Examining How Women are Influenced by Inaccessibility to Clean Water

~ Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

Since 1990, 2-3 billion people have gained access to improved drinking water sources, however, much is yet to be done, as billions still do not have access to safe drinking water (Dora, et al., 2015). This has led to several negative health consequences among many communities, as one-third of deaths are linked to the intake of contaminated water in low-resourced countries (West & Hirsch, 2013). Women are often responsible for housework such as cooking, cleaning and maintaining good hygiene. They are also mainly responsible for the care of children and the sick. As all of these tasks require the use of water, women in low-resourced countries are disproportionately affected by the inaccessibility to safe water.

Risks Associated with Water Collection

In 71 percent of households in sub-Saharan Africa women are responsible for collecting water (West & Hirsch, 2013).  As a result, in places such as the mountainous areas of Eastern Africa, women use up to 27 percent of their caloric intake to get water (West & Hirsch, 2013). Sometimes, they must travel a long distance, often several times in one day. This can lead to physical strain, especially among the elderly. This strain can be exacerbated by extreme heat or with heavy pumps at well sites. Water collection can also be dangerous in remote locations where there is increased risk of rape or other forms of violence.

Impacts on Women as Caretakers, and the Terminally Ill

With a high prevalence of HIV and AIDS in these regions, there has also been an increase in care needed for the terminally ill, and once again, it is the responsibility of the woman to provide the needed care (West & Hirsch, 2013). This involves emotional support, but also other aspects such as bathing and toileting. Providing this type of assistance can become more difficult when there is little accessibility to clean water. Furthermore, caregivers also have an increased chance of developing physical pain and infections because of the risks they are exposed to. Increasing accessibility to clean water will not only improve the outcomes of HIV treatment, but it will also reduce the burden of care on women. As a result, this can improve the quality of life for both groups (Figure 1).

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Figure 1: How improved water and sanitation influences the health of those with HIV/AIDS, and caretakers (West & Hirsch, 2013).

Overall, inaccessibility to clean water increases the emotional distress on women and reduces the level of care they are able to provide to those around them. When mothers have poor health status they are unable to provide the adequate resources needed for the well being of their children, which can lead to growth stunts (Requejo, et al., 2015).

Like any other public health issue, this one is complex. Many factors must be examined to determine how improvements can be made to increase the availability of safe water, while also empowering women. For example, while women have to travel long distances in order to get clean water, this also gives them a chance to socialize with other women and spend some time away from the home. Thus, what can be done to preserve this time for social interaction, while minimizing the health risks?  In order to answer this and similar questions, governments and NGOs must critically analyze social systems, specifically gender norms, health systems and physical infrastructure in low-resourced countries.

References:

Dora, C., Haines, A., Balbus, J., Fletcher, E., Adair-Rohani, H., Alabaster, G., et al. (2015). Indicators linking health and sustainability in the post-2015 development agenda. The Lancet , 385 (9965), 380-391.

Requejo, J. H., Bryce, J., Barros, J. A., Berman, P., Bhutta, P., Bhutta, Z., et al. (2015). Countdown to 2015 and beyond: Fulfilling the health agenda for women and children. The Lancet , 385 (9966), 466-476.

West, B. S., & Hirsch, J. S. (2013). HIV and H2O: Tracing the connections between gender, water and HIV. AIDS Behaviour , 17 (5), 1675-1682.  

Sustaining the Fight against Malaria

~ Written by Randall Kramer, PhD, M.E. (Professor of Environmental Economics and Global Health, Duke University) & Leonard Mboera, PhD, MSc (Chief Scientist, Tanzania National Institute for Medical Research)

*Also published on the Duke Global Health Institute Website 

On World Malaria Day, April 25, there’s much to celebrate and acknowledge when it comes to the fight against malaria. Over the past 15 years, we’ve seen a huge ramp-up of international funding, and the latest statistics show impressive progress—a 46% decrease in malaria infections among children in sub-Saharan Africa and an estimated 4.3 million deaths averted globally over time.

One of the most effective malaria control measures has been the free distribution of several hundred million insecticide-treated mosquito nets that protect people from mosquitoes while sleeping. In 2004, only 3% of at-risk people in sub-Saharan Africa had an insecticide-treated mosquito net available to them, compared to 49% in 2014 after an international campaign.

The U.S. government is among the major funders of malaria control, and it’s one of the few international assistance programs that has garnered bipartisan support through the Bush and Obama terms. But despite the upsurge in spending and the laudable success of these programs, malaria remains one of the leading causes of death in poorer and tropical parts of the world.

The need for continued support is critical; it’s estimated that eliminating malaria as a major global disease threat would require double the current $3 billion invested annually in malaria control. But in the face of so many other pressing needs, why should we continue to invest in malaria?

In the last year, nearly 200 million people suffered from malaria, and its death toll—more than 500,000—was 50 times greater than that of the widely publicized outbreak of Ebola in West Africa. And malaria takes a particularly devastating toll on the young. More than 80% of the deaths from malaria are in children under five, and those who manage to survive the illness often suffer lasting effects on development, school performance and lifetime earnings.

Because malaria is such a resilient killer, we can expect to see these malaria losses continue and potentially rise in the absence of continued financial support. In fact, with temperatures steadily increasing throughout the world as a result of global warming, malaria-transmitting mosquitoes have begun to take residence in new regions, raising the specter of malaria spreading far beyond its current boundaries.

In addition to the physical suffering malaria causes, the disease stunts national economic progress.

Studies by Columbia University economist Jeffrey Sachs suggest that, if not for malaria keeping children out of school and agricultural workers out of the fields, the rate of economic development in sub-Saharan Africa would have been much higher in the past few decades.

And lastly, we can’t underestimate the goodwill generated by our investments in mosquito nets and other malaria-defeating approaches in recipient countries. As one community member told our research team in rural Tanzania, “Mosquito nets have been a great help to us. The day when mosquito nets were distributed, people were very happy, because many people in our community could not afford to buy the mosquito nets.”

The malaria parasite, a resilient and opportunistic pest, has successfully co-inhabited with humans for thousands of years, and it continues to adapt and evolve, damaging populations and economies across the globe. We now have the knowledge, technology and health systems to significantly reduce its devastating human impacts. But putting these assets into action will require renewed political will and financial commitment from rich and poor countries around the globe—including the U.S.

Corporate Responsibility and Duty of Care - Health Insurance and Assistance

-Written by Mike Emmerich, Specialist Emergency Med & ERT Africa consultant (Contact: mike@nexusmedical.co.za) 

https://twitter.com/MikeEmmerich

"Between one in two and one in three expatriates has no international health insurance" International Private Medical Insurance Magazine REPORT: International And Expatriate Healthcare And Insurance 2014

I believe this to be a very accurate statement notably, with regard to the African continent (where I spend most of my time), this figure might even be flattering to some companies employing expat staff in Africa.

The globally mobile population has grown dramatically. There are over 50 million expatriates, and by 2020 this will be 60 million. 232 million people now live away from their country of birth. Between one in two and one in three expatriates has no international health insurance, although a minority is covered by domestic health insurance. Several countries seek to get expatriates and migrants to pay for healthcare or have compulsory health insurance.

This is a disturbing issue, as too many companies are happy to send their staff abroad, or to remote work sites, without any or inadequate medical cover; be it insurance or assistance. This shows very poor duty of care. In discussions with some of these companies, when trying to assist them with advice on even basic assistance packages or client managed services, their responses are troubling; when viewed against the light of corporate responsibility and duty of care. To defer the responsibility to the employee and abdicate corporate responsibility, should be cause for concern.

The duty of care of the employer, is a term that is often thrown about and The UN Global Compact, is one way that companies are being encouraged to show a greater duty of care, although some would cynically say that Corporate Social Responsibility is a box-ticking exercise, companies are just paying lip service, but do no more than is necessary to avoid affecting the bottom line. The UN Global Compact, is engaging over 8,000 companies in more than 145 countries on human rights, labour standards, environment and anti-corruption, hopefully at the same time pushing to commit to a sustainable workforce, via duty of care and corporate social responsibility.

The level of care offered by companies, will depend where the company is registered, as to what laws could be enforceable, hence most companies register an off-shore shell for hiring, staffing and contracts. (this is in itself a topic for another day – relating to contracts, taxes etc.)

Possibly other avenues should be explored, with respect to medical assistance/insurance; by pushing that investors use their muscle, ensuring that their investment capital is being well managed. Staff that cannot be properly cared for (ex-pat and local), via medical cover that is in place, place a further drain on company resources, shifting capital away from its intended purpose. A well managed corporate health care plan, ensures ongoing confidence in the company.

Till now I have only been speaking about expat staff, but the issue of medical care for local staff would also need to be addressed, in fact poor care for expat staff, could be viewed as an indicator of poor care for local staff. The ever growing impact of business on society means that staff, investors and consumers expect corporate power to be exerted responsibly, the corporate community will have to step up its game and build greater trust with respect to duty of care. Business are being expected to do more in areas that used to be the exclusive domain of the public sector – ranging from health, education and to community investment.

Having insurance/assistance programs from reputable companies, linked to well managed onsite managed health care programs, which is in place for ALL staff, makes good business sense. This then empowers staff to work safely in environments that might be deemed risky, allowing them to work with confidence and be fully focused on their daily tasks.

References:

http://www.researchandmarkets.com/reports/2788557/internationalandexpatriatehealthcareand 

https://www.unglobalcompact.org/abouttheGC/thetenprinciples/index.html 

Health Issues on the African Horizon for 2015

~ Written by Mike Emmerich - Specialist Emergency Med & ERT Africa consultant (Contact: mike@nexusmedical.co.za)

https://twitter.com/MikeEmmerich 

As 2014 draws to a close and we review what has happened over this past year, we also look forward to 2015 and all of it challenges. Numerous organisations and commentators have written of the challenges that lie over the horizon for 2015, as regards Global Health. From my own experience of working on the continent I have identified the following challenges for 2015 for Africa.

Some of the issues/challenges overlap and/or influence one another. They do not stand alone, the one can exacerbate the other.

Water

Water, on its own, is unlikely to bring down governments, but shortages could threaten food production and energy supply and put additional stress on governments struggling with poverty and social tensions. Water plays a crucial role in accomplishing the continent's development goals, a large number of countries on the continent still face huge challenges in attempting to achieve the United Nations water-related Millennium Development Goals (MDG)

Africa faces endemic poverty, food insecurity and pervasive underdevelopment, with almost all countries lacking the human, economic and institutional capacities to effectively develop and manage their water resources sustainably. North Africa has 92% coverageand is on track to meet its 94% target before 2015. However, Sub-Saharan Africa experiences a contrasting case with 40% of the 783 million people without access to an improved source of drinking water. This is a serious concern because of the associated massive health burden as many people who lack basic sanitation engage in unsanitary activities like open defecation, solid waste disposal and wastewater disposal. The practice of open defecation is the primary cause of faecal oral transmission of disease with children being the most vulnerable. Hence as I have previously written, this poor sanitisation causes numerous water borne disease and causes diarrhoea leading to dehydration, which is still a major cause of death in children in Sub-Saharan Africa.

“Africa is the fastest urbanizing continent on the planet and the demand for water and sanitation is outstripping supply in cities” Joan Clos, Executive Director of UN-HABITAT

Health Care Workers

Africa has faced the emergence of new pandemics and resurgence of old diseases. While Africa has 10% of the world population, it bears 25% of the global disease burden and has only 3% of the global health work force. Of the four million estimated global shortage of health workers one million are immediately required in Africa.

Community Health Workers (CHWs) deliver life-saving health care services where it’s needed most, in poor rural communities. Across the central belt of sub-Saharan Africa, 10 to 20 percent of children die before the age of 5. Maternal death rates are high. Many people suffer unnecessarily from preventable and treatable diseases, from malaria and diarrhoea to TB and HIV/AIDS. Many of the people have little or no access to the most fundamental aspects of primary healthcare. Many countries are struggling to make progress toward the health related MDGs partly because so many people are poor and live in rural areas beyond the reach of primary health care and even CHW's.

These workers are most effective when supported by a clinically skilled health workforce, and deployed within the context of an appropriately financed primary health care system. With this statement we can already see where the problems lie; as there is a huge lack of skilled medical workers and the necessary infrastructure, which is further compounded by lack of government spending. Furthermore in some regions of the continent CHW's numbers have been reduced as a result of war, poor political will and Ebola.

Ebola

The Ebola crisis, which claimed its first victim in Guinea just over a year ago, is likely to last until the end of 2015, according to the WHO and Peter Piot, a scientist who helped to discover the virus in 1976. The virus is still spreading in Sierra Leone, especially in the north and west.

The economies of West Africa have been severely damaged: people have lost their jobs as a result of Ebola, children have been unable to attend school, there are widespread food shortages, which will be further compounded by the inability to plant crops. The outbreak has done untold damage to health systems in Guinea, Liberia and Sierra Leone. Hundreds of doctors and nurses and CHW's have died on the front line, and these were countries that could ill afford to lose medical staff; they were severely under staffed to begin with.

Read Laurie Garrett's latest article: http://foreignpolicy.com/2014/12/24/pushing-ebola-to-the-brink-of-gone-in-liberia-ellen-johnson-sirleaf/

The outcome is bleak, growing political instability could cause a resurgence in Ebola, and the current government could also be weakened by how it is attempting to manage the outbreak.

Political Instability

Countries that are politically unstable, will experience problems with raising investment capital, donor organisations also battle to get a foothold in these countries. This will affect their GDP and economic growth, which will filter down to government spending where it is needed most, e.g.: with respect to CHW's.

Political instability on the continent has also lead to regional conflicts, which will have a negative impact on the incomes of a broad range of households,and led to large declines in expenditures and in consumption of necessary items, notably food. Which in turn leads to malnutrition, poor childhood development and a host of additional health and welfare related issues. Never mind the glaringly obvious problems such as, refugees, death of bread winners etc...

Studies on political instability have found that incomplete democratization, low openness to international trade, and infant mortality are the three strongest predictors of political instability. A question to then consider is how are these three predictors related to each other? And also why, or does the spread of infectious disease lead to political instability?

Poverty

Poverty and poor health worldwide are inextricably linked. The causes of poor health for millions globally is rooted in political, social and economic injustices. Poverty is both a cause and a consequence of poor health. Poverty increases the chances of poor health, which in turn traps communities in poverty. Mechanisms that do not allow poor people to climb out of poverty, notably; the population explosion, malnutrition, disease, and the state of education in developing countries and its inability to reduce poverty or to abet development thereof. These are then further compounded by corruption, the international economy, the influence of wealth in politics, and the causes of political instability and the emergence of dictators.

The new poverty line is defined as living on the equivalent of $1.25 a day. With that measure based on latest data available (2005), 1.4 billion people live on or below that line. Furthermore, almost half the world, over three billion people, live on less than $2.50 a day and at least 80% of humanity lives on less than $10 a day.

Malnourishment: A Growing Concern - Food as a Weapon

~Written by Mike Emmerich, Specialist Emergency Med & ERT Africa Consultant (Contact: mike@nexusmedical.co.za)

https://twitter.com/MikeEmmerich

The number of hungry people has fallen by over 200-million since 1992, so says the 2014 Hunger Map and a report titled “The State of Food Insecurity in the World: Strengthening the Enabling Environment for Food Security and Nutrition” jointly prepared by World Food Programme (WFP), the Food and Agriculture Organisation (FAO) and the International Fund for Agricultural Development (IFAD).

They go on to say that 805 million people, or one in nine of the world’s population, go to bed hungry each night. But in Sub-Saharan Africa, this is even worse, with one in four people suffering from undernourishment. The report says that sub-Saharan Africa faces the most severe challenges in securing its food; mainly due to sluggish income growth, high poverty rates and poor infrastructure, which hampers physical and distributional access.

It states: “In general, in Africa, there has been insufficient progress towards international hunger targets, especially in the sub-Saharan region,”

The report also says limited progress had been made in improving access to safe drinking-water and providing adequate sanitation facilities, while the region continues to face challenges in improving dietary quality and diversity, particularly for the poor. I did some work in the Southern DRC (based out of Lubumbashi in 2006) and we noted then that dehydration, was the leading cause of death in children under the age of 5. Dehydration as the result of diarrhoea, caused by unsanitary drinking water. For those who survive they are then in turn faced with stunted growth, which is made worse by poor food nourishment.

This report just published confirms that the situation has not changed in the past 8 years, limited progress had been made in improving access to safe drinking-water and providing adequate sanitation facilities. In fact the report notes, that progress has been so poor, that the WFP target of halving the number of undernourished people by 2015, will not be realised.

The report highlights the following to move forward:

1. Sustained political commitment at the highest level

2. Placing food security and nutrition at the top of the political agenda

3. Creating an enabling environment for improving food security and nutrition through adequate investments

4. Better policies, legal frameworks and stakeholder participation

5. Institutional reforms are also needed to promote and sustain progress.

Plus an integrated plan focussing on:

1. Public and private investments to raise agricultural productivity

2. Better access to inputs, land, services, technologies and markets

3. Measures to promote rural development

4. Social protection for the most vulnerable (persons and countries)

5. Including strengthening their resilience to conflicts and natural disasters

6. Specific nutrition programmes, especially to address micro-nutrient deficiencies in mothers and children under five.

As reports go it is a very good piece of work tackling many complex issues and outlining clear broad action plans. As with most reports though, I take issue with their expected outcomes, to broad, not specific and in my opinion, to broad. Its like position papers from government departments or even aid agencies. It does not tackle the problem head stating what is at fault and what needs to be done in clear action plans; to do that will require stepping on toes or worse – maybe even naming names!

Regional conflicts, greedy power hungry warlords all demanding access to food, how it is priced and distributed. This can affect when and if crops are planted, and who gets the produce, and they who sells it. Food can be and is used as a weapon, to control people or even to get votes, Zimbabwe and South Africa are cases in point.

The cost of food is then another key factor, Lester Brown wrote in 2011's “Food Issue” of the Foreign Policy magazine:/ Americans generally spend less than 10% of their income on food, but there are 2 billion people who live in poverty around the globe who spend 50 to 70 percent of their income on food/. A slight increase in the cost of food for these persons could be life or death, and the costs when they do escalate, are beyond the control of the consumer, at times manipulated by external forces, for their own (political or economic) gain.

On a sad and macabre note, Saudi Arabia, South Korea and China ventured beyond their borders in 2008 to grow grain in cheaper regions, such as Ethiopia and Sudan, where, of course, people where starving and did not get any of the planted grain.

So where to from here; I think if we cast our eyes to Burkina Faso, we might see a way out, People Power. The people need to speak and speak loudly in the only way the politicians and regional leaders will listen.