I've ceased to expect much from the English Guardian on the subject of development now that their development section is "in partnership with the Bill and Melinda Gates Foundation". But a recent blog post from the section takes pretty much the opposite stance to that of the Gates Politbureau when it comes to the question of basic water, sanitation and hygiene over vaccination.
The Gates publicity machine tends to gush about vaccines, about how they are the future of health and development, about how they are investing $10 billion in them, advocating for a 'decade of vaccines', etc. This flies in the face of public health experience over many decades. For Gates, public health means giving people some drugs and letting them swallow them with contaminated water.
But according to the Guardian article, the World Health Organization estimates that 10% of global disease could be prevented through the provision of safe water, sanitation and hygiene facilities. That estimate sounds rather low, especially for infant and childhood diseases. But at least it is recongized that conditions such as cholera and guinea worm can not be eradicated without providing people with the basics.
Gates, on the other hand, wishes to sink much of his Foundation's money into a vaccine for cholera and polio, with only dribs and drabs going to WASH. And it's not just the Foundation's money that is involved here. It seems that when the Foundation makes a pronouncement about anything, regardless of its serious lack of understanding of the issues, global policy does likewise.
The massive cholera epidemic currently raging in Haiti is a result of a lack of water, sanitation and hygiene services in the country. This lack is not purely a result of some recent disasters, either. The country has been left dangerously underdeveloped as a result of numerous factors, many of them political. Even if a vaccine was available, people would be unlikely to have received it in Haiti and they would likely have been infected with many of the other water borne diseases that are as debilitating and deadly as cholera.
The author of the Guardian article, Yael Velleman, is a policy analyst at WaterAid. The article also calls for closer cooperation between government departments responsible for health, on the one hand, and water, sanitation and hygiene, on the other. This means that donors and those working in development need to connect these two development themes and recognize that they are interdependent.
So, yes to vaccines and other medical technologies. But without better living conditions, they will make little or no difference to people's lives. WASH must come first because without it vaccines will be useless. If you don't believe me, carry out this quick thought experiment: mix vaccine with water drawn from the nearest source of contaminated water and swallow.
These are excellent and sobering insights from WaterAid and Yael Velleman, in particular. There is more on the above issues on their website, including some clarification of the Gates Foundation's stance on immunization and how inimical it is to development (my words, not hers!). The issue is covered in pictures in another Guardian article.
Showing posts with label diarrhoea. Show all posts
Showing posts with label diarrhoea. Show all posts
Monday, May 23, 2011
Thursday, April 23, 2009
Immediate Needs Sidelined by HIV
Wildly exaggerated estimations of how many lives could be saved by mass male circumcision or universal HIV testing and treatment grab the headlines. But stories about being able to save two million children a year who are dying from diarrhoea don't seem to attract so much attention. The treatment for the acute diarrhoea that kills children, an oral rehydration solution of a pinch of salt and a handful of clean water (CLEAN water!), just doesn't jingle the way expensive programmes and drugs do.
Another thing that doesn't grab headlines is something like a nutrition programme that targets starving children. Free meals in a school in Tanzania has had the effect of increasing attendance and allowing almost all children to graduate from primary to secondary school. Before the programme started, pupils who made it to school were too tired and undernourished to concentrate and most failed to finish primary school. Mainstream media has a taste for good news sometimes, but this seems to lack the high sugar content that appeals to them.
If children just turned up at school to be fed and then left or didn't bother to do any work, this programme would be disappointing. But the fact that they were enabled to go on to secondary school means that the programme could have many benefits aside from nutritional and educational. According to the most recent figures, fewer children go to secondary school in Tanzania than in Kenya or Uganda. And only around 1% go to tertiary level education.
One of the problems with current HIV prevention programmes, the ones that are implemented in schools, anyhow, is that the general level of education in the country is low. I have met people who, at the age of 15, started having sex, usually with an older partner. That's not the surprising bit; the surprising bit is that they didn't know what sex was or if they did, they didn't know that that's what they were indulging in.
I came across a paper about reproductive awareness among adolescent girls (10-19 years) in Bangladesh and many had incorrect knowledge or misperceptions about reproduction, the fertile period, STIs and HIV. This is often connected with the educational status of girls or that of their mother. 18 out of 20 married adolescents who had recently given birth didn't understand why they had become pregnant. Most had never heard of STIs and while 40% had heard of HIV, only 20% had knowledge about how HIV is transmitted.
Many girls experience sex of some kind in their teens, whether they chose it or not. Most of them know so little about sex that they don't know how to avoid doing what someone is coercing them into doing, they don't know how to negotiate precautions, such as using a condom, they may not even know what condoms are, where to buy them or how to use them. To understand what safe sex is, children need to understand what sex is. There is no evidence that teaching children about sex encourages them to try it, all the evidence is to the contrary.
Many school based programmes have had little effect except to give people a superficial ability to answer questionnaires about sex in the required manner. Well educated young people are ones who can make decisions, negotiate, relate to other people at a level other than a reflex level, where they simply say things like 'sex is bad' or 'abstinence is the safest sex' or whatever brainless platitude is the current favourite. People need to learn to think, not just repeat what they are told to think.
Even adults are confused about the 'ABC' strategy, Abstain, Be faithful, use a Condom. The word ‘abstain’ is widely misunderstood, or ignored where it is understood (I certainly ignore it); being faithful is sometimes understood as meaning that it is ok to have other partners as long as your main partner doesn't know; and condoms are a somewhat exotic commodity that used to be really common a few years ago. You can still get condoms free of charge sometimes but, apparently, the free ones are not as common as they used to be. (A packet of three condoms made in Tanzania costs the price of a small bottle of soda. A packet of three produced in rich countries cost about four times that much. Some splash out for the local brands but others spend the money on soda.)
Children (and adults) have rights, that are enshrined in the Universal Declaration of Human Rights, to a good level of nutrition, water and sanitation, health and education. There is nothing in the declaration that says they only have the right to remain HIV negative and to other rights only insofar as they maintain a HIV negative status. HIV is just one aspect of development and underdevelopment. To many, it doesn't even matter that much compared to the urgent need for something that the lack of will kill them very quickly.
HIV has deflected attention from vital areas of development. In fact, many HIV prevention and care programmes have poor results because most areas of development, such as health, education, social services, infrastructure, governance, human rights and equality, have been ignored.
Another thing that doesn't grab headlines is something like a nutrition programme that targets starving children. Free meals in a school in Tanzania has had the effect of increasing attendance and allowing almost all children to graduate from primary to secondary school. Before the programme started, pupils who made it to school were too tired and undernourished to concentrate and most failed to finish primary school. Mainstream media has a taste for good news sometimes, but this seems to lack the high sugar content that appeals to them.
If children just turned up at school to be fed and then left or didn't bother to do any work, this programme would be disappointing. But the fact that they were enabled to go on to secondary school means that the programme could have many benefits aside from nutritional and educational. According to the most recent figures, fewer children go to secondary school in Tanzania than in Kenya or Uganda. And only around 1% go to tertiary level education.
One of the problems with current HIV prevention programmes, the ones that are implemented in schools, anyhow, is that the general level of education in the country is low. I have met people who, at the age of 15, started having sex, usually with an older partner. That's not the surprising bit; the surprising bit is that they didn't know what sex was or if they did, they didn't know that that's what they were indulging in.
I came across a paper about reproductive awareness among adolescent girls (10-19 years) in Bangladesh and many had incorrect knowledge or misperceptions about reproduction, the fertile period, STIs and HIV. This is often connected with the educational status of girls or that of their mother. 18 out of 20 married adolescents who had recently given birth didn't understand why they had become pregnant. Most had never heard of STIs and while 40% had heard of HIV, only 20% had knowledge about how HIV is transmitted.
Many girls experience sex of some kind in their teens, whether they chose it or not. Most of them know so little about sex that they don't know how to avoid doing what someone is coercing them into doing, they don't know how to negotiate precautions, such as using a condom, they may not even know what condoms are, where to buy them or how to use them. To understand what safe sex is, children need to understand what sex is. There is no evidence that teaching children about sex encourages them to try it, all the evidence is to the contrary.
Many school based programmes have had little effect except to give people a superficial ability to answer questionnaires about sex in the required manner. Well educated young people are ones who can make decisions, negotiate, relate to other people at a level other than a reflex level, where they simply say things like 'sex is bad' or 'abstinence is the safest sex' or whatever brainless platitude is the current favourite. People need to learn to think, not just repeat what they are told to think.
Even adults are confused about the 'ABC' strategy, Abstain, Be faithful, use a Condom. The word ‘abstain’ is widely misunderstood, or ignored where it is understood (I certainly ignore it); being faithful is sometimes understood as meaning that it is ok to have other partners as long as your main partner doesn't know; and condoms are a somewhat exotic commodity that used to be really common a few years ago. You can still get condoms free of charge sometimes but, apparently, the free ones are not as common as they used to be. (A packet of three condoms made in Tanzania costs the price of a small bottle of soda. A packet of three produced in rich countries cost about four times that much. Some splash out for the local brands but others spend the money on soda.)
Children (and adults) have rights, that are enshrined in the Universal Declaration of Human Rights, to a good level of nutrition, water and sanitation, health and education. There is nothing in the declaration that says they only have the right to remain HIV negative and to other rights only insofar as they maintain a HIV negative status. HIV is just one aspect of development and underdevelopment. To many, it doesn't even matter that much compared to the urgent need for something that the lack of will kill them very quickly.
HIV has deflected attention from vital areas of development. In fact, many HIV prevention and care programmes have poor results because most areas of development, such as health, education, social services, infrastructure, governance, human rights and equality, have been ignored.
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