Friday, 14 September 2012

Post-2015 Blog Week: 'Improving healthcare information is a matter of life and death' by Martin Carroll, BMA

Martin Carroll, Deputy Head of the International Department at the British Medical Association, highlights the importance of healthcare information in the post-2015 agenda. 

Clean, safe and available: three words which neatly sum up End Water Poverty’s vision. Clean water which does not carry life-threatening disease, safe sanitation which does not make water dirty, and both of these universally available. Earlier this year, a major step was made towards realising the vision.  UNICEF and WHO announced that the Millennium Development Goal (MDG) target to halve the proportion of people without sustainable access to safe drinking water had been achieved, well in advance of the 2015 deadline.

UNICEF claimed that the gains made demonstrated that MDG targets could be met with will, effort and funds. But it also acknowledged that the most difficult work lay ahead. 11% of the global population – 783 million people – are still without access to clean, safe drinking water and billions more have no sanitation facilities.

The post-2015 landscape offers the chance to develop a more inclusive and participative framework which can foster innovative and integrated approaches like those described in “Join Up, Scale Up”, a collection of case studies, published in 2011 by a group of six influential aid agencies, including EWP. The ‘interconnected’ nature of the MDGs has long been acknowledged: “Join up, Scale Up” showed how it could work in practice, with water, sanitation, nutrition, and education programs connecting and collaborating in a variety of combinations to achieve tangible results. The advantage of the integrated approach is that it can be adapted to suit a range of collaborations with other sectors and campaigns. Healthcare Information forAll by 2015 (HIFA2015) – of which End Water Poverty is already a member - is a prime example.

Like clean and safe water, the availability of relevant and reliable healthcare information is fundamental for health. Yet thousands of children, men and women die needlessly every day because their parent, caregiver or health professional did not know what to do or where to seek help.

Childhood diarrhoea, the biggest killer of children worldwide and frequently the result of unclean water and poor sanitation, is one area where ‘information poverty’ has a particularly significant impact. Evidence from India shows that 4 in 10 mothers believe that fluids should be withheld when their child develops diarrhoea, thereby tragically contributing to the risk of death of their own children; 1000 children are dying every day - in India alone - due to dehydration associated with diarrhoea. More than 90% of these lives could have been saved with basic life-saving interventions that are locally available but simply not provided due largely to lack of basic healthcare knowledge. HIFA2015 members report similar problems in Africa and other LMICs.

It is a typical example of a wider problem which HIFA2015 is addressing: healthcare providers’ information and learning needs are not being met. HIFA2015 is working to harness the experiential knowledge of its membership - 8000 individuals from 2000 organisations in 167 countries worldwide – to determine what those needs are, the barriers and drivers to meeting them and how to improve availability of relevant and reliable healthcare information in low- and middle-income countries. At the heart of the network is a group of solution-focused email forums in English, French and Portuguese, in collaboration with the BMA, WHO and many other health and development organisations. As I write this, a discussion is taking place on the main HIFA2015 forum about public understanding of the links between water and disease, and ways to promote and scale up effective solutions such as solar water disinfection, a simple procedure to disinfect drinking water, using UV-radiation to kill diarrhoea-generating pathogens. Join here:

The potential for HIFA2015 and End Water Poverty to integrate efforts and break the vicious cycle which claims the lives of thousands of children every day is clear. Success in meeting the challenges of the post-2015 world will depend upon the willingness of governments to provide political and financial support for powerful alliances like these.

Post-2015 Blog Week: 'Civil society is a vital part of the development process' by Yakub Hossain, VERC and FANSA

Yakub Hossain is the Deputy Executive Director of Village Education Resource Center (VERC) - a national NGO in Bangladesh, and the National Convenor of Fresh Water Action Network South Asia (FANSA) Bangladesh Chapter.

On the whole, the MDGs have been partly successful in Bangladesh. The water and sanitation situation has improved as an outcome of local and global initiatives, however, current progress rates on achieving the sanitation target is only 1.1% per year, yet in order to meet the target, we need 4% progress rates per year. At these rates, the WHO calculates that it will take until 2033 to reach the MDG target - this is not good enough. A recent WHO report also stated that the financial flows at both national and local government levels are less than 75% of needs as required for meeting the MDG targets.

The lack of funding for the Least Developed Countries, especially in Africa and South Asia, has been a big problem with the MDGs. Also, governments have not always used funds smartly, and there is a need for a more collaborative monitoring process in place.

We need a revised action plan in order to make progress with global development. One important issue which should be addressed in the new development framework is proper evidence of progress, certified by an international body. The national governments also need to be answerable to their people, and to the donor communities.

Another key area which needs to be addressed by the new development framework is to prioritize the countries that are lagging behind - they should be given more attention. Countries in South Asia such as Bangladesh have big needs - it is not just countries in Africa which need to be given greater priority.

In terms of sanitation and water, we definitely need a global goal to address them - without a clear global goal, we won't be free from the water and sanitation crisis.

The decision-making process for the new development framework should involve all the stakeholders, including the local people. My organisation, the Village Education Resource Center (VERC), has a good relationship with the government, and we use the mechanism of a forum with the highest body in the Ministry to communicate our views. At the country-level, government, civil society, and UN institutions should work together - civil society especially is a vital part of the development process.

Post-2015 Blog Week: 'Building our future, one girl at a time', by Joanna Hoffman, Women Deliver

 Joanna Hoffman is Special Projects Manager at Women Deliver, a global advocacy organization bringing together voices from around the world to call for action to improve the health and well-being of girls and women. In this post she explains why women and girls must be at the centre of the post-2015 process, and invites you to join the Women Deliver global conference in 2013.

In just a few years, key international agreements such as the Millennium Development Goals (MDGs) and the International Conference on Population and Development’s (ICPD) Programme of Action will expire. Opinions about what will come next are mixed: some believe all health issues—including maternal health, child health, and HIV/AIDS—will be collapsed into one objective; others believe the MDGs should be extended; and others believe an entirely new framework will shape the path forward. 

Regardless of what is chosen, we are sure of one thing—girls and women must be at the center of development in 2015 and beyond. More than 215 million women still have an unmet need for modern contraceptives and 287,000 women around the globe die each year from complications arising in pregnancy and childbirth. Most of these deaths occur in developing countries and are entirely preventable.

Safe drinking water is a proven, life-saving solution to preventing maternal deaths, yet still at least 783 million people around the world lack access. Sepsis accounts for 15% of maternal deaths in developing countries. Contact with unsafe water can result in a wide range of bacteria, viruses, and parasites which can weaken pregnant women’s immune systems, leading to potentially fatal complications.

Girls and women are the ones most affected by unsafe water, and by nearly all development challenges. Moving forward, it will be increasingly important to recognize the linkages between girls, women, and all development areas. Girls and women form the majority of the world’s poor and illiterate. In Africa, they account for 75% of those living with HIV/AIDS. They are also those most affected by toxic cooking fumes. 

Given these areas of intersection, it’s important that we now begin to work together across sectors, development fields, and the globe. Tackling the greatest obstacles to human and sustainable development require all hands on deck.

Saving women’s lives is not only the right thing to do, it’s also the smart thing to do. Healthy mothers are more likely to have healthy, educated children. More of their income goes to food, medicine, and other family needs, and their unpaid labor contributes up to one-third of global Gross Domestic Product (GDP). In short, when girls and women win, we all win. 

In an effort to mobilize strategic partnerships and bring the best and brightest minds together to save the lives of girls and women, Women Deliver is holding a third global conference this May in Kuala Lumpur, Malaysia. We will gather over 5,000 civil society advocates, researchers, Ministers, journalists, Parliamentarians, private sector executives, and youth activists to call on world leaders to prioritize girls and women in 2015 and beyond. The conference will feature over 120 breakout sessions, high-level speakers, and a full day dedicated to discussion on the post-MDG framework. 

I hope you will consider joining us in Kuala Lumpur. Together, we will put the world on notice that girls and women are at the heart of development. They are, in every sense, the future of our world. 

Thursday, 13 September 2012

Post-2015 Blog Week: 'So we've achieved the water MDG in theory, but what about in practice?' by Rob Waugh, Busoga Trust

Rob Waugh is Development Manager at Busoga Trust, and can be found on Twitter at

There is a scene in the film “The Great Escape” where Steve McQueen and Angus Lennie decide to escape from the prison camp by digging their way to freedom overnight. They achieve speed by simply burrowing like moles, filling in the tunnel behind them as they move forward. They don’t bother worrying about building the support structure behind  them to ensure that the tunnel doesn’t collapse because that would slow them down in achieving their goal; freedom. 

You may have guessed where this tenuous analogy is leading. 

There are many criticisms of the MDGs, especially when it comes to their prioritisation of water, sanitation (which didn’t even make an appearance in the original draft) and hygiene (which still isn’t specified, despite it being one of the most important public health interventions), but it is worth giving them credit for making the international community strive towards a goal. 

Unfortunately, in terms of water and sanitation, the pursuit of that goal has been all too similar to that of McQueen and Lennie; we have made achieving the goal our priority, without giving enough thought to whether a solid tunnel remains intact to allow others to use it

The UN-WHO JMP report which makes the claim that we have hit the “water target” also concedes that this doesn’t take into account the functionality or the water quality of protected sources and rightly notes that sanitation is well off track. So we’ve achieved the MDG in theory, but in practice?  We questioned this assertion but our voice is small. Then Ned Breslin, CEO of Water for People, brought his guns to bear and shot gaping holes in the JMP report, citing surveys of functionality in Mozambique.

However, this is not an exercise in stone throwing. We all want to achieve full, sustainable coverage. We want to have full, sustainable access to safe drinking water, sanitation and hygiene. 

The Busoga Trust is a small organisation but an experienced one and we have learnt many lessons. Learnt, more often than not, through our mistakes and the mistakes of others. We have constructed a lot of water sources in that time, but a few years ago we realised that we could not be sure how many were still functional. This was an unacceptable situation in our eyes, though one which partly as a result of being at the mercy of donor priorities. We resolved to ensure that 100% of our sources are functional and now 50% of our monthly workload is in carrying out rehabilitations. Our strategy, is to look to the past, present and future of our work in Uganda;

Past:            Identify non-functional sources and rehabilitate them. Fully review and update our database.

Present:       Reinstate our comprehensive long term monitoring, evaluation and maintenance system.

Future:     Continue to provide water sources to communities but only as one part of an integrated intervention where sanitation and hygiene come first.

So the question which this whole article has been gearing up to ask in a circuitous way is;“What would we like to see in the successor to the MDGs?”

Leaving aside the issue of greater prioritisation of WASH within the MDGs/successor, because we assume this will be argued for by many others in this blog series,  we would like any future MDGs  to contain a clear and distinct provision for accurate reporting of coverage levels and consolidation of the work carried out in the last 15 years. 

We do not want the international community to pat itself on the back in 2015 on a job well done without first checking that the job has actually been done. Is the provision sustainable? Are pumps working? Is open defecation still polluting water from safe sources? Are aquifers being drained to serve a short term economic purpose? 
We found this derelict well on a village survey - the villagers had actually gone back to taking water from the traditional source. The well had only been installed about 3 years previously.

This should happen across the board, not just in the WASH sector; are DOTS programmes for TB experiencing full participation? Are cases of malaria being properly diagnosed and if so, is the full course of treatment being adhered to? If skilled birth attendants are trained and employed, are the transport logistics in place to actually get them to patients? 

Children drinking from one of our newly installed pumps in rural Uganda.
In the WASH sector, such work is already happening; in Uganda the Ministry of Water & Environment has produced the Water Atlas, a comprehensive mapping exercise detailing every rural water point and functionality levels. They also record reasons for water point failure. The question is whether that data can be kept current. The organisation Water for People also launched a macro-reporting concept model at World Water Week in Stockholm, pithily entitled “Reimagining Reporting”.  

Our point is that any successor to the MDGs ought to pursue accurate reporting and integrity of information as a goal in itself. Governments should be supported in developing their monitoring capacity, rather than purely chasing the donor dollar down unsustainable avenues. 

I doubt consolidation or monitoring is as easy to sell as a set of aspirational targets, but if we fail to do this then that tunnel will collapse behind us and the whole exercise of the MDGs will need repeating by successive generations.