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Archive for May 17th, 2013

Pakistan: Doctors wanted the family to pay a bribe to get into the Intensive Care Unit – corrupt system contribute to unnecessary deaths

Posted by African Press International on May 17, 2013

LAHORE/DUBAI, – Hamza Mazhar, a 35-year-old teacher from Pakistan’s eastern city of Lahore, says he never wants to see the inside of a government hospital again.

“My mother was taken to the hospital with an upper respiratory tract infection in February this year and doctors said she needed care in the hospital’s Intensive Care Unit (ICU),” he told IRIN.

But the doctors in charge wanted the family to pay a bribe to get into the ICU, which had plenty of spare beds. They could not afford to pay. His mother was unable to get the treatment she needed and in March she died.

Health care in Pakistan is identified as one of the country’s most corrupt sectors, according to surveys by Transparency International; general surveys suggest the majority of Pakistanis are unhappy with the health services they are offered.

This is just one of the many challenges facing Pakistan’s health system, as identified in the first ever comprehensive assessment of the sector, published in the medical journal The Lancet and launched today in Islamabad.

Entitled Health Transitions in Pakistan, the series of articles says Pakistan’s health sector lags behind 12 countries in the region with cultural, economic and geographic similarities.

Pakistan has no national health insurance system and 78 percent of the population pay health care expenses themselves. It is the only country in the world without a National Health Ministry.

The report authors say the recently elected government has a unique opportunity to push through reforms and take advantage of recent constitutional changes that devolve health care to the provinces.

The findings are not entirely negative. Progress has been made on all health indicators in the past 20 years. The rates of child deaths and maternal mortality have fallen, and the community-based Lady Health Workers programme is singled out for praise.

But improvements have been much slower coming than in other similar countries. IRIN picked out four major challenges from the health assessment.

1. Avoidably high child and maternal mortality

The assessment’s authors describe Pakistan’s progress towards meeting the Millennium Development Goals for reducing child and material mortality (4&5) as “unsatisfactory”.

Pakistan, with its population of 180 million, has more child, foetal and maternal deaths than all but two of the world’s nations.

The report calls child survival “the most devastating and large-scale public health and humanitarian crisis Pakistan faces”.

An estimated 423,000 children under-five die each year, almost half of them new-born babies. Family planning options are also limited and nearly a million women attempt unsafe abortions each year.

Simple measures like training more nurses and midwives (currently outnumbered by doctors 2:1) could save more than 200,000 women and child lives in 2015, the report’s authors say.

2. Nutrition

A lack of adequate nutrition for children contributes to the high number of child and maternal deaths. Nearly 40 percent of children under-five are underweight and more than half are affected by stunting.

Poor nutrition weakens the body’s natural defence mechanisms.

But the report also says that malnutrition affects the Pakistani economy, with estimates that it costs the country 3 percent of GDP every year, particularly through reduced productivity in young adults.

3. “Lifestyle diseases

In Pakistan, as more widely throughout south Asia, non-communicable diseases like cancer, diabetes and heart problems have replaced communicable diseases like malaria and diarrhoea in the past two decades as the leading causes of death and morbidity.

This general trend has not been matched by an adaptation in the Pakistani health system or government policy. Poor road safety, cheap cigarettes and high-levels of obesity (one in four adults) all lead to preventable deaths.

So-called “lifestyle diseases” could cost the country nearly US$300 million in 2025, according to the report’s authors.

They say the right government action, including higher excise taxes on cigarettes, new legislation, and information campaigns could cut the premature mortality rate from cardiovascular diseases, cancers, and respiratory diseases by 20 percent by 2025.

4. Low public spending

Humanitarian crises provoked by earthquakes, flooding and conflict over the past decade have mobilized large sums of money both internationally and within the country.

But corresponding sums have not been spent on underlying health services, which have the potential to save many more lives.

Public health spending has declined from 1.5 percent of GDP in the late 1980s to less than 1 percent, according to the report – equivalent to less than 4 percent of the government budget.

That has left Pakistanis with little support for medical costs, which are responsible for more than two-thirds of major economic shocks for poor families, according to the Ministry of Social Welfare and Special Education.

Rapid population growth only makes what resources are spent on health care produce ever smaller results.

kh/jj/cb source

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168 countries signs a 10-year plan to make the world safer from natural hazards

Posted by African Press International on May 17, 2013

JOHANNESBURG,  – A month after the Indian Ocean tsunami struck in December 2004, affecting millions, 168 countries signed on to a 10-year plan to make the world safer from natural hazards. Yet the plan, the Hyogo Framework for Action (HFA) 2005-2015, focused primarily on “what to do to prevent disasters, but not enough on how to implement it,” says Neil McFarlane, chief coordinator and head of all regional programmes at the UN Office for Disaster Risk Reduction (UNISDR).

Countries have since begun discussing what a follow-up action plan, the Hyogo Framework for Action 2 (HFA2), should look like. The results of these talks, a sketch of the HFA2, will be presented at the Fourth Session of the Global Platform for Disaster Risk Reduction, which begins in Geneva on 19 May.

A draft will be finalized towards the end of 2014, for consideration and adoption at the World Conference on Disaster Reduction in Japan in 2015.

The HFA2 will need to take on a number of emerging risks and concerns. While the HFA has helped countries reduce the loss of human lives, the economic consequences of natural disasters have continued to rise. For three consecutive years, natural hazards have cost the world more than US$100 billion a year, according to data from the Brussels-based Centre for Research on the Epidemiology of Disasters (CRED) released in March 2013.

Additionally, disaster risks are changing: The effects of the changing climate are expected to prompt more intense and frequent extreme natural events, including floods, droughts and cyclones. Urban populations are growing, as is demand for food, ratcheting up pressure on resources like land and water.


In tackling the HFA2, experts are discussing how to improve accountability. “We have a framework with options to develop good disaster plans in the Hyogo, but how do we make governments, agencies… ensure it is implemented?” Tom Mitchell, head of the climate change programme at the Overseas Development Institute (ODI), told IRIN.

Mitchell says one of the major weaknesses of the HFA is its failure to ensure that “well-crafted” disaster risk reduction (DRR) policies were actually implemented. The agreement is voluntary, and there are no penalties for failing to put in place measures to protect citizens.

“Because it [HFA] is voluntary, we have to ask how… effective it can be,” remarked Frank Thomalla, senior research fellow with the Stockholm Environment Institute (SEI) in Asia.

Some question whether the world should consider a legal disaster-prevention treaty with a provision for penalties.

The new plan’s timing is significant for the global community; 2015 also marks the end of the Millennium Development Goals and possibly the implementation of new Sustainable Development Goals (SDGs), which are still under discussion. A new agreement on addressing and adapting to climate change is also likely to be put into place around that time. Aid agencies and think tanks are all calling on the global community to consider the synergies among these policy-shaping developments.

Many observers now question whether DRR policies should become a part of the legal climate deal, which might ensure their implementation. Countries’ DRR activities are increasingly considered part of their climate change adaptation plans, and are being funded as such.

But there is no appetite for a legal treaty on DRR, says UNISDR’s McFarlane.

Harjeet Singh, ActionAid‘s international coordinator for DRR and climate change adaptation (CAA), says he is uncertain if a legal treaty “will bring about a dramatic change… After all, we have seen how [the UN’s] climate convention (UNFCCC) … failed to deliver in the last 20 years.”

Besides, the climate change deal will not consider geophysical events such as earthquakes and other triggers of potential disasters unrelated to climate, he added.

“Many of the drivers of vulnerability result from inequality and marginalization, meaning certain regions and social groups are more vulnerable to hazards than others and are more strongly affected by the impacts”

That fact, plus the range of social and economic factors contributing to disaster risk, calls into question the rationale for viewing DRR, CCA and development from a purely climatological perspective, SEI’s Thomalla told IRIN in an email.

But the Cancun Adaptation Framework adopted by countries at the UNFCCC talks in Mexico in 2010 urges countries to implement the HFA, so it does make it a part of a stronger commitment linked to climate change says UNISDR’s MacFarlane.

Taking measurements

Under the HFA, countries are required to report on how far they have complied with implementing DRR strategies and policies. But how “reliable is this data?” asked Thomalla. “How much opportunity is there for governments to ‘manipulate’ the information in order to be seen to be doing something?”

For instance, a country might report to the HFA that it has established an early warning system to reduce hazard vulnerability. “But how can we be sure that the system works…? That people know how to respond to the warnings?” Thomalla said.

There is no proper baseline at the start of HFA, nor are there specific targets for countries to follow, said Singh.

“Targets and milestones for implementation should… be relevant and realistic for each country and agreed on through multi-stakeholder consultations,” noted Mitchell in a briefing paper co-authored with colleague Emily Wilkinson.

McFarlane and Mitchell suggest the development of a peer-review mechanism, which is just taking off in some developed countries, could be an effective way to ensure countries comply.

UNISDR Chief Margareta Wahlstrom said there has been a change in mindset since HFA: “The most visible signs of this change are summarized by the facts that 121 countries have enacted legislation aimed at reducing the potential impact of disasters, and 56 countries have national disaster-loss databases, which illustrates the growing recognition that you cannot manage risk management if you are not measuring your disaster losses.”

Mitchell’s ODI briefing paper also suggests “a human rights approach, in which countries fulfil obligations to respect, protect and fulfil basic human rights, including the ‘right to safety’ of vulnerable people exposed to hazards.”

This suggestion has support. Singh says, “Legislation to ensure safety and security of people is a good first step.” But it has to be implemented effectively all the way down to the community level, and must take into account the voices of the poor and women, he added.

Thomalla says a rights-based approach would be a good way to address DRR “because many of the drivers of vulnerability result from inequality and marginalization, meaning certain regions and social groups are more vulnerable to hazards than others and are more strongly affected by the impacts.”

But, again, creating global legislation could be problematic, he noted. “Monitoring and enforcement will also be difficult. Rich countries must come forward to provide resources and transfer skills to developing countries to reduce disaster risks.”

Resilience is key

Most experts pin their hopes on the new-found interest in “building resilience”. Resilience is billed as a concept that will better link development, DRR and CCA by bringing the humanitarian aid community, which deals with disasters, closer together with development agencies. A focus on resilience might also help push for the implementation of DRR plans and promote funding.

“The current separation of what is mainly [a] humanitarian response to disasters, through DRR and CCA, from business-as-usual development funding no longer makes sense,” said Thomalla.

In fact, disasters routinely reverse development gains. For example, floods in Thailand in 2012 cost three percent of the country’s annual GDP, affected education and caused the loss of vulnerable families’ household assets.

“New development goals must factor in risk, whereby all goals, to the extent possible, are risk- informed,” said Antony Spalton, the DRR specialist with the UN Children’s Fund (UNICEF). “Given the significance of the risks posed by climate change, fragility and conflict, a post-2015 framework that better draws together DRR, climate change adaptation and conflict prevention/peace building under a goal or target for resilience could be considered.”

UNISDR has already drafted a resilience-based disaster plan for the post-2015 development agenda, the Plan of Action on Disaster Risk Reduction for Resilience. It calls for an assurance that “DRR for resilience” is central to post-2015 development agreements and targets. It calls for timely, coordinated and high-quality assistance to countries where disaster losses pose a threat to development, and for making DRR a priority for UN funds, programmes and specialized agencies.

Singh says countries “should develop a comprehensive resilience strategy rather than a piecemeal …strategy, when ‘pushed’ by donors.”

Building resilience to a range of changes and risks does make sense, according to Thomalla. But we have a long way to go.

“While we have made a lot of progress in thinking about resilience as a unifying concept, we need to strengthen our methods and tools to help… develop the institutions and governance structures that enhance resilience and enable them to measure and demonstrate success,” he said.

Ultimately, Singh says, “it all depends on the willingness of country governments to take concrete steps from local to national levels and enhance [the] resilience of poor and vulnerable communities.”

McFarlane says there are lots of ideas and suggestions on the table. Stay tuned.

jk/rz  source

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What now for UNPOS and AMISOM in Somalia?

Posted by African Press International on May 17, 2013

NAIROBI,  – Following the unanimous adoption of a UN Security Council (UNSC) resolu tion setting up an integrated mission in Somalia, the UN Assistance Mission in Somalia (UNSOM) will be set up for an initial one-year period beginning on 3 June; it will be based in the capital Mogadishu

The UN defines an integrated mission as one in which there is a shared vision among all the UN actors at country level.“This strategic objective is the result of a deliberate effort by all elements of the UN system to achieve a shared understanding of the mandates and functions of the various elements of the UN presence at country level and to use this understanding to maximize UN effectiveness, efficiency, and impact in all aspects of its work,” say the Integrated Mission Planning Guidelines endorsed in 2006 by the Secretary-General.According to the resolution, the mission is intended to help Somalia build on the political gains made over the past year; assist the country to develop a federal system of government; review its constitution and hold a constitutional referendum; and facilitate preparations for presidential and parliamentary elections in 2016.

In addition, UNSOM will “promote respect for human rights and women’s empowerment, promote child protection, prevent conflict-related sexual and gender-based violence, and strengthen justice institutions.”

UN agencies working in Somalia are expected to move there. Many are currently based in Nairobi, the Kenyan capital.

In this briefing, IRIN looks at what an integrated approach means for Somalia.

What is the political, humanitarian situation in Somalia?

Somalia has recently made progress towards stability. In 2012, the country set up a functioning federal government under the leadership of President Sheikh Hassan Mohamud, the first such administration since 1990.

However, there continue to be huge political and humanitarian challenges. Insurgents, who still control parts of the country, continue to launch deadly attacks regularly, while more than one million Somalis are displaced due to conflict and drought. One million more have crossed into neighbouring countries, mainly Kenya and Ethiopia.

A 2013 report published by the UN Food and Agriculture Organization (FAO) revealed that over 250,000 Somalis, many of them children under five, died as a result of famine between October 2010 and April 2012. They were unable to receive any humanitarian assistance, in part, due to insecurity.

What is UNSOM’s role?

On 6 March 2013 the Security Council had, while partially lifting a 20-year-old arms embargo on Somalia and extending the mandate of the African Union Mission in Somalia (AMISOM), for another year, agreed with the UN Secretary-General that the UN Political Office for Somalia (UNPOS) had “fulfilled its obligation” and needed to be replaced by an integrated mission to give the Somali administration “a single door to knock on”.

“It looks like an ambitious plan and is probably the most significant engagement in Somalia by the UN in decades,”

The new mission, to be headed by a special representative of the Secretary-General would include, “the provision of policy advice to the Federal Government and AMISOM on peace-building and state-building in the areas of governance, security sector reform and rule of law (including the disengagement of combatants); development of a federal system (including preparations for elections in 2016); and coordination of international donor support.”

All the UN country teams, both political and humanitarian in Somalia, would be expected, with immediate effect, to coordinate all their activities with the head of the newly established mission.

The office of the UN humanitarian coordinator for Somalia is expected to fall under the office of the special representative from the beginning January 2014.

What now for UNPOS and AMISOM?

With the creation of an integrated mission, UNPOS ceases to exist. Established in 1995 and headed by a special representative of the Secretary-General, UNPOS’s role was mainly political, facilitating political dialogue and peace-building activities. In his letter to the UNSC seeking the establishment of an integrated mission in Somalia, the Secretary-General said UNPOS had fulfilled its mandate and should “be dissolved and replaced by a new expanded special political mission as soon as possible”.

The Somalia Federal Government is largely propped up by the 18,000-strong AMISOM force.

A technical assistance mission to Somalia by the Secretary-General recommended in its report “use of local UN-contracted and trained security guards, the impending deployment of an AMISOM guard force in Mogadishu, and reliance on Somali National Security Forces (SNSF). If these are deemed insufficient, UN Guard Units or international private security companies could be utilized.”

AMISOM has always been involved in limited humanitarian assistance but it is not clear if this will continue with UNSOM.

The UNSC in its resolution, urges the newly appointed special representative to align closely with other stakeholders in Somalia, including UN country teams, the federal government, AMISOM, the Intergovernmental Authority for Development (IGAD), the European Union and “other regional, bilateral and multilateral partners”.

Experts, say the success of UNSOM will depend on whether it aligns its operations with the different actors in Somalia, some of whom may have qualms about sharing their areas of expertise and/or influence.

“The number of pivotal actors dealing with Somalia has increased as of late, not least as new donors have come in and stepped up their support. Hence, if the international community is serious about UNSOM and would like to see it fulfil its mandate, actors need to be aligned behind UNSOM,” Dominik Balthasar, an expert on Somalia at Chatham House, told IRIN. “Yet, this might possibly be a hard bullet to bite for other actors such as AMISOM or IGAD, as the participation of UNSOM is likely to restrict the roles they have played thus far.”

Abdi Aynte, executive director of the Heritage Institute for Policy Studies (HIPS), a Mogadishu-based think tank, said: “With respect to its relations with AMISOM, the hope is that they become mutually reinforcing [and] not mutually exclusive [since] AMISOM is widely viewed positively.”

What are the merits of UNSOM?

UNSOM will merge the UN’s humanitarian and political operations in Somalia, providing an opportunity to harness the operational capacities of the many agencies into a single mission.

“It looks like an ambitious plan and is probably the most significant engagement in Somalia by the UN in decades,” Cedric Barnes, director, Horn of Africa programmes at the International Crisis Group, told IRIN.

HIPS’s Aynte said the integrated mission will provide a single international community narrative on Somalia, something he says the Somalis have wanted for a long time.

A unification of the development and humanitarian pillars in Somalia, others have argued, would help marshal the much-needed international funding to remedy the situation in Somalia while also “creating coherence and unifying strategies”.

Elmi Ahmed Duale, Somalia’s ambassador to the UN, described the resolution as important and said it had ensured “there was only “one door” to knock on, “as opposed to fragmented approaches in coordinating assistance”.

According to ICG’s Barnes, this will be dependent on how much the government is willing to cede in the new engagement.

“It would be interesting to see how this will play out with a government that might want to assert authority while at the same time fronting the issue of sovereignty,” Barnes added.

The fact that Al Shabab is listed as a terrorist group has made it difficult for many humanitarian agencies to have an engagement with it, at least for the purposes of offering humanitarian assistance in areas still under the group’s control.

Why the dissenting voices against UNSOM?

Humanitarians have voiced their concerns against merging humanitarian operations with political and military activities, arguing it would make their work in Somalia difficult as it runs the risk of delegitimizing humanitarian actors.

“As many Somalis continue to struggle to obtain the basic necessities for survival, such as food, health care, and protection from violence, humanitarian assistance must remain a priority and it must remain completely independent of any political agenda,” Jerome Oberreit, secretary-general of Médecins Sans Frontières, said in a statement.

“The humanitarian aid system must not be co-opted as an implementing partner of counter-insurgency or stabilization efforts in Somalia,” he added.

In March, InterAction, The International Council of Voluntary Agencies (ICVA) and Voluntary Organizations in Cooperation in Emergencies (VOICE), said in a joint statement that the decision risked jeopardizing the delivery of impartial humanitarian assistance in the country: “By requiring UN humanitarian coordination to fall under the political mandate of the new UN peace-building mission in Somalia, the neutrality, impartiality and independence of humanitarian action will be compromised.”

Russel Geekie, public information officer at the UN Office for the Coordination of Humanitarian Affairs, Somalia office, said: “The integration should not hamper the delivery of aid. In its most recent resolution on Somalia (SC resolution 2102, which follows up on 2093), the Security Council reiterated that impartial, neutral and independent humanitarian assistance must be ensured, wherever those in need are.”

According Chatham House’s Balthasar, integrating humanitarian operations into the broader politico-military stabilization plans “runs the risk of constraining humanitarian space, but that this does not necessarily need to be the case. Moreover, it should not be forgotten that humanitarian aid has always been political and that it has frequently been instrumentalized by a wide variety of actors – not least by those who oppose the government.” With an eye towards the dynamics surrounding humanitarian space in Somalia, he added that ever since Al Shabab had been put on the back foot, humanitarian actors who had become accustomed to negotiating with the insurgents to deliver humanitarian aid lacked clarity over who was in control and how to safely deliver aid.

“Basically, the political situation on the ground appears to have become more, rather than less, complicated. In this situation, devising an integrated mission might not be the worst of all options for the sake of prioritizing stability and the establishment of functioning structures of governance,” he added.

ko/kr/oa/cb source

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