Here's the video of last week's seminar on Bono, "aid celebrities" and the RED campaign, by Lisa Ann Richey, Professor of International Development Studies at Roskilde University.
If embedding doesn't work, here's the link: Brand Aid seminar
For more about our seminars and other events, see the event list on the STEPS Centre website. Read more
Monday, 29 November 2010
Here's the video of last week's seminar on Bono, "aid celebrities" and the RED campaign, by Lisa Ann Richey, Professor of International Development Studies at Roskilde University.
Thursday, 25 November 2010
By Adrian Ely, STEPS Centre member
[Edit (7/12/10): The Africa Manifesto has now been launched: you can download it from the ATPS website.]
Ten years after the African Technology Policy Studies network was incorporated, nearly 200 delegates from 29 African countries are gathering in Egypt to discuss ‘The State of Science, Technology and Innovation in Africa: Implications for Achieving the Millennium Development Goals’.
There was a buzz as delegates gathered for the first morning of the conference, many of them greeting friends who they had not seen since last year’s meeting in Abuja. The introductory session included welcomes from ATPS and other delegates representing key stakeholders and drivers of science, technology and innovation in Africa - youth, women and journalists - as well as international partners. Dr Kevin Urama, Executive Secretary of ATPS, provided an introduction to the workshop (which he reminded us was NOT a "talkshop"), stressing that delegates were expected to go away from the conference with a fuller understanding of their potential contribution to Science, Technology & Innovation (STI) for Africa’s development.
The cover of the "African Manifesto"
Dr Urama highlighted the African Manifesto, which will be presented to the meeting tomorrow (he'd spoken about it at the launch of the STEPS Centre Manifesto in June). The African Manifesto was produced under the European SET-DEV project, alongside its ‘sister manifesto’ in India, Knowledge Swaraj. I'll blog more on the African Manifesto tomorrow, but today we learned that it “makes a case for Africa’s sovereignty in science, technology and innovation”, arguing “for full socialization and democratic governance of STI in Africa, for Africans, by Africans as a pre-requisite for sustainable development in Africa”.
Later presentations in the morning focussed on the challenges of STI governance, R&D investment, youth in STI, the risk of brain drain and making the most of the African diaspora.
The afternoon was dedicated to lessons provided from other regions – the Caribbean, Europe and India. The audience was clearly interested in the experiences of these regions, but the question remained: how transferable were they to the African continent? Whilst recognising the benefits of learning from international colleagues, the African Manifesto and the discussions today made it clear that Africa would have to conduct its own experiments, reap its own rewards, and learn its own lessons. The ATPS conference will clearly provide a forum for this learning and an inspiring gathering for those interested in science, technology and innovation in Africa.
> African Technology Policy Studies network: Annual Conference
> Innovation, Sustainability, Development: A New Manifesto
What happens when you "scale up" health services to try to provide widespread coverage in a region or country? The "Beyond Scaling Up" panel at the Health Systems Research symposium last week posed this question. The speakers answered with success stories from Brazil, China and Nigeria; some cautionary tales from attempts to "scale up" that have gone wrong; and a warning that health programmes need to be aware of lots of factors which can put a spanner in the works:
"There has been a shift from absolute scarcity to problems with safety, quality and cost with changing patterns of inequality, the introduction of new technologies and institutional arrangements, the rise of patient and citizen movements and mixed systems."
Kate Hawkins has written a post reporting on the session on the Future Health Systems blog.
> Future Health Systems blog: Exploring the spread and scale up of health interventions and service coverage
> Beyond Scaling Up panel: details
> STEPS Centre: Beyond Scaling Up working paper & briefing
Monday, 22 November 2010
By Michael Loevinsohn, STEPS Centre member
On Wednesday I chaired a session on New Directions in Health-Environment Research: Implications for Health Systems.
The topic is a bit off the beam of the Symposium’s thrust: it's one of 13 concurrent sessions, and about 20 people attend. Setting the stage, I describe the methodological challenges researchers are tackling to uncover how environmental change, of different kinds, is creating health risks. Researchers are identifying developmental processes that are loosening structures of risk, and clarifying how the health sector and other sectors can collaborate to realize these opportunities (View or download my slides).
The first case I talk about is an (un)natural experiment: the 2001-03 famine and its impact on the evolution of HIV in Malawi. Using existing data, I show how hunger profoundly affected the distribution of HIV and of people, by pushing people into "survival sex" (sex in exchange for food, shelter or protection) and distress migration. The data also show that hunger was less severe, maize prices less volatile, and migration and change in HIV prevalence less marked, where people had access to robust crops like cassava alongside the maize staple. Cassava appears to have provided a “prevention dividend”.
Richard Coker from the London School of Hygiene and Tropical Medicine explains how the economic and social changes that have shaken Russia have altered the landscape of TB risk (view Richard's slides). Driven by the payment system, hospitals release patients in December, regardless of treatment status. Declining budgets have meant patients receive under 2000 Kcal/day, less than a prisoner of war. These and other effects on medical and hospital practice are likely contributing to the spread of drug resistance and the growing burden of TB in the population.
Ashok Dyalchand, Institute of Health Management, Pachod (view Ashok's slides), describes the emergence of new social norms in Indian villages that have taken up Community-Led Total Sanitation. People are disgusted when they realize that, because of open defecation, they are ingesting each others’ feces. They construct toilets and use them more consistently than where outside schemes construct them. Villages are cleaner and people enjoy greater privacy but diarrheal infections are not yet any less frequent. There may be greater collective commitment now to undertake the additional innovations that will be needed to sustainably reduce these risks.
Working in Java, Paul Forster has been examining the political economy of avian flu risks in poultry systems serving the Jakarta market (view Paul's slides). Other studies have followed the movement of birds, and viruses, between breeding, rearing, slaughtering and commercial operations. Paul has shown that by following the money, the critical role of brokers is revealed. Through extending credit to different actors, they maintain the structure of the industry and influence the exposure of those actors to birds and the virus. Any attempt at change must take them into account.
Finally, Hayley MacGregor describes the STEPS Centre approach to understanding epidemics and the complex dynamics at play at the health-environment interface (view her slides). She highlights how epidemic narratives, embodying the perspectives of different actors, shape responses, illustrating this with recent research on haemorrhagic fevers. A “global outbreak” narrative has dominated control efforts particularly for ebola virus. Local understandings indicate the virus has long been endemic and suggest several culturally acceptable measures. More effective responses are possible when such diverse perspectives are acknowledged.
> STEPS Centre: Socio-ecological dynamics of disease
> STEPS Centre: Epidemics
> STEPS Centre: Avian flu
By Michael Loevinsohn, STEPS Centre member
You know you’re a discipline or a significant sub-discipline when you can organize and find funding for a global symposium. Twelve hundred participants from umpteen countries also testify to the self-awareness that marks a field. And the Symposium’s theme is fittingly ambitious: Science to Accelerate Universal Health Coverage.
Charlie Chaplin is in town but can’t make it to the Symposium. He’s buried just down the road. But I wonder what his Little Tramp, bowler-hatted and down-at-heels, would make of it. Would he be considered part of the System? Am I? My interest is in the determinants of disease in the turbulent social, economic and natural environment, and what that understanding can contribute, especially to prevention.
A huge variety of material is presented in 110 plenary and concurrent sessions related to the mobilization of knowledge, capacity and financing and the translation of research into policy and action. Access to care and immunization is the focus of most of the discussion. Not much is said about the determinants of disease – which lie outside the health system “proper” – and how they’re understood and responded to. I don’t hear much reference to how other sectors approach complexity and rampant change.
But there are some welcome resonances. A session on neglected tropical diseases – lymphatic filariasis, onchocerciasis and others, which often occur together – describes how vertical control programs for each visit the same village, sometimes with the same village health worker who distributes drugs, sometimes the same one, to households – but at different times. Integration would make a lot of sense. It becomes clear, however, that the obstacles are not at the local level but mostly at the program level: integration means one program director and four former directors.
Control of one of the neglected diseases, blinding trachoma, includes educating people to wash their face. The message is repeated in Sahelian villages where people have to walk 3 km for a bucket of water – and washing their face is not the first thing they’re going to do with it. There are echoes of condom promotion for HIV – even in places where everyone knows power relations prevent many women from using them.
Irene Agyepong talks as a participant observer on the evolution of health insurance in Ghana. A number of small scale experiments were run by different institutions trying various approaches. A larger scale experiment was also implemented but ran into serious problems. Yet when the political winds build and a broader program can no longer be avoided, it is the failed experiment that most influences its design. Close to hand and ready to go, its proponents say, "we can correct mistakes later". Irene points to rent-seeking behaviour but also says there are no easily-labelled saints or demons. It's the reality of evolution.
René Loewenson from Zimbabwe talks about national health systems as knowledge systems. She points to the vastly under-exploited sources of evidence that exist within countries. Researchers’ attentions shift away from them, swayed by external priorities and funding. The consistency of focus that is essential to build trust with national audiences is lost. It’s not just a problem for health systems.
> First Global Symposium on Health Systems Research
> STEPS Centre work on Health and Disease
Tuesday, 16 November 2010
Gerry Bloom, STEPS Centre health convenor, will be holding a session tomorrow (Thursday) at the the First Global Symposium on Health Systems Research in Montreux, entitled "Beyond Scaling Up".
Here's a summary:
"This session will present findings and conclusions of a stream of work jointly organised by the Future Health Systems Consortium and the STEPS Centre. It will explore lessons from implementing large scale changes to health systems aimed at increasing access to important health services, particularly by the poor.Presenters include:
It will begin with brief presentations of literature reviews and conceptual frameworks for analysing rapid health system change. These presentations will be followed by papers that present evidence on the experiences with large scale health system change in Nigeria, Brazil and China. These will include a study of the experience of a large donor-funded project for strengthening primary health care services in Northern Nigeria, the experience of the Ministry of Health of Brazil in extending a decentralised, rights-based health system to meet the special needs of indigenous people and the Chinese experience with the management of health system reform in the context of rapid economic and social change. Each paper will present evidence on what worked and why.
The aim is to contribute to a more nuanced understanding of the challenge of managing rapid increases in the delivery of health services and the strategies that have been shown to work in addressing this challenge."
Gerry Bloom, STEPS Centre: "Beyond Scaling Up: Pathways to Universal Access to Health Services"
Ligia Paina: "Pathways to Scaling Up Health Services in Complex Adaptive Systems"
Emmanuel Sokpo: "Beyond Technical Solutions: Critical Pathway in the Political Economy of Health Development in Northern Nigeria"
Xiao Yue: "Implementing rapid health system reform in China: the importance of a learning approach"
Vera Schattan Coelho: "Making the Right to Health a Reality to Indigenous People in Brazil"
First Global Symposium on Health Systems Research
Future Health Systems blog
STEPS: Health overview
Some of us are at the First Global Symposium on Health Systems Research in Montreux and running events discussing our recent work (see the STEPS Centre events page for full details).
Tomorrow (Wednesday), Michael Loevinsohn will be chairing a session at Montreux entitled "New directions in environment-health research: implications for health systems". (Michael's session's at 4pm - see also the full day programme.)
Here's what's going to be discussed:
"Environmental health research has traditionally been concerned with the impact of particular aspects of the environment on particular diseases. Rapid and multi-faceted environmental change is increasing the challenge to health systems, creating new sources of ill-health – in many cases zoonotic in origin – and exacerbating existing ones, often in the same place.The speakers include:
Participants in this session will gain a clearer appreciation of methods and approaches that are being employed:
> to elucidate how change is creating situations of risk for multiple sources of ill-health that are experienced and perceived differently by people differently situated;
> to identify and assess developmental dynamics that may be loosening risk structures, with the potential to yield multiple benefits in terms of health and well-being and
> to forge relationships with other sectors to develop and pursue these opportunities."
Richard Coker, London School of Hygiene and Tropical Medicine(UK/Thailand): TB and HIV in the Former Soviet Union: social transformations and the challenge of control
Ashok Dyalchand, Institute of Health Management, Pachod (India): Benefits of rural sanitation implemented through a community-led social norms approach: implications for health systems
Paul Forster, IDS (UK/Indonesia): Politics, power and economics: how debt creates avian influenza (H5N1) risk in Jakarta's poultry supply chains
Hayley MacGregor (UK): The social dynamics of disease ecology: case studies from African contexts
First Global Symposium on Health Systems Research
STEPS Centre: Socio-ecological dynamics of disease
STEPS: Health overview
Traditional forms of energy supply are being challenged. Photo: Gas meter dials by Leo Reynolds on Flickr (Creative Commons)
By Adrian Smith, STEPS Centre member
How does a new way of doing things – say, fair trade, or community energy production – get a foothold? How does it avoid being overwhelmed or crushed by the dominant, existing system? What are the conditions that can help it or prevent it from flourishing?
The study of “sustainability transitions” aims to answer these questions. Sometimes, transitions happen on a massive scale – for example, with the “green revolution” in the 1940s-1970s – and usually with mixed results. Often, however, the dominant system can stifle the emergence of radically novel technologies or practices, so that even good ideas find it hard to gain traction.
For those wanting to promote more sustainable pathways, it’s important to understand how transitions can be nurtured when they’re at a small, vulnerable stage. Transitions thinking talks about supportive spaces (“niches”) where a new practice or technology can develop, sheltered from hostile structures or market forces. Once it has had chance to grow, it can start to move outside the niche and interact and compete more successfully with existing systems.
From fossil fuel to alternative power
An example of a dominant system and a possible transformation is in the area of energy. The dominant model of energy generation and use is currently being challenged by social pressure to reduce climate change, as well as fears over the security of energy supply. The assumption that development can continue to be powered by large fossil-fuel plants, for instance, is increasingly challenged by a variety of alternatives and their advocates. Whether it is nuclear energy, solar power, or managing patterns of demand, there is an increasing amount of political and material support for alternative pathways.
There are parallels to this picture in many development domains. What is needed is more analysis of the interactions and co-existence of plural pathways, and how each is affected differently by the others and the incumbent regimes of provision which they are all trying to displace.
What are niche spaces for?
As researchers, we are interested in the idea of ‘niche spaces’ that allow pathways to materialise and gain momentum through practical experimentation in the real world. Niche spaces are opened-up through networking processes amongst initiatives, which establish and foster alternative pathways.
What can this kind of networking do? Well, it allows people to share lessons – for example, about the development of viable off-grid electricity projects in diverse development settings. But while sharing lessons is a good thing - for example, it's undoubtedly an important area for learning-based development approaches and ideas for strategic niche management - on its own, lesson-sharing is somewhat limited and limiting. So, in addition, we are interested in how the networking that goes on in niche spaces cultivates shared identities, solidarities and mutual interests, which help mobilise demands for changes to wider institutions and social structures – changes that would enable niche practices to diffuse, scale-up and translate into much wider practices. This might happen through new institutions, or transformed markets, or through links with social movements, or through a re-thinking and re-design of large-scale development assistance programmes.
But niche spaces can also find it hard to develop. We need to confront head-on the political economy of incumbent regimes that makes the creation of niche spaces so difficult to establish and grow. Attention to the social movements that challenge these political economies can be helpful here, especially for the opportunities these social movements give to niche space developments.
STEPS Centre work on transitions
There is an emerging agenda for rethinking the roles of bottom-up and alternative social, technological and environmental development initiatives in the construction and realisation of sustainability pathways. The STEPS Centre plans to develop a ‘transitions’ cluster of projects that address this agenda as part of its second phase of work (how we do this depends on some funding decisions happening later this year).
Meanwhile, we continue to engage through a variety of projects and processes that include the following:
As we do more work on transitions, we’re looking forward to developing a number of exciting new projects and partnerships as part of the STEPS Centre’s ‘transitions’ research cluster. It would be great to hear from others doing similar work.
> STEPS Centre work on Dynamics (including transitions)
> Adrian Smith's profile
Monday, 15 November 2010
Lawrence Haddad, IDS Director, has written about the future of biofortification (and mentioned the STEPS Centre's work) on his blog, Development Horizons:
"To date, biofortification has relied on conventional breeding techniques and behavior change research to answer 3 questions: (a) is there a significant, in terms of human nutrition, variation in the micronutrients zinc, iron, provitamin A in naturally occurring varieties of rice, wheat, maize and tubers? (b) can these varieties be crossed with high yielding varieties so that they are equally profitable for farmers to adopt? and (c) will they be acceptable to consumers?
The evidence is accumulating and is looking increasingly positive on all 3 counts--but not for all crops and not in all contexts."
Full post: Development Horizons: Growing More Nutritious Cereals and Tubers: Will it Work?
Monday, 8 November 2010
Lisa Ann Richey, Professor of International Development Studies at Roskilde University, will be talking about aid partnerships, RED and "aid celebrities" in the next STEPS Centre seminar on 25 November.
"For decades, aid has been under attack from right-wing political constituencies in the US, and it is now coming under attack even in European countries that have long been ardent aid supporters. Aid, it is argued, is ineffective and wasteful, and business is better at delivering development than traditional aid mechanisms. The international aid community has responded by developing new public-private partnerships, by attempting to reform its delivery mechanisms, and by arguing that given the right conditions, including sufficient funding, aid can make a difference. The involvement of celebrities in pressuring politicians to deliver more and better aid, especially to Africa, has also been part of this response.
“Has there ever been a better reason to shop?” asks an ad for the Product RED American Express card, informing members who use the card that buying “cappuccinos or cashmere” will be helping to fight AIDS in Africa. Co-founded in 2006 by the rock star Bono, Product RED has been a particularly successful example of a new trend in celebrity-driven international aid and development, one explicitly linked to commerce, not philanthropy. Aid celebrities – Bono, Jeffrey Sachs and Paul Farmer – guarantee the ‘cool quotient,’ the management and the target of what we call ‘Brand Aid.’ At the same time, campaigns like RED sell both the suffering of Africans with AIDS and the power of the average consumer to ameliorate it through familiar and highly effective media representations. Rescuing inter-national aid from its dour predictive graphs and disappointing ‘lessons learnt’, Brand Aid spins international development into something young, chic and possible."
For more information, contact firstname.lastname@example.org
> Event flyer: Brand Aid: Shopping Well to Save the World (pdf)
> STEPS Centre events
Thursday, 4 November 2010
We're living in an age of anxiety where politicians, policy makers and the public search for solutions to narrowly-defined problems and risks.
At the recent CRASSH conference, "Challenging Models in the Face of Uncertainty", Melissa Leach, STEPS Centre Director, spoke about how this search for solutions can lead to social injustice. She argues for a greater appreciation of the various kinds of incomplete knowledge, understanding different ways of imagining futures and the "pathways" to get there. The video's online at the CRASSH website.
> Video: Imagining and Negotiating Pathways in an Age of Anxiety and Incomplete Knowledge
> Conference details: Challenging Models in the Face of Uncertainty
> Centre for Research in the Arts, Social Sciences and Humanities (CRASSH)
Wednesday, 3 November 2010
A few things to look forward to this month:
16 November: STEPS Water Seminar: India and Pakistan’s truculent cooperation: Is 50 years enough? Undala Alam, School of Politics, International Studies and Philosophy at Queen's University, Belfast (from 1 December 2010). Water seminar flyer (pdf, 58kb)
Venue: IDS. Time: 3.00-5.30pm. All welcome, email email@example.com for enquiries.
17 November: Michael Loevinsohn: "New directions in environment-health research: implications for health systems". Session at the First Global Symposium on Health Systems Research in Montreux, Switzerland.
18 November: Gerald Bloom: "Beyond Scaling Up". Session at the First Global Symposium on Health Systems Research.
As always, you can keep up to date with all our events on our events page - which also has materials from past events.
In the last 15 years, the way sanitation is treated in Brazil has changed dramatically. The picture of poor investment and danger to public health is being replaced by climbing investment and a vision of sanitation as an issue of rights, dignity and equity. The seminar "Shit and Citizenship: The Political Economy of Sanitation Investment in Brazil", held at IDS on Monday, explored how and why this has happened.
The speakers were Alex Shankland (from the Participation, Power and Social Change team at IDS) and Ken Caplan (Director of Building Partnerships for Development in Water and Sanitation).
Alex and Ken explained how the politics of sanitation has evolved over that time, both nationally and locally at the level of one city, Salvador. (Brazil was one of four cases in a global study coordinated by Oxford Policy Management for Water & Sanitation Program (WSP) and World Bank on the political economy of sanitation investments.)
At the national level, former President Lula broke certain taboos on sanitation. In December 2009, Lula caused a storm by describing a mission of his government as being “to take the people out of the shit”. He has also cleverly defused ideological tensions on sanitation provision, by introducing laws which allow for a wide variety of approaches to be taken.
Things didn't just change at a national level. In Salvador - a big, vibrant city on the North-East coast - Antonio Carlos Magalhães, a right-wing governor elected in 1990, saw the city's poor sanitation as a disgrace and a barrier to tourism. His vision of the city as a clean, modern tourist destination led him to arrange a massive programme of investment in sanitation.
Sanitation has also moved up the ladder of importance, partly because of a sense of embarassment at Brazil's being left behind compared to other countries. As people gain nearly universal access to electricity and water, sanitation has become the next-in-line priority for the urban poor.
Areas can be transformed by sanitation - not just physically, but in terms of their identity. Alex observes that, when a favela (shanty town) gained a sanitation system, it ceased to become a favela and became a "barrio" (neighbourhood) - raising people's pride in the area, as well as house prices.
In their talk, Alex and Ken cover the highlights of the political economy of sanitation in Brazil over the last 15 years. The talk covers the facts (when and where great changes in investment and provision happened) but also the subtext (why things happened, and what was going on politically to make this possible).
This seminar is one of the events in our series of Water Seminars. For forthcoming events, see the STEPS Centre website.
> Shit and Citizenship: The Political Economy of Sanitation Investment in Brazil (Alex and Ken's presentation, Slideshare)
> STEPS Centre: events
> Participation, Power and Social Change team, IDS
> Building Partnerships for Development in Water and Sanitation Read more
Wednesday, 27 October 2010
Professor Andy Stirling, STEPS Centre Co-Director, will be part of a keynote debate entitled "Engineering the future: cautionary tale or utopia?" on Sunday. The debate is part of the Battle of Ideas festival at the Royal College of Art in London.
"Are we are living in a world where utopian thinking is at best idle day-dreaming and at worst downright dangerous? Popular visions of large-scale engineering seem to be overshadowed by the negative aspects of the man-made world, from climate change to unsustainable growth to the unforeseen side effects of cutting-edge technology. Do we have to let go of the vision that engineering and technology can promise us continued improvement in quality of life? Is it really just wishful thinking to argue for a more ambitious role for human ingenuity, and the transformative power of innovation? Are we limited to only doom-and-gloom nightmares of nature taking revenge on humanity’s arrogance, to a perceived need for belt-tightening austerity and a tomorrow of ‘make do and mend’."
Battle of Ideas 2010 - Engineering the Future: cautionary tale or utopia? Read more
Wednesday, 13 October 2010
Our conference featured keynote speeches with ideas on sustainability and the sciences; and a roundtable on policy for the 2012 Earth Summit.
Keynote speech 1: Prof Melissa Leach, STEPS Centre
Melissa explains the STEPS Centre's "pathways" concept, with illustrations from our work on health, water & sanitation, and food & agriculture.
Keynote speech 2: Prof Arun Agrawal, University of Michigan
Prof Agrawal examines how responsible the social sciences are in their use of human subjects and cases.
The videos from the policy roundtable are below, after the jump.
Rio+20 Policy/Research Roundtable
A roundtable on sustainability research and its implications for policy, in the run-up to the Earth Summit 2012.
Full roundtable (54 min)
Extracts from the roundtable:
Thursday, 30 September 2010
by Katharina Welle, DPhil student
Water is a vital piece in the sustainability jigsaw. It’s also a resource that requires careful management. In the final plenary session at the STEPS Centre’s Annual Conference last week, Andy Stirling encouraged us to exercise “intellectual judo” in pursuing pathways to sustainability: finding "levers" where we can change or redirect the momentum of mainstream ideas to open up more options and directions of change (pathways).
Well, one question that I ask myself sometimes is what role water plays in the pathways concept (for more about pathways, see the STEPS working paper or briefing). More broadly, how do we engage with water as a resource for sustainability in general?
The conference highlighted at least two ways to conceptualise water as part of pathways for sustainability: 1) to concentrate on water itself, and explore sustainable ways to manage it; and 2) to view water as one of many inputs into sustainability and sustainability debates (where other inputs might be land, food, people etc). In Friday's panel on Water Dynamics, the four presentations offered a mixture of these two ways of looking at water.
Christian Stein (Stockholm Resilience Centre) is using social network analysis to look at the interaction of organisations involved in the management of “blue water” (resources in aquifers, lakes and dams) and those working with “green” water (ie water embedded in moisture and soils). In the session, he suggested that water could be managed more sustainably if we better understand the links between these two types of actors. Alan Nicol (Institute of Development Studies) also talked about more sustainable ways of managing water. He proposes using social network analysis to better understand the linkages in water resources management - his particular focus is on river basin management in various parts of Africa. He suggested that river basin management is dominated by the agendas of powerful actors, with possibly negative results for sustainability – nicely expressed in the metaphor of his title “When hippos hug – what happens to the pond life?”
The other two contributions highlighted the role of water in wider sustainability debates. Maria Teresa Armijos (DPhil, Institute of Development Studies) and Synne Movik (independent consultant) used water to illustrate how a resource can be used to increase sustainability or how it can be subject to trade-offs between different social, economic or environmental forces.
Maria Teresa Armijos presented findings from her DPhil field work on the communal dynamics of water resources management. In the Andes, water is used as a political tool to exercise power; but in the community Maria studied in Ecuador, local people also use water to express their sense of identity. This resonated nicely with Synne’s presentation. She asked the interesting question of what role sustainability plays in distributive justice, based on her reading of Armatya Sen’s book The Idea Of Justice. Drawing on a case from South Africa, Synne argued that the subjective framing of sustainability can easily ignore the question of justice. In South Africa, arguments for sustainability tend to focus on economic and environmental sustainability; in the case of water resources management, these arguments portray social justice as a barrier to sustainability.
Both ways of engaging with the domain of water in pathways to sustainability are useful in their own right. But are there more ways of looking at water in relation to sustainability pathways? Let’s continue the intellectual judo!
>> STEPS Centre: Water & Sanitation research
>> STEPS Centre Conference 2010: Pathways to Sustainability
Friday, 24 September 2010
This year's conference - Pathways to Sustainability: Agendas for a new politics of environment, development and social justice - was chock full of provocations and insights on the STEPS Centre's "Pathways" concept and what it could mean for sustainability science and action.
Among the topics: what sustainability really means; how social and natural scientists talk to each other; why social scientists should stop using people as abstract "instruments" to support their theories... and how we can do "sustainability judo" to influence the rich and powerful.
We've tweeted some thoughts as we went along. Many delegates had differing things to say about the concept of pathways, what's missing, and what could be done in the run up to Rio+20. We'll be digesting these thoughts over the weekend and will blog about it in more detail next week.
Pathways to Sustainability working paper (pdf, 690kb)
Pathways short briefing (pdf, 210kb)
Monday, 20 September 2010
The British Medical Journal's podcast this week features Lyla Mehta, STEPS Centre Water and Sanitation convenor, talking about sanitation and the UN MDGs.
This week, to steal a line from the latest BMJ editor’s choice, we’ll be talking shit. The millennium development goal on sanitation is way off track; Lyla Mehta, a sociologist from the Institute of Development Studies, tells us why, and Kamal Kar, a development consultant from India, explains how his grass roots initiative changes the way people view sanitation.
BMJ podcast: "Shit happens"
by Ian Scoones, STEPS Centre co-director
There is something for everyone in the long-awaited World Bank report, Rising Global Interest in Farmland: Can it yield sustainable and equitable benefits? Some sections contain a damning critique of the situation; others a positive spin, with a narrative offering a bright future. Not surprisingly, then, the press have picked up different angles in the few days since its release. The Financial Times, for example, headlines with “World Bank backs farmland investment”, while Bloomberg reports the World Bank as saying that “Large Land Deals Threaten Farmers”. Both are equally valid interpretations of an often ambiguous report.
The bottom-line, take-home message seems to be that external investment in land is a good thing in some places, especially those where there are “large tracts of suitable land, but also a large proportion of smallholders with very low productivity”, but that governance measures, based on a set of high-sounding principles, are required to make this happen equitably and sustainably. But what does this mean? How should we interpret this report?
Overall, the report certainly offers a useful compilation of existing data and provides a selective review of other studies. Like other research, the report shows how the global ‘land grab’ is complex, often involving multiple actors, including national governments. It is not simply a rapacious grab by outsiders. Despite the concerns raised at the peak of the food crisis, many deals have yet to be put into practice and it is unclear what the longer-term consequences will be. But what new dimensions does it offer? The report has been long trailed, and there has been much excited expectation around its publication. Overall though it is a disappointment: long on detail, but short on analysis and flawed in key aspects of its methodology.
The highlights are some short case studies from the Democratic Republic of Congo, Liberia, Mexico, Mozambique, Tanzania, Ukraine and Zambia. These show how land investments have very often failed – not only for the investors but also for local people. For Mozambique, job creation was “significantly lower than expected” and the investors “damage non-renewable natural resources (water) without compensation, disadvantaging women”. Issues of poor governance abound. In Tanzanian for example “investors often circumvent land acquisition procedures”, while in Liberia the “investor encouraged illegally on fertile wetlands and displaced 30 percent of the population”. These cases however are given only limited coverage in a long and rather dense study, and a systematic analysis of livelihood impacts and wider consequences for agrarian change in different locales is absent.
Elsewhere a bizarre ‘yield gap’ analysis takes up many pages and pinpoints the potential of vast tracts of land apparently suitable and available for agricultural exploitation in some countries. This of course conveniently forgets that such areas may be used for other purposes, and that existing land use may well be the most productive, equitable and sustainable. The heroic assumptions of the model are not very transparent, and there is little attention to past experiences when grand schemes for the transformation of the unproductive African bush ended in large-scale and embarrassing failures. The seductive imagery of satellite maps and projections of vast riches to be gained from exploitation are not rooted in a ground-truthed understanding of local livelihood conditions.
A set of principles – the famed ‘code of conduct’ - are hailed as the administrative-managerial solution to the troublesome governance problems of large-scale land investment, but there is no political analysis of how they might actually work in such settings. Pleas for an “evidence-based multi-stakeholder approach” are all well and good, but actual practice is a world away from such ideals. Other sections of the report, focusing on institutions and governance, show clearly why such principles are likely to be doomed to failure, given the lack of capacity, failures of institutional authority, corrupt practices and so on. There are clearly strong political economy reasons for a simplistic code not to work, yet this dilemma is not grappled with. Nor are the “open and impartial”, “accountable and representative” mechanisms by which local land rights get recognised, and more importantly, realised in such challenging settings discussed at any length. Good ideas about low-cost, participatory approaches to land registration, alongside broad-based processes of consultation, are forwarded, but will these really work in the forests of the Congo or the savannahs of Sudan?
In sum, the overall message is deeply confusing. The confusion arises from several fronts: methodological, presentational and conceptual. Methodologically, the report draws on data sources of highly varying quality. As the report admits, data on land acquisitions is shaky at best, and the Bank relied on government surveys, which in most settings are less than reliable. The mapping of agricultural potential and suitability is done at a large scale with assumptions which can be challenged on many counts. Yet the case studies, where particular examples of land acquisition are examined, are by comparison much more rich and detailed, offering some starkly contrasting conclusions to the cornucopian vision projected from space. The presentation of these highly contrasting perspectives is very unbalanced in the final report. The case studies occupy just a few pages in the main report, summarised in a one-page table and accompanied by only very tentative, shallow analysis. By contrast the land suitability study is given much more coverage, with its authority projected through a false sense of quantitative precision.
This mismatch between data sources, analytical depth and a failure to add them up into a coherent picture is the consequence of another major weakness: a narrow economistic conceptualisation. A political economy analysis of agrarian change and the role of large scale investments in historical perspective is essentially absent from the report. No surprise for something coming from the World Bank, but this lack of historically-located political analysis is a gaping hole. Without an understanding of what drives investments, what politics surrounds the deals, and the socio-political dynamics shaping livelihood outcomes, it is very difficult to make sense of recent events. The argument that investment in farming – and small-scale farmers in particular – rather than farmland makes much sense, but this is easy to state, but less easy to realise. Why is it that governments prefer large-scale deals over investment in smallholder farming? What factors are pushing the investment in land as an asset? What global connections between state elites, financiers and private businesses are significant? And how is it that the terms of incorporation within leases, contracts and partnership deals seem always to fail the smallholder?
These are very basic, first-stop questions in the fields of agrarian and global political economy. And this is the analytical terrain, unfortunately missed by this report, which reveals the dynamics of land deals, and which allows us to see beyond the economics to the wider politics of land. Read more
Wednesday, 15 September 2010
By John Thompson, STEPS Centre Food and Agriculture Convenor
In advance of the UN Millennium Development Goal (MDG) Summit in New York on 20-22 September, the United Nations Food and Agriculture Organization (FAO) released new figures on the number of people worldwide who suffer chronic hunger in 2010. The latest estimates, which will soon be published in its annual State of Food and Agriculture report, show that there are 925 million hungry people on our planet – that’s roughly one in our six of us.
While this is a shockingly high number, the good news is that it is lower than the 1.023 billion people who were estimated to be hungry in 2009 and represents a decline in real terms of over nine percent.
Nevertheless, this figure is still significantly higher than the previous estimates before the global food crisis of 2007-8 and the global financial crisis which followed it.
There are two principal reasons for the decline in the total number of hungry people and both have to do with the reversal of two recent crises: (1) the reduction of food prices from their peak levels of 2007-8 and (2) the projected positive economic growth in developing countries in 2010. These trends contributed to increasing access to food for nearly 100 million people in the last year.
If, however, we look back over the past two decades, we can observe that (except for the current downturn) hunger has been on the increase. Between the early 1990s and 2007, we had periods in which food prices were low and economic growth was strong, but hunger kept rising.
What does this mean? It means that the improvement in the current hunger picture is only the result of the reversal of recent crisis effects. Furthermore, it means that there's a fundamental structural problem with our food system that goes beyond temporary increases and decreases in food prices. That food problem is rooted in poverty and radically unequal distributions of income and assets, within and across countries, which influence both food production systems and food consumption patterns.
If we take the base period from which we track progress towards the MDG target on hunger – to reduce by half the proportion of people who suffer from hunger – we observe that the percentage of hungry people in the world has declined from 20 percent in 1990-92 to 16 percent today. However, if we are to hit the actual MDG target, which is to reduce the prevalence of hunger to 10 percent by 2015, we have less than five years in which to do it. According to the FAO, the region with the most undernourished people is Asia and the Pacific with 578 million, while Sub-Saharan Africa remains the region with the highest proportion of undernourished at 30 percent of the total population (239 million). Both regions have significant structural problems that lock people into poverty, limit their access to key assets, keep agricultural productivity low and make it difficult to reduce hunger on any significant scale.
These structural factors must be addressed before we are likely to see any dramatic decreases in either regional or global hunger figures, but this will require a much more concerted effort by the international community. And it is particularly urgent that we start now, because in the years ahead we will probably be seeing more of the turbulence we have experienced over the past few decades, as food and agricultural markets are expected to become more volatile in the medium term because of increases in extreme weather events (e.g., drought in Russia, floods in Pakistan) linked to climate change and the growing influence of non-commercial actors in food commodities markets.
When launching its new hunger data, the FAO called on governments to increase investment in agriculture, expand social protection programmes and enhance income-generating activities for the rural and urban poor. But individual governments alone cannot tackle the root causes of hunger and some greater coordination is needed at both regional and international levels. To be fair, some progress has been made on this since the recent food crisis, in the form of the G8 L’Aquila Food Security Initiative, the United Nations Secretary-General’s High Level Task Force on the Global Food Security Crisis and the G20 Pittsburgh Summit Partnership on Food Security, which led to the launch of the World Bank’s Global Agriculture and Food Security Program, a multilateral financing mechanism which will allow the immediate targeting and delivery of additional funding to public and private donors to support national and regional strategic plans for agriculture and food security in poor countries.
Much of this appears to be a step in the right direction. But, as my colleague Erik Millstone and I observed in a recent paper we prepared for the UK Foresight Global Food and Farming Project (under review), if we are thinking long-term, we should also be envisioning a new structure for governing the food system through the creation of some kind of Global Food Security Authority (GFSA), which could be housed in the United Nations and implemented by an International Commission, working with different stakeholders, including governments, businesses, civil society and representatives of small-scale producers.
The GFSA would provide an institutional and legal framework to guide the governance of national, regional and international food systems and include binding commitments that seek to meet the four key dimensions of food security at all levels – sufficiency, safety, equitability and sustainability. Governments would, of course, have sovereignty to define their own food and agricultural policies, but they would also be held accountable for international human rights, including the right to food. Moreover, the GFSA would prioritise stabilising international supply and mandate strategic grain reserves for food security. Clear mechanisms would also need to be put into place to moderate commodity speculation and set floors and ceilings to guarantee fair prices for farmers. Further, the GFSA would mandate that trade and investment rules would provide national policy space to allow countries the flexibility to protect their own domestic food systems (within reasonable limits) and to invest in pro-poor agricultural research and development. It would also establish multi-stakeholder participation to develop multilateral and national investment programmes that promote rather than undermine local food sovereignty and small-scale agriculture that is productive, financially competitive and labour absorbing. Lastly, a Global Food Security Authority would link international economic policies to international human rights and environmental norms.
Realising this kind of vision is no small task, but if we are serious about reforming the global food governance system and meeting MDG 1 to as great a degree as possible, there is every reason to try. The burning question now is whether there is the political will to do so.
Tuesday, 14 September 2010
We've added three new research projects we're involved in to the website, under the heading "Socio-ecological dynamics of disease". The projects are all looking at the social, ecological, biological and institutional dynamics of disease. The work focuses particularly on diseases originating in animals, using cases in Africa and Asia. Photo: Fruitbat / Brian Gratwicke / Flickr
Diseases that are transmitted through livestock or wildlife take a major toll on people's lives. The research will identify the tipping points and thresholds involved, and how to lessen some of the negative impacts of these diseases on people's lives and livelihoods.
- Socio-ecological dynamics of disease (main page)
- Dynamic drivers of disease in Africa: interactions of livestock/wildlife, poverty and environmental change
- From bats to humans: The social, ecological & biological dynamics of pathogen spillover
- The intensification of livestock production and its impact on zoonotic disease risk in Asia
Monday, 13 September 2010
by Timothy Karpouzoglou, research student, SPRU
World Water Week (WWW) 2010 is over, leaving me with some questions. Is WWW really about "opening up" or about "closing down" the debate on water resource management?
The overall theme for this year WWW has been water quality. WWW aims "to highlight positive action and new thinking towards water related challenges and their impact on the world’s environment" and also to "deepen the understanding of, stimulate ideas, and engage the water and development community around the challenges related to water quality". These are all valid and urgent concerns in moving the debate forward.
So what is this new thinking? Some of it can be seen as more of the old thinking restated with today’s policy buzzwords. "Water quality" is still decided by scientists, talking to scientists about the science behind the solutions. The framing of the problem was often about the right technology. Common effluent treatment plants and wastewater treatment plants are commonly-suggested solutions, even if the costs associated are too high and unaffordable in many parts of the developing world.
However, it was good to see the importance of stakeholder participation being included even in some more technically-centred debates, even if it was not always clear what type of participation is desired. Maybe participation is about "letting the people find the solutions themselves", as one engineer from the Pakistan Water Authority wholeheartedly supported.
Encouragingly, juxtaposed with the general air of technological optimism, ideas about "non-linearity", "complexity" and "resilience" have also entered the debate. Friday’s session on resilience, uncertainty and tipping points, convened by the Stockholm International Water Institute, provided a new perspective and sparked a lot of debate. The session was also interesting because it encouraged people to think across each other’s own research and professional experiences. But it seemed to me that social concerns - and particularly the importance of poorer communities that are dependent on vulnerable ecological contexts - were not touched upon enough. How can "systems" thinking become more relevant to the concerns of poorer and ecologically marginalized people?
More generally, my experiences at World Water Week 2010 have also made me wonder: for whom is this event most important? What kind of dialogue can WWW achieve? The clearly divided opinions highlighted by the session on the World Commission on Dams+10 present the challenge of how dialogue can move forward, when the norm is for people to agree to disagree. For those working on water and sanitation, this challenge is not easily solved.
Thursday, 9 September 2010
By Lyla Mehta, STEPS Centre Water and Sanitation convenor
It’s my fourth day at World Water Week, the annual mecca for policy-makers and players from the World Water Council, the Water and Sanitation Programmes (WSP), Stockholm Water Institute, WaterAid, the International Water Management Institute (IWMI), as well as several UN and bilateral agencies such as DFID and others who can afford to pay the entry fee. Most people seem to come for networking, meetings, dinners and drinks, to launch new initiatives and reports... and occasionally even to attend the odd session.
I've been doing the same, though I had hoped to be more excited by some of the sessions and workshops. Most of them have been highly technical, with many of the same global perspectives and declarations that we have been hearing for a long time. But this is probably a reflection of how mainstream most talk about water is, be it in the media, policy or research realms.
This year’s focus is on water quality: a very timely issue, since worsening water quality and pollution are increasingly affecting human health and wellbeing, as well as the integrity of ecosystems. Still, as a sociologist, I found that the sessions have lacked critical social-science analyses about diverse perceptions of risk and water quality; how water quality affects different social groups differently; and the politics of standards, monitoring and risk assessments. In fact, an American anthropologist told me that her proposal to host a seminar on the cultural dimensions of water quality had been rejected by the organizers. Is the water and sanitation domain as represented in global foras still a bastion of engineers, economists and natural scientists?
At the opening plenary, Dr Rita Colwell, 2010 Stockholm Water Prize laureate, drew on over 35 years of research to demonstrate the reach and spread of cholera pathogens. She described how the use of a simple old sari cloth can keep cholera at bay, if used as a water filter. It would be interesting to hear more about how local practitioners and policy makers could draw on this research to create the right institutions to fight this deadly disease.
It's also heartening to see that the conference includes many sessions on sanitation, with many practitioners, policy makers and academics not shying away from using the word "shit" to talk about different strategies and approaches to end open defecation. This more direct language is, at least in part, thanks to the Community-Led Total Sanitation movement. Every day two million tonnes of shit are released in water bodies.
For me, the highlight of the conference was the session on “Revisiting the Large Dam Controversy” hosted by the very exciting online journal Water Alternatives. It’s been 10 years since the World Commision on Dams published its landmark report, which provided guidelines for dam-building, covering social, environmental, economic and institutional aspects. This was the only session I attended where there was passion and debate, not surprising due to the topic even though a few were hoping for more blood-letting! Ten years on, there has been much progress. WCD guidelines are now mainstreamed in many new and ongoing projects all around the world. The WCD principle on the "right to consent" is also gaining acceptance in many global organisations and institutions.
Still, there are many ideological rifts and no clear consensus on ways forward, with early opponents still openly rejecting the WCD process and conclusions. This was exemplified by the words of ex-World Bank official John Briscoe, who proudly stated that the WCD and similar commissions should pack up since they are often rejected by dam-building nations who reject their guidelines. But Briscoe didn’t seem to do himself or his former institution any favours by continuing to ignore the fact that water resources development remains a highly contested process, often shaped by forces in the wider political economy. Moreover, southern governments who claim to be ‘democratic’ may not necessarily be representing the interests of the poor and marginalised through dam-based development.
On Tuesday afternoon in a session on water and the city, I was struck by the massive differences between water and urban planning in the North and South. In many affluent cities of the global North, water is an aesthetic element in urban planning and can be an objet d’art.
By contrast, in our session on Liquid Dynamics on Wednesday, we presented STEPS research in peri-urban areas to show that water provision for many is non-existent or of highly dubious quality, leaving poor residents to fend for themselves: either by acquiring water through illegal means, or by paying exorbitant prices. Still, even here, poor residents give different meanings to polluted water bodies, and find different ways to cope with worsening water quality and inadequate access. Our session also had presentations on the politics of risk assessment and regulation, and how regulation has largely been framed as a technical discourse, thus leaving out the perspectives and interests of the peri-urban poor.
Unfortunately, I missed some interesting events on Wednesday that coincided with our event. In the afternoon I struggled to find something to keep me awake. A PhD student wondered if there was an Alternative Forum run by critical NGOs that take place every three years. But there was none and she left to check out Stockholm. I went to my favourite spot in the conference, the café where I meet up with old friends. I ran into several people there who proudly told me that they had only attended one or two sessions so far, spending most of the time networking and in meetings. As I wrote this blog, I looked around for other blogs on WWW. But apart from this blog, I couldn’t find any: were most of the sessions so dull that nobody feels compelled to write about them?
Stockholm WWW is an extremely well-organised and well-publicized annual event that attracts most of the well-heeled in the water sector, especially from the global North. It’s become a big jamboree that everyone in the water sector feels compelled to attend. In reality, most of the action takes place over drinks, coffee and dinner and through networking. There are some interesting insights in smaller seminars and side events, where the seating capacity is quickly exceeded. There was some passion and energy in smaller events. Most of the official programme, though, is business as usual - with very little passion, true concern for water justice, or critical debate. It feels like a lot of old water in old bottles. Read more
Tuesday, 7 September 2010
by Jeremy Allouche, STEPS Centre Research Fellow
Here’s our first blog from World Water Week - some call it ‘the pilgrimage of water’. Well... the price of the pilgrimage (about £650) makes it difficult to attend and it remains very much an elitist club. In this regard, one always wonders how useful these high-level international events are and whether we are not repeating the same stuff again and again.
The disconnect between the conference and the world outside is sometimes too evident: while the international media reports on the floods in Pakistan and the droughts and floods in Niger, here the focus of the conference is on partnerships between water professionals and projects around new sexy ideas on water. Although water quality is the focus of the conference, climate change is another hot topic here: mainstreaming water and climate change, governance and capacity building for water and climate change, etc...
Still, the big highlight of this morning was the session on “Revisiting the Large Dam Controversy”. Although the World Commission on Dams (WCD) report has been criticised (especially around implementation guidelines), there has been some consensus around the principles and values it articulated. But now, with the development of climate change adaptation strategies and the arrival of new financiers, some fear that the new context (WCD+10) may end this fragile consensus.
Two quotes stood out from the session:
Kader Asmal: "The water situation is now worse than it was ten years ago in Africa despite the promising 'numerical' numbers, and water quality is deteriorating." A useful reminder from Prof. Asmal on the limits and hidden realities of water statistics.
John Briscoe: I didn’t note his exact words, but to paraphrase, he suggests that governments are the legitimate actors; multi-stakeholder forums cannot impose any norms and guidelines on dam building. (To do him justice, read his article on the politics of the WCD in Water Alternatives.)
As somebody who had worked in the World Bank for many years, this view seems quite surprising. What autonomy do countries with structural adjustment programs have? Leaving it all to governments doesn’t help us in dealing with 1) dam building and the issue of transboundary water resources and 2) political economy problems – as raised by many participants at today’s session.
The session was certainly interesting, but there was a lot of confusion between principles and guidelines. Some may feel that reaching a global agreement on common principles is an illusory goal. But principles are undoubtedly an issue to reflect on and push for, given the formidable legacy of the WCD process and report. Moreover, establishing principles also opens up a space for national and local dialogues and the elaboration of guidelines at a range of levels.
Finally, a couple of interesting questions to think about:
> can we learn something from the WCD process for the land grabbing issue?
> how can we include social and environmental issues in the risk assessment process in order to allow more space for deliberation before the design phase?
That's it for now - more from World Water Week soon. Our lunchtime session is tomorrow at 12.45 - follow the link for more details.
>> Liquid Dynamics II: Linking Quality and Access for Pro-Poor Sustainability
>> Our work on Water
There's an interview with Adrian Smith, STEPS Centre Research Fellow, about "social technologies and niches for sustainable transformation" in the September edition of Saber Cómo (the monthly newsletter of the Argentinean National Institute for Industrial Technology). There are also contributions from Renato Dagnino from Unicamp and Hernan Thomas from Quilmes University.
Social technologies are processes of technology development that seek to be inclusive towards the poor and marginalised, as well as environmentally sustainable.
For the full article (in Spanish), click on the link below.
>> Saber Cómo: Un debate en ambos lados del Atlántico Latinoamérica: de corazones rojos y mentes grises
>> Innovation, Sustainability, Development: A New Manifesto
Monday, 6 September 2010
We're at World Water Week in Stockholm this week. Our session, Liquid Dynamics II: Linking Quality and Access for Pro-poor Sustainability is at 12.45pm on Wednesday.
In the session, we'll discuss the complex interactions between the social, technological and ecological/hydrological dimensions of water and sanitation. These interactions are often sidelined in water and sanitation management.
If you can't make it, we'll be posting blogs and other things from World Water Week here.
>> Liquid Dynamics II
>> World Water Week 2010
>> STEPS Work on Water and Sanitation
>> Community-Led Total Sanitation Working Paper (pdf) / briefing (pdf)
Thursday, 2 September 2010
Community-Led Total Sanitation is a rapidly-spreading way of getting local people involved in planning toilets and other facilities. CLTS taps into people's feelings of disgust to encourage action. Photo: Kalangaba Village Open Defecation Free Sign, from the CLTS Flickr photostream
Our new working paper (with a short briefing on the side) looks at how this might work in different cultures, and the difficulties of creating sustainable sanitation. It also looks at how CLTS can interact with governments as other institutions as it becomes more popular.
>> CLTS Working Paper (pdf, 570kb)
>> Briefing: CLTS: Challenges and opportunities (pdf, 240kb)
>> Our work on water and sanitation
>> Community-Led Total Sanitation website
Tuesday, 31 August 2010
By Kate Hawkins, Communication Officer for Health and Social Change
We've published seven new briefings on "scaling up" in the health sector. Among the themes covered are improving access to health services, building sustainable health systems, and harnessing a spirit of innovation to improve equity. Photo: Shimla street scene by Liz Highleyman from Flickr (Creative Commons)
The papers follow a workshop held at IDS earlier this summer with more than 40 academics, policy makers and innovators.
The workshop aimed to explore approaches that have fostered innovation and change in the health sector. We also looked at practical ways for innovators, governments and funders to work together to enable health systems to meet the needs of the poor.
For the last couple of years, Future Health Systems and the STEPS Centre have been looking beyond traditional narratives about how poor people access health services. In fact, health systems may evolve in many different directions over time - some of which are often ignored or under-recognised.
Real world challenges
The workshop shed light on real-world challenges experienced by those working directly in the health sector.
A common challenge was how to tailor global goals, or donor expectations, to the local context. When reforms of health systems come from the international level, there is a significant transfer and allocation of resources. So these reforms are intensely political. Jeff Mecaskey of Health Partners International talked about the Partnership for Reviving Routine Immunisation in Northern Nigeria, which is working to understand and build on different political interests, and pinpointing which interests might be drivers for change.
Abbas Bhuiya, from ICDDR,B in Bangladesh, explained how scaling-up efforts need to engage with the informal sector which makes up 95 per cent of the health workforce. Informal providers earn their living by selling drugs, and over-prescription and other harmful practices are common.
The private sector was also a focus of the paper by Barun Kanjilal, of the Indian Institute of Health Management Research. Barun described how a major change in the relative roles of market and state since 1990 in India had been reflected in the health sector. India has seen a rapid spread of largely unregulated private actors, as well as an expansion of opportunities for modern medicines and innovations.
Citizen-state relations was another area of focus. The Treatment Action Campaign in South Africa supports the right of people living with HIV to access quality comprehensive prevention and treatment services and to live a healthy life. Initially, the campaign had a bio-medical focus but this led on to campaigning on a broader set of vulnerabilities and socio-economic rights, as treatment access became more widespread. Other campaigns have taken similar journeys.
A shift in focus from health care provision and access, to issues of social justice, equity and the experiences of marginalised groups was also central to the paper on indigenous people in Brazil, given by Alex Shankland of IDS.
The resulting seven briefing papers provide more information on each of the following areas:
>> Framings of scaling up
>> Large scale health interventions
>> Local innovations
>> Scaling up in context of transition
>> Information and communication technologies
>> Citizen and health system relations
>> Building evidence to support rapid change
Thursday, 12 August 2010
by Gerry Bloom, STEPS Centre Health domain convenor
On August 11 the Lancet published an article that demonstrated the emergence of a new antibiotic resistance mechanism (known as NDM-1) in India, Pakistan and the UK. The article points out that many of the UK people carrying resistant bacteria had visited the Indian sub-continent during the past year or had links with these countries. The authors warn that the spread of bacteria resistant to almost all known antibiotic drugs could pose a serious public health hazard. What's to be done?
Today, the British newspapers have responded to the issue from a number of points of view. The Daily Mail argues that “we’ve only ourselves to blame”, highlighting that people seeking inexpensive plastic surgery in India are amongst the carriers of the new bug to the UK. The Guardian contemplates "a world without antibiotics”, calling for world-wide surveillance to identify emergent resistant organisms. An editorial in the Financial Times (registered users only) emphasises the need for investment in new anti-microbial products.
This is the latest of a stream of stories about the emergence of organisms (strains of HIV, tuberculosis and malaria) resistant to existing treatments. These emergences share a common pattern: a new drug is developed, and its use spreads rapidly, including in partial doses. The problem is that in places where many people have a lowered capacity to fight infection because they are malnourished, are exposed to multiple infections through contaminated water, or have a chronic infection such as with HIV, the possibilities that a new strain of a bacterium or virus will take hold and spread are increased.
This isn't fully surprising. The Lancet article refers to a past editorial by AD Ghafur in an Indian medical journal about the availability of antibiotics in that country’s informal markets and a prediction of the emergence of resistant organisms. We need to recognise the consequences for global public health of the persistence of severe poverty and the rapid spread of health-related markets. In many parts of the world, poor people obtain most of their drugs from informal health workers or shops functioning largely outside a regulatory framework. A substantial proportion of these products are counterfeit and of low quality. People often buy several antibiotics and they do not necessarily take a full course of treatment. In this context, the rapid emergence of resistant organisms is inevitable.
What can be done?
One option is to try to protect the UK population through more effective surveillance and measures to reduce exposure of people to emergent organisms. The Lancet article, for example, opposes proposals that the British NHS refer patients to Indian hospitals as a way to save money.
A second option would be to prevent the easy movement of pharmaceuticals to localities without a well-organised health system. This would, in effect, deny many of the world’s poorest people access to effective drugs.
Neither option is politically acceptable or practically feasible in a world of increasing movement of people between countries and rapid communications, where it is almost impossible to avoid links between the very rich and poor people seeking health care in markets thousands of kilometres away.
We need to recognise the potential gravity of the problem of treatment resistant organisms. Recent efforts to make drugs widely available at an affordable cost have made a major impact on the lives of millions of people. They now need to be complemented by a similar effort to ensure that drugs are used responsibly. This cannot be achieved by simply announcing new regulations, which are unlikely to have much impact on the largely unorganised markets through which a large volume of pharmaceuticals flow.
An effective response to this problem needs to combine research on new pharmaceuticals, the creation of new global capacities for surveillance and measures to enable poor people to gain access to effective drugs while reducing the risks of resistant organisms. These measures will require a new kind of partnership between governments, pharmaceutical companies, providers of health services, participants in informal health markets and poor people, themselves, to improve access to anti-viral and anti-microbial drugs and ensure their responsible use.
>> Epidemics: Science, Governance and Social Justice, edited by Sarah Dry and Melissa Leach
>> Avian Influenza: Science, Policy and Politics, edited By Ian Scoones
>> Future Health Systems
>> Our research on Rethinking Regulation Read more