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Volume 2 • June 2011

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THE PROMISE OF PROTECTION Dr. Noeleen Heyzer1 It is widely agreed that crises create opportunities of sorts. As the Asia-Pacific region emerges from the recession of 2008 and attempts to cope with the continuing effects of food and fuel price crises and natural disasters – including the earthquake and tsunami in highly-prepared Japan – governments are looking anew at ways to mitigate the rising insecurity and heightened social risks experienced by millions of people across the region, especially those living in or close to poverty. The region’s capacity to ensure all citizens receive a minimum level of security was at the heart of discussions when Heads of State, Ministers and Senior Officials from across Asia and the Pacific met in May 2011 for the 67th Session of the Economic and Social Commission for Asia and the Pacific (ESCAP). The Commission Session focused on a critical challenge facing us: our ability to match the economic recovery underway in Asia and the Pacific with a renewed emphasis on the social dimension of development as well. The region’s new economic growth, following the shock of the global financial crisis, our growing urbanization, and the continuing migration of people, within our countries and across our sub regions, require a new commitment by our governments to institute social protections to secure the benefits of economic growth for all the people of the Asia-Pacific region. Instead of approaching specific development setbacks and challenges through limited, reactive interventions, our governments are now prepared to seek and implement comprehensive, universal coverage solutions capable of strengthening coping capacities and resilience as part of their vision of inclusive development. The resumption of food and fuel price inflation in many of the region’s countries and continuing aftershocks of the global financial crisis has lent new urgency to their efforts. But importantly, the just-released ESCAP study, “The Promise of Protection,” shows that a basic social protection package is affordable and within the reach of most countries in the region, at virtually any stage of economic development. And at a cost lower than countries may realize, of around 1 to 3 per cent of their gross national income for essential health, education and pension schemes. Social protection programmes make good economic sense – acting to broaden and deepen opportunities for all and thus building more resilient and Continues on page 5

Dr. Noeleen Heyzer is Under-Secretary-General of the United Nations and Executive Secretary of the Economic and Social Commission for Asia and the Pacific.

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CONTENTS Volume 2

June 2011

THE PROMISE OF PROTECTION

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DR. NOELEEN HEYZER

DONORS MISSED 2010 AID TARGETS – OECD

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IVY MUNGCAL

AFRICAN YOUTHFUL POPULATION: POTENTIALS AND WAY AHEAD

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BUNMI MAKINWA AND RICHMOND TIEMOKO

LANGUAGES MATTER! A KEY TO ACHIEVE THE MDGS

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KYUNGAH KRISTY BANG

MAKING SENSE OF THE TERM SOCIAL BUSINESS

Cover by Aco To Manurung

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DR. RIAZ KHAN

Dr. Sandro Calvani

THE BEIRUT DECLARATION ON HIV AND INJECTING DRUG 12 USE: A GLOBAL CALL TO ACTION CLAUDIA STOICESCU

GOOD PRACTICE: MOBILE DIAGNOSIS

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DR. LIVIA BELLINA

RE-DESIGNING POLICY TO STRENGTHEN MDGS BEYOND 2015: FROM GLOBAL PERSPECTIVE TO COUNTRY-SPECIFIC STRATEGY

DETTY SALULING

Detty Saluling Publication Staff Mahbooba Amin Abramo Abderrahmane Chabib

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Tania Albertini Freedom from Want is a quarterly publication published by the

TANIA ALBERTINI AND ABRAMO ABDERRAHMANE CHABIB

BOOK REVIEW

Assistant Editor

ARCMDG. The views and opinions

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expressed in the Magazine do not necessarily reflect those of the ARCMDG or AIT.

ARCMDG ASEAN Regional Center of Excellence on MDGS Asian Institute of Technology P.O. Box 4, Klong Luang Pathumthani 12120, Thailand Tel: +66 2 524 6722 Fax: +66 2 516 2126 Email: staff_arcmdg@ait.asia Website: www.arcmdg.ait.asia

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Donors Missed 2010 Aid Targets - OECD Ivy Mungcal1

The article is reproduced from the Development News Wire of Devex2

he world’s biggest donors failed to meet their aid targets for 2010 despite an increase in aid levels over the past six years, according to the Organization for Economic Cooperation and Development’s latest annual review of development assistance. Aid levels reached $128.7 billion in 2010, up from approximately $120 billion in 2009, the review says, adding that aid levels continue to rise. But OECD said that despite increasing the volume of aid by $30 billion since 2005, G-8 member countries and other donors missed their target by at least $19 billion. OECD said only a fraction of the shortfall can be attributed to the recent economic crisis. “Only a little over $1 billion of the shortfall can be attributed to lower than expected GNI levels due to the economic crisis. The remaining gap of $18 billion was due to donors that that did not meet their ODA commitments,” the Paris-based organization said in a news release. G-8 member countries also failed to meet their pledge to increase the amount of aid they provide to Africa by $25 billion by 2010, OECD said, explaining that donors only delivered $11 billion out of their pledged target. “This shortfall is larger in percentage terms than the shortfall in total ODA. The main reason is the poor performance of several of the donors that provide large shares of their aid to Africa,” OECD said. Oxfam International has urged leaders of donor countries that failed to meet their commitments to “come to the table” in the upcoming European Union and G-8 summits to explain how they plan to get their pledges back on track. “The future for the poorest people in the world looks bleak and they must not pay with their lives for the broken promises of rich countries. Aid levels must go up rapidly

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© Miguel Ángel Horcajada

rather than stagnating or being slashed,” Oxfam’s Max Lawson said. European Commissioner for Development Andris Piebalgs said the bloc will focus its aid on clean energy and food security over the next five years, the Guardian reports. Later this year, Piebalgs said he will unveil proposals “regarding the clearer focus on the future of development policy, better co-operation and a higher impact on the ground.” “[The proposals] will focus on less sectors, basically those making the biggest impact, such as agriculture, food security … and climate change, providing support for clean energy, and also the knowhow. In these two areas, the EU has been successful in sustainable agriculture and renewable energy,” he told the Guardian. Of the EU member states, only Luxembourg, Sweden, Denmark, the Netherlands, Belgium, the United Kingdom, Finland and Ireland met their aid targets in 2010.

Staff Writer of Devex Website at http://www.devex.com/en/blogs/the-development-newswire/donors-missed-2010-aid-targets-oecd-says?g=1

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The Promise of Protection - Continued from page 1 inclusive economies. Furthermore, the study shows social protection is an investment which helps people escape from poverty. To date, many countries have relied for poverty reduction primarily on the trickle-down effects of economic growth. However, if they introduced more comprehensive social protection with appropriate supporting policies, they would reduce poverty much faster. Thus, rather than seeing social protection as costly measures, effective protection should be seen as an investment that will increase productivity and reduce the need for future spending. Building universal social protection programmes is not without its challenges. But the long-term political and economic dividends that such comprehensive mechanisms would yield, including greater domestic consumption, higher levels of human development and greater shared opportunity – including for women – and ultimately more equitable and robust economic growth, are undeniably compelling grounds for action. That is the opportunity – and the challenge -- before us. Working together, Asia Pacific can shape the forces of the economic recovery by investing in its people, its human capital, by strengthening our social commitments and implementing social protections as a mainstay of national development. The opportunity is now for Asia Pacific to emerge as a leader: in the global economy, in the realm of social progress, and in safeguarding our global environment. Let us demonstrate that Asia Pacific’s development can be balanced – with our focus on all three pillars working together, our economic wealth shared, our social gains secured, and the gifts of the earth protected.

African Youthful Population: Potentials and Way Ahead Bunmi Makinwa1 and Richmond Tiemoko2

© Rita Willaert

Introduction

The youthful population of the Sub-Saharan Africa could be an asset or ticking time bomb. The continent’s rapid population growth outpaces that of all other regions, and management of population in relation to resources is more important than ever. However, through informed policies and programmes supported by use of up-to-date population data, and with effective involvement of young people in social, political and economic activities, Sub-Saharan Africa can reap the benefit of its youthful population. African population has reached one billion mark with 60 percent of the population under the age of 25 years. With this youthful population and the relatively high fertility rate and low contraceptive rate, Africa’s population will continue to grow at a relative high rate. Again young people may hold the key to addressing high population growth. Volume 2 • June 2011

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Overview of development outcomes

African continent has recorded a number of positive developments in the last two decades with a noticeable improvement in democratic process, a reduction of socio-political crisis and expansion of socio-economic infrastructure3. Even using internationally agreed development indicators, the continent as a whole and Sub-Saharan Africa in particular is making substantial progress; hence, the continent recorded high economic growth outpacing Western Europe in 2009. The future looks bright, according to the World Bank and International Monetary Fund’s prediction of an economic growth rate of over 5 percent for Africa. With regard to social and human development, the review of the implementation of the International Conference on Population and Development (ICPD) and the Mid-term review of the Millennium Development Goals (MDGs) points to the same conclusion: Africa is generally doing well and can do even better particularly in improving maternal health, reducing poverty, investing in youth health and education.

How do young people fare?

Despite of the economic growth and other positive development outcomes, young people in Sub-Saharan Africa continue to face various challenges in skills-oriented education including life skills education, employment and health which constrain their participation in socio-political and economic lives. Education Children and youth’s education including sexuality education is critical to African development. In the last decade the continent has recorded major advance in primary education although school enrolment rate in Sub-Saharan Africa remains the lowest in the world and over 31 million children are out of school in the region. There are however good experiences and practices in the region which could provide opportunity for regional cooperation and experience sharing: for instance only 37 percent of children who start grade one reach grade five in Chad against 99 percent in Mauritius. Similarly Gabon records the highest youth (15-24 years old) literacy rate in Sub-Saharan Africa. There are good lessons to be learned in such success cases.

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© Rita Willaert

Employment Over half of Sub-Saharan African youth were participating in the labour market in 2000. The proportion of male employed is 13 percentage points higher than employment rate for young female (64.1 percent against 51.4 percent). Data for 2010 reveal that participation in the labour market has not changed significantly at 57.4 percent for all youth although there was increase by 2 percentage points in girls’ employment against a decrease in young male employment4. In South Africa, 51 percent of young people were unemployed in 2010.

Encouraging initiatives on the continent

With an increasing number of activities, initiatives and framework for evidence-based youth-related development programming, the second decade of the 21st century provides a unique opportunity for investing in young people. Taking cognizance of the potential role of young people in Africa and the need to protect them and harness their potential for development, African political leaders adopted and approved the African Youth Charter in 2006 and declared the years 2009-2018 as the decade for youth development. The youth Charter addresses the rights and obligations of young people and therefore constitutes the social contract between the state and youths. The Africa Union, the umbrella political body of the continent, has established a directorate of youth development within the AU Commission to ensure effective coordination, monitoring and evaluation of youth development interventions. In addition, to promote youth employment and address the critical issue of young people lack of work experience, the Africa Union Commission


© Miguel Àngel Horcajada

African political leaders adopted and approved the African Youth Charter in 2006 and declared the years 2009-2018 as the decade for youth development. has developed and launched the African Youth Volunteer corps programme in December 2010 in Abuja, Nigeria. The programme targets people aged 18-30 years who could be deployed for 3 to 12 months as volunteers. Furthermore, AU is devoting the July 2011 AU summit to “Accelerating Youth Empowerment for Sustainable Development”. Many countries are developing their youth policy and designing strategy to involve young people in programme implementation. For instance, to address the critical issue of understaffing in the health sector especially at community level but also to promote young girls’ employment, Ethiopia created, trained and employed over two years 30,000 rural community health workers - all girls with secondary school education.

Two fundamental informed policies and programme for young people and higher returns from investment in youth While there may be various ways of improving the impact on and benefits of development effort for young people, it is important that stakeholders consider the following two fundamental approaches:

Back to the basic 1: Facts and data for evidence-based planning African development policies and programme could record better results for young people if decision-making is supported by accurate and up-to date disaggregated population data. It is not uncommon to see ‘no-data” “estimate” when it comes to critical information on many African countries in official statistical records of publications and databases. For instance, it is estimated only about 50 percent of African population were covered in the 2000 round of census and only about 50 percent of children are covered by civil registration5 – two major and comprehensive sources of population data. It is therefore important to seize the opportunity of the 2010 round of population and housing census to get this right by counting everyone – because every person counts. It is equally important to make the census data and other data sources widely and easily available to the public – democratization of access to data. This is not yet the case. Back to the Basic 2: Making good use of the asset For Africa, the young people are a majority of the population. It is a potential asset. Use it! Policy formulation and the development and implementation of programme on youth related issues will have a far reaching impact if young people are involved in all relevant aspects. Considering the young population which is the majority, involving young people in policy, politics, development and business makes good politics and good business. In the emerging economic areas, such as green economy and information technology and communication, young people have a comparative advantage and they can serve their countries admirably. The young people’s potentials in these areas should be unlocked. Knowing and using its asset – the youth-, African countries can speed up their development and the achievement of their full potentials.

Director, United Nations Population Fund (UNFPA) Africa Region Senior Technical Adviser, UNFPA Africa Regional Office 3 African Child Policy Forum (2008), The African Report on Child Wellbeing: How child-friendly are African governments? Addis Ababa: The African Child Policy Forum 4 International Labour Organization (2010) Global employment trends for youth: August 2010: special issue on the impact of the global economic crisis on youth / International Labour Office. - Geneva: ILO, 2010. 5 Setel P W, S B Macfarlane, S Szreter, L. Mikkelsen, et al (2007) – Who counts. A scandal of invisibility – making everyone count by counting everyone. The Lancet Vol 370 November 3, 2007 1 2

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Languages Matter! – A Key to Achieve the MDGs Kyungah Kristy Bang1

umerous efforts have been made to include marginalized ethnolinguistic minority p opulations into current rapid social transformation. However, our efforts to reach marginalized groups can only succeed if due consideration is given to the role of language in education and development. Language is an essential tool for learning, to acquire information needed to actively participate in facing the challenges of social, economic and technological changes. Thus, it is important to pay attention to the significant role of language in order to achieve the Millennium Development Goals (MDGs) and Education for All (EFA). These issues were discussed in a recent conference “International Conference on Language, Education and the Millennium Development Goals (MDGs)”2 in Bangkok. About 6,000-7,000 languages are spoken worldwide, but only 300 languages are spoken by the majority (over 90%) of the world’s population3. More than 2500 languages are found in the Asia-Pacific region and the speakers of these languages face obstacles in accessing quality basic education which results in a vicious cycle of poverty, illiteracy and disease as well the increased likelihood of conflict arising from exclusion. The extreme poverty rate for ethnic minorities is 29 percent in Vietnam which is over nine times higher than the ethnic majority.4 As such, in some countries, ethnic and language minority groups account for a large share of the bottom 20% in education. In Nepal, about one quarter of the ‘education poor’ is Maithili speakers – a group that makes up 10% of the population5.

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More than 2500 languages are found in the Asia-Pacific region and the speakers of these languages face obstacles in accessing quality basic education which results in a vicious cycle of poverty, illiteracy and disease as well the increased likelihood of conflict arising from exclusion.

Disadvantages associated with languages are major impediments to achieving sustainable development. Language plays a crucial part in the development process, but in many cases ethnic minorities around the world often get left behind because state education systems do not do enough to teach children at the primary school level in their mother tongue or in another language they understand. For example, having Baluchi as a home language in Pakistan carries a 55% risk of having fewer than four years of schooling at age 17 to 22 compared with less than 10% for Urdu speakers.6 We can address this challenge by mother tongue-based (MTB) multilingual education (MLE). MTB MLE refers to the schooling which


Local people will have more ownership of development when they can participate and discuss development issues among themselves and with outsiders without the barrier of someone else’s language. begins with the learner’s home language or mother tongue (L1) for reading, writing and learning, and which adds official/second languages (L2) gradually as additional languages of instruction, thus making the education system multilingual. Many ethnolinguistic minority students are failing to master basic literacy and numeracy skills, even when they complete a full cycle of primary education, creating a language barrier for children and causing high ratio of class repetition and school dropout.7 Teaching students in their mother tongue, not only improves their academic results, but also provides communication skills, critical mindsets and opportunities to learn through aspects of their own culture. MTB MLE empowers ethnolinguistic minorities to promote sustainable development and reduce poverty and environmental degradation. Local people will have more ownership of development when they can participate and discuss development issues among themselves and with outsiders without the barrier of someone else’s language. For example, the Kalinga Institute of Social Sciences (KISS) provides professional skills and Gandhian principles to help empower tribal people in the state of Orissa, India. In total, more than 10,000 pupils from kindergarten to college age have been educated in the state language of Odiya, as a link language among the diverse ethnic communities, and offered vocational training. By participating in this program, the ethnolinguistic minority students were able to have better opportunity for their future employment.8 Reaching out to people in their mother

tongue plays a crucial role in efforts to protect the environment and mitigate climate change, as many minority groups live in forests and natural settings facing environmental degradation. The local communities often possess a deep understanding of the forest, water and life in the area. Local languages are the best means to transfer this traditional knowledge from one generation to another to preserve environment. People also can protect themselves from harmful diseases through education based in the local language and culture. For example, an anti-malaria program for the Akha and Lahu hill tribe villages in Myanmar used language, metaphors and stories to break through the communication barrier to educate villagers of such precautions as using mosquito nets at night. After two years of implementation of this project, there was a 40 to 50% drop in malaria infections.9 The target year for the MDGs is less than five years away, and multilingual education can be used to reduce present disparities and help speed up achievement of MDGs. Poverty, health protection, conservation of biodiversity and environment sustainability are all correlated to each other and languages are center of this relationship. It is clear that we cannot achieve any of the MDG and EFA goals without prioritizing importance of multilingual education. By giving power of knowledge to ethnolinguistic communities via MTB MLE, we can prevent minorities being left out from aggregate efforts to achieve the MDG and EFA goals. To make this happen priority must be given to the language through which they learn.

Coordinator of Multilingual Education Working Group for Asia, UNESCO Thailand http://www.seameo.org/LanguageMDGConference2010/ 3 UNESCO 2005. First Language First: Community-based Literacy Programmes for Minority Language Contexts in Asia. Bangkok: UNESCO. p.v 4 World Bank, Viet Nam Development Reports for 2008 and 2009. 5 UNESCO 2010. Education for all Global Monitoring Report 2010. Paris: UNESCO. p.152 6 UNESCO 2010. Education for all Global Monitoring Report 2010. Paris: UNESCO. p.150 7 UNESCO 2010. Education for all Global Monitoring Report 2010. Paris: UNESCO. p.7 8 Prashanta Kumar Routray. Empowerment of Tribal through Education and sustainable Livelihood: A KISS Model. International conference on language, education and the MDGs, 2011 9 Ellen A Herda and Valerie Dzubur. Tradition and New Ways of Learning Among Akha and Lahu: Reinterpreting Malaria Prevention. International conference on language, education and the MDGs, 2011 1 2

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Making Sense of the Term Social Business Riaz Khan1

Rajat Bansal

n 2005, Professor Yunus had a lunch meeting with Franck Riboud CEO of Groupe Danone. At this meeting, Franck Riboud talked about Danone’s interest in social development and requested ideas from Professor Yunus on how they could help the poor. Professor Yunus suggested that since Danone was in the business of producing food, they could tackle the problem of malnutrition among poor children in Bangladesh, by means of a joint venture Grameen Danone. When Frank Riboud agreed to this, Professor Yunus added a condition that this venture would have to be a social business. By the term social business, Professor Yunus meant a special kind of business dedicated to a social cause where the investors would not get any dividend or profits. They would only be eligible to recoup their initial investment and even that could not be adjusted for inflation. Danone agreed to the stipulation that the joint venture would be a social business and the Grameen Danone factory was set up in Bogra, Bangladesh. The venture produces yoghurt fortified with vitamins and minerals and the social 10

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goal is to tackle malnutrition among poor children. The Grameen Danone operation sources its raw materials from the local area. Villagers sell their milk to the operations, through milk collection centers located in rural areas. The milk is then transported by means of rickshaw vans to the chilling centers, where the milk is chilled, before being transported to the factory. The yoghurt is sold through several channels including Grameen members who are sales persons who work on commission, retail outlets in Bogra and larger outlets in the capital city Dhaka. Near the factory is another social business set up by Grameen, called the Grameen GC Eye Care Hospital. This is an eye hospital that

It is a delicate balancing act to create a successful social business, because we are seeking to combine the efficiency of the modern business sector with the idealism of the non-profit sector.


provides affordable eye care to everyone, poor or rich. Everyone who comes to the hospital gets the same quality of treatment, but the fees that they pay depend on their income. The hospital manages to cover all its costs through the fees that it levies. It is possible to get a pair of prescription spectacles for as low as $2 at the hospital. The hospital is modeled after the highly successful Aravind Eye Hospitals in India. These hospitals are the brainchild of Dr. Venkataswamy, who started the first one in 1976. Aravind has provided technical assistance to Grameen GC Eye Care including training for the nurses and doctors at the hospital. Grameen Danone and Grameen GC Eye Care are examples of what Professor Yunus calls a non-loss, non-dividend company dedicated to a social cause. In such a company the investors only expect to get back what they originally invested in the company, nothing more. Any profit is put back into the company. Professor Yunus has designated such businesses as Type I social businesses. He has also defined a Type II social business as a profit making company that is owned by the poor and is dedicated to addressing a social problem. The best known example of such a social business is Grameen Bank. The terms social enterprise, social entrepreneurs and social business are gaining currency especially after the financial crisis of 2008 showed the weaknesses of the world market systems. We discuss some alternate approaches to defining these terms. Bill Drayton, Founder of Ashoka, the pioneering organization in the field of social entrepreneurship, talks about hybrid value chain, which combines the strengths of the business and social sectors. Michael Porter of Harvard Business School talks about creating shared value where businesses create not only economic value and but also social value. In Thailand, Mechai Viravaidy of Population and Community Development Association, talks about social enterprises where the investors do not even recoup their original money. He feels that such investors should be in the social sector purely for the excitement of doing something good. A common thread running through all these ideas is that of moving away from a single dimensional view of a business to a multidimensional view. The work of organizations 1

Rajat Bansal

can be considered as falling inside two broad spheres: financial and social. Most conventional businesses operate in the financial sphere. Their major target is to make money and if they happen to do some social good then that is a welcome consequence, but financial gain will trump the social indicators if there is any difficulty. Most charities and not-for profits, on the other hand work in the social sphere. They may be able to generate enough money to cover their costs, but if there is a tradeoff between the social and financial returns they will opt for the social return. Social businesses fall into the region where the firm is both contributing to the social cause and is able to cover its costs. Obviously the social return is the more important of the goals, and financial profitability has to be subservient to the social goal. It is a delicate balancing act to create a successful social business, because we are seeking to combine the efficiency of the modern business sector with the idealism of the non-profit sector. As we face the challenges of poverty and deprivation we should recognize that people are multifaceted. They have a selfish side and a selfless side. If we look upon ourselves as purely selfish creatures who are interested only in maximizing our income then we are left with a very limited view. A view moreover, that does not correspond to who we are. Instead we should acknowledge we are also attracted to the notion of helping those less fortunate than ourselves. A social business is designed to take advantage of the multi-faceted nature of people. If we can successfully tap into the need for helping others and the creative urge to solve problems in the social sphere, then we have a chance to solve some of the very problems of deprivation that the world presently faces.

Director of Yunus Center - AIT Volume 2 • June 2011

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The Beirut Declaration on HIV and Injecting Drug Use: A Global Call to Action Claudia Stoicescu1

Civil society organisations from around the world call for accountability after decades of failure in response to HIV and injecting drug use and for immediate action to address it

hen world leaders meet in New York at the United Nations General Assembly High Level Meeting on HIV/ AIDS (June 8–10, 2011), they will review progress and chart the future of the global AIDS response. The meeting marks three decades of the HIV epidemic, ten years since the landmark adoption at the UN of time-bound, measurable goals and targets, and five years since the commitment was made by world leaders to achieve universal access for all to comprehensive HIV programmes by 2010. In the past ten years, there have been fewer new HIV infections globally, significantly fewer infections among newborns and improved access to HIV treatment. As a result AIDS-related deaths have decreased by more than 20% since 2006. But thirty years into the global HIV epidemic, we have not come far enough. Progress towards universal access has proven to be selective. People who inject drugs have little to celebrate. Accounting for 30% of HIV infections outside of sub-Saharan Africa, and up to 80% of infections in Eastern Europe, Central Asia and parts of South East Asia, the proportion of new HIV cases in people who use drugs is increasing. 33.3 million people live with HIV across the globe, and an estimated three million of this group are people who inject drugs. A further 16 million are at risk of infection through injecting drug use. For people

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who inject drugs, access to HIV prevention, treatment, care and support has been inadequate. Stigma, discrimination and punitive policies associated with the failed, U.S.-promoted ‘war on drugs’ approach have exacerbated the risk of HIV infection. Funding for harm reduction works out to three US cents a day per person injecting drugs, and accounts for less than 10% of estimated 20092 and 20103 UNAIDS targets for harm reduction financing globally. In order to mount a response commensurate with the magnitude of the epidemic among people who inject drugs, a 2009 economic analysis by Harm Reduction International estimated that at least 20% of total global funds allocated for HIV prevention in low and middle-income countries must go toward harm reduction programs. The new draft declaration on HIV/AIDS set to emerge out of the UN Meeting in June, tentatively titled “Zero New Infections – Zero Discrimination – Zero AIDS Related Deaths,” provides little hope of significant movement. The document contains weak, indecisive references to these issues, and an aversion to naming explicit harm reduction interventions and policies that we know work. There is no mention at all of opioid substitution therapy, a proven, effective intervention for treating opioid dependence, preventing HIV transmission, improving adherence to HIV


Stigma, discrimination and punitive policies associated with the failed, U.S.-promoted ‘war on drugs’ approach have exacerbated the risk of HIV infection.

treatment and reducing overdose-related deaths (a leading killer of people who use drugs living with HIV). There are further weaknesses. Despite bearing a disproportionate burden of HIV infections, stigma and human rights violations, and experiencing limited or no access to gender-specific harm reduction and reproductive health services, the needs of women are only addressed in reference to heterosexual transmission. Unacceptably, “abstinence and fidelity” make it into the draft text despite significant scientific evidence of the failure of abstinence-based HIV prevention measures for young people. Meanwhile, there is no strong acknowledgment that young people, who are increasingly affected by HIV as a result of drug injecting and drug use in several countries, are being left behind against the global trend of reduced HIV incidence. Thirty years into the AIDS epidemic, the draft UN document provides evidence that governments are still evading the disastrous impact that HIV has had on the lives of people who inject drugs, their families, friends and communities. A new call to action led by Harm Reduction

International (formerly the International Harm Reduction Association), the Beirut Declaration on HIV and Injecting Drug Use, addresses these gaps directly, and sets out action points for governments and the international community at the UN Meeting in June. The Beirut Declaration, launched in April 2011 at the 22nd International Harm Reduction Conference in Beirut, Lebanon, calls for the implementation, scale-up and financing of evidence-based harm reduction programmes, including needle and syringe exchange programmes and opioid substitution therapy, in both communities and detention settings. One hundred and fifty-eight countries and territories report injecting drug use yet almost half of these still lack these essential services, and with poor coverage in the majority of countries that do implement them, the world is far from ‘universal

Public Health Analyst, Harm Reduction International (formerly known as the International Harm Reduction Association). Email: Claudia.Stoicescu@ihra.net or declaration@ihra.net 2 US$2.13 billion. 3 $3.2 billion. 1

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access’. Instead, people who use drugs face stigma, discrimination and human rights violations as law enforcement and abusive drug control measures continue to trump public health in country after country around the world. Punitive responses to drugs have been proven to impede HIV prevention efforts. To facilitate a more intensified response to the HIV epidemic in the drug-using community, the Beirut Declaration calls for a comprehensive review and reform of ineffective, expensive, drug policies,

Funding for harm reduction works out to three US cents a day per person injecting drugs, and accounts for less than 10% of estimated 2009 and 2010 UNAIDS targets for harm reduction financing globally. from a punitive criminal justice approach to one rooted in public health and human rights-based principles. Specifically, it calls for the amendment of laws criminalising the possession of drugs for personal use and the carrying of paraphernalia such as sterile needles. Over 300 organisations from around the world and from a range of disciplines, as well as high profile decision-makers, have endorsed the Beirut Declaration since its launch. Among them is Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the America Foundation for AIDS Research (amFAR), Medicins du Monde, International Federation of Red Cross and Red Crescent Societies, International Network of People who Use Drugs, Canadian HIV/AIDS Legal Network, International HIV/AIDS Alliance, Open Society Foundations, Catholic Overseas Development Agency (CAFOD), Save the Children UK and many others. In their April 9th editorial, the respected international medical journal The Lancet featured the Beirut Declaration as a key document for informing UN High Level Meeting priorities, echoing its calls for evidence-based harm reduction programmes and drug policy reform to be “explicitly included in the new global

Roberto Gonzales-Garza

declaration on HIV/AIDS that will be drafted at the June meeting with measurable targets to hold governments accountable,” adding that “millions of lives are at stake”. The Beirut Declaration on HIV and Injecting Drug Use is an urgent call to action for states and the international community to respond to HIV and AIDS with evidence-based, cost-effective programs and policies founded on public health and human rights. A strong acknowledgement of the role of injecting drug use in the AIDS epidemic and the programmatic and policy actions the world must take to address its impacts is crucial if we aim to achieve zero new infections, zero discrimination and zero AIDSrelated deaths. Thirty years into the HIV epidemic, it’s about time, and it’s still not too late. The Beirut Declaration is currently available online in English, Spanish, Arabic and Russian (please check back for French and Portugese translations soon).

TAKE ACTION Sign up to the Beirut Declaration and share with your networks: http://www.ihra.net/declaration Find out more information by e-mailing: declaration@ihra.net ‘Like’ the Beirut Declaration on Facebook: http://www.facebook.com/TheBeirutDeclaration View the April 9th Lancet editorial: http://download.thelancet.com/pdfs/journals/lancet/ PIIS0140673611604753.pdf For further inquiries, please contact Claudia Stoicescu at [claudia.ctoicescu@ihra.net]. For media inquiries please contact Michael Kessler at [mkessler@ya.com] or +34 655 792 699.

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GOOD PRACTICE

Mobile Diagnosis

© Livia Bellina

Dr. Livia Bellina

n 2008, while I was working as a pathologist on the Italian Island of Lampedusa, I found myself in the urgent need to confirm a diagnosis of malaria from a blood sample of an African immigrant. With no other means at hand, I took a picture of the microscopic field using the camera incorporated in mobile-phone, without additional devices, and sent it via MMS for tele-diagnostic purposes to a reference center. When I took my first picture of a microscopic field with my cell phone in February 2008, I could not guess that two years later that method would become the most powerful and easiest tool to spread an affordable telemedicine and, moreover, to share the knowledge through significant impact on imaginary of people, especially of low-resource communities, and never had I expected that I would have been the subject of an interview about the m-health by an American journalist. In fact, had I not known Eduardo Missoni1, my life, my ideas, and especially my way of thinking would not have changed: I would still be a pathologist of the Italian public health service, and instead, I am now in Dinajpur, northern rural Bangladesh, in the woods of bamboo teaching local students, diagnostic pathology and “mobile diagnosis” such as taking images from microscope field with my cell phone. This is my

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fourth “mission” to share this simple method with low-resource health workers of the poorest and most isolated communities. The method is very simple: First, one simply approaches the lens of the integrated cell-phone camera to the ocular of the microscope and takes the picture. The idea is free of cost. It is obviously possible to use the same technique to take pictures from the ocular of any other bio-medical optical device. This is practicable and, where possible, to send image from microscope, dermatological, ultrasound, rx, etc., as a very simple telemedicine. Secondi, it is a potent tool for training because students are fascinated and can learn immediately and easily about the medicine, laboratory microscopic technologies and has the same method as taking pictures and in any context. I have trained health workers in Uganda, Gulu, Bangladesh, in rural areas-Tangail-Bhuapur, Comilla, and now Dinajpur, with excellent results. All students have learned immediately and easily. The third advantage is that in addition, in two of these ”mobilediagnosis units”, the Grameen Rural Health Centers in Bhuapur and in Comilla, the trained health workers can then send the images from rural health center to central office in Dhaka2. In order to share our work with all low-resource health workers in September 2009, together with


Eduardo, I launched the site http://www. mobilediagnosis.net. Then, in 2010, Medting, a web network, joined us and we are now planning to export and share these field experiences to other countries. In our scenario, the peripheral health center sends a “critical” diagnostic image taken with cell phone by MMS (where’s possible) or by mail to reference center that alerts the doctor on call by SMS for the doctor to consult, and the doctor’s response will also be received by SMS. The images then are stored in the web platform to be visualized by other consultants (nationals and internationals experts) for a third-opinion because this is a global network of solidarity and to create a database to control

the diagnosis anytime. This web platform may be also a tool to share medical knowledge, including a distance-education and the clinical case discussions. This is only a simple representation, and we are working to complete this “architecture” to clarify and overcome the difficulties, to the extent that is allowed by the maximum file size for MMS, as established by standard local regulations. The next step is to ensure that the technique will be widely utilized and that poor and isolated labs in the world can share their doubts and findings with more privileged centers that may help them to make the right diagnosis in a spirit of solidarity. Digital divide can be overcome with a simple cell phone without any cost.

Everything can occur, but had I not met Eduardo Missoni nothing would have had happened Bellina, L., Missoni, E., Mobile cell-phones (M-phones) in telemicroscopy: increasing connectivity of isolated laboratories, Diagnostic Pathology, 2009, 4: 19 ii Bellina L., Missoni E., Increasing Connectivity of Isolated Health Workers in Poor Countries Using Locally Available Technology. The International Journal of Tuberculosis and Lung Disease, 2010, Vol. 14, 11 (suppl. 2): S46-S47 1 i

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© Aco To Manurung

Re-designing Policy to Strengthen MDGs Beyond 2015: From Global Perspective to Country-Specific Strategy Tania Albertini and Abramo Abderrahmane Chabib

This article is a review of two papers1 written by Jan Vandemoortele, former UN staff member and co-architect of the MDGs. At present he is an independent researcher, writer and lecturer.

ince 2000, several successful steps for ward have been taken to attain a more equitable human development, but the world is still facing an unacceptable level of poverty, hunger, illiteracy and under-development. The Millennium Development Goals (MDGs) are put under criticism since many countries are apparently off-track in achieving the global targets by 2015. A wide debate is emerging on the world consensus policies after 2015, which is urgently demanding a new effective and efficient strategy to hit the targets, in order to generate optimism and more reliability on this world promise. MDGs were conceived to generate a global favourable spirit but focused to enable local changes. The MDGs rationale was a result of inspired UN staff who extracted them verbatim from the UN Millennium Declaration: the MDGs started then an impressive and complex change and monitoring mechanism which involved several different actors. In fact MDGs had a big power of mobilization and of conditionality to public and political opinion, besides a sizeable variety of stakeholders, primary developed countries. The goals effectively helped countries to attract attention of external donors, financial aid and private investments to local development plans. A stunning amount of capital was addressed towards effective and durable development endeavors to provide solutions to wide and heterogeneous human needs. The global targets as a challenge contributed to foment an in-depth global debate and sensitize the international community towards the shared mission: initiating a results oriented cross-cutting work in the

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human development field. Moreover, the international public opinion and the media interest made a further result possible: the mapping out of a global transparent and consistent strategy exposed to international analysis and auditing. The international attention was pointed to a new emergent global MDGs policy and acted as a powerful watchdog of all national implementations of development plans. However, those that in the mind of the prime architects were goals have slowly been turned into just an implementation strategy. The international momentum offered to Least Developed and Developing Countries the basic tools to set up a local MDGs-implementation oriented policy. Nevertheless, a global strategy based on a monotype, economical and narrow conception of the MDGs soon took priority over the initial mission which was “to help align national priorities with the MDG agenda so as to foster human well-being”. As a consequence of this, each country started a competition with all the others neglecting the internal differences and gaps, the real root of the failure of the MDGs. Vandemoortele observes that the push to deliver a worldwide implementation led to an erroneous interpretation of MDGs as a “universal yardstick” for measuring progress into countries, regardless of the peculiar needs and hindrances. As a consequence, MDGs became aseptic patterns of economical-technical nature. For the same reasons faster economic growth was considered as the only and main evidence of achievement of concrete


targets. The faster a country recorded economic welfare the better that country was considered winning in the MDGs achievement. Evaluation was based on unreliable statistics which took into account inappropriate data, criteria and assumptions. First of all, confusing focus was the income-poverty pattern, using the $1/day threshold, which presents the slow economic growth as the main cause of the MDGs failure. Secondly, several MDGs targets are not well defined and this does not allow an accurate and realistic monitoring. On the contrary, the targets’ indefiniteness led to “policy-based evidence making, instead of evidence-based policy making”. In fact, the MDGs attainment cannot be evaluated by reporting whether a country has grown in the last decades more than another on the basis of the capital it received from the donor countries. Such kind of analysis led to the conclusion that the apparent growth measured on all countries is the key element to answer affirmatively or negatively to the question: will MDGs be reached by 2015 by all the states? This criterion is totally misleading. If we compare an ASEAN country, such as Thailand with an African country, for sure we have to admit that African continent is very far to reach the MDGs targets, despite the respectable progress it has recorded. This wrong conclusion is a consequence of neglecting the initial conditions of each country. However, if we recognize that the African initial (1990s) level of human development was very low, we should admit that the claim that Africa’s performance is worse than that of other regions is incorrect. Therefore, in order to correctly evaluate the MDGs targets and countries accomplishment, the specific national contest, including the initial starting position should be taken into account. A general social and economic progress in many countries has not benefitted a large part of the population. In fact, the existing internal disparity in each country, both least developed and developing, was not considered as a key factor in the evaluation of MDGs attainment. As Vandemoortele states, “within-country disparities have grown to the point of slowing global progress” and consequently “have turned the MDGs into mission impossible”. Since the 2015 global deadline is now very close, the MDGs policy should change course. Vandemoortele suggests a few hints that are likely to shape the future of MDGs: 1) formulate MDGs more clearly as global targets and the ways that are more even-handed for all categories of countries; 2)

focus on their measurability and not on their perfectibility; 3) focus on the ends and not on the means; 4) capture the equity dimension in terms of opportunity for personal development; 5) include interim targets as stepping stones towards the long-term goals; and 6) establish a global custodian of MDGs. MDGs need to be focused on local and national context and limited in number. Moreover they should present “clarity of concepts, solidity of indicators, robustness of data”. They further should “focus on ultimate outcomes, not on the means by which to realize them”. The “beyond 2015 MDGs” should not be underpinned by erroneous statistics measuring the general country progress; Rather the new evaluation system should record the real beneficiaries of it. In fact, only with reliable statistics the international community will be able to monitor whether the progress is reaching all the population or only a part of it and so make the evaluation of the MDGs attainment possible and credible. In fact, as Vandemoortele underlines, the spirit of MDGs is not only to make sufficient progress possible, but also to “ensure equitable conditions of self-realization”, fully respecting one of the most pivotal human rights: non-discrimination. Finally, strengthening of a qualitative and effective dialogue between the world leaders should be promoted to fulfill the underpinning mission of the MDGs concept. To that end the establishment of a global custodian of the MDGs, based on a “genuine partnership among equals”, is required to guarantee a more transparent monitoring. In conclusion, MDGs’ spirit should not be abandoned but must be re-designed as a policy on country-specific needs. However, they “cannot be reduced to a standard set of macroeconomic policies and sectoral interventions of a technical nature”. They cover a wide range of the human development, encompassing both the social and the economic aspect, as well as the respect of fundamental human rights. Therefore “they require fundamental transformation in society, which are invariable driven by domestic politics and local actors”.

Jan Vandemoortele, If not the Millennium Development Goals, then what?, in Third Quarterly, Vol. 32, No.1, 2011., and The MDG Story: Intention Denied, in Development and Change, 1-21 2011 International Institute of Social Studies.

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BOOK REVIEW Do Our Children Have A Chan

Do Our Children Have A Chance?

The 2010 Human Opportunity

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ce?

Report for Latin America and

the Caribbean

Conference Edition

Detty Saluling

The 2010 Human Opportunity Report for Latin America and the Caribbean (Conference Edition)1 “Imagine a country where your future did not depend on where you come from, how much your family earns, what colour your skin is, or whether you are male or female. Imagine if personal circumstances, those over which you have no control or responsibility, were irrelevant to your opportunities, and to your children’s opportunities.” es, notable progress has been achieved, allowing substantial percentage of fortunate children to benefit from basic rights and improved facilities. But this progress is selective as statistics show that several less fortunate children are still deprived of it simply because their background was disadvantaged and/or it lacks opportunities of access. World Bank has developed the Human Opportunity Index (HOI), a measurement of coverage rates and equity, to assist governments and policy makers to reassess and plan their efforts to achieve the goal of human development. Perhaps most important, is the Chapter 1 which elaborates rationales behind and construction of the HOI. Three key steps were performed: (1) selection of basic goods or services (education, water, and housing); (2) choosing a set of relevant circumstances (parents’ education, gender, residential location, etc); and (3) calculation of Index equation, which reflected the authors’ wide-range expertise in economics, poverty reduction and public policy. The HOI is measured “by discounting a penalty for inequality of opportunity (P) from the overall

José R. Molinas, Ricardo Paes

de Barros, Jaime Saavedra, Marc

With Louise J. Cord, Carola Pessin

o, Amer Hasan

elo Giugale

coverage rate (C).” While computing penalty for inequality of opportunity requires mathematical proficiency, it offers logical interpretation which should be comprehensible and practical for other types of audience. Surprisingly, there were not as much assessment and discussion on how each of the seven selected circumstances influence children’s human opportunity as expected. There can be interesting findings on the interconnection of all these aspects, which can encourage further analysis and, hopefully, offer more effective and targeted approaches and potential policies. The HOI was constructed using data of household surveys for 19 Latin American and the Caribbean (LAC) countries over the span of 10 years, representing 200 million children age 0 to 16 years. The report was furnished with sufficient statistical tables and graphs to display developments, disparities and challenges of the region’s opportunity conditions. The statistics showed that over the last 15 years, human opportunity in LAC has grown by 1 percent per year; if the same progress rate will be kept the region is projected to take 24 years to achieve universal basic education. The Human Opportunity Index is undoubtedly an innovative and important approach to look at the situations and challenges of the core element of human development, children’s right to access and equal opportunity to develop their potentials.

Authors are José R. Molinas, Ricardo Paes de Barros, Jaime Saavedra, Marcelo Giugale with Louise J. Cord, Carola Pessino, Amer Hasan, The World Bank The full report can be accessed at www.worldbank.org

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Freedom From Want