WHEC Update - March 2008
|A Newsletter of worldwide activity of Women's Health and Education Center (WHEC)
March 2008; Vol. 3, No. 3
The most important factor to make motherhood safer appears to be political commitment in a country -- the conviction among decision-makers and society in general that maternal deaths can and must be avoided. This conviction needs to permeate a society. It is linked to the value given to women and to women's equal right to live. To promote this conviction people must be made aware that steps can be taken to reduce maternal mortality, and they are feasible even within the limits of scarce resources. One reason why maternal mortality has not received the attention and resources it needs is that it involves some of the most intimate and culturally sensitive aspects of life: birth, death and sexuality. Adolescents in most countries have more difficulty than adults in getting accurate information on sexual and reproductive health services, methods of contraception, maternal healthcare, and care for sexually transmitted diseases. This contributes significantly to the number of unnecessary maternal deaths among adolescent women. Our publication WomensHealthSection.com addresses the need for improving access to reproductive health services for adolescent women and men is thus essential for the reduction of maternal mortality. Pregnancy is special -- let us make it safer.
Long-held attitudes do not change overnight -- it took many years of campaigning to improve services in industrialized countries and reduce maternal deaths. Political commitment in developing countries is now crucial if the necessary steps are to be taken. Safe motherhood, however, is not ensured only be good health services. Poverty, lack of education, and women's lack of power to make decisions about their own health also contribute to maternal morbidity and mortality. Above all, achieving safe motherhood is about a more equitable distribution of resources so that nothing and nobody stands in the way of women's access to essential services. Concerted action is needed to make safety a reality for millions of women around the world who give birth without the essential services. Women have a right to safe motherhood -- midwives and obstetricians have an indispensable role to play in making it happen -- we should take up the challenge. While pregnancy is safer in the USA than in the last century, many minority women still face increased risks of morbidity and mortality, associated with social and economic factors. Until economic, educational and cultural barriers are removed, it will be difficult to eliminate the gaps in maternal health to promote safe and happy pregnancies for all women.
The Road Ahead
Rita Luthra,, MD
Your Questions, Our Reply:
What can be done about the private health sector in low-income countries? How can the activities of the private sector in these countries be influenced so that they help to meet national health objectives?
Restructuring the Market: A very large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. Although the evidence base is not good, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behavior of providers and on what might be the necessary conditions for success. There is much less evidence, however, of effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments.
In recent years there has been a considerable growth of interest in the activities of providers in the private health sector in low income countries, and in how policy-makers might best capitalize on the accessibility and popularity of this sector. However, the evidence is limited as to which approaches work best. There have been many references to social marketing, accreditation, franchising and contracting, but much of the experience is documented only in the unpublished literature or has been gained in relatively small projects. Recognizing the importance of the private sector in health system outcomes does not imply that the public sector has a diminished role to play. Rather, attention is drawn to the often neglected governmental role of stewardship, without which the private sector operates unchecked and unguided. Governments should regulate the private sector not just in the sense of legislating and administering formal rules but also by intervening to alter the incentives available to private sector institutions and thereby their activities and performance outcomes.
We at Women's Health and Education Center (WHEC) support the activities of the private health sector in low-income countries so that they help to meet national health objectives. Research is necessary on the success of demand side strategies, which could both complement and increase the effectiveness of interventions targeted at the providers.
About NGO Association with the UN:
The Millennium Declaration, signed by world's leaders of 189 countries in 2000, established 2015 as the deadline for achieving most of the Millennium Development Goals (MDGs). The majority of MDG targets has a baseline of 1990, and is set to monitor achievements over the period 1990-2015.
Millennium Development Goals (MDGs) 3: Promote Gender Equality and Empower Women
TARGET: Eliminate gender disparity in primary and secondary education preferably by 2005 and in all levels of education no later than 2015. Women's participation in paid, non-agricultural employment has continued to increase slowly. The greatest gains are in some of the regions where women have the least presence in the labor market -- in Southern Asia, Western Asia and Oceania. In Northern Africa, where women's participation is also low, progress has been insignificant. Only one in five paid employees in that region is a woman, a situation that has remained unchanged for the last 15 years. In other regions, women are slowly gaining access to paid employment at a level on par with men, or, in the case of the Commonwealth of Independent States (CIS), exceeding it. Doors are opening slowly for women in the labor market. In Africa, although the share of parliamentary seats held by women has increased substantially, from 7 per cent in 1990 to 17 per cent this year, the share of women who earn a salary, aside from farming, still stood at less than one-third in 2005.
Poverty cannot be eradicated without gender equality and women's empowerment, and this would require a change of traditional and cultural gender norms. While failing to effectively address the impact that macroeconomic policies have on national poverty, Governments often view micro-credit as the solution to women's poverty, because they have a strong track record as prudent savers and borrowers in micro-finance programs. Another crucial point for poverty eradication is women's access to land, which becomes more difficult with growing privatization. Not only in the developing world do labor market discrimination and cultural and political mechanisms demote ethnic minority and migrant women to low-waged and low-skilled sectors; even developed countries seldom provide women with effective policies that reconcile family and working life. Equal pay and women's integration in non-traditional sectors are still an exception to the rule.
Collaboration with World Health Organization (WHO):
About World Health Organization (WHO)
WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends. In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats.
"Our greatest concern must always rest with disadvantaged and vulnerable groups. These groups are often hidden, live in remote rural areas or shantytowns and have little political voice." Dr Margaret Chan, WHO Director-General. Working for health; An introduction to WHO Download [pdf 1.24Mb]
Bulletin of the World Health Organization; Volume 86, Number 3, March 2008, 161-240 Table of contents
Collaboration with UN University (UNU):
UNU-WIDER (World Institute for Development Economics Research) Expert Series on Health Economics:
Capital Flows to Developing Countries Since the Asian Crisis: How to Manage their volatility?
The project intends to fill the gaps in knowledge in two related areas: 1) what determines decisions by lenders / investors to enter or withdraw from individual developing countries? Even more, how has this decision making process been modified by recent crises and by the subsequent discussion of and measures taken for - a new financial architecture; 2) at a national level, in developing countries, what are the policy implications especially for macroeconomic and financial regulation policies, as well as for their interconnections - of volatile and reversible capital flows? In this context what policies are best pursued to maximize growth, investment and employment in the long-term, whilst minimizing risk of developmentally costly currency and financial crises? The project will consist of two closely integrated and highly complementary parts: 1) analysis of new trends in the supply of different categories of capital flows, since the Asian crisis, as well as their determinants, and international policy and regulatory implications of these trends and 2) evaluation of national policies to reduce both the volatility of capital flows and its' negative domestic impact."
Project co-directors: Ricardo French-Davis; Stephany Griffith-Jones
(Details of the paper can be accessed from the link of UNU-WIDER on CME Page of WomensHealthSection.com)
Point of View:
Peoples Open Access Education Initiative for Public Health: Peoples-uni.org
An educational initiative http://www.peoples-uni.org aims to develop educational context around Open Educational Resources, freely available on the Internet, to help with Public Health capacity building in low- to middle-income countries. Local universities offering public health education may be oversubscribed for face to face courses and fees for overseas universities, including e-learning distance programs, are higher than can be afforded by most potential students in these countries. Internet-based e-learning has the exciting potential to deliver high quality learning resources anytime and anywhere, and although access is by no means universal it is improving quickly. There is an ever expanding range of high quality on line education resources freely available through the Internet, and a number of universities are putting educational material on-line for open access, although they do not include either teaching or accreditation of learning. The starting point is identified problems in Public Health, building towards Masters level courses, and a pilot of our first course module on Maternal Mortality attracted a large interest and was well received (1). Peoples-uni.org aims to provide educational context around the materials freely available on the Internet. A number of national and international partners have agreed to be part of this, and momentum is building.
The Peoples-uni.org is still in development, and the Web 2.0 philosophy which underpins the initiative allows for continuous change and revision of the material and educational process, in particular to ensure 'localization' of the education to ensure it is relevant to the setting in which it is offered. To this end, any input or collaboration from individuals or organizations in low-- to middle-income countries would be welcome. The initiative is largely dependent on volunteerism, taking place outside traditional educational and institutional settings. The main current issue for us to solve is how to engage health professionals in helping as course developers and facilitators of on-line learning. We seek volunteers from the 'north' and the 'south' to help in this.
- Bulletin of the World Health Organization 2007; 85:930-934
By Richard F Heller
Universities of Manchester, UK, and Newcastle, Australia
Peoples Open Access Education Initiative
United Nations Charter:
We the Peoples of the United Nations .... United for a Better World
Chapter IV -- THE GENERAL ASSEMBLY
The General Assembly shall consist of all the Members of the United Nations. Each Member shall have not more than five representatives in the General Assembly.
FUNCTIONS and POWERS
The General Assembly may discuss any questions or any matters within the scope of the present Charter or relating to the powers and functions of any organs provided for in the present Charter, and, except as provided in Article 12, may make recommendations to the Members of the United Nations or to the Security Council or to both on any such questions or matters.
The General Assembly may consider the general principles of co-operation in the maintenance of international peace and security, including the principles governing disarmament and the regulation of armaments, and may make recommendations with regard to such principles to the Members or to the Security Council or to both.
The General Assembly may discuss any questions relating to the maintenance of international peace and security brought before it by any Member of the United Nations, or by the Security Council, or by a state which is not a Member of the United Nations in accordance with Article 35, paragraph 2, and, except as provided in Article 12, may make recommendations with regard to any such questions to the state or states concerned or to the Security Council or to both. Any such question on which action is necessary shall be referred to the Security Council by the General Assembly either before or after discussion.
The General Assembly may call the attention of the Security Council to situations which are likely to endanger international peace and security.
The powers of the General Assembly set forth in this Article shall not limit the general scope of Article 10.
While the Security Council is exercising in respect of any dispute or situation the functions assigned to it in the present Charter, the General Assembly shall not make any recommendation with regard to that dispute or situation unless the Security Council so requests.
The Secretary-General, with the consent of the Security Council, shall notify the General Assembly at each session of any matters relative to the maintenance of international peace and security which are being dealt with by the Security Council and shall similarly notify the General Assembly, or the Members of the United Nations if the General Assembly is not in session, immediately the Security Council ceases to deal with such matters.
The General Assembly shall initiate studies and make recommendations for the purpose of:
a. promoting international co-operation in the political field and encouraging the progressive development of international law and its codification;
b. promoting international co-operation in the economic, social, cultural, educational, and health fields, and assisting in the realization of human rights and fundamental freedoms for all without distinction as to race, sex, language, or religion.
The further responsibilities, functions and powers of the General Assembly with respect to matters mentioned in paragraph 1 (b) above are set forth in Chapters IX and X.
Subject to the provisions of Article 12, the General Assembly may recommend measures for the peaceful adjustment of any situation, regardless of origin, which it deems likely to impair the general welfare or friendly relations among nations, including situations resulting from a violation of the provisions of the present Charter setting forth the Purposes and Principles of the United Nations.
The General Assembly shall receive and consider annual and special reports from the Security Council; these reports shall include an account of the measures that the Security Council has decided upon or taken to maintain international peace and security.
The General Assembly shall receive and consider reports from the other organs of the United Nations.
The General Assembly shall perform such functions with respect to the international trusteeship system as are assigned to it under Chapters XII and XIII, including the approval of the trusteeship agreements for areas not designated as strategic.
The General Assembly shall consider and approve the budget of the Organization.
The expenses of the Organization shall be borne by the Members as apportioned by the General Assembly.
The General Assembly shall consider and approve any financial and budgetary arrangements with specialized agencies referred to in Article 57 and shall examine the administrative budgets of such specialized agencies with a view to making recommendations to the agencies concerned.
Each member of the General Assembly shall have one vote.
Decisions of the General Assembly on important questions shall be made by a two-thirds majority of the members present and voting. These questions shall include: recommendations with respect to the maintenance of international peace and security, the election of the non-permanent members of the Security Council, the election of the members of the Economic and Social Council, the election of members of the Trusteeship Council in accordance with paragraph 1 (c) of Article 86, the admission of new Members to the United Nations, the suspension of the rights and privileges of membership, the expulsion of Members, questions relating to the operation of the trusteeship system, and budgetary questions. Decisions on other questions, including the determination of additional categories of questions to be decided by a two-thirds majority, shall be made by a majority of the members present and voting.
A Member of the United Nations which is in arrears in the payment of its financial contributions to the Organization shall have no vote in the General Assembly if the amount of its arrears equals or exceeds the amount of the contributions due from it for the preceding two full years. The General Assembly may, nevertheless, permit such a Member to vote if it is satisfied that the failure to pay is due to conditions beyond the control of the Member.
The General Assembly shall meet in regular annual sessions and in such special sessions as occasion may require. Special sessions shall be convoked by the Secretary-General at the request of the Security Council or of a majority of the Members of the United Nations.
The General Assembly shall adopt its own rules of procedure. It shall elect its President for each session.
The General Assembly may establish such subsidiary organs as it deems necessary for the performance of its functions.
To be continued...
Top Two Articles Accessed in February 2008:
- Fetal Alcohol Syndrome: Recognition & Prevention;
WHEC Publications. Special thanks to St. Elizabeth's Medical Center, Boston, MA (USA), Department of Obstetrics and Gynecology for the assistance in preparation of the manuscript.
- Menopause: A Close-up Look;
WHEC Publications. Special thanks to World Health Organization for the contributions.
News, Invitations and Letters:
In advance of the General Assembly's commemorative high-level plenary session to mark the mid-decade point for the Plan of Action "A World Fit for Children (WFFC)," UNICEF has launched its Progress for Children: A World Fit for Children Statistical Review. The statistical review reports on how well the world is doing in meeting its commitments for the world's children and analyses progress towards the Millennium Development Goals in four priority areas for children: promoting healthy lives, providing a quality education, combating HIV and AIDS, and protecting against abuse, exploitation and violence. For the first time, annual global deaths of children under age five fell below the 10 million mark, to 9.7 million. This represents a 60% reduction in the under-five mortality rate since 1960. Major improvements in the coverage of a number of key child survival interventions, including measles immunization, vitamin A supplementation, insecticide-treated mosquito nets and breastfeeding, are also highlighted.
This edition also provides comprehensive information on such indicators as birth registration, child labor, female genital mutilation/cutting, child marriage and children affected by war, which offer a snapshot of the state of child protection. It reveals that the number of primary-school-age children who are not in school has declined from 115 million at the time of the 2002 Special Session to 93 million in 2005-2006, and that new evidence suggests declining HIV prevalence in some sub-Saharan African countries, although these trends are not yet widespread or strong enough to turn the tide. The report is available online.
UNITED NATIONS; THE SECRETARY-GENERAL --MESSAGE ON INTERNATIONAL WOMEN'S DAY 8 March 2008
At the 2005 World Summit, Governments of all nations agreed that "progress for women is progress for all". Yet the 10-year review of the implementation of the Beijing Platform for Action revealed a serious gap between policy and practice in many countries. A lack of political will is reflected in the most telling way of all: lack of resources and insufficient budgetary allocations. That is why the theme of this International Women's Day is "Investing in Women and Girls". This failure of funding undermines not only our endeavors for gender equality and women's empowerment as such; it also holds back our efforts to reach all the Millennium Development Goals. As we know from long and indisputable experience, investing in women and girls has a multiplier effect on productivity and sustained economic growth. No measure is more important in advancing education and health, including the prevention of HIV/AIDS. No other policy is as likely to improve nutrition, or reduce infant and maternal mortality.
In the United Nations family too, we need to better match demands with resources. The resources available for gender mainstreaming must be made more sustainable and predictable -- particularly at the regional and country levels. And to make a real difference, our gender-specific machinery needs funding that is commensurate with the challenges. I firmly believe that one dynamic and strengthened gender entity, consolidating resources currently scattered among several structures, would attract better funding from the donor community. By mobilizing forces of change at the global level, and inspiring enhanced results at the country level, such an entity would better advance our cause to empower women and realize gender equality worldwide. I urge Member States to muster the political will to bring the consultations on this issue to a successful conclusion. This year we find ourselves at the mid-point in the race to reach the Millennium Development Goals by the target date of 2015. Only by investing in the world's women and girls can we expect to reach our destination. On this International Women's Day, let us resolve to unite in this mission.
WHEC thanks Dr. Baha M. Sibai, Professor and Chairman, Department of Obstetrics and Gynecology, University of Cincinnati (USA) for his priceless contributions. It is indeed a pleasure to work with you. We hope to develop many projects/programs in women's healthcare of mutual interest. Thanks again.
Beyond the numbers...
In all cultures, trained personnel with special knowledge of health are under an obligation to follow the written and unwritten rules that will ensure good practice. The solid principles of ethics and social well-being that have always formed part of health care will be the pillars that continue to support the future development of medical care and the health of society, even in the whirlwind of change in which we live.
Dedicated to Women's and Children's Well-being and Health Care Worldwide