Bill and Melinda Gates: Aid Mythbusters

For some reason, people do not know how much the world continues to improve. Bill and Melinda Gates took to the Wall Street Journal to bust a few myths and show that a lot of assumptions held by Americans are just plain wrong.

The two leaders of the Gates Foundation are set to publish their annual letter, timed to coincide with world leaders meeting in Davos, Switzerland for the World Economic Forum, tomorrow. The WSJ OpEd looks to be a preview of what is to come. Here are the highlights from each of the myths:

Poor countries are doomed to stay poor.

They’re really not. Incomes and other measures of human welfare are rising almost everywhere—including Africa…

In our lifetimes, the global picture of poverty has been completely redrawn. Per-person incomes in Turkey and Chile are where the U.S. was in 1960. Malaysia is nearly there. So is Gabon. Since 1960, China’s real income per person has gone up eightfold. India’s has quadrupled, Brazil’s has almost quintupled, and tiny Botswana, with shrewd management of its mineral resources, has seen a 30-fold increase. A new class of middle-income nations that barely existed 50 years ago now includes more than half the world’s population.

And yes, this holds true even in Africa. Income per person in Africa has climbed by two-thirds since 1998—from just over $1,300 then to nearly $2,200 today. Seven of the 10 fastest-growing economies of the past half-decade are in Africa.

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The Daily Impact: Food aid reaches isolated Syrian town

January 20, 2014

Food aid reached a besieged suburb of Damascus, reaching thousands of trapped civilian who are malnourished and without medicine due to being cut off from any support. From Reuters:

The delivery was the first to the Yarmouk Palestinian district, where 15 people have died of malnutrition and 18,000 are trapped, since forces loyal to President Bashir al-Assad imposed the siege seven months ago.

An attempted United Nations aid trip on Monday was aborted when gunfire erupted but a safer route was used on Saturday, residents said.

An activist in Yarmouk, who asked to remain anonymous as the topic is sensitive, said that only 50 food parcels had arrived. “The supplies entered from a government-held checkpoint. Women are gathering to take the supplies,” he said.

Aid workers in Syria have accused authorities of hampering deliveries to opposition-controlled areas and threatening groups with expulsion if they try to avoid bureaucratic obstacles to help those trapped in an almost three-year civil war.

Syria blames rebel attacks for aid delays.

The Yarmouk activist said the food distribution was organized by local Palestinian groups in Yarmouk. State media said a delivery was made but did not give details.

Syria is home to half a million Palestinians, refugees of the 1948 conflict which led to the creation of the state of Israel. Before the 2011 uprising against Assad, many lived in Yarmouk on the southern edge of the Syrian capital.

Since then, around 70,000 Yarmouk residents have fled.

Those that remain have been trapped with rebels under the government siege. Opposition activists say residents have survived by scavenging for food and highly dangerous smuggling trips. The United Nations has called for greater access.

Chris Gunness, spokesman for the U.N. Relief and Works Agency (UNRWA), said it donated 200 food parcels on Saturday after authorities requested its support for the delivery.

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Matt Damon’s Lessons on Innovative Philanthropy

Actor Matt Damon helped to co-found water.org with Gary White. The two are dedicated to finding solutions to the problem safe drinking water experienced by millions of people around the world. In their years of work, the two have learned that partnerships are a key to solving some of the sector’s most intractable problems.

“As water scarcity becomes all too real, collaboration will become essential,” write Damon and White in The Economist.

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“Although governments need to lead and commit themselves to infrastructure expansion and affordable service, in 2014 it will be corporate financial innovation and smart philanthropy that help to bring safe water and sanitation to some of the billions in need.”

PSI has been working with partners like Unilever and Merck on a wide range of areas. Damon and White have it right, partnerships are the most effective way to find sustainable solutions. That is because the unique expertise and assets brought to the table by different people and organizations can fill in any potential gaps.

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The Daily Impact: Liberia Launches National Pneumonia Campaign

January 17, 2014

Liberia’s President Ellen Johnson Sirleaf launched a new anti-pneumonia campaign this week. Deutsche Welle reports:

At the Redemption Hospital in the Liberian capital Monrovia, Henrietta Fatoma, is waiting with her son Francis Harmon. “I brought him for vaccination,” she told Deutsche Welle. “We are encouraged to bring our children for vaccination because it is good for them,” she said.

The World Health Organization (WHO) says that pneumonia is the single largest cause of death in children worldwide.

Henrietta Fatoma waiting for her son to be vaccinated

It is an acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli which fill up with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid which makes breathing painful and limits the oxygen intake.

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. It can be prevented by vaccination, adequate nutrition and by addressing environmental factors such as indoor air pollution and parental smoking.

The WHO also recommends exclusive breastfeeding for the first six months of a child’s life so as to build up its natural defenses against disease.

The WHO says that pneumonia kills more than a million children under the age of five every year

Pneumonia caused by bacteria can be treated with antibiotics but globally only 30 percent of children with the disease receive the antibiotics they need.

(snip)

Tolbert Nyenswah, assistant minister at Liberia’s Ministry of Health and Social Welfare, said they were planning to vaccinate more than 100,000 children. “Last year we lost 7,000 children from pneumonia alone. If we had had this vaccine would have averted a lot of those deaths,” he said.

The vaccination program is being sponsored by the Global Alliance for Vaccines and Immunization (GAVI), a public-private global health partnership committed to increasing access to vaccines in poor countries. It brings together governments, the WHO, the vaccine industry and private philanthropists.

With this program, Liberia hopes to cut its infant mortality rate.

One of the Millennium Development Goals is to reduce infant mortality for under-fives by two thirds between 1990 and 2015.

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Campaign successfully identifies HIV positive persons, in Cameroon

This story appeared in the recent ACMS newsletter.

Under the leadership of its HIV Department, the Association Camerounaise pour le Marketing Social (ACMS) once again highlighted its noble mission, which is to improve the health of vulnerable people in Cameroon sustainably and measurably.

For one week, the people in Douala, Yaoundé, Ebolowa, Ambam and Kye-Ossi had the opportunity to get free HIV screening tests. With the support of teams from mobile units in regional technical groups in the fight against HIV of the National Centre for the Fights against AIDS, the dynamic ACMS team enhanced by peer educators from the project 100% Jeune, especially the “Reglo Girls”, roamed markets and hot spots in the cities concerned to mobilize people and raise awareness about the importance of knowing their HIV status.

From the Mokolo market in Yaounde through the place known as Base Elf in Douala, people across ages and gender overcame the fear and prejudice to get tested. Outside major cities, residents in border towns like Kye-Ossi (Cameroon- Equatorial Guinea border) and Abang Minko’o (Gabon-Cameroon border) also enjoyed the opportunity offered the ACMS to know their HIV status. For the case of these border towns especially, they often host both seasonal workers and sex workers who are among the most at risk populations.

At the end of the campaign that mobilized ACMS staff for seven days, 8,909 were recorded, including 331 who were tested positive. Several gifts such as condoms and educational brochures were given to individuals who came for their results in order to encourage them to adopt healthy behaviors.

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The Daily Impact: More than $2 Billion Pledged for Syria, says UN

January 16, 2013

Donors pledged some $2.4 billion for the Syrian crisis response, said UN Secretary General Ban. From Reuters:

The pledge arose from a U.N. appeal for $6.5 billion in 2014, which was launched last month and is the largest in the organization’s history.

The world body estimates the conflict has reversed development gains in Syria by 35 years, with half its people now living in poverty.

But only around 70 percent of $1.5 billion pledged at a similar meeting last year has reached U.N. coffers, hinting at donor fatigue with no end to the bloodshed on the horizon.

U.N. humanitarian chief Valerie Amos said all sides in the conflict had shown “total disregard for their responsibilities under international humanitarian and human rights law”.

“Children, women, men are trapped, hungry, ill, losing hope,” Amos told the 69 countries attending a donor conference held in Kuwait.

The Gulf state’s ruling emir, Sheikh Sabah al-Ahmed al-Sabah, promised $500 million in new aid, while the United States announced a contribution of $380 million.

Qatar and Saudi Arabia pledged $60 million each. The European Union pledged $225 million and Britain $165 million.

U.N. Secretary-General Ban Ki-moon said the total was more than $2.4 billion.

Money raised last year in Kuwait was used by the United Nations to provide food rations, medicine, drinking water and shelters for people in Syria and surrounding countries.

The largest donations at that conference came from Gulf Arab governments, which have mainly backed Syrian rebels trying to oust President Bashar al-Assad.

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Global Health and Development Beat

Valley Fever - A new report in The New Yorker investigates the problem of fungus Coccidioides immitis, kicked up by dust storms in the American west and causing health problems.

Plague - Researchers say that the poor conditions of prisons in Madagascar contribute to the recurrance of the plague in the country.

Refugees - Thousands of South Sudanese have been arriving in northern Uganda, where their situation is dire and has elicited security concerns.

Hunger - Some rain has not provided relief from the drought in Namibia, says the government expressing concerns of hunger.

Disability - Children with disabilities in Mozambique are marginalized by stigma and lack of opportunity.

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The Players

UN - UNSG Ban strongly condemned the commandeering of humanitarian vehicles and the theft of food and other desperately needed aid by government and anti-government forces in South Sudan.

WFP - Launched, this week, a nearly $58-million operation in South Sudan to provide aid to up to 400-thousand people.

UN - Warned that around 245,000 Syrians are living in towns and cities under siege and facing extreme hardships, including food shortages.

USAID - A rundown of what the nearly $3 billion in US aid to Haiti has achieved in the four years since the earthquake, reports the GlobalPost.

DfID - Aid experts say DfID should produce an overarching strategy on disability as it would send an important message to its staff and other organisations that it was taking disability seriously.

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Spotlight on PSI

The status quo is not working in the fight against meth in Thailand. Groups working on the ground, like PSI, say policy changes are necessary to make a difference. From IRIN:

Thailand’s Office of the Narcotics Control Board (ONCB) revealed that in 2013 there were almost 50,000 more drug arrests and about 40 million more meth pills seized, compared to 2012.

Meth has become cheaper and easier to obtain because levels of manufacturing and trafficking from Myanmar continue to increase as a result of opium eradication efforts there, advocates say. A single meth pill costs as little as US$4 on the street in Thailand.

“If it’s about controlling the [illegal drug] market, it has been a complete and utter disaster,” Pascal Tanguay, a programme director with the NGO, Population Services International in Thailand, said of the government’s anti-drug policy.

A 2013 report by the British Columbia Centre for Excellence in HIV/AIDS found that drug abuse and corruption is also widespread among Thai police, and is affecting the country’s war against drugs.

Many drug users claim they have had drugs planted on them, have been beaten, or forced to take an unlawful urine test, or have had to pay a bribe to police officers, who have also been known to sexually assault female drug users, advocates claim.

“There needs to be a policy that makes drug users feel comfortable about accessing health services,” said Tanguay, whose NGO promotes harm reductionservices intended to prevent the dangers associated with drug use.

(snip)

Thailand’s Ministry of Justice announced in August that it would consider decriminalizing kratom, a tropical tree in the coffee family that can have stimulant effects at low doses. Kratom could serve as a substitute in drug dependence programmes and help manage cravings and withdrawal symptoms.

“I think it’s very interesting that Thailand is going in that direction,” Tanguay said. “There’s an opportunity for substitution treatment and also a possible economic market for it [kratom].”

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Buzzing in the Blogs

Bill Gates blogs why it matters that India crossed the polio-free milestone this week.

Five years ago, India was home to nearly half of the world’s new polio cases. At the time, if you asked any health expert, they would have said India would be the last place on earth to end polio. India’s population density and high birth rate (27 million new children are born each year), combined with poor sanitation, was like a petri dish for polio.

But the government of India, with help from the organizations that make up the Global Polio Eradication Initiative including Rotary International launched an all-out effort to stop the disease. The country deployed 2 million vaccinators to reach children who had never before been reached with polio vaccines or any other health services—children who live in flooded regions or hard-to-find rural towns, or are regularly in-transit with their families. One of the most powerful images I’ve seen during my visits to India is that of parents proudly holding vaccination cards showing that their children were protected from deadly diseases for the first time.

And now that these children have been found, health workers can supply them with much more than just polio drops. They can provide other critical health services like measles vaccines, clean water, and information about how to deliver their babies safely and care for them during their first weeks of life.

India’s victory galvanized the global health community to commit to achieving a polio-free world by 2018. Now, we only have 3 more countries to go, down from 125 in 1988. All three countries face unique challenges that make eradication difficult, but India’s success gives the polio program valuable lessons to apply in the remaining countries and confidence that eradication is possible.

India’s success is cause for celebration – but not complacency. We saw last year, in Syria and the Horn of Africa, how this disease can silently spread to places that have not had cases in many years.  Two years before, polio popped up in more countries, including China and Tajikistan. These outbreaks are stark reminders that as long as polio exists in the last reservoirs in Northern Nigeria, Pakistan, and Afghanistan, the disease is still a threat everywhere. India showed us what is possible – we can end polio, and protect all children everywhere from this debilitating disease forever. Doing the hard work to make this dream come true is up to us.

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Capital Events

Thursday

4:00 PM - How Social Movements Succeed: Lessons from HIV/AIDS - CGD

Friday

12:00 PM - The Organization of Islamic Cooperation: Free Speech Implications of a Proposed Ban on “Islamophobia” - Hudson Institute

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By Mark Leon Goldberg and Tom Murphy

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Mixed Grades for US Reproductive Health Report Card

If states were people, the parents of California, Washington, Oregon, and Maryland would be pretty darn proud. They are the only states to receive A’s on the Population Institute’s annual State of Reproductive Health And Rights report card.

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On the other hand, the disappointing set of states are Texas, South Dakota, Mississippi, Missouri, Louisiana, and Indiana. All an F-. Given that F stands for failure, doing worse than a plain old F is pretty bad.

The overall picture is not too great. The report scores the US as a whole with a C-. Though it is not all bad news.

“This year we have seen a lot of victories at the national level, but with states limiting the full scope of that progress. The major victories include: HHS ruling that Plan B One Step be made available over the counter without an age restriction, the Affordable Care Act giving women access to family planning services without a co-pay requirement, and expanded Medicaid eligibility ensuring that millions more women would be eligible to access reproductive health services,” said Population Institute President Robert Walker.

“Unfortunately, at the state level, attacks on reproductive health care have continued unabated and 25 states have refused to expand their Medicaid program denying millions of women access to health care.”

Here are how all the states fared:

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The scores are on a 100 point scale and broken down by the following criteria:

- Thirty percent of the grade is based on measures of effectiveness. This includes the latest available data on the teenage pregnancy rate (15%) and the rate of unintended pregnancies (15%).
- Twenty percent of the grade is based upon prevention. This includes mandated comprehensive sex education in the schools (15%) and access to emergency contraception (5%).
- Thirty percent of the grade is based upon affordability. This includes if states are expanding Medicaid under the Affordable Care Act (10%), Medicaid eligibility rules for family planning (10%), and funding for family planning clinics serving low-income families (10%).
- The final twenty percent of the grade is based upon clinic access. This includes abortion restrictions (10%) and percent of women living in a county without an abortion provider (10%).

Read the report here.

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The Daily Impact: Global Fund and UNAIDS Concerned by Nigeria Gay Ban

January 15, 2014

The Global Fund and UNAIDS are worried that the passage of a new law criminalizing homosexuality in Nigeria will harm progress against HIV/AIDS.

image001The new law could prevent access to essential HIV services for LGBT people who may be at high risk of HIV infection, undermining the success of the Presidential Comprehensive Response Plan for HIV/AIDSwhich was launched by President Goodluck Jonathan less than a year ago.

The health, development and human rights implications of the new law are potentially far-reaching. Homosexuality is already criminalized in Nigeria. The new law further criminalizes LGBT people, organizations and activities. The law states: “A person who registers, operates or participates in gay clubs, societies and organisation, or directly or indirectly makes public show of same sex amorous relationship in Nigeria commits an offence and is liable to conviction to a term of 10 years imprisonment.

The law also criminalizes any individuals or group of people who support “the registration, operation and sustenance of gay clubs, societies and organisations, processions or meetings in Nigeria.” The conviction is also 10 years imprisonment.

The provisions of the law could lead to increased homophobia, discrimination, denial of HIV services and violence based on real or perceived sexual orientation and gender identity. It could also be used against organizations working to provide HIV prevention and treatment services to LGBT people.

Nigeria has the second largest HIV epidemic globally––in 2012 there were an estimated 3.4 million people living with HIV in Nigeria. In 2010, national HIV prevalence in Nigeria was estimated at 4 percent among the general population and 17 percent among men who have sex with men.

In the 2011 United Nations Political Declaration on HIV/AIDS, all UN Member States committed to removing legal barriers and passing laws to protect populations vulnerable to HIV.

UNAIDS and the Global Fund call for an urgent review of the constitutionality of the law in light of the serious public health and human rights implications and urge Nigeria to put comprehensive measures in place to protect the ongoing delivery of HIV services to LGBT people in Nigeria without fear of arrest or other reprisals. UNAIDS and the Global Fund will continue to work with the Nigerian authorities and civil society organisations to ensure continued and safe access to HIV services for all people in Nigeria.

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Global Health and Development Beat

Women - A women’s group says the military in Burma is still using rape as a weapon of war, with more than 100 women and girls raped by the army since a 2010 election.

UHC - The rollout of universal health coverage in Indonesia has been greeted with public enthusiasm, but health experts warn that inadequate funding could undermine the quality of care.

Haiti - Thousands of Haitians sought refuge on the island of La Gonave after the earthquake, but little help arrived reports the GlobalPost.

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The Players

Syria - NGOs pledged $400 million in support of the humanitarian response to the crisis in Syria, in Kuwait. International donors are expected to pledge more today.

WFP - Is very concerned about food security as Zimbabwe enters the peak of its so-called hunger season — the last three months before the traditional harvest.

HRW - Human Rights Watch called on international donors to demand access for relief deliveries to Syrian civilians trapped by the fighting.

WFP - The WFP delivered rations to a record 3.8 million people in Syria in December, but civilians in eastern provinces and besieged towns near the capital remain out of reach.

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Spotlight on PSI

Despite a decreasing prevalence of HIV/AIDS among commercial sex workers, stigma and the harsh laws are undermining sex workers’ access to HIV-related services. IRIN spoke to PSI, UNAIDS and others about the challenges:

“Prevalence has been decreasing in all risk groups other than drug users,” Anne Lancelot, director of the Targeted Outreach Programme at Population Services International (PSI) confirmed.

Surveys reveal that in 2008, prevalence among sex workers stood at 18.4 percent, whereas 7.1 percent of sex workers were HIV positive in 2012.

While government data estimates that there are currently 60,000 sex workers in Myanmar, PSI puts the real number at closer to 80,000. The national HIV infection rate is 0.5 percent, making HIV/AIDS a concentrated epidemic, said Murphy, adding, “However there have been quite a lot of deaths due to a lack of access to treatment.”

The stiff penalties for commercial sex work contained in Myanmar’s Suppression of Prostitution Act (1949) are a major barrier to accessing HIV treatment. The punishment is one to three years in prison for sex workers, but clients are not punished under the law.

“Very harsh laws are in place against sex workers, instead of the mobilizers, the traffickers and the gangs who push women into sex work,” said Sid Naing, the country director for Marie Stopes, an international NGO working to improve sexual and reproductive health.

Even possessing a condom could be used as circumstantial evidence of prostitution until 2011, when the Ministry of Home Affairs issued a directive to the contrary, yet according to UNAIDS most of the public are unaware of the directive.

“People are still not comfortable about carrying large amounts of condoms because they could be targeted as sex workers,” PSI’s Lancelot noted.

Another barrier to the prevention and treatment of HIV is the stigma surrounding commercial sex work – the word “prostitute” literally translates to “bad woman”.

“Myanmar isn’t like other countries where sex work is more organized, with red-light districts which are brothel-based. There’s a great deal of indirect sex work, such as in massage parlours and karaoke bars,” said Krittayawan Tina Boonto, the UNAIDS investment and efficiency advisor.

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Buzzing in the Blogs

The cross-cutting effects of NTDs make it crucial that the international community prioritize them in the post-2015 development agenda, says Neeraj Mistry in the Guardian.

To build on these commitments, we must ensure that endemic countries have the capacity to deliver medicines to the most at-risk communities and achieve sustainable progress. Endemic countries have a critical role to play in demonstrating political will to prospective development partners by expanding “last mile” access and raising in-country support for NTD control and elimination efforts. This increase in demand will encourage donor governments to include NTDs in their future global health and development investments. As the millennium development goals expire in 2015, we have a great opportunity to focus on NTDs and identify effective areas of integration of NTD control into broad development programmes, but to take advantage of that opportunity, three things must happen:

The first step is to encourage UN decision-making bodies to embrace the recommendations issued by the UN high-level panel of eminent persons on the post-2015 development agenda, and incorporate NTDs in the revised post-2015 development framework and related sustainable development goals.

Civil society organisations and individuals must also continue to play a key role in influencing the discussion. Last autumn, over 3,000 people worldwide urged the UN to include NTDs in the post-2015 development agenda. The UN secretary general’s special adviser on post-2015 development planning positively responded: “I share your view that the fight against NTDs is paramount to the global efforts to eradicate poverty and achieve sustainable development.”

It will take broad resources to overcome the current funding gap of approximately $300m (£220m) each year (pdf). WHO’s regional director for Africa Luis G Sambo emphasised this in October: “We need sustained support from all stakeholders.” This requires intensive advocacy that urges policymakers in donor and endemic countries alike to recognise how NTD control and elimination will help advance progress in many of their current health and economic development priorities.

Ultimately, endemic countries must self-finance NTD programmes within existing budgetary structures to ensure sustainability; however, leadership from both donor and endemic countries is needed now to quickly develop and expand programmes.

By including NTDs and specific targets in the post-2015 development agenda, we will support country-led efforts to reach control and elimination goals, improve the health and well-being of hundreds of millions of people, and accelerate progress in global poverty reduction by 2030 and beyond.

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Capital Events

Wednesday

10:00 AM - Powering Africa – A Conversation about Progress and Prospects - CGD

2:00 PM - Subcommittee Hearing: A Report on the G-8 Dementia Summit - US House Committee on Foreign Affairs

2:00 PM - Global Youth Workforce Development - CSIS

Thursday

4:00 PM - How Social Movements Succeed: Lessons from HIV/AIDS - CGD

Friday

12:00 PM - The Organization of Islamic Cooperation: Free Speech Implications of a Proposed Ban on “Islamophobia” - Hudson Institute

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By Mark Leon Goldberg and Tom Murphy

Sign up on the right-hand column to receive the Daily Impact in your inbox each morning!

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Come Learn about the Equity Measurement Toolkit

The Social Franchising Metrics Working Group is pleased to invite all interested participants to the webinar launch of the Equity Measurement Toolkit. This toolkit, sponsored by the International Finance Corporation, includes everything a health program needs to measure the wealth distribution of its clientele. Contents include text and video tutorials; surveys; and training, planning and pre-programmed data analysis tools.

Webinar participants are invited to preview the toolkit ahead of the event. Upon registration confirmation, you will receive a link to the password-protected site.

Date: Tuesday January 28, 2014
Time: 5:20 AM PST

Agenda (in Pacific Standard Time):

5:20 – 5:30 am: Audience members sign in and fine-tune their audio set-up

5:30 – 5:35 am:  Introductions and welcome (Speaker: Andrei Sinioukov)

5:35 – 6: 25 am: Orientation on the equity measurement toolkit (Speaker: Kenzo Fry)

6:25 – 6:45 am: Questions and answers

Participants are encouraged to submit questions to the speaker ahead of time. The webinar organizers will follow this notice with an email invitation to you to join the online Social Franchising Community of Practice. Simply accept the invitation and post your questions on the discussion board.

This event is hosted by the Private Sector Healthcare Initiative, Global Health Group, University of California at San Francisco.

To register, go here.

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Is the Female Condom the New It Thing?

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You can’t really call it a comeback. The female condom initially failed to gain support and use when it was introduced two decades ago. Now, groups like PSI, Pathfinder and others are helping to revitalize the once cast-aside family planning tool by working with partners at the government, business and individual level.

Success is coming thanks to innovative new condoms and changing the ways to sell them to women. For example, PSI is working with hair salons to sell condoms to women. The informal atmosphere allows for freewheeling discussions and a safe space for women to learn about family planning options.

New research about the female condom is promising. The BBC summarized a trial published in the Lancet, by Mags Beksinska from the University of the Witwatersrand in South Africa.

- The Woman’s Condom, already available in China and soon to be distributed in South Africa, is the fruit of a 17-year project by Path – an NGO that specialises in health innovation – which has tested more than 50 versions. Out of the packet, it’s smaller than the FC2. It looks like a tampon, with most of the condom gathered into a rounded polyvinyl capsule, which dissolves inside the vagina. Once it has expanded, dots of foam help keep it in place.
- The Cupid is available in India, South Africa and Brazil. It is vanilla scented and comes in pink or natural colours. It is currently the only model besides the FC2 to have been qualified by the World Health Organization (WHO) for public-sector purchase. A smaller version aimed at the Asian market is in trial.
- The VA Wow, like the Cupid, contains a sponge which helps users to insert the condom and prevents it slipping.

It goes on to speak with various advocates and people working on the frontlines of women’s health, including PSI affiliate the Society for Family Health.

In Africa, the free availability of female condoms at clinics has led to an unexpected fashion trend. Women have taken to removing the flexible ring from the device and using it as a bangle. “If you are [romantically] available you have a new bangle on,” says Marion Stevens from the female health campaigning body Wish Associates. “If you are in a long-term relationship your bangle is old and faded.”

Meyiwa Ede, from the Society of Family Health in Nigeria (sic), says that while men are often excited by the prospect of sex without having to wear a regular condom, women are taken aback by their first glimpse of the device.

“They look at it and say ‘OK – are you saying I have to put that in myself?’” she says.

Ede’s team of demonstrators use a mannequin to show the condom is inserted and compare the task to using a new phone – bewildering at first, but second nature after a while.

In most developed countries there is still that 20-year-old image problem to overcome.

“I think the issue is when you open the package they’re already open – they’re not like male condoms that are in these neat little packages and then they’re unrolled,” says Mags Beksinska from the University of the Witwatersrand in South Africa. “In fact, they’re the same length as a male condom so if you hold the two together open, they’re not that different.”

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