Bangladesh: New initiative to combat malnutrition, anaemia

September 1, 2009 · 0 comments

DHAKA, 1 September 2009 (IRIN) – There have been mixed reactions to a private-public partnership to popularize a nutritional supplement known to reduce the incidence of anaemia in infants and young children.

The supplement, known as Sprinkles, is a blend of powdered micronutrients which, when sprinkled onto food, provides children with all the necessary vitamins and minerals.

Renata, a leading generic drugs manufacturer based in Dhaka, will produce, market and sell the food supplement alongside BRAC (Building Resources Across Communities), the biggest NGO in the developing world, and the Social Marketing Company (SMC), a not-for-profit enterprise.

But the cautious Bangladeshi government has declined to comment on Sprinkles or its promotion. Fatima Parveen Chowdhury, director of the government-run Institute of Public Health Nutrition (IPHN), explained that since Sprinkles is a new product, the government would only be in a position to comment once its effect on Bangladeshi children had been established.

Recent research indicates that Sprinkles can halve the incidence of anaemia in infants and young children.

The UN Children’s Fund (UNICEF) has endorsed Sprinkles but is not convinced that the market-based approach taken by Renata, SMC and BRAC can provide a satisfactory solution for poorer Bangladeshis.

“It is scientifically proven that Sprinkles can work against anaemia but if we only promote the sale of this product not everyone will have access to it,” said Josephine Ippe, nutrition manager with UNICEF in Bangladesh, which is piloting the free distribution of Sprinkles in a limited number of badly-affected districts.

Sprinkles costs around three US cents per sachet and has been available in Bangladesh since last year but, with no marketing or public information campaign, only one million sachets are currently sold every month in a country of more than 150 million people.

Bangladesh was hit badly by recent food price hikes and with the expanding population and food security issues, there has been a slowdown in the battle against malnutrition
Too expensive?

“The prevalence of anaemia is very high in rural areas and urban slums,” explained Ippe. “The vast majority of people cannot afford Sprinkles, even at two taka [three US cents] a sachet. Sprinkles needs to be taken every day or every other day, so that’s 30-60 taka a month, which is a lot of money for a poor family.”

Sales have hitherto been held back by the government’s decision to class Sprinkles as a drug, which means it can only be bought in pharmacies.

Bangladesh has two million children aged six months to five years suffering from acute malnutrition because of poverty, badly-balanced diets and poor infant-feeding practices, according to a recent study by the World Food Programme (WFP), UNICEF and the government’s Institute of Public Health Nutrition.

Surveys in early 2003 in Bangladesh found that anaemia, which is largely due to iron deficiency, affects about 50 percent of children under five, a level which denotes a severe public health problem, according to UNICEF.

“Iron deficiency is a massive problem here, with more than half of the children under-two suffering from anaemia,” Kaiser Kabir, chief executive of Renata, told IRIN at the company’s main production facility in Dhaka.

Progress in the fight against malnutrition has been mixed.

The proportion of underweight children under five fell from above 70 percent in the early 1990s to around 50 percent by 2000, Monira Parveen, head of WFP’s nutrition unit in Dhaka, explained, citing data from the Bangladesh Demographic and Health Survey.

However, since 2000, only small reductions have been achieved, with the latest survey from 2007 showing that 41 percent of children are still underweight.

“Bangladesh was hit badly by recent food price hikes and with the expanding population and food security issues, there has been a slowdown in the battle against malnutrition,” Parveen noted.

Earlier this year, UNICEF warned that the extent of child malnutrition in Bangladesh amounted to a “silent emergency” and that unless urgent action was taken, the country was unlikely to achieve and sustain the Millennium Development Goals.

The knock-on effects for the country’s fragile economy are severe, both in terms of increased healthcare costs and decreased productivity.

Public-private initiative

The new public-private initiative has been cultivated and part-financed by the Global Alliance for Improved Nutrition (GAIN), a Geneva-based nutrition advocacy organization.

GAIN will provide US$3m to Renata and BRAC to ramp up production of Sprinkles and launch a nationwide campaign to promote it in rural areas and slums.

SMC has also received funds from GAIN to push ahead with a social marketing drive which includes an interactive theatre group which visits 600 villages every month to educate the population about the benefits of home food fortification using Sprinkles.

The new food fortification initiative is very ambitious, with Renata hoping to nearly double sales of Sprinkles to 20 million sachets in the first year and hit 70 million by the second year.

Source – Sept. 1, 2009, http://www.irinnews.org/Report.aspx?ReportId=85954

SuSanA case studies on urban/peri-urban sanitation

September 1, 2009 · 0 comments

Below are links to selected SuSanA case studies:

- UDD toilets with reuse in allotment gardens, Cagayan de Oro, Philippines (PDF)

- Constructed wetland for a peri-urban housing area, Bayawan City, Philippines (PDF) – Draft version

- Blackwater and greywater reuse system Chorrillos, Lima, Peru (PDF)

- Use of reclaimed wastewater in agriculture Jordan Valley, Jordan (PDF)

- Co-composting of faecal sludge & organic solid waste, Kumasi, Ghana (PDF) – draft

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More information resources are on the Sustainable Sanitation Alliance website

Nov 7, 2009 – URBAN HEALTH IN DEVELOPING COUNTRIES: A MAJOR NEGLECTED AREA

September 1, 2009 · 0 comments

NOVEMBER 7, 2009 – URBAN HEALTH IN DEVELOPING COUNTRIES: A MAJOR NEGLECTED AREA – APHA COMMUNITY-BASED PRIMARY HEALTH CARE CAUCUS 2009 ANNUAL PRE-CONFERENCE WORKSHOP (PHILADELPHIA CONVENTION CENTER, PHILADELPHIA, PENNSYLVANIA)

This is the Annual Pre-Conference Workshop of the Community-Based Primary Health Care (CBPHC) Working Group of the International Health Section of the American Public Health Association (http://www.apha.org/membergroups/sections/aphasections/intlhealth/cbphcw).

It will be held on Saturday, November 7 from 8:30am to 5:00pm. The workshop leader is Diana Silimperi, Vice President of the Center for Health Services at Management Sciences for Health

Urban health in developing countries is a major neglected area of public health. In the near future, more than half of the world’s population will live in urban areas with most of this population living in underserved neglected urban slums in developing countries. The workshop aims to define the current status of urban health in developing countries, discuss what tools are currently used, and distinguish the particular needs of urban versus rural CBPHC. Using participant contributions the workshop will grapple with the problem issues encountered in public health in this urban setting and what solutions are needed to address these problems.

See http://www.ccih.org/bulletin/0809files/2009-CBPHCWorkshopAnnouncement.doc for more details.

To facilitate planning, pre-register by contacting Sandy Hoar at npaseh@gwumc.edu. A registration fee of $25 is payable onsite. For further information, contact Sandy or the Working Group Chair, Paul Freeman at freeman.p.a@att.net.

2008 & 2009 Urban health studies – African Population & Health Research Centre

August 28, 2009 · 0 comments

Below are citations and abstracts to 6 urban health studies by the African Population and Health Research Centre that were published in 2008 or 2009. Entries are arranged by publication date:

1 – Malar J. 2009 Jul 15;8:160

Fever treatment in the absence of malaria transmission in an urban informal settlement in Nairobi, Kenya.

Ye Y, Madise N, Ndugwa R, Ochola S, Snow RW.

African Population and Health Research Centre, Nairobi, Kenya. yyazoume@aphrc.org

BACKGROUND: In sub-Saharan Africa, knowledge of malaria transmission across rapidly proliferating urban centres and recommendations for its prevention or management remain poorly defined. This paper presents the results of an investigation into infection prevalence and treatment of recent febrile events among a slum population in Nairobi, Kenya.

METHODS: In July 2008, a community-based malaria parasite prevalence survey was conducted in Korogocho
slum, which forms part of the Nairobi Urban Health and Demographic Surveillance system. Interviewers visited 1,069 participants at home and collected data on reported fevers experienced over the preceding 14 days and details on the treatment of these episodes. Each participant was tested for malaria parasite presence with Rapid Diagnostic Test (RDT) and microscopy. Descriptive analyses were performed to assess the period prevalence of reported fever episodes and treatment behaviour.

RESULTS: Of the 1,069 participants visited, 983 (92%) consented to be tested. Three were positive for Plasmodium falciparum using RDT; however, all were confirmed negative on microscopy. Microscopic examination of all 953 readable slides showed zero prevalence. Overall, from the 1,004 participants who have data on fever, 170 fever episodes were reported giving a relatively high period prevalence (16.9%, 95% CI:13.9%-20.5%) and higher among children below five years (20.1%, 95%CI:13.8%-27.8%). Of the fever episodes with treatment information 54.3% (95%CI:46.3%-62.2%) were treated as malaria using mainly sulphadoxine-pyrimethamine or amodiaquine, including those managed at a formal health facility. Only four episodes were managed using the nationally recommended first-line treatment, artemether-lumefantrine.

CONCLUSION: The study could not demonstrate any evidence of malaria in Korogocho, a slum in the centre
of Nairobi. Fever was a common complaint and often treated as malaria with anti-malarial drugs. Strategies, including testing for malaria parasites to reduce the inappropriate exposure of poor communities to expensive anti-malarial drugs provided by clinical services and drug vendors, should be a priority for district planners.

2: Reprod Health. 2009 Jun 16;6:9.

Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services?

Fotso JC, Ezeh AC, Essendi H.

African Population and Health Research Center (APHRC), Nairobi, Kenya. jcfotso@aphrc.org.

BACKGROUND: Despite various international efforts initiated to improve maternal health, more than half a million women worldwide die each year as a result of complications arising from pregnancy and childbirth. This research was guided by the following questions: 1) How does women’s autonomy influence the choice of place of delivery in resource-poor urban settings? 2) Does its effect vary by household wealth? and 3) To what extent does women’s autonomy mediate the relationship between women’s education and use of health facility for delivery?

METHODS: The data used is from a maternal health study carried out in the slums of Nairobi, Kenya. A total of 1,927 women (out of 2,482) who had a pregnancy outcome in 2004-2005 were selected and interviewed. Seventeen variable items on autonomy were used to construct women’s decision-making, freedom of movement, and overall autonomy. Further, all health facilities serving the study population were assessed with regard to the number, training and competency of obstetric staff; services offered; physical infrastructure; and availability, adequacy and functional status of supplies and other essential equipment for safe delivery, among others. A total of 25 facilities were surveyed.

RESULTS: While household wealth, education and demographic and health covariates had strong relationships
with place of delivery, the effects of women’s overall autonomy, decision-making and freedom of movement were rather weak. Among middle to least poor households, all three measures of women’s autonomy were associated with place of delivery, and in the expected direction; whereas among the poorest women, they were strong and counter-intuitive. Finally, the study showed that autonomy may not be a major mediator of the link between education and use of health services for delivery.

CONCLUSION: The paper argues in favor of broad actions to increase women’s autonomy both as an end and as a means to facilitate improved reproductive health outcomes. It also supports the call for more appropriate data that could further support this line of action. It highlights the need for efforts to improve
households’ livelihoods and increase girls’ schooling to alter perceptions of the value of skilled maternal health care.

3: BMC Public Health. 2009 May 27;9:153.

HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey.

Kyobutungi C, Ezeh AC, Zulu E, Falkingham J.

African Population & Health Research Center, Nairobi, Kenya. ckyobutungi@aphrc.org

BACKGROUND: The proportion of older people is increasing worldwide. Globally, it is estimated that older people (those 60 years or older) constitute more than 11% of the population. As the HIV/AIDS pandemic rages in sub-Saharan Africa (SSA), its impact on older people needs closer attention given the increased economic and social roles older people have taken on as a result of increased mortality among adults in the productive age groups. Few studies have looked at older people and their health in SSA or indeed the impact of HIV/AIDS on their health. This study aims to assess the effect of being directly or indirectly affected by
HIV/AIDS on the health of older people in two Nairobi slums.

METHODS: Data were collected from residents of the Nairobi Urban Health and Demographic Surveillance
area aged 50 years and above on 1st October 2006. Health status was assessed using the short SAGE (Study on Global AGEing and Adult Health) form and two outcome measures–self-rated health and a composite health score–were generated. To assess HIV/AIDS affected status, respondents were asked: Have you personally been affected by HIV/AIDS? If yes, a follow up question: “How have you been personally affected by HIV/AIDS?” was asked. Ordinallogistic regression was used in models with self-rated health and linear regression in models with the health score.

RESULTS: About 18% of respondents reported being affected by HIV/AIDS in at least one way, although less than 1% reported being infected with HIV. Nearly 60% of respondents reported being in good health, 27% in fair health and 14% in poor health. The overall mean health score was 70.6 (SD: 13.9) with females reporting worse health outcomes than males. Respondents directly or indirectly affected by HIV/AIDS reported worse health outcomes than those not affected: mean health score: 68.5 and 71.1 respectively (t = 3.21, p = 0.0007), and an adjusted odds ratio of reporting poor health of 1.42 (95%CI: 1.12-1.80).

CONCLUSION: Poor health outcomes among older people affected by HIV/AIDS highlight the need for policies that target them in the fight against HIV/AIDS if they are to play their envisaged care giving and other traditional roles.

4: Matern Child Health J. 2009 Jan;13(1):130-7.

What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya.

Fotso JC, Ezeh A, Madise N, Ziraba A, Ogollah R.

African Population and Health Research Center (APHRC), P.O. Box 10787, 00100 GPO, Nairobi, Kenya. jcfotso@aphrc.org

OBJECTIVES: The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health
facilities.

METHODS: The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable.

RESULTS: Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy “wantedness”, and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women.

CONCLUSION: Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.

5: J Urban Health. 2008 May;85(3):428-42.

Provision and use of maternal health services among urban poor women in Kenya: what do we know and what can we do?

Fotso JC, Ezeh A, Oronje R.

Population Dynamics and Reproductive Health, African Population and Health Research Center (APHRC), Nairobi, Kenya. jcfotso@aphrc.org

In sub-Saharan Africa, the unprecedented population growth that started in the second half of the twentieth century has evolved into unparalleled urbanization and an increasing proportion of urban dwellers living in slums and shanty towns, making it imperative to pay greater attention to the health problems of the urban
poor. In particular, urgent efforts need to focus on maternal health. Despite the lack of reliable trend data on maternal mortality, some investigators now believe that progress in maternal health has been very slow in sub-Saharan Africa. This study uses a unique combination of health facility- and individual-level data collected in the slums of Nairobi, Kenya to: (1) describe the provision of obstetric care in the Nairobi informal settlements; (2) describe the patterns of antenatal and delivery care, notably in terms of timing, frequency, and quality of care; and (3) draw policy implications aimed at improving maternal health among the rapidly growing urban poor populations. It shows that the study area is deprived of public health services, a finding which supports the view that low-income urban residents in developing countries face significant obstacles in
accessing health care. This study also shows that despite the high prevalence of antenatal care (ANC), the proportion of women who made the recommended number of visits or who initiated the visit in the first trimester of pregnancy remains low compared to Nairobi as a whole and, more importantly, compared to rural
populations. Bivariate analyses show that household wealth, education, parity, and place of residence were closely associated with frequency and timing of ANC and with place of delivery. Finally, there is a strong linkage between use of antenatal care and place of delivery. The findings of this study call for urgent
attention by Kenya’s Ministry of Health and local authorities to the void of quality health services in poor urban communities and the need to provide focused and sustained health education geared towards promoting use of obstetric services.

6: Popul Health Metr. 2008 Mar 10;6:1.

The burden of disease profile of residents of Nairobi’s slums: Results from a Demographic Surveillance System.

Kyobutungi C, Ziraba AK, Ezeh A, Yé Y.

African Population & Health Research Center, P,O Box 10787, GPO 00100, Nairobi, Kenya. ckyobutungi@aphrc.org.

BACKGROUND: With increasing urbanization in sub-Saharan Africa and poor economic performance, the growth of slums is unavoidable. About 71% of urban residents in Kenya live in slums. Slums are characteristically unplanned, underserved by social services, and their residents are largely underemployed and poor. Recent research shows that the urban poor fare worse than their rural counterparts on most health indicators, yet much about the health of the urban poor remains unknown. This study aims to quantify the burden of mortality of the residents in two Nairobi slums, using a Burden of Disease approach and data
generated from a Demographic Surveillance System.

METHODS: Data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected between January 2003 and December 2005 were analysed. Core demographic events in the NUHDSS including deaths are updated three times a year; cause of death is ascertained by verbal autopsy and cause of death is assigned according to the ICD 10 classification. Years of Life Lost due to premature mortality (YLL) were
calculated by multiplying deaths in each subcategory of sex, age group and cause of death, by the Global Burden of Disease standard life expectancy at that age.

RESULTS: The overall mortality burden per capita was 205 YLL/1,000 person years. Children under the age of five years had more than four times the mortality burden of the rest of the population, mostly due to pneumonia and diarrhoeal diseases. Among the population aged five years and above, HIV/AIDS and
tuberculosis accounted for about 50% of the mortality burden.

CONCLUSION: Slum residents in Nairobi have a high mortality burden from preventable and treatable conditions. It is necessary to focus on these vulnerable populations since their health outcomes are comparable to or even worse than the health outcomes of rural dwellers who are often the focus of most interventions.

India – Anganwadis (government sponsored child-care and mother-care centers) and medical surveillance in informal settlements

August 28, 2009 · 0 comments

Anganwadis have a role to play

PUNE: A network of approximately 1,203 anganwadi workers, spread across the length and breadth of city’s slums, is lying untapped.

These angandwadi workers say that if they are given basic training, they can work as counsellors and create awareness about the H1N1 contagion among the slum dwellers.

“Anganwadi workers should be given some kind of formal training. With this, we can at least spread basic awareness about the symptoms of the flu among slum dwellers during our home visits. Besides, knowledge about a few precautionary measures can make a huge difference in containing the spread in slums,” said Prema Ghadge, project officer of Dapodi-Bopodi project. The Dapodi-Bopodi ICDS project has around 86 such anganwadi workers operating in slums of Vishrantwadi, Lohegaon, Dapodi, Bopodi and Sangamwadi, said Ghadge.

The death of 35-year-old Shabana Shaikh from Kashewadi slums in Bhavani Peth on Wednesday has underscored the need for extensive awareness and exhaustive medical surveillance of the 560 slums scattered across the city. Corporators have asked the administration to carry out medical surveillance of these slums on top priority since 42 per cent of the population of the city live in these slums.

Every anganwadi worker is responsible for 1,000 slum dwellers. “An anganwadi worker is supposed to visit five families in slums every day. The major focus of their work is to look after pregnant women and malnourished children and maintain their record. Moreover counselling family members on these health parameters is also a prime area of their routine work,” said Ghadge.

When asked about the need and benefits of such training, Ghadge said, “Anganwadi workers are just 10 class passed. They are trained in particular health issues like pregnancy and malnutrition. That’s why they should be given formal training about the basic aspects of the H1N1 influenza.”

“An anganwadi worker is a known face among the slum dwellers. That’s why a training given to them about the H1N1 influenza can make a lot of difference,” said Dilip Sarda, president of the city unit of Indian Medical Association (IMA).

“All the information that we are disseminating among slum dwellers about the H1N1 influenza is either through television or newspapers. A formal training in this regard would prove helpful,” said Ashwini Kamble, child development project officer (CDPO), Shivajinagar.

Yojna Shinde, the CDPO of Ghorpadi-Kondhwa, agreed that a formal training will help them in doing their job better. “Anganwadi has a huge resource which can be tapped in this state of emergency. There are 152 anganwadi workers under me and the total population of the areas that come under me is roughly 1.5 lakh. There are about seven other officers like me with approximately equal population. That means we have access to a very large population. Though at our own level also we are planning to invite an expert or a medical officer to talk to people living in slums in the coming week,” said Shinde.

Commenting on the need for a basic training course, Mahendra Gaikwad, project officer of the Hadapsar project said, “A basic training seminar would not take more than two hours. But it can be of great help and it is the need of the hour.” Around 167 anganwadis come under the Hadapsar project. They collectively cater to a population of roughly 1.7 lakh people. If the flu spreads across these slums, it will become very difficult to contain it, said Gaikwad.

Vijay Taware, project officer of the Kothrud project said, “We have been educating two employees in each of the 136 anganwadis in swine flu that come under the kothrud project. We have given them basic information about the disease, how it spreads and how it can be prevented. However, whatever we have told them is what we see on the television or read in the newspapers. We are no doctors or experts to train these people. Hence, a formal training, even if a basic one given by an expert can be of a lot of help.”

Seconding the idea of a basic training on H1N1 influenza for these anganwadi workers, Suvarna Pawar, who looks after the slums of Bhavani peth said, “More than 1 lakh 35 thousand slum dwellers come under my supervision. And there are 133 anganwadis to look after them. Giving all the anganwadi workers some sort of training regarding the disease is the easiest way of spreading awareness among these people as they are in regular contact with the people of these slums.

She further added, “Under the ICDS scheme, we have been spreading awareness about other diseases like malaria, tuberculosis and dengue. But since H1N1 is a new disease, we ourselves did not know much about it. Hence, a training course can be of a lot of help as then these people will be able to counsel a large number of people.”

When contacted M S Devnikar, additional municipal commissioner of PMC said, “It is true that this network of anganwadi workers can be roped in effectively to check the spread of H1N1 influenza in slums. Earlier, we have taken some steps to educate them. We will definitely extend them proper training in the next few days.”

Agreeing to it, Sanjay Maskar, deputy CEO of Zilla Parishad said, “It is true that these anganwadi workers should be given formal training about the H1N1 influenza. Earlier, we have conducted a few camps in the districts. Now, we will conduct their formal training and give them clear cut information regarding the basic aspects of the dreaded infection.” There are 4316 anganwadi workers in Pune district, added Maskar.

India – Number of urban poor to rise by 11% in Maharashtra

August 26, 2009 · 0 comments

Mumbai: The downturn and price rise seem to be pushing more people towards poverty in urban areas, especially in Maharashtra, compared to the last financial year. The number of urban poor in the state is expected to go up from 1.31 crore to 1.46 crore by March-end next year, a rise of nearly 15 lakh, or 11.3%, in 2009-10, according to estimates of the Union ministry of housing and urban poverty alleviation.

The rise in urban poverty in the state was negligible in the 2008-09 fiscal compared to 2007-08, according to the ministry’s estimates.

Home to the highest number of urban poor, the state is followed by Uttar Pradesh (1.17 crore), Madhya Pradesh (74.03 lakh), and Tamil Nadu (69.13 lakh). The ministry has projected an 18% growth in urban poverty across India in 2009-10.

The estimates were recently published along with details of funds to be tentatively allocated to the urban poor for self-employment and vocational training.

The estimates have been released at a time when funds to the state for alleviating poverty are being reduced.

Funds under the Swarna Jayanti Shahari Rozgaar Yojna are expected to come down by 10% — the state has been allocated Rs80.75 crore this year.

According to state officials, a majority of urban poor in Maharashtra live in Mumbai. In a recent door-to-door survey conducted by the civic body, more than 10 lakh families in the city had claimed to be living below the poverty line (BPL).

City-based slum activist Simpreet Singh said recession and price rise may have hit those on the brink of poverty. “There are linkages between the formal and the informal sector. The lull in the construction industry, for instance, has hit the livelihood of construction workers, carpenters and electricians,” he said. Price rise has only compounded their woes, putting pressure on their reserves, he said.

Neeraj Hatekar, professor of economics at the Mumbai University, said the unorganised urban sector is the biggest contributor to the poverty pocket. “We lack a system where the urban poor can work themselves out of poverty. The delivery mechanism for poverty alleviation schemes needs to be upgraded,” he said.

Source: DNA India, Aug. 26, 2009

Asia – Why our region needs an urgent health check

August 26, 2009 · 0 comments

asiaAsian workers in the Middle East are losing their jobs and returning home, often without employment opportunities or access to an adequate level of accommodation and food.

It’s becoming alarmingly clear who is paying the highest price for the global financial crisis – and it’s not Wall Street, writes Daniel Tarantola, Professor of Health and Human Rights at the University of New South Wales.

The United Nations estimates 55 to 90 million more people will be plunged into poverty this year alone by the continuing economic downturn, while at the same time the escalating food crisis has pushed world hunger through the one billion mark.

Last month the UN conceded its Millennium Development Goals for 2015 – the ambitious blueprint set by world leaders in 2000 to make the world a fairer, better place – are now in jeopardy.

We’re not just looking at a short term disaster in the third world, but at a long term health crisis: the forces of poverty, globalisation, climate change and pandemics are compounding to threaten health as never before.

This comes at a time when we’ve never had such a wealth of medical knowledge and technology. We can restore sight with a patient’s own stem cells and we’ve achieved a more than 50 per cent cure rate for cancer – but in much of the world, especially in our region, the right to good health is becoming a distant dream.

Being poor makes people sick – and, often, being sick makes people poor. Health care services are being pushed out of the reach of many as free market economic reforms lead to a shift from centralised public health systems to private health care.

Asia now has the highest level of out of pocket expenditure on health care and the highest number of households driven into poverty by the costs of sickness – even if the most sophisticated medical facility is just next door.

The conditions of impoverishment themselves, such as poor sanitation, a lack of adequate food and shelter, substandard education and forced migration, also lead to ill health.

Just as the 19th Century industrial revolution saw millions of people moving into squalid slums and factories, so 21st Century globalisation – even though it has lifted 600 million people out of poverty in Asia since 1990 – is making many people more vulnerable to ill health in squalid slums or from exposure to new toxic threats.

Mass people movements due to the financial crisis are of growing concern. Asian workers in the Middle East who are losing their jobs are returning to their homes in Vietnam or the Philippines, often without employment opportunities or access to an adequate level of accommodation and food.

What happens when the next pandemic strikes the cramped, unsanitary slums in which many of these workers are finding themselves? Or when their numbers are boosted by thousands forced from their homes by the next weather catastrophe wrought by climate change?

The 21st Century economy is affecting health in other ways, too. New multilateral or bilateral trade agreements are imposing stricter controls on drugs – while they are ensuring better quality, they are also restricting people’s access to cheaper generic medicine.

The food market is also under patent protection which is making food more expensive across the region and leading to an increase of counterfeited products which themselves can jeopardise health, such as contaminated milk products from China.

Ironically, globalisation has also exposed people in the third world to a host of Western health concerns, such as obesity, cardiovascular disease, cancer and depression. Globally, traffic accidents are increasing and tobacco-related deaths will outnumber those from HIV/AIDS this century.

All of these crises compound people’s vulnerabilities to ill health, but they have traditionally been considered in isolation.

Health and development are inextricably linked. We need to understand how they intersect and build bridges between our responses to these multiple crises so they can be addressed in a more meaningful way.

A human rights-based approach is the most promising. Everyone has a right to the highest attainable standard of health – and also the right to the basic determinants of health such as clean water and food, shelter, health services and equality.

It is only by addressing people’s most basic needs, and recognising these as fundamental rights, that we can bring the extraordinary potential of modern medicine to everyone in a globalised world.

Daniel Tarantola is Professor of Health and Human Rights at the University of New South Wales (UNSW). Professor Tarantola was formerly a senior advisor to the World Health Organisation, where he supervised the team responsible for eradicating small pox worldwide. He has held senior positions with the Harvard School of Public Health and played a key role in the creation of Medicins Sans Frontieres. Professor Tarantola is Chair of UNSW’s Initiative for Health and Human Rights, which is organising Asia’s first international conference on health, rights and development to be held in Vietnam in October.

APHRC/Kenya – Public-Private Partnerships are Crucial for Healthy Cities

August 25, 2009 · 0 comments

June 2009 – Public-Private Partnerships are Crucial for Healthy Cities

A recent assessment of health facilities conducted in three slums in Nairobi, Kenya by APHRC and other partners reveal that majority (85%) of health facilities that serve the city’s informal settlements are Private-for-Profit (PFP). The assessment further reveals that most of these facilities, which majority of the slum residents visit commonly for health care needs do not meet the government’s regulatory standards for operation.

Personnel in these private facilities are not trained in some of the most basic guidelines provided by the Kenyan government through its two health ministries such as infection control and Integrated Management of Childhood Illness (IMCI) – only 27% of personnel in PFP facilities had received training on infection control, compared to 89% of those working in public hospitals. In addition, since the private facilities charge a small fee, they remain inaccessible to most slum residents. These factors largely explain why informal settlements continue to register high disease burden and death rates as they are left with few or no options when it comes to accessing health care.

The assessment is based on a situation analysis of health facilities in Kibera, Korogocho and Viwandani slums of Nairobi which was funded by the Doris Duke Charitable Foundation (DDCF). Among the 503 facilities visited, a mere 1% were public, 85% were PFP, and the rest were Private-not-for-Profit (non-governmental and/or faith-based).With a rapidly increasing population of slum dwellers, what can the Kenyan government and others in similar situations do to ensure that these segments of their population have access to quality healthcare?

The analysis explored the viability of Public-Private Partnerships among the health facilities. Such partnerships would provide an opportunity for the government and the private practitioners to work together for the common good of the people. This ensures that private facilities meet regulatory requirements set by the government, have their personnel trained on key health areas, and enable the facilities to offer subsidies/charge a lower fee for their services.

Such a partnership is viable and is an option that both private facilities and the government are willing to explore. A large percentage of both public and private health providers agree that they both work towards the same goals and that the government should have a say in the kind of services that private facilities offer. Of the private facilities, 86% said they would be willing to comply with the government’s standards if there were any benefits or if government supported them with essential supplies and commodities, and a further 87% agreed to having the government supervise them through a third party.

The assessment was part of a DDCF-funded initiative that brought together various partners including APHRC, African Medical Research Foundation (AMREF-Kenya), City Council of Nairobi, JHPIEGO – an affiliate of Johns Hopkins University, Nairobi Health Management Board, Population Council, AAR Health Services, Kenya Medical Training College and the National Health Insurance Fund. Under the ‘Partnership for a Healthy Nairobi’ (PHN) banner, the initiative was aimed at leveraging each others strong points and areas of expertise to improve the quality of health services for poor communities in Nairobi. The PHN proposes to strengthen community ownership of health, fostering better public-private partnership, training the health workforce and strengthen district health service management and planning. The partnership is a good example of how strong collaborations can help to overcome obstacles that limit the capacity of both public and private health systems to deliver primary health care.

Source – http://www.aphrc.org/news.asp?ID=44

Global City Indicators Program

August 25, 2009 · 0 comments

The Global City Indicators Program provides an established set of city indicators with a globally standardized methodology that allows for global comparability of city performance and knowledge sharing. This website serves all cities that become members to measure and report on a core set of indicators through this web-based relational database.

Link to website – http://www.cityindicators.org/

Upcoming Events
United Nations – World Urban Forum 2010
GCIF is planning an event with member cities and the launch of its Annual Report at UN HABITAT’s World Urban Forum in Brazil 2010.

Dubai Workshop Fall 2009
GCIF will co-host a workshop with the Center for Research and Urban Innovation on the importance of global indicators for the Gulf Region.

CITYNET Yokohama Congress – Yokohama, Japan September 7-11, 2009
The Global City Indicators Facility will be attending the CITYNET Yokohama Congress in Japan to present the Program to cities in the Asian region.

Philippines Training Workshop – Manila, Philippines September 11, 2009
GCIF will co-host a training workshop with the League of Cities of the Philippines to train current member cities in the Philippines to enter data on the GCIF website and to introduce the Global City Indicators Program to potential new members.

Vietnam Workshop – Haiphong, Vietnam September 18, 2009
The GCIF will hold a workshop in Haiphong, Vietnam in collaboration with Haiphong City on the importance of indicators for Vietnamese cities.

UHRC – Workshop on Maternal, Neonatal and Child Health Scenario in the Slums of Meerut

August 25, 2009 · 0 comments

Workshop on Maternal, Neonatal and Child Health Scenario in the Slums of Meerut: Implications for Program and Policy, New Delhi, 14th April, 2009

Link to Workshop Presentations – http://uhrc.in/module-ContentExpress-display-ceid-100.html

It is estimated that about 335 million people inhabit India’s cities, of which about a fourth (80.8 million) are poor. Uttar Pradesh (UP), which is the second largest state in terms of urban poor population, houses nearly 11 million urban poor. The state’s urban poor have a high Neonatal, Infant and Under-5 Mortality Rates.

Of the 340,000 pregnancies every year among this group, only 2% receive complete antenatal care. More than 80% deliveries are conducted at home. Only 15% children receive complete immunization. (Source: National Family Health Survey (NFHS)-3 data for UP, reanalyzed on the basis of wealth index.)

It is a challenge for the Government to provide quality and affordable healthcare services to the urban poor. Effective program strategies require in-depth insight into the health related problems faced by this population, especially with regard to maternal, neonatal and child health.

To enhance understanding in this regard, a study was conducted on the Maternal, Neonatal and Child Health Scenario among the urban poor, in the slums of Meerut, Uttar Pradesh, in 2008. Meerut was selected for the study in view of being one of the largest cities in the programmatically high priority state of Uttar Pradesh, with a population of 1.07 million persons. It also has the highest slum population among cities in the state and is second highest after Mumbai in terms of slum-population ratio.

The study was conducted jointly by Urban Health Resource Centre, Johns Hopkins Bloomberg School of Public Health, and Chatrapati Sahuji Maharaj Medical University. It was funded by United States Agency for International Development.

A Workshop was organized in New Delhi to share the findings of the study on Maternal, Neonatal and Child Health Scenario in the slums of Meerut: Implications for Program and Policy”, on 14th April 2009, at India International Centre.

The workshop brought together officials from the Ministry of Health and Family Welfare, Government of India, State Governments of UP and Delhi, Meerut District Health Department, faculty from Meerut Medical College, King George Medical University (KGMU), Johns Hopkins University, and members of the National Neonatology Forum, who shared their experiences at the event.

Workshop Sessions

Dr Marta Levitt Dayal, MCH Star, presented an Overview of the Workshop, laying out the sessions for the day.

Professor Robert Black, Chair of the Dept of International Health, Johns Hopkins University, gave a presentation on the Global Overview of Maternal Neonatal and Child Health – Need for an Urban Focus.

Dr Gajraj Prasad, Additional Director, Maternal and Child Health (MCH), Directorate of Family Welfare, Government of UP, delivered the Special Remarks. He gave a presentation on Urban Health in Uttar Pradesh: Challenges and Opportunities.

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