How does global health fare in the Sustainability Development Goals?

This originally appeared on Global Health TV on Sept. 28, 2015.

Last weekend in New York City, world leaders formally approved the Sustainability Development Goals (SDGs), which will guide development efforts over the next 15 years. They replace the Millennium Development Goals (MDGs) that were signed in 2000 and expire on Dec. 31, 2015.

The MDGs were terrific for global health, both in raising money, and raising its profile on the global agenda.

Eight goals made up the MDGs, and three of them were entirely focused on health. In addition, two other goals included health-related targets. Eight (38%) of the 21 total MDG targets were health-related, and seven of those targets were numerical (i.e. reduce maternal mortality by three quarters).

Between 2000 and 2014, $228 billion was allocated to address the three health-related MDGs, according to the Institute for Health Metrics and Evaluation (IHME) 

More importantly than how much was raised, serious progress was made on many of these health fronts. For example, two weeks ago, the World Health Organization announced that malaria death rates have plunged by 60% since 2000 and that the malaria target to have halted and begun to reverse the incidence of malaria by 2015 has been met “convincingly.” Most people think the Target 1A to halve the proportion of people living on less than $1.25 has been met.

But where is health in the SDGs? The answer to that question contains both good and bad news for global health advocates.

Using technology to talk to Ethiopian university students about HIV

The home page of Temarinet.com.

This article originally appeared on The ONE Blog on Oct. 26, 2012.

ADDIS ABABA, Ethiopia — The most dramatic demographic divergence in Ethiopia in recent years has been an explosion in the number of young adults enrolled in post-secondary education. Ten years ago, there were 15,000. In 2012, that has risen to 380,000 students attending state universities — a 25-fold increase. Most of them moved out of their family homes and also from the protective shields of their parents, with all the implications that has for their sexual and reproductive health.

To reach them in the most effective way with information about protecting themselves from HIV and other sexually-transmitted infections, health programs in Africa are increasingly turning to technology — digital, mobile and social. In Ethiopia, for example, DKT Ethiopia, an affiliate of the non-profit organization DKT International, launched the Higher Education Initiative in 2009 in an effort to get on top of this demographic trend and the potential negative health consequences it portends.

Kenyans struggle to come to terms with abortion and its impact on maternal health

This was originally published on The Huffington Post on Oct. 17, 2012.
 
NAIROBI, Kenya -- The abortion issue in Kenya is raucous, rancorous and highly emotional and political, just like in the U.S., but there is one major difference: In Kenya, abortion rights have been liberalized in certain cases in a Constitution approved in a public referendum two years ago.

I spent four weeks in Kenya this year working with the Reproductive Health and Rights Alliance, a coalition of six Kenyan organizations committed to improving maternal health, to communicate better to key groups the nature of those changes. I talked to some 40 doctors, gynecologists, nurses, lawyers, government bureaucrats and technocrats and non-governmental workers and journalists. And a few taxi drivers.

The issue of abortion is so sensitive and taboo in Kenya that it almost derailed the constitution-making process. I discovered that even though the debate was heavily covered by the Kenyan media leading up to the August 2010 referendum, there's still a lot of misinformation on what exactly the Constitution changed, or didn't change -- even among health providers. Some think the Constitution legalized abortion on demand. Others think it changed nothing and abortion remains virtually illegal. The truth lies somewhere in the middle.

Using sexiness to stop unsafe sex

Sexy condom ads like this helped DKT increase condom sales in Brazil.

This article was published originally by Fast Company's Co.EXIST blog on October 5, 2012.

Sex and sexuality have long been used to market a variety of consumer products in wealthy countries. But when it comes to HIV prevention and family planning in developing countries, global health practitioners have mostly shied away from using the titillating strategies so effective in the commercial world.

The Pleasure Project and a small group of like-minded nonprofit partners are trying to change that, by shaking up an international reproductive health community that tries to promote safer sexual behavior by influencing the most intimate aspects of the lives of people in developing countries. With their motto, “Putting the sexy back into safer sex,” the Pleasure Project is spreading that message far and wide. At the XIX International AIDS Conference in Washington, D.C., this summer, they held a session entitled “Pleasure at AIDS 2012: Everything You Wanted to Know About Pleasurable Safer Sex but Were Afraid to Ask” that explored whether pleasure and eroticism can be harnessed to enhance HIV prevention. The conclusion was that they can indeed, even though most campaigns don’t even try.

Do you think you know where faith groups stand on family planning? Think again

This husband and wife are World Vision-trained community health workers in India who advocate birth spacing. They began using family planning when their son (right) was born.

NOTE: This blog was originally published on Impatient Optimists, the blog of the Bill & Melinda Gates Foundation, on April 3, 2012.

Religious leaders from a diversity of faiths—Muslims, Buddhists, Christians, and Hindus—have come together to profess support for family planning access around the world. This multi-faith support for family planning is something we simply don’t hear enough about in the United States. But we should.

Last year in Kenya, an interfaith meeting led by Christian Connections for International Health (CCIH) of the U.S., Deutsche Stiftung Weltbevoelkerung of Germany, and Muhammadiyah of Indonesia resulted in an “Interfaith Declaration” unanimously endorsed by well over 200 Catholic, Protestant, Muslim, Hindu, and Buddhist religious leaders.

The declaration expressed clear support for providing couples with the information and means to plan the timing and spacing of their children “consistent with their faith,” and called on others to support this initiative to influence government and donor policies and funding.

The truth is that faith-based organizations have been providing health care and even family planning for decades.

NGOs can also contribute to innovative financing

DKT advertises IUDs in Indonesia.

NOTE: This blog was originally published on Impatient Optimists, the blog of the Bill & Melinda Gates Foundation, on Feb. 2, 2012.

In difficult economic times like these, governments are looking for ways to cut their budgets. Foreign aid is often an easy target. Innovative financing—the idea of using a range of non-traditional tools such as micro-contributions, taxes, and public-private partnerships—has developed over the last 10 years as an alternative to traditional donor aid. Innovative financing mechanisms have raised $2 billion over three years, according to a 2010 report, mostly for health.

Most innovative financing has originated with governments—such as UNITAID and the International Finance Facility for Immunization—and private sector efforts such as Project RED, which engages in “cause marketing.”

But NGOs can also play a role. In fact, they have already been doing this through social entrepreneurs like Muhammad Yunnus (Grameen Bank), Bill Drayton (Ashoka), and Jacqueline Novogratz (Acumen Fund).

Top Ten Global Development Communications Stories of 2011

The first ladies of Kenya and South Africa tweeting for the first time at the Social Good Summit in New York.

This was originally posted to the Impatient Optimists, the blog of the Bill & Melinda Gates Foundation, on Dec. 21, 2011.

 

As was the case in 2010, global development non-profits continued their love affair with social media, finding Twitter, Facebook and the like amazing tools for communicating and advocating on a wide range of global issues. From global health to climate change to political systems, we’ve seen health improved, lives saved, policies changed, and governments overturned when we harness these new information pathways effectively.

Based on the 11,196 non-profit professionals surveyed in the 3^rd Annual Non-Profit Social Network Benchmark Report,  the Facebook average member community size increased 161 percent in 2011, and the average Twitter base was up 2 percent. International groups reported the highest use of Facebook up by a whopping 97 percent, and nearly double the number of Twitter followers as compared to all non-profits. As a global health and development communicator, I’ve been tracking the incredible progression of how health and development organizations use both new and traditional media to connect, engage, and inspire.

It’s why I’ve created my very own Top 10 list of favorite global development communication picks of 2011. Now, on to my other subjective picks for 2011 (and, yes, the Gates Foundation is on the list!) in no particular order:

Bringing the Avon Lady Philosophy to Rural Ghana

One of the HealthKeepers sales ladies heading out on her rounds.

In many rural areas of Ghana, a ringing bell is the traditional way that itinerant sales agents announce their arrival in a village. More and more, those bells are announcing the arrival of the entrepreneurial women from the HealthKeepers Network who are promoting health while also making a living, with the motto “prevention is better than cure.” And they are forging a new way of using the private sector to deliver health and hygiene to rural areas often overlooked by traditional global health programs.

Daniel Mensah, head of HealthKeepers

Although different private sector strategies have been tried to promote contraceptive use in Ghana (where the 2008 Demographic and Health Survey  indicated a contraceptive prevalence rate for modern methods was 16.6%), the impact of these strategies has been limited due to the long distances to be traveled to reach relatively small numbers of people with limited purchasing power.

In October 2009, I visited HealthKeepers with two colleagues and Executive Director Daniel Mensah in a village about an hour outside of Accra. We were the first visitors just after HealthKeepers had been registered to continue the work begun by Freedom from Hunger. I immediately thought of Avon, a U.S. company I remember from my youth, and its Avon ladies who have sold cosmetics door-to-door since the 1930s. The HealthKeeper difference is that these sales ladies travel by foot, with their products in a basket perched on the top of their heads.

The merchandise includes a mix of health products — such as contraceptives, insecticide-treated mosquito nets, oral rehydration salts and home water treatment tablets —and other carefully selected personal care products which help ensure that the ladies turn enough of a profit to keep them motivated. In 2009, they were also selling low-cost eyeglasses; they gave one of my colleagues an impromptu eye exam under the mango tree.

How committed is Hillary to reproductive health?

Last year in Berlin, I attended an NGO forum on the the 15th anniversary of the International Conference on Population and Development which was trying to figure out how to achieve the ICPD targets set in 1994 on universal access to reproductive health. I met several people there who had been delegates to the 1994 summit in Cairo and one of them recollected how the stars had aligned that year to produce something important in sexual and reproductive health amid a sea of “bad years.” She cited three developments that made this historic alignment possible:

- The existence of a charismatic, committed and politically saavy leader in the person of Undersecretary of State Tim Wirth (now the president of the United Nations Foundation), who was unrelenting in pushing forward the agenda of the ICPD;

- A supportive U.S. administration and Congress: Bill Clinton had been in office for less than two years and had given reproductive health higher priority than it had for many years; and

- An increasingly sophisticated non-governmental organization movement which played a leading role in making ICPD a reality.

This unprecedented alignment started falling apart later that same year when conservative Republicans took control of Congress and the Clinton Administration lost its early momentum.

This ICPD delegate told me she saw a similar aligning of the stars happening now – a progressive and supportive American administration and Congress — after eight long years — and an even more sophisticated civil society than was the case in 1994. The only thing missing, she said, was a charismatic and committed leader like Tim Wirth.

Later that same day, I talked to another person who had been in Cairo in 1994 as a senior U.S. government official. He agreed with this scenario and thought that Secretary of State Hillary Clinton could be that leader that some believe will be necessary to finally ensure universal access to reproductive health.

This Friday, Secretary Clinton is making a major speech marking the 15th annniversary of ICPD in Washington. That speech might give us a glimpse of whether she has the passion and the commitment to not only reaffirm the 2015 goals and targets of ICPD, which she will undoubtedly do, but take the cause to the next level, providing the leadership to inspire others to actually achieve the vision of ICPD over the remaining five years. Those of us who care about family planning and reproductive health are looking forward to watching Secretary Clinton this week and are ready to support her in this effort.

Berlin Delegates Demand Adoption of ICPD Agenda

BERLIN, Germany – Four hundred delegates from 130 countries released the “Berlin Call to Action” earlier this month at the NGO Forum on Sexual and Reproductive Health and Development that followed up on the historic International Conference on Population & Development held in Cairo 15 years ago.

After long and sometimes heated discussions, the delegates demanded that donors and governments accelerate implementation of the ICPD Program of Action “as fundamental to achieving equality and equity, human rights and social and economic development.” They urged the following actions to be taken immediately:

1. Guarantee that sexual and reproductive rights, as human rights, are fully recognized and fulfilled. This reflects the delegates’ desire to go beyond the realm of public health and position sexual and reproductive rights as fundamental human rights.
2. Invest in comprehensive sexual and reproductive health (SRH) information, supplies and services as a priority in health system strengthening. The new idea here is to acknowledge the fact that the current aid architecture emphasizes health system strengthening and the delegates belief that associating SRH with health systems can help our cause.
3. Ensure the sexual and reproductive rights of adolescents and young people. Approximately 25% of all of the delegates were under the age of 30 and the focus on youth was a recurring theme of the conference. Jill Greer, chair of the Steering Group, said that it was vital that the movement develop new leaders for the future.
4. Create and implement formal mechanisms for meaningful civil society participation in programs, policy and budget decisions, monitoring and evaluation. The message here is that governments have to bring civil society organizations to the table as meaningful partners.
5. Ensure that donor contributions and national budgets and policies meet the needs of people for sexual and reproductive health and rights. This financial aspect was enhanced considerably from the earlier draft and reflects the delegates’ recognition that their lofty visions will not be realized without the financial resources to carry them out.

Sivananthi Thanenthiran, a co-chair of the Steering Group, recognized that the most intractable hurdle to overcome in finalizing the text was the split between those who preferred ICDP language, and those who preferred the language of the Millennium Development Goals. “We have positioned ourselves in the middle,” said Ms. Thanenthiran. “We want to move beyond Cairo and leverage the MDGs.”

Another key issue was toning down the rhetoric because of the fundamentalism of many countries where the legitimacy of governments is based on religion. To overcome this, the Drafting Committee tried to find language that would not offend.

G8 Talks the Talk, but Breaks Prior Promises

L’AQUILA, Italy — The G8 released its communiqué on health, water and sanitation commitments to Africa Wednesday and, as I predicted in an earlier blog, the NGO community here is not impressed. But neither are they surprised. The communique largely reaffirms previous promises, at which the G8 has become quite accomplished.

There are some things I like a lot, especially the G8’s pledge to ”accelerate progress” on combating child mortality and on maternal health, “including sexual and reproductive health care and services and voluntary family planning.” I think those areas of health have been long neglected but regret that the G8 countries did not establish a more formal mechanism from making those laudable goals reality.

I also like a reaffirmation of a $60 billion pledge to fight infectious diseases and strengthen health systems by 2012 and the establishment of a mechanism to monitor health commitments made at the last three summits, which may be the only significant new health commitment made here at L’Aquila.

What I don’t like, and this feeling is widespread among civil society representatives here, is the indisputable fact that the G8 has not come close to meeting past commitments. In fact, The DATA Report, the most credible source of information on this subject link text, says that the G8 had delivered only one-third of all assistance increases it had promised to deliver to Africa by the end of 2010. I write about this more in my last blog.

I must hasten to add, though, that the U.S. is one of the least guilty of the G8 members on this score. The DATA Report points out that the U.S. increased its assistance to Africa by 26% in 2008, a significant increase that outpaced the global average of 16%, and is now on track to meet or even exceed its 2010 target. It may surprise many that former President George W. Bush can take much credit for this development.

However, the NGOs represented at the G8, largely European, were not pleased with the communique’s language on global health, water and sanitation, climate change, education, and the economy as laid out in a letter to Italian Prime Minister Silvio Berlusconi and the other seven G8 leaders earlier this week.

“The communiqué is pretty disappointing with no real new initiatives or recognition of the dire state of the progress to meeting their previous commitments,” said Kel Currah, chair of the Global Call to Action Against Poverty G8 Working Group, which represents a broad cross-section of NGOs at the G8. “On the good side, they did produce an accountability annex but again, this was only for a few of their commitments and there are a lot of holes in the report.”