Determinants of HIV testing among Nigerian couples: a multilevel modelling approach

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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Determinants of HIV testing among Nigerian couples: a multilevel modelling approach
Aurélia Lépine*, Fern Terris-Prestholt and Peter Vickerman
Author Affiliations
London School of Hygiene and Tropical Medicine, Global Health and Development Department, London, WC1H 9SH, UK
Accepted April 5, 2014.
Abstract
In this article we analyse the determinants of HIV testing among Nigerian couples using Demographic and Health Survey data set (2008). This study is motivated by the fact that although there is a strong willingness from the Nigerian Government to examine new HIV preventions approaches such as Pre-Exposure Prophylaxis for HIV (PrEP) and Treatment as Prevention (TasP) for HIV serodiscordant couples, the implementation of such policies would require the HIV status of each partner in the couple to be known. This is far to be achieved in the Nigerian context since in Nigeria only 6% of couples know their HIV status. In order to identify potential policies that are needed to increase HIV testing uptake, we use a three-level random intercept logistic model to separately explore the determinants of knowing HIV status among female and male partners. The use of the multilevel modelling allows including the unobserved heterogeneity at the village and state level that may affect HIV testing behaviours. Our results indicate that education, wealth, stigma, HIV knowledge and perceived risk are predictors of HIV testing among both partners while routine provider initiated testing appears to be very effective to increase HIV testing among women. The introduction of financial incentives as well as an increase in routine testing and home-based testing may be needed for large scale increase in HIV testing prior to the implementation of new HIV prevention technologies among discordant couples.

Measuring political commitment and opportunities to advance food and nutrition security: piloting a rapid assessment tool

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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Measuring political commitment and opportunities to advance food and nutrition security: piloting a rapid assessment tool
Ashley M Fox1,*, Yarlini Balarajan2, Chloe Cheng3 and Michael R Reich4
Author Affiliations
1Department of Health Evidence and Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA and 2Nutrition Section, Programme Division, United Nations Children’s Fund (UNICEF), Three United Nations Plaza, New York, NY 10017, USA, 3Department of Health Evidence and Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA, 4Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
Accepted April 6, 2014.
Abstract
Lack of political commitment has been identified as a primary reason for the low priority that food and nutrition interventions receive from national governments relative to the high disease burden caused by malnutrition. Researchers have identified a number of factors that contribute to food and nutrition’s ‘low-priority cycle’ on national policy agendas, but few tools exist to rapidly measure political commitment and identify opportunities to advance food and nutrition on the policy agenda. This article presents a theory-based rapid assessment approach to gauging countries’ level of political commitment to food and nutrition security and identifying opportunities to advance food and nutrition on the policy agenda. The rapid assessment tool was piloted among food and nutrition policymakers and planners in 10 low- and middle-income countries in April to June 2013. Food and nutrition commitment and policy opportunity scores were calculated for each country and strategies to advance food and nutrition on policy agendas were designed for each country. The article finds that, in a majority of countries, political leaders had verbally and symbolically committed to addressing food and nutrition, but adequate financial resources were not allocated to implement specific programmes. In addition, whereas the low cohesion of the policy community has been viewed a major underlying cause of the low-priority status of food and nutrition, the analysis finds that policy community cohesion and having a well thought-out policy alternative were present in most countries. This tool may be useful to policymakers and planners providing information that can be used to benchmark and/or evaluate advocacy efforts to advance reforms in the food and nutrition sector; furthermore, the results can help identify specific strategies that can be employed to move the food and nutrition agenda forward. This tool complements others that have been recently developed to measure national commitment to advancing food and nutrition security.

The cost of a knowledge silo: a systematic re-review of water, sanitation and hygiene interventions

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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The cost of a knowledge silo: a systematic re-review of water, sanitation and hygiene interventions
Michael Loevinsohn1,*, Lyla Mehta1,2, Katie Cuming1, Alan Nicol1,4, Oliver Cumming3 and
Jeroen H J Ensink3
Author Affiliations
1Knowledge, Technology and Society Team, Institute of Development Studies, Library Road, Brighton BN1 9RE, UK, 2Noragric, Norwegian University of Life Sciences, P.O. Box 5003, NO-1432 Aas, Norway, 3Environmental Health Group, Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT and 4Present address: CARE International in Uganda, Box 7280 Kampala, Uganda
Accepted April 5, 2014.
Abstract
Divisions between communities, disciplinary and practice, impede understanding of how complex interventions in health and other sectors actually work and slow the development and spread of more effective ones. We test this hypothesis by re-reviewing a Cochrane-standard systematic review (SR) of water, sanitation and hygiene (WASH) interventions’ impact on child diarrhoea morbidity: can greater understanding of impacts and how they are achieved be gained when the same papers are reviewed jointly from health and development perspectives? Using realist review methods, researchers examined the 27 papers for evidence of other impact pathways operating than assumed in the papers and SR. Evidence relating to four questions was judged on a scale of likelihood. At the ‘more than possible’ or ‘likely’ level, 22% of interventions were judged to involve substantially more actions than the SR’s label indicated; 37% resulted in substantial additional impacts, beyond reduced diarrhoea morbidity; and unforeseen actions by individuals, households or communities substantially contributed to the impacts in 48% of studies. In 44%, it was judged that these additional impacts and actions would have substantially affected the intervention’s effect on diarrhoea morbidity. The prevalence of these impacts and actions might well be found greater in studies not so narrowly selected. We identify six impact pathways suggested by these studies that were not considered by the SR: these are tentative, given the limitations of the literature we reviewed, but may help stimulate wider review and primary evaluation efforts. This re-review offers a fuller understanding of the impacts of these interventions and how they are produced, pointing to several ways in which investments might enhance health and wellbeing. It suggests that some conclusions of the SR and earlier reviews should be reconsidered. Moreover, it contributes important experience to the continuing debate on appropriate methods to evaluate and synthesize evidence on complex interventions.

Monitoring the ability to deliver care in low- and middle-income countries: a systematic review of health facility assessment tools

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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Monitoring the ability to deliver care in low- and middle-income countries: a systematic review of health facility assessment tools
Jason W Nickerson1,2,*, Orvill Adams3, Amir Attaran4,5, Janet Hatcher-Roberts6 and Peter Tugwell7
Author Affiliations
1Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, 2Bruyère Research Institute, Ottawa, ON, Canada, 3Orvill Adams and Associates, Ottawa, ON, Canada, 4Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, 5Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, 6Canadian Society for International Health, Ottawa, ON, Canada and 7Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
Accepted April 25, 2014.
Abstract
Introduction
Health facilities assessments are an essential instrument for health system strengthening in low- and middle-income countries. These assessments are used to conduct health facility censuses to assess the capacity of the health system to deliver health care and to identify gaps in the coverage of health services. Despite the valuable role of these assessments, there are currently no minimum standards or frameworks for these tools.
Methods
We used a structured keyword search of the MEDLINE, EMBASE and HealthStar databases and searched the websites of the World Health Organization, the World Bank and the International Health Facilities Assessment Network to locate all available health facilities assessment tools intended for use in low- and middle-income countries. We parsed the various assessment tools to identify similarities between them, which we catalogued into a framework comprising 41 assessment domains.
Results
We identified 10 health facility assessment tools meeting our inclusion criteria, all of which were included in our analysis. We found substantial variation in the comprehensiveness of the included tools, with the assessments containing indicators in 13 to 33 (median: 25.5) of the 41 assessment domains included in our framework. None of the tools collected data on all 41 of the assessment domains we identified.
Conclusions
Not only do a large number of health facility assessment tools exist, but the data they collect and methods they employ are very different. This certainly limits the comparability of the data between different countries’ health systems and probably creates blind spots that impede efforts to strengthen those systems. Agreement is needed on the essential elements of health facility assessments to guide the development of specific indicators and for refining existing instruments.

Sexual violence in India: addressing gaps between policy and implementation

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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Sexual violence in India: addressing gaps between policy and implementation
Prachi Sharma1, M K Unnikrishnan1 and Abhishek Sharma1,2,*
Author Affiliations
1Manipal College of Pharmaceutical Sciences, Manipal University, Madhav Nagar, Manipal 576104, Karnataka, India, 2Department of International Health, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118, United States of America
Accepted February 6, 2014.
Abstract
The savage Delhi rape of 16 December 2012 was instrumental in generating the Verma Report that framed policies for amending the Criminal Laws related to sexual violence, professionalizing forensic/medical examination of victims, and sensitizing the police, electorate and the educational sectors. Unfortunately, even after a year, the Indian Home Ministry has abysmally failed to implement most recommendations, even underutilizing budgetary allocations. This article addresses gaps in governance systems and offers solutions to the problem of sexual violence in India.

Journal of Community Health – June 2015 [HPV Vaccination]

Journal of Community Health
Volume 40, Issue 3, June 2015
http://link.springer.com/journal/10900/40/3/page/1

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Latino Parents’ Perceptions of the HPV Vaccine for Sons and Daughters
Echo L. Warner, Djin Lai, Sara Carbajal-Salisbury, Luis Garza, Julia Bodson, Kathi Mooney,
Deanna Kepka
Abstract
Latinas have the highest incidence of cervical cancer. Latino parents’ perceptions of the human papillomavirus (HPV) and willingness to have their sons and daughters vaccinated in Utah is largely unknown. Latino parents/guardians of children ages 11–17 years were recruited from two community organizations (N = 52) to participate in a mini-survey and focus group. Guided by the social ecological framework, a Latina facilitator conducted five focus groups that were recorded, transcribed and translated. Descriptive statistics were calculated from the mini-survey. Two members of the research team performed inductive content analysis of the focus group transcriptions separately. Discrepancies were discussed and resolved during bi-weekly meetings with group members who were present during the focus groups. Parents reported low HPV vaccine knowledge, high vaccine costs, and lack of strong provider recommendations as the main barriers to vaccine receipt. Language appropriate educational resources and consistent provider recommendations may enrich Latino parents’ perceptions about the HPV vaccine.

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HPV Vaccination Completion and Compliance with Recommended Dosing Intervals Among Female and Male Adolescents in an Inner-City Community Health Center
Rula M. Wilson, Diane R. Brown, Dennis P. Carmody, Sushanna Fogarty
Abstract
Human papillomavirus (HPV) vaccination continues to lag behind other adolescent vaccines, especially in areas with pervasive disparities in HPV-related cancers. The purpose of this study was to examine HPV vaccine completion and dosing intervals among low-income adolescents in urban areas. The study included electronic health record data on HPV vaccination for 872 adolescents who received at least one dose of the HPV vaccine. Only 28.4 % completed the 3-dose series. For the whole sample, HPV vaccine completion was higher for non-English speakers and among adolescents seen at Newark-South and East Orange sites. Completion was higher among non-English speaking female and Hispanic adolescents, females seen in Newark-South and East Orange sites, and insured Black adolescents. Completion was also dramatically lower among non-English speaking Black adolescents seen at Newark-North, Irvington, and Orange sites (12.5 %) compared to other Black adolescents (22.0–44.4 %). The mean dosing intervals were 5.5 months (SD = 4.6) between dose 1 and 2 and 10 months (SD = 6.1) between dose 1 and 3. Longer durations between vaccine doses were found among uninsured adolescents and those seen at Newark-North, Irvington, and Orange sites. Non-English speakers had longer duration between dose 1 and 3. Further, durations between dose 1 and 3 were dramatically longer among insured adolescents seen at Newark-North, Irvington, and Orange locations for the whole sample (M = 11.70; SD = 7.12) and among Hispanic adolescents (M = 13.45; SD = 8.54). Understanding how the study predictors facilitate or impede HPV vaccination is critical to reducing disparities in cervical and other HPV-related cancer, especially among Black, Hispanic, and low-income populations.

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Knowledge Management for Development Journal – Vol 11, No 1 (2015)

Knowledge Management for Development Journal
Vol 11, No 1 (2015)
http://journal.km4dev.org/journal/index.php/km4dj/index

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The Facilitator Role within Learning Networks at USAID
Ashleigh Mullinax, Cydney Gumann
Abstract
How can facilitation help to drive meaningful peer-to-peer learning in a formalized learning network? This article will explore the core role that facilitators play in implementing a learning network, as defined by USAID. USAID’s model of learning networks differs from other peer-to-peer learning opportunities, such as communities of practice or networks of practice, in a number of ways including selection of grantees through a competitive process, dedicated funding of learning network partners, and creation of deliverables within a designated timeline. This paper outlines three core differences that make facilitating learning networks at USAID distinctive: 1) The organization of the learning network around evolving learning agendas that facilitate learning on multiple levels; 2) The time and process involved in the development and implementation of a learning network; and 3) The unique intra- and inter-personal dynamics of the learning network through the involvement of both the funded (network members) and the funder (the donor). In this article, the role of a learning network facilitator will be overlaid primarily with lessons learned generated from implementation of the Growing Organizational Value Chain Excellence (GROOVE) Learning Network.

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Group facilitation in CGIAR: experiences and lessons from international agricultural research organizations
Simone Staiger, Ewen Le Borgne, Michael Victor, Juergen Hagmann, Cristina Sette, Petr Kosina
Abstract
This article describes CGIAR’s experience with group facilitation over 10 years. CGIAR is a global partnership that unites organizations engaged in research for a food-secure future. Including 15 research centers with a total of nearly 9,000 staff, CGIAR embarked a decade ago on an effort to improve how teams meet, think collectively, and make decisions. Inspired by participatory approaches, which had been used since the 1980s to involve farmers in research, the leaders of this effort aimed to tackle challenges faced by research teams and partnerships, and since then, the need for more effective stakeholder engagement and the consequent demand for group facilitation have steadily increased. Based on the experiences of the co-authors, a survey, complemented by follow-up conversations with CGIAR in-house facilitators and researchers, as well as professional consultant-facilitators and partners, this case study analyzes the evolution of facilitation, its added value, and current trends. In addition, the authors discuss the different ways and contexts in which facilitators have worked in CGIAR and some of the facilitation essentials that emerge from the author’s enquiry. This article should be of particular interest to knowledge management practitioners working in research and development, as it offers hints on how to position facilitation as an essential tool for stakeholder engagement and participatory decision-making in research-for-development organizations.
Full Text: PDF

The Lancet – May 09, 2015

The Lancet
May 09, 2015 Volume 385 Number 9980 p1803-1916 e45-e46
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Rural health inequities: data and decisions
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60910-2
70% of the world’s 1.4 billion people who are extremely poor live in rural areas. A new report released on April 27 by the UN International Labour Organisation (ILO), Global evidence on inequities in rural health protection: new data on rural deficits in health coverage for 174 countries, presents the first global, regional, and national data on the extent and major causes of rural–urban inequities in coverage, and access to health care. 56% of rural residents worldwide are without legal health coverage (defined as protected by legislation or affiliation with a health insurance scheme)—compared with 22% of the urban population.

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Editorial
Keeping watch on women’s cancers
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60911-4
Cancer is a perennial public health issue. With refined estimates of the global burden of disease (GBD), the picture of cancer has become clearer and has begun to yield crucial new details about where the challenges lie. According to the 2013 GBD study, the cancers that contribute to the most deaths are: lung (1•64 million), stomach (840 000), liver (820 000), colorectal (770 000), and breast (470 000). But other areas of concern emerge when aggregating across types of cancer, such as cancers that specifically affect women.

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Comment
Global health security now
Richard Horton, Pamela Das
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60909-6
The concept of security as an important dimension of health divides opinions. To invoke the idea of security risks giving permission to more authoritarian-minded governments to use health crises as justification for sometimes extreme curbs on liberty or the political, economic, and social rights of citizens. During the Ebola virus disease outbreak, photographs appeared in news media of police brutally attacking the public for breaching curfews. Invoking arguments of global health security might further encourage this kind of violent response.

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Comment
Putting science into practice for early child development
Anthony Lake, Margaret Chan
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61680-9
The debate between nature and nurture as determinants of early child development is over. Today, we understand that the two are inextricably linked. The degree of their interdependence—and the impact of this interplay on the developing brains of children—is even greater than we previously imagined.1 This knowledge has tremendous implications for how we design and deliver early child development interventions…

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Public Policy
Global health security: the wider lessons from the west African Ebola virus disease epidemic
Prof David L Heymann, MD, Lincoln Chen, MD, Prof Keizo Takemi, MA, Prof David P Fidler, BCL, Jordan W Tappero, MD, Mathew J Thomas, MPH, Thomas A Kenyon, MD, Thomas R Frieden, MD, Derek Yach, MBChB, Sania Nishtar, FRCP, Alex Kalache, Prof Piero L Olliaro, MD, Prof Peter Horby, MD, Els Torreele, PhD, Prof Lawrence O Gostin, JD, Margareth Ndomondo-Sigonda, MBA, Prof Daniel Carpenter, PhD, Simon Rushton, PhD, Louis Lillywhite, MSc, Prof Bhimsen Devkota, PhD, Prof Khalid Koser, PhD, Rob Yates, MBA ,Ranu S Dhillon, MD, Ravi P Rannan-Eliya, DPH
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60858-3
Summary
The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.

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Public Policy
A retrospective and prospective analysis of the west African Ebola virus disease epidemic: robust national health systems at the foundation and an empowered WHO at the apex
Prof Lawrence O Gostin, JD, Eric A Friedman, JD
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60644-4
Summary
The Ebola virus disease outbreak in west Africa is pivotal for the worldwide health system. Just as the depth of the crisis ultimately spurred an unprecedented response, the failures of leadership suggest the need for innovative reforms. Such reforms would transform the existing worldwide health system architecture into a purposeful, organised system with an empowered, highly capable WHO at its apex and enduring, equitable national health systems at its foundation. It would be designed not only to provide security against epidemic threats, but also to meet everyday health needs, thus realising the right to health. This retrospective and prospective analysis offers a template for these reforms, responding to the profound harms posed by fragile national health systems, delays in the international response, deficient resource mobilisation, ill defined responsibilities, and insufficient coordination. The scope of the reforms should address failures in the Ebola response, and entrenched weaknesses that enabled the epidemic to reach its heights.

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Viewpoint
What is a resilient health system? Lessons from Ebola
Margaret E Kruk, Michael Myers, S Tornorlah Varpilah, Bernice T Dahn
Ebola vaccines: keep the clinical trial protocols on the shelf and ready to roll out
David L Heymann, Guenael R Rodier, Michael J Ryan

Foreign Medical Teams in the Philippines after Typhoon Haiyan 2013 – Who Were They, When Did They Arrive and What Did They Do?

PLOS Currents: Disasters
[Accessed 9 May 2015]
http://currents.plos.org/disasters/

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Foreign Medical Teams in the Philippines after Typhoon Haiyan 2013 – Who Were They, When Did They Arrive and What Did They Do?
May 5, 2015 • Research article
Background:
Foreign medical teams (FMT) are international medical teams sent to provide assistance in the aftermath of a disaster. In the last decade, there has been an increase in FMTs deployed following disasters. Despite the potential benefit FMTs might have in substituting the collapsed health care and caring for excess morbidity after large-scale disasters, several studies have demonstrated the difficulties in determining the quality of the response, mainly due to lack of reliable data. In order to bridge the knowledge gap on functioning of FMTs, the aim of this study is to assess the timing, capacities and activities of FMTs deployed to the Philippines after typhoon Haiyan.
Methods:
This is a retrospective, descriptive study. Data on characteristics of FMTs present in the Philippines after typhoon Haiyan was provided by the World Health Organization (WHO) and compiled into a single database. Additional data was collected through a web survey, email correspondence and internet searches.
Results:
A total of 108 FMTs were identified as arriving to the Philippines within the first month following typhoon Haiyan. None of these were operational in the affected areas within the first 72 h and the average time between arriving and being on-site operational was three days. Of the 108 FMTs, 70% were FMT type 1, 11% were FMT type 2 and 3% were FMT type 3. 16% of FMTs had unknown status. The total number of staff within all these FMTs were 2121, of which 210 were medical doctors, 250 nurses and 6 midwifes. Compared to previous sudden onset disasters, this study found no improvement in data sharing.

PLoS Currents: Outbreaks (Accessed 9 May 2015)

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 9 May 2015)

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Assessing Measles Transmission in the United States Following a Large Outbreak in California
May 7, 2015 • Research
The recent increase in measles cases in California may raise questions regarding the continuing success of measles control. To determine whether the dynamics of measles is qualitatively different in comparison to previous years, we assess whether the 2014-2015 measles outbreak associated with an Anaheim theme park is consistent with subcriticality by calculating maximum-likelihood estimates for the effective reproduction number given this year’s outbreak, using the Galton-Watson branching process model. We find that the dynamics after the initial transmission event are consistent with prior transmission, but does not exclude the possibilty that the effective reproduction number has increased.

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Epidemiological and Surveillance Response to Ebola Virus Disease Outbreak in Lofa County, Liberia (March-September, 2014); Lessons Learned
May 6, 2015 • Research
Ebola Virus Disease (EVD) outbreak was confirmed in Liberia on March 31st 2014. A response comprising of diverse expertise was mobilized and deployed to the country to contain transmission of Ebola and give relief to a people already impoverished from protracted civil war. This paper describes the epidemiological and surveillance response to the EVD outbreak in Lofa County in Liberia from March to September 2014. Five of the 6 districts of Lofa were affected. The most affected districts were Voinjama/Guardu Gbondi and Foya. By 26th September, 2014, a total of 619 cases, including 19.4% probable cases, 20.3% suspected cases and 44.2% confirmed cases were recorded by the Ebola Emergency Response Team (EERT) of Lofa County. Adults (20-50 years) were the most affected. Overall fatality rate was 53.3%. Twenty two (22) cases were reported among the Health Care Workers with a fatality rate of 81.8%. Seventy eight percent (78%) of the contacts successfully completed 21 days follow-up while 134 (6.15%) that developed signs and symptoms of EVD were referred to the ETU in Foya. The contributions of the weak health systems as well as socio-cultural factors in fueling the epidemic are highlighted. Importantly, the lessons learnt including the positive impact of multi-sectorial and multidisciplinary and coordinated response led by the government and community. Again, given that the spread of infectious disease can be considered a security threat every effort has to put in place to strengthen the health systems in developing countries including the International Health Regulation (IHR)’s core capacities.

Screening and Treating UN Peacekeepers to Prevent the Introduction of Artemisinin-Resistant Malaria into Africa

PLoS Medicine
(Accessed 9 May 2015)
http://www.plosmedicine.org/

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Essay
Screening and Treating UN Peacekeepers to Prevent the Introduction of Artemisinin-Resistant Malaria into Africa
Stan Houston, Adam Houston
Published: May 5, 2015
DOI: 10.1371/journal.pmed.1001822
Summary Points
:: The Haitian cholera epidemic provides a tragic demonstration of the potential for United Nations peacekeepers to introduce serious disease into vulnerable populations.
:: Resistance to artemisinin derivatives, now the global standard therapy for falciparum malaria, has emerged and is spreading in Southeast Asia.
:: UN peacekeeping troops from Southeast Asia are frequently deployed in sub-Saharan Africa.
:: These circumstances entail a high risk of introducing artemisinin resistance into the populations most affected by malaria, with potentially disastrous consequences for malaria treatment and control in sub-Saharan Africa.
:: The UN has a responsibility to prevent such an outcome; selective predeployment screening and treatment of UN peacekeeping troops is feasible and urgently needed.
Introduction: The Precedent of Cholera in Haiti
In the aftermath of the massive earthquake that devastated Haiti in 2010, an ongoing epidemic of cholera introduced by United Nations peacekeepers has resulted in over 730,000 cases and over 8,700 deaths—the largest single-country cholera epidemic in nearly a century [1,2]. This disaster should serve as an urgent warning about the potential for introduction by UN troops of other serious infectious diseases into the vulnerable populations they were sent to protect. Indeed, the UN has recently agreed to avoid rotation of African troops to Haiti because of concern about the introduction of Ebola [3]. But the tragedy in Haiti pales in comparison to the scale of long-term impact on malaria morbidity, mortality, and control programs that would result from the introduction of artemisinin-resistance into sub-Saharan Africa, where 85% of the world’s falciparum malaria cases and over 90% of all malaria deaths now occur [4]. This threat demands urgent action, in particular on the part of the UN…

Millennium Development Goal Four and Child Health Inequities in Indonesia: A Systematic Review of the Literature

PLoS One
[Accessed 9 May 2015]
http://www.plosone.org/

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Millennium Development Goal Four and Child Health Inequities in Indonesia: A Systematic Review of the Literature
Julia Schröders, Stig Wall, Hari Kusnanto, Nawi Ng
Research Article | published 05 May 2015 | PLOS ONE 10.1371/journal.pone.0123629
Abstract
Introduction
Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework?
Methods and Findings
We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable “disadvantaged populations” was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities.
Conclusion
This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.

Science – 8 May 2015

Science
8 May 2015 vol 348, issue 6235, pages 605-728
http://www.sciencemag.org/current.dtl

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Report
Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality
Michael J. Mina1,2,*, C. Jessica E. Metcalf1,3, Rik L. de Swart4, A. D. M. E. Osterhaus4, Bryan T. Grenfell1,3
Author Affiliations
1Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.
2Medical Scientist Training Program, School of Medicine, Emory University, Atlanta, GA, USA.
3Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
4Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands.
Abstract
Immunosuppression after measles is known to predispose people to opportunistic infections for a period of several weeks to months. Using population-level data, we show that measles has a more prolonged effect on host resistance, extending over 2 to 3 years. We find that nonmeasles infectious disease mortality in high-income countries is tightly coupled to measles incidence at this lag, in both the pre- and post-vaccine eras. We conclude that long-term immunologic sequelae of measles drive interannual fluctuations in nonmeasles deaths. This is consistent with recent experimental work that attributes the immunosuppressive effects of measles to depletion of B and T lymphocytes. Our data provide an explanation for the long-term benefits of measles vaccination in preventing all-cause infectious disease. By preventing measles-associated immune memory loss, vaccination protects polymicrobial herd immunity.

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Review
Soil and human security in the 21st century
Ronald Amundson1,*, Asmeret Asefaw Berhe2, Jan W. Hopmans3, Carolyn Olson4, A. Ester Sztein5, Donald L. Sparks6
Author Affiliations
1Department of Environmental Science, Policy, and Management, University of California, Berkeley, CA 94720, USA.
2Life and Environmental Sciences Unit, University of California, Merced, CA 95343, USA.
3Land, Air, and Water Resources, One Shields Avenue, Davis, CA 95616, USA.
4Climate Change Program Office, Office of the Chief Economist, U.S. Department of Agriculture (USDA), 14th and Independence SW, Washington, DC 20013, USA.
5Board on International Scientific Organizations, National Academy of Sciences, 500 Fifth Street NW, Washington, DC 20001, USA.
6Plant and Soil Science, Chemistry and Biochemistry, Civil and Environmental Engineering, and Marine Science and Policy, University of Delaware, Newark, DE 19716, USA.
Structured Abstract
BACKGROUND
Earth’s soil has formed by processes that have maintained a persistent and expansive global soil mantle, one that in turn provided the stage for the evolution of the vast diversity of life on land. The underlying stability of soil systems is controlled by their inherent balance between inputs and losses of nutrients and carbon. Human exploitation of these soil resources, beginning a few thousand years ago, allowed agriculture to become an enormous success. The vastness of the planet and its soil resources allowed agriculture to expand, with growing populations, or to move, when soil resources were depleted. However, the practice of farming greatly accelerated rates of erosion relative to soil production, and soil has been and continues to be lost at rates that are orders of magnitude greater than mechanisms that replenish soil. Additionally, agricultural practices greatly altered natural soil carbon balances and feedbacks. Cultivation thus began an ongoing slow ignition of Earth’s largest surficial reservoir of carbon—one that, when combined with the anthropogenic warming of many biomes, is capable of driving large positive feedbacks that will further increase the accumulation of atmospheric greenhouse gases and exacerbate associated climate change.
ADVANCES
The study of soil is now the domain of diverse schools of physical and biological science. Rapid advances in empirical and theoretical understanding of soil processes are occurring. These advances have brought an international, and global, perspective to the study of soil processes and focused the implications of soil stewardship for societal well-being. Major advances in the past decade include our first quantitative understanding of the natural rates of soil production, derived from isotopic methods developed by collaboration of geochemists and geomorphologists. Proliferation of research by soil and ecological scientists in the northern latitudes continues to illuminate and improve estimates of the magnitude of soil carbon storage in these regions and its sensitivity and response to warming. The role of soil processes in global carbon and climate models is entering a period of growing attention and increasing maturity. These activities in turn reveal the severity of soil-related issues at stake for the remainder of this century—the need to rapidly regain a balance to the physical and biological processes that drive and maintain soil properties, and the societal implications that will result if we do not.
OUTLOOK
Both great challenges and opportunities exist in regards to maintaining soil’s role in food, climate, and human security. Erosion continues to exceed natural rates of soil renewal even in highly developed countries. The recent focus by economists and natural scientists on potential future shortages of phosphorus fertilizer offers opportunities for novel partnerships to develop efficient methods of nutrient recycling and redistribution systems in urban settings. Possibly the most challenging issues will be to better understand the magnitude of global soil carbon feedbacks to climate change and to mitigating climate change in a timely fashion. The net results of human impacts on soil resources this century will be global in scale and will have direct impacts on human security for centuries to come.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 2 May 2015

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf verion: The Sentinel_ week ending 2 May 2015

blog edition: comprised of the 35+ entries to be posted below on 3 May 2015

Yemen’s INGO Steering Committee calls for an urgent end to all hostilities and full humanitarian access

Yemen’s INGO Steering Committee calls for an urgent end to all hostilities and full humanitarian access
YEMEN – Fighting in Yemen is continuing despite Saudi Arabia’s recent announcement of an end to military operations, a group of leading aid agencies has warned. The ongoing conflict is preventing humanitarian organisations from delivering life-saving assistance, the agencies say.
While welcoming the announcement by Saudi Arabia of an end to ‘Operation Decisive Storm’ the INGO Forum Steering Committee in Yemen, representing 47 major aid agencies, is calling for all parties to the conflict to end the violence and seek a negotiated peace.

International humanitarian organisations working in Yemen welcome the Kingdom of Saudi Arabia’s recent announcement which brought Operation Decisive Storm to an end. However, we remain concerned about the ongoing effects of the continued fighting and we urgently call on all parties to the conflict to end the violence and seek a negotiated peace. All efforts must be taken to ensure that civilians and civilian infrastructure are protected and spared from the ongoing violence. We reassert that international humanitarian and human rights laws must be upheld by all parties at all times.

We call for the international community to support a coordinated and impartial response that addresses both short and long-term civilian needs across the country. In many conflicts, weapons do not cause the greatest casualties and suffering, most often the secondary impacts of war are the most devastating for civilians. Disease, hunger, the destruction of infrastructure and property are the most devastating for innocent civilians. As a country already experiencing food insecurity among 12 million people, and maternal-child health risks, it is all the more crucial the humanitarian response take into account the challenges civilians face now, as well as those we know they will face in the future.

We call for increased and safe humanitarian access necessary to ensure the delivery of life-saving supplies and assistance to those in need. International aid organizations working in Yemen are ready to respond, but have not yet been able to do so at full scale. The continued fighting has resulted in limited access for humanitarian aid workers and severely jeopardizing their safety. Recent reports indicate that three Yemeni aid workers have been killed in crossfire in Aden while trying to save the lives of critically injured civilians. The international community must call on the parties in the conflict to guarantee aid workers safe access and passage to priority areas to ensure the delivery of lifesaving assistance. We are calling on all parties to immediately open land, sea and air routes into the country in order to facilitate the delivery of life-saving aid to the millions of people who continue to suffer from the impact of the violence. Reliant on imports to meet 90 percent of national food consumption, the continued closure of land, sea and air routes is exacerbating the unfolding humanitarian catastrophe. Fuel supplies, also largely reliant on imports, are now dwindling, and the effects are being felt at all levels. Access to water, often pumped by generator, is severely reduced. Without fuel to provide electricity and water, the ability of health facilities to operate life-saving equipment is severely hampered and transportation of essential commodities, such as food to the most in need, becomes extremely challenging.

Yemen has been caught in a protracted crisis and the recent escalation of conflict is exacerbating the situation. Before the escalation of violence, over 60 percent of the population – more than 16 million, including approximately 250,000 refugees – were already reliant on aid, and nearly a million children under five were suffering from acute malnutrition. What little infrastructure the country had is facing collapse. Water, electricity, fuel and food supplies are running low and prices for these essential supplies are increasing exponentially. Many hospitals have been damaged, made inaccessible, or are not functioning due to shortages of staff and essential medical supplies and fuel. This has severe consequences not just for the injured, but also for the approximately 700,000 pregnant women in the country, people with disabilities, and those who rely on recurrent health care.
The community of international humanitarian aid agencies working in Yemen ask for the full support of the international community in our humanitarian efforts in order to pull Yemen back from humanitarian catastrophe.

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[No listing of the INGOs represented on the INGO Forum Steering Committee in Yemen – “representing 47 major aid agencies” – was identified]

Migrant Crossings – Mediterranean [to 2 May 2015]

Migrant Crossings – Mediterranean

EU: Press release – Migration: Parliament calls for urgent measures to save lives
29/04/2015 15:02 | European Parliament
The EU should do everything possible to prevent further loss of life at sea, e.g. by expanding the mandate of “Triton” operation in the Mediterranean to include “search and rescue operations at EU level”, says a resolution voted by Parliament on Wednesday. MEPs also call for a binding quota for distributing asylum seekers among all EU countries, bigger contributions to resettlement programmes, better cooperation with third countries and tougher measures against people smugglers.

Parliament urges the EU and its member states to establish a clear mandate for Triton, “so as to expand its area of operation and increase its mandate for search and rescue operations at EU level” (Triton is coordinated by the EU border agency Frontex and currently extends only 30 nautical miles from the Italian coastline).

The EU and its member states should ensure that “search and rescue obligations are effectively fulfilled”, stresses the resolution, which was approved by 449 votes to 130, with 93 abstentions.

Parliament calls for “a robust and permanent humanitarian European rescue operation, which, like Mare Nostrum, would operate on the high seas and to which all member states would contribute financially and with equipment and assets”. MEPs urge the EU to co-fund such an operation.

EU countries should also continue to show solidarity and commitment by stepping up their contributions to the budgets and operations of Frontex and the European Asylum Support Office (EASO), MEPs add. Parliament also undertakes to provide these agencies with the resources (human and equipment) needed to fulfil their obligations “through the EU budget and its relevant funds”.

Stepping up solidarity and responsibility-sharing among EU countries
Parliament regrets that the 23 April European Council did not pledge to set up a binding EU-wide solidarity mechanism. To respond to the latest tragedies in the Mediterranean with “solidarity and fair sharing of responsibility”, MEPs say that:
:: the European Commission should establish a “binding quota” for distributing asylum seekers among all EU countries,
:: member states should make full use of existing possibilities for issuing humanitarian visas and seriously consider whether to trigger the 2001 Temporary Protection Directive or Article 78(3) of the TFEU (both foresee a solidarity mechanism in the event of mass and sudden inflows of displaced persons),
:: EU countries should make greater contributions to existing resettlement programmes, and
:: the Common European Asylum System rules should be rapidly and fully transposed into national law and implemented by all participating member states.

Cooperating with third countries and fighting smugglers
The resolution calls for closer coordination of EU and member state policies in tackling the root causes of migration and more cooperation with partner countries in the Middle East and Africa.

It also calls for the strongest possible criminal sanctions against human trafficking and smuggling and urges member states and EU agencies to work more closely to detect and trace these criminal networks’ funding and identify their modus operandi, so as to prevent them from making money by putting migrants’ lives at risk.

Note to editors
The purpose of this resolution is to respond to the recent tragic events in the Mediterranean, to the European Council conclusions of 23 April 2015 and to propose a set of urgent measures to be taken immediately. The Civil Liberties, Justice and Home Affairs Committee is currently drafting a report which will reflect Parliament’s medium- and longer-term policy orientations on migration.

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Joint Statement on Protection in the Mediterranean in light of the EU Council’s Decision of 23 April 2015
27 April 2015
:: António Guterres, United Nations High Commissioner for Refugees
:: Zeid Ra’ad Al Hussein, United Nations High Commissioner for Human Rights
:: Peter Sutherland, Special Representative of the UN Secretary-General For Migration and Development
:: William L. Swing, Director-General of the International Organization for Migration

Given the intensification of boat movements and continued unbearable loss of life in the Mediterranean Sea, we…take note of the Special European Council’s decision of 23 April 2015. We acknowledge the Council’s specific undertaking to “mobilize all efforts at its disposal to prevent further loss of life at sea and to tackle the root causes of the human emergency.”

The Council’s decision is an important first step towards collective European action: the only approach that can tackle a phenomenon of such a scale, complexity and trans-national nature. It will also help pave the way for further elaboration of a new EU Migration Agenda.

A number of preliminary measures have been decided. We appreciate that the details still need to be worked out in consultation with a range of stakeholders, including the institutions we represent, and pledge our full support for developing them further.

The announced tripling of resources for the Frontex Operations Triton and Poseidon is encouraging to the extent it results in increasing rescues of migrants and refugees in distress at sea now and in the foreseeable future. While the efforts of merchant ships are to be commended and welcomed, they are not best equipped to rescue hundreds of people at a time, and are no substitute for a comprehensive and well-resourced EU-led effort with a particular focus on addressing the protection needs of vulnerable migrants and refugees, not least unaccompanied children, survivors of violence and those with special needs.

A number of proposed measures focus on disrupting the smuggling trade and stemming movements, in cooperation with third countries. But law enforcement measures must be accompanied by efforts aimed at reducing the need for migrants and refugees to turn to smugglers in the first place. The situation today calls for measures going beyond border security.

Most smuggling does not involve the crime of trafficking. This distinction is important to maintain in statements and actions initiated in response to the current crisis. Moreover, people resorting to smugglers and those falling prey to traffickers are not criminals. Those boats are carrying human beings who are entitled to their human rights and are in need of international aid and protection. All actions must scrupulously respect International Human Rights Law, International Refugee Law, International Humanitarian Law, the Law of the Sea, and ensure the dignified, safe and humane treatment of migrants.

We look forward to working with EU Member States and institutions on elaborating concrete actions respecting the rights of all migrants and refugees, and consultations to increase resettlement places on offer, on arrangements for pre- and post-arrival assistance, and on relocation to ease the burden on States on Europe’s southern border.

Efforts to deter smuggling will be in vain unless measures are adopted to address overly restrictive migration policies in Europe, as well as the push factors of conflict, human rights violations and economic deprivation in many of the countries of origin and transit. Enforcement measures need to comply with applicable standards for human rights in law enforcement and in the administration of justice.

As the EU Institutions and Member States work on development of a European Agenda for Migration, we look forward to working closely with EU and other stakeholders to expand and enhance the measures announced, with a view to setting in place a more holistic plan consistent with international norms and standards.

In this regard, we believe that additional measures are needed, beyond those already announced, to address the many factors compelling people to move in such precarious circumstances and to transform this into a truly comprehensive response. These measures would, inter alia, include: setting in place migration policies that meet real labour market needs; increasing the provision of safe and regular channels for entry, including by making family reunification more readily accessible and easier; making the Common European Asylum System work more cohesively , especially though intra-EU solidarity measures; making evidence-based and better targeted development investments in origin and transit countries; revisiting measures relating to trade practices and labour migration; stemming arms trafficking; promoting proactive peaceful settlement of disputes; and vigorously combatting all forms of racism, religious intolerance and xenophobia.

The international community has a shared responsibility to ensure the protection of migrants and refugees who are making the journey across the Mediterranean Sea. The scale, complexity and sophistication of the response should be in line with the scale and complexity of the problem. We need a truly comprehensive response that will serve as a testimony to those lost at sea and those who have survived to recount the experience.

The institutions we represent all have a stake in being part of the solution to the on-going tragedy in the Mediterranean. We are drawing up plans to increase our support in a number of indicative areas, for example by:

SRSG FOR MIGRATION AND DEVELOPMENT
:: Active diplomacy with States in Europe, Africa and elsewhere to safeguard the rights of all migrants and promote fair and equitable migration policies that contribute to sustainable development.

UNHCR
:: Stepping up operational support, as needed, in Southern and South Eastern Europe, North Africa and in the Horn of Africa
:: Supporting various proposals already made under the Central Mediterranean Sea Initiative, including: increased refugee resettlement, enhanced family reunification and other forms of admission; support for intra-EU solidarity and responsibility sharing measures, including relocation possibly through a pilot project for Syrian arrivals in Greece and Italy; and information campaigns along transit routes aimed at informing people of the risks of onward movements
:: Disseminating the SAR Guide developed with the International Maritime Organization and International Chamber of Shipping

OHCHR
:: Disseminating OHCHR’s Recommended Principles and Guidelines on Human Rights at International Borders
:: Supporting an independent inquiry into the recent tragic incidents in the Mediterranean
:: Providing advice on the human rights of all migrants at points of origin, transit and destination
:: Promoting compliance with international standards for human rights in law enforcement
:: Combatting racism, religious intolerance and xenophobia in all its forms

IOM
:: Implementing the Missing Migrants project which seeks to document loss of life
:: Cooperating with and implementing anti-smuggling and trafficking efforts
:: Setting in place a Migrant Response and Resource Mechanism along migratory routes in key sub-Saharan African countries to identify persons in need of help, offer counselling, make referrals and provide assistance, including with voluntary return for economic migrants
:: Supporting EU Regional Development and Protection Programmes
:: Following the specific call on IOM in the EU Council conclusion, working towards building capacities of and supporting countries of origin in the voluntary return and reintegration to ensure that return forms part of a comprehensive response

Progress of the World’s Women 2015-2016: Transforming Economies, Realizing Rights

Progress of the World’s Women 2015-2016: Transforming Economies, Realizing Rights
UN Women
2015 :: ISBN: 978-1-63214-015-9 :: 342 pages
Report documentation: http://progress.unwomen.org/en/2015/download/index.html#report

FOREWORD
BY PHUMZILE MLAMBO-NGCUKA, UNDER-SECRETARY-GENERAL AND EXECUTIVE DIRECTOR, UN WOMEN
In 2014, an unprecedented number of countries provided reports on the extent to which they had been able to implement the Beijing Platform for Action, adopted 20 years ago in 1995 as a global blueprint for the achievement of gender equality.

These 167 reports, and the associated regional and global reviews, gave us the clearest reading to date of the status of gender equality across the world.

Progress of the World’s Women: Transforming economies, realizing rights, provides a timely, action-oriented counterpoint to the Beijing+20 findings. With a view to changing both economic and social institutions, it distils and confronts the most glaring gaps between the laws and policies that guarantee equal rights for women and girls, and the reality on the ground. The drive to achieve substantive equality – making rights real for women – is at the heart of this Progress report, and it provides the evidence and recommendations for public action to achieve it.

Our analysis shows that economic and social policies can contribute to fairer and more gender-equal societies, as well as stronger and more prosperous economies, if they are designed and implemented with women’s rights at their centre. For example, to increase women’s access to decent work, the removal of formal legal barriers to their employment is important, but we also need measures that free up women’s time, such as affordable childcare options and investments in basic infrastructure. We need to enable shifts both great and small in social norms, so that men can take on care work and engage in other areas that foster and demonstrate altered attitudes of responsibility.

As Secretary-General Ban Ki-moon has said, ours is the first generation with the potential to end poverty.

Equally important, and intrinsically linked to that goal, it is in this generation’s reach to transform gender relations, to empower women and girls, and humanity as a whole.
We know what needs to be done to achieve equality and a 50:50 Planet by 2030. Together with the findings of the Beijing +20 review, let this report be a call to urgent and sustained action, frontloaded for the next five years, to start real, visible change, especially in the lives of the most marginalized. My hope is that everyone will be inspired to be part of a re-energized and growing movement for gender equality. With determined people from all walks of life, and with more determined leaders, gender equality can be a defining achievement of the first quarter of the 21st century.

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Press release: New report from UN Women unveils far-reaching alternative policy agenda to transform economies and make gender equality a reality
“Progress of the World’s Women 2015-2016: Transforming Economies, Realizing Rights” launches in seven cities
Date : 27 April 2015
(London, 27 April, 2015) A major report from UN Women, released today in seven locations globally, brings together human rights and economic policymaking to call for far-reaching changes to the global policy agenda that will transform economies and make women’s rights, and equality, a reality. It takes an in-depth look at what the economy would look like if it truly worked for women, for the benefit of all.

Progress makes the case that the alternative economic agenda it outlines would not only create fairer societies, it would also create new sectors of employment, for instance in the care economy.

The report is being published as the international community comes together to define a transformative new agenda for sustainable development, 20 years after the landmark Fourth World Conference on Women in Beijing, China, which set out an ambitious agenda to advance gender equality.

Since the Beijing Conference, significant advances have been made by many societies, particularly in advancing women’s legal rights. However, as Progress shows, in an era of unprecedented global wealth, millions of women are still consigned to work in low paid, poor quality jobs, denied even basic levels of health care, without access to clean water and decent sanitation.

Globally, only half of women participate in the labour force, compared to three quarters of men. In developing regions, up to 95 per cent of women’s employment is informal, in jobs that are unprotected by labour laws and lack social protection.

Women still carry the burden of unpaid care work, which austerity policies and cutbacks have only intensified. To build fairer, more sustainable economies which work for women and men, a future comprising more of the same will no longer do.

“Our public resources are not flowing in the directions where they are most needed: for example, to provide safe water and sanitation, quality health care, and decent child- and elderly-care services. Where there are no public services, the deficit is borne by women and girls,” said UN Women Executive Director Phumzile Mlambo-Ngcuka.

“This is a care penalty that unfairly punishes women for stepping in when the State does not provide resources and it affects billions of women the world over. We need policies that make it possible for both women and men to care for their loved ones without having to forego their own economic security and independence,” she added.

Through solid, in-depth analysis and data, this evidence-based report provides ten key recommendations for actions that governments and others can take in order to move towards an economy that truly works for women, to the benefit of all.

Progress sets out a vision of a global economy fit for women, where they have equal access to productive resources and social protection, which provides them with sufficient income to support an adequate standard of living. In such an economy, the work that women do would be respected and valued; stereotypes about what women and men can and should do would be eliminated; and women would be able to work and live their lives free from violence and sexual harassment.

The reality, however, is very different.

The report reveals that globally, on average, women are paid 24 per cent less than men. The gaps for women with children are even wider: In South Asia, for example, the gender pay gap is 35 per cent for women with children (compared to 14 per cent for those without). Lower rates of labour force participation, gender pay gaps and lower access to pensions add to a huge care penalty for women. In France and Sweden, over their lifetime, women can expect to earn 31 per cent less than men; in Germany 49 per cent less than men; and in Turkey, an average woman can expect to earn a staggering 75 per cent less than an average man over her lifetime.

Women are clustered into a limited set of under-valued occupations. For example, 83 per cent of domestic workers worldwide are women and almost half of them are not entitled to the minimum wage. Even when women succeed in the workplace, they encounter obstacles not generally faced by their male counterparts. For example, in the EU, 75 per cent of women in management and higher professional positions and 61 per cent of women in service sector occupations have experienced some form of sexual harassment in the workplace in their lifetimes.

An economy designed with women’s needs in mind would give them an equal voice in economic decision-making: from the way in which time and money are spent in their households, to the ways in which resources are raised and allocated at the national level, to how broader economic parameters are set by global institutions.

Women are still under-represented in economic leadership positions, from trade unions to corporate boards, from finance ministries to international financial institutions. Women’s membership in trade unions is growing in some countries, but they rarely reach top leadership positions. In 2014, across six of the most influential global economic institutions, women’s representation on their boards ranged from 4 to 20 per cent.

Through case studies and concrete examples of change from Bolivia to Botswana, Progress calls for a paradigm shift in the way governments, financial institutions, businesses and civil society approach economic policy thinking and human rights, to bring about an alternative economic agenda which places women and their rights at its centre.

“The new economic agenda that UN Women is advocating for is not a pipe dream. Many countries, including low-income developing countries, are already implementing elements of this agenda,” said Shahra Razavi, Chief of UN Women’s Research and Data Section and lead author of the report. “The kind of change we need is far-reaching, but it can be done.”

In its key recommendations, Progress underlines that with the right mix of economic and social policies, governments can generate decent jobs for women (and men) and ensure that the unpaid care work that goes into sustaining all economies is recognized and supported. Well-designed social services (e.g. health, care services) and social protection measures (e.g. pensions) can enhance women’s income security, from birth to old age, and enhance their capacity to seize economic opportunities and expand their life options.

Macroeconomic policies can and should support the realization of women’s rights, by creating dynamic and stable economies, by generating decent work and by mobilizing resources to finance vital public services. Governments need to go beyond the old metrics of GDP growth and low inflation, and instead measure success in terms of the realization of human rights.

Women’s economic and social rights – the right to a decent job, to health care and a life free from violence and discrimination – are guaranteed in human rights treaties, which almost all governments in the world have signed. Governments are ultimately responsible for delivering these rights, but they cannot do it alone. International financial institutions and the private sector are among the key players that shape the economy. They all need to be held accountable by civil society and the public, to play their part.

The changes proposed in the report will not only make the economy work for women, but also benefit the majority of men for whom the economy is not working either. The report argues that progress for women is progress for all.

Global evidence on inequities in rural health protection

Global evidence on inequities in rural health protection
New data on rural deficits in health coverage for 174 countries
ILO – ESS (Extension of Social Security) Paper Series No. 47
Edited by Xenia Scheil-Adlung, ILO
2015 :: 83 pages
Summary
This paper presents global estimates on rural/urban disparities in access to health-care services. The report uses proxy indicators to assess key dimensions of coverage and access involving the core principles of universality and equity. Based on the results of the estimates, policy options are discussed to close the gaps in a multi-sectoral approach addressing issues and their root causes both within and beyond the health sector.

Foreword
While inequities in health protection are increasingly recognized as an important issue in current policy debates on universal health coverage (UHC) and in the post-2015 agenda, the rural/urban divide is largely ignored. A key reason for disregarding equity in coverage and access to health care of large parts of the population relates to the nearly complete absence of disaggregated data providing sufficient information at national, regional and global level. Only vague and fragmented information, often limited to microdata, can be found.

Given this gap in information, it is hardly possible to quantify and assess the extent of disparities and deficits experienced by rural populations as regards key aspects of their rights to health and social protection; the availability, affordability and financial protection of needed health services; and increases or decreases in inequities. Further, governments and policy-makers lack evidence to set priorities, and thus face challenges in addressing the issues that are spread over various policy domains including health, social protection, labour market and more generally economic and fiscal policies.

This paper presents and analyses for the first time related global, regional and national data. It is developed and made available by the ILO. The data allow investigating both the extent of and major causes of rural/urban inequities in coverage and access to health care. Further, it discusses impacts and policy options to achieve more equitable results.
The data development and related assessments provided in this paper are anchored in the framework of universal health protection along the lines of international legal standards, particularly the ILO Social Protection Floors Recommendation, 2012 (No. 202) and the UN Resolution on Universal Health Coverage (12 December 2012).

The paper has been developed as part of the mandate of the ILO Areas of Critical Importance (ACI) on Decent Work in the Rural Economy as well as the ACI on Creating and Extending Social Protection Floors, and has been reviewed by a significant number of experts in relevant development agencies. It highlights the needs of disadvantaged, marginalized and vulnerable rural populations and contributes to related global research products and statistics. Further, it provides guidance to ILO member States on establishing and extending social protection floors for all as a fundamental element of national social security systems.

The evidence provided in the paper suggests that inequalities in coverage and access to health care exist globally, in every region and nearly every country. In fact, the place of residence can be considered as the entry door or key barrier to accessing needed health care. Against this background, the paper aims at contributing to the development of urgently needed policy responses realizing the universal human rights to social protection and health, particularly for rural populations.
Isabel Ortiz
Director
Social Protection Department
International Labour Organization

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Press Release
Social Protection
More than half of the global rural population excluded from health care
ILO report shows huge differences in health care access between rural and urban areas worldwide.
27 April 2015
GENEVA (ILO News) – A new ILO report shows that 56 per cent of people living in rural areas worldwide do not have access to essential health-care services – more than double the figure in urban areas, where 22 per cent are not covered…

…The highest number of people in rural areas who are not covered by essential health-care services is in Africa where it amounts to 83 per cent. The most affected countries also face the highest levels of poverty.

The largest differences between rural and urban areas, however, exist in Asia. For example, in Indonesia the percentage of people that are not covered is twice as high in rural areas as in urban areas.

“Decades of underinvestment in health interrupted efforts to develop national health systems and ultimately resulted in the neglect of health in rural areas. This has a huge human cost. Health is a human right and should be provided to all residents within a country,” said Isabel Ortiz, Director of the ILO’s Social Protection Department.

Lack of health workers in rural areas
The ILO study further finds that even if access to health care is guaranteed by law, people in rural areas remain excluded from health care because such laws are not enforced where they live.

The situation is worsened by the lack of health workers in the world’s rural areas. Although half of the world’s population lives in them, only 23 per cent of the global health workforce is deployed to rural areas. The ILO estimates that 7 million out of the total 10.3 million health workers who are lacking globally are needed in these areas.

Africa and Latin America are the two regions where this problem is most acute. In Nigeria, for example, more than 82 per cent of the rural population is excluded from health-care services due to insufficient numbers of health workers compared to 37 per cent in urban areas.

Underfunding is closely linked to the unavailability of services. The ILO study shows that financial resource gaps are nearly twice as high in rural than in urban areas. The largest gaps are found in Africa. However, significant inequities also exist in Asia and Latin America.

The extent of impoverishing out-of-pocket payments (OOPs) is also high in rural areas. The study shows that rural populations in Africa and Asia are burdened with OOPs that amount to 42 and 46 per cent of total health expenditure respectively. In many Asian countries such as Afghanistan, Bangladesh, Cambodia and Sri Lanka, OOPs are two to three times higher in rural than in urban areas.

“The lack of legal coverage, insufficient numbers of health workers, inadequate funding, and high OOPs have created life-threatening inequities in many countries,” said Xenia Scheil-Adlung, Health Policy Coordinator at the ILO.

“Strengthening both the demand and supply side of services is crucial when moving towards universal health protection, particularly in rural areas. Legal health coverage is necessary, but not sufficient. Only when quality services are actually made available and affordable for all those in need can effective access to health care be ensured,” she added.

Closing the gaps
The study explains that closing rural health access gaps requires a comprehensive and systematic approach that simultaneously addresses missing rights, health workers, funding, financial protection and quality. Such an approach needs to be based on the principles of universality and equity and calls for solidarity in financing and burden sharing.

“Addressing such inequities needs to consider the specific characteristics of rural populations, including high poverty rates and informality of work. This means moving from charity to rights, the provision of health workers with decent working conditions that enhance productivity, and the minimization of out-of-pocket payments by patients to avoid poverty. It also requires complementary socio-economic and labour market policies to trigger inclusive economic growth,” said Scheil-Adlung.

The study highlights the key role that national social protection floors can play in reducing and eliminating rural/urban gaps through human rights-based approaches. In this sense, it points to the importance of ILO Recommendation 202 on social protection floors.

“This study shows that investing in rural health, as part of a national health system, is affordable and yields significant economic and social returns. Progress towards universal health protection is possible in any country, irrespective of its level of income,” Ortiz concludes.

FAO – Platform for pastoralists aims to give a voice to millions

FAO – Platform for pastoralists aims to give a voice to millions
New initiative aims to bring pastoral concerns into global policy dialogue

27 April 2015, Rome – Millions of pastoralists will benefit from a new online knowledge hub that will help them raise their voices in international policy debates and share valuable information to strengthen their agricultural livelihoods.

The Pastoralist Knowledge Hub – launched today by FAO, the European Union, Germany and other partners – will enable mobile livestock keepers to connect, to meet and discuss issues like agricultural innovations or land regulations and find shared solutions to common challenges.

“Pastoralists are able to produce food where no crops can be grown. Yet, their concerns are poorly heard by the international community,” Helena Semedo, FAO Deputy Director-General, said on Monday. “This hub is an important platform to help them project their voices, share knowledge, and affect policy debates.”

The hub also offers a growing database of research on pastoralism, contacts for a worldwide network of pastoral representatives, and discussion forums for pastoralist networks and partnering institutions.

It also includes a mechanism that lets pastoral communities nominate and select representatives to global forums such as the Committee on World Food Security.

Seven regional meetings with pastoralist networks to shape the initiative are being held until October 2015.

Rich legacy, diverse challenges
The several hundred million pastoralists who manage the world’s rangelands rely on a rich legacy of traditional knowledge and mobility to survive in the harshest environments on the planet.

They remain important producers of livestock, meat, milk, hair and hides and in many countries produce more than half of agricultural GDP.

Livestock grazing on pastoralist rangelands also provides valuable benefits to ecosystems, including helping to recycle plants back into fertile soil and controlling the growth of bush and weeds.

Examples of more well-known pastoral societies include the Bedouin of North Africa and the Arabian Peninsula, the Maasai in East Africa, the Navajo of North America, the Sherpa in Nepal, and Scandinavia’s Sami people.

Despite their importance to food production and ecosystems, pastoralists have traditionally been marginalized in decision-making on matters like the decrease of rangelands and the disruption of their mobility routes that negatively affect their lives and livelihoods.

They have frequently been subject to attempts to alter their nomadic lifestyles and often find it hard to access health services and schools

Pastoralists are also still poorly represented in decision-making processes in high-level institutions such as the United Nations and their own national governments.

Teaching and learning about child rights: A study of implementation in 26 countries – UNICEF

Teaching and learning about child rights: A study of implementation in 26 countries
UNICEF
2015 :: 88 pages
Lee Jerome, Lesley Emerson, Laura Lundy and Karen Orr
This research was commissioned and funded by the Advocacy and Child Rights Education Unit at the UNICEF Private Fundraising and Partnerships Division, Geneva. This baseline research undertaken by the Centre for Children’s Rights in Queens’ University Belfast
Full report pdf: http://www.unicef.org/crc/files/CHILD_RIGHTS_EDUCATION_STUDY_final.pdf

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Press release
Children in 15 out of 26 industrialised countries lack easy access to child rights education
GENEVA, 30 April 2015 – Education curricula in 15 industrialised countries fail to meet children’s entitlements to learn about their rights, a new UNICEF report shows. The report, Teaching and learning about child rights: A study of implementation in 26 countries, also finds that none of the countries studied ensure that all teachers are trained in child rights and are familiar with the Convention on the Rights of the Child.

“This report is a wakeup call for countries that have ratified the Convention on the Rights of the Child, to take the necessary measures to ensure systematic implementation of a child’s right to learn about her or his rights,” said Gérard Bocquenet, UNICEF Director of Private Fundraising and Partnerships.

The report, commissioned by UNICEF and undertaken by the Centre for Children’s Rights at Queen’s University Belfast, analysed the situation and identified challenges around child rights education in 26 industrialised countries and territories, including to what extent child rights are embedded in formal education settings and teacher training.

The Convention on the Rights of the Child, which applies in all of the 26 countries and territories, requires a formal commitment to make its principles and provisions widely known to adults and children alike. The 15 countries where children lack systematic access to child rights education in curricula are Australia, Austria, Belgium, Canada, Denmark, Germany, Hong Kong, Ireland, Israel, Italy, Netherlands, New Zealand, Scotland, Spain and United States.

Twenty five years after the adoption of the Convention on the Rights of the Child – the most widely ratified UN Convention – much work remains to be done to ensure that child rights are widely known and implemented in schools, including in industrialised countries. The report highlights that a fundamental step towards exercising rights is knowing and understanding those rights. Implementing systematic child rights education in schools is therefore essential to realise the Convention on the Rights of the Child.

The report also shows that:
:: Seven countries (Austria, Belgium, Canada, Germany, Israel, Italy and United States) include some child rights education in school curricula but fail to do so nationwide.
:: Only 3 out of 26 countries explicitly and consistently monitor child rights education.
:: Even when children learn about rights they may not learn about the Convention on the Rights of the Child or about key aspects of what it means to have rights.

Despite these findings, the research highlights many examples of how UNICEF National Committees and civil society partners are successfully addressing all aspects of child rights education at different levels in all the countries analysed. This is being done through policy, curriculum reform, and teacher training, as well as by embedding child rights into monitoring and inspection frameworks and by transforming the whole school environment to become rights-respecting.

“A key challenge is to ensure that these examples of good practice are aligned and fully integrated throughout education systems,” said Marta Arias, UNICEF Advocacy and Policy Specialist. “The report will guide countries in this task and help them to identify the best way forward within to their national context.”

With this study, UNICEF encourages all countries to take concrete actions to comply with Article 42 of the Convention on the Rights of the Child and repeated recommendations made by the Committee on the Rights of the Child to each country.

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Background
The countries and territories studied are Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Hong Kong, Hungary, Iceland, Ireland, Israel, Italy, Netherlands, New Zealand, Norway, Poland, Republic of Korea, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, and United States.

The research includes a literature review, results from an on-line survey completed by national experts in 26 countries and territories, seven country case studies (Belgium, Finland, France, Germany, Hong Kong, Israel and Scotland) and a series of benchmarking statements for implementing child rights education in formal education settings.