Partnering for the health of people and planet

Climate change has far-reaching impacts on human health and well-being. Changing temperature and rainfall patterns impact crop yield, food and water security, and nutrition. The increased frequency and intensity of extreme events can cause not only injury, but also increase the risk of water-borne diseases (diarrheal disease, Hepatitis A and E, bacterial diseases such as cholera), diseases associated with crowding (measles, meningitis, acute respiratory infections) and vector-borne diseases (malaria, dengue), as well as psychological and emotional distress related to traumatic events.

The World Health Organization (WHO) estimates that climate change will cause an additional 250,000 deaths each year between 2030 and 2050, just considering risks from malnutrition, malaria, diarrhea and heat stress.

Health impacts from climate change are exacerbated in countries where health systems already struggle to manage existing health risks, and capacity to adapt to additional climate change-related health risks is limited.

Only through critical partnerships between governments, civil society, UN agencies, and global environment and health organizations, support can be provided to countries in responding to the health impacts of climate variability and change by working at the nexus of health, environmental sustainability and climate change, disaster risk reduction, gender equality, and poverty alleviation.

[UNDP]

Why Humanitarian Aid Matters

From an interview with Gregory Gottlieb, former acting assistant administrator for USAID’s Bureau for Democracy, Conflict, and Humanitarian Assistance:

President Donald Trump has made it clear that foreign aid is not a top priority for his administration. His 2018 budget proposal includes steep cuts to the State Department, the U.S. Agency for International Development (USAID), and the United Nations. That policy change could have lasting impact on humanitarian efforts worldwide.

The United States has really helped to build the international system of humanitarian relief. We have been the biggest giver, the donor of last resort in many respects. And if you want to change that, you don’t do it by saying we’re going to cut our budget by 40 percent overnight. That is just going to damage the system. Right now, we—all donors—meet only about 62 percent of what we think humanitarian needs are. You can’t just cut our budget and hope that other nations step in to make up the difference.

“Soft power” like humanitarian aid can be very beneficial and serve as a tool for political advantages. After the tsunami in Asia in 2004, the fact that we supplied humanitarian assistance allowed our military to collaborate with Indonesia’s military. That kind of broke the ice and improved relations between our countries. If you looked at how people there viewed the United States, our ratings went way up. The same in Pakistan after the 2005 earthquake—the military did a fantastic job of delivering things, despite what was going on in Afghanistan. Some of the people who did that work are still incredibly well thought of. In South Sudan, our humanitarian assistance opened up a better dialogue between Sudan and South Sudan as they were forced to negotiate about how to move food across the lines.

[Tufts University]

Why do nations invest in international aid? Ask Norway. And China.

Norwegian aid and Chinese aid pursue widely different strategies. While Norway provides substantial funding for budget support and funds civil society organizations, China offers a combination of grants and concessional loans and prioritizes infrastructure development in poor countries.

Given its size and lack of military might, Norway has actively tried to promote the virtues of the Nordic model — a peaceful, rule-based, globalized and prosperous world. It has done this through offering a generous amount of aid, consistently giving away more than 1 percent of its Gross National Income. Such acts of generosity give Norway a seat at the table usually reserved for the bigger players in peace processes or efforts to promote development and reduce poverty around the world.

With China, little distinction is made between grants and loans, and it does not offer detailed information about aid disbursements at country level. In turn, it expects poor countries to offer access to such natural resources as oil, minerals, and agricultural products, which China needs for its own development. China’s approach is characterized by pragmatism. It does not believe in offering aid conditioned on improving local governance or combating corruption. Unlike Western donors, China controls the implementation process by bypassing the public administration of recipient countries, and awards contracts to Chinese companies.

[Washington Post]

African agricultural transformation strategy

The African Development Bank (AfDB) has developed a new initiative called the Technologies for African Agricultural Transformation (TAAT) initiative, which includes 25 African countries that have confirmed their readiness to help transform their agriculture.

TAAT is designed to eliminate the current massive importation of food and transform its economies by targeting agriculture as a major source of economic diversification and wealth, as well as a powerful engine for job creation. The initiative should result in almost 513 million tons of additional food production and lift nearly 250 million Africans out of poverty by 2025.

The commodities value chains to benefit from this initiative are rice, cassava, pearl millet, sorghum, groundnut, cowpea, livestock, maize, soya bean, yam, cocoa, coffee, cashew, oil palm, horticulture, beans, wheat and fish.

“TAAT …brings together global players in agriculture, the Consultative Group on International Agricultural Research, the World Bank, the Food and Agriculture Organization of the United Nations, the International Fund for Agricultural Development, World Food Programme, Bill and Melinda Gates Foundation, Alliance for a Green Revolution in Africa, Rockefeller Foundation and national and regional agricultural research systems, ” said AfDB President, Akinwumi Adesina, at a TAAT side event at the 2017 World Food Prize in Des Moines, Iowa.

Adesina explained that TAAT would help break down decades of national boundary-focused seed release systems. Seed companies will have regional business investments, not just national ones, he said. “That will be revolutionary and will open up regional seed industries and markets.”

The African Development Bank, World Bank, AGRA, Bill and Melinda Gates Foundation, and the Rockefeller Foundation intend to mobilize US $1 billion to help scale up technologies across Africa.

[African Development Bank]

Money spent on MDGs well-invested

A recent Brookings study revealed that the Millennium Development Goals (MDGs) – the development agenda set by the US and others for the first fifteen years of this century – were more successful than anybody knew. Bottom line: The study concludes that at least 21 million more people are alive today as a result.

This tells us that the simple MDG approach worked; the U.S. and other, smaller donors helped save a number of lives equivalent to the entire population of Florida. If USAID continues to focus on effective targets, the American public could be reassured that every dollar is achieving the most possible.

The reduction of childhood malnutrition deserves funds. Evidence for Copenhagen Consensus showed that every dollar spent providing better nutrition for 68 million children would produce over $40 in long-term social benefits.

Malaria, too, deserves attention. A single case can be averted for as little as $11. We don’t just stop one persons suffering; we save a community from lost economic productivity. Our economists estimated that reducing the incidence of malaria by 50% would generate a 35-fold return in benefits to society.

Tuberculosis is a disease that has been overlooked and under-funded. Despite being the world’s biggest infectious killer, in 2015 it received just 3.4 per cent of development assistance for health. Reducing TB deaths by 90 per cent would result in 1.3 million fewer deaths. In economic terms, this would bring benefits worth $43 for every dollar spent.

There are 19 such targets that deserve prioritization, because each dollar would do a lot to achieve a safer, healthier world – a result that leads to lasting benefits for the US. When it comes to development, everyone’s goal should be the same. Rather than slashing funds for development, the United States should maintain its global leadership by focusing on the areas where every dollar achieves the most good.

[Inter Press Service]

US humanitarian aid to select countries facing food insecurity and violence

The United States announced more than $575 million in additional humanitarian assistance to the millions of people affected by food insecurity and violence in Yemen, South Sudan, Nigeria, and Somalia.

This additional funding brings the total U.S. humanitarian assistance to nearly $2.5 billion for these four crises since the beginning of Fiscal Year 2017.

The announcement was made by United States Agency for International Development Administrator Mark Green at the United Nations General Assembly.  With this new funding, the United States is providing emergency food and nutrition assistance, life-saving medical care, improved sanitation, emergency shelter, and protection for vulnerable groups who have been affected by conflict.  The United States is also providing safe drinking water and supporting health and hygiene programs to treat and prevent disease outbreaks, including cholera, which has taken hold in all four countries.

During today’s announcement, Administrator Green reiterated the U.S. Government’s commitment to working with international and local partners to avert famine and provide life-saving aid to people impacted by these crises.

[USAid]

Closing an HIV lifeline in Africa

President Trump’s re-introduction of the policy banning US government funds from going to organizations with any links to abortion jeopardizes a wide range of healthcare clinics in dozens of countries because family planning advice is often bundled up with other provision.

In all, nearly $9bn is at stake, and hundreds of thousands of women could be affected. Such drastic cuts will inevitably mean the end of programs that have nothing to do with abortion but which provide vital support to people living with the physical, psychological and social implications of HIV.

In Mozambique alone, figures from 2015 show that about 110,000 children aged 14 and under were living with HIV.

Amodefa – the Mozambican Association for Family Development— has various social projects on HIV, tuberculosis, malaria, sexual and reproductive health, and sexual rights. The lives of the poorest women in southern Africa depend on organizations such as this. Yet they will be among the worst affected by Donald Trump’s crackdown on family planning groups around the world. Advocates across the region say the move risks undermining progress in tackling HIV and AIDS in southern Africa, one of the areas hardest hit by the epidemic.

“Projects already approved run the risk of being cancelled, and those that are already ongoing run the risk of not being renewed when they come to an end in September, said  Amodefa director Santos Simione. USAID currently provides $2m of the organization’s $3m annual budget.

[The Guardian]

Redesigning the architecture of US Foreign Aid

Donald Trump is hardly the first U.S. president to call for bureaucratic reorganization to improve government efficiency and effectiveness. But his demand for disproportionate cuts in international spending, his attacks on multilateral cooperation, and his aversion to “soft power” make it clear that his agenda is to sideline, not strengthen, U.S. foreign policy institutions.

Thus when Secretary of State Rex Tillerson announced his intention to conduct a “complete and comprehensive review” of aid effectiveness, development advocates jumped to preempt what they feared might be a bid to dismantle the U.S. Agency for International Development (USAID) by putting together proposals for evidence-based, results-oriented reform.

The first of those proposals is now in: a discussion draft of a new foreign aid architecture released by the co-chairs of the Modernizing Foreign Assistance Network (MFAN). The MFAN proposal would give the development agency control over the Millennium Challenge Corporation (MCC), currently an independent agency, as well as the AIDS relief and refugee assistance programs now overseen by the State Department. The proposal would eliminate USAID’s regional bureaus and consolidate all development programs into five “centers” based on broad functional categories.

[Read full article]

Aid credibility figures at stake

Some of the world’s richest European countries spend billions at home that they report as “aid”, exploiting a loophole that enables them to cut vital development budgets.

Under current accounting rules, the costs of receiving refugees can count towards a donor country’s total overseas development assistance (ODA).

In 2016, leading donor countries reported $15.4 billion of domestic spending on refugees as ODA, a huge rise from $3.9 billion in 2012 and several times more than they spend on refugees abroad.

That’s also more than they spent on emergency aid in foreign countries, and more than three times the income of the UN refugee agency.

[Read full article]

Watchdog says State Dept. failing to adequately track US foreign aid

The State Department and the U.S. Agency for International Development (USAID) have failed to adequately track the more than $30 billion they spend annually on foreign aid, according to a government watchdog report released Friday.

The report released by the State Department’s Office of the Inspector General noted that the department has failed to build infrastructure for tracking billions of dollars in foreign aid despite being ordered to do so in 2015. According to the report, little progress has been made at all. The report’s summary faults the State Department, saying it “had not complied with the report’s recommendation” in 2015.

The Trump administration has suggested cutting the State Department’s budget for foreign aid by 37 percent. The move was blasted by members of Trump’s own party, who called the idea a “disaster.”

Deputy Secretary of State John Sullivan responded to the report in a memo, saying the department accepted the watchdog recommendations and would begin implementing them.

[The Hill]

Investing in poor children saves more lives per dollar spent, UNICEF study finds

Investing in the health and survival of the most deprived children and communities provides more value for money than investing in less deprived groups, saving almost twice as many lives for every $1 million spent, according to a new study by the United Nations Children’s Fund (UNICEF).

“The evidence is compelling: Investing in the poorest children is not only right in principle, it is also right in practice – saving more lives for every dollar spent,” said UNICEF Executive Director Anthony Lake in a press release on the study, titled Narrowing the Gaps.

The study backs up an unconventional prediction UNICEF made in 2010: the higher cost of reaching the poorest children would be outweighed by greater results.

“This is critical news for governments working to end all preventable child deaths at a time when every dollar counts,” Mr. Lake said, noting that investing equitably in children’s health also helps break intergenerational cycles of poverty and gives them a better chance of learning more in school and earning more as an adult.

The study analyzed new data from the 51 countries where around 80 per cent of all newborn and under-five deaths occur. It assessed access to six high-impact maternal, newborn and child health interventions: the use of insecticide-treated bed nets, early initiation of breastfeeding, antenatal care, full vaccination, the presence of a skilled birth attendant during delivery, and seeking care for children with diarrhea, fever or pneumonia.

[UN News Centre]

A fresh look at Global Africa

Global Africa is a striking, original volume that disrupts the dominant narratives that continue to frame our discussion of Africa, complicating conventional views of the region as a place of violence, despair, and victimhood.

This new book documents the significant global connections, circulations, and contributions that African people, ideas, and goods have made throughout the world—from the United States and South Asia to Latin America, Europe, and elsewhere.

Through succinct and engaging pieces by scholars, policy makers, activists, and journalists, the volume provides a wholly original view of a continent at the center of global historical processes rather than on the periphery. Global Africa offers fresh, complex, and insightful visions of a continent in flux.

“In much writing about Africa, the continent is portrayed either as a self-contained space or as a region whose fate has been determined from outside—by enslavement, colonization, and, indeed, ‘globalization.’ The rich variety of contributions to Global Africa point to more diverse and complex ways of thinking about the importance and limitations of Africa’s connections to the rest of the world.”—Frederick Cooper, author of Africa in the World: Capitalism, Empire, Nation-State

[Amazon]

Bill Clinton on proposed US foreign aid cuts

Drastic reductions to the U.S. foreign aid budget would be “a bad thing” because the relatively small amount of money is well-spent, former President Bill Clinton told a coalition of U.S. humanitarian and development groups on Tuesday.

“It’s a bad thing if the government cuts US AID, because it’s a little bit of money doing an outsize amount of good,” Clinton said.

The Trump administration wants to cut funding to the U.S. Agency for International Development by nearly one third in the fiscal year starting in October. There is strong congressional opposition to the proposal, part of efforts to slash the diplomatic and development budget from $54.9 billion to $37.6 billion.

Clinton was speaking to InterAction, which says the cuts would be “devastating” at a time when famine threatens the lives of 30 million people and conflict has displaced 65 million worldwide, an all-time high.

He said responding to challenges such as climate change and poverty required interdependence rather than an “us and them” mentality, which has gained traction in response to some of the negative effects of globalization.

[Associated Press]

Foreign aid can work wonders

Foreign aid can work wonders. It set South Korea and Taiwan on the path to riches, helped extinguish smallpox in the 1970s and has almost eliminated polio.

Aid can also burden weak bureaucracies in developing nations, distort markets, prop up dictators and help prolong civil wars.

A decade ago governments rich and poor set out to define good aid. They declared that aid should be for improving the lot of poor people [and] it should be coordinated.

Official development aid, which includes grants, loans, technical advice and debt forgiveness, is worth about $130 billion a year. The channels originating in Berlin, London, Paris, Tokyo and Washington are deep and fast-flowing; others are rivulets, though the Nordic countries are generous for their size.

More than two-fifths flows through multilateral outfits such as the World Bank, the UN and the Global Fund. Last year 9% was spent on refugees in donor countries, reflecting the surge of migrants to Europe.

[The Economist]

Is international aid to Haiti a failure?

Excerpts of a EURACTIV France interview with Joel Boutroue, formerly the deputy special representative of the secretary general of the United Nations for the UN Stabilization Mission in Haiti:

Haiti is one of many poor countries where international aid has failed to fulfil its objectives. Despite billions of dollars being pumped in, little has changed since the disastrous earthquake of 2010. Beyond poor governance in Haiti, which is the central problem, agriculture is still a big problem. Haiti is an agrarian country but no investment has been made in this sector, there has been no implementation of sustainable practices.

The second big issue is education. It has deteriorated at a terrifying pace these last few decades. Until the 1960s, the Haitians were exporters of knowledge but today the level is catastrophic.

And finally, the third issue is water and sanitation. Haiti is an open sewer in need of treatment. This challenge comes upstream of any action on health, because the population in poisoning itself. There is not one sewer, not one sanitation station in the whole country. This is an enormous problem and will only grow with demographic expansion: Haiti’s population will grow from 11 million to 18 million in 40 years.

Haiti is often described as the NGO republic, which is not entirely false. The NGOs financed by international donors pay very little heed to the Haitian state. But in so doing, the state becomes marginalized and weakened in its interactions with the population. And this creates other problems. Aid in Haiti is not a partnership, it is not a relationship of equals.

Donors are often caught between a rock and a hard place. One the one hand there is the need to demonstrate tangible results to their own citizens and show that their money has served a purpose. On the other hand, the beneficiary country only has a certain capacity for absorption. And many donors, either out of cynicism or laziness, pursue short term interests.

The end of Foreign Aid as we know it?

According to a detailed 15-page State Department budget document obtained by Foreign Policy, President Trump has vowed to drastically cut assistance to developing countries. Additionally, Trump administration officials are considering folding USAID into the State Department.

The agency anticipates that the budget proposal will necessitate eliminating 30 to 35 of its field missions while cutting its regional bureaus by roughly 65 percent. In addition to closing missions, global health funding is also targeted, with 41 countries facing cuts.

Likewise, the Bureau for Food Security is slated to lose 68 percent of its funding. This would reduce development aid geared toward preventing food shortages and may instead force the United States and other donor countries to spend more resources on emergency food assistance.

Other programs and offices that are on the chopping block include the ambassador-at-large for global women’s issues, the Office of the Coordinator for Cyber Issues, and the Trans-Sahara Counterterrorism Partnership.

Foreign-policy and national security experts on both sides of the aisle have argued that the cuts pose concrete risks to U.S. security interests.

[Foreign Policy]

Who gives 0.7% of their gross national income to overseas aid?

Under legislation approved in 2015, the UK government is legally required to spend 0.7% of gross national income (GNI) on overseas development assistance (ODA), popularly known as foreign aid. And Microsoft founder Bill Gates has urged the UK to maintain its promise to spend 0.7% of national income on overseas aid, warning that reducing the commitment would cost lives.

According to the latest figures from the OECD, in 2016 two G7 countries met this target: the UK and, for the first time, Germany. Other countries that spent at least 0.7% were Sweden, Luxembourg, United Arab Emirates, Turkey, Denmark and Norway.

Earlier this year, British Prime Minister Theresa May described the target as a “critical pillar” of the country’s foreign policy. But some Conservative MPs and newspapers have suggested that the figure is too high and should not be maintained after the election.

The top 10 country recipients of UK aid in 2015 were Pakistan, Ethiopia, Afghanistan, Nigeria, Syria, Sierra Leone, South Sudan, Tanzania, India and Bangladesh. Humanitarian projects received the largest proportion of aid in 2015.

 [BBC]

Top European givers

Despite budgetary constraints, the European Union and its member states have collectively managed to keep their place as the world’s largest aid donor. Below is a overview of six major European donors.

United Kingdom – One of the only major aid actors with a development ministry responsible for both policy and implementation, the United Kingdom is also the first country to enshrine in law the U.N. target to spend 0.7 percent of gross national income on aid every year. U.K. aid is praised for its clear focus on the neediest. Out of the 28 countries it prioritizes, 21 are fragile and conflict-affected states.

Germany – These are promising times for the world’s third biggest bilateral donor. After undergoing major reforms in 2011, German foreign aid is seeking to be more selective and strategic in its spending priorities. But for the time being, Germany’s political commitment to focus on the poorest countries, especially in Africa, has yet to be reflected in its ODA allocations.

France – President François Hollande’s budgetary choices might have set the country back by more than a decade in reaching the 0.7 percent aid target, but France is expected to stabilize its aid budget. In the next few years, French ODA is further slated to increase the amount dedicated to climate change.

Sweden – Despite the global financial crisis, Sweden’s aid program has managed to stay the course.  Since 2006, the Nordic country has maintained its ODA at around one percent of its GNI. In line with its strong poverty focus, most of Sweden’s bilateral aid resources are directed to low income countries and fragile states. Three specific priorities drive Sweden’s aid giving: democracy and human rights; environment and climate change; and gender equality and the role of women in development. Sweden has also been particularly reactive to the critical situation in the Middle East.

The Netherlands – The Netherlands was one of the first countries to meet the ambitious goal of spending at least 0.7 percent of its GNI on ODA, but Dutch aid has plummeted in recent years.  Historically focused on social sectors, Dutch aid is now increasingly geared toward economic development and national interests.

Norway – Known for its long-standing commitment to high aid targets, Norway disbursed 1 percent of its gross national income in 2014 — making it the third most generous OECD DAC member in terms of its ODA/GNI ratio after Sweden and Luxembourg. In the future, ODA levels are likely to be maintained at this level. Norway is one of the world’s most committed donors to least-developed countries. Global education especially in conflict or disaster contexts — a topic which has been sliding off the aid agenda of many top donors — is another area where Norway is trying to lead the way.

[DeVex]

British Cabinet split over foreign aid spending

Government Ministers have urged British Prime Minister Theresa May to drop Britain’s commitment to spending 0.7 per cent of national income on helping poorer countries, and have proposed diverting money to a new combined defense and security budget.

The UK, the world’s third-biggest donor, spends £13 billion per year on aid, and the Prime Minister has stood by the spending commitment despite pressure to reduce it following a series of scandals over where the money goes.

Some ministers believe Britain is doing more than its fair share when it comes to helping poorer countries, and point to the fact that the average spend by other wealthy nations is just 0.4 per cent of GNI.

In fact, the USA spends just 0.18 per cent.

Mrs May, however, has made it clear that she is a supporter of the 0.7 per cent spending pledge and remains “fully committed” to it. Priti Patel, the International Development Secretary, also sees the commitment as a key part of the post-Brexit “global Britain” brand.

A Whitehall source explained: “A lot of the world’s biggest problems, such as disease, mass migration and terrorism, are incubated in countries affected by conflict, such as Somalia, Yemen and South Sudan.

[The Telegraph]

Why Trump should use Foreign Aid to make America great

Investing in global health is essential to the safety, security, and future prosperity of the United States. In addition to the humanitarian case for foreign aid, there are three very powerful reasons, which are aligned with President Donald Trump’s populist “America first” vision, why the administration should maintain and even spend more on global health.

  1. Deadly epidemics threaten US lives and prosperity – Over the course of the past two decades, we have faced numerous periodic crises stemming from infectious diseases, including severe acute respiratory syndrome (SARS), swine flu, Ebola, and now the Zika virus. Each of these cost US lives and billions of US dollars in response. By investing in health research to develop and stockpile new vaccines and drugs, and stronger health systems to deliver these preventive tools and cures, we will get out ahead of new infectious diseases before they become global disasters.
  2. Foreign Aid for health yields huge returns for the United States – Every US dollar spent on HIV prevention and treatment generates $10 in health and productivity benefits for the countries mounting large AIDS programs with our help, as a result of the infections and deaths averted; every dollar spent on tuberculosis generates $30 in societal benefits. US leadership in global health has helped produce remarkable improvements in global well-being.
  3. It strengthens US leadership on the global stage and counters our rivals – The United States launched its first international health programs in Africa after World War II out of Cold War ideological concerns. These early investments in health were motivated by the belief that training health professionals and controlling infectious disease would improve the population’s quality of life, and in turn, reduce their susceptibility to communism. Since that time, global health aid has continued to serve as an economically efficient way for the United States to promote its values and promote conditions that discourage turmoil around the world, from which the United States stands to gain in the long term.

If we cut our aid and leave a vacuum, it will be filled by US rivals, starting with China. Chinese foreign aid is growing fast, at an annual rate of more than 20 percent per year, and is rapidly catching up with US assistance. Chinese health aid to Africa in particular has grown rapidly. China is now one of the top ten bilateral global health donors to Africa and provided at least US$3 billion dollars in African health aid from 2000 to 2012. If our health support to developing nations … is severely curtailed, we should expect China to fill the void.

In addition, withdrawal of US support for health in areas affected by military conflict and military crisis could lead to the entry of non-state actors whose views are antithetical to those of the United States. Health aid can help fight the underlying causes of terrorism.

[Read full article at Health Affairs Blog]