hectares to individuals and corporations that seized control and cleared or otherwise degraded the forest through logging or conversion to palm oil plantations. Mina says that the subsequent displacement of many indigenous peoples “created a lot of problems, not only that we lost our forests but further economic and social problems.”

Frances recalls that when she first arrived in Indonesia some 25 years ago, “indigenous peoples were not only invisible, but to talk about indigenous peoples’ rights was a taboo.” Although indigenous people were recognized in the constitution, they did not have any actual operational rights to their traditional lands, she says, adding that conversations about such rights only began to gain momentum three or four years ago.

AMAN had tried to raise the issue of indigenous peoples’ rights nationally without success, Mina said. It was only when “the international community started talking about forests and REDD+ that we had the opportunity to show that we do exist,” she added. “When talking about forests, you cannot escape talking about the people who have been living there nurturing the forests since even before Indonesia existed.”

Related Blogs

Indigenous Peoples Rights and Redd+ by Frances Seymour

Not everybody views REDD+ so favorably. Indeed, a lively debate about the impact of REDD+ on indigenous land rights continues, as Frances explains in a new blog post marking the International Day of the World’s Indigenous Peoples. Some people continue to worry that payments for forest protection envisioned by REDD+ will provide yet another reason for outsiders to push indigenous people out of their forest homes.

“The change in positioning of indigenous groups in recognizing REDD+ as having elements of opportunity and not just threat” is quite recent, says Frances. One reason: REDD+ programs developed in consultation with indigenous peoples, such as Indonesia’s ongoing national mapping initiative.

The maps give indigenous groups the opportunity to prove the legitimacy of their land claims, and Mina hopes it will continue to grow. “We hope that in 2022, we can map forty million hectares of indigenous territories all over Indonesia, as evidence that we do exist,” she says.

However, the continued success of the REDD+ programs depends on international support, Frances explains. With the noticeable exception of Norway, this has yet to happen.

Listen to the full Wonkcast for more on indigenous efforts to be recognized in Indonesia and how Mina and Frances view the interaction between indigenous people’s rights and the global effort to reduce protect forests and thereby reduce the emission of heat-trapping gases.

My thanks to Kristina Wilson for recording and editing the Wonkcast and to Kristin Sadler for a first draft of this blog post. 

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Is PrEP Cost-Effective?

As we predicted, this year’s International AIDS Conference featured several presentations on pre-exposure prophylaxis, or PrEP. But more attention at the conference was devoted to UNAIDS’ new treatment target, referred to as “90-90-90”[1], which proposes to triple the number of people on antiretroviral treatment by 2020.  In this context, the cost-effectiveness of PrEP in comparison to plausible alternative HIV interventions is a crucial consideration.  When treatment advocates are calling to bring the number of HIV-infected people on ARVs from 9 to 28 million in just five years, can use of these same drugs for the uninfected be justified?  Research points to some specific contexts where PrEP may be cost-effective. At the TasP workshop in Vancouver, we learned that in KwaZulu-Natal—a province in South Africa with high HIV incidence and prevalence rates—oral PrEP for young women can be cost-effective compared to a threshold of per capita GDP, through the presentation of a mathematical model by Roger Ying and Connie Celum from the University of Washington’s (UW’s) International Clinical Research Center (ICRC).  Ying et al.

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CGD Hosts Advocates at Girl Summit Satellite

(We hope that listeners who normally download the Wonkcast audio feed will find this video-rich blog post of interest!)

Nearly 200 practitioners and advocates gathered at CGD recently for an update on efforts to end within a generation female genital mutilation (FGM) and child, early and forced marriage. A satellite event for a Girl Summit in London hosted by British prime minister David Cameron and UNICEF, the CGD event was organized in conjunction with British Embassy, Girls Not Brides USA, and the Coalition for Adolescent Girls.

Welcoming the audience to the Birdsall House, CGD president Nancy Birdsall said that she had agreed to name the conference center in her honor provided that it serves not only as a space for presenting CGD’s own work but also as “a welcoming venue for the community concerned with women and development and gender equality.” She described CGD’s previous work on girls’ health and education (see here, here and here) and said that CGD senior fellow Charles Kenny is leading efforts to “find where we can have value added to an incredibly rich body of policy work and research.”

Patrick Davies, deputy head of mission at the British Embassy, then described the Summit’s core themes: “Sharing What Works” and “Agreeing an Agenda for Change.” Quoting from prime minister Cameron’s remarks at the London event, Davies said: “It is absolutely clear what we are trying to achieve. It such a simple, but noble and good ambition, and this is to outlaw the practice of female genital mutilation and early and forced marriage; to outlaw them everywhere, for everyone within a generation.”

The first panel, on Sharing What Works, was moderated by Judithe Registre, PLAN International USA, Coalition for Adolescent Girls Steering Committee, and featured:

  • Ann Warner, Senior Gender and Youth Specialist, International Center for Research on Women (ICRW), Representative, Girls Not Brides, who highlighted ICRW strategies to help end child marriage: (1) providing social support and education to girls who are at risk of early marriage and who are already married, and (2) working with girls’ families and communities as girls often don’t have the power to control their own futures. Warner announced ICRW and the World Bank will be conducting a three-year study to define the economic costs of child and early forced marriage.
     
  • Antonia Kirkland, Legal Advisor, Equality Now, stressed that ending FGM—which she said affects an estimated 3 million girls each year—is a human rights issue. While enforcement of laws prohibiting FGM can be a major deterrent, ending FGM will require further raising awareness and educating people about how they can help to prevent the practice.
     
  • Jeanne Smoot, Senior Counsel for Policy and Strategy, Tahirih Justice Center, described a 2011 US national survey of 500 teachers, police officers, domestic violence advocates and social workers, which revealed 3,000 cases of forced marriage had been encountered in the US. She announced that the Tahirih Justice Center, in collaboration with a partner in Canada, will be launching a major outreach tour this September in New York.

Between panels, a brief video of UN General Secretary Ban Ki Moon from the London event was shown. Secretary Ki Moon called for the end of FGM and early and child forced marriages and commended “global leaders and brave activities for confronting these problems, especially the courageous young women in these affected communities.”

The second panel, on Agreeing an Agenda for Change, focused on UK and US governments’ commitments to help end FGM and early and forced marriages. The panel was moderated by Rachel Vogelstein, Director of Women and Girls Programs, Clinton Foundation, and featured:

  • Emma Wade, Counsellor of the Foreign and Security Policy Group, British Embassy, who shared the UK government’s efforts, including donating $50 million to support 17 African countries to end FGM, $40 million to a joint UN program around ending child marriage, and $50 million to a new research program to find the best ways of transforming the lives of poor girls. Domestically, the UK has established and is enforcing relevant laws to provide the legal framework to address such issues and prime minister Cameron has committed $2.4 million to a prevention and care initiative.
     
  • Carla Koppell, Chief Strategy Officer and former Senior Gender Coordinator, US Agency for International Development, underscored that an integrated framework to ending FGM and child marriage – i.e., one that includes the education, health, legal and economic sectors – is critical to USG efforts. She also reiterated USAID administrator Raj Shah’s announcements from the London event, highlighting that the USG has committed to investments in Nepal, Bangladesh, and Yemen that will build on existing programs and complement efforts to change behaviors and attitudes and enforce laws surrounding FGM and child marriage.
     
  • Wanda Jones, Assistance Secretary for Health, Department of Health and Human Services, noted that data on the prevalence of FGM and child marriage in the US has been extremely limited. Efforts to raise awareness and build accountability for these issues in the US are just beginning, she said.

You can watch a video of the entire event here. To learn more about FGM and child and early forced marriages, and to sign the Girl Summit pledge, visit girlsummitpledge.com.

 

 

 

 

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A TPPing Point on Trade? – Harsha Singh

TPP? TTIP? In the world of trade negotiations, there is no shortage of acronyms. And who better to break them down for us than Harsha Singh, former deputy director general at the World Trade Organization? Harsha recently visited CGD to join Kim Elliott in leading a roundtable to discuss with other trade experts the implications of these proposed mega-regional trading blocs for developing countries. After the roundtable, I invited Harsha to join me on the Wonkcast to explain the development implications of these trade deals to interested non-experts, with a particular focus on the impacts of smaller, poorer countries who are unlikely to be included.

Proposals for the Trans-Pacific Partnership (TPP) and the Transatlantic Trade and Investment Partnership (TTIP) arose in part out of frustration with the World Trade Organization’s Doha Round, Harsha explains. (The TPP is proposed to include the United States, Canada, Mexico, Peru, Chile, Australia, New Zealand, Brunei, Singapore, Vietnam, Malaysia, and Japan; TTIP would include the United States and the EU.)

The TPP and TTIP aim to enhance trade and investment among members, but they could also pose huge challenges for small, poor countries that find themselves excluded, he says. One of the primary concerns “is the diversion of markets away from their products to those who get preferential treatment as members of these mega-regionals.” Harsha says that while most of the focus has been on tariff preference erosion, nontariff barriers to market access may pose a much more serious problem. 

“The important thing is not just meeting the standards, but also the system which is used to determine that the standard actually is consistent with what is being demanded,” Harsha explains. “That system can often be exclusionary.”

For more on these issues, read Kim Elliott’s account of the roundtable discussion and listen to the Wonkcast. Among the topics we tackle: the impact of the mega-regional trade deals on the big emerging market economies, Brazil, China, and India, and the global value chain for an iconic 21st century product: the iPhone.

My thanks to Kristin Sadler for a first draft of this blog post and to Kristina Wilson for recording and editing the Wonkcast. 

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