International Rescue Committee [to 14 February 2015]
12 Feb 2015
Humanitarian crisis in Ukraine deteriorates as International Rescue Committee sends emergency team

12 Feb 2015
Thousands displaced by attacks in Niger in desperate need of food, says IRC

09 Feb 2015
Putting on the brakes: Averting a deepening crisis in South Sudan

ICRC – International Committee of the Red Cross [to 14 February 2015]
http://www.icrc.org/eng/resources/index.jsp

Red Cross Red Crescent denounces continued violence against volunteers working to stop spread of Ebola
News release
12 February 2015
The International Red Cross and Red Crescent Movement is deeply concerned about continued violence perpetrated against its volunteers in Guinea. Due to the fear and mistrust surrounding Ebola virus disease, Red Cross staff and volunteers have regularly been attacked by scared communities.

Colombia: Dutch citizen released
News release
11 February 2015
Geneva / Bogotá (ICRC) – A Dutch citizen who was captured last month by the National Liberation Army (ELN) was today handed over to a team made up of delegates from the International Committee of the Red Cross (ICRC) and representatives of the Catholic Church. The handover took place in a rural part of Norte de Santander department, in north-eastern Colombia.

Lebanon: Strengthening the resilience of communities affected by violence
News release
11 February 2015
Tripoli, Lebanon’s second largest city, has been the scene of recurrent outbursts of armed violence between the marginalized communities of the Bab al-Tabbaneh and Jabal Mohsen neighbourhoods. Since November 2014, the ICRC has launched several projects to help both communities to recover from long-standing cycles of poverty and violence and regain their dignity.

IRCT [to 14 February 2015]

In focus
IRCT’s new strategy: to become global knowledge hub on health-based rehabilitation of torture victims and chief promoter of the right to rehabilitation
09 February 2015
The IRCT has published its strategic plan for 2015-2020, which details the progress the movement has made in the last strategic period and outlines new objectives and commitments for the upcoming five-year period.

The movement’s two key strategic objectives for the next five years are to become a leading hub of global knowledge on health-based rehabilitation and to lead global consensus-making processes on the right to rehabilitation’s contents, scope and standards. The IRCT will seek to achieve these objectives through a series of activities grouped under capacity building, research development and advocacy.

“We are very pleased to share our vision and goals for the next strategic period. This document is a critical milestone for the IRCT and its members as it sets out the direction for the torture rehabilitation movement over the coming five years,” says Victor Madrigal-Borloz, IRCT Secretary-General.

Mercy Corps [to 14 February 2015]
http://www.mercycorps.org/press-room/releases

Mercy Corps, Rockefeller Foundation Launch Asia Regional Network to Build City Resilience to Climate Change
Indonesia, February 12, 2015
Local and regional urban practitioners in Asia urged to join expanded resilience network
Bangkok, Thailand — At the first Asia-Pacific Forum on Urban Resilience and Adaptation this week in Bangkok, the Asian Cities Climate Change Resilience Network (ACCCRN) will launch a member-based regional network headed by global humanitarian organization Mercy Corps. As a result of ACCCRN’s expanding footprint, Mercy Corps will build a larger coalition of national, regional and local practitioners and institutions committed to helping cities withstand and recover from the projected impacts of climate change. Today more than half of the world’s population lives in urban areas, and this number will increase along with vulnerability to erratic and severe weather patterns.

Testimony on the humanitarian response in the Democratic Republic of Congo by Andrea Koppel at the World Bank’s 2015 Fragility Forum
DR Congo, February 11, 2015
On Wednesday, February 11, 2015, Mercy Corps was invited to provide remarks at the annual World Bank Fragility Forum. Andrea Koppel, the Vice President of Global Engagement and Policy spoke on behalf of Mercy Corps, presenting the findings of a joint report, “Assessing Humanitarian Response in North Kivu,” produced by Mercy Corps, World Vision, the Search for Common Ground and the Congolese government.

USAID and Skoll Foundation Announce Joint Investment in Evidence Action for Clean Water in Uganda
Uganda, February 11, 2015
Low-cost chlorine dispensers to provide safe water to 3.2 million people in rural Uganda
Washington, D.C. –DATE- The U.S. Agency for International Development (USAID), and the Skoll Foundation announced a joint investment of $2 million in Evidence Action to scale up its Dispensers for Safe Water program, a proven and highly cost effective approach for providing clean water to rural communities.
The investment is the third of its kind by the Innovation Investment Alliance, a Global Development Alliance between the Skoll Foundation and USAID that is supported by the global humanitarian agency Mercy Corps, which is focused on scaling the impact of proven social entrepreneurs.
Dispensers for Safe Water installs innovative low-cost chlorine dispensers directly at the water source in rural communities in Uganda, Kenya and Malawi….

OXFAM [to 14 February 2015]
http://www.oxfam.org/en/pressroom/pressreleases

Putting on the brakes: Averting a deepening crisis in South Sudan
9 February 2015
NGOs urge regional leaders and donors to redouble efforts to push for a lasting peace agreement that transforms South Sudan’s trajectory from devastation to development.

Plan International [to 14 February 2015]
http://plan-international.org/about-plan/resources/media-centre

13/02/2015:
Radio continues to give a voice to thousands of children across the developing world
Radio continues to be the most important tool to provide young people with information and give a voice to children across the developing world, many of whom live in remote or disaster-prone areas, says Plan.

09/02/2015:
Plan International leads on child protection in Sierra Leone
Plan International has been named lead humanitarian organisation in the field of child protection by the government of Sierra Leone, particularly for its response work involving Ebola survivors.

Save The Children [to 14 February 2015]
http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.6150563/k.D0E9/Newsroom.htm

.
Save the Children Calls on EU leaders to Urgently Strengthen the Search and Rescue Capacity in the Mediterranean
FAIRFIELD, Conn. (Feb. 11, 2015) — More than 300 migrants are presumed dead, according to UN’s refugee agency, after the boats carrying them sank trying to reach Italy having departed the Libyan coast on Saturday. Latest reports indicate that just 9 people survived.

“Save the Children has repeatedly raised concerns that the Italian navy’s comprehensive search-and-rescue operation, Mare Nostrum, was stopped last October, citing fears about accentuating the already extreme risks faced by migrants, especially those most vulnerable, such as women and children, in migrant sea crossings,” said Carolyn Miles, president and CEO of Save the Children.

“Sadly, despite this latest tragedy, the number of migrants continuing to attempt treacherous sea crossings is increasing. In January 2015, despite the bad weather conditions, 3,528 migrants reached Italy, including 195 women and 374 children — a staggering rise of 60 percent compared to the number of migrants arriving in 2013.

“Save the Children calls on EU leaders to urgently strengthen the search and rescue capacity in the Mediterranean to help mitigate the high number of migrant and refugee deaths at sea.”…
.

Search and Rescue Must be Strengthened After Migrant Deaths
Lampedusa, Italy (Feb. 10, 2015) – Save the Children is calling upon on Italy and Europe to strengthen its search and rescue capabilities in the Mediterranean Sea to prevent further tragedies following the deaths of 29 migrants owing to hypothermia.

The migrants attempting this treacherous sea crossing were picked up by the Italian coastguard after fleeing from violence in their home countries, including Libya.

“Appalling sea conditions encountered in the winter haven’t disrupted the flow of arrivals by sea. There is firm evidence of no alternatives for those who are forced, in spite of everything, to attempt this desperate crossing,” said Rafaella Milano of Save the Children Italy…

ODI [to 14 February 2015]
http://www.odi.org/media

EU State Building Contracts: early lessons from the EU’s new budget support instrument for fragile states
Research reports and studies, February 2015
Myra Bernardi, Tom Hart, Gideon Rabinowitz
First lessons from the European Union’s new instrument for budget support in fragile states.

Adapting development: improving services to the poor
Publication – February 2015
Leni Wild, David Booth, Clare Cummings, Marta Foresti and Joseph Wales
On current trends, it will take decades or longer to bring basic services to the world’s most disadvantaged people. Meeting this challenge means recognising the political conditions that enable or obstruct development progress – a radical departure from the approach of the Millennium Development Goals.

Start Network [Consortium of British Humanitarian Agencies] [to 14 February 2015]
http://www.start-network.org/news-blog/#.U9U_O7FR98E

What does the future hold for humanitarians? Notes from the Futures Roundtable
February 11, 2015
Posted by Paul Currion in Blog.

Last November the Start Network was invited to participate in a Futures Roundtable, held at the Royal Society in London. This was planned as part of the consultation process for the World Humanitarian Summit (WHS), but with a twist. It wasn’t just humanitarian practitioners sitting round the table, but a selection of experts from completely different sectors: the insurance industry, the technology sector, the research sciences.

The workshop was convened by one of our long-term partners, Randolph Kent of the Planning from the Future project at Kings College London, and UN OCHA. The future always excites us (it’s where all of us are going to live, after all) and so our own Sean Lowrie and Paul Currion agreed to co-facilitate the workshop. The results were interesting – and you can read a short report we’ve attached below – but what was more interesting was the process.

By bringing together participants with more diverse backgrounds than usual, the workshop was able to discuss issues and generate scenarios that had not previously been raised in WHS consultations. The workshop could have gone on for longer, but we were lucky to get these participants – all of whom told us they found the workshop very constructive – for a day and half. The future? We’re talking with Randolph about how to repeat the experience.

Read the summary report here

MacArthur Foundation
http://www.macfound.org/

Publication
Protecting Human Rights Defenders and Journalists in Mexico
Published February 11, 2015
A report from the Washington Office on Latin America and Peace Brigades International assesses Mexico’s Mechanism to Protect Human Rights Defenders and Journalists. The report draws on a series of case studies to identify several areas for improvement of the Mechanism, including staffing and funding shortages and delays in risk assessments that determine protections for individuals. The report provides recommendations for strengthening the Mechanism to the Mexican government, the governments of Mexico’s 31 states and Federal District, and the U.S. government.

February 10, 2015 – From The Field
Foundations Partner to Build a Stronger Digital Society
Five foundations will jointly address the challenges and opportunities of the digital age, including committing to help keep the Internet open, secure, accessible and affordable to all. MacArthur and its NetGain partners – the Ford, Knight, Mozilla, and Open Society Foundations – will together seek to strengthen digital society, guided by a set of shared principles on the role of the Internet and technology in advancing the public interest. [See Declaration above in Week in Review]

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 14 February 2015)

Research article
Historical account of the national health insurance formulation in Kenya: experiences from the past decade
Timothy Abuya, Thomas Maina, Jane Chuma BMC Health Services Research 2015, 15:56 (12 February 2015)

Research article
Streamlined research funding using short proposals and accelerated peer review: an observational study
Adrian G Barnett, Danielle L Herbert, Megan Campbell, Naomi Daly, Jason A Roberts, Alison Mudge, Nicholas Graves BMC Health Services Research 2015, 15:55 (7 February 2015)

BMC Public Health
(Accessed 14 February 2015)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Health care providers’ perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data
Ulrika Loi, Kristina Gemzell-Danielsson, Elisabeth Faxelid, Marie Klingberg-Allvin
BMC Public Health 2015, 15:139 (12 February 2015)

Research article
Effectiveness of short message services reminder on childhood immunization programme in Kadoma, Zimbabwe – a randomized controlled trial, 2013
Donewell Bangure, Daniel Chirundu, Notion Gombe, Tawanda Marufu, Gibson Mandozana, Mufuta Tshimanga, Lucia Takundwa
BMC Public Health 2015, 15:137 (12 February 2015)

Research article
The world health organization’s health promoting schools framework: a Cochrane systematic review and meta-analysis
Rebecca Langford1*, Christopher Bonell2, Hayley Jones1, Theodora Pouliou1, Simon Murphy3, Elizabeth Waters4, Kelli Komro5, Lisa Gibbs4, Dan Magnus1 and Rona Campbell1
Author Affiliations
BMC Public Health 2015, 15:130 doi:10.1186/s12889-015-1360-y
Published: 12 February 2015
Abstract (provisional)
Background
Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization’s Health Promoting Schools (HPS) framework is a holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed.
Methods
We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013.We included cluster randomised controlled trials. Participants were children and young people aged four to 18?years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school’s ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses.
Results
We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates.
Conclusion
This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.

Research article
Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study
Rhoune Ochako, Mwende Mbondo, Stephen Aloo, Susan Kaimenyi, Rachel Thompson, Marleen Temmerman, Megan Kays
BMC Public Health 2015, 15:118 (10 February 2015)

BMC Research Notes
(Accessed 14 February 2015)
http://www.biomedcentral.com/bmcresnotes/content

Short Report
Wealth and under-nourishment among married women in two impoverished nations: evidence from Burkina Faso and Congo Democratic Republic
Ayo Adebowale, Martin Palamuleni, Clifford Odimegwu BMC Research Notes 2015, 8:34 (8 February 2015)

Conflict and Health
[Accessed 14 February 2015]
http://www.conflictandhealth.com/

Research
Assessing the experiences of intra-uterine device users in a long-term conflict setting: a qualitative study on the Thailand-Burma border
Gedeon J, Hsue SN, Walsh M, Sietstra C, MarSan H and Foster AM Conflict and Health 2015, 9:6 (12 February 2015)

Human Rights Quarterly
Volume 37, Number 1, February 2015
http://muse.jhu.edu/journals/human_rights_quarterly/toc/hrq.37.1.html

Who Trusts Local Human Rights Organizations?: Evidence from Three World Regions
James Ron, David Crow
pp. 188-239
Abstract
Local human rights organizations (LHROs) are crucial allies in international efforts to promote human rights. Without support from organized civil society, efforts by transnational human rights reformers would have little effect. Despite their importance, we have little systematic information on the correlates of public trust in LHROs. To fill this gap, we conducted key informant interviews with 233 human rights workers from sixty countries, and then administered a new Human Rights Perceptions Poll to representative public samples in Mexico (n = 2,400), Morocco (n = 1,100), India (n = 1,680), and Colombia (n = 1,699). Our data reveal that popular trust in local rights groups is consistently associated with greater respondent familiarity with the rights discourse, actors, and organizations, along with greater skepticism toward state institutions and agents. The evidence fails to provide consistent, strong support for other commonly held expectations, however, including those about the effects of foreign funding, socioeconomic status, and transnational connections.

.
Rethinking Human Rights and Culture Through Female Genital Surgeries
Ekaterina Yahyaoui Krivenko
pp. 107-136
Abstract
The article revisits the relationship between culture and human rights through the analysis of one traditionally condemned cultural practice known in human rights law as female genital mutilation. The analysis draws on anthropological and medical literature and demonstrates the importance of interdisciplinary analysis to any inquiry within the area of relationship between culture and human rights. An analogy between the traditional practice of female genital mutilations and the less widely publicized female genital aesthetic surgeries practiced in many Western countries serves as a methodological tool. Laws and attitudes towards both practices are compared, demonstrating many similarities and thus the difficulty of drawing a clear-cut line between a cultural and an a-cultural practice. In this light, human rights’ insistence on condemnation of the practices of the Other exclusively appears as hegemonizing, racializing, and, ultimately, discriminatory in its effects. Some suggestions as to what a more adequate human rights approach could look like are made as well, as the constant necessity for interdisciplinary inquiry in human rights law is emphasized.

Human Service Organizations Management, Leadership & Governance
Volume 39, Issue 1, 2015
http://www.tandfonline.com/toc/wasw21/current#.VOAi4i5nBhV

Social Change Efforts of Direct Service Nonprofits: The Role of Funding and Collaborations in Shaping Social Innovations
DOI:10.1080/23303131.2014.973623
Micheal L. Shiera* & Femida Handyb
pages 6-24
Accepted author version posted online: 03 Nov 2014
Published online: 23 Jan 2015
Abstract
Direct social service nonprofit organizations have taken on increasing responsibility in initiatives seeking to create social change for their service user populations and within the community. This research utilized a mixed methods study design to investigate the characteristics of the inter-organizational context that are particularly supportive of these social change efforts. The results show that characteristics of collaboration, degree of marketization, and funder support predict the extent of engagement in social change efforts. The results have implications for developing the capacity of direct service nonprofits to undertake their social missions.

Globalization and Health
[Accessed 14 February 2015]
http://www.globalizationandhealth.com/

Debate
Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions
Swanson RC, Atun R, Best A, Betigeri A, de Campos F, Chunharas S, Collins T, Currie G et al. Globalization and Health 2015, 11:5 (12 February 2015)

Research
Maternal mortality: a cross-sectional study in global health
Sajedinejad S, Majdzadeh R, Vedadhir AA, Tabatabaei MG and Mohammad K Globalization and Health 2015, 11:4 (12 February 2015)

Infectious Diseases of Poverty
[Accessed 14 February 2015]
http://www.idpjournal.com/content

Research Article
An ecohealth assessment of poultry production clusters (PPCs) for the livelihood and biosecurity improvement of small poultry producers in Asia
Libin Wang, Edi Basuno, Tuan Nguyen, Worapol Aengwanich, Nyak Ilham and Xiaoyun Li
Infectious Diseases of Poverty 2015, 4:6 doi:10.1186/2049-9957-4-6
Published: 9 February 2015
Abstract (provisional)
Background
Poultry production cluster (PPC) programs are key strategies in many Asian countries to engage small commercial poultry producers in high-value production chains and to control infectious poultry diseases. This study assessed the multiple impacts of PPCs through a transdisciplinary ecohealth approach in four Asian countries, and drew the implications for small producers to improve their livelihoods and reduce the risk of spreading infectious diseases in the poultry sector.
Methods
The data collection combined both quantitative and qualitative methods. It comprised: formal structured household survey questionnaires, measuring the biosecurity level of poultry farms with a biosecurity score card; and key informant interviews. Descriptive statistics were used to process the quantitative data and a content analysis was used to process the qualitative data.
Results
This research found that poultry farms in clusters do not necessarily have better economic performance than those outside PPCs. Many farmers in PPCs only consider them to be an advantage for expanding the scale of their poultry operations and improving household incomes, and they are less concerned about–and have limited capacities to–enhancing biosecurity and environmental management. We measured the biosecurity level of farms in PPCs through a 14-item checklist and found that biosecurity is generally very low across all sample sites. The increased flies, mosquitoes, rats, and smells in and around PPCs not only pollute the environment, but also cause social conflicts with the surrounding communities.
Conclusion
This research concluded that a poultry cluster, mainly driven by economic objectives, is not necessarily a superior model for the control of infectious diseases. The level of biosecurity in PPCs was found to be low. Given the intensity of poultry operations in PPCs (farms are densely packed into clusters), and the close proximity to residential areas of some PPCs, the risk of spreading infectious diseases, in fact, increases. Good management and collective action for implementing biosecurity measures are key for small producers in PPCs to address common challenges and pursue health-based animal production practices.

JAMA
February 10, 2015, Vol 313, No. 6
http://jama.jamanetwork.com/issue.aspx

Viewpoint | February 10, 2015
The 2014 Ebola Outbreak and Mental Health: Current Status and Recommended Response
FREE
James M. Shultz, MS, PhD1; Florence Baingana, MB, ChB, MMed (Psychiatry), MSc (HPPF)2; Yuval Neria, PhD3
Author Affiliations
JAMA. 2015;313(6):567-568. doi:10.1001/jama.2014.17934.

…CONCLUSIONS
Fear reactions are predictable and pervasive and may exacerbate disease spread in pandemic areas. Efforts to develop effective treatments and vaccines should be coupled with a response to help with efforts to control preventable viral transmission and support the psychological needs of the public overall as well as infected patients, family members, health care workers, and other responders. The West Africa pandemic provides insights into the psychological consequences associated with a “worst case scenario” event involving a highly virulent infectious disease. An effective response is essential both in West Africa to address the psychosocial needs associated with population-wide direct exposure to disease, death, and distress; and in the United States, to counterbalance fear-driven behaviors and policy making with prudent and effective preparedness for emerging infectious diseases.

The Lancet
Feb 14, 2015 Volume 385 Number 9968 p577-662 e7-e11
http://www.thelancet.com/journals/lancet/issue/current

Comment
Older people’s health in sub-Saharan Africa
Isabella A G Aboderin, John R Beard
Published Online: 05 November 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61602-0

Awareness is growing that the world’s population is rapidly ageing. Although much of the related policy debate is about the implications for high-income countries, attention is broadening to less developed settings.1 Middle-income country populations, in particular, are generally ageing at a much faster rate than was the case for today’s high-income countries, and the health of their older populations could be substantially worse.2 However, little consideration has been given to issues of old age in sub-Saharan Africa, which remains the world’s poorest and youngest region.3 Development and health agendas for that region, including those being discussed in relation to targets to succeed the Millennium Development Goals,4 understandably centre on how to increase the capacity of and opportunities for the region’s young people. Yet strong arguments exist for why the health of older people (aged 60 years and older) should not be overlooked. Not least is the substantial size of these populations—already double the number of older adults in northern Europe—which is expected to grow faster than anywhere else, increasing from 46 million in 2015 to 157 million by 2050.5 Furthermore, life expectancy at age 60 years in sub-Saharan Africa is 16 years for women and 14 years for men, suggesting that, for those who survive early life, a long old age is already a reality.2

However, perhaps the most important reason to consider the older population in present plans for increased human and economic wellbeing in sub-Saharan Africa is that, contrary to common assumptions, older Africans play roles that are crucial to achievement of this wellbeing. Within families, older people are often carers or guardians of younger kin. They directly shape younger generations’ access to health, education, and other capabilities, and thus their future human capital. The extent of older people’s caregiving is increasingly recognised in the context of HIV/AIDS—more than 60% of orphaned children in Namibia and Zimbabwe, for example, are looked after by their grandmothers.5 This care function is also important in everyday settings of poverty or labour-related parental absence—in the urban slums of Nairobi, Kenya, for instance, more than 30% of older women and 20% of older men (aged 60 years or older) care for one or more non-biological child (African Population and Health Research Center, Centre for Research on Ageing, University of Southampton, unpublished).

Beyond the family, older African people have key economic roles. In most sub-Saharan African countries, older people largely remain in the labour force,6 particularly in smallholder agriculture, which encompasses the bulk of food production and must be revitalised if nutrition security and sufficient job opportunities are to be ensured for younger generations. As a result of selective rural–urban outmigration, incapacity, or uninterest of younger adults in farming, older people constitute a substantial share of smallholders. In Kenya, for example, the average age of a farmer is estimated to be 60 years.7 Similarly, preliminary analyses of national survey data from Malawi and Kenya show close to 20% of decision makers on smallholder land use in both countries to be aged 60 years and older (African Population and Health Research Center, unpublished). The extent to which older African people can execute their social and economic functions effectively depends heavily on their physical and mental capacity.8, 9 Conversely, if their health deteriorates to a point at which they themselves need care, the responsibility is likely to fall on female younger kin, whose own health, and employment and education opportunities, can be affected.10 Impaired health in older age in sub-Saharan Africa thus affects not only older individuals, but families, communities, and prospects for development more broadly.

Yet older African people face a large morbidity and disability burden, particularly from chronic disease. Our preliminary analysis of 2010 Global Burden of Disease data identifies cardiovascular and circulatory disease, nutritional deficiencies, cirrhosis of the liver, and diabetes as major causes of disability-adjusted life years in sub-Saharan Africa’s older population. Moreover, representative surveys of older adults’ health show high rates of hypertension,11 musculoskeletal disease,12 visual impairment,13 functional limitations,9 and depression.14 Additionally, infectious diseases continue to affect older Africans, underscored by a substantial prevalence of HIV infection and its exacerbating effect on several non-communicable diseases.15 At the same time, evidence of heterogeneity in health and function within older populations and the importance of modifiable factors in shaping it underscore the importance of health-promoting interventions to enable successful ageing in the region.16 Yet a large proportion of, or even most, older Africans lack the requisite care—results of the WHO Study on Adult Health and Ageing11 in Ghana, for example, showed 96% of those with hypertension to have no adequate treatment for the disorder.

A crucial but often omitted perspective is a comparison with younger age groups. Illness and disability rates of older people substantially outstrip those of younger adults.17, 18 This contrasts starkly with findings from high-income countries that show older age to be an increasingly unreliable predictor of greater morbidity or impaired function.19 Yet, despite having worse health than younger age groups, older people in sub-Saharan Africa have been observed to use health services substantially less than younger people do.17, 18 This disparity points to possible age-based inequalities in access to health care that need attention in addition to the widely considered axes of inequities in health (ie, economic status, sex, ethnic origin, or rural or urban residence).

Barriers to health care faced by older African people include absence of an escort or high costs of transport to health providers, and private sector fees for medicines or treatment.18, 20 Older patients use commercial providers because of the unavailability, perceived poor quality, or age insensitivity of services in government facilities.18 These providers, in a bid to achieve the health Millennium Development Goals, typically remain focused on services for infectious diseases, children, and reproductive age adults.18, 20 The supply-side difficulties are exacerbated by important demand-side factors. Such obstacles include resource allocation norms within poor families, which can prioritise the needs of the young at the expense of the old, and older adults’ often little appreciation of the value of, or need for, management of asymptomatic chronic disease.18, 20

In view of the direct importance of older African people’s physical and mental health for the achievement of core development goals, their burden of ill health and likely inequitable access to necessary care provide compelling economic and social grounds for action. These needs should be incorporated into emergent frameworks for attainment of universal health coverage in sub-Saharan Africa in the form of a commitment to maintenance of health and function across the entire life course. Essential action on non-communicable diseases, in particular, will need to extend beyond a focus on prevention of early mortality from key diseases to include provision of chronic care for key non-fatal disorders that affect the function of older populations. However, such a commitment will need to be accompanied by concerted evidence generation if it is to be converted into practice. Such research will need to: better define health needs and care gaps for older Africans; identify feasible and effective models for adaptation of health systems in sub-Saharan Africa; and persuade decision makers to invest in these models.
Longitudinal studies such as the WHO Study on Adult Health and Ageing or 10/66 dementia research are starting to improve understanding of priority intervention needs in a small number of sub-Saharan African countries. However, further social and epidemiological investigations are needed in these and other national contexts. These studies will need to be complemented by assessments of effectiveness of the few existing health financing, human resource, essential medicine or technology, and service delivery approaches targeted at older people in sub-Saharan Africa, and by design and testing of new models.

Lastly, national evidence on possible age-based health inequities and economic effects of ill health in the older population is needed to help garner political will for action. Such information could be generated—as part of the called-for data revolution for the post-Millennium Development Goals agenda—through systematic expansions to sampling, data collection, or analysis protocols of routine surveys, such as Demographic and Health Surveys, regularly undertaken by countries in sub-Saharan Africa. The fact that developing-country governments have launched a joint Commission on Ageing in Developing Countries bodes well. This Commission should help promote the necessary research and operationalisation of emerging findings by policy makers and external drivers of health-system development in sub-Saharan Africa.
We declare no competing interests.
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