PLoS Medicine
(Accessed 6 December 2014)
http://www.plosmedicine.org/

Health in Action
Tracking Rural Health Facility Financial Data in Resource-Limited Settings: A Case Study from Rwanda
Chunling Lu mail, Sandy Tsai, John Ruhumuriza, Grace Umugiraneza, Solange Kandamutsa, Phillip P. Salvatore, Zibiao Zhang, Agnes Binagwaho, Fidele Ngabo
Published: December 02, 2014
DOI: 10.1371/journal.pmed.1001763
Summary Points
:: Tracking financial data for rural health facilities is difficult in low-income countries because of unstandardized accounting practices and the absence of effective health financial information tracking systems.
:: Poor-quality financial data hinders monitoring and evaluation of health facility performance.
:: We present a five-step procedure developed for gathering financial data from 21 health centers in two rural districts of Rwanda.
:: The five-step procedure generated financial data with internal consistency and a low percentage of reports of “missing” for in-kind support (donated goods and services). In-kind support (mainly medicine and equipment) accounted for a large proportion of the total expenditure of health centers.
:: We report challenges faced by the project and make suggestions for how Rwanda’s national web-based financial data collection system can be improved.
Knowledge gained from the Rwanda field experience may inform other low-income countries on how to establish an information system to track health facility financial data.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 6 December 2014)

Research Article
Comparative Effectiveness of Different Strategies of Oral Cholera Vaccination in Bangladesh: A Modeling Study
Dobromir T. Dimitrov, Christopher Troeger, M. Elizabeth Halloran, Ira M. Longini, Dennis L. Chao mail
Published: December 04, 2014
DOI: 10.1371/journal.pntd.000334
Abstract
Background
Killed, oral cholera vaccines have proven safe and effective, and several large-scale mass cholera vaccination efforts have demonstrated the feasibility of widespread deployment. This study uses a mathematical model of cholera transmission in Bangladesh to examine the effectiveness of potential vaccination strategies.
Methods & Findings
We developed an age-structured mathematical model of cholera transmission and calibrated it to reproduce the dynamics of cholera in Matlab, Bangladesh. We used the model to predict the effectiveness of different cholera vaccination strategies over a period of 20 years. We explored vaccination programs that targeted one of three increasingly focused age groups (the entire vaccine-eligible population of age one year and older, children of ages 1 to 14 years, or preschoolers of ages 1 to 4 years) and that could occur either as campaigns recurring every five years or as continuous ongoing vaccination efforts. Our modeling results suggest that vaccinating 70% of the population would avert 90% of cholera cases in the first year but that campaign and continuous vaccination strategies differ in effectiveness over 20 years. Maintaining 70% coverage of the population would be sufficient to prevent sustained transmission of endemic cholera in Matlab, while vaccinating periodically every five years is less effective. Selectively vaccinating children 1–14 years old would prevent the most cholera cases per vaccine administered in both campaign and continuous strategies.
Conclusions
We conclude that continuous mass vaccination would be more effective against endemic cholera than periodic campaigns. Vaccinating children averts more cases per dose than vaccinating all age groups, although vaccinating only children is unlikely to control endemic cholera in Bangladesh. Careful consideration must be made before generalizing these results to other regions.

Author Summary
Bangladesh has a high burden of cholera and may become the first country to use cholera vaccine on a large scale. Mass cholera vaccination may be hard to justify to international funding agencies because of the modest efficacy of existing vaccines and their limited duration of protection. However, mass cholera vaccination can induce high levels of indirect protection in a population, i.e., protecting even unvaccinated individuals by lowering cholera incidence, and a case for cost-effective cholera vaccination could be made. Mathematical modeling is one way to predict the magnitude of indirect protection conferred by a proposed vaccination program. Here, we predict the effectiveness of various mass cholera vaccination strategies in Bangladesh using a mathematical model. We found that maintaining high levels of vaccination coverage in children could be very effective in reducing the burden of cholera, and secondary transmission of cholera would virtually stop when 70% of the population is vaccinated. Mathematical modeling may play a key role in planning widespread cholera vaccination efforts in Bangladesh and other countries.

PLoS Pathogens
http://journals.plos.org/plospathogens/
(Accessed 6 December 2014)

Pearls
War and Infectious Diseases: Challenges of the Syrian Civil War
Sima L. Sharara, Souha S. Kanj mail
Published: November 13, 2014
DOI: 10.1371/journal.ppat.100443
Overview
Syria’s ongoing three-year civil war has displaced 6.5 million Syrians, left hundreds of thousands wounded or killed by violence, and created a vacuum in basic infrastructures that will reverberate throughout the region for years to come. Beyond such devastation, the civil war has introduced epidemics of infections that have spread through vulnerable populations in Syria and neighboring countries. In this article, we discuss the growing epidemics of poliomyelitis, measles, and cutaneous leishmaniasis in Syria and the region to examine the impact of conditions of war on the spread of infectious diseases in a public health emergency of global concern.

Stability: International Journal of Security & Development
[accessed 6 December 2014]
http://www.stabilityjournal.org/articles

Presumption of Innocence and Public Safety: A Possible Dialogue
Ana Aguilar-Garcia
Abstract
In Mexico, increasing demands for public safety coupled with the need for a more effective criminal justice system resulted in the security and justice constitutional reform of 2008. The outcome was a constitutional framework with provisions based on the highest standards of human rights on the one hand, and on the other, exceptional measures that restrict rights in an attempt to improve public safety. Unfortunately, the crime rate and incidence of unreported crime have changed little. When public safety is demanded, a clear, rational and concrete response is required. Limiting the alternatives to pre-trial detention or increasing penalties is rarely the appropriate response. This paper focuses on pre-trial detention and non-custodial measures supported by the new criminal justice system, how they relate to the principle of the presumption of innocence and the tension between this and the punitive demands for increased imprisonment. In addition, this study discusses a technical solution, found in pre-trial services, which seeks to balance the presumption of innocence and the right to personal liberty with public safety.

UNMEER [UN Mission for Ebola Emergency Response] @UNMEER #EbolaResponse
UNMEER’s website is aggregating and presenting content from various sources including its own External Situation Reports, press releases, statements and what it titles “developments.” We present a composite below from the week ending 6 December 2014.

UNMEER site: Press Releases & Statement
:: UN employs ‘district-by district’ approach in fight against Ebola (1 December 2014)

:: Remarks by David Nabarro, Special Envoy of the Secretary-General on Ebola, to mark the first 60 days of UNMEER, Freetown, Sierra Leone (1 December 2014)

UNMEER External Situation Reports
UNMEER External Situation Reports are issued daily (excepting Saturday) with content organized under these headings:
– Highlights
– Key Political and Economic Developments
– Human Rights
– Response Efforts and Health
– Logistics
– Outreach and Education
– Resource Mobilisation
– Essential Services
– Upcoming Events
The “Week in Review” will present highly-selected elements of interest from these reports. The full daily report is available as a pdf using the link provided by the report date.

5 December 2014 | UNMEER External Situation Report
Key Political and Economic Developments
2. The government of Guinea-Bissau announced on 4 December that it would reopen the country’s official border crossings with Guinea within 5 days. Guinea-Bissau had closed the border in August 2014 in an effort to prevent cross-border transmission of EVD. Surveillance measures will be strengthened along the border. The recent summit of Heads of State of the Economic Community of West African States (ECOWAS) held in Ghana had recommended the reopening of borders with the most affected countries to accelerate response efforts and avoid stigmatization of their populations.
3. The United Nations Mission in Liberia (UNMIL) on Thursday said that a member of its military personnel had tested positive for EVD. The patient is receiving treatment at an Ebola Treatment Unit in Monrovia. In line with WHO protocols, the medical team of UNMIL has immediately conducted robust contact tracing to ensure that all those who came into contact with the individual while he was symptomatic have been assessed and quarantined. All areas where the individual is known to have been while symptomatic have been decontaminated.
4. A ceremony scheduled on 4 December for Guinea’s Prime Minister to lay the first stone of a new ETC in Matoto commune in Conakry, was cancelled when groups of local youth ransacked the premises. They were reportedly protesting against the establishment of the ETC, arguing that it would lead to a spike in EVD cases in their community. Government officials, diplomats and representatives of non-governmental organizations were forced to leave the site of the planned ceremony due to the tensions.
Response Efforts and Health
7. 17,256 confirmed, probable, and suspected cases of EVD have been reported in the three most affected countries, where there have been 6,113 reported deaths.
Resource Mobilisation
11. The OCHA Ebola Virus Outbreak Overview of Needs and Requirements, now totaling US$ 1.5 billion, has been funded for $ 993 million, which is around 66 percent of the total ask.
Essential Services
15. The EVD crisis is destroying livelihoods, according to a newly released UNDP socioeconomic study. The study shows disproportionate numbers of economically active people are getting infected. In Sierra Leone, for instance, 65% of the sick were in the 15-49 age group. As caregivers, women are especially vulnerable. They represent up to 74% of the people who get infected in some areas of Guinea. Because women are often responsible for growing and trading food in all three countries, these sectors are also particularly impacted. 97% of respondents in a recent survey reported reduced incomes from farming, petty trading and service delivery. Employment in the informal sector and in education is especially affected in all three countries. The report calls for boosting informal and formal loan schemes and microfinance; investments in the next planting season; promotion of value chains in export-oriented primary commodities; and continuing to build skills among the workforce.
16. As schools remain closed, two million children in Sierra Leone are affected. The Emergency Radio Education Programme (EREP) continues to broadcast daily lessons through 41 radio stations nationwide. Some 47% of 2,489 surveyed households have children listening. The Ministry of Education and UNICEF are working to increase listenership through community outreach. UNICEF is in the process of procuring 50,000 solar powered radios for the most vulnerable households.

4 December 2014 | UNMEER External Situation Report
Key Political and Economic Developments
1. Europe must send more medical staff to West Africa to help rebuild local health systems and tackle the outbreak of EVD, EU Ebola coordinator Christos Stylianides has said, adding that he was in touch with European capitals on additional assistance to counter the disease in Guinea, Liberia, Sierra Leone, and Mali. At European level the mobilisation is “satisfactory but we must not relax our efforts” he indicated. Sweden has already announced that it will send 42 healthcare workers, while Greece is readying its first team. The EU’s medical evacuation system is “fully operational” with four planes on standby in Luxembourg and the US, and nine countries ready to treat repatriated staff. Mr. Stylianides is due to present an EVD action plan in December. Brussels is counting on more help;
2. MSF expressed concern on Tuesday about what it called a slow and uneven international response that portends further setbacks. MSF president Dr. Joanne Liu acknowledged an outpouring of financial and construction help from abroad in the past few months, but added that most of the work on tracking, isolating and treating patients, burying the dead and raising awareness to minimize contagion had fallen to the three countries at the heart of the outbreak: Guinea, Liberia and Sierra Leone. “It is extremely disappointing that states with biological disaster response capacities have chosen not to utilize them,” Dr. Liu said. “How is it that the international community has left the
Response Efforts and Health
8. The WFP-led Emergency Telecommunications Cluster is equipping rapid response teams in Sierra Leone with tools such as satellite phones and portable internet to ensure efficient and effective communication even in the remotest of areas. These teams of 15-20 people include a burial team, medical professionals and contact tracers amongst others, and are managed by the government of Sierra Leone.
Resource Mobilisation
13. Guinea, Liberia and Sierra Leone will each receive US$ 500,000 to help curb the impact of EVD on food security and on the livelihoods of people in rural areas. The $ 1.5 million grant from the Africa Solidarity Trust Fund will be used in support of FAO’s recently launched Regional Response Programme to tackle agriculture and food security issues related to the EVD outbreak in West Africa.
Outreach and Education
18. UNDP in Sierra Leone, working with local NGO One Family People, has completed the first stage of a sensitization campaign for people living with disability, having reached out to 10,000 women, men and children. Thanks to the campaign, people who are deaf, blind or physically impaired received messages in braille, sign language and pictures on how to protect themselves and others.

3 December 2014 | UNMEER External Situation Report
Key Political and Economic Developments
2. The World Bank said Tuesday that EVD is costing the three most affected countries more than US$ 2 billion, as the virus causes their economies to slow down or shrink. The bank sharply revised down its 2014 and 2015 economic growth estimates for Sierra Leone and Guinea, but said the outlook for Liberia was improving slightly. For 2015, it now forecasts Sierra Leone’s economy will shrink 2.0%, down from a 7.7% growth forecast in October and 8.9% before the crisis. Guinea will shrink 0.2% versus October’s estimate of 2% growth and a pre-outbreak forecast of 4.3%. In Liberia, where there are signs of progress and increasing economic activity, the bank increased its 2015 GDP growth estimate to 3.0%, up from 1.0% in October, but still less than half the pre-crisis estimate of 6.8%.
3. With more than half of its population already under lockdown, Sierra Leone has now quarantined a sixth district. Tonkolili, in the centre of the country, was added to the growing list of districts which no one is allowed to leave or enter without special dispensation, in an effort to combat the outbreak. The northern districts of Port Loko and Bombali were closed off indefinitely in September, along with the southern district of Moyamba – effectively sealing in more than one million people. With the eastern districts of Kenema and Kailahun also under quarantine, more than half of the population of six million, in six of the nation’s 14 districts, now finds itself unable to move freely. Tonkolili is expected to end its quarantine on December 15, according to health ministry officials.
Response Efforts and Health
5. Community resistance, denial and resorting to traditional healers remain prevalent in Gbarpolu and Grand Cape Mount counties, Liberia. The high mortality rates in the remote communities affected by the EVD flare ups (e.g. 17 deaths vs 2 survivors as last reported by the Glensyasu community), combined with limited outreach in hard to reach places, contribute to maintaining a worrying trend in the two counties.
10. UNICEF has provided EVD prevention (hygiene and sanitation) supplies and infection control training to wardens and staff of 14 prisons housing juvenile offenders across Liberia.
Logistics
12. The WFP-led Emergency Telecommunications Cluster is providing technical support to the International Rescue Committee (IRC) to programme 400 mobile phones to be used for data collection by health workers in Bo, Sierra Leone. Internet equipment provided by standby partners Emergency and Ericsson Response will be sent to the International Humanitarian Partnership camp in Port Loko, to provide 80 organisations with internet access by the end of this week.

2 December 2014 | UNMEER External Situation Report
Key Political and Economic Developments
2. In his press conference, the SRSG also reported on performance against the targets the UN had set for 1 December: 70 per cent of burials being done safely and 70 per cent of new cases isolated in a treatment facility. He indicated that those targets have been exceeded in most cases. In the case of safe burials, those targets are exceeded in all three countries. The other target – 70 per cent of new cases being isolated – is being exceeded in two of the three countries, in Liberia and Guinea. And it is being exceeded in many places in Sierra Leone – but some areas remain in serious crisis, and there, targets are not yet being met. Those areas are the focus of UNMEER’s efforts now. Nonetheless, the 70/70 target in 60 days was set so the crisis could be turned around, and that has been achieved.
3. Despite the positive news, the SRSG also emphasized that there was still a long way to go. Special Envoy David Nabarro said the disease was slowing down in some districts and increasing in others. He cautioned that the distribution changes from week to week, and the situation can worsen unexpectedly. EVD remains a very complex, multidimensional crisis, and additional efforts remain needed. The strategy that has been designed to get it under control has proven to work, SRSG Banbury said – putting people in treatment facilities, ensuring safe burials, contact tracing and social mobilization. But it needs to be present everywhere, and it need to be supported with logistics, with payments to response workers, with the information management needed for these activities.
4. The SRSG stressed that to achieve the goal of zero cases, the response needs to be present everywhere. As numbers get lower, more and more emphasis needs to be on contact tracing, on surveillance, and on rapid response capabilities. UNMEER and its partners are looking at putting in place a district-by-district strategy for 62 districts in the three countries, with interventions in every district that are appropriate to the circumstances there. That will be the focus for the next 60 days. SRSG Banbury expressed his confidence that 60 days from now the three countries will be in a much better condition than they are now, though that will still require a lot of hard work. There remains a lot to be done to get to zero cases, but the global EVD response is on the right track.
Response Efforts and Health
9. The Global Fund to Fight AIDS, Tuberculosis and Malaria has agreed to contribute € 500,000 to bolster UNDP’s support to the Malian Ministry of Health. The funds will be used to strengthen preventive measures in health facilities; train and pay health staff, and purchase protective gear.
Essential Services
19. Beyla prefecture in Guinea has 45 community agents working as contact tracers in EVD affected areas. Out of these 45 personnel, only 13 staff members received their salaries in November. The 32 others have not been paid for more than a month. UNMEER’s FCM has followed up with the prefectoral Ebola response coordinator on this payments issue, and has requested the coordinator to bring this to the attention of the National Ebola Response Cell.
20. In Montserrado, where Monrovia is located, UNDP and the Liberian Ministry of Health have set up a task force to increase communication within communities around denial, stigma, safe burials and hiding of sick people. The group will dispel widely held fears that no one comes back from ETUs, and help locate contacts, secret burials and households hiding sick people.

1 December 2014 | UNMEER External Situation Report
Response Efforts and Health
7. On Thursday 27 November, the UNMEER ECM in Liberia hosted the first NGO partnership meeting, to seek inputs from a broad range of implementing partners. Building county level capacity to decentralize policy discussions and coordination was deemed of high importance. Partners agreed that UNMEER has a central role in this regard. In addition, partners agreed to rationalize ad hoc coordination and create specific task groups to address issues such as CCC strategy and funding imbalances. The NGO partnership meeting will be held on a bi-weekly basis.
Outreach and Education
20. According to UNICEF, women in Samana sub-prefecture (Beyla prefecture), an area where there has been community resistance to EVD response, abandoned plans to march in protest against the presence of EVD responders after a sensitization by women leaders via rural radio. Also in Beyla, an agreement was reached for the establishment of a rapid response team within the prefectural communication commission. This cell plans advocacy activities to overcome community resistance.
21. In Liberia’s Grand Geddeh county, WHO, UNICEF, IRC and other partners conducted community engagement activities in Zwedru together with the county health team. The main aim was to have an interactive and informative session with community members and to share health information on EVD. More than 200 EVD posters were distributed. Teams also brought the emergency hotline telephone numbers to the attention of the communities.
Essential Services
22. UNICEF formed a partnership with Africa Humanitarian Action this week to expand the coverage of essential health services to 14 primary healthcare facilities in Montserrado County, Liberia, serving 158,181 people, including 26,890 children under five and 7,909 pregnant women. The provision of lifesaving medical and nutritional supplies is key in enabling access to lifesaving interventions.
World Bank [to 6 December 2014]

http://www.worldbank.org/en/news/all

:: Transcript of Press Conference with World Bank Group President Jim Yong Kim and President of Sierra Leone Ernest Bai Koroma December 3, 2014

:: Remarks by World Bank Group President Jim Yong Kim in Press Conference with President of Guinea Alpha Condé December 3, 2014

:: Transcript of Press Conference with World Bank Group President Jim Yong Kim and President of Liberia Ellen Johnson Sirleaf December 2, 2014

:: Ebola: New World Bank Group Report Shows Growth Shrinking, Economic Impact Worsening in Guinea, Liberia, and Sierra Leone
December 2, 2014
WASHINGTON, December 2, 2014 – The Ebola epidemic continues to cripple the economies of Guinea, Liberia, and Sierra Leone, and is projected to result in negative or contracting growth in these countries next year as they work to eradicate the virus, according to an Ebola Economic Impact Update released today by the World Bank Group. The report comes as World Bank Group President Jim Yong Kim begins a two-day visit to West Africa to assess the epidemic’s impact and discuss with governments and international agencies what steps need to be taken to reach the goal of zero cases as soon as possible.

This report updates the World Bank Group’s October 8 analysis of the economic effects of the Ebola crisis on the three hardest-hit countries. GDP growth estimates for 2014 have been revised sharply downward since pre-crisis estimates to 2.2 percent for Liberia (versus 5.9 percent pre-crisis and 2.5 percent in October); and 4.0 percent for Sierra Leone (versus 11.3 percent pre-crisis and 8.0 percent in October); and 0.5 percent for Guinea (versus 4.5 percent pre-crisis and 2.4 percent in October). All three countries had been growing rapidly in recent years and into the first half of 2014.

In addition, the World Bank Group is now projecting negative growth for 2015 of -0.2% in Guinea (down from pre-crisis estimates of 4.3 percent and 2.0 percent in October) and -2.0% in Sierra Leone (down from 8.9 percent and 7.7 percent in October). In Liberia, where there are signs of progress in containing the epidemic and some increasing economic activity, the updated 2015 growth estimate is 3.0 percent, an increase from 1.0 percent in October but still less than half the pre-crisis estimate of 6.8 percent. These latest projections imply forgone income across the three countries in 2014–15 totaling more than $2 billion.

“This report reinforces why zero Ebola cases must be our goal. While there are signs of progress, as long as the epidemic continues, the human and economic impact will only grow more devastating,” said Jim Yong Kim, President of the World Bank Group. “As we accelerate the immediate health response, the international community must also do everything we can to help the affected countries back on the road to economic recovery and development.”…

United Nations
The Road to Dignity by 2030: Ending Poverty, Transforming All Lives and Protecting the Planet
Synthesis Report of the Secretary-General On the Post-2015 Agenda
New York
December 2014 :: 47 pages
http://sustainabledevelopment.un.org/content/documents/5527SR_advance%20unedited_final.pdf

p.20
3.3. Six essential elements for delivering on the SDGs
:: Dignity: to end poverty and fight inequalities
:: People: to ensure healthy lives, knowledge, and the inclusion of women and children
:: Prosperity: to grow a strong, inclusive, and transformative economy
:: Planet: to protect our ecosystems for all societies and our children
:: Justice: to promote safe and peaceful societies, and strong institutions
:: Partnership: to catalyse global solidarity for sustainable development

66. The following six essential elements would help frame and reinforce the universal,
integrated and transformative nature of a sustainable development agenda and ensure that
the ambition expressed by Member States in the outcome of the Open Working Group
translates, communicates and is delivered at the country level (Figure 1).

Dignity: to end poverty and fight inequalities
67. Eradicating poverty by 2030 is the overarching objective of the sustainable development agenda. We live in a world of plenty, and in a moment of enormous scientific promise. And yet, for hundreds and hundreds of millions across the globe, this is also an age of gnawing deprivation. The defining challenge of our time is to close the gap between our determination to ensure a life of dignity for all on the one hand, and the reality of persisting poverty and deepening inequality on the other.

68. While we have made important progress in recent years, addressing gender inequality and realizing women’s rights remains a key challenge in all regions of the world. It should by now be recognized that no society can reach its full potential if whole segments of that society, especially young people, are excluded from participating in, contributing to, and benefiting from development. Other dimensions of inequality continue to persist, and in some cases have worsened. Income inequality specifically is one of the most visible aspects of a broader and more complex issue, one that entails inequality of opportunity. This is a universal challenge that the whole world must address. The agenda must accommodate the voices of women, youth and minorities, seek the prior and informed consent of indigenous peoples, remove obstacles to full participation by persons with disabilities, older persons, adolescents and youth, and empower the poor. It must not exclude migrants, refugees, displaced persons, or persons affected by conflict and occupation.

People: to ensure healthy lives, knowledge, and the inclusion of women and children
69. Millions of people, especially women and children, have been left behind in the unfinished work of the MDGs. We must ensure women, youth and children have access to the full range of health services. We must ensure zero tolerance of violence against or exploitation of women and girls. Women and girls must have equal access to financial services, and the right to own land and other assets. All children and adolescents have a right to education and must have a safe environment in which to learn. Human development is also the respect of human rights.

70. The agenda must address universal health-care coverage, access and affordability; end preventable maternal, new-born and child deaths and malnutrition; ensure the availability of essential medicines; realize women’s reproductive health and rights; ensure immunization coverage; eradicate malaria and realize the vision of a future free of AIDS and tuberculosis; reduce the burden of non-communicable diseases, including mental illness, nervous system injuries and road accidents; and promote healthy behaviours, including those related to water, sanitation and hygiene.

71. Today, more than ever, the realities of 1.8 billion youth and adolescents represent a dynamic, informed, and globally connected engine for change. Integrating their needs, rights to choice and their voices in the new agenda, will be a key factor for success. It is essential that young people receive relevant skills and high-quality education and life-long learning, from early childhood development to post-primary schooling, including life skills and vocational education and training, as well as science, sports and culture. Teachers must be given the means to deliver learning and knowledge in response to a safe global workplace, driven by technology.

Prosperity: to grow a strong, inclusive, and transformative economy
72. Economic growth should lead to shared prosperity. As such, the strength of an economy must be measured by the degree to which it meets the needs of people, and on how sustainably and equitably it does so. We need inclusive growth, built on decent jobs,
livelihoods and rising real incomes for all and measured in ways that go beyond GDP and
account for human well-being, sustainability and equity. Ensuring that all people, including women, persons with disabilities, youth, aged, and migrants have decent employment, social protection, and access to financial services, will be a hallmark of our economic success.

73. Innovation and investments in sustainable and resilient infrastructure, settlement, industrialization, small and medium enterprises, energy and technology can both generate employment, and remedy negative environmental trends. An enabled, properly regulated, responsible and profitable private sector is critical for employment, living wages, growth, and revenues for public programmes. Transforming business models for creating shared value is vital for growing inclusive and sustainable economies.

74. The world’s richness of natural resources also provides a formidable economic
opportunity, if it is translated not only into GDP growth but into shared prosperity.
Sustainable approaches to landscape management (including agriculture and forests),
industrialization (including manufacturing and productive capacities), access to energy
and water and sanitation, are key drivers of sustainable production and consumption, job
creation, as well as sustainable and equitable growth. They drive sustainable management
of natural resources and tackle climate change.

Planet: to protect our ecosystems for all societies and our children
75. To respect our planetary boundaries we need to equitably address climate change, halt biodiversity loss, and address desertification and unsustainable land use. We must protect wildlife, safeguard forests and mountains, and reduce disaster risk and build resiliencies. We must protect our oceans, seas, rivers and atmosphere as our global heritage, and achieve climate justice. We must promote sustainable agriculture, fisheries and food systems; foster sustainable management of water resources, and of waste and chemicals; foster renewable and more efficient energy; decouple economic growth from environmental degradation, advance sustainable industrialisation and resilient infrastructure; ensure sustainable consumption and production; and achieve sustainable management of marine and terrestrial ecosystems and land use.

76. Sustainable development is at risk as evidence proves that warming of the climate system is now undeniable and human activities are its primary cause. We must limit global temperature rise to below 2 degrees Celsius if we are to avoid the worst effects of climate change. Carbon dioxide is the largest contributor to human-induced climate change. Fossil fuels usage and deforestation are its two main sources. Increasing warming will make severe, pervasive, and irreversible impacts more likely. The longer we wait to take action towards sustainable production and consumption, the more it will cost to solve the problem and the greater the technological challenges will be. Adaptation can reduce some risks and impact of climate change. Most urgently, we must adopt a meaningful, universal climate agreement by the end of 2015.

Justice: to promote safe and peaceful societies, and strong institutions
77. Effective governance for sustainable development demands that public institutions in all countries and at all levels be inclusive, participatory, and accountable to the people. Laws and institutions must protect human rights and fundamental freedoms. All must be free from fear and violence, without discrimination. We also know that participatory democracy, free, safe, and peaceful societies are both enablers and outcomes of development.

78. Access to fair justice systems, accountable institutions of democratic governance, measures to combat corruption and curb illicit financial flows, and safeguards to protect personal security are integral to sustainable development. An enabling environment under the rule of law must be secured for the free, active and meaningful engagement of civil society and advocates reflecting the voices of women, minorities, LGBT groups, indigenous peoples, youth, adolescents and older persons. Press freedom and access to information, freedom of expression, assembly and association are enablers of sustainable development. The practice of child, early and forced marriage must be ended everywhere. The rule of law must be strengthened at the national and international level, to secure justice for all.

79. We need to rebuild and reintegrate societies better after crises and conflicts. We must address state fragility, support internally displaced persons and contribute to resilience of people and communities. Reconciliation, peacebuilding and state-building are critical for countries to overcome fragility and develop cohesive societies, and strong institutions. These investments are essential to retaining the gains of development and avoiding reversals in the future.

Partnership: to catalyse global solidarity for sustainable development
80. A revitalized global partnership for sustainable development must be built on the foundations agreed in the Millennium Declaration and in Monterrey and Johannesburg. It must be effective in mobilizing the means and in creating the environment to implement our agenda. Mobilizing the support to implement the ambitious new agenda will require political will and action on all fronts: domestic and international, public and private, through aid and trade, regulation, taxation and investment.

81. Implementation is not just about quantity. It is also about doing things together, uniting around the problem. Inclusive partnerships must be a key feature of implementation, at all levels: global, regional, national and local. We know the extent to which this may be transformative. The sustainable development goals provide a platform for aligning private action and public policies. Transformative partnerships are built upon principles and values, a shared vision, and shared goals: placing people and planet at the center. They include the participation of all relevant stakeholders. Mutual accountability is at the center. This means principled and responsible public-private-people partnerships.

3.4. Integrating the six essential elements
82. Sustainable development must be an integrated agenda for economic, environmental, and social solutions. Its strength lies in the interweaving of its dimensions. This integration provides the basis for economic models that benefit people and the environment; for environmental solutions that contribute to progress; for social approaches that add to economic dynamism and allow for the preservation and sustainable use of the environmental common; and for reinforcing human rights, equality, and sustainability. Responding to all goals as a cohesive and integrated whole will be critical to ensuring the transformations needed at scale.

83. The agenda itself mirrors the broader international human rights framework, including elements of economic, social, cultural, civil, and political rights, as well as the right to development. Specific targets are set for disadvantaged groups. Indicators will need to be broadly disaggregated across all goals and targets.

84. The essential elements are further integrated by the application of the principle of universality. In addressing them to all countries and all people we take account of environmental, economic, and social interdependence, while also recognizing the realities
of differentiated national needs and capacities.

85. Finally, the new framework provides a much-needed opportunity to integrate the broader United Nations agenda, with its inextricably linked and mutually interdependent peace and security, development, and human rights objectives.

86. All of this will have important implications for the way that all partners pursue sustainable development, requiring transformations in approaches to leadership, policy coherence, strategy, and collaboration. It will also have a beneficial unifying effect on the organization of work within the UN system at the global, regional and country levels.