Thursday, 1 November 2012

MALNUTRITION: ‘Breastfeeding Best for Bangladesh’


By Naimul Haq

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Dhaka maternity hospitals encourage exclusive breastfeeding. Credit: Sujan-map/IPS
Dhaka maternity hospitals encourage exclusive breastfeeding. Credit: Sujan-map/IPS
DHAKA, Oct 30 2012 (IPS) - Bangladesh’s achievement in raising exclusive breastfeeding rates for infants under six months from 43 percent to 64 percent, over the last five years, is said to be the result of a determined campaign by government and non-governmental organisations (NGOs).
At the Shaheed Suhrawardy Medical College and Hospital in the national capital, Razia Khatun, 36, is being assisted with feeding her eight-day-old infant. “I was told to start breastfeeding within the first hour of my child’s birth but failed and so I am back here for help.”
Shahida Banu, a trained staff nurse at the hospital, told IPS: “Razia had clogged ducts because her milk wasn’t draining completely, but this could be rectified by steady massaging.”
Peyara Begum, 29, a mother from the city’s Gabtoli area with similar problems, says, “The nurses here attend to you the moment you enter and there are smiling faces all around – and that makes all the difference.”
Prof. Soofia Khatoon, head of the paediatric department of the hospital, told IPS, “Mothers tend to switch to substitutes when they face such minor problems as cracked or flat nipple, low  output and overflow – we have been able to reverse this trend just by speaking to the mothers and encouraging them.”
Many of the nurses employed at the hospital trained at the Bangladesh Breastfeeding Foundation (BBF) which has, since 1989, been running intensive programmes to promote exclusive breastfeeding.
“Exclusive breastfeeding along with awareness building on improving the health of undernourished mothers is the best way to address child malnutrition in Bangladesh,” says BBF chairman Dr. S.K. Roy.
“The challenge now is to take the breastfeeding rate to even higher levels and thereby drastically reduce child malnutrition which is a problem in Bangladesh,” Roy told IPS in an interview.
An internationally acclaimed scientist working on child health, Roy said BBF’s main role was to function as a catalyst to build the capacity of the government, NGOs, the private sector and other stakeholders.
A survey carried out by the National Institute of Population Research and Training attributes the raising of exclusive breastfeeding levels to 64 percent by 2011 to “several intensive programmes that focus on maternal and newborn care and child health.”
Bangladesh’s achievement seems especially impressive when compared with the low exclusive breastfeeding average in South Asia for infants under six months, languishing at 39 percent.
“We have a high level of commitment and support from the government, which is why we have been able to form a nationwide  network for our advocacy programmes in a relatively short time,” Roy said.
In 2010, Bangladesh enforced a directive for extending maternal leave to six months from the previous four for working women to allow them to exclusively breastfeed their newborn.
“This is a sign of the seriousness with which the government is taking the issue as a key to achieving the United Nations millennium development goal that calls for reducing child mortality rates,” Khurshid Jahan, a senior BBF member, told IPS.
“Many don’t realise that exclusive breastfeeding can address  stunting and low weight problems,” Jahan said. “If every mother practices breastfeeding we would have a healthier and more productive  population,” she added.
Workers like Jahan credit the Baby-Friendly Hospital Initiative (BFHI) – a global programme sponsored by the World Health Organisation and the United Nations Children’s Fund (UNICEF) – that assists hospitals in giving mothers confidence and skills to initiate and continue breastfeeding.
About 1,200 government hospitals and health facilities now have centres under the BFHI, while another 500 clinics run by NGOs have similar facilities where mothers are nudged towards exclusive breastfeeding.
In rural areas, mother support groups (MSGs) are at work counselling new mothers and weaning them away from old wives’ myths and traditions that are not friendly to breastfeeding.
When new mothers get back home from the hospital after delivery they are often surrounded by women who insist on feeding the babies prelacteals such as honey or mustard oil, ignoring the naturally protective value of colostrum.
Prof. M. A. K. Azad Chowdhury, head of neonatology department at the Dhaka Shishu (Children’s) Hospital, told IPS, “MSGs work to bring back confidence in mothers who fail to breastfeed their babies. People tend to look for alternative sources of milk in such a situation.”
Infants exclusively breastfed are likely to be exposed less to contaminated foods and this helps reduce the incidence and severity of infectious diseases, Chowdhury said.
After six months, infants should receive nutritionally adequate and safe complementary foods while continuing to be breastfed for up to two years of age or beyond.
UNICEF representative in Bangladesh, Pascal Villeneuve, told IPS, “While we reflect on the successes, we must also note that many babies under six months old in Bangladesh are still not exclusively breastfed.”
Villeneuve said there is work to be done to increase awareness regarding the benefits of exclusive breastfeeding and provide  support to nursing mothers at home, community or workplace.
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MALNUTRITION: Food Production Accounts for 29 Percent of Greenhouse Gases



By Fabiola Ortiz
Fabíola Ortiz interviews SONJA VERMEULEN and PHILIP THORNTON, climate change and agriculture experts
Food’s carbon footprint is measured “from fertiliser to fork”: Thornton and Vermeulen. Credit: Courtesy CCAFS
Food’s carbon footprint is measured “from fertiliser to fork”: Thornton and Vermeulen. Credit: Courtesy CCAFS
RIO DE JANEIRO, Oct 31 2012 (IPS) - Food production, including agriculture, represent 29 percent of the greenhouse gases that are causing global warming, say scientists with the Consultative Group on International Agricultural Research (CGIAR).
Feeding the global population today involves the release of 10,000 to 16,000 megatonnes of CO2 equivalent into the atmosphere annually, say two reports published Wednesday Oct. 31 in Copenhagen by CGIAR’s Research Programme on Climate Change, Agriculture and Food Security (CCAFS).
Rising global temperatures and shifting rainfall patterns will affect production of staple foods like maize, rice and wheat. The reports estimate that by 2050, climate change could cause irrigated wheat yields to fall by 13 percent in developing countries, and irrigated rice yields by 15 percent.
The reports are “Recalibrating Food Production in the Developing World: Global Warming Will Change More Than Just the Climate” by CCAFS theme leader Philip Thornton, and “Climate Change and Food Systems” by CCAFS head of research Sonja Vermeulen. IPS spoke to the two researchers by telephone. Excerpts of the interviews follow:
Q: What is the global warning sounded by the reports launched by CCAFS?
PHILIP THORNTON: I would say that the overall message from the two studies is that climate change may have considerable impacts on agriculture in developing countries, but there are many things that can be done now to help reduce the burden on smallholders.
Action is required now at many levels, not only to adapt but also to mitigate – and there are wide overlaps of actions that can serve both adaptation and mitigation.
Q: Agriculture and the food production chain are among the biggest contributors to greenhouse gas (GHG) emissions. Does feeding the world produce a huge carbon footprint?
SONJA VERMEULEN: The emissions footprint of food production involves the combined emissions of all the stages of food production, from ‘fertiliser to fork’. It includes manufacture of inputs like fertilisers, then agriculture itself, but also food distribution and sales, use of food in the home, and how food waste is managed.
There are large country variations, but food production, including agriculture, contributes from 19 to 29 per cent of anthropogenic (man-made) emissions. The sector that contributes the most is the energy industry, however.
An important part of the impact of agriculture and food production on GHG emissions is of course the energy it uses: machinery on farms, refrigeration, transport over long distances. (Feeding the world represents) between 10,000 and 16,000 megatonnes of CO2 equivalent.
Q: How could climate change impact people’s lives with regard to food security, especially commodities and natural resources?
SV: It highlights the imperative of providing help to those people who need it to adapt – most of whom are in developing countries and contribute very little to the global footprint of agriculture – while at the same time doing everything we can to reduce the footprint of agriculture in the developed countries.
Ensuring food security for nine billion people (the projected global population in 2050) has to be a priority, but we have to do this in a way that reduces emissions.
Q: The reports point to the urgent need to mitigate and adapt due to the reality of climate change. What actions should countries and food companies take?
SV: There are a wide variety of options that can both help smallholders adapt to climate change as well as reduce emissions – reducing waste, restoring degraded lands, feeding livestock better diets to reduce the amount of emissions per kg of meat and milk, for example.
Q: What are the consequences of the rise in temperatures and the reduction in rainfall periods?
PT: Rising temperatures and changing rainfall amounts and patterns will inevitably change the nature of growing seasons in some places and will also change the suitability of different places for different crops. In such cases, it may be that there are different varieties that can be used that are more heat-tolerant; perhaps the areas of production can be shifted to more suitable areas (e.g. shifting potato cultivation to higher elevations where it is cooler).
Regarding pests and diseases, it is certain that the prevalence and distribution of these will change, and in some cases will become increasingly important.
Q: What are the changes we may see in our diets?
PT: Climate change impacts on agricultural production may bring about substantial changes in the relative costs of different sources of calories and proteins. In developed countries, we may want to consider ways of reducing the over-consumption of certain types of food and reducing waste, because such things can help cut emissions.
In developing countries, research and development organisations may want to start thinking about ways to help smallholders grow and utilise new crops that they currently have no or only limited experience with. The issue here is to help provide smallholders with options to diversify their diets where this is appropriate.
Q: The reports say farmers around the world, especially smallholders in developing countries, should have access to the latest technology and science. Is climate-smart agriculture possible?
PT: Smallholders have enormous experience of farming, but the pace of change means that many of them are having to operate in very unfamiliar conditions. In such cases, proven technology and good science can surely help enhance food security and livelihoods – this may involve the use of new varieties that are drought-tolerant, or helping farmers to use seasonal weather forecasts to adapt their management practices to the current season. But yes, to help them towards an intelligent and resilient agriculture.
Q: How will these global changes affect different parts of the world?
PT: Several studies show that large areas of sub-Saharan Africa and parts of South Asia and South-East Asia may be particularly vulnerable to the effects of climate change.
Q: Is it true that growing crops is about to become even more unpredictable at a global level?
PT: The climate during the rest of this century is very likely to become more variable (more droughts, more floods, more extreme events), and as a result, agricultural production may well become more variable, particularly in developing countries in rain-fed situations. This is one reason why it is so important to enhance smallholders’ resilience and ability to adapt.
Q: The CCAFS reports predict a catastrophic scenario in the near future. How can we deal with this?
PT: My take would be: it doesn’t have to be like this – if we sit and do nothing, the future does indeed look bad, particularly for those who are in fact least to blame for the emissions trajectory we are currently on. But what I take from these two publications is that there are many practical things that we can do to reduce emissions and to help smallholders adapt. We need action at all levels – local, national, regional and global.
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POVERTY: AFGHANISTAN: Disease outbreaks prompt action



Vaccination teams face many challenges accessing remote areas of Afghanistan
DUBAI, 1 November 2012 (IRIN) - Afghanistan is taking steps to improve its routine immunization coverage, after a drop in coverage led to a sharp increase in measles outbreaks last year, killing more than 300 children.
 
Since the start of the last Afghan winter, in November 2011, 9,000 measles cases were reported across almost every province in the country, as compared to 3,000 cases over the same period the year before. Aid workers described the increase as an emergency situation that should serve as a “ringing alarm bell”. 
 
It was the culmination of several years of decreasing vaccination coverage due to rising insecurity, decreased access, difficult terrain and harsh winters that cut off thousands of villages. Last year’s severe drought also contributed. 

Routine immunization is supposed to cover measles, polio, Hepatitis B, Haemophilus influenza type B, diphtheria, pertussis, tetanus and tuberculosis. 

“The main issue is access,” said Maria Luisa Galer, the coordinator of the international aid community’s health cluster in Afghanistan. “We probably have to revise and adapt the strategy to this context,” she told IRIN. 

In its 2011-2015 plan for the National Immunization Programme, the Ministry of Public Health writes: “Considering the current constraints and challenges in Afghanistan, reaching 95 percent [measles vaccine] coverage nationally and at least 80 percent in each district through routine immunization services is not easily achievable.” 

According to the UN Office for Coordination of Humanitarian Affairs, the number of suspended or non-functional health facilities in Afghanistan increased by 40 percent between 2011 and 2012, reaching 540. 

The Basic Package of Health Services (BPHS), the government programme responsible for healthcare delivery at the primary level, does not cover the whole country. “On paper it covers 80 percent, but practically it is close to 60 percent,” said Islam Saeed, director of the government’s Disease Early Warning System (DEWS). The rest is left to humanitarian NGOs and the private sector, but they, too, face challenges. 

“Day by day, the [security] situation becomes worse and our access to the people for providing health services becomes more limited,” said Sayed Zubair Sadat, responsible for the Afghan Red Crescent Society’s 45 health clinics nationwide. “We had problems conducting the [Expanded Programme on Immunization] in the border areas and conflict provinces,” he told IRIN. 

“Not covered by anyone”

Experts say nearly 30 percent of the population has no or very poor access to primary health care, including immunization, and the percentage is estimated to be as high as 70 percent in areas of conflict in the south. In some communities, the closest health facility is 70km away. Last year, there were some districts where the government was not present at all. 

“We have lots of big areas… that are not covered by anyone - no health facilities, no private sector, no NGOs in the whole area,” Saeed told IRIN. 

Where vaccinations do take place, quality can also be an issue, and government officials readily admit the lack of capacity of their staff to properly manage cold chains, for example. 

“There has been a decline not only in the coverage, but also in the quality of routine immunization,” said Elena Vuolo, external relations officer with the World Health Organizations (WHO) in Afghanistan. BPHS, which is responsible for immunizations, “is overburdened with several activities they have to carry out with limited resources, and difficult access,” she told IRIN.

In the National Priority Programmes, which outline government priorities until 2015, the government admits many vaccinators lack initial training, and that budget shortages in past years prevented supervisory and monitoring visits by provincial level management teams. It found this to be “a major cause” in decreasing immunization coverage. 

Quality of vaccinations

The last national measles vaccination campaign was in 2009, but according to Shakoor Waciqi, who used to manage the government’s immunization programme in the 1990s but now works with WHO, the target age group was limited and “the quality of the campaign was sub-optimal”. 

''Day by day, the [security] situation becomes worse and our access to the people for providing health services becomes more limited''
Given the number of outbreaks last year, health workers say the immunization clearly did not reach 90 percent of children in every district - the minimum required to prevent outbreaks. According to DEWS, there have been 285 disease outbreaks, including 179 measles outbreaks, in 2012 so far. (An outbreak is defined as more than five cases within a defined geographical area within the incubation period of the disease).

“In some areas, the coverage is less than 20 percent. In some areas, it is zero percent,” Saeed, of DEWS, said. 

Another problem is the lack of a baseline to accurately gauge how many children to target. Afghanistan has not conducted a census since the 1970s. Aid workers worry that the figures used to create targets are outdated, and thus many children are missing in the national statistics.

Preventing a repeat 

As a new winter approaches, WHO is trying to prevent a repeat of last year. 

In July, it began an emergency nationwide measles vaccination campaign, vaccinating more than six million children between nine months and 10 years old in 16 provinces. It is planning to continue with the remaining 18 provinces in November.
 
While measles cases are still appearing, the numbers have decreased sharply after the first phase of the measles campaign, WHO says. In November, the government and WHO will be training immunization officials in advance of the second phase of the measles vaccination campaign.

Health officials are also taking other steps to improve immunization. 

This year, WHO, the UN Children’s Fund (UNICEF) and the Ministry of Public Health combined the measles and polio vaccination campaigns, Vuolo said, suggesting the “piggy-back” model could make better use of resources in the future. 

As part of a winter contingency plan, health workers also started pre-positioning medicines in areas that will be cut off during the winter; and establishing temporary sub-health centres to serve villagers in remote areas through the winter. 

Mobile health teams

The government is increasingly recognizing the important role of mobile health teams, in some cases airlifting teams by helicopter into remote areas. This is part of an approach to tailor immunization strategies to the specific context of an area, instead of applying “one blanket method for every province”, Galer said. The government is also planning to use more female vaccinators to increase access to women; and to improve the reporting forms to improve monitoring.

A new task force is aimed at coordinating activities linked to the surveillance of and response to diseases, bringing together people from different government departments as well as WHO, Saeed and Waciqi said. 

There are also initiatives aimed at integrating the various disease surveillance systems into one mechanism and consolidating all health information under one department responsible for analysis. 

ha/cb

[This report does not necessarily reflect the views of the United Nations]
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POVERTY: SOMALIA: Mogadishu IDPs suffer extortion, eviction



A hard knock life
MOGADISHU/NAIROBI, 1 November 2012 (IRIN) - Already struggling to access sporadic humanitarian assistance, internally displaced people (IDPs) in the Somali capital Mogadishu are also facing eviction by returning landowners and unscrupulous camp "gatekeepers" who siphon away what little aid is received, a new report says. 

"When [insurgent group] Al-Shabab gave up control of the Somali capital, militia leaders, politicians and influential landowners re-consolidated their control over various parts of the city. This control extends to the displacement camps where international humanitarian assistance is directed," notes the report, Gatekeepers and Evictions: Somalia's Displaced Population at Risk, by Refugees International (RI). 

"On site, camp 'gatekeepers,' connected to these local powerbrokers through a complex network of influence, regularly demand a portion of the aid that displaced people receive as 'rent'." 

While some gatekeepers provide security in exchange for payment, others treat IDPs "as commodities for their own personal gain", the report says. 

Lack of management 

RI says the gatekeeper system emerged from "remote-control" service delivery, in which international humanitarian agencies provided assistance through local NGOs, during the years Mogadishu was highly dangerous to operate in. 

A June 2012 report by the UN Monitoring Group on Somalia and Eritrea found that aid agencies working in Somalia "encountered a variety of sophisticated strategies to attract, control and divert humanitarian assistance". "The most pervasive and subtle of these involved the role of IDP camp managers and district officials as 'gatekeepers' to control physical access, manage aid resources and prevent effective monitoring of the use of aid," it found. 

Aid agencies say despite the withdrawal of Al-Shabab from Mogadishu in 2011, several militia groups continue to operate in the city. This insecurity and the lack of organizational structures within the camps continue to make it difficult to provide a steady stream of support. 

"Access to the IDPs remains difficult because of poor security, and humanitarian services are there but irregular. IDPs are coping by setting up bases in several settlements to access all services," Kilian Kleinschmidt, deputy humanitarian coordinator for the UN in Somalia, told IRIN. 

"One major shortcoming has been the lack of management and administrative structures within the IDP settlements, many of which are controlled by unscrupulous NGOs and gatekeepers, who may divert funds and supplies [intended for] the settlements. Some have even been known to set up fake camps, organizing for people to be there when aid agencies are visiting when in actual fact no one lives there," he said. 

Tough conditions 

"Our shelters, which we build ourselves, cannot even protect you from environmental factors like wind and sun, let alone provide our security. Besides this, it is overcrowded, and one is not even able to get enough space to cook or boil water," said Asha Ahmed, an IDP in Mogadishu. 

Healthcare in the camps is also hard to come by. "My womb is in critical condition after I gave birth to a dead infant earlier this year, and I am fearing that this may affect my other subsequent pregnancies," Amina Osman told IRIN. 

Thousands of IDPs recently demonstrated in Mogadishu to demand better service provision and housing. 

"The demonstration was about long-standing issues, and the IDPS are right to express their feelings. We hope that once the [political] transition comes to an end and the government falls into place, humanitarian issues will not be forgotten," Kleinschmidt said. 

"There needs to be a joint effort between line minsters, district commissioners, political leaders, humanitarians and other key stakeholders to ensure sustainable provision of services to the IDPs in Mogadishu." 

He stressed the need for proper policy on IDP settlements, without which humanitarian action would continue to be "sporadic and unpredictable". 

There are no concrete population statistics on the number of IDPs in Mogadishu, but a 2012 survey by the International Committee of the Red Crescent estimated that the number could be as high as 400,000, with 15 percent being urban poor originally from the city. 

Read more
 IDPs in Luuq seek more assistance
 Food insecurity still a problem
 Floods displace thousands in Beletweyne
"IDPs are living in very bad conditions with few humanitarian standards met. We had hoped that many would return after the end of the 2011 drought, but that has not really happened since many of the IDPs found livelihoods in the booming city," Kleinschmidt said. 

"When AMISOM [the African Union Mission in Somalia] took Afgooye [a town 25km west of Mogadishu] in February, many of the IDPs there moved to Mogadishu; many of them have joined the IDPs within and on the outskirts of the city." 

Better aid monitoring 

The RI report also highlights eviction as a major problem faced by Mogadishu IDPs. 

"As Mogadishu develops, businessmen, returning members of the Somali diaspora and government officials are all seeking to reclaim land where IDPs have settled," it states. "Both Somalia's new government and its donors must ensure that any urban planning and development takes into consideration the impact on IDPs." 

The report urges the UN and international NGOs to increase their presence in IDP camps and improve their monitoring of aid delivery, recommending that donor nations increase their funding for monitoring and evaluation. It also says the new Somali government "must hold local officials to account for the theft of aid and prevent any forced evictions of displaced persons or communities that violate international humanitarian law". 

Kleinschmidt noted that several UN agencies and international NGOs were increasing their presence within Somalia. He said 14 UN agencies and NGOs have started reorganizing one of the largest and most notorious IDP settlements, organizing the services’ shelters in a structured manner to promote ease of access. 

"Now that most of the city is fairly accessible, mapping of settlements and service provision is ongoing… while an interagency effort has begun profiling the city's IDP population to better understand who they are," he said. 

Improving security in the camps is also crucial for the expansion of humanitarian assistance. "Security is a precondition for the provision of services. We need stronger policing around the camps. AMISOM police is working with local police to address the issue of militias in the city who are responsible for insecurity. The return of the rule of law is crucial. UNDP's rule of law programme, in cooperation with the humanitarians, is trying to ensure that security in IDP settlements is provided by police,” he said. 

"The solution is not to pour more food and supplies [into the city] if they are not going to reach their intended beneficiaries but to change the security and governance paradigm," Kleinschmidt added. 

kr/hb/rz 

[This report does not necessarily reflect the views of the United Nations]
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POVERTY: NIGER: Farmers must prepare for more flooding



Photo: OCHA
Up to half a million Nigeriens were displaced by flooding this year (file photo)
DAKAR, 1 November 2012 (IRIN) - Elderly Nigerien rice-farmer Adamou Sambeye shows IRIN his rice plot on the banks of the River Niger near the capital Niamey: water lilies fill his still-flooded field. In one corner of it naked children are having fun trying to catch the fish that now swim in it. 

“I put everything I had into this field to produce a good harvest this year,” he told IRIN, adding that he had used two 50kg bags of fertilizer, but the field was flooded soon after he planted his seedlings. 

An inter-ministerial committee set up to assess and help manage flood damage estimates 700 fields in the Tillabéri region where Niamey is located, were flooded this year. Ayouba Hassane, director-general of the Federation of Rice Producer Cooperatives, said 14,000 tons of paddy rice have been destroyed since July. 

Rice farmers usually produce 80,000 tons of the country’s annual 130,000 ton production during the rainy season, while a further 200,000-300,000 tons of rice is imported each year. 

The Niger Basin Authority (ABN) predicts further flooding from mid-November based on the annual rising of the River Niger which occurs both during the rainy season and as river water from neighbouring countries such as Guinea and Mali eventually reaches Niger in mid-November to January. 

According to ABN, the swell will be bigger this year than in recent years. 

Residents along the river say it is already rising again, despite there having been no rain in a month. “This is a normal phenomenon, but excessive rise can cause new floods,” said Valerie Batselaere, head of NGO Oxfam in Niger. 

Flooding between July and October killed 81 people and affected 520,000 - hundreds of thousands of them displaced - according to the UN Office for the Coordination of Humanitarian Affairs. The government called it the worst flooding in decades. 

"A few weeks ago, this whole area [surrounding Niamey] was occupied by water," recalls Sambeye. 

Drainage ditches and flood barriers are urgently needed to protect farmers along the river, said a September 2012 study by NGOs ACTED and Oxfam, and the UN Children’s Fund (UNICEF). 

The same study revealed that among Nigeriens displaced by floods, by far the most vulnerable were the 18 percent who were farmers or market gardeners relying solely on agriculture to get by. 

Given their need for cash - half of displaced families have become further indebted, borrowing up to US$100, according to the survey - and the need for flood protection, the study recommends these farmers be paid to rebuild flood barriers and drainage ditches as soon as possible. 

Oxfam is currently submitting proposals to do this. To date the government and aid agencies have given emergency aid, but no help to rebuild livelihoods. 

Sambeye said he had received nothing thus far. “We need help in repairing the ditches around our paddies if we are to have any hope of feeding our families,” he told IRIN. 

Floods have displaced or damaged the property or crops of at least 3 million people across West and Central Africa this season, according to the latest official figures. 

bb/aj/cb 

[This report does not necessarily reflect the views of the United Nations]
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MALNUTRITION: International Facing the Facts on World Food Day: Scarcity Isn't the Problem



CEO, Action Against Hunger | ACF 
Posted: 10/16/2012 3:47 pm

It's a good thing you're reading this piece electronically, because if you had a hard copy chances are it'd now be accessorized by a coffee ring and crumbs from your breakfast. I wouldn't mind, though. You might take a moment to feel extra appreciative of that spoonful of cereal as today is World Food Day.
Over the years, as I've traveled the globe with Action Against Hunger, many faces and stories have stuck with me -- some haunt me -- but one teenage boy named George I met three years ago in Uganda has come to serve as my guiding star. By the time I met George, Uganda was emerging from the depravity of a long civil war like none other in which young children were abducted and forced to kill or be killed. We talked about the struggles he and his family faced -- the loss of friends and family to the war and the hunger and thirst that stalked his part of northern Uganda for years afterwards. He expressed a deep appreciation for the assistance he and his community had received, which had saved their lives and helped them regain stability and dignity. This kid had a wisdom and warmth that seemed a small miracle -- and a symbol of a hopeful future. In passing a colleague said to the teen, "Hey, maybe you can work with us one day!" He paused, thought a moment, and replied, "Thank you, but I really hope you won't need to be here by the time I'm grown up." I so want to make him right. It's his face I see when I think about what's possible.
What George somehow knew was that even though the aid he was getting was needed at the time, he and his generation had to eradicate hunger for good. Not by filling and re-filling a void, but through permanent, sustainable solutions. Ending hunger, George knew, is the critical first step toward education and prosperity. So, what do we need to do to make it so? First and foremost, we need to debunk the major myth that persists -- that hunger is all about food scarcity. It isn't. The Institute for Food Policy and Development once cited this as its number one myth about hunger. We live in a world with abundance, where there's actually enough food to feed every person twice over. The problem is one of access, of poverty.
It's also one of nutrition. Our focus shouldn't be so single-mindedly about making more food, but rather getting better food to those who need it -- especially children. Earlier this year at the Copenhagen Consensus, top economists from around the world concluded that the single most effective investment to combat the world's greatest challenges is micronutrient interventions for children, in the interest of fighting hunger and improving education. For example, something as simple and inexpensive as fortifying foods with Vitamin A and Zinc -- nutrients that were in your morning breakfast cereal -- has been proven to significantly increase immunity and decrease rates of infection, which are key to ensuring child growth and development.
We're at a critical turning point in our efforts to give the world's hungry children a second chance. For the first time in measured history, child deaths have fallen below seven million per year across the globe. Data released just last month by UNICEF and the United Nations Inter-agency Group for Child Mortality Estimation show that the number of children under the age of five dying globally has decreased, from nearly 12 million in 1990 to an estimated 6.9 million last year.
My colleagues in the NGO community and I are of course thrilled that the trend line of hunger continues to decline. The tragedy is that more than a third of those 6.9 million child deaths were caused by undernutrition. Acute malnutrition kills, and when it doesn't, it can cause permanent cognitive and physical damage. It really, truly, unequivocally doesn't have to be. Acute malnutrition is predictable and preventable, and totally treatable. It's also completely affordable; the micronutrient interventions I referenced above cost next to nothing per meal. For those kids already suffering from acute malnutrition, just $45 can provide a full treatment regimen. Ready-to-use therapeutic foods, or "RUTFs" in NGO-speak, are cheap, portable, and highly effective.
It makes sense that I'm thinking of George today, but the truth is that I think of him often. He's right, you know. NGOs like mine shouldn't have to work in Uganda, or anywhere else. It may sound crazy, but every single day I am diligently trying to work myself out of a job. It can happen in our lifetime. It should. It must.
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MALARIA: Study backs 'controversial' malaria drugs subsidy

31 October 2012


Jane DreaperHealth correspondent, BBC News
Malaria drugCombining drugs can reduce the risk of resistance

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Researchers who evaluated a global subsidy for malaria treatment say it had a substantial impact in a short space of time.
Publishing their results in The Lancet, the global health experts acknowledged that the scheme had been "highly controversial".
The Affordable Medicines Facility for malaria (AMFm) was called into question by Oxfam last week.
The research says it reduced the price of drugs and led to more treatment.
AMFm was launched in seven African countries by the Global Fund with the aim of bringing down the price of the most effective form of malaria treatment, to discourage problems with resistance.

“Start Quote

"This programme rapidly met its benchmarks despite the many constraints, expectations and unrealistic timelines imposed on it”
Comment article by scientistsThe Lancet
The researchers, led by a team from London School of Hygiene and Tropical Medicine, found the subsidy led to large falls in the price of drugs in most of the pilot schemes.
They said: "There had been concern that the poorest would not benefit from the programme, because the drugs were not free.
"The effect of AMFm in Niger and Madagascar was limited, with low orders.
"In all other pilots, it's likely AMFm had a dramatic effect on drugs sold through the private for-profit market.
"These changes were substantial and achieved in only a few months, which showed the power of tapping into the distributional capacity of the private sector."
Oxfam has criticised the scheme for focusing on "untrained shopkeepers" to help deliver treatment in rural communities - but supporters of AMFm claim these objections are purely ideological.
US opposition
The evaluation did not measure health outcomes, and the researchers said data on the use of treatment was not yet available.
In an accompanying comment article, 10 eminent scientists noted "unremitting opposition" to AMFm from the United States, and appealed for the scheme to be preserved in its current form when the Global Fund's board decides its future next month.
The scientists said: "This programme, when fully implemented, rapidly met its benchmarks despite the many constraints, expectations and unrealistic timelines imposed on it.
"We must acknowledge that an efficient approach to subsidising anti-malarial drugs has worked, making them available in the private sector where people go to buy them."
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