USAID and Partners Unveil New Efforts to Save Millions of Women and Children from Preventable Deaths

USAID and Partners Unveil New Efforts to Save Millions of Women and Children from Preventable Deaths
More than $600 million in major public/private partnerships and awards with 26 partners to improve maternal and child survival announced
[Excerpt; Editor’s text bolding]

Wednesday, June 25, 2014
WASHINGTON, D.C. – The U.S. Agency for International Development (USAID) announced today that it is realigning $2.9 billion of the Agency’s resources to save up to half a million children from preventable deaths by the end of 2015—refocusing resources on high-impact programs with proven track records to save the most lives.

USAID also released a transparent action plan that reveals how the Agency, working with the global community, will prioritize results for the most at-risk families in the most vulnerable countries. USAID Administrator Rajiv Shah announced these goals today, along with more than $600 million in new public/private partnerships and awards with 26 partners and representatives from the governments of all 24 priority countries (most at the ministerial level) at the Acting on the Call: Ending Preventable Child and Maternal Deaths forum in Washington, D.C.

“Every day this year, 17,000 more children will live—and 700 more mothers will survive childbirth—than 20 years ago,” said Shah. “Right now, we are partnering with engines of innovation — corporations, foundations, NGOs, faith-based communities, entrepreneurs and local leaders—to solve one of the greatest development challenges: ending extreme poverty and build thriving, resilient societies. We know that, by working with the global community, we can end preventable child and maternal deaths, which is critical to our own national security, economic prosperity and moral leadership.”…

…Since 2009, the United States has invested more than $13 billion in child and maternal survival—a 56 percent increase in annual funding. Now, after a careful review of every dollar spent across 24 countries, USAID is aligning its resources with those of partner countries—creating a double-down effect on targeted efforts to reduce child and maternal deaths.

Ray Chambers, UN Special Envoy for Financing the Health Millennium Development Goals and Malaria, worked for 18 months with Shah and a panel of esteemed business, health and development experts and bipartisan former Congress members to identify opportunities for improved efficiency and effectiveness that will realign $2.9 billion of the Agency’s resources by the end of 2015 to save up to 500,000 children from preventable deaths. In addition, USAID announced more than $600 million dollars in new partnerships and awards with more than 26 partners… Full release

The Lancet – Why the Sustainable Development Goals will fail

Offline: Why the Sustainable Development Goals will fail
Richard Horton, Editor
The Lancet
Jun 28, 2014 Volume 383 Number 9936 p2185 – 2268
http://www.thelancet.com/journals/lancet/issue/current

Where are we now? The Open Working Group, a chaotic and unruly committee of nations (chaired by the Governments of Kenya and Hungary), has proposed 17 Sustainable Development Goals (SDGs) in its June 2 “zero draft” for the post-2015 era. It begins: “End poverty in all its forms everywhere”. Sustainable development? No. Try utopia instead. The SDGs are fairy tales, dressed in the bureaucratese of intergovernmental narcissism, adorned with the robes of multilateral paralysis, and poisoned by the acid of nation-state failure. Yet this is served up as our future. The health goal—”Attain healthy life for all at all ages”—is a mixture of business-as-usual (the MDGs rebooted), non-communicable diseases and universal health coverage (deservedly new entrants), and a strange assortment of promises about healthy life expectancy, essential medicines, and air pollution. Is this negotiated wish-list really the best we can do?

What is sustainable development? The conventional triple helix binds together social, economic, and environmental determinants of human lives. But this formulation fails to meet the urgent needs of today’s most excluded and threatened. In an important, but now overlooked, paper published in 2000 in World Development, Sudhir Anand and Amartya Sen argued that the central idea of sustainability was intergenerational equity: the lives of those to come should be of equal concern to us as the lives of those today. Anand and Sen questioned the prevailing idea that, if poverty is our target, wealth maximisation should be our weapon. As they so eloquently put it: “The most basic problem with the opulence view is its comprehensive failure to take note of the need for impartial concern in looking at the real opportunities individuals have. The exclusive concentration only on incomes…ignores the plurality of influences that differentiate the real opportunities of people.” Those “plurality of influences” include the vast ecological threats we face—among them, climate change, biodiversity loss, ocean acidification, and chemical and atmospheric pollution. But this is only half the human story.

Physical systems that shape our lives are important. But more important still are the human systems we have (or have not) created—our civilisations, our economic and political regimes, our prospects for peace and social stability. Corruption, incompetence, insecurity, disease, conflict, chaos, fracture, fragmentation. These determinants define our resilience, our capacity to adapt, our vision, our ability to recover, reconstitute, reconstruct. The secret to our future surely lies in defining, measuring, and tracking these determinants. But what determinants exactly? Not those (or not only those) of the Open Working Group, which has conspicuously failed to articulate a compelling vision for sustainability. Here are six possible dimensions of sustainability: wellbeing, capability, intergenerational equity, externalities, resilience, and one more. Wellbeing means a state of being healthy, comfortable, or happy. The literature on the measurement of wellbeing is riven with confusion. A reasonable place to start could be “healthy life expectancy”. Capability means what people do and what they can become. Martha Nussbaum famously derived ten “central capabilities”, which included life, bodily health, and bodily integrity. But for a metric of sustainability, one might choose instead “years of schooling” or “participating in decisions about one’s life”. Intergenerational equity concerns the distribution of wellbeing and capability over time, the resources to be administered in trust for future generations. “Rates of loss of biodiversity” capture this quality. An externality is a consequence of an activity that is experienced by an unrelated third party. Externalities can be positive (eg, vaccination coverage) as well as negative (eg, carbon dioxide emissions). Resilience means the capacity of a system to survive, adapt, and flourish in the face of turbulent change. It depends on diversity, redundancy (efficiency is the enemy of sustainability), connectivity, complexity, learning, participation, and polycentric governance. A final determinant of sustainability is the strength of our civilisations—their solidarity and wealth, their degrees of inequality and corruption, their susceptibility to conflict, and the quality of their deliberative institutions. Unless we embrace and measure the full meaning of sustainability, the SDGs will fail. None of us, and certainly not our children, can afford that failure.

World Investment Report 2014 – Investing in the SDGs: An Action Plan

World Investment Report 2014 – Investing in the SDGs: An Action Plan
UNCTAD
June 2014 – 265 pages Full Report
Excerpt from Press Release; Editor’s text bolding

The Sustainable Development Goals (SDGs), which are currently being formulated by the United Nations and a wide range of stakeholders, will require a step-change in both public and private investment in developing countries, if an estimated annual $2.5 trillion funding gap is to be filled, UNCTAD argues. Private sector contributions – through both good governance in business practices and investment in sustainable development – will be critical to the realization of the SDGs, the report says. Public sector contributions will remain indispensable, but may be insufficient to meet demands across all SDG-related sectors. Nevertheless, increasing private sector contributions poses challenges and policy dilemmas which must be addressed.

Key findings of the report include that at current levels of investment in SDG-relevant sectors, developing countries face an annual gap of $2.5 trillion (figure 1). Estimates for total investment needs in developing countries alone range from $3.3 trillion to $4.5 trillion per year, for basic infrastructure (roads, rail and ports; power stations; water and sanitation), food security (agriculture and rural development), climate change mitigation and adaptation, health, and education… Bridging such a gap may seem a daunting task, but it is achievable. The potential for increased private sector investment contributions is significant, especially in infrastructure, food security and climate change mitigation sectors. Structurally weak economies need special attention; UNCTAD estimates that a doubling of the growth rate of private investment in the least developed countries (LDCs) is required.

UNCTAD identifies four key policy dilemmas:
:: risks of increased private sector participation in sensitive sectors;
:: the need to maintain quality services affordable and accessible to all;
:: the respective roles of public and private investment; and
:: the apparent conflict between the particularly acute funding needs in structurally weak economies, especially LDCs, and the fact that especially these countries face the greatest difficulty in attracting such investment…

UNCTAD proposes a Strategic Framework for Private Investment in the SDGs which addresses key policy challenges and solutions… Increasing private investment in SDGs will require leadership at the global level, as well as from national policymakers to provide guiding principles for dealing with policy dilemmas, and also to set investment targets, ensure policy coherence and create synergies, establish a global multi-stakeholder platform on investing in the SDGs, and create a multi-agency technical assistance facility for investment in the SDGs.

Progress in getting all children to school stalls but some countries show the way forward

Progress in getting all children to school stalls but some countries show the way forward
UNESCO Policy Paper 14 / Fact Sheet 28
Jointly released by the Education for All Global Monitoring Report (GMR) and the UNESCO Institute for Statistics (UIS)
June 2014
[Excerpt from press release and report; Editor’s text bolding]

…As debate continues over the goals and targets of the post-2015 development agenda, new data show that the world will not fulfil one of the most basic commitments: to get every child in school by 2015. According to UIS data, nearly 58 million children of primary school age (typically between 6 and 11 years of age) were not enrolled in school in 2012 (see Figure 1). Many of them will probably never enter a classroom.

The momentum to reach out-of-school children has slowed considerably in recent years, with the global primary out-of-school rate stuck at 9% since 2007… The standstill at the global level is the result of opposing trends: a significant decline in the number of out-of-school children in certain countries due to important policy initiatives, and a rising school-age population in sub-Saharan Africa.

In view of the most recent UIS data, it is certain that the world will not reach the (MDG) goal of UPE (universal Primary Education) by 2015.

UN Women Executive Director Phumzile Mlambo-Ngcuka at the UN Women Executive Board Annual Session

Speech: Closing remarks of UN Women Executive Director Phumzile Mlambo-Ngcuka at the UN Women Executive Board Annual Session
19 June 2014, New York.
[Excerpt; Editor’s text bolding]

“…We want to reach a point where our discussions are no longer focused on our shortage of funds, but rather on our collaboration and concrete accomplishments for the future women want by 2030.

We want to direct our energy and total commitment to the mission of our time which is to end all forms of discrimination and violence against women and girls by 2030.

I thank the board for its commitment and the good work of the Secretariat and our staff. We are moving forward with renewed energy after this board session.

I call upon all Member States to commit themselves to the Beijing +20 review and appraisal process. The campaign is a call for action, the momentum for change.

We expect to see you at the Apollo Theater on 26 June for our special event when we celebrate our Beijing+20 campaign, Empowering Women, Empowering Humanity. This is not a mission impossible. This is a mission of our time.

Disruptive Innovation: Where It Matters Most

Disruptive Innovation: Where It Matters Most
It’s time to stop quibbling over what “disruptive innovation” means and focus on how to put it to work for good.
By Steve Davis | Jun. 24, 2014
Standford Social Innovation Review: Social Entrepreneurship

Jill Lepore’s recent New Yorker article, “The Disruption Machine,” has sparked a spate of commentary on outlets such as Slate, Forbes, and Salon.com. The hullabaloo has revealed vastly different perspectives on what “innovation,” “innovators,” and “disruption” mean.

What these writers are not talking about is where “disruption” and “innovation” matter most—saving people’s lives.

Disrupting the cycle of entrenched poverty and poor health can tip the world on its axis. And innovation has the ability to drive massive improvements in the health and well-being of children, communities, and countries.
Put together, “disruptive innovation,” a term Clayton M. Christensen brought forth in his book The Innovator’s Dilemma, is more than a winner-takes-all game where one technology replaces another or where a business that does the job faster and cheaper replaces an existing, lucrative one. To me, it’s about game-changing, curve-bending opportunities to drive impact—not necessarily through technologies like Amazon’s Fire Phone, which is now caught up in this debate, but through vision, adaptation, and a die-hard commitment to collaboration.

For example, almost every year, a swathe of Africa endures devastating epidemics of meningitis A. The disease can kill a child in 48 hours. Despite the size and impact of the epidemics, for years no vaccine manufacturer was willing to make a vaccine at an affordable price—per African health ministers, it needed to cost less than $0.50 per dose to be a viable option.

The answer: a new model for vaccine development. In 2001, the World Health Organization partnered with our organization, PATH, to create the model. We brought together dozens of collaborators from the United States, Africa, Europe, and India with expertise in such areas as pharmaceutical development, vaccine manufacturing, and clinical and laboratory work. By working across public and private sectors, the Meningitis Vaccine Project brokered the intellectual capital, political will, and technical know-how needed to create an affordable and effective vaccine.

Both the strategy and the vaccine were revolutionary. Affordability was the central feature of the innovation. The project met the target price by procuring an important technology for free from the US Food and Drug Administration and looking to emerging economies for an affordable manufacturer (the Serum Institute of India, Ltd).

As a result of the cross-sector collaboration and the commitment to affordability, the Meningitis Vaccine Project developed the vaccine in record time and at one-tenth of the $500 million cost usually needed to develop and bring a new vaccine to market. The impact: no cases of meningitis A among the more than 150 million Africans who have been vaccinated since 2010.

The most fruitful innovations in global health and development may occur when organizations take a proven technology or intervention, and adapt it for use in low-resource settings. These adaptive technologies are critical when markets have failed, prices must be kept low to ensure access and utilization, and design needs vary due to differences in culture or infrastructure. For example, PATH helped a manufacturer in China (the China National Biotec Group Co., Ltd.) shepherd an existing vaccine for Japanese encephalitis and get it through international regulatory approval and deliver it to millions of children in Asia, where the debilitating disease is prevalent.

The kind of innovation I’m describing—whether in health care, economic development, or other areas—requires a high level of collaboration rather than competition. It means sticking with good ideas until the end—making sure that we put the mechanisms and support in place to bring them through research, development, and introduction, and to scale them up so that we can reach as many people as possible. It means adapting to geopolitical and technological evolutions, and working across borders and sectors to turn great ideas into transformational changes.

All over the world, people are using new ideas and novel tools to solve age-old health problems. And there is evidence of their massive impact: A study just published in the Lancet found that new vaccines, drugs, diagnostics, devices, and other health innovations led to 4.2 million fewer child deaths in 2013, compared to 1990. The study, led by the Institute for Health Metrics and Evaluation in Seattle, was one of the first to quantify the overall impact of innovation on child health. While other factors such as maternal education and rising incomes are also significant drivers behind the decline, new technologies and methods for delivering health interventions account for the largest share.

So let’s recognize that innovation manifests in many ways, whether we call it disruptive, adaptive, or evolutionary. It has astonishing potential to improve the day-to-day lives of people around the world. Let’s talk about that.
Steve Davis (@SteveDavisPATH) is president and CEO of PATH.

Editorial – Health Care in Danger: Deliberate Attacks on Health Care during Armed Conflict

Editorial
Health Care in Danger: Deliberate Attacks on Health Care during Armed Conflict
The PLOS Medicine Editors
http://www.plosmedicine.org/
Published: June 24, 2014
DOI: 10.1371/journal.pmed.1001668

Since 2001, June 20th has been the day when the world considers the plight of refugees and internally displaced people by commemorating World Refugee Day [1]. This year’s theme is a continuation of the “1” campaign, in which the world is asked to take 1 minute to consider the situation for a family forced to flee, many of whom may have just 1 minute to get ready [2]. Keeping with the time theme, the UN High Commissioner for Refugees (UNHCR) estimates that world-wide, one person is forced to flee to become a refugee or internally displaced person every 4.1 seconds [3].

One of the main drivers of displacement is armed conflict, which is the disruptive force responsible for most of the world’s 45.2 million displaced people [3]. Providing health care to displaced people is challenging, even to those in relatively stable settings, such as camps. For example, earlier this month, PLOS Medicine published an article by Joshua Mendelsohn from the London School of Hygiene & Tropical Medicine and colleagues from the UNHCR calling for equity in antiretroviral therapy provision for refugees and internally displaced people with HIV. The authors focused on stable settings and proposed several recommendations mostly targeted at host countries [4]. Previously, PLOS Medicine published an article from Unni Karunakara from Médecines Sans Frontières and Frances Stevenson from HelpAge International highlighting the particular challenge of meeting the health needs of older people caught in conflict and other emergency settings [5].

The devastating effects of armed conflict on the health of populations is in no doubt, with both the direct effects of violence and the indirect effects, such as disruption to health services, having a huge toll on mortality and morbidity. For example, a study by Amy Hagopian and colleagues published in PLOS Medicine last year showed that, between 2003 and 2011, the majority of deaths in Iraq during the war and occupation were caused by the direct effects of violence and a third were due to indirect effects of health system disruption, resulting in a total of approximately half a million deaths attributable to the conflict [6].

To further add to the destruction and chaos of conflict, the past few years have brought mounting concern over the deliberate attacks on health care facilities and health workers, perpetrated to cause maximum damage to the health of populations. In 2011, the International Committee of the Red Cross (ICRC) published a landmark report that documented attacks on health care in 16 countries affected by conflict [7]. As the ICRC says: “Statistics represent only the tip of the iceberg: they do not capture the compounded cost of violence–health-care staff leaving their posts, hospitals running out of supplies, and vaccination campaigns coming to a halt” [7]. These knock-on effects of attacks dramatically limit access to health care for entire communities. Furthermore, such attacks are an insult to the Geneva Conventions, and the international community has responded with several initiatives and activities. For example, the ICRC launched the Health Care in Danger campaign, with the slogan “Violence against health care must end” [8]. And several organizations worldwide have recently joined forces to form the Safeguarding Health in Conflict Coalition, with the aim of promoting respect for international humanitarian and human rights laws for the safety of health facilities, health workers, ambulances, and patients during conflict [9].

Furthermore, in 2012, the World Health Assembly adopted a resolution (WHA 65.20) calling for the World Health Organization to improve reporting of, and data collection on, attacks on health care in conflict settings [10]. Then last November, an international conference in Bellagio, Italy on the protection of health workers, patients, and facilities in times of violence issued a call for action (targeted particularly at states and UN agencies but also at health professional organizations) to advance the security of health, particularly in situations of armed conflict and internal disturbances [11].

With such concerted activity attempting to tackle the egregious acts of attacks on health care, it is disappointing to note the distinct lack of progress in reducing the number of such attacks. A report by Human Rights Watch and the Safeguarding Health in Conflict Coalition, released to coincide with last month’s World Health Assembly, catalogued recent examples of attacks on health workers and facilities [12]. The report makes depressing reading and provides explicit examples from 18 countries of attacks on health care, some better known than others. For example, in September 2013 the UN-mandated Independent International Commission on the Syrian Arab Republic stated that Syrian health workers and facilities have been deliberately and systematically targeted [12]. And the report states that since December 2013, South Sudan’s conflict has led to widespread attacks on civilians, including in hospitals, and massive destruction of dozens of hospitals and clinics [10]. The report notes that the level of attacks has escalated recently and calls on the global community to recognize attacks targeted against health care as a critical human rights issue [12]. The report also adds to the Bellagio call for action and stresses that more action is urgently needed, including expanding and coordinating research on attacks and on the interference with health care, through in-depth qualitative studies [12].

PLOS Medicine supports the importance of research on practical approaches to prevent such attacks, as well as studies that evaluate interventions to improve health care in conflict settings more broadly. Such research is difficult and fraught with “real world” factors, but, as a recent article published in PLOS Medicine argues, disaster health interventions and decision-making can benefit from an evidence-based approach [13]. In this article, Martin Gerdin and colleagues from the initiative Evidence Aid argued that health care decision-making in disaster preparedness and response needs to move towards a reliable and robust evidence base for all interventions being considered in disaster risk reduction, planning, response, and recovery [13].

Deliberate attacks on patients, hospitals, and clinics are atrocious acts. While of course improved data collection on the number and nature of the attacks is important, practical action is also necessary to help improve the health outcomes of people terrorised, harmed, and displaced by such attacks. The PLOS Medicine editors welcome the research, debate, and discussion on how such practical measures can be implemented. Let’s hope that next year’s World Refugee Day will have more positive news.

References
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