The Limits of Medical Interventions for the Elimination of Preventable Blindness

Tropical Medicine and Health
Vol. 42(2014) No. 1
https://www.jstage.jst.go.jp/browse/tmh/42/1/_contents

The Limits of Medical Interventions for the Elimination of Preventable Blindness
Pablo Goldschmidt, Ellen Einterz
Released: March 18, 2014
Abstract
Background: Health authorities are working toward the global elimination of trachoma by the year 2020 with actions focused on the World Health Organization SAFE strategy (surgery of trichiasis, antibiotics, face washing and environmental changes) with emphasis on hygienist approaches for education. Objectives: The present survey was performed to assess the sustainability of the SAFE strategy 3 years after trachoma was eliminated from 6 villages. Methods: In February 2013 a rapid trachoma assessment was conducted in 6 villages of Kolofata’s district, Extreme north Region, Cameroon, where trachoma was eliminated in 2010. A total of 300 children (1–10 years) from 6 villages were examined by trained staff. Results: The prevalence of active trachoma (children aged > 1 and < 10 years) in 2013 was 15% and in at least 25% was observed absence of face washing and flies in their eyes and nose. Income level, quality of roads, hygiene, and illiteracy were similar in all the villages; they did not change between 2010 and 2013 and could not be analyzed as independent risk factors. Discussion: The heterogeneity of methods described for clinical trials makes it inappropriate to conduct meta-analysis for the present and for other SAFE-related trials. The results obtained after implementation the SAFE strategy (recurrence) reveal that the causes (infectious agents and dirtiness) and effects (illness) were not connected by illiterate people living under conditions of extreme poverty. So far, antibiotics, surgery and hygiene education are insufficient for the sustainability of trachoma elimination and highlight that hypothetic-deductive processes seem not operational after implementing the awareness campaigns. Trachoma recurrence detected in 2013 in sedentary populations of Kolofata receiving efficacious treatments against Chlamydia sp. suggest that the elimination goals will be delayed if strategies are limited to medical actions. Restricting efforts to repeated pharmacological and surgical interventions for people infected with susceptible bacteria could be understood as the hidden side of a passive attitude toward basic education actions.

From Google Scholar+ [to 10 May 2014]

From Google Scholar+ [to 10 May 2014]
Selected content from beyond the journals and sources covered above, aggregated from a range of Google Scholar monitoring algorithms and other monitoring strategies.

Refugees, Food Security, and Resilience in Host Communities: Transitioning from Humanitarian Assistance to Development in Protracted Refugee Situations
Mabiso, Athur; Maystadt, Jean-François; Vandercasteelen, Joachim; Hirvonen, Kalle
2020 Resilience Conference Paper 2 –
Building Resilience for Food and Nutrition Security – May 15-17, 2014 – Addis Ababa, Ethiopia
An emerging literature shows how the mass arrival of refugees induces both short- and long-term consequences to hosting countries. The main contribution of this paper is to conduct a selective review of this literature from a food-security and resilience perspective. First, the paper identifies a number of direct and indirect food-security consequences of hosting refugees. It provides a conceptual framework for discussing these various channels through which refugee inflows influence food security in the hosting countries. In the short run, violence, environmental degradation, and disease propagation are risks, with indirect implications for food security, while the long-run channels include changes in infrastructure, trade, and labor markets, as well as competition for resources. Second, the literature review finds that the impact of large-scale influxes of refugees on host communities and on their food security is unequally distributed among the local population. Locals with better ex ante access to resources, education, and political connections are more likely to benefit as a result of refugee inflows, while the disadvantaged become increasingly vulnerable. In the short run, humanitarian aid (for example, food aid) is the usual global response, with varying impact on the food security and resilience of host countries. Effectiveness of the humanitarian aid depends, however, on its nature and on the country context, both of which need careful consideration. In the long run, humanitarian aid should pave the way for development. In particular, investments such as improving road infrastructure and fostering trade with refugees’ countries of origin are strategies worth exploring for enhancing resilience and transitioning toward development. Finally, we stress the need for more research on the consequences of refugees and alternative polices on food security and resilience in host communities.
2020resilienceconfpaper02.pdf(1.9MB)

Brown Journal of World Affairs
Spring/Summer 2014 • volume xx, issue 1i
The Changing Face of Humanitarian Crises
FM Burkle Jr, G Martone, PG Greenough
[Initial text]
The scale and cadence of crises that demand international humanitarian response is increasing. The cumulative frequency and severity of climate change on large populations, rapid and unsustainable urbanization, decreasing biodi¬versity, and the impending realities of resource scarcities and the armed conflicts they might catalyze are only some of the challenges that loom ahead. It is ironic that while human civilization today possesses the most advanced technologies, global prosperity, and abundance, we face the greatest absolute number of people lacking access to clean water, food, shelter, and basic healthcare.1 Worldwide standards of living show that health status, life expectancy, child survival, de¬mocratization and political participation, literacy and matriculation, and gender equality are at their best while the incidence of armed conflicts is at the lowest level in human history.2 Yet despite the improvement in global standards, the shortcomings in worldwide accessibility to basic needs make the preparation of the humanitarian complex even more urgent in the face of emerging crises.
Critical masses of evidence indicate that the frequency, duration, and intensity of extreme events affecting populations are on the rise.3 These “mega-catastrophes” are attributable to a number of converging megatrends, defined here as global, sustained, and often slow to form forces that will define our future. An increasing number of droughts on every continent; rapid and unsus¬tainable urbanization plagued by insufficient public health infrastructure…

World Journal of Surgery
Volume 38, Issue 6, June 2014
http://link.springer.com/journal/268/38/6/page/1
The Extent of Soft Tissue and Musculoskeletal Injuries after Earthquakes; Describing a Role for Reconstructive Surgeons in an Emergency Response
A. J. P. Clover, B. Jemec, A. D. Redmond
Abstract
Background
Earthquakes are the leading cause of natural disaster-related mortality and morbidity. Soft tissue and musculoskeletal injuries are the predominant type of injury seen after these events and a major reason for admission to hospital. Open fractures are relatively common; however, they are resource-intense to manage. Appropriate management is important in minimising amputation rates and preserving function. This review describes the pattern of musculoskeletal and soft-tissue injuries seen after earthquakes and explores the manpower and resource implications involved in their management.
Methods
A Medline search was performed, including terms “injury pattern” and “earthquake,” “epidemiology injuries” and “earthquakes,” “plastic surgery,” “reconstructive surgery,” “limb salvage” and “earthquake.” Papers published between December 1992 and December 2012 were included, with no initial language restriction.
Results
Limb injuries are the commonest injuries seen accounting for 60 % of all injuries, with fractures in more than 50 % of those admitted to hospital, with between 8 and 13 % of these fractures open. After the first few days and once the immediate lifesaving phase is over, the management of these musculoskeletal and soft-tissue injuries are the commonest procedures required.
Conclusions
Due to the predominance of soft-tissue and musculoskeletal injuries, plastic surgeons as specialists in soft-tissue reconstruction should be mobilised in the early stages of a disaster response as part of a multidisciplinary team with a focus on limb salvage.

Nonprofit and Voluntary Sector Quarterly
April 2014; 43 (2)
http://nvs.sagepub.com/content/current
Nonprofit–Public Collaborations Understanding Governance Dynamics
Chris Cornforth1, John Paul Hayes1, Siv Vangen1
1Open University Business School, Milton Keynes, UK
Chris Cornforth, Open University Business School, Walton Hall, Milton Keynes, MK7 6AA, UK.
Abstract
As many of the challenges facing society are too complex to be addressed by single organizations working alone, nonprofit organizations are increasingly working in collaboration with public authorities. The governance of nonprofit–public collaborations is important for their effectiveness, yet it remains poorly understood. Drawing on case study research, this article examines and develops an extant conceptual model developed by Takahashi and Smutny that seeks to explain the formation and demise of nonprofit collaborations in terms of “collaborative windows” and the inability to adapt initial governance structures. The research finds that while initial governance structures are an important constraint on development, they can be adapted and changed. It also suggests that the development of collaborations is not only influenced by changes in the collaborative window but also by how key actors in the collaboration respond to important internal tensions.

UN Secretary-General Ban Ki-moon reappoints Anthony Lake Executive Director of UNICEF

UN Secretary-General Ban Ki-moon reappoints Anthony Lake Executive Director of UNICEF
[Full text]
UNITED NATIONS, 2 May 2014 – Following consultations with the UNICEF Executive Board, the Secretary-General is pleased to reappoint Mr. Anthony Lake as Executive Director of UNICEF. The Secretary-General noted his appreciation of UNICEF’s progress in effective management for results, especially for the most disadvantaged children.

UNESCO Report: Reading in the mobile era – A study of mobile reading in developing countries

UNESCO Report: Reading in the mobile era – A study of mobile reading in developing countries
UNESCO, Nokia and Worldreader
2014 86 pages pdf: http://unesdoc.unesco.org/images/0022/002274/227436e.pdf
ISBN 978-92-3-100023-2

Millions of people do not read for one reason: they do not have access to text. But today mobile phones and cellular networks are transforming a scarce resource into an abundant one.
THE CURRENT STUDY
To better understand how technology can facilitate reading, UNESCO, in partnership with Nokia and Worldreader, developed a survey to learn about the habits, preferences and attitudes of mobile readers. Specifically, the survey was designed to discover who reads on mobile phones and why; if and how mobile reading changes reading habits and attitudes towards reading; what people read and want to read on their mobile phones; what the central barriers are to mobile reading; and what factors predict people’s intentions to read and keep reading on mobile phones.

The survey was completed by over 4,000 people in seven countries (Ethiopia, Ghana, India, Kenya, Nigeria, Pakistan and Zimbabwe) and supported by qualitative interviews with numerous respondents. The depth and breadth of data collection make this study the most comprehensive investigation of mobile reading in developing countries to date.

The findings are significant. Among other conclusions, UNESCO has learned that people read more when they read on mobile devices, that they enjoy reading more, and that people commonly read books and stories to children from mobile devices. The study shows that mobile reading represents a promising, if still underutilized, pathway to text. It is not hyperbole to suggest that if every person on the planet understood that his or her mobile phone could be transformed – easily and cheaply – into a library brimming with books, access to text would cease to be such a daunting hurdle to literacy. An estimated 6.9 billion mobile subscriptions would provide a direct pipeline to digital books (GSMA, 2014).

The current study – by breaking down who reads on mobile devices and for what reasons – is a roadmap for governments, organizations and individuals who wish to help people better leverage mobile technology for reading. Knowing, for instance, that younger people are more likely to read on a mobile device than older people is instructive, as it indicates that older people will likely require significantly more guidance as they discover how to turn a device they may already own into a gateway to text. The study also exposes governments to the idea that digital libraries and mobile reading initiatives may have more impact than traditional, paper-based interventions.

In essence, the study shines light on a new strategy to bring text to the people who need it most.

It is important to qualify that access to books does not, by any means, assure or necessarily even promote literacy. Parachuting books to people – whether through mobile phones or other
mediums – is exactly that: dropping books and leaving. Deriving meaning from text is a deeply complex act that does not happen through exposure alone. People who think that literacy can be achieved by mere proximity to reading material should be reminded that it took the most talented linguists on the planet over a thousand years to decipher Egyptian hieroglyphs. The challenge wasn’t access to hieroglyphs; it was figuring out what they communicated. Humans may have a language instinct, but there is nothing natural about reading; it is a skill that needs to be taught and practiced, again and again and again. It is UNESCO’s hope that mobile reading will be integrated into broader educational systems that teach people how to use text productively – from access to comprehension, and all the stages in between.

Nevertheless, the primacy of access cannot be overstated. While it is true that books, by themselves, will not remedy the scourge of illiteracy, without them illiteracy is guaranteed.
A key conclusion from this publication is that mobile devices constitute one tool – in a repertoire of other tools – that can help people develop, sustain and enhance their literacy
skills. They can help people find good books and, gradually, cultivate a love of reading along with the myriad advantages that portends – educationally, socially and economically. This report, by explaining who reads on mobile devices and why, illuminates how mobile reading can be encouraged and spread, with a goal of making book shortages obsolete and thereby eliminating a long-time obstacle to literacy.

OECD Paper: Focus on Top Incomes and Taxation in OECD Countries: Was the crisis a game changer?

Paper: Focus on Top Incomes and Taxation in OECD Countries: Was the crisis a game changer?
OECD Directorate for Employment, Labour and Social Affairs
May 2014 8 pages
Excerpt from overview information; Editor’s text bolding

30/04/2014 – The share of the richest 1% in total pre-tax income have increased in most OECD countries over the past three decades. This rise is the result of the top 1% capturing a disproportionate share of overall income growth over that timeframe: up to 37% in Canada and 47% in the United States, according to new OECD analysis…
…But the incomes of the poorest households have not kept pace with overall income growth, with many no better off than they were in the mid-1980s. Stripping out the richest 1 percent of the population leaves income growth rates considerably lower in many countries – which is why so many people have not felt their incomes rising in line with overall economic growth.

The crisis put a temporary halt to these trends – but it did not undo the previous surge in top incomes. On average, real incomes of the top 1% increased by 4% in 2010, while the lower 90% of the population saw their real incomes stagnate…
…“Without concerted policy action, the gap between the rich and poor is likely to grow even wider in the years ahead,” said OECD Secretary-General Angel Gurría. “Therefore, it is all the more important to ensure that top earners contribute their fair share of taxes”.

The paper outlines a series of reforms governments could make to help ensure that top earners contribute their fair share of the tax burden. These include:
:: Abolishing or scaling back a wide range of those tax deductions, credits and exemptions which benefit high income recipients disproportionately;
:: Taxing as ordinary income all remuneration, including fringe benefits, carried interest arrangements, and stock options;
:: Considering shifting the tax mix towards a greater reliance on recurrent taxes on immovable property;
:: Reviewing other forms of wealth taxes such as inheritance taxes;
:: Examining ways to harmonise capital and labour income taxation;
:: Increasing transparency and international cooperation on tax rules to minimise “treaty shopping” (when high-income individuals and companies structure their finances to take account of favourable tax provisions in different countries) and tax optimisation;
:: Broadening the tax base of the income tax, so as to reduce avoidance opportunities and thereby the elasticity of taxable income;
:: Developing policies to improve transparency and tax compliance, including continued support of the international efforts, led by the OECD, to ensure the automatic exchange of information between tax authorities.

A comprehensive policy strategy is needed to tackle overall inequality
The tax policy avenues above will help ensure that wealthier individuals contribute their part towards more inclusive growth. However, in many countries, the rise in overall inequality has also been driven by low-income households falling behind in relative and, sometimes, in real terms. Therefore, a comprehensive policy strategy is needed to tackle overall inequality and promote equality of opportunities, which includes effective and well-targeted transfer policies and other social policies, as well as labour market and education policies.

More information on OECD work on inequality: www.oecd.org/social/inequality.htm

Editorial: Convergence to Common Purpose in Global Health

Editorial: Convergence to Common Purpose in Global Health
David J. Hunter, M.B., B.S., Sc.D., M.P.H., and Harvey V. Fineberg, M.D., Ph.D.
New England Journal of Medicine
May 1, 2014 Vol. 370 No. 18 p1753-1755 DOI: 10.1056/NEJMe1404077
[Full text; Editor’s text bolding]

Health and disease are, to a large extent, effects of local environmental conditions, and the work of health professionals is still largely performed one patient at a time, facilitated or constrained by local resources. So does it make sense to conceptualize “global health” on a worldwide basis rather than as a patchwork of national and local jurisdictions and responses? In examining the 17 contributions to this series (concluding with the article by Gostin and Sridhar in this issue of the Journal 1), we see five major forces and trends suggesting that as the 21st century progresses, a global perspective on public health will be increasingly critical.

First, the demographic transition from high birth and death rates to low birth and death rates in most countries, leading to a doubling of life expectancy in the 20th century and a quadrupling of the world population, is associated with the epidemiologic transition from infectious causes of death to noncommunicable diseases as the primary causes of death. In terms of morbidity, mental illness now accounts for a large proportion of years lived with a disability. Between 2010 and 2050, the proportion of the world’s population older than 65 years of age will almost double, and the proportion older than 85 will be three and a half times as large.2 This dramatic reshaping of the age structure of the world population predicts an equally dramatic reshaping of disease patterns, which will challenge health systems to adjust across the spectrum of preventive and therapeutic services. Although the transition will be completed in some countries, people in many low- or middle-income countries will face a “double burden” of disease — the “unfinished agenda” of persisting common infections, undernutrition, and maternal mortality, plus a growing burden of noncommunicable diseases.

The second major trend relates to the health consequences of globalization. The tripling of world merchandise exports since 1980, a result of economic liberalization and cheaper transport, has had manifold effects on health. Economic growth and countries’ movement from low-income to middle-income status have led to decreased poverty rates in countries such as China and India, along with an ability to invest more in health infrastructure and to plan for, or at least debate, approaches to implementation of universal health coverage. By 2030, India will probably have the world’s largest population, and China will probably be the largest economy; decisions made in New Delhi and Beijing are arguably already more important to global health than those made in Washington, Brussels, or Geneva. Jamison et al.3 have proposed that by 2035, a “grand convergence in health” is possible, as mortality patterns equilibrate in many countries.

Economic growth, however, has been accompanied by rapid urbanization, reduced physical activity, increased tobacco and alcohol consumption, and adverse changes in dietary patterns. Increases in the volume and speed of travel will enable pandemics to spread more rapidly — but there has been no corresponding acceleration in the development and manufacturing of drugs and vaccines. Diseases such as polio, which had been limited to a handful of countries and attended by hopes for worldwide eradication, can recrudesce when conditions favor the virus and a pool of unimmunized children is present. These changes in lifestyle and habitation and in the numbers of people traveling are predicted to increase, along with the consequences for human health. International disease-control regulations and other global governance mechanisms are rudimentary when compared with the size of the challenges.

Third, environmental threats are destabilizing long-standing agricultural and residential patterns and access to clean air and water, setting off unpredictable changes that affect all regions of the globe. The most obvious threat comes from climate change; related threats include the cross-border spread of air and water pollution and the export of toxic wastes. Global solutions to these problems will require unprecedented global solidarity and coordinated responses. The multilateral actions aimed at reducing atmospheric chlorofluorocarbons set a promising precedent, but the actions needed to reduce the effects of climate change are far more complex, and the delay between action and mitigation longer — all of which suggest that scaling up capacities for humanitarian response to address the increased incidence of weather-related disasters will be a necessary activity for several decades.

The fourth major trend is the internationalization of medical knowledge and the globalization of the health workforce. As little as 30 years ago, medical knowledge traveled slowly, if at all, in the pages of journals, sometimes in “airmail editions” printed on lightweight paper. Now, key articles appear online a month or two before publication in print and are available around the world instantaneously. But because drugs and devices are far from universally available and affordable, there are growing inequities in doctors’ ability to treat their patients using the latest medical knowledge. These limitations are particularly unfortunate now that medical knowledge flows in multiple directions and innovations borne of necessity in poor countries may hold the key to reducing the cost of health care in rich countries.4 New educational opportunities, such as massive open online courses, or MOOCs, hold the promise of training more health workers more quickly than can possibly be done in standard brick-and-mortar classrooms.

The globalization of the health workforce has many benefits, but rich countries’ importing of health professionals from poorer countries, a result of poor workforce planning, strips poorer countries of precious health professionals and reduces their populations’ access to care.5 We must not let the communications revolution, which should lead to more up-to-date and better-trained health professionals and more globally engaged and collegial interactions around the world, become a Trojan horse for accelerated medical migration from poorer countries. To the extent that such migration is fed by frustration with inadequate infrastructure for practicing medicine to the highest standards, those problems could be mitigated by relatively modest investments in improving health facilities.3

The final trend is the globalization of medical science. Since the report in the late 1980s of the Commission on Health Research for Development,6 the number of countries engaged in what the commission referred to as “essential national health research” has increased substantially; China, a developing country at the time, is now second in the number of articles published annually and listed in the Science Citation Index. Countries can increasingly decide for themselves what medical science they wish to pursue, instead of relying on the interests of scientists in other countries.

How we handle these five trends will do much to determine the quality of health and health services in the world in the coming decades. The environmental community uses the concept of “local to global” to remind us that individuals and communities have a role in environmental impact worldwide. Although the individual patient encounter is a local event, and global health institutions may constitute a patchwork of entities, each patient encounter takes place in a global tapestry of influences that constitute “global public health.”

Unhealthy Practice – Medical Work in Conflict Zones Is Compromised

Unhealthy Practice
Medical Work in Conflict Zones Is Compromised
By Leonard S. Rubenstein
Foreign Affairs
http://www.foreignaffairs.com/
[Excerpt; Editor’s text bolding]

For the second time in less than six months, polio vaccine workers in Pakistan have come under fire. In early April, an unidentified armed group attacked a team of Pakistani health workers administering vaccines and killed one of the police officers guarding them. The program suffered a tragic loss last December, when gunmen killed nine polio workers. Since then, the government has suspended the vaccination campaign in Pakistan’s tribal region — a major setback to public health in a country where polio remains endemic. By the end of March, almost a quarter of a million children scheduled for polio vaccinations had not received them in that region. Meanwhile, in northern Nigeria, where polio is also endemic, vaccination efforts are strained. Last February, nine vaccine workers there were killed by gunmen associated with Boko Haram, a militant Islamist group that claims polio vaccinations are part of a Western plot against Islam.

Some observers, such as the Council on Foreign Relations Senior Fellow Laurie Garrett, persuasively argue that the CIA is partially to blame for turning health workers abroad into targets. In 2011, the CIA employed a Pakistani doctor to conduct a fake vaccination campaign in an effort to track down Osama bin Laden. News of the scheme reinforced the population’s worst suspicions about the motives behind immunization campaigns. Earlier this year, deans of a dozen of the United States’ most prestigious public health schools wrote a letter to President Barack Obama demanding that public health programs never again be used as a cover for intelligence gathering operations…

…Those who attack medical personnel in conflicts should be prosecuted under international law for war crimes. As a start, the Security Council should refer the Syrian government’s killing, arrest, and torture of medical personnel for investigation by the International Criminal Court. Russia and China will no doubt resist, but their opposition is no excuse for refusing to demand criminal accountability.

The international community must recognize the fragility of health care in conflict, reaffirm the norms of protection and respect, and take vigorous action toward assuring adherence to legal obligations. Otherwise, health workers who provide care will remain at high risk and people who need care the most will be abandoned.

Transformative Scale Means “Crowding In”

Transformative Scale Means “Crowding In”
By Susan Davis
Stanford Social Innovation Review – Nonprofit Management Blog
April 28, 2014
We must develop and scale programs and ideas that harness the power of social movements.

If you’re trying to solve a problem, the scale of the proposed solution needs to match the scale of the problem itself. BRAC (formerly Bangladesh Rural Advancement Committee) began as a small relief effort in a remote part of Bangladesh after the 1972 war of liberation, but early on, we established an institutional mentality that focused on the scalability of interventions. We designed our interventions with the bigger, global problem of extreme poverty in mind. BRAC has become perhaps the world’s largest NGO—actually more like a social enterprise hybrid—touching the lives of an estimated 135 million people.

BRAC has pursued two main pathways to grow impact to a transformative scale. One is to directly multiply what works, millions of times over, balancing both scale and localism. Our organization’s disciplined program development process makes this possible. It first pilots a solution to ensure that it is effective, and then perfects the operational model to make it ultra-efficient. The result is effective, low-cost interventions in health, education, and livelihood development that are rooted in community demand and context, and that can spread to a great many other people. But such “massification” is not the only way to achieve transformative scale. The second pathway is to scale an approach with and through others. These two options are not mutually exclusive and can combine effectively.

For example, BRAC started its primary education program in 1985 in Bangladesh, responding to demands from landless parents that their children have access to the same sort of basic numeracy, literacy, and problem-solving classes BRAC was already conducting for adults. The government schools system wasn’t reaching these youth, the poorest children in the villages.
BRAC created an education program for these children, drawing teachers from the ranks of the poor themselves and focusing on teacher training. This approach supported the local economy, helped ensure teacher commitment, and kept costs very low. In selected villages, the program gave local women a standardized, two-week crash course on student-centered learning in the Freirean Pedagogy, a clean break from the drudgery and rote memorization of state schooling. On-the-job training and supervision, and monthly refreshers with a peer group followed.

The model worked. Women who hadn’t finished high school showed that they could learn and implement the basics of effective teaching. Dropout rates at BRAC schools were almost nonexistent. Moreover, parents proved willing to make financial sacrifices to give their children the chance for a better future. As a result, the final program was eminently scalable. BRAC now runs the world’s largest private, secular educational system, with 1.1 million children currently enrolled in its primary and pre-primary education program, at a cost of $36 per year per child. It has graduated more than 9 million children from its schools, and research shows that children from BRAC schools tend to perform better academically than those from government schools, despite the challenges they face growing up.

Of course, access and quality are perennial problems in education, and they intersect with health, nutrition, and livelihood issues. The complexity of these interconnected problems pushed BRAC to expand its role over time; today, it intervenes at every point along the education value chain. For example, its advocacy work and body of evidence over many years persuaded the national government to provide pre-primary school for poor children. It opened BRAC University in 2001 to expand the nation’s pipeline of talent: Today, this full-fledged higher-education institution enrolls some 6,000 students and has 22 departments, centers, and institutes. Within the university, BRAC has also created the Institute for Educational Development, which incubates new ideas and educational policies to further strengthen both government and private schools.

This education work is one example of achieving impact at scale. BRAC’s Targeting the Ultra Poor program illustrates a different pathway: achieving significant impact by enlisting others and “giving away” the program. Since 2002, BRAC has helped 1.4 million families with a tailored approach to the problem of ultra-poverty, a form of dire poverty impervious to basic microfinance. The two-year “graduation” model involves cash stipends, livelihood training, asset transfer, access to savings, and other forms of social and emotional support—all used in combination as a springboard to better life. Though this approach is not a panacea, it has been highly effective, and as a result we now believe that there may finally be an end in sight for ultra-poverty.
For this program, we didn’t just scale up directly—although direct implementation is important for knowledge and credibility. Instead, we chose to open-source the idea and give away its implementation knowledge to interested parties. Through patient participation in building a global community of practice, BRAC and BRAC University positioned the graduation idea to scale across borders and find the communities that could best benefit from it.

For example, intrigued by the powerful evidence from this program, the Ford Foundation and the Consultative Group to Assist the Poor (CGAP) launched a global experiment in 2006 to test the model in eight other countries, implemented by organizations other than BRAC. At a recent global gathering at the World Bank, we presented the research findings to policymakers, practitioners, and academics interested in ending extreme poverty. The overwhelming conclusion is that the approach works. Not only did 75 percent to 98 percent of households “graduate,” but also the vast majority stayed out of extreme poverty.

In light of these results, we’re redoubling our efforts to encourage others to “crowd in.” We are inviting policymakers, funders, microfinance institutions, NGOs, academics, media, and others into the space, because all of these groups are critical to building and sustaining the social change movements essential for tackling extreme poverty.
BRAC may be big in the nonprofit world, but extreme poverty is much bigger. Matching the scale of solutions with the scale of global problems requires that we do more than just grow institutions and programs. Disciplined program development is an important part of effective scaling, but we also need to harness the power of social movements, and encourage and support the many others who have a stake in truly transformative change.

Susan Davis (@SusanDavisBRAC) is a co-founder, and president and CEO of BRAC USA, an independent grant-making affiliate of BRAC and a member of the BRAC International board of directors.

Amref Health Africa [to 3 May 2014]

Amref Health Africa [to 3 May 2014]

International Day of the Midwife: 5 May 2014
Sub-theme: Midwives changing the world one family at a time
Preamble
On the occasion of the celebration of the International Day of the Midwife, it is noted that lack of skilled attendance at birth remains a major cause of maternal mortality. This is because countries do not have adequate numbers of midwives to provide the needed skilled care.

It is estimated that Sub-Saharan Africa needs an additional 551,000 midwives by 2015 to bridge its deficit for midwifery1. It is also estimated that at the current rate of increase in numbers of midwives, it will take 29 years to reach the WHO recommended numbers of midwives and other health professionals of 2.28 per 1000 population in Africa2.

It is notable that midwives are at the heart of deliveries in Africa. More often than not, whether in the larger hospitals, or in dispensaries, midwives play a key role in ensuring safe delivery. It is imperative to have adequate numbers of midwives in all health facilities to improve skilled attendance at birth and reduce the high maternal and perinatal mortality in most African countries.

As 2015 draws near, it is noted that countries in Africa have not been able to meet the 5th MDG. This is attributed to a number of factors. By just bridging the 510,000 deficit for midwives however, maternal mortality would fall by more than one third in Africa3. It is therefore important that health systems not only employ but also retain adequate numbers of midwives.

It is in realisation of the role that midwifery plays in saving lives of women and newborns that Amref Health Africa has prioritised training of midwives in the last few years. As such, Amref Health Africa has ongoing courses for certificate, diploma, bachelors and masters degrees offered in accordance with nursing and midwifery regulations in countries where Amref Health Africa works.

Through its three year campaign – Stand Up for African Mothers, Amref Health Africa aims to train 15000 midwives between 2013 and 2015. To date 5452 midwives have been trained through this campaign. This number will go a long way in meeting the current deficit for midwives across countries in Africa.

On this day of midwives, Amref Health Africa renews its commitment to work hand in hand with governments, development partners and civil society organisations to:
Amref Health Africa promises to:
:: Assess adequacy of the health workforce with special attention to numbers of midwives in countries and its impact on maternal and child health and develop strategies for improvement.
:: Work hand in hand with midwifery regulatory bodies and training institutions to continue building skills of practicing midwives through innovative training approaches that do not take the midwives away from their work for too long
:: Using acceptable country curricular, do basic training for midwives to add numbers of midwives to the market and reduce the deficit in Africa
:: Work closely with midwifery associations and training institutions to advocate for improved coverage, equity and quality of maternal and child health services

Amref Health Africa realises that governments are solely responsible for ensuring the right to health for their citizenry. We only support the governments to meet this objective. To that extent, Amref Health Africa urges governments as well as their development partners to meet the following obligations for improving access to midwifery care:
Amref Health Africa asks governments and development agencies supporting them to:
:: Allocate adequate resources to train more midwives to reduce the current deficit.
:: Absorb any unemployed trained midwives into the health system
:: Improve working conditions for midwives as a strategy for motivating them as well as for improving quality of maternal health services
:: Enact policies on task sharing that ensure the application of all midwifery skills as listed by the International Confederation of Midwives (ICM)
Bibliography
Alexander S. P., Richard M. S., Chris B. M., Brent D. F., Mario R. D., Estimates Of Health Care Professional Shortages In Sub-Saharan Africa By 2015, Accessed on 24th Feb. 2014 at http://content.healthaffairs.org/content/28/5/w849.full.pdf+html
Birth Rate Plus (2014), Ratios For Midwifery Workforce Planning at National, SHA and Local Level, accessed 24th Feb. 2012 at http://www.birthrateplus.co.uk/index.php?option=com_content&task=view&id=14&Itemid=1
Vincent De Brouwere and Wim Van Lerberghe (2001), Safe Motherhood Strategies, a Review of the Evidence, accessed on 24th Feb. 2014 at http://www.plan.givewell.org/files/DWDA%202009/Interventions/Maternal%20Mortality/SafeMotherhoodStrategies.pdf#page=105

Retweeted by Amref Health Africa
Sharon Rainey @RaineySharon • May 1
@AMREF_Worldwide #IDM2014 @FHWCoalition Ugandan Madudu calls 4 more support of frontline healthworkers @Capitol Hill

BRAC [to 3 May 2014]

BRAC [to 3 May 2014]

BRAC (Learning Division) signed a MOU with the Department of Women Affairs (DWA)
The Department of Women Affairs (DWA), Government of Bangladesh and BRAC has signed an MOU on 24 April 2014, aiming to sensitise DWA’s working couple groups in gender equality to create a sharing culture in their family through training. BRAC Learning Division and GJD are collaboratively working with the project, which will continue for one year from the signing date of the MOU…

MoU signing ceremony between BRAC and Ministry of Posts, Telecommunication and IT
BRAC signed a MoU with the ICT division of Ministry of Posts, Telecommunication and IT on 28 April 2014. The purpose of this partnership is to develop interactive multimedia contents for primary education on mathematics, science and social science. The content is based on NCTB primary (class 1-5) curriculum.
This will ensure conceptual clarity and better application of lessons for both students and teachers; improve the quality of education by shifting the style from teacher-centred to an interactive and engaging learner-centred. Teachers can use technology as an effective tool to deliver lessons in the classroom. The material will be developed involving relevant stakeholders and experts…

BRAC @BRACworld • Apr 29
Truly innovative #mobilemoney ideas and a rigorous selection process, BRAC’s #digital #revolution is on the roll! http://blog.brac.net/2014/04/challenge-accepted/ …

BRAC @BRACworld • Apr 28
Be sure to check out the new @SSIReview blog post by @BRACWorld’s @SusanDavisBRAC http://bspan.org/1hJz392 #TransformativeScale

Retweeted by BRAC
Rakib Mohammad Avi @RakibAvi • Apr 28
Govt of #Bangladesh and @BRACworld joining hands to develop interactive #digitalcon

tent for primary school kids

BRAC @BRACworld • Apr 27
When #mobilemoney is much more than just money transfer!! http://blog.brac.net/2014/04/bangladeshs-bkash-adoption-puzzle/ …

Casa Alianza :: Covenant House [to 3 May 2014]

Casa Alianza [to 3 May 2014]
Covenant House [to 3 May 2014]

Combatting Slavery in the 21st Century
Monday, April 28, 2014 at 10:45 am
Kevin M. Ryan. President, Covenant House
As we gathered at the United Nations earlier this month, I felt the emergence of a movement. Advocates and activists convened for “Combatting Slavery in the 21st Century,” determined to shine a light on the forced sexual exploitation and forced labor that enslave millions across the world.
We heard about varying forms of slavery over the centuries, domestic workers earning a pittance an hour, and the effects of deep poverty and immigration law on trafficked people. Professor Melissa Breger of Albany Law School observed that, worldwide, two children are sexually trafficked every minute.
I told the story of young Raquel, who, at great risk to her safety, testified against her traffickers in Guatemala, and, when asked what their sentence should be, asked that they be jailed, “so they won’t be able do that to other girls.” (My comments start here, at 1:33:50.)
The most compelling sentence of the day? “Consent is irrelevant…in the face of great vulnerability.” That’s the gist of the Palermo Protocol, the United Nations document setting forth the terms of our global fight against human trafficking, which 159 countries have signed.
That one sentence sums up what we see too often among trafficked people, particularly the homeless youth we serve at Covenant House — If you’re a prostituted person who is younger than the age of consent, society sees you as a criminal, when you are actually a victim of statutory rape. If you are prostituted and raped through force, fraud, or coercion, you had no real choice in the matter. And, on a larger scale, if you’re prostituted because it was the only way you can obtain shelter, or food, or because your life is devoid of financial security and opportunity, you too are being exploited.
We see that far too often at Covenant House, where we care for homeless, runaway and trafficked youth across 30 cities in 6 countries. In our New York City shelter, we discovered through a recent study that 23 percent of the young people surveyed reported either being trafficked or engaging in survival sex. In New Orleans, which saw a doubling of reported human trafficking incidents between 2012 and 2013, another study showed a quarter of our male shelter residents and a third of our female residents reported having traded sex for money or shelter. Given that 1.6 million young people experience an episode of homelessness each year in the United States, the potential scope of this problem is mind-blowing.
Warda Henning, an international lawyer with the United Nations, said human trafficking is a $32 billion industry worldwide, and children make up 27 percent of trafficked people. The vulnerability of kids feeds this marketplace. Women and girls account for two-thirds of trafficking victims, and only one in 100 trafficking victims ever gets rescued.
We heard talk of nation-wide policies that have reduced the number of trafficking victims. Dorchen A. Leidholdt, director of the Center for Battered Women’s Legal Services at Sanctuary for Families, spoke about how in countries like The Netherlands and Germany, the legalization of prostitution went hand-in-hand with increases in trafficking and crime, leading to the conclusion that legalization was “a well-meaning law that was little more than a subsidy for pimps.”
Then she described Sweden’s anti-trafficking laws of 1999, criminalizing traffickers and those who purchased sex, but not prostituted people. An intensive public education campaign, including slogans like “It’s time to flush the johns out of the Baltic,” proved effective, according to Leidholdt. These laws, which have become the inspiration for the Nordic Model, adopted by a handful of other countries, focus on women’s rights and human rights, the right of a person never to be bought and sold by another. Several years after the passage of Sweden’s laws, only 11 percent of Swedish men surveyed said they had bought or would buy sex, compared to much greater percentages of men in The Netherlands, where prostitution was legalized.
If we could do half as good a job of creating a meaningful taboo in the United States around buying and selling young people for sex as we do around smoking, we’d be so much further along the road to eliminating demand.
We must create the widest possible anti-trafficking movement, and there are burgeoning signs the movement is taking root and is bigger than the labels that often divide us. I’ve seen feminists and evangelicals holding hands in this 21st Century abolitionist movement, planning together how to achieve progress. And the movement must grow broader and deeper — our abolitionist ranks should include experts in child welfare, anti-poverty, affordable housing, technology, and immigration law. We have to transcend ideological and partisan lines and keep our eyes on the prize of justice for commercially sexually exploited children and young adults. Together, we can build a better world for the exploited, if first we allow ourselves to be led by them, and if we allow their truths and yearning for justice to help us construct a world where freedom for all means freedom for all.
Building a movement is never easy, but we can start by listening to the voices of survivors and placing their intelligence and experience at the front of our work. We must follow their light, and magnify it.

Casa Alianza UK @CasaAlianzaUK • 6h
Raped Guatemalan girls need much more than pity: http://www.iamnotthebabysitter.com/casa-alianza-guatemala/ … via the Director of @LaAlianzaGT #Guatemala #humanrights #noalatrata

Covenant House @CovenantHouse May 1
Our Rights of Passage program provides transitional living & life skills training to #HomelessYouth. For more info: http://ow.ly/wn7yG

Covenant House @CovenantHouse Apr 28
May 2nd. 2 Cities. Over 100 Moms sleeping out 4 #HomelessYouth. Join us 4 the #MomsSleepOut. http://ow.ly/i/5nTI8 http://ow.ly/wf6wn

Covenant House @CovenantHouse Apr 28
A must read – fighting human trafficking at the UN by @CovHousePrez http://m.huffpost.com/us/entry/5208401 …

ECPAT [to 3 May 2014]

ECPAT [to 3 May 2014]

ECPAT celebrates 24 years fighting against modern slavery
Posted on 04/30/2014, 14:54
ECPAT was born on 1 May 1990, when a few good people came together with a common concern for children caught in modern slavery. It was clear that there was a growing trend in the use of children for sex tourism – not a topic that many wanted to acknowledge, much less address, at that time. Over the next few years a committed few worked strenuously to break through the culture of silence and, as their voices were increasingly heard, groups from around the world joined, transforming ECPAT into a global network dedicated to ending all manifestations of commercial child sexual exploitation.
Today the ECPAT network includes 80 organisations in 74 countries – reflecting both the unfortunate breadth of the problem and the robust international response…

Retweeted by ECPAT International
Ecpat Belgium @ecpatbelgium May 2
Empowering children to become responsible digital citizens is primary for @ecpat #makeitsafe project http://bit.ly/1k8Itww @CommissionerHR

ECPAT International @ECPAT Apr 30
Today we are celebrating ECPAT’s birthday! 24 years of fighting against commercial sexual exploitation of children. http://bit.ly/1hQQ2e1

ECPAT International @ECPAT Apr 28
Proud to have John Carr representing ECPAT @Harvard today, exploring Priority Research Problems @#DigitallyConnected http://buff.ly/1m4jLjh

Heifer International [to 3 May 2014]

Heifer International [to 3 May 2014]

Heifer International @Heifer • Apr 29
RT @HeiferCEO Happy Int’l #danceday see @Heifer women’s group members in Bihar, India dance: http://oak.ctx.ly/r/z7uj

Heifer International @Heifer • Apr 29
Heifer’s staff is participating in lunch #BelowTheLine today … $1.50 on a lunch of rice & beans.

Heifer International @Heifer • Apr 27
Change the way you think about poverty and join Heifer for the Live #BelowtheLine challenge. https://www.livebelowtheline.com/us/partner/heifer …

HelpAge International [to 3 May 2014]

HelpAge International [to 3 May 2014]

HelpAge @helpage • May 2
Download now: Second issue of the Age & Disability Monitor looking at our joint work on #Syria crisis with @HI_UK http://bit.ly/PXaQ8N

HelpAge @helpage • May 1
“Out of disaster has sprung movement focused on empowered older people” D. Cordner @HelpAge_USA http://www.interaction.org/blog/four-years-later-building-more-structures-together … (via @InterActionOrg)

HelpAge @helpage • Apr 30
Download new publication “Advocating for social #pensions: Lessons learnt from the #Philippines” http://bit.ly/1ksN67I (@PensionWatch)

HelpAge @helpage • Apr 29
Updated link to video of our CEO @tobyhporter speaking at @GlobalPhilGrp forum on dignity and demographic change: http://youtu.be/yL5AicjbFJ8?t=37m …

HelpAge @helpage • Apr 28
Age Helps is out! http://paper.li/helpage/1360751304 … Stories via @HelpAge_USA @GlobalAgeing @Aging_Society

International Rescue Committee [to 3 May 2014]

International Rescue Committee [to 3 May 2014]

Thursday, 1 May 2014
In conjunction with US Secretary of State, John Kerry’s visit to South Sudan tomorrow, Friday 2 May, the IRC is reissuing a press release sent earlier this week…
South Sudan is at tipping point – [Press Advisory] International Rescue Committee calls for immediate action
27 Apr 2014 –
Excerpt
The International Rescue Committee is calling on the world not to give up on South Sudan but to make every effort to ensure that the fighting stops. Since the conflict started in December 2013, and despite a Cessation of Hostilities agreement signed in January, violations are committed regularly by all sides to the conflict, increasingly accompanied by widespread human rights abuses.
Protected areas, supposed to be safe havens for the displaced, are under attack. On 17 April armed men attacked a UN base in Bor and massacred 58 unarmed civilians including two IRC staff members. Children as young as two months were killed. On the same day armed men attacked churches, mosques and hospitals in Bentiu.
“South Sudan is at tipping point,” says the IRC’s president, David Miliband. “Without immediate, high level engagement to stop the violence, the people of South Sudan will face more killings and be plunged further into a food crisis. Having lost two of our own staff in the recent wave of killings, we know that people fear they are running out of options on where to flee.”
Miliband says, “There must be increased political pressure on the government and opposition and much greater support for the UN presence — both actions are critical to curb the crisis. It is easy to dismiss this as an ethnic conflict but the root of the crisis is political, exacerbated by easy access to weaponry. The interruption of planting and the consequent fear of famine top off the dangerous brew.”
The IRC welcomes the decision by the U.S government to allow targeted sanctions and is calling for the resumption of negotiations in Addis Ababa, Ethiopia, led by the Intergovernmental Authority on Development (IGAD).
The IRC is also stressing that the Office of the High Commissioner for Human Rights (OHCHR) should establish a permanent, independent presence in South Sudan to monitor violations of human rights committed by all parties. “The atrocities perpetrated by all parties are proof enough that more accountability is crucial,” says Miliband.
The IRC further emphasizes the need for the United Nations Mission in South Sudan (UNMISS) to deploy more peacekeepers on the ground. “Last December, the UN Security Council authorized deployment of an additional 5,500 UNMISS troops,” Miliband says. “Only 1,400 have arrived so far. The case for more troops remains pressing.”…

Intl Rescue Comm IRC @theIRC • Apr 30
Listening to Syrian Refugees through drawings, by @DocEdH on #FastSlow: http://bit.ly/1m82lTO

Intl Rescue Comm IRC @theIRC • Apr 30
We are honored that @Joshua_Redman joins our #IRCVoices program. More: http://bit.ly/IRCJoshuaRedman #InternationalJazzDay

IRCT [to 3 May 2014]

IRCT [to 3 May 2014]

IRCT in Geneva
IRCT welcomes modest steps in reform of UN treaty body system and encourages vigorous implementation efforts
29 April 2014
On 10 April 2014, the UN General Assembly concluded an almost 5 year long process to reform the UN treaty body system, including the Committee against Torture.
While the result was below expectations, the IRCT welcomes the important improvements to the functioning of the treaty body system initiated by this reform. Among the most noticeable gains are the increased resourcing of the treaty bodies allowing them to perform their mandate more efficiently; the decision to webcast all public meetings of the treaty bodies thus increasing transparency of their work at the national level; and the increased focus on capacity building in relation to reporting and implementation of treaty body recommendations.
From the beginning of the process, the IRCT has been one of the leading organisations in promoting a constructive reform with a specific focus on increasing transparency and accessibility for civil society and victims of human rights violations at the national level.
The IRCT is pleased to see that several of our concrete recommendations, especially the webcasting of all public meetings, have been included in the final reform document. However, it is concerned to see that initiatives to promote national implementation of treaty obligations, our other key priority, has been largely left unaddressed.
“For years, the treaty body system has been suffering from a lack of funding and effective engagement with national stakeholders. This reform takes a first step toward addressing these shortcomings and it is now up to all those working with the treaty bodies to ensure these words become reality. In addition, we must all focus on bringing to life those many unaddressed proposals seeking to improve implementation at the national level and to make the treaty bodies more accessible and relevant to rights holders,” said Asger Kjaerum, Head of the Geneva Liaison Office.

News
IRCT calls for justice as a Palestinian dies from torture in Israeli custody
26 April 2014

MSF/Médecins Sans Frontières [to 3 May 2014]

MSF/Médecins Sans Frontières [to 3 May 2014]

Iraq: Violence in Anbar Displacing Thousands
April 29, 2014
MSF is providing aid to victims of conflict in western Iraq.

South Sudan: Gruesome Targeted Killings In Bentiu Hospital
April 28, 2014
JUBA, SOUTH SUDAN/NEW YORK APRIL 28, 2014 – The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today condemned unspeakable acts of violence in Bentiu, South Sudan, after it received information detailing targeted killings in the city’s main hospital.

Three MSF Staff Among 16 Civilians Killed at Central African Republic Hospital
April 28, 2014
“We are extremely shocked and saddened by the brutal violence used against our medical staff and the community,” said Stefano Argenziano, MSF head of mission in CAR.

Doctors w/o Borders ‏@MSF_USA May 1
.@nytimes: MSF finds small, cheap doses of medicine helped children significantly during rainy season in West Africa http://bit.ly/1iHktPR

Doctors w/o Borders @MSF_USA Apr 29
Thanks to @eMedCert for naming @MSF_USA one of the top 100 Twitter accounts for health care professionals to follow! http://bit.ly/1pKYnpd

Doctors w/o Borders @MSF_USA Apr 28
Three MSF Staff Among 16 Civilians Killed at Central African Republic Hospital http://bit.ly/1isGmrV #CAR

Operation Smile [to 3 May 2014]

Operation Smile [to 3 May 2014]

Upcoming Mission Schedule
May 2 – 9 | Musanze, Rwanda
May 3 – 11 | Yangon, Myanmar
May 5 – 9 | Cambodia
May 9 – 19| Mekelle, Ethiopia
May 12 – 16 | Ho Chi Minh City, Vietnam
May 14 – 18 | El Bagre, Colombia
May 15 – 21 | Liangshan, China
May 15 – 21 | Huangshi, China
May 17 – 24 | David, Panama
May 23 – 31 | Lima, Peru

Partners In Health [to 3 May 2014]

Partners In Health [to 3 May 2014]

May 02, 2014
Video: PIH Nurses Deliver High-Quality Health Care around the World
Nurses—who comprise more than 84 percent of Partners In Health’s clinical staff—play a vital role in delivering high-quality medical care, advocating for patients, and strengthening the health system in every country PIH works. Learn more about how PIH is elevating the role of nurses around the world.

May 02, 2014
From Russia to Haiti, Nurses Deliver
For International Nurses Week, we’re celebrating the work of our nurses—the clinicians who provide the majority of care in the countries where we work.

Apr 28, 2014
Inside University Hospital’s 24-hour Emergency Department
Emergency medicine doctors could see any illness or injury at any moment—and PIH is training them to be ready.

Partners In Health @PIH May 2
Dr. Paul Farmer, this week @amfAR, said community-based care is what we need in the US. Learn more: http://bit.ly/1lIo2uE