Surviving the First Day – State of the World’s Mothers 2013 #Vaw #Womenrights


A basket weaver at work with her baby at her side, in Tamil Nadu. The infant mortality rate is very high for working women, particularly those in the primary sector, a large proportion of whom are labourers.

A basket weaver at work with her baby at her side, in Tamil Nadu. The infant mortality rate is very high for working women, particularly those in the primary sector, a large proportion of whom are labourers.

From the Report……………..

“…….Each year, 3 million newborns die, making up nearly half (43 percent) of the world’s under-5 child deaths. And yet almost all newborn deaths originate from preventable and treatable causes: we already have the tools available to save about three-quarters of the newborns who needlessly die each year.

This report reveals that we know how to stop this trend, because we understand the causes and solutions of newborn death like never before. Simple lifesaving treatments like a basic antiseptic for cleansing the umbilical cord can prevent deadly infections. Antenatal steroids help premature babies breathe. “Kangaroo mother care” keeps them warm, encourages breastfeeding and protects them from infection. These inexpensive interventions haven’t taken hold, but a new analysis in this report shows that four basic solutions alone could save more than 1 million newborns annually as soon as they do. Improvements in access to contraceptives, maternal nutrition and breastfeeding practices would save even more………..”.

Melinda Gates, Co-chair of the Bill & Melinda Gates Foundation

“…………This report contains our annual ranking of the best and worst places in the world for mothers – but no matter if they’re in the United States or Malawi or India, all mothers are fundamentally the same. Every night, millions of mothers around the world lean over their sleeping newborns and pray that they will be safe, happy and healthy. It’s what we all want for our children. And it’s certainly not too much to ask………..”.

Carolyn Miles, President and CEO of Save the Children USA

Key Findings……

“……In South Asia, mothers and babies die in great numbers. An estimated 423,000 babies die each year in South Asia on the day they are born, more than in any other region. South Asia accounts for 24 percent of the world’s population and 40 percent of the world’s first-day deaths. In India – where economic growth has been impressive but the benefits have been shared unequally – 309,000 babies die each year on the day they are born (29 percent of the global total). Bangladesh and Pakistan also have very large numbers of first-day deaths (28,000 and 60,000 per year, respectively.) Mothers in South Asia also die in large numbers. Each year, 83,000 women in South Asia die during pregnancy or childbirth. India has more maternal deaths than any other country in the world (56,000 per year). Pakistan also has a large number of maternal deaths (12,000). (To read more, turn to pages 27-35 and 65-74.)….”.

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“…..Babies born to mothers living in the greatest poverty face the greatest challenges to survival. At the heart of the newborn survival problem is the widening gap between the health of the world’s rich and poor. Virtually all (98 percent) newborn deaths occur in developing countries, and within many of these countries, babies born to the poorest families have a much higher risk of death compared to babies from the richest families. A new analysis of 50 developing countries found babies born to mothers in the poorest fifth of the population were on average 40 percent more likely to die compared to those in the richest fifth. Disparities within countries like Bolivia, Cambodia, India, Sierra Leone, Morocco, Mozambique and the Philippines are especially dramatic. Many newborn lives could be saved by ensuring services reach the poorest families in developing countries. For example: If all newborns in India experienced the same survival rates as newborns from the richest Indian families, nearly 360,000 more babies would survive each year. Closing the equity gaps in Pakistan and Democratic Republic of the Congo would similarly save the lives of 48,000 and 45,000 newborns each year, respectively. (To read more, turn to pages 15-21.)….”.

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Recommendations…………..

1. Address the underlying causes of newborn mortality, especially gender inequality.

2) Invest in health workers – especially those working on the front lines – to reach the most vulnerable mothers and babies.

3) Invest in low-cost, low-tech solutions which health workers can use to save lives during pregnancy, at birth and immediately after birth.

4) Strengthen health systems and address demand-related barriers to access and use of health services.

5) Increase commitments and funding to save the lives of mothers and newborns.

 

Access the full report at:

http://www.savethechildrenweb.org/SOWM-2013/files/assets/common/downloads/State%20of%20the%20WorldOWM-2013.pdf

 

#India – Unhealthy Health Governance


EPW Vol – XLVIII No. 20, May 18, 2013 | Ravi Duggal
Global Health Governance by Jeremy Youde (Cambridge, UK: Polity Press), 2012; pp 176, $26.95 (paperback).

Ravi Duggal (rduggal57@gmail.com) is an independent health researcher and is associated with the International Budget Partnership and the People’s Health Movement.

Good governance has in recent times emerged as the new mantra to address the failures of public systems. Especially so, in the arena of public health where there is a clear divide between the front line providers of healthcare who face the public and the bureaucracy that makes the decisions. There is growing literature both at the country level1and globally2 on the criticality of governance in delivering efficient and good quality services. Jeremy Youde’s book is an addition to this literature focusing on global governance in health.

Global Issues

Governance implies the exercise of political and administrative authority and within countries this is derived from the sovereignty of the nation state. At the global level such sovereignty is absent and this poses a major challenge to address inter-country or global issues. In the health arena there are numerous global challenges and the difficulties in meeting them hinge on governance failure.

In a recent article in the New England Journal of MedicineFrenk and Moon have identified three global health challenges that are difficult to realise because of governance failure – the unfinished agenda of infections, undernutrition and reproductive health problems; rising global burden of non-communicable diseases and associated risk factors like smoking and obesity; and the challenges arising out of globalisation itself such as health effects of climate change and trade policies.3 Youde’s book deals precisely with these issues and how global mechanisms for dealing with this have been coping.

An Overview

Global Health Governance by Youde begins with an overview of the historical evolution of international health governance efforts and then moves to discuss how some of the key actors like the World Health Organisation (WHO), World Bank, Global Fund, Gates Foundation, Treatment Action Campaign, among others have played their roles to reign in various global health challenges, and finally, discusses some key issues like infectious disease surveillance, health security and access to pharmaceutical as examples of the struggle to address global health governance challenges.

While the book does justice to documenting the evolution of global health governance and some of the key events which shaped its form, functioning and influence, it fails to adequately capture the political-economy context under which such governance efforts developed or rather failed to sustain. Historically WHO (emerging from its precursor the Health Organisation of the League of Nations) was mandated by nation states to engage with global health governance issues with a clearly defined constitution to direct it, but the character of the global political economy prevented it from achieving its goals. The profit-first nature of global capitalism, exemplified by the global pharmaceutical industry, and the cold war did not permit WHO to exercise its authority in right earnest. Due to these political-economy factors the evolution of global health governance assumed a direction in which a fragmented and selective approach developed leading to the spawning of a number of other players like the Global Fund and UNAIDS – the United Nations Programme on HIV/AIDS – on one hand, and private players like the Bill & Melinda Gates Foundation and the Clinton Foundation on the other.

Youde recognises the problems of these developments, but does not attribute the failure of WHO to these developments. Rather, Youde mentions that the failure of WHO was responsible for emergence of these mechanisms. This may appear to be true when we view it from the evolutionary perspective, but if we recognise the political economy context, then the story is very different. Let me summarise Youde’s trajectory of arguments.

Evolutionary History

Youde begins with identifying four key attributes of effective global health governance – it must focus on factors that cross and ignore geographical boundaries, it must employ multisectoral and multidisciplinary approaches to craft effective interventions, it should give voice to a wide range of actors and it needs to rely on transparent and accountable systems. No disagreement with this. But for governance to be effective two other factors are critical. First an adequate budget to deal with its mandate, and second a political backing to make it work. Later in the book Youde does identify these factors while discussing why WHO failed, but if Youde had recognised these upfront, then the trajectory of arguments could have developed differently.

The evolutionary history of global health governance is very well-documented by Youde from the international sanitary conferences of 19th century to the role of the Rockefeller Foundation post-first world war and right through to today. But there is one factual issue that needs to be addressed. There seems to be an assumption that the cross-border spread of disease was an east to west phenomena. While many diseases emerged in Asia and Africa, the west also contributed through syphilis, typhus, tuberculosis, etc, which spread to the east through trade.

The earliest response to contain epidemics was quarantine and this was done on country borders and entry points, but traders did not like it as it affected movement of goods, and consequently, their profits. Soon international conventions emerged like the International Sanitary Bureau in Americas, International Office of Public Hygiene in Europe and ultimately culminating into the Health Organisation of the League of Nations and post-second world war, WHO.

Key Players of Global Health

In the next section Youde discusses the key players like WHO, World Bank, Global Fund and a few non-state actors who are presently part of the global health governance mechanism. Again each organisation that Youde discusses is done quite thoroughly and here Youde does factor in the influence of the political economy context, especially in the discussion of the WHO. Youde tells us that over time WHO does evolve into a strong organisation and the Alma Ata Declaration forms a key watershed of its strength as a global organisation addressing global health challenges as well as supporting public health issues within countries, especially the developing world. It reaches its peak under the leadership of Halfdan Mahler with Health for All as the epitome of its success – what Youde calls the activist orientation phase of WHO which promoted health equity.

This phase of WHO demonstrated that global health governance is feasible – there was a political leadership under Mahler and its finances were quite robust. Youde acknowledges this but does not go far enough to say that this in itself posed a threat to global capitalism which in the health sector operates primarily through the pharmaceutical industry. After Mahler, the next director general of WHO, Hiroshi Nakajima, was indeed, a pharmaceutical man (who had earlier worked for Roche in Japan), who changed the trajectory of WHO setting it on a path of destruction. This changed political economy destroyed WHO and opened up the arena for new players in the global health governance arena led by the World Bank.

WHO under Nakajima

The fact that the World Bank entered the scenario, not only undermined WHO, which under the two terms of Nakajima’s leadership (incidentally Nakajima died recently on 26 January 2013 and the world over obituaries focused on how under his leadership WHO became fragmented and deteriorated as an organisation) was considerably weakened through under-financing of the core budget – a clear shift of resources of WHO from the dominance of its regular budget that member countries contribute to a dominance of programme – and project-based budgets that donors contribute and then dictate the agenda.

Youde has captured this quite well. This budget shift also began the process of fragmentation of WHO’s strategy into dealing with global health challenges as vertical programmes. The latter was already happening with public health programmes across most developing countries and this clearly moved the agenda from Health for All, a universal access approach, to a selective and fragmented approach to deal vertically with specific diseases and health issues like polio, malaria, immunisation, tobacco control, and later HIV/AIDS and reproductive and child health (RCH). This shift has been largely under the leadership of the World Bank,4 Global Fund and various private players like Gates, Ford and Clinton Foundations, among others, as also various bilaterals like the United States Agency for International Development (USAID) and Department for International Development (DFID).

Fragmenting Global Health

Youde has again documented very well the roles of the World Bank, UNAIDS, the Global Fund and the Clinton and Gates Foundations in supporting this new trajectory in global health governance where the control shifted from nation state controlled-WHO to these other so-called “non-political” players. It is precisely the change in politics of health that changed the lead players in global health governance and Youde acknowledges this by quoting Nuruzzaman5 – the World Bank’s strategy as a change from understanding health as a fundamental right to a conception of health as a private market-based good. This, in turn, changed the political economy of global health governance. User fees, public-private partnerships, privatisation, outsourcing, health insurance, etc, are some of the strategic changes that the structural adjustment policies of the World Bank brought to global health governance. WHO, unfortunately now follows this along with most other key players in global health, and primarily because WHO’s budget is predominated by donor contributions who call the shots.

Youde explains that UNAIDS actually emerged out of a conflict situation within the WHO, whose Global Program on AIDS (GPA) was headed by Jonathan Mann, who was a great fundraiser and helped raise the profile of HIV/AIDS globally that attracted huge funding and this created strong jealousies and disagreements with the leadership of WHO under Nakajima forcing Mann to quit, and subsequently, the GPA was transformed into an independent agency of the United Nations (UN) christened as UNAIDS under the leadership of Mann’s assistant Peter Piot. Since UNAIDS focused on providing technical and informational support, another agency to play the funding support role called the Global Fund to Fight AIDS, tuberculosis and malaria was created. This maintained the continuum of fragmenting global health governance and reducing the importance and strength of the WHO.

Youde describes all this very illustratively. One question comes to mind when reading Youde’s discussion of these institutions: What was the underlying reason of setting up these institutions and moving it out of WHO’s control? Was it the new patents regime and the need to facilitate pharmaceutical industry’s profit-making by keeping the control of governance of global health outside the nation state-controlled WHO? And a related question – despite having strong oversight mechanisms in the Global Fund, why has there never been an audit of pharmaceutical purchases by the Global Fund?

The private actors discussed by Youde, Gates and Clinton Foundations, basically fell in line with the World Bank strategy and supported the need to raise substantially the involvement of non-state actors in global health governance. Both these institutions also helped raise further the HIV/AIDS profile globally with more resources being committed to it and also advocated for a more market-oriented approach, for instance, in the procurement of antiretroviral (ARV) medicines. In reality what they were doing is trying to address market failures in health so that the larger health system can be made more market-oriented.

Conclusions

The chapter on civil society organisations (CSOs) focuses on the role that CSOs have played in global health, primarily representing the interests of the common people, as Youde puts it – as voices for the voiceless. Youde illustrates this with the examples of OXFAM International and the Treatment Action Campaign from South Africa.

In the last section Youde goes back to the key issues around which he has built his discussion on global health governance – surveillance of infectious diseases, framing health security and access to pharmaceuticals, mainly ARVs. The first two issues revolve around global regulation of communicable diseases and the response of the international community and how the global health governance mechanisms discussed above have at best been able to engage in firefighting. In the case of access to pharmaceuticals, the access to ARV campaign is viewed as one that could possibly lay the basis for a larger campaign for access to free medicines – regarding medicines and public goods. The Twelfth Five-Year Plan in India, based on the experiences of Tamil Nadu and Rajasthan, is promising access to free medicines in all public health institutions. Will this become a stepping stone towards universal access to healthcare and take us back to the Health for All intiative?

Youde concludes by saying that global health governance has evolved from being a technical issue addressing mechanism until the 1970s to a more rights- and equity-based phase during the 1970s and 1980s, when WHO was in control and since then has entered its neo-liberal phase under the tutelage of the World Bank and various non-state actors, though in recent years, there is a clear effort with pressure from civil society to bring back the Health for All agenda under universal access to healthcare. But this would cost money, conservatively at least 5% of gross domestic product (GDP). Is there the political will of the G-8 or G-20 or other G’s to muster these resources by putting the burden on capitalism by imposing the Tobin tax or financial transaction tax, for instance, which can rein in huge resources in this era of finance capital, and of course, we do not want to forget the old Rio commitment of developed nations to contribute their 0.72% GDP for the global development agenda. The shaping of the post-2015 development agenda goals needs to emphasise this very strongly.

To conclude, Youde’s book is a very good documentation of how global health governance has evolved in the last 150 years or so but it is limited in its conclusions because Youde opted to use the lens of communicable diseases. Today, as Youde acknowledges in his conclusions, non-communicable diseases are much larger global health challenges, but governance issues for these would be very different from what he has discussed in the present book. To deal with these we will have to steep much deeper into issues governing global political economy.

Notes

1 Kumar (2005) 38-53 also see website http: //indiagovernance.gov. in Rao (2013).

2 See for example: Demmers et al (2004); see alsohttp://www.ohchr.org/EN/Issues/Development/GoodGovernance/Pages/Good-Gov… accessed 25 March 2013.

3 Julio Frenk and Suerie Moon, “Governance Challenges in Global Health”, NEJM, 368: 10, 7  March 2013, pp 936-42.

4 See the 1993 World Development Report – Investing in Health, OUP, New York, which became the Bible of this new approach to healthcare.

5 Quoted by Youde from Nuruzzaman, Mohammad (2007).

References

Demmers, Jolle, Alex E Fernández Jilberto and Barbara Hogenboom, ed. (2004): Good Governance in the Era of Global Neoliberalism: Conflict and Depolitisation in Latin AmericaEastern Europe, Asia and Africa (London: Routledge).

Frenk, Julio and Suerie Moon (2013): “Governance Challenges in Global Health”, The NewEngland Journal of Medicine(NEJM), 368: 10, 7 March, pp 936-42.

Kumar, G Narendra (2005): “An Institutional Framework for Good Governance in India”, ASCI, Journal of Management,34(1&2), Administrative Staff College of India, Hyderabad, available at http://journal.asci.org.in/Vol 34 (2005)/04.% 20G N.%20Kumar.pdf accessed on 25 March 2013.

Nuruzzaman, Mohammad (2007): “The World Bank, Health Policy Reforms and the Poor”, Journal of Contemporary Asia, 37(1), pp 59-72.

Rao, N Bhaskara Rao (2013): Good Governance – Delivering Corruption-free Public Services, (New Delhi: Sage).

 

Civil Society Declaration: Rights must be at the centre of the Family Planning Summit


Women on Top: How Real Life Has Changed Women'...

Women on Top: How Real Life Has Changed Women’s Sexual Fantasies (Photo credit: Wikipedia)

CALL FOR ENDORSEMENT

 

Amnesty International, Center for Reproductive Rights,  Development Alternatives with Women for a New Era (DAWN),  International Women’s Health Coalition and RESURJ have prepared a statement *Rights must be at the centre of the Family Planning Summit *in advance of the DFID/Gates Family Planning Summit which will be held in London on 11 July 2012.

 

We would like to invite you or your organization to endorse this statement (at bottom of this email), which will be presented to the organisers prior to the Summit.

 

To endorse this statement, please send the following information to CRR’s Kate Meyer (kmeyer@reprorights.org).

 

Name of organization or individual (please specify which):

Country:

Name and email of contact person:

 

Please also circulate this statement to your contacts and networks. The deadline for endorsements is Monday, 11 June 2012.

 

* We will circulate the statement again after endorsements have been received.

 

——————–

 

Rights must be at the centre of the Family Planning Summit: Civil Society Declaration

 

We, civil society organizations working to promote women’s and young people’s human rights, call on world leaders on the eve of the “Family Planning Summit”, hosted by the UK Government and the Bill and Melinda Gates Foundation, to ensure that sexual and reproductive health and rights are at the centre of all efforts to meet reproductive health needs, including family planning.

 

Contraceptive information and services – “family planning” – form an essential part of the health services that women need throughout their lives. Any steps to increase demand for contraceptives must actively support efforts to improve comprehensive and integrated sexual and reproductive health. Contraceptives must be provided through primary healthcare, with full regard for women’s human rights and the specific needs of young and unmarried women and other groups.

 

Our experience, built over decades of work around the world, has taught us that the failure to take actions guided by women’s human rights – to health, to life, to live free from discrimination among others – can have devastating consequences. Policies that accept or tacitly condone forced sterilization, the coercive provision of contraceptives, and the denial of essential services to the young, poor and marginalized women that need them every day have violated, and continue to violate, women’s human rights.

 

Nearly twenty years ago, governments at the International Conference on Population and Development agreed that respect for women’s reproductive autonomy is the cornerstone of population policy. Any return to coercive family planning programs where quality of care and informed consent are ignored would be both shocking and retrograde. The Family Planning Summit must ensure that the clocks are not put back on women’s rights: women’s autonomy and agency to decide freely on matters related to sexual and reproductive health without any discrimination, coercion or violence must be protected under all circumstances.

 

In order to expand contraceptive access with full respect for women’s human rights, we urge governments, donors and other actors supporting the Family Planning Summit to:

 

·           Take all possible measures to ensure that this initiative is designed with quality of care and human rights at its core, so that no coercive measures are introduced in the provision of contraceptives;

 

·           Ensure that meaningful participation by women, including young women, is built into all stages of program design and implementation to ensure that services are responsive to their needs and to prevent any human rights violations;

 

·           Ensure that the provision of contraceptives is integrated into existing and new sexual and reproductive health services, and that a full range of contraceptive methods is offered;

 

·           Design and implement a system for monitoring, evaluation and accountability to track and measure its impact on the rights of women as this initiative is rolled out, and urgently make necessary corrections should violations come to light;

 

·           Commit to tackling the existing legal and policy barriers that hinder access to contraceptive information and services, without which efforts are likely to be ineffective and exacerbate disparities in access.

 

In 2012, nothing less will do.

 

Endorsed by:

Center for Reproductive Rights

Amnesty International

Development Alternatives With Women for a New Era, DAWN

International Women’s Health Coalition

RESURJ

Pentavalent Vaccine Court Case: Govt Says, not we, the petitioners are corrupt


PIL on Pentavalent to aid pvt biz, says govt

TNN Jan 17, 2012,
KOCHI: The public interest litigation challenging implementation of Pentavalent vaccination programme in Kerala citing adverse effects is aimed at helping private companies supplying the vaccine, the central government contended on Monday.
Pentavalent vaccine, including the vaccine against Haemophilus Influenzae Type B (Hib), was rolled out across the State on December 14 last year as part of the Universal Immunization Programme.
National and international experts of World Health Organization investigated the deaths alleged to be due to Pentavalent vaccination in Sri Lanka, Bhutan, and Pakistan but were found to be not related to the vaccine, central government stated in the affidavit.

Pentavalent vaccine is available in Indian private market since 2004 and is being administered by private practitioners at an exorbitant price whereas the same is being given under Universal Immunization Programme of the central government freely, the affidavit said.
Out of a total 1.67 crore doses administered since 2004, 1.56 crore doses have been administered during the period of 2007 to 2011. Indian manufacturers for Pentavalent have increased from one in 2004 to five in 2009 due to the surge in demand, and Rs 6,000 is being charged for a single course of Pentavalent.
The intention of this petition is only to prevent the government from providing the vaccine free of charge so that commercial interests of private sector are protected, the affidavit states.
The central government also stated in the affidavit that more than 41,000 children have been vaccinated with Pentavalent since its introduction in Kerala and Tamil Nadu recently and no adverse event was noted. Pentavalent has been used in Goa since 2008, with more than 28,000 vaccinations until July last year, and no adverse event was noted, the affidavit said.
Countering a petition by a Wayanad-based NGO that the vaccination programme is being implemented without scientific health studies, the central government filed an affidavit at the Kerala High Court that pointed out that Pentavalent has been used for the past seven years by private players and 1.67 crore doses have been sold without any adverse effects

Dr Jagannath Chatterji ‘s response to the TOI article that has not been published ,is below :

THE GOVT OF INDIA HAS BADLY LET US DOWN ON THE PENTAVALENT VACCINE ISSUE

It is a pity that the Govt of India, in tandem with private agencies like the Bill & Melinda Gates Foundation, the GAVI and PATH is misleading the public and ignoring genuine fears and concerns of the public.

It is true that deaths have occurred shortly after administering the vaccine (Pentavalent) in three neighbouring countries and the vaccine consequently pulled out. It has been reintroduced in Sri Lanka after tampering with the adverse effect reporting format which ensures that deaths cannot be linked to the vaccine. The same has been done in India.

Why is an agency like GAVI giving such a costly vaccine free of cost to the GoI? What interest does this private agency have? Is it not true that this is also a temporary arrangement and the GoI will have to spend a huge amount of money to procure the vaccine after the contract is over? What skullduggery is going on here?

Why doesn’t the Govt pull up the IAP for recommending and administering 1.67 crores of doses of a vaccine with highly questionable credentials? What long term follow up has been done on these children? How many of them have died? How many have suffered adverse reactions? Were the informed consent of the parents taken before administering the vaccine? Where are the papers to prove that?

The Nuremberg Code clearly says ALL medical interventions and prescriptions should follow the principle of Informed Consent. The GoI that is a signatory to this act cannot feign ignorance.

Dr Harold Buttram, MD, of the USA in a path breaking book has accused Pentavalent vaccines of causing Sudden Infant Death syndrome and also Shaken Baby Syndrome. The death reported in Kerala strongly resembles the latter.

Why was the press asked for “positive reporting” after a series of genuine negative reports appeared of this vaccine reflecting the genuine doubts of very senior doctors and medical scientists of our country? Is the press being gagged? Are the doctors and health workers free to report deaths and adverse reactions? One sincerely doubts.

I am sure the people of Kerala will not tolerate this chicanery and will give a fitting reply. What a mess we are in! We are having to battle our own Government to fight for the lives and health of our children! Will our Health Minister and his Secretary kindly stand up and upon oath tell us what the ground situation really is?

We are waiting for your explanation Mr Health Minister. Kindly let us know if the facts mentioned in this letter have been considered before the Central Govt replied to the Kerala High Court Enquiry.

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