Countries Facing a Critical Healthcare Worker Shortage

A fantastic interactive graphic by the Guardian highlights which countries are in the most dire straits. Check it out here, and hover over a country’s name to get the statistics.

Some of the facts I found most interesting:

The Democratic Republic of the Congo has one physician and five nurses per 10,000 people and the infant mortality rate is 199 deaths before age five per 1,000 births.

Tanzania has less than one physician and two nurses per 10,000 people and an infant mortality rate of 103.

Chad also has less than one physician and three nurses per 10,000 people, and an infant mortality rate of 209.

Highest infant mortality rate? Afghanistan.

Check it out.

Maternal Health and the Status of Women

Both globally and domestically, maternal health and the standing of women are inextricably linked. If women do not have the means and access to give birth safely, with trained and educated midwives, physicians and nurses, with appropriate prenatal education and care, it is often indicative of the standing of women in their communities and countries overall. Women’s inequality is also linked to the soaring population growth in developing countries, which will pose a range of new challenges for the next few generations.

Some may point to the United States as an anomaly, citing women’s increasing economic and financial independence, education, and leadership roles in America, while in terms of maternal health rankings, we remain pathetically far down the line for our resources (49 other countries are safer places to give birth than the U.S. – despite us spending more money on healthcare than anywhere else). Of course, the recent and incessant attacks on allowing women to access credible, accurate, up-to-date and comprehensive sexual and reproductive health education and services makes this statistic not entirely…surprising, shall we say.

So, I found the incredibly detailed and visually impressive infographic by the National Post, pulled from spectacular data and research done by Save the Children to be particularly fascinating. What they did was combine information on the health, economic, and education status of women to create overall rankings of the best and worst countries for women, splitting the countries into categories of more developed, less developed, and least developed, and the countries were ranked in relation to the other countries in their category (the divisions were based on the 2008 United Nations Population Division’s World Population Prospects, which most recently no longer classified based on development standing). While these divisions and the rankings can certainly be contentious and may incite some disagreement (nothing unusual there, these kind of rankings usually are), I thought the results were interesting. Some highlights – Norway is first, Somalia is last. The United States was 19th, and Canada was 17th (Estonia fell in between us and the Great White North) in the most developed. Israel is first in the less developed category, and Bhutan is first in the least developed category. The full report with data from Save the Children is also available, if you want to learn more about the information combined to make this image. Take a look:

A Woman’s Place – Courtesy of the National Post

One thing that I thought was particularly great was that the researchers combined women’s health and children’s heath data to create rankings specific to being a mother, when that category is sometimes only assessed based on access to reproductive care.The specific rankings of maternal health highlights largely mimics the overall standing of women, as seen here – Norway is number one, again, and Niger falls into last place:

Mother’s Index, Courtesy of Save the Children

I think these images and graphs are particularly moving given one of the top health stories coming out of the New York Times today, which showed that a recent Johns Hopkins study indicated meeting the contraception needs of women in developing countries could reduce maternal mortality (and thereby increase the standing of women in many of the nations doing poorly in the above ranking) globally by a third. When looking at the countries in the infographic that have low rates of using modern contraception and the correlation between that and their ranking in terms of status of women, it’s not surprising what the JH researchers found. Many of the countries farther down in the rankings have rates below 50%, and for those countries filling the bottom 25 slots, none of them even reach a rate that is a third of the population in terms of contraceptive use – which of course in most cases has to do with availability, not choice. Wonderfully, the Gates Foundation yesterday announced that they would be donating $1 billion to increase the access to contraceptives in developing countries.

Also of note, and in relation to maternal and newborn health, is a new study recently published by Mailman researchers that showed PEPFAR funded programs in sub-Saharan Africa increased access to healthcare facilities for women (particularly important for this region, as 50% of maternal deaths occur there), thereby increasing the number of births occurring in these facilities – reducing the avoidable (and sometimes inevitable) complications from labor and delivery, decreasing the chance of infection and increasing treatment if contracted. This has clear implications for children as well (and why I think this study relates to the National Post infographic and the NY Times article), since newborns are also able to be assessed by trained healthcare workers and potentially life-threatening conditions averted – including HIV, if the newborns have HIV+ mothers and need early anti-retroviral treatment and a relationship with a healthcare worker and system. And it goes without saying that if a new mother is struggling with post-delivery healthcare issues, including abscesses and fistulas, or was dealing with a high-risk pre-labor condition like preeclampsia, the child will have an increasingly difficult early life, perhaps even a motherless one.

Child Mortality – What Are the True Biggest Causes?

A great image from Population Services International‘s most recent issue of their magazine, Impact, from the cover article written by Desmond Chavasse, Ph.D, Vice President, Malaria Control & Child Survival, PSI, about causes of child mortality globally.

Causes of Child Mortality – Image courtesy of Population Services International

One of the purposes of the image, of course, is to show the stark contrast between directed funding for treatment and eradication of certain diseases and the number of children afflicted with these illnesses. How does this impact our understanding of global health and of the marketing around certain hot topic health issues and ways in which donors feel as though they are contributing to a decline in preventable deaths?

When I worked in development for HIV/AIDS organizations, it was fascinating to speak with donors about their reasons for giving and their understanding of the prevalence and incidence (and the general audience grasp of the word incidence, which is the measure of risk of contracting a certain illness or disease within a specified time frame) of HIV. Contrast this with the understanding of malaria, TB, diarrhea, deaths due to childbirth complications (for the mother and the infant), and the gap between perception and reality was startling. In no way do I want to deny the importance of consistent development support for all diseases on a global scale, but I do think there is something lacking in terms of the education around these issues for donors and even some advocates.

Solutions? Come chat with me on Twitter.

The Changing Face of Development in the Fight for Gender Justice

As International Women’s Day approached, I was thrilled to attend a panel at the United Nations, “Youth Approaches to Funding Gender Equality and Women’s Human Rights,” with the Executive Director of an organization I am very excited to be a part of, Spark, as one of the speakers. Shannon Farley was joined by Mia Herndon from the Third Wave Foundation and Amina Doherty from the Young Feminist Fund. These dynamic leaders provided what turned out to be unique though complementary perspectives on engaging youth in development strategies, and I came away feeling revitalized and encouraged that Spark’s work is at the forefront of essential evolution in philanthropy and development.

While powerhouse young women lead each of these organizations, their differences should be noted. Spark, at 7 years old, is the middle child of the organizations, and the only one that operates within a member-driven framework, allowing those active members to vote on grantees and possible themes. Granting more than $1 million since its inception, a great feat since most gifts are seed money of the couple thousand dollar range, Spark’s offering of extensive pro-bono services to granting organizations also sets us apart – that and statistic of having nearly 50% male members. FRIDA is the new baby in the gender equality, women’s rights development world, and they interestingly refer to themselves as a “learning fund,” as each organization that applies for funding does some fairly in-depth research on other groups with whom they are competing for funds. Of the more than 1,000 applications from over 120 countries this year, FRIDA selected 125 ‘short-listed’ groups who then voted for a group in their region other than themselves who they felt deserved the grant based on their work and application. Lastly, the Third Wave Foundation, which has been around for 15 years, funds work that benefits 15 – 30 year-old women and transgender youth. They emphasize leadership development and advocacy, and given their size, are also able to offer multi-year ‘arc’ grants, supporting groups as they get off the ground, giving them a big financial push during subsequent cycles, and tapering off as the group begins to grow.

Despite these differences in age, funding history, and model of grant making, one can see the overlaps. My favorite element of the panel was discovering throughout the presentation how similar the roots of the missions of these groups are – interactivity, democratic funding policies, involvement of the grantees and groups for whom they are advocating, and leadership that represents the interests of the grantees. Each of these groups – and this is what I think draws many to Spark in the first place – emphasizes the input of passionate members or supporters who are emotionally and mentally invested in working for justice, and who may have previously been rebuffed in other volunteer development efforts. Equally important, they value the participation of those on the ground seeking to be funded. Panelists actually articulated how important the flow of communication was in the funding process, not only to ensure that the funding organizations were really sound in their understanding of the grantees, but also so the beneficiaries feel as though they are being heard and understood throughout the process. This is actually fairly empowering. This kind of communication between funding agencies and grantees used to be unheard of – grant applications would be filled out on one side, and grant-making decisions would be made on the other side, often with grantees not feeling as though they were making meaningful connections with funding organizations that would enable them to better articulate their needs.

These newer models can bring up questions of validity for some, and this query was posed by an audience member who asked the panel about issues of monitoring and evaluation (M&E), and how that was considered within these newer frameworks. This garnered perhaps my favorite answer, which was that one of the ways M&E can be handled is by changing the definition of what a successful program or initiative looks like. One of the ways these newer development organizations does this is by defining at the outset what success looks like to the grantees and how that will be measured, and emphasizing those goals in the evaluation process as opposed to adhering to strict, traditional methods that may not be appropriate measures for many of the newer, innovative groups that are seeking funding.

Piggybacking on this part of the conversation, panelists were asked about what they saw as the primary benefits and drawbacks of not working within the more traditional development models. Luckily, and unsurprisingly, these leaders focused mainly on the positive. Working within newer models allows them to take risks; to explore relationships with new groups and leaders that older, more established organizations may not have the time or framework to take on; and to nurture long term relationships with groups that can use the leadership guidance and seed money granted by organizations like Spark to get off the ground and be ready to present themselves to progressively larger funds. Essentially, these groups – Spark, the Third Wave, and FRIDA – are building a foundation to get a foot into the door of the local and global conversations about eradicating injustice for groups that may have been historically overlooked.

As the landscape for women’s rights and gender disparities shifts, this kind of risk-taking is essential in assisting burgeoning efforts of organizations that may have been traditionally ignored.

While each of these organizations emphasized the need for young women’s leadership and articulated how their models centered on the unique and essential perspectives of young leaders, the speakers also championed the importance of inter-generational work. When concern was raised by an audience member over being dismissive of the work of older activists and development organizations, panelists were adamant about the fact that their communities were grateful for the work that had come before them, and the wisdom that is often culled from creating partnerships with leaders who have been involved in gender equality development work for years.  The experience of these more senior leaders is not only valuable in gaining insight into what isn’t working and why within traditional giving pathways, but collaborating with them often leads to grant-making opportunities for these newer funding organizations. Shannon’s remarks specifically about how larger, older funds had passed on applications to Spark that are more suitable for our funding model than theirs was met with nods of appreciation from many in the audience – an audience that was in and of itself diverse in age and funding experience. And of course, having big voices in the field champion the work of newer organizations for their innovation certainly doesn’t hurt when trying to increase our donor circles.

I encourage my readers to check out Spark, and consider becoming a member. It’s an incredible organization that offers great opportunities for young leaders to get involved. In light of International Women’s Day, I’d also encourage you to check out these other fantastic on-the-ground groups doing fantastic work for gender equality and justice (some of them Spark grantees!):

The Komera Project: Education for girls in Rwanda, financial and mentoring assistance, started by Margaret Butler.

CAMFED: Investing in girls’ education in Africa

She’s the First: Education investment in the developing world

Plan International: Children’s rights and development around the globe

No coincidence that these organizations tend to focus on education access! Have organizations that you’re passionate about and want me to include in this list? Send ’em my way!

Feminism in Zambia: Finding an Unexpected Champion

Our last guest post this month is by Stephanie Reinhardt. Stephanie is a Program Officer with Jhpiego and is currently working to support HIV/AIDS and maternal health programs in east and southern Africa. Growing up in San Francisco and joining forces with Larkin Callaghan at the age of 4 has left her overly opinionated and easily distracted by all the exciting things around her. Hey look – a baboon just walked by my office window! When she’s not bouncing around the globe, she’s very busy procrastinating.

Gabriel, a Zambian taxi driver who works outside an overpriced hotel in the capital Lusaka, drove me to a township on the outside of town last week. We started with the usual conversation.

“Where are you from?” he asked.

“California,” I responded, “though I’m starting to feel like Zambia is my second home”.

I’ve been to Zambia six times in the past four years supporting public health programs run through Jhpiego, an affiliate of Johns Hopkins. After some discussion about various locations in the US he had learned about from other passengers, he jumped into his favorite story about American history to see if I knew it as well.

After slowing his taxi to traverse a particularly rough patch of potholes, Gabriel looks at me and said, “Well, you know about the Gremich sisters?” (Upon further research, I learned the correct spelling of Grimké sisters). I shook my head no, which gave Gabriel the green light to dive into his story:

“During the time of slavery in America (perhaps in California, or Texas or wherever), there were two sisters who wanted to put an end to slavery.”

I jumped in to briefly describe (with my best recollections from high school) the divisions between the north and the south that eventually led to the civil war, which I explained, for future reference was on the east coast of America, so I would guess that the Grimké sisters were probably from a state like New York. (Turns out they were from South Carolina, but later joined abolitionist circles in Philadelphia, New York and New Jersey.)

Gabriel gave me a polite nod, but the civil war was clearly not his target conversation. With the eagerness of a school kid sitting in the front row, he continued his story, which he credited to a book he had read called, No Fear of Trying. Gabriel’s eyes grew large as he told the story of these sisters’ amazing bravery to publicly speak out against slavery. He looked at me and repeatedly tapped the top of the steering wheel with his palm to emphasize the profundity of this story. “These were the first women to speak at a podium…to men. Women did not do that at that time.” He described the message of equality and freedom that they took all the way to the US government. “People thought that women should not give public speeches to men. Lots of people threatened them and told them to stop, but these women were so brave, ” he continued. I was nodding in agreement, but apparently not giving the reaction he wanted.  “Isn’t that amazing?” he exclaimed. “It’s great!” I responded.

Despite a few factual inaccuracies (that the Gimké sisters final speech ended slavey, and this all took place in the 1950s), Gabriel’s story is pretty spot on. The Grimké sisters grew up in South Carolina with all the advantages of a privileged class awaiting them.  Unlike many other northern born abolitionists, the Grimké sisters had seen slavery first hand and felt compelled to not only put an end to the practice, but to put an end to racial and gender discrimination – an idea radically progressive for their time. They promoted extremely advanced messages for both racial and gender equality. Angelina Grimké letters demanded “educational reform, equal wages and an end to other forms of discrimination against women.”

What fascinated me most about Gabriel’s story was not that I was previously unaware of this significant historical biography (I am never shocked by the amount of information I don’t know or frankly, don’t remember). Rather, I was completely taken aback by his emotional response to this story. He loved these women for their bravery to stand up to men and wanted to share it with anyone who got in his cab.

Zambia is not a country known for its progressive gender relations. Women unfortunately still live very much as the mercy of their husbands, cultural laws and the State. As explained in a 2002 OMCT report on violence against women in Zambia:

Women in Zambia currently face many obstacles to the realisation of their human rights including high rates of violence against women in the family, in the community and by the State, discrimination in the application of customary laws relating to family and inheritance rights, low levels of representation in political and other decision-making structures, a lack of access to education and employment opportunities, poor health care services and the limited availability of affordable contraception.

The 2007 Zambian Demographic Health Survey (DHS) included an assessment of women’s empowerment by asking questions on employment and decision-making.  While great variations exist with regard to education level and location, overall 37 percent of men think that decisions about how to spend the wife’s cash earnings (if she has employment outside of the home) should be made mainly by the husband.  These views extend to a woman’s body as well – 46 percent of men think that the husband alone should make the decision on the number of children to have.  Only 64.8 percent of currently married women responded that they are the primary decision makers or make joint decisions with their husbands regarding their own health care.

So, given this context, I was baffled. I wondered if I had stumbled into the cab of an outspoken Zambian male feminist. As Gabriel’s taxi approached our destination, I probed him on his thoughts on women’s rights in Zambia. “Oh,” he responded, “we have learned a lot from Americans. Everyone is equal here.” Then he dropped the famous development buzz word “gender” and it was all over. “Yes, we have learned gender is important, so now we are all equal.” Ack.

I was hugely disappointed. My image of this Zambian male taxi driver in a superhero outfit championing women’s rights quickly vanished. I thanked him for the ride and started to get out of the car. As I was about to depart, he pulled out a small piece of paper and said, “You work in health? Can I ask you a question?” I nodded, and he continued: “My wife has decided that we should only have three kids, and so we want to stop now that we have three. Can you look at this list and tell me what you would recommend?” On the piece of paper was a list of family planning methods that they had received from their local clinic. I sat with him and explained the differences between some of the short term methods and the long term methods. I also described the vasectomy process should he be interested in the procedure. I explained that if his wife wants no more kids, a long term method, such as an IUD might be best, as it offers protection for 5-7 years. He smiled and responded, “Great, thank you. I will tell my wife this information and see what she wants to do.”

Maybe we have our champion after all.